Circumcision and genital mutilation: let's discuss.

Replies to This Discussion

Permalink Reply by TNT666 on March 28, 2010 at 3:05pm

You're absolutely on the mark. It's also true that women who get breast reduction surgery drastically reduce their risk of breast cancer !!!!!!!!!!! :) Of course, if you remove the cells, there are less cells left to go cancerous!

It's just one of the many misleading statistics cancer prevention groups push. Frankly, from where I stand, we'd be better fighting cancer through eliminating toxins from our lifestyle. Cancers are a panacea for drug companies. So much money to be made. Bigpharm has no financial reason to cure cancer, it's much more profitable to 'manage' cancer.

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Permalink Reply by Eric Luther on May 20, 2010 at 1:18am

Circumcision of males represents a "surgical vaccine" against a wide variety of infections, adverse medical conditions and potentially fatal diseases over their lifetime, and also protects their sexual partners. In experienced hands, this common, inexpensive procedure is very safe, and can be pain-free. Although it can be performed at any age, the ideal time is infancy. The benefits vastly outweigh risks.

http://www.circinfo.net/

From personal experience in a doctor's office where I assisted in a number of circumcisions, there is a largely pragmatic aspect to parent's decision to have their children circumscribed. The foreskin retains fluids post coitus and this increases exposure time to possibly infectious agents. The male urethra is a small target, so this is pretty easy to visualize. You get infections when the mucous membrane of the urethra is penetrated by an organism.

I grew up in church and had an intellectual interest in scripture. Most of the ancient sexual ethics were found alongside dicta to prevent other sorts of diseases. We find the passages difficult to relate to in this era with all of its contraceptives, but because the Jews were a very tribal group disease was prone to spread. The various rules for sex had good reasoning and were handed down by community authorities. It makes sense then that perhaps an ancient Jew -we'll call him Abraham- had a scientific revelation as to the practicality of removing the foreskin and passed it of as a religious rite like the rest of the sexual ethics.

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Permalink Reply by Aaron S. (USA) on May 20, 2010 at 1:22am

Someone else forgot to read the thread before posting...

While it's true circumcision lowers the risk of some diseases, the diseases are not at all dangerous and the complication rate is about the same as the risk of infection. As a result, there's no medical organization in the world that promotes routine infant circumcision for medical reasons.

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Permalink Reply by Eric Luther on May 20, 2010 at 2:29am

I had read the post, but due credence isn't being given to the evidence. I invite people to visit the link I included. The tendency in the conversation seems to be there is evidence but it's inconclusive. The website is a database for the answers to all of the questions that are being treated in this forum.

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Permalink Reply by Aaron S. (USA) on May 20, 2010 at 2:59am

I have read through the site, and basically, nowhere does it (or you) address the criticism I made - that the diseases circumcision is meant to prevent are generally easily treatable, that the complication rate is roughly the same as the rate of the diseases it's meant to prevent, and that there's no professional medical organization in the world that promotes RIC.

The main problem with the website you posted is that it's a pro-circ propaganda site - notice that there's no place in the entire site that discusses the main reasons why people are anti-RIC (that is, that there are no clear benefits and that it ought to be the man's choice, not his parents). Nowhere in the entire site does it even set the supposed benefits side-by-side with the costs. When it does give actual numbers, they cite studies that are biased in favor of circumcision.

It's not that we think that the evidence is inconclusive, it's that it's been studied and there's no net medical benefit.

To my brief, unaddressed criticisms I made before, I'll add that for things like STDs, a far better solution is not to cut off the most sensitive parts of men's genitalia without their permission, but to 1) not sleep around and 2) if you do, use a condom. In other words, lifestyle is by far the more operative variable, not circumcision.

The rate of infection by various diseases before age 18 is virtually nil. Granted, the complication rate from circumcisions is also small - but this only underlines my basic point that circumcision is not a medical decision, but a personal one.

In short, we've read stuff like your site over and over again and while it's not completely bogus, it's blatantly biased and you're going to have to give us something better.

And also, I'd recommend that you not tell us circumcision is good because it's in the Bible. That sort of reasoning isn't so effective here.

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Permalink Reply by Rob van Senten on May 20, 2010 at 8:49am

Hi Eric,

It could be me, but nowhere on the website that you linked to can I find anything about whether or not RIC is a violation upon the basic human rights of the infant.

Earlier in this topic, I wrote:
When done on a person under the age of consent, infant circumcision is a violation upon their rights. Nobody should be allowed to remove a part of the body of an infant because of any ethical or societal value. The removed part has a function and it does effect the infant during his whole life. This is a decision that should be made by the adult that has to live with the consequences, not by anybody else.

Also quite important since you mention the medical benefits of RIC:

Gliktch wrote

... back to the 'medical benefit' rebuttal that's been covered several times; since removal of breast tissue can demonstrably lead to a reduction in the rate of breast cancer in adulthood, should this procedure thus be performed on infants?

I'm really looking forward to your explanation why RIC is not a violation upon the basic human rights of the infant. And whether or not you would approve of involuntary breast tissue removal for infant girls.

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Permalink Reply by Eric Luther on May 20, 2010 at 6:44pm

Let me qualify whatever I say and whatever I had said that I have only a passing interest in this topic at hand. My greater concern is how it is being treated without due credence given to objectivity.

It seemed to me that there was too much emphasis on the child having a choice in having his foreskin removed. I am circumcised and as an adult have never seen any obvious benefits or complications from not having a foreskin. It wasn't performed as a religious rite as far as I can tell, and the circumcisions I've seen in person in hospitals didn't seem informed by any desire to mutilate a baby for religious reasons. Any anecdotal account should be taken with a grain of salt however, because I've not had the opportunity to live with and without a foreskin. I'm only trying to assert my neutrality on the subject.

The immediate benefits and risks are most based in sound evidence, so talk about long term complications isn't based in sound reasoning. Anecdotal evidence is the basis for research into long term complications. However assertions of this type are first person and too difficult to discern motivations for complaining- other sexual impotencies for example- from genuine medical complaints. The discussions of long term complications from circumcision (loss of sexual sensation for example) are predominantly of the anecdotal type and should be considered with a lean towards skepticism. This is not to say long term complications shouldn't be studied, but as of yet they have not been treated in a scientifically sound, or conclusive manner.

The basic human rights of an infant is kind of a tricky subject. I have heard the legal relationship between children and their parents described as a community of interest. Parents ideally make decisions for their children that they perceive as best. The likelihood of complications are on par with the likelihood of benefits, but how those benefits and risks come about are of a differing nature. According to the AMA position paper on circumcision those benefits are best realized in the first year of a child's life including reduced UTIs. It would make sense that parents faced with a choice would opt for an active stance (let's try and give Johnny the best advantages as possible) as opposed to the passive stance (let's see what happens if the foreskin remains intact). Because circumcision is a simple medical procedure the complications seem far removed from possibility. Therefore parents make the choice to have a circumcision performed, because the results seem in the hands of a medical professional rather than left to the realm of chance.

Ostensibly this is only an attempt to explain the thought process of parents though, and does not fully address the issue of infant's fundamental rights. However, the idea that parents would act with the best of intentions and circumcision is an extension of that thought process indicates that a community of interest is being fostered. This is the extent of infants rights. Rights are accompanied by duties and it is understood that infants cannot fulfill any of the burdens that accompany their assertion of rights, so their position in society is subordinate to their parents unless the community of interest standard is not being fulfilled. Doctor's provide information that demonstrates the nature of benefits and risks, but it is understood that, especially in the hands of experienced doctors, the risks are very low. Given that infants cannot assess the risks themselves, that the benefits are best realized in early childhood, and that the long term risks are unestablished it would seem lying down normative suggestions that contraindicate allowing parents the choice would be a violation of the community of interest and by proxy the rights of the infant. The science is still out, so the atheist community should take the philosophical stance until better evidence for or against circumcision arises.

That being said this is my opinion of circumcision clarified. At this point it is scientifically established to have neutral effects on the individual and ideally reflects the interest of the parents in a child's well being. Practically it has been demonstrated that the choice to have the child circumcised reflects the parent's circumcision status, so parents who have not discerned any disabilities due to their circumcision status tend to pass on their personal experience in the matter. Because of this superficial motivation, I believe that medical scientists can and will continue to work towards establishing a clearer position on the effects of circumcision. Only after a point where it is demonstrated that it is reasonably only a cosmetic procedure, should thinking people as ourselves be up in arms over the potential harms to the child. Until that point, however, speculation is useless and assertions that fall outside of established evidence demonstrates more personal bias than any knowledge or willingness to remain objective on the matter.

As for voluntary breast tissue removal in infants I know little of the matter and am having difficulty finding any. Links and sources pertaining to the evidence, cost benefit analysis, et cetera would be appreciated. My speculation is that circumcision should be treated separate from infant mastectomy. While both are sex organs it seems that the situation would be disanalagous on account of the social role of foreskin being very different from the role of breasts. Marred breasts for example are more easily perceived in the general public compared to a man's circumcision status. As I've said though, I would need to see the evidence to make a substantiated decision.

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Permalink Reply by Aaron S. (USA) on May 20, 2010 at 8:38pm

What I'm still not getting from your posts so far is why you think this is such a good idea in the first place. From what you've said yourself, any evidence of circumcision's benefits is small and very arguable in any case; so since there are no clear benefits to circumcision that we're currently aware of, why should we promote it?

More to the point, you can always get circumcised later, but you can't bring back what's cut off once it's gone. Why are you suggesting that it's permissible to make a fundamental change to a man's body and sexuality when there are no clear benefits? Why do you believe that this is something that's okay to take away from men when there's no clear benefit in doing so?

I'm still waiting a response to my previous criticisms, as well.

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Permalink Reply by Eric Luther on May 20, 2010 at 10:45pm

That previous post was in response to Rob and his question of rights.

I'll address your criticisms point by point.

1."that the diseases circumcision is meant to prevent are generally easily treatable"
Treating a disease does not necessarily return a person to their baseline especially in cases of infectious disease. Considering UTIs, complications from UTI involve scarring of the kidney and in extreme cases renal failure which can result in death. Infants are most susceptible to UTIs because of an underdeveloped immune system and the nature of their waste removal (they tend to steep). While once a causative organism can be identified it can be treated, the effected organs do not always heal properly. Circumcision cuts the occurrence of UTIs in infants by one half so it is a statistically significant method of prevention (which is to be preferred over treatment). This is one of those cases where it's better to never have the disease. Just because it is treatable does not mean it is reasonable to forgo a preventative method.

2."that the complication rate is roughly the same as the rate of the diseases it's meant to prevent"
This is a fallacious argument, because the equal rates of complication does not speak to the magnitude of each complication. Circumcision complications may be less harmful than UTIs etc. Additionally circumcision is a man made procedure that can be bettered and hence the degree of complication reduced. Just because something is a certain way does not mean that it will remain that way or should be abandoned.

3."there's no professional medical organization in the world that promotes RIC."
There's also no professional medical organization in the world that openly condemns it. They are on the fence waiting for more evidence which is what I advocate in my previous post.

4."When it does give actual numbers, they cite studies that are biased in favor of circumcision."
Just because the outcome of a study doesn't reflect your point of view doesn't mean it's biased. The studies are scholarly and I double checked a number of them when forming an opinion on this matter. If you go to the references page there are over a thousand articles from various relevant journals. Each claim made on the website is supported by scientific evidence. The tendency of the website to promote circumcision is based on scientific evidence of its positive effects and an optimism that the problems surrounding the procedure can be clarified.

5."Nowhere in the entire site does it even set the supposed benefits side-by-side with the costs"
http://www.circinfo.net/benefits_outweigh_the_risks.html
If there's worry about bias investigate the individual reports.

6."It's not that we think that the evidence is inconclusive, it's that it's been studied and there's no net medical benefit."
it's very difficult to find scholarly articles that make this assertion, and they have to contend with the numerous articles that say otherwise. The predominant force of the anticirc movement is ethical not pragmatic. Asserting otherwise is disingenuous and dangerous in that it colludes the troubled waters of reason through which we have to navigate.

7."And also, I'd recommend that you not tell us circumcision is good because it's in the Bible. That sort of reasoning isn't so effective here."
This is a mistake in a differentiation between explanation and justification. The possibility of historically recognized benefits of circumcision begs the question of whether this practice ever arose as a chiefly ethical/moral/social tool or whether or not along its entire history it has been pragmatically implemented. It's important to untangle the reasons people have circumcisions so that they are not too closely associated with the mania of religion in which it originated. There are some practical tips in the early bible and the fact that some of those practices became emblematic of a faith does not necessarily discount them. This is not to say that we should accept any part of the bible as a sound source of information, but we should consider the possibility that a practical medical procedure is being stigmatized because of its tenuous ties to a religion.

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Permalink Reply by Aaron S. (USA) on May 21, 2010 at 12:39am

Treating a disease does not necessarily return a person to their baseline especially in cases of infectious disease.

This is a slightly surprising argument to me considering that we're considering cutting off a part of a man's body that doesn't grow back in one hundred percent of cases.

You're right, the rate is UTI is much lower, but my point is that UTIs are so rare in the first place that it doesn't matter. A 50% reduction in the incidence of UTIs is still less reduction than the rate of complication - the cure is still worse than the disease.


This is a fallacious argument, because the equal rates of complication does not speak to the magnitude of each complication. Circumcision complications may be less harmful than UTIs etc.

They may be, but there's no evidence to presume so. On the other hand, it could be argued just as effectively that circumcision complications may be much worse. Both have led to infant deaths or other serious injury; unfortunately, tracking the exact numbers is difficult since hospitals rarely record whether a problem was due to a circumcision specifically or some other disease or operation.


There's also no professional medical organization in the world that openly condemns it.

The medical organizations are speaking on medical terms, not terms of human rights. It doesn't matter if they don't speak against it, it only matters whether they speak for it.

Again, the point is that there's no clear medical evidence that RIC is beneficial, and certainly no evidence that it's so beneficial that it's worth taking away a man's right to bodily autonomy.


Just because the outcome of a study doesn't reflect your point of view doesn't mean it's biased. The studies are scholarly and I double checked a number of them when forming an opinion on this matter.

I understand that objective, scientific data do not necessarily need to coincide with my personal opinions. However, I am also aware that even the best scientific studies are not perfect, and the studies cited on your link happen to be the studies that came out with the results most favorable to circumcision. This is not good science. I'm going to borrow a quote from the Wikipedia article for circumcision:

"Urinary tract infections

A meta-analysis of 12 studies (one randomised controlled trial, four cohort studies and seven case-control studies) representing 402,908 children determined that circumcision was associated with a significantly reduced risk of urinary tract infection (UTI). However, the authors noted that only 1% of boys with normal urinary tract function experience a UTI, and the number-needed-to treat (number of circumcisions necessary) to prevent one urinary tract infection was calculated to be 111. Because haemorrhage and infection are the commonest complications of circumcision, occurring at rate of about 2%, assuming equal utility of benefits and harms, the authors concluded that the net clinical benefit of circumcision is only likely in boys at high risk of urinary tract infection (such as those with high grade vesicoureteral reflux or a history of recurrent UTIs, where the number needed to treat declined to 11 and 4, respectively).[194]"


And to quote from your "Benefits Outweigh the Risks" page...

"... 100,000 were circumcised and 193 (0.19%) had complications, mostly minor, with no deaths, but of the 36,000 who were not circumcised the problems were more than ten-times higher and there were 2 deaths [Wiswell & Hachey, 1993].

A study by others found that of the 11,000 circumcisions performed at New York's Sloane Hospital in 1989, only 6 led to complications, none of which were fatal [Russell, 1993]. An early survey saw only one death amongst 566,483 baby boys circumcised in New York between 1939 and 1951 [National, 2003].

There are no deaths today from medical circumcisions in developed countries.

Very similar to the study by Wiswell above, it was found that of 354,297 infants born in Washington State from 1987-96, only 0.20% had a complication arising from their circumcision, i.e., 1 in every 476 circumcisions [Christakis et al., 2000]."


it's very difficult to find scholarly articles that make this assertion, and they have to contend with the numerous articles that say otherwise. The predominant force of the anticirc movement is ethical not pragmatic. Asserting otherwise is disingenuous and dangerous in that it colludes the troubled waters of reason through which we have to navigate.

I thought about retracting or rephrasing my wording before, but I decided against it. I will instead repeat that we currently have no grounds to assume that routine infant circumcision is beneficial, and that as a result, we have absolutely no reason to force them on men who may not want them later and don't need them. I have never claimed, so far as I am aware, that the anti-circ position is (for me, at least) pragmatic, but have rather pointed out that routine infant circumcision is unnecessary. I don't see how that is either disingenuous or dangerous.


This is a mistake in a differentiation between explanation and justification.

There was no error in differentiation; it just didn't matter. Whether you were trying to argue that circumcision is good because the Bible says so (and the Bible contains reliable information), or because the Jews thought it was good (and as a result they put it in the Bible) is irrelevant - the argument is weak in either case.


This is not to say that we should accept any part of the bible as a sound source of information, but we should consider the possibility that a practical medical procedure is being stigmatized because of its tenuous ties to a religion.

I agree. Unfortunately for circumcision, however, it's not a practical procedure.

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Permalink Reply by Hugh Young on June 28, 2010 at 4:32am

3."there's no professional medical organization in the world that promotes RIC."
There's also no professional medical organization in the world that openly condemns it.

Well that's no longer true. The Royal Dutch Medical Association, KNMG, has come out unequivocally against it. http://www.circumstitions.com/news/news37.html#dutch-policy

we should consider the possibility that a practical medical procedure is being stigmatized because of its tenuous ties to a religion.

We should also consider the reverse, that an unnecessary medical intervention has been mainstreamed and made acceptable because of its apparently inextricable tie to a religion.

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Permalink Reply by Limber Lightfoot on June 28, 2010 at 4:38am

Australia too, I found this..

The most recent and authoritative statement was issued by the Royal Australasian College of Physicians in August 2009. This document states clearly:

“the RACP does not recommend that routine circumcision in infancy be performed.”

"When considering routine infant circumcision, ethical concerns have focused on recognition of the functional role of the foreskin, the non-therapeutic nature of the operation, and the psychological distress felt by some adult males circumcised as infants. The possibility that routine circumcision contravenes human rights has been raised because circumcision is performed on a minor for non-clinical reasons, and is potentially without net clinical benefit for the child.

Recently there has been renewed debate regarding both the possible health benefits and the ethical concerns relating to routine male circumcision. The most important conditions where some benefit may result from circumcision are urinary tract infections, and in adults HIV infection and cancer of the penis. The frequency of these conditions, the level of protection offered by circumcision and complication rate of circumcision do not warrant a recommendation of universal circumcision for newborn and infant males in an Australian and New Zealand context.

After extensive review of the literature the RACP does not recommend that routine circumcision in infancy be performed, but accepts that parents should be able to make this decision with their doctors. One reasonable option is for routine circumcision to be delayed until males are old enough to make an informed choice. In all cases where parents request a circumcision for their child the medical attendant is obliged to provide accurate information on the risks and benefits of the procedure. Up-to-date, unbiased written material summarising the evidence should be widely available to parents. In the absence of evidence of substantial harm, parental choice should be respected.

If the operation is to be performed, the medical attendant should ensure this is done by a competent surgeon, using appropriate anaesthesia and in a safe child-friendly environment."

http://www.circinfo.org/doctors.html

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