Why circumcision is a very good thing

I’ve written numerous posts about circumcision and its benefits, but I want to write one more big one. My goal here is to gather together all the relevant information to the debate in one place. Certain myths need to be dispelled in some places while the details of arguments need to be laid out with ridiculous clarity; the anti-circumcision crowd is as stubborn as young Earth creationists. As such, this post isn’t so much directed towards the entrenched anti-circumcision folk as it is towards the people on the fence. Perhaps there are a few people out there who have simply bought into easy arguments, and so their commitment to their position can be swayed. I would equate these people with the occasional church patron that grows up learning the Universe is 6,000 years old, only to later shed that false belief when engaged on the matter. I hope I’m able to adequately mount a defense of circumcision and change the minds of any such people who end up reading this post.

There are several topics that should be addressed when discussing circumcision. Safety, efficacy, and ethics are the broad categories, and each one contains its share of details. Let’s start with safety.

Safety:

As with any surgery, complications are possible. The most common complication due to circumcision is minor bleeding, which can be fixed with a little bit of gauze. Infections occasionally happen, but they’re rare. Circumcision should always be done under sterile conditions to maintain this rarity. (That means the Rabbis and other non-medical professionals out there who do these things need to be stopped.)

Pain and Trauma:

A favorite of the anti-circumcision crowd is to find awful looking restraining devices doctors use to keep infants steady. Aside from the fact that those devices aren’t the iron maidens people make them out to be, circumcision needn’t be painful in the least. Any search will find a mix of estimates for how frequently anesthesia is used during circumcisions, but it is certainly used a majority of the time, and its use is always increasing. Any parent worried about the pain their baby may feel can simply request anesthesia be used. This 100% addresses any pain argument the anti-circumcision crowd wants to raise. Indeed, it also addresses any trauma argument they wish to raise, but it isn’t necessary for that purpose. Trauma is something which has lasting physical or psychological damage. Since no infant can possibly remember being circumcised, there’s no way any amount of pain could be traumatic here. Moreover, the pain of being squeezed through a vaginal canal just days earlier is clearly much more significant than any minor medical procedure.

Nerve Ending Hypothesis:

There is a popular hypothesis that because the foreskin has 10,000 to 20,000 nerve endings, any removal of it must affect sensitivity. It makes sense and it’s worth investigating. Unfortunately, it’s that investigation aspect that many in the anti-circumcision crowd don’t like; for many, the hypothesis is conclusive. Occasionally, though, they may point to a study or two they incidentally find – so long as it supports their beliefs, of course. These studies (which are usually actually just subjective surveys) sometimes indicate decreased sensitivity in circumcised men. Other times, they show just the opposite. (The anti-circumcision crowd ignores those.) Mostly, though, they show statistically insignificant differences. Moreover, the better studies and meta-analyses out there show the same wash. Since science operates on bodies of evidence rather than individual studies – if you can’t repeat your data, it’s bullshit – the correct conclusion here is that not only is there no body of evidence that circumcision decreases sensitivity, but there is actually an active body of evidence which shows it has no effect.

Efficacy:

This is where the majority of this debate centers. It isn’t enough to look at all the evidence and conclude that circumcision is low-risk, painless, non-traumatic, and inconsequential in sexual sensitivity and performance. That’s all great, but none of that adds up to a reason to circumcise someone, much less to implement it as a public health policy. What we need is data which show circumcision offers some sort of benefit. You’ll never guess what we’ve had for the better part of a decade.

Three randomized control studies were undertaken and completed between 2005 and 2007. These studies looked at the effect of circumcision on HIV transmission rates from women to men during heterosexual intercourse. (Prior to these studies there was a body of observational studies which indicated a likely link between circumcision and HIV, but it wasn’t nearly concrete enough to enact any type of policy.) These studies concluded that circumcision significantly reduces HIV transmission in the aforementioned context; one study went so far as to compare the reduction to what would be achieved by “a vaccine of high efficacy”. Between the studies, the relative risk reduction was 60%.

Relative versus Absolute

For some time I had an anti-circumcision troll around here. He enjoyed raising the issue of relative risk versus absolute risk. I’m not sure he understood the difference, though. Whereas the relative risk reduction for circumcised males was found to be 60%, the absolute risk reduction is between 1.3% and 1.8%. Choosing the latter of these numbers is a good way to muddle the discussion. Here’s what these numbers mean.

Relative risk reduction is how much a given treatment, behavior, or characteristic reduces a given risk in one group versus another. This is the number that matters most of the time in lay terms. Absolute risk reduction, on the other hand, looks at an entire population and takes into account its susceptibility to some given condition. For instance, most people aren’t going to get the flu. It doesn’t matter whether a person has the vaccine or not. Odds are low that he or she will catch anything. That’s why anti-vaccine quacks love to use absolute numbers. The flu vaccine is generally somewhere near 60% effective, but absolute numbers are closer to 1.5%. That isn’t an argument against getting vaccinated, though.

Problems with the Studies

The three aforementioned studies were robust and have been largely accepted by the scientific community. The WHO, UNAIDS, the CDC, the Bill and Melinda Gates Foundation, and a dozen and a half African health ministries have all embraced their results. Of course, that isn’t going to stop the anti-circumcision crowd from coming up with something to question. Most commonly, the issues raised are non-issues. For instance, I’ve frequently seen the point raised that condoms are more effective. This is like when a creationist tries to argue against evolution by talking about the Big Bang. It just isn’t on topic. Other issues include the region where the studies took place, the early termination of the studies, and control and intervention groups being treated differently. Let’s start with where these studies took place.

It should first be noted that, as I mentioned earlier, there is a large body of observational studies on the effectiveness of circumcision in HIV transmission reduction. This body is global; what it indicated panned out in these trials. Second, Africa is massive. Uganda and Kenya are neighbors, but South Africa isn’t even close. These places have commonalities, but they are also significantly different in a host of aspects, including culturally. Repeated results across a wide swath of area cannot be simply dismissed out of hand: the limited region of each individual study could be a confounding factor, but when taken as a whole, the studies necessarily reduce any potential confounding factor due to regional effect.

Each study was halted early on ethical grounds. The results were so overwhelming, the monitoring boards for each study had no choice but to put an end to the trials and recommend that all the uncircumcised men be circumcised. Regardless, the studies still all lasted between about a year and a half and two years. Potential bias as a result of these abrupt endings was taken into account. From the Kenya study:

Because the Data and Safety Monitoring Board recommended to stop the trial after the intermediate analysis, it was not possible to follow all the participants as initially planned, and, as a consequence, only those participants recruited at the beginning had a full follow-up. This potential bias was taken into account by adjusting the analysis for the recruitment period; such an adjustment cannot fully account for the confounding effect associated with partial follow-up. When restricting the analysis to those participants who had a full follow-up, the intervention had an effect that was similar in size and significance, suggesting that this potential bias had a negligible impact.

Another common complaint is that a large number of participant follow-ups were lost due to the early terminations. The effect was likely negligible since the numbers actually weren’t that significant for these type of studies, plus many of the follow-ups were actually lost for reasons unrelated to HIV infection (such as moving from the area). Knowing this is one of the benefits of having actually read the studies rather than agenda-driven websites.

Finally, I frequently come across Internet comments that declare the control and intervention group were treated differently. The claim is that the intervention (circumcised) group was given education, condoms, and counseling over and above what the control group was given. This is simply a lie. I’m not sure of its origin, but I’ve seen it enough that I feel it deserves to be killed. The groups were given and/or offered consistent treatment. The only reason to say otherwise is for the same reason Lyndon Johnson told one of his aides to spread the story that one of his opponents fornicated with pigs. He knew it wasn’t true, but if he could make the other guy deny it, he would be giving it credence by simply addressing it. As usual, I’m willing to forgo the public perception in favor of assuming a literate readership.

How It Works

The evidence is in when it comes to circumcision, but how it works is still up for question. One hypothesis says that the foreskin offers a relatively damp environment that is friendly to various pathogens. Another hypothesis says that Langerhans cells are a target of HIV, causing them to act as a vector. Since the relatively thin foreskin has these cells, that means there is an increased surface area and number of these cells where HIV can attach.

Other Benefits

Circumcision has been found to have a host of other health benefits (.pdf). UTI’s are decreased among newborns, penile cancers are reduced, general infections are reduced, and HPV is 30% less prevalent. One study from 1954 to 1997 that looked at cases of invasive penile cancer found that 87 out of 89 (98%) of the men were uncircumcised. Other studies have found a 30% decrease in contracting herpes.

Developed World Efficacy

The CDC has recently come out as endorsing circumcision has a healthy decision for parents to make. It’s a one time cost for a procedure with a low incidence rate of what are only minor complications anyway. The child feels no pain, there is no trauma, sensation isn’t affected at sexual maturation, and a host of diseases are reduced. If the CDC didn’t stop short of recommending circumcision as a health policy for political reasons, then they only did it because STD’s are not an epidemic in the United States. But, then, neither is the flu.

Condoms and Hygiene

The anti-circumcision crusader may get to this point and say, “Fine, even if everything to this point is true, it’s still undeniable that condoms, education, and basic hygiene can best take care of the major health issues raised here where Africa is concerned.” And that’s fair enough. Condoms are 97-99% effective at preventing sexual transmitted diseases. Retracting the foreskin and washing with soap and water will prevent most (maybe even all) infection. But this is a poor understanding of reality.

Let’s start with condom use. Even with wide spread education campaigns, millions of Americans have unprotected sex with untested partners every single day. STD’s are still transmitted here and teen pregnancy (and other unintended pregnancies) still exist. It strikes me as near-racist to assume that we can throw education and condoms at people in Africa and get great results. They aren’t monkeys we first worlders get to train. People in Africa will largely behave how people around the globe behave. Some will use condoms. Some won’t. Some will be willing but unable. Sometimes people run out of condoms and want to have sex. Sometimes they will have sex where they don’t happen to keep their condoms. Sometimes they want to take a risk because it feels better. The “they” here is global.

It’s obviously true that condoms and education are key components in the fight against HIV. However, we should never limit ourselves to one option simply because it may be the most effective option. This fight isn’t a zero sum game; we can – and should – use every tool available. Doing so will literally save lives.

As for hygiene, even with rigorous cleaning practices, infections can still happen. I have a friend who got circumcised in his early 20’s for this exact reason. He showered every day and was specific about his cleaning regimen, but he still had issues. That won’t be the case for everyone, but it will certainly be the case for many. It’s far easier to entirely prevent this issue after birth than to force men to see doctors later in life for something that needn’t be an issue.

Ethics

The anti-circumcision crowd has lost on the scientific front. Circumcision protects against HIV and other STD’s. It reduces penile cancers and other infections. It doesn’t hurt and it doesn’t alter sensitivity. Aside from the minor risks of surgery (which exist largely by virtue of what surgery is in the first place), it literally has zero physiological drawbacks. That leaves the anti-circumcision folks with limited recourse in the debate. Enter the ethical argument.

There is effectively only one ethical argument against circumcision. It isn’t a good one, but it does have a basis in established ethical theory. However, before I address that argument, I want to address a common philosophical argument I hear. It isn’t technically about ethics, but we’re in the same ballpark. It’s the argument that says removing the foreskin in order to protect against disease is like removing a foot to prevent foot cancer or gout. Eventually, the argument usually ends with the suggestion of death in order to prevent all disease. Even without the especially absurd end, this is nothing more than an argumentum ad absurdum. Removing a piece of skin which has no discernible function and the loss of which has no negative consequence is not the same as removing a significant body part or altering the body in a way which affects quality of life negatively.

The primary ethical argument against circumcision – the argument from bodily autonomy – is slightly better. This argument says that it is wrong to permanently alter a person’s body without their consent for non-medically necessary reasons. That means a haircut is fine, or even a piercing (though there may be other objections to the latter). Indeed, any life-saving procedure is allowed under this argument. Like with most ethical arguments, there will be examples that raise gray areas (and those will generally come down to personal judgement calls more than anything), but there are certain things that are black and white. Tattooing one’s infant wouldn’t be allowed, for example. The child necessarily cannot consent and the procedure is absolutely not medically necessary, so there is not justification for it.

With circumcision, it is true that the procedure is not medically necessary. All the benefits laid out above are still very much true, but that doesn’t make the procedure necessary. A person who doesn’t get circumcised can live a perfectly happy life, free from all sexually transmitted diseases and infections. Indeed, billions have done and are currently doing it. Furthermore, it cannot be reversed. Once that foreskin is gone, it’s gone. Some people will say it can be returned, but it will simply be extra skin, at best.

Now let’s make a comparison.

Vaccines are some of the greatest achievements of science. Everyone should get at least the basic vaccines we expect people in the 21st century to have. And for those who live in certain areas or travel to certain areas, a number of other vaccines are recommended. For instance, I have a vaccine for yellow fever because I visited Tanzania about 5 years ago. If I visit any similarly at-risk location 5 years from now, I’ll get a booster shot first. All that said: vaccines are not medically necessary. Again, they’re fantastic and everyone should get them. Public policy should dictate all students must get them. These are things which save lives. But, again, they are not medically necessary. Even when polio was a significant public health concern, very few people actually died from the disease. Only a small minority of the population ever contracted it, and of that small minority, only a minority became sick at all. It was great when a vaccine became widely available. Lives were saved. But being unvaccinated did not put someone at active risk of sickness or death; being unvaccinated was a passive risk. This exactly mirrors the issue with circumcision. Furthermore, vaccines cause permanent change to the body via the addition of anti-bodies. This again mirrors the permanent change of circumcision.

The first counter to this comparison is generally to note that anti-bodies aren’t a visible change whereas removal of the foreskin is. The argument from bodily autonomy makes no such exception. The argument doesn’t say it’s wrong to permanently alter a person’s body without their consent unless you totally can’t see it. That would entirely gut the argument, making it into nothing more than a cosmetic argument. Something so superficial doesn’t pass any sort of ethical muster in my book. Besides, I’m not so sure the anti-circumcision crowd should be making a cosmetic argument anyway.

The second counter to the circumcision-vaccine comparison is to note that whereas vaccines add something to the body, circumcision actually removes something. I suppose that’s true, but I don’t see where such a distinction would matter within the argument from bodily autonomy. We can no more rid ourselves of anti-bodies than we can rejuvenate foreskin.

Before I reach the end of this post, I want to quickly recap the argument from bodily autonomy. The argument says it’s wrong to permanently alter a child’s body without his consent unless it’s for a medically necessary procedure. Neither circumcision nor vaccines are medically necessary. Both are highly effective and both save lives. Without either, we would have fewer people in the world, that’s for sure. However, neither one is required to live a long, happy, and healthy life. This, of course, is not an argument against either one. This is an argument against this incantation of the argument from bodily autonomy. That isn’t to say bodily autonomy isn’t important. It is. But it isn’t an argument that works under the auspices of libertarian ethics as applied to global health issues. That is, bodily autonomy is important because it is the best way to protect the individual and populations at-large; it isn’t important in and of itself/because it maintains liberty. (Dead people don’t have liberty.) Or to put it another way, bodily autonomy only works under a utilitarian framework.

Conclusion

This one is simple. Circumcision is a safe procedure that needn’t cause pain, doesn’t cause trauma (indeed, it can’t cause psychological trauma by definition), and it doesn’t affect sexual sensitivity, satisfaction, or performance. Furthermore, it reduces female-to-male HIV transmission, invasive penile cancers, UTI’s, STD’s, and general infections. Along with education and condom use, circumcision is a phenomenal tool in the fight against HIV; circumcision literally saves lives. The World Health Organization, UNAIDS, the Bill and Melinda Gates Foundation, a dozen and a half African health ministries, the CDC, and the AAP all support it as good health practice. The science and the ethics are in: Excepting for the minor (and rare) risks inherent with surgery by virtue of what it is, there are literally zero drawbacks to circumcision; when performed under sterile conditions and by medical professionals, circumcision increases the odds a boy will have a disease and infection free life.

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52 Responses

  1. Excellent article. Thanks Michael.

    Wonderful news for women as well – early research shows that female circumcision has huge health benefits. Let’s make sure we don’t “ignore the science” as far as women are concerned please.

    It’s good to see that Michael supports the benefits of female as well as male circumcision.

    **Female Circumcision can reduce the chances of contracting HIV by 50-60%.**

    And don’t worry — more and more, female “circumcision” in Africa is being done by “professionals” in “hygienic” conditions:

    http://www.cruxnow.com/life/2015/01/10/african-church-leaders-worry-about-the-medicalization-of-female-genital-mutilation/

    **Female Circumcision & Health Benefits**

    *”Stallings et al. (2005) reported that, in Tanzanian women,
    the risk of HIV among women who had undergone FGC
    was roughly half that of women who had not; the association
    remained significant after adjusting for region, household
    wealth, age, lifetime partners, union status, and recent ulcer.”*

    Note: when it’s found that circumcising *female* genitals reduces HIV/AIDS it’s called a *”conundrum”* rather that a wonderfully exciting “medical” opportunity to reduces HIV/AIDS.

    http://www.iasociety.org/Default.aspx?pageId=11&abstractId=2177677

    *”Georgia State University, Public Health Theses”* — a USA University of international renown:

    The Association between Female Genital Mutilation (FGM) and the Risk of HIV/AIDS in Kenyan Girls and Women (15-49 Years):

    *”RESULTS: This study shows an inverse association (OR=0.508; 95% CI: 0.376-0.687) between FGM and HIV/AIDS, after adjusting for confounding variables.”*

    *”DISCUSSION: The inverse association between FGM and HIV/AIDS established in this study suggests a possible protective effect of female circumcision against HIV/AIDS. This finding suggests therefore the need to authenticate this inverse association in different populations and also to determine the mechanisms for the observed association.”*

    *”This study investigated whether there is a direct association between FGM and HIV/AIDS. Surprisingly, the results indicated that the practice of FGM turned out to reduce the risk of HIV. While a positive association was hypothesized, a surprising inverse association between cases of female circumcision and positive HIV serostatus was obtained, hence indicating that FGM may have protective properties against the transmission of HIV.”*

    http://scholarworks.gsu.edu/cgi/viewcontent.cgi?article=1113&context=iph_theses

    *”National Bureau of Statistics, Tanzania – 50% reduction in HIV/AIDS in women who have have parts of the genitals amputated:”*

    http://www.tzonline.org/pdf/femalecircumcisionandhivinfectionintanzania.pdf

  2. Circumcision can be compared to affirmative action, as it favors women.

  3. Peter,

    You’ll notice the support for male circumcision from the scientific community was low prior to the three African studies. That’s because observational studies weren’t enough. That’s what you’ve presented here. And it isn’t even a body of observational studies. Furthermore, female circumcision does affect sexual function and pleasure. It isn’t comparable to male circumcision.

  4. Michael,

    Many thanks for your reply. As a defender of science, I’m sure you would be happy if it could be shown that women too could benefit from female circumcision. And there is no real reason why that could not be the case.

    The studies I cite above are interesting to say the least, and are enough to trigger much needed further research in this area. Male circumcision does little to reduce female HIV infection in Africa, and female HIV infection is much greater than male HIV infection. We need to start campaigning for more observational studies in this area, that could hopefully lead to trials.

    Why should there not be gender equality in this area? I consider myself a feminist, and I fight for females to benefit from all medical advances.

    I’m also keeping my finger’s crossed that female circumcision will help in other areas: For instance, females produce around 10 times as much smegma as men, as female genitals have much more mucus membranes than men. And thus the number of “infections” that smegma is believed to cause could be so much more in women. Female circumcision reduces smegma.

    Cancer of vulva is much more common than cancer of the penis; and as women have shorter urinary tracts than men, their rates of UTIs are much higher. I’m sure there are many other examples; not least of which is the possible reduction of HIV infections by 60%.

    It’s also believed that male on female oral sex can result in HPV-related oropharyngeal cancer in men. And again, female circumcision could perhaps help in this area; just as male circumcision has been shown to reduce cervical cancer in women.

    Of course I’m only talking about surgical female circumcision in a modern, clinical and anti-septic setting — just as for male circumcision. And it would only require the amputation of the inner labia lips and the prepuce (foreskin) of external glans clitoris. We’re not talking about infibulation with a rusty razor blade!! This type of modern female circumcision would remove less flesh that a male circumcision; but could have the same benefits. And to be honest, it’s not much different to the genital cosmetic surgery that western women are so keen on!

    And please don’t worry about such female circumcision affecting sexual function and pleasure. That’s just a silly, un-scientific myth. Just like male circumcision, there is lot’s of good evidence to show this is not the case. Here are some links to research on this matter from peer reviewed journals:

    *Female Circumcision Does Not Always Reduce Sexual Experiences*

    *”International Journal of Obstetrics and Gynaecology”* — a peer reviewed journal of international renown:

    Female genital cutting in this group of women did not attenuate sexual feelings:

    http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2002.01550.x/abstract

    *”The Journal of Sexual Medicine”* — a peer reviewed journal of international renown:

    Pleasure and orgasm in women with Female Genital Mutilation/Cutting (FGM/C):

    http://www.ncbi.nlm.nih.gov/pubmed/17970975

    *”The New Scientist”* (references a medical journal)

    Female Circumcision Does Not Reduce Sexual Activity:

    http://www.newscientist.com/article/dn2837-female-circumcision-does-not-reduce-sexual-activity.html#.Uml2H2RDtOQ

    *”Journal of General Internal Medicine”* — a peer reviewed journal of international renown:

    Female “Circumcision” – African Women Confront American Medicine

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497147/

    Medical benefits of female circumcision: Dr. Haamid al-Ghawaabi [Not research — but the observations of a doctor]

    http://islamqa.info/en/ref/45528

    More and more women worldwide are circumcised in medical conditions:

    http://www.cruxnow.com/life/2015/01/10/african-church-leaders-worry-about-the-medicalization-of-female-genital-mutilation/

    *”Pediatrics (AAP)”* — a peer reviewed journal of international renown:

    Genital Cutting Advocated By American Academy Of Pediatrics

    http://pediatrics.aappublications.org/content/102/1/153.short

  5. Many thanks for your reply. As a defender of science, I’m sure you would be happy if it could be shown that women too could benefit from female circumcision.

    Provided it was sufficiently similar to male circumcision and didn’t lead to sexual malfunction or loss of sensitivity, I would be entirely in favor of it. Furthermore, even if there was a body of evidence that demonstrated the efficacy of female circumcision, and even if I and everyone else in the world denied it, that wouldn’t be an excuse to deny the evidence for male circumcision. I get the feeling that’s really the point of this hand-waving; there’s no scientific reason to oppose male circumcision, and there’s no ethical reason to oppose it, so all that’s left is to draw weak comparisons with female circumcision and attempt to play the hypocrite card. Indeed, this is quite obviously more than simple hand waving. This is some strong copypasta.

    Male circumcision does little to reduce female HIV infection in Africa, and female HIV infection is much greater than male HIV infection.

    For every male that doesn’t contract HIV, there is a necessary decrease in the number of women who can contract it. Fewer overall cases of infection decreases how prevalent a disease can be. Women benefit from male circumcision.

    We need to start campaigning for more observational studies in this area, that could hopefully lead to trials.

    The evidence is already in that female circumcision has adverse effects. That was never and is not the case with male circumcision. The two are not comparable.

    Ignoring that trollish aspect of your post, and ignoring the largely anti-scientific bend of your post, your primary point is that if female circumcision and male circumcision are sufficiently similar, the arguments presented in the scientific and philosophically coherent post I created would apply equally to both. That is true. You can stop with being a genuinely bad poster. You haven’t the science on your side to support either the efficacy of female circumcision nor the lack of harm in female circumcision. The fact that you haven’t even bothered to respond to any of the science in the original post is indicative of your poor position in all this. Male circumcision has virtually zero drawbacks while offering significant benefits. It is actively the health policy of a huge swath of Africa, and its utilization is primed to spread. When and if the world creates an HIV vaccine, these policies can and should be reviewed. Until then, this is one of the best tools we have available to save lives.

  6. “The greatest crime against humanity is the torture and mutilation of children. Child abuse and neglect, particularly in its extreme forms, represents a form of torture and mutilation. Not commonly recognized as child abuse and neglect and a form of torture and mutilation is the ritual mutilation of genitals of children (male and female). One reason for the non-recognition of these crimes of genital mutilation and torture is their common occurrence and their support by religious and social traditions of various kinds. Another reason is the denial and/or indifference to the pain that is being inflicted upon these children.”
    James Prescott, Ph.D.
    Developmental Neuropsychologist, Cross-Cultural Psychologist

  7. Circumcision is not painful, nor is it mutilation. The penis functions just as it otherwise would. The difference is that its protective performance increases dramatically.

    As I said in the original post, when performed by medical professionals, circumcision has virtually no drawbacks. It literally saves lives.

  8. There is only one group on the planet that say circumcision has no adverse effects on men, I think it’s really important from a scientific standpoint to always look at the reviews from a peer reviewed study, the problem with almost every study that shows circumcision in a good light all have peer reviews to show its fraudulent, like all of Tobians studies where all of his statistics and findings are based on assumptions and unscientific correlations, or Morris’s studies :

    “The highest-quality studies suggest that medical male circumcision has no adverse effect on sexual function, sensitivity, sexual sensation, or satisfaction.”

    Morris, B. J., & Krieger, J. N. (2013). Does male circumcision affect sexual function, sensitivity, or satisfaction?—a systematic review. The journal of sexual medicine, 10(11), 2644-2657.

    http://onlinelibrary.wiley.com/doi/10.1111/jsm.12293/

    And a critical peer review in Advances in Sexual Medicine:

    “By selectively citing Morris’ own non-peer-reviewed letters and opinion pieces purporting to show flaws in studies reporting evidence of negative effects of circumcision, and by failing adequately to account for replies to these letters by the authors of the original research (and others), Morris and Krieger give an incomplete and misleading account of the available literature. Consequently, Morris and Krieger reach an implausible conclusion that is inconsistent with what is known about the anatomy and functions of the penile foreskin, and the likely effects of its surgical removal.”

    http://www.scirp.org/Journal/PaperInformation.aspx?PaperID=55256#.VRsWlfzF9PM

    Again, when researching circumcision (or any topic), it’s important to read the original documents in full as well as the peer commentaries. Peer commentaries may support the conclusions of the original article or may address inaccuracies and oversights that could invalidate the conclusions of the authors.

  9. And as an Atheist myself, I find it disturbing that you would bring up the AAP, with their religious bias being disguised as science.

    Atheists and agnostics need to stop promoting pseudoscience and keep blood sacrifice rituals away from people.

  10. The AAP has a history of being on both sides of the circumcision debate depending on the evidence at the time. They were actually slow to come around this time.

  11. The AAP wasn’t actually slow, the Taskforce on Circumcision has been made of of different doctors over the last decade, Doctor Black who’s incharge of the group has removed and replaced people that defied her way of thinking with people from her own religious background, there is still a large amount of dissent with in the community with its current stance, especially when they defended it by saying their main conclusion was based on a “feeling.” A feeling isn’t science and the man who defended that statement had just done an interview and revealed in that interview that he had previously circumcised his own son on his parents’ kitchen table. “But I did it for religious, not medical reasons,” “I did it because I had 3,000 years of ancestors looking over my shoulder.” So great, we get Jewish mumbojumbo disguised as science.

  12. Pretty decent article published today in huff post that contradicts most of your conclusions http://m.huffpost.com/us/entry/7031972

  13. The majority of that article is filled with unsupported claims. I’ve provided more than enough evidence already which shows the opposite of what the HuffPo article shows. Moreover, the person is largely relying upon the argument from bodily autonomy and ad hominen tactics. First, the ethical argument has already been tossed around like the rag doll it is. Second, the author is making the same arguments anti-vaxxers make when they talk about Big Pharma. The CDC and AAP were both slower than the WHO, UNAIDS, the Bill and Melinda Gates Foundation, and the dozen and a half African health ministries on the matter. If they’re so biased, they’re doing a bad job showing it.

  14. I also find it funny that he tried to call circumcision cosmetic. Since he doesn’t equally apply his argument from bodily autonomy point to vaccines (unless, of course, he’s an anti-vaxxer), he is necessarily relying on the fact the circumcision causes a visible change. It’s a petty, childish argument.

  15. What’s childish is believing that you can change form with out changing function or sensation, for you to believe that you have the slightest scientific argument in this mix of all of this and to believe that it has no ill effects just boggles the mind, and goes against the recently modified and published health policies of the BMA, RACP, KNMG just to name a few and there are many more, to argue for circumcision goes against peer reviewed studies that actually followed peer review guidelines, and unlike vaccines that have a very high 99% plus effectiveness, every positive claim in regards to circumcision has not ever once been proved to be correct in the history of man, not one has been conclusive. So for you to sit there and claim “because science” is laughable. Do you even read the peer review commentaries of studies you believe? If you did there is no way you would hold such a sound belief in this, unless you are trying to justify some kind of personal preference. Coming from a Jewish background myself, I understand that, but as an atheist and a humanist who’s grown beyond old rituals, it’s time to let go of things like that.

  16. And as far as WHO goes their own reports say to use circumcision in areas where AIDS is a pandemic, that doesn’t compute with using circumcision in the U.S. where HIV transmission is mainly a gay black male or an IV drug user issue, we don’t have an issue here with female to male HIV infections and in the small cases that we do, those men are already circumcised, circumcision has no place in westernised societies, we need non religious science based sex education in the U.S. not bogus pseudoscience.

  17. You: “Circumcision is not painful…”
    Me: Then why is the baby in the video above screaming as the Gomco clamp is being applied to his tiny penis? His obvious distress is a glaring contradiction of your assertion.
    Medical license holders used to hold that infants felt no pain at all because their nervous systems were not sufficiently developed to perceive it. Open heart surgeries were performed on babies using no anesthetic at all under this wrongful thinking. But such thinking was abandoned more than 20 years ago. Why has it taken so long for you to get the message?
    http://edition.cnn.com/HEALTH/9712/23/circumcision.anesthetic/
    http://www.sickkids.ca/AboutSickKids/Newsroom/Past-News/1997/Study-shows-that-infants-feel-and-remember-circumcision-pain.html

  18. Scion,

    The foreskin has no apparent function. Study after study and survey after survey shows it makes no difference in sensation or sensitivity. Why we have it today is more a mystery than anything, but what’s clear is that it doesn’t do anything useful. It’s just a piece of skin, at best. At worst, it provides a surface area and a breeding area for viruses and bacteria.

    Vaccine effectiveness varies by vaccine and sometimes even by year. Furthermore, if your argument is that vaccines are more effective than circumcision (most are, but not all), then you’ve admitted that the argument from bodily autonomy doesn’t matter. That is, if the efficacy of a procedure or medicine is the deciding factor here, then bodily autonomy is inherently irrelevant.

    All the studies cited are peer reviewed. They come on the heels of a large body of evidence dating back to the 70’s whereas STD’s are concerned and back to the 80’s where HIV is specifically concerned. The independent scientific bodies that oppose circumcision – that is, the groups which weren’t created for the sake of opposing circumcision – do so for ethical reasons. I reject their reasons and ask why they aren’t also against vaccines.

    Circumcision probably won’t do a lot to curb HIV in the US. It will curb penile cancers and infections while thwarting other STD’s, though. Whereas it’s a one time cost that has virtually no drawbacks, it is recommended by the CDC.

    (Let’s remember this point about HIV being largely a problem within the gay community and drug community should someone later seek to compare US and European circumcision rates as they relate to HIV rates.)

  19. John,

    Young Earth creationists quote-mine. I don’t think you’re much better, but you could be. Unfortunately, you haven’t proven that here. Circumcision is a pain free procedure when done with anesthesia. It’s that simple.

    Though, hey, I did see news about vaccine requirements in Australia today. Lots of kids were crying their eyes out. I guess we better knock off that silliness, right?

  20. Only general anesthesia can eliminate all of the pain of forced infant circumcision but is not used because it kills too many babies. Studies have shown that about 60% of cut docs use no anesthesia at all, a kickback to the old thinking. Of the ones using it many don’t wait long enough for it to take effect as time is of the essence. There are no safeguards, assurances or oversight in place to guarantee that any anesthesia will be used, and the anesthesia will add $10 – 15 to the doc’s overhead. One can see lots of videos on YouTube where anesthesia is even injected and the poor infant still screams in unabated anguish throughout the procedure. The pain of this amputation cannot be eliminated and this is why the baby in my video post above is in such obvious distress. The links provided support this position overwhelmingly.

    From SciOn above: “Pretty decent article published today in huff post that contradicts most of your conclusions” http://m.huffpost.com/us/entry/7031972
    Sci has got that right. The wonder is why you don’t go over to Huff Post, into the real world, and use your science to restore all that of yours which the article truly debunks. You could post your article in its entirety or try to defeat the opposition piecemeal. Best of all there’s no moderation to suppress any contrary views and the article by Dr. Frisch has already won 28K likes as well as 440 comments. This guarantees that many readers will be exposed to your work, unlike the situation here. What could possibly be holding you back?

  21. John,

    It’s a plain lie that anesthesia isn’t used because it kills infants. Furthermore, it’s a lie that you have any idea how many doctors use it in the first place. I already addressed that in my original post. Moreover, any parent can ask that it be used if they’re concerned it won’t be.

  22. No, GENERAL anesthesia is NOT being used because of its lethal effects on infants. Your denial constitutes a false statement. And when it comes to ritual circumcision sometimes sugar water or a few drops of wine will be placed on the neonates lips: pure theatrics.
    Now here is a blogger that has penned the best Science blog on circumcision ever written. Take a few minutes to read it. I’m sure that you will agree!
    http://madsciencewriter.blogspot.co.nz/2013/05/the-foreskin-why-is-it-such-secret-in.html
    I’ll be looking for you over on Huff Post!

  23. John,

    Your point is that because localized anesthesia is being used instead of general anesthesia that therefore general anesthesia isn’t being used and therefore circumcision is painful?

    Stop the presses.

  24. There is no one so blind as the person who refuses to see.
    Now here’s a link to the latest debunking of your patron saint Brian Morris. Soon Morris will have nowhere to publish but here on your blog!
    https://www.academia.edu/9872471/Does_science_support_infant_circumcision_A_skeptical_reply_to_Brian_Morris?auto=download&campaign=upload_email

  25. If you are honest, you’ll admit that you’re confusing “is” with “ought” more than once to make your points. Also, in an article meant to be serious, your snark against people who have genuine complaints about what was done to them for no good reason is bizarre. Last, they must be using Occam’s Razor to cut men in Africa, because regardless of the studies, men there, just like here, are told that they must continue to wear condoms to prevent HIV and other STDs even after the procedure. Because in the real world, it does nothing.

  26. How very scientific…at another point in history, circumcision was considered an effective method for the prevention of masturbation and through this, also prevented retardation. And this was considered science.

    https://murdercroweatcrow.wordpress.com/2015/04/13/the-corn-flake-connection-a-secret-american-history-of-guilty-pud-whacking-penis-mutilation-forced-neuterings/

  27. That’s actually an outright lie that study after study has come out saying foreskin has no function, only Brian Morris’s group of studies have stated that, and we all know that no one should be trusting his studies because he does not follow proper peer review guidelines, how about this recent gem http://onlinelibrary.wiley.com/doi/10.1002/ca.22501/abstract;jsessionid=DA83424FC408B7A4D4010CB9B1FCA554.f03t03

  28. Randy,

    There aren’t any legitimate complaints against circumcision at-large. It’s a safe, effective procedure that causes no change in sensitivity, sensation, or performance. The only valid complaints involve premature births, blood issues, and a handful of specific conditions. As soon as the anti-circumcision crowd rises above the qualities of the creationist crowd, I’ll stop treating them as scientific equals.

    As I already addressed, the fight against HIV isn’t a zero sum game. Moreover, Africans aren’t monkeys you can train to magically behave differently from anyone else around the globe. Please review my original post so we can avoid addressing resolved topics in the future.

  29. John and scion,

    I’ve never heard of Brian Morris. Whatever hard-on the two of you have for talking about him can be put away.

    Scion,

    I’ve given reference here. There are a host of studies and surveys from a large number of sources. They routinely show it’s a wash – circumcised and uncircumcised penises have the same sensitivity during intercourse. The nerve ending hypothesis is now firmly a myth.

  30. Reblogged this on oogenhand.

  31. Reading your blog reminds me how limited the thinking is of most of ‘educated’ people on this planet. I feel terribly sorry for you.

  32. Explain to me, Elena…

  33. Female Circumcision: Clitoris is a part of female sexual organ which is gifted from God. I think as usual part of body of human beings can not be removed (Circumcision). If it is done it will go against nature.

  34. Maybe we should figure out why circumcision reduces HIV transmission rates and attempt to apply to utilize this mechanism to avoid having to circumsize. A non-invasive, non-altering method would certainl be preferential to skin removal.

  35. You’ve gotta be kidding on that “Circumcision only decreases penile sensitivity sometimes” bullshit. Science isn’t just something that forgets. Everyone’s penis is built the same way (except because you wrote this dim witted post we see where you stand on the size spectrum) the REASON we have ANY feeling in our body is because it’s filled with many many nerves. Let alone dying without nerves we wouldn’t feel shit without it. Same applies to your penis, if you cut nerves off you won’t feel shit. If you cut your foreskin off the only thing pleasurable about sex is when you get off, no pleasuring sensitivity or anything. So good luck never getting a good fuck. You seem to intertwine your religious bias and confuse it with scientific evidence. In the last 20 years people have proved that circumcision has absolutely no benefits and you confronted it with your religious bias. The fact that you defend it with outdated evidence and rely on invalid facts just proves how braindead you are.

  36. You’ve gotta be kidding on that “Circumcision only decreases penile sensitivity sometimes” bullshit.

    Who said that? They must surely be out of their minds. There is no evidence that circumcision decreases penile sensitivity ever.

    the REASON we have ANY feeling in our body is because it’s filled with many many nerves. Let alone dying without nerves we wouldn’t feel shit without it. Same applies to your penis

    There are many different types of nerves in your body. How much any given type increases any sort of sensation will vary. The penis nerve-ending hypothesis was a great hypothesis, but that’s it. We know now it is firmly a myth. Moreover, it turns out the guy who started it was just making numbers up because he is an anti-circumcision crusader, putting him a half-step above the rationality of YouTube commenters who supported Ron Paul in 2012.

    http://thecircumcisiondecision.com/20000-nerve-endings/

    If you cut your foreskin off the only thing pleasurable about sex is when you get off, no pleasuring sensitivity or anything.

    Your beef is with science, not me.

    You seem to intertwine your religious bias and confuse it with scientific evidence.

    I’m an atheist. You could have easily viewed the Categories for this blog and found that out.

    In the last 20 years people have proved that circumcision has absolutely no benefits and you confronted it with your religious bias.

    Organizations have been turning towards circumcision left and right. A dozen and a half African health ministries have implemented it as a health policy. Of course, it’s clear you’ve never bothered to read any of the studies, including the three from Kenya, Uganda, and South Africa from roughly a decade ago, so I’m not surprised that you’re entirely unfamiliar with the position of the scientific community.

    The fact that you defend it with outdated evidence and rely on invalid facts just proves how braindead you are.

    The latest evidence is exactly why I support circumcision. It literally saves lives.

    Thank goodness for circumcision.

  37. I wish I’d found your blog earlier Michael. It is excellent, and also it is refreshing to see a skeptic who has not bought into the intactivist bullshit. I am in the U.K. and, sadly, intactivism is penetrating the skeptic movement on this side of the pond. Our own “Skeptic” magazine has published a dreadful piece by Darby & Earp, and refused my rebuttal, to give just one example (I saw it cited in a post above). Anyway, I note you mentioned 10000 to 20000 nerves in your article. Be aware this is an urban myth with no evidential basis whatsoever. Google my article “Sloppy scholarship and the anti-circumcision crusade”. Also, condoms are not 97-99% effective. More like 80 % for HIV according to a Cochrane review (pubmed/11869658).

  38. I should have done a better job on the section about nerve endings. The relevant scholarship on the point indicates that the estimate was effectively made up by an anti-circumcision crusader. I looked into this a couple of months after I made my original post when I started to see the anti-circumcision crowd start to change the range from 10,000 – 20,000 to upwards of 70,000. It would appear that someone or some site has recently taken to using the larger number, turning it into another circumcision myth and meme.

    http://thecircumcisiondecision.com/20000-nerve-endings/

  39. Yes, I’ve also seen it inflated to 70,000. Marilyn Milos, matriarch of American intactivism, used it in her post on the CDC website when they were open to public consultation, and the intactinuts flooded it with negative comments as a result of a social media campaign. And I’ve seen it appearing on comments threads too. Sigh, another “circumcision myth and meme”, as you say. Without wishing to seem immodest, I was the one who did “the relevant scholarship” exposing the 20000 myth. The link you provide cites my article “Sloppy scholarship and the anti-circumcision crusade” in J. Med. Ethics. Google it, it’s free and you may find it useful. I did not have room to include the origins of the 10000 myth. That one came from a guestimate by New Zealand intactivist Ken McGrath at a conference in the 1990s. He has since retracted (McGrath, personal communication) but this seems not to have got out. Even if it had, the intactinuts would ignore it anyway. Keep up the good work. I think I shall start following your blog. Wish I had time to put together a website of my own, perhaps debunking intactivism, it being a pseudoscience I have been following for years now.

  40. Michael, great blog. I wish I had found it sooner.
    Everything you said matches what I think based on what
    I’ve read.

    Unfortunately, the only good comments to what you wrote are
    now at the end of the list.

    You might want to mention http://circumcisionusa.org as a place
    to get unbiased accurate information.

    You can add this to the research:

    http://www.independent.co.uk/life-style/health-and-families/health-news/circumcision-does-not-reduce-penis-sensitivity-research-finds-a6986316.html

    http://www.medicaldaily.com/circumcision-sexual-pleasure-382158

  41. Great blog. I just want to say I agree with probably nearly everything you say in regards to quackery, except for possibly your position on circumcision. I take it by “anti-cirumcision folk” you mean those who are against the routine circumcision of male infants, and that you advocate for it. I’ll concede you have a reasonable argument for routine it, but I find it a bit puzzling why you’d so readily suggest that those who oppose it should be counted along with groups who reject science such as young Earth creationists, when it seems just as likely that many don’t reject science but simply are not strict utilitarians, and are opposed to the practice based more on ethical or philosophical principles that aren’t undermined by the evidence for or against its alleged health benefits or harms. Surely you’d agree that lots of things could be done that would reduce the spread of disease, but are off the table due to unrelated ethical or social considerations. I’m skeptical of the practice, because even if you’re correct that it reduces STD transmission, and even if certain anti-circumcision groups go overboard in claims of reduced sensitivity, I don’t think such intrusive and irreversible medical procedures should be forced on people aside from cases of immediate necessity.

  42. Sorry, you definitely did address this with the vaccine comparison. But again, not everyone is a strict utilitarian or agrees that such bodily autonomy is only important insofar as it protects our lives. Aside from the ethical principles, I’d also note that vaccination antibodies are arguably in fact more reversible (I’m not an expert, but for example, the studies into “resetting” the immune system for one thing). But most importantly, the success of vaccination is in large part from protecting against illnesses very young children are susceptible to, and can’t otherwise easily protect themselves from, while circumcision’s alleged benefits don’t kick in until people are sexually active, against harms that have effective countermeasures. The vaccine comparison would be more apt if circumcision provided any benefits to very young children. Aside from this, HIV isn’t the deadly public health emergency it used to be (in first world countries at least). Lastly, perhaps this is arguably a genetic fallacy, but circumcision’s religious basis shouldn’t be left out of any discussion viewing it as analogous to vaccination.

  43. With respect to John’s remarks above, I agree with Michael when he compares intactivists to creationists. I have debated both on-line for years, and both employ the standard pseudoscientific tactics (cherry-picking, misrepresenting, using discredited arguments, quote-mining, bad logic, outright lying, etc). John is correct about not everyone being utilitarian, however. And I suspect this is one of the things that divide pro & anti-circers. I am essentially utilitarian, and take the view that if a procedure clearly wins a cost and risk benefit analysis then do it. Intactivists take a rigid absolutist line, that the circ decision should be left to the individual when old enough to decide. I see a suggestion of this in John’s 2nd post too. Trouble with this is that it results in more dead people. There are literally dozens of studies into acceptability of circ, and barriers to it. It is now abundantly clear that majorities of men, if given the facts about circ (not intactivist BS off the internet) are positive about circ, but reluctant to get it done themselves because of the barriers (fear of pain, need to abstain from sex during healing, cost, inconvenience etc., etc.). But they are happy to get their sons done (to whom most of the barriers do not apply). So one gets a much higher rate of uptake with infant circ than with adult. It may not matter as much in a low HIV setting, but in epidemic settings it is a matter of life and death on a terrifying scale. To give just one example which came up in my PubMed alerts today, 84% of Botswanans would get a son circ’d: pubmed/27716224 This is far better than one can hope to achieve by targeting adults. Thus, by leaving the decision till adulthood one ends up with a bunch of men who’d be happy to have been circ’d but are deterred from it by the barriers. Consequently they are vulnerable and, inevitably (in a country with 25 % HIV rate), many will get infected and pass the infection on. The result – greater mortality, morbidity and health care costs. Now where’s the ethics in that?

  44. I was circumcised as an adult. I wish it had been done at birth.
    There is nothing positive about having foreskin.

    25 years later, I have no regrets.

    If the anti-circ’s stopped breathing their own hot air and actually listened, this debate would be over for all the reasons that Michael mentioned.

  45. With respect to John’s remarks above, I agree with Michael when he compares intactivists to creationists. I have debated both on-line for years, and both employ the standard pseudoscientific tactics (cherry-picking, misrepresenting, using discredited arguments, quote-mining, bad logic, outright lying, etc). John is correct about not everyone being utilitarian, however. And I suspect this is one of the things that divide pro & anti-circers. I am essentially utilitarian, and take the view that if a procedure clearly wins a cost and risk benefit analysis then do it. Intactivists take a rigid absolutist line that the circ decision should be left to the individual when old enough to decide. I see a suggestion of this in John’s 2nd post too. Trouble with this is that it results in more dead people. There are literally dozens of studies into acceptability of circ, and barriers to it. It is now abundantly clear that majorities of men, if given the facts about circ (not intactivist BS off the internet) are positive about circ, but reluctant to get it done themselves because of the barriers (fear of pain, need to abstain from sex during healing, cost, inconvenience etc., etc.). But they are happy to get their sons done (to whom most of the barriers do not apply). So one gets a much higher rate of uptake with infant circ than with adult. It may not matter as much in a low HIV setting, but in epidemic settings it is a matter of life and death on a terrifying scale. To give just one example which came up in my PubMed alerts today, 84% of Botswanans would get a son circ’d: pubmed/27716224 This is far better than one can hope to achieve by targeting adults. Thus, by leaving the decision untill adulthood one ends up with a bunch of men who’d be happy to have been circ’d but are deterred from it by the barriers. Consequently they are vulnerable and, inevitably (in a country with 25 % HIV rate), many will get infected and pass the infection on. The result – greater mortality, morbidity and health care costs. Now where’s the ethics in that?

  46. I share the sentiments of James Circ’d (above). And the experience (23 years in my case).

  47. You keep saying the foreskin has no function. This is a flat out lie. It’s main purpose is to protect the glans and keep it moist and soft (and sensitive) instead of dried out and keratinized. Ask any man who’s “restoring” and he’ll tell you the difference in sensitivity is noticeable when that sloughs off. The foreskin also supplies a gliding motion that makes sex and masturbation much more comfortable, and also helps keep the woman’s fluids inside instead of pulling it out with each thrust.

    Your benefits are over-exaggerated, too. Penile cancer is rarer than male breast cancer, and the CDC has disavowed any connection between it and foreskin. BTW, the rare cases that occur typically form on the foreskin or the circumcision scar line. In the intact men, there is now a medical need for circumcision. Guess what happens to the circumcised guys. Infections – UTIs are ten times more common in girls. We give them antibiotics instead of surgery. The mostly-circumcised U.S. has a higher rate of virtually every STI than Europe, so it obviously isn’t helping much.
    I see you also refuse to acknowledge the risks of the surgery. Skin bridges, adhesions, tight erections, meatal stenosis, even not taking enough off and having to have it done again. And, honestly, the complication rate is 100% because every circumcision results in the loss of normal healthy tissue.

  48. I haven’t been saying it has no function. It clearly has one function: in utero protection. And that’s it. Everything else is unsupported – often contradicted – myths. Circumcision does nothing to affect sensitivity or sensation, so the foreskin can’t possibly protection any such thing. Indeed, the added moisture contained by foreskins is one of the reasons they retain so much more bacteria and viruses, leading to diseases.

    The CDC has done no such thing. Indeed, the studies I cited came from a collection of evidence put together by the CDC itself.

    The mostly-circumcised U.S. has a higher rate of virtually every STI than Europe, so it obviously isn’t helping much.

    I can’t say I’m shocked that an intactivist would so readily conflate causation and correlation. Japan has even lower rates of STDs and HIV than Europe, yet it has a similar circumcision rate. Is it just that Japan is extra-uncircumcised? Or are you suddenly ready to entertain the notion that correlation and causation are not the same thing?

    Circumcision saves money, health, and lives at the expense of nothing more than a quick trip to the doctor’s office. The science is firmly in on this and it has been for some time.

  49. Well said, as usual Michael. It is refreshing to see a skeptic with an evidence-based view on this topic. Sadly I see intactivism penetrating the sceptical community all too often. People who ought to know better seem to see this issue as a convenient stick to beat religion with, and don’t look further, as they ought to. I have been trying to persuade a fellow UK skeptic (Myles Power) that he got it all wrong in his awful video “The Science of Circumcision” on YouTube. A year later, and after a face-to-face confrontation at a skeptic conference in England, he has still to correct most of his errors. He has conceded on UTIs & HIV, but not (yet) his garbage about nerves, keratinisation etc. He says he is looking into those, but I fear that by the time he does his video, which is being touted by intactivists, will be flagged on one of the African intactivist Facebook pages where it could do real harm.
    Anyway, there is one detail in your post I am unconvinced by. You have the foreskin as an in utero developmental feature, redundant after birth. In this case it would be, in effect, a spandrel – a quirk of developmental biology. A bit like male nipples, or the useless bony bump pandas have on their ankles that corresponds with the useful pseudothumb on their wrists. As I understand it, one argument in favour of this hypothesis is that males born without a foreskin (aposthia) also often have hypospadias. Yet there are cases of aposthia without accompanying hypospadias (http://applications.emro.who.int/emhj/1302/13_2_2007_280_286.pdf?ua=1 ). So I remain unconvinced.
    I incline towards the foreskin being a vestigial structure – a bit like the eyes of blind cave animals. Or to use human examples, or the coccyx at the end of the spine, or the little muscles that enable some to twitch their ears. I can envisage a protective cover being useful for naked hominids encountering long grass and prickly foliage, but rendered redundant by clothing. It may be no coincidence that (at least as far as I can determine) tribal people who routinely go naked don’t circumcise. There is some evidence for the vestigial hypothesis. Aside from the quality studies showing its absence makes no difference to function etc., the foreskin is also immensely variable.
    Kigozi et al (www.ncbi.nlm.nih.gov/pubmed/19770623 ) found that the surface area of a foreskin ranges from 7 to nearly 100 square cm (average around 40, or 6 square inches). Aside from debunking an intactivist myth about foreskin size (15 square inches!) this agrees with Darwin’s observation that “An organ, when rendered useless, may well be variable, for its variations cannot be checked by natural selection” (Origin of Species, chapter 13). Note that Kigozi’s sample was for ages 15 and above. I guess the youngest subjects may account for the smallest foreskins, but the variation is still impressive. Note also that the measurements are for both inner and outer surfaces combined (I emailed and asked Dr Kigozi to confirm this, as it is not obvious from the paper).
    At least we agree that, whether spandrel or vestigial, foreskins are useless! Keep up the good work.

  50. Adding to your rebuttal of Rob’s comments, which are the usual mix of half-truths and outright nonsense to be found on intactivist websites, I would suggest that men who report benefits from “restoring” are experiencing a placebo effect. Penile cancer affects roughly 1 in 1000 men in developed countries, many more in some developing ones. UTIs are more common in boys in the first few months after birth, when the risk of renal damage is also higher. Later they become more common in girls, by which time the risk of renal damage is much less. The complication rate is <0.5 %, and is mostly minor things, easily remedied, according to the largest study yet (https://www.ncbi.nlm.nih.gov/pubmed/24820907 ). The unwanted pregnancy rate in the US is about four times higher than for other developed nations. It really stands out. This indicates big differences in sexual behaviour, like promiscuity and condom use. Therein lies the explanation for the differences in STIs. One wonders how much worse the US situation would be, were it not for circumcision!

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