For the Sake of Science

Any time male circumcision is discussed, people can usually be described in one of three ways: 1) those who have had it done and thus favor it. 2) those who have not had it done and thus do not favor it. 3) Women. This third category doesn’t have any significant, inherent bias that can be easily detected (at least by me). That notion is true for Christiane Northrup and her anti-circumcision article.

Believe it or not, circumcision was introduced in English-speaking countries in the late 1800s to control or prevent masturbation, similar to the way that female circumcision–the removal of the clitoris and labia–was promoted and continues to be advocated in some Muslim and African countries to control women’s sexuality. [1]

Routine female circumcision, which has been practiced in some cultures, is completely unacceptable. Few people would argue otherwise. In fact, the United Nations has issued a decree against it. Circumcision is a form of sexual abuse whether it’s done to girls or boys.

I never like this tactic. Northrup first mentions female circumcision and does so relevantly – circumcision has been used as a tool to control sexuality. But then she goes on about it in the next paragraph, quickly trying to draw a connection between it and male circumcision. These are two entirely different things. One is violent, messy, often comes with complications, and is emotionally scarring in most instances. Who can guess which one I just described?

We justify male infant circumcision by pretending that the babies don’t feel it because they’re too young and it will have no consequences when they are older. This is not true. Women who experience memories of abuse in childhood know how deeply and painfully early experiences leave their marks in the body. Why wouldn’t the same thing apply to boys?

What does “abuse” mean in this context? While the article is generally well written, this paragraph is a bit of a mish-mash. Northrup tries equating female and male circumcision, goes on about pain, and throws in abuse, undefined. If female circumcision is meant here, it’s quite odd since Northrup talks about childhood trauma. If female circumcision isn’t meant here, then abuse first needs to be defined, then Northrup needs to explain why she is equating what happens to an infant to what happens to older children; one will remember the event – a key aspect in what defines “traumatic”.

In medical school, I was taught that babies couldn’t feel when they were born and therefore wouldn’t feel their circumcision. Why was it, then, that when I strapped their little arms and legs down on the board (called a “circumstraint”), they were often perfectly calm; then when I started cutting their foreskin, they screamed loudly, with cries that broke my heart? For years, in some hospitals, surgery on infants has been carried out without anesthesia because of this misconception!

The “pain argument” is often used by anti-circumcision advocates. That’s seemingly fair enough, especially coming from someone qualified like Northrup (who is an M.D.), but she quickly undermines the argument by pointing out the use of anesthetic. If hospitals are now using them, then there is virtually no pain, right? So…argument defeated?

But these are justifications that science has been unable to support. Nor is there any scientific proof that circumcision prevents sexually transmitted diseases.

This includes the recent studies done in Kenya, South Africa, and Uganda by Ronald H. Gray, a professor at Johns Hopkins University. He recently reported that men who were circumcised were less likely by half to contract HIV virus and less likely by one-third to become infected with HPV and herpes. [2]

While this sounds promising, I agree with my colleague George Denniston, M.D., who said, “The United States has high rates of HIV and the highest rate of circumcision in the West. The “experiment” of using circumcision to stem HIV infection has been running here for decades. It has failed miserably. Why do countries such as New Zealand, where they abandoned infant circumcision 50 years ago, or European countries, where circumcision is rare, have such low rates of HIV?”

When I first read this article, I had no knowledge of the author or anything of that nature. Upon reading the above excerpt, I assumed the person was a journalist or a passionate advocate, but not a doctor.

The evidence continues to mount that HIV transmission is reduced with circumcised penises during penile-vaginal intercourse. A number of studies have supported this. It’s surprising enough that Northrup disagrees on the point, but what really raises an eyebrow is her quote of George Denniston. Yes, the U.S. has a relatively high rate of HIV and yes, many in the U.S. are circumcised. So what? Where’s the evidence? Right now I see a broad correlation: the U.S. has a lot of two things. Okay, that’s great, but are there studies showing that HIV transmission is no different in circumcised versus uncircumcised men? Could other factors be at play? Given that the HIV prevention studies are based upon vaginal sex, could the higher acceptance of homosexuality be a contributing factor in the U.S. versus poorly developed, less accepting nations? What about number of partners? Do Americans tend to have more partners than others? There just needs to be more than a simple correlation.

Similarly, one of the main reasons people choose to have their child circumcised is they believe that it’s nearly impossible to keep an uncircumcised penis clean. This also isn’t true.

The best I have for the U.S. is a simple anecdote of a friend who got a circumcision at age 22 due to recurrent infections, and this was despite reportedly vigilant cleaning. Of course, on the whole, Northrup is right; it isn’t that hard to clean basically any part of the body, including the foreskin area. But one important caveat: for the West. Developed nations have constant access to showers and baths. Poorer nations where HIV is rampant are not always so high on hygiene. While cleaning is possible, the reality is that it may not always happen. That can be remedied, but I personally have to favor circumcision over a long and constant hygiene education program.

The next part of Northrup’s argument is titled “Religious Reasons”, but instead of really giving any or arguing against them, she describes how one religion does it and then concludes,

This allows the parents to practice their faith and adhere to tradition while protecting their child from a painful, medically-unnecessary procedure. This is far superior to what baby boys are subjected to in most hospitals. I know. I’ve done hundreds of circumcisions personally.

Again, the “pain argument” seems to be undermined.

Circumcision also has profound implications for male sexuality.

No. The evidence is weak, subjective, inconclusive, and extremely difficult to compare.

It would seem that a far better argument for the anti-circumcision crowd would be to just put the onus on the pro-circumcision crowd. Why do it at all? Here are basically the only real arguments.

1) Religion. This one sucks because all religions hold many falsehoods, tend to be based upon falsehoods, and do not offer actual arguments, only decrees and dogmas.

2) Tradition. So what? Circumcision is a non-moment in a baby’s life; he won’t remember it. The only way out of this is to say it’s a moment for a family. That might be true for Jews and some other religious groups (which aren’t merely doing it out of tradition, but religion, obviously), but it hardly seems to be the secular norm. And do families ever celebrate circumcisions later in life? What good comes out of this? There seems to be no point, no benefit from this reason.

3) Aesthetics. This is highly subjective, but more than a few accounts enthusiastically describe uncircumcised penises in negative terms. This is likely also true of circumcised penises, but would seem to be less so. This argument holds more water in countries where circumcision has become the norm.

The first two arguments are weak and dismissible. The third offers the most strength, I think. There seems to be no harm and it looks better by many standards. At the very least, this is a good argument against the level of vociferous opposition.

Filed under: Politics and Social | Tagged: Christiane Northrup, Circumcision, George Denniston, HIV, STD | 35 Comments »