According to a recently published paper, circumcision can prevent the spread of certain sexually transmitted infections and even prevent cancer.
Not everyone, however, believes that disease-prevention is justification for cutting infant foreskins off.
Researchers including Brian Morris, a professor emeritus at the University of Sydney, and Jay Krieger, a professor emeritus of urology at the University of Washington School of Medicine, reviewed 81 previously published studies and found that circumcision is an effective means for reducing the transmission of HPV and other sexually transmitted infections. By preventing the spread of these infections, circumcision, according to the researchers, may also help prevent cervical cancer, which can be deadly in women.
The paper was published in the journal Frontiers in Public Health. In a UW blog post, co-author Krieger says that rates of circumcision have been declining in the U.S., in part due to the “anti-circumcision lobby" (you may see members of this lobby standing outside of Pike Place with signs reading, "Circumcision is a sex crime") and that women can (and should) use their considerable power of influence to advocate for male circumcision.
Many pediatricians in the U.S., as well as the American Academy of Pediatrics, continue to advocate for the procedure, because, they say, the benefits to public health outweigh the risks. Still, this issue continues to be hotly debated among sex researchers and pediatricians. I sent the paper to a number of people working in sexology, medicine, and medical ethics, and their reactions were widely mixed.
"As circumcision is currently practiced, it is an irreversible bodily modification being done on infants without their consent," Neil McArthur, a medical ethicist at the Centre for Professional and Applied Ethics at the University of Manitoba, told me in an email. "If there are positive health effects either for men or for women, that would be a very good reason for adult males to choose to have it done. It's not a good reason to maim non-consenting infants."
Another sexpert, however, disagreed with his use of the term "maim." James Pfaus, a professor of Neuroscience at Centro de Investigacion Cerebrales, Universidad Veracruzana in Xalapa, Mexico, said in an email, "To ‘maim’ means to wound or injure someone so that part of the body is permanently damaged. How does removing the foreskin permanently damage the penis or genital function? And what is damaged exactly? How does its removal alter sensory or ejaculatory function? There ARE data on this, and they do not support the term 'maim' at all. I know this is a charged issue, and surely the infant cannot consent to anything, but to contend that circumcision ‘maims’ the genitals (in, say, the same way that clitoridectomy does), is an absolutely ridiculous idea."
Regardless of whether cutting off the tip of an infant's penis is technically a "maiming" or not, there is some evidence that circumcision reduces the sensitivity of the penis. For this and other reasons, it sure seems like an odd custom, albeit one with long roots. According to the Old Testament, the alleged God allegedly promised Jewish patriarch Abraham that his descendants would prosper if—and only if—their foreskins were cut when they reached the ripe old age of eight days. Today, circumcision is most commonly practiced among Muslims, Jews, and both religious and non-religious families in the U.S. (From my own anecdotal experience, the most common reason secular dads give when ask why they decided to circumcise their sons is that they want the kid to "look like" them, for some reason.)
McArthur agrees that it's an odd custom. "I have always wondered who holds a beautiful precious new baby boy in their arms and immediately says to themselves: 'I should definitely start cutting pieces of flesh off his penis. First order of business!'" he said. "I can't speak as a cultural historian, but I would say within the context of pre-modern medical practices, it is weird, but not the weirdest. People did crazy stuff back then! And it clearly does have certain health benefits if you don't have access to modern hygiene and if routine infections can kill young children."
Today, however, most people in the developed world have access to modern hygiene, so death-by-smegma should be less of an issue than it was before the advent of showers. As McArthur pointed out, the benefits of circumcision don’t arise until later in life. “For this reason,” he said, there is “no justification for infant circumcision. If the benefits don't come till you're an adult, why not have it done as an adult? The only argument advocates for adult circumcision can use to justify infant circumcision is that no adult in their right mind would consent to it despite the health benefits.”
Timothy McCajor Hall, a professor of family medicine at UCLA Medical Center, said that this issue frequently comes down to culture. "Medical reviews in countries that do no routinely practice circumcision as a cultural matter seem never to conclude that circumcision is all that useful," he wrote in an email. "Reviews in the U.S. (and other countries in which a majority of males are circumcised for cultural reasons) seem to find the slightest potential benefit of circumcision, with small effect sizes and potential confounds in the data, to be a strong argument in favor of their existing cultural practice."
According to a 2013 CDC report, the rate of circumcision in the U.S. dropped from 65 percent in 1979 to 58 percent in 2010. In most of Western Europe, on the other, the circumcision rates is less than 20 percent.
Still, the practice certainly has its proponents. Brian Morris, the lead author of this latest literature review and the author of the 1999 book In Favour of Circumcision, has been on a mission to “rid the world of the male foreskin,” according to a review of his book by Basil Donovan, the Director of the Sydney Sexual Health Centre. Donovan writes that while Morris has published hundreds of papers on the benefits of circumcision, he’s a molecular geneticist, not a physician, and, furthermore, Donovan concludes that parts of Morris’s book are so misinformed and “dangerous” that there are “sufficient grounds for the publishers to withdraw the book.” Other researchers claim that Morris has a long habit of cherry-picking data. One of his preferred tactics, according to several critics, is to respond to any study that questions the validity of circumcision with a letter to that journal’s editor. He later cites his own letters in literature reviews that tout the benefits of circumcision, like the one published in Frontiers in Public Health.
When asked about these claims, Morris defended his work. In an email, he called the allegations against him “scurrilous ad hominem attacks” and compared his critics to the “anti-vaccination lobby and others who deny the benefits of a variety of evidence-based public health interventions.”
“I make no apology for being a public health advocate and do so in other areas of public health as well, such as healthy diet, exercise, addressing the obesity epidemic, anti-smoking, alcohol and drugs, having appeared on TV and engaged with other news media in all of these various areas,” he wrote, adding that the head of his university is very supportive of his work on circumcision.
UW's Krieger responded as well. “Brian Morris is a well regarded scientist who has won numerous awards for his work,” he wrote me in an email. “He has published many well peer reviewed articles in this (and other) areas. He is also a frequent target of the anti-circumcision folks (whose ‘work’ generally comes off poorly when reviewed critically.)”
Still, while fight over circumcision is unlikely to be definitively resolved any time soon, what is clear is that even if circumcision does reduce the rates of HPV, there are other ways to prevent it that don't inflict pain: namely, vaccination.
“We have known for a long time that male circumcision reduces the risk of HPV infection and cancer of the cervix,” Joan Robinson, a professor of pediatric medicine at the University of Alberta, told me in an email. “However, HPV vaccines are far more effective than male circumcision. Current HPV vaccines are thought to prevent about 90 percent of cases of cancer of the cervix, plus prevent almost all genital warts.” And vaccinations don’t require cutting the flesh from anyone’s penis.