New circumcision study

I have previously written quite a lot about circumcision. See for example (1) here, (2) here, or (3) here. Circumcision proponents use different arguments when they try to spread this surgical procedure. Sometimes they say that your hygiene benefits, which may be true if you never ever clean yourself under the foreskin - hardly a reason for removing the foreskin. Another rather medievil argument is that circumcision will make it harder for the child to masturbate, and after all sexual pleasure is something you should avoid!


The only potentially valid argument for the use of circumcision, an argument which has only been around for perhaps five years (before that circumcision was conducted for irrational reasons entirely), is that it may reduce the risk of getting HIV if you have unprotected sex. Based on this some people argue that we should use mass circumcision to prevent the spread of HIV. There are many arguements against this.

First of all, people normally don't make their sexual debut when they are still in diapers, so let them choose themselves whether they wan't to be circumcised when they have reached an age where they can actually make such decisions. Secondly, condoms work much better than having your penis circumcised, so why not spend all the money advocating the use of condoms and handing them out for free instead? Furthermore, people who have been circumcised may feel safer and therefore have more unprotected sex, thus cancelling the potential gain...

Another serious argument against circumcision is that circumcision may cause serious problems for the patient in terms of penile function and penile sensitivity. The foreskin has a lot of sensory nerve endings. According to estimates that I have read, 50% of the nerve endings in the penis are in the foreskin. Just recently a study investigating the consequences of circumcision came out.

The study seems to show that people who have been circumcised do not suffer from reduced pleasure, at least that is what they say. However, as Mary Crewe points out, studies like these do not take into account psychological biases which are very likely to be at work. If you go and have yourself circumcised (the people in the study voluntered of course), then you will want to justify that decisions afterwards. As a result, minor troubles are likely not to be reported. The patient will simply bite together and say "I am fine, and my sex life is great".

For this reason I think it would be a mistake to start circumcising people based on this type of questionnaire evidence. Some sort of medical examination of penile function (or dysfunction) would be preferred.

Probably my last post on circumcision, for a while a least...

Following my two posts on male circumcision I have received a fair amount of feedback from which I have learned some new things. The commentators have pointed out where I have been wrong about things and they have also provided some great links that I would like to share with my readers here.

After my first entry on the subject I received one comment from anonymous with a link to a blog which is entirely dedicated to male circumcision. Here you can among other things, see pictures of the surgical procedure, and read about the similarities between male and female circumcision. I always thought that female circumcision was quite a bit worse, but it seems that this is not necessarily the case...

When I wrote my second entry I also received some very nice feedback. The first comment really makes the general point well. Beanie's Appa, who wrote the comment has got his own blog which you will find here. This is what he wrote (I agree completely with what he says).

"Wonderful post. Thank you for your words of wisdom. I'm one of those men who was cut as a baby, but I wish they hadn't done that to me. For me, there's no choice. My parents and the doctor took that from me. But for someone who wasn't cut at birth and wishes he was, he can do that stupid thing any time he feels like it."

A few days later I received a comment from TLC tugger who is in the business of helping circumcised men get back their foreskin, an honorable business indeed. You can listen to his podcast here. Apparently it is possible to restore your foreskin following circumcision using TLC's product, which amazingly does not require surgical interventions. (I am wondering whether this approach will give you back some of your sensitivity to the foreskin). TLC, having restored his own foreskin also pointed out that sex is a great deal more pleasant with the foreskin. Furthermore, TLC pointed out that only very rarely (1 case in 10,000) is there a medical reason for doing circumcision. For most problems, there are less invasive techniques available. For instance, if you have a tight foreskin, you can simply stretch it using a balloon. I am actually quite confused about peoples' readiness to pick up the knife whenever there is a problem with the penis. Surgical procedures are usually avoided until there are no other options, and for good reasons...

Concerning the supposedly positive health effects associated with male circumcision I read somewhere (I cannot remember where I read this) that the correlation between circumcision and a lower incidence of HIV would not occur even if we circumcised all males in Africa. The reason why not is really quite obvious (at least if you have ever been to an African hospital, which I have). A lot of people in Africa get HIV because a procedure is not done in sterile environments, that is, they are infected with the virus during the procedure. Furthermore, many circumcisions in Africa are not even done at a hospital. Sometimes the procedure is done with dirty and not so sharp knives (see picture), out in the nature. Man I would not want to be that baby... Maybe more sterile environments could be achieved, but I suspect that in Africa today a mass circumcision campaign would have greater costs than benefits.

Finally, just earlier today I received an email from Frank. He gave me a table with STD (sexually transmitted diseases) statistics for circumcised and non-circumcised men respectively. I found the original study in which it is shown that there are no significant differences (differences that are unlikely to be caused by chance alone) in the occurrence of sexually transmitted diseases for circumcised and non-circumcised men. In other words, to circumcise a baby will not reduce the overall risk of STDs in the future. In the study they conclude that parents should be informed about the costs and benefits associated with circumcision prior to the intervention. I agree.

Of course I am still very interested in what all of you have to say, both people who agree as well as my critics, so keep sending me comments...

Circumcision debate continues

A few weeks ago I wrote about the cruelty of male circumcision. I wrote that I am opposed to male circumcision because of the fact that the foreskin has many important functions.

Since my post some interesting posts with interesting subsequent discussions has appeared on other blogs. If you understand swedish, take a look on ergo ateism here and here, or you can also take a look at Tobias Malm's excellent blog here. In the discussions following these posts some objections to the circumcision objections appeared, that is there were some people who defended circumcision. The four main objections that I recall were.

1. People who have their foreskin cut off can have sex for a longer time without ejaculating.
2. Circumcision protects against all sorts of different diseases
3. "I am circumcised and I haven't noticed anything bad about it"
4. Sometimes circumcision need to be done for medical reasons (e.g. foreskin in too tight).

The first objection I think is a really bad one for several reasons. Without getting to concrete, I have heard from experts that sex is not just about how long the guy can do it. Furthermore, according to some studies that I have read (see my previous post for references), people who have been circumcised often suffer from too early ejaculation as well as delayed ejaculation. Doesn't sound so great if you ask me.

Concerning the second objection I actually asked the guy who claimed that circumcision protects you against all sorts of diseases whether he could be a bit more precise. He admitted that he may have overstated it a little. In fact, I am aware of only one disease which circumcision provides some marginal protection against: HIV. If circumcision provided a really good protection against HIV, then I think it might have been worth it, but that doesn't seem to be the case. Also if you are really serious about sacrificing your penis in order to get protection against disease, then why not cut off the whole thing while you are at it? Then you would really get protection!

The third objection is not a valid one either because just like I cannot know what it feels like not to have a foreskin, a person without a foreskin cannot know how life would have been like with a foreskin. It is a fact that the foreskin has many important functions, and based on that I assume that removing it will take away those functions.

To me, only the last one of the four objections above sounds reasonable, and of course I am not opposed to circumcision when it occurs for medical reasons. I mean, sometimes we need to amputate someones’ leg to save the patient, but that doesn't make it alright to saw off everyones' leg at birth (I think these two examples are actually almost perfectly analogous).

To sum up, sure there are cased in which I think circumcision is ok. If there are medical reasons why the foreskin should be removed then go ahead. I also don't mind very much if a grown man decides to remove his foreskin, I think it is stupid, but it is not my decision to make. I do have a problem when parents want to cut off the foreskin of their baby without a good reason, in fact, I think this should be prohibited.

The cruelty of male circumcision

Today it is quite unthinkable to question the cruelty of female circumcision if you are a relatively informed person. However, to my own amazement, male circumcision (see picture) is still considered by many to be perfectly justified. It must evidently be so, considering how often this surgery is performed on young naive infants.

At one point in my life I actually became a little bit ambiguous as to whether circumcision might perhaps be justified. It was last year when, during my exchange year at UCSB, I attended some highly entertaining and informative lectures on Human Sexuality taught by two very charismatic (and married) professors John Baldwin and Janice Baldwin. You can read more about the Baldwins' view on circumcision here. I am not being ironic when I say that these were indeed great lectures, and that is perhaps why they almost convinced me that the costs and benefits associated with male circumcision more or less cancels out. As far as I can remember they referred to two positive consequences associated with male circumcision. One is the supposedly improved hygiene, which by the way is one of the most common justifications that people in favor of circumcision refers to. However, bad hygiene under the foreskin is only a problem for guys who never clean under the foreskin, so if we would simply remind guys that they need to remember to clean their more private regions this would not be a big problem. In any case I hardly think that this justifies circumcision….

The other favorable effect of male circumcision, the one that made me think that perhaps it was justified, is the reduced risk of being infected with the HIV virus. A few studies of this kind have been made and the effects superficially seem quite large. However, the studies which have shown this difference have been of poor quality, with poor control. Just as an example, in one large and frequently cited study, circumcised males were given advice on sexual behavior whereas those who had not been circumcised did not get this offer. Was the lower incidence of HIV among the circumcised due to the sexual advice or the circumcision? Studies with better control i.e. studies which try to rule out alternative explanations, have found smaller effects (see here for more information). I will not go as far as to say that circumcision does not give any improved protection at all, on the contrary, I believe that there is some truth in this. Nevertheless, it seems that the effects are significantly smaller than what the original studies suggested.

The fact that there seems to be no great benefits of circumcision is however not my main problem with it. Neither do I dislike it just because it is very much entangled with religion. I think it is a good example of how religious beliefs sometimes takes the upper hand over rational arguments, but it is not the main reason why I disprove of male circumcision. So what is the main reason? The reason is that the foreskin, which is removed during a circumcision, has a lot of very important functions. I think that this is hardly surprising because if the foreskin had been completely useless or even a burden to us, natural selection would probably have taken care of it long ago. The benefits of having a foreskin are many. To name a few, the foreskin is important because it gives protection to the glans penis, it reduces friction during intercourse, it gives important feedback to our brain about the "state" of the penis, it aids erection, and it regulates the timing of the ejaculation (people who have been circumcised often either ejaculate too early or too late). You can read about these as well as other function of the foreskin on this excellent page.

However, I think that the most important function of the foreskin, and hence also the most important reason why circumcision should not be allowed, is that it brings sexual pleasure to its owner. This of course also means that lack of foreskin will result in reduced pleasure. Sex, along with drink and food and neuroscience (that last one is probably rather personal), are things that make life worth living, and taking away the pleasure associated with sex just seems rather cruel to me. Now I am not saying that circumcised people do not feel any pleasure, I would not know, all I am saying is that there is good reason to believe that they feel less pleasure.

Summing up, besides just being a nasty and invasive surgical procedure which could well cause some kind of trauma in the infant, taking away the foreskin is associated with many other disadvantages. Even if the risk of contracting HIV would be slightly reduced, this hardly justifies circumcision.