Circumcision: cutting edge controversy in the 90s

Pros and cons

At issue here is whether the procedure is beneficial, medically unnecessary, or harmful. Unfortunately, studies are controversial and subject to individual interpretation. Advocates of the procedure cite studies showing that circumcised men have lower rates of penile cancer and AIDS. Many studies have also shown that urinary tract infections are more common in uncircumcised infants. A number of studies have documented higher rates of cervical cancer in women who have had at least one uncircumcised partner. The uncircumcised male is more prone to a buildup of smegma, which is a cheesy substance composed of dead cells and other secretions. This accumulation, which can be controlled with proper hygiene techniques, may lead to odors that are deemed aesthetically unpleasant. And on a purely practical basis, the advent of the zipper fly has caused more than one traumatic injury to an intact foreskin!

From a sociosexual point of view, there is some indication that circumcised men experience slightly higher rates of sexual activity, and that women with circumcised lovers are more likely to achieve simultaneous climax. Although circumcision is favored by women for appearance and hygiene, women report that an uncircumcised penis is easier to bring to orgasm by hand; the circumcised penis was preferred for oral sex.

When asked in a 1988 survey about their penile preferences, women said that an uncircumcised penis was "cleaner" (92%); that it looked "sexier" (90%); that it looked "cleaner to touch" (85%); and that it smelled better (55%). Even women who had uncircumcised partners preferred the look of a circumcised penis (76%). This last fact is not lost on erotic movie producers and photographers; they tend to choose men who are circumcised or uncircumcised men whose foreskin is smooth. Apparently looser, wrinkled skin lacks visual appeal.

Another study, the U.S. National Health and Social Life Survey, found that uncircumcised men were more likely to experience social dysfunction. This was slight at younger ages and became more pronounced later in life, leading to difficulties in maintaining or achieving erection. This survey also found that circumcised men tend to engage in a more elaborate set of sexual practices.

On the negative side, there are some risks associated with circumcision.

• Excessive bleeding
• . Men with hemophilia should never be circumcised.
• Injury
• . Subsequent surgery may be needed because too much or too little of the foreskin was removed, or because of injury to the penis itself. This is estimated to be a 1 in 15,000 risk.
• Death.
• In a 35 year period, 50,000,000 circumcisions were performed in the United States. Three men died. This compared with the 11,000 men who died from penile cancer, which is confined to men who are not circumcised.

The American Academy of Pediatrics Committee for the Newborn stated in 1971 that "there are no valid medical indications for circumcision." In 1975 that statement was modified to "no absolute valid", and in 1989 it was changed significantly to read that "New evidence has suggested possible medical benefits".

Understanding the controversy

Much of the circumcision controversy revolves around human rights concerns. The National Organization to Halt the Abuse and Routine Mutilation of Males (NOHARMM) has put together a video promoting the idea that circumcision causes psychological trauma. The producer, Tim Hammond, hopes that "a cultural shift will happen where we recognize and respect the right of all children to bodily integrity." Adult males who underwent circumcision in infancy have added their voices to the debate. "Forcefully restraining an infant and cutting off part of his genitals can have a very deep psychological impact on him as a man," says Ron Goldman in his book, Circumcision: The Hidden Trauma.

NOCIRC, the National Organization of Circumcision Information Resource Centers, states in its literature that it opposes "the performance of a single additional foreskin.....amputation procedure" and that the only person who may consent to medically unnecessary procedures on themselves are "individuals who have reached the age of consent." In 1989, the Declaration of the First International Symposium on Circumcision was adopted, key points of which included that:

• "Parents and guardians do not have the right to consent to the surgical removal or modification of their children's normal genitalia. Physicians and other health-care providers have a responsibility to refuse to remove or mutilate normal parts. The only person who may consent to medically unnecessary procedures upon themselves are the individuals who have reached the age of consent (adulthood), and then only after being fully informed about the risks and benefits of the procedure. Physicians who practice routine circumcisions are violating the first maxim of medical practice...."First Do No Harm". Anyone practicing genital mutilation is violating Article V of the United Nations Universal Declaration of Human Rights: "No one shall be subjected to torture or to cruel, inhuman or degrading treatment."

UNCIRC and NORM, two other anticircumcision groups, have gone so far as to advocate procedures to reverse circumcision. In The Joy of Uncircumcising, Dr. James Bigelow shows men how they can gently stretch their remaining penile skin to cover their glans. Restoration is purportedly very therapeutic for men in improving body image and self-esteem, dispelling feelings of victimization, and empowering them to make their own choices about their sexuality.

The debate about circumcision is bound to continue. If you're a parent wondering if you should circumcise your child, try to put the issue in perspective. As Ronald Poland, a Pennsylvania pediatrician, reported to the Wall St. Journal, "Compared with the other decisions you've got ahead as a parent, this is trivial. If you can't get past this one, you're in trouble."