Circumcision (aka MGM, Male Genital Mutilation)
Summary: unnecessary in first world nations. It serves little to no medical purpose and all downsides can be rectified through use of a condom or vaccination.
Side note: It should go without saying that all forms of female circumcision (aka FGM) are bad.
- Brazil did a study on circumcision which found that 1.3% of the male population required circumcision for medical reasons and 0.013% of the male population died. For the US, I don’t know how many children need a procedure done, but a 2010 study said that approximately 117 (0.009%) of the male population dies as a result each year (only slightly less than Brazil). With these statistics in mind, more male babies die from circumcision than measles, suffocation, or cribs. However it's worth noting that there are studies which place the numbers lower.
- Africa, Eastern Cape: annually, approximately 6.19% of procedures end in mutilation and 10.05% end in death. Foreskins in Africa are seen as valuable in some areas and can be crushed/ground into “medicine” so it seems unlikely all circumcisions are done with the health of the person being circumcised in mind.
- This study by the World Health Organization has lots of useful information but it doesn’t seem very conclusive in regard to weighing risks vs benefits. One part says “circumcision would only have a favourable cost–benefit ratio for boys at high risk of urinary tract infection.” (p.16) Complications seem to arise in 2% of clinical procedures, but this varies by region/definition and can be as high as 55%. In non-clinical settings the rates are obviously much higher and can be above 85%. The WHO study advocates circumcision on the basis that it prevents HIV (this is irrelevant in western society since condoms do this and are widely available) and unequivocally condemns female circumcision in all forms. Other studies (see below) state that circumcision has little to no effect on preventing the spread of HIV.
- A study by Dr. Douglas Gairdner in 1949 mentioned infant mortality (16 to 200+ deaths a year) and recommended against circumcision for a number of reasons.
- Dr. John Harvey Kellogg recommended circumcision without anesthesia for teenage boys caught masturbating, as a possible deterrent against doing it in the future ("...the pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment") but did not recommend circumcision as a routine procedure for infants due to potential complications. (source)
Various sources on why circumcision should not be done:
- "Lies, Damned Lies, and Medical Science" by David H. Freedman (not specifically on circumcision but still has good information)
- http://www.bbc.co.uk/news/magazine-19072761
- http://www.biomedcentral.com/content/pdf/1471-2334-14-75.pdf
- http://www.circumstitions.com/death.html
- http://www.circinfo.com/guide_to_decision/disadvantages.html
- http://www.cirp.org/library/disease/cancer/
- http://www.cirp.org/library/general/wallerstein/
- http://www.genitalautonomy.org/mgm/
- http://www.theguardian.com/world/2010/jan/17/circumcision-zulu-south-africa-hiv
- http://www.intactamerica.org/resources/decision
- http://www.nbcnews.com/id/22096758/
- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1718533/
- http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2012.10917.x/full
- http://www.psychologytoday.com/blog/moral-landscapes/201109/myths-about-circumcision-you-likely-believe
- http://news.smh.com.au/breaking-news-national/ceremonial-circumcisions-botched-in-nt-20100111-m2kf.html
- South African Broadcasting Corporation
- https://www.youtube.com/watch?v=TY5g4fFhxWA (NSFW)
- http://hagakura.tumblr.com/post/69281387406
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Potential complications that some people say circumcision prevents:
Balanitis/Balanoposthitis
Cancer (penile human papillomavirus infection (HPV), cervical cancer, etc)
- The lowered risk of cancer largely comes from the lowered risk of HPV, which is not such a drastically lowered risk that it would be any guarantee from it - and again, the man should be having safe sex regardless. Cancer of the penis occurs in fewer than 1 in 100,000 men in the US and accounts for less than 1% of all cancer; it is also highly treatable, with 95% of tumors being readily treatable squamous cell carcinoma. If treated early, the majority of men survive it.
- The HPV vaccine is available for people of all ages and genders, so there is no reason to circumcise as long as you are inoculated against HPV.
- The tumors occur most commonly on the penile glans, followed by the foreskin. While the risk is higher in uncircumcised men, 40% of all penile cancer tumors (and not all are tested, nor is the test 100% accurate) test positive for HPV; safe sex is the only way to avoid HPV. Most instances of penile cancer occur in older men and it is directly tied to poor bodily hygiene, which is why it occurs more frequently in developing countries. Teaching your son how to clean himself and to check himself for tumors (along with checks for testicular cancer) is a much better course of action than forcefully chopping off part of his genitals and exposing him to a number of considerable risks.
- Almost as many men die from tumors on their foreskin annually, as infants die from getting their foreskins removed.
HIV
- Over 20 studies state that circumcision has no effect on preventing the spread of HIV among heterosexual or homosexual men.
- Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: Methodological, ethical and legal concerns by Gregory J Boyle and George Hill
Phimosis
- Most cases of phimosis can be corrected non-surgically by slowly stretching the skin, and cases of phimosis (that are problematic) occur in less than 1% of adult men. It's also possible to misdiagnose phimosis when it isn't actually there.
- Phimosis can be treated without circumcision and up until a mean age of ten, a male's foreskin is actually fused and phimosed; when puberty sets in then males can retract their foreskin. Phimosis doesn’t even have to be treated if the male doesn’t have any difficulties with hygiene or sex. Phimosis is natural until around the age of 3-4 years old. At the age of 5, if left untreated, it can have medical consequences.
Urinary Tract Infection (UTI)
- Only 20% of all urinary infections occur in men; about 13% of men suffer one annually. Although that may seem high, note that every infection puts you at higher risk of having another one and that your rate goes up drastically over the years, from 3% in men under 40 to 42% in men over 75. Further more, while circumcision does lower your risk of UTIs, it doesn’t do such drastically and the limited decrease in risk is likely attributed to most young boys not knowing how to properly clean under their foreskin.
- The UTI rate in girls is about ten times higher than in males and UTIs are easily avoided if you avoid retracting the foreskin prematurely. There was research out of Australia and Israel that showed susceptiblity to UTI’s increased post-circumcision.
- http://www.circinfo.org/utis.html
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A collection of various information:
Surveys have shown that the main reason people choose to circumcise in America is because the father had it done to him, and he wants the son to be like him. That’s vanity. The vast majority of medical organizations in the world with a policy on circumcision are outright against it. Including:
Swedish Pediatric Society (they outright call for a ban)
Royal Dutch Medical Association calls it a violation of human rights, and calls for a “strong policy of deterrence.” this policy has been endorsed by several other organizations:
The Netherlands Society of General Practitioners, The Netherlands Society of Youth Healthcare Physicians, The Netherlands Association of Paediatric Surgeons, The Netherlands Association of Plastic Surgeons, The Netherlands Association for Paediatric Medicine, The Netherlands Urology Association, and The Netherlands Surgeons’ Association.
College of Physicians and Surgeons of British Columbia
This procedure should be delayed to a later date when the child can make his own informed decision. Parental preference alone does not justify a non‐therapeutic procedure…. Advise parents that the current medical consensus is that routine infant male circumcision is not a recommended procedure; it is non‐therapeutic and has no medical prophylactic basis; current evidence indicates that previously‐thought prophylactic public health benefits do not out‐weigh the potential risks.…. Routine infant male circumcision does cause pain and permanent loss of healthy tissue. |
Australian Federation of Aids organizations They state that circumcision has “no role” in the HIV epidemic. The German Association of Pediatricians called for a ban recently.
The German Association of Child and Youth Doctors recently Attacked the AAP’s claims, saying the benefits they claim, including HIV reduction, are “questionable,” and that “Seen from the outside, cultural bias reflecting the normality of non-therapeutic male circumcision in the US seems obvious, and the report’s conclusions are different from those reached by doctors in other parts of the Western world, including Europe, Canada, and Australia.” (scroll to page 7 for the English translation.)
The AAP was recently attacked by the President of the British Association of Paediatric Urologists because the evidence of benefit is weak, and they are promoting "Irreversible mutilating surgery."
The College of Physicians and Surgeons of Saskatchewan has taken a position against it, saying it is harmful and will likely be considered illegal in the future, given the number of men who are angry that it was done to them and are becoming activists against it.
The President of the Saskatchewan Medical Association has said the same (link above).
The Central Union for Child Welfare “considers that circumcision of boys that violates the personal integrity of the boys is not acceptable unless it is done for medical reasons to treat an illness. The basis for the measures of a society must be an unconditional respect for the bodily integrity of an under-aged person… Circumcision can only be allowed to independent major persons, both women and men, after it has been ascertained that the person in question wants it of his or her own free will and he or she has not been subjected to pressure.”
Royal College of Surgeons of England
"The one absolute indication for circumcision is scarring of the opening of the foreskin making it non- retractable (pathological phimosis). This is unusual before five years of age."…"The parents and, when competent, the child, must be made fully aware of the implications of this operation as it is a non-reversible procedure." |
it is now widely accepted, including by the BMA, that this surgical procedure has medical and psychological risks. …. very similar arguments are also used to try and justify very harmful cultural procedures, such as female genital mutilation or ritual scarification. Furthermore, the harm of denying a person the opportunity to choose not to be circumcised must also be taken into account, together with the damage that can be done to the individual’s relationship with his parents and the medical profession if he feels harmed by the procedure. …. parental preference alone is not sufficient justification for performing a surgical procedure on a child. …. The BMA considers that the evidence concerning health benefit from non-therapeutic circumcision is insufficient for this alone to be a justification for doing it. |
Australian Medical Association Has a policy of discouraging it, ad says “The Australian College of Paediatrics should continue to discourage the practice of circumcision in newborns.”
Australian College of Paediatrics:
"The possibility that routine circumcision may contravene human rights has been raised because circumcision is performed on a minor and is without proven medical benefit. Whether these legal concerns are valid will probably only be known if the matter is determined in a court of law …..Neonatal male circumcision has no medical indication. It is a traumatic procedure performed without anaesthesia to remove a normal and healthy prepuce.”|
Royal Australasian College of Physicians
Some men strongly resent having been circumcised as infants. There has been increasing interest in this problem, evidenced by the number of surgical and non-surgical techniques for recreation of the foreskin.|
On that note, 74% of Australian doctors overall believe circumcision should not be offered, and 51% consider it abuse. Circumcision used to be common in Australia, but the movement against it spread faster there than America, where rates continue to drop.
Royal Australasian College of Surgeons I like this one especially. It’s a detailed evaluation of the arguments in favor of circumcision, They note that during one of the recent trials in Africa, the researchers claimed there was no loss of sexual satisfaction, when in fact there was. But the RACS called them out:
“Despite uncircumcised men reporting greater sexual satisfaction, which was statistically significant, Kigozi et al (2008) concluded that adult male circumcision does not adversely affect sexual satisfaction or clinically significant function in men.” In general, they discuss how there’s no evidence to support circumcision.
The Norwegian Council of Medical Ethics states that ritual circumcision of boys is not consistent with important principles of medical ethics, that it is without medical value, and should not be paid for with public funds.
The Norwegian Children’s Ombudsman is opposed as well.
The Denmark National Council for Children is also opposed.
And recently, the politically appointed Health minister of Norway opposed a ban on circumcision, yet the ban was supported by the Norwegian Medical Association, the Norwegian Nurses Organization, the Norwegian Ombudsman for Children, and the University of Oslo.
Swedish Association for Sexuality Education published this guide that talks about circumcision in a pretty negative way. Not an official policy but it makes things fairly clear. it also mentions the frenulum is sexually sensitive, and helps prevent infection by blocking fluid from the urethra; the frenulum is often removed in an infant circumcision, yet easier to leave intact if an adult is circumcised.
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A list of medical literature showing some dangers of circumcision:
Significant harm to male sexual ability and satisfaction after circumcision
Circumcision decreases penile sensitivity
Circumcision associated with sexual difficulties
Circumcision linked to alexithymia
The exaggeration of the benefits of circumcision in regards to HIV/AIDS transmission
Circumcision/HIV claims are based on insufficient evidence
Circumcision decreases sexual pleasure
Circumcision decreases efficiency of nerve response in the glans of the penis
Circumcision policy is influenced by psychosocial factors rather than alleged health benefits
Circumcision linked to pain, trauma, and psychosexual sequelae
Circumcision results in significant loss of erogenous tissue
Circumcision has negligible benefit
Neonatal circumcision linked to pain and trauma
Circumcision may lead to need for increased care and medical attention in the first 3 years of life
Circumcision linked to psychological trauma
Circumcision may lead to abnormal brain development and subsequent deviations in behavior
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These are the only semi-legitimate reasons for circumcision:
- MAYBE prevents HIV sometimes in some third-world countries
- Faster to clean the penis by a couple of seconds
- Religious tradition - although there's some Jewish, Muslim, and Islamic (nsfw link) opposition.
Meanwhile countless men die from circumcision around the world every year (infection, medical error, etc) and most medical professionals do not recommend the procedure.
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Some of this information is from links posted by other Tumblr users such as mister-krampus and oratorasaurus.
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