What are the pros and cons of circumcision?

[Frog march]

I have seen much debate about circumcision, on the internet, and I wondered what people here thought about it....and what the scientific evidence for and against it were.

Some babies die of complications of circumcision.1 There has been a need to assemble information concerning death from complications of circumcision in one convenient location. This page is designed to fill that need.
Deaths occur secondary to loss of blood or systemic infection from the circumcision wound.
A few deaths are reported in the medical literature. Other medical literature discusses the frequency of those deaths. A few deaths are reported in the popular press.
There is reason to believe that many deaths from circumcision are attributed to other causes. For example, if a baby were to die of meningitis that was contracted through the circumcision wound, the death may be attributed to meningitis while ignoring the fact that the baby would not have had meningitis if he had not been circumcised.

Several doctors have given estimates of the number of deaths that occur each year. Douglas Gairdner reported 16-19 actual deaths a year in England and Wales from neonatal circumcisions in the 1940s.10 Sydney Gellis believed that "there are more deaths from complications of circumcision than from cancer of the penis.11 There are various figures for the number of deaths from penile cancer ranging from 200 to 480 deaths per year. Robert Baker estimated 229 deaths per year from circumcision in the United States.

http://www.cirp.org/library/death/

personally I'm against it, and see it as an unnecessary, and dangerous, operation.

And that it is sometimes performed without anesthetic boggles the mind.

[geonuc]

16-19 deaths from circumsion in the 1940's? That was seventy years ago. Surely there are more recent data?

[alec1806]

One advantage of circumcision is the decrease in the spread of AIDS. Underneath the foreskin is an ideal place for the virus to live and be transmitted. In circumcised men, the virus is much less likely to find a place to live to be spread.

[Frog march]

The problem is that deaths indirectly due to circumcision, such as that of Dustin Evans Jr, are not attributed to it as they should be, since it is unnecessary surgery

THYMOS: Journal of Boyhood Studies, Vol. 4, No. 1, Spring 2010, 78-90

LOST BOYS: AN ESTIMATE OF U.S. CIRCUMCISION-RELATED INFANT DEATHS

- Dan Bollinger

Abstract: Baby boys can and do succumb as a result of having their foreskin removed. Circumcision-related mortality rates are not known with certainty; this study estimates the scale of this problem. This study finds that approximately 117 neonatal circumcision-related deaths (9.01/100,000) occur annually in the United States, about 1.3% of male neonatal deaths from all causes. Because infant circumcision is elective, all of these deaths are avoidable. This study also identifies reasons why accurate data on these deaths are not available, some of the obstacles to preventing these deaths, and some solutions to overcome them.

http://www.circumstitions.com/death.html

[Swift]

Please post carefully folks, this is a family-friendly board and if anything inappropriate is posted, this thread is done.

[Spoons]

It's also done for medical reasons. It can be of great benefit.

Infections are an issue worthy of great attention in any surgical procedure.

[Antice]

Circumsition is a wholly un-needed procedure in this day and age where cleanliness is the norm. almost all issues related to the foreskin can be traced back to poor hygiene. It's much better to teach children good hygiene rather than mutilate their genitals. exempting ofc those cases where there is a medical need for performing the procedure.

[Gillianren]

One advantage of circumcision is the decrease in the spread of AIDS. Underneath the foreskin is an ideal place for the virus to live and be transmitted. In circumcised men, the virus is much less likely to find a place to live to be spread.

I'd have to go check my sources, but my understanding is that the case for this is greatly exaggerated. For one thing, the virus lives in bodily fluids. Period. So if it lives in the place in question, you really have some serious sanitation issues.

[TJMac]

I remember reading about this issue a while back. Researchers had discovered in Africa that AIDS was less prevalent among men who had been circumcised, to the point that they quit the study because the researchers felt it unfair to the men who were not circumcised. (I believe that was the case.)

However, it later appeared that the research depended upon "self-reporting" from the subjects, and due to that, possibly not as accurate as originally stated.

I found a website that had some discussion. http://www.cirp.org/library/disease/HIV/

In 1982, Prakash and colleagues reported finding lytic material (lysozyme) in the sub-preputial wetness beneath the prepuce.1 Lysozyme is an enzyme secreted in human bodily fluids that acts to destroy bacteria, fungi, and other infectious agents. Bacteria are capable of producing lesions through which the HIV virus can enter the body. Lysozyme has long been known to destroy the cell walls of bacteria. Fleiss et al. have elaborated the natural protective properties of the prepuce. Compellingly, Lee-Huang and colleagues reported in 1999 that lysozyme is an effective agent for killing HIV directly in vitro.41 Hill has prepared a summary of the evidence for the hypothesis that the intact prepuce may offer a protective effect against HIV infection.

The effectiveness of lysozyme at destroying HIV in or on the body has not been tested. More research is needed to establish what direct protection, if any, is afforded by the lysozyme found in the subpreputial wetness of the anatomically complete penis as designed by nature.

Fleiss, Hodges and Van Howe describe the immunological protections that the foreskin provides against infection.29 In another review, Van Howe found that men with circumcised penises were at statistically greater risk of acquiring HIV than a man with a non-circumcised penis.32 This is consistent with the results of Dezzutti, who discovered that intact epithelium (skin and mucosa) is resistant to penetration by HIV.28 The possible role of circumcision in the high rate of HIV infection in the US needs further study.

That article tends to make me think that there is no advantage to circumcision, in fact, possibly the opposite. Is it a knee-jerk reaction to say, we were born with it, it has a purpose? Which, of course, applies to our belly buttons as well.

(I hope it is acceptable to post quotes from another site, if not, please let me know)

[kleindoofy]

First off, I hope we're speaking about male circumcision and not about female circumcision, which is nothing short of torture and mutilation.

... personally I'm against it, and see it as an unnecessary, and dangerous, operation. ...

And your personal opinion is based on what?

Are you a member of the medical community?

Is circumcision really something one is for or against when not personally involved? Is it really that important a question?

[JohnD]

First off, I hope we're speaking about male circumcision and not about female circumcision, which is nothing short of torture and mutilation.

I'm with you there, kleindoofy.
The BMJ felt strongly enough about a recent American Academy of Paediatrics suggestion that they offer a modified operation to write an editorial castigating it.
See: http://www.bmj.com/cgi/content/short..._2/c2728?rss=1 (Only the first few paras, I regret unless you subscribe, but you will feel the force!)
Now, if such an operation on females is a "fundamental violation of their human rights", where does that leave circumcision?
There would have to be some very good evidence of a very high level of protection against very common diseases (Is HIV 'common'? Pevalent, yes.) to justify a similar violation.


But Gillianren,
"the virus lives in bodily fluids. Period. So if it lives in the place in question, you really have some serious sanitation issues."
You, me, everyone, has a population of bacteria and viruses living in and on us.
Some people are 'carriers', in that they harbour organinisms that will harm other people, but which they have 'learned' to live with.
Examples abound, from good old Typhoid Mary to people with MRSA up their noses.
People with HIV on board may take many months to become sick, even without treatment.
There is no need to be 'dirty', or to have insanitary habits to pass on such an infection.
Sure, Typhoid Mary didn't wash her hands after going to the lavatory - that IS an insanitary habit in anyone but esp. a cook.
In the special circumstances of an intimate meeting, you will swap body fluids and all the bugs therein, however clean you keep yourself!
John

[Frog march]

First off, I hope we're speaking about male circumcision and not about female circumcision, which is nothing short of torture and mutilation.


And your personal opinion is based on what?

Are you a member of the medical community?

Is circumcision really something one is for or against when not personally involved? Is it really that important a question?

No, I am not a member of the medical community, but I do consider medically unnecessary circumcision unethical, in infants, for the reason I implied ie because it can lead to the death of the baby, amongst other reasons.

If you knew that someone in your town was performing tattoos on babies, and that some babies died from the procedure, would you not have an opinion on this too, or would it not matter, because you weren't personally involved?

[mugaliens]

...rather than mutilate their genitals.

This grossly inaccurate misrepresentation of circumcision is at the heart of most anti-circumcision arguements. That and wrongly labeling it "barbaric."

FrogMarch, the tatoo analogy is a non-sequitor, as there's no medically redeeming quality of obtaining a tatoo.

[Antice]

This grossly inaccurate misrepresentation of circumcision is at the heart of most anti-circumcision arguements. That and wrongly labeling it "barbaric."

FrogMarch, the tatoo analogy is a non-sequitor, as there's no medically redeeming quality of obtaining a tatoo.

And how would you accurately and objectively represent a practice performed on a non consenting infant that has no way to get a say in the matter? Let's look in the dictionary before going any further with this.

mu·ti·late (mytl-t)
tr.v. mu·ti·lat·ed, mu·ti·lat·ing, mu·ti·lates
1. To deprive of a limb or an essential part; cripple.
2. To disfigure by damaging irreparably: mutilate a statue. See Synonyms at batter1.
3. To make imperfect by excising or altering parts.
[Latin mutilre, mutilt-, from mutilus, maimed.]
muti·lation n.
muti·lative adj.
muti·lator n.

The American Heritage® Dictionary of the English Language, Fourth Edition copyright ©2000 by Houghton Mifflin Company. Updated in 2009. Published by Houghton Mifflin Company. All rights reserved.

I'd say the word fit's my meaning fairly well. Physically and permanently altering the body of anoter person without this persons consent fits the description perfectly.

It does not matter to what degree the dammage is. weither it is grossly life quality dammaging like it is for females that has been circumsized, or if it is relatively minor but still potentially life quality dammaging for males.

Any practice of involuntary physical alteration of the bodies of children for religous or cultural dogmatic reasons fits the description of barbaric imo. And that is as far as i can express my feelings on this matter without breaking the rules. if i haven't broken them already that is.

[Frog march]

FrogMarch, the tatoo analogy is a non-sequitor, as there's no medically redeeming quality of obtaining a tatoo.

well, can you say what the medically redeeming qualities of circumcision are?

anyway an analogy doesn't have to cover all the bases, does it?....maybe having a tattoo would prevent a child not being picked on in the playground, in some cultures.

[Antice]

The tatto analogy fits pretty well imho.
Unless someone is capable of scaring up a conclusive medical advantage of being circumsized then the only reasons possibly left is aestethics and cultural dogma. We in the west tend to frown upon other cultures dogma and frequently apply even more derogatory terms than barbaric to them.
well I'm not shy of frowning at even my own cultures dogma whenever it is being harmfull to others.
Relativistic ethics are too conditional upon culture for me to be able to considder it a useful ethical system. Objectivism has it's pitfalls too. But at least it allows one to see the double standards one tend to employ when allowing some practices in ones own culture to continue whilst judging other cultures similar practices as barbaric.

There are indeed cultures out there where tatooing children is normal and tied into the rituals of growing up. some cultures do even worse to their progeny. I find it hard to condone such practices on general principles. and exempting circumsition from this category of ethical standards is a blatant showing of double standards Imo.

[HenrikOlsen]

There are indeed cultures out there where tatooing children is normal and tied into the rituals of growing up. some cultures do even worse to their progeny. I find it hard to condone such practices on general principles. and exempting circumsition from this category of ethical standards is a blatant showing of double standards Imo.

The thing is that for those cultures, it is part of an initiation ritual were the endurance of the ritual is an indication of the person's willingness to become a full member of the society. Those cultures also tend to have well defined roles for people who fail at the initiation.

That infant circumcision was a practice that had real practical advantages at the time it was introduced, in the same way that not eating pig makes sense in hot countries without refrigeration, is a different matter which isn't really relevant for whether it should be acceptable now where the circumstances are very different, since without a practical purpose it really is infant genital mutilation, performed without consent.

[mugaliens]

...it really is infant genital mutilation, performed without consent.

It's no more "mutilation" than getting vaccine equates to being "run through with a sword."

mutilate: 1: to cut up or alter radically so as to make imperfect; 2: to cut off or permanently destroy a limb or essential part of: cripple. Synonym - maim. Source.

I am circumcised, yet I'm neither imperfect, nor destroyed, nor cut off, nor destroyed, nor maimed.

I am in no way, shape, or form "mutilated."

Using such terms is a severely gross overstatement of the procedure and reflects anti-circumcision sentiments, not the reality of the procedure itself.

It's as misleading as calling for a complete ban on nuclear power because Chernobyl and Three Mile Island were catastrophes.

[Antice]

Just because a procedure in most of the time does not cause severe damage does not mean that it is okay to perform it needlessly on unconsenting individuals.
I suspect that for many circumcised men this is a very emotional issue. nobody likes the idea of others maybe considering them as damaged in any way.
In most cases of circumcision the procedure is neutral and the alteration is purely cosmetic as far as function goes. These men are not damaged nor harmed in any way by the procedure. Nor would I consider them to be damaged either. These men are in the majority.
However.
I can easily point to people who are undergoing painful and expensive procedures to have their foreskin replaced or "grown back".
The mere fact that there are people who feel that they have been damaged to such a degree that they are willing to endure serious amounts of pain to have it reversed is a clear testament to the fact that some of the people who have had this procedure performed on them while infants, do indeed consider themselves damaged.
So the real ethical question is not about you personally, and the fact that you are circumcised. but rather the fact that others that also have had this procedure without their consent do suffer as a consequence of it.
The suffering of a few is in this case not counterbalanced by a benefit by the many.
Unlike with vaccines where the few may even die or worse from allergic reactions, but where the many gain the benefit of immunity against diseases that are capable of decimating entire populations.

It is important to separate between voluntary and involuntary circumcision in this debate. If you want to alter your body in any way, and if that alteration makes you happy then you are free to do so. I dare say it is your right to be able to do so as part of your right for pursuing happines.

Your allegory is false btw. nobody is clamoring for a ban on circumcision. what some of us do advocate otoh. is that involuntary circumcision should not be performed on infants. I'ts un-needed. It's potentially dangerous like all surgery, and it can lead to deep seated psychological issues later in life.

The lessons from chernobyl and TMI is not that nuclear is bad. It's that due caution must be followed. Despite these two worst case disasters the victims of nuclear power are very few. So few in fact that nuclear power (not bombs. that is another thing entirely) has fewer victims than any other power technology in existence today. And without having actually checked any numbers. probably fewer fatalities than circumcision has caused since the first nuclear power-plant was switched on.

[Gillianren]

But Gillianren,
"the virus lives in bodily fluids. Period. So if it lives in the place in question, you really have some serious sanitation issues."
You, me, everyone, has a population of bacteria and viruses living in and on us.
Some people are 'carriers', in that they harbour organinisms that will harm other people, but which they have 'learned' to live with.
Examples abound, from good old Typhoid Mary to people with MRSA up their noses.
People with HIV on board may take many months to become sick, even without treatment.
There is no need to be 'dirty', or to have insanitary habits to pass on such an infection.
Sure, Typhoid Mary didn't wash her hands after going to the lavatory - that IS an insanitary habit in anyone but esp. a cook.
In the special circumstances of an intimate meeting, you will swap body fluids and all the bugs therein, however clean you keep yourself!

Yes, I know. But the argument was that that particular location was a place for HIV to live. This particular virus only lives in bodily fluids, not just on the skin. Mary was a carrier, yes, and couldn't be convinced of it. But she's irrelevant to the discussion at hand, because the typhoid bacterium doesn't work the same way as HIV. If you just have a "pocket" of virus, that means you have a pocket of fluids there. That's just how that particular virus works.

[Antice]

If you are a HIV carrier then you have HIV. It's just not believable at all that anyone could have a pocket of fluids suitable for carrying the HIV virus around for any kind of length of time to be able to move it from one person to another without being in fact infected themselves.
I mean seriously. I cannot imagine even in my most fever induced fantasies how that is remotely possible without the owner of said genitalia being in a state that is not describable in this forum. nuff to say that the owner of said genitalia must either be dead or close to dying from other causes before this happens.

[clop]

Since it is a permanent "body modification" akin to tattooing, scarification and tongue bifurcation I would pass a law making it illegal (unless necessary for medical reasons) until the male reaches a certain minimum age (say 16 or 18) and makes the decision for himself.

clop

[JohnD]

Gillianren,
There is no "pocket" of virus, for HIV or any other virus. Sure, certain viruses favour certain tissues to grow in (Polio, rabies), but HIV inhabits the whole body, not just the sexual organs and the blood. Needlestick injury is a way of transmitting HIV, in blood. Kissing could be, but is rarely carried out with the vigour and duration of the more intimate experience, and involves tough, squamous epithelium or mouth mucosa, not the thin, easily damaged epithelium used in the latter, and the natural secretions are less.

I fear you are mistaken about "If you just have a "pocket" of virus, that means you have a pocket of fluids there."
Please explain in more detail how you think "that particular virus [HIV?] works"?
Are you confusing a virus infection with a bacterial infection causing an abcess?

John

[Gillianren]

There is no "pocket" of virus, for HIV or any other virus. Sure, certain viruses favour certain tissues to grow in (Polio, rabies), but HIV inhabits the whole body, not just the sexual organs and the blood. Needlestick injury is a way of transmitting HIV, in blood. Kissing could be, but is rarely carried out with the vigour and duration of the more intimate experience, and involves tough, squamous epithelium or mouth mucosa, not the thin, easily damaged epithelium used in the latter, and the natural secretions are less.

Which is why I keep saying "bodily fluids."

I fear you are mistaken about "If you just have a "pocket" of virus, that means you have a pocket of fluids there."
Please explain in more detail how you think "that particular virus [HIV?] works"?
Are you confusing a virus infection with a bacterial infection causing an abcess?

Someone said that "underneath the foreskin is an ideal place for the virus to live." This would indicate something more akin to bacteria, which can prefer certain warm, moist environments to just generally living on the skin. However, this is not the case for this virus. This is not possible for this virus, because it doesn't accumulate in one place in the body for preference above others. (Well, except it really does prefer blood, given its method of reproduction tends to involve T-cells.) Ergo, for the virus to live for preference underneath the foreskin, it would require having a greater amount of bodily fluids under the foreskin, a "pocket," if you will, than is anatomically possible.

[HenrikOlsen]

I fear you are mistaken about "If you just have a "pocket" of virus, that means you have a pocket of fluids there."
Please explain in more detail how you think "that particular virus [HIV?] works"?
Are you confusing a virus infection with a bacterial infection causing an abcess?

You may have misunderstood who is arguing which position.
Gillianren is arguing against the pro-circumcision propaganda that the foreskin is an ideal place for HIV, exactly because HIV doesn't live in pockets but rather in tissue/ bodily fluids, so in order for HIV to be there the person's hygiene has to be atrocious enough that pockets of bodily fluids (with the virus) are there.

[clop]

If infected fluid is allowed to dry, the HIV virus soon becomes non-viable, i.e. "dies". If infected fluid is kept moist and warm, the HIV virus can survive a few hours/days.

clop

[Jens]

I think probably the only sensible thing is to really evaluate whether there are any medical benefits and how they weigh against the risk. If the balance is negative, then stop the practice.

[mugaliens]

On one hand we have those who say the virus cannot exist by itself on the skin for any appreciable length of time. This is true. On the other hand we have those who say it can remain viable within the foreskin for an appreciable length of time. This is not true.

The virus lives only within the cell. Once outside the cell, it quickly dies. In order for it to remain alive outside the body, it must be inside a cell, and that cell must be of a type which can also remain alive for an appreciable length of time in the warm, moise environment of the foreskin.

While this warm moist environment is host to hundreds of strains of bacteria, human cells themselves do not live long in warm moist environments teeming with bacteria, unless they're directly supported by the body's circulatory system, and then only if the human cells are specifically designed to exist in warm moist environments.

There is one human fluid which is specifically well-adapted at living in warm, moist environments unsupported by a circulatory system, and it's very adept at harboring HIV. Human seminal fluid harbors far more HIV than sperm itself, if the sperm even harbors HIV at all, and it's this premise that's behind the idea of sperm washing. More to the point, AIDS is transmitted by virally-infected "Trojan horse leukocytes" in semen, not in the sperm itself, and those leukocytes are quite happy living for a time in nothing more than "warm, moist" environments.

Thus, a man having unprotected sex with multiple partners is a viable means of passing HIV from an infected partner to an uninfected one by means of seminal fluid hitchiking in the foreskin, even while dodging the infection one's self.

[clop]

What's to stop the seminal or blood-borne Trojan horse leukocytes from surviving in their media for a significant length of time in the warm moist conditions under the foreskin? You don't need many to infect someone. I'll agree though that the likelihood of infection via this route must be very small, unless the person involved is working in the sex industry.

And on the subject of cleanliness I'm reminded of a line by indignant comedian Mitch Fatel (who was circumcised without his consent as an infant) ridiculing the notion of hygiene difficulties imposed on uncircumcised men - [inappropriate humor redacted]

clop

[Gillianren]

What's to stop the seminal or blood-borne Trojan horse leukocytes from surviving in their media for a significant length of time in the warm moist conditions under the foreskin? You don't need many to infect someone. I'll agree though that the likelihood of infection via this route must be very small, unless the person involved is working in the sex industry.

Actually, my understanding is that it takes a relatively hefty viral dosage to be infected with HIV. I don't understand why, but that's what I've read. And if your blood or, um, other fluid is staying liquid for very long outside the body, regardless of its environment, that's usually the sign of a bigger health problem.