ON THE ISSUE OF MALE CIRCUMCISION

—HUMANIST HEISENBERG

After a few months of not being able to write much I finally had an interesting conversation on Facebook that prompted this essay.  I had asked on my science page: what thing have you changed your mind about due to evidence?  Most people cited religion or global warming or nuclear technology or some other thing.  One gentleman put circumcision, which wasn’t clear what his flip was on the issue.  Needless to say I have never really thought about it, being circumcised myself, I have never known any other position.  I also had my son circumcised at the hospital after he was born; but again I never thought about it.  Doctors certainly didn’t discuss any issues about it and I went ahead just out of reflex from my own experience.  The gentleman made the argument that he was pro-circumcision because he thought science demonstrated valid reasons for the practice.  An article he gave for his argument was one on male circumcision and its relation to sexually transmitted infections (STI).  He indicated that he believed there was a higher likelihood of Sexually transmitted diseases (STDs) from being uncircumcised (MacNeily & Afshar, 2011).  Because while I did it to my son, my transition through humanism and Satanism and the idea of bodily autonomy made me somewhat regret my decisions for my son.  When I started this essay I was firmly on the ground of no you shouldn’t circumcise your child because it is against their autonomy.  So I began reading this article and others and began to have conflicting ideas about where I stood on this issue.

I find myself in the position of now challenging my beliefs based on evidence.

Here are the issues I have to address:

  1. Health benefits of the procedure vs Not
  2. Bodily autonomy of a child

In an easy ideal world these two things should coincide and bring us to an easy conclusion.  My comparison to start are things like vaccinating, we know there are health benefits to it and thus as parents we do things for our children because it’s good for them even if it hurts at the time.  No one makes the argument that vaccinating your infant is against their bodily autonomy because of the overwhelming science to the benefit.  We weigh the risks and understand that vaccinating has risks but they are far outweighed by the benefit.

So the question here is similar, are there sufficient medical benefits in a first world nation to circumcision that warrant us as parents making a life changing decision for our child in violation of what we might consider bodily autonomy?

Also let me address the issue of comparisons of female genital mutilation to male circumcision; I don’t think there is anyone in any realm of science that supports female genital mutilation.  I think that it is a false equivalent to compare female genital mutilation to male circumcision.  Yes, they are a surgical alteration of a child’s genitals but let’s be honest these are not comparable in their outcome.  I don’t want to belabor this particular issue at this point.

So what are the health benefits if any to circumcision? There is sufficient evidence from research conducted in African countries that men who are circumcised have a degree of protection against acquisition of HIV over their counterparts (Gray, Kigozi, Serwadda, 2007; Bailey, Moses, Parker, 2007; Auvert, Taljaard, Lagarde, 2005). The issue is not as overwhelmingly clear for other STIs, as there are differences between ulceration STIs and non-ulcerated STIs. There is some evidence for benefits related to Human papillomavirus (HPV) and transmission of cervical cancers as well as penile cancer.  There is also reported benefits for avoiding urinary tract infection (UTI) (Morris, Krieger, Klausner, & Rivin, 2017). So are we protecting our sons from STIs later in life by getting them circumcised? Yes and no.  Here, we are talking about a first world nation issue, not that of African countries.  Are the scientific findings worth the practice of circumcision or are we simply looking for a way to justify it and avoid other alternatives like contraception and sex education?

Getting circumcised doesn’t always demonstrate a reduced risk of contracting STIs and some forms of cancer due to HPV (Howe, 2007).  But, we have a vaccine for HPV.  If you get your child vaccinated, you immediately reduce their risk of contracting the virus or the related cancers.  Providing our children with comprehensive sex education and making sure they have access to contraception and the knowledge to use it properly, would in my guess be far more effective than any surgical procedures.  Current research on STI reduction and circumcision is predominantly focused on third world African countries where both education and contraception are deficient.

We should keep in mind the CDC and American Academy of Pediatrics (AAP) do support circumcision both scientifically and ethically.  They make their recommendation based on the Hippocratic Oath which contains the statement, “I will prevent disease whenever I can, for prevention is preferable to cure”.  Most medical groups support that given the evidence for protection from STI and urinary tract infections are worth the practice.  So if the scientific community at large supports the practice as beneficial we have to weigh that against the risks.

So we are in a border of not distorting scientific findings for our beliefs and wanting to preserve the bodily autonomy of our children.

For opposition arguments, there are comments made that it reduces future sexual pleasure, or that the procedure has risks of infection or complications.  The problem with these particular objections is that they are not necessarily backed by evidence.  Having the procedure done at the hospital as an infant does carry less risk of infection as opposed to having it done as an adult (Cathcart, 2006). There is also no evidence to suggest that there is any difference in sexual pleasure from circumcised people.  The issue of pain for the procedure is difficult to address since much of childbirth and early neonatal things involve some level of pain or discomfort for the child. There is no real evidence to support any lasting or prolonged pain or discomfort for infants who get circumcised at the hospital.

So here is my final assessment based on my research on this issue and put into context of our tenets.  If following science is paramount; there is enough compelling evidence provided and supported by the medical community that getting your son circumcised has a moral equivalent of getting them vaccinated.  There are some benefits that do outweigh the cons.  This being said, most of the benefits are rendered moot, in the face of other medical advances like the HPV vaccine, and educating your child on sexual health and contraception.

If bodily autonomy is an important issue to you then I don’t think that in the long run of your son’s health that there is any real deficit by not getting him circumcised.  There are higher risks of infection in the procedure later in life and more men who are not circumcised regret their position over their counterparts.  But these are not impediments if bodily autonomy is of particular interest to you as a parent.

After my research on this I no longer regret my decision getting my son circumcised, I feel this issue is a push between bodily autonomy and science and either decision you make as a parent is likely a good one for you and your family.  I would advise communication with your partner to decide which aspect is more important to you.

 

WORKS CITED

MacNeily, A & Afshar, K. (2011) Circumcision and non-HIV sexually transmitted infections. Canadian Urological Association Journal. 5(1): 58–59. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036761/?fbclid=IwAR3eDpRW0bxZWRpgwciJFB_A_AdHKySogZHjGLIY_an-nWSNuTWofdxezho

Gray RH, Kigozi G, Serwadda D, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomzed trial. Lancet. 2007;369:657–66.

Bailey RC, Moses S, Parker CB, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomized controlled trial. Lancet. 2007;369:643–56.

Auvert B, Taljaard D, Lagarde E, et al. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS Med. 2005;2:e298.

Morris, B; Krieger, J.; Klausner, J.; & Rivin, B. (2017) The Ethical Course Is To Recommend Infant Male Circumcision — Arguments Disparaging American Academy of Pediatrics Affirmative Policy Do Not Withstand Scrutiny.  The Journal of Law, Medicine & Ethics, (45) 647-663.

Van Howe RS. Human papillomavirus and circumcision: a meta-analysis. J Infect. 2007;54:490–6.

Cathcart, M. Nuttall, J. van der Meulen, M. Emberton, and S. E. Kenny, “Trends in Paediatric Circumcision and its Complications in England Between 1997 and 2003,” British Journal of Surgery 93 (2006): 885-890.

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