December 11, 2007, 1:01 pm The Rights of Baby Boys
Circumcision is the most common surgical procedure performed in the United States. But does it violate the human rights of baby boys?
That's the provocative question raised this month by The British Medical Journal, which published a debate between two physicians about the benefits, risks and social reasons behind circumcision. Some medical experts view circumcision as a potentially important medical intervention for stopping the spread of AIDS. Last year, a report showed that the procedure appears to reduce a man's risk of contracting AIDS from heterosexual sex by half.
Around the world, about 30 percent of men are circumcised, and most were circumcised in infancy. Circumcision is more common in English-speaking and Muslim countries. In the United States, about 70 percent of men are circumcised, although rates vary by race and ethnic group, according to a September study in PLoS One. That same study suggested circumcision rates in the United States are on the decline as parents begin to debate the medical vs. cultural reasons for seeking the procedure.
Dr. Geoff Hinchley, a British emergency doctor, notes that most circumcisions take place for religious rather than medical reasons. He also notes that circumcision continues "unchecked" in countries where other rituals, such as female circumcision and facial scarification, have been made illegal.
Dr. Hinchley notes that historically, the medical community has made many unsupported health claims to promote circumcision, including the prevention of penile cancer, masturbation, blindness and insanity. Although he acknowledges recent data showing circumcision lowers risk for H.I.V. transmission, he argues that is an issue for sexually active adults, not children. "The decision about whether to have this procedure should be left until the person is old enough to make his own informed health care choices,'' he writes. "The unpalatable truth is that logic and the rights of the child play little part in determining the acceptability of male genital mutilation in our society.''
British physician Dr. Kirsten Patrick argues that the future sexual health benefits justify parents' choices to have their sons circumcised. Dr. Patrick writes that the pain of circumcision, if done under local anesthesia, is comparable to that from an immunization shot.
She also cites evidence of medical benefit to men and women, noting that circumcised men are less likely than uncircumcised men to have human papillomavirus infection, and that male circumcision is associated with a reduced risk of cervical cancer in women with high-risk sexual partners. A large New Zealand study suggested that uncircumcised men are almost twice as likely to get a sexually transmitted infection.
But Dr. Hinchley counters with a recent study that showed the uncircumcised adult penis is more sensitive than the circumcised penis, largely because the five most sensitive areas are removed during circumcision. "This implies a reduction in future sexual sensitivity for circumcised adults,'' he notes. "Far from being a harmless traditional practice, circumcision damages young boys."
Dr. Patrick disagrees, noting that no good research has examined the long-term psychological effects of male infant circumcision. "Until a large, representative study of sound methodology examines this issue, we cannot know for sure if men who grew up without a foreskin feel that they were assaulted,'' she writes. "Only a tiny proportion of the billions of circumcised men have reported emotional distress as a result of it."
She concludes, "It is far better to help parents to find a competent operator than to force them to navigate the unregulated circumcision services alone, which increases the likelihood of harm. Circumcision is a choice that parents will make on behalf of their male children, for cultural or other reasons, and regulating its provision is the wisest course of action."
Read the full debate in The British Medical Journal here, as well as responses from BMJ readers on both sides of the issue here.
Finally, I recommend this fascinating post from my colleague John Tierney, who writes about A New Debate on Female Circumcision on the TierneyLab blog.