Some thoughts on Male Circumcision

This is a blog post by Nicholas Fogelson thought would be of interest to my fellow bloggers. Although I am of the Jewish faith and have been circumcised, I thought this was a balanced discussion by fellow physician. I am interested in reading your comments and opinions on this very controversial topic.

One of the interesting things about running a semi-popular blog is that from time to time the blog community decides to take up a topic and run with it, completely without any stimulation from me. This happened recently on the Academic OB/GYN Facebook page, where a group of concerned individuals carried on a serious and passionate discussion about the merits of circumcision. As such discussions tend to be, this one was dominated by the anti-circumcision activists, with occasional interjections by those that were less concerned about the issue, including myself.
Circumcision is an interesting issue because it crosses multiple boundaries. It is a social tradition in many cultures, and in some cases considered a religious mandate. It is also an ethical issue for many, with some feeling that it is an assault on an infant with long term negative impact on their psychosocial health. For some it is just cosmetic.
As a young person, I always thought that my penis looked like penises were supposed to look. It looked like my father’s and my brother’s, and anyone else’s I had ever seen. For the most part, I was blissfully unaware that a penis could look any other way, until one day in high school when my world completely changed. I happened to see a friend’s penis we were showering after wrestling practice, and in that flash of a moment all kinds of things went through my mind. Did he have some kind of growth on his penis? Could he pee out of that thing? A few other choice thoughts. I can still remember the shock to this day. All I had ever seen looked like mine, and in that moment what I saw was foreign, revolting even. You see, from my frame of reference he looked like an alien. It took me a few minutes and SNAP! it came to me like a ton of bricks – he has a foreskin. He probably doesn’t have an alien death ray then. I can relax about that one.

Of course now I realize that I also was born with a foreskin, and at some point in early life had it cut off. Despite what was no doubt a anesthesia free surgical procedure, I have no memory of ever having had a foreskin, or of any trauma of it having been removed. It never occurred to me to miss my foreskin, but apparently others do.
I hear stories from various anti-circumcision activists about how men are traumatized by their lack of foreskin, or even that some use strange devices to try to restore their foreskin in some way. I am struck with these stories, and have one burning question – when did they start missing their foreskin? From the moment they had the capability to store long term memories, they had no foreskin. Being circumcised was their frame of reference; it was their ‘normal’. The only way they could ever ‘miss’ their foreskin would be through some outside influence that convinced them of some new ‘normal’, and that they were somehow incomplete. Some of these men express anger at their parents or doctors for circumcising them as an infant, it seems to me that this anger is misplaced. It would make far more sense for them to be angry at the person who felt the need to drive a message into one’s head they were somehow incomplete, a message without which the feeling of loss never could have occurred.
I also hear stories of how the lack of a foreskin somehow interferes with sexual pleasure. I just don’t understand how this can be verified. I can say that from a personal point of view, everything down there seems to work just fine. I also don’t notice a preponderance of Jews who do not enjoy sex. Anecdote aside, one can only know what one has, and so again, anyone that feels that their sexual pleasure was supposed to be better than what it was got that idea from some other person, not from their personal experience. There’s plenty of people with foreskins that feel like their sexual pleasure was supposed to be better as well.
My biggest question in all of this is just why? Why do people care so much about this? Its really hard to say that an infant is being victimized by the procedure. Their frame of reference is being changed, no doubt, but as that frame is changed so early in their life there will be no sense of loss unless someone feels the need to convince them of it.
One could just as easily ask ‘why circumcise?”. There are plenty of data to suggest that circumcision decreases horizontal transmission of some STDs and the rate of penile cancer, though these effects are small. The anti-circumcision folks like to act like this data doesn’t exist, but this is just their ignorance. When I first thought of writing this blog post I was going to lay all this data out, but as I now write I realize that it doesn’t really matter. Those that believe or don’t care will see the strength in the data, those that are against will call it faulty or corrupt in some way. So goes academia. In the end, circumcision is a cultural practice that is done for cultural reasons, not for medical benefit. In Jewish tradition, circumcision is done as a way of honoring the covenant between God and Abraham, a covenant which commanded that all of Abraham’s sons and male servants, and their descendants, as a mark of allegiance and agreement. Though I have Jewish heritage, I am atheist. Nonetheless, I would feel a cultural desire to circumcise my son when and if I have one.
Some of my comenters, of which there no doubt will be many, will call this stance unethical. To this I say “grow up”. We are hard pressed to find ethical principles on which all humans agree, and this is certainly not one of them. A very large part of this world feels completely fine with male circumcision, and if one doesn’t, they certainly are under no pressure to circumcise their son. This is one of the many things that we don’t all agree on.
Other commenters will say “I’m not against circumcision, I’m against forcing it on newborns.” This is the same as saying that we shouldn’t do ritual circumcision at all. That’s a perfectly fine goal if one is really against the procedure, but just state it that way. Male circumcision is a cultural rite performed on newborns. Its pretty obvious that by 18 years old, very few boys are going to choose to have their foreskins removed. Their frame of reference has already been set, and they are fine with who they are. If we did that, we would be just fine, just as we are with a large part of the population circumcised. A cultural tradition would be lost, but that would also be ok. It just wouldn’t really matter.
Other commenters will say “they are dangerous and cause complications.” This is a half-truth. By in large, they are not very dangerous. That said, like any surgical procedure, there are some small risks. There have even been babies that have died from complications of the procedure. Ultimately, it is very important that anyone doing circumcisions know what they are doing and doesn’t do them wrong.
In truth, its an issue that I don’t care a great deal about, and as such am vexed on why it matters so much to others. Sometimes when someone writes a piece on the net, they are instantly labeled as an activist for that cause. People certainly label me as an activist for delayed cord clamping, which I would deny. I just wrote an article about the topic and lots of people read it. They can make up their own mind. I just wish people would treat this issue the same way. Everyone is free to circumcise their child or not, and the boy will grow up just fine either way.

Bottom Line: Circumcision is probably the most common surgical procedure performed on men for thousands of years. For many boys the decision is made by their parents and is done for religious reasons. For others it is a matter of looking like dad and grandpa and the parents don’t want any differences in the genitals of men in the family. Others have the procedure for hygenic purposes. To circumcise or not may be a difficult decision for those who are not motivated bh religious reasons. I hope this article helps with that decision.

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One Response to “Some thoughts on Male Circumcision”

  1. Hugh7 Says:

    To Dr Fogelson:

    “It would make far more sense for them to be angry at the person who felt the need to drive a message into one’s head they were somehow incomplete, a message without which the feeling of loss never could have occurred.”

    Not a “message” which anybody needed to “drive” but a conclusion which many men come to by their own reasoning powers. Men such as these: http://www.circumstitions.com/Resent.html

    In Jewish tradition, circumcision is done as a way of honoring … a covenant which commanded that all of Abraham’s sons and male servants [be circumcised],”

    Slaves actually, and “everyone in his household”. Does that include the live-in Mexican gardner?

    “I would feel a cultural desire to circumcise my son when and if I have one.”
    A cultural desire, or anxiety about having a son with a diifferent pensi from you? (And MORE penis than you.)

    “Parents make all kinds of decisions for their children…”
    But no decision quite like this, to cut a normal, integral, healthy, functional, non-renewable part off his body.

    “I just find it odd that people give a damn about what others do in this regard.”
    How about giving a damn about fellow human beings having their bodies permanently diminished without their consent? (Who does it isn’t of any consequence – for the first half of the 20th century, doctors often did it without asking parents.) The male foreskin is the only such part it is even legal to cut off without pressing medical need. (And this lawyer argues that it is not actually legal:: http://www.youtube.com/watch?v=C6a_Xw1BDVk ) Why the anomaly? The female foreskin (clitoral prepuce) has Federal protection. Why the double standard?

    “Its pretty obvious that by 18 years old, very few boys are going to choose to have their foreskins removed.” An EXCELLENT reason for not doing it before they can choose.

    To Dr Baum:
    There is no need for any decision. In most of the developed world it isn’t offered and not considered – and not because they haven’t caught up with US medicine. English-speaking countries tried it, found it did no good and have virtually given it up. In Australia and New Zealand it’s hard to find a doctor who is willing to do it. New Zealand’s HIV rate is one of the lowest in the world.

    And “looking like dad and grandpa” is a terrible reason, if you give it a moment’s thought. See http://www.circumstitions.com/Images/looklike.gif .

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