A Sensitive Subject

It seems that I have inadvertently stirred up a hornet’s nest…

A throwaway comment spread to a blog entry by Libertine on the subject of circumcision. It would seem that neither he nor I could have anticipated the relative heat of the subsequent debate. Although, I feel that some of that heat may be overrated somewhat. Certainly my input has been as always, a dispassionate analysis of the argument. There are accusations that the discussion is getting personal. I must have missed something here – I did not detect any such thing. Strongly held opinions, yes; personal comments, no. Surely we can manage to have a heated debate without falling out? It seems that Jane over at Coffee and Varnish was suitably irritated by my comments. I certainly never intended to irritate – my comments were made in the spirit of discussion, so I believe censure is inappropriate.

On the subject itself; the circumcision of infant boys, I remain implacably opposed. Various cultures have embraced the practice throughout history – from the Ancient Egyptians, through Judaism Islam and some African cultures. However, because a holy book says we should do something, it doesn’t mean that we should. Nor should we blindly do something because our parents did or their parents did. Society evolves by challenging the beliefs and traditions of the past.

While Islam and Judaism practice infant circumcision, other cultures adopted it as a transition into manhood. At least at that age, the subject is in a position to understand what is about to happen and object; difficult though that may be.The widespread practice in the United States is a more recent manifestation, but has become deeply ingrained into the culture. So much so, that a challenge leads to heated refutation and debate. Perhaps I shouldn’t be too surprised at the reaction, but, I must confess, I was. Debra S Olliver traces the history of the American relationship with circumcision to the Victorian obsession with masturbation.

“Dr. John Harvey Kellogg, a well-known fundamentalist health reformer and medical journalist (his 1888 “Plain Facts for Old and Young” included roughly 100 pages dedicated to “Secret Vice [Solitary or Self Abuse]”) who went on to create the world’s preeminent corn flake, was more direct in his approach. “A remedy for masturbation which is almost always successful in small boys is circumcision,” he wrote. “The operation should be performed by a surgeon without administering an anesthetic, as the brief pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment. In females, the author has found the application of pure carbolic acid to the clitoris an excellent means of allaying the abnormal excitement.””

My own objections to the procedure are primarily pragmatic. As is pointed out by James L. Synder, M.D, the hippocratic oath, the core of medical ethics, exhorts medical practitioners to “do no harm”. He goes on to point out:

“In the matter of circumcision of newborn males, it must be recognized that the child is normal as born, and that circumcision inflicts loss of a normal body part and leaves a scar. This is contrary to the motto of medicine which is “First, do no harm. “”

For me, this sums up both the pragmatic (it is unnecessary) and the ethical (it causes harm – even if, for the most part, it is minor).

At the root of the issue, though, given that the medical evidence does not justify the reasoning offered, is; why? I’ve never really understood this. I recall recently listening to a radio interview with a practicing Jew discussing his son’s circumcision. He talked of culture and history and being in touch with his ancestors. All good stuff – but none of it justified cutting off his son’s foreskin.

The other arguments that have been offered centre around risk to the child; cancer of the penis – or transferring cancer causing agents to the cervix, AIDS and hygiene generally. None of these stack up when examined rationally. This, again from Dr Snyder:

“Circumcision is the only surgery which is used to prevent disease. In contrast, consider that in absolute numbers over a ten-year period (1943-1953) the Danish Cancer Registry reported 251 cases of penile cancer and for the same period reported 10,000 cases of breast cancer in women. Yet, nobody seriously advocates removing the breasts of female infants to prevent this more common malignancy of breast cancer. Almost certainly such a proposal would be greeted by howls of outrage over such a mutilation of women to prevent breast cancer. Circumcision must be recognized as an equally serious mutilation of men with equally insubstantial justification for continuing the practice.”

As far as the risks of having the procedure are concerned, it is difficult to say. Dr Snyder suggests that complications are under reported and I’ve heard this from other medical practitioners. Certainly if it all goes wrong, the child will be sexually dysfunctional. I made a comment in this discussion about a balance of risks. All surgical procedures involve risk. The patient – or the patient’s guardians – must balance the risk of the procedure against the long term prognosis without it. The long term prognosis without circumcision is a normal healthy life. The risk, though small, of having it, is disfigurement. So why take a risk that is not necessary? I still don’t understand it.

At the core of this disagreement is this: A normal healthy, functioning part of an infant’s body is removed at the behest of someone else. I cannot rationalize this. And, so far, I’ve not come across a decent rationalization from the procedure’s proponents.

I’ll leave the final word to Debra Olliver who makes this amusing comparison:

If penises could walk and talk, the circumcised penis would be a suit and tie, a clean shave and a shoulder-high salute. The intact penis would be a rumpled shirt, a five o’clock shadow and a finger flipping you the bird.

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Addendum: During the course of my research, I came across some interesting reading by Dr Janet Menage MA MB ChB, on the psychological effects of circumcuision. Well worth a read.