To Cut or Not To Cut: The Debate Over Circumcision

Apologies for the hiatus. I went on an out-of-country vacation and due to everything else going on leading up to it, I didn't have the opportunity to write-up posts for when I was gone. This one was actually supposed to be published on 4/20, but I didn't actually finish it, so you get it today instead.

This has come into press a lot more than I expected it to lately, so I figured it was good enough for another topic. Circumcision has been around for thousands of years. Traditionally, it was a way of distinguishing the Hebrews from everyone else, but in Western society as a whole, it has become fairly popular. In fact, in the US, we had a rate of 83% circumcision of newborn males in the 1960s. This has declined to 77% in 2010, but this is still high compared to, say, Hispanic cultures (44% of Hispanic men in America are circumcised, compared to 91% of white men), and may be more reflective of the population of the US than a change in attitudes about circumcision.

The main argument against circumcision is that it is a surgical procedure that has lifelong consequences and only serves a cosmetic function. Some will go to the point of comparing it to female genital mutilation. Others will argue only that it is an issue of informed consent, and that males should be able to make the decision for themselves when they reach a certain age. This particularly argument is usually rebutted with the fact that parents make many decisions for their children, medical or otherwise, which have more notable consequences than the presence or absence of a foreskin.

The primary argument for circumcision is that it reduces the risk of a variety of diseases, including early urinary tract infections (which can lead to renal scarring), the transmission of HIV, and the risk of penile cancer. Most of the studies looking at the transmission of HIV were done in subSaharan Africa. These studies were so compelling that they were stopped early, and demonstrated a 66% decrease in the HIV transmission rate. Granted, these studies were done in adults. But, circumcision in infant boys is generally considered to be less costly, easier to perform, and safer than adult circumcision, so if it poses such a great benefit later in life, it'd be best to do it in infancy.

It should be noted, however, that the advocates for circumcision do not claim that it reduces all sexually transmitted diseases. One study shows that there is no difference in Herpes (HSV-2) transmission in circumcised vs uncircumcised men.

Currently, physicians take a more neutral stance. The AAP states that circumcision has benefits that outweigh the risks, but that the benefits are small enough that it's up to the individual families on whether or not to do the procedure. In the past, the AAP has taken a more negative view of circumcision, claiming in the 70s that there was no medical benefit to circumcision, but not taking a stance against it. However, there are those that take a hard stance one way or the other: one compares circumcision to vaccines, believing that the benefits are so great that circumcision should be routine.

What are your thoughts on the matter?