What is the REAL effect of circumcising men?

Those who grow up in the U.S. are often surprised to find out that in many European countries almost no men are circumcised. In the U.S., where the majority of men have had the procedure performed on them, it is pretty common to hear people say that foreskin is unclean, ugly, or even unhealthy. On the other hand, Europeans tend to find the idea of circumcision bizarre. “Why would you cut off a healthy part of your body?”, they wonder. And “How would you feel about a culture that cut off their children’s ear lobes?”

Even medical experts in the U.S. and Europe can’t seem to agree about the benefits and costs. As one fairly recent paper put it:

The American Academy of Pediatrics recently released its new Technical Report and Policy Statement on male circumcision, concluding that current evidence indicates that the health benefits of newborn male circumcision outweigh the risks. The technical report is based on the scrutiny of a large number of complex scientific articles. Therefore, while striving for objectivity, the conclusions drawn by the 8 task force members reflect what these individual physicians perceived as trustworthy evidence. Seen from the outside, cultural bias reflecting the normality of nontherapeutic male circumcision in the United States seems obvious, and the report’s conclusions are different from those reached by physicians in other parts of the Western world, including Europe, Canada, and Australia. In this commentary, a different view is presented by non–US-based physicians and representatives of general medical associations and societies for pediatrics, pediatric surgery, and pediatric urology in Northern Europe. To these authors, only 1 of the arguments put forward by the American Academy of Pediatrics has some theoretical relevance in relation to infant male circumcision; namely, the possible protection against urinary tract infections in infant boys, which can easily be treated with antibiotics without tissue loss. The other claimed health benefits, including protection against HIV/AIDS, genital herpes, genital warts, and penile cancer, are questionable, weak, and likely to have little public health relevance in a Western context, and they do not represent compelling reasons for surgery before boys are old enough to decide for themselves.

When experts disagree we’re in a bind. We have little choice but to fall back on our own thinking and research to separate bias from the truth. There are, of course, many people who circumcise their children for religious reasons. For those who have no religious reason, is there any reason to do it?

It seems to me  that we can  formulate a pretty strong argument about circumcision, before we even start to dig into the evidence:  circumcision should only be performed routinely on all male infants if we can identify strong benefits to the child from doing so. That is, without a strong reason to perform the procedure, we should not do it. I conclude this for three reasons:

  1. Some of the costs of circumcision are obvious to everyone and very real (e.g. the monetary cost to parents and insurance companies, the pain inflicted on the baby, and the very occasional surgical error, maiming and death). Performing the procedure only makes sense if there are compelling positives that outweigh these well-known costs.
  2. The foreskin is a natural part of the human body, and therefore very likely promotes a useful survival or mating purpose. There have been different proposals for what this purpose might be (like keeping in moisture, protecting the penis, or increased sexual pleasure). But one can reasonably assume that foreskin is not merely a fluke, and therefore may well have some use we care about, even if we don’t know quite what that use is.  Because of this, it seems we should not remove the foreskin unless there is a pretty useful reason to do so.
  3. Since adults can elect to get circumcised, we should be careful about forcing children to get this procedure at ages where they are too young to make such a choice. If a strong general reason to circumcise children is not found, it would make sense to let each person choose whether they want that procedure when they are old enough to make such a choice.

This line of reasoning leads us to ask: is there compelling evidence that circumcision adds significant value in the form of increased health, improved sexual function, or reduced disease transmission?

Well, you can take a look at the claims and evidence yourself. Here is a table I compiled of the many, many alleged pros and alleged cons of circumcision that I’ve heard made by people on the different sides of the debate. For each claim, I try to link to some studies that support or deny that claim. I focus on meta-analyses of randomized controlled trials, and randomized controlled trials themselves, since they provide far stronger evidence than other study designs. This does not provide a comprehensive set of all studies on male circumcision of course, nor is it a formal systematic review of the literature. But some conclusions quickly emerge:

  • Some of the alleged pros and cons that people throw around have randomized controlled trials contradicting them, but continue to be used to support agendas anyway.
  • A number of studies are themselves contradicted by other studies (for instance, various results about the impact of circumcision on sexual pleasure seem to point in opposite directions).
  • Circumcision does seem to substantially reduce the rates of transmission of HIV from women to men in countries where HIV prevalence is very high.
  • Even so, it’s not obvious that this HIV reduction effect is worth it for those who practice safe sex in areas of the world where HIV prevalence is low.
  • There is some (small) amount of evidence that hints that male circumcision may make woman more at risk for HIV, but without more studies it’s hard to say.
  • Many of the studies used to support claims on both sides are of low quality (for instance, a lot of the evidence of reduced urinary tract infections for circumcised infants is based on observational studies, which are very bad for answering this sort of question…we need randomized controlled trials).
  • This topic is extremely complicated! There are tons of different claims being made and there are inconsistent research results for some of the claims. In many cases, few studies have ever been done in the first place, and even fewer high quality studies have been done (though keep in mind that this table is not anywhere close to a complete listing of all circumcision studies).

Click here for the complete table with studies that support and deny each claim.

ALLEGED Pros of Circumcision ALLEGED Cons of Circumcision
Reduction in HIV risk for men Increase in HIV risk for men (especially immediately after surgery)
Reduction in HPV risk for men Monetary cost to parents and health insurance companies
Reduction in HSV II risk for men Performed without child’s consent or ability of male to choose what he wants
Reduction in general STI risk for men Painful procedure
Reduction in penile cancer risk Gives infant permanent cultural or religious branding without consent
Reduction in Urinary Tract Infections for men Risk of surgical complications, infections and error
Reduction in penile pain and injury from sex Increase in HIV risk for women
Increased ease of orgasm for males Risk of getting STIs from circumcision procedure
due to poor sterilization (in some countries)
Increased sexual satisfaction for female partners Reduction of sexual satisfaction for female partners
Consistency with cultural norms in some areas Reduction of sensitivity or sexual satisfaction for males
Hygienic benefit when bathing is difficult (e.g. military) Loss of lubricating effect of foreskin
May make child look more like father Causes less condom use
May make child look more like peer group Increased general STD transmission to women
Psychological trauma or nervous system shock to infant
Loss of some other possible evolutionary function of the foreskin
Lessened ability to control pacing or timing of orgasm

 

5 thoughts on “What is the REAL effect of circumcising men?

  1. James Loewen says:

    Spencer Greenberg’s statement, “In the U.S., where the majority of men get the procedure” is inaccurate. In the US the foreskin amputation is forced upon infants, the men they become have no say in whether they get the “procedure.” Circumcision obviously harmful in a myriad of ways. Cultures that force genital cutting on children have endless excuses to try to justify this.

    1. Spencer Spencer says:

      You are of course correct that they do not receive the procedure as men, and of course that is not what I meant to imply. I will edit the post to say “In the U.S., where the majority of men have had the procedure performed on them”

  2. Francelle says:

    Hi Spencer. I appreciate this write-up. Just a couple quick points to add. 1) It is not just Europeans who are shocked to learn that the majority of Americans routinely circumcise. With regard to circumcision, the USA is an outlier among all the western nations. 2) To this point: “When experts disagree we’re in a bind.” Given that your blog posts are frequently to do with how to improve ones ability to detect bias, I was surprised that you made no mention of the fact that the American experts feverishly churning out posts in favor of circumcision are almost certainly engaging in motivated reasoning. While circumcision rates have fallen over the past few decades, the majority of doctors currently practicing were born at a time when the national average was much higher. Most American male doctors are circumcised and American doctors of either gender would have had their sons circumcised. Most pediatricians and obgyns would have performed circumcisions hundreds or thousands of times over. So these people have a very vested interest in NOT arriving at the conclusion that they were wrong about past actions which are both harmful and irreversible. For a country so familiar with the concept of “conflict of interest” as it relates to legal matters, it is astounding to me that circumcision is discussed among Americans as though no one has a dog in the fight, when in fact virtually everyone does.

  3. Hugh7 says:

    The table is interesting, but it has an inherent cultural bias. From a Martian perspective, or just from outside the USA, we would look first not at circumcision, but at the structure and functions of the foreskin. For example:
    http://www.circumstitions.com/Anatomy.html
    http://www.circumstitions.com/Works.html
    http://www.circumstitions.com/Functions.html
    Only after they were well understood would we look at any alleged benefits of cutting it off, and the detriments. We might look also into the cultural history of circumcision, including its endless search for a new jusitification as old ones are debunked, and the steady drizzle of vilification of the foreskin that rains down from US media.
    http://www.circumstitions.com/tv-thatthing.html
    From that point of view, circumcision gets much shorter shrift.

  4. Since the majority of the world’s men are intact and live without the dire consequences American doctors claim will occur, it seems evident that we should, at least, let a male reach the age of majority so that he can decide whether or not he is capable of washing himself (retract, rinse, and replace), have safe sex, and determine for himself the body parts he wants to keep. Circumcision of infants interferes with the maternal/infant bond, disrupts breastfeeding and normal sleep patterns, and undermines the baby’s first developmental task of establishing trust. It is where sex and violence meet for the first time and leaves both physical and psychological scars. Circumcision affects the wholeness of the hydraulic genital system of the male (see http://research.cirp.org, click on “function”) and the way the penis functions during intercourse, also affecting the partner in adverse ways. The foreskin is a normal body part that belongs to the baby. A consent form is a construct of adults to allow a violation of the rights of the baby to his own body. It is our job as parents to protect our children until they are old enough to defend and protect themselves. Circumcision is not a medical issue, it is a human rights issue. His body, his choice!

Leave a Reply