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Jul 02 2012

The nonexistent benefits of circumcision

Those who defend the practice of circumcision tend to fall into two camps. The first argue that to forbid it is to violate the religious freedom of the groups (mainly Jews and Muslims) who practice it. This is absurd. No one is saying that people should be forbidden from getting circumcised. What we are saying that circumcision should not be forced on anyone else. If any adult wants to get circumcised, they should be allowed to do so. But to allow parents to mutilate their babies to satisfy their own religious beliefs is simply wrong. You shouldn’t be allowed to establish your bona fides with god by mutilating your children.

The other reason given in favor of circumcision is the supposed health benefit. The one that is most touted is supposedly enhanced defense against AIDS transmission. This was never a convincing argument since babies don’t have sex. Even if it were true, people could choose for themselves to be circumcised later in life when they become sexually active.

But thanks to commenter Jeff Hess, I came across this article (via Andrew Sullivan) that debunks this whole idea of circumcision being an AIDS inhibitor, saying that is based entirely on bad science and that the supposed benefits are not only non-existent but the practice may actually increase the risk of AIDS transmission.

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  1. 1
    Raging Bee

    How the Hell did anyone get the idea that circumcision has any chance of inhibiting AIDS transmission in the first place. Has anyone even tried to describe the mehcanism by which this happens?

    No one gets AIDS by touching an infected man’s foreskin; they get it by ingesting an infected man’s bodily fluids, either by mouth, by vagina, or through tiny tears in rectal tissue that result from anal sex. What does a man’s foreskin have to do with any of this?

  2. 2
    Jaketoadie

    The way I always understood the reduced risk of transmission of AIDS was to the man. The idea being, I guess, that after sex with an infected individual the foreskin would tend to trap possibly infected fluid, while in a circumcised individual this wouldn’t happen.

    I tend to fall sort of into the second camp that Mano is talking about here. Ever since I actually started to look into it and form an opinion regarding the practice I have seen that the studies tend to show very minor health benefits, that can be almost entirely negated in uncut individuals with proper hygiene. It has always seemed to me that since proper hygiene can negate most of the benefits then the risk to the child from the procedure was not warranted.

  3. 3
    Forbidden Snowflake

    I think the claim was that the risk is smaller for a circumcised man in an insertive role, not for his sex partner.

  4. 4
    Raging Bee

    Thanks you both for your responses to my question, but none of those answers make any sense to anyone with even a basic grasp of the relevant anatomy. What fluids, exactly, is the foreskin supposed to trap? Fluids from someone else who is infected? How does that work, when the said fluids go into an orifice, not onto the foreskin, which isn’t even near any of the orifices through which infection is known to spread?

    AS bad as the cited study is, it’s almost worse that anyone could actually believe such an implausible hypothesis long enough to even organize such a study to verify it.

    I’m beginning to suspect that this whole idea of circumcision slowinng the spread of AIDS was made up by right-wing religious pond-scum, not scientists; whose main priorities are a) preventing the use of condoms, and b) justifying genital mutilation any damn way they can, regardless of facts or consequences.

  5. 5
    jaxkayaker

    Raging Bee, if I understand you correctly, by your logic a man could only ever contract the HIV virus in the receptive role. That is not the case, though I suspect the chance of infection is generally higher in the receptive role, given the greater volume of material transferred to the receiver than to the insertive partner (all else being equal).

  6. 6
    Raging Bee

    Correction noted, but I still don’t see how circumcision changes anything, for either the insertive or receptive partner.

  7. 7
    jaxkayaker

    One hypothetical mechanism might be that the foreskin would hold viral particles against the skin of the glans penis for longer, increasing the opportunity for infection through microscopic tears in the glans skin. Obviously, the evidence doesn’t support this now, but it’s not impossible.

  8. 8
    Raging Bee

    If that’s the mechanism, that’s not bloody much to go on, especially since the retention of the virus wouldn’t make much difference after those tiny tears have healed.

    Basically, what you have there is a small reduction of an alraedy-small probability of getting AIDS a certain way, and that only applies to the partner who already has the least probability of getting it. And when it comes to the most well-known and likely means of getting AIDS — receiving bodily fluids from an infected partner or from infected blood — circumcision doesn’t mean jack shit. There was no justification to even waste resources on this study, let alone on an actual mass-circumcision campaign. Looks like someone is really desperate to avoid talking about condoms.

    Tell me, did you get that mechanism you described from an actual knowledgeable party, or is it just a wild guess on your part?

  9. 9
    TGAP Dad

    From my perspective here, the pertinent point is that we discard the two studies due to their design flaws. (I am not a scientist, and I leave that battle for them.) So with that in mind, are there any well-designed epidemiological studies comparing infection rates between circumcised and uncircumcised men and their partners? I am curious about men who were circumcised as infants, and included in the study group after sexual maturity. Is it possible that these discredited studies could in fact, despite their flaws, indicate a possible effect of circumcision? Conversely, are there any data which convincingly demonstrate that circumcision performed in infancy causes lasting harm (i.e. beyond the ~1 week healing period)?

  10. 10
    jaxkayaker

    I don’t know if anyone had ever proposed a mechanism for what was a statistical observation: that circumcised men were at lower risk for contracting HIV than uncircumcised men. If that observation had been supported by additional studies and not discredited by its own poor study design, the hypothesis I related above is one I would propose for additional testing. As to knowledgeable parties, perhaps the person who didn’t understand which party in a sexual interaction was purportedly at reduced risk of contracting the infection due to the circumcision or that insertive males do receive some vaginal fluids during unprotected vaginal intercourse shouldn’t be casting aspersions.

    It wouldn’t be necessary for the viral particles to hang on until microscopic tears heal, the foreskin might simply prevent the particles from being washed or wiped away just a bit longer to allow an infectious dose to enter the tears. Alternately, the foreskin tissue itself might have been more susceptible to invasion by viral particles even without tearing.

    For the record, I never found the study convincing, but I don’t find the idea preposterous in theory. Your argument from incredulity is reminiscent of creationists who just can’t understand how the complexity of life came into being without a guiding intelligence, therefore god.

  11. 11
    Jared A

    You’re not wrong, Walter, you’re just an asshole.

  12. 12
    lorn

    Would you similarly outlaw people under 21 getting their ears pierced?

    How about hair cutting? Nobody needs to have their hair cut. There are no medical benefits that aren’t easier to obtain other ways. And it isn’t without real risks, while rare, the chances of a cut ear remains non-zero, and infections are always a risk.

    Pretty much everything you can do with a kid has some down side. And up sides are often estimated as beneficial only based upon social norms, like haircuts, wearing clothes and bathing.

    Life is risky. Kids always die, given a century or so. This is too close a call for public policy and law enforcement. FGM is, given the general air of abuse, highly questionable methodologies, and obvious damage done mentally and physically, clearly on the other side of the line.

    If you want to advocate for banning FGM, or safer circumcisions, I’m with you but borderline cases need to be left alone as long as there are larger issues.

  13. 13
    Mano Singham

    Actually, I did not allow my own daughters’ ears to be pierced until they were old enough to decide for themselves. Then one did and the other did not. Hair cutting is not irreversible bodily mutilation. It grows back

    I am not sure why you think circumcision is a close call or borderline. It seems an easy one. The only reason people do it is because parents want to indelibly mark their religious beliefs on the child. There are no benefits to the child. It is something the child can decide on becoming an adult. Why should they not decide for themselves?

  14. 14
    TGAP Dad

    Mano: I’m only addressing the motivation for circumcision you asserted in this reply. When I was born, and for some years prior and since, circumcision was nearly universal for (white) male newborns in the U.S. Most hospitals/OBs/pediatricians performed the procedure routinely, usually without specific consent unless the parents opted out. Among those opting out were those doing so for religious reasons, because they wanted this done later as a religious rite. Having showered through years of PE classes (in nearly-all-white schools) I can assure you of two things: the vast majority of penises (>98%) we’re circumcised, and there were virtually no non-Christian religions. We can speculate about how this large a majority came to be circumcised, but I am pretty confident that the motivations were NOT religious.

  15. 15
    Marcus Ranum

    Uh, yeah, the jews knew about the HIV-protective properties of circumcision 2,000 years ago and that’s why they’ve been doing it. Mighty foresightful of them.

    Why can’t people just admit that it’s all about religion and not bother lying about its supposed health benefits? Sheeesh! What’s next? “No, really, he actually liked it a lot! Baby was gurgling and waving his hands to give informed consent.”

  16. 16
    Tracey

    Actually, TGAP Dad, routine infant circumcision was started under the ridiculous delusion that it would keep a boy or man from masturbating. Kind of like the ridiculous delusion that people with epilepsy were possessed by demons. The idea was wrong, a large number of baby boys are harmed, left permanently mutilated, and even killed for a practice that has no benefit whatsoever.

  17. 17
    TGAP Dad

    Tracey,
    As I noted, I was only addressing Mano’s assertion that

    The only reason people do it is because parents want to indelibly mark their religious beliefs on the child.

    I think we can both agree that if a procedure was “routine” then Mano’s statement is proven false, yes?

    I notice you use inflammatory language describing the procedure, a’la the anti-abortion movement (“infanticide”, “partial-birth abortion”, etc.) The plain fact is that this little flap of skin will never be missed. When done in infancy, circumcision completely heals in about a week. Yeah, it’s not the best week, but it passes quickly. There are no data to indicate that circumcised adults suffer from reduced sexual functioning, or are at increased risk of anything other than feeling victimized because they are gullible enough to listen to inflammatory rhetoric on the topic. This is no more harmful than ear piercing – probably less so since newly-pierced ears become infected far more often than freshly-circumcised penises.

    What benefit does your incendiary language serve? What is the intended effect on a teenager when he hears that he has been “mutilated” against his will? Are you intending to cultivate an entire class of victims here?

    FWIW: I am not a scientist, but there exists enough evidence over and above the flawed African studies that circumcision is considered by UNAID and WHO to be an important measure to deploy in fighting the spread of AIDS.

  18. 18
    Raging Bee

    You actually think that circumcision is no more radical or destructive than ear-piercing? I don’t have to be anti-circumcision to see how totally ignorant your comparison is.

  19. 19
    Raging Bee

    When done in infancy, circumcision completely heals in about a week.

    So does a good punch in the face, a minor stab wound, and lots of unnecessary minor surgical procedures. Kids heal quickly from a lot of stuff, but that doesn’t make it right.

    There are no data to indicate that circumcised adults suffer from reduced sexual functioning…

    I’ve heard otherwise from a few sources.

  1. 20
    Hooray Germany! « Joe's Average Blog

    [...] Update: Also, just to be clear here…just in case you were wondering…there are no medical benefits to circumcision. Share this:TwitterFacebookLike this:LikeBe the first to like [...]

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