Ezra Klein: Men and Circumcision

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June 22, 2007

Men and Circumcision

This report has a very small sample size (five), but it suggests that men circumcised as adults report significant decreases in sexual pleasure.

Update: This study (via) shows a very subtle difference, and not all in one direction:

Category scores for responders with the same sexual partner before and after circumcision (30 men):
Erectile function 12.3 11.1
Penile sensitivity 10.1 9.4
Sexual activity 9.8 10.1
Satisfaction 11.2 12.3

So function and sensitivity are both slightly down, but general satisfaction and activity are both up.

Of the responders 47% reported that sex was physically more pleasurable and 47% also said that their sex lives were more satisfying after circumcision. Additional comments included improved penis cleanliness and easier voiding after circumcision. When asked generally about benefits and harms, 50% reported a perceived benefit or improvement, and 38% reported a perceived problem or difficulty as a result of the procedure. Overall, 62% of men were satisfied with having been circumcised.

Plus: "In a survey of college women 87% expressed preference for pictures of circumcised over uncircumcised penises."

Take that, Sanchez.

June 22, 2007 | Permalink

Comments

Very first sentence of the report:

Five men underwent circumcision in adulthood for reasons of infection, inflammation, or phimosis.

How many for phimosis? It doesn't say. That itself would mean that a man, before circumcision, were probably not getting much happiness from sex, especially if it was actually the reason he got circumcised. I've considered being circumcised myself because the phimosis means I can't have sex without a condom - it hurts too much when the skin is forced back and forth.

In general, the fact that these were 5 men who were all circumcised for MEDICAL REASONS means that we shouldn't compare their experiences before and after; they were not representative of most uncircumcised men if they actually had to be circumcised because of medical problems. It would have been far better to compare the experiences of men who got circumcised without having experienced any medical problem with the foreskin - like those who did it when converting to Judaism.

Posted by: George Washington | Jun 22, 2007 3:02:48 PM

Phimosis? Oooh, so that's what that condition is called! I had forgotten the name. Thanks.

Overall, let me say that I much prefer the previous post on this study.

Posted by: NotNormallyAnon | Jun 22, 2007 3:22:51 PM

The second study you link has a sample size of 123. That's not exactly impressive. Also, following up on our founding father's comment above, I notice that "Indications for circumcision included phimosis in 64% of cases, balanitis in 17%, condyloma in 10%, redundant foreskin in 9% and elective in 7%." So the vast majority of these men were getting circumcised for medical reasons; only 7% - maybe 16% if throw in the nebulous-sounding "redundant foreskin" - got circumcised for elective or cosmetic reasons. Given that the vast majority of this small sample got this procedure to improve preexisting medical conditions, it's no real surprise that they were largely pleased with the outcome. What we're talking about, however, is the wisdom of routinely circumcising male infants for cosmetic purposes, and this data doesn't begin to address that.

By the way: the "survey of college women" you mentioned was this survey, conducted in 1976, with a sample size of 55 women. There's no way that data could possibly be shoddy or out of date!

Posted by: Christmas | Jun 22, 2007 3:22:52 PM

Something not considered in these before-and-after studies of men circumcised in adulthood is that being circumcised in infancy vs. adulthood are not at all the same situations neurologically or behaviorally. The infant's brain will organize around whatever nerve endings are present after the circumcision, and through puberty and adolescence the circumcised boy will learn how to stimulate the penis he's got for successful sexual behavior. A man circumcised as an adult has neither advantage; after his entire nervous system is organized to use a penis with a foreskin, and then he suddenly doesn't have one. Small wonder that he might experience less sexual satisfaction. It's impressive that the post-operative satisfaction measures aren't much lower than reported here.

Posted by: cerebrocrat | Jun 22, 2007 3:36:37 PM

It strikes me that getting reliable data on this will be particularly daunting, since anti-circumcision advocates have an ax to grind and the medical establishment, that has been signing off on the practice for decades, has no incentive to prove themselves wrong.

Besides, isn't this a topic more suited to grade school boy's rooms and Scout camping trips?

Ezra, as long as your "significant other" is happy, who cares?

Posted by: W.B. Reeves | Jun 22, 2007 3:52:42 PM

Agreed - it always amazes me how worked up people get about a subject that, per individual case, doesn't seem to be especially consequential.

Posted by: cerebrocrat | Jun 22, 2007 4:02:57 PM

the medical establishment, that has been signing off on the practice for decades,

The American Academy of Pediatrics doesn't recommend it, even discouraging the practice.

Posted by: Stephen | Jun 22, 2007 4:44:38 PM

"Ezra, as long as your "significant other" is happy, who cares?"

It's Friday. And I don't want to think about health policy...

Posted by: Ezra | Jun 22, 2007 5:12:42 PM

But this is health policy. Sort of.

Posted by: Sanpete | Jun 22, 2007 5:15:46 PM

best circumcision joke ever....

there once was a mo'el, (rabbi who performs circumcisions)and he had the finest and most beautiful, but magical,leather briefcase...
it was a great mystery, but everytime someone rubbed the briefcase, it got bigger!!!!

(sorry, but i love to share my circumcision joke!! haha)

Posted by: jacqueline | Jun 22, 2007 5:17:12 PM

I chose to be circumcised when I was in my mid-20s purely for aesthetic reasons. I'm in my mid-40s now and there is less sensitivity, but I don't find this to be a bad thing. Prior to circumcision, the glans area was almost too sensitive, and could be uncomfortable in certain sexual situations (e.g. oral sex). The too tender feeling is gone, but the sensations of a build up to orgasm and orgasm itself haven't changed. The real upside was the loss of self-consciousness in the locker room and in the bedroom. I was the only boy I knew growing up that wasn't circumcised and that was difficult at times. I also object to Andrew Sullivan's use of the term 'genital mutilation" which conflates the practice of male circumcision with female circumcision. Women are actually mutilated when the female equivalent of the glans penis is lopped off. There is no equivalency between the two practices.

Posted by: anon | Jun 22, 2007 5:31:38 PM

i think that circumcision is a barbaric and awful practice. snipping the skin on a brand new, little baby...after the trauma they have just endured coming into the world, and then subjecting them to that.
...babies should be hidden away in warm, loving arms, near a heartbeat and milky breast...not enduring exquisite pain.
what a way to be introduced to life on earth.
it figures, though...doesnt it.
awful awful awful

Posted by: jacqueline | Jun 22, 2007 5:35:32 PM

Hey, if adult men want to get it clipped, more power to them, but I would have preferred to have the choice. Not that I'm bitter, or anything. But I really can't see any legitimate reason for taking that choice away from a man by circumcision as an infant.

Posted by: Glenn | Jun 22, 2007 5:46:05 PM

Ezra, you missed a very important study, recently released, which found significant reduction in sexual satisfaction after adult circumcision:

The Effect Of Male Circumcision On Sexuality

The entire study in pdf form can be found here.

Those interested in the effects of circumcision on males should also read Sorrells. Released three months ago, it found that circumcision removes the most sensitive areas of the male sex organ.

Circumcision is insidious because its harms are difficult to detect and admit to by many of those affected by it, who have no other basis for comparison. Very few males would ever choose this for themselves. We must stop inflicting it upon infants.

Posted by: respect | Jun 22, 2007 6:05:17 PM

I'm not an anti-circumcision "advocate" with an "ax to grind" per se, but I think it's really damn weird that in America it's considered not only perfectly normal, but the default, to surgically remove part of a male infant's penis for no medical reason. Given that this is generally done to infants incapable of consenting to a life-altering procedure with the small but very real possibility of infection and permanent mutilation, I really don't see how it can be justified. Even putting aside loss of sensitivity, there are kids whose penises are destroyed in botched circumcisions and have to undergo sexual reassignment surgery, long before they're even capable of forming coherent thoughts, much less consenting to a dangerous elective medical procedure. Would anyone think this sort of thing wasn't insane if everybody wasn't already doing it out of habit?

Posted by: Christmas | Jun 22, 2007 6:07:05 PM

Maybe this convo need to be nipped in the bud, so to speak.

I was clipped as an infant, but I'm really sensitive enough, thank you very much.

I think cerebrocrat has it right: if its going to be done, the pain as an infant seems very minor compared to the weeks/months of agony as an adult (I've known adult men who were cut, and they really suffered), with likely only minor sensitivity damage later in life.

The argument that the baby doesn't consent is bogus. He doesn't get to make any medical decisions until legally of age (vacinations, tonsilectomies, etc.)

There ARE serious health complications from not circumsizing, the most serious being HIV disease, but the condyloma's referred to above are HPV warts which are highly contagious.

That said, there's no skin off my.... so I just should let parents do what they believe is best. This is a message brought to you by "Family Values".

Posted by: JimPortlandOR | Jun 22, 2007 6:53:43 PM

if i were a man thinking of converting to judaism, and required a circumcision, i would spend some serious time rethinking the virtues of buddhism.

Posted by: jacqueline | Jun 22, 2007 7:16:29 PM

There ARE serious health complications from not circumsizing, the most serious being HIV disease, but the condyloma's referred to above are HPV warts which are highly contagious.

Good thing we have these things called condoms, which are far more effective at preventing disease transmission than circumcision.

Posted by: Christmas | Jun 22, 2007 7:31:08 PM

The argument that the baby doesn't consent is bogus. He doesn't get to make any medical decisions until legally of age (vacinations, tonsilectomies, etc.)

But there are legitimate medical reasons to get vaccinations. There are no such justifications for circumcision. The American Academy of Pediatrics doesn't recommend routine neonatal circumcision and hasn't for years, specifically on the grounds that the health benefits of circumcision aren't enough to warrant such a policy. When you contrast this with the mainstream medical consensus regarding, say, measles immunizations, it becomes pretty clear that circumcision isn't considered a medical priority by doctors. And I don't think it's considered such by parents, either - parents who get their kids circumcised do so for aesthetic/cosmetic reasons, not because they want to spare their kids the hassle of bathing regularly and buying condoms.

Posted by: Christmas | Jun 22, 2007 7:39:31 PM

JimPortlandOR,

I am truly baffled that you ascribe considerable importance when adults choose a circumcision and "really suffer," yet apparently have no sympathy for the real suffering of newborns. Adults also have better anesthesia, and foreskins which need not be ripped from the glans to which they are still attached.

The "I don't remember mine" justification rings hollow, unless applied consistently. What other infant amputations are acceptable, so long as the patient doesn't consciously remember the surgery?

Your beliefs about supposed risks of being a normal male without any genital modifications are unfounded. There is no epidemic of foreskin-related disease, despite the majority of males worldwide remaining gentially intact.

Family Values include recognizing that your son's sex organ belongs to your son, not to the family. Only he has any business reducing it.

Posted by: respect | Jun 22, 2007 7:52:42 PM

Plus: "In a survey of college women 87% expressed preference for pictures of circumcised over uncircumcised penises

Those are pictures. Foreskin just doesn't photograph well.

Posted by: McG | Jun 22, 2007 9:35:26 PM

Christmas: I'm not arguing the case for compulsory circumcision, but there are now medical reasons not recognized earlier for parents making the choice to circumsize. The data on HIV transmissibility in the cut/uncut cases was only available with the last year or so, and the situation on HPV-related warts is a result of recent trends to more sexual intimacy of all kinds among younger people. So there now IS medical evidence.

Condoms should be the norm in non-exclusive sex relations. But people don't always use them, or occasionally are non-conforming in exclusivity, particularly for oral and other non-insertive sex - but the danger of transmission of disease is present in all cases, and all reasonable means to reduce transmission are a very good idea.

So the recommendations made by professional societies in earlier decades needs to be reviewed and perhaps modified. If I was a new parent, I'd sure consider recent data that make earlier recommendations questionable.

As to the question of pain: Of course I don't remember this. But thousands of years of practice of circumsizing among certain religious/ethnic groups would seem to confirm that the period/depth of pain for the baby is not prolonged or traumatic as it is in adults. In fact, many ethnic groups do this prior to puberty as a rite of passage. Whether this is medically advisable, now, or not, is not something I cannot provide - I'm not an expert.

I have said that parents should choose, based on current information - and I believe MDs have a responsibility to present balanced information that is needed for decision.

I don't believe that 'group think' in favor of the practice (especially here in the US) should be replaced by the same pressure against it.

In a choice between a questionable pleasure difference versus a non-trivial probability of disease that can be fatal or life-long, it seems obvious that disease prevention should be weighted higher.

Posted by: JimPortlandOR | Jun 22, 2007 9:59:45 PM

JimPortlandOR,

Evidence of potential benefits don't even outweigh the known risks of circumcision, much less rise to the level of justifying a sexual amputation.

The disease prevention meme that you're employing is without merit. Identical evidence would never be accepted to justify amputation of any other body part without consent.

Posted by: respect | Jun 22, 2007 10:11:31 PM

Helmet v anteater?

Wow,I haven't heard so much talk about the relative virtues of H v A since Jr. High and while in grad school, when I waitered with my old buddy, Bobby D, a former ballet dancer and self professed connoisseur of c--k. That boy could describe either variation in such florid, loving, titillating detail that it could almost make me, a rather dedicated artisan of the straight team, wonder if I was really missing out on something...big!

What I can tell you via old Bobby D. is that among your average Apple Pie lovin, American gay males, anteaters appear to be preferred. A different aesthetic and according to BD, an illusion of an additional 2 inches. Which can make all the difference in the proper circs...

Posted by: thepersianslipper | Jun 23, 2007 12:27:08 AM

So, Jim, are you suggesting that because the infant cannot remember what pain they feel when they're older...causing them pain is hunky dory? Do we have any way of measuring how much pain an infant actually feels during and after being circumsized, and for how long? Any data to back up your rather glib response to what, if it were being done to any other body part of an infant, would cause massive outrage?

I mean..why not chop off a toe? He'll heal, and he won't remember it. Or tattoo him? He won't remember that either. I mean, weeks-old infants don't remember anything later, so let's do what we want to them!

I have no sympathy...none..for the idea that an adult's having to deal with circumcision pain justifies harming him as an infant instead. Adults also have painkillers, and rational brains to understand what's happening to them. And if the surgeons giving them this procedure cause them so much pain, then perhaps the procedure should be improved.

I have an uncut son. If he, as an adult, truly wants a circumcision, he will have that option. And it will be his choice, not mine or his father's.

Posted by: emjaybee | Jun 23, 2007 12:43:21 AM

Barbaric stuff, this practice of slicing off an infant's foreskin without his consent and usually without anaesthesia. Baby boys are typically strapped down on a cross-shaped board, called a circ board, with arms and legs outstretched in a very unbabylike arrangement. They scream in terror at that alone. Many infants, when the skin is cut, scream loud and hard enough they almost lose their breath; some vomit and go silent; some continue to sob quietly long after the initial shock of the pain. They suffer.

This is how we want a baby's neurology to begin its existence and growth: building on a traumatic event of extreme fear and physical restraint followed by excruciating pain inflicted on one of the most sensitive areas of his body?

It's madness. And I can't get my head around it.

When my first son was born in 1992, I had to tell them twenty times no, no, no circumcising. I was told, Oh, sorry, it's just that most American moms have their boys "done". As though I just were being weird and difficult and foreign. By the time Son Three came along (1999), opting-out was more commonplace.

I truly believe that most (if not all) parents, were they to see the procedure as it's performed in hospitals (or at the very least have it clearly and honestly explained to them in terms of what will actually be done to their son after he's whisked away, out of sight), would choose to let their boys decide for themselves what to do with their own bodies.

Posted by: litbrit | Jun 23, 2007 10:42:31 AM

I truly believe that most (if not all) parents, were they to see the procedure as it's performed in hospitals...

When my mom was in nursing school and saw some circs done, she went home crying & apologized to my brother for having allowed it to be done to him. I'm a bit surprised that he was done at birth, actually, because he was a 33/34 week preemie, and at least these days they'd consider it too risky wrt blood clotting, etc.

Posted by: latts | Jun 23, 2007 12:04:09 PM

Okay, I was hoping that I wouldn't have to bring this up but when I see words like "barbaric" being tossed around, I think it's time to remind folks that they are talking about something that is a religious practice to a sizable segment of our population. You might want to reconsider the implications of your language.

Litbrit, I don't care for the role of smartass all that much but considering your vivid discription of the horrors of infant circumcision I have to ask. How is it you came to observe this process since none of your boys have undergone the procedure?

I also think it's worth pointing out that far more extreme forms of "amputation" have been left to the judgement of parents of infants as a matter of course. Sexual reassignment for example, or the separation of conjoined twins. In the latter case, even when such separation is likely to result in the death of one of the infants.

Posted by: W.B. Reeves | Jun 23, 2007 1:08:20 PM

being jewish, i know that circumcision is a sacred rite of initiation, and i still think it is a barbaric custom, and a form of mutilation.
...mutilation is not permitted in the jewish religion.in fact, if you choose to receive a tattoo, i believe it prohibits you from burial in a jewish cemetary.
even the biting of nails was supposedly forbidden after the death of moses, as it was a form of intended punishment to the body.
...and then we come upon the rite of circumcision...
.....the first weeks of an infant's life should be filled with as much warmth, tranquility and protection as possible.
...what a way to be greeted by the world...for a little baby boy to have a part of his penis lopped off..and in a jewish circumcision, there isnt even anaesthesia...just a little wine on the lips.
....it makes me cringe just thinking about it.
i think it is a horrible custom.
i dont really know what the health benefits are for circumcision, but i think most of the time, it it aint broke, dont fix it.

Posted by: jacqueline | Jun 23, 2007 1:55:26 PM

Plus: "In a survey of college women 87% expressed preference for pictures of circumcised over uncircumcised penises."

Ironically, although this might seem like evidence that there are aesthetic benefits to circumcision, one imagines that this very same fact is what motivates the vigorous anti-circumcision lobby. After all, if you were uncircumcised, you'd have an interest in altering people's perceptions!

Posted by: Greg | Jun 23, 2007 3:45:00 PM

With regard to sexual satisfaction, I would say that one thing is being overlooked in this discussion: masturbation. Being uncircumcised makes it much easier to masturbate. The foreskin is self-lubricating, so there's no need for things like saliva or lotion or any artificial lubricants.

Posted by: Greg | Jun 23, 2007 4:32:27 PM

I don't know if circumcision is a good idea on balance, but I take cerebrocrat's point seriously, that putting off the decision is to leave the child without the same options, because getting circumcised as an adult doesn't allow for the same possibilities as being circumcised as a baby. You could let boys decide when they're ten or something, but that will be far more traumatic physically and psychologically. In practice, parents have to decide on behalf of their baby boys, with their best interests at heart.

If there's a problem with the way babies are circumcised, then the operation can be performed differently. But no one who observes a typical baby, circumcised or not, can long believe that there's an option of life with no pain for most babies. Most babies will sometimes have what apparently affects them as great, completely overwhelming pain no matter what, and circumcised babies I've seen don't seem any more in pain than others afterwards.

Posted by: Sanpete | Jun 23, 2007 4:39:25 PM

sanpete....
that is an interesting thought there...
"most babies will sometimes have what apparently affects them as great, completely overwhelming pain no matter what, and circumcised babies i've seen dont seem any more in pain than others afterwards."

is your first statement a justification for minimizing the pain of circumcision? all people eventually experience completely overwhelming pain, does that mean it should happen, or that it is a good thing?
.........second, there is an overwhelming school of thought that seems to feel that babies or children "bounce back" more easily than adults from trauma.
i have never understood why anyone would think that.
so often, when children endure terrible or difficult things, people say, "oh, they will get over it, they are still young."
what does that mean?
that they are not more impressionable, more deeply injured by a new feeling of suffering that they have never experienced before?
personally, i think those stored and stuffed early experiences dont vanish, they help to build permanently traumatized adults...especially if the pain cannot be articulated or addressed.
.....and lastly, just because a baby who has just been circumcised doesnt seem in any more pain than one who hasnt been...well, who really knows.
.....mostly after a circumcision, babies seem to fall asleep...probably as a way to recover from the trauma.
...but perhaps pain just registers for them as an acute, traumatic sensation that affects the nervous system, and stores a bright red memory and a first lesson that scary things happen in this new place, and one often has little or no control over them.
...and that seems to be a good description at least in part for this new place they have arrived at.
why cant we at least try to protect infants and very young children from the traumas and separations and sadnesses that are somewhat elective?

Posted by: jacqueline | Jun 23, 2007 5:49:50 PM

Jacqueline, if circumcision is done it ought to be performed in as pain- and trauma-free a way as possible. That it causes pain, though, doesn't seem a very strong reason not to do it in comparison with the other issues involved. I think we can tell pretty well when a baby is in pain; I see no reason after millennia of observation and centuries of research to suspect that babies don't show traumatic pain when they have it. Normal babies seem very proficient at registering pain in any circumstance where they would be expected to have it.

Posted by: Sanpete | Jun 23, 2007 6:04:29 PM

Sanpete,

There are several problems with giving serious credence to the argument that letting males decide for themselves actually deprives them of one particular outcome, namely, having been circumcised since a few days of age.

The most serious flaw with that argument is the extreme imbalance.

Circumcision at birth means that if that person turns out to value having a whole body, he's completely out of luck, left feeling and being actually violated and deprived of choice, and stuck forever without the sexual function and sensation as provided by nature. That's an extremely high price.

On the other hand, letting males choose the fate of their own body, it's well known that only a very small number choose circumcision. Those few will have the satisfaction of exercising free will to balance against any surgical discomfort. Furthermore, they can have anesthesia, and their prepuce needn't be ripped apart from the glans penis.

Another problem is that the same logic cannot be applied consistently to removal of other body parts, thus exposing a double-standard. One could say that a person who didn't get their earlobes removed at birth has, if later in life they choose it, been deprived of having to live so long with earlobes. But that's ridiculous. The way nature made you is the only sensible default. If it makes no sense when applied to every other body part, you know it's not a good argument.

The only kind of argument that can justify infant circumcision is one that would justify removing any other body part, namely, a very serious medical or public health necessity.

Imagine a scale from 0 to 9.

0 - No proven net health benefit
...
9 - Proven health benefit enough to justify prophylactic amputation without consent

Infant circumcision is not even above 0. Not a single medical association claims circumcision to have potential benefits which even exceed the known risks of the surgery. Not even one.

Non-therapeutic circumcision is a serious blight on the medical profession. When boys grow up missing a part of their body, the physician who caused that condition for no medical need should be held financially liable.

Posted by: respect | Jun 23, 2007 7:26:24 PM

I don't care for the role of smartass all that much but considering your vivid discription of the horrors of infant circumcision I have to ask. How is it you came to observe this process since none of your boys have undergone the procedure?

W.B.Reeves, I learned about the procedure in graphic detail from various among the multiple-trunkloads of books I checked out from the library when I found out we were expecting our first. I spoke to a family friend who's an OB, as well as my own labor/delivery nurse; both confirmed that yes, that's exactly how it is.

It has been fifteen years, and I don't recall the titles of the various library books--all I had in the way of research materials back then. If my first pregnancy had taken place a few years later, I'd have simply gone online and found any number of resources--pro, con, and straightforward medical abstracts--learning therefrom essentially the same thing. Google away if you still think what I described is a mere figment of my imagination.

Even if general anesthesia had been offered (it wasn't, and isn't still, not routinely), we'd have made the same decision, three times over; I would have felt the same way about the ethics of surgically altering my child's body without his permission when no medical necessity existed. That said, I hope parents who do choose to circumcise their sons--for religious or whatever purposes--research the matter well and request pain relief on behalf of the infant who can't ask for it himself.

Incidentally, the separation of conjoined twins is done for medical necessity, as defined by the children's parents and team of doctors and weighed against the obvious and formidable risks; it is not exercised as a religious rite or because most Moms have their sons done. Of course parents sometimes choose surgery for a child when there are substantial and often lifesaving benefits to be gained, which is simply not the case in the vast majority of circumcisions.

Posted by: litbrit | Jun 23, 2007 7:53:17 PM

Respect, I don't think you read cerebrocrat's post, which isn't about avoiding pain as an adult. If there's no good reason to do circumcisions, then we shouldn't do them. I've seen conflicting views on that, and make no claims about it. But it's misleading to claim that the decision can be made by the male as an adult: it won't really be the same decision at all.

Posted by: Sanpete | Jun 23, 2007 9:04:53 PM

Ezra,

Plus: "In a survey of college women 87% expressed preference for pictures of circumcised over uncircumcised penises."

This matters why? What's the percentage of college men who express a preference for pictures of large-breasted women over small-breasted women? We wouldn't start giving our daughters breast implants to fit the assumed preference of their future sexual partners.

JimPortlandOR,

You wrote a lot I disagree with, but much of that's been challenged. I'd like to mention the "non-trivial probability of disease" directly. That's simply not true, unless you want to be consistent and apply that thought process to anything that might go wrong with a child's body. What other preventive surgeries would you suggest we do to all children before anything goes wrong?

You probably only apply it exclusively to the foreskin, though. So, facts: A 50% reduction in the risk of HIV is not the same as the actual, small absolute risk of HIV, for example, with or without the foreskin. Same thing with UTIs, penile cancer, and whatever else you want to believe.

Sanpete,

But no one who observes a typical baby, circumcised or not, can long believe that there's an option of life with no pain for most babies.

Who's asking for a life without pain for babies as a realistic goal? That's an irrational assumption not held by infant circumcision opponents. What's irrational, though, is believing that it makes sense to cause all (male) babies pain to save a few adult males the pain of circumcision. That's just nonsense, especially given that intact adult males almost never choose (or need) circumcision. Many might avoid circumcision precisely because of the pain, but that tells us they value not suffering pain more than they value whatever benefit they perceive from circumcision.

What makes anyone here believe that infants subscribe to a different thought process?

Posted by: Tony | Jun 24, 2007 12:54:35 PM

What's irrational, though, is believing that it makes sense to cause all (male) babies pain to save a few adult males the pain of circumcision.

Again, this isn't the issue I've been addressing. Please read cerebrocrat's post, which is what I've referred to several times.

Posted by: Sanpete | Jun 24, 2007 2:46:18 PM

Sanpete,

My apologies. I went back and reviewed the comments closer, just to make sure. I think I skimmed too much initially. In that context, what I quoted was unintentionally out of context.

To cerebrocrat's point, perhaps there's merit there, although the idea seems easily refuted by the data in the study. It's irrelevant as a consideration in the decision on infant circumcision. Basically, if the intact adult male deems that potential change bad, then he won't go through with circumcision. Either way, the choice is up to him. Surgery isn't justified just because the boy might adapt better if it happens before he knows differently.

That said, I'm not sure my comment was off target. The underlying issue, the flaw in parental choice for routine infant circumcision, remains. As you said in the same comment I excerpted:

In practice, parents have to decide on behalf of their baby boys, with their best interests at heart.

You're still advocating a position where parents can choose, even though that choice is entirely subjective, absent any immediate medical need that can't be resolved with less invasive treatments and/or prevention. Good intentions are simply not enough.

There are four possible scenarios for each boy.

(1) intact and happy
(2) circumcised and happy
(3) intact and unhappy
(4) circumcised and unhappy

Numbers (1) and (2) are irrelevant to our discussion. They're happy; nothing needs to be done.

The difference rests in (3) versus (4). Number (3) has the option to have himself circumcised. The decision to circumcise becomes a cost-benefit to him. Either he values being circumcised more, or he values not having the pain of adult circumcision more. Either way, it's his choice.

Number (4) has no such option. Parents aren't psychic and can't know that, if they circumcise, their son will fall into (2) and not (4). We're left either relying on a silly utilitarian argument about how many unhappy kids are enough to make us question the procedure. That's ridiculous because we're discussing the bodies of individuals, not society. Given that infant circumcision is medically unnecessary at the time it's performed, such a surgery can not be ethically justified, regardless of parental preference.

Posted by: Tony | Jun 24, 2007 4:27:37 PM

Tony, my point remains that the options for an adult male aren't the same options that exist for a male baby. Waiting forecloses the choice to grow up circumcised. It's false that there is no option lost by waiting.

That doesn't imply anything about whether there should be circumcision. It's simply a point against a certain line of argument you and several others have used here. Obviously if there's no good reason for circumcision it shouldn't be done. But that's a further issue, on which there are differing opinions. Since a baby isn't competent, parents must decide, considering all the relevant evidence and factors, just as they do in myriad other things that can't be undone when the baby grows up.

Posted by: Sanpete | Jun 24, 2007 5:15:19 PM

Sanpete,

You're right, there is an option "lost" by waiting to circumcise. It's just silly to think the choice to grow up circumcised matters. The right to grow up with all healthy body parts trumps that notion from the viewpoint of what parents should be allowed to do. It's the difference between asking "why did you remove my foreskin unnecessarily" and "why didn't you remove my foreskin unnecessarily". The latter is absurd.

Parental choice on circumcision is not like the myriad of other things that can't be undone. With everything else involving surgical intervention, we require medical need. Potential benefits are not medical need, the good opinion of parents notwithstanding.

Posted by: Tony | Jun 24, 2007 6:43:30 PM

So what I'm hearing is that male circumcisions is perfectly fine until L.A. area plastic surgeons start offering it at labioplasty clinics. Where it would be wrong.

Seriously. Either way it's removing sexually beneficial but technically dispensable tissue for reasons of esthetics, partner-preference, and marginal claims of improved hygiene thanks to less chaffing and fewer sticky creases.

For the record there really isn't a "right" answer -- certainly not when piercing, branding, and tattoo parlors are as common, and sought after, as skateboard shops. But if there isn't a "right" answer there appear to be some really *different* answers depending on who's getting the snip and how old they are at the time.

figleaf

Posted by: figleaf | Jun 24, 2007 7:05:42 PM

Again, Tony, if there is no reason for circumcision, then it obviously shouldn't be done.

I don't think I follow your idea about medical need. There is no medical need for cosmetic surgery that must be done to a baby or child to be most effective. Not all good reasons are medical.

Posted by: Sanpete | Jun 24, 2007 7:58:46 PM

Sanpete,

Are you a professional fence-sitter? Why are you so carefully avoiding analysis of the actual medical claims, merely citing that there are conflicting views? The existence of conflicting views in no way implies balance. The medical picture is fairly clear: Known risks are equal to or greater than potential benefits. That means that circumcision is not even shown to have any net medical benefit whatsoever. Prophylactic ablative surgery cannot be ethically justified for a surgery with at best dubious potential benefits.

I hope you will have the courtesy to agree or disagree, but not just stay out of it. It is the crux of the issue, because as you've admitted, unless there is proper justification, the no person should be involuntarily circumcised. There is no lack of information available to you.

Posted by: respect | Jun 24, 2007 9:33:31 PM

Respect, I don't know much about the medical evidence, or the other reasons for and against circumcision. Sorry. As I said, medical considerations aren't the only valid considerations.

Posted by: Sanpete | Jun 24, 2007 9:49:01 PM

Sanpete,

Please explain to me what "valid considerations", other than the medical interests of the patient, are in play which could justify a physician choosing to offer, accept proxy-consent for, and perform, an ablative surgery on the genitals of an infant?

Posted by: respect | Jun 24, 2007 10:19:16 PM

I already mentioned cosmetic considerations, and others have mentioned religious ones, and these two circumcision threads have been mostly about considerations related to sexuality. Whether any of these justify circumcision (some might weigh against it) depends on the facts about them and the medical considerations.

Posted by: Sanpete | Jun 24, 2007 10:43:35 PM

Sanpete,

Your aloofness here is bordering on silly. You say that it all depends on a number of things, none of which you have much to say about.

So let me try this. I'll make a simple statement, and if you disagree, tell me why:

Males have and deserve as much right to keep the entire genitals they were born with as any person has to keep any part of their own body.

Posted by: respect | Jun 24, 2007 11:40:30 PM

Respect, does a person have the same right to an ear lobe as a brain? In some ways we might say yes (no one has a right to my ear lobe but me), in some ways no (but the obligations others have not destroy my brain are far greater in regards to care called for, penalties, etc.).

But I don't think your statement would settle anything. My right to my body parts doesn't entail my parents are wrong to remove a part of my body when they are the guardians of my rights. It depends on whether it's to my good. I don't see how the question of circumcision can be settled independently of the facts about the particular issues relating to it.

Posted by: Sanpete | Jun 25, 2007 12:47:04 AM

Sanpete,

You are being so fuzzy and evasive that the following line of logic is especially appropriate: Your arguments fail because they are unique to the male prepuce. Do you believe physicians have the right to give a patient breast implants for no medical reason, simply because "the guardians of [the child's] rights" agrees? When you need to make special exceptions, you know you're general rule is faulty.

And please, if you're taking the time to have an in-depth discussion like this, it is incumbent upon you to investigate the medical claims and formulate an opinion. When someone points out to you that the medical claims are weak, and wholly inadequate to justify ablative surgery without patient consent, it's pretty lame for you to act helpless in the face of ample information on which to judge the claims. Thus far, you seem content chalking it up to "I've heard conflicting views", which essentially abdicates your own responsibility to judge the evidence. If you aren't willing to do that, why even have this discussion?

Posted by: respect | Jun 25, 2007 2:02:39 AM

Do you believe physicians have the right to give a patient breast implants for no medical reason, simply because "the guardians of [the child's] rights" agrees?

Depends on the purpose. It always depends on why it's done. The parents must have a good reason. (This isn't a matter of physicians' rights.)

What I've been discussing are the arguments presented here, some of which are based on faulty logic. That doesn't require settling the question itself. That would probably take considerably more time.

Posted by: Sanpete | Jun 25, 2007 2:26:16 AM

sanpete and respect....
do you think this is what breakfast is like in the carville/matalin household...as the children push away their plates of french toast, inexplicably losing their hunger, as their parents do a seamless intellectual pas du deux over their orange juice?
what a great match you two are!
"repect" becoming exasperatingly more engaged by sanpete's cool and exhaustively objective analysis of things...
you two should do this over dark colombian coffee, or green tea....maybe you are, sort of!!

Posted by: jacqueline | Jun 25, 2007 9:23:41 AM

Sanpete,

Mostly, I'll just echo respect's comments. However, this is interesting:

My right to my body parts doesn't entail my parents are wrong to remove a part of my body when they are the guardians of my rights.

Yes, it does. Parents are guardians of the child's rights, not owners. Protecting rights means making medically decisions, where necessary, up to and including surgical intervention. But medical necessity is all that matters. We don't need to look at "other" reasons, whether social or religious. They aren't enough.

It depends on whether it's to my good.

and...

It always depends on why it's done. The parents must have a good reason.

I hope you'll agree that "good" is subjective. It doesn't matter if you agree, though, because "good" in terms of demonstrably unnecessary surgery is subjective. Good intentions simply aren't enough. All kinds of heinous acts are committed on children because the parents think it's "good" for the child. We must use a better standard.

Conveniently, for surgery, we understand that medical need is the best standard. Except with infant male circumcision, where we cave to our cultural blindspot and perpetuate the idea that it's somehow different. Nonsense. It's surgery, and it's benefits are subjective.

Three negatives occur with every unnecessary circumcision on a child. He will have scarring. He will lose his right to choose because his bodily integrity will be violated without (valid) reason. He will face a inherent risk of further complications from surgery, because risk and complications are not the same.

Posted by: Tony | Jun 25, 2007 11:40:19 AM

Jacqueline, I vaguely remember Carville saying he and Matalin don't talk much about politics. I can well imagine any conversation they did have wouldn't be very cool and objective.

But medical necessity is all that matters. We don't need to look at "other" reasons, whether social or religious. They aren't enough.

What's your basis for this, Tony? You seem to have the idea that reasons that you call subjective are always trumped by reasons you would apparently consider objective or medical. I don't think that distinction would stand to scrutiny, and even if it could, I don't think it would follow that the one should outweigh the other.

I haven't suggested that good intentions are enough. Good reasons are enough, and there can be a variety of reasons that might qualify, depending on the facts.

Scarring from properly performed circumcision is minimal. Again, a choice is lost whether circumcision is performed on a baby or not performed. Medical complications seem to be rare, judging from this thread and what I've heard. This can't be settled independently of actually sorting out the facts of the various reasons and outcomes. There's no short cut.

Posted by: Sanpete | Jun 25, 2007 1:03:05 PM

Sanpete said:

Scarring from properly performed circumcision is minimal.

Scarring from a circumcision, even one which achieves its intended result, is not minimal. It extends the entire circumference of the organ, up where the frenulum ws connected, and very often there is additional scarring on the glans due the fact that tissue is forcefully separated.

It is only your subjective opinion and cultural bias which allows you do define such scarring as "minimal."

Again, a choice is lost whether circumcision is performed on a baby or not performed.

There is no equality between losing the choice to keep your whole body (which is caused by infant circumcision), and losing the choice of having never even experiencing a whole body. To suggest otherwise is intellectually dishonest at best.

Medical complications seem to be rare, judging from this thread and what I've heard.

The medical complications that are fully documented are sufficient to offset the potential benefits, leaving no net medical benefit. Furthermore, a great many additional complications are not counted, including the scarring, discomfort caused by converting an internal organ to an external one, adhesions, etc.

This can't be settled independently of actually sorting out the facts of the various reasons and outcomes. There's no short cut.

Is the same true for removing the female prepuce? In both cases, they are unnecessary ablative surgery without consent, and with no potential health benefit that could possibly justify a prophylactic amputation.

Let's see if Sanpete has any response that doesn't boil down to: Well, it all depends on lots of things. I don't know all the facts. I've heard this, and I've heard that. Life is so complicated anyway, I just can't really say.

Posted by: respect | Jun 25, 2007 2:34:06 PM

It is only your subjective opinion and cultural bias which allows you do define such scarring as "minimal."

Whereas your assessment that it isn't minimal is objective and free from bias?

As often happens when charges of intellectual honesty are brought up, it's actually the one raising the issue who is misrepresenting things. (Interesting how that works.) The choice in question isn't never even experiencing a whole body, which can end just as well when you lose your tonsils. Again, the choice lost is to grow up circumcised, which matters for the reasons cerebrocrat outlined. If honesty is your concern, please start at home.

Again, whether the choices are on a par depends on the facts about and reasons for circumcision and its consequences. You seek a short cut; there isn't one.

And, speaking of treating things that aren't on a par as though they are, the case with female circumcision is plainly far more obvious in regard to the consequences. Not on a par at all in that regard.

Posted by: Sanpete | Jun 25, 2007 2:59:31 PM

Sanpete Said:

Are you familiar with the Harborview procedure?

http://www.cirp.org/news/1996.10.28_Chicago/

"It would be a small cut to the prepuce, the hood above the
clitoris, with no tissue excised, and this would be conducted
under local anesthetic for children old enough to understand the
procedure and give consent in combination with informed consent
of the parents," said Harborview spokeswoman Tina Mankowski.

How would you assess that, versus male infant circumcision?

Posted by: respect | Jun 25, 2007 3:36:05 PM

That's more on a par with male circumcision in some respects, though less consequential physiologically, it appears. Unlike male circumcision, the only rationale for it is tradition.

Posted by: Sanpete | Jun 25, 2007 5:00:26 PM

Again, the choice lost is to grow up circumcised, which matters for the reasons cerebrocrat outlined.

I addressed this, and cerebrocat also acknowledged that the data in the study ran counter to that theory. Regardless, the idea that growing up circumcised is a "choice" for the boy is absurd. As I mentioned earlier, I'm not about to give equal weight to "why did you circumcise me unnecessarily?" and "why didn't you circumcise me unnecessarily?". The latter deserves no attention when deciding what parents should do.

As for my basis, let me repeat: at the time it's performed, infant circumcision is medically unnecessary in almost every case. The foreskin is healthy. That is objective fact. Everything else is subjective.

Aesthetics? Even if scarring is the only complication, and it's minimal, it's still a change in the natural penis. The value of that is subjective.

Locker room concerns? Subjective. Kids will tease about anything different. I've been teased my entire life about my red hair. I'm not about to dye it to please others, and that's not permanent.

Look like daddy? Subjective. The boy may not want to look like daddy. And if daddy has other scars or tattoos, do we offer those? Balding? And how many times will father and son compare genitalia?

Religion? Whose religion? The parents, of course. They're free to believe what they want, and they're free to raise their children in their religion. But they are not free to do physical harm to another. The child may not choose the same religion, believing instead in a religion that doesn't require circumcision. Or he may have a different interpretation of his religion that doesn't demand circumcision. Ultimately, religion is not provable, so it's subjective, too. And civil law trumps religious law in a free society.

Posted by: Tony | Jun 25, 2007 5:06:52 PM

That's more on a par with male circumcision in some respects, though less consequential physiologically, it appears. Unlike male circumcision, the only rationale for it is tradition.

And yet, it's also illegal in the United States, thanks to the Female Genital Mutilation Act. Why does medically unnecessary genital cutting of a non-consenting individual have a gender test in a free, equal society?

Please don't think it's because the only rationale for FGM is tradition, while male circumcision has other "rationales". Again, the only rationale for forcing surgery on another is medical. Male circumcision can't pass that test. Nothing else counts.

Posted by: Tony | Jun 25, 2007 5:10:25 PM

As I mentioned earlier, I'm not about to give equal weight to "why did you circumcise me unnecessarily?" and "why didn't you circumcise me unnecessarily?". The latter deserves no attention when deciding what parents should do.

Again, whether these are on a par, whether "unnecessarily" applies, whether circumcision is best regarded as physical harm, and so on, all depends on the facts, not an a priori argument of the form you and others have given. Your view of the facts implies you don't give those concerns equal weight. It may well happen that as the facts become better worked out and well known that your view about circumcision will become the common-sense one.

Medical necessity is relative to a particular view of health. By ordinary standards in our culture there is no medical necessity, and maybe even no valid medical reasons, which is a different matter, but that too goes in part to subjective standards of what is healthy.

And civil law trumps religious law in a free society.

Circumcision is legal, of course.

Again, the only rationale for forcing surgery on another is medical.

Again, you haven't shown this, and I think it's plainly false. Babies are given cosmetic surgery, for example, even though there's no medical necessity for that.

Posted by: Sanpete | Jun 25, 2007 5:35:12 PM

respect:

So?

It is only your subjective opinion and cultural bias which allows you do define such scarring as "minimal."

Hmm, just quoting that back to you seems sufficient.

In fact, what's intellectually dishonest is pretending there's some bright line between the "choice" of keeping one's foreskin and the millions of other aspects of one's upbringing, many of far greater import, over which one had no choice. The fact is, circumcised or not, most men are happy the way they are.

Scarring and discomfort? Not this helmet head.

I certainly doubt you could say with any authority that life is definitively better one way or the other. Your attitude towards "the facts" seems to be to ignore whatever circumcised men can relate FROM THEIR OWN EXPERIENCE becuase it doesn't jive with your "facts."

Parents make a decision about which state they think their son would be happier and healthier in. That includes physical and psychological health, which are informed both by biology and by culture. Whether or not circumcision rises to the level of medical necessity, there are real perceived disadvantages - which may be labeled subjective - according to some people's cultural attitudes, to being uncircumcised. In my view there are objective medical and non-medical disadvantages as well. The sensitivity debate strikes me as a red herring. Just about any circumcised male will have no complaints about his sensitivity; and getting off sexually is at least as much a head thing as a dick thing. Any "issues" involving the foreskin become issues well before legal adulthood. And the fact that most adults wouldn't opt to get circumcised is precisely why concerned parents do it for them when they're little - they heal quicker, they don't remember it an hour later and they should in this day and age use a DPNB for stopping the pain. No doubt a happy life can be led either way, either status can be accommodated, and whether or not you're grateful for being circumcised, or uncircumcised, or not will depend on who you are and how you were brought up. I personally have read enough complaints from circumcised men to be less than curious about life on the other side. Others will have the opposite experience. I've heard this, I've heard that. Life is so complicated anyway, I can't really say!

Posted by: Bill | Jun 25, 2007 5:52:50 PM

I wrote:

"I personally have read enough complaints from circumcised men to be less than curious about life on the other side."

Er, that should read "from UNcircumcised men"!

Posted by: Bill | Jun 25, 2007 5:57:56 PM

Sanpete:

I should not have translated faulty reasoning into an accusation of intellectual dishonesty. It's a charge that demeans the conversation, so to whatever degree possible, I retract it.

Bill:

Your arguments falls prey immediately to your treating the male prepuce with standards uniquely applied to it alone. The same standards applied to fingers, toes, earlobes and other appendages, as well an anatomically homologous structures in the female, lead to results American society deems intolerable.

How do you reconcile this?

Posted by: respect | Jun 25, 2007 6:31:58 PM

Sanpete,

Again, you haven't shown this, and I think it's plainly false. Babies are given cosmetic surgery, for example, even though there's no medical necessity for that.

I have shown this. Infant circumcision is not medically indicated, unless you can name me an existing ailment with the foreskin that circumcision cures at the time it's performed. The performance of other cosmetic surgeries (which ones?) does not justify infant circumcision. Your unwillingness to accept facts, or desire to hedge, is irrelevant.

Bill,

And the fact that most adults wouldn't opt to get circumcised is precisely why concerned parents do it for them when they're little...

Is that what you're going to argue? Seriously? Because it's logically ridiculous, despite the word concerned.

"You won't get it done as an adult. Oh, I know you really want it. I mean, who wouldn't? Let me do it now, because you'll want it. You just don't know it yet."

That's a ridiculous belief in psychic powers, not parenting. That's not a standard for unnecessary surgical intervention.

You say a happy life can be led either way. True enough. But for the men who are circumcised and unhappy, they're out of luck. That can't be excused away with any argument other than medical need for the circumcision, which is almost never present. Parental wish is not a medical need.

The individual's rights matter, not the majority's opinion that whatever their foreskin status, they're happy.

Posted by: Tony | Jun 25, 2007 6:50:48 PM

respect:

How do you reconcile this?

I guess the same way American society does, by perceiving different standards for different appendages.

Tony:

That's a ridiculous belief in psychic powers, not parenting. That's not a standard for unnecessary surgical intervention.

That's begging the question twice over. By assuming both the standard and what is unnecessary.

But for the men who are circumcised and unhappy, they're out of luck. That can't be excused away with any argument other than medical need for the circumcision, which is almost never present. Parental wish is not a medical need.

Out of luck? Melodramatic much? Get it through your head: parents make many many irrevocable decisions on behalf of their kids. If it's such an almighty tragedy there's always foreskin restoration, which at least gets you halfway there.

Good luck pursuing that to its logical conclusion, Tony.

Posted by: Bill | Jun 25, 2007 7:30:50 PM

To clarify, my last comment, "Good luck pursuing that to its logical conclusion" (i.e. where parenting is concerned) was in reference to this, which got accidentally deleted:

The individual's rights matter, not the majority's opinion that whatever their foreskin status, they're happy.

Posted by: Bill | Jun 25, 2007 7:33:18 PM

Bill said:

I guess the same way American society does, by perceiving different standards for different appendages.

Well, Bill, I appreciate your honesty in admitting that there's a double-standard.

Posted by: respect | Jun 25, 2007 7:41:39 PM

Well, Bill, I appreciate your honesty in admitting that there's a double-standard.

I guess that's where the debate team meets real life.

Posted by: Bill | Jun 25, 2007 8:00:01 PM

Bill,

Melodramatic? I fail to see how stating a simple fact is melodramatic, unless you deny that fact's existence.

Get it through your head: parents make many many irrevocable decisions on behalf of their kids.

Umm, hate to disappoint, but I haven't denied this. You seem to think that the general necessity of parental choice is enough to discard more compelling arguments against circumcision. It's not. You need to focus a little more on irrevocable and a little less on parents.

If it's such an almighty tragedy there's always foreskin restoration, which at least gets you halfway there.

A poor, incomplete substitute is also not a valid argument in favor of circumcision. More generally, see "irrevocable" and "medically unnecessary". Both are objective.

Good luck pursuing that to its logical conclusion, Tony.

The humor of that following foreskin restoration aside, please elaborate. Are you saying that it's not possible? Too hard? Unjustified? I'm not sure exactly which angle you're taking.

Based on what I think you're implying, I have no intention of standing aside just because the majority believes something stupid. History provides plenty of examples of society being collectively ignorant and then moving past it. This will be the same, eventually.

Posted by: Tony | Jun 25, 2007 8:36:33 PM

Respect, it would help if you could show that something I've said is faulty. You haven't done that.

I have shown this.

Tony, you haven't even come close to showing that medical indications are the only valid reasons for surgery. You just keep saying it, which isn't the same as showing it's true.

The example of cosmetic surgery on babies (to remove blemishes or to reconstruct features that don't look normal) isn't intended to justify circumcision. As I said, it shows that medical indications aren't the only valid reasons for surgery, contrary to your claim. I'm perfectly willing to accept facts. Your saying something repeatedly doesn't make it a fact, though. I require some good argument or evidence, especially when what you say appears plainly false.

Posted by: Sanpete | Jun 25, 2007 9:14:09 PM

Melodramatic? I fail to see how stating a simple fact is melodramatic, unless you deny that fact's existence.

It's not the fact, it's the attitude taken toward the fact. Yes, when you're circumcised there's no going back. Someone could choose to turn that or any number of other *relatively* inconsequential irrevocables into something tragical or not, according to how psychologically lathered up about it one wanted to become. From my point of view that's silly because, well, I'm a happy circumcised man. Oh well, I'm stuck in my own perspective.

The trouble is I find the arguments for and against circumcision to be more or less comparably compelling. I honestly don't think I would like having a foreskin any better, and don't blame my parents for removing it.

A poor, incomplete substitute is also not a valid argument in favor of circumcision. More generally, see "irrevocable" and "medically unnecessary". Both are objective.

Yet I've read accounts of men who went through this very poor incomplete substitute and are delighted. Go figure.

The humor of that following foreskin restoration aside, please elaborate. Are you saying that it's not possible? Too hard? Unjustified? I'm not sure exactly which angle you're taking.

Well, somewhat unjustified unless you raise the standard of demonstrating the harm inflicted considerably, I would think.

(Who you callin ignorant and stupid?) To circumcise or not to circumcise oneself is, we agree, an issue about which reasonable minds can disagree. Permission to circumcise one's child may be a trickier case to make, but in order to succeed in illegalizing it where it is already popular you'll of course have to persuade a large number of adults that some injustice has been perpetrated on them. Which is no doubt your plan or hope. And clearly this battle is mostly won worldwide, and you'd prefer to see it stamped out in its remaining enclaves. I really don't care which way it goes myself. The custom, since it's been around for so many thousands of years, will probably come and go in waves here and there. I here reports of flareups in the Far East...seems reasonable to assume, given the sensitive and insecure aspect of people's attitudes about sexuality, that it could go like wildfire once it became an "in" thing to do in a given culture. Bottom line, the jury's still out for me on its supposed horrific outrageousness.

Posted by: Bill | Jun 25, 2007 9:30:17 PM

Sanpete,

When analyzing this, we must start at the beginning:

- Infant circumcision isn't medically necessary when it's performed.
- There is an inherent risk of complication when performing the surgery.
- There are less-invasive preventions and/or treatments for every medical "benefit" provided by circumcision in almost every case.

What's false about those three? What's false about anything else I've said?

There are sufficient arguments against every other subjective reason for surgery that you can offer. But routine infant circumcision can't pass the initial test. It fails medical ethics, since no ethical foundation can support imposing surgery on a patient without his consent that has the three characteristics above. Why should I humor anything beyond that?

Because society deems it traditionally acceptable? Because we allow cosmetic surgery for medical abnormalities? The foreskin is not an abnormality. We can argue the validity of allowing cosmetic surgery in those cases, but that's irrelevant to routine infant circumcision. Permitting cosmetic intervention in the extreme case does not automatically justify cosmetic intervention in the normal case.

Arguing here seems to be an exercise in futility. I've shown that medical non-indication is enough to prohibit. You're not buying it. That doesn't mean I'm wrong.

Posted by: Tony | Jun 25, 2007 9:45:53 PM

Bill,

From my point of view that's silly because, well, I'm a happy circumcised man.

I'm only saying that this could skew your perception. You don't value the foreskin. That doesn't mean all circumcised men will agree. Basic assumption. Using your position, and terms like "*relatively* inconsequential", incorrectly minimizes the argument that the boy's opinion matters.

Yet I've read accounts of men who went through this very poor incomplete substitute and are delighted. Go figure.

I've heard the same, but I'm sure you'll agree it's anecdotal evidence. Given the loss of nerve endings, delight is probably relative, too. "More than what I had before restoring" can still be "less than what I had before circumcision."

...unless you raise the standard of demonstrating the harm inflicted considerably...

We clearly disagree, and I doubt I'll convince you here. But the burden should rest on circumcision proponents to demonstrate the benefit, particularly in the proper context of actual risks. The foreskin is innocent until proven guilty, so to speak.

(Who you callin ignorant and stupid?)

I only said ignorant, implying incomplete knowledge, not an inability to understand. It was directed at society more than anyone in particular. The tone of your response suggests you got that, so moving on.

...have to persuade a large number of adults that some injustice has been perpetrated on them. Which is no doubt your plan or hope.

Not so much, actually. I don't care if circumcised men believe they've had an injustice perpetrated on them. I can accept a worldview in which people understand that society used to circumcise, but now that we know better (that "ignorance" thing again), we leave the choice to each male. I don't need each person to believe its horrific outrageousness or that he's damaged.

Also, if you leave a son intact, but tell him that you're exceedingly happy with what you have, okay. I hope he has the fortitude to make his own decision, based on his experience and wishes. I'd trust you as a parent to instill that in him. But if he wants to take that conditioning, or even use his own judgment, and have it done to himself? Couldn't care less.

Posted by: Tony | Jun 25, 2007 10:10:36 PM

What's false about those three?

All true as far as I know, though I'm not sure about the third. But it doesn't follow that circumcision is wrong. For that you need an additional premise, such as the one that appears to be false:

What's false about anything else I've said?

As I just pointed out in the previous posts, your claim that only medical reasons are valid reasons for surgery appears plainly false. I gave the not uncommon counterexample of cosmetic surgery.

It fails medical ethics, since no ethical foundation can support imposing surgery on a patient without his consent that has the three characteristics above.

You haven't shown this. It doesn't follow from your three points without the false premise about medical reasons being the only ones that justify surgery.

Permitting cosmetic intervention in the extreme case does not automatically justify cosmetic intervention in the normal case.

Again, it isn't supposed to justify anything (and it isn't only about extreme cases). It just shows your premise is false. You can't have a sound argument with a false premise.

Arguing here seems to be an exercise in futility.

That's because you're trying short-circuit a complex issue with a simple argument that depends on a false premise. Dump the attempted shortcuts and just argue the merits and demerits of circumcision, and you might do better. But it takes longer, requires more work, and will probably not be as clear-cut (so to speak).

Posted by: Sanpete | Jun 25, 2007 10:25:03 PM

Sanpate,

Are you prepared to apply the same standards to both males and females, necessitating that if male circumcision is acceptable, then so too is the Harborview procedure?

Posted by: respect | Jun 25, 2007 11:10:20 PM

I don't think the two cases are entirely parallel, but I wouldn't object to the kind of symbolic and non-injurious procedure the doctors at Harborview came up with in the context they suggested it. That's assuming the ritual involved isn't harmful for other reasons.

Posted by: Sanpete | Jun 25, 2007 11:42:36 PM

Sanpete,

The Harborview procedure is outlawed in the USA, so which do you prefer, allowing female genital cutting of lesser or equal magnitude to male circumcision, or protecting members of both sexes?

Posted by: respect | Jun 26, 2007 12:39:32 AM

I don't know why the procedure is illegal or if I would agree with the reasons, so that doesn't give me any further reason to oppose male circumcision. I suppose you might ask your question of someone who opposes the Harborview procedure.

Posted by: Sanpete | Jun 26, 2007 2:04:56 AM

Sanpete,

I appreciate your consistency exhibited by not opposing the Harborview procedure. Do you also not oppose the same procedure performed upon an infant?

Posted by: respect | Jun 26, 2007 3:04:54 AM

I wouldn't oppose it.

Posted by: Sanpete | Jun 26, 2007 3:13:18 AM

Sanpete,

I think we can rest with an honest difference of opinion. I oppose non-consentual genital cutting of all persons without regard to sex (with consistent standards for medical exceptions that apply to other body parts), while you consider involuntary genital cutting permissible (to some degree), regardless of sex.

I appreciate your honest.

Posted by: respect | Jun 26, 2007 3:32:37 AM

Sanpete,

You're putting me on, right?

It doesn't follow from your three points without the false premise about medical reasons being the only ones that justify surgery.

I did not argue that medical reasons are the only ones to justify surgery. But you're taking a general claim, as well as an extension of that argument that I did not approach, as evidence that I'm short-changing the discussion. I haven't done that, despite your repeated determination to believe that I have.

I've set a logical order for the decision-making process regarding permissible infant circumcision. You don't seem to want a logical order, instead gathering all arguments used today into a little ball where we must pick and choose at random, giving each reason equal weight. That's silly.

Surgery, which infant circumcision surely is, is first a medical decision. If it can't pass the merits of medical need, we must progress to ethics and rights. Routine infant circumcision is not medically necessary. It fails test one. Test two suggests a specific criteria for allowing the surgery. Can the person consent? An adult can consent to surgery on himself, so the surgery passes the ethical test for him. It can move on to whatever further analysis you deem worthy. I have zero interest in stopping adult males (or females) from undergoing unnecessary genital cutting, as long as they consent.

A child can't consent. Yes, we give his parents the choice to consent by proxy. Our understanding is flawed. Proxy consent is for medically necessary decisions, not medical decisions. There is a significant difference. Routine infant circumcision is cosmetic surgery, using the three steps I pointed out. It should never be imposed on a non-consenting individual because the inherent risk is objective and the cosmetic benefit is subjective. No further analysis is necessary. With medically unnecessary decisions, a child is a non-consenting individual, regardless of his parents' opinion on the validity of the surgery. That is not the same as saying I can't or won't address any other justification offered.

I'm not trying to short-circuit anything. First things first. My premise is true. You choose not to believe facts, or at least the logical flow of the decision-making process. I can't help that.

I can write about this all day, with whatever amount of work necessary. But the answer is clear-cut, unless you continue to foolishly insist that subjective reasons like a "choice to grow up circumcised" must be considered on par with objective criteria like lack of medical need. They are not. Again, that doesn't mean I can't or won't explain why I'm right on .

So, let me ask you a point-blank question. I'll carry on this conversation as long as we can make progress. But you have to answer this question first: which merit(s) of infant circumcision would you like me to address?

Posted by: Tony | Jun 26, 2007 12:49:35 PM

Tony, you've said repeatedly that medical indications are the only valid reasons for surgery. You seem to blame me now for pointing out why it isn't so. Without that premise, your "logical order" is nothing but your unsupported assertion of how decisions should be made. Without some reason to accept it, you shouldn't expect anyone but you to do so.

I don't give equal weight to all reasons and have never implied such a thing. Neither do I assume a priori as you do that certain reasons are not sufficient merely because they aren't medical. There are more and less important and valid reasons of all kinds, including medical. Not all medical reasons are equal; not all religious reasons are equal; not all medical reasons outweigh all religious reasons, nor vice versa.

Proxy consent is for medically necessary decisions, not medical decisions.

Not so, and the counterexamples have already been given. Are you arguing that elective surgery, to correct non-life-threatening conditions such as cleft palate, should never be performed on babies? If not, you agree with me that this premise is false.

It should never be imposed on a non-consenting individual because the inherent risk is objective and the cosmetic benefit is subjective.

Again, you've given no argument for this and I see no reason to accept it. You say it's a fact, but you don't give any reason to think it's a fact. Why should subjectively based reasons not matter as much as what you call objective ones? They're just as important to people, and ultimately, as I've pointed out already, all the reasons are subjective, including medical ones, which are relative to a subjective idea of health.

which merit(s) of infant circumcision would you like me to address?

The ones people base their decisions about circumcision on. That includes religious, traditional, medical, cosmetic, sexual. There are pros and cons in regard to all of them.

Posted by: Sanpete | Jun 26, 2007 1:49:36 PM

Sanpete,

Neither do I assume a priori as you do that certain reasons are not sufficient merely because they aren't medical.

We're talking about surgery on children. Lack of medical necessity is enough. Without it, the only reasonable assumption is that a child would not want that surgery. We must err on the side of objective caution, not a subjective analysis of the interests of and imposed by another.

Not so, and the counterexamples have already been given.

I've given my explanation. The extreme does not justify the normal. And by pointing out the difference of extreme versus normal does not automatically mean I support elective cosmetic surgery for the examples you gave earlier. We could debate that, but we're going in circles on basic assumptions.

Are you arguing that elective surgery, to correct non-life-threatening conditions such as cleft palate, should never be performed on babies? If not, you agree with me that this premise is false.

Nice try, but again, you're comparing an abnormality with the normal. Also, a medical condition does not need to be life-threatening to be medically necessary. Is it affecting the functional processes of the person's life? I'd argue that a cleft palette certainly does.

You say it's a fact, but you don't give any reason to think it's a fact.

The lack of medical necessity is not open for debate. At the time it's performed, it is almost never indicated. That's an objective measure. If you reject that, we're wasting our time.

You are correct that the potential medical benefits are subjective, though. Which leads to:

Why should subjectively based reasons not matter as much as what you call objective ones?

Again, I call them objective because they are objective. But the rest is really the gist, isn't it? The subjective reasons do not matter because the person making the subjective valuation is not the person being cut.

The ones people base their decisions about circumcision on. That includes religious, traditional, medical, cosmetic, sexual. There are pros and cons in regard to all of them.

Religious: It's the parents practicing their religion, not the child practicing his religion. He may choose a religion that requires an intact body, or at least does not demand circumcision. He's lost his choice to decide. The right of parents to practice their religion stops before the removal of healthy tissue.

Traditional: Entirely subjective. There is no guarantee the boy will value fitting in with the norm. If he values fitting in, he can have himself circumcised. If he doesn't value fitting in, choosing foreskin instead, he loses his choice if he's circumcised. If the cultural mood changes from preferring circumcised, he loses his choice to fit in if he feels fitting in matters most.

Medical: This requires a comment of its own, but allow me to hit a few key points.

- HIV. The 50% reduction numbers being thrown around are fascinating, but entirely out of context. The absolute risk of female-to-male HIV transmission is tiny. Adding circumcision reduces a tiny risk to a tinier risk. Whether that's worth it is subjective, although the difference is not. To counter that objective difference, there are condoms and monogamy. Those make the difference irrelevant. And a circumcised male having unprotected sex with an HIV+ female will get the disease. It may take him longer, but he's not immune.

- UTIs. Infant girls get many more than even intact boys in the first year, which is where the "benefit" of circumcision rests. We don't cut girls. Aside from knowing that it's wrong, we also understand that antibiotics work well. Even on boys. Less invasive measures to achieve the same result.

- Penile Cancer. The actual rate of penile cancer in America is about 1,300 cases per year. That's about 1/100,000 men. Strangely, the penile cancer rate in a country like Denmark, where almost no one is circumcised, is the same. The actual risk factors are smoking, poor hygiene, and promiscuity, not the foreskin.

- Hygiene. Retract. Soap. Water. Rinse. Done. This is irrational.

- HPV. There's a vaccine for girls. Only a few strains cause cervical cancer. Promiscuity happens to be a far better indicator, not foreskin status. Women must be responsible for themselves. They can demand their partners wear condoms. This may not be the case in a society that devalues the status of women, but that does not describe the United States. Pre-emptive cutting of boys to protect girls is irrational.

Ultimately, I don't deny any potential medical benefits. I have no need to. As I wrote above, in almost every case, there are equally effective, less invasive preventions and/or treatments than infant circumcision. Medical ethics demands that we err on "First, do no harm." Cutting instead of treating is harm. Only the individual can decide if he wants that harm.

Also, let's not forget that the foreskin adheres to the glans and penis at birth. It will naturally separate during the child's early years, but may remain adherent until well into his teens. To circumcise an infant, this bond must be torn. Adult circumcision requires no such tear. The foreskin is separated. Also, the man can inform the doctor how much skin to remove or not remove from his developed penis. With an infant, the doctor merely guesses because the boy's penis is not mature. He can't know if he'll take too much, causing painful erections; too little, causing readhesions; or just enough, leading to the subjective question of how much is enough.

Cosmetic: Entirely subjective. Presumably you're thinking of a few considerations. In no particular order... His parents can't know that he'll think one is "prettier" than the other. His parents can't know that his sexual partners will value one or the other. By circumcising, they make an unchangeable choice for him. His parents aren't psychic. The parents prefer one or the other, usually expressed as "look like daddy" or mom thinks foreskins are "icky". Parents don't generally compare genitals, but when they do, explaining the difference is parenting, whereas surgery is a punt. And parental preference on the "ick" factor is worthless. Parents aren't viewing their children as sex objects. It's subjective; parents must err on the side of choice for the boy.

Sexual: All sorts of conflicting data exists on this. It's worse, it's better. It's different, it's the same. The only objective points are that circumcision removes nerve endings, causes mucosal tissue to toughen, and scars the penis. The mechanical process of sex also changes. The foreskin acts as a lubricating sheath for the penis during intercourse. With the foreskin spread out over the erect penis, the erogenous zone is also larger, since both layers of the inner foreskin become exposed.

Is the foreskin essential to good sex? I don't know. I have nothing to compare. But it's clearly subjective because there's a wide-range of sexual activities and stimuli that people enjoy. Parents can't know in advance what the boy will value, and whether he'd value the foreskin's biological functions. Again, see the four statuses I discussed above. The only male who can't do anything is the circumcised male. His parents can't know which conclusion he'll draw based on the subjective valuation he makes.

How many more do you want?

Posted by: Tony | Jun 26, 2007 4:06:55 PM

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