Circumcision, Science, and Religion: Part 1

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By Tracy G. Cassels

One of the touchier subjects in natural parenting circles is the issue of male circumcision.  It can cause two individuals who agree on every other aspect of parenting to cease speaking or supporting one another.  It raises ire amongst those adamant that it’s akin to abuse and defensiveness amongst those who practice the rite for religious purposes.  In the interest of honesty, I will say now that I am not Jewish and I would never circumcise my own son, should I have one.  I would also personally love to see an end to the practice.  However, I also believe that the issue is more complicated than a simple “I’m right, you’re wrong” attitude allows for various reasons.  Religious beliefs must be considered, as should legal ones, but the primary focus here will be on the science behind circumcision.  Many sites that promote circumcision have done so using certain scholarly articles to argue for the benefits of the circumcised penis and here I will look at these and other articles in hopes of offering a fully-rounded picture.

Legal Standing and the Relationship to Female Circumcision

Circumcision is one of the few areas in which there is a gendered imbalance that favours girls in Western societies.  While most Western nations have outlawed all forms of female circumcision, the same does not apply for male circumcision.  Now many will argue that the two are completely different, and I would say that those people are most likely thinking only of Type III female circumcision in which all or part of the inner and outer labia as well as the clitoris are removed and the wound is sewn shut, not to be opened until the girl is ready for intercourse.  This barbaric (yes, barbaric) practice is actually the least practiced form of female circumcision, though still occurs far more than it should.  And this type of female circumcision is most certainly different from male circumcision.  Why?  Well, for starters, it’s far more painful, leaves much longer lasting damage, but most importantly, it is done as means of subjugating women.  It is done to keep them in line, to ensure they don’t have premarital sex.  It is a form of control.  But what many people seem to ignore is that are other forms of female circumcision, specifically Type I is the removal of the skin around/above the clitoris (and sometimes the clitoris itself) while Type II includes the removal of the clitoris and part of the inner labia.  These two types comprise most of female circumcisions and Type I is considered the most similar to male circumcision.  Notably, though, even Type I is considered illegal in Western countries, even for religious or cultural purposes.

How do we reconcile this?  How can one practice be illegal in many parts of the world, and yet a similar procedure is said to be protected by the same religious and cultural arguments that were previously rejected?  Here I must give my own opinion and I believe there are (at least, as I don’t dare believe I’ve thought of everything) three factors at play:

1.  Judaism is not seen as a fringe or eccentric religion and thus its practices are deemed more civil and acceptable.  Furthermore, the reason behind the Jewish (and Muslim) male circumcision is “holier” than that of female circumcision (a topic that will be returned to later on).

2.  Females are seen as needing protection whereas males are not.  Perhaps it is due to the horrific nature of certain types of female circumcision (e.g., type III) or perhaps because it has been tied so closely to forms of sexual slavery, but girls are seen as being more vulnerable to forms of abuse, and thus must be helped legally.  There is also the fact that women are outspoken for other women and girls and have made it loudly clear that they do not tolerate female circumcision.  Males have not taken up the cause for other males to the same degree over the same amount of time (though I believe that’s changing).

3.  Finally, I think there’s the issue of science, which I will get to next.  Briefly, there have been many articles written that discuss the positives of male circumcision, something that has not been done for female circumcision of any kind.

So we end up here, with gender inequality in the law, and one practice that is seen as barbaric, while its cousin is generally deemed acceptable.  It’s a tricky spot to be in.

The Science around Circumcision

One of the things that struck me when I started reading up on religious reasons for circumcision was the overwhelming tendency of these religious sites to also talk about the scientific health benefits of circumcision.  I say it struck me as odd because if you’re doing something because it has a strong religious meaning, all the science in the world shouldn’t matter.  However, there it was and I couldn’t help but feel that I needed to do some digging of my own.  Below I will cover the research on the main health arguments surrounding male circumcision.

HIV Transmission

Perhaps the most well-known benefit of circumcision is its seemingly protective factor against HIV in Africa.  In the 1990s it was found by many observational studies in Africa that men who had been circumcised were dramatically less likely to be infected with HIV (for a systematic review, see[1]).  People jumped on this and intervention studies offering circumcision to sexually active men (and teenagers) was offered as a way to potentially reduce HIV in these areas.  Early intervention studies didn’t quite go as planned, with the circumcision of older men not conferring much benefit[2], and a Cochrane review of the research up to 2003 showing that the protective effects of circumcision may have more to do with the religious and thus behavioural aspects of life for men who were circumcised[3].  However, it was soon realized that part of the problem with the intervention trials was that many older men who received the circumcision as part of the targeted intervention believed that circumcision would reduce their chance of getting HIV down to zero and thus were not engaged in what would be considered safe practices[2][4].  Thus, during the beginning of the 21st century, clinical trials took place that included sex education for both the intervention and control groups in areas where HIV was rampant.  What these trials have consistently found is that targeted circumcision of older men does confer a benefit; the reduction of HIV transmission ranges from 40-60%[5][6][7].

What does this mean?  It means that, yes, circumcision does confer a level of protection against the transmission of HIV in areas in which there is a high-risk of infection.  There have been speculations as to why this is the case (generally to do with properties of the foreskin)[8], but nothing conclusive (that I’m aware of).  But I must caution one thing: the research is only applicable to places like Africa with high transmission rates of HIV and even then must be taken with caution.  Why would it possibly be any different?  First because our rates of HIV transmission are much lower and thus any intervention would have to have a very strong effect to have a practical effect.  But more importantly, there is research that these circumcision trials are also reducing the transmission rates of the herpes simple virus type 2 in these countries[9] and yet the same effects cannot be found in the United States[10].  While the reason behind this discrepancy is unknown, it is something we must consider.

UPDATE: An amazing piece questioning the research on the Africa trials.  Click here to read it all.

To Be Continued… Click Here for Part 2

 


[1] Weiss HA, Quigley MA, Hayes RJ.  Male circumcision and risk of HIV infection in sub-Saharan Africa: a systematic review and meta-analysis.  AIDS 2000; 14: 2361-2370.

[2] Kelly R, Kiwanuka N, Wawer MJ, et al.  Age of male circumcision and risk of prevalent HIV infection in rural Uganda.  AIDS 1999; 13: 399-405.

[3] Siegfried N, Muller M, Volmink J, et al.  Male circumcision for prevention of heterosexual acquisition of HIV in men (review).  Cochrane Database of Systematic Reviews 2003, Issue 3. Art. No.: CD003362.

[4] Halperin DT, Bailey RC.  Male circumcision and HIV infection: 10 years and counting.  The Lancet 1999; 354: 1813-1815.

[5] Auvert B, Taljaard D, Lagarde E, et al.  Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 trial.  PLoS Med 2005; 2: e298.

[6] Gray RH, Kigozi G, Serwadda D, et al.   Male circumcision for HIV prevention in men in Rakai, Uganda: a randomized trial.  The Lancet 2007; 369: 657-666.

[7] Bailey RC, Moses S, Parker CB, et al.  Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomized control trial.  The Lancet 2007; 369: 643-656.

[8] Szabo R, Short RV.  How does male circumcision prevent against HIV infection?  British Medical Journal 2000; 320: 1592-1594.

[9] Tobian AAR, Serwadda D, Quinn TC, et al.  Male circumcision for the prevention of HSV-2 and HPV infections and syphilis.  New England Journal of Medicine 2009; 360: 1298-1309.

[10] Xu F, Markowitz LE, Sternberg MR, Aral SO.  Prevalence of circumcision and herpes simplex virus type 2 infection in men in the United States: the national health and nutrition examination survey (NHANES), 1999-2004.  Sexually Transmitted Diseases 2007; 34: 624.

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Comments

  1. Jespren says

    Good start, although I would also say that not only are those who say it is completely different than female circumcision only (likely) looking at the most extreme form of female circumcision, they are also looking at (one of) the most benign forms of male circumsicion. Just like some tribes cut off the entire genital mound and both lips of the vagina, some tribes likewise skin the entire shaft of the penis (and at least one also skins the upper portions of the thighs as well). We’re accustomed to the ‘westernized’ version of male circumsicion, were the forskin, usually od an indivudial too young to remember is removed being compared to the, as you said, most barbaric form of female circumsicion. But if one turns the tables, comparing the ‘westernized’ version of female circumsicion, where to satisfy religious rules the clitorial hood is pricked to bleed on a generally willing prepubescent female, to the most barbaric form of male circumsicion, a adolscent boy leaned against a public wall in full view of the marriagable women of the tribe forced to endore the skin on his penis and upper thighs being skinned off without crying out, male circumsicion starts to look a whole lot more ‘barbaric’.
    Also, there *are* lots of ‘scholarly’ papers published on the health benefits (lowered stds, less urinary infects, etc) of female circumsicion, it’s just hard to find them outside of practicing countries. But I’ve read a few from Arab or African nations before.
    Did you read my peice on circumsicion? I can’t remember.

    • says

      I feel like I have and yet I can’t remember. Did it talk about ear piercing? I have that in my head (wow my brain is mush). I would be interested in reading articles on the benefits of less invasive female circumcision – do you have any links I can read? I do look at articles from elsewhere as long as they’re in peer-reviewed journals. That may be the difference as peer-reviewed journals are primarily Western.

      • Jespren says

        Ear piercing gets brought up in passing, you didn’t comment on it (which doesn’t mean you didn’t read it), here’s the link in case you want a gander: http://tigaseren.blogspot.com/2010/11/circumcision-and-common-sense.html?m=1#comment-form
        I’ll see if I can find you something about female circumcision, but it’s been a long time and I didn’t save the links. I came across them while looking at coming of age rituals, and truth I’ve seen/read more references to them than the actual studies. Although I know I came across at least on online that actually had the full study.

        • says

          I have read it :) I didn’t comment because for the longest time, I just didn’t know how to comment on this. Without having done research on the religious aspects, I didn’t feel I could make an intelligent comment on it! I like your take on the debate – I do agree that the way the debate is phrased doesn’t aid the cause at all. People get too defensive about things like mutilation and then become even more adamantly for it when they feel attacked. It’s a tricky one though for sure!

  2. Jespren says

    Oh, btw, the main reason why members of a faith seek, publish, etc medical benefits, health benefits, scientific validation is to show outsiders (primarily) ‘see, our God/god/gods and therefore faith isn’t crazy, without reason, or illogical, it is backed up by outside support. Our God/god/gods don’t do things for nothing’. The ability to dfend one’s faith logically (apologetics) is a huge difference (sometimes the only difference) between a recognized faith and a cult. It’s alsolargely necessary to maintain the next generation. an unanswered ‘why?’ is a huge reason why children leave the faith of their elders. Being able to answer with more than ‘God said so’ is just important in a religious upbringing as having a better answer than ‘because I said so’ is in general parenting. (Even if occassionally the only answer better than ‘because I said so’ is ‘because I’m the mom/dad and therefore I make the rules’, sometimes the only answer better than ‘God said so’ is, likewise ‘because He’s God and He makes the rules’. But most of the time there is something else that can be pointed to in order to give a fuller explaination.)

    • says

      Good point! Hadn’t thought of that – the way it read in the articles was like a pleading which is probably why I didn’t take it that way. But you’re absolutely correct.

  3. says

    Circumcisions benefits are pretty poor. It is shown to reduce the transmission of STIs but I am a bit dubious about those findings.
    The reason I am dubious is because circumcision is the whole, “we have the cure, now we must find what it cures” approach.
    Want a good near fool proof way to reduce STIs and AIDS transmission? Wear a damn condom. The end. No need to mutilate a child. If they want to mutilate themselves (circucision, piercings, tattoos, etc..>) when they have the ability to make that decision, then so be it. Just don’t mutilate them without their approval.

  4. Bev says

    Thanks for taking a shot at this, as I am not entirely sure what side I am on. I wanted to add a few things/questions. First, we literally just covered circumcision in my nursing classes, and the gist of what we were taught is that while there can be medical benefits, they are minute (for example, circumcised males have a lower risk of penile cancer, but the risk of penile cancer for the entire population is already extremely low). What I am curious about and am wondering if you might be able to address later on in your article is if there is any data on the incidence of uncircumcised adult males who decide to undergo a circumcision. I’ve been told that adult male circumcision is more painful and has a longer healing time compared to infant boys. An OB nurse at the hospital where I delivered my daughter said that they had males on a weekly basis coming in to be circumcised. I also wonder about how parents might address any feelings an uncircumcised little boy might have if they realize they are different from their dad. Not that I think this is the best reason to base a circumcision decision on, but is something that has crossed my mind. Thank you!

    • says

      Bev, I’ll definitely take a look at these for later parts. It’s looking to be a 3 or 4 part piece as I just finished part two which only covers penile cancer, urinary tract infections, and pain! There’s a lot of ground to get through!!! But I will add bits on adult circumcision and fitting in (which will really be covered with religion as that’s the crux of some of the religious arguments).

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