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.