Male Circumcision: Are We Making the Cut Too Soon?

Posted on Jan 4, 2016

Male Circumcision: Are We Making the Cut Too Soon?

 

Written by: Megan Wood

Male circumcision and its necessity is a frequent debate in today’s society. However, the topic of circumcision cannot be regarded as new. Circumcision has been a prevalent aspect of history for religious humans; both Judaism and Islam regard circumcision as an important ritual [1]. Research estimates that around 30% of the male population is circumcised [1]; in current North American society, the completion of male circumcision – a procedure which involves the surgical removal of some of the foreskin [2] – has been routinely practiced for either religious, personal, or health reasons. Rates of this practice vary by country and continent; in the United States, 75% of males aged 15 or older are circumcised for nonreligious reasons, while in the United Kingdom only 6% of men are circumcised [1]. The practice of circumcision was and continues to be a current debate amongst the population where two distinct opposing views emerge: proponents for male circumcision, and those who object to the surgery. The debate between health professionals concerning male circumcision continues because of the questionable necessity and ethical concerns of the elective surgery. Since male circumcision is prevalent in North American society, it is important to research whether circumcision is positive and beneficial or a violation of human rights. The research and reasoning for both sides to this debate is analyzed in this short essay.

Health care practitioners who promote male circumcision do so because they believe that the medical benefits and proactive prevention gained by circumcision outweigh the potential side effects of the surgery. Male circumcision is endorsed by a large number of groups, including the American Academy of Pediatrics (AAP) [3]. In fact, the American Academy of Pediatrics issued a review of the current medical literature in 2007, and concluded that the benefits of newborn male circumcision outweigh the risks of the procedure [3]. Indeed, the American Academy of Pediatrics asserts that significant acute problems caused by male neonate circumcision are rare (neonatal range of complications is from 0.19%-0.60% in [2]), with more complications manifesting after a procedure with an untrained, as opposed to well-trained, circumcision provider. The identified benefits gained from male circumcision are: the prevention of urinary tract infections, a lowered rate of acquisition of HIV, a lower transmission of some sexually transmitted infections (specifically ulcerative STIs such as syphilis and genital herpes simplex), and a lower rate of penile cancer [1, 2, 3]. Pukall also notes that circumcision is the only cure for phimosis – where the foreskin cannot fully retract over the glans penis – and thus that neonate circumcision sometimes occurs as a preventative measure [4]. Thus, medical advocates for male circumcision point to circumcision as a preventative measure for infections, STIs, HIV, and other potential problems concerning the penis.

However, it is not simply medical professionals deciding whether circumcision is right for their patients; many circumcision procedures in North America occur when the male is an infant. Thus, parental opinion and reasoning is an important aspect of the circumcision decision. In a Canadian study, reasons for parents supporting circumcision are for hygiene (61.9%), prevention of infection or cancer (44.8%), and because the father is circumcised (40.9%) [5]. This indicates that there are both medical and personal reasons for male circumcision.

Penis shaped cookie cutters. Image credit: Flickr user JokesByMail

Penis shaped cookie cutters. Image credit: Flickr user JokesByMail

Although there are clearly positive aspects to male circumcision, those who oppose the surgery do so for a number of valid reasons. A survey published by Rediger and Muller indicates that most parents (54.3%) that are unsupportive of circumcision see the procedure as not medically necessary [5]. Indeed, most of the benefits from this proactive surgery can be acquired from using a condom when engaging in sexual activity. Other reasons for choosing not to circumcise were concerns about infection and bleeding, pain, and the baby not having an input in the decision [5] Some studies report that circumcision decreases penile sensitivity and can cause pain and trauma [6]. However, one of the main aspects of the circumcision debate is that the methodology of the circumcision literature is unreliable and generalized when it should not be.

Unfortunately, some of the medical literature concerning health benefits and problems of male circumcision can be misleading and the methodological and generalizability of the research is questionable (see [2]). Studies that promote male circumcision as a strategy to prevent HIV acquisition in men are misleading, as circumcision decreases the potential of acquiring HIV but does not award complete prevention [1, 2]. As well, most of the male circumcision studies are conducted in Africa, which has a overall different population to North America in regards to the general time of circumcision (adulthood vs. neonate in North America), those who have HIV (heterosexual men in Africa vs. gay men in North America), and type of sexual education received [2]. Studies that condemn circumcision note small differences in penile sensitivity due to circumcision, but do not report whether those circumcised feel distress [7]. These methodological problems must be understood before a medical professional can provide parents or males with correct information about the circumcision procedure and its benefits and potential problems.

The male circumcision debate has not yet come to a conclusion. Some health care workers believe the benefits of the surgery outweigh the potential problems; others believe that it is an elective, unnecessary surgery that can cause pain and post-surgery complications. However, the main issue in this debate is the lack of research on the effects of circumcision. The research that is currently available is of poor methodological quality and makes generalizations unsupported by the research. As well, most research investigates medical gains of circumcision, while research on sexual functioning and body image and satisfaction trails behind [2]. A lack of methodologically sound research engenders a lack of understanding of pertinent information that healthcare providers need to communicate to expecting parents and males considering circumcision. The male circumcision debate is crucial to understanding the sexual, physical, and psychological benefits and issues connected to the circumcision surgery and dissipating biased and unfounded beliefs about the procedure. Overall, the circumcision debate has positively impacted the field of sexual health, as it has gained attention for investigating the sexual benefits and problems associated with an elective surgery that may alter infection rates as well as sexual functioning.

Sources:

[1]. Tobian, A., Kacker, S., Quinn, T. (2014). Male circumcision: A globally relevant but under-utilized method for the prevention of HIV and other sexually transmitted diseases. Annual Reviews, 65, p. 293-306. Doi: 10.1146/annurev-med-092412-09539

[2] Bossio, J., Pukall, C., Steele, S. (2014). A review of the current state of the male circumcision literature. International Society for Sexual Medicine. doi: 10.1111/jsm.12703

[3] American Academy of Pediatrics. (2012). Technical report: Male circumcision. American Academy of Pediatrics, 130(3). doi: 10.1542/peds.2012-1990

[4] Pukall, C. (2015). Lecture about male circumcision at Queen’s University [Discussion].

[5] Rediger, C., & Muller, A. J. (2013). Parents’ rationale for male circumcision. Canadian Family Physician, 59, 110–115.

[6] Boyle, G., Goldman, R., Svoboda, J., Fernandez, E. (2002). Male circumcision: Pain, trauma, and psychosexual sequeale. Journal of Health Psychology, 7(3), 329-343. doi: 10.1177/1359105302007003225

[7] Bronselaer, G. A., Schober, J. M., Meyer‐Bahlburg, H. F., T’sjoen, G., Vlietinck, R., & Hoebeke, P. B. (2013). Male circumcision decreases penile sensitivity as measured in a large cohort. BJU international, 111(5), 820-827. doi: 10.1111/j.1464-410X.2012.11761.x

 

Image credit: Flickr user StreetFly JZ