1. Ethically, I think it's less wasteful than simply throwing out the stuff as medical waste. I'd be surprised to hear that any parents chose to circumcise their child because Sandra Bullock wanted a facial, so think she's probably on solid moral ground. I'd be even more surprised to hear that there's any real benefit to someone's face from doing this, so the retailers are likely somewhat ethically dubious. (Also, ewwwwwww.)
2. Medically, my understanding is that the evidence supports circumcision so I do as well. The support isn't overwhelming though, so I figure that letting people choose to do what they think best with their child makes sense in this situation. I certainly wouldn't hold it against someone for choosing one over the other.
3. There is no equivalent of male circumcision for women, as there are no medical benefits to 'female circumcision'.
1. You are still supporting non-consensual mutilation of boys. If the market for this continues, and grows due to celebrities hyping it, then there will be pressur eto continue the practice. I think your argument that parents aren't doing because some american actress wants a facial is super weak. In that case why should I care about any atrocities or abuse related to the manufacturing of any product?
There is medical reason to perform a circumcision early on (significant reduction of complications - please see below for links to the research that proves it).
I reject your use of the term 'mutilation'. Mutilation refers to serious and lasting damage. Removing a child's foreskin in the vast majority of cases has no lasting negative impact on him as a grown man* in terms of sexual pleasure (
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3042320/), and in fact confers well researched health benefits (see below).
*It does appear that circumcision may slightly reduce sexual pleasure of women having sex with circumcised men though. (
https://onlinelibrary.wiley.com/doi/pdf/10.1046/j.1464-410x.1999.0830s1079.x)
2. What is the medical reason? The evidence is pretty weak. I'd suggest you do some research.
In a stable Copenhagen population with on average 10,858 boys born each year between 1996 and 2014, only 53 boys needed a circumcision for medical reasons before age 18 years during the calendar year 2014. This indicates that approximately 99.5% of Danish boys will go through infancy, childhood, and adolescence without any medical need to be circumcised (Sneppen & Thorup, 2016 Sneppen, I., & Thorup, J. (2016). Foreskin morbidity in uncircumcised males. Pediatrics, 137. doi: 10.1542/peds.2015-4340 [Crossref], [PubMed], [Web of Science ®], [Google Scholar]).
As you've pointed out, an actual
need for circumcision is not too common. Technically there's no
need for most people to be vaccinated either. However vaccines confer a lifetime of potential benefit to a child. The evidence is very clear that circumcision is safe, less risky/detrimental when performed during infancy, and carries with it permanent benefits through life.
The evidence is quite strong actually, but some may decide that the benefit is not worth the risks for their child (which seems perfectly reasonable to me):
Benefits of male circumcision
Urinary tract infection (UTI): A UTI is an infection that affects part of the urinary tract. Of any year of life, UTI in males is most common in the first year, affecting 1%-2% of uncircumcised boys compared to 0.1%-0.2% of boys who are circumcised[22,23]. Risk reduction continues, however, beyond infancy. The most recent meta-analysis (in 2013) noted that over the lifetime 1 in 12 circumcised males experience a UTI compared with 1 in 3 uncircumcised males[22]. Recurrent UTI in particular may lead to renal parenchymal disease[24,25]. While treatment by oral antibiotics can be used for older children and men, an infant with a UTI presents with fever, often leading to blood collection, lumbar puncture, and if UTI is diagnosed, hospitalization to enable intravenous antibiotic administration[26]. Emergence of resistance to most or all antibiotics, including methicillin, will make treatment of UTI more challenging[27-29], including in Australia[30]. Swabs taken under the foreskin of boys aged 7 d to 11 years identified 50 bacterial isolates, most of which were multi-drug-resistant strains[31]. Maternal antibiotic use during pregnancy also increases the risk of resistant pathogens causing early infant UTI[32].
Phimosis: Phimosis is a penile condition where the foreskin cannot be fully retracted over the glans penis. Phimosis affects approximately 10% of uncircumcised adolescent and adult males[33-47]. Even though regular application of steroid creams, which may cause undesirable systemic absorption of glucocorticoids, can be used to alleviate this condition, the definitive treatment is MC. Paraphimosis (a condition in which the foreskin cannot be returned after retraction) is less common, but when it occurs represents a medical emergency because of haemostasis and risk of gangrene[48].
Inflammation: Inflammation of the glans (balanitis) or the foreskin and/or the underlying glans (balanoposthitis) is also common in uncircumcised males and can contribute to secondary phimosis[49-53]. A meta-analysis found circumcised males are at reduced risk of balanitis [odds ratio (OR) = 0.32; 95%CI: 0.20-0.52][54]. A form of penile inflammation, lichen sclerosis, is diagnosed in up to 40% of foreskins removed for phimosis and peaks at around 10 years of age[51,52]. Early infant MC virtually eliminates the risk of lichen sclerosis[53,55]. MC is, moreover, the definitive cure.
Hygiene: Hygiene is less easily attained for an uncircumcised penis[56]. In the more highly populated east coast states of Australia, MC prevalence increases from south to north[20], correlating with the greater frequency of inflammatory conditions and skin irritation in an uncircumcised penis in hotter more humid climates. Candidiasis (thrush) is 60% lower in circumcised Australian men[19].
STIs in men: Several STIs are more prevalent in uncircumcised males[57,58]. These include oncogenic types of human papillomavirus (HPV)[59-65], that are the most common STIs in Australia and New Zealand, just as in the United States, and HSV-2[62,66-69] that is also common. There is a disproportionate burden of these STIs among adolescents and young adults[66].
Randomized controlled trials (RCTs) showed MC reduced infection of men by high-risk HPV by approximately 40%[61-63,70-72]. A meta-analysis in 2012 of 21 observational studies and 2 RCTs of MC found risk reductions in high-risk HPV of 43% and 33%, respectively[73]. A similar result was obtained in an earlier meta-analysis[65]. In one RCT circumcision of heterosexual men was found to reduce flat penile lesions, which typify oncogenic HPV, by 98%[63], and in another RCT viral load was reduced by 95%[72]. In those Australian homosexual men who predominantly practice insertive anal intercourse, protection afforded by MC against the major oncogenic type, HPV16, was 57%[74].
In the case of HSV-2, RCTs have shown MC reduces infection by approximately 30%[68,69,75,76] and a meta-analysis of older observational studies found infection to be 15% lower in circumcised men[67].
Other STIs against which MC affords protection include Trichomonas vaginalis[77], Mycoplasma genitalium[78], syphilis[67,79,80], chancroid[67], genital ulcer disease[81,82] and HIV[83-90]. Coital injuries, which increase risk of HIV infection, are higher in uncircumcised men[91]. In comparable developed countries in which HIV prevalence is low, the prevalence of heterosexually acquired HIV in those with low MC prevalence (the Netherlands and France) was 6 times higher in men and 10 times higher in women compared with Israel, a country having a very high MC prevalence[92].
National HIV statistics for Australia show that after excluding cases from a high prevalence country, the number of cases whose exposure to HIV was attributed to heterosexual contact has increased by 28% over the past decade. In 2013 there were 1236 new diagnoses, 313 (25%) of these being attributed to heterosexual contact (29% of the latter involving individuals born in Australia)[93].
HIV prevalence is high amongst Australian men who have sex with men, but a Sydney study found those adopting an exclusively insertive role during anal intercourse exhibit 89% protection if circumcised[94,95].
In the United States the latest data show approximately 10% of new HIV cases were in men infected heterosexually, with one estimate suggesting that universal infant MC could prevent 2500 HIV infections annually[96]. The increase in HIV infections in African Americans, however, has been faster than in all other groups in the United States[97]. The CDC has recommended MC for HIV prevention in such groups[90]. Such findings indicate an important public health role for early infant MC in developed countries, including Australia and New Zealand[98,99].
It is anticipated that a steep increase in multiple morbidities and drug interactions in aging HIV-infected patients on combination antiretroviral therapy is looming and will lead to a major medical burden[100], suggesting a flow-on of benefits resulting from the ability of MC to reduce HIV cases.
STIs in women: Circumcision of males also partially protects their female sexual partners from oncogenic types of HPV[59,60,101], HSV-2[102], Trichomonas vaginalis[103], bacterial vaginosis[103], Chlamydia trachomatis[104] and syphilis[79]. MC, by reducing HIV prevalence in heterosexual men, will help reduce HIV prevalence in women[105] and children[106]. Other STIs that MC protects against include ones that exacerbate HIV risk[107-110].
The impact of condoms on STIs: Condoms are 80% protective against HIV infection, but must be used consistently and correctly[111,112]. A Cochrane systematic review and meta-analysis of RCTs of condom use (two in the United States, one in England and four in Africa) found, however, “little clinical evidence of effectiveness” and no “favorable results” for HIV prevention[113]. This study did, however, find condoms exhibited 42% effectiveness against syphilis[113]. Unlike condoms, MC is a one-off procedure that does not require future voluntary compliance each time a man has sexual intercourse. In this respect MC can thus be compared with vaccination. However, the only vaccines currently in widespread use for STIs are those that protect against certain types of HPV (discussed below). Nevertheless both MC and condom use should be advocated[98].
Genital cancers: Penile cancer affects approximately 1 in 1000 uncircumcised men over the lifetime, thus making it uncommon, but not rare[2,114,115]. Infant MC reduces penile cancer later in life by 95%-99%[116-118]. Prevalence was 22-fold higher in uncircumcised men in a United States study[116]. MC appeared to afford lesser protection in a meta-analysis[119], although the inclusion of men circumcised as part of their treatment for penile cancer meant the level of protection was under-estimated. Oncogenic HPV is found in one-quarter to one-half of penile cancers[73,114,120], prevalence varying with type of penile lesion[121]. Based on meta-analyses of risk factors, phimosis increases risk of penile cancer 12.1-fold (95%CI: 5.57-26.2), balanitis increases risk 3.82-fold (95%CI: 1.61-9.06) and smegma is associated with a 3.04-fold (95%CI: 1.29-7.16) increase in risk[114]. Each of these conditions is much more common in uncircumcised males. Vaccination of boys against HPV16 and HPV18 may, under the most optimistic of scenarios, reduce penile cancer by 35%[115]. Vaccination, MC, consistent condom use and monogamy should all be advocated to achieve maximum protection.
For prostate cancer, MC prior to sexual debut reduces prevalence by 15%-50%[115,122-124]. The significant protective effect was confirmed in a recent meta-analysis[125]. In countries globally in which MC prevalence is greater than 80%, prostate cancer-related mortality, corrected for potential confounding factors, is half that of countries with a low or intermediate MC prevalence[126].
Cervical cancer is 10 times more common than penile cancer. This malignancy is up to 5 times more prevalent in women whose male partner is uncircumcised[59,60]. Since virtually all cases of cervical cancer are caused by oncogenic types of HPV, the ability of MC to reduce transmission of high-risk HPV to women[59,60,101] accounts for its protective effect against this commonly fatal and difficult to treat cancer. While prophylactic HPV vaccination of 12-13 years old girls can attenuate, but not eliminate, their future risk, vaccine uptake has not been universal. Current vaccines do not protect against all oncogenic HPV types, but only types HPV16 and HPV18 seen in approximately 70% of cervical cancers. Vaccination has a smaller effect against vulval epithelial neoplasia[127], oncogenic HPV types being present in only half of cases. There is uncertainty about the long-term durability of the benefits of vaccination. Although introduction of a nonavalent HPV vaccine, which will protect against additional high-risk types 31, 33, 45, 52 and 58 (meaning approximately 90% coverage), should further reduce cervical cancer prevalence, concerns about breadth of protection, adherence and long-term immunity will remain.
Therefore a benefit from MC remains, both for males and for their female sexual partners, in partial protection against genital cancers. In Australia, universal MC would prevent 2800-8400 cancers, comprising 2400-8000 of the prostate, 67 of the penis and 350 of the cervix annually[115].
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5296634/Male circumcision provides a degree of protection against acquiring HIV infection, equivalent to what a vaccine of high efficacy would have achieved.
http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020298The single risk factor of lack of circumcision confers a 23.3% chance of urinary tract infection during the lifetime. This greatly exceeds the prevalence of circumcision complications (1.5%), which are mostly minor. The potential seriousness of urinary tract infection supports circumcision as a desirable preventive health intervention in infant males.
https://www.jurology.com/article/S0022-5347(12)05623-6/fulltextThe American Urological Association, Inc.® (AUA) believes that neonatal circumcision has potential medical benefits and advantages as well as disadvantages and risks. Neonatal circumcision is generally a safe procedure when performed by an experienced operator. There are immediate risks to circumcision such as bleeding, infection and penile injury, as well as complications recognized later that may include buried penis, meatal stenosis, skin bridges, chordee and poor cosmetic appearance. Some of these complications may require surgical correction. Nevertheless, when performed on healthy newborn infants as an elective procedure, the incidence of serious complications is extremely low. The minor complications are reported to be three percent.
Properly performed neonatal circumcision prevents phimosis, paraphimosis and balanoposthitis, and is associated with a markedly decreased incidence of cancer of the penis among U.S. males. In addition, there is a connection between the foreskin and urinary tract infections in the neonate. For the first three to six months of life, the incidence of urinary tract infections is at least ten times higher in uncircumcised than circumcised boys. Evidence associating neonatal circumcision with reduced incidence of sexually transmitted diseases is conflicting depending on the disease. While there is no effect on the rates of syphilis or gonorrhea, studies performed in African nations provide convincing evidence that circumcision reduces, by 50-60 percent, the risk of transmitting the Human Immunodeficiency Virus (HIV) to HIV negative men through sexual contact with HIV positive females. There are also reports that circumcision may reduce the risk of Human Papilloma Virus (HPV) infection.
https://www.auanet.org/guidelines/circumcisionRecent studies have found that circumcision may provide relative benefits including the potential prevention of UTIs (urinary tract infections) in infancy. Among adults in developing countries where the prevalence of sexually transmitted disease is high, circumcision reduces the risk of HIV/AIDS, syphilis and chancroid. In developed countries, circumcision may decrease the lifetime risk of penile cancer in men and cervical cancer in women among high-risk populations later in life. Despite these potential benefits, evidence must be placed in the context of study settings, local prevalence rates, timing of circumcision and cultural and religious beliefs. It should also be highlighted that circumcision provides only partial protection from the above conditions and there is a need for proper hygiene of the penis. Safe sexual practices are still essential and should not be replaced by circumcision.
Circumcision provides some benefit in preventing UTI in boys, particularly in those with underlying anatomical anomalies of the urogenital tract. In low prevalence populations such as Australia and New Zealand circumcision does not provide significant protection against STIs and HIV, and is less effective than safe sex practices. Circumcision decreases the risk of penile cancer probably by preventing phimosis.Circumcision may offer protection against development of cervical cancer in high risk populations, but is overshadowed as a protective measure by HPV vaccines.
https://www.racp.edu.au/docs/default-source/advocacy-library/circumcision-of-infant-males.pdf3. The proponents of female circumcision say it has medical benefits. For example, some say it reduces chances of infection. Sound familiar? Does that make it right?
I'm not terribly familiar with female circumcision (I thought that it was all clitorodectomies) or the evidence touting benefits. Can you please provide me some of the peer reviewed medical articles that recommend it?
The evidence pretty clearly indicates that male circumcision has medical benefits. Because of that I'd recommend it if someone asked my opinion, but am also fine with a person who isn't comfortable with it.
I think if you want to cite medical reasons why stop there. I hear you can reduce the rate of testicular cancer if you remove the testes at birth!
There's typically a weighing of risk/reward when choosing to recommend a procedure. There are significant and common disadvantages (ranging from hormonal and growth problems to sexual function) to removing the testes. According to the evidence (please read some of the links I've posted above) these are quite rare when considering circumcision.