Wednesday, June 6, 2012

Refuting Pro-Circumcision Propaganda of Health Benefits for Infants

The latest strategy of The Pro-Circumcision Propaganda movement is to claim infant circumcision cannot or will never be banned because it has legitimate "health benefits".  From the CDC & the AAP, you'll hear the latest defence of circumcision is that its a legitimate medical practice and it has proven health benefits. This despite the multitude of evidence to the contrary, and whilst at the same time ignoring the risks, harms and losses.

In their strategy to promote infant circumcision and  their latest propaganda attempt the are quoting from a Procirc Website which makes the dangerous claim that Circumcision will help create a generation free of HIV AIDS.  This is a very dangerous public health statement because WE already have many African Nations where the circumcised populations have higher HIV rates than Non-Circumcised, and the USA which has the highest adult circumcision rates in the developed world, with also the highest HIV infections in the developed world.  In fact reported in press there has been a rise in HIV infections following circumcision campaigns reports here: To say circumcision will create a HIV free generation is just irresponsible propaganda!!!!!!!  

The First valid criticism of this pro-circumcision propaganda is that Routine Infant Circumcision violates the human rights of the infant.   Human Rights outweigh any possible health benefits.  Consider female circumcision, there are 3 reported studies that show female circumcision lowers HIV infections in circumcised women.  This has never been pursued because the human rights of females are considered more important than any possible health benefit.  To remove a functional sex organ/s from a being that cannot consent is a human rights violation, for either sex male or female. 

The Second refutation is the lack of medical consensus on the health benefits of circumcision in particular for infants or children.  No Medical organisation in the world recommends infant circumcision, and since the wide publicity of the African Trials, medical organisations from Australia & The Netherlands have released explicit medical statements stating infant circumcision is niether required nor recommended.    This is because there is zero evidence that infants require circumcision for  health & well-being, even the AAP acknowldege this. The only potential benefit which has any relevance to an infant is UTI, which the medical literature shows is easily treatable with antibiotics and of low incidence in male infants (Female's have much higher UTI's and antibiotics is considered the best treatment & not surgery.)  In fact the complications of infant circumcision (2 to 3 in 100) far outweigh any protective effect for a male infant UTI (1 in 100) making more children sick from circumcision than a UTI, not to mention losses of function, pain, and human rights violations. Outside of the USA, the foreskin is recognised as a normal functional sex organ of the male penis, and worth preserving for the male to enjoy when sexually active.   Health outcome data shows that in developed countries, the nations with best health outcomes, including lowest HIV/STI's are all from Non-Circumcision cultures.  There is a large body of evidence that shows intact men, live long healthy lives with foreskins intact. In Finland where these statistics are gathered the rate of circumcision for an adult requiring a medical circumcision are 1 in 16700.  Most medical organisations believe that conservative medical practice,  health education, safe sex behaviour, and genital hygeine, give far superior health benefits, in comparison to circumcision, without any losses of function or human rights violations. 

The third refutation is related to the denial and minimisation of harm done by circumcision to a perfectly healthy baby. The harms are numerous, from pain during and post surgery, problems of excessive bleeding, problems of infection, less of sensation and function, externalising an internal organ, meatal stenosis, penile damage, death, the list goes on and on.......

The Fourth Refutation is  Relevance.  In particular, that the data from the African RCT HIV Studies have zero relevance to infant children.  The African research was conducted on paid adult male volunteers, who were part of Trials which went for between 18 to 24 months. And while these African studies have been widely criticised, if we put all our criticism of the African research aside, and take the results on face value, that male circumcision reduces some risk of HIV infections from females to males, over an 18 to 24 month period.  The following can be said about relevance:

  1. The majority of issues where it is claimed circumcision has health benefits are for adolescent and adult males, and of these conditions most can be treated or prevented by other means such as barrier method use of condoms for STI/HIV, gential hygeine, HPV vaccine, and steroid creams or preputioplasty for tight foreskins.  These do not apply to infants and using African Research on adults is not relevant and does not justify circumcision of infants.
  2. The research used to justify infant circumcision comes from Africa.  Africa is a continent with Extreme poverty and disease, and has high prevalence of HIV & when sexually transmitted it is predominantly via hetero-sexual transmission, whereas in western nations, HIV is a low  prevalence disease, and when sexually transmitted is predominantly via homosexual transmission, or a disease spread in the injecting drug user community from needle sharing.  The small protective effect of circumcision if there is one, is only for heterosexual transmission protecting males from female infections.  Condoms are more effective, and protect both partners not just one.  Females are not protected from male circumcision, with one trial showing women were infected at higher rates by circumcised men.  Circumcision is not protective for MSM, not protective for IV Drug users, nor for contaminated blood.  The relevance of the studies only applies to consenting heterosexual adult male volunteers in high prevalence settings.
  3. Research outcome data and recommendations must logically follow from each other, therefore any recommendations can only apply to heterosexual adult male volunteers in high prevalence settings.  These outcomes cannot be applied to infants, nor in low prevalence settings, and it is impossible to know whether an infant is heterosexual?
  4. The outcome data has no relevance to newborn infants or children.
  5. Infants do not have sex.
  6. Infants have not chosen their sexual orientaton or lifestyles.
  7. Infants may grow into men that want to be in faithful monogamous relationships.
  8. Most Infants born in low prevalence communities will never have exposure to a HIV infected sexual partner in their entire lives.
  9. Given the foreskin is a highly enervated pleasure giving sex organ in itself, Infants may grow into men that want to have an intact penis.
  10. Infants may grow into men that choose to practice safe sex, and use condoms consistently.
  11. Infants may grow into men, that choose to never travel to Africa, and to never have sex with HIV African infected women, or African sex workers.
  12. Infants may grow into men that choose celibacy for themselves.
  13. Infants may grow to be Gay Men.
  14. A man who is informed about sex, about safe sex, about condoms, and about circumcision, may make a choice for himself on any of these matters for himself, and it is not necessary that he be circumcised as a baby. 
  15. Circumcision is not required in infancy and best left to the man to decide for himself when he understands the sorts of choices he wants to make for himself. 
  16. Circumcision does not prevent HIV/STI's.
  17. Circumcision is not a barrier method, the circumcised penis is made of skin, and has vulnerable areas like the meatus & circumcision scar, and circumcised men get HIV/STI's and have to wear condoms.
  18. So if we give every benefit of  the doubt to Pro-Circumcison advocacy, all they can ethically justify is that adult men, particularly those in high prevalence settings,  be informed of circumcision's potential health benefits, along with the criticisms and harms of circumcision and doubts about its efficacy, and that if circumcised he must still use a condom, and  it be left to adult men to make an informed consent decision for themselves.
Ultimately, and the strongest argument against infant circumcision is "That taking the choice about a man's body away from him, particularly when he is an infant, is a human rights violation".


  1. The list is quite instructive and infromative. As I know Africa always takes the leading position with high prevalence of HIV and sexually transmitted diseases. Although some points are quite contradictive.

    1. Cindy, explain which bits are contradictive and I'll try and address them?

    2. Yes you are right Cindy, having re-read it, there were some contradictory themes, so I have tried to clarify, and made some adjustments in bold italics.

    3. These and many other claims if "researchers" in Africa rely on the assumption that Africans have crazy unmitigated sex. There is reason to believe this assumption is false, and that it is passed off as matter of fact because many "researchers" and their work rely on it. Attention is drawn away from the fact that Africans contract many diseases asexually, HIV being notorious for being spread at health care facilities.

      I highly recommend you read "HIV in Kenya," a blog by Simon Collary. He is a man on the ground and a witness to the many lies and propaganda being pawned off on Africans.

  2. "The more "benefits" (or "potential benefits") we can "prove" with "research," the more justified infant circumcision is" is a covert contract that circumcision advocates have made with themselves.

    Of course, advocacy of male infant circumcision has absolutely nothing to do with medicine, as there is nothing wrong with healthy children and men.

    Circumcision advocates would like for their audience to believe that circumcision is this "innovation," they only just discovered yesterday. They want to draw attention away from circumcision's history and the history of its advocacy.

    The reasoning they try to employ here works under no other circumstances. Usually, medicine dictates that there be a medical necessity that indicates surgery, not that surgery is warranted in the healthy if enough "benefits" can be argued for. This logic is absolutely backwards.

    The "benefits" of circumcision can all already be afforded in other ways. It should be telling that advocates are focused on necessitating this one particular "solution," which also happens to be a religious blood rite historically steeped in controversy.

    It is mistaken, the belief that the violation of basic human rights can be justified if only enough "research" is produced.

    This is nothing more than an attempt to clothe cherished beliefs, traditions and an easy stipend with "science," and it is about time academia dismissed it.

    1. All very good points, Joseph! A comment I will make is that I've heard it said: "the health benefits are what allows it to be justified under the hippocratic oath." In other words, the health benefits are so significant that it is doing the patient more harm to leave him intact. The reason why this statement is allowed to stand is because of the following argument: "there are no significant health benfits to FGM which is why it is harmful". And around and around we go...

    2. This comment has been removed by the author.

    3. the fact is simple circumcision is wrong for exactly the same reason as the amputation of healthy arms and leggs. while these procedures will keep yuor boy of th Sreets and out of the miitary they would donothing for his health or hapines. circumcision is wrong and is first degree childmolesting. you hate the odd peadaphile wel I would have hated to have had my foreskin stolen more and I know what iam talking about

  3. There are so many issues at work against us. American research and American journals have a huge effect on determining what "consensus" is in the medical community. American male researchers who advocate circumcision may deny what was done to them, may want to justify what was done to them, or just plain be ignorant of what a foreskin is. Or they could be circumfetishists.

    In any case, this hurts our cause severely. Forgive me for using a strong word, but what we have here is an apartheid in the medical community: the minority opinion gets the most studies because the minority has the money to conduct those studies and the motivation to do so.

    A European researcher knows his foreskin is good. Why would he research to prove that? He has no motivation and research is expensive. An American researcher may have any number of reasons for proving circumcision is beneficial: ties to a medical device manufacturer, to receive additional funding from pro-circumcision organizations, etc. The result is the minority opinion dominates due to money!

    The human rights angle, in my opinion is the most convincing argument. After all, it worked for FGM! But cultural bias plays a huge role as well. In Egypt, FGM is not a human rights issue just as MGM is generally not considered to be a human rights issue in America.

    What makes the human rights argument difficult goes back to "health benefits". If enough benefits can be proven, it is considered that MGM is of the greatest benefit to the infant.

    My counter to the "health benefit" argument is the following: Even if the health benefits claimed for circumcision are true, you're talking about minor issues like UTIs (women get these all the time and treated with antibiotics), phimosis (easily treated with steroid cream/stretching and likely caused by forced retraction), and penile cancer (an extremely rare form of cancer). Circumcision causes more deaths (> 100/year) than it prevents. This is an indisputable fact. On the other hand, infant mastectomies would save 500,000+ women's lives each year. Babies can do just fine on formula (< 10% of women breastfeed through the first year in the US and less than half try it for any length of time at all). My example seems extreme and absurd. But look at how many lives can be saved! Yet we take the choice away from boys whether they have an intact penis for virtually insignificant benefits (if there are any).

    I'm a huge fan of breastfeeding, by the way. My statement above was for hyperbole only.