Circumcision on the Block

For several years in the midst of otherwise erudite and compelling debates and lectures against Christianity and the metaphysical claims of all religion, Christopher Hitchens would veer into a soliloquy that would equate slicing off the clitoris with circumcision lumping them both together in a rousing renunciation of “genital mutilation” On the other side of the English class and ideological divide, we've got Andrew Sullivan of the Daily Beast who is against infant circumcision convinced it is in fact “genital mutilation” and therefore a violation of human freedom. My reaction would always be, “I'm not mutilated, what's he talking about.” When I've had sex with an uncircumcised man, have we been having significantly different experiences, even experiences that due to my dulled sexual response from circumcision aren't truly comparable? Oh, no!!! Everything seemed to be going jolly well indeed, until these two British intellectuals planted this fear in my brain that sex has been going off at 80% of how it might have been … that alone is depressing if it's true, and then add the idea of bodily defect, damage, and mutilation, and suddenly I'm reviewing the tapes wondering how I could have recognized the unrecognizable. I suppose my biggest mistake was to allow the thoughts of these two rather un-sexy Englishmen intrude upon the repose of my tenderest memories.

In the event, today we will figure it all out. Is infant circumcision a medically beneficial, safe, and pain-free procedure, or is it a risky, deforming, excruciating assault on bodily integrity, heightened sexual response, and human freedom? Our sources are the paltry products of a quick Internet search. There is a fact sheet from Doctors Opposed to Circumcision a D.C. Based advocacy organization and a health group webpage from Nemours Kids Health

First question: does it hurt. The oppositions says the procedure “Is excruciating for an infant as well as an adult. Tightening the circumcision clamp puts crushing pressure on a large area of sensitive skin.”The kids health site says, alarmingly, that until recently “anesthesia hasn't been universally used,” but that two forms of local anesthetic are recommended by the American Academy of Pediatrics (AAP): (1) a topical cream and (2) a much quicker acting injectible anesthesia. Besides the anesthetics, the site says “giving a pacifier dipped in sugar water can help reduce your baby's level of stress,” which when you think about it is not very re-assuring – if the anesthetic is truly eliminating any pain how come something more is needed to sooth the baby's stress level?

A website for NY area Rabbi Boruch Mozes (a certified Mohel) the Rabbi reviews many anesthetic options, and claims that a traditional bris circumcision is quicker and less painful than the procedure performed in a hospital. If this is in fact true, then the medical profession must adopt the quicker less painful procedure Also, what is a Rabbi doing performing a medical procedure? We don't let Priests suture wounds even if they originate from an instance of stigmata. And we wouldn't let Priests train to suture such wounds, and we wouldn't allow physicians to be used as spokespersons for a Priest suturing such wounds. But Rabbi Mozes has numerous highly qualified physicians on his website endorsing him as qualified to perform circumcision. The Rabbi does say “There are situations where Bris circumcision on children and adults are performed in a hospital. A surgeon performs the surgical procedure and a mohel participates in the removal of the foreskin.” For me, that settles it. It is a medical procedure, a doctor must perform it. And it must take place in a hospital or medical facility. Most importantly, the most effective anesthetic must be used.

Interestingly, the two sides give only conclusory or vague indication of whether circumcision has health benefits. The opponents state penile cancer is not prevented by the procedure, and without mentioning the claim that circumcision helps prevent STDs, asserts without citation it leads to “increased exposure to sexually transmitted diseases.” The health site indicates that the circumcised suffer a lesser risk of urinary track infection, while admitting only about 1% of male babies are at risk for that condition. It equivocates on STDs, saying “ Some studies indicate that the procedure might offer an additional line of defense against sexually transmitted diseases (STDs), including HIV”

What about sexual pleasure? The opponents claim the foreskin provides “most of the nerves for sexual response.” Really? Most? Seems like I've got more than half of 'em. Anyway, they go on to say the loss of the foreskin “contributes to inferior sexual relations, which leads to increased divorce rates, increased violence, increased exposure to sexually transmitted diseases, and contributes to impotence, especially after age 40.” No studies are cited for any of these broad claims. Kids Health takes an odd tack on this issue – “Some people claim that circumcision either lessens or heightens the sensitivity of the tip of the penis, decreasing or increasing sexual pleasure later in life. But neither of these subjective findings has been proved.” Ummm … that means they have not been disproved either, and so the conclusion is that no one has taken the trouble of determining for sure if sexual response is significantly diminished by circumcision. That doesn't strike me as either very scientific or humane. If sexual response is significantly diminished that would be something the medical profession ought to want to know about for sure before it sanctions a surgical intervention. The claim the the answer is subjective is bogus. There is undoubtedly an objective way to measure this and the fact that neither side seems terribly interested in testing this crucial hypothesis is disheartening.

A ban on circumcision is not – on the record I've been able to develop in a coupla hours – justified. What I've learned is that circumcision is a medical procedure and therefore must be performed by doctors in a medical facility using the scientifically determined most effective anesthesia. No excuses, No exceptions. Each side in the debate must take the question of whether circumcision in fact helps prevent sexually transmitted diseases seriously and advocate for ways to answer this vital question empirically. Similarly, advocates on both sides of the issue are obliged to support true scientific investigation into the issue of sexual response and provide parents with an answer they can rely upon in deciding about the procedure for their male children. As long as there is health benefit and it is clear that sexual response is not significantly diminished, it would not be a human rights violation for parents to make the call. On the other hand, should any significant diminution in sexual response be discovered and proven and the health benefits remain speculative or refuted, then the medical profession would be obliged to discourage circumcision.

A ban could be justified solely on the grounds that the health benefit is basically zero. That would make circumcision as “elective” as a medical procedure could be. Obviously there is more to learn and skeptically evaluate. I'm curious what I missed. Hoping you'll fill me in.