Diem-Tran (Bijou) Nguyen is a senior at USC pursuing a major in history and minor in natural science. She plans on attending medical school after graduation. She is originally from Huntington Beach and is the oldest of four children. She loves working with children and animals, trying new places to eat, and traveling.
Though the practice of male circumcision is based in age-old religious and cultural traditions, today it is often performed for non-religious reasons. Given the prevalence of this procedure in Western culture, it may be surprising that circumcision has recently come under scrutiny on the basis of its ethicality. Anti-circumcision advocates argue that neonatal circumcision is child abuse; they see it as a blatant violation of human rights since infants cannot consent to surgery. Other critics highlight the historical use of circumcision to restrain male sexuality, and contend that the laws prohibiting female genital mutilation, which is often considered to be a sexual crime, should also apply to male circumcision. Some opponents of circumcision have even attempted to eliminate the practice entirely.
As explained by Mike Stobbe, recent efforts by anti-circumscision activists to add a proposal banning underage circumcison to the November 2011 ballot in San Francisco resulted in heated debate when citizens considered the medical and religious arguments made in favor of the procedure by parents and religious groups respectively. Ultimately, the medical benefits of male circumcision are too important to be overlooked, and therefore the state of this practice in the United States should not change. Assuming that this surgery continues to be safe and low-risk, circumcision should continue to be an elective procedure, provided that those involved are fully informed of all potential outcomes.
“Circumcision in America is more often than not performed for non-religious purposes, and it is the associated medical rewards that have made this surgery relatively common.”
In the past, circumcision has been accepted as a required practice for certain religious groups. According to Dr. Laurence S. Baskin, circumcision is the surgical removal of the penile foreskin. J.M. Glass, a member of the Department of Urology at Northwick Park Hospital, stipulates that circumcisions have been “essential components” of the Muslim and Jewish faiths for four millennia. Glass asserts that all Jewish males, ranging from those who are orthodox to those who are unobservant of Jewish practices, must be circumcised to honor a covenant made between God and the Jewish people. Circumcision is directly referenced in the book of Genesis (17:10-14), as cited by Glass, when God stated, “Every [Jewish] male… shall be circumcised…. [A]n uncircumcised male… shall be cut off…, [as] he has invalidated My covenant.”
Such examples of the religious motivation behind the procedure illustrate the urgency and uncompromising nature of circumcision to the Jewish people. Glass continued to emphasize the vitality of circumcision in Judaism when he noted, “Circumcision… will be part of Judaism forever. There is no need to seek reasons for it to be performed.” Therefore, for those individuals religiously or culturally affiliated with faiths that mandate circumcision, justification for this procedure is unnecessary. Rather, circumcision is accepted as a sacred practice, and as a result, the fact that its legitimacy is being currently contested is alarming to many religious groups.
In addition to the religious arguments made in favor of circumcision, many medical and social motivations also contribute to the pro-circumcision stance. Baskin cites a study from 2008 where researchers found the incidence of neonatal circumcision to be 55-57%; the same study estimated that 80% of all males in America were circumcised. Baskin also referenced cross-sectional studies that revealed that “40 to 67 percent of parents reported that they chose to have their son circumcised because of its hygienic and medical benefits; 23 to 37 percent…for social reasons…; and 11 to 19 percent…for religious reasons.” These statistics illuminate that circumcision in America is more often than not performed for non-religious purposes, and it is the associated medical rewards that have made this surgery relatively common.
“Given the medical benefits associated with this procedure, it is unsurprising that parents often choose neonatal circumcision.”
Baskin explained that neonatal circumcision tends to be more popular than postnatal circumcision because male circumcision past infancy is often painful and requires longer recovery periods. He also notes that many parents elect to have their babies circumcised because it “has been associated with… lower rates of urinary tract infection (UTI), penile cancer, penile inflammation, penile dermatoses, and sexually transmitted infections.” Baskin pointed out how circumcision has been affiliated with cleanliness as the foreskin “is susceptible to microabrasions… [that] facilitate acquisition and transmission of infection.” In addition, he mentions that circumcision has been proposed as a preventative measure to check the rampant HIV/AIDS epidemic, and has been linked to decreased rates of cervical cancer, genital ulceration, and bacterial vaginosis in sexual partners. Given the medical benefits associated with this procedure, it is unsurprising that parents often choose neonatal circumcision.
In spite of the various medical benefits correlated with circumcision, some groups have lobbied for the surgical procedure’s elimination. In addition to the aforementioned activists in San Francisco, organizations such as Doctors Opposing Circumcision have fought to outlaw circumcision, and the topic of circumcision has stirred up rousing debate in medical journals. In their article published in the Journal of Medical Ethics, M. Fox and M. Thomson explain why they believe circumcision is unethical. They criticized the “problematic” willingness of physicians to “tolerate the non-therapeutic, non-consensual excision of healthy tissue,” and heatedly debated what constitutes a child’s best interests. They, like other opponents of circumcision, question the morality of parental jurisdiction over neonatal circumcision, and contest that the practice is unnecessary, and even harmful.
“Fox and Thomson contend that these stereotypical portrayals of the male and female bodies unethically divide the sexes, and go as far to suggest that the failure to treat female and male circumcision equally perpetuates gender inequality.”
To champion their view of circumcision as a human rights violation, Fox and Thomson use an extended analogy that compares and contrasts societal attitudes towards female and male circumcision. They place male circumcision on the same level as cliterodectomy, or the amputation of the clitoris, proposing that the hostility applied to female genital mutilation (FGM) by the bioethical community should also be applied to male circumcision. Fox and Thomson reference the UK Female Genital Mutilation Act 2003 and the US Federal Prohibition of Female Genital Mutilation Act 1997, which forbid female circumcision under any circumstances, including religious and cultural grounds, due to its historical motivations rooted in patriarchy and female disempowerment. They noted, “By contrast with such extraordinarily punitive laws [for FGM], the absence of any statutory regulation governing the practice of male circumcision is striking.”
To bolster their argument that the oppressive motivations linked to FGM should be applicable to male circumcision, Fox and Thomson reference historical accounts in which the removal of the foreskin was believed to discourage masturbation and to diminish male sexuality, which was viewed as “a threat to public health and social stability.” They asserted that it is immoral that “law… construct[s] the male body as invulnerable…. [while] the female body [is] characterised by vulnerability, which leaves it more open to medical intervention and management.” Fox and Thomson contend that these stereotypical portrayals of the male and female bodies unethically divide the sexes, and go as far to suggest that the failure to treat female and male circumcision equally perpetuates gender inequality. The views appropriated by Fox and Thomson are opinions held by many anti-circumcision advocates, and the comparison of female and male circumcision is therefore one that should be explored.
While anti-circumcision activists like Fox and Thomson champion the alteration of circumcision’s current standing in the United States, their arguments are not necessarily legitimate. The analogy that relates clitoridectomy to male circumcision is unfortunately faulty because it demerits the medical benefits of male circumcision and simultaneously disregards the risks of FGM. Carla Makhlouf Obermeyer, an associate professor of international health at Harvard University, outlines an extensive list of injuries that can result from FGM. According to a compilation formed by the World Health Organization in 1996, which Obermeyer references, FGM can result in “fatal hemorrhage…, acute and chronic infections…, infertility, keloid scars, abscesses and cysts, …sexual dysfunctions, …problems in pregnancy and childbirth, [and] sexual, mental, and social [problems].” To add to those statistics, a study conducted by Emmanuel Monjok, E. James Essien, and Laruen Holmes Jr. concluded that FGM “may increase the possibility of HIV transmission, due to inflammation and abrasions to the vaginal epithelium.”
“Given the vast differences in the original rationales behind male and female circumcision, we should understand that these two surgical procedures cannot be compared on simple terms.”
Furthermore, Monjok, Essien, and Holmes state that FGM is often associated with “psychological trauma including post traumatic stress and chronic behavioral ailments.” Given this data, there are decidedly no known medical benefits of cliterodectomy. Male circumcision, on the other hand, as outlined before, has been linked to reduced rates of numerous penile afflictions. Unlike male circumcision, FGM is blatantly harmful, and it is because of these medical perils that female circumcision is illegal. The vagina and the penis are two distinct organs and comparing them on such an unsophisticated level is problematic because it fails to account for anatomical differences and a wide range of medical complexities.
To continue this discussion from a more social standpoint, we can note that the limited comparison of female and male circumcision downplays the history of male chauvinism behind cliterodectomy. Obermeyer described FGM as a “violation of [the] female essence” and as “emblematic of all women’s suffering under global patriarchy.” Historically, Obermeyer contends, clitoridectomy has been implemented to quash female enjoyment during intercourse in order to assert male dominance, guided by the belief that amputating the clitoris prevents females from achieving orgasm.
Although male circumcision may have been used to thwart young boys from masturbating, the original motives of this practice were not to restrain male sexuality in the same way that cliterodectomy was. In modern Western culture, male circumcision is most often performed for medical, social, and religious reasons—not to reduce male sexual pleasure. In fact, Baskin cites two studies that surveyed males who participated in a randomized trial of adult male circumcision which concluded that “there was no significant change in sexual satisfaction after the procedure and no change in sexual function.” Given the vast differences in the original rationales behind male and female circumcision, we should understand that these two surgical procedures cannot be compared on simple terms.
“Circumcision should continue to be an elective procedure, provided that those involved are fully informed of all potential outcomes.”
Male circumcision as it stands is a highly debated issue, but we must strive to come to some basic agreements. First, it should make sense that circumcision, when required to prevent infection or to treat an illness, should be performed without question. Controversy over consent should come second to saving a child’s life. Second, banning circumcision, a practice considered sacred in some branches of faith, would undoubtedly infringe on rights to freedom of religion. Third, we should understand that parents are generally not guided by malicious motives when they decide on circumcision for their children.
Most parents, as illustrated by the statistics presented by Baskin, have their children circumcised for medical reasons, and often as preventative, defensive measures. Based on this line of reasoning, parents do have their children’s best interests in mind. To address the controversy over an infant’s inability to provide adequate consent to surgery, perhaps an analogy can be used. Children under the age of eighteen cannot consent to the removal of their wisdom teeth, but their parents often choose to have this surgery performed to relieve impending discomfort and to prevent gum disease and impacted teeth. Yet, the morality of wisdom teeth extraction has not been challenged.
“We must facilitate discussion that involves mutual respect and willingness to listen to different viewpoints to work towards a definitive conclusion about the ethics of circumcision.”
Undoubtedly, there is something inherently more personal about certain parts of the body than others; therefore, part of the reason that circumcision is such a controversial topic is because it affects an organ that has the potential to be tied to one’s sense of self. However, when it comes to health, it is important that parents be able to make preventative decisions, regardless of the location of such treatment, in order to ensure the well-being of their children. To eliminate a low-risk procedure like circumcision due to concerns regarding dubious consent might draw other surgical procedures into question, undermining parental authority and perhaps even resulting in failure to treat graver illnesses. As long as parents are fully informed of circumcision’s risks and details, and the surgery is not imposed on unwilling parents or mandated by the government and medical professionals, neonatal circumcision should continue to be a viable, available option.
To dispel any rumors, to delinate the facts clearly, and to allow the public to develop well-educated stances on circumcision, I propose organizing a panel with leaders from the lobbying forces of both sides of the circumcision controversy. Ideally this panel would be held at the University of Southern California, which boasts a diverse racial, ethnic, and religious student body—a vocal student body whose members may have definitive positions on circumcision. This conference would be open and free to the public in order to achieve as wide of a scope as possible. Invitees would include leaders of Doctors Opposing Circumcision and other anticircumcision advocates, such as Fox and Thomson, experts on female circumcision, gynecologists from the Keck School of Medicine and Cedar Sinai, and members of the religious center at USC, such as Chabbad, Hillel, and the Muslim Students Union.
The goal would be to create a public forum in which speakers could feel comfortable outlining their opinions on circumcision. Ideally, this convention would allow for open dialogue among individuals who hold circumcision sacred, those who see it as an immoral practice, and members of the population who look solely at circumcision’s health-based benefits. We must facilitate discussion that involves mutual respect and willingness to listen to different viewpoints to work towards a definitive conclusion about the ethics of circumcision.
In addition, to help both adult males and parents decide whether circumcision is beneficial for themselves or their children, medical professionals educated about circumcision should provide pamphlets outlining the pros and cons of the procedure. These pamphlets should be government-funded, as circumcision has found its way into political spheres of debate, and be available in the offices of gynecologists. Ideally, they should emphasize that neonatal and postnatal circumcision are by no means required, but rather are elective procedures that may be considered.
The leaflets should elucidate that circumcision does not make men invulnerable to disease; rather, they should explain that the use of contraceptives, intercourse with a limited number of partners, and proper cleaning of penile tissue, as Baskin delineated, are more likely to protect a man from contracting a sexually transmitted infection than circumcision is. In addition, the provision of educational information to those who choose not to undergo circumcision is necessary as well. Ultimately, whatever a male personally decides regarding his genitalia, medical resources should be available for him to maintain his health.
“When it comes to health, it is important that parents be able to make preventative decisions, regardless of the location of such treatment, in order to ensure the well-being of their children.”
In the past, circumcision has mainly been a private family matter, but as the ethics of this procedure have been challenged, it is vital that we try to understand the varying opinions in order come to a well-informed decision about circumcision’s existence in our country. Given the broad range of medical benefits associated with this practice, male circumcision should continue to exist in the United States as it has in the past provided that the surgery continues to be performed in safe, sterile environments. Medical, religious, and social reasons offer sufficient incentive to allow circumcision to persist in American society. Perhaps, with further research on this surgical procedure, science can unveil further medical benefits of circumcision that can contribute to the treatment of a multitude of illness and outbreaks plaguing society today.
Baskin, L.S. (2012). Neonatal circumcision: Risks and benefits. In C.J. Lockwood & J.G. Bartlett (Eds.), UpToDate. Retrieved from http://www.uptodate.com/contents/neonatalcircumcision- risks-and-benefits
Essien, E.J., Holmes, L., and Monjok, E. (2007). Female genital mutilation: Potential for HIV transmission in sub-saharan Africa and prospect for epidemiologic investigation and intervention. African Journal of Reproductive Health/La Revue Africaine de la Santé Reproductive, 11, 33-42. Retrieved from http://www.jstor.org/stable/30032486
Fox, M. and Thomson, M. (2005). A covenant with the status quo? Male circumcision and the new BMA guidance to doctors. Journal of Medical Ethics, 31, 463-469. Retrieved from http://www.jstor.org/stable/27719454
Glass, J.M. (1999). Religious circumcision: a Jewish view. BJU International, 83, 17-21. Retrieved from http://www.jstor.org
Obermeyer, C.M. (1999). Female genital surgeries: The known, the unknown, and the unknowable. Medical Anthropology Quarterly, 13, 79-106. Retrieved from http://www.jstor.org/stable/649659
Stobbe, M. (2011, May 18). San Francisco circumcision ban to appear on ballot. Huffington Post. Retrieved from http://www.huffingtonpost.com/2011/05/18/san-franciscocircumcision- ban_n_863945.html 1