The Science of Circumcision

By: Myles Power Edited by: Hannah
.
Male circumcision is the surgical procedure for the removal of the foreskin from the human penis. It has grown in popularity over the past hundred and fifty years to such an extent that it is now considered a common medical procedure in America. For such a popular procedure, very few people actually know much about it, including its benefits, its side effects and its history. This article hopes to shed some light on those key points and make you think about what circumcision really is.
.
The first evidence of circumcision dates back to the time of the ancient Egyptians. Carvings on a tomb thought to date from between 2400-2300 BC clearly show the procedure being performed. Although no historians disagree with what is being depicted, they do disagreed about why the Egyptians would do it. Some think it was a rite of passage into adulthood, while others think it was to make a distinction between the elite and the rest of the population. Circumcision was later featured in the Hebrew Bible, which describes the circumcision of Abraham and his relatives and slaves not as a spiritual act, but as a physical sign of their covenant with God.
 cur1
Although circumcision has been around for a while, it was not as popular in America a hundred and fifty years ago as it is now. It was seen more as a religious act and not a medical procedure, unless used to alleviate specific genital problems. This was until a Dr. Lewis Sayre (one of the most prominent physicians in America at the time, who was responsible for the Bellevue Hospital Medical College and the American Medical Association) came up with some very strange theories indeed. In 1870, he was asked to look at a 5-year-old boy who was presenting with either paralysis or severe motor problems. Sayre diagnosed the boy’s condition as a result of his penis being constricted by his foreskin… I’m not kidding. The boy’s health actually improved and Sayre attributed it solely to the circumcision he performed. He then began to promote circumcision for a wide range of medical and social problems including syphilis, headaches, alcoholism, masturbation, and “lunacy”. His “interesting” theories regarding circumcision astonishingly caught on with the medical community, who – prompted by Sayre – began to investigate a whole host of genital surgeries designed to alleviate psychological problems and cure unrelated illnesses.
Believe it or not, masturbation in the Victorian times was considered a serious problem. John Harvey Kellogg (whose name you may recognise from your box of cereal in the morning) was one of the physicians investigating circumcision. He worked for the “rehabilitation of masturbators” and often employed extreme measures in his research. This would include the forced circumcision of boys and young men caught masturbating, intentionally performed without anaesthetic. In his book, ‘Plain Facts for Old and Young‘ he wrote: “The operation should be performed by a surgeon without administering an anaesthetic, as the brief pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment, as it may well be in some cases.” He also burnt the clitoris of young women with phenol as a way of preventing “abnormal excitement”. I want you to remember this next time you are eating your Kellogg’s cornflakes.
 cur4
The views of the medical community then changed and they began to see circumcision as more of a preventable measure than a cure. They began to promote it to the public, who then began to get their children circumcised. As time went on, circumcision became a widely accepted practice in America. However, an ever-growing body of evidence that questioned the medical justification of such a procedure convinced European doctors that it was nothing more than a fad. As a result, the levels of boys circumcised in Europe decreased from the early 20th century, whereas circumcision remains a common procedure in America to this day.
.
Although claims that circumcision can cure syphilis, headaches, alcoholism, etc, have been thoroughly disproven, there has recently been a resurgence in claims that the procedure has medical benefits. Many claim that men who are circumcised have a reduced risk of HIV infection. In case you missed it, that means the research focusses on female-to-male transmission only, which is often something overlooked by people promoting circumcision. Wikipedia gives an example of one such study, which showed that heterosexual, circumcised men in sub-Saharan Africa had a decreased risk of infection (between 38% and 66%) over two years. It then goes on to postulate the mechanism of action and says that circumcision removes large amounts of Langerhans cells which can be targeted by the HIV virus.
cur5After reading the research it’s quoting, I believe the Wikipedia article is missing out some very important information. The study in question gathered three large groups of men from South Africa, Uganda and Kenya, who I believed would be a mixture of circumcised and uncircumcised people. It turns out however, that the study performed 2,328 circumcisions on half of the men themselves and then immediately began the study. It doesn’t take a rocket scientist to know that if you have part of your penis cut off you are probably not going to have sex in the near future, thereby reducing the probability of catching the virus over a set time; the study never addresses this issue. It then says that out of the 2,328 performed circumcisions, there were 178 (7.6%) “adverse events”. These included erectile dysfunction, swelling or haematomas, excessive bleeding, infections, damage to the penis, problems with appearance, etc.
.
Langerhans cells are present in all layers of the epidermis but are abundant in the mouth, foreskin, and vagina. There is debate in the scientific community as to whether these cells are the primary viral entry point, as they could be a vector to the lymph nodes, but they also express a protein called Langerin, which blocks the transmission of HIV. It should be mentioned that there is a lot of other research that shows a link between circumcision and a decrease of risk of HIV transmission. There is also a large amount of research that shows no link. The truth is that at this moment, we are not 100% sure one way or the other.
 cur6
If we step back here for a moment, we see the research for what it is – nothing more than an interesting tidbit; just like the fact that my being European means that I have a 1 in 10 chance of actually being immune to the HIV virus. Even if everything in the study mentioned above was true and you had the maximum 66% decrease in risk, it is still not protection against the HIV virus! The only way to prevent the transmission of HIV through sex (and most other STDs), is to wear a condom. I would not rely on my chance of having immunity and you should not rely on your circumcision to protect you.
.
Proponents of circumcision say that having a foreskin increases your chance of getting urinary tract infections. This is simply incorrect, not supported by any evidence and even if it was the truth, urinary infections are easily curable by antibiotics. You would not preventatively remove your eye in fear of contracting pink-eye, so why would you cut off your foreskin to prevent a urinary tract infection?
cir7
Some people have brought up circumcision as being a preventative measure against the risk of penile cancers. Penile cancers are very rare – about 1 case per 100,000 per year – with the number decreasing with the introduction of the HPV vaccination. If this is seen as an acceptable preventative measure against a type of cancer with rates this low, then why are we not removing the breasts from all women? Many of you would probably say that’s because breasts have a function and the foreskin doesn’t. Well, as it happens, that is not the case.
.
Among other things, the foreskin enhances sexual pleasure, protects the glans and keeps it moist. There are between 10,000 and 20,000 nerve endings compacted onto the human foreskin, which are used in the ejaculation reflex. Medics and scientists know exactly where these nerve endings are and they know exactly what they do. If those nerve endings are missing, it will decrease sexual pleasure for the participant. Since the foreskin also protects the glans and keeps it moist, without it the glans becomes thicker through a process called keratinisation. The process desensitises the glans and again, decreases sexual pleasure. There are a lot of men who can testify to this having had a circumcision later on in life, but their evidence is often dismissed as anecdotal. It should also be noted that removal of the foreskin can leave a scar and later in life, make the penis slightly smaller or even an odd, bent shape.
cur7
A lot of people say that they have had their son circumcised because it’s more hygienic. In saying this they are referring to the build up of a substance called smegma – a mixture of dead skin, oils and moisture that can accumulate under the foreskin. Many people are unaware however, that it is also produced by female genitalia. Why is not a problem for women, I hear you ask? Well, the same reason that it’s not really a problem for men – it can simply be washed away.
.
So, to sum up, there is no real scientific or medical reason for circumcision as a preventative measure. Even the most optimistic of benefits do not outweigh the negative side effects. Circumcision is like every surgical procedure – it has a risk. On average 1 out of every 100 circumcised children in America will develop complications. The majority are non-severe, but the odd few are and can even result in death. It is estimated that 1 in every 500,000 babies circumcised in America die from this unnecessary procedure. I am aware that some of you reading this will be saying you’re circumcised and you have no problem with it. That’s fine, but the decision to be circumcised should really be yours and sadly that’s not the case for most circumcised men in America.
.
We see female genital mutilation as extremely harmful and a violation of human rights – in the UK it is a criminal offence and carries a maximum sentence of 14 years in prison. We know it’s morally wrong and without merit, yet many of us see nothing wrong with the similar (albeit less severe) male circumcision. For the second time, stand back for a moment and this time imagine a world without circumcision altogether. What do you think would happen to a person found performing a circumcision on a newborn child; a procedure that will significantly decrease his sexual pleasure as an adult, by mutilating his genitalia for questionable (and as yet, unproven) benefits?
.
Advertisements
About Myles Power (580 Articles)
My name is Myles Power, and I run the educational YouTube channel, powerm1985. I spend what little free time I have sharing my love of SCIENCE! through home experiments, visiting sites of scientific interest, and angrily ranting at pseudoscience proponents. I am also one of the founding members of the podcast 'The League of Nerds' - which I co-host with James from 'The History of Infection'.

7 Comments on The Science of Circumcision

  1. Thanks for a marvelous posting! I quite enjoyed reading it,
    you may be a great author. I will be sure to bookmark your blog and definitely will come back later in life.
    I want to encourage you continue your great job, have a
    nice afternoon!

    Like

  2. It’s in reality a nice and useful piece of info.

    I’m happy that you shared this useful information with
    us. Please keep us up to date like this. Thanks for sharing.

    Like

  3. May I simply just say what a comfort to discover someone who
    really understands what they’re talking about online.
    You actually know how to bring a problem to light and make it important.
    A lot more people really need to look at
    this and understand this side of your story.
    It’s surprising you’re not more popular since you most certainly possess
    the gift.

    Like

  4. Thanks a lot for sharing this with all people you actually understand what you’re
    talking approximately! Bookmarked. Kindly additionally discuss with my
    web site =). We will have a link alternate contract among us

    Like

  5. Attention Nega Myles. You have work to do. I note that you have already indicated that your altar ego Myles had got some of his circumcision video wrong, but I don’t think you realise just how spectacularly, wildly wrong much of it is, and how damaging it is as he sets out to make circumcised males needlessly miserable. So I look forward to you taking him to task in your next Nega Myles presentation. Thus, in order:

    Kellogg and the Victorians. Aside from how seriously Kellogg’s views were actually taken (probably not as seriously as Myles thinks) it is irrelevant. Look up “genetic fallacy”.

    African HIV. Myles talks about “the study” when actually there were three independent Randomised Controlled Trials (RCTs – the “gold standard” of epidemiology). What he is citing is a Cochrane review – a review of the literature including these RCTs. The S. African one (pubmed/16231970) had n = 3274 of whom 3128 were HIV –ve, and of those 1546 were circumcised. The Kenyan trial (pubmed/17321310) had n = 2784, of whom 1391 were circumcised. The Ugandan trial (pubmed/17321311) had n = 4996, of whom 2474 were circumcised. This leaves me wondering where he got his 2328 figure from. That aside, he shows his ignorance when he states: “It doesn’t take a rocket scientist to know that if you have part of your penis cut off you are probably not going to have sex in the near future, thereby reducing the probability of catching the virus over a set time; the study never addresses this issue.” This is the tired old “lead time bias” argument that intactivists keep using despite it being refuted (pubmed/23156651). HIV tests were conducted at 0, 6, 12 and 24 months. If the benefit was due to men abstaining during recovery then it should show in the first 6 months. In fact the benefit got greater with time, so it cannot have been due to abstinence during recovery. And if Myles had tried reading the primary source documents (it helps, you know) he would have found that the S. African trial did allow for a 6 week healing time in its calculations, and found it made little difference. They wrote, “To analyze the impact of the 6-wk period of abstinence, the analysis was repeated with the duration of the period M1–M3 reduced by 42 d in the intervention group.” They found it only “plays a minor role in explaining the effect of the intervention”. So it WAS addressed.

    Before Myles embarrasses himself further with any more mistakes in this area he should read the debunkings of other criticisms of the African trials here (pubmed/22452415) and here (futuremedicine.com/doi/pdf/10.2217/17469600.2.5.399).

    What Myles calls an “interesting tidbit” is set to avert 3.4 million new infections, and save $16.5 billion in health care costs by 2025 (pubmed/22140367) which makes Myles’ error all the more inexcusable, and irresponsible. He, of all people, should know better, being so knowledgeable about HIV/AIDS denialism he should know about the delays in implementation of anti-retroviral therapy in S. Africa after Thabo Mbeki fell for denialist pseudoscience on the internet. Circumcision is no different. Delays in its implementation have cost millions of lives (theguardian.com/lifeandstyle/2009/jul/05/circumcicision-health-children) according to epidemiologist Elizabeth Pisani. Please Nega, tell Myles, this is a major life or death matter. Literally, MILLIONS of African lives are at stake (and likely elsewhere too as circumcision is now being considered outside of Africa). He MUST do his homework, and get his facts right or else he is no better than the deniers he debunks.

    Sadly Myles’ knowledge of the effect of circumcision on sexual function and pleasure is no better. “There are between 10,000 and 20,000 nerve endings compacted onto the human foreskin” says Myles, parroting urban myths that are all over the internet. Did it not occur to him to fact check these numbers first? The 10000 one came from New Zealand intactivist Ken McGrath who has since retracted (McGrath, personal communication) but this seems not to have got out. The 20000 one can be traced back to the magazine “Mothering” in 1997. This same magazine, it may be noted, has a history of publishing HIV/AIDS denialism. How do I know this? Because Myles said so at a “Skeptics in the pub talk” I attended in Liverpool on 15th January 2015. Oh, the irony! In fact “Mothering” has quite a history of peddling quackery (sciencebasedmedicine.org/mothering-peddling-health-misinformation-and-misinformed-consent/). Oh Nega, you could have a field day here! For detail on exactly how the 20000 urban myth originated Google my article “Sloppy scholarship and the anti-circumcision crusade” and tell Myles to scrape the egg off his face.

    “which are used in the ejaculation reflex” Oh give it a rest Myles. This is male bovine excrement. There is not a jot of evidence to support this, it is pure speculation, and refuted by multiple studies showing that circ make no difference to sexual function and satisfaction. These include RCTs (pubmed/18086100 & pubmed/18761593) meta-analysis (pubmed/23749001) and an extensive review (pubmed/23937309). Myles doesn’t give his source, but I suspect it may be the extensively cited work by intactivists Cold &Taylor (pubmed/10349413). This is rich in descriptive detail, but fails to demonstrate that the foreskin is erogenous, fails to distinguish genital corpuscles (which are thought to be the source of erogenous sensation), downplays the importance of the glans, ignoring work showing it to be a densely innervated sexual sensory structure (pubmed/9598486, pubmed/10037378, pubmed/3697758) and its claim about the foreskin being erogenous tissue necessary for sexual function has been rightly dismissed as unproven speculation (pubmed/15097799). For the most up to date review of the histology Myles should read pubmed/26185672.

    Having parroted the 20000 nerves myth Myles goes on to parrot the keratinisation myth. Nega, now is your chance to be cruel to Myles. Challenge him to produce some evidence for this! He could spend hours trying to find a scientific study that actually measures glans keratinisation of circumcised vs uncircumcised, and which finds a difference. He will fail. It is just another of those evidence-free claims endlessly parroted all over the internet (in fact it predates the internet), the parrots never bothering to fact check it first. In fact the ONLY study to look for it (by actually taking tissue samples, sectioning them, staining for keratin and looking at them down a microscope) found no difference (pubmed/10845974). Even the late John Taylor, on his website, said that keratinisation is “Probably not to any significant extent” (research.cirp.org/faq1.html). Now if it does not happen, why should the glans be desensitised? And indeed it is not desensitised (pubmed/15833526).

    Circ opponents greatly hype up the supposed merits of foreskins, and harm of circumcision, cherry-picking and misinterpreting their way through the literature as they go, and ignoring the critiques of the few studies that superficially support their cause (Nega, you must advise Myles to beware works by Bollinger, Van Howe, Sorrells, Bronselaer & Frisch, he must read the rebuttals before using them). But it is all hype and speculation aimed at scaring parents into not circumcising their sons, and making circumcised males miserable, thereby drawing angry, motivated new recruits into the movement. So again Myles is doing real harm here by damaging the self-esteem of circumcised males. Please Nega, ask Myles to retract his false claims about circumcision harming sexual pleasure. It does not. Myles is only going to cause unnecessary anxiety and distress to circumcised males. Is that what he wants? Is he really such a cruel ba$tard, or is he just ignorant of the facts?

    He is certainly ignorant of the complication rate for medical infant circumcision. It is not 1 in 100. It is <0.5 %, and is mostly trivial things easily remedied (pubmed/24820907). I’ll be generous because that one may not have been available at the time Myles put together his first effort at producing his own pseudoscience (sorry, his video is just so bad I can’t think of a more polite way of describing it). The link he provides to the supposed fatality rate of 1 in 500,000 does not say this, but does state: “The potential health benefits from circumcision justify it being a covered medical service by third-party payers, and it should be an available service for those who desire it.” This being the most recent AAP and CDC position, and which contradicts his claim that, “Even the most optimistic of benefits do not outweigh the negative side effects”. Now, he can fairly point out that other professional bodies disagree (but only outside of high HIV countries) so the honest approach is to acknowledge that a case can be made, but that the jury is still out on this one (for low HIV countries). This is the appropriate position to take at present, and is mine.

    So Nega, you have a big job to do. Re-emphasise the importance of circumcision against HIV in Africa, and acknowledge that in low HIV countries the debate is still on-going. And please reassure circumcised men that they are not missing much. I look forward to you giving Myles a good debunking. Oh, and please tell him to avoid anti-circumcision websites for his information. That is like trying to learn about evolution by going to answersingenesis.org. I recommend pubmed.

    Like

  6. I embarked on a 26-day diet bet with a friend who wanted to go
    on the HCG (Human chorionic gonadotropin) diet so I could write about it as an HCG
    diet review. ‘ High grade HCG should be procured from a licensed physician and the weight loss program should
    be conducted only under the supervision of an experienced practitioner.
    For that reason, Noetic science is a multi-disciplinary field that brings
    objective scientific equipment and methods with each other with very subjective inner realizing
    to study the full range of human being experiences.
    By limiting the level of food intake so severely, the body struggles to
    obtain the required vitamins, minerals, fiber, and other necessary
    components of a healthy diet. You will find that with h
    – CG on board, you will burn fat very easily.

    Like

  7. FYI Practically all boys and young men in my country, Australia, are uncircumcised. This has been the case for at least 25 years. I believe that the USA is the only western country where circumcision of baby boys is routinely offered and practised.

    Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s