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.

 

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.

 

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.

After 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.

 

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?

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.

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?