Considering  Circumcision?


One of the fundamental purposes of the CIRCLIST website is to guide newcomers through the circumcision decision.

Starting with the basics, in this chapter we address the key issues of “Why circumcise?” and “When to circumcise?”.

If, having considered the evidence, you agree that circumcision is a wise choice, there’s more detail for you to explore via the Navigation Panel that appears at the foot of just about every page.



Last updated: 14 May 2014, 09:33 UTC



Reasons to circumcise - the basics

The benefits of male circumcision fall into several distinct categories: Once the detail is added, this becomes a lengthy and formidable list. But there are counter-arguments and it would be invidious not to mention the existence of these.

Some opponents of circumcision challenge the scientific evidence. Suffice it to say in this brief introduction that both the World Health Organisation (WHO, a division of the United Nations) and the Centers for Disease Control and Prevention (CDC, the world’s clearing house for Public Health information) have accepted the scientific validity of the key parts of the pro-circumcision case.

Entirely separately, a moral and ethical debate exists in respect of the circumcision of minors, the opponents of child circumcison asserting that the procedure should not be permitted on the basis of parental initiative. The critics want the individual to decide for himself once of an age to self-consent to circumcision. This issue is explored in greater depth on our web page dedicated to rebutting the anti-circumcision arguments.



At what age can circumcision take place?

The short answer is “at any age”. Let’s consider each possibility in turn:

icon - baby Infancy:  Circumcision in infancy maximises the total lifetime benefits and minimises the complexity of the surgery. Later in life the individual has no memory of his pre-circumcision state and no specific recall of the procedure being done. The circumcised state is his “norm”. For a more detailed look at the benefits of circumcision in infancy, see BMC Pediatrics 2012, 12:20.
icon - boy Boyhood:  Circumcision pre-puberty remains a fairly simple procedure. The majority of circumcisions done at this age are performed for cultural or religious reasons, often as part of a coming-of-age ceremony. In such a context, circumcision will normally be welcomed as a badge of maturity.
For the United Nations / World Health Organisation / UNAIDS view of neonatal and child circumcision, please read their publication  'Neonatal and child male circumcision : a global review'  published April 2010.
icon - teenager Teenage:  Once puberty has commenced, circumcision becomes a progressively more complex procedure. Many (maybe most) circumcisions in this age group arise as a matter of medical necessity, due to phimosis ‘discovered’ when sexual activity commences. Circumcision at this age can be embarrassing, requiring intimate disclosures in order to obtain access to healthcare that is still subject to parental consent.
icon - adult Adult:  From the surgical point of view, adulthood is probably the least favourable time to circumcise. But it does happen, for example as a matter of medical need, for cultural reasons associated with a change of religious faith or simply as an individual’s lifestyle choice.
icon - adult Geriatric:  In the final years of life, many require assistance with personal care such as bathing. Especially in psychogeriatric situations, circumcision may be the only practical way of maintaining genital hygiene. How much easier if the patient had been circumcised earlier in life!



Common questions answered in detail




Circlist Logo'   Icon denoting 'Editorial'

Editorial comment

It used to be the case that the argument between the pro-circumcision and anti-circumcision lobby groups was an argument of opinion versus opinion. That is no longer the case. The pro-circ groups (CIRCLIST included) now have proven scientific fact on their side, whereas the anti-circ groups continue to rely on a less tangible line of reasoning based primarily on the morality of genital integrity - especially as regards child circumcisions. Of necessity they have, in the main, quietly dropped their assertions that the science is bunk.

What has developed in consequence is reminiscent of the Chinese proverb about the irresistible force meeting the immovable object. The scientific case for circumcision is now proved; be in no doubt about that. Not just in respect of HIV/AIDS but also other sexually transmitted diseases too. The resulting Public Health implication that circumcision is beneficial to society at large becomes the irresistible force in the analogy, not far removed from the reasoning behind mass vaccination campaigns against smallpox, polio and suchlike.

But the scientific proof does nothing to overturn the morality argument about circumcisions performed on children. Even if the anti-circumcision camp were to accept every aspect of the science, they would probably still maintain their view that an assumed right to genital integrity is paramount. They become the immovable object in the analogy, stubborn and unyielding.

Any newcomer to the scene faces a trade-off situation. Which should they accept - the proven facts about medical benefits or the contentious opinion about morality? Ultimately it is their choice. Our task in the pro-circ lobby is to ensure that our side of the case is adequately presented and not drowned out as the opposition would wish (and, indeed, attempt to do).

My own view is that the surgical removal of an infant or child’s foreskin, properly done, is so trivial a matter that it is entirely reasonable for a parent or guardian to decide that their son should be circumcised. I go on from that point to express opinions about style, technique and so on but those issues only come into the frame once the fundamental decision to circumcise has been taken.

If one makes circumcision the norm, nobody frets about being different and everyone benefits from both the personal and public health advantages.

Undoubtedly there is angst amongst those who resent having been circumcised as children. Such resentment I consider to be amplified (maybe even caused) by the anti-circumcision lobby and it is something that I condemn unreservedly. The engendering of worry seems to have become a deliberate campaign technique of lobby groups in all walks of life. That’s always unfortunate, if only because worry leads to irrational thinking and bad judgement. But retrospective criticism of an individual’s circumcision can lead to feelings of sexual inadequacy and consequent depressive illness. That in my view cannot be excused. Lobby groups are entitled to their opinion whether you or I agree with them or not, but they should not build their position at the expense of the mental health of those who cannot turn the clock back and thereby attain the circumstances being promoted.

CE

[Adapted from text that originally appeared in the Circlist Google Group on Tuesday 27.October.2009]




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