Tuesday, 20 April 2010

20 reasons revisited

SagaciousMama has posted an article entitled 20 Reasons I Did Not Circumcise My Son.

Now I'm supportive of parents who choose not to circumcise, as well as those who do, but this article is alarmingly misinformed. Here's my analysis.

1) The Pain is Excruciating

Always? Even when local anaesthetic is used? If that were so, men circumcised as adults would report unbearable pain. But in fact, men circumcised under local anaesthetic generally report only mild pain, if any. (Eg., Long et al. report "No patient experienced pain during circumcision.")

The foreskin is attached like a fingernail (see #4).

This is a common anti-circ myth. In fact, the fingernail is fused to the nail bed; in contrast the foreskin's attachment to the glans is primed to detach anyway, and can easily be separated. (This is quite obvious from the many circumcision technique videos on the Internet, which show that the foreskin can be detached through moving a probe around, without excessive force.)

2) The procedure and pain has long lasting consequences.

Here SagaciousMama cites only a number of weak sources. These sources speculate that neonatal circumcision causes numerous psychological problems, but they fall short of the most important quality of scientific work: testing one's hypothesis. In no cases do they provide any evidence showing that their theory is correct.

Until they do their theories don't really seem worthy of a response.

3) It is genital mutilation.

No, it isn't. "Mutilation" is defined as:

1. To deprive of a limb or an essential part; cripple.

The foreskin isn't a limb, and it is clearly not essential, since if it were we would not be able to survive without it.

2. To disfigure by damaging irreparably: mutilate a statue.

Circumcision neither damages nor disfigures. If it damaged the penis, then there would be clear evidence that the penis functioned better with a foreskin than without, but — if anything — the opposite seems to be true. "Disfigurement" is a little more subjective, but the fact that circumcision is widely perceived as a cosmetic improvement is incompatible with the notion that it is a disfigurement.

3. To make imperfect by excising or altering parts.

Again, this is somewhat subjective. That circumcision excises the foreskin is clear, but does this make the penis imperfect? Or does it make it more perfect?

Since SagaciousMama appears to indicate that her statement is a kind of timeless truth, frankly I think she needs something stronger than highly subjective assessments.

4) In babies, the foreskin is attached like a fingernail.

This is a repeat. See no. 1.

5) I wouldn’t alter a girl in this way, and boys count, too.

It would be impossible to alter a girl in this way: girls don't have penes. But, as a hypothetical, suppose that there was a form of minor surgery that could be performed on girls, that had multiple benefits, minimal risks, and no long-term harms. Would it be rational to oppose it?

Here SagaciousMama quotes the ever nutty circumstitions.com:

For over a hundred years, circumcision has been a solution looking for a problem, and the problem has typically been the most frightening disease of the day - ... “masturbation insanity” in the 19th century, ... then tuberculosis, ... Sexually Transmitted Diseases (then called Venereal Disease or VD) after World War I, ... penile cancer in the 1930s, and ... * cervical cancer in the 1950s, when cancers were terrifyingly untreatable, ... urinary tract infections from 1982 onward, ... * and now HIV.

Oh dear. It's troubling that anyone can find this line of argument convincing. The basic idea is this: construct a list of positive claims that have ever been made about a subject, regardless of merit or basis in evidence. Now present them side by side. For example, you can show that hand-washing used to be a religious ritual in ancient times, and more recently, as germs became known, it was promoted for that reason. It's true, but what does it prove? That we should abandon handwashing? Of course not — such a conclusion is ludicrous.

6) It is pointless and absolutely unnecessary. ... There are no advantages to genital mutilation for either a boy or a girl however there are many disadvantages and risks.

With a little interpretation, what SagaciousMama is claiming here is that there are no advantages to circumcision. That's wildly incorrect: there are multiple health benefits to circumcision, including prevention of phimosis, balanoposthitis, urinary tract infection, HIV, HPV and (some) other STDs, penile cancer, etc. Some of these benefits are very minor, some less so, but to say that they don't exist is simply absurd.

7) I don’t have the right.

Actually, you do, but you don't have to exercise that right if you don't want to.

8.) Decreases sensitivity. ... This is the most studied and obvious aspect of this topic. Regardless of the volumes of studies on the tissue, the science, etc, the best evidence of this comes from studies of intact men who get circumcised as adults. Regret is almost inevitable. They do this for newly adopted religious reasons, misguided ideas or information on benefits and other reasons.

What planet is SagaciousMama living on? There's a reasonable overview of study results at Wikipedia. Far from regret being "almost inevitable", high rates of satisfaction are commonplace.

The foreskin is full of nerve endings and is the cause of natural lubrication. It is also a protective cover. Removing that cover exposes the glans of the penis to constant stimulation and rubbing against clothing. This idea makes an intact male shudder. Where some people think the exposed glans heightens sensitivity and sexual pleasure, the reverse is actually true. The penis desensitises to cope. The newly cut man will experience heightened sensitivity, however it is usually uncomfortable more than enjoyable and it does not last.

According to what evidence? Almost none. Studies of penile sensitivity have almost invariably shown no statistically significant differences. See, eg., Masters & Johnson, Bleustein 2003, Bleustein 2005, Payne 2007. None of these studies were performed on recently circumcised men, and none were able to find evidence of this desensitisation.

If you ask a circumcised man about sexuality and sensitivity he will usually tell you everything is fine, great, just dandy. However, he doesn’t know it any other way. You can’t miss something you’ve never had. Only those who have been circumcised as adults have that perspective.

True, and what do they (we, strictly speaking) describe? "After the procedure 82% of patients referred an upgrade on the quality of their sexual intercourse, ...", "Compared to before they were circumcised, 64.0% of circumcised men reported their penis was "much more sensitive," ...", "Penile sensation improved after circumcision in 38% (p = 0.01) but got worse in 18%, with the remainder having no change."

9) Causes problems for female partners.

There's really no reliable evidence that this is the case. SagaciousMama cites a dubious website on the subject, which is full of speculative nonsense but very little evidence.

10) The option will always be there when he grows up.

True, though it's not exactly an argument against circumcision.

11) It is irreversible. ... Restoration is not the same.

This is technically true, but neither is adult circumcision the same as infant circumcision (it almost invariably causes heavier scarring, for example), so whatever choice you make will have lasting consequences.

12) Risk of Physical Damage and Death.

Yes, there are risks, albeit small. These should be considered alongside the risks associated with non-circumcision (such as death due to complications of UTI, for example).

13) Babies Tell You They Don’t Want To Be Circumcised.

This is too silly to deserve a response.

14) Interferes With Breastfeeding.

No. It doesn't.

15) It Goes Against Natural and Attachment Parenting

I'm going to skip this one because, as far as I can tell, SagaciousMama is basically just saying that it is incompatible with her personal parenting philosophy. That seems a good reason not to circumcise.

16) It is Medieval, Shocking Barbaric and Weird. ... and ... 17) Spread eagled restraint is like torture to a baby.

Not really, no.

18.) The historical reasons for it are morality based

Yikes. This is frighteningly irrational: deciding against something because of the reasons why people used to do it. It's like being opposed to dancing because some tribes, somewhere in the world, perform rain dances in the belief that it will induce precipitation. So what? Given the number of human societies and their longevity, it seems inevitable that sometimes people do good things for stupid reasons.

19) 80% of the World’s Males are Intact.

This isn't a very rational argument. A considerable fraction of the world's population lack clean water, but this doesn't strike me as a compelling argument for having my water supply disconnected. The correct figure is probably closer to 60%, by the way.

20) The Foreskin is a Necessary and Amazing Anatomical Structure.

This is simply nonsense.