Month: April 2009

Following on my last entry, Lauren at Can You Be A Part of My Life continues her series on circumcision with information from her next source, a list at Justmommies.com titled “Common lies about circumcision“. I’ll get to that in a moment. First, this from Lauren’s second entry, “Follow Up Facts and Statements”:

It isn’t necessary for a Harvard bullshit artist to come and spout his manipulative opinions either or any other such nonsense. And furthermore there are serious HUMAN RIGHTS VIOLATIONS happening right now in the world toward women, mostly in MUSLIM countries right at this moment. Girls being “honor killed” and women being flogged or hung because they spoke to a man outside of their family or because they were raped by thugs. So please spare me the human rights cockamame argument about less than an inch of skin that is done to increase the health and well-being of little boys as well as grown men.

An action doesn’t have to be “serious” to be a human rights violation. Major violations occur every day. They should not be overlooked. Killing a woman (or a man) is worse than cutting the genitals of a man (or a woman). This does not negate the argument that male genital cutting is a human rights violation. Unnecessary genital cutting on a healthy, non-consenting individual is wrong.

We can look at gender, but that is analyzing degrees of reality, not separating the two actions from each other. Anti-FGM laws rightly dismiss any reason for cutting a female minor other than immediate medical need. No consideration of religion matters. No consideration of extent of cutting matters. No consideration of potential benefits, either medically or socially, matters. Only the child’s immediate, objective health needs inform the decision.

How is that logic exclusive to females? Males are equally human beings, with equal human rights. The undeniable fact that great atrocities occur against women in other parts of the world does not excuse violations in the Western world. Nor does calling infant male circumcision a violation suggest an indifference to or acceptance of genital mutilation (and other atrocities) committed against women. Again, unnecessary genital cutting on a healthy, non-consenting individual is wrong. How we punish each depends on the circumstances of the actual cutting on the individual and why, but gender is not the proper identifier for what is and is not harm.

**********

Like her last entry, Lauren provides a list from her source without additional commentary. She lists the first four items. The justmommies.com list of “common lies” icludes twenty-six items. I will address the statements that need comment or rebuttal.

2) No organization in the world recommends circumcision:

… Both the World Health Organization (WHO) and the United Nations (UNAIDS) have recommended circumcision as a preventative measure against AIDS.

The studies WHO and UNAIDS rely on involved adult volunteers. Children are neither. Nor are infants sexually active, in need of protection against STDs. The ethical issue can not be dismissed simply by assuming that the findings from Africa, where the HIV epidemic is different, should be transferred to male minors in Western nations.

Remember, six days after the findings, UNAIDS stated that circumcision plans should start with infants. If there’s an epidemic that warrants circumcision as an action plan, it is irrational to start with those males who will not be sexually active for more than a decade. I won’t respect their judgment on ethical issues, which is what prophylactic genital cutting is.

4) Circumcision is a human rights violation:

Not true. I agree there are some people that think that circumcision should be a human rights violation and they have every right to feel that way. Still, that doesn’t make it a reality. We have accepted organizations that deal with these issues and decide- based on many factors- which activities are acceptable and which violate basic human rights. These organizations have agreed that circumcision IS NOT a human rights violations because of it’s a very safe procedure and it carries some medical benefits. This myth usually goes hand in hand with a comparison of male circumcision and Female Genital Mutilation (FGM). However, the two practices are completely different in every single aspect: physical, psychological, emotional, social and religious. They’re not comparable in the slightest, but since they’re both done is the same general area, and because FGM is a degrading practice and an accepted human rights violation, anti-circumcision activists usually use it to try to put circumcision in a more negative light. Sadly, it does the opposite. By comparing something as traumatic, damaging, dangerous and degrading as FGM with a simple, safe and beneficial procedure demeans the impact of FGM. It’s a poor way of treating the women that have been victims of FGM and a way to demean their pain.
Finally, Amnesty International has directly declined to accept male circumcision as a human rights violation 3 times.

I’ve already addressed this, and the justmommies approach should convince no one otherwise.

To one specific claim, I’ve long thought that people who reject the simple claim that unnecessary genital cutting on a healty, non-consenting individual has no valid gender distinction are determined to believe that my argument intends to diminish the violation of FGM rather than change society’s mistaken beliefs about male genital cutting. I have been very clear that FGM is mostly worse, and to a large extent. That does not change the core point. Murder is the ultimate violation, but that does not mean that a punch to the face is therefore valid because it is a lesser violation. The issue is the act, not the gender.

For a slight deviation to continue this point, in her entry Lauren responds to a comment with this:

@Rhonda- yes you did what you felt was best and right and that is the point. KUDOS! and hugs.

The point is is what is done, not why. They are separate. A well-intentioned action can be flawed. This gets to the core that the right belongs to the individual child, not to the parents to decide based on their preferences. Very often those preferences are objectively indefensible.

8) Circumcision affects sexuality

No reliable study has proven that circumcision has any effect on sensitivity and overall sexual function. …

Circumcision clearly affects sexuality. That is not open to dispute because it changes the structure of the penis. How that change is evaluated may be positive, negative, or neutral. Only the person losing a portion of his healhty genitals is may make the unnecessary decision based on his conclusion on whether the change is positive, negative, or neutral. His evaluation may not match that of his parents.

10) Informed parents will choose not to circumcise

Actually, since information exists to support arguments from both sides, informed parents can make either choice.

The fact that there are two sides demonstrates that parents make a subjective decision. When that decision is unnecessary, as it is with almost every child circumcision, informed has no meaning. The parents act without input from the child on an irreversible – and, again, usually unnecessary – surgery. That is different than what #10 attempts to reject.

The shorter version: the ci
rcumcision decision for a child should be informed only by whether or not it is necessary.

12) Most babies are circumcised without pain relief-

Lies, lies. Unless you’re stuck living in the 70s.
But for the rest of us who accept and embrace the new millenium, the vast majority of circumcisions are now performed with pain relief.

I was circumcised in the ’70s, probably without pain relief. Was that a violation of my rights? And is it not a violation for the boys not in the “vast majority” who are given pain relief?

Proper pain relief does not make the surgery defensible. Behaving humanely in an indefensible action changes nothing.

13) Moms who choose not to circumcise are protecting their sons

Nice emotional outburst, completely in character of intactivism who love to use guilt and fear to spread their message, but completely false.
Protection is highly subjective and according to what we believe, our definition of “protecting” will be different. Sure they’re “protecting” their children from initial pain and from the tiny risks of circumcision. But parents who choose to circumcise will tell you they’re protecting their children from penile cancer, phimosis, balanitis and all that list we now know by heart.
It’s a common anti-circ tactic- language twisting.

First, it’s interesting that throughout the list the author rejects the simplifications used by those against infant circumcision, yet it’s somehow reasonable to engage in the same behavior against those people.

To the issue in #13, saying that you’re protecting your son from penile cancer, phimosis, etc. is the same tactic. The correct analysis in this silly use of protect is that not circumcising a healthy child protects him from the risk of complications. Without need, the risks inherent in the surgery are all that are immediate.

14) How can it be cleaner to have urine and feces directly up against an open wound?

Ok, first of all, the “open wound” lasts for like two days. …

If it is “like two days”, that’s two days longer than an intact penis is an open wound.

16- Circumcision isn’t “just a snip”

Actually, that’s exactly what it is. You see, a “snip” is “to cut with a small, quick stroke, or a succession of such strokes, with scissors or the like.” and “a small cut made by snipping”. Both describing circumcision perfectly.
Why the common lie saying that it isn’t a snip? Because intactivists love to say that the adult foreskin measures 3 x 5 inches. But we’re not talking about adult foreskins, are we? At the moment the foreskin is removed, it’s a small piece of skin, therefore, regardless of how big it becomes, at that moment, it’s a “snip”. So infant circumcision is just a snip. Adult circumcision is a little more complicated.

The author rebuts on semantics while ignoring the word that is the center of the argument. “Just a snip”, not “just a snip“. One word is an objective claim, a fact the author pointlessly focuses on. The other word is a subjective evaluation. Who is to decide what qualifies as just anything?

I could use a reference to boys who suffer serious complications and ask if they consider it just a snip. That’s valid, but the more common outcome is more useful here. Does the male who receives the expected results from the surgery think it’s just a snip? Would he value the subjective benefits of having his normal body more than the subjective value of the potential benefits his parents forced upon him? Words have meaning.

Like Lauren’s use of “about less than an inch” in the excerpt above, the author thinks we should focus on what foreskin is removed rather than what will be if we don’t remove the foreskin. But what will be there matters. Like in economics, what is unseen must still factor in the process. Removing X will have a result as an adult. Removing X – Y will have a different result as an adult. Removing X + Y will have a different result as an adult. X – Y can lead to adhesions. X + Y can lead to painful adult erections. It is impossible to know. That is the key. We can’t pretend that what we want to be will be what is if we ignore inconvenient facts.

17) Doctors who perform circumcision violate the AMA’s Code of Ethics:
…

A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.

I’m going to break this excerpt apart to deal with two principles separately. With this one, surgically altering a healthy child who will most likely grow into a healthy adult is a violation of that child’s human dignity and rights. The child is the patient. What he needs or doesn’t need is the only factor in competent medical care. If it is wrong to cut a healthy female, it is wrong to cut a healthy male.

A physician shall, while caring for a patient, regard responsibility to the patient as paramount.
…

VIII. And seeing as all medical organization agree that the “best interests” of the patient in the cases of infant circumcision are to be determined by the parents, a doctor abiding by the wish to circumcise doesn’t violate this principle.

Responsibility to the patient is paramount, but somehow bowing to the wishes of the parents to surgically alter their healthy sons, even for non-“medical” cultural and religious reasons, doesn’t violate this because medical organizations agree that it’s okay? No. The analysis must focus on objective facts, not what people simply agree to believe.

Using the author’s convoluted rationale, female genital cutting was acceptable in Victorian England and America in the 1800s because doctors agreed that it was beneficial. Or today, countries that cut females could use the same rationale because of what they collectively believe. The author’s requirement that a majority consensus is all that’s necessary is unbounded by principles, just socially approved behavior. How do we decide whether the medical organization is correct? Consensus means nothing by itself.

19) Considering male circumcision acceptable and FGM (Female Genital Mutilation) wrong is a “double standard”.

First of all, what IS “double standard”? Here are some definitions.

American Heritage Dictionary – Cite This Source – Share This

double standard
n. A set of principles permitting greater opportunity or liberty to one than to another, especially the granting of greater sexual freedom to men than to women.
…

Now, if we STRICTLY adhere to what a “double standard” is by these definitions, then we can consider underage prohibition to drink, smoke or vote, the Olympics, non-smoking rules, etc, “double standards” and therefore unacceptable.

This means, obviously, that there are certain acceptable double standards. Furthermore, it means that in order to consider something an actual double standard, there are other considerations besides the treatment received by the two groups. So basically, to speak of an actual double standard, all things being equal, one group is being treated differently.

Men and women ARE different. I don’t see anyone claiming that we should remove the gender categories from the Olympics because it’s a “double standard”. Why not let men and women compete against each other if we’re SO “equal”? The answer is because we’re not absolutely equal. It’s a physical fact that men are generally stronger and faster than women. It would actually be unfair to have women compete against men as the former have a physical advantage.

And if we’re saying that men and women are physically different, nowhere is this difference more pronounced than in the genitals. Male and female genitals are different. Therefore, the consequences of removing the foreskin cannot be compared with those of removing/altering female genitalia. And because of this, differentiating between the two IS NOT a double standard.

A female minor may not be cut e
ven if the culture she is born into believes that cut female genitals are preferable, yet male minors may be cut for this cultural reason. How is that not included in “a set of principles permitting greater opportunity or liberty to one than to another”? Females are granted the liberty to decide what to do – or to not do – with their normal bodies that is not granted to males. That is a double standard.

The remaining arguments are unconvincing. To compare forced genital cutting to voluntary involvement in something like the Olympics is ridiculous. We do not agree that male and female genitals are different in the way they’re being discussed. There is not a set of principles that apply to the vagina and another set of principles that apply to the penis. The set of principles apply to human beings. Human beings have genitals. Those genitals have reproductive, sexual, and excretory functions. Consideration of male versus female in how genitals should be protected is an incorrect deviation from logic. The individual human beings matter exclusively.

Yes, we make distinctions for smoking, drinking, and voting. However, those distinctions apply to everyone. The difference is that everyone has the the opportunity to be included in that group. Everyone will reach the minimum age for each (in most cases). Not everyone will meet the distinction the author demands for protection from unnecessary genital cutting on a healthy, non-consenting individual. There is no point in my life when I will become a female, reaching a basic level of protection. I was unprotected in childhood, and my genitals were altered. Females are protected from birth from having done to their genitals what was done to mine. That is a double standard.

21) Adult circumcision is easier and safer than neonatal circumcision

Nothing could be farther from reality.

And most males left intact will never need or choose circumcision. The fact that something can be done easier in childhood is not a justification that it should be done. It changes the decision from “Should it be done?” to “Is it difficult?”. This is the “he won’t remember it” defense. What else may parents do to their children because their children won’t remember it? If a parent punches the child, the child will not remember it. And it will do less damage to the child than circumcision. But we know it’s wrong to punch a child in the face. “Is it difficult” to recover from is not part of the equation.

23) Circumcision is a “cosmetic” procedure

No. Circumcision is a MEDICAL procedure, with proven HEALTH benefits acknowledged and admitted by every single medical organization in the world. Therefore, it’s not just “cosmetic”, it’s prophylactic.

Why the intactivists’ insistence that it’s just “cosmetic”? Very simple, really. By saying that parents are doing something “cosmetic” to their children it makes the choice seem shallow, selfish and useless. By even admitting that there’s one advantage to being circumcised, they would be giving some validity to circumcision and there’s no way a self-respecting intactivist will ever agree to any validity. Therefore, they spread the lie that it’s just “cosmetic”.

Infant circumcision is a surgical procedure performed without medical need because it offers potential health benefits. The latter defense is what proponents obsess on, as the author does here. But just to prove that the author’s last claim is ad hominem deployed to prop up her indefensible case, there are potential advantages to being circumcised as an infant. The reduction in UTI risk is likely real. The reduction in HIV-infection risk is likely real, at least in the short-term. And so on. I accept this.

But so what? That gives no validity to prophylactic infant male circumcision. There are better, more effective, less invasive ways to achieve every single benefit or to treat the maladies in the unlikely instances where they occur. The objective health is what matters for proxy consent for a child. Is the intervention indicated and necessary? Infant circumcision fails this core test. Moving forward is unethical because objective reality trumps the subjective chase for justifications.

However, if the author wishes to imply that the potential benefits dismiss the cosmetic nature of the surgery as a reason why some parents circumcise their sons, she is mistaken. There are parents who circumcise for cosmetic reasons. They find the foreskin “icky” or dangerous or bothersome. The fathers and mothers prefer circumcised penises sexually (for different reasons, obviously). They push this preference on their sons because they assume that the child’s future partners will share their opinion on the aesthetic value of a circumcised penis and thank them. Sometimes, they also assume that the child will agree, although they assume that the opinion of his partners will determine his opinion. For this segment of parents, circumcision is a cosmetic decision. We allow child circumcision for this subjective reason because we mistakenly believe that this determination can be defended as the parents making a decision in the child’s best interests. It is not because parents are not psychic. They can’t know what he will prefer, or whether he would willingly enter a sexual relationship with someone shallow enough to expect his body to be changed to meer her (or his) expectations.

It is appalling that parents consider their opinions relevant on the subjective question of unnecessary genital cutting. It is obscene that they consider them superior to the child’s opinions, both real and potential, for these irrational excuses. That is a shameful mark against our society, and should be recognized as such by the law.

In an entry titled “The Facts As Promised“, Lauren at Can You Be A Part of My Life fails to consider the context of her selected (and occasionally incorrect) facts about infant circumcision. I expected little going in because she opened with her attributions. Among her three sources were the websites of Professor Brian Morris and Dr. Edgar Schoen. It would be difficult to find a greater propagandist than either of those two.

Throw that truth out, though. Where they are correct with statistics, they ignore the most important fact present in almost every case where they advocate infant male circumcision, which Lauren readily ignores along with them: the child is normal and healthy. No surgery is indicated. There is no need to weigh against the inevitable risks. That is the only proper evidence-based analysis. One need not reject any of the statistics claimed to understand that the individual does not require circumcision. Circumcision by parental proxy is therefore unjustifiable.

But the claims merit a response. Here is an excerpt from the first paragraph of substance on circumcision in Lauren’s entry:

… And it is MUCH harder to keep this area clean in infant babies for various reason and therefore leads to: a higher risk of death in the first year of life (from complications of urinary tract infections: viz. kidney failure, meningitis and infection of bone marrow).

WebMD, a site that generally endorses unnecessary infant circumcision, states this about the normal infant foreskin, with emphasis in the original:

Do not force the foreskin back over the tip of the penis. At first, a baby’s foreskin may be difficult to pull back over the tip of the penis. After the first few years of life (though it may take somewhat longer), the foreskin will gradually become more retractable. By the time a boy is age 3, his foreskin is usually fully retractable. Up to this time, wash the outside of the penis with soap and water. Pushing your son’s foreskin back too early can cause scar tissue formation and damage.

Is washing the intact penis that MUCH harder to keep clean than the circumcised penis? Considering the process is identical, it’s clearly not MUCH harder. Pretending otherwise is misinformation. It is also worth remembering that circumcision creates an open wound that must be cared for properly to avoid infection and readhesion. This makes care for the circumcised penis more complicated for parents than properly caring for the normal penis.

Here I’d like to add a special caveat. If you don’t wish to care for normal, healthy children, don’t reproduce. Otherwise, the proper care of your normal, healthy children is an obligation, not a chore to be discarded in reverence to fear and mistaken beliefs.

For the the remainder of this entry, I’ll take the issues point-by-point. However, I want to make it clear that from this point forward, I’m challenging the claims of Professor Brian Morris. The bulk of Lauren’s entry involves only a copy-and-paste from Morris’ site. Lauren (wisely) provided some editorial input, omitting several absurdly irrelevant claims proffered by Morris. Of course, those should be considered to fully understand his judgment in pushing the other claims over the objective reality of health for most infant males. “A penis that is regarded by most as being more attractive” is not an indication of medical necessity. It’s a sign of an ability to think only collectively, to not understand that all tastes and preferences are subjective and individual. That is flawed because it ignores ethics and human rights.

So, addressing Professor Morris’ claims. (Link is here: http://www.circinfo.net/summary.html) Under the section titled “The benefits are clear” from Lauren’s entry, this list from Morris titled “Getting circumcised will result in”:

• Improved hygiene.

This is misleading, at best. See my comments above on this.

• Much lower risk of urinary tract infections.

The risk is lower, by a factor of approximately 10. However, the risk is already very low. More on this in a moment. (Note: The risk for girls is also approximately 3 times higher than it is for intact boys. We treat UTIs in infant girls if/when they appear.)

• Much lower chance of acquiring AIDS heterosexually.

Condoms and monogamy or condoms, monogamy, and circumcision. Those are the two choices. Circumcision is superfluous. Unprotected sex with HIV-infected partners will lead to infection. Circumcision has not helped me avoid HIV infection because I do not behave irresponsibly. Had my parents used this excuse, it would’ve been misguided. Parents are not Nostradamus.

Notice, too, how easily this omits the fact that the studies were performed on adult volunteers, not infants. Surgery is different technically and ethically for the two patient groups. The infant foreskin must be forcibly retracted. Infants aren’t sexaully active.

• Virtually complete elimination of the risk of invasive penile cancer.

The risk of penile cancer is small, regardless of foreskin status. From the 1999 AAP statement on infant circumcision, the risk of penile cancer varies little among Western nations. It is generally around 1 per 100,000 males. Other risk factors appear to be more significant. The consensus seems to be that, circumcised or not, healthy, responsible living is the best way to protect against such illnesses.

For context, there were 1,250 new cases of penile cancer in America in 2008 and 290 deaths. There were an estimated 1,990 cases of invasive breast cancer in American men in 2008, including 450 deaths. Time to panic and remove infant male breast tissue? The logic would be the same.

• More favourable hygiene for the man’s sexual partner.

This can be read as either a claim that women prefer a circumcised penis because it is cleaner or that it improves female hygiene. I’ve already dismissed the former claim, and Lauren correctly points out the absurdity of suggesting that adult males are incapable of cleaning their foreskins. The latter claim would tie in to the next bullet point.

• Much lower risk of cervical cancer and Chlamydia (and thus infertility and other problems) in the female sexual partner.

The ethical questions aside, there is a vaccine for HPV. That aside, as it relates to the foreskin, personal responsibility among the sexual pair matters: “In men with low-risk sexual behaviour and monogamous female partners, circumcision makes no difference to the risk of cervical cancer.” It is flawed to assume at birth that the male will be promiscuous. It is also flawed to assume that it’s ethical to surgically alter one person to protect his potential sexual partners. For example, what if he is gay?

• More favorable sexual function and no reduction in sensation during arousal or in the sensitivity of the flaccid penis.

Circumcision clearly alters sexual intercourse. Whether or not that is “more favorable” – a subjective evaluation – can only legitimately be determined by the individual himself. The foreskin contains thousands of nerve endings. Again, removing those alters sexual intercourse. Whether or not
that reduces sensation is impossible to compare once the foreskin is removed. Only the male himself is qualified to make that decision.

Now, to Morris’ claims under “lack of circumcision” linked in Lauren’s entry. He states:

Is responsible for a 12-fold higher risk of urinary tract infections in infancy. Risk = 1 in 20. Higher risk of UTI at older ages as well.

He provides no source for his claim of a 12-fold higher risk. I assume he’s pulling this from a study by Thomas Wiswell, but I’m guessing, since he didn’t source it. I have no idea where he found the risk to be 1 in 20. According to the more recent statement from the AAP, estimates are “that 10 of 1000 (1%) uncircumcised male infants will develop a UTI during the first year of life compared with 1 of 1000 (0.1%) circumcised male infants.” Claims like “12-fold higher risk” don’t look quite as compelling when considered in context. Also, females in the first year of life have a risk of UTIs equal-to or higher-than intact males. We treat those without surgery, even after they actually occur.

Confers a higher risk of death in the first year of life (from complications of urinary tract infections: viz. kidney failure, meningitis and infection of bone marrow).

I addressed this above with the hygiene issue, so here I’ll take a different approach. What is that risk of death? Professor Morris does not state the risk, nor does he link to a source for his claim. I have no problem accepting that it’s true, but are we debating a 50% risk of death from the foreskin? A 25% risk? Or are we discussing a risk significantly lower than 1%? I would wager the third option is closest to the truth. Ultimately life has risks. We can’t live in bubbles to prevent bad things from happening, particularly when those bad things are very unlikely.

One in ~400-900 uncircumcised men will get cancer of the penis, which is over 20 times higher in uncircumcised men. A quarter of these will die from it and the rest will require complete or partial penile amputation as a result. (In contrast, invasive penile cancer never occurs or is extraordinarily rare in men circumcised at birth.) (Data from studies in the USA, Denmark and Australia, which are not to be confused with the often quoted, but misleading, annual incidence figures of 1 in 100,000).

The often-quoted figures are quoted by the AAP. I’m willing to consider that it’s misquoted, and I’ll correct if it is. But Morris does not show here how this statistic is misused. He merely attempts to scare us with a few numbers that are not impressive in the context of actual population sizes and risk factors. He expects the reader to accept his cost-benefit analysis, weighing the 400-900 and 200 against the 1,000,000+ infant males circumcised to achieve these results. I do not because we are discussing surgery on individuals, not groups. Actual human beings, with opinions, preferences, and needs are involved. I refuse to behave like an irrational collectivist.

Is associated with 3-fold higher risk of inflammation and infection of the skin of the penis. This includes balanitis (inflammation of the glans), posthitis (inflammation of the foreskin), phimosis (inability to retract the foreskin) and paraphimosis (constriction of the penis by a tight foreskin). Up to 18% of uncircumcised boys will develop one of these by 8 years of age, whereas all are unknown in the circumcised. Risk of balanoposthitis = 1 in 6. Obstruction to urine flow = 1 in 10-50. Risk of these is even higher in diabetic men.

Balanitis

Balanitis is easily treated. Practising good hygiene and avoiding substances that irritate the penis will often clear the balanitis. (See the Treatment section for more information).

The rest…:

Phimosis

Phimosis is when the foreskin is very tight and cannot be pulled back over the head of the penis (glans). It’s normal for the foreskin to be attached to the head of the penis up until about age five. Parents should not try to pull the foreskin back because it can cause pain or injury. However, after the age of five, the foreskin will usually separate by itself and can be pulled back.

In some boys, phimosis can continue up to the age of 10 and, occasionally, it can continue into adulthood. Boys who have phimosis, and are under the age of six, do not usually require circumcision, but it may be considered after this age if the foreskin is damaged. Damage can happen as a result of severe or repeated infections. However, in the majority of cases, the foreskin will loosen naturally, with true phimosis (see below) only accounting for about 1% of cases.
…

Paraphimosis

Paraphimosis is a tight foreskin that cannot be pulled back, meaning the penis is squeezed, which causes pain. It forms a ring around the penis, cutting off some of the blood flow to the glans, and making it swell up. Doctors can sometimes treat paraphimosis by gently squeezing the trapped glans until the foreskin is able to slide over it. However, if this is not possible, circumcision may be needed.

I do not deny that risks exist, and that maladies occur. These conditions indicate a legitimate need for medical treatment. If parents must make a decision here, so be it. But the clear evidence is that these can – and therefore should – be treated with methods less invasive than circumcision, if possible. That is the reasonable medical approach to a permanent, irreversible decision.

Means increased risk of problems that may necessitate 1 in 10 older children and men requiring circumcision later in life, when the cost is 10 times higher the procedure is less convenient, and the cosmetic result can be not as good as when done in infancy.

Morris would circumcise 10 in 10 male infants to avoid circumcising 1 in 10 males later in life. He states that the cost is 10 times higher. The overall financial burden to society is unchanged, contrary to what he’s trying to convey through fear. (Future financial burden is not a valid reason to circumcise a healthy child.)

Speaking strictly from a finance perspective, advocating for infant circumcision is the more expensive approach. His analysis is that the cost is 10 times 0.1 for his preference and 0.1 times 10 for his worst case. The present value of $1 spent over many years in the future is less than the $1 spent today. Professor Morris prefers the more expensive option.

Nor should convenience be considered. That is not a medical indication. If the male wishes circumcision more than the inconvenience, he will choose it. If not, it is not acceptable for parents to choose that for him, against his (probable, based on statistics) future choice.

As for cosmetic results, this is simply insane. Circumcising an infant places the parents’ aesthetic sexual preference as the justification, even though the child may not choose it. He gets zero choice, and the cosmetic results aren’t guaranteed to be good by whatever future subjective standards he develops. If he is left with his decision, he can decide if he values the risk of a poor cosmetic outcome versus his normal penis.

Increases by 2-4 fold the risk of thrush and sexually transmitted infections such as human papillomavirus (HPV), syphilis, chancroid and, in some studies Chlamydia.

And:

Is the biggest risk factor for heterosexually-acquired AIDS virus infection in men. 3 to 8-times higher risk by itself, and even higher when lesions from STIs are added in. Risk per exposure = 1 in 300.

And:

In the female partners of uncircumcised men is
associated with a 5 fold higher incidence of cervical cancer (caused by sexually transmitted HPV), pelvic inflammatory disease, infertility from blockage of fallopian tubes, extopic pregnancy (each caused by Chlamydia), genital herpes, and other conditions.

Condoms and monogamy are necessary, regardless. Forcing circumcision on sexually-inactive infant males does not change the necessity of practicing safe sex when they become sexually active. At its core, this is merely a belief that males will be irresponsible and/or female health is more important than a male’s normal body. It also assumes that his future female (or male?) partners will not be responsible enough to protect themselves from STDs.

The core evaluation is very simple. If the child is healthy, no surgery is indicated or justifiable. Chasing benefits for children is an illogical path that can be pursued to other irrational avenues and on both genders. It has no place in the proxy decision-making of parents for the genitals of their male children, as we already understand clearly for female children.

UPDATE: I corrected one point of grammar and added the word males to “1 in 10” for clarification. I also added if possible to my statement that less invasive treatments should be used to treat foreskin ailments. Circumcision is sometimes necessary, of course, but it should be used as the last option, not the first.