I’ve cited Andrew Sullivan’s entries on male circumcision in the past as support for my arguments to protect infant males from surgical alteration of their genitals. Today, I’m at a loss for words because of this:
As long-time readers know, I’m a big opponent of male genital mutilation, aka circumcision. But the data are clear on HIV infection, and under those circumstances, as I’ve said before, I’m prepared to make an exception.
I’m not one of the multitudes of routine infant circumcision opponents who denies the results because they somehow don’t fit my argument. Maybe there are methodological flaws in the studies, maybe not. I don’t know, and it doesn’t matter. The studies offer evidence, not recommendations. It takes reasoning to filter the research into a coherent approach to preventing HIV. Circumcising (male) infants to prevent HIV is neither reasonable nor coherent.
Children do not engage in sex until well beyond the period in which they can be taught responsible behavior and an understanding of consequences. Their intact genitals do not expose them to HIV. They do not need to fret over whether or not condoms will provide them adequate protection. For each boy, HIV will not jump onto his penis, crawl in between his glans and foreskin, and burrow through the susceptible cells. His intact foreskin will not create a public health crisis.
That’s what makes Mr. Sullivan’s statement so frustrating. He does not say if his exception is limited to adult circumcision or includes infant circumcision. Perhaps his limit is adult circumcision, but reading the linked article, I suspect he’s willing to concede on infant circumcision. If it is the former, he should note that distinction to avoid confusion (I noted an example here). If it is the latter, he is wrong.
Consider:
Richard Feachem, executive director of the Global Fund to Fight Aids, Tuberculosis and Malaria, said research revealing the protective effect of circumcision against HIV was set to change parental expectations and medical practice across the world. Instead of viewing the operation as an assault on the male sex, it was increasingly being seen as a lifesaving procedure which every parent would want for their sons.
Show me how routine infant circumcision is considered an assault on the male sex, outside of opponents such as myself. Unfortunately, I must concede that I am in the minority. So, again, show me how public opinion will now reverse to make the procedure so desirable.¹ One caveat: you must use science instead of fear. Will circumcision alone be enough? Are there better, less invasive methods of prevention? Does circumcision in conjunction with other methods of prevention add a significant increase in protection? Is this solution targeting those most at risk?
Removing the foreskin is thought to harden the glans (head) of the penis, making it less permeable to viruses. Research conducted in 2005 showed the transmission of HIV from women to men during sex was reduced by 60 per cent if the men were circumcised.
Hardening (thickening, really, through keratinization – explicit warning: NSFW) of the glans used to be understood and accepted as an outcome of circumcision. Punishing masturbation is much easier when the penis loses sensitivity. Then it became a lie propagated by circumcision opponents, presumably because knowledge of the foreskin as mucous membrane disappeared among physicians. Also, selling surgery is easier if the supporter pretends that there will be no harm from removing the “useless” flap of skin. Now keratinization is a feature again? Using reduced sensitivity to sell routine infant circumcision is like pretending that the Ford Pinto had a secondary heating system. At least they’re honest now.
And what about female-to-male transmissions?
CONCLUSION.–The odds of male-to-female transmission were significantly greater than female-to-male transmission. The one case [from 379 couples] of female-to-male transmission was unique in that the couple reported numerous unprotected sexual contacts and noted several instances of vaginal and penile bleeding during intercourse.
How about another study? This back-and-forth could go on.
Dr Feachem said: “We know the factors that cause HIV to spread rapidly in a country – the number of concurrent sexual partners, the use of condoms, the presence of other sexually transmitted diseases and male circumcision. Other things being equal, in a circumcised population you have a low and slowly developing epidemic and in an uncircumcised [sic] population you have a high and fast developing epidemic.”
Beware conclusions drawn from poorly phrased assumptions and questions. All other things are not equal. The other three factors listed are not consistent. Two of them can be taught. The other is also a function of individual responsibility. But not included here is why there is a disparity in the populations. The studies include only Africa, which is not particularly analogous to Europe and the United States. The U.S., for instance, has the highest HIV infection rate among industrialized nation. We’re primarily circumcised. European nations have lower incidences of HIV infection. Those nations are predominantly intact. The researchers should explain the difference before so quickly assuming that boys must lose healthy tissue.
He added: “Circumcision is growing strongly in popularity in South Africa and in North America. We see males seeking circumcision very commonly in South Africa. The news of its protective effect caused a substantial increase in demand for adult male circumcision.
I reiterate my point from earlier. North America (i.e., the United States) has had a love affair with circumcision for more than a century, so growing strongly in popularity is absurd. Facts matter, no? But what’s important is the key word in Dr. Feachem’s statement, adult. Adults can consent; infants can not. There is also a significant difference in the penile development of infants and adults. Adults do not require tearing of the foreskin from the glans to remove the foreskin, as is necessary with infants. Making the leap from what’s appropriate for adults into what’s appropriate for infants without considering intellectual and anatomical differences is absurd.
“Circumcision fell out of favour in North America and the UK as an unnecessary operation. Following this research, I think it extremely probable that parental d
emand for infant male circumcision will grow as a consequence.”
Repeating the notion that circumcision is out of favor in the United States (specifically) does not make it true. It’s falling, but the majority of newborn males still have their healthy foreskins surgically removed.
Returning to the impact of a male’s sexuality as he grows from infancy into young adulthood, when he reaches an age where he may become sexually active, the presence of his foreskin could potentially cause him problems. Responding to that calls for parenting. Parenting might include a discussion of sexual promiscuity and HIV. It might also include consideration of circumcision. What’s important is that the boy will have input. If he is against it as a preventive measure, it should not be forced upon him. Short of medical necessity, the decision should remain his alone. When he reaches adulthood, he can make the decision based on his understanding of his HIV-risk.
If that scenario had occurred for me, I’d be intact today. I understand my sexual history and risk enough to make informed decisions. I have never put myself in a position where HIV was a significant risk worthy of pre-emptive amputation. I do not intend to do so. How has genital surgery helped me? How can parents know which scenario their child son will live? Permanent medical decisions should not be made for infants/children based on fear of the unknown. That is not science, that is superstition and ignorance.
Instead of writing what I’ve said enough times already, consider this counter-balance:
Deborah Jack, chief executive of the UK-based National Aids Trust, said the research findings were encouraging.
“It is clear the promotion of voluntary circumcision can play an important role in reducing the risk of HIV transmission,” she said. But she warned: “People who are circumcised can still be infected with HIV and any awareness campaign would have to be extremely careful not to suggest that it protects against HIV or is an alternative to using condoms.”
I didn’t volunteer for circumcision any more than the one million infant males circumcised in America every year volunteer. Or the millions of infant males around the world who will now be circumcised as a result of this research. Parental demand for prophylactic surgical amputation was never sane, is not sane, and will never be sane, regardless of the various wonderful explanations we can create to justify it. In America we do not allow female circumcision (calling it female genital mutilation) for any reason other than specific medical indication. Boys, however, are subject to parental whim. Parental whim is subject to scientific discovery open to expansive interpretation. Radical surgical amputation should not be the first response to imagined future risks involving infants.
Post Script: More on this topic here.
¹ The article is from a British newspaper. Noted. However, it will be apparent in a moment that the target audience for routine infant (male) circumcision as a preventive measure against HIV includes the United States.
