Circumcision

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Circumcision refers to the surgical removal of the foreskin (partially or fully) from the penis. While it is rarely therapeutically required,^[2] it is commonly performed across the world for non-therapeutic reasons such as religious or cultural reasons, or for perceived prophylactic benefits. Circumcision can be performed at any age, although it is often performed on babies and children. Female circumcision is sometimes used to euphemistically refer to female genital mutilation.^[3]

Non-therapeutic circumcision on babies and children who are too young to consent to the procedure is a highly controversial practice that has become the subject of much debate in contemporary times.^[4][5] Critics of the practice argue against it on a variety of grounds, but primarily due to bodily autonomy concerns and alleged detriments of the practice such as pain, risk, and supposed loss of sexual function or sensation.^[6][7][8][9] This movement is sometimes known as Intactivism (portmanteau of intact + activism).^[10] Other individuals and organizations defend the practice. Some believe that Routine Infant Circumcision (RIC) should be strongly recommended, arguing that the procedure confers great prophylactic benefits that easily outweigh any risk, and that infancy is the optimal time for the procedure.^[11] Others believe that non-therapeutic child circumcision is permissible at parents' discretion, in part due to its significance to certain religious and/or cultural groups, but stop short of outright recommending the procedure as routine.^{[citation needed]}

At RationalWiki, we support the right to bodily autonomy and integrity, and we therefore find that non-therapeutic circumcision of babies and children who cannot consent is unethical. While circumcision performed by qualified practitioners in clinical settings is a low-risk procedure, circumcision causes significant harm to children because it is a painful and invasive surgical operation which removes a significant part of the genitalia, and adversely affects sexual function at the very least insofar as precluding any sexual act inherently requiring the foreskin. We find that the prophylactic and hygienic benefits of circumcision, especially for those living in developed countries, are insufficiently compelling to justify invasive, non-consensual genital surgeries on children. In particular, many ostensible benefits are factually dubious, immaterial to babies and young children, have more effective and less invasive means of prophylaxis and/or treatment, confer a low absolute risk reduction, or benefit the child's possible future sexual partners rather than himself.^{[note 1]} The claim that infancy is by far the optimal time for circumcision is questionable, and even if this claim were true, it would not justify non-therapeutic infant circumcision. Parental discretion, whether motivated by perceived religious obligation or otherwise, is ethically inappropriate to authorise medically unnecessary genital surgeries on children who cannot give their own consent.

Despite the controversy over non-therapeutic child circumcision, it isn't explicitly illegal anywhere in the world,^{[citation needed]} although some authors have argued that it may already be implicitly unlawful under existing national and/or international law.^[12][13][14] In recent years, there have been attempts or proposals to ban the practice in some European countries, and despite general public support among people in Germany, Denmark, and the UK for such bans,^[15][16][17] they were ultimately vetoed, in large part due to allegations that the proposed bans would infringe freedom of religion.^[18][19]

Groups that circumcise[edit]

A global map of male circumcision prevalence at the country level.

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It is one of the world's most common medical procedures, generally performed for prophylactic,^{[note 2]} religious, and cultural reasons. An estimated 37–39% of the global male population is circumcised, with the most circumcised areas being the Middle East, Africa, Southeast Asia, and the Anglosphere. Global rates are presently significantly rising, probably in part due to African and Islamic population growth. South Korea has a high circumcision rate as well,^[20] probably, one could say, because they're on the tip of the peninsula.^{[note 3]}

Western world[edit]

In the U.S., the majority of males are circumcised, usually as newborns.^[23] The percentage circumcised has decreased in recent decades.^[24][25] The still-considerable amount of circumcision in the United States has more to do with various claims of health or hygiene benefits, which historically included preventing masturbation,^[26] than religious requirement. Canada and Australia do it for this reason as well, albeit not nearly to the same extent, and in fact it's been drastically declining in both countries over the last few decades. It is virtually non-existent in most other Western nations, except among religious or cultural minorities who practise it.

Abrahamic religions[edit]

Judaism customarily requires circumcision of Jewish boys on their 8th day of life (brit milah, "Covenant of Circumcision"), as commanded in Genesis 17:10-14 as a contract between G-d and Abraham, and unto his descendants. It is also an integral part of the conversion of a non-Jewish man^{[note 4]} to Judaism,^[27] although some Reform Rabbis do not require it.^[28][29] A Jewish traditional circumciser is known as a mohel. If the person was previously circumcised, or born without a foreskin, hatafat dam brit ("Covenant of a drop of blood") is performed instead.

However, some Jews choose not to circumcise their sons and sometimes have an alternative ritual to welcome their son into the world, known as brit shalom ("Covenant of Peace").^[30][31]

It is worth considering that originally, only the very tip of the foreskin was cut away. It wasn't until the Hellenization period that periah, the removal of the entire foreskin, caught on. This was because a fair number of Hebrew traditionalists were upset with how younger men were restoring their foreskin under advice and/or pressure from the Greeks, who viewed even the slight circumcision as a vile travesty against the sacrosanct physical body. This early form of foreskin restoration was known as epispasm. Despite the end of Hellenization, reversion to pre-periah has been… slow.^[32]

Islam, through ordering followers to uphold the religion of Ibraheem and respect of the hadiths, similarly strongly supports circumcision (khitān), although it is not mentioned in the Qur'an.^[33][34] The age of circumcision in Islam varies, though it is often around seven years old. Circumcision in Islam is seen as an matter of cleanliness, and/or being like the Prophet Muhammad (PBUH), who was ostensibly born without a foreskin.^[35] Male circumcision is considered wājib (obligatory) by some sects of Islam and sunnah (optional) by others.^[36][37]

Christianity does not require circumcision.^[38]

Cultural rites[edit]

Circumcision of boys is a rite of passage in some cultures, such as in the Philippines (where the rite is known as Tuli^[39], and typically occurs between the ages of 8 and 12.) and in some cultures in Africa.^[40]

Arguments for circumcision of babies or children[edit]

Therapeutic reasons[edit]

Circumcision is rarely required for therapeutic reasons.^[2][41] Inability to retract the foreskin of a baby or young boy is normal, as the foreskin is fused to the glans penis at birth and does not fully separate until around age 5-10.^[2] The foreskin should never be forcefully retracted on babies or young children, as this can cause injury. Phimosis can usually be resolved without resorting to circumcision, such as with topical steroids, or less invasive surgeries that preserve the foreskin. Circumcision may also be an emergency treatment for paraphimosis, although a doctor may be able to return the foreskin to its original position.^[42] Circumcision may also be a treatment for recurrent infections such as Balanitis, although this is rarely needed, as balanitis can usually be treated by less invasive means such as antibiotic or antifungal creams.^[43]

As the vast majority of infancy and childhood circumcisions are performed in the abscence of any therapeutic indication, these points are in most cases moot.

Purported prophylactic benefits[edit]

Phimosis and Paraphimosis[edit]

Removal of the foreskin ensures that problems such as phimosis and paraphimosis cannot occur. (NSFW)

Of course, no one recommends routinely removing other body parts that might possibly get cancer or experience other medical issues. As a justification for circumcision, this argument amounts to a rationalization. Notably, both conditions can usually be treated without surgery anyway^[42], meaning it's irrational to pre-emptively perform genital surgery on all boys to prevent them.

Balanitis and/or Posthitis[edit]

Circumcision quite obviously eliminates a male's risk of contracting posthitis (inflammation of the foreskin) for the same reason it prevents phimosis. Circumcision has also been touted as a way to prevent balanitis, although Van Howe (1997) found the opposite conclusion among boys under the age of 3.^[44] Since these conditions are "not usually serious", can usually be treated conservatively, such as with the use of antifungal or antibiotic treatments, and often are caused by not washing the penis properly or using irritating substances such as soap,^[43] treatment of balanitis and posthitis is rarely a good reason to circumcise a child, and prevention is not a compelling reason at all to circumcise a healthy child.

HIV / AIDS[edit]

Circumcision is sometimes promoted as a way of reducing HIV transmission, especially in endemic regions. This claim comes chiefly from three randomized control trials (RCTs) in countries in Africa (specifically, Uganda, Kenya, and South Africa) where HIV is endemic, which found that "Voluntary Medical Male Circumcision" (VMMC) reduces relative risk of female-to-male HIV transmission by approximately 60%.^[45][46][47] All three RCTs were terminated early, which may cause "implausibly large treatment effects",^[48] and makes it hard to say if the protective effect would have been seen in longer-term follow-ups (the control group were offered VMMC at the end of the trial, making later follow-ups impossible). More participants were lost to follow-up than were found to have contracted HIV.^[49] The group that were given VMMC couldn't have sex while recovering from the operation, obfuscating the results (lead time bias).^[50] Furthermore, the RCT in Uganda (while it was terminated early, making it difficult to conclude about long-term effects) possibly seems to suggest VMMC may have increased male-to-female HIV transmission.^[51] Boyle & Hill (2011) also accused the 3 RCTs of researcher expectation bias, participant expectation bias, and selection bias.^[50] Of course, a man's circumcision status can't be hidden from him, meaning a double-blind RCT would be impossible. According to Van Howe & Storms (2011), a significant proportion of men who contracted HIV in the trials didn't do so from sexual contact.^[52] Furthermore, assuming the findings of the 3 RCTs are correct, the absolute risk reduction in female-to-male HIV transmission is approximately 1.3%.^[50] It can then be calculated that the Number Needed to Treat (NNT) is 1 / (0.013) = 77 circumcisions to prevent one HIV infection.^[53] And that is for men in endemic regions — outside of endemic regions, it is likely the NNT would be considerably higher. In fact, Sansom et al (2010) found that, based on the protective effect observed in the three RCTs in Africa, "The number of circumcisions needed to prevent one HIV infection [in the United States] was 298 for all males, and ranged from 65 for black males to 1,231 for white males."^[54]

Nonetheless, the World Health Organization responded with a statement advocating VMMC in HIV-endemic places,^[55] apparently targeting procedures at both adult men and adolescent boys. As of 2020 they reported: "Over 25 million men and adolescent boys in East and Southern Africa have been reached with VMMC services."^[56]

Meanwhile, Nayan et al (2022) found that "circumcision was not independently associated with the risk of acquiring HIV among males from Ontario, Canada."^[57] Frish & Simonsen (2022) found that "non-therapeutic circumcision in infancy or childhood did not appear to provide protection against HIV or other STIs in males [in Denmark] up to the age of 36 years."^[58]

By contrast, circumcision does not seem to reduce risk of transmission for men who have sex with men.^[59], who are much more at risk of HIV/AIDS than straight men in the UK^[60]

Condoms, when used correctly, are very effective in preventing sexual transmission of HIV,^[61][62] including for gay men.^[63]

Pre-Exposure Prophylaxis (PrEP) is also extremely effective at HIV prevention when used correctly, offering 99% protection from sex.^[64]

In the U.S., where 77% of men are circumcised as of 2010,^[65] the prevalence of HIV is 0.3%,^[66] whereas in Denmark, where only 1.6% of men are circumcised,^[67] the prevalence of HIV is only 0.1%.^[68]

We conclude that the claim that circumcision reduces female-to-male HIV transmission risk by about 60% is very possibly untrue or exaggerated, and even if this claim were true, circumcising a boy for this reason amounts to performing a genital surgery on a child who can't consent, in the hope that it may offer him protection from HIV in the distant future (by which time he may be able to consent to circumcision). Should he transpire to be LGBT, abstinent, in a monogamous relationship with an HIV-negative partner, or an intravenous drug user, it will confer him no benefit. Even if he transpires to be none of those things, circumcision alone would still be insufficient to reliably protect against HIV (and may be ineffective or even disadvantageous for male-to-female transmission), so other more effective means of protection against HIV are important regardless. It is clear that HIV prophylaxis is not a good justification for circumcising boys.

Other Sexually Transmitted Infections[edit]

Based on the 2000 British National Survey of Sexual Attitudes and Lifestyles (Natsal 2000), Dave et al (2003) found "We did not find any significant differences in the proportion of circumcised and uncircumcised British men reporting ever being diagnosed with any STI ... We also found no significant associations between circumcision and being diagnosed with any one of the seven specific STIs. [Gonorrhoea, Genital chlamydia, Syphilis, Non-specific urethritis, Genital herpes, Genital warts, and Trichomonas]"^[69]

Frish & Simonsen (2022) did not find that non-therapeutic childhood circumcision "did not appear to provide protection" against STIs, and even increased incidence of certain STIs.^[58]

Safe sexual practises, and not circumcision, are the the best way to prevent STIs and remain necessary regardless of a man's circumcision status. Even if circumcision did appreciably reduce STI incidence, this benefit would only apply after an age that he may be able to consent to circumcision himself (16 is the age of sexual consent in the UK^[70] and also the age at which a person is presumed competent enough to consent to their own medical treatment^[71]), so it would not be a good reason to circumcise a boy in infancy or early childhood. In particular, if it were found that circumcision reduces STI transmission incidence to women, it'd be unethical to surgically alter a child's genitals to potentially benefit someone else.

Penile cancer[edit]

Obviously, by removing the foreskin (or any other part of the human body), circumcision removes any risk of cancer in the removed body part, though penile cancer, in general, is very rare and often stems from infection with HPV (against which boys can be immunized by the HPV vaccine^[72]).

Proponents of circumcision often bring up research from the Journal of the American Academy of Dermatology, which finds that "Regarding penile cancer, epidemiologic data have shown that penile SCC is extremely rare in men circumcised at birth."^[73] However, due to later studies contradicting it, medial authorities have largely dismissed it. For example, the American Cancer Society writes "the protective effect of circumcision wasn't seen after factors like smegma and phimosis were taken into account."^[74] In fact, to quote a study from the National Center for Biotechnology Information: "Recent medical literature has failed to confirm the protective effect of circumcision on penile neoplasms. Physicians need to be aware that men circumcised after 1 month of age may be at higher risk for penile cancer than those never circumcised."^[75]

While penile cancer can occur in anyone with a penis, penile cancer mostly affects men over 50.^[76] According to data from Cancer Research UK, penile cancer is practically non-existent in children and men under 25.^[77]

Furthermore, the lifetime risk of developing penile cancer in the United States, where around 77% of all men are circumcised as of 2010,^[65] is 1/1437.^[75] However, in Denmark, where only 1.6% of all men are circumcised,^[67] the lifetime risk is only 1/1694.^[75]

HPV / Cervical cancer in female sexual partners[edit]

Circumcision has been claimed to reduce cervical cancer in the female sexual partners of circumcised men, as the vast majority of cases of cervical cancer are caused by infection with Human PapillomaVirus (HPV),^[78] and transmission of HPV is allegedly reduced by male circumcision. Even ignoring the large ethical problem of performing a non-voluntary invasive surgery on a child's genitals for the possible distant future benefit of someone else's health, and even if circumcision were significantly effective in reducing oncogenic HPV incidence, it would not be a compelling reason to circumcise healthy boys since boys and girls can now be immunized against HPV.^[72]

Male circumcision is not associated with overall incidence and clearance of HPV in men, and increases time to clearance of HPV type 16,^[79] one of the two types of HPV that most commonly cause cervical cancer.^[80] Additionally, Winer RL et al (2003) found that among female university students in the Washington state, with a mean follow-up time of 41.2 months, circumcision of their male partners was "not associated with incident infection" of HPV.^[81]

Urinary tract infections[edit]

Non-therapeutic neonatal male circumcision is sometimes purported as reducing Urinary Tract Infections (UTIs) during their first year of life. To et al (1998) found that it would take 195 circumcisions to prevent a single hospital admission for a UTI during the first year of life.^[82] UTIs are also significantly more common in girls anyway.^{[83][note 5]} UTIs in boys and girls can easily be treated with a course of antibiotics,^[84] without anything as invasive as genital surgery. UTIs are hence not at all a compelling reason to circumcise infant boys for prophylaxis.

Freedom of religion[edit]

Attempts to prohibit circumcision in European countries have been accused of infringing the freedom of religion of Jews and Muslims.^[85][86][87]

However, per Article 18 of the International Covenant on Civil and Political Rights,^[88] "Freedom to manifest one's religion or beliefs may be subject only to such limitations as are prescribed by law and are necessary to protect public safety, order, health, or morals or the fundamental rights and freedoms of others." (A very similar limitation on freedom of religion and belief is declared in Article 9 of the European Convention on Human Rights.^[89])

Since circumcision causes significant harm to children and violates their absolute right to bodily autonomy and physical integrity, it follows that the qualified right to freedom of religion can justifiably be restricted to exclude ritual circumcision.

Parental authority[edit]

It is argued by some^{[90][better source needed]} that at the end of the day, since a baby boy cannot make any decision for himself, it is ultimately the decision of his parents whether or not he shall be circumcised. After all, parents make decisions for their sons all the time, such as bedtimes, what name he'll be given at birth, and which school he'll go to — so why shouldn't they get to choose how much of his genitals he gets to keep?

Clearly, there are limits to the choices that are acceptable for parents to make for their children. Parents have a responsibility for and a duty to protect their children, and not dominion over them. We don't allow parents to make other permanent alterations to their children's bodies without medical need. Parental authority to consent to treatment on behalf of their children is considered limited to those that are deemed in their child's "necessary" medical interest,^[91] or at least their "best" interest.^[92] It follows that if circumcision cannot be proven to be in the best interests of a boy, his parents have no right to have him circumcised.

Hygiene[edit]

Perceived hygiene benefits are one of the most common reasons why American parents choose to circumcise their sons.^[93] This isn't a very good reason to ablate body parts from your son instead of teaching him to spend a few seconds in the shower to wash himself properly (which is important regardless of circumcision status). The foreskin should never be forcefully retracted during infancy or early childhood. Once a boy becomes able to do so, he should gently retract his foreskin and rinse the glans penis and inside of the foreskin with warm water (not with soap). Smegma is a natural lubricant of the penis, but can become a breeding ground for bacteria if it builds up too much, so all boys should regularly clean their genitalia.^[94][43]

"Better early than late"[edit]

Some authors contend that it is in some ways significantly "better" to be circumcised in infancy than in adolescence or adulthood, and therefore it is in a boy's best interest to be circumcised while he is still an infant so that he won't have to deal with the supposedly "worse" experience of being circumcised as an adult.^[95] This point is sometimes brought up as a counterargument to the view that boys not circumcised in infancy or childhood can choose to get circumcised as an adult (while a circumcised man can never fully reverse his circumcision). The "better early than late" argument is used to argue that even benefits of circumcision that don't matter prior to late adolescence or adulthood (such as all STIs including HIV/AIDS and HPV, and penile cancer) should be important considerations in the discussion of whether it is a baby boy's interest to be circumcised.^[95]

Ways in which is it is suggested that infancy is the "best" time to be circumcised include:

• Risk of complications: It has been claimed that infant circumcisions have much lower risk of adverse surgical complications than adult circumcisions.^[96] However, complications of adult circumcision in the African RCTs occured around 1.7% to 3.8% of the time, and were generally mild to moderate complications that were effectively resolved.^[45][46][47] This is compared to a 1.5% complication rate in babies.^[97] It therefore seems that increased risk of complications, while possibly a genuine disadvantage of deferring your son's circumcision decision until he is capable of making it himself, is not a compelling enough reason to circumcise him as a baby.
• Pain: It has been claimed that adult circumcision is more painful than infant circumcision, and/or that it's better to have such a painful experience as an infant because he won't remember it later.^[95] During the 20th century, it was commonly believed, even by medical professionals, that babies couldn't feel pain.^[98] For this reason, many surgeries including circumcisions were often performed on babies with zero pain relief. It is now known that babies if anything feel more pain than adults,^[99] and while it is certainly true that little to no men circumcised as infants will consciously recall that experience, it nonetheless may cause lasting trauma.^[100] The fact that the boy won't consciously remember the pain is not an excuse at all for inflicting it in the first place, especially when it is likely to be a frightening experience for him as he cannot understand what is happening, unlike an adult or adolescent who has requested circumcision of his own volition. Furthermore, newborn boys cannot safely receive general anesthesia for the procedure, unlike a male undergoing the procedure later in life.^{[citation needed]}
• Cost: Some argue that it's more cost effective to circumcise infants than adults.^[96]
• Simplicity: Infant circumcision is believed by some to be a "simpler" operation than adult circumcision.^[96] Note that for neonatal circumcision, the foreskin must first be forcefully separated from the glans due to the natural adhesion to the glans in the first few years of a boy's life, which is untrue of adolescent or adult circumcision.^{[citation needed]}
• Recovery: Some argue that for infant circumcision, the recovery from the surgery is shorter and/or less inconvenient than for adults.^[96] This is likely true to some extent,^{[101][better source needed]} as men must take a week off work, while newborn boys wouldn't be walking around anyway.

Notably, one could object to the "better early than late" argument by pointing out that few men not circumcised at birth will ever want or need to be circumcised later in life.^{[citation needed]} Therefore, rather than thinking about it as "circumcision early or circumcision later", it would be more accurate to think of it as "have circumcision forced on him at birth, or he gets to choose as an adult."

In conclusion, the claim that it is overwhelmingly better to be circumcised as a baby than as an adult is questionable, and even if it were true, it would not be an ethical reason to deny children autonomy over their own genitalia.

Other rationales to circumcise[edit]

Parents also circumcise their sons for other rationales, including some that are unrelated to health or religion. Many rationales are related to the cultural normalization of circumcision, such as in the United States:

• Belief that a boy's circumcision status needs to match his father's.^[93]
• Aesthetic reasons.^[93]
• Belief that being circumcised will be more sexually pleasing to his future partners.^{[citation needed]}
• Thinking that non-therapeutic neonatal circumcision "just seems right" or "it's just what you do."^[93]
• Concern that he may be teased for being uncircumcised.^{[citation needed]}

Arguments against circumcision of babies or children[edit]

Bodily autonomy and integrity[edit]

Bodily autonomy is the right of a person to ownership and choice over their own body.^[102][103], while bodily integrity refers to the right "freedom from physical non-consented acts."^[104]

Non-therapeutic circumcision of infants and children who are too young to consent to the procedure is a violation of the child's right to bodily autonomy and integrity. It subjects children to an unnecessary irreversible alteration of their bodies (indeed the most private and intimate part of their bodies, no less), with significant lifelong consequences for the appearance, anatomical structure, and possibly function of their genitalia, that they certainly cannot consent to, and usually have not requested, and in the case of infants, are entirely unable to even object to. It denies a boy, and the man he will become, the right to own his complete genitalia that he was born with. It is a violation of bodily integrity because it subjects him to a physical invasion of his genitalia without his own consent.

Pain and trauma[edit]

Having part of your genitalia cut off as a child with no pain relief is a supremely painful experience.^{[citation NOT needed]} In the 20th century, it was widely believed that newborn babies couldn't feel pain, and therefore many neonatal circumcisions were done without any pain relief.^[98] Some circumcisions performed today still do not use pain relief, especially those performed in non-medical settings as a custom or ritual.^[105]

No method of pain relief can fully prevent clinically significant pain from the procedure.^[106] Thus, the only way to spare a boy from suffering significant pain is to not circumcise him.

All circumcisions cause physical trauma, as the surgery causes injury to the tissue in order to excise the foreskin.

69% of boys in the Philippines circumcised in the traditional Tuli ritual, and 51% of those circumcised by medical operators or medical assistants, exhibit symptoms of Post-Traumatic Stress Disorder (PTSD).^[105] Note that Filipino boys are typically circumcised between the ages of 8 and 12.^[39]

The pain that circumcision causes to infants is often downplayed by the belief that "he won't remember it". Even if this were entirely true, it's certainly not an excuse to inflict unnecessary pain on a defenseless baby. Furthermore, while men cannot consciously recall their infant experiences, pain in infants can cause long-term consequences,^[107] including heightened responses to vaccination which were only mitigated by pain relief (specifically EMLA cream).^[108]

Adverse sexual effects[edit]

Though the foreskin is noted for its significant innervation,^[109] there does not appear to be a clear consensus in the medical community on whether or not circumcision markedly reduces overall sexual pleasure. It is a difficult topic to assess, due to the extremely subjective nature of sexual pleasure, and the fact that both uncircumcised and circumcised men usually have nothing to compare to. Obviously however, circumcision renders impossible any sexual act that inherently requires a foreskin, such as docking.

According to the NHS, circumcision in men may cause "permanent reduction in sensation in the head of the penis, particularly during sex".^[41] However, a 2009 manual by the World Health Organization, UNAIDS, and Johns Hopkins Program for International Education in Gynecology and Obstetrics instructed that circumcision didn't cause impotence or a reduction of sexual pleasure.^{[110]:Chapter 3-4}

Data from Bossio et. al (2016) indicates that the foreskin has lower thresholds to tactile sensitivity than any other part of the penis, and lower and warmth detection than the glans penis.^[111] Bizarrely, however, media reporting of this study and even the study's own Abstract contradicts this data.^[112] On the other hand, the study did find that the parts of the penis not ablated by circumcision are no less sensitive in circumcised men. Limitations of this study include a low sample size (62 participants) and a lack of older participants (all were <= 37 years).

A study performed by the British Journal of Urology found that, of their sample of roughly 1,300 men (of which 310 were circumcised), those that were circumcised "reported decreased sexual pleasure and lower orgasm intensity. They also stated more effort was required to achieve orgasm, and a higher percentage of them experienced unusual sensations (burning, prickling, itching, or tingling and numbness of the glans penis [as well as other complications])."^[113]

Sorrells et al (2007) found that "The glans of the circumcised penis is less sensitive to fine touch than the glans of the uncircumcised penis" and also found that the most sensitive part of the uncircumcised penis was the "transitional region from the external to the internal prepuce", therefore concluding that "circumcision ablates the most sensitive parts of the penis."^[114]

Kim & Pang (2007) reported that men circumcised as adults reported that circumcision had generally negatively impacts on masturbatory pleasure (48% decrease vs 8% increase) and more difficulty in masturbation (63% more difficult, 37% less difficult), and more men reported worse (20%) than better (6%) sex lives after circumcision.^[115]

Frisch et al (2011) reported that circumcision is associated with orgasm difficulties in Danish men and various sexual difficulties in their female sexual partners.^[116]

A meta-analysis by Morris & Krieger (2013) concluded that circumcision had "no adverse effect on sexual function, sensitivity, sexual sensation, or satisfaction."^[117] However, this has been criticized by other authors, including allegations that Morris cited his own letters and opinion pieces which criticized studies indicating adverse sexual effects of circumcision without accounting for authors' replies to these letters, and failing to account for serious limitations of studies that show no adverse effects.^[118][119] Other works about circumcision by Morris have faced similar criticism. ^[120][121]

Lack of safety[edit]

According to the NHS, "The risks associated with circumcisions when carried out by qualified and experienced doctors are small." ^[2]

Unfortunately, circumcision performed outside of hygienic clinical settings by non-medical practitioners is unambiguously risky. In New York City, at least 11 baby boys were infected with herpes over an 11-year period in the early 21st century due to an Ultra-Orthodox Jewish circumcision ritual known as metzitzah b’peh in which a mohel orally sucks off the tip of the bloody baby penis sucks blood out of the incision.^[122][123] Other sects of Judaism do not have the mohel suck blood out of the incision, so their practices are less risky. Circumcision initiation rites in some cultural groups in Africa are also very dangerous as they are carried out in unsafe settings by traditional practitioners.^[40] According to Dan Bollinger, "a prominent opponent of circumcision",^[124] around 117 neonatal deaths occur in the United States every year due to circumcision, or 1 out of every 77 neonatal deaths. This is compared with 44 neonatal deaths from suffocation, 8 in automobile accidents, and 115 from Sudden Infant Death Syndrome.^[125] However, this statistic is "widely disputed by medical professionals. A spokeswoman for the Centers for Disease Control and Prevention said the agency did not keep track of deaths from infant circumcision [in the United States] because they are exceedingly rare. In the agency’s last mortality report, which looked at all deaths in the country in 2010, no circumcision-related deaths were found."^[124]

Neonatal circumcision increases risk of Meatal Stenosis by 10-26 fold and risk of other urethral stricture diseases (USDs) by 5-14 fold. The former affects 5%-20% of circumcised boys. ^[126]

Unfortunately, as with any medical procedure, on rare occasions things can go wrong, even with a medical circumcision performed by professional surgeons in a hospital; the tragic story of David Reimer began with a botched circumcision due to phimosis,^{[note 6]} using a somewhat unconventional method: electro-cauterization. There is conflicting testimony, but the doctors may have also used a non-standard clamp.^{[127]:12–15} This left his penis so badly burned that it necessitated removal.^[128] Ouch.

Sex reassignment surgery[edit]

While circumcision does not render sex reassignment surgery impossible for trans women, circumcision complicates the surgery and possibly adversely affects its results, since circumcision ablates tissue that would ideally be used to create parts of the vulva.^[129][130]

Far-right opposition[edit]

Unfortunately, criticism of the procedure has often been co-opted as an antisemitic dog-whistle by some far-right parties and activists in the Western World,^[131] as well as a wrongful justification to bash feminism from individuals within the so-called men's rights movement.^[132]

Circum-parisons[edit]

Female Genital Mutilation[edit]

Female Genital Mutilation (FGM), also known as Female Genital Cutting (FGC) or female circumcision, is a term that collectively refers to procedures that remove, alter, or injure the female genitalia in the abscence of a valid medical reason for this to be done.^[133][3]. The vast majority of such procedures are carried out on children who can't consent to it, as with male circumcision. Some people compare medically unnecessary male circumcision to FGM, as the former removes, alters, and injures part of the male genitalia, arguing that the strong categorical condemnation (and explicit illegality) of FGM in the West, coupled with acceptance of male circumcision, is a double standard.^[134][135]. However, others object to this comparison, arguing that FGM is very different from, and much worse than, male circumcision.^{[citation needed]}

While more severe forms of FGM such as excision of the glans clitoris (Type Ib) or infibulation (Type III) are above and beyond male circumcision - more congruous procedures would be castration or subincision which are thankfully much less common across the world today - other forms of FGM are no more destructive than male circumcision. For example, in 2017 in Michigan, USA, several people were prosecuted for performing a minor form of FGM that involved “removing a sesame seed-sized amount of mucous membrane from the clitoral hood" without removing the clitoris. This corresponds to Type Ia FGM.^[136]

FGM is performed at a variety of ages, usually between infancy and age 15^[133]. Some contend that FGM shouldn't be compared to male circumcision because the former often happens at an age where the victim will remember the horrid experience for life^{[citation needed]}, although the same can be said about male circumcision in some cultural groups^[105], and the fact infants "won't remember it" isn't an excuse to inflict unnecessary pain to infants - especially as it may still cause long-term effects.^[137]

FGM is usually carried out by non-medical practitioners, often without proper sterile tools, although this is not always the case.^[133] While circumcision in United States usually takes place in hygienic medical settings by medical practitioners, the same cannot be said of male circumcision in some other groups (see Lack of safety).

According to the NHS, the Metropolitan Police, and the World Health Organization, FGM confers "no health benefits".^{[133][3][138]}. However, bioethicist Brian D. Earp contends it would be more accurate to say "we actually don’t know if certain minor, sterilised forms of FGM have health benefits, because it is unethical – and would be illegal – to find out."^[139] Meanwhile, the health benefits conferred by male circumcision (see Purported prophylactic benefits) are ultimately quite minor and are not substantial enough to justify surgical alterations to a child's genitalia without consent - just as all forms of FGM would rightfully still be illegal and unethical if it were found that certain forms conferred minor benefits.

Some authors contend that FGM and male circumcision shouldn't be compared because the former is primarily motivated by oppressive or misogynistic intent, such as sexual control, whereas the latter is primarily motivated by benign intentions, such as perceived health or hygiene benefits.^{[citation needed]} However, in societies where FGM is practised frequently, it is often actually women rather than men who control it^[140], who often cite remarkably similar reasons for performing FGM as some parents do for male circumcision such as cosmetic enhancement^[140], tradition and conformity^[141], supposed hygiene benefits^{[142][better source needed]}, or perceived religious obligation^[143].

We conclude that although FGM and male circumcision are not identical issues, and FGM is typically the more severe of the two practices, it is a double standard to condemn all forms of nonconsensual FGM, regardless of age, surgical conditions, severity of harm, or reasons for the practice, while accepting medically unnecessary nonconsensual male circumcision; every child has the rights to genital autonomy and integity, and hence the right not to be subjected to medically unnecessary, nonconsensual genital cutting, and to afford these rights to only one sex constitutes discrimination. Interestingly, while many countries have banned FGM, none have banned non-therapeutic circumcision of boys. This is a touchy point with men's rights activists because they believe that outrage over FGM and acceptance of circumcision is proof of anti-male bias^{[citation needed]}. This is despite the fact that many feminists and human rights activists, such as Gloria Steinem and Ayaan Hirsi Ali, have condemned the procedure in addition to condemning female genital mutilation.^[144][145]. After all, bodily autonomy is a key principle of feminism, and feminists recognise that patriachy can harm boys and men, but it isn't suprising that feminists should focus on the more severe of the practices, and to combat the disadvantages that women and girls face. Political scientist Rebecca Steinfeld contends that reasons for this double standard include ethnocentrism (as male circumcision is culturally normalised in the West, especially the United States, while FGM is not, the latter is "more liable to be seen as barbaric") and sexism (under patriarchy, "vulnerability is gendered.")^[146]

Notably, this comparison may also be invoked the other way by supporters of FGM - indeed, in certain religious or cultural groups, FGM is seen as a parallel ritual to male circumcision^{[citation needed]}. Of course, the best response to this is that medically unnecessary genital cutting of children, regardless of sex, is unacceptable.

Vaccinations[edit]

Some proponents of non-therapeutic childhood circumcision justify the practice by comparing it to routine childhood vaccinations, as they both are painful procedures performed on children who are too young to consent but (supposedly) confer prophylactic benefits that outweigh any associated risk.^[147][148]

Claims of health benefits are far more compelling for vaccination than circumcision, both in terms of credibility and in terms of the magnitude of the benefits. If circumcision were comparable to vaccination, the United States would've all but eradicated the diseases that circumcision purportedly protects against, such as HIV, penile cancer, and male UTIs. This is quite clearly not the case, as the US actually has higher rates of some of these diseases than European countries where circumcision isn't the norm.^[66][68][75] Vaccinations are also more imminently needed, as many diseases that have been virtually eradicated by vaccination would otherwise infect many children before they are old enough to consent to being vaccinated, whereas many supposed health benefits of circumcision do not apply prior to adolescence or adulthood, such as sexually-transmitted diseases or penile cancer which mostly affects older men.^[77] Many diseases supposedly prevented by circumcision have another means of prevention or treatment that is both more effective and less invasive, such as safe sexual practices, proper washing of the penis, or steroid creams, whereas vaccination has no reasonable alternative to prevent diseases that would otherwise be highly contagious and deadly in children.

Every major medical organisation strongly recommends routine childhood vaccination against diseases such as rubella, meningitis, and rotavirus, whereas none outright recommend routine childhood male circumcision.

Circumcision constitutes a considerably greater invasion of a child's bodily autonomy and integrity than vaccination, as vaccination doesn't permanently ablate a significant part of a child's most intimate body part. Circumcision is probably also far more painful than vaccination, and some vaccinations don't involve a painful injection at all, but instead may be introduced nasally^[149] or orally.^[150]

In short, routine childhood circumcision confers much more marginal health benefits than vaccination, while much more seriously violating their bodily autonomy and integrity, and therefore it is ethical to routinely vaccinate children, but not to routinely circumcise boys.

Intersex Genital Mutilation[edit]

Medically unnecessary surgeries performed on intersex children who are too young to consent, also known as Intersex Genital Mutilation (IGM)^[151], have also faced opposition by intactivists, who believe that IGM violates bodily autonomy and integrity similarly to circumcision.^{[7][152][better source needed]}

Trans healthcare[edit]

Provision of trans healthcare (Puberty Blockers (PBs), Hormone Replacement Therapy (HRT), and Gender Affirming Surgeries (GAS)) to minors has been compared to the circumcision of minors, often to accuse people of hypocrisy for supporting one practice but not the other.^{[153][154][155][12]} While critics of the former practice often argue that "minors cannot consent", this is not necessarily true: for example, in the United Kingdom, 16-17 year olds are presumed capable of consenting to their own medical treatment, while minors under 16 may be able to consent if deemed Gillick competent.^[156] Trans healthcare is typically provided to adolescents who ardently request the treatment of their own accord and sometimes can and do consent to it, whereas circumcision is usually imposed on children who absolutely can't consent, and often don't have a say in the procedure whatsoever (as is the case for babies.) Just as importantly, while both procedures are performed in the abscence of a physical health indication, trans healthcare is indeed a therapeutic treatment and quite arguably a medically necessary one: it is indicated by persistent dysphoria. To that end, it is very effective^[157], and unparalleled by solely psychological treatment.^[158] Meanwhile, most circumcisions are performed on children who have no physical or mental distress indicating surgical intervention, and many if not most circumcisions are done primarily for religious or cultural reasons, unlike trans healthcare.

Note that circumcision is of course, an invasive, painful, and permanent surgical operation, meanwhile GAS are not ordinarily prescribed to minors^[159] per international standards^[160], and in the rare cases that they are it is likely to be on older adolescents presenting with severe, persistent dysphoria^{[citation needed]}. HRT tends to be prescribed to older adolescents, typically at around an age they are likely to be able to consent,^[159] and in the uncommon cases where it is prescribed to earlier adolescents, it is likely because they are found to be Gillick-competent, or it is determined that postponing the treatment would be prejudical to the patient's health. PBs are believed to be largely physically reversible, particularly in terms of their intended physical effect^[159], as opposed to circumcision whose intended effect is irreversible. PBs are a very time-sensitive treatment, as postponing the treatment not only causes harm by prolonging dysphoria, but effectively forces undesired (possibly even traumatic) physical changes that can never be undone (or may require surgery to do so) once the patient is older, unlike circumcision which can feasibly be postponed until late adolescence or adulthood, when the patient can consent. Indeed, because of this, PBs are ethical ironically for the very reason that nonconsensual circumcision is unethical: bodily autonomy.

It follows that provision of PBs and HRT to trans adolescents, if they demonstrate Gillick competence or if the treatment is otherwise demonstrably necessary for their mental health (due to persistent dysphoria) is not only ethically permissible, but ethically obligatory, while circumcision of Gillick-incompetent minors in the abscence of a therapeutic indication is ethically impermissible. On the other hand, the fact that efforts to prohibit trans healthcare tend to turn a blind eye to childhood circumcision (often also IGM) or even specifically exempt it^[161], is rather telling of their true motives...

Ways of restoring the foreskin[edit]

Non-surgical techniques[edit]

Accomplished by stretching tissue to stimulate mitosis. Can be done manually or with a device. Just make sure you know what the heck you're doing so you don't rip your dick off get sore.

Surgical[edit]

• Foreskin reconstruction
  • Involves skin transplant
• Foreskin regeneration
  • Regrowing the patient's foreskin — the organization ForeGen^[162] has professional assistance to prove out preliminary procedures needed, including the successful decellularization of a human foreskin scaffold.

Uses for the foreskin[edit]

Historically, the main use of severed foreskins was in religious practice, with holy foreskins ostensibly from Jesus's wiener featuring in various Roman Catholic rituals. However, publications have reported that foreskins could be the next big beauty treatment. Epidermal growth factor from the foreskins of newborn boys reportedly helps "generate collagen and elastin, which can help to boost the radiance of your face".^[163][164] "Neonatal foreskin fibroblast culture" features in the TNS range from SkinMedica of Carlsbad, CA, USA, and in one clinical trial showed a statistically significant improvement in the appearance of fine lines.^[165]

See also[edit]

• Holy Foreskin

Notes[edit]

References[edit]