The debate over surgically removing an infant's penis foreskin has continued over the years, with proponents touting circumcision's health benefits, and opponents arguing against what they say is the barbaric nature of the procedure. An anticircumcision group in San Francisco is the latest to join the fray, pushing for a ban on the practice.
Circumcision proponents, however, argue against the proposal, citing the procedure's history as a religious ritual, as well as its sexual health benefits -- some research suggests that circumcision helps prevent the spread of HIV.
Plenty of research has been conducted on both sides of the debate, so which point of view does the science favor?
An ancient tradition
Circumcision started as a ritual act by the Egyptians as far back as 2500 B.C. and later by Jewish people. They did it to mark a boy's passage into manhood, some believe. Other proposed reasons include: as a marking to distinguish those of higher social status; as a male "menstruation," or sign of the onset of puberty; and as a way to discourage masturbation.
Since then, however, people of many faiths began following suit: Circumcision is now the most common surgery performed on males in the United States. In a survey by the Centers for Disease Control and Prevention (CDC) during the period 1999 to 2004, 79 percent of men reported that they were circumcised.
Circumcision is widely believed to prevent diseases, such as HIV, and there is some evidence that it reduces the risk of male-to-female HIV transfer. The proposed mechanism is that circumcision removes what are called Langerhans cells in the foreskin, which are more susceptible to HIV infection. Langerhans cells are equipped with special receptors that may allow HIV access into the body.
Three studies published in 2009 in the Cochrane Database of Systematic Reviews revealed that circumcised men were 54 percent less likely to get HIV than uncircumcised men. The trials included more than 11,000 men in South Africa, Uganda and Kenya between 2002 and 2006.
The practice may also protect women from contracting the virus that causes AIDS. A review of past medical files of more than 300 Uganda couples, in which the man was HIV positive and the woman wasn't, showed circumcision reduced the likelihood that the female partner would become infected by 30 percent. That study was presented in 2006 at the Conference on Retroviruses and Opportunistic Infections.
While HIV prevention is becoming a well-supported argument for circumcision in developing countries, it is not as strong of an argument for the United States,.
"A number of important differences from sub-Saharan African settings where the three male circumcision trials were conducted must be considered in determining the possible role for male circumcision in HIV prevention in the United States," according to a report published by the CDC. The report goes on to say that, "studies to date have demonstrated efficacy only for penile-vaginal sex, the predominant mode of HIV transmission in Africa, whereas the predominant mode of sexual HIV transmission in the United States is by penile-anal sex among [men who have sex with men]."
As for medical complications, a review of 52 relevant studies from 21 countries found circumcision of infants by trained professionals rarely showed adverse health outcomes. For instance, the researchers found that among those under age 1, there was just a 1.5 percent average risk of minor adverse events such as excessive bleeding, swelling and infection. Severe complications were very rare, the study found, which was published in 2010 in the journal BMC Urology. However, risk of both minor and severe complications went up when inexperienced providers did the circumcisions.
Despite the benefits of circumcision and a lack of strong evidence showing negative side effects, the debate continues as opponents look for ways to outlaw the practice.
Put it to a vote?
A proposal to ban circumcisions in San Francisco has moved forward as proponents of the ban delivered more than 12,000 signatures to the Department of Elections this week. If the petition has enough valid signatures from registered voters, the ban will appear on the ballot in the November election. The ban would make circumcision of any male under the age of 18 a misdemeanor and carry with it a fine of up to $1,000 and jail time of up to one year.
According to Reuters reports, Lloyd Schofield, the leader of the proposal, says circumcision is "excruciatingly painful and permanently damaging surgery that's forced on men when they're at their weakest and most vulnerable."
The CDC disagrees that the procedure is painful. "Data has shown that with anesthesia, the majority of infants have no objective pain reaction," Scott Bryan, a spokesperson for the CDC, told Life's Little Mysteries.
The banning of circumcision may be an extreme measure, especially given the fact that the procedure is not mandatory. There are also still many unanswered questions on both sides of the argument. We'll have to wait until November to see how the debate actually plays out.
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