Circumcision: tell me, one more time, why this is a good idea?

The other day, my sister, who is due to give birth to a baby boy any day now, wrote me with a question:

Hi,

It is a bit strange to e-mail about this, but... Would you feel comfortable telling me your thoughts re: circumcision---we have that decision coming right up.

I can't really imagine doing it....but wanted to know your thoughts....

If she was looking for a concise response, she asked the wrong guy. I could talk about male circumcision all day, and I do, below. Be forewarned that this post gets graphic and if you read it in its entirety, you will have learned so much about my anatomy that you and I will basically have had sex.

First of all...

...I am uncircumcised. My parents were liberal, Europe-traveling hippies, and they couldn't find a good reason to cut off a significant section of their son's genitalia.

Second...

...I'm damn glad they didn't circumcise me. True, there was a time I felt out of place in the locker room (I was in a Jewish camp, for Chrissakes); I even went so far as to ask my family doctor about the possibility of getting circumcised as a teenager (answer: no problem). And I'm sure I'd get by if they had circumcised me. But it comes down to this: I know exactly what part would be missing if I were circumcised, and I'd miss the hell out of it. It's the part that feels the best. It's probably my favorite part of my body. I'd sooner give up a finger than give it up now.

Why circumcise?

Here's what I wrote my sister in response to her question:

Thanks for asking.

I used to be 100% dead set against circumcision, and I still lean that way, but I see it as more of a complicated picture now.

In general, the reasons in support of circumcision that people most often have are:

1. It's normal, at least in the US (in most of the rest of the world, it's actually become rare, except for the Muslim world, where in a few areas boys are circumcised between the ages of 6 and 11--ouch!), so your son will look like the other boys and not be self-concious or different;


2. It's more healthy, because the extra skin can cause infection;


3. It's better for his future sex life, because the penis feels less sensation, so he will last longer in bed when he starts having sex; and


4. Women (at least in the US) prefer circumcised penises.

Let me address each of these briefly.

1) It's true that it's normal in the US to be circumcised. One way this is significant is that the boy's penis will look like his father's when he starts learning what his penis is (assuming dad is circumcised too).

2) There's disagreement over whether it's more healthy or less to be circumcised. The medical evidence actually suggests that, on balance, being circumcised does indeed lower your risk of certain life-threatening diseases slightly, but "on balance" plays a big role here. There are risks unique to each kind of penis, which largely cancel out; and the overall numbers are incredibly tiny either way. The medical consensus used to be that the opposite was true--that uncircumcised penises were healthier. (This fact never penetrated far into the American medical establishment.) Most Europeans still believe this, but recently AIDS and a better understanding of other blood-borne diseases have changed the medical picture.

3) Most guys who have experienced it both ways (having had surgery to get circumcised late in life) say that they have less sensation with the foreskin gone. Now that can be a good thing or a bad thing. Some guys who were premature ejaculators were overjoyed to find that now they could last as long as 15 minutes! (I wish I was kidding.) Circumcised guys can obvioiusly still reach orgasm, so when it comes down to it they're feeling plenty. On the other hand, knowing what the part is that they would cut off, I wouldn't get circumcised now for a million bucks.

And a few guys who got circumcised as adults report that they regret it because they can't feel things they used to.

4) As for women's preference, this one is just wrong. True, many women do prefer one way or the other. But in my experience, they generally don't even notice the difference unless I point it out, because erections pull the skin back naturally, so an erect penis looks more or less the same whether circumcised or not. Female friends have told me they don't like uncircumcised penises, and then on further questioning have revealed that actually, they've just never encountered one.

Why not circumcise?

My letter continues:

Moving on, the reasons people most often cite for not circumcising a baby are:

1. It's the way mother nature made them. Why mess with that?


2. The penis feels more when uncircumcised.


3. It puts the baby in danger at the time of circumcision. (this is incredibly rare, but a tiny number of babies do die after circumcision because of bleeding, shock or infection).


4. The baby doesn't have a choice in the matter, so it's a violation of his fundamental rights as a human.

I think, on the whole, that a man can be healthy and happy either way. With that said, numbers 1, 2 and 4 feel to me like very strong arguments. When it comes down to it, there are two choices, and only one of them is irreversible. Most of all, I strongly believe that in a day and age when we appreciate sexual pleasure and don't fear it anymore, if either parent could know what it feels like to still have the part that's supposed to get cut off, they would not circumcise their child.

And so...

Letter continues:

In a nutshell, then, here is what I think:

• Why mess with nature? If being uncircumcised is good for most men in the world, and it's good enough for mother nature, it'll be good enough for my kid.


• When it comes down to it, an uncircumcised guy feels more sexual pleasure. A tiny bit more? A lot more, of a vastly different quality? It's impossible to really say, but why reduce it at all?


• If the baby is circumcised, how do you know he won't wish, later, that he hadn't been? It's not conventional to think of it this way, but he has the right to decide that for himself.

Of course, if you ask a man which way is better, I guarantee he'll endorse whichever way he happens to be. So take this with a grain of salt.

-Ben

A few comments

A few years ago, a group of American men who were circumcised because that was the default policy of the hospitals where they were born--their parents weren't asked--brought a class-action lawsuit against several hospitals. I don't know what happened with that case, but I'd like to find out. I wonder if one day, a man will sue a hospital that did ask his parents, on the grounds that parents do not have the authority to order medically unnecessary procedures on their children (after all, parents can't legally have their daughters circumcised, or their son's toe cut off, can they?).

It may be that eventually, the magic of the American lawsuit will preempt the need for us to think seriously about the convention of circumcision. This could be much like the magic of managed health care, which is ending the preemptive removal of tonsils and the appendix--all without requiring that anyone spend time wondering why our culture allowed us to be cowed into these procedures (which resulted, like all surgery, in some rate of death) for so long without pushing for more information about their utility.

It's no secret that people cling to all kinds of beliefs without any evidence (and often long after they are shown to be untrue), but it always surprises me when Americans insist, with no evidence but what their friends and family say, that circumcision is by far the healthier option. (Europeans can just as irrationally insist that the opposite is true.) Of course, no one can know the relative risks for certain, but it's astonishing that millions of new parents around the world make such a huge decision every day without first trying to find out what the medical consensus is. I'd be surprised if practically any American parents at all gave the question of circumcision as much thought as they do, say, the baby's name.

This is what interests me most about the question of circumcision: it deals directly with the assumptions and laziness of thought that make up the dangerous side of culture. Cultural relativism is not very popular in America outside universities, but what really justifies mutilating male genitals besides culture? If America didn't do it, and only Africa did, there would be public campaigns in America to end it in Africa which would treat male and female genital mutilation as a single phenomenon, and defenders of male circumcision would be derided as apologists for butchery, as defenders of female circumcision rightly are in the real, non-hypothetical America that my imagination does not, unfortunately, control.

But what does the research say about sensation?

As for sensation, some of the medical literature is against me. One article reports that significantly more men who get circumcised as adults actually report more sexual satisfaction:

Based on a sample of 84 men who'd been circumcised as adults for medical reasons, a 2005 article in Urologia Internationalis found a 61 percent satisfaction rate, with 38 percent saying that penile sensation improved after the procedure, 18 percent saying it got worse, and the rest reporting no change. "No consensus exists regarding the role of the foreskin in sexual performance and satisfaction," the article's urologist authors wrote.

To be honest, knowing what part would be cut off and how sensitive it is, I am baffled by this article's numbers. Maybe there is a strong tendency among men to believe, or at least assert, that their genitals are doing just great, whatever their actual state? Also, in a climate where masturbation is still stigmatized, could lots of men just not have an accurate perspective on their own sexual pleasure?

It's also easy to conflate phyical sexual pleasure with the overall pleasure of lovemaking, which of course could well be increased by the simple fact that less stimulation allows a man to last longer before ejaculating. Emily Bazelon, writing in Slate (with a great title--"Or ot to Snip?"), quotes a man who was pleasantly surprised to find an increase in the total pleasure he took from lovemaking, due to a decrease in the physical pleasure he took from coitus:

Daniel got snipped as a college sophomore to combat recurrent genital warts and premature ejaculation. "You can imagine my relief when I found that sex could last much longer," he wrote.

(The disappearance of the genital warts couldn't have hurt either.)

The article continues:

"Sex became less exciting but more satisfying," he wrote. Other men reported a similar trade-off. ("Is it better to have a glass of excellent wine, or a bottle of very good wine?" mused one.)

Daniel's sentiment alarms me (though I admit I'd take the bottle). Have these guys ever heard of the revolutionary method known as "taking a break", perhaps to do something sexual other than intercourse for a little while?

One guy has a particularly detailed description of the changes that resulted from his late circumcision:

Boris moved to the United States as a child and "soon discovered that I looked different from almost every other boy." As he grew up, he became more comfortable and started teasing his circumcised friends about their relative lack of sensitivity. Then at 27, he developed phimosis and decided to get circumcised at a doctor's recommendation. Eight months later, he wrote:

If you were to visualize sex as arousal plotted against time, the simplest kind of x/y graph, you would expect to see a line that is rising towards orgasm, where it drops off. I think an accurate way to picture that rise is as a series of spikes—particular moments that are punctuated with especially pleasurable sensation, taking you higher and higher, until the ultimate spike that brings you over the top. The best way I can describe sex without a foreskin is that the very tips of these spikes are shaved off, but the line steadily progresses upwards nonetheless, with the orgasm completely unaffected. Maybe this sounds substantial but somehow it isn't. … Sex is about so much more than raw sensation from one little strip of skin, no matter how sensitive, that pleasure doesn't feel diminished. Who you're with, their excitement, your chemistry together, the sensation of your entire body against another—there are so many things that play into the equation. The marketing slogan would be something like "Hey, it's sex. It still feels really, really good."

Okay, so can everybody raise their hands if they kind of want to have sex with Boris right now?

Anyway, Boris's is a valuable perspective, and it's one thing that makes me feel that maybe male circumcision isn't so bad after all--certainly not as bad as female circumcision, which is usually more gruesome (though being a Muslim boy turning ten in an Uzbekistan village without anaesthetics must be pretty awful, too), interferes far more with the basic ability to have sex comfortably, and, from what I understand, often prevents women from having orgasms, ever.