Circumcision and Medical Ethics

Ah, the circumcision debate.

I've been reading a lot about it lately, which probably isn't good for me, but oh well. I've analyzed both sides of the issue, I watched Penn and Teller's Bullshit on it, I read the medical literature. My conclusion is physically, it's not necessary-- but it doesn't harm them, either.

Circumcision has been consistently proven to not decrease fertility (clearly, Eritrea has a 95% rate of circumcision and they have a population growth rate of 2.5% with 33.97 births per 1000 population), it has been proven to have no effect or a positive effect on sex enjoyment and ability to have sex repeatedly, with all studies stating it had no effect on sex drive, two studies saying it improved and two studies saying it decreased erectile function, with three more claiming no difference, most studies claiming it prevented premature ejaculation, of seven studies, only one claimed it decreased penile sensation, and absolutely no studies claiming it decreased overall satisfaction.

In other words, no impact on sex. At all. No impact on fertility. Complications are very rare (comes from practice all these years) and they can be performed under local anesthesia to prevent pain (and should be, after all, we numb ears before piercing). There's some evidence that they reduce the risk of STDs, including AIDS, but there haven't been enough studies for me to comfortably say that is the case, and anyway, condoms do a much better job. The truth is, medically, there's not really any reason to bother circumcising, and it's just a body modification which we perform for aesthetic and cultural reasons. At the same time, though, it's not actually doing any long-term damage. I think the closest real comparison we have is the idea of piercing ears. Pierced ears are incredibly common, they show up in many cultures, and piercing usually happens when the person is still a child or a teen (ie not a legal adult). They are socially acceptable, and yet, they are body modification-- it is punching holes in a child's body and forcing the skin to grow back around a metal object to produce a permanent hole. They also hurt like all hell if you don't get numbed first.

So the question-- medically, neonate circumcisions (usually, barring complications) aren't needed; thus, are they ethical? Well, pierced ears aren't considered unethical. I don't think I'd want to pierce a baby's ears myself, but I wouldn't stop someone who did so to their kid, and it's quite common. And since there is no long-term pain or disability, there's nothing unethical about doing it as an initiation into a religion or something. People do all kinds of weird shit to their kids in the name of religion, and body modification is a common religious practice, so as long as the kid's life isn't really impacted, I see no objection to that. Provided, naturally, that the religious official performing the circumcision is trained, licensed, and willing to use anesthetic.

But what about people who simply think the circumcised penis looks better? Is it ethical for a doctor to circumcise a boy?

Honestly? I don't think so. I don't really like the idea of doctors doing it. However, at the same time, I think we should have people who are licensed and trained to perform circumcisions for anyone who wants it for their son or themselves. The trouble with doctors doing it is it becomes about "healing" the kid somehow. I say take medicine out of the equation, except in the sense that a person performing a circumcision should have training and licensing, same as someone who does tattoos or piercings, and more so because a mistake could be problematic. Or perhaps list it as a form of plastic surgery or something. I think it should be made quite clear to parents that it is an aesthetic/religious, not medical, choice for them to make.

But ethically, I see no problem with them making that choice. It's not like FGM, where a woman can no longer enjoy sex because her sexual organs have been cut out. The foreskin is a small and relatively insignificant part of the genitalia. Losing it does not cause lasting pain, it does not decrease sexual abilities, nothing. In other words, yes, it is a body modification, yes, it is unnecessary, no, doctors should never suggest it or encourage it for medical reasons (unless there actually IS a medical reason, like phimosis), though they should answer any questions as free from personal bias as possible. At the same time, I think that it is still firmly the choice of the parents and there is nothing unethical about allowing parents to choose to do so to their son. If it bothers him that much, he can have it restored as an adult, same as the girl whose ears are pierced can let them grow back together.

And me personally? I don't really care. I don't practice a religion that cares about foreskins, and while I find circumcision more aesthetically pleasing myself, my opinion on the appearance of my son's penis is irrelevant, what matters is what his future girlfriends/spouse thinks of it. What I find more attractive shouldn't really apply to my son's genitals. So I'll probably defer to my husband on the subject.