Circumcision is the act of removing the foreskin from a male penis. Many modern American textbooks and magazines illustrate the penis without a foreskin because circumcision has been notably prevalent in previous generations of American society. As a result of this, many young American circumcised males are ignorant of their status, perhaps thinking that they were born that way. Meanwhile, young uncircumcised males know virtually nothing about the purpose and function of the foreskin and are often teased in locker rooms because they look different.
Now we come to circumcision's relation to the fight against AIDS. Many recent articles have cited studies in Africa that seem to prove that circumcision helps to prevent AIDS, foremost among them "To snip or not to snip?" from The Economist and "Male Circumcision Could Prevent Millions of Infections" from AIDS Weekly. While I cannot attack the scientific studies that have been conducted in relation to circumcision and AIDS, I do believe that certain facts may be overlooked and that many cultures [and thus their researchers and subjects] are oblivious to some of the actual facts about circumcision.
"To Snip or Not To Snip" presents the argument that a circumcised penis presents a tougher front towards abrasion and infection, so routine circumcision would be a somewhat effective means of protecting people from AIDS. This phenomenon is explained elsewhere by Joseph Zoske: "The permanently exposed glans forms a dried, less sensitive skin layer called the corneum, as a somatic response to needing a protective replacement for the foreskin. The impact of circumcision upon the sexual nature of boys and men deserves consideration. A man's foreskin afterall is not an anachronistic error by nature, but an important functional aspect of masculine sexuality (Zoske)."
Obviously circumcision can be a preventative measure, but that function is a result of the body's attempt to replace something that was already in place and functioning correctly. "Snip" [note the incredibly irreverent title, which certainly influenced my reading] also fails to take into account the fact that the foreskin acts as an aid to the natural lubrication of sex, and without it sexual activity can be more abrasive to both parties. Another article states: "Trauma such as vaginal abrasion, dryness, pain and coital bleeding are unique to the female partners of circumcised men. (Laumann)" More bleeding during intercourse would have to lead to increased AID's transmission, both in the woman due to tearing and in the man due to increased presence of blood. The effects of this are surely inseparable from the results of the study, but I wonder if the researchers were aware of them.
Another major factor is the social standpoint of non-religious circumcision. The act came into vogue in America in the late Victorian age to prevent or discourage children from masturbation. "Circumcision [played] a role in another concern of late-19th-century physicians and moralists: masturbation, a practice to which were attributed such diverse conditions as paralysis, tuberculosis, and convulsions. In some instances, circumcision was prescribed not only to diminish the pleasure but also to punish, by inflicting pain on the source of a boy's ill-gotten delights. (Levenson)" While this may have been an admirable effort at the time, the effects it has today are worth noting. The foreskin obviously facilitates masturbation; without it most men resort to the use of lubricants to aid them. An adolescent male who is circumcised might be less likely to easily discover masturbation on his own at an early age depending on the severity of his circumcision [or, at least he might not have discovered an effective way to carry it out]. Thus, the circumcised child is reliant on either his own ingenuity or outside information to fuel his knowledge of personal gratification. I would argue that it is possible that circumcised males are more likely to participate in earlier sexual conduct with others in a sexually conservative society, seeing as how they are deprived of both the information and the means to masturbate. Maybe circumcision prevents AIDS, but it may as well predispose early sexual intercourse.
It is irresponsible for the article "Male Circumcision Could Prevent Millions of Infections." to say: "The number of infections probably caused by lack of male circumcision already reaches into the millions," says Halperin. "We would expect the international health community to at least consider some form of action, but male circumcision remains largely unexplored as a tool against AIDS." To say that AIDS cases can be "caused" by "lack of male circumcision" is ludicrous. Even with concrete evidence one cannot say that lack of male circumcision causes AIDS; it just facilitates its spread. So does lack of public awareness, religious opposition to barrier contraceptives, and peer pressure. Among these "causes," lack of male circumcision is the easiest one to do away with, since it affects a child with no say in the matter and is not opposed by any major social or religious groups.
Maybe it should be opposed. Aside from the AIDS/HIV connection, one major argument for circumcision is that lack of it leads to a high incidence of urinary tract infections (UTI). UTI's can be as prevalent as 5% in uncircumcised males, but 1 in 500 circumcised children suffer complications such as "excess bleeding or, worse, permanent damage to the penis" (Horowitz.). However, there is some indication that UTI's in uncircumcised children are often caused by improper care for the foreskin: "It has been proven that retraction and washing of the infant foreskin can cause urinary tract infections by irritating the mucous membranes and destroying the naturally occurring beneficial flora which protects against pathogens (Faulk)." It is commonly held that the foreskin should not be forcefully retracted by any means until it does so on it's own. Says one article at "The Men's Center": "At birth and throughout childhood the foreskin is fused to the glans. This desirable situation protects the meatus from contaminants. By puberty, the glans and meatus will have separated and developed independent mucosal surface (Fleiss)." Despite this, many children are taught to retract it for urinary and bathing purposed early in life with their parents doing it for them even before that. Furthermore, many doctors unfamiliar with the proper care for a foreskin may attempt to forcefully retract it (Zoske). How often is that fact considered in UTI screenings, I wonder. Furthermore, the mistreatment of the foreskin in early childhood might even predispose the child for later problems such as AID/HIV transmission. Again, there is no indication that studies have taken this into account.
Circumcision does have an effect on male sexual function, even though the fact is not often cites by circumcision supporters. This effect is perhaps not as drastic as that of female circumcision, but it is especially notable. "The foreskin is an integral part of the penis. Depending on the length of the penile shaft the foreskin represents from 60% to 80% of the penile skin covering. The foreskin also represents 25% to 50% of the overall length of the flaccid penis (Fleiss)." There is, of course, a myth that would state that the foreskin is nothing but an extra flap of skin. In fact, "To Snip" seems to support this assertion, saying "the loss of a small flap of skin can help prevent the loss of from AIDS." Nowhere in either of my two primary articles is the actual function of the foreskin mentioned. Without the foreskin the penis is left with less overall nerve endings, and the ones that are left over quickly become desensitized because the glans is exposed (www.norm.org). "A piece of skin the size of a quarter contains more than three million cells, 12 feet of nerves, 100 sweat glands, 50 nerve endings, and almost three feet of blood vessels (Montagu)." I realize that decreased sexual function is a small concern in the face of the AIDS epidemic, but the pro-circumcision articles lack of any facts about the foreskin's natural functions disturbs me.
All of these arguments were tidily summed up by the American Academy of Pediatrics (AAP) last year: "Circumcision is not essential to a child's well-being at birth, even though it does have some potential medical benefits," said Carole Lannon, MD, chair of an AAP task force that produced a new policy statement appearing in this month's Pediatrics ... Studies show that the relative risk of developing a urinary tract infection in the first year of life is higher in male infants who are not circumcised. But the AAP said the absolute risk of infection remains low, at 1% or less. Similarly, uncircumcised men are at higher risk for penile cancer. But, because only 9 to 10 cases per year per 1 million men are diagnosed in the United States, the overall risk of penile cancer is extremely low. The AAP policy also stated that behavior is more important than circumcision status in the risk for contracting a sexually transmitted disease (Voelker). Here we see every argument for circumcision neatly refuted. The one issue I have with this statement is that it only takes into account the situation in America. Obviously we are somewhat capable of affecting sexual behaviors here, so circumcision is not a must. Is this possible in sub-Saharan Africa? Articles and class discussions would indicate otherwise.
The final question would seem to be "Do the ends justify the means?"; that is to say, is the practice of routine male circumcision in justified by its benefits. In general, the answer is "no." The answer is "no" in all of America. Is the answer "no" all around the world, specifically in Africa? No one seems to be entirely sure yet. So we are left with the question: "Should male circumcision be routine in parts of Africa as a means of AIDS prevention?" One side of the argument might ask how long will we conduct studies before we begin to implement this potentially life-saving procedure in Africa. The other side would point out that much further study would have to be conducted to convince them that circumcision of all male children was a necessary preventative measure both in terms of cost and human effect.
Sadly, the AIDS epidemic is a greater risk than the threat of masturbation, and in this case circumcision could be justified. This returns me to one of my first points, which is that masturbation is combated by removing the foreskin. Would more masturbation prevent AIDS cases in Africa? That might seem like a ridiculous question, but it is a valid one. Masturbation can be directly linked to prolonged sexual abstinence at any age. I honestly do not know enough about the societies in question to further this point very much, but masturbation can and does take the place of adolescent sexual activity. What I do know from personal experience and research is that many uncircumcised children in America wind up with a much more informed look at sex and sexual function, partly because most textbooks do not address their own anatomy so they have to seek out information on their own. Again, this would not hold true in Africa. I will end my speculation here, but I feel that they are all significant both in the argument over circumcision with regards to AIDS and in the argument over circumcision in general.
In the end, however unfair circumcision may be to a newly born male, the removal of the foreskin to save a child's life could be entirely fair. In this case, only time will tell if the trade-off will affect the spread of AIDS. Unfortunately, time is not a commodity we have on our side in this battle. The fight against the AIDS epidemic has and continues to utilize nearly every legal and medically sound means that it can to prevent transmission. If circumcision becomes one more tool in the fight against AIDS I will not object, since lives will be saved. However, the overall uninformed attitude towards circumcision seems to be supported by both of my main articles, and to that I object very much.
"To snip or not to snip?"
The Economist, Nov 27, 1999 v353 i8147 p49.
[No author listed]
Fleiss, Paul M.
"The Case Against Circumcision."
Mothering, Winter 1997, pp. 36--45.
Fleiss, Paul; Hodges, Frederick
"The Foreskin Is Necessary."
http://www.themenscenter.com/page31.html, April 1996.
Henderson, Charles W.
"Male Circumcision Could Prevent Millions of Infections."
AIDS Weekly; Dec 27, 1999.
Laumann, Edward O.; John H. Gagnon: Robert T. Michael Stuart Michaels.
The Secret Organization of Sexuality: Sexual Practices in the United States.
Chicago University of Chicago Press 1994 pp. 369-375.
[Citation from within another source]
Levenson, Jon D.
"The New Enemies of Circumcision."
Commentary, March 2000 v109 i3 p29.
Montagu, Ashley; Matson, Floyd.
The Human Connection.
McGraw-Hill, 1979.
Voelker, Rebecca.
"Circumcision Isn't Necessary."
JAMA, The Journal of the American Medical Association, March 24, 1999 v281 i12 p1075(1).
Zoske, Joseph.
"Male Circumcision: A Gender Perspective."
The Journal of Men's Studies, Volume 6, Number 2, Winter 1998, pp. 189-208.
This paper also takes into account facts provided by the following webpages:
Norm.org
Foreskin.org