Sunday, 19 June 2011

What Lay People Should Know about Male Circumcision – General

by Zad Datu

Religious circumcision today is practiced mainly by Jews and Muslims. Circumcision is not discussed in the Qur’an but it is practiced widely amongst Muslims and often considered to be a sunnah, and some even say it is religiously mandatory – at least the religious teacher in my secondary school said it was. In Judaism, male circumcision is a commandment as written in Genesis 17:9-14.

{9}Then God said to Abraham, “As for you, you must keep my covenant, you and your descendants after you for the generations to come. {10} This is my covenant with you and your descendants after you, the covenant you are to keep: Every male among you shall be circumcised. {11} You are to undergo circumcision, and it will be the sign of the covenant between me and you. {12} For the generations to come every male among you who is eight days old must be circumcised, including those born in your household or bought with money from a foreigner—those who are not your offspring. {13} Whether born in your household or bought with your money, they must be circumcised. My covenant in your flesh is to be an everlasting covenant. {14} Any uncircumcised male, who has not been circumcised in the flesh, will be cut off from his people; he has broken my covenant.”

Historical evidence shows that this culture predates Judaism. The oldest documented evidence of this practice dates back to Egypt’s sixth dynasty (2345 - 2181 BC) through a relief on Ankmahor’s tomb. Another evidence of circumcision from ancient Egypt is of a statue of a man named Merire-hashetef, who must have been a person of importance locally but not a king. He had a provincial tomb cut into a cliff face at Sedment el-Gebel, a three to four mile long ancient Egyptian cemetery – seventy miles south Cairo, where three statues of him at different stages of his life, which dates back to about 2230 BC stood. The middle and largest statue depicts Merire-hashetef as young naked man without the foreskin on his penis.

Relief on Ankmahor’s tomb of boys undergoing circumcision

Illustration based on the relief

Statue of Merire-hashetef, Egyptian Museum, Cairo

It is believed that circumcision in ancient Egypt marks the passage from childhood to adulthood, where this ritual is suppose to give access to ancient mysteries to the circumcised. Another source also suggests that the ancient Egyptian observed that when a snake shed’s it skin it becomes renewed, seemingly immortal. So it occurred to them that a human male too might become immortal if he were to shed a piece of his skin. It became clear that the skin to be shed should be that of from an organ which best resembles a snake – the penis. The Niger-Congo speakers of Africa too had an ancient male circumcision culture which also serves as a rite of passage from childhood to adulthood.

The ancient Greeks and Romans, on the other hand, disliked the look of a circumcised penis and considered circumcision a mutilation of a previously perfectly shaped organ, and this lead to a decline of the practice. This dislike becomes obvious if you observe ancient Greek and Roman statues of naked men – they obviously prefer the aesthetics of an uncircumcised penis.  The only groups of people during the Roman Empire who practiced circumcision were the Jews, Jewish Christians, Egyptian priests and the Nabatean Arabs.

Bronze Sculpture, thought to be either Poseidon or Zeus, c. 460 B.C, National Archaeological Museum, Athens

For those of you who were brought up in a culture where child circumcision is practiced, such as me, nothing about it may seem anywhere near to a criminal act to you. Often, parents who send their child for circumcision do not consider the benefits and risks of the medical procedure. Neither is the practice reasoned with medical purposes. Such an act by a parent seems to not be in the wrong in such communities. In fact, not having one’s child circumcised is more likely to be viewed as wrong and taboo. Hence we all must hire an expert to slice off the foreskin of our children’s penises regardless of the child’s wishes, and if the child wishes not to, we shall to convince them that they have to.

If you are from a community such as mine, try imagining the following scenario: There is a couple who decided to hire a surgeon to pluck of the nails of all the toes of their child for no apparent medical reasoning and without even placing a thought onto the benefits and risks of the procedure. Such an unethical act may get them into jail. Exaggerating this further, imagine an entire community which has a culture of parents sending their children, some newborns, to undergo this procedure with no medical reasoning and without taking any consideration about the benefits and risks of the procedure regardless of the child’s wishes, and if the child wishes not to, the parents would succeed to convince their children that they have to. This clearly is an act of unethical child mutilation. The culture of circumcision is therefore a culture unethical child genital mutilation. Disgusting isn’t it?

I don’t mean to say that parents never have the rights to have their child to undergo a medical procedure. Of course if a child is in need of medical operation, it is only the parents or guardian who has to make the decision. The act of doing so without medical reasoning and without taking the benefits and risk in consideration is simply completely unethical. This is the logic behind the points made forth by opponents of circumcision in my own words. I myself never saw this cultural circumcision to be unethical until I thought through it deeper, and being in my position I can understand why anyone from my community and others of similar culture would grow up to never find the culture to be unethical, hence continuing this tradition.

A review on male circumcision and heterosexual transmission of HIV in Africa, published in 2000, shows that the relative risk for HIV infection was 44% lower in circumcised men, and up to 71% for men at high risk of the infection, such as patients at STD clinics. Another review stratified by study type or population mostly in Africa, published in 2003, shows that 16 out of 35 observational studies, which were performed in the general population, had inconsistent result, but one large study of this group shows that the odds of infection were 42% lower for circumcised men. The remaining 19 studies were conducted in high risk population results in a consistent result that circumcision gives substantial protective effect. Ecological studies also show that African and Asian countries with less than 20% of the male population circumcised are significantly several times more likely to be infected with HIV than countries where more than 80% of the male population circumcised. The transmission of human papillomivirus infection, which promotes penile and cervical cancer, is also associated to lack of male circumcision. A meta-analysis of 26 studies concludes that there is a significantly lower risk of syphilis and chancroid among circumcised men. Studies in the US also show that among men with known HIV exposure, circumcision was associated with a significant 58% reduction in risk for infection.

Studies of risks associated to male circumcision shows that rates for inpatient complication are 0.2% to 2.0% of most commonly minor bleeding and local infection for infant circumcision in the United States, and 2% to 8% of most commonly pain or mild bleeding for adult circumcision in Africa. There are no reports of deaths as a result of circumcision.

As of the effect of circumcision on penile sensation and sexual function, there have also been studies on the matter but results are mixed and inconsistent to whether stimulation is increased or decreased after circumcision.

Circumcision is widely practiced outside of religious culture as well. In the United States 79% of men circumcised between 1999–2004 where the majority were non-Hispanic white men (88%), followed by non-Hispanic black men (73%) and Mexican American men (42%), according to a survey by National Health and Nutrition Examination Surveys. The remaining 50% are that of other ethnicities. National Hospital Discharge Survey reports that 65% of newborns were circumcised in 1999 and that this proportion was stable from 1979 through 1999.

The question is whether they choose to circumcise based on medical reasons or not. A 1999 survey study on the attitude of parents with children under the age of 3 years on circumcision in the United States, where 149 parents were surveyed, reports that 39.6% of them selected “medical reasons” as how they made their choice to circumcising or to not circumcise their child, and 12.1% selected “religious practice”. 20.1% percent selected “not necessary”, 12.1% selected “painful”, 4.7% selected “affect sexual function”, and 2.0% selected “dangerous” (there were more choices to select from in the survey which are not presented here). The study also shows that families who had their child circumcised are more satisfied with their decision than those who did not, and that parents with uncircumcised sons were are more likely to reconsider their decision.

Yes, it seems that the benefits of circumcision outweigh the risks, and yes there are large populations who choose to have their children circumcised for medical reasons. Hence they find it ethically appropriate to do so. However there still are those who raise objections against the ethics of this act. The argument is that even though the primary purpose is to prevent HIV and STDs contraction, such risks do not occur until young adulthood.
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