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Biology 103

2005 Final Paper

On Serendip


Iris Mejia

Male circumcision has been dated back to 2500 B.C. in Egypt [(1)]. It has been performed as rituals in many cultures specifically Judaism as a symbol of the covenant. However, its spread into the English Speaking world, around the 19th century, is attributed to the outrage manifested against masturbation and the perceived, unproven, diseases associated with masturbating. It is an extremely common procedure around the world. Most recently discussion about male circumcision results in debates about the possible benefits and risks of the act. There still remains significant differences in the way male and female circumcision are addressed, mainly due to the lack of benefits for female circumcision. With 60 to 70% American newborn males being routinely circumcised [(1)], I will look at its prevalence, mainly the reasons why it may still exist in such high percentages by examining its cost and benefits.

A discussion about circumcision is incomplete without knowing what it is. Male circumcision begins with the removal of the foreskin that covers the glans of the penis and continues through a child's development as the foreskin retracts. The cutting can be done with numerous tools. Depending on the method used for the circumcision, different levels of complications may occur, which are cited as risks for the operation. If performed correctly, the rate of complication in America is estimated between 0.2 to 2% [(2)], which is quite small compared to the incidence in the developing world. Other costs of male circumcision includes pain, infection and bleeding among a list of others, which can be easily treated and don't normally occur in operations performed by medically qualified individuals. There are some complications that are deemed severe, which include laceration of the glans, as well as, death but they are extremely uncommon. Opposition to circumcision also arises from the belief that it reduces sexual enjoyment in males, but a study found a slight increase in sexual dysfunction in men who had not been circumcised [(2)]. The most compelling reason against circumcision is its similarity to female circumcision, which tends to be looked at as mutilation. Mutilation in itself can be seen as positive or negative in that yes a part of the body is being removed, but circumstances may deem it necessary or beneficial for it to occur.

Research shows that circumcision lowers the risk of certain diseases including STDs. Among the top STDs being investigated there are AIDS/HIV and HPV. "The international Agency for Research on cancer found that the odds that circumcised men had penile HPV infection were about 60% lower than the odds that uncircumcised men had this diagnosis[(3)]. Circumcision also lowered the transmission of HPV to women, but mainly in men exhibiting risky sexual behavior. Research into a link between circumcision and AIDS began due to the puzzling difference in the rate of AIDS in America and Africa. Scientists were looking for an explanation and discovered that "uncircumcised men run a greater risk of becoming infected by AIDS"[(4)], which can be supported with the fact a really large percentage of American Males were circumcised. Other research showed that not being circumcised increased the risk of AIDS infection by 5 to 8 times [(3)]. An analysis that pooled data from 28 studies also had similar findings. It differed in finding that circumcision before the age of 12 decreased risk of HIV yet at 13 yrs or older it did not [[(5)]. The lower risk has been associated with the lack of foreskin, which typically provides a moist protective environment that would allow viruses to live longer, but the previous statement suggests it must be more than just lack of foreskin.

In the Jewish community, the lack of penile cancers led to a perceived correlation between not being circumcised and penile cancer. Generally, circumcised individuals have not been found in any case of penile cancer. In five studies of this disease, "all penile cancers occurred in uncircumcised individuals"[(2)]. Due to the low likelihood of developing penile cancer, circumcision is not advocated for prevention. It is considered an option for males with phimosis, which is a condition that prevents the retraction of the foreskin in uncircumcised males and is considered a risk factor for penile cancer. It is indicated for loosening the foreskin, but it can also be done by self-loosening, which means the male performs foreskin stretching exercises. Recent studies of penile cancers take into account the different forms of the disease compared to circumcision. The results showed that less severe forms of the disease were found in circumcised men and that there is no protectiveness of circumcision against these forms [(6)]

A benefit of circumcision that has not had contrary results is that circumcision lowers the risk of urinary tract infections. The percentage of the decrease varies, but even with a universal percentage it can be argued that there isn't considerable benefits since the disease affects males in the early stages of life and it is easily curable.

Studies on male circumcision attempt to show that the costs and benefits balance out one another, but for parents concerned with particular diseases the benefits for that disease may be most important, hence they opt for circumcision. However, this is assuming parents have been educated about the risks and benefits of circumcision, which doesn't seem to be the case. Many parents are influenced by their culture, including religious and societal reasons. As I mentioned earlier, it is a part of Jewish custom. In certain cultures, males who have not been circumcised are treated differently. For example, Among the Karembola of Southern Madagascar circumcision is an ancestral blessing and during funerals uncircumcised men are marked [(7)]A societal reason includes parents wanting their children to be accepted into their culture. In places were circumcision is "normal" many parents circumcise their children so that they will fit in.

Dritsas, Lawrence S. Science, Technology, & Human Values. Vol. 26, No. 2.
Hirji, Hassan. Male Circumcision: a review of the evidence. JMHG. Vol. 2, No. 1.
Lane, T. Circumcision may lower risk of both acquiring ad transmitting HPV. Perspectives on Sexual and Reproductive Health. Vol. 34, No. 4.
Marx, Jean L. Circumcision may protect against the AIDS Virus. Science. New series, Vol. 245 No. 4917.
Hirozawa, A. In Sub-Saharan Africa, circumcised men are less likely than uncircumcised men to become infected with HIV. International Family Planning Perspectives, Vol. 27, No. 2.

Benatar, Michael and David Benatar.2003. Between Prophylaxis and child abuse: The Ethics of Neonatal Male Circumcision. The American Journal of Bioethics Vol. 3, No. 2.
Middleton Karen. Circumcision, Death, and Strangers. Journal of Religion in Africa, Vol. 27 Fasc. 4.

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