Burden of Proof
“Strictly speaking, it is not the opponents of routine male circumcision who need to make a case against the procedure, but its supporters who must prove its necessity: they need to explain why a natural part of the human body, and one common to all primates, is so dangerous that it must be amputated before a baby can talk, crawl or do anything much except scream. But since the operation has become entrenched in the medical culture of English-speaking countries over the past 120 years, it has come to be seen as reasonable, customary or even normal. As the sorcerer’s apprentice found to his cost, starting a practice (“seemed a good idea at the time …”) is often much easier than stopping it.
Advocates of RNC (Routine Neonatal Circumcision) particularly have to
* demonstrate (1) that the benefits of the operation significantly outweigh the injury inflicted, the risks of the procedure and the disadvantages of living without the normal covering of the penis; and (2) that the operation must be done before the child is able to give legal consent;
* explain how a part of the body which has evolved over millions of years could be pathogenic (disease-producing) and must be removed to ensure a normal level of health.
Advocates of RNC have never been able to explain why all primates (monkeys, chimps etc) have foreskins, or how humans became the most successful mammal on the planet while carrying this supposedly pathogenic burden. For 99 per cent of the million or so years during which modern humans have prospered, males have lived and died with their foreskins intact, and in that time our species managed to colonise just about every corner of the earth. Perhaps the foreskin was a factor in that triumph. There is good evidence that the human foreskin became longer, more luxuriant and more richly networked with sensory nerves than those of our near relatives, suggesting that it must have conferred a selective advantage: the more foreskin you had, the more offspring you left behind, and the more your extra-foreskin genes spread through the population. (Ref. 1) This could not have happened if the foreskin had been as troublesome as its enemies claim: what has naturally evolved must be presumed to be beneficial or harmless unless there is overwhelming evidence to the contrary. (Ref. 2)
Trying to come up with the goods
It is this proof that circumcision advocates are obliged to provide, and which they have been struggling unsuccessfully to manufacture since the 1850s (when Jonathan Hutchinson announced that his statistics showed that circumcised men were all but immune to syphilis). The world is still waiting for them to make a convincing case. Although there have been mountains of reports and studies (more than anybody could read in a lifetime), the issue is still inconclusive. The most that even a scaremongering evangelist like the Queensland GP Terry Russell can say is that RNC “may reduce the risk of STDs (syphilis, gonorrhoea, herpes and candida) and carcinoma of the cervix in female partners”, as well as phimosis, paraphimosis, HIV-AIDS, neonatal UTIs and carcinoma of the penis. (Ref. 3) This is not good enough: “may” is not much different from “may not”.
Australia’s other prominent crusader for RNC, Professor Brian Morris, cites several studies which purport to show a higher incidence of gonorrhoea and syphilis among uncut males and reaches the dithering conclusions that (1) “based on the bulk of evidence it would seem that at least some STDs could be more common in uncircumcised males under some circumstances”; but that (2) “there may be little difference in most STDs between those with and those without a foreskin”. (Ref. 4) That’s really helpful.
Can these guys be serious? They want to circumcise all boys at birth because retention of the foreskin “may” increase the risk of their getting a few diseases they most likely would not get anyway; most of which are curable; and which, even if they did get them, do not strike until many years later. Except for infantile UTIs (which are usually cured easily by antibiotics), there is plenty of time for a boy to reach maturity and make his own assessment of the risks and choose the best means, for him, of managing them. To make a convincing case for RNC Russell, Morris and Co must do much better than they have done so far: we need proof that that if the foreskin is not cut off urgently the child will get seriously ill or die before he is old enough to make his own health decisions. Nothing like this has ever been achieved by the circumcision lobby, or even seriously attempted. Statistics are not available, but it is quite likely that more boys under the age of eighteen die as a result of circumcision, or its complications, than from any of the diseases circumcision is supposed to protect them against. Certainly this is true in South Africa, where several hundred boys a year die as a result of tribal circumcision.
Both Dr Russell and Professor Morris are frequently seen in the media urging parents to have their boys circumcised, and much of their routine is just a long list of nasty diseases, designed to terrify people into seeking urgent medical aid. How different it is from the rantings of a Victorian quack is a matter of personal judgement. In 1891 Dr Peter Charles Remondino wrote:
“The prepuce seems to exercise a malign influence in the most distant and apparently unconnected manner; where, like some of the evil genii or sprites in the Arabian tales, it can reach from afar the object of its malignity, striking him down unawares in the most unaccountable manner; making him a victim to all manner of ills, sufferings and tribulations; unfitting him for marriage or the cares of business; making him miserable and an object of continual scolding and punishment in childhood, through its worriments and nocturnal enuresis; later on, beginning to affect him with all kinds of physical distortions and ailments, nocturnal pollutions, and other conditions calculated to weaken him physically, mentally, and morally; to land him, perchance, in jail or even in a lunatic asylum.” (Ref. 5)
How could Drs Russell or Morris disagree with him when he writes:
“Circumcision is like a substantial and well-secured life annuity; every year of life you draw the benefit, and it has not any drawbacks …. Parents cannot make a better paying investment for their little boys, as it insures them better health, greater capacity for labor, longer life, less nervousness, sickness, loss of time, and less doctor-bills, as well as increases their chances for an euthanasian death.” (Ref. 6)
Drs Russell and Morris are radicals and extremists: most Australian doctors are opposed to RNC or undecided on the issue, and the Royal Australasian College of Physicians has recently issued yet another statement against the practice . The truth is that RNC has never been supported by more than a small fraction of the world’s medical establishment and remains a controversial and unproven therapy. Back in the 1890s an early opponent of RNC noted this confusion and uncertainty, not only over the risks and touted benefits of the operation but when and how to do it, how much tissue to excise, how to stop bleeding etc, and asked: “Where doctors differ, who shall decide?” (Ref. 7)
There can be only one answer to that question: the owner of the organ in question.”
1. J.R.Taylor, A.P. Lockwood and A.J.Taylor, “The prepuce: specialized mucosa of the penis and its loss to circumcision”, British Journal of Urology, Vol. 77,1996, pp. 291-295; C.J. Cold and J.R. Taylor, “The prepuce”, BJU International, Vol. 83, Supplement 1 (January) 1999, pp. 34-44; C.J. Cold and K.A. McGrath, “Anatomy and histology of the penile and clitoral prepuce in primates: Evolutionary perspective of specialised sensory tissue in the external genitalia”, in George C. Denniston, Frederick Hodges and Marilyn Milos (eds), Male and female circumcision: Medical, legal and ethical considerations in pediatric practice (New York and London, Kluwer Academic/Plenum Publishers, 1999), pp. 19-30
2. The argument holds even if you believe in the creationist account of human origins. If God created men with a foreskin it must be presumed that He intended them to have one.
3. Terry Russell, “Debate: Male circumcision remains a valid procedure – Yes”, Australian Doctor, 24 May 1996, p. 54
4. Brian Morris, In favour of circumcision (Sydney 1999), pp. 38 and 39. See the scathing review by Basil Donovan in Venereology, Vol. 12 (1999), pp. 68-9. Professor Donovan describes Morris as “a man on a mission to rid the world of the male foreskin” and some of his claims as “so dangerous” that the publishers ought to withdraw the book.
5. P.C. Remondino, History of circumcision from the earliest times to the present: Moral and physical reasons for its performance (Philadelphia and London 1891), pp. 54-5
6. Remondino, p. 186
7. Herbert Snow, The barbarity of circumcision as a remedy for congenital phimosis (London 1890), p. 32