Male circumcision is a controversial procedure, with passionate voices on both the pro- and anti- sides of the debate. Now, new research published in Mayo Clinic Proceedings bolsters the pro-circumcision argument, claiming that the "benefits" of circumcision "far outweigh risks."
"I see infant male circumcision as akin to childhood vaccination," lead researcher Brian Morris - professor emeritus in the School of Medical Sciences at the University of Sydney, Australia - told Medical News Today. "Each confer major benefits but also minor risks. Society accepts vaccination. They should also accept circumcision. Indeed, most US parents do."
"When so much benefit to health can be gained from a simple intervention such as circumcision, then indeed it would be unethical for doctors not to recommend it," he added.
Attitudes toward male circumcision vary from country to country and culture to culture. At its height in the US during the 1960s, the procedure was performed on 83% of baby boys.
The new study finds that prevalence of infant circumcision in modern times has dropped to 77% - a figure described as "an alarming decrease" in an accompanying news release.
Circumcision rates in adult men, though, have risen. In white, black and Hispanic men, the prevalence has risen to 91%, 76% and 44% of the population, respectively. This gives an estimated total prevalence of 80.5%, up slightly from the 79% prevalence recorded a decade ago.
The disparity between the prevalence of circumcision in white and Hispanic populations shows that, culturally, there is a relative reluctance among Hispanic groups toward this procedure.
The study also suggests that - despite an increase in circumcisions among adult Hispanic men - the expanding Hispanic population could have influenced the decline of the practice in infants. "Hispanic families tend to be less familiar with the custom, making them less likely to circumcise their baby boys," the news release claims.
A second factor identified by the study that could have influenced the fall in infant male circumcision is withdrawal of Medicaid coverage across 18 US states. In states with no Medicaid coverage, circumcision prevalence is 24% lower.
The cost of circumcision versus the cost of treatment
The study warns that "if male circumcision rates were to decrease to the levels of 10% typically seen in Europe," then treatment of urinary tract infections and sexually transmitted infections would exceed $4.4 billion annually, with each forgone infant circumcision procedure leading to an average of $407 in increased direct medical expenses per male, and $43 per female.
As the analysis did not consider other conditions or indirect costs, the researchers write that "it seems logical then that this analysis might have greatly underestimated the true cost."
The researchers also refer to a study of a Medicaid birth cohort of 29,316 people, which found that for every year of decreased circumcision due to a lack of Medicaid funding, there would be more than 100 additional HIV cases and $30 million in net medical costs, as a result. By contrast, the cost of circumcising males in this cohort would come to $4,856,000.
Is infant circumcision ethical?
However, the most contested area of the circumcision debate is likely to remain the question of ethics. Anti-circumcision experts and campaign groups claim that circumcision of baby boys is a violation not only of the child's body, but of his right to "bodily integrity."
We put this to Prof. Morris, who responded:
"The violation you refer to applies more to not circumcising him and then exposing him to risk of a wide range of medical conditions over his lifetime. One might imagine what a man with penile cancer might think about his parents decision not to have him circumcised, knowing that this devastating disease would not have occurred had they done so."
A risk-benefit analysis was conducted by Prof. Brian Morris, who finds that there is a 1 in 2 chance of uncircumcised men contracting a medical condition caused by retention of the foreskin, and that the benefits of circumcision exceed the risks by more than 100 to 1. Prof. Morris cites HIV, prostate cancer and syphilis among the conditions for which uncircumcised men are more at risk.
We put Prof. Morris' findings to Larissa Black, director of the anti-circumcision campaign group The Whole Network.
"I would be highly suspicious of any study that showed circumcision having this kind of benefit," she responds. "We have seen numerous studies showing the exact opposite of Brian Morris's findings - even that circumcision actually increases the likelihood of HIV and various other STDs.
"Circumcised males are still at risk for all of these conditions, and damage caused by circumcision is not being taken into account. What benefit can be reaped when the child dies from circumcision-related complications?"
Another contentious issue surrounding infant circumcision is to what extent it disrupts sexual function later in life. In the video below, Prof. Morris insists that there are no adverse effects to sexual function from circumcision. However, this is disputed by The Whole Network, who point to several studies that find the contrary.
"Studies have established not only that circumcision ablates the most sensitive parts of the penis," Larissa Black told Medical News Today, "but that it's also associated with premature ejaculation, orgasm difficulties and other issues for both the man and his partner. Common sense dictates that you simply can't remove that much erogenous tissue from a penis without it seriously impacting function and sensation."
But Prof. Morris identifies parallels between the anti-circumcision movement and the anti-vaccination movement. He considers that "the dismissal of science, misinformation, deceit and outrageous lies of each follow the same pattern. Added to this," he continued, "is the self-righteous bullying these fringe groups undertake in order to further their ill-conceived, ignorant campaigning - and in some cases hidden agendas."
"The attacks include ones directed at academics or public figures who advocate circumcision as a wise, evidence-based public health policy. It is clear that infancy is the best time to perform circumcision as it provides immediate benefits."
Larissa Black not only disputes the accuracy of Prof. Morris' figures, but also considers that "comparing circumcision to vaccination is a very dangerous game. People are being led to believe that their lack of foreskin makes them immune to sexually transmitted disease and as a result they are given a free pass from safe sex practices including condoms. We are already seeing this happening in Africa."
"Social media and the internet have greatly aided in the dissemination information," The Whole Network told us, suggesting an alternative reason behind the fall in rates of infant circumcision. Larissa Black explains:
"Personal accounts from unhappily circumcised men are reaching the masses. Videos of the procedure being performed along with studies showing the functions of the foreskin and the damage caused by circumcision are only a few keystrokes away. People are educating themselves on this issue and overwhelmingly coming to the conclusion that circumcision is not only unnecessary but in fact harmful."
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