By Anthony Weiss / jta.org

An infant being carried before his circumcision at an Orthodox synagogue in Berlin in 2013. (Sean Gallup / Getty Images)
An infant being carried before his circumcision at an Orthodox synagogue in Berlin in 2013. (Sean Gallup / Getty Images)

LOS ANGELES (JTA) — In the circumcision wars, circumcision has been winning some big battles.

A new survey of medical data going back more than two decades has found that the health benefits of circumcision far outweigh the risks. The publication of the article on April 4 by the medical journal Mayo Clinic Proceedings is the latest development to tip the scales in favor of circumcision in the long-running scientific, cultural, and political struggles over the practice.

Some say this series of blows has damaged the efforts of American anti-circumcision activists.

“They’re in disarray. They used to be very organized, raising money and so forth,” said Edgar Schoen, a clinical professor emeritus of pediatrics at the University of California, San Francisco, and a longtime champion of the medical benefits of circumcision. “People don’t listen to them that much anymore.”

The authors of the new survey reviewed some 3,000 studies on male circumcision published since 1988 and found evidence indicating that circumcision significantly reduced the chances of contracting a number of diseases, including urinary tract infections, human papillomavirus, and HIV.

“When considered together with ethical and human rights arguments, neonatal circumcision should logically be strongly supported and encouraged as an important evidence-based intervention akin to childhood vaccination,” wrote authors Brian Morris, Stefan Bailis, and Thomas Wiswell.

Morris, the study’s lead author and a professor emeritus of medical sciences at the University of Sydney, has long been an advocate for the health benefits of male circumcision, authoring the 1999 book In Favour of Circumcision.

Circumcision opponents — known in some circles as “intactivists” — generally dismissed the new study.

“It’s very easy for researchers to design their studies and the analysis of their studies to come out with conclusions that they want,” said Ronald Goldman, author of Circumcision: The Hidden Trauma. “So they’re finding what they’re seeking, in other words. There’s no objectivity here.”

The so-called “circumcision wars,” as they have been dubbed by the media, spilled into the American political sphere in 2011 when anti-circumcision activists submitted more than 12,000 signatures to place a San Francisco city ballot measure to ban the practice. The measure spurred heated debate as pro- and anti-circumcision advocates traded accusations of anti-Semitism and child abuse.

However, before the measure could go before voters, a state judge ordered it struck from the ballot as a violation of state law. The California State Legislature subsequently outlawed any local bans on circumcision.

The medical landscape tilted against anti-circumcision activists in 2012 when the American Academy of Pediatrics issued revised guidelines on the practice, stating for the first time that “the health benefits of newborn male circumcision outweigh the risks.” This marked a reversal of the academy’s neutral stance and undercut a key talking point of anti-circumcision activists, who had argued that the practice had no support from any major medical organization.

Anti-circumcision advocates disputed the notion that their efforts have run aground, but some acknowledged that the legal and political terrain has become more challenging.

“There was an enormous and immediate clampdown on any type of legislation gaining a foothold to protect male children in the United States,” said Lloyd Schofield, an anti-circumcision activist who served as a spokesman for the San Francisco ballot measure.

However, Schofield and other anti-circumcision activists point to Europe as more receptive territory.

Attempts to limit or ban non-medical circumcision of boys under 18 have intensified in Europe in recent years. The efforts gained steam after a German court ruled in 2012 that circumcision amounted to causing bodily harm — a ruling that triggered brief bans in various locales in three German-speaking countries.

Last October, the Parliamentary Assembly of the Council of Europe issued a non-binding resolution condemning the practice of circumcision for boys as a “violation of the physical integrity of children.” Several Scandinavian political parties and medical associations are seeking a ban, as are the children’s welfare ombudsmen of Denmark, Finland, Greenland, Iceland, Norway, and Sweden.

Jewish groups have pushed back strongly against efforts to ban the practice.

Part of the trans-Atlantic difference in attitudes may be rooted in cultural practices. The study in Mayo Clinic Proceedings cited an estimate that only 10 percent of European males are circumcised. In the United States, the authors calculated that neonatal circumcision rates had dropped from 83.2 percent in the 1960s to 77.1 percent in 2010 as a result of demographic and policy changes.

One of the primary reasons cited by the authors for declining circumcision rates is the country’s rapidly growing proportion of Hispanics, who tend to circumcise their children at far lower rates than non-Hispanic blacks and whites. The report cited figures from the Centers for Disease Control and Prevention indicating that only 44 percent of Mexican-American male infants were circumcised, compared with 76 percent of black males and 91 percent of white males. However, the report also noted that circumcision rates among all three groups appear to be increasing.

Another major factor cited by the report for lower circumcision rates was the reduced number of states that provide Medicaid coverage for circumcision. Currently, 18 states do not cover the procedure through Medicaid, up from just six in 1999. Anti-circumcision groups have urged additional states to cease covering circumcisions.

The new study calculates that hospital circumcision rates are 24 percent higher in states that cover the procedure through Medicaid compared to those that do not, after controlling for other factors.

The American Academy of Pediatrics’ 2012 policy statement explicitly urged insurance providers, including Medicaid, to cover neonatal circumcisions. Though there have been reported efforts in several states to restore Medicaid coverage, to date none has made the switch.


10 thoughts on “Health Benefits of Circumcision Far Outweigh the Risks

  • There’s nothing actually new in this study, and many national medical organizations continue to recommend against infant circumcision.

    PZ Myers:
    “But then, that’s Brian Morris all over the place. He actively tries to suppress work that doesn’t support his conclusions, he inflates any evidence that suggests circumcision might have a few benefits (there are some!), and dismisses any evidence to the contrary…or worse, twists it around to claim it supports the opposite of the author’s interpretations. All this in defiance of worldwide statements from pediatric organizations that say the evidence for health benefits from circumcision are weak, and that routine circumcision is not recommended.”

    Another doctor:

    “But Professor Kevin Pringle, the Professor of Paediatrics and Head of Obstetrics and Gynaecology at the University of Otago in Wellington, says he found the paper extremely worrying.

    Prof Pringle says the report quotes a more than 20-fold increase in the risk of penile cancer for uncircumcised men, but the figures didn’t agree.

    “In fact, the incidence of penile cancer in Israel (almost 100 per cent of males circumcised) is about the same as that in Scandinavia
    (circumcision the exception), suggesting that it is cleanliness, rather than godliness that is important,” he said.

    Prof Pringle said the authors overestimated the level of cases of two other conditions, phimosis and balanitis, and said 80 per cent of children with phimosis respond to the application of a steroid cream. Only a small percentage needed a circumcision.

    Prof Pringle said the comparison with vaccination was inappropriate as most of the diseases for which infants are vaccinated are potentially lethal or produce significant handicap.

    “Circumcision is an intervention with significant risks (ignored or minimised by the authors of this paper) to prevent problems that will not develop in the vast majority of males.”

  • Mark,
    I notice that your comments ignore the significant benefit of male circumcision on the health of female sexual partners.

    I’m not sure why you need to go to Australia for your information, which appears to disagree in almost every aspect with information that is available here in the good old USA. Please continue reading for a few points from two highly regarded US sources of medical information: Centers for Disease Control and Prevention (CDC) and the website webmd.com.

    The facts they provide seem to prove that our Heavenly Father truly knows best in requiring His people to circumcise neonatal males in their first week (and females not at all).

    Female partners of [uncircumcised] men were more likely than the partners of circumcised men to be infected with human papilloma virus (HPV) most often associated with cervical cancer.

    Johns Hopkins University trials showed that male circumcision reduces HIV infection, HPV in men, and genital herpes.

    CDC Summary
    • Male circumcision reduces the risk that a man will acquire HIV from an infected female partner, and also lowers the risk of other STDs, penile cancer, and infant urinary tract infection.

    • For female partners, male circumcision reduces the risk of cervical cancer, genital ulceration, bacterial vaginosis, trichomoniasis, and HPV. Although male circumcision has [easily managed] risks including pain, bleeding, and infection, more serious complications are rare.

    Penile Sensation and Sexual Function
    Several studies conducted among men after adult circumcision suggest that most men report improvement or no change in their sexual functioning.

    Cost-effectiveness of neonatal circumcision
    A large, retrospective study of circumcision in nearly 15,000 infants found neonatal circumcision to be highly cost-effective, considering the estimated number of averted cases of infant urinary tract infection and lifetime incidence of HIV infection, penile cancer, balanoposthitis (inflammation of the foreskin and glans), and phimosis (a condition where the male foreskin cannot be fully retracted from the head of the penis). The cost of postneonatal circumcision was 10-fold the cost of neonatal circumcision.

    Pain increases with age at time of procedure
    Reported complication rates depend on the type of study (e.g., chart review vs. prospective study), setting (medical vs. nonmedical facility), person operating (traditional vs. medical practitioner), patient age (infant vs. adult), and surgical technique or instrument used.

    In large studies of infant circumcision in the United States, reported inpatient complication rates are approximately 0.2%. The most common complications are bleeding and infection, which are usually minor and easily managed.

    Male circumcision by medical providers on [older] children tended to be associated with more complications (6%) than for neonates and infants.

  • Yes, the good old USA is now alone in the developed world in supporting neonatal male genital cutting. The rest of the English-speaking world tried it at the same time as the US did. In the 1950s, Australia and New Zealand were still cutting babies as enthusiastically as the US. After public funding was taken off it in the UK, Australia and New Zealand (and because doctors hated doing it) the rates have fallen away, to about 10% in Australia and residual levels in New Zealand and the UK. There have been no epidemics or outbreaks of any of the things circumcision was supposed to be good against – including cervical cancer. The rest of the developed world, such as Europe and Scandinavia, have never done it, and their health statistics (again including cervical cancer) are as good or better than the USA.

    Unfortuantely for your patriotism, the main author of most of the papers you cite is an Australian, Emeritus Professor Brian Morris, formerly of the University of Sydney. He has never seen a reason for cutting boys’ genitals he didn’t like, including to prevent “bathroom splatter” and zipper injury. He plays fast and loose with facts, as documented here: http://www.circumstitions.com/morris.html

    His papers (including the one published by the Mayo Clinic) simply rehash his own earlier claims. When you trace them to their sources, they either fail to say what he says they did, or have been refuted by studies he does not cite.

    Sadly, even would-be scientific bodies such as the CDC are subject to cultural bias on such an intimate matter as men’s relationship with their favourite part. The position is nothing like as clear as the CDC summary says. It would take well over 100 circumcisions wasted (by the circumcision advocates’ own figures) to prevent one UTI, which can be treated conservatively, over 1000 to prevent one penile cancer in an old man with a readily detected and treated abnormality of his foreskin (and who probably smokes). Circumcised men are at MORE risk of penile cancer than men with normal foreskins.

    • I’m sorry, Hugh7,
      Your arguments aren’t very compelling, especially when your facts don’t add up. ONE of the professor/authorities cited in the article is Aussie, the rest are American—from Florida, Massachusetts, Minnesota, and California.

      Your spelling of “favourite” leads me to believe that you hail from the British Empire, which also explains your unflattering language regarding American culture. Your website really doesn’t like our American Academy of Pediatrics. Fair enough. But your statistics of how many circumcisions would be needed to prevent one UTI or case of cancer lack authoritative backing up and rely on your say-so to contradict the conclusions of scientific studies. Just like Mark in the previous comment, you ignore the bigger picture that includes women’s health and instructions from the Creator of your “favourite part”—The Almighty. You cannot ignore the God of Israel on this website unchallenged.

      Science is catching up to the Bible every day, and this post on the health benefits of male neonatal circumcision is simply further evidence of the narrowing gap.

  • Dr Schoen (now 89) is obviously not keeping up with social media. The Intactivism movement is thriving on Facebook, with a growing movement among young mothers to inform each other about the harms and risks of the surgery, and the ease of caring for an intact baby. They are united with a growing number of men outraged that such an intimate and valuable body part was taken from them forever before they could resist. They hold frequent demonstrations in US cities, gaining increasing attention.

  • Mark–
    I have removed your last three comments. You reported that the system bounced them back to you as “a bit spammy” and I had to agree. If anyone wants to read your lengthy and somewhat dated information, I have it archived and will share it. Zola Levitt Ministries doesn’t “mute” oppositional voices, but we do try to spare our readers wading through redundant verbiage.

    You are entitled to your opinion just as atheists are entitled to theirs. Also, unless you are Jewish, you have no obligation to circumcise. However, to wise Christians (who are also free to follow their own leanings), Yahweh’s opinions matter and human arguments eventually fall on deaf ears. As I said in my reply to Hugh7, science eventually proves that Yahweh’s Word was right all along. So, though we Believers may initially consider human logic in making our decisions, most of us rely on faith that, even if we cannot understand the reasons behind Yahweh’s instructions, His way works best and science will eventually catch up.

    This philosophy applies to more than circumcision. His system of authority and social decorum continues to provide the most beneficial environment for peaceful living. Humans didn’t devise the rules, but centuries of empirical evidence show observers that it works and why. Circumcision is no different, and medical studies will eventually prove God’s wisdom in instructing it. If this most recent study cited in the posted article doesn’t convince you, just wait for more convincing evidence to appear. It will.

    I trust this lively discussion will aid others in their own decisions. This discussion on these pages is now over.

  • ZLM Editor, We have been observing Mr. Morris’ modus operandi for years. He typically will publish one (poorly authored) study or critique of a different study, send press releases to all media about how impeccable his new study is, and a few months later will reference the study in third person (“experts have demonstrated that…”). Every article that disputes his arguments will be considered to be low quality or published in low quality publications.

    I’m not trying with this to do an ad-hominem attack. It is fair to understand the background, personal bias and repeated offenses when you are going to consider the value and objectivity of a person’s argument.

    • Juan Alzate —
      I’m leaving your comment in this discussion as a final cautionary note to inform our readers of how some studies can be “documented.” I cannot verify that your information is accurate for this particular study, but I suspect that the method you describe does happen. That is another reason why we recommend researching articles from several sources, preferably known and reputable like the CDC. I doubt very much that the CDC “doctored” their results, which appear to agree with the study published by Morris et al.

  • ZLM Editor’s note: The poster here shared this link to an Australian medical center that offers help in making the decision whether or not to circumcise. The information offered on the website is helpful for those contemplating this procedure. The center offers a location for Australians deciding to proceed.
    Posting this link does not constitute ZLM’s endorsement of the medical center or associated personnel; the link is provided as an added resource for interested readers.

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