As others have remarked, it will be difficult to keep this thread out of Great Debates. What makes it so difficult is the blatantly one-sided assumptions implicit in the OP’s “question”…
Do you think, xanakis, that you could have put your “question” any more provocatively? Any more likely to start a feud?
I, for one, have no problem clipping my toenails or getting a haircut. Yet these are clearly “chopping off a part of the body”. Using language like “chopping off a part of the body” strongly suggests that you are unable to consider this question fairly.
Allow me to rephrase your question such that this thread might just remain here for a while later…
Question: Do the benefits accruing from neonatal circumcision exceed the costs and risks of the procedure?
The preponderance of the scientific evidence concludes: Yes. There are greater risks from not circumcising.
For a more complete treatment of the answer, you may wish to consider the scientific findings compiled by Dr. Brian Morris in his book: In Favour of Circumcision (ISBN 0-86840-537-X). You can see a portion of the results at http://www-personal.usyd.edu.au/~bmorris/circumcision.shtml
To be adequately informed for participation in this debate, I STRONGLY recommend these five sites: http://www.medicirc.org/
http://www.vernon.dircon.co.uk/G_Weiss/index.html
http://www.users.dircon.co.uk/~vernon/ICIRC/myths_and_lies.html
http://www.geocities.com/HotSprings/2754/wiswell.html
http://www.geocities.com/HotSprings/2754/newuti2000.htm
. . .
Here’s a small sampling of additional abstracts and/or quotations from medical papers on the issue demonstrating that circumcision is advisable for all newborn males. If you have doubts, you should also look up the following cites in the mainstream, scientific medical literature (I’ve added additional emphasis in several places):
Fink AJ “In defense of circumcision.” Pediatrics 1986 Feb;77(2):265-7.
Schoen EJ. "Neonatal circumcision and penile cancer. Evidence that circumcision is protective is overwhelming." BMJ. 1996 Jul 6;313(7048):46
Sandeman TF. “Carcinoma penis.” Australas Radiol 1990 Feb;34(1):12-6
Here’s a quotation from the Peter MacCallum Cancer Institute, Melbourne:
"Between 1954 and 1984, 102 cases of carcinoma of the penis were seen at the Peter MacCallum Cancer Institute. Their mean age was 62.5 years. Nearly twice as many patients were referred in the last decade as in the first, and this observation may be linked to the reduction in numbers of neonatal circumcisions in the last forty years… Prevention by circumcision in infancy is still the best policy."
More:
Kochen M,McCurdy S “Circumcision and the risk of cancer of the penis. A life-table analysis.” Am J Dis Child 1980 May;134(5):484-6
"The low incidence of penile cancer in the United States is frequently cited as a reason for not justifying the risk of neonatal circumcision as a prophylactic measure. Although uncircumcised men are UNIQUELY at risk for this malignant neoplasm, previous approaches have used annual incidence data collected without regard to circumcision status, thus tending to underestimate the true risk to this susceptible group. In addition, the concept of lifetime risk has not been addressed.
“Using data from the Third National Cancer Survey and previously published circumcision prevalence figures in a life-table analysis, we estimated the lifetime risk for cancer of the penis in uncircumcised males. The predicted risk is 166 per 10(5), or one in 600 !!; the estimated median age of occurrence is 67 years. These data deserve to be considered with other morbidity factors in the context of the neonatal circumcision debate.”
(In other words, people who say circumcision isn’t necessary because penile cancer is rare in the United States are deluding themselves. The reason the penile cancer rate is so low today is because the overwhelming majority of men who would now be old enough to have cancer of the penis were “CURED” of the possibility by being circumcised back in the days when almost EVERY male in the U.S. was circumcised!!)
More: Persky L, “Epidemiology of cancer of the penis. Recent Results”, Cancer Res 1977;(60):97-109
“World-wide incidences of penile cancer are reviewed and epidemiologic factors including circumcision, hygiene, phimosis, smegma, irritation, infection, venereal disease, viruses, environment, race, immune response, trauma, and age are discussed. The lowest rates appear in groups practicing infant circumcision.”
More: Onuigbo WI, “Carcinoma of skin of penis.” Br J Urol 1985 Aug;57(4):465-6
“A retrospective review of approximately 15,000 surgical specimens collected from this ethnic group [Eskimos, If I recall] over a period of 13 years revealed 32 cases of carcinoma of the prostate but only 4 cases of penile carcinoma. One tumour arose on the glans penis. This localisation pattern suggests that, in circumcised males, smegma-induced squamous carcinoma of the glans can be abolished but not the ordinary squamous carcinoma that can develop by chance on the rest of the penis as well as on the glans.”
More: Gueye SM, Diagne BA, Ba M, Sylla C, Mensah A, “Cancer of the penis. Epidemiological aspects and therapeutic problems in Senegal”, J Urol (Paris) 1992;98(3):159-61 from PubMed
"Penile carcinoma is rare in Senegal representing 0.35% of all cancers and 0.97% of cancers in the male adult. Neonate circumcision widely used in this country seems to prevent this disease."
Some people suggest that they wish their sons to decide for themselves whether they want to undergo circumcision later in life. This is very risky advice! Not only does the pain increase dramatically as an adolescent or adult, not only do the adverse complications increase dramatically by that time, but by then it is too late to avoid risks of penile cancer!
From Magoha GA, Kaale RF “Epidemiological and clinical aspects of carcinoma of penis at Kenyatta National Hospital.”, East Afr Med J 1995 Jun;72(6):359-61
"Thirty one patients with carcinoma of penis were studied retrospectively at Kenyatta National Hospital, Nairobi, over a 20-year period (1971-1990). The majority of patients presented late with symptomatology of over one year duration. 88% of patients with carcinoma were uncircumcised, while the three (12%) patients who were circumcised but developed carcinoma WERE ALL CIRCUMCISED LATE IN ADOLESCENCE AND ADULTHOOD, confirming that late circumcision may not protect one from developing penile carcinoma as reported in literature.
Here’s some quotations from MedScape (which you can join yourself to get these references)
Here’s one about how undeniably obvious it is that circumcised men are MUCH less likely to contract or at least spread HIV, from: http://www.medscape.com/medscape/features/question/2000/09/q869.html
“How does circumcision affect the risk of HIV acquisition?”
"An entire session of the XIII International AIDS conference held in Durban, South Africa, in July 2000 was devoted to discussion of circumcision to prevent acquisition of HIV. Evidence of the benefit of circumcision was provided by a community-based, cross-sectional study comparing African communities with high and low HIV prevalence. Two thousand people were studied in each of 4 towns. The investigators found that in Yaounde, Cameroon, and Cotonou, Benin, the prevalence of HIV was 3.8% and 4.4%, respectively. Ninety-nine percent of the men studied were circumcised.
Conversely, in Kisumu, Kenya, and Ndola, Zambia, where the HIV prevalence was 21.9% and 25.9%, respectively, only 26.8% (Kisumu) and 7.6% (Ndola) of men were circumcised. Statistical analysis, including adjustment for sexual behavior, marital status, ethnic group, herpes simplex virus-2 antibodies, and syphilis, demonstrated that circumcision appeared to provide SIGNIFICANT PROTECTION from HIV acquisition."
Here’s another study, this time a meta-analysis:
http://www.medscape.com/medscape/cno/2001/RETRO/Story.cfm?story_id=2033
“Circumcision as an HIV Prevention Intervention”, February 6, 2001
Myron S. Cohen, MD
"… Dr. Robert Bailey,[1] from the University of Illinois at Chicago, reviewed evidence supporting the benefits of circumcision and described a remarkable randomized, controlled trial designed to prove the benefits of this intervention.
"Dr. Bailey summarized 35 studies focused on HIV and circumcision. Meta-analysis of 15 studies demonstrated uniform protection, and statistically significant protection was noted in 10 of the 15 studies. The relative risk of acquiring HIV in circumcised men is reduced by a factor ranging from 0.53 to 0.18. For example, Quinn and coworkers[2] analyzed the effects of circumcision in HIV transmission in serodiscordant couples [i.e., one partner HIV positive, the other HIV negative]. They observed HIV acquisition in 40 of 137 uncircumcised men compared with NONE (NOT ONE!!!) of 50 circumcised men.
"Why should circumcision protect from HIV? Dr. Bailey believes that the foreskin represents an important route by which HIV can gain access to the body. He and his coworkers have shown that the foreskin contains a variety of the cellular elements potentially important for HIV acquisition and can be successfully infected with HIV in vitro. Langerhans cells represent 4.7% of foreskin cells and express both the CD4 and the CCR5 receptors required for HIV acquisition.
Reference [1]: Bailey R. “Male circumcision as an effective HIV prevention strategy: current evidence.” Program and abstracts of the 8th Conference on Retroviruses and Opportunistic Infections; February 4-8, 2001; Chicago, Illinois. Abstract S22.
Reference [2]: Quinn TC, Wawer MJ, Sewankambo N, et al. “Viral load and heterosexual transmission of human immunodeficiency virus type 1”. N Engl J Med. 2000;342:921-929.
Still More…
Moses S, Plummer FA, Bradley JE, et. al. “The association between lack of male circumcision and risk for HIV infection: a review of the epidemiological data.” Sex Transm Dis 1994 Jul-Aug;21(4):201-10
From the abstract: “Because a substantial body of evidence links noncircumcision in men with risk for HIV infection, consideration should be given to male circumcision as an intervention to reduce HIV transmission.”
Seed J, Allen S, Mertens T, et. al. Male circumcision, sexually transmitted disease, and risk of HIV. J Acquir Immune Defic Syndr Hum Retrovirol 1995 Jan 1;8(1):83-90
From the abstract: “Despite the low-risk profile, uncircumcised men had a higher prevalence of HIV infection than circumcised men”
Hunter DJ, Maggwa BN, Mati JK, et. al. Sexual behavior, sexually transmitted diseases, male circumcision and risk of HIV infection among women in Nairobi, Kenya. AIDS 1994 Jan;8(1):93-9
From the abstract: “Women whose husband or usual sex partner was uncircumcised had a threefold increase in risk of HIV, and this risk was present in almost all strata of potential confounding factors.”
Urassa M, Todd J, Boerma JT, et. al. Male circumcision and susceptibility to HIV infection among men in Tanzania. AIDS 1997 Mar;11(3):73-80
“CONCLUSION: Male circumcision has a protective effect against HIV infection”
Kreiss JK, Hopkins SG “The association between circumcision status and human immunodeficiency virus infection among homosexual men.” J Infect Dis 1993 Dec;168(6):1404-8
From the abstract: “HIV infection was significantly associated with uncircumcised status (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.2, 3.8)”
Tyndall MW, Ronald AR, Agoki E, et. al. “Increased risk of infection with human immunodeficiency virus type 1 among uncircumcised men presenting with genital ulcer disease in Kenya.” Clin Infect Dis 1996 Sep;23(3):449-53
From the abstract: “A logistic regression model adjusted for behavioral and historical showed that HIV-1 positivity was independently associated with being uncircumcised (adjusted odds ratio [OR], 4.8; 95% confidence interval [CI], 3.3-7.2) … Male circumcision should be considered as an intervention strategy for AIDS control.”
Schoen EJ “Benefits of newborn circumcision: is Europe ignoring medical evidence?” Arch Dis Child 1997;77:258-260
"DISCUSSION AND CONCLUSIONS: The decision to discourage newborn circumcision in the UK and the resultant decrease in the number of circumcised males occurred before the accumulation of this evidence about the protective effect of circumcision against UTI and HIV infection. Particularly in the face of an expanding worldwide AIDS epidemic, these benefits are a powerful argument in favour of encouraging universal newborn circumcision."
Jessamine PG, Plummer FA, Ndinya Achola JO, et. al. “Human immunodeficiency virus, genital ulcers and the male foreskin: synergism in HIV-1 transmission.” Scand J Infect Dis Suppl 1990;69:181-6
From the abstract: “Over 95% of attributable risk in men with STD was either genital ulceration or the presence of a foreskin.” Cook LS, Koutsky LA, Holmes KK Circumcision and sexually transmitted diseases. Am J Public Health 1994 Feb;84(2):197-201
“CONCLUSIONS. Uncircumcised men were more likely than circumcised men to have syphilis and gonorrhea…”
Niku SD, Stock JA, Kaplan GW “Neonatal circumcision.” Urol Clin North Am 1995 Feb;22(1):57-6
From the abstract: “The medical benefits of circumcision appear to exceed the risks of the procedure.”
Serour F, Samra Z, Kushel Z, et. al. “Comparative periurethral bacteriology of uncircumcised and circumcised males.” Genitourin Med 1997 Aug;73(4):288-90
From the abstract: "It has been established that lack of circumcision increases the risk of urinary tract infection in infants. … Our results also support the role of the prepuce as a reservoir for sexually transmitted organisms."
Weiss GN, Weiss EB “A perspective on controversies over neonatal circumcision.” Clin Pediatr (Phila) 1994 Dec;33(12):726-30
From the abstract: "Controversy continues to surround the issue of male circumcision, especially in the United States. … It is our conclusion that, as the safest and most commonly performed surgical procedure in this country, the benefits of posthetomy (circumcision), which include a reduction in some kinds of cancer and sexually transmitted diseases, well outweigh the risks cited by those who oppose it."
Dr Tom Wiswell, a respected authority in the USA was a strong opponent [of circumcision], but then switched camps as a result of his own research findings and the findings of others. This is what he has to say: "As a pediatrician and gerontologist, I am a child advocate and try to do what is best for children. For many years I was an outspoken opponent of circumcision … I have gradually changed my opinion". This ability to keep an open mind on the issue and to make a sound judgement on the balance of all available information is to his credit — he did change his mind! Wiswell looked at the complication rates of having or not having it performed in a study of 136,000 boys born in US army hospitals between 1980 and 1985. 100,000 were circumcised and 193 (0.19%) had complications, with no deaths, but of the 36,000 who were not circumcised the complication rate was 0.24% and there were 2 deaths [156]. A study by others found that of the 11,000 circumcisions performed at New York’s Sloane Hospital in 1989, only 6 led to complications, none of which were fatal [110]. An early survey saw only one death amongst 566,483 baby boys circumcised in New York between 1939 and 1951 [125]. (There are no deaths today.) A retrospective study of boys aged 4 months to 12 years found significantly greater frequency of penile problems (14% vs 6%; P < 0.001) and medical visits for penile problems (10% vs 5%; P < 0.05) among those who were uncircumcised, compared with those who were circumcised.
As for the view that the trend is against circumcision in the US, the very latest trend is actually toward a return of favoring routine infant circumcision. I quote from an article dated March 3, 1999 by Dr. Morris: “However, a reversal of this trend [against circumcision] is starting to occur. In the light of an increasing volume of medical scientific evidence pointing to the benefits of neonatal circumcision a new policy statement was formulated by a working party of the Australian College of Pediatrics in August 1995 and adopted by the College in May 1996 … The American Academy of Pediatrics has moved far closer to an advocacy position and many recognised authorities in the USA strongly advocate circumcision of all newborn boys.”
What about the view that says the boy should decide for himself later in life whether to undergo circumcision? From the book In Favour of Circumcision by Dr. Brian Morris, ISBN 0-86840-537-X, published 1999 (emphasis mine): “It is argued by opponents of circumcision that the male himself should be allowed to make the decision about whether he does or does not want to be circumcised. However, there are problems with this argument, not the least of which is the fact that the greatest benefits accrue the earlier in life the procedure is performed. If left till later ages the individual has already been exposed to the risk of urinary tract infections, the physical problems and carries a residual risk of penile cancer [not to mention a vastly increased risk of contracting HIV]. Moreover, it would take a very street-wise, outgoing, adolescent male to make this decision and undertake the process of ensuring that is done. Most males in the late teens and 20s, not to mention many men of any age, are reticent to confront such issues, even if they hold private convictions and preferences about their penis. Moreover, despite having problems with this part of their anatomy, many will suffer in silence rather than seek medical advice or treatment. Really, though, parental responsibility must over-ride arguments based on ‘the rights of the child’. Think what would happen if we allowed children to reach the age of legal consent in relation to, for example, immunization, whether they should or should not be educated, etc, etc. A period of great benefit would have been lost, to the potential detriment of the person concerned.”
In conclusion, let me discuss an issue that’s often raised in these debates: the ridiculous MYTH that the foreskin consists of special, highly sensitive skin with a higher-than-average density of nerve cells.
I hope by now you folks realize that this is too stupid to be true. It turns out that there was only ever ONE “researcher” who made this claim, who he never published it in any scientific journals, nor was the result repeatable by any other scientist! In fact, specialists laugh at that preposterous claim. Think about it: why would natural selection put the most sensitive skin of the human body on the OUTSIDE of the penis? Which for millions of years was almost constantly being abraded and injured during everyday activities? Face it, men: the foreskin is thick, less sensitive, almost calloused skin developed as a shield for the skin that really mattered, which is the head of the penis. Thus, only this thick, unimportant shell is trimmed back during circumcision.
Remember, folks,
“…as the safest and most commonly performed surgical procedure in [the USA], the benefits of posthetomy [circumcision], which include a reduction in some kinds of cancer and sexually transmitted diseases, well outweigh the risks cited by those who oppose it.”
Q. E. D.