History of circumcision

David Gollaher, Circumcision: A history of the world's most controversial surgery, (New York, Basic Books, 2000)
Review by Dr Robert Darby

See also the review by Dr Hanoch Ben-Yami, Philosophy Department, University of Tel-Aviv

Circumcision and male sexual function: the verdict of the centuries
A collection of telling quotes over the last 2000 years, with an irreverent commentary
Circumcision and male sexual functioning

The foreskin from 300 million years BCE to 2002
Circumcision chronology

Male circumcision and female sexual pleasure

Kristen O'Hara (with Jeffrey O'Hara), Sex as nature intended it (Hudson USA, Turning Point Publications, 2001)
See Kristen's website: www.SexAsNatureIntendedIt.com

Links

See the revealing (fascinating and horrifying) collection of quotes from nineteenth and twentieth century medical authorities in medical journals and books: http://circquotes.tilted.com/

The Circumcision Information and Resource Pages has an excellent collection of articles on recent research into the anatomy of the penis (and importance of its foreskin), the history of circumcision, its metaphysical and psychological effects, the various myths about the foreskin and disease, and the legal and ethical issues which must be considered when performing unnecessary surgery on children: www.cirp.org/library

Circumcision and disease

HIV-AIDS

Cancer

For reliable information on all types of cancer, see the New South Wales Cancer Council

Information on penile and cervical cancer

For full details on cervical cancer, see cervical cancer page on this site.

Urinary Tract Infections (UTIs)

This is a major selling point of circumcision advocates today, but the main reason babies get urinary tract infections (usually caused when intestinal bacteria from their mother colonise the inner surface of the foreskin and then spread up the urethra) is not because of the foreskin. The most important cause is when new-born babies are taken away from their mothers in modern hospitals before they have a chance to receive their mother's antibodies, and thus natural resistance, to the maternal bacteria. The best solution is simply to make sure that a newborn baby stays with his mother and starts to breast feed ASAP; mother's milk will supply the necessary antibodies and thus protect the urinary tract. (There is nothing wrong with intestinal bacteria on the inner foreskin surface; in fact, they probably keep out harmful bacteria.)

For full details
www.cirp.org/library/disease/UTI

It has recently come to light that most of the uncircumcised boys in the studies by Thomas Wiswell, the main source of data for the view that uncircumcised boys are more subject to UTIs, were born in US military hospitals, where the rule was to retract their foreskins in infancy for cleaning purposes. This harmful practice is contrary to all current medical knowledge advice and is known to be a major cause of injury and infection. It is thus likely that the higher incidence of UTIs shown by these unfortunate boys was the result of the forcible retraction of their foreskins by ignorant doctors and nurses. The foreskin probably provides protection against UTIs. Further information

Breastfeeding

An important statement on circumcision and breastfeeding, and the link between breastfeeding and prevention of UTIs, is available here

Sexually Transmitted Diseases (STDs)

Anybody can get these if they engage in risky sexual behaviour; nobody need get them if they play it safe. The foreskin is only an innocent bystander.

The United States journal Pediatrics has for many years been a safe haven for the pro-circumcision forces within the American Association of Pediatrics (whose generally anti-circumcision policy the journal has consistently sought to undermine). Recently it published an article by David Fergusson et al purporting to show that circumcision reduced the risk of certain STIs (Chlamydia, genital warts, nonspecific urethritis (NSU), gonorrhea and genital herpes, but not syphilis, genital ulcerative disease or HIV) by up to 50 per cent, and suggesting that neonatal circumcision was thus a wise measure of public policy. Following a number of critical responses posted on the on-line edition of Pediatrics website, Fergusson was forced to retract his claims. One wonders, however, whether the news service which picked up his breathless media release will also report the backdown, and whether Pediatrics will publish the responses in its print edition and formally withdraw the original article.

David M. Fergusson, Joseph M. Boden and L. John Horwood, Circumcision Status and Risk of Sexually Transmitted Infection in Young Adult Males: An Analysis of a Longitudinal Birth Cohort Pediatrics 2006;118;1971-1977.

For the critiques and Fergusson's response:

http://pediatrics.aappublications.org/cgi/eletters/118/5/1971

In the late nineteenth century Anglo-American doctors became convinced that circumcision would infallibly protect men from syphilis (the AIDS of that era), and millions of baby boys in Britain, the USA and Australia were circumcised in the hope that it would overcome the health crisis thought to be threatening the nation. In fact, circumcision had no impact on the incidence of syphilis at all, the prevalence of which was reduced by screening, early treatment, safe sex (especially condoms) and finally defeated when penicillin was introduced in the 1940s. (Syphilis and all other STDs are still quickly cured with antibiotics.)

For details of the nineteenth century campaign to enforce mass circumcision as a preventive of syphilis, see Robert Darby, “Where doctors differ: The debate on circumcision as a preventive of syphilis, 1855-1914”, Social History of Medicine, Vol. 16, pp. 57-78; and his book, A Surgical Temptation: The Demonization of the Foreskin and the Rise of Circumcision in Britain (University of Chicago Press, 2005) Chapter 12.

For full details
www.cirp.org/library/disease/STD

Balanitis

Inflammation of the glans is more common in circumcised boys.

For full details
www.cirp.org/library/disease/balanitis

Non-surgical treatments

Treatment of penis and foreskin problems do not necessarily mean amputation; conservative approaches are often preferable.

Further information on this site

Phimosis

Phimosis (inability to pull the foreskin back) is natural and proper in all male babies and rarely a problem in boys of any age. In babies the foreskin is long (extending far beyond the glans), tight and usually not separated from the glans. This was known to be the normal condition of male babies until the 1840s, when English doctors suddenly decided it was an abnormality (called "congenital phimosis") which had to be surgically corrected. One of the three main reasons for the introduction of routine circumcision in the nineteenth century was based on a gross medical error and sudden amnesia towards previous knowledge: one of modern medicine's great leaps backwards.

In England the error was corrected by Douglas Gairdner in 1949, but the news took a long time to reach Australia and even longer to reach the USA, where many doctors were still in the grip of nineteenth century delusions as late as the 1980s.

Further Information:
www.cirp.org/library/treatment/phimosis

Frequently asked questions about care of the normal penis

Paraphimosis
(can't return foreskin)
www.cirp.org/library/treatment/paraphimosis

Balanitis Xerotica Obliterans (BXO)
(a rare fungal infection)
www.cirp.org/library/treatment/BXO

Injuries to the foreskin
www.cirp.org/library/treatment/zipper

Anatomy and physiology of the foreskin

Role of the foreskin in normal sexual function
www.cirp.org/library/sex_function

New research on the ridged band

The ridged band is a special zone of tissue on the underside of the foreskin, with probably the densest concentration of nerve endings in the human body. Until recently doctors did not even know it was there because they were too busy amputating foreskins before they had studied what they were tossing in the trash. In terms of its role in sexual responsiveness, it could be regarded as the male clitoris.

For further details
http://research.cirp.org

Effects of circumcision on brain development and psychology

Did you know that an early circumcision can prevent the development of neural pathways in the brain? And that circumcision often has harmful, and permanent, psychological effects?

For full details
www.cirp.org/library/psych

Evolution of the prepuce

Discussion of the evolution of the prepuce in response to Geoffrey Miller's
book on sexual selection, The mating mind:
www.human-nature.com/nibbs/02/darby.html

Circumcision increases risk of prostate problems

Recent papers by Dr G.G. Giles et al show that circumcised men experience more prostate problems, and that prostate cancer is not related to STDs.

Prevalence of urinary symptoms in urban Australian men aged 40-69. McCredie M; Staples M; Johnson W; English DR; Giles GG.  Department of Preventive and Social Medicine,  Dunedin Medical School, University of Otago, New Zealand. J Epidemiol Biostat 2001;6(2):211-8

BACKGROUND:  This study was devised to determine the prevalence of urinary symptoms among men living in the Australian cities of Melbourne, Sydney or Perth, and to identify factors associated with the presence of moderate-to-severe urinary symptoms.

METHODS:  The study comprised a population-based sample of 1,216 men, aged 40-69 years, whose names were obtained through electoral rolls and who participated as controls in a case-control study of risk factors for prostate cancer. As part of a structured face-to-face interview, the men completed the International Prostate Symptom Score (IPSS). Men with moderate (IPSS = 8-19) or severe (IPSS > or = 20) urinary symptoms were compared with those with mild or no symptoms (IPSS < 8) using unconditional logistic regression.

RESULTS:  The age-specific prevalence of moderate-to-severe urinary symptoms (IPSS > or = 8) in men aged 40-49, 50-59, 60-69 years was 16%, 23% and 28%, respectively. Compared with men with no or mild urinary symptoms (IPSS < 8), men with moderate-to-severe symptoms were more likely to report not currently living as married [odds ratio (OR) = 1.5; 95% confidence interval (CI) 1.1-2.0] and being circumcised (OR = 1.5; 95% Cl 1.2-2.0). The increased likelihood associated with drinking an average of > 60g per day of alcohol in the 2 years before interview was of marginal statistical significance (OR = 1.6; 1.0-2.6). There were no significant differences between men with IPSS > or = 8 and those with IPSS < 8 with respect to body mass index, education level, having had a vasectomy, or cigarette smoking.

CONCLUSION:  Among Australian men, being circumcised, or not currently living as married, were associated with increased prevalence of urinary symptoms.

Comments

There was no media coverage of this paper, but you can be sure that if the study had, on the contrary, shown that being circumcised was associated with reduced prevalence of urinary symptoms, there would have been newspaper headlines, and the circumfanatics would have been crowing about yet another reason to circumcise baby boys.

How significant are these findings?

Urinary symptoms are often an indication of benign prostatic hyperplasia (BPH). Enlargement of the prostate is a common male ailment, often requiring surgery such as transurethral resection of the prostate (TURP) to improve the sufferer's quality of life. In about 80% of cases, TURP results in infertility (because the semen goes into the bladder rather than being ejaculated) and in 5% to 8% of cases, TURP results in impotence. About 400,000 TURPs are performed annually in the US.

If being circumcised increases a man's risk of BPH by 50% (as found in the study above), then if 60% of the at risk population in the US have been circumcised, almost 100,000 of the 400,000 TURPs (25 per cent) were the result of circumcision. Quite apart from the loss of function, think what a waste of surgical resources this represents.

Statistics derived from:

http://www.usrf.org/questionnaires/AUA_SymptomScore.html
http://www.fonendo.com/noticias/9/2001/02/1.shtml
http://www.dva.gov.au/media/publicat/2001/prostate/index.htm

No link between STDs and prostate cancer

In a separate study Giles et al found that prostate cancer was not associated with sexually transmitted diseases, but that it was associated with a low frequency of ejaculations.

Sexual factors and prostate cancer. G.G. Giles, G. Severi, D.R. English, M.R.E. Mccredie, R. Borland, P. Boyle, J.L. Hopper. BJU International, Vol. 92, 2003, 211–216

OBJECTIVE:  To assess whether prostate cancer might be related to hormone levels and, by inference, to differences in sexual activity.

PATIENTS, SUBJECTS AND METHODS:  In a case-control study of men with prostate cancer aged <70 years at diagnosis and age matched control subjects, information was collected on two aspects of sexual activity; the number of sexual partners and the frequency of total ejaculations during the third to fifth decades of life

RESULTS:  There was no association of prostate cancer with the number of sexual partners or with the maximum number of ejaculations in 24 h. There was a negative trend ( P < 0.01) for the association between risk and number of ejaculations in the third decade, independent of those in the fourth or fifth. Men who averaged five or more ejaculations weekly in their 20s had an odds ratio (95% confidence interval) of 0.66 (0.49–0.87) compared with those who ejaculated less often.

CONCLUSIONS:  The null association with the number of sexual partners argues against infection as a cause of prostate cancer in this population. Ejaculatory frequency, especially in early adult life, is negatively associated with the risk of prostate cancer, and thus the molecular biological consequences of suppressed or diminished ejaculation are worthy of further research.

In other words, the Victorians could not have been more wrong: the more ejaculations a man has, the lower his risk of prostate cancer, and healthier he will be.