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To Cut or Not to Cut

by DAVID ROSEN

Two recent reports of clinical trials in East Africa successfully demonstrated that circumcision of adult men significantly reduces the risk of contracting HIV. The trials have renewed a debate in the U.S. as to the procedure’s efficacy. While female circumcision is nearly universally denounced in the West as a form of barbarity, male circumcision persists for medical, cultural and religious reasons.

Murray Bookchin, the late anarchist theoretician, once observed that the first form of social hierarchy was the tyranny of the old over the young. And circumcision, whether inflicted on male or female children, may well be the oldest form of tyranny, the brutal imposition of pain and disfigurement on the young to enforce the rule of the old, especially older men.

While the medical reports confirm the value of male circumcision under particular conditions, a value that has its origin in the procedure’s centuries-old practice, the question remains whether it is a medically unnecessary procedure in the U.S. today?

* * *

As reported in “Science News” [December 23, 2006] and other publications, the circumcision studies took place in Uganda and Kenya. These are countries with historically very low levels of male circumcision. In Uganda, researchers enrolled 4,996 male volunteers between the ages of 15 and 49. In Kenya, 2,784 men between 18 and 24 participated. According to “Science News,” “scientists randomly assigned half the men in each trial to get circumcised upon enrollment and the other half to wait 2 years for the procedure.”

The two studies’ findings were significant: Circumcision halved a man’s risk of contracting HIV. “Science News” notes that “[t]he fragile foreskin around the penis harbors immune cells that are easily infected with HIV. After the foreskin is removed in circumcision, the remaining outer layer becomes tough and more difficult for HIV to penetrate.” Among the circumcised men, 22 in each trial became infected with HIV. Among uncircumcised men, 42 in Uganda and 47 in Kenya became infected.

According to Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases in Bethesda, MD, the studies “offer definitive evidence that circumcision confers strong — though not complete — protection against infection by the virus.” So impressive were the findings that researchers halted both trials earlier then planned because the circumcised men were contracting fewer HIV infections.

These findings mirror the results from other studies, including the still-earlier one from Orange Farm, South Africa. As reported in “Science” [August 2005], the study, conducted in an impoverished township south of Johannesburg, was the first to demonstrate that circumcising adult men can dramatically lower their risk of becoming infected by HIV from heterosexual sex.

In still another study, “Pediatrics” [November 2006] reported on a 25-year longitudinal survey of New Zealand children on the association between circumcision status and sexually transmitted infection. It found that “[b]eing uncircumcised had a statistically significant bivariate association with self-reported sexually transmitted infection. Ö Male circumcision may reduce the risk of sexually transmitted infection acquisition and transmission by up to one half, suggesting substantial benefits accruing from routine neonatal circumcision.”

These findings added additional weight to the now-famous study, “Male Circumcision, Penile Human Papillomavirus [HPV] Infection, and Cervical Cancer in Female Partners,” reported in “The New England Journal of Medicine” [April 11, 2002]. This study was of 1,900 Spanish couples and found that circumcised males were less likely to be infected with HPV that causes genital warts. As it reported, “Male circumcision is associated with a reduced risk of penile HPV infection and, in the case of men with a history of multiple sexual partners, a reduced risk of cervical cancer in their current female partners.”

In sub-Saharan Africa where AIDS/HIV infection is a catastrophic epidemic, Jeckoniah Ndinya-Achola, a physician at the University of Nairobi, acknowledges that no country has yet adopted a formal policy promoting or subsidizing circumcision. Nevertheless, the World Health Organization finds that a growing movement for safe and affordable circumcision services for adult men is gaining momentum in Botswana, Lesotho, South Africa, Swaziland, Tanzania and Zambia.

(Ironically, South Africa’s president, Thabo Mbeki, recently signed a law banning circumcisions for boys younger than 16. While there are exceptions for religious practices among Jews and Muslims, the law is aimed at stopping the practice among rural tribes which, annually, results in numerous injuries and deaths.)

The Joint United Nations Program on HIV/AIDS found that, in Swaziland, the health ministry has responded to the increase in demand by organizing a workshop to train doctors and nurses in circumcision. Some clinics are promoting what they call, “Circumcision Sundays,” as an anti-HIV measure, charging $40 for the operation. [“Bulletin of the World Health Organization,” July 2006]

* * *

The origins of circumcision are obscure, perhaps having as much to do with hygienic precaution as with patriarchy. Some scholars argue that it dates some six thousand years ago, and was practiced by the Egyptians before being adopted by Jews where it assumed its traditional religious significance, as a sign of a covenant between the Jewish people and their deity. As told in the fierce spirit of the Old Testament, Genesis 17, when Abram was ninety-nine years old, God appeared to him and intoned:

Ö This is my covenant, which you shall keep, between me and you and your offspring after you: Every male among you shall be circumcised. You shall circumcise the flesh of your foreskins, and it shall be a sign of the covenant between me and you. Throughout your generations every male among you shall be circumcised when he is eight days old, including the slave born in your house and the one bought with your money from any foreigner who is not of your offspring. [Emphasis added.] Any uncircumcised male who is not circumcised in the flesh of his foreskin shall be cut off from his people; he has broken my covenant.

A further expression of this covenant was Abraham’s willingness to sacrifice his son, Isaac.

Over the intervening centuries, male circumcision has been retained by two of the Abrahamic faiths, Jews and Muslims. Christianity, however, opposed it. Following the Greek and the Roman custom which placed a high value on the foreskin or “prepuce,” the early Church rejected circumcision at what is know as the Council at Jerusalem in 50 AD and St. Paul argued against it, saying: “Now they have heard of thee that thou teachest those Jews who are among the Gentiles to depart from Moses: saying that they ought not to circumcies their children, nor walk according to the custom.” [Acts: 21]

The modern use of circumcision as a medical practice dates from around the middle of the 19th century. “Circumcision: A History of the World’s Most Controversial Surgery,” by David Gollaher, provides one of the best overviews of the practice. The “scientific” acceptance of circumcision in the U.S. coincided with two developments that defined the latter-half of the century, the fear of masturbation and a new awareness of sanitary hygiene.

During the late-19th-century, physicians and moralists warned that masturbation could lead to a host of medical maladies, from paralysis to tuberculosis to madness. Circumcision was seen as an affective way to curtail masturbation. Similarly, the social imposition of public hygiene, including circumcision, helped not only to cultivate a growing middle class, but reduce disease common to rapidly-growing, congested cities. However, as Gollaher points out, circumcision helped to differentiate middle-class white gentiles from “recent immigrants, African Americans, the poor, and others at the margins of respectable society.”

Circumcision in the U.S. reached its zenith in the post-WWII period. Foreskin infections had plagued U.S. soldiers during the war which, in turn, led to the extensive adult circumcisions and its wide-scale imposition on male infants. Thus, in the 1950s, it was estimated that about 90 percent of American baby boys were circumcised.

However, in the 1960s and 1970s, routine circumcision began to face challenges from many fronts. In 1970, the “Journal of the American Medical Association” [JAMA #213] published an influential article by Dr. E. Noel Preston that argued that circumcision offered no therapeutic or prophylactic benefits. In 1971, the American Academy of Pediatrics [AAP] issued a statement that “[t]here are no valid medical indications for circumcision in the neonatal period.” These pronouncements signaled a major shift in thinking within the medical establishment.

In 1976, no less a public authority on child care than Dr. Benjamin Spock came out against it: “I am in favor of leaving the penis alone. Pediatric opinion is swinging away from routine circumcision as unnecessary and at least mildly dangerous. I also believe that there is a potential danger of emotional harm resulting from the operation.”

Since the mid-70s, the rate of circumcision of male infants in the U.S. has steadily declined. Based on data from the National Hospital Discharge Survey, an annual survey since 1965 of some five hundred hospitals, the rate of circumcision peaked in 1971 and, by 1994, dropped to 63 percent. The most recent data show that the circumcision rate continues to fall and, by 2003, was at 56 percent.

* * *

Today, the debate over male circumcision continues, but at a higher pitch than since its first adoption in the 19th century. The worldwide condemnation of female genital mutilation intensified the debate. And the recent medical reports as to the procedure’s value in the prevention of HIV transmission in Africa have refocused attention as to its utility under certain circumstances.

Over the last couple of decades, a host of groups emerged to challenge male circumcision. The oldest appears to be Brothers United for Future Foreskins (BUFF) founded in 1982. A second group, the National Organization of Restoring Men (NORM), originally known as Recover A Penis (RECAP), was founded in 1989 for men restoring their foreskins and has chapters in the U.S. and internationally; in 1994, UNCIRC (UNCircumcising Information and Resources Center) was incorporated into this group. While it is difficult to measure the effect of these groups, they have contributed to a growing opposition to the procedure.

Opposition took other forms. One serious issue concerns the fact that of the million or so newborn boys who are circumcised each year, the majority of them get no local anesthesia. A recent report in “Prevention” [April 2005] claims that one study found that 92 percent of male infants subject to circumcision were not given anesthesia during the procedure.

Others, including some Jews, opposed the fact that a number of Jewish infants were reported acquiring a virus infections from the man, or “mohel,” who performed the procedure. In 2004, New York City Department of Health [NYC-DH] received reports that newborn, male babies had been infected with the herpes simplex virus.

According to Dr. Howard Markel, “there have been 11 cases of male babies who contracted herpes following circumcisions Ö reported over the past 5 years in New York, Canada, and Israel. In 2005, there were 4 infected babies in New York City.” The NYC-DH deduced that the mohel used his mouth to suck blood away from the infant’s symbolic wound, thus transmitting the virus to the child. It proposed a voluntary ban on the practice that was endorsed by the Rabbinical Council of America; however, the ultra-Orthodox Hasidic Jewish community refuses to honor the ban as a violation of their covenant with God and freedom of religion. [Medscape Pediatrics, October 17, 2006]

Still others opposed circumcision for more sensational reasons. Ted Spiker, writing in “Men’s Health” [May 2000], claimed that “[w]omen like sex with uncircumcised men.” He informed his readers: “By lopping off the nerve endings in [your son’s] foreskin, you limit the sensations he feels. But it’s not just the fact that he’ll have better sex; he’ll probably have more of it. Ö An added bonus: The uncircumcised men lasted an average of 4 minutes longer than their circumcised pals.”

(These assertions, medically speaking, are dubious. In a study reported in “Urology Times” [May 2003], Dr. Arnold Melman, of New York’s Montefiore Medical Center, found little to no difference in penile sensitivity between circumcised and uncircumcised men and whatever differences were found were due to age and if a person had a disease.)

Opposition has also taken a more moderate form. A review of leading pregnancy and new-born baby magazines like “Baby Talk,” “Fit Pregnancy” and “Mothering” indicates that while circumcision is a recurring subject of consideration, the general attitude is one of dispassionate neutrality. For example, in “Baby Talk” [“Should We Circumcise Our Son?,” March 2003], Melanie Howard cautions parents that “You should make your decision based on what you believe are the best interests of your child.”

Howard does report that the AAP acknowledges that the procedure can help limit sexually transmitted diseases (STDs), infant urinary tract infections (UTIs) and cancer of the penis. But she repeats its warning: “Existing scientific evidence demonstrates potential medical benefits of newborn male circumcisions; however these data are not sufficient to recommend routine neonatal circumcision.”

Australia is an example of a Western society where there seems to have been a 180-degree change on circumcision. As a circumcised Australian friend discovered: “When I left Melbourne in 1980, I had known only one or two uncircumcised men. My wife and I returned with a baby son in 1990, and went to the beach with friends. They looked at our baby, and ripped into us for practicing ëpenis mutilation’. We were stunned.” The consensus acceptance of circumcision is long gone throughout the West.

* * *

In the face of the growing opposition to and steady decline in the procedure, those who continue to promote circumcision have become increasingly militant. The most thorough, and rancorous, defense of the procedure is Jon Levenson’s attack on “the new enemies of circumcision” in “Commentary” [March 2000]. He assailed opposition to circumcision as “waving the red-flag of anti-Semitism.” And adds: “The whiff of anti-Semitism (and/or Jewish self-hate) that one occasionally picks up in the literature of the anti-circumcision movement may be a harbinger of much stronger odors to come.”

Levenson concludes by invoking the injunction of premodern patriarchy: “Where much of contemporary American culture now places the highest valuation on pleasure, especially sexual pleasure, and on the avoidance of any sort of pain, the classical Jewish texts value the willingness to suffer for a worthy cause, speak of the sanctity of marriage, and elevate self-control over self-expression.”

Many Jewish male and female reformers have raised concern about circumcision, often arguing that one can remain an observant Jew without adopting the procedure. Nevertheless, among orthodox and conservative Jews (as well as many Muslim denominations), circumcision remains an important testament of faith. The question persists: What is circumcision a testament to?

Murray Bookchin’s insight into the formation of social hierarchy speaks as much to the structure of tyranny as the possibilities of freedom. In those now-lost days when human civilization was in its earliest formation, the old, the infirmed, the weak had an even more precarious existence than the vigorously, the young and the strong.

The traditional veneration of the old, for their alleged knowledge, skills and wisdom, seems meaningless in a world in which tools were few and survival not guaranteed. Only with the hard-fought aggregation of a meager social surplus could a tribe or community begin to support those whose continued survival was less than required.

With the survival of the old comes the social tyranny of a vengeful deity. For who better speaks in its name than those who have the least to lose. Who better, in Levenson’s formation, to “elevate self-control over self-expression” to a universal principal than those old men and women who can gladly reject the sexual pleasure that had long ago passed them by and share a “willingness to suffer for a worthy cause” as they make their way to the grave. And who better than the old to attest to an infant boy’s “willingness to suffer” and (at eight days of age!) proudly give his foreskin to preserve patriarchal order?

Most ironically, if as the Jewish deity commanded Abraham, circumcision was to be inflicted on males, “including the slave born in your house and the one bought with your money from any foreigner who is not of your offspring,” than slavery must surely have been a sanctified feature of premodern patriarch. So, one wonders, why has circumcision persisted as a testament to faith while slavery has been superceded by wage labor? Are they both but vestigial organs of social formation thankfully lost to the past?

Male circumcision might be a valid medical procedure in some parts of the world, like East Africa, with a questionable public hygiene infrastructure and faced with a catastrophic health crisis. It also might be required in the West under certain critical conditions like a similar pandemic. But this does not mean that circumcision, like slavery and the hanging of witches, should not disappear as a social practice.

In conclusion, the debate about circumcision has reached its most absurd form in the growing use of the male foreskin in female beauty products. In a valuable article, “Foreskin Face Cream and Other Beauty Products of the Future,” Amanda Euringer reports that “foreskin fibroblasts are big business. A fibroblast is a piece of human skin that is used as a culture to grow other skin or cells — like human yogurt kits.” She points out how a foreskin-based face cream, SkinMedica, was featured on Oprah Winfrey’s show and is used by celebrities like Oprah and Barbara Walters as an alternative to cosmetic surgery. [Originally on the British Columbian online site, The Typee, and available at AlterNet, February 9, 2007]

DAVID ROSEN and can be reached at drosen@ix.netcom.com.

 

 

David Rosen is the author of Sex, Sin & Subversion:  The Transformation of 1950s New York’s Forbidden into America’s New Normal (Skyhorse, 2015).  He can be reached at drosennyc@verizon.net; check out www.DavidRosenWrites.com.

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