The British Journal of Urology recently published a study from the University of Montreal on the protective effects of circumcision against the development of prostate cancer. Whilst a number of studies have been performed in this area, the significance of this particular study lies in its size – over 3,000 subjects were studied, making it one of the largest studies of its type. Specifically, they illustrated that circumcised men were less likely to develop prostate cancer, although their results didn’t quite reach statistical significance. When circumcision was performed before the age of 1, it provided some protection against future development of prostate cancer. Interestingly, they found a strong correlation between the protective effects of circumcision performed after the age of 35 and development of prostate cancer.[1]
As is the case with any piece of scientific evidence, this study does have its limitations. For example, the authors did not document the reason for patients who were circumcised, which would have been useful in helping to answer the question whether ‘prophylactic’ circumcision has any benefit. Nevertheless, the size of this study and the volume of data collected make it an important study.
The topic of circumcision always seems to be one that causes interest, with scientists trying to prove or discredit the benefits of the procedure, and ethicists debating the morality and legal status of infant male circumcision. It was over a year ago when circumcision was headline news, after a German court in Cologne banned religious male circumcision, citing the fact that it could inflict serious bodily harm to an individual who had not consented to the procedure.[2] Whilst anti-circumcision groups viewed this as a resounding success for the promotion of children’s rights, German parliamentarians saw this as an affront to religious liberty and later passed a law to protect religious circumcision from future legal threats. Further fuel was added to the debate when the American Academy of Paediatrics (AAP) issued a policy statement on the issue of circumcision, suggesting that the health benefits of circumcision outweigh the risks of the procedure.[3] Naturally, the statement has received harsh criticism from academics in the field that happen to be against religious circumcision. It will be interesting to observe their response to the latest Canadian study, which seems to affirm the position of the AAP.
The debate surrounding male circumcision raises a number of delicate issues. There are of course the surgical questions – can we justify undertaking a surgical procedure on a normal individual for prophylaxis against infection and prostate cancer? Moreover, is it acceptable to perform such a procedure on an individual who is not able to consent to the procedure? Then there are the questions surrounding religious freedom; should parents have the right to subject their child to a surgical procedure purely on the basis of a religious belief? What if the child later grows up to have a different religion to that of his parents? Indeed, It is astounding that a small piece of skin situated on the tip of the male reproductive organ, which has no clear anatomical or physiological function[4] can cause so much public furore.
The principle argument used to justify religious circumcision is centred on the issue of religious liberty. Parents generally have the freedom to dictate the course in which they bring up their children and to decide what is in their best interests. Hence, the decision for parents to circumcise their son is usually justified on the basis of their religious views. The anti-circumcision lobby contends this belief with the argument that parents are unjustified in believing that their child would maintain their religious values. They maintain that just as it is important for the religious liberty of parents to be preserved, so the religious freedom of their children must also be respected as children are not born with a particular set of religious beliefs, nor do they have the choice to be brought up under certain religious customs and beliefs. Therefore, it may well be the case that later on in life, a child might not share the same religious belief as his parents and will grow up to resent the fact that he was once circumcised.
This is a problematic argument, primarily because it would make it almost impossible for parents to make any decision on behalf of their child on the basis that they might have chosen differently. Parents continually make decisions on behalf of their children on a number of contentious issues, ranging from the type of milk they receive at birth, to the manner in which they are educated. It is vital that the right for parents to make decisions on what they deem best for their child is preserved. In addition, the ability for one to have the right to practice their religion is inextricably linked with the manner in which they bring up their child. Hence, the anti-circumcision lobby might be accused of limiting the freedom parents have in practicing their religion. Surely this cannot be allowed in the free society that we live in?
A second and perhaps more convincing argument put forward by anti-circumcision proponents lies in the suggestion that the act of religious circumcision should not be protected under the banner of religious liberty due to the harm that the procedure can cause. Naturally when circumcision is performed for therapeutic reasons, few would argue against the value of the procedure. The issue arises on the justification for undertaking circumcision for non-therapeutic reasons. Whilst it is beyond the scope of this article to analyse the medical evidence for and against circumcision as a prophylactic procedure, what is clear is that there is no evidence to suggest that non-therapeutic circumcision is a wholly harmful procedure without any benefit. This is reflected in the position of many medical organisations worldwide, who acknowledge that there isn’t enough evidence to mandate routine circumcision of all infant males and likewise, there isn’t enough evidence to suggest that infant male circumcision is so harmful that it should be outlawed altogether.
Anti-circumcision pressure groups will still maintain that circumcision is harmful primarily due to the complications which can result from the procedure, as well as the harmful effects of the procedure itself. Every medical intervention carries some risk of complications; however, something can only be deemed harmful if the complication rate is unacceptably high. The reality is that when circumcision is performed by adequately trained individuals in sterile conditions, the complication rate is as low as 0.9%.[5] Therefore, labelling the procedure as harmful on this basis alone is somewhat ludicrous; even the notion that circumcision can have harmful effects is largely baseless. Whilst some academic papers have claimed that circumcision can irreversibly damage the penis,[6] or that circumcision results in the loss of skin that serves a protective and sexual purpose (a somewhat bold statement, given that there is still much ambiguity on the purpose of foreskin), there are no large scale epidemiological studies to prove these points. An oft-quoted paper suggests that circumcision results in impaired sensory function of the male reproductive organ on the basis of a study of 22 cadavers.[7] Even if we were to ignore the meagre sample size in this study, drawing conclusions of the ability of living circumcised individuals to enjoy sexual intercourse on the back of a cadaveric study seems nonsensical. The fact remains that there is no robust scientific evidence to suggest that sexual function is hampered as a result of circumcision.
The circumcision debate is one which is unlikely to be concluded any time soon. However, I cannot help but question the motives of the anti-circumcision lobby (many of whom also happen to be anti-religion); are they truly interested in protecting the rights of children, or are they simply using this debate as yet another means to try and score some points against the Abrahamic faiths and their followers? It would be interesting to see how much work the most vocal members of this debate have undertaken in other aspects of children’s wellbeing, such as child poverty and child abuse. What is perhaps even more sickening is the way in which they may be using the most vulnerable members of our society as a means to push forward their own atheistic and secular agenda. This is somewhat ironic, for on the one hand they are calling for what they deem to be children’s rights, but at the same time they are exploiting them for their own cause. Combining this possible underlying agenda with the fact that the case to limit a parent’s ability to circumcise their child is extremely weak, religious circumcisions should continue, and be allowed to continue in order to preserve our religious and social freedoms.
[1] Spence AR, Rousseau M-C, Karakiewizc PI, Parent M-E. Circumcision and prostate cancer: a population-based case control study in Montreal, Canada. BJU International. (2014) March 24 (Epub Ahead of Print) PMID: 24655933
[2] http://www.bbc.co.uk/news/magazine-18793842
[3] http://www.aap.org/en-us/about-the-aap/aap-press-room/pages/Newborn-Male-Circumcision.aspx
[4] “Male circumcision: Global trends and determinants of prevalence, safety and acceptability” (PDF).World Health Organization.p. 13.
[5] “Male circumcision: Global trends and determinants of prevalence, safety and acceptability” (PDF).World Health Organization.p. 13.
[6] “Male circumcision: Global trends and determinants of prevalence, safety and acceptability” (PDF).World Health Organization.p. 13.
[7]Taylor JR, Lockwood AP, Taylor AJ. The prepuce: specialized mucosa of the penis and its loss to circumcision. Br J Urol 1996;77:291–5.
