General notes about the medical evidence on circumcision and the foreskin

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Circumcision is a subject which arouses strong controversy and for which opinions tend to be strongly polarised for or against.  The conclusions of research literature reflect the preexisting bias of the researcher.  As such it is difficult to present an unbiased opinion on the subject and anyone who claims to do so should not be trusted.  The typical position of those who favour circumcision can be summarised:-

Circumcision gives lifelong protection against many diseases.  It causes no harm to physical, psychological or sexual function.  Complications are rare, mostly minor and can be easily treated.  Circumcision in infancy confers more benefits and is cheaper and safer than circumcision in older children or adults.  Parents have the right to make decisions about options for their children.

The typical position of those who oppose child circumcision can be summarised:-

The protections from disease given by circumcision are doubtful and certainly overstated.  Circumcision does real harm and the risks, albeit rare, can be devastating.  Risks include the risk of death.  Children have a right to self determination.  In the absence of immediate medical need, their bodies should not be modified until they are old enough and mature enough to decide for themselves.

While we freely admit to being in the second camp, these two positions may both have some element of truth and neither position should be dismissed out of hand.  It is possible that circumcision may confer partial protection against some diseases, it is also the case that children have a right to an open future.  We take the position we do because we wish to protect that right for every child.  It is wrong to dismiss our position on the grounds that we are biased or “emotional”.  Chidren’s rights are just as important as hard research evidence.

All the literature we present on these pages should be viewed from that perspective.  We have no objection to a consenting adult being circumcised, but he has a right to full disclosure of the potential for risk and harm and a realistic assessment of the goals of treatment being met.  Children have in general a right to an open future and we think therefore that they should be protected from circumcision unless there is a genuine immediate medical need for it.

Most research into circumcision is carried out by doctors (and others) with an interest in circumcision.  Hence it is perhaps unsurprising that the literature tends to support a worldview that infant circumcision is an acceptable intervention and that it has potential benefits.  These research authors are no more or less biased than we are.  All research is subject to bias although proper research governance should ensure valid results.  What is uncommon in the context of circumcision is for literature to take proper account of the ethics of surgery on those who have no disease and give no consent.  To be fair however the Journal of Medical Ethics has considered this not once, but twice, in recent  years.

We will try to highlight sources of potential bias, or conflict of interest, in our comment on the literature.  We do however take the policy that something which is reported in the peer-reviewed medical literature and which has not been retracted is valid evidence.  This may not always be popular with all our supporters.  We will try to be as even-handed as we can while putting the medical evidence into context and stating the strengths and limitations of the evidence.

All research evidence has limitations and some research, such as into the experience of sexual pleasure, has to be highly subjective.  It can for example certainly be argued that there is not enough scientific proof that circumcision damages sexual function.  The burden of proof however rests with those who wish to remove normal tissue from normal children that what they do is harmless.  To put this in context, there is not a lot of scientific evidence to show that it is harmful to cut off a child’s ear-lobe; but that does not make it acceptable to cut off a child’s ear lobe.  We believe that, even in the absence of scientific evidence of harm, it is equally wrong cut off a child’s foreskin.  Evidence of benefit in terms of preventing disease does not negate the potential for harm.  Even if it can be scientifically proven that circumcision of infants does provide benefits it is still necessary to show that it is safe and ethically acceptable before you can do it do a child.  As such we consider that research into circumcision preventing disease is a red herring.

We must say that science does not exist in a vacuum.  Rather it has its place in in the wider culture and society.  This governs what research gets funded, what research is taken more seriously and the use to which scientific findings are put.  While it is possible that circumcision confers partial protection against some diseases, and adults may choose to get those benefits in so far as they are real, we say that circumcision of healthy – non-consenting – children is wrong.  This may seem an outlandish proposition to people who promote circumcision, but it is no more  than the normal standard of care.  Those who propose to circumcise children have to justify why it is an exception.  This requires more than merely proving that some cases of disease may be prevented.

Finally a buyer beware.  Whenever a paper is published reporting adverse outcomes from circumcision, or calling into question the benefits, one procircumcision author always responds by publishing a “scholarly, erudite and blistering refutation” of the original paper.  He is, of course, no less biased than we are.

This page provides General notes about the medical evidence on foreskin removal and circumcision

There is a good page on circumcision.org comparing and contrasting circumcision advocates and critics on various issues.

2013-07-29T14:01:39+00:00

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