Is male circumcision a humanitarian act?
By Jesse Bering
So there’s this fellow—an inquisitive sort, even if not particularly bright—whom one day is asked by his ogress of a wife to drive to the store to buy a ham. Obediently, he does so, finds an impressive specimen of meat at the store, returns home and, grinning widely, places it proudly on the kitchen table before the woman. “You idiot!” screams the boorish wife. “Why didn’t you have the butcher cut off the end?” Now, our man might be dim-witted, but he’s not without a certain practical mindedness. So he asks his wife, meekly, why the end must be cut off. “Ach,” she grumbles, heaving the ham onto the counter where she begins fussily carving off the end. “Such a stupid question. That’s just the way it’s done. Mother did it and her mother before her and her mother before her.” There’s a rather puzzling hesitation in his wife’s answer that intrigues the man, however. So, still perplexed, he phones his mother-in-law—who apparently is as pleasant as his wife is unpleasant—and asks the old lady why she cuts off the ends of her hams. “You know,” says the woman, “I once posed this very question to my own grandmother. And do you know what she told me? Her old baking tray was so small that she had to cut off the end of the ham to fit it inside!”
There are many different versions of this parable of the severed ham, but the moral of the story is this: many of today’s rituals—even sacred ones held by uncompromisingly stern authority figures—are just empty repetitions of a utilitarian past. In considering male circumcision, this tale of a needlessly removed hunk of ham doesn’t require a terribly huge stretch of our imaginations to apply. The surgical removing of foreskin from a neonate’s penis is seen by many critics as an outdated, cruel and unnecessary procedure that—although it may once have had some practical purpose in times past—is now done primarily out of blind habit and unquestioning obedience to “because I said so” authority figures. Although male circumcision is rare in Europe except for Jewish and Islamic subpopulations for which the procedure is a core part of religious group identity, about 70 percent of U.S. males—regardless of their religion—are circumcised. It’s embarrassing to admit, but growing up in Middle America, I didn’t even know what a nonmutilated penis looked like until the advent of the Internet. (Then again, I was also 14 before I realized that condoms weren’t, in fact, what old people in Florida lived in.) According to a 2003 report, the only meaningful predictor of whether parents will opt to get their infant son circumcised is whether the father’s own penis is circumcised—there’s a positive correlation, in case you’re wondering. Cut off the end of the ham—er, penis—because that’s what my daddy did and his daddy before him.
But much as I may want to join the cause to save the prepuces, the anti-circumcision stance may not be as humanitarian as it appears. Objection on the grounds that male circumcision is a somewhat bizarre, bloody and frightening ritual was probably very reasonable throughout much of modern history. But this ancient practice, which dates back at least to the Neolithic period, just happens to have important health implications today that are completely unrelated to the hollow rituals of our forebears’ foreskin removal. This strange procedure of lopping off the ends of penises may well have persevered over the eons on the shakiest grounds of justification, grounds that invoked religious, cultural or aesthetic reasons. But, ironically, it may now finally be playing a serious—even heroic—role in staving off a much more crippling problem:
Mounting evidence shows that male circumcision dramatically reduces the risk of HIV infection, at least for heterosexual males.
According to researchers writing in a 2009 issue of AIDS Patient Care and STDs, the prophylactic effect of male circumcision is owed to the following physical facts:
There are high densities of HIV target cells in the inner mucosal surface of the human foreskin … These HIV target cells lie beneath a protective layer of keratin, which is absent on the inner surface of the prepuce. By removing all or part of the foreskin, circumcision reduces both the number and susceptibility of target cells to HIV infection.
Since 2007, several randomized clinical trials have established that male circumcision could lower the risk of HIV acquisition in heterosexual men by as much as 62 percent. Sixty-two percent! So far, these studies have been limited to African populations that have been particularly hard-hit by AIDS-related casualties. In South Africa, a third of reproductive-aged women are infected. If you’re a 15-year-old living in that country today, there’s a 59 percent chance that you’ll die before reaching your 60th birthday; just 10 years ago, these odds were only 29 percent.
Here’s how the clinical trials basically worked. Thousands of adult, HIV-negative, sexually active, uncircumcised men in Kenya, Uganda and South Africa agreed to be randomly assigned to a circumcision group or a no-circumcision group. Those randomly assigned to the circumcision group had their foreskins removed by medical professionals, were told to abstain from intercourse until their wounds healed (about three weeks—there may actually be a greater risk of HIV infection during this period, so this is vital), and then were instructed to return to the clinic at six-month intervals to test for the virus. The results were unequivocal: two years later, the circumcised males were significantly less likely than their uncircumcised peers to have contracted HIV. In fact, the researchers decided to end these clinical trials early for ethical reasons: with data so clearly showing the advantages of circumcision in an environment rife with the virus, it’s hard to justify a further wait-and-see approach for those men that had been randomly assigned to the no-circumcision group.
For the Ugandan study, 22 of 2,387 circumcised men acquired HIV over the two-year period compared to 45 of 2,430 uncircumcised men who were infected during this time span. Extensive interview methods confirmed that the two groups did not differ in terms of their actual sexual behaviors, enabling the authors to conclude that the results were owed directly to the circumcision intervention. (For those data heads among you, P <>