A short digression on genital mutilation.

[Whilst the content of this post may seem weird and perhaps crude to some, understand it came as a perfectly natural progression from my studies (which have been almost exclusively on sexual health) so far at medical school.]

If circumcision had not been taught to us as a perfectly reasonable cultural concept in school would we think of it now as something stranger? I mean, it IS the removal of a part of the body - by definition, mutilation. The questions are; is this right? Moral? Helpful? Safe? Essential in cultural appreciation?

Jews and some Islamic and Christian branches participate in removal of the foreskin very near birth (because man was made in God's image... but not that bit; as Hitchen's pointed out whenever the subject was raised) for religious reasons. But are there any inadvertent benefits that result from it?

The short answer is yes:

Circumcision is seen as a significant preventative treatment in the transmission of AIDS. The main pathway is expected to be the removal of groups of Langerhans cells in the foreskin. These cells are localised CD4 cells and are one of the key target sites for HIV infection. The removal of these therefore reduces the chances that the HIV gets a hold in the affected. There are voluntary circumcision programs all across high prevalence areas (where heterosexual spread is the most common; Botswana (24% rate),  Lesotho (23%), Namibia (15%) where positive results have been consistently seen, with up to 60% effectiveness in reduction of transmission rates.
Another benefit is the ease in cleaning under the foreskin, around the corona without foreskin. Whilst infection due to lack of cleaning is uncommon, it is still an issue. Accumulation of smegma under the glands penis can eventually lead to balanitis (inflammation of the corona and hence pain and often infection). Phimosis (inability to retract foreskin) is often the result of balanitis and general miscare of one's penis. This condition in cases has been seen to directly be linked to penile carcinoma and urinary retention. The point is that with proper care there isn't an issue. Yet there will always be some who aren't informed about about washing under the foreskin and in these cases, say hypothetically if all men were circumcised, this would be reduced.

Along with the possible benefits that no foreskin gives there are always downsides. The most prominent one is the fact that this procedure is minor surgery, and like any surgery carries potential infection and side effects. Nomiya churches in Kenya for example, or Islamic communities in Turkmenistan often do not perform this surgery under sterile conditions; the result, infection. There are still cases each year in the most developed countries of infection or excessive bleeding (as the very young boy had undiscovered hemophilia). Cases of some practices by ultra-orthodox groups have led to the death of children (2 this year) after they contracted herpes from the oral-sucking circumcision performing Rabi. (Seriously.)
Another negative point (in my opinion anyway) is that the sensitivity of the penis is reduced and therefore sexual enjoyment too. The head of the penis is highly innervated by nerves with the most concentrated parts being the glands and corona. Removal of the foreskin exposes these areas which build up a thicker layer of skin in an attempt to protect it. The constant stimulation of these areas reduces the nervous intensity and leads to a subconscious hedonistic adaptation to the individual - overall reducing the sexual enjoyment of the individual. I personally think this is wrong - the foreskin is an evolutionary adaptation to stop the desensitisation, and make sex more likely and removal of it seems like a move to semi-castrate a person, reducing their sexual experiences, this, in my opinion, without consent is completely unjust.


The argument in this debate is that should genital mutilation be a choice made by a competent adult or be allowed to be the choice of the parent? I would argue that the benefits to the child (in a developed society with low HIV rates etc.) are not enough to justify mutilation. If a culture wants circumcision then it should allow a choice for the child themselves, where they are informed of the pros (getting into heaven??) and the negatives.


A few of the links to extra reading stuff:
http://www.who.int/hiv/topics/malecircumcision/en/
http://en.wikipedia.org/wiki/Circumcision
http://abcnews.go.com/blogs/health/2012/09/13/nyc-approves-ritual-circumcision-consent-form/