Our friend, Justin B. Terry-Smith, MPH, DrPH, wrote an article for AU magazine, where he detailed his position on male circumcision from his perspective as a “doctor of public health”. He concluded that he “is in favor of circumcision but only because of the medical benefits”. After lots of e-mails and Tweets asking us what the truth is, we decided to take a look at those benefits to see if they outweigh the negatives of male genital mutilation.

To be clear, we found no benefits to being circumcised, no matter what people may think. Every alleged benefit has been debunked by modern science and facts, but we wanted to take a long look at Mr. Terry-Smith’s list of rationales because it contains the most common arguing points of the pro-cut movement. Also, from a gay male health stance, he also mentions the highly controversial issue of male circumcision as a method of HIV prevention.

Note: Mr. Terry-Smith’s points are bulleted, our research/replies follow in bold type.

Positive Effects

  • Circumcision protects heterosexual men, by reducing HIV transmission by sixty percent

We are not going to fight with this bullet point because we are gay males, and nothing regarding straight sex effects us.

  • Circumcision protects homosexual men, by reducing HIV transmission by fourteen percent

We are not sure where this statistic came from because Mr. Terry-Smith does not link or cite any of his resources, but it might be from an article published by AIDSMAP.com, which begins with the sentence:Most of the evidence suggests that circumcision is unlikely to reduce HIV transmission between gay men. This is not unexpected, as more HIV is likely to be acquired rectally than via the penis, but there is little evidence that even ‘tops’ who exclusively practise insertive sex (or claim to) are likely to benefit as a group, though there could be benefit on an individual level

Most importantly, this same article continues with: Overall, the studies reported a non-statistically significant reduction of 14% in HIV infection for circumcised men. A subset of studies that looked at results in 2238 men who only had insertive sex found a 29% reduction in HIV infection among circumcised men, but this difference was also not statistically significant.

(But, we found a few other studies to prove our point)

In Australia, Grulich et al. found no association between circumcision status and infection by insertive unprotected anal intercourse.

Templeton et al. reported no association between circumcision and HIV infection in a cohort study of HIV-negative MSM. A meta-analysis of studies involving more than 53 000 MSM participants showed no overall effect of circumcision on HIV infection.

  • Circumcision has been suggested for older boys and men to treat phimosis (the inability to retract foreskin), balanitis (inflammation), paraphimosis (inability of the foreskin to return to its original location), and/or infections.

Yes, having a tight foreskin could cause some guys discomfort but, it isn’t usually a problem unless it causes symptoms. In young boys phimosis is the foreskin’s natural state and over time, and as he ages, it will release. Immediate treatment is needed only in cases where phimosis causes problems such as difficulty urinating. Most cases of balanitis can be easily managed using a combination of good hygiene, creams or ointments, and avoiding substances that irritate the penis.

Circumcision may be considered if other treatments have failed, but it carries risks such as bleeding and infection. This means it’s usually only recommended as a last resort.

  • Easier hygiene

Two (2) words. Warm, Water. This is most likely the most offensive of all reasons given to remove a male’s foreskin. Basic hygiene, is just that…BASIC. If you can teach your son to brush his teeth, wash behind his ears and wash his hands, you can teach him to gently retract his foreskin and clean under the hood. (soap shouldn’t be used around the genitals, or under the foreskin, as the skin is very sensitive and harsh chemicals can cause irritation.)

Just to be on the safe side, we have a detailed article about Penis Care and Maintenance that gives guidance no matter your level of foreskin expertise or experience.

  • Decreased risk of penile cancer and urinary tract infections

Penile cancer is rare in developed countries, with an incidence of less than 1 in 100 000 and accounts for less than 1% of cancers in men in the United States. The American Cancer Society estimates for penile cancer in the United States for 2018 are: about 2,080 new cases of penile cancer diagnosed. Because “Cancer of the penis is a very rare cancer, it would therefore be very difficult to justify routine circumcision as a preventative method for penile cancer.”

Moreover, the survival rate is very high with about 80% of men as likely to live for at least 5 years after being diagnosed, as men without cancer.

Urinary tract infections (UTI) are usually a condition for young boys, not men. This condition is very treatable but can become an issue if on-going or the symptoms are severe. Most UTIs are mild and do not cause serious damage, so circumcision is usually only recommended when there is a pre-existing risk factor that increases the likelihood of the boy having repeated UTIs., So, even though circumcision reduces the risk of UTI “haemorrhage and infection are the commonest complications of circumcision, occurring at rate of about 2%. Assuming equal utility of benefits and harms, net clinical benefit is likely only in boys at high risk of UTI.”

Negative Effects

Mr. Terry-Smith does include some of the basic negative effects of circumcision, which are pretty severe in our opinion:

• Bleeding, permanent injury, inflammation, and pain.
• Loss of nerve endings and nerve damage
• Keratinization, which is when a circumcision exposes a normally covered part of the skin which can cause glans to become abnormally dried out and thickened
• Premature ejaculation
• Decreased sexual pleasure and lower orgasm intensity

But, he neglected to include these:

Though uncommon, complications of circumcision do represent a significant percentage of cases seen by pediatric urologists. Often they require surgical correction that results in a significant cost to the health care system. Severe complications are quite rare, but death has been reported as a result in some cases.

The Lost Boys

Boys have been lost to circumcision in the United States from the time it was first practiced to the present day, for a variety of reasons, as the following examples illustrate. The first known reported circumcision-related deaths were in New York City, where circumcision was introduced. The first was Julius Katzenstein in 1856 (NewYork Times) and the second was one-week-old Myer Jacob Levy in 1858 (New YorkTimes). Both boys were circumcised by a Dr. Abrahams, and the same coroner re-viewed both deaths. The coroner found that Abrahams had performed the surgeries properly, and that the boys died from blood loss as a result of parental neglect. Neither boy had received a follow-up examination.

Death sometimes occurs following repair of a circumcision complication. DustinEvans, Jr., was circumcised soon after being born in 1998. The surgeon took so much shaft skin that the scar healed as a tight “collar” around his penis, preventing him from urinating. When he was later given an anesthetic in order to repair the damage, he immediately died of cardiopulmonary arrest (Giannetti, 2000). His father lamented, “You think, ‘What could go wrong with a circumcision?’ The next thing I know, he’s dead.”

In a 2004 Vancouver, Canada, incident, one-month-old Ryleigh McWillis was sent home from the hospital immediately following his circumcision. He later bled to death, his disposable diapers absorbing the small amount of blood from his circumcision wound necessary to send him into hypovolemic shock (Newell, 2004).

In 2008, 6-week-old Native American Eric Keefe died from massive blood loss. Hospital officials claimed his circumcision was not to blame, but instead faulted the parents because they had administered over-the-counter pain medication that, they also claimed, thinned his blood. The parents were not told about this possible complication (Verges, 2009). Since then the hospital has stopped per-forming infant circumcisions.

We will never know the true number of boys in the U.S. and around the world that have lost their lives due to circumcision because the causes are never listed, attributed to other complications and/or poor record keeping. But if you would like to see a longer list of those who have died due to this cosmetic procedure, click HERE, and/or you can read more about The Lost Boys of Circumcision.

Bonus issue

  • Mr. Terry-Smith states: “In 2007 the World Health Organization advised heterosexual African males to get circumcisions in order to prevent against the transmission of HIV. Honestly, when I first heard that, it didn’t make any sense to me whatsoever.”

He should have followed his instinct.

Charlotte Shane for Splinter magazine pondered this same question and came up with this logical conclusion.

If circumcision were such a magic bullet for African states, why hadn’t it worked better here at home? I thought. And if it’s so effective, why wasn’t the recommendation that males everywhere be circumcised?The implicit argument seemed to be that it was easier to convince African men to sever a piece of their genitals than it was to convince them to use condoms—either that, or parts of Africa were to be the test region for a prescription not yet applied to the Western world. It had the hallmarks ofcolonial mentality run rampant.

Circumcision is still not regarded as a viable HIV deterrent on any other continent. Even South Africa has rejected circumcision as a way to prevent HIV, and has prohibitions in place on circumcisions performed on boys under 16. Yet circumcision continues to be touted by many American doctors as a “surgical vaccine”—an inflated claim so widely criticized and so breathtakingly irresponsible it’s a wonder it’s still repeated.

So, what does this all mean?

According to Quartz nearly six of ten newborn boys in America are circumcised by the time they leave the hospital. It’s not quite as popular in Europe where The Washington Post reports that fewer than one-fifth of men have had their penis foreskin removed.

In Denmark, the procedure has come into dispute in the past 12 months after a major doctors association stated that it should be a personal choice that a man can make when he is an adult, as reported by the New York Times. In most of Asia, Europe, Central America, and South America, circumcision is less common, with prevalence rates below 20%.

By the time you read this you either have a foreskin, or you don’t. It is very rare for adult males to have this procedure done without some sort of extreme medical reason or personal rationale. No one should be forced into circumcision, even as a baby. If you believe we all have choice over our bodies, what greater decisions could a man make than if a large portion of his penis is cut off and sold for cosmetic supplies or medical testing. The very notion of claiming genital mutilation will stop the spread of HIV is not only offensive but easily debunked by comparing the infection rates in the U.S.A, with those in the E.U. Fear mongering and scare tactics shouldn’t be a reason to get circumcised.

If you are happy with your cut cock, great! If you are pleased to still have your foreskin, good on you! But we need to stop the myths that this isn’t genital mutilation, baby boys don’t feel pain, or that it has some sort of health benefits.

The research and writing of Jessica Wapner, for Mosaic was very instrumental in this article, and she sums up the issue in a clear and concise manner.

“Because the procedure results in the loss of something whose value cannot be quantified: the foreskin, we must be careful in our decision making. If you view the foreskin as disposable, circumcision might be worth it. For those who see the act as the removal of a valuable body part, the reverse is likely true.”

“More than the medical data, it’s these unquantifiable feelings about the foreskin that shape doctors’ thinking about circumcision, or at least that of male doctors. Because when it comes to medical opinions on circumcision, the foreskin status of the opiner matters. A 2010 survey in the Journal of Men’s Health found that close to 70 per cent of circumcised male physicians supported the procedure. An almost identical fraction of uncircumcised physicians were opposed.”

Mr. Terry-Smith writes: “I am cut myself and since I don’t remember being circumcised as a baby I really don’t have a problem with myself being cut.”

We, the entire staff at GMJ, are fully intact, uncircumcised males.

Take it for what it’s worth.