Talk:Circumcision

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Sources about Medical Organizations are False

The vast majority of medical organizations condemn non-therapeutic, male circumcision. You only included a short list of ones that did not, however, the vast majority do after conducting thorough risk-benefit analyses. Please edit this article as it is unfactual. Here is a list of organizations that have come out against circumcision:

• Canadian Paediatric Society
• College of Physicians and Surgeons of Saskatchewan
• College of Physicians and Surgeons of Manitoba
• College of Physicians and Surgeons of British Columbia [pdf]
• Australian Pædiatric Association
• Australian College of Pediatrics
• Australasian Association of Paediatric Surgeons
• Australian College of Paediatrics
• Royal Australasian College of Physicians [pdf]
• Australian Medical Association
• Paediatric Society of New Zealand
• New Zealand Society of Paediatric Surgeons
• Belgium Advisory Committee on Bioethics
• British Medical Association
• General Medical Council (GMC) of the United Kingdom
• British Association of Paediatric Surgeons
• President of the British Association of Paediatric Urologists
• The Royal Dutch Medical Association (KNMG) [pdf]
• The Netherlands Society of General Practitioners
• The Netherlands Society of Youth Healthcare Physicians
• The Netherlands Association of Paediatric Surgeons
• The Netherlands Association of Plastic Surgeons
• The Netherlands Association for Paediatric Medicine
• The Netherlands Urology Association
• The Netherlands Surgeons’ Association
• German Association of Pediatricians
• German Association of Child and Youth Doctors
• Nordic Association of Clinical Sexology [pdf] joint statement issued on behalf of Finnish Association for Sexology, *Norwegian Society for Clinical Sexology, Danish Association for Clinical Sexology, Swedish Association for Sexology, *Icelandic Sexology Association and Estonian Academic Society for Sexology
• Nordic Ombudsmen for Children and Pediatric Experts [pdf] (representing Norway, Sweden, Finland, Denmark, and Greenland)
• Finnish Association of Pediatric Surgeons (Sulamaa Society)
• Finnish Medical Association
• Norwegian Council of Medical Ethics [pdf]
• Norwegian Children’s Ombudsman
• Norwegian Medical Association
• Norwegian Nurses Organization
• Norwegian Nursing Association
• University of Oslo
• Swedish Pediatric Society
• Swedish Children's Ombudsman
• Swedish Society of Medicine (SLS)
• Swedish Society of Health Professionals (Vårdförbundet)
• Swedish Paediatric Society (BLF)
• Swedish Association of Pediatric Surgeons (SLF)
• Danish Medical Association (Lægeforeningen)
• Danish Society of Family Physicians (Dansk Selskab for Almen Medicin)
• Danish Society for Anaesthesiology and Intensive-care Medicine (DASAIM) [pdf]
• South African Medical Association
• Icelandic Medical Association [pdf]

^{— Unsigned, by: 2603:7000:2406:1600:2875:da4e:ba14:3bed / talk}

South Korea

Seems like an anomaly. All I've heard of this is that they bought into it being medically helpful and started doing it after the Koreas split. Chillpilled (talk) 10:08, 11 March 2023 (UTC)

Popular in Japan and Taiwan too. Maybe not popular in Mainland China. I don't know. Spud (talk) 13:16, 11 March 2023 (UTC)

The comparatively recent and unique (for East Asia) popularity of circumcision in South Korea is commonly understood as a product of American military presence during the Korean War. Nope Rocket (talk) 04:34, 15 March 2023 (UTC)

Circumcision causing autism

How would that even happen? Not surprised to learn that study had pushback. Chillpilled (talk) 19:20, 10 December 2023 (UTC)

Inaccurate claims of sexual function/sensation

Actual urologist here. I noticed that over the past year a set of major changes have been implemented by MiracleDinner that variously describe circumcision as "mutilation" and imply that there's a general agreement in the literature that circumcision inherently reduces sexual pleasure. This is far from the case. Prominent philosophers have historically argued that circumcision reduces pleasure. However, the World Health Organization, Canadian Medical Association, and every other policy statement that I found from actual medical organizations directly contradicts this, with the only papers to the contrary being written by writers affilated with anti-circumcision groups. (Milos, Earp, Sorrells, etc.) Here's a good article from Mark Joseph Stern from Slate going into this. Note that Brian Morris is a notorious pro-circumcision research as well. It should be clear that neither of these groups should be republished uncritically on here. The actual consensus among major medical organizations is that consensual adult circumcision in Africa has significant benefits, infant and circumcision in developed nations has debatable (or even questionable) ethics, and that it doesn't really matter in terms of sexual pleasure or function if you are or not. A lot of this page needs to be completely rewritten.

RationalWiki is generally a good site. Hopefully an informative (and funny!) version of this page could be developed soon. DocRyan (talk) 19:05, 8 September 2024 (UTC)

Responding to DocRyan

Dear DocRyan (@DocRyan),

Thank you for your contributions and suggestions about the RationalWiki article on Circumcision over the last month.

I hope you don’t mind me replying here in this new section rather than as a reply to your other section on the talk page, because this has more to do with more than just the adverse sexual effects discussion. I also apologise for my response being fairly belated, as I don't check RationalWiki often these days and composing my response has taken a while.

Many of your comments express concern about content added to the article by myself largely in late 2023 / early 2024. Whilst I appreciate honest and open discussion about this issue and our article, I’d like to take the time to address your concerns:

You Write: “Sources don't claim that *Europeans* (in general) support circumcision bans. At best, they show slight majority support in three countries. At best, they show slight majority support in three countries, so [MiracleDinner] completely misquoted the citations”

My Response: The three sources I cite most definitely do show that a profound majority of people in Denmark, the UK, and Germany - 86%, 62% (+25% “Don’t know”), and 70% respectively - would support a law prohibiting the practise of non-therapeutic circumcision of non-consenting male children. Your statement, therefore, that “At best, they show slight majority support in three countries” is untrue.

On the other hand, you do raise a valid point that the sources I cite are specific to Denmark, the UK, and Germany, so I will edit the article to be more accurate (as your edits have largely been reversed by other users), however I nonetheless feel that it is an exaggeration to claim I “completely misquoted the citations”, especially given the broader context of the original sentence: “In recent years, there have been attempts to ban the practice in some European countries, and despite general public support among Europeans for such bans,[15][16][17] they were ultimately vetoed, in large part due to allegations that the proposed bans would infringe freedom of religion”, as two out of three of the countries that I provide data regarding public support on (Denmark and Germany) are also countries that considered a circumcision ban or in Germany’s case, a Cologne court ruled non-therapeutic non-consensual circumcision an unlawful bodily assault, but which were ultimately vetoed (in Germany’s case, overruled by the Bundestag passing the German Circumcision Act) in large part due to controversies over freedom of religion.

Finally, my pronouns are she/her and I would appreciate it if you could refer to me this way going forward.

You Write: “The claim that circumcision is "illegal" already in any part of the European Union is fringey.”

My Response: This is another thing that may require further clarification. Firstly, “Europe” and “the European Union” are not synonymous, and my own country - the United Kingdom - is one that is part of the former but is no longer part of the latter.

Sticking to the UK for now as an example (I am sure the same could be said of many if not most other European countries, with the exception of Germany where circumcision is explicitly legal both de juro and de facto due to the German Circumcision Act), as that is the country where I live and thus am most familiar with the political and legal system, there does not exist a law which specifically, directly addresses the legality of non-therapeutic non-consensual circumcision of male children (as there exists for the practise of female genital cutting, the Female Genital Mutilation Act 2003). Nor is it the case that people have been known to face consequences such as arrest, prosecution, revocation of medical licences, or being separated from children for performing or authorising the act of non-therapeutic non-consensual male circumcision unless those operations were carried out particularly recklessly and/or was botched.

In other words, the practice could be described as de facto legal in the UK.

On the other hand, the practise involves causing a bodily wound to the body of a non-consenting person which prima facie, is a criminal assault under the Offences Against the Person Act 1861, specifically grievous bodily harm with intent, or if not that then at least assault occasioning bodily harm. To quote Lempert et. al 2022, “Those wishing to circumcise rely on a presumed exception to the law of assault which uniquely allows for circumcision. However, English courts have repeatedly held that religious/cultural motives do not amount to a defence against what would otherwise constitute assault; and both European and English courts have repeatedly affirmed that freedom of religion is a qualified, not an absolute, right; and one that is personal to the individual and to be balanced against the rights and freedoms of others (e.g. the right not to be assaulted).”

Notably, the Cologne ruling in 2012 did not pass any new laws, but simply correctly interpreted that causing bodily injury to the genitals of a non-consenting child without medical indication or necessity is unlawful under existing laws against bodily assault.

According to Lempert et al 2022, “Neither criminal nor civil law has ever ruled directly on the lawfulness of NPC on children per se, but at most have referred to it in passing (so-called “obiter dicta”), and as such its lawfulness remains in question”

In my view it is doubtful that the “surgical exemption” to the offence of wounding would withstand legal scrutiny as regards a non-therapeutic, medically unnecessary, irreversible genital surgery on a child who has not agreed to the surgery, and subsequently, I conclude that the practise is likely de juro illegal, if not due to a specific law as FGM has, then due to general laws against bodily assault (i.e. it is implicitly rather than explicitly de juro illegal).

This is what I was referring to in the text of the article: “isn't explicitly illegal anywhere in the world … although some authors have argued that it may already be implicitly unlawful under existing national and/or international law.”

You Write: “Removed another false statement from a single-purpose account. (MiracleDinner.)”

My response: This comment is attached to an edit where you delete two sentences containing multiple statements, some of which were moral rather than factual statements (e.g. “At RationalWiki we support the right of every child to bodily autonomy and integrity”, which I certainly hope is something that you, DocRyan, believe in.)

My contribution history contains a significant history of making edits that have nothing to do with Circumcision, therefore the assertion that my account is a “single-purpose” one is false. On the other hand, your contribution history is almost entirely about Circumcision.

You Write: “The Canadian Medical Organization states: "There is lack of any convincing evidence that neonatal circumcision will impact sexual function or cause a perceptible change in penile sensation in adulthood [Warning that the article linked to includes uncensored graphic images that some might prefer not to see.]"

My Response: The link you provided takes me to an article from the Canadian Urological Association, yet you seemingly misattributed this article as being from the Canadian Medical Association (unless I’m missing something, in which case please clarify).

I want to establish something I feel is important. The question at hand is, does it pose a significant risk of sexual harm to remove a substantial, richly innervated part of a child’s genitals without medical indication, without medical necessity, and without the child’s agreement? In my view, the claim that no such risk of sexual harm exist is a positive claim and an extraordinary one at that, and should therefore carry the burden of proof.

Taking the CUAJ article’s words literally, “there is a lack of any convincing evidence that neonatal circumcision will impact sexual function” does not equate to “there exists convincing evidence that neonatal circumcision will not impact sexual function”, which unfortunately they don’t particularly seem to acknowledge. It’s worth taking a closer look at their reasoning and the sources the article cites leading up to that conclusion.

The CUAJ article itself notes that there are several difficulties in determining “whether this presumed loss of sensation [from the removal of the innervated tissue of the foreskin] or a possible decrease in glans sensitivity impacts sexual satisfaction in a measurable and consistent way after accounting for several confounders.”, including that “lack of a single objective measure of sensitivity” and that “It is hard to extrapolate results of adult MC studies on sexual function and sensation to neonatal circumcision.”

The CUAJ article cites Kigozi et al (2008), which concerns men who underwent voluntary adult circumcision from the HIV RCT in Uganda, followed up at a maximum of 24 months. It is plausible that the sexual impact of circumcision in adult men who were involuntarily circumcised as newborns may differ from the impact of circumcision on adults who were voluntarily circumcised as adults no more than 24 months ago. As this data is obtained from one of the three RCTs which were heavily flawed and biased, this further casts doubt on the validity of Kigozi et al 2008’s findings. Notably, Godfrey Kigozi himself was one of the co-authors of the deeply flawed 2007 RCT in Rakai, Uganda and moreover is very highly involved with the promotion of VMMC.

It also cites Krieger et al (2008), which is co-authored by J. N. Krieger, an extremely prominently pro-neonatal circumcision author, which you yourself express scepticism about. Krieger is closely associated with Brian J. Morris, and co-authored many studies with Morris, including Morris & Krier (2013), which is rightfully critiqued in the RationalWiki Circumcision. Like Kigozi et al (2008), Krieger et al (2008) has a maximum follow up time of 24 months and exclusively concerns voluntary adult circumcision. It perhaps comes as no surprise then that Krieger et al (2008)’s results are, frankly, suspicious, as they report that over half of circumcised men reported “much more” penile sensitivity and ease of reaching orgasm, and that “rates of any reported sexual dysfunction decreased from 23.6% and 25.9% at baseline to 6.2% and 5.8%” Claiming circumcision doesn’t impact sexual function is one thing, claiming it cuts down (pun intended) the risk of sexual dysfunction by approximately 75% (relative risk) is quite another.

Despite all this, the CUAJ article ranks both Kigozi et al (2008) and Krieger et al (2008) as “Level 1-2” evidence seemingly because they are based on RCTs, which are generally considered a “gold standard” of medical evidence, but that is not so when the RCTs are as problematic as the three HIV trials in Kenya, South Africa, and Uganda.

The CUAJ article does in fact cite multiple studies all showing that a significant risk of sexual harm from circumcision may exist, including Bronselaer et al (2013), Frisch et al (2011), Sorrells et al (2007), but considers them “Level 3-4”. Bizarrely, the CUAJ article cites Kim & Pang (2007) but seemingly fails to acknowledge that this study found that circumcision has generally negative effects as regards ease of masturbation, pleasure of masturbation, and overall sex life.

You also omit that the CUAJ article itself describes the evidence level as “(Level 3–4, Grade C)” when concluding “There is lack of any convincing evidence that neonatal circumcision will impact sexual function or cause a perceptible change in penile sensation in adulthood”

Other critiques of this article I would make include that they mention the AAP’s 2012 statement on circumcision without mentioning that it was significantly flawed and biased and subject to high levels of criticism, nor does the CUAJ article acknowledge that the statement was allowed to expire and was not renewed in 2017, which is one year prior to the article’s publication.

In conclusion, given that the burden of proof lies on the claim that neonatal circumcision does not confer a significant risk of adverse sexual effects, and given that the majority of evidence in favour of this claim which the CUAJ cites appears to be questionable, meanwhile there are several studies, which as far as I can tell are fair besides a potential researcher bias in Frisch’s and Sorrells’ cases, agreeing that a risk of sexual harm may exist, I maintain (for now) that the reasonable assumption is that non-therapeutic circumcision of babies and children may confer a significant risk of sexual harm, although given the multiple hurdles in determining the sexual effects of circumcision, it is certainly very difficult to be sure at this time.

Furthermore, and as is mentioned in the Circumcision article on RationalWiki, there do exist some sexual experiences that involve using the foreskin in unique ways, and I consider it indisputable that circumcision carries the harm of making those experiences impossible, which I do consider to be in itself a significant harm.

You Write: “Claims that circumcised men are mutilated and *always* have reduced sexual function is universally rejected”

You Write: “over the past year a set of major changes have been implemented by MiracleDinner that variously describe circumcision as "mutilation" and imply that there's a general agreement in the literature that circumcision inherently reduces sexual pleasure.”

My response: You make three accusations against my edits to RationalWiki Circumcision article: first, that I wrongly describe circumcised men as “mutilated”, secondly, that I claim circumcised men “always have reduced sexual function”, and thirdly, that I wrongfully imply “there’s a general agreement in the literature that circumcision inherently reduces sexual pleasure”

To address the first accusation, the revision of the Circumcision article as of my latest edit of 27 May 2024, there is no point in the article where the words “mutilation” or “mutilated” are used to describe male circumcision in the article’s own words, with the exception of one instance that was specifically referring to David Reimer’s botched circumcision, and that sentence was not written by myself. For your convenience, here’s a link to that revision: https://rationalwiki.org/w/index.php?title=Circumcision&oldid=2652306

To address the second and third accusations, the article as of the 27 May edit does claim “[circumcision] adversely affects sexual function at the very least insofar as precluding any sexual act inherently requiring the foreskin … there does not appear to be a clear consensus in the medical community on whether or not circumcision markedly reduces overall sexual pleasure. It is a difficult topic to assess, due to the extremely subjective nature of sexual pleasure, and the fact that both uncircumcised and circumcised men usually have nothing to compare to. Obviously however, circumcision renders impossible any sexual act that inherently requires a foreskin.”

Do circumcised men *always* experience the loss of a unique, richly innervated body part and, with it, the loss of the ability to have sexual experiences specific to this body part, yes. Do circumcised men *always* experience a reduction in the sexual function, sensitivity, or pleasure in the rest of their sexual anatomy - that is more contestable.

You Write: “However, the World Health Organization, Canadian Medical Association, and every other policy statement that I found from actual medical organizations directly contradicts this”

My response:

• The World Health Organization (WHO): The WHO Document linked states “there are many myths about male circumcision that circulate. For example, some people think that circumcision can cause impotence (failure of erection) or reduce sexual pleasure. Others think that circumcision will cure impotence. Let me assure you that none of these is true.” It is certainly worth mentioning that the context for this statement is very much not a formal, direct statement from the WHO about the impact of circumcision on sexual pleasure: rather, the context is a comment made in passing within guidance for counselling adult men on voluntary prophylactic circumcision (which may have different potential sexual effects than circumcisions in infancy or childhood). Moreover, and perhaps most importantly, this statement is, as far as I can tell, entirely uncited, so I feel it is rational to be sceptical of this claim when the WHO cannot tell us where it’s getting this information from. Finally, I’m not particularly trusting of the WHO when it comes to circumcision, as the three HIV RCTs by Auvert, Bailey, and Gray that took place in the 2000s are severely biased and flawed in ways that render their conclusions contestable (as is elaborated on in the RationalWiki Circumcision page), yet the WHO uncritically accepts the conclusions of the three trials as fact (as is, for instance, described in preface of the very document you linked to), and to my knowledge they have never acknowledged let alone addressed the criticisms against the three trials.

• The Canadian Paediatric Society (CPS): You mention the “Canadian Medical Association”, yet the statement you linked to is from the Canadian Paediatric Society, so like with the CUA, you are misattributing the statement to the CMA unless I’m missing something (in which case please do clarify). Moving on, the CPS statement linked was, in fact, already cited on the 27 May edit, specifically their statement that the scope of parental authority to consent to medical interventions on behalf of their incapable children is limited to those that are medically “necessary.” Bizarrely, the CPS states “In cases in which medical necessity is not established or a proposed treatment is based on personal preference, interventions should be deferred until the individual concerned is able to make their own choices … With newborn circumcision, medical necessity has not been clearly established.”, yet rather than draw the logical conclusion that newborn circumcision fails the appropriate ethical standard to perform permanent surgical interventions on a non-consenting child, they go on to implicitly conclude that neonatal circumcision is acceptable if the parents request it on the grounds that “there are some health benefits … Therefore, some parents view circumcision as being in their child’s best interest” notwithstanding that having some arguable medical benefits or being viewed by some parents as "in their child’s best interests” are far weaker - and in my opinion, far less appropriate as far as painful, irreversible genital surgeries on infants are concerned - standards than “medical necessity.” Anyhow, you cite the CPS statement in the context of a sentence where you challenge the contention that circumcision reduces sexual pleasure; as far as I can see, the only sentence in the CPS statement regarding this topic is the following: “The foreskin serves to cover the glans penis and has an abundance of sensory nerves, but medical studies do not support circumcision as having a negative impact on sexual function or satisfaction in males or their partners.” As I have mentioned earlier, a lack of evidence does not equal evidence of absence, and I think it is reasonable that the claim that circumcision has no adverse sexual effects should carry the burden of proof, so the CPS statement should not be read as stating that we have conclusive proof that circumcision does not have “negative impact on sexual function or satisfaction.” The CPS cites three sources for this statement: the first and second studies are Kigozi et al (2008) and Krieger et al (2008) which I have criticised earlier. The third study, Kim & Pang (2007), found “Masturbatory pleasure decreased after circumcision in 48% of the respondents, while 8% reported increased pleasure. Masturbatory difficulty increased after circumcision in 63% of the respondents but was easier in 37%. About 6% answered that their sex lives improved, while 20% reported a worse sex life after circumcision”, which outright contradicts the CPS’ claim that “medical studies do not support circumcision as having a negative impact on sexual function or satisfaction.” All three studies concern voluntary adult circumcision.

• Other medical organisations: You claim “every other policy statement that I found from actual medical organizations directly contradicts [that circumcision has adverse sexual impacts]”, despite the fact that the RationalWiki Circumcision article as of the 27 May edit explicitly cites one major medical organisation who state that circumcision can lead to “permanent reduction in sensation in the head of the penis, particularly during sex” in men, namely the British National Health Service (NHS.) There is also for instance, the KNMG’s statement which critiques the contention that circumcision has no adverse sexual effects, a statement endorsed by several other Dutch medical organisations.

'You write: “Here's a good article from Mark Joseph Stern from Slate going into this.”

My response: I find Stern’s article problematic in many ways. Overall, Stern clearly writes from a very pro-RIC point of view, which appears inconsistent with even your own views, especially when you state “There is significant debate about whether routine prophylactic circumcision in developed nations is justified. (My view: I don't think it is.)”

• Stern promotes the Centre for Disease Control and Prevention (CDC) as a reliable source of information on circumcision. The CDC have endorsed and agreed with the American Academy of Pediatrics Task Force on Circumcision 2012 policy statement
  • The AAP 2012 statement was severely flawed and biased and has been subject to great levels of criticism, and is out of line with the recommendations of most other major medical organisations. For example, the AAP considered the “risks” of circumcision only in terms of the risk of unforeseen surgical complications, rather than the inherent harm of removing a unique part of the body which has value to many men.
  • In 2017, the policy was allowed to expire and was not renewed.
  • One member of the task force, Dr Andrew Freedman, has admitted to circumcising his own son on his parents’ kitchen table for “religious, not medical” reasons.
  • The CDC have not to my knowledge acknowledged or responded to these criticisms or to the expiration of the 2012 policy statement.
  • Brian D. Earp also writes an excellent, and as far as I can tell, sound critique of the CDC’s proposed guidelines.
• Stern’s article focuses in large part on selectively mentioning the behaviour of “intactivists” to portray the movement as a “fringe group … dismissing science, slamming reason, and tossing splenetic accusations at anyone who dares question their conspiracy theory.” Whilst I agree that the intactivist movement sometimes engages in behaviours that I frown upon to say the least, I do not see this as a reason to dismiss the entirety of genital integrity activism as irrational, hateful, or violent, especially as many prominent opponents of circumcision such as Brian D. Earp are far more civil and reasonable. You cannot dismiss an entire movement just by cherry-picking the worst behaviours of extremists.
• Stern’s article describes the comparison of male circumcision and female genital mutilation/cutting (FGM/C) as “an utter falsity that is demeaning to victims of FGM” whilst citing a 2011 The Guardian article by Adam Wagner which, like Stern’s article, outright condones the practise of non-therapeutic infant circumcision in developed, low-risk populations (namely the UK, where Wagner lives).
  • Wagner’s article argues that the comparison is a falsity in part because male circumcision is seen as a religious obligation by some religious groups, notwithstanding that the same is true of FGM/C in some groups.
  • As stated previously, I think it is very much reasonable that the burden of proof should be carried by the claim that removing a substantial part of a non-consenting child’s genitalia without medical indication carries no significant risk of harm, yet Wagner bizarrely declares the opposite; and he completely ignores the multiple empirical studies which do find that male circumcision may confer significant harm, such as Kim & Pang (2007), as well as disregarding the scientific evidence finding circumcision is very painful that was cited in Howard and Steinfeld’s article to which Wagner’s article is a reply.
  • Wagner attempts to refute the claim that male circumcision is harmful by citing the WHO’s findings that “a very low rate of adverse events, which are usually minor”, which seemingly addresses only the potential unforeseen surgical complications rather than inherent harms of removing part of a child’s genitals (including the serious pain), a similar error to the AAP’s 2012 report.
  • Wagner’s strongest argument in favour of a moral separation between male and female genital cutting is that (according to the WHO) the former is “effectively recommend[ed] … in order to prevent HIV infection” whilst the latter “has no known health benefits.” (we don’t have conclusive evidence that I’m aware of that FGM/C has zero health benefits at all, but my vehement categorical condemnation of it would be no different if it did) However, the WHO’s recommendation of male circumcision is limited to prophylactic circumcision in areas such as Kenya and Uganda; and does not extend to populations such as the UK, where the potential prophylactic benefits of male circumcision are far less compelling, and thus less likely to justify a stark and categorical moral separation between the ethical and legal treatment of male and female genital cutting practises.
  • Wagner quotes the WHO as saying “When male circumcision is performed by well-trained, equipped and experienced healthcare personnel, "complications are minor and rare"”, notwithstanding that a substantial number of circumcisions of non-consenting male children, including in the UK, take place outside these circumstances.
  • As is explained in the RationalWiki Circumcision article, FGM/C is typically the more severe practise compared to medically unnecessary male circumcision, but there exists a significant overlap between the two in terms of “age, surgical conditions, severity of harm, or reasons for the practice.” Some forms of FGM/C are actually less invasive than male circumcision, which Stern and Wagner appear to overlook.
• Stern cites three studies attempting to refute the claim that “That circumcision seriously reduces penis sensitivity and thus sexual pleasure”.
  • Two of these studies are the same as those cited by the CPS and the CUA (Kigozi et al 2008, Krieger et al 2008), so see above for my responses to those.
  • The third, Payne et al (2007), concludes “These results do not support the hypothesized penile sensory differences associated with circumcision. However, group differences in penile temperature and sexual response were found.” (which I see as a far cry from the claim that circumcision has no potentially negative sexual impacts at all) It has a low sample size (20 participants for each group), and is directly contradicted by other studies such as Sorrells et al (2007), and Bossio et al (2016).
• Stern also uncritically cites the 2013 “meta-analysis” by Morris & Krieger, which is rightfully critiqued in the RationalWiki Circumcision article.
• Stern unironically compares intactivists to anti-vaxxers.
• Stern’s article completely ignores the bodily autonomy issue and the fact that the procedure is very painful for babies and children. The sole argument against circumcision that he even attempts to actually refute is the claim that it negatively impacts sexual sensitivity/function/pleasure.
• Stern’s article implies he believes circumcision is “medically necessary” (by critiquing the view of intactivists that it is “medically unnecessary”). To the end of justifying this, he merely goes on to state the usual list of purported prophylactic health benefits of non-therapeutic circumcision, notwithstanding that “having some potential health benefits” is a very different and much weaker standard than being “medically necessary.”
  • The very article he cites for the reduction in UTIs claim admits that it would take 111 circumcisions in healthy boys to prevent a single UTI.
  • He claims that “circumcised men are far less likely to contract genital warts” but this is an outright misquote - the study he cites only found that HPV - which causes genital warts - was reduced in female partners of circumcised men, and it is far more ethically problematic to justify a non-therapeutic, painful, irreversible genital surgery on an infant boy because it might one day benefit someone else rather than himself (and which may never come to be should he grow up to be LGBT, sexually abstinent, or in a monogamous relationship where both partners are HPV-negative, and which is nearly obsoleted by the HPV vaccine in populations with access to that vaccine). And even that result is contestable as it is contradicted by some other studies, such as those currently cited in RationalWiki’s article.
  • Stern uncritically cites the findings of the three African HIV RCTs as fact notwithstanding that they were severely biased and flawed. He also implicitly extrapolates this conclusion - from voluntary adult circumcision in high-risk areas such as Uganda and Kenya - to involuntary infant circumcision in low-risk areas such as the United States and fails to mention that the NNT in the United States would be remarkably high.
• For further reading, I recommend Brian D. Earp’s open letter replying to Stern

You write: “Note that Brian Morris is a notorious pro-circumcision research as well. It should be clear that neither of these groups [pro-circumcision authors and anti-circumcision authors] should be republished uncritically on here.”

My response: I’m not opposed to adding notes to this article (with citations) that some of the authors of the “anti-circumcision” studies are prominent advocates against the practise, albeit I do not see this as a reason to dismiss such studies entirely unless, like with the three African HIV RCTs and with Morris & Krieger (2013), there are identifiable methodological concerns in addition to potential researcher bias.

You write: “The actual consensus among major medical organizations is that consensual adult circumcision in Africa has significant benefits… [but that] infant and circumcision [sic] in developed nations has debatable (or even questionable) ethics, and that it doesn't really matter in terms of sexual pleasure or function if you are or not.”

My response: I welcome that we may add to the RationalWiki Circumcision article that major medical organisations have this stance, although if such medical organisations are uncritically relying on the three African HIV RCTs, that is something that should be mentioned since the flaws and bias with those RCTs cast doubt on the validity of their conclusions. It should also be mentioned that the potential protective effect of male circumcision against HIV/AIDS may not be able to be extrapolated to other populations such as the United States, and even if it could, it may take hundreds or even thousands of circumcisions to prevent a single HIV/AIDS infection, a fact even Freedman admits.

Relatively few major medical organisations hold a stance akin to the AAP’s 2012 statement, none outright recommend non-therapeutic infant circumcision in developed nations, and many, such as the KNMG, explicitly condemn it, so I feel you’re making a bit of an understatement there.

Besides the WHO’s apparently uncited advice that voluntary adult circumcision does not “reduce sexual pleasure”, I have not found in my experience that a “consensus” of major medical organisations conclusively and positively affirm that circumcision has no effect on sexual pleasure and function. If you wish I will try to gather a list of citations.

You write: “Removed Eurocentricism. Only Americans and Jews circumcise at birth. A majority are African tribal/prophylactic or Islamic religious. Both types happen during adolescence. This is written from a very American point of view.”

My response: This edit summary is attached to an edit where you delete large parts of the intro paragraph.

I’m genuinely not sure how you think the intro paragraph as of the 27 May revision was “written from a very American point of view” given that it was more or less entirely by myself - a British user - and gave two citations, both of which were major British organisations, namely the NHS and the Metropolitan police. I’m also confused as to how, simultaneously to this claim, you accuse the 27 May intro of “Eurocentrism” but you do not clarify which statements in the intro you consider Eurocentric and why.

Additionally, your statement “Only Americans and Jews circumcise at birth” is demonstrably false, as if nothing else, a significant number of Muslim boys are circumcised in early infancy.

Furthermore, your statement that “A majority [of circumcisions] … happen during adolescence” flat out does not contradict the text you deleted from RationalWiki’s article, which had stated that “Circumcision can be performed at any age, although it is often performed on babies and children.” The word “often” rather than “usually” is used, and “children” can describe young people up to and including early adolescence (in the more common usage/developmental sense of the word) or even up to the age of majority (in the strict legal sense).

You write: “Another edit from MiracleDinner that is misleading. Religious circumcision is illegal nowhere in the world. (De facto.) Added actually funny quote from Rabbi Tuckman from Robin Hood: Men in Tights. (This article is missing humor.)”

My response: This edit summary is attached to an edit where you do not delete or alter any of the text of the article written by myself, making it difficult for me to ascertain which of my statements you are accusing of being “misleading”.

Your claim that religious circumcision is de facto legal in all places in the world (i.e. it is not enforced as a civil or criminal offence in practise, regardless of whether it may technically violate the law itself) is one I agree with, and also not one that was contradicted by the 27 May revision of the article, as the claim that “some authors have argued that it may already be implicitly unlawful under existing national and/or international law” was intended to refer to de juro illegality (if you feel that this was not clear enough, I am happy to edit this to make it clearer.)

You write: “Another misquote/questionable claim.”

My response: This edit summary is attached to an edit where you delete two entire paragraphs from the article’s prelude, and your edit summary states that you removed “another misquote/questionable claim” in the singular notwithstanding that your edit actually removed several claims and you do not specify which one you consider “questionable”.

You write: “The United Kingdom does not have a constitution in the same way that most countries do. (It is unwritten.)”

My response: The 27 May revision of the article never stated that the UK has a constitution, so this is a strawman.

You write: “It's also important to separate legitmate and logical criticism of circumcision v. Men's Rights Activism/antisemitic dogwhistling criticism.”

My response: Yes, as a queer feminist and an opponent of Antisemitism, the fact that opposition to medically unnecessary genital surgeries on non-consenting children (a position which, if anything, I consider aligned with my progressive feminism and support for LGBTQ+ rights) has been latched onto by a number of Antisemites, MRAs, and more generally nasty people on the right (such as Hans Kristian Graebener) is something I find deeply concerning and problematic, and I am not at all opposed to calling this out in our RationalWiki article.

Once again, however, I’d like to stress that (as you thankfully seem to recognise) this should not be a reason to entirely dismiss the viewpoint that genital integrity is a universal and absolute human right, especially as it is one held by many more reasonable people such as (in my experience) most feminists, the majority of the LGBTQ+ community (trans women in particular), as well as a non-trivial amount of Jewish people, including Abraham Geiger, the 19th century founding father of progressive Judaism.

You write: “the claims on the circumcision article are not in line with those of professional medical organizations, and are almost always entirely from heavily biased sources such as Morris (pro-circ) and Milos (anti-circ)”

My response: “Professional medical organisations” can indeed be “heavily biased”, and they are not nearly unanimous regarding their positions on circumcision, so I believe that their statements, too, should not be accepted uncritically. You have a valid point that many of the sources I’ve cited may indeed potentially suffer from researcher bias, however in the absence of methodological flaws I really don’t think that should be a reason to dismiss them. I’d also question your assertion that the citations are “almost always entirely from heavily biased sources” as, for example, I don’t see particular evidence that Bronselaer et al (2013) or Dave et. al (2003) are “heavily biased sources.”

Take for example that the British Medical Association (BMA) published guidance on non-therapeutic penile circumcision (NPC) in 2019 which would later be scrutinised in Lempert et al (2022). Having read both the BMA’s guidance and Lempert et al.’s paper, I find that BMA guidance is indeed severely flawed and that Lempert et. al raise excellent points of criticism grounded in sound reasoning and facts. But seemingly according to your logic, the BMA’s 2019 problematic guidance would hold more weight as they are a “major medical association”, whilst Lempert et al’s 2022 reasonable critique would be largely dismissed as “heavily biased” since all four of its authors - Antony Lempert, Rebecca Steinfeld, Brian D. Earp, and James Chegwidden - are prominently pro-genital integrity authors and/or activists, and at least three of them - Lempert, Earp and Chegwidden - have written or spoken for the National Secular Society (NSS), a British organization which prominently opposes medically unnecessary circumcision of children.

You write: “However, the article then proceeds to claim that consensual adult circumcision in Sub-Saharan Africa has little to no-evidence supporting it”

My response: This is not entirely an accurate description of what the 27 May revision of the article says. The 27 May revision describes: “Circumcision is sometimes promoted as a way of reducing HIV transmission, especially in endemic regions. This claim comes chiefly from three randomized control trials (RCTs) in countries in Africa (specifically, Uganda, Kenya, and South Africa) where HIV is endemic, which found that "Voluntary Medical Male Circumcision" (VMMC) reduces relative risk of female-to-male HIV transmission by approximately 60%” before proceeding to offer various critiques of these three RCTs, ultimately concluding “We conclude that the claim that circumcision reduces female-to-male HIV transmission risk by about 60% is very possibly untrue or exaggerated.”

More clarity in this section would be welcome to also discuss the challenges in extrapolating data from Uganda, Kenya, and South Africa to developed countries with low baseline HIV prevalence such as the UK, and in extrapolating between voluntary adult and involuntary infancy or childhood circumcision.

In short, the 27 May revision doesn’t claim the evidence straight up doesn’t exist, rather it draws attention to the fact that the main evidence base cited by organisations like the WHO to support VMMC programs in Africa has been subject to credible criticisms, accusing them of significant flaws or biases which may make their conclusions debatable.

You write: “It treats these four types of circumcision completely similarly:

• Non-religious, English-speaking prophylactic circumcision in developed nations. (United States, Australia, Canada, New Zealand.)
• Religious circumcision (Judaism and Islam)
• Infant circumcision in Sub-Saharian Africa. (HIV/AIDS)
• Adult and teenage circumcision in Sub-Saharian Africa. (HIV/AIDS)”

My response: This is a false allegation. The article as of the 27 May revision absolutely does contain discussion of the morally meaningful differences between these four scenarios.

The 27 May revision contains discussion of the background of circumcision within the Abrahamic religions, which I significantly expanded on since late 2023. It also contains a section (“Freedom of religion”) addressing the argument that non-therapeutic circumcision of non-consenting male infants and children should be allowed because parents of some religious backgrounds may perceive it to be a religious obligation, and that because they have the right to Freedom of Religion (for example, as Wagner argues, is declared in the ECHR), the practise must be allowed. However, the article (rightfully) concludes that the right of the child to their own body is absolute and cannot be overridden by the qualified right of an adult to manifest their religion in practise. I would welcome expanding this section to make it very clear that Antisemitism, Islamophobia, etc. are unacceptable and that the issue must be handled with sensitivity, even if, at the end of the day, religion can never be a sound ethical or legal justification to perform medically unnecessary, painful, and irreversible modifications of a non-consenting person’s body. Therefore, the allegation that religious and secular circumcisions are “completely” conflated is false.

The latest edit I made to the Circumcision article before you came along was one in which I added the following to the prelude: “especially for those living in developed countries”, and in my edit summary, I wrote “My view has slightly changed recently in that I realise the benefits might be more compelling for those in developing countries without access to medicine/hygiene.” Furthermore, there is also one point in the HIV/AIDS section where it is commented that the Number Needed to Treat (NNT) is significantly higher in “outside of endemic” regions compared to “endemic” regions - for example, the United States vs Kenya. So, to claim that the article as of 27 May “completely” conflates circumcision as a prophylactic health measure in developed and developing countries is false. On the other hand, I would welcome further edits to the article in order to expand on the distinction between circumcision as a prophylactic health measure between developing and developed countries, especially as, I will admit, many of the things I wrote prior to that final edit were indeed primarily through the lens of someone living in a developed / non-endemic region, specifically the UK.

Finally, the 27 May article’s discussion of the ethics of circumcision heavily involves the issue of consent. The article’s explicit impermissive stance on “medically unnecessary” circumcisions of children is very much because of their inability to consent. The “bodily autonomy and integrity” section offers an argument against the practise specifically because infants and young children cannot consent. I do not take moral issue with circumcision of validly consenting adults (or Gillick-competent teenagers). Therefore, your allegation that “adult and teenage circumcision” who consent is treated “completely similarly” to circumcision of babies and young children who cannot possibly consent couldn’t be further from the truth.

You write: “Without any context or explanation. I think many of the editors here are simply associating circumcision with Islam, Judaism, and the United States, without any knowledge of where the literature is at.”

My response: Speaking at least for myself, this allegation is false. I am very aware of circumcision outside of these three groups.

You write: “Brian Morris, Marilyn Milos, Morris Sorrells, and others are pro/anti-circumcision activists, and their conclusions heavily contradict those of major medical organizations. We should be turning to major medical associations to build the article. Not cherry-picked studies from activists.”

My response: You appear to have a particularly - and in my opinion, undeservedly - trusting view of the word of “major medical organisations.” Given that this point is effectively already covered in many of my previous replies, I’ll try not to repeat myself too much.

Medical organisations are very much not free from bias or from flawed studies, logic, and ethics - the AAP and CDC in particular being particularly bad offenders - so when there are sound evidence- and logic- based reasons to be sceptical of the conclusions of major medical organisations, including when the WHO states that circumcision doesn’t “reduce sexual pleasure” whilst seemingly citing zero evidence despite that they ought to carry the burden of proof there - we at RationalWiki have every right to be sceptical.

Particularly worth noting is that many of the medical organisations do, in fact, cite studies that were clearly influenced by bias, such as the CUA citing Krieger’s studies. We simply cannot dismiss all of the studies authored by Sorrells, Kim, Van Howe, Lempert, etc. just because of potential researcher/author bias yet uncritically cite the word of medical organisations who, if not strongly biased themselves (as was the AAP Task Force in 2012 for example), are directly uncritically relying on studies with evident, strong researcher/author bias.

Moreover, who do you expect to author and publish studies uncovering the harms of circumcision, if not people who take a stance that circumcision is harmful?

You write: “There's no good evidence that circumcision increases (Morris) or reduces (Milos) pleasure.”

My response: I don’t agree with entirely dismissing Milos’ study (of which there is only one cited in the article, and Milos was only one of several authors) just because Milos openly takes a strong negative stance towards the ethics of medically unnecessary non-consensual circumcision. I do agree with dismissing Morris’ 2013 “meta-analysis”, but that is not solely because Morris openly takes a strong positive stance towards the same issue, but because, in addition to his evident and profound researcher bias, the meta-analysis itself is deeply flawed.

Conclusion: I welcome the open discussion here, and I agree that there are some ways in which the article could be improved going forward, such as having more humour, a clearer distinction between prophylactic circumcision in developed and developing countries, and a clear condemnation of those who latch onto the issue in order to promote Antisemitism or Islamophobia. However, I maintain that the ethical standard to perform painful and irreversible genital modifications on a non-consenting child should be medical necessity, and the burden of proof ought to lie on the claim that the procedure is medically necessary.

Best wishes, MiracleDinner (talk) 14:29, 8 October 2024 (UTC)

Holy shit, this comment is 50k bytes. Like bro, just write an article. Chef Moosolini’s Ristorante Italiano^{Try our pumpkin spice lasagna!} 18:48, 8 October 2024 (UTC)