10 Reasons not to circumcise?

Melanie Lindwall Schaab, RN, MS, FNP-C

August 20, 2022

Intact America promoted a list of "10 reasons not to circumcise baby boys." [1][2] Certified nurse-practitioner Melanie Lindwall Schaab responded to these reasons. Reprinted by permission.

1. Because there is no medical reason for 'routine' circumcision of baby boys.

They're actually quoting the pro-circumcision American Academy of Pediatrics here. "Routine" in medical lingo means done without seeking specific consent because the intervention or treatment is covered by the basic Consent for Care form you sign when you are admitted to the hospital. For example, taking your blood pressure every four hours, starting an IV or drawing blood, etc. You don't have to sign a separate consent form for these things.

But you do have to sign a separate consent form for surgery. Circumcision is a surgery, so it can't be treated as an opt-out routine procedure; it has to be treated as opt-in and you have to sign a consent form specifically for the circumcision. This is not a reason against circumcision. It's a reason for health professionals to have the parents sign a specific consent form.

2. Because foreskin is not a defect.

An immune system unaltered by vaccines isn't a birth defect. That fact by itself doesn't make vaccines bad. Breasts, appendixes, wisdom teeth, and tonsils are not birth defects. That doesn't change the fact that complications can occur with those organs. The difference with foreskin is that the benefits of removing it outweigh the risks by a lot in the newborn period and by slightly less later in life. The other organs are generally only removed after they cause problems because the risks of those surgeries are much higher and the benefits much lower.

3. Because you wouldn't circumcise your baby girl.

I also wouldn't do a pap test or mammogram on a man or a prostate or testicular exam on a woman. That isn't because I'm sexist. It's because a man doesn't have a cervix or breasts large enough for a mammogram and a woman doesn't have a prostate or testicles. Similarly, a baby girl doesn't have a foreskin; she has a clitoral hood, and research shows the removal of the clitoral hood has no medical benefits.

4. Because your baby does not want to be circumcised.

How would you know? Did you ask him?

If you're making that judgment on the basis of whether he fusses or cries, and you are philosophically consistent and not a hypocrite, then you would have to avoid doing anything the child doesn't like (everything with which he fusses or cries). For example, no kid likes getting vaccines, but parents who choose it do so because they've decided the benefits outweigh the risks. No baby likes getting the vitamin K shot, and the oral vitamin K tastes bad, so they don't like the oral vitamin K either. When my child had chronic constipation, she didn't like taking the supplements that helped her poop. When she was constipated in spite of the supplements, she really didn't like getting an enema. When another one of my kids had an ear infection, she didn't like taking her antibiotics. My oldest child hated diaper changes. She'd scream bloody murder. Another of my kids hated being undressed and dressed as a baby.

So I guess I should never have dressed or undressed my baby or changed her diaper? I should never have given supplements, enemas, and antibiotics to my kids? No one should ever vaccinate or give any form of vitamin K, not because research says it's bad, but purely because my kid cries when it's given? “Your baby doesn't want X" is generally not a good enough reason not to give or do X to your baby.

5. Because removing part of a baby's penis is painful, risky, and harmful

Circumcision doesn't remove part of the penis any more than removing a mole on your arm constitutes removing "part of your arm." Circumcision removes a piece of skin on the penis, not part of the penis. This is not mere semantics. The difference is actually very important because the benefits of circumcision vastly outweigh the risks, but there are only exceptionally rare cases where the benefits of removing part of the actual penis is net beneficial. It's like the difference between removing the appendix, which hangs on the large intestine, vs. removing part of the large intestine.

Lots of things are painful and risky, but we do them anyway because we believe the benefits outweigh the risks -- including vitamin K, vaccines, blood draws, etc. In the case of circumcision, the science is very, very clear that the benefits outweigh the risks. "X has risks" is not a good enough excuse. Everything has risks. But "The risks of X outweigh the benefits" IS a valid reason. The risks of keeping the foreskin outweigh the benefits of keeping the foreskin, so it's perfectly valid to choose NOT to keep the foreskin.

6. Because times and attitudes have changed

Times and attitudes have changed about a lot of things, but that didn't make those things either good or bad. Depending on how it's phrased, it's a bandwagon fallacy or appeal to popularity fallacy to claim that something is good or bad just because it's popular or becoming popular or believed and practiced by the majority.

For example, clitoridectomies (removing a woman's clitoris) became popular for the treatment of mental illness in the U.S. in the late 1800s. The fact that it was popular didn't make it good. It became unpopular in the early 1900s. The fact that it became unpopular didn't make it bad. It was bad because it's harmful, not because it was unpopular.

Besides that, over 70% of boys born in the U.S. are circumcised today, and the incidence is rising in states where Medicaid has reinstated coverage. In other words, among the general population, the popularity of circumcision hasn't changed significantly. Furthermore, the AAP was opposed to newborn circumcision in the 1970's, but has since then become pro-circumcision because of growing scientific evidence of the medical benefits. So if you're going to argue that circumcision should be done or should not be done on the basis of local popularity or changing opinions, then you should support circumcision in the U.S.

7. Because most medically advanced nations don't circumcise baby boys.

Again, just because something is popular or unpopular doesn't make it good or bad. While America is accused of cultural bias, other countries that don't circumcise are also accused of cultural bias. Furthermore, some research from countries with low or very low circumcision rates suggests that they need to circumcise more. For example, a 2007 British study was tellingly titled, "Are We Circumcising Enough?" (The answer was no, we need to circumcise more.)

8. Because caring for and cleaning the foreskin is easy

Let's take this at face value and pretend it's 100% true. The fact remains that a boy or man on average is much better off without his foreskin. For example, a pair of studies by British researchers O'Farrell and Egert found that uncircumcised men were more likely to thoroughly clean their penises, but circumcised men nevertheless still had better penile hygiene and fewer infections. In other words, it doesn't matter how well you clean your (or your baby's) uncircumcised penis; it may average worse hygiene and more infections than a circumcised penis.

9. Because circumcision does not prevent HIV or other diseases.

This is just false. For instance, of 24 studies and 5 meta-analyses on circumcision and UTI, ALL 24 studies and ALL 5 meta-analyses (including those by anti-circumcision researchers) found that infant circumcision drastically reduces the UTI rate. To claim that circumcision has no benefits, intactivists have to completely ignore 100% of the research on the subject of circumcision and UTI. They can't even point to a rare outlier study and pretend it's reliable, ignoring the others, because there isn't an outlier study that supports their opinion. They literally have to ignore all the science on the issue and just lie about it.

On the issue of HIV, I've collected over 130 studies and 25 meta-analyses. The vast majority of the studies (including many by anti-circumcision researchers) and all of the meta-analyses (including one by anti-circumcision researcher Van Howe) admit that circumcision reduces the risk of HIV. So intactivists have to ignore a TON of research in order to claim that circumcision doesn't reduce HIV, and they usually point to one of the four studies (again, out of over 130) that suggested an increased risk. In order to turn the tide, they'd have to come up with something like 90 studies and 25 meta-analyses showing the opposite to be true (i.e., increased risk). Frankly, I find it very unlikely that such will ever happen. Furthermore, we now have real-life evidence in countries where circumcision was implemented showing that the use of condoms and sex education made no difference (actually, a rising HIV rate) for several decades, but once circumcision was introduced, the HIV rate started to drop.

10. Because children should be protected from permanent body alteration inflicted on them without their consent in the name of culture, religion, profit, or parental preference.

It's bad because it's done for culture, religion, parental preference, or profit? The majority of parents cite medical reasons, including those who are religious, so that one blows this out of the water. But let's pretend no parent has ever once considered the medical indications. Let's pretend it's all about culture, religion, parental preference, or profit.

Riddle me this... If I don't want to vaccinate my child, but I do it because of culture - specifically, my state won't let my kid go to school without the vaccine(s) in question (e.g., California, Mississippi, West Virginia) - does that fact by itself (the fact that I got it for my kid purely for cultural reasons) make the vaccine bad? Or is it possible for a parent to make a "good" decision for the "wrong" reason?

Note that there are cultures and one religion (Sikhism) where circumcision is frowned upon; that some parents will literally put their son at risk of death to avoid circumcision for cultural and cosmetic reasons (as demonstrated, for example, in the 2016 study of foreskin morbidity in Denmark by Sneppen and Thørup); and that the medical and pharmaceutical establishments make more money off uncircumcised boys.

So by the same token, you could argue that it's unethical to deprive a boy of a beneficial and potentially life-saving gift purely because of culture, religion, parental preference, or profit.

[1] Apparently this meme appeared as a file on the Intact America website. The file link is broken as of August 2022. The 10 Reasons list is posted on another anti-circumcision website. The Intact America website includes a photo of a banner with a similar version of the "10 Reasons" list, apparently directed at physicians attending a medical conference.

[2] Copyright disclaimer under Section 107 of the Copyright Act of 1976, allowance is made for "fair use" for purposes such as criticism, comment, news reporting, teaching, scholarship, education, and research.