Thursday, September 27, 2007

Mask of Silence and an Unspeakable

Everything that I keep to myself - personal thoughts, opinions, beliefs - is hidden under my Mask of Silence. Despite being more open to some people close to me, there are still many things that remain under this mask. The extent of the things under this mask is diverse and wide-reaching, from politics, to medicine, to ethics, to controversies, etc.

But it's ironic that I would feel so much more comfortable writing about things hidden under my Mask of Silence on this blog, but perhaps that luxury is afforded through my Mask of Anonymity. I feel one can learn so much about a person by how and what he/she writes. Pay attention to grammar, word choice, format, context, and you are essentially looking into part of a person's soul. So before I forget (and this has already been a draft for days now), I will write about a topic that came up 2-3 times in conversations (very briefly each time) that is an "Unspeakable" to me: (male) circumcision.
Why do I consider this an Unspeakable? One, because I have a physical aversion to talking about it for extended periods of time. After I cross a certain threshold (or something like that) I start twitching a bit uncontrollably. It's like how some people have a physical aversion to vomit or blood, they just can't stand the sight of it. I just can't stand talking about this too long. There are very few things that bother me - I can watch a bloody surgery, talk about gross procedures and weird things, etc - but this really does bother me after a while. Two, I've learned that this topic can be very sensitive to a lot of people and I generally have little interest in getting into a heated debate about things. So I leave it alone for the time being (basically, I'm biding my time till I'm a physician and can influence people one-on-one).

Now, what about it? Personally I'm against circumcision for "non-medically necessary" and "non-religious" reasons. I make a special exception for religion because that's a whole another touchy area I don't want to trespass into. One of my philosophies towards medicine is: if it's not causing any problems (and probably won't cause problems in the future), leave it alone. There are many reasons why I'm against this procedure (I don't called it surgery; surgery, according to, is "the art, practice, or work of treating diseases, injuries, or deformities by manual or operative procedures," which circumcision isn't in the vast majority of cases) but where to begin?

I suppose I'll begin with by saying there's nothing wrong with having a foreskin. It's really not hard to clean and keep clean, so anyone who advocates circumcision for hygienic reasons needs to just shut up. And as long as it's clean, the guy's not significantly more prone to getting STDs or infections, and most studies support this. It also doesn't smell (much) most of the time. Besides, 70-80% of the world's men are uncircumcised; since no one hears a large proportion of them complaining about problems relating to their foreskins, it can only be assumed that problems occur rarely or are easily taken care of without surgical intervention.

Along this line, it's very disturbing to me that circumcisions are usually performed on a non-consenting infant within hours or days of birth. Words can't really describe how terribly upsetting it is for me to think that one of the first experiences for many males is unthinkable pain in an area of his body that's supposed to give so much pleasure. It wasn't too long ago in the US that doctors didn't routinely use anesthesia, so most infants felt the full pain of the procedure, in addition to the pain of recovery. And the thing is, circumcision is almost always unnecessary. No other "medical" procedure is performed on infants without proof that it can only benefit the individual, and only after something has gone wrong does that procedure then becomes necessary.

There are studies indicating that it might lower UTIs (urinary tract infections), but UTIs are easily treated and female infants get more UTIs than either circumcised or uncircumcised male infants, and women get more UTIs throughout life than men. So this argument for circumcision is rather null and void in my opinion, because nothing is done to/for women to reduce their UTI rates. And while there is a slightly increased chance of an uncircumcised guy getting a yeast infection (thrush), yogurt and good hygiene easily takes care of this. (Yogurt is pretty amazing, it can help prevent yeast infections.)

Recent studies also seem to indicate a reduced HIV contraction rate in circumcised men. There is no good cause-effect relationship for this, so I think this is a bit dubious. Until someone proves a cause-effect relationship, it might just be a really strong correlation. Correlations are among the most dangerous things in biology and medicine, because they may/may not be true and it's very difficult to tell. Besides, safe sex practices (like condom use) and good hygiene make circumcision practically obsolete in industrialized nations. It might be a good idea in Africa, where there's a lack of clean water (amongst many other problems), but it doesn't really apply to the rest of the world. Even so, infants aren't sexually active so they can't get HIV through sex. If a guy wants to get circumcised later to reduce his chances of getting HIV in Africa, by all means, he can do whatever he thinks helps. But circumcision is never a substitute for safe sex and condom use. And if you consistently use condoms, does circumcision really help? Not really, I think.

What's also disturbing to me is how the complications and risks from circumcision are so grossly understated. Since it's a surgical procedure, it carries with it the same risks as any legitimate surgery. This includes excessive bleeding, hospital infections (and if you get MRSA - the antibiotic-resistant staph infection - you're pretty much screwed), removal of too much/too little tissue, skin bridges (this one's really common, look it up), etc. Deaths have resulted from circumcisions, even in the US, at a rate of a handful per year. Most of the time the actual cause of death is from (or reported as) a secondary source, such as an infection or hemorrhage. Interestingly, the rate of complication/risk from circumcision is, on average, almost the same as the probability of the guy developing a problem with his foreskin if it were left alone.

And perhaps the most controversial aspect of the circumcision debate is sensitivity. Some studies vehemently state that circumcision does decrease sensitivity while others strongly oppose this statement. Logically, since there are many nerve endings in the foreskin, removing the foreskin will remove these nerve endings. And since nerve endings are the raw source of sensation, circumcision could reduce raw sensation and thus reduce sensitivity. Also, the foreskin protects the glans (penis head) from contacting the outside world more than it really needs to; so it keeps it a bit more softer and sensitive. All I know is, I can't stand to have my glans exposed all day long and I don't understand how anyone else can. Besides, not ever needing lube is a good thing, though I could choose to use some if I wanted and had the time/privacy.

So where am I now? Well, in summary, most guys worldwide are uncircumcised and the vast majority of them never have any problems. The foreskin is easy to clean and keep clean. It's painful for infants and it shouldn't be one of their first experiences in life. UTIs are easily prevented and treated anyway, so are yeast infections. Safe sex is so much more important than circumcision in terms of HIV (and any other STD). Circumcision comes with its own set of complications and risks that are too often understated. And circumcision logically would reduce sensitivity. Oh, and the circumcision rate in the US has fallen to just under 60% in recent years (with that rate being much higher/lower depending on the state).

Basically, as long as one's foreskin is working, he maintains good hygiene, and he practices safe sex, then there's really no good reason for circumcision in my opinion. I believe it should be the individual's choice if it's not for medical or religious reasons. Circumcision is irreversible. If a guy's circumcised and he doesn't like (or he suffers some complication from it), there's really nothing he can do. But if an uncircumcised guy doesn't like his foreskin (or has some problem with it), then at least the choice is his. Choice is one of the most sacred things in my mind; free will should not be shortchanged. As a (future) physician, I would refuse to do circumcisions unless there's a medical need or the person himself chooses it.
This is actually a rather short sample of my argument on this issue, as not everything's coming to mind and I'm not using articles and studies to make/prove my point. If anyone's offended by this in any way, I do apologize but it is my opinion. But it's also not something I'll yield my position to easily, as it's not very easy to argue against me on this issue.

So, if no one comments, I'd like to return this Unspeakable back under my Mask of Silence until it's brought up again. I promise the next several posts won't be "heavy" and controversial.


Mark said...

I agree with you on this topic. I am really happy that I wasn't circumcised.

Aek said...

I'm glad I'm not alone. Sometimes, it feels that way.