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Aug. 23 2005 7:25 AM

To Snip?

Help Slate'scircumcision research project.

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When researchers announced a study last month showing that South African men who have been circumcised are 70 percent less likely to contract HIV from infected women, AIDS-prevention groups didn't rush to whip out the knife. They can be forgiven for proceeding with caution, because circumcision is a topic that, well, cuts deep. For more than a century, doctors and scientists have thrown the weight of modern medicine behind the biblical ritual, and for just as long other doctors and scientists have derided it as unnecessary and barbaric. Even if circumcision proves the best means of halting the spread of AIDS short of a vaccine, the war over it will continue.

Emily Bazelon Emily Bazelon

Emily Bazelon is a staff writer at the New York Times Magazine and the author of Sticks and Stones

Cultural anthropologist Leonard Glick explores the history of the Snip from a skeptical perspective in Marked in Your Flesh, published this summer by Oxford University Press (serious scholarship, truly!). Glick acknowledges that in the book of Genesis, circumcision is the sign of God's covenant with Abraham. But then he takes the line of the anti-circumcision movement: Circumcision is painful, irreversible surgery to which newborn boys cannot consent. Its health benefits are marginal and overstated. And far from being an extraneous bit of flesh, the foreskin is "richly endowed with specialized nerves," making it "the principal site of sexual sensation" in a man who has one. "Circumcised men have lost more capacity for optimal pleasure than they will ever know," Glick sighs. (He never comes out and says so, but his sense of loss seems personal.) In support of this proposition he cites the 12th-century Jewish physician and philosopher Moses Maimonides, who wrote that "if at birth this member has been made to bleed and has had its covering taken away from it, it must indubitably be weakened."

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As Glick is aware, the problem for modern-day opponents is the historic tie between attacking circumcision and attacking Judaism. Muslims and some Africans circumcise their sons too, but in Western culture, the practice has been identified primarily with Jews. In the New Testament, Paul drew a distinction between Abraham-style circumcision of the body and "circumcision of the heart" (also a concept in the Hebrew Bible) to symbolize the difference between carnal, law-obsessed Judaism and spiritual, exalted Christianity. Though the later church didn't object to the veneration of the foreskin of Jesus, it vilified anyone else's circumcision as "the height of foulness," in the words of one Lutheran reformer whom Glick quotes.

Then, in 19th-century Britain and the United States, circumcision started to catch on. Doctors noticed that their Jewish male patients had lower rates of venereal disease and attributed the difference to snipping. Circumcised penises were praised as more hygienic. Jewish doctors played a role in touting the procedure, but non-Jewish physicians also got behind circumcisions, though performed in hospitals rather than by mohels. By 1910, Glick reports, more than a third of all male babies in the United States were circumcised. As the rate of hospital-based childbirths rose, the circumcision rate in the U.S. climbed to 60 percent in 1940 and 80 percent in the 1970s. A majority of American boys—the estimate is 1.2 million a year—continue to be circumcised.

Meanwhile, some of the claims for circumcision's benefits—that it's optimal for penile hygiene and that women whose partners are circumcised are at less risk of cervical cancer—haven't panned out. There is evidence that circumcision is related to lower levels of penile cancer and urinary-tract infection. But penile cancer is rare (nine to 10 cases a year per 1 millionmen), and UTIs are usually a minor annoyance. According to the latest policy statement on circumcision by the American Academy of Pediatrics, the potential medical benefits of snipping aren't great enough to recommend it routinely. So, the AAP punted: When "the procedure is not essential to the child's current well-being,parents should determine what is in the best interest of the child."

Hence the significance, for the circumcision wars, of this summer's HIV study. The South African findings match up with earlier findings of a relationship between circumcision and lower rates of sexually transmitted diseases like syphilis and between snipping and HIV prevention. More than 3,000 men participated in the latest study; half of them were circumcised, and the other half were controls. The researchers planned to observe them for 21 months but stopped after 10 because the circumcised men were averting the virus in such greater numbers. (One theory for why that would be: HIV homes in on a type of cell that's near the underside of the foreskin and has more difficulty penetrating the thicker skin that covers the head of a circumcised penis.)

By any measure, the South African results are dramatic. Still, circumcision is a lot trickier to implement widely than other preventive measures like vaccines. This is surgery, after all, which when done on adult men involves weeks of recovery. If the South African findings are borne out, says Seth Berkley, president of the International AIDS Vaccine Initiative, it may make sense to mount a public-health campaign to circumcise as many men as possible in places like South Africa where AIDS is rampant. But that says little about the United States, where the risk of contracting HIV is low for most people.

Which is why the American circumcision debate probably will never be settled by science. Glick asks some good questions: Why do many of us instinctively think sons should look like their fathers? Why do secular Jews who rarely or never set foot in synagogue still circumcise their kids? Here are a couple more: Why would half the human race be born needing immediate surgery? Is the best approach the studied neutrality of the AAP—fine to snip away if you want to for religious reasons, also fine to leave your kids intact (in the lingo of the anti-snippers)? Or is that a cop-out?

The answers to these questions depend in part on whether you think circumcision causes babies lasting subconscious trauma or momentary discomfort, like ear piercing. In my limited experience (two sons), it's somewhere in between. Both my boys screamed and then cried hard until the mohel stuffed a gauze pad soaked in Manischewitz wine in their mouths. Then they nursed and fell into a deep sleep. On a Richter scale of pain, I'd say their newborn vaccine shots were a 3, circumcision was a 5, and the spinal tap my older son had shortly after birth was a 7. Since the kids don't remember any of this—at least not in any way I'll hear about—none of it much concerns me. Also, I love the carnal, discomfiting aspect of a bris.

But Glick has left me with another worry. What about my kids' future sex lives—have they been deprived of the "capacity for optimal pleasure"? With no definitive scientific literature on the question, here's the best way I can think to find out. I propose a highly unscientific Slate study of men who have experienced sex as both circumcised and uncircumcised—in other words, who changed their status as adults. If you fit that description and would be willing to discuss it (tastefully, of course), write to slatecircumcision@gmail.com. * Women and men who have had sex with circumcised and uncircumcised men and think they have something to add are welcome to weigh in. I'll report back (names and identifying details will be kept confidential, I promise).

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