Was Foreskin Evolution’s Great Mistake?
Currents
Imagine if we as a society decided to permanently dull infants’ sense of taste as a standard practice, perhaps by applying some kind of chemical solution shortly after birth. If we felt the need to defend the practice, we could come up with plenty of justifications. Obesity is, after all, a major health problem. Dulling our sense of taste could empower people to eat healthier but more unpalatable foods, which would save money and improve health. To anyone outside of our hypothetical culture, however, this would rightfully sound insane. Think of how we react to arguments in favor of “female genital mutilation” (FGM), also known as female circumcision, a practice that is common in parts of the Middle East and Africa, but which international organizations consider a human rights violation. Yet its male equivalent remains distressingly commonplace. As of 2016, according to one estimate, just under 40% of males were circumcised globally, and 71% in the United States, which is an extreme outlier among Western nations.
Circumcision is, in a sense, easy to justify through the trappings of science by overgeneralizing from limited findings. For example, a randomized control experiment from Kenya published in 2007 showed that male circumcision reduced rates of HIV infection. Studies like this have led scientists to recommend circumcision in the United States, where rates of HIV and other STIs are a fraction of what they are in Africa, and where condoms are more freely available. In fact, HIV/AIDs deaths have sharply declined in recent years, as has the rate of new infections among gay and bisexual men, the most at-risk group.
Comparing circumcision to other issues, we begin to see how strange the practice truly is. Gender-affirmation surgery for trans individuals has become a hot-button political issue in many countries, but whatever your take on the matter, at least those being operated upon — even teens — have some say in what happens to their bodies. In general, just about every culture allows for the removal of a body part if there is a medically valid reason to do so. Male circumcision, on the other hand, is widely inflicted upon infant boys as a matter of course — and nobody can truly argue that it’s life-saving or even has clear and substantial benefits. It is like nothing else in modern society, and the post-hoc justifications for the practice are weak.
Outside of countries with extremely high HIV rates and low availability of condoms, the supposed benefits of circumcision are quite small. For example, the American Cancer Society notes that while circumcision was once thought of as protective against penile cancer, many of the studies involved did not properly account for variables such as hygiene and a congenital foreskin problem known as phimosis, which can be dealt with through less drastic measures. The fact is that the difference in rates of cancer between circumcised and uncircumcised men in the US is minimal.
Other proponents argue that circumcision can prevent infections. But one must consider the magnitude of any effect size. One paper estimates for every 111 boys who are circumcised, one case of urinary tract infection can be stopped. Most UTIs either go away on their own or can be treated with antibiotics, and only about 3% lead to any kind of serious complications. How many parents would agree to have any other part of a child’s anatomy excised for a less than one percentage point reduced chance of getting a relatively minor infection during childhood?
One may ask why we as a society aren’t open to evidence suggesting that disfiguring the genitalia of young girls has equivalent benefits. After all, some Muslim proponents of the practice argue that it does. There appears to be little scientific inquiry into the matter in Western countries, probably because we don’t think such research would discover anything of value and we wouldn’t care if it did. We readily recognize that mutilating young girls and dulling their capacity for sexual pleasure is an ethically unacceptable practice, whether or not it may have some benefits in a few narrow areas of life. We regard FGM, rightly, as a cruel, misogynistic, and barbaric custom. But our own cultural baggage doesn’t allow us to similarly evaluate male circumcision on its merits.
As different as we might think we are from Muslim societies, it’s helpful to remember that concerns about masturbation were central in the original push to institute the widespread circumcision of male infants in the English-speaking world. In 1893, when the practice was still rare among Christians, surgeon Jonathan Hutchinson published a medical article in the Archives of Surgery titled “On Circumcision as a Preventative for Masturbation.” The doctor informed readers that he had from his experience “formed a strong opinion that Jewish young men do not suffer nearly so frequently as others from the maladies which we associate more or less definitely with masturbation and nocturnal emissions.” While the belief was that males who were circumcised would hopefully never start masturbating, Hutchinson argued that cutting off the foreskin was still useful for certain adults, as it “may often accomplish much, both in breaking the habit as an immediate result and in diminishing the temptation to it subsequently.”
There isn’t a great deal of evidence for this. Not that we should care, but circumcised males might be slightly more likely to masturbate. Modern medicine may no longer see male sexual pleasure itself as harmful, but the legacy of Victorian-era obsessions remains with us today, uncritically passed from one generation to the next. Sexual pleasure has an evolutionary purpose; otherwise, we wouldn’t have it in the first place. But because we cannot objectively measure enjoyment in the same way we can measure rates of various STIs, for example, it becomes easy to deemphasize pleasure in matters of public health. While Islamic fundamentalism openly rails against female “hypersexuality” when arguing for FGM, in the secular West, it is male pleasure that is more likely to be discounted.
Foreskins are observed among practically every mammalian species. When biologists find phenomena that are this universal, they usually assume nature wouldn’t be so frivolous as to equip a large number of distantly related species with the same feature if there wasn’t a great benefit to doing so. One possible evolutionary benefit in this case is that a foreskin increases the difference between the pleasure of sex and that of masturbation, spurring individuals to seek out more mating opportunities. It’s unclear if this particular theory, which I just made up, is true, but speculating as much demonstrates that there are an endless number of factors that one must consider when deciding whether a practice like circumcision is net-beneficial. Modern science is rarely precise enough to provide conclusive answers to these sorts of questions.
None of this is to suggest that just because something is “natural” it is automatically good. Indeed, the naturalistic fallacy is one of the most common errors made in reasoning about social and political issues. Medical interventions like vaccination or chemotherapy shouldn’t be rejected simply because they weren’t available to our ancestors. That said, the much narrower “don’t remove healthy body parts from infants” rule seems imminently reasonable and generally uncontroversial — except when it comes to the foreskin.
Thankfully, the tide appears to be turning against male circumcision in the US, albeit slowly. This may be because anti-circumcision advocates are winning in the marketplace of ideas, or due to immigration, as the trend away from the practice appears particularly pronounced in the western part of the country, which has a high Hispanic population. According to one study, circumcision rates for newborns dropped from 83% in the 1960s to 77% in 2010. Another shows a dip from 61% to 57% between 2000 and 2010 alone. While there is wide variation across publications, they generally show a downward trend.
Medical organizations have also become more equivocal on the issue, and at least 10 states have dropped Medicaid coverage for the procedure. This is thought to have resulted in a 21% decline in circumcision among Medicaid recipients in those states. Such a finding may simply indicate that many poor people refrained from circumcising their sons simply because they couldn’t afford to. But it may also lead one to believe that people adjust their normative and scientific views based on what the medical system is willing to pay for. For the anti-circumcision movement, then, removing insurance coverage for the procedure should be a major policy goal.
More important, however, is winning the battle of ideas. Anti-circumcision advocates have been making slow but steady progress over the last several decades. Even if the entire decline over time is due to immigration, it would indicate that a lack of assimilation towards this one practice might change norms and accepted standards of behavior, affecting even Americans whose ancestors have lived in the country for generations. Thankfully, circumcision has not been engulfed in the culture war to anywhere near the same degree as so many other issues, which provides hope that the practice may decline universally, as long as it does not become tied up in polarized political identities.
Yes, we should trust science. But science, like anything else, is practiced by humans who are capable of error and bias. When medical recommendations contradict the fundamental, biological “logic” of evolution — and there are few clearer examples of this than the idea that all penises must be surgically altered because they are naturally defective — they should be rejected unless there is overwhelming evidence to the contrary. And when it comes to circumcision, this has yet to materialize. Only by drastically lowering our standards of evidence can we pretend that there is a sound medical case for circumcision. The fact that the defenders of the practice don’t apply a similar dubious logic to its female equivalent reveals their obvious cultural bias. We should be thankful that Western culture has come to appreciate the value of female bodily autonomy. Boys deserve the same respect. We should stop accepting flimsy evidence and relying on irrational double standards just to prop up what is an indefensible status quo.
Published Jan 26, 2024
