December 21, 2019
Psychologist Noam Shpancer wrote an article that was published last week in Psychology Today. Shpancer is the latest to argue that the benefits of circumcision are overstated. A preliminary review of his analysis turned up several statements that are false or misleading.
He began by repeating the assertion that circumcision became popular as a cure-all for a variety of ailments. Melanie Lindwall Schaab recently pointed out on this blog that 19th century researchers observed differences in health between circumcised men and uncircumcised men. He also repeated the tired old masturbation assertion. Two years ago we refuted the "poison the well" fallacy that circumcision became popular as a prevention for masturbation.
Medical Benefits
Next Shpancer turned to the medical benefits, dismissing the evidence as "written by U.S. researchers, who tend to be circumcised males and culturally biased in favor of circumcision." This is an example of circumstantial ad hominem, which is a logical fallacy because a person's nationality or genital status "has no bearing on whether or not the claim is true or false." Schaab explained that the claim "that Western research is biased in favor of circumcision is wrong". She noted that by the same reasoning, researchers who are from non-circumcising cultures or are themselves uncircumcised would be biased against circumcision.
Shpancer falsely claimed that penile cancer occurs "in less than 1 man in every 100,000". That statistic represents the annual risk: in other words, the risk that a man will develop penile cancer in any given year. The lifetime risk of penile cancer for an uncircumcised man is 1 in 900. (Since circumcision reduces the risk by 99%, the lifetime risk for a circumcised man would be about 1 in 90,000.) He repeated the misleading claim that "approximately 300,000 circumcisions would need to be done to prevent one case of penile cancer". In fact a parent needs just one circumcision to protect her son from penile cancer.
Turning to phimosis, Shpancer claimed that topical creams and stretching will resolve most cases of phimosis. However researchers in Denmark found otherwise. They reported that 5% of boys under 18 suffered from a foreskin infection serious enough to require treatment at a medical center. About 95% of the patients were diagnosed with phimosis, and treatment for 24% of patients included circumcision.
While admitting that circumcision has been shown to reduce the risk of men acquiring HIV, Shpancer falsely stated that circumcision "may actually increase the risk of HIV for female partners", citing a Johns Hopkins University study in Africa. The author failed to inform his readers that the increased risk applied just to the few weeks immediately following circumcision. The study showed that the overall risk decreased by greater than 80%.
"Data showed that among the 183 men not taking anti-retroviral drugs, less than 10 percent were shedding HIV before circumcision, but nearly 30 percent were shedding the virus two weeks after surgery. The percentages dropped sharply as the men’s wounds healed, to less than three percent at six weeks and less than two percent at 12 weeks."
He claimed that "generalizing [HIV] data from consenting adults in developing countries to non-consenting infants in developed ones is highly problematic. The U.S. Centers for Disease Control disagrees, saying that parents should be informed about the medical benefits and risks of neonatal circumcision, including future prevention of HIV. The CDC explained, "Because the foreskin can serve as a portal of entry for STIs (including HIV), it is biologically plausible that circumcision plays a role in preventing STI and HIV acquisition through insertive sexual intercourse."
Regarding urinary tract infections (UTIs), Shpancer dismissed the evidence as "problematic" because it's "based mostly on cohort and observational studies" rather than randomized clinical trials (RCTs). Ironically the article links to one such RCT study, which concluded that "circumcision could be considered as a part of UTI therapy".
Shpancer wrote that "multiple infants need to be circumcised in order to prevent one UTI case". We again emphasize: a parent needs to circumcise only one boy in order to provide UTI protection for her son. The author suggested using "other less invasive and risky procedures" such as antibiotics. However the World Health Organization is concerned that UTIs are becoming more resistant to antibiotics, which can have significant harmful side effects. Circumcision reduces the need for antibiotics in the first place. Shpancer's mention of UTI treatments for girls is puzzling. The female urinary system differs from the male urinary system, such that urgical cutting wouldn't reduce the risk of infection. In fact surgery might increase the risk of infection in girls.
Medical Ethics
Shpancer maintains that the ethical argument in support of circumcision is more difficult to sustain because removing healthy, functional body tissue without consent or medical need. is seen as a violation of basic individual rights. British bioethicist Joseph Mazor disagrees. He argued that the right to bodily integrity only applies to situations in which the procedure in question is unarguably not beneficial, neither medically nor otherwise.
The author appealed to a group of scholars "with expertise in genital cutting" who authored a consensus statement that newborn circumcision is unethical. First we question the phrase "expertise in genital cutting", which implies that a scholar routinely performed circumcisions, an unlikely skill for a group of people who oppose the procedure. Second, most of the signers are from countries where circumcision is rare. If the author can devalue science-based studies because the American researchers are "culturally biased in favor of circumcision", then the opinions of European and Australian scholars can be dismissed as the product of cultural bias against circumcision. Shpancer cannot have it both ways.
He cited Brian Earp as a "leading scholar" on circumcision. One could alternately describe him as an "obsessed scholar". [1] In any case, Earp assumes that female genital mutilation provides "some health and psychosocial benefits for some women", without providing one medical authority to support his assumptions. Based on a review of selected articles and lectures, we wonder whether Earp is capable of discussing circumcision without comparing it to FGM.
Conclusion
Shpancer concludes by asking why the arguments against FGM would not apply to circumcision. FGM causes physical, psychological, sexual, and obstetric harm that is immediate, often severe, and often lifelong. FGM has no proven medical benefits. By contrast circumcision has an array of medical benefits that outweigh the slight risks. Circumcision during infancy is a simpler procedure with quicker healing time and fewer complications than circumcision at an older age. And circumcision does not adversely affect the three functions of the penis.
In attempting to make the case against circumcision, Noam Shpancer made several of the same errors that other partisans have previously made. We at Circumcision Choice continue to await a paper with an anti-circumcision perspective that contains information - about the benefits and risks - that is complete, accurate, and in context. This Psychology Today article does not meet that standard.
Other Psychology Today articles
Click here for our refutation of "Myths About Circumcision You Likely Believe".
Click here for our refutation of "Circumcision's Psychological Damage".
[1] Based on Earp's Curriculum Vitae, as of August 2019: 2 of his 3 books are about circumcision; approximately 48 of his 151 papers, articles, chapters, and blog posts are about circumcision; and 39 of his 84 speaking presentations are about circumcision. It seems that in his professional career, he has written and spoken about circumcision far more than about any other topic. In 2016 he was the first recipient of the Jonathon Conte Award "for furthering the cause of Genital Autonomy".