We’ve all heard something about it: circumcision in America. Yes, it’s a thing. In the United States, it’s quite popular for parents to have a physician strap down their newborn child and take a knife to his body. It happens with anesthesia. It happens without it. Some boys suffer severe complications, and others don’t. Some grow up without a care, and others harbor resentment over it.

Yet, this cultural habit lingers on as a deeply shrouded taboo in the fabric of American society. Few really want to talk about it in an open and fair manner. For most, it’s likely too uncomfortable. It’s too violent, too dark, too unpleasant. It’s something that has been done to so many millions of human beings and to yet to face this bloody reality is to confront the full magnitude of its harm and of its tragedy.

So if you’re an expecting parent in the U.S. and you want to know what is to come, you may want to familiarize yourself with this whole genital cutting thing. Because you are going to be asked the question: would you like to have him circumcised?

Here are six things to know before you make this decision.

1. It is no longer the norm

In recent years, the rates of male circumcision in the U.S. have fallen from heights of up to two-thirds throughout the 1970s and ’80s to less than half, as recently as 2009. Enthusiasm for the procedure varies across different regions of the U.S. as well, with rates being highest in the Midwest and lowest on the West Coast. A child born and circumcised in Michigan is no longer a member of the majority if he simply moves to California, or most any other place in the world, for that matter.

Why is this important? Secular American parents have been circumcising their children since the 1940s, which over time became a social norm that was passed down from one generation to the next. For many, it became a question of locker room talk and the question, “do I want my son to be teased for being different?” But now, things have changed. By circumcising their child, a contemporary parent is compelling him to both violently lose the complete genitalia he was born with and lose his membership to the majority group within the archetypal ‘locker room’. He will no longer be protected against whatever teasing and peer pressure that may have been the subject of original concern in years gone by.

Yet, if it were the case that circumcision rates were not suffering a steep decline in the United States, would an appeal to the status quo still be sufficient justification for performing a medically unnecessary surgery upon a child without consent?

2. The oft-cited medical justifications fall apart under scrutiny

In the United States, proponents of the circumcision norm often cite medical benefits as the reason why little boys should be circumcised. “It’s cleaner. It’s healthier,” some people say. But is it, really?

HIV/AIDS

There have been numbers floating around the internet and other media outlets since the mid-2000s, boasting that circumcised men are 60% less likely to acquire HIV than uncircumcised men. That’s an impressive number, but what does this really mean?

Well, it would take more time than is ideal for a post like this to sort out all the details, but for the sake of brevity, a few basic questions do arise that can be discussed here. First, how did researchers come up with this magic 60 percent number?

Three Randomized Control Trials were conducted in three separate Sub-Saharan African countries, Uganda, Kenya, and South Africa. If we take a real look at these three studies, significant issues arise.

Across all three trials, 10, 908, uncircumcised adult men were recruited to participate. 5,411 of these men were given a circumcision while the remaining 5,497 were not. They then continued their lives as before, and were followed up with in 6-month increments. The trial was originally intended to last for 24 months, but was cut short at month 18 for ethical concerns. What the researchers found at the end of the study, was that 64 of the circumcised men were infected at the end of the study, and 137 of the uncircumcised men were infected. In terms of relative difference, this represents a percentage of 60 percent. However, in terms of absolute difference, it only amounts to 1.31 percent. This is quite misleading, and certainly nowhere near the kinds of numbers we would expect for a procedure that has been touted to have a similar efficacy as vaccines.

Professional critics have pointed out numerous and significant flaws with these three studies, as laid out here. And there are just too many to give them proper attention in this piece. But one that does stick out is the fact that the circumcised group were given a time lead bias. In other words, since they began the trial at the time of circumcision for those men, the other men were able to have sexual intercourse for a period of approximately six weeks while the circumcised men were still healing from their procedure. This is a significant amount of time during which one group could acquire HIV while the others were physically incapable of doing so. The circumcised men were also given safe sex education while the others weren’t.

Now, what does all this mean? If you’re a circumcised male, can you get by without a condom? Well, no. If you want to actually protect yourself against HIV, you must wear a condom if you’re unsure of your partner’s status. This creates a deeply ironic contradiction: in order to be safe against HIV, you have to wear a condom whether you’re circumcised or not. Since condoms are the most effective means of protection at our disposal, there is no reason to get circumcised in the first place, if you use them. This is because a circumcised man wearing a condom is protected against HIV to the very same degree as an uncircumcised man wearing a condom.

Lastly, babies simply aren’t having sex. So it doesn’t make much sense to try and use these STI arguments in favor of circumcising children. An infant derives no benefit of this supposed protection against STIs if they’re not having sex in the first place. And if your baby is, then you’ve got bigger problems on your hand. The circumcision decision should be given to the individual and delayed until the age of sexual debut, which conveniently coincides approximately with the age of consent.

In the end, all of this is based upon a bevy of troublesome assumptions, which include the idea that an effective treatment or vaccine for HIV won’t be developed during the years between the child’s infancy and adulthood.

UTIs

It is often claimed that circumcision will reduce the risk of an infant has of acquiring a Urinary Tract Infection. And while this may be true, the absolute difference between the two groups is 1 percent. Research as shown that 1.1 percent of uncircumcised infants will get a UTI while only 0.1 percent of circumcised infants will develop one. This is an absolute difference of 1 percent, and it means that approximately 100 babies would have to be circumcised to prevent one UTI. This is a lot of money and destroyed foreskins to prevent an infection which, by the way, could instead be easily treated with antibiotics.

The list of medical justifications goes on and on, most of which have already been effectively countered elsewhere.

3. There is no global consensus

There is no professional medical organization from a developed country outside of the United States that has suggested that it is appropriate to routinely circumcise children. In fact, these opinions from abroad are virtually unanimous in their overwhelming opposition to the practice:

There is no convincing evidence that circumcision is useful or necessary in terms of prevention or hygiene… circumcision entails the risk of medical and psychological complications… Non-therapeutic circumcision of male minors conflicts with the child’s right to autonomy and physical integrity.

The Royal Dutch Medical Association, 2010

After reviewing the currently available evidence, the RACP believes that the frequency of diseases modifiable by circumcision, the level of protection offered by circumcision and the complication rates of circumcision do not warrant routine infant circumcision in Australia and New Zealand.

The Royal Australasian College of Physicians, 2010

There is no reason from a medical point of view to remove an intact foreskin from …boys unable to give their consent.

German Association of Pediatricians, 2012

As clinical sexologists, we are concerned about the human rights aspects associated with the practice of non-therapeutic circumcision of young boys. To cut off the penile foreskin in a boy with normal, healthy, genitalia deprives him of his right to grow up and make his own informed decision. Unless there are compelling medical reasons to operate before a boy reaches an age and a level of maturity at which he is capable of providing informed consent, the decision to alter the appearance, sensitivity and functionality of the penis should be left to its owner, thus upholding his fundamental rights to protection and bodily integrity.

Nordic Association of Clinical Sexologists, 2013

We should also acknowledge some European prejudices on the USA view that it is against nature and there is the suspicion that it is a good excuse for good business (1.4 million circumcisions are done each year in the USA). Interestingly, the Canadian Pediatric Society stated that “circumcision in newborns should not be routinely performed”, and Canada has a health care system similar to Europe. An important matter of principle should also be taken into consideration: “should infant male circumcision be considered an abuse of the rights of the child?” Circumcision is believed by some to be a male genital mutilation performed without personal consent. Even if circumcision is believed to have some benefits, these are mainly related to adult life, consequently, why should circumcision be performed in newborns rather than waiting until age of consent?In Italy, we do not do circumcision routinely. Ritual circumcision is not allowed in public hospitals under the free health care system, because the procedure is not recognized/accepted as a therapeutic process. In some Departments of Pediatric Surgery/Urology in Italy, there is even the rule not to touch/retract the foreskin before the age of 5 years. After 5 years of age, we may check for residual preputial adhesions and phimosis.

Roberto De Castro, MD, Bologna, Italy, 2009

Circumcision of boys that violates the personal integrity of the boys is not acceptable unless it is done for medical reasons to treat an illness. The basis for the measures of a society must be an unconditional respect for the bodily integrity of an under-aged person. Circumcision intervenes in the sexual integrity of a male child causing a permanent change in organisms and has consequences pertaining to both health and quality of life.

Central Union for Child Welfare in Finland, 2003

Physicians without a cultural predisposition towards circumcision commonly take an oppositional stance

Independent physicians, researchers, and other civic and non-profit organizations have tossed their hats into the ring as well:

Cultural and religious biases perpetrate an atrocity, physical and mental, upon innocent children who are unable to defend themselves. With no verifiable benefits to neonates and children, the practice of circumcision is the mutilation of an innocent child. Unnecessary or elective surgeries, such as aesthetic procedures, do not fall under the domain of parental rights; they in no way affect the parent, only the child. The greatest effect is that boys have had choices made for them; parents and doctors regularly overstep their duties and rights, forever destroying and demeaning those they were supposed to protect.

Jason A. Domashevskiy and Artem V. Domashevskiy, 2016

I speak up for keeping babies whole because those babies have no voice, no say in what is being done to them. I firmly believe that every human being has a right to autonomy, and this includes making elective decisions over permanent modifications to one’s own genitalia. I believe that boys should be afforded the same protection as girls, and that ethnic traditions, culture, religion, or parental preference must not supersede their right to genital autonomy.

Alexandre T. Rotta, MD

How could a being that has been aggressed in this way, while totally helpless, develop into a relaxed, loving, trusting person? Indeed he will never be able to trust anyone in life, he will always be on the defensive, unable to open up to others and to life.

Frédérick Leboyer, MD

Circumcision is ‘son sacrifice’-lite. In performing it both father and doctor (and occasionally mother) collude in act that proves their commitment to the state or religion they were raised in. They stamp the dominion of male roles & accepted scripts over the day old boy, onto his very manhood. They wield blades, wires and pain to divorce the child from the female world and initiated them into the male world. But this is not a healthy male world the child is brought. It is a world of obedience without true choice, of toughness without honour, of authority without wisdom, and most of all of meaningless, pointless pain. A pain that is bureaucratic, mechanical, covered with a thinnest veneer of rationality but driven by the ignorance and sadism of those in power. Circumcision is the perfect rite for the 20th century. A male rite for a century of industrial war and alienated work. A pointless rite of metal weapons conquering uncomprehending flesh, of absurd pain as a way of life, of state control of its populace, of all the ruptured relations between fathers, mothers and their sons.

Hobb Beckett, PhD