‘Have you cleaned behind your foreskin? Have you pulled it right back?” my mother bellowed up the stairs to my brother every evening of my childhood. I grew up aware that male genital hygiene was important — and, I’m sure, so did the neighbours, given that we lived in a terraced house with cardboard walls.
Today my two sons also get the end-of-bath check-up. They have to because, until recently, I was totally opposed to male circumcision unless medically required.
Seven years ago I rescued my newborn son from circumcision. He was apparently the only baby boy in the private maternity ward not scheduled for the operation. Alerted by the nurses’ confusion over the list of male babies, I lurked around the nursery as the cots were lined up for the trip for the snip. Sure enough, he was wheeled into line until the offending nurse was confronted by threats of lawsuits.
I still see circumcision as a form of mutilation. For a long time I’ve thought of circumcising baby boys as one of those strange human behaviours, with its roots in ancient times, which greater knowledge of disease and hygiene, and improved living conditions, should have rendered superfluous. It appeared to be a relict of an operation-happy and ”dirtiness”-obsessed past where neither parents nor doctors appreciated the beautiful functionality of all parts of the human body.
Which is why I was so surprised a month ago to find myself wondering whether I had made the wrong choice, following research about the role of circumcision in preventing HIV infection. The evidence strongly suggests that removing a man’s foreskin reduces his chances of contracting HIV, and may protect him and his sexual partners from a range of other sexually transmitted infections.
There have been years of research suggesting that circumcision can have a protective effect against HIV, but the data was not conclusive. Then came the results from a research project in Orange Farm, a prospective study following several thousand men. It showed that men without a foreskin were up to 65% less at risk from contracting HIV than those with that flap of skin. If true, male circumcision could have a significant role in containing the spread of HIV because fewer infected men should mean fewer infected women.
But reports of the benefits of circumcision have been met with angry responses from the International Coalition for Genital Integrity (ICGI) and two local anti-circumcision groups.
Much of what these groups say is true. Circumcision is mutilation, for both males and females. The foreskin is more than a wrinkly bit of skin, it contains layers of nerves and immunological organs, much of which is not fully understood. I also know that removing the foreskin leads to less sensitivity. This point was made by a doctor I know, who had to be circumcised in his twenties. Before, he says sadly, his sex life was in technicolour; afterwards it was in black and white.
Having looked at several anti- circumcision websites, I realise that being bereft of their foreskin is traumatic for many men. But, my sympathy is lost when men conflate female genital mutilation with male circumcision. There is a gross difference between removing a boy’s foreskin and cutting out a girl’s clitoris or sewing her vagina shut (infibulation).
The ICGI’s statement exposes a lack of understanding of the extent to which girls are mutilated: ”A second study, performed by Stallings among African females in Tanzania shows that HIV transmission is also reduced among circumcised FEMALES (sic). This has gone unreported by the media. Such selective reporting suggests the need for analysis from a gender prejudice point-of-view and suggests that male and female circumcision should be dealt with as a unity.”
That Tanzanian study surprised its author, who pointed out that expectations were that circumcised women would have a higher risk of HIV given the damage done to the genitalia, the risks of unhygienic instruments used in the mutilation and the tendency for anal sex to be substituted for painful vaginal sex. The fact that this study showed the reverse is probably the result of anthropological factors: circumcised women tend to come from conservative communities where HIV prevalence is lower because extramarital sex is far less common.
Like it or not, data suggests that circumcision can play a role in protecting men from HIV: that is not the result of anti-male bias, but data from carefully designed studies. In today’s environment of a rampant and unrelenting epidemic, anything that can reduce the spread of HIV should be considered. If the protective effects of male circumcision are confirmed, then it should at least be regarded as a potential tool in a holistic strategy against HIV.
Campaign against routine circumcision of children but don’t deny men the right to make an informed choice. And don’t equate losing a foreskin with scraping away a girl’s external genitalia.