The mythical origins of circumcision

In our last issue, Hugh Young looked at the practice of circumcision. But how did such a bizarre tradition ever get started?

Hugh Young’s article on circumcision (Skeptic 86) was excellent but it is worth looking further at the origins of the practice. Some parents claim they have the right to circumcise their sons because it is a necessary part of their religion. But is it?

According to the Old Testament, circumcision started as a Jewish custom. God instructed Abraham, as a mark of a covenant between them, to adopt this practice for all males of his extended family. In this story Abraham had lived in Egypt, he had Egyptian slaves and a half-Egyptian son, Ishmael.

However the story ignores the fact that circumcision had been an Egyptian custom for many centuries. It seems probable that Ishmael’s Egyptian mother (even though she was a slave) would have tried to insist on her son being circumcised according to ancient custom; it seems incredible that she would not have at least mentioned this to the child’s father. How could Abraham (and of course God), have been ignorant that circumcision was an ancient Egyptian practice?

Centuries later, in the story of Moses’ childhood, he is discovered as a baby by an Egyptian princess who instantly recognises he is a Jewish child. Generations of Christians have claimed this is because she saw he was circumcised but this cannot be true. All Egyptian boys were circumcised; it is possible that some Jewish babies were not.

Jesus supposedly said (John 7.22.) “Moses gave you the law of circumcision (not that it originated with Moses but with the patriarchs)”. This reflects an ignorance of the Bible shared by many modern Christians and Jews.

According to Exodus, Moses led the Israelites out of Egypt to the Promised Land but it was a slow journey. In this story Moses was entirely opposed to the Egyptian custom of circumcision and while he ruled (for about 40 years) Israelites were not allowed to circumcise male babies. Clearly Moses had no knowledge of any prior agreement with God about circumcision, nor did God enlighten him on the subject although (according to the story) they met more than once. Only after Moses’ death did the Israelites resume the Egyptian practice (Joshua 5). Furthermore Moses refused to circumcise his own sons, which caused some marital disharmony (Exodus 4).

The precedent of Moses is very important when dealing with modern Jews who insist circumcision is necessary for the proper practise of their religion. If uncircumcised boys were good enough for Moses, why are they not good enough for you?

Herodotus writing about 450BC states clearly that the Egyptians and Ethiopians were the first to use circumcision, but it is unknown as to which of them started the practise, while all other nations admit they learned it from the Egyptians either directly or indirectly. The inhabitants of Palestine he calls ‘Syrians’ and ‘Phoenicians’ and both circumcise their sons, (although some Phoenicians under Greek influence had stopped the practice). Did a separate Jewish state exist in the middle of the 5th century BC? If so Herodotus was clearly unaware of it. It is certainly a myth that circumcision distinguished Jews from their neighbours in Palestine.

Jewish ritual circumcision is (or was) odder than one might imagine. Originally it was supposed to have been done with a stone knife, but by Roman times a steel blade was acceptable. The operator was and is called a ‘mohel’ and there are three parts to the operation. The first part, the cutting of the foreskin was called the ‘milah’. In the second phase called the ‘periah’, the mohel used his thumb nail and index finger to separate the inner lining of the foreskin from the glans. The third part is the ‘mesisah’ and until the 19th century this involved the mohel sucking the blood from the wound by taking the penis in his mouth. This raises some interesting questions about the circumcision of adults. According to Acts 16.3, Paul personally circumcised Timothy; however according to his own letters, Paul was vehemently opposed to circumcision. Reading these to get Paul’s opinion on the subject, it is difficult to believe that Paul circumcised anybody. Consider: Philippians 3.1-3 (most but not all Bible scholars accept this letter as authentic): “Beware of those dogs and their malpractices. Beware of those who insist on mutilation – ‘circumcision’ I will not call it; we are the circumcised, whose worship is spiritual”.

Galatians is regarded as authentic by all serious Bible scholars and there Paul wrote: Gal.5.2-3. “… if you receive circumcision, Christ will do you no good at all.” and, “… every man who received circumcision is under obligation to keep the whole law.”

The details of the mesisah sound so strange that it seems almost unbelievable. Indeed open-minded skeptics may imagine it is just another anti-Semitic ‘blood libel’. They can easily check via the internet that these details come from unprejudiced Jewish sources. The Jewish abhorrence about tasting blood may seem to cast doubt on the story, but one should remember that in religion there is a close relationship between sacred and banned practices. A practice may be offensive unless it is involved in a sacred ritual.

There is however an obvious medical explanation. The periah using a nail and finger is obviously so unhygienic that infection would be likely without proper cleaning. Sucking the wound is an excellent mode of cleaning (compared with alternatives available when the custom originated) and we might expect it would have become widely used once it became obvious that it reduced the risk of infection. However once medical hygiene became understood during the 19th century it became permissible to use a swab for the completion of the operation.

As one might expect there are conservative groups of Jews that cling to old custom. Christopher Hitchens in Op-Ed Free Inquiry Feb/March 2006 states that a primitive sect of Hasidic Jews in New York still have mohels who perform circumcision in the traditional manner. The mohel “sucks off the foreskin and spits it out in a mouthful of blood”.

Hitchens also states that the practice has caused several cases of genital herpes and at least two deaths. There has been pressure to outlaw the custom but the New York health authorities have decided to “be neutral”. Hitchens in this article is protesting the views of liberals who justify the health authority action as part of “free exercise of religion”.

Jim Ring is a Nelson skeptic, who says there is nothing like a childhood in the Exclusive Brethren for instilling a deep knowledge of obscure parts of the Bible.

Newsfront

Biologist expelled from ‘Expelled’

The Intelligent Design (ID) movie Expelled (Editorial, NZ Skeptic 86) has scored a spectacular public relations own-goal at a screening in Minneapolis (New York Times, 21 March). University of Minnesota developmental biologist PZ Myers, best known for his blog Pharyngula, was one of many who took up the offer to register on-line for the pre-release public screening.

A vocal critic of creationism, he appears in the film, and is even thanked for his participation in the credits. But, when he turned up at the theatre, a security guard refused him entry. Myers’ wife, his daughter and her boyfriend, and his guest were, however, allowed in. No one seemed to recognise the guest, who was … Richard Dawkins! He also appears in the film, along with Eugenie Scott from the National Centre for Science Education, and skeptic Michael Shermer. All say they were interviewed under false pretences, having been told it was a film about the interface between science and religion, to be called Crossroads. On Pharyngula, Myers recounts how Dawkins, who was in town to attend the American Atheists conference, used the question and answer session at the end to challenge the film’s producer, Mark Mathis, on Myers’ expulsion. What Mathis must have thought when he spotted Dawkins in the audience one can only guess. The irony of someone being expelled from a movie called Expelled-a movie which purports to defend intellectual freedom-has been lost on no one.

Except, possibly, the ID lobby group, the Discovery Institute. In full damage control mode, they’re accusing Myers and Dawkins of trying to sneak in without a ticket, in what they call a sophomoric stunt. But this was a screening where nobody had tickets, and Myers had registered, in the approved way, under his own name. Dawkins was not asked for identification, although he had his passport ready. In any case, surely these two are justified in attending a film they both appear in? The hypocrisy of the people behind this movie defies belief.

New Age fair does roaring trade

“Psychic medium” Sue Nicholson was picked out for special attention by the Nelson Mail (25 February) in their coverage of a recent New Age fair, the Festival of Opportunities. Best known for her appearances on Sensing Murder and TV One’s Good Morning show, Nicholson was selling copies of the book she has written to capitalise on her TV-enhanced fame. On the first page of each copy she wrote a brief message-two purchasers reported themselves happy with their messages, declaring them accurate and relevant. She also held psychic workshops on both afternoons of the fair.

The Wellington-based Mrs Nicholson said she had seen spirits from an early age but only “came out of the closet” as a psychic 13 years ago. She claims everyone is born with a sixth sense and just has to learn how to develop it and be open to it.

Festival organiser Debby Verdonk estimated the event attracted about 1800 people, despite the drizzly weather.

New twist on Nigerian scam

Nigerian scammers seem to be getting craftier (Dominion Post, 4 March). Dawn McKee, a US-born Auckland woman seeking a partner on the NZMatch.com website, was contacted by a man calling himself Robert Thomas, and claiming to be a 41-year-old, Italian-born man who had gone through a “messy divorce” in the US before coming to New Zealand. He provided photographs, including some with friends, and the pair developed a rapport.

Two weeks later, he said he was going on a business trip to Amsterdam … then Nigeria. And not long after that, Ms McKee received an email from him asking her to lend him money, saying his cheques were useless in the country as only cash was used there. She sent $400, then $900 to help with airline tickets. When he asked her for another $400 to cover “flight tax”, alarm bells rang and she cut off contact.

Ms McKee, a computer programmer, told her story to the paper to warn others against fraudsters during Fraud Awareness Week.

“He said all the right things,” she said. “I feel a bit stupid … and really angry. How could people be so non-caring that they hurt somebody else like that?”

Fraud Awareness Week was organised by the Commerce Commission and Consumer Affairs Ministry, who were promoting the message: “Fight the Scammers. Don’t Respond” to educate people about those trying to fleece them.

Commission spokeswoman Deborah Battell said it was impossible to say how many people were targeted as fewer than five percent reported their experiences-most were too embarrassed. Most scams originated from outside the country and probably cost the economy millions every year, she said.

“People have been scammed out of hundreds of thousands of dollars. They need to be extremely careful and not respond.”

Scams can be reported at www.consumeraffairs.govt.nz/scamwatch

Kennedy conspiracies still hold appeal

More than 40 years later and half a world away, the assassination of John F Kennnedy continues to fascinate. Now three young Palmerston North film-makers have concocted an 88-minute documentary, titled Imagining the Kennedys (Manawatu Standard, 10 March).

The film is the work of school friends Matthew Keenan and Seamus Coogan, now in their 20s, and Agnieska Witkowski, who “wandered into their lives from Nova Scotia, Canada.”

In the years immediately following World War II America was unquestionably The Good Guy, Coogan said. Now, this has eroded to distrust and events such as the assassination and 9/11 have become wreathed in conspiracy theories. “The result has been the birth of a conspiracy industry and the dehumanising of the victims.”

The trio point out their documentary doesn’t set out to solve any mysteries. Rather, it looks at the impact of the event on people like Coogan thousands of miles from Dallas. The documentary follows him as he travels to the US and talks to Americans about the event.

Seamus Coogan admits to having had a fascination with the assassination since he was about eight. He said he believed Oswald was set up to be caught as a cover for another shooter.

“My mother always said there was something more to it and the moment I saw the Zapruda film I said ‘Holy guacamole, there’s no way that shot came from behind.'”

In one of those coincidences science can’t explain, I watched an episode of Penn and Teller’s Bullshit! last night on conspiracy theories. The pair showed, with the aid of a honeydew melon, how a shot to the back of the head will propel the head backwards. Hard to see where any second gunman could have been standing, then. Certainly not on that grassy knoll.

Foreskins and the universe

There was plenty of interesting reading in the Sunday Star Times‘ Sunday magazine recently (23 March). First, a cover story on the circumcision debate-remember, you read it here first (NZ Skeptic 86).

Circumcision is still seen as a rite of passage in some Polynesian cultures, and there have been calls for the procedure to be publicly funded. But the Ministry of Health says that won’t happen any time soon. Says Auckland University of Technology pathology lecturer Ken McGrath: “We spent 50 years turning it [circumcision] off, and we don’t want to see that sort of nonsense again.”

The same issue also discussed Rhonda Byrne’s best-selling book, The Secret, which states the universe will give you anything you ask, if you truly believe. It recommends downloading a blank cheque made out to the universe from the book’s website, and believing the money into existence. Writer Angela Barnett wrote out a cheque for $100,000; all she got was a $25 library refund. The Secret has a handy explanation, she says-she must not have believed enough that she really deserved the money.

The article concludes by quoting Einstein: “Two things are infinite: the universe and human stupidity; and I’m not so sure about the universe.”

Circumstitions

Intersecting as it does sex, religion, blood, medicine and masculinity, circumcision is a subject that is hard to discuss rationally.

The male human foreskin or prepuce is a remarkable structure. Far from being “just a flap of skin,” it amounts to about 100 cm2 (15 sq in) or about half the outer surface of the adult penis. It is rich in specialised sensory nerves, and has a unique way of unrolling out over itself to uncover the glans and cover the shaft during intercourse. Men who have involuntarily lost their foreskins in adulthood compare the effect with going colour-blind.

The more remarkable, then, that human history is rife with crazes for cutting the foreskin off. Three cultures originated male genital cutting: in Africa, Australia and the Pacific. The African custom seems to have been taken through Egypt to the Middle East and then to Europe, and in the 19th century in England and the US it was medicalised with the aim of preventing masturbation, becoming widespread throughout the English-speaking world. It continues to be claimed as a panacea for whatever ailment people most fear at the moment.

Christchurch skeptic Jay Mann wrote (NZ Skeptic 84), “One thing that activates my BS-meter is a miracle treatment with too many claims.” Mine too. I started collecting bad reasons to circumcise (“circumstitions”) in 1998. There seemed too many to be reasonable, and I thought a complete list of as many as 30 would make Jay’s point. I now have 340 reasons, in 30 classes, and they show no sign of stopping-see Table 1. The classes are so bafflingly varied that something else has to be going on.

Aesthetic Instructive Revenge
Anti-sexual Irrational Reward
Cleanliness Medical Sexual
Concealment Mistake Status
Conformity Non-conformity Submission
Control Pity Symbolic
Convenience Pre-emptive Sympathetic magic
Financial Prudery
Iatrogenic Punitive To benefit someone else
Ignorance Religious
Initiation Reproductive Vague
Table 1. Reasons given for circumcision (And yes, some of those do contradict each other).

Skeptics will, I hope, dismiss out of hand the many obviously irrational reasons for circumcising such as ‘tradition’ and ‘to look like his father’ (conformity), but medicine has the seductive respectability of science.

Medical reasons for circumcision include the prevention or cure of the conditions listed in Table 2.

Alcoholism Headaches Penile cancer
Arthritic hips Hernia Plague
Asthma HIV Philmosis
Balanitis HPV Posthitis
Bedwetting Hydrocephaly Prostate cancer
Blindness Hydrocoele Rectal prolapse
Boils Hypertension Rheumatism
Cervical cancer Insanity Schistosoma
Chicken pox Kidney disease Spinal curvature
Epididymitis Kleptomania Stomach infection
Epilepsy Leprosy Tuberculosis
Gallstones Moral depravity Urinary tract infections
Gout Paraphimosis Yeast infections
Table 2. Medical conditions for which circumcision has been claimed as a cure.

Some of those are obviously bogus-the others, less obviously so. In each case the science is non-existent, flawed or misinterpreted, but these few look plausible:

STDs: A 2006 study in Christchurch by Fergusson et al, gained headlines around the world before Fergusson admitted his result was anomalous and it would take at least 20 circumcisions to prevent one minor STD. (He found no major STDs.) His retraction was not widely reported.

Urinary Tract Infection: It would take more than 170 circumcisions to prevent one boy contracting a UTI, according to To et al (1998). The rate among girls is several times that of boys. The major study (by US army paediatrician Thomas Wiswell) showing a protective effect:

  • was entirely based on boys born in military hospitals
  • used different means of collecting urine samples in the two groups
  • assumed that any bacteria cultured from a sample represented a UTI
  • neglected the effect of premature birth postponing or cancelling circumcision, and leading to intensive care and catheterisation-which causes UTIs.

Penile cancer: one of the rarest of cancers (with a lifetime incidence of less than one in 600, less common than male breast cancer), generally occurs only in old men. The rate is higher in the circumcised US than non-circumcising Denmark.

Cervical cancer (in partners): The main study on which this claim relies (Castellsagué et al, 2002), pooled data from five different countries. Almost all the circumcised men were in the Philippines, most of the intact men in the other four countries (Brazil, Colombia, Spain and Thailand). Naturally, there are many other demographic differences between those countries. The evidence boiled down to

  • 1 circumcised man in Brazil,
  • 1 in Colombia and
  • 3 in Spain who didn’t have HPV,
  • nobody in Thailand, and
  • 1 intact man in the Philippines who did have HPV –
  • a total of 6 men.

After all that, it referred only to Human Papilloma Virus (HPV) (of which there are a number of varieties, only some of which are linked to cervical cancer), not to cervical cancer itself.

HIV


It was inevitable that HIV/AIDs would fall under circumcision’s spell. It would take hundreds or even thousands of circumcisions to prevent one transmission of HIV in a country with a low incidence like New Zealand, if the three African random controlled trials (Auvert et al, 2005; Bailey et al, 2007; Gray et al, 2007) were correct. In fact, they have multiple flaws; for example:

  • they were not double-blinded or placebo-controlled, and they were conducted by circumcision enthusiasts, at least one of whom had campaigned for mass circumcision before the trials were ever held;
  • the men were not a random sample of the population, but volunteers given a substantial reward;
  • the circumcised experimental groups were given safe-sex advice that the intact control groups were not;
  • the trials were cut short, so we will never know what the long-term effect will be, and they can probably never be replicated;
  • at least 380 (10 percent) of the circumcised men dropped out of the trials-those who found they had HIV would feel let down and be more likely to do so. Only a few such men would reduce the results to non-significance;
  • the studies’ significance would be diluted by sex with men and non-sexual transmission, believed to amount to about 40 percent of transmission in Africa because of “needle men”-amateurs who offer injections for any and every complaint, using the same needle;
  • the non-circumcised control group in Uganda got less HIV than the circumcised experimental group in Kenya, probably because Uganda had campaigns against promiscuity (“zero grazing”), while the Kenyans were mainly fishermen on Lake Victoria with ‘girlfriends’ in every port.

Earlier, cross-sectional studies were confounded by such factors as religion-the circumcised men were largely Muslim, with different sexual customs and prohibitions.

In spite of this, an invitation-only meeting in Montreux, Switzerland (whose participants have not been publicly listed but seem to have included those same circumcision enthusiasts) has mobilised WHO and UNAIDS to “roll out” mass-circumcision campaigns in Africa-using a manual that was in preparation before the trials began.

Risks and costs

A baby can afford to lose only about two tablespoons of blood before he needs a transfusion. Modern absorbent nappies such as Treasures can easily conceal this much blood loss. Circumcision presents a real risk of MRSA or VRE infection. A recent death in Ontario was due to the device Prof Sitaleki Finau of Massey University calls “non-surgical” blocking the baby’s urethra. Ablation of part or all of the penis can occur-in the most famous case, Bruce/Brenda/David Reimer of Winnipeg, Canada, was unsuccessfully reassigned as female, and eventually committed suicide. There are many lesser complications and adverse outcomes that may not be noticed until the victim reaches adulthood. The pain reaction is measurable for months afterwards; for decades, babies were circumcised without anaesthetic.

Sexuality

It should be self-evident that cutting part of the penis off has a detrimental effect on sexuality-this was known for centuries before circumcision became widespread. Incredibly, the most widely reported studies of penile sensation (Masters & Johnson, 1966; Payne et al, 2007), both claiming circumcision had no effect, didn’t measure the foreskin. One that did (Sorrells et al, 2007) found a striking difference. Circumcised men insist that “if I was any more sensitive, I’d have a heart attack” (a claim that itself suggests something is amiss) yet intact men do not fill our cardiac wards. Such a claim mistakes quantity for quality. The answer demands closer study of the neurology.

Psychology

How, you may wonder, can a practice so bizarre, abhorrent even, have become so popular? A good question, not yet fully answered, but we can look at power and control, sympathetic magic, a multi-faceted memeplex that has a momentum of its own, money, and men’s refusal to admit that they have lost anything, but rather a determination to ensure that nobody may have more penis than they do. Some circumcision enthusiasts (who call themselves ‘circumsexuals’) have an unwholesome interest in the procedure itself. Intersecting as it does sex, religion, blood, medicine and masculinity, circumcision is a subject it is hard to discuss rationally. Much scientific writing on the subject is tainted by these biases.

Human rights

Many men are so outraged that part of their penis was cut off, that they go to considerable trouble to replace it. (A good aesthetic effect can be achieved by slowly encouraging the skin to grow by applying tension-not ‘stretching’-but the sensory effect can never fully return. Surgical means are not advised.)

It should be obvious that cutting an integral part of a healthy baby’s body off is a human rights violation. It is obvious when the baby is a girl, and an amendment to the Crimes Act outlaws female genital cutting specifically and totally, regardless of degree, under all circumstances (except medical need), with no exception for religion or culture, or even the adult woman’s own consent.

Male vs female genital cutting

The objection is often vehemently raised that there is no comparison between male and female genital cutting (MGC, FGC). But both cover a range of practices, and the mildest of FGC is milder than the most severe of MGC. MGC may be carried out under conditions similar to FGC (with nearly 40 deaths a year in Eastern Cape Province alone). As ethical issues, as human rights violations and as invasions of a person’s most personal space, they are equivalent.

Recent history

Infant circumcision became near-universal in New Zealand by the 1950s. (It is not true that many men had to be circumcised in the North African desert campaign of World War II, though that reason was commonly given. I am grateful to Manfred Rommel for taking the trouble to enquire of his father’s surviving troops.) It declined to near-zero through the rest of the century, the main exceptions being Pacific Islanders, Muslims and Jews. This apparently happened top-down, National Women’s Hospital refusing to offer circumcision at public expense from the day it opened in 1962. In the mid 1970s, it became policy not to offer it to new parents (the ‘sleeping dogs’ policy), and some time during that decade it was taken off Social Security. The result is that most New Zealand men over 35 are circumcised, most under that age are not. (In England, the probability goes up with class, in the US, as you go north and east.)

In August 2007, Victorian public hospitals banned the operation, South Australia announced a review of its policy and the Children’s Commissioner for Tasmania called for the female genital cutting ban to be made gender-neutral.

Yet in October 2007, Prof Finau called for infant male genital cutting to be offered in New Zealand public hospitals again.

The movement to oppose non-consensual (male) genital cutting (Intactivism) is small and unpopular, and generally regarded as eccentric, yet we know we are the rational ones.

List of references available from the editor.