Why I Write About Medical Circumcision

As a nineteenth century surgical innovation, medical circumcision was less about fighting disease than controlling male sexuality.

Contrary to the formula that opens so many articles in medical journals and the popular media, circumcision is not the oldest known surgical operation. As a medical procedure (as opposed to a religious/cultural rite) circumcision of males is a recent invention, appearing first in the eighteenth century as a therapeutic intervention on adult men whose penises were corroded by various sexually transmitted infections (probably syphilis and chancre in most cases). In the nineteenth century, circumcision underwent a further development as a prophylactic (preventive) intervention on male infants and boys—not primarily for health reasons, however, but as a means of controlling juvenile sexuality.

Why Write a Book about the History of Circumcision?

As an independent historian and freelance write, I am the author of a scholarly account of the rise and fall of routine medical circumcision in Britain (A Surgical Temptation). My doctoral research was in the politics of literature, leading many friends and colleagues to wonder what led me to study such an esoteric and perhaps trivial issue as circumcision, and one so far removed from my background in the humanities. I replied that the practice is far more than a mere footnote to history: if it seems esoteric, it is only because the study of sexuality is still struggling to achieve respectability within academia; and if it seems trivial it is because most people are too reticent to talk frankly about the condition of their genitals—however heavily their health and vigour may weigh on their minds. In my experience, the condition of their penis is a matter of deep concern to most boys and men. Seen in a broad context, circumcision raises many significant questions, not only about medical history, sexuality and the body, but about ethics, human rights and social justice.

As to my competence to venture into a biomedical subject field, it has always been my view (along with that of my old school headmaster) that a broad liberal education should equip most people to write intelligently on just about any non-technical subject. Medical history is no more difficult or esoteric than any other kind of history, and I found that the close reading demanded by literary criticism was quite useful when analysing the rhetorical strategies deployed by the authors of articles in medical journals. Anyway, the proof of the pudding is always in the eating: as it turned out, the book was accepted by a major university press, and the reviews were strongly positive.

My interest in routine circumcision developed as part of a wider interest in the history of male sexuality, and of the various ways in which it has been viewed and managed by different societies. I began to study the history of circumcision because it seemed a useful guide to how a society perceived and valued masculinity, and how it judged or categorised sexual behaviour, and because it provided a particularly sharp focus on the point where culture, sexuality, anatomy and medical knowledge converged. I was particularly concerned to redress what I saw as a glaring imbalance in sex and gender studies—too often seen as the history of women—by bringing men into the picture; and to correct the tendency in studies of masculinity to concentrate on the mind and downplay the importance of the body. It seemed to me that many studies of masculinity, and even of the penis—particularly those written by Americans—seemed blithely unaware of the fact that most penises all over the world and throughout history have included the foreskins with which they came into the world. Ignoring the fact that the biologically—and on a world scale, numerically—normal penis was not circumcised seemed a dangerous example of cultural blindness.

Limitations of Gender Studies & Social Constructivism

This blindness was especially apparent in many recent studies of the masturbation scare, most of which ignore the fact that in nineteenth-century debates the foreskin was as central to the male version of the problem as the clitoris to the female. A striking instance is Thomas Laqueur’s celebrated Solitary Sex (2003) which embodies nearly all of these biases: focusing more on women than on men; passing only briefly over the crucial nineteenth century; ignoring the numerous medical authorities that urged circumcision as a preventive; treating the body as a mental/cultural/social construct, rather than as a material, anatomical reality, and thus showing no understanding of the contribution of the foreskin to the generation of sexual pleasure. Other historical studies that discussed masturbation offered plenty of information, often written in a tone of impassioned indignation, about surgeries such as clitoridectomy on women; but such texts were usually silent about the fact that similar surgery on men’s genitals had been introduced first and was always far more common. It is significant that at the very time (1860s) when circumcision of boys was being introduced as a preventive of masturbation and other behavioural problems, English doctors rejected circumcision of girls and women as morally unacceptable; indeed, as I show in my book, the rejection of female genital cutting was argued in terms that actually assumed the desirability of male circumcision. In the USA, by contrast, many doctors continued to assert the medical or moral efficacy of various forms of female genital surgery until well into the twentieth century.

Trying to Solve a Puzzle

The puzzle I particularly wanted to solve was why, during the nineteenth century, educated English  males turned so suddenly against what had been their most prized possession. I found that so profound a revolution in attitudes had multiple causes that had to come together at the same time. These included:

  • horror of expressions of juvenile sexuality, especially masturbation;
  • consequent loss of knowledge about the normal developmental trajectory of the penis, leading to the myth of congenital phimosis;
  • fear of venereal disease and cancer, both becoming more common—the first as a result of urbanisation, the latter as a consequence of increased life expectancy;
  • suspicion of and hostility to sexual pleasure and corresponding valorisation of purity—what has been called anti-sensualism or a culture of abstinence;
  • rising prestige and power of the medical profession;
  • therapeutic stagnation—despite increasing knowledge of disease causation, little progress towards cures;
  • corresponding faith in surgery as the one area where medical treatment was making progress, leading to what has been called an amputational culture;
  • low status of children, to be seen but not heard;
  • absence of any meaningful concept of medical ethics or patient autonomy.

It was the conjunction of these factors that created the right conditions for the emergence of routine prophylactic circumcision of male infants and boys—a practice that has proved more difficult to halt than to initiate.

The Strange Revival of Victorian Medical Values

When I began research on circumcision in the late 1990s, I thought I was writing its obituary; by the time the book was published I found myself embroiled in what had become an acrimonious controversy. I was aware that while routine circumcision had died out in Britain in the 1950s, it was still common in the USA, and that Australia had a history of the practice. Since United States, Canadian and Australian paediatric authorities had been discouraging the procedure since the early 1970s, and I had observed that the boys of my same-age relatives and friends were growing up with unaltered penises, however, I assumed that the practice was a thing of the past. Nobody with any medical knowledge or scientific understanding would ever try to revive the old Victorian stories about the health benefits of pre-emptive amputation—or so I thought.

It therefore came as a surprise to observe some sort of revival of the old medical case for circumcision, coupled with new cultural relativist arguments that the customs of minority cultures ought to be respected. Both these trends drew strength from fear of a frightening new disease, HIV-AIDS, and particularly from African studies suggesting that circumcision (of adult males) could make men less susceptible to (heterosexually transmitted) HIV. Having seen similar nineteenth century arguments that circumcision would confer immunity to syphilis I was (and remain) sceptical of the value of the African mass circumcision campaigns, and I note that they are at last beginning to attract critical scrutiny. It seems that whenever a new and incurable disease involving the genitals appears, some people always jump to the conclusion that the solution is to cut part of them off.

Part of the reason for this tendency may be found in the fact that circumcision emerged as a valid prophylactic medical treatment at a time when the causes of most diseases were poorly understood, children were not regarded as having any independent human rights, no meaningful standards of medical evidence had been established, and medical ethics were rudimentary or non-existent. As Peter Gay (in The Tender Passion) commented with respect to the masturbation phobia, nineteenth century doctors displayed “willing ignorance,” expressed in their failure to carry out objective research into sexual anatomy and function or to test claims that masturbation induced physical or mental disease by actual clinical trials or other forms of empirical investigation. History can thus help to explain the persistence of the practice into the age of evidence-based medicine and bioethics.

Although I did not aim to take issue with contemporary claims for the “benefits of circumcision,” I came to hope that a historical perspective would encourage people to take a sceptical view of reports that the practice can prevent AIDS, cervical cancer, urinary tract infections etc., and show them to be not so far removed from nineteenth century assertions that circumcision could prevent masturbation, syphilis, epilepsy, bed-wetting, hip-joint disease, hernia, tuberculosis, pimples and other disorders too numerous to mention. In recent times an increasing weight of bioethical opinion has come to the view that it would be unethical to perform circumcision without informed consent even if such claims were true.

Whig History and the Problem of Moral Judgement

So despite my reference above to an objective scholarly interest in sexuality and the body, I did have a moral motivation or purpose in writing the book. It soon became apparent from my study of circumcision in Britain that, despite the promise of physical or at least moral improvement, many of the early recipients of the operation were no happier with the result than many circumcised men today; I therefore wanted to tell something of their story and to arouse some sympathy for the indignities inflicted on men and boys in the name of controlling disease and curbing sexual desire, especially in the nineteenth century, when masturbation was seen as such a serious crime that forcible surgery seemed an acceptable response. My hope is that this perspective did not so much corrupt my research as motivate me to seek out and reveal the truth about the past, in much the same spirit as Roy Medvedev’s history of Stalinism, Let History Judge. My own inspiration was E. P. Thompson’s celebrated remark at the opening of his Making of the English Working Class —that he wanted to rescue the early victims of the Industrial Revolution from the condescension of posterity. As David Wootton argues in his recent studies of medicine and the rise of science, there is not much point in studying history if a historian is not permitted to make informed judgements about past events and practices.

One reviewer of my manuscript twitted me for occasionally falling into the trap of Whig history, but I contend that acknowledging the reality of progress towards better understanding and treatment of disease or kinder treatment of children is not what Herbert Butterfield was referring to when he wrote The Whig Interpretation of History (1931). The syndrome he had in mind was the (Hegelian) view that history had a purpose or goal, identified as an inexorable march towards our own cherished values and institutions. His targets were historians and propagandists who wrote history in order to celebrate current political arrangements and glorify the present as the final, happy outcome of historical evolution. The sort of thing Butterfield meant was Macaulay’s celebrated history of the defeat of absolutism and the triumph of England’s mixed constitution. His charge would also be applicable to The History of the CPSU (B) (Short Course) and the textbooks used by the unfortunate pupils in the schools of Airstrip One in 1984.

But the accusation of whiggery or whiggism  is not applicable to those who find and report that, in certain areas at least, or at certain periods, there is progress in history (as Steven Pinker demonstrates in The Better Angels of our Nature), nor to those who offer judgements about past practices, events, values or beliefs. As E. P. Thompson remarks in The Poverty of Theory, his witty, humane polemic against Louis Althusser’s disembodied Stalinism, “I am not in the least embarrassed by the fact that, when presenting the results of my own historical research, I offer value judgements as to past process … This is proper … because the historian is examining individual lives and choices, and not only historical eventuation.” It would be a bold, indeed tone-deaf, spirit who would venture to write a non-judgemental history of slavery, the Inquisition, the Holocaust or Mao’s Great Leap Forward. But judging these episodes to be destructive and instances of evil does not require the invention of data or the deployment of rhetorical terms of condemnation. On the contrary, such value judgements provide an incentive to explain how such terrible things could happen by delving into the records so as to uncover and reveal the facts. That, at any rate, was what I sought to do; how far I succeeded is for readers to assess.

A Footnote on Postmodern Relativism

A footnote to these points illustrates the extent to which pos-modern epistemological relativism has infected students in the humanities and social sciences. This piece was actually commissioned by an online blog on the history of sexuality, but when I sent it in the graduate students in charge demanded many changes to make it fit in with their evidently postmodernist worldview; in particular, they wanted me to refer to Victorian medicine as having  “different understandings” of disease, “alternative standards of medical evidence” and “different ideas about medical ethics,” rather than, as I put it, poor or incorrect understandings of disease causation, (mostly) futile or harmful treatments and a yawning absence in the ethics department (see note). In a blatant act of editorial censorship, they quietly deleted a sentence referring favourably to David Wootton’s histories of medicine and science —no doubt on account of his strongly empiricist, anti-postmodern approach. I was not keen to accept these conditions and alterations which would have compromised my own sense of intellectual integrity; and I decided to find an alternative publication option. Thanks, Areo!

Note: For a glimpse into the nature of medical ethics in the 1860s, see the testimony of Dr James Paterson at the trial of Dr Edward Pritchard for murdering his wife by administering antinomy. Paterson testified that, although Pritchard had called him in for an opinion and he recognised the symptoms of antimony poisoning, he could not interfere because the woman was not his patient; to do so would have been “a breach of the etiquette of my profession.” See here for more details.

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  1. There are an awful lot of words in this piece. So please forgive me for missing the point but what specifically is the harm? Unnecessary, I am inclined to agree but to what extent harmful?

    1. There is harm. Trauma, pain, babies go into shock. This isn’t usually remembered but that isn’t really a justification for inflicting an unnecessary procedure on a baby.
      Then there’s infection and scarring.
      If we consider the amount of cutting involved – would we be okay with allowing the equivalent to be done on female babies? Probably not.
      Americans show their insular thinking in regarding this practise as “normal”. It’s practice outside America is limited to religious foolishness.
      It should be a crime.

  2. Circumcision should be placed among foot binding, neck rings, scarification, breast implants, teeth carving, FGM, lip and ear plating, tattooing, even botox. These are all deliberate alterations of the body in the name of beauty, wealth, or some other non-medical but very tribal reason.

    1. Yes – and none of these things should be done without consent – whether to infants or adults – unless there is an overwhelming medical need and no viable alternative.

      1. I’m not sure that consent makes any of these things more justifiable or palatable. Ask ourselves, what would someone be consenting to if not simple acceptance of the misplaced/misinformed and very often patriarchal traditions from where these arise. For example, foot binding was first introduced as a form of eroticism by Chinese royalty and the practice spread throughout China as a mark of status and beauty. Would it be ok for a woman to consent to having her feet bound, knowing the horrible conditions and medical issues under which she would live as a result? If the answer is yes, then none of the arguments against circumcision (or other practices) hold.
        And I’m not splitting hairs over people who choose to tattoo or split their tongue to “be counter-culture”. The real problem isn’t the actual mutilation, but rather the fact they are culturally imposed (through “tradition”, shame, or threat of violence/death) on people where consent would imply that there is value in one human mutilating another.

        1. I agree that these things can still be bad / regrettable even with consent. At the same time, they’re much worse when done to infants (who by definition can’t consent) or to adults without consent.

  3. “[P]os-modern epistemological relativism has infected students in the humanities and social sciences.”

    I am always a little concerned whenever someone implicitly compares ideas to diseases (referring to people being “infected”). As a previous Areo article has argued (https://areomagazine.com/2019/02/20/aesthetic-norms-germs-and-the-medicalization-of-ugliness/):

    “[W]hen disease risk is high, there will be more authoritarianism and xenophobia and a much higher tendency to pathologize and marginalize difference…[I]f you want to effectively ensure obedience to authority and group conformity, one key tool is to convince the population that they are being invaded by pathogens.”

    As such, the language of contagion is often used by those who want to restrict the free exchange of ideas.

  4. The fundamentalist prohibitionists strike me as unreasonable. They deny facts and they exaggerate harms.

    1. Do they exagerrate harms? Any surgery has risks and we know that the unplanned harms from circumcision can be very severe indeed up to death. These severe harms do not occur often but so many circumcisions occur that this is not insignificant. It has been estimated at around 100 per year (Van Howe 1997 & 2004, Bollinger 2010). Lesser complicatiosn are presumeably much more common but just as significant to the person concerned.

      Against these undoubted risks and harms we have no significant benefit, yes if you ampute anythinbg in principle that body part can no longer get cancer and perhaps a tiny protective effect against STDs but any such effest is tiny as can be seen by observing that the european mal epopulation is as least as healthy as the american.

      It seems to me the people denyong facts are the pro-circumcission advocates. Deaths and severe injuries do result from thsi procedure and for little or no benefit.

    2. You’re OK with an equivalent procedure being done on female babies then? Maybe the removal of part of the labia or the clitoral hood. You would be very relaxed about that?
      It’s a disfiguring procedure. A penis isn’t supposed to have part of it removed.

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