An open wound: The heated debate surrounding circumcision

The medical benefits of circumcisions are not so convincing.

By TALI KORD
A ‘MOHEL’ holds a scalpel as he performs a circumcision (photo credit: RONEN ZVULUN/REUTERS)
A ‘MOHEL’ holds a scalpel as he performs a circumcision
(photo credit: RONEN ZVULUN/REUTERS)
In 21st-century secular Israel – in which a religious wedding ceremony, for instance, is no longer necessarily seen as a must – three main arguments can still be heard in favor of brit mila (the Jewish ceremony in which a baby boy is circumcised).
The first is the religious one, according to which the belief in God compels parents to circumcise their son.
The second argument can be called the societal one, raising questions such as, “What will my son’s friends and fellow soldiers think when they see him naked in the showers? Won’t they make fun of him, make him feel left out?” Also, “How will my own parents react?” and “Won’t it hurt his and my sense of belonging to the Jewish people?”
The third and final argument is the medical one, where researchers claim that circumcision is beneficial in reducing chances of contracting HIV, for instance.
Another, smaller argument is the one concerning “the question of aesthetics.” It was left out of the list as it holds no water on its own. Few parents would subject their days-old infant to purely cosmetic surgery.
Up to the not-so-recent past, you could say these arguments weren’t very relevant, in that there wasn’t really a discussion to be had. Nowadays, while having a brit mila is still very much the norm (it is estimated that fewer than 10% of Israeli Jewish boys are purposefully left uncircumcised; a more specific number is hard to find), more and more parents are starting to ask whether this ancient tradition still has a place in their modern lives.
Some consider the facts and opt for the ceremony, while others decide against it and brave the risks. Either way, the crucial fact is that questions are being asked.
The religious argument, in this regard, is no argument at all. It’s a binary fact: either you feel obligated to the brit or you don’t. That makes it the most obvious – and frankly, uninteresting – part of the discussion. But what about the other two arguments?
A hellish time
“During my first pregnancy, eight years ago, I was with my ex-husband, and we were living in a kibbutz in the Jordan Rift Valley. There weren’t many children there – and all girls,” says Lihi Bar-Haim, a freelance graphic designer from Haifa. “Then I discovered I was carrying a boy and one of the first thoughts that came up alongside this discovery was: ‘OK, what do we do about the brit?’ For most people there isn’t any question about it. But I knew I would have to give it a lot of thought.”
Bar-Haim says she spent the rest of her pregnancy reading and trying to understand the topic, using materials from both sides of the argument.
“The more I read, I just couldn’t find any relevant reason in favor of circumcision. I’m not religious and no other argument was convincing enough to make me say, OK, this is something I would cut my son for.”
Her husband at the time, however, did not see it the same way. The more sure she became of her opinion, the more they realized they were in serious disagreement over this sensitive issue. Her husband, she explains, felt the need to have the brit mila as a symbol of belonging to the Jewish people and of having that symbol in common with his son.
“We’re both left-wing, atheist kibbutzniks, yet he had this whole element of belonging he felt was important to him and I just couldn’t relate. I couldn’t understand why that sense of belonging has to come at the expense of his son’s genitals.”
As the birth neared, they fought over the subject, but ended up deciding – as a rule – that as long as they are in disagreement about something, they would choose the path that was reversible. They skipped the brit mila.
Bar-Haim says she didn’t really feel pressured by her family and friends on this, but comments did come along that surprised her.
“At some point my father told me: ‘don’t pursue your ideology at expense of the boy.’ That’s so funny – if anything at all is ideological here, it’s to cut his organs!” Still, any discussions that were had on the subject happened because she allowed for them – because she herself was in a dilemma, open to be convinced by either side. All was very civil and her family did not threaten her with any sanctions over the subject, but that has a lot to do with the fact that they had already dealt with the same dilemma once before.
Bar-Haim’s sister-in-law, Anat Kramarge, a special- education professional from Haifa, had a very different experience with her own son some 20 years ago. “My partner and I are secular. We had no religious wedding, we’re not people of faith.… We actually became a couple when we got pregnant by accident.”
When Kramarge had gotten pregnant, she and her partner Yoram didn’t know each other’s families yet. She knew his mother had died five years earlier and her own father died during her pregnancy, a month before the birth.
“When our son was born, both Yoram and I agreed we would not be circumcising him, because there was no reason in the world to abuse a baby. I do consider it a kind of abuse. At that point began an unbelievable amount of pressure from both families, who really wanted us to have a brit mila, with a lot of statements that were actually very hurtful.”
Kramarge says her mother told her that “[her] father would turn over in his grave,” while her partner’s family used his great-grandfather as a pressure point. “Yoram’s grandparents had lost their firstborn daughter, Yoram’s mother, a few years before; Yoram was their first grandchild and our son was to be their first great-grandchild.”
She loves her grandparents-in-law dearly to this day, says Kramarge, but their reaction to the circumcision issue made her very nervous. “The grandfather’s father was still alive at the time – 98 years old, a religious man who didn’t even need a walking stick or a hearing aid. The grandmother said to me: It would kill him. To take that enormous responsibility for hurting Yoram’s family so badly, plus my mother’s own hysteria over this… I went though a very difficult few weeks.”
Add to that how fast everything was moving – she was 30 at the time, her partner 25, they had only known each other a few months, and meeting his family for the first time – the pressure was just too much.
“After two weeks of endless phone calls I told my mother I couldn’t take it. That I would have the circumcision, but only at the hands of a surgeon.” The procedure was followed by a hellish week, says Kramarge. “I regretted it with every diaper change and seeing my son’s pain, because it does hurt. Before my second pregnancy I announced to everyone that there was no way in the world I’m circumcising again. Happily, we ended up having a daughter. But I was ready to fight if it came to it.”
At least one good thing came from the ordeal – it made Bar-Haim’s insistence easier when her own son was born, some 13 years later.
Risk management
Bar-Haim and her (then) husband divorced when their son was three years old. She since moved to Haifa, met her current partner, Doron, and recently had a second son. This time there was no room for discussion. She knew that she would not be circumcising him, and both partners saw eye-to-eye on the subject.
As for the other type of social pressure – the reactions the boys themselves might encounter – Bar- Haim insists it’s a complete non-issue.
“As a young child, he’s been seen naked in the beach, in the pool, he’s showered with friends, no one has even noticed the difference. I expected that question to come, but it never did.”
She’s not particularly worried about what they might face in army showers either, says Bar-Haim.
“I don’t think people are occupied with each other’s genitals – and if they are, we have a bigger problem than the question of circumcision.”
“The so-called social demon doesn’t really exist,” agrees Eran Sadeh, founder of the anti-circumcision website Gonen Al Hayeled (Protect the Child). “The children suffer no ostracism and no psychological damage. That’s nonsense. What does happen, and can be very difficult, is that the parents themselves go through a lot of pressure and attempts to convince them from their surroundings, which many times come to actual threats: We’ll erase you from our will, etc.”
According to Sadeh, pressure and ignorance are the two major problems when it comes to the brit mila.
“Parents tend to do a whole research on every little thing – they want to buy a new stroller, they research. But when it comes to circumcision, they find a mohel (a Jew trained in the practice of brit mila) with a recommendation and that’s it, they don’t want to know anything about it.”
Sadeh says once a parent starts reading about the surgical procedure and what it involves – and particularly what it involves when done by a mohel and not an actual doctor, for example the oral suction part – there’s a big shock. But many parents prefer staying in the dark.
“I tried talking to parents and I often encounter a fortified wall. They say, just drop it. We’re going to do it anyway so it’s best we don’t know too much.”
Sadeh sees this as a serious obstacle, precisely because he realizes that if anything is to change, it has to be through spreading knowledge.
“I went back and forth over the years with the thought of ‘should this be illegal.’ Having been trained in law and having worked in criminal law for two years, it was clear to me that there is a problem with taking the legal route. Having a brit mila tradition means we’re actively disobeying the law.”
As Sadeh sees it, there’s no need for legislation on this subject. “Circumcision is already technically illegal in that it is an assault on a helpless minor, and with a weapon no less. But no one else seems to make that connection.”
Or at least, few people do.
“I think [circumcision] is simply mutilation,” says Ronit Tamir, one of the founders of Kahal, a parents’ group for uncircumcised children and undecided parents who want to consult with them.
“A religious person who says God compels them to have this ceremony, I have no argument with them... Every person has the right to believe whatever they like. But a non-religious person doing that ritual of taking a baby and – for no medical reason – cutting in their flesh, that’s different.”
Tamir explains that she had looked into the medical benefits of circumcision and was not convinced by them. “There’s no other preventive surgery in the world done on children in this way, so that already raises suspicions.”
Furthermore, says Tamir in regard to circumcision as HIV-preventative, “It’s not as if you can count on it alone, you would still have to protect yourself with a condom, also because there are other sexually transmitted diseases you would have to look out for.”
She gives as another example penile cancer, which usually appears in particular on the foreskin.
“So people say, there, [brit mila] prevents penile cancer. But then the treatment for that type of cancer is circumcision anyway, so what’s the point of doing it in advance?”
On the other hand, considering the severity of HIV and cancer, doesn’t every little bit help?
“The advantages [of circumcision] should not be underestimated,” says Dr. Amos Neheman, director of pediatric urology at Assaf Harofeh Medical Center, who performs many circumcision procedures in his daily work. Neheman says the proof of this procedure’s benefits is unambiguous in helping reduce, among other things, chances of contracting HIV, HPV, penile cancer and various other infections and complications.
It’s hard to put it in actual numbers because odds of contracting HIV, for instance, depend greatly on whether you’re a part of the at-risk population. He gives as an example Uganda, where Israeli doctors were sent to perform circumcisions and managed to significantly lower HIV statistics.
Of course, Israel is nothing like East Africa – are those numbers even relevant to us?
“I recently met a department manager in a hospital in the Netherlands who is against the procedure because in Scandinavia hardly anyone gets circumcised and they’re just fine,” continues Neheman. “But you could also look at China – the Chinese don’t have brit mila. Do they have more medical penile problems then us? Yes, unambiguously so.”
All things considered, the question remains one of risk management. Are the benefits enough to warrant putting half the population of newborn babies through an irreversible surgical procedure?
For Tamir, the answer is no. She says since circumcision does not affect the person’s Jewish status, doesn’t actually benefit them socially and the medical benefits are small, the whole conversation is only justification for not questioning the norm.
“I think the discussion over health is just an excuse to make the whole thing easier to accept,” says Tamir. “It’s like they say not eating meat and dairy together is healthier, rationalizing mitzvot to make them easier to follow. But if you’re religious, why are you looking for external reasons?”
For Neheman, the answer is… maybe.
“I’m not a religious person at all, but I did circumcise my son, and if I had another son, I’d circumcise him too.”
But he doesn’t strongly promote it either.
“If you don’t want to do it, don’t. That’s your problem. If you do want to do it, fine, that’s also your problem. Everything has advantages and disadvantages.”
“I think the whole issue is more populistic than medical,” comments Neheman. “The proof exists and people continue to resist. The fervor around the subject can confuse a lot of parents and bring about anxiety. The American Academy of Pediatrics, which is a very strong and influential organization, phrases it in a very American way,” he says, quoting the AAP’s Task Force on Circumcision:
“Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks; furthermore, the benefits of newborn male circumcision justify access to this procedure for families who choose it.” At the same time, writes the AAP, “parents should weigh the health benefits and risks in light of their own religious, cultural and personal preferences, as the medical benefits alone may not outweigh these other considerations for individual families.”
Neheman explains this half-recommendation as a financial matter: the cost of treating HIV and penile cancer in a small fraction of the population versus the cost of paying for universal circumcision. In other words, the benefits of circumcision do justify giving parents the option to do it, but they’re not big enough to force or strongly recommend it across the board (unlike vaccinations, for instance).
Taking all the different arguments into account seems to leave puzzled parents right on the 50% mark. Circumcision has health benefits, but not tremendous ones (and nothing that medicine has no other solutions for). It probably will not affect the child’s life socially, but it certainly might drag his parents into a fight with their own families. It carries a religious and heritage meaning, but so do keeping Shabbat and separating meat from dairy, which most Israelis don’t do.
For a growing number of secular Israeli parents, the choice seems to be clear. But they are still very much a minority.
The rest will have to keep debating it for now.


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