Dear Dr. H,

I am a male, and I am very angry that, like most U.S. males, I was circumcised as a baby. I believe this is a very painful process and has taken away pleasure in sex. Why is male circumcision justified (“It’s cleaner”; “It looks nicer”, etc.) but female circumcision is illegal? How is this ethical?

Dear anonymous,

Wow, great question—so many layers! You are right: Male circumcision is common in the U.S., and this is a decision left mostly to the parents of babies (nearly 60 percent of newborns are circumcised). In that sense, I can sympathize that you feel violated that a decision was made about your body without your knowing. That being said, I do want to discuss the health impact of male circumcision and make important distinctions between male circumcision and female genital mutilation.

Male circumcision is the removal of some or all of the foreskin from the penis. Although there are some associated risks, these are greatly reduced when circumcision occurs on infants (vs. children) in a medical setting (versus outside of a medical setting) by a medical practitioner (vs. a traditional practitioner). In the U.S., circumcisions are done in this way, and a general numbing agent is used to substantially control pain. There are some reports of men experiencing a decrease in sensitivity during sex post-circumcision as adults; however, the Centers for Disease Control (CDC) finds the majority of research shows men report either improvement or no change.

Research shows that circumcision can greatly reduce the spread of sexually transmitted infections, including HIV, as well as the incidence of related cancers. The evidence is so clear that contemporary public health interventions for HIV reduction in high-risk areas now include widespread circumcision on newborn and adult males. For more, fascinating reading on this, please visit the CDC and search “male circumcision”.

So, why is “female circumcision” illegal? Recognizing the true nature of these practices, the term female genital mutilation (FGM) is now used to underscore the vast difference between the surgical procedure that is done on males and the violent procedure that is done on females.

Although it is illegal in the U.S., there are other communities in parts of the world that practice FGM as part of their culture.

We can argue male circumcision is done for health; we cannot state the same for FGM. Removing the clitoris of young girls robs them of their ability to experience sexual pleasure. Removing the clitoris and either all or part of their labia, as well as narrowing the vaginal opening by sewing it together, increases risk for infection, as well as the risk of death for both the mother and child during pregnancy.

FGM is not done for health reasons; it is done to disempower women. For more, devastating reading on this topic please visit the World Health Organization website and search “Female Genital Mutilation.”

On the topic of ethics, we trust parents to make many decisions for their children. If we have a safe and effective procedure to reduce the spread of STIs, including HIV, shouldn’t we implement it on a mass scale? This is similar to childhood vaccinations. Johns Hopkins Medical Center reports that male circumcision is actually on the decline – so there are parents out there that may feel more like you than you know.

However, a word from an expert: “Our economic evidence is backing up what our medical evidence has already shown to be perfectly clear,” says Aaron Tobian, M.D., PhD., of Johns Hopkins University School of Medicine. “There are health benefits to infant male circumcision in guarding against illness and disease, and declining male circumcision rates come at a severe price, not just in human surfacing, but in billions of health care dollars as well.”

If you’re ever in the position to make this decision for your child, perhaps you will make a different one than your parents. And that’s your right. Just equip your child with radically accurate and comprehensive sex education, so he has the skills, confidence, and resources to use condoms every time he has sex, to get regular STI screening and to discuss testing history with his partners.