Flawed Circumcision Defense: Dr. Paul Rein

As activists we’ve all encountered poorly thought out, often incomprehensible arguments advocating for non-therapeutic child circumcision. In their mildest forms, these merely conclude that parents should do what “works for their family”, as if all penises in the family belong to the parents. In their worst form, they’re clueless, uninterested in learning, and offer any number of bizarre justifications that defend the decision while remaining ignorant of basic facts. This essay by Dr. Paul Rein is built on the latter foundation, with the surprise of an irrational excuse for surgically altering healthy boys that I’ve never heard before.

After an introduction and a brief, incomplete history of circumcision, Dr. Rein quotes Genesis 17, including the bit about circumcising one’s slaves. In response, he writes:

… WOW, pretty powerful stuff when taken literally. So why do you think this “law” came about? For me, like Jewish dietary laws (sic) it was all about health. In days past, before modern times, food such as a pig was not considered ok to eat by the Jews because pigs were dirty, ate garbage and carried worms. Bottom feeders in the waters fall in the same category. Circumcision was a matter of numbers of complications for not doing it. Circumcision is done on day 8 of life for what reason? Is there something magical about day 8? It turns out that on day 8 of a boy’s life his blood clotting factors are normal, such that his risk for bleeding is less. In most countries of the world where babies are delivered in the hospital a circumcision if performed is done in the first couple of days and the babies are given a shot of Vitamin K which helps the blood clot, in other words it is a convenience to be done then. Surely the Jews figured out by trial and error that day 8 was the earliest, best and safest time to perform the circumcision. Most likely their dietary laws also discovered that eating pigs caused more illness than not eating them. So lets get back to circumcision.

This is conjecture. It shows the logic-optional framework upon which Dr. Rein is willing to build his conclusion on non-therapeutic child circumcision. I’d like to see citations for the number of complications throughout history “for not doing it”. But I can accept that without citations because it’s irrelevant to the more immediate question: what is justified today?

For example, whether or not there’s something magical about day 8 or the availability of Vitamin K may be interesting, but neither is a valid defense for circumcising healthy infants. Being convenient doesn’t make it acceptable. Any biological magic of a healthy human’s Day 8 ability to properly clot his blood still applies to his Day 6,574¹ ability to properly clot his blood. But, ethically, only one of those is valid.

When Dr. Rein begins to discuss risks of circumcision, he fails to include a complete list of objective outcomes. Some are possible and some are guaranteed.

… The risks include, pain on performing the procedure, bleeding and infection, irritation of the glans, increased risk of meatitis- which is an inflammation to the opening of the penis, injury to the penis during the procedure, and a belief by some that removing the foreskin decreases sexual pleasure. There are also some people who believe it is a violation of the child’s human rights because they did not consent to the procedure.

He should’ve mentioned that circumcision includes the risks of amputation and death. Those are rare, but if he’s not including the absolute risk of the maladies against which non-therapeutic circumcision is a prophylaxis, a full set of known risks should be included.

He should also state that circumcision leaves a scar. That could lead into an actual discussion of whether the male himself wants that, as well as the intended cost of the surgery, the loss of his foreskin. The foreskin is not, biologically, an inert afterthought. I’m not surprised he would omit this because I don’t think he understands this. But the burden is on him to be educated, not on others to defend why healthy, normal body parts exist.

His advice focuses into one key paragraph:

What is a FAMILY to do when they have a newborn boy? …

Celebrate and not cut his healthy genitals. This is what a family does when they have a newborn girl.

… As I have mentioned in the past it is up to you to make informed choices. You as the responsible adult who has had a child should make an informed decision. Educate yourself as to the benefits and risks remembering that most of the risks are small, but when they do happen to you they are 100% in your experience. Nothing is without risk and you weigh the risk versus the benefit. …

Being the “responsible adult” does not mean that option is valid. Tradition does not justify its imposition. The possibility of benefits, the “responsible adult’s” subjective minimization of the risks involved, or the doctor’s omission of the full costs also fail as justifications. The surgical alteration is not medically indicated or necessary. That is the sole relevant information. Where circumcision is being imposed on another who can’t consent, only medical need can justify it.

… Regarding circumcision if you choose not to have your child circumcised and as an older boy or adult he needs to be circumcised the risks increase. The risk of surgery such as pain, bleeding and infection are higher for older boys and men. …

This logic could be applied to any non-therapeutic surgery one might choose to force on a healthy child, primarily with respect to pain. The claimed inability to remember the pain as an infant does not mean the infant does not experience the pain. As an adult, the individual has the choice to use sufficient pain management. It’s also worth noting that actual need for circumcision is rare. Where an adult male’s circumcision is optional, his preference for the possible benefits demonstrate that he values them more than the costs, including the pain. Infants don’t get that choice.

… If you believe that the pain of a circumcision is traumatic to the child and affects him for the rest of his life then don’t do it. To that I say, c’mon. A newborns brain is immature and the few seconds to minutes of crying is no more traumatic that a night of crying from colic. Does that baby who has colic from a formula become so traumatized that he never wants to drink from a bottle? …

Dr. Rein’s lack of concern for the child and what he may experience from unnecessary surgery is scary. Is “c’mon” the scientific term for a newborn’s pain coping mechanism?

… Arguments such as decreased sexual pleasure from a man’s point of view are pretty tough to make. Do you really know any guys who say, geez I wish ….?

Here I am: Geez, I wish I had my foreskin. I am not alone. Dr. Rein should research the topic before he mocks opinions he does not understand. Research would allow him to reject his own incorrect ideas that are easily refuted.

It gets worse:

… Another thing to think about in making your decision is are you a single mother having this child? Little boys, 5 and up are probably not inclined to have their mom making sure that they are practicing proper hygienic techniques and in light of the fact that the USA has the highest rate of single parent homes in the western world that might be something you want to consider. …

Yeah. I thought I’d heard all the dumb arguments. I’m not pleased to know that more creative stupid excuses develop. Raising children involves teaching them proper hygiene and setting expectations for maintaining that throughout childhood. Dr. Rein’s suggestion is nothing more than telling parents (i.e. the “responsible adults”) it’s okay to abdicate their parental responsibilities because that responsibility is too uncomfortable.

To put it in a different perspective, as someone stated in the comments section of the essay, would it be legitimate to suggest that single fathers have their daughters’ genitals cut because it would be too uncomfortable to monitor their hygiene? Even if I accept the incorrect suggestion that forced, non-therapeutic female and male genital cutting don’t involve the same rights (and ethical) violation, the underlying implication of Dr. Rein’s statement is that parents should act against their child if it’s more convenient for them to do so. All other considerations be damned. It’s about the parents, not the patient. That’s unethical, anti-science nonsense.

Dr. Rein addresses the human rights point, badly:

… Finally the human rights issue is in my opinion a weak argument. As parents we are making many decisions for our children. Children don’t get to make too many medical decisions including vaccinations and antibiotics that are often forced on them when they don’t need them.

This decision is not like other decisions. It’s the unnecessary surgical alteration/reduction of a child’s body in pursuit of subjective outcomes based on someone else’s preferences. Parents vaccinate to protect their children, so, yes, in that limited non-useful manner, vaccinations and non-therapeutic circumcision can be viewed the same way. But the same thing could be said about comparing vaccinations to removing the healthy breast buds of a girl whose family has a history of breast cancer. There has to be more for it to be intelligent and useful. So, vaccinations work to build the body by using its natural mechanisms. Circumcision simply removes a body part that may develop a future problem. Dr. Rein’s comparison is invalid.

If Dr. Rein thinks that the irresponsible use of antibiotics by parents is a defense of the irresponsible use of circumcision, he’s more interested in establishing defenses for his pre-determined conclusion than reaching a conclusion based on facts and logic. I’m going with that because I read his essay. He didn’t provide any evidence for me to conclude otherwise.

¹ Or Day 6,575…