The Truth About Circumcision and HIV: A Conversation with Marilyn Milos, R.N.
“80-85% of all the males in the world are intact. The fact that all these
intact males aren’t running around with infected penises should be our
first clue that Mother Nature made no mistake.” —Marilyn Milos, R.N.
By Cat Saunders
Marilyn Milos and I have been allies in the fight against involuntary infant circumcision for many years, long before we knew each other personally. Although my first article against circumcision was published in 1988, I didn’t find out about Marilyn’s work until 1995, when I was researching another piece about it.
Since then, I’ve been constantly in awe of Marilyn’s lifelong commitment to protect babies all over the world from genital surgery performed on them against their will. She believes, as I do, that all infants—boys and girls alike—have the right to preserve the natural integrity of their own bodies.
In 1985, Marilyn founded NOCIRC, which stands for the National Organization of Circumcision Information Resource Centers. In the years since NOCIRC’s inception, Marilyn has worked tirelessly and courageously—even in the face of death threats—to fulfill her mission. In January 2016, NOCIRC became Genital Autonomy America, with Marilyn as its Executive Director.
By introducing you to Marilyn as the founder of NOCIRC and Genital Autonomy America, I am purposely exposing her bias to you up front. That way, you will know in advance that this interview is expressly designed to give more support to the “other side” of the controversy surrounding circumcision and HIV.
Unfortunately, there is a great deal of misinformation about circumcision, both in general and in regard to the issue of HIV and AIDS. Although I, too, am biased in the direction of infant rights, I know I can rely on Marilyn to help me separate the facts from the hype. She can be trusted to address all questions and concerns with honesty and an open heart, no matter how skeptical or outlandish or even “anti-baby” those questions might seem.
With a level of patience I’ve rarely seen in anyone, Marilyn understands the importance of dealing gently and respectfully with people’s fears and concerns about infant circumcision. She knows that it helps no one to personally attack those who support it. What works is to address all concerns with clarity and calm, to offer education in the face of fear, and to stay focused on the goal, namely, the protection of all babies everywhere.
In the following interview, Marilyn talks in depth about the recent controversy surrounding circumcision and HIV, not only in this country, but in countries around the world. She also provides a brief history of the practice of circumcision; she discusses the issue of human rights as it relates to genital cutting; and she graphically describes a “routine” circumcision in America.
In addition, Marilyn educates us about the effects of male circumcision on human sexual function. The interview also provides links to several Web sites and other informational resources, including free online videos of live circumcisions for those who are willing to witness what actually happens behind closed doors.
In offering you this interview with Marilyn, I realize that the subject matter is intense and interwoven with deeply rooted socio-religious beliefs and conditioning. Because of this, I also realize that the interview may be difficult to read without getting upset or going numb.
Therefore, I want to convey my deepest gratitude to those of you who are willing to read this interview with an open mind and an open heart, not only for the sake of your own education, but for the sake of compassion and for the sake of babies everywhere.
Cat: What is the current rate of male infant circumcision in the United States and how many adult American men are already circumcised?
Marilyn: The rate of circumcision in the U.S. is 52.5% as of 2006, the last year for which we have statistics. Unfortunately, these statistics are probably unreliable, because no one is actually keeping accurate medical records of circumcisions, or the complications from circumcision, or the number of deaths resulting from circumcision.
That 52.5% figure is reportedly the national average for our country. However, in the western United States, the circumcision rate is much lower. For example, California’s rate is down to about 20% now.
Cat: Which countries have the highest rate of male infant circumcision and which countries have the lowest?
Marilyn: Again, it’s difficult to ascertain exact figures. Depending on the country, circumcisions are performed in hospitals, in homes, in synagogues, in back street alleys, and in the bush. Today, it is predominantly North Americans, Muslims, and Jews who circumcise, and more recently, South Koreans have joined the list because of our country’s presence there.
South Korea may actually have the highest rate of circumcision in the world right now, because they circumcise not only their babies, but also the males who were not circumcised at birth. Fortunately, there is a NOCIRC Center in South Korea and its directors are working hard to overcome the problem there.
Circumcision is also practiced as a puberty rite in the Philippines and in some Australian aboriginal tribes. As for the rest of the world—including Europe, Asia, Russia, and South America—circumcision is not generally practiced, and for the most part, it never was. It’s important to note that the vast majority of the world’s men—80 to 85%—are not circumcised.
Cat: How does the U.S. rate of circumcision compare to our HIV-infection rate? And how do our statistics compare to those in countries with higher or lower rates?
Marilyn: The United States has the highest rates of both circumcision and HIV in the developed world. The majority of people who have died from AIDS in the United States were circumcised.
In contrast, Europe and Japan—which generally do not practice circumcision—have low rates of HIV.
As of November 2008, the breast cancer incidence for women in the United States is about 1 in 8 (13%). When I hear officials at the Center for Disease Control (CDC) talk about trying to prevent HIV by removing the foreskins of all baby boys, it sounds as crazy to me as removing baby girls’ breast tissue at birth as a way to prevent breast cancer.
In fact, breast amputation to prevent a deadly disease actually makes more sense than the removal of the foreskin, because the absence of breasts does prevent breast cancer, but the absence of a foreskin does not prevent HIV. Even so, I don’t recommend either one!
Cat: Does the CDC have the authority to override personal rights for the sake of public welfare, or can they only make recommendations for or against a procedure such as infant circumcision?
Marilyn: I don’t know anything about the parameters of authority for the CDC, but our new organization, Intact America, is watching that organization closely. The idea of promoting non-therapeutic foreskin amputation of newborn boys to prevent a sexually transmitted disease later in life defies logic.
If babies are left intact as Nature intended, parents would have more than a decade to educate their sons about the dangers of HIV/AIDS and the importance of safe sex and condom use. It’s obviously more logical—not to mention more humane—to wait until boys are old enough to make their own decisions about their bodies, rather than impose genital cutting on them against their will when they’re too little to resist or escape.
After the CDC’s August 2009 conference on the subject of circumcision and AIDS—and following Intact America’s objection to their promotion of circumcision as a preventative to AIDS—the CDC backed down a little. They issued a statement saying they haven’t yet made a determination, and further, that any recommendation they did make would be completely voluntary.
Let’s get one thing straight here: Babies do not volunteer for circumcision!
Cat: Regarding any potential revisions of the CDC’s policy about circumcision, a formal draft of which is due by the end of 2009, who gets to make the final decision about its recommendations?
Marilyn: After the CDC’s committee comes up with its new recommendations, their legal team and executive board would likely do a review. But in the end, as far as I know, the CDC has the final say on its own recommendations, without oversight or veto power by any other governmental group.
Bob Van Howe, M.D., addressed the CDC committee about the benefits of safe sex, the 98% effectiveness rate of condoms, and the fact that condoms are 95 times more effective than circumcision in preventing the transmission of AIDS. Epidemiologist Lawrence Green, Ph.D., invited his CDC colleagues to join him for a discussion about flaws in the African studies, pointing out that there is not enough evidence to promote circumcision to prevent the spread of AIDS.
I’m not sure either one of them got very far with the CDC, because the dominant paradigm, the current Western medical model, and the status quo still pushes for infant circumcision.
I wonder how many circumcised males sit on that CDC committee, wanting desperately to believe that circumcision—their own and their loved ones’—is a good thing? How many CDC committee members are mothers of circumcised boys, and might these mothers also need to justify their decision not to leave their sons intact?
In the face of this country’s prevailing attitudes that still support infant circumcision, our message about its harmful effects is obviously not a message most people want to hear. Nevertheless, the truth must be told to make change possible.
Cat: In a New York Times article by Roni Caryn Rabin reprinted in The Seattle Times (“U.S. Considers Endorsing Circumcision to Fight HIV”), the author discusses circumsion rates for Blacks and Hispanics, along with their HIV infection rates, and then compares these rates to those for white men. That part of the article was confusing to me, so I wonder if you could help?
Marilyn: Rabin’s claims in that article are a bit confusing because they aren’t quite correct. It’s true that Blacks in this country didn’t used to practice infant male circumcision, but with the advent of Medicaid’s funding for it, Blacks could and did begin to circumcise their baby boys. Sadly, circumcision for Blacks became a sort of status symbol.
Today, the circumcision rate among Blacks in the United States is actually higher than it is for Whites, who (in this country) have become more educated on the topic and, therefore, have increasingly stopped allowing this non-therapeutic, debilitating surgery on their infants.
In regard to Hispanics, it is true that they don’t generally practice circumcision, but Rabin is incorrect about their HIV rates being disproportionately higher than it is for Whites. In point of fact, the incidence of HIV/AIDS among Hispanics in this country is low.
Cat: Given that we now have a Black man in the White House, do you know if President Obama has taken a stand on this issue yet?
Marilyn: No, I don’t think he has. However, given Obama’s gentle nature and the fact that his father was from the non-circumcising Luo tribe in Africa, I suspect he’s intact.
I’ve written personally to Michelle Obama about the issue of protecting infants and children from non-therapeutic surgery, but I only received a form letter in return. I will definitely write again. Hopefully, both Michelle and Barack Obama will stand up in defense of all children.
Although this interview is primarily focused on male circumcision, the truth is that involuntary genital cutting is also a serious problem for girls. According to statistics reported by Nicholas Kristof and Sheryl WuDunn in their new book, Half the Sky: Turning Oppression into Opportunity for Women Worldwide, every ten seconds a girl’s genitals are cut, usually by a woman with no medical training and usually without any anesthetic.
Cat: For those who aren’t familiar with the main arguments of the African studies about circumcision and HIV, would you describe them?
Marilyn: In Africa, three randomized control studies (RCTS) were conducted to determine whether or not circumcision would stop the spread of HIV. However, there were countries in Africa that had a high prevalence of both circumcision and HIV that were not mentioned in these studies.
These studies are suspect for many reasons, including questionable methodology, a lack of control for ethical concerns and biases, sample numbers so small as to be practically meaningless, vast numbers of participants lost in follow-up, and results being tallied before the data properly converged. In addition, their findings are at odds with nearly all similar studies for the last 20 years, and no mention of this fact—or any rationale to explain it—was included in the African studies.
It’s important to note that women are actually more at risk of HIV infection if their partners are circumcised. Surely, those who blindly promote male circumcision as an HIV preventative aren’t intentionally trying to protect one gender at the sacrifice of the other, are they?
Cat: I know you’ve been working closely with the United Nations and other human rights organizations to debunk the conclusions of the African studies since they were first released. Can you synopsize NOCIRC’s main counterpoints to the conclusions of those studies?
Marilyn: In addition to the objections stated above, there are other problems with the African studies. For example, the spread of HIV/AIDS has already been successfully curbed in Thailand, Senegal, and Eastern Uganda, whose governments have aggressively promoted educational campaigns about the danger of HIV/AIDS, emphasized the importance of safe sex and condom use, and distributed free condoms. Circumcision isn’t even mentioned in these government campaigns, because it doesn’t help!
The truth is, circumcision is a deadly distraction to the AIDS issue. Because of recent misconceptions about circumcision being useful as an HIV preventative, many circumcised men have come to believe that they don’t need to use condoms. This is obviously a serious situation because unsafe sex inevitably contributes to the spread of HIV.
Cat: In an interview I did with you in 2002 (see end of article for link), you offered a brief “tour” of the common myths that have been used to perpetuate infant male circumcision over the last 150 years. Would you share that information again here for people who didn’t see our previous interview?
Marilyn: As early as 1860, when only .001 percent of the urban American male population was circumcised, articles began to show up in medical literature touting circumcision as an extremely painful operation purposely done without anesthesia, in hopes of serving as a preventative to masturbation, because masturbation was believed to cause disease. Of course, it didn’t work.
By the turn of the century, the microscope had been developed and the germ theory of disease became the new medical model. Fear of bacteria and lack of hygiene, then, became the next excuses to circumcise.
During the 1930s, fear of penile cancer kept circumcisers in business. That idea persists today, even though we know that the penile cancer rate in circumcising America is the same as that in non-circumcising Denmark or Finland.
The fifties brought the fear of cervical cancer, but now we know that cervical cancer is caused by the HP virus, not by foreskins. The sexual revolution of the sixties brought the fear of sexually transmitted diseases, which we quickly learned were not prevented by circumcision.
During the 1970s, people began to challenge medical practices such as routine tonsillectomies, radical mastectomies, routine episiotomies, and routine infant circumcision. When medical excuses for circumcision proved invalid, the next fabricated excuse was an emotional one: “You don’t want your son to look different from the other boys, do you?”
The latest fear—one that Western pro-circumcision advocates are trying to promote in Africa—is the alleged role of the foreskin in the spread of HIV/AIDS. However, this preposterous notion is easily debunked by the fact that the USA has one of the highest rates of both circumcision and HIV/AIDS.
Obviously, if circumcision prevented the spread of AIDS, our country would not have the highest rate of HIV infection in the developed world.
Cat: Were there any uncontrolled factors involved in the African studies—such as poverty, health care issues, education, or lack of access to clean water—that might explain why the uncircumcised men in those studies were more susceptible to HIV infection?
Marilyn: Yes. At our Padua symposium in 2006, Dr. Leo Sorger and his wife Elizabeth Noble spoke about their trip to Africa, where they visited medical facilities across the continent. They witnessed the terrible toll of malnutrition, tuberculosis, and malaria, as well as some cases of HIV, which was not the major concern in those countries.
They also saw how money was being poured into African countries to help, but very little of it was reaching the people. Instead, government officials were living the high life and obviously abusing funding allocated for suffering individuals. This is truly an atrocity.
Cat: Over the years, I’ve read various studies that say circumcision does not prevent HIV infection in men who have sex with men. If that’s true, what’s the reason?
Marilyn: It’s the same reason that circumcision doesn’t prevent HIV infection for anyone.
The bottom line is that circumcision does not cut off enough of the penis to prevent anything—and obviously, nobody wants to cut off the whole penis to prevent the spread of AIDS!
There are better ways to prevent disease than amputating body parts. Education is the first step.
Cat: If it’s true that gay sex is indeed one of the primary avenues of HIV transmission in the United States, and if most American males are circumcised, why are public health officials here ignoring this fact as they consider the possibility of endorsing infant male circumcision as an HIV preventative?
Marilyn: There is big money involved in bringing an end to HIV/AIDS. Follow the money trail! Think about all the medical professionals involved in so-called “routine” non-therapeutic circumcisions at a few hundred dollars a baby.
Think about all the new disposable circumcision devices being promoted for sale, not only here in the United States, but also worldwide. Imagine how much money these companies could make if they had customers in every country—even in the outback of Australia or in the African bush!
I don’t mean to sound cynical, but I wonder who has purchased stock in these companies. That would be a productive line of inquiry!
Unfortunately, money still rules the day in many areas of life, including the area of disease prevention. Sometimes even the flimsiest of studies can be used by greedy individuals and corporations to promote their products and services, so they can make as much money as possible for as long as possible.
Fortunately for people, and unfortunately for greedy corporations, the true solution to the AIDS crisis is safe sex and condoms. Condoms are 98% effective and 95 times more cost-effective than circumcision. Universal circumcision is not the answer!
Urologist James Snyder, M.D., who is a member of NOCIRC’s board of directors, has this to say about the insanity of circumcising men to prevent HIV: “When all males are circumcised, only circumcised males will get HIV/AIDS!”
Cat: In the aforementioned article by Roni Baryn Rabin, she quotes Dr. Peter Kilmarx, who is the chief of epidemiology for the CDC’s division of HIV/AIDS prevention: “We have a significant HIV epidemic in this country and we really need to look carefully at any potential intervention that could be another tool in the toolbox we use to address the epidemic. What we’ve heard from our consultants is that there would be a benefit for infants from infant circumcision, and that the benefits outweigh the risks.”
Marilyn: That statement is downright absurd. For one thing, those “consultants” never mention how circumcision affects the infant. Circumcision is a primal wound that interferes with the maternal/infant bond, it disrupts breastfeeding and normal sleep patterns, and it seriously undermines the infant’s first developmental task of establishing trust.
Those consultants also refuse to consider the important structures and functions of the normal penis and how the loss of the foreskin affects its owner. They never talk about how circumcision affects the man the baby becomes, nor do they seem to have any idea about the benefits of the foreskin in regard to health and sexual pleasure. Instead, they rely on flawed studies to perpetuate the status quo and protect those who perform unnecessary and cruel sexual surgeries on nonconsenting minors.
Since the 1970s, the American Pediatric Association has advised against routine infant circumcision and their highly regarded medical opinion contributed greatly to the decrease in American circumcision rates.
Now it appears that they, too, are considering revising their guidelines to encourage circumcision, saying it has various health benefits. Is it true that infant male circumcision reduces the risk of urinary tract infections or the risk of STD infections later in life?
The urinary tract infection (UTI) studies of the 1980s were scientifically flawed and have since been completely refuted. Both baby girls and boys get urinary tract infections and antibiotics are given to both genders. Circumcision isn’t necessary to prevent UTIs.
STD infections are rampant in the United States, where the majority of sexually active men are circumcised. In other words, it is simply not true that circumcision reduces the risk of urinary tract or STD infections.
Cat: I know you’ve heard me state my opinion about circumcision in these crude terms before. That is, if foreskins actually contributed to the spread of infection, there would be a lot of animals running around with infected penises!
Marilyn: The same could be said for the majority of men on this planet! The fact is, 80-85% of all the males in the world are intact. The fact that all these intact males aren’t running around with infected penises should be our first clue that Mother Nature made no mistake.
Cat: Do you know if the CDC is listening to the “other side” of this controversy, in terms of giving a fair hearing to physicians, public health officials, and human rights organizations that refute the conclusion of the African studies and advocate leaving babies intact?
Marilyn: Well, they’ve already recanted their position of “considering recommending circumcision” when they said recently that they haven’t yet made a determination, and that any recommendation they do make would be completely voluntary. Remember, babies do not volunteer for circumcision! We are closely watching the CDC because it’s a governmental agency, so it can and should be held accountable to the people.
Cat: For those who don’t know, would you describe what happens during a “routine” infant male circumcision in America?
Marilyn: As a nursing student, when my youngest son was ten, I saw a circumcision for the first time. I haven’t gotten over that experience. I never will. It was May of 1979. We students filed into the hospital nursery to find a baby boy strapped spread-eagle to a plastic board on a counter top. He was struggling against his restraints—tugging, whimpering, and crying helplessly.
When the doctor began the operation, the baby let out a piercing scream—his reaction to having his foreskin pinched and crushed as the doctor attached a clamp to his tiny penis. The infant’s shrieks intensified when the doctor inserted an instrument between the foreskin and the head of the penis, tearing them apart.
Then the baby started shaking his head back and forth—the only part of his body he could move—when the doctor used another clamp to (lengthwise) crush the foreskin, which he then cut. This made the foreskin opening large enough to insert a circumcision device designed to prevent the head of the penis from being severed during the surgery.
During the last stage of the operation, the doctor crushed the foreskin against the circumcision device, and then, finally, amputated it. By that time, the baby was limp, exhausted, spent.
To see part of a baby’s penis being cut off—without anesthesia—was shocking. Even more shocking was the doctor’s comment, barely audible under the piercing screams of the infant: “There’s no medical reason for doing this.”
Even today, the majority of boys in the USA are circumcised without analgesia, even after all the studies that have been done to document how pain and trauma affect newborns. Studies done in 1987 to determine the effects of pain on babies used circumcision as the determinant.
It took the American Academy of Pediatrics another 12 years before it acknowledged infants’ pain and the need to use analgesia for circumcision. That we continue to circumcise babies today, in the face of overwhelming evidence documenting its harm, is unconscionable!
Cat: It breaks my heart to hear people advocate infant circumcision as if it’s no big deal for babies, as if it’s only a public health issue that overrides all other considerations, and as if it has no effect on men’s intimate relationships later in life.
I don’t want this interview to end without at least mentioning how circumcision affects sexual function in adult males, which of course affects their partners as well. Although I realize there are ramifications from circumcision for all kinds of sexual activity, including masturbation, feel free to answer this question in terms of heterosexual sex and let people extrapolate for themselves from there.
Marilyn: The foreskin of an intact penis has a ridged band just inside and encircling its opening. This ridged band contains Meissner’s corpuscles, which are like nerve receptors in the fingertips.
During sexual stimulation of the penis, the foreskin’s exquisitely sensitive interior band of nerve receptors glides back and forth across the corona of the glans (the head of the penis), which itself has a high concentration of neurovascular end organs.
Thus, the foreskin and the glans stimulate each other. The loss of this foreskin-glans stimulation is probably why men who are circumcised as adults say the difference is like seeing in black and white, rather than seeing in color.
During heterosexual sex, the intact penis is stimulated both by the vagina and this foreskin-glans action. Therefore, the movements an intact man needs for stimulation are small. Circumcised men, however, must stimulate whatever is left of the frenulum (the area on the underside of the penis where the foreskin is attached to the glans) in order to reach orgasm. The long strokes necessary to stimulate the remaining frenulum take the man’s body away from the woman’s mons pubis (pubic mound), so her clitoris isn’t stimulated.
Thus, the movements necessary for a circumcised man to reach orgasm are not compatible with the movements a woman needs to reach orgasm. No one talks about this potential cause for deep tension in relationships. However, it’s important to understand that the natural mechanics of sex are disturbed when men are circumcised, and movements during sexual relations must be adjusted to compensate for genital alteration.
Cat: If circumcision is such a great idea, and if people really believe its benefits are irrefutable, why do they insist it be performed on infants against their will, instead of letting people choose it for themselves as teenagers or adults?
Marilyn: Circumcision is done to babies because it can be done to babies. If anyone put an adult man in four-point restraints and then, without any anesthesia, tried to cut off the most sensitive part of his penis, do you think he would allow it? Of course not!
Babies do everything they can to resist, but they’re tiny and they don’t have a chance against the adults who are restraining them and forcing the surgery on them. The infants’ violent thrashing and their desperate screams for help go unheeded. It’s unnecessary and barbaric, and if anyone doesn’t think so, they should at least watch a video of a so-called “routine” circumcision to see for themselves what is happening behind closed doors (see end of article for more information about circumcision videos).
Circumcision is not a nice thing to do to a baby or to the man he becomes. Circumcision is not a medical issue. No national medical organization in the world recommends circumcision. Circumcision is a human rights issue, pure and simple.
Does a baby have a right to his own body or doesn’t he? I believe he does!
Cat: For those who would like to protect babies from infant circumcision, would you suggest some specific actions they can do to help?
Marilyn: For those who want to help protect babies from non-therapeutic circumcision, the first thing to do is to become educated on the topic yourself. You can visit www.gaamerica.org and read the highlighted items on that site. Then, if you have questions, you can visit our library at www.cirp.org. Our library has a search function, so you can readily get answers to any questions you may have.
To learn more about circumcision’s history, background, and other important facts, you can visit www.circumstitions.com. If you have more questions about the latest excuses to circumcise—namely, the misconception that it can prevent the spread of STDs, including HIV/AIDS-please visit www.CircumcisionandHIV.com.
Also, because the CDC is now thinking about recommending male infant circumcision, one very important thing you can do right now is to sign the petition to stop the CDC from making this recommendation. It only takes a moment, and you can easily do it online at www.IntactAmerica.org.
For those who are able to contribute financial support, tax-deductible contributions to Genital Autonomy America and/or Intact America can help us with our campaign to end non-therapeutic circumcision of nonconsenting males.
Once you’ve become educated about circumcision, just talk, talk, talk! Talk to your friends, talk to your family, talk to your doctors and nurses, talk to anyone who will listen. If you’re worried about offending somebody, remember the babies! They can’t speak for themselves, so it’s up to us to speak for them.
We have to help educate people so everyone knows why it’s important to protect our infants and children from unnecessary genital cutting. All babies and children need to be loved, respected, and protected—and it’s the job of adults to protect all children until they are old enough to protect themselves.
This interview was originally published in 2009 and updated in March 2017.
Additional Information and Resources: gaamerica.org, www.cirp.org, www.noharmm.org, www.circumstitions.com, www.IntactAmerica.org, and www.CircumcisionandHIV.com all have extensively researched sites to answer all your questions about circumcision.
Several different videos of live circumcisions are also available for online viewing through www.circumstitions.com. The home page of this site has an overwhelming array of links, so be ready! Scroll down until you see a highlighted box that includes links for various videos of live circumcisions. Note their warning comments about which videos are not for the squeamish. And if a video makes you squeamish, just think about the poor infant who is experiencing what makes you squeamish!
For detailed descriptions, diagrams, and photographs of foreskins, including a moving picture of a real foreskin in action, please visit noharmm.org/anatomy.htm.
Some of Cat’s other articles and interviews about circumcision are reprinted on this website at the links below:
Cat Saunders, Ph.D., is a counselor in private practice in Seattle, Washington. She is also the author of Dr. Cat’s Helping Handbook: A Compassionate Guide for Being Human (available through Amazon). Contact Cat by emailing her or by calling 206-329-0125 (24-hour voicemail).