Circumcision is the cutting of the foreskin or prepuce away from the penis. Jews, Muslims, and some African tribes practice circumcision as a matter of religion and sometimes culture. Most Jews circumcise their male babies on the eighth day, but in some other cultures circumcision is performed at puberty and functions as a rite of passage to adulthood. Christians also practice circumcision, but usually for health, rather than religious, reasons. In the United States, routine, preventative circumcision of neonates peaked in popularity in the 1960s, when over 80 percent of male babies were circumcised. Gradually since then, many have come to believe that circumcision is unnatural and even harmful, and the percentage of male newborns circumcised has fallen to just over 50 percent.
In Genesis 17, God changed Abram's name to Abraham, and made a covenant with him that He would make of him a great nation. Sarai was to change her name to Sarah, and God promised that a male child would be born to her. Abraham's part was to ensure that every male within his household was circumcised and, going forward, that male children would be circumcised on the eighth day (Gen. 17:12). Over the centuries and millennia, circumcision came to be the definitive mark of Judaism. Because Christianity arose out of Judaism, worships the same God, and shares common Scriptures, the question naturally arose whether gentile converts to Christianity must be circumcised, as gentile converts to Judaism were. This issue was settled at the Jerusalem Council, narrated in Acts 15.
It is crucial to understand the issue decided at the Jerusalem Council: “Certain people came down from Judea to Antioch and were teaching the believers: 'Unless you are circumcised, according to the custom taught by Moses, you cannot be saved'” (Acts 15:1). The circumcision party was arguing that circumcision was necessary for salvation. Peter responded, “No! We believe it is through the grace of our Lord Jesus that we are saved, just as they are” (Acts 15:11). The Jerusalem Council ruled that gentiles do not need to be circumcised in order to be saved. The Council did not rule that God was being foolish when he made circumcision the symbol of His covenant with the descendants of Abraham, or that circumcision was a bad idea, or that no one should be circumcised.
The Apostle Paul was not anti-circumcision. He rhetorically asked what value there was to circumcision, and answered his question, “much, in every way!” (Rom. 3:1-2). Even after the Jerusalem Council, Paul had Timothy circumcised to allay the suspicions of the Jews he would be trying to bring to Christ (Acts 16:3) and be “all things to all people” (1 Cor. 9:19-23). Paul's detractors falsely accused him of teaching Jews not to have their children circumcised (Acts 21:21). So keen was Paul to counter that slander that he inadvisedly joined some Jewish men in purification rites at the temple, leading to his arrest and lengthy imprisonment (Acts 21:22-36). Paul's strong statements about circumcision in his epistles are directed at Judaizers who were teaching that gentiles had to be circumcised in order to be saved (Gal. 5:7-12; 6:12-15). Paul was forced to repudiate these false shepherds, or else see the gospel of faith in Christ replaced with a non-gospel of legalism, salvation by works of the flesh (Gal. 1:6-12; 3:1-14; 5:2-12).
Based upon the Jerusalem Council and the Pauline epistles, it is clear that there is no religious or ritual obligation to be circumcised. What counts for the believer is not physical but spiritual circumcision, circumcision of the heart, which consists of faith in Christ (Rom. 2:29; Col. 2:11) and obedience to His commands (Rom. 2:25-27; 1 Cor. 7:19).
But are there health benefits that make physical circumcision advisable? God is not arbitrary in his directives to mankind. Ellen White tells us that “the distinction between articles of food as clean and unclean was not a merely ceremonial and arbitrary regulation, but was based upon sanitary principles” (PP 562). And although the ceremonial laws, including the food laws, are not binding upon Christians (Mark 7:14-23; Rom. 14:14, 20; 1 Cor. 10:25-27; 1 Tim. 4:3-5, Titus 1:15), the health benefits of avoiding unclean meat are real, and the Christian who honors his body as God's temple should avoid meat from unclean animals. Many deadly diseases have taken their toll on mankind because humans use unclean animals for food; these plagues including the 1918 influenza pandemic from pigs, SARS from horseshoe bats and civet cats, Avian Flu from unclean birds mediated by pigs, and AIDS and Ebola from eating monkeys and fruit bats as “bushmeat.” How much suffering and death could have been avoided if only people observed God's sanitary principles regarding what meat is safe to eat!
By the same token, we should expect circumcision to have collateral health benefits. Just as God was not arbitrary in proscribing unclean foods, we would expect that He was not arbitrary in His choice of circumcision to be the sign of the covenant between Himself and Abraham. We would expect that there will be tangible health benefits of circumcision, and that is indeed the case.
Health Benefits of Circumcision
We must understand that God's directives are made with typical conditions in mind. There is little health benefit to circumcision under conditions where men can shower or bathe daily, and daily retract and wash under the foreskin. We take these conditions for granted in affluent Western countries with indoor plumbing, but in the whole history of the world, how often has this level of cleanliness been available? Significant health problems for the uncircumcised crop up when conditions are less than ideal. With infrequent washing, an unsanitary, germ-laden paste called “smegma” builds up between the foreskin and the penis.
Such conditions are prevalent in war, when soldiers typically go several weeks between showers. In the Second World War, some 150,000 American troops had to be hospitalized due to foreskin issues. General John Patton stated, “Time and money could have been saved had prophylactic circumcision been performed before the men were shipped overseas.” Many soldiers with only a minimal tendency toward phimosis—having a tight, difficult to retract foreskin—were likely to develop balanoposthitis, a bacterial or fungal inflammation of the foreskin and glans. Had these men been circumcised stateside, the problem would have been virtually nonexistent. Australia actually sent urologists to circumcise its troops fighting in North Africa.
During the first year of life, when the foreskin is difficult to retract, uncircumcised males suffer urinary tract infections at a rate ten times that of circumcised baby boys. Men who are circumcised as babies also have a substantially lower chance of getting penile cancer. Circumcised men are also far less likely to get and stay infected with the human papilloma virus (HPV), even after accounting for differences in sexual behavior. HPV, when transferred to female sexual partners, often leads to cervical cancer. A large, retrospective study of 15,000 infants found neonatal preventive circumcision to be highly cost-effective, considering the estimated number of averted cases of infant urinary tract infection, and lifetime incidence of penile cancer, balanoposthitis, phimosis, HPV and AIDS.
Circumcision and AIDS
Over forty studies have shown that circumcision dramatically lowers the risk of contracting AIDS. Three recent large-scale studies in Africa (Orange Farm township, SA, with 3,273 subjects, Kenya, with 3,000 subjects, and Uganda, with 5,000 subjects) have shown that circumcised men are roughly 50 to 60 percent less likely to contract AIDS than men with intact foreskins.
In an attempt to understand why circumcision so markedly lowers the risk of contracting AIDS, one group of researchers began a study on the microbiomes of circumcised versus uncircumcised men by swabbing penises and then developing cultures from the swabs. They found that circumcised men harbored dramatically fewer anaerobic bacteria, that is, bacteria that live in low oxygen environments. They also had 81 percent less penile bacteria overall compared to the uncut men.
As to why this reduction in bacteria halves the risk of AIDS, researchers hypothesized that a chronic high burden of bacteria disrupts the function of specialized immune cells known as Langerhans cells, which are present in abundance on the underside of the foreskin. Normally, Langerhans cells grab pathogens and present them to other immune cells for recognition as an invader to be destroyed, thus training the immune system. But Langerhans cells that are overwhelmed by chronic bacteria and inflammation of the foreskin begin presenting pathogens to normal cells instead of other immune cells, thus acting as a vector for the introduction of the immunodeficiency virus rather than as a defense against it.
Studies done in the United States, though on a smaller scale, have confirmed the results of the African studies. In one prospective study of heterosexual men attending an STD clinic, uncircumcised men were over three times as likely to contract HIV as circumcised men. In an analysis of clinic records of African American men attending an STD clinic, among heterosexual men with known HIV exposure, circumcision was associated with a 58% reduction in HIV infection.
No Loss of Sexual Pleasure
It is sometimes asserted that circumcision reduces the pleasure of the marital act, but the best evidence refutes this. A literature review by researchers at the University of Washington School of Medicine and the University of Sydney, published in November 2013, in the Journal of Sexual Medicine, surveyed 36 studies with primary data from over 40,000 participants. The meta-analysis found that circumcision had no overall adverse effect on penile sensitivity, sexual arousal, sexual sensation, erectile function, premature ejaculation, ejaculatory latency, orgasm difficulties, sexual satisfaction, pleasure, or pain during penetration. The highest-quality studies suggest that male circumcision has no adverse effect on sexual function, sensitivity, sexual sensation, or satisfaction.
Why Circumcise on the Eighth Day?
Why did God direct Abraham to circumcise newborn males on the 8th day? (Acts 17:12) Why so specific? Science now understands that vitamin K facilitates the liver's production of proteins that are essential to coagulation, or blood-clotting. Because of near-sterile intestinal tracts, newborn babies do not produce vitamin K, and hence exhibit a susceptibility to bleeding between. But during the fifth through the seventh days, vitamin K begins to be produced. One of the proteins essential to the blood-clotting cascade is prothrombin (a/k/a Factor II). By the eighth day, the amount of prothrombin present in the bloodstream is elevated above normal, typically the only day in the male’s life when this will be true. So by the eighth day, the blood-clotting mechanism is functioning well, reducing the risk of hemorrhage during the minor surgery of cutting off the foreskin.
It was once believed that babies did not feel pain, but most scientists now believe they do feel pain at a reflex level. When a child is born, the lower portions of the nervous system (the spinal cord and brain stem) are well developed, whereas the higher regions (the limbic system and cerebral cortex) are largely undeveloped. The lower brain controls behavior associated with babies: kicking, grasping, crying, sleeping, and feeding. The cerebral cortex is responsible for conscious thoughts, feelings, memories, and voluntary actions. The neurons in the cortex are not connected by synapses during gestation; the synapses are created during post-natal development, including a massive burst of synapse formation known as the “exuberant period.”
Additionally, newborns' brains contain little myelin, the impermeable substance that coats mature brain cells and is necessary for clear, efficient electrical transmission. The lack of myelin is the main reason why young children process information so much more slowly than adults. Myelination of the cerebral cortex begins in the primary motor and sensory areas and then progresses to higher-order regions that control complex integration of perception, thoughts, memories, and feelings.
These facts of developmental biology mean that a newborn, although possessing reflexes, has no ability to feel (in an adult sense), perceive, or remember the brief process of being circumcised. Keeping in mind that circumcisions would most often be performed in non-clinical conditions by midwives or other non-physicians, the best practice would be to perform the procedure before the baby has developed the ability to process perceptions and form memories, but after the blood-clotting mechanism is fully functional, and that is the eighth day. Clearly, a greater than human wisdom directed Abraham to circumcise on the 8th day.
Although Christians are not ritually obligated to circumcise, there are sound health reasons to do so. The health benefits of circumcision mean that it should be recommended as part of the healthy Adventist lifestyle, along with avoidance of tobacco, alcohol, caffeine and other stimulants, a vegetarian diet, exercise, rest, and fresh air. Preventive circumcision is especially important, even urgent, in areas where daily showers are not available, and in areas, such as Africa, where AIDS is rampant.
Modern science has amply verified God's foreknowledge and mercy in making circumcision the sign of His covenant with Abraham. Divine wisdom was manifested in the covenant of circumcision, and Christians today can still benefit from that wisdom.