Circumcision: can any rational thinker defend it ?

[Skeptic Ginger]

I am going by my extensive review of the medical literature. There is unequivocal evidence HIV risk is decreased considerably. The other medical benefits are small but favor circumcision. Look over the sources I cited.

If you have current sources that come to different conclusions, post them. I am an evidence based health care provider. Evidence is always subject to mount in wavering directions. The most current research (not opinions now, but research) favors circumcision in terms of pure medical outcome.

When the risk of HIV is low, the benefit of circumcision is not large enough to mean one should recommend it over the parent's wishes. OTOH, for a completely neutral parent, you tell them what the medical research shows and discuss what some people believe about the negative effects on sexual pleasure. From there it is a individual choice.

If the child is at high risk of HIV exposure then I would highly recommend circumcision to the parents. Kids have sex before they become responsible decision makers. It's simply a fact of life.

[Skeptic Ginger]

It will take me a while to look at your citation, someguy.

[robinson]

Male circumcision overstated as prevention tool against AIDS

In new academic research published today in the online, open-access, peer-reviewed scientific journal PLoS ONE, male circumcision is found to be much less important as a deterrent to the global AIDS pandemic than previously thought. The author, John R. Talbott, has conducted statistical empirical research across 77 countries of the world and has uncovered some surprising results.

http://www.physorg.com/news101559563.html

Circumcision does away with the most sensitive parts of the penis

June 16 : A new study has found that what boys lose in the process of circumcision turns out to be the most sensitive parts of the penis.

The long-term-health impact of neo-natal circumcision has received little study, while the consequences of circumcision on sexual function in the adult male have received even less attention.

(more at link)

http://www.ebiologynews.com/2154.html

One could argue forever about the science of it all, but the bottom line still stands. It is woo. It is based on Religion, not science.

And if you don't have a penis, shut the hell up about it.






heh

[Ivor the Engineer]

I guess it depends upon how strongly physicians feel about their role in shaping cultural traditions? Or maybe it reflects the fact that we all tend to be products of our environment? The idea that physicians can refuse requests for treatment is relatively recent. I'm trying to think of something relatively equivalent....maybe growth hormone supplementation?

I tend to think it has more to do with culture than the evidence of benefit. Being applied scientists, physicians should evaluate the evidence and recommend either (a) All infants should be circumcised or (b) Infants should be circumcised when it is medically indicated. This would be consistent with all other preventative treatments, including the examples you gave: vaccinations (a/b), braces (b) and tonsillectomies (b).

Why is this of interest to you? My personal threshold is quite low, but my public threshold is much higher. I tend to be someone that is reluctant to impose my opinions onto others, so I usually require a moderately strong reason to do so. Plus my ethical consideration of others is strongly influenced by medical ethics, which promotes more of a hands-off, self-autonomy attitude than is usually acceptable to the general public.

It is interesting to me because you are a physician and a parent in the US.

Not if it's life or seriously health-threatening.

Maybe. It really depends upon the nature of the harm. I use a hierarchy of death, disability, disease, discomfort, dissatisfaction. I think that in most cases, I would find the first three adequate reasons to interfere. The last two would depend upon the details.

If this were a general practice, there should be research performed to look at the overall benefit (i.e. advantages and disadvantages).

Do you think a study would show a risk reduction for the removal of infants’ toenails? From my limited research (and personal experience) it seems to be very effective at treating the problem.

I don't know why you'd be interested in my limit except to show that it's unreasonable. I'm perfectly willing to concede that you think I'm unreasonable to save you the trouble.

You are one of the most reasonable people I converse with. I was more interested to find out if I was being unreasonable. I'm perfectly willing to concede that you think I'm unreasonable to save you the trouble:)

So the state should intervene? Or at the very least, we should be able to brand the parents with a scarlet M (for Mutilator)?

Linda

We don’t need to do that: We know who they are by looking at their child’s penis:D

I think that the medical professions across the developed world should get their act together and inform parents that very few infant circumcisions are medically indicated and that the rare complications that occur in uncircumcised boys and men can usually be treated without removing the foreskin.

Clearly, if the number of medically performed circumcisions in Europe is 1-2% and in the US it is 10 to 20 times higher, then one group of medical professionals, to put it bluntly, have their heads in the sand. I believe that it is American physicians who are acting dumb, as they are effectively saying “don’t ask me, it’s up to you” to parents for an easier life.

I take issue with medical (or other scientific) professionals perpetuating cultural traditions without reasonable medical justification. Isn’t one of the virtues of EBM is that it allows doctors to use their resources effectively and in the best interests of the patient? I wonder if the UK’s EBM review board NICE would see neonatal circumcision as cost effective?

[Skeptic Ginger]

Someguy, if you expect to convince a skeptic and a health care provider, this kind of crap is not helpful. This kind of crap pisses me off. I am more than willing to look at evidence but not woo type distortions of what the evidence actually says. The following conclusion citing the following evidence is absurd. Here is the very first research they cite.

It is documented (http://www.cirp.org/library/disease/STD/) that circumcised adult males exhibit a greater tendency to engage in risky sexual behavior. Hooykaas and colleagues (http://www.cirp.org/library/disease/STD/hooykaas1/) reported that circumcised men in the Netherlands engage in more risky sexual behavior and have markedly higher rates of STDs.

RESULTS: Besides STD-related complaints, ethnicity was an important independent predictor of one or more diagnosed genital STDs. STD-prevalence was higher among men born in Turkey (47%, OR = 3.4) and men born in Surinam (36%, OR = 2.1), compared with Dutch men (21%). While Turkish men had mainly riskful sexual behaviour with prostitutes, Surinam men had more often riskful sexual contact with private partners. Among women, STD prevalence was higher among West-European (38%, OR = 2.3) and Latin-American women (30%, OR = 1.6), compared with Dutch women (21%). Latin American women had more often riskful sexual contact with clients; sexual behaviour of West-European women was riskful with both clients and private partners.

CIRP says [CIRP Note: This study is significant because Dutch men are usually non-circumcised intact males, but immigrant men from Turkey and Surinam are Muslims, who are usually circumcised for religious reasons. This is a clear attempt to find evidence supporting a cause rather than looking at the evidence and concluding what it means. Why should we expect two completely different cultures to only differ by their circumcisions?

I'll keep looking but your source had already proven itself to be BS.

[Skeptic Ginger]

CIRCUMCISION IN THE UNITED STATES (http://www.cirp.org/library/general/laumann/) Objective. - To assess the prevalence of circumcision across various social groups and examine the health and sexual outcomes of circumcision.

Main Outcome Measures. - The contraction of sexually transmitted diseases, the experience of sexual dysfunction, and experience with a series of sexual practices.

Results. - We find no significant differences between circumcised and uncircumcised men in their likelihood of contracting sexually transmitted diseases. However uncircumcised men appear slightly more likely to to experience sexual dysfunctions, especially later in life. Finally, we find that circumcised men engage in a more elaborated set of sexual practices. This pattern differs across ethnic groups, suggesting the influence of social factors. Why on Earth would circumcision determine the "set of sexual practices" one engaged in? It is very likely any differences in sexual behaviors are going to be related to culture, with circumcision being much more coincidental than causal. Without an alternate explanation it is hard to believe their interpretation of the evidence.

Conclusions. - The National Health and Social Life Survey evidence indicates a slight benefit of circumcision but a negligible association with most outcomes. These findings inform existing debates on the utility of circumcision. The considerable impact of circumcision status on sexual practice represents a new finding that should further enrich such discussion. Our results support the view that physicians and parents be informed of the potential benefits and risks before circumcising newborns.A benefit in circumcision?

Differences in circumcision levels across racial and ethnic groups are more revealing. In particular, whites are considerably more likely to be circumcised than are blacks or Hispanics (81% vs 65% or 54%). These differences remain significant when other variables are controlled. Net of these factors, the odds of a black being circumcised are roughly half (95% confidence interval[CI], 0.40-0.85) that of whites; the odds for Hispanics are about one third (95% CI, 0.26-0.44) that of whites. There has been some convergence in circumcision rates for the 3 groups across cohorts, though differences among groups have persisted (Table 1).So culture differs along with rates of circumcision. Then you have to distinguish between culture and circumcision. You cannot assume circumcision causes any specific behaviors without controlling for cultural differences.

Table 2 compares the incidence of various STDs reported by circumcised and uncircumcised respondents. I'm not convinced by the data given the previous interpretations, but assuming the data is correct, they are claiming all STDs are lower in uncircumcised men. But they fail to mention the glaring difference in HIV infection in their own data: All men, rate per 1,000, circumcised 1.0; uncircumcised, 5.4. Instead they point out the non-statistically different results:Several instructive features of the data presented in Table 2 deserve attention. First, circumcision status does not appear to lower the likelihood of contracting an STD. Rather, the opposite pattern holds. Circumcised men were slightly more likely to have had both a bacterial and a viral STD in their lifetime. While these differences are not statistically significant, If they aren't statistically significant, why are they reporting them as if they were?

But the following conclusion is even more biased.Table 2 shows a marked decrease in the experience of STDs as the number of partners increases. The small, nonsignificant tendency for circumcised men to contract STDs at greater rates appeared for each category of sexual experience. In addition, contraction of bacterial STDs occurred at a significantly greater rate for men who have had more than 20 sex partners in their lifetimes. Among circumcised men with such a sexual background, the odds of contracting a bacterial STD are estimated at 2.88 that for uncircumcised men. While significant, the exact size of the difference is difficult to establish as indicated by the wide confidence interval (95% CI, 1.03-9.03). Note as well that this difference is driven largely by differential contraction of gonorrhea.So their data supposedly shows the more partners the less STDS? I would say then they either need to explain this bizarre outcome or they need to assess the accuracy of their data.

I am getting tired, so if I have overlooked something here, let me know. I'll look at the rest of the evidence tomorrow. Needless to say I am not impressed. It should be clear, don't take people's word for things without checking their sources for yourself.

[Ivor the Engineer]

One for you, skeptigirl:

http://www.mja.com.au/public/issues/178_04_170203/spi10278_fm.html

[fls]

You also make a lot of false statements.

Not all the may results have been confirmed.

Also the HIV-prevention is not as clear cut as you and other make it out to be.

Since I am one of the others, I am going to address this post.

http://www.cirp.org/library/disease/HIV/ is an update-to-date and seemingly unbiased report on the research done on HIV and circumcision.

Unfortunately, that is a biased source of information. I know that it is sometimes difficult to assess how reliable a source of information is when you do not have independent knowledge and experience in the area. And that is a whole 'nother topic. But in my read through the page that you linked and then through parts of the rest of the site I found multiple examples where incomplete information was given (i.e. the research that contradicted the author's conclusions was not mentioned) and summaries of research papers misrepresented the actual contents of the papers.

While indeed all studies in Africa between circumcized and uncircumcized men show a positive correlation between circumcision and preventing HIV infection, the research done in Europe and America has been THE OTHER WAY AROUND.

STDs and HIV in the western world are more prevalent among circumcized men than uncircumsized men.

America is the western country where circumcision is most common, it's also the western country with the highest HIV-infection rate. However correlation is not causation (if that makes sense, not native speaker, sorry). Still it gives some indication that mass circumcision is not really a solution.

Something that has been shown BOTH in Africa and in the western studies is the fact that HIV-transfer for male-to-female is higher for circumsized men.

Something that's also often ignored is that circumcision in Africa is a cultural thing, those different cultures may also have distinctly different sexual morale etc.. All in all there is simply not enough evidence to say circumcision prevents HIV-transfer, in fact, the opposite seems to be the case in those countries with a high degree of personal hygiene. But there's also not enough evidence to state the latter with a degree of certainty.

It turns out that none of this information is relevant when you have much better quality information to look at. As you mention, all kinds of things can influence the prevalence of HIV in any population. So information that comes from a study that is designed to eliminate all these influences except the influence of circumcision is really the only relevant information to look at when it is available. And there have now been three large randomized controlled trials looking at this. The author glosses over this fact. He dismisses one of the trials as "controversial" solely because letters criticizing the study were published. However, most studies will generate letters of criticism (especially when the research is important). Rather, the question should be, "does the study hold up to the criticism?" And in this case, the criticisms were addressed by the authors and none of them were sufficient to alter the main conclusions drawn from the study. The other two RCT's have been published, and all three show a consistent, large and robust effect. In addition, information was collected looking at the influence on male-to-female transmission, and preliminary reports show a reduction in transmission from circumcised men.

This is one example of the dishonesty exhibited by the author. When the bulk of the article should be spent on looking at the best available information, he chooses instead to devote 3 dismissive paragraphs to that information and to focus on low quality information. Most of his subsequent criticisms aren't even relevant. He brings up "contradictory" studies, yet none of them are remotely comparable as none of them are randomized controlled trials. He mentions ethical concerns about violating the rights of children by performing these trials, yet the trials themselves were conducted on adults giving informed consent.

Back to the point of wether it's relevant that the conclusions about circumcision and health benefits are post-hoc.

Yes it's very important, the difference are extremely small, and if you look generally for effects, you're datamining.

This means that you will always find something, you should NEVER draw conclusions from that, this kind of research is only useful for determining what to test.

There is a difference between starting with a particular bias and looking only for information to confirm that bias, and starting from a neutral position and looking at all the information in order to see what conclusions can reasonably be drawn from that information. I am talking about the latter situation.

As far as I can tell the penial cancer claims have not been followed up by actual research TESTING the effect.

It's much the same with the other claims...

Hey here we find UTI rates are down... let's claim that as an advantage...

Here the penial cancer is down, let's claim that as an advantage etc...

I think this simply demonstrates your unfamiliarity with the actual research, and with the conclusions that can reasonably be drawn from that research. Did you read papers where these associations were demonstrated?

These are at best starting points, at worst the effects dissappear completely when all the tests are added up...

At this point you're just making stuff up. You have no idea what happens when "all the tests are added up".

Linda

[MortFurd]

Does anyone else hear the ghost of Jack Dean Tyler cackling in the background?

What IS the dorsal side, anyway?

[Ivor the Engineer]

Does anyone else hear the ghost of Jack Dean Tyler cackling in the background?

What IS the dorsal side, anyway?

Derived from the latin for back, dorsum. Generally means 'towards the back'.

[fls]

I tend to think it has more to do with culture than the evidence of benefit. Being applied scientists, physicians should evaluate the evidence and recommend either (a) All infants should be circumcised or (b) Infants should be circumcised when it is medically indicated. This would be consistent with all other preventative treatments, including the examples you gave: vaccinations (a/b), braces (b) and tonsillectomies (b).

Isn't (b) the way it is now?

It is interesting to me because you are a physician and a parent in the US.

I've only lived here for a couple of years. I'm mostly Canadian. And Canadians are boring, dontcha know?

Do you think a study would show a risk reduction for the removal of infants’ toenails? From my limited research (and personal experience) it seems to be very effective at treating the problem.

I would suspect that a mass program would demonstrate that the complications would outweigh the benefit. Unless there was some background information to provide some guidelines, you couldn't ethically get this off the ground. The only reason there's been any study with circumcision is because information was available from its use as a cultural practice. There's no way you could have proposed it out-of-the-blue.

I think that the medical professions across the developed world should get their act together and inform parents that very few infant circumcisions are medically indicated and that the rare complications that occur in uncircumcised boys and men can usually be treated without removing the foreskin.

Isn't that already the case?

Clearly, if the number of medically performed circumcisions in Europe is 1-2% and in the US it is 10 to 20 times higher, then one group of medical professionals, to put it bluntly, have their heads in the sand. I believe that it is American physicians who are acting dumb, as they are effectively saying “don’t ask me, it’s up to you” to parents for an easier life.

It is my impression that Americans are much more reluctant to been seen as challenging religious practices, in addition to being much more religious than other developed countries.

I take issue with medical (or other scientific) professionals perpetuating cultural traditions without reasonable medical justification. Isn’t one of the virtues of EBM is that it allows doctors to use their resources effectively and in the best interests of the patient? I wonder if the UK’s EBM review board NICE would see neonatal circumcision as cost effective?

You seem to be straying into a paternalistic view of medicine. I thought we had worked really hard to get away from that?

I don't see medical professionals generally perpetuating this cultural tradition. It's seems to me that further changes would come from cultural change. You could argue that physicians should be more pro-active (which I suppose is the reason for the negative characterizations - "how can you just sit there when parents are mutilating their children in order to satisfy their god-complex!!!"), but maybe it's just a matter of priorities. I really don't know what the typical interaction is between the parents and the physician in the US. Or you're thinking that physicians should be refusing the practice? I think that you'd be on pretty shaky ground on an individual basis, and I'm not sure we can ask individual physicians to bear the risk of laying themselves open to legal attack.

I'll give you an example of my contribution to the "cultural change". I was chatting with my next-door-neighbour and he was wondering whether he should have his 9-year-old son circumcised. The child had been adopted from a country where circumcision rates are low, and his father was thinking that he might feel out of place around circumcised kids. I mentioned that my own son (who frequently would be naked in front of him as they changed into their bathing suits) was uncircumcised so he probably wouldn't feel that out of place. My neighbour was surprised to find out that in most places other than the US, most boys are uncircumcised. He seemed reassured by this information - more willing to consider it not a big deal. Now, I don't know whether or not I made a real difference, but I think I contributed my mote to what I suspect is something that is already changing in the US, similar to what happened decades ago in Canada.

Linda

[fls]

What IS the dorsal side, anyway?

I always wondered about this as well, since depending upon the position, either side can be facing toward the back. I was generally too embarrassed to ask for clarification during class, though.

Linda

[Abooga]

One question:

Losing nerve endings can make you lose sensitivity?

Or, a man with half a d*ck would feel THE SAME as a man with a whole one? ("The same" as in quantity or quality of the feeling they´d get from stimulation etc.)

Cut guys usually will say that they lose no feeling but I´m rather skeptic about it. Most likely, if they do lose some nerve endings, they do lose SOME sensitivity. And the foreskin is a very sensitive area... Taking the slippery slope, if you take off chunks of d*ck little by little won´t you end up not feeling anything? Would you have different degrees of sensitivity as you keep chopping away? If so, it seems that circuncision alone would result in SOME loss of sensitivity.

But as you try explaining them this (cut guys), they go into a state of denial (it´s understandable, losing a chunk of functional d*ck is quite a tragedy). But guys, react, be brave and admit your wang MIGHT have been slightly insensitized by that unnecessary mutilation! Then we might be able to help those poor l ittle jewish kids!

[ThatSoundAgain]

And my son was circumcised because I thought it was better according to the medical evidence, and I've not met a circumcised man that wasn't sexually satisfied and I have no moral qualms whatsoever about my decision. As it turns out, I had not heard of this controversy before I made that decision. However, after an extremely thorough review of the medical literature, I have no regrets about my decision.

That's it! I'm getting snipped! :D

[Z]

Er, the infant shrieks in agony - a much higher pitched sound than a normal cry for attention - and then subsides, not because they have 'settled down' but because they have gone into shock!

Far from being less traumatic, infant tissue is considerably more sensitive to pain than adult tissue. Just because a new born baby can't regale you with endless stories about how much it hurt doesn't mean it didn't.

I also understand that any studies showing medical benefit from circumcision (eg less chance of urinary infection) have been rather questionable and that international medical organisations have found no conclusive evidence.

I'm astonished that the practice is so widespread in America...


I'm wondering what barbaric method you use that causes the baby to shriek so? My boys were all circumcised using the plastibell method, and not one made a single sound for the duration of the application (other than normal infant-related noises). I even watched the procedure in one case, and was absolutely amazed at how calmly he took it (of course, they also used localized anaesthesia, which I fully support).

But much better to inflict such minor pains upon someone who will quickly forget it, than the much greater pain (which will be remembered) of performing the process as an adult.

As for the appendectomy issue, personally I'd remove those neonatally as well, if they served as little function as the foreskin does. As for tonsils, apparently tonsilectomies are vastly overstated; some doctors don't even remove the tonsils now even in cases of tonsilitis, because it can be treated effectively.

The myth about sexual enjoyment is just that. There is no difference in sensitivity and no difference in sexual enjoyment between circumcised and uncircumcised men; the only recognized difference is that a circumcised man has more staying power, generally, than an uncircumcised man. And we could certainly count that as a benefit.

This thread stuns me, though, to see people normally intelligent and skeptical instead reacting like common woos, trying to poo-poo off the benefits of circumcision, while making up indefensible fictions about the risks of the procedure and the importance of the foreskin.

What also stuns me, is the one person who did claim that he was mutilated by doctors, offers absolutely no evidence to support his claim, and appears unwilling to consider the idea that it might not be the surgery in general that mutilated him, but the incompetance of a single doctor. Yet I see the exact same behavior many times in unsatisfied circumcised men - they mention being ruined, yet refuse to say how; they often have wives and children (so they're functional), and aren't seeing any specialists for urinary concerns; and to a man, every one I've ever talked to has refused uncategorically to consider that the problem might be a botched surgery, rather than the nature of the surgery itself!

It's very strange how the penis can so affect the minds of men...

[Ivor the Engineer]

Isn't (b) the way it is now?

Around most of the developed world, yes. The fact that the US circumcises so many more infants indicates the reasons there are definitely not based on medical science.

I've only lived here for a couple of years. I'm mostly Canadian. And Canadians are boring, dontcha know?

I like to think of you as polite, intelligent Americans:)

I would suspect that a mass program would demonstrate that the complications would outweigh the benefit. Unless there was some background information to provide some guidelines, you couldn't ethically get this off the ground. The only reason there's been any study with circumcision is because information was available from its use as a cultural practice. There's no way you could have proposed it out-of-the-blue.

We will never know about this potentially beneficial preventative treatment for ingrown toenails.

Isn't that already the case?

Again, around most of the developed world, yes. In the US, medical professionals appear to be either unwilling or scared to tell parents there is no medical reason to circumcise the vast majority of boys. Are they worried about repeat trade?

It is my impression that Americans are much more reluctant to been seen as challenging religious practices, in addition to being much more religious than other developed countries.

I don’t think it’s mainly religious. I think it’s become so routine that Americans don’t see how bizarre it is and because of the pressure to conform, as your recollection below hints at.

You seem to be straying into a paternalistic view of medicine. I thought we had worked really hard to get away from that?

So parents deciding on unnecessary surgical procedures for their child is not paternalistic medicine? I’m all for empowering the patient, who in this case are currently unable to speak for themselves.

However, I suppose you could argue that if the child is going to grow up in a pro-circumcision environment, then the choice of the parent is highly likely to reflect the choice of the child when it is older, just as children typically have the same faith as their parents.

I don't see medical professionals generally perpetuating this cultural tradition. It's seems to me that further changes would come from cultural change. You could argue that physicians should be more pro-active (which I suppose is the reason for the negative characterizations - "how can you just sit there when parents are mutilating their children in order to satisfy their god-complex!!!"), but maybe it's just a matter of priorities. I really don't know what the typical interaction is between the parents and the physician in the US. Or you're thinking that physicians should be refusing the practice? I think that you'd be on pretty shaky ground on an individual basis, and I'm not sure we can ask individual physicians to bear the risk of laying themselves open to legal attack.

With respect to the God complex, as a parent don’t you sometimes feel just a little bit pleased when your kids do as their told? Don’t you bask in the reflected glory from their successes? The God complex comment was supposed to be provocative. However, as I said earlier I think the main reasons are down to social conformity and the belief that everyone else is doing it.

Going back to my toenail analogy, do you think a physician would be open to legal attack for refusing to remove the toenail(s) of a young child because their parents requested it?

I'll give you an example of my contribution to the "cultural change". I was chatting with my next-door-neighbour and he was wondering whether he should have his 9-year-old son circumcised. The child had been adopted from a country where circumcision rates are low, and his father was thinking that he might feel out of place around circumcised kids. I mentioned that my own son (who frequently would be naked in front of him as they changed into their bathing suits) was uncircumcised so he probably wouldn't feel that out of place. My neighbour was surprised to find out that in most places other than the US, most boys are uncircumcised. He seemed reassured by this information - more willing to consider it not a big deal. Now, I don't know whether or not I made a real difference, but I think I contributed my mote to what I suspect is something that is already changing in the US, similar to what happened decades ago in Canada.

Linda

Now he probably just thinks Canadians are weird:D

[Z]

One question:

Losing nerve endings can make you lose sensitivity?

Or, a man with half a d*ck would feel THE SAME as a man with a whole one? ("The same" as in quantity or quality of the feeling they´d get from stimulation etc.)

Cut guys usually will say that they lose no feeling but I´m rather skeptic about it. Most likely, if they do lose some nerve endings, they do lose SOME sensitivity. And the foreskin is a very sensitive area... Taking the slippery slope, if you take off chunks of d*ck little by little won´t you end up not feeling anything? Would you have different degrees of sensitivity as you keep chopping away? If so, it seems that circuncision alone would result in SOME loss of sensitivity.

But as you try explaining them this (cut guys), they go into a state of denial (it´s understandable, losing a chunk of functional d*ck is quite a tragedy). But guys, react, be brave and admit your wang MIGHT have been slightly insensitized by that unnecessary mutilation! Then we might be able to help those poor l ittle jewish kids!


Apparently not. Tests have been conducted, and there's no loss in sensitivity. I know that seems to go against logic, but so does so much science these days.

Most American men are circumcised, and given all the babies born every year in the U.S., I'm guessing circumcised men are plenty enough sensitive to do their duty... :D I've been cut my whole life and never had any problems with sensitivity (above and beyond my own skin condition). I've also never had any problems with infections in that region, or bad odor, or any other foreskin-related problem. And I've never, ever had an unsatisfied sexual partner - indeed, in three cases, they discovered that they preferred, strongly, a cut man to an uncut man - though I personally like to think my techniques won them over, rather than the appearance of the tool.

[Ivor the Engineer]

I'm wondering what barbaric method you use that causes the baby to shriek so? My boys were all circumcised using the plastibell method, and not one made a single sound for the duration of the application (other than normal infant-related noises). I even watched the procedure in one case, and was absolutely amazed at how calmly he took it (of course, they also used localized anaesthesia, which I fully support).

But much better to inflict such minor pains upon someone who will quickly forget it, than the much greater pain (which will be remembered) of performing the process as an adult.

As for the appendectomy issue, personally I'd remove those neonatally as well, if they served as little function as the foreskin does. As for tonsils, apparently tonsilectomies are vastly overstated; some doctors don't even remove the tonsils now even in cases of tonsilitis, because it can be treated effectively.

The myth about sexual enjoyment is just that. There is no difference in sensitivity and no difference in sexual enjoyment between circumcised and uncircumcised men; the only recognized difference is that a circumcised man has more staying power, generally, than an uncircumcised man. And we could certainly count that as a benefit.

This thread stuns me, though, to see people normally intelligent and skeptical instead reacting like common woos, trying to poo-poo off the benefits of circumcision, while making up indefensible fictions about the risks of the procedure and the importance of the foreskin.

What also stuns me, is the one person who did claim that he was mutilated by doctors, offers absolutely no evidence to support his claim, and appears unwilling to consider the idea that it might not be the surgery in general that mutilated him, but the incompetance of a single doctor. Yet I see the exact same behavior many times in unsatisfied circumcised men - they mention being ruined, yet refuse to say how; they often have wives and children (so they're functional), and aren't seeing any specialists for urinary concerns; and to a man, every one I've ever talked to has refused uncategorically to consider that the problem might be a botched surgery, rather than the nature of the surgery itself!

It's very strange how the penis can so affect the minds of men...

Would you say you're risk adverse?:D

[pgwenthold]

Thought I'd check in to see where this discussion was going and I find no one challenging these claims. You cannot support those false claims. I looked at volumes of research on this.

You are wrong. These claims are not only supportable, they are tautological. If there is at least one circumcision that has complications, and at least one death that results, then my statements are true.

What is the rate of death due to circumcision in circumcised males? What is the rate of death due to circumcision in uncircumcised males? I don't know the former, but the latter is zero.

Notice I never made any claims based on those rate differences. It was only an exercise to demonstrate why using disease rates between circumcised and non-circumcised is not necessarily useful.

Again, how do you compare a 4 fold increase in the rate of penile cancer to an infinite fold in circumcision related deaths? The answer is, you don't. When talking about such small numbers, rate differences aren't the baseline you use. My comment is mostly in response's to Z's statement that it doesn't matter if it is small numbers, wouldn't you do whatever to improve the chances?

[Ivor the Engineer]

Apparently not. Tests have been conducted, and there's no loss in sensitivity. I know that seems to go against logic, but so does so much science these days.

Most American men are circumcised, and given all the babies born every year in the U.S., I'm guessing circumcised men are plenty enough sensitive to do their duty... :D I've been cut my whole life and never had any problems with sensitivity (above and beyond my own skin condition). I've also never had any problems with infections in that region, or bad odor, or any other foreskin-related problem. And I've never, ever had an unsatisfied sexual partner - indeed, in three cases, they discovered that they preferred, strongly, a cut man to an uncut man - though I personally like to think my techniques won them over, rather than the appearance of the tool.

How can science look into something as subjective as "sensitivity"? Clearly there is a HUGE psychological component, or men would be walking around with hard-ons from the stimulation of their underwear.

[Z]

How can science look into something as subjective as "sensitivity"? Clearly there is a HUGE psychological component, or men would be walking around with hard-ons from the stimulation of their underware.

There are scientific ways to test nerve sensitivity, skin sensitivity, etc. that are far less subjective than you apparently believe. I have to undergo a number of those tests regularly because of my psoriasis variation... my skin is steadily becoming less sensitive overall, for no apparent reason.

I don't know for certain what methods were used in the study, but I know that there are several methods that can be used, including reading nerve responses to stimuli, observing physical reaction to stimuli, etc.

....


And I usually do walk around with a hard-on from the stimulation of my underwear. Doesn't everyone?

[ThatSoundAgain]

This thread stuns me, though, to see people normally intelligent and skeptical instead reacting like common woos, trying to poo-poo off the benefits of circumcision, while making up indefensible fictions about the risks of the procedure and the importance of the foreskin.


It's not the first time in this thread I've seen this accusation, and to be honest it gets old real fast. Being critical of your position does not equate to woo. If you look closer, my position, and that of several others here, are arrived at in a rational fashion - we're not claiming the foreskin is magic.

Regarding "poo-pooing off" the benefits, that's not at all what I am doing (can only speak for myself). I'm just saying that circumcision doesn't prevent any problems that aren't trivial to treat, except for phimosis and the like, where the surgical correction is either - you guessed it - circumcision or closely resembling it. Is there any other minor, easily corrected condition affecting ~1% of the population you would advocate preventive surgery for? With HIV, would you argue that (in a developed nation), the only preventive measure that should be taken is circumcising all males?

Regarding the "indefensible fictions", it's easy to declare opposing arguments as such. Care to list a couple, and why they're indefensible?

As you note, this is a hot button topic. It's hard to speak out against circumcision in a culture where it's common, because you're criticising something directly applicable to your audience's sexuality, and by extension their parents.

I don't know about the others here, but I'm not doing this to claim superiority. I'm not doing it to say there's something wrong with anyone who's circumcised. I'm not saying circumcision is crippling, sexually. I'm not even saying it's a big deal.

What I am saying is that some data indicates that the foreskin is functional, and that it's generally not well understood. From this information I argue that one should think twice before removing it, since it can't be reattached.

[ThatSoundAgain]

This thread moves too fast.

Z, Disregard my request that you address the "indifensible fictions" above - I see you've engaged them in the mean time.

I might have a reply for the sensitivity issue later.

[Z]

By the way - the foreskin apparently CAN be restored. Wiki article http://en.wikipedia.org/wiki/Foreskin_restoration.

I had never heard of this before - it's not common among those who don't find circumcision to be a bad thing, of course. But it might make for an interesting research lead, yes?

[ThatSoundAgain]

By the way - the foreskin apparently CAN be restored. Wiki article http://en.wikipedia.org/wiki/Foreskin_restoration.

Indeed it can, to some degree.


I had never heard of this before - it's not common among those who don't find circumcision to be a bad thing, of course. But it might make for an interesting research lead, yes?

What / how do you propose we use this in research?

[ponderingturtle]

True, but I'm arguing that this is inconsequiential, seeing as one state (uncircumcised) is 100% reversible and the other is not. So, the (my guess) relatively few adults that wish they'd had it done as infants can still get it done at the expense of some discomfort, while the already circumcised adults who wish they weren't can never get full functionality back.

They can get it done as infants as adults? There have been effects that change based on when it is done, and the question was how many would want it done as infants not how many would want it done as adults. Between the pain and temporary sexual dysfunction that is enough to discourage people.


I see the appeals to emotion on both sides. And yes, principle, the one about being allowed to choose, plays a part in my stance on this, but there's also the very pragmatic wish to err on the side of caution - in the case of my (hypothetical) newborn son, he'll hopefully have much better data in 18 years, and can make a more informed decision.
But which side is the side of caution? If someone said "well the link between autism and vaccination is questionable best err on the side of caution" but the side of caution in both cases involves an irreversible treatment that the person can never go back to a "natural" condition.

The strong opinions seem to be entirely emotion based.



I don't quite follow this. But I think I can try for a more clear statement of my own position:

- If it ain't broken, don't fix it.
- If you want to fix it, despite the data being unclear, the benefits of doing so small, the drawbacks of doing so not well examined, the procedure a risk (albeit small), be sure it's your own foreskin you fix, not someone else's.

So you are for the practice of circumcision because as a common practice if that is "broken" is the basis of your argument or an appeal to "natural" being the preferred state.

The if it ain't broke don't fix is just as much an appeal to maintain the status quo as it is to preserve the natural state of man. Most people here do not automatically assume "natural"=Better very much but that seems to be at the heart of these debates.

[Abooga]

Z: [ I'm guessing circumcised men are plenty enough sensitive to do their duty... :D QUOTE]

Yes, you could manage even with half a d*ck, but don´t you get the nagging doubt that perhaps us with the beatleneck are getting (a bit) more satisfaction out of our willies? :p

And thanks for admitting there is some logic to what I said...

(what did I do wrong with the quoting thingy?)

[Z]

Indeed it can, to some degree.



What / how do you propose we use this in research?


I meant, for personal research, of course... studying the available literature, analysing the pros and cons...

The Wiki article suggests to me that it's more cosmetic/psychological, though from what I can tell, that's about the same extent of the damage caused by circumcision, so it would be functionally equivalent.

However, it also appears inadequate at best, so at this point I certainly wouldn't use it to support the idea that adults have the choice of 'uncircumcising'.

Still, this is merely a Wiki article. So more (personal) research is indicated.

[Z]

Yes, you could manage even with half a d*ck, but don´t you get the nagging doubt that perhaps us with the beatleneck are getting (a bit) more satisfaction out of our willies? :p

Absolutely not. I'm quite satisfied with the satisfaction I get with my trouser snake. In fact, I'm rather alarmed at the idea that it might have been larger with the foreskin, since it's already rather larger than some women like or can endure. (I'm probably the only non-abnormal-sized male who has considered penile reduction surgery...) And I'm quite please in that, living in a culture that considers foreskins ugly, my John Thomas has a higher chance of being considered desirable - and therefore, a better chance of scoring. Plus, no unpleasant Smegma aroma or taste.

So no nagging doubts there. My ONLY complaint about my Monkey is that it's slightly too large for the comfort and complete pleasure of those I regularly use it with.

And thanks for admitting there is some logic to what I said...

Well, there is, it just happens to run counter to evidence.

(what did I do wrong with the quoting thingy?)

Somehow you erased part of the first quote box, I think.

[Z]

Z: [ I'm guessing circumcised men are plenty enough sensitive to do their duty... :D QUOTE] <snip>
(what did I do wrong with the quoting thingy?)

OK, the opening code should look like this:
The closing code is simply:

See?

[Katana]

Again, around most of the developed world, yes. In the US, medical professionals appear to be either unwilling or scared to tell parents there is no medical reason to circumcise the vast majority of boys. Are they worried about repeat trade?


Upon what evidence do you base this assertion?

[fls]

Around most of the developed world, yes. The fact that the US circumcises so many more infants indicates the reasons there are definitely not based on medical science.

But there's no reason to think that it's coming from physicians - i.e. physicians may be recommending that it only be done for medical reasons and people are choosing to ignore their advice in favour of other reasons.

We will never know about this potentially beneficial preventative treatment for ingrown toenails.

Just like we will never know about the potential benefits of ear-lobe or belly button removal.

Again, around most of the developed world, yes. In the US, medical professionals appear to be either unwilling or scared to tell parents there is no medical reason to circumcise the vast majority of boys. Are they worried about repeat trade?

What evidence do you have that medical professionals in the US are not telling parents that there is no medical reason to circumcise?

I don’t think it’s mainly religious. I think it’s become so routine that Americans don’t see how bizarre it is and because of the pressure to conform, as your recollection below hints at.

I agree. I'm just saying that a concerted, pro-active effort might be seen as an attack on a religious practice; something which people in the US seem sensitive to.

So parents deciding on unnecessary surgical procedures for their child is not paternalistic medicine? I’m all for empowering the patient, who in this case are currently unable to speak for themselves.

Paternalistic medicine usually refers to the physician acting as the decision-maker. Wouldn't the case of a father acting paternalistic be kind of a tautology?

However, I suppose you could argue that if the child is going to grow up in a pro-circumcision environment, then the choice of the parent is highly likely to reflect the choice of the child when it is older, just as children typically have the same faith as their parents.

With respect to the God complex, as a parent don’t you sometimes feel just a little bit pleased when your kids do as their told? Don’t you bask in the reflected glory from their successes?

I think this is one of those situations where first-hand experience is very enlightening. I gave up basking a long time ago. Now all I ask for is not to feel like a harpy every minute of every day. :)

The God complex comment was supposed to be provocative. However, as I said earlier I think the main reasons are down to social conformity and the belief that everyone else is doing it.

I also think that is a large component of it here (i.e. in the US).

Going back to my toenail analogy, do you think a physician would be open to legal attack for refusing to remove the toenail(s) of a young child because their parents requested it?

There isn't an established practice of providing the procedure or an established research base showing the benefit/harm of the procedure like there is for circumcision.

Now he probably just thinks Canadians are weird:D

Trust me. He had plenty of opportunity to come to that conclusion beforehand. ;)

Linda

[Abooga]

Thanks Z.

Oh, and about those "tests" that have been performed, I feel quite suspicious about that research that says less HIV risks and no loss of sensitivity after circuncision. Since the emotional side of the issue is mostly on the part of the "pro-cut" guys, that research is more likely to have been done by them and to show the results they want to hear. "Anti-cut".-s usually don´t give a toss.

Also, this "evidence" is quite widely used by muslims and piled together with those really suspect "science" facts such as the supposed lack of intermediate evolutionary forms, the alleged tomb of Jesus and similarly wooish "science" that happens to confirm their views... and that too makes me suspicious...

[ImaginalDisc]

If they were circumcised as a baby, they have no basis for comparison. How do they know that not all penises are "numb to some degree"?

Because in two cases there are regions where they have no sensation.

[Ivor the Engineer]

There are scientific ways to test nerve sensitivity, skin sensitivity, etc. that are far less subjective than you apparently believe. I have to undergo a number of those tests regularly because of my psoriasis variation... my skin is steadily becoming less sensitive overall, for no apparent reason.

I don't know for certain what methods were used in the study, but I know that there are several methods that can be used, including reading nerve responses to stimuli, observing physical reaction to stimuli, etc.

....


And I usually do walk around with a hard-on from the stimulation of my underwear. Doesn't everyone?

Sensitivity is subjective, as is pain. What you have described are relative measurements for a single individual. Even then the results will be mixed up with a huge number of psychological factors. I.e. you don't "feel" anything until your brain interprets the input(*).

(*) This is not quite true. There is processing in the spinal cord that can initiate quite complicated motor responses. But you don't know about the sensation until the signals have reached you're brain and been processed.

[Ivor the Engineer]

But there's no reason to think that it's coming from physicians - i.e. physicians may be recommending that it only be done for medical reasons and people are choosing to ignore their advice in favour of other reasons.

<snip>

What evidence do you have that medical professionals in the US are not telling parents that there is no medical reason to circumcise?

Linda / Katana

I don't have evidence that medical professionals in the US are not telling parents that there is no reason to circumcise.

I have an inference that if they were consistently telling parents there was no medical reason to circumcise their child then the rate would not be so inflated compared to other developed countries.

However, I admit it is a bit of a leap and apologize if this is in fact incorrect:o

Paternalistic medicine usually refers to the physician acting as the decision-maker. Wouldn't the case of a father acting paternalistic be kind of a tautology?

Linda

It would. It sounded good at the time though.

I'm unclear on the ethical position of a doctor facing a request for unrequired surgery on a child from its parents. In my mind the doctor is obliged _not_ to operate on the child. Especially since it is reasonable to assume the patient will be able to decide in the future. I.e., the parents are not advocating for someone who is loosing or has lost the ability to understand or communicate, or making short term life or death decisions that the child cannot make for itself.

Again, the only way I can see around this is if the doctor assumes that the child will be brought up in an environment such that its "free" choice on the issue will likely match whatever the parents think. That just seems a bit back-to-front to me, though.

This doesn't apply for circumcisions performed for increased protection against HIV in regions of the world where HIV is prevalent, because there is a large risk reduction for a deadly disease and there are clear public health benefits.

[Cleon]

Since the emotional side of the issue is mostly on the part of the "pro-cut" guys, that research is more likely to have been done by them and to show the results they want to hear. "Anti-cut".-s usually don´t give a toss.

Wait--what? Have you been reading this thread? I think you may want to re-evaluate the above claim.

[Morrigan]

Well...
Frankly, a penis, already pretty funny looking, is 1000000 times uglier with the foreskin. Look at all the circumcised male porn stars? See much porn with non-curcumcised men? Doubt you could find much.

a) I think circumcised cocks are pretty funny-looking myself. Then again, I don't come from an area where the majority of men are circumcised. Whodathinkit??
b) An erect circumcised penis looks remarkably similar to a non-circumcised one, anyway... and nobody looks at the flaccid cock out of aesthetic interest, now do they.
c) Because we all know that porn stars are the epitome of beauty... especially male porn stars being the epitome of male beauty. Just look at Ron Jeremy!
d) The majority of porn is produced in the USA, which might explain your data - because you probably won't find many circumcised non-American porn stars.

All in all, tongue-in-cheek or not, your statement was just a whole load of bollocks in every way (no pun intended).


But in essence, the foreskin, like other evolutionary holdovers, is not necessary. It's like when people are born with tails, webbing, etc. Clothing makes having a foreskin superfluous.
This analogy is so wrong, I can't help but shake my head. A foreskin might not be essential but it's certainly not useless, and claiming otherwise and comparing it to a tail is sheer intellectual dishonesty.



One could argue forever about the science of it all, but the bottom line still stands. It is woo. It is based on Religion, not science.

Agreed.


And if you don't have a penis, shut the hell up about it.

Oh, sorry.
Well, okay - so long as the men stay out of abortion discussions. :D

[Abooga]

Wait--what? Have you been reading this thread? I think you may want to re-evaluate the above claim.

Nope... It´s the circumcised posters (in general) who seem to have problems to admit that there might just be some loss of feeling there... Something quite reasonable, anyway, as "Z" himself admitted...

[Cleon]

Nope... It´s the circumcised posters (in general) who seem to have problems to admit that there might just be some loss of feeling there... Something quite reasonable, anyway, as "Z" himself admitted...

And it's the "anti-cut" people who are trolling other threads (hence the necromancy of this one), accusing people of "barbaric" views, calling people a "sadistic butcher" who should be imprisoned for daring to say they plan on having their kids circumcised, and so forth.

The idea that the "pro-cut" posters are getting "emotional" while the "anti-cut" people don't give a toss is completely at odds with reality.

[Katana]

I have an inference that if they were consistently telling parents there was no medical reason to circumcise their child then the rate would not be so inflated compared to other developed countries.

However, I admit it is a bit of a leap and apologize if this is in fact incorrect:o


No prob. :)

I just wanted to assure you that there are a LOT of docs in this country who definitely inform parents that, unless there is a specific medical condition being treated, circumcision is an elective procedure. The vast majority of circs in this country fall into that category.

It is in the best interest of the doc to do this and to make sure that he/she documented that fact lest one of the fortunately-rare-but-very-real complications occurs. It's about informed consent. The consent form that my hospital uses says several times that, despite some studies showing potential future benefit from it, circumcision is at the end of the day an elective procedure with risks.

I doubt that we're unique in the information that we provide. Part of it is a sincere desire to inform parents as completely as possible to the potential risks/benefits of circumcision, but the other is, of course, an effort to address medico-legal concerns.

[billydkid]

We had my son circumcised when he was born. I guess we just did it because I am circumcised and it is just what everyone does around here. I agree it is absurd and ridiculous. I did think about it a little. I guess part of the reason we had it done is because I read the ridiculous notion that it makes you less prone to certain infections - ridiculous because the risk of infection from the circumcision itself is not trivial. Also, I guess we wanted him not to be different in that respect from everyone else. It is a tremendously stupid custom, but nearly everybody in the US does it. Just another in a long, long list of cultural idiocies. I once saw on the internet that there is a device being marketed which is intended to stretch what is left of your foreskin so that it eventually is something of a foreskin. Well, my dick has had enough trauma for one lifetime.

[billydkid]

Er, the infant shrieks in agony - a much higher pitched sound than a normal cry for attention - and then subsides, not because they have 'settled down' but because they have gone into shock!

Far from being less traumatic, infant tissue is considerably more sensitive to pain than adult tissue. Just because a new born baby can't regale you with endless stories about how much it hurt doesn't mean it didn't.

I also understand that any studies showing medical benefit from circumcision (eg less chance of urinary infection) have been rather questionable and that international medical organisations have found no conclusive evidence.

I'm astonished that the practice is so widespread in America...In fairly recent times doctors used to perform major surgical procedures on awake infants using the argument that infants can't really feel pain. It's nauseating and horrifying to contemplate.

[fls]

I'm unclear on the ethical position of a doctor facing a request for unrequired surgery on a child from its parents. In my mind the doctor is obliged _not_ to operate on the child. Especially since it is reasonable to assume the patient will be able to decide in the future. I.e., the parents are not advocating for someone who is loosing or has lost the ability to understand or communicate, or making short term life or death decisions that the child cannot make for itself.

Again, the only way I can see around this is if the doctor assumes that the child will be brought up in an environment such that its "free" choice on the issue will likely match whatever the parents think. That just seems a bit back-to-front to me, though.

What about this makes it unrequired in a way that doesn't make the majority of what we do for our children unrequired?

It is not a simple thing for a physician to refuse to provide service. The physician has to believe that it will not offer a net benefit to the patient, something that would be very difficult to support considering that the available information demonstrates 1) a net benefit to circumcision and 2) a net benefit to neonatal circumcision over and above that provided by circumcision later. This is particularly tricky in the US, and may be an additional contributor to the higher rate of circumcision.

Linda

[billydkid]

The only actual reasoning that made any sense to me was that parents don't want to clean the boy's part properly. I guess they think hygiene can be considered kinky? But I think that's probably the root reason, others are just cover stories.While I agree that anything having to do with genitalia in the US is fraught with hysteria (sort of a joke there) and certainly there may be some underlying puritanical cultural stupidity involved, I really doubt that really enters into the motives of individual parents. They have it done because that is what they know and that is what their culture tells them and in the back of their minds they assume there must be some benefit. It doesn't really occur to most folks that the practice is cruel and pointless and irrational.

[billydkid]

I just realized something.

Are you circumcized, bignickel? Because men who aren't generally don't think the glans is the only part of the penis that gives pleasure. The most sensitive part of the penis, the frenulum, is removed in circumcision.Oh great! Now you tell me!

[kellyb]

Regarding infants and UTI's, I'm still waiting for someone to show me a study where they controlled for prematurely born infants who were both too young to be circumcised and who were also more prone to develop UTIs because they were so small and weak. I wouldn't be terribly surprised if there was some small effect there, but I think it's being overstated, at the least. I'm also pretty sure there's probably some genital modification that could be done on infant girls that would reduce their UTI's. That would be silly, though.

With the penile cancer thing...this one makes sense. More penis to get penis cancer--> higher rate of penile cancer. It wouldn't surprise me if HPV "likes" the foreskin. It's a weird reason to advocate RIC, though. I'm sure you could remove large areas of the vagina and get a reduction in vaginal cancer, too.

The HIV thing is "the best" reason to circ, I suppose. I don't think the Langerhans' cells theory is correct, though. In fact, the opposite is probably the case:
http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=17334373

Langerin is a natural barrier to HIV-1 transmission by Langerhans cells.

Human immunodeficiency virus-1 (HIV-1) is primarily transmitted sexually. Dendritic cells (DCs) in the subepithelium transmit HIV-1 to T cells through the C-type lectin DC-specific intercellular adhesion molecule (ICAM)-3-grabbing nonintegrin (DC-SIGN). However, the epithelial Langerhans cells (LCs) are the first DC subset to encounter HIV-1. It has generally been assumed that LCs mediate the transmission of HIV-1 to T cells through the C-type lectin Langerin, similarly to transmission by DC-SIGN on dendritic cells (DCs). Here we show that in stark contrast to DC-SIGN, Langerin prevents HIV-1 transmission by LCs. HIV-1 captured by Langerin was internalized into Birbeck granules and degraded. Langerin inhibited LC infection and this mechanism kept LCs refractory to HIV-1 transmission; inhibition of Langerin allowed LC infection and subsequent HIV-1 transmission. Notably, LCs also inhibited T-cell infection by viral clearance through Langerin. Thus Langerin is a natural barrier to HIV-1 infection, and strategies to combat infection must enhance, preserve or, at the very least, not interfere with Langerin expression and function.

But nevertheless, the effect of circumcision preventing HIV seems to be real. But I think the way it works is through herpes sores and other ulcerative genital sores that work in tandem with the HIV virus. That would also explain why female circumcision works to prevent AIDS, too. So if you're going to advocate infant circumcision for HIV prevention, you should really also advocate scientific inquiry into forms of FGM that might work the same way and have the same effect. But that would be silly, too, huh?

[kellyb]

No prob. :)

I just wanted to assure you that there are a LOT of docs in this country who definitely inform parents that, unless there is a specific medical condition being treated, circumcision is an elective procedure. The vast majority of circs in this country fall into that category.

It is in the best interest of the doc to do this and to make sure that he/she documented that fact lest one of the fortunately-rare-but-very-real complications occurs. It's about informed consent. The consent form that my hospital uses says several times that, despite some studies showing potential future benefit from it, circumcision is at the end of the day an elective procedure with risks.

I doubt that we're unique in the information that we provide. Part of it is a sincere desire to inform parents as completely as possible to the potential risks/benefits of circumcision, but the other is, of course, an effort to address medico-legal concerns.

I think there might be a lot of variation in what happens in different areas of the country?
The OB who saw me though the first part of my delivery actually pressured me to circumcise, and then when it was "time", it was just a nurse who came in with paperwork and asked if I wanted it done. When my best friend gave birth, it was just a nurse with paperwork who spoke with her. She just rattled off the list of possible complications and my friend signed the consent form.
This is in the south, though.

[fls]

I think there might be a lot of variation in what happens in different areas of the country?
The OB who saw me though the first part of my delivery actually pressured me to circumcise, and then when it was "time", it was just a nurse who came in with paperwork and asked if I wanted it done. When my best friend gave birth, it was just a nurse with paperwork who spoke with her. She just rattled off the list of possible complications and my friend signed the consent form.
This is in the south, though.

How long ago was that?

They asked me if we wanted the baby to be circumcised. I said no and that was that (my first boy was born 16 years ago in Minnesota). I think there is likely to be a lot of variation, but I wonder if there is a trend with time.

Linda

[kellyb]

How long ago was that?

They asked me if we wanted the baby to be circumcised. I said no and that was that (my first boy was born 16 years ago in Minnesota). I think there is likely to be a lot of variation, but I wonder if there is a trend with time.

Linda

It was three years ago that I gave birth, and 8 years ago that my friend did.
I really think it's probably more of a regional thing? In my area, the overall circumcision rate is still around 80%, and I think it's much higher among caucasians.
There's probably a trend with time, as well, but the south is a decade or so behind the north and the west. There's still a very strong religious element to circumcision here in the Bible Belt, too, even if it's down to "God thought of it, so it can't actually be a bad thing."

[BlackKat]

Actually here are some statistics broken down by year and region in the U.S.
http://www.cirp.org/library/statistics/USA/
I still have not been able to determine if this is a pro / con / neutral site but their numbers seem to have come from the NHDS so they're probably accurate.

Quote:
But in essence, the foreskin, like other evolutionary holdovers, is not necessary. It's like when people are born with tails, webbing, etc. Clothing makes having a foreskin superfluous.
This analogy is so wrong, I can't help but shake my head. A foreskin might not be essential but it's certainly not useless, and claiming otherwise and comparing it to a tail is sheer intellectual dishonesty.


This is hardly a faulty analogy. The foreskin is the human equivalent to other animals having furred sheathes which their penis withdraws into when not erect (like land mammals) or body cavities (like birds or fish or whales). Since the invention of pants (some thousands of years ago) the foreskin has just been an evolutionary holdover from when we needed to hide our penis to keep it safe and warm.

[fls]

http://www.cirp.org/library/statistics/USA/
I still have not been able to determine if this is a pro / con / neutral site but their numbers seem to have come from the NHDS so they're probably accurate.

Based on the direction of the misleading and misrepresentative information provided in the articles and FAQ's, it's a con site. I agree that it's hard to tell if you don't have independent knowledge.

Linda

[kellyb]

This is hardly a faulty analogy. The foreskin is the human equivalent to other animals having furred sheathes which their penis withdraws into when not erect (like land mammals) or body cavities (like birds or fish or whales). Since the invention of pants (some thousands of years ago) the foreskin has just been an evolutionary holdover from when we needed to hide our penis to keep it safe and warm.
No, in the human, the foreskin does more than that.
The prepuce keeps the glans soft and protects it from abrasions and drying out (keratinized), releases pheromones, assists in lubrication during intercourse, etc. In lower primates, the glans penis is actually more sensitive than the foreskin. In humans it's reversed, making it impossible for it to be a simple vestigial organ.

[Ivor the Engineer]

What about this makes it unrequired in a way that doesn't make the majority of what we do for our children unrequired?

I think in the case of circumcision the benefit really is in the eye of the beholder. The only other unrequired things we do for our children that I can think of is vaccinate them. Typically these are for unpleasant and sometimes deadly diseases, which there is few treatments for (since they are viral) except support for the body while it is healing itself.

However, we don't vaccinate children (or anybody else for that matter) until just before they are likely to be at risk. Standard vaccinations have extremely low risk and large benefits. They also do not affect the individual at a level they can perceive for a significant length of time. I.e. the administration of them is quick and the after effects are minor.

I really can't think of any other medical treatments that are not indicated first before treatment commences. Were you just thinking about medical interventions? Give me some examples of other things parents do for their children that are not required.

It is not a simple thing for a physician to refuse to provide service. The physician has to believe that it will not offer a net benefit to the patient, something that would be very difficult to support considering that the available information demonstrates 1) a net benefit to circumcision and 2) a net benefit to neonatal circumcision over and above that provided by circumcision later. This is particularly tricky in the US, and may be an additional contributor to the higher rate of circumcision.

Linda

Again, it comes down to who's viewing the benefit.

Claiming circumcising an infant to avoid problems associated with tight foreskin is a benefit for most children is ridiculous. Most of the (non-US) research concludes that this 'problem' cures itself for the vast majority of boys by the time they're 15. If it does occur there are techniques other than circumcision to try first.

It reduces infections of the foreskin/glans. I can only talk from personal experience*, but I would certainly not have chosen to be circumcised to avoid the 1-2 days of discomfort caused by one of these. (I didn't even have a day of work). Plus it's something to talk about in the pub:)

It provides protection against HIV. No one in their right mind would think circumcision is going to be a significant advantage for the control of HIV in the US.

That leaves UTI's, which presumably in women are treated with antibiotics. Why raise the ethical problems of operating on a healthy, non-consenting patient when there exists effective treatment for the problem if it occurs in the first place?

Circumcision does have a role, but it should be much closer to the 0.6% figure quoted in the paper I linked to earlier if it is being used when it is an appropriate treatment.

*This was caused by not washing my hands before going for a pee after using mineral oil on a lathe.

[fls]

I think in the case of circumcision the benefit really is in the eye of the beholder.

Haven't we all agreed on that?

The only other unrequired things we do for our children that I can think of is vaccinate them. Typically these are for unpleasant and sometimes deadly diseases, which there is few treatments for (since they are viral) except support for the body while it is healing itself.

However, we don't vaccinate children (or anybody else for that matter) until just before they are likely to be at risk. Standard vaccinations have extremely low risk and large benefits. They also do not affect the individual at a level they can perceive for a significant length of time. I.e. the administration of them is quick and the after effects are minor.

I really can't think of any other medical treatments that are not indicated first before treatment commences. Were you just thinking about medical interventions? Give me some examples of other things parents do for their children that are not required.

Education, braces, treatment of most ailments, sunscreen, glasses, haircuts, piercings, tatoos, diagnostic tests.

Again, it comes down to who's viewing the benefit.

Claiming circumcising an infant to avoid problems associated with tight foreskin is a benefit for most children is ridiculous. Most of the (non-US) research concludes that this 'problem' cures itself for the vast majority of boys by the time they're 15. If it does occur there are techniques other than circumcision to try first.

It reduces infections of the foreskin/glans. I can only talk from personal experience*, but I would certainly not have chosen to be circumcised to avoid the 1-2 days of discomfort caused by one of these. (I didn't even have a day of work). Plus it's something to talk about in the pub:)

It provides protection against HIV. No one in their right mind would think circumcision is going to be a significant advantage for the control of HIV in the US.

That leaves UTI's, which presumably in women are treated with antibiotics. Why raise the ethical problems of operating on a healthy, non-consenting patient when there exists effective treatment for the problem if it occurs in the first place?

Circumcision does have a role, but it should be much closer to the 0.6% figure quoted in the paper I linked to earlier if it is being used when it is an appropriate treatment.

We've gone over all this already. Nobody's disagreeing with you on these issues.

*This was caused by not washing my hands before going for a pee after using mineral oil on a lathe.

TMI!!!

Linda

[kellyb]

I really can't think of any other medical treatments that are not indicated first before treatment commences. Were you just thinking about medical interventions? Give me some examples of other things parents do for their children that are not required.

Education, braces, treatment of most ailments, sunscreen, glasses, haircuts, piercings, tatoos, diagnostic tests.
I'm not really seeing the parallel between circumcision and the application of sunscreen.:confused: Glasses, medications, and diagnostic tests tend to be done after there's already a problem, so I'm not seeing that, either.
Circumcision appears to be rather unique.

[BlackKat]

Quote:
This is hardly a faulty analogy. The foreskin is the human equivalent to other animals having furred sheathes which their penis withdraws into when not erect (like land mammals) or body cavities (like birds or fish or whales). Since the invention of pants (some thousands of years ago) the foreskin has just been an evolutionary holdover from when we needed to hide our penis to keep it safe and warm.
No, in the human, the foreskin does more than that.
The prepuce keeps the glans soft and protects it from abrasions and drying out (keratinized).
I am circumcised and have never had abrasions or kerantization. I would think this a symptom of too much of a good thing. Precum is emitted by the ureathra anyhow, not by the foreskin. If you're refering to smegma as was already addressed earlier this is a sign of a penis that is not washed enough. All pores on humans emit oils and other liquids over time. But since we bathe at least daily unless we are hobos we do not keep them there.

, releases pheromones,
How many do you need? Are you going to complain if I give you 1,234,345,227 instead of 1,234,345,230 ? Human phermones are still unproven anyhow although there is some evidence they may exist.


assists in lubrication during intercourse, etc.
see above.

In lower primates, the glans penis is actually more sensitive than the foreskin. In humans it's reversed, making it impossible for it to be a simple vestigial organ.
Circumcised men (as Z has said) are having no problems with lack of sensation in their de-foreskinned members. I'll testify to this as well.
But again comparing sensations (which are subjective and could be as much psychological as physical anyhow) is pointless. But in case it's not pointless the most nerves in the penis (circumcised or not) are in the tip and along the bottom length. Not in the foreskin.

[fls]

I'm not really seeing the parallel between circumcision and the application of sunscreen.:confused: Glasses, medications, and diagnostic tests tend to be done after there's already a problem, so I'm not seeing that, either.
Circumcision appears to be rather unique.

They are examples of things that we force upon our children that are not required (to force a clarification of what is meant by "required").

Linda

[Katana]

I think there might be a lot of variation in what happens in different areas of the country?
The OB who saw me though the first part of my delivery actually pressured me to circumcise, and then when it was "time", it was just a nurse who came in with paperwork and asked if I wanted it done. When my best friend gave birth, it was just a nurse with paperwork who spoke with her. She just rattled off the list of possible complications and my friend signed the consent form.
This is in the south, though.


That was pretty irresponsible. A nurse is no more qualified to consent you for your son's circumcision than he/she is for any other surgical procedure. That is not meant to cause offense. It's a matter of the physician taking the responsibility to ensure that patients are adequately-informed since he/she is the one actually doing the procedure and who is, therefore, best-qualified to do so. It's the same reason that medical students don't consent patients. What happened to you and your friend put the nurses in a bad position in that they were asked to do the docs' work for them.

Having said that, you might be right about there being some geographic differences in even in the way that physicians approach the matter. However, going on my experiences in a variety of settings and the opinions of many docs expressed at conferences that I have attended, I know that my hospital is not alone. That much I can say, but, admittedly, that is anecdotal. :con2:

[tabitha]

Circumcision is pretty horrible. I fortunately live in the UK where it is not the norm. No medical body on the world recommends it, The HIV arguments have been pretty much defused to my knowledge. (I have links but I can't post them as I am new!).

I don't know why anyone would put a newborn through cosmetic surgery though (that is what it is). It's pretty hard to understand for us on this side of the pond! Why would you want to decrise the sexual capacity of your baby??? Foreskins have functions!!! Honestly, they do!;)

Two of my friends are now married to circumcised americans and both of them are finding it hard. Foreskins glide up and down when you make love...it can be pretty harsh to make love with a circumcised guy sometimes, for the woman. "Lasting longer" is NOT always a good thing iykim;) :p

[Thunder]

Id feel more comfortable with circumsision of they gave the baby anesthesia

[BlackKat]

Circumcision is pretty horrible. I fortunately live in the UK where it is not the norm. No medical body on the world recommends it, The HIV arguments have been pretty much defused to my knowledge. (I have links but I can't post them as I am new!).

I don't know why anyone would put a newborn through cosmetic surgery though (that is what it is). It's pretty hard to understand for us on this side of the pond! Why would you want to decrise the sexual capacity of your baby??? Foreskins have functions!!! Honestly, they do!;)

Two of my friends are now married to circumcised americans and both of them are finding it hard. Foreskins glide up and down when you make love...it can be pretty harsh to make love with a circumcised guy sometimes, for the woman. "Lasting longer" is NOT always a good thing iykim;) :p

The HIV arguments have not been defused.
But it does not matter since as the vast majority of circumcised males are quite happy with their elective, cosmetic surgery even if we did not choose it. We are so happy with it we choose it for our children in turn. This is because foreskins are considered ugly and dirty by most Americans. To most of us it would be like keeping most of the umbilical cord attached and dragging it along with you. Or like not having warts removed with liquid nitrogen.

The lack of a foreskin has little to no effect on sexual lubrication because most sexual lubricants come from the female genitals or a jar. In any case you should wear condoms when you have sex so even if your foreskin is unwashed and lubricating it won't matter.

Also foreskins or circumcised penises can not be proven or disproven to make sex any more or less pleasurable and wether your partner prefers them is also subjective so it is all moot.

[Ivor the Engineer]

Education, braces, treatment of most ailments, sunscreen, glasses, haircuts, piercings, tatoos, diagnostic tests.

Education: Huge disadvantage if not provided.

Braces: I think it would make an interesting court case if a child really did not want to wear braces, against the parents will.

Treatment of most ailments: To reduce suffering that is occurring at the time of treatment. E.g., Calpol

Sunscreen: Interesting one. Does work but encourages more time in sun so benefit is reduced. Then there's the whole vitamin D thing...

Glasses: Not being able to see clearly is a significant disadvantage for most children. E.g., they can't read the blackboard in school or learn to write properly unless they can see.

Haircuts: Not essential, but handy if the school has an outbreak of head lice. Also rather trivial until you start noticing the opposite sex.

Piercings/Tattoos: Hey, the region of England I come from even the women have L-O-V-E H-A-T-E on their knuckles! If either of these procedures were performed on a non-consenting child it would raise similar ethical problems for the person performing them.

Diagnostic Tests: Apart from aliens and Greg House, who performs diagnostic tests without some medical problem in the first place?

TMI!!!

Linda

What's TMI? Is it rude?:D

ETA: Got TMI. Sorry if you were eating...

[robinson]

TMI = too much information

and yes, giving too much information is rude

[kellyb]

I am circumcised and have never had abrasions or kerantization.
Uuh...maybe you're some rare exception, but I've never....seen...the glans of a circumcised adult male that weren't keratinized. I don't know if it's allowed on this forum, but there are compare/contrast pictures available on the web from non-pornographic sources that show the difference.
I would think this a symptom of too much of a good thing.
What do you mean?
Having shiny, smooth pink parts isn't an issue in a negative way for intact men. Or for uncircumcised women, either.
Precum is emitted by the ureathra anyhow, not by the foreskin.
It has to do with the way the penis "behaves" with lubrication produced by the female. I'm not sure how to describe it without being vulgar.
If you're refering to smegma as was already addressed earlier this is a sign of a penis that is not washed enough.
I wasn't talking about that, either, but it's not like only "dirty" penises can produce it. It's something that's produced and that washes away. Just like with females.
All pores on humans emit oils and other liquids over time. But since we bathe at least daily unless we are hobos we do not keep them there.
Ok. Either way, the foreskin contains apocrine glands. It's part of our pheromonal signalling system.

How many do you need? Are you going to complain if I give you 1,234,345,227 instead of 1,234,345,230 ? Human phermones are still unproven anyhow although there is some evidence they may exist.

I was unaware that pheromones in humans were unproven. I'd be very surprised if they didn't exist. Perhaps that would be a subject for another thread, though. I read some interesting research on pheromones and the MHC a while back, and I'm personally convinced.
Regarding the relevance to circumcision, I guess it's unknown at this time, since it hasn't been studied.
Circumcised men (as Z has said) are having no problems with lack of sensation in their de-foreskinned members. I'll testify to this as well.
There are similar testimonials from women who've undergone various forms of female circumcision. It's hard to know what it "means" as far as which is really "better", though.
But again comparing sensations (which are subjective and could be as much psychological as physical anyhow) is pointless. But in case it's not pointless the most nerves in the penis (circumcised or not) are in the tip and along the bottom length. Not in the foreskin.
Have you seen this?

http://www.blackwell-synergy.com/doi/abs/10.1111/j.1464-410X.2006.06685.x

OBJECTIVE

To map the fine-touch pressure thresholds of the adult penis in circumcised and uncircumcised men, and to compare the two populations.

SUBJECTS AND METHODS
Adult male volunteers with no history of penile pathology or diabetes were evaluated with a Semmes-Weinstein monofilament touch-test to map the fine-touch pressure thresholds of the penis. Circumcised and uncircumcised men were compared using mixed models for repeated data, controlling for age, type of underwear worn, time since last ejaculation, ethnicity, country of birth, and level of education.

RESULTS
The glans of the uncircumcised men had significantly lower mean (sem) pressure thresholds than that of the circumcised men, at 0.161 (0.078) g (P = 0.040) when controlled for age, location of measurement, type of underwear worn, and ethnicity. There were significant differences in pressure thresholds by location on the penis (P < 0.001). The most sensitive location on the circumcised penis was the circumcision scar on the ventral surface. Five locations on the uncircumcised penis that are routinely removed at circumcision had lower pressure thresholds than the ventral scar of the circumcised penis.

CONCLUSIONS
The glans of the circumcised penis is less sensitive to fine touch than the glans of the uncircumcised penis. The transitional region from the external to the internal prepuce is the most sensitive region of the uncircumcised penis and more sensitive than the most sensitive region of the circumcised penis. Circumcision ablates the most sensitive parts of the penis.

[kellyb]

But it does not matter since as the vast majority of circumcised males are quite happy with their elective, cosmetic surgery even if we did not choose it. We are so happy with it we choose it for our children in turn. This is because foreskins are considered ugly and dirty by most Americans. To most of us it would be like keeping most of the umbilical cord attached and dragging it along with you. Or like not having warts removed with liquid nitrogen.
That sounds a lot like what women in Africa think about FGM.
It's a totally illogical cultural bias.

[Ivor the Engineer]

They are examples of things that we force upon our children that are not required (to force a clarification of what is meant by "required").

Linda

First thoughts would be an act is required if in-action could reasonably be expected to have negative consequences for the child in the foreseeable future, based on your list (Death, Disability, etc.). The amount of foresight would vary depending on the act being considered.

[Soapy Sam]

Well this hardy perennial has come around again!

I still say what I did at the start: If adults want to cut bits off themselves, fine. Doing it to children is at best unfair and at worst, I can't see how it differs from abuse. The fact that it's common custom in certain areas is no argument at all. Clitoral circumcision is common practice some places. Doesn't make it right.
If this makes me anti-semitic or anti-whoever the hell cuts girls' clitorises off, I think I can live with it.

[BlackKat]

That sounds a lot like what women in Africa think about FGM.
It's a totally illogical cultural bias.

Have to strongly disagree here as the foreskin is vestigal. A holdover from pre-underpants cultures. Removal of the foreskin does not (we can argue this all day but in the end circumcized men feel plenty of pleasure) detract from sex nor is it removed for that express purpose.

The clitoris is not vestigal. It's removal (and other types of femal genital mutilation) in cultures (primarily in Africa) is specifically to prevent women from enjoying sex as much or at all.

I think it's disingenuous to the women who suffer from such abuse to even try to put foreskin removal anywhere near the subject of female genital mutilation.

[fls]

Education: Huge disadvantage if not provided.

Equivalent to women finding your sexual organ distasteful? Sorry, I couldn't resist.

Braces: I think it would make an interesting court case if a child really did not want to wear braces, against the parents will.

I can't tell how I'm supposed to judge that.

Treatment of most ailments: To reduce suffering that is occurring at the time of treatment. E.g., Calpol

Some of the reduction of suffering is minimal or non-existent. I don't know what Calpol is.

Sunscreen: Interesting one. Does work but encourages more time in sun so benefit is reduced. Then there's the whole vitamin D thing...

At least equivalently required.

Glasses: Not being able to see clearly is a significant disadvantage for most children. E.g., they can't read the blackboard in school or learn to write properly unless they can see.

So this relates to whether or not education is "required".

Haircuts: Not essential, but handy if the school has an outbreak of head lice. Also rather trivial until you start noticing the opposite sex.

Less required.

Piercings/Tattoos: Hey, the region of England I come from even the women have L-O-V-E H-A-T-E on their knuckles! If either of these procedures were performed on a non-consenting child it would raise similar ethical problems for the person performing them.

Presumably not required, yet I don't recall seeing a single anti-child-piercing thread here.

Diagnostic Tests: Apart from aliens and Greg House, who performs diagnostic tests without some medical problem in the first place?

They can be performed for screening or case-finding where the benefit may be non-existent (therefore not required).

So at least some of what we do seems to be as unrequired as circumcision, so I'm not sure that can be used as a criterion.

Linda

[tabitha]

The HIV arguments have not been defused.
But it does not matter since as the vast majority of circumcised males are quite happy with their elective, cosmetic surgery even if we did not choose it. We are so happy with it we choose it for our children in turn. This is because foreskins are considered ugly and dirty by most Americans. To most of us it would be like keeping most of the umbilical cord attached and dragging it along with you. Or like not having warts removed with liquid nitrogen.

The lack of a foreskin has little to no effect on sexual lubrication because most sexual lubricants come from the female genitals or a jar. In any case you should wear condoms when you have sex so even if your foreskin is unwashed and lubricating it won't matter.

Also foreskins or circumcised penises can not be proven or dis proven to make sex any more or less pleasurable and whether your partner prefers them is also subjective so it is all moot.


No you are wrong...are you old?!:p My friends are in California But MOST boys are not circumcised there! My nephews are 6 and 8 and only one each of their friends are circumcised...it is a practice that is dying out...admit it...there is NO reason for it!;)


Ok plus:o Now i am a little embarrassed! But lack of foreskin had a BIG effect on sexual lubrication...honestly. Sex with a circumcised person vs with an normal one is SOOOO different. The circumcised can be better to start , maybe.
, but it just pounds away and is really unpleasant when you (eventually!) get to the end. The "glide thing" doesnt work!!! rofl...this is my first post's on this forum...I never thought they would all be about dicks!!!!LOL

[ThatSoundAgain]

They can get it done as infants as adults?

No, you don't honestly think that was what I meant, do you?

I agree with you that the regret over not having been circumcised as an infant is irreparable. You can't wish it into having been so - but what you can do is get circumcised as an adult if you think it's important.

Which is just not possible the other way around.

What I'm saying is simply that this regret (however common it is) is the lesser of two evils. Whether you do circumcise the majority or not, you're going to get a group of people who are unhappy with it. Fact of life.

There have been effects that change based on when it is done, and the question was how many would want it done as infants not how many would want it done as adults. Between the pain and temporary sexual dysfunction that is enough to discourage people.


Like I said, whatever you do there's going to be regrets. Is it a problem, in your view, that the majority of uncircumcised adults don't get it done when they can?

But which side is the side of caution? If someone said "well the link between autism and vaccination is questionable best err on the side of caution" but the side of caution in both cases involves an irreversible treatment that the person can never go back to a "natural" condition.


That, to me, is the central point we're debating here. And my position hinges upon the observation that as long as we don't know more about the function of the foreskin, better leave it be. So that, in my opinion, is the side of caution.

Of course, you can (and apparently do) disagree.


The strong opinions seem to be entirely emotion based.


Yes, I'm tired as well of the appeals to emotion. I know where my sensitivities and cultural background (Europe, as stated) place me on the scale of emotional responses. But that won't get us anywhere, so I try to disregard it and not get too emotional, at least in the way I write it.



- If it ain't broken, don't fix it.
- If you want to fix it, despite the data being unclear, the benefits of doing so small, the drawbacks of doing so not well examined, the procedure a risk (albeit small), be sure it's your own foreskin you fix, not someone else's.


So you are for the practice of circumcision because as a common practice if that is "broken" is the basis of your argument or an appeal to "natural" being the preferred state.


Let me just clarify my original position. Maybe it would have been clearer if I'd said "If the foreskin ain't broken..." (but it just hasn't the same ring to it). So I'm not talking about the common, default practice across the population (which would be different depending on which side of the Atlantic you're on, anyway). I'm talking about the specific, individual foreskin. If there's not a problem with it (like phimosis), leave it be unless you know very specifically what foreskins do and don't do.

I hope that makes it clear(er). That's my position, take it as you will.

The if it ain't broke don't fix is just as much an appeal to maintain the status quo as it is to preserve the natural state of man. Most people here do not automatically assume "natural"=Better very much but that seems to be at the heart of these debates.

Which is wise (acknowledging that "natural" and "better" are independent variables). But to me there's a hint in that most healthy males are born with foreskins. It may be vestigial or not - the level of confidence in that has to me not been reached to the point of advocating routine removal.

Not even in the same league as "herbal medicine is better beacuse its natural".

[kellyb]

Have to strongly disagree here as the foreskin is vestigal. A holdover from pre-underpants cultures. Removal of the foreskin does not (we can argue this all day but in the end circumcized men feel plenty of pleasure) detract from sex nor is it removed for that express purpose.

The clitoris is not vestigal. It's removal (and other types of femal genital mutilation) in cultures (primarily in Africa) is specifically to prevent women from enjoying sex as much or at all.

I think it's disingenuous to the women who suffer from such abuse to even try to put foreskin removal anywhere near the subject of female genital mutilation.

You're assuming total clitoral removal is the the most common form of FGM, and it's not. Removal of the clitoral hood and other forms of cutting are more common. But I agree that total clitoral removal is not the same as male circumcision.
You're also assuming that the main reason cultures who practice FGM do it is to oppress women, and that's also incorrect. They really think it's "healthier"and "more attractive" . They could have a point on the "healthier" thing. The more I think about it, the more I think removing the labia at birth might actually have some obscure health benefits that could be found if someone were to look hard enough.

Vestigial organs serve no purpose and have no function. The foreskin does not qualify. Foreskins do all kinds of things. Saying the things the foreskin does don't matter very much in your opinion doesn't make the foreskin a vestigial organ.
Saying "circumcised men feel plenty of pleasure" doesn't mean that circumcision doesn't detract from sex.

[Ivor the Engineer]

Equivalent to women finding your sexual organ distasteful? Sorry, I couldn't resist.

I cannot say whether she'd like the taste or not.

Education is clearly required.

I can't tell how I'm supposed to judge that.

By the time a child needs a brace they're old enough to start having a say in what happens to them and can remove the brace at will. Plus healthy but crooked teeth are the norm in the UK, don't you know that:rolleyes:

Some of the reduction of suffering is minimal or non-existent. I don't know what Calpol is.

Calpol is paracetamol for kids.

I now have a vision of your kids saying "Mummy! It hurts!" and you replying "Life is pain kid. Get used to it.":D

Seriously, which is worse as a kid: having a pain and being alone or having a pain and having your mum there?

At least equivalently required.

Yes.

So this relates to whether or not education is "required".

No, that was just the example I attached to it. Playing catch with the other kids is pretty hard if you can't see the ball clearly.

Less required.

It should really be classed as hair care, which is required. You know, like washing.

Presumably not required, yet I don't recall seeing a single anti-child-piercing thread here.

I very rarely visit the Current Events forum. If you like I'll start a thread.

They can be performed for screening or case-finding where the benefit may be non-existent (therefore not required).

The benefit is in the information gained, which if I'm correct has to be disclosed to the patient or a guardian. Knowing you don't have something can be useful too.

So at least some of what we do seems to be as unrequired as circumcision, so I'm not sure that can be used as a criterion.

Linda

The only one I see in the same league as circumcision is piercing/tattoos of infants. I would argue against that too on ethical grounds.

Going to bed. Catch you later.

[BlackKat]

You're assuming total clitoral removal is the the most common form of FGM, and it's not. Removal of the clitoral hood and other forms of cutting are more common. But I agree that total clitoral removal is not the same as male circumcision.
You're also assuming that the main reason cultures who practice FGM do it is to oppress women, and that's also incorrect. They really think it's "healthier"and "more attractive" . They could have a point on the "healthier" thing. The more I think about it, the more I think removing the labia at birth might actually have some obscure health benefits that could be found if someone were to look hard enough.

Sorry but there are almost no cases where female genital mutilation is not performed with the express purpose of preventing women from enjoying sex.
And in most cases it does involve deliberate removal or sabotage of the clitoris:
http://www.who.int/mediacentre/factsheets/fs241/en/

Vestigial organs serve no purpose and have no function. The foreskin does not qualify. Foreskins do all kinds of things. Saying the things the foreskin does don't matter very much in your opinion doesn't make the foreskin a vestigial organ.

I didn't say they don't matter much in my opinion. I said they don't matter much at all. No opinion, just a cold hard fact. The ONLY purpose of the foreskin (that is not served equally well by other parts of the penis) is to keep it warm and tucked away like a dog's penis sheathe (or horse, or bull, or hippopotomus).
Because we are such advanced cultures that developed PANTS we don't need this sheathe anymore. We have PANTS. Now if we were all Scots this would be another issue as we would need to have foreskins to wear under our kilts (provided we could get a license to wear a kilt as apparently Scot imposters are quite common so they're licensing kilts now). I suppose you could argue that the foreskin does prevent chaffing from said pants. But I would counter that arguement with a bottle of fabric softener.

Saying "circumcised men feel plenty of pleasure" doesn't mean that circumcision doesn't detract from sex.
Yes it does. I hate to sound cocky, but I would gladly challenge any foreskinned male on this board to a pleasure competition and am sure I could at least tie the best of them. ;)

[fls]

Education is clearly required.

I remember that you have some sort of standing offer....

Calpol is paracetamol for kids.

I now have a vision of your kids saying "Mummy! It hurts!" and you replying "Life is pain kid. Get used to it.":D

Puhleeze. I have the Amazing Magic Mommy Kisses on my side.

Actually, I'm dumping the rest of the examples in favour of the definition you provided:

First thoughts would be an act is required if in-action could reasonably be expected to have negative consequences for the child in the foreseeable future, based on your list (Death, Disability, etc.). The amount of foresight would vary depending on the act being considered.

Putting aside our bias for physical integrity, could not the small (tiny) absolute benefit in infant UTI and penile cancer, and variable (depending upon the prevalence wherever the child lives when they become sexually active) absolute benefit in reducing the risk of acquiring HIV be considered as consequences worth avoiding through inaction? (Focusing on those issues in which some or all of the benefit is lost by waiting until the child is an adult.)

Linda

[athon]

rofl...this is my first post's on this forum...I never thought they would all be about dicks!!!!LOL

I'd like to say you've got nowhere to go but up from here.

I'd like to say that. But...well, this place is like a gutter with a basement. There's always a way to go lower.

Welcome to the forums. :D

Athon

[kellyb]

Sorry but there are almost no cases where female genital mutilation is not performed with the express purpose of preventing women from enjoying sex.
That's not true.
http://pediatrics.aappublications.org/cgi/content/full/102/1/153
FGM has been documented in individuals from many religions, including Christians, Muslims, and Jews. Some proponents of the practice claim that it is required by the Islamic faith. However, scholars and theologians of Islam state that female circumcision is not prescribed by their religious doctrine, emphasizing that the procedure is almost never performed in many major Muslim countries such as Saudi Arabia, Iran, and Pakistan.17

Kopelman18 has summarized four additional reasons proposed to explain the custom of FGM: 1) to preserve group identity; 2) to help maintain cleanliness and health; 3) to preserve virginity and family honor and prevent immorality; and 4) to further marriage goals, including enhancement of sexual pleasure for men. Preservation of cultural identity has been noted by Toubia19 to be of particular importance for groups who have previously faced colonialism and for immigrants threatened by a dominant culture. FGM is endemic in poor societies where marriage is essential to the social and economic security for women. FGM becomes a physical sign of a woman's marriageability, with social control exercised over her sexual pleasure by clitorectomy and over reproduction by infibulation.


And in most cases it does involve deliberate removal or sabotage of the clitoris:
http://www.who.int/mediacentre/factsheets/fs241/en/
If you want to call removing the prepuce "sabotage".
(ETA: notice that my link is from 2005 and yours from 2000. That WHO media release is pretty old now.)

http://www.unicef.org/publications/files/FGM-C_final_10_October.pdf

In the majority of countries that have included
questions regarding type of FGM/C, excision
of the prepuce (Type 1) is found to be the most
common. Only in Burkina Faso is excision of the
clitoris (Type 2) found to be most frequent.


I didn't say they don't matter much in my opinion. I said they don't matter much at all. No opinion, just a cold hard fact.
What fact? You haven't provided any facts at all so far.
The ONLY purpose of the foreskin (that is not served equally well by other parts of the penis) is to keep it warm and tucked away like a dog's penis sheathe (or horse, or bull, or hippopotomus).
Can you provide some evidence to back that claim?
Because we are such advanced cultures that developed PANTS we don't need this sheathe anymore. We have PANTS. Now if we were all Scots this would be another issue as we would need to have foreskins to wear under our kilts (provided we could get a license to wear a kilt as apparently Scot imposters are quite common so they're licensing kilts now). I suppose you could argue that the foreskin does prevent chaffing from said pants. But I would counter that arguement with a bottle of fabric softener.
See above.
Yes it does. I hate to sound cocky, but I would gladly challenge any foreskinned male on this board to a pleasure competition and am sure I could at least tie the best of them.
I bet you'd cheat. This would have to rely on "self-reporting", right?
:)
In all seriousness, I'll dig up the studies that have looked into sexual satisfaction after circumcision if you want. Circumcision generally reduces sexual pleasure.

[kellyb]

Putting aside our bias for physical integrity, could not the small (tiny) absolute benefit in infant UTI and penile cancer, and variable (depending upon the prevalence wherever the child lives when they become sexually active) absolute benefit in reducing the risk of acquiring HIV be considered as consequences worth avoiding through inaction? (Focusing on those issues in which some or all of the benefit is lost by waiting until the child is an adult.)

Linda

Are you sure the penis cancer thing only "works" if a male is circumcised in infancy?
And the choice to use circumcision as an HIV preventive could be made around the time of puberty, as well. Realistically, most of the benefits there could still be gained if circumcision was performed around age 18. (I'm going out on a limb here and guessing that an overwhelming majority of HIV infected men picked up the virus after age 18, although I haven't looked it up.)

[Morrigan]

Have to strongly disagree here as the foreskin is vestigal. A holdover from pre-underpants cultures. Removal of the foreskin does not (we can argue this all day but in the end circumcized men feel plenty of pleasure) detract from sex nor is it removed for that express purpose.
You keep repeating that claim, without any evidence. And you claim it's all fact, while ignoring the evidence showing that the foreskin does have a use. Hmm, sounds iffy, even disingenuous.


The clitoris is not vestigal. It's removal (and other types of femal genital mutilation) in cultures (primarily in Africa) is specifically to prevent women from enjoying sex as much or at all.

That is not the reason they give, actually. Preventing women from enjoying sex is a result, not necessarily the primary, or even secondary objective.

I think it's disingenuous
Oh the irony.

[kellyb]

Oh the irony.
I think this issue creates a lot of cognitive dissonance (http://en.wikipedia.org/wiki/Cognitive_dissonance) in Americans which tends to manifest like that.

[Katana]

Id feel more comfortable with circumsision of they gave the baby anesthesia


That's fairly standard practice these days.

Feel better?

ETA: Didn't mean for that to sound so confrontational, so I'll add: :p

[kellyb]

That's fairly standard practice these days.

Feel better?

ETA: Didn't mean for that to sound so confrontational, so I'll add: :p

This is the most recent thing I could find on it:

http://pediatrics.aappublications.org/cgi/reprint/101/6/e5.pdf

Anesthesia or analgesia is
used by 45% of circumcisers and is more likely to be
used by PEDs (71%) than by either FPs (56%; P ,
.001) or OBs (25%; P , .001)
An overall average of less than half, and only one out of four OBs doing it in the hospital use it.

:(

[Katana]

No you are wrong...are you old?!:p My friends are in California But MOST boys are not circumcised there! My nephews are 6 and 8 and only one each of their friends are circumcised...it is a practice that is dying out...admit it...there is NO reason for it!;)


Ok plus:o Now i am a little embarrassed! But lack of foreskin had a BIG effect on sexual lubrication...honestly. Sex with a circumcised person vs with an normal one is SOOOO different. The circumcised can be better to start , maybe.
, but it just pounds away and is really unpleasant when you (eventually!) get to the end. The "glide thing" doesnt work!!! rofl...this is my first post's on this forum...I never thought they would all be about dicks!!!!LOL


Ok, tabitha.

First of all, excellent first post.

Second of all, welcome! :D

This is the most recent thing I could find on it:

http://pediatrics.aappublications.org/cgi/reprint/101/6/e5.pdf


An overall average of less than half, and only one out of four OBs doing it in the hospital use it.

:(


:seerrrr:

Damn. Jerks.

Thanks, kellyb.

I'm a bit too inebriated to the research that I should have done before, so I thank you. If this really is reflective of the majority of docs, it's pathetic. My only hope is that, because it's from 1998, it doesn't reflect current practice.

I can only hope...

I'll try to look into it more tomorrow.

:viking1

[BlackKat]

I bet you'd cheat. This would have to rely on "self-reporting", right?
:)
In all seriousness, I'll dig up the studies that have looked into sexual satisfaction after circumcision if you want. Circumcision generally reduces sexual pleasure.

That's my point. Claims on this post go both ways from men and women for and against the circumcised penis for satisfaction. The same is true for more organized studies. Since sexual satisfaction is subjective and dependent on so many factors it's almost silly to bring sexual satisfaction into debate. If people are enjoying sex who are both circumcised or not, or whose partner(s) are/have been circumcised and/or not.... Can you quantify this enjoyment in terms of levels? Pretty difficult if not impossible.

Sorry but there are almost no cases where female genital mutilation is not performed with the express purpose of preventing women from enjoying sex.
And in most cases it does involve deliberate removal or sabotage of the clitoris:
http://www.who.int/mediacentre/factsheets/fs241/en/

That's not true.
http://pediatrics.aappublications.or...full/102/1/153
I suppose we could all call up conflicting studies but I'm going to believe the World Health Organization's claim that 80% of female genital mutilation procedures are designed to remove the clitoris, labia, or both for the purpose of as your own source stated:
1) to preserve group identity; 2) to help maintain cleanliness and health; 3) to preserve virginity and family honor and prevent immorality; and 4) to further marriage goals, including enhancement of sexual pleasure for men.

Now it's perfectly ok to call into question the medical studies which are stating 2) for circumcision. But the HIV studies done are fairly conclusive. More so are the ones about wearing condoms, which would make the HIV transmission studies about having a foreskin or not moot.

As far as 1) goes. I'd agree this probably is the reason most Americans are circumcised. But you know what? We like our circumcised penises. We (those of us who are circumcised) think our penises are less ugly. I am SOOOOOOO glad I was circumcised as an infant. I would almost certainly have made the same choice as an older person, but am spared the thought and discomfort of having the procedure done because it occurred when I was too young to remember a thing, let alone probably notice it. I am calling my mother right now to thank her for having me circumcised. Just because a child is too young to appreciate getting a less unattractive penis does not mean they won't love you for it later.

[kellyb]

Hopefully it's changed since 1998.

Hey Katana...since you're drunk, you'll like this. I was trying to find the purpose of the female prepuce earlier (I was going to make the point that it's not a vestigial organ) and ran across a bunch of pictures of diseased vulvas.

Is the one on the bottom right...scroll all the way down....does that look like the face of James Randi to you??? The one for a mysterious condition called "Vulvar vestibulitis"?
(Warning! Graphic pictures!!!!)
http://www.brooksidepress.org/Products/Military_OBGYN/Textbook/Vulva/VulvaAtlas.htm
I had a moment of pareidolia when I saw that.

[kellyb]

That's my point. Claims on this post go both ways from men and women for and against the circumcised penis for satisfaction. The same is true for more organized studies. Since sexual satisfaction is subjective and dependent on so many factors it's almost silly to bring sexual satisfaction into debate.
But there's hard biology that explains the how's and why's of the loss of sensitivity that comes with circumcision, though. You'd only have a case if self-reports were the only thing we had to work with.
If people are enjoying sex who are both circumcised or not, or whose partner(s) are/have been circumcised and/or not.... Can you quantify this enjoyment in terms of levels? Pretty difficult if not impossible.
But the general experience is that men report a loss of sensation and pleasure after being circumcised. And this makes sense since we know there are millions of nerves lost and whole erogenous zones removed.

I suppose we could all call up conflicting studies but I'm going to believe the World Health Organization's claim that 80% of female genital mutilation procedures are designed to remove the clitoris, labia, or both for the purpose of as your own source stated:
1) to preserve group identity; 2) to help maintain cleanliness and health; 3) to preserve virginity and family honor and prevent immorality; and 4) to further marriage goals, including enhancement of sexual pleasure for men.
First of all, none of those say "to make sex less enjoyable for women"...and even if you can squeeze that out of number 3, it's one out of 5 reasons given. That doesn't mean ALL cultures use ALL five reasons. You just want it to mean that so FGM can stay firmly planted on the "evil" side, so it maintains a stark contrast with male circumcision.

[fls]

Are you sure the penis cancer thing only "works" if a male is circumcised in infancy?

"Neonatal circumcision confers some protection from penile cancer; however, circumcision at a later age does not seem to confer the same level of protection."

And the choice to use circumcision as an HIV preventive could be made around the time of puberty, as well. Realistically, most of the benefits there could still be gained if circumcision was performed around age 18. (I'm going out on a limb here and guessing that an overwhelming majority of HIV infected men picked up the virus after age 18, although I haven't looked it up.)

It seems to me that kids start having sex long before they are capable of making responsible decisions. Having two teenagers myself, I'd be happy if you could find evidence to the contrary, so I could rest easy. :)

Linda

[BlackKat]

But there's hard biology that explains the how's and why's of the loss of sensitivity that comes with circumcision, though. You'd only have a case if self-reports were the only thing we had to work with.

But the general experience is that men report a loss of sensation and pleasure after being circumcised. And this makes sense since we know there are millions of nerves lost and whole erogenous zones removed.

If you look at a penis diagram most of the nerves (erogenous zones) are on the underside of the shaft and on the glans. I can only relate my personal satisfaction (or Z's since he also expressed the same earlier this thread). There's a reason American men recite baseball stats in their heads during sex you know... it's to keep going longer.

First of all, none of those say "to make sex less enjoyable for women"...and even if you can squeeze that out of number 3, it's one out of 5 reasons given. That doesn't mean ALL cultures use ALL five reasons. You just want it to mean that so FGM can stay firmly planted on the "evil" side, so it maintains a stark contrast with male circumcision.

Well ... I may be wrong because I am not female. But I would think removing the clitoris and/or labia would make sex (including masturbation) a lot less pleasurable. I don't think I was making a huge intellectual leap of faith to add that with the patriarchal societies and second class treatment of women to conclude that female genital mutilation is an act of deliberate sabotage.

[kellyb]

"Neonatal circumcision confers some protection from penile cancer; however, circumcision at a later age does not seem to confer the same level of protection."



It seems to me that kids start having sex long before they are capable of making responsible decisions. Having two teenagers myself, I'd be happy if you could find evidence to the contrary, so I could rest easy. :)

Linda
Ok...I just looked through some of the research making that claim, and it looks to me like circumcision's effectiveness for penis cancer has to do with whether or not it's performed before men become sexually active. It's not very good research, though. It's hard to say for sure what's going on there.

Regarding teens making good decisions, I'm just not seeing this as an argument for infant circumcision. You just can't go around whacking off other people's sex organs when they're babies because you think they're going to maybe make bad choices later. Penile cancer is somewhat avoidable by means other than circumcision, as well.

[Dorian Gray]

1) If removing the clitoris/labia makes sex less pleasurable for women, then doesn't removing the foreskin make sex less pleasurable for men?

2) Justifying circumcision by arguing that it can reduce the chances of getting HIV is utterly ridiculous.
First of all, then how do you justify circumcision for the hundreds of years BEFORE the 1970s (i.e., before AIDS existed to any appreciable degree)?
Secondly, there are FAR better ways to reduce your chances of getting HIV.
Third, AIDS is not a prevalent disease outside of Africa, and not many people contract it compared to numerous other diseases.
Fourth, why stop there? Shall we remove women's breasts after the onset of puberty to reduce their chances of getting breast cancer? How about preemptive bypass surgery on all people to reduce their chances of having a heart attack?


The argument that men won't get a circumcision later, so let's do it now while they are infants is pretty sick. Why don't we give everyone gastric bypass surgery as infants because fat people won't diet and exercise later?

Face it, it is societal pressure and not anything remotely resembling logic or reason that is leading people to perform this procedure. When you understand how 'shocking' it is for girls to have the equivalent procedure, then you will understand how shocking it should be for this as well.

[kellyb]

If you look at a penis diagram most of the nerves (erogenous zones) are on the underside of the shaft and on the glans. I can only relate my personal satisfaction (or Z's since he also expressed the same earlier this thread). There's a reason American men recite baseball stats in their heads during sex you know... it's to keep going longer.

Well, maybe foreskins could help with timing between men and women?

http://www.nzma.org.nz/journal/116-1181/595/
While vaginal dryness is considered an indicator for female sexual arousal disorder,1,2 male circumcision may exacerbate female vaginal dryness during intercourse.3 O’Hara and O’Hara reported that women who had experienced coitus with both intact and circumcised men preferred intact partners by a ratio of 8.6 to one.4 Most women (85.5%) in that survey reported that they were more likely to experience orgasm with a genitally intact partner: ‘They [surveyed women] were also more likely to report that vaginal secretions lessened as coitus progressed with their circumcised partners (16.75, 6.88–40.77).’4

Presence of the movable foreskin makes a difference in foreplay, being more arousing to the female.4 Women reported they were about twice as likely to experience orgasm if the male partner had a foreskin.4 The impact of male circumcision on vaginal dryness during coitus required further investigation.

We conducted a survey of 35 female sexual partners aged 18 to 69 years who had experienced sexual intercourse with both circumcised and genitally intact men.

Participants completed a 35-item sexual awareness survey. Women reported they were significantly more likely to have experienced vaginal dryness during intercourse with circumcised than with genitally intact men χ2 (df = 1, n = 20) = 5.0, p <0.05.5

Well ... I may be wrong because I am not female. But I would think removing the clitoris and/or labia would make sex (including masturbation) a lot less pleasurable.
I would think so, too. I'd also think removing the clitoral prepuce at birth would negatively effect pleasure. Then again, I have all my parts, so of course I think that. Women circumcised with the other various, lesser degrees of circumcision would probably diasagree, though.
I don't think I was making a huge intellectual leap of faith to add that with the patriarchal societies and second class treatment of women to conclude that female genital mutilation is an act of deliberate sabotage.

It is the women themselves who primarily perpetuate the practice, though. It's their culture. They think it's healthier. It was done to them so they have it done to their daughters. They don't think there's anything wrong with it.

[athon]

1) If removing the clitoris/labia makes sex less pleasurable for women, then doesn't removing the foreskin make sex less pleasurable for men?

Not sure if this was an accidental mistake or not, but the clitorus is the equivalent of the glans on the penis, and is full of nerves. The equivalent of the foreskin is the clitoral hood.

2) Justifying circumcision by arguing that it can reduce the chances of getting HIV is utterly ridiculous.
First of all, then how do you justify circumcision for the hundreds of years BEFORE the 1970s (i.e., before AIDS existed to any appreciable degree)?
Secondly, there are FAR better ways to reduce your chances of getting HIV.
Third, AIDS is not a prevalent disease outside of Africa, and not many people contract it compared to numerous other diseases.

The argument is a small risk for a small gain. Sure, condoms work better, but HIV isn't just for Xmas - it's for life. That tiny added bit of protection for some is argued as being beneficial for a tiny compensation (removing the foreskin).

I also question the risk-benefit, to be honest. Which is why I think this decision is personal, and not to be imposed by the parent.

Fourth, why stop there? Shall we remove women's breasts after the onset of puberty to reduce their chances of getting breast cancer? How about preemptive bypass surgery on all people to reduce their chances of having a heart attack?

Because removing the breasts are a large loss for small potential of gain, therefore not equivalent. I would argue that removing the appendix is more similar.

Athon

[BlackKat]

Well, maybe foreskins could help with timing between men and women?

http://www.nzma.org.nz/journal/116-1181/595/



I would think so, too. I'd also think removing the clitoral prepuce at birth would negatively effect pleasure. Then again, I have all my parts, so of course I think that. Women circumcised with the other various, lesser degrees of circumcision would probably diasagree, though.


It is the women themselves who primarily perpetuate the practice, though. It's their culture. They think it's healthier. It was done to them so they have it done to their daughters. They don't think there's anything wrong with it.

There are studies showing both circumcision making men and women happier and studies showing foreskins making men and women happier. Thus there is no firm conclusion either way. It's all subjective. Some people like blue cars better, some people like red cars better. If your circumcised penis works just fine why would you want a foreskin and if you always have had a foreskin why would you not want one? Thus no matter what kind of penis you have, you like that kind the best.

Just because women sometimes perform (and sadly sometimes willingly partake in) the operations does not make them any less of a human rights violation:
http://www.4woman.gov/faq/fgc.htm

I'm not trying to say that male children SHOULD be automatically circumcised. I'm not trying to say that male children should NOT be automatically circumcised. But I am saying circumcision is not a hostile procedure as the foreskin is superfluous in terms of the functions of the penis as a reproductive organ. Men with them have functional and fun sex. Men without them have functional and fun sex.

The difference between male circumcision and female mutilation is because after circumcision the penis functions perfectly well. In 80% of the cases of female genital excision... it's broken. The only way you could lump the two together is if nearly 75% of the male organ was removed. This is because almost all of the nerves in the penis are in the shaft and glans.

[Skeptic Ginger]

...But lack of foreskin had a BIG effect on sexual lubrication...honestly. Sex with a circumcised person vs with an normal one is SOOOO different. The circumcised can be better to start , maybe.
, but it just pounds away and is really unpleasant when you (eventually!) get to the end. The "glide thing" doesnt work!!! rofl...this is my first post's on this forum...I never thought they would all be about dicks!!!!LOLBut did you have a large enough sample size to rule out other variables? ;)

[Skeptic Ginger]

This is the most recent thing I could find on it:

http://pediatrics.aappublications.org/cgi/reprint/101/6/e5.pdf


An overall average of less than half, and only one out of four OBs doing it in the hospital use it.

:(Recently trained PEDs and FPs were more likely to use anesthetics than were their older colleagues, but OB use of pain relief was independent of their practice longevity. Physicians in the western states were significantly more likely to use anesthesia than were other physicians from the rest of the United States.Hooray for NPs and the western states, ahead of the crowd.

I have seen this in other areas of medicine. You have to wait for the old guys to die out for old practices to change.

[Skeptic Ginger]

...
2) Justifying circumcision by arguing that it can reduce the chances of getting HIV is utterly ridiculous.
...Third, AIDS is not a prevalent disease outside of Africa, ...l.You are rehashing. Your examples are false analogies. And if you were paying attention, not a single person here (that I saw) is advocating the HIV prevention EXCEPT where there are high rates of HIV and in those countries, other measures are used as well. They need them all.

You also need to update your pandemic knowledge. I'm afraid HIV has spread much much further than Africa. India, Asia, and Eastern Europe have considerable numbers of HIV infected individuals now.

[Ivor the Engineer]

I remember that you have some sort of standing offer....

Only in my dreams:(

Puhleeze. I have the Amazing Magic Mommy Kisses on my side.

Hey, a debate with TV / Film quotes!

Actually, I'm dumping the rest of the examples in favour of the definition you provided:

Ok.

Putting aside our bias for physical integrity, could not the small (tiny) absolute benefit in infant UTI and penile cancer, and variable (depending upon the prevalence wherever the child lives when they become sexually active) absolute benefit in reducing the risk of acquiring HIV be considered as consequences worth avoiding through inaction? (Focusing on those issues in which some or all of the benefit is lost by waiting until the child is an adult.)

Linda

So reducing a lifetime risk of 1 in 600 of penile cancer is worth raising the ethical problems by operating on a non-consenting patient? What other surgery is justified for such a low risk? I think I'm correct in saying HPV vaccinations would help with this as well? Any idea on the NNT?

The benefit of increased resistance to HIV does not kick in until long after the child is able to make that choice for themselves.

Let's say you're right and the lots of 15 year old boys are having unprotected sex. Why can't the decision be put off until they are 12, 13 or 14? I.e. the doctor knows that the benefit she is providing by operating on the infant could be provided later with fewer ethical problems.

The money parents spend on a circumcision would probably have a better return by putting it in a bank account and buying a stash of condoms for their son when he's 15.

As for UTI's it still raises the ethical problem that there are alternative and much less severe ways to deal with the problem if it arises in the first place.

In summary, circumcision of infants in the developed world (with relatively low incidence of HIV) raises the big ethical problem of performing surgery on a non-consenting patient, for which the outcome of the various benefits it provides can be attained or surpassed by alternative measures.

[fls]

Ok...I just looked through some of the research making that claim, and it looks to me like circumcision's effectiveness for penis cancer has to do with whether or not it's performed before men become sexually active. It's not very good research, though. It's hard to say for sure what's going on there.

Regarding teens making good decisions, I'm just not seeing this as an argument for infant circumcision. You just can't go around whacking off other people's sex organs when they're babies because you think they're going to maybe make bad choices later. Penile cancer is somewhat avoidable by means other than circumcision, as well.

There are two ways I am looking at this.

First of all, if preventative measures are to be undertaken, they should be done well before they are likely to be needed and when it is easiest to undertake that measure. If circumcision was going to be used as a preventative measure (and we are agreed that the absolute benefit would need to be much larger before we would consider the possibility), then the best time to do it would be as a neonate. Doing it later changes it into a more involved operation with a much longer recovery period and puts the child through much more stress.

The second way I am looking at this is whether or not we can prove to parents who want it done that it is harmful. And we can't when the information that we have shows a net benefit.

Linda

[Megalodon]

Are you that oblivious to the plight of the nations experiencing the full force of the HIV pandemic?

No, I am not. As a matter of fact, I have several friends in such nations, and am probably more in touch with the situation in the field than you are. So please grab your rigteous indignation and store it away from sunlight...

Quoting the old adage, two wrongs don't make a right. Additionally, I would think that the infection rates in women will soar if most men are circumcized. Afterall, without the foreskin, there will be an increase in friction and abrasions, which will maximize the potential of infection.

Maybe increasing education about ways of infection, respect for your partners health and condom use could actually acomplish something useful?

[Megalodon]

These are false analogies. They may sound good to a non-skeptic, but a good skeptic can see right through them.

My dear, you wouldn't know a good skeptic if one fell on you playing tuba.
The only problem with my analogy is that you can't, AFAIK, do a mastectomy to a new born (maybe you can remove the tissue that will originate the breasts, I don't know).
Other than that, according to some of the arguments presented, there is no objective use for the breast that could justify the increased risk of death by cancer.
The only objections would be that it is a secondary sexual feature and that lactation is good. And, of course, that parents have no business mutilating their children.

But that would be my point from the beginning...

Here's my analogy: You are comparing trimming fingernails to a finger amputation.

How do you tie your shoelaces in the morning?

Here's a clue: You cannot grow back a removed foreskin!

[fls]

1) If removing the clitoris/labia makes sex less pleasurable for women, then doesn't removing the foreskin make sex less pleasurable for men?

Your analogy is incorrect. Removing the clitoris/labia would be equivalent to removing the penis and scrotum of the male.

2) Justifying circumcision by arguing that it can reduce the chances of getting HIV is utterly ridiculous.
First of all, then how do you justify circumcision for the hundreds of years BEFORE the 1970s (i.e., before AIDS existed to any appreciable degree)?

Is anybody attempting to do so?

Secondly, there are FAR better ways to reduce your chances of getting HIV.

In the population for which circumcision is now recommended for a preventative measure, the research consistently shows that circumcision provides a marked benefit in addition to the concerted promotion of other methods.

Third, AIDS is not a prevalent disease outside of Africa, and not many people contract it compared to numerous other diseases.

Which is why the recommendations mostly focus on Africa and other developing nations where the prevalence is high.

Fourth, why stop there? Shall we remove women's breasts after the onset of puberty to reduce their chances of getting breast cancer? How about preemptive bypass surgery on all people to reduce their chances of having a heart attack?

Because none of those measures are remotely comparable and cannot provide any hope of net benefit. And it is possible to make that distinction using reason, without recourse to hyperbole, emotional appeals, false analogies, and name-calling.

The argument that men won't get a circumcision later, so let's do it now while they are infants is pretty sick.

You've missed the point. The argument is that men would get a circumcision as adults anyway and would prefer to have the procedure done at a point in time when it is quick and easy.

Why don't we give everyone gastric bypass surgery as infants because fat people won't diet and exercise later?

Probably because one can tell a priori that that would lead to excessive deaths in infants.

Face it, it is societal pressure and not anything remotely resembling logic or reason that is leading people to perform this procedure.

Isn't that what we've all been saying for at least the last 10 pages?

When you understand how 'shocking' it is for girls to have the equivalent procedure, then you will understand how shocking it should be for this as well.

You did not compare it to an equivalent procedure, though.

I don't know if you are usually a reasonable person, but this is yet another example of how the topic seems to generate diatribes consisting of false analogies and scathingly presented suggestions that we are not considering the obvious (despite explicit statements otherwise) or that we are providing justification for the bizarre, in order to generate an emotional response. Is it really necessary? (Serious question)

Linda

[fls]

So reducing a lifetime risk of 1 in 600 of penile cancer is worth raising the ethical problems by operating on a non-consenting patient? What other surgery is justified for such a low risk? I think I'm correct in saying HPV vaccinations would help with this as well? Any idea on the NNT?

How many times do I have to say this? Reducing a lifetime risk of 1 in 600 of penile cancer is not justification for circumcision. Who do you think is using that as justification for circumcision?

The benefit of increased resistance to HIV does not kick in until long after the child is able to make that choice for themselves.

I disagree. A 12-year-old boy will make different decisions than an adult. Specifically, they will heavily discount future benefit, making them poor judges in this kind of situation. And you are intentionally increasing the suffering by changing it from a simple operation that will not be remembered, to a more involved operation that takes several weeks to recover from.

In summary, circumcision of infants in the developed world (with relatively low incidence of HIV) raises the big ethical problem of performing surgery on a non-consenting patient, for which the outcome of the various benefits it provides can be attained or surpassed by alternative measures.

You have made this point over and over and over again. And I got it the first time. Since you have not addressed the points I brought up in my responses I don't think continued attempts on my part are likely to be successful. I am willing to concede the fault may be mine, since this is a recurring theme with you and me.

Linda

[Ivor the Engineer]

How many times do I have to say this? Reducing a lifetime risk of 1 in 600 of penile cancer is not justification for circumcision. Who do you think is using that as justification for circumcision?

You put it in your post as a small absolute benefit.

I disagree. A 12-year-old boy will make different decisions than an adult. Specifically, they will heavily discount future benefit, making them poor judges in this kind of situation.

Now who's advocating paternalistic medicine?

(I'll add that I'm _not_ talking about regions of the world with high incidence of HIV, just the US).

And you are intentionally increasing the suffering by changing it from a simple operation that will not be remembered, to a more involved operation that takes several weeks to recover from.

That is one way to look at it. You missed out the part about this being performed for a small benefit that can easily be surpassed by the correct use of condoms.

You have made this point over and over and over again. And I got it the first time. Since you have not addressed the points I brought up in my responses I don't think continued attempts on my part are likely to be successful. I am willing to concede the fault may be mine, since this is a recurring theme with you and me.

Linda

Linda,

I assure you I am not doing this on purpose. I thought I was replying to the point(s) you made about the small absolute benefits for the conditions you listed vs. the ethical considerations of action or in-action, given my definition.

Clearly this is not the question you asked or thought you asked. What do you want me to reply to?

Are there benefits to (infant) circumcision? Yes.

Are there ethical issues with operating on non-consenting individuals? Yes.

Are there alternative courses of action that raise fewer ethical issues while providing similar or better benefits compared to infant circumcision? Yes.

Are there alternative courses of action that raise more ethical issues while providing fewer or no benefits compared to infant circumcision? Yes.

Please pick the question-answer pair that fits the reply you wanted OR ask your question in a simple enough fashion that I stand a chance of answering it appropriately, even if not to your liking.

[ImaginalDisc]

"Congratulations on the birth of your baby boy. I've looked at his chart, and all seems well. You should be able to take him home in twenty-four hours, right after the nostrilectomy."

"Thanks, we're so happy! All I - Wait, what? Nostilwhodemy?"

"Nostrilectomy. It's a routine procedure."

"We informed the nurses that we didn't want that procedure done."

"Oh, I see. I am of course here to advise you of all the benefits and risks associated with the procedure."

"We do want what's best for our son, and you are a doctor. . .go on."

"It's a relatively simple operation. We just remove the outermost portion of the nostril, under anesthesia, of course. Some other hosptials forgo that, saying that infant don't remember pain, but that's. . .unsound."

"Why would we want to remove the nostrils from our son?"

"It's the norm! Almost every boy has it done!"

"That's not a very convincing arguement."

"Well, I imagine his girlfriend is going to lose interest in him if he's got a funny looking nose with extra skin on it."

"I imagine that if his girlfriend, or boyfriend, prioritizes nostrils above everything else, she's not good enough for our son. Besides, if he grows up and wants it done, he can have it done then. There's nothing special about the procedure that prevents it from being done in adults, is there?"

"No, but it's extremely uncommon."

"I'm sure."

"Er...There's also some very small, but statistically significant health benefits. Your son will slightly less likely to catch influenza. Influenza's contagious, you know. If your son doesn't catch it, he can't spread it. It's your obligation to have the nostrilectomy done."

"I've seen those studies, and not only is the benfit quite small, ordinary hygine's much more important, as are simple precautions."

"True, but there are other benefits. Skin cancer, in all its forms, is quite dangerous. If you remove the nostril, you remove the possiblity of skin cancer of the nostril."

"Skin cancers on the scalp are many times more dangerous than skin cancers of the nostril, and yet you're not recomending that I have his scalp removed. Besides, aren't there risks of complications?"

"Yes, about 1% of patients have complications that result in some damage to the rest of the nose."

"So, even though the risk of dangerous nostril cancer is smaller than one percent, you want me to take a one percent risk of complications with this procedure?"

"I see your point. But, it's a routine procedure. Will you give your consent?"

"I don't think so."

[Katana]

Hopefully it's changed since 1998.

Hey Katana...since you're drunk, you'll like this. I was trying to find the purpose of the female prepuce earlier (I was going to make the point that it's not a vestigial organ) and ran across a bunch of pictures of diseased vulvas.

Is the one on the bottom right...scroll all the way down....does that look like the face of James Randi to you??? The one for a mysterious condition called "Vulvar vestibulitis"?
(Warning! Graphic pictures!!!!)
http://www.brooksidepress.org/Products/Military_OBGYN/Textbook/Vulva/VulvaAtlas.htm
I had a moment of pareidolia when I saw that.


Thanks for thinking of me, kellyb. ;)

Pretty awful, isn't it? It's a hideous condition and very difficult to treat.

And people think ob/gyns only deliver babies.

[fls]

You put it in your post as a small absolute benefit.

I thought that we had agreed that benefit alone may not be sufficient reason, especially in this situation.

Now who's advocating paternalistic medicine?

(I'll add that I'm _not_ talking about regions of the world with high incidence of HIV, just the US).[/QUOTE]

That's not an example of paternalism, but there does not seem to be much point in repeating my explanation yet again.

That is one way to look at it. You missed out the part about this being performed for a small benefit that can easily be surpassed by the correct use of condoms.

That comment is not relevant to what came before.

I assure you I am not doing this on purpose. I thought I was replying to the point(s) you made about the small absolute benefits for the conditions you listed vs. the ethical considerations of action or in-action, given my definition.

I don't think you are doing it on purpose.

Clearly this is not the question you asked or thought you asked. What do you want me to reply to?

Are there benefits to (infant) circumcision? Yes.

Are there ethical issues with operating on non-consenting individuals? Yes.

Are there alternative courses of action that raise fewer ethical issues while providing similar or better benefits compared to infant circumcision? Yes.

Are there alternative courses of action that raise more ethical issues while providing fewer or no benefits compared to infant circumcision? Yes.

Please pick the question-answer pair that fits the reply you wanted OR ask your question in a simple enough fashion that I stand a chance of answering it appropriately, even if not to your liking.

Is there any way that you could consider a person who disagrees with you on this issue reasonable (please note that I am not one of them)?

Linda

[Ivor the Engineer]

<snip>

Is there any way that you could consider a person who disagrees with you on this issue reasonable (please note that I am not one of them)?

Linda

Yes. Would you like me to provide an example?

[fls]

Yes. Would you like me to provide an example?

No. I'm afraid my tenuous understanding wouldn't survive.

Linda

[Ivor the Engineer]

No. I'm afraid my tenuous understanding wouldn't survive.

Linda

:confused:

[kellyb]

There are two ways I am looking at this.

First of all, if preventative measures are to be undertaken, they should be done well before they are likely to be needed and when it is easiest to undertake that measure. If circumcision was going to be used as a preventative measure (and we are agreed that the absolute benefit would need to be much larger before we would consider the possibility), then the best time to do it would be as a neonate. Doing it later changes it into a more involved operation with a much longer recovery period and puts the child through much more stress.
Well, I disagree. When you circumcise a newborn, you have to rrrrrrrrrrriiiip the foreskin off the glans. This traumatizes the entire penis, and appears to be excruciatingly painful. Then you have poop and pee in diapers, bandages that require ointment, etc. Some of that is going to be very problematic in the two thirds world. Then there's the fact that circumcision can interfere with breastfeeding (I'll find that study if you haven't seen it) which is bad for health in a variety of ways. Then there's the unresolved issue of meatal stenosis. It looks to me like the research saying that's a very rare complication is from the 1970's when almost all boys were circumcised and it was thought that many boys "naturally" needed their pee holes surgically enlarged around potty training time. Skeptigirl's point in the last thread was that it's not life threatening, which is true...but it's extremely traumatic for a child to have it corrected. I know a few guys who say that's one of their earliest memories, and definitely is the earliest memory of a doctor.
Either way, it's something that happens, even if the true incidence is presently unknown. And it's something that only happens with infant circumcision.
Then there's the whole issue of anaesthesia. I'm getting the vibe that in Africa they're going to be going with "sugar water" and call it good. Is that ethical??? How can one really say what's more traumatic...circumcision without pain relief as a newborn vs. circumcision later when excellent pain relief can be given?
What are the rates of bacterial infections going to be after neonatal circumcision in areas without running water?
These factors, in my mind, at the very least make the newborn period the WORST time to circumcise. And that's not even getting into the issue of human rights and informed consent. Most of the benefits can still be gained if circumcision is performed around the age of 17 or 18. For all the good reasons to do it in infancy, there are as good or better reasons to wait.

The second way I am looking at this is whether or not we can prove to parents who want it done that it is harmful. And we can't when the information that we have shows a net benefit.

Linda

I'm seeing that net benefit melting away when meatal stenosis is added into the equation. And the fundamental right to have all your sex organs if you want them counts for something, too. Losing a sensitive sex organ that can provide it's owner with sexual pleasure is a significant loss, even if it's not one that translates into morbidity and mortality.

[kellyb]

There are studies showing both circumcision making men and women happier and studies showing foreskins making men and women happier. Thus there is no firm conclusion either way. It's all subjective.
Have you found any studies saying women were twice as likely to orgasm with circumcised penises, though?

Just because women sometimes perform (and sadly sometimes willingly partake in) the operations does not make them any less of a human rights violation:
Even type one? The most common kind? You think that's a human rights violation?

But I am saying circumcision is not a hostile procedure as the foreskin is superfluous in terms of the functions of the penis as a reproductive organ. Men with them have functional and fun sex. Men without them have functional and fun sex.
Men with foreskins don't tend to find them superfluous. Sort of like how I like my labia and clitoral prepuce.

[BlackKat]

Have you found any studies saying women were twice as likely to orgasm with circumcised penises, though?


Even type one? The most common kind? You think that's a human rights violation?


Men with foreskins don't tend to find them superfluous. Sort of like how I like my labia and clitoral prepuce.

Orgasms are subjective from person to person just like tastes. Everyone's got something different that they like best. The sensations that will make me orgasm the quickest are not necessarily the same as those which will make others. Are women different in this regard? It was my understanding that the female genetalia also had some degree of uniqueness.

Again I will point you to:
http://www.who.int/mediacentre/factsheets/fs241/en/
which states:
The most common type of female genital mutilation is excision of the clitoris and the labia minora, accounting for up to 80% of all cases

That means 80% of the time the clitoris is removed.

My point is not that men with foreskins find them superfluous. It's that men without foreskins don't miss them because they are superfluous to their activities of sex and urination. I think that many men with foreskins have somehow developed an emotional attachment to their foreskins and just can not comprehend people who have been circumcised not missing theirs in the slightest.

[BlackKat]

.... Then there's the fact that circumcision can interfere with breastfeeding (I'll find that study if you haven't seen it) which is bad for health in a variety of ways...

I believe you mean this:
http://www.cirp.org/library/birth/
and that is a real stretch if I ever saw one.

In any case babies do not remember, nor care that they had a flap of skin cut off. Nor do they even notice it much if at all. Not only do most hospitals use anesthesia but even in cases where it is performed outside of a hospital (such as by a mohel) there is frequently a doctor present. If people are claiming to be traumatized by something they in no way remember I will just lump them in with mass murderers who claimed they were given formula instead of breast milk as a child and that's why they killed eighteen large breasted women. It's not more traumatic for the child than the severing of the umbilical cord.

[fls]

Well, I disagree. When you circumcise a newborn, you have to rrrrrrrrrrriiiip the foreskin off the glans. This traumatizes the entire penis, and appears to be excruciatingly painful. Then you have poop and pee in diapers, bandages that require ointment, etc. Some of that is going to be very problematic in the two thirds world. Then there's the fact that circumcision can interfere with breastfeeding (I'll find that study if you haven't seen it) which is bad for health in a variety of ways. Then there's the unresolved issue of meatal stenosis. It looks to me like the research saying that's a very rare complication is from the 1970's when almost all boys were circumcised and it was thought that many boys "naturally" needed their pee holes surgically enlarged around potty training time. Skeptigirl's point in the last thread was that it's not life threatening, which is true...but it's extremely traumatic for a child to have it corrected. I know a few guys who say that's one of their earliest memories, and definitely is the earliest memory of a doctor.
Either way, it's something that happens, even if the true incidence is presently unknown. And it's something that only happens with infant circumcision.
Then there's the whole issue of anaesthesia. I'm getting the vibe that in Africa they're going to be going with "sugar water" and call it good. Is that ethical??? How can one really say what's more traumatic...circumcision without pain relief as a newborn vs. circumcision later when excellent pain relief can be given?
What are the rates of bacterial infections going to be after neonatal circumcision in areas without running water?
These factors, in my mind, at the very least make the newborn period the WORST time to circumcise. And that's not even getting into the issue of human rights and informed consent. Most of the benefits can still be gained if circumcision is performed around the age of 17 or 18. For all the good reasons to do it in infancy, there are as good or better reasons to wait.



I'm seeing that net benefit melting away when meatal stenosis is added into the equation. And the fundamental right to have all your sex organs if you want them counts for something, too. Losing a sensitive sex organ that can provide it's owner with sexual pleasure is a significant loss, even if it's not one that translates into morbidity and mortality.

Sorry. I must have wandered into the wrong room.

Linda

[Z]

Orgasms are subjective from person to person just like tastes. Everyone's got something different that they like best. The sensations that will make me orgasm the quickest are not necessarily the same as those which will make others. Are women different in this regard? It was my understanding that the female genetalia also had some degree of uniqueness.

Again I will point you to:
http://www.who.int/mediacentre/factsheets/fs241/en/
which states:
The most common type of female genital mutilation is excision of the clitoris and the labia minora, accounting for up to 80% of all cases

That means 80% of the time the clitoris is removed.

My point is not that men with foreskins find them superfluous. It's that men without foreskins don't miss them because they are superfluous to their activities of sex and urination. I think that many men with foreskins have somehow developed an emotional attachment to their foreskins and just can not comprehend people who have been circumcised not missing theirs in the slightest.

I think you might have nailed it right on the head... and I think I can empathize.

See, I had my wisdom teeth for a very long time - up until I was 22, in fact. Then the military dentist gave me a long song-and-dance about possible future complications for wisdom teeth, etc... MY teeth were perfect, placed well, fully formed and expressed, etc. But the army pulled them anyway.

And even though I certainly didn't NEED those teeth, I still sometimes feel regret at not HAVING those teeth anymore.

I can only imagine that this is what the owner or recent loser of a foreskin feels - and, of course, goes to great lengths to attempt to justify his feelings.

I have to say, though, that having read everything presented by everyone on this thread, and more, the issue is still contraversial in both directions. I still feel that the foreskin is an evolutionary dead-end for humans, and its removal is nothing but recognition of its unclean and unpleasant nature. The reduction of HIV risks alone, IMO, is sufficient to make circumcision mandatory everywhere - since condoms aren't always readily available, but sex is. And all the crap about how 'traumatized' the babies are is just pure B.S. Modern facilities, at least, use (or can use, if asked) local anaesthesia (as each doctor did for each of my boys). And the pain, if any, is QUICKLY forgotten. In fact, with the plastibell method, after-surgery care is simple and painless, too. You do more work and cause more pain cleaning up the umbilical area than you do after circumcision.

And babies don't remember the pain. Certainly, in the aftermath of the trauma of birth itself, a little sharp tug isn't going to compare. This is opposed to attempting to convince a teenage or adult male that first, we're going to rip the foreskin off your penis, and second, you're not going to be able to use it for a week or more, and third, you'll clearly remember the trauma of this event.

Sorry, I'm not at all convinced. I've never in my life heard any male complain about the pain of his neonatal circumcision, or any memory of it, or anything else; but I've heard more than a few regretting waiting so long to have it done to themselves (and cursing their parents for not doing it sooner). And a few who needed it done, who instead chose to live with infections and secondary urine tubes rather than get a medically prescribed treatment done.

But neither side of this debate is going to convince the other side, and the global situation isn't likely going to change due to our debate, either.

So at this point, I'll snip off my own useless comments and let this discussion stand erect and beautiful free of my foreposts.

[Z]

Orgasms are subjective from person to person just like tastes. Everyone's got something different that they like best. The sensations that will make me orgasm the quickest are not necessarily the same as those which will make others. Are women different in this regard? It was my understanding that the female genetalia also had some degree of uniqueness.

Seems as good a point as any to derail over (sorry, my forepost is longer than I thought)...

I had a girlfriend whose genitals didn't form quite correctly. The sensitive nerve bundles normally found in the clitoris were instead to the left, in the labia, about a half-inch from her clitoris. Massaging her clitoris only annoyed her. (She was also only about four inches in depth, which made our couplings very difficult on both of us.)

Another girlfriend I had could only orgasm through vaginal penetration in female-dominant position, and had a VERY sensitive G-spot - but an almost insensitive clitoris.

So just from what I can tell, women are VERY different.

(And guys, take this as a hint - actually LEARN what your women enjoy INDIVIDUALLY, and remember what goes to whom. You'll be amply rewarded for it.)

[kellyb]

Orgasms are subjective from person to person just like tastes. Everyone's got something different that they like best. The sensations that will make me orgasm the quickest are not necessarily the same as those which will make others. Are women different in this regard? It was my understanding that the female genetalia also had some degree of uniqueness.
So I take it the answer to this question:
Have you found any studies saying women were twice as likely to orgasm with circumcised penises, though?
..is "No"?


Again I will point you to:
http://www.who.int/mediacentre/factsheets/fs241/en/
which states:
The most common type of female genital mutilation is excision of the clitoris and the labia minora, accounting for up to 80% of all cases

That means 80% of the time the clitoris is removed.
Do I need to point you to the more recent 2005 survey again?

I believe you mean this:
http://www.cirp.org/library/birth/
and that is a real stretch if I ever saw one.

Perhaps you should take it up with the AAP?

http://pediatrics.aappublications.org/cgi/content/abstract/93/4/641

Results. Neonates in both groups showed significant increases in heart rate, respiratory rate, and crying during circumcision with no clinically significant differences observed between the groups. Postoperative comfort scores showed no significant differences between the groups until the 360-minute postoperative assessment, at which time the acetaminophen group had significantly improved scores (P < .05). Feeding behavior deteriorated in breast- and bottle-fed neonates in both groups, and acetaminophen did not seem to influence this deterioration.


http://pediatrics.aappublications.org/cgi/reprint/108/3/793.pdf

Local anesthetics and strategies to soothe and minimize
distress should be considered even for simple
procedures, such as venipuncture. Some common
painful minor procedures, such as circumcision, do
not always receive the warranted attention to comfort
issues. Available research indicates that newborn
circumcisions are a significant source of pain
during the procedure and are associated with irritability
and feeding disturbances during the days afterward.
9–11



http://pediatrics.aappublications.org/cgi/content/full/100/6/1035

Breastfeeding should begin as soon as possible after birth, usually within the first hour.80-82 Except under special circumstances, the newborn infant should remain with the mother throughout the recovery period.80,83,84 Procedures that may interfere with breastfeeding or traumatize the infant should be avoided or minimized.

In any case babies do not remember, nor care that they had a flap of skin cut off. Nor do they even notice it much if at all.
Some do when they grow up, some don't.

Not only do most hospitals use anesthesia
You haven't been following the thread very closely, have you?

It's not more traumatic for the child than the severing of the umbilical cord.
Again I'm going to have to ask you to substantiate that claim with evidence.

[Ivor the Engineer]

While I've been stunned or rather, confused into silence with Linda, I'll just say that the effects of early childhood trauma are unknown. Just because you don't remember something explicitly does not mean your central nervous system has not been effected by it for an extended period of time after the event.

The brain of a circumcised man may compensate for the lack of sensory input from a foreskin by "remapping" input from other nerves to the area of the brain that would have been used to interpret sensation from the foreskin.

[BlackKat]

So I take it the answer to this question:
Originally Posted by me
Have you found any studies saying women were twice as likely to orgasm with circumcised penises, though?

..is "No"?
My point is that you can not quantify pleasure or extrapolate results of such studies to larger groups of people beyond the participants because each person is unique in their response to different sexual stimulus. I will gladly point out that all the same anectedotes Z gave us about his different partners can be evenly matched by my own. In fact I have never had any two sexual partners that could achieve orgasm the same way.


Some do when they grow up, some don't.
No some THINK they do when they grow up. But they are wrong.
However if I had circumcision performed on me last week instead of 36 years ago you can damn well bet I would remember the discomfort (because the procedure would have been much more complex and difficult).


Quote:
It's not more traumatic for the child than the severing of the umbilical cord.

Again I'm going to have to ask you to substantiate that claim with evidence.
Do you know how both procedures are performed? Clamps and scissors/scalpel. Clamp. Snip. Done. No tears.

[kellyb]

My point is that you can not quantify pleasure or extrapolate results of such studies to larger groups of people beyond the participants because each person is unique in their response to different sexual stimulus. I will gladly point out that all the same anectedotes Z gave us about his different partners can be evenly matched by my own. In fact I have never had any two sexual partners that could achieve orgasm the same way.
So the answer is "no". Ok.

No some THINK they do when they grow up. But they are wrong.
You were misunderstanding me. I meant "some care" when they grow up.

Do you know how both procedures are performed? Clamps and scissors/scalpel. Clamp. Snip. Done. No tears.

It appears that you're just making things up now, so I'm not sure what the point is.
But I'll give it a go anyway.
http://video.google.com/videoplay?docid=-6584757516627632617&q=circumcision&hl=en

[kellyb]

While I've been stunned or rather, confused into silence with Linda, I'll just say that the effects of early childhood trauma are unknown. Just because you don't remember something explicitly does not mean your central nervous system has not been effected by it for an extended period of time after the event.

The brain of a circumcised man may compensate for the lack of sensory input from a foreskin by "remapping" input from other nerves to the area of the brain that would have been used to interpret sensation from the foreskin.

Well, feel free to jump on in with me and BlackKat over here. :)

Circumcision does appear to have effects on the nervous system that extend beyond the actual procedure:

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=9057731&dopt=Citation

BACKGROUND: Preliminary studies suggested that pain experienced by infants in the neonatal period may have long-lasting effects on future infant behaviour. The objectives of this study were to find out whether neonatal circumcision altered pain response at 4-month or 6-month vaccination compared with the response in uncircumcised infants, and whether pretreatment of circumcision pain with lidocaine-prilocaine cream (Emla) affects the subsequent vaccination response. METHODS: We used a prospective cohort design to study 87 infants. The infants formed three groups--uncircumcised infants, and infants who had been randomly assigned Emla or placebo in a previous clinical trial to assess the efficacy of Emla cream as pretreatment for pain in neonatal circumcision. Infants were videotaped during vaccination done at the primary care physician's clinic. Videotapes were scored without knowledge of circumcision or treatment status by a research assistant who had been trained to measure infant facial action, cry duration, and visual analogue scale pain scores. FINDINGS: Birth characteristics and infant characteristics at the time of vaccination, including age and temperament scores, did not differ significantly among groups. Multivariate ANOVA revealed a significant group effect (p < 0.001) in difference (vaccination minus baseline) values for percentage facial action, percentage cry time, and visual analogue scale pain scores. Univariate ANOVAs were significant for all outcome measures (p < 0.05): infants circumcised with placebo had higher difference scores than uncircumcised infants for percentage facial action (136.9 vs 77.5%), percentage cry duration (53.8 vs 24.7%), and visual analogue scale pain scores (5.1 vs 3.1 cm). There was a significant linear trend on all outcome measures, showing increasing pain scores from uncircumcised infants, to those circumcised with Emla, to those circumcised with placebo. INTERPRETATION: Circumcised infants showed a stronger pain response to subsequent routine vaccination than uncircumcised infants. Among the circumcised group, preoperative treatment with Emla attenuated the pain response to vaccination. We recommend treatment to prevent neonatal circumcision pain.

[BlackKat]

It appears that you're just making things up now, so I'm not sure what the point is.
But I'll give it a go anyway.
http://video.google.com/videoplay?docid=-6584757516627632617&q=circumcision&hl=en

The baby in that video was either anesthetized (and was crying for other reasons) or that video was not made in the U.S. (at least recently). In U.S. hospitals babies are anesthetized when circumcised. Even in the olden skool days when mohel's did all the circumcisions they gave the baby a mouth full of sugar or wine to dull or distract him from the pain.

And like I said... in that video it was: clamp. snip. done.

[kellyb]

The baby in that video was either anesthetized (and was crying for other reasons) or that video was not made in the U.S. (at least recently). In U.S. hospitals babies are anesthetized when circumcised. Even in the olden skool days when mohel's did all the circumcisions they gave the baby a mouth full of sugar or wine to dull or distract him from the pain.

And like I said... in that video it was: clamp. snip. done.

You know, repeating an incorrect statement over and over and over again doesn't actually end up making it correct.

Since I have already once in this thread gone to the trouble of looking up the percentage of OBs in the US who provide pain relief, could you perhaps make some small token gesture to give the appearance of at least attempting to substantiating your claims with evidence?
Please?

[Z]

Kelly, are you reading your own posts?


"...preoperative treatment with Emla attenuated the pain response to vaccination."

Now, in the case of my own boys, born between 1995 and 2002, each was treated with pain-killers just prior to circumcision; each failed to cry or react to the procedure whatsoever; and each has had minimal - almost non-existent - reaction to vaccinations. In fact, my 8-year-old is completely impassive to the needle, only complaining of soreness in intramuscular (is that the right word?) shots. We didn't even need to request anything beyond the circumcision itself - anesthesia was given as routine.

This was in two Army hospitals and one local Catholic hospital, in three different states. Not a LARGE sample size, but not restricted to any unusual area.


...


Damn, I keep clipping that forepost, and it keeps growing back. Shoulda had it done as a neoposter.

[kellyb]

Kelly, are you reading your own posts?


"...preoperative treatment with Emla attenuated the pain response to vaccination."

Now, in the case of my own boys, born between 1995 and 2002, each was treated with pain-killers just prior to circumcision; each failed to cry or react to the procedure whatsoever; and each has had minimal - almost non-existent - reaction to vaccinations. In fact, my 8-year-old is completely impassive to the needle, only complaining of soreness in intramuscular (is that the right word?) shots. We didn't even need to request anything beyond the circumcision itself - anesthesia was given as routine.

This was in two Army hospitals and one local Catholic hospital, in three different states. Not a LARGE sample size, but not restricted to any unusual area.


...


Damn, I keep clipping that forepost, and it keeps growing back. Shoulda had it done as a neoposter.

I guess I just need to accept having to repost the same links several times in this thread.
:confused:

http://pediatrics.aappublications.org/cgi/reprint/101/6/e5.pdf

[Ivor the Engineer]

<snip>

http://video.google.com/videoplay?docid=-6584757516627632617&q=circumcision&hl=en

I'll let all of you reading this into a little secret. I was toying with the idea of a change of career to medicine.

Having just watched that video and getting the feeling I would have to be dragged of the F**CKER doing that "routine medical procedure" on the kid if I was in the vicinity, it has put me off the idea.

Probably for the best.

[Skeptic Ginger]

No, I am not. As a matter of fact, I have several friends in such nations, and am probably more in touch with the situation in the field than you are. So please grab your rigteous indignation and store it away from sunlight...You suggested people were recommending circumcision in areas with low rates of HIV. And the following 2 comments reveal you are not well informed or in touch. Sorry to make a pissing contest of it but I'm trying to stay with what the fact reveal.

Quoting the old adage, two wrongs don't make a right. Additionally, I would think that the infection rates in women will soar if most men are circumcised. Afterall, without the foreskin, there will be an increase in friction and abrasions, which will maximize the potential of infection. This is not only illogical, but also a baseless hypothesis. Anything which lowers the incidence of HIV is going to lower the risk of HIV. And there is no evidence women have a higher risk of contracting HIV from circumcised as opposed to uncircumcised males. I also doubt you could find any medical research showing circumcision caused vaginal abrasions. You are just making up emotional tripe here.

Maybe increasing education about ways of infection, respect for your partners health and condom use could actually acomplish something useful?Condom promotion is an extremely effective means of lowering HIV risk. Uganda was a model showing it could be every effective (until Bush allowed the religious police to interfere by pushing their failed abstinence only garbage, but that is a separate issue). Again, and where my complaint comes in about your position, facing the HIV risk, even where condom promotion has been effective is still so high in many parts of the world, it is absurd to have some Westerner who enjoys a low risk of HIV judging a parent in the third world who would choose to add the protection of a circumcision to their struggle to keep their infant alive.

[Beleth]

I've only skimmed this thread, but I have to say I have found it very informative.

First, thanks to skeptigirl for that tsunami of pro-circumcision evidence. Were I a neutral observer, I'd probably end up on the pro-circumcision side.

But I am not a neutral observer; I have cast my die, and it has come up anti-circumcision. At the current time, there is only one foreskin I have had any say in removing, and that is my son's. My spouse and I had had many discussions about this before he was born in 2000. We talked to the OB-GYN, and our first pediatrician, and they were not much help at all. The health issues, they said, were fairly balanced out, and his peers in school were going to be split about 50/50 cut/uncut.

So we decided to leave him with what he was born with.

If we ever have another boy, he'll also be uncut, despite the studies, because I'm not going to have one with and one without.

If my son(s) ever want to become circumcised, they will be able to make that choice themselves, and I will fully support them in it. As it stands, my now-6-year-old son has never had trouble keeping it clean and uninfected. At the risk of giving TMI, he rather enjoys keeping it clean...


And not to end this post with a controversial bomb or anything, but the rate at which women achieve orgasm with circumcised vs. uncircumcised men should never be a consideration -- not even a little bit.

[Skeptic Ginger]

...
The benefit of increased resistance to HIV does not kick in until long after the child is able to make that choice for themselves.

Let's say you're right and the lots of 15 year old boys are having unprotected sex. Why can't the decision be put off until they are 12, 13 or 14? I.e. the doctor knows that the benefit she is providing by operating on the infant could be provided later with fewer ethical problems....You are missing something here which any parent of a teenager knows. A 12 yr old, and even an 18 yr old can probably make many informed decisions. However, they are still immature in many ways and some decisions they are not so good at making. One that is well documented is poor judgment of risk. That's why so many teenage drivers are killed in vehicle accidents. That's why kids experiment with drugs. That's why cigarette manufacturers know they have to addict kids to cigarettes before they are young adults because young adults rarely decide to start smoking now that the dangers have been revealed. So risk perception is an issue.

The second type of decision which teens are often not mature enough make is that of choosing something they know will hurt.

[Skeptic Ginger]

As long as you aren't in a country with a soaring HIV pandemic, Beleth, your decision does not go against any of the research I posted.

[Beleth]

I'm not; I'm in the good ol' USA.

[Ivor the Engineer]

You are missing something here which any parent of a teenager knows. A 12 yr old, and even an 18 yr old can probably make many informed decisions. However, they are still immature in many ways and some decisions they are not so good at making. One that is well documented is poor judgment of risk. That's why so many teenage drivers are killed in vehicle accidents. That's why kids experiment with drugs. That's why cigarette manufacturers know they have to addict kids to cigarettes before they are young adults because young adults rarely decide to start smoking now that the dangers have been revealed. So risk perception is an issue.

The second type of decision which teens are often not mature enough make is that of choosing something they know will hurt.

Not in my experience. I chose to have surgery on two ingrown toenails (both sides of each one) when I was 12. I knew it was going to hurt - I'd had several procedures to remove the sides of the nails temporarily about once every month for a year before. I even went to one guy who just put the scalpel straight in, causing a fair amount of blood to be let. When they got infected from time to time just having the covers on in bed would make them ache.

And yet, even that I knew how much it was likely to hurt (and they DID hurt like hell for a day after and were very sore for about a week) I chose to have it done. Are you claiming my choice as a 12-year old is unique?

Having said all that, what that kid went through in the video (you have watched it, haven't you?) was much worse. Did you choose to put your son through that because you prefer the look of a circumcised penis? Or did you come up with an elaborate delusion to make yourself feel better?

My once high level of respect for you has plummeted, as it has for all parents (and medical "professionals" who tolerate it to go on) who have had that done to their child(ren) when it was not required, for what boils down to cosmetic or ritualistic reasons no matter how much they pretend otherwise.

[BlackKat]

...Having said all that, what that kid went through in the video (you have watched it, haven't you?) was much worse. Did you choose to put your son through that because you prefer the look of a circumcised penis? Or did you come up with an elaborate delusion to make yourself feel better?

My once high level of respect for you has plummeted, as it has for all parents (and medical "professionals" who tolerate it to go on) who have had that done to their child(ren) when it was not required, for what boils down to cosmetic or ritualistic reasons no matter how much they pretend otherwise.

I think most of us pro-circumcision posters have been pretty open about prefering circumcised penises for cosmetic reasons. The other potential benefits are just that, potential and largely secondary. But what that kid "went through" in the video was not any more horrific to me than the snipping of the umbilical cord, the removal of a vestigal tail, or the clipping of ingrown toenails is to me.

[Skeptic Ginger]

Come on Ivor, you are using your personal single anecdote as evidence that all or even a majority of twelve year olds would be the same, and that cutting a toenail was equal to cutting on one's genitals, something a 12 year old would clearly have emotions interfering in the thought process about.

I know you know better than to draw that conclusion based on that evidence.:rolleyes:

[Ivor the Engineer]

I think most of us pro-circumcision posters have been pretty open about prefering circumcised penises for cosmetic reasons. The other potential benefits are just that, potential and largely secondary. But what that kid "went through" in the video was not any more horrific to me than the snipping of the umbilical cord, the removal of a vestigal tail, or the clipping of ingrown toenails is to me.

All your examples are either required for normal functioning or extremely rare. I.e. they are medically indicated. Hopefully they are carried out quickly (matter of seconds) or with appropriate and significant pain relief.

The pro-circumcision parents and medical professionals on this thread are not skeptical; they are True Believers. They can close their eyes and block their ears to the sight and sound of torture performed and perpetuated because of their delusions and whims.

[Ivor the Engineer]

Come on Ivor, you are using your personal single anecdote as evidence that all or even a majority of twelve year olds would be the same, and that cutting a toenail was equal to cutting on one's genitals, something a 12 year old would clearly have emotions interfering in the thought process about.

I know you know better than to draw that conclusion based on that evidence.:rolleyes:

I think you're getting confused with my point of view about regions of the world with high incidence of HIV (infant circumcision is, on balance, indicated), and the US, where the effects of torture are being researched to see if it has any advantages.

ETA: In the regions of the world it is indicated it better be performed with a hell of a lot more pain relief that the child in the video got.

[Skeptic Ginger]

It has nothing to do with real risk or real pain, Ivor. It is what a 12 year old perceives the risk and pain to be.

I give thousands of shots to people. You cannot feel that needle going in. Yet some people are unable to sit still because they anticipate pain which is not going to happen. You have to tell adults, "no I'm not waiting", otherwise they want you to wait while they just get more freaked out.

I didn't watch the video, BTW. I've seen hundreds of circumcision procedures including my son's.

[kellyb]

I think you're getting confused with my point of view about regions of the world with high incidence of HIV (infant circumcision is, on balance, indicated)
I'm still not seeing it really being indicated even there. It comes closer, but still not worth it. People could still be allowed to make the choice for themselves around the age of 17 or 18.

[luchog]

I am going by my extensive review of the medical literature. There is unequivocal evidence HIV risk is decreased considerably. The other medical benefits are small but favor circumcision.

Nope, sorry, this was thoroughly debunked the last time it was brought up. I'm not going to bother digging up all the citations again, since they're easily available by going to the previous thread.

The gist of the thing was:

1) The data was not unequivocal, it was, in fact, in dire need of some serious tightening of methodology with some sampling issues; particularly as it conflated several different modifications of sexual behaviour along with the circumcision. One of the biggest problems was simply self-reporting, and the cultural tendency to not report certain types of sexual activity. It also didn't account for high-risk sexual practices such as "dry sex".

2) The only effect noted was on Female to Male transmission, focusing on vaginal intercourse. Statistically the lowest rate of transmission. Data on FTM and rMTiM transmission through anal intercourse, the second and third lowest rates of transmission, was inadequate due to reporting issues. Compared to MTF and iMTrM transmission, the rate of FTM transmission is statistically insigificant.

3) Even the best, most generous estimate of the reduction of FTM HIV transmission is less than half the reduction accomplished by proper use of a condom. More reasonable estimates put it at about a quarter of the reduction created by proper condom use.

4) Circumcision does not have a statistically signifcant impact on any other problem where adequate personal hygiene is practiced. That includes penile cancer and HPV transmission, where the measured differences were equal to or lower than the margin for error.

The only situation were circumcision was shown to have any significant benefit at all was in condition of inadequate personal hygiene.

[luchog]

The argument is a small risk for a small gain. Sure, condoms work better, but HIV isn't just for Xmas - it's for life. That tiny added bit of protection for some is argued as being beneficial for a tiny compensation (removing the foreskin).
Except that it isn't added. The effect isn't cumulative in any statistically significant way. The difference between transmission rates with condom use vs. non-condom use is orders of magnitude higher than the difference between circumcized vs. non-circumcized. It's the equivalent of wearing a scuba-diving wetsuit inside a submarine. Yes, it does provide some additional protection against getting wet if the submarine happens to leak, but not that much, since with enough time the water and will soak through anyway.

[luchog]

it is absurd to have some Westerner who enjoys a low risk of HIV judging a parent in the third world who would choose to add the protection of a circumcision to their struggle to keep their infant alive.[/B]

Since I can't find any information, do you have any data on HIV transmissibility through infant sexual activity? How many uncircumcised neonates aquire HIV through unprotected sex, vs. the number of circumcised neonates who aquire HIV through unprotected sex? You seem to have all the answers here, so I'm sure you can find a study on this somewhere.

Or perhaps this is something that adults are capable of deciding for themselves.

[fls]

Nope, sorry, this was thoroughly debunked the last time it was brought up. I'm not going to bother digging up all the citations again, since they're easily available by going to the previous thread.

The gist of the thing was:

1) The data was not unequivocal, it was, in fact, in dire need of some serious tightening of methodology with some sampling issues; particularly as it conflated several different modifications of sexual behaviour along with the circumcision. One of the biggest problems was simply self-reporting, and the cultural tendency to not report certain types of sexual activity. It also didn't account for high-risk sexual practices such as "dry sex".

I'm trying to understand what you are getting at with your criticisms. How would not accounting for high-risk sexual practices influence the results, given that these other practices should be evenly distributed among both groups (by the process of randomization)? Or are you talking about the speculation that circumcised men had less sex (while recovering from the procedure) and that accounts for the lowered risk - an idea that was not born out once the results were published?

2) The only effect noted was on Female to Male transmission, focusing on vaginal intercourse. Statistically the lowest rate of transmission. Data on FTM and rMTiM transmission through anal intercourse, the second and third lowest rates of transmission, was inadequate due to reporting issues. Compared to MTF and iMTrM transmission, the rate of FTM transmission is statistically insigificant.

Focusing on rates is misleading. For example, a low rate in a high frequency activity can have much larger absolute effect than a higher rate in a low frequency activity. The penile cancer issue is a good example. If we wished to make circumcision look fabulous, we could announce the 20-fold reduction in penile cancer in big letters (combining careful selection of which research to quote with the withholding of crucial information about frequency). Using all of the information to look at the size of the effect (for HIV) does show that it would be substantial/desirable under the specific circumstances for which it is recommended.

3) Even the best, most generous estimate of the reduction of FTM HIV transmission is less than half the reduction accomplished by proper use of a condom. More reasonable estimates put it at about a quarter of the reduction created by proper condom use.

The best information we have puts the reduction at 50% (generous estimates are 75%). Regular condom use is estimated to reduce it by 85%. Programs to promote regular condom use have variable success. In the trials (which included an educational program promoting safe sex practices including condom use and the provision of free condoms), the best results were up to 41% regular condom use. So while regular condom use has a higher rate of success (although it would require serious fudging to come up with some way to make it four times better), the end result depends upon how many people participate in either activity. Circumcision showed a substantial benefit in addition to the promotion of regular condom use.

Linda

[Skeptic Ginger]

Luchog, what you claim to be, "thoroughly debunked the last time it was brought up", is nothing more than your unsupported opinion. Support it with some research refuting the conclusions that have now become an evidence based recommendation for countries with high rates of HIV by the leading public health authorities in the world.

[robinson]

I just read this from Islamic Rage Boy, and for some reason I thought of this topic.

http://www.thenoseonyourface.com/2007/06/27/ask-islamic-rage-boy/

[Ivor the Engineer]

It has nothing to do with real risk or real pain, Ivor. It is what a 12 year old perceives the risk and pain to be.

What has that got to do with anything in the developed world? Any studies done of circumcision on an infant, with their brain being monitored with fMRI?

There's this (http://www.stopinfantcircumcision.org/BrainVisualizationArticle.htm), but it's a biased site.

The baby was kept in the machine for several minutes to generate baseline data of the normal metabolic activity in the brain. This was used to compare to the data gathered during and after the surgery. Analysis of the MRI data indicated that the surgery subjected the infant to significant trauma. The greatest changes occurred in the limbic system concentrating in the amygdala and in the frontal and temporal lobes.

A neurologist who saw the results to postulated that the data indicated that circumcision affected most intensely the portions of the victim’s brain associated with reasoning, perception and emotions. Follow up
tests on the infant one day, one week and one month after the surgery indicated that the child’s brain never returned to its baseline configuration. In other words, the evidence generated by this research indicated that the brain of the circumcised infant was permanently changed by the surgery.

The latter part is not surprising, or to me relavent, since an infants' brain is changing very quickly anyway.

IMO this research should be made a priority in the US to make sure the minimum trauma is being caused by this procedure.

I give thousands of shots to people. You cannot feel that needle going in. Yet some people are unable to sit still because they anticipate pain which is not going to happen. You have to tell adults, "no I'm not waiting", otherwise they want you to wait while they just get more freaked out.

So? I'm still not getting how this relates the issue I have with circumcision of infants in the developed world.

I didn't watch the video, BTW. I've seen hundreds of circumcision procedures including my son's.

And no doubt grandma will be recommending that her grandson is circumcised because it looks good.

[Skeptic Ginger]

Have you totally lost track of this discussion, Ivor? I don't have a clue what you are on about in half your post.

You suggested parents wait and let kid decide.
Problem: Kids are sexually active and thus at risk for HIV before they are mature enough to decide.
You suggested because you volunteered to have an ingrown toenail removed at age 12 that all kids were mature enough by age 12 to decide if they want to be circumcised.
Problem: That isn't evidence, and a toenail and a foreskin have different emotional issues especially for a 12 yr old.
The parent has to make the decision because the kid will be at risk of HIV before the kid is mature enough to have the responsibility to decide.
If they decide to circumcise to protect the baby from HIV (which is valid in some countries), then the best time is as an infant.

The example of the shots shows people have irrational fears so just considering the amount of pain in a 12 yr old will have getting a circumcision does not tell you when they would be mature enough to weigh actual risk of HIV or pain. They would be weighing perceived risk.

And grandma, if you are referring to me in the future, has no concerns what my son chooses for his son. It isn't that big of a deal to me one way or the other. I have not been convinced that the loss of sexual pleasure is as great as people make it out to be. The only people who really know the degree are those men circumcised as adults. I am convinced there is a very small medical benefit except the HIV risk, that is a huge medical benefit. That makes the decision for a child born in the USA today pretty neutral.

[Ivor the Engineer]

Have you totally lost track of this discussion, Ivor? I don't have a clue what you are on about in half your post.

You suggested parents wait and let kid decide.
Problem: Kids are sexually active and thus at risk for HIV before they are mature enough to decide.
You suggested because you volunteered to have an ingrown toenail removed at age 12 that all kids were mature enough by age 12 to decide if they want to be circumcised.
Problem: That isn't evidence, and a toenail and a foreskin have different emotional issues especially for a 12 yr old.
The parent has to make the decision because the kid will be at risk of HIV before the kid is mature enough to have the responsibility to decide.
If they decide to circumcise to protect the baby from HIV (which is valid in some countries), then the best time is as an infant.

The example of the shots shows people have irrational fears so just considering the amount of pain in a 12 yr old will have getting a circumcision does not tell you when they would be mature enough to weigh actual risk of HIV or pain. They would be weighing perceived risk.

Er, no. READ WHAT I SAID:

I think you're getting confused with my point of view about regions of the world with high incidence of HIV (infant circumcision is, on balance, indicated), and the US, where the effects of torture are being researched to see if it has any advantages.

[Ivor the Engineer]

Some people may find this (http://www.cirp.org/library/statements/cpsbc2004/) interesting:

Human Rights Considerations

The matter of infant male circumcision is particularly difficult in regards to human rights, as it involves consideration of the rights of the infant as well as the rights of the parents.

Under the Canadian Charter of Rights and Freedoms and the United Nations Universal Declaration of Human Rights, an infant has rights that include security of person, life, freedom and bodily integrity. Routine infant male circumcision is an unnecessary and irreversible procedure. Therefore, many consider it to be "unwarranted mutilating surgery".

Many adult men are increasingly concerned about whether their parents had the right to give consent for infant male circumcision. They claim that an infant's rights should take priority over any parental rights to make such a decision. This procedure should be delayed to a later date when the child can make his own informed decision. Parental preference alone does not justify a non-therapeutic procedure.

Others argue that this stance violates the parents' right to religious or cultural expression, and that adherence to their religious and cultural practices would be in the best interests of the infant.

Ethical Considerations

Ethical considerations regarding infant male circumcision centre on the welfare (or "best interests") of the infant and the potential benefit and harm associated with the procedure. Ethics points us to corrective vision, i.e. to question practices that have become routine, or which we take for granted.

<snip>

You are not obliged to act upon a request to circumcise an infant, but you must discuss the medical evidence and the current thoughts in bioethics that dissuade you from performing this procedure. You must also inform the parents that they have the right to see another doctor.

Looks like Canada is leading the way with the ethics of this procedure.

[Abooga]

There is something I don´t understand:

Most optimistic estimates give a protection rate of circumcision against AIDS of around 40% (correct me if I´m wrong.)

How can this be even considered to be a valuable, practical protection against AIDS? You´d still need to use condoms anyway... I wouldn´t have sex with a 60% risk of getting AIDS!

And it could even have negative consequences, badly informed people having more unprotected sex, with a false sense of security.

I´ve often seen these "studies" cited (and probably funded) by muslim apologists, and since we can´t expect much regard for science from these lkind of lobbies, I think it would be a good thing to look at them with a heavily skeptical attitude.

And were those studies about AIDS protection debunked or not? Please tell us! (I can´t be arse to read another of these threads, even though they are quite funny...)

[Ivor the Engineer]

There is something I don´t understand:

Most optimistic estimates give a protection rate of circumcision against AIDS of around 40% (correct me if I´m wrong.)

How can this be even considered to be a valuable, practical protection against AIDS? You´d still need to use condoms anyway... I wouldn´t have sex with a 60% risk of getting AIDS!

And it could even have negative consequences, badly informed people having more unprotected sex, with a false sense of security.

I´ve often seen these "studies" cited (and probably funded) by muslim apologists, and since we can´t expect much regard for science from these lkind of lobbies, I think it would be a good thing to look at them with a heavily skeptical attitude.

And were those studies about AIDS protection debunked or not? Please tell us! (I can´t be arse to read another of these threads, even though they are quite funny...)

The research is solid. The Risk Reduction is ~60% for the men in the study. The controversy is whether infants should be circumcised because it is a simpler and safer procedure, but violates their human rights.

ETA: The effect is best viewed at a population, rather than individual level.

[BlackKat]

There is something I don´t understand:

Most optimistic estimates give a protection rate of circumcision against AIDS of around 40% (correct me if I´m wrong.)

How can this be even considered to be a valuable, practical protection against AIDS? You´d still need to use condoms anyway... I wouldn´t have sex with a 60% risk of getting AIDS!

And it could even have negative consequences, badly informed people having more unprotected sex, with a false sense of security.

I´ve often seen these "studies" cited (and probably funded) by muslim apologists, and since we can´t expect much regard for science from these lkind of lobbies, I think it would be a good thing to look at them with a heavily skeptical attitude.

And were those studies about AIDS protection debunked or not? Please tell us! (I can´t be arse to read another of these threads, even though they are quite funny...)

The studies about decreased HIV risk are indeed valid. The only thing in question is the exact % of risk reduction. As to the false sense of security, that would indeed be a risk if you do not combine it with other safety education. Also, condoms are not a 100% fool-proof safety measure. They break sometimes, or fall off sometimes, or... Combine the two and you're even safer.

I don't know why you're bringing in "muslim apologists" though. Circumcision is (or was) most prevalent in North America, Europe, Oceanic (Aus, NZ).

Circumcision is almost universally a cosmetic surgery and the people giving and receiving the surgery are not trying to fool anyone. The only real question is whether it's fair to make a decision for a child that they are going to have a circumcised penis. So far in this thread the uncircumcised men who love their foreskins have said NO. And the circumcised men who love their circumcised penises have said YES.

[Ivor the Engineer]

<snip>

Circumcision is almost universally a cosmetic surgery and the people giving and receiving the surgery are not trying to fool anyone. The only real question is whether it's fair to make a decision for a child that they are going to have a circumcised penis. So far in this thread the uncircumcised men who love their foreskins have said NO. And the circumcised men who love their circumcised penises have said YES.

So one could argue that circumcision does have a long term effect on a man's brain with respect to ethical decisions:)

[Blue Bubble]

<snip>



Ivor, not wishing to bring frivolity into this discussion, but do you really have to cut out stuff with a <snip> ... :D

[BlackKat]

So one could argue that circumcision does have a long term effect on a man's brain with respect to ethical decisions:)

I think the only thing we've proven in this thread so far are that all men love their own penises. ;)

[Ivor the Engineer]

Ivor, not wishing to bring frivolity into this discussion, but do you really have to cut out stuff with a <snip> ... :D

I was wondering how long it would take for someone to notice that.:D

[fls]

There is something I don´t understand:

Most optimistic estimates give a protection rate of circumcision against AIDS of around 40% (correct me if I´m wrong.)

The most optimistic give a rate of 76%. Most of the results cluster around the 50-55% range.

How can this be even considered to be a valuable, practical protection against AIDS? You´d still need to use condoms anyway... I wouldn´t have sex with a 60% risk of getting AIDS!

Ummm....that's not what the number means.

The risk of getting HIV in the population in question is about 2 to 3 percent per year in those who are not circumcised and about 1 percent in those who are.

And it could even have negative consequences, badly informed people having more unprotected sex, with a false sense of security.

I´ve often seen these "studies" cited (and probably funded) by muslim apologists, and since we can´t expect much regard for science from these lkind of lobbies, I think it would be a good thing to look at them with a heavily skeptical attitude.

The studies have nothing to do with Muslim apologists - not the researchers (personal knowledge), nor the funding. The quality of the studies was very good and the conclusions drawn from the studies were supported by the results. My attitude was skeptical (it usually is anyway) as I am not in favour of circumcision.

And were those studies about AIDS protection debunked or not? Please tell us! (I can´t be arse to read another of these threads, even though they are quite funny...)

No.

Linda

[Ivor the Engineer]

Linda, do you know if the info. I posted earlier about Candian Physicians not having to perform routine infant circumcision is (still) correct?

I just noticed the website the document was from cirp.org - which has already been pointed out to have a biased view (anti-circ).

Also, do you know of any fMRI studies done on infants while being circumcised? It seems strange that there's only the one very dodgy been done (complete with conspiracy theory!), given the potential for the data from a study like this to help settle the argument over infant pain and distress.

[Abooga]

Thankyou Linda, Ivor and BlackCat. I trust your criteria (for now).

The only thing that I´m still not sure about is the loss of sensitivity and other functions of our "beloved" foreskins... but this thread is becoming a bit repetitive so I won´t keep nagging about it.

[Ivor the Engineer]

Here's what some of the target population think:

Acceptability of male circumcision for prevention of HIV infection in Zambia.Lukobo MD, Bailey RC.
Chicago State University, USA.

Numerous observational studies and three clinical trials have shown male circumcision (MC) to be partially protective against HIV acquisition in heterosexual men. This has led to consideration of introducing circumcision as an HIV prevention strategy in parts of sub-Saharan Africa. This study assesses the acceptability of male circumcision as an intervention to improve male genital hygiene and reduce sexually transmitted infections, including HIV-1 in Zambia. Thirty-four focus group discussions were conducted - 17 with men and 17 with women - in four districts chosen to represent urban and rural communities where circumcision is and is not traditionally practiced. In communities where circumcision is little practiced, the main facilitators for acceptance were improved genital hygiene, HIV/STI prevention, and low cost. The main barriers were cultural tradition, high cost, pain, and concerns for safety. If MC is proven to reduce risk for HIV and STIs, most participants reported that they would seek circumcision for themselves or their partners or their sons if it was free or at a minimal cost. Acceptability of male circumcision for STI and HIV prevention appears to be high in Zambia.

[Ivor the Engineer]

Some new research on the effects of circumcision on sexuality:

The effect of male circumcision on sexuality.Kim D, Pang MG.
Department of Physics and Astronomy, Seoul National University, Seoul, Korea.

OBJECTIVE: To prospectively study, using a questionnaire, the sexuality of men circumcised as adults compared to uncircumcised men, and to compare their sex lives before and after circumcision. SUBJECTS AND METHODS: The study included 373 sexually active men, of whom 255 were circumcised and 118 were not. Of the 255 circumcised men, 138 had been sexually active before circumcision, and all were circumcised at >20 years of age. As the Brief Male Sexual Function Inventory does not specifically address the quality of sex life, questions were added to compare sexual and masturbatory pleasure before and after circumcision. RESULTS: There were no significant differences in sexual drive, erection, ejaculation, and ejaculation latency time between circumcised and uncircumcised men. Masturbatory pleasure decreased after circumcision in 48% of the respondents, while 8% reported increased pleasure. Masturbatory difficulty increased after circumcision in 63% of the respondents but was easier in 37%. About 6% answered that their sex lives improved, while 20% reported a worse sex life after circumcision. CONCLUSION: There was a decrease in masturbatory pleasure and sexual enjoyment after circumcision, indicating that adult circumcision adversely affects sexual function in many men, possibly because of complications of the surgery and a loss of nerve endings.

PMID: 17155977 [PubMed - indexed for MEDLINE]

[Abooga]

Some new research on the effects of circumcision on sexuality:

Now let´s see what the "emotionally unattached" pro-cut commentators have to say about this... because if that study is sound... there´s no way one can defend doing it to kids... I mean, "decrease in masturbatory pleasure and sexual enjoyment"... If an adult wants to take that risk, ok, but newborns...

And they´ll say we´re being "emotional" about it... If maiming a newborn baby doesn´t get you emotional then the problem is yours matey...

[BlackKat]

Now let´s see what the "emotionally unattached" pro-cut commentators have to say about this... because if that study is sound... there´s no way one can defend doing it to kids... I mean, "decrease in masturbatory pleasure and sexual enjoyment"... If an adult wants to take that risk, ok, but newborns...

And they´ll say we´re being "emotional" about it... If maiming a newborn baby doesn´t get you emotional then the problem is yours matey...

The problem with the study is it involved people who had it done after 20+ years. In essence they've had to get used to having a new penis. Psychology plays as much a role in sexual pleasure and ability as what parts you have.

There is no way to judge subjective sensations in the penis between someone who has a foreskin and someone who does not have one (virtually their whole life). This is because they are two different people. Best you can get in this case is self-reporting and this is not an accurate way to measure.

My penis is circumcised and I feel TONS of pleasure when I masturbate or have sex. I mean how are we going to compare my pleasure to yours? Time us? It's silly to try to compare.

[BlackKat]

...not to mention that you can find studies going the opposite direction, and no direction at all:
http://content.karger.com/ProdukteDB/produkte.asp?Doi=85930
Results: Fifty-nine percent of patients (88/150) responded. The total mean IIEF-5 score was 22.41 ± 0.94 and 21.13 ± 3.17 before and after circumcision, respectively (p = 0.4). Seventy-four percent of patients had no change in their libido levels, 69% noticed less pain during intercourse (p < 0.05), and 44% of the patients (p = 0.04) and 38% of the partners (p = 0.02) thought the penis appearance improved after circumcision. Penile sensation improved after circumcision in 38% (p = 0.01) but got worse in 18%, with the remainder having no change. Overall satisfaction was 61%. Conclusions: Penile sensitivity had variable outcomes after circumcision. The poor outcome of circumcision considered by overall satisfaction rates suggests that when we circumcise men, these outcome data should be discussed during the informed consent process.

In otherwords this study found that it didn't really matter if you're circumcised or not ... that some people liked it better (61% is a majority but not by much especially in a sample size less than millions of men) and some did not. It's inconclusive. Having a foreskin or not is really just a matter of looks.

[Abooga]

"There is no way to judge subjective sensations in the penis between someone who has a foreskin and someone who does not"

The fact that a lot of nerve endings are lost together with with the poor little foreskin? Having no purely objective way to judge it, shouldn´t we take the side of caution?

[Z]

And now, to lighten the mood:

A man shows up one morning at his local hospital, and speaks to a surgeon.

The surgeon says, "What can I do for you today, Mr. Longfellow?"

"Well," Longfellow replies, "I've decided to be castrated."

The doctor blinked and his jaw slightly dropped, but he quickly covered his professional aplomb. "Castrated? Are you sure?"

"I know what you're going to say, Doc... I've read all the arguments for and against it. I'm not doing this for religious grounds, but I'm doing it for my wife. She thinks it'll make things better for both of us, and I'll do anything for her. My own doc says the process is simple and painless, but he won't do it on ethical grounds. That leaves you..."

The doc considered for a moment, agreed, and made arrangements for the operation. A few days later, as Longfellow was resting in the recovery room, he turned to his neighbor.

"Hey, Manny Longfellow," he introduced to his neighbor. "What're you in for?"

"Pete Zimmer," the neighbor replied. "Circumcision."

Longfellow snapped his fingers and said, "Damn, I knew it started with a 'C'."

[BlackKat]

LOL Z. That's just what I needed to read before going to work (which is kind of like being castrated).

[Morrigan]

Circumcision is almost universally a cosmetic surgery and the people giving and receiving the surgery are not trying to fool anyone.

Which is why this whole thread has been about its so-called medical benefits, and you're the only one harping about aesthetics. :rolleyes:


The only real question is whether it's fair to make a decision for a child that they are going to have a circumcised penis. So far in this thread the uncircumcised men who love their foreskins have said NO. And the circumcised men who love their circumcised penises have said YES.
As was said earlier, female genital mutilation is perpetrated by women who have had it done, and think it normal and "right".

If you sincerely think that it's perfectly fine to remove a body part of an unconsenting infant just for a subjective, irrational cosmetic purpose (since, as you say yourself, it's all that there's left), you're not quite right in the head.

[BlackKat]

Which is why this whole thread has been about its so-called medical benefits, and you're the only one harping about aesthetics. :rolleyes:
The thread is about both. Because almost all circumcisions are done for aesthetics reasons the arguement is also whether it is fair or not to make aesthetics judgements for our children.


As was said earlier, female genital mutilation is perpetrated by women who have had it done, and think it normal and "right".

If you sincerely think that it's perfectly fine to remove a body part of an unconsenting infant just for a subjective, irrational cosmetic purpose (since, as you say yourself, it's all that there's left), you're not quite right in the head.

You can not compare the two. Castration would be an equivalent to female genital mutilation, not circumcision. Also female genital mutilation is almost never done for aesthetics. It is almost always done with the express purpose of making sure a woman can not enjoy sex or even have it at all. It does not matter if the person who thinks women should not enjoy sex is a man or a woman. It's still opression.
Female genital mutilation consists of excising the clitoris and or labia, and also can include sewing mostly shut the vagina.

[kellyb]

You can not compare the two. Castration would be an equivalent to female genital mutilation, not circumcision. Also female genital mutilation is almost never done for aesthetics. It is almost always done with the express purpose of making sure a woman can not enjoy sex or even have it at all. It does not matter if the person who thinks women should not enjoy sex is a man or a woman. It's still opression.
Female genital mutilation consists of excising the clitoris and or labia, and also can include sewing mostly shut the vagina.
Aaaand again...repeating a false claim over and over and over again does not make it incrementally more true with each repetition.
It might appear to make it more true in the mind of the one repeating the claim, but in objective reality, it doesn't actually work like that.

[Ivor the Engineer]

There are women who choose to have cosmetic surgery on their genitals. Apparently, some want to feel like a virgin again after having had a baby or two, while others just want to 'tidy' their vulva up.

What do the pro-circumcision people think about the parents of a baby girl judge the aesthetic quality of their child's vulva and have it made more similar to the concept of a "normal" one?

[Darat]

...snip...

You can not compare the two. Castration would be an equivalent to female genital mutilation, not circumcision. Also female genital mutilation is almost never done for aesthetics. It is almost always done with the express purpose of making sure a woman can not enjoy sex or even have it at all. It does not matter if the person who thinks women should not enjoy sex is a man or a woman. It's still opression.
Female genital mutilation consists of excising the clitoris and or labia, and also can include sewing mostly shut the vagina.


FGM covers a huge range of mutilation, from just the removal of some tissue to as you rightly say complete excision of most of the tissues of the vagina.

As for the reasons why FGM is carried out - it is for the same reasons as male circumcisions are carried out e.g. hygiene, aesthetics, not wanting to be different and so on.

See: http://www.siue.edu/~jfarley/nicho490.htm

http://www.who.int/mediacentre/factsheets/fs241/en/



...snip...

The reasons given by families for having FGM performed include:
psychosexual reasons:

reduction or elimination of the sensitive tissue of the outer genitalia, particularly the clitoris, in order to attenuate sexual desire in the female, maintain chastity and virginity before marriage and fidelity during marriage, and increase male sexual pleasure;
sociological reasons: identification with the cultural heritage, initiation of girls into womanhood, social integration and the maintenance of social cohesion;
hygiene and aesthetic reasons: the external female genitalia are considered dirty and unsightly and are to be removed to promote hygiene and provide aesthetic appeal;
myths: enhancement of fertility and promotion of child survival;
religious reasons: Some Muslim communities, however, practise FGM in the belief that it is demanded by the Islamic faith. The practice, however, predates Islam.



...snip...


Supporters of male circumcision should logically also be supporters of at least Type 1 female genital mutilation.

[BlackKat]

FGM covers a huge range of mutilation, from just the removal of some tissue to as you rightly say complete excision of most of the tissues of the vagina.

As for the reasons why FGM is carried out - it is for the same reasons as male circumcisions are carried out e.g. hygiene, aesthetics, not wanting to be different and so on.

See: http://www.siue.edu/~jfarley/nicho490.htm

http://www.who.int/mediacentre/factsheets/fs241/en/

Supporters of male circumcision should logically also be supporters of at least Type 1 female genital mutilation.

You're right. But in 80% or more cases (at least according to the WHO's survey linked earlier in the thread) it's excision of the clitoris or worse. If those numbers have changed then that's good. And I don't have a problem with FGM that does not involve removal of some body part. But it's hard to draw parallells between circumcision and any form of female genital mutilation because females don't have much that is extraneous the way the foreskin is. There are a number of piercings I would not have an issue with. But anytime you're cutting something off it's going to be something vital.

[kellyb]

reduction or elimination of the sensitive tissue of the outer genitalia, particularly the clitoris, in order to attenuate sexual desire in the female, maintain chastity and virginity before marriage and fidelity during marriage, and increase male sexual pleasure;
Similarly, many Christians to this day "believe in" circumcision to prevent masturbation and sexual immorality.
But not ALL or necessarily even most parents who have their kids circumcised do it for that reason.

[kellyb]

You're right. But in 80% or more cases (at least according to the WHO's survey linked earlier in the thread) it's excision of the clitoris or worse.
Why would a 2000 survey be more accurate in 2007 than a 2005 survey?

It's hard to draw parallells between circumcision and any form of female genital mutilation because females don't have much that is extraneous the way the foreskin is. There are a number of piercings I would not have an issue with. But anytime you're cutting something off it's going to be something vital.
Why would the female prepuce or labia be "vital"?

[BlackKat]

Similarly, many Christians to this day "believe in" circumcision to prevent masturbation and sexual immorality.
But not ALL or necessarily even most parents who have their kids circumcised do it for that reason.

I find that hard to believe that any people believe in "circumcision to prevent masturbation and sexual immorality."
It's just for looks. Parents want their children's penises to look like what they think penises should look like.

[kellyb]

I find that hard to believe that any people believe in "circumcision to prevent masturbation and sexual immorality."
It's just for looks. Parents want their children's penises to look like what they think penises should look like.
How many fundamentalist Christians do you know who really, really don't want their kids ever masturbating?

[BlackKat]

How many fundamentalist Christians do you know who really, really don't want their kids ever masturbating?

So what does circumcision have to do with that?

[Ivor the Engineer]

Something else that's crossed my mind is how do people see their children? As property to do with as they wish (within the law) or something else? At what age does this change?

[kellyb]

So what does circumcision have to do with that?


http://www.giveshare.org/BibleStudy/134.circumcision.html

Left uncleansed this [smegma in an uncircumcised male] may cause inflammation and trouble. It is, therefore, necessary, in the case of an uncircumcised male baby, for the mother to regularly push the prepuce [foreskin] back behind the glans penis, and wash it; and as he grows old enough, the boy must be taught to do this regularly. This very need for sanitation causes irritation of the very seat of voluptuous sensation. It is very likely to stimulate sex arousal, and lead to masturbation [which is wrong]. This has been the chief cause of a serious ‘sex problem’ in the lives of countless young men prior to marriage.
The prepuce forms a protective covering over the easily aroused sensation-producing glans — yet, instead of actually ‘protecting’ it, the cleansing need produces just the opposite [effect]. The glans of the uncircumcised boy or man is exceedingly tender and sensitive. After circumcision, the glans gradually loses much of its sensitiveness, until the touch or rubbing of underclothing over it produces no more sensitiveness than clothing does to any other part of the body. Still, the circumcised enjoy all the voluptuous pleasure God made possible in marital coitus.
Parents are advised not to let a doctor perform circumcision of their baby at the time of birth. Insist that it be done when the baby is eight days old. Finally, Armstrong advises parents to insist that a little of the foreskin be left, for if all of the foreskin is cut off, "the skin is drawn back from the point of joining with the glans on erection, and this causes undue arousal and temptation" (page 228). Proper circumcision, Armstrong notes, will greatly lessen the danger of masturbation

[BlackKat]

http://www.giveshare.org/BibleStudy/134.circumcision.html

Fringe groups do not mean much though. I could also point to a buch of white supremecist sites. But if I said:
White people hate black people

You'd of course want a quantifier, at the least for me to say:
A few white people hate black people.

So there's a handful of people who think circumcised penises are less easy to arouse. Won't they be in for a big surprise.

[kellyb]

Fringe groups do not mean much though. I could also point to a buch of white supremecist sites. But if I said:
White people hate black people

You'd of course want a quantifier, at the least for me to say:
A few white people hate black people.

So there's a handful of people who think circumcised penises are less easy to arouse. Won't they be in for a big surprise.

Interesting analogy.
I'd say it's more than "a few" white people who hate blacks, and having spent most of my life as a Christian, I'd say that that's more than a fringe opinion in Christianity that having to clean under the foreskin will tempt a boy to masturbate.

But on both points I'm not sure I can actually prove I'm right.

[Ivor the Engineer]

Interesting analogy.
I'd say it's more than "a few" white people who hate blacks, and having spent most of my life as a Christian, I'd say that that's more than a fringe opinion in Christianity that having to clean under the foreskin will tempt a boy to masturbate.

But on both points I'm not sure I can actually prove I'm right.

Hey, more than two shakes at the urinal and your likely to get a funny look.

Bad design by God, really. You'd have thought it would have made a man's penis so it required the chemicals from a woman's vagina on it to allow a man to reach orgasm.

That is unless it's testing us. (I failed very early:D)

[osmosis]

Most of the stuff brought up here, ie. cosmetics, tradition, functionality, etc. are, in my view, essentially moot. There is one issue that trumps all other issues.

For me the crux of the issue is really simple. It's called basic human rights. Absent medical necessity, people should not be altered or mutilated in ANY way without their educated consent. To do so is criminal.

The question of medical necessity is probably best left to doctors.

[Ivor the Engineer]

Ok, looks like the thread is coming to a close, but I'll ask anyway.

My reasoning while watching (and importantly I think, listening to) the video clip of the routine circumcision was two-fold. Firstly, I felt empathy for the child's suffering. I thought (felt?) the child was in significant pain and distress, and the pain and distress was caused by the procedure. Secondly, I assumed the child would be no worse off with his foreskin intact. Thus I perceived someone hurting a child for no valid reason which made me angry and I wanted to stop it.

If you haven't watched and listened to the video, but have been in the room while another child or your own has been circumcised (not for a medical reason), I want to know what you were thinking and feeling then instead.

So my questions are these:

Did everyone who was ok with it feel some empathy for the child? Or did you not feel anything? Was it just a sequence of actions to you?

What thoughts or assumptions made the difference for those who were ok with it? E.g., do you think (feel?) about foreskin in a negative sense?

I want to know the reasoning you used to come to the conclusion that it was worth it.

[kellyb]

Ok, looks like the thread is coming to a close, but I'll ask anyway.

My reasoning while watching (and importantly I think, listening to) the video clip of the routine circumcision was two-fold. Firstly, I felt empathy for the child's suffering. I thought (felt?) the child was in significant pain and distress, and the pain and distress was caused by the procedure. Secondly, I assumed the child would be no worse off with his foreskin intact. Thus I perceived someone hurting a child for no valid reason which made me angry and I wanted to stop it.

If you haven't watched and listened to the video, but have been in the room while another child or your own has been circumcised (not for a medical reason), I want to know what you were thinking and feeling then instead.

So my questions are these:

Did everyone who was ok with it feel some empathy for the child? Or did you not feel anything? Was it just a sequence of actions to you?

What thoughts or assumptions made the difference for those who were ok with it? E.g., do you think (feel?) about foreskin in a negative sense?

I want to know the reasoning you used to come to the conclusion that it was worth it.

The answer's probably going to depend on if pain relief was used, and if so, what type. From what I understand, using EMLA cream, then waiting an hour or so, and then using local, and then using a nerve block works pretty well.
In hospitals this is almost never done, and that's also the place where mothers are the least likely to be there to see what actually happens.

[BlackKat]

Ok, looks like the thread is coming to a close, but I'll ask anyway.

My reasoning while watching (and importantly I think, listening to) the video clip of the routine circumcision was two-fold. Firstly, I felt empathy for the child's suffering. I thought (felt?) the child was in significant pain and distress, and the pain and distress was caused by the procedure. Secondly, I assumed the child would be no worse off with his foreskin intact. Thus I perceived someone hurting a child for no valid reason which made me angry and I wanted to stop it.

If you haven't watched and listened to the video, but have been in the room while another child or your own has been circumcised (not for a medical reason), I want to know what you were thinking and feeling then instead.

So my questions are these:

Did everyone who was ok with it feel some empathy for the child? Or did you not feel anything? Was it just a sequence of actions to you?

What thoughts or assumptions made the difference for those who were ok with it? E.g., do you think (feel?) about foreskin in a negative sense?

I want to know the reasoning you used to come to the conclusion that it was worth it.

I watched the video mentioned (and a few others) of circumcision, and been in the room during circumcisions (bike courier picking up just removed foreskins for delivery to testing facility - and no that's not the oddest cargo I ever had). I do feel sorry for the child but in the same sense I feel sorry for them when they get a rectal thermometer, or get their bath, or... Anything beyond cuddling up to mommy's breast or a bottle or sleeping when you're a newborn is going to be uncomfortable. Now if I had seen a circumcision where I /knew/ there were no anesthetics involved I would feel badly for the child. But even still... the procedure is generally done quickly and as painlessly as possible, and at that age there's just not much going through your mind beyond eat, poop, sleep.

For me the HIV tests, the easier cleaning, etc... are all just bonuses to having the foreskin removed. Although I myself love not having a foreskin, and would seriously consider having any son of mine circumcised, it is for aesthetic reasons first and foremost. I just don't like the way foreskins look (and I am well aware this is a case of not being used to penises with foreskins as much as anything else.). But I'm ok with that.

Perhaps it's because I've always been circumcised and nigh everyone I know as well.

Perhaps it's because I have spent most of my life in social circles and cliques where body modification is not frowned upon, almost required, in the form of tattoos, body piercing, and more... just for aesthetics.

Perhaps it is because I view the foreskin in the same light as other animals similar penis mechanics but know that those mechanics are designed to warm and protect the penis. The advent of clothing negates a lot of necessities and in fact many men end up with impotency problems as their testicles get too warm to produce enough sperm. Just as we no longer have hairy, calloused, hobbit-like feet as the norm because we wear shoes.

I would never want anyone to have to get their children circumcised if they were not comfortable with the procedure. But I would also never condemn anyone for having their children circumcised (or for that matter - such as in many Latino families - ears pierced). If I thought there was extreme pain involved or that the child would be missing out on something I would feel differently. But as a sexually satisfied circumcised male surrounded by other sexually satisfied circumcised males it's hard to feel left out.

[Skeptic Ginger]

I know several men who say that they wish they hadn't have been circumcised as infants, and now think their penises are numb to some degree as a result.Well this is a bit late to be asking since you posted this a while back but, how do they know their penises wouldn't be numb to some degree even if they were not circumcised?

[Skeptic Ginger]

If anyone wants to look at the research that led to the recommendation circumcision prevented HIV, I posted a lot of sources for circumcision preventing HIV in this thread on Skepchick. (http://www.skepchick.org/forum/viewtopic.php?t=390&postdays=0&postorder=asc&highlight=circumcision&start=0)

Here they are as is from that discussion so the discussion on these posts will be out of context, and some of the sources may have already been posted here. You can go to the thread to see comments and responses. There is more than just circumcision being discussed in the thread.

Posts don't have numbers, this one is on page 2.

A good example is HIV. The cells in the foreskin allow a direct portal of entry for HIV. Circumcised men in Africa have been shown to have a lower rate of HIV than circumcised males.

Do you have a source for this information? Another group I'm in is having a feud about circumcision and I'd like to post this info. There's one guy in particular who keep crying about how circumcision is child abuse. (I've actually bailed from the group until the penis frenzy is over, but this would be worth adding to the conversation.)The penis frenzy? That's cute.

Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=16231970&dopt=Abstract)...A total of 3,274 uncircumcised men, aged 18-24 y, were randomized to a control or an intervention group with follow-up visits at months 3, 12, and 21. Male circumcision was offered to the intervention group immediately after randomization and to the control group at the end of the follow-up....There were 20 HIV infections (incidence rate = 0.85 per 100 person-years) in the intervention group and 49 (2.1 per 100 person-years) in the control group, corresponding to an RR of 0.40 (95% CI: 0.24%-0.68%; p < 0.001). This RR corresponds to a protection of 60% (95% CI: 32%-76%)....

But hold on a minute folks. I brought this up in response to the, 'foreskin evolved therefore it must be good' post. I certainly never meant circumcised men were safe from HIV. It was observed in some African countries with high rates of HIV that tribes which practiced circumcision had lower rates of HIV than tribes which did not practice it. This study followed and it was conclusive enough that the trial was stopped so the rest of the men could be circumcised. In addition, the cells in the foreskin have been shown to be the portal of entry for the HIV.

Circumcision is of benefit in countries such as those in Africa with high rates of HIV. All possible measures to control HIV need to be implemented in those countries. (Bush of course has his head up his ass and is spending all our money on teaching abstinence there while spending very little on other measures. He'd rather please his base than actually slow the spread of HIV.) But I digress...

I will repeat what I posted earlier. Circumcision has been shown to offer a small health benefit. The chance of the foreskin getting stuck in the retracted position and cutting off circulation to the tip, the chance the foreskin will not properly retract due to the size of the opening, and the collection of bacteria under the foreskin which can be a risk in itself and adds a slightly increased risk of urethra or urinary tract infection are the risks of not circumcising. These are rare, and manageable risks. Infection post-op or reaction to the anesthetic are risks with circumcision, also very rare, but to be fair need mention.

The benefit is not big enough that it should be the only deciding factor in the choice to circumcise your child. If you were poor and lived in Africa, India, or a few other places in Asia and Eastern Europe, the HIV protection, while not complete, would be a very good reason to circumcise your infant. Ysabella doesn't live in one of those countries. (Hey you're in my state. :D ) But if she did I would have said, without a doubt she should get the thing done. For everyone else, there is a slight health benefit but not a big health benefit.

-

[page 5]
I am not invested in the outcome here. I am not campaigning for nor against circumcision in Western countries or in Africa or any other third world countries. It's annoying to be pegged as pro-circumcision here just for posting current research and responding to an inaccurate conclusion the relationship between HIV and circumcision had been ruled out.

I have read sufficient research to conclude the relationship between circumcision and HIV is supported. No studies to date, regardless of the quality of the studies that have been done, have found data contradicting the relationship. But that is a completely different statement from proposing or supporting the use of circumcision as a means of controlling HIV in Africa or elsewhere. It suggests there are benefits in countries with such high rates of HIV that everything possible should be utilized in the effort to combat the disease.

The UNAIDS statement on South African trial findings regarding male circumcision and HIV (http://www.who.int/mediacentre/news/releases/2005/pr32/en/):Although UNAIDS believes that it is premature to recommend male circumcision services as part of HIV prevention programmes, there is heightened interest from governments and the general public in male circumcision in a number of African countries. News of the trial results presented today may increase demand for male circumcision services. Governments should take steps now to ensure that male circumcision is conducted by trained practitioners in safe and equipped settings in order to reduce the rate of post-operative complications.

I looked at the first 40 returns from a Pub Med search for HIV and circumcision (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=pubmed). Unfortunately many of these links did not have abstracts so I didn't really look at 40 citations. Sometimes you can find the citations without fees if you Google them. I didn't have time. But the point of posting the following was just to give the thread readers some idea where the research is on this matter.

This 2005 review, Male circumcision and the risk of HIV infection, (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15786575&query_hl=2&itool=pubmed_DocSum) supports a similar conclusion as the 1999 review posted above.These studies' systematic lack of control of important confounding factors makes the assessment of the association between male circumcision and HIV transmission very difficult and raises doubt about the validity of the current findings. Randomized trials are needed to determine the true strength of the association. Until then, a decision to recommend mass male circumcision to prevent HIV transmission in sub-Saharan Africa is premature and risky.

But this one, HIV and male circumcision--a systematic review with assessment of the quality of studies, (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15766651&query_hl=2&itool=pubmed_DocSum) objects to the validity of any of the meta-analyses.Study quality was very variable and no studies measured the same set of potential confounding variables. Therefore, conducting a meta-analysis was inappropriate. Detailed quality assessment of observational studies can provide a useful visual aid to interpreting findings. Although most studies show an association between male circumcision and prevention of HIV, these results may be limited by confounding, which is unlikely to be adjusted for.

Many well done individual studies support the link regardless of the meta-analyses, including the randomized study (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16231970&query_hl=2&itool=pubmed_DocSum) I first linked to. Here is another. Female-to-male infectivity of HIV-1 among circumcised and uncircumcised Kenyan men. (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15655778&query_hl=2&itool=pubmed_DocSum)CONCLUSIONS: After accounting for sexual behavior, we found that uncircumcised men were at a >2-fold increased risk of acquiring HIV-1 per sex act, compared with circumcised men.

This one, HIV infection and circumcision: cutting through the hyperbole, (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16353456&query_hl=2&itool=pubmed_docsum) discusses some other factors which must be considered besides merely a single clinical outcome.Our results show that the medical literature supporting mass circumcision for the prevention of HIV infection is inconsistent and based on observation studies. Even if the two ongoing randomised controlled trials in Africa show a protective benefit of circumcision, factors such as the unknown complication rate of the procedure, the permanent injury to the penis, human rights violations and the potential for veiled colonialism need to be taken into account. Based on the best estimates, mass circumcision would not be as cost-effective as other interventions that have been demonstrated to be effective. Even if effective, mass circumcision as a preventive measure for HIV in developed countries is difficult to justify.

Which some studies are now trying to address such as this one, Adult male circumcision: results of a standardized procedure in Kisumu District, Kenya. (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16225538&query_hl=2&itool=pubmed_DocSum)CONCLUSION: Safe and acceptable adult male circumcision services can be delivered in developing countries should male circumcision ultimately be advocated as a public-health measure.


Here's an example of the controversy, which sadly should be based on science, not emotion, but clearly isn't. news article: nternational AIDS Society conference update. Male circumcision as a prevention method? Study was controversial from day one. (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16206400&query_hl=2&itool=pubmed_DocSum)Investigators presented evidence at the July International AIDS Society conference in Rio de Janeiro, Brazil, in that male circumcision helps reduce the risk of HIV infection among men who have sex with women. The study showed that circumcised men were more than 60% less likely than uncircumcised men to be infected with HIV when having sex with infected female partners. The news was not welcomed by all quarters. Anti-circumcision activists quickly called on the United Nations to classify circumcision of children younger than age 18 as a human rights crime.

There was one study addressing risk in the USA. Sexual risk, nitrite inhalant use, and lack of circumcision associated with HIV seroconversion in men who have sex with men in the United States. (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15851918&query_hl=2&itool=pubmed_DocSum)factors for HIV seroconversion were increased number of reported HIV-negative male sex partners (adjusted odds ratio (AOR) = 1.14 per partner, population attributable risk (PAR) = 28%), nitrite inhalant use (AOR = 2.2, PAR = 28%), unprotected receptive anal sex with an HIV unknown serostatus partner (AOR = 2.7, PAR = 15%) or HIV-positive partner (AOR = 3.4, PAR = 12%), protected receptive anal sex with an HIV-positive partner (AOR = 2.2, PAR = 11%), lack of circumcision (AOR = 2.0, PAR = 10%), and receptive oral sex to ejaculation with an HIV-positive partner (AOR = 3.8, PAR = 7%). Having a large number of male sex partners, nitrite inhalant use, and engaging in receptive anal sex explained the majority of infections in this cohort and should be targeted in prevention strategies for MSM.Note they cut off their measure of "most" at 11% and did not list circs, 10% nor oral sex with an infected partner, 7% in their conclusion.

And this one looked at cost benefit analysis regardless of HIV transmission. Cost analysis of neonatal circumcision in a large health maintenance organization. (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16469634&query_hl=2&itool=pubmed_docsum)Cost benefits of circumcision resulted from prevention of infant urinary tract infection, balanoposthitis, phimosis, HIV infection and penile cancer. Assuming initial neonatal circumcision cost to be 200 dollars, the future health care cost offset (avoided) was calculated as 183 dollars (range 93 dollars to 303 dollars in 95% of simulations). CONCLUSIONS: Multiple lifetime medical benefits of neonatal circumcision can be achieved at little or no cost. Because postneonatal circumcision is so expensive, its rate is the most important factor determining future cost savings from newborn circumcision.

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[page 6]
SZABO, R. and SHORT, R. How does male circumcision protect against HIV infection? Bristish Medical Journal 320: 1592-1594. Jun. 10, 2000. (Available: http://www.bmj.com/cgi/reprint/320/7249/1592.pdf , Accessed Jun. 27, 2001)

How does male circumcision protect against HIV infection? (http://www.circumcisioninfo.com/szabo1.htm) (non pdf link)

To summarize, the foreskin is susceptible to small scratches and tears during intercourse and contains a high density of Langerhans cells - primary target cells for HIV.

I had no idea this was such a hot topic (http://www.circumstitions.com/Short-HIV.html) for you boys. Mind you I'm not complaining. I have my personal preference but really don't care that many prefer intact foreskins or object to removing them from infants.

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[page 9]
Circumcision could prevent millions of AIDS cases in Africa: report (http://news.yahoo.com/s/afp/20060711/hl_afp/africahealthaids_060711214237)

It's a WHO sponsored report. I haven't had time to read it yet but it sounds like one study I already cited..The study, coordinated by Brian Williams of the World Health Organization (WHO) and published in the US review PLoS Medicine, is based on results of a trial conducted in South Africa, in which men were offered the chance to be circumcised. Those who chose to be circumcised had a lower HIV infection rate 18 months later.

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[page 9]
http://news.yahoo.com/s/nm/20061129/hl_nm/aids_africa_circumcision_dc_1

Seems the research is now strong enough to start promoting circumcision as an HIV prevention tactic.

Mind you we are talking Africa here and not the USA.

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[Morrigan]

It's just for looks. Parents want their children's penises to look like what they think penises should look like.
Evidence?

[Z]

I was present for the circumcisions of my sons. In the first two cases, a cream was applied before circumcision, and in the last three cases, a spray was used. There was a wait of a few minutes, and the plastibell procedure began.

The entire time, the infants were fairly calm and undisturbed by the process of circumcision (my oldest was only interested in sucking the pinky of a nurse who was with him). The procedure was very quick, and the results were clean and hygenic-looking.

Naturally, as a man, I wondered what it might actually feel like, sans pain relief; and I was grateful that they used the cream/spray on my child.

My feelings about the children at the point of the circumcision was relief and satisfaction, knowing I was saving them from infections, from the filthy stench of the foreskin, and from the hideous bestial appearance that an uncut penis has. At that time, I'd never heard of the HIV studies about foreskins, and had never heard of any complications later in life about circumcised men; my own experience was that it was UNcircumcised men who had problems. I was largely surrounded in the military by circumcised men (communal showers let you know a LITTLE too much about your comrades), and the scant few who hadn't been cut regularly spoke of problems as teens and young adults with infections and urinary difficulty. A few even got cut as adults, at the suggestion of the medical staff and the urging of their wives and/or girlfriends.

In all that time, it had never occured to me that there were those who thought circumcision was a BAD thing.

Of course, it also had never occured to me that getting a toddler's ears pierced, as we did with my daughter, would ever be seen as a bad thing, but I encounter people who tell me how horrible it is that my daughter has pierced ears. WTF?

I feel more empathy for the pain of my children when they get shots, when my second-born had to get an IV in his scalp, when they had to extract a piece of foam from my third-born's sinus that he had somehow managed to get in there at a year old... Compared to those pains, the circumcisions were quick, painless, and most importantly, rapidly forgotten.

I agree that some circumcisions are cruel and inhumane - those that don't use pain relief, those that use primitive methods (like teeth - ugh!), those that result in excessive bleeding and infections. But those done on my sons were none of that. They were quick, clean, and tidy. The results are beautiful (as penises go).

But I did have doubts, for a while, about whether it was really all that useful. Until I met our housemate, and her two uncut sons.

The two boys regularly suffer from infections, swelling, and stink. The younger of the two, a high-functioning autistic, so dislikes his penis that he's expressed a desire to have the entire thing removed (EEEK!), while being jealous of my sons' privates. The older boy mentions pain on those rare occasions when, for whatever reason, his penis becomes erect (I had no idea penises could get erect at five years old, but apparently they can).

And I sympathize greatly with the two of them, and wonder how their father can be so horrible as to not remove the terrible foreskin from his sons!

In fact, until I came to JREF, I'd never, EVER heard anyone claim that keeping the foreskin was a GOOD idea. Then again, I was rarely ever exposed to anyone who WASN'T from the U.S. (minus Koreans, who rarely ever discuss their genitals, and various hispanics, who seem to think that circumcisions are a good thing for hygiene reasons).

I have to admit, the argument has definitely made me think, long and hard, about the whole thing. But so far, I still remain unconvinced. I think the benefits - from health and hygiene to aesthetics and acceptance within culture - far outweigh any perceived drawbacks - including tiny chances of complications I'd never heard of or experienced, psychological damage that seems unlikely in a culture where circumcision is so common...

Then there's the whole 'human rights' aspect. Frankly, I think there are certain parental rights that trump individual human rights. And decisions about circumcision, piercing, tattoos, etc., IMO, fall firmly under the umbrella of parental rights, just as hair style (cutting vs. not cutting), clothing, makeup, who they hang with, etc. also fall under that umbrella.

When a child reaches the age of majority, they can make any decision they want for themselves. But until then, they are the responsibility of the parent, and that includes the parent deciding what's best for the child - braces, circumcisions, piercings, the removal of wisdom teeth, corrective eye surgery, and other forms fo cosmetic surgery included.

I've had moles removed from one of my sons before - a somewhat more painful and arguably less necessary procedure than circumcision - because I thought it would improve his appearance and acceptance. I've looked into treatment for my third-born's mongolian mark, a purplish mark covering one shoulder that is hot to the mark and unpleasant to look at. Unfortunately, those treatments are wildly painful, often leaving scars, and are not guaranteed to work - so we've decided against them.

And you can't even claim that my decisions were based on religion. I've never belonged to any formal religion until recently. My mother was raised Roman Catholic - where circumcisions aren't terribly common - and my father was Apache and a pragmatic theist. I was very eclectic, but never belonged to any group that required a cut tadger (in fact, as a religious practice, I find it abhorrent).

But I do belong to a society which accepts circumcision as normal, desirable, and attractive. That probably did color my earlier perceptions on circumcisions.

If you choose to see me as a horrible parent because I chose to circumcise my sons, that's your choice. I've gotten my kudos from professionals in several fields related to children - child psychiatrists, social workers, OT/PT therapists, teachers, pediatricians, behavioral specialists... I've been praised for being an exemplary parent many, many times. My children are healthy, active, intelligent, educated, extremely well behaved and polite, creative, energetic, sociable, and as close to perfect as any parent could want. My housemate is jealous at how good my kids tend to be, compared to her two sons (who have improved by vast leaps and bounds since coming to live with us).

But I've been insulted by people for: disciplining my children when they have tantrums or outbursts; letting them discover things for themselves, rather than rubber-padding their entire environment; taking them with me to go shopping, or out to dinner at fine restaurants (managers, on the other hand, thank us for our well-behaved children); feeding them a wide variety of foods that we ourselves eat (my roommate used to feed her kids pretty much nothing but chicken nuggets, ravioli, and PB&J sandwiches, 'cuz that's what kids eat, you know?'); speaking to my children as equals, rather than as children; explaining things as they are, rather than using sugar-coated euphamisms and lies; taking them off the bottle as soon as possible, and the pacifier as soon as the child shows no real need for it; letting my children eat spicy foods like Indian foods or Mexican foods at early ages; letting them have toys rated above their age limit; and many other perceived offenses.

Amazingly, not one of the people criticising me in these areas was qualified to judge! And those who ARE qualified, have praised me for many of these same things.

So if I'm a bad parent, fine. We need more bad parents, then, and maybe our world wouldn't be going to Nomandy in a hand-basket, like it currently is.

[HawkeyeMD]

Wow, go off the boards for a while and look at the sort of thing you miss.

I don't have much to add, but I wanted to thank you all for showing me what I'm likely to come up against during the pediatric portion of my upsoming residency. :cool: FWIW, I tend towards the "it's medically unnecessary in most cases" viewpoint. I understand that there will be parents who want it done for a variety of reasons; I do not intend to perform circumcisions unless I think there's a medical reason for it.

In addition, the cells in the foreskin have been shown to be the portal of entry for the HIV.

How does male circumcision protect against HIV infection? (http://www.circumcisioninfo.com/szabo1.htm) (non pdf link)

To summarize, the foreskin is susceptible to small scratches and tears during intercourse and contains a high density of Langerhans cells - primary target cells for HIV.

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Just a word here--I'm not sure this is entirely correct. Langerhans cells are *not* the primary target cells for HIV. This paper presumes that because they have some of the same target receptors as CD4+ T-cells that HIV will use them as a port of entry. However, this hasn't been conclusively proven. From what I recall from lecture, there are also a lot of people who think that the Langerhans cells--a type of dendritic cell that is prevalent in the mucosal tissue--may actually be protective against HIV, because its job is to take up the virus before it gets to the lymph nodes and HIV can't multiply in these cells.

On the other hand, no one knows for sure. What I do agree with is that I think this is something a man should decide for himself. My husband convinced me of that. :D

[Kevin_Lowe]

If you were trolling, Z, that was pretty good.

I thought about rewriting your post to justify female genital mutilation ("saving them from infections, from the filthy stench of the labia, and from the hideous bestial appearance that an uncut vulva has.... what? I'm an awesome parent, everyone says so, how could I be wrong about FGM? The world needs more parents like me!") but in the end I decided it would be too icky.

I'm in favour of circumcision in areas with high rates of AIDS for the same reasons that I'm in favour of immunisation against deadly diseases. Saving lives justifies the lesser risks of circumcision in my mind. None of the other proposed justifications put forward for circumcision that I have seen make circumcision a clear net win for the subject, and a clear net win is what I think should be required for irreversible surgical alterations to infants.

[Ivor the Engineer]

Thanks to the people who've explained their thoughts while watching the video or another circumcision. Any more?

Skeptigirl, what goes through your mind while watching a circumcision of an infant?

[Skeptic Ginger]

... FWIW, I tend towards the "it's medically unnecessary in most cases" viewpoint. I understand that there will be parents who want it done for a variety of reasons; I do not intend to perform circumcisions unless I think there's a medical reason for it.The AAFP and the AAP have a different position on the matter. Their position is to give parents the risks and benefits without prejudice and accept the parents decision.

AAFP Position Paper on circumcisions. (http://www.aafp.org/online/en/home/clinical/clinicalrecs/circumcision.html)Summary
Considerable controversy surrounds neonatal circumcision. Putative indications for neonatal circumcision have included preventing UTIs and their sequelae, preventing the contraction of STDs including HIV, and preventing penile cancer as well as other reasons for adult circumcision. Circumcision is not without risks. Bleeding, infection, and failure to remove enough foreskin occur in less than 1% of circumcisions. Evidence-based complications from circumcision include pain, bruising, and meatitis. More serious complications have also occurred. Although numerous studies have been conducted to evaluate these postulates, only a few used the quality of methodology necessary to consider the results as high level evidence.

The evidence indicates that neonatal circumcision prevents UTIs in the first year of life with an absolute risk reduction of about 1% and prevents the development of penile cancer with an absolute risk reduction of less than 0.2%. The evidence suggests that circumcision reduces the rate of acquiring an STD, but careful sexual practices and hygiene may be as effective. Circumcision appears to decrease the transmission of HIV in underdeveloped areas where the virus is highly prevalent. No study has systematically evaluated the utility of routine neonatal circumcision for preventing all medically-indicated circumcisions in later life. Evidence regarding the association between cervical cancer and a woman’s partner being circumcised or uncircumcised, and evidence regarding the effect of circumcision on sexual functioning is inconclusive. If the decision is made to circumcise, anesthesia should be used.

The American Academy of Family Physicians recommends physicians discuss the potential harms and benefits of circumcision with all parents or legal guardians considering this procedure for their newborn son. (2001)AAP Policy Paper on Circumcision (http://aappolicy.aappublications.org/cgi/content/full/pediatrics%3b103/3/686)Over the past several decades, the American Academy of Pediatrics has published several policy statements on neonatal circumcision of the male infant.1-3 Beginning in its 1971 manual, Standards and Recommendations of Hospital Care of Newborn Infants, and reiterated in the 1975 and 1983 revisions, the Academy concluded that there was no absolute medical indication for routine circumcision.

In 1989, because of new research on circumcision status and urinary tract infection (UTI) and sexually transmitted disease (STD)/acquired immunodeficiency syndrome, the Academy concluded that newborn male circumcision has potential medical benefits and advantages as well as disadvantages and risks.4 This statement also recommended that when circumcision is considered, the benefits and risks should be explained to the parents and informed consent obtained. Subsequently, a number of medical societies in the developed world have published statements that do not recommend routine circumcision of male newborns.5-7 In its position statement, the Australian College of Paediatrics emphasized that in all cases, the medical attendant should avoid exaggeration of either risks or benefits of this procedure.5

Because of the ongoing debate, as well as the publication of new research, it was appropriate to reevaluate the issue of routine neonatal circumcision. This Task Force adopted an evidence-based approach to analyzing the medical literature concerning circumcision. The studies reviewed were obtained through a search of the English language medical literature from 1960 to the present and, additionally, through a search of the bibliographies of the published studies.

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Just a word here--I'm not sure this is entirely correct. Langerhans cells are *not* the primary target cells for HIV. This paper presumes that because they have some of the same target receptors as CD4+ T-cells that HIV will use them as a port of entry. However, this hasn't been conclusively proven. From what I recall from lecture, there are also a lot of people who think that the Langerhans cells--a type of dendritic cell that is prevalent in the mucosal tissue--may actually be protective against HIV, because its job is to take up the virus before it gets to the lymph nodes and HIV can't multiply in these cells.

On the other hand, no one knows for sure.I'd be interested in alternative research, but I believe the rebuttals have not borne fruit.

Expression of DC-SIGN in human foreskin may facilitate sexual transmission of HIV (http://jcp.bmj.com/cgi/content/abstract/57/1/77)ABSTRACT
This study demonstrates that the human immunodeficiency virus (HIV) binding C-type lectin DC-SIGN is coexpressed with CD4 and CCR5 on dendritic cells/macrophages in human foreskin. It is hypothesised that DC-SIGN may contribute to the sexual transmission of HIV in the foreskin, by enabling infection of permissive cells in cis and/or in trans.Facilitation of HIV transmission in the foreskin (http://sti.bmj.com/cgi/content/extract/80/2/81)A study of nine normal human foreskin specimens may explain at a molecular level why circumcised men are less frequently infected with HIV than those who are not circumcised.

The C-type lectin DC-SIGN (dendritic cell specific intercellular cell adhesion molecule grabbing non-integrin) binds human immunodeficiency virus (HIV) avidly, and has been shown to facilitate HIV infection of permissive cells both in trans and in cis. This study shows that DC-SIGN may also contribute to HIV transmission in the foreskin.

Cells such as maternal and alveolar macrophages and fetal Hofbauer cells at the placental interface, facilitate HIV infection where DC-SIGN and the HIV entry receptors CD4 and CCR5 are coexpressed. This study of dendritic cells and macrophages in foreskin specimens showed that all the DC-SIGN+ cells expressed both CD4 and CCR5 suggesting that DC-SIGN may potentiate HIV infection of these cells in cis. Most CD4+DC-SIGN- cells also expressed CCR5 and could . . .

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Here is a pretty decent Power Point presentation discussing the mechanism of circumcision in preventing HIV transmission:

Biological Rationale (http://aidsvaccineclearinghouse.org/pdf/MC/SLIDES_MC_for_HIV_prevention_de_Bruyn_PHRU.pdf)
��Biological plausibilityBiological plausibility
��Inner mucosa of foreskin is rich in HIV target cells (9x)
��External foreskin/ shaft keratinized and not vulnerableExternal vulnerable
��After circumcision, only vulnerable mucosa is meatusmeatus
��Foreskin is retracted over shaft during intercourseForeskin intercourse
��Large inner mucosal surface exposureLarge exposure
��MicroMicro-tears, especially of frenulum
��Intact foreskin associated with infectionsIntact infections
��GUDGUD
��Balanitis/phimosisBalanitis/phimosis
��Possible increase HIV entry or sheddingPossible shedding

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The following are letters and the author's reply regarding the Szabo article. I take it with a grain of salt when I see, "Nature has not made a design error; Cruz, Rio (International Coalition for Genital Integrity), as the source of the objections. Not that I won't look at the evidence regardless but still, there's a lot of chafe on this topic.

Male circumcision and HIV prevention; Some science would not have gone amiss (http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1119176)Editor—While a number of studies suggest an association between the foreskin and HIV infection, a simple tallying of studies, such as performed by Szabo and Short,1 is unscientific and misleading. Meta-analysis suggests that men engaging in high risk behaviours may be placed at further risk by having a foreskin, but in the general population circumcision status is not a significant factor. It also showed an important degree of heterogeneity between studies, calling into question the validity of the summary results.2 The multiple confounding factors influencing sexual behaviour and HIV susceptibility make it irresponsible to place blame on normal anatomy.

Langerhans' cells in the preputial mucosa are nothing new: all mucosal tissues have Langerhans' cells. Szabo and Short did not report Langerhans' cell concentrations in comparison with other mucosal tissues, their concentration in the glans, foreskin remnant, and circumcision scar in circumcised men, the presence of associated T cell infiltration (which may be necessary for viral transmission), or how findings in elderly cadavers correlate to sexually active young men. Szabo and Short state that the inner surface of the foreskin and the frenulum must be regarded as the most probable sites for viral entry of primary HIV infections in men; but without quantitative comparative data their statements are pure speculation.

The only reports of preputial Langerhans' cells have been in specimens from neonates3 and elderly cadavers. If normal genital mucosa is at risk, we need to know the concentration of Langerhans' cells in healthy men, men with multiple sexual partners, men with genital infections, men with HIV, and men of differing races and ages before any recommendations can be made.

Szabo and Short dismiss the complications of circumcision as having a low incidence; but the rate of immediate complications in the United States is between 3.1% and 9%,4 and another 5% will later develop meatal stenosis.5 A higher rate of complications is believed to follow circumcisions performed in the developing world, where circumcision has been linked to tuberculosis, tetanus, penile amputation, and death.

HIV transmission is heavily dependent on certain sexual behaviours, not anatomy. The authors have not provided any new information to alter this fact but have taken the discussion off on a needless tangent. Indiscriminate mass circumcision, which is currently popularised by some Western researchers, is unproved and does not address the core behavioural issues that have fuelled this pandemic. Therefore, it will not alter the course of AIDS in Africa.Nature has not made a design error

Cruz, Rio (International Coalition for Genital Integrity, Box 8462, Santa Cruz, CA 95061, USA riocruz@cruzers.com).

Editor—Szabo and Short's article on male circumcision and HIV places them in splendid solidarity with Victorian notions of sex and hygiene, together with tribal initiation rituals.1-11-2 They are completely isolated from their major peer medical organisations, not one of which endorses routine infant circumcision as a prophylactic measure despite over 100 years of pressure brought to bear by circumcisers.

To accept that circumcision is a really good idea, we first have to believe that nature made some huge design error in human anatomy that requires removal by force. This is a great leap of faith given the fact that not just humans but all mammals, both male and female, have evolved over millions of years to end up with a prepuce. But for some reason known only to religious types and medicalised capitalism the only mammal to be benefited by summarily removing this omnipresent organ through surgery is the human male.

The history of medicalised circumcision is a fascinating study in Victorian medicine and anti-sexuality.1-4 Amputating the normal prepuce of human beings started in the English speaking countries as a measure to prevent masturbation. It did not work, but circumcisers have learnt that the pretexts for penile pruning are inexhaustible. Simply by playing on the fears of the culture they can keep the practice going—and the income flowing. At the turn of the 20th century better hygiene was the big issue, followed by penile cancer in the 1930s,1-3 cervical cancer in the '50s, sexually transmitted diseases in the '60s, urinary tract infections in the '80s,1-4 and, perhaps the most dreaded of all, AIDS in the '90s. If it looks as if routine infant circumcision is an operation in search of a disease, that's because it is. Every single claim for legitimate medical benefit justifying this routine has been discredited.1-5

But still the amputations go on. Every 26 seconds another penis is reduced in the United States. This is in sharp contrast with the rest of the world, where over 80% of the male population are left whole and intact—including all of Europe, most of non-Muslim Asia and Latin America—their genitals as nature designed them before the collective wisdom of Szabo and Short and other pro-circumcision proponents had a “better” idea.
1-1.
Szabo R, Short RV. How does male circumcision protect against HIV infection? BMJ. 2000;320:1592–1594. . (10 June.). [PubMed]
1-2.
Moscucci, O. Clitoridectomy, circumcision, and the politics of sexual pleasure. In: Miller AH, Adams JE. , editors. Sexualities in Victorian Britain. Bloomington and Indianapolis: Indiana University Press; 1996. pp. 63–65.
1-3.
Fleiss PM, Hodges F. Neonatal circumcision does not protect against cancer. BMJ. 1996;312:779–780. [PubMed]
1-4.
Wiswell TE, Smith FR, Bass JW. Decreased incidence of urinary tract infections in circumcised male infants. Pediatrics. 1985;75:901–903. [PubMed]
1-5.
Fleiss P, Hodges F, Van Howe RS. Immunological functions of the human prepuce. Sex Trans Inf. 1998;74:364–367. [PubMed]No case was made for circumcising unconsenting children

Dalton, John D (Howgate Farm, Linglabank, Frizington, Cumbria CA26 3SU).

Editor—Szabo and Short have concluded that circumcision of male children should be seriously considered as an additional means of preventing HIV.2-1 Whether they have a valid argument for the circumcision of consenting adults, they have certainly not made a case for circumcising unconsenting children who are not sexually active. Furthermore, there are certain failings of the article that should not have escaped the attention of the peer reviewer.

Szabo and Short conducted a Medline search for relevant literature, but they present no full listing of the search results. An objective review of the literature would have shown that there was no consensus that male circumcision protects against HIV.2-2 One meta-analysis showed circumcised men to be more at risk of HIV than those with the normal, intact penis.2-3

No evidence is presented by Szabo and Short to confirm their claim that HIV enters the body through CD4 and CCR5 receptors on Langerhans' cells located in the penis. As such their proposed mechanism for prevention of HIV by male circumcision is little more than supposition.

It is unacceptable for Szabo and Short to claim that circumcision has a low incidence of complications on the basis of a booklet favouring circumcision that has had no peer review.2-4 Although a complication rate as low as 0.06% has been claimed for circumcision, rates as high as 55% have also been reported.2-5 A detailed literature review of the complication rate for circumcision concluded that a realistic rate of significant complications is 2-10%.2-6 It seems possible that any programme of child circumcision would cause more serious complications than it would prevent cases of HIV.

We believe that we live in an enlightened age. What is most surprising is that we still believe that we should ward off disease by cutting children's genitals. Publishing the opinion of Szabo and Short will do more to perpetuate non-therapeutic circumcisions of unconsenting children in North America and Australia than it will for the prevention of HIV in Africa.
2-1.
Szabo R, Short RV. How does male circumcision protect against HIV infection? BMJ. 2000;320:1592–1594. . (10 June.). [PubMed]
2-2.
De Vincenzi I, Mertens T. Male circumcision: a role in HIV prevention? AIDS. 1994;8:153–160. [PubMed]
2-3.
Van Howe RS. Circumcision and HIV infection: review of the literature and meta-analysis. Int J STD AIDS. 1999;10:8–16. [PubMed]
2-4.
Morris, B. In favour of circumcision. Sydney: University of New South Wales Press; 1999.
2-5.
Patel H. The problem of routine infant circumcision. Can Med Assoc J. 1996;95:576–581. [PubMed]
2-6.
Williams N, Kapila L. Complications of circumcision. Br J Surg. 1993;80:1231–1236. [PubMed]More studies need to be done before widespread circumcision is implemented

Oliver, R T D (St Bartholomew's Hospital, London EC1A 7BE e.m.davies@mds.qmw.ac.uk). Oliver, Josephine (University of Birmingham medical School, Birmingham B15 2TT). Ballard, Ron C (National Reference Centre for Sexually Transmitted Diseases, South African Institute for Medical Research, Johannesburg, South Africa).

Editor—Szabo and Short suggest that the increased number of Langerhans' cells on the surface of the foreskin explains why circumcised men are less likely to become infected with HIV.3-1 They did not mention an issue that has long dogged debate on the protective effect of circumcision on the incidence of cervical cancer and now increasingly prostate cancer3-13-2—that is, the extent to which improved hygiene and affluence are confounding variables to the benefits of circumcision. This is exemplified by the lower incidence of cervical cancer in educated high caste women in India whose husbands were not circumcised than in less educated Muslim women with circumcised husbands.3-3 Undoubtedly the increased numbers of Langerhans' cells with HIV receptors in the foreskin may well contribute to an increased susceptibility to HIV.

Evidence that nutritional state and other sexually transmitted diseases also play a part in acquiring HIV infection prompted us to examine the role of the foreskin in the occurrence of HIV infection in a series of 83 new patients (40 positive for HIV) attending a urethritis clinic at East and West Drakefontein Gold Mines Carltonville, Gauteng, South Africa, as part of a study of the impact of HIV and sexually transmitted diseases on serum concentrations of prostate specific antigen.3-3 After giving their signed informed consent the miners received a questionnaire and were examined to ascertain whether they were circumcised (including whether the glans penis was visible) and the retractability of the foreskin. In addition, a limited history of sexual activity was recorded.

As expected, the frequency of HIV infection was significantly lower in those who were circumcised (table). The small subgroup who had been circumcised after puberty seemed to show some benefit in reducing the incidence of HIV infection. Even more interesting in the light of Szabo and Short's hypothesis about the increased numbers of Langerhans' cells in the foreskin, we found, contrary to what might be expected if their hypothesis was correct, that the frequency of HIV infection was less in men with long foreskins that were difficult to retract than in those with short easily retractable short foreskins.

Clearly this observation is based on too small a sample size for us to be totally confident in the results. However, these observations, added to those on the role of hygiene versus circumcision in reducing cervix cancer from India,3-4 suggest that further studies would help to clarify Szabo and Short's hypothesis and need to be done before widespread use of circumcision is implemented to try to reduce the spread of HIV infection. Furthermore, work needs to be done on the influence of circumcision after puberty because performing such a procedure after the first infection of a sexually transmitted disease could be more effective than circumcision based on the total population.
3-1.
Szabo R, Short RV. How does male circumcision protect against HIV infection? BMJ. 2000;320:1592–1594. . (10 June.). [PubMed]
3-2.
Ross R, Shimizi H, Paganini-Hill A, Honda G, Henderson B. Case-control studies of prostate cancer in blacks and whites in southern California. J Natl Cancer Inst. 1987;78:869–874. [PubMed]
3-3.
Oliver J, Oliver R, Ballard R. Influence of circumcision and sexual behaviour on PSA levels in patients attending a sexually transmitted disease (STD) clinic. Prostate Cancer and Prostate Diseases (in press).
3-4.
Gajalakshmi C, Shanta V. Association between cervical and penile cancers in Madras, India. Acta Oncologica. 1993;32:617–620. [PubMed]Authors' reply

Szabo, Robert (Mildura Base Hospital, Mildura, Victoria, Australia). Short, Roger V (r.short@unimelb.edu.au Department of Obstetrics and Gynaecology, University of Melbourne, Royal Women's Hospital, Carlton, Victoria 3053, Australia).

Editor—Our review article was primarily concerned with exploring the mechanisms by which male circumcision protects against heterosexually acquired HIV infection in men. We concluded that it is the inner aspect of the foreskin, which is poorly keratinised but well supplied with Langerhans' cells, that is likely to be one of the principal sites of HIV entry into the penis.

We have now developed an active research programme on this topic, and, together with our collaborators, we hope to publish a number of papers in the near future on the distribution of Langerhans cells in the foreskins of young men with and without balanitis, the degree of keratinisation of the various penile epithelia, and the uptake of live HIV virus applied to the inner and outer aspects of adult human foreskins in vitro. Some of our histological findings were shown on the BBC Horizon/Discovery television programme “The Valley of Life or Death” on 16 November.4-1

The claim by Van Howe et al that a meta-analysis of the many papers that show a significant correlation between lack of male circumcision and HIV infection is unscientific and misleading makes little sense, since most of the 40 studies that show such an association have incorporated multivariate analysis to correct for confounding variables such as different sexual practices. Furthermore, Van Howe's own meta-analysis has been invalidated because of several major methodological errors.4-24-3

Male circumcision, like all minor surgical procedures, carries a small risk of postoperative complications. But this should not detract from the twofold to eightfold protective effect that circumcision provides against HIV infection, which, unlike the surgical complications, is almost invariably fatal. Other than recommending that male circumcision should be seriously considered as an additional means of preventing HIV in all countries with a high prevalence of infection, we have avoided all discussion about the relative advantages and disadvantages of neonatal male circumcision as a routine procedure in developed countries, where the prevalence of HIV infection is low. We do not intend to enter that debate, where objectivity is hard to find.

It is pleasing to note that organisations are now beginning to give serious consideration to the policy implications arising from the protective effect of male circumcision against HIV infection. In June 2000 the Horizons Project of the Population Council published a report of an international discussion meeting entitled “Male Circumcision and HIV Prevention: Directions for Future Research,”4-4 and in July the World Health Organization held a similar consultation in Durban at the time of the international AIDS conference, although its findings have yet to be published.

It would be unfortunate if the zealous opponents of neonatal male circumcision in developed countries, however well meaning, distracted attention from the glaring fact that in central and southern Africa, where 24.5 million people are infected with HIV,4-5 circumcision could offer some immediate protection against spread of the disease until such time as effective vaccines become available.
4-1.
Jackson T. No news is bad news. BMJ. 2000;321:1419. . (2 December.).
4-2.
Van Howe RS. Circumcision and HIV infection: review of the literature and meta-analysis. Int J STD AIDS. 1999;10:8–16. [PubMed]
4-3.
Moses S, Nagelkerke NJD, Blanchard J. Analysis of the scientific literature on male circumcision and risk of HIV infection. Int J STD AIDS. 1999;10:626–628. [PubMed]
4-4.
Van Dam, J.; Anastasi, MC. Male circumcision and HIV prevention: directions for future research. Horizons Project. The Population Council; 2000. p. 28.
4-5.
The Durban Declaration. Nature. 2000;406:15–16. [PubMed]

References
1.
Szabo R, Short RV. How does male circumcision protect against HIV infection? BMJ. 2000;320:1592–1594. . (10 June.). [PubMed]
2.
O'Farrell N, Egger M. Circumcision in men and the prevention of HIV infection: a “meta-analysis” revisited. Int J STD AIDS. 2000;11:137–142. [PubMed]
3.
Hussain LA, Lehner T. Comparative investigation of Langerhans' cells and potential receptors for HIV in oral, genitourinary and rectal epithelia. Immunology. 1995;85:475–484. [PubMed]
4.
Sutherland JM, Glueck HI, Gleser G. Hemorrhagic disease of the newborn: breast feeding as a necessary factor in the pathogenesis. Am J Dis Child. 1967;113:524–533. [PubMed]
5.
Van Howe RS. Variability in penile appearance and penile findings: a prospective study. Br J Urol. 1997;80:776–782. [PubMed]

-

What I do agree with is that I think this is something a man should decide for himself. My husband convinced me of that. :DOn the one hand we learn from people and our experiences, on the other hand, your husband is not the father of the babies you will be treating. Just as I wouldn't tell any parent who chose to not circumcise their child that I believed he/she had made the wrong choice, neither would I try to influence another parent not to circumcise the child. In spite of people such as some in this thread who have strong feelings about what other parents should do, the medical evidence is equivocal. It should remain a personal choice. It wouldn't be practicing good medicine, in my opinion, to judge this particular decision. Good medicine is giving patients complete, correct information to make their own informed decision. That means discussing the issues claimed by some rather adamant men about circumcision, but it doesn't mean allowing the loudest voices to cloud one's perception of the evidence.

[Skeptic Ginger]

...Skeptigirl, what goes through your mind while watching a circumcision of an infant?As a young nurse watching a male doctor performing them without anesthesia, I complained more than once that it was absurd not to use anesthesia.

But other than that, it takes less than a minute, it just doesn't seem like that big of a deal.

In the scheme of things, try debriding extensive 3rd degree burns on a child day after day, or taking care of a 17 year old quadriplegic from an accidental gunshot wound to the neck by his friend playing with a gun. Spend a month taking care of a single child getting a bone marrow transplant (because there is so much to do you can't take care of 2 patients) knowing some of them aren't going to make it. After the radiation, all the cells from the mouth thru to the other end die and slough off. Infections can set in anywhere and they usually do.

No, Ivor, I just don't think circumcisions are that big of a deal. Sorry.

[Ivor the Engineer]

As a young nurse watching a male doctor performing them without anesthesia, I complained more than once that it was absurd not to use anesthesia.

But other than that, it takes less than a minute, it just doesn't seem like that big of a deal.

In the scheme of things, try debriding extensive 3rd degree burns on a child day after day, or taking care of a 17 year old quadriplegic from an accidental gunshot wound to the neck by his friend playing with a gun. Spend a month taking care of a single child getting a bone marrow transplant (because there is so much to do you can't take care of 2 patients) knowing some of them aren't going to make it. After the radiation, all the cells from the mouth thru to the other end die and slough off. Infections can set in anywhere and they usually do.

No, Ivor, I just don't think circumcisions are that big of a deal. Sorry.

Thanks for your thoughts. And I appologise for my earlier outburst towards you (and others here who took any offense). You were just in the wrong place at the wrong time.

What prompted the question was another thread where Milgram's experiment was brought up (again), something a co-worker who travels to the less pleasant areas of the world said to me and our discussion somewhere else about empathy.

It appears that not only do we have the ability to experience another individuals suffering, but we also have the ability to ignore it or give it much less weight in our calculation of appropriate behaviour when there are other things to consider, or when we have become habituated to the stimulus that triggered it initially.

This is why I replied to Linda's question that I thought a reasonable person could come to a different conclusion than my own with respect to infant circumcision; they are applying different weights to the (ethical and physical) costs, benefits and risks. I think the answers provided to my question by the pro routine-circumcision people and yourself demonstrate this to be the case.

If someone is using incorrect data in their decision making process then that can and should be corrected. But if they just don't empathize the same amount or way, or they disagree with the UN statement on human rights, what can be done about that?

[Morrigan]

My feelings about the children at the point of the circumcision was relief and satisfaction, knowing I was saving them from infections, from the filthy stench of the foreskin, and from the hideous bestial appearance that an uncut penis has.

I believe the word you are looking for is believing, not knowing.


In fact, until I came to JREF, I'd never, EVER heard anyone claim that keeping the foreskin was a GOOD idea.

This really creeps me out.

[kellyb]

Skeptigirl...
Here's some research that contradicts the Langerhans cells theory...

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=17334373

Langerin is a natural barrier to HIV-1 transmission by Langerhans cells.

Human immunodeficiency virus-1 (HIV-1) is primarily transmitted sexually. Dendritic cells (DCs) in the subepithelium transmit HIV-1 to T cells through the C-type lectin DC-specific intercellular adhesion molecule (ICAM)-3-grabbing nonintegrin (DC-SIGN). However, the epithelial Langerhans cells (LCs) are the first DC subset to encounter HIV-1. It has generally been assumed that LCs mediate the transmission of HIV-1 to T cells through the C-type lectin Langerin, similarly to transmission by DC-SIGN on dendritic cells (DCs). Here we show that in stark contrast to DC-SIGN, Langerin prevents HIV-1 transmission by LCs. HIV-1 captured by Langerin was internalized into Birbeck granules and degraded. Langerin inhibited LC infection and this mechanism kept LCs refractory to HIV-1 transmission; inhibition of Langerin allowed LC infection and subsequent HIV-1 transmission. Notably, LCs also inhibited T-cell infection by viral clearance through Langerin. Thus Langerin is a natural barrier to HIV-1 infection, and strategies to combat infection must enhance, preserve or, at the very least, not interfere with Langerin expression and function.

I still think the "circumcision effect" with HIV is "real", but I think it has to do with ulcerative genital sores like herpes....pathogens that work in tandem with the HIV virus, where HIV causes immunosupression, which helps the other virus make more sores, and the sores spread the HIV virus, too. Circumcision reduces the amount of skin there to have the sores (the pathogens probably evolved to propogate through intact genitals). Cutting off exterior sex organs that the ulcerative pathogens are adapted to throws a wrench in their transmission cycle. That would explain why some types of FGM "work" to prevent HIV, too.

[HawkeyeMD]

I am aware that there are alternate opinions on circumcision from the major professional organizations in pediatrics.

The studies you cite are interesting, but my point is the same--no one is sure yet of the role of Langerhans cells in the transmission of HIV.

Your lecture in response to my final comment is not appreciated. I did not say that I would "judge" parents who chose circumcision. I will explain what I see to be the pros and cons of the procedure and, if they still want it done, refer them elsewhere. It is also not "practicing good medicine" to perform any procedure just because a patient or a parent desires it. At this time, my opinion is that for a child who will grow up in a country like the USA--which is where I will practice--there is not sufficient medical justification for circumcision. The evidence from the African studies is still very much being debated, but that is not really germane to the question of circumcision in the US. (I appreciate the argument about teenagers making poor decisions, but I can't really get behind the idea of permanently altering someone's body structure because of decisions you anticipate that they will make down the line, either.)

I have no problem with other doctors performing circumcisions, if that is what they feel to be correct. That is their decision.

[Skeptic Ginger]

It will take more research to sort out. While that study is intriguing, the fact these cells fail to overcome whatever is the factor making circumcision lower the HIV infection rate suggests they may be missing something. HIV might overwhelm such a cellular mechanism by a dose related function. Macrophages may be involved or some other binding sites.

I probably should revise my comments, however, and say possible mechanisms have been hypothesized rather than the mechanism is known. I should know better than to think cellular physiology is ever something simple. :)

[Skeptic Ginger]

Then I misunderstood your comments, Hawk, when you said, "I do not intend to perform circumcisions unless I think there's a medical reason for it." That sounds to me like you plan to be fairly judgmental.

Obviously one doesn't ignore evidence based medicine in favor of a patient's desires. But two academies found there was not medical evidence suggesting ending the practice of circumcisions. That leaves a statement such as yours above based on personal biases affecting judgment rather than medical evidence.

I am an advocate of patient's rights. If you found my comments offensive I'm sorry. I should also add that while it is far from absolute, and somewhat oversimplifying things, the nursing model does lean more toward patient advocacy while the medical model is more paternalistic. That doesn't meant there aren't times when one may be better suited to a situation than the other. They both have their advantages. I merely state this as something which I have often observed in the underlying philosophies of health care practitioners. While subtle, it nonetheless observably affects decision making, and how information is relayed to patients.

[Ivor the Engineer]

Then I misunderstood your comments, Hawk, when you said, "I do not intend to perform circumcisions unless I think there's a medical reason for it." That sounds to me like you plan to be fairly judgmental.

Obviously one doesn't ignore evidence based medicine in favor of a patient's desires. But two academies found there was not medical evidence suggesting ending the practice of circumcisions. That leaves a statement such as yours above based on personal biases affecting judgment rather than medical evidence.

I am an advocate of patient's rights. If you found my comments offensive I'm sorry. I should also add that while it is far from absolute, and somewhat oversimplifying things, the nursing model does lean more toward patient advocacy while the medical model is more paternalistic. That doesn't meant there aren't times when one may be better suited to a situation than the other. They both have their advantages. I merely state this as something which I have often observed in the underlying philosophies of health care practitioners. While subtle, it nonetheless observably affects decision making, and how information is relayed to patients.

Skeptigirl, I'd say you are more an advocate of parent's rights as far as circumcision is concerned:rolleyes:

How do you get round the UN human rights statement that an infant has the right to body integrity? Ignore it? Think it's wrong? I.e. You would change the document to state that an infant does _not_ have the right to body integrity.

I'm still finding it hard to understand how you can have the two concepts in one brain at the same time. How do you do it?

[Skeptic Ginger]

...I appreciate the argument about teenagers making poor decisions, but I can't really get behind the idea of permanently altering someone's body structure because of decisions you anticipate that they will make down the line, either....There are two things here.

One, whose decision is it? That we seem to disagree, though I await your comments re my above post.

The second is the continual blurring of situations being discussed in this thread.

If you have the luxury of not having to weigh the "decisions they might make later" and the devastation of HIV in the society one is functioning in, then your position is logical and reasonable.

But if you are in a society that is literally being destroyed by HIV, such a position is naive.

[ImaginalDisc]

Obviously one doesn't ignore evidence based medicine in favor of a patient's desires. But two academies found there was not medical evidence suggesting ending the practice of circumcisions. That leaves a statement such as yours above based on personal biases affecting judgment rather than medical evidence.


Is there medical evidence suggesting ending the practice of piercing the ears of infant girls? Even assuming that circumcision is harmless, which I disagree with, that isn't a reason to perform the procedure.

[robinson]

A good source of information (not Woo) on circumcision, policy, research, scientific/medical type stuff.

http://www.cirp.org/library/statements/

Medical organizations in the various English speaking nations have found it appropriate to issue policy statements for the information of the medical community and the public. The Circumcision Reference Library has collected these official policy statements, both old and new, from the various English speaking nations. The medical societies of non-English speaking nations do not issue circumcision policy statements because neonatal male circumcision is not a practice of those countries. The older statements may not reflect current policy but are presented for reference purposes.

Conflict of interest. Medical organizations are political associations of doctors that have a duty to represent the interests of their doctor members, of whom some may profit by performing circumcision. The protection of the income and estates of the members may be given high priority. This duty to the members may in some instances prevent complete candor about the effects of non-therapeutic circumcision. The content of circumcision policy statements may also be influenced by political considerations.

(File revised 20 February 2007)

[Skeptic Ginger]

Skeptigirl, I'd say you are more an advocate of parent's rights as far as circumcision is concerned:rolleyes:

How do you get round the UN human rights statement that an infant has the right to body integrity? Ignore it? Think it's wrong? I.e. You would change the document to state that an infant does _not_ have the right to body integrity.

I'm still finding it hard to understand how you can have the two concepts in one brain at the same time. How do you do it?I could, as a provider, feel personally that the medical benefit outweighed the cost, because the case has not been made that the cost is as high as "believers" (don't know what else to call them) are claiming. So should I then advocate for the infant by recommending circumcision?

Regardless of how I would decide, given the fact in this case, there are two equally supportable evidence based decisions (there is a medical benefit and there are costs associated with that benefit) the parents are the rightful decision makers for that infant. Just as the parents are the rightful decision makers for many other medical choices involving weighing risk and benefit.


BTW, I never felt you were overly hostile or out of line or whatever it is you are referring to in you previous post.

[Skeptic Ginger]

A good source of information (not Woo) on circumcision, policy, research, scientific/medical type stuff.

http://www.cirp.org/library/statements/



(File revised 20 February 2007)Yeah, right, robinson, this isn't woo. :rolleyes:

"The medical societies of non-English speaking nations do not issue circumcision policy statements because neonatal male circumcision is not a practice of those countries."

"Medical organizations are political associations of doctors that have a duty to represent the interests of their doctor members, of whom some may profit by performing circumcision. The protection of the income and estates of the members may be given high priority."

That's bu!!$h!+.

[Skeptic Ginger]

Is there medical evidence suggesting ending the practice of piercing the ears of infant girls? Even assuming that circumcision is harmless, which I disagree with, that isn't a reason to perform the procedure.
'Round and 'round the cobbler's bench
eleven pages repeating,
as if it makes another point
but it's just more emotion appealing'

Sorry, not a valid analogy. I believe it's been addressed.

[HawkeyeMD]

I appreciate your clarification.

Then I misunderstood your comments, Hawk, when you said, "I do not intend to perform circumcisions unless I think there's a medical reason for it." That sounds to me like you plan to be fairly judgmental.

No, it sounds like exactly what I said: that I don't plan to perform circumcisions routinely, on a medical-evidence basis. The judgement, if any, is in your interpretation. I'm not obliged to perform a procedure if I don't think it's in my patient's best interest.

I'm all for patient's rights, and I want to be careful here because this is email and I know things tend to come off harsher than they sound (I think part of my initial response to your post came from the fact that you chose to boldface your comments--which I'm sure you did just to set them off from the flurry of quotations, but they gave me a sense of being lectured). Still--please be careful with the innate assumption that all doctors are out there trampling patients' rights and being paternalistic. Maybe some of them are. I've seen nurses behaving exactly the same way, and I'm sure, so have you. My training--and my inclination, I assure you--is very much the opposite.

In answer to your question "Whose decision is it?"--What I want is for parents to understand that there *are* two sides to this issue. Being a pediatrician means there has to be a balance--taking the best interest of the patient--the child--into account along with the wishes of the parent or guardian. Based on medical evidence, I do not feel that the benefits of circumcision outweigh the risks for my patient population, unless there is a separate medical issue. If the evidence changes, so may my opinion. It's not like I'm going to go to court to keep people from doing it, but again, it is not good medicine not to give my opinion.

If I were practicing medicine in Africa, my opinion might also be different. But--as I pointed out previously--I will be practicing medicine in the US. Here, the best defense against HIV is the use of a condom. It does not require the permanent alteration of the human being. I don't think that's "blurring the lines"--I think that's pointing out the very great difference between the two situations.

And in answer to the other poster--not that I consider it to be an analogous situation--my age cutoff for doing ear piercings on children is a child who is old enough to ask for the procedure and to understand basic instructions on how to care for it. That doesn't make me judgmental of parents who may choose to have it done earlier. It just means I'll be a pediatrician who doesn't do piercings on infants. Not everyone has to perform every possible procedure.

[Ivor the Engineer]

I could, as a provider, feel personally that the medical benefit outweighed the cost, because the case has not been made that the cost is as high as "believers" (don't know what else to call them) are claiming. So should I then advocate for the infant by recommending circumcision?

Regardless of how I would decide, given the fact in this case, there are two equally supportable evidence based decisions (there is a medical benefit and there are costs associated with that benefit) the parents are the rightful decision makers for that infant. Just as the parents are the rightful decision makers for many other medical choices involving weighing risk and benefit.


BTW, I never felt you were overly hostile or out of line or whatever it is you are referring to in you previous post.

You forget that the most important evidence is in front of your face when you look at the individual child's penis. It either needs to be circumcised or it does not need to be circumcised.

Future benefits provided by reducing risk, unless they are likely to occur AND there is no less invasive or effective alternative treatment available if they do occur, are not applicable to the judgement. They are excuses to justify the choice after it has been taken.

You still haven't answered how you can have the idea that the infant has the right to body integrity and that circumcision is the parent's choice in your brain at the same time. Please could you do this?

Logically, you must believe one is correct and the other is wrong. Up to this point you have advocated the parent's rights to choose. Logically, therefore, you do not believe the infant has the right to body integrity.

Is it your view that an infant does not have the right to body integrity?

[Ivor the Engineer]

I appreciate your clarification.



No, it sounds like exactly what I said: that I don't plan to perform circumcisions routinely, on a medical-evidence basis. The judgement, if any, is in your interpretation. I'm not obliged to perform a procedure if I don't think it's in my patient's best interest.

I'm all for patient's rights, and I want to be careful here because this is email and I know things tend to come off harsher than they sound (I think part of my initial response to your post came from the fact that you chose to boldface your comments--which I'm sure you did just to set them off from the flurry of quotations, but they gave me a sense of being lectured). Still--please be careful with the innate assumption that all doctors are out there trampling patients' rights and being paternalistic. Maybe some of them are. I've seen nurses behaving exactly the same way, and I'm sure, so have you. My training--and my inclination, I assure you--is very much the opposite.

In answer to your question "Whose decision is it?"--What I want is for parents to understand that there *are* two sides to this issue. Being a pediatrician means there has to be a balance--taking the best interest of the patient--the child--into account along with the wishes of the parent or guardian. Based on medical evidence, I do not feel that the benefits of circumcision outweigh the risks for my patient population, unless there is a separate medical issue. If the evidence changes, so may my opinion. It's not like I'm going to go to court to keep people from doing it, but again, it is not good medicine not to give my opinion.

If I were practicing medicine in Africa, my opinion might also be different. But--as I pointed out previously--I will be practicing medicine in the US. Here, the best defense against HIV is the use of a condom. It does not require the permanent alteration of the human being. I don't think that's "blurring the lines"--I think that's pointing out the very great difference between the two situations.

And in answer to the other poster--not that I consider it to be an analogous situation--my age cutoff for doing ear piercings on children is a child who is old enough to ask for the procedure and to understand basic instructions on how to care for it. That doesn't make me judgmental of parents who may choose to have it done earlier. It just means I'll be a pediatrician who doesn't do piercings on infants. Not everyone has to perform every possible procedure.

You give me hope:)

[ImaginalDisc]

'Round and 'round the cobbler's bench
eleven pages repeating,
as if it makes another point
but it's just more emotion appealing'

Sorry, not a valid analogy. I believe it's been addressed.

Why? It's an elective procedure. If it can't be demonstrated to have a significant benefit, why perform it?

[Beleth]

Evidence?
I don't speak for all parents, of course, but it was a major deciding factor in my spouse's and my decision to not circumcise our son. Specifically, we wanted his to look like what his peers' will look like.

[HawkeyeMD]

You give me hope.

Thanks, Ivor. ;) But I think we're all just here tryin' to save a few lives.

Why? It's an elective procedure. If it can't be demonstrated to have a significant benefit, why perform it?

It's a poor analogy because the risks are not the same, and while there can be a permanent effect (holes in the earlobes), these can often close up on their own, and they are made in a portion of the anatomy that is much less personal and sensitive than the one under discussion. Additionally, there is absolutely no medical argument to be made in favor of the procedure.

However, the basis of the comparison--if there is no significant benefit, why perform it--is the crux of the disagreement about circumcision, which is why I addressed it. Insofar as that goes, I'll take it as an analogy. All analogies break down eventually. :D

Here is what I think is a more apt comparison: suppose, instead of a neonate, the patient brought to my office is a 16-year old boy. His parents say "We know he's sexually active, we want him to be protected against HIV, so we want a circumcision." The kid says "No way, get away from me with that scalpel."

You think any physician in his/her right mind would perform that procedure? The risk of HIV infection is not a sufficient reason to perform a circumcision. It is not protective enough, even if I accept the current evidence on its face (and I am not entirely comfortable with that evidence as yet). And yet these are parents, with the 'right' to make medical decisions for a minor child.

The ethics of pediatric medicine are complex, and they get exponentially more so as the child approaches maturity. An infant can't speak for himself, and so my feeling is that before any procedure is performed that can't be undone, I need to feel that there is a medical necessity for it. Both ear piercing and circumcision do have this in common--they can always be done later on if the patient desires it. I can't justify making that decision many years before the potential danger even occurs.

When I referenced the fact that my husband was the one who made me reconsider this subject, I was being a little flippant, but in all seriousness, it was his comment that he wouldn't have had it done if he'd had a choice that made me look into the medical evidence. And what I found was that there didn't seem to be enough in favor of circumcision to recommend it. Therefore, I changed my mind. It happens. :cool: But his opinion, even not buttressed by any medical evidence, has weight because he's the one with the penis. It's not like he's particularly concerned about it one way or the other at this late date. But he'd have made a different decision, had he been able to make it for himself. That matters to me.

Skeptigirl's own analogy of the "no big deal" quality of the procedure compared to debridement or chemotherapy, which I just noticed, also strikes me as peculiarly inappropriate. These are horrible things to have to do, to see, or to undergo. But they are unequivocably necessary to try and save that patient's life. These examples are also, forgive me, an attempt at emotional appeal.

[Beleth]

If you choose to see me as a horrible parent because I chose to circumcise my sons, that's your choice. I've gotten my kudos from professionals in several fields related to children - child psychiatrists, social workers, OT/PT therapists, teachers, pediatricians, behavioral specialists... I've been praised for being an exemplary parent many, many times.


That's interesting. I and my child-rearing abilities, on the other hand, have never been praised by child psychiatrists, social workers, OT/PT therapists, or behavioral specialists -- mainly because I've never had the need to visit with child psychiatrists, social workers, OT/PT therapists, or behavioral specialists.

But I've been insulted by people for: disciplining my children when they have tantrums or outbursts; letting them discover things for themselves, rather than rubber-padding their entire environment; taking them with me to go shopping, or out to dinner at fine restaurants (managers, on the other hand, thank us for our well-behaved children); feeding them a wide variety of foods that we ourselves eat (my roommate used to feed her kids pretty much nothing but chicken nuggets, ravioli, and PB&J sandwiches, 'cuz that's what kids eat, you know?'); speaking to my children as equals, rather than as children; explaining things as they are, rather than using sugar-coated euphamisms and lies; taking them off the bottle as soon as possible, and the pacifier as soon as the child shows no real need for it; letting my children eat spicy foods like Indian foods or Mexican foods at early ages; letting them have toys rated above their age limit; and many other perceived offenses.
Likewise here. Looks like the only difference we have is our choice regarding circumcision. (Well, that, and the aforementioned dealing with behavioral therapists et al.) Perhaps the choice of whether or not to circumcise has very little, if anything, to do with how good a parent one is.

[fls]

Your lecture in response to my final comment is not appreciated. I did not say that I would "judge" parents who chose circumcision. I will explain what I see to be the pros and cons of the procedure and, if they still want it done, refer them elsewhere. It is also not "practicing good medicine" to perform any procedure just because a patient or a parent desires it. At this time, my opinion is that for a child who will grow up in a country like the USA--which is where I will practice--there is not sufficient medical justification for circumcision. The evidence from the African studies is still very much being debated, but that is not really germane to the question of circumcision in the US. (I appreciate the argument about teenagers making poor decisions, but I can't really get behind the idea of permanently altering someone's body structure because of decisions you anticipate that they will make down the line, either.)

I have no problem with other doctors performing circumcisions, if that is what they feel to be correct. That is their decision.

The problem I have with taking this stance, is that it essentially passes the buck so that one can make a show of advocating for one's patient or taking a moral position, without actually doing so. After all, no behaviour has been changed if it is simply someone else that does the procedure.

I think we have a duty to be willing to be more proactive than that.

Linda

[kellyb]

The problem I have with taking this stance, is that it essentially passes the buck so that one can make a show of advocating for one's patient or taking a moral position, without actually doing so. After all, no behaviour has been changed if it is simply someone else that does the procedure.

I think we have a duty to be willing to be more proactive than that.

Linda

Actually, (this is anecdotal, so you're just going to have to take my word for it) seeing physicians refuse to do it has made many a parent think more deeply about the issue.

[tek]

Thanks, Hawk. I'd been wanting to jump in this thread for a while but I couldn't figure out how to express my position without simplifying the issue too much; your analogy works and I think it demonstrates the clear ethical reasoning I couldn't synthesize into coherence.

I'd like to add that another basis on which I find myself against the idea of circumcision is the issue of sensation. It's been briefly touched on-- no pun intended (ok, maybe a little intended), but the trouble is it quickly turns into a comparison with FGM which muddles the issue signifigantly. I'd like to propose another analogy, hopefully one which is not too biased: Let's say the chance of some airborne illness can be reduced by the neonatal or adult application of some chemical which has the unfortunate side effect of permanently dulling the sense of smell. Not by any great amount - the nose is still perfectly functional, and those who have had the procedure in no way find themselves unable to appreciate the smell of a rose, for example(though some, curiously, claim it enables them to last longer in smelly environments).

To me --and of course, an ethical position can only be an opinion-- the idea of reducing the senses, our "window to the world," so to speak, seems abhorrent, minor loss or no. Considering the importance of the sense of touch to the pleasure of sex, I would think this would magnify the issue. It's difficult to weigh something like this against potential illness, and ends up being fairly subjective and greatly dependent on 1) the amount and quality of sensation lost and 2) the prevalance and severity of the illnesses in question, and the amount in which the chance can be reduced. Obviously then, you can say that in a epidemic situation, you have a lot more leeway. Personally I don't feel in developed nations the benefit outweighs the cost.

I suppose a counter argument would be to say, if you never know the intensity of smell you're missing, who's to say your actual experience is any worse? It's hard to argue against something like that, as the argument devolves into issues of "contrast" and "qualia." Still, I DO think it's safe to say, loss of nerve endings = loss of sensation, and I think I'll use that to prop up my assertion.

[HawkeyeMD]

The problem I have with taking this stance, is that it essentially passes the buck so that one can make a show of advocating for one's patient or taking a moral position, without actually doing so. After all, no behaviour has been changed if it is simply someone else that does the procedure.

I think we have a duty to be willing to be more proactive than that.

Linda

Short of taking a parent to court, there is very little more than that I can do. My viewpoint is that it will probably not be worth the potential alienation of the parents to pick, you should forgive the metaphor, that hill to die on. And I don't mean solely from the point of view of my future income, I mean from the POV that I would undoubtedly not get to be that child's physician in the future. Which I personally think would be to the child's detriment. :cool:

You see above the reaction to my purported infringement of the parents' right to choose? Imagine if that was actually the parent of a patient. You have to find a way to work with the parents. At some point, that may mean saying, "Well, you understand my point of view. If you still want it done, I can give you some names of doctors who do perform the procedure." I don't think that's making a show of advocacy. It's just that in the course of a career, you are not going to win every fight. If they listen to me, and they still want it done, well...it's not illegal and I can't say that I think it's hugely harmful. I just don't think it's necessary. If I go into this thinking I personally can change everyone's behavior overnight, I won't last long.

But I disagree that I would not be taking my own stance. I will not do the procedure, after all.

Actually, (this is anecdotal, so you're just going to have to take my word for it) seeing physicians refuse to do it has made many a parent think more deeply about the issue.

That would be my great hope. And isn't that what we're all supposed to be in favor of? Getting people to think?

FWIW, I haven't yet thought much about future activity as regards medical policy or public health advocacy. I would be much more likely to be proactive in that arena.

[tek]

Oh, and if anyone is a fan of the TV show Arrested Development, I think the strongest case is Lindsay Bluth's anti-circumcision quote for HOOP (Hands-Off Our Penises): "It's a Doberman. Let it have its ears." ;)

[fls]

Actually, (this is anecdotal, so you're just going to have to take my word for it) seeing physicians refuse to do it has made many a parent think more deeply about the issue.

Yeah, when I was thinking about ways that refusal could have an influence on the behaviour, I thought that would be a possibility. I just have no real idea as to the extent.

Linda

[Ivor the Engineer]

The problem I have with taking this stance, is that it essentially passes the buck so that one can make a show of advocating for one's patient or taking a moral position, without actually doing so. After all, no behaviour has been changed if it is simply someone else that does the procedure.

I think we have a duty to be willing to be more proactive than that.

Linda

Does this mean you've changed your mind from when you were conversing with me? I remember you mentioning something along the lines of 'not intervening'. It's late, so I'm going to bed. I'll re-read the thread tomorrow and see if I've just imagined or misunderstood what you said earlier.

[HawkeyeMD]

Yeah, when I was thinking about ways that refusal could have an influence on the behaviour, I thought that would be a possibility. I just have no real idea as to the extent.

Linda

Linda, I was just reading some of the middle parts of this thread, and I had not realized that you are in fact a doctor. Apologies if I should have known that from before this thread, too--I don't get around here all that much any more.

That being said, regarding my last post, what would you as a practicing physician do differently in that situation? I was phrasing my answer as to a non-medical-professional, but not meaning any challenge or disrespect, what else could one do?

Clearly, this subject is going to come up for me in the future. :confused:

[fls]

Short of taking a parent to court, there is very little more than that I can do. My viewpoint is that it will probably not be worth the potential alienation of the parents to pick, you should forgive the metaphor, that hill to die on. And I don't mean solely from the point of view of my future income, I mean from the POV that I would undoubtedly not get to be that child's physician in the future. Which I personally think would be to the child's detriment. :cool:

Yeah, that's my attitude...."you should be so lucky as to have me as your doctor." :)

I wasn't really talking about singling out individuals in order to make a stand (when talking about doing more), but about taking the fight to a more productive area. I'm getting the impression that in the US, there is room for more effort on the part of physicians to discourage the practice, which includes getting more physicians to discourage the practice. I don't have a good feel for the nature of the discussion in the US, since the part of my training that had anything to do with circumcision was in Canada.

My specialty is internal medicine, so the analogous situation I am more likely to deal with is children making decisions for their incompetent parents - something like the insertion of a gastric feeding tube. It is a very difficult situation when you cannot persuade others to what you (strongly) feel is the right course of action (or rather inaction). It does not make me feel any better to pass that decision off to someone else, though.

You see above the reaction to my purported infringement of the parents' right to choose? Imagine if that was actually the parent of a patient. You have to find a way to work with the parents. At some point, that may mean saying, "Well, you understand my point of view. If you still want it done, I can give you some names of doctors who do perform the procedure." I don't think that's making a show of advocacy. It's just that in the course of a career, you are not going to win every fight. If they listen to me, and they still want it done, well...it's not illegal and I can't say that I think it's hugely harmful. I just don't think it's necessary. If I go into this thinking I personally can change everyone's behavior overnight, I won't last long.

But I disagree that I would not be taking my own stance. I will not do the procedure, after all.

And other than a salve to your conscience, what does that accomplish for your patient? I realize that I am picking on you unfairly (I think you are still in training?). It is though I am asking you to compel physicians to a particular course of action at a point where attending physicians are inclined to dismiss your opinions (not me of course ;)). And I am open to the possibility that your action is seen as compelling by others. But the graphs presented earlier about rates of circumcision in the US (and I could not confirm their accuracy as the NCHS data that I could easily find only went to 1999) does not yet show a definite downward trend comparable to the other developed countries. This suggests that it may take more than just the AAP position paper (which essentially hasn't changed since the 70's) and some conscientious objectors to really effect change. I am totally out of the loop on this, though.

Linda

[HawkeyeMD]

Yeah, that's my attitude...."you should be so lucky as to have me as your doctor." :)

That's the only attitude to have. ;)

I wasn't really talking about singling out individuals in order to make a stand (when talking about doing more), but about taking the fight to a more productive area. I'm getting the impression that in the US, there is room for more effort on the part of physicians to discourage the practice, which includes getting more physicians to discourage the practice.

I agree with this wholeheartedly. FWIW, the one time I can remember it coming up in lecture, it was mentioned that the medical evidence was equivocal at best. That doesn't mean much, though, since not all lecturers are practicing physicians, and not all the lecturers who are talking about such things are actually dealing with them. I don't remember if it was a pediatrician speaking.

It is a very difficult situation when you cannot persuade others to what you (strongly) feel is the right course of action (or rather inaction). It does not make me feel any better to pass that decision off to someone else, though.

Again, I agree, but what can you do except pick your battles? Ethical issues are always challenging. (I've been a student member of our hospital's ethics committee since first year; some of the cases have been doozies.) It wouldn't make me feel better to pass it off, but it would make me feel better to know that I've refused to do something I don't agree with.

The results of doctors disagreeing with putative caretakers came to its unbelievably ridiculous worst-case scenario in the Schiavo case, for example. There are topics I'd go to the mat for, but I just don't know that circumcision can be one of them. I am perfectly willing to argue with my colleagues on this subject, and I'm sure I will. At the end of the day, though, realistically speaking, my choices are to accept the parents' decision or to permanently alienate them. I suppose I could say that they need to find the alternate doctor themselves, but I don't think that's ethically justifiable either.

And other than a salve to your conscience, what does that accomplish for your patient? I realize that I am picking on you unfairly (I think you are still in training?).

No, you're not, and yes, I am. I'll be a fourth year starting Monday (yay! Three hundred-odd days to go!). Now is a good time to be thinking these things through.

My desired area of specialty is actually pediatric neurology, so the likelihood is that for most of my career this will be an academic question--my experience is that most of the procedures are done by OB/GYNs anyway; I've never seen a pediatric resident or attending do one. Still and all.

As far as the US attitude goes: I happen to live in New York, and my school is in Brooklyn. That means, among other things, that there is a very large Jewish population there who are unlikely to be swayed on this issue, so that may color my views on how to handle the question. (Although I'm Jewish by heritage myself, so there's always hope. ;)) We also care for a largely underserved population and I see a lot of suspicion of doctors. So I'm sensitive, maybe overly so, to the idea that if I alienate the parent, the child may not get medical attention at all.

None of which means that I should support, or do, anything I am against. And I won't, but I think there is a difference between, say, whether or not a child should be circumcised and whether or not he should get an NG tube. I would prefer that the former not happen, but I can't honestly say I think it's damaging enough that I'd go into full-out challenge mode over it. Maybe I'll have to rethink that. I have already been asked by a new mother whether I thought she should have it done, and I said exactly what I've said here--that I don't think it's medically necessary and that there's no reason to do it. She didn't. But then, I didn't really have to convince her.

I think we're just kind of talking at cross-purposes--I'm talking about an individual level, and you're talking about the profession's entire attitude. I do think that more and more doctors are coming around on this issue, but it's going to take time before everyone is convinced. In the aggregate, I think the rates are dipping, right?--just not as quickly as we might like. I'll be spreading the word, though.

[Kevin_Lowe]

Is it your view that an infant does not have the right to body integrity?

The problem with rights-based moral talk is that there is no simple way to figure out what happens when rights clash.

Infants have the right to bodily integrity, parents have the right to decide what elective medical procedures their infants undergo, now what?

Attempts to solve this kind of problem always seem to end up with complicated hierarchies of rights, but no one story about how to rank rights has gained popular acceptance. Probably because it all gets too messy.

[robinson]

Personally I think it should be illegal; it's rather irrational that it isn't actually illegal in countries like the UK or the USA where it is already illegal for parents to cause their child to be mutilated.

Interesting point.

In the past, have there been other medical surgeries, procedures, operations, whatever, performed on people without their consent, that were found to be irrational, dangerous, and are now considered stupid, harmful, or illegal?

I thought of tonsils. I remember when tonsils were removed, and considered dangerous to leave, and it was believed they caused disease. That surgery to remove them (it always seemed to be on kids), was common.

Does anybody still believe that? Could a rational thinker defend removing a kids tonsils?

[HawkeyeMD]

Infants have the right to bodily integrity, parents have the right to decide what elective medical procedures their infants undergo, now what?


At the risk of returning to a lighthearted tone, if every infant is given two parents so as to ensure a second opinion, perhaps a pediatrician's role is to provide the tiebreaker. ;)

Well, it may be only a matter of time before this 'elective medical procedure' is considered differently. Things change, you see.

I thought of tonsils. I remember when tonsils were removed, and considered dangerous to leave, and it was believed they caused disease. That surgery to remove them (it always seemed to be on kids), was common.

Does anybody still believe that? Could a rational thinker defend removing a kids (sic) tonsils?

Yes! When medically necessary. This might be a pretty good analogy (though I am unaware of any cultural, religious or aesthetic issues involved in tonsillectomy). Tonsillar tissue can become problematic if it is chronically inflamed or becomes infected so many times that its integrity is compromised. But tonsils are a very good example of an 'elective' surgery that has become largely extinct because of awareness by both parents and physicians that it did not do what it was intended to do.

[Skeptic Ginger]

...(I think part of my initial response to your post came from the fact that you chose to boldface your comments--which I'm sure you did just to set them off from the flurry of quotations,Sorry, it was purely for ease of reading. I know when I post long discussions that many people do not want to read all that stuff. I have taken to highlighting what I hope someone skimming the post will read if they don't read anything else. I also put incorporated quotes in italics because it is easier to see that someone else said something in my post.

I was lecturing a little. People who have been around for ever can't help themselves when around someone new. But there is nothing to be defensive about. As a nurse, I am specifically tasked to advocate for the patient. It's part of the collaborating roles of nursing and medicine. I think if we were in a face to face discussion, you'd find I have a completely different tone than you are reading into my posts.

...-please be careful with the innate assumption that all doctors are out there trampling patients' rights and being paternalistic.As should you be careful making this erroneous assumption about me. I made a point of the non-exclusivity and the over-generalization of my statement. It was easy to miss. ... Maybe some of them are. I've seen nurses behaving exactly the same way, and I'm sure, so have you.Nothing used to annoy me more than ICU nurses kicking family members out of a room of a dying patient so the nurse didn't have to accommodate the visitors in some minor way when providing care. When necessary, sure, but a lot of ICU nurses are all about the technical care and not so much about the other side of nursing care.

I have worked both sides of the isle. I was educated as a nurse before becoming a family nurse practitioner. Now I have a private practice that is more medical than nursing. I do see a big difference in medical vs nursing philosophies. It doesn't mean physicians aren't equally compassionate. What it does mean however, is your education has been to "decide", to recommend, to know the answers. Nursing education is all about teaching, assisting, helping, and so on. It doesn't make nurses any less knowledgeable. We have a parallel profession with medicine. PhDs are granted in Nursing Science. But the whole focus really is different.

..If I were practicing medicine in Africa, my opinion might also be different. But--as I pointed out previously--I will be practicing medicine in the US. Here, the best defense against HIV is the use of a condom. It does not require the permanent alteration of the human being. I don't think that's "blurring the lines"--I think that's pointing out the very great difference between the two situations.It's blurring the line of the discussion. No one in this thread is saying HIV prevention is a factor in the decision to circumcise an infant in the US.*

*Emphasized because it's at least the third time I have said it in this thread.

[Skeptic Ginger]

...
Is it your view that an infant does not have the right to body integrity?Look, I am not the only one with my perspective. I am following the recommendations of The American Academy of Pediatrics, and The American Academy of Family Physicians, which I also happen to agree with. I posted their position statements. You want me to accede to your emotional appeal. It ain't gonna happen. When the evidence based medical consensus changes, I'll change.

[Skeptic Ginger]

I don't speak for all parents, of course, but it was a major deciding factor in my spouse's and my decision to not circumcise our son. Specifically, we wanted his to look like what his peers' will look like.I think this is a compelling reason. You decided, and you state which of the deciding factors were most relevant to your decision.

[Skeptic Ginger]

... My viewpoint is ....The position of the AAP and the AAFP is to give the parents the information in an unbiased way. If you can rationalize your viewpoint, then you should be able to convey it to any parent whose child you are caring for.

Why after having done that, would you not respect the values they then used to make their decision?

[HawkeyeMD]

The position of the AAP and the AAFP is to give the parents the information in an unbiased way. If you can rationalize your viewpoint, then you should be able to convey it to any parent whose child you are caring for.

Why after having done that, would you not respect the values they then used to make their decision?

:jaw-dropp

If, after reading the last few posts I have made, you seriously think you can justify saying that I would not respect the values of parents...I don't think there is any point in continuing this discussion. That is far more judgmental than anything I have even implied and is, frankly, insulting.

I was willing to let the whole "alternate philosophies" idea slide, even though I very much disagree with any such notion. Nurses do not have a monopoly on 'teaching' and 'assisting' and 'helping'. If you honestly think that you can do any of that without conveying an opinion, without 'deciding', 'recommending' or 'knowing an answer', you are kidding yourself at best. 'Unbiased' does not mean the same thing as 'unknowledgable'.

Your viewpoint is clear. You think circumcision is a good thing. Fine. You will have to accept the fact that there are other medical professionals who disagree with you. And the reason that people keep responding to the idea that you are espousing the concept of circumcising American boys for the purpose of avoiding HIV infection is that you keep responding this way to those of us who are making the point that it does not apply in non-Third-World nations with posts like these.

I remember a previous thread where you took on a rather obvious troll about the parallel nature of the professions of medicine and nursing, and I also recall posting in your support. I am now inclined to reassess my support, because you are now sounding very much like the bad caricature of a nurse who wishes she were a doctor. And I would prefer not to think that of anybody, because I prefer not to think that such a creature exists.

Let me state for the record that, although I am only a fourth-year medical student, I am not a kid. I'm 39 years old and had a couple of careers prior to returning to school to become a doctor. I have the utmost respect for my patients and for those who make decisions for them. That is why I feel I should give them the benefit of the knowledge I have worked so hard to acquire. To suggest acquiescing to anything else in the name of "values" is to condescend to them. I have made it clear that I would never try to prevent a parent who, having heard my opinion, still wanted the procedure, from having it done.

Exactly where do you find an attack on a patient's parents values in that?

[Skeptic Ginger]

...
Skeptigirl's own analogy of the "no big deal" quality of the procedure compared to debridement or chemotherapy, which I just noticed, also strikes me as peculiarly inappropriate. These are horrible things to have to do, to see, or to undergo. But they are unequivocably necessary to try and save that patient's life. These examples are also, forgive me, an attempt at emotional appeal.You are again taking two different things here and blurring them.

The point I was making was, on a scale of one to ten how tragic/traumatic did I view a circumcision because Ivor asked about how I perceived them.

You're blurring the point into something about decision making. There is no emotional appeal to anyone in my statement. I gave an example to illustrate how I viewed something.

[Ivor the Engineer]

Look, I am not the only one with my perspective. I am following the recommendations of The American Academy of Pediatrics, and The American Academy of Family Physicians, which I also happen to agree with. I posted their position statements. You want me to accede to your emotional appeal. It ain't gonna happen. When the evidence based medical consensus changes, I'll change.

Nice dodge. It is not an appeal to emotion; it’s an appeal to logical (i.e. consistent) reasoning. Something you think you’re rather good at. All you’ve said above is that you're just following orders. That’s not very logical, Skeptigirl.

Let’s try again.

Is it your view that an infant does _not_ have the right to body integrity? I.e., that the parent’s rights to choose trump the child’s rights to not have an unnecessary medical procedure, based on the available* evidence, that will permanently alter their body.

Yes or No will do, but I’d prefer a reasoned, consistent argument, if you think one is possible for your position. However, I doubt you’ll answer because the cognitive dissonance I think you have on this issue will make you dismiss my question as stupid or emotional.

It seems I can change my position on circumcision for increased resistance to HIV infection in Africa, but you can’t do the same for unnecessary (based on the evidence) circumcisions in the US. Ah well, I suppose no one can be sceptical all the time about all issues.

*The available evidence includes an individual assessment by a professional of the child’s body. Seems a lot of people in the US currently tend to weight that bit of evidence rather lightly when it disagrees with their wishes.

[Ivor the Engineer]

You are again taking two different things here and blurring them.

The point I was making was, on a scale of one to ten how tragic/traumatic did I view a circumcision because Ivor asked about how I perceived them.

You're blurring the point into something about decision making. There is no emotional appeal to anyone in my statement. I gave an example to illustrate how I viewed something.

Actually, I think your reaction to circumcision has been attenuated because you have seen children in even more pain and suffering. This is similar to my work colleague who commented it's amazing how quickly people get used to the kids begging for food while on their way back to a luxury villa. It's most likely a survival mechanism that keeps us able to function.

I had to do it while watching my father die over a period of 12 months. Many of the nurses at the hospice where he died appeared to do it to.

Empathy is fine so long as you can do something about it or get away, otherwise it just immobilises you.

[fls]

Again, I agree, but what can you do except pick your battles? Ethical issues are always challenging. (I've been a student member of our hospital's ethics committee since first year; some of the cases have been doozies.) It wouldn't make me feel better to pass it off, but it would make me feel better to know that I've refused to do something I don't agree with.

The results of doctors disagreeing with putative caretakers came to its unbelievably ridiculous worst-case scenario in the Schiavo case, for example. There are topics I'd go to the mat for, but I just don't know that circumcision can be one of them. I am perfectly willing to argue with my colleagues on this subject, and I'm sure I will. At the end of the day, though, realistically speaking, my choices are to accept the parents' decision or to permanently alienate them. I suppose I could say that they need to find the alternate doctor themselves, but I don't think that's ethically justifiable either.

I'm sort of thinking of the opposite response - that you accept the parents' decision by performing the procedure yourself. I know it sounds weird, but I think it forces you to take a harder look at the issue than you would by otherwise taking the easier route. I'm not really advocating that you do this, I'm just bringing it up for consideration. I have this same argument with my colleagues - not about circumcision, but about refusing treatment, for example, of active smokers. Disagreement is the rule there, too. :)

To accept their decision means that you help them carry it out to the best of your ability. If you discover that your strong feelings against that decision interfere with your ability to provide the best care, then it is reasonable to pass part (or all) of that care on to a colleague.

I think we're just kind of talking at cross-purposes--I'm talking about an individual level, and you're talking about the profession's entire attitude. I do think that more and more doctors are coming around on this issue, but it's going to take time before everyone is convinced. In the aggregate, I think the rates are dipping, right?--just not as quickly as we might like. I'll be spreading the word, though.

I just wanted to bring up a different perspective about what it means to interfere with the care of an individual.

Linda

(This is also meant to be an answer to your second post to me.)

[Z]

I think you're both relying rather heavily on appeals to emotion.

For my own part, no, I don't think infants have a right to bodily integrity - I think they have a right to reasonable levels of bodily integrity, meaning they have a right to have sufficient bodily integrity to function normally, but anything further is the right and responsibility of the parents to decide. For example, if a child is born with webbed feet, or an extra finger, or a deformed face, the parents should have the right to correct these errors without needing the child's permission - and I think most of us would agree, since these are deformities. But is it medically necessary to remove webbing or extra fingers? Is it medically necessary to restructure the face to more closely resemble everyone elses? Not necessarily. These cosmetic changes might make life easier for the child, but they aren't required (in every case) for preservation of life or prevention of disease or whatever.

The only real difference with the issue of foreskin, is that it's NORMAL to be born with the foreskin. But removing it clearly does NOT significantly impair either function or enjoyment (I will concede that it MAY impair enjoyment minimally). So removing a foreskin is akin to removing an extra finger or webbing between the toes - or removing the appendix or the tonsils or a vestigial tail, or excessive labia. To me, the parent has the right and responsibility in these cases. Just as the parent has the right to pierce ears, or in other cultures to tattoo their children. Just as the parent has the right to decide whether or not to cut a child's hair, or how the child will dress, or whether the child will wear contacts, glasses, or get corrective surgery, and so forth.

I suppose I would change the statement to read 'functional bodily integrity', allowing for the removal or alteration of non-vital portions. And evidence so far concerning the foreskin see-saws back and forth so much, based entirely on who is doing the research, that it's not clear that the foreskin is vital. Personal experience says it is not, and that in fact the foreskin is a burden, not a necessity.

But it's interesting that the UN statement says one thing, while the WHO statement says something entirely different, isn't it? You'd think they'd talk at least ONCE in a while... :D

(By the way, Beleth: I'm glad you've never had to interact with any child professionals. You're fortunate to have children that are free of the many problems that have plagued both my children and my stepchildren - autism, sensory integration, an abusive father [in the case of my stepkids], malformation of the feet [correctable, thank the Goddess], ear issues requiring tubes for three of our kids, delayed speech and walking [due to the same ear problems]... And if your kids DO have similar problems and you HAVEN'T dealt with those professionals - then I strongly question your parenting skills. But I hope that it's just that you've been blessed with genetically superior stock. I married into a genetic smorgasborg of flaws and errors, so my children's flaws are my own fault; and as to my stepkids, I strongly suspect that a few branches on their father's family tree connect at both ends to the trunk...)

[E.J.Armstrong]

The only real difference with the issue of foreskin, is that it's NORMAL to be born with the foreskin. But removing it clearly does NOT significantly impair either function or enjoyment (I will concede that it MAY impair enjoyment minimally). So removing a foreskin is akin to removing an extra finger or webbing between the toes - or removing the appendix or the tonsils or a vestigial tail, or excessive labia.


If having a foreskin is normal, as you concede then, by your own definition, removing it is an abnormal thing to do, especially as normal people would not say that it was in any way similar to having an extra finger or a tail.

It is nothing more than a medically unnecessary personal cosmetic choice of the parents. As such it no different to docking the tails of dogs, a barbaric practice which is now held in contempt by decent people.

[Ivor the Engineer]

Ok Linda, so you’re ignoring me again. I'm getting used to it:)

Here's what you said earlier in reply when I asked you:

What I'm trying to understand is where your limit is. What act performed towards a child leads you to conclude that it should not be tolerated?

...My personal threshold is quite low, but my public threshold is much higher. I tend to be someone that is reluctant to impose my opinions onto others, so I usually require a moderately strong reason to do so. Plus my ethical consideration of others is strongly influenced by medical ethics, which promotes more of a hands-off, self-autonomy attitude than is usually acceptable to the general public.

Then in reply to HawkeyeMD’s post (which she posted in reply to Skeptigirl):

Your lecture in response to my final comment is not appreciated. I did not say that I would "judge" parents who chose circumcision. I will explain what I see to be the pros and cons of the procedure and, if they still want it done, refer them elsewhere. It is also not "practicing good medicine" to perform any procedure just because a patient or a parent desires it. At this time, my opinion is that for a child who will grow up in a country like the USA--which is where I will practice--there is not sufficient medical justification for circumcision. The evidence from the African studies is still very much being debated, but that is not really germane to the question of circumcision in the US. (I appreciate the argument about teenagers making poor decisions, but I can't really get behind the idea of permanently altering someone's body structure because of decisions you anticipate that they will make down the line, either.)

I have no problem with other doctors performing circumcisions, if that is what they feel to be correct. That is their decision.

You posted this:

The problem I have with taking this stance, is that it essentially passes the buck so that one can make a show of advocating for one's patient or taking a moral position, without actually doing so. After all, no behaviour has been changed if it is simply someone else that does the procedure.

I think we have a duty to be willing to be more proactive than that.

Linda

So which is it Linda: Hands-off or proactive?

[kellyb]

For my own part, no, I don't think infants have a right to bodily integrity - I think they have a right to reasonable levels of bodily integrity, meaning they have a right to have sufficient bodily integrity to function normally, but anything further is the right and responsibility of the parents to decide. For example, if a child is born with webbed feet, or an extra finger, or a deformed face, the parents should have the right to correct these errors without needing the child's permission - and I think most of us would agree, since these are deformities. But is it medically necessary to remove webbing or extra fingers? Is it medically necessary to restructure the face to more closely resemble everyone elses? Not necessarily. These cosmetic changes might make life easier for the child, but they aren't required (in every case) for preservation of life or prevention of disease or whatever.

The only real difference with the issue of foreskin, is that it's NORMAL to be born with the foreskin. But removing it clearly does NOT significantly impair either function or enjoyment (I will concede that it MAY impair enjoyment minimally). So removing a foreskin is akin to removing an extra finger or webbing between the toes - or removing the appendix or the tonsils or a vestigial tail, or excessive labia.

You're contradicting yourself here. On one hand, you say that a foreskin is not a deformity, and on the other, you're saying it's removal is like correcting a deformity.
Can't have it both ways.

In the Wester world, we have Muslim immigrants who wish for their daughters to be circumcised. Do you think the removal of the clitoral prepuce and/or labia should be allowed for these cases when it's accepted and normal for their culture?

[HawkeyeMD]

I'm sort of thinking of the opposite response - that you accept the parents' decision by performing the procedure yourself. I know it sounds weird, but I think it forces you to take a harder look at the issue than you would by otherwise taking the easier route. I'm not really advocating that you do this, I'm just bringing it up for consideration. I have this same argument with my colleagues - not about circumcision, but about refusing treatment, for example, of active smokers. Disagreement is the rule there, too. :)

To accept their decision means that you help them carry it out to the best of your ability. If you discover that your strong feelings against that decision interfere with your ability to provide the best care, then it is reasonable to pass part (or all) of that care on to a colleague.



Mmmm...interesting. :cool:

It's food for thought, but I have to disagree, ultimately, with the idea that "to accept their decision means that you help them carry it out to the best of your ability." I can accept their decision because ultimately, I don't think circumcision is particularly harmful. (I brought this up again with my husband last night and he agreed it's not something that's ever bothered him one way or another. That's the thing--I don't see it as a huge moral issue, I just see it as medically unnecessary, which is not the same thing as actively harmful.) But that doesn't mean I have to agree with the decision. Personally, I think if I don't agree with it, I shouldn't do it. As you say, reasonable people may come to different conclusions. ;)

I could postulate a decision that I would disagree with so vehemently that I would not even consider being involved with it, or even one so against what I see as the patient's best interests that I would be willing to take legal action to prevent its being acted on. (The ethics committee/legal department has had two of those since I've been in school--no one likes that.) But this just isn't that decision.

Somewhere backalong you said something about no behavior (pardon the American spelling) having been changed if I passed on the decision. Not quite true. I mean, mine has been, right? :D

[BlackKat]

You're contradicting yourself here. On one hand, you say that a foreskin is not a deformity, and on the other, you're saying it's removal is like correcting a deformity.
Can't have it both ways.

In the Wester world, we have Muslim immigrants who wish for their daughters to be circumcised. Do you think the removal of the clitoral prepuce and/or labia should be allowed for these cases when it's accepted and normal for their culture?

You can't compare most cases FGM with circumcision. That's like comparing an ear piercing to cutting off an ear. The only "operation" on the penis that compares to the most common forms of FGM is castration. As far as I know there are no cultures where castration is done to infants. Back in the days of the eunuch maybe...

So no, FGM should not be allowed despite it being part of their culture because we don't allow castration.

There is a rarer form of FGM where a small incision is made in the clitoral hood to expose the clitoris but neither it, nor the clitoris, is removed at all. This /might/ be considered equivalent to circumcision except that the clitoris is not an exact equivalent to the penis glans.

[kellyb]

You can't compare most cases FGM with circumcision. That's like comparing an ear piercing to cutting off an ear. The only "operation" on the penis that compares to the most common forms of FGM is castration. As far as I know there are no cultures where castration is done to infants. Back in the days of the eunuch maybe...

So no, FGM should not be allowed despite it being part of their culture because we don't allow castration.

There is a rarer form of FGM where a small incision is made in the clitoral hood to expose the clitoris but neither it, nor the clitoris, is removed at all. This /might/ be considered equivalent to circumcision except that the clitoris is not an exact equivalent to the penis glans.

COME ON, DUDE.
All you responded with was a straw man. I'm not talking about cutting off ears or castration. I'm asking about removal of the clitoral prepuce and/or labia.
Would that or would that not be ok if the child was coming from and would remain actively involved in a culture where it was accepted, expected, and normal?

[BlackKat]

COME ON, DUDE.
All you responded with was a straw man. I'm not talking about cutting off ears or castration. I'm asking about removal of the clitoral prepuce and/or labia.
Would that or would that not be ok if the child was coming from and would remain actively involved in a culture where it was accepted, expected, and normal?

The problem here is the inclusion of labia and the word removal rather than pierce or trim.

Piercing or trimming the clitoral hood will not impede sexual functionality. Removal could as it is designed to protect the clitoris from excessive friction. Removal of the labia, which protect the vaginal and urethral openings, is also detrimental.

So you are trying to compare the complete removal of essential parts of the body (the female clitoral hood and labia) with a non-critical part of the body (the male foreskin). They just don't match up.

If you are against the removal of the foreskin (despite the arguments of circumcised males who are happy) that is your perrogative. Please do not try to compare it to FGM though as they are barely similar.

[Ivor the Engineer]

The problem here is the inclusion of labia and the word removal rather than pierce or trim.

Piercing or trimming the clitoral hood will not impede sexual functionality. Removal could as it is designed to protect the clitoris from excessive friction. Removal of the labia, which protect the vaginal and urethral openings, is also detrimental.

So you are trying to compare the complete removal of essential parts of the body (the female clitoral hood and labia) with a non-critical part of the body (the male foreskin). They just don't match up.

If you are against the removal of the foreskin (despite the arguments of circumcised males who are happy) that is your perrogative. Please do not try to compare it to FGM though as they are barely similar.

This is clearly a compelling delusion for you. Got any evidence that what you claim is actually true?

[Ivor the Engineer]

Mmmm...interesting. :cool:

It's food for thought, but I have to disagree, ultimately, with the idea that "to accept their decision means that you help them carry it out to the best of your ability." I can accept their decision because ultimately, I don't think circumcision is particularly harmful. (I brought this up again with my husband last night and he agreed it's not something that's ever bothered him one way or another. That's the thing--I don't see it as a huge moral issue, I just see it as medically unnecessary, which is not the same thing as actively harmful.) But that doesn't mean I have to agree with the decision. Personally, I think if I don't agree with it, I shouldn't do it. As you say, reasonable people may come to different conclusions. ;)

I could postulate a decision that I would disagree with so vehemently that I would not even consider being involved with it, or even one so against what I see as the patient's best interests that I would be willing to take legal action to prevent its being acted on. (The ethics committee/legal department has had two of those since I've been in school--no one likes that.) But this just isn't that decision.

Somewhere backalong you said something about no behavior (pardon the American spelling) having been changed if I passed on the decision. Not quite true. I mean, mine has been, right? :D

Did you watch the video of the circumcision being performed, apparently without pain relief?

If it was not a baby, but an adult, would it be "a huge moral issue" for you?

What if that pain was inflicted on you, but then you could be made to forget it, would you be up for that?

From my point of view infants make the perfect victims; they're small, can't speak and don't explicitly remember the pain that was inflicted upon them if it is done early enough in their existence.

I agree that the removal of foreskin is not a particularly big ethical issue in itself. The conditions under which it is removed are. Did you catch the earlier post that stated it looks like less than half of infant circumcisions in the US use anaesthetic?

Perhaps that was what Linda was talking about, if you did it, you would make sure the infant went through the minimum amount of suffering.

[Z]

I'm with BlackKat here. The foreskin is a non-essential part of the male anatomy; the clitoral prepuce and labia are essential parts. Apples and antelopes, really.

It's like this: FGM, in most cases, causes harm to females. From personal experience, I know that circumcision causes no harm to males (or shouldn't, if done right), while being uncircumcised can lead to infections and hygeine issues, based on observing my kids vs. my stepkids, as well as the males in my various military units. Circumcised males have better longetivity than uncircumcised, my experience shows, and circumcised males have less potency problems than uncircumcised.

That's all anecdotal and all experiential; but the 'research' so far has always shown bias, one way or another, so it's hard to accept the word of clearly biased researchers over personal experience in these cases.

It's also interesting to observe how much emotional language creeps into the anti-circ rhetoric. Ivor refers to 'delusions' - an unnecessarily loaded term to describe BlackKat's understanding of the facts. EJ Armstrong makes an attempt to associate circumcision with indecency. Earlier on, Ivor questions the skepticism of other posters, essentially because they disagree with him.

Earlier still, and I forget who said this, someone claimed that you were somehow demented or messed up or something if you DIDN't get emotional over the issue of circumcision. Frankly, that tells me a lot about who is, and who is not, clearly seeing the issues for what they are.

[kellyb]

This is clearly a compelling delusion for you. Got any evidence that what you claim is actually true?

That's what I was thinking. Specifically, evidence to back up this part:

Piercing or trimming the clitoral hood will not impede sexual functionality. Removal could as it is designed to protect the clitoris from excessive friction. Removal of the labia, which protect the vaginal and urethral openings, is also detrimental.
The foreskin also protects the penis from excessive friction. I'd like to see evidence that the effects would be different.
I'd also like to see evidence that removing the labia (major or minor) results in anything negative that removal of the foreskin doesn't.