Nov 04 2008
Circumcision: What Does Science Say?
Some people think circumcision is mutilation; others want one even if they don’t know what it is. When I was working in an Air Force hospital emergency room one night, a young airman came in requesting a circumcision. I asked him why he wanted one. He said a couple of his friends had had it done, and he’d heard it was a good idea, and he was going to be getting out of the Air Force pretty soon and wanted to have it done while Uncle Sam would still foot the bill. I examined him: he had a neatly circumcised penis without so much as a hint of any foreskin remnant. I’ve always wondered what he thought we were going to cut off.
The subject of circumcision evokes strong emotions. Some people think of neonatal circumcision as a religious duty or a valuable preventive health measure; others think it is the epitome of child abuse. I have no strong feelings either way. I’m not sure what I would have decided if I’d had sons; fortunately my children were both daughters so I didn’t have to decide. I’m going to try to stand back and look at the scientific evidence objectively. What are the medical benefits and risks of circumcision?
There is a website that is admittedly biased in favor of circumcision but that has collected an impressive amount of information in one place, with 660 references. I learned way too much from that website. For instance that the circumcised penis averages 0.8 cm shorter than the uncircumcised penis (possibly due to improper technique occasionally removing too much tissue and “tethering” the organ slightly). And that an intact foreskin is an absolute requirement for a mutual masturbation practice amongst homosexual men known as “docking,” in which the penis is placed under the foreskin of the male partner. I didn’t need to know that. You probably didn’t want to know that either, but now it’s too late.
In addition to pro-circumcision groups like Circinfo.net, there are numerous anti-circumcision activist groups. There are even groups that encourage re-creation of the lost foreskin by stretching the penile skin with specially-designed weights. Penn and Teller featured this on an episode of their cable TV series Bullshit! An elderly man exposed his genitals – weights and all – on national television to promote his cause. It was pretty amazing. A somewhat blurred version can be seen on U-Tube.
Arguments against circumcision
- “Nature makes no mistakes.”
- It’s genital mutilation and a violation of human rights.
- Doctors just do it to earn more money.
- It’s cruel; babies suffer terrible pain.
- Babies remember the pain.
- There are permanent physiologic consequences: boys who were circumcised at birth are more sensitive to pain later in life.
- The uncovered glans becomes less sensitive.
- Circumcised men don’t get as much pleasure from sex.
- Circumcised men are psychologically damaged.
- Some men mourn their lost foreskin; some miss it so much that they try to reconstruct it.
- The foreskin is required for the homosexual practice of “docking.”
- An intact foreskin provides more scope for body art like piercings and tattoos.
- There are complications from the surgery including hemorrhage, infection and even death (in one famous case a boy’s penis was accidently burned off by an electrocautery device and they elected to raise him as a girl).
- Other complications include poor cosmetic results and meatal stenosis.
- If reconstructive surgery is needed later in life, an intact foreskin can provide tissue.
- It’s elective surgery and the patient doesn’t get a choice in the matter.
Some of these arguments are medical; some are not. Some are questionable. The “doctors want to make money” argument doesn’t seem to hold water, since plenty of circumcisions are done in settings where doctors are on a fixed salary and circumcisions just mean more work.
There’s no good evidence that circumcised men get less pleasure from sex. Studies have shown little or no difference in sensitivity or sexual satisfaction with circumcision. If there were lowered sensitivity it might theoretically enhance pleasure by allowing more prolonged intercourse; and one man commented, “most [circumcised] men will tell you that if their genitalia were any more sensitive, it would cry during Meryl Streep movies.”
If some men are psychologically damaged by circumcision and mourn their lost foreskin, their mental health must be pathologically fragile. Get over it, guys!
I don’t think there is any evidence that babies are capable of remembering the pain of circumcision or for that matter the birth experience. There have been studies suggesting that infant circumcision alters pain response later in life, but they are contradictory and unconvincing.
The risks are minimal if the procedure is done under sterile conditions by an experienced operator. Many of the serious complications documented in the literature were easily preventable. “Overall complications should approach zero for an experienced operator” especially if the safer techniques are used and contraindications like hemophilia and penile abnormalities are heeded.
A colleague told me he challenges his students to find any difference in babies who just had the procedure, and they can’t. Babies seem to get just as upset from lesser procedures like having blood drawn, and sometimes an irritable baby goes into a hissy fit just from being dressed or from being hungry. They cry uncontrollably for even trivial reasons, but they get over it promptly.
I used to do assembly-line circumcisions where we’d strap several babies to molded plastic restraining boards; they didn’t like being restrained, but by the time the last baby was restrained, the first one would usually have stopped crying and would often remain calm throughout the actual procedure, especially if he’d been given a sugar pacifier. Sometimes he’d even go to sleep. I used a Plastibell device: the actual cutting part of the procedure is painless even without anesthesia, because the tissue is already “dead” – the blood supply has been cut off by tying a string over the groove in the plastic ring. Studies have documented physiologic changes during the procedure, but it’s not clear that those changes mean anything that really matters to the child’s mental state or physical welfare. It’s current practice to inject an anesthetic, but that carries its own small risk and also causes pain: it’s not 100% clear whether we’re using it for the infant’s benefit or the adults’. Some doctors still wonder if it might be kinder to skip the anesthesia and just get the procedure over with and the baby back in Mom’s arms as quickly as possible.
Arguments for Circumcision
Some of the arguments for circumcision are unavoidably intertwined with a separate issue: hygiene. The warm, moist space under the foreskin is a prime breeding ground for bacteria, it can harbor sexually transmitted disease organisms, and it produces a cheese-like, foul-smelling substance called smegma. It is plausible that this could contribute to infections in the man and his partner, and even to cancer. Many studies support that idea, others don’t. There doesn’t seem to be any good evidence comparing circumcised men to uncircumcised men who practice meticulous hygiene. It’s difficult to sort out whether it is the circumcision itself or just improved hygiene that makes the difference. Circumcision undoubtedly facilitates hygiene, but is that a reason to operate?
- Circumcision reduces the transmission of AIDS. Maybe. A 2008 meta-analysis of studies in Africa indicated that one case of heterosexually transmitted AIDS would be prevented by 72 circumcisions. It seems to be less effective at preventing male-to-male homosexual transmission. This gets confusing, because knowing they have had a risk-reducing procedure might increase promiscuity, and improved hygiene alone might reduce risk. Anyway, circumcision doesn’t remove the risk entirely, and safe sex is still necessary. Since there are other more effective ways to prevent AIDS transmission, few would argue for circumcision just for the purpose of AIDS prevention.
- Circumcision prevents penile cancer. The incidence of penile cancer is about 1 in 100,000 in the US. By one estimate, the lifetime risk for an uncircumcised man in the US is 1 in 600. The 5 year survival rate is about 65%. Penile cancer is almost never seen in circumcised men; such a case is unusual enough to be written up as a case report in a medical journal. In third world countries where hygiene is poorer and circumcision is less common, penile cancer causes up to 10% or 20% of cancers in men. Disgusting photos can be seen at http://www.circinfo.net/cancer_of_the_penis.html
The American Cancer Society thinks the studies showing reduced penile cancer rates were flawed because they failed to consider other factors that are now known to affect risk, such as smoking, personal hygiene, HPV infection, and multiple sexual partners. It concluded:The current consensus of most experts is that circumcision should not be recommended as a prevention strategy for penile cancer.
- Reduced risk of urinary tract infection. Several studies have shown that circumcised baby boys have fewer UTIs but the reduction is small and this study suggests confounding factors might be responsible.
- Reduced risk of balanitis (inflammation of the glans penis). Most studies show balanitis is more common in uncircumcised males, but at least one study indicated that it was more common in circumcised males, especially in early childhood.
- Reduction of the incidence of various sexually transmitted diseases in men and in their female partners. Reduction of cervical cancer and maybe even breast cancer in women. Again, these are likely more related to hygiene than to surgery.
- Circumcision prevents phimosis (the inability to retract the foreskin) and paraphimosis (a painful inability to pull the retracted foreskin back down). Paraphimosis can obstruct urine and blood flow and is a medical emergency.
- About 10% of uncircumcised infants will require circumcision later in life for medical reasons. Adult circumcision is more expensive, more difficult, riskier, requires stitches, and causes more suffering than neonatal circumcision. The conditions that lead to the medical necessity for circumcision also cause suffering that would have been avoided by neonatal circumcision.
- Hygiene. It’s easier to keep a circumcised penis clean. Certainly it’s a convenience, but that doesn’t constitute a medical indication.
- Aesthetics. Women allegedly prefer the appearance of a circumcised penis. Even if true, not a medical indication.
- Zipper injuries to the foreskin can’t occur if you don’t have a foreskin. True, but trivial.
- Other boys will laugh at you in the locker room if you’re uncircumcised. (I don’t think this one even deserves a comment.)
Not Medically Indicated or Contraindicated
What all this really boils down to is that there are no compelling scientific arguments for or against neonatal circumcision.
There are small risks and there are small benefits. The decision is not a medical one. Medical organizations are not “pro” circumcision, but they’re not “con” either. The American Academy of Pediatrics’ official policy states:
Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In circumstances in which there are potential benefits and risks, yet the procedure is not essential to the child’s current well-being, parents should determine what is in the best interest of the child.
Aside from religious reasons, the main reason parents give for circumcision seems to be simply to make junior match Dad. Even if you believe potential medical benefits outweigh the risks, does that justify doing an elective procedure to remove a piece of the child’s skin without his consent? That’s a value judgment and an ethical dilemma that will continue to evoke strong emotions, like abortion.
I used to live in Spain, where you could tell girl babies from boy babies just by looking at their ears: all the baby girls had their ears pierced in the delivery room. That was a “mutilating” procedure with no conceivable medical benefit and a small risk of infection, deformity, or ingestion of earring parts. It was nowhere near as controversial as circumcision. I wonder why.
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232 Responses to “Circumcision: What Does Science Say?”
I appreciate the compilation of the pros and cons of circumcision in one handy post. I have read very emotional contra-male circumcision threads at various sites, and one aspect that is commonly encountered is that males are loathe to consider themselves ‘mutilated’, therefore opting to consider their circumcised state as being expedient and useful. And in the reality of evidence, in most cases the physical state of their penises is just the decision of their parents which is usually based on their own cultural bias on for what constitutes the best physical state.
Having been accustomed to non-circumcised penises, the circumcised ones do look odd to me, but of course still adorably attractive!
Come on, Harriet! Just a moment of imagination will help you understand why circumcision is more controversial than ear-piercing..
It seems clear to me that circumcision is no more than the most widespread example of superstitious, ritual mutilation of children, something that seems sadly, and inexplicably still widespread in the modern age, and all around the planet. I don’t think it’s a coincidence that globally the practice is strongly linked to religion (albeit not, I understand, in the US, where it seems to link with other cultural norms).
Of all the “advantages” that you cite: the idea cutting off part of your body in order to save time bathing to keep it clean made me smile the most. I imagine that circumcised men will generally find it convenient and sensible to wash their dongs whenever they are in the shower, just as the uncircumcised ones do. But perhaps they do indeed thank their parents each day, that thanks to their missing foreskin they can complete that small ritual just a few seconds faster. …
Way past being a “live issue” for me, but a datum:
If circumcision causes males to be more sensitive to pain later in life, then it’s perhaps the greatest benefit I got from it. If my pain sensitivity were any lower, I might well have died of a burst appendix. As it is, my main argument with caregivers is convincing them that I really, truly, absolutely do not need any “pain management” e.g. following surgery.
I give you credit for trying to appear balanced, but like most pro-circumcision types, you make circumcision sound like the way to go.
You kind of gloss over meatal stenosis there. The rate is almost 10% and occurs exclusively in circumcised males. It requires a surgical correction.
You cite HIV. The United States has the highest circumcision rate and the highest per capita HIV infection rate in the industrialized world. Promoting circumcision as an HIV preventative is dangerous because circumcised men can and do get HIV. All at risk men need to wear condoms to protect them and their partners from HIV.
You cite penile cancer. According to the American Cancer Society, men are more likely to acquire and die from breast cancer than penile cancer. Also, a simple search of Pubmed will reveal that circumcised men do get penile cancer. In any case, our penile cancer rates are quite similar to Denmark where circumcision is nonexistant.
You cite UTIs, but fail to mention that girls get far more UTIs than any boys and they are treated with antibiotics.
You mention balanitis but fail to note that it is associated with filth. In America, we have an abundance of soap and running water. Keep it clean and you won’t get balanitis. Trust me, men have no problem keeping it clean as long as they don’t have body issues caused by puritanical parents.
You mention phimosis but nothing of normal development. In an intact male, it is quite normal for the child to have congenital phimosis up through puberty. Most don’t, but its still possible and normal. You also don’t mention that much phimosis is caused by improper care, usually promoted by doctors. Doctors have long advised parents to retract their son’s foreskin, even when it was still in the state of congenital phimosis. This causes pain, bleeding, and scarring. When it becomes time for the phimosis to naturally resolve, the scars don’t, leading to an adhesion. In any case of phimosis, steroid creams and stretching exercises will generally resolve the problem.
You mention STDs, but like HIV, we’re doing a lot worse than intact Europe and Japan. The STD and HIV problems in our nation are related to our puritanical attitudes towards sex education and condom use, not surgical issues. Circumcised men can and do get STDs. Circumcised men and intact men alike need to wear condoms if there is concern about STDs.
You say that 10% of infants require circumcision later in life. I’d say that’s more due to American ignorance about normal development. I’ve heard stories of circumcision for phimosis at age 1. Anyone who can pick up an anatomy book can tell you that’s nonsense but the doctors don’t seem to care.
I think it shows that the science is lacking when you have to list your final few reasons.
Hygiene: Infants require minimal care. Wipe the outside like a finger when it gets dirty. Children’s bathtime activity is enough to keep them clean. If they can retract, they can be instructed to do so. Once a child is old enough to bath himself, he can also be instructed to retract and wash in the shower. These things aren’t rocket science and spending extra time one one’s gentials is hardly an inconvenience, unless one has body issues.
Aesthetics: This is a self esteem issue. If I were lucky enough to have avoided a doctor like you and had a woman comment negatively on my intact genitals, I would politely show her the door. There are plenty of fish in the sea and I have no use for shallow women. Preferring a man who has been surgically altered is like preferring women with breast implants. Pathetic.
Locker room: I think that the guy who got caught checking out other guys would be laughed at more, but hey, I’m just a guy who’s been in the locker room. Guys don’t check each other out unless they’re gay. Period.
Zipper Injury: Yeah, nature has a way of weeding out guys that dumb.
Bottom line: Circumcision is permanent and the reasoning is flimsy at best. If an adult male wants to get cut, that’s his business. Doctors should not be offering circumcision to newborns and especially if they believe the things that this doctor does.
And yes, I’m a male and I hate being circumcised.
@circ guy:
Many of your arguments are interesting and relevant, but the fact that you “hate being circumcised” is perhaps the least persuaive of your arguments.
Oh, and Harriet, from my experiences on certain bb’s, you’ve opened a can of worms, so to speak—should be interesting.
Dr. Harriet Hall reports that she is a retired serial circumciser. Dr. Ronald Goldman (http://www.circumcision.org/circumcisionpolicy2004.htm) reports that such doctors have a need to justify their former practice. Goldman writes:
“For physicians who have performed hundreds or thousands of circumcisions (or have chosen circumcision for their own son), the possible use of such psychological defence mechanisms to deny some of the evidence against circumcision could serve, in part, to protect their self-esteem, which could be adversely affected by the conscious recognition that circumcision may harm infants.”
That certainly seems to be the case here because Dr. Hall has provided a highly biased paper. She does not recognize that almost all of the pro-circumcision medical literature is written by circumcised doctors who have a need to justify their own circumcision and loss of erogenous tissue.
Dr. Hall has provided a link to only one website – that being the most pro-circumcision website on the Internet.
Dr. Hall says there is no evidence that babies remember pain, however, this is well documented. (http://www.cirp.org/library/pain/taddio2/)
Dr. Hall has failed to report that there is a strong case for genital integrity (the opposite of circumcision). That case is documented in the evidence-based Genital Integrity Policy Statement of Doctors Opposing Circumcision. (http://www.doctorsopposingcircumcision.org/DOC/statement0.html)
Dr. Hall needs to confess her guilt for the intentional injury of scores of infant males and reexamine her motives in writing this document.
” all the baby girls had their ears pierced in the delivery room. That was a “mutilating” procedure with no conceivable medical benefit and a small risk of infection, deformity, or ingestion of earring parts. It was nowhere near as controversial as circumcision. I wonder why.”
It is kind of hard to take you seriously when you ask such a question. I don’t like the idea of people piercing their babies’ ears, but I also recognize that merely piercing nearly nerveless cartilage is quite different than permanently excising a functional and very sensitive part of a penis.
Are you people kidding me? Nothing in Dr. Hall’s post led me to believe that she advocates circumcision. If you have relevant data showing that circumcision is or isn’t a good idea for most boys, or even data showing that it is indicated or contraindicated for a subset of them, show it. Why should we care about claims like “more girls get UTIs” when we’re comparing the odds ratios for two populations of boys?
Peter Lipson, its no surprise that you don’t care about the feelings of adult men who wish their parents has chosen differently. The American medical establishment has been belittling intact men and men like me for decades. I take it in stride and its part of the reason why I don’t take doctors at their word. I’m not an alternative medicine kook, but the circumcision issue makes it painfully obvious that many doctors don’t take their craft as seriously as they should.
Its pathetic that you don’t consider your patients’ future wants before you take a knife to them. But anything for a quick buck, I guess… BMWs aren’t free!
Alexander Han, why shouldn’t you compare the UTI rates of boys and girls and compare the treatment methods? Are the bacteria that cause UTIs in boys different than that which cause bacteria in girls? Do male UTIs fail to respond to antibiotics?
Its completely bizarre that one group “requires” preventative surgery while the other is treated with antibiotics.
You anti-circumcision nuts sound just as loony and emotional as any true believer in other non-sense. Instead of accusing Dr. Hall of bias, and misinterpreting her conclusions, just present the evidence please.
I personally found Dr. Hall’s article very informative and useful. It’s refreshing to see an analysis of this topic that doesn’t devolve into accusations of ‘mutilation’.
Also, as to the accusation that circumcision is wrong because it’s a religious ritual. That is clearly fallacious. Other beneficial activities that have later proven useful were pioneered in religious circles, such as mandatory hand washing before meals in Judaism.
Ah, the circ wars. They take me back to misc.kids in the early 90s.
The great thing about the circ wars is that they’re the one subject that gets even more heated rhetoric than vaccination where kids are being discussed.
Maybe I should clue John Scudamore onto the fact that Dr. Hall opened this can of worms. A circumcision flamefest just isn’t the same without him.
Oh, and as long as JorgeM is going all argumentum ad hominem and all, please note that Dr. Lipson is known to associate with Jews, too.
“Are you people kidding me? Nothing in Dr. Hall’s post led me to believe that she advocates circumcision.”
Advocates? I suppose it depends on what you mean by that. But as to “bias” even a cursory glance at the OP shows that it appears to favor circumcision, just read the bolded type and it is pretty obvious:
————
————
Biased? I don’t know. It could be that the case really is stronger for circumcision than against, but regardless, the balance of the OP is clearly, IMO, pro-circumcision. Being “neutral” about a non-indicated elective, body modifying, aesthetic surgery with functional side effects, a surgery forced on children without their consent, is, I think, ultimately “pro” circumcision.
*waits for Dr. Hall’s reply, brings popcorn, munches*
Well said. This sums up my feelings exactly. I made the decision not to circumcise my son because I couldn’t justify it medically. The reasons in the ‘pro’ column seem pretty baseless, to me, and I’m having a hard time understanding the neutral position of the AAP. If there isn’t a compelling medical reason to perform this (minor) surgical procedure, how is it ethical to do it simply because the parents desire it?
It is rather alarming to me that the practice is still as common as it is in the US, given that the chief reasons for continuing to circumcise seem to be aesthetic/social and not medical. Why aren’t the justifications for making a permanent, unnecessary modification to someone else’s body questioned more by the patients or by the doctors doing the procedures?
The most disconcerting “advantage” I ever read on a web site promoting non-circumcision was that when the glans can pleasurably slide within the sheath of the foreskin, vaginal sex doesn’t require any lubrication.
“The most disconcerting “advantage” I ever read on a web site promoting non-circumcision was that when the glans can pleasurably slide within the sheath of the foreskin, vaginal sex doesn’t require any lubrication.”
In a perfect world, no. But back in reality, many people do need additional lubrication for a variety of reasons–and, yes, even for **vaginal** intercourse, where natural lubrication may be naturally inadequate for many individuals. And, of course, you are forgetting that many people use condoms, which only increase the need for lubrication and increase the advantage that a foreskin can offer some people for sensitivity while using condoms.
Odd to see that you find the idea of “pleasurably slid[ing] within the sheath of the foreskin” to be a highly “disconcerting” thing. In a sense, your statement is a descendant of the anti-”self abuse” hysteria of the Victorian era, where all manner devices and schemes were advocated to restrict the horror of sexual pleasure–schemes including circumcision.
If I were to make broad inferences from your post I would think that you seem to be advocating that the only sexual pleasure that is proper is vaginal intercourse (presumably in the “Missionary” position and in pursuit of procreation) and that if removing part of a penis will make other kinds of sexual pleasure less appealing to people then by all means, break out the scalpel and start the involuntary procedures.
For those whose emotions interfere with their ability to read:
I am not pro-circumcision.
I listed more reasons against than for (16 vs. 11). I dismissed most of those reasons as non-scientific and I concluded that there were small risks and small benefits from a strictly medical standpoint and that the decision is not a medical one based on science.
I ended by asking whether, even if you believed potential medical benefits outweighed the risks, that would justify doing an elective procedure to remove a piece of the child’s skin without his consent.
Some readers were apparently so influenced by their strong prior opinions that they responded to what they wanted to think I wrote rather than to what I really wrote.
Some people will rant on their favorite topics at the drop of a hat — and carry spare hats just to be sure.
Skeptic: I am certainly not Victorian by any definition. What I found disconcerting was the idea that no thought needs to be made for the very real situations where lubrication is lacking.
As overshoot pointed out, this is a seriously hot button issue–perhaps even more so than vaccines and the antivaccine movement. I wouldn’t be surprised if this comment thread grew to massive proportions.
Zeteticon 04 Nov 2008 at 2:03 pm
Skeptic: I am certainly not Victorian by any definition. What I found disconcerting was the idea that no thought needs to be made for the very real situations where lubrication is lacking.”
Then I have misinterpreted your post and I apologize for the error.
At my hospital, it is the obstetrician that does the circumcision. The diagnosis used for coding the procedure is always “phimosis”. The insurance companies don’t seem to have a problem with the fact that the “phimosis” of a newborn male is normal and, IMHO, should not be grounds for surgery. We don’t recommend that parents of uncirced boys retract the foreskins.
While there may be some semi-legit reasons for circumcision, “phimosis” in a 24 hour old boy is not one of them.
That was a subtle way of putting it. Of course, I hope that the spam filters are up to the load of the “organ enhancement” attacks this thread is bound to draw …
To follow up on what TBWM said – I think transparency would clear a lot of this up. Until an overwhelming concensus is reached within the medical community that the benefits of elective neonatal circumcision vastly outweigh the risks (in terms of cost, life expectancy, quality of life, etc.), then it is cosmetic surgery, pure and simple. It should be referred to as such, presented to new parents as such, and most importantly, billed as such.
And this fits, too. Parents who elect for circumcision don’t cite UTI rates or penile cancer risks. They do it so Junior looks like dad, so Junior won’t be made fun of in locker rooms, so Junior’s future partners will be more willing to fellate Junior, or so “Junior’s won’t look like a g*d-d*mned monkey”. (Yes, I’ve heard all of these – and sadly, all from my own immediate family).
I blogge this awhile ago, and indeed, the comment trail hypertrophied.
Here’s another viewpoint, though: If you ask the Urologists, they’ll point out that an uncircumcised phallus is a frequent source of great misery later in life (read: in the geriatric population.) Between infections, phimosis/paraphimosis, etc; if everyone were circumcised, they’d have a lot less business (which actually pleases the altruistic ones I know.) Furthermore, by the time they get called in to do it (ie, past the neonatal period) all the other issues (pain, expense, psychological anguish) come into play. The only way to get around them is to do it as a neonate.
My Darling Spouse had another take on this whole issue: Most of the arguments against circumcision are based on antisemitism. I didn’t agree at first, though the more you read, the harder is it to argue against it.
“My Darling Spouse had another take on this whole issue: Most of the arguments against circumcision are based on antisemitism. I didn’t agree at first, though the more you read, the harder is it to argue against it.”
You haven’t made a convincing argument for it (or any argument at all other than to make the insinuation), and this is the first I’ve heard of such an argument. It rather defies credulity to posit that to be opposed to the forced non-indicated removal of part of a child’s penis that one must hate Jews.
I wonder, do people here who consider themselves pro male circumcision also support female circumcision in Africa in its various forms? Why or why not? Do they support all acts of genital modification of babies for religious or cultural reasons? Or are some okay and some not?
Bald Ape – Are you sure they don’t do it so dad doesn’t have to discuss penis hygiene with his son? Or so mom doesn’t? Seriously, I’m sure some people do circumcise their baby boys to avoid having to discuss cleaning around the foreskin, why some penises have foreskins and why some don’t and all kinds of stuff regarding sex, genitals and culture that they probably intend to try to avoid discussing with their kids anyway!
“Odd to see that you find the idea of “pleasurably slid[ing] within the sheath of the foreskin” to be a highly “disconcerting” thing.”
Skeptic, the reason why I found that to be a disconcerting advantage is that some men may be so focused on their own pleasure that they completely dismiss the thought that their partner would be more comfortable with some vaginal lubrication. This advantage might also provide some men with justification for rape.
“Most of the arguments against circumcision are based on antisemitism.”
I just love how practically everything under the sun can be twisted into anti-semitism.
As another with extensive experience of circumcision in both babies and adults, I’m with Harriet — the argument is about evenly balanced.
I did, however, stop performing circumcisions in babies about halfway through my surgical career for another reason.
Any distress to the baby and also some of the risks are very dependent upon being able to perform the procedure by about the end of the first week of life. Harriet is absolutely correct in saying that the often ten-second distress seems easily forgotten by these younger babies, as is that of far more major procedures and stressful hospitalizations that some babies have to endure.
However, once neonatal circumcision stopped being a more or less regular event in my patient population, it became a late afterthought for many parents, and especially some grandparents. I was regularly being asked to perform the procedure on normal 2-3 month old babies, an age when a general anaesthetic is virtually essential if the baby is not to be greatly distressed and struggling throughout the procedure. I was unable to control this matter, and, eventually fed up with constant arguments with multiple generations of some families via desperate meat-in-the-sandwich mothers, I stopped performing baby circs altogether. In these older babies it is not a justifiable procedure, because of the added risks of the GA, more stress, and greater risk of complications.
That is how finely balanced the argument was in my mind.
PS Note that even some Supreme Beings have reached the independent conclusion that the optimum time for neontal circumcision is at about seven to eight days of life.
Fifi on 04 Nov 2008 at 5:44 pm “I wonder, do people here who consider themselves pro male circumcision also support female circumcision in Africa in its various forms?”
Speaking as one who is neutral (read, “confused”), I don’t think there is any comparison. In the extreme form, female genital mutilation is done to prevent enjoyment of sex; thus, keeping the wife from roaming. At the least, it doesn’t provide any of the minimal benefits claimed for males.
And, no, I am not neutral about that- it makes me angry.
Joe Said:
“In the extreme form, female genital mutilation is done to prevent enjoyment of sex; thus, keeping the wife from roaming. At the least, it doesn’t provide any of the minimal benefits claimed for males. ”
Ah but only in the most extreem form. Many cultures that practice FGM only perform either a type I Ritual circumcision:
The clitoris is wounded by pricking it with a needle or by pinching it so as to make a few drops of blood run. In Somalia even this way is called “sunna” or a type II Sunna: The covering of the clitoris is removed, not the clitoris itself.
In many places it is performed, such as Indonesia or Egypt, it is done by medical professionals. So the question is a good one. Why are we vehemently opposed to one, in even it’s mildest form, and not the other.
Joe – Are you sure there’s no comparison? Or are you just comfortable with what you’re comfortable with and not with something you’re not? Certainly there are men who feel that they’ve had their sexual enjoyment diminished and that they’ve been mutilated because they were circumcised. Of course, there are others who consider themselves more of a man because their penis is circumcised. Personally I find female circumcision horrific but it’s generally the women in the culture who keep the tradition going and perform the ritual cutting.
The history of male circumcision is pretty interesting. The form that’s usual in hospitals is actually a more extreme form that came into existence as a means to prevent circumcised Jewish men from “passing” as non-circumcised (the first form was much less extreme, essentially cutting off the tip of the foreskin). The history of how and why it became routine amongst Christians has a lot to do with Christian religious ideas and values including the desire to repress sexual enjoyment and prevent masturbation tied in with the idea that the genitals are “unclean”. The hygiene defense seems to have always been tied up in ideas about sex being “dirty” rather than science.
Fifi on 04 Nov 2008 at 6:44 pm “Joe – Are you sure there’s no comparison? Or are you just comfortable with what you’re comfortable with and not with something you’re not?”
As Dr. Hall said, concerning circumcision, there is no compelling evidence either way. I submit there is compelling evidence against female genital mutilation, and no evidence favoring it in any case. I am sure a doctor here will correct me if I am wrong in the latter case. Keep in mind that the range of practices for FGM range from the extraordinarily barbaric to the merely barbaric, I could have missed something.
Joe Said:
“Keep in mind that the range of practices for FGM range from the extraordinarily barbaric to the merely barbaric, I could have missed something.”
Actually, the range would be from much less severe than male circumcision to much more severe. And I bet I could find a potential benefit for you.
My only real problem with Dr. Hall is in this comment:
Right, so there are some men who “mourn” their lost foreskin. Would you be so dismissive of a woman who underwent circumcision? “So your clitoris has a split in it, get over it, girls!” Somehow, I think not.
The earring comparison is invalid in my opinion because the child can choose to take the earrings out later, thus undoing, for all intents, the procedure. Circumcision is in no way like this – you are physically changing another person based on your (not their) beliefs, religious or otherwise, which the child may grow up not to hold.
My opinion, for what it is worth: If you are in favor of circumcision, then choose that option for yourself when you are old enough to make that decision. Same goes for abortion, gay marriage and essentially any procedure/ceremony that involves no one but you.
I hate wading back into this shitstorm, which I thought I left behind a while back on the Dawkins board, but two issues deserve mention:
1) Female genital mutilation and male circumcision, whatever else you may think of them, are not equivalent, and barely analogous. FGM is always mutilitory, an exertion of power and control, and there is little controversy about its negative effects on the girl/woman.
Male circumcision, whatever individual experiences may be, is rarely viewed as an impediment in any way. Most circumcised men couldn’t care less. And saying something like, “but they don’t know what they’re missing” is simply showing how unlike FGM it is.
2) has to do with ethics, and i’ll come back to it later.
Joe1 on 04 Nov 2008 at 7:28 pm “Actually, the range would be from much less severe than male circumcision to much more severe. And I bet I could find a potential benefit for you.”
Then do it, don’t keep us in suspense.
Joe your wish is my command.
Female circumcision and HIV infection in Tanzania: for better or for worse? Stallings R.Y.1, Karugendo E. presented at the 3rd IAS Conference on HIV Pathogenesis and Treatment in 2005. They concluded in part that: “In the final logistic model, circumcision remained highly significant [OR=0.60; 95% CI 0.41,0.88] while adjusted for region, household wealth, age, lifetime partners, union status, and recent ulcer.”
http://tinyurl.com/d9uom
I just can’t figure out why the characterize it as a conundrum.
Joe1,
An abstract from a conference is not persuasive. Moreover, in this particular report, the definition of FMG is impossibly vague.
You need to cite reliable, medical literature.
IMHO, if circumcision is child abuse, then abortion is murder. Sorry, you can’t have it both ways. Why is cutting off a piece of useless skin (that can sometimes lead to medical problems down the road) right after a baby is born so awful compared to aborting an unborn child, which, depending on stage of pregnancy, may feel immense pain? Does anyone else see this parallel?
To me, you cannot be pro-choice (when the baby is in the tummy) and fervently anti-circumcision (when the baby is outside the tummy). It’s inconsistent. Is it because the baby has a soul when it’s born? At what point does the soul enter the body? The Jews believe it’s when it takes its first breath, but then again, they circumcise, so that’s no help.
There is no comparison between male and female circumcision. The latter is intended to reduce enjoyment of sex and prevent infidelity.
I’d like to know how men know that being circumcised as a baby has reduced their enjoyment of sex. They have nothing to compare their current situation to. But I suppose it’s a more novel excuse than a partner who is frigid.
As for the religious origins of male circumcision being intended to reduce enjoyment of sex because it’s “dirty”, well those folks are extremely slow to learn. Society isn’t exactly overrun with circumcised men who don’t enjoy sex.
I said it before in another thread about something entirely different, but I’ll say it again here because it’s appropriate: WTF?
Yeah, that threw me too, David.
Wrongo. Circumcision for men has also been advocated to reduce sexual enjoyment, especially in the Victorian anti-self abuse hysteria.
Joe you can certainly get the paper that presentation was based on if you want, I provided the reference if you want to follow it. However, you completely miss the point.
It was not to say that female circumcision is just fine because there may or may not be some demonstrable benefit. It isn’t even the point to demonstrate that there are wide variations of FGM about half are less then or equal to in severity to male circumcision. Which is in fact the case: http://tinyurl.com/5b5rlu It isn’t as you describe, barbaric and more barbaric.
It is the fact that these two issues are treated with an amazing amount of hypocrisy. We didn’t hear for further studies based on the results of that work, we shouldn’t because it shouldn’t matter. We have already decided that female circumcision is an appalling human rights violation and so do not even flirt with the idea of using it even if there is some hint at a benefit. And boys deserve the same respect for their bodies that girls are given.
Joe1 on 04 Nov 2008 at 9:29 pm wrote “It was not to say that female circumcision is just fine because there may or may not be some demonstrable benefit. It isn’t even the point to demonstrate that there are wide variations of FGM about half are less then or equal to in severity to male circumcision. Which is in fact the case: http://tinyurl.com/5b5rlu It isn’t as you describe, barbaric and more barbaric.”
Another, irrelevant citation. Can’t you learn?
Cite the possible benefit of FGM in reliable, medical literature.
You cannot do so. It is entirely the province of monsters.
I have learned. I demonstrated that FGM isn’t always as destructive as MGM. I have provided a potential benefit. Would you suggest further work to confirm or refute it? No of course not. When FGM is bounded to the two less extreme practices (which are the most common anyway) they are the same, and in fact the least extreme form of FGM is less damaging than MGM. The only difference are culturally blind people like yourself. They should both be illegal for anyone under the age of majority.
If male circumcision is considered to be a human rights violation of the same calibre as female circumcision, why are men still doing it? If the majority of men viewed male circumcision as a violation of their rights you can bet the practice would have ended long ago.
misschief said:
If male circumcision is considered to be a human rights violation of the same calibre as female circumcision, why are men still doing it? If the majority of men viewed male circumcision as a violation of their rights you can bet the practice would have ended long ago.
The same reason female circumcision continues in the parts of the world where it occurs like Indonesia or Egypt among other places. Belief in potential but trivial or imaginary benefits, cultural tradition, religious dogma, and failure to apply 20th century or rather 21st century medical ethics.
In countries where FGM occurs it is usually the women who perpetuated it onto their daughters, they often don’t feel it was a violation. Heck in Indonesia it’s done on neonates, just like males here. So how do they know what is missing? What reason would they have to stop it, they’re fine. It’s the same dance just a different tune.
David, ya I guess WTF is appropriate. I’m just trying to say that calling circumcision child abuse is a misuse of the term abuse. I’m sure that people who have experienced real child abuse would disagree with the flippant use of the term. Maybe that’s a better example. I just don’t think emotionally charged words like abuse should be so lightly thrown around. PETA is guilty of that, pro-lifers are too, and it doesn’t help their cases.
The standard of care used for all other pediatric surgery requires the medical benefits of the surgery to far outweigh the risks and harms of the surgery or for the surgery to correct a congenital abnormality. Non-therapeutic circumcision of healthy boys does not even come close to meeting that standard of care.
The fact that Jews and Muslims believe circumcision is a religious requirement is not a sufficiently good reason for American doctors to use a different standard of care for a boy’s penis than they use for all other parts of a child’s body.
[...] Circumcision: arguments for and against [...]
“Infant male circumcision was once considered a preventive health measure and was therefore adopted extensively in Western countries. Current understanding of the benefits, risks and potential harm of this procedure, however, no longer supports this practice for prophylactic health benefit. Routine infant male circumcision performed on a healthy infant is now considered a non-therapeutic and medically unnecessary intervention.”
College of Physicians and Surgeons of British Columbia
Circumcision (Infant Male)
http://www.cpsbc.ca/files/u6/Circumcision-Infant-Male.pdf
Dr. Hall, I find your information highly outdated and inaccurate. As a physician sharing your views, I find this highly unacceptable. At first blush, you appear to write an article that is neutral and unbiased but there are many contradictions. First, you discredit the circinfo site as being biased yet use it as a source. Then you use information from that site to construct your article. As a result, there are a great many inaccuracies. It appears you used pick and choose to find information to lead the reader on. It appears the message you were sending was “There is no difference so just do what you want.” For instance:
SENSITIVITY: There have been studies that show both no difference but there have also been studies by reputable researchers that shows highly significant differences. You also address prolonged intercourse attainable by circumcision but reasearch indicates that premature ejaculation may be caused by circumcision. The hypothesis is that tight circumcisions cause the penile shaft to be constantly pressed against the prostate gland and the undulating pressure during intercourse over stimulates it causing premature ejaculation. A small study of this overwhelmingly validated it. The respondents were women who evaluated whether their partners suffered premature ejaculation and whether they were tightly circumcised or loosely circumcised. Virtually all of the women who reported partners with tight circumcisions also reported they suffered premature ejaculation. In contrast, the women who reported their partners were loosely circumcised rarely reported premature ejaculation.
PSYCHOLOGICAL DAMAGE: Your response of “Get over it guys” was particularly inappropriate. Would you tell African women who have been circumcised to “Get over it gals?” In fact, it may be impossible to “get over it.” Laumann and Cohen in two separate studies found that circumcised men suffer impotency at signifcantly younger ages than genitally intact men. Anedotal evidence supports this. American men consume 54% of the world’s supply of Viagra, Malaysian men (Muslim and circumcised) consume the world’s highest percapita rate of Viagra type products and Israel is the world’s leading counterfieter of Viagra type products. See a trend here?
RISK: Three separate studies over a 20 year span have found that more than 200 babies die each year from their circumcision procedure. Indeed, a death in Canada was responsible for the country mostly abandoning neonatal circumcision. In a single two year period, the circumcision rate dropped from 17% to 6%. That is certainly a substantial risk and one that most parents would want to avoid.
COMPLICATIONS: Indeed complications should be avoided and the operator should be experienced but the plain fact is that most of the complications come from highly experienced operators, not beginners. In wrongful circumcision court cases I have seen in the last few years, they physicians seem to be confounded and unanimously report they have performed thousands of circumcisions during their careers.
PAIN: Your experience is directly contradicted by a study by The AMA conducted in Chicago in 1998. The purpose of the study was to investigate various methods of pain management and no pain management during the procedure. The evidence that these babies who received no pain management was so compelling that they stopped the study less than half way through the study. They found that the only adequate form of pain management was the subcutaneous ring block method. Additionally, another study completed at about the same time, they found that only 4% of circumcisers had ever used the ring block method. These two studies resulted in The AMA issuing a policy statement that adequate pain management should be used.
BREEDING GROUND FOR BACTERIA: Indeed it is a breeding ground! This is an oft used statement from circumcision advocates to convince parents to circumcise their sons. The fact is that there are colonies of beneficial bacteria over the entire body and inside the body. For instance, in the digestive system, there are more than 300 different bacteria present and without them, we would be in dire straits. These beneficial bacteria are also present in the preputial space and are essential for good health. As an illustration of the nature of these bacteria, after administration of antibiotics, these beneficial bacteria will be destroyed and absent. A popular homeopathic remedy is to apply plain unsweetened yogurt to the penis. If we are eating these bacteria, how could their presence be harmful?
HIV/AIDS: If circumcision had the protective effect reported in these claims, HIV/AIDS would be conspiciously absent from The US with 80% – 85% of sexually active American men circumcised. HIV/AIDS would have taken the same route as polio which was defeated with a vaccine with only 70% efficacy. The fact that the ethnic demographic group with the highest circumcision rate in America, African Americans also have the highest HIV/AIDS infection rate. The vectors of transmission would be significantly broken that the disease could only be present if it were constantly reintroduced into the country on a massive scale from Africa. That simply is not happening.
PENILE CANCER: Here is an obvious example of your bias. You quote 1/100,000 thousand in one instance but then quote 1/600 in another. Those figures come from two separate sources. Indeed, only 1 in 18,000 men in Sweden go to their graves without their foreskins firmly in place. Using your numbers, how is this possible. The truth that you should know is that both penile cancer and cervical cancer is caused by the same HPV virus and it is not exclusive to intact men by any means. You also seem to consciously ignore the availability of the HPV vaccine that holds the promise of wiping out the disease. Why exactly is that?
Do I need to go on? In the face of confirmed deaths, men with penises that cause pain during intercourse, an alarmingly high rate of circumcision induced meatal stenosis and the lack of evidence that circumcision benefits them in any way, should we continue the practice or should we abandon it until compelling evidence is present? Your writing indicates that it is a sum zero procedure but the evidence contradicts that view. We should abandon it if not prohibit it entirely. Already, two countries have banned the procedure, another is considering legislatively banning it, one has banned the procedure in all public hospitals, 17 states no longer pay for infant routine circumcisions with Medicaid funds and it appears another country is about to address the issue. Why should The US not take the leadership position and not take the same step?
.
It’s interesting how much of this debate really revolves around culture not medicine – even the beliefs that people believe they hold on purely rational and logical grounds. The reality is, most of us will have some kind of aesthetic bias towards the circumcised or uncircumcised penis based either on our own penis (if we have one) or our experiences of other people’s penises (or just cultural norms, with the circumcised penis obviously getting more air time). There aren’t too many people who don’t have a cock in this fight for one reason or another.
The reality is, one culture’s modification is another culture’s mutilation. Since, in our culture, we associate circumcision as a distinguishing ritual associated with Judaism, there have been cries of anti-semiticism leveled against people who speak out against it. This is a bit ignorant and ethnocentric because many other cultures also have male circumcision rites that have nothing to do with Judaism (with the circumcision being done as a ritual to mark a boy’s emergence into manhood). One also has to question whether everyone would feel quite so okay if a less established religious group started somehow changing babies’ genitals to obviously mark them as belonging to that religion (in some senses, circumcision is a form of religious branding). It brings up questions of individual religious freedom, as well as the obvious questions about ownership of one’s own body.
Genital modification seems to generally be related to cultural norms and meaningful rituals rather than physical health. The roots of circumcision in Christian culture and ergo modern hospitals, is just as tied up in cultural and religious beliefs as is female circumcision in other cultures. I find it interesting that circumcision in hospitals is based on a form of ritual religious circumcision that has more to do with religious identity than medicine. Medicine’s history vis a vis gender and genital modification leaves something to be desired, particularly vis a vis babies.
I do understand and appreciate that Harriet wrote this to offer up the science part but clearly, even in medicine, culture and religion have played a role in shaping how medicine treats male and female genitals. Not to mention aesthetics, with circumcised penises being more the norm in North America. For my part, I believe people have the right to make their own choices about religion and sex, and to their own body. While it may seem a bit silly to mourn one’s foreskin to many of us, there does often seem to be a sort of knee jerk dismissal of men’s feelings that all seems a bit macho. I do have to wonder, would a woman’s feelings about losing a breast be greeted with the same sort of attitude? Or if a religion decided to cut off baby girls’ labia for aesthetic reasons would we be so calm? (I do personally tend to feel that men who take on circumcision as an emblem of being oppressed and victimized are being lame and over-dramatizing. I do, however, also recognize I don’t have a penis so it’s a very different issue for me psychologically, socially and so on, and that I also have cultural and personal biases.) It would be kind of nice if we could just start accepting boys penises as they are individually rather than trying to constantly “normalize” people’s genitals (which usually means some surgical change AWAY from nature!).
Frank O’Hara’s comments boil down to “I hate circumcision and I can cherry pick studies and come up with some logical fallacies to support my bias.”
I was particularly amused by his support for bacteria. Sure, I eat yogurt – but I wouldn’t want to eat smegma!
Just to clarify one point: I found reports that the incidence of penile cancer in the US is 1 in 100,000 overall (including cirucmcised and uncircumcised), and 1 in 600 for uncircumcised men. The statistics may not be accurate, and they are confounded by the hygiene factor, but most sources agree that penile cancer is less common in the circumcised. I made it clear that fact does not constitute a recommendation for circumcision.
Would I tell African women who have been circumcised to just get over it? If their circumcision resulted in no more objective harm than the average male circumcision, I most cerrtainly would.
In fact, “just get over it” is pretty good advice for anything that can’t be remedied. No good comes from obsessive mourning or stewing in resentment. Life goes on. If you feel you were harmed, you can be an activist and try to prevent others from being harmed, but that doesn’t mean you have to cultivate personal misery.
Frank OHara wrote:
Um, somebody doesn’t understand what homeopathic means…I was enjoying your rebuttal but the credulous, and erroneous, invocation of homeopathic remedies is a rather obvious red flag that reduces your credibility.
“Probiotic” cultures are not homeopathic and you haven’t demonstrated that the topical application of yogurt to a penis is either “popular” or efficacious.
…and I wouldn’t want to eat the contents of your colon, but that doesn’t mean the bacteria there aren’t beneficial. Your flippant dismissal doesn’t wash either. I don’t know if there is a way to create a beneficial culture under one’s foreskin, but you haven’t proven the idea wrong. You are being flippant, not scientific.
You are making a false characterization in the sense that circumcision may not be reversible for those who’ve had one, but they are entirely preventable for future children. I don’t see your flippant attitude as being based on practical and proven efficacious psychological advice so much as dismissiveness and derision, again not scientific approaches.
Skeptic,
Your criticisms might be more credible if you took the time to read more carefully.
The question was not whether smegma contained beneficial bacteria. O”Hara had asked about the bacteria in yogurt: “If we are eating these bacteria, how could their presence be harmful?” The fact that we eat friendly bacteria in yogurt in no way implies that all the bacteria in smegma are harmless. There is more than one logical fallacy in his argument: I don’t think I need to spell them out for this audience.
As for preventing circumcision for future children, I said, “If you feel you were harmed, you can be an activist and try to prevent others from being harmed, but that doesn’t mean you have to cultivate personal misery.”
Regarding aesthetics – this appears to be very much a cultural thing. Women in the US, where circumcision is common, may prefer the look of a cut penis. But in the UK, where it is rarely performed except for medical reasons, they prefer them uncut.
It seems to be very much a case of prefering what is seen as “normal” rather than anything related to circumcision itself.
Dr Hall, in a previous comment you wrote:
“I found reports that the incidence of penile cancer in the US is 1 in 100,000 overall (including cirucmcised and uncircumcised), and 1 in 600 for uncircumcised men.”
You also stated that the statistics may not be accurate. I would just like to point out that these statistics cannot in fact be accurate for any population where less than 99,4% of the men are circumcised. (Do the maths yourself if you don’t believe me!)
The proportion of circumcised men in the USA is approximately 75% (Source: http://www.who.int/hiv/topics/malecircumcision/JC1320_MaleCircumcision_Final_UNAIDS.pdf)
Thus it must be concluded that the statistics that you posted above are indeed inaccurate.
Mike Hall – I’d agree that what people consider “normal” vis a vis both male and female genitals tends to reflect what they’re used to seeing, so is a social and cultural thing. There are a wide variety of genital modifications out there in various cultures (and a wide variety within our own culture these days).
At this point, porn seems to have a large role in defining what genitals (male and female) “should” look like. Not surprisingly, in the US at least, this has led to an increase in plastic surgery for genitals to make them look more “normal” (of course, they actually become less natural) or photogenic when shaved since that’s the current dominant aesthetic (if not practical) norm. Though, the retro trend towards bushy 70s era facial hair does indicate that the 90s inflated and shaved porn aesthetic may be on its way out.
As a circumcised young man, I can say that I wouldn’t have accepted it if I had the choice. It’s not because I have any real problems with it, but I find the way of thinking simply irrational.You don’t just cut off a part of your body because it makes your life a little easier. I mean nowadays many people don’t get out of their house, will we in the future begin to cut off the feet because people can’t take care of them and they stink? This is a very exaggerated example but you get the point. This shouldn’t be for the parents or the medical community to decide in my opinion. My circumcision was completely because of cultural conditions by the way.
Other than that, the high “HIV” rates in the US -and also in Africa- are more easy to explain through less strict criteria for the so called “HIV tests”, for example in comparison to Canada’s testing standards. Who is considered HIV+ depends not so much on the test results but also where you live and how your results will be interpreted:
http://www.healtoronto.com/wbchart.pdf
But this is being ignored of course…too uncomfortable. It’s easier to risk the health of millions of people…
The best way to prevent HIV infection and AIDS is through safer sex practices (AIDS is hugely complicated by malnutrition in Africa and horribly politicized by both the US and some African governments). Hopefully the US government’s abstinence based only approach both at home and in Africa will become more rational and less ideological with the election of a President who has a direct relationship with Africa.
Svante,
I agree that the statistics I found are flawed. If anyone has a source of more accurate numbers, please tell us.
Whatever the actual numbers, I didn’t find anything that contradicted the principle that penile cancer is less common in circumcised men (whether that’s attributable solely to better hygiene is a separate question). Penile cancer in circumcised men is unusual enough to warrant the publication of case reports in medical journals. I personally saw one case of cancer of the foreskin – that definitely could not have occurred if the foreskin had been removed.
Dr. Hall–I think the joke was on you! I would bet good money that the airman was either participating in a dare, or else just wanted to have an attractive woman examine his manhood and figured that was the easiest way at the time.
Lame-R,
I’ve seen a little of everything, from exhibitionists with erections to a lesbian patient who had a crush on me. If the airman was doing it on a dare, there was no way for anyone else to know whether he actually carried through. And he sure didn’t act like someone who wanted to display his wares. He acted like someone who illustrates the priniciple that military intelligence is an oxymoron.
Where to begin?
First off in spite of the title, there is no SCIENCE in this screed!
“There’s no good evidence that circumcised men get less pleasure from sex. Studies have shown little or no difference in sensitivity or sexual satisfaction with circumcision.
Sorry, but this indicates a total lack of research or an inability to critically analyse the scientifically-credible evidence…
Here is concrete evidence for loss of sensation and sensitivity:
http://www.nocirc.org/touch-test/bju_6685.pdf
Perhaps the author could present a logical rebuttal?
“If there were lowered sensitivity it might theoretically enhance pleasure by allowing more prolonged intercourse; and one man commented, “most [circumcised] men will tell you that if their genitalia were any more sensitive, it would cry during Meryl Streep movies.”
Anecdotal and suppositional nonsense at best.
“If some men are psychologically damaged by circumcision and mourn their lost foreskin, their mental health must be pathologically fragile. Get over it, guys”
Get your facts straight..
“Circumcision Causes Lifelong Harm, Concludes New Reearch
US attorney for children warns doctors, “The foundation is well laid for lawsuits.”
BOSTON (Tuesday July 25, 2002) – A new study on circumcision in the latest edition of Journal of Health Psychology concludes that the surgery may cause a host of psychological problems – including post traumatic stress disorder (PTSD) – in adults who have suffered the surgery as babies. The study is due on doctor’s desks this week.
“Half of all men who were circumcised may have some degree of PTSD. This is what happened to adults who were sexually abused as children, and parents are doing it to their babies,” said Steven Svoboda, Executive Director of Attorneys for the Rights of the Child, a lawyer and co-author of the study.”
“I don’t think there is any evidence that babies are capable of remembering the pain of circumcision or for that matter the birth experience. There have been studies suggesting that infant circumcision alters pain response later in life, but they are contradictory and unconvincing.”
Contradictory and unconvinincing? HOW?
“The risks are minimal if the procedure is done under sterile conditions by an experienced operator. Many of the serious complications documented in the literature were easily preventable. “Overall complications should approach zero for an experienced operator” especially if the safer techniques are used and contraindications like hemophilia and penile abnormalities are heeded.”
Really, and your assertion is contradicted by reality..
1. iatrogenic Phimosis 2.9%
2. Adhesions 71%
3. Meatal ulcers 31%
3. Meatal stenosis 8%
4. infection up to 10%
5. Bleeding <35%
1. JOURNAL OF UROLOGY, Volume 169, Number 6: Pages 2332-2334,
June 2003.
Outpatient Management of Phimosis Following Newborn Circumcision.
H. Jason Blalock, Vijaya Vemulakonda, Michael L. Ritchey, Michaelene Ribbeck
2. JOURNAL OF UROLOGY; Volume 164 Number 2: Pages 495-496, August 2000.
Penile adhesions after neonatal circumcision.
Ponsky LE, Ross JH, Knipper N, Kay R
3. CANADIAN MEDICAL ASSOCIATION JOURNAL, Volume 95: Pages 576-581,
September 10, 1966.
The Problem of Routine Circumcision
http://www.emedicine.com/ped/topic2356.htm
4. BRITISH JOURNAL OF SURGERY, Volume 80, 1231-1236, October 1993.
Williams % Kapila
HAWA PATEL, M.B., Ch.B. (Cape Town), D.C.H., M.R.C.P.(E),*
Kingston, Ont.
5. BRITISH JOURNAL OF SURGERY, Volume 80, 1231-1236, October 1993.
Williams % Kapila
HAWA PATEL, M.B., Ch.B. (Cape Town), D.C.H., M.R.C.P.(E),*
Kingston, Ont.
“A colleague told me he challenges his students to find any difference in babies who just had the procedure, and they can’t. Babies seem to get just as upset from lesser procedures like having blood drawn, and sometimes an irritable baby goes into a hissy fit just from being dressed or from being hungry. They cry uncontrollably for even trivial reasons, but they get over it promptly.”
So, anecdotes are now science?
“I used to do assembly-line circumcisions where we’d strap several babies to molded plastic restraining boards; they didn’t like being restrained, but by the time the last baby was restrained, the first one would usually have stopped crying and would often remain calm throughout the actual procedure, especially if he’d been given a sugar pacifier. Sometimes he’d even go to sleep.”
UNTIL you actually started the ripping, slicing and crushing– then comes the “sleep”–
Never heard of shock-induced “coma”? Do you expect rational people to actually believe this absolute nonsense? Would YOU sleep through having YOUR genitals ripped apart, sliced, and crushed?
” I used a Plastibell device: the actual cutting part of the procedure is painless even without anesthesia, because the tissue is already “dead” – the blood supply has been cut off by tying a string over the groove in the plastic ring.”
Painless? With ripping the foreskin from the penis, slicing it, and crushing it? Again, do you expect rational people to actually believethis nonsense?
Any evidence to support this assumption?
“Studies have documented physiologic changes during the procedure, but it’s not clear that those changes mean anything that really matters to the child’s mental state or physical welfare. It’s current practice to inject an anesthetic, but that carries its own small risk and also causes pain: it’s not 100% clear whether we’re using it for the infant’s benefit or the adults’. Some doctors still wonder if it might be kinder to skip the anesthesia and just get the procedure over with and the baby back in Mom’s arms as quickly as possible.”
So changes exist, but since you cannot concretely prove harm, you ASSUME that they are meaningless?
“Some of the arguments for circumcision are unavoidably intertwined with a separate issue: hygiene. The warm, moist space under the foreskin is a prime breeding ground for bacteria, it can harbor sexually transmitted disease organisms, and it produces a cheese-like, foul-smelling substance called smegma. It is plausible that this could contribute to infections in the man and his partner, and even to cancer. Many studies support that idea, others don’t. There doesn’t seem to be any good evidence comparing circumcised men to uncircumcised men who practice meticulous hygiene. It’s difficult to sort out whether it is the circumcision itself or just improved hygiene that makes the difference. Circumcision undoubtedly facilitates hygiene, but is that a reason to operate?”
Really, so your assumptions are now supposed to be science–I would prefer compelling and scientifically-credible EVIDENCE instead of your “plausible assumptions. Even the pro-circ AAP sates that this hygiene excuse is not valid..and what is this silly “meticulous” nonsense”? Does it apply to females also?
“Circumcision reduces the transmission of AIDS. Maybe. A 2008 meta-analysis of studies in Africa indicated that one case of heterosexually transmitted AIDS would be prevented by 72 circumcisions. It seems to be less effective at preventing male-to-male homosexual transmission. This gets confusing, because knowing they have had a risk-reducing procedure might increase promiscuity, and improved hygiene alone might reduce risk. Anyway, circumcision doesn’t remove the risk entirely, and safe sex is still necessary. Since there are other more effective ways to prevent AIDS transmission, few would argue for circumcision just for the purpose of AIDS prevention. ”
Logical disconnect here:
One of the most basic of scientific tenets requires a theory or hypothesis to fulfill it’s predicitons. This alleged “reductive effect does no appear in the real world.
Also, if one still needs a condom, it is illogical to amputate the foreskin anyway..
P.S. Studies have shown circumcised men are more reluctant to use condoms due to a loss of sensation from circumcision.
“Circumcision prevents penile cancer. The incidence of penile cancer is about 1 in 100,000 in the US. By one estimate, the lifetime risk for an uncircumcised man in the US is 1 in 600. The 5 year survival rate is about 65%”
Logically WHY do many intact countries have lower rates of Penile cancer than circumcising USA–SCIENCE is based on LOGIC!
“Penile cancer is almost never seen in circumcised men; such a case is unusual enough to be written up as a case report in a medical journal.”
Nonsense do some research!
“In third world countries where hygiene is poorer and circumcision is less common, penile cancer causes up to 10% or 20% of cancers in men.”
Supporting evidence?
“Disgusting photos can be seen at http://www.circinfo.net/cancer_of_the_penis.html”
Scare propaganda! Plain and simple
“The current consensus of most experts is that circumcision should not be recommended as a prevention strategy for penile cancer.”
So, why then are you presenting this pro-circumcision -penile screed?
“Reduced risk of urinary tract infection. Several studies have shown that circumcised baby boys have fewer UTIs but the reduction is small and this study suggests confounding factors might be responsible. ”
Then the studioes are not credible if they are flawed–BASIC scientific tenet!
“Reduced risk of balanitis (inflammation of the glans penis). Most studies show balanitis is more common in uncircumcised males, but at least one study indicated that it was more common in circumcised males, especially in early childhood.”
If not consistent, than not credible.
“Reduction of the incidence of various sexually transmitted diseases in men and in their female partners.”
WRONG! get your facts straight.
“Reduction of cervical cancer and maybe even breast cancer in women. Again, these are likely more related to hygiene than to surgery.”
This nonsense was rejected decades ago, why are you repeating it now?
“Circumcision prevents phimosis (the inability to retract the foreskin) and paraphimosis (a painful inability to pull the retracted foreskin back down). Paraphimosis can obstruct urine and blood flow and is a medical emergency. ”
Hardly PREVENTS–the rate of iatrogen phimosis (from circumcision) is higher that actual phimosis.. And without “foreskin fiddling” the rate of phimosis is only:
The Finnish National Board of Health provided national case records for the year 1970 for both phimosis and paraphimosis. A total of 409 cases was reported for males 15 years and older,which represents only 2/100ths of 1% (0.023%) of the total male population in that age group. This means that 99.97% did NOT develop a problem. Moreover, according to Finnish authorities, only a fraction of the reported cases required surgery– a number too small to reliably estimate.
Wallerstein, Edward, CIRCUMCISION: AN AMERICAN HEALTH FALLACY p.128
“About 10% of uncircumcised infants will require circumcision later in life for medical reasons.”
WRONG!
First of all, for a man who was not circumcised as an infant the chances of him having to get circumcised as a adult are extremely rare. In fact it’s only 6 in 100,000. (0.006%)
Health officials of each Scandanavian country were queried about adult circumcision.. None of the health officials could provide precise data, because the numbers were so small that they weren’t worth compiling. Each official stressed that foreskin problems were present but said they were largely treated medically-surgical solutions were extremly rare.
“in Oslo, Norway, over a 26-year period in which 20,000 male babies were cared for, 3 circumcisions were performed-a frequency rate of 0.02%.
In Denmark. 1968 children up to the age of 17 were examined over a period of several years. In this group, 3 circumcisions were performed-a frequency of 0.15%. In this study, in retrospect, the physicians believed that all three operations might have been avoided. Both of these studies related to the infrequency of circumcision and puberty, they did not deal with the issue in adulthood.
Wallerstein, Edward, Circumcision: An American Health Fallacy. pg 128
“Adult circumcision is more expensive, more difficult, riskier, requires stitches, and causes more suffering than neonatal circumcision. The conditions that lead to the medical necessity for circumcision also cause suffering that would have been avoided by neonatal circumcision. ”
It is estimated 230 INFANTS die directly or indirectly from circumcision –not a SINGLE death from adult circumcision. ANY proof that for these other assertions?
“Hygiene. It’s easier to keep a circumcised penis clean. Certainly it’s a convenience, but that doesn’t constitute a medical indication.”
Even the pro-circ AAP disputes this assertion.
“Aesthetics. Women allegedly prefer the appearance of a circumcised penis. Even if true, not a medical indication. ”
Only American, Jewish, and Muslim women–80% of the women in the world prefer a normal penis.
“Zipper injuries to the foreskin can’t occur if you don’t have a foreskin. True, but trivial.”
Yeh, it is better to catch the exposed more sensitive mucuosal tissue that the less sensitive outer foreskin skin….can we get sillier?
“What all this really boils down to is that there are no compelling scientific arguments for or against neonatal circumcision.”
No, what it boils down to is that the SCIENCE boils down to is it cannot be justified and certainly not by all of these silly assertions picked up from Brain Morris’s site.
“There are small risks and there are small benefits. The decision is not a medical one. Medical organizations are not “pro” circumcision, but they’re not “con” either. The American Academy of Pediatrics’ official policy states:
Wrong again, there is NO scientifically credible evidence of ANY medical benefit..not a single PROVEN benefit, but much scientifically credible evidence aginst it
“I used to live in Spain, where you could tell girl babies from boy babies just by looking at their ears: all the baby girls had their ears pierced in the delivery room. That was a “mutilating” procedure with no conceivable medical benefit and a small risk of infection, deformity, or ingestion of earring parts. It was nowhere near as controversial as circumcision. I wonder why.”
Can we get any sillier? How many girls had their ears amputated?
I AM a scientist (biochemist) and this article tells me nothing about science and circumcision, however it does tell me that the author lacks any baisc understanding of science or the scientific process.
A hint to the author, science is NOT collecting questionable talking points (cherry-picking) about circumcision from an uber-circumciser whose hobby is traveling to witness and photograph mass circumcisions.
BTW Some of us seem to be better educated on the “plastibel” form of circumcision than you appear to be. May I suggest you do some research on it–it is requires ripping the foreskin from the penis, slicing it and then crushing it (HARDLY painless) –AND it seems to have the highest rate of complications.
If someone used cancer of the labia as a justification for cutting off the labia of infant girls, people would be outraged.
In my opinion there is no ethical difference between using cancer of the labia as a justification for cutting the genitals of girls and using cancer of the foreskin as a justification for cutting the genitals of boys.
The standard of care for pediatric surgery requires the medical benefits of the surgery to far outweigh the risks and harms of the surgery or for the surgery to correct a congenital abnormality.
Dr. Hall, is there any surgical procedure besides male circumcision that doctors will perform on a child that does not meet that standard of care?
Yes: ear piercing. A small risk and no conceivable medical benefit. Infection, bleeding, contact dermatitis, keloid scars, ingestion of earring parts, buried earrings, torn earlobes, permanent deformities.
There is a clear consensus that cancer prevention by itself is not sufficient justification for neonatal circumcision. See the quotation from the American Cancer Society in my article.
I don’t think anyone does a circumcision solely to prevent cancer; I think most people have strong feelings either pro or con and just use medical arguments to rationalize a decision they have already made on more emotional grounds. Humans are not very rational: if we were all like Mr. Spock we would all agree instead of fighting the circ wars.
BDwyeron wrote:
Harriet Hall responded:
Is ear piercing surgery? Either way you, I think, dodged the question:
Does circumcision meet the ordinary standard of care? It seems not.
Most medical societies don’t recommend circumcision. Several are quite negative.
American Academy of Family Physicians. Position Paper. February 14, 2002.
The small medical benefits of circumcision lead many to consider routine circumcision to be a cosmetic procedure. This leads to questions regarding medical ethics. http://www.cirp.org/library/statements/aafp2002/
American Academy of Pediatrics. Policy Statement. March 1, 1999.
There are anecdotal reports that penile sensation and sexual satisfaction are decreased for circumcised males. http://www.cirp.org/library/statements/aap1999/ (Some reports state that on a scale of 10 to 1 sensation was reduced from 10 to 3 or less). http://circumcision.org/adults.htm
Royal Australasian College of Physicians (six medical groups in Australia and New Zealand). Policy Statement. September 2004.
There is no medical indication for routine circumcision. Reports of complications vary from 0.06% to 55%. Circumcision may contravene human rights. http://www.racp.edu.au/download.cfm?DownloadFile=A453CFA1-2A57-5487-DF36DF59A1BAF527
Canadian Pediatric Society. Policy Statement. 1996.
A recent report has described numerous nerve corpuscles in the inner mucosal surface of the prepuce. Circumcision of newborns should not be routinely performed. http://www.cps.ca/english/statements/FN/fn96-01.htm
College of Physicians & Surgeons of British Columbia. Policy Statement. June 2004.
Circumcision removes the prepuce. The prepuce is composed of an outer skin and an inner mucosa that is rich in specialized sensory nerve endings. Circumcision is painful, and puts the patient at risk for complications ranging from minor, as in mild local infections, to more serious such as injury to the penis, meatal stenosis, urinary retention, urinary tract infection and, rarely, even hemorrhage leading to death. Circumcision is not a recommended procedure; it is non-therapeutic and has no medical prophylactic basis; it is a cosmetic procedure. Ethics points us to corrective vision i.e. to question practices that have become routine. http://www.cirp.org/library/statements/cpsbc2004/
College of Physicians & Surgeons of Saskatchewan. Memo. February 2002.
You can, and should respectfully decline to perform the procedure [circumcision] just as you respectfully decline to carry out other requested medical acts that you regard to be inappropriate.
http://www.cirp.org/library/statements/sask2002/
British Medical Association, United Kingdom. The law & ethics of male circumcision, guidance for doctors. June 15, 2006.
Doctors must consider whether their decisions impact on a person’s human rights. The BMA does not believe that parental preference alone constitutes sufficient grounds for performing a surgical procedure on a child. The BMA considers that the evidence concerning the health benefit from non-therapeutic circumcision is insufficient for this alone to be a justification for doing it. http://www.cirp.org/library/statements/bma2003/
So, is there a single scientifically-proven benefit for circumcision?
There are MANY proven harms from circumcison….
If the answer to the first is no, then there is no rational reason for circumcision and hence it cannot be justified.
If it cannot be justified than it is unethical and a violation of the victim’ most basic human right–that of bodily integrity.
What does this say about parents who request, and more importantly, about those who do them?
This isn’t a debate with an easy answer (like many questions to do with sex and gender, and both those rear their…ahem…head in these discussions). I don’t think demonizing anyone is particularly constructive and it all ends up stinking a bit like personal bias.
It’s reasonable to conclude that most parents think they’re doing the best thing for the child. Ditto doctors. Whether they’re mistaken in their assumption is unclear since there doesn’t seem to be conclusive evidence regarding impact and most people seem to be choosing to accept the evidence that confirms their bias and reject that which doesn’t. The majority of parents who have chosen to circumcise their children think they’re doing it for their child’s own good (but then let’s not forget parents tend to tell themselves that when they’re hitting their children too!) Doctors have the same reasons.
However, I suspect that many doctors would have a hard time accepting that something they did as a routine thing (thinking it was good and beneficial) actually ended up being cruel and medically unnecessary? (This is born out by the reactions of some doctors who performed sexual assignment surgeries on babies to streamline them into whatever sex was surgically easier based upon Dr John Money’s theories regarding gender and sex. Incidentally, his most famous case was a boy who had his sex reassigned as female after a botched circumcision.) Innocent ignorance is one thing, willful ignorance based upon personal bias and denial of evidence is another thing all together. One involves being mistaken, the other complicit. (And I include feminists who couldn’t adjust their theories about gender and sex to acknowledge new evidence as being willfully ignorant too. Though they’re generally wielding pens and placards not scalpels, ideas have power too.)
There’s also the issue of bias. Is the doctor themselves circumcised? Have they circumcised their children? If it was proven that circumcision reduced sexual pleasure for men, how easy would it be for a circumcised man to acknowledge he’s lost out? I mean, it’s not like men identify by and with their penises to a larger or smaller degree depending on the man! And why would we dismiss reduced male sexual pleasure but not female? (Clearly once the opposite was the case, I don’t see how this would be any less imbalanced!)
Of course, at this point we don’t have clear answers to many of the questions circumcision raises and there are a lot of assumptions going on. While it can sound sensationalist to speak about circumcision as sexual abuse, a lot of how things “sound” have to do with what we consider “normal” and accept (to put it in perspective, many people in the world consider female circumcision normal while others consider it sexual abuse). We don’t dismiss or allow sexual abuse of children simply because we hold a personal belief they’re too young to remember suffering (there seems to be evidence for both perspectives). It seems to me that there’s a historical tendency to dismiss the suffering of children that is often accompanied by an explanation about how the abuse is “for the child’s own good”. This is also a common refrain in authoritarian religions as well.
To highlight just how complex this issue is, my personal bias is towards accepting people as they are and allowing adults to make their own choices about their bodies. I’m very happy to live in a time when it’s been acknowledged that homosexuality is natural, that people of all colors are equally human and having genetic differences doesn’t change that, ditto women being just as human despite not being men. So it could easily be said that I’m a proponent of “bodily integrity” – which I am in many ways. However, if we take that to a logical extreme then I’d have to advocate no medical intervention ever – which is clearly silly and not in a child’s best interests all the time either (in fact, it could be considered negligence and a form of abuse itself).
The reality is that in most countries that don’t have sexual health policies based on religious morality, circumcision isn’t recommended by pediatricians as being a medically desirable procedure. It’s not warned against either (however that could be partly because it’s such a potent hot button issue in terms of culture). American culture still has a very unique and strange relationship with natural sexuality and the body.
Personally, what I find fascinating is that (from what I’ve read) the extreme form of circumcision that is practiced today seems to have emerged mainly from a desire by Rabbis to prevent ancient Jews from faking being gentiles by stretching their remaining foreskins to appear uncut.
Like non-therapeutic male circumcision, ear piercing is a form of permanent body modification.
Dr. Hall, what other forms of permanent body modification besides ear piercing and male circumcision do you feel it is ethical for a doctor to do to a child?
Would it be ethical for a doctor to pierce a boy’s penis if his parents requested it for cultural or religious reasons?
Would it be ethical for a doctor to brand or scarify a boy’s back if his parents requested it for cultural or religious reasons?
Genital piercing, branding, and scarification are less severe forms of permanent body modification than male circumcision.
BDwyer,
My article was on what science shows, not on ethics. I deliberately did not say whether I personally thought circumcision or ear piercing was ethical or unethical. I don’t think my personal opinions are relevant.
Science is the same everywhere and we can reach a consensus about what the evidence shows. We can’t do that with ethics. Ethics vary with time and place; churches once supported slavery. People disagree about things like abortion and body modification.
In this time and place, some people choose circumcision and others don’t; some think it is ethical and some think it isn’t. I can understand and respect both viewpoints and try not to judge people.
Your opinion that genital piercing, branding, and scarification are less severe forms of permanent body modification than male circumcision constitute a value judgment that not everyone would agree with. Circumcision is unique among the procedures listed in that it is not simply a cosmetic, cultural or religious procedure, but one for which there is some evidence of health benefit, whether or not you feel that benefit justifies the risk or outweighs the ethical considerations.
Harris Hall,
Unlike medicine, science is not a collection of opinions–deciding what is valid and what is not. It is a process with a rigid and essential set of qualifications.
1. any conclusion based on known flawed data cannot be considered valid.
NONE of the “studies” purporting benefits for circumcison are flawed–many fatally.
2. The worth of a hypothesis and/or theory is dependent on it’s ability to make accurate predicitions iof unable to do so, then they are not credible.
NONE of the alleged benefits for circumcision manifest in the real world (empirical evidence).
Now I probably spent more time and effort on refuting your asssertions and commenting on the facile and unsupported ones than you did copying and pasting them from BM’s site.
Do you intend to offer anything resembling a counter-rebuttal–or just pick and choose which and who you respond to (mostly with flippant and facile remarks)?
Now if there are no scientifically proven benefits, CAN the forced amputation of one of the body’s part ever be ethically justified?
“Circumcision is unique among the procedures listed in that it is not simply a cosmetic, cultural or religious procedure, but one for which there is some evidence of health benefit,”
This assertion only applies IF you can provide proof for the existence of these alleged benefits, and so far ALL of those you provided have been refuted–so can we expect you to support those assertion by refuting the rebuttals?
As stated before , you seem to lack basic understand of what science is–it is NOT medicine. Medicine has very little SCIENCE, and a lot of beliefs and nonsense.
Correction:
“NONE of the “studies” purporting benefits for circumcison are flawed–many fatally.”
ALL of the “studies” purporting benefits for circumcison are flawed–many fatally
With all due respect, it does seem that cultural bias even seeps into the medical science in this case, which is hardly surprising since religion and personal beliefs have always had a large influence on any aspect of medicine involving sex, gender and sexuality. The root of circumcision in Christian European culture and America seems very much to be a puritanical belief that was sold as a medical necessity. It seems a bit odd to me to just brush this aside, as if it has no relevance.
As noted before, many doctors who have performed circumcisions already have a bias (since, one would hope, that they wouldn’t have performed the surgery if they didn’t consider it in the patient’s best interest at the time….the patient being the child not the parents). I don’t say this to demonize anyone or doctors, doctors are people and come in all flavors and circumcision was a routine procedure in hospitals at a certain point (as was recommending formula over breast feeding) and a cultural norm. I’m pointing out that if one DOES do or has done circumcisions because one holds the belief that there are only positive outcomes to the surgery or at the very least no potentially negative ones or undue suffering for the patient in the moment or the future, then one clearly has a bias, an active bias in fact since one is personally implicated in the issue as an actor and it directly confronts the medical ethos of “first do no harm” and a person’s belief they did or are doing no harm.
Not that having a bias means one can’t absorb new information or change practice when one learns something new. Or that most nations and doctors that base their health policies on science haven’t changed their policies regarding circumcision. Certainly in Canada, Australia and New Zealand circumcision is not promoted or suggested by medical organizations as being a healthier choice or medically necessary or superior. Another example is how Dr Moran doesn’t do circumcisions on older babies for ethical reasons based on the current science (ethics do enter into this discussion, simply because what was previously recommended and no longer done was grounded in a moral/ethical belief not science, even though science was used to promote the practice).
This IS a complex ethical question, as are many of the issues in areas where science and cultural beliefs potentially confront each other. Certainly scientific studies can guide us but considering the history of this surgery in medicine and previous bias, it’s worth keeping in mind that few of us are free from bias and that medicine has a history of bias vis a vis sex, gender and children that came from a religious/moral aspect of our culture and, despite many very constructive changes based on new research and changes with the larger culture.
Just worth noting, how we regard and deal with pain in ourselves and others is learned, it’s cultural. So we all already have some bias towards how we believe others SHOULD feel or experience (or at least express) pain and suffering. If we tend towards stoicism and denial culturally and have incorporated that into our personality/identity, we’re more likely to dismiss the pain of others as trivial and the expression of suffering as being worthy of derision. Overall, general American culture does tend to be highly derisive of sensitivity or suffering in, particularly, straight men (perhaps due to the association of having feelings with being homosexual). This isn’t true of all European cultures obviously but seems particularly tied in with Protestant and Puritanical Christian cultures (Jewish cultures, from my understanding, seems to elevate male sensitivity and, in the orthodox variety, often more or less dismissal of women emotional and psychological life).
Let’s not forget that mothers and aunts that circumcise their daughters also believe they’re doing no harm and it’s for their daughters’ own good (as their mothers and aunts believed when they did the same thing to them).
I personally find this issue fascinating – partly because it IS complex and means I have to examine my own biases and reactions based in cultural expectations. It forces me to examine my own ethics and the complex ethical questions that our advances in practice and scientific understanding bring. Of course, the only way we’re ever going to deal with any of the very complex issues that new research and practices give rise to – in great part because they DO conflict with religious/moral/cultural beliefs (such as the US’s stand on stem cell research) – is to discuss the issues, as tempting as it is to just take a black or white stance and retreat to the simplicity of certainty in the face of complexity.
Fifi,
With all due respect, I cannpt believe that mere BELIEF one in not doing harm and doing good when the facts prove otherwise cannot justify doing it.
Beliefs have caused both good and bad, and merely BELIEVING one is not doing harm is insufficient to make something acceptable, let alone good.
Relativistic morality cannot make something good and the obverse bad–this is determined by the facts. FACTS are not complex!
This leads me back to the fundamental question: can a procedure that has no proven benefit and with proven harm and pain EVER be ethically justified?
One does not take UNNECESSARY risks and deliberate harm when it applies to another being based merely on a belief to the contrary.
Consult – What one can and cannot believe is indeed part of the issue here, and your belief about beliefs is….a belief! So, we can discuss beliefs but I see no reason why your beliefs should trump anyone else’s since, as I pointed out, this is an issue that we all bring some form of bias to discussing.
You seem to believe your position is based in fact and that your position can’t possibly contain any bias (it actually quite clearly does from the way you write about your beliefs as being fact, since the actual evidence doesn’t actually confirm your position, or so it seems to me). Dr Hall believes (or so it seems) that she’s presenting unbiased facts and evidence. I do understand it’s tempting to see issues such as this as hermetic black or white issues, righteous certainty has a very strong emotional appeal and there’s often an accompanying personal element that has to do with one’s self identity (particularly as a “good” person in contrast to someone else’s “evil”, or as a victim or healer) which adds to complexity.
Facts are often complex, particularly when there is evidence that is incomplete or contradictory. To claim they are simple and one’s personal ideological position is factual based on cherry picked facts/evidence simplifies things but it’s essentially not an honest reliance upon facts/evidence but rather an attempt to make the facts fit one’s belief. My bias is towards not modifying babies’ genitals for a variety of reasons, some evidence based and some having to do with my personal sense of ethics regarding children’s rights and individual freedom. However, I don’t assume that my position has absolutely no bias and can acknowledge that there are conflicting facts and a lot of cultural issues that inform the complexity of discussing this issue.
Sorry Fifi, but MY belief is based ON scientific facts… not contradicted by it. Science has no bias.
The people who believe in circumcision base their beliefs on contradicted facts…or irrational assumptions.
Hall’s beliefs can hardly be unbiased if her beliefs are contradicted by the scientific evidence…and so far she has not provided any rational counter-rebuttal to the rebuttal to her assertions..so where do we stand?
SCIENCE is either black or white, and no amount of non scientifically credible belief can hardly change that.
SCIENTIFIC certainty IS unemotionally righteous.
If one does a scientifically critical analysis, one can weed out “facts” and FACTS. They are not subject to any bias. Either they can stand up to scientific scrutiny or they cannot.
Please go back and read the basic and fundamental requirements…they provide a starting point for this analysis.
Again the fundamental questions remains:
Can a procedure with no proven benefit and with proven harm be ever be morally and ethically justified?
Consult,
No, I don’t intend to respond to your comments. By calling my article a “pro-circumcision screed” it is obvious that you did not understand it. If you are a scientist, you should realize that citing individual articles does not refute a conclusion based on the entire body of published literature. And you should realize that emotional language and personal attacks are uncalled for.
I do thank you for bringing to my attention that article saying that circumcision causes post-traumatic stress disorder in half of circumcised men. I almost fell out of my chair laughing. That idea is a perfect example of how people’s preconceived ideas can interfere with their judgment.
Consult – I’m not sure that you actually understand the scientific process if you believe that there’s no room for dissention and disagreement in science or gaps in knowledge or room for error. The scientific process exists exactly because science acknowledges that individuals are biased so the process is intended to limit and mitigate bias as much as possible, it doesn’t claim perfection (though you clearly are claiming some form of absolute knowledge for science). What science does is offer us the best evidence available at this point in time which we can then use to inform our choices, this best evidence is usually replaced with better evidence that may or may not change choice. Science is not infallible, it’s practiced by people after all
You also seem to be woefully ignorant of the intertwined history of science and medicine, and both the historical and current limitations of medical science. I do think it’s a shame that Dr Hall won’t discuss the science or ethics – mainly because, whether she recognizes it or not, she’s made her own bias towards a belief that it’s harmless very clear through her own emotional asides. Let me be clear, I’m not saying that I see Dr Hall as having a pro-circumcision stance from what she’s written here. What I see is a bias towards believing that babies don’t remember the pain and there are no negative effects (so she didn’t cause any lasting damage to a baby, something I’m sure she’d never purposely do). The other thing she expressed was an emotional and cultural belief regarding pain – we all have them, of course. Personally I think it’s pretty impossible NOT to bring a personal bias to discussions such as this for reasons already laid out, that’s why it’s worth discussing the science and ethics to inform our understanding of the choices we make individually and collectively.
“No, I don’t intend to respond to your comments. By calling my article a “pro-circumcision screed” it is obvious that you did not understand it. If you are a scientist, you should realize that citing individual articles does not refute a conclusion based on the entire body of published literature. And you should realize that emotional language and personal attacks are uncalled for.”
Oh, you feel attacked, so you can use this as an excuse to NOT address the rebuttal–how convenient. I have seen this more often than I wish to remember.
I am aware that citing a study is not evidence. I know that it must survive a vritical analysis.. something you seem NOT ro realize. I am not attacking you personally–only your understanding of the scientific process and an attemopt to redefine it as mere OPINIONS.. It is YOu that actually seem to believe citing studie is sufficient s as that is all you have provided. You have NOT refuted the rebuttal of those studies YOU have merely cited.
ANY part of an entire body must stand or fall on it’s own, Science dictates this. You seem to believe that a consensus is all it takes to validate a position.
Don’t confuse medicine and science–one is opinions and beliefs, the other is credible evidence…fulfilling definite and rigid requirements.
“I do thank you for bringing to my attention that article saying that circumcision causes post-traumatic stress disorder in half of circumcised men. I almost fell out of my chair laughing. That idea is a perfect example of how people’s preconceived ideas can interfere with their judgment”
Thanks for yet another flippant dismissal of the information.. perhaps you might provide something approaching a rebuttal. Sounds like someone indeed dismissed the evidence due to a preconceived idea. But God forbid it might be yours and not mine.
Now do you plan on discussing all of the other points, or merely cherry pick those you wish to dismiss as you did with this one?
Fifi, you can try to redefine science all you wish, but without fulfilling it’s requirements, any idea it is mere conjecture.
Science is not politically correct. It is NOT a political discussion where both side must be given equal value or credence.
There is plenty of room for discussion, BUT the side that has no scientifically-credible evidence is hardly on par with that with the supporting evidence–discussion will not alter that. So there comes a point where discussion offers nothing.
One can believe that gravity doesn’t exist due to some bias, but it will continue to do so regardless of any discussion.
I don’t know if I am getting the concept across.. I can only continue to lay one thought upon another to try to convey the whole process. I do not type will enough to cover the entire subject.
When doctors ignore the standard of care that is used for all other pediatric surgery in order to accommodate a cultural and religious practice, medical ethics is relevant.
The standard of care for pediatric surgery requires the medical benefits of the surgery to far outweigh the medical risks and harms or for the surgery to correct a congenital abnormality. Non-therapeutic circumcision does not even come close to meeting that standard of care by any objective scientific analysis.
The best that can be said about non-therapeutic male circumcision is the medical benefits are about equal to the medical risks and harms. “About equal” falls far short of the required standard for pediatric surgery.
In terms of severity male circumcision is similar to cutting off the hood of a girl’s clitoris or cutting off her labia minora.
Body piecing, branding, and scarification do not remove healthy tissue from a person’s body. Male and female circumcision remove healthy tissue from a person’s body.
Therefore it is an objective observation that cutting off a boy’s foreskin or cutting off the hood of a girl’s clitoris is a more severe form of permanent body modification than piercing, branding, and scarification.
Harriet,
I understand that you were providing a scientific analysis of the pros and cons, and I appreciate that. I found it useful. One thing to keep in mind on the sensitivity issue is that circumcised men can’t give an informed opinion on it (if circumcised as infants). Uncircumcised men can, because they can always pull back the foreskin. And at least in my case, there is no way the glans could be as sensitive if circumcised (couldn’t wear pants, have oral sex, etc.).
That small issue aside, as you well know, medicine doesn’t consist only of science. You never addressed the key point raised here (by Skeptic):
“Being “neutral” about a non-indicated elective, body modifying, aesthetic surgery with functional side effects, a surgery forced on children without their consent, is, I think, ultimately “pro” circumcision.”
And I must agree with Skeptic that the last paragraph of your post is ridiculous.
I’d like to add that I don’t support piercing the ears of infants either, but it is not comparable to circumcision.
For those who believe circumcision reduces sensitivity, see http://www.circlist.com/considering/sensitivity.html I stand by my statement that there is little or no difference in sensitivity or sexual satisfaction.
Being neutral is not being pro – it is being tolerant of both those who are pro and those who are con, which is a very different matter.
I’ll say it once more: the evidence shows a small benefit and a small risk from circumcision. It is not medically indicated but it is not medically contraindicated either.
And from a purely ethical standpoint, I think ear piercing for purely cosmetic reasons is less justifiable than circumcision chosen by parents who believe (whether rightly or wrongly) that it is in their child’s best interests.
“For those who believe circumcision reduces sensitivity, see http://www.circlist.com/considering/sensitivity.html I stand by my statement that there is little or no difference in sensitivity or sexual satisfaction.”
Here is yet another example of why I don”t believe you understand the scientific process..
You were given concrete scientific evidence of sensation and sensitivity loss:
http://www.cirp.org/library/anatomy/taylor/
&
http://www.nocirc.org/touch-test/bju_6685.pdf
And what do you post to support your assertions–a collection of anecdotes by the Bailey group.
“Being neutral is not being pro – it is being tolerant of both those who are pro and those who are con, which is a very different matter.”
Science is not neutral–either something is valid or it is not. And so far you have provided no scientifically-credible evidence to support circumcision..so until and if you do provide such evidence your assertions are NOT valid (and not neutral).
“I’ll say it once more: the evidence shows a small benefit and a small risk from circumcision. It is not medically indicated but it is not medically contraindicated either.”
You can repeat this until the end of time, but we need something a bit more concrete that your repeating it and merely citing queationable studies. Care to try your hand at providing a counter to my rebuttal to your assertion?
Repetition is also not science.
“And from a purely ethical standpoint, I think ear piercing for purely cosmetic reasons is less justifiable than circumcision chosen by parents who believe (whether rightly or wrongly) that it is in their child’s best interests.”
Since both are merely cosmetic–how can you say either are justifiable–parental beliefs have no effect on reality or outcomes…harm is harm.
Consult – No, I’m not redefining science and I in no way was saying that all knowledge is equal, I was saying that science doesn’t have absolute knowledge. You’re the one that’s redefining science by pretending it’s an omniscient religion that can determine what is morally right and wrong. Science is a body of knowledge, the scientific process is a what is used to gather and test this knowledge. Scientific knowledge is fluid and ever changing simply because it’s about building upon or refuting previous understandings.
I do wish Harriet would just address studies that people believe prove their anti-circumcision position and say why she doesn’t think so since this blog is theoretically about the science. However, it’s her blog so her choice obviously.
For the record, I don’t personally think ear piercing is analogous to circumcision on a physical level but as a cultural ritual it is in some ways (though it IS interesting that we accept aesthetic body modificiation of baby girls as aesthetic but justify male body modification as being medical or spiritual). I also don’t think male circumcision is the same as cutting off the clitoris (cutting off the head of the penis would be more analogous to cutting off the clitoris). However, like with male circumcision, there are cultural variations and not all female circumcision involves a clitorectomy. It’s also worth listening to the voices of people within the culture about their practices.
As I’ve already said, I advocate erring on the side of caution and leaving babies’ genitals intact. Certainly cosmetic genital surgery on babies seems to be more about a parent’s desires than anything else. I personally do think parents are being done a disservice if they’re told by a medical professional in the US that there’s no downside and it’s just kinda of a neutral issue. This certainly isn’t the perspective taken my medical organizations in other countries of European descent who don’t have a public sexual health policies that are heavily influenced by religion.
http://tierneylab.blogs.nytimes.com/2007/11/30/a-new-debate-on-female-circumcision/
A quick read of the work presented at that site show some potential problems:
These were adult men seeking circumcision, from a culture that promotes circumcision.
This was a follow up study by authors of the African RCTs who all seem to have substantial biased in favor of circumcision.
Satisfaction was reported on only a four point scale but they seem to report only two, satisfied or not satisfied. This seems to be too coarse. Are the men in this cohort, and this society, capable of reporting sexual dysfunction? Are most men capable of reporting sexual dysfunction?
The lowest level of sexual dysfunction was 98.4%, that seems far too high. Other researchers who’ve attempted to measure this, such as Laumann et. al., found much higher levels in the same age group for both circumcised and intact men.
Those who try to objectively measure sensitivity seem to frequently ignore the foreskin with the exception of Sorrells et al. who found that the foreskin is by far the most sensitive part of the penis.
But does this really matter? Can we say, ethically, that imposing circumcision is just fine so long as one doesn’t know what they are missing? A 2002 study found: Circumcised women experience sexual arousal and orgasm as frequently as uncircumcised women. Does that make it ethical Dr. Hall?
This is not in following of the principles of modern medical ethics. In a situation of substitute judgment, if there is equal doubt as to where or not a procedure is medically therapeutic, the procedure cannot be carried out. The burden of proof is on the one requesting the procedure to show that it is necessary to the health of the patient. Physicians performing this procedure to satisfy parents need for some decorative effect are acting irresponsibly, unethically, and not in the best interest of their patients (an infant or child in most cases).
The only thing ear piercing has in common with circumcision is that it is decorative. Though ear piercing is less physically damaging and reversible.
“No, I’m not redefining science and I in no way was saying that all knowledge is equal, I was saying that science doesn’t have absolute knowledge. You’re the one that’s redefining science by pretending it’s an omniscient religion that can determine what is morally right and wrong. Science is a body of knowledge, the scientific process is a what is used to gather and test this knowledge. Scientific knowledge is fluid and ever changing simply because it’s about building upon or refuting previous understandings. ”
Of course it is not absolute, but the critical requirement is that the predicition within an hypothesis or theory be fulfilled everytime..all it takes is one exception to invalidate that theory.
This from another source might help to clarify the concept. Notice the emphasis on needing to fulfill prediction.
http://www.uic.edu/classes/bios/bios100/labs/scimethod.htm
“The Principles of Science
As this is a science class, it would be beneficial to start out with a discussion on just what is “science.” Science is a methodical process which seeks to determine the secrets of the natural world by using the scientific method.
The Scientific Method The scientific method is a process scientists must follow in determining the workings of the universe. There are five basic components to the scientific method:
1. From observations of the natural world, determine the nature of the phenomenon that is interesting to you (i.e. ask a question or identify a problem).
2. Develop one or more hypotheses, or educated guesses, to explain this phenomenon. The hypotheses should be predictive – given a set of circumstances, the hypothesis should predict an outcome.
3. Devise experiments to test the hypotheses.
All valid scientific hypotheses must be testable.
4. Analyze the experimental results and determine to what degree do the results fit the predictions of the hypothesis.
5. Further modify and repeat the experiments.
It is impossible to prove something to be true (this dips deeply into philosophy, but Truth is an ever-elusive principle.) One can create a theory with an overwhelming amount of support, but one valid piece of contrary evidence can strike it down. As such, science and scientific theories are an ever-evolving as new ideas and technologies allow us to create and test hypotheses in new and exciting ways.”
Now IF the allegations of benefits are invalid and those of harm valid, then one must reach the conclusion that it is unethical.
““I’ll say it once more: the evidence shows a small benefit and a small risk from circumcision.”
I posted the actual rates of complication (posted again below).
Since you never commented on them, I have to ask: Did you even read them?
Can you honestly believe these risk rates are small?
Complication rates..
and the lies of the AAP.
Even if these rates were only 1/10 of what they are, cumulatively they would far exceed the ridiculous numbers claimed by the AAP.
1. iatrogenic Phimosis 2.9%
2. Adhesions 71%
3. Meatal ulcers 31%
3. Meatal stenosis 8%
4. infection up to 10%
5. Bleeding <35%
1. JOURNAL OF UROLOGY, Volume 169, Number 6: Pages 2332-2334,
June 2003.
Outpatient Management of Phimosis Following Newborn Circumcision.
H. Jason Blalock, Vijaya Vemulakonda, Michael L. Ritchey, Michaelene Ribbeck
2. JOURNAL OF UROLOGY; Volume 164 Number 2: Pages 495-496, August 2000.
Penile adhesions after neonatal circumcision.
Ponsky LE, Ross JH, Knipper N, Kay R
3. CANADIAN MEDICAL ASSOCIATION JOURNAL, Volume 95: Pages 576-581,
September 10, 1966.
The Problem of Routine Circumcision
http://www.emedicine.com/ped/topic2356.htm
4. BRITISH JOURNAL OF SURGERY, Volume 80, 1231-1236, October 1993.
Williams % Kapila
HAWA PATEL, M.B., Ch.B. (Cape Town), D.C.H., M.R.C.P.(E),*
Kingston, Ont.
5. BRITISH JOURNAL OF SURGERY, Volume 80, 1231-1236, October 1993.
Williams % Kapila
HAWA PATEL, M.B., Ch.B. (Cape Town), D.C.H., M.R.C.P.(E),*
Kingston, Ont.
The foreskin has an important role in sexual pleasure for both sexes; due to its specialized nerve endings, [1] and to its natural lubricating and gliding functions. [2] Circumcision greatly reduces penile sensation (as measured by neurological testing). [3] Men circumcised as adults who describe the difference are remarkably consistent with this study. [4] Several surveys have documented reduced satisfaction and erectile function after adult circumcision. [5 – 8]. The sensitivity of the foreskin was described by Jacopo Berengario in the15th Century. [9].
1. Taylor JR, Lockwood AP, and Taylor AJ. The Prepuce: Specialized Mucosa of the Penis and Its Loss to Circumcision. British Journal of Urology, Volume 77, Pages 291-295, February 1996. http://www.cirp.org/library/anatomy/taylor/
2. Anatomy of the Penis, Mechanics of Intercourse. http://www.cirp.org/pages/anat/
3. Sorrells ML, et al. Fine-Touch Pressure Thresholds in the Adult Penis. BJU International, Volume 99 Issue 4 Page 864 – April 2007. http://www.nocirc.org/touch-test/bju_6685.pdf
4. William E. Krueger, Winston-Salem NC, USA, open letter to newspapers and Intactivist organizations, 12 July 1993 http://www.circumstitions.com/Pleasure.html#kreuger
5. FINK KS, et al. Adult Circumcision Outcomes Study: Effect on Erectile Function, Penile Sensitivity, Sexual Activity and Satisfaction. Journal of Urology, Volume 167, Number 5: Pages 2113-2116, May 2002. http://www.cirp.org/library/sex_function/fink1/
6. Avshalom Zoossmann-Diskin and R. Blustein, Challenges to Circumcision in
Israel: The Israeli association against genital mutilation, 1999.
http://www.circumstitions.com/Pleasure.html#zoossmann
7. Shen Z, et al. Erectile Function Evaluation After Adult Circumcision. Zhonghua Nan Ke Xue (National Journal of Andrology, [Article in Chinese] Volume 10, Number 1: Pages 18-19, January 2004. http://www.cirp.org/library/sex_function/shen1/
8. DaiSik Kim, and Myung-Geol Pang, The Effect of Male Circumcision on Sexuality. BJU International, Volume 99 Issue 3 Page 619 – March 2007. http://www.circumstitions.com/News23.html#seoul
9. Jacopo Berengario da Carpi, A short introduction to anatomy, translated by L.R. Lind, University of Chicago Press, 1959, pp. 72-3 http://www.circumstitions.com/Pleasure.html#jacopo
There are a lot of studies out there, and they contradict each other. I’m not about to get into a study-citing pissing contest. The point is that no one study nor selected group of studies can “prove” the anti-circumcision position. One needs to look at the entire body of published studies and see where the weight of evidence lies. I tried to do that, and numerous medical organizations like the AAP have also tried to do that. We all reached similar conclusions.
We may all be wrong, and if we are, the scientific process will continue to work and the weight of evidence will shift and our provisional conclusions will change. Meanwhile I stand by my assessment of the current state of the evidence.
Dr Hall, I am not asking you to change your opinion. I was just hoping you’d actually say why you think particular studies aren’t valid so I (and others who may be interested) could understand why you feel they’re invalid from a scientific standpoint. Particularly because you link to a pro-circumcision site as your source of information, and then simply ridiculed people who are anti-circumcision, which doesn’t really seem to be weighing the evidence but rather making fun of people (even if their suffering is merely a manifestation of neurosis that hardly seems very kind).
I do understand that you feel that the AAP backs up your opinion on the matter but it does seem that medical and pediatric boards in other countries like Canada and Australia have taken a less neutral stance. This appeal to authority certainly gives me pause, not because I have any disrespect for you, your experience or knowledge, but because I have a greater respect for medical associations in countries where medical practices aren’t tied to profit in the same way and public sexual health issues are dealt with as health issues not ways to impose religious morality on people (which is not to deny that political considerations can come into play, as they can anywhere).
“There are a lot of studies out there, and they contradict each other. I’m not about to get into a study-citing pissing contest. The point is that no one study nor selected group of studies can “prove” the anti-circumcision position. One needs to look at the entire body of published studies and see where the weight of evidence lies. I tried to do that, and numerous medical organizations like the AAP have also tried to do that. We all reached similar conclusions.”
So, you seem to believe that studies need not be subjected to a scientifically-credible analysis to determine scientific validity–in essence, science should not enter into the process of evaluation? That science should be discarded simply beause there exist conflicting studies? And that the requirement for fulfillment of predicition is unnecessary?
Since you like to cite the OPINION of the AAP. perhaps you can provide scientific evidence to support their OPINION? So far I have seen NONE!
And they certainly have not- since they must fall back on non-medical excuses like religion and culture to try to justify it.
This in itself is interesting since they are a MEDICAL body and not a religious nor a cultuural body and have NO authority to make such pronouncements.
“We may all be wrong, and if we are, the scientific process will continue to work and the weight of evidence will shift and our provisional conclusions will change. Meanwhile I stand by my assessment of the current state of the evidence.”
Sorry, but the circumcision benefit hypothesis cannot fulfill it’s predicitions,yet you continue to believe that your (uncritical) assessment) carries more weight than the scientific process? An interesting take on the scientific process-to say the least!
Today is one for those days where I am in a reflective mood. I went back and looked at Harriet Hall’s original article. She claims to be neutral.
It may be my imagination, but it seemed to me that her assertions were almost all pro-circumcision. There were no anti-circumcision assertions. The closest she got to any was to present some allegations which she proceded to trivialize, minimize, or just dismiss outright or deride.
If I am mistaken, perhaps Harriet Hall can point out where she presents a single anti-circ assertion which she has not trivialized, minimized, dismissed, or derided.
Things don’t seem to be going too well for her position, so, as per a trend I have seen in the past, I expect that shortly this forum will be closed. Anyone wish to offer odds on this?
This is true and, in fact, medical communities and organizations in countries where circumcision is essentially unheard of have even more scathing opinions, when they bother to even discuss it. The Central Union for Child Welfare (Lastensuojelun Keskusliitto) fore example has issued a strong statement saying:
Hell, the Australians are even looking at a ban on circumcision.
The better question is how can a Dr. ethically justify an invasive procedure that is not therapeutic in a proxy consent situation. Where then are the boundaries? If an immigrant family came to a Dr. saying, “In our culture it is customary to cut off the bottom part of a babies ear lobes.” Would the Dr. do it? And if so, what might happen to the Dr. when some independent person notices that disfigurement. I suspect CPS would be quickly involved even if this was a cultural or religious requirement. Circumcision is essentially the same thing and if we imagine a world where it was previously unheard of, had no ties to someones culture or religion, no one would entertain the ridiculous notion to perform it on an infant or child.
I’m not saying any study is invalid. I’m saying that when studies contradict each other, we have to look at the weight of evidence on both sides. That is part of the scientific process, not (as Consult seems to think) a rejection of science.
Your statement that I depended on an anti-circumcision site for my information is inaccurate and unfair. I took advantage of its handy compilation of 660 references in one place, but I also cited other sources including original articles, meta-analyses, and the American Cancer Society.
I’m sorry you think I was ridiculing sick people by telling men to stop obsessing over something that can’t be changed. I can certainly feel sorry for those people, but it does them no good to keep ruminating over their lost foreskins. A little tough love is in order. I would say “get over it” just as readily to a woman who had had a hysterectomy and was making her life miserable by obsessing over her loss. I would not “just” say get over it: I would offer understanding, positive suggestions, and counselling.
The organizations that are anti-circumcision are anti- on ethical grounds, not strictly medical ones.
There is one very good argument against neonatal circumcision: it involves an elective procedure without the consent of the patient. If people would stick to that argument instead of cherry-picking the scientific evidence, they would be more credible. It is possible to admit that there is a small health benefit and still say the benefit is so small that it doesn’t outweigh the risks and the ethical considerations.
“I’m not saying any study is invalid. I’m saying that when studies contradict each other, we have to look at the weight of evidence on both sides. That is part of the scientific process, not (as Consult seems to think) a rejection of science.”
IF you did a critical analysis, then you could say that such and such study is invalid, but it seems this beyond either your ability or comprehension.
The weight of the evidence depends SOLELY on the validity of that information–not OPINIONS nor consensus. When there is a contradiction, one should only cite that information that is scientifically credible. Not to follow this is really the rejection of science. You seem to be confusing medicine with science. Science has rigid requirement, medicine only requires OPINIONS and beliefs.
Did you even bother to read that piece on scientific requirements–the one about the necessity for fulfillment of predicition? Are you now prepared to present a alleged benefit that IS able to fullfill this requirement?
“Your statement that I depended on an anti-circumcision site for my information is inaccurate and unfair. I took advantage of its handy compilation of 660 references in one place, but I also cited other sources including original articles, meta-analyses, and the American Cancer Society.”
Really, then why did you not include those studies that debunk your conclusions…(you have been given many) Prove me wrong by providing ONE SINGLE purely negative piece of information in your article.
And if the ACS has stated that circumcision has no bearing on penile cancer, why did you bring it up?
A meta-anlysis is only valid when the original information is critically analyzed. Collecting and doing a metanalysis of invalid information is less than useless.
“I’m sorry you think I was ridiculing sick people by telling men to stop obsessing over something that can’t be changed. I can certainly feel sorry for those people, but it does them no good to keep ruminating over their lost foreskins. A little tough love is in order. I would say “get over it” just as readily to a woman who had had a hysterectomy and was making her life miserable by obsessing over her loss. I would not “just” say get over it: I would offer understanding, positive suggestions, and counselling.
Oh give me a break, would your sympathy also apply if the women had a unnecessary and cosmetic hysterectomy?
And now men who regret losing the most sensitive part of their genitals are “sick”?? This is nothing more than the tired old “blame the victim” mentality. I believe that the sickness of needing to amputate normal, healthy, functioning foreskins shows a greater sickness.
“The organizations that are anti-circumcision are anti- on ethical grounds, not strictly medical ones.”
Gee another assertion that will likely be put forqward with no substantaiating evidence–something you seem to delight in.
“There is one very good argument against neonatal circumcision: it involves an elective procedure without the consent of the patient. If people would stick to that argument instead of cherry-picking the scientific evidence, they would be more credible. It is possible to admit that there is a small health benefit and still say the benefit is so small that it doesn’t outweigh the risks and the ethical considerations.”
This concept of cherry-picking coming from you is humorous since all you have provided seems to be cherry-picked. Can you show a single circumcision negative piece of information in your article? These exist in abundance.
ANYTHING is possible, but since you have not provided any PROVEN benefit, I think it would be wiser to think of probabilities. It is POSSIBLE that a meteor will hit NYC in the next ten minutes, but the probability is so small as to seem ridiculous. IF these are possible, please show from actual stats that ANY of these exist in the real world, or have ever existed.
BTW, when can we expect you to comment on the REAL risks for circumcision?
“I’m not saying any study is invalid. ”
Why not? What did you fail to understand about this BASIC scientific requirement:
Any conclusion based on known flawed data cannot be considered valid.
Or do you choose to believe against all evidence that your studies have no known flaws?
I didn’t go into details about the risks of circumcision in my article. I’ll elaborate here. I’m not going to try to list all the studies, but you can go to PubMed and look for yourself and make up your own mind.
You can find any rate of complications you want, from 0 to 55%. The most common reported rates are in the 2% or less range. In one study of circumcisions done in the home by non-doctors in a developing country, the complication rate was 2.3%, mostly consisting of infections that were easily controlled by local wound care. A systematic review of studies in South Africa showed complication rates from 0% to 50.1% – the 50.1% was in a series of patients with hemophilia! Minor complications are reported in 2.4% of circumcisions done with the Plastibell device.
When “complications” are listed, it’s important to understand how complications are defined. In one study over half the reported complications consisted of “redundant foreskin” – in other words, the circumciser didn’t do a thorough enough job. In another study over half the complications consisted of bleeding during the procedure, bleeding that was easily controlled with pressure. I must say it’s practically impossible for bleeding to occur if proper technique is used with the Plastibell procedure.
It is easy to find reports of devastating complications of circumcision including amputation of the penis and even death, but these are extremely rare with good technique. The most famous was the case of John Money’s patient who was raised as a girl – in that case it was due to an accident with an electrocautery device; there is no reason to use such a device.
Meatal stenosis and meatal ulcers can be late complications of circumcision that may not be considered in some of these studies. Careful hygiene (prompt diaper changes, etc.) would probably prevent at least some of these cases. The incidence of meatal stenosis in circumcised males has been variously estimated at anywhere from 0.9% to 11%, but it also occurs in uncircumcised males. In a recent UK study of home dilation as an alternative to surgical treatment, 17 out of the 18 cases of meatal stenosis were due to causes other than circumcision. It is easily treated by surgery if dilation is ineffective.
This study from 2000 looks like a reasonably fair assessment of early complications: http://www.sciencedaily.com/releases/2000/01/000111074855.htm The authors concluded that one in 500 circumcised children may suffer a complication, and one in 100 children may derive a benefit. 230 out of the 285 complications consisted of intraoperative bleeding which was easily controlled.
I don’t know why I bother, because those of you who are biased against circumcision will choose your own studies and find reasons to reject everything I say.
After all this, I still don’t know what I would choose to do if I had a boy baby. If that doesn’t qualify me as neutral, I guess nothing could.
Ah yes, if the job is done right, “proper technique” little consolation especially to the boy who suffers one of those more serious consequences, isn’t it? Especially for a procedure which has no significant benefit and is not medically therapeutic. In fact, the boy you speak of, Money’s little project, eventually committed suicide about five years ago if I recall.
One can play games by choosing what one wishes to call a complication.
But the comprehensive definition is:
A complication is ANY adverse outcome. And since circumcision is an unnecessary procedure, ANY complication is uncalled for–whether operator error or other causes.
This includes the loss of the penile nerves and the resulting loss of sensation and sensitivity and the rate of that is 100%.
“I must say it’s practically impossible for bleeding to occur if proper technique is used with the Plastibell procedure.”
Impossible? so why does it occur so often?–operator error is no excuse since one cannot eliminate operator error in any procedure–s*** happens!
So bleeding is the ONLY complication for the plastibel? I don’t think so..
http://www.medscape.com/content/2004/00/48/41/484130/484130_fig.html
Figure 3. (A) Petechiae. Infant with an infected plastibell circumcision; the responsible organism was Group B streptococcus. Note the scattered petechiae surrounding the penis and extending upward to the periumbilical area. Photo courtesy of Dr. William Edwards, the Children’s Hospital at Dartmouth. (B) Purpura. Note the area of small hemorrhages on the right leg of this infant compared to the petechiae (minute, pinpoint-sized hemorrhages) in Figure 3A. Purpura is often associated with decreased platelet counts.
&
http://www.cirp.org/library/complications/woodside2/
&
http://www.cirp.org/library/complications/bliss/
“This study from 2000 looks like a reasonably fair assessment of early complications: http://www.sciencedaily.com/releases/2000/01/000111074855.htm The authors concluded that one in 500 circumcised children may suffer a complication, and one in 100 children may derive a benefit. 230 out of the 285 complications consisted of intraoperative bleeding which was easily controlled.”
THIS is a study you believe is valid? Let’s look at thsi study it’s origins and it’s methodology and conclusion.
Reason for the study (author’s own words):
“Christakis said the study was prompted by the influential American Academy of Pediatrics’ announcement last year that it no longer recommended routine circumcision because of questionable benefits and medical and anecdotal evidence that circumcised men have less penile sensitivity.”
BUT he never addressed the issue of penile sensitivity–then jumped off onto alleged reasons for circumcsision.
Methodology:
This is nothing more than a retrospective examination of hospital records. No babies were actually examined, no parents were interviewed.
Babies usually are discharged within a few hours of their circumcision, so such a study cannot identify the complications that arise later. Meatitis, meatal ulceration, and meatal stenosis are common complaints of circumcised boys who have lost the protection of their prepuce. Other complaints common in circumcised boys are adhesions, skin bridges and skin tags. Later in life such complications as painful erections, sexual difficulties, psychological problems emerge. So the reality has to be much worse than this report.
The number of complications experienced by circumcised boys was 20 times greater than that experienced by intact boys.
The report states:
“Results. Of 354 297 male infants born during the study period, 130 475 (37%) were circumcised during their newborn stay.
Overall 287 (.2%) of circumcised children and 33 (.01%) of uncircumcised children had complications potentially associated with circumcision coded as a discharge diagnosis.”
Conclusions:
the risk rate is ~ 1 in 500
BUT in the suthors own words
The authors claim a benefit, where do the authors offer any scientifically-credible evidence of any benefit
“The research team reported in a supplement to Tuesday’s Pediatrics that 287 of the boys, or one in every 476, had complications related to the procedure. The most common complications were bleeding during the operation and damage to the penis requiring further treatment. The team’s estimate is very conservative, Christakis said, because **** it does not include common complications, such as infections, that develop after children leave the hospital.”***
In other words, fatally flawed! And we know that a conclusion based on flawed data cannot be considered valid!
“I don’t know why I bother, because those of you who are biased against circumcision will choose your own studies and find reasons to reject everything I say.”
You should bother because you brought up the subject in a forum that is supposed to be science-based, and you need to scientifically support it–or admit that there is no acceptable medical reason for doing it…the choice is up to you.
And please don’t confuse refuting with rejecting. It is YOU that rejects my studies but fails to refute them.
BTW, are you just going to ignore these rates? if so, WHY?
1. iatrogenic Phimosis 2.9%
2. Adhesions 71%
3. Meatal ulcers 31%
3. Meatal stenosis 8%
4. infection up to 10%
5. Bleeding <35%
ALL of these are adverse and unnecessary.
Now we can go on and discuss catastrophic complications if you wish, but we have to keep in mind that ALL of them were due to an unnecessary procedure..then we have to ask–would these be acceptable for any other unnecessary procedure forced onto an infant?
I was asked what I thought was a legitimate scientific question about the true rate of complications but there was no point in my answering it because the anti-circumcision people won’t accept “any” risk and they won’t admit that there could possibly be “any” benefit. And they expect me to accept the studies they cite but they won’t accept “any” evidence that I find.
As I said before, you would be a lot more credible if you acknowledged the evidence for a small benefit and stuck to the very valid ethical arguments. I gave my evaluation of the existing evidence in my article and I stand by it. I’ll leave the emotion and the ethical battles to the rest of you. Signing off…
I believe you are still dodging the question of whether circumcision meets the ordinary standard of care for pediatrics, as cited by BDwyer:
I have yet to see anyone demonstrate that circumcision meets this standard. If we remove the cultural bias from the equation, clearly the non-indicated surgical mutilation of children is not acceptable. We wouldn’t consider it ethical to surgically remove other body parts or tissue without medical indication, so it can’t be objectively said that circumcision is ethical by the ordinary standard of care for pediatrics.
While you have repeatedly claimed not to be “pro circumcision” your spurious analogies to the non-analgous practice of infant ear piercing seem to suggest otherwise.
To remove gender bias, take any arguments you read for or against foreskin amputation and parse them as if they were about clitoral hood amputation. For (very nearly) all arguments on either side where it would make a difference, discard them.
In reference to the ethical question of performing medically unnecessary surgery on an infant who can’t consent to it: would you give an infant cosmetic rhinoplasty if the parents asked for it and the infant was not deformed in appearance? Are infants generally acceptable recipients of cosmetic surgery based on the whims of the parents? Under what circumstances does it become child abuse?
“I was asked what I thought was a legitimate scientific question about the true rate of complications but there was no point in my answering it because the anti-circumcision people won’t accept “any” risk”
You forgot the word “unnecessary”..that posits the fundamental question IS ANY risk from an unnecessary procedure acceptable?
” and they won’t admit that there could possibly be “any” benefit. And they expect me to accept the studies they cite but they won’t accept “any” evidence that I find. ”
I don’t accept something without proof–”possible” without being probable hardly justifies a harmful and unnecessary procedure forced onto infants. All evidence you have posted have been refuted?
“As I said before, you would be a lot more credible if you acknowledged the evidence for a small benefit and stuck to the very valid ethical arguments.”
Glady IF you would present us scientifically-credible evidence for them–but you have not. And if YOU presented any ethical arguments instead of ignoring the ethical questions asked of you many times by skeptic and others. Evasion is hardly credible.
” I gave my evaluation of the existing evidence in my article and I stand by it. I’ll leave the emotion and the ethical battles to the rest of you. Signing off…”
You stand by something you cannot support by science and then claim OTHERS are emotional? How interesting.
This discussion is not about what you choose to believe–it is about science-based medicine. It is not about merely posting cherry-picked information from a rabidly procirc site and then trying to claim neutrality.
Not to worry, those remaining will likely continue to discuss the science (or the lack thereof) behind circumcision –to see IF circumcision can be ethically justified.
Personally I don’t see anyone here actually backing up their position and opinion with science (or really offering more than an opinion – be that myself, Dr Hall or those who seem to be quite dedicated anti-circumcision activists who are on this blog specifically because there was a post about circumcision). I see everyone claiming that their position is validated by science but so far no one has used the evidence to prove it through debate and weighing the evidence – apart from going through the motions but cherry picking the studies that support their personal beliefs mixed in with appeals to larger authorities that share their opinions. (I make no exception for myself – however I’m not claiming I have no bias and am going purely by the science, child welfare is always an issue of ethics for me.)
Dr Hall – You say you’ll change your opinion when the scientific evidence is overwhelming but isn’t that a bit hard to do if we only give weight to the evidence that supports one’s position? Or if we refuse to ackowledge that we tend to have a bias due to having personally engaged in an activity (once again, there aren’t many people who don’t have some sort of bias or personal connection to either cut or uncut penises). There seems to be a pretty large consensus from medical organizations in other nations of European origin that seems quite different than in the US. This could well be due to political or social considerations as well as being evidence based decisions, but the country where religion as politics has the biggest influence over medicine of all these nations is the US so it seems odd to me to assume every other medical organization is being influenced by politics/religion but the US isn’t!
I’ve always wondered why this was such a hot-button issue – here’s my theory:
http://ihasahotdog.com/2008/06/21/funny-dog-pictures-you-are-infatuated-with-your-weiner/
IMO, I don’t think you can make the argument that circumcision is just like FGM. Clitoridectomy DESTROYS sexual response; some people think male circumcision slightly impairs sexual response. Equating the two is just shows how obssessed some men are with their genitals.
I’m with Harriet; acknowledge the real but slight medical benefits, and make the real and significant ethical argument.
IMO, I don’t think you can make the argument that circumcision is just like FGM. Clitoridectomy DESTROYS sexual response; some people think male circumcision slightly impairs sexual response. Equating the two is just shows how obssessed some men are with their genitals.
I disagree. I think this is only the case if, when thinking about FGM, you only consider the worst situations. FGM in fact covers a rage of procedures some less damaging some more damaging. So when FGM is bounded half the types are either less than or equal to circumcision yet we outlaw all types of FGM and that is hypocritical.
“IMO, I don’t think you can make the argument that circumcision is just like FGM. Clitoridectomy DESTROYS sexual response; some people think male circumcision slightly impairs sexual response. Equating the two is just shows how obssessed some men are with their genitals. ”
Really? Perhaps you didn’t see the posting above that circumcised women are not adversely affected sexually.
Or how about this one:
Female circumcision does not reduce sexual activity 12:30 24 September 02
NewScientist.com news service
Circumcised women experience sexual arousal and orgasm as frequently as uncircumcised women, according to a study in Nigeria.
The researchers also found no difference in the frequency of intercourse or age of first sexual experience between the two groups of women. These findings remove key arguments used to defend the practice, they say.
Friday Okonofua and colleagues at the Women’s Health and Action Research Centre in Benin City studied 1836 women, 45 per cent of whom had been circumcised.
During the operation, all or part of the clitoris and the labia are removed. Proponents of female circumcision claim it makes virginity at marriage and marital fidelity more likely. Opponents condemn it as dangerous and painful.
The women filled in questionnaires, asking about their sexual history. The results show “female genital cutting cannot be justified by arguments that suggest it reduces sexual activity in women,” write the team in BJOG: An International Journal of Obstetrics and Gynaecology.
“Slightly impairs male sexual response”? Is the loss of 3/4 of the sensation and sensitivivity a “slight impairment?
BTW, perhaps you did not know there are many kinds and degree of FGM –just as there are for MGM–and for every kind of FGM, there is a more severe and harmful kind of MGM?
Since you agree with Harriet, perhaps YOU can provide scientific evidence of “benefit” since she has so far failed to provide any?
KristinMH – You are, of course, entitled to your opinion…as are we all (it’s just none of our opinions, whether we’re in agreement or not, are anything more than opinions). Just to be clear, my personal opinion is it’s an ethically and medically questionable activity to be modifiying a male OR female baby’s genitals based on the aesthetic or religious desires of the parents. (And the issue of the genital modification of intersex babies is an even more complex issue involving cultural expectations, bodily integrity, nature vs culture and personal choice/individual rights.)
No medical association (including even in the US) actually recommends male circumcision as a health measure – they used to so clearly the cost/benefit ratio as determined on the evidence continues to contain increasing potential cost next to decreasing potential benefit. This means that circumcisions are no long routine or standard medical procedure where they once used to be recommended. (This indicates that as the scientific understanding evolves and new evidence comes in we’re moving further and further away from considering male circumcision to be ethical in light of the evidence, the US seems to be quite far behind nations that don’t mix up religion in their sexual health policies.)
Of course a clitorectomy destroys clitoral sexual response, removing the clitoral hood would change sexual responsiveness too but not destroy it. Just like there are a number of different types of male genital modification/mutilation, there are different types of female genital modification/mutilation. Even women who’ve had their clitoris removed still have vaginal sexual response available so it doesn’t destroy all potential for sexual gratification (not that this in any way justifies the practice). Would you be okay with the removal of the clitoral hood or labia minora but just not the whole clitoris? Do you think you may experience a change in clitoral sensitivity if the protective hood and inner labia were removed?
As a woman, I certainly have more of an sympathetic and visceral response to the idea of a girl’s genitals being modified than I do a boys. I can extend that to having emotional empathy for a man but my sympathetic physical response, my visceral response, is related to the experience of my own body. Historically women’s concerns about our bodies and health have more often than not been dismissed by male doctors who just didn’t think female sexual pleasure is important and often ignored self reporting by women – dismissing it as being hysterical and emotional. I see the same thing happening here to men who aren’t conforming to the cultural expectations of both some women and some other men. I don’t actually see any real discussion of science or evidence – from any quarter – that isn’t just an affirmation of a pre-existing bias. I’m clear of what my personal bias happens to be and why but that doesn’t mean I hold a black/white position on the matter (quite the opposite, I think the complexity needs to be addressed and there’s lots of variables and gray areas).
Consult wrote – “Women filled in questionnaires, asking about their sexual history. The results show “female genital cutting cannot be justified by arguments that suggest it reduces sexual activity in women,” write the team in BJOG: An International Journal of Obstetrics and Gynaecology.”
This is a misrepresentation of what is being said in the study. Sexual ACTIVITY is not the same as sexual PLEASURE. One can be very sexually active and derive no sexual pleasure from the activity at all.
One of the justifications for FGM is that it stops women from desiring and having extra marital affairs, it stops them from “straying”. Essentially, in some ways, the idea is not unlike that of making men eunichs to guard harems – if one removes the capacity for sexual enjoyment then the impetus to have sex for enjoyment is removed. (Of course, people have sex and romantic affairs for reasons other than just genital stimulation and pleasure.)
I’m sorry but misrepresenting this study does nothing to support your argument.
“This is a misrepresentation of what is being said in the study. Sexual ACTIVITY is not the same as sexual PLEASURE. One can be very sexually active and derive no sexual pleasure from the activity at all.”
Fifi, what does this statement say to you as far as sexual pleasure? ARE arousal and orgasms divorced sexual pleasure?
” Circumcised women experience sexual arousal and orgasm as frequently as uncircumcised women, according to a study in Nigeria.”
Consult – I’d suggest you consider that New Scientist actually has more articles that consider FGM to be dangerous and that Dr Okonofua has also conducted and contributed to studies that those articles are based upon which talk about the increased dangers women who’ve been genetically modified go through during childbirth (which, of course, are horribly confounded by giving birth in rural areas where medical treatment for complications in childbirth is not available).
http://www.emmabonino.it/press/world/4134
Here is the link to the article you refer to in New Scientist though it’s hard to know what the study really found since it’s not detailed so it’s hard to know just how valid and free from inbuilt bias it is (since Dr Okonofua seems to be trying to refute a justification FOR FGM. (And obviously the same argument can be made about not knowing what one is missing thereby making reports anecdotal and necessarily biased, pleasure is like pain in that it is very subjectively measured and there are also cultural aspects to the experience….as much as seemingly everyone would like this to be a simple issue all about hard facts and just dismiss the complexity of the cultural dimensions of pleasure, pain, gender and sex in all our, ahem, cultures…none of us exist within a cultural vaccuum and neither does medicine).
http://www.newscientist.com/article/dn2837-female-circumcision-does-not-reduce-sexual-activity.html
From the site you may or may not have gotten the New Scientist info from since you didn’t link to the source…
“GM (like MGM) is a human rights outrage regardless of its effect on sex, if any.
When FGM seems to have no effect on sexual response, this is seen as an argument not to do it, yet the self-same “fact” in the case of the male is used in the US as an argument for doing it. In fact, however, this result (like that of such work as has been done on the effect of MGM) is probably just an artifact of using too crude a measure of sexual response, ability to have intercourse and reach orgasm.
Someone responded to the above article that a woman circumcised before puberty learns her erotic response with whatever erogenous tissue she is left, such as her nipples. (In the same way, paraplegics gain an inordinate sensitivity in the parts of their bodies still wired to their brains.) So it would be quite wrong to say that her sexual response was unchanged.
While the quantity of women’s arousal and orgasm may be undiminished by FGM, the loss of erotic tissue inevitably degrades its quality.
It may be true that most sexual activity happens in the brain, but the response of the brain depends on the quality of the stimulation it receives. All music appreciation happens in the brain too, but the quality of the music depends on the quality of the instruments as well as the performance.
The same is true for circumcised men.”
The link to the site for anyone who may want to check the context of where the information above comes from (it is from an anti-circumcision site).
http://www.circumstitions.com/FGM-sex.html
There is a glaring double standard here.It is automatically assumed ((without any scientific evidence) by western cultures who do not perform it, that FGM diminishes female sexual sensation and pleasure.
Yet, western cultures that circumcise demand concrete evidence of the same sexual sensation and pleasure loss for males. And even when this evidence is presented, they merely dismiss it offhand.
This provides a striking example that unfounded propaganda can be so successful in spite of the lack of scientifically credible evidence.
“Of course a clitorectomy destroys clitoral sexual response, removing the clitoral hood would change sexual responsiveness too but not destroy it.”
And removal of the foreskin destroys the foreskin sexual response and changes sexual responsiveness, but not destroy ALL sexual response..now what should one assume other forms of MGM affects, changes/and or destroys certain sexual responses?
“When FGM seems to have no effect on sexual response, this is seen as an argument not to do it, yet the self-same “fact” in the case of the male is used in the US as an argument for doing it. In fact, however, this result (like that of such work as has been done on the effect of MGM) is probably just an artifact of using too crude a measure of sexual response, ability to have intercourse and reach orgasm.”
Too crude? Not for MGM
http://www.cirp.org/library/anatomy/taylor/
http://www.nocirc.org/touch-test/bju_6685.pdf
And opposing this for FGM are OPINIONS..
“While the quantity of women’s arousal and orgasm may be undiminished by FGM, the loss of erotic tissue inevitably degrades its quality.”
An assumption we should also then apply to MGM?
Consult – As someone who IS of the opinion that both male and female circumcision of babies is not in the babies’ best interests (and who HASN’T been dismissing loss of penile sensitivity in males), you’re starting to make me want to move to the other side of the argument just not to associated with the way you’re pretending to be motivated and interested in the actual science part of this discussion when it’s clear you also have an ideological bias that you refuse to acknowledge. People who can’t even acknowledge their subjectivity certainly aren’t in any position to be accusing others of being subjective or cherry picking their evidence to suit their beliefs. You keep claiming your position is objective, as does Dr Hall. From where I sit (a subjective perspective, of course), neither of you is actually being objective in the ways you’re claiming.
And, with that, I too will leave this discussion since I can’t see it being particularly interesting or constructive continuing to talk with you and unfortunately Dr Hall didn’t want to do an analysis or respond to issues regarding how the evidence has been interpreted by medical associations in countries other than the US.
Fifi,
You and Harriet Hall seem to believe that bias, culture, and/or religion can alter or even negate science. I disagree and think that I have refuted every aspect of that concept.
Regardless of all the verbiage used to try to alter it, no one has provided any scientifically-credible evidence (using it’s basic and fundamental tenets) to support circumcision.
And I have posited, that if there is none, then circumcision cannot be rationally justified. This is what lies at the root of the circumcision dilemma and this discussion…can it scientifically, and rationally be justified? I think not.
Consult – No, that’s not what I believe and I’m getting a bit sick of you trying to mount me on your hobbyhorse. What I have said is that cultural bias (yours included) plays a role in people’s beliefs and what is considered acceptable or not. I’ve also said that personal bias plays a role in people’s opinions and beliefs regarding this issue. Additionally, I’ve been saying that what is and isn’t considered ethical or moral – what we can accept and rationalize or cannot accept nor rationalize – has a social and cultural aspect (in fact, ahem, studies show that even personal ethics is contigent upon context).
Despite all your verbiage you haven’t provided conclusive evidence either. Despite all your accusations of bias you have yet to have the integrity to acknowledge your own bias or that of your sources. This failure to acknowledge or understand how your own biases (and those of your sources) influence your reading of the evidence is why all your claims to hold the scientific highground fall flat and are entirely unbelievable (since you clearly wouldn’t change your opinion based upon evidence). It’s quite telling that your beliefs are so black and white that you lump all people who disagree with you together as holding the opposite beliefs – even though in this instance Dr Hall and I disagree on many (if not all) aspects of this issue and hold quite different opinions. People who see the world in black and white are generally ideologues – this is particularly evident when someone argues their position without even bothering to discover where their “enemy” actually stands.
I love it when one reaches a conclusion based on the credible scientific evidence and defends that conclusion with the same evidence and then is accused of a bias..
How can a scientific conclusion have a bias?
As for evidence not being provided–what did you not understand about this CONCRETE scientific evidence?
http://www.cirp.org/library/anatomy/taylor/
http://www.nocirc.org/touch-test/bju_6685.pdf
Can it be scientifically refuted?
I doubt –and if it cannot, then how can any claim of bias, culture, or religion justify this unnecessary and harmful procedure? This is still the fundamental question that has not been answered let alone adequately addressed.
Consult – All the evidence you present is directly from anti-circumcision sites so clearly that’s where you get all your info from. Your claims to have evaluated all the evidence when you’re simply reposting from a biased site are, once again, as hollow as your other claims that you’re not biased. It’s very clear you reject studies that don’t support your ideological belief and embrace ones that do – this is a clear indication of bias and attempt at an authoritarian use of science for ideological purposes. (Though I suspect that in your mind’s eye you see yourself as a radical freedom fighter who is the saint/martyr to what you consider Dr Hall’s evil authoritarian misuses of science for ideological reasons and because in her heart of hearts she really wants to destroy babies.)
As I’ve already said, your inability to acknowledge your own bias and constant attempts to make science serve your ideology make attempting to discuss any aspect of this issue with you futile since you’re not actually open to discussion or weighing evidence but “proving” your own emotional and ideological perspective (which you won’t acknowledge is a perspective) on the matter.
If you don’t understand how “scientific conclusions” can have bias (or can be proven to be entirely inaccurate at a later point) you clearly don’t understand much about science or why the scientific method was developed.
Fifi – To be fair although the articles linked by Consult are hosted by an ‘anti-circumcision’ site, both articles were published in the BJU and not simply random commentary. Though I don’t think that is what you’re implying I think it is important to make that point. From what I understand about the Taylor work, British Journal of Urology, Volume 77, Pages 291-295, February 1996, it was one of the first close examinations of the structure and possible functions of the foreskin. If that is true, it is quite a surprise that such an easily accessible structure was not studied closely until a little over 10 years ago. Indeed even today most American anatomy books make no mention of the foreskin. And if they do they simply say this is the part removed during circumcision. No discussion about it’s structures or possible functions. Now that’s biased.
Similarly, Sorrells et al. is also a published work the link provided just happens to be hosted at an anti-circumcision site but that doesn’t change the work itself. I will also add that the funding for the research discussed in Sorrells et al was provide by NOCIRC and yes there is clear intent in the work to demonstrate that the foreskin is not simply redundant useless tissue. As I see it Sorrells does at least two things that haven’t been previously attempted (to my knowledge). First, they did try to objectively quantify the sensitivity of the penis in both circumcised and intact men. Second, unlike work before, and at least one subsequently, they actually included the foreskin as part of the measurement. The question then becomes how do you map their findings to people? I would say that greater sensitivity to fine touch proabably leads to a closer more intimate experience but then we are getting into the realm of subjectivity.
Are there problems with those pieces? Possibly. I haven’t read the whole Taylor article yet and it would have been nicer to see a larger sample size in the Sorrells article. I guess my point is that just because they are hosted where they are doesn’t mean they should be dismissed out of hand. Plus I think that whether or not there is a loss is not entirely relevant as non-therapeutic circumcision of minors is just simply wrong ethically.
“If you don’t understand how “scientific conclusions” can have bias (or can be proven to be entirely inaccurate at a later point) you clearly don’t understand much about science or why the scientific method was developed.
Ok, then try to find the bias in those slides in Taylor’s specimen box. No one has refuted his study and can never refute it..The empirical evidence is there for all to see. And empirical evidence is the strongest evidence in science.
As for the Sorrel’s study, it was a blind study much like an audiometer hearing test..and objective. So instead of just trotting out the claim of bias, why not just actually read it and try to show where bias could be.
“Consult – All the evidence you present is directly from anti-circumcision sites so clearly that’s where you get all your info from.”
And now all you need to show is that the site itself somehow has introduced bias into the studies themselves…Have they somehow altered the PUBLISHED and information?
Consult – As noted before, the fact that you can’t even recognize their own potential bias makes your accusations that others are biased nothing more than a projection of your own unacknowledged bias. You clearly don’t understand what objective and subjective mean vis a vis science (or even in general apparently) if you’re claiming objectivity for yourself or a study.
No scientific study is “objective” – studies merely try to control parameters and minimize variables. This is why context – such as who funded a study, double blind or not, where the results fit into the larger picture, etc – are so very important to MINIMIZE bias. This is why we rely upon accummulated bodies of evidence and not one study.
The site’s bias comes from uncritically promoting and/or funding studies that support the site’s bias. The same goes from studies pulled from pro-circumcision sites. You only take your info from one source and disregard the other, that’s your bias in action.
This is my last post to you since, at this point, I’m pretty sure you’re just trying to bang everyone over the head with your ideology for personal, emotional reasons. I’ve already said I’m against modifying babies’ genitals (I have no problem recognizing and owning my biases or being honest) yet you continue to try to convert me to your ideological position. It’s very clear that your aim is merely to use science to promote an ideology, so I see no point or reason to give legitimacy to farcical claims of objectivity and respect for evidence.
Fif, I am sorry that you cannot understand that it takes more than making a claim of bias to discredit or dismiss a study. In science, one needs to do a critical analysis of each study individually. If the study is found to survive this analysis and meet the basic requirements of science, then and only then can it be deemed valid–if not, then it is invalid–and no amount of empty claims of bias will alter that conclusion.
Speaking of ideology, what prompts you to repeatedly try to dismiss studies under the pretext that objective evidence cannot exist without bias?
Unless you can prove that who funded or posted a study has had an effect on the results of the study, your claims can hardly be deemed credible…merely making this claim of bias is insufficient.
Please show that MY so-called bias in any way alters the scientific evidence? You make this claim over and over and still fail to address this fundamental question.
My aim is, and always has been to try to help people to understand that science is logical process and when done properly is not subject to bias–you seem to believe that science cannot exist outside of subjective thought–yet that is precisely what science was created to do.
I can now see why Dr Hall didn’t both interacting with Consult.
Science is just a body of knowledge, some accurate and now some proven inaccurate. The scientific METHOD was developed after science as a body of knowldge and discipline had existed for quite a long time already. It was developed to MINIMIZE bias and to give as objective a measure as possible. Even when scientists are pretty damn sure something is correct, they never claim absolute knowledge.
You’re very far off the mark of your stated aim, as shown by the fact that you repeatedly dismiss your own subjectivity and ideological bias, that you only link to studies presented on a pro-circumcision site (at least Dr Hall was open about the bias of her source).
The fact that you think “science was created” rather than it being something that evolved shows just how little you understand science and the history of science. It’s like some ID version of the history of science!
Joe1 – No, what site hosts a study doesn’t mean that a study is innately biased (though the bias of a site will lead them to not only cherry pick studies but to misrepresent the actual findings). The site Consult links to uses studies as propaganda – though the site doesn’t hide its bias or agenda so I don’t take issue with that. What I take issue with are Consult’s claims that he’s backed up by some form of omniscient infallable science and that his beliefs are evidence based not ideological beliefs. The very fact that he treats science as a religion shows that he greatly misunderstands both the process and discipline of science. Dr Hall, at least, said she may possibly be proven wrong at some point. Consult is trying to prop up his emotional position by appealing to and assuming for himself the authority of science. Science is a very useful tool to inform decision making but, as I’m sure you’ll know if you’re up on the science regarding human decision making, you’d be aware that decisions made on purely rational/logical grounds can be very inhumane and ethically unacceptable (and actually, if they’re entirely rational, put aside the rights and feelings of the individual for the survival of our species).
My point is that Consult is clearly only getting his info from a site with a bias and claiming that the studies he presents are objective while those on a site that doesn’t support his ideological position are biased. It makes it pretty pointless to even start discussing science with him if he doesn’t understand the basics of bias and can’t acknowledge his own.
So,
Lili, you cannot scientifically refute the study, so you fall back on repeating un unsupported claim of bias. You cannot show any impact by this bias, yet you keep repeating it as if it was a magic mantra to dimiss it.
Could you prove that decisions made on rational grounds are inhumane.?. how is not deliberately causing unnecessary harm and damage to another person be inhumane? How would preventing a person from unnecessarily removing a normal, healthy, functioning, and very sensitive body part be INHUMANE. I thought it would be the opposite.
Again, please show how MY bias has altered the scientifically-credible evidence.
It all boils down to–can you prove any effect your alleged bias has affected the results of the two studies. if not, then why are repeating them without anything to support them? Does repetition make them any more credible?
“Science is just a body of knowledge, some accurate and now some proven inaccurate. The scientific METHOD was developed after science as a body of knowldge and discipline had existed for quite a long time already. It was developed to MINIMIZE bias and to give as objective a measure as possible. Even when scientists are pretty damn sure something is correct, they never claim absolute knowledge. ”
Wrong, science is a PROCESS that enables us to gain knowledge–I don’t know how many times this must be repeated before it is understood…it is NOT the knowledge that derives from it., but the process itself.
And yes, you are right, there is not absolute positive or negative proof–but there sure is a process to separate valid from invalid information–just use the basic tenets and requirements inherent in the process.
Science is a process that was created, it evolved into a formalized structure by EFFORTS of those creating it–this did not occur without the efforts of it’s creators.
Dude, you can keep huffing and puffing as much as you like but you’re clearly not interested in science but rather in making science subservient to your ideology. This makes discussing studies with you pointless. While I may hold a different position on this issue than Dr Hall, I can entirely understand why she’s been ignoring you.
Science wasn’t “created”, it evolved out of a hodge-podge of things that included all kinds of things we now consider antithetical to science. In fact, a lot of pseudoscience is basically just discredited scientific ideas or medical practices that someone couldn’t let go.
Seriously, you need to educate yourself about the neurobiology and psychology of decision making, as well as educate yourself about the history of medicine and science. If you did, you wouldn’t be making the kinds of claims you are about absolute knowledge and absolute objectivity and pretending they apply to science because you’d know exactly what that leads to….
Fifi,
In my opinion you are making this more difficult than it needs to be.
As a medical procedure, non-therapeutic circumcision of boys is a clear violation of the standard of care that is used for all other pediatric surgery.
The standard of care for pediatric surgery requires the medical benefits of the surgery to far outweigh the risks and harms or for the surgery to correct a congenital abnormality.
Dr. Hall could not cite any other surgery that doctors will perform on children that does not meet that standard of care. The only procedure she could cite was another form of permanent body modification, ear piercing.
It would be easier for me to respect doctors who circumcise healthy boys if non-therapeutic circumcision were one of several surgical procedures that do not meet the standard of care for pediatric surgery. But non-therapeutic circumcision is not one of several exceptions. It is not even one of a few exceptions. It is the only exception to the standard of care that doctors use for all other pediatric surgery.
The standard of care requires the medical benefits to far outweigh the risks and harms of the procedure. All of the professional medical organizations say the potential benefits of infant circumcision are about equal to the risks and harms.
Thankfully younger doctors recognize the ethical problems with making a unique exception to the standard of care for pediatric surgery in order to accommodate form of permanent body modification motivated by culture and religion.
Circumcision by Muslim and Jewish parents is a more difficult ethical issue. However Muslim and Jewish religious circumcision should not be used as a justification by doctors to violate the standard of care for pediatric surgery for non-Muslim and non-Jewish boys.
BD Dwyer – Clearly it’s not as simple an issue as you and Consult would like to make it out to be. People motivated by ideology often try to dismiss complexity and make issues black/white to serve their desire to make the world suit their personal ideology. I find it strange that you align yourself with Consult yet you consider circumcision a different issue in cultures that have religious reasons and ones that don’t – it seems that your ethics are quite contingent and influenced by cultural context and NOT based in science.
I’ve bowed out of this discussion, but readers might be interested in what one of my co-bloggers had to say at http://scienceblogs.com/denialism/2008/11/why_male_circumcision_and_fema.php
Fifi – I appreciate your frustration. I am curious if you could elaborate on the point you made to BDDwyer. How is it not as simple as he describes? I see it in terms very much has he/she defined which can be summed up as, without a clear medically therapeutic need it should not be performed on a non-consenting individual.
For the record, I don’t have the same reservations with regard to the religious significants. I also noticed, I think, that you are basically opposed to the procedure on ethical grounds too, is that right?
Fifi – I don’t think you are doing it, but in my opinion some people motivated ideology try to make this issue more complex than it really is to serve their personal cultural or religious agenda.
For the record I don’t align myself with Consult. We agree that infant circumcision is not medically necessary, but I do not agree with all of Consult’s arguments, nor his or her style of debate.
I believe that all children, both boys and girls, have a basic right to decide what permanent body modifications are done to their own body. In my opinion there needs to be a compelling reason to override an individual’s right to genital autonomy. Clearly there is no compelling medical reason to circumcise healthy boys. I do not find the cultural reasons in support of circumcision given by non-Muslim and non-Jewish parents to be compelling.
However I acknowledge that many Muslim and Jewish parents feel that their religious beliefs are a compelling reason to circumcise their sons. I am willing to listen to their reasons why they think their religious beliefs as adults should take priority over their son’s right to genital autonomy. To date I have not found their arguments to be persuasive, but I am willing to consider their point of view.
“I’ve bowed out of this discussion, but readers might be interested in what one of my co-bloggers had to say at”
Before I waste some more time, could you tell me if they post any scientifically credible evidence or is it merely more unsubstanatiated opinions and speculation?
“Seriously, you need to educate yourself about the neurobiology and psychology of decision making, as well as educate yourself about the history of medicine and science. If you did, you wouldn’t be making the kinds of claims you are about absolute knowledge and absolute objectivity and pretending they apply to science because you’d know exactly what that leads to….”
Oh, so now there is a science behind decision making? Sorry I have had courses in neurophysiology and while we understand how neurons work, we have no credible idea (just speculation)how the brain works for even memory let alone decision-making.
It seems you fail to read what I have stated–repeatedly–remember the terms scientifically-credible evidence? How did you manage to read “absolute” in that statement?
“BD Dwyer – Clearly it’s not as simple an issue as you and Consult would like to make it out to be. People motivated by ideology often try to dismiss complexity and make issues black/white to serve their desire to make the world suit their personal ideology. I find it strange that you align yourself with Consult yet you consider circumcision a different issue in cultures that have religious reasons and ones that don’t – it seems that your ethics are quite contingent and influenced by cultural context and NOT based in science.”
Sorry, but irrational desires can hardly justify DOCTORS doing a harmful procedure–it IS as simple as that–doctors should be doing MEDICINE!
But as you stated, rational thinking and actions can be harmful?
Since we’re talking about science-based medicine, it’s worth remembering that we wouldn’t even be having this discussion if it weren’t for the fact that 19th century doctors thought that :
a) masturbation caused various physical and mental problems (including epilepsy, convulsions, paralysis, tuberculosis etc), and
b) circumcision stopped masturbation.
Both of those sound ridiculous today I know, but if you don’t believe me, then check out this link:
http://www.noharmm.org/docswords.htm
(A Short History of Circumcision in North America In the Physicians’ Own Words)
Over a hundred years later, circumcised men keep looking for new ways to defend the practice.
You might also want to check out the following:
Canadian Paediatric Society
http://www.cps.ca/english/statements/fn/fn96-01.htm
“Recommendation: Circumcision of newborns should not be routinely performed.”
http://www.caringforkids.cps.ca/pregnancy&babies/circumcision.htm
“Circumcision is a non-therapeutic” procedure, which means it is not medically necessary. Parents who decide to circumcise their newborns often do so for religious, social or cultural reasons. To help make the decision about circumcision, parents should have information about risks and benefits. It is helpful to speak with your baby’s doctor.
After reviewing the scientific evidence for and against circumcision, the CPS does not recommend routine circumcision for newborn boys. Many paediatricians no longer perform circumcisions.”
Royal Australasian College of Physicians
http://www.racp.edu.au/download.cfm?DownloadFile=A453CFA1-2A57-5487-DF36DF59A1BAF527
“After extensive review of the literature the Royal Australasian College of Physicians reaffirms that there is no medical indication for routine neonatal circumcision.”
(those last nine words are in bold on their website, and almost all the men responsible for this statement will be circumcised themselves, as the male circumcision in Australia in 1950 was about 90%. “Routine” circumcision is now *banned* in public hospitals in Australia in all states except one.)
British Medical Association
http://www.bma.org.uk/ap.nsf/Content/malecircumcision2006?OpenDocument&Highlight=2,circumcision#Circumcisionformedicalpurposes
“to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate.”
National Health Service (UK)
http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=649
”Many people have strong views about whether circumcision should be carried out or not. It is not routinely performed in the UK because there is no clear clinical evidence to suggest that it is has any medical benefit.”
“Since we’re talking about science-based medicine, it’s worth remembering that we wouldn’t even be having this discussion if it weren’t for the fact that 19th century doctors thought that :
a) masturbation caused various physical and mental problems (including epilepsy, convulsions, paralysis, tuberculosis etc), and
b) circumcision stopped masturbation.”
Yes it is worth remembering, which is one of the things that I’ve been saying repeatedly and one of the reasons why it’s not nearly as simple an issue as people with ideological positions they’d like to impose one way or the other would like to make it out to be. It’s also worth remembering that it’s science-based medicine that has shown that masturbation is actually a healthy, natural activity (it’s actually good for us not harmful) and that the decision to circumcise was based in a moral/ethical consideration that then used medicine to enact that morality/ethos. So, what happened historically was that medical practice was influenced by cultural concerns. (Most SCAM is a lingering reminder of this now discarded concept since it equates health with morality – “good energy” or “connection with the divine” or past life wrongdoing or whatever.) Medicine isn’t practiced in a vaccuum, as is clear by the differences in how medicine is practiced in different countries today (looking back over a century to compare with today is obviously even more problematic!!!)
“Yes it is worth remembering, which is one of the things that I’ve been saying repeatedly and one of the reasons why it’s not nearly as simple an issue as people with ideological positions they’d like to impose one way or the other would like to make it out to be.”
It IS simple if you confine it to science–and not try to excuse it with cultural or religious excuses…complications only occur when one tries to introduce tangential excuses.
Fifi, what happens to your claim of bias impugning the study due to the site that posts the study:
TWO sources for the same study..
http://www.cirp.org/library/anatomy/taylor/ (biased?)
OR:
http://www.blackwell-synergy.com/servlet/useragent?func=synergy&synergyAction=showAbstract&doi=10.1046/j.1464-410x.1996.85023.x&area=production&prevSearch=allfield%3A%28circumcision%29
From Medscape fyi
Nerve-Sparing Circumcision in Adults Maximizes
Protection Against HIV
By Karla Gale
NEW YORK (Reuters Health) Nov 12 – A
modified approach to circumcision in adult
men developed by surgeons at Robert Wood
Johnson Medical School should substantially
increase resistance to HIV infection while
preserving sensory nerves.
“Conventional circumcisions offer protection against AIDS because the mucosa on the
uncircumcised foreskin is not keratinized and permits viral attachment, and immune cells called
Langerhans cells that attract the AIDS virus are numerous under the mucosa,” Dr. Joel Marmar said
in an interview with Reuters Health.
Dr. Marmar presented details of the revised technique and operative results at the annual meeting of
the American Society for Reproductive Medicine in San Francisco.
“This procedure is intended for adults in an at-risk population for AIDS who are interested in a
circumcision that offers nerve preservation,” he noted.
“With conventional circumcision, one simply pulls the foreskin down over the glans and amputates it,
not really minimizing the amount of undersurface, just whacking off nerves and vessels and
everything else,” the surgeon said. “I wanted to preserve the outer skin as much as possible but
minimize the undersurface.”
In the modified circumcision, he explained, a “sleeve of foreskin” overlying and extending beyond the
glans is incised, followed by injection of normal saline beneath the penile skin and mucosa for hydro-
dissection.
“I then simply remove as thin a layer of skin as possible, leaving behind most of the blood vessels
and nerves,” he continued. The skin and mucosa are then re-approximated.
Dr. Marmar and his associates in Camden, New Jersey, found that the seven men who underwent
the nerve-sparing procedure required fewer postoperative pain pills than five men who underwent
conventional circumcision (12 vs 26, p = 0.001), and they returned to intercourse earlier (mean 59 vs
88 days, p<0.001).
The mean mucosal border in uncircumcised patients at their clinic was 4.5 cm. The remaining
mucosal border was substantially smaller following the revised surgery (mean 0.5 cm) than after
conventional surgery (3.2 cm, p < 0.001). However, the nerve count in the removed skin was
significantly less following the modified technique.
Dr. Marmar expects, based on the more extensive removal of mucosa, that the revised circumcision
will offer better protection against infection. “The number of Langerhans cells that appear in a square
centimeter of mucosal tissue is phenomenal,” he added.
What a lot of utter nonsense–on two fronts..
First the bogus concept of circumcision reducing HIV. Pure specualtion on causation..and already disproven by the CDC!
Secondly, this moron has apparently not even bothered to read Taylor, just assumed that nonsense that removing mucuosa retains nerves–forgetting about the ridged band. And totally forgetting the mucuosa also has specialized nerves–a cute bit of cognitive dissonance at best. The retained outer skin has almost NO nerves!
Guess some are such circumfanatics, they grasp at any straw to get to circumcise men.
“There’s no good evidence that circumcised men get less pleasure from sex.”
Most men would like to believe this but I don’t think it is true. If you were to examine the studies that led you to that conclusion, you would find they were flawed in some way. What about the thousands of men who have restored their foreskins, just send an e-mail to the people at NORM-UK: http://www.norm-uk.org/index.html
,and ask them if there is any difference.
One of the reasons used in favour of circumcision is reduced risk of contracting HIV during penile-vaginal sex. The reason for this, so they say, is because of keratinization of the glans. Then they say that circumcision doesn’t reduce sensitivity. So how can the glans be both keratinized and not lose sensitivity?
Have you actually looked at a comparison between a glans that has been covered and protected by the foreskin, and a glans that has been left to dry out a rub against clothes?
Here is one site that gives you that comparison:
http://www.noharmm.org/IDcirc.htm
———————————————
“most [circumcised] men will tell you that if their genitalia were any more sensitive, it would cry during Meryl Streep movies.”
Good tactic – keep the tone light,cheery and informal – let us not get too serious about this – it is only genital mutilation without consent.
———————————————
“If some men are psychologically damaged by circumcision and mourn their lost foreskin, their mental health must be pathologically fragile. Get over it, guys!”
Hmm. I thought you were a doctor? Guess you skipped Ethics and Psychology lectures – must have been sick that day?
———————————————
“I don’t think there is any evidence that babies are capable of remembering the pain of circumcision or for that matter the birth experience.”
Maybe, maybe not – it is not really that important in the whole realm of this discussion. He still has a reminder in the circumcision scar. And one of his first experiences will be pain. This could affect his behavior and this in turn could affect his behavior with his mother. And this in turn could effect his personality. So not as simple as you make out. and certainly shouldn’t be dismissed so easily.
———————————————–
“The risks are minimal…”
Define risk. Quantify minimal. Would it be better to use the word complication?
————————————————-
“I used to do assembly-line circumcisions where we’d strap several babies to molded plastic restraining boards; they didn’t like being restrained, but by the time the last baby was restrained, the first one would usually have stopped crying and would often remain calm throughout the actual procedure”
You sound like you are trying to justify putting the baby through this pain. Is this why you became a doctor? If there is any doubt in your mind that this isn’t for the good of the patient then it shouldn’t be done. Primum non nocere. Particularly when you know that it isn’t done in Europe and they have no problems whatsoever.
————————————————–
Langerhans cells in the foreskin have recently been shown to destroy HIV. This is being ignored by circumcision proponents.
http://www.medicinenet.com/script/main/art.asp?articlekey=79688
Demographic data from sub Saharan Africa, which show no overall protective effect against HIV from circumcision, are also being ignored. http://www.ingentaconnect.com/content/nisc/ajar/2008/00000007/00000001/art00001 (abstract and full text). HIV prevalence in the United States, where 75% of adult men are circumcised, is 3 to 7.6 times that in many European countries, where circumcision is rare. http://www.who.int/whosis/database/core/core_select.cfm Only abstinence, monogamy, or the consistent use of condoms reliably prevents HIV or other sexually transmitted diseases. Circumcision does not!
Also ignored by those pushing circumcision to reduce HIV is the study by the CDC that destroys their assertion by showing that the undamaged epithelia (unkeratinized and with Langerhan cells) does NOT transmit the virus:
http://www.cirp.org/library/disease/HIV/dezzutti/
Dr. Marmer above has believed a lot of unfounded assertions and then went on to concoct a procedure that then ignores the anatomical evidence and claims to have improved the process..
Forest Gump–”stupid is as stupid does”.
Now on to the pro-arguments, although i think you already started early in the “against” section. You begin with a few tired cliched assumptions:
“Some of the arguments for circumcision are unavoidably intertwined with a separate issue: hygiene. The warm, moist space under the foreskin is a prime breeding ground for bacteria, it can harbor sexually transmitted disease organisms, and it produces a cheese-like, foul-smelling substance called smegma. It is plausible that this could contribute to infections in the man and his partner, and even to cancer. Many studies support that idea, others don’t. There doesn’t seem to be any good evidence comparing circumcised men to uncircumcised men who practice meticulous hygiene. It’s difficult to sort out whether it is the circumcision itself or just improved hygiene that makes the difference. Circumcision undoubtedly facilitates hygiene, but is that a reason to operate?”
This sounds like someone from a circumcision activist site. How do we trust your definition of hygiene when you already hold the incorrect belief that smegma is a bad thing? You do know that women produce more smegma than men, right? Why not go at the vagina with a knife to reduce any crevices? We don’t want a perfectly natural substance hiding in there, do we? Smegma is a natural oily substance, it contains anti-bacterial enzymes. It helps lubricate the gliding action of the foreskin. Remember the consequence of no smegma – a dried out penis. Here are a few studies:
http://www.cirp.org/library/disease/STD/fleiss3/
http://www.cirp.org/library/disease/cancer/vanhowe2006/
——————————————————
AIDS – I think this section is better than the others, although you should have been a bit more critical. You could have also said that circumcision has had no effect on reducing HIV infection in the USA despite a 90% circumcision rate at one point. Circumcision is also highest among African-Americans yet these have the highest rate of STI’s. Outside the USA, in places where they do not circumcise, like Britain and Scandinavia, the rates are a lot lower than the USA’s. That goes for all STI’s – not just HIV. Also keep in mind that the chances of getting HIV through penile-vaginal sex is rare. Even if you sleep with a HIV infected woman the chances of you getting it are about 1 in 500. Some say it is as little as 1 in a 1000. Condoms have been shown to be 95 times more effective than circumcision.
Let us turn our attention to the subject of cherry-picking studies because i agree with you that there are studies on both sides of the argument. So it is important that the studies are analyzed in detail. I have deliberately refrained from saying that there is evidence on both sides of the argument for exactly this reason.
One of the most reliable studies is supposed to be a longitudinal cohort study. According to Van Howe only 2 have been done on STI’s. Let us take Fergusson’s one in Christchurch, New Zealand:
http://pediatrics.aappublications.org/cgi/content/abstract/118/5/1971
Now you can do 2 things here, you can read the abstract and just go to the conclusions and then use it as an argument to promote circumcision,
OR you can click on full text and look at the whole study and analyze it for yourself. After that, you can read the responses from other authorities on circumcision, to the study:
http://pediatrics.aappublications.org/cgi/eletters/118/5/1971
By doing this you see that the study has flaws. You also see that it is in contrast to cross-sectional studies showing no difference and that these studies had a larger number of participants.
Robert Van Howe provides some good criticisms. He also mentions the other longitudinal study, done by Dickson also in New Zealand:
http://www.cirp.org/library/disease/STD/dickson2008/
as you can see it showed the opposite result.
———————————————————-
On to the other “advantages”. First, I’d like to say, I can’t tell whether you are listing arguments that pro-circ people use (true or not) or you are actually listing the advantages as if you actually believe them to be true yourself?
To rebut your case for lack of circumcision reducing your risk of Cancer, I’ll quote from one survey:
“It has been suggested that circumcision prevents cancer of the penis and of the uterine cervix. Both kinds of cancer are associated with genital infection with specific types of human papillamoviruses. It has been alleged that cancer of the penis is virtually unknown among men circumcised in infancy. However penile carcinomas have in fact been reported among circumcised men. The incidence of cancer of the penis in the United States, where most men have been circumcised at birth, is reported to be between 0 and 2.1 per 100,000, representing less than 1 percent of all cancers in men. This incidence of penile cancer is similar to the rates in Denmark (1.1 per 100,0000 and Japan (0.3 per 100,0000 where neonatal circumcision is not routinely performed.
One study, reporting contradictory data, claimed that the lifetime risk in American men is 1 in 600. This estimate was extrapolated from a study of the incidence of male circumcision and depended on three incorrect assumptions: that all penile carcinomas occur in men who are not circumcised at birth, that the circumcision rate between 1890 and 1905 was the same as that in 1959, and that men presenting at a cancer detection center in Los Angeles, 40 percent of whom were classified as professionals or managers, were representative of the U.S. male population. Thus the lifetime risk of cancer reported in this study is probably incorrect. The evidence that penile cancer has a viral cause and the disease’s similar incidence rates in countries with very different rates of circumcision cast doubt on the proposition that circumcision is the most effective way to prevent cancer of the penis.”
Source: http://www.cirp.org/library/general/poland/
-See what I mean about cherry-picking studies. you must analyze them first before you take them as true.
—————————————————————-
“Reduction of the incidence of various sexually transmitted diseases in men and in their female partners. Reduction of cervical cancer and maybe even breast cancer in women. Again, these are likely more related to hygiene than to surgery.”
Again what do you mean by hygiene? It is more to do with not contracting the HPV virus – this is safe sex, not hygiene. There is now a vaccine for the HPV virus. And condoms are much more effective. So would you still categorize it as one of your advantage points?
————————————————————–
“About 10% of uncircumcised infants will require circumcision later in life”
Huh? where did you pluck that figure from? So 1 in 10 men in Britain gets a circumcision later in life? Erm, no he doesn’t. Stupid doctors in the USA can’t tell the difference between normal developmental non-retractability of the foreskin and phimosis. The average age of retractability of the foreskin is 10 years of age and by age 18 most boys have retractable foreskins. Whenever he gets an infection, they put it down to him being circumcised. It is probably more to do with parents pulling the foreskin back and creating tears. Also by trying to clean inside you do more harm than good – you just introduce infections and disturb the natural flora of the penis. It is the same reason why women are told not to clean out their vagina. Phimosis is very rare, misdiagnosed a lot in the USA, and usually caused by unusual masturbation habits:
http://www.cirp.org/library/treatment/phimosis/beauge/
—————————————————————–
“Reduced risk of urinary tract infection”
You don’t mention that these are easily treated with anti-biotics. So again, not really an advantage of circumcision at all.
————————————————————————-
Brian morris who runs circinfo.net is a rabid circumfetishist. I don’t know why you chose to get all your info from his site. You can read a rebuttal to his arguments here:
http://www.circumstitions.com/Morris.html
—————————————————————————-
For what it’s worth at this late stage in the game, I am a vehement opponent of circumcision (I’m a European-born, uncircumcised male), and yet I had few problems with Dr. Hall’s post. I’m willing to accept that the scientific evidence supporting both positions is pretty much a wash, and that the benefits are either negligible or achieved with greater effect by other means (particularly hygiene and HIV protection), but that the drawbacks aren’t that major a cause of concern either, medically speaking.
That said, the ethical question remains that Dr. Hall herself acknowledges: absent a compelling medical need, can one justify removing part of the body of an individual who is incapable of giving consent? In my opinion, the answer is an unqualified no, and that alone is sufficient reason to oppose FGM, circumcision and yes, neonatal ear piercing.
I really don’t have a lot of patience for people who claim that “you can’t compare” those procedures. In the strictest sense, such a statement is paradoxical, because it cannot be made without having, in fact, compared them to each other. Of course, what such people mean is that they are not equivalent, and there I would agree, but only to the extent that the degree of severity differs. The underlying principle, in all three cases, is precisely the same: the unnecessary alteration of the body of a person incapable of giving consent for the sole purpose of making that individual conform more closely with some cultural norm.
I’ll admit that I’m a little perturbed by Dr. Hall’s acknowledgment that there is a strong ethical argument against circumcision, combined with her description of having carried out multiple circumcisions on more than one occasion. I suppose I would have hoped for a little more introspection regarding the justifiability of her past actions. But as she has asserted, she has attempted to take up a neutral stance in this post, and I think she has succeeded in doing so. Perhaps the problem that those who claim she has not have is they have trouble accepting that anyone can, or would want to, remain neutral about an issue that evokes such strong emotions. I admit that, to my own mind, failing to condemn the practice is, in effect, condoning it, and such an effort to remain neutral does come off as rather suspect when the person involved is someone who has herself performed circumcisions. But that is an emotional response on my part, and to claim that Dr. Hall’s post is not neutral because her own behavior has not been neutral with regard to this issue would be a perfect example of an argumentum ad hominem (or, more correctly, ad mulierem).
I think Harriet”s attempts to scientitifically justify circumcision and hence ethically and morally justify her having performed this procedure without the patient’s consent fall far short.. cherry-picking questionable studies and inserting facile and silly “reasons” AND ignoring the proven harms and risks is hardly neutral –regardless of her claims that they are.
And this is hardly an ad hominem argument–merely one analyzing her claims.
Speaking as an uncircumcised man, all I can say is “Ouch! Ouch! Ouch” I think I’ll stay in my monogamous relationship instead.
Jurjen S,
I wasn’t going to respond to this thread any more, but I can’t resist applauding you for reading what I actually wrote and not reading more into it, for being able to separate the science from the emotion, and for providing a sterling example of critical thinking. Thank you.
Your comment stands in stark contrast to the following comment by Consult that misinterprets what I wrote.
“Your comment stands in stark contrast to the following comment by Consult that misinterprets what I wrote”
Gee, now I am confused, HOW and WHAT have I misinterpreted that you wrote?
“I think Harriet”s attempts to scientitifically justify circumcision and hence ethically and morally justify her having performed this procedure without the patient’s consent fall far short.. cherry-picking questionable studies and inserting facile and silly “reasons” AND ignoring the proven harms and risks is hardly neutral –regardless of her claims that they are.”
Once again, you are confusing “cutting you a break” with doing a critical analysis–so far the only critical analysis iI have seen here are those on the studies you have provided..
AGAIN, I ask you,–where is this SCIENCE that you allege you have provided? Do you understand what the scientific process is?
Anyone who reads what I wrote and thinks I was trying to scientifically justify circumcision, that I was trying to ethically or morally justify it, that I was cherry-picking studies, or that I ignored the proven harms and risks obviously can’t read.
It’s really sad when intelligent people are so overwhelmed by their prejudices that it interferes with their ability to understand plain English.
“Anyone who reads what I wrote and thinks I was trying to scientifically justify circumcision, that I was trying to ethically or morally justify it, that I was cherry-picking studies, or that I ignored the proven harms and risks obviously can’t read. ”
The title of the site is science-based medicine. You posted cherry-picked pro-circumcision studies from BM’s site exclusively..not a single anti-circumcision study. You posted a lot of non-medical anecdotes and “reasons” for circumcision–from locker-room laughter to zipper injuries. You even resorted to trivializing and ridiculing the reactions of men to their forced circumcision. You gave us your skewed opinion to the procedure and how it was so harmless, and you pertsonally have done many with no adverse affects (those you have dismissed or ignored). Lastly after all of this, you threw in the superstition justification..and with this HUGE imbalance, you then asked If it was justified.
“It’s really sad when intelligent people are so overwhelmed by their prejudices that it interferes with their ability to understand plain English
Intelligent people are able to perceive patterns formed from those plain english words.
Even more sad, is when people go to the lengths you have to try to justify the procedure and their participation in it–and are even then unable to see what is obvious to all objective people.
Are you still going to ignore the risks and harms that I posted, and pretend that your claim for that small number you posted are correct and credible?Prove me wrong or show me that you are willing to accept evidence against circumcision.
First JurjenS, Excellent post.
Second, Go Denmark!
http://politiken.dk/newsinenglish/article598875.ece
Male circumcision should be cut
While there are laws preventing female genital mutilation in Denmark, there are none preventing male genital mutilation. Demands for action.
The Children’s Council and the Chair of the Ethical Council say it is objectionable and ethically indefensible that while there is a law preventing female genital mutilation, no such law exists for males.
Both the Jewish, Muslim and other traditions call for the circumcision of males. In Denmark, the Chief Rabbi Bent Lexner carries out the circumcision of Jewish boys. Muslim circumcisions are often carried out in clinics or hospitals.
Religious links
The Children’s Council Chair Charlotte Guldberg says the practice should be stopped.
“There is a deep problem here. Society is in no doubt that the genital mutilation of girls is unacceptable – but we accept it with boys and have tolerated it for many years because it is linked to religion. It is gender discrimination from birth that we make a distinction between boys and girls,” says Gulberg, who adds that circumscision should be banned for boys under 15 years of age. According to tradition, young Jewish boys are circumcised at the age of eight days.
Voice
The Ethical Council does not have a general view of circumcision, although Chairman Peder Agger does not immediately reject the notion of legislation.
“There is an ethical problem. I would prefer people to wait until the child is 15, thus respecting his right to choose and so that he knows what is going on. I believe that one should not undertake physical procedures that leave lasting scars or have lasting effect until a child is 15. And there should be some discussion as to whether the procedure should be ritualised in another way. In Denmark we have also stopped putting a child’s head completely under water during baptism,” says Agger.
Symbolic
In the United States there is an increasing tendency to carry out symbolic male circumcision by simply pricking the foreskin to draw blood. But in Denmark, as in many other countries, boys have the entire foreskin removed.
Covenant
In the religious tradition, circumcision is part of the covenant reported between God and Abraham. The relevant passage regarding Abraham is found in Genesis 17: 9-14 and reads:
“Then God said to Abraham, “As for you, you must keep my covenant, you and your descendants after you for the generations to come. This is my covenant with you and your descendants after you, the covenant you are to keep: Every male among you shall be circumcised. You are to undergo circumcision, and it will be the sign of the covenant between me and you. For the generations to come every male among you who is eight days old must be circumcised, including those born in your household or bought with money from a foreigner–those who are not your offspring. Whether born in your household or bought with your money, they must be circumcised. My covenant in your flesh is to be an everlasting covenant. Any uncircumcised male, who has not been circumcised in the flesh, will be cut off from his people; he has broken my covenant.”
Violation
Nonetheless, religions cannot set themselves outside norms and violate a child’s physical integrity according to Kirsten Ketscher, Professor of Social Law at Copenhagen University. She tells Kristeligt Dagblad that the procedure should wait until a child is old enough to decide itself.
Reject
Chief Rabbi Bent Lexner, who has received special training in the procedure, rejects both the idea of a legal ban and the introduction of symbolic circumcision.
“Jews have been fighting for many years to maintain the tradition, as it is a sign of Jewish identity. Even among Jewish families who do not live according to Jewish practice there are only very few who do not have their children circumcised. If you want to be part of the Jewish people, you have to fulfill precisely that rule. Getting rid of circumcision would be the same as removing baptism from the Christian faith,” says Chief Rabbi Lexner.
Imam Abdul Wahid Pedersen says that parents exert their decisions on children in many other issues also.
“They decide what clothes children have to wear so they aren’t bullied. And if children are to be able to decide, why shouldn’t they be able to decide themselves whether to be baptised,” the Imam tells Kristeligt Dagblad.
There are some Christian directions and sects who practice circumcision. These are predominantly the Coptic, Ethiopian and Eritrean Orthodox churches.
Edited by Julian Isherwood
Notice the non-rational (excuses)
The Jewish one of requirement from god–however research has shown that this circumcision nonsense was inveneted by priests circa 550BCE
“They decide what clothes children have to wear so they aren’t bullied. And if children are to be able to decide, why shouldn’t they be able to decide themselves whether to be baptised,” the Imam tells Kristeligt Dagblad.”
None of these parental dec isions are permanemtly harmful to children–logic is lacking in this excuse.
I guess a point here is that the author is not really able to:
“stand back and look at the scientific evidence objectively. What are the medical benefits and risks of circumcision?”
I read this and I can only think that deep down the Author is pro circumcision. I know as a professional that if I havd been doing something for years and it was shown to not be helpfual and instead hamrful I could want to defend myself. I sense that here. Why else would there be no mention that this surgery removes the most sensitive part of the male genitals. I cannot overtate this as this part of the body feels SO SO good to the owner. If you don’t have these touch sensitive parts, you should at least heavily investigarte before giving an opinion of the sceintific reasons to saty natural and not cut off thepart. It is an active promotion of the amputation to NOT mention the lost nerves and lost touch sensitivity.
The points that were included make the point(s) absent more significant. This is clearly a persuasion piece.
JUST silly to include:
Zipper injuries to the foreskin can’t occur if you don’t have a foreskin. True, but trivial
I have never had this problem and I have never heard of this. Possibly the author does note really know what this part of the anatomy is all about. This rediculous and non existant issue was worth mentioning over: the fact that the foreskin contains about 20,000 nerve endings which are extremely touch sensitive (like the female clitoris). These touch-sensitive nerves are called “Meissner’s Corpuscles and Circumcision cuts off ‘more than 3 feet of veins, arteries and capillaries, 240 feet of nerves, and 20,000 nerve endings”
The silly point was the homosexual docking practice. This is important to very few people and again becomes a silly point to include. Why not include the basic human practice of pulling forward the foreskin upon entry into the vagina to provide smooth insertion and enjoyable coitius. This slip in practice is a human interaction that goes away with the cut. Coitus is a big issue with humans and this part of the anatomy is very helpful for enjoyment.
This part of the body feels so good to the owner. Please start paying attention to that instead of theoretical zipper injuries.
Jack, it’s not theoretical. I’ve known a guy who managed to get his foreskin caught in his fly zipper, and mangled it so badly (he was seriously inebriated at the time, and his movements were rather uncontrolled) that his doctor advised him to have it removed entirely. I cannot begin to imagine the pain he must have been in.
That said, however, my reaction at the time was “good thing he had a foreskin” because what would have happened if he’d done that to his glans? So you can turn that around and make it an argument against circumcision, because at least that way there is something to prevent zipper injury to the glans itself (at least once).
Consult, are you reading the same piece I am? Dr. Hall explicitly says:
“What all this really boils down to is that there are no compelling scientific arguments for or against neonatal circumcision.”
Italics mine. How does that translate to “attempt[ing] to scientifically justify” the procedure? She literally says there are no compelling scientific arguments for neonatal circumcision.
“Consult, are you reading the same piece I am? Dr. Hall explicitly says:
“What all this really boils down to is that there are no compelling scientific arguments for or against neonatal circumcision.”
Italics mine. How does that translate to “attempt[ing] to scientifically justify” the procedure? She literally says there are no compelling scientific arguments for neonatal circumcision.”
You are confusing her claims there ARE scientifically-credible benefits with the fact that there are NO scientifically-credible ones. …Presenting ALLEGED ones IS trying to justify it.
And to further my point, there IS compelling scientific evidence against circumcision which she has, and continues to ginore.
Consult, not to put too fine a point on it, you’re peddling horseshit. Dr. Hall literally says “there are no compelling scientific arguments for [...] neonatal circumcision” and yet you persist in claiming that she asserts that there are. Are you delusional? Are you so insecure about the correctness of your stance on neonatal circumcision that you absolutely have to have a safety blanket of science-based arguments to fall back on? Isn’t the simple ethical argument–that it’s unacceptable to perform a permanent and medically unnecessary procedure on a newborn incapable of giving any kind of consent, let alone informed consent–sufficient?
Consult, I can only repeat my previous question:
Dr. Hall literally says that “there are no compelling scientific arguments for [...] neonatal circumcision.” How can this possibly translate to claiming that there are?
(And to be a “grammar Nazi” for a moment: when you put an adverb before an adjective, you don’t need a hyphen. It’s “scientifically credible,” not “scientifically-credible.”)
THIS is what she stated..
“What all this really boils down to is that there are no compelling scientific arguments for or against neonatal circumcision.”
Agreed, there is no credible scientific evidence FOR circumcision-none at all. Yet, there is credible and compelling evidence AGAINST circumcision.
In the main part of her article, she quoted alleged benefits from BM’s site with NO critical analyses.
And then she proceded to pretend these benefits actually existed–and deliberately ignored the proven harm from circumcision.
This pretense of there being ANY science behind the advocation of circumcision (in a so-called science-based article) is what I consider to be the real “horseshit peddling”.
So where is this “horseshit peddling?
Oh boy… My apologies to Drs. Hall, Gorski et al. I did NOT mean to start a war on the anniversary post. I just fealt that since there are over 170 comments by now, and most of us don’t have time to read through all of them, it means that not all arguments have been counted and completely supported or refuted.
My starting point: I’m an Atheist Israeli. I feel myself part of the Jewish people but I’m not too happy with many archaic bits of the Jewish Religion, that’s why personally circumcision was an interesting subject for me. I was generally anti circumcision and most of the post confirmed that and then this piece of data came up: “About 10% of uncircumcised infants will require circumcision later in life for medical reasons.”
10% is not a number to gloss over. I wanted to get more info on where that information came from, if it was reliable, is it for Africa, the USA or Europe, etc. I saw there was a little discussion about it later in the comments, but I could not find Dr. Hall’s exact opinion about that, links to data and what the final verdict was. if 10% is a correct, unbiased number, unrelated to hygiene and other parameters, this could be a reason to reconsider my stand on the matter. I’d vaccinate kids against much smaller odds of other health issues, so the argument at least about this item needs a bottom line.
Ira,
I did a lot of research for this post, and I didn’t take the time to document every source. I can’t locate the 10% citation at the moment, but as I remember it was from a credible primary source (a paper by a urologist?) and a US population. It would be comforting to think some of the 10% could have been avoided by optimal hygiene, but there’s no evidence to support that.
A typical example: a pediatrician friend of mine chose not to have either of her boys circumcised at birth, and ” the older one at about age 12 had phimosis bad enough that I could hear him having trouble initating urination. He had an in office circ and did fine with it. ”
She didn’t have a crystal ball, but I bet if she could have known this was going to happen she would have preferred neonatal circumcision (safer and less emotionally traumatic to the child).
As I said, I never decided whether I would want my own son circumcised if I had one. My dilemma boiled down to this: I didn’t like the idea of doing an elective procedure on an infant who couldn’t give consent, but if my child were one of those who was going to need circumcision later on, or who was going to develop penile carcinoma, I could save him a lot of grief by having it done when it was safer, simpler, and would not even be remembered. In my mind, these two arguments pro and con were of comparable weight. So much so that I would have been glad to leave the decision to my husband and would have happily accepted whichever path he chose.
The whole circumcision question is a tempest in a teapot: a “big issue over a little tissue.” People who are emotionally invested in it will continue to argue forever and will continue to misinterpret whatever I write. The fact remains: there is evidence that circumcision provides a small health benefit and has only a small risk. It is neither medically indicated nor medically contraindicated. That’s the conclusion I reached from reviewing the medical literature, and it is also the consensus reached by many medical organizations. Nothing in the comments made me question that consensus.
Ok then… I guess I’ll take the middle road as you (and the AAP recommendation) do: leave it to the parents. I wonder what it says now about the supposedly unbalanced organizations like the CDC and WHO, both recommended circ. in the past year.
As always, I’ll be following these subjects, the “too close to call” ones are always the most fascinating of course
Happy New Year,
Ira.
I’ve read a lot of circ debates on the mom websites. I’ve also read a lot of the evidence, although not as many articles as I think Harriet did in writing this post. I think Harriet did a very good job of looking at the larger body of evidence and boiling it down. I think she was neutral in presenting the evidence.
Looking at what has been said here, it is evident that Consult is arguing from a fixed conclusion, not from an unbiased reading of the entire body of evidence. But of course, those who make this mistake, will rarely admit they have already reached a conclusion and acknowledge that they have biases. They then try to fit the evidence to their conclusion.
Brava to you, Harriet, for taking on the subject!
Harriet, I did the exact same thing as you decided– let my husband decide whether to circ our son.
“Brava to you, Harriet, for taking on the subject!” I second storkdok’s brava. It takes a Klingon to tackle this issue!
““About 10% of uncircumcised infants will require circumcision later in life for medical reasons.”
Actually this is nonsense promulgated by Dr schoen..
the real numbers from countries that don’t mistreat the normal penis is:
First of all, for a man who was not circumcised as an infant the chances of him having to get circumcised as a adult are extremely rare. In fact it’s only 6 in 100,000. (0.006%)
Health officials of each Scandanavian country were queried about adult circumcision.. None of the health officials could provide precise data, because the numbers were so small that they weren’t worth compiling. Each official stressed that foreskin problems were present but said they were largely treated medically-surgical solutions were extremly rare.
“in Oslo, Norway, over a 26-year period in which 20,000 male babies were cared for, 3 circumcisions were performed-a frequency rate of 0.02%.
In Denmark. 1968 children up to the age of 17 were examined over a period of several years. In this group, 3 circumcisions were performed-a frequency of 0.15%. In this study, in retrospect, the physicians believed that all three operations might have been avoided. Both of these studies related to the infrequency of circumcision and puberty, they did not deal with the issue in adulthood.
Wallerstein, Edward, Circumcision: An American Health Fallacy. pg 128
“I did a lot of research for this post, and I didn’t take the time to document every source. I can’t locate the 10% citation at the moment, but as I remember it was from a credible primary source (a paper by a urologist?) and a US population. It would be comforting to think some of the 10% could have been avoided by optimal hygiene, but there’s no evidence to support that.”
From what I have read of your posts–nearly ALL of your “research” consisted of copying and pasting info from BM’s site–without doing any critical analysis of his information. and as posted, this nonsense came from Schoen–a fanatic promoter of circumcision–and a proven liar–even in his articles (proof upon request).
“A typical example: a pediatrician friend of mine chose not to have either of her boys circumcised at birth, and ” the older one at about age 12 had phimosis bad enough that I could hear him having trouble initating urination. He had an in office circ and did fine with it. ”
And likely due to mistreatment of the foreskin.. the real rates of it occurring when left alone is:
The Finnish National Board of Health provided national case records for the year 1970 for both phimosis and paraphimosis. A total of 409 cases was reported for males 15 years and older,which represents only 2/100ths of 1% (0.023%) of the total male population in that age group. This means thaat 99.97% did NOT develop a problem. Moreover, according to Finnish authorities, only a fraction of the reported cases required surgery– a number too small to reliably estimate.
Wallerstein, Edward, CIIRCUMCISION: AN AMERICAN HEALTH FALLACY p.128
But thanks for the anecdote–so much more credible than actual research–NOT!
“She didn’t have a crystal ball, but I bet if she could have known this was going to happen she would have preferred neonatal circumcision (safer and less emotionally traumatic to the child).”
yes, neo-natal circumcision is so much better than as an older child? How so?
“As I said, I never decided whether I would want my own son circumcised if I had one. My dilemma boiled down to this: I didn’t like the idea of doing an elective procedure on an infant who couldn’t give consent, but if my child were one of those who was going to need circumcision later on, or who was going to develop penile carcinoma, I could save him a lot of grief by having it done when it was safer, simpler, and would not even be remembered. In my mind, these two arguments pro and con were of comparable weight. So much so that I would have been glad to leave the decision to my husband and would have happily accepted whichever path he chose.”
Ah, the old fear-mongering rationale for neo-natal circumcision.. too bad you didn’t do enough research and critical thinking to realize that these fears are mostly unfounded. the rationale of “IF”. Do you apply this “logic’ to other possible problematic body parts?
Safer? HOW? there are documented deaths from neonatal circumcision, yet not ONE from later circumcisions.
So, leaving it to your husband? WHY? Is he more educated on the subject than yourself? What qualifies HIS decision-making ability better than yours?
“The whole circumcision question is a tempest in a teapot: a “big issue over a little tissue.” People who are emotionally invested in it will continue to argue forever and will continue to misinterpret whatever I write.”
Interestingly you still are trying to call this a “little tissue” in spite of the large amount of scientifically credible evidence to the contrary–WHY and HOW is this still your perception?
“The fact remains: there is evidence that circumcision provides a small health benefit and has only a small risk. It is neither medically indicated nor medically contraindicated. That’s the conclusion I reached from reviewing the medical literature, and it is also the consensus reached by many medical organizations. Nothing in the comments made me question that consensus.
Still clinging to This OPINION when you have been given credible evidence proving there really are no proven benefits and many proven risks and harm? A whole lot of denial seems to be in play here. Research? from one-radically pro-circ site. Science is NOT a consensus procedure. Before re posting your OPINION and conclusions, I suggest you DO some research and critical analysis..this repetition of unsupported opinions hardly presents you in a good light.
1A. Any study, conclusion, or opinion predicated on flawed or invalid data is inherently flawed and invalid.
1B. Any conclusion or opinion predicated on any number of flawed studies with invalid data is inherently flawed and invalid..
2. ALL conclusions from all data must be consistent and agree with all other conclusions very time, or it is considered flawed.
3. Any theory or hypothesis that is unable to fulfill it’s prediction EVERY time is inherently flawed and invalid.
But hey, don’t let science get in the way of your opinion.
“Ok then… I guess I’ll take the middle road as you (and the AAP recommendation) do: leave it to the parents. I wonder what it says now about the supposedly unbalanced organizations like the CDC and WHO, both recommended circ. in the past year.”
This is the old “appeal to authority” default position. If you are of that mentality, why not follow all advice of all of the rest of the world’s medical organizations–do not circumcise.
At least their position is not predicated on lies like that of the AAP, both lies of omission and lies of commission.
“I’ve read a lot of circ debates on the mom websites. I’ve also read a lot of the evidence, although not as many articles as I think Harriet did in writing this post. I think Harriet did a very good job of looking at the larger body of evidence and boiling it down. I think she was neutral in presenting the evidence.”
Looking at BM’s site and copying and pasting the info with no critical analysis is a “good job”? HOW?
“Looking at what has been said here, it is evident that Consult is arguing from a fixed conclusion, not from an unbiased reading of the entire body of evidence. But of course, those who make this mistake, will rarely admit they have already reached a conclusion and acknowledge that they have biases. They then try to fit the evidence to their conclusion.”
Sorry, but I am coming from science–the conclusion is predicated on that process–NOT questionable evidence, anecdotes, and opinions. The mistake is accepting evidence based on those, and not a critical analysis.
“Harriet, I did the exact same thing as you decided– let my husband decide whether to circ our son.
”
WHY? what credible scientific evidence does he bring to the decision that warrants his decision valid?
Harriet – “And that an intact foreskin is an absolute requirement for a mutual masturbation practice amongst homosexual men known as “docking,” in which the penis is placed under the foreskin of the male partner. I didn’t need to know that. You probably didn’t want to know that either, but now it’s too late.”
What’s the big deal about talking about a sexual practice? Why “didn’t you need to know that”? What makes this so particularly icky to you? It’s just sex and people enjoying each other’s bodies.
Harriet – “I don’t think there is any evidence that babies are capable of remembering the pain of circumcision or for that matter the birth experience. There have been studies suggesting that infant circumcision alters pain response later in life, but they are contradictory and unconvincing.”
There’s no proof either way yet you choose to think/believe one thing over the other (and equate circumcision with being born, which seems very odd to me since clearly they’re entirely different contexts vis a vis pain!). This seems to be the promotion of a non-evidence based belief – naturally a preferable one for someone who has done circumcisions. I know pain isn’t your speciality (and I’m not claiming to be a pain specialist myself!) but it’s not so incredibly far fetched that early pain experiences would have a lasting effect – whether they’re medical or due to abuse. It’s a rather old fashioned belief that what a child can’t remember didn’t effect them and certainly not based in evidence of any kind!
Harriet – “If some men are psychologically damaged by circumcision and mourn their lost foreskin, their mental health must be pathologically fragile. Get over it, guys!”
This belittling of a person – in a way that would be considered unacceptable if we were talking about a woman’s genitals due to a hell of a lot of consciousness raising in both general society and medicine by women – really was the clincher for me in revealing Harriet’s bias. While I suspect she was just trying to keep the blog post light and entertaining – not only does it seem unnecessarily provocative but it refuses to even consider the topic seriously since Harriet has decided that it’s not a big deal (even though she doesn’t have a penis). The whole stoic man-up and get over it kind of attitude Harriet reveals here probably comes more from working in the military than being a doctor but it really is far from neutral and reveals a fundamental sexism where male vulnerability is mocked.
Harriet, of course, is human and I don’t expect her to be bias free and I respect that her intention was to present the subject in a humorous and what she considered neutral way. I am, however, disappionted she couldn’t see or own her own bias in this case – not that admitting a bias changes the facts or makes anti-circumcision people somehow “right”. Sadly, Harriet’s personal asides and beliefs do make an appearance on this blog in a way that disempoweres any claims to being neutral or presenting the evidence in a neutral fashion.
2. ALL conclusions from all data must be consistent and agree with all other conclusions very time, or it is considered flawed.
3. Any theory or hypothesis that is unable to fulfill it’s prediction EVERY time is inherently flawed and invalid.
The medical literature rarely meets these two criteria.
You have to decide what the bulk of data suggests combined with biologic plausibilty.
Off topic, but in my own field, should you treat MRSA with two drugs, one being rifampin? Got me. I have to make clinical decisions on treatments when 2 and 3 certainly do apply and the data is flawed. If I had to wait for 2 and 3 to be true before I treated a patient, I would rarely treat a patient.
“Science is NOT a consensus procedure”
Medical science is, and the consensus changes with time.
“Science is NOT a consensus procedure”
“Medical science is, and the consensus changes with time.”
The problem still exists when “medical science” is contradicted b
actual science–should one still depend on consensus? Should OPINIONS supersede scientifically credible evidence which exists as it does concerning circumcision?
I see it that consensus can apply IF and UNTIL credible evidence exists; after that the credible evidence should apply.
“You have to decide what the bulk of data suggests combined with biologic plausibilty.”
So, anything “plausible” that someone can dream up is sufficient to perform a procedure?–should not that “plausibility” be proven to even exist?
What happens when that plausibility is proven not to be true or to exist? What then?
“So, anything “plausible” that someone can dream up is sufficient to perform a procedure?–should not that “plausibility” be proven to even exist?
What happens when that plausibility is proven not to be true or to exist? What then?”
Here is an example of what happens. Back in the early 1980s people with palpitations would have a Holter monitor placed and found to have many PVCs. It seemed plausible that they would be at greater risk of sudden death. These patients were therefore treated with antiarrhythmics. Studies came out that convicingly showed that patients thus treated were dying at a higher rate than those not treated. What did we do? We stopped using antiarrhythmics to treat PVCs.
“What happens when that plausibility is proven not to be true or to exist? What then?”
Here is an example of what happens. Back in the early 1980s people with palpitations would have a Holter monitor placed and found to have many PVCs. It seemed plausible that they would be at greater risk of sudden death. These patients were therefore treated with antiarrhythmics. Studies came out that convicingly showed that patients thus treated were dying at a higher rate than those not treated. What did we do? We stopped using antiarrhythmics to treat PVCs.”
If this is the case, then we should do the same with circumcision. The convincing and EMPIRICAL evidence shows there are no medical benefits for circumcision and there are unnecessary risks and harm from doing it– instead we get the “cultural and religion” rationales. Why has the American medical industry not stopped doing it? Or does circumcision exist in a special category that need not follow the usual criteria.
@Consult:
“Or does circumcision exist in a special category that need not follow the usual criteria[?]”
Yes, it most certainly does, like it or not. This is the first thing you’ve written that we can probably all agree on. In her post, Harriet tacitly granted that fact and addressed the question of whether science—not ethics, not religion, not culture—has anything to add to it. Her (correct) answer: little to none. This is exactly what anti-circ crusaders should want to hear. Armed with that, take your battle to the relevant fields: ethics, culture, religion. You’re barking up the wrong tree here.
“Yes, it most certainly does, like it or not. This is the first thing you’ve written that we can probably all agree on. In her post, Harriet tacitly granted that fact and addressed the question of whether science—not ethics, not religion, not culture—has anything to add to it. Her (correct) answer: little to none. This is exactly what anti-circ crusaders should want to hear. Armed with that, take your battle to the relevant fields: ethics, culture, religion. You’re barking up the wrong tree here.”
Since circumcision has no valid scientific foundation I have to wonder why Harriet posted all the pseudo-scientific rationales for circumcision in a forum called “science based medicine”.
Perhaps she should have shortened her posts by stating simply that there is no scientific basis for it, and said that therefore the medical industry violates it’s ethical and moral code everyday by doing them while promoting it to parents and then telling parents that the industry cannot do them without the PARENTS’ consent.
This begs the question is WHY is the foreskin the only body part that is amputated with no medical indication–or even a logical reason.
Consult: “The Finnish National Board of Health provided national case records for the year 1970 for both phimosis and paraphimosis. A total of 409 cases was reported for males 15 years and older,which represents only 2/100ths of 1% (0.023%) of the total male population in that age group. This means thaat 99.97% did NOT develop a problem. ”
That gives the rate of the events in one year only. It also ignores the children who may need later circumcision. 30,000 would be a more accurate figure over a male uncircumcised lifetime. A lot of other men will be simply putting up with penile problems, and others will be afflicted by penile warts, cancer, greater risks of venereal disease, and increasing similar risks for their women.
Not as trivial as you wish to make out. How can you say elsewhere that there is NO reason and NO evidence in favor of circumcision?
Nevertheless, I don’t know of a single doctor or surgeon who is currently “promoting” neonatal circumcision, as you allege. . There is still some difference of opinion as to its wisdom, but there is a strong swing away from it in most countries where it was previously almost routine.
The main stumbling block to the complete abandonment of neonatal cirfcumcision is not medical avarice but considerable inertia in social mores. When I gave up performing neonatal circumcisions I was put under intense pressure to resume, and decades later I was getting regular inquiries as to where parents could get it done.. It is usually grandma or the circumcised father who insists on it in the face of any argument.
I’m sorry. That, IMO, simply isn’t good enough. The 10% citation is one of the most compelling arguments you make, but only if it is actually true. While I trust that your impression of the source being a seemingly reliable one to be an honest statement, that is not a good basis to use the 10% claim as a fundamental point in your article. The figure may well be true, or their may be serious flaws in the methodology. But we can’t easily check for ourselves since you don’t even know where the figure came from.
What if I had said “many patients” rather than quoting a number? How many would justify a pro-circumcision argument? 9%, 8. 7%? One percent? If even an occasional person requires circumcision later in life, some would still opt for circumcision thinking that that occasional person might just happen to be their son. Whatever the real number, you are playing the odds. Even if the 10% figure is accurate, or even if it were 20%, that does not constitute a clear and compelling medical indication for circumcision, and the decision is still based on non-medical grounds.
I’m quite willing to question the 10% figure, so if anyone has better information about the rate in the US, please let us know. I don’t think it’s appropriate to use far lower figures from another society where circumcision is not as acceptable and people may go to greater lengths to avoid surgical resolution of penile problems.
“That gives the rate of the events in one year only. It also ignores the children who may need later circumcision. 30,000 would be a more accurate figure over a male uncircumcised lifetime. A lot of other men will be simply putting up with penile problems, and others will be afflicted by penile warts, cancer, greater risks of venereal disease, and increasing similar risks for their women.”
I am sorry, but your assumptions (speculations) are not contradicted by the EMPIRICAL evidence.
First of all, for a man who was not circumcised as an infant the chances of him having to get circumcised as a adult are extremely rare. In fact it’s only 6 in 100,000. (0.006%)
Health officials of each Scandanavian country were queried about adult circumcision.. None of the health officials could provide precise data, because the numbers were so small that they weren’t worth compiling. Each official stressed that foreskin problems were present but said they were largely treated medically-surgical solutions were extremly rare.
“in Oslo, Norway, over a 26-year period in which 20,000 male babies were cared for, 3 circumcisions were performed-a frequency rate of 0.02%.
In Denmark. 1968 children up to the age of 17 were examined over a period of several years. In this group, 3 circumcisions were performed-a frequency of 0.15%. In this study, in retrospect, the physicians believed that all three operations might have been avoided. Both of these studies related to the infrequency of circumcision and puberty, they did not deal with the issue in adulthood.
Wallerstein, Edward, Circumcision: An American Health Fallacy. pg 128
Also, if you took the trouble to find the actual rates of the other problems in the US and Europe, you would also find they are lower (or the same).
“Not as trivial as you wish to make out. How can you say elsewhere that there is NO reason and NO evidence in favor of circumcision?”
You forgot the phrases “scientifically credible evidence” and “non-therapeutic” —THEREIN are the critical points.
“Nevertheless, I don’t know of a single doctor or surgeon who is currently “promoting” neonatal circumcision, as you allege. . There is still some difference of opinion as to its wisdom, but there is a strong swing away from it in most countries where it was previously almost routine.”
By quoting questionable scientifically evidence in favor of RIC, one IS promoting it.
Now matter how you phrase it, the American medical industry promotes medical RIC and no other. Other countries that have pretty much dropped circumcision because thay have based their position on circumcision by the valid evidence and not by the profit margin.
“The main stumbling block to the complete abandonment of neonatal cirfcumcision is not medical avarice but considerable inertia in social mores. When I gave up performing neonatal circumcisions I was put under intense pressure to resume, and decades later I was getting regular inquiries as to where parents could get it done.. It is usually grandma or the circumcised father who insists on it in the face of any argument.”
Sorry, but this is called passing the buck–all it takes is telling parents that circumcision is not medically justified and refuse to do it. You cannot be responsible for the morals and ethics of others–only for your own.
YOU (pl) created the circumcision craziness in this country–and now you are trying to blame the parents for the efficacy of your propaganda?– sorry, you can’t have it both ways.
“I’m quite willing to question the 10% figure, so if anyone has better information about the rate in the US, please let us know. I don’t think it’s appropriate to use far lower figures from another society where circumcision is not as acceptable and people may go to greater lengths to avoid surgical resolution of penile problems.”
Sorry, Harriet, but this dodge is not adequate–the EMPIRICAL evidence exists that actual the necessity for later circumcision with NO mistreatment can be applicable if American professionals like yourself would just educate yourselves and your patients.
The ignorance of the medical industry is hardly an excuse to cling to a number that inflates reality.
This is an ARTIFICIAL problem created and maintained by your profession… more commonly called an iatrogenic problem!
“This begs the question is WHY is the foreskin the only body part that is amputated with no medical indication–or even a logical reason.”
We need a source for cloning neurosurgeons?
for neurosurgeon fill in your least favorite profession:-)
Consult: “By quoting questionable scientifically evidence in favor of RIC, one IS promoting it.”
Not at all. I have been trying to persuade parents against it for years, and refusing to do it myself,
I am merely responding to over-the-top, mindless attempts to use this issue to portray the medical profession in general in the most unfavourable light possible. We are by no means perfect, but we are not as stupid, avaricious or careless as to the interests of our patients as you want to make out. We are culpable to the extent that there are no redeeming social or medical benefits to circumcision so it suits you to pretend that there are none.
And which of any assertions that I made about circumcision are at all “questionable”? You yourself quoted certain rates for phimosis and paraphimosis but will not allow that you did not notice that the source you were presumably quoting grossly underestimated the true rate. Be man enough to admit it.
“YOU (pl) created the circumcision craziness in this country–and now you are trying to blame the parents for the efficacy of your propaganda?– sorry, you can’t have it both ways.”
Me? Personally? I have never been to America but I know that it is another free country like mine , and that while parents determinedly seek circumcision there will be doctors who will be prepared to do it. In other countries it is dying out naturally and it will almost certainly do so do so in America at least in non-Jewish and non-Muslim communities.
I think it’s important to remember context as well. Doctors are part of society, they’re people and influenced by social values. GPs and MDs generallly aren’t research scientists, and particularly historically, they tended to be heavily embedded within the community. It’s unrealistic (not to mention a bit crazy) to expect doctors to magically know things that weren’t then known, and to hold social values and concerns that are only now emerging. As in most professions, there are a variety of motivations for becoming doctors that range from incredibly noble (Medicins Sans Frontiers, as just one example) to pure greed (most cosmetic surgeons fall into this category but there are obviously obstetricians to the stars and such who do too – not surprisingly, these are the ones who can be found using their MD to sell woo since that’s flying off the shelves these days and has a high profit margin…or diet books).
Now, it is reasonable in retrospect to critique and acknowledge some of the strange, now clearly more harm than help, kinds of practices and attitudes towards babies that emerged in hospitals. I don’t bring up things like this to disempower medicine – we all realistically know medicine exists within society and is practiced by people (or one would hope we understand this and don’t resort to cartoons and social stereotypes). Medicine was just reflecting larger social, religious norms of the time. An obvious more harm than help example being the push for women to feed their babies formula rather than breast feeding (America’s very strange attitude towards breastfeeding persists today, though I certainly don’t put the whole thing at the door of medicine, it has to do with America’s rather distorted public policies and attitudes towards the body and sex that extends beyond breast feeding).
pmoran – No offense but as an Australian/Canadian who’s spent lots of time in the US, it’s not really the same as Canada or Australia (and Canada is more like the US than Australia, well apart from being a bilingual nation – but then it could be easily argued that’s still more similar to the US which has Spanish as an unofficial second language and residual remenants of Francophone culture). Not only is the political system quite different in the US than Commonwealth countries, so are the social systems and values. Medicine, in particulary, is a very different animal than it is in most other nations for a number of reasons. The concept of “freedom” is also very different in the US than in countries with more collective social contracts (particularly since it’s one of the main signifiers and propagandistic slogans of the American Dream/MythTM and national identity….er, under God, of course..). The US is markedly less “free” than many other nations – not only does it have an outrageously high percentage of it’s citizens in jail (mainly poor people), it’s also much less socially mobile than Canada or Australia (this has to do with the lack of educational opportunities in the US), it’s also very far behind in all kinds of civil rights issues (from Gay marriage to separation of Church and State to abortion and on the list goes, getting longer every day). Freedom is a brand in America more than it is a reality (particularly on a legal level after the Patriot Act, though we’ve all lost some ground in terms of basic human rights in the last five years). So, yes, America is a “free” country but not like Canada or Australia…and it really depends who you are and how much money you have as to how much “freedom” you can buy.
“This begs the question is WHY is the foreskin the only body part that is amputated with no medical indication–or even a logical reason.”
To make wallets that are convertible into suitcases just by rubbing?
“And which of any assertions that I made about circumcision are at all “questionable”? You yourself quoted certain rates for phimosis and paraphimosis but will not allow that you did not notice that the source you were presumably quoting grossly underestimated the true rate. Be man enough to admit it.
C’mon, these rates were the OFFICIAL rates for Finland..
The Finnish National Board of Health provided national case records for the year 1970 for both phimosis and paraphimosis. A total of 409 cases was reported for males 15 years and older,which represents only 2/100ths of 1% (0.023%) of the total male population in that age group. This means that 99.97% did NOT develop a problem. Moreover, according to Finnish authorities, only a fraction of the reported cases required surgery– a number too small to reliably estimate.
Wallerstein, Edward, CIRCUMCISION: AN AMERICAN HEALTH FALLACY p.128
“Me? Personally? I have never been to America but I know that it is another free country like mine , and that while parents determinedly seek circumcision there will be doctors who will be prepared to do it. In other countries it is dying out naturally and it will almost certainly do so do so in America at least in non-Jewish and non-Muslim communities.”
In all of my posts I have tried to use used the term “American medical industry”–that should have been assumed here when I used the (pl).
“Not at all. I have been trying to persuade parents against it for years, and refusing to do it myself, ”
Good for you–and I mean that sincerely.
Now we have an “adopted son and DIL” who are both doctors–when I asked them separately what they were taught about circumcision in medical school they both replied pretty much the same: it cures or prevents every disease known to man and is a billable procedure.
Well, Harriet, if i have a son and you’re in town…
I really think some of this anti-circ rhetoric is kinda nuts. Just sayin’.
Consult – Anecdote alert here – my brother wasn’t circumcised (he was born mid-60s in Australia) and both my parents, who are doctors, made that choice. My brother did develop phimosis as an adult and had a circumcision – he doesn’t seem to consider either particularly a big deal (but then we were brought up with a very natural and non-hysterical attitude towards the body and sex). Now, clearly I’m not going to extrapolate my brother’s experience and impose it upon everyone but, I’d suggest, that both ends of the extremes regarding this debate come off as slightly hysterical about cultural issues that ultimately aren’t to do with science or medicine.
There is a subset of the larger blame culture in the US that has developed into a sort of competitive victim culture where men continually try to position themselves as victims (I find this particularly problematic since it’s often men who are actually abusers who claim this kind of victimhood since the majority of abusive men don’t take responsibility for their actions and blame someone else – be it their parent, spouse or partner). This is not to say that there aren’t men who are abused by female partners, or male on male or female on female violence and abuse doesn’t exist, it’s just being realistic about who really is a social victim and why some people who are shunned are not victims but architects of their own loneliness and aloneness. This also doesn’t mean that people aren’t victimized and that men in the lower classes aren’t used as factory and cannon fodder – however even poor white men really aren’t and weren’t victimized in the same way as women and people of color in the same economic bracket (this is not to deny America’s class system, it’s just putting things in context).
“My brother did develop phimosis as an adult and had a circumcision”
Apparently your parents did not know that there are very effective, non amputation treatments for phimosis– steroids and/or:
http://www.cirp.org/library/treatment/phimosis/beauge/
the information is readily available, so likely his circumcision was unnecessary–reinforcing my position about ignorance of the normal penis in countries that do or have circumcised.
If your brother is happy without his full sensation or sensitivity–good for him since he has no other choice.
What does the “compare the victimization game” have to do with unnecessary circumcision?
Consult – Yes, my brother looked at the options and decided he wasn’t particularly emotionally attached to his foreskin so he had the operation. He was an adult capable of making his own choices (my parents chose not to circumsize him, there’s no bias towards circumcision in my famiy – if anything it’s towards leaving the body intact, which is why I still have my tonsils even though I had recurring tonsilitis as a child). He also reports no loss of sensation or sensitivity – so please don’t impose your beliefs and desires onto his experience when he’s quite happy with the outcome (and was happy and comfortable with his penis in the first place, genitals weren’t taboo in my family, they’re just part of the body…though I will confess that my brother did think his penis was pretty fab as a kid since neither me or my sister had one).
You claim the stance of a victim, so much so that you want to impose your self identification as a victim onto my brother even though he doesn’t consider himself victimized or “missing out” (and he’d know what he’s missing out on – were you circumcised as an adult and lost sensitivity and are therefore projecting your own experience onto others or did you hold this belief because you read about it somewhere?) I suspect you think that you can manipulate people through sympathy by continually casting yourself as being victimized. You’re so attached to this concept of yourself as a victim that you want to impose your beliefs on the experiences of others!!!
Consult: you have not understood the point that the Finnish statistics refer to cases reported in one year only. The true lifetime figure would be 70 times that at least.
Also no country keeps records that would provide such population information for medical consultations. The figures would almost certainly refer to hospital visits for either circumcision or reduction of a paraphimosis i.e. non-trivial episodes. Paraphimosis may not always progress to circumcision but those who are said to not have undergone circumcision for phimosis or paraphimosis may well have had to put up with considerable ongoing discomfort and uncleanliness because of difficulty in retraction of the prepuce (which is essential for good hygiene in adults otherwise the smelly gunk that can collect is most unpleasant for all, as well as being carcinogenic.)
No man seeks circumcsion with any enthusiasm so that such figures may even considerably underestimate the amount of preventable preputial pathology in the community. Medical science is rarely as cut and dried as you wish to find it.
Steroid cream treatment works for some children with phimosis but not so well with adults. It is one of the reasons for being less supportive of routine circumciusion, but it is most unlikely to be permanent solution in most adults. A dorsal slit is another alternative to circumcision but many find the appearances of that unappealing, and recovery is about the same as with the full oepration.
My last comment.
“Yes, my brother looked at the options and decided he wasn’t particularly emotionally attached to his foreskin so he had the operation. He was an adult capable of making his own choices (my parents chose not to circumsize him, there’s no bias towards circumcision in my famiy”
He chose it, and therefore his anecdotes are hardly valuable in showing no sensation is lost..as the Fink study has indicated.
“You claim the stance of a victim, so much so that you want to impose your self identification as a victim onto my brother even though he doesn’t consider himself victimized or “missing out” (and he’d know what he’s missing out on – were you circumcised as an adult and lost sensitivity and are therefore projecting your own experience onto others or did you hold this belief because you read about it somewhere?)”
Huh?
Do you even bother to read the evidence? Did you even see the concrete scientific evidence? If so, why would one believe the assertion of no sensation loss from someone who chose this procedure?
Since we did not assess men’s expectations before they were circumcised, we are unable to comment on how their expectations might have affected their biases. ****Another limitation is that men may have been recalling sexual experiences before circumcision when suffering from the medical problem ****that was the indication for the procedure.**** However, if circumcision was supposed to correct the problem then we would have expected entirely favorable outcomes. Instead we found worsened erectile function and decreased penile sensitivity.****
We found that adult circumcision appears to result in worsened erectile function, decreased penile sensitivity and improved satisfaction. ****Overall, the majority of men were satisfied that they had undergone circumcision which suggests that in this population factors in addition to sexual function affect satisfaction.***
Note: Think cultural and/or psychological factors..
The logic to me is inescapable–loss of the majority of penile nerves = loss of sensation.
“The figures would almost certainly refer to hospital visits for either circumcision or reduction of a paraphimosis i.e. non-trivial episodes.
I consider compression, packing in sugar, or an injection of hyaluronidase to be a lot more trivial than amputation.
“Paraphimosis may not always progress to circumcision but those who are said to not have undergone circumcision for phimosis or paraphimosis may well have had to put up with considerable ongoing discomfort and uncleanliness because of difficulty in retraction of the prepuce (which is essential for good hygiene in adults otherwise the smelly gunk that can collect is most unpleasant for all, as well as being carcinogenic.) ”
Oh, and this pain and discomfort is worse than ripping the foreskin from an infant’s penis? How?
Smegma collects?
http://www.cirp.org/library/anatomy/cold-mcgrath/
Clinically, the presence of smegma preputii is a rare finding; in a prospective examination of 4521 uncircumcised boys, only 0.5% had smegma [72]. In adult men with clinically confirmed phimosis, only 6% had smegma present on examination [73]. Smegma can also be found in up to 25% of circumcised male children [25] and can be detected in circumcised adults.
Smegma cause cancer? An outdated notion that even the ACS has dismissed..
A 1947 study of the carcinogenic effects of smegma resulted in the test mice living longer than the control group. They have no explanation for the outcome.
Plaut A, Kohn-Speyer AC (1947) The carcinogenic action of smegma.
Science 105(2728):391-392.
“There was no significant difference in the survival rates of treated and control mice up to the 400th day of life: 85 and 88 per cent, respectively, after 200 days; 74 and 80 percent after 300 days; 65 and 57 percent after 400 days. After 500 days, 47 percent of those treated with smegma were alive as compared with 30 percent of the controls. From the 600th day on, there was a marked difference (26 and 6 percent, respectively), and on the 700th day, the survival rates were 12 and 1½ per cent.”
First of all, for a man who was not circumcised as an infant the chances of him having to get circumcised as a adult are extremely rare. In fact it’s only 6 in 100,000. (0.006%)
Health officials of each Scandanavian country were queried about adult circumcision.. None of the health officials could provide precise data, because the numbers were so small that they weren’t worth compiling. Each official stressed that foreskin problems were present but said they were largely treated medically-surgical solutions were extremly rare.
“in Oslo, Norway, over a 26-year period in which 20,000 male babies were cared for, 3 circumcisions were performed-a frequency rate of 0.02%.
In Denmark. 1968 children up to the age of 17 were examined over a period of several years. In this group, 3 circumcisions were performed-a frequency of 0.15%. In this study, in retrospect, the physicians believed that all three operations might have been avoided. Both of these studies related to the infrequency of circumcision and puberty, they did not deal with the issue in adulthood.
Wallerstein, Edward, Circumcision: An American Health Fallacy. pg 128
Consult – The “evidence” you keep asserting proves our point has already been critiqued, now you’re just pretending. Like I said, I was relating an anecdote not providing evidence. Though, I trust my brother who is non-hysterical about his penis and who has had the actual experience of adult circumcision (therefore experienced both) over your rather hysterical and exaggerated claims to be a victim based on a really poor study that’s already been addressed.
The fact that you’re so evangelical even though I’m actually against routinely circumcising babies and was raised by two doctors who chose not to circumcise their boy child, just points to how this isn’t about reason or the science to you but a personal crusade and a rather desperate need to self identify as a victim (so much so that you insist others can’t have had the experiences they had because you say so!). Sighs….shakes head….walks away.
“Consult – The “evidence” you keep asserting proves our point has already been critiqued, now you’re just pretending. Like I said, I was relating an anecdote not providing evidence. Though, I trust my brother who is non-hysterical about his penis and who has had the actual experience of adult circumcision (therefore experienced both) over your rather hysterical and exaggerated claims to be a victim based on a really poor study that’s already been addressed.
The problem with anecdotes is there can be found those on both sides..those who disagree with your brother’s are just as valid on the surface as his..but theirs is supported BY the evidence, his contradicted by the evidence–which is more credible?
“The fact that you’re so evangelical even though I’m actually against routinely circumcising babies and was raised by two doctors who chose not to circumcise their boy child, just points to how this isn’t about reason or the science to you but a personal crusade and a rather desperate need to self identify as a victim (so much so that you insist others can’t have had the experiences they had because you say so!). Sighs….shakes head….walks away.”
Thanks for the amateur psychobabble. I do love your assumption of me as a victim with nothing behind this assumption.
You may be against circumcision, but you are willing to excuse it on nebulous things such as society, ignorance of people and doctors
I don’t assume you’re a victim and don’t think you’re one. What I said is you’re trying to claim victim status for yourself, which you have been doing here quite consistently. I’m sure I’m not the only one who’s noticed and it is clear you’re blind to your own biases and the biases you’re peddling here.
As for your assertion that I’m “willing to excuse it on nebulous things such as society, ignorance of people and doctors” that’s hardly the position I’ve taken so once again you are misrepresting what I say to try to put me on a convenient “side” in your ideological battle. I’ve called Dr Hall on what I consider to be her blind spot repeatedly (and you and other anti-circ ideologues jumped all over what I said and repeated it, so clearly you only hear and use whatever you think supports your ideological position and ignore anything that might challenge your self perception as a victim). What you don’t seem to understand – being an ideologue who wants to claim they’ve been victimized – is reality and historical context.
I didn’t claim my anecdote was evidence. I presented it to explain why I don’t buy into the anecdotal evidence you have presented expecting it to be considered valid. Though, I must say, it’s very telling that you tried to impose victimhood and your ideology on my brother’s penis rather than respecting his personal experience – that’s ideology-based body fascism at its most basic.
“I don’t assume you’re a victim and don’t think you’re one. What I said is you’re trying to claim victim status for yourself, which you have been doing here quite consistently. I’m sure I’m not the only one who’s noticed and it is clear you’re blind to your own biases and the biases you’re peddling here.”
So, someone who is the helpless victim of unnecessary pain and harm is now somehow not a victim? Like Rachel Maddow, I will need to be talked down on this. If what I post is merely bias, then you should be able to scientifically rebut them.Once again, please don’t try the emotional bit about alleged victimhood–mine or your brother’s..try sticking to the evidence.
“I didn’t claim my anecdote was evidence. I presented it to explain why I don’t buy into the anecdotal evidence you have presented expecting it to be considered valid. Though, I must say, it’s very telling that you tried to impose victimhood and your ideology on my brother’s penis rather than respecting his personal experience – that’s ideology-based body fascism at its most basic.”
I am not painting your brother as a victim, only one who chose the be circumcised. And pointed out the scientific evidence that he did suffer the losses.
Interestingly you don’t seem to understand the difference between concrete evidence and anecdotes..once again, can you provide a credible rebuttal to the evidence? The anatomical slides exist showing the loss of nerves, the blind quantification study exists–prove the are anecdotes.
Adhering to the credible evidence is hardly fascism–fascism depends on propaganda and deceit. Adherence to the evidence is also not ideology–except perhaps that of science and rational thought.
No, just vomiting.
Peter – I find myself having the same reaction to consult and his attempts to impose his victim ideology upon my brother and his penis. It’s just the kind of body fascism that consult claims he’s personally a victim of!
“No, just vomiting.”
An interesting reaction –then you must vomit constantly since your female partner(s) make and retain much more of it.
“I find myself having the same reaction to consult and his attempts to impose his victim ideology upon my brother and his penis. It’s just the kind of body fascism that consult claims he’s personally a victim of!”
Time to get over yourself and your over-emotional response to facts and evidence that does not fit into your world view. Reality is what I have “imposed” upon your anecdote.
Just what do you think your anecdotes, psychobabble, and AD Hominen” arguments contribute to a science-based discussion? Love the pejoratives, they really always seem like the last resort when one has nothing left to offer.
You’ve been offered all kinds of perspectives on your ideology and the evidence has been weighed – you turned on me when I didn’t agree with you about you being a victim since it screws with your self image and the info you cherry pick to sustain your mission to view yourself as a victim. It’s hardly like you’ve been dealing with science – since the science is inconclusive and one can cherry pick to support either pro or anti circumcision stances, Harriet was being more honest than you about this DESPITE having a bias – but then maybe you just mistake your ideological stance with reality and this causes you to deny anything that contradicts it.
The accusation of being overly emotional is funny coming from someone who is clearly hysterical about their penis and blaming being circumcised for all their life issues as an adult. I’m not only against routine circumcision but come from a medical family that didn’t practice it, I’ve been critical of what I see as Harriet’s bias and I’m equally critical of your bias. You were perfectly happy to repeat my “psychobabble” when you thought it supported your position, you just don’t like having the clearly ideological and biased position you take being analysed the same way. Once again, you expect to be treated with privilege and exception which is what seems to attract you to assuming a victim ideology.
You’ve been offered all kinds of perspectives on your ideology and the evidence has been weighed – you turned on me when I didn’t agree with you about you being a victim since it screws with your self image and the info you cherry pick to sustain your mission to view yourself as a victim. It’s hardly like you’ve been dealing with science – since the science is inconclusive and one can cherry pick to support either pro or anti circumcision stances, Harriet was being more honest than you about this DESPITE having a bias – but then maybe you just mistake your ideological stance with reality and this causes you to deny anything that contradicts it.
Un-cherry- pick this if you believe if you actually believe that there is no conclusive evidence in science–it is called EMPIRICAL evidence:
http://www.cirp.org/library/anatomy/taylor/
And in all of circumcision, it is the ONLY empirical evidence.
AND your argument might have more wight IF you understood and did a critical analysis of the information–not all evidence is of equal value.
It seems that instead of discussing the evidence, you prefer to discuss the person and their motivations, so let’s discuss motivations..
Since the 11th century, physicians have known and stated that the purpose of circumcision was reduce sensation.
In the 50’s, people started thinking of the rights of individuals and the possibility of litigation for doing this to males; suddenly the American medical industry did a complete flip-flop and tried to pretend that the impossible occurred everyday and that there was NO loss of sensation. Since their primary excuse for doing circumcisions vanished, they invented new bogus ones–and called them “medical benefits”.
Without ready access to correct information, the American public, accepted these pronouncements from “esteemed professionals” and ate the bowl of bull crap being fed to them.
This enabled circumcision to become a multi-billion dollar industry in America.
The rest of the world (with not-for-profit insurance systems) has abandoned medical circumcisions, and does not recognize any “medical benefits” for RIC.
From this history, it seems obvious to me that the primary motivation for infant circumcision in America is greed. It is going to take a lot of rational and logical arguments to talk me down of this one.
So, how does this example of “motivations” work for you?
consult – As you conveniently forget, you glommed on to MY critique of Harriet and medical bias. I AM against routine circumcision and come from a medical family where it WASN’T done. The only thing I won’t give you is acknowledgment that YOU are the victim you claim to be – clearly this is what you desire more than anything else since you’ve willing to actually drive people away from your cause to claim it for yourself!
“consult – As you conveniently forget, you glommed on to MY critique of Harriet and medical bias. I AM against routine circumcision and come from a medical family where it WASN’T done. The only thing I won’t give you is acknowledgment that YOU are the victim you claim to be – clearly this is what you desire more than anything else since you’ve willing to actually drive people away from your cause to claim it for yourself!”
Still trying to deny the evidence of loss with no rebuttal?
Whether or not YOU are against it or not, we are discussing the SCIENCE of circumcision, not your position.
At least “I” am trying amidst all of the psychobabble you are trying to introduce..speaking of which, why are you addressing only MY imagined motivations and not addressing the motivations of circumcisers?
I have no idea who this Harriet Hall is, but I’ve seldom seem such a mix of misinformation and bias in covering a topic.
To take one example – to say that 10% of uncircumcised men will need to have it done eventually is just a TOTAL FALSEHOOD. If that were true, the 80% of males worldwide who escape this mutilation s babies would be keeping doctors so busy they would have time for little else! (pop about 6 bn: uncirc. about 4.8 bn: 10% of that 480 million – nonsense! But anyway there is actual data out there showing that the number who need it, for instance tin the Scandinavian countries where it is virtually never done, is an infinitesimal fraction of 1%. See http://www.fathermag.com/health/circ/circumcision/circumcision4.shtml
Practically her other pro-circumcision statements – about minimal pain, no loss of sensation etc – are refuted by well-reported studies..and by natural common-sense!
What a load of tripe.
For a very informative discussion, where many posters quote factual studies, I recommend:
http://www.amazon.com/tag/health/forum/ref=cm_cd_et_up_redir?_encoding=UTF8&cdForum=Fx1EO24KZG65FCB&cdPage=1&cdSort=newest&cdThread=Tx1GKBSW7Y102WF&displayType=tagsDetail&newContentID=Mx3CNULN4P6CGWE#Mx3CNULN4P6CGWE
[...] posts that provoke a lot of comment, as another of her posts, specifically the one in which she discussed circumcision, also garnered hundreds of comments. However, to my great surprise, the one post that stands out as [...]
In the mail today, NEJM for March 26. Pg 1298 has “Male Circumcision for the prevention of HSV 2, HPV Infections and Syphilis”
worked for prevention of hsv and hpv.
“In the mail today, NEJM for March 26. Pg 1298 has “Male Circumcision for the prevention of HSV 2, HPV Infections and Syphilis”
worked for prevention of hsv and hpv.”
It has? Then why does circumcising USA have much higher rates of these than intact Europe?
One needs to have some COMMON SENSE when reading articles–ESPECIALLY from NEJM..
http://home.comcast.net/~consult2/nejm.html
New England Journal of Medicine on Circumcision
Medicine? —no
Science? —-no
Politics?——yes
Did the New England Journal of Medicine Circumcise Medical Information?
To the Editor:
The New England Journal of Medicine(NEJM) printed a strongly pro-circumcision (anti-normal anatomy) editorial by Dr. Thomas Wiswell,1 but did not print the pro-normal anatomy alternative opinion (see Abstracts & Analysis). When misinformation in Wiswell’s editorial was brought to the attention of the editor, there was no attempt to correct Wiswell’s exaggerated benefit claims. Strangely enough, the NEJM printed a Sounding Board discussion of circumcision in 1990 examining the purported advantages and disadvantages of circumcision2,3.
What has happened in the last seven years to make circumcision less controversial? Why does the NEJM only present the purported benefits of circumcision? Why did the NEJM fail to print any letters critical of this pro-circumcision agenda? Let’s recap some of the research that they overlooked.
Circumcision is losing popularity in the United States and has been discredited by the Canadian Pediatric Society4 and the Australasian Pediatric Surgeons5 in 1996 position papers. Taylor described the unique innervation of the preputial mucosa in 1996, and its loss to circumcision6. Taddio et al. showed that circumcision with and without local anesthesia (EMLA) resulted in negative behavioral changes in a child’s’ response to pain7. Laumann has shown that circumcision causes sexual behavior changes and an apparent increased risk of many venereal diseases in adult men8. Price has questioned whether parents can ethically change their child’s genitalia9. The editorial staff at NEJM could not have missed these advances. So why did they not present another Sounding Board article, and instead choose to present only a pro-circumcision editorial by Wiswell?
In a previous article in the NEJM, Royce et al. insinuated that the prepuce may be a risk factor for HIV infections.10 This factually inaccurate article was referenced in a letter to the editor as proof that circumcision protects an individual from HIV infections.11 Fortunately, Laumann pointed out the fallacy of this logic. “The lack of rigorous, systematic controls for co-factors relevant to the particularities of the African context, the prophylactic status of the presence or absence of the foreskin remains an open question12.” But the fact that the NEJM failed to print our letter of criticism (see Abstracts & Analysis), suggests that the NEJM only prints material that supports neonatal circumcision.
Beyond Wiswell’s proclamation of the benefits of circumcision, the research presented by Taddio et al.13 was proclaimed as a major advance. When the limitations of this form of local anesthesia was brought to the attention of the editors, they failed to print the criticism (see Abstracts & Analysis). They failed to point out that this form of local anesthesia (EMLA) did not prevent the long term negative behavioral response to pain previously reported in the Lancet7!
Interestingly, the lack of effects of EMLA on long term negative behavioral changes caused by circumcision was printed in a British medical journal. Presumably, Taddio is smart enough to submit negative studies to European medical journals7,14 and luke-warm studies to American medical journals13.
Certainly, over the last seven years, the NEJM has shifted from a balanced approach, to a one-sided, pro-circumcision stance, even though the lion’s share of the medical literature would encourage a shift in the opposite direction. It is hoped that in the near future, the NEJM will have the courage to confront the ethical problems and medical complications associated with circumcision. Maybe then, it will be acceptable for a physician to tell the parents of a newborn child, “Your baby has normal anatomy, so there is no need to charge you money to surgically alter this child’s genital anatomy. If your son or daughter wants to change their genital anatomy, they are free to do so after age 18, when they can make an informed decision.” Physicians will then be able to teach parents not to fear normal anatomy.
Normal anatomy is not as dirty and dangerous as once thought. Even if a part of the body is malformed, diseased, or carries some risk, an individual must retain the right to refuse surgery. Prophylactic removal of normal anatomy to please parents, or to produce income for the physician is unethical. I hope the NEJM can temper its pro-circumcision agenda. Circumcision of medical knowledge and information is more dangerous than amputating part of the penis from a restrained, non-consenting baby.
Christopher J. Cold, MD
Department of Pathology
Marshfield Clinic
i don’t like the fact that she states that men who mourn their lost foreskin should get over it ( the psychological trauma) and are fragile . for those who , after the fact, grew up and decided they would have rather not of had it done, the psychological trauma can be very real.
it is very disturbing that a doctor would state this opinionated dig at a real phenomenon.
also didn’t mention the fact that it is a religious, cultural superstition that has persisted for thousands of years. the tribes in the Amazon cut holes in their lips, but people think that and things like it our superstition/ritual and circumcision is not
not everyone likes the look or feel of a circumcised penis.
and give me a break you can zip up any of your parts in your zipper no matter if circumcised or not. even your bigballs
As someone who remembers catching his pee pee in his pjs, I can add anecdotal evidence that circumcision does not preclude penis injury by zipper.