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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.

Posted in: Medical Ethics, Surgical Procedures

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232 thoughts on “Circumcision: What Does Science Say?

  1. Michelle B says:

    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!

  2. botogol says:

    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. …

  3. overshoot says:

    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.

  4. JorgeM says:

    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.

  5. Peter Lipson says:

    @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.

  6. George70 says:

    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.

  7. Skeptic says:

    ” 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.

  8. Alexander Han says:

    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?

  9. JorgeM says:

    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!

  10. JorgeM says:

    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.

  11. jonny_eh says:

    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.

  12. overshoot says:

    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.

  13. Skeptic says:

    “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:

    ————

    Arguments against circumcision

    Arguments for Circumcision
    Circumcision reduces the transmission of AIDS.
    Circumcision prevents penile cancer.
    Reduced risk of urinary tract infection.
    Reduced risk of balanitis.
    Reduction of the incidence of various sexually transmitted diseases
    Circumcision prevents phimosis and paraphimosis
    About 10% of uncircumcised infants will require circumcision later in life
    Hygiene.
    Aesthetics.
    Zipper injuries
    Other boys will laugh at you
    Not Medically Indicated or Contraindicated

    ————

    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.

  14. *waits for Dr. Hall’s reply, brings popcorn, munches*

  15. Danio says:

    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.

    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?

  16. Zetetic says:

    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.

  17. Skeptic says:

    “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.

  18. Harriet Hall says:

    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.

  19. overshoot says:

    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.

  20. Zetetic says:

    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.

  21. David Gorski says:

    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.

    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.

  22. Skeptic says:

    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.

  23. The Blind Watchmaker says:

    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.

  24. overshoot says:

    I wouldn’t be surprised if this comment thread grew to massive proportions.

    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 …

  25. Bald Ape says:

    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).

  26. 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.

  27. Skeptic says:

    “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.

  28. Fifi says:

    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?

  29. Fifi says:

    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!

  30. misschief says:

    “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.

  31. misschief says:

    “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.

  32. pmoran says:

    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. :-)

  33. Joe says:

    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.

  34. Joe1 says:

    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.

  35. Fifi says:

    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.

  36. Joe says:

    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.

  37. Joe1 says:

    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.

  38. BigHeathenMike says:

    My only real problem with Dr. Hall is in this comment:

    If some men are psychologically damaged by circumcision and mourn their lost foreskin, their mental health must be pathologically fragile. Get over it, guys!

    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.

  39. Peter Lipson says:

    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.

  40. Joe says:

    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.

  41. Joe1 says:

    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.

  42. Joe says:

    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.

  43. jonny_eh says:

    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.

  44. misschief says:

    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.

  45. David Gorski says:

    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.

    I said it before in another thread about something entirely different, but I’ll say it again here because it’s appropriate: WTF?

  46. BigHeathenMike says:

    Yeah, that threw me too, David.

  47. Skeptic says:

    # misschiefon 04 Nov 2008 at 9:04 pm

    There is no comparison between male and female circumcision. The latter is intended to reduce enjoyment of sex and prevent infidelity.

    Wrongo. Circumcision for men has also been advocated to reduce sexual enjoyment, especially in the Victorian anti-self abuse hysteria.

  48. Joe1 says:

    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.

  49. Joe says:

    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.

  50. Joe1 says:

    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.

  51. misschief says:

    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.

  52. Joe1 says:

    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.

  53. jonny_eh says:

    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.

  54. BDwyer says:

    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.

  55. BDwyer says:

    “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

  56. Frank OHara says:

    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?

    .

  57. Fifi says:

    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!).

  58. Harriet Hall says:

    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.

  59. Skeptic says:

    Frank OHara wrote:

    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?

    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.

    I was particularly amused by his support for bacteria. Sure, I eat yogurt – but I wouldn’t want to eat smegma!

    …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.

    In fact, “just get over it” is pretty good advice for anything that can’t be remedied.

    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.

  60. Harriet Hall says:

    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.”

  61. Mike Hall says:

    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.

  62. Svante says:

    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.

  63. Fifi says:

    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.

  64. sadunkal says:

    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…

  65. Fifi says:

    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.

  66. Harriet Hall says:

    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. :-)

  67. Lame-R says:

    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.

  68. Harriet Hall says:

    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. :-)

  69. Consult says:

    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.

  70. BDwyer says:

    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.

  71. BDwyer says:

    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?

  72. Harriet Hall says:

    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.

  73. Skeptic says:

    BDwyeron wrote:

    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.

    Harriet Hall responded:

    Yes: ear piercing.

    Is ear piercing surgery? Either way you, I think, dodged the question:

    Does circumcision meet the ordinary standard of care? It seems not.

  74. Jim says:

    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/

  75. Consult says:

    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?

  76. Fifi says:

    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.

  77. BDwyer says:

    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.

  78. Harriet Hall says:

    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.

  79. Consult says:

    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.

  80. Consult says:

    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

  81. Fifi says:

    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.

  82. Consult says:

    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.

  83. Fifi says:

    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.

  84. Consult says:

    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?

  85. Harriet Hall says:

    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.

  86. Fifi says:

    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.

  87. Consult says:

    “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?

  88. Consult says:

    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.

  89. BDwyer says:

    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.

  90. BDwyer says:

    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.

  91. Charon says:

    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.

  92. Charon says:

    I’d like to add that I don’t support piercing the ears of infants either, but it is not comparable to circumcision.

  93. Harriet Hall says:

    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.

  94. Consult says:

    “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.

  95. Fifi says:

    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/

  96. Joe1 says:

    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.

    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?

    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.

    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.

  97. Consult says:

    “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.

  98. Consult says:

    ““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.

  99. Jim says:

    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

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