Jan 07 2010
The case for neonatal circumcision
Imagine if we could save lives from a dread and often fatal disease simply by performing a minor surgical procedure. People would hail this simple victory and rush to adopt it… Not exactly. The disease is HIV and the simple surgical procedure is circumcision and anti-circ activists oppose it under almost any circumstances.
In this month’s edition of the Archives of Pediatrics and Adolescent Medicine, Tobian, Gray and Quinn present a compelling case for neonatal circumcision. The paper is entitled Male Circumcision for the Prevention of Acquisition and Transmission of Sexually Transmitted Infections. The authors report:
The American Academy of Pediatrics (AAP) male circumcision policy states that while there are potential medical benefits of newborn male circumcision, the data are insufficient to recommend routine neonatal circumcision. Since 2005, however, 3 randomized trials have evaluated male circumcision for prevention of sexually transmitted infections. The trials found that circumcision decreases human immunodeficiency virus acquisition by 53% to 60%, herpes simplex virus type 2 acquisition by 28% to 34%, and human papillomavirus prevalence by 32% to 35% in men. Among female partners of circumcised men, bacterial vaginosis was reduced by 40%, and Trichomonas vaginalis infection was reduced by 48%. Genital ulcer disease was also reduced among males and their female partners. These findings are also supported by observational studies conducted in the United States. The AAP policy has a major impact on neonatal circumcision in the United States. This review evaluates the recent data that support revision of the AAP policy to fully reflect the evidence of long-term health benefits of male circumcision.
The AAP had long recommended male circumcision for prevention of urinary tract infections in young boys, but backed down in 1999, partly in response to pressure from anti-circumcision activists. According to circumcision.org:
Based on a review of medical and psychological literature and our own research and experience, we conclude that circumcision causes serious, generally unrecognized harm and is not advisable.
Anti-circ activists have employed inflammatory language to express their opinion. Circumcision is “mutilation” and parents who choose to circumcise their sons are “mutilators”. But the benefits of circumcision are real and clinically important. As Tobian, et al. explain:
The biological mechanisms whereby circumcision could reduce viral STIs may be due to anatomic and/or cellular factors. The foreskin is retracted over the shaft during intercourse and this exposes the preputial mucosa to vaginal and cervical fluids.61 It has been hypothesized that viral infections may enter the mucosa through microtears in the preputial mucosa. The moist subpreputial cavity may also provide a favorable environment for viral survival. The inner mucosa of the foreskin is lightly keratinized compared with the epithelium of the shaft, coronal sulcus, and glans, which may facilitate mucosal access of HIV, HSV-2, or HPV. The mucosa of the foreskin also contains a high density of dendritic (Langerhans) cells, macrophages, and CD4_ T cells, which are all targets of HIV …
Anti-circ activists are convinced that circumcision reduces sexual satisfaction. Until recently, it was difficult to study that claim because very few men were circumcised after becoming sexually active, making it almost impossible to determine the sensory effect of circumcision. But recent studies make it clear that sexual satisfaction is not affect by circumcision:
… [T]here were no reported differences in sexual satisfaction in the randomized study arms in either the Ugandan or Kenyan male circumcision trials or among men before and after they were circumcised. In addition, it has been hypothesized that behavioral disinhibition may counteract any protective effects of male circumcision. However, there was no consistent or substantial evidence of change in sexual behavior after circumcision in the Kenyan or Ugandan randomized controlled trials.
Tobian et al. call on the AAP to revise its policy to reflect the latest scientific evidence:
The World Health Organization/Joint United Nations Program on HIV/AIDS has concluded that “the research evidence that male circumcision is efficacious in reducing sexual transmission of HIV from women to men is compelling … and has been proven beyond reasonable doubt.” In 2007, the American Urological Association revised their policy to state that “circumcision should be presented as an option for health benefits.” However, the AAP, American College of Obstetricians and Gynecologists, and American Medical Association are likely to have the greatest influence on parental decisions and insurance coverage for neonatal circumcision in the United States. With the mounting evidence that male circumcision decreases viral STIs, genital ulcer disease, and penile inflammatory disorders in men, and bacterial vaginosis, T vaginalis infection, and genital ulcer disease in their female partners, it is time for the AAP policy to fully reflect these current data.
The AAP should heed the authors’ call.
653 Responses to “The case for neonatal circumcision”
Shouldn’t males be entitled to informed consent when it comes to irreversible and non-essential surgical procedures that may affect quality of life in future? Especially so when some evidence suggests that those who undergo the procedure as adults report a loss in sexual satisfaction, despite your cherrypicked assertions otherwise.
And why isn’t the permanent removal of a physical feature for no immediate medical benefit not mutilation and grossly immoral?
“The AAP had long recommended male circumcision for prevention of urinary tract infections in young boys, but backed down in 1999, partly in response to pressure from anti-circumcision activists”
I’m not aware of any evidence that not being circumcised increases the risk of UTIs. Also, it would seem very odd to be advocating circumcision to avoid UTIs in boys when they are so very rare (any case of a UTI in a boy warrants further investigation of their renal tract, not the decision that it was due to the foreskin).
Neonatal circumcision saves lives the same way neonatal leg amputation does. “Hey, it might come in handy some day!”
People can sarcasm-quote the word Mutilation when they’re talking about male circumcision as much as they want, it doesn’t change the fact that’s exactly what it is, both in the linguistic as in the medical sense.
I’m sure if they tried to find “medical benefits” to female genital mutilation as hard as they do with male genital mutilation, they’d find plenty. (http://www.fgmnetwork.org/intro/mgmfgm.php)
All the supposed benefits of this measure are related to sex, but newborns and infants are not supposed to be having sex. Once boys get old enough to start having sex, however, parents and doctors might be fully encouraged to include this discussion in their sex talks, presenting all the available information (http://www.youtube.com/watch?v=1vxeGQe_opU), so the boy can now make an informed and, most important, VOLUNTARY decision.
Apparently “My body, my choice” only counts if you’re a woman.
“”The trials found that circumcision decreases human immunodeficiency virus acquisition by 53% to 60%, herpes simplex virus type 2 acquisition by 28% to 34%, and human papillomavirus prevalence by 32% to 35% in men.”"
I don’t like the way those statistics are worded, especially when you look at the CDC website. There were only about 10,000 cases of HIV in this country in 2007, with just about 400,000 cumulative. Once you factor in race, income level, lifestyle and other factors–my boys are very low risk category. Decreasing that risk by another 50-60% sounds great on the surface, but they are already very low risk already.
So for me, a yes, mutilating, permanent procedure that has all of it’s origins based in religion….I’m still more than 100% confident in my decision to not circ my boys. People flip their lids over female circumcision…why not for males?
I apologize–it’s o-dark-30 here and I didn’t finish my thought. To me, circ’ing boys to prevent STDs seems like a silly (for lack of a better word) reason to do it. We should be looking for other ways to prevent STDs.
Since it is non-reversible it must be VERY effective for it to be forced on babies, it would have to be more effective than a vaccine (essentially there should be almost no circumcised men with HIV).
I do not know anyone who is circumcised, here it is the norm to not circumcise and I have not heard of a difference in HIV infections with other countries where circumcision is the norm.
And what is wrong with elective adult circumcision? If an adult wants to mutilate himself (piercings, scarring, circumcision, …) I have no qualms with that.
You can just grow a spine and deny my comment already. Keeping it “awaiting moderation” is not fooling me.
Oooh, this should be fun.
Disclaimer: I had both my sons circumcised for the usual cultural, ethnic, mumbo jumbo reasons. These are pretty much the only reasons that anyone in my country does infant circumcision. I felt happy in doing so, because I have no difficulty with circumcision per se, and I believe it should be the parents’ decision as to whether to circumcise their son – falling into the same category as the countless other irreversible decisions we make on behalf of our children.
Having said that, I think Dr Amy’s argument around the AAP change of position deserves closer scrutiny.
First, the AAP had “long recommended male circumcision for prevention of urinary tract infections in young boys.” But no mention of whether they were correct in doing so. What does science have to say on this subject? Given that presence of a foreskin is the physiological default, isn’t it for proponents of circumcision to properly demonstrate the benefits of its removal? Had the AAP done so, in their long history of recommending male circumcision? Surely the answers to these questions form part of any science-based discussion on routine infant circumcision.
Second, the AAP “backed down in 1999, partly in response to pressure from anti-circumcision activists”. I would like to see some evidence to support this statement. There may be a correlation between the rise of anti-circumcision activism, and change in AAP position, but can we conclude causation? What other factors may come into play here? Perhaps both ‘activists’ and paediatricians were both responding to a single-cause, for example lack of evidence to support the procedure – which may increase ‘activism’ insofar as many more people come to view their circumcisions as having been ‘unnecessary’ and may change the position of the AAP in an increasingly evidence-based medical context? Or perhaps the activism and AAP change of position are unrelated. Activism tapping into a culture that rewards victim status, while the AAP change of position may reflect a more conservative use of surgery in paediatrics generally (mirroring the decline in tonsilectomy, for example). The above narratives are, of course, entirely speculative. But no more speculative than the narrative presented in the opening post.
While the research into the prophylactic effects of circumcision with regard to HIV is certainly interesting, for a population with low prevalence it doesn’t substantially change the terrain of the discussion about the benefits/risks of circumcision.
I usually back the doctors on SBM but I have to disagree this time. I cannot see the necessity for circumcision. Parents of uncircumcised boys have to teach them a bit more hygiene is all. The basis for most circumcision is religious and cultural, not medical.
A visitor from outer space might be forgiven for concluding that the most important part of the human body is the foreskin. It is, after all, the only part of the body that has multiple organizations devoted to its preservation in the natural state. The visitor might get the impression that the choice of circumcision is a fateful choice with profound implications for the rest of life.
Why does the issue of what other parents choose for their sons generate so much heat? The authors of the article are not proposing that circumcision be mandatory, merely that parents be informed of the benefits as well as the risks.
Why do people attempt to derail the discussion by using inflammatory language like “mutilation”? If you don’t want to circ your sons, don’t do it, but why shouldn’t other parents make their own decisions?
“If an adult wants to mutilate himself (piercings, scarring, circumcision, …) I have no qualms with that.”
So you are equally opposed to piercing babies’ ears? By your definition, that’s mutilation, too?
I didn’t have any male children so never had to make this decision. And, not being a male, I can’t speak from the sexual pleasure state. However, I have found that the glans of an uncirc’d male seems to be softer and more sensitive to touch during foreplay.
I don’t have access to the full article so I don’t know if the studies looked only at the US, or at other countries. If they only looked at the US, I would prefer to see a study comparing STD levels in countries with high circ levels (i.e. the USA and Israel) to countries with very low circ levels (i.e. many of the European countries). Looking at the US, with its dismal record of sex education, use of contraceptives, and lack of health insurance only skews the results, in my mind. Compare the US to Belgium, The Netherlands (where prostitution is legal and controlled), or another European country.
“People flip their lids over female circumcision…why not for males?”
Because the male analogue of female “circumcision” is amputation of the penis. Why do anti-circ activists disingenuously equate male circumcision with clitoridectomy?
“However, I have found that the glans of an uncirc’d male seems to be softer and more sensitive to touch during foreplay.”
If that were the case, wouldn’t that be an argument FOR circumcision since prolonging intercourse seems to be an accepted goal for many men? There are certainly quite a few products out there that claim to let men “last longer” by decreasing sensitivity?
Amy
Why does the issue of what other parents choose for their sons generate so much heat? The authors of the article are not proposing that circumcision be mandatory, merely that parents be informed of the benefits as well as the risks.
Could you deal with the ethical issues of why an irreversible medical procedure of no immediate benefit and of some risk should be carried out on a patient unable to give their consent?
“Because the male analogue of female “circumcision” is amputation of the penis.”
You don’t need the clitoris in order to have intercourse.
“a patient unable to give their consent?”
Infants are unable to give consent to anything. They routinely undergo medical procedures with far more risks than circumcision based solely on parental consent. Why should circumcision be viewed differently?
Why do you gloss over the point of choice in the person being circumcised? What is wrong with actually waiting to perform circumcision in later life?
In medical school now, our profs lecture us on patient and child autonomy. As MDs we need to as much as possible respect that. So what in this case necessitates performing this procedure when we’re doing without individual choice. Certainly, parent have some control over their children’s medical care but this doesn’t give them final say (i.e. parents of female children with severe mental retardation have wanted to have the reproductive organs removed to prevent menstruation as it creates a mess or there are issues with pregnancy from sexual abuse, they haven’t been allowed to do so). It would seem that many of the benefits are realized later in life. So why not wait? And again I don’t understand why don’t address that issue in your post, it’s a huge part of the debate.
I don’t know, Amy. Maybe if the male was having problems with premature ejaculation, decreased sensitivity would help. But, again, since I’m not a male, I won’t make that call!
Can you clarify if the studies looked only at the US for the populations? Certainly, I am all for a procedure that is efficacious, but I want more information before I recommend it. And, were the populations matched for use of condoms, etc? As I said, I can’t get into the study so don’t know what they looked at.
As someone with an intact husband and no sons this isn’t anything I’ve ever had to think about, but the idea of removing body parts just in case of future infection or disease seems a bit odd. Why stop at foreskins? Why not other non-essential bits of anatomy that might go wrong in future? Breasts, anybody? Where I live, lots more people die because of having breasts than because of having foreskins.
BTW I disagree with having babies’ ears pierced …
Amy
Why should circumcision be viewed differently?
Because its not medically necessary.
PS as regards the ear piercings argument, in many countries it is illegal to pierce the ears of a child under the age at which the state considers them capable of giving consent.
Because the male analogue of female “circumcision” is amputation of the penis. Why do anti-circ activists disingenuously equate male circumcision with clitoridectomy?
+++++++++
Actually, that is not completely accurate.
There are many variations of female genital modification, as follows:
Type Ia, removal of the clitoral hood only – this *is* analogous to male circumcision.
Type Ib, removal of the clitoris and hood – as you say, analogous to penectomy.
Type II – removal of clitoris and labia. The analogous structure to the labia is the scrotum, albeit that the contents are located elsewhere women.
Type III – infibulation with excision – the equivalent would be sewing the remaining skin together after removal of the penis and scrotum.
Type IV – “other” (pricking, piercing etc…), but which in a literal sense probably include genital piercings that are fairly widely-practised in the west.
Efforts to eradicate the genital modification of girls typically do not differentiate between the types listed above (e.g. the Maputo protocol mandates signatories to prohibit all forms). One can see why from a legal perspective: if you allow Type Ia, then you can going to see a lot of intentionally ‘botched’ procedures to get around the law, especially given that Type Ia has always accounted for a small percentage of procedures amongst a much more damaging continuum. However, from a scientific standpoint, Type Ia in women is a exact analogue of the removal of the male foreskin, so it is worth asking ourselves (especially those of us who have circumcised our sons!) why we are content for this procedure (Type Ia) to be criminalised.
“since prolonging intercourse seems to be an accepted goal for many men”
I would say that the real goal is to ejaculate. How long it takes for this goal to be achieved depends on many circumstances.
It is a poor argument for pro circ.
Well, when the time comes I think I will be recommending to my son that he make use of condoms rather than editing is anatomy. The slant here seems to be (indirectly) endorsing riding bareback.
Also, this post reads as pretty biased in favour of circ. Perhaps the author should work on her posts of persuasion coming off more impartial and less..well, smug.
I don’t think the case is as self-evident as the author’s tone implies.
Yours,
CBB
“Because its not medically necessary.”
No one claimed it was necessary, merely that it is has medical benefits. In that, it is similar to many other medical decisions that we make for ourselves and our children every single day. It is not “necessary” to be vaccinated, but it is medically beneficial.
I think Harriet’s post on osteoporosis drugs is relevant here. What’s the number needed to treat to prevent one case of these diseases? This, I think, is just as important for a surgical procedure as it is for any drug.
Also, FYI, Harriet has written about this before:
http://www.sciencebasedmedicine.org/?p=269
She mentioned that the NNT for sexually transmitted diseases is 72.
Peter has written on this as well:
http://www.sciencebasedmedicine.org/?p=431
“There are many variations of female genital modification”
And none have any medical benefit at all.
Female genital mutilation is designed to mutilate. The purpose is to deprive women of sexual satisfaction in order to strengthen male power over women.
“It is a poor argument for pro circ.”
I wasn’t making that argument. I was pointing out that what anti-circ activists claim is a downside might just as easily be viewed as an advantage.
“A visitor from outer space might be forgiven for concluding that the most important part of the human body is the foreskin.”
While the reactionary and inflammatory language of the anti-circumcision side is justly identified, so should the condescending language seen here. No one is saying that the foreskin is the “most important” body part.
With respect to the ear-piercing, it’s the same thing, in my personal opinion. I’m against doing anything surgical to my kid(s) that is attractive to me or beneficial in an elective way. When she’s old enough to ask, we’ll talk about it and then deal.
It seems that with the statistics you (Amy) have stated, condoms are better in preventing the STIs and transmission, so they should be used. The exception would be places like Kenya and Uganda where there are wide-spread religious and cultural reasons to not use the most effective modality so to fight HIV, circumcision should be used.
In locations like North America where there are no issues with condom use (apart from personal), the choice to circumcise boys should be the parents’ with the same, unchanged recommendation from the pediatric organizations, again, in my opinion.
“Well, when the time comes I think I will be recommending to my son that he make use of condoms rather than editing is anatomy.”
Great. And other people will make different decisions and different recommendations. The authors of the paper are arguing only that parents be informed of the very real medical benefits of circumcision. You might think those benefits are meaningless, or too small to lead to a decision to circ, but the benefits are real.
“condoms are better in preventing the STIs and transmission, so they should be used.”
Condoms should ALWAYS be used, but unfortunately are often not used. Circumcision provides another form of protection. It doesn’t render condoms unnecessary (particularly for prevention of unwanted pregnancy, obviously) but that doesn’t change the fact that circumcision independently lowers the risk of transmission of HIV and other STDs.
No one claimed it was necessary, merely that it is has medical benefits. In that, it is similar to many other medical decisions that we make for ourselves and our children every single day. It is not “necessary” to be vaccinated, but it is medically beneficial.
Just as long as those benefits aren’t exaggerated, just like breastfeeding benefits are exaggerated at times. And unlike vax diseases, STDs are often contracted due to lifestyle choices (unprotected sex). My sons do not have the choice as to whether or not they sit next to an un-vax’d kid at school or at the playground. They do have the choices as to whether or not to have unprotected sex, or participate in IV drug use.
I would also hate to see us reach a point in this society where a man doesn’t use a condom, thinking that he’s safe because he’s circ’d. Because although the benefit is there, it’s a very small benefit.
And fwiw, dictionary.com defines mutilate as:
1. to injure, disfigure, or make imperfect by removing or irreparably damaging parts: Vandals mutilated the painting.
2. to deprive (a person or animal) of a limb or other essential part.
So while it is certainly a dramatic word, it’s not incorrect to use it.
Also, this phrasing: “”The AAP had long recommended male circumcision for prevention of urinary tract infections in young boys, but backed down in 1999, partly in response to pressure from anti-circumcision activists. “”" makes those of us who don’t circ sound like the anti-vax crowd, when I really don’t think that is an accurate comparison.
“There are many variations of female genital modification”
And none have any medical benefit at all.
Female genital mutilation is designed to mutilate. The purpose is to deprive women of sexual satisfaction in order to strengthen male power over women.
+++++++++++++
Actually, we don’t know that
The possible medical benefits of those forms of female genital modification analogous to male circumcision have not been studied. Since the removal of the male prepuce has been found to have some medical benefits it is quite plausible that the exactly analogous procedure in women might also be found to have some benefits, if it were to be studied.
Moreover, I would have had my sons circumcised even if there were not one shred of evidence that it was medically beneficial since I had it done for purely non-medical reasons. Jews (even cultural ones) are not going to stop circumcising their sons because this or that study shows a statistically significant decrease/increase of this or that – it is a non-medical decision.
Your description of the purpose(s) of female circumcision massively oversimplifies. The proponents of FGM (many of them women) obviously do not regard it as a mutilation, but as something that enhances the status of women. Traditional discourse on male circumcision (e.g. Maimonides) also cite the reduction of sexual pleasure (this is seen as a ‘pro’, since this gives men control over their animal urges). (And if you want a laugh – see Scott Stein here http://whenfallsthecoliseum.com/2008/10/30/circumcision-jewish-conspiracy-theory/ )
Anyway, if you are going to get into this, you do actually have to make the argument and not simply fall back on your cultural prejudices. Many parenting practices are sexist (including the inclusion of male children in the covenant without equivalent recognition of female children) but not criminal. What, specifically, is wrong with Type Ia FGM (removal of the female prepuce) such that it is reasonable to criminalise parents who wish to have this procedure performed?
It has been a major disappointment to see this in sbm.
* There are ‘claims’ that circumsition can somehow reduce the risk of infections the rates’ change seems extremely low however. Condoms are a magnitude more effective and do not involve such change to anatomy.
* How exactly do you do correct trials for circumsition? This is exactly like trialing for acupuncture which has been taken care of by this site multiple times. I think the complaint is still valid in this case.
* “anti-circ” people call it mutilation because it is exactly so. The prepuce is a very sensible sensory organ. The neonats do feel the pain. Besides that this organ is very important in the acquisition of pleasure during intercourse. At the end of the day, I’d rather use a condom…
* This advice sounds exactly like the conservative groups’ advice for abstinence. Instead of recommending the most effective prevention – condoms- we lose time recommending things that , in theory, reduce the risks. But at least we know that abstinence is effective as long as you practice it. In the case of circ, the evidence is still way too blurry and the risk reduction is quite poor.
Possible, but no more dangerous than America’s myriad other deficits of sex ed. Actually, it may provide some comfort that the study above considered this angle, and so far haven’t seen evidence of it, as quoted above:
@Oedipa
“You don’t need the clitoris in order to have intercourse.”
No, only to enjoy it.
Why this phobia of foreskin ? It’s natural part of body.
It’s ridiculous. Circumcision is painful and it’s disturbing. And female circumcision isn’t like removing the entire penis (it’s not even close).
History shows circumcision is a cure in search of a disease. It was supposed to cure :
1832 Nocturnal Emissions
1845 Masturbation
1855 Syphilis
1865 Epilepsy
1870 Proof that circumcision cures epilepsy
1870 Spinal Paralysis
1873 Bed Wetting
1875 Curvature of the spine, Paralysis of the bladder, and clubfoot
1879 Abdominal Neuralgia
1881 Unspecified “eye problems” due to masturbation
1886 Crossed Eyes
1888 Circ as punishment for masturbating
1890 Blindness, Deafness, Dumbness
1894 Keeping blacks from raping whites
1894 Urinary and Rectal Incontinence
1900 Discourage Sexual Immorality
1914 Tuberculosis
1915 Clitoral Hood is the source of neuroses, female circumcision is recommended (Yes. This is the USA)
1918 Female Circ will curb Masturbation
1926 Penile Cancer
1930 Claim of Epilepsy cure from a circumcision (notice the 65 year gap between claim and supposed proof?)
1942 Prostate Cancer
1949 Venereal Disease and Cancer of the Tongue
1951 Male circumcision prevents Cervical Cancer
1954 Cervical Cancer again
1058 “the same reasons that apply for the circumcision of males are generally valid when considered for the female.” CF McDonald
1959 Making Clitoris easier for husband to find
1966 Masters & Johnson claim no difference in sensitivity between intact and severed penises. No proof given.
1969 Nervousness, and of course masturbation (Still with the masturbation and we’re in Viet Nam by now)
1971 Rectal Cancer & Bladder Cancer
1973 Carcinoma
1975 AAP declares circumcision has no medical indications, and does not recommend it
1976 Benjamin Spock: “I strongly recommend leaving the foreskin alone. Parents should insist on convincing reasons for circumcision — and there are no convincing reasons that I know of.”
1985 Urinary Tract Infection
1986 AIDS
1988 Group B Streptococcal Disease
1989 AAP Reverses circumcision policy, and recommends it when Dr Edgar Schoen (known circumcisionist) presides over board.
1991 Schoen tries and fails to get European countries to circumcise en masse
1991 For sand in soldier’s foreskins (Desert Storm time)
1997 Schoen once again tries and fails to chop off european dicks
1996 JR Taylor finds that the average amount of removed foreskin is nearly half of penile skin.
1997 Janice Lender discovers that circumcision without anesthesia is traumatic.
1999 JR Taylor: foreskin “… a primary erogenous tissue necessary for normal sexual function.”
1999 AAP after 40 years of research, reverses policy again..”potential medical benefits of newborn male circumcision… are not sufficient to recommend routine neonatal circumcision.” Hygiene “there is little evidence to affirm the association between circumcision status and optimum penile hygiene.” STDs “behavioral factors appear to be far more important than circumcision status.” Cancer “in a developed country such as the United States, penile cancer is a rare disease and the risk of penile cancer developing in an uncircumcised man, although increased compared with a circumcised man, is low.” UTIs “breastfeeding was shown to have a threefold protective effect on the incidence of UTI in a sample of uncircumcised infants. However, breastfeeding status has not been evaluated systematically in studies assessing UTI and circumcision status.” Ethics “is not essential to the child’s current well-being”
2003 Edgar Schoen tries to pressure AAP to reverse it’s policy his way, claiming it prevents AIDS.
2005 HIV rates are lower in females who have been FGM’d
2007 The infamous Bailey/Auvert study … touting circumcision as a ‘vaccine’ that prevents HIV infection.
2007 Langerhans Cells in the foreskin are found to to be a natural barrier to HIV
2007 M Sorrels releases study that finds the foreskin the most sensitive art of the penis and the glans the least.
Most authors of pro-circumcision studies claim that they have no vested interests in their work. However, when we examine who conducted these studies – their motives become evident. These studies are usually done by circumcised males who try to validate their own circumcision and legitimize the practice. Doctors who circumcise must protect their reputations and careers. Statements to the effect by the authors that they have no vested interest in conducting these studies are merely a facade to provide credibility to their research. It doesn’t take a great genius to see the obvious conflict of interest.
I don’t think it’s up to parents to decide if a child is allowed (or not) to keep healthy and erogenous tissues. Infant circumcision should be banned unless there’s a solid medical reason and all other less invasive treatments have failed.
Most parents are mislead into thinking circumcision is healthier. This isn’t true. Circumcision is medical fraud.
@provaxmom
“1. to injure, disfigure, or make imperfect by removing or irreparably damaging parts: Vandals mutilated the painting.
2. to deprive (a person or animal) of a limb or other essential part. ”
Does removal of the foreskin:
Injure? No, it offers some protection against disease.
Disfigure? I suppose that is a matter of opinion.
Make imperfect? Again, a matter of opinion
Deprive of an essential part? Hardly.
Mutilate is a word used in this context to inflame rather than to explain.
That said, I fail to understand the rush to clip. If the literature demonstrated some huge, positive protection against a plague of dangerous adolescent UTIs then an argument could be mounted in favor of circumcision. But as I understand it the benefits, such as they are, accrue only to the sexually active and their partners.
I for one would be more than disturbed to learn that a 6 year old son was having a hot affair. Circumcision pro and con could as easily be presented as part of sex education at an appropriate age and the choice made by the owner of the aforementioned foreskin.
I think this post shows a fairly clear lack of critical analysis from a cost/benefit perspective. That circumcision has some benefits is fairly clear. The benefits are not, by any measure, earth shattering. Since the benefits are marginal risk reduction, shouldn’t a real look at the risks be offered? I’m not saying specifically that the risks outweigh the benefits, but the fact that there are entirely omitted from this post is a glaring omission.
This doesn’t even touch the ethical basis, in that the majority of the benefits of circumcision do not occur until after a male would be old enough to make this decision for themselves. There is little justification for the loss of autonomy by a parent making a decision for a child as a baby that could be left until they are old enough to at least have input in the decision. This is obviously not true with vaccines, so it is a specious analog to the autonomy issues raised.
There would seem to be some evolutionary advantage to the foreskin, though I can’t imagine what it might be. Does anyone know or care to speculate?
Or perhaps it is simply vestigial?
*If* there are clinically significant benefits (which has not been demonstrated) then the risks of the procedure may be reduced by it being performed in the neonatal period, rather than during adolescence.
“the possible medical benefits of those forms of female genital modification analogous to male circumcision have not been studied.”
And therefore you cannot make claims about their existence.
@Nick
If you’re going to post putative facts complete with dates, how about citing a source so that those of us with a cynical bent can check for ourselves?
Further, when you make statements like:
“Circumcision is painful and it’s disturbing.” Disturbing? To whom and in what way?
and more egregious still:
“And female circumcision isn’t like removing the entire penis (it’s not even close).” Yes Nick, it is in most cases EXACTLY like removing the entire penis.
and from bad to childish:
“1997 Schoen once again tries and fails to chop off european dicks.” The use of gutter slang in a serous discussion is inappropriate.
You mark yourself as someone disinclined to serious discourse.
“Condoms are a magnitude more effective and do not involve such change to anatomy.”
Why do you view it as an either-or choice? The benefits of condoms are only available when they are used. In contrast, the benefits of circumcision are always present.
“How exactly do you do correct trials for circumsition?”
You cannot correct RCTs, but RCTs are not the only studies that provide valuable and valid information.
“This advice sounds exactly like the conservative groups’ advice for abstinence.”
Actually, it is the anti-circ folks who sound most like the abstinence folks. Those advocating abstinence point out that it is 100% effective at preventing pregnancy and STDs. And the rest of us point out that 100% abstinence is not likely to happen in the real world.
Similarly, anti-circ activists point out that condoms are effective in preventing transmission of STDs. However, 100% condom use is not likely to happen in the real world.
Amy,
I can’t help but notice that you STILL haven’t responded to the repeatedly raised question, “why INFANT circumcision?” What is the rationale for circumcision of infants, as opposed to letting them make their own decision later in life?
The fact that parents can make such decisions on behalf of an infant doesn’t necessarily mean that they should. There are clear and compelling benefits to waiting. Therefore there need to be clear and compelling benefits to NOT waiting in order for that to be a justifiable choice. You haven’t provided any.
“I can’t help but notice that you STILL haven’t responded to the repeatedly raised question, “why INFANT circumcision?”
This post is not about defending circumcision. It is an explanation of the current state of research on the reduction in transmission of HIV and other STDs by circumcision.
If you don’t want to circumcise your sons, don’t do it. If you don’t think the benefits outweigh the risks, don’t do it. Just don’t claim that there are no medical benefits when there are real benefits.
I did not make any claims about their existence. I merely observed that since the removal of the male prepuce has some medical benefits, it is plausible that the removal of the analogous structure in women may also have some (as yet unknown) medical benefits.
Contrast with your own statement “And none have any medical benefit at all.” If you had said “And none have been shown to have any medical benefit” you would have been correct. It is also the case that, while we have copious evidence on the harm done by more extensive FGM, no research into the specific harms (and any possible benefits) of the removal of the prepuce only informed the decision to criminalise this procedure.
So, I ask again, what, specifically, is wrong with Type Ia FGM (removal of the female prepuce) such that it is reasonable to criminalise parents who wish to have this procedure performed?
Amy said: “It is not “necessary” to be vaccinated, but it is medically beneficial.”
I would expect that Amy would understand that there is a chasm of difference between a vaccination and a circumcision. For one, a vaccination is typically the cheapest, most efficient, safest, and frequently the only way to gain a particular benefit. Circumcision almost never meets any of these criteria let alone most or all of them.
I don’t, for example, know any other reasonable way to protect a child from measles other than a vaccination. On the other hand, as has alread been pointed out, there are far better ways to protect from STDs.
“This post is not about defending circumcision.”
That is an odd claim to a post titled “The case for neonatal circumcision.”
One of the expectations I’ve always had for this blog is that the views provided are balanced. When an issue is raised, it is covered in a reasonable perspective, discussing things like risk and practical and ethical implications. Many of the posts on here discussing vaccines cover the (albeit small) risks of vaccination. How can you make a balanced case when you say “Here are the benefits, now go form an opinion?”
Please try to be a little more reasonable in your discourse. The ability to see shades of gray and deal with real world complexities is what separates us from the woo peddlers.
Please – can anyone tell me the location(s) of the population studied and whether or not the population was controlled for condom use?
Given the intervening comments, my comment above would have been clearer had I begun
“I did not make any claim that there are medical benefits for Type Ia FGM.”
Amy said: ““the possible medical benefits of those forms of female genital modification analogous to male circumcision have not been studied.”
And therefore you cannot make claims about their existence.”
Actually, Stallings et. al. IAS 2005 did find that “circumcised” women in Tanzinia had a significantly lower risk of contracting HIV too. Couriously, they called this a “conundrum” and nobody cared to follow it up.
@Scott
I also see no compelling reason for ‘infant’. If there is a “benefit” to circumcision then present your case to the individual when they can make an informed choice. Particularly when you’re talking about benefits that have nothing to do with the infant or child’s health. That is the only ethical approach.
@windriven :
If male circumcision wasn’t socially acceptable, common sense should tell you that removing a natural part of body isn’t the right thing to do. (especially without consent)
It’s obvious that this procedure is unnatural. It’s a religious practice that became medicalized.
The foreskin is supposed to be there, it’s not a birth defect and there’s nothing wrong with it. There are a ton of men (including myself) who are unhappy with a circumcised penis. I strongly feel it wasn’t up to my parents to make this decision. I have been restoring my foreskin for almost 2 years now and it enables me to get back a ton of sensitivity :
http://www3.interscience.wiley.com/journal/118508429/abstract?CRETRY=1&SRETRY=0
Also, where did you see that “in most cases”, female circumcision is like removing the entire penis ? Do you have any statistic ? And if removing the clitoral hood is banned because it violates basic human rights, can you tell why infant circumcision is still allowed ? Because the inner foreskin has far more nerve ending than the clitoral hood.
Studies claiming male circumcision has health benefits are debatable at best. It is said that it reduces HIV by 55%. Why the USA has both the highest rates of circumcison and HIV among industrialized countries ? Why other countries like Sweden or Japon have both very low rate of HIV and circumcision ,
If you want more information about history of circumcision in US, you can make your own research. It just takes a couple of minutes to realize it’s cure in search of a problem. You can start by reading that :
http://www.historyofcircumcision.net/index.php?option=content&task=view&id=31
In light of:
I don’t think you can duck the issue that way. The current policy as quoted by the paper:
The change you are endorsing is apparently that the policy should state that the data are sufficient to recommend routine neonatal circumcision. But unless there are data showing that neonatal circumcision has specific benefits that circumcision later in life does not, then that is not true and the current policy remains accurate.
The AMA recommending circumcision prior to becoming sexually active would be justifiable based on the data presented. But not the AAP recommending neonatal circumcision.
there are two issues here
a) the reviewed medical benefits/risks concerning male circumcision
b) the question of whether it is sensible for medical institutions to advise parents to have it performed
Concerning A:
I think that research in recent years has shown that overall (especially in less developed countries) male circumcision does have tangible benefits when it comes to lowering the risks for STD. These effects are clinically relevant when one considers them in the context of unprotected sex. Of course, when one wears a condom these benefits disappear… as has been pointed out previously. Now while it is true that a condom “comes off” but circumcision is forever there is only a special subset of cases where circumcision would make a real benefit to lower the rates of say HIV infections:
- it is certainly not in those who practice safe sex
- it is also not in those who practice unsafe sex regularly with multiple partners (they will get infected perhaps only with somewhat of a temporal delay)
- circumcision would probably help reduce infection rates in groups of people who “occassionally” (rarely) perhaps have unprotected intercourse.
This is my personal opinion given what I know of infectious diseases. It would be nice if one could ascribe exact numbers to this and perhaps run a few simulations to see just what kind of an effect circumcision would have in certain countries.
I suspect a generalized circumcision program say in some African country would lower infection rates quite a bit more than say in some European country.. since in the latter condom usage is mostly higher.
Concerning B:
This is more or less a value judgment and one needs to separate it from basic science so you do confuse the issues. In my own personal opinion the supposed benefits of circumcision are not nearly enough to warrant a recommendation for such an operation on infants in, say my region – Europe.
If I were however practicing in Nigeria, I would have to reevaluate this stance based on what the local populus does, how high the rates of STDs are, how much condoms are used etc.
If I were practicing in the US, I also would not recommend such a procedure because just like in Europe, simply educating on safe sex and promoting condom usage is far far more effective in my opinion.
We would have to look at this procedure in terms of NNT (numner needed to treat) – that is how many people do we have to have circumcised to prevent say a certain number of STD infections. I have yet to see decent numbers on this topic. Any formal medical recommendation should be based on the comparison of this NNT against the % of possible circumcision related side effects.
For those who are hopping mad about their circumcision, foreskin restoration is there for you. Rejoice smegmates – let Google Image show you the way…
I am in full agreement with provaxmom. You can’t look at reduction in the disease without also looking at the prevalence of the disease. It is misleading to say that there is a reduction of 60% (or whatever) without also looking at how often the disease occurs. Or Dr. Gorski’s NNTT.
Thankfully, circ rates in Europe are well below 50% and the U.S. I believe are right around 50% and plummeting. And yet, there has been no increase in HIV that I’m aware of. There’s a big difference between STDs in Africa and here.
Furthermore, the authors and Dr. Tuteur are advocating that ACOG, AMA, and AAP change their policies to RECOMMEND infant circumcision. This is not just a matter of presenting it to parents as an option- that is what is done now. And apparently it’s not good enough.
This is just another example of Dr. Tuteur’s extremist, out dated, and unsupported by evidence views on current policies. I have to say that every single doctor who examined by sons (in the early 2000s) said some variation of “Good. It’s not necessary.” or “I’m glad to see you didn’t circumcise.” These were almost exclusively males.
Please see Dr. Hall’s blog for a more reasoned exploration of the debate.
A pertinent point, especially in light of Amy’s reluctance to answer the question about “why *infant* circumcision”? Her title indicates that she is specifically talking about the circumcision of infants, which would suggest that the article would contain something of relevance as far as circumcising as young as possible.
I had no sons, so luckily did not have to make this choice. My husband is in favor of infant circumcision.
Interestingly, my grandfather is also in favor of infant circumcision. He is himself uncircumcised. I have never really felt comfortable asking him for his rationale; it’s an awkward topic to discuss with one’s elders. I am ambivalent about it myself; I would likely have formed a better opinion had ultrasounds not revealed the absence of relevant anatomy on my children. It was something of a relief not to have to think about it, to be honest.
As far as female genital mutilation, numbers are not consistent so it is difficult to tell what the true rate of various procedures are, largely because it is primarily practiced in regions without consistent reporting and usually performed by non-medical personnel. It definitely has higher complication rates than male circumcision. (BTW, I think the term “circumcision” is odd for female genital mutilation, mostly because the word literally means cutting around the circumference, and that’s not really descriptive of the female procedure.)
Both male and female procedures were originally designed to limit sexual desire, for a variety of reasons. Yes, they wanted to reduce *male* sexual desire as well, and a parent wanting to control his sons would want them circumcised if this would help in that effort. There are also factors of ethnic identity, not just in Judaism but in many groups. In some parts of Africa where various forms of genital modification are practiced, it is not done at infancy but rather at puberty as part of a coming-of-age ritual. To become a man or a woman, and ready for marriage.
It is not surprising that there are some modest health benefits. But I still fail to see why it is better to do it as an infant rather than later in life. The one thing I am sure of is that it is absolutely abhorrent that until recently, it was common practice to do it without anesthesia or post-operative pain relief. Okay, I can kinda understand the religious aspects of that, but doctors should not be complicit in that. No, the baby won’t remember the pain ten years later. But the baby feels the pain *now*, and that ought to be significant. If the risks of pain relief and local anesthesia are too great in a newborn, maybe they should consider whether it’s really worth doing it right now anyway.
Dr. Tuteur:
“This post is not about defending circumcision.”
Pattoye:
“That is an odd claim to a post titled “The case for neonatal circumcision.”
LOL! Seriously, this is like the fifth direct contradiction in two months between the blog posts and Dr. Tuteur’s comments. Really bizarre.
I can’t believe all the fallacies I’ve counted reading these comments. I expect more from this audience.
So far (that I’ve noticed):
-False dichotomy (condom vs circumcision)
-Appeal to nature (It’s unnatural to remove the foreskin)
-Appeal to emotion (Calling it mutilation)
-False equivocation (Comparing it to removing a leg or female circumcision)
-Appeals to anecdotes
I suspect that many skeptics are not thinking very rationally on this issue due to its association with religion.
This is a debate worth having, but please try to use valid arguments and avoid inflammatory rhetoric. It really reads like people are taking this issue personally.
Thank you for also adding argument from fallacy to the list.
If condoms are a lot more effective against STDs, specifically AIDS than circumcision. How is it worth doing it? Also, how is it not mutilation? This article is of pseudo-scientific nature first appealing to using AIDS as a scare (which is not too effective as condoms are a lot more effective than that) and at the end trying to appeal to authority and also indures on false equivocation itself by trying to put people who oppose to circumcision in an equal level to anti vaccine nuts. It seriously harms SBM’s reputation.
How can these studies be believable at all? You cannot make double blind tests with circumcision. I also think that exposing humans to having intercourse with people that have infections or AIDS would not be humane. All the studies seem to do is measure infection rates between circumcised people and non-circumcised people which would not really be scientific at all.
What we have here is an article that advices a surgical procedure that removes a part of the body that increases the sensory experience of intercourse stating that there are dubious trials that demonstrate doing this can mildly reduce the rates. While there is already a solution for STDs and AIDS that is a lot more effective and without permanent effects.
You are right though that the only reason humans have started doing it is related to religious beliefs and also some conservative groups that would think it would stop masturbation. It is the only way such great idea would come to pass and we wouldn’t have these ‘studies’ if it weren’t for such irrational reasons. It is fairy science all over again.
“That is an odd claim to a post titled “The case for neonatal circumcision.”
That’s the subtitle of the scientific paper.
“False dichotomy (condom vs circumcision)”
Condoms are cheaper and much more effective than circumcision. Not to mention these African studies are flawed in many ways. Please note than infants and children aren’t sexually active so that doesn’t justify neonatal circumcision. HIV is another poor excuse to justify a barbaric procedure (please read my post about history of circumcision).
“Appeal to nature (It’s unnatural to remove the foreskin)”
I don’t see any problem with that. Foreskin is nautral part of body and is supposed to be there.
“Appeal to emotion (Calling it mutilation)”
I don’t have any problems with emotions, we aren’t robots, are we ? Have you ever watched a video of infant circumcision ?
Also appeal to emotion has been also used in this article : “Imagine if we could save lives from a dread and often fatal disease simply by performing a minor surgical procedure.”
This seems exaggerated, if not completly incorrect.
And circumcision is mutilation.
“False equivocation (Comparing it to removing a leg or female circumcision)”
Please reread the different posts. There are many types of female circumcision. Some types are equivalent or less invasive than male circumcision. But all types of female circumcision are banned because they all violate bodily integrity and cause harm. So why male circumcision isn’t banned yet ?
You could have fooled me. That’s certainly how it came across to me when I read it. Indeed, the wag in me can’t resist asking: If your post isn’t a defense of infant circumcision, why entitle it “The Case for Neonatal Circumcision” even if it is the title of the paper you’re discussing and especially given that there was no discussion of a risk-benefit ratio? I don’t deny that circumcision likely has benefits, but given the aforementioned NNT, are they worth the risks (even relatively small ones) and the need to do 72 circumcisions to prevent one case of STI?
Now, it’s entirely valid to present the case for circumcision in a single post, but isn’t presenting the case for circumcision in essence defending it, particularly given the glowing first sentence about stamping out disease, the dismissive references to the “anti-circ” crowd, and your final sentence, in which you state bluntly that the AAP should heed the authors’ call,” presumably to change its position statement stating that the evidence doesn’t justify recommending routine circumcision of neonates to parents? What is that if not defending neonatal circumcision, at least implicitly? Why deny that that’s what you were doing? There’s nothing wrong with taking a position, as long as it’s clear what your position is and you back it up with evidence.
““That is an odd claim to a post titled “The case for neonatal circumcision.”
That’s the subtitle of the scientific paper.”
That’s dodging the original claim that your post is not in defense of circumcision.
You open with a sentence that all but endorses circumcusion as a minor surgical procedure that can save lives from a dread and often fatal disease. That certainly sounds like a defense of circumcision to me.
You close with the sentence “The AAP should heed the authors’ call” to update its circumcision recommendations to more strongly support circumcision.
I’d say your position is clear. There is nothing wrong with having a clear position. Unless, of course, you then try to say that it isn’t your position at all. I’m baffled as to why you would even make that argument.
I am “anti-circ” as that seems to be the derrogatory term of choice today. However, I think that if these claims were true (and I don’t agree the studies mentioned are doing science right) then it would be an argument for neonatal circumsition since in theory, adult circumcision is a much more complicated and risky procedure.
“HIV is another poor excuse to justify a barbaric procedure ”
It is the single poorest excuse since circumcised males still need to use a condom to protect themselves against AIDS. However, as barbaric as it is it is not necessary to appeal to that fact to show that circumcision is definitely not necessary.
“I don’t have a problem with emotions”
Well the thing is that they aren’t a scientific argument. So appealing to emotions does not really help to justify the argument.
I don’t . I do see that even if the “studies” named were reliable the small rate decrease will require me to still use a condom even if I was circumside.
Unfortunately , the studies have failed to demonstrate beyond doubt that these benefits exist at all. They did demonstrate that even if they did exist I would still need to use a condom when circumcised.
It sounds unnecessary. I also think that maybe there are chances an uncircumcised guy did not receive the important teaching that he needs to clean it up. There are no studies that ensure that we are comparing circumcised males and uncircumcised males that practice hygiene…
JurijD said: “I think that research in recent years has shown that overall (especially in less developed countries) ”
And indeed this is what the recommendation from the WHO and UNAIDS has indicated, that circumcision should be considered as a potential intervention for HIV where there is high prevalence and the epidemic is not focused in a particular population. This would exclude most countries including the US and those in Europe.
One must also consider the ethics of such an intervention, something which Amy in her many posts on this subject consistently ignores.
On the “condom-circumcision” false dichotomy issue
A number of commenters and Amy herself have asserted that bringing condoms into this debate somehow constitutes a case of the false dichotomy fallacy. I do not believe this is the case for how most people formulated the argument (myself included) and here is why:
saying just “circumcision is not warranted as we have condoms that offer more protection” could be considered a false dichotomy as one could argue that performing circumcision alongside wearing a condom is perfectly possible but this ignores all the baggage that comes with both of these two options.
Circumcision is not just an added procedure with no risks to it. As performed usually (religiously) it does cause pain and suffering to infants and while this could be prevented by having the procedure performed only in hospitals under anesthesia there are other risks that are common to all operative procedures: risks of infections, scarring, genital mutilation etc. On top of that I am not convinced that the available literature can give a decent enough guarantee that removing the foreskin does not lessen sexual pleasure in men. It does seem to lean in that direction but we have to set the bar much higher if we plan on cutting away a perfectly functioning part of the male anatomy in the hope of some future benefits.
There is really no false dichotomy here. One cannot just casually perform circumcision with the rationale that it lowers STD risks while claiming that those who point out that we have a more effective way of doing that with no operative risks attached, are making a false dichotomy fallacy.
We DO have an excellent way of preventing STDs – condoms. They do not require us to impose operative risks on children and then also do not require us to possibly risk diminishing their future sexual pleasure to gain what is only a partial decrease of STD infection risk. If this were not the case the circumcision option would be far more appealing.
It can be logically argued then that in light of this non-invasive option, circumcision is simply not justified for the benefits attributed to it and in light of the fact that it is not risk-free.
It would however be greatly beneficial to have hard numbers here: NNT for circumcision related STD risk reduction (in say western countries), % circumcision related adverse effects, and the prevalence of condom usage.
If such data was available and it pointed strongly towards circumcisions lowering the risk of STDs while having only an insignificant number of adverse effects in the whole NNT population IN western countries then a case could be made for a general recommendation to have males circumcised.
The question of whether one is justified in performing this operation on infants is another matter entirely.
But currently I tend to err on the side of caution and not promote an operative procedure with questionable benefits in a real-life European scenario and real adverse effects – in the complete absence of hard data on the issue.
“adult circumcision is a much more complicated and risky procedure.”
Where did you see than it’s much more complicated and risky for an adult ? Do you have some studies to support that position ?
I would think it’s the opposite. During infancy, the foreskin is fused to the glans whereas for an adult, the foreskin is already retracted making the amputation more easier. Also the foreskin is bigger, the procedure can be performed with greater precision, it can be a loose/tight etc… cut whereas for an infant the result is more random. ALso adults are under genral anesthesia, they don’t feel anything during the procedure. So it’s more uncomfortable than painful.
“adult circumcision is a much more complicated and risky procedure.”
Where did you see than it’s much more complicated and risky for an adult ? Do you have some studies to support that position ?
I would think it’s the opposite. During infancy, the foreskin is fused to the glans whereas for an adult, the foreskin is already retracted making the amputation easier. Also the foreskin is bigger, the procedure can be performed with greater precision, it can be a loose/tight etc… cut whereas for an infant the result is more random. ALso adults are under genral anesthesia, they don’t feel anything during the procedure. So it’s more uncomfortable than painful.
Regarding a commenter who pointed out the potential for decreased sexual sensitivity in men, Dr. Teuter responded,
I have to ask by what authority does anyone have that can claim a) how much sensitivity is ideal b) why “lasting longer” is necessarily desirable for all men, c) whose business is it that men should have decreased sensitivity anyway? Some men last too long, and cannot climax because of too little sensitivity. I worry that a forced procedure would contribute to that problem even more.
In contrast, another commenter brought up the (barbaric) practice of female genital mutilation, to which Dr. Teuter (rightly) responded,
I admit to some cognitive dissonance here, and I’m hoping Dr. Teuter could clear this up. Why is decreasing sexual sensation in men okay but not okay in women? I understand that part of it is a level of degree (in women it’s intended as total removal of sexual sensation), but that doesn’t appear to be the argument, which is about having sexual sensation in general.
It seems to border on hypocritical and I’d like this apparent conflict cleared up please. Thanks.
johnnyeh wrote:
“So far (that I’ve noticed):
-Appeal to nature (It’s unnatural to remove the foreskin)”
But it is unnatural. Please give me another socially and medically accepted example of where we surgically remove body parts without serious justification.
Why don’t we just start removing gall bladders, appendices and spleens, and routinely do double mastectomies? Then we would have zero appendicitis, spleen and gall bladder disease, and we could effectively reduce breast cancer to zero. After all, we know that we can live without them, right?
“How can these studies be believable at all? You cannot make double blind tests with circumcision. ”
There are many instances where double blinding cannot occur. Still studies must be done and taken on their merits. It is a limitation sure, but studies shouldn’t be dismissed because of it.
I think the scientifically supported position should be to recommend AGAINST routine newborn circumcision, and discuss it as an option to adults.
You need to watch out for the way comparisons are made between adult and infant circumcision. I remember one study I read on the WHO AIDS page said that adults had more complications but then I looked at the criteria and the adults figures included “pain” while the infants did not!
Also, many infant complication numbers do not include things like metal stenosis or webbed penis.
sorry that should read “meatal stenosis”
“I remember one study I read on the WHO AIDS page said that adults had more complications but then I looked at the criteria and the adults figures included “pain” while the infants did not!”
For a long time doctors used to think infants didn’t feel pain. No, we know it’s untrue. In fact, they may be far more sensitive to pain. There are a decent number of studies showing infant have long term consequences for the future adult :
http://www.sciencedaily.com/releases/1999/08/990816065623.htm
http://www.circumcision.org/response.htm
“Also, many infant complication numbers do not include things like metal stenosis or webbed penis.”
Of course they do.
Amy I see you are an Ob/Gyn.
You do seem to be clutching at straws looking for the benefit.
A reduction in infection rates of 10-15% is not significant enough to allow any scientist to claim a benefit in face of the risks and potential complications. After all you are talking about clinical amputation.
Furthermore, to make the claim that there may be a benefit because men might last longer is nothing short of scandalous from a medical professional.
On the balance of probabilities, it is far more likely that surgical amputation upon the penis is equally or even more likely to create dysfunction.
But given your profession, I see where you’re coming from in this.
Given some people’s stridency on the right to circumcise, I can only see a few justifications:
1) cognitive dissonance – i.e. they have participated in performing it, or themselves have suffered it, and must make the case to themselves that there is nothing wrong with taking knives to any young boy’s penises;
2) religious indoctrination;
3) castration fantasies.
The argument that the child has no right to their body integrity is completely unsupportable. The parent simply does not have a right to circumcise their child, male or female. They should not bind the feet of their child.
We could save a lot of lives if we mandatorily circumcised breasts, and indeed nobody would get HIV at all if you just lopped the entire thing off!
However it is fundamentally a crime against the rights of a child to do body modifications upon them without their consent.
You aren’t saving anyone, you are merely justifying the act of circumcision and violations of the rights of the child post-fact.
Some may see it as quite unfortunate that the scientific evidence is not in line with politically correct thinking on the subject of circumcision, but that doesn’t change the scientific evidence.
Would anyone like to discuss the actual evidence? An argument can be constructed that the benefits in a low risk population do not justify the World Health Organization recommendation for circumcision, but I haven’t seen that argument. Instead there is a lot of opinion on why other people should not circumcise their sons.
Forget the false (and in my judgment misogynistic) attempts to equate FMG and male circumcision. Forget the naturalistic fallacy that the existence of the foreskin means that it must be “good.” Let’s talk about the evidence of whether circumcision decreases the transmission of HIV and other STDs and how that may translate into fewer deaths, less disease, less female infertility, and decreased cervical cancer.
This debate is getting heated because of the lack of proper facts.
1: Raw risk/benefit ratio. How many circumcisions have complications and how often does it result in protections from STI that couldn’t becured with simple antibiotics?
2: Ethics. Does a (possible) medical benefit warrant an ethically questionable practice? Is it OK to steal from the rich if it’s for the poor, or is it still stealing? Would you kill your wife if it could save your child? 5 children? 100 children? Is it OK to clean up our genome by sterilising the genetically sick? It’s a question of utilitarism, and to answer it we need to quantify harm done by circumcising (both physical, psychic, to autonomy, human rights etc) and benefit acquired, and discuss it WITHOUT religious and cultural bias. This is the tough one…
3: Quality of the studies that support circumcisions. How long was the follow-up? Were they based on self-reporting of sexual activity in religious individuals? Difference in condom-use before/after? Bias of the authors? This is the most interresting thing, and it is what I’d come to expect being answered in a SBM entry. I strongly suspect that the studies are questionable at best, but I’d like to see someone smarter than me point it out. If the science isn’t good, then there is no question that the medicalization of circumcision was fueled by religious and cultural bias and should be treated as such (eg. with disdain)
There is a huge amount of bias from both sides. Pro side won’t admit that it would be the same as performing prophylactic neonatal appendectomy, and con side won’t admit that there may be a benefit that would warrant routine circumcision of boys in countries, where it’s the only preventative measure other than abstinence that the church (and therefore state) will allow.
Still, there is no medical reason to do it while they are infants, other than the fact that it would be cheaper, and infants don’t remember pain anyway (Or do they? Studies anyone?)…
Imagine if noone in the world ever thought about cutting off the foreskin – would we begin doing it with the kind of evidence at hand now? That’s how most Europeans feel about this.
“This debate is getting heated because of the lack of proper facts.”
Yes, and I’m waiting for the anti-circ folks to present some numbers, as opposed to personal opinions.
Dr Teuter, I wasn’t equating male and female circumcision (though others certainly were), I was merely asking why you think that decreasing sexual sensation in men is okay (just so that they can supposedly “last longer”) but not okay in women (of course a clitorectomy is barbaric….I don’t think anyone was suggesting that the two are equal procedures). Cognitive Dissonance: I haz it.
“Let’s talk about the evidence of whether circumcision decreases the transmission of HIV and other STDs and how that may translate into fewer deaths, less disease, less female infertility, and decreased cervical cancer.”
what exactly is your evidence that in a western country with a low prevalence of STDs and high condom usage a general circumcision would lead to reduced deaths and less disease ?
What is the NNT for circumcision in say the US (or Europe) to prevent a single HIV infection ?
What are all the possible adverse side effect applied to that NNT ?
What is your data that circumcising infants specifically and not say young adults is needed?
I’ve never seen data like that, if I do perhaps I’ll change my position that circumcision is not justified in countries with low STD rates and good sexual education (high condom usage).
I understand that some complication rate studies do look at meatal stenosis but others do not, which is why I simply said you have to be careful about the comparison and make sure you look at what is included in the numbers.
@Johnny_eh
I’m with you, buddy. This debate has gone off into the weeds where emotion and partisanship prevail.
@DevoutCatalyst
“Rejoice smegmates – let Google Image show you the way…”
I’ll forward my dry cleaning bill to you but a few papers on my desk have been damaged beyond reclaim.
The other issue worth raising is the difference between efficacy as measured in clinical trials, and real-world effectiveness. The risk of transmitting a blood borne infection is present in any surgical procedure, and lots of precautions are taken in light of this fact.
Now translate that not to the context of a well-funded clinical trial, but to the real world of countries with very restricted access to trained health care professionals and disposable/sterile equipment.
“Forget the false (and in my judgment misogynistic) attempts to equate FMG and male circumcision.”
It was already said that there are MANY types of FGM. Some of them are the same and even less invasive than male circumcision. But all forms of FGM are banned.
“Forget the naturalistic fallacy that the existence of the foreskin means that it must be “good.” ”
Why is it fallacy ? It seems logic (like 2+2=4, the basics of science) that if you are born with, it is there for a reason and shouldn’t be removed. Why do you want to forget that ? Why not studying the role of foreskin instead of always finding a new excuse to remove it ?
Do you know the history of circumcision in US ? Why this phobia of foreskin ?
Let’s look at the backgrounds of the doctors who are conducting these studies. How many are long-standing circumcision advocates who have failed to make an association between circumcision and other diseases? How many are Jewish?
Are these people REALLY interested in “HIV reduction,” or are they interested in circumcision evangelization?
I think it’s about time we outlawed all of these circumcision “studies.” They’re not looking for a solution to a problem, they’re looking for problems to legitimize their pre-determined “solution.”
“This debate is getting heated because of the lack of proper facts.”
Even if these pseudo scientific studies claiming circumcision prevent HIV by 55% were true, that still doesn’t justify neonatal circumcision. However, I’ve nothing against adult circumcision with consent if someone thniks it will protect him from AIDS.
My main point here is to question why Dr. Tuteur suggested (and still holds to it) that the AAP change its position with respect to neonatal circumcision when the situation with respect to education and disease prevalance contrasted with certain African countries is obviously different.
Making pre-sexually-active circumcision routine in high HIV-rate/low condom use countries makes sense, but in North America it does not and the AAP’s position statement refects this.
Please clarify the need to change the policy in light of this, if you would.
Would anyone like to discuss the actual evidence?
++++++++++++
Yes, and that’s what I’ve asked from right at the top of this comment thread.
“First, the AAP had “long recommended male circumcision for prevention of urinary tract infections in young boys.” But no mention of whether they were correct in doing so. What does science have to say on this subject?
Second, the AAP “backed down in 1999, partly in response to pressure from anti-circumcision activists”. I would like to see some evidence to support this statement.”
Any chance of a response?
Only a doctor could advise someone to a amputate part of their child’s body to decrease the risk HIV – of a disease for which that child will never be at risk. Amazing!
@Sid Offit
Only a doctor? I can think of a few more professions which advocate it…..some with the precise surgical tools of a Rabbi’s teeth!
http://intactbydefault.blogspot.com/2010/01/dr-amy-tuteurs-cloudy-view-of-newborn.html
Actually, the WHO states that circumcision as it pertains to HIV is a targeted intervention. From the French National Council on AIDS:
http://www.cns.sante.fr/IMG/pdf/2007-05-24_rap_en_politique_internationale.pdf
“The same measures are not applicable to the Northern countries. The recommendations of the WHO state that this strategy is aimed
at countries with high prevalence, and not at countries with low prevalence or in countries where it relates specifically to one part of the population such as in France or the United States.”
This seems a reasonable application of the information I am still waiting to hear though how Amy can believe that such a recommendation would be useful in a country where the prevalence is low and the vast majority of transmission occurs in a population where circumcision has not shown to provided much (if any) benefit.
I agree with others who are posting that this subject was presented without enough reference to the research which might go against circumcision.
However, there is a point I would like to see some of the vociferous opponents to circucision posting here who seem to view this in absolutist terms as human rights issue, address. Most specifically: how do you view the use of routine circumcision in a country where the HIV prevalence rate is more than 25%, anti-virals are expensive and in short supply and culturally, condom use is viewed as taboo and has failed to take hold despite years of effort? There are currently four such countries and many more follow closely behind at 15+%prevalence rates. With rates this high and the lack of condom use, circumcision appears to be a way to save live. There are people who give their lives for the greater good and the the science proves out, I would have no problem with my child giving up his foreskin for the greater good.
And there are significantly less risks/negatives for neonatal vs adult circumcision – if you are going to circumsize. These risks include: increased risk of bleeding, the need to often use general anesthesia and its inherent risk and not to mention cost differences.
The bottom line is that parents should get to recieve ALL the information about potential risks and benefits of a given procedure and then make an informed decision.
I remember your post on the eugenics / “natural” birth connection.
You should use the same vigor to pursue the anti-sex / Victorian mindset behind circumcision.
“Any chance of a response?”
Wouldn’t hold your breath.
Ironically, there was no “science” in the original post. Dr. Tuteur posted a review of previous studies- author opinion. Were these studies conducted in the U.S (no)? Were they even conducted in a first world country or continent? Were the RCTs double blinded (no)? How many subjects were there (I don’t know)? What is the absolute vs relative risk (very low absolute)? What is the NNTT (fairly high)? What are the risks of the procedure (varied)? Should they be done on neonates or adults? How on earth are these not scientific objections?
Dr. Tuteur, did you even read the studies, or did you just post a review (not even a meta-analysis) as confirmation bias? Because, sorry, the review from the Archives was solely author opinion.
Now, I agree that there’s a lot of heated rhetoric from both sides.
But YOU are the one who made the claim that the AAP should revise it’s recco. Well, darn well PROVE it.
I should also add that Amy’s assertion that certain posters are ‘anti-circumcision’ is a bit misleading. I am not certain but I don’t think I saw anyone post that adults shouldn’t be allowed to get themselves circumcised for any or no reason.
You could say that there are posters who are against infant circumcision where there is no clinical need or immediate benefit to the infant or child. That would be accurate. This is in fact the position of many other professional medical organizations
The British Medical Association for examples notes:
http://www.bma.org.uk/ethics/consent_and_capacity/malecircumcision2006.jsp
“Unnecessarily invasive procedures should not be used where alternative, less invasive techniques, are equally efficient and available. It is important that doctors keep up to date and ensure that any decisions to undertake an invasive procedure are based on the best available evidence. Therefore, to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate. ”
And this seems to be a reasonable stance, one American’s should adopt.
“Let’s talk about the evidence of whether circumcision decreases the transmission of HIV and other STDs and how that may translate into fewer deaths, less disease, less female infertility, and decreased cervical cancer.”
We could talk about something far more interesting :
It becomes increasingly clear, as more and more studies are done, that the same group of U.S. researchers keep looking for newer ways, and more and more excuses, to promote
circumcision. If it weren’t so serious, it would almost be comical.
These individuals seem to have a fixation with promoting and performing circumcisions. Perhaps the next study should be of these researchers’ brains, to discover why they have
such an unhealthy fascination with cutting off healthy foreskins from others. It almost borders on pathological! (Or, could it be just their way to get more research dollars?)
Perhaps the next study should be a mental health assessment of these researchers, conducted by unbiased psychiatrists and psychologists. Hopefully there’s a treatment for
their disorder.
“Would anyone like to discuss the actual evidence? An argument can be constructed that the benefits in a low risk population do not justify the World Health Organization recommendation for circumcision, but I haven’t seen that argument. Instead there is a lot of opinion on why other people should not circumcise their sons.”
My opinion is based on evidence. Since the ‘beginning of AIDS/HIV’ there have been a half-million Americans reported to have it. Include the unreported cases and the confidentiality issues…and I’ll double that to 1 million. So since the early 80s, only 1 million people in this country have gotten it. We have what, 300 million people. Granted our population hasn’t always been 300 mill, but we have 4 million births, over 2 million deaths each year. I’m not the math major, so I don’t know what that 1 million figure is truly out of, 350 million perhaps?
And out of that one million, only 35% are white, 75% are men. Over half of the cases are due to high-risk activities.
So if you want to call it an emotional decision, so be it. I don’t have a penis, so really it was all about logical deduction for me. Just like I don’t want to be overmedicated or over prescribed antibiotics, I’m not going to subject myself or my kids to what I see as unnecessary medical procedures. Yes, I am agnostic, so the fact that over time this has largely been a religious procedure….I’d be lying if I said that wasn’t a factor. But that *is* how is started. To me, the fact that some very minor (in my son’s situation) health benefits have been found, it wasn’t enough to sway me.
I will agree with you that yes, via scientific analysis, benefits have been found. But for someone in my situation, those benefits are too small for me to consider. My emotions have nothing to do with it.
“Would anyone like to discuss the actual evidence? An argument can be constructed that the benefits in a low risk population do not justify the World Health Organization recommendation for circumcision, but I haven’t seen that argument. Instead there is a lot of opinion on why other people should not circumcise their sons.”
My opinion is based on evidence. Since the ‘beginning of AIDS/HIV’ there have been a half-million Americans reported to have it. Include the unreported cases and the confidentiality issues…and I’ll double that to 1 million. So since the early 80s, only 1 million people in this country have gotten it. We have what, 300 million people. Granted our population hasn’t always been 300 mill, but we have 4 million births, over 2 million deaths each year. I’m not the math major, so I don’t know what that 1 million figure is truly out of, 350 million perhaps?
And out of that one million, only 35% are white, 75% are men. Over half of the cases are due to high-risk activities. (this was all from a UK website, avert)
So if you want to call it an emotional decision, so be it. I don’t have a penis, so really it was all about logical deduction for me. Just like I don’t want to be overmedicated or over prescribed antibiotics, I’m not going to subject myself or my kids to what I see as unnecessary medical procedures. Yes, I am agnostic, so the fact that over time this has largely been a religious procedure….I’d be lying if I said that wasn’t a factor. But that *is* how is started. To me, the fact that some very minor (in my son’s situation) health benefits have been found, it wasn’t enough to sway me.
I will agree with you that yes, via scientific analysis, benefits have been found. But for someone in my situation, those benefits are too small for me to consider. My emotions have nothing to do with it.
“Would anyone like to discuss the actual evidence? An argument can be constructed that the benefits in a low risk population do not justify the World Health Organization recommendation for circumcision, but I haven’t seen that argument. Instead there is a lot of opinion on why other people should not circumcise their sons.”
My opinion is based on evidence. Since the ‘beginning of AIDS/HIV’ there have been a half-million Americans reported to have it. Include the unreported cases and the confidentiality issues…and I’ll double that to 1 million. So since the early 80s, only 1 million people in this country have gotten it. We have what, 300 million people. Granted our population hasn’t always been 300 mill, but we have 4 million births, over 2 million deaths each year. I’m not the math major, so I don’t know what that 1 million figure is truly out of, 350 million perhaps?
And out of that one million, only 35% are white, 75% are men. Over half of the cases are due to high-risk activities. (this was all from a UK website, avert)
So if you want to call it an emotional decision, so be it. I don’t have a penis, so really it was all about logical deduction for me. Just like I don’t want to be overmedicated or over prescribed antibiotics, I’m not going to subject myself or my kids to what I see as unnecessary medical procedures. Yes, I am agnostic, so the fact that over time this has largely been a religious procedure….I’d be lying if I said that wasn’t a factor. But that *is* how is started. The fact that some very minor (in my son’s situation) health benefits have been found, that doesn’t change the fact that the origins are based in religion. And the scientific evidence just wasn’t enough for me to change my mind.
I will agree with you that yes, via scientific analysis, benefits have been found. But for someone in my situation, those benefits are too small for me to consider. My emotions have nothing to do with it.
@moderation
I don’t think anyone here is against circumcision where there is an actual need or an adult is making the decision for themselves. So the term ‘anti-circ’ is misleading.
Quickly, I would say that in the situation you describe, we could consider offering it to mature individuals. Where that line is is open to debate. However, there is a danger in doing this in countries that you describe. Specifically, there is a strong possibility of individuals misinterpreting the level of “protection” provided and shedding the condom altogether. I suspect this phenomenon will be under reported for years but rarely does an article about this issue in Africa get written where they don’t quote a bunch of men who cheer their new ‘virtual condom’. We also have to consider that nonsocial infection is a large and underreported vector in these countries.
As to the supposed higher risk, that is part of the individuals decision. If the benefit is worth the risk he can take it, if not he won’t. It’s up to him. The difference is not significant. Though I will say that I’ve heard of infants (in developed countries) dieing as a result of circumcision, I’ve never heard of an adult dieing of a circumcision (except perhaps in some of those African ritual circumcisions.).
Apparently you can only “see” what you want to “see,” then. You’ve got to be kidding on #3 and hugely exaggerating on #1. #2 may have some validity, but that’s certainly not the “only” reason.
As for castration fantasies? Got any evidence to support that last assertion? I’ll wait, although I suspect I’ll be waiting a long time.
Amy, you said the AAP should heed the authors’ call. The AAP Policy Statement says
“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. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. If a decision for circumcision is made, procedural analgesia should be provided.”
I don’t see any reason to change this statement. It is fair and balanced. The new information about STD risks automatically becomes part of the “accurate and unbiased information” given to patients.
I don’t think you are recommending routine neonatal circumcision, but questioning the current AAP policy makes it sound like you are. Perhaps you could clarify exactly what you think the AAP should say differently.
I forgot to bookmark this review and it took a while for me to find it again:
Can Routine Neonatal Circumcision Help Prevent Human
Immunodeficiency Virus Transmission in the United States?
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2678848/pdf/nihms98333.pdf
It discusses several reasons why the “African” studies on relative HIV-risk reduction with circumcision are not a decent guide for any kind of health-policy recommendation in the US (or by analogy Europe).
To recap, there are a number of differences and confounding variables that cast serious doubt on whether the US would also benefit from a more generalized circumcision schedule.
1. Different HIV prevalence rates (young adults):
US 0,14 %
Europe <0,1%
Uganda, Kenya 6-7 %
South Africa ~25%
The NNT for circumcision in Europe and the US would be quite significant compared to the 3 African "study" countries in which the recent better-quality studies were performed. A cost benefit analysis should be most revealing. This NNT data must then be compared to the number of adverse effects incurred on all circumcised males.
2. Different HIV modes of transmission:
Africa: predominant mode high-risk heterosexual contact
US: 49% penile-anal mode, 33% high-risk heterosexual
If circumcision has a different protective effect for different HIV transmission modes (which is not all that unlikely) it is difficult to extrapolate from African data.
3. Presence of concurrent STDs
- 5% of all trial participants (young adults) in Kenya had a Chlamydia infection, which is know to increase the risk of HIV transmission
- the US/EU prevalence for the entire population is about 1-3%
any concurrent infection that leads to either ulceration or any kind of genital mucosal damage can obviously lead to a much greater infection risk where the advantages of circumcision might shine through. If these same diseases are not present in the US or Europe to such a degree one can reasonably expect the benefits of circumcision to also be lower – or at the very least that such benefits are not established for the western context.
4. Differing numbers of sexual partners / sexual behavior and condom usage.
Given these reasons it is even more clear that studies conducted in Africa cannot be a serious basis for such a drastic change in health-care policy. Advocating general circumcisions in Europe or the US would requite studies to be performed in these countries or at least in a reasonable analogue.
If you want to go that way, then I feel obligated to point out that I haven’t seen you address the question of risk versus benefit either, quite frankly. The word “risk” doesn’t even appear in your post, and your first paragraph frames circumcision as “saving lives from a dread and often fatal disease simply by performing a minor surgical procedure.” Your post came across to me as a glowing endorsement of circumcision. It’s true that the really emotional anti-circ crowd has come out in force (they always do whenever the post is about circumcision and is not an angry screed against the practice) and it’s easy to dismiss them based many of their dubious arguments, but you haven’t addressed the very point you accuse them of not addressing.
Again, going back to Harriet’s post, the NNT to prevent one case of HIV/AIDS in Africa was estimated by a meta-analysis to be 72. It is not an unreasonable question to ask whether it is worth performing 72 circumcisions in order to prevent one case of HIV/AIDS. The NNT in the U.S. and western nations is, of course, likely to be much higher because the prevalence rate is lower, meaning that the African studies are not well-matched to the question of circumcision’s benefits in the U.S.
In other words, I’m with Harriet on this one. Perhaps you should clarify.
I don’t think this issue can’t just be about medical facts. Quite frankly, I think it is a dangerous practice in most cases. We cannot seperate our health from our cultural, religious and moral beliefs…Nor should we. Health research should always ben interpreted within a cultural context. I will never say ‘circ is bad’. There are many cultures in which it is a critical rite of passage.
Who am I to say than an intact penis is more important than a young boy being able to become a man?
“Yes, and I’m waiting for the anti-circ folks to present some numbers, as opposed to personal opinions.”
Here are some numbers. The risk of a man contracting HIV from a woman, which is the only HIV route circumcision has proven to reduce risk, is .04% or .0004 in the United States. One in every 2,500 sexual acts (http://www.aidsmap.com/en/news/E1249D29-0DDE-4CFF-9CC7-16B3FADB3E59.asp) . Exactly how many men do you think are going to be having sex 2,500 times before the age of 18 when they can make an educated decision for themselves about whether or not the risk reduction is worth it? Even the most conservative risk complication rate of circumcision is WELL above .0004.
Like others have pointed out, there is no need to circumcise infant boys. There are many types of female circumcision, and not all of them are analogous to removing the entire penis of a boy. If girls are protected from even a ceremonial pin prick to their genitals, boys should be protected from having their foreskin removed. I doubt anyone would argue that a single needle prick to the labia of an infant girl carries less risks and is less harmful than removing foreskin from a baby boy. It is unconstitutional to make a human rights law that protects one gender and not the other.
If scientists are correct in speculating that the reason circumcision reduces HIV risk is because of the prevalence of Langerhans Cells in the foreskin, why are they not proposing further study in female circumcision to reduce the risk of HIV since the genitals are where the majority of Langerhans Cells are for females as well? Even if studies proved that female circumcision reduced the risk of HIV and UTIs the law to protect infant girls would not change, because it is a violation of human rights and not the cultural norm.
I really get tired of the argument that male circumcision is Ok because female circumcision is worse. How is that logical? Should raping children be legal because murdering children is worse? Laws don’t work that way. Just because something is worse doesn’t make a lesser offense right. And, as others have pointed out, removing the clitoral hood in females is analogous to removing the foreskin in males, it is not worse. If someone held a man down and cut his pinky off that would be bad. If someone held a man down and cut his entire leg off that would be worse. So should forcibly cutting a man’s pinky off be Ok? I don’t think so.
I’ve only got a few minutes before I leave work to post this.
Having a quick look at the article quoted, this is a review article, mixing data from some RCTs and a meta-analysis.
It’s not clear if there is some crossover between the meta-analysis and the RCTs. The 2 of the 3 RCTs use rates per 100 person years (a dubious concept) and the quoted 60% reduction is a reduction from 1.33 cases per 100 persons years to 0.66. (Not significant enough for me to consider operating on my sons).
Not to mention this is data is from adult males aged 18-24 in high risk countries and should not be extrapolated to infants in low risk countries.
I thought SBM was better than this…
Dr. Tuteur, you sure know how to bring them out of the woodwork.
It seems to me that what is missing from most of the posts (including my own I’m ashamed to say) is any citation of studies or meaningful critical examination of the facts. Instead, we have rants steeped in personal and cultural prejudices.
I would like to understand if the reduction in sexually transmitted diseases in circumsized males has been noted in first world countries as well as in societies with less robust hygienic infrastructures. Do the reduced rates relate to reduced need to carefully clean the genitals? Is there literature to demonstrate this one way or the other?
“I would like to understand if the reduction in sexually transmitted diseases in circumsized males has been noted in first world countries ”
there has been a few studies in this regard and they are mostly negative. – that is they show that in those populations most at risk for HIV infection in developed countries, circumcision does not decrease HIV infection risk.
A recent review of these studies that asses high-risk populations and circumcision (homosexual, bisexual men)
http://jama.ama-assn.org/cgi/content/short/300/14/1674
The problem is that, to my knowledge, there are no good RTCs of circumcision as a preventative measure against HIV infection in developed countries. The observational studies are quite mixed, some report a decrease in risk, some even an increase in risk, but they are difficult to interpret.
“It seems to me that what is missing from most of the posts (including my own I’m ashamed to say) is any citation of studies or meaningful critical examination of the facts. Instead, we have rants steeped in personal and cultural prejudices.
I would like to understand if the reduction in sexually transmitted diseases in circumsized males has been noted in first world countries as well as in societies with less robust hygienic infrastructures. Do the reduced rates relate to reduced need to carefully clean the genitals? Is there literature to demonstrate this one way or the other?”
Here is a site with links to countries and the prevalence of HIV in each of them. (http://hivinsite.ucsf.edu/global?page=cr-00-02)
Of all the western countries including the UK, Australia, New Zealand and Canada, the United States has by far the highest rate of HIV and the highest rate of circumcision. Circumcision rates in those countries are under 20 percent. Also note that the primary means of transmission is the same in all of these countries : Homosexual male intercourse, which circumcision has shown to have no effect in reducing transmission in. In stark contrast is Africa, whose primary means of transmission is male to female sex, which is among the rarest form of transmission in the United States and all western countries.
And multiple commenters who cannot reasonably be termed “anti-circ” are still waiting for you to provide ANY BASIS WHATSOEVER for a central point you are advocating. You haven’t even gotten to the point of presenting personal opinion!
So yet again. In light of the ethical issues of permanent modification of an individual’s body without their consent, from where does the urgency arise to justify neonatal circumcision as opposed to recommending it to the individual when they are old enough to express an opinion, but before they become sexually active?
“Amy, you said the AAP should heed the authors’ call.”
Yes, the authors call on the AAP to revise its policy in light of the latest evidence. I take that to mean advising parents of the benefits of circumcision in preventing transmission of HIV and STDs.
“In stark contrast is Africa, whose primary means of transmission is male to female sex, which is among the rarest form of transmission in the United States and all western countries.”
Sorry I meant to say female to male is the primary means of transmission in Africa, not male to female.
Does the fact than a Kenyan man is in the circumcised arm somehow change his behavior? Did they control for this?
Amy, you know damn well these African studies are flawed in many different ways and not applicable to those living in first-world countries. Studies about cir done in European or American contexts have had very mixed and informative results.
Anyway, it was interesting that those women that answered that sex with their husband was more satisfying post-cir cited “cleanliness” as the reason. Then the authors go on to claim that as a universal applicability. How about if these folks had access to washing everyday and using soap, “cleanliness” either way would not be a problem. We aren’t living in 1st century Israeli or Uganda. This cleanliness issue is no longer a problem.
Dr. Dean Edell has a really good segment on this issue. Look it up on itunes, folks.
Because the male analogue of female “circumcision” is amputation of the penis. Why do anti-circ activists disingenuously equate male circumcision with clitoridectomy?
—————-
Can you reproduce without a clitoris? Can you reproduce without a penis? Bad analogy.
” Yes, the authors call on the AAP to revise its policy in light of the latest evidence. I take that to mean advising parents of the benefits of circumcision in preventing transmission of HIV and STDs.”
———————
but the point we’ve been trying to get you to recognize this whole time is that, the “new” evidence is only a small piece of the puzzle and not in line with some other evidence. Especially when one looks at the bigger picture and asks if it is reasonable to extrapolate from Africa to Europe or the US.
To my knowledge there is no decent evidence to support the contention that generalized circumcision will help reduce HIV infection rates in the US or Europe. Furthermore I have yet to see rigorous analysis of NNT for the US/EU case and a comparison with relevant adverse effects.
On top of that there are review papers published for the case of Europe and US (liked one in my previous post) that conclude that circumcision does not decrease HIV infections for high-risk groups (MSM).
In light of these facts, that you consistently dodge, I cannot see how one can reasonably conclude that recommending routine circumcisions is a good idea and will lead to the desired effect in the US or Europe.
If you want real information on HIV/circumcision :
http://www.youtube.com/watch?v=OlsUg0sdAtE
instead of losing your time with novice doctors from Science-Biased Medecine with all sorts of incomprehensible statistics that come from nowhere : “NNT to prevent one case of HIV/AIDS in Africa was estimated by a meta-analysis to be 72″.
“David Gorski”
She mentioned that the NNT for sexually transmitted diseases is 72.
That’s African data. Let’s bring it back to America where most of us live
If the anti-circ crowds argument is ‘the infant newborn should ahve a say in anything that isn’t immediate medical need” then you must be against the following or you are hypocrite:
‘brushing gums’, later teeth.
Cleaning behind the ears.
Fixing damaged clefts
removing unusable extra limbs (Polydactyly)
separating Siamese twins (some case are immediately medically necessary, but many aren’t)
and so on.
the fact of the matter is circumcision reduce the chance of catching some deadly STDs.
It can be very difficult to have a boy entering puberty ti do proper cleaning.
The study looking at sensitivity showed no los, and the people taking the position thet they have or don’t have more sensitivity aren’t really qualified for the judgment because they have no way to compare, and they will be rife will personal bias. This is logically no different then saying my son got a vaccine, and then was diagnosed with autism and since it happened to me, I must be right.
Not get your child circumcised means you have chose to let your child have a hire risk of dying from STDs. That’s the bottom line no matter how you like to paint it.
On a personal note: as a man I would appreciate less stimulation during intercourse. well, until I turned 45, now I need all I can get~
Windriven:
“It seems to me that what is missing from most of the posts (including my own I’m ashamed to say) is any citation of studies or meaningful critical examination of the facts. Instead, we have rants steeped in personal and cultural prejudices.”
Might it be because this is, at it’s core, an ethical/religious/philosophical debate, at least in the U.S.?
The AAP and most medical organizations in the world (including the WHO, for developed countries, contrary to Dr. Tuteur’s “facts”) do NOT recommend routine infant circumcision. The medical benefits DO NOT justify American neonates being routinely circumcised. A study of the relevant medical literature as a whole don’t present compelling arguments for RIC. If a parent wishes to have a surgical procedure for their infant, that’s fine. The risks are minimal, most likely. But don’t pretend there aren’t cultural issues (on either side). And stop using medicine and science (as was done for the first 90 years of the 20th century) to justify your (general) religious beliefs. A fringe few in the 21st are still at it.
Thus, it’s not a medical issue for most boys born in this country. It’s a cultural/religious one, and people on either side are going to go nuts about it.
@ Geekoid:
Surely you must see the difference between a permanent modification of the body and your cited examples.
As for dismissing anybody who questions what the proper timing for the decision is as “anti-circ” – well, there’s simply zero justification for that.
And in particular:
Unless you have some evidence to support a claim that neonatal circumcision is more effective in this regard than teenage circumcision, this claim is completely false.
Wouldn’t MNTBA be a better metric, as in members needed to be amputated
Lets not for get about female risk as well:
“Among female partners of circumcised men, bacterial vaginosis was reduced by 40%, and Trichomonas vaginalis infection was reduced by 48%. “
Geekoid:
“the fact of the matter is circumcision reduce the chance of catching some deadly STDs.”
This is in fact NOT the whole story. This is likely the case for Africa where the recent 3 good RCTs were done. It is far from certain in the US or European context (see the review I linked previously)
Geekoid:
“It can be very difficult to have a boy entering puberty ti do proper cleaning.”
Really? How difficult can it be to get a boy entering puberty to “play” with himself in the shower ? You must be from some kind of a bizzaro-universe because this is certainly not the case where I’m from
Geekoid:
“Not get your child circumcised means you have chose to let your child have a hire risk of dying from STDs. That’s the bottom line no matter how you like to paint it.”
This is not established in the European or US context at all. Some studies show a decrease in risk but others even an increase in risk. A large review for the MSM group shows no benefit in (mostly) developed countries.
Apart from that you are only looking at one side of the coin. Even if it were established that circumcision does significantly reduce the risk of say HIV infection in the US or European context this would only be ONE side of the decision-equation. You would also have to weight this benefit against the side effects of circumcision especially since the NNT in the US/EU would be huge.
It is therefore not just a choice between exposing your child to an increased risk for STDs or not (even if that were established). You must weight that benefit against other circumcision related operational side effects.
@Geekoid :
You are talking about birth defects or some medical conditions.
The foreskin is neither of them.
FORESKIN ISN’T A BIRTH DEFECT
It’s supposed to be there, there’s no need to remove it despite false claims of non-cleanliness. How the rest of the world has done just fine without lobbing off baby peni, I don’t know. Maybe their kids can clean themselves?
Zoe-
I generally agree though Dr. Tuteur’s post – at least as I read it – was nothing more than an introduction of the study, presumably as a springboard for this sort of discussion. I think there are interesting and legitimate scientific areas of exploration:
- Is the noted decrease in STD transmission fundamentally one of hygiene?
- Is there or was there an evolutionary benefit to having a foreskin and if so, what is/was it?
- Does presence or absence of a foreskin correlate with sexual satisfaction of either partner?
- What are the ethical issues of performing an irreversible (for the most part) surgical procedure on an infant and where and how is that line drawn. This last of course transcends the circumcision discussion but is still, I think, appropriate.
Personally, I don’t have a dog in this fight and I am amused by the level of emotion evident in many of the posts. I had my son circumcised as it was the thing to do at the time. I frankly didn’t give it any thought. If I were making the decision today I would likely leave the decision to be made by him. But as a circumcised male I certainly don’t feel psychologically scarred, maimed, deprived of sexual satisfaction or otherwise hard done by. Much of the heat of this thread seems a tempest in a teapot to me.
I call editing fail on myself, sorry. That should have read “first two cited examples”, and been followed by
The others have real and clear benefits to acting swiftly; unless you can provide evidence of urgency for circumcision they fail as well.
Wind,
I would add cultural significance in there too.
@Geekoid
Last time I checked brushing gums and teeth are an issue of hygiene; if not done, the usual consequence ensues such as tooth decay and gum disease. While not cleaning behind the ears might not lead to the same problems, such a minimally invasive intervention doesn’t seem to raise the same ethical questions.
A damaged cleft, extra limbs and Siamese twins represent birth defects. In the case of a cleft, it might lead to problems with feeding, ear disease, and speech to name a few that springs to mind.
It seems disingenuous to compare necessary hygiene practices and birth defects, which have immediate impacts on the child, to a practice that involves none of these things. And circumcision is significantly different from vaccinations in just about every conceivable way.
There is definitely with Amy Tuteur hen I read her articles.
She obviously hates nature and feels the compulsive need to destroy it using the excuse to protect it :
she is against homebirth
she is against natural birth (preference for c-section)
she is against breastfeeding
she is against natural penis
There is definitely something wrong with Amy Tuteur when I read her articles.
She obviously hates nature and feels the compulsive need to destroy it using the excuse to protect it :
she is against homebirth
she is against natural birth (preference for c-section)
she is against breastfeeding
she is against natural penis
“‘brushing gums’, later teeth.”
- does this remove any healthy tissue from an infant or child? Does this change the function of the teeth or gums of the child? Does brushing teeth cause any permanent change that cannot be undone? Is brushing your child’s teeth legal for one gender and illegal for another?
“Cleaning behind the ears.”
-does this remove any healthy tissue from an infant or child? Does this change the function of the ears of the child? Does cleaning behind the ears cause any permanent change that cannot be undone? Does cleaning the ears permanently change the appearance of the ears?Is cleaning your child’s ears legal for one gender and illegal for another?
“Fixing damaged clefts”
- Are children normally born with damages clefts, or is it a birth defect? Are foreskins a birth defect? Can you fix a damaged cleft for a boy and not for a girl?
“removing unusable extra limbs (Polydactyly)”
- Are children normally born with unusable extra limbs, or is it a birth defect? Are foreskins a birth defect? Can you remove the extra limb from a boy but not from a girl?
“separating Siamese twins (some case are immediately medically necessary, but many aren’t)”
- Are children normally born attached to another human being, or is it a birth defect? Are foreskins a birth defect? Can you separate siamese boys but not siamese girls? Also note that unless there is immediate medical need, siamese twins are not usually separated until much older when they can voice whether or not they want to remain that way. The risk of surgery to separate twins is not worth it if there is no immediate life threatening risk to the twins, and you would be hard pressed to find a doctor that would perform such a surgery if both infants were completely healthy and weren’t at any such risk.
“This is logically no different then saying my son got a vaccine, and then was diagnosed with autism and since it happened to me, I must be right.”
Actually it is very different. Studies have not shown a definitive link to autism and vaccines. Diseases that children are vaccinated against such as polio, smallpox, and measles are not sexually transmitted. They are contracted by such unforeseeable circumstances are unknowingly breathing the same air as someone who is infected. You can’t get sneezed on and contract HIV or herpes or genital warts. Vaccines are also the most effective, least invasive and usually ONLY way of achieving the desired effect, and they show the same risk reduction for everyone. These vaccines are responsible for eradicating the diseases for which they provide immunity for on a global scale. You would never see 4 out of 5 vaccinated people getting polio. Or even 5 out of 10. Circumcision is a risk reduction, vaccination is an immunity. Also, vaccination does not remove healthy functioning tissue, or alter the appearance or function of their body parts, thus their imposition on human rights is minimal at best.
Nick,
you just went off the rails
My baloney meter is going off. Here’s what the AAP policy says about HIV and benefits ALREADY:
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;103/3/686
And with the following quotes from the blog, and the title, pretending that you aren’t arguing for neonate circumcision is… disengenous at best.
The so called reason why circumcision prevent AIDS is because of Langerhans cells found in the foreskin. Hoever some other studies show that these Langerhans PROTECT against HIV :
http://www.circumcisionandhiv.com/files/de_Witte_2007.pdf
The so called reason why circumcision prevent AIDS is because of Langerhans cells found in the foreskin. However some other studies show that these Langerhans PROTECT against HIV :
http://www.circumcisionandhiv.com/files/de_Witte_2007.pdf
I think we’ve had this debate here a few too many times. The polarization is astounding, it’s almost as strange as with vax vs. anti-vax!
What a load of horse hockey!
I’ve sparred with Amy from time to time in the comments, but what you’re saying is just plain ridiculous. Please, show us where Amy has ever said that she prefers C-sections or that she is against breast feeding or a natural penis. True, she does appear to take a dim view of home birth, but I don’t know that you can characterize her as being totally against it.
A dim view indeed! Have you read homebirthdebate.blogspot.com ?
Amy,
You said “Yes, the authors call on the AAP to revise its policy in light of the latest evidence. I take that to mean advising parents of the benefits of circumcision in preventing transmission of HIV and STDs.”
The AAP policy already says
“To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision.” I think that covers advising parents about the HIV/STD information. Do you disagree?
edgar,
I absolutely agree that cultural bias is a huge component.
That doesn’t necessarily make it right are wrong; I would argue that some scientific truths trump cultural/religious beliefs. But I certainly don’t think this one rises to anything close to that level.
BTW, hope you enjoyed a pleasant holiday season.
@Zetetic
I’m with you. I wonder if the editors might not set up a separate area where the ranters might amuse themselves. There they might while away the hours engaging each other in ad hominem attacks, puerile arguments and hagiographies of their favorite deities, cults, fads, fashions and woo.
@Nick
The link to the de Witte in Nature is interesting but only tangentially related to the issue at hand. De Witte argues that Langevin disrupts the transmission of HIV by Langerhans Cells. Very interesting indeed. But in and of itself, that only means that we know one pathway whereby HIV is NOT transmitted. That is rather different from the epidemiologically noted differential rate of transmission in circumcised v. uncircumcised males.
As Dr Hall points out, the current AAP reccomendation includes the statement, “To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision.”
I’m with Dr Hall: I really don’t see anything that needs changing in that recommendation.
For an informed choice, we would need to know:
1) NNT for the country the boy is born into.
2) NNH (number needed to harm) for infant circumcision.
3) NNH for adult circumcision.
Do you know any of those? Can you guess? Can you explain how you know or don’t know, or why you can or cannot guess? Can you talk about the difficulty in discussing the facts with parents when we don’t know all the facts? That would be Science-Based Medicine at its finest!
According to Dr Hall, the NNT in Uganda seems to be about 72. There are differences between Uganda and the US, the country for which the AAP is making recommendations.
One is prevalence of HIV/AIDS. Prevalence in the US is lower, which means the NNT would be higher in the US. How much higher? Can you estimate it based on relative prevalence rates? (I can’t, by the way. I wouldn’t know what the relevant numbers are. This means I can’t make any assumptions or guesses about whether the US NNT would be extremely reasonably or ridiculously small. But if you could, that would be really interesting, and it would shed some light on what exactly you think should be presented to American parents that is not already.)
Another is patterns of sexual relationships. Serial monogamy is the most frequent pattern in the US. (No, I have no data to say by what degree and I don’t know enough about sexual anthropology to name all the different patterns and discuss them intelligently.) In African countries with a high HIV/AIDS prevalence, serial monogamy is less frequent. (I don’t know how much less frequent. I heard this analysis from a CBC radio inerview with one of the doctors doing one of the Ugandan studies — he did have the data to back up what he was saying — and this assertion made sense to me based on personal anecdotal evidence, so I did not question it. Maybe the statement could be challenged, but I think “less frequent” is a reasonable assessment that makes no claims to degree.) Though the number of lifetime partners may be the same, people tend to return to the same partners over the course of a lifetime. This affects transmission rates. If I have five lifetime partners but never return to an old partner once we have split up, then I can only retransmit any STI I contract to future partners. My exes are safe, and I am only exposed to a partner’s STIs for the time we are together.
If I have five lifetime partners and I reconnect with one of them when I return to my hometown and contract the STI they contracted after splitting up with me, I will then retransmit it to my spouse.
So prevalence of HIV/AIDS is higher in Uganda (greater chance that any given partner will be infected) and likelihood of retransmission is also higher (even with a similar number of lifetime partners to an American, more of one’s lifetime partners are at risk of contracting an STI.)
Given these two differences — one of which is more easily quantifiable (prevalence rates) and one of which is less easily quantifiable (patterns of sexual relationships) — the NNT for the US is not going to be the same; but without a gross estimate of NNT and NNH in the US, we can’t make informed choices.
IN this light, an argument for waiting until adulthood for circumcision would be that the individual would have a better understanding of what their risk factors would be. On average, a gay man’s sexual partners will be taken from a pool with a higher HIV/AIDS prevalence rate. That might affect his decision. And if he knows that serial monogamy is not appealing to him, that might also have an impact. The NNT for a moderately promiscuous gay man in the US might be similar to the NNT for a moderately promiscuous Ugandan of any sexuality.
All these are really interesting numbers to me — even if I don’t know what the numbers are, I know they are out there.
How do doctors use science to decide which ones are relevant to communicate to parents? That would be a really interesting post.
This isn’t physics or chemistry. Medical science is messy.
I am still waiting for a mention of the risks associated with this procedure. No mention of NNH (number needed to harm).
Finally, the 3 commonly cited RCTs were in men. Is there any evidence that this procedure translates into the same benefits (small as they are, and certainly exaggerated by some) when performed on infants or children. (I may have missed it in this long list of posts, if someone has already provided the evidence)
this is a wholly absurd debate.
there appear to be benefits. up to you (your penis and your choice for your children) as to how encouraging those benefits are.
only in the most far fetched of circumstances, will the decision to circ or not impact others.
I do not recall, loath, regret, notice or in anyway consider my own circ. my guess is that if you sampled the population, that sentiment would remain pretty consistent.
the docs are accountable to present the evidence as it is appears. do with it what you will.
always use a condom
sex is just as much mental is it is physical
but, im sure there is some fantastic reason to get all bent out of shape about all of this…carry on
Eric G,
“the docs are accountable to present the evidence as it is appears. do with it what you will.”
Actually, doctors are accountable for interpreting the science for us, not just list PubMed references. This is hard to do. (If it weren’t, the AAP reccomendations would be trivial because everyone would be coming to the same undeniably correct conclusions simultaneously and independently.)
If there are risks and benefits to balance — and there always are — then I need my doctor to explain them to me.
What’s frustrating about Amy is that she doesn’t explain things. She makes a statement without nuance or clarity (vague but not nuanced… , asserts that anyone who disagrees with her is an irrational extremist ninny (without actually quoting anyone who disagrees with her stated opinion and explaining why they are wrong), and sits back and waits for the complaints.
She thinks that lots of complaints about lack of nuance is a sign of an effective educator.
I disagree.
Eric G,
“the docs are accountable to present the evidence as it is appears. do with it what you will.”
Actually, doctors are accountable for interpreting the science for us, not just list PubMed references. This is hard to do. (If it weren’t, the AAP reccomendations would be trivial because everyone would be coming to the same undeniably correct conclusions simultaneously and independently.)
If there are risks and benefits to balance — and there always are — then I need my doctor to explain them to me.
What’s frustrating about Amy is that she doesn’t explain things. She makes a statement without nuance or clarity (vague but not nuanced… , asserts that anyone who disagrees with her is an irrational extremist ninny (without actually quoting anyone who disagrees with her stated opinion and explaining why they are wrong), and sits back and waits for the complaints.
She thinks that lots of complaints about lack of nuance is a sign of an effective educator.
I disagree.
Having read most of the comments posted here I have to say, this discussion would make an interesting sociological experiment. It is quite interesting to note that individuals who would probably discuss vaccination or homeopathy in a quite dispassionate manner seem to devolve into ranting and raving when discussing the aspects and choice of circumcision, especially when the author of this article never calls for an end to parental choice. It does appear to me that the only people arguing against choice are those against circumcision, but I could be wrong.
I think some of Dr. Tuteur’s statements are a little too strongly worded for the data, but certainly agree that parents should be presented with all of the facts, including the information showing a reduction in STD risk. But, if Dr. Hall is correct and the AAP guidelines already make such a statement, then no change in policy is required and this information should simply be added to the information that would be given to parents.
It is also interesting how some parent’s consider their children to be at a lower risk group for STD’s simply because they think they would be. As the child of parents who didn’t know I was gay until I came out to them, I would say that you probably do not understand your own children’s risks as accurately as you may think you do. I certainly never talked to my parents regularly about my sexual experiences (either before or after coming out).
As a “mutilated” male myself I have to say that I am not at all unhappy with my parent’s decision. As a matter of fact I do not even give it any thought whatsoever, nor do I have any sort of memory of the event (but I have not gone for hypnotic memory regression therapy lately, so maybe its there and I’m not sure about it). I am quite happy (sometimes too happy) with my sexual pleasurability (not sure if thats a word). Also, as a gay man I have seen both types in action and, personally, I prefer mine…but that’s just me. I’m glad my parents made the choice they did, when they did. I would rather not have to deal with the pain that I would certainly remember were I to do it now.
Tuteur undermines her credibility completely by lying about the AAP’s position statements. Nowhere in the organization’s history has it recommended newborn circumcision. In reverse chron order:
1999 Position Statement: “data are not sufficient to recommend routine neonatal circumcision”
1989 Addendum to 1975 Statement (did not alter 1975 position): “circumcision… may result in a decreased incidence of urinary tract infection. However, in the absence of well-designed prospective studies, conclusions regarding the relationship of urinary tract infection to circumcision are tentative.”
1975 Position Statement: “There is no absolute medical indication for routine circumcision of the newborn.”
1971 Position Statement: “There are no valid medical indications for circumcision in the neonatal period.”
Tuteur’s bold claim: “The AAP had long recommended male circumcision”
Please disregard anything else she writes.
Well, this is a very interesting case.
let’s start with a sentence like “it is time for the AAP policy to fully reflect these current data.”
is quite a ugly mix up!
let’s replace those “data” with : “removing all boys hands reduce drastically the death rate by gun shot.” (which, you might accept for the sake of the demonstration).
And, thus, start again : “AAP should encourage, hands cut off.”
Sounds ridiculous, isn’t it ?
Be careful to always separate facts (evidence) goals, and means.
“Circumcision reduces STD transmission rate”. It’s a fact.
“Everybody’s goal is to be healthy at any cost ?” it’s a goal, and implicit here.
“We should perform chirurgical procedure to achieve this goal” It’s the mean.
When, someone go and visit doctors, they share the goal (getting better), and doctors propose a mean (or even several ones). But when it comes IRL, there is a trade off between life and health. Do not forget that.
Evidence based “sciences” should never discuss goals, rather discuss (means,goals) couples.
“Imagine if we could save lives from a dread and often fatal disease simply by performing a minor surgical procedure. People would hail this simple victory and rush to adopt it”
No. Simply because, you have forgotten that not everybody share this goal. You are falling on false assumptions.
You should try evidence-based politics.
Alison: “What’s frustrating about Amy is that she doesn’t explain things. She … asserts that anyone who disagrees with her is an irrational extremist ninny.”
Well indeed. The biggest issue I have with this article is that she clearly endorses *neonatal* circumcision, yet has provided zero evidence to back (circumcision in general, but not neonatal circumcision).
The presentation of evidence is also completely one-sided. Ethical considerations like the right of an individual to choose are completely ignored, as are the medical side-effects of circumcision (aside from sexual performance), as are any recent studies reaching different conclusions.
Anyway, I have written a detailed response here:
Circumcision: A Response to Amy Tuteur
http://layscience.net/node/878
Let’s take a closer look at the scientific issues:
1. There is copious scientific evidence that circumcision lowers the risk of transmission of HIV and a variety of sexually transmitted diseases including herpes and HPV. There is some evidence that circumcision of protective against cervical cancer and penile cancer, both associated with HPV.
There’s really not much doubt about the protective effect of circumcision. So the next issue is whether the impact of circumcision would justify recommending it.
2. What is the estimated benefit of instituting routine circumcision in a high prevalence population?
As mentioned above, the NNT for is 72 circumcision to prevent one case of HIV.
According to Weiss et al (Male circumcision for HIV prevention: from evidence to action?):
“assuming full coverage, male circumcision could avert 2.0 (95% CI 1.1–3.8) million new HIV infections and 0.3 (95% CI 0.1–0.5) million deaths over the next 10 years in sub-Saharan Africa, and 3.7 million (95% CI 1.9–7.5) new HIV infections and 2.7 (95% CI 1.5–5.3) million deaths in the following 10 years.”
Those are not trivial numbers. They would have a major impact on the spread of HIV.
3. What about a low prevalence population?
The answer to that question is not as straightforward as anti-circ activists claim. That’s because countries with low prevalence of HIV tend to have high rates of circumcision already. Such high rates of circumcision may be contributing to the low prevalence.
As Weiss et al. explain:
“Countries with very high or universal coverage of male circumcision have, without exception, relatively low and stable HIV prevalence which has never exceeded approximately 6%. The importance of male circumcision in ‘containing’ the HIV epidemic was highlighted in the Four Cities’ Study [43], which found higher levels of reported risk-taking behaviour in Yaounde,the capital city of Cameroon, where prevalence has been fairly stable at below 7% for many decades, compared with Kisumu, Kenya and Ndola, Zambia where HIV is more prevalent. The authors concluded that biological cofactors
for HIV transmission, notably male circumcision and herpes simplex virus type 2 infection,were likely to be key factors in the HIVepidemic in sub-Saharan Africa and this has been confirmed in subsequent modelling of the data.”
So it far from clear that circumcision does not have the same impact in low prevalence countries. The low prevalence may be a result of high circumcision rates.
4. What are the harms of circumcision, and how do they compare to the benefits?
A Trade-off Analysis of Routine Newborn Circumcision, a study done before the latest data was obtained from Africa reviewed circumcision over over 100,00 male neonates in the US reported:
“Overall 287 (.2%) of circumcised children and 33 (.01%) of uncircumcised children had complications potentially associated with circumcision coded as a discharge diagnosis. Based on our findings, a complication can be expected in 1 out every 476 circumcisions. Six urinary tract infections can be prevented for every complication endured and almost 2 complications can be expected for every case of penile cancer prevented.”
5. Do these data mean that we should recommend routine neonatal circumcision in low risk countries?
In my judgment, at the moment there is no enough data to recommend routine neonatal circumcision in populations with low prevalence of HIV. However, if decreasing rates of circumcision lead to increased prevalence of HIV, that issue would need to be revisited.
In summary, the benefits of neonatal circumcision are real, definitely make a difference in populations with high prevalence of HIV, and may make a significant difference in populations with low prevalence of HIV. That doesn’t even address the benefits that may accrue from decreasing transmission rates of other STDs, particularly HPV, known to be associated with cervical cancer and penile cancer.
snfraser notes: “This isn’t physics or chemistry. Medical science is messy.”
Perhaps, but medical science writing needn’t be messy as this article and the majority of comments are. Kind editorial assistance for the former and some more minutes of thought before the latter hits “submit comment” would do the world a world of good.
Alison Cummins later notes: “What’s frustrating about Amy is that she doesn’t explain things…and sits back and waits for the complaints.”
Some people’s style resembles that of the provocateur. For subjects without so many footnotes available and studies to cite, this is often an effective way to draw attention to something. However, in medical science matters, it’s most often used by those without a firm grasp of their subject matter. I don’t think this is the case with Dr. Tuteur but rather a problem of style not being well suited to the substance. If the intent is to educate then the most effective means should be used. If the intent is to get page hits and “controversy” going then anything goes but goes away quickly without much beneficial long-term impact.
“Having read most of the comments posted here I have to say, this discussion would make an interesting sociological experiment. It is quite interesting to note that individuals who would probably discuss vaccination or homeopathy in a quite dispassionate manner seem to devolve into ranting and raving when discussing the aspects and choice of circumcision, especially when the author of this article never calls for an end to parental choice.”
I agree (not surprisingly).
I was never particularly supportive of routine neonatal circumcision for health reasons, but new data has challenged my old assumptions. The issue is whether we are willing to go where the scientific evidence takes us.
Oh, lord not yet another forum where American medical industry personnel are trying to convince people that there are any scientifically credible benefits for circumcision–I thought this was debunked at another forum by Harriet Hall.
There, as well, as here, some think merely having a study deems it scientifically credible. Also that OPINIONS by organizations profiting from this unnecessary procedure can hardly be considered EVIDENCE.
Notice also, that the questions of ethics of inflicting an unnecessary procedure on unconsenting infants are not being addressed..nor the proven harm and proven risks of this unnecessary FORCED procedure.
If people here wish to actually defend this practice, they better start with trying to justify it with PROVEN facts and evidence.
Perhaps people might wish to see what REAL science has to say on the subject..
http://mysite.verizon.net/dortfay/science.html
I think Jason is right – I don’t think the AAP ever recommended routine neonatal circumcision.
Amy, when you said “The AAP had long recommended male circumcision for prevention of urinary tract infections in young boys,” did you mean to say they had long acknowledged that it was effective in preventing UTIs?
“I was never particularly supportive of routine neonatal circumcision for health reasons, but new data has challenged my old assumptions. The issue is whether we are willing to go where the scientific evidence takes us.”
What is this SCIENTIFIC EVIDENCE? Specifically evidence that satisfy the criteria for being scientifically credible–merely having flawed and questionable studies does not automatically confer credibility.
PLEASE provide even ONE single scientifically credible benefits for circumcision..scientific, not just medical evidence…they are not the same!
http://mysite.verizon.net/dortfay/science.html
Amy said: “3. What about a low prevalence population?
The answer to that question is not as straightforward as anti-circ activists claim. That’s because countries with low prevalence of HIV tend to have high rates of circumcision already. Such high rates of circumcision may be contributing to the low prevalence.”
Well to start off this is certainly not true. Circumcision outside of the US (and perhaps Canada to an extent too) is practically unheard of. So Amy, which European country, for example, where rates of circumcision in the population are easily below 5%, has higher HIV prevalence than the US?
That’s because countries with low prevalence of HIV tend to have high rates of circumcision already. Such high rates of circumcision may be contributing to the low prevalence.
++++++
Please can you give some evidence for this assertion.
Amy Tuteur, MDon 07 Jan 2010 at 4:29 pm
Perfect! A look at the science and a discussion of how they might relate to the real world. Exactly what I hope for from SBM.
(Well, almost perfect. We have NNT and also NNH—newborn but not NNH—adult.)
Amy, I’m truly curious. If you can write a clear, interesting and informative resumé of the science, why don’t you do it more often? Is your goal with your SBM really just to generate complaints — including complaints from people who agree with you? (In other words: are your posts deliberate trolls?)
“The answer to that question is not as straightforward as anti-circ activists claim. That’s because countries with low prevalence of HIV tend to have high rates of circumcision already. Such high rates of circumcision may be contributing to the low prevalence.”
That’s not true either. Many countries in Europe and Japan have low circumcision rates and low rates of HIV. In fact the US. has one of the highest HIV rates of the developed world. And highest circ rates.
I’m also questioning the confidence intervals in the Weiss report (and whether the data matches the conclusions), but it’ll have to wait until later when I can actually read it.
Interesting about the AAP positions through the years too. Honestly, I’m wondering if Dr. Tuteur said it was raining, I should go outside to check.
Amy said: “The issue is whether we are willing to go where the scientific evidence takes us.”
And if there is data to suggest it is necessary in the neonatal period then we can examine the strength of that data and whether the intervention meets the normal ethical standards practiced in medicine. At this point we are far from that place.
OK, now I am wondering if there is censorship going on here..I posted two comments–one apparently never made it through moderation (yet never even shown as awaiting moderation), and the second is now awaiting moderation–can I expect to see either one make it through your process?
IF they do not make it through moderation, will I be informed as to why not?
I concur. It doesn’t look to me as though the AAP ever recommended routine neonatal circumcision, at least not within the last 40 years.
I’m afraid that’s not the impression you gave with your original post.
@ Allison Cummins
– Eric G,
“the docs are accountable to present the evidence as it is appears. do with it what you will.”
-AC
“Actually, doctors are accountable for interpreting the science for us, not just list PubMed references. This is hard to…”
How about:
the docs are accountable to present *and interpret* the evidence as it appears. do with it what you will. ??
a quibble, but point taken.
i hope no one here thinks that a doctor’s opinion/assessment/advice precludes their own autonomy…given the trivial nature of the issue…well, carry on.
I suspect it’s more that we all want validation that we are “doing the right thing.” No one *wants* to be wrong.
@ archangl508
“As a matter of fact I do not even give it any thought whatsoever, ”
Ditto. much ado about nothing.
Amy Tuteur: “I agree (not surprisingly).”
Then why did you write your post in such an aggressive fashion? You flat-out accuse the AAP of manipulating the evidence on the basis of pressure from “anti-circ activists” in their 1999 policy statement, yet you’ve failed to address that statement, or the evidence in it, and explain where they went wrong.
You must realise that you can’t make these sorts of unevidenced accusations, then claim that it’s just your opponents who are ‘ranting and raving’?
At the very least, you need to address the evidence presented by organizations like the AAP – who based on far more substantial reviews of the current literature than you’ve provided continue to find the totality of the evidence not strong enough to recommend routine circumcision – rather than simply asserting that you’re right on the basis of hand-picked individual studies.
It’s also worth noting that you have still not addressed the question posed by the article’s title, and by a number of commenters – what is the case for *neonatal* circumcision? The last time I checked, most infants don’t have a lot of sexual partners, and won’t do until their mid-to-late teens. Why deny them choice? Why not wait until they’re old enough to decide for themselves what precautions they would like to take?
well, one thing is for sure. Dr. T, you sure know how to generate some traffic!
I do find it interesting that among developed countries the US is the only one that is really thinking about circumcision and HIV with regard to their population. Articles like this give an interesting perspective on how those from countries where circumcision is rare see our zeal to justify the practice:
http://news.bbc.co.uk/2/hi/health/7960798.stm
“Dr Colm O’Mahony, a sexual health expert from the Countess of Chester Foundation Trust Hospital in Chester, said the US had an “obsession” with circumcision being the answer to controlling sexually transmitted infections.”
I’m afraid that’s not the impression you gave with your original post.
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@David Gorski
Surely this is within your remit, as managing editor of this site?
You probably triggered the spam filter somehow. As you can see, I released your comments, as I do nearly all nonspam comments that get caught up in the spam filters.
Be aware, however, that I do not sit at my computer all day doing nothing but moderating comments so that commenters like you do not have to wait one second to see your comment appear. I have a very demanding day job. Generally, during business days I check every few hours if I can. If it’s a day that I happen to be busy in the O.R. or clinic, it can take several hours before I get around to checking the spam filter. Be patient. Just because your comment got hung up for moderation and I didn’t get to it for–gasp!–nearly a whole hour does not mean there is any “censorship.”
Yes, I’m being sarcastic. Commenters insinuating that they are being “censored” (presumably because they are disagreeing with one of our bloggers) brings that out in me. Mea culpa. No, on second thought, I make no apologies. Just be aware that censorship of that sort is a characteristic of CAM blogs and anti-vaccine crank blogs like Age of Autism, not of Science-Based Medicine.
mjrobbins said:
“Why deny them choice? Why not wait until they’re old enough to decide for themselves what precautions they would like to take?”
I think it’s because when you present the issue to most rational thinkers as, to reduce your risk of HIV you should:
Get circumcised, always wear condoms, and be choosy about your sexual partners.
or
Always wear condoms and be choosy about your sexual partners
The first choice isn’t too compelling. “Minor” surgery is always surgery performed on someone else.
So far as I know, the AAP has never recommended non-therapeutic circumcision. It has only adjusted its position on the fence from time to time.
The supposed correlation between intactness and UTIs was only discovered in 1982, long after the custom of circumcision was well-established in the US. Ironically, all the 1982 paper did was quite casually note that “95% of the [male] infants [with UTI] were uncircumcised.” without mentioning that virtually no babies born at that hospital (Parkland in Dallas, Texas) were circumcised. The paper went on: “All infants responded promptly to antimicrobial therapy.”
The main proponent of circumcision to prevent UTIs has been Thomas Wiswell, but his huge sample sizes (in the hundreds of thousands) were not random, being all born in military hospitals, where intactness would have been rare and largely confined to premature babies. In fact the huge sample sizes raise doubts about his methodology.
“parents who choose to circumcise their sons are “mutilators”. In more than 10 years in the Intactivist movement, I have NEVER seen that descriptor for parents, only (rarely) doctors.
A good critique of the three RCTs for HIV is at http://www.futuremedicine.com/doi/full/10.2217/17469600.2.3.193
“These findings are also supported by observational studies conducted in the United States.” Many studies in the US have failed to find any such correlation. For example, Zenilman et al. found “Women with uncircumcised current partners are not at increased risk for B[acterial] V[aginosis].” (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1758232/) News stories often headline non-significant correlations, or correlations in small, high-risk subgroups, as though they were significant or generalised.
A flurry of pro-circ studies has come out in the last few years, but strikingly all from the same small group of researchers (Daniel Halperin, Robert Bailey, Stefan Bailis, Stephen Moses, Malcolm Potts, Ronald Gray, Thomas Quinn, Helen Weiss, Brian Morris, Jeffrey Klausner, Edgar Schoen, Thomas Wiswell and a handful of others. Sure enough, this one is by Gray and Quinn.)
The Ugandan study found no difference in sexual satisfaction after circumcision, because it found virtually perfect sex in almost every man both before and after circumcision. This does not correlate with findings in the developed world. Either Uganda is a sexual paradise, or the questions were too insensitive to find any difference.
Though they are inclined to stay silent in the US, men with foreskins generally appreciate having them for the direct sexual pleasure they give (described as not just “more sensitive” but “a symphony of sensation”) and would not willingly give them up.
Stunningly absent from all this is any consideration of the ethics of non-therapeutic surgery on neonates. Judging by the sales of devices, many tens of thousands of men are unhappy about what was done to them, and go to considerable trouble to reverse it. Changing the policy will increase that number.
“Why does the issue of what other parents choose for their sons generate so much heat?”
The reason is because it was not the victims’ choice. It is sexual abuse to amputate sexual tissue from an infant, whether it be male or female. Imagine being the victim of a circumcision you didn’t want. Imagine that your sexuality is affected.
How can you possibly question that sex is important to men? How can you possibly know that circumcision didn’t affect any particular man’s sex life? The only sensible thing is to leave the poor infant alone, and let the man decide when he is of age.
joep,
“The first choice isn’t too compelling.”
I think it depends very much on how many of your friends, relatives and sexual partners have died horribly of AIDS. My understanding is that many Ugandans are actually quite keen on anything that will reduce their risk, including circumcision.
FYI:
If I post a comment that doesn’t immediately show up, and I really want it to be a part of the discussion right way, I can usually figure out what likely triggered the holdup (key words, too many links, etc- it’s not too hard to figure out) and compose a substitute comment to suffice until the original gets approved.
@Allison
Indeed, which is why this is a context sensitive and individual decision. I wouldn’t begrudge a teen or adult in that situation or not to make that decision so long as the choice is his. However, if I noticed my friends dropping dead around me from HIV and knowing the efficiency of condoms, I sure wouldn’t ever forget it.
“where rates of circumcision in the population are easily below 5%”
You need to distinguish between current rates of neonatal circumcision and prevalence of circumcision within sexually active populations. While the rates of neonatal circumcision have been declining in a number of first world countries, prevalence of circumcised adults males is still quite high.
You need to distinguish between current rates of neonatal circumcision and prevalence of circumcision within sexually active populations. While the rates of neonatal circumcision have been declining in a number of first world countries, prevalence of circumcised adults males is still quite high.
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Some citations please!
What are you defining as ‘still quite high’? Can you name some of these ‘first world countries’?
Thank you Dr. Tuteur, I enjoyed your article very much! I think parents having boys should be informed and consider both sides before making their decision. As Africa and India face AIDS epidemics, is circumcision being recommended and are rates increasing in these areas? (I read where you said it “should” be recommended in areas with high HIV rates, but was unclear if any of those areas are recommending it).
Amy said: “You need to distinguish between current rates of neonatal circumcision and prevalence of circumcision within sexually active populations. While the rates of neonatal circumcision have been declining in a number of first world countries, prevalence of circumcised adults males is still quite high.”
Current rates in most first world countries haven’t changed in generations because it’s never been common in places like continental Europe among others. Yet they have among the lowest rates of HIV prevalence.
You might be right about England where it was somewhat common until 1948 after which the rates of neonatal and child circumcision declined significantly. Neonatal rates there are easily under 5% and it’s in fact quite difficult to find a doctor willing to do it. I doubt the prevalence in the adult population is much more than 20%, mostly men born before the 1960s. It is perhaps a bit higher in New Zealand (they didn’t start to discourage it until the 1960s) now the neonatal rate is less than 1% and the adult prevalence is perhaps now below 50% and Australia where it is 10% and 50%.
So what you say might be true for Anglican countries but of those who practiced circumcision at one time in the recent past (England, Australia, and New Zealand) most discontinued it and those men at highest risk (say 25 – 35) are predominately not circumcised.
Further most of the relevant medical authorities in those countries don’t seem quite as persuaded by the effectiveness of circumcision in their populations.
“You need to distinguish between current rates of neonatal circumcision and prevalence of circumcision within sexually active populations. While the rates of neonatal circumcision have been declining in a number of first world countries, prevalence of circumcised adults males is still quite high.”
http://hivinsite.ucsf.edu/global?page=cr-00-02
Look at the HIV prevalence in Japan, China, Greece, Finland, Vietnam, Russia. None of these countries have ever routinely circumcised infants and they maintain some of the lowest HIV rates in the world.
The majority of babies haven’t been circumcised in the UK since the 1950′s when campaigns were done to show that there was no medical need to perform them on infants. As it is now 2010, it is safe to say that the majority of men 18-55 are not circumcised in the UK, and they have a lower prevalence of HIV than the US.
@Karl:
Good for you that you can figure it. I have had this happen to me with the most innocuously worded post, without any hyperlink. Possibly it has something to do with the Spam filtering plugin that this version of WordPress is using. But I agree that there is no censorship going on. As David indicated, that is the policy of crank, pseudoscience sites like AoA and AiG.
@Plonit:
In the same vein, all the authors of this SBM blog are responsible for determining the accuracy and veracity of what they post, and any reaction their post generates are to be handled by them, too. It is not David’s function – even as managing editor of the site – to censor or sanction posts. He would rather – heck, I’d rather he did – encourage a debate based on the scientific merit of the post, and argue points of evidence – which he did and does adequately.
@Dr. Tuteur: I am intrigued by the accusation of false equivalences by you towards those who are protesting the reason for routine neonatal circumcision. At random, let me take the figures from a 1990 paper in the American Journal of Epidemiology, which stated that in the US, the lifetime risk of appendicitis was 8.6% for males and 6.7% for females; the lifetime risk of appendectomy is 12.0% for males and 23.1% for females. Going by your logic for advocating neonatal circumcision, would it also not justify neonatal appendectomy?
The issue of circumcision is bound to raise emotions, since it is often firmly linked to religious and cultural practices. Adult circumcision is different; the adults have a choice.
I don’t much buy the lack of neonatal choice argument, since (a) neonates are incapable of conscious, informed consent, making the point moot, and (b) parental consent is considered sufficient for a plethora of difficult decisions in favor of invasive practices when medically warranted. But alone on the off-chance that the person in his adulthood would be exposed to STDs and HIV by engaging in risky behaviour, can the routine deployment of this procedure be justified?
Annabel’s sound question above is IMO very pertinent.
Could you please address this, Dr. Tuteur?
The prevalence in the non-religious circumcision in the UK adult population is estimated to be 6% (UNAIDS figures, 2007).
It is not David’s function – even as managing editor of the site – to censor or sanction posts.
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Sanction is in the form of inviting someone to become a contributor to SBM, which suggests that minimal standards of accuracy and veracity will be upheld as a matter of course.
“At random, let me take the figures from a 1990 paper in the American Journal of Epidemiology, which stated that in the US, the lifetime risk of appendicitis was 8.6% for males and 6.7% for females; the lifetime risk of appendectomy is 12.0% for males and 23.1% for females. Going by your logic for advocating neonatal circumcision, would it also not justify neonatal appendectomy?”
In general, parents choose circumcision for non-medical reasons, often religious, cultural or just to have sons “look like” Dad. Rarely do parents choose circumcision for medical reasons, and I don’t think the data on STD transmission is strong enough to recommend routine neonatal circumcision for public health reasons.
My main point is that the accusation that circumcision has no medical benefit is simply untrue. I have emphasized all along that if individuals don’t wish to circumcise their sons, they shouldn’t do so. But those who do wish to circumcise should not be vilified for “mutilating” their children with no medical benefit.
As regards appendectomy, if removing the appendix were as simple as removing the foreskin, I suspect it would be recommended as a routine preventive health measure.
My gosh, this disinformation just flows out: “While the rates of neonatal circumcision have been declining in a number of first world countries, prevalence of circumcised adult males is still quite high.”
Dr Tuteur has successfully sidestepped the point being made by fudging about ONLY Canada, Australia and New Zealand with the vague phrase “a number of first world countries”. Perhaps she would like to leave visitors with the impression that infant circumcision has been “prevalent” in developed countries at some time in the past. The truth is that infant circumcision has never risen above 2% in any Western European or developed Asian country, except for the England region of the United Kingdom and, of late, South Korea. And in England, neonatal circumcision rates never reached 35% and have been under 2% for more than 50 years.
The comparison suggested was the US with Europe. Tuteur hemmed and hawed something about “a number of first world countries”. No. Circumcision is not practiced in Western Europe. It is disingenuous go to off on a tangent with veiled references to a couple of former British commonwealth countries (which have now followed the lead of the UK in abandoning infant circumcision).
Approximately half of sexually active adult males in Canada and Australia are circumcised, and the percentage declines annually.
The clear trend in developed countries with regard to circumcision is marked movement from low to much lower, with favorable outcomes.
“Look at the HIV prevalence in Japan, China, Greece, Finland, Vietnam, Russia. None of these countries have ever routinely circumcised infants and they maintain some of the lowest HIV rates in the world.”
The prevalence is affect by other factors besides circumcision. Perhaps in low prevalence environments where circumcision is uncommon, increasing circumcision may make no difference. However, that does not change the fact that circumcision does reduce transmission of HIV and other STDs.
To David Gorski and Harriet Hall:
For clarification, the AAP’s 1971 Position Statement on circumcision was its first-ever pronouncement regarding the practice. That is why the chronology provided only went back that far.
Perhaps in low prevalence environments where circumcision is uncommon, increasing circumcision may make no difference.
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And the logical corollary for low prevalence environments where circumcision is common? that decreasing circumcision may make no difference?
“UNAIDS figures, 2007″
Yes, the same report also concludes:
“There is substantial evidence that male circumcision protects against several diseases, including urinary tract infections, syphilis, chancroid and invasive penile cancer, as well as HIV. However, as with any surgical procedure, there are risks involved. Neonatal circumcision is a simpler procedure than
adolescent or adult circumcision and has a very low rate of adverse events, which are usually minor (0.2–0.4%). Adolescent or adult circumcision can be associated with bleeding, haematoma or sepsis, but these are treatable and there is little evidence of long-term sequelae when undertaken in a clinical setting with experienced providers. In contrast, circumcision undertaken by inexperienced providers with inadequate instruments, or with poor after-care, can result in serious complications.”
Indeed, I have read the report. In fact, I commented (upthread) on one of the complexities alluded to in that paragraph: the difference between efficacy in controlled clinical trial settings and effectiveness in’ real life’ situations with lack of access to trained health professionals and safe equipment. A comment that you have chosen not address.
“I have emphasized all along that if individuals don’t wish to circumcise their sons, they shouldn’t do so.”
The problem is, where does that leave the poor victim that wishes to have his foreskin?
Foreskin feels really good, anyone would want theirs, so you can’t preemptively take THEIR choice away.
“In general, parents choose circumcision for non-medical reasons, often religious, cultural or just to have sons “look like” Dad. Rarely do parents choose circumcision for medical reasons, and I don’t think the data on STD transmission is strong enough to recommend routine neonatal circumcision for public health reasons.”
I think this is a major reason why circumcision is unethical. If a mother went to a doctor and said she wanted her some circumcised because she thought the foreskin looked funny that would be a legitimate reason and the doctor would perform it.
So the argument that a girl shouldn’t be circumcised because there is no proven medical benefit is biased. A male can get circumcised for any reason. What if a person thought their daughter’s labia hung too low and it looked funny? Would she be allowed to get it “trimmed”? Just a little snip? it wouldn’t be cutting the clitoris, so little sexual pleasure is lost, so is it Ok? No, it isn’t. The fact that it is legal for infant boys but not infant girls is unconstitutional. It should be illegal for both if it is illegal for one.
A person has the right to practice their religion. They don’t have a right to impose that religion on another person, including their child. If parents from a minority religion said that, in order to please their god, they had to burn a small cross on the leg of their child would that be legal? Why should removing foreskin be any different just because there are more Jewish parents than this hypothetical minority religion? Just as everyone has a right to religion, they also have a right from religion. There is no way of determining whether or not an infant will want to be Jewish as an adult, and his body should not be permanently marked as a result.
These double standards in regards to male circumcision is what adds fuel to the fire. Americans are obsessed with male circumcision, for whatever reason and constantly overlook these double standards.
Amy said: “However, that does not change the fact that circumcision does reduce transmission of HIV and other STDs.”
I don’t see a lot of people directly challenging that statement; it’s all about context. I find it interesting how medical groups in other countries realize this but the US seems to struggle with that concept.
Just as an example the Australian Federation of AIDS Organization: http://www.afao.org.au/view_articles.asp?pxa=ve&pxs=169&pxsc=&pxsgc=&id=633
“African data on circumcision is context-specific and cannot be extrapolated to the Australian epidemic in any way.”
The French as I posted previously:
http://www.cns.sante.fr/IMG/pdf/2007-05-24_rap_en_politique_internationale.pdf
“The same measures are not applicable to the Northern countries. The recommendations of the WHO state that this strategy is aimed
at countries with high prevalence, and not at countries with low prevalence or in countries where it relates specifically to one part of the population such as in France or the United States.”
And there have been a smattering of comments from the British in BBC articles and their BMA policy. Here is one:
http://news.bbc.co.uk/2/hi/health/7960798.stm
“Dr Colm O’Mahony, a sexual health expert from the Countess of Chester Foundation Trust Hospital in Chester, said the US had an “obsession” with circumcision being the answer to controlling sexually transmitted infections.”
So perhaps Amy what you tell parents is that there may be some reduction in risk but it’s relevance is trivial in the US context. You know like most others seem to do.
Dr Tuteur says:
“You need to distinguish between current rates of neonatal circumcision and prevalence of circumcision within sexually active populations. While the rates of neonatal circumcision have been declining in a number of first world countries, prevalence of circumcised adults males is still quite high.”
Dr Tuteur, please provide hard numbers on this. You are the one making the claim. Are you seriously telling me that the prevalence of circumcision in France, Germany, Belgium, Italy, UK is altered post neonatal period, to such an extent that it effects the transmission of HIV? This seems to be a stretch.
What are the adult circumcision figures across Western Europe, and their respective HIV infection rates?
–
I must make a passing comment on my previous comment which referenced “castration fantasy”.
When I read you post these two writings, independently:
“Female genital mutilation is designed to mutilate. The purpose is to deprive women of sexual satisfaction in order to strengthen male power over women.”
“Let’s talk about the evidence of whether circumcision decreases the transmission of HIV and other STDs and how that may translate into fewer deaths, less disease, less female infertility, and decreased cervical cancer.”
You do seem to be discussing women’s issues in your postings here. I cannot overstate how absolutely reprehensible I find the circumcision, and indeed cliterodectomy and female genital mutulation.
However, to be making social comments to say its purpose is to reinforce the male power over women? And then to claim we must discuss the positive effect that male circumcision will have on the transmission of diseases to women?
I would have to be gormless not to detect a rather feminist viewpoint on this.
And my real question is whether the circumcision of male children should ever be an issue for discussion in regards female epidemiology.
Finally, let me make a note on a fair number of posters that say “I was circumcised and I never give it a moment’s thought.”
Well that is absolutely fine, but surely yourselves must understand that personal point of view is not an appropriate place to argue an ethical viewpoint.
A geisha might say she appreciated that her family bound her feet and she suffered no ill from it and even benefited – but this does not validate this, and it does not make it not to be a violation, a risk, and inappropriate.
Some of you on this chat are parents of children that you have had circumcised. It is in your best interests, personally, to not question whether you may have done harm.
The truth is most likely you have. Circumcision routinely excises 70% of the nerves of the infant penis. If you don’t have it then maybe you won’t miss it.
But even paraplegics can have orgasms (surprisingly.) It doesn’t make them whole however.
The main benefit of circumcision is reduced susceptibility to disease, as stated in your post.
Condoms do a better job of preventing the spread of disease.
Also, not performing circumcision completely eliminates any chances of side effects from circumcision, such as coronal penile amputation:
http://www.springerlink.com/content/3wlr08kuj7q5x1a7/
“I would have to be gormless not to detect a rather feminist viewpoint on this.”
A feminist viewpoint? Guilty as charged.
In addition, although I did not spend much time discussing it, I believe that the impact of male circumcision on female health is a legitimate public health topic.
“In addition, although I did not spend much time discussing it, I believe that the impact of male circumcision on female health is a legitimate public health topic.”
Certainly, but how much surgical intervention is ethical for the benefit of females?
Let’s reverse that for a second.
How much unelected surgical intervention should one perform on a female infant for the benefit of males?
“In addition, although I did not spend much time discussing it, I believe that the impact of male circumcision on female health is a legitimate public health topic.”
Then it’s time to start cutting, just a tiny little bit, you understand, off of females, just to SEE if it impacts male health.
Think of the ethics of that. Think of the ethics of what you are saying.
Fact is, the majority of circumcised women say they are happy being circumcised, and that they feel no resentment from being circumcised. Here are some excerpts from a statement made by African Women Are Free to Choose (AWA-FC). I think you will find the uncanny similarity to statements made by circumcised men very interesting.
“Though we do not condone the use of violence or intimidation we are also deeply affected by the inflammatory impact of language such as Female Genital Mutilation (FGM). We declare categorically that this language is offensive, demeaning and an assault against our identities as women, our prerogatives to uphold our cultural definitions of womanhood including determining for ourselves what bodily integrity means to us African women from ethnic groups that practice female and male initiation as parallel and mutually constitutive processes in our societies.
We declare that thus far the representation of female circumcision (FC) – its social and ideological meaning in terms of gender and female sexuality and impact, if any, on reproductive health and psychosexual wellbeing has been over the last thirty years dominated by a small but vocal number of African women that make up the Inter-African Committee (IAC) with the enormous backing, if not outright instigation of powerful western feminist organizations and media personalities.
Thus far, the negative medical or health claims about various forms of FC have been disputed as grossly exaggerated by several independent medical researchers and practitioners. The claims that various forms of FC reduce or eliminate sexual desire and feeling in women have also been disproven by affected women themselves, the researchers who relentlessly question them and medical doctors who examine and treat them. We can provide ample references for anyone who is interested in any of this work.
The assertion that FC violates the rights of children falters in the face of WHO’s promotion of routine neonatal male circumcision (MC) to protect against HIV infection in Southern African. Incidentally, circumcised African women also have some of the lowest rates of HIV infection among women in the world, so why the double standard? ”
You can read the statement in its entirety here : (http://www.thepatrioticvanguard.com/article.php3?id_article=3752)
“Then it’s time to start cutting, just a tiny little bit, you understand, off of females, just to SEE if it impacts male health.
“Think of the ethics of that. Think of the ethics of what you are saying.”
Precisely. Dr Mengele’s assistant.
A person has the right to practice their religion. They don’t have a right to impose that religion on another person, including their child.
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The argument that communal identification should not be ‘imposed’ upon children cannot be sustained, since you cannot be brought up outside of one community or another. Christianity as a religion is characterised by the centrality of individual profession of faith (concordant with the centrality of choice in your assertion above). Most religious communities are not so characterised. Body modification (such as tattooing and scarification) is a very common feature of belonging to an ethnic group. Where there is not strong evidence of harm, I don’t think there is a compelling reason to disallow people ‘imposing’ some kind of ethnic or communal identity on their children, which may include body modification. Where there is strong evidence of harm, then no other considerations need apply. But the standard surely can’t be that children are blank slates until age of majority at which time they fashion their identity from a random selection of the world’s cultures.
@Plonit – are you saying that scarification and tatooing should be legal acts? I see you qualify this with “I think.”
I believe you are at divergence with the legal standards and accepted social norms of Western society.
“Where there is not strong evidence of harm, I don’t think there is a compelling reason to disallow people ‘imposing’ some kind of ethnic or communal identity on their children, which may include body modification.”
The law in the United States does not allow these kinds of modifications on children, especially without their consent. A parent cannot tattoo their child for religious or cultural reasons in the United States. As far as I know, no studies have shown that tattooing a child is any more dangerous than tattooing an adult. You would not be allowed to burn a small symbol on a child either in the United States. You could not ask a doctor to perform a ceremonial pin prick on the labia of a female child for cultural or religious reasons. You could not ask a doctor to remove the clitoral hood from a female child, even if it is part of your religion, unless there is immediate medical need. A parent can, however, have the foreskin removed from a male without immediate medical reason for any reason. See the double standard?
Plonit said: “Body modification (such as tattooing and scarification) is a very common feature of belonging to an ethnic group. Where there is not strong evidence of harm, I don’t think there is a compelling reason to disallow people ‘imposing’ some kind of ethnic or communal identity on their children, which may include body modification.”
Indeed it is a common feature of many ethnic groups and here is how they would be treated in the US:
http://www.bvblackspin.com/2010/01/05/parents-face-charges-for-tattooing-six-of-their-young-children
Sure this was done at home but I don’t think the result would have been different if it was done by a clean professional tattoo parlor. In fact I suspect it would be quite difficult to find a quality tattoo parlor to tattoo a child. Doesn’t this take away their “parental rights” though?
Annebal said: “You could not ask a doctor to perform a ceremonial pin prick on the labia of a female child for cultural or religious reasons.”
This actually happened in the US. The incident was called the Seattle Compromise you can read a legal review about it here:
http://www.law.duke.edu/shell/cite.pl?47+Duke+L.+J.+717
Here is another story of a man getting arrested for tattooing his son, who was seven years old.
“Fresno, CA (KFSN) — It was a shocking form of child abuse … forcing a tattoo on a seven year old boy. It was a small tattoo of a dog’s paw, a symbol of Fresno’s notorious Bulldog Gang.
The boy’s father, Enrique Gonzalez is accused of holding the squirming child down during the painful procedure, while a tattoo artist did the procedure. The tattoo artist was arrested shortly after the April 20th incident. Police have been looking for Gonzalez since then. He was spotted at a motel near the Madera County town of Coarsegold on Wednesday, and police moved in. Police Chief Jerry Dyer described what happened to local news media on Wednesday night.
“The suspect attempted to escape through one of the windows but saw officers in the back of the hotel and surrendered peacefully,” said Dyer.
Gonzalez is charged with six felonies including child abuse. His girlfriend, Mikayla Ramirez was also arrested, charged with harboring a fugitive. Dyer said investigators also discovered a photograph of the tattooed boy, and another unidentified child.”
“See the double standard?”
Absolutely! To even STUDY infant circumcision is completely devoid of ethics. Here we have “science based medicine” studying the sexual abuse of children and infants. Where is the evidence of ALL of what circumcision means?
What does it mean if a lot of skin is taken off versus just a little? It’s just inconceivable that there should be this studying of male circumcision without the preliminary evidence saying that there is anything ethical about it.
Evidence based science should start at the BEGINNING of an atrocity like male circumcision, not after billions are cut.
@ Hugh7
“Though they are inclined to stay silent in the US, men with foreskins generally appreciate having them for the direct sexual pleasure they give (described as not just “more sensitive” but “a symphony of sensation”) and would not willingly give them up.
Stunningly absent from all this is any consideration of the ethics of non-therapeutic surgery on neonates. Judging by the sales of devices, many tens of thousands of men are unhappy about what was done to them, and go to considerable trouble to reverse it. Changing the policy will increase that number.”
1, 2, 3…4…7! bald assertions of considerable size with no evidence. nice!
how could someone who is un-circ describe their experience as “more sensitive?” do they compare to the…circ’ed backup they use?
what if I, a circ’ed male, say that I too experience a “symphony of sensation?” does my anecdote cancel yours? i can only envision the questionnaire
circle 1 for “bummer” 2 for “ho hum”…5 for “fantastic!” and 43,000 for a “symphony of sensation!”
“unhappy about what was done to them…”
linking circs to male “enhancement.” That rubs more as a advertising plug meant to instill insecurity than a response to “mutilation.” how might an “enhancement “pill reverse a circ? might you suggest that doctors who advocate circs are in bed with..wait for it…wait…Big Penis?!
“This actually happened in the US. The incident was called the Seattle Compromise you can read a legal review about it here:
http://www.law.duke.edu/shell/cite.pl?47+Duke+L.+J.+717 ”
Yes, I know. Which is how I know that such a thing would be illegal in the United States, as it should be. All children have the right to an intact body.
geskoi said: “Evidence based science should start at the BEGINNING of an atrocity like male circumcision, not after billions are cut.”
I think it goes without saying that were we in the west innocent of infant circumcision, nothing presented thus far would compel us to start doing it.
I will clarify.
Where there is no compelling evidence of harm, it would be wrong to prevent communities from ‘imposing’ some kind of ethnic or communal identity on the children born into those communities, this may include body modification.
As to whether any specific act was prohibited, my own view would depend on whether there was compelling evidence of harm. Since I don’t view body modification to be intrinsically harmful, the fact that the body is modified would not, in and of itself, be compelling evidence of harm in my opinion. However, many forms of body modification can nonetheless be shown to be harmful in other terms. I am aware that this is not necessarily the legal or social standard in many Western societies with regard to specific forms of body modification. But are we talking about what ‘ought’ or what ‘is’? Just because something is normative, doesn’t mean it is logical or right.
Amy Tuteur – I was taught that circumcision was the right thing to do. I have intentionally sought evidence to support my world view as it would make me uncomfortable to be wrong after so long and especially when I have done so much to encourage the performance of this procedure.
Average creationist – I was taught that the world is 6000 years old. I have intentionally sought evidence to support my world view as it would make me uncomfortable to be wrong after so long and especially when I have done so much to encourage the belief of this knowledge.
The less harm done in this case is to not perform surgury on either boys OR girls without their explicit consent, and to promote condom use and safe sex practises.
@ Plonit -
You say ” I don’t view body modification to be intrinsically harmful…”
That’s fine and dandy, go ahead and modify your own body then. You don’t speak for everyone. If I had been tattooed as a child I would greatly resent it now as an adult, and that is why it is unethical. I am twenty five years old and don’t have any tattoos or any piercings, not even on my ear lobes. Even though piercings and tattoos are socially acceptable, I don’t prefer them for myself. My mother told me that when I turned 16 she would allow me to get mine pierced if I wanted, but I had no desire to, and she was fine with that.
The lack of choice in neonatal circumcision is what the whole debate hinges on. No one cares if an adult circumcises himself, because it would be his choice. The law realizes this basic human right in regards to tattoos and other body modifications, but not circumcision.
“A feminist viewpoint? Guilty as charged.
In addition, although I did not spend much time discussing it, I believe that the impact of male circumcision on female health is a legitimate public health topic.”
It’s good for women that men are given circumcisions instead to being taught to practise safe sex and to use condoms?
That the relatively small improvement in infection rates that circumcision may bring is better than the almost complete protection that condom use brings?
Yeah, you’re a real feminist, protecting patriarchal religious practices in the face of the real solution that education, poverty relief and condom use protect women far more than archaic priestly practices.
Annabel, I really appreciate hearing a woman’s view on this.
It is personal to me, but my mother was advised by the medical profession when she was 18 years old.
Irrespective of myself, and my personal relationship to it, I believe it to be an ethical situation.
There is no proven benefit and it is ultimately ritualistic. Surely this is in utter contravention of the rights of any human being to have their body surgically altered without their consent.
They stretch necks with gold rings in a tribe in Africa. Would that be accepted here? No way.
As I say, it is a revelation to hear you so strident and have such a clarity of thought. It is such a simple issue of election and personal right to me.
I can do anything I want to my body. But I don’t need people in white coats doing utterly unnecessary things to me, and things which are completely invasive to the most innervated part of my body for heaven’s sake.
Female genital mutilation is an utter disgrace and an utter tragedy. It is a great shame that male circumcision is not seen as an equal violation of the right of the child, even if not necessarily as absolutely catastrophic.
If I had been tattooed as a child I would greatly resent it now as an adult, and that is why it is unethical. I am twenty five years old and don’t have any tattoos or any piercings, not even on my ear lobes. Even though piercings and tattoos are socially acceptable, I don’t prefer them for myself. My mother told me that when I turned 16 she would allow me to get mine pierced if I wanted, but I had no desire to, and she was fine with that.
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But presumably you feel that way because you grew up to be all twenty five years old as part of a community in which individual choice and self-expression are highly prized and in which tattooing and piercing is not normative. In other words, you don’t prefer them for yourself because of who you are, and who you are has been shaped by the community you are a part of.
Suppose you are a girl in a community where ear piercing for girls in completely normative, and this distinguishes girl babies from boy babies from day 1. Your parents decide that they don’t go along with all this gender normativity stuff. Without pierced ears every single person in the community assumes you are a boy. Gradually the rest of the community come to realize that you are not a boy after all, instead you are a ‘girl without pierced ears’. Since having pierced ears is an important component of what it means to be a girl in your community, your may have done you a disservice by not getting your ears pierced. Of course, you can say that the community is wrong and that your parents are right, but is it right to impose your will on the entire community over this, for example by criminalising the entire community? Why is it more important for children to have more freedom of action over their ear lobes than over what is between their ears (since you presumably were educated in some form or other, in ways which have permanent ramifications and over which you had little or no control)?
The issues are even more complex when we consider the position of tribal communities and ethnic minorities vis-a-vis dominant cultures. I am perfectly willing for the rights and sensitivities of minorities to be trampled where there is compelling evidence of harm, not so much where evidence of harm is tenuous.
“but is it right to impose your will on the entire community over this, for example by criminalising the entire community”
So we roll back 500 years of science and development because the Mediaeval English thought that soap and taking a bath caused scrofula and the ague?
If something is done without explicit consent, that does not have an immediate benefit, can cause further medical problems, and can later be performed WITH explicit consent and when any benefits may be realised, then it’s wrong.
You vaccinate children because they need it when they’re children. You teach condom use and safe sex to teenagers because they may need it soon. You circumcise when explicit permission has been given by the adult.
If the reason for doing the circumcision in UK or US context is for purported health benefits, then I think the parents are mistaken and should be advised as such. For a medical procedure, the onus is on proponents to show evidence of benefit.
If, however, you are using a surgical technique to cultural ends, then I don’t think your arguments about ‘when benefits may be realised’ apply, since the benefit of the procedure is the inclusion of the child into a community in which that procedure is a mark of membership. To do otherwise is to ‘mutilate’ the person by cutting them off from their community and cultural identity (they become ‘the uncircumcised muslim/jew’ – as in the example above about the ‘girl with unpierced ears’). Can you explain why having a foreskin is more important than having a secure cultural identity?
If there were compelling evidence of harm, I say it trumps all of that. But where is the compelling evidence of harm? Every survey I’ve seen suggests that circumcised and uncircumcised men are satisfied and disastisfied with their bodies, sexuality etc… in equal numbers, which suggests that it really makes no difference.
“Can you explain why having a foreskin is more important than having a secure cultural identity”
Cultural Identities can and do change, often by simply not performing archaic practices that have no modern cultural imperative.
Southern US cultural racism changed, though proor to the civil rights movement, not refering to a blakc person by the n-word resulted in cultural isolation and shunning.
The English considering Catholics to be dangerous and to empathise with a Catholicresulted in expulsion from that culture.
When a cultural belief is wrong, it’s wrong, and often the easiest way to recognise it is when a right ascribed to a culture impinges on the right of the individual.
@ Plonit
I disagree with you that ear piercings and tattoos are not normative. I am in the minority of all women in my family and all my friends by not having my ears pierced.
I also disagree with your idea that just because something is the cultural norm it should be allowed. Slavery used to be the cultural norm in the United States and Europe. Not having slaves usually implied you were not high class, and poor. Does that make slavery right? I don’t think so. What about segregation? Making African americans go to separate schools and sit in certain seats was the cultural norm until very recently. Does that make it right?
Cultural values change. When a cultural value imposes on a human beings constitutional rights, it is unethical.
“The prevalence is affect by other factors besides circumcision. Perhaps in low prevalence environments where circumcision is uncommon, increasing circumcision may make no difference. However, that does not change the fact that circumcision does reduce transmission of HIV and other STDs.”
Fascinatingly, if you look at the circumcision prevalence of the english-speaking countries (England, Australia, Canada, New Zealand, the US), it’s positively associated with HIV/AIDS prevalence. Quick and dirty R2=.4. (No, I do not imagine this proves anything at all. Not even close. I just think it’s fascinating, that’s all.)
These are all countries with an HIV/AIDS prevalence of less than 1% and may have more in common with one another than they do with Scandinavian countries or with African countries.
“My main point is that the accusation that circumcision has no medical benefit is simply untrue.”
I read your post. It seemed very clear that your main point is 1) given that in high-HIV prevalence areas circumcision is almost certainly helpful in preventing HIV/AIDS, 2) the AAP should change their recommendations for routine neonatal circumcision in a low-prevalence country.
Your secondary point seemed to be that the antic-circ movement was successful in causing the AAP to make non-science-based changes to its recommendations.
You have not been clear on exactly how or why you think the AAP should change their recommendations (main point), and you seem to have been mistaken about the history of AAP recommendations (secondary point). So I can understand that you wish you had written the post differently, or that you wish that we would understand what you meant to say instead of what you did say.
On your part, can you understand why people are responding to the post you actually wrote, instead of to some other, more easily defensible post?
Another question: have you ever said “I stand corrected”? If we knew which parts of your statements you revised we could stop arguing about them and move on to more interesting and profitable discussion.
I also disagree with your idea that just because something is the cultural norm it should be allowed.
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I didn’t say that AT ALL. Please do read what I wrote.
The test of whether or not something should be prohibited is not whether it is normative. The test of of whether or not something should be prohibited is whether it is harmful, and whether prohibition reduces succeeds harm without creating greater harms.
Can I ask you a question? Just because something is a cultural norm should it be disallowed?
What I actually wrote was “Where there is no compelling evidence of harm, it would be wrong to prevent communities from ‘imposing’ some kind of ethnic or communal identity on the children born into those communities, this may include body modification.”
I further qualified that by saying that many forms of body modification can be shown to be harmful.
I am fully aware of the ‘double standard’ (see my earlier comments on Type Ia FGM upthread).
The reason I place “imposing” in inverted commas is because cultural identity/ethnicity/belonging to a community is inevitably imposed, how could it be otherwise. You are not kept nice and pure until the age of majority and then choose your culture, like shopping in the supermarket. Yes, it is imposed on you for good and ill. And yes, it is part of you/you are part of it and as people change, culture changes. Nothing wrong with that, and huge amount right with that.
But when majorities decide that the cultural practices of minorities are barbaric and need prohibiting, they need to be sure that the harms of those practices are actually greater than the harm done by the act of prohibition itself.
None of which has anything to do with advocacy for routine circumcision, since medical procedures require evidence of benefit and not just absence of evidence of harm.
prohibition reduces succeeds harm without creating greater harms.
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It’s late! that should be “whether prohibition succeeds in reducing harm without creating greater harms”
“Where there is no compelling evidence of harm, it would be wrong to prevent communities from ‘imposing’ some kind of ethnic or communal identity on the children born into those communities, this may include body modification.”
http://www.circumstitions.com/Restric/Botched1sb.html
*** PICTURES OF BOTCHED CIRCUMCISIONS, VIEW AT YOUR OWN DISCRETION**
There is an inherent risk of complication with EVERY circumcision, many of which aren’t known until a person is an adult. If you think there is no compelling evidence of harm in circumcision, you are wrong. Aside from physical harm, there are thousands of men who greatly resent the removal of their foreskin without their consent. They would have preferred to remain intact if given the choice.
Every year babies die in the United States as a direct result of circumcision. Penises get amputated. These risks are inherent with every circumcision. No one signed off for their child to get circumcised thinking it would be botched, but you don’t know if you will be one of those statistics until it is too late.
I linked this study earlier, but a man has a .04 percent or .0004 of contracting HIV from a woman. That is a 1 in 2,500 chance. Even the most conservative complication risk rate of circumcision is well above that number. HIV is not a spontaneous disease, you have control over your behaviors.
@Amy Teuter: “However, that does not change the fact that circumcision does reduce transmission of HIV and other STDs.”
So what changes that fact in Cameroon, Ghana, Lesotho, Malawi, Rwanda, Swaziland, Tanzania and parts of Uganda, where more of the circumcised men have HIV than the non-circumcised men, according to National Demographic and Health surveys, or New Zealand, where a large cohort study found no significant difference in STDs?
“Adolescent or adult circumcision can be associated with bleeding, haematoma or sepsis…”
So can neontatal circumcision, and with ablatio penis, ablatio glandis and death, not to mention a variety of lesser and aesthetic damage, that can still negatively impact on sexuality. (And any mistake on a baby’s penis is magnified when he grows up, like writing on a balloon before blowing it up vs after.) The big difference is that the adolescent or adult can be informed of these risks before he gives his informed consent to the removal of part of his own body.
@EricG: There have been no scientific studies, but several informal polls have found that non-circumcised men are much more likely to be happy about their condition than circumcised.
When I said “devices” I was referring to devices specifically for foreskin restoration, not penile enlargement. Some men who have been circumcised as adults (not by their own choice or for something that made their sex sub-optimal) describe the difference as “like going colour blind”. I said NOT just ‘more sensation’.” The “symphony of sensation” is perceived as being detected by the foreskin itself. No foreskin, no symphony.
“So we roll back 500 years of science and development because the Mediaeval English thought that soap and taking a bath caused scrofula and the ague?”
There have been many comments so maybe I missed this, but I have not yet seen compelling scientific evidence showing the detriments of circumcision.
As a “victim” of circumcision I question whether I want you speaking for my plight. I am extremely happy with my sexual function and the sensitivity of the various sections of my organ. Who are you to say that I am wrong? Do you have compelling evidence showing that my sexual satisfaction is far below that of uncircumcised individual?
I am quite grateful for the decision my parents had made and would not want someone taking that decision away from them without good evidence of harm (which I have yet to see rationally detailed). I have no memory of the event. If I was given the opportunity now, I would probably choose not too precisely because I would have memory and obvious pain. But seeing as I have no memory of any pain or trauma from the event I am not the least bit unhappy about it. Is there data to suggest that males have residual memory of the trauma sufferred?
Furthermore, being a gay man, and encountering several of both kinds in my travels, I will say that I like the way mine is a little bit more, but that’s just one man’s opinion.
“You vaccinate children because they need it when they’re children. You teach condom use and safe sex to teenagers because they may need it soon. You circumcise when explicit permission has been given by the adult.”
I don’t think you can compare this to vaccination at all. The potential harm of not vaccinating is certainly much higher than the potential harm caused by circumcision. Do you have any evidence to show otherwise?
Bottom line is, parents should be given all the available information, both pro and anti-circumcision and allowed to make the decision for their children. Advocacy groups can make whatever recommendation that they like, but the end result should be allowing parents to decide. That is a responsibility that the parent must bear and one that should not be taken away unless you can show evidence of substantial harm, which I have yet to see presented.
“There have been no scientific studies, but several informal polls have found that non-circumcised men are much more likely to be happy about their condition than circumcised.”
As this is a science based medicine site, I don’t think informal polls should be trusted as accurate sources of information. They wouldn’t be trusted if this was a discussion about vaccines and autism, therefore are not accurate sources of information within this debate either.
“Some men who have been circumcised as adults (not by their own choice or for something that made their sex sub-optimal) describe the difference as “like going colour blind”. I said NOT just ‘more sensation’.” The “symphony of sensation” is perceived as being detected by the foreskin itself. No foreskin, no symphony.”
How do you know its not a developmental issue? When you are born, all your neural connections are not completely developed yet. So an adult with a foreskin may have developed different sensory inputs based on the inputs recieved. However, an neonatal circumcised adult may develop the same experience but from different inputs. Therefore, the removal of the foreskin as an adult, after neural pathways are formed, could result in loss of sensation, whereas a neonatal circumsized adult retains similar sensation to a uncircumcised adult because those pathways were formed from different inputs following circumcization.
That would be a rather difficult question to answer and there has been no evidence presented either way on such a question.
As someone who has lost friends to AIDS, both men and women, I’m appalled that it would ever be used in such an irresponsible and political manner. I’m particularly appalled that an ob/gyn, who will be passing along information about sex and safe sexual conduct to girls and women, would apparently be that incredibly ignorant about AIDS and STDs. (Or unethical enough to ignore the reality of AIDS prevention simply to promote a personal bias masquerading as being about the reality of circumcision and AIDS. You are aware that uncircumcisized men die of AIDS too? And transmit it to partners? To be clear, since I don’t have a penis and I don’t think men should be determining what I do with my body as a woman, I’m neutral about circumcision of adults and wary about ANY unnecessary surgery on babies.)
The way to prevent transmission of STDs and AIDS is to practice safer sex – this means using condoms and barriers. Are you advocating people have unprotected sex and promoting the idea that as long as you’re circumcised that it’s somehow safer to have unprotected sex?
The risk of HIV is irrelevant to the discussion of whether there is compelling evidence of HARM.
Yes, every surgical procedure has a risk attached – accepted. What is the risk of having a botched circumcision? And is your claim that circumcision is wrong because you run the risk of it going wrong? Or that every circumcision is already wrong from the outset?
As for the thousands of men who greatly resent….I think that is very dependent on cultural context. I would expect that men who feel that their circumcision was unnecessary feel badly about it. It’s a consideration for parents thinking of circumcising on tenuous medical grounds. Is there any research on the effects of the promotion of ‘foreskin restoration’, either positively or negatively, on the feelings that men have about being circumcised?
What is the death rate from circumcision?
Amy Tuteur MD:
Still not true. Not even getting warmer. Circumcision was practiced in Queen Victoria “circumcision to prevent masturbation” countries. The U.K. starting declining many years ago (the 1940s) and is somewhere around 6% now. The main countries where circumcisions are done to neonates routinely are Jewish or Muslim ones- religious reasons. Besides the U.S. and Canada and Australia, this remains pretty much exclusively true.
(And I am in total agreement with Plonit about circumcision as religious ritual or cultural identity). I also think the foreskin restoration/outlaw circumcision/amputating penises people are… trying to be nice… exagerrating their case. The risks are minimal. But I also cannot understand, unless you are Jewish or Muslim or living in Uganda, wanting to circumcise your son.
See page 9 and 12.
http://whqlibdoc.who.int/publications/2007/9789241596169_eng.pdf
Annabelle:
Well, to be fair, she did give the example of Cameroon as a high circ-low HIV state. The UK, Netherlands, France, Italy etc etc etc just don’t count.
Dr. Tuteur:
Now, there is one interesting, loaded question. And not suprising from Dr. Tuteur, who once proposed that ALL pregnancies should be induced at 38 weeks to prevent stillbirths at 39 and 40 weeks, if that’s where the science will take us (implying that that is what the science will show in the next few years). I really think that people are underestimating the extremism.
Here’s what the “Pediatrics” study that Dr. Tuteur cited also concluded (for the US):
So, 100 NNT for UTI, 909 NNT for penile cancer, they can’t even make a guess for HIV/ other STDs because of the differing populations. The NNH are small, and so are the NNT.
http://pediatrics.aappublications.org/cgi/content/full/105/1/S2/246/T1
“Furthermore, being a gay man, and encountering several of both kinds in my travels, I will say that I like the way mine is a little bit more, but that’s just one man’s opinion.”
I’m glad that you didn’t mind the choice your parents made for you. Whilst you may not have seen the evidence that circumcision may be detrimental, and may I point you up a couple of posts to Annabel. Any medical procedure has risks, and the side that medicine has fallen on is that you don’t perform a medical procedure unless there is a very good reason to do it there and then. Circumcision can be left till much later, and be chosen by the person involved, with their explicit permission, before any benefits become apparent.
Also, I would like to say, also as a gay man, that I prefer dick however it comes. This isn’t an argument about aesthetics, it’s about risk – the risk of infection and scarring, consent – a decision about surgery where any possible benefits will be seen only decades into the future, and about Ms. Tuteurs belief that you can roll out a shoddy second rate medical procedure where better options already exist.
Circumcision is not a replacement for safe sex and condom use, a minor improvement in infection rates are dwarfed by condoms and safe sex. The supposed medical benefits are a rationalisation for archaic tradition and habit.
“The way to prevent transmission of STDs and AIDS is to practice safer sex – this means using condoms and barriers. Are you advocating people have unprotected sex and promoting the idea that as long as you’re circumcised that it’s somehow safer to have unprotected sex?”
I agree. I myself have not seen or heard of any study or statistic that shows being circumcised and wearing a condom is any safer or provides any increased protection than being uncircumcised and wearing a condom. Circumcision is not the least invasive or best method of reducing your chance of getting AIDS. Condoms and responsible lifestyle choices are the least invasive and most effective method of reducing HIV.
“Circumcision is not the least invasive or best method of reducing your chance of getting AIDS. Condoms and responsible lifestyle choices are the least invasive and most effective method of reducing HIV.”
This certainly sounds sensible, but it depends on where you are. People want to be twice as safe, three times as safe. If you are a monogamous heterosexual in a low-prevalence community and you spend enough time with your partner to know that they couldn’t possibly be stepping out on you, circumcision will seem completely irrelevant to you. You aren’t even using condoms!
Other people who are in high-risk communities (prostitutes; very promiscuous gay men; people who live in Swaziland — HIV/AIDS prevalence of 26%!) are often very keen on using as much protection as possible.
Condoms.
Double-bagging (two condoms). Except, oh dear, using two condoms causes the condoms to rub against eachother and increases breakages. Gah.
Ok then, condoms and microbicides. Nonoxynol-9 is a spermicide and it kills HIV in a test tube. Two for one! Lower the risk of pregnancy and the risk of HIV/AIDS at the same time! Except that nonoxynol-9 causes irritation and small tears in the vagina, actually increasing the risk of contracting an HIV infection. Double-gah!
Having sex only with girls from the country. Mmm… that might have worked in the early 80s. Not any more! And besides, that might work for you but is not so great for the country girls contracting HIV from city boys.
Having sex only with virgins. Yeah, but if everyone’s using that strategy then there are fewer and fewer virgins left, and you end up chasing little girls. No matter where you are in the world, if you have sex with a seven-year-old virgin her parents are going to be very unhappy with you. And if you’re a very promiscuous gay man, that just isn’t an option for you.
The reality is, if 26% of your friends, relatives, fellow-citizens have HIV/AIDS, you’ll be grasping at straws. If your wife or boyfriend has HIV/AIDS you’ll use condoms and be very interested in the possiblity of getting circumcized.
It’s all very well to say that people shouldn’t be very promiscuous gay men, but since when did that stop anyone? If I were a very promiscuous gay man I would certainly think about condoms + circumcison. Likewise, if I were having sons in Swaziland I would be getting me to the mohel lickety-split.
The reason that circumcision as a partial risk-reduction strategy can seem so absurd is that HIV/AIDS seems so easily avoidable in a low-prevalence world. And in a low-prevalence world, circumcision really doesn’t seem to be worth it.
I knew someone who was working in development in Mozambique in the eighties. He went back to Mozambique after two years. All the drivers who had been working for the government ministry were dead. Two years after that, the government officials he had been working with were dead or dying.
You would take a lot of risks to prevent that. Either that, or you would give up.
But if you’ve never met anyone with AIDS? The risk seems so theoretical as to be nonsensical.
“Circumcision is not a replacement for safe sex and condom use, a minor improvement in infection rates are dwarfed by condoms and safe sex.”
I don’t think it was ever claimed to be a replacement for safe sex.
“Circumcision can be left till much later, and be chosen by the person involved, with their explicit permission, before any benefits become apparent.”
But again, why can it not be left to the parents to make the decisions. Parents make many decisions for their children, decisions that are far more important and have much further reaching potential harms than circumcision. Why is it wrong to allow parents to be presented with all of the information and to then make the choice most appropriate to them?
There are many arguments being made that have little evidenciary support, especially those claiming that there is a loss of sensation in circumcised men compared to uncircumcised. I would argue that that comparison, especially one regarding experience, is difficult to make, and that adult circumcision recipients are not the correct control population for infant circumcision recipients.
“This isn’t an argument about aesthetics, it’s about risk – the risk of infection and scarring, consent – a decision about surgery where any possible benefits will be seen only decades into the future, and about Ms. Tuteurs belief that you can roll out a shoddy second rate medical procedure where better options already exist.”
I haven’t seen evidence that it is at all a “shoddy second rate medical procedure”. It does carry risk, but what is the percentage of error rate. What is the actual risk ratio for an individual?
From what I have seen on this blog, those arguing against circumcision appear to use many of the same tactics as the anti-vaccination folks and to me that definitely turns me off from keeping more of an open mind to that side of the debate. Personally, it is not something I ever give much thought to, being quite happy with my “multilation”.
“This certainly sounds sensible, but it depends on where you are. People want to be twice as safe, three times as safe. If you are a monogamous heterosexual in a low-prevalence community and you spend enough time with your partner to know that they couldn’t possibly be stepping out on you, circumcision will seem completely irrelevant to you. You aren’t even using condoms!”
Show me a study that says condom + circumcision offers a greater benefit than condom + being intact. I haven’t seen any, but I could be wrong.
Quite honestly, I can’t believe that someone whose job is meant to be caring for women’s health is promoting unsafe sex (which is what ignoring the absolute necessity of condoms and barriers in AIDS prevention, and preventing the transfer of other STDs, is doing).
This blog seems more to be about attention seeking around a hot/controversial topic and promoting a personal opinion than science-based medicine or reality-based thinking. As a woman, it makes me sad that it’s by a woman whose job it is to care for women’s sexual and reproductive health.
Archangl508 said: “But again, why can it not be left to the parents to make the decisions.”
Why should the decision about my penis be made by my parents when there is no objective need for them to make that decision for me?
Archangl508 said: “I haven’t seen evidence that it is at all a “shoddy second rate medical procedure”. It does carry risk, but what is the percentage of error rate. What is the actual risk ratio for an individual?”
Well it is a shoddy second rate medical procedure. At least the purported benefits can typically be realized in far more effective, safer, and less invasive ways. The risk is not well known because nobody has actually studied it closely. Funny for such a common procedure isn’t it? The AAP low balls the risk at about 0.2% authorities in places like England or Australia estimate about 2% or so. But for a procedure that has no point is any error acceptable?
Archangl508 said: “those arguing against circumcision appear to use many of the same tactics as the anti-vaccination folks ..”
Maybe some but not most. These two issues are distinctly different. There is a chasm of difference between them, vaccines have a purpose circumcision has little if any.
“But again, why can it not be left to the parents to make the decisions.”
It’s a medical procedure. One, that for all the conflating of circumcised adult, the phenomenon studied, and neo-natal circumcision, the completely different phenomenon advocated, in Dr Tuteur’s post, does not have to be done until at least puberty. There hasn’t been a single argument that favours neo-natal circumcision over adult circumcision. The argument is a fig leaf so that some MDs can go on happily surgically removing the foreskin of babies without feeling too guilty about it.
Neo-natal circumcision is a wholly aesthetic choice on the part of the parents and advising physician, and has the risks of any medical procedure. Aesthetic surgery performed on newborns is not good medicine.
“But again, why can it not be left to the parents to make the decisions. Parents make many decisions for their children, decisions that are far more important and have much further reaching potential harms than circumcision. Why is it wrong to allow parents to be presented with all of the information and to then make the choice most appropriate to them?”
Yes, parents make many decisions for their children. Like what to eat, where to go to school etc. But there are limitations. Children are not property. You cannot make the choice to NOT feed your children. You cannot make the choice to NOT educate your children.
Whether or not to circumcise is not a choice parents make for their children, it is a choice a parent make for their sons. Daughters are protected from this “choice” under the law. Even the most minor pin prick or incision is against the law when done to girls. This is unconstitutional. There is no evidence that shows a woman who resents her circumcision is anymore distressed than a man who resents his. The majority of women who are circumcised are happy with it, and claim the harms are grossly over exaggerated. Babies are not having sex. Why the rush? Let the owner of the penis decide if the risks are worth it or not. After the age of about 6 the child is going to be the person who deals with the majority of the cleaning and care of his penis. He is the one who is going to have to look at it every day of his adult life. I am not against circumcision. I am against infant circumcision.
Do you not agree that it is a double standard that parents can choose to circumcise their sons for any reason but can’t circumcise their daughters for any reason? You don’t have to believe or even know that a medical benefit exists to circumcise your son, the fact that you think it “looks funny” is a valid and legal reason in this country to mutilate your baby. I have spoken to women who did not know that not circumcising their babies was even an option. They were just given a consent form and asked to sign. No one explained the risks or benefits to them, it is just the norm.
Ack…”You are aware that uncircumcisized men die of AIDS too? And transmit it to partners?”
That was meant to be “circumcised men”.
The point is that trying to justify circumcision on the grounds that it’s supposed to offer some protection from AIDS and STDs is scientifically ridiculous in this day and age where everyone should be using condoms and barriers unless they’re in a committed partnership. If you’re using a condom being circumcised doesn’t offer any secondary protection – this is meant to be a science-based medicine blog and that is a very poor scientific argument for circumcision considering the reality of how to prevent the transmission of STDs.
Annabel,
“In addition, it has been hypothesized that behavioral disinhibition may counteract any protective effects of male circumcision. However, there was no consistent or substantial evidence of change in sexual behavior after circumcision in the Kenyan or Ugandan randomized controlled trials.”
What this means is that whatever these men were doing to try to keep themselves safe before they were circumcised, they kept doing it. And their infection rates dropped after they were circumcised.
If you are trying the argument that if a foreskin never contacts another human being then HIV/AIDS cannot be contracted through the foreskin, then you are absolutely correct. Very educated and vigilant people can and do maintain sexual relationships with serodiscordant partners without ever seroconverting.
But we all know that over the course of a lifetime, the likelihood of a horny foreskin never making contact with another horny person is… well, small. Condoms break. Young men get overexcited. People are jerks. You know.
It’s kind of like saying that birth control is an unnecessary consideration because all you have to do is just not have sex. Ever. Except when you’re actively trying to conceive a child. And in fact, there are people out there who are models of self-control. They don’t ever have voluntary sex.
However, not only is birth control commonly accepted as helpful, “double-Dutch” is the best birth control out there: birth control pills to prevent pregnancy + condoms to prevent transmission of STIs = very very low rate of abortions in Holland.
Just for the record, if I had a son here in Canada, today, I probably would not have him circumcised. The risk/benefit ratio is just not what it is in Uganda or Swaziland, and foreskins are the default position. I wouldn’t want to mess with it without a compelling reason.
(Then again… with peak oil, condoms might not be easily available thirty or forty years from now. If I had a son today, he might be making do in difficult circumstances very different from the ones I enjoy today. So… never say never.)
“If you’re using a condom being circumcised doesn’t offer any secondary protection – this is meant to be a science-based medicine blog and that is a very poor scientific argument for circumcision”
Actually, I’m not too bothered about circumcision per se. Circumcision of newborns just makes me annoyed.
The problems raised by using circumcision as a method of STD control are completely different. We already have better solutions, condoms are near perfect if used correctly and are available.
This is the real problem, condoms aren’t universally available and education on their correct use is next to non-existent in poor countries and close to non-existent in many developed nations.
So it’s really just a cheap solution for the ravages of STDs. One where you don’t have to raise the standard of living so the people can afford condoms, and where you don’t have to annoy those pesky fundamentalists.
And it’s that that makes me actually angry about circumcision, it’s that it’s the solution for the lazy and the penny pinching.
Like all good snake-oil salesmen, Amy Tuteur leaves out important information. For instance, she doesn’t mention that sexually transmitted infections can be prevented much more effectively by using condoms.
1) If you’re going to make a case for something then please *make a case*. You didn’t. You spoke in favour of something (largely without reference to any data).
You know that there’s more than 3 studies in favour of Homeopathy, right?
2) Your comments regarding “Infants are unable to give consent to anything. They routinely undergo medical procedures with far more risks than circumcision based solely on parental consent. Why should circumcision be viewed differently?” seem disingenuous.
You have “MD” after your name. That implies some familiarity with Medical Ethics, and the thing that the parents give consent to is typically a treatment for something that the child has contracted.
In this case, the child hasn’t contracted anything.
A secondary reason for parental consent for a medical procedure is to prevent (or reduce the risk of) something from occurring during childhood. In the cases listed above, all are to do with sex. Since children aren’t (usually) having sex, this medical procedure offers the child (as a child) no medical benefit.
Why the push to circumcise children?
Or to phrase it more polemically: why the push for an unnecessary medical procedure that will have *zero* medical benefit for the duration of the childhood?
Why aren’t you making the case to *adult men* about why *they* should be circumcised?
As an adult man, why aren’t you trying to convince *me* to get circumcised?
3) Some people (such as myself) consider mutilation to be any damaging of the human body. Yes, that includes ear piercing. Yes, that includes surgery.
In the case of surgery, the medical benefits outweigh the (short-term) damage to the body (usually).
In the case of ear piercings: no, absolutely the parents should not be entitled to turn their kids into walking advertisements for their taste in jewellery. Kids aren’t property…
Demonising people for their choice of precise (though emotive) terms doesn’t address their arguments, or the massive gaping holes in yours.
“The point is that trying to justify circumcision on the grounds that it’s supposed to offer some protection from AIDS and STDs is scientifically ridiculous in this day and age where everyone should be using condoms and barriers unless they’re in a committed partnership.”
Male latex condoms have a 15% “typical use” failure rate preventing pregnancy and a 2% “theoretical” failure rate.
Female polyurethane condoms have a 21% “typical use” failure rate preventing pregnancy and a 5% “theoretical” failure rate.
Let’s assume that the typical users of these barrier methods deserve their high failure rate, deserve unwanted pregnancies and deserve to die of AIDS. Fine. That still leaves a 2% failure rate for condoms when they are used perfectly. Enough of them break that over the course of a year of a loving, respectful relationship, 2 vigilant, careful heterosexual couples out of 100 will have unwanted pregnancies.
There are other birth control methods to double-up with and it’s generally considered sensible to use them. Condoms with spermicide. With birth control pills. With a diaphragm. Something.
There aren’t other STI-prevention methods to double-up with.
Is it not ok to want a backup plan? Even if it’s not a great one?
If the risk that you’re having sex with an HIV positive partner is low, you may not care about a backup plan. If it’s high (26% in Swaziland) or if it’s 100% (your beloved serodiscordant spouse), you will want all the backup plans you can get.
With respect to circumcision generally, the foreskin is the default position. Someone who thinks it should be removed needs to come up with facts to justify themselves.
With respect to doubling-up, intuitively it makes sense that condoms aren’t perfect and people aren’t perfect, so some form of doubling-up would be helpful. It’s documented with respect to pregnancy and there’s some evidence from Uganda and Kenya that it’s true with respect to HIV transmission as well. If you want to say it’s not true, then you need to come up with data showing that someone who wants to try protecting himself, or protecting her sons, should not try.
A mutilated penis is not good, but AIDS is much worse. Balancing a 100% probability of a somewhat-bad thing (mutilated penis) against the possibility of a terrible, horrible, no-good very-bad thing (AIDS) will always be a judgement call but needs to be informed by just how possible AIDS is. If AIDS not very probable in the first place, then why mutilate a perfectly good penis to help avoid it? If AIDS is extremely probable, then yeah, every little bit counts. Too bad, foreskin.
“However, there was no consistent or substantial evidence of change in sexual behavior after circumcision in the Kenyan or Ugandan randomized controlled trials.”
How would the researchers know this? Humans are not lab rats, we have sex in unpredictable ways. This data was gathered by self report, which is an extremely unreliable way of gathering data.
“…they kept doing it. And their infection rates dropped after they were circumcised.”
Perhaps you also know that the trials ended early, by the admission of the researchers. It is very likely that the rate of infection would have caught up to the uncircumcised group if given time to do so. Circumcision is a risk reduction, after all. It is not an immunity. A 60 percent risk reduction to a circumcised man who continues to have unprotected risky sex is minimal. Circumcision is not a vaccine, it is similar to the reduction in risk of getting the flu by washing your hands.
“But we all know that over the course of a lifetime, the likelihood of a horny foreskin never making contact with another horny person is… well, small. Condoms break. Young men get overexcited. People are jerks. You know.”
And what do you think the risks of those few times that a horny foreskin touches a horny vagina ( since circumcision has no proven benefit in protecting gay men, or protecting heterosexual men when having anal sex with a woman.. so horny person is a bit misleading) that they will get HIV? Minute. “A 1996 Wall Street Journal article on AIDS reports that the chance of contracting HIV from random unprotected sex with non-IV drug using heterosexuals is “smaller than the risk of ever being struck by lightening.” I think it’s safe to say that the risk of dying during a circumcision is greater than the risk of contracting HIV from a horny “slip up” with a non drug using heterosexual female.
“So it’s really just a cheap solution for the ravages of STDs. One where you don’t have to raise the standard of living so the people can afford condoms, and where you don’t have to annoy those pesky fundamentalists.
And it’s that that makes me actually angry about circumcision, it’s that it’s the solution for the lazy and the penny pinching.”
Makes sense to me. I’d be totally with you philosophically, except that “close to” perfect doesn’t help everyone.
However, I suspect all our standards of living, all over the world, will start to fall. Where Africa is today, the rest of the world will be, sooner or later. We’ll be penny-pinching on our own behalfs. If they are coming up with creative solutions then we had better be paying attention. We might need them.
Let’s start with the premise that the male prepuce is a normal, functional body part.
Once this basic and entirely reasonable premise is accepted, one can begin to discuss its removal from an unconsenting minor in the same ethical / potential-benefit context as removing any other healthy tissue; like an earlobe, a finger, a clitoris…
Parental choice should never extend to submitting their children to permanent surgical modification.
Why are people even talking about some dodgy African trials which were never even completed??? It’s not like circumcision is new in the West.
The Great Circumcision Experiment has been run in the West and has failed spectacularly. The US population has inflicted great harm at great cost for zero health benefit. The U.K., Canada, Australia and New Zealand abandoned this cruel and harmful custom and saw in improvement in overall health outcomes of boys.
Perhaps 100 million boys have been circumcised in the U.S. in the past century. Around 80% of the sexually active population is already circumcised. Wouldn’t it be a human tragedy if this was all for nothing?
Is it possible we are circumcising boys and seeking to justify it on the same basis as FGM is justified in other cultures? Cleanliness, health, tradition? The uncomfortable truth is that both are ancient blood rituals, except that western medicine has been turning itself inside out to find new ways to justify the practice and maintain the stream of revenue while continuing to dismiss the obvious harm caused.
Mass circumcision of boys is a most shameful chapter in modern medical history and must end immediately.
“‘A 1996 Wall Street Journal article on AIDS reports that the chance of contracting HIV from random unprotected sex with non-IV drug using heterosexuals is “smaller than the risk of ever being struck by lightening.”’ I think it’s safe to say that the risk of dying during a circumcision is greater than the risk of contracting HIV from a horny “slip up” with a non drug using heterosexual female.”
Right, if your sexual partner is a non-drug-using heterosexual female in a low-prevalence region or country and if you only slip up once.
If your sexual partner is a non-drug-using heterosexual female in Swaziland, there’s a 26% chance she’s HIV positive. And if she’s your wife, you will probably end up slipping up more than once.
That’s why the NNT in Kenya and Uganda (8% and 4% HIV prevalence respectively) is important to consider when you are trying to apply their findings to the US (0.6% HIV prevalance) or Swaziland (26% HIV prevalence).
And what if your partner is not a non-drug-using heterosexual female?
You might not think these other people — Swazis, gay men, hookers and their customers — are important, but I do.
The reason the study was ended early was that the evidence was so clear that circumcision was effective in reducing the transmission rate. They didn’t need to keep going to see that it helped.
You are correct that reducing the transmission rate is different from conferring absolute immunity. It is certainly likely that some of the men who would otherwise have seroconverted during the course of the study still seroconverted later on. But it’s false to conclude that there is no benefit to getting sick later rather than sooner. It gives you a longer useful life and it reduces the number of partners you will infect.
As Akheloios emphasises, the people we think circumcision will help protect the most are people without a lot of options.
For people who are probably at low risk, circumcision is unlikely to change that one way or another.
Personally, I am starting to quite resent the fact that the anti-circumcision folks are deciding what should have been done with my body. If I’m happy with my parent’s decision, why is that a problem? If you aren’t happy with your parent’s decision, take it up with them. Do you have any level of evidence supporting the assertion that circumcised males are unhappier than uncirmcumcised ones?
It seems to me that the evidence for medical need for circumcision is as weak as the evidence of the great harm caused by circumcision. Therefore, without strong evidence on either side, parental choice should stay within the equation. If you had some level of evidence showing that infant circumcision leads to decreased sexual pleasure, then maybe you could convince me, but until then, I resist taking away people’s rights of choice without overt evidence of harm.
“You know that there’s more than 3 studies in favour of Homeopathy, right?”
I don’t know why this was brought up, but if the anti-circumcision folks are also pro-homeopathy, I’m sorry, but that’s definitely a strike against your ability to approach subjects rationally. But I could be misunderstanding the meaning of this particular line as well.
“Right, if your sexual partner is a non-drug-using heterosexual female in a low-prevalence region or country and if you only slip up once.”
It was my impression that we were talking about neonatal circumcision in western countries, so bringing up statistics of the prevalence in Africa isn’t relevant, unless you plan on traveling to Africa and having sex with people there.
“For people who are probably at low risk, circumcision is unlikely to change that one way or another.”
We are in agreement there.
“Personally, I am starting to quite resent the fact that the anti-circumcision folks are deciding what should have been done with my body. If I’m happy with my parent’s decision, why is that a problem? ”
The fact that you are happy with your circumcision is irrelevant. You don’t speak for everyone.
If a person has foreskin and is unhappy about it, he can get circumcised. If a person is circumcised and unhappy about it, he can’t do anything. Best to err on the side of caution, since the baby is the one who will have to live with the results for the rest of his life.
“The fact that you are happy with your circumcision is irrelevant. You don’t speak for everyone. ”
Of course it is entirely relevant. You would like to take that decision away from the people who I believe looked after my best interests, namely my parents. So if I think they acted in MY best interest, why would you not trust other parent’s to act in their child’s best interests. You certainly do not get monopoly on deciding all children’s best interests. You do not get to speak for everyone either.
“If a person has foreskin and is unhappy about it, he can get circumcised.”
What if I would have wanted to event to happen as an infant and to not remember it? Now you have taken that potential decision away from my parents. What if infant circumcisions provide greater sexual pleasure than adult circumcision or even than uncircumcised individuals. You have no evidence in either direction, yet you want to remove the choice from parents, based on an emotional response, certainly not hard data.
“Best to err on the side of caution, since the baby is the one who will have to live with the results for the rest of his life.”
Best to let parents make their own informed choices for their children. You have still not presented significant evidence of the overwhelming harm caused.
“Yes, parents make many decisions for their children. Like what to eat, where to go to school etc. But there are limitations. Children are not property. You cannot make the choice to NOT feed your children. You cannot make the choice to NOT educate your children.”
No, but you can make a choice what to feed your children, how to educate them, how to discipline them, or what religion they should grow up with. I would argue that all of those decisions will have farther reaching effects than circumcision and can certainly be far more detrimental to a child’s life. Will you choose to legally regulate those decisions as well?
I am not saying there should be mandatory circumcision, nor even that it should be considered medically necessary. I simply think that you have not presented sufficient evidence showing that this procedure causes a huge amount of harm to the male population. I think parents should be given appropriate information from both sides of the issue and allowed to make their own choice for their child. You should not make that decision for them anymore than some right-winger should decide to take the abortion decision away from a mother.
Archangl508 said, “Personally, I am starting to quite resent the fact that the anti-circumcision folks are deciding what should have been done with my body.”
That’s not a “fact”, and obviously you are posing the question from feelings of frustration. We’re not trying to frustrate anyone from having the body they want, but neither can we give it to you. We simply don’t do body modification on children, other than trying to provide good nutrition to help them grow to their potential.
The prima facie evidence of harm is the cutting off and disposal of sexual tissue. No other proof is needed, but think about what it is you are trying to accomplish if, by chance, a man’s circumcision actually improved sex for him. Were you trying to create a sex zombie? Did you really want a sex addict on the loose? What exactly are you trying to accomplish?
No, your frustrations cannot be solved by other people, and we cannot allow you to frustrate others at reaching their sexual potential, or to even try to enhance their sexual potential. We don’t do that to children.
Archangl508:
Wow! Is this akin to some kind of Stockholm syndrome?
It is your prerogative if you think post facto that your parents did everything best for you. Good for you. But the point in question is not your feelings, nor a medical decision taken to preserve your life or well-being. The question is about the validity of neonatal circumcision, and if, later in life, you do happen to question the decision to have it done as an infant, all your parents can say is “Oops!” – and the foreskin ain’t coming back or regrowing.
Annabel,
“It was my impression that we were talking about neonatal circumcision in western countries, so bringing up statistics of the prevalence in Africa isn’t relevant, unless you plan on traveling to Africa and having sex with people there.”
It’s not at all clear what we’re talking about! Amy cited research on adult circumcision in Uganda and Kenya to assert that the AAP should change their recommendation on routine neonatal circumcision in the US. (This is quite a stretch, and many of us asked Amy to elaborate on that thought process.)
Since the AAP’s current recommendation is that parents should be educated about the risks and benefits of circumcision and then make their own decisions, the only conclusion to be drawn was that Amy wanted the AAP to switch to recommending routine neonatal circumcision of US infants to reduce the risk of HIV transmission. However, in the comments she appears to claim that she never wanted the AAP to change their recommendations and she states that she does not favour routine neonatal circumcision. She now says in the comments that the only point that she ever wanted to make is that circumcision can be of benefit some times to some people in some circumstances – in Africa and possibly elsewhere, though we don’t know enough to be sure. This is in fact consistent with the evidence.
How often “some times to some people in some circumstances” applies in the US, where the AAP makes recommendations, we are trying to get Amy to help us with. She appears to believe it does apply but isn’t giving a full answer on why she believes that.
I am sceptical that it applies to most groups in the US, but it probably could be important for some people there. How parents and doctors could take that into account could be an interesting Science Based Medicine discussion but Amy doesn’t want to talk about it; she seems to just want to say that the usefulness is different from 0 and then walk away.
So we have been talking a lot about Africa as well as the rest of the world. When you say that “condoms are enough” without qualifying by saying “condoms are usually enough for straight non-drug-using people in the US” it’s not clear that you accept that having a Plan B might be useful for people who are not straight non-drug-using-people in the US.
And since you asked, yes, I have travelled to Africa and had sex with Africans when I was there. With a condom.
So what. If in later life an uncircumcised man happens to question the decision not to circumcise as a neonate (when complications are lower, and he would have no memory of the event), all his parents can say is “Oops!” – and you can’t turn back to the clock to the neonatal period. Circumcising in adulthood is possible but not the same as having been circumcised as a neonate (especially if the ritual to which circumcision is connected is an initiation of newborns).
Obviously, the parents have to consider the likelihood of those two events (“Oops, you’re foreskin is gone” and “Oops, we have deprived you of the possibility of neonatal circumcision”) and the default is that the foreskin exists, so if unsure it makes sense to keep it. On the other hand, there are communities where the latter Oops is overwhelmingly more likely than the former.
Amy Tuteur hasn’t explained yet why performing the procedure on infants and not letting the child decide what he wants to do with his penis when he is old enough.
Ahem!
That’s it. This thread is now officially out of the purview of the AAP!
[Just kidding!]
@Plonit: Just tell me why – WHY is neonatal circumcision necessary in your opinion? Why is it that you are so tenaciously defending this practice?
Also, where did you get the idea that complications in neonatal circumcision are lower, and there is no memory of the pain?
The pro circumcision lobby perfectly knos that if the decision was left to the child when he’s old enough, this useless procedure would dissapear very quickly.
The very idea that someone would be “considering circumcision” is proof that it is a complex decision for an adult to make ABOUT HIS OWN GENITALS !!
I find myself comparing the more emphatic arguments against neonatal circumcision with arguments against childhood Hepititis B and HPV vaccines. In each case, an opponent might argue that an invasive intervention in a child for prevention (and public health) is not justified because perfectly effective alternatives exist in the future adult (condoms, monogamy).
I am certainly not suggesting that circumcision is equivalent to or as compelling as vaccination. Personally, I am unconvinced about neonatal circumcision. This comment is just a reflection on a surprising rhetorical similarity.
For Jews and some variety of Muslims, circumcision is a ritual that should be performed on Day 8. It follows that simply saying “The boy can make the decision when he is an adult” doesn’t work, because no one can make the decision to do something in the past (i.e. no time travel to go back and have circumcision as part of the traditional ritual).
I don’t ‘tenaciously defend’ this practice, I simply say that prohibition (which requires the criminalisation of entire communities) should be based on clear evidence of harm. Obviously, if people within those communities want to change their ritual practice that is fine – but I don’t think there should be legal compulsion to do so, unless there is compelling evidence of harm.
I said “no memory of the event”, not “no memory of pain”. Pain can be ameliorated by local anaesthetic during the procedure and appropriate analgesia post-operatively if required. There is no reason that adequate pain relief cannot be legally mandated if legislatures require it. Bam, there goes that argument.
By “no memory of the event” I mean that people don’t have direct memories of events that occur in the neonatal period. Doesn’t mean those events don’t have effects, but they don’t create memories. But show me the evidence of harmful effects, okay?
The rate of complications for neonatal circumcision (0.2-0.4%) is lower than for adults (2%) – by a factor of 5-10. (UNAIDS, 2007). The muslim circumciser responding to the Royal College of Paediatrics and Child Health comments on the differences between performing neonatal and adolescent circumcision in community-setting, stating that neonatal circumcision has lower rates of complications. Mohels who are also doctors and audit their practice demonstrate very low rates of complications.
Am I imagining things, or has David Gorski deleted his commented in which he disavowed responsibility for Dr Tuteur being a contributor to SBM, and passed the buck to the “SBM team”?
Am I imagining things, or has David Gorski deleted his commented in which he disavowed responsibility for Dr Tuteur being a contributor to SBM, and passed the buck to the “SBM team”?
I’ve read the comments twice today and have seen no such comment (but with 274, could have missed it). Weird…
@Archangl508: “What if I would have wanted to event to happen as an infant and to not remember it?”
Isn’t that rather like wishing to have been born into a rich family? One of the first and hardest lessons of life is that we can’t change the past.
The number of intact men who want to be circumcised is miniscule, especially in societies where it is not customary and convention/conformity is not a reason. So the default supposition is that he will not want to be circumcised as an adult, and his chances of happiness are maximised by leaving his genitals alone. (It’s hardly radical to want nothing to be done.)
“Is there data to suggest that males have residual memory of the trauma sufferred?” Yes, Taddio A, Goldbach M, Ipp M, Stevens B, Koren G. Effect of neonatal circumcision on pain responses during vaccination in boys.
Lancet 1995; 345: 291-2. – found that circumcised babies reacted more strongly to the pain of being vaccinated than intact ones, months after their circumcisions.
“When you are born, all your neural connections are not completely developed yet. So an adult with a foreskin may have developed different sensory inputs based on the inputs recieved. However, an neonatal circumcised adult may develop the same experience but from different inputs. Therefore, the removal of the foreskin as an adult, after neural pathways are formed, could result in loss of sensation, whereas a neonatal circumsized adult retains similar sensation to a uncircumcised adult because those pathways were formed from different inputs following circumcization.”
There are ~20,000 highly sensitive, specialised Meissner corpuscles (similar to those in the fingertips and lips) in the foreskin, concentrated in a ridged band that encircles the tip on the inside. They are much more sparse in the glans. Circumcised men generally report that their frenulum remnant under the glans is their most sensitive part. That is all that is left of their ridged band.
It may well be that, after circumcision, nerve endings from the glans and frenulum-remnant invade the part of the brain that has been “waiting in vain” for signals from the foreskin. (Experiments involving [I'm sorry to say] half-blinding kittens have found something equivalent in the optic area.) Thus it is that circumcised men report that their glandes are erogenous while intact men do not.
But it is hard to escape the conclusion that the quality of the sensation, lacking nerves (and a rolling, gliding structure) evolutionarilly “designed” to confer it, must be diminished rather than enhanced. This was the anecdotal consensus for centuries before non-ritual circumcision was customary. (See http://www.circumstitions.com/Pleasure.html and http://www.circumstitions.com/Sexuality.html) It is only in the last century that a curtain of silence has fallen on the subject.
Without resorting to “Nature knows best” (Evolution is a great kludger) to demand scientific evidence that cutting part of the body off does not diminish the function of that part borders on the perverse.
Plonit “Am I imagining things, or has David Gorski deleted his commented in which he disavowed responsibility for Dr Tuteur being a contributor to SBM, and passed the buck to the “SBM team”?”
Zoe “I’ve read the comments twice today and have seen no such comment (but with 274, could have missed it). Weird…”
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Well, I’m sure he responded to my comment on his sanctioning her presence here by saying that his remit as editor extended only to organizing guest posts, planning posting schedule and stuff like that, but that permanent contributors were a decision of the ‘group’. I paraphrase, but it is certainly weird to have read something along those lines and then see it disappear. Perhaps my mind is playing tricks on me.
the default supposition is that he will not want to be circumcised as an adult
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Unless he is part of a culture in which it is customary, surely?
Circumcision is medical fraud :
http://med-fraud.org/
“the default supposition is that he will not want to be circumcised as an adult”
So if an adult will not want to be circumcised, how is ethical to perform this procedure on infants ??
I don’t think David Gorski said anything himself. If he did, it was up so briefly that I missed it.
Plonit on 07 Jan 2010 at 5:20 pm
“Surely this is within your remit, as managing editor of this site?”
The only response I ever saw to that was:
Kausik Datta on 07 Jan 2010 at 6:19 pm
@Plonit:
“Surely this is within your remit, as managing editor of this site?
“In the same vein, all the authors of this SBM blog are responsible for determining the accuracy and veracity of what they post, and any reaction their post generates are to be handled by them, too. It is not David’s function – even as managing editor of the site – to censor or sanction posts. He would rather – heck, I’d rather he did – encourage a debate based on the scientific merit of the post, and argue points of evidence – which he did and does adequately.”
If memory serves Gorski posted in response following my comment responding to Kausik Datta on 07 Jan 2010 at 6:32 pm. Is curious though – maybe my memory is faulty?
Plonit – maybe. Maybe mine is.
Archangl508 said: “Personally, I am starting to quite resent the fact that the anti-circumcision folks are deciding what should have been done with my body. If I’m happy with my parent’s decision, why is that a problem? If you aren’t happy with your parent’s decision, take it up with them.”
And I resent the fact that my parents should be permitted to make a decision on a personal part of my body with no objective need to back up that right. It’s a decision largely based on their subjective whim and nothing more. Taking it up with them does not right the wrong. Though I agree that those who are unhappy should tell their parents; one of the myths that keeps neonatal circumcision alive is that no one could resent it. As others have said, if you were not circumcised and want it done good for you. Like a piercing or a tattoo nobody is going to stop you but the guy on the other side of the coin can do practically nothing about it.
The medical ethicist Margaret Summerville on this issue noted that (and I am paraphrasing) if the case for and against circumcision are evenly balanced, and that is the most favorable position for circumcision, then as an ethical matter the operator (Doctor) cannot proceed. Parents can still be free to want circumcision and even try and seek it out but, especially in the west doctors are not acting in the interest of children or ethics of their profession by performing it.
Margaret Summerville has also had some interesting things to say about the distinction between medically and religiously-motivated circumcision
“the people opposing a practice based on religious beliefs should have to justify any interference with this practice. Therefore, when infant male circumcision is carried out as an absolute religious obligation, the burden of proof, which is usually on those carrying out infant male circumcision to show that the surgical procedure is justified, would shift to those opposing it to show that it should be prohibited.”
Presumably a doctor may also be under a religious obligation to assist members of his or her community to fulfil their religious obligations?
“Margaret Summerville has also had some interesting things to say about the distinction between medically and religiously-motivated circumcision”
There isn’t that much difference between medically and religiously-motivated circumcision.
For a lot of people now, science and medicine are the “new religion”. Circumcision is a ritual act that became a medicalized procedure. The hypothesis (which was based on nothing) that circumcision decreases HIV came from a Jewish doctor.
“If memory serves Gorski posted in response following my comment responding to Kausik Datta on 07 Jan 2010 at 6:32 pm. Is curious though – maybe my memory is faulty?”
Well, he hasn’t denied it, but neither has anybody else confirmed seeing the post. So who knows.
“The hypothesis (which was based on nothing) that circumcision decreases HIV came from a Jewish doctor.”
I wondered how long the anti-semitic strain of anti-circumcision could hold back.
Can we end the thread here? Or do we actually have to wait until someone says that doctors are worse than Nazis to call Godwin?
“And I resent the fact that my parents should be permitted to make a decision on a personal part of my body with no objective need to back up that right. It’s a decision largely based on their subjective whim and nothing more. ”
I was incorrect in my writing my above statment. I allowed emotion to cloud my wording quite a bit, as have many others responding to this posting. I am human. Mea culpa.
However, you are advocating the removal of parental choice, I assume by legislation. Anytime freedom of choice is altered by legislation, in my mind, that is something that requires significant amount of evidence on one side to achieve. As a pro-choice individual myself, I certainly am always hesitant to remove choice from any individual. I would be interested to know where people think this lies on the priority list of important decisions made by parents for their children. I would argue that there are many decisions that parents make that have far more consequences on a child’s existence, compared with a child’s education, affection, or nutrition. Unless circumcision is at the top of the list, should we not also consider legislation of removing choice of those other parental decisions as well. So far, I have yet to see compelling evidence to drive legislation for the removal of parental choice for circumcision is justified.
I will agree that I have seen evidence to claim that this is not a medically necessary procedure, possibly even more than the evidence that claims it is a medically necessary procedure. But one can hardly claim that it is a simple issue with an easy answer, as there is evidence on both sides, that while maybe not equivalent, is certainly similar and not a slam dunk like mandatory vaccination. It is not a purely scientific claim, but also has cultural and relgious significance as well. Hence why parental choice should be allowed. If you provide evidence showing a large proportion of neonatal circumcised men are unhappy about their plight, then I will certainly change my tune. And if it is a small proportion of circumcised men who are unhappy, then I think that information should be provided to the parents are making the choice in order for them to understand the likelyhood that their child is unhappy. By doing that, you would reduce circumcision over time, fading it away to the point where it is virtually non-existent.
“There isn’t that much difference between medically and religiously-motivated circumcision.”
In your mind. To a religiously minded individual there may be a world of difference. If Ms. Summerville’s ethical knowledge and considerations are to be taken in account against medical circumcision, then they must also be taken into account for religious circumcision. You don’t get to pick and choose the ideas of an ethicist to support you claims.
Plonit -
I do recall Dr. Summerville discussing the complication of the religious issue but don’t remember those exact words. Was that taken from the Ethical Canary?
I’ll be honest I don’t support the religious reason either because I find that would be hypocritical, to support religious circumcision and not circumcision for any other whim of the parent. To me that would be strong grounds for a equal protection suit.
In fact, I feel that the current situation, total prohibition of FGM in any form while permitting circumcision already is either an equal protection violation or (in the US) a title 6 violation. Depending on who is filing the complaint.
Things are moving so fast, I think my request was lost in the shuffle.
.as this is called “science-based medicine”.
Could someone please provide me a single SCIENTIFICALLY credible benefits for circumcision–where it meets the requirements for SCIENTIFIC credibility–not just “medical credibility”..since the two are definitely not equivalent?
Since we have now reached parental choice, there are some important questions that must be asked and answered..
WHY SHOULD a parent be allowed to make an unnecessary, proven harmful, and proven risk-laden procedure choice for an infant?
WHY should the parents” choice supersede the choice of the owner of the penis?
Happiness of the victim is immaterial, since there is objective evidence of harm–that is what is paramount.
What it all comes down to is can anyone provide a RATIONAL ethical justification for infant circumcision?–this is the ultimate ethical question that demands to be answered.
Archangl508 said: “However, you are advocating the removal of parental choice, I assume by legislation.”
I would phrase it more like I advocate ensuring that the choice is given to the only one who at this time can evaluate the subjective value of circumcision to themselves. By allowing parents to make that choice in the individuals place you are taking that away from the only one whose opinion matters on this issue. If there are objective clinical needs the matter changes but there are not.
It’s true that parents make many other decisions but it seems to me that by and large these are decisions made because the parents need to meet the objective needs of their child and it is typically a time critical decision. The child must be fed and educated to name a few. Whether the parents made good or bad choices is one thing but the point is that a choice had to be made. That is where it differs.
Joep, this will be my last posting as I actually should be doing work, but thank you for making me consider issues I normally would not. You don’t have a convert, but you have convinced me that there is a valid debate, one worth considering the other side of the issue.
“I would phrase it more like I advocate ensuring that the choice is given to the only one who at this time can evaluate the subjective value of circumcision to themselves. ”
But in reality, you are advocating the legislative removal of parental choice. Having just read the Wikipedia entry on this subject there appear to be bioethicist articles written upon both sides of the issue, so it is hard for me to consider this a settled ethical conclusion. And again, I am hesitant, to remove any level of choice legislatively without clearly settled evidence or ethics.
There is, also, some evidence of potential medical benefits. It is not overall strong and should not be acceptable for mandating circumcision or even for allowing doctors to recommend it. However, it seems to me to be sufficient to allow parents to make the choice themselves when given all of the information including the risks of the procedure, the potential for future resentment, and any other potential harm or benefits from the procedure.
I think you can’t make the argument for waiting til adulthood for the child to make the choice unless you can show that there are no advantages to neonatal circumcision versus adult circumcision. In my mind there are potential advantages including no memory of the event including no memory of pain.
“It’s true that parents make many other decisions but it seems to me that by and large these are decisions made because the parents need to meet the objective needs of their child and it is typically a time critical decision.”
But are there decisions made, not in the objective needs of a child, that could potentially be more damaging or have a greater effect on the child than circumcision? If the answer is yes, then we must also consider legislating those parental choices as well.
Bottom line is, although there is evidence to suggest the procedure is not medically necessary (although there is some as well suggesting the converse). In my opinion, I have yet to see enough evidence of harm to advocate the removal of parental choice from the equation. If such evidence becomes available, then I will certainly change my mind.
“Bottom line is, although there is evidence to suggest the procedure is not medically necessary (although there is some as well suggesting the converse). In my opinion, I have yet to see enough evidence of harm to advocate the removal of parental choice from the equation. If such evidence becomes available, then I will certainly change my mind.”
Sure there is evidence, but simply having evidence does not convey credibility on that evidence. None of the evidence of benefits fulfills the SCIENTIFIC requirements of being without known flaws and fulfilling its predictions.
As for proof of harm, I suggest you read the Taylor and Sorrels papers PROVING the loss of up to 3/5 of the sensation and sensitivity.
There are many studies linking circumcision to erectile dysfunction or impairment.
As for PROVEN unnecessary risks, you might do some research.
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
And these do not even include the documented deaths from circumcision.
I have to wonder just HOW MUCH proven harm and risk would it take to compel you to accept that parents should not have the right to force this unnecessary harm onto infants.
Archangl508 thanks for the careful consideration. I too should be paying attention to other things but I am sure this conversation will continue; perhaps when it’s more convenient you will continue to contribute. I do enjoy the discussion when the points are well thought out and rational. I’ll say I don’t expect nor endeavor to convince someone (such as yourself) to be unhappy if they were circumcised. Nor do I expect to move anyone’s needle fully to prohibition.
Several months ago I had a similar conversation with an individual that went on for more than a month. He started out supportive of circumcision for a potential son but when he really looked at the issue said he wouldn’t do it but at the same time couldn’t support a prohibition for many of the reasons you cite. That’s good enough for me. My only intent is to get individuals to really think about something they may not have given any thought about before so at least in your case I succeeded.
I don’t see it as taking away a choice from someone but preserving that choice for the only one who can really make it. I also don’t deny that there may be potential benefits but whether or not the potential benefits cited are sufficient to justify an irreversible, non-indicated, intervention can only be adequately evaluated against the associated risks of surgery using the subjective preferences of the individual affected by the circumcision. This includes any concern of pain which can be adequately managed in an adult. I had all four of my third molars removed at 18 and though one might suggest that would be a very painful event, I don’t recall it as such. In my case the intervention was clearly necessary and there for any transient pain that there might have been becomes part of my personal evaluation. There are also benefits to performing this as an adult such as better cosmetic result (if that’s what you’re looking for) and although minor complications (such as bleeding) might occur more frequently I suspect major complications are much rarer in adults. It’s more difficult to accidently sever the entire penis or part of the glands; I’ve also never heard of an adult dieing either though these are complications that occur in infants and children. They occasionally make the news. And to me, any amount of complications when there is no objective reason and no informed consent of the individual is too many.
While I don’t necessary discount the possibility of benefit to some people in some situations neither the author of this post nor the original paper seem to meet the burden to make this an ethical choice, such as a vaccination. As I’ve pointed out previously it is very interesting that all other western agencies that have examined this issue have not seen fit to in any way adjust their recommendations for their local populations which in most cases are far more critical of circumcision than the US. Basically, they recognize the context and ethics something both the article and the post here misses completely.
@joep
“He started out supportive of circumcision for a potential son but when he really looked at the issue said he wouldn’t do it but at the same time couldn’t support a prohibition for many of the reasons you cite. That’s good enough for me.”
If that’s what you are after — that parents be educated and thoughtful — that is consistent with the current AAP recommendations. Neither you nor the AAP seek a prohibition; neither you nor the AAP recommend routine neonatal circumcision.
@ Alison
I do seek prohibition I would like to see the 1998 FGM bill be gender neutural. But from a practical perspective I realize that the social situation as it stands will be unlikely to support that.
What is good enough for me is that in that environment I can move individuals to a position that questions the practice or better yet to say you’re right I won’t impose that on my son yet at the same time I can’t fully support prohibition. I do realize that is perhaps as far as most are willing to go.
Zoe,
I don’t specifically know about Uganda, but many African cultures circumcise (or used to) as a coming of age ceremony…Until of course, colonization.
Now they are being told to do it again.
In this case, I see the benefits of circumcision for a young man (not a neonate) as well as the community in a multiplicity of ways.
I also wonder about the difference in HIV I and HIV II transmission differences.
I think it’s also important to note that the vast majority of intact adult men don’t choose circumcision for themselves, even in the United States. I can’t find the link, but it was around 1 in 250 intact men ever need or want circumcision for themselves in the US, and the number is much lower in countries where circumcision is less common( if someone knows the link, I would appreciate it!). Even though the number is higher in the US than other countries, 1 in 250 is still a great minority of men. So is it ethical to perform a surgery that, statistically speaking, a boy most likely wouldn’t choose for himself given the choice?
I understand that many parents feel that their rights are at stake on this issue. But children have rights, too. Their rights don’t come into effect once they are old enough to talk, they have rights the moment they are born, and the same rights as little girls. Why do I never hear an American parent lament the fact that their right to circumcise their daughter is taken away from them as well? Why do they so want the right to circumcise their son but not their daughter? Here is what the WHO says about FGM :
“FGM is recognized internationally as a violation of the human rights of girls and women. It is nearly always carried out on minors and is a violation of the rights of children. The practice also violates a person’s rights to health, security and physical integrity, the right to be free from torture and cruel, inhuman or degrading treatment, and the right to life when the procedure results in death.”
They then go on to list the different forms of FGM, a lot of which are understandably more severe than male circumcision. But not all. Here is what type four of FGM reads on the WHO website:
4) Other: all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area.
If girls are have the right to physical integrity shouldn’t boys have the same rights?
Hmmmm…. Adult males asking for circumcision. In my 40+ years in healthcare, I’ve only encountered maybe a half dozen cases. Interesting reasons, some clinical and some sociological:
- Girlfriend requested – they liked circumcized penis better (a couple of them)
- An Indian (from India) who thought American girls like the circumcised penis more
- Circ done to remove significant HPV warts
- A phimosis correction
If girls are have the right to physical integrity shouldn’t boys have the same rights?
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It’s a good question.
I expect the explanation lies in the fact that at the time of description and legislation FGM was regarded as a continuum of practice ranging from pricking/incising through to the complete removal of clitoris and labia with infibulation. Law-makers would have found it difficult to proscribe some practices and not others, for fear of creating a range of legal defenses for more extreme practices. As I said upthread “if you allow Type Ia, then you can going to see a lot of intentionally ‘botched’ procedures to get around the law, especially given that Type Ia has always accounted for a small percentage of procedures amongst a much more damaging continuum.”
Contrast this with male circumcision. With the exception of castration (not practised today, AFAIK) there is no continuum of male genital surgery. Or rather the continuum involves removing more or less of the foreskin, making all male circumcisions equivalent to Type Ia. If the practice of penectomy (structurally equivalent to Type Ib FGM) or removal of the penis and scrotum (structurally equivalent to Types II & III FGM) were current and widespread, then I could imagine that removal of the male foreskin might similarly be outlawed, as a by-product of the campaign to erradicate the more extreme practices.
The different treatment of male and female prepuce in terms of legal protection may be more a consequence of this difference in context (i.e. existence of Type Ib, II & III FGM, for which there is no current analogous practice in men) rather than intentionally unequal treatment. Indeed, had all FGM been of the Type Ia variety, I find it hard to believe that it would ever have been outlawed.
“I expect the explanation lies in the fact that at the time of description and legislation FGM was regarded as a continuum of practice ranging from pricking/incising through to the complete removal of clitoris and labia with infibulation.”
I have to disagree with some of your statements. There was a case in the United States where a Somalian family wanted just a ceremonial prick done to their daughter, and it was deemed illegal to do so. (http://www.law.duke.edu/shell/cite.pl?47+Duke+L.+J.+717)
I doubt many would argue that a small needle prick is less dangerous and causes less psychological harm than complete removal of foreskin. A pin prick most likely wouldn’t leave any long term scars or physical markings. I also don’t really see how a pin prick performed by a competent surgeon could result in the accidental removal of the clitoris. Removal of the clitoris would require some sort of scalpel incision. Sure, I can accept that there is an extremely miniscule chance that the pin prick could get infected resulting in the loss of other structures, including the clitoris. I would argue that the chance of that happening is at least as likely and probably smaller than the chance of a penis getting amputated during a routine circumcision. Why is the risk of a clitoris getting amputated unacceptable but the risk of a penis getting amputated acceptable? When parents of females want to have the surgery done on their daughters for many of the same reason parents want the surgery done to their sons? Why the double standard?
I was speculating as to the intent of legislators, that is to say – they wanted to avoid a legal loophole, given the existence of more damaging forms of FGM. In discussing intentional ‘botching’ I was not referring to the risk of complications/errors, but to the risk of creating a legal loophole in which practitioners can deliberately perform Type Ib FGM, while claiming to have intended Type Ia.
I don’t know the ins and outs of legal discussions having to do with the framing of anti-FGM legislation, but the existence of more serious varieties of FGM would seem to be at least part of the answer to your question about double standards.
“In discussing intentional ‘botching’ I was not referring to the risk of complications/errors, but to the risk of creating a legal loophole in which practitioners can deliberately perform Type Ib FGM, while claiming to have intended Type Ia.”
I don’t think there is any evidence to this claim. If you are talking about doctors intentionally botching female circumcision, I don’t think that is very plausible. The legal ramifications for such a thing would be astronomical, just as they would be for intentionally botching a male circumcision, and would not be worth it. It would be very hard for a doctor to explain how a pin prick to the labia resulted in an accidental removal of the clitoris. You would almost have to literally stab it until it was no longer functional.
If you mean parents accidently botching a female circumcision, that already happens. Parents that want their daughter circumcised often resort to family members or local elders, and even fly to their home countries where the risk of complication is significantly higher. If anything, making it legal would be safer for girls from those countries living in the United States. Much like the argument that making abortion illegal would just make abortions more dangerous, as people would always find a way if they want it bad enough.
“He started out supportive of circumcision for a potential son but when he really looked at the issue said he wouldn’t do it but at the same time couldn’t support a prohibition for many of the reasons you cite. ”
That would be the place where I am. If I were to have a child I think I would carefully consider the various information and make the best choice for the child. But I would still want to have that choice to make. If the available information were to swing much farther towards the “harm” side of the issue, then I would join you in favor of prohibition of the practice.
I also thank you for giving me something to think about and your reasoned responses. It was good to see that within a discussion that had previously seen much inflammatory, emotional language (that I was also guilty of; i.e. multilation/victim/etc.). That sort of discussion and use of rhetoric does nothing to help either side of the debate. All that does is inflame passions and shut down reasonable thinking.
I wish you luck in finding better information to more securely prove your case and at that time I would be happy to support your position.
Annabel,
Just going waaay back to one of the numbers you presented.
“Here are some numbers. The risk of a man contracting HIV from a woman, which is the only HIV route circumcision has proven to reduce risk, is .04% or .0004 in the United States. One in every 2,500 sexual acts. Exactly how many men do you think are going to be having sex 2,500 times before the age of 18 when they can make an educated decision for themselves about whether or not the risk reduction is worth it? Even the most conservative risk complication rate of circumcision is WELL above .0004.”
If the chance of of a man’s contracting HIV during a a single, random encounter with a non-injection-drug-using woman is 0.04%, then after 2,500 encounters there’s a 63% percent chance he will have become HIV+.
After 1,250 encounters the chance is 39%.
625 encounters: 22%.
26 encounters: 1%.
But wait! The rate of 0.04% is for a combination of circumcised and uncircumcised men. Circumcision seems to reduce transmission by about 56%, and 75% of American men are circumcised. The rate should be about 0.03% for circumcised men and .07% for uncircumcised men.
A circumcised man would have a 1% chance of contracting HIV after 33 random unprotected encounters with a low-risk woman.
An uncircumcised man would reach a 1% risk after just 15 random unprotected encounters.
There are many, many young men out there who will have had unprotected sex 15 times before their 18th birthdays. Is a 1% chance low enough?
Remember, we are talking about 15 unprotected encounters with low-risk women in the US. We are not talking about high-risk partners or high-prevalence regions, and I’m working with your numbers.
The theoretical, perfect-use level of protection condoms offer against pregnancy is 98% over the course of a year. If a couple are having sex twice a week, that’s 13 acts of intercourse that could have resulted in pregnancy. Working backwards, a perfectly-used condom seems to fail 0.16% of the time.
At that rate, using a condom perfectly during sex with a low-risk female partner will result in 1% of diligent circumcised men seroconverting after 21,500 random encounters; a diligent uncircumcised man would not have to work quite as hard, reaching a 1% risk of seroconversion after 9,200 encounters. That still requires sex twice a week for 88 years, so that’s probably good enough.
Real-world, typical-use failure rates of condoms are higher, however: 15% by the end of a year. So in the real world, at this rate 1% of ordinarily imperfect circumcised men would seroconvert after 2,700 random encounters; an ordinarily imperfect uncircumcised man would reach a 1% risk of seroconversion after 1,150 encounters — 11 years of sex twice a week. (Agreed, very few teenagers will reach 1,150 encounters by the time they are 18, but it’s not impossible.)
Again, this math applies to low-risk partners in a low-prevalence region.
These numbers are based on various assumptions, and they are all calculations. If they are accurate, it’s just by chance. The point is that if you aren’t familiar with probability they can work out to something quite different from what your intuition tells you. An average 0.04% chance of seroconverting after a single unprotected encounter sounds pretty safe. Most people would never think that’s equivalent to a 1% chance of seroconverting after 15 unprotected encounters if you’re uncircumcised. If a parent understands this, it is likely to shape their decision-making.
There are men who remember being frisky and irresponsible teenagers and who think it’s likely their infant son will grow up to be a frisky and irresponsible teen too. Sure, you can lecture your kids about condom use. But there are parents who would be a lot more comfortable with the notion of their son having 33 unprotected encounters versus 15, before reaching a theoretical risk of 1%.
You might not think it’s worth it, or fair, or ethical. But 15 unprotected encounters is not that many. And it would be unreasonable to forbid parents to take that into consideration.
Yes, it would be much better if everyone were a perfect condom user; it would be best of all if young men never had sex before their eighteenth birthdays; and we would avoid the entire ethical dilemma if there were no reason to think that circumcision reduces transmission rates. But they aren’t, they do, and there is, at least for now.
“If the chance of of a man’s contracting HIV during a a single, random encounter with a non-injection-drug-using woman is 0.04%, then after 2,500 encounters there’s a 63% percent chance he will have become HIV+.”
You have misunderstood the study. Here is a paragraph from the study :
“Pooling the data from studies in high-income countries, the researchers calculated that the risk of transmission from an HIV-positive man to his female partner was 0.08% per sexual act: in other words, it was likely to occur once every 1250 sexual acts. When it was the female partner who was HIV-positive, the male partner’s risk of acquiring HIV was 0.04% per sexual act – in other words, once every 2500 sexual acts.”
I really don’t know how you get numbers like “After 1,250 encounters the chance is 39%.”
That is an astronomical number. There isn’t any data from the CDC or WHO that shows a man has a 39 percent chance of getting HIV after 2500 sexual acts. Or that he has a 1 percent chance of contracting HIV after 26 sexual acts. Could you please provide the math or statistics that lead to this number?
C’mon folks, can we have a little logic here..
People who are trying to use the threat of HIV to promote circumcision, need to provide the following:
Scientifically credible studies showing circumcision reduces HIV that have no KNOWN flaws.
The prediction of reducing circumcision reducing fails to manifest itself every time?
THESE are the crucial points that determine if a theory is scientifically credible and/or valid.
Now all studies have many and fatal flaws,
The real world stats show that this reduction does not always exist…in fact in many cases, the exact opposite.
Now, since this supposedly a science-based discussion, we need to actually discuss the scientific aspects–merely repeating over and over the results of flawed studies hardly advances this discussion.
Here is a link that actually looks at the scientific basis..so until and if people actually read and debate the critical points here, all we have is a lot of flooby dust being tossed into the air.
http://mysite.verizon.net/dortfay/science.html
So, can we expect this to be a science-based discussion or the back and forth of bogus and/or questionable science and invalid assertions?
Discussing FGM vs. MGM, there seems to ba a lot of opinions and denial..
Before people dismiss MGM as being less harmful than all of the forms of FGM, they need to include the more drastic forms of MGM..
Subcision–slitting the penis down the length
Yemeni circumcision–amputating the foreskin and flaying all of the skin from the navel to the crotch..
Now can anyone find a form of FGM that is worse than this? If not, then the crucial question remains..
RATIONALLY WHY is any form of FGM illegal yet MGM is legal?
“Before people dismiss MGM as being less harmful than all of the forms of FGM, they need to include the more drastic forms of MGM..
Subcision–slitting the penis down the length
Yemeni circumcision–amputating the foreskin and flaying all of the skin from the navel to the crotch..”
I think this is an interesting point. Especially in light of the arguments that Plonit makes that since more severe forms of female genital mutilation exist, all should be illegal because of the potential of “intentional botched circumcisions” that might be performed as a round about way of getting the desired result of the more severe forms of FGM.
Now, I don’t think that either of those is plausible in the United States, because the legal ramifications that would ensue if a doctor was found to be performing intentional botched circumcisions for boys or girls would be astronomical. Losing a life’s worth of work and medical license and imprisonment for a surgery most doctors in the US would deem unethical seems implausible.
But it does raise and interesting question : Why are ALL forms of female circumcision, even ones equivalent or less severe than complete removal of foreskin, illegal in the United States but not all forms of male circumcision? At least in the context of minors.
@Alison
With regard to chances of HIV infection in non-iv heterosexual men in low prevalence countries, the Australian Federation of AIDS Organizations estimated that the lifetime risk for those men in Australia is approximatly 0.02% which I believe is an upper bound. So the difference circumcision could make for an individual over there lifetime would be on the order of perhaps hundreths of a percent. I will provide the link when I can get it.
I have, in the past, worked out that the risk in the US is about the same, a bit higher though since we don’t seem to do quite as well with regard to STD prevalence. Funny when we have an adult circumcision prevalence of at least 80%. *shrug*
“With regard to chances of HIV infection in non-iv heterosexual men in low prevalence countries, the Australian Federation of AIDS Organizations estimated that the lifetime risk for those men in Australia is approximatly 0.02% which I believe is an upper bound.”
Here is the information from that study :
“An Australian-born man is estimated to have a 0.02% (0.0002) risk of HIV acquisition if he does not
inject drugs or have sex with men.11 This very low risk means that the population health benefit of an
intervention like generalised circumcision programs would be negligible. However it has been argued
by Professor Alex Wodak in the mainstream press, that circumcision would play a valuable role in
assisting to prevent the emergence/development of a heterosexually mediated epidemic in Australia.
This view is not currently supported by a consensus or statement from any organisation currently
involved in Australia’s HIV partnership. ”
11
This estimate was supplied by the National Centre in HIV Epidemiology and Clinical Research in February 2009, based on median lifetime
partners, sexual acts within partnerships over time, estimated prevalence within the female population of 0.03-0.05%, and average transmission
rates and condom use within partnerships
(http://www.afao.org.au/library_docs/policy/BP09_Circumcision.pdf)
Annabel, I didn’t misunderstand the study: I didn’t read it! (I do have to agree with Amy on this one: one needs to read the study oneself!) I relied on your quote of someone else who may have read a study fourteen years ago, and fed your numbers back to you.
“‘A 1996 Wall Street Journal article on AIDS reports that the chance of contracting HIV from random unprotected sex with non-IV drug using heterosexuals is “smaller than the risk of ever being struck by lightening.”’ I think it’s safe to say that the risk of dying during a circumcision is greater than the risk of contracting HIV from a horny “slip up” with a non drug using heterosexual female.”
and
“Here are some numbers. The risk of a man contracting HIV from a woman, which is the only HIV route circumcision has proven to reduce risk, is .04% or .0004 in the United States. One in every 2,500 sexual acts. Exactly how many men do you think are going to be having sex 2,500 times before the age of 18 when they can make an educated decision for themselves about whether or not the risk reduction is worth it? Even the most conservative risk complication rate of circumcision is WELL above .0004.”
If you misrepresent the numbers, then don’t complain when they are fed back to you incorrectly. If you meant to say (you and Amy are alike in this: you complain that people don’t understand what you mean to say, we very annoyingly respond to what you do say) “The risk of an HIV- man contracting HIV from an HIV+ woman, which is the only HIV route circumcision has proven to reduce risk, is .04% or .0004,” then you should have said that. Mentioning 2,500 sexual acts by a teenager is misleading, because those acts would all have to be with HIV+ women to correspond to your figures. If that is accurate, then you are saying that an HIV- man and an HIV+ woman could have unprotected sex twice a week for 24 years and the man would still have only a 63% chance of seroconverting. That’s miniscule. (Why do we even care if straight people in the US use condoms at all, then, since it’s a low-prevalence region? Is it just about the herpes?)
Here is the math, based on your figures. (As I said previously, these are calculations. Reality is messy and may differ.)
A man has a 0.0004 chance of being infected with HIV when he has sex with an HIV+ woman.
He therefore has a 0.9996 chance of not being infected with HIV when he has sex with an HIV+ woman.
To not seroconvert after repeated encounters, he needs to be in the 0.9996 category each time.
After 1 encounter, he has a 0.9996 chance of not seroconverting. (Chance of seroconverting is 1-0.9996, or 0.0004.)
After 2 encounters, he has a 0.9996*0.9996, or 0.9992, chance of not seroconverting. (Chance of seroconverting is 1-0.9992, or 0.0008.)
After 3 encounters, he has a 0.9996*0.9996*0.9996, or 0.9988, chance of not seroconverting. (Chance of seroconverting is 1-0.9988, or 0.0012.)
After 26 encounters, the chance of not seroconverting is 0.9996^26, or 0.9897. (Chance of seroconverting is 1-0.9897, or 0.0103, or 1%.)
After 2,500 encounters, the chance of not seroconverting is 0.9996^2,500, or 0.3678. (Chance of seroconverting is 1-0.3678, or 0.6322, or 63%.)
The math is correct, but the results are only as good as the inputs.
Anabel, plausibility is irrelevant, as is intention and risks..
IF the rationale for the banning of ALL forms of FGM is that MGM is less harmful, then the mere presence of a form of MGM worse than a minor form of FGM negates this rationale..
And worse, if there is a more severe form of MGM than ANY form of FGM, then this is an irrational basis for banning FGM and not MGM..
And the nail in the coffin for this excuse is that there IS a more severe form of MGM than any form of FGM.
I am tired of people playing with numbers and not examining the basic scientific credibility of the claim of circumcision reducing HIV..
Basic tenets of science: These can be used as a litmus test for claimed benefits.
1. Conclusions based solely on known flawed data cannot be considered valid.
2. All studies have known flaws – flaws of commission and/or flaws of Omission.
Flaws = not scientifically compelling
The worth of a theory is determined by its ability to make accurate predictions.
No predicted reduction or elimination is found in the real world.
Failure to fulfill prediction = not scientifically credible.
The rates of these are HIGHER in many circumcising countries than in many intact countries, hence the alleged predictions are contradicted by empirical evidence. Unlike “medical science,” SCIENCE demands that prediction be fulfilled EVERYTIME to be credible.
The link I provided earlier cited links to the flaws in the African studies..
Here is the critical analysis of how well the theory fulfills its prediction..
Failure of prediction-In science, it only takes ONE exception to invalidate a hypothesis or theory.
Circumcision rates:
Japan 10 % in all cultures…
OR
That even though people in Ethiopia can barely afford food and shelter, they can afford 88X the recreational drugs than Japan and 8X that of the USA.
“IF the rationale for the banning of ALL forms of FGM is that MGM is less harmful, then the mere presence of a form of MGM worse than a minor form of FGM negates this rationale..
And worse, if there is a more severe form of MGM than ANY form of FGM, then this is an irrational basis for banning FGM and not MGM..
And the nail in the coffin for this excuse is that there IS a more severe form of MGM than any form of FGM.”
I agree. Was that directed at me? I am a tad confused, because I agree with you.
You said : “If you meant to say (you and Amy are alike in this: you complain that people don’t understand what you mean to say, we very annoyingly respond to what you do say) “The risk of an HIV- man contracting HIV from an HIV+ woman, which is the only HIV route circumcision has proven to reduce risk, is .04% or .0004,” then you should have said that. ”
In my statement that you quoted I said :
Here are some numbers. The risk of a man contracting HIV from a woman, which is the only HIV route circumcision has proven to reduce risk, is .04% or .0004 in the United States. One in every 2,500 sexual acts (http://www.aidsmap.com/en/news/E1249D29-0DDE-4CFF-9CC7-16B3FADB3E59.asp) .
If you notice, I linked the study that I was referring to, so that people could read it if they had questions about the numbers. I obviously wasn’t intentionally trying to dupe people or I wouldn’t have linked the study. If anything, not saying HIV negative man and HIV positive woman would skew the results in favor of the pro circumcision group, as the chance that an average man getting HIV from an average women is lower than studies that show the risk of sexual relations with ONLY HIV positive women.
As far as my question of ” how many men do you think are going to have sex 2,500 times before the age of 18 ” is a valid question. Let’s make up a number that when having sex with an average woman who may or may not be HIV positive a mans chance of contracting HIV is is 1 in 5,000. It makes sense to take the lesser of those two numbers ( 1 in 2500 vs 1 in 5,000) to demonstrate that even the most extreme case ( that every-time a man has sex it will be with an HIV positive individual ) it is still unlikely that he would accumulate that many sexual acts before the age of 18.
But this is silly, why waste all this time over a few words when I linked the study I was referring to?
“I wondered how long the anti-semitic strain of anti-circumcision could hold back.
Can we end the thread here? Or do we actually have to wait until someone says that doctors are worse than Nazis to call Godwin?”
How is it anti-semetic to say that a Jewish doctor advanced the idea that circumcision reduced HIV.
It just shows that there’s a obvious conflict of interest.
“I agree. Was that directed at me? I am a tad confused, because I agree with you.”
No, not at you at all–merely a succinct summation and examination of the rationale for the banning of FGM, and allowing MGM.
I hardly think the rationale holds up to rational examination.
Cochrane report on monogamous heterosexual seroconversion rates:
http://apps.who.int/rhl/reviews/langs/CD003255ru.pdf
If they never use condoms: seroconversion rates of 1.14 per 100 person-years (roughly 2 months to reach 1% risk and 7 years to reach 25% risk).
If they always use condoms: seroconversion rates of 5.75 per 100 person-years (roughly 10.5 months to reach 1% risk and 38 years to reach 25% risk).
If they sometimes or usually use condoms: they weren’t included in the study.
They didn’t break this down by men vs women or by circumcised vs uncircumcised. The “nevers” seemed to have about the same rate of seroconversion in the US, Italy and Africa. The “always” folks varied from study to study, so they used the studies where the couples stayed together longest, which tended to be couples where the HIV+ partners were hemophiliac or transfusion patients.
Whether looked at per act of intercourse or per year, *always* using condoms seems to reduce transmission rates by about 80% compared to *never* using condoms.
Which is interesting to compare to the Kenyan and Ugandan studies where circumcision seems to reduce transmission rates by about 53% to 60%. If you think condoms (80%) are almost perfect, then circumcision (about 56%) is not that bad.
Caveat: I did not read all the Cochrane report studies. Neither have I read the Kenya and Uganda studies.
Nick, I agree, and frankly am tired of people throwing out the antisemitic term just because it is pointed out that a Jewish doctor started the circumcision/HIV speculation. Truth is truth–even if uncomfortable.
If the Pope put out an article on abortion it would automatically be construed as a conflict of interest, so why should not this likely probability in the case of a circumcision speculation by a Jew–why should he get a special exemption?
This whole antisemitic name-calling is simply another attempt to sabotage the discussion.
Would it be more antisemitic to also point out that this speculation was promoted by other Jews?
Sorry my post about the scientific credibility of the claim of HIV reduction by circumcision was truncated..
the gist is that the discrepancy of prediction for the USA, Ethiopia, and Japan is 1100% and 8800% respectively.
and that
The largest acceptable error in science is 1 sigma = 5%
Those advocating circumcision to reduce the incidence of HIV either ignore this empirical and contradicting evidence, or try to dismiss it with various excuses, like: Intravenous drug usage or homosexual activities.
However, they never provide any hard numbers of these factors for various countries or a model that should include them to explain this discrepancy.
For these excuses to be credible, one would need to assume:
That the US has 11X as many homosexuals than Japan; and Ethiopia has 88X as many as Japan—when it is widely accepted that the rate of homosexuality is 5 –>10 % in all cultures…
OR
That even though people in Ethiopia can barely afford food and shelter, they can afford 88X the recreational drugs than Japan and 8X that of the USA.
“Which is interesting to compare to the Kenyan and Ugandan studies where circumcision seems to reduce transmission rates by about 53% to 60%. If you think condoms (80%) are almost perfect, then circumcision (about 56%) is not that bad.”
STILL trying to pretend that the African studies are scientifically credible?
Do you plan to read the link debunking the studies and their prediction? or do you plan on pretending the information was not presented to you, and continue to play the questionable numbers game?
Not reading the critical and crucial analysis of the information is a prime example of ignoring SCIENCE in this discussion.
Until and if the information can be shown to be scientifically credible, all this back and forth is predicated on nothing objective…and essentially useless!
“Which is interesting to compare to the Kenyan and Ugandan studies where circumcision seems to reduce transmission rates by about 53% to 60%. If you think condoms (80%) are almost perfect, then circumcision (about 56%) is not that bad.”
First, I have seen studies that showed numbers higher than an 80 percent effectiveness of condoms. Second, condoms work for everybody. The 50-60 percent risk reduction is only applicable to heterosexual men who have vaginal intercourse with an HIV+ women, which is incidentally one of the rarest forms of HIV transmission in the United States. So 80 percent risk reduction for everybody is significantly better than a 60 percent risk reduction for a very specific group of individuals who are unlikely to get HIV regardless. Just because there is a difference of 20 percent between 60 and 80 doesn’t mean that condoms are only 20 percent better, when looking at the United States as a whole.
I’d like to see studies that show how effective condoms are at preventing HIV when the woman has HIV and a man does not.
Annabel, as I said, I should have read the study myself, but didn’t. I didn’t bother because I assumed (and I shouldn’t assume either) that you were linking to the old WSJ article you’d mentioned previously. (I have just pulled up the aidsmap article you linked to and it’s a plain-language article, not the published study.)
The point I was making, and the reason I wasn’t too worried about where the numbers were coming from, was that even if 0.0004 sounds miniscule it can look surprisingly different when you bring frequencies into it. That’s all. It could have been 0.0001, or 0.00001, and I could have illustrated the same phenomenon.
I am actually quite relieved that random sex with a low-risk woman doesn’t carry a risk of 0.0004 for a serodiscordant man! That would be huge, and the implications were worrying me.
Annabel,
“The 50-60 percent risk reduction is only applicable to heterosexual men who have vaginal intercourse with an HIV+ women, which is incidentally one of the rarest forms of HIV transmission in the United States.”
Yes, you’re absolutely right. The big issue right from the beginning was how and why this finding should be applicable to AAP recommendations. Amy said the Uganda/Kenya studies should result in the AAPs revising their recommendations. It appears that she simply didn’t know what the AAP recommendations are, and was never able to be specific about what she thought should be revised.
The thing is, when somebody says “everybody should be using condoms, condoms are almost perfect, nobody should be considering circumcision,” the words “everybody” and “nobody” mean Swazis and johns too unless you specifically exclude them.
If someone is saying that the entire planet should reject circumcision because they don’t need it, because condoms are almost perfect, they really need to be able to address the figures of 80% vs 56%; the fact that some people are high risk; that some people do live in high-prevalence areas; that some risks can be known or estimated at the time a child is born.
That doesn’t mean they will come to any particular conclusion. But it does mean we have numbers to talk about, which is what Science Based Medicine should be all about.
I really wish Amy were able to come to the table with proper numbers and analyses thereof. I work in business and I’m flying by the seat of my pants. I want to understand the numbers, and I have a little bit of experience with rudimentary statistics, but I don’t know anything about the field. So I look here and there and play with a spreadsheet and talk about If Then (IF the odds are 0.0004 THEN 26 encounters is 15) but I don’t actually know if the odds are 0.0004 or what that means, for who.
From the beginning, I’ve been asking how the Ugandan/Kenyan studies might affect decision making in the US, and I still don’t know. But I have learned that in the real world, the effectiveness of always using condoms appears to be not that far off from the effectiveness of being circumcised in preventing HIV transmission, which is absolutely not something I had expected to learn.
Why nobody talks about that adult circumcision was found to INCREASE the proportion of HIV in partners of subjects in Uganda ? Researchers abandoned the trial because of the “futility” of carrying on with it.
“It was found that a higher proportion of women were infected with HIV in the intervention group (18%) versus the control group (12%).”
Not to mention circumcised men are more likely not to use condoms because they rongly think they are protected from HIV. This is exaclty what is happening in Africa :
http://www.youtube.com/watch?v=OlsUg0sdAtE
It’s obvious that these researchers are more interested in promoting infant circumcision than a better HIV prevention.
“It’s obvious that these researchers are more interested in promoting infant circumcision than a better HIV prevention.”
That’s because the researchers make so much money from circumcision … oh, wait, they don’t benefit in any way.
Maybe it’s because they want lots of people to die of AIDS so they are deliberately recommending useless (and evil) strategies … oh, wait, they don’t benefit in any way from more people getting HIV and dying of AIDS.
What is it you are trying to say?
“But I have learned that in the real world, the effectiveness of always using condoms appears to be not that far off from the effectiveness of being circumcised in preventing HIV transmission, which is absolutely not something I had expected to learn.”
Why don’t you actually look at the fallacies of the African studies that others have linked before you come to this conclusion? the numbers 50 and 60 percent are questionable at best, and medical professionals are divided on the research.
Not one other western country ( UK, New Zealand, Australia, and Canada) have been impressed with the studies done in Africa as it applies to their country.
British Medical Assosiation :
“There is significant disagreement about whether circumcision is overall a beneficial, neutral or harmful procedure. At present, the medical literature on the health, including sexual health, implications of circumcision is contradictory, and often subject to claims of bias in research”
Royal Australasian College of Physicians revised statement in August 2009:
“Recently there has been renewed debate regarding both the possible health benefits and the ethical concerns relating to routine male circumcision. The most important conditions where some benefit may result from circumcision are urinary tract infections, and in adults HIV infection and cancer of the penis. The frequency of these conditions, the level of protection offered by circumcision and complication rate of circumcision do not warrant a recommendation of universal circumcision for newborn and infant males in an Australian and New Zealand context.
After extensive review of the literature the RACP does not recommend that routine circumcision in infancy be performed”
The College of Physicians and Surgeons of British Columbia, September 2009 revised statement :
“Until recently, only public health and religious views were taken into consideration in the debate over infant male circumcision. However, our understanding of medical practice must change as research findings become available. The College is issuing this guide for physicians regarding routine infant male circumcision in light of evidence-based medicine and contemporary principles in ethics, law and human rights.
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. From a religious standpoint, infant male circumcision is acknowledged to be an important ritual and an integral part of Jewish and Islamic religions. Male circumcision is also practiced in other parts of the world as a rite of puberty.
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 haemorrhage leading to death. The benefits of infant male circumcision that have been promoted over time include the prevention of urinary tract infections and sexually transmitted diseases, and the reduction in risk of penile and cervical cancer. Current consensus of medical opinion, including that of the Canadian and American Paediatric Societies and the American Urological Society, is that there is insufficient evidence that these benefits outweigh the potential risks. That is, routine infant male circumcision, i.e. routine removal of normal tissue in a healthy infant, is not recommended.”
@ Alison
“They didn’t break this down by men vs women”
This is a very important distinction since efficiency of transmission is far greater from men to women, I’ve seen numbers up to 8 times. It also depends largely on viral load in the positive partner and whether there are coinfections present among other things. In fact, just last year, a group of Swiss researchers in their HIV agency completed a study and made the statement that condoms were not necessary for long term heterosexual couples that were serodiscordant (think married couples) where the positive partner is being treated. That is to say being on anti-virals was enough to make the positive partner non-infectious (other conditions applied such as coinfections status).
If I recall though as far as condom vs. no condom there is at least an order of magnitude difference i believe this was discussed in: Reducing the Risk of Sexual HIV Transmission, Varghese et al, Sexually Transmitted Diseases, January 2002 if I recall.
However, as noted above some organizations such as AFAO have provided lifetime estimations for risk of infection.
“It also depends largely on viral load in the positive partner and whether there are coinfections present among other things.”
Yes, that’s a very good point about the difficulty of assessing risk of seroconversion when the risk doesn’t depend primarily on the diagnosis of HIV/AIDS but on many other factors as well.
“condoms were not necessary for long term heterosexual couples that were serodiscordant (think married couples) where the positive partner is being treated.”
Right, which applies when the HIV+ partner is being treated. What if the HIV+ isn’t being treated, as is too often the case in poor countries? What should they do then?
# Amy Tuteur, MDon 08 Jan 2010 at 5:47 pm
[in response to Nick]
“What is it you are trying to say?”
He’s already said it a couple of times. Circumcision is a Jewish Conspiracy.
Being as I’m of Irish Catholic descent, may I respectfully request that Nick be put on moderation? May I strongly urge it?
“Being as I’m of Irish Catholic descent, may I respectfully request that Nick be put on moderation? May I strongly urge it?”
Why? denying that there are biases in research is ignorant.
““It’s obvious that these researchers are more interested in promoting infant circumcision than a better HIV prevention.”
That’s because the researchers make so much money from circumcision … oh, wait, they don’t benefit in any way.
Maybe it’s because they want lots of people to die of AIDS so they are deliberately recommending useless (and evil) strategies … oh, wait, they don’t benefit in any way from more people getting HIV and dying of AIDS.
What is it you are trying to say?”
The problem with the “studies” and the people behind them is that they’re not focusing on HIV prevention; their stated agenda has always been to legitimize circumcision. These resaerchers (Halperin, Bailey etc…) are known circumcision evangelists.
1. This obsession of circumcision and the very idea that foreskin is something “wrong” is nothing ne in US. Circumcision in US has a long reputation for being a cure in search of a disease. HIV is just the latest candidate. Please read hoistory of circumcision : http://www.historyofcircumcision.net/index.php?option=com_content&task=view&id=31&Itemid=54
2. Many reasons can explain this obsession. First : money.
Circumcisions aren’t free. Doctors who circumcise must protect their reputations and careers especially when rates are decreasing in US.
It’s a long chain of money making….first there’s the doctor who pockets the cash from the surgery, then there is the ped who sees the kid for meatal stenosis, who then refers the child to a ped urologist who does another surgery to open up his urethral opening, then there’s the personal lubricant industry who manufacturers something to help restore some gliding action taken away with the foreskin. Not to mention, neonatal foreskin is highly valuable to the medical industry. It is processed and sold in a variety of products ranging from beauty creams to artificial skin grafts.
3. Second reason : tradition and culture. All doctors promoting circumcision are circumcised men. The fact that these men come from cultures where it is INFANTS that are circumcised tells me that the circumcision of infants was the target of their “studies” all along. The fact that the say HIV+ men should be circumcised to avoid having to reveal their status to them, the fact that they explain away the recent studies in women and insist men be circumcised anyway reveals to me that it is circumcision, not the reduction of HIV, with which they are concerned with.
Much of their identity is based on circumcision. There is not a doubt that part of what drives these men is self-validation and a problem of ego.
I don’t think we need to get into the trouble that circumcised men go to deny to themselves the fact that circumcision is needless mutilation, and that they were victims to it.
““It’s obvious that these researchers are more interested in promoting infant circumcision than a better HIV prevention.”
That’s because the researchers make so much money from circumcision … oh, wait, they don’t benefit in any way.
Maybe it’s because they want lots of people to die of AIDS so they are deliberately recommending useless (and evil) strategies … oh, wait, they don’t benefit in any way from more people getting HIV and dying of AIDS.
What is it you are trying to say?”
Amy,
The problem with the “studies” and the people behind them is that they’re not focusing on HIV prevention; their stated agenda has always been to legitimize circumcision. These resaerchers (Halperin, Bailey etc…) are known circumcision evangelists.
1. This obsession of circumcision and the very idea that foreskin is something “wrong” is nothing ne in US. Circumcision in US has a long reputation for being a cure in search of a disease. HIV is just the latest candidate. Please read hoistory of circumcision : http://www.historyofcircumcision.net/index.php?option=com_content&task=view&id=31&Itemid=54
2. Many reasons can explain this obsession. First : money.
Circumcisions aren’t free. Doctors who circumcise must protect their reputations and careers especially when rates are decreasing in US.
It’s a long chain of money making….first there’s the doctor who pockets the cash from the surgery, then there is the ped who sees the kid for meatal stenosis, who then refers the child to a ped urologist who does another surgery to open up his urethral opening, then there’s the personal lubricant industry who manufacturers something to help restore some gliding action taken away with the foreskin. Not to mention, neonatal foreskin is highly valuable to the medical industry. It is processed and sold in a variety of products ranging from beauty creams to artificial skin grafts.
3. Second reason : tradition and culture. All doctors promoting circumcision are circumcised men. The fact that these men come from cultures where it is INFANTS that are circumcised tells me that the circumcision of infants was the target of their “studies” all along. The fact that the say HIV+ men should be circumcised to avoid having to reveal their status to them, the fact that they explain away the recent studies in women and insist men be circumcised anyway reveals to me that it is circumcision, not the reduction of HIV, with which they are concerned with.
Much of their identity is based on circumcision. There is not a doubt that part of what drives these men is self-validation and a problem of ego.
I don’t think we need to get into the trouble that circumcised men go to deny to themselves the fact that circumcision is needless mutilation, and that they were victims to it.
4. Trauma of circumcision :
Persons who have lost body parts must grieve their loss.The first stage of grief is denial of the loss. Fitzgerald and Parkes state that “Anything that seriously impairs sensory or cognitive function is bound to have profound psychological effects, not only on the person who is affected but also on family, friends, workmates, and caregivers.” The thought of permanent loss of sensory function is so painful that persons deny their loss in order to avoid facing the painful feelings.41 Denial of loss causes a flight from reality. Parkes et al. state that persons in denial may minimize their loss. Circumcision causes the loss of a body part and all of its functions including a drastic loss of erogenous sensory function, so denial of loss is not uncommon in circumcised males. Van der Kolk identified a compulsion in traumatized persons to repeat the trauma. This frequently results in circumcised fathers adamantly insisting that a son be circumcised. And this is also true for all these circumcised reseaechers that promote “universal circumcision”. HIV is just a poor excuse to achieve their goals and legitimize circumcision.
@ Amy
Also, look up where the majority of erectile dysfunction medications are sold, such as viagra. If you don’t think that circumcising babies is a multi million if not billion dollar a year industry in the US, you are in denial or ignorant of the facts.
“The May 1998 issue of Business Week provided a glimpse into this sadistic industry. “One piece of foreskin can produce four acres of engineered skin”. Skin that sells for more than $3,000.00 a square foot. The February 1998 issue of Wired magazine quotes one of these companies, “The cells from a single foreskin can produce 200,000 units of manufactured skin”. “That’s enough skin to cover about 250 people.”"
“He’s already said it a couple of times. Circumcision is a Jewish Conspiracy.
Being as I’m of Irish Catholic descent, may I respectfully request that Nick be put on moderation? May I strongly urge it?”
I’ve never talked about conspiracy. I just mention that the idea that circumcision prevent HIV came from a Jew : Aaron Fink.
Claiming my posts are anti-semitic is a weak way to avoid a real debate about circumcision.
“The problem with the “studies” and the people behind them is that they’re not focusing on HIV prevention; their stated agenda has always been to legitimize circumcision.”
If it’s there stated agenda, then you should be able to provide their statements. Where are they?
“Doctors who circumcise must protect their reputations and careers especially when rates are decreasing in US.”
Can you name EVEN ONE HIV researcher, infectious disease specialist or public health professional who makes even a dollar from circumcision? Of course not.
Do you even know who actually pockets the money from circumcision?
Annabel,
Unless you can show that the people who recommend circumcision for HIV prevention make any money from it, you’re just spouting conspiracy theories.
Are you trying to suggest that it is the HIV researchers, infectious disease specialists and public health officials who are surreptitiously selling foreskins to industry? If so, you need to provide proof for such an outrageous accusation.
Alison said: “Right, which applies when the HIV+ partner is being treated. What if the HIV+ isn’t being treated, as is too often the case in poor countries? What should they do then?”
I agree this is a problem and as I’ve said before under certain situations I am not necessarily opposed to men being offered circumcision in high risk countries. In fact, like tattoos or piercings, I don’t care if men anywhere get circumcised for any or no reason. All I care about if infant/child what an adult does to themselves is their own business and their own problem.
In the poor countries that we are talking about despite the possibility of circumcision being potentially useful I still have significant misgivings and I think there are problems that will get overlooked in the zeal to apply this high tech quick fix. For example:
1. I am significantly concerned about men overestimating the level of protection and abandoning condoms all together. Hardly an article on this issue is written that doesn’t interview a bunch of mopes praising their new virtual condoms.
2. I am concerned about women’s ability to negotiate safe sex when men over estimate the level of protective effect of their circumcision.
3. I am not confident that circumcision at any level can be provided in countries where the doctor patient ratios are measured in the tens of thousands in some cases. Where do those with severe complications go?
4. I am not convinced that this will be successfully combined with “other safe sex messages” such as condoms since as it stands most men in many of these places only have access to a small number of condoms each year. If we can’t deliver condoms how can we deliver circumcisions?
5. I am concerned about the under reported phenomenon of nonsocial infections which is said to be a significant contributor to the HIV problem yet is under reported. A recent string of papers by Potterat et. al. in the International Journal of STD and HIV estimated at least 1 in 5 new infections in these countries are caused by that vector. How is a circumcision champaign in a place where clean water is a luxury going to manage this?
6. One of the reasons stated for starting this champaign was to provide a way to get men into clinics to talk about the more effective strategies and get tested (but only if they want to get tested). If you then move to infants or children, when how will you then get the message to them?
This is just a short list off the top of my head. Like I said I am not saying men shouldn’t be allowed to opt for it but the risk reduction in the west is vanishingly small and I think in poor countries there are a number of hurdles and unforeseen problems that I fully expect to get the bureaucratic push aside.
If they want to go to the trouble of actually getting around to setting up clinics then make sure they have condoms, clean water, and access to testing for the whole population first. We’ve never even come close to that yet but we need all of those things anyway to support the potential of offering circumcision to men.
Since 1995, Dr. Bailey has devoted most of his research activities to the issue of male circumcision as a possible HIV prevention strategy. He has conducted circumcision-related studies in varying communities in Uganda, Kenya, Malawi, Zambia, and the U.S. He has studied adverse events and conducted needs assessments associated with medical and traditional circumcisions in Kenya.
Dr. Bailey is the principal investigator of the randomized controlled trial of male circumcision to reduce HIV incidence in Kisumu, Kenya, and he has served as a consultant to WHO, UNAIDS, UNICEF, the World Bank, USAID, the CDC, and other national and international governmental and non-governmental agencies.
This also wouldn’t be the first study he heads regarding circumcision. Robert Bailey has been trying to find the ultimate alibi for circumcision, and has been trying seriously hard to make HIV circumcision’s cash cow. He is known to get extremely frustrated when countries and municipalities reject his calls to implement mass circumcision. This man has an axe to grind. He is on a mission. He has a vested interest in rigging his “studies” and manipulating his figures, and it is written in plain sight that he has.
“Robert Bailey has been trying to find the ultimate alibi for circumcision”
Where is the evidence that he has received even one dime from circumcisions?
@ Amy
Are you implying that the only bias that could possible exist is one related to money?
Look at this recent report :
“Dr David Shaw, lecturer in ethics at Glasgow University, argues that circumcising boys for no medical reason is unethical.
He wrote in the journal Clinical Ethics that any doctor who does perform circumcision without a medical reason could be guilty of negligence and in breach of the Human Rights Act as the child cannot consent to the operation and it can be argued it is not in their best interests.
Dr Shaw wrote: “Imagine a situation where two adherents of a minority religion ask their doctor to pull off their son’s thumbnails, as this is part of the religion in which they want to bring up their son.
“The pain will be transient, and the nails will grow back, but the parents claim that it is an important rite of passage. I think it is reasonable to say that the doctor would send them packing.
“In the case of non-therapeutic circumcision, the foreskin will not grow back; why should this procedure be treated differently simply because of the weight of religious tradition?”
The controversial view is likely to cause a storm among Jewish populations who routinely circumcise boys when infants.
He said guidance to the medical profession on the issue from the General Medical Council and the British Medical Association are flawed and should be revised.
He added that the only medical reason for circumsing men is that there is some evidence it may prevent HIV in countries where cases are very high but that will not be relevant for doctors working in Britain. ”
“Non-therapeutic circumcision (NTC). The SMF continues its work towards ending NTC in the UK. At the end of November they chaired a meeting combining senior members from several organisations working to develop a joint strategy and action plan.
The Daily Mirror reported on a 20 year old man initiating legal proceedings against the doctor who performed a NTC on him as an infant because of his parents’ religious beliefs. The young man has been in regular contact with the SMF.
The Daily Telegraph reported on a paper recently published in the Journal Clinical Ethics concluding that current GMC and BMA guidance to doctors is itself unethical in that it allows parents to procure a non-therapeutic, irreversible surgical procedure on their children to satisfy their own religious beliefs. The author of the paper, Dr David Shaw, is a lecturer in ethics at Glasgow University.
The SMF will be contacting both the BMA and the GMC asking them to revisit their respective guidelines. Members of the NSS may wish to contact their MPs, NHS trusts and local media to bring these developments to their attention and to raise public awareness. ”
http://www.secularism.org.uk/116437.html
It is a big fear for people of the Jewish faith that if they don’t maintain the idea that circumcision is medically beneficial, numbers will continue to drop and more questions are going to start being asked about the legality of infant circumcision. I think that this could clearly be a bias in research.
Actually, Nick, it was you who said: “Many reasons can explain this obsession. First : money.”
So if money comes first, show me the money.
“It is a big fear for people of the Jewish faith that if they don’t maintain the idea that circumcision is medically beneficial, numbers will continue to drop and more questions are going to start being asked about the legality of infant circumcision.”
That’s baloney, like so much else of what you’ve written. Circumcision is a religious obligation and medical benefit has nothing to do with it.
joep,
Many of the concerns you express relate to the difficulty of providing safe circumcision facilities.
Upthread, Amy quoted a 2007 UNAIDS report as follows:
“There is substantial evidence that male circumcision protects against several diseases, including urinary tract infections, syphilis, chancroid and invasive penile cancer, as well as HIV. However, as with any surgical procedure, there are risks involved. Neonatal circumcision is a simpler procedure than adolescent or adult circumcision and has a very low rate of adverse events, which are usually minor (0.2–0.4%). Adolescent or adult circumcision can be associated with bleeding, haematoma or sepsis, but these are treatable and there is little evidence of long-term sequelae when undertaken in a clinical setting with experienced providers. In contrast, circumcision undertaken by inexperienced providers with inadequate instruments, or with poor after-care, can result in serious complications.”
What this means is that in regions with poor health care, neonatal circumcisions are simple enough that they can be done by the local health care provider, whoever that is.
Adolescent or adult circumcisions are more difficult and need to be done in a properly supplied clinic with trained and experienced staff.
While we might take these more complex health facilities for granted and assume that an adolescent or adult can access them as needed, this may not be true elsewhere. In these situations, the only way of ensuring that circumcision is available is to offer it to infants.
I know many people have said that they “feel” or “think” that adult circumcisions must be easier to do than infant circumcisions, and that they simply disbelieve health care workers who say that really, it is more difficult to circumcise an adult. But nobody has actually cited research to show that circumcision is easier to perform on adults. So far, the information we have is that it’s less complex to circumcise an infant. Presumably it can be done at home by someone with a razorblade and a bottle of alcohol. The elaborate health infrastructure only really needs to be there if you’re going to restrict circumcisions to adults.
No, it’s not perfect. It doesn’t have to be. It just has to be better than the alternative.
Yes, of course there is pain and risk. That’s why it needs to be balanced against the pain and risk of the alternatives. In the US, the balance is not the same as in, say, Rwanda.
“That’s baloney, like so much else of what you’ve written. Circumcision is a religious obligation and medical benefit has nothing to do with it.”
First of all, I am not Nick. Second of all, circumcision is unique in that a parent of any other religious minority would not be allowed to permanently mark their child for religious reasons. Not a tattoo, not a small incision, not a small burn- nothing. A baby cannot say whether or not he is Jewish. There is no way of knowing whether or not he will want to be a part of the Jewish religion as an adult, therefore it is unethical. As long as people believe there is a medical benefit it will most likely continue to be a legal procedure. It would be unethical for doctors to say ” You can only circumcise your son if you are Jewish,” that would be discrimination. Either everyone can or everyone can’t. If there are no medical benefits, the procedure is likely to eventually fall out of favor in America like it has with every other Western country.
@Alison
I disagree with your assessment. Primary concerns focus on overestimation of effect, womens’ issues, and nonsocial infections, and infrastructure. If they may be doing it with a razor blade and a bottle of alcohol as you suggest then it’s worse than I thought.
@Alison
And just to give you a feel for the situation here is a report from last year that discussed the complication rates of circumcisions in medical settings in these ‘deployed’ clinics.
http://www.aidsmap.com/en/news/03B54A29-5328-43FE-80D8-735C78D21F56.asp
18% in medically performed ones.
So how many urologists does this country have to clean up such a mess?
I reiterate in a place where we have failed to provide basic services I don’t see how this will be successfully implemented. If they go after infants, I don’t see how they will “integrate” safe sex messages. And I don’t see how they will manage nonsocial infections.
“That’s baloney, like so much else of what you’ve written. Circumcision is a religious obligation and medical benefit has nothing to do with it.”
The problem isn’t about medical benefits but basic human rights ang bodily integrity. Now, more and more peole are considering circumcision to be an ethical issue. FGM was banned recently in US (in 1996). Scandinavian doctors refuse to perform male circumcision without solid medical reasons. Several parliamentary parties are considering creating legislation that would spare all children from circumcision. Considering these facts, it’s important for religious authorities to find new excuses (like HIV prevention) to legitimize circumcision when it appears that religious reasons aren’t enough to perform infant circumcision.
“So if money comes first, show me the money.”
I’ve already written how circumcision is a long chain of money making. There is money to be made in circumcision, not only for doctors, but also manufacturers of circumcision equipment, such as Gomco clamps, Circumstraints, PlastiBells, etc., not to mention that foreskins are sold to pharmaceutical companies, and not to mention there is a line of products created from the foreskins of children, for example, Oprah Winfrey’s SkinMedica.
I just have to add Alison that with respect to the complications ect. The numbers cited must come from western (US) sources it’s the same figure used by the AAP, the British and Australians site about a 2% rate BTW. I have little doubt it will be higher in Africa as I have no faith in their health care delivery system to execute this plan any better than condom distribution, safe sex education, or really most anything else.
But even given that a complication like minor bleeding might occur less often in an infant, the risk of a major complication for an adult is much less. For example, please provide me an example of an adult death in a western medical circumcision. I know I can find examples of infant deaths but I’ve never heard of an adult death.
Joep,
1. I am significantly concerned about men overestimating the level of protection and abandoning condoms all together.
If men abandoned condoms (more effective) once they were circumcised (less effective), then infection rates would drop. That’s not what has been seen in the studies to date, which is why circumcision is now thought to be a health benefit in high-prevalence areas.
2. I am concerned about women’s ability to negotiate safe sex when men over estimate the level of protective effect of their circumcision.
In my experience, too often men are not worried about what they can transmit nearly as much as they worry about what they might catch. If a woman is thought to be STD-free, there’s a good chance she’ll have trouble convincing a male partner to use condoms no matter where she is in the world. I don’t see circumcision changing that.
3. I am not confident that circumcision at any level can be provided in countries where the doctor patient ratios are measured in the tens of thousands in some cases. Where do those with severe complications go?
Nowhere. Ditto those with AIDS. If you are more likely to get deadly circumcision complications than AIDS, then circumcision is not a good bet for you. If you are more likely to die of AIDS, that changes the equation.
Severe complications requiring a professional clinic are less likely with neonatal circumcision — see my previous comment.
4. I am not convinced that this will be successfully combined with “other safe sex messages” such as condoms since as it stands most men in many of these places only have access to a small number of condoms each year. If we can’t deliver condoms how can we deliver circumcisions?
If condoms aren’t available today, circumcision isn’t going to change that. So that’s an argument for circumcision, not against it.
Circumcision has been performed for thousands of years, long before the existence of medical clinics. See my previous comment about easier infant circumcision.
5. I am concerned about the under reported phenomenon of nonsocial infections which is said to be a significant contributor to the HIV problem yet is under reported. A recent string of papers by Potterat et. al. in the International Journal of STD and HIV estimated at least 1 in 5 new infections in these countries are caused by that vector. How is a circumcision champaign in a place where clean water is a luxury going to manage this?
It will reduce transmission from women who contract HIV from their drinking water to their male partners.
6. One of the reasons stated for starting this champaign was to provide a way to get men into clinics to talk about the more effective strategies and get tested (but only if they want to get tested). If you then move to infants or children, when how will you then get the message to them?
STI clinics. Billboards. Radio.
If they want to go to the trouble of actually getting around to setting up clinics then make sure they have condoms, clean water, and access to testing for the whole population first.
Any public health agency is going to look at what is most cost-effective. If subsidising condoms will get better outcomes more consistently for more people for the same money as promoting infant circumcision, then they will do that. I don’t think you need to worry about other people’s budgets.
Why test? It’s expensive and could reduce motivation to use condoms. Testing is for monogamous people who want to stop using condoms and can pay for the tests.
We’ve never even come close to that yet but we need all of those things anyway to support the potential of offering circumcision to men.
What do you mean “we”?
An African public health organization would need to provide some of those things to support circumcision for adult men. Supporting circumcision for neonates would require less infrastructure. It’s their call.
If they may be doing it with a razor blade and a bottle of alcohol as you suggest then it’s worse than I thought.
How do you think country people do it today, all over the world?
Steve Novella regularly points out that almost everyone has a sacred cow that they won’t have attacked, and that they’ll often go out of their to cherry pick evidence in support of that sacred cow, even when the majority of evidence is either neutral or against.
One of Dr. Tuteur’s sacred cows seems to be neo-natal circumcision. She’s managed to cherry pick a study on adult circumcision which show a marginal improvement in STD transmission rates.
If adult circumcision does in fact reduce transmission rates, why call for neo-natal circumcision? The evidence at hand does not support it in any way, in fact the investigations cited in her post make it clear that we have enough males that were circumcised as adults to have enough data to see if adult circumcision is just as effective.
The call for neo-natal circumcision is not supported by the evidence, and adult circumcision is only supported in circumstances where the almost perfect protection offered by condoms and safe sex is not universal.
As I’ve pointed out above, male circumcision appears only to be of benefit in poor and/or uneducated populations without access to condoms.
As circumcision is far less effective than condom use, the only excuse to use it is where the will to improve education, standard of living and condom availability is lacking.
Dr. Tuteur must know that circumcision is far less effective than poverty relief, education and condom use.
I must conclude that Dr Tuteur is therefore supporting circumcision not for any supposed medical benefits, but for ideological reasons. If she doesn’t want to feel guilty about performing irreversible, unneeded surgery on males unable to give explicit consent, then she should stop doing it, rather than finding fig leaves to cover her suppressed guilt.
You’ve gotten ridiculous in your conspiracy-mongering now, given that the researchers advocating circumcision don’t share in this loot. (Or maybe Oprah and Big Circ bought them off.) Moreover, do you have any idea just how big an industry this is? My guess would be: Not very.
There are reasons to doubt whether the benefits of circumcision are with the high NNT and the potential complications, but Big Circ paying off the researchers isn’t one of them.
@Alison
I’ll have to look at the rest later but this stood out most.
Alison said: “Why test? It’s expensive and could reduce motivation to use condoms. Testing is for monogamous people who want to stop using condoms and can pay for the tests.”
Because a program of testing and then going on antivirals if you’re positive would do far more to alleviate the situation in 10 years than circumcision could do in 20 years.
Link: tinyurl.com/yc23pha
Link: tinyurl.com/ao2aty
The major hurdle sited:
* The ethical problem of implementing a universal HIV testing program;
* The ethical problem of starting treatment when one has contracted HIV but still has a high CD4 count.
An ethical problem? Surely they must be joking.
@Alison
I’ll have to look at the rest later but this stood out most.
Alison said: “Why test? It’s expensive and could reduce motivation to use condoms. Testing is for monogamous people who want to stop using condoms and can pay for the tests.”
Because a program of testing and then going on antivirals if you’re positive would do far more to alleviate the situation in 10 years than circumcision could do in 20 years.
Link: tinyurl.com/yc23pha
Link: tinyurl.com/ao2aty
The major hurdle sited:
* The ethical problem of implementing a universal HIV testing program;
* The ethical problem of starting treatment when one has contracted HIV but still has a high CD4 count.
An ethical problem? Surely they must be joking.
I am not sure if this keeps getting caught in the spam filter or not, I didn’t see a waiting for moderation message so if this pops up more than once I apologize.
“There is no way of knowing whether or not he will want to be a part of the Jewish religion as an adult”
You really need to learn a lot more about Judaism before you make claims about it. Being Jewish is not a choice. It is inherited through the mother. You can convert later if you want, but if your mother is Jewish, you’re Jewish, whether you want to be or not.
“I’ve already written how circumcision is a long chain of money making.”
You’ve accused people by name or by profession and you are obligated to prove it or withdraw it. Saying “some people” make money, is not enough.
“Being Jewish is not a choice. It is inherited through the mother.”
Can you point to the place on the X chromosome where Jewishness resides?
It’s a social construct. You’re no more a Jew at birth than a Catholic or a Republican or a Marxist.
You’re really digging yourself in deeper with these completely innacurate and ideological bugbears.
“You’re no more a Jew at birth than a Catholic or a Republican or a Marxist.”
Clearly you need to do a little more research on religion.
“Clearly you need to do a little more research on religion.”
And you need to do a serious revision of your basic biology textbooks. You can be born with dark skin, left handed, a redehead, or gay, or having any other number of genetically predetermind characteristics.
What you can’t be born as is a part of a social construct. You can only be born to parents who are a member of a social construct, but seeing that has no effect whatsoever on your genetics or even epigentics, you’re a priori born without any political affliation to a social construct.
Religious people might like to imagine that their children are members of their personal religion from birth, but wishing doesn’t make it so. They can force the child to undergo religious indocrination, but that by definition is post birth, and is most definately nothing to do with the child’s state at point of birth.
Just because a religion claims something, doesn’t make it true. This is Science Based Medicine, and you just made a theological claim unsupported by any evidence whatsoever.
Instead of guessing about Judaism and presenting your guesses as facts, why don’t you do a little research and let us know what you find?
Biologically, I suppose you could have a point, but culturally Judaism is passed through the maternal lineage. If your mother is a Jew, you are a Jew. Period.
You’re just plain wrong here. Or you’re intentionally attacking a straw man (that somehow Judaism is genetically inherited through the mother) in order to troll.
“Instead of guessing about Judaism and presenting your guesses as facts, why don’t you do a little research and let us know what you find?”
You’re avoiding the question entirely aren’t you. Can you make one scientific claim that supports your assertion that children are born belonging a priori to any religion because of their birth mother?
Your retreat to theology only makes it clear that you have no grounds on which to support your scientific claims.
Go and read some basic biology textbooks on heredity and see if you can claim that a social construct can be inherited biologically.
I understand your arguments, I can point to any number of societies where legitimacy comes from the matriliniar line. This is a claim based on the fact that a wise person can only know his mother, and in societies where legitimacy is important is a quite clever solution.
Still it does not say any more than about the child than it was born of that woman. Social constructs are not genetic, unless you’re claiming that certain religions are exclusive extended phenotypes, and that is clearly wrong as you can change your religion like any other social construct.
(sorry if this is a double post, I couldn’t see that it had been posted but got a message that it had)
“Biologically, I suppose you could have a point, but culturally Judaism is passed through the maternal lineage. If your mother is a Jew, you are a Jew. Period.”
No, what it says is that the only people who can be considered to be Jews are those born of a Jewish mother. That is something completely different than you are automatically a Jew if your mother is one.
Condom efficacy…
http://www.rho.org/html/cont-male_condoms.htm
Male Condoms
Overview
A male condom is a sheath designed to fit over a man’s erect penis and prevent passage of sperm into the female reproductive tract. Most condoms are made of thin latex rubber; some are made of animal tissue or of polyurethane. Condoms come dry or lubricated with a water-based lubricant or spermicide. (See the condoms and nonoxynol-9 discussion below.) Condoms can be very effective in preventing pregnancy when used correctly and consistently with every act of intercourse (perfect use); however, they are less effective with typical use. A meta-analysis of the male condom in preventing HIV suggests that their effectiveness at preventing HIV is 87 percent (with a range from 60 to 95 percent depending on the incidence among nonusers) (Davis, 1999). Condoms do not affect breastfeeding or have hormonal side effects; no medical condition restricts a client’s eligibility for use of the method except allergy to latex. In addition to preventing pregnancy, latex condoms are effective in protection against sexually transmitted infections (STIs). Male condoms may be less effective in protecting against those STIs that are transmitted by skin-to-skin contact, since the infected areas may not be covered by the condom (WHO, 2001; NIAID/NIH/DHHS, 2001).
Characteristics of condoms
Effectiveness : 3% to 12% failure rate during first year of typical use; 3% failure rate during first year of perfect use.
User issues
Condoms in various forms have been used for centuries. Since the 1930s latex condoms have been used, though generally not extensively, in many parts of the world to prevent both pregnancy and STIs. The promotion of condoms for HIV prevention led to an increase in research and technical knowledge during the past decade and the first substantial modifications in manufacturing of condoms since the 1930s.
If used consistently and correctly, condoms can be very effective. Reviews of literature confirm that condoms can prevent both pregnancy and STIs, including HIV (Lisken, 1990; FHI, 1998; PATH/Outlook, 1994; Gardner, 1999). Laboratory studies show that sperm and disease organisms cannot pass through an intact latex condom. Consistent condom use is very effective at preventing HIV infection, even among serodiscordant couples, where one partner is infected and the other is not. Studies have confirmed that, with consistent condom use, the HIV infection rate among the uninfected partners was less than 1 percent per year (de Vincenzi, 1994). Where one partner is definitely infected, however, inconsistent condom use can be as risky as not using condoms at all.
In actual use, however, couples relying on condoms generally are not as successful at preventing unwanted pregnancy as users of many other methods. Evidence suggests that the individual—not the condom—is usually responsible for most condom failures and to inconsistent use, incorrect use, and breakage due to improper use. Breakage rates for high-quality condoms are quite low (less than 1 to 12 per 100 condoms) during either vaginal or anal intercourse. Substandard products, either manufactured badly or stored badly, may have holes or defects that lead to tearing the condom or leakage. Failure also may be caused by the condom user’s behavior. A recent study found that breakage related to: (1) having a male sexual partner, (2) infrequent condom use, (3) having the condom partially slip, and (4) the technique use to don the condom (Richters, 1995). Slippage was related to: (1) young age, (2) having less lifetime condom experience, *******(3) being circumcised******, and (4) the donning technique. These researchers suggest that condom counseling protocols should acknowledge the complexity of condom use.
Amy, it is getting more than a little boring for you to demand others support each and every claim, yet you never support ANY claim you make..
Incidentally, I am still waiting for YOU to provide a single scientifically credible benefit for circumcision..
Lacking proof for one, it certainly is a double standard for you to demand this from others for every assertion.
As for this Jewish claim of being born a Jew, that is a patently absurd claim made by Jews. NO one is born as any religious group, and chopping off part of their genitals does not make them one either.
This “covenant” claimed by Jews is a made up mandate by Priests circa 550BCE–it was never part of the original covenant.
“This post is not about defending circumcision. It is an explanation of the current state of research on the reduction in transmission of HIV and other STDs by circumcision.”
Then perhaps, you might wish to provide some scientifically credible evidence that circumcision DOES reduce the rates of HIV and STD’s because frankly the empirical evidence in the real world refutes these claims–or are you scientifically illiterate?
If so, then read the link I posted earlier on the scientific process–or choose to remain ignorant and then pretend that you never had the chance to remedy this ignorance.
“You really need to learn a lot more about Judaism before you make claims about it. Being Jewish is not a choice. It is inherited through the mother. You can convert later if you want, but if your mother is Jewish, you’re Jewish, whether you want to be or not.”
Wow, so you’re saying that religion is genetic or not a choice simply because it’s imposed upon a child? If you can convert to Judaism it’s obviously a choice. If you can denounce your birth religion, obviously it’s as much a choice as any other religion. Just because the Jewish religion decides to not recognize children born of a Jewish father and a gentile mother doesn’t mean that being born of a Jewish mother somehow makes you biologically a Jew and not biologically a Jew if only your father is Jewish. Is a child born to a Jewish mother but given up for adoption and raised Catholic still Jewish in your opinion? Do you believe one is born Muslim too? Religion is culture not biology – no matter how hermetic a religion it is and even if intermarrying may have created distinct genetic lineages (as happens in other hermetic religions or cultures, the hermetic culture of the Ashkenazi Jews is responsible for their distinct genetic heritage, not all Jews have the same genetic heritage, it’s specific to a group…people in the Lac St-Jean district of Quebec are also studied because of distinct genetic traits due to hermetic culture, do you believe they’re born Catholic? Icelanders as well.) You really are reaching far here and wandering into some strange territory that is certainly ideological and uncomfortably close to what people who hate Jewish people claim. Do you only have this rule for Jewish people or is everyone defined by the label slapped on them at birth and forever destined to be their parent’s religion?
Seriously, I now suspect you just made your initial blog post in the first place to argue ideology from what your argument has devolved into (particularly since Harriet Hall had already posted about this topic before). You’re making a joke out of this being a science-based blog by clearly promoting an ideological perspective and pretending you’re doing it in the name of science. It’s a shame and I’m doubly appalled that you’ve pushing such ignorant ideas about safe sex and now religion.
@ David Gorski:
I’ve heard of foreskin being used for surgical repairs in the eye (as well as the amniotic sac). How does it get from point A to point B? Legitimate question here. Is it sold? Donated? I would imagine it would be deemed biological waste, but then what…?
This “Jewish” argument has me confused.
I thought that being Jewish was a faith, not genetics. Wikiepedia describes “Jewish people” as “an ethnoreligious group originating in the Israelites or Hebrews of the Ancient Near East.”
Wouldn’t that mean religion.. not genetics?
If you convert to Judaism, you are of the same status as people who were born into the Jewish faith.
So a family who converts to Judaism, and has a son.. circumcises their son who was “born Jewish”who may or may not grow up to worship in the Jewish faith… but isn’t *genetically* an Israelite.
Am I making any sense? Or do I have it completely fudged up?
“You really need to learn a lot more about Judaism before you make claims about it. Being Jewish is not a choice. It is inherited through the mother. You can convert later if you want, but if your mother is Jewish, you’re Jewish, whether you want to be or not.”
Wow. Ok, this takes the cake. That has to be one of the most ignorant things I have read on a circumcision blog or forum ever, and that is saying a lot.
““You’re no more a Jew at birth than a Catholic or a Republican or a Marxist.”
Clearly you need to do a little more research on religion.”
Amy, I suggest you do the same IF you believe that one is born Jewish or that the Jewish deity mandated circumcision.
The first is a logical absurdity–an infant is born human and nothing else regardless of the silly notion that popping out of a womb of someone who follows a certain belief system somehow receives that belief system through her genes.
The second is a completely ignorant assumption.
Please try not to talk down to people who just might be more educated on a subject than yourself.
“If your mother is a Jew, you are a Jew. Period.”
A better illustration. I turn up to Synagogue and say that I’m Jewish, the Rabbi asks me if my mother was Jewish, I say yes. Then I’m Jewish.
Or I turn up to Synagogue and the Rabbi asks me if my mother was Jewish, I say no. Then I’m not Jewish. Fine, it’s an exclusion principle based on matriliniar ancestry.
I turn up the Atheist Alliance annual bake sale and debauchery festival and I’m asked if I’m an atheist and I say that, though my mother and father are Jewish, I’m an Atheist. Then I’m not Jewish.
You can’t claim that just because you are Jewish, and you had children, that they are Jewish. You let them decide for themself.
The same goes for every other religion. I was actually born to Catholic parents, though I have Jewish ancestors on my mother’s side, and now consider myself to be a 6.9 on the Dawkins scale, then I’m certainly not Catholic or Jewish or anything else that someone else may consider me to be just because of their conventions.
Besides, you should really check into why circumcision started to be practiced within the Jewish faith.
Amongst gentiles circumcision really does have roots in wacky anti-sex ideas, including that beloved grandfather of many things woo Kellog who promoted wacky anti-sex and anti-masturbation ideas.The idea it protects from disease – including the disease of sexual pleasure that rots mens’ minds – is equally rooted in antiquity. Really, in 2010 the way to protect oneself from STDs is via using condoms and barriers. Do you even teach women about using barriers other than condoms?
I’m not anti-circumcision – I like a wide variety of penises, it’s who they’re attached to that makes them attractive ultimately – but I do question practicing unnecessary surgery on babies and there are members of the tansgender community that have had to live with doctors’ mistakes and then lies about the mistakes most of their lives (these mistakes are very often covered up). I think you’re entirely discounting their suffering in favor of promoting an ideological perspective (which is simply to say that even if this is an infrequent event – it’s hard to know since it’s often hidden from the victim and not reported historically – that the consequences can be extreme) . At the moment parents can choose whether to circumcise their children or not, why you’d want it to be recommended in the US when people should be using condoms and barriers (and good sense) to prevent getting an STD (fatal or otherwise) is just weird and irrational.
Perhaps you should read about David Reimer
http://en.wikipedia.org/wiki/David_Reimer
“That is something completely different than you are automatically a Jew if your mother is one.”
I’m not sure why you are having such difficulty with this concept. It’s a social construct just like citizenship. Just like citizenship, you are born with it, don’t get to choose, and cannot change it by whim. A boy born in Italy to Italian parents is Italian, whether he has chosen it or not. And no amount of wishing will make him Canadian as an adult.
Really, you can’t entitle something ‘The case for neonatal circumcision’ and make a case for the recommendation of neonatal circumcision and then claim you’re not making a case for neonatal circumcision. You’re not weighing the evidence, you’re making a case for something and cherry picking the evidence and dismiss the reality of AIDS and safer sex and condom use to make your case for neonatal circumcision. Seriously, it’s just idiotic to claim you’re not promoting a particular perspective based upon one study.
What does matrilineal ethnoreligious anything have to do with whether the apparent effectiveness of circumcision of Ugandan adults in reducing transmission of HIV has any bearing on the current AAP recommendations on routine neonatal circumcision?
Judaism is a red herring. Circumcision is either effective or it’s not. If it’s effective, the benefits may or may not outweigh the costs. If they do, it may or may not be possible. If it is, it may or not be ethical. If it is, it may or may not be preferred. That’s science-based medicine.
The studies could have been funded by the Taliban and conducted by the Illuminati. They still have to stand or fall on their own merits. If their findings are correct, then they are correct. If they aren’t, then future studies will demonstrate that.
Someone who has a conflict of interest can be right just as much as they can be wrong. And we all have conflicts of interest somewhere. We’re human. We’re proud. We have friends. Whatever. What science does is provide a discipline for figuring out what’s really going on anyway, even though scientists are human. And this discipline does not involve conspiracy theories.
Actually, if he wants to be a Canadian as an adult he simply has to apply for Canadian citizenship. That’s how it works in Canada, you are then Canadian. You seem to be the one that’s having issues with understanding what a social construct is and how labels work. You do understand that it’s quite possible to be born labeled as a man and then become a woman – as uncomfortable as mutable identities may make you, biological, national and cultural identities are mutable.
“he simply has to apply for Canadian citizenship.”
That’s right, and Canada may or may not decide to grant it after he completes certain requirements. However, he cannot simply announce that he is Canadian and thereby become Canadian.
Moreover, unless he takes specific legal steps to renounce his Italian citizenship, he is still Italian, no matter how much he’d like to be viewed as something else.
The same thing applies to Judaism. You are Jewish until you take specific steps to convert to something else. No amount of claiming to be an atheist changes the fact that you are Jew if you were born a Jew.
Why is this so difficult to understand?
“The studies could have been funded by the Taliban and conducted by the Illuminati. They still have to stand or fall on their own merits. If their findings are correct, then they are correct. If they aren’t, then future studies will demonstrate that.”
Does nobody think it’s kind of biased to be conducting studies centered around legitimizing an ancient religious rite?
Are there any “studies” being done in the FEMALE microbiome and “the effect of female circumcision” on it?
What would we do with studies from African doctors who on the front want to “reduce HIV transmission,” through female circumcision?
What is with this compulsive obsession and fixation by certain researchers to try to discredit the existence of a normal part of the male anatomy since the beginning of mankind? Surely they could find, by their line of research, that excising female labia will give oxygen the chance to kill bacteria that researchers don’t like. Try proposing that! Most of the world laughs at America’s peculiar sexual hangups and notions that foreskins are unworthy. Foreskins are part of mammals, male and female.
I think it’s about time we outlawed all of these circumcision “studies.” They’re not looking for a solution to a problem, they’re looking for problems to legitimize their pre-determined solution.
Amy Tuteur: “You really need to learn a lot more about Judaism before you make claims about it. Being Jewish is not a choice. It is inherited through the mother.”
Your defenses are beginning to cast serious doubt on your objectivity. The semantics of what it means to belong to a religion are irrelevant to the point that Akheloios was making. Just because a child is born to parents of a particular religion does not justify permanently marking the child with the signs of that religion, when it’s obvious that the child didn’t choose that religion.
Amy Tuteur: “Why is this so difficult to understand?”
What does any of this have to do with Akheloios’ original point? Why can’t you address the issue that Akheloios raised, which is how being born to a Jewish mother justifies body modification? Why is this form of religious body modification okay, when others are not? And what does any of it have to do with science based medicine?
David Gorski: “You’re just plain wrong here. Or you’re intentionally attacking a straw man (that somehow Judaism is genetically inherited through the mother) in order to troll.”
I think it’s quite clear what Akheloios’ point was. It was Dr. Tuteur who sidetracked the issue and began obfuscating a viable point with pedantry.
I’ve long been a defender of science based medicine, and for that reason I find this entire thread deeply troubling. The “pro-circ” crowd has revealed itself to be hypocritical, ideological, and anything but scientific.
It’s clear that there is a double standard when it comes to the treatment of female versus male genitals in infants (previous commenters have provided descriptions of the extent and nature of both). A similar double standard exists with respect to religious traditions and infant body modification. Why is this? This has been brought up repeatedly in this thread, yet I haven’t seen anyone from the “pro-circ” camp comment on this, except to misrepresent the statements of others, or to trivialize what many of us have come to regard as institutionalized child abuse.
It’s clear that infant circumcision is an unnecessary body modification, rooted in religion and misguided attempts at sexual repression, whose potential benefits, still questionable and only secondarily realized, can wait until the child is of an age to make the decision for himself. The “pro-circ” camp has not sufficiently explained why they think circumcision cannot wait until the individual is able to consent, and seems to consistently ignore this question, despite the frequency with which it has been raised. Once again, why can’t circumcision wait? Why must it be performed on infants? Please provide justification for this.
It’s also clear that if there were no cultural precedence for infant male circumcision and it were a novel idea, very few would consider it acceptable — beneficial or not. Again, are members of the “pro-circ” camp really incapable of seeing the issue outside of the present cultural context? Attempts to downplay the severity of male genital mutilation by calling it “minor” and referring to those who use emotional language to describe their emotions as “inflammatory” are really quite distressing. Can anyone really be so unimaginative that they can’t see why some of us find this appalling? Can they not for one moment try to envision analogous procedures on toes, fingers, breasts, or other body parts, and appreciate the sense of horror that we feel? Historical precedence is not an excuse for suspending basic human rights. When you look at infant circumcision from an outsider’s perspective, it seems monstrous. The callousness with which some people write it off or try to downplay is all the more disturbing to me.
The fact is we don’t know if there are psychological effects. And to steal from an earlier poster, we don’t know that society isn’t suffering from some form of Stockholm Syndrome that leads us to trivialize and even rationalize what might otherwise be considered child abuse. It certainly seems plausible that there are negative psychological consequences. Does the “pro-circ” camp have sufficient evidence to show that it is psychologically safe? Have they done rigorous testing on the psychological and emotional well-being of males who are circumcised as infants? If not, then why? If you’re going to perform an unnecessary surgery on someone without their consent, you really need to investigate the potential side-effects, both psychological and physical.
But that is beside the point. Even if there is no psychological damage, it remains an unnecessary violation of one’s physical autonomy. How can this be justified? While merely anectdotal, I do know several circumcised men who lament their lack of choice. What would you say to these men, who had a part of their body taken from them for no good reason and can never get it back? I would say that they’ve been violated. Would you disagree? If so, then why?
And why do people keep pretending that the only possible biases are monetary? I find this very disingenuous. Other commenters have already spelled out potential cultural, psychological, and religious biases. Acknowledging and weeding out bias is a vital part of science. Cherry-picking the comments about monetary bias and then calling them conspiracy theories while ignoring the comments about other forms of bias does not resolve the issue.
Why continue to condone and even promote a violation of an individual’s “physical integrity” (to borrow a phrase from the WHO) that is neither ethically nor medically justified? These are not rhetorical questions, I want answers.
The onus is on the “pro-circ” camp to provide sufficient evidence that necessitates violating a child’s right to choose, not the other way around. Such evidence has not been provided. This is the opposite of science based medicine. I think some of you should seriously consider whether your cultural biases are not interfering with your objectivity, and I will do the same.
It would be interesting to see how medical professionals in the future will judge their predecessors.
@ Amy
Are you really comparing a legal citizenship to a religion? Seriously? Nowhere on any birth certificate or any drivers license or any passport do I see the word Jewish. Nor are there any legal proceedings a person must perform to become “un Jewish.” You are comparing apples and oranges. A person is not Jewish if they say they are not Jewish. We are not talking about a persons race, we are talking about a religion.
“Why is this so difficult to understand?”
“If your mother is a Jew, you are a Jew.”
This is true only if you consider yourself a Jew and are part of this religion, that means you must respect the rules. If you mother is Jew and you’re no longer interested in this religion, the fact you are Jew because your mother is (only according to Jewish law) doesn’t really matter anymore.
But someone isn’t a Jew until someone announces they’re a Jew, what don’t YOU understand? In the Jewish tradition, uncircumcised men can’t get into heaven so it’s questionable if one’s truly a Jew if not circumcised (or a Catholic if not baptized, these are rituals of faith that are necessary to belong). If a Jewish woman had a baby, left it at a Catholic church and it was baptized and raised Catholic, is that child still a Jew if it hasn’t been proclaimed one? Your argument is specious and ultimately has nothing to do with circumcision as a medical procedure outside of religion. Particularly since the very origins of the more extreme form of circumcision was used as a means of making sure that Jews and didn’t wander off and stop being Jewish (it was to prevent Jews from trying to pass as gentiles). Really, it’s no different than branding people so they can’t escape their masters (in this case, the Rabbi).
The hierarchal tradition of circumcision was challenged when Alexander the Great conquered Jewish lands between 334 B.C. and 331 B.C., and as a result, Greek culture swept through Jewish communities. It was counter to Greek beliefs to violate the natural human form, and this caused young Jewish men to try to appear to be uncircumcised, which greatly annoyed Jewish rabbis. In response, Jewish rabbis argued that the foreskin was an imperfection that needed to be cut off in order to reveal the correct human male form.
Like I said, I’m against unnecessary surgery for babies but I have no preference for an circumcised or uncircumcised penis. Nor, unlike you, do I have a desire to impose or promote one or the other. There’s science that can be presented for and against – particularly by those who want to cherry pick the evidence – though most seems to lean towards allowing the person to make an adult choice (since safer sex isn’t a consideration for a child so that’s a specious argument on many levels, unless you’re advocating sex with children). Still, I’m much more tempted to side with the Ancient Greeks and modern nations that have universal healthcare (and actually practice real preventative medicine) on this one. Particularly since the roots of circumcision in Christian culture are so wacky and come from the same source as so much weird and anti-science new agey woo, and are distinctly based on the idea that masturbation is evil and creates sickness and circumcision is the cure. There really don’t seem to be any real benefits for babies or children and there are potential dangers – the risks do seem to outweigh the benefits. Adults can make up their own minds about body modification, whatever form it takes, and their sexual health.
Yes, I do think it was quite clear what his purpose was: To construct a straw man and tear it down. He knew what Amy was talking about, but instead decided to try to make it sound as though she were making an argument that Jewishness is some sort of biological trait passed through the mother. It was pointless and served no useful purpose in the discussion.
And this doesn’t even get into the dichotomy between cultural Jews and religious Jews. In fact there are quite a few atheists who consider themselves Jewish by culture because they were born to a Jewish mother into a Jewish family. There are secular Jews who take part in the religious rituals to varying degrees from not at all to just some extent. This whole argument about whether being Jewish is more religious or cultural is not a new argument. The bottom line is that, to the Jewish religion, a person is considered Jewish if his mother is Jewish. That person may choose to accept or reject Judaism, but even if that person rejects it the Jewish religion will still consider him Jewish and take him back if he ever changes his mind.
But what does any of this have to do with the scientific evidence for and against circumcision? It’s acknowledged that to Jews circumcision is a religious obligation and not done for any health purposes. Let’s put it this way yet again. I’ve taken Amy to task in this thread for some things she’s said, but I really don’t see why in this discussion of Judaism it’s even an issue whether having a Jewish mother makes a person Jewish by birth. That is indisputable, because it’s part of the Jewish religion.
I apologize. It was Annabel who first said “A baby cannot say whether or not he is Jewish. There is no way of knowing whether or not he will want to be a part of the Jewish religion as an adult, therefore it is unethical.”
Dr. Tuteur then responded to this with “You really need to learn a lot more about Judaism before you make claims about it.” Akheloios then took up the thread of that discussion, and I mistakingly attributed the original idea to Akheloios. However my point stands. The semantics of religious inclusion does not address Annabel’s original point.
There are studies going on regarding infants and pain, perhaps the sane (and scientific and ethical) thing to do would be to wait until we know more and can truly make a science-based decision regarding non-religious circumcision. A radical idea, I know! (I say non-religious because at this point in time parents can pretty much choose to let their child die – refuse blood transfusions, needed medical care, etc – on religious grounds.)
http://blog.taragana.com/health/2009/09/26/how-infant-pain-has-repercussions-in-adulthood-12578/
My understanding is that the answer to that question is yes, depending on the sect. Certainly orthodox and conservative Jews would consider such a child a Jew who was never raised Jewish. Reform Jews would probably still consider such a child Jewish by culture but it would probably be a moot point, given the child’s Catholic upbringing.
Also, in Reform Judaism circumcision is not mandatory, and Reform Jews also have modified the law of matrilineal descent, declaring that a child is Jewish if either one of the parents is Jewish:
http://judaism.about.com/od/whoisajew/a/amijewish.htm
http://judaism.about.com/od/whoisajew/a/whoisjewdescent.htm
In any case, this whole discussion of matrilineal descent as the determinant of who is and is not Jewish is all very interesting, but it is not about the scientific issues and is thus a distraction from the topic of this post, as far as I’m concerned.
“There are studies going on regarding infants and pain, perhaps the sane (and scientific and ethical) thing to do would be to wait until we know more and can truly make a science-based decision regarding non-religious circumcision. A radical idea, I know! (I say non-religious because at this point in time parents can pretty much choose to let their child die – refuse blood transfusions, needed medical care, etc – on religious grounds.)”
That’s very interesting !
http://epublications.bond.edu.au/cgi/viewcontent.cgi?article=1036&context=hss_pubs
http://www.asnatureintended.info/3/post/2009/11/male-neonatal-circumcision-trauma-and-brain-damage.html
Another interesting article :
http://www.menweb.org/circtom.htm
Dr Gorski – I agree but this doesn’t seem to have been about science from the start, just dressed up as being about science. It’s difficult to discuss this topic when people have so many obvious biases that they don’t want to acknowledge.
I’m an atheist and don’t have a penis or a preference for circumcised or not circumcised ones in sexual partners (like I said, it’s who the penis is attached to that really counts). I’m not foolish enough to think that whether a man is circumcised or not has much impact on real world sexual safety (his sexual habits and previous partners are much more important than whether he has a foreskin or not in this regard). My bias is towards not performing unnecessary surgery on babies and letting adults make choices about permanent changes their body. The issue here is about whether a medical association should be promoting circumcision, if in real world terms circumcision really has anything to do with AIDS prevention, and whether there’s actually a real weighing of scientific evidence going on here or a perpetuation of personal and cultural biases. Simply looking at this one study, and not even considering studies done regarding infants and pain, seems negligent to me (and it seems as if we’ve got more research to do in this area). What’s the rush to circumcise? It’s not like babies or children are having sex. What happened to first do no harm?
Thank you, untitled. You have summed up almost every question that I want the ” pro circumcision” camp to answer.
Why neonatal circumcision?
Why the double standard when comparing female and male genitals?
Why the double standard with religious practices? If jewish parents can modify their children in the name of religion, why can’t parents of a minority religion do the same?
“Does the “pro-circ” camp have sufficient evidence to show that it is psychologically safe? Have they done rigorous testing on the psychological and emotional well-being of males who are circumcised as infants? If not, then why?”
“What would you say to these men, who had a part of their body taken from them for no good reason and can never get it back? I would say that they’ve been violated. Would you disagree? If so, then why?”
“And why do people keep pretending that the only possible biases are monetary?”
“Why continue to condone and even promote a violation of an individual’s “physical integrity” (to borrow a phrase from the WHO) that is neither ethically nor medically justified?” to add to this, why is it only female babies whose right to physical integrity is in violation, when male circumcision is more severe than some of the forms of FGM that WHO claims violates the physical integrity of females?
I would really like some straight answers from the pro circumcision camp on these issues. They have been raised several times and have not been answered. I would especially like to hear from Amy, since she has remained mostly silent when these questions have been brought up.
( The quotes in parenthesis are from a previous post written by “untitled.” )
Kiki,
1) The AAP does not promote circumcision.
2) While she was extremely unclear about this in her post, Amy says in the comments that she never thought there was enough evidence to recommend it though might be changing her mind based on new evidence.
3) There might be a rush to circumcise neonates in poor African countries with a high prevalence of AIDS. Benefits might heavily outweigh risks, and the infrastructure in these countries might be able to handle infant circumcision more easily than adult circumcision.
4) My guess that the reason nobody has explained why circumcision needs to be routine and neonatal in the US is that nobody has said it does.
Thank you, untitled. You have asked almost every question that I want the pro-circumcision camp to address.
Why neonatal circumcision?
Why the double standard when dealing with male vs female genitals?
Why the double standard when it comes to religious practices? If jewish parents can perform bodily modification in the name of religion, shouldn’t parents from a minority religion be allowed to do the same?
“It certainly seems plausible that there are negative psychological consequences. Does the “pro-circ” camp have sufficient evidence to show that it is psychologically safe? Have they done rigorous testing on the psychological and emotional well-being of males who are circumcised as infants? If not, then why?”
“While merely anectdotal, I do know several circumcised men who lament their lack of choice. What would you say to these men, who had a part of their body taken from them for no good reason and can never get it back? I would say that they’ve been violated. Would you disagree? If so, then why?”
“And why do people keep pretending that the only possible biases are monetary?”
“Why continue to condone and even promote a violation of an individual’s “physical integrity” (to borrow a phrase from the WHO) that is neither ethically nor medically justified?” adding to this, why is it only a females right to physical integrity that is violated, when there are several forms of FGM that are less severe than male circumcision? Do boys not have the same basic human rights as girls?
( all quotes are from a previous post written by “untitled”.)
I would really like these questions addressed by the pro-circumcision camp. Especially Amy, since she has remained mostly silent on these issues when brought up, or has cherry picked a sentence out of an entire post three paragraphs long to respond to, avoiding these fundamental questions.
“Yes, I do think it was quite clear what his purpose was: To construct a straw man and tear it down.”
Where is the straw man? You can’t inherit religion as though it’s a biological phenotype, and it’s highly unscientific of Dr. Tuteur to do so.
The point that the evidence presented deals with a decline in STD transmission rates in populations where sexually active males have been circumcised.
Nowhere in her evidence does Dr Tuteur show that this circumcision has to be done to newborns.
She has not presented any evidence whatsoever for the benefits of circumcising infants. People have rightly said that due to the side effects, the non-consensual nature of the surgery and the fact that it can be performed later WITH explicit consent, and that there is already a much better method of reducing STD transmission already available in the form of safe sex and condoms.
Dr Tuteur has presented the straw man, and a huge one at that. That demonic bands of anti-circumcision activists roam the lands preventing good doctors from performing this life saving procedure on infants.
She’s conflated adult circumcision with infant circumcision and ignored evidence of better alternatives. She hasn’t produced Science Based Medicine argument, she’s produced a straw man and both of you appear angry that people have pointed this out on the ‘Science-Based Medicine’ website comments.
“Instead of guessing about Judaism and presenting your guesses as facts, why don’t you do a little research and let us know what you find?”
No you didn’t, Amy Tuteur. The three most obnoxious words in blog commenting – do the research. Translation: read stuff that agrees with me and you will see how wrong you are.
It is the mantra of so many anti-vaxxers, I really cringed when you wrote that.
“Translation: read stuff that agrees with me and you will see how wrong you are. ”
Translation: I want you to spoon feed me; I can’t think for myself.
Esquire had a blurb about this issue the other day: http://www.esquire.com/women/sex/getting-circumcised-0210
“Only 25% of the world circumcises, and not necessarily the good 25%. ” LOL.
“Instead of guessing about Judaism and presenting your guesses as facts, why don’t you do a little research and let us know what you find?”
Ironic coming from someone in their original post making direct contradictions and outright falsehoods:
The AAP should revise their current recommendation (oh wait, that’s not what she “meant,” despite the title of the blog and the last sentence).
The World Health Organization already recommends circumcision for neonates in first world countries (false)
The AAP flipped on their recommendation (due to pressure from anti-circ advocates) of neonatal circumcision. (false- it was never recommended).
Developed countries who have high circumcision rates also have low HIV rates (false, according to the WHO).
It’s rather difficult to get into the science of such a procedure when it’s not a medical issue in this country (that’s why virtually all of the med org in the developed world don’t make a recommendation either way), it’s a religious and cultural issue. Not to mention the reluctance of anyone (besides Alison Cummins, to an extent) to respond to criticisms of the African studies.
My 2 cents….if you use ‘wiki’ as a reference, for or against an argument, you are are automatically discredited.
I think one of the big problems here with the OP is that she barely tried to address the large number of substantive issues raised but then came back to rapidly interact on a completely unrelated side point which should have been left to die.
Zoe237,
Yup, I agree with everything you say. That’s why I don’t think Amy’s posts are up to the standard of SBM.
Interestingly, I’ve learned a huge amount following this discussion. I think Amy might have been a great classroom teacher (she was a clinical teacher), throwing out obnoxious, vague, un-nuanced and unsupported statements and motivating angry students to write thoroughly documented research papers.
I do think I could have learned as much from a more disciplined discussion following a more complete, nuanced post, however; and I’m quite sure that I don’t want to have to write a term paper to learn something from a blog post.
““Only 25% of the world circumcises, and not necessarily the good 25%. ” LOL. ”
I thought that was funny as well, but also something to think about.
According to Forbes 2009 world’s most dangerous countries, Somalia is number one, followed by Afghanistan and Iraq. While not scientific, I think it is interesting that all three of those countries have male circumcision rates well above 50 percent. Also, of all the western countries, the United States is by far the most dangerous in terms of murders and crime in general, and we also have the highest rate of circumcised adult men. Just thought it was something interesting to ponder.
(http://www.forbes.com/2009/03/04/most-dangerous-countries-lifestyle-travel_dangerous_countries.html)
joep,
Yep.
Grinch on 09 Jan 2010 at 9:42 am
“My 2 cents….if you use ‘wiki’ as a reference, for or against an argument, you are are automatically discredited.”
Discredited from what? Being confused by someone that I went to wiki?? Which, in my opinion is pretty informative.
I’ve never claimed to have credentials of any kind, or even an argument that I’ve been trying to back up. There’s nothing to discredit.
Dr. Amy however, has yet to back up her argument, provide relevant studies for her post, or answer anyone’s questions. Yet.. I’m discredited.
Is there a study out there I should have looked at instead, to answer my question? By all means…
If Dr Tuteur has evidence that neo-natal circumcision is better than adult circumcision, and that any circumcision is better than condoms and safe sex, she should present it. In the absence of such evidence, she’s wrong.
When they say it is not the money, it is the money.
“I have some good friends who are obstetricians outside the military, and they look
at a foreskin and almost see a $125 price tag on it. Each one is that much money.
Heck, if you do 10 a week, that’s over $1,000 a week, and they don’t take that much
time.”
Dr.Thomas Wiswell quoted in the Boston Globe June 22, 1987
“Profit should never dictate morality, but in the case of nontherapeutic circumcision it does. In 1999 the American Academy of Pediatrics found that neonatal circumcisions in the United States added between $150 and $270 million annually to healthcare costs.” -Respect for Bodily Integrity: A Catholic Perspective on Circumcision in Catholic Hospitals, from AMERICAN JOURNAL OF BIOETHICS, Volume 3, Number 2: Pages 1f-3f. Spring 2003.
An overview of the profitable industry of MGM:
http://www.acroposthion.com/acroposthion_018.htm
The humble foreskin has long been the source of much controversy and continues today particularly in North America to generate even more unbelievable controversy. The most disturbing and alarming is in the unethical trafficking of neonate foreskins. Not only do parents of North American baby boys have to pay between $200 to $300 to obstetricians to circumcise their boys that no sooner are the circumcised foreskins cut off that they are sold on to bio-engineering and cosmetics companies by the hospitals. The numbers of dollars involved are bewilderingly staggering, and this financial force is one which is providing the funds to continue the spread of medical propaganda advocating circumcision. The resale value of neonate foreskins is astronomically dizzying in that from one boy’s foreskin can be grown bio-engineered skin in a lab to the size of a football field. That’s 4 acres of new skin or around 200,000 units of manufactured skin, which is enough skin to cover about 250 people and sells at $3,000 a square foot. Considering that there are 1.25 million neonate foreskins circumcised each year in the U.S alone this translates to one of the most lucrative trades, if not THE most lucrative trade in human body parts ever in the history of humanity.
The justifiable explanations are that this newly bio-engineered skin is used for burns, persistent leg ulcers, bed sores, reconstructive surgery and other skin problems. Companies such as Advanced Tissue Sciences, BioSurface Technologies, Genzyme, Ortec International, and Organogenisis (and many others) are huge purchasers of infant foreskin tissue. The latest wonder in medical technology, Organogenesis’s Apligraf is the first and only human skin construct with FDA (Food and Drug Administration) approval. Closing wounds is what skin constructs do best thus Bio-engineering researchers want to switch to skin constructs for some of their testing. No one’s sure how these constructs work, but the statistics are incredible. Made of newborn penis-wraps (neonatal foreskin) and cow fat (bovine collagen), Apligraf placed over pernicious wounds magically heals the treated area. Almost 50 percent more wounds heal with Apligraf than with compression alone. The following is a description of what Apligraf is from their website “Apligraf is a unique biological product, containing living cells and structural (rebuilding) proteins and growth factors similar to healthy human skin. Because it is biological, the body can use the elements in Apligraf to help repair itself. As a result, Apligraf is natural and well tolerated, with no major reported side effects.” Not surprisingly, nowhere on this website is it mentioned that neonate foreskins are used for this product, preferring to say that the product contains “living cells” or that it’s a “biological” product.
Theories abound as to why newborn foreskins work so well. According to the most accepted theory, newborn skin cells can morph into any kind of skin cell, whereas adult skin cells perform a specific function, which is why skin grafting is problematic. Also, neonatal tissue hasn’t yet developed the immunity proteins that cause rejection with adult human skin. Human skin constructs certainly put a spin on the circumcision debate. Previously, parents had only weak evidence of the health benefits of circumcision, such as a lower risk of infection. Now, circumcision really does have health benefits, only it’s not the baby boys who are losing parts of their penises who benefit.
Other companies also know the value of neonate foreskins and the Cosmetics Industry has been silently taking advantage of newly circumcised babies by using the ‘fresh’ baby boy foreskins to utilise in skin rejuvenating lotions, creams and solutions because of the ability of foreskins cells to regenerate new skin cells. Cosmetics companies, such as Estee Lauder, Helene Curtis, and Mary Kay Cosmetics, use babies’ foreskins in their products. There is a product called TNS Recovery Complex by SkinMedica whose face cream costs over US$100 for a 0.63 oz bottle and is used by many high-profile celebrities (such as Oprah Winfrey and Barbara Walters) as an alternative to cosmetic surgery. It happens to be made from that discarded piece of skin that some parents opt to have removed from their newborn baby boys before they leave the hospital.
It’s been talked about enthusiastically on ‘The Oprah Show’ where it was announced that this new product which boosts collagen production and can rejuvenate skin contains an ingredient “engineered” from human foreskin cells. TNS contains an ingredient called NouriCel-MD which is the trade name for a combination of Natural Growth Factors, matrix proteins, and soluble collagen. TNS is comprised from six natural human growth factors found in normal healthy skin engineered from human foreskin. Proteins and collagen are not new but Natural Growth Factors are a new category of compounds that act as chemical messengers to turn on and off a variety of cellular activities. Human Growth Factors extracted from cultured cells of foreskin which are then “engineered” into cosmeceuticals is the same as saying the product CONTAINS human foreskin. Oprah Winfrey YOU SHOULD KNOW BETTER than to promote unethical products on your show and your website. Shame on you Oprah for using your influence to promote and advocate circumcision to make your ageing skin look good at the expense of a baby boy’s most sensitive part, his foreskin. Fighting oppression and highlighting human rights abuses have been key Oprah Winfrey themes but here you are promoting male oppression, which is incredibly shocking, disappointing and unacceptable. It makes you look like a heartless, conceited, self serving and vain cow, therefore shame, shame, shame on you Oprah Winfrey.
Circumcision is a multi billion dollar industry in North America and one doctor alone in the Lower Mainland of British Columbia claims having performed 20,000 circumcisions over the past decade, charging around $250 per procedure, which has earned this doctor an unbelievable $5 million. It is estimated that between the surgery and the foreskin’s resale value, each foreskin is worth approximately $100,000. The number crunchers estimate the developed world’s market for human-skin constructs is somewhere between $1 billion and $2 billion for the treatment of burns alone; for the treatment of chronic wounds (diabetic ulcers, pressure sores, and venous ulcers), the market is roughly $10 billion. Advanced Tissue’s flagship skin-construct, Dermagraft (described on their website as “manufactured from human fibroblast cells derived from newborn foreskin tissue”), sells for $3,000 per square foot, harvesting 250,000 square feet of Dermagraft from one foreskin alone. The math translates theoretically into a $750,000,000 transaction, which is astounding, outrageous and atrociously sickening….Is it not? Foreskin Mafia indeed! This is the sort of information that everyone especially all North Americans MUST know about to curtail and ultimately stop this outrageous scam for once and for all.
Because most baby foreskins are used in insulin production, breathable bandages, and in the cosmetics industry, one has to wonder why the sale of all other human tissue is considered illegal, or is highly regulated, yet doctors are allowed to remove healthy tissue without the patient’s consent and against all medical recommendations, and then sell it for profit in a for-profit industry. Huge amounts of money are being made in an ethical vacuum, but whose palms are getting greased? Organogenesis, Novartis (the distributors of Apligraf), and Advanced Tissue Sciences were unresponsive to inquiries, and anti-circumcision activists claim the biotech companies won’t talk to reporters about the money. John A. Erickson, owner of sexuallymutilatedchild.org an anti-circumcision web site, received an anonymous email saying the going rate for infant foreskins at a large hospital in the greater San Diego area was $35 each, and that ethical doctors deducted that amount from their circumcision fees.
“It’s rather difficult to get into the science of such a procedure when it’s not a medical issue in this country (that’s why virtually all of the med org in the developed world don’t make a recommendation either way), it’s a religious and cultural issue.”
Ah, and even more revealing is that while the AAP cannot recommend infant circumcision, it excuses it for “religious and cultural” reasons.
The bottom line is that infant circumcision has no scientific or even medical justification! Hence, no RATIONAL justification.
It seems that the obvious fact that most adults would not consent to genital amputation, especially without pain control (more than 50% of american physicians who circumcise don’t use any pain relief at all) is not enough to sway the true believers in the religion of medical infallibility. Even the long trail of the devastated victims of the admitted history of medical disasters ranging from lobotomy to thalidomide doesn’t seem to be enough to give them pause. Even now handwashing must be actively promoted in the obstetrical literature to overcome the inertia and culture of narcisissm prevalent in the medical community. It doesn’t take a medical degree to be deluded as to one’s own infallibility, but it definitely increases the damage which can result.
A fellow activist for the human rights of babies believes that the best way to change the situation is to educate fathers on what to expect and guard against in the obstetrical wards, since the mother is frequently incapable of protecting her baby. I think she’s right on.
“Frenar band”. Google it, Amy. And then consider the impact that its amputation has had on family cohesiveness in america, land of the divorcees. Then you could investigate the impact MGM has on male->female HIV transmission. (DOH!) Or do you require a double-blind study to sow some doubt? That will be coming I’m sure, but why wait when common decency demands that even the most helpless among us have human rights?
Medicine will soon be trying to disown this monster which haunts the nightmares of children.
“Thank you, untitled. You have asked almost every question that I want the pro-circumcision camp to address.
Why neonatal circumcision?
Why the double standard when dealing with male vs female genitals?
Why the double standard when it comes to religious practices? If jewish parents can perform bodily modification in the name of religion, shouldn’t parents from a minority religion be allowed to do the same?
“It certainly seems plausible that there are negative psychological consequences. Does the “pro-circ” camp have sufficient evidence to show that it is psychologically safe? Have they done rigorous testing on the psychological and emotional well-being of males who are circumcised as infants? If not, then why?”
“While merely anectdotal, I do know several circumcised men who lament their lack of choice. What would you say to these men, who had a part of their body taken from them for no good reason and can never get it back? I would say that they’ve been violated. Would you disagree? If so, then why?”
“And why do people keep pretending that the only possible biases are monetary?”
“Why continue to condone and even promote a violation of an individual’s “physical integrity” (to borrow a phrase from the WHO) that is neither ethically nor medically justified?” adding to this, why is it only a females right to physical integrity that is violated, when there are several forms of FGM that are less severe than male circumcision? Do boys not have the same basic human rights as girls?
( all quotes are from a previous post written by “untitled”.)
I would really like these questions addressed by the pro-circumcision camp. Especially Amy, since she has remained mostly silent on these issues when brought up, or has cherry picked a sentence out of an entire post three paragraphs long to respond to, avoiding these fundamental questions.”
I would still like to hear a response to these questions from someone from the pro-circumcision camp, especially from Amy Tuteur, who has yet to provide any substantial answers to these issues, although they have been brought up and asked multiple times in this thread.
I find that I may have to revise my stance on the benefits of circumcision, but the one thing I am concerned about is whether it is necessary to perform this on babies rather than at a time closer to when the benefits would be reaped (nearer the beginning of sexual activity). The only other benefit to performing the circumcision neonatally is reduction of UTIs. Is that enough to justify this procedure?
I could see that if boys were given a choice then they’d likely say “Hell, no!” I know I would have. Is that a consideration for suggesting that this be done neonatally as well?
I still don’t buy the “reduction of sexual pleasure” angle. I never used that as a reason to support not circumcising. I enjoy sex just fine as I am. I would have no way to comparing, either, so it is pointless to use this “what might have been” as an argument.
Thanks for the article, Dr. Tuteur.
“I still don’t buy the “reduction of sexual pleasure” angle. I never used that as a reason to support not circumcising. I enjoy sex just fine as I am. I would have no way to comparing, either, so it is pointless to use this “what might have been” as an argument.”
Persons who have lost body parts must grieve their loss.The first stage of grief is denial of the loss. Fitzgerald and Parkes state that “Anything that seriously impairs sensory or cognitive function is bound to have profound psychological effects, not only on the person who is affected but also on family, friends, workmates, and caregivers.” The thought of permanent loss of sensory function is so painful that persons deny their loss in order to avoid facing the painful feelings. Denial of loss causes a flight from reality. Parkes et al. state that persons in denial may minimize their loss. Circumcision causes the loss of a body part and all of its functions including a drastic loss of erogenous sensory function, so denial of loss is not uncommon in circumcised males
“I still don’t buy the “reduction of sexual pleasure” angle. I never used that as a reason to support not circumcising. I enjoy sex just fine as I am. I would have no way to comparing, either, so it is pointless to use this “what might have been” as an argument.”
So you prefer to ignore the scientific evidence?
You might wish to look up the evidence for this loss..
Taylor’s study on penile anatomy, and the Sorrel’s study on sensation and sensitivity loss.
Here is a summation..
http://www.urotoday.com/42/browse_categories/erectile_dysfunction_ed/finetouch_pressure_thresholds_in_the_adult_penis.html
Fine-Touch Pressure Thresholds in the Adult Penis l
http://www.nocirc.org/touch-test/bju_6685.pdf
“Analysis of results showed the glans of the uncircumcised men had significantly lower thresholds than that of circumcised men (P = 0.040). There were also significant differences in pressure thresholds by location on the penis (p < 0.0001). The most sensitive location on the circumcised penis was the circumcision scar on the ventral surface. It was remarkable that five locations on the uncircumcised penis that are routinely removed at circumcision had lower pressure thresholds that the ventral scar of the circumcised penis.
This study suggests that the transitional region from the external to the internal prepuce is the most sensitive region of the uncircumcised penis and more sensitive than the most sensitive region of the circumcised penis. It appears that circumcision ablates the most sensitive parts of the penis."
http://www.prweb.com/releases/2007/3/prweb512999.htm
"A new study in the British Journal of Urology International shows that men with normal, intact penises enjoy more sexual sensitivity — as much as four times more — than those who have been circumcised. Circumcising slices off more of a male's sensitivity than is normally present in all ten fingertips. "
Ignorance of, or denial of loss hardly negates that loss.
“I could see that if boys were given a choice then they’d likely say “Hell, no!” I know I would have. Is that a consideration for suggesting that this be done neonatally as well?”
If anything, that is a reason it should not be done during the neonatal period in my opinion.
How is it ethical to perform a surgery that, by your own admission, you ( and most every man, statistically speaking ) would not perform on themselves when given the free will to do so as an adult? I think that this is an extremely over looked point.
Is it ethical to perform a surgery on a baby who would most likely not choose the surgery for himself just because he is incapable of fighting back as an infant? I don’t think it is.
Removing the breast from females offers a 97-99 percent risk reduction in getting breast cancer( I linked to this statistic in a previous post if you are interested ), which affects thousands of more people than HIV does in the United States. So is it ethical to perform this surgery on infants, even when their family history puts them at an elevated risk? No, because the girl may not want the intervention. I would much prefer to be responsible and get annual screenings once I am at an age where that is beneficial than to have my breasts removed ” just in case.” Non essential breast tissue is no different than non essential foreskin. Neither is required to survive, and formula is readily available for infants.
If people believe that circumcision reduces the risk of HIV, by all means present your case to competent adults at high risk for HIV. As others have already states, babies are not having sex and there is no evidence that circumcision offers an additional benefit when done on neonates.
joep
“I think one of the big problems here with the OP is that she barely tried to address the large number of substantive issues raised but then came back to rapidly interact on a completely unrelated side point which should have been left to die.”
Exactly!
The anti-circumcision side (with whom I sympathize to an extent), might do well to avoid the following arguments (at least with a audience more interested in evidence rather than emotion):
1. There is a vast financial conspiracy for circ or baby foreskins.
2. The female genital mutilation angle (while I can see the point/analogy here to an extent, for type 1a, it just angers rather than persuades).
3. Saying anything about it being a Jewish conpiracy. While I personally agree that religion is a bias, looking at the medical history of grasping at straws to find medical justifications over the past 100 years, there is too much history of persecution of Jews and the culture/religion (and yes, it’s both). It is impossible to make this argument in a vacuum.
4. Calling it mutilation. Possibly technically true, but a word designed to invoke emotion rather than persuade.
5. Sexual feeling with or without a foreskin. I have seen studies both ways. It’s probably impossible to prove, even with adults before and after.
6. Foreskin restoration, or that circumcised men should forever be in mourning. This should go without saying.
“If anything, that is a reason it should not be done during the neonatal period in my opinion.
How is it ethical to perform a surgery that, by your own admission, you ( and most every man, statistically speaking ) would not perform on themselves when given the free will to do so as an adult? I think that this is an extremely over looked point. ”
I easily imagine that the pro circumcision lobby perfectly knows that, that’s why Amy (despite her claims in the comment section) is making the case for NEONATAL circumcision.
Circumcision only exists because it is performed on unconsenting infants or children. That’s why I’m against routine infant circumcision. If an adult male wants to be cut he can go for it, I’ve nothing agaisnt that. And it’s notable that Amy makes no mention of ethics at any point.
Well, Zoe,
since all of the points you have mentioned should not be discussed, have been discussed and been shown to be accurate, WHY do you believe they should be avoided?
All you seem to be saying is don’t confront people with the truth, they might feel offended–well, I say, if you can’t take the heat-get out of the kitchen.
If people need to be emotionally coddled to act rationally, then perhaps they might instead consider the effect on those infants they are harming rather than THEIR emotions?
Ending Circumcision:
Where Sex and Violence First Meet
by Jeannine Parvati Baker
http://www.mothersagainstcirc.org/feature.htm
Where Sex and Violence First Meet
There is another psychological benefit to keeping our sons intact. The workof Dr. Rima Laibow (1991) concludes that a man carries unconscious rage againsthis own mother for betrayal, abandonment, and the assault itself. In otherwords, the unconscious mind of the son blames his mother for his circumcision,not “the tradition,” the circumcisor, or the father who wanted the son tolook like himself–only the mother. It’s just like some bad Jewish-motherjoke.
Indeed for a newborn, his world is mother. If she cannot protect him fromviolation at the beginning, a baby loses trust. And isn’t lack of trust anissue in relationships between the genders nowadays? Can circumcision be a symptom of profound resentment between the genders? Can sexuality be healedon a very deep, unconscious level during the perinatal period?
A connection exists between crimes of sexual violence, rape for example,and circumcision. The first heterosexual encounter–with a female nurse preppingthe infant male–as well as betrayal by the mother, is revenged in sexual assaults against women. As Marilyn Milos, Founder and Director of NOCIRCsays, “Circumcision is where sex and violence meet for the first time.”
Another great review of Amy Tuteur’s article :
http://layscience.net/node/878
A great comment by Marilyn Milos (founder of NOCIRC) :
Circumcision is a primal wound and it interferes with the maternal/infant bond, disrupts breastfeeding and normal sleep patterns, and undermines the baby’s first developmental task of establishing trust. It leaves a scar on the body and the psyche of the non-consenting minor and it is an assault on the baby’s body. Circumcision is where sex and violence meet for the first time.
The Number One complaint of circumcised males in America is premature ejaculation, which occurs because the specialized, erogenous nerve endings in the foreskin that let a man know what his penis is feeling and allow him to ride the wave to orgasm are missing. Without them, a man goes “Ooh, ooh, oops! Sorry, honey, it’s because I’m so sensitive.” Nope, it’s because he lost what was rightfully his, a normal penis, with the 20,000-70,000 nerve endings that encircle the opening of the foreskin.
At the other end of life, the exposed, calloused, desensitized, glans becomes more and more difficult to stimulate. It’s no surprise that males in the US have a high rate of erectile dysfunction, and the USA has the highest sales of Viagra in the world.
You cannot alter form without altering function. When a male’s foreskin is amputated, it affects him for life and his partner’s sex life is affected as well. The mechanics of sex must be altered to compensate for what was lost. As CJ Fallier wrote in JAMA in 1970, “…the fundamental biological sexual act becomes, for the circumcised male, the satisfaction of an urge and not the refined sensory experience it was meant to be.”
Circumcision is not a medical issue, it is a human rights issue. We protect females from genital cutting in the USA and it’s time we protect our males as well.
To return to the FGM/double-standard issue for one moment (sorry Zoe!), Annabel misunderstood my point upthread.
Firstly, there clearly IS a “double standard” with regard to Type Ia FGM and male circumcision, insofar as they involve the removal of morphologically, developmentally equivalent biological structures, and are done for similar reasons (control of sexuality, group marking, initiation/lifecycle ritual). Legistlative efforts to limit the rights of parents to make irreversible decisions for their children, should be restricted to those issues where there is clear evidence of harm. No such evidence exists for Type Ia FGM specifically, as distinct from FGM in general, even if Type Ia FGM can be shown to originate in sexist precepts. Much parenting practice is sexist, without being criminal. Indeed, it could be argued, that the symbolic/literal inclusion of male infants in a convenant by marking on the body, with not equivalent for female infants is also sexist. It follows that there is a strong case that the law has no business in regulating Type Ia FGM.
However (and this was my point that Annabel missed), you don’t need a conspiracy theory to explain why the double standard exists. You merely need to look at the pragmatic law-making issues involved in FGM and male circumcision.
In the case of FGM, law-makers confronted a continuum of practice, in which the least damaging type (type Ia) was very marginal (maybe 99%+ of male genital modification is Type Ia equivalent. If that had been the case for female genital modification, I doubt that concerted international pressure to end the practice would exist.
“Well, Zoe,
since all of the points you have mentioned should not be discussed, have been discussed and been shown to be accurate, WHY do you believe they should be avoided?
All you seem to be saying is don’t confront people with the truth, they might feel offended–well, I say, if you can’t take the heat-get out of the kitchen.
If people need to be emotionally coddled to act rationally, then perhaps they might instead consider the effect on those infants they are harming rather than THEIR emotions?”
LOL… rational you are not.
Sorry, but you guys sound almost as loony as the “cut every American newborn male” people. It enables people to completely disregard any real point that you manage to make among the insane rants.
oops, scrub that last paragraph. It should have read:
In the case of FGM, law-makers confronted a continuum of practice, in which the least damaging type (type Ia) was very marginal (maybe 99%+ of male genital modification is Type Ia equivalent. If that had been the case for female genital modification, I doubt that concerted international pressure to end the practice would exist.
oops, scrub the last paragraph of my last comment. It should have read:
In the case of FGM, law-makers confronted a continuum of practice, in which the least damaging type (type Ia) was very marginal (maybe 99%+ of male genital modification is Type Ia equivalent. If that had been the case for female genital modification, I doubt that concerted international pressure to end the practice would exist.
About the “evidence” circumcision prevents HIV by 57% :
http://www.doctorsopposingcircumcision.org/info/HIVStatement.html
WordPress is treating my comments very strangely.
One last try..
oops, scrub that last paragraph. It should have read:
In the case of FGM, law-makers confronted a continuum of practice, in which the least damaging type (type Ia) was very marginal (maybe less 1%). In practice, removal of the foreskin constitutes close to 100% of all male genital modification. In the case of FGM, the existence of a ‘loophole’ permitting Type Ia might hinder the erradictation of Types Ib, II & III – which constitute the overwhelming majority of FGM. In the case of male circumcision, none is equivalent to Type Ib, II & III, therefore similar pragmatics (banning Type Ia to assist in the eradication of Types Ib, II & III) do not apply. The references to “Yemeni circumcision” etc in an attempt to demonstrate that male genital modification goes beyond removal of the foreskin refer to a single case report from the 1920s, and not to current widespread practices. I think anyone would accept that more than 99% of male genital modification is Type Ia equivalent. If that had been the case for female genital modification, I doubt that concerted international pressure to end the practice would exist.
Aha! Don’t use “more than” “less than” signs in your comments, folks.
“LOL… rational you are not.
Sorry, but you guys sound almost as loony as the “cut every American newborn male” people. It enables people to completely disregard any real point that you manage to make among the insane rants.”
So this is how you handle reality?–name-calling and this provides you with an excuse to dismiss the evidence and facts.
Speaking of being rational, can YOU provide a rational justification for infant circumcision, or is name-calling and dismissal all you can conjure up?
“In the case of FGM, law-makers confronted a continuum of practice, in which the least damaging type (type Ia) was very marginal (maybe less 1%)”
Do you have any evidence to support this claim ?
Where did you that type Ia is very marginal (<1%) ?
Did you know, that in Indonesian female circumcision, the mutilation is minimal? It's true. The NY times released this article a couple of years ago:
http://www.nytimes.com/2008/01/20/ma…mcision-t.html
A more extreme version of the practice, known as Pharaonic circumcision or infibulation, accounts for 15 percent of cases globally and involves the removal of all external genitalia and a stitching up of the vaginal opening.
Studies have shown that in some parts of Indonesia, female circumcision is more ritualistic — a rite of passage meant to purify the genitals and bestow gender identity on a female child — with a practitioner rubbing turmeric on the genitals or pricking the clitoris once with a needle to draw a symbolic drop of blood. In other instances, the procedure is more invasive, involving what WHO classifies as “Type I” female genital mutilation, defined as excision of the clitoral hood, called the prepuce, with or without incision of the clitoris itself.
The amount of flesh removed, if any, was alternately described by circumcisers as being the size of a quarter-grain of rice, a guava seed, a bean, the tip of a leaf, the head of a needle.
“In the case of FGM, law-makers confronted a continuum of practice, in which the least damaging type (type Ia) was very marginal (maybe 99%+ of male genital modification is Type Ia equivalent. If that had been the case for female genital modification, I doubt that concerted international pressure to end the practice would exist.”
Even so, the media and public outrage when the Somalian parents wanted doctors to perform just a ceremonial pin prick on their daughter is clearly a bias. It was deemed illegal and doctors would not perform it. People claimed it violated a child’s right to physical integrity. Imagine if they wanted the clitoral hood removed from their daughter, which is analogous to removal of the male foreskin, for religious reasons? It would never be legally allowed in the United States, even though Jewish parents can circumcise their son for religious reasons. I am not convinced that even if the only type of FGM was removal of the clitoral hood that it would be legal. It is not the social norm in the United States so we view it is a heinous crime, even though it is analogous to male circumcision.
Recommendations of routine infant circumcision require clear evidence of benefit. The onus is on proponents to provide the evidence.
Calls to prohibit infant circumcision require clear evidence of harm. The onus is on proponents of prohibition to provide the evidence.
It seems to me that Zoe was merely trying to define the terrain of rational debate which focusses on these issues.
Circumcision (male or female) is an obvious form of violence and it hurts like hall. The fact one procedure is worse than another one doesn’t make the latter OK.
There’s an obvious double standart :
http://blogs.myspace.com/index.cfm?fuseaction=blog.view&friendID=1000579069&blogID=317371456
Both male and female traumatize young children, do you see any difference ? :
http://blogs.myspace.com/index.cfm?fuseaction=blog.view&friendID=1000579069&blogID=350337158&Mytoken=626220D0-2193-48A4-A4D2B818991698EF160410465
http://blogs.myspace.com/index.cfm?fuseaction=blog.view&friendId=1000579069&blogId=422594729
It is not the social norm in the United States so we view it is a heinous crime, even though it is analogous to male circumcision.
++++++++++
And I agree with you, that is an irrational and mistaken response.
This was my second comment upthread (some several 100s comments ago).
“One can see why from a legal perspective: if you allow Type Ia, then you can going to see a lot of intentionally ‘botched’ procedures to get around the law, especially given that Type Ia has always accounted for a small percentage of procedures amongst a much more damaging continuum. However, from a scientific standpoint, Type Ia in women is a exact analogue of the removal of the male foreskin, so it is worth asking ourselves (especially those of us who have circumcised our sons!) why we are content for this procedure (Type Ia) to be criminalised.”
I think we are content (beyond the pragmatics of law-making) for exactly the reasons you suggest, i.e. cultural familiarity/prejudice/ethnocentrism.
Circumcision (male or female) is an obvious form of violence and it hurts like hall. The fact one procedure is worse than another one doesn’t make the latter OK.
There’s an obvious double standart :
http://blogs.myspace.com/index.cfm?fuseaction=blog.view&friendID=1000579069&blogID=317371456
Both male and female traumatize young children, do you see any difference ? :
http://blogs.myspace.com/index.cfm?fuseaction=blog.view&friendID=1000579069&blogID=350337158&Mytoken=626220D0-2193-48A4-A4D2B818991698EF160410465
http://blogs.myspace.com/index.cfm?fuseaction=blog.view&friendId=1000579069&blogId=422594729
“especially given that Type Ia has always accounted for a small percentage of procedures amongst a much more damaging continuum. ”
Where did you see that ?
I would like some proof to support your claims
I’ve already shown an article from NYtimes which goes against your claims.
Male or female circumcision is an obvious form of violence and it hurts like hall. The fact one procedure is worse than another one doesn’t make the latter OK.
There’s an obvious double standart :
http://blogs.myspace.com/index.cfm?fuseaction=blog.view&friendID=1000579069&blogID=317371456
Both male and female traumatize young children, do you see any difference ? :
http://blogs.myspace.com/index.cfm?fuseaction=blog.view&friendID=1000579069&blogID=350337158&Mytoken=626220D0-2193-48A4-A4D2B818991698EF160410465
Zoe237: “LOL… rational you are not.”
You’ve made a rather arbitrary list of things we’re not allowed to talk about without justifying why we’re not allowed to talk about them. Simply calling us irrational for not agreeing with you does not get us anywhere. Please explain in more detail why you think those particular lines of reasoning are not valid.
Regarding the FGM and MGM comparisons: It has already been demonstrated that both are umbrella terms covering a wide variety of practices. Circumcision is only one type of MGM, while arguably less extreme forms of FGM have been discussed above, which are notably illegal. Insisting that we reserve the term “genital mutilation” for all forms of FGM but not for circumcision seems to me both flippant and sexist.
Nick – Rima Laibow is insane/sociopathic and probably the worst source you could use to support your argument. As is her husband, General Stubblebine (who is responsible for some of the torture techniques used in various American wars, was a key player in the military/woo insanity book/film The Men Who Stare At Goats is based upon and is behind all kinds of weird new agey astroturf activism and other assorted weirdness and atrocities). Incidentally, there were also key Scientologists involved in the military/woo insanity and Rima Laibow’s main agenda is totally aligned with Scientology’s anti-science agenda). Sometimes truth really is stranger than fiction. Nick, by using her as your chosen expert, you’ve pretty much aligned yourself with the quackiest of quacks. Not only are they sketchy on the new age and Scientology tip but they’re military torture, disinfo, mind control sketchy. Oh, and of course she pushes vitamin cures just like Scientology, which her and Stubblebine sell on their site.
http://forums.whyweprotest.net/8-education-research-inside-reports/conspiracy-lady-dr-rima-laibow-scilon-43230/
For some reason your link doesn’t give me access to the NY Times article, but I would refer you to the WHO on this subject. But do remember that Type I FGM includes both Type Ia and Ib, they are not the same thing, and only Type Ia is equivalent to male circumcision. The WHO changed their typology in 2007 to reflect a better understanding of practice.
Type I: Excision of the prepuce, with or without excision of part or the entire clitoris. (WHO typology 1995)
Type I: Type I: Partial or total removal of the clitoris and/or
the prepuce (clitoridectomy). (WHO typology 2007)
I refer you to the rationale for the change in typology.
“Comments on the modifications to the 1995 definition of Type I
The reference to the clitoral prepuce is moved to the end of the sentence. The reason for this change is the common tendency to describe Type I as removal of the prepuce, whereas *this has not been documented as a traditional form of female genital mutilation.* However, in some countries, medicalized female genital mutilation can include removal of the prepuce only (Type Ia) (Thabet and Thabet, 2003), but this form appears to be relatively rare (Satti et al., 2006). *Almost all known forms of female genital mutilation that remove tissue from the clitoris also cut all or part of the clitoral glans itself.*” WHO, 2008
Circumcision is only one type of MGM
++++++++++++
Please describe the other types which are currently widespread. What is their prevalence vis-a-vis circumcision?
Plonit,
Here’s the link (it should work now) :
http://www.nytimes.com/2008/01/20/magazine/20circumcision-t.html
“A more extreme version of the practice, known as Pharaonic circumcision or infibulation, accounts for 15 percent of cases globally and involves the removal of all external genitalia and a stitching up of the vaginal opening.”
“Studies have shown that in some parts of Indonesia, female circumcision is more ritualistic — a rite of passage meant to purify the genitals and bestow gender identity on a female child — with a practitioner rubbing turmeric on the genitals or pricking the clitoris once with a needle to draw a symbolic drop of blood. In other instances, the procedure is more invasive, involving what WHO classifies as “Type I” female genital mutilation, defined as excision of the clitoral hood, called the prepuce, with or without incision of the clitoris itself.”
“The amount of flesh removed, if any, was alternately described by circumcisers as being the size of a quarter-grain of rice, a guava seed, a bean, the tip of a leaf, the head of a needle.”
Thanks for the OPINION of WHO, but until and unless people can PROVE that somehow MGM is COMPLETELY harmless, all the terminology does not justify the banning of FGM and allowing MGM.
THAT is the ethical foundation that all must address, and so far, none have done so.
Nick – Rima Laibow is insane/sociopathic and probably the worst source you could use to support your argument.
I can give you other sources :
http://www.circumstitions.com/Nursing.html
And I don’t think Rima Laibow is more sociopathic than all these American circumcision evangelists. These individuals seem to have a fixation with promoting and performing circumcisions. Perhaps the next study should be of these researchers’ brains, to discover why they have such an unhealthy fascination with cutting off healthy foreskins from others. It almost borders on pathological!
“Calls to prohibit infant circumcision require clear evidence of harm. The onus is on proponents of prohibition to provide the evidence.”
This part has been satisfied–Taylor and Sorrels.
Now we are still waiting for this..
“Recommendations of routine infant circumcision require clear evidence of benefit. The onus is on proponents to provide the evidence.
“Calls to prohibit infant circumcision require clear evidence of harm. The onus is on proponents of prohibition to provide the evidence.”
http://www.nospank.net/fleiss1.htm
Studies have shown that in some parts of Indonesia, female circumcision is more ritualistic
++++++++++
Firstly, there is no citation to those studies in the NY Times report. Secondly, they do not distinguish between Type Ia and Type Ib. Thirdly, the significance of the removal of a “rice grain/bean/guava pip etc…” of the clitoral glans tissue would vary according to the age of the child on which the procedure was performed. I refer you to the WHO report cited above, and ask whether your NY Times article refutes it.
Finally, the fact that “in some part of Indonesia” female circumcision is more ritualistic doesn’t undermine the assertion that Type Ia is totally marginal and hardly practised, since “some parts of Indonesia” constitute only a small part of the population in which FGM of some type is practised.
unless people can PROVE that somehow MGM is COMPLETELY harmless
+++++++++
Impossible. NOTHING can be PROVED to be completely harmless. Even participating in a web-based comment thread can be harmful.
“Circumcision is only one type of MGM
++++++++++++
Please describe the other types which are currently widespread. What is their prevalence vis-a-vis circumcision?”
Gee, who now is trying to limit the evidence?
The mere existence of different forms of MGM is sufficient to discredit the double standard–magnitude or prevalence is irrelevant..and using the word”circumcision” in no way alters the basic concept. All one needs to do is call all forms of FGM “circumcision, and this vanishes in a puff of smoke.
“I still don’t buy the “reduction of sexual pleasure” angle. I never used that as a reason to support not circumcising. I enjoy sex just fine as I am. I would have no way to comparing, either, so it is pointless to use this “what might have been” as an argument.”
Nick:
“Persons who have lost body parts must grieve their loss.The first stage of grief is denial of the loss. ”
You honestly expect people to take you seriously when you claim that the vast majority of American men *should* be mourning their lost foreskin? This is exactly the kind of insanity I’m talking about.
I never said that people couldn’t talk about arguments like this or that they weren’t valid (necessarily). Just don’t expect any people (particularly circumcised males who are investigating the issue for their sons) to believe you. My husband and I chose not to circumcise our sons, but not because of hysterical arguments about the lost primal foreskin.
I will not respond again. Obviously, mine was a subjective list. I only believe that there are more effective, reasonable arguments against infant circumcision.
“unless people can PROVE that somehow MGM is COMPLETELY harmless
+++++++++
Impossible. NOTHING can be PROVED to be completely harmless. Even participating in a web-based comment thread can be harmful.”
EXACTLY my point..hence the double standard that FGM is not acceptable and MGM is.
magnitude or prevalence is irrelevant
++++++++
It is not irrelevant to the legislative approach (see comments upthread).
The vast majority of FGM can be shown to be harmful, and, on balance FGM has been shown to be harmful.
If some sub-types that have not been shown to be harmful, then there is a pragmatic legal question as to whether permitting the practice of this sub-type of FGM undermines efforts to erradicate demonstrably harmful types. I’m willing to be persuaded in either direction on this question, according to the evidence.
“You honestly expect people to take you seriously when you claim that the vast majority of American men *should* be mourning their lost foreskin? This is exactly the kind of insanity I’m talking about.
Zoe, where have you been spending your time?
perhaps you are not aware of this?
http://www.noharmm.org/synopsis.htm
http://www.noharmm.org/bodyimage.htm
http://www.noharmm.org/bju.htm
This survey indicated there are 52 million men in the US that are dissatisfied with their circumcision. This number almost exactly duplicates a study in Journeyman in 1992. It must be fairly accurate.
192 respondents (average age 44 years,85% circumcised
circumcised intact
Satisfied 38% 78%
Dissatisfied 20% 3%
Ambivalent 41% 17%
“I will not respond again. Obviously, mine was a subjective list. I only believe that there are more effective, reasonable arguments against infant circumcision.”
There sure are, and they have been presented, but some irrational people refuse to accept the evidence for them. Some need a clue by four upside their heads.
Finally, the fact that “in some part of Indonesia” female circumcision is more ritualistic doesn’t undermine the assertion that Type Ia is totally marginal and hardly practised, since “some parts of Indonesia” constitute only a small part of the population in which FGM of some type is practised.
But you didn’t show any real evidence either. And the male foreskin is much bigger and has far more nerve endings (about 20,000) than the clitoral hood.
Plonit, I was referring to an earlier post by Robert Samson. I don’t know the prevalence, but I don’t see why that matters.
My point is this: I don’t see any way to construct a clear and consistent definition of the term “genital mutilation” that admits all currently recognized forms of FGM while omitting circumcision, without making explicit mention of gender.
And what about this article ? :
http://www.newscientist.com/article/dn2837
“The vast majority of FGM can be shown to be harmful, and, on balance FGM has been shown to be harmful.
If some sub-types that have not been shown to be harmful, then there is a pragmatic legal question as to whether permitting the practice of this sub-type of FGM undermines efforts to erradicate demonstrably harmful types. I’m willing to be persuaded in either direction on this question, according to the evidence.”
It has? Where is there any scientific study proving this, so far all I have seen is a facile ASSUMPTION of harm? I know of no study confirming harm, but I know of some studies showing harm from MGM.
Where is the harm in a pinprick?
And again, none of these attempted qualifications justifies the double standard.
Yup. Stubblebine is about as far into the woo as it’s possible to get, and so is Rima Laibow–proof positive that right wingers can be just as woo-prone as the left-wing New Agey types. He heads up an entire organization dedicated to “health freedom,” or, as I like to call it, the freedom of quacks from any pesky interference from the government. You know, come to think of it, one of us here ought to do a post about Stubblebine and Raibow.
And about tattoos ?
http://www.bvblackspin.com/2010/01/05/parents-face-charges-for-tattooing-six-of-their-young-children
Why parents are facing child cruelty for tattooing a child when neonatal circumcision doesn’t seem to disturb most people ?
Tattoos are less invasive and painful than circumcision. It doesn’t remove any erogenous and healthy tissues. Why parents are allowed to cut off part of their male children’s genitals when tattooing is child cruelty ? Not to mention, children gave their consent.
Instead of finding new excuses to legitimize circumcision, parents should recognize it for what it is: a violation of the
human rights of their son, a violation of their genital integrity, a
violation of every person’s sovereignty of his own body. It should be a decision each male is allowed to decide as an adult (like tattoo).
Nick, you’ve wandered so far into the weeds I’m not sure you’d know what the path looked like even if you were on it. Do you have some kind of weird head thing going on because mommy took your foreskin away?
“Circumcision is a primal wound and it interferes with the maternal/infant bond, disrupts breastfeeding and normal sleep patterns, and undermines the baby’s first developmental task of establishing trust. It leaves a scar on the body and the psyche of the non-consenting minor and it is an assault on the baby’s body. Circumcision is where sex and violence meet for the first time.”
Yeah, and all penetration is rape, too.
A strong ethical case can be made for delaying circumcision until the informed consent of the foreskin’s life support entity is obtained. But you sure aren’t making it.
Nick – “And I don’t think Rima Laibow is more sociopathic than all these American circumcision evangelists. These individuals seem to have a fixation with promoting and performing circumcisions.”
Hmmm, well one person’s crazy doesn’t negate another person’s crazy. (And quite honestly both the “procirc” and “anticirc” sides seem to be ideologues and need each other, as extremists that avoid reality based thinking in favor of ideologies generally do.) The fact that you think one extreme of crazy negates the other pretty much discredits your argument again, as well as showing that you actually have no interest in good science and medicine and are happy to align yourself with Scientologists, people who invent ways to torture other people, seriously sketchy military types and dangerous pseudomedical quacks as long as you think what they’re saying supports your ideological position. Your polarized and clearly anti-science stance does absolutely nothing to further rational discussion about the ethical implications of circumcision, the cost/benefit analysis of it as a medical procedure or to actually discount the people you’re arguing against.
Besides, Stubblebine and Laibow aren’t activists, they’re propagandists /marketers and disinfo agents (I’d assume mainly for personal profit and because they’ve heavily invested in tin foil, alongside selling Big sCAM quackery on their site). They actively and directly profit off the disinfo they promote and fearmongering.
It has? Where is there any scientific study proving this, so far all I have seen is a facile ASSUMPTION of harm?
++++++++++++
For harm of FGM, see the WHO 2008 report already linked to. Annex 5 is a summary of the health complications, with citations to research studies. I think these research studies need to be discussed dispassionately and impartially, and if you think they are wrong – then let’s discuss that. In particular, I think the difference in chronic health complications and increased risk in childbearing arising from FGM need to be considered.
What are the chronic health consequences that arise from male circumcision/MGM? Are there increased risks reproductive risks to men arising from being circumcised?
David Gorski – “Stubblebine is about as far into the woo as it’s possible to get, and so is Rima Laibow–proof positive that right wingers can be just as woo-prone as the left-wing New Agey types. He heads up an entire organization dedicated to “health freedom,” or, as I like to call it, the freedom of quacks from any pesky interference from the government. You know, come to think of it, one of us here ought to do a post about Stubblebine and Raibow.”
I’d love it if one of you did, they seem to be behind a lot of disinfo and it’s such a weird story – particularly the covert Scientology connection. My (subjective, of course) observation is that Left/Right is a false dichotomy at this point, it’s really about reality-based thinking versus fantasy-based thinking. After all, Senators Kennedy and Orrin Hatch often worked together to promote woo (and there’s similar bipartisan support of Big Pharma and the insurance industry). It’s a bit like how the Big Pharma vs Big sCAM dichotomy is a false dichotomy that serves both well in that it obscures what’s really going on, which is industry promoted pseudoscience vs good science. It makes it a battle of ideologies and polarizes people around emotional ideologies instead of asking what the reality is and who or what our governments are serving if it’s not “we the people”.
Kudos to “untitled” who posted on 08 Jan 2010 at 11:56 pm, saying, “Your defenses are beginning to cast serious doubt on your objectivity.” and much more.
I know that took a long time to put together, especially as it’s taking me a long time to study it, and appreciate your effort.
There are a few things you suggest that we don’t know at all, and yet for specific individuals, we can and do know more than that. Plus, circumcision has been forced on males of all ages, and we have reports from these victims, which can be tied together by the age of the victim at the time of circumcision. We also have men who learned what was done to them at various ages, and have trauma that they can articulate based on that discovery alone.
There really is a lot more we could know if we just open our eyes.
We also need to educate men as to exactly what the foreskin is, and what was done to them. Most do not know, and indeed, too many think they were not cut. The ignorance is part of what keeps circumcision in place, so it has not been in the interest of physicians in doing this. Call it monetary, Stockholm, or whatever, it’s what happens. Fortunately, now we have the internet, and that is changing. My web pages on circumcision and foreskin restoration were the first ones to be found on the WWW.
Listen to the victims, and that includes more than just those that get cut.
“The fact that you think one extreme of crazy negates the other pretty much discredits your argument again, as well as showing that you actually have no interest in good science and medicine and are happy to align yourself with Scientologists, people who invent ways to torture other people”
@fiffy :
I didn’t know about personal conviction of Rima Laibow, is that OK?
I also put other studies showing how circumcision is disturbing for a newborn and consequently for the future adult.
You are talking about torture ?
Please explain me how neonatal isn’t torture ?
Despite AAP recommandations, it’s usually not even done with anesthetics, and if you do a respiratory response analysis of a baby boy during a circumcision his heart rate reaches 180 beats per minute and his cortisol levels rise to around 300 nanmoles per liter, which are levels you would expect from a torture victim.
And circumcision has nothing to do with medecine (unless there’s a valid medical reason). It’s a bloody ritual that has become medicalized for the last 150 years. Please read hostory of circumcision in US, it’s almost comical. You may find different studies showing “health” benefits but so far empirical evidence shows that none of the alleged benefits for circumcision manifest in the real world. One telling example : US has both the highest rates of HIV and circumcision among industrialized world.
Nick: “Why parents are allowed to cut off part of their male children’s genitals when tattooing is child cruelty?”
I can tell you in one word: Tradition!
(Sorry, I couldn’t resist.)
This article is not up the standards of Science Based Medicine. As mentioned earlier, it appears newborn circumcision is this author’s Sacred Cow. The ad hominem arguments in the text are actually tame compared those made earlier and competently responded to here:
http://www.rollingdoughnut.com/2009/04/if_you_cant_beat_them_resort_t_1.html
I would like the author to address the arguments made recently by major medical associations in Canada and Australia. They have seen the same data, they reject newborn circumcision on medical grounds, and they extensively question the ethics of irreversibly removing body parts from a healthy, normal child who cannot consent.
The Dr. has still not explained why a surgery with risks and potential benefits to sexually active adults should be performed on newborns who cannot consent.
“A visitor from outer space might be forgiven for concluding that the most important part of the human body is the foreskin. It is, after all, the only part of the body that has multiple organizations devoted to its preservation in the natural state.”
What else is routinely amputated for no reason? (Even if you are correct that there are now valid medical reasons for this admittedly minor amputation, those are quite recent results. We’ve been doing this for no valid reasons for a long, long time.)
“If you don’t want to circumcise your sons, don’t do it. If you don’t think the benefits outweigh the risks, don’t do it. Just don’t claim that there are no medical benefits when there are real benefits.”
But there aren’t any medical benefits for children. All the benefits you cite are about STIs. You did not address why this is even a question for the parents at all. Seriously, WTF?
Nick – “I didn’t know about personal conviction of Rima Laibow, is that OK?”
That’s exactly what discredits you, you have no idea about the sources you’re presenting and claiming are scientific evidence that support your argument. It makes it obvious you’re an ideologue and not interested in reality but promoting a particular viewpoint your emotionally attached to.
Btw, your credibility isn’t enhanced by making up new names for people. I recognize it’s a common internet trolling tactic – as well as being a popular arguing strategy amongst five year olds – but all it does is make you look silly and juvenile and at a loss to make a real argument. I mean, go ahead if that’s the best you’ve got but I’d hardly have called myself something as silly as Fifi if my ego was all wrapped up in my internet pseudonym. Apparently your ego IS very tied up with the ideology you’re promoting and the idea of yourself as some grandiose victim.
You promote torturers and quacks and then wail about how others don’t see how circumcision is torture. It may well be cruel and painful – the evidence really isn’t in on that yet – it’s not torture. Once again you’re coming off as irrational and as someone who is really just using this as an excuse to claim victimhood. How many failures in your life do you blame on the lack of a foreskin? One of the things I greatly admire about women who have been subjected to female circumcision (often held down by female relatives) and who speak publicly about it is that they are empowered survivors who are most definitely getting on with their lives. They’re brave women who aren’t looking for pity or making false comparisons vis a vis other people’s suffering but are rather doing practical things to help other girls.
(The only other vaguely comparable preventative procedure that comes to mind is the HPV vaccine… but that causes no physical damage, and 12 != infant.)
This has been a very interesting discussion in the comments. The original post, however, was a complete and utter waste and a slap in the face to the mission of this blog. While there is undoubtedly some scientific evidence that circumcision may provide POTENTIAL benefits, there are also studies that contradict circumcision’s benefits. The book is not closed on any circumcision’s supposed benefits, so to slam those who are skeptical of the hype of circumcision’s protective benefits from HIV as “foreskin fetishists” belies a closed mind and an ideologue.
Dr. Amy Tuteur has an axe to grind on the subject of neonatal circumcision and this post is just another of her self-admitted campaign to provoke and stir controversy.
http://open.salon.com/blog/amytuteurmd/2009/10/17/dr_amy_was_mean_to_me
She aims to emulate the incendiary styles of Ann Coulter and Rush Limbaugh, and by her own admission, she conjures up provocative headlines to elicit exactly the type of response this post has gotten. Which makes her seemingly innocent claim that she merely borrowed the headline from the paper she cited a flat out joke. She knew what she was doing and she has gotten exactly the response she wanted.
Those expecting an answer to the reasoned challenges put forth to Dr. Tuteur to explain exactly HOW the AAP recommendation should be changed and why the HIV studies make neonatal circumcision an imperative, will likely not get an answer. That would put her out of her “online persona.”
“Hmmm, well one person’s crazy doesn’t negate another person’s crazy. (And quite honestly both the “procirc” and “anticirc” sides seem to be ideologues and need each other, as extremists that avoid reality based thinking in favor of ideologies generally do.)”
Intactivists have no need to justify their position. Opponents of circumcision have no axe to grind. They have no reputations or careers to protect. They do not reap huge profits by engaging in unethical practices. Those who promote ethical and legal practices have no need to be accountable for their words and actions. Their aim is to protect the rights and interests of those who are unable to defend themselves. They are to be commended and supported for their actions and should not be subjects of ridicule, which appears to be the norm today. It is those who advocate or perform circumcisions who need to justify their perverted activities.
“That’s exactly what discredits you, you have no idea about the sources you’re presenting and claiming are scientific evidence that support your argument. It makes it obvious you’re an ideologue and not interested in reality but promoting a particular viewpoint your emotionally attached to.
Btw, your credibility isn’t enhanced by making up new names for people. I recognize it’s a common internet trolling tactic – as well as being a popular arguing strategy amongst five year olds – but all it does is make you look silly and juvenile and at a loss to make a real argument. I mean, go ahead if that’s the best you’ve got but I’d hardly have called myself something as silly as Fifi if my ego was all wrapped up in my internet pseudonym. Apparently your ego IS very tied up with the ideology you’re promoting and the idea of yourself as some grandiose victim. ”
Do you know what projection means in psychology ?
It is the unconscious act of denial of a person’s own attributes, thoughts, and emotions, which are then ascribed to the outside world, such as to the weather, the government, a tool, or to other people (like me in this particular case). Thus, it involves imagining or projecting that others have the same feelings or motives, rather than what they really think.
It applies perfectly for you.
Do you have any idea of the sources coming from pro circ lobby? I have shown you that these “studies” are of questionable value for many reasons.The first being that the authors, especially Robert Bailey, are known circumcision evangelists. It doesn’t take a great genius to see the obvious conflict of interest.
Also just google “circumcision”. There are millions of results. Do you know ALL the authors of different studies ?
“You promote torturers and quacks and then wail about how others don’t see how circumcision is torture. It may well be cruel and painful – the evidence really isn’t in on that yet – it’s not torture. Once again you’re coming off as irrational and as someone who is really just using this as an excuse to claim victimhood. How many failures in your life do you blame on the lack of a foreskin?”
What is your obsession about claiming I promote torture (except the fact I show a study coming from a debatable source that I wasn’t aware of) ? I already responded to you about that and show you other studies proving the exact same results.
Sorry but neonatal circumcision is torture. It is exaclty what it is.
Have you ever seen a video of circumcision ?
Please watch this and tell me how it isn’t torture ?
http://video.google.co.uk/videoplay?docid=5933355699286047639&ei=7A1JS8nbKsSp-AbTjuysCg&q=circumcision&hl=fr&view=3#
You claim I’m coming off as irrational ? How is it irrational to defend a man’s right to choose for himself what he wants to do with his penis ?
How is it rational to remove healthy and erogenous tissues from a baby without his consent ?
“I greatly admire about women who have been subjected to female circumcision (often held down by female relatives) and who speak publicly about it is that they are empowered survivors who are most definitely getting on with their lives. They’re brave women who aren’t looking for pity or making false comparisons vis a vis other people’s suffering but are rather doing practical things to help other girls.”
Good for you.
90% of the world’s population already lives under laws banning FGM with no religious exemption. A male is more than 5 times as likely as a female to be missing sexual parts due to non-therapeutic genital cutting.
Cutting women is bad but cutting men is good? You should have your heads examined. The American idea that there is something congenitally wrong with the human penis is madness.
Keep reading pseudo scientific articles promoting male genital mutilation and tell yourself that what you’re doing is sane and ethical. Maybe some day you’ll grow up and join the rest of the civilized world. Well, shamble on in your blissful ignorance.
It’s obvious that you make the deliberate choice to be in denial. There’s nothing I can do about that but maybe your doctor can help you (and don’t take it personally, I would be very happy if you could find some psychological help because judging by your posts it’s obvious you need some).
Sunkenship – Well said. As a woman, I find it particularly disappointing to see this coming from another woman when there are so many brilliant and ethical women working in science and medicine who are very much defenders of science-based medicine.
Nick – “Intactivists have no need to justify their position. Opponents of circumcision have no axe to grind. They have no reputations or careers to protect. They do not reap huge profits by engaging in unethical practices.”
Ah, jargon and making a position into an identity, once again you’re revealing your an ideologue and not actually interested in science. Clearly you’ve constructed an identity for yourself around being an “intactivist” and a “victim of torture”, you’re gaining an identity as an “ist” rather than just being another person. You’ve been grinding axes here from the start, it’s pretty much all you’ve done.
All those links you posted as “evidence” – particularly the one to Rima Laibow – are people who profit professionally and monetarily from promoting a certain ideological perspective and selling things. They reap huge profits from engaging in unethical practices and promoting pseudoscience. In fact, you’re personally so unethical and out to gain (narcissistic gain is still gain) – and anti-science – that you don’t even recognize when people are making sane arguments against circumcising infants and you’re damaging the case for what you claim to care so deeply about. Why? Because it’s not actually about protecting anyone else for you or having a rational discussion based on evidence, it’s all about positioning yourself as a victim and your self interest.
Nick – “Those who promote ethical and legal practices have no need to be accountable for their words and actions.”
Wow…. The very essence of being ethical is being accountable for one’s words and actions. Something you’re clearly not willing to be. As someone who has engaged in much real activism for human rights, I can tell you that being accountable and ethical is essential if we’re calling upon others to be accountable and ethical.
You’re making yourself appear ridiculous, partly by refusing to be accountable for your words and actions. And you’re not fooling anyone into believing you’re being heroic when it’s obvious you’re all about your own drama and identity as a victim.
Nick – You really are stupendously dense aren’t you? I’ve been consistently arguing that unnecessary surgery on infants isn’t ethical and that circumcision (and all body modification) should be an adult choice. As are other people here who you’ve gotten all in a lather about. Clearly you’re just here seeking attention (that would be your narcissistic gain at work again) and to make grandiose claims about your personal victimhood. You do a great disservice to people who actually are championing the rights of children, something you’re clearly not actually doing. It’s a bit pointless continuing to converse with you since it clearly just fills your me-me-me agenda for being here.
“Ah, jargon and making a position into an identity, once again you’re revealing your an ideologue and not actually interested in science. Clearly you’ve constructed an identity for yourself around being an “intactivist” and a “victim of torture”, you’re gaining an identity as an “ist” rather than just being another person. You’ve been grinding axes here from the start, it’s pretty much all you’ve done.”
Woaaa you are really a hard nut to crack or you don’t get my point. I’ve already told you that I strongly believe that circumcision has nothing to do with science for 4 major reasons :
FIRST (I agree this is just MY opinion) : we are talking about NEONATAL circumcision and not adult circumcision. How ethical would it be to perform circumcision on adults without their informed consent because it might prevent HIV by about 50% ? How is it more ethical to perform this surgery on babies ?
SECOND : You want me talk about science ? So far, there’s NO evidence or proof that circumcision prevent HIV by X%. Studies aren’t scientific proof. The entire set of studies are based on the hunch that somehow HIV transmission is facilitated through Langerhans cells found in the foreskin. However this is a very debatable hypothesis. I’ve already posted a scientific study showing that these Langerhans cells fight against HIV :
http://www.circumcisionandhiv.com/files/de_Witte_2007.pdf
There’s nothing conclusive so far.
THIRD : There’s ac ompulsive obsession and fixation by certain researchers to try to discredit the existence of a normal part of the male anatomy for almost 170 years in US. Have you studied the history of circumcision in US ?
http://www.youtube.com/watch?v=srGTtm56R2A
When you look at the backgrounds of the doctors who are conducting these studies, it’s a very testable hypothesis to say that there’s an obvious conflict of interest.
FOURTH : There are many other factors to take into account in the equation especially as regards complications of circumcision, infant pain, potential trauma for a newborn, the role of foreskin…these are interesting points that should be studied more carrefully in order to provide good scientific results. However this is something that Amy Tuteur completly completely neglects.
So if you think I’m saying someting wrong (point 1,2,3 or 4), please explain me why and show your arguments. I’m ready to listen to them. However if you have nothing interesting to say, then just say nothing.
And please claiming it’s obvious I’m about my own drama and identity as a victim is just retarded, so far I haven’t talked about my personal experience.
“Clearly you’re just here seeking attention (that would be your narcissistic gain at work again) and to make grandiose claims about your personal victimhood.”
Where did you see that ?
Fiffy,
If an adult was strapped down to a plastic board and circumcised without his informed consent and without anesthesia (like neonatal circumcision), wouldn’t you consider this act as a form of obvious torture ?
Please explain me the difference with a baby who is much more vulnerable than adult.
@Zoe237
Zoe237 said: “The anti-circumcision side (with whom I sympathize to an extent), might do well to avoid the following arguments (at least with a audience more interested in evidence rather than emotion):”…
Yes, I know and completely agree. Actually most of those arguments are best avoided altogether but they always crop up. The case against infant circumcision, especially in the west, is strong enough on its own.
What I really regret is that those arguments are the only ones that Amy has really chosen to answer. Despite there being a significant number of good counter points to the original post made by most contributers. I’ll have to dig through and see if there is anything worth discussing today.
# Amy Tuteur, MDon 07 Jan 2010 at 8:15 am
“There are many variations of female genital modification”
And none have any medical benefit at all.
1.
# Amy Tuteur, MDon 07 Jan 2010 at 9:18 am
“the possible medical benefits of those forms of female genital modification analogous to male circumcision have not been studied.”
And therefore you cannot make claims about their existence.
Is this meant to be ironic?
obviously you know it’s a principle of empiricism that you can’t claim there’s a link nor claim there isn’t one without testing. you can assume all you like, but without testing it, it’s pulling things out of thin air.
“admitted campaign to provoke and stir controversy.
http://open.salon.com/blog/amytuteurmd/2009/10/17/dr_amy_was_mean_to_me
She aims to emulate the incendiary styles of Ann Coulter and Rush Limbaugh, and by her own admission, she conjures up provocative headlines to elicit exactly the type of response this post has gotten.”
Thanks for posting that; it was enlightening, particularly the comments. It also explains why she’s not publishing in journals or debating with actual scientists about her apparent mission/obsession in life (mothers who birth at home are babykillers). So the best thing to do for naysayers is to ignore her.
Rush Limbaugh doesn’t usually have his facts straight either. Particularly his recent defense of “Muslims should be in concentration camps” bs. Dr. Tuteur’s missing the humor, entertainment, cult personality part of the Limbaugh success equation though- she just ends up sounding arrogant. Not to mention this is some random blog, not tv or radio.
People are attracted to extremist ideologues because it practically gives them permission to not have to think critically.
Why is she even writing at Sciencebasedmedicine? This seems entirely contrary to the stated aims of most of the main bloggers here and to simply be dragging science even further down to the level decried so often here. It would be a different matter if Dr Tuteur was actually entertaining, intellectually provocative, clever, witty, eloquent or a good or even fairly good writer. You do need at least a bit of talent to get away with being an ass unless you are intending to pander and compete for Fox’s core audience. I don’t expect Christopher Hitchens level provocation, intelligence or eloquence but, really, SBM is stooping to Fox News levels here. The insult to the reader is not provocative, it’s just corrosive to SBM’s credibility, as is Tuteur’s obvious disregard for science as anything but an ideological tool. I may not always agree with the other bloggers here but at least I can generally respect them as medical professionals and writers.
“For harm of FGM, see the WHO 2008 report already linked to. Annex 5 is a summary of the health complications, with citations to research studies.”
Could you provide the link to this please?
“What are the chronic health consequences that arise from male circumcision/MGM? Are there increased risks reproductive risks to men arising from being circumcised?”
Besides documented deaths, there are these:
There are literally hundreds of medical journal articles documenting the complications of circumcision. Some published from 1940 to 1998 are listed below.
Bleeding after circumcision. Gold S. Canadian Medical Association Journal 1940;43:473.
Wound diphtheria in the newborn infant following circumcision. Rosenstein JL. Journal of Pediatrics 1941;18:657-658.
Osteomyelitis of femur (probably due to circumcision) in infant. Altman H. Bulletin of the Hospital for Joint Diseases 1946;7:109-113.
Tuberculosis of the penis: a report of 5 new cases, and a complete review of the literature. Lewis EL. Journal of Urology 1946;56:737-745.
Total denudation of the penis. Editor/ Banham. Urologic and Cutaneous Review 1949;53:309.
Gangrene of penis following circumcision with high frequency current; plastic reconstruction of penis. Hamm WG, Kanthak FF. Southern Medical Journal 1949;42:657-659.
Reconstruction of penis with split-thickness skin graft; case of gangrene following circumcision for acute balanitis. Thorek P, Paul E. Plastic and Reconstructive Surgery 1949;4:469-472.
Amputation of the penis as a complication of circumcision. Lerner, BL. Medical Record and Annals 1952;46:229-231.
Surgical reconstruction of the penis. Brown JB, Fryer MP. GP 1958;17:104-107.
Plastic repair of the denuded penis. Wilson CL, Wilson MC. Southern Medical Journal 1959;52:288-290.
Excessive penile skin loss from circumcision. Van Duyn J, Warr WS. Journal of the Medical Association of Georgia 1962;51:394-396.
Meatal ulceration following neonatal circumcision. MacKenzie AR. Obstetrics and Gynecology 1967;28:221-223.
Hazards of circumcision. Editor. Practitioner 1967;198:611.
Glans necrosis as a complication of circumcision. Rosefsky JB. Pediatrics 1967:39:774-776.
Penile urethral fistula as a complication of circumcision. Limaye RD, Hancock RA. Journal of Pediatrics 1968;72:105-106.
Hazards of plastic bell circumcisions. Malo T, Bonforte RJ. Obstetrics and Gynecology 1969;33:869.
Thirty years of ritual circumcisions: appraisal of personal experiences, after-care and postcircumcision complications. Schlosberg C. Clinical Pediatrics 1971;10:205-209.
Circumcision complicated by pulmonary embolism. Curtis JEA. Nursing Mirror 1971;132:28-30.
Concealed penis: another complication of circumcision. Trier WC, Drach GW. American Journal of Diseases of Children 1973;125:276-277.
Impotence and adult circumcision. Stinson JM. Journal of the National Medical Association 1973;65:161,179.
Preputial skin-bridging: complication of circumcision. Klauber GT, Boyle J. Urology 1974;3:722-723.
Neonatal septicemia after circumcision. Kirkpatrick BV, Eitzman DV. Clinical Pediatrics 1974;13:767-768.
Complication of ritual circumcision in Israel. Frand M, Berant N, Brand N, Rotem Y. Pediatrics 1974;54:521.
Ablatio penis: normal male infant sex-reassigned as a girl. Money J. Archives of Sexual Behavior 1975;4:65-71.
Urinary retention due to ritual circumcision. Berman W. Pediatrics 1975;56:621.
Reconstruction following iatrogenic burn of the penis. Pearlman CK. Journal of Pediatric Surgery 1976;11:121-122.
Abdominal distension following ritual circumcision. Horwitz J, Schussheim A, Schalettar HW. Pediatrics 1976;57:579.
Iatrogenic microphallus secondary to circumcision. Levitt SB, Smith RB, Ship AG. Urology 1976;8:472-474.
Neonatal meningitis and circumcision. Scurlock JM, Pemberton TJ. Medical Journal of Australia 1977;1:332-334.
Circumcision and obstructive renal disease. Linshaw MA. Pediatrics 1977;59:790.
Staphylococcal scalded skin syndrome: a complication of circumcision. Annunziato D, Goldblum LM. American Journal of Diseases of Children 1978;132:1187-1188.
Impotence following anesthesia for elective circumcision. Palmer JM, Link D. Journal of the American Medical Association 1979;241:2635-2636.
Gangrene of the penis after circumcision. Du Toit DF, Villet WT. South African Medical Journal 1979;55:521-522.
Overwhelming infection with Group B Beta-Hemolytic streptococcus associated with circumcision. Cleary TG, Kohl S. Pediatrics 1979;64:301-303.
The case against neonatal circumcision. Fleiss PM, Douglass J. British Medical Journal 1979;2:554.
Necrotizing fasciitis after neonatal circumcision. Woodside JR. American Journal of Diseases of Children 1980;134:301-302.
Circumcision disasters. Cleary TG, Kohl S. Pediatrics 1980;65:1053-1054.
Successful replantation of a traumatically amputated penis in a neonate. Izzidien AY. Journal of Pediatrics 1981;16:202-203.
Necrosis of the glans penis following neonatal circumcision. Sterenberg N, Golan J, Ben-Hur N. Plastic and Reconstructive Surgery 1981;68:237-236.
Plastic reconstruction of partially amputated penis at circumcision. Hanash KA. Urology 1981;18:291-293.
Staphylococcal scalded skin syndrome: a complication of circumcision. Anday EK, Kobori J. Clinical Pediatrics 1982;21:420.
Myocardial injury following immediate postnatal circumcision. Ruff ML, Clarke TA, Harris JP, Bartels EK, Rosenzweig M. American Journal of Obstetrics and Gynecology 1982;144:850-851.
Penile adhesion: the hidden complication of circumcision. Gracely-Kilgore KA. Nurse Practitioner 1984;9:22-24.
Acute gangrene of the scrotum in a one month old child. Evbuamwan I, Aliu AS. Tropical and Geographical Medicine 1984;36:299-300.
Penoplasty for buried penis secondary to radical circumcision. Radhakrishnan J, Reyes HM. Journal of Pediatrics 1984;19:629-631
Penile denudation injuries after circumcision. Sotolongo JR Jr, Hoffman S, Gribetz ME. Journal of Urology 1985;133:102-103.
Complications de la circoncision rituelle [Complications of ritual circumcision]. Gross PH[?], Pages R, Bourdelat D. Chirurgie Pédiatrique 1986;27:224-2265.
Impetigo in newborn infants associated with a plastic bell clamp circumcision. Stranko J, Ryan ME, Bowman AM. Pediatric Infectious Disease Journal 1986;5:597-599.
Tachycardia and heart failure after ritual circumcision. Mor A, Eshel G, Aladjem M, Mundel G. Archives of Disease in Childhood 1987;62:80-81.
Circumcision complications and indications for ritual recircumcision – clinical experience and review of the literature. Breuer GS, Walfisch S. Israel Journal of Medical Sciences 1987;23:252-256.
Mechanical complications of circumcision with a Gomco clamp. Feinberg AN, Blazek MA. American Journal of Diseases of Children 1988;142:813-814.
Methemoglobinemia following neonatal circumcision. Mandel S. Journal of the American Medical Association 1989;261:702.
Total ablation of the penis after circumcision with electrocautery: a method of management and long-term followup.Gearhart JP, Rock JA. Journal of Urology 1989;142:799-801.
Scrotal abscess with bacteremia caused by salmonella Group D after ritual circumcision. Uwyyed K, Korman SH, Bar-Oz B, Vromen A. Pediatric Infectious Disease Journal 1990;9:65-66.
Ruptured bladder following circumcision using the Plastibell device. Jee LD, Millar AJW. British Journal of Urology 1990;65:216-217.
Skin bridge – a complication of paediatric circumcision. Sathaye UV, Goswami AK, Sharma SK. British Journal of Urology, 1990;66:214.
Gastric rupture associated with prolonged crying in a newborn undergoing circumcision. Connelly KP, Shropshire LC, Salzberg A. Clinical Pediatrics 1992;31:560-561.
Toxic methaemoglobinaemia after circumcision. Ozbek N, Sarikayalar F. European Journal of Pediatrics 1993;152:80.
Keloid of the penis after circumcision. Warwick DJ, Dickson WA. Postgraduate Medical Journal 1993;69:236-237.
Phallic construction in prepubertal and adolescent boys. Gilbert DA, Jordan GH, Devine CJ Jr, Winslow BH, Schlossberg SM. Journal of Urology 1993;149:1521-1526.
Pathogenesis of post-circumcision adhesions. Attalla MF, Taweela NM. Pediatric Surgery International 1994;9:103-105.
Botched circumcisions. Miya PA. American Journal of Nursing 1994;94:56.
Penile reconstruction following post-circumcision penile gangrene. Ahmed S, Shetty SD, Anandan N, Patil KP, Ibrahim A.I.A. Pediatric Surgery International 1994;9:295-296.
Buried penis as a contraindication for circumcision. Alter GJ, Horton CE Jr; Horton CE. Journal of the American College of Surgeons 1994;178:487-490.
Male ritual circumcision resulting in acute renal failure. Eason JD, McDonnell M, Clark G. British Medical Journal 1994;309:660-661.
Iatrogenic penile gangrene: 10-year follow-up. Kural S. Plastic and Reconstructive Surgery 1995;95:210-211.
Clinical presentation and pathophysiology of meatal stenosis following circumcision. Persad R, Sharma S, McTavish J, Imber C, Mouriquand PD. British Journal of Urology 1995;75:91-93.
Newborn penile glans amputation during circumcision and successful reattachment. Gluckman GR, Stoller ML, Jacobs MM, Kogan BA. Journal of Urology 1995153:778-779.
Serious complications of routine ritual circumcision in a neonate: hydro-ureteroephrosis, amputation of glans penis, and hyponatraemia. Kanukoglu A, Danielli L, Katzir Z, Gorenstein A, Fried D. European Journal of Pediatrics 1995;154:314-315.
Bipolar diathermy haemostasis during circumcision. Marsh SK, Archer TJ. British Journal of Surgery 1995;82:533.
Amputations with use of adult-size scissors-type circumcision clamps on infants. Editor. Health Devices 1995;24:286-287.
Amputation of distal penile glans during neonatal ritual circumcision – a rare complication. Neulander E, Walfisch S, Kaneti J. British Journal of Urology 1995;77:924-925.
Partial amputation of glans penis during Mogen clamp circumcision. Strimling BS. Pediatrics 1996;97:906-907.
Circumcision: successful glanular reconstruction and survival following traumatic amputation. Sherman J, Borer JG, Horowitz M, Glassberg KI. Journal of Urology 1996;156:842-844.
Sex reassignment at birth: long-term review and clinical implications. Diamond M, Sigmundson K. Archives of Pediatrics and Adolescent Medicine 1997;151:298-304.
Amputation of the penis during traditional circumcision. Ameh EA, Sabo SY, Muhammad I. Tropical Doctor 1997;27:117.
Necrotizing fasciitis after plastibell circumcision. Bliss DP Jr, Healey PJ, John HT Waldhausen. Journal of Pediatrics 1997;131:459-462.
Surgical repair of urethral circumcision injuries. Baskin LS, Canning DA, Snyder III HM, Duckett Jr JW. Journal of Urology 1997;158:2269-2271.
Reconstruction of the penis after necrosis due to circumcision. Belkacem R, Amrani A, Benabdellah F, Outarahout O. Ann-Urol-Paris 1997;31(5):322-5.
““If you don’t want to circumcise your sons, don’t do it. If you don’t think the benefits outweigh the risks, don’t do it. Just don’t claim that there are no medical benefits when there are real benefits.”
Gee, how many times have we heard this claim of real benefits?–MANY,
and how many times have circumcision advocates supported the claim with scientifically credible evidence of even one benefit?–NONE.
“What are the chronic health consequences that arise from male circumcision/MGM? Are there increased risks reproductive risks to men arising from being circumcised?”
Again, here is an attempt to limit the consequences from circumcision..
Reproduction is not the only parameter we need to consider–we need to consider sexual fulfillment–and that is impeded with the loss of sensation and sensitivity.
And what about erectile impairment? Should we not also consider this?
nick – Nick – “Those who promote ethical and legal practices have no need to be accountable for their words and actions.”
zoe – “People are attracted to extremist ideologues because it practically gives them permission to not have to think critically.”
Well said zoe and it appears to be as true of Dr Tuteur as the rabid anti-circ posters here (who give themselves away by using the usual tactics of those ideologically opposed to the practice of good science and reality-based thinking and discussion). Apparently neither is willing to take responsibility for their words or actions! Nor do either really want a rational discussion based upon science.
Link for WHO 2008
http://data.unaids.org/pub/BaseDocument/2008/20080227_interagencystatement_eliminating_fgm_en.pdf
I just happened to notice that Amy is an obygyn? Perhaps the fact that most circumcisions are done by them might be a motive in her promotion of circumcision?
When they say it is not the money–it is the money.
“Link for WHO 2008″
Thanks, interestingly ALL of these factors also occur in MGM–and there are extensive studies documenting prevalence.
So again, rationally, why should FGM be illegal and not MGM?
Nick – “Those who promote ethical and legal practices have no need to be accountable for their words and actions.”
zoe – “People are attracted to extremist ideologues because it practically gives them permission to not have to think critically.”
Well said zoe and obviously equally true of Dr Tuteur and the extremist ideologues who are anti-circ. Both seem proud of the fact that they don’t think critically, while they’re both busy abusing science and pretending to be critical thinkers promoting a science-based position.
It looks like the extremist on the anti-circumcision side are using the usual tactics employed by anti-vaxers of trying to flood the forum so discussion is now futile. It’s pretty obvious that neither side actually cares about people or anyone’s suffering, particularly if it intrudes upon their narcissistic promotion of their ideological position (and attention seeking, both Tuteur and the evangelical/ideological trolls seem to have that as their primary agenda and then are pretending that they’re doing this for others and have the moral high ground…I say moral because the taint of evangelicism lingers over both as they try to abuse science to support their ideological position).
And to repeat what should be obvious but apparently isn’t to some, the very essence of being ethical is being accountable for one’s words and actions.
Sorry, that should have read reproductive *health* risks. I was referring to the increased risks of childbirth for women who have had FGM. AFAIK, male circumcision does not result in long-lasting and ongoing health risks for men who decide to reproduce.
What is the evidence that circumcision makes a difference either to sexual function or sexual pleasure?
Pleasure is subjective. It makes sense to say “You haven’t lost as much blood as you think you have” – because we can measure that objectively. It doesn’t make sense to say “You haven’t had as much pleasure as you you think/feel you’ve had” – because pleasure is defined by the person experiencing it. Therefore, the fact that the skin removed contains a lot of nerve endings may be suggestive of reduced pleasure, but whether it actually reduced pleasure for men in the real world (as opposed to looking at cells under a microscope) would be the research question. Where is the evidence that it does?
Similarly, where is the evidence that circumcision causes erectile impairment?
You list a large number of commentaries and some studies. But an equally large number could be listed to show the benefits of circumcision.
When I look at studies showing benefits of circumcision, I find them deficient in various ways (in particular, the lack of attention to absolute risk reduction and whether the benefits are clinically significant, rather than merely statisitcally significant, the failure to compare circumcision with conservative treatments rather than ‘no action’, and so forth). The huge *quantity* of studies showing benefits of circumcision do not, in my view, provide a basis for recommending routine infant circumcision.
Similarly, when I look at the totality of studies showing harms of circumcision, I find them dificient in various ways. The huge *quantity* of studies showing harms of circumcision do not, in my view, provide a basis for prohibiting routine infant circumcision.
The point is not to list the studies, but to evaluate their quality. This is what I invited you to do in relation to WHO 2008 (“I think these research studies need to be discussed dispassionately and impartially, and if you think they are wrong – then let’s discuss that.”) Similarly, we can discuss the research strengths and weaknesses on male circumcision harms.
I am surprised to see an activist for prohibition of male circumcision seek to undermine claims of harm of FGM, given the way the the harms of FGM are usually used rhetorically by campaigners for prohibiting male circumcision/MGM. Frankly, if you successfully persuade me that the harms of FGM are no greater than the harms of male circumcision/MGM, I would have to conclude that the former should not be prohibited.
Perhaps the fact that most circumcisions are done by them might be a motive in her promotion of circumcision?
+++++++++++
Amy Tuteur hasn’t been an Obgyn since 1994.
The issue currently being debated in this thread are whether the risks outweigh the benefits, and many commenters feel that the benefits are not sufficient. That’s fine, but let’s not lose sight of the basic fact: there are real benefits, and defending on the population, those benefits can extend to hundreds of thousands of lives saved.
There’s no need to invoke nefarious motives of anyone, least of all those people who devote their professional lives to looking for ways to stop the deadly HIV epidemic.
I’m sure that by now we are quite clear on the concept that some people believe that neonatal circumcision is ethically unacceptable regardless of the benefits. But, beyond the risk of individual complications, no one has yet shown any harm of any kind from widespread neonatal circumcision. That’s not, of course, an argument in favor of neonatal circumcision, but it is quite clear that widespread neonatal circumcision does not harm populations and may even benefit them in the long term.
Amy said: “But, beyond the risk of individual complications, no one has yet shown any harm of any kind from widespread neonatal circumcision. That’s not, of course, an argument in favor of neonatal circumcision, but it is quite clear that widespread neonatal circumcision does not harm populations and may even benefit them in the long term.”
The individual risk is really the first risk (and likely the only risk) I am going to think about. What do you say to a child who suffered one of the more extreme complications of a procedure that was not of clinical need for him? I am sorry son we were trying to reduce your lifetime risk of disease X by one or two hundredths of a percent. No clearly it wasn’t necessary and yes even then there were better options for protection and yes you could have been included in the risk/benefit discussion at a later date but that vanishingly small difference appeared compelling.
And I might qualify your ‘may even benefit’ with ‘under certain extreme conditions’ because it is far from clear when comparing the rates of STDs between say Europeans and Americans that there is any benefit at all. If nothing else the comparison shows that far better control of STDs in a population than we see in the US can be achieved in the absence of neonatal circumcision. If Americans want to see European rates perhaps we should take a look at what they are doing.
“Well said zoe and obviously equally true of Dr Tuteur and the extremist ideologues who are anti-circ. Both seem proud of the fact that they don’t think critically, while they’re both busy abusing science and pretending to be critical thinkers promoting a science-based position”
And anti female circumcision people are also extremist ideologues ?
Or do they need a more moderate point of view to appear credible ?
Fiffy, you dodged some questions I asked you. I’ve always presented my arguments so discuss them and show me where I’m wrong. So far you have jsut been splashing around, nothing more.
If an adult was suddenly strapped down against his will and was circumcised without his informed consent and without his anesthesia, it would be an obvious form of torture.
Please tell me how is it different for babies if you claim neonatal circumcision isn’t torture
You haven’t answered yet, I really would like to now.
I also told you circumcision has NOTHING to do with science/medecine. What would we do with studies from African doctors who on the front want to “reduce HIV transmission,” through female circumcision?
Circumcision has nothing to do with science, it’s a human right issue.
I explained that these studies are likely to be flawed and even if there were correct ie male circ prevent HIV by 55%, it still doesn’t justify neonatal circumcision.
“The individual risk is really the first risk (and likely the only risk) I am going to think about.”
Fine, but that’s not the only factor in public health decisions, not should it be.
Even if we all agree that adult circumcision in parts of Africa where there is high prevalence of HIV can save hundreds of thousands of lives, we’d still need to acknowledge that at the individual level some men will suffer complications. So the mere fact that individual complications can occur does not tell us whether a public health recommendation is beneficial.
The issue of the harm of the procedure without pain relief can be separated entirely from the issue of circumcision per se, simply by ensuring that pain relief is used (local anaesthesia for the procedure and simple analgesia post-operatively if required).
“Sorry, that should have read reproductive *health* risks. I was referring to the increased risks of childbirth for women who have had FGM. AFAIK, male circumcision does not result in long-lasting and ongoing health risks for men who decide to reproduce.”
Males and females are different as regards reproduction. Men haven’t childbirth issues so your argument is retarded. It’s like saying do you know a circumcised female that suffer from erection problems ?
“What is the evidence that circumcision makes a difference either to sexual function or sexual pleasure? ”
Many people show different articles regarding this problems :
You cannot alter form without altering function. When a male’s foreskin is amputated, it affects him for life and his partner’s sex life is affected as well. The mechanics of sex must be altered to compensate for what was lost. As CJ Fallier wrote in JAMA in 1970, “…the fundamental biological sexual act becomes, for the circumcised male, the satisfaction of an urge and not the refined sensory experience it was meant to be.”
You decide to ignore these posts
“Pleasure is subjective. It makes sense to say “You haven’t lost as much blood as you think you have” – because we can measure that objectively. It doesn’t make sense to say “You haven’t had as much pleasure as you you think/feel you’ve had” – because pleasure is defined by the person experiencing it.”
I could use these same circular arguments to claim female circumcision doesn’t reduce sexual pleasure. After all, pleasure is subjective, isn’t it ?
If pleasure is defined by the person experiencing it, you can’t scientifically prove that FGM reduce pleasure.
“The huge *quantity* of studies showing benefits of circumcision do not, in my view, provide a basis for recommending routine infant circumcision.”
If you’re talking sexual benefits, there isn’t a huge quantity of studies, just a couple. Most them don’t show benefits anyway but say that it doesn’t reduce sexual pleasure. Quite different.
Amy said: “Even if we all agree that adult circumcision in parts of Africa where there is high prevalence of HIV can save hundreds of thousands of lives, we’d still need to acknowledge that at the individual level some men will suffer complications. So the mere fact that individual complications can occur does not tell us whether a public health recommendation is beneficial.”
You should really do a better job of compartmentalizing the issue. Whereas you were speaking about low prevalence neonatal you now are focusing on high prevalence adult .
In fact I have never said that an adult should be prevented from choosing to seek out circumcision, under any circumstances. Just like they should be allowed to get tattoos or piercings on or through what ever they care. They can be presented with the risks and potential benefits. Any complication they suffer from choosing the intervention is then on the adult to deal with.
In some location in Africa that might be presented as a modest protection against HIV when a condom is not used. In most other industrialized countries that would have to be changed to a trivial (almost immeasurable) reduction in lifetime risk. And because it’s trivial in those industrialized countries, neonatal should not even enter ones mind.
Amy, this is for you..
“there are real benefits, and defending on the population, those benefits can extend to hundreds of thousands of lives saved.”
Amy, I have repeatedly asked for SCIENTIFICALLY CREDIBLE evidence for ANY benefit. You have ignored this request, yet keep repeating this mantra as if it was valid. You have tried to conflate HAVING a study with it being automatically BEING a VALID study. So unless and until you can provide one, mere repetition is not credible.
“But, beyond the risk of individual complications, no one has yet shown any harm of any kind from widespread neonatal circumcision.”
Look, just because you refuse to read and address the Taylor and Sorrels study, hardly adds credilbility to this notion of no harm–ignorance of the evidence (ESPECIALLY CHOSEN ignorance) hardly makes it disappear.
“Fine, but that’s not the only factor in public health decisions, not should it be.”
But the crucial factor you are choosing to ignore is that you have yet to provide a single SCIENTIFICALLY CREDIBLE benefit..and your mantra falls flat without this.
“Even if we all agree that adult circumcision in parts of Africa where there is high prevalence of HIV can save hundreds of thousands of lives, we’d still need to acknowledge that at the individual level some men will suffer complications. So the mere fact that individual complications can occur does not tell us whether a public health recommendation is beneficial.”
But the crucual problem is that we do NOT agree–and we do not agree because, as we have pointed out again and again, that the studies suggesting this are predicated solely on KNOWN flawed studies and fail to fulfill the prediction inherent in those studies..
At the bottom is you ASSUME something is valid that is NOT.
Please humor me and go to this link, and debate the points therein before you keep repeating your mantra.
http://mysite.verizon.net/dortfay/science.html
Dr Tutuer – That’s a very reasonable position to take NOW but you still haven’t taken responsibility for your words or actions, or the fact that you weren’t actually weighing the evidence and apparently go out of your way to be inflammatory. Even when called out by a respected and established SBM blogger, you avoided taking responsibility for your words and obvious intention to be inflammatory. You haven’t actually engaged in an evidence-based discussion regarding circumcision, instead you continued to be inflammatory in the comment section. The fact that you are still avoiding being accountable and now trying to present as if you are being reasonable and have been all along is merely an indication that you’re mainly interested in image control (and how you look or having people look at you) and will continue to behave as you did originally.
To claim that you’re actually on some moral high ground regarding AIDS and HIV at this point – when it’s clear that AIDS is something you were merely using to promote your agenda, a fact made evident by your avoidance of discussing safer sex practices when initially brought up by many posters here – is yet more image massaging that is no different than the anti-circ/intactivist claim to be holding some moral high ground. Your use of the suffering of others in this manner is just as unethical and narcissistic as it is when it is done by the anti-circ/intactivist camp. You’re simply the other side of the same ideological coin and you’re playing exactly the same game – which isn’t engaging in discussions that respect science-based medicine or compassionately engaged in a discussion about human rights and reducing suffering.
“You cannot alter form without altering function.”
Evidently in the case of circumcision, you can do so.
Are there any metrics on which circumcised and uncircumcised men differ?
Ability to have intercourse? No.
Frequency of intercourse? No.
Ability to reproduce? No.
Number of children? No.
Reported sexual satisfaction? No.
Ability to urinate? No.
Long term health sequelae? No.
I could go on and on, but I think you get the point.
There’s no evidence that circumcision alters function in any way.
I’m not arguing FOR circumcision, and I’ve not made any claims for sexual benefit.
If you argue FOR prohibition, you must show clear evidence of harm.
The prohibition of FGM is not based solely or mainly on evidence that sexual pleasure is reduced, but rather on a wide-range or harm to health.
Just because someone wrote “the fundamental biological sexual act becomes, for the circumcised male, the satisfaction of an urge and not the refined sensory experience it was meant to be” in JAMA in 1970 doesn’t make it so. Is it the case that the sexual act for the circumcised male is “not the refined sensory experience it was meant to be”? How would we measure this? (self-reporting?ability to achieve and sustain an erection? to achieve orgasm? length of time to orgasm?). That is the research question to be addressed.
“I have repeatedly asked for SCIENTIFICALLY CREDIBLE evidence for ANY benefit.”
And you’ve ignored the evidence. There is no doubt that circumcision decreases transmission of HIV and other sexually transmitted diseases, and is associated with reductions in cervical cancer and penile cancer.
That it not enough to support an argument that all male infants should be circumcised, but the scientific evidence itself is not in doubt.
Dr Tuteur – It’s also highly irresponsible and ignorant to talk about AIDS in Africa (particularly Uganda) without addressing the very concerted effort made by the US to block access to sex education and condoms. Proposing circumcision as a solution, while ignoring the reality of ideological interference with sexual healthcare and education, and access to condoms and other forms of birth control, is yet again simply trying to further your agenda/opinion while ignoring reality. You really are no friend of SBM, you clearly just like how you think pretending to be one makes you look and the reaction you can get from people you like to feel superior to.
It’s perhaps as irresponsible as proposing that circumcision is a good thing in America because it protects from AIDS or STDs when everyone should be using barrier methods if they’re not in a long term, committed, monogamous relationship. As someone who has lost friends to AIDS, I find your narcissistic use of AIDS offensive and your claims to be somehow helping and caring self-serving and dishonest.
“What is the evidence that circumcision makes a difference either to sexual function or sexual pleasure?”
Sensations and sensitivity are part of the “function” and pleasure
http://www.cirp.org/library/anatomy/taylor/
http://www.urotoday.com/42/browse_categories/erectile_dysfunction_ed/finetouch_pressure_thresholds_in_the_adult_penis.html
Fine-Touch Pressure Thresholds in the Adult Penis l
http://www.nocirc.org/touch-test/bju_6685.pdf
“Analysis of results showed the glans of the uncircumcised men had significantly lower thresholds than that of circumcised men (P = 0.040). There were also significant differences in pressure thresholds by location on the penis (p < 0.0001). The most sensitive location on the circumcised penis was the circumcision scar on the ventral surface. It was remarkable that five locations on the uncircumcised penis that are routinely removed at circumcision had lower pressure thresholds that the ventral scar of the circumcised penis.
This study suggests that the transitional region from the external to the internal prepuce is the most sensitive region of the uncircumcised penis and more sensitive than the most sensitive region of the circumcised penis. It appears that circumcision ablates the most sensitive parts of the penis."
http://www.prweb.com/releases/2007/3/prweb512999.htm
"A new study in the British Journal of Urology International shows that men with normal, intact penises enjoy more sexual sensitivity — as much as four times more — than those who have been circumcised. Circumcising slices off more of a male's sensitivity than is normally present in all ten fingertips. "
"Pleasure is subjective."
Without nerves and sensations, there can be no pleasure–subjectively or objectively!
"Similarly, where is the evidence that circumcision causes erectile impairment?"
"The nerves in the foreskin apparently provide an impulse to aid erection. Circumcision has long been associated with an increased incidence of impotence. Glover reported a case in 1929. Winkelmann suggested impotence as a possibility in 1959.6 as did Foley in 1966. Stinson reported five cases in 1973. Palmer & Link reported two cases in 1979. More recently, additional evidence of sexual dysfunction after circumcision has emerged. Coursey et al. reported that the degradation in sexual function after circumcision is equivalent to the degradation experienced after anterior urethroplasty. Fink et al. reported statistically significant degradation in sexual function. A survey carried out in South Korea found that circumcised men reported painful erections, and diminished sexual pleasure, and a few reported curvature of the penis upon erection. Shen et al., in a study carried out in China, reported erectile dysfunction in 28.4 percent of the men in the study after circumcision, and 'weakened erectile confidence' in 34.7 percent."
http://www.cirp.org/library/sex_function/ (File revised 28 February 2004)
If you require more, just ask.
"Similarly, when I look at the totality of studies showing harms of circumcision, I find them dificient in various ways. The huge *quantity* of studies showing harms of circumcision do not, in my view, provide a basis for prohibiting routine infant circumcision."
Sorry, but until and IF circumcisers can provide SCIENTIFICALLY CREDIBLE evidence of benefit, it is hardly fitting to arbitrarily dismiss prohibition by simply stating YOU do not find SUFFICIENT harm…First do NO harm!
"The issue of the harm of the procedure without pain relief can be separated entirely from the issue of circumcision per se, simply by ensuring that pain relief is used (local anaesthesia for the procedure and simple analgesia post-operatively if required)."
Sorry, but this apologia does not fly simply because ANY KNOWN pain relief method used on infants does NOT eliminate pain–only reduces it.
“Ability to have intercourse? No.
Frequency of intercourse? No.
Ability to reproduce? No.
Number of children? No.
Reported sexual satisfaction? No.
Ability to urinate? No.
Long term health sequelae? No.
I could go on and on, but I think you get the point.
Ability to urinate? No.
Long term health sequelae? No.
I could go on and on, but I think you get the point.”
Yes I get the point, but it’s not the point it’s YOUR point, not the one I was trying to make. Basically your point is a circumcised man can still have intercourse and have children etc…My point is that circumcision have impacts on sexuality (both as regards quality and quantity) :
the fundamental biological sexual act becomes, for the circumcised male, the satisfaction of an urge and not the refined sensory experience it was meant to be.
Also, at the end of life, the exposed, calloused, desensitized, glans becomes more and more difficult to stimulate. It’s no surprise that males in the US have a high rate of erectile dysfunction, and the USA has the highest sales of Viagra in the world.
This has nothing to with ability of reproduction, circumcision etc…
ME:“I have repeatedly asked for SCIENTIFICALLY CREDIBLE evidence for ANY benefit.”
AMY:”And you’ve ignored the evidence. There is no doubt that circumcision decreases transmission of HIV and other sexually transmitted diseases, and is associated with reductions in cervical cancer and penile cancer.”
NO, I have critically and scientifically evaluated the evidence–YOU obviously have not!
All you are doing with your endless repetition is showing you are scientifically illiterate. And by you not going to the link provided and actually discussing the SCIENCE in regards to your “evidence” is showing that you are CHOOSING to remain ignorant of the scientific process.
“That it not enough to support an argument that all male infants should be circumcised, but the scientific evidence itself is not in doubt.”
I am afraid you use the term “scientific evidence” without understanding what it really is.
Once again, please go to the link and actually debate your “evidence” based on the real scientific process.
Your empty repetition is tiring beyond belief.
“And you’ve ignored the evidence. There is no doubt that circumcision decreases transmission of HIV and other sexually transmitted diseases, and is associated with reductions in cervical cancer and penile cancer.”
Could you explain why US has both the highest rates of circumcision and HIV among industrialized countries ? Why other countries like Sweden, Finland etc…where circumcision rate is close to 0% have the lowest rates of HIV in the world ?
Why empirical evidence doesn’t confirm these studies ?
“My point is that circumcision have impacts on sexuality (both as regards quality and quantity)”
Yet there’s absolutely no evidence of that.
”
“My point is that circumcision have impacts on sexuality (both as regards quality and quantity)”
Yet there’s absolutely no evidence of that.
”
I show you a couple of studies saying it does. Why these studies have zero credit according to you when at the same time you are very happy to show a study from Africa claiming it doesn’t have any impact on sexuality ? Why these studies coming from Africa have more than value than mines ?
Amy said: “And you’ve ignored the evidence. There is no doubt that circumcision decreases transmission of HIV and other sexually transmitted diseases, and is associated with reductions in cervical cancer and penile cancer.”
Well fair is fair, you have ignored the ethical considerations, where it relates to neonatal, which is at least equally important.
I always liked the cervical cancer and penile cancer argument. Especially when we’ve had not just one but two HPV vaccines which are in excess of 90% efficient available for what four years now? I am curious Amy, do you agree with the British Medical Association’s view:
“Therefore, to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate. ”
A yes or no should be sufficient.
“You cannot alter form without altering function.”
Evidently in the case of circumcision, you can do so.
Are there any metrics on which circumcised and uncircumcised men differ?
Ability to have intercourse? No.
Frequency of intercourse? No.
Ability to reproduce? No.
Number of children? No.
Reported sexual satisfaction? No.
Ability to urinate? No.
Long term health sequelae? No.
I could go on and on, but I think you get the point.
There’s no evidence that circumcision alters function in any way.”
Oh, god, where to start on this????
“Ability to have intercourse? No.”
YES!! especially when one is dead, lost glans, suffer from erectile impairment.
“Frequency of intercourse? No.
Ability to reproduce? No.
Number of children? No.”
YES–see directly above
“Reported sexual satisfaction? No.”
YES.
http://www.cirp.org/library/sex_function/kim2006/
http://www.cirp.org/library/sex_function/fink1/
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14979200&dopt=Abstract
http://www.nzma.org.nz/journal/116-1181/595/
http://www.cirp.org/library/sex_function/vissing1/
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1464-410X.2006.06685.x
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1464-410X.2006.06646.x?prevSearch=keywordsfield%3A%28%22Circumcision%22%29
http://www.cirp.org/library/anatomy/taylor/
AND the Sorrels study posted earlier.
“Long term health sequelae? No.”
Now, go back and look at the list of complications I posted earlier.
Amy,
Please read this study and tell me where they are wrong :
http://www.circumstitions.com/Images/sorrellsvm&j-poster.pdf
You claim in your article :
“But recent studies make it clear that sexual satisfaction is not affect by circumcision”
It really isn’t clear and there were no studies about sexual satisfaction, just a survey
“Could you explain why US has both the highest rates of circumcision and HIV among industrialized countries ? Why other countries like Sweden, Finland etc…where circumcision rate is close to 0% have the lowest rates of HIV in the world ?
Why empirical evidence doesn’t confirm these studies ?”
YES!! I wish she would please do so, as this ability to always fulfill prediction is a critical and crucial requirement for scientific credibility–as she would realize if she actually went to the link provided discussing her claims as they relate to the SCIENTIFIC PROCESS.
But apparently she instead choose to remain ignorant of SCIENCE so she can then pretend that her claims are valid.
And I find it amusing that she seems to believe known flawed studies have more weight than EMPIRICAL evidence (in science–this is the strongest form of evidence). Oh, well!
Correlation is not (on its own) evidence of causation. There may be a lot of confounders, which is why the presence of low or high circumcision withe low or high HIV rates doesn’t (on its own) tell us a lot about the effect of circumcision. There was a nice post last week on this site which will help you make sense of this (Causation and Hill’s Criteria). Sometimes, and where it is possible/ethical to design a good trial, it is necessary to use RCTs to clarify these issues and remove confounding factors.
But at least your observations on the *correlation* (not causation) of circumcision and HIV in Sweden and the US is accurate, unlike Dr Amy’s assertion upthread that “countries with low prevalence of HIV tend to have high rates of circumcision already” which is demonstrably not true.
I would like to add something on my post of 10 Jan 2010 at 1:05 pm
Ability to urinate:
Meatal stenosis 8%
Meatal stenosis – Complications
“Persistent urinary problems including abnormal stream, painful urination, frequent urination, urinary incontinence, blood in the urine, and increased susceptibility to urinary tract infections can be complications.”
And iatrogenic phimosis:
http://www.cirp.org/library/complications/williams-kapila/\
*****Insufficient excision of the foreskin and inner preputial epithelium may result in wound contraction and cicatrization of the distal foreskin. The fibrotic ring so produced may result in true phimosis, an event observed in 2 per cent of cases in one UK series15. In severe cases urinary obstruction may ensue19.”
“But at least your observations on the *correlation* (not causation) of circumcision and HIV in Sweden and the US is accurate”
The true importance of this empirical evidence is that it shows that the hypothesis that circumcision reduces HIV is not fulfilled, and hence not SCIENTIFICALLY valid.
And any conjecture WHY this is not fulfilled without HARD numbers of the other alleged co-factors and used in a working model that explains the discrepancy is nothing but a speculative excuse–and SCIENCE accepts neither speculation nor unsupported excuses.
“There is no doubt that circumcision decreases transmission of HIV and other sexually transmitted diseases, and is associated with reductions in cervical cancer and penile cancer.”
While we are looking at real world rates vs claims of circumcision reducing them..
WHY are the rates of all of these HIGHER in the USA than in other intact counties?
HOW CAN these rates be higher in the USA with high circumcision rates when the circumcision rates are lower in those other countries with lower rates of these diseases?
Or are we supposed to just ignore logic and even common sense?
Well, the claims of risk reduction relate mainly to female-to-male transmission. Most HIV in the US is either transmitted male-to-male, or IV drug use. In the former case, no evidence exists to show benefit of circumcision, in the latter case there is no plausible biological mechanism for reduced transmission. So, the efficacy of circumcision in risk reduction will depend on the populations/prevalence/mode of transmission in a given country/context.
“Please read this study and tell me where they are wrong”
Read the study and explain why it is clinically relevant? The fact that a phenomenon can be demonstrated in a small group of people doesn’t tell us whether it is real, or even if it is real, whether it has any clinical effects.
Millions upon millions of men have been circumcised. If there were clinically significant differences, we would see them in large populations and we would have seen them long ago.
“Well, the claims of risk reduction relate mainly to female-to-male transmission. Most HIV in the US is either transmitted male-to-male, or IV drug use. In the former case, no evidence exists to show benefit of circumcision, in the latter case there is no plausible biological mechanism for reduced transmission. So, the efficacy of circumcision in risk reduction will depend on the populations/prevalence/mode of transmission in a given country/context.”
If it’s true Africa and America are very different in many ways, but Europe and US have almost the same level of education, access to condoms, safe sex etc…
If circumcision really prevent HIV by 55%, even if correlation is not evidence of causation, you should at least expect US with lower rates than European countries. But in fact it’s just the opposite !
If there are other factors to consider into the equation, why not studying these factors instead on focusiing only on circumcision ?
And these studies are also debatable for many reasons :
The circumcised men in the study were given a head start, not to mention, the studies were ended early. The circumcised men were told to abstain from sexual activity for 6 weeks following their operation. Furthermore, they were instructed in the use of condoms. The credit of “HIV reduction” was given, not to the education and condoms the circumcised men received, but their circumcisions. How can this even be called a “study?”
Links to the studies can be found here:
Consenting to avoid sexual contact (except with condom protection) during the 6 weeks following the medicalized circumcision”
http://clinicaltrials.gov/show/NCT00122525
“When you are circumcised you will be asked to have no sexual contact in the 6 weeks after surgery. To have sexual contact before your skin of your penis is completely healed, could lead to infection if your partner is infected with a sexually transmitted disease. It could also be painful and lead to bleeding. If you desire to have sexual contact in the 6 weeks after surgery, despite our recommendation, it is absolutely essential that your (sic) use a condom.”
http://medicine.plosjournals.org/archive/1549-1676/2/11/supinfo/10.1371_journal.pmed.0020298.st003.pdf
The conductors of these “studies” have conflicts of interest; Robert Bailey is a known long-standing circumcision advocate, and Daniel Halperin is Jewish, where infant circumcision is central to his cultural and ethnic identity, and he has openly stated he wants to continue his grandfather’s legacy. The authors of these studies have compelling reasons to skew the information in favor of circumcision, and it is evident that they have.
The highest profit making anything in the Pediatric Hospitalist group affiliated with the Internal Medicine Hospitalist group I am a member of is…. circumcision.
The leading cause of STDs is sticking things in places they shouldn’t be stuck. And Dr. Tuteur, please refrain from projecting onto the male half of the species your thoughts about our motivations. Peoples’ motivations are complex.
Oh, as Robin Williams pointed it out, “it’s a rediculous piece of skin! Look it’s a snake wearing a sweater!” But it’s a part of me that I was born with, it’s attached. Is there any research looking into negative outcomes of circ? What are the theories about why we — as in class mammalia — evolved with foreskins? The end of my coccyx is a vestigal tail, but I’m not looking for an orthopod or neurosurgeon to cut if off.
but Europe and US have almost the same level of education, access to condoms, safe sex etc…
+++++++++++
They are also similar insofar as most HIV transmission is male-to-male sexual transmission, or associated with IV drug use. We have no evidence that circumcision has any impact on male-to-male sexual transmission, and we have no reason to suspect that circumcision makes a difference to transmission associated with IV drug use. If circumcision makes no difference for these routes of transmission, then we wouldn’t expect diferences in circumcision rates to make a difference in countries where HIV is transmitted primarily by routes upon which circumcision has no effect.
“They are also similar insofar as most HIV transmission is male-to-male sexual transmission, or associated with IV drug use. We have no evidence that circumcision has any impact on male-to-male sexual transmission, and we have no reason to suspect that circumcision makes a difference to transmission associated with IV drug use. If circumcision makes no difference for these routes of transmission, then we wouldn’t expect diferences in circumcision rates to make a difference in countries where HIV is transmitted primarily by routes upon which circumcision has no effect.”
In that case where making a case for circumcision, more precisely neonatal circumcision, in US ?
Amy,
I still haven’t seen you link any scientific evidence that neonatal circumcision offers any more or even equal benefit than adult circumcision. As others have asked multiple times, why NEONATAL?
Aside from the ethical difference of circumcisions performed on *adult* *volunteers*, circumcision on infants is physically different than the circumcision of adults. In adults the foreskin is, in almost all cases, fully retractible. In infants, it is fused to the glans much like a fingernail. The foreskin must be forcibly separated from the glans before it can be removed. Could this make a difference in the benefits of HIV transmission risk reduction? It could, we don’t know. Until you or someone from the pro circumcision camp can find a study that proves that INFANT circumcision shows the same benefits that adult circumcision does, you need to explain why you recommend it be done on neonates.
Just because something can be achieved, doesn’t mean it is ethical to do so. Sure, I could keep my child in an underground bomb shelter the first 18 years of life ( while still getting food, water, and home school education) to prevent her from dying in a car accident, or getting struck by lightning, or dying in a tornado. Does that mean I SHOULD do this? just because the desired result CAN be achieved this way? This example is intentionally ridiculous, but it is proving a point.
Would you also recommend removing the breast buds of infants? It would save thousands of more lives than a 60 percent risk reduction in HIV in the United States, where 1 in 8 women will get diagnosed with breast cancer. If not, why? Is non essential breast tissue different than non essential foreskin? It could be safer when done to babies, since there is less breast tissue to remove, and it would be less invasive.
Just so this doesn’t get buried, I am curious Amy, do you agree with the British Medical Association’s view:
http://www.bma.org.uk/ethics/consent_and_capacity/malecircumcision2006.jsp
“Therefore, to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate. ”
A yes or no should be sufficient.
In that case where making a case for circumcision, more precisely neonatal circumcision, in US ?
+++++++++++
I agree. The differences between the contexts of the trials and the US/Europe certainly undermine any case for routine infant circumcision in the US.
“Millions upon millions of men have been circumcised. If there were clinically significant differences, we would see them in large populations and we would have seen them long ago.”
WE have!
Just because you refuse to even look at the evidence, speaks volumes.
I have yet to see you post anything of substance other than your denial to look at the evidence.
Plonit said: “I agree. The differences between the contexts of the trials and the US/Europe certainly undermine any case for routine infant circumcision in the US.”
I would have to agree too, it is clear that this discussion isn’t really being properly compartmentalized. There are four cases as I see it: neonatal in a place like Africa, adult in a place like Africa, and the same two options in industrialized/low prevalence countries. You could currently make a plausible case in Africa and ethically I think you have to limit it to consenting adults. There are big hurdles to it though which I think have been and will be ignored. But on the actual subject of this post I can’t see any rational thinker making a case for neonatal circumcision in the US.
BTW Amy,
Have you looked at the link looking at the scientific credibility of the claim of HIV reduction yet?
IF so, any rebuttal you wish to offer?
If you haven’t looked at it yet, why not?
So you don’t need trouble yourself to look for the link, here it is again:
http://mysite.verizon.net/dortfay/science.html
I will await your response…..
http://hivskeptic.wordpress.com/2009/09/10/clinical-trials-of-circumcision-against-%E2%80%9Chiv%E2%80%9D-%E2%80%9Cinfection%E2%80%9D/
Pseudo science and circumcision :
http://hivskeptic.wordpress.com/2009/09/10/clinical-trials-of-circumcision-against-%E2%80%9Chiv%E2%80%9D-%E2%80%9Cinfection%E2%80%9D/
I agree that female circumcisions on infant girls and female teens prevent HPV, HIV infectious disease transmissions to the male partners. In a study by CDC, the circumcisions of female teens & infants at birth reduced the spread of HPV & AIDS transmissions later in lfe by 92%, as well as is more hygienically sound.
Can’t argue with science and facts.
I prefer a circumcised female partner because of the smell.
Oh, well now we have moved into different territory.
Nick, do you contend that HIV is not the cause of AIDS?
Nick, do you contend that HIV is not the cause of AIDS?
The article wasn’t about origin of AIDS and has nothing to do with it. It just mentions the flaws of HIV&Circumcsion studies without questionning origin of AIDS. Also the site isn’t saying HIV is not the cause of AIDS but HIV is not the necessary and sufficient cause of AIDS.
“Nick, do you contend that HIV is not the cause of AIDS?”
How did you get from pointing out some of the many flaws in the African studies to the notion that HIV does not cause AIDS????
BTW, all three of these trials are the same–and based on the nonsense dreamed up by Bailey–and all have the same fatal flaws.
here is some food for thought:
The CDC itself has debunked the notion of epithelia transmiting the HIV virus–which lies at the very foundation of the circumcision/HIV hypothesis.
http://www.cirp.org/library/disease/HIV/dezzutti/
Communicable Disease Center, June 1998
[278/32124] Mechanisms of HIV Transmission through Epithelial Cell Barriers
Charlene S. Dezzutti
R.B. Lal. CDC, Mail Stop G19,
1600 Clifton Rd,
Atlanta, Ga 30333,
USA
Abstract
Objectives: Previous studies have shown that HIV can be transcytosed across epithelial cell line barriers; however, there is no information concerning primary epithelial cells. Our objectives were to determine if primary epithelial cells have the ability to harbor and transmit HIV and to determine if primary epithelial cells can transcytose HIV.
Methods: For HIV transmission, primary prostate epithelial cells (PrEC) and two epithelial cervical carcinoma cell lines, ME-180 and CaSKI, were inoculated with HI and washed. Various concentrations of resting or activated CD8-depleted PBMCs were added before or after the epithelial cells were trypsinized.
Supernatants were monitored every 2 days for HIV expression using a p24 ELISA. DNA PCR was performed on the pot-trypsinized epithelial cells to evaluate proviral integration. For HIV transcytosis, the epithelial cells were cultured on 0.4 mM transwell filters until confluent (day 7). Cell-free HIV (LAI; MOI .001) or cell-associated (18 hours, TNF a-induced OM10.1 cell line) HIV was added to the apical side. The basolateral medium was sampled for HIV p24.
Results: Without trypsinization, HIV was recovered by day 3 from ME-180 and CaSKI cell lines and by day 7 from the PrEC cells y activated PBMCs but not by resting PBMCs. For all epithelial cells, at least 5 [times] 105 activated PBMCs (2 PBMCs to 1 epithelial cell) were required for HIV recovery. Trypsinization of the epithelial cells resulted in a loss of recoverable HIV from PEC, but not ME-180 and CaSKI cells, even though all transiently had provirus. We next explored HIV transcytosis. PrEC developed a tight-junction monolayer as seen by high transepithelial resistance (433 W [times] cm2). CaSKI cells developed a moderate tight-junction monolayer (50 W [times] cm2), while the ME-180 cells failed to make a tight-junction monolayer. Consequently, cell-free HIV was readily transcytosed through ME-180 cells by 1 hour and through CaSKI cells by 2 hours. Cell-associated virus began to transcytose through ME-180 and CaSKI cells by 24 hours. Importantly, PrEC did not transcytose cell-free or cell-associated HIV.
Conclusions: Both primary and immortalized epithelial cells have the capacity to transiently sequester HIV, but primary (PrEC) cells are incapable of transmission. Further, formation of a tight-junction monolayer by PrEC did not allow transcytosis of cell-free or cell-associated HIV. Collectively, these data suggest that the in vivo mucosal epithelial barrier protects against HIV transmission, and that factors, such as STDs, affecting the integrity of transepithelial tight-junctions may allow viral entry and thus have implications for sexual transmission.
http://www.cirp.org/library/disease/STDnew/geneva/
GENEVA, Jul 02 (Reuters) — Healthy epithelial cells that line the body cavities and cover structures such as the cervix and prostate resist HIV infection, according to a report presented Thursday at the 12th World AIDS Conference by researchers from the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia.
But this protection against infection is lost when the cells have been altered by infection with other sexually transmitted diseases (STDs).
“This is the first study to demonstrate that normally functioning epithelial cells are incapable of transmitting HIV,” said CDC researcher Dr. Charlene Dezzutti in a press statement. “But STDs and other factors which damage these cells can play a major role in the sexual spread of this epidemic.”
“The normally functioning cells formed a tight bond between cells that would not allow HIV to pass through, while the (diseased) cells failed to develop a tight bond and did allow passage of the virus,” according to the CDC statement.
So, why is the CDC seriously looking into possibly recommending circumcision??
This commentary from a lawyer attending their conference might probvide us a clue:
http://www.circumcisionandhiv.com/
This week I attended the CDC sponsored 2009 National HIV Prevention Conference in Atlanta, Georgia where I live. The assembled CDC worthies were promoting circumcision on the basis of three African Randomized Controlled Trials (RCTs), the conclusions of which were presented by one speaker as being “beyond a reasonable doubt.” [Those trials purport to show a dramatic reduction in HIV acquisition in circumcised adult men. They have been subjected to considerable criticism and doubt by others including noted physicians and public health professionals. See http://www.circumcisionandhiv.com. Katrina Kretsinger, MD, of the CDC was asked if the RCTs would be repeated in the U.S. She replied that they would not be because it would be unethical to do so! Then how were they ethical to start with? When I attended the session where Deborah Gust of the CDC presented a paper demonstrating that circumcision made no difference in the acquisition of HIV by insertive gay males, I asked why these results did not bring into question the conclusions of the RCTs since the anus supposedly contains more HIV than the vagina. The reply, as I understood it, was that since the insertive males also were sometimes receptive males you could not say how they got HIV. Of course, if that is the case, then the study was worthless. But since it was presented as being worthy (otherwise why present it?), I am of the opinion that it does bring into question the validity of the RCTs, as does the known fact that the U.S. has the highest rate of HIV in the industrialized world (a fact one speaker brought up), the highest STD rate in that same world, and the highest rate of male circumcision in that same world. So much for the great American circumcision experiment! It has already failed! Why would reasonable scientists want to repeat it?
At one of the last sessions the speaker from “Operation Abraham”, a Jerusalem, Israel group that apparently hopes to be engaged to assist the U.S. in circumcising the black and Hispanic males who are not circumcised, put a photo of an intact male up on the screen. The figure of an elephant had been drawn around the penis so that the intact penis looked like an elephant’s trunk. The words “Please circumcise me” had been added to the photo. I remonstrated loudly until this smear against intact males was taken down. I then promptly left the session. I am still awaiting a deserved, written, direct apology from Dr. Peter Kilmarx, Chief of the Epidemiology Branch of the Division of HIV/AIDS Prevention of the CDC, who was in attendance and from whom I demanded an apology. I think this shows the mindset of the CDC. They seem to have abandoned all scientific objectivity to promote a useless and mutilating surgery. I expect the men are all circumcised and the women are all married to circumcised men. So the trauma repeats itself and those who have been traumatized fulfill their need to traumatize others. [See http://www.circumcision.org. And apparently they think it is socially and ethically acceptable to denigrate a normal body part and to attempt to humiliate all intact boys and men into submitting to circumcision.
“Nick, do you contend that HIV is not the cause of AIDS?”
The article wasn’t about origin of AIDS and has nothing to do with it. It just mentions the flaws of HIV&Circumcsion studies without questionning origin of AIDS. Also the site isn’t saying HIV is not the cause of AIDS but HIV is not the necessary and sufficient cause of AIDS.
Nick, do you contend that HIV is not the cause of AIDS?
To answer your question I dunno probably not.
But one thing is sure : The more I read Amy’s articles the less I believe in “official” science.
Dr. Tuteur, in response to your quote below, please answer the following questions:
1. Is sensory perception a function of the human body?
2. Does the tissue that would be removed by circumcision perform a sensory function in intact men?
3. Can you cite any evidence which contradicts Sorrells’ measurements of fine-touch pressure thresholds in anatomy possessed only by intact males? (Full text here: http://www3.interscience.wiley.com/cgi-bin/fulltext/118508429/HTMLSTART )
4. Do you accept objective loss of sensory capability as a “clinical effect”, or do you consider such loss not “clinically relevant” and therefore irrelevant?
4. Will you separate science and medical evidence from policy advocacy propped up by cultural sacred cows unconstrained by principles of medical ethics?
Dr. Tuteur wrote:
“Are there any metrics on which circumcised and uncircumcised men differ?
Ability to have intercourse? No.
Frequency of intercourse? No.
Ability to reproduce? No.
Number of children? No.
Reported sexual satisfaction? No.
Ability to urinate? No.
Long term health sequelae? No.
I could go on and on, but I think you get the point.
There’s no evidence that circumcision alters function in any way.”
Please don’t judge science by Dr Amy’s articles. She is a controversialist, and shows scant regard for science when it gets in the way of her prejudices.
I’m not sure I know what you mean when you say you probably believe that “HIV is not the necessary and sufficient cause of AIDS.”
If HIV is a not a necessary cause of AIDS, that implies that AIDS can have other causes. What are those other causes?
If HIV is not a sufficient cause of AIDS, do you mean that some other factor(s) must *always* be present for HIV to cause AIDS? If so, what are those other factors?
Nick – You’re very obviously here to troll this blog and are anti-SBM. How is this obvious? You’re even arguing with people who don’t support circumcision when we call you on promoting the anti-science and Scientology-connected insanity of infamous quacks like Rima Laibow as evidence. If you truly were here arguing out of a concern for infants and actually had any respect for science – and weren’t just using it as an ideological tool like Dr Tuteur also did in this blog post – you wouldn’t keep resorting to pseudoscience, attacking people who make reasonable and non-ideological arguments against neonatal circumcision.
To present your own words again and to reveal just how unethical you really are…
*Nick – “Those who promote ethical and legal practices have no need to be accountable for their words and actions.”*
Dr. Tuteur is tarnishing the name of Science-Based Medicine.
Oh my, this seems to be getting off the mark again. Let’s get back on track. Just so this doesn’t get buried, I am curious Amy, do you agree with the British Medical Association’s view:
http://www.bma.org.uk/ethics/consent_and_capacity/malecircumcision2006.jsp
“Therefore, to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate. ”
A yes or no should be sufficient.
fiffy,
What is your obsession with scientology and Rima Laibow? What interesting scientific articles did you bring so far ? What scientific arguments did you bring ?
Why are you writting the same posts again, again and again ?
It’s just ridiculous or boring at best.
Do you need science to be against FGM ?
Is anyone strongly against FGM also biased and has an axe to grind ?
What would we do with studies from African doctors who on the front want to “reduce HIV transmission,” through female circumcision?
“Those who promote ethical and legal practices have no need to be accountable for their words and actions.” : if someone was saying that as regards FGM, would it be also unethical ? Or do they need science to justify their positions ?
It’s obvious the only trolling is you and nobody else
“If HIV is a not a necessary cause of AIDS, that implies that AIDS can have other causes. What are those other causes?
If HIV is not a sufficient cause of AIDS, do you mean that some other factor(s) must *always* be present for HIV to cause AIDS? If so, what are those other factors?”
This is probably not the right topic to answer these questions. I’m not qualified enoug to answer these question, maybe ask fiffy ?
Also did you read this article ? It says that the studies were flawed because the circumcised group were given condoms which clearly means that you have to support the official hypothesis (HIV origin of AIDS) to give this article some credit
Teen boys in hospital after botched circumcisions
This is really sad…
http://www.heraldsun.com.au/news/national/teen-boys-in-hospital-after-botched-circumcision/story-e6frf7l6-1225817889024
Ethic and circumcision :
http://www.circumcision.org/ethics.htm
“Like all professions, medicine has its own ethical code and principles of conduct. One rule of conduct is “First, do no harm.” Removing a normal, healthy body part and causing unnecessary pain is doing harm.”
Dear Dr Teuter,
I am an Australian Medical Professional who practices on the science-practitioner model and have recently studied the Royal Australasian College of Physicians 2009 Statement on Infant Circumcision. They have taken into account the very studies you mention to argue your case however concluded the following:
When considering routine infant circumcision, ethical concerns have focused on recognition of the functional role of the foreskin, the non-therapeutic nature of the operation, and the psychological distress felt by some adult males circumcised as infants. The possibility that routine circumcision contravenes human rights has been raised because circumcision is performed on a minor for non-clinical reasons, and is potentially without net clinical benefit for the child.
Recently there has been renewed debate regarding both the possible health benefits and the ethical concerns relating to routine male circumcision. The most important conditions where some benefit may result from circumcision are urinary tract infections, and in adults HIV infection and cancer of the penis. The frequency of these conditions, the level of protection offered by circumcision and complication rate of circumcision do not warrant a recommendation of universal circumcision for newborn and infant males in an Australian and New Zealand context.
AS one scientist speaking to another I need to hear what scientific evidence and ethical philosophy you have used to come to such a different conclusion to the RACP, one of Australia and NZ highest respected medical Authorities.
Male genital mutilation is a crime against humanity :
http://www.youtube.com/watch?v=WaZMHUdY70I
But wait, aren’t the more extreme form of male circ performed on adults?
Why should they be banned (and I could have gone my whole life without knowing about those two forms. Gack)
“Nick – You’re very obviously here to troll this blog and are anti-SBM. How is this obvious? You’re even arguing with people who don’t support circumcision when we call you on promoting the anti-science and Scientology-connected insanity of infamous quacks like Rima Laibow as evidence. If you truly were here arguing out of a concern for infants and actually had any respect for science – and weren’t just using it as an ideological tool like Dr Tuteur also did in this blog post – you wouldn’t keep resorting to pseudoscience, attacking people who make reasonable and non-ideological arguments against neonatal circumcision.”
Fiffy,
It is not up to those opposed to circumcision to justify their demands. It is up to those who advocate circumcision, who need to justify their actions legally and ethically. The ridicule and vilification of opponents of circumcision (as well as victims who object to this unlawful intrusion upon their bodies) by accusing them of being radical, or belonging to special interest groups, is the only means left to these charlatans. They are unable provide explanations regarding the ethics of performing surgery for which there is no medical necessity.
Why would parents go to the doc for a ceremonial pinprick?
And How do ‘they’ know 1A is the least common? it would seem to me that it would the kind least likely to have complications, thus the least likely to be detected.
Ian Wilkinson – Thanks for being a voice of reason and advocate of science-based medicine on this subject. Let’s see if you can be heard over the intentional noise creation or will be drowned out by the ideologues! It really would be nice to read, for once, a rational discussion about this topic. There seems to be a lot of penis waving going on from both sides (and by both genders)!
“There is no way of knowing whether or not he will want to be a part of the Jewish religion as an adult”
You really need to learn a lot more about Judaism before you make claims about it. Being Jewish is not a choice. It is inherited through the mother. You can convert later if you want, but if your mother is Jewish, you’re Jewish, whether you want to be or not.”
This is a very interesting issue. Obviously Amy states what the Jewish faith and tradition claims. And it is a social construct to be sure. Jewish folks believe that if your mother is Jewish then you are, too.
Muslims believe that ALL newborn babies are inherently Muslim.
So the difference is what the faith believes to be so, and what the individual person believe to be so. They may or may not coincide. Since we have freedom of religion in this country, where does that leave us? I am sure I don’t know the answer.
And another though, as I have mentioned in the past, I work in Indian country, and the nuance of cultural differences and having practices be ‘banned’ scares me to some degree, because we have seen over and over, that loss of traditional cultural ceremonial practice and illness(mental and physical)go hand in hand. I would not go so far to say that ‘banning circumcision causes diabetes.’ But the imperialism in which we approach health issues may or may not apply to all cultures. mass hysteria and banning of practices (or overzealous promotion of others) can have far reaching negative consequences.
“there are real benefits, and defending on the population, those benefits can extend to hundreds of thousands of lives saved.”
No. There are absolutely no benefits at all to RNC.
Ian Wilkinson wrote:
“Recently there has been renewed debate regarding both the possible health benefits and the ethical concerns relating to routine male circumcision. The most important conditions where some benefit may result from circumcision are urinary tract infections, and in adults HIV infection and cancer of the penis. The frequency of these conditions, the level of protection offered by circumcision and complication rate of circumcision do not warrant a recommendation of universal circumcision for newborn and infant males in an Australian and New Zealand context.”
Thank you for your comments. It is interesting that ethical considerations were included in the formulation of the RACP policy.
I would like to ask about your observation that urinary tract infections may be an important consideration with regard to infant circumcision. Has the RACP in fact studied and documented a linear increase in male infant UTI as the infant circumcision rate has fallen in New Zealand and Australia since about 1970? Or has the RACP simply absorbed the US claim that circumcised male infants and children are at lower risk for UTI?
After almost 30 years of scrutiny, it is abundantly clear that Wiswell’s 1982 data review that made this claim was deeply flawed. It was not a controlled prospective study; it failed to take into account congenital irregularities from premature birth (likely a large component of the relatively few intact subjects); and most important, it failed to control for proper care of the penis. As it has become better understood that the healthy foreskin may not become freely mobile on its own until puberty (previously thought to be expected by about age 3), premature retraction of the foreskin has been implicated in the transmission of bacterial and viral infections. It is counterintuitive that circumcision would reduce UTI, since the procedure removes an effective cover with muscle tissue that closes in a unique whorl fashion to protect the urethra from irritants and pathogens, as well as the meatal lips that protect the urethra but are routinely damaged through circumcision.
The RACP should clarify its basis for claiming a circumcision-UTI connection. If the basis is its own study or observations, this would carry more weight than merely repeating the conclusions of one large data review in American military hospitals from a generation ago. To my knowledge, there have been no published reports of statistically significant increases in male infant UTI in Canada, Australia or New Zealand during that time period.
Jasonon
The full research paper of the RACP 2009 Statement is not available last time I looked on their website, However the Chairman David Forbes was reported in the media as stating that the more we find out about renal function in the role of UTI’s the less relevant circumcision becomes.
Dr Tueter,
It would benefit the science-based medical community if you could share your scientific evidence and ethical philosophy that appears to contradict the RACP 2009 Statement.
In particular I would like to hear your views, about the level of protection offered by circumcision as analysed and assessed by the RACP is deemed to not warrant infant circumcision.
Also the acknowledgement that the foreskin is functional anatomy, what is your view on this?
Further that there are ethical concerns about performing a non-therapeutic clinical procedure on an infant that cannot consent?
And that in a western medical context such as Aust & NZ that circumcision is not warranted. Would you place the USA in a similar medical context to Aust and NZ?
Further that the RACP acknowledges that some men experince psychological harm due to their circumcisions, do you acknowledge this or deny this?
The answer to these questions would further the the scientific discussions, there are many Aust & NZ Medical practitioners interested in your response to these questions?
Science Based Medicine
DR Tueter
AS you have not responded I will ask again, and clarify my questions further:
To further science it is important that we provide the scientific rational for our public statements including scientific data, a cost benefit analysis of that data, and the ethics and philosophy surrounding this data.
I and my Aust & NZ colleagues would be most interested in hearing your views on the following:
The RACP stated ethical concerns have focused on recognition of the functional role of the foreskin, Do you consider the foreskin as functional anatomy? If not was is your evidence? If it is functional anatomy what is your ethical position on removing this from a non-consenting infant?
The RACP stated that routine infant circumcision is non-therapeutic in the nature of the operation, What is your view on this?
The RACP has acknowledged the psychological distress felt by some adult males circumcised as infants. Do you believe this is the case? If not what is your evidence to state this is not the case?
The RACP has also stated “The possibility that routine circumcision contravenes human rights has been raised because circumcision is performed on a minor for non-clinical reasons, and is potentially without net clinical benefit for the child” is another reason not to recommend RIC. How do you respond to this?
The RACP also stated “Recently there has been renewed debate regarding both the possible health benefits and the ethical concerns relating to routine male circumcision. The most important conditions where some benefit may result from circumcision are urinary tract infections, and in adults HIV infection and cancer of the penis. The frequency of these conditions, the level of protection offered by circumcision and complication rate of circumcision do not warrant a recommendation of universal circumcision for newborn and infant males in an Australian and New Zealand context.”
How do you respond to the frequency of the conditions in a western medical context not warranting a recommendation of circumcision for infants.
How do you respond to the level of protection for UTI, HIV and Penile cancer not warranting circumcision for infants?
How do you respond to the complication rate of circumcision not warranting circumcision for infants?
The RACP 2009 statement concluded with: “After extensive review of the literature the RACP does not recommend that routine circumcision in infancy be performed”
Have you conducted an extensive Literature Review? Have you performed a rigorous cost benefit analysis of the Literature’s findings and how this applies to an American context?
I think it is critically important that you answer these questions in the name of Science-Based Medicine.
@Ian
With regard to Dr. Forbes the editorial he wrote can be read here:
http://www.6minutes.com.au/articles/z1/view.asp?id=498029
Where he noted:
“Further the stated benefits of protection against urinary tract infection are marginal, and do not justify mass circumcision. Our changing understanding of the relationship between urinary tract infection and chronic renal disease further weakens the case for routine circumcision.“
@Amy Tueter “Are there any metrics on which circumcised and uncircumcised men differ?
Ability to have intercourse? No.
Frequency of intercourse? No.
Ability to reproduce? No.
Number of children? No.
Reported sexual satisfaction? No.
Ability to urinate? No.
Long term health sequelae? No.
I could go on and on, but I think you get the point.
There’s no evidence that circumcision alters function in any way.”
Carefully chosen metrics that slalom around all the ways circumcised sex differs from integral sex (lovemaking, the whole journey between arousal and orgasm). Circumcised men report that their frenulum (“the male G-spot”) is their most sensitive part. The frenulum is all that is left of Taylor’s ridged band, the concentration of Meissner’s corpuscles running around the inside of the foreskin that provide what has been called “a symphony of sensation”. Women who have experienced both report that circumcised men have to thrust harshly to achieve enough stimulation to reach orgasm. This emphasis on “reaching orgasm” may be what makes (circumcised) men so goal-directed. Intact men don’t have to work so hard so they can savour the journey more. With more nerves, they get more feedback, and hence have more control.
Sure, this isn’t very science-based, but I think anyone will admit that the scientific study of sex hasn’t progressed very far. Masters & Johnson, in particular, were driven by their own prejudices in this area, making no measurement of the foreskin or study of circumcised vs intact sex whatsoever, before delivering their much-quoted opinion that circumcision has no effect on sex.
A disclaimer is required, I suppose: I am myself circumcised; I was circumcised as an infant. I have never felt any lack from having had this done, and I have been more or less indifferent on the subject of whether or not it should be done. Up until now, my position has been: “If you feel strongly about it, then go ahead. If not, then don’t.”
That said, if the science supports its usefulness, and there isn’t any non-ideologically motivated argument against it, then it seems like a sensible thing to do.
Tuteur claims that
You really need to learn a lot more about Judaism before you make claims about it. Being Jewish is not a choice. It is inherited through the mother.
This is an astounding thing to say in a blog about science based medicine. Is there a Jewish gene that I don’t know about? Basically Tuteur is making a claim that is no different from saying that being in the Untouchable Class is not a choice: it’s inherited. The astounding part about her statement is its implicit agreement. Interestingly, Judaism has its own touch of caste system, codified by the rules of being a mamzer (Jewish bastard). This is a person born out of wedlock under certain rules, and in the supposedly secular state of Israel being a mamzer affects marriage, and it is a curse that is passed down through the generations. Of course, it’s all constructed: you can’t tell under a microscope that somebody is a mamzer, and you can’t test for it.
And, Tuteur, I happen to know a lot about this subject, and the subject of botched circumcisions. Mamzerim are not spared the knife, and in my case I am sure that my mamzer status provoked an especially brutal bris. Give the mamzer a good tight circumcision, something he’ll remember.
Tuteur would do well to walk this one back, but it seems she can’t bear the idea of admitting that on this point, she’s an idiot.
Ian Wilkinson,
Perhaps Dr Auteur is not responding because she has already answered most of those questions in her replies to others.
It would be a simple matter to peruse these 500+ comments for those made by Dr. Amy Auteur. If you did so, you would find the answer to most of your questions:
Q: Do you consider the foreskin as functional anatomy?
A: No
Q: The RACP stated that routine infant circumcision is non-therapeutic in the nature of the operation, What is your view on this?
A: Agree. It is a preventative, not a therapeutic, operation
Q: The RACP has acknowledged the psychological distress felt by some adult males circumcised as infants.
A: I don’t think she has answered this one
But would you please provide a reference that quotes NNT.
Q:“The possibility that routine circumcision contravenes human rights has been raised because circumcision is performed on a minor for non-clinical reasons…”
A: Disagree. It is a preventative activity similar to vaccination.
Q: “…and is potentially without net clinical benefit for the child”
A: Disagree. It can help to reduce the chances of contracting UTI, HIV (50%), HSV (30%), HPV (30%), vaginosis, trichomonas, cervical cancer, penile cancer.
Q: “…[this] is another reason not to recommend RIC.
A: Dr Auteur does not recommend routine/universal infant circumcision either. Moreover, Dr Auteur agrees with their following recommendation:
“the RACP does not recommend that routine circumcision in infancy be performed, but accepts that parents should be able to make this decision with their doctors….In all cases where parents request a circumcision for their child the medical attendant is obliged to provide accurate information on the risks and benefits of the procedure. Up-to-date, unbiased written material summarising the evidence should be widely available to parents. In the absence of evidence of substantial harm, parental choice should be respected.”
Q: How do you respond to the frequency of the conditions in a western medical context not warranting a recommendation of [universal/routine] circumcision for infants.
A: Dr Auteur does not recommend routine/universal infant circumcision.
Q: How do you respond to the level of protection for UTI, HIV and Penile cancer not warranting [universal/routine] circumcision for infants?
A: Dr Auteur does not recommend routine/universal infant circumcision.
Q:How do you respond to the complication rate of circumcision not warranting [universal/routine] circumcision for infants?
A: Dr Auteur does not recommend routine/universal infant circumcision.
Q: The RACP 2009 statement concluded with: “After extensive review of the literature the RACP does not recommend that routine circumcision in infancy be performed”
A: Dr Auteur does not recommend routine/universal infant circumcision.
Q: Have you conducted an extensive Literature Review?
A: I don’t think Dr. Auteur has answered this question. However… have you? I suspect that, like yourself, Dr Auteur relies on the appropriate authorites to do this for her. There is no need to reinvent the wheel.
Q: Have you performed a rigorous cost benefit analysis of the Literature’s findings and how this applies to an American context?
A: Probably not. Have you? I suspect that, like yourself, Dr Auteur relies on the appropriate authorites to do this for her.
Hugh,
“Women who have experienced both report that circumcised men have to thrust harshly to achieve enough stimulation to reach orgasm. ”
Was this a criticism or a support for circumcision?
I really don’t understand the argument that it’s okay UNTIL proven harmful. That’s generally not the way we do things anymore. Quite the contrary, we don’t cut things off without a VERY good reason, especially when the person is unable to give their consent. Except foreskins. As far as I can tell, they only get special treatment because of tradition.
America’s experiment with infant circumcision has failed. While proponents of the surgery, nearly all personally affected by and invested in circumcision, leapfrog each other to come up with supposed benefits and advantages, no studies have ever conclusively shown circumcision to have improved overall health outcomes in the United States. It does not suffice to infer these outcomes from other studies, however well or poorly constructed and conducted, in non-comparable populations as a basis to make recommendations to parents or the medical profession as a whole. From a purely cost-benefit standpoint, infant circumcision has been a net disaster for almost a century, costing the healthcare sector approximately half a billion dollars a year at present levels in fees, materials and necessary surgical follow-up. Between 2 and 5 percent of the one million infant circumcisions performed annually in the United States require further treatment or surgical correction by a pediatric urologist or other physician; most “botches”, including skin tags, skin bridges, uneven scars, and meatal stenosis, go unreported and untreated.
There is no question that infant circumcision alters the appearance of the genitalia, and this change is by no means universally welcome. It is an issue that circumcision proponents seldom want to acknowledge, or dismiss out of hand. Yet it is an undeniably valid concern of the owner of the penis, whose potential preference (likely preference, judging by those countries that do not practice circumcision) must be respected.
Circumcision does not remove a flap of skin; it is not a simple procedure. It cuts through dense nerves and vascular tissue that contributes to the effective responsiveness and bloodflow of the penis. In the neonate, the synechia actually binds the foreskin to the glans, indicating incomplete development of the structures and contraindicating surgical interference. There is no evidence whatsoever that the foreskin is vestigial or superfluous; rather, its complexity surpasses that of most of the rest of the penis (certainly the glans) and impacts dynamics from temperature regulation to tumescence and detumescence.
The foreskin provides ample tegument for comfortable erections with mobile shaft skin. In contrast, the shaft skin of many circumcised penises is stretched unnaturally taut upon erection and does not move at all, sometimes causing discomfort to the owner and his partner. Circumcision removes muscle tissue with known functions in both infancy and adulthood, as documented in the published literature, and lays down a dense network of fiber in its ring cicatrice. This fibrous tissue inhibits the penis’s natural range of motion and also blocks full nerve transmission, not to mention usually leaving an unsightly, untreated scar around the penis.
The routine iatrogenic wounding of American youth happens without sufficient medical indication and with inexcusable disregard for its overall cost ineffectiveness. As other developed nations have moved away from the fad of infant circumcision over the past 50 years, they have not only maintained or improved overall health outcomes, but they have saved hundreds of millions of dollars a year and avoided tens of thousands of instances of surgical mishap and inflicted pain. On that, everyone should agree.
BillyJoe,
I am not sure why you have responded on Dr Tuter’s behalf, are you her spokesperson, if so you need to identify yourself, and demonstrate where you have been given approval to speak on her behalf?
I have read most of the 575 replies and did not find any critical analysis of the data which convincingly disputed the RACP’s 2009 statement. The Data presented to make the case for infant circumcision was used from a scientific report based on the findings from African Studies, which do not reflect either the medical health resources of first world nations, the viral loads in first world medicine nations, nor do the African findings reflect the epidemiological data from First World Medical Nations. These are the main arguments of the RACP 2009 statement.
I also believe you are playing with semantics, have you read Dr Tueter’s last line @’I believe the AAP should heed the Authors call’, what is implied is obvious to any scientific mind.
When I am asked about circumcision by parents, I show them a copy of the RACP 2009 statement, and its previous research documents and go through these with them. if Dr Tueter has further information which disputes the RACP, then I would like to know what that is, so I can make an informed decision or at least do further reserach to investigate the matter.
Eg. You say that Dr T would dispute that the foreskin is functional anatomy, what is this based on? Her argument where she espouses that the circumcised penis can still urinate etc. is most unconvincing from a scientific point of view, Taylor et al. documented the physiology of the foreskin including the gliding mechanism during intercourse and masturnbation, as well as the interaction effects of the foreskin and glans, which are lost to circumcision.
If a scientist is going to make a public call about a public health matter then this needs to be backed by rigorous science, including an analytical cost benefit analysis of the pros & cons & I have not seen this demonstrated? It is contingent upon Dr T for her to have scientific credibility, to demonstrate a ananalytical cost benefit analysis has been undertaken, or there is a question mark left against her reputation as an impartial medical scientist?
I would imagine Dr T is a very busy person and doesnt have the time to do such a rigorous analysis of the data, thats OK we’re all human, we all make mistakes……..A respected medical professional should not be tainted by an error like this, though would be helpful if she admitted her mistake, makes it easier for us all connect with her humanity then.
Ian Wilkinson,
I assume we are responding to Dr. Auteurs article AND her clarifications in the commentary.
Her article was certainly ambiguous, but her comments have surely clarified her opinion.
It should now be clear that she is not advocating “routine” infant circumcision.
She is advocating that parents make a “informed choice” about whether or not their male infants will be circumcised.
She is saying that parents need updated “information” in order to make this “informed choice”.
This is not a matter of semantics.
There is a very real difference between “routine” infant circumcision and “informed choice” infant circumcision.
In case you don’t see the difference, let me explain:
If the evidence for infant circumcision is overwhelming, the RACP would be advocating “routine” circumcision. In other words they would be encouraging all parents to have their infants sons circumcised.
In fact the evidence is neither strongly for nor against circumcision.
It is appropriate, in these circumstances, that they advocate that parents make an “informed choice” as to whether or not they personally will have their infant sons circumcised.
Dr. Auteur is saying that the “information” supplied to parents making an “informed choice” should include the new evidence about the role of circumcision in the prevention of the various STDs etc.
I agree this was not clear in her article, but it should be clear from her subsequent comments.
As to the function question: Dr. Auteur quoted a paper which found no difference in sexual function between the circumcised and uncircumcised penis. I suppose, however, that what we need is the results of a systematic review. I don’t even know that one exists, but Cochrane would be a good place to find out.
(Note: I am only responding on her behalf because I have read her commentary where she has effectively answered most of your questions and I imagine she might be a little loathe to keep repeating them)
I think you’ll find that the RACP 2009 statement clearly states that the current evidence does not warrant a recommendation of RIC, I wonder why this isn’t emphasised?
I have young parents coming to my consulting rooms fearing their sons will die of AIDs if they are not circumcised, because of the misinformation that is caused by blogs such as this one.
How ethical is it the some of our Medical Professionals are allowed to create such a climate of fear in young parents who live in low viral load HIV populations in the First World of Medicine? and Then when these so-called medical professionals are called to justify their statements with rigorous analytical science the name calling starts with inflammatory terms such as anti-circ activists and foreskin fetishists, is this rigorous medical science?
I think the onus is on The Dr T’s of the world to make a rigorous scientific case or be called for their emotive unscientific defences. In the name of science be scrupulous & rigorous or be called out as unscientific.
Ian,
“I think you’ll find that the RACP 2009 statement clearly states that the current evidence does not warrant a recommendation of RIC”
But I think you still don’t understand what this means.
Here are relevant exerpts form their statement:
(Note: They seem to use the words “newborn”, “infancy”, and “children” interchangeably. Similarly for the words “universal” and “routine”. I presume this will be tidied up in their final statement)
“The frequency of these conditions, the level of protection offered by circumcision and complication rate of circumcision do not warrant a recommendation of universal circumcision for newborn and infant males in an Australian and New Zealand context.”
In other words:
They do not recommend UNIVERSAL circumcision for newborn
“After extensive review of the literature the RACP does not recommend that routine circumcision in infancy be performed but accepts that parents should be able to make this decision with their doctors”
In other words:
They do not recommend ROUTINE circumcision in infancy.
“In all cases where parents request a circumcision for their child the medical attendant is obliged to provide accurate information on the risks and benefits of the procedure. Up-to-date, unbiased written material summarising the evidence should be widely available to parents. In the absence of evidence of substantial harm, parental choice should be respected.”
In other words:
They recommend parents make an INFORMED CHOICE regarding circumcision for their children.
Don’t you understand that: if the evidence was strongly in favour of infant circumcision, they would be recommending infant circumcision; if the evidence was strongly against infant circumcision, they would be recommending against infant circumcision; but because the evidence is not strong either way, they recommend that if parents enquire about circumcsion, they should be given the most up to date evidence so that they can make an informed choice.
As for the fear tactics, unfortunately it exists on both sides of the argument.
I cannot find anything in Cochrane, but here is lots of information collected and provided by “a review of the literature” by an academic, Professor Brian J. Morris, with no apparent vested interests.
http://www.circinfo.net/socio_sexual_aspects.html
http://www.circinfo.net/circumcision_sensitivity_sensation_sexual_function.html
Here is some information about the author and his motives:
http://www.circinfo.net/about_the_author_professor_brian_j_morris.html
regards,
BillyJoe
BillyJoe wrote:
“It should now be clear that she is not advocating “routine” infant circumcision.
She is advocating that parents make a “informed choice” about whether or not their male infants will be circumcised.
She is saying that parents need updated “information” in order to make this “informed choice”.
This is not a matter of semantics.
There is a very real difference between “routine” infant circumcision and “informed choice” infant circumcision.
In case you don’t see the difference, let me explain:
If the evidence for infant circumcision is overwhelming, the RACP would be advocating “routine” circumcision. In other words they would be encouraging all parents to have their infants sons circumcised.
In fact the evidence is neither strongly for nor against circumcision.
It is appropriate, in these circumstances, that they advocate that parents make an “informed choice” as to whether or not they personally will have their infant sons circumcised.”
Ahem.
Not everyone shares your definition of routine infant circumcision (RIC). Your definition could also be termed widespread or universal circumcision. To others, the term “routine circumcision” means circumcision on demand without present medical indication. Many people believe that in a neutral environment in which circumcision is not encouraged by subsidy or lecture, there should be substantially less infant circumcision than the United States sees today. RIC could still be “routine” at 20% if there is no compelling medical reason to recommend it. “Routine” just means more than is medically necessary.
What Tuteur actually seems to advocate is increased US circumcision from levels where they are today (you and she can claim all you want that it’s still not “routine”) through public and private funding and sales-pitches. One really has to wonder why. Which parents specifically are not making an “informed choice” today? Presumably, Tuteur means many of the parents who are not electing RIC for their sons. Or are you suggesting that she wants to inform parents more fully in order to prevent so many of them from blindly choosing circumcision, as they do today? More parents of intact sons have done their homework than parents of circumcised boys, because in the United States infant circumcision is still the default choice. Ask any new parent.
Many people strenuously object to public dollars being spent on routine circumcision when they themselves see the surgery as unnecessary and harmful and have very happily not put their own children through it. States are in a deep budget bind, and circumcision is entirely elective. There are no real (observed, documented) health outcome differences for circumcised and intact children, other than the relatively high complication and re-do rates from the surgery. There is no ethical basis for paying other parents’ costs of unnecessary genital surgery on their children. Nor should parents have to go through a physician-prescribed gantlet to get their child home intact and healthy.
Circumcision has failed every evidence-based examination of the practice and its outcomes. Great Britain, Canada, Australia and New Zealand have been roaring successes at reducing or eliminating the practice of infant circumcision with superb health outcomes and tremendously better cost-benefit ratios over several decades. Meanwhile, the United States inexplicably subsidizes surgery that few parents actually request (but are nearly always offered), especially physicians themselves.
Infant circumcision is a hoax. It is a solution desperately in search of something to address. It has never been proven scientifically to improve health outcomes in the United States or anywhere else.
Tuteur and her colleagues likely fear a movement afoot to make RIC illegal — it’s close to that in some European countries — but that is simple paranoia. There is no prospect of that in the US. Nevertheless, Tuteur strikes preëmptively to pitch circumcision in an effort to raise the baseline. There is no other explanation for her zeal to “educate and inform” every parents of the “benefits” of circumcision while ignoring the physiology of what it does and its unacceptable complication rate.
Risk/benefit is a fallacy (even though RIC fails it)
Advantage/disadvantage is the relevant comparison
Jason,
I was responding to Ian’s interpretation of the RACP 2009 statement on infant circumcision.
My definition of “routine” is therefore in the context in which it is used in that statement.
I believe my definition is correct and I have tried to show why by an analysis of that statement.
make RIC illegal — it’s close to that in some European countries
++++++++
Are you sure? Prohibition is quite different from regulation.
Sweden has regulated infant circumcision for almost a decade, requiring that it be performed only by a board-certified practitioner with a licensed anesthesiologist present if performed within the first 2 months of life, and only by a physician if performed at later than 2 months. Denmark and Finland have both had parliamentary bills introduced to discuss whether circumcision of minors is a criminal offense, and Sweden is not completely finished debating the legality of nontherapeutic circumcision of minors across the board. Ethical concerns have been raised that could trump religious arguments.
Circumcision of male minors (under 16) is unlawful in South Africa except in certain cases of religious requirement or medical necessity, under the 2007 Children’s Act. The UK Law Commission has also initiated an inquiry into the legal status of nonreligious, nontherapeutic circumcision of minors.
If by regulation you mean exceptions for health, then that is correct.
No, by regulation I mean that specifying the presence of a licensed anaesthesiologist is not the same as prohibition.
Demanding that practitioners be board certified is not the same as prohibition.
Discussion of the legal status of circumcision is not the same as legislating against it.
I’d be grateful for a link to or reference for the UK Law Commission inquiry, as I couldn’t find it on the Law Commission website.
None of the European countries you mention have legislated to prohibit or restrict circumcision, only to regulate it.
“That said, if the science supports its usefulness, and there isn’t any non-ideologically motivated argument against it, then it seems like a sensible thing to do.”
This is the crux, contrary to Amy’s claim.. SCIENCE nor the real world does not support it–all that does are a bunch of MEDICAL questionable studies.
To address all word games by Billy Joe..
they boil down to a single statement–there is no scientifically-credible evidence for non-therapeutic circumcision and therefore cannot be rationally recommended regardless of the terminology used to defend Amy’s advocating circumcision.
Circumcision forced or coerced onto any non-adult is an ethical and moral crime.
INFORMED decision for adults is predicated on correct, valid, and complete information–not the garbage Amy is trying to pass off as legitimate.
I find it both amusing and amazing that for a “science-based’ forum, how little SCIENCE is even posted. And when someone posts something containing science how totally it is ignored.
This speaks volumes to the scientific literacy and understanding of most people here.
Billyjoel,
I, and I think a lot of “intactivists”, agree that neonatal circumcision should not be something that is ” up to the parents ” when urgent medical need is absent.
If female circumcision ( even just the removal of the labia and/or clitoral hood ) showed a decrease in UTIs and HIV transmission, do you think the United States would reverse its anti FGM laws to accommodate? As other posters have shown, with links to an African study, females who were circumcised had lower HIV rates than females who were not. Why have doctors in the United States not actively sought out studies to show the benefits of female circumcision? I am not aware of any such studies.
All things that male circumcision has been shown to have proven benefits ( UTIs, cancer, and STDs ) are all treated in girls without routine amputation of any healthy tissue, why should boys be different? Amputation is a last resort, and is neither the best, least invasive, or only means of achieving the desired result.
As has been brought up several times, double mastectomies have been shown to reduce the risk of breast cancer by 97 to 99 percent, which effects thousands of more people than HIV in the United States, and effects women indiscriminately. Why do proponents of circumcision not also recommend performing mastectomies on babies or children?
Foreskin is unique in that there is not any other instance where doctors routinely remove healthy functioning tissue or organs to prevent a future disease. We don’t remove spleens, or appendixes, or even tonsils (anymore) without medical need. Since HIV and other STDs are adult diseases, why should it not be up to the adult to decide whether or not the risks are worth the benefits? The penis is only a concern for the parent until the age of about six, when boys can then take care of themselves. So why should this decision be ” up to the parents ” when the result will effect the owner of the penis his entire life? The vast majority of men, even in the United States, never need or want a circumcision, and I think that is a strongly overlooked point.
Brian Morris has no vested interests in promoting circumcision?
This is a man whose hobby is traveling to and filming mass circumcisions.. his interests is what many people would term “circumfetishist”
Now as to his credibility, here are a FEW examples of it..
Let’s see what we know of Brian Morris..
Rebuttal to the BM website:
http://www.circumstitions.com/Morris.html
His hobby-traveling to mass circumcision rituals to view and film:
Quotes from “personal” website of Brian Morris:
“I have some wonderful photographs of a group of Masai boys in their early teens that I met in Kenya in 1989 dressed in their dark circumcision robes, with white feathers as headwear, and white painted facial decoration that stood out against their very black skin.
Each wore a pendant that was the razor blade used for their own circumcision. The ceremony that they had gone through is a special part of their tribal culture and was very important to these boys, who were proud to show that they were now ‘men’. In other cultures it is associated with preparation for marriage and as a sign of entry into manhood.”
And his site links to proven circumfetish sites (and vice-versa).. and the usual testimonials present in all fetishist sites.
http://circinfo.net/
http://circinfo.net/htmlnew/circumcision_sources.htm
http://circinfo.net/htmlnew/author_brian_morris.htm
Reviews of his book which contains info from his site–including one from the Jam and from some of his fellow Austs..
Brian Morris is a professor of Molecular Biology and hypertension-field of study at the Univ Of Sidney, Aust HE is NOT a MD nor a circumcision expert.
The Journal of Australian Medicine (1999, vol.11, no.11, p.18), which has no apparent interest in either defending or condemning circumcision, has reviewed Dr. Morris’ book and given it a thumbs down. Here’s an excerpt from that very sensible review:
“In those with a normal bladder and kidneys the argument for circumcision may be akin to suggesting prophylactic removal of the tonsils or the appendix; the latter are obviously as silly as taking seriously any study supposedly concluding that either version of the penis ‘looks better’.
Also, is the author really serious in suggesting that routine circumcision is needed to prevent zipper injury? Unfortunately, once again, a presentation on the subject of circumcision has not advanced the development of a scientific approach.”
Reviewer: A reader from Bond University Men’s Health Research Center, Gold Coast, Queensland, Australia September 2, 1999
This book was reviewed (above) in “glowing terms” by a physician, who openly admits to having circumcised a large number of unconsenting minors (who happen to be boys). Consequently, he has a vested interest in promoting genital reduction surgery (erogenous foreskin amputation). Are physicians now to take their medical advice from obsessive genital cutters, rather than from recognized professional bodies? Not one national medical association anywhere in the world recommends unnecessary circumcision!
This book selectively cites outdated studies many of which have been thoroughly discredited in the scientific medical literature for decades. For example, this book states that penile cancer is reduced by circumcision. Nothing could be further from the truth.
Representatives of the American Cancer Society (Feb 16, 1996) stated that infant circumcision is not a valid or effective measure to prevent penile cancer which affects only one in 100,000 males.
The Australasian Association of Paediatric Surgeons stated (April, 1996) that “neonatal circumcision has no medical indication.”
The Queensland Law Reform Commission (Dec, 1993) stated that “routine circumcision could be regarded as a criminal act.”
The primary dictum of ethical medical practice is “First do no harm.” Yet there is now overwhelming evidence that infant circumcision causes irreparable harm physically, sexually, and psychologically.
Much of the life-long harm caused by imposed genital cutting (on unconsenting minors) is documented in the British Journal of Urology, 1999 (Vol 83, Supplement 1). Also see website: http://www.cirp.org listed by the British Medical Association.
Gregory J. Boyle, Ph.D Professor of Psychology and Director, Men’s Health Research Centre Bond University, Gold Coast 4229 Australia
BOOK LACKS SCIENTIFIC EVIDENCE AUSTRALIAN MEDICINE, 1999, Vol. 11 (No. 11), p. 18. by Professor Paddy Dewan
Extract — “….[The author] understates the nature of the procedure, omits several potential complications and downplays the importance of circumcision to the income of American doctors. Also, Dr Morris omits to mention the medical treatment of phimosis, and he overstates the adverse events associated with phimosis when he states that “as a result of phimosis, males will be unable to urinate. The bladder fills up and urinary retention becomes a painful, alarming and dangerous experience”. This is a marked variance to the many boys who usually present with minimal symptoms with phimosis, which is easily treated by the application of steroid cream for four to six weeks.
“The increased risk of urinary tract infection in uncircumcised boys is probably real, but it remains arguable if the data used to support circumcision is analysed more critically. Even so, circumcision for boys with renal anomalies, that is, those having intermittent catheterisation or with immune deficiencies, is probably appropriate–these arguments are not presented in Dr Morris’ book. In those with a normal bladder and kidneys the argument for circumcision may be akin to suggesting prophylactic removal of the tonsils or the appendix; the latter are obviously as silly as taking seriously any study supposedly concluding that either version of the penis “looks better”. Also, is the author really serious in suggesting that routine circumcision is needed to prevent zipper injury?
Furthermore, he chooses to select penile cancer figures that support his argument, then proceeds to accuse the anti-circumcision group, NOCIRC, of “distortions, anecdotes and testimonials”, and Dr. Paul Fleiss of “off the wall statements” to support his case to keep the foreskin. Dr Morris then concludes, “if anything, circumcision by freeing the penis of the encumbrance of a foreskin can only serve to enhance penis size”.
“In quoting a Forum magazine study, referring to the opinion of a “Seinfeld” character and stating that “the uncircumcised man may need several showers per day”, further undermines Dr Morris’ efforts to have us take seriously the data otherwise collected. Unfortunately, once again, a presentation on the subject of circumcision has not advanced the development of a scientific approach….”
Professor Paddy Dewan is a Paediatric Urologist from the Royal Children’s Hospital, Melbourne.
Dr. James Powell from Chicago, Illinois , October 28, 1999 A book without emotions…..or FACTS! I find it totally ridiculous that such a book exists in which the author makes his claims on completely anecdotal grounds. There are few facts presented in this book. You will not find the information you need to educate yourself about this topic in this book. If you want GOOD information from people that know what they are talking about, refer to the vast multitude of anti-circumcision facts that are on the internet, or the vast amount of more factual books available. And please avoid Mr. Morris’s own website as you will find nothing but the same delusions on it as in his book.
Dr Morris recently wrote a letter to the Medical Journal of Australia to promote circumcision.
Here is the response by the authors:
http://www.mja.com.au/public/issues/178_11_020603/matters_arising_020603-5.html
“The letter by Morris is more difficult to discuss as it relates, on the whole, to the use of routine circumcision, which was not the focus of our article. The issues raised by Morris seem to be at complete odds with the 2002 Policy Statement on Circumcision by the RACP — which is also consistent with the recommendations of the Canadian Paediatric Society and the American Academy of Paediatrics.4 The RACP Policy Statement reviewed most of the points raised by Morris, including urinary tract infections, STDs, human papillomavirus and carcinomas of the cervix and penis. In each case, after an extensive review of the literature, the RACP reaffirmed that there is no medical indication for routine circumcision. Morris’s view on the reduction of risk of sexual problems is at odds with the article by Darby,9 published in the same issue of the Journal as our article, and is beyond the scope of our study. His claim that circumcision improves appearance is highly subjective and unsubstantiated, and should not be used to justify the surgical removal of tissue that may have a benefit to the individual later in life”
His deceits:
Dr. Brian J. Morris, Ph.D. is a biochemist at the University of Sydney.
He has written a very pro-circumcision page on the Internet.
His page is full of errors. He frequently misrepresents his sources. Many of his sources are on the CIRP so one should go there and read them to see what they really say.
For example, Dr. Morris writes”
“In the light of an increasing volume of medical scientific evidence pointing to the benefits of neonatal circumcision a new policy statement was formulated by a working party of the Australian College of Paediatrics in August 1995 and adopted by the College in May 1996 [6]. In this document medical practitioners are now urged to fully inform parents of the benefits of having their male children circumcised.”
In reality, the Australian College of Paediatrics states:
“The College believes informed discussion with parents regarding the possible health benefits of routine male circumcision and the risks associated with the operation are essential. Up-to-date, unbiased written material summarising the evidence in plain English should be widely available to parents.”
Dr. Morris omitted risks. See
http://www.cirp.org/library/statements/acp1996/
Dr. Morris originally had his pages on the departmental board at the U. of Sydney. He was forced to move his pages to the personal pages section because of professional criticism of his diatribe.
For commentary on Dr. Morris’ work please go here:
http://www.circumstitions.com/Morris.html
http://rainforest.parentsplace.com/dialog/get/newcircumcision19/1.html
The essay “Medical Benefits From Circumcision” by Brian Morris is a case study in misinformation! For example …
Morris – “In the light of an increasing volume of medical scientific evidence pointing to the benefits of neonatal circumcision a new policy statement was formulated by a working party of the Australian College of Paediatrics in August 1995 and adopted by the College in May 1996. In this document medical practitioners are now urged to fully inform parents of the benefits of having their male children circumcised.”
Australian College of Paediatrics – “The College believes informed discussion with parents regarding the possible health benefits of routine male circumcision and the risks associated with the operation are essential.”
The full text can be read at http://www.nocirc.org/position/acp.html
Morris says that the ACP urged that parents be fully informed of the benefits, but he totally ignores their recommendation that parents also be fully informed of the risks.
Morris – “Similar recommendations were made recently by the Canadian Paediatric Society who also conducted an evaluation of the literature, although concluded that the benefits and harms were very evenly balanced.”
Canadian Paediatric Society – “The overall evidence of the benefits and harms of circumcision is so evenly balanced that it does not support recommending circumcision as a routine procedure for newborns. There is therefore no indication that the position taken by the CPS in 1982 should be changed.”
The full text can be read at http://www.cps.ca/english/statements/FN/fn96-01.htm
In 1982 the CPS took a position against routine infant circumcision because “there are no valid medical indications for circumcision in the neonatal period.” The CPS did not change their position against RIC in 1996. Morris conveniently ignores the Canadian Paediatric Society’s opposition to routine infant circumcision.
Morris – “The American College of Pediatrics has moved far closer to an advocacy position …”
The Department of Pediatrics at Johns Hopkins University has a web page that lists many pediatric organization. There is no organization called the “American College of Pediatrics”. The following are among the many organizations they list – American Academy of Pediatrics, American Pediatric Society, and American Pediatric Surgery Association.
“Pediatric Points of Interest” compiled by the Department of Pediatrics at Johns Hopkins University
http://www.med.jhu.edu/peds/neonatology/organ.html#Organizations
Also “American College of Pediatrics” is not listed in online phone directories.
Morris has probably confused the American College of Pediatrics with the American Academy of Pediatrics. Assuming that is what he did, let’s look at the statement, “The American Academy of Pediatrics has moved far closer to an advocacy position …”
The American Academy of Pediatrics (AAP) issued statements on routine infant circumcision in 1971, 1975, 1983, and 1989.
AAP (1971) – “there are no valid medical indications for circumcision in the neonatal period.”
AAP (1975) – “there is no absolute medical indication for routine circumcision of the newborn.”
The AAP reiterated their 1975 position again in 1983.
AAP (1989) – “Newborn circumcision has potential medical benefits and advantages as well as disadvantages and risks. When circumcision is being considered, the benefits and risks should be explained to the parents and informed consent obtained.”
The full text can be read at http://www.aap.org/policy/02624.html
While it may be “technically” correct to say that the AAP has “moved closer to” an advocacy position, the statement by Morris is misleading because the AAP has *not* taken an advocacy position in favor of routine infant circumcision. A more correct statement would be, “The American Academy of Pediatrics has softened its opposition to routine intact circumcision.” Softening one’s opposition to a policy is not the same thing as advocating that policy.
Later in the article Morris again misrepresents the position of the American Academy of Pediatrics (AAP).
Morris – “The trend not to circumcise started in the mid to late 1970s, after the American Academy of Paediatrics Committee for the Newborn stated, in 1971, that there are ‘no valid medical indications for circumcision’. In 1975 this was modified to ‘no absolute valid … ‘, which remained in the 1983 statement, but in 1989 it changed significantly to ‘New evidence has suggested possible medical benefits …’”
The sentence that Morris quotes from the 1989 AAP report is in the introduction, not the conclusion. The conclusion of the report states clearly that there are both potential medical benefits and risks. Morris does not mention the disadvantages and risk of infant
circumcision. He leaves the impression that the AAP only mentions benefits.
AAP – “Newborn circumcision has potential medical benefits and advantages as well as disadvantages and risks. When circumcision is being considered, the benefits and risks should be explained to the parents and informed consent obtained.”
Actual statements by Aust Ped societies:
Australasian Association of Paediatric Surgeons. Guidelines for Circumcision. http://www.cirp.org/library/statements/aaps/
“The Australasian Association of Paediatric Surgeons does not support the routine circumcision of male neonates, infants or children in Australia. It is considered to be inappropriate and unnecessary as a routine to remove the prepuce, based on the current evidence available.”
“We do not support the removal of a normal part of the body, unless there are definite indications to justify the complications and risks which may arise. In particular, we are opposed to male children being subjected to a procedure, which had they been old enough to consider the advantages and disadvantages, may well have opted to reject the operation and retain their prepuce.”
“Neonatal male circumcision has no medical indication. It is a traumatic procedure performed without anaesthesia to remove a normal functional and protective prepuce. At birth, the prepuce has not separated from the underlying glans and must be forcibly torn apart to deliver the glans, prior to removal of the prepuce distal to the coronal groove.”
AMA (Aust):
The AMA will discourage circumcision of baby boys in line with the Australian College of Paediatrics’ Position Statement on Routine Circumcision of Normal Male Infants and Boys.
The statement, released in June and supported by the AMA’s November Federal Council meeting, includes: The Australian College of Paediatrics should continue to discourage the practice of circumcision in newborns.
Now if you think this man has any credibility–you need to think again.
As a mom who routinely consults with pediatric specialists regarding therapy, tests and surgeries for my son, the truly disconcerting thing when meeting a new specialist is trying to figure out whether I’m dealing with a Dr. Gorski/Dr Hall type or a Dr Tuteur type. The first can offer a senescent summary of risk and benefit, possible complications and long term effects.
The second, well I always come out of her post feeling kind of worried and then her comments tell me she wasn’t really saying what her post seemed to say. How does that method play out in the doctor’s office?
When we adopted our son at age 2 he was not circumcised. Our Ped gave us the standard run down of information basically saying it wasn’t needed, but it wasn’t harmful. The HIV research came out shortly after, but like Harriet’s post said, it’s still not a clear recommendation in the U.S.
My son is 5 now. The thing I end up thinking is this. Because we know my son will need several future surgeries, I want to be able to tell him each time that this surgery is necessary or will offer him a noticeable benefit. Based on the run down in Harriet’s article and other online reading, I find it hard to do that with a circumcision surgery.
““I have some wonderful photographs of a group of Masai boys in their early teens that I met in Kenya in 1989 dressed in their dark circumcision robes, with white feathers as headwear, and white painted facial decoration that stood out against their very black skin.
Each wore a pendant that was the razor blade used for their own circumcision. The ceremony that they had gone through is a special part of their tribal culture and was very important to these boys, who were proud to show that they were now ‘men’. In other cultures it is associated with preparation for marriage and as a sign of entry into manhood.”
I don’t really see the problem with this, and I don’t understand why you included it? That would fit the criteria of ‘consenting adult(s)’ would it not?
“I don’t really see the problem with this, and I don’t understand why you included it? That would fit the criteria of ‘consenting adult(s)’ would it not?”
I also agree that any adult stupid enough to get circumcised should be allowed to, it was posted to show that BM is hardly disinterested or academic about circumcision–he certainly has some unusual non-academic interests (hobby) in promoting circumcision.
@BillyJoel
You bring up the vaccination comparison again but that is one that just doesn’t stick for many reasons which have been listed here. It is common enough that Dr. Forbes (who is head of the RACP group that reviews this issue) noted as part of a recent editorial:
http://www.6minutes.com.au/articles/z1/view.asp?id=498029
The option of delaying the decision to circumcise is one way of dealing with the ethical and potential legal issues of undertaking an elective procedure on a minor. The procedure is not to be equated with vaccination, either in its delivery or in its effectiveness.
The two just shouldn’t be compared.
Returning to an often posted, but never answered s question..
Can anyone provide a scientifically credible reason for infant circumcision?
I realize that it is a troubling question for the scientifically illiterate and circumcisers, but it still is a crucial question that demands an answer.
Is ANY poster here (Amy?) willing to try to provide an answer?
If so, it would provide an interesting diversion to the usual nonsense being posted here?
MSNBC is covering the issue of neonatal circumcision today.
Circumcise or not? Parents, you’re on your own. Two medical journals take disparate stances within just one week
That’s right Dr. Tuteur, and so is The Globe and Mail:
Circumcision health benefit virtually nil, study finds
http://www.theglobeandmail.com/life/health/circumcision-health-benefit-virtually-nil-study-finds/article1427972/
Outside the bubble of cultural acceptance in the United States, there is a clear consensus that newborn circumcision is not medically indicated.
Now, will you answer my questions, Dr. Tuteur?
http://www.sciencebasedmedicine.org/?p=3310#comment-39428
Haven’t you yet realized that Dr. Tuteur does NOT “answer” questions (ESPECIALLY science-related questions). She only throws out more and more worthless OPINIONS or OPINION sites.
“Circumcise or not? Parents, you’re on your own. Two medical journals take disparate stances within just one week”
WHICH one of these provides ANY scientifically credible information? AND which one provides medical rubbish? In essence, which one deserves my attention and time?
Please advise.
“Routine” is a wonderfully slippery word, and it would add to clarity if it were not used in the context of non-therapeutic circumcision.
In common parlance, it means “as a matter of course, without further thought”. If anyone said “Babies are routinely circumcised in X hospital”, you would suppose that parents have to take some action to make sure they are not. This was the case in many US hospitals a few decades ago, but hardly anyone would advocate that today.
So to use it to mean “without medical indication, but with parents’ informed consent” creates ambiguity.
Prof. Brian Morris has never seen a reason for circumcising he does not like, up to and including
“The prepuce can become entrapped in zippers, leading to swelling and scarring. This is painful and traumatic. ‘The Bathroom splatter’ of uncircumcised males can be a source of annoyance.”
(“Why circumcision is a biomedical imperative for the 21st century” BioEssays 29:1147–1158, p1153 – this paper acknowledges The Gilgal Society, a circumfetish organisation)
It should go without saying that the circumcised glans can also become entrapped in zippers (and it is more sensitive to pain), and that the bathroom splatter of circumcised males can also be a source of annoyance.
He also says “Recurrent UTIs occur in 19% of uncircumcised boys, but in none of the circumcised.(61)” (ibid, p1151) which sounds frighteningly common, but you have to go to the source to find that the “19%” amounted to FIVE intact boys out of 26 with recurrent UTIs, out of 36 whose circumcision status was known (the 10 known to be circumcised didn’t have recurrent UTIs, hence “none”), out of 68 boys with any UTI (but the circumcistion status of the other 32 was unknown), out of nearly 75,000 children altogether! (543 of the girls had UTIs, 75 recurrent.) This is, to say the least, selective, and it is typical of his method of arguing.
He has also described himself as “the expert reviewer for the RACP” and was publicly corrected by the chair of the RACP’s Paediatrics & Child Health Policy & Advocacy Committee: “Professor Morris … is not a member of the RACP and is not and has not been engaged as a reviewer for the College.”
annabel,
“neonatal circumcision should not be something that is ” up to the parents ””
If the risk/benefit assessment is neither for nor against infant circumcision, should it then be “up to the parents” to decide? I don’t know.
This comes up in a lot of medical issues. Prostate cancer for example. Looking at the evidence and the risk/benefit ratio, there is no good medical reason to have a PSA test. In fact, the RACGP have never recommended it on that basis. But they do advise GPs that if men ask about the test they should give them the most up to date information and let them “decide for themselves”. But should they? Should they not advise GPs to advise against having a test which has no real proven benefits above risks. Also should medical funds, and especially Medicare cover it when there is no clear evidence of benefit?
I suspect you may be talking about something else though.
Only trouble is, if parents are not allowed to make the decision about circumcision for their children, where do we stand in regards to vaccination which also has risks?
Joep,
“The procedure is not to be equated with vaccination, either in its delivery or in its effectiveness.”
I wasn’t.
I was comparing them from the point of view of whether parents have the right to decide for their children. Some have argued that infant circumcision should be illegal/criminal because the child cannot give informed consent. That particular argument would also apply to vaccination.
@BillyJoe
Comparing circumcision and vaccination is a flawed analogy. It has been covered here in the thread and if you missed it, I again direct you to a recent editorial by Dr. Forbes (who is head of the RACP group that reviews this issue) which noted as part of that recent editorial:
http://www.6minutes.com.au/articles/z1/view.asp?id=498029
The option of delaying the decision to circumcise is one way of dealing with the ethical and potential legal issues of undertaking an elective procedure on a minor. The procedure is not to be equated with vaccination, either in its delivery or in its effectiveness.
Again, the two shouldn’t be compared.
@All
I read with great interest the article that Xero posted:
http://www.theglobeandmail.com/life/health/circumcision-health-benefit-virtually-nil-study-finds/article1427972/
I find it interesting to see the contrast between American doctor and their counter parts abroad. I am not surprised the Americans largely dismiss any concerns about ethics, complications, and psychology. It’s more of an after thought whereas the Australians feel it’s more worthy of consideration.
Hugh,
“So to use it to mean “without medical indication, but with parents’ informed consent” creates ambiguity.”
Nevertheless that is the obvious meaning in the context of the RACP statement.
Do you think otherwise?
Robert Sampson,
Thanks for your rundown on Brian Morris.
I have no idea whether or not he is a reliable source of information.
I have no ax to grind here. I was searching for the results of systemic reviews about the effects of circumcision on sexual function. I did not find any, even in Cochrane, but came across Brian Morris’ website which offered lots of information on this subject together with a summary of the evidence. It seemed reasonable on the surface.
I tried medical sites initially but they either did not mention the topic or mentioned it only very briefly without references to any evidence for or against.
My own opinion, for what it is worth, is that no medical/surgical procedure or test should be performed unless there is a clear benefit above risks. I also find it problematic that Specialist Colleges “leave it to parents to decide” whenever the evidence is not strong either way. I also find it problematic that medical insurance companies, and Medicare, cover procedures and tests for which there is no clear benefit above risks.
Regards
Show me someone who was vaccinated within the last year (or the last 70 years) and I wouldn’t be able to tell you whether he was or not. Even if he’s nude.
Show me someone who was circumcised within the last year (or the last 70 years) and I can almost certainly tell you whether he was or not (nude). Indeed, it’s not something he’ll ever be able to disguise for the rest of his life; it’s a permanent removal of a significant amount of genital tissue and the scarring of his sexual organ. That type of change is so intimate and personal to the individual that it is simply not appropriate for parents to make except in the case of medical necessity. Nigerians (Igala, Ondo, Oyo) scarify the cheeks of their adolescent (or younger) sons with a knife and argue it doesn’t remove any tissue; should it be the parents’ right? Should children just “get over it”?
“Because marking is usually done to youngsters, most Nigerians whose faces bear ethnic marks had little choice in the matter. When they become parents, however, they must decide whether to mark their children.
“Others deeply resent the marks. Tajudeen says about the marking on his face: “I hate it, and I curse the day it was inflicted on me.” And a teenage girl praises her mother for not allowing her to be subjected to the operation as a child. She says: “I would consider suicide if I had been given the marks.”
http://www.watchtower.org/e/19990108/article_01.htm
In the absence of evidence that European, South American, Asian and now a fortunate majority of Canadian and Australian youth are in any way dissatisfied with or disadvantaged by their intact status, there is no defensible reason to subject healthy American children to genital surgery.
American circumcision has never really been about health; it is about uniformity, control and power.
So a procedure that has disadvantages that potentially (or significantly) outweigh advantages should still be performed because it is “low risk”?
I still don’t get how risk/benefit analysis is appropriate when it comes to circumcision. The problems with non-medically indicated circumcision are not limited to risk.
Billyjoel,
You said
“I suspect you may be talking about something else though.
Only trouble is, if parents are not allowed to make the decision about circumcision for their children, where do we stand in regards to vaccination which also has risks?”
Parents aren’t allowed to make the decision about circumcision for their children, they are allowed to make it for their sons. There is a difference. I don’t understand why parents think it is a violation of their rights to not circumcise their sons, yet I never hear that as an argument when the fact that circumcising their daughters is illegal is brought up. Show me a study that says pricking the vagina of a baby does harm later in life. Yet this is illegal in the United States.
As others have pointed out, vaccinations are not to be compared with circumcision. Vaccines don’t permanently change the appearance or function of any body part. The diseases for which children are most commonly immunized against ( such as polio and small pox ) are caught while doing things that a person cannot control, like unknowingly standing next to someone who has the disease. HIV and other STDs take a specific action to contract, an action I hope most parents don’t think their children will be doing until at least a teenager.
Point is, there are many things parents aren’t allowed to do to children, because children aren’t property. They have rights. Two parents just recently are facing jail time for tattooing a small cross on the hands of their children, who asked for the tattoo.
I have yet to hear anyone from the pro circumcision lobby address whether or not they think removing the breast tissue from babies or children is something they think is ethical. Since, after all, breast cancer effects thousands of more people than HIV( 1 in 8 women, or 12 percent), and it hits women indiscriminately. What is your opinion on this?
“Only trouble is, if parents are not allowed to make the decision about circumcision for their children, where do we stand in regards to vaccination which also has risks?”
Oh, lord, now we get the tired old “vaccination analogy”.
Let’s just ignore that vaccination has proven benefits and very little proven harm and/or .. circumcision has no proven benefit and many proven harms and risks?
@BillyJoe
BillyJoe said: “I was comparing them from the point of view of whether parents have the right to decide for their children. Some have argued that infant circumcision should be illegal/criminal because the child cannot give informed consent. That particular argument would also apply to vaccination.”
And I am one who would argue that it should be illegal, and criminal, unless there was a medically therapeutic reason to perform it. I don’t see how that compares to vaccination since vaccines have a medically therapeutic purpose. On the other hand circumcision is essentially a tribal/social ritual like say tattooing.
Jason,
“American circumcision has never really been about health; it is about uniformity, control and power.”
In fact, circumcision has always been more about health than anything else. But the medical/surgical reasons for doing circumcisions have often been flawed.
Prior to 1870, circumcision was done only for phimosis and balanitis and this was justifiable.
After 1870, the addtional indications for circumcision were either much less justifiable or not justifiable at all and included hernias, bladder infections, erectile dysfunction, kidney stones, insomnia, chronic indigestion, rheumatism, epilepsy, asthma, bedwetting, syphilis, insanity, and skin cancer.
In fact, it was thought to help for so many conditions that circumcision eventaully became universal.
The germ theory of disease helped to propel it along because the foreskin was seen to be habouring infection and disease.
It was also thought that masturbation caused a wide variety of diseases and that circumcision discouraged masturbation (it doesn’t). To be sure there was a moral element here as well.
The improvement in surgical techniques and the discovery of local anaesthetic also made the procedure easier and less painful and therefore more widespread.
Only relatively recently has it become an issue of “uniformity”. About 65% of Americans are circumcised, but in some parts of America it can be as high as 80%, which makes a uncircumcised American male the odd man out.
Where “control” and “power” come in I’m not sure, but I’m happy to learn.
Annabel,
“As others have pointed out, vaccinations are not to be compared with circumcision.”
And I agree.
Unless you make the specific argument that circumcision should be illegal/criminal on the basis that the child cannot make an informed choice.
That specific argument would also apply to vaccination.
Joep,
“And I am one who would argue that it should be illegal, and criminal, unless there was a medically therapeutic reason to perform it. I don’t see how that compares to vaccination since vaccines have a medically therapeutic purpose”
And I would say that this is an entirely different argument.
@BillyJoe
I am not sure what you mean by:
“And I would say that this is an entirely different argument.”
but you also said: “That specific argument would also apply to vaccination.”
Except the same argument (informed consent of the infant/child) doesn’t apply to vaccine as they are medically therapeutic.
Joep,
Let me put it this way:
What would your argument be against routine infant circumcision:
1) Infants cannot make informed choices.
2) There is no medical need.
If you pick (1), that would apply equally to vaccinations.
If you pick (2), that would apply to infant circumcision but not vaccination.
That is all I’m saying.
BillyJoe,
The answer is both 1 and 2. Since there circumcision is non-therapeutic there is no need to present it to parents as an option and it would be unethical to perform it on an infant or child at the request of a parent when no need is present. It amounts to asking a doctor to tattoo your child because you think it looks cool, or some other similar type of reason.
Now, I am not against an adult choosing a circumcision for any or no reason. The consequences, if any, are on them.
Joep,
Okay, let me put it this way.
You picked (1) and (2), but it seems to me that you picked (1) only because (2) is true.
Fine.
But some would pick (1) regardless of whether or not (2) is true.
Those individuals would also have to be against vaccination for the same reason.
BillyJoe,
You’re correct. For me 1 follows from 2 but because of 2, it’s probably superfluous to discuss 1, except as an exercise. Like vaccination, a compelling medical need, allows one to be presented with an option to do it or not to/for their child.
I could be wrong on this but most people who are against circumcision don’t argue one without two and in the few situations where two is met don’t oppose it any more than any other medically therapeutic procedure.
It appears that Dr T will not answer questions about her level of rigorous and analytical research on the matter of circumcision, I accept that she may be too busy, but she probably needs to take more care about making public references to recommending certain types of public health policy without being properly researched.
Did someone here mention Professor Brian Morris of Sydney University as a reliable source for circumcision information? Mr Morris is well known in medical circles in Australia and NZ, and it is my understanding that his work has been rejected many times by the Royal Australasian College of Physicians. I would put to the author that The RACP is far more respected and recognised when it comes to the interests and welfare of children than Mr Morris.
Ian,
“Did someone here mention Professor Brian Morris of Sydney University as a reliable source for circumcision information?”
Um…nope
I like my clitoral hood. I would be pissed if someone took that off without my permission.
sugarbeth: cancer of the vulva frequently occurs under the clitoral hood, as well as other parts of the vulva. Considering that the clitoral hood is exactly homologous to the foreskin, there’s no reason to believe that its removal would cause any sexual harm, affect fertility, etc. The clitoral hood can also harbor foul smelling bacteria, and its proximity to the urethral opening warrants further investigation as to whether its removal might reduce urinary tract infections in women. Given that it has no use, and can cause harm, science-based medicine, as practiced here, suggests that it would be perfectly ethical for parents to remove it, preferably during the neonatal period.
In fact, women are increasingly seeking the removal of this redundant tissue, along with unsightly and unhygienic labia through a popular surgical procedure called labiaplasty. While not medically indicated, it certainly proves that there’s no harm done!
I’m not suggesting mandatory removal, but the benefits of removing the clitoral hood would accrue throughout life, and when done in infancy the pain isn’t remembered, and healing is quick.
“Circumcision provides another form of protection. It doesn’t render condoms unnecessary (particularly for prevention of unwanted pregnancy, obviously) but that doesn’t change the fact that circumcision independently lowers the risk of transmission of HIV and other STDs.”
That’s wonderful news. Why not let a male reach an age of consent to make such a decision? The age at which one begins consensual activity is certainly old enough to decide whether or not a man wants to be circumcised. I think it’s also a bad thing to pierce a baby’s ears. I would at least wait until they were old enough to ask for them.
I see NO REASON WHATSOEVER that a male infant should be circumcised at birth to prevent future STD infections. The evidence you posted is worth considering at an age when the patient can consent on their own. I’m an M4 student, and just became a father last month to a baby boy. I could see no legitimate reason (including yours) to circumcise him at birth. I was circumcised at birth, and if I had been able to voice my input at the time, I would have REFUSED. I’ve only ever been sexually active with my wife, so I consider the risk to be acceptably low.
re:J_
I wish women that were pro-circumcision could see things that way. The clitoral hood is nowhere near the amount of tissue that a male’s foreskin is, but if someone were to even suggest removing it routinely at birth for “health benefits”, they’d be met with gasps of horror.
The whole pro-circ argument is so full of misandry – that because men are incapable of hygiene or using protection and their brains, we should proactively chop up their bits to save them from themselves. If the sexes were reversed as in J_’s post, it makes this sexism a little more obvious, doesn’t it?
Infant circumcision differs from vaccination because
1) the level of protection offered by vaccination is vastly greater than that offered by circumcision;
2) the diseases children are susceptible to and that vaccination protects against are all contagious, unlike circumcision. Thus vaccination offers (unfortunate term) “herd immunity” – circumcision doesn’t;
3) the diseases children are susceptible to and that vaccination protects against are much more serious than those supposedly protected against by circumcision;
4) vaccination comes without any of the cultural baggage carried by circumcision. (Nobody is vaccinated because his father was, or to look like his father, nobody is vaccinated to make him look better or more acceptable to future mates or peers, nobody is vaccinated because God demands it or because Jesus was or because unvaccinated children are “Eeew, gross!”)
5) vaccination does not have side-effects in unrelated fields, like sexuality or breastfeeding;
6) it is hard to make a case that there is a human right not to be vaccinated.
Since when removing a foresking is NOT a mutilation? Sorry, Amy, but I lost my respect for you after you started advocating violence against babies. No, it is not parents right to mutilate them, the same as it is not a parents right to cut the limbs of babies.
Recommending routine neonatal circumcision is precisely like recommending routine neonatal appendix removal. As well, it does infringe upon the male child’s right to choose to protect himself from disease by hygiene practices and condom use rather than surgery. The only argument for “neonatal” circumcision is that babies are too young to protest, and hopefully won’t remember the pain, otherwise there is no good reason why the decision to be circumcised can’t wait until the male child is old enough to provide informed consent.
So, after this interesting discussion, would it be logical that baby boys should be protected under the same laws as baby girls – no modification of the genitals allowed until they are old enough to consent. Even then, it should be done for medical or religious/cultural reasons. That means that grown boys can be circumcised if a religious or medical certificate is presented. That also means that grown girls can be circumcised (only clitoral hood = foreskin counterpart) after presenting a religious/cultural or medical certificate. How about that?
Maybe we can move on to a discussion of how wearing a veil and abaya can benefit women greatly by reducing their sun exposure and therefore their risk of skin cancer.
A religious/cultural practice that can be justified with some “scientific’ benefits…
Statlerwaldorf,
“Recommending routine neonatal circumcision is precisely like recommending routine neonatal appendix removal.”
With a minimum of training, you could do your own circumcision, but I suggest that you don’t try to remove your own appendix under any circumstances.
“Even then, it should be done for medical or religious/cultural reasons.”
Why exactly does religion get a free ride?
“That also means that grown girls can be circumcised (only clitoral hood = foreskin counterpart) after presenting a religious/cultural or medical certificate.”
On the other hand, if religion is to get a free ride, why no ALL religions. Why not a muslim girl who wants the full deal?
BillyJoe, it doesn’t matter about the invasiveness of the surgery, it is the necessity of the surgery for preventing problems in the future. Some men might get an STD, some people might get appendicitis and need an emergency appendectomy. Let’s save everyone the possible problems and remove the responsible piece of anatomy shortly after birth.
I was thinking it would be impossible to tell Jewish and Muslim folks that they aren’t legally allowed to circumcise their boys. Could you see that working?
Female “circumcision” is not part of Islam, it is a cultural practice that happens in some conservative societies in Asia and Africa, and some of those happen to be Islamic but some don’t. You are right though, it is a slippery slope… I guess the rule would have to be that what can be surgically done to boys should also be allowed for girls and vice versa. So, if infibulation with excision of the clitoris is allowed for girls, then castration should be allowed for boys. Sounds scary doesn’t it?
[...] grief it would be likely to cause is worth it. (Take the heat generated any time circumcision is discussed here and ramp it up by a factor of 10.) On the other hand, there is so much misinformation out there [...]
Good grief, not another (devoid of any real science) science-based medicine topic?
“Female “circumcision” is not part of Islam, it is a cultural practice that happens in some conservative societies in Asia and Africa, and some of those happen to be Islamic but some don’t.”
Well to be truthful, male circumcision is NOT a legitimate part of any religion either–it is not part of the Koran, and the Jewish part was nothing but an invention and insertion into the writings by the priests circa 550BCE.
In terms of “absolute numbers” to compare, I found this from the Canadian Paediatric Society: http://www.cps.ca/caringforkids/pregnancy&babies/Circumcision.htm
“Of every 1,000 boys who are circumcised:
20 to 30 will have a surgical complication, such as too much bleeding or infection in the area.
2 to 3 will have a more serious complication that needs more treatment. Examples include having too much skin removed or more serious bleeding.
2 will be admitted to hospital for a urinary tract infection (UTI) before they are one year old.
About 10 babies may need to have the circumcision done again because of a poor result.”
“Of every 1,000 boys who are not circumcised:
7 will be admitted to hospital for a UTI before they are one year old.
10 will have a circumcision later in life for medical reasons, such as a condition called phimosis. Phimosis is when the opening of the foreskin is scarred and narrow because of infections in the area that keep coming back. Older children who are circumcised may need a general anesthetic, and may have more complications than newborns.
Circumcision slightly lowers the risk of developing cancer of the penis in later life. However, this form of cancer is very rare. One of every one million men who are circumcised will develop cancer of the penis each year. By comparison, 3 of every one million men who are not circumcised will develop penile cancer each year.”
This doesn’t bring in the latest AIDS data, though in Canada or the USA one would expect very little impact, since the rate of transmission through heterosexual intercourse is so low. The Canadian Paediatric Society is currently reviewing and revising their position statement on neonatal circumcision, so this information may change.
Oh, and on the Female Genital Cutting topic, this is a VERY interesting article: http://www3.interscience.wiley.com/cgi-bin/fulltext/123192872/PDFSTART
Note how similar the reasons for women desiring FGC, as listed on the final page of the article, are to the reasons commonly stated for circumcision.
FGC has been found to be correlated with a 50% reduction in the risk of HIV, even when all known confounding variables are considered.
http://www.ias-2005.org/planner/Presentations/ppt/3138.ppt Other data indicates that it increases the risk of HIV for virgins (which has also been found to be true for circumcision) but is correlated with a significant decrease in the risk of HIV for sexually active women.
This information has been dismissed with “there must be a confounding variable that we haven’t considered,” and no one is investigating the possibility of promoting FGC to combat AIDS because FGC is assumed to be unethical. I agree that it is so, but I believe that we also have a cultural bias that assumes that circumcision IS ethical, while assuming that all forms of FGC are not. What if FGC in certain forms were shown to not negatively affect the woman’s sex life (which is precisely what many women who have undergone FGC claim) and in fact has health benefits? Would we *ever* be willing to consider its promotion? Why not?
Oh, and on the Female Genital Cutting topic, this is a VERY interesting article: http://www3.interscience.wiley.com/cgi-bin/fulltext/123192872/PDFSTART
Note how similar the reasons for women desiring FGC, as listed on the final page of the article, are to the reasons commonly stated for circumcision.
FGC has been found to be correlated with a 50% reduction in the risk of HIV, even when all known confounding variables are considered.
http://www.ias-2005.org/planner/Presentations/ppt/3138.ppt Other data indicates that it increases the risk of HIV for virgins (which has also been found to be true for circumcision) but is correlated with a significant decrease in the risk of HIV for sexually active women. I would assume that medically supervised FGC, just like medically supervised circumcision, would not carry an increased risk of HIV.
This information has been dismissed with “there must be a confounding variable that we haven’t considered,” and no one is investigating the possibility of promoting FGC to combat AIDS because FGC is assumed to be unethical. I agree that it is so, but I believe that we also have a cultural bias that assumes that circumcision IS ethical, while assuming that all forms of FGC are not. What if FGC in certain forms were shown to not negatively affect the woman’s sex life (which is precisely what many women who have undergone FGC claim) and in fact has health benefits? Would we *ever* be willing to consider its promotion? Why not?
Oh, and on the Female Genital Cutting topic, this is a VERY interesting article: http://www3.interscience.wiley.com/cgi-bin/fulltext/123192872/PDFSTART
Note how similar the reasons for women desiring FGC, as listed on the final page of the article, are to the reasons commonly stated for circumcision.
FGC has been found to be correlated with a 50% reduction in the risk of HIV, even when all known confounding variables are considered.
http://www.ias-2005.org/planner/Presentations/ppt/3138.ppt Other data indicates that it increases the risk of HIV for virgins (which has also been found to be true for circumcision) but is correlated with a significant decrease in the risk of HIV for sexually active women. I would assume that medically supervised FGC, just like medically supervised circumcision, would not carry an increased risk of HIV.
This information has been dismissed with “there must be a confounding variable that we haven’t considered,” and no one is investigating the possibility of promoting FGC to combat AIDS because FGC is assumed to be unethical. I agree that it is so, but I believe that we also have a cultural bias that assumes that circumcision IS ethical, while assuming that all forms of FGC are not. What if FGC in certain forms were shown to not negatively affect the woman’s sex life (which is precisely what many women who have undergone FGC claim) and in fact has health benefits? Would we *ever* be willing to consider its promotion? Why not?
Sorry for the repeated posts!
“10 will have a circumcision later in life for medical reasons, such as a condition called phimosis. Phimosis is when the opening of the foreskin is scarred and narrow because of infections in the area that keep coming back. Older children who are circumcised may need a general anesthetic, and may have more complications than newborns.”
This does not match the results found in countries that have no history of circumcision, and treat the intact male genita in a medical aspect.
Phimosis in those countries are simply corrected by the application of a topical steroid…and most cases of Phimosis are caused by mal-treatment of the normal penis.
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
In Finland — a non-circumcising country — the operative rate is only a tiny fraction of this percentage. A male’s risk of being circumcised for any reason during his entire lifespan is less than one in 16,000.
http://www.fathermag.com/health/circ/circumcision/circumcision4.shtml
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
http://www.sciencebasedmedicine.org/?p=269
Seems to me it would be far more practical and responsible to teach men to wash their penises and foreskins properly and use condoms rather than to use surgery as a fix.
Condoms are far superior to circumcision at preventing disease anyway, and then we get away from the issue of consent for minors. As an adult you may mutilate yourself any way you see fit, but let’s not push painful and unnecessary surgery as an answer.
The replies to this essay are now much more cogent than the essay itself.
A blogger called Martin has posted a rebuttal to this as The Lay Scientist, http://layscience.net/node/878 .
The elephant in the room is this: why is the US medical profession not primarily focused on understanding the development (at all ages), physiology and function of the male foreskin, and on developing and disseminating techniques for keeping it healthy?
Does no one else find it extremely odd, if not suspicious, that the first instinct is to cut it off?
Robert, I actually thought the 1% (10 in 1000) for future “required” circumcision was conservative for a North American publication, as I have seen statistics as high as 10%. I agree that the truly medically needed circumcisions are likely rarer than that, however I believe far more than 1% of intact men in the US will be *told* that circumcision is required at some point.
Of course, the “hygiene” issue goes into this. Americans are lead to believe that they must be retracting their infant or toddler boys’ foreskins and thoroughly cleaning them, and teen and adult intact men are lead to believe that hygiene must be thorough. While washing after sex is important for adults (but don’t use soap, please!) an obsession with thorough cleansing is more likely to cause problems than help. Whenever I hear nursing home nurses or day care workers complain about the extra work for them with an intact male, I have to wonder what the hell they’re doing and why they think they have to do it. I’ve also heard of parents told that there is something wrong with their son’s foreskin, because it is not retractable when he is preschool or elementary school aged. Then measures are taken to forcibly retract it.
In other words, the “care instructions” being promoted are actually likely part of the cause of all the “needed” circumcisions, and this is compounded by a medical establishment that views foreskins as troublesome and circumcision as normal. If a foreskin is viewed as a functional body part, then amputation will be a last, and not a first, resort.
I see we are in total agreement–I just wanted to clarify for OTHERS that circumcisers many times say circumcision is necessary–when that opinion is really based on ignorance and abuse.
I also want to point out that Dr. Amy is entirely mistaken on the AAP issue, as in fact the 1999 statement on circumcision is *more* in favor of circumcision than earlier statements.
The earliest AAP statement on circumcision was in 1971 and simply said, “There are no valid medical indications for circumcision in the neonatal period.” Here’s a review of the various AAP statements on circumcision: http://www.cirp.org/library/statements/aap/
The only real “benefit” to infant circumcision is the fact that an infant cannot protest. Very, very few adult males would consent to having one of the most sensitive parts of their genitals cut off “just in case” they might decide to have unprotected high-risk sex someday or to prevent the less than 1% risk of ever getting a UTI that they would have to *gasp!* take antibiotics for just like any normal woman would. (a fact that is obvious when you consider that circumcision is easily accessible in most European countries, yet it is rarely performed) If circumcision actually had any real protective effects against AIDS, then that disease would be virtually unknown in the US where the circ rate has been over 90% at one point in our history. The fact is, it is a pointless procedure that kills over 200 otherwise healthy babies annually in a misguided attempt to lower an already miniscule risk of getting AIDS, prevent easily treatable infections, or just to make the baby’s weenie look “prettier” to the parents. It leaves thousands of other little boys with complications like adhesions, skin bridges, and meatal stenosis (1 out of 10 boys) a condition almost unheard of in intact males. Painful erections, bowed penis or buried penis are extremely common results of cutting off too much skin, yet there is no way to know how much skin to leave when cutting an infant. Reduction in sensation does not show up until much later in life, but when it does, it can have devastating effects on a couple’s intimate life, including vaginal chaffing and pain for the woman, since it takes so much more pressure/friction for her partner to climax.
Your knee-jerk reaction to the threat of AIDS fails to take into account the numerous risks involved in the procedure. The risk of getting AIDS is remote, the risk of losing the normal function of the penis is 100%.
Doctor, You will NEVER change the hearts and minds of the anti-circ. Better to educate with facts as you have continually presented, to the rest of the population that is sick and tired of the anti-choice mob.
Clearly the thread shows that when you cannot attack the facts then you attack the character of the person who wrote the article.
“# Akheloioson 10 Jan 2010 at 6:28 pm
Dr. Tuteur is tarnishing the name of Science-Based Medicine.”
That comment shows you the mindset of the people you are arguing with…a population that cannot even express themselves with simple terms properly. BTW Akheloioson, the term is medical evidence, not science-based evidence.
The doctor gave clear medical evidence. She has never stated her position or emotion. That IS what you want from your medical professionals, dare I point out.
No one is forcing any parent to choose circumcision or to choose against. Oh except for the intactivists.
Horrible horrible will imposers that they be. If I ever were to make a medical choice based on emotion, it would certainly be in opposition to intactivists because of their mob mentality and will imposing beliefs.
Doctor, there is a silent majority. I promise you that. We are silent because as evidenced on this thread, they will surround you relentlessly when you use your freedom of speech in any forum and pressure you into submission. These types are no different than the Taliban.
@bapartofmylife: It is those who cut an integral, healthy part of babies off and deprive them of any choice in the matter who are anti-choice, and it is we who want the infant male foreskin to have the same protection as the whole of the rest of the body (until its owner is old enough to choose for himself) who are pro-choice.
The name of this blog is “Science-Based Medicine”. Scroll up and see for yourself if you don’t believe me.
“She has never stated her position”. The item is called “The Case for Neonatal Circumcision”. What is that but a posiition?
“or emotion” – like when she writes “That’s baloney, like so much else of what you’ve written.”?
“No one is forcing any parent to choose circumcision or to choose against. Oh except for the intactivists.” It’s hard to believe you’ve still missed the point. The people who are being forced to accept (with no chance of choosing) circumcision are the penises’ OWNERS. The parents are only the penises’ owners’ guardians/custodians – they don’t own them.
(And actually, there are many cases of parents being browbeaten to accept circumcision: see http://www.circumstitions.com/coerce.html)
“These types are no different than the Taliban.” As extreme Muslims, you can be absolutely certain that the Taliban are all circumcised, and all rabidly in favour of all boys being circumcised.
[...] While I have read some of these studies, as always, Science Based Medicine does a better job than I might on summarizing the salient points and flaws. [...]
First let me say I am not surprised at how much we value our own freedom of choice, and how little we often respect that of others. The best explanation I ever heard of right and wrong is that if something works, it is right, and if it does not work, it is not right. Applying this principle, the same thing may be right for some people, and not right for others.
Remaining intact works well or reasonably well for most males, and I can’t think of any problems caused by being circumcised. So for a typical male either may be right, since they typically work.
Choosing to deny medicine and science does not make us right. The benefits of circumcision may not be so compelling that we can decide that all males must be circumcised. The benefits to both the male and his sexual partners are real just the same. Circumcision may be preventive only 30% or 60% of the time, but it’s real. We can overlook statistics that indicate about one third of teenagers and even preteens have one to four STIs, but if your child or mine has sex, they are at risk. According to an article in MSNBC Health, many men report that typical condoms are too large for them, so just imagine some kids trying to protect themselves with something that fits like a bread bag. We can say they should use condoms, but they dont’ know how and they don’t fit. Condom manufacturers report that condoms will prevent passing of sperm at least 98% of the time. Viruses are much smaller, and bacteria too. So giving them every little bit of protection we can is wise.
Birth circ’d guys usually start out thinking they were born that way, and are fine with it, same as intact guys. I grew up intact, and had several issues with my foreskin. I had a number of painful UTIs, and other infections that weren’t any fun at all. My foreskin was very tight; tight enough to make my penis appear very small. My frenulum was short, and as a youth when I had erections, my penis bent painfully to the right. Sometimes I would get that extra skin at the tip caught in my zipper, and I know I am not the only one that ever happened to! Painful difficult retraction meant that I did not clean in there. After retraction became possible in my mid teens, I often would wake up at night with lots of pubic hairs caught inside the foreskin.
So when I was a man, I got circumcised. It has been good for me in every way. As a result I expected to have my sons the same so they might have all the benefits it brought to me. My second son was adopted at age eleven from South Korea, and arrived intact. When he spoke English well enough, he expressed a desire to remain intact. I told him that was fine, and it would be fine if he changed his mind. He was a young man when he changed his mind. My youngest son was adopted from South America at age seven, and arrived intact. I tried to teach him proper hygiene, and that didn’t go so well. But when he started middle school and had to change in the locker room, he decided he wanted to be circ’d, and he was.
Way back in my school days, there were three guys who had similar partial circs. They were happy being such, and other guys expressed that it was pretty cool. A nephew has a minimal circ, where just the bundle or tube of extra skin at the tip is removed. It was a compromise by the parents, and the kid looks naturally intact, but does have real protection from UTIs and other local infections and easy retraction for cleaning, which they taught him. After a friends toddler got a minimal circ to end repeated infections, his younger brother got the same at birth. I know families where some boys are circ’d and their brothers are not. If it is not an issue for them, what should we care?
Doctors say that circumcision after about six months becomes more difficult, typically requires general anesthesia, and costs about ten times more. A child can grow into a less than perfect circ, but a man needs to be just right. Circumcision after the neonatal period is usually to cure a problem. There can be no statistics for how many problems birth circs cured. STIs are more common where circumcision is less common. Reduced rates of HPV statistically saves lives of women, but we cannot know which ones. So some of us call circumcision prevention and cure, and others choose to call it mutilation. I was one of about ten percent of intact guys who grew up with real foreskin issues. I wish I had been circ’d as a child. Circumcision is a reasonable choice for parents to make.
@L8r: “…how much we value our own freedom of choice, and how little we often respect that of others.” You too, when you say “Circumcision is a reasonable choice for parents to make.”
In between you have a lot of anecdotes (about individuals who benefited from being circumcised or don’t mind being circumcised). You ignore the equal or greater number of available anecdotes about men who hate having been circumcised without their consent, men who chose to be circumcised and regretted it, and circumcisions that went wrong.
I consider “A child can grow into a less than perfect circ, but a man needs to be just right.” to be just disgustingly callous to the child and “less than perfect” a fine euphemism for “botched”. A man can ask for what he wants, and it is much easier to get it right on a full-sized penis.
“Birth circ’d guys usually start out thinking they were born that way, and are fine with it, same as intact guys.”
Sure but finding out what’s been done to then can be devastating, unlike intact guys. I know of one man who expected his foreskin to grow at puberty. He was 17 before the awful truth sank in.
“After retraction became possible in my mid teens, I often would wake up at night with lots of pubic hairs caught inside the foreskin.”
And so you chose to have part of your penis cut off, rather than trim the hair? That suggests you really, really wanted it cut off. And your wise parents had left you that choice.
Your figure of 10% of guys with “real foreskin issues” is wildly exaggerated. In countries outside the US where they value intactness and doctors know more about the foreskin than how to cut it off, the lifetime risk of circumcision is one in the thousands.
@L8r: Oh, and your phimosis could have been treated non-surgically or by lesser surgery, and the infections were probably the result of parental/medical meddling.
@L8r
Look at the forums of any foreskin restoration site to see all the anecdotal evidence of men that are extremely angry at being circumcised against their will.
Or this recent facebook group called ” Thanks Mom and Dad!”
http://www.facebook.com/topic.php?uid=2234965184&topic=14602#topic_top
Kids born today WILL have access to the internet, and more and more of the under 18 crowd are speaking up against being circumcised in the United States.
The ” my parents didn’t have access to the internet” (although legitimate) excuse is not going to fly for this next generation so parents be prepared to have some water tight answers to give them on why you wouldn’t wait until they were old enough to decide for themselves.