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New AAP Policy on Circumcision

Back in 2008, I tried to look objectively at the scientific evidence for and against circumcision.  I got a lot of flak from commenters who focused on the ethical issues rather than the scientific evidence. I concluded that the evidence showed small benefits and small risks, and I didn’t advocate either for or against the procedure. At the time, the American Academy of Pediatrics’ position was:

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.

On August 27, 2012, the American Academy of Pediatrics issued a revised Circumcision Policy Statement saying that the benefits outweigh the risks.

 

The revised policy is based on the findings of a multidisciplinary task force that did a systematic evaluation of the peer-reviewed literature from 1995 through 2010. The new statement has been endorsed by the American College of Obstetricians and Gynecologists. It says: 

…preventive health benefits of elective circumcision of male newborns outweigh the risks of the procedure.  Although health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it … Parents ultimately should decide whether circumcision is in the best interests of their male child.

They cite evidence that circumcision reduces the risk of urinary infections in infancy and reduces the risk of HIV and other sexually transmitted infections in later life. They point out that complications are infrequent and far less likely in the newborn period than if circumcision is performed later in life. Evidence for other benefits and detailed information about risks are included in the Technical Report by the panel along with a discussion of the arguments and with further recommendations. 

They report the scientific data. The decision to circumcise or not to circumcise is based on those data along with non-scientific considerations like religion, ethics, and cultural practices. It seems that most people are unable to discuss the risk/benefit data without getting all riled up about those other issues.

This confusion between scientific data and other issues is illustrated by a detailed 20 point critique  of the AAP report that was published by an anti-circumcision group, the Circumcision Resource Center.  

It’s worth looking at the 20 points in detail. I’ve commented on some of them in parentheses and left it to my readers to spot the logical fallacies in the rest:

  1. The underlying flawed assumption is that the way to evaluate circumcision is to perform medical studies. They say all that is needed is feelings and common sense.
  2. Committee members were biased because many of them were circumcised or had performed circumcisions.
  3. Other countries recommend against circumcision.
  4. Many of the cited studies have been challenged.  (The challenges they cite are unconvincing or based on issues outside of the studies themselves.)
  5. The report doesn’t mention the word “condom.”
  6. The report says circumcision prevents penile cancer. (They try to refute this by citing cancer incidence in two countries with different rates of circumcision.)
  7. The decrease in UTIs is small and they can be treated with antibiotics.
  8. Preventive benefits are not actual health benefits.
  9. Is doesn’t mention the effects of circumcision pain. (The report advised adequate anesthesia).
  10. It doesn’t mention ethical objections or all circumcision risks. (False. It has a whole section about ethical issues, and it covers all reported risks.)
  11. It doesn’t mention physician coercion and unauthorized circumcisions.
  12. It makes an issue of penile hygiene.
  13. It doesn’t mention the functions of the foreskin. (Actually it does, and it provides evidence that foreskin removal doesn’t affect sexual pleasure or cause any significant loss of function.)
  14. It doesn’t examine the connection between circumcision and erectile dysfunction. (There’s no credible evidence of any connection.)
  15. It doesn’t mention psychological harm. (Because there’s no evidence in the literature.)
  16. It lacks balance, devoting more space to benefits than to harms. (Because there is more evidence of benefits than harms.)
  17. It calls for more research into potential benefits but doesn’t specifically call for more research into the harms.
  18. It ignores difficulties with informed consent.
  19. It shifts responsibility from physicians to parents.
  20. It ignores serious ethical questions. (same point as #10)

This critique is far less credible than the AAP statement. It gets some of its facts wrong, moves the goalposts, says studies are not the way to look at the problem but then cites studies… the whole thing amounts to anti-circumcision apologetics rather than a reasoned scientific critique.

  • It refers to removing 12 square inches (77 square centimeters) of tissue. That’s an overestimate. According to this study the average area of the adult foreskin is more like 37 to 43 sq. cm.
  • It says some infants don’t cry during circumcision “because they go into shock.” That’s ridiculous. They are clearly not in circulatory shock, and the idea that they are in some state of emotional shock is nothing more than a fanciful speculation.  I would argue that it’s more likely to be because they aren’t experiencing pain. My own anecdotal observation: I’ve seen babies cry from being restrained but then calm down before anything else was done and not cry during the actual procedure, even when it was done without anesthesia. The cutting itself would not be expected to hurt, because the tissue that is cut has already been crushed and numbed by the application of hemostats and clamps.
  • They say anesthetics are injected into the penis and don’t eliminate pain. That’s misleading. For the most effective anesthesia, the dorsal penile nerve block, two injections are given adjacent to the base of the penis, and they prevent pain from the circumcision, although the injections themselves are painful.
  • They cite some poor quality cherry-picked studies.
  • They engage in wild speculation:

the effect of circumcision on male distrust, anxiety, and anger toward women is unrecognized and unexamined. Do the psychological and sexual consequences of circumcision affect America’s uniquely high divorce rate? We do not know.

 Conclusion

The AAP policy is based on a fair evaluation of the scientific evidence for and against circumcision. Ethical, religious, legal, and cultural issues are outside the sphere of science, and the AAP rightfully leaves those issues for parents and society to decide.

 
 
 

Posted in: Surgical Procedures

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178 thoughts on “New AAP Policy on Circumcision

  1. Ceratius says:

    I’m probably going to regret entering this debate, as it always seems to get quite heated. This latest policy seems to indicate that circumcision reduces the rates of STIs significantly enough to be a beneficial procedure (please correct me if I’m wrong in my reading). From other reading it seems to be based on studies primarily in Africa, yet I have not seen any comparisons with countries from the west such as Europe which which would, to my mind (again, please correct me if I’m wrong) be better comparisons. Have there been any studies comparing STI rates between European men and American men?

    I ask as a Brit who had never heard of circumcision as anything other than a religious practice until I began reading American blogs. It is a rare thing, certainly not routine, here and I have to wonder why, if the health benefits are so pronounced, there aren’t efforts to introduce it here?

  2. Barefoot Intactivist says:

    Actually, the AAP’s review of literature stopped at 2010, leaving out the most important scientific piece of work ever conducted on the sexual impact of circumcision (indeed, one of the only ones ever conducted) — a study of 5,000 couples by Frisch et al, published in late 2011, that found circumcised men and their partners were 3.5X more likely to have frequent orgasm problems, in addition to less sexual satisfaction and increased problems with vaginal pain.

    http://ije.oxfordjournals.org/content/early/2011/06/13/ije.dyr104.short?rss=1

    The KNMG, representing 40,000 Dutch doctors, cited this study in a recent symposium on circumcision, following their 2010 report condemning infant circumcision as being risky and without medical benefit.

    http://knmg.artsennet.nl/Nieuws/Nieuwsarchief/Nieuwsbericht-1/Jongensbesnijdenis-wereldwijd-ter-discussie.htm
    http://knmg.artsennet.nl/Publicaties/KNMGpublicatie/Nontherapeutic-circumcision-of-male-minors-2010.htm

    Moreover, a study was just published by Rodriguez et al that found a sample of men in Puerto Rico were more likely to have HIV if circumcised. This is in line with a 2009 USAID study that found, in 10 of 18 countries with data available, circumcised men were more likely to have HIV. This is important given several flawed studies in AFRICA were the primary basis for the AAP’s updated stance more heavily favoring circumcision. No population level data has ever shown an HIV reduction from circumcision.

    http://onlinelibrary.wiley.com/doi/10.1111/j.1743-6109.2012.02871.x/abstract
    http://www.measuredhs.com/pubs/pdf/CR22/CR22.pdf

    I encourage you to read the AAP’s full “Technical Report” on infant circumcision, where the “Task Force” never even bothers to describe what exactly the foreskin is or the anatomy and physiology of the penis. You won’t find the word ‘frenulum’ anywhere in the report.

    Taylor’s studies discussing the “Ridged Band” of nerve endings are never mentioned, and Sorrells’ findings on penile sensitivity are glossed over. The AAP admits that circumcision has been found to reduce masturbatory pleasure, but omits this from any of their conclusions.

    The section on penile cancer is an absolute absurdity — penile cancer is rarer than male breast cancer. The AAP Task Force found one credible study showed that there would need to be 322,000 infant circumcisions, and 644 circumcision complications, to prevent one case of penile cancer.

    Science, my friend, does not support infant circumcision. The AAP supports it because they are biased and defending their members, who are responsible for millions of infant circumcisions over the past 100 years.

    Case in point: the head of the Task Force is an STD expert from the CDC. Babies aren’t even sexually active. How does this make any sense?

    I notice that while criticizing Goldman’s 20 point response, you cherry pick your points, much like you accuse him of cherry picking the science. How does the foreskin being 6 square inches or 12 square inches make any difference in whether it should be amputated from a baby?

    ~Barefoot Intactivist

  3. Cymbe says:

    “It doesn’t mention physician coercion and unauthorized circumcisions.”

    So it requires that they get the baby’s permission? If not, the mutilation is unauthorized coercion. How absolutely revolting.

    Why do people get HIV? Because they do not use protection. They can easily avoid it. This disgusting practice slightly reduces the chance that someone who does not use protection gets HIV, at the price of mutilating the genitalia of the defenseless, robbing them of dignity, bodily integrity, and in some cases, of their lives. The New York Times referred to one estimate that 117 boys in America alone die every year. Yes, that’s the spirit.

    And let us not forget that this is the selfsame group that endorsed a form of illegal bloodletting from girls – also “rightfully”, Harriet: http://www.nytimes.com/2010/05/07/health/policy/07cuts.html – only to retreat after several weeks of withering criticism. If that does not demonstrate that this group is political and only political, what does?

  4. Catherina says:

    I have read the recommendations of the AAP and I must say, I find it downright weird that they argue (a lot) with incidence of STIs. Independent of whether those studies were poorly designed or not (and the HIV transmission studies obviously were), STIs will not be relevant for most boys until they are sexually active. Medically, these criteria do not make sense when looking at a procedure to be performed on infants. Politically, that fits with the general (European) notion that US Americans are obsessed with their children’s sexuality.

    Looking in from the outside (UK/Europe), the AAP’s criteria do look like the attempt to justify a religion/culture/tradition-based practise by carefully selecting literature.
    The fact that ethical and cultural considerations are carefully avoided is interesting in itself. The AAP had no such reservations when they released their statement on female “circumcision” http://pediatrics.aappublications.org/content/125/5/1088.full

    To quote the AAP: “Health educators must also be prepared to explain to parents from outside North America why male genital alteration is routinely practiced here but female genital alteration is routinely condemned.”. Indeed.

  5. Catherina says:

    Barefoot Inactivist! Excellent point about the lack of anatomical description – the statement about female ritual genital cutting has several drawings to illustrate the practise and consequences of FGM.

  6. BillyJoe says:

    “Although health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it”

    If the health benefits, as judged by an expert panel, are not great enough to recommend circumcision (the word “routine” and the phrase “for all male newborns” seems superfluous, but I am open to challenge), then why should there be access to those choosing it against the recommendations of that expert panel, and on what basis could parents, devoid of a medical degree and the data to which the expert panel had access, decide to choose circumcision.

    “Parents ultimately should decide whether circumcision is in the best interests of their male child.”

    And on what basis are they to judge what is in the best interests of their child.

  7. Catherina says:

    Without wanting to hog the discussion, Harriet, I looked back at your previous assessment (http://www.sciencebasedmedicine.org/index.php/circumcision-what-does-science-say/) where you said

    “I used to live in Spain, where you could tell girl babies from boy babies just by looking at their ears: all the baby girls had their ears pierced in the delivery room. That was a “mutilating” procedure with no conceivable medical benefit and a small risk of infection, deformity, or ingestion of earring parts. It was nowhere near as controversial as circumcision. I wonder why.”

    In Germany, the Bundesverband der Kinder- und Jugendärzte (basically the AAP equivalent) clearly states that ear piercing constitutes a violation of physical integrity/a permanent physical alteration and that therefore, parents should not do it until their children have reached the age of consent. Following the recent judgement against non-medically indicated circumcision in Cologne and the judgement in another trial where a girl sustained permanent damage from her ear piercing, several papers have run polls on whether ear piercing should be expressedly forbidden. An interesting year for children’s rights.

  8. Cymbe says:

    My comment won’t get approved. But all of you need to know that this selfsame organization, the AAP, in 2010 endorsed a form of FGM: http://www.nytimes.com/2010/05/07/health/policy/07cuts.html Supposedly because it’s in the best interests of the child. After a few weeks of criticism, they withdrew this statement – so I guess it was not in the best interests of the child after all. It’s in the best interests of the AAP.

  9. Joseph4GI says:

    This blog should be re-named “myth based medicine.”

    Firstly, I’d like to address the relevance of ACOG’s endorsement of the new AAP statement; their business is the health and well being of WOMEN. Just what do they care?

    Answer; as charlatans with first dibs on babies, they perform the greater bulk of circumcisions in the US. Without endorsement from some medical organization they’re up a creek. It should otherwise be irrelevant what ACOG thinks. All circumcisers of children would like the AAP’s latest statement.

    “…preventive health benefits of elective circumcision of male newborns outweigh the risks of the procedure.  Although health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it … Parents ultimately should decide whether circumcision is in the best interests of their male child.”

    It bears pointing out the conflicting message; the AAP believes parents should have “access to” and public coffers should pay for an elective procedure on healthy, non-consenting individuals that it cannot bring itself to endorse.

    That being said, I must criticize this author for merely self-servingly repeating what the AAP has to say regarding its new statement. The AAP is highly selective on the data it chose to evaluate, and yet the author dares to say they did a “thorough evaluation of the data,” and call opponents of infant circumcision “cherry-pickers.” Circumcision advocates have an incorrigible problem with projection.

    The author appears to want to the 20 points put out by the Circumcision Resource Center based on pure opinion alone, hoping readers will take the dismissal at face value. Let’s look at some of the “commentary.

    “(The challenges they cite are unconvincing or based on issues outside of the studies themselves.)”

    According to WHOM? What were these challenges? Or does the author hope readers will simply take her word at face value?

    (They try to refute this by citing cancer incidence in two countries with different rates of circumcision.)

    What is the data the AAP evaluates? Why have other medical organizations in the world not come to the same conclusions using the same data the AAP has access to?

    (The report advised adequate anesthesia).

    Which isn’t exactly the same as talking about the pain and it’s effects.

    (False. It has a whole section about ethical issues, and it covers all reported risks.)

    False. The not all ethical issues nor risks were addressed. Actually, the report comes out and says they were unable to evaluate the risks.

    It doesn’t mention the functions of the foreskin. (Actually it does, and it provides evidence that foreskin removal doesn’t affect sexual pleasure or cause any significant loss of function.)

    Actually, no it doesn’t, and it even says the best evidence they had was the African trials, which were basically skewed surveys. Self serving hogwash.

    (There’s no credible evidence of any connection.)

    Credible according to WHOM? Again, are you going to tell us, or we’re just going to have to trust you?

    It doesn’t mention psychological harm. (Because there’s no evidence in the literature.)

    At least not that the AAP, or any other group whose members profit from circumcision…

    It lacks balance, devoting more space to benefits than to harms. (Because there is more evidence of benefits than harms.)

    Or at least that’s why you and the AAP think…

    “This critique is far less credible than the AAP statement. It gets some of its facts wrong, moves the goalposts, says studies are not the way to look at the problem but then cites studies… the whole thing amounts to anti-circumcision apologetics rather than a reasoned scientific critique.”

    Fortunately, readers can come to their own conclusions.

    “It refers to removing 12 square inches (77 square centimeters) of tissue. That’s an overestimate. According to this study the average area of the adult foreskin is more like 37 to 43 sq. cm.”

    And, of course, it’s the only one that counts…

    “It says some infants don’t cry during circumcision “because they go into shock.” That’s ridiculous. They are clearly not in circulatory shock, and the idea that they are in some state of emotional shock is nothing more than a fanciful speculation.”

    Yes, clearly. No citation or anything.

    “I would argue that it’s more likely to be because they aren’t experiencing pain.”

    Yes, you would… They’re actually in a state of bliss. And the research you have to show for this is…?

    “My own anecdotal observation: I’ve seen babies cry from being restrained but then calm down before anything else was done and not cry during the actual procedure, even when it was done without anesthesia.”

    That’s not what other attending nurses say…

    “The cutting itself would not be expected to hurt, because the tissue that is cut has already been crushed and numbed by the application of hemostats and clamps.”

    And, of course, crushing flesh with clamps and hemostats doesn’t hurt at all… The shrieks we hear in videos are all imagined and/or have absolutely nothing to do with the fact a child’s most sensitive organ is have a part of it cut off… You, Harriet Hall, must think your readers are idiotic.

    “They say anesthetics are injected into the penis and don’t eliminate pain. That’s misleading. For the most effective anesthesia, the dorsal penile nerve block, two injections are given adjacent to the base of the penis, and they prevent pain from the circumcision, although the injections themselves are painful.”

    Actually, no, there is actually research that shows that not even all of this is effective in killing pain. Not that it matters, because 93% of circumcisers don’t even use pain relief anyway.

    “They cite some poor quality cherry-picked studies.”

    This.

    “The AAP policy is based on a fair evaluation of the scientific evidence for and against circumcision.”

    False; it is based on a highly selective group of “studies,” mostly in favor of circumcision, and mostly written by the same group of people in Africa. Respected medical boards in other parts of the world have access to the same “research” the AAP has, and they’ve reached different conclusions; I’m afraid the AAP is out of line, and stands alone defying the whole of modern medicine in claimin “the benefits outweigh the risks.”

    “Ethical, religious, legal, and cultural issues are outside the sphere of science, and the AAP rightfully (conveniently?) leaves those issues for parents and society to decide.”

    Note: For most other surgery, the doctor is usually the one to decide whether it is medically necessary; circumcision seems to be the only instance where parents do their own diagnosis and must evaluate the evidence (which wasn’t enough to bring the AAP or any other medical organization in the world to endorse it) and the doctor, too stupid to know better (shouldn’t evaluating the “evidence” and issuing a prognosis I be *his* job?) conveniently acquescences.

    Readers are encouraged to read the AAP statement for themselves, and to evaluate the evidence presented by intactivists and come to their own conclusions as to who is more credible.

    In the mean time, I challenge a publication that calls itself “evidence-based medicine” to furnish the causal link between circumcision and a reduced HIV transmission rate. So far, we hear many “theories” as to how circumcision is supposed to prevent HIV transmission, but not a single, solid scientifically demonstrable proof. Check the “gold standard trials; they are but ill-conceived statistics embellished with correlation hypothesis, why are purely based on beliefs which have been shown to be completely false. The Langerhans cells are quite effective at destroying HIV, for example. (deWitte) Also, no difference in inner skin (mucosa) nor outer skin can be visualized. (Dinh)

    Without a causal link, claiming circumcision prevents HIV is about as valid as claiming garlic keeps away vampires.

    Where is the evidence?

    How does circumcision prevent HIV?

    And why are HIV transmission rates higher in the US, where 80% of adult men have been circumcised from birth, than in Europe, where circumcision is rare?
     
    Could you please provide a demonstrable causal link? Researchers in Africa don’t seem forthcoming…
     
     

  10. bakteriofag says:

    Just minor point from me – I think that there is a huge amount of more or less effective treatments where at the end it all boils down to whether we can afford it. 200-600$ per procedure seem to be quite expensive for it very vogue outcome.
    I also think that in this particular case the reason people mix ethics/tradition with science is understandable since that’s exactly the reason people do these procedures. We might now have enough data to say that it most likely have positive health outcome, but why is it possible? Simply because we had a huge group of people circumcised because of non-scientific reasons. And therefore this debate formed with different focus and since everybody got used to discussing it with perfect analogy of cutting the lobule they just stick with it.
    Personally I must admit, being European, that it feels as a violation of a child’s body and I don’t know if I’d feel comfortable taking this decision for it. Though there is a tipping point, when data would convince me that it should be done because of health benefits.
    I don’t feel like were there yet and it seems that in making this decision we’re still driven by other motivations but I’m following the discussion closely;).

  11. James Loewen says:

    Genital cutting of infants and children is UNETHICAL.

    Forced circumcision of anyone is UNETHICAL.

    Surgery without need and the fully informed consent of the individual on whom its being performed is UNETHICAL.

    Forced circumcision is the illness, a social illness rooted in religion.

    The AAP lost all credibility when they tried to reinstitute genital cutting (nicking) of female children in 2010.

    The harm from botched infant circumcision (death, penile ablation, too much sin being removed, part or all of the glans destroyed) far outweighs the specious “benefits” the AAP is currently touting.

    Children’s rights demand that all unnecessary body modifications be deferred until the owner of that body can make INFORMED CHOICES for themselves.

  12. Lytrigian says:

    I wonder: This sort of research on male circumcision is possible only because we have this huge population of men who received the procedure involuntarily. I’m certain it was involuntary in my case; at the time I was born parents were generally not even offered the choice. (I know it was possible to refuse it, but a parent had to take positive action to do so; they weren’t asked.) We can also be sure that until the past couple of decades there really was inadequate research into the benefits and risks of male circumcision. This procedure has been done routinely for over a century, and for any procedure with that long a history I’d have expected the issue to have been well-settled long before now, but clearly it is not. Anyone familiar with the history of it knows that it was introduced for totally bogus reasons, with nothing like adequate understanding of any real risks or any real benefits.

    It is only because the procedure was performed on so many men for so long, and for such inadequate reasons, that we have the data available on it that we do. Why do we not institute other procedures in this way? The self-righteous horror over female genital mutilation seems oddly contrasted with the shrug over the origins of routine male circumcision. Sure, we have no evidence that the former has any benefits at all, and the risks are significant — but both were also true of routine male circumcision when it was first promoted. Surely if we were to start cutting all newborn girls’ genitals, and kept doing it for 100 years, we’d find SOMETHING within a whole range of possible conditions that seemed to make it worthwhile, no?

    That, of course, seems abhorrent, and rightly so. But perhaps looking at it that way might provide some insight into why this issue provokes such strong reactions. For any man who has stepped back to examine the history of this thing, that’s exactly what it looks like.

    Are there any other cases where we routinely perform prophylactic surgery to remove healthy body parts because there may be a detectable decrease in risk for one condition or another, when the patient is not particularly at risk for any of them? If not, why are we so fixated on doing it with penises?

  13. elmer says:

    What do you think of ritual (Jewish) circumcision? I don’t remember my bris, of course, but I’d assumed it must have been pretty unpleasant.

  14. Catherina says:

    Elmer – Jewish ritualistic circumcision significantly increases the number of UTIs (a finding that was also not mentioned by the AAP)

    http://www.ncbi.nlm.nih.gov/pubmed/12380588
    http://www.ncbi.nlm.nih.gov/pubmed/1628463
    http://www.ncbi.nlm.nih.gov/pubmed/18838417
    http://www.ncbi.nlm.nih.gov/pubmed/20929075 (yes, inappropriate control group, but this is just one of several)

  15. Catherina says:

    I have a comment in moderation (4 links) detailing that Jewish ritualistic circumcision significantly increases the number of UTIs (a finding that was also not mentioned by the AAP)

  16. Michael K says:

    As someone who still has all his parts I have to call BS on the “no loss in sensitivity” line that I hear over and over again.

    There is a whole lot of sensation in the foreskin alone, just play a bit with it if you want to get a rise out of me. Same goes for the head. Ask any uncut teenager how it feels to suddenly get a hardon in your underwear, I can assure you that is not a pleasant experience, it stands to reason that the head is not protected at all it will reduce sensitivity over time, simple as that.

    So that would address the “personal experience” part and we can probably debate this until the cows come home as those who are cut will continue to insist that they have no loss of feel (how do they know if they were cut as a baby?).

    As for the science, as mentioned before, most of it seems to revolve around STIs and I would love to see a study between Europe and the US where we would probably get a much clearer picture about the risk of STIs in adults.

    BTW, with the AAP being so obsessed with circumcision and STIs, why aren’t they advocate comprehensive SexEd?

  17. Janet Camp says:

    I have three sons. The eldest was circumcised because the very paternalistic doctor overrode our choice to NOT do it with arguments on the order of, “he’ll surely die of some hideous infection if you don’t do it–and he won’t look like all the other little boys”.

    We were only 23 and gave in, but I was ready for the next two. My objection is that a grown male would think hard before having two needle sticks into his penis for the negligible medical advantages, so why do this to a tiny baby? Also, while the issue of male sexual pleasure is covered, no one mentions the female view of this!

    It’s a cultural practice for the most part, but I agree with Billy Joe that many (perhaps most) parents have insufficient information to make a reasoned “choice” and are largely guided by the personal views of their physicians in the absence of strict religious direction–a view that may or may not be strictly guided by absolute science.

    I should add that my sons argue incessantly about their status–the circumcised one declaring loudly that he is glad to be rid of “that nasty bit of gristle”, while the two that are not, argue equally loudly that the women in their lives much prefer the “gristle”.

  18. maus says:

    ” (a finding that was also not mentioned by the AAP)”

    Likely because the AAP believes that intact foreskin increases the number of UTIs?

  19. DevoutCatalyst says:

    Gristle matters.

  20. mousethatroared says:

    @BillyJoe – I’m not going to get into the cultural, etc issues. I think I’ll just sit back and watch that debate.

    I’ll say that when my son was younger he had an inflammation of the foreskin that was quite painful.. Our Ped noted that if it didn’t clear up quickly, she would recommend to a urologist for treatment, which might include circumcision. The inflammation did clear up quickly and didn’t return, so didn’t need further treatment.She has also mentioned that circumcision might be recommended for boys with repeat UTIs.

    So those are a couple medical reasons that circumcisions might be recommended on a individual basis. Of course, I’m not a doctor, so take that info with a grain of salt.

  21. rmgw says:

    “What do they call that extra bit of skin on the end of the penis”?

    - a man.

  22. windriven says:

    This highway leads to the shadowy tip (if you’ll pardon the expression) of reality: you’re on a through route to the land of the different, the bizarre, the unexplainable … Go as far as you’d like on this road. Its limits are only those of mind itself. Ladies and Gentlemen, you’re entering the wondrous dimension of imagination … the commentary section of SBM.

    With sincere apologies to Rod Serling

  23. Janet Camp says:

    @Devout Catalyst and rmgw

    Thanks for that :)

  24. Joseph4GI says:

    Mouse that roared, when we talk about a different part of the body, similar stories sound ho-hummish.

    Most other surgery is performed because there was some sort of medical indication, where other forms of treatment were tried, and they failed.

    It should strike people as odd that, instead of looking deeper for the root of the problem, some people are content to hear something quick and easy like “oh, it’s just the foreskin that needs to be cut off… No big deal.”

    We dont cut off the toes to prevent recurring cases of toe fungus. We don’t consider removing the labia in girls if they keep getting yeast infections. We don’t remove a child’s toungue after their second bout of thrush. No. We find the root of the problem and amputate only when absolutely necessary.

    Few doctors are aware that premature retraction of the foreskin can cause iatrogenic infections and problems, and yet they continue to advise parents to forcibly pull back on their child’s foreskin “for cleaning,” making “medically indicated circumcision” a self fulfilling prophecy.

    Are we going to hear a more thorough explanation to UTIS than “they’re caused by the foreskin?” In women, we would never dream to attack say, they presence of the labia or clitoris.

    There has got to be something inherently wrong with “science” that tries to justify, no, necessitate, no require the destruction of a normal body part, as opposed to preserving the integrity of the human body.

  25. pharmavixen says:

    Female genital mutilation does the equivalent of chopping off the entire head of the penis. Just saying.

    The “intactivists” are an obsessive lot, no? Just Google “foreskin restoration.”

  26. muletonic says:

    Dr. Hall’s articles are usually pretty good, but this is sadly weak. Both the CRC and Doctors Opposed to Circumcision critiques are from wild and screechy activist groups, so it’s easy to use them as examples to knock down. There are, however, some genuinely dubious conclusions in the AAP’s report, and it would have been much more interesting to see those addressed rather than dismissed in deference to the AAP. For instance:

    - The HIV prevention aspect is being judged based upon the alleged connection between HIV and adult circumcision in Africa, but there is no evidence to suggest that infant circumcision in the US will have a preventative effect. Those are totally different populations with totally different behaviors. Aside from the extremely poor quality of the studies* their recommendation is based on, I consider this extrapolation to be very bad science.

    - The reduction in absolute risk for male infant UTIs is extremely low, which the AAP report admits, stating it to be at most, 1% (largely occurring among those with genetic predispositions). This is only slightly higher than the circumcision complication rate – and let’s be real, while major complications are rare, they’re extremely severe in impact to the recipient.

    - Not only do they not mention condoms, but they don’t mention HPV vaccination, which is a much better way to prevent HPV transmission than infant circumcisions.

    Honestly, it’s rather silly to claim that circumcision is an effective way to prevent STIs while completely neglecting the importance of far superior and cost-effective methods. This would have been a much better article if Dr. Hall had actually examined the claims of the AAP and the validity of the evidence for and against them, rather than using wacky activist groups as a foil.

    * http://www.salem-news.com/fms/pdf/2011-12_JLM-Boyle-Hill.pdf

  27. BillyJoe says:

    Michelle: “So those are a couple medical reasons that circumcisions might be recommended on a individual basis”

    But we are talking here about routine circumcision, not circumcision for medical reasons.

  28. BillyJoe says:

    Anyway…

    The main point here is that, if the AAP can find no reason to actually promote circumcision, then why are they okay about circumcisions being done. If there is not a clear advantage then, quite simply, they should not be done and they should be advising against it.

    And why do they say that it is okay for parents to make the choice without explaining why they think so. Do they really think that parents have the background and the knowledge to make a medical (as opposed to a cultural, personal, or religious) decision about circumcision?

  29. moderation says:

    I consider myself a fence sitter on this topic and appreciate the information coming out of this discussion. It does however seem the majority of respondents are vehemently opposed to circumcision. So to inform my own point of view, I do have a couple of questions/points:

    1. Like mentioning Nazis in a discussion, in any way comparing female circumcision (clitoral removal) to male circumcision (foreskin removal) makes it hard to take anything else someone says seriously.

    2. It is completely logical and consistent, if you concluded that that benefits outweigh risks to allow parents to make this decision for their children. You can argue that it is not true that benefits outweigh risks, but parents routinely consent to non-life saving medical procedures for their children, that could be deferred until they are older.

    3. For Joseph4GI: Your wave of the hand dismissal of the the significance of UTI’s in infants shows a real lack of knowledge of their implications. Under 2 months old it means hospital admission for IV antibiotics after a blood draw and spinal tap and for older infants there can be issues with reflux and kidney disease and failure … not to mention the possibility of urosepsis. Like complications of circumcision, all are uncommon I will grant you, but it is not as simple as “just treating them with antibiotics”.

    4. Also, the implication that there is some kind of huge profit to be made off circumcision is crazy, if it were the cash cow that some think, why are there so few health care providers willing to do them? I live in one of the 20 largest cities in the US and there are very few OB’s and almost no Pediatricians that still do the procedure, despite the fact it is mostly paid in cash since insurance does not generally cover it.

    5. Finally, for opponents, what evidence would there have to be to make circumcision a viable choice for you? Is this a moral objection that no evidence would overcome?

  30. lilady says:

    First of all, I give Harriet Hall credit for even “tackling” the revised AAP Circumcision Policy.

    I’ve read the pros and cons about non-religious circumcision and I find them somewhat bizarre when it comes to sexual satisfaction as reported by circumcised-versus-uncircumcised men. Did I miss something here? Isn’t sexual satisfaction a very subjective opinion?

    The issue of the transmission of sexually transmitted diseases was thoroughly discussed in the AAP Policy. As was the issue of proper cleaning of a baby’s/young child’s uncircumcised penis, but is there a risk that parents will not follow those cleansing techniques *religiously*? Here’s a webpage about care of a baby’s “natural penis” and the natural progression of teaching young boys about penis hygiene, so that when these kids reach sexual maturity, they are well versed in penis hygiene, to virtually eliminate STDs transmission.

    http://www.webmd.com/parenting/baby/tc/caring-for-your-young-sons-uncircumcised-penis-topic-overview

    The nonsense on some of the anti-circumcision websites is not based on science. The question of “why the AAP Circumcision Policy does not address sex education is silly, because other AAP Policies Statements do address sex education for boys and girls.

    (Anecdotal) When I had my babies, 1970 and 1976, most of the young parents had their boys circumcised before leaving the hospital. Now I read in the AAP Policy that ~ 60 % of boys are circumcised in the United States.

    (Anecdotal) I’ve been to several brises. The last one was performed by a female mohel (mohelet)…better yet, she is a pediatrician. She was so competent and explained throughout the procedure, the rite of circumcision. The little guy was anesthetized with a strong “numbing” cream and pacified with a few drops of sugar water; he did cry for a few minutes and then stopped.

    I’m not going to *venture there* about my own personal opinion about circumcision…suffice to state I concentrated on the parents/ grandparents faces and listened intently to what the mohelen was saying.

  31. Narad says:

    Note: For most other surgery, the doctor is usually the one to decide whether it is medically necessary; circumcision seems to be the only instance where parents do their own diagnosis [sic] and must evaluate the evidence

    Apparently, Joseph4GI has never heard of epidermoid cysts.

  32. moderation says:

    Billy Joe:

    I understand your point. However, if something is 90/10 it is easy to recommend one way or the other, but what if the risk-benefit falls more toward the middle of the spectrum. Shouldn’t the approach be more nuanced in that case?

  33. Narad says:

    Did I miss something here? Isn’t sexual satisfaction a very subjective opinion?

    Venture over to MDC’s intactivist retinue if you want to see the response in its full floridness. The short version is that failure to complain bitterly is repression of psychological trauma over the horrible deed that one’s parents have inflicted upon one. In other news, circumcision causes both excessive sensation and lack of sensation, and not a male that I’ve discussed it with, circumcised or not, really seems to give a damn.

  34. Cymbe says:

    Pharmavixen: Female genital mutilation does the equivalent of chopping off the entire head of the penis. Just saying.

    No, this comment only shows your unawareness of the fact there are many forms of FGM – all of them disgusting. It is very telling that the AAP’s policy statement on a ‘nick’ drawning a single drop a blood from girls drew more outrage than this new statement, endorsing a practice that kills 117 boys every year.

    Pharmavixen: The “intactivists” are an obsessive lot, no? Just Google “foreskin restoration.”

    On the contrary, they are not the ones seeking to deny people a choice when they are babies. They are merely trying to reclaim their lost bodily integrity.

  35. Cymbe says:

    Moderation: 1. Like mentioning Nazis in a discussion, in any way comparing female circumcision (clitoral removal) to male circumcision (foreskin removal) makes it hard to take anything else someone says seriously.

    Again, you are unaware of the fact that there are multiple forms of FGM – all of them disgusting and immoral, some of them similar to the removal of skin, others less severe. Culture is the only reason drawing a drop of blood from girls draws more outrage than the practice that kills 117 boys every year in America alone. You’re opining on matters that you clearly know not very much about, and this makes it difficult to take your statements seriously.

    Frankly, I do not think we should be putting knives to the genitalia of children at all – boy or girl. I know, what a completely crazy statements.

    Moderation: Finally, for opponents, what evidence would there have to be to make circumcision a viable choice for you? Is this a moral objection that no evidence would overcome?

    If it is such a great practice, and it has such great benefits, then why the need to inflict it on the defenseless? Of course, no one actually does that, notwithstanding the “benefits”.

  36. Cymbe says:

    Lillady: Isn’t sexual satisfaction a very subjective opinion?

    Then are you saying that we cannot say that FGM affects sexual satisfaction, as sexual satisfaction is a very subjective opinion?

  37. lilady says:

    @ Narad: MDC is one of my *favorite* sites for reliable information.

    Would you believe that Wikipedia has an article on male and female sexual satisfaction, comparing circumcised-vs-uncircumcised males?

    Here’s everything you ever wanted to know (or not know), and were *afraid to ask* about circumcision and sexual satisfaction :-)

    http://en.wikipedia.org/wiki/Sexual_effects_of_circumcision

  38. Matt Roman says:

    Most of the points made to say benefits outweigh risks are poorly backed up by evidence. For example, the idea that HIV incidence is decreased is based on African studies. Extrapolating that evidence to a different population is poor science. Furthermore, all but one studies supporting that notion were only FAIR, and prone to biases and/or confounders. The one that was GOOD evidence, used information from the aforementioned studies to predict and calculate rates of HIV prevention in the US. Therefore, its a good study that used fair studies from another population to come to a conclusion in the States.

    And then there’s the whole condom thing. Wear condoms vs. circumcision?? Clearly a condom would prevent STDs more than circumcision.

    As for prevention of penile carcinoma, the authors throw around a lot of numbers about circumcision preventing it, and how non-circumcised have it more, and then at the end they say, “in addition these findings are likely to decrease with increased HPV vaccination.” Umm YEAHHHH. Evidence shows that penile cancer is decreased in those vaccinated and the vaccination of boys for HPV has only just been recommended last year. It is very effective in decreasing rates of such cancer in boys. So, why discuss all that pro-circumcision talk in the first place and give only one sentence to something that makes all the prior discussion irrelevant? This kind of “scientific” reporting demonstrates an inherent bias in the writing, which I have picked up throughout the whole article. The whole article is a very unprofessional smear against uncircumcised men, masquerading as evidence-based writing.

    And finally, UTIs are treatable. Circumcision is not. I know for sure that I would not recommend circumcision to any family based on the scientific evidence. Even if there is a little benefit, it’s not that great. Do we, as physicians, recommend antibiotics for acute sinusitis? No. We don’t. Because the benefits are few, and the risks are few but present, so we don’t recommend it. That is true of many, many treatments/procedures in medicine. Circumcision falls wayyy to the one side of such “possibly beneficial” therapies, and if it wasn’t such a emotionally affecting procedure (especially for those w/ the tips of their penises cut off… sure guys, theres a good thing to that…. keep fooling yourself and convince the public of that), doctors would never actually support it.

  39. muletonic says:

    Moderation: I largely agree (except for 2) – people, shut up about FGM and argue the case on its own merits. No, they are not equivalent, yes there are similarities, yes there are different types – however, fact remains that it’s inflammatory and unhelpful to bring it up.

    In regards to 5, there would really have to be an overwhelmingly clear and very significant danger posed to all infants by being uncircumcised, exceeding the complication rate many times over. In the absence of this, I don’t think it’s ethical to perform it as an elective procedure. I always find it weird that people who are otherwise very secular and scientifically minded are willing to accept a bizarre religious ritual as being normal and medically beneficial with only the flimsiest of evidence – probably just because they had it done to them. I mean seriously, humanity’s historical justifications have been terrible:

    a) magic skygod told us to
    b) it prevents masturbation
    c) everyone else is doing it
    d) “parents should decide”
    e) someone said it might prevent diseases that we already have better methods for preventing

    Narad: I realize that the fervency of “intactivists” often comes off as loopy (this is a source of constant frustration to me), but just because you haven’t personally encountered someone with a negative circumcision story doesn’t mean that everyone that does have one is just a crybaby or making it up. Most men who were circumcised don’t give a damn, sure – however, there really are people with excessive scar tissue, deformations, excessively tight skin that causes tears and abrasions, desensitization, etc. I’ve noticed there’s an extremely strong tendency to classify any man who’s unhappy with his circumcised penis as an unmanly whiner. Knowing some of these people personally and having seen the cringeworthy results in person, I consider it fairly insensitive to dismiss them out of hand.

    I think people often look at the fact that the sexual results are subjective and go “well, there’s no scientific evidence supporting a gain or loss of sexual capacity, so let’s just go ahead and do it” – especially if the person stating this has never had a foreskin (or a penis, for that matter). But just because sexual pleasure is subjective and difficult to measure does not mean that people’s experience of it is not real or relevant, and the fact that there’s so much disagreement here seems like just another good reason to leave well enough alone.

    At the end of the day, it’s really hard to engage in a debate about this kind of thing, because people inherently think that the opposing side is characterizing the their side’s penis as inferior. But for me, it’s not about that – it’s just ethically wrong to perform involuntary unnecessary surgery on someone else’s genitals, even if their parents said to.

  40. Cymbe says:

    Lilady: Would you believe that Wikipedia has an article on male and female sexual satisfaction, comparing circumcised-vs-uncircumcised males?

    Earlier, you said that this was “very subjective” and suggested that it was not prone to measurement.

  41. Narad says:

    Narad: I realize that the fervency of “intactivists” often comes off as loopy (this is a source of constant frustration to me), but just because you haven’t personally encountered someone with a negative circumcision story doesn’t mean that everyone that does have one is just a crybaby or making it up.

    I asserted neither.

    Most men who were circumcised don’t give a damn, sure – however, there really are people with excessive scar tissue, deformations, excessively tight skin that causes tears and abrasions, desensitization, etc. I’ve noticed there’s an extremely strong tendency to classify any man who’s unhappy with his circumcised penis as an unmanly whiner. Knowing some of these people personally and having seen the cringeworthy results in person, I consider it fairly insensitive to dismiss them out of hand.

    I’m not dismissing anyone out of hand. Are you actively seeking out these cases for inspection?

  42. mousethatroared says:

    See, you learn something new everyday. I would have thought that male sexual satisfaction was pretty objective, binary, you might say. He is either satisfied or not satisfied.

  43. I have a beautiful circumcised penis.

  44. muletonic says:

    Narad: Apologies if I was reading too much into your comment – the sarcastic “horrible deed” seemed along the lines of mocking those that feel aggrieved by circumcision. And no, I’m not actually seeking out these cases – I just happened upon them via my social circle. It’s not a vast number of people, but it’s also probably not something people often readily volunteer, especially if badly botched.

    Speaking of which, while I don’t vouch for any of the other site’s content, the gallery of circumcisions at circumstitions.org (http://goo.gl/PUHBP) and the “Complications” page it links to are worth perusing to get an idea of some of the defects circumcision can cause. Again, serious ones of these are very rare, but when we’re talking about an elective procedure with very little evidence of useful health effects and no informed consent, it should give some pause for thought.

  45. @BillyJoe

    The main point here is that, if the AAP can find no reason to actually promote circumcision, then why are they okay about circumcisions being done. If there is not a clear advantage then, quite simply, they should not be done and they should be advising against it.

    And why do they say that it is okay for parents to make the choice without explaining why they think so. Do they really think that parents have the background and the knowledge to make a medical (as opposed to a cultural, personal, or religious) decision about circumcision?

    You have possibly some of the worst reasoning abilities on earth. Hey, we know that giving kids french fries and coca-cola is bad for them. So why not make a law preventing parents from feeding them junk food? And we know that they possibly could be shot in school, so why not outlaw both guns and school? And then they could die in a car wreck – it’s one of the more dangerous modes of transportation – so we should probably outlaw cars. Alcohol has minor health advantages but can cause severe complications such as cirrhosis and heart failure, not to mention drunk driving (ack! cars again!) and having dangerous sex. So we should outlaw alcohol.. and extra-marital sex. And condoms, because kids could choke on condoms. And while we’re at it, what about all those pesky household chemicals that kids could consume by accident? We shouldn’t allow people to buy them, because they could be dangerous. We need to control every aspect of their lives.

  46. mousethatroared says:

    @SH – you forgot teeter totters…oh wait, we don’t have teeter totters anymore.

  47. mousethatroared says:

    Also SH – that was in response to your last comment, not the one before that. :)

  48. muletonic says:

    SkepticalHealth: 4/10. Sadly, that’ll probably be enough.

  49. lilady says:

    Cymbe:

    Twice you twisted what I stated in my posts above. I posed two (rhetorical) questions
    in my first post (about questioning circumcised men and uncircumcised men about their degree of sexual satisfaction).:

    Did I miss something here? Isn’t sexual satisfaction a very subjective opinion?

    You, then totally (deliberately?), misinterpreting what I stated, posed this out-of-left-field question:

    “Then are you saying that we cannot say that FGM affects sexual satisfaction, as sexual satisfaction is a very subjective opinion?”

    Why don’t you read the subject of this blog which is the AAP Policy about male circumcision? Did I mention anything about female circumcision?

    Moving along, you “read” my post back at Narad. I stated to Narad and linked to a Wikipedia entry:

    “Would you believe that Wikipedia has an article on male and female sexual satisfaction, comparing circumcised-vs-uncircumcised males?”

    Here again, you totally (deliberately?) misinterpreting what I stated and have put your own spin on what you *believe* I stated:

    “Earlier, you said that this was “very subjective” and suggested that it was not prone to measurement.”

    It appears to me that you have some sort of personal issues and you are using this blog for your own agenda. I really don’t care to know what your issues are or what your agenda is. Just don’t assume you can work out your issues and advance your agenda, by attacking me.

    Earlier, you said that this was “very subjective” and suggested that it was not prone to measurement.

  50. lilady says:

    Disregard last sentence which is redundant; sorry I still make mistakes *proofing* my posts.

  51. BillyJoe says:

    SH,

    “You have possibly some of the worst reasoning abilities on earth.”

    Back on you.
    But I blame your poor comprehension skills.
    Note that I said nothing about banning, or outlawing circumcision. Here are the words I used:

    “If there is not a clear advantage then, quite simply, they [circumcisions] should not be done and they [the AAP] should be advising against it.”

    I’m not saying that circumcision should be banned or outlawed, I’m saying that the AAP should be advising against circumcsion, and that circumcisions should not be done because there is no clear evidence of benefit.

    It’s similar to the PSA debate. The evidence is that it is not a useful screening test, therefore, the colleges should be advising against it (as does the RACGP in Australia). But they (RACP) also accept that patients, driven by media publicity, will ask for the test to be done, so they also advise what should be done in this situation: explain the pros and cons and if the patient still wishes to proceed, then it is reasonable to order the test. The consequences of not doing so being the possiblity of being sued by that patient if he is later diagnosed with prostate cancer.

    Based on the evidence, neither PSA nor circumcisions should not be done.
    But uniformed, poorly informed, and incompletely informed decisions by patients often overrule what the evidence available to experts says should be the case. It’s a pity that these experts often do not stand by the obvious conclusions of the evidence they have considered.

  52. BillyJoe says:

    SH,

    “You have possibly some of the worst reasoning abilities on earth.”

    Back at you.
    But I blame your poor comprehension skills.
    Note that I said nothing about banning, or outlawing circumcision. Here are the words I used:

    “If there is not a clear advantage then, quite simply, they [circumcisions] should not be done and they [the AAP] should be advising against it.”

    I’m not saying that circumcision should be banned or outlawed, I’m saying that the AAP should be advising against circumcsion, and that circumcisions should not be done because there is no clear evidence of benefit.

    It’s similar to the PSA debate. The evidence is that it is not a useful screening test, therefore, the colleges should be advising against it (as does the RACGP in Australia). But they (RACP) also accept that patients, driven by media publicity, will ask for the test to be done, so they also advise what should be done in this situation: explain the pros and cons and if the patient still wishes to proceed, then it is reasonable to order the test. The consequences of not doing so being the possiblity of being sued by that patient if he is later diagnosed with prostate cancer.

    Based on the evidence, neither PSA nor circumcisions should not be done.
    But uniformed, poorly informed, and incompletely informed decisions by patients often overrule what the evidence available to experts says should be the case. It’s a pity that these experts often do not stand by the obvious conclusions of the evidence they have considered.

  53. @BillyJoe

    I’m not saying that circumcision should be banned or outlawed, I’m saying that the AAP should be advising against circumcsion, and that circumcisions should not be done because there is no clear evidence of benefit.

    I’m well aware of what you are saying. What I’m saying is that every time you come here saying how doctors should practice, or how an expert panel should advise, it’s always based on a completely naive understanding of medicine.

  54. BillyJoe says:

    SH,

    “What I’m saying is that every time you come here saying how doctors should practice, or how an expert panel should advise, it’s always based on a completely naive understanding of medicine.”

    That was actually not what you were saying, but anyway…

    What I said was reasonable and tempered with the practicalities of actual patient encounters.
    The evidence says X but patients do not have the background knowledge and the evidence at hand to understand X and doctors must deal with that fact. What I disagree with is that some doctor organisations do not make the correct decision based on the evidence in the first place before conceding the fact that patients have their own agenda (or the media’s agenda) and that these patients must be dealt with in a practical way. Instead they jumble the two together and come up with a decision at odds with the evidence.
    The RACGP is a good example of doing it correctly, so I can’t be far off base.

  55. Helga435 says:

    This blog states that some studies show a small health benefit to male circumcision so the author endorses the AAP’s policy statement that the parents should decide and it should be paid for via medical insurance.

    I have seen multiple times in this blog that some studies show a small health benefit to acupuncture (via the magical placebo effect) yet this blog consistently rails against acupuncturists and their desire to be covered through medical insurance.

    This article states that 86 people were killed from acupuncture gone wrong over the past 45 years: http://www.guardian.co.uk/science/2010/oct/18/dozens-killed-acupuncture-needles . Multiple comments have quoted a 117 boys killed per year (I don’t know where the figure came from) from complications of male circumcision.

  56. DWATC says:

    I’m not remotely looking to get into this philosophical debate, but have a suggestion for the anti-circumcision crowd…

    Ban religion! …. Can’t do that? Well then good luck changing this social norm based on something one can’t currently ban (especially since it now has support via potential benefits).

    Also have a couple questions for anyone that can answer it…

    How many nociceptors and Meissner’s corpuscles are in the prepuce of the average newborn male? Can one differentiate a reaction from simply being touched and a reaction of pain?

    *This is out of the scope of my practice as a lowly athletic trainer….well other than pain perception.

  57. DWATC says:

    The number 117 per year came from this “study”. Here’s the math they used…

    “Multiplying the 772% adjustment factor for age-at-time-of-death by the 14.5 hospital-stay deaths calculated above, the result is approximately 112 circumcision-related deaths annually for the 1991–2000 decade, a 9.01/100,000 death-incidence ratio. Applying this ratio to the 1,299,000 circumcisions performed in 2007, the most recent year for which data are available (HCUP, 2007), the number of deaths is about 117. This is equivalent to one death for every 11,105 cases, which is not in substantial conflict with Patel’s observation of zero deaths in 6,753 procedures. It is more than some
    other estimates (Speert, 1953; Wiswell, 1989),”

    Lost Boys: An Estimate of U.S. Circumcision-Related Infant Deaths
    Journal Thymos: Journal of Boyhood Studies
    Publisher Men’s Studies Press
    ISSN 1931-9045 (Print)
    1872-4329 (Online)
    Issue Volume 4, Number 1 / Spring 2010
    Pages 78-90
    DOI 10.3149/thy.0401.78
    Online Date Monday, April 26, 2010

  58. DWATC says:

    “The CDC’s online searchable database, Mortality: Underlying cause of death, 2004 (CDC), lists causes by various age ranges and reveals that the percentage of deaths after release, compared with deaths before, is 772% greater. This ratio is comparable to Patel’s (1966) 700% postrelease infection rate.”

    where the 772% came from…

  59. Cymbe says:

    SkepticalHealth: Hey, we know that giving kids french fries and coca-cola is bad for them…We need to control every aspect of their lives

    Aren’t you the one granting yourself the right to control every aspect of their lives, up to what part of their genitalia you will decree to be cut off? Mutilation of children is already against the law. That’s not “control”. It’s just that bizarrely, an exception is made in the case of the genitalia of boys.

    Lilady: “Then are you saying that we cannot say that FGM affects sexual satisfaction, as sexual satisfaction is a very subjective opinion?” Why don’t you read the subject of this blog which is the AAP Policy about male circumcision? Did I mention anything about female circumcision?

    You didn’t, and neither did the AAP (which earlier endorsed a form of FGM), but you did say that sexual satisfaction is “very subjective” and thus implied that it is not prone to measurement. If that is true for men, it is true for women. Consequently, if one cannot measure the effect genital mutilation of boys has on sexual satisfaction, neither can one do it for girls.

    Lilady: It appears to me that you have some sort of personal issues and you are using this blog for your own agenda…Just don’t assume you can work out your issues and advance your agenda, by attacking me.

    Comedy, attack another personally while claiming that he is attacking you. Were you so lucky that only people with personal issues would point out the inconsistencies in your posts. Your personal attacks are not particularly impressive, they only show the weakness of your position, that you do not even bother to defend them.

    Lilady: Disregard last sentence which is redundant; sorry I still make mistakes *proofing* my posts.

    No problem at all, I would much prefer proofing posts for facts and logic.

  60. Cymbe says:

    DWATC: I’m not remotely looking to get into this philosophical debate, but have a suggestion for the anti-circumcision crowd… Ban religion! …. Can’t do that? Well then good luck changing this social norm based on something one can’t currently ban

    So shall we legalize honor killing and FGM (as they are in some places) – because we can’t ban religion, which is marshaled as a defense for these practices? Or should we defend the rights of innocents?

    DWATC: (especially since it now has support via potential benefits).

    Well, it does give gravediggers 117 extra jobs every year, I suppose that is a benefit.

    DWATC: The number 117 per year came from this “study”. Here’s the math they used…

    I see no problem with the study, other than the fact that the results are unfriendly to your cause. No, putting study in scare quotes does not refute it. If you have a better study, present it. Until then, enlighten us on why we should be pleased that 117 babies have to die every year.

  61. DWATC says:

    @Cymbe…

    This is what I find entertaining about philosophical debates. People love to assume the other positions like this …

    “other than the fact that the results are unfriendly to your cause”…as in assuming you know my “cause”.

    I put “scare quotes” because it’s a quote that they call it a “study”. I was only presenting where the number came from, whether it’s rational statistics or not. I’m indifferent either way. Parents do all kinds of ignorant stuff to their children including religious/political indoctrination. Circumcision is an emotional, philosophical debate, not one of science. When it’s discussed, people go on irrational rants and tell people to cite their claims or “enlighten us” to various ideologies opposing the claims when they, themselves, are doing the exact same thing as the people they’re condemning. I wish circumcision wasn’t done, but as I said, good luck changing a social norm.

    I notice you tend to manipulate context of others comments. The only thing I can recommend when talking about your particular “facts and logic” is don’t forget to cite when making specific claims and be able to differentiate opinion from those “facts”.

  62. DWATC says:

    …and you’re right, I don’t have a better study. You’d think in the US, they’d document adverse reactions such as death from a specific procedure like circumcision, and said data would be easily accessible.

    Any speculation to why it’s not……

  63. Cymbe says:

    DWATC: “other than the fact that the results are unfriendly to your cause”…as in assuming you know my “cause”.

    It is no more an assumption than you ‘assuming’ that I am a foe of genital mutilation. It may be that you were playing devil’s advocate, or who knows what, but that would then not be immediately clear to me, and I can only respond to what I see in your comments.

    DWATC: Parents do all kinds of ignorant stuff to their children including religious/political indoctrination.

    And that still does not mean that people have to be OK with the ignorant things that people do, especially when it involves irreversible mutilation of the body.

    DWATC: I wish circumcision wasn’t done, but as I said, good luck changing a social norm.

    The same is true for any social norm, but that does not mean that opponents should do nothing. It is difficult, I will grant you that, perhaps impossible to completely end this practice, but if good people do nothing, evil will necessarily prevail.

    DWATC: I notice you tend to manipulate context of others comments.

    There is no basis for that statement, other than Lilady’s comment, who was displeased with the fact that I pointed out an inconsistency in her posts. But then again, she also claimed that I was ‘attacking’ her while leveling a personal attack of her very own – so her claims are not to be taken seriously. If you look at the source yourself, then you will see that I did no such thing, to her or anyone else.

  64. Draal says:

    Did ya’ll know that neonatal foreskin is used in deriving pluripotent cells?
    http://www.nature.com/nprot/journal/v5/n2/abs/nprot.2009.241.html

    About 5 years ago, I worked next door to a lab that worked on keratinocytes. A grad student would go to a local hospital and have to request foreskin tissue. I can imagine what it was like asking a help desk where to pick up the samples. In the lab, there would be jars fill with liquid and floating foreskin.

  65. Helga435 says:

    Furthermore, if the foreskin is a superfluous piece of skin, why has evolution not gotten rid of it? Humans no longer have tails for this reason.

    To me, this article (and the AAP’s endorsement) reek of a bias that reads “What the heck, it’s no big deal, just cut it off.” This ignores the fact that boys are born with a foreskin and there needs to be a demonstrable (not small) gain from removing it based on standard science rules. If not, then there are many other body parts that we should also be removing at birth because it may prevent illness later in life i.e. appendices, tonsils, adenoids, etc.

  66. lilady says:

    @ Cymbe: You were “caught” criticizing two of my innocuous statements from two of my posts…and I called you out on your behavior.

    Now, clutching you pearls in a lame attempt to defend your unwarranted criticisms…and issuing another invective directed at me, you misinterpreted what I stated, “It appears to me that you have some sort of personal issues and you are using this blog for your own agenda…Just don’t assume you can work out your issues and advance your agenda, by attacking me.”

    “Comedy, attack another personally while claiming that he is attacking you. Were you so lucky that only people with personal issues would point out the inconsistencies in your posts. Your personal attacks are not particularly impressive, they only show the weakness of your position, that you do not even bother to defend them.

    Lilady: Disregard last sentence which is redundant; sorry I still make mistakes *proofing* my posts.

    No problem at all, I would much prefer proofing posts for facts and logic”.

    Other posters have also called you out for your pugnacious accusations and your deliberate misreading of the content of posters’ statements, in order to evoke responses to your off-topic subject of female circumcision by posting back at you, “I notice you tend to manipulate context of others’ comments”.

    Your reply to this poster is another example of your deliberate misinterpreting of my innocuous comments, your animus directed at me and your inability to own up to your deliberate and consistent misinterpreting of my comments.

    “There is no basis for that statement, other than Lilady’s comment, who was displeased with the fact that I pointed out an inconsistency in her posts. But then again, she also claimed that I was ‘attacking’ her while leveling a personal attack of her very own – so her claims are not to be taken seriously. If you look at the source yourself, then you will see that I did no such thing, to her or anyone else.”

    My post are available upthread, I suggest you re-read them in their entirety, before you even attempt to defend your actions.

    Let me reiterate, the subject of this blog is the AAP Policy on male circumcision, not female circumcision.

    Let me add, that I have every right and intend to continue posting about subjects that interest me. Not having a penis is not a disqualifying factor for any female poster, nor is it a disqualifying factor for Harriet Hall to blog about the AAP male circumcision policy. If anyone has a problem with restricting bloggers and posters to subjects that pertain to bloggers’ and posters’ genders, then submit those *problems* to the Executive Editor Dr. Novella and the Managing Editor Dr. Gorski of SBM. I *suspect* that you wouldn’t find support from David Gorski, a breast cancer surgeon and researcher, who frequently blogs about female breast cancer and updates us on breast cancer research.

  67. DWATC says:

    @Cymbe…

    I’ll gladly admit when I’m assuming your position, even though I made no comment of your position beyond the context comment. I can say I assume your position based on previous comments such as repeated use of the term “mutilation” and various terms of personal moral stance on the subject. I wouldn’t say I’m playing devil’s advocate. I’m just for the choice of the parent, regardless of how ignorant or what the perceived ethics are thought to be.
    It will get weeded out, if it truly becomes an issue of concern. I would say if 117 per year is an accurate estimate as a direct result of circumcision, it would classify as “of concern”. The anti-circumcision crowd rarely look at anything with skepticism if it supports their side as shown in many comments here. I’m circumcised (irrelevant), and hold no resentment to my parents for it, and my opinion on such things would be to question ones psychological state if they hold resentment, as there are apparent emotional insecurities. Male sexual pleasure is subjective as it requires recruitment of touch receptors which are highly adaptive. I’m not sure why the various female circumcision types are brought up when talking about this particular topic. It’s not a social norm based on religion anymore. It’s based on aesthetics now. I would say that makes it much harder to change.

    Its similar to talking about abortion. It’s a philosophical debate in the “interest” of the adults’ view of the child’s interest, not the child themself or the impact on the population. Children only understand what is relayed to them via the environment they’re brought up in. If the parent finds circumcision to be disgusting and immoral, and it’s relayed in a manner thats displayed to the child, the child will feel the same. The problem with this topic I’m seeing, is it often falls in the conspiracy realm of profiteering doctors and coersion. Websites are built on these ideologies, then they’re propagated by those thinking they’re doing good by spreading it. My view is that patient education and compliance are severely lacking in our system. Omission of circumcision info and parents disinterest in it play a huge role.

    I’m interested in finding out who here is male or female. Anecdotally, I often see an uproar among the females about circumcision but indifference among males.

  68. lilady says:

    @ Dwatch: I’m a female…but I suppose you already surmised that by completely reading my first post, especially the last few paragraphs:

    “(Anecdotal) When I had my babies, 1970 and 1976, most of the young parents had their boys circumcised before leaving the hospital. Now I read in the AAP Policy that ~ 60 % of boys are circumcised in the United States.”

    For you Dwatch, I’ll expand on that first anecdote. Neither I nor my husband, when I was pregnant, ever contemplated having our soon-to-be-born child(ren) circumcised. My second child was a boy. We specifically declined circumcision at the time of his birth. BTW, he was born with a second degree hypospadias penis, amongst other birth defects and the surgical repair would have required tissue from his intact partial foreskin.

    (Anecdotal) I’ve been to several brises. The last one was performed by a female mohel (mohelet)…better yet, she is a pediatrician. She was so competent and explained throughout the procedure, the rite of circumcision. The little guy was anesthetized with a strong “numbing” cream and pacified with a few drops of sugar water; he did cry for a few minutes and then stopped.

    I’m not going to *venture there* about my own personal opinion about circumcision…suffice to state I concentrated on the parents/ grandparents faces and listened intently to what the mohelen was saying.

    To add to this anecdote and the other comment, the grandparents are my closest friends. This bris ceremony was a celebration of their long-awaited only grandchild that they would ever have. It was a continuation of the family lineage and a reaffirmation of life, because grandpa was an only child of survivors of the holocaust.

    Here’s an additional “anecdote”. Years ago while in University in a nursing program, I declined to watch a circumcision while doing a clinical rotation in pediatrics.

  69. Cymbe says:

    Lilady: You were “caught” criticizing two of my innocuous statements from two of my posts…

    I did not criticize them, I pointed out the inconsistency between the two, innocuous or not. There’s a difference. You responded, not by laying the question of the inconsistency to rest, but by attacking me personally, which speaks volumes.

    Lilady: Now, clutching you pearls in a lame attempt to defend your unwarranted criticisms…and issuing another invective directed at me, you misinterpreted what I stated,

    No invective can be found in any of my posts. On the other hand, baselessly accusing another skeptic of having “personal issues” – now that is invective. No misinterpretation.

    Lilady: Other posters have also called you out for your pugnacious accusations and your deliberate misreading of the content of posters’ statements

    Another poster took your word for it. As a good skeptic, you undoubtedly know that two sources count as one source, when one of the two sources can be traced back to the other. And the only one being pugnacious is the one baselessly accusing another of having “personal issues”.

    Lilady: My post are available upthread, I suggest you re-read them in their entirety, before you even attempt to defend your actions.

    You have not pointed out any way in which me pointing out that your two statements were inconsistent was in error.

    Lilady: Let me reiterate, the subject of this blog is the AAP Policy on male circumcision, not female circumcision.

    True, but for the questions of the ethics, it is worthy to inquire into the nature of this organization. It turns out that it has in the past endorsed a form of FGM. Its disregard for the sanctity of the bodies of children is a relevant issue. As is your claim that sexual satisfaction is very subjective – which, if true, applies to women as well as men. Hence, my question was an entirely appropriate one.

    Lilady: Let me add, that I have every right and intend to continue posting about subjects that interest me. Not having a penis is not a disqualifying factor for any female poster

    Then tell me, who questioned your ‘every right’ to post about subjects that interest you? And who mentioned the fact that you are female? There is absolutely no need to play the victim, when you are in fact the one leveling the personal attacks, and I have patiently and civilly responded to your comments, not responding in kind.

  70. Cymbe says:

    DWATC: I’m just for the choice of the parent, regardless of how ignorant or what the perceived ethics are thought to be.

    How far are you willing to extend this principle? After all, you are advocating a parent’s choice to deny choice, which seems to me to be the very negation of the concept. It’s akin to having the freedom to deny another person freedom. Would you, for example, advocate a parent’s right to inflict FGM on his daughter?

    DWATC: I’m circumcised (irrelevant), and hold no resentment to my parents for it, and my opinion on such things would be to question ones psychological state if they hold resentment, as there are apparent emotional insecurities.

    Not true. If this were a practice unknown, it would be universally criminalized – as cutting into any other part of a child’s body currently is a crime. And all people would respond with horror at the idea of pulling down the pants of a child and putting a knife to his genitalia, at the whims of a parent.

    DWATC: I’m not sure why the various female circumcision types are brought up when talking about this particular topic.

    If one is unwilling to respect the bodily integrity of a child, why restrict the practice to boys? Remember, there are multiple forms of FGM, some of them more ‘innocuous’ than mutilating boys. And yet they are criminalized, because, as you as, it is a cultural norm.

    DWATC: The problem with this topic I’m seeing, is it often falls in the conspiracy realm of profiteering doctors and coersion.

    Well, I am not a conspiracy theorist. But I will tell you this, why is it ‘coercion’ when a child’s genitalia are mutilated against a parent’s will, but not coercion when they are mutilated against a child’s will? It is not the parent who is coerced, it’s the child, with or without the permission of the parent.

    DWATC: I’m interested in finding out who here is male or female.

    Cymbe = Cymbeline

  71. lilady says:

    You still wont acknowledge, will you Cymbe, that there were NO inconsistencies in my remarks? The only inconsistencies are with you and your conjuring up in your own fertile imagination that I ever made a comment about female circumcision.

    Again I don’t care what your issues are and what your agenda is. I care that you are criticizing my comments, based on your inability to read my basic comments posted in easy-to-understand language.

  72. Narad says:

    I see no problem with the study, other than the fact that the results are unfriendly to your cause. No, putting study in scare quotes does not refute it.

    It’s not clear that there’s really much of anything to refute in the first place. I can’t see the original, but it appears to be prestidigitation somewhat akin to Lazarou et al. (putting it generously). If there’s more here than pure inference plus extrapolation, I’d be curious to see the relevant parts. There’s nothing obvious in HCUP Statistical Brief 56 or Statistics on Hospital-based Care in the United States, 2007, which are apparently being relied on. Bollinger certainly doesn’t seem to have any revelant training whatever.

  73. Cymbe says:

    Lilady: You still wont acknowledge, will you Cymbe, that there were NO inconsistencies in my remarks?

    Any fair-minded person can see whether there are:

    “Isn’t sexual satisfaction a very subjective opinion?”

    “Would you believe that Wikipedia has an article on male and female sexual satisfaction, comparing circumcised-vs-uncircumcised males? Here’s everything you ever wanted to know (or not know)”

    Either it is subjective, or it is not. Reality does not change with your mind.

    Lilady: The only inconsistencies are with you and your conjuring up in your own fertile imagination that I ever made a comment about female circumcision.

    I didn’t, I asked a very simple question, which you have refused to answer in your multiple posts: whether your statement that sexual satisfaction is “a very subjective opinion” also applies to FGM. It mystifies me why a simple question would make you behave in this manner.

    Lilady: Again I don’t care what your issues are and what your agenda is. I care that you are criticizing my comments, based on your inability to read my basic comments posted in easy-to-understand language.

    Your greatest ability appears to be making baseless personal attacks. Three in your latest four sentence post alone. Again, it speaks volumes that you think personal attacks are a defense of your position.

  74. Cymbe says:

    Narad: If there’s more here than pure inference plus extrapolation, I’d be curious to see the relevant parts.

    And if not, I would like you to present a better study, because until then, inference plus extrapolation is the best we’ve got.

  75. Narad says:

    And if not, I would like you to present a better study, because until then, inference plus extrapolation is the best we’ve got.

    I don’t know how that is supposed to represent an answer. In fact, I’m not sure it even really parses. If you have the original, I’d like to know the methodology. If you don’t, there’s no particular reason to describe it as “the best” of anything.

  76. lilady says:

    Give it up Cymbe. Everyone knows your game here. You are persistently and consistently drawing wrong conclusions, based on your inability to read English and YOUR interpretation of what I and other posters have stated.

    Don’t like the pushback for your insulting criticism, eh? Too bad.

  77. Cymbe says:

    Narad: I don’t know how that is supposed to represent an answer. In fact, I’m not sure it even really parses. If you have the original, I’d like to know the methodology. If you don’t, there’s no particular reason to describe it as “the best” of anything.

    Enough to be cited in the New York Times. In the absence of actual reporting of deaths, an estimate is the best we will have, and considering the gravity of the matter, dismissing out of hand any inconvenience for your position is not what I would recommend.

    Lilady: Give it up Cymbe. Everyone knows your game here.

    Pointing out the inconsistencies in your comments, which you have given up on even tepidly defending.

    Lilady: Don’t like the pushback for your insulting criticism, eh?

    Pointing out your inconsistency is not “insulting”. Stop playing the victim, like you did when you asserted your “right” to voice your opinion (which no one had disputed). The only person insulting others here is you. Go ahead. I will continue to uphold decency and civility, while you continue in your own manner. You give yourself way too much credit, if you think I care about what venom and hatred you send my way. I point it out because it shows that you have no arguments, or else you’d be making them.

  78. Narad says:

    Enough to be cited in the New York Times. In the absence of actual reporting of deaths, an estimate is the best we will have, and considering the gravity of the matter, dismissing out of hand any inconvenience for your position is not what I would recommend.

    “Enough”? Enough what? What am I “dismissing out of hand”? What is “my position”? Can you read?

    Anyway, as Cymbe seems to be of no help whatever on the “gravediggers” front, the work of refrigerator-magnet magnate Bollinger is here. It’s the rambling mess that I suspected. Basically, he assumes that all-cause deaths while hospitalized after birth in which circumcision occurred are candidates for being due to circumcision, times 0.4 because “males have a 40.4% higher death rate than females from causes that are associated with male circumcision complications, such as infection and hemorrhage,[4] during the period of one hour after birth to hospital release (day 2.4).”

  79. mousethatroared says:

    heheh – damn lies and statistics

  80. Cymbe says:

    Narad: Basically, he assumes that all-cause deaths while hospitalized after birth in which circumcision occurred are candidates for being due to circumcision

    Uh… no. You have posited no reason why boys should suffer more deaths from infection and hemmorhage than girls, and yet they die at a 40.4% higher rate than girls. It is entirely reasonable to conclude that what is inflicted on boys and not girls, and which is known to cause infection and hemmorhage, is at least in large part responsible for these deaths. Is this unreasonable? You are completely silent on Gairdner’s even higher estimate – presumably also a “rambling mess”. Of course, both are estimates and no more than that, but in the absence of any better information, one cannot escape the conclusion that many babies die because of genital mutilation.

    You’ve made it abundantly clear on what side of this debate you are, and it is natural that you would attempt to dismiss an estimate that implicates this practice in so many deaths as a “rambling mess”. But of course, attacking someone is not an actual argument.

  81. Narad says:

    Uh… no. You have posited no reason why boys should suffer more deaths from infection and hemmorhage than girls, and yet they die at a 40.4% higher rate than girls. It is entirely reasonable to conclude that what is inflicted on boys and not girls, and which is known to cause infection and hemmorhage, is at least in large part responsible for these deaths. Is this unreasonable?

    Why yes, it is unreasonable. In fact, it’s completely without basis. The further extrapolation (the “adjustment factor”) is simply idiotic.

    You’ve made it abundantly clear on what side of this debate you are

    Go ahead and tell me, just so I know.

  82. mousethatroared says:

    Joseph4GI Sorry, I missed that a comment was addressed to me.

    you said “Few doctors are aware that premature retraction of the foreskin can cause iatrogenic infections and problems, and yet they continue to advise parents to forcibly pull back on their child’s foreskin “for cleaning,” making “medically indicated circumcision” a self fulfilling prophecy.”

    That’s strange because our Ped instructed us NOT to forcibly pull back the foreskin at least a year before our son experienced the inflammation. We followed her instructions. On what do you base your comment that few doctors know that? Does the AAP state that parent should “clean” this way?

  83. mousethatroared says:

    @Cymbe

    You know, my son is not circumcised (Due to information we received from our Ped) and I’d actually kinda like the percentage of uncircumcised guys to be relatively high, so that he doesn’t have to deal with being different in the locker room and bedroom.

    But I really feel like you are undermining my cause with your poor arguments. There are people here who you could learn from, if you listen. If you are open to learning you could build a better argument, but instead you are focused on alienating the people who are trying to show you how your evidence is lacking.

  84. I love that when an expert consensus agrees with someones world views, that they are “legitimate, science-minded practitioners.” But when the same expert consensus disagrees with someones world views, they are “biased people with an agenda.”

    People are stupid. The world is f-ed :)

  85. baldape says:

    Lilady,

    You did enter into this forray with the following comment:

    I’ve read the pros and cons about non-religious circumcision and I find them somewhat bizarre when it comes to sexual satisfaction as reported by circumcised-versus-uncircumcised men. Did I miss something here? Isn’t sexual satisfaction a very subjective opinion?

    This is semantically equivalent to “Because “sexual satisfaction” is a very subjective opinion, it makes no sense to me to compare reports of sexual satisfaction reported by circumcised and uncircumcised men when evalutating pros and cons of circumcision.”
    First of all – is that what you meant? If not, I think you need to work on your communication skills a bit. This is no different than:
    “I find it bizzare that she would order the hamburger. Did I miss something? Isn’t she a vegetarian?”
    being (obviously) equivalent to:
    “Because she is is a vegetarian, it makes no sense to me that she would order the hamburger.”

    Assuming that the paraphrased comment above was what you intended to say, Cymbe was simply pointing out that the reduced sexual satisfaction associated with FGM is CERTAINLY a sensible (one of many) “con” to point out in discussing pros and cons of FGM.

    Logic dictates that either:
    1) You disagree, and think reduced sexual satisifaction reported by women who’ve been subjected to FGM, relative to those who haven’t, is a bizarre reason to denounce the procedure.
    2) You believe that reports comparing relative rates of sexual satisfaction is relavent to the issue of FGM, but somehow “bizarre” in the context of circumcision.
    3) You meant something other than what I paraphrased above (in which case, I can hardly find fault in Cymbe’s follow-ups, because either #1 or #2 are pretty untenable positions to hold).

  86. antiskepticalhealth says:

    # SkepticalHealthon 04 Sep 2012 at 10:56 pm
    says “I have a beautiful circumcised penis”.

    You forgot to insert ” teeny”

  87. BillyJoe says:

    SH:

    “I love that when an expert consensus agrees with someones world views, that they are “legitimate, science-minded practitioners.” But when the same expert consensus disagrees with someones world views, they are “biased people with an agenda.” ”

    False characterisation of my post, but…

    When all their reasoning adds up to “no”, but they instead conclude “yes”, I think we have a problem that is as obvious as the foreskin on your penis. Oh wait…

  88. lilady says:

    @ baldape: What you stated in your first paragraph as what I meant, is correct. Odd, that you were able to interpret my meaning which somehow eluded another poster.

    Now re-read the posts from me and show me where I ever went off-topic from the subject of this thread, which is the AAP Male Circumcision Policy. Show me where, in my original two posts, I ever mentioned female circumcision.

  89. Mrs. N. says:

    Ah, the intactivist harangue– same tropes, same ideologically-motivated extremism. It’s funny, too, how many of them cry “parental rights” when it comes to things like refusing vaccination and subjecting their children to CAM quackery, but when it comes to circumcision, a procedure which for thousands of years remains despite the apocalyptic consequences purported by the anti-circ crowd, they have no problem forcing the rest of us to conform to their point of view. Perhaps if intactivists could convince more “normal” circumcised MEN that their circumcision isn’t something they want to pass on to their sons, they wouldn’t have to be so nutty. As it is, they’re mostly convincing crunchy-inclined extreme-parenting mothers and some men who need to externalize blame for their life’s problems.

    And, no, no variant of FGM is comparable because there aren’t any benefits to the procedure, not even hygiene, only significant risks. One of the primary purposes is to reduce “illicit” sexual behavior (something no one who circumcises males in the 21st century west would even find rational, let alone licit). Additionally, something like a clitoridectomy can be said to OBJECTIVELY cause harm sexually because you cannot have clitoral stimulation or a clitoral orgasm without a damn clitoris! Circumcised males, on the other hand, are (easily) sexually stimulated and do have successful orgasms so the subtleties of “satisfaction” are subjective and nuanced.

    I’m happy to admit that I am a very satisfied customer of a circumcised penis. And, frankly, that’s my preference… but the more important thing is the MAN attached to the penis. That’s why all this focus on an appendage who’s lifetime utility is consumed mostly by urine elimination is so mind boggling! IT’S A PENIS. NOT THE ARC OF THE COVENANT! (And, yes, I’d say the same thing if there were an equivalent procedure– generally benign with some hygiene and some potential minor benefits– for females.)

  90. @BillyJoe,

    YOU LEAVE MY PENIS ALONE!! :)

  91. mousethatroared says:

    BillyJoe “When all their reasoning adds up to “no”, but they instead conclude “yes”, I think we have a problem that is as obvious.”

    Have you read the actual statement? Because I was just reading it and I don’t think your statement is a fair summary. In my reading, the reasoning adds up to a very slight inclination to “yes” there appears to be a slight health advantage to circumsicion, although not to the point that’s it’s considered a necessity and the conclusion is the medical community should give the parent the information they need to decide within the context of their culture, family, religion…

  92. mousethatroared says:

    It’s actually kind of interesting to compare the 1982 statement with the recent statement. Gives you a good sense for what new information has been incorporated as well as a little lesson in how bureaucratic language has changed over time. :)

    http://www.cirp.org/library/general/king1982/

    Yes, I’m spending my time reading archived AAP circumscisions statements. How twisted is that? In my defense, I’m still having the side pain that the doctors think is kidney stones, seems to hurt much less laying down and I’ve run out of new Doctor Who episodes.

  93. mousethatroared says:

    Oh and by the way, the 1982 statement says that records tracking circumsicisions preformed by qualified surgeons in NY showed 500,000 circumsicisions with no deaths. Figures for annual number of circumcisions in the U.S. was 1.2 million. If we are doing projects on data, how many annual deaths from circumcisions does that make?

    Not 117, I think.

  94. baldape says:

    Hi Lilady,

    I’m glad that we are in agreement; that I did properly misrepresent your original statement. So, are we agreed that the basic flow of conversation (paraphrased) was:

    L1: Because sexual satisfaction is subjective, it makes no sense to consider lower reported rates of sexual satisfaction in circumcised vs uncircumsices men as having any bearing on the question of male circumsion.

    C1: Wouldn’t that rationale imply ‘Because sexual satisfaction is subjective, it makes no sense to consider lower reported rates of sexual satisfaction in mutilated vs unmutilated women as having any bearing on the question of FGM.’?

    L2: Stop putting words in my mouth; I never said anything about FGM. This conversation is about male circumcision.

    If not, please tell me what I’m misinterpretting. Because if that /was/ the basic flow of conversation, I have to say your “L2″ retort is either incredibly obtuse or deliberately disengenuous. Cymbe was merely pointing out that your rationale, if applied consistently, leads to statements about FGM which most people would consider false, and heinously so. This is a very common way to show somebody that their reasoning is flawed. Consider a Jack/Jill conversation:

    Jack: Because cars are red, they can drive on the highway.
    Jill: Are you saying that “since barns are red, barns can drive on the highway”?
    Jack: Stop putting words in my mouth, I never said anything about barns. This conversation is about cars!

    In that Jack/Jill conversation, would you say “Jill was derailing by mentioning barns” or that “Jack was arguing in bad faith”?

  95. BillyJoe says:

    Michelle,

    Sorry, but this post is going to be repetitively repetitive. :|

    There has to be a clear benefit over risks, not a possibly very slight benefit over risks, in order to accept a medical/surgical procedure. Think of all the money, time and manpower that would otherwise be wasted on something of marginal benefit at best. And the decision should be a medical one, not based on or influenced by cultural, personal, or religious considerations.

    There should be a clear statement from the AAP that circumcision is not a medically justified procedure because of lack of clear benefit above risks. Having made that clear, then consideration should (and I do mean ‘should’) be given to the practicalities of dealing with individual patients who come with their own media-driven, cultural, personal, or religious baggage (and I do mean ‘baggage’), at the same time as making it clear that the procedure is not medically justified becasue of no clear benefit above risks.

    To be clear, if the evidence was otherwise, I would have no hesitation accepting circumcision as a valid procedure. In other words, I do not have an agenda other than defending science, reason and logic.

  96. baldape says:

    D’oh, morning post before coffee = bad idea :-) That should read, “I’m glad that we are in agreement; that I did properly represent your original statement. “

  97. BillyJoe says:

    Michelle: “the 1982 statement says that records tracking circumsicisions preformed by qualified surgeons in NY showed 500,000 circumsicisions with no deaths.”

    http://www.aafp.org/online/en/home/clinical/clinicalrecs/guidelines/Circumcison.html

    “An estimated 1 million circumcisions are performed each year in the United States.”
    “Death is rare, and mortality risk has been estimated to be 1/500,000 procedures.”

    That makes 2 deaths per year on average.
    (They don’t say if these deaths are at the hands of unqualified surgeons)

  98. mousethatroared says:

    Thanks BillyJoe

  99. Cymbe says:

    Narad: Why yes, it is unreasonable. In fact, it’s completely without basis. The further extrapolation (the “adjustment factor”) is simply idiotic.

    Then you can demonstrate what causes the 40.4% greater deaths in boys than girls due to infection and hemmorhage, or else it is not unreasonable.

    Narad: Go ahead and tell me, just so I know.

    Don’t play games.

    Lilady: What you stated in your first paragraph as what I meant, is correct. Odd, that you were able to interpret my meaning which somehow eluded another poster.

    And that was exactly the way I interpreted it. So now what is the problem?

  100. mousethatroared says:

    BillyJoe – medical procedures are not always based on medical need, for instance cochlear implants, many plastic surgery procedures and dental procedures.

    It is not medically nesscessary for a person with profound hearing loss to hear, but, a deaf person can experience a substantial cultural disadvantage. Many people in the deaf community argue that that cultural disadvantage should not exist, but it currently does. Is it the AAP job to set up guidelines that deny the present cultural reality?

    Similar realities exist for certain birthmarks, congenital differences, accidental injuries and dental differences. Many procedures are carried out on children (and adult) that do not have a clear medical benefit but do have the clear cultural benefit of allowing the individual to more easily fit in with the people around them.

    If you think the culture is wrong in this case, fine. I suggest you do what you can to change the culture or create a viable alternative-culture, as the deaf community has. But I don’t find the argument that the AAP should be blind to human’s emotional need to easily integrate with society, convincing.

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