Circumcision and Clean Syringes

I couldn't agree more.

"we don't allow female circumcision, thank goodness. So I really think we should take the same step for males"

This is a dangerous comparison. Male circumcision is an esthetic operation that can be the basis of a valid discussion about children's rights. Female "circumcision" (a grave misnomer) is barbaric mutilation that removes some sexual function from victims for life. Supporters of female genital mutilation like to blur the public's understanding of this inhuman religious practice by calling it "circumcision". Please do not feed the myth by equating an ethical choice with a vicious crime.

It's become popular to talk about circumcision like it is a barbaric mutilation, but this isn't true. It's prophylaxis against several different diseases, most notable being HIV:

http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10…

My friends, there's clearly some misunderstanding here. It's long been popular to talk about circumcision like it is a esthetic operation, but this isn't true. It's a barbaric mutilation done for reasons that have nothing to do with prophylaxis against disease.

But it's good to know that we agree about female genital mutilation.

You haven't explained why male circumcision is a "barbaric mutilation." I don't think the choice of my parents to have me circumcised has affected my life at all.

If circumcision were merely a religious ritual, I would agree that it was a barbaric mutilation on par with branding, and some of the more hardcore piercings that people do. But you're wrong, there are several health benefits:

http://www.mayoclinic.com/health/circumcision/PR00040

That said, the American Academy of Pediatrics (AAP) says that the benefits don't outweigh the risks (though I suspect that statement predates the relatively new HIV results). I tend to disagree with the AAP. The link I gave above was the first (of several) papers that demonstrate that HIV is transmitted at dramatically lower rates to males who have been circumcised. In a world where HIV has become epidemic, and there is no cure or functioning vaccine, I think that preventing HIV transmission is something important that I can give to my son (we had him circumcised when he was born a year ago). Granted, he should still practice safe sex (when he arrives at the appropriate age) but this is one more protection that we can give him.

Like nearly all readers here I'd like the decision to be made primarly on public health issues. There are two points of fact that should be considered. Does it improve health prospects for the baby?
If there is some reduction for some types of STD, there is also a public health benefit by decreasing the spread of these STDs. For a given degree of unsafe sex in a society, there is likely to be a threshold value of protection (vaccine condoms circumcision...) beyond which certain STDs can no longer effectively propagate (meaning one victim infects fewer than one more so over time the incidence in the general population dies out). To the extent that the proceedure could
(or could-not) accomplish this, it could be a huge societal benefit.

I don't know what the medical evidence says.

Michael, nor would it have if they had removed one of your testicles / kidneys / earlobes at age 3 days. And I'm sure by now you wouldn't have remembered it if they had branded you with the McD logo on the sole of one of your feet.

Factie, if STDs are your concern, then why not wait until puberty?

The foreskin is primary erogenous tissue, with a large complement of nerve endings that are different from those of the glans penis - including fine touch discrimination that the glans penis lacks.

http://www.cirp.org/library/anatomy/cold-taylor/

The glans penis is primarily innervated by free nerve endings and has primarily protopathic sensitivity [43]. Protopathic sensitivity refers to cruder, poorly localized feelings (including pain, some temperature sensations and certain perceptions of mechanical contact) [44]. In the glans penis, encapsulated end-organs are sparse, and found mainly along the glans corona and the frenulum [43]. The only portion of the body with less fine-touch discrimination than the glans penis is the heel of the foot [45]. In contrast, the male prepuce ridged band (Fig. 7) at the mucocutaneous junction has a high concentration of encapsulated receptors [46]. The innervation difference between the protopathic sensitivity of the glans penis and the corpuscular receptor-rich ridged band of the prepuce is part of the normal complement of penile erogenous tissue.
===

In males, circumcision is essentially a partial penile mucosectomy. The residual exposed glans mucosa becomes abnormally keratinized with an increase in the number of cell layers in glanular mucosal epithelium. The urethral meatus is exposed and prone to irritation. Meatal stenosis can be a complication after circumcision. During circumcision, the frenular artery may also be ablated, depriving the anterior urethra of its major blood supply. The combined effect of urethral ischaemia and irritation results in the development of meatal stenosis in 5-10% of circumcised males [25,83-86]. The risk of glanular injury when tearing the fused penile mucosa, and the development of meatal stenosis, makes circumcision in the newborn period inadvisable [87-89].

During circumcision, most of the penile dartos muscle is removed; all that remains is a few bundles of muscle at the circumcision scar. It has been observed that the flaccid penis in circumcised males tends to hang less vertically than in those with complete anatomy. The loss of dartos muscle support may explain the difference. Certainly, the loss of most of the penile dartos muscle makes the penis less able to make positional adjustments during erection and with temperature changes.

Is there any empirical evidence that male circumcision does any harm? The Mayo link lists rare surgical risks, pain which can be controlled, permanence, and expense (depending on insurance). It seems like permanence is the one you are most worked up about, and I don't really see the issue there. How much time does anyone spend worrying about whether or not they've got a foreskin?

Removing a testicle could have developmental and fertility impacts, removing a kidney would pose real health risks, and removing an earlobe would be pretty obvious to anyone you see on the street. Removing a foreskin has none of those risks, and can potentially simplify hygiene and reduce disease transmission, cancer incidence and urinary tract infections.

Some parents opt for it, others opt against it, and I'm not aware of any evidence that children in either group have any psychological differences as a result. Assuming anesthetic is used, where's the barbarism? Unlike a clitorectomy, there's no loss of function or feeling.

It's true that I don't know if things would be different for me if my parents made a different choice, but I don't care, either. As far as anyone can tell, my life would be basically the same either way, and under those circumstances, why not just let people make their own private choices?

Big Tom, it's a self-determination issue and an issue of cruelty to children. If it's aesthetic, then I don't want my parents to make any irreversible choices about body modification for me. If it's about epidemology, then let's remember that a) babies don't fuck, b) circumcision provides less than 60% of the protection against HIV that a condom does.

Go on worshipping whatever fictional character in the sky you like, just don't let that interfere with the genitals of defenseless children entrusted to your care.

Let's apply that to children born with ambiguous genitals as well. Surgically "assigning" intersex infants seems to cause far more harm then benefit. Hormones are different, but by the time for puberty rolls around the children should be able to tell you what sex works for them‐if they know they have that choice. I am "pro-choice" on this issue: to the extend possible it is the individual person that should decide how their body should and shouldn't be modified.
One more thing: there may be similarities between male and female "circumcision", but the differences are enormous.

"Is there any empirical evidence that male circumcision does any harm?"

Well, I may be wrong, but I hear it sort involves the loss of a body part.

"why not just let people make their own private choices?"

Now you're talking! Yeah! Let people decide for themselves if they want to be circumcised! I'm sure most 18-year-olds are mature enough for that decision.

Andy W, I heartily agree about ambiguous folks. That surgery is done purely for the cognitive harmony of the parents.

"there any empirical evidence that male circumcision does any harm? "

Josh, it removes significant amounts of erogenous tissue (something like 30% of the nerve endings in the penis are in the prepuce), and there is solid evidence that the procedure ends up reducing sensitivity of much of the remaining erogenous tissue via keratinization of the glans.
The prepuce has nerve endings that are distinct from those of the glans penis, both in morphology/physiology and in function. Among other things the prepuce has quite good fine touch discrimination, while the glans penis does not. In otehr words, removing the prepuce does not only reduce the sensation by removing nerve endings, it removes an entire class of sensation from the penis.

That sounds like harm to me.

So to avoid HIV, you have to accept reduced sensation. You have the choice of doing so by a) using a condom which is protective in >95% of the cases, b) circumcision which is protective in less than 60% of the cases, or c) both.

I used condoms when my wife and I dated. And you know what? After a few months I quit. Guess where on the sensitivity scale I've been since.

*sigh* Thank you. This has been driving me insane, as an HIV researcher.

The CDC explicitly forbids female circumcision-- one reason is that they are rarely done under sterile conditions. How are male circumcisions magically going to be different? You are absolutely right about the difficulty we have getting people to sterilize their damn needles, and now WHO is telling males in Africa to go get cut?

*blink*

I am 100% in favor of male circumcision (which ought to be especially promoted in Southern Africa and other AIDS-ravaged regions - with sterile procedures obviously) while being 100% opposed to female genital mutilation.

Hypocritical? Hardly. Here's why:

1) Male circumcision does not adversely affect male sexual functioning, or at least not by much.
2) Male circumcision greatly reduces the mucosal surface which is a major mechanism by which HIV is transmitted between heterosexual partners. Circumcision is highly effective in reducing AIDS transmission.
3) As for the "wait until they're adults" argument, it's a much more major operation in adulthood than in infancy.
4) Female genital mutilation reduces female sexual functioning and in the more severe forms, reproductive function and has even worse detrimental health effects.
5) Female genital mutilation is related to the patriarchal domination of women and girls, while male circumcision has not been associated with the wholesale subjugation of males.

OK, now you're gonna get a tirade for the ex-daycare lady: This is a fairly big issue with parents where I live (Mennonite Central, Canada). As for myself, had we had sons instead of daughters, there is no chance in Hel I'd have done it, mainly because I am not a religious person, and the reason why we ever started circumsing boys in the first place was for religious reasons.
Many parents here have it done "so that he'll look like Daddy", which is just a bullshit argument unless you are truly a devoutly religious person. Children spend many years trying to differentiate themselves from their parents (in common lingo, we call it rebellion, terrible twos and teenagers). How about letting them decide for themselves when they're old enough, just like they decide to pierce themselves and tattoo themselves just to piss of Mom and Dad? It should be no different than confirmation at church. When you're old enough to decide if you want to be one of Jehova's flock, you get confirmed. With circumcision, you've decided for them at three days old what their religious "choice" is to be as adults.
Having changed diapers of over 400 kids in my former professional life, I can tell you that only once have I come across a boy who may have benefitted from such surgery at such a young age. On the other hand, I have had several with hacked up penises, where the rabbi "slipped", infections and decreased sensitivity.
Having said all that, where I come from, female circumcision is illegal, male is not, BUT it is not covered by the provincial medical plan. You as a parent have to make the choice of your child having a painful, unnecessary procedure done first thing after he's born. It is a choice, and therefore you foot the bill. If it is a necessary medical procedure (such as the foreskin is too tight or too long, causing hygene probliems, which in turn cause infections and such, as was the case with my daycare charge), the government will pay for it. Logic, to me.

If you propose slicing up the genitals of small children, there is something wrong with you. You have a problem in your brain. It is not right to see an infant and say "AHA! A penis! Pass me the knife!" That is just plain wrong on an axiomatic level: anyone who is a human being with feelings should automatically react with revulsion to the prospect of cutting healthy, functional parts of a helpless infant off.

Many people are utterly convinced that male circumcision has absolutely no negative impact on sexuality and that even the possibility is ridiculous.

I have concluded after many years of trying to reason with such people that some of the reasons are as follows:

1) Thinking that one's genitalia might be unusual or substandard or any way is deeply distressing to human beings

2) Thinking about genital modification in any way is deeply distressing to many people

3) There is a powerful desire to be 'normal', most especially in matters touching sexuality, which is why women are sometimes sensitive about breast size and men about penis size, et cetera; in regions where male circumcision is a common cultural practice, people define 'normality' by what's common and wish to remain classified as such

4) Doctors are really, really slow to recognize that things they were taught in medical school aren't true

5) People in general are really, really slow to recognize that they've made a mistake when there are convenient rationalizations available

I agree, "so he'll look like Daddy" is a lame reason. Surgery to merely change breast or penis size is also unnecessary - although a free choice of adults - except in extreme cases where there is functional impairment or for reconstructive purposes.

If the circumcision of helpless male infants is such a heinous abrogation of human rights, shouldn't the sanction against such a practice go beyond simply barring providing public funding or insurance for the procedure? Logically, shouldn't it be illegal to subject minors to it? Unless it really is not that bad in the first place, and even most of the anti-circumcision side knows that - because otherwise they would insist on its abolition.

Let's keep in mind that we're talking about plain old male circumcision, not glandectomy, subincision, or bisection. As for these middle-aged guys who had non-botched circumcisions and now think they're entitled to the indignation of a character in an Alice Walker novel or otherwise have the moral capital someone who underwent infibulation - with all due respect, gimme a break.

Colugo, we are talking about removing some 30% of the sensory innervation of the penis, including an entire class of sensation.

I don't know a single person who still has their prepuce who would willingly have it removed. I have known two people who had adult circumcision, and both of them reported substantial alterations in sensation - and were NOT happy about it. They were still sexually functional - they just were unable to feel or enjoy as much during sex. To me, this is harm.

And you have the argument backwards. We are talking about removing healthy functional sensory tissue from a baby unable to consent to the procedure. You are arguing, essentially, "give me adequate justification not to do it." That is backwards - it should be, 'give me compelling reason to do it, or leave it alone."

"I have known two people who had adult circumcision, and both of them reported substantial alterations in sensation - and were NOT happy about it."

I just had a thought - perhaps removing the prepuce in adulthood is more injurious to pleasure that removing it during infancy, and maybe there are good theoretical reasons to suspect that this is the case.

The brain, including sensorimotor mapping, is highly labile in infancy and early childhood. While there is some plasticity in the adult brain, it is greatly reduced. Hence, the loss of the prepuce in infancy may be compensated for while its loss in adulthood may be registered in the sensory cortex as an absence of feedback. I don't know.

On "do no harm" and burden of proof: If Scandinavians and other non-HIV prevalent regions don't want to do it to their male infants, it probably won't make much difference. However, in Southern Africa and other regions, it will assuredly save many lives, of both men and women. And that's definitely worth some infringement on the rights of infants and even some risk of harm. (Of course, the decision should be entirely left up to the parents, not the state.)

http://news.bbc.co.uk/2/hi/health/6502855.stm

Why not wait until adulthood, or at least adolescence? Similarly, giving the HPV vaccine to girls before they become sexually active, not after, is the most effective practice.

Two simple questions:

If you are a creationist/bible basher: if the foreskin is such an evil thing, why did god ever put it there?

If you are an evolutionist: if the foreskin is such an impediment, why didn't it evolve itself off?

The "argument" that male genitalia mutilation and female genitalia mutilation are chalk and cheese fails before it even gets off the ground. Why are they done? Religious practice. What do they do? Make that filthy sex thing less fun.

Each study that shows that male genitalia mutilation has "health benefits" has been shown to be either very limited in scope, or just scientifically bogus. If you take a group of five cut men vs. five uncut men and look at their STD rates, you may well find a 10% difference. if you add to that how often and with how many partners each has sex (aka, the "fun" parameter), the studies break down.

Want to stop AIDS? Comprehensive and realistic sex education, all the condoms you can eat, and please try to start taking the "dirty" taboo away -- an informed fucker/fuckee is both cleaner medically and dirtier sexually -- best solution all round.

I am an atheist and evolutionist. Evolution doesn't result in perfect structures. Sometimes these often require surgical intervention: wisdom teeth, the infection-prone appendix, bad backs, prostates that impede urination when they enlarge, vaginal delivery problems that require episiotomies and Caesarians (I know, that's a whole other can of worms) ...

"Make that filthy sex thing less fun."

That's part of the cultural rationale for FGM. But do you really think circumcized guys have reduced sex drives and enjoyment of sex?

"Comprehensive and realistic sex education, all the condoms you can eat, and please try to start taking the "dirty" taboo away"

That sounds great. You know what? That won't cut it, not in time, in places like Southern Africa. I'd rather see lives saved in the short term, and the long term. Look, whatever we Westerners think of circumcision, many African men are eagerly lining up to get circumcised. And these men will get their sons circumcised too, either as babies or kids. And that's a good thing.

Frankly, I'm surprised by all of the anti-circumcision sentiment on this thread.

Wow, I'm shocked at the amount of people who think cutting a healthy, functional body part off of a defenseless infant is a good idea.

Also, for those saying that it reduces HIV transmission, this is straight from the WHO.

"In countries where the HIV epidemic is concentrated in specific population groups such as sex workers, injecting drug users or men who have sex with men, there would be limited public health impact from promoting male circumcision in the general population. However, there may be an individual benefit for men at high risk of heterosexually acquired HIV infection."
http://www.who.int/mediacentre/news/releases/2007/pr10/en/

Also, there is a study stating that circumcision removes the most sensitive parts of the penis.
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1464-410X.2006.06685…

Colugo, why are you surprised that a lot of people don't share your fondness for slicing healthy, normal body parts from healthy, normal infants? Why don't you understand that a lot of people think that it is not a good thing to mutilate tiny children with sharp knives?

I'm shocked that you think that mass circumcision is a good thing -- encourage people to undergo a painful, unnecessary operation in a part of the world where surgical facilities are not always up to scratch, to say the least -- and thereby DISCOURAGE CONDOM USE AND EDUCATION. You sneered at the ideas of promoting condom use and education. Promoting circumcision as a prophylactic against AIDS will have disastrous results; if we tell people that circumcision prevents AIDS, what does that tell them about condoms? Not to bother, is what it says. We know how to prevent AIDS transmission, but you are so obsessed with the idea of cutting up babies' genitals that you want to promote that above all else. The infants must bleed. Oh, and wait until the UN starts explaining this whole arrangement in places where grotesque FGM is the norm.

It's beyond absurd. It's unconscionable.

First it was argued that circumcision was good for "moral hygiene", as it made it harder for males to masturbate and gave them fewer excuses to do so.

Then it was argued that it prevented penile cancer, during a period where 'cancer' was a dreaded foe against which there was little hope. (It really doesn't.)

Then it was argued that it reduces urethral infections in infants (which effect is negligible at best and attainable through non-surgical methods).

Now, in the age of HIV and AIDS, it's being called a HIV-control method. (Which it probably is, to some limited degree, as the sensitive and delicate tissues within the foreskin are vulnerable to viruses, just like the eyelids and muscosal membranes.)

They're just excuses. When the justifications change but the action remains the same, we can be confident that the claimed justifications are lies. The underlying motivations remain constant: we've kept doing it, so we must continue doing it.

There are at least 4 different issues here.

- Is circumcision a mutilation? By default it is a body alteration. Male circumcision also removes functional tissue.

First, the foreskin presents antigens to the immune system. [I'm not going to provide references to all of this - and they are easy to google.] It could even conceivably prepare sperm for impregnation as much as sperm prepares the female body, but I'm not aware of any published research here.

Second, sensitivity changes. There are some reports of loss of sensitivity.

Third, the mechanics of sex changes appreciably when the penis can't slide inside the foreskin. IIRC presented data such as it is seems to say uniformly that females reports less satisfaction.

Fourth, protective tissue is removed.

- Is circumcision beneficial? It depends.

Apparently it will protect millions of people from death in areas with an HIV infection. The WHO decision to support this on pure medical grounds seems correct.

There are also small investigations (not so much interest there) that uncircumcised males are efficiently protected against chlamydia. This would be a concern in other areas, not least because untreated chlamydia lowers fertility. On the same grounds as above, and considering the risks, circumcision here should be acted against.

- Should circumcision be done in presexual and/or dependent individuals?

No and no.

- Is circumcision an esthetic operation?

In cultures where it is seen as mutilation it seems to be mostly unesthetic.

In other cultures, religious and esthetic purposes seems conflated. It is also hard to understand why the corresponding female 'light' circumcision of labia isn't likewise considered to be default religious and esthetical.

I am uncircumcised, When I came to the US I was amazed how many men were. They don't know what they are missing! The sensitivity of the natural moist glans of the penis under the foreskin is incredible! It's very easy to clean when you shower with mild soap. I feel really sorry for circumcised men with their dried up glans; some seem to have no more feeling at the tip of the penis than any place along the shaft. If you are concerned about catching disease, then always use a condom. Don't go for sexual mutilation.

Stephanie:

The primary reason for WHO decision was probably that, as your reference mentions, that "Modelling studies suggest that male circumcision in sub-Saharan Africa could prevent 5.7 million new cases of HIV infection and 3 million deaths over 20 years."

It is hard to argue against observations (I believe they have several independent investigations behind the models) and tested (I assume, for epidemics) models.

But there is nothing that says male circumcision in non-epidemic areas are beneficial. On the contrary, it seems it is many reasons that it is not.

Leaving a baby intact is cleaner than circumcising. The foreskin of an infant has not yet separated from the head, so urine and feces in the diaper won't irritate the head. Way way cleaner than a huge surgical wound.

"it seems it is many reasons that it is not" - there seems to be many reasons it is not.

Yes, I believe GB is correct. Properly mantained hygiene seems to not result in higher health risks (infections or allergies) in females. (But here I'm less sure about references, so it could be wrong.)

On another note, it is encouraging that this topic finally gets a rise out of web visitors.

It is really an atrocious concept a priori. And a posteriori, why not for example dissect away the breast tissues in everyone? Many females and some males risks serious disease, while bottle feeding is only non-beneficial for the baby. It could even be seen as esthetic after a while...

Caledonian: "a HIV-control method. (Which it probably is, to some limited degree"

Torbjörn Larsson: "The primary reason for WHO decision was probably that, as your reference mentions, that "Modelling studies suggest that male circumcision in sub-Saharan Africa could prevent 5.7 million new cases of HIV infection and 3 million deaths over 20 years.""

That settles it. Or at least it should. Loss of sensitivity? Big deal, compared to millions of lives. And I doubt that a single person on this thread would argue that male circumcision is as bad as FGM.

All of us knows that condoms aren't foolproof - even though of course their use ought to be promoted in order to prevent STDs. Why not add even more protection? People in the Third World don't always have access to condoms, for a variety of reasons.

CDC, March 2007:
http://www.cdc.gov/hiv/resources/factsheets/circumcision.htm

"Lack of male circumcision has also been associated with sexually transmitted genital ulcer disease, infant urinary tract infections, penile cancer, and cervical cancer in female partners of uncircumcised men. The latter two conditions are related to human papillomavirus (HPV) infection.Transmission of this virus is also associated with lack of male circumcision. A recent meta-analysis included 26 studies that assessed the association between male circumcision and risk of genital ulcer disease. The analysis concluded that there was a significantly lower risk of syphilis and chancroid among circumcised men, while the reduced risk of herpes simplex virus-2 infection had a borderline statistical significance. ...
In large studies of infant circumcision in the U.S., complications rates range from 0.2 to 2.0%. In the recently completed South African study of adult circumcision by general medical practitioners in their surgical offices, the overall complication rate was 3.8%. ... There were no reported deaths or problems with urination."

The facts are in.

Colugo: That settles it. Or at least it should. Loss of sensitivity? Big deal, compared to millions of lives. And I doubt that a single person on this thread would argue that male circumcision is as bad as FGM.

All of us knows that condoms aren't foolproof - even though of course their use ought to be promoted in order to prevent STDs. Why not add even more protection? People in the Third World don't always have access to condoms, for a variety of reasons. What about this study? http://news.yahoo.com/s/hsn/20070305/hl_hsn/scientistsdiscovernaturalba…

So instead of passing out condoms, (which are 85-99% effective), we will circumcise, which leaves 40% of the men to contract HIV? If the choice is between unlimited condoms or mass circumcision, which is better? And how does this pertain to infant circumcision? The WHO is suggests circumcising adults, not hacking bits off babies.

That settles it. Or at least it should. Loss of sensitivity? Big deal, compared to millions of lives.

What you've got is a somewhat-reasonable argument for circumcising adults in Africa and other places with high HIV prevalence. But in countries with low prevalence there's still no justification for it.

Personally, this is where I'd draw the line between enforcing a practice as a public health measure and upholding personal freedom. The more I learn, the more I'm pissed that I was born at a time when boys were circumcised as a matter of course in the US (and not just for religious purposes). I don't care if my risk has been reduced -- I am not okay with the fact that part of me was permanently damaged without my consent.

Colugo, you know full well that circumcision makes absolutely no difference in HIV transmission rates in men who PRACTICE SAFE SEX. You want to discourage people from practising safe sex. You openly sneer at the concept of encouraging condom use and education, because you love the idea of infant boys having their penises cut so much that that must prevail against all else. That must happen, in your world, and goddamit you'll find a way to justify it no matter what.

Never mind that it's a barbaric religious ritual that you're trying to find pathetic ex-post-facto justification for, thousands of years later. Just so long as there is pain and adults are taking knives to babies' genitals, that's all you care about. That is your guiding principle; all fact and reason is subjegated before that cause. Babies must have their genitals cut up with knives. You will find a way why that must be so, come what may.

I understand that once you find yourself committed to a position as obviously repugnant as yours, you need to do some pretty frantic work to find a defence for it, but in doing so you forfeit every right to call yourself an atheist and a rational person. Or a person at all, really. Doesn't it ever make you feel a bit creepy and weird, advocating doing violent, bloody things to babies' penises? I don't think you're right in the head. I think there is something seriously wrong with you.

It's great to discuss this issue with so many generic Americans around. In Sweden, where only religious minorities circumcise, it's really hard to talk about it because you get bogged down in accusations of anti-Semitism almost immediately.

I consider myself a pro-Semite. I like them so much that I wish they could keep their foreskins!

So, in our provisional world government, perhaps we could agree to prohibit infant circumcision while making it freely available to anyone above the age of 18. And let's promote safe sex in areas with HIV epidemics.

Martin R: "And let's promote safe sex in areas with HIV epidemics."

And everywhere else.

"making it freely available to anyone above the age of 18."

On that part, I agree.

ben: "You want to discourage people from practising safe sex. You openly sneer at the concept of encouraging condom use and education"

Totally false. My argument is that while this is necessary, it is not sufficient in some areas due to complex local factors.
http://www.medicalnewstoday.com/medicalnews.php?newsid=42242

The WHO are about to condemn millions of men in Africa to death. They are, in effect, telling them that circumcision prevents AIDS. The people won't hear the message about "partial protection", they will hear "prevents AIDS".

Not to mention the further spread of infection and death due to complications of the procedure itself - in the study of 1000 circs external to his project that Bailey did at the same time, there was a 37% complication rate when it was done by traditional circumcisers, and, just as alarmingly, 11% complication rate when done by supposedly "trained" local health clinics. If they attack children/babies in Africa, who are already weakened and vulnerable, can you imagine the death toll there is going to be? It was already bad enough that South Africa had made it ILLEGAL to circumcise anyone under the age of 16 because of the high death toll - and the WHO want to encourage this?

When you read the full text of the recent studies, published in PLoS and The Lancet, you wonder how the hell the WHO managed to come to the conclusion they did, given A) the background of the researchers (notorious for advocating universal circumcision of infants) and B) the results. ALL the studies were cut short, they only lasted a year to 18 months, so the best that can be concluded from them is that there is a 50% reduction in infection FOR THE FIRST YEAR AFTER CIRCUMCISION (which, of course, includes the healing period). When you analyse the results, you realise that you are looking at the beginning of two bell curves, with the one for the intervention group (the circumcised men) timeshifted by about year - so in effect, by circumcising all these men, you are buying them a year's worth of risky behaviour, and after that it makes no difference at all.

The US cut off the supply of condoms to Africa because they want to promote genital mutilation and abstinence, the governments PETFAR project has strings and won't help sex workers because it encourages porn and prostitution. What they are actually encouraging is to allow men to have a year's grace before they get it anyway.

Using condoms and an effective education programme IS successful, as the results in Eastern Uganda (before US interference cut off the condom supply and the funds) and Thailand prove. I think the WHO, the UN and the US are effectively committing genocide by this action. It's a disgrace.

Circumcision is genital mutilation, which removes the most sensitive part of the penis, and is the exact equivalent to a type 1 female genital mutilation. ALL types of genital mutilation should be illegal everywhere, a person should be allowed to choose for themselves when old enough to do so, what they want to do with their own body.

Oops, typo, that should of course be PEPFAR....

To Torbjorn: I should have said "I'm an uncircumcised male." in my post instead of just saying "I am uncircumcised." The barbaric custom of female mutilation deserves its own name, perhaps "declitorization".
GB

In Sweden, where only religious minorities circumcise, it's really hard to talk about it because you get bogged down in accusations of anti-Semitism almost immediately.

Oh, you get that here, too. If you're not shouted down first as a penis-obsessed disease-loving freak.

And Colugo... I suppose the old saying is true: you can lead a brain to data, but you can't make it think.

Medical procedures need to demonstrate not only that they are safe and effective, but that they are justified - that the same benefit cannot be attained through less-invasive means.

Can you do that? If not, why are you arguing in favor of circumcision? If so, why haven't you produced said argument yet?

Condoms and circumcision: zero sum? Hardly.

Kinsey Institute:
http://www.idsnews.com/news/story.aspx?id=35932

"When it comes to circumcision, it is true that uncircumcised men have higher rates of condom slippage compared to men who have been circumcised."

Where are the pro-circumcision ScienceBlogs readers? Does anti-circ ideology dominate in Western liberal circles? If so, little matter. More and more African men will wisely decide to have themselves and their sons circumcised regardless.

Colugo:Condoms and circumcision: zero sum? Hardly.

Kinsey Institute:
http://www.idsnews.com/news/story.aspx?id=35932

"When it comes to circumcision, it is true that uncircumcised men have higher rates of condom slippage compared to men who have been circumcised."

- From your article "They might be able to reduce their slippage risk by retracting their foreskin prior to putting on a condom." Thats a pretty easy fix, isn't it?

I am a circumcised male. My parents had me snipped when I was a baby. I do not know what I miss in life. I wish that I did. At times I am furious that they did this to me. I am similarly displeased with parents that have their baby girls' ears pierced. It may be a cultural norm, but that does not justify mutilating peoples' bodies without their consent.

As for the African HIV issue, I am firmly in the camp that condoms are preferable over circumcision. Consider not only their higher protection rate for males but also their immensely higher protection rate for females!

Regarding slippage, let me report that it's mainly an issue if your bonking is interleaved with less passionate moments of sweet talk when John Thomas goes limp for a while, flooding the rubber with love drops. I imagine this would occur even if you've been mutilated.

Nobody slips on a rubber without unsheathing first. All the good sensory stuff is inside that little sock.

Geez. If it's circumcize or die, I guess you do it. But it isn't that simple. Anyway, is this the best that the Fisrst World can offer to the Third? To... geez. Okay, so maybe circumcized men are more religious and that changes the statistics, or maybe the reduced sexual pleasure means they don't get the same satisfaction from horning around. Or maybe some religious-sponsored groups fiddle the numbers in God's name. Which implies that we should look at the sexual health statistics on castration. I'd bet it works even better. On religious leaders specifically, let's see figures.

Does penis-mutilation really gives better protection against HIV? I've heard that there's reliable studies that talks both FOR and AGAINST this claim. See Penn And Teller's Bullshit on Circumsision where they claim this too.

Wait until kids are 18? Does anyone really think that kids are waiting until 18 to have sex? The fundies here in the U.S. are actively fighting against the vaccine that prevents HPV (and thusly, cervical cancer) and are suggesting similar ideas (that children wait until they're 18 to have it). That is a sizeable part of the problem: that by the time we're saying that kids are legally able to make major life decisions (choose their vaccines, choose circumcision, choose to vote) they've likely already been sexually active for some time. If you want to ensure that these things are done before they are sexually active, you're going to have to choose an age where they are legally not an adult (and whether or not a 14 year old boy can decide to have a circumcision, he will largely be affected by his parent's wishes). I believe that's around the age that Jewish folks do it, right? (please, correct me if I'm wrong)

I'm just going to check here to see: are the folks who are against circumcision also against piercings? I think many popular piercings are at least as much a mutilation as circumcision.

And as to decreased sexual pleasure? I have a hard time imagining how one could do the experiment. I suppose one would have to enroll a bunch of men and ask them to rate their sex before and after having a circumcision (it's rather uncommon to circumcise as an adult). Has anyone done such a study? And how does one do a placebo-control (can you fake a circumcision?). I dunno, but I think claims about sensitivity have to be just that: claims. Might be true, but might not. Anyway, I know I'd have a hard time rating sex. I don't know about you guys, buy I always rate sex a 10.

Circumcision isn't as good protection against STDs as condoms, so what we need to provide 14-year-olds with is information about that.

Yes, I'm against piercing, indeed any body modification, of babies.

You don't need to measure the pleasure decrease because you already know that there's significant loss of nerve endings.

Jewish circumcision is supposed to occur when the baby boy is eight days old. There are fewer complications associated with neonatal circumcision than with adult circumcision, (both of which are low).

http://www.aafp.org/online/en/home/clinical/clinicalrecs/circumcision.h…

William Saletan makes the case for circumcision
http://www.slate.com/id/2148034/

August 06: anti-circumcision conference in Seattle
http://www.thestranger.com/seattle/Content?oid=60418

I think The Onion says it all: "Let's hope that Africans are more adept at outpatient surgery than they are at handling condoms."

http://www.theonion.com/content/amvo/u_n_urges_circumcision_to_fight

That's the stance people like Colugo are taking. So obsessed are they with their crusade to commit this act on small children that they will justify it however they can. Encouraging unsafe sex in Africa? Discourage condom use and send confusing, mixed messages about both safe sex and FGM? Absolutely, so long as it means more baby boys are being needlessly mutilated. That's the goal. It must be justified and encouraged no matter what.

Circumcision: Fact, Fiction and Hype
Christopher Wanjek, LiveScience
http://www.livescience.com/humanbiology/060822_bad_circumcision.html

Hugo Schwyzer
http://hugoboy.typepad.com/hugo_schwyzer/2006/10/in_january_2005.html

"In January 2005, at the age of thirty-seven, I was circumcised. ...

I write as a pro-feminist angered by the "victim consciousness" of anti-circumcision advocates, who equate a quick, safe, beneficial procedure that rarely produces lasting trauma to an operation performed on girls that produces lasting pain and robs them of the opportunity for sexual delight."

Colugo, do you honeslty think an obviously biased article and some random guy's blog supports your argument in any way? Hell, if we can post random people's blogs and expect others to respect that as the gospel I'd be more than happy to provide a few.

In most uncircumcised males, the prepuce or foreskin rolls back and completely disappears upon a full erection. This makes a condom easy to insert at that time. A flaccid uncircumcised penis will not hold a condom well. I would guess that would apply to circumcised men as well.

Lucky am I to have readers who say "flaccid uncircumcised penis" without so much as flinching. (-;

"You don't need to measure the pleasure decrease because you already know that there's significant loss of nerve endings."

Are you worried about loss of nerve endings? Or loss of sensation? If loss of nerve endings didn't result in loss of sensation, would you worry about it? I suspect there are also loss of nerve endings when an elective appendectomy is performed, but do we care if there's no change in quality of life? If there is indeed loss of sensation (and there may well be, but I doubt there's data to support it one way or the other) that's a point against elective circumcision, but I don't think loss of nerve endings per se (in the absence of loss of sensation) would be a point against circumcision.

I think this all comes down to a cost/benefit analysis. In an African country, where HIV prevalence is absurdly high, I would think one would take the circumcision route (*in addition* to better sex education and condom usage). In Western countries, where we currently don't suffer from the HIV prevalence rates seen in many other parts of the world, it certainly seems less urgent.

"Circumcision abates the most sensitive parts of the penis"

http://www.doctorsopposingcircumcision.org/pdf/sorrells_2007.pdf

I have the greatest sympathy for Opisthokont and other men who regret they were circumcised as babies. All they can do is try to prevent infants in their own families, or of their friends, from suffering the same indignity. I am sure the number of adult men who choose to be circumcised must be minuscule, they know what they stand to lose. Circumcision is mostly promoted by circumcised doctors and circumcised laymen who cannot accept the fact that they were robbed of an intrinsic human ability and wish to inflict it on as many others as possible, including their own children.

The foreskin or prepuce serves 2 purposes: normally it covers the glans or bulbous end of the penis for protection. The glans and the underside of the foreskin are moist and soft in uncircumcised men, akin to the inside of the mouth. They are very sensitive; if the foreskin contracts a little and leaves a bit of the glans exposed to rub against underwear, that can cause great irritation in uncircumcised men. During an erection, the foreskin is pulled back by the enlargement of the penis; at full erection, the stretched foreskin becomes the front surface of the enlarged penis, behind the glans. Although without doubt this is an erogenous area, I would say that in uncircumcised men it is the glans which is the apex of sensation.

Yes, there is a price to pay for this. This moist area, just like the mouth, is vulnerable. However, it is easy to keep clean and those who are monogamous or regularly use condoms have nothing to worry about. Cruelty to infants is unforgivable; circumcision should be restricted to adults only.

I sympathize with those who regret being circumcised. (But of course I can't really grasp those feelings.)

The people won't hear the message about "partial protection", they will hear "prevents AIDS".

Sounds plausible. And perhaps WHO didn't factor in that. (I'm haven't time to check today.)

Let's us say that I'm tentatively skeptic to the reports and decision for the time being. It would be tragic if it was wrong. And I prefer condoms everywhere that is (socially and economically) realistic.

You don't need to measure the pleasure decrease because you already know that there's significant loss of nerve endings.

Presumably this is observable too. First, circumcised men take reportedly longer to orgasm on average. (One can discuss if that is bad for the partner, of course. But IIRC there are now chemical and perhaps CBT fixes available for too fast males.) Second, adult circumcised have given subjective ratings.

Now, the reason the question is even asked may have to do with the fact that circumcision is mostly done on pre-sexual individuals...

Anne:"The people won't hear the message about "partial protection", they will hear "prevents AIDS"."

NYT: 'W.H.O. Urges Circumcision to Reduce Spread of AIDS' 3/29/07
http://tinyurl.com/2yvj2d

"Dr. Halperin, who said he had interviewed hundreds of African men about sex and AIDS, said he had seen growing acceptance of circumcision among those whose tribes or religions did not practice it.

And I can count on one hand the number who said, Oh, yeah, if I get circumcised, Im bulletproof, I cant get AIDS, he said. Many say that circumcision makes them feel cleaner, he said, and that it reduces their chances of getting other venereal diseases.

The countries where the operation is likely to do the most good those where AIDS prevalence is high and circumcision is low are places like South Africa, Botswana, Swaziland and other southern countries that have, by African standards, good health care.

They can do it safely, Dr. Halperin said."

J Acquir Immune Defic Syndr. 2007 Jan 1;44(1):66-70.
Male circumcision in Siaya and Bondo Districts, Kenya: prospective cohort study to assess behavioral disinhibition following circumcision.
http://tinyurl.com/2ydohr

"During the first month following circumcision, men were 63% and 61% less likely to report having 0 to 0.5 and >0.5 risky sex acts/week, respectively, than men who remained uncircumcised. This difference disappeared during the remainder of follow-up, with no excess of reported risky sex acts among circumcised men. Similar results were observed for risky unprotected sex acts, number of risky sex partners, and condom use. DISCUSSION: During the first year post-circumcision, men did not engage in more risky sexual behaviors than uncircumcised men, suggesting that any protective effect of male circumcision on HIV acquisition is unlikely to be offset by an adverse behavioral impact."

Circumcision, Fidelity More Effective HIV Prevention Methods Than Condoms, Abstinence, Researchers Say

Article Date: 27 Apr 2006 - 1:00am (PDT)

Promoting male circumcision and fidelity to one partner seems to be more effective at curbing the spread of HIV than promoting abstinence and condom use, USAID researcher and technical adviser Daniel Halperin said last week, the Chicago Tribune reports.
Medical News Today Article

Halperin would say or do anything to get those foreskins amputated. Including lying and twisting the truth. We know that education and condoms are effective because it has halted the spread of HIV in Eastern Uganda and Thailand, and that proper education programmes without the need for genital mutilation work.

Now that the "circumcision protects against HIV" meme has spread, people have ceased talking about infant urinary tract infections and penile cancer.

Why do you think that is, Colugo?

For one thing, HIV transmission is a more urgent and widespread health problem than urinary tract infection and penile cancer.

But for argument's sake, let's say that your implied suggestion is the case - namely, that some simply have advocacy of infant circumcision as their default position, and will cite whatever the latest studies are in support of it. They will just keep changing their tactics while their pro-circumcision stance never wavers.

I would suggest that whether this is the case or not, others have the opposite position: they are opposed to infant circumcision no matter what. Regardless of what the latest studies indicate, regardless of the urgency of public health problems that the data indicates that circumcision will have beneficial impact on.

I would not advocate infant circumcision if the balance of reliable evidence did not show that it had a beneficial health impact, especially for serious transmissible diseases like HIV/AIDS. (However, even so I would still not think that it was a crime, atrocity, or serious infringement on human rights.)

Under what circumstances would you support routine circumcision of healthy, normal male infants in a population? Is it even hypothetically possible that, given that the data were adequately strong and convincing about a health benefit - especially concerning the epidemiology of a disease like HIV/AIDS - you would endorse the practice?

Or, is it the case that you believe that the practice is so heinous that you would never condone it, no matter what?

Why am I the only one talking about castration? Look at the evidence!

Well Colugo, since you seem to have lost your case on that ad hominem attack, perhaps it could be turned around.

I would ask you, if there were accurate fatality statistics for the number of little boys killed each year (through infections, MRSA, anaesthesia deaths during recircs etc. - never currently attributed to the original cause which was their circumcision), believed to be at least 200 in the States, if not more, and we know that hundreds of boys are killed and horribly maimed in South Africa every year (which, of course is why they made it illegal for anyone under 16), would you still be pushing for mass genital mutilation?

It remains the case that there is NOTHING that circumcision will prevent or cure, even if there is something to the latest studies - which on the balance of evidence and reading the actual texts is NOT the case - there are other, non-invasive ways to achieve a better result ie. save more lives. All mass MGM is going to do is to divert much needed resources from other policies that are known to be effective, and which other countries have used to control their own epidemics.

What is being proposed is, in effect, an invitation to start another genocide. It's a disgrace, and an insult to the people of Africa that the will to use proven methods and policies that have worked in other countries simply isn't there from the US. Why the obsession with genital mutilation, what is wrong with providing money for the same condoms and education that works in other countries?

It's the Africans' misfortune that the people providing the "education" there are the likes of Halperin, Bailey, Brody etc. who can't see anything past their own lack of foreskin and the obsessive desire to ensure that everyone else in the world doesn't have one either.

There are hints in the Old Testament that Jehovah really likes foreskins and wishes to own as many as possible.

Under what circumstances would you support routine circumcision of healthy, normal male infants in a population? Is it even hypothetically possible that, given that the data were adequately strong and convincing about a health benefit - especially concerning the epidemiology of a disease like HIV/AIDS - you would endorse the practice?

For starters, clear evidence that there was a net benefit to the practice. This HIV claim is only about ten years old, and it's only been seriously supported to any degree by data in the last few years. So why was it performed before then?

Medical associations around the world have recognized that even largest claimed benefits of infant circumcision are no greater than the accepted risks of the procedure - and that's with Western medicine, excluding the possibility that removal of a third of the penis alters the sexual experience, and taking the [i]largest[/i] claimed benefits.

Or, is it the case that you believe that the practice is so heinous that you would never condone it, no matter what?

I started out thinking that infant circumcision must be justified if it was so common, and went looking for data to counter the arguments of anti-circ advocates. It's not there, and I changed my mind.

Even if we presume for a moment that the HIV claims are all totally accurate, and circumcision is a wonderful tool in fighting AIDS, a question arises:

Given that the evidence that circumcision protects against other things is essentially nil, why were claims that it prevents penile cancer / urinary tract infections / etc. made so commonly? Why are diagnoses of adhesions and foreskin problems made so much more commonly in the US than in Europe? Why was the procedure routine in the first place? The principle of non-intervention requires that any medical intervention be withheld unless it can be shown that there are benefits that outweigh the risks and costs, and simple common sense suggests that surgical alterations of the genitalia is likely to be a bad thing, and at best should be avoided if possible.

So how do we explain the presence of the routine procedure, Colugo?

May I add a slightly different viewpoint here. I was circumsized myself, and while I can't compare what I would have been like uncircumsized, I have probably had more experience with different penises than most of the participants here, as a bisexual man who prefers oral sex and casual sex with guys. And from a strictly aesthetic viewpoint, I find circumsized males look, feel, smell, and taste better. I would be curious to hear from women and other gay and bi guys who are not monogamous how they feel about the question. Do you prefer men cut or uncut? It might not be the most important consideration, but it certainly should be a factor.

In my opinion, the most important viewpoint on the issue is that of the owner of the penis, not that of his parents or future sex partners.

"Dear, let's circumcise little Archibald. That way, his penis will taste so much better when that day comes."

Prup aka Jim Benton: Do you prefer men cut or uncut?

Most certainly uncut. I feel that sex with an intact man is more gentle, and they don't have to pound away as hard to achieve an orgasm. I find sex with circumcised men more painful, and less satisfying. With intact men, you can enjoy the gliding action of the foreskin, and I've found that intact men can control their urge to orgasm much more effectively than circumcised men. I've personally never found a difference is smell or taste, and I find an intact penis more asthetically pleasing.

But, I do not feel that circumcising an infant based on the parent's sexual preferences is valid. The decision of look and functionality of the penis should be left up to the owner of said penis.

Colugo:Under what circumstances would you support routine circumcision of healthy, normal male infants in a population? Is it even hypothetically possible that, given that the data were adequately strong and convincing about a health benefit - especially concerning the epidemiology of a disease like HIV/AIDS - you would endorse the practice?

Or, is it the case that you believe that the practice is so heinous that you would never condone it, no matter what?

When there are less invasive means to treat the problems, I will not support any procedure. Condom use protects men and women much more than circumcision. I am also not fully convinced by the recent studies that have been published.

Why do you support circumcision? Why do you believe that the amputation of a healthy child's foreskin is a decision best left to parents?

Prup aka Jim Benton:
Being female, totally heterosexual and rather partial to men I think whole penises are infintely preferable to a cut one. They feel better, they aren't so rough, they're a LOT more sensual, and they don't rub you raw, don't need any extra lubrication, and provide a much better experience.

A whole penis also looks better when erect, there's no scar, the glans is moist and glossy, it's a much bigger turn on.

As for tasting better, if we're going to get into that, who wants a penis that tastes of whatever he last washed with, I'd rather it tasted like it is supposed to than the de-flavoured cut one.

But besides all that, my (or anyone else's) view on the sexual superiority of the whole penis is utterly immaterial. The status of a man's penis should be decided by the owner of that penis and no-one else. Cutting up a baby to your own sexual preference is just perverted.

Regarding spotted dick, umm, sorry -- regarding unwashed penis, my experience is that if someone wants to fellate you and finds your equipment grotty, then they will simply send you to the washbasin to do something about it before they go on with their intended business. And vice versa. It doesn't call for infantile amputation.

"went looking for data to counter the arguments of anti-circ advocates. It's not there, and I changed my mind."

And I assume that if evidence were to emerge that you found convincing, you would change your mind again, which is admirable. In principle, that is an objective and reason-based position. However, I would suggest that on this particular topic your revulsion at a perceived infringement on human rights has, unfortunately, clouded your judgment.

The assertions about the benefits of circumcision for penile cancer, urinary tract infection, HPV transmission, etc. have not, in fact, been refuted, as shown by the CDC's March 2007 statement linked to above. Are they not as strong or persuasive as some have previously claimed? Without my reviewing the history of these studies and associated public pronouncements, perhaps. But they're not nonexistent, either.

http://www.cdc.gov/hiv/resources/factsheets/circumcision.htm

The historical practice and religion-based reasons for male circumcision are being conflated with the recent studies on its effects on HIV transmission. Hypothetically, circumcision could be everything the anti-circumcision side says it is - but none of that changes the legitimacy of epidemiological studies of circumcision and HIV transmission.

"When there are less invasive means to treat the problems, I will not support any procedure."

Even if they are less effective?

I believe my suspicion about much of the anti-circ side is correct - many are simply to opposed to (especially pre-adult) circumcision no matter what; there is no dataset, no amount nor quality of evidence, no severity of public health crises, that can possibly sway them. They firmly believe that infant male circumcision is a heinous atrocity and/or they believe that the principle of individual right to bodily integrity outweighs all other considerations.

Not only that, but I suspect that many of them are unhappy about rising trend of voluntary adult male circumcision in Africa because they know that this leads to newly-circumcised men having their preadult sons circumcised, as is already being documented in Africa.

I am a heterosexual man who was circumcised in infancy. Like myself and Jim Benton, the vast majority of circumcised men do not feel that they have been traumatized, disfigured, or deprived of something. Go ahead and call it anecdotal or whatever you like - it's a fact that can't be wished away.

Colugo, you've lost the argument.

Not only ad hominem attacks, you are also repeating yourself.

Sadly, you didn't need to tell us that you were circumcised in infancy, it's blindingly obvious. The way you feel that you have to defend and promote it, is classic of men who have been cut, had no choice in the matter, and feel the need to validate what happened to them, by promoting it as a good thing, no matter what, even in the face of overwhelming evidence to the contrary. I feel sorry for you and pity for your loss, you don't know what you're missing.

The foreskin is not "just a meaningless flap of skin", as intact men know. The only way an intact man is ever going to part with his foreskin is if he is conned into it - which is why they do it in the States before he can object, and in Africa, by touting it as protection against AIDS.

Why do you think that men do not have a right to bodily integrity?

There is a reason that the countries with the highest healthcare standards in the world do not routinely circumcize, and the ones with the lowest do, nor is it a coincidence that the places that do are both the most religious and the most backward.

It's not a coincidence that the European nations that don't circumcize have lower rates of penile cancer than the US does. It's not a coincidence that male infants in Europe do not show higher rates of urinary tract infections than those in the US. It's not a coincidence that adhesions are diagnosed far more commonly in the US - it's because the doctors here are frequently so grossly ignorant that they don't recognize that the foreskin can detatch any time between infancy and puberty, and those who do know better want an excuse to perform the "wise and beneficial" procedure, and know that the parents won't know any better.

It's not a coincidence that the American media presents foreskin as being gross and weird, and circumcision as not only harmless and health-beneficial but leading to an improved sex life. (Sex and the City had a whole episode dedicated to just this theme - the only woman of the group who thought foreskins were possibly useful was the slutty tramp.)

You're willfully ignorant, Colugo. That's worse than being dumb by birth - it's being dumb by choice.

Declaration of the First International Symposium on Circumcision
Adopted March 3, 1989, Anaheim, California
We recognize the inherent right of all human beings to an intact body. Without religious or racial prejudice, we affirm this basic human right.
We recognize that the foreskin, clitoris and labia are normal, functional body parts.
Parents and/or guardians do not have the right to consent to the surgical removal or modification of their children's normal genitalia.
Physicians and other health care providers have a responsibility to refuse to remove or mutilate normal body parts.
The only persons who may consent to medically unnecessary procedures upon themselves are the individuals who have reached the age of consent (adulthood), and then only after being fully informed about the risks and benefits of the procedure.
We categorically state that circumcision has unrecognized victims.
In view of the serious physical and psychological consequences that we have witnessed in victims of circumcision, we hereby oppose the performance of a single additional unnecessary foreskin, clitoral, or labial amputation procedure.
We oppose any further studies which involve the performance of the circumcision procedure upon unconsenting minors. We support any further studies which involve identification of the effects of circumcision.
Physicians and other health�]care providers do have a responsibility to teach hygiene and the care of normal body parts and explain their normal anatomical and physiological development and function throughout life.
We place the medical community on notice that it is being held accountable for misconstruing the scientific database available on human circumcision in the world today.
Physicians who practice routine circumcisions are violating the first maxim of medical practice, "Primum Non Nocere," "First, Do No Harm," and anyone practicing genital mutilation is violating Article V of the United Nations Universal Declaration of Human Rights: "No one shall be subjected to torture or to cruel, inhuman or degrading treatment..."

This is from the NOCIRC site at http://www.nocirc.org/

Anne: "Colugo, you've lost the argument."

I don't think so. Commenters have confirmed that many on the anti-circ side are dogmatically opposed to circumcision (especially pre-adult circumcision, but they are unhappy about adult circumcision as well because it inevitably leads to the former) no matter what the evidence says. Their priorities are hopelessly skewed towards notions of bodily integrity despite the stakes for public health. Maybe I'm repeating myself, but no one can refute that, and it is not a trivial charge.

"Ad hominem"? What about all of the comments accusing me of being indifferent to the evidence and merely having a pathological urge to have surgery performed on babies for its own sake? One problem with that "theory" is that the objective evidence favors the pro-circ, not the anti-circ, side. If any position is driven by emotion rather than reason it is anti-circumcision.

In any case, even though I am outnumbered on this thread, I think my side is winning in the larger arena, despite the best efforts of Western anti-circumcision activists.

New York Health Department Plans To Promote Male Circumcision To Help Reduce Spread of HIV
Apr 05, 2007
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=44069

"The New York City Department of Health and Mental Hygiene plans to launch a campaign promoting male circumcision after the World Health Organization and UNAIDS last month recommended the procedure as a way to help reduce the spread of HIV, the New York Times reports."

Uganda plans countrywide circumcision
http://allafrica.com/stories/200704040203.html

It's noticeable that the only countries enthusiastically embracing this, are the ones that were already into genital mutilation. There is nothing new about anywhere in the States pushing circ, or indeed those poor saps in Africa who have been suckered into it by US propaganda, it's the US obsession to cut up their kids; you won't find any intact nations embracing this, their men know what they've got to lose - and they know circ doesn't work because their HIV rates are lower than those in the US.

Brazil (who are one of the intact nations with their HIV epidemic fully under control and dropping) have already told the WHO that their advice is dangerous, crazy and to take a hike, bet the other fully intact nations follow suit.

Again, Colugo, before HIV became an issue, how did people justify the procedure then? Are you prepared to and capable of defending those arguments? Do you even know what they are?

In the regions in Africa where circumcision is commonplace, it has a very high complication rate. People develop major scarring and infections, lose their genitalia, and die because of it.

And yet people keep doing it. Why do you think that is, Colugo? It's almost as if once cutting off part of the penis becomes necessary to be recognized as a man, social forces are enough to continue to practice even against clear evidence that it's harmful.

There is anecdotal evidence both that circumcision in adults has no negative impact and has negative impact. Have you considered the possibility that it might have both in different people? How have you ruled out this possibility?

Present some actual arguments.

Colugo, this is from your link: "The studies in Africa were conducted among heterosexual men, and men who are most at risk of contracting HIV in New York are MSM, injection drug users and their sexual partners."

How is this going to help at risk men in the US? The studies show no evidence that circumcision decreases the risk of transmission for homosexual men or for women. Also, circumcision certainly isn't going to prevent IV drug users from contracting HIV.

What evidence other than the HIV studies do you have to prove that circumcision is a valid choice for parents to make for their children? If studies showed that female circumcision lowered the risk of contracting HIV, would you support that? If not, why should baby boys be the only onews giving up sensitive tissue for the cause? Why discriminate? If cutting up one sex's genitals is mutilation, then cutting up the other's is too.

Removing the penis entirely from all men of fertile age would do wonders both for the AIDS epidemic and for overpopulation.

Studies do show that female circ lowers the risk of getting HIV.

Abstract

But that one has been quietly buried. Why is that? Could it be that this has not been followed up because US cutters shudder at the idea of cutting women? It's all down to US hegemony. FGM is perfectly acceptable in most African countries, they already do it in many countries, and it has been shown to lower the rate of HIV in those women, BUT it isn't acceptable to the same Americans that happily cut up their boys for whatever fashionable reason happens to be current.

It's a sickening double standard. Few Americans have foreskins and they refuse to recognise the harm it has caused them, indeed, are now trying to convince the rest of the world (rather like Aesop's fox without a tail) that they don't need a foreskin and are better off without one, so everyone will stop pitying American men (or laughing at them).

I recently had my son circumcised after much thought, research, debate, inner turmoil, and conversation with my wife. A very tough decision that I still question, and will likely question until the day he is able to tell me how he feels about his penis.

However, this decision is no different from the thousands of decisions I have and will make that will undoubtedly affect his life forever. No doubt there will be many decisions I make for my children that turn out to be wrong or that they don't like (neighborhood, vaccinations, schools, medicines, activities, discipline, doctors, organic, antibiotics, going out alone, etc). Last night I was up with my daughter with a 103 fever, debating whether we need to take her to the ER. We opted to wait till this morning to go to the doctor. (Wrong/ right??? We will see). When we get the prescription for an antibiotic, which is how all Dr�s visits end, another discussion will be triggered about whether we want to give them antibiotics, and so on, and so on. All these decisions have a potentially profound effect in their lives. These days even letting them play in the yard is a high stakes decision.

Good parents avoid being "culture cattle" by seeking as much information, talking, crossing your fingers you've done right by your child, and apologizing when you have not.

I argue that WHAT you decide for your children (although important), is less important than HOW you decided.

This debate is helpful. I am forwarding it to a friend who will soon make a decision about his newborn's foreskin.

Martin! Removing the penis, especially of fertile men, is a no,no! However, removal of the testicles is a time honored thing, which supplied the Catholic church with singing castrati for centuries. Furthermore, castrati not only lose their libido, but also most of their anger. Read the recent NYT article by a castrato at http://www.nytimes.com/2007/03/27/health/27case.html?ei=5070&en=2d97c1a…

There is NO reason to remove a child's foreskin at birth.

It is NOT a decision that a parent needs to make.

It isn't like feeding them, clothing them, deciding which schools they go to, giving them antibiotics when they're ill, or other parental decisions that HAVE to be made whilst they are still children. A child's penis needs its protective foreskin while they are in nappies (diapers) to protect the glans and urethra from urine and faeces (10% of circumcised children end up with meatal stenosis and the need for further surgery), and from rubbing on clothing. Then there are the "adhesions" that 79% of circumcised babies develop, which doctors keep (erroneously) insisting must be ripped apart, causing more excrutiating pain and scarring. There is absolutely NO REASON to remove it in infancy at all, and a LOT of reasons to leave it exactly where it is.

What you do when you remove a baby's foreskin is to impose your personal preferences on his body, which will stay with him for the rest of his life. If he wants his foreskin back, tough. You have just removed his personal choice about his own body. You have removed the most sensitive, most richly enervated, part of his penis, why?

However, if you leave it alone (and that means not messing with his penis at all - you just wipe it like a finger to clean in infancy, and never retract it for any reason) then he has the choice when he grows up. In fact almost all intact men choose to keep their foreskins, an adult circumcision is extremely rare in intact countries. That should tell you something.

Rick: You made a VERY bad decision there. What gives you the right to impinge on your son's sex life (and that of his partner) when he is an adult?

P.S.
You do know that a baby's foreskin is actually fused to the glans, and doesn't separate for years, sometimes not until puberty, don't you? Nothing is going to get under there, and it doesn't need "cleaning" internally.

They have to forcibly rip the foreskin off the glans using a blunt metal instrument to be able to insert the clamp to crush and cut it off. It's barbaric, gruesome, and excrutiatingly painful, and I'll never understand how supposedly civilised people manage to somehow convince themselves that this archaic mutilation is acceptable behaviour for the 21st century.

Anne, when people are confronted with two statements that contradict each other, the outcome tends to be one of the following possibilities:

1) They conclude that the first statement is correct and the second one incorrect.

2) They conclude that the first statement is incorrect and the second one correct.

When confronted with evidence against a strongly-held belief, most people disregard the evidence. People are certain that they're civilized and intelligent people. Since they're intelligent and civilized people, their decisions to surgically remove parts of infants' penises must be humane and medically necessary.

The more emotional the issue makes people, and the more obviously wrong they are, the more ego defense they'll put in place.

It is worth noting that societies in which circumcision was once common but is now fading (Great Britain and Canada are the prime examples), it wasn't any amount of enlightenment that was responsible. Instead, it seems to be the case that the movement to public healthcare caused only truly necessary procedures to be paid for by insurance, and many people didn't feel the need to spend hundreds of dollars for circumcision.

It's still seen as culturally acceptable, but as a general practice, it's gone into a major decline. Maybe something similar will one day happen in America. I can only hope.

Here is an article I wrote on circumcision that might be of some interest to this discussion:
http://www.quickswood.com/my_weblog/2007/02/circumcision.html#more

Cheers

Caledonian:

"Maybe something similar will one day happen in America. I can only hope."

This is a bit of an aside, but I'm curious: would you favor a British or Canadian-style healthcare system in the US in order to reduce the number of circumcisions?

This is a bit of an aside, but I'm curious: would you favor a British or Canadian-style healthcare system in the US in order to reduce the number of circumcisions?

Are you presenting strawmen intentionally, or did you really fail your reading comprehension so spectacularly that you think I want to restructure our healthcare system for the sole purpose of reducing circumcisions?

I would favour a British- or Canadian-style healthcare system in the US, period.

On a more serious vein than my previous post, since circumcision is now being touted as a panacea for AIDS, I would like to point out that a number of scientists, starting with Dr Peter Duesberg and including Nobelists, believe that AIDS is not caused by HIV, but instead is a collection of unrelated diseases, caused, among other things, by the poisonous drugs promoted as a cure by the pharmaceutical companies & their allies. Try http://www.duesberg.com/ , http://rethinkingaids.com.93.seekdotnet.com/ , and http://www.virusmyth.net/aids/ .

Did you read this study before making your decision Rick?

Abstract
"OBJECTIVE

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

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

The glans of the uncircumcised men had significantly lower mean (sem) pressure thresholds than that of the circumcised men, at 0.161 (0.078) g (P = 0.040) when controlled for age, location of measurement, type of underwear worn, and ethnicity. There were significant differences in pressure thresholds by location on the penis (P

CONCLUSIONS

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

Men have been brain-washed by the vast pro-glans lobby , that would have us believe the glans is by far the most important part of the penis. Intuitively, this makes sense. but In fact, the glans is insenitive to fine touch, pin-prick, heat and cold. Touch it with a finger tip; compare with the back of hand or face. Prick it with a pin if you feel brave. Next test: to find the 'ridged band of the preuce': look for the ring of corrugated mucosa just inside the tip of the prepuce: it is pink-brown or brown-pink depending on skin color. Next: gently rub finger tip across the ridged band: compare with glans. Or play your warm shower on the exposed glans and ridged band and compare sensations. Next: stretch ridged band gently but quickly: note reflex (non-voluntary) contraction of bulb muscles around the root of penis,just behind scrotum and in front of anus. (Voluntary bulb muscle contraction is used to expel the last dribs of urine\). In short, stretchihng of the ridged band, as in sexual intercoure, trigger a 'sexual reflex' for deep erogenous sensation and ejaculation, both thanks to bulb muscles. If continued, the same reflex helps sustain erection, Next: never mind, you get my drift. Just remember, circumcision goes beyond pain and ethics etc into serious sexual function. John