In the 1980s, the United States had an astronomic rise in HIV cases. This, coincidentally, happened at the same time in American history that 80% or so of American males were circumcised. If circumcision prevented HIV, we would have not seen the rise in infections that we did.

Because there is no compelling reason for non-Muslim and non-Jewish parents to cut off their son's foreskin, the decision should be left for the boy to make for himself once he is an adult.

You're attacking a strawman, Michael. Nobody has claimed that circumcision completely prevents HIV; it merely reduces the risk of infection. And there's no logical reason why such partial protection should prevent such a rise from taking place. For that matter, even if circumcision were completely protective, it would still be perfectly possible for HIV rates to rise to 20% (ie., 100% of the uncircumcised population), so your argument doesn't make a lot of sense even then.

the CDC and the WHO are not recommendations for children only sexually active consenting adults in Africa because they are desperate to end the endemic. HIV is today fear and one day this will seem silly.

Contradictory HIV research:
http://www.doctorsopposingcircumcision.org/info/HIVStatement.html
http://intactamerica.org/sites/default/files/DangerousMistake.pdf

The mistaken idea that circumcision prevents the acquisition and spread of STD’s is an old myth from the 19th century. The claim that circumcision prevents syphilis first appeared in a publication that dates back to 1855, [1] in the days before germ theory! Doctors where eager to claim that they could treat and prevent the spread of syphilis because of its endemic among soldiers during the American Civil War.

The theory that circumcision does prevent STD's gained new impetus in the 1940s' Through the determined efforts of urologist Eugene A. Hand. [2] At this time, there was a general panic in the medical profession over African American solders spreading STD’s. [3] It is important to remember that this was in the days before penicillin was cheaply and widely available. STD’s were hard to treat and doctors had little understanding about how they were transmitted. Doctors where desperate and eager to claim that they could treat and prevent STD's.

they use to think that they could regulate sexual activity using circumcision hence reducing STDs. for example one campaign wought to circumcise African Americans to prevent the rape of white women(9)

1 ↑ Hutchinson J. On the influence of circumcision in preventing syphilis. Med Times Gazette 1855; 32; 542-3.
2 ↑ Hand EA. CIRCUMCISION and venereal disease. Archives of Dermatology and Syphilology 1949 sep;60(3):341-6
9 Remondino PC. Negro rapes and their social problems. National popular review 1894 Jan;4(1) 3-6

racism also played a BIG role, it was believed Jews where superior in health, they used circumcision to explain this unfounded idea.

No-one has SCIENTIFICALLY shown there to be a reduction in HIV acquisition in circumcised males.

The 3 randomised trials were not conducted in a scientific manner. For instance, you should never conclude your study early. This gives the possibility that change will happen and not be observed. The trials were already a short term trial. They should have been 5 years long long give a good picture and examine long term damage.

You would also not have stated the trial until 6 weeks post op, when the circumcised candidates were allowed to start having sex again. The circumcised candidates were also given information about condom use which would increase their likelihood of continuing condom use, further skewing the figures.

The figures used for the conclusion used a relative risk reduction (RRR) and not an absolute risk reduction (ARR). RRR figures were used because it yields a big number- 50-60%, but the ARR shows that the percentage of protection was about 1.8%. That means that a theoretical 1.8% may have been protected by circumcision. Factor in the 6 weeks and you lose 5% from the RRR and 0.2% from the ARR.

true, you don't even want o get me started n the flaws. Not to mention the mountain of contradictory evidence.

The flaws with these new Randomized “Controlled” Trials (RCT).

Why go to Kenya(6), Uganda(7), and Sub-Saharan Africa(8) to perform randomized “controlled” trials(RCTs) on circumcision and HIV? These are some of the only countries in Africa where circumcised communities have a lower prevalence of HIV(9). Hard-line circumcision advocates with and known bias, know this, and they often exploit the cultural differences in these communities that cause intact communities to acquire HIV more often. This is how they are mining the data they need to promote their agenda. After receiving criticism for observational studies circumcision advocates have sought to use these randomized controlled trials in order to control for the cross-cultural differences that studies in these places have been criticized for in the past. However there are still obvious flaws in methodology that can not be denied. Here are just some of the variables that where not controlled for in many studies used to claim that circumcision prevents HIV, and specifically in the RCT’s .

1)The time needed for healing for those circumcised before the trial was initiated means less exposure time. Circumcision is a serious injury, men who have just been circumcised can not be expected to continue normal sexual behavior during the trial. Behavior always effects your risk by many orders of magnitude more then circumcision ever could.
2)Dry sex is A practice that is common in many of these communities. It entails drying the vagina with dirt, sand, dried leaves, corn meal, or powders to absorb lubrication. This practice is unsanitary and causes lesions and other entry points that increase risk for STD transmission.(10)
3)Genital warts and ulcers re-occurrence, how they were treated, the final efficacy of that particular treatment (Excision or chemical). And the irresponsible sexual behavior on both men(11) and prostitutes while afflicted with genital ulcer disease(GID)(12). GUD is an endemic in parts of Africa.
4)One U.S. study showed that circumcised men were more likely to engage in riskier and "more highly elaborated" sexual practices including anal sex, and sex with multiple partners(13). These factors may not come into play for an intervention group immediately after circumcision. This also shows that sexual behaviors for those circumcised as infants may not reflect sexual behaviors of those circumcised as adults. Therefore results determined in circumcising an intervention group are not applicable to men circumcised as infants.

5)Female circumcision: where male circumcision exists female circumcision usually exists as well.
6)Anal sex
7)Homosexual sex
8)The accuracy of the tests to determine rates of false or negative determinations
9)The time needed to manifest all seroconversions
10)In the case of these new RCT’s any chance of a follow-up was lost because the test was stopped early and all subjects were circumcised.
11)Equal amount of "safe-sex counseling" for both groups

Some of these new short term studies, determined that circumcised significantly less likely to acquire HIV then genitally intact men. This does not mean this benefit exists in the real world. Repeat exposure to partners with HIV will eventually lead to the acquisition of HIV. If the real world reduction was significant we would see a significant difference among intact and circumcised populations, when in reality we do not see any clear association. The conductors of these studies took a quick snap shot of the data before the results turned on them and then circumcised all study participates so that a follow-up survey could not be performed. If they tried to present this to any reputable organization who wished to maintain scientific integrity, they would be laughed out of the room, as they have. Attributing the results of their tests to anatomically correct male genitalia is not only ludicrous but plainly irrepressible.

What we have here are “studies” performed in an abstracted theoretical situation. This theoretical situation is unrealistic and does not represent real world situations. In the real world people are sexually active for more then twelve or twenty months of their life. In the real world people would not wear a condom that is only marginally effective. The only thing that can prevent HIV is safe sex or abstinence.

(6)Bailey RC, Moses S, Parker CB, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet. 2007 Feb 24;369(9562):643-56.
(7)Gray RH, Kigozi G, Serwadda D, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet. 2007 Feb 24;369(9562):657-66.
(8)Auvert B, Taljaard D, Lagarde E, Sobngwi- Tambekou J, Sitta R, Puren A. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS Med. 2005 Nov;2(11):e298. Erratum in: PLoS Med. 2006 May;3(5):e298.

(9)Vinod Mishra, Rathavuth Hong, and Yuan Gu, and Amy Medley and Bryant Robe . Levels and spread of HIV seroprevalence and associates factors: evidence form national household surveys. USAID 2009 Feb; 51-53
(10) Runganga A, Pitts M, McMaster J. The use of herbal and other agents to enhance sexual experience. Soc Sci Med 1992 Oct;35 (8):1037-42.
Runganga AO, Kasule J. The Vaginal use of herbs/substances; an HIV transmission facilitatory factor? AIDS Care 1995;7(5):639-45.
Sandala L, Lurie P, Sunkutu MR, Chani EM, Hudes ES, Hearst N. “Dry sex” and HIV infection among women attending a sexually transmitted disease clinic in Lusaka Zambia. AIDS 1995 Jul;9 Suppl 1:s61-8
Brown JE, Ayowa OB, Brown RC. Dry and tight: sexual practices and potential AIDS risk in Zaire. Soc SCI Med 1993 Oct;37(8):989-94

The glans keratinises over time and this could see a rise in susceptibility, over time. The studies were on adult males who would not have time for keratinisation to take place. What effect that would have in increasing or decreasing acquisition, could not be observed in such short term studies. You would also not be able to observe any loss of sensation, over time.

There has been no study in the developed world that shows the same results as the African trials. Studies in Europe and North America have shown no association between circumcision and HIV acquisition. Looking at the circumcision and HIV rates in different African countries shows that some have higher rates of HIV in circumcised males and some have lower, suggesting that there are other contributing factors that have to be accounted for.

These studies also create ethical problems.

First, should you do it to an infant who cannot give consent- especially when there is no study to show that circumcising an infant has the same effect.

If we accept these studies then we also have to accept the studies that show that circumcision increases female acquisition of HIV at a about the same rate as the male decrease. Since HIV affects females disproportionately more than males, this would be a further disaster for women in Sub-Saharan Africa.

We would also have to accept the studies that show that women who have had FGM performed on them, have a decrease in HIV acquisition (even though they tried to prove the opposite)

Dallabetta GA, Miotti PG, Chip hangwi JD, Liomba G, Canner JK, Saah AJ. Traditional vaginal agents: use and association with HIV infection in Malawian women. AIDS 1995 Mar;9(3):239-7.
Gresenguet G, Kriess JK, Chapko MK, Hillier SL, Weiss NS. HIV infection and vaginal douching in central Africa. AIDS 1997 Jan;(1):101-6.
Baleta A. Concern voiced over “dry sex” practices in South Africa. Lancet 1998 Oct 17;352(9136):1292
Beksinska ME, Rees HV, Kleinschmidt I, McIntyre J. the practice and prevalence of dry sex among men and women in South Africa: a risk factor for sexually transmitted infections? Sex Transm infect 1999 Jun;75(3):178-80
Nyirenda MJ. A study of the behavioural aspects of dry sex practice in urban Lusaka. Int Conf AIDS 1992;8:D461
Van de Wijgert J, Mason PR, Ray CS, et al. Use of intravaginal preparations, presence of lactobacillus in the vagina, and risk for HIV in Zimbabwean women. Int Conf AIDS 1996;11:34 (abstract no MoC 223).
Morar NS, Karim SS. Vaginal insertions and douching practices among sex workers at truck stops in KwaZulu- Natal. South Afr Med J 1998;88:470.
Civic D, Wilson D. Dry sex in Zimbabwe and implications for condom use. Soc Sci Med 1996;42:91–8.
Hira SK, Mangrola UG, Mwale C, et al. Apparent vertical transmission of human immunodeficiency virus type 1 by breast-feeding in Zambia. J Pediatr 1990;117:421–4.

Mann JM, Nzilambi N, Piot P, et al. HIV infection and asso-ciated risk factors in femalesocal concerns prostitutes in Kinshasa, Zaire. AIDS 1988;2:249–54.
Irwin K, Mibandumba N, Mbuyi K, et al. More on vaginal inflammation in Africa. N Engl J Med 1993;328:888–9.
Mbizvo MT, Chipato T, Mashu A, et al. Trends in HIV-1 prevalence and risk factors in pregnant women measured by clinic on-site testing and laboratory confirmation in Harare, Zimbabwe. Int Conf AIDS 1996 (abstract no MoC 1485).
Jinju M, St Louis ME, Mbuyi K, et al. Risk factors for heterosexual HIV transmission: a case-control study among married couples concordant and discordant for HIV-1 infection. Int Conf AIDS in Africa. Dakar, December 1991 (abstract no TO 105).

(11) Peoin J, Quigley M, Todd J, Gaye I, Janneh M Van DyckE, Piot,P, Whittle H. Association between HIV-2 infection and genital ulcer diseases among male sexually transmitted diseases patients in the Gambia. AIDS 1992 May;6(5):489-93.
O’Farrell N, Hoosen AA, Coetzee KD, van den Ende J. Sexual behavior in Zulu men and women with genial ulcer disease. Genitourin Med 1992 Aug;68(4):245-8.
De Vincenzi I Mertens T. Male circumcision: a role in HIV prevention? AIDS 1994 Feb;8(2)
(12)Kaul R, kimani J, Nagelkerke NJ, Plummer FA, Bwayo JJ, Brunham RC, Ngugi EN, Ronald A. Risk factors for genital ulcerations in Kenyan sex workers: the role of human immunodeficiency virus type 1 infection. Sex Transm Dis 1997 Aug;24(7):387-92
(13)Laumann EO, Masi CM, Zuckerman EW. Circumcision in the United States: prevalence, prophylactic effects, and sexual practice. JAMA 1997;277:1052-7.

Jamie:

"The glans keratinises over time" -- actually, the glandes of circumcised and uncircumcised men are equally keratinised, as Szabo & Short showed in 2000.

"There has been no study in the developed world that shows the same results as the African trials" -- wrong. See section entitled "HIV Infection and Male Circumcision in the United States" in http://www.cdc.gov/hiv/resources/factsheets/circumcision.htm

"If we accept these studies then we also have to accept the studies that show that circumcision increases female acquisition of HIV at a about the same rate as the male decrease." -- fine, but we should bear in mind that only a small minority of studies found this. The majority found no difference, unlike studies of circumcision.

this 2008 meta analysis(1) was done by a non bias author using publications form both sides INCLUDING the RCTS and Weisses 2000 meta analysis. and found no clear association.

in most places in Africa HIV is more common among circumcised men(2). this is a very embarrassing fact for any one who does pretend circumcision prevents HIV.

(1)Michel Garenne. African Journal of AIDS Research 2008, 7(1): 1–8.

http://www.google.com/url?sa=t&source=web&cd=1&ved=0CBgQFjAA&url=http%3A%2F%2Fwww.circumcisionandhiv.com%2Ffiles%2Fajar2008garennelong_term_effect_of_male_circumcision.pdf&rct=j&q=Michel%20Garenne.%20African%20Journal%20of%20AIDS%20Research%202008%2C%207(1)%3A%201%E2%80%938.&ei=-HaKTeLTOIO-tgeH3Pn2DQ&usg=AFQjCNEX1CWVl3q-s3UpgUSFe4m3zH8oXA&cad=rja

(2)Vinod Mishra, Rathavuth Hong, and Yuan Gu, and Amy Medley and Bryant Robe . Levels and spread of HIV seroprevalence and associates factors: evidence form national household surveys. USAID 2009 Feb; 51-53

You keep saying that no one is saying that circumcision prevents the spread of HIV. Maybe you should tell the others that, then. There are many people on your side of the argument that claim it everywhere you read. If saying that it prevents HIV is wrong then I suggest you step up, belly up to the bar and tell them to stop spreading lies.

Any reduction in risk has been shown in adults and not neonates and in areas of poor sanitation and not in America. There have been no studies to show conclusively that risk of HIV infections is reduced for Americans.

No, Michael, I'm saying that nobody is saying that circumcision *completely* prevents HIV infection. It doesn't. It does, however, offer *partial protection*. Put another way, if you take a large number of men and circumcise them, you'll prevent some of the cases of HIV that otherwise would have occurred, but you won't prevent all of them.

I know you're not saying it but people are. The rumor mill is out of control. It is misinformation in support of circumcision.

Back to my point is that there has been no study on neonates to support the taking of private property without patient consent for an adult disease for which there ***may*** be benefit. That doesn't seem ethical, does it? This could quite possibly be a constitutional matter.

Contrary to Jack's claim, there is little evidence that uncircumcised men enjoy more sexual pleasure. Multiple studies have examined this issue, and they have generally found that sexual satisfaction is unchanged or improved as a result of circumcision. Sexual sensation, too, may be enhanced (possibly due to an increase in direct stimulation to the glans): in the largest study to date, 64% of men described their penis as "much more sensitive" after the procedure. http://www.ncbi.nlm.nih.gov/pubmed/18761593

Jack is also incorrect in his assertion that HIV, HPV, and other STDs are the same or more common in circumcised men in the US. See, for example, sources cited by the CDC in "HIV Infection and Male Circumcision in the United States" in the CDC's factsheet: http://www.cdc.gov/hiv/resources/factsheets/circumcision.htm Or, regarding, HPV, see: http://www.ncbi.nlm.nih.gov/pubmed/15388997

Case Study

Understanding Jake requires understanding of several common and several bizarre psychological phenomenon. The common ones are projection and cognitive dissonance. The bizarre ones are Apotemnophilia, Body Integrity Identity Disorder (BIID), and Acrotomophilia.
Cognitive dissonance (free thought paradigm)

The person holding the belief must have committed himself to it; that is, for the sake of his belief, he must have taken some important action that is difficult to undo. In general, the more important such actions are, and the more difficult they are to undo, the greater is the individual's commitment to the belief. [1]

This Phenomena has been widely documented. When an important decision is made people evaluate there end result higher then they would have if they did not make the decision.

Using the free choice paradigm and an MRI, Sharot and colleagues have shown that after making a choice, activity in the striatum changes to reflect the new evaluation of the choice object, increasing if the object was chosen and decreasing if it was rejected. [2] Follow-up studies have largely confirmed these results. [3] [4] In other words people are actually programed to think this way.

In a different type of experiment conducted by Jack Brehm [5] , 225 female students rated a series of common appliances and were then allowed to choose one of two appliances to take home as a gift. A second round of ratings showed that the participants increased their ratings of the item they chose, and lowered their ratings of the rejected item. This can be explained in terms of cognitive dissonance. When making a difficult decision, there are always aspects of the rejected choice that one finds appealing and these features are dissonant with choosing something else.

Dissonance is aroused whenever individuals voluntarily engage in an unpleasant activity to achieve some desired goal. Dissonance can be reduced by exaggerating the desirability of the goal. Aronson & Mills [6] had individuals undergo a severe or mild "initiation" in order to become a member of a group. In the severe-initiation condition, the individuals engaged in an embarrassing activity. The group turned out to be very dull and boring. The individuals in the severe-initiation condition evaluated the group as more interesting than the individuals in the mild-initiation condition.

Similarly the authors of the “ikea effect” state:

Our research shows that labor enhances affection for its results. When people construct products themselves, from bookshelves to Build-a-Bears, they come to overvalue their (often poorly made) creations.We call this phenomenon the IKEA effect, in honor of the wildly successful Swedish manufacturer whose products typically arrive with some assembly required.
“
”
http://danariely.com/tag/experiments-2/page/3/ retrieved. 3/5/11

Cognitive dissonance as it applies to Jake

In the case of Jake. Jake spent many years wishing he had been circumcised he did tons of research on circumcision, and then he purchased and received a circumcision, and then there was the healing process. All these elaborate efforts and rituals add to the invested interest which must be defended. The more time spent on the product you are building, the research spent on an action you are about to perform, the more time in invest in such a matter, the more irreversible the decision, the more you over inflate the value of your end choice. And consequently the more you become predisposed to stronger feelings of cognitive dissonance. People like Jake will most likely experience permanent and strong feelings of cognitive dissonance. Jake is an extreme in all these categories.

After getting circumcised Jake is quoted:

But finally I has what I wanted and now I love my dick
“
”
http://www.adequacy.org/stories/2001.10.31.23859.193.html#84

In another post Jake said

I find it difficult to believe that I would regret something that I've regretted *not* having done since age 5!
“
”
--Yahoo Circlist. Message #26333, 2003 July 30th

Here is Jakes free choice paradigm right here. He wanted to be circumcised and he had already made up his decision about the results before experiencing them. This is the very definition of the free thought paradigm. He had spent a life time embellishing his goal of being circumcised.

Dissonance is aroused when people are confronted with information that is inconsistent with their beliefs. If the dissonance is not reduced by changing one's belief, the dissonance can result in misperception or rejection or refutation of the information, seeking support from others who share the beliefs, and attempting to persuade others to restore consonance. [7]

In another post Jake said

I'm in favour of informing the public, parents especially
“
”
----Yahoo RoundHeadsUK. Message #2, 2006 Mar 10th

Hence his conquest to restore consonance begins.

The individual believer must have social support. It is unlikely that one isolated believer could withstand the kind of disconfirming evidence that has been specified. If, however, the believer is a member of a group of convinced persons who can support one another, the belief may be maintained and the believers may attempt to proselyte or persuade nonmembers that the belief is correct. [8]
In another post Jake said

I will never forget the feeling of not being alone, being among like-minded people. Circlist for me has always been a place to have intelligent, thoughtful discussion about circumcision, and a place to talk to like-minded individuals
“
”
Google Circlist. Message #**, 2005 Ma7 24th 12:06pm

Circlist is a pro circumcision web site, here Jake has found the social support necessary to grow his ideas.
Projection

Psychological projection or projection bias is a psychological defense mechanism where a person unconsciously denies his or her own attributes, thoughts, and emotions, which are then ascribed to the outside world, such as to other people. Thus, projection involves imagining or projecting the belief that others have those feelings. [9]
Projection as it applies to Jake

His personal fantasy is to have been circumcised as an infant.
Jake says:

I think that failing to circumcise a boy at infant actually denies him a choice. Because it is so difficult to get circumcised as an adult
“
”
http://www.adequacy.org/stories/2001.10.31.23859.193.html#84

Which doesn't make much sense since he got to chose the type of cut he wanted.
Jake says:

The scar line is about half way down my shaft when flaccid
“
”
Yahoo Circlist. Message #26279, 2003 July 27th 4:00am

He projects this preference on other people by promoting circumcision.
In another post Jake said

I'm in favour of informing the public, parents especially... I would personally choose to circumcise a son (and hopefully I will one day adopt)
“
”
-Yahoo RoundHeadsUK. Message #2, 2006 Mar 10th

Adopting because Jake is a homosexual.

Here he is showing his projection of his his own preference for circumcision on to others.
Jake's Rationalizations of his Projections

He also uses flawed Internet surveys and study's to rationalize his projection. [10] [11] [12] Some of these anonymous internet surveys and study's conclude that intact men desired circumcision and that circumcised men where content. However, only one study he uses was actually published in a peer reviewed journal, and it found that people where incorrect about their own circumcision status at an alarming rate. [13] This makes the results of self reporting scrupulous. Furthermore Intact men are typically made to feel outcast in a majority circumcised U.S. Since humans value conformity so much [14] this effect, if it exists, will exist no longer because the majority of children born today in the U.S. are left intact. [15] Also, younger people tend to value conformity more then adults, so an internet surveys geared toward younger people will yield results infavor of conformity.

Therefore It is irrational to project a preference for circumcision onto infant children based on such information.

Jake goes further to supply study's of adult men who underwent circumcision, some study participants reported an improvement, [16] Another study was from Africa where sexual practices have absolutely no resemblance of sexual practices in the U.S. [17] In any event it is flawed to use such study's to rationalize a projection because as i discussed above in the section on cognitive dissonance, human animals are programed to over state the value of their end decision while simultaneously rationalizing the effort it took to get irreversibly circumcised as an adult.

Jake goes on to use another study of self assessment in determining the sensitivity of the foreskin. [18] But as discussed earlier people are not even able to determine their own circumcision status much less the five components of the foreskin and their sensitivity.

In any event Jake has combed the internet for what ever information, flawed or not, he required in order to rationalize his projections.

Apotemnophilia

Jake may also suffer from these disorders

Apotemnophilia is a neurological disorder in which otherwise sane and rational individuals express a strong and specific desire for the amputation of a healthy limb or limbs. [19] There is often a sexual interest in becoming an amputee. [20]

One of his piers said “Some of us who do get erotic and sexual gratification out of not only the finished product, but also the procedure itself.” The “finished product” is the sexual interest in becoming an amputee and the “procedure it self” is akin to the Ikea effect that was previously discussed.
Body Integrity Identity Disorder (BIID)

Body Integrity Identity Disorder (BIID), formerly known as Amputee Identity Disorder, is a neurological and psychological disorder that makes sufferers feel they would be happier living as an amputee. It is typically accompanied by the desire to amputate one or more healthy limbs to achieve that end. [21]
Acrotomophilia

Acrotomophilia , refers to a paraphilia in which an individual expresses strong sexual interest in amputees. [22]

References

1. ↑ Festinger, L. (1957) Cognitive dissonance. Stanford, Calif.: Stanford University Press.
2. ↑ Van Veen, V., Krug, M.K., Schooler, J.W., & Carter, C.S. (2009). Neural activity predicts attitude change in cognitive dissonance. Nature Neuroscience, 12(11), 1469–1474.
3. ↑ Izuma, K., Matsumoto, M., Murayama, K., Samejima, K., Sadato, N., & Matsumoto, K. (2010). Neural correlates of cognitive dissonance and choice-induced preference change. Proceedings of the National Academy of Sciences, U.S.A., 107(51), 22014-22019.
4. ↑ Qin, J., Kimel, S., Kitayama, S., Wang, X., Yang, X., & Han, S. (2011). How choice modifies preference: Neural correlates of choice justification Neuroimage, 55(1), 240–246.
5. ↑ Brehm, J. (1956). Post-decision changes in desirability of alternatives. Journal of Abnormal and Social Psychology, 52(3), 384–389.
6. ↑ Aronson & Mills Aronson, E. & Mills, J. (1956). The effect of severity of initiation on liking for a group. Journal of (7)Abnormal and Social Psychology, 59, 177–181.

7. ↑ Festinger, L. (1957) Cognitive dissonance. Stanford, Calif.: Stanford University Press.
8. ↑ Festinger, L. (1957) Cognitive dissonance. Stanford, Calif.: Stanford University Press.
9. ↑ Wade, Tavris "Psychology" Sixth Edition Prentice Hall 2000
10. ↑ Edwards R. Definitive penis size survey results [online]. 1998 [cited 2004 Sep 26]. Available at: http://sizesurvey.com/result.html
11. ↑ JackinWorld 5th anniversary survey [online]. 1996-2004 [cited 2004 Sep 26]. Available at: http://www.jackinworld.com/library/surveys/survey5.html
12. ↑ Badger J. How do men and women feel about circumcision? [online]. 2001 [cited 2004 Sep 26]. Available at: http://www.users.bigpond.net.au/xeyr/circum/feelings.htm
13. ↑ Schlossberger NM, Turner RA, Irwin CE Jr. Early adolescent knowledge and attitudes about circumcision: methods and implications for research. J Adolesc Health 1992 Jun; 13(4): 293-7
14. ↑ Asch, S. E. (1955). "Opinions and social pressure". Scientific American 193: 31–35. doi:10.1038/scientificamerican1155-31.
15. ↑ RONI CARYN RABIN. Steep Drop Seen in Circumcisions in U.S. New York Times. August 16, 2010 http://www.nytimes.com/2010/08/17/health/research/17circ.html retrieved 3/6/11
16. ↑ Masood S, et al. Penile sensitivity and sexual satisfaction after circumcision: are we informing men correctly? Urol Int. 2005;75(1):62-6.

17. ↑ Krieger JN, et al. Adult male circumcision: effects on sexual function and sexual satisfaction in Kisumu, Kenya. J Sex Med. 2008 Nov;5(11):2610-2
18. ↑ Ref: Schober JM, et al. Self-ratings of genital anatomy, sexual sensitivity and function in men using the 'Self-Assessment of Genital Anatomy and Sexual Function, Male' questionnaire. BJU Int. 2009 Apr;103(8):1096-103. Epub 2009 Feb 24.
19. ↑ Everaerd,W. (1983). A Case of Apotemnophilia: A Handicap as Sexual Preference. American Journal of Psychotherapy, 37 285–293.
20. ↑ Brang,G. (2008). Apotemnophilia: A Neurological Disorder. Cognitive Neuroscience and Neuropsychology, 19 1305–1306.
21. ↑ Large MM (October 2007). "Body identity disorder". Psychol Med 37 (10): 1513; author reply 1513–4.
22. ↑ Solvang, P. (2007). The amputee body desired: Beauty destabilized? Disability re-valued? Sex and Disability, 25, 51–64.

cognitive dissonance is a psychological defence mechanism that states people are programed to evaluate their end choice as positive no matter what. especially with an irreversible choice like circumcision. People who get cut as a adults wanted to get cut they already mad up their mind about the end results before achieving them. humans are very feeble minded animals and their opinions are worthless, hence study's that rely on opinions are worthless. I know people cut as adults who where in denial for a period of time. These survey questions could have been asked during that denial period.

First of all, Jackie, there's no evidence that circumcision takes away 20-30,000 nerve endings at all. Yes, you see this figure quoted a lot on anti-circumcision websites, but when you look into it you'll find that there isn't any substance to the claim. No study has ever counted the number of nerve endings in the foreskin.

That said, it's reasonable to assume that there are *some* nerve endings in the foreskin (it is, after all, capable of sensing stimulation), but it's not logical to assume that circumcision would necessarily reduce sensation as a result. After all, there are mechanical changes as a result of circumcision, and one of the effects of these is greater stimulation to the glans. Whether there's a net gain or loss in sensation, as a result, is difficult to predict. Fortunately a number of studies have actually followed adult men through circumcision and directly asked, so we don't have to guess.

Once again Jake misses the forest for the trees. There is no compelling medical reason to circumcise a child. The decision should be left to the man to make for himself once he is an adult.

Stan, Jackie and I were discussing the effect (if any) of circumcision on penile sensitivity. That's a completely separate question from whether circumcision can or should be performed. Please try to stay on-topic. Thanks.

Specialized nerve receptors in the foreskin

The enervation of the foreskin is impressive (17). Genitally intact males know from personal experience that the foreskin is one of the most sensitive parts of the body. Consequently, for over a century, some of the most respected names in medical science have turned their attention to this part of the body. Anatomists have transformed their inner knowledge into careful scientific observation about the complex enervation of the foreskin
As the most richly innervated part of the penis, the foreskin has the largest number of nerve receptors, as well as the greatest variety of nerve receptors. These specialized nerve ending include Meissner's corpuscles(18), free nerve endings, end bulbs of Krause(19), Corpuscles of Ruffini(20), Pacinian corpuscles(21), genital and bulbs(22) Genital bodies(23), Merkels disks, Golgi-Mazzoni corpuscles(24), and Vater-Pacinian corpuscles(25). These remarkable organs provide the foreskin with its amazing ability to detect the slightest sensations of touch, motion, temperature, and pressure. We are still unaware of all the facts about these fascinating structures. Future research may discover even more nerve receptors in the foreskin and help clarify what purposes they serve.

Erogenous zones of the foreskin

The foreskin is what's known as a specific erogenous zone (26). This means that it is richly equipped with a high density and concentration of specialized and sophisticated nerve receptors that convey pressure. The only other specific erogenous zones on the male body are the conjunctiva of the eye, lips, nipples, perianal skin, and the head of the penis. The presence of specialized erogenous nerve receptors makes this part of the body especially important.
The primary zones of erogenous sensitivity are the frenulum, ridged mucosa, and the preputial orifice and the external fold of the foreskin. All of these zones are orgasmic triggers. Continuous gentle stimulation of any one of these areas can elicit pleasure, orgasm, and ejaculation.

How the glans compares with the foreskin

Most people are surprised to learn that the glans penis is one of the least sensitive parts of the entire body (27). Obviously, this news may be worrying for circumcised males. The glans is insensitive to light touch, heat, cold, and even pinpricks, as researches at the Department of Pathology in the Health Scientists center at the University of Manitoba discovered (28). The corona of the glans contains scattered free nerve endings, genital end bulbs, and pacinian corpuscles, which transmit sensations of pain and deep pressure. The glans is nearly incapable of detecting light touch.
The nerve receptors of the corona are designed to be stimulated through the medium of the foreskin. Direct stimulation of the glands of the intact penis is most pleasant with the stimulus mimics the moist, massaging action of the foreskin.
The Moving ring of pressure created by the lips of the foreskin and ridged mucosa stimulate the nerve receptors in the rim of the glands. While pleasurable stimulation of the frenulum and ridged mucosa is instantly perceived, sensation of the corona is slow and gradual. When fully stimulated the erotic sensations felt in the corona are perceived as having a slow, warm, and rich quality. As nice at this is, it hardly compares to the erotic sensations generated by the foreskin.

Circumcised males have been robbed of a normal level of sexual sensation. Just as a person whose lips where amputated could can never really appreciate the sensations that lips convey, so a circumcised male can never under stand what his intact friends experience. This helps explain why some circumcised males defend circumcision so vehemently. They have no idea what was taken from them and are psychologically unprepared to deal with their loss.

In order to confirm all of this information, a most recent study in 2007 physically measured the sensitivity of all the parts of the penis. They used a very accurate pressure sensing probe while the test subject, who’s view was blocked with a screen, registered a sensation of touch. To demonstrate precision they took each measurement multiple times. Statistically, their results where very consistent. To no surprise, their results corroborated with the nero-anatomy that has been discussed previously.

"Five locations on the uncircumcised penis that are routinely removed at circumcision were more sensitive than the most sensitive location on the circumcised penis[...] The glans in the circumcised male is less sensitive to fine-touch pressure than the glans of the uncircumcised male[...]The most sensitive location on the circumcised penis is the circumcision scar on the ventral surface [...] When compared to the most sensitive area of the circumcised penis, several locations on the uncircumcised penis that are missing from the circumcised penis were significantly more sensitive. "(29)

The results of a fascinating study conducted by Dr. Christopher Cold and Dr. Kenneth A. McGrath demonstrate that the human foreskin in an evolutionary advancement over the foreskins of other primates. The human foreskin is far more sophisticated and responsive, as their comparative anatomy studies prove. This is seen most clearly in the evolutionary increase in corpuscular innervation and simultaneous decrease in corpuscular receptors in the human glans relative to the innervation of the foreskin and glands of lower primates (30). In other words, in monkeys and apes, the glans is more sensitive then the foreskin. In humans, this is reversed, so that the foreskin is more sensitive then the glands.

(17) Moldwin RM, Valderrama E. Immunohistochemical analysis of nerve distribution patterns within preputial tissues. J Urol 1989 Apr;141(4):499A. (abstract)
(18) Taylor JR, Lockwood AP, Taylor AJ. The prepuce: specialized musocsa of the penis and its loss to circumcision. Br J Urol 1996 Feb;77(2): 291-5
(19) Dogiel AS. Die Nervenendigungen in der Haut der ausseren Genitalorgane des Menschen. Archiv fur Mikroskopische Anatomie 1893:41:585-612
Bazett HC, McGlone B, Williams RG, Lufkin HM. Depth, distribution and probable identification in the prepuce of sensory end-organs concerned in sensations of temperature and touch; thermometric conductivity. Archives of Neurology and psychiatry 1932 Mar; 27(3):489-517
(20)Bazett HC, McGlone B, Williams RG, Lufkin HM. Depth, distribution and probable identification in the prepuce of sensory end-organs concerned in sensations of temperature and touch; thermometric conductivity. Archives of Neurology and psychiatry 1932 Mar; 27(3):489-517
(21) Ohmori D. Uber die Entwicklung der Innervation der Genitalapparate als peripheren Aufnahmeapperat der Genitalen Reflexe. Zeitschrift fur Anatomie und Entwicklungsgeschichte 1924;70(1):347-410.
(22)Halata Z, Munger BL. The neuroanatomical basis for the protopathic sensibility og the human glans penis. Brain Res 1986 Apr23;371(2):205-30.

(23)Ohmori D. Uber die Entwicklung der Innervation der Genitalapparate als peripheren Aufnahmeapperat der Genitalen Reflexe. Zeitschrift fur Anatomie und Entwicklungsgeschichte 1924;70(1):347-410.
(24)Ohmori D. Uber die Entwicklung der Innervation der Genitalapparate als peripheren Aufnahmeapperat der Genitalen Reflexe. Zeitschrift fur Anatomie und Entwicklungsgeschichte 1924;70(1):347-410.
(25)Winkelmann RK. The Cutaneous Innervation of the human newborn prepuce. Invest Dermatol 1956 Jan;26(1):53-67
(26)Winkelmann RK. The erogenous zones: their nerve supply and its significance. Proceedings of the staff meetings of the Mayo Clinic 1959 Jan21(2):39-47
(27)Halata Z, Munger BL. The Neuroanatomical basis for the protopathic sensibility of the human glands penis. Brain res 1986 Apr 23;371(2):205-30.
(28)Taylor JR, Lockwood AP, Taylor AJ. The prepuce: specialized musocsa of the penis and its loss to circumcision. Br J Urol 1996 Feb;77(2): 291-5
(29)Morris L. Sorrells, James L. Snyder. Fine-touch pressure thresholds in the adult penis . BJU 2006 Oct:22, pp. 864-869
(30)Cold CJ, McGrath KA. Anatomy and histology of the penile and clitoral prepuce in primates: an evolutionary perspective of the specializes sensory tissue of the external genitalia. In: Denniston GC, Hoges MF, Milos FM (eds). Male and female circumcision: Medical, Legal, and Ethical Considerations in Pediatric Practice. New York: Kluwer Academic/Plenum Publishers, 1999. pp. 19-29

The only question that really matters is whether or not non-therapeutic circumcision of healthy boys is ethical. Since there is no compelling reason for the surgery, the decision should be left for the boy to make for himself.

The difficulty with your argument, Charleen, is that comparing aggregate rates of HIV and circumcision in various countries does not isolate the effect of circumcision. The rate of HIV in a country reflects the sum total of multiple factors, including circumcision rates but also other factors such as levels of condom usage, prostitution, etc. Research indicates that levels of sex education and condom usage are lower in the US, which one might reasonably expect to result in higher rates of HIV. (For information re sex education and condom usage, see, for example: Michael RT, et al. Private sexual behavior, public opinion, and public health policy related to sexually transmitted diseases: a US-British comparison. Am J Public Health. 1998 May;88(5):749-54. Weinberg MS, et al. AIDS risk reduction strategies among United States and Swedish heterosexual university students. Arch Sex Behav. 1998 Aug;27(4):385-401. Brick P. How does Europe do it? Fam Life Matters. 1999 Winter;(36):3)

Once again Jake ignores the ethical problems with cutting off a normal, healthy part of a child's genitals. There are effective, non-surgical ways for a male to protect himself and his partners from sexually transmitted diseases.

Cutting the genitals of a child when there is no compelling reason to do so is unethical.

Once again, Stan, you're conflating separate issues. The question I'm addressing is whether circumcision is protective against HIV. The question you're addressing is whether infant circumcision should be performed. Please try to stay on topic.

Jake, protection is relative. No studies have been done on neonates. No studies have been performed in the USA. All studies (3 active studies) have been done in Africa. These studies were ended short of their intended length because of the difference in the rates of infection was about 1-2%. Hardly a change on which to base worldwide mandate.

Michael,

First, several studies have been conducted in the US; for a summary see the section "HIV Infection and Male Circumcision in the United States" in http://www.cdc.gov/hiv/resources/factsheets/circumcision.htm

Second, there have been a lot more than three studies, probably more than 50. The three studies that you refer to are randomised controlled trials, a particularly high standard of evidence, which is why people have paid so much attention.

As for your apparent implication that an absolute HIV risk reduction of 1-2% is not worthwhile, I find that truly perplexing. In any case, this figure isn't terribly useful by itself: we need to scale the risk reduction to a lifetime, and then to different environments where the background HIV rate may be higher or lower. The relative risk reduction tends to be more useful for such calculations. In the US, for example, the adult HIV prevalence is 0.6%, so one could not hope for an absolute risk reduction greater than that.

If giving aspirin to babies was popular, would you do it?

No research has been done on children to warrant such a drastic change to neonatal genital structure. The only research done has been on adult males in an area of the world with horrible sanitation. You can't equate the two populations of Africa and America.

Cutting off a part of your sons penis is not a logical way to prevent a rare and easily treatable UTI. The idea that circumcision prevents children form a UTI’s in the first six months of life was based on an egregiously flawed series of studies that where fabricated by determined circumcision advocate Thomas E. Wiswell that began in 1983. [1] [2] [3] [4] [5]

When children are born prematurely they are not circumcised due to the potential risks that come with a traumatic and unnecessary surgery on a very tiny infants penis. Premature infants are placed in the NICU where they can not obtain breast milk, and since they are premature, their immune system is weaker in general. Breast-milk is highly efficacious at preventing UTI. [6] [7] [8] [9] [10]

In another study, one researcher found infant UTI to have a correlation to the birth weight of the baby. [11]

These lack of controls in certain studies may generate the appearance that genitally intact males are more susceptible to UTI’s during the first six months of life. There is not any claim that circumcision reduces UTI in adult life. The claim that circumcision prevents UTI has long since been put to rest by the AAP Task Force on Circumcision in 1999 which states:

“Few of the studies that have evaluated the association between UTI in male infants and circumcision status have looked at potential confounders (such as prematurity, breastfeeding, and method of urine collection) in a rigorous way. For example, because premature infants appear to be at increased risk for UTI, the inclusion of hospitalized premature infants in a study population may act as a confounder by suggesting an increased risk of UTI in uncircumcised infants. Premature infants usually are not circumcised because of their fragile health status. In another example, breastfeeding was shown to have a threefold protective effect on the incidence of UTI in a sample of uncircumcised infants. However, breastfeeding status has not been evaluated systematically in studies assessing UTI and circumcision status” [12]

Many other publications have clearly demonstrated the flaws due to co-founding factors. This claim has not been taken seriously in many years. Another publication concluded:

“Previously reported differences in the rate of urinary tract infection by circumcision status could be entirely due to sampling and selection bias. Until clinical studies adequately control for sources of bias, circumcision should not be recommended as a preventive for urinary tract infection” [13]

Studies performed by objective researchers have discovered that the circumcision surgery in and of itself puts the child at greater risk of contracting a UTI as another study concludes.

“There was a higher preponderance of UTI among male neonates. Its incidence peaked during the early post-circumcision period, as opposed to the age-related rise in females. UTI seems to occur more frequently after traditional circumcision than after physician performed circumcision” [14]

A 2005 review of randomized trials and observational studies stated:

“Hemorrhage and infection are the commonest complications of circumcision occurring at rate of about 2%” [15]

The risks and harms are proven to be greater then the alleged benefits. Women by design are far more susceptible to UTI’s due to a shorter urinary tract. It would be no more logical to remove the labia minor to prevent UTI in women. A UTI is also a potential complication of circumcision. The plain fact is that UTI in boys is generally uncommon and almost exclusive to boys with urinary tract abnormalities. Even if circumcision did prevent UTI, it would not be logical to subject 200 children to a dangerous penile reduction surgery on the off chance that it might prevent a single boy from experiencing an easily treatable UTI while simultaneously causing 4 infections and between 4 and 20 surgical complications.

Using circumcision to prevent infections is a cultural superstition and it is no more scientifically valid then the notion of amputating your eye lid on the off chance that it may reduce the risk for conjunctivitis (pink eye). If this was a common practice in our culture we would have all kinds of rationalizing literature for this as well. The removal of your eye lid like like the removal of the foreskin detracts form the primary function of those body parts and it is not any more logical then amputating the entire penis to reduce STD’s or the amputation of one eye to prevent eye cancer by 50%. The use of circumcision to promote hygiene is hysterical madness that is perpetuated by myth, superstition, the arbitrary status quo of American culture, the incentive of financial gain that clouds the judgments of doctors, adamant fathers, and the resulting irrational fear of anatomically correct male genitalia. If you do some digging in the field on anthropology you will find that cultures that practice female genital mutilation, cling to all the same rationalizing myths and superstitions.

1. ↑ Wiswell TE, Smith FR, Bass JW. Decreased incidence of urinary tract infections in circumcised male infants. Pediatrics 1983 may;75(5):901-3
2. ↑ Wiswell TE. Circumcision and urinary tract infections. Pediatrics 1986; 77: 267-8.
3. ↑ Wiswell TE, Roscelli JD. Corroborative evidence for the decreased incidence of urinary tract infection in circumcised male infants. Pediatrics 1986;78:96-99.
4. ↑ Wiswell TE, Enzenauer RW, Holton ME, Cornish JD, Hankins CT. Declining frequency of circumcision: implications for changes in the absolute incidence and male to female sex ratio of urinary tract infections in early infancy. Pediatrics 1987; 79: 338-42.
5. ↑ Wiswell TE, Hachey WE. Urinary tract infections and the uncircumcised state: an update. Clin Pediatr (Phila) 1993; 32: 130-4.
6. ↑ Gothefors L, Olling S, Winberg J. Breastfeeding and biological properties of faecal E. coli strains. Acta Paediatr Scand 1975 Nov;54(6):807-12
7. ↑ Coppa JV et al. Preliminary Study of Breastfeeding and Bacterial Adhesion to Uroepithelial Cells. The Lancet 1990;335:569-571.
8. ↑ Mårild S. Breastfeeding and Urinary Tract Infections. Lancet 1990;336:942.
9. ↑ Pisacane A, et al. Breastfeeding and urinary tract infection. The Lancet, July 7, 1990, p50
10. ↑ Pisacane A, Graziano L, Mazzarella G, et al. Breast-feeding and urinary tract infection. J Pediatr 1992;120:87-89.

11. ↑ Littlewood JM. Infants with urinary tract infection in first month of life. Arch Dis Child 1972;47(252):218-26.
12. ↑ AAP Task Force on Circumcision. Circumcision Policy Statement. Pediatrics 1999;103(3):686-693.
13. ↑ Van Howe RS. Effect of confounding in the association between circumcision status and urinary tract infection. J Infect 2005;51(1):59-68.
14. ↑ Prais D. Shoov-Furman R, Amir J. Is ritual circumcision a risk factor for neonatal urinary tract infections? Arch Dis Child Published Online First: 6 October 2008. doi:10.1136/adc.2008.144063
15. ↑ Singh-Grewal D, Macdessi J, Craig J. Circumcision for the prevention of urinary tract infection in boys: A systematic review of randomized trials and observational studies. Arch Dis Child 2005;90:853-8.

Genital warts, also known as human papilloma virus (HPV), is the most common STD in the U.S. Its association with circumcision, has been a heavily debated topic for many years. As more recent studies enact more rigorous controls and use larger study groups, the association between circumcision and HPV has become more clear.

A classic 1993 study on HPV, came up with the conclusion that:

"Uncircumcised men had a lower prevalence of genital warts then circumcised men... The presence of the foreskin may confer non specific protection of the proximal penis from acquisition of HPV infection." [1]

A meta-analysis Performed by D.r. Robert Van Howe in 2006 found no significant association between circumcision status and HPV infection.

"The medical literature does not support the claim that circumcision reduces the risk for genital HPV infection" [2]

Most studies on HPV performed before 2006 had poor controls and relatively small study groups. In order to clear up this confusion, a recent 2008 study on HPV had an enormous study group of almost nine thousand men in the United States. This is currently the largest study on circumcision and HPV ever performed in the U.S. And since the study was performed in the U.S., the results are directly applicable to people who live in the U.S. They concluded:

"The percentage of circumcised men reporting a diagnosis of genital warts was significantly higher than uncircumcised men, 4.5% (95% CI, 3.6%–5.6%) versus 2.4% (95% CI, 1.5%–4.0%)". [3]

Circumcised men where about twice as likely to have HPV! The claim that circumcision prevents cervical cancer in women is a detestable myth with sexist implications. This is based on the presumption that circumcision prevents HPV and that HPV increases the risk for both cervical cancer and penile cancer. Since this HPV claim has been thoroughly discredited, the cervical cancer myth is also now debunked. It has now been shown that circumcision increases the risk for HPV. Hence circumcision may increase the risk of both penile and cervical cancer by increasing the spread and acquisition of HPV. The practice of circumcision could very well be a contributing factor to the prevalence of HPV in the U.S.

Nevertheless pro circumcision advocates have continued to mine for data in inapplicable communities like rural Uganda with the intent to prove that circumcision does reduce the risk for HPV. Yet, when these studies are performed they get an incredible amount of press. Why did the previous study I present not gain any publicity?

In the studies I have provided thus far, they have have used racially and socioeconomic homogeneous study groups in developed urban western settings. This is something that most if not all of these pro-circumcision studies do not account for.

1. ↑ Cook LS, Koutsky LA. Holmes KK. Clinical presentation of genital warts among circumcised and uncircumcised heterosexual men attending an urban STD clinic. Genitourin Med 1993 Aug;69(4): 262-4 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1195083/
2. ↑ Van Howe, Robert S. (May 2007). "Human papillomavirus and circumcision: A meta-analysis". Journal of Infection 54 (5): 490–496.http://www.cirp.org/library/disease/cancer/vanhowe2006b/. Retrieved 2008-09-18.
3. ↑ Dinh, T.H.; M. Sternberg, E.F. Dunne and L.E. Markowitz (April 2008). "Genital Warts Among 18- to 59-Year-Olds in the United States, National Health and Nutrition Examination Survey, 1999–2004". Sexually Transmitted Diseases 35 (4): 357–360.http://journals.lww.com/stdjournal/Fulltext/2008/04000/Seroepidemiology_of_Human_Papillomavirus_Type_11.8.aspx Retrieved 2011-03-5

if male circumcision has any benefits, it would be logical that female circumcision would have benefits.

why are you using study's study for Africans? NO one uses these to delegate policy in the U.S.

herpes is by far the weakest claim

An exhaustive 1994 study on herpes simplex virus type 2 (HSV-2) concluded:

"We have found no evidence the presence of an intact foreskin being a risk factor for HSV-2 infection… Importantly, our study group was relatively racially homogeneous, lack of circumcision was not a marker of lower socioeconomic status ." [6]

[6]Bassett I, Donovan B, Bodsworth NJ, Field PR, Ho DW, jeansson S, Cunningham AL. Herpes Simplex virus type 2 infection of heterosexual men attending a sexual health centre. Med J Aust 1994 Jun 6:160(11);697-700 http://www.ncbi.nlm.nih.gov/pubmed/8202004

risk estimates have been well above 0.2 for like 15 years now. they are topicality 2-10%. who edger you 0.2 edger showen?

who are you gonna believe people? The royal Austrian college of pediatricians or bob?

Bob's figure corresponds with the low end of the scale quoted by the American Academy of Pediatrics (0.2-0.6%). It's not unreasonable; however I would think that 1.5% is a more reasonable figure, being the conclusion of a recent systematic review by Weiss et al (http://www.biomedcentral.com/1471-2490/10/2).

Part of the problem is in defining what constitutes a complication. Some authors consider a little oozing or redness to be a complication; others consider less trivial issues. Serious complications are extremely rare.

its also worth noting the 2-10% estimate(1) is The largest review of complication literature NOT DONE BY A KNOWN PRO CIRC ADVOCATE LIKE WEISS OR WISWELL BOTH AFFILIATED WITH CIRCUMFETISHIST GROUPS.

(1)Williams, N; L. Kapila (October 1993). "Complications of circumcision". British Journal of Surgery 80 (10): 1231-1236.

You're welcome, Charleen. People like Jake and his cronies need to be exposed for the type of people they are.

Circumcision advocates quickly moved on to manufacture a number of outrageous health claims. These claims were tailored to the fears and anxieties of the day. Circumcision has been claimed to cure epilepsy, convulsions, paralysis, elephantiasis, tuberculosis, eczema, bed-wetting, hip-joint disease, fecal incontinence, rectal prolapse, wet dreams, hernia, headaches, nervousness, hysteria, poor eyesight, idiocy, mental retardation, insanity, strabismus, hydrocephalus, clubfoot, cancer, STD’s, UTI’s, ect.(15) Doctors were eager to claim that they could prevent and cure many of these aliments,conditions and diseases because there were no treatments available then. Even though all of these claims have been throughly discredited, circumcision has remained a solution in search of a problem ever since. Many Americans are surprised to find out that female genital cutting (FGC) shares a strikingly similar history in the United States.(7,16,17,18,19,20,21) FGC was even covered by Blue Cross Blue Shield until 1977. Nowadays, many forms of FGC are now considered forms of female genital mutilation (FGM), which are banned in all western countries.

Perhaps the most shocking fact is that circumcision continues to be practiced in the United States even though no official western medical organization in the world recommends it. The Royal Dutch Medical Society, The British Medical Association, the Canadian Pediatric Society, and the Royal Australian College of Physicians have all made official policy statements against circumcision. The American Academy of Pediatrics, the American Medical Association, the American Academy of Family Physicians, and the American Urological Association all do not recommend circumcision, and are also in agreement that there are no proven benefits.

For some reason this information is not making it to parents. Studies have shown that doctors provide parents with almost no accurate or useful information about circumcision. One study showed that 40% of parents believed that their doctors failed to provide enough information, 46% reported that their doctors failed to give them any medical information at all, and 82.8% of parents regretted their decision they made within the first six months of their son’s life.(22) Another study found that physicians were less likely to circumcise their own sons.(23) This suggests that doctors are very well aware that circumcision is a non-therapeutic surgery (in short, a ritual); but they do not appear to share this knowledge with parents. A busy physician can supplement their income by as much as $60,000 per year from circumcision surgeries alone.(24) This incentive can cloud a physician’s judgment when it comes to providing parents with information about circumcision.

Many parents are surprised to hear that anesthetics are used in only a minority of cases.(25) The use of local anesthetics significantly drives up the costs of surgery. When anesthetics are used, they can only reduce the pain. Infants can not be given general anesthesia because of the medical risks involved. In the recent past, anesthesia was rarely used, if ever. Because of this, circumcision has always been an extremely traumatizing experience causing an array of short and long term behavioral and developmental problems (26,27,28,29,30,31,32,33,34,35), including altered perceptions of pain(36,37,38), post traumatic stress disorder (PTSD)(39,40,41,42), and a possibly of adult self destructive behavior(43,44,45). Many circumcised men, some of whom are doctors, experience a strong denial of loss which in turn fuels an emotional compulsion to repeat the trauma to normalize their loss.(46,47,48,49,50)

What is the foreskin? is a question that many Americans would have trouble answering. Information about the foreskin is virtually absent during discussions of anatomy in biology classrooms, and yet, the foreskin provides a well-documented set of crucial sensory, protective, immunological, hygienic, and sexual functions. The foreskin is a double fold of skin that is twice as big as its appearance. It can make up to 80% or more of the penile skin covering, and includes around 12-20 square inches of skin (the size of a 3x4 or a 4x5 index card!)(51,52), and in turn includes a specialized sheet of dartos muscle(53)

One of the functions of this mobile skin system is to glide up and down the shaft of the penis in order to facilitate non-abrasive stimulation during sexual activity without any need for artificial factory made lubricant. This frictionless gliding mechanism is the principal source of stimulation for the intact penis and facilitates non-abrasive intercourse.(54)

The neuro-anatomy of the penis has been rigorously studied by respected anatomists of all kinds. The component tissues that comprise the foreskin are richly innervated with the greatest quantity and variety of sensory nerve endings than any other part of the penis; the foreskin can discern the slightest pressure, the lightest tough, the smallest motion, the subtlest changes in temperature, and the finest gradations in texture.(52,55,56,57,58,59,60,61,62) Many people are surprised to discover that the glans or “head” of the penis is actually the least sensitive part and is insensitive to light tough, heat, cold and even pin-pricks.(52,61,62) Permanent unnatural exposure of the penis further desensitizes the glans, the foreskin keeps the glands healthy, clean, shiny, warm, soft, moist, and sensitive; with out the foreskin the glans are scared, dry, cracked, and pitted. Most notably, circumcision drastically reduces the glans sensitivity to vibration.(63)

To no surprise, this information was corroborated in a 2006 study which measured the sensitivity of all the parts of the penis. Researchers used an extremely sensitive pressure sensing probe while each test subject, whose view was blocked with a screen, reported a sensation of touch. To demonstrate precision they took each measurement multiple times. The results were statistically consistent. They concluded:

"Five locations on the uncircumcised penis that are routinely removed at circumcision were more sensitive than the most sensitive location on the circumcised penis[...] The glans in the circumcised male is less sensitive to fine-touch pressure than the glans of the uncircumcised male[...]The most sensitive location on the circumcised penis is the circumcision scar on the ventral surface [...] When compared to the most sensitive area of the circumcised penis, several locations on the uncircumcised penis that are missing from the circumcised penis were significantly more sensitive."(62)

The foreskin, like the eyelid, also serves an important set of protective and immunological functions. The foreskin protects the delicate glans of the penis and puts the urethra at a distance form its environment protecting it from foreign contaminants of all kinds. While simultaneously shielding the penis from injury. The foreskins inner fold and the glans of the penis are comprised of mucous membrane tissue. These are also present in your eyes, mouth, and all other bodily orifices including the female genitals. These mucous membranes perform many immunological and hygienic functions. Certain components such as Langerhans cells(64), plasma cells(65), apocrine glands(66), and sebaceous glands(67), collectively secrete emolliating lubricants(68) rich in enzymes such as lysosomal enzymes, chymotrypsin, neutrophil elastase, immunoglobulin, cytokine(69), cathepsin B (70) , and langerin which kills the HIV virus(71), all these substances function to sequester and “digest” foreign pathogens. The foreskin is also responsible for the production, retention, and dispersal of pheromones such as androsterone(72). In time we will discover even more information about the foreskin and its functional components.

The intact penis is naturally clean and maintains a level of hygiene that is optimal when compared to a penis that has been altered by circumcision. In fact, a myriad of rigorously controlled studies performed by objective researchers among racially and socioeconomically homogeneous study groups in developed urban settings have shown that circumcision is either often associated with an increased risk of bacterial infections, viral infections, and major STD’s, or no significant difference. (73,74,75,76,77,78,79,80,81,82,83,84).

Needless to say, circumcised men have been denied normal bodily functions associated with anatomically correct genitalia.

Refrences:
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(42) Menage J. Post-traumatic stress disorder in women who have undergone obstetric and/or gynaecological procedures. J Reprod Infant Psychol 1993;11:221-28.
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(46) Van der Kolk BA. The compulsion to repeat the trauma: re-enactment, revictimization, and masochism. Psychiatr Clin North Am 1989;12(2):389-411.
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(51) See photographic series in: lander MM. The Human prepuce. In: Denniston GC, Milos MF (eds). Sexual Mutilations: a human Tragedy. New York: Plenum Press; 1997. pp.79-81
(52) Taylor JR, Lockwood AP, Taylor AJ. The prepuce: specialized musocsa of the penis and its loss to circumcision. Br J Urol 1996 Feb;77(2): 291-5
(53)Jefferson G. The peripenic muscle; some observations on the anatomy of phimosis. Surgery, Gynecology and Obstetrics 1916 Aug;23(2):177-81.
(54)K. O'Hara and J. O'Hara. The effect of male circumcision on the sexual enjoyment of the female partner. BJU International, Volume 83, Supplement 1, Pages 79-84, January 1, 1999.
(55) Moldwin RM, Valderrama E. Immunohistochemical analysis of nerve distribution patterns within preputial tissues. J Urol 1989 Apr;141(4):499A. (abstract)

(56) Dogiel AS. Die Nervenendigungen in der Schleimhaut der asseren Genitalorgane des Menschen. [The nerve endings in the afferent mucosa of the human genital organs.] Arch f. mkr. Anat. 1893; 41: 585-612.
(57)Bazett HC, McGlone B, Williams RG, Lufkin HM. Depth, distribution and probable identification in the prepuce of sensory end-organs concerned in sensations of temperature and touch; thermometric conductivity. Archives of Neurology and psychiatry 1932 Mar; 27(3):489-517
(58) Ohmori D. Uber die Entwicklung der Innervation der Genitalapparate als peripheren Aufnahmeapperat der Genitalen Reflexe. Zeitschrift fur Anatomie und Entwicklungsgeschichte 1924;70(1):347-410.
(59)Winkelmann RK. The Cutaneous Innervation of the human newborn prepuce. Invest Dermatol 1956 Jan;26(1):53-67
(60)Winkelmann RK. The erogenous zones: their nerve supply and significance. Mayo Clin Proc 1959;34(2):39-47.
(61)Halata Z, Munger BL. The neuroanatomical basis for the protopathic sensibility of the human glans penis. Brain Res 1986 Apr23;371(2):205-30.
(62)Morris L. Sorrells, James L. Snyder. Fine-touch pressure thresholds in the adult penis . BJU 2006 Oct:22, pp. 864-869
(63)Yang, DM; Lin H, Zhang B, Guo W (April 2008). "Circumcision affects glans penis vibration perception threshold". Zhonghua Nan Ke Xue 14 (4): 328–330

(64) Weiss GN, Sanders M, Westbrook KC. The distribution and density of Langerhans cells in the human prepuce: site of diminished immune response? Isr J Med Sci 1993 Jan;29(1);42-3
(65) Flower PJ, Ladds PW, Thomas AD, Watson DL. An immunopathologic study on the bovine prepuce. Vet Pathol 1983 Mar;20(2):189-201.
(66)Ahmed A, Jones AW. Apocrine Cystadenoma: a report of two cases occurring on the prepuce. Br J Dermatol 1969 Dec; 81(12):899-901.
(67)Hyman AB, Brownstien MH. Tyson's "glands": ectopic sebaceous glands and papillomatosis penis. Arch Dermatol 1969 Jan;99(1):31-6
(68)Parkash S, Jeykumar S, Subramanyan K, Chaudhuri S. Human Subpreputial collection: its nature and formation. J Urol 1973 Aug 110(2):211-2
(69) Ahmed AA, Nordlind K, Schultzberd M, Liden S. Immunohisto chemical localization of IL-1 alpha-, IL-1 beta-, IL-6- and TNF-alpha-like immunoreactivities in human apocrine glands Arch
(70) Frohlich E Shamburg-Lever G, Klesses C. Immunelectron microscopic localization of cathepsin B in human apocrine glands. J Cutan Pathol 1993 Feb;20(1):54-60
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(72) Cohn BA. In search of human skin pheromones. Arch Dermatol 1994 Aug; 130(8):1048-51
(73)Dermatol Res 1995;287(8):764-6Smith GL, Greenup R, Takafuji ET. Circumcision as a risk factor for urethritis in racial groups. AM J Public Health 1987 Apr;77(4):452-4

(74) Bassett I, Donovan B, Bodsworth NJ. Male circumcision and common sexually transmissible diseases in a developed nation setting. Genitourin Med 1994 Oct;70(5):317 -20.
(75) Bassett I, Donovan B, Bodsworth NJ, Field PR, Ho DW, jeansson S, Cunningham AL. Herpes Simplex virus type 2 infection of heterosexual men attending a sexual health sentre. Med J Aust 1994 Jun 6:160(11);697-700
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(79) Cook LS, Koutsky LA. Holmes KK. Clinical presentation of genital warts among circumcised and uncircumcised heterosexual men attending an urban STD clinic. Genitourin Med 1993 Aug;69(4):262-4
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(83)Amir J. et al. Circumcision and Urinary Tract Infections in Infants. Am J Dis Child (1986), vol. 140, p. 1092.
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there is no concrete evidence, each and every single claim has been discredited with conflicting studies.

intactipedia.org

all bias in formation. interesting how you only picked sites on one side of the issue.

http://intactipedia.org/index.php?title=Main_Page
http://www.cirp.org/library/
http://www.doctorsopposingcircumcision.org/
http://www.drmomma.org/2009/10/circumcision-study-ends-early-due-to.html
http://www.thewholenetwork.org/

for HIV
http://www.doctorsopposingcircumcision.org/info/HIVStatement.html
http://intactamerica.org/sites/default/files/DangerousMistake.pdf

I am not like you, Craig, I am not an activist for a cause. I am just providing links & information to help parents and others make an informed decision.

based on your site choices you seen like a pro circ activist to me. how is it you filtered out any opposing opinions and arguments?

To be fair, circumcision is not strictly comparable to cosmetic surgery. The key distinction is that cosmetic surgery does not, as a rule, have medical benefits. In contrast, circumcision does. And as a result of these benefits, the risk-benefit balance is different: cosmetic surgery is a net harm generally (though psychological benefits in individual cases may change that), whereas circumcision is neutral or a net benefit, on balance. Consequently, it is reasonable and ethical for parents to make that decision for their sons, even if their primary reasons may be cosmetic.

its not cosmetic because it drastically alters to FUNCTION of the penis. It permanently desensitizes, denudes, and immobilizes the penis.

Jake, can you please back up your claim that circumcision has medical benefits?
Also, cosmetic surgery does not have a net harm generally, there are bone reconstruction surgeries, etc.

Sorry, Craig, but you are wrong. Scientific evidence has shown that circumcision does not alter the function of the penis. Also, millions of Jews, Muslims, and American men (and their partners) enjoy rich & fulfilling sexual intercourse.

Willie Serano: yes, certainly. Well-established benefits include reduced risk of urinary tract infections; penile cancer; acquired phimosis; balanitis and posthitis; HIV; HPV; and several other sexually transmitted infections. There are reasonable (if slightly dated) overviews in the AMA and AAP policy statements: http://www.ama-assn.org/ama/no-index/about-ama/13585.page http://aappolicy.aappublications.org/cgi/content/full/pediatrics;103/3/686

Hey Bob,
I would appreciate it if you can provide answers to these questions:
1) Can you cite this scientific evidence that circumcision does not alter the function of the penis?
2) Why is circumcision virtually absent in continental Europe?
3) Millions of American men do not enjoy rich & fulfilling sexual intercourse. The evidence? Viagra.

W

There is no other surgery that doctors will perform on a child that has a similar ratio of benefits to risks as non-therapeutic male circumcision. There are effective, non-invasive ways to treat almost all problems that male circumcision is supposed to prevent.

It is shameful that American doctors still tolerate medically unnecessary surgery on the genitals of a child where there is no compelling medical reason to perform the surgery.

NO BOB U R WRONG. this is from a chapter on the functions of the foreskin by Paul M. Fleiss M.D. in abood called "what your doctor may not tell you about circumcision" The royal Australian college of pediatricians talks about the function of the foreskin too.

WHo r your gonna believe people the RACP or BOB?

The Functions of the Foreskin

“The prepuce is primary, erogenous tissue necessary for normal sexual function. The complex interaction between protopathic sensitivity of the corpuscular receptor-deficient glands penis and the corpuscular receptor-rich ridged band of the male prepuce is required for normal copulative behavior (1).”
Christopher J. Cold, M.D., and John R Taylor, M.D.

Now that you now what the foreskin is, you are probably wondering what it does. Most people are interested to learn that the foreskin has a great number of important protective, sensory, and sexual functions.

The foreskin in babyhood

Babies are born perfect. Every part of your baby's body is there for a special purpose. Every part of your baby's body helps him grow, develop, learn, and experience our wondrous world. The foreskin is one of these special body parts. In fact, the foreskin is an important body part throughout the entire life of the male. The foreskin adds more to the penis then just increased sexual functioning and pleasure. It keeps your baby’s penis safe, warm, clean, and moist. It allows the baby's glands to complete its development normally. The glans are meant to be an internal organ covered and protected from the outside world.
No attempt should be made to retract the foreskin before the penis has fully developed. Premature separation causes the glands to become dry hard and scared with pitting and adhesions. The foreskin protects the glands from injury simply by covering it. The first person to retract the foreskin and expose the glands should be the child himself, and only when the child is ready to do so. It is best that parents avoid concerning them selves with this natural process. All by themselves, little boys will make the discovery that their foreskin can be retracted.

Protection

Just as the eyelid protects the eye; the foreskin protects the glands, keeping its surface soft, moist, warm, and sensitive. It also maintains optimal warmth, PH balance, and cleanliness. The glands itself contains no sebaceous glands-glands that produce the moisturizing oil that out skin needs to stay healthy.(2)
The foreskin produces the moisturizer that keeps the surface of the glans glistening, smooth, soft, and a deep healthy red or purple color.
The foreskin will protect the entire penis when accidents happen, such as contusions, abrasions, lacerations, and burns. The foreskin is the first layer and a double layer of defense from injury to the rest of the penis.
o

The intact penis is naturally clean. The common view of the penis or the foreskin as "dirty" is unscientific and irrational.
The penis, however, does provide an entry point into the body, and it is exposed to foreign microbes every day, especially during sexual intercourse. The immunological functions of the foreskin and the self cleansing function of the penis protect the body from harm.
Every time a genitally intact male urinates, the urine stream flushes out the urethra and foreskin of foreign microbes that may have strayed inside. In healthy individuals, urine is sterile and has a disinfectant quality. Researchers have demonstrated that the swirling action of urine as it rushes through the foreskin flushes it out effortlessly and naturally (3). This function is especially efficient when the foreskin is long and the preputial orifice is narrow.
Though urine passes through the foreskin every day, the inner foreskin is remarkably free of urea-a by-product of liver metabolism that is secreted in urine. Studies demonstrate that washings from the foreskin are rich in fructose, acid phosphatase, and mucin, but never urea. It appears that the secretions of seminal vesicles, prostate, and urethral mucous glands, collectively or individually, keep the foreskin clear and clean as well 4).

These self cleaning functions of the penis are analogous to the self cleaning functions of the eye, which similarly maintains its cleanliness through fluid washings (tears) and mucus secretion. Therefore, you never need to worry about the foreskin being "unclean".

Self protecting functions

The urinary meatus(the opening of the glands through which urine and semen flow), is an entry point into the body. From infancy to childhood, the foreskin ensures optimal protection of the glands and urinary meatus from contaminants of all kinds. During childhood, the foreskin is also usually firmly attached to the glands to prevent contaminants from invading the urethra. The neck of the foreskin places the vulnerable urinary meatus at a distance form the external environment and defends it against invading contaminants. The fusion of the foreskin and glands and the non-expandability of the preputial orifice in the child's penis are therefore necessary for the health of the child. Even after the foreskin separates from the glands and becomes retractable, it continues throughout life to cover the glands and meatus in order to protect these delicate structures from dirt, contamination, abrasion, or bacterial invasion

Immunological protection:

The mucous membranes that line all body orifices are the body's first line of immunological defense. Glands in the foreskin produce antibacterial and antiviral proteins such as lysozyme (5). Lysozyme is also found in tears and mother's milk. Specialized epithelial Langerhands cells, an immune system component, abound in the inner foreskins inner surface(6). Plasma cells in the foreskin's mucosal lining secrete immunoglobulins, antibodies that defend against infection.(citation7)
Rigorously controlled studies have also demonstrated that the foreskin plays a protective role in shielding the rest of the penis and thus the rest of the body from the contagion of common sexually transmitted diseases(STDs) encountered during sexual activity. This will be discussed in the section on STDs.
In infancy, antibacterial substances, such as the simple sugars in breast milk, the oligosaccharides, are passed from mother to child during breast feeding and are secreted in the babies urine.(9) The penis retains these substances in the foreskin. University studies have shown that their substances protect against urinary tract infections, as well as infections in other parts of the body (10). Babies excrete in their urine 300-500 milligrams of obligosaccharides a day. These compounds prevent virulent strains of Escherichia coli from adhering to the mucosal lining of the entire urinary tract, including the foreskin and glans.

Researchers conducting immunological experiments with the foreskin of bulls have found that plasma cells in the mucosal lining of the foreskin secrete immunoglobulin (11). The researchers hypothesize that this provides immunity form bacteria and other germs. This may be true for other mammals like humans as well.
Apocrine glands are important glands found in the skin they are found in the foreskin and elsewhere on the body.(12) They secrete important lysosomal enzymes cathepsin B, lysozyme, chymotrypsin, and neutrophil elastase (13). All of these enzymes help protect the body from many kinds of bacteria. These enzymes are also found in tears and other bodily fluids. Human apocrine glands also produce cytokine, a non-antibody protein that generates an immune response on contact with specific agents (14). All these substances have immunological functions and protect the penis from viral and bacterial pathogens. The natural protective function has been destroyed in circumcised males.

Coverage during erection

During erections, the penile shat becomes thicker and longer. In some males, the penis can extend to twice its flaccid length. Sometimes it can become even longer. The double-layers foreskin provides exactingly the right amount of skin necessary to accommodate the expanded organ and to allow the penile skin to glide freely, smoothly, and pleasurably over the shaft and glands.
It is important to consider the fact that every penis is unique. By looking at an infant’s penis, it is impossible to predict how big his penis will become when he is an adult. Heredity does play a role in determining the ultimate shape, size, and configuration of the penis, but it is difficult to predict the adult size and shapes of an infant's penis even if one looks at the penises of his father, brothers, and other male relatives.
What we can say with certainty is that your baby’s penis will develop and mature according to his own unique genetic coding. This, the amount of foreskin he is born with is exactly the amount he will need for his penis to develop properly and experience comfortable, pleasurable erections thorough life. As a result, the idea that any amount of penile skin can be cut off without affecting the later function of the penis is false. In nature there is no surplus, only economy. Everything provided is required.
In the natural penis, as the shaft elongates during erection, the lips of the foreskin slowly expand.

The glans begins slowly to protrude through the widening opening. Since the foreskin is soft, elastic, and pliable, it can easily and comfortably stretch to allow the passage of the glands. The stretching process elicits pleasurable sensations as the foreskin gently unrolls (everts) over the glans and shaft. Eventually, in most males, the glans can be fully exposed.
Some males well endowed with a generous foreskin, have the glans fully covered even when the penis is fully erect. Most, however, if they chose, can manually roll the foreskin all the way back to expose the glans.
During full erection, the sensitive inner sleeve of the foreskin is turned inside out, exposing it. In this position it receives and transmits pleasurable sensations. The natural penis is a marvelously engineered organ for receiving and giving natural pleasure.
Needless to say, circumcision destroys all these functions and imposes a diminished, scared, immobile, dowel like penis that has permanently lost the ability to experience normal levels of sexual sensations. A circumcised male, or his partner for that matter, can never know the intimacy of the normal penis and the ability to open and glide up and down the shaft. An entire dimension of sexuality has been lost to both the male and his sexual partner.

E

Erogenous sensitivity

The foreskin is more sensitive then the fingertips or the lips of the mouth. It contains a richer variety and grater concentrations of specialized nerve receptors than any other part of the penis (15). These specialized nerve endings can discern motion, subtle changes in temperature, and fine gradations of texture (16). This function enables genitally intact males to experience a superior dimension of sexual pleasure, compared to males who were circumcised. Intact males can be more tender, gentle, relaxed, and loving during sex because the slightest and subtlest gesture of motion evokes deeply satisfying sensations. Circumcised males have to work harder just to feel sensations. This is an unhealthy situation for both the male and female partner.

Self-stimulating sexual functions

The intact penis has moving parts. The foreskin's double layers sheath enables the penile shaft skin to glide back and fourth over the penile shaft. The foreskin can usually be slipped all the way or almost all the way, back to the base of the penis and also slipped forward beyond the glands. This wide range of motion stimulates the orgasmic triggers in the foreskin, frenulum and glans. This is the natural whay the penis is erotically stimulated. The movement of the foreskin over the glands and the pressure of the glands pressing against the foreskin is pleasurable. Sadly, males circumcised at birth can never imagine the pleasure of this natural sensation.
In the natural penis, the foreskin is the most important source of erotogenic, orgasm inducing sensations. As we learned in the previously , the foreskin contains a highly organized erotogenic sensory nerve-receptor system. It transmits special sexual sensations to the central nervous system and brain.

The glans also have erotogenic sensory nerve receptors along its rim (the corona of the glans), but far fewer then the foreskin. The massaging action of the foreskin against the glands produces sexual stimulation in both organs—something else that the circumcised male will never experience.
Some genitally intact males can even stimulate themselves to organism without touching their penis. They simply clench the groin muscles that help fill the penis with blood. Each voluntary contraction pf the muscles forces more blood into the erectile tissues. This causes the shaft and glans to engorge even further and pushes the glands though the lips of the foreskin. Each dilation of the lips of the foreskin stimulates the specialized nerve receptors in the foreskin. In addition, the tension exerted on the foreskin stimulates the nerve receptors in the glans. The resulting sensation can lead to orgasm. A circumcised male would never be able to accomplish this natural feat.

The foreskin enhances fore-pleasure

Fore-pleasure is the pleasurable stimulation of the genitals with or without the intention of eliciting orgasm. Fore-pleasure takes place during foreplay. Fore-pleasure of the penis stimulates the brain to release beneficial and health giving hormones into the blood stream. The hormones improve overall bodily health, improve emotional state, and can even reduce pain in any part of the body. Fore-pleasure, as the name implies, feels great.
Orgasm and ejaculation are usually the smallest part of sexual activity. They take only a few seconds and generally signal the end of sexual interest. The period devoted to fore-pleasure is the greatest component of sexual activity and can continue as long as there is interest to do so. The intact penis is masterfully designed to give and receive fore-pleasure. Its many surfaces, structures, and moving parts lend themselves to pleasurable exploration. Unrolling the foreskin and exposing the glans is an intimate discovery that provides fascination and delight, since different parts of the penis respond to different kinds of pleasurable attentions. The explorations and discovery of these differences provide a lifetime of intimate enjoyment and satisfaction.

Sexual functions of the foreskin during intercourse

One of the foreskin's functions is to facilitate smooth, gentle, and slow movement between two partners during intercourse. The foreskin enables the penis to slip in and out of the vagina non-abrasively inside its own slick sheath of self lubricating movable skin. The female is thus stimulated by moving pressure rather than by friction only, as when the males foreskin is missing.
The foreskin fosters intimacy between two partners by enveloping the glands and maintaining it as an internal organ. The sexual experience enhances when the foreskin slips back to allow the male's internal organ, the glans, to meet the female's internal organ, the cervix-- a moment of supreme intimacy and beauty.
You may have heard circumcision promoters allege that the foreskin is "dangerously thin and delicate" and that it "rips and tears easily during sexual intercourse." this is unscientific nonsense and has no basis in anatomical fact. I am sorry to say that it is a deception calculated to provide false reassurance to anxious circumcised males and to frighten parents into letting their children be circumcised. The simple truth is that the foreskin is perfectly designed to function effortlessly and pleasurably during sexual activity. Its double-layered integument is strong, flexible, and resilient. The foreskin is a durable and vigorous organ that enhances and facilitates sexual intercourse. If it didn't, it would have atrophied millions

of years ago.

Self lubricating function

Analogous to the eyelid, the foreskin protects and preserves the sensitivity of the glans by maintaining optimal levels of moisture, warmth, PH balance, and cleanliness. The glans is an internal organ. The glans itself contains no sebaceous glands and relies on the foreskin for production and distribution of sebum to maintain proper epithelial lubrication. Lubrication is naturally secreted by Cowper's glands in the urethra. This clear fluid begins to flow out of the meatus as the male becomes sexually aroused.
During intercourse, this natural lubricant assists the male in inserting the penis into the vagina, because the fluid is sheltered under the foreskin of the erect penis, it is less likely to dry up. Instead, it keeps the penis well lubricated and prevents the vagina from drying out. In the circumcised penis, the Cowper's gland fluid quickly evaporates. When the circumcised male inserts his dry penis into the vagina, it soon uses all up all the females natural lubricants, causing friction and pain for both partners. This can lead to small tears and painful bleeding in the organs of both partners. It comes as no surprise that in the Unites States today, where a large majority of sexually active males have been circumcised, painful vaginal dryness is the biggest complaint women have about sex.

This is also the reason that there is such a large industry in the United States that manufactures artificial sexual lubricants. I doubt there has ever been a study to determine the long-term effects of using these chemicals on delicate organs.
Genitally intact males are free of the need for lubricants of any kind either for manual stimulation of the penis or for the vaginal intercourse.
Many circumcised males also resort to using these artificial factory-made lubricants to masturbate. Other circumcised males reach orgasm by friction of their hand over their externalized glands. They have been deprived of the gliding movement of the foreskin to stimulate themselves naturally. The penis is a different organ with out the foreskin, and sexual function is altered when the foreskin has been amputated.
Many circumcised men will think they are normal because they are able to function sexually to their own satisfaction, never realizing that their sexual functions as an adult was changed forever by a medically unnecessary and extremely painful procedure done to them as an infant.

In my practice, I have examined little boys who have had so much foreskin removed that there is hardly any loose skin on their penis. The skin on their flaccid non-erect penis is taut. I wonder what will happen to a boy with such a radical circumcision when he gets an erection: Will he be able to have as much pleasure from his penis as he would have had is the circumciser amputated less? This most unfortunate situation is all too common in the Untied States.

Production, retention, and dispersal of pheromones

The sense of smell is one of the oldest, most precise, and most important senses in humans. Smells convey vital information to the brain. Pheromones are hormonal chemical messengers secreted by an individual and perceived by another individual of the same species. They create sexual arousal and attraction in the person perceiving the pheromone. These glands are found in the armpits, breasts, and in the genital area. The penis itself is a specific site for these glands. Pheromones may well be secreted by the apocrine glands in the foreskin. These glands are present at birth, but during puberty they develop in the presence of testosterone .
Although pheromones themselves are odorless, that are released by the foreskin into the air where they are perceived by the vomeronasal organ, a small tubular structure in the mucosa of the nasal septum. This organ is a component of the accessory olfactory system.

The olfactory area of the cerebral cortex is closely associated with the limbic system, the part of the brain that organizes emotional responses, mood, memory, and sexual arousal. Elicited by caress.

The perception of any scent associated with pheromones varies from individual to individual and depends largely on bacteria. The bacteria itself may be needed to chemically interact with there pheromones to make them active(17). Diet, Bathing habits, and general health also affect the quality of these scents. The predominant odor associated with male pheromones is musk. Nearly all human cultures esteem the rich, earthy, musky pheromone rich scent produced by the glands in the foreskin. Perfume makers obtain musk from the foreskin glands of the musk deer. The nonhuman pheromones contained in this musk are unable to elicit sexual arousal in humans, but the fragrance of the musk itself, by association may elicit a pleasant response in humans that evokes sympathetic erotic arousal(18). This is, at least, the effect that the perfume industry hopes to create.

If you wish to learn more regarding the effect circumcision has on the female partner then I recommend this literature for further reading:
K. O'HARA and J. O'HARA. The effect of male circumcision on the sexual enjoyment of the female partner. BJU INTERNATIONAL, Volume 83, Supplement 1, Pages 79-84,
January 1, 1999. http://www.cirp.org/library/anatomy/ohara/

(1)Cold CJ, Taylor JR. The prepuce. BJU Int 1999 Jan;83:34-44. [here, p.41]
(2)Hyman AB, Brownstein MH. Tysons's "glands": ectopic sebaceous glands and papillomatosis penis. Arch dermatol 1969 Jan;99(1); 31-6
(3)Parkash S, Jeykumar S, Subramanyan K, Chaudhuri S. Human Subpreputial collection: its nature and formation. J Urol 1973 Aug 110(2):211-2

(4)Parkash S. Penis: some facts and fancies. Journal of Physician's Association pf Madras June 1982: pp.1-13
(5)Ahmed A, Jones AW. Apocrine Cystadenoma: a report of two cases occurring on the prepuce. Br J Dermatol 1969 Dec; 81(12):899-901.
(6)Weiss GN, Sanders M, Westbrook KC. The distribution and density of Langerhans cells in the human prepuce: site of diminished immune response? Isr J Med Sci 1993 Jan;29(1);42-3
(7)Flower PJ, Ladds PW, Thomas AD, Watson DL. An immunopathologic study on the bovine prepuce. Vet Pathol 1983 Mar;20(2):189-201.
(8) See references under for Sexually Transmitted Diseases (STD’s), Other Heath Claims, and Circumcision
(9) Hanson LA, Karlsson B, Jalil F, et al. Antiviral and antibacterial factors in human milk. In: Hanson LA, ed. Biology of Human Milk. New York Raven Press; 1988. pp. 141-57
(10) Coppa GV, Gabrielli O, Giorgi P, Catassi C, Montanari MP, Veraldo PE, Nichols BL. Preliminary study of breast feeding and bacterial adhesion to uroepithelial cells. Lemcet 1990 Mar 10;335(8689):569-71.
(11) Flower PJ, Ladds PW, Thomas AD, Watson DL. An immunopathologic study on the bovine prepuce. Vet Pathol 1983 Mar;20(2):189-201.
(12) Ahmed A, Jones AW. Apocrine Cystadenoma: a report of two cases occurring on the prepuce. Br J Dermatol 1969 Dec; 81(12):899-901.
(13) Frohlich E Shamburg-Lever G, Klesses C. Immunelectron microscopic localization of cathepsin B in human apocrine glands. J Cutan Pathol 1993 Feb;20(1):54-60

(14) Ahmed AA, Nordlind K, Schultzberd M, Liden S. Immunohisto chemical localization of IL-1 alpha-, IL-1 beta-, IL-6- and TNF-alpha-like immunoreactivities in human apocrine glands Arch Dermatol Res 1995;287(8):764-6
(15)Halata Z, Munger BL. The Neuroanatomical basis for the protopathic sensibility of the human glans penis. Brain Res 1986 Apr 23;371(2):205-30.
(16)Taylor JR, Lockwood AP, Taylor AJ. The prepuce: specialized musocsa of the penis and its loss to circumcision. Br J Urol 1996 Feb;77(2): 291-5
Bazett HC, McGlone B, Williams RG, Lufkin HM. Depth, distribution and probable identification in the prepuce of sensory end-organs concerned in sensations of temperature and touch; thermometric conductivity. Archives of Neurology and psychiatry 1932 Mar; 27(3):489-517
Ohmori D. Uber die Entwicklung der Innervation der Genitalapparate als peripheren Aufnahmeapperat der Genitalen Reflexe. Zeitschrift fur Anatomie und Entwicklungsgeschichte 1924;70(1):347-410.
De Girlamo A, Cecio A [contribution to the knowledge of sensory innervation of the prepuce in man]. Boll Soc Ital Bio Sper 1968 sep 30;44(18):1521-2
Dogiel AS. Die Nervenendigungen in der Haut der ausseren Genitalorgane des Menschen. Archiv fur Mikroskopische Anatomie 1893:41:585-612
Bourland A, Winkelmann RK. [ The innervation of the prepuce of a new born infant]. Arcg Belg Dermatol Syphiligr 1965 oct;21(2):139-53

Winkelmann RK. The Cutaneous Innervation of the human newborn prepuce. Invest Dermatol 1956 Jan;26(1):53-67
Winkelmann RK. The erogenous zones: their nerve supply and its significance. Proceedings of the staff meetings of the Mayo Clinic 1959 Jan21(2):39-47
(17) Cohn BA. In search of human skin pheromones. Arch Dermatol 1994 Aug; 130(8):1048-51
(18) Berliner DL, Jennings-White C, Lavker RM. The human skin: fragrances and pheromones. J Steroid Biochem Mol Bi

more about the immunological and hygienic foreskin functions here:

http://intactipedia.org/index.php?title=Immunological_and_Protective_Function_of_the_Foreskin

If an advocate of female genital cutting tried to use the reduced risk of vulvar cancer in women as a justification for cutting the genitals of girls we would be outraged. In my opinion there is no ethical difference between an advocate of female genital cutting using the reduced risk of vulvar cancer to justify cutting the genitals of girls and an advocate of male genital cutting, like Jake, using the reduced risk of penile cancer to justify cutting the genitals of boys.

Sorry, Craig, but Bob is essentially correct here. Various anti-circumcision authors have *claimed* a variety of purported functions of the foreskin, but they have not been able to provide anything approximating proof of these functions. Furthermore, scientific hypotheses must always be tested to see whether they represent a correct understanding of the subject matter, and their claims are largely contradicted by the available evidence. For example, consider Fleiss, Hodges, and Van Howe, whose claims regarding "immunological function" you've plagiarised above. If their claims were correct, one would expect to see lower rates of local inflammation, but in fact every study (with the exception, coincidentally, of Van Howe) has found higher rates.

there is no debating the mechanical or the innervation of the foreskin that's for sure.

how many Americans know your are not supposed retract the foreskin. i bet the data would look very different if people knew how to take care of the penis properly with out inflicting damage on it.

Jake: "Various anti-circumcision authors have *claimed* a variety of purported functions of the foreskin, but they have not been able to provide anything approximating proof of these functions."

I wonder what the response would be if an advocate of female genital cutting wrote, "Various anti-circumcision authors have *claimed* a variety of purported functions of the labia minora, but they have not been able to provide anything approximating proof of these functions."

When talking about neonates, the words prostitutes, sex and HIV should never be coupled. Since when does a neonate get exposed to HIV via his penis?

Since when do we look at babies' penises in an aesthetic sort of way? Isn't that pedophilia?

You are aware that neonates grow to become adults, aren't you?

Yes, neonates grow to become adults who have their own ideas about what permanent body modifications they want to have done to their own body. Because there is no compelling medical reason to cut off a baby boys healthy foreskin, the decision should be left for him to make for himself as an adult.

So, then, sex and consequently HIV are relevant to neonates. The question of whether circumcision should be performed in infancy is a separate matter, and one which you clearly have strong beliefs about.

How do you get to the conclusion that HIV is relevant to neonates? If neonates were later in the life cycle then perhaps but this is not the case. It is not a separate matter. You apparently have strong beliefs about it, too, which is quite apparent in quite a few websites.

"How do you get to the conclusion that HIV is relevant to neonates?" Because neonates grow to become adults, who (generally speaking) have sexual intercourse, and who are therefore potentially exposed to HIV.

Potential exposure to HIV (and other viruses) as an adult does not warrant circumcision as a neonate regardless of effectiveness of the procedure as an adult in any area of the world.

I can't believe my eyes!

and no reply from Jake, is there? LOL ... he promotes his fetish yet can't deny that it should not be performed on minors without their expressed consent as is the case with every other cosmetic surgery in the medical industry and is a violation of medical ethics. In fact, I believe in every other case of surgery without consent - it is illegal.

No, Michael, it's not a violation of medical ethics at all. Circumcision is justified by normal standards of medical ethics because of the medical benefits associated with the procedure, or more specifically the benefit-risk balance. For detailed analysis, see: http://www.circs.org/index.php/Library/Benatar2

Incidentally, please do not make libellous allegations about fetishes. Thank you.

Whats the benefit risk balance on breast amputation? Where is the data?. Why have we not tried to figure out if this is good. The Benefits tend to outweigh the risks and harms when you overstate the benefits and understate the risks and harms.

There is no benefit to neonates. It has not been proven. It, ethically speaking, can not be proven without submitting neonates to crazy medical studies.

Where are the rights of the child? Regardless of the benefits to the adult male, after procedure ON an ADULT male, there are absolutely no proven benefits to neonates. Given that there are no proven medical benefits, it is an ethical mistake and quite possibly illegal to force a neonate to undergo a cosmetic procedure.

I do not make the allegations. I am just repeating public knowledge.

Medical ethics HAVE been violated. Surgical procedures require a surgical consent form which , for OBVIOUS reasons (read: neonates have no ability to consent), can not be signed by the patient. Who is the patient? The neonate is the patient and NOT one of the parents or guardians. It may be standard practice to allow parents to consent to the procedure but it is becoming a topic of legal discussion. Standard practice or status quo is not always right.

In cases of incapacitation, loved ones can give an idea of what the patient would want but the decision is left to the physician or surgeon to act in the patients behalf. Now comes the question if a circumcision is such a necessary procedure such that medical staff must override patient consent for a cosmetic procedure - one that does not benefit the patient. (e.g. - "oh while I've got her under I might as well give her a boob job.")

"There is no benefit to neonates. It has not been proven." -- on the contrary, the benefits are now well established.

Really? WOW! Show me the money! I want proof. You can't get away that easily.

Look at the AAP or AMA policy statements: http://aappolicy.aappublications.org/cgi/content/full/pediatrics;103/3/686 http://www.ama-assn.org/ama/no-index/about-ama/13585.page

yes a very well documented state of Nero genic shock.

http://knol.google.com/k/circumcision-and-human-behavior#

http://www.cirp.org/library/pain/

http://www.cirp.org/library/psych/

actually you have provided only very weak evidence.

FGM is more similar then you think. You have no evidence to prove me other wise just what ever arbitrary stars quo of your primitive cultural indoctrination. very unscientific of you. BTW if read my sources have the references you can read them yourself because those ARE peer reviewed and CIRP has British medical journal recognition. It is you using ad hominem attacks now

its not may fault circumcised women can orgasm, i don't get to decide this stuff. How come you don't push these study's?

Some studies seem to suggest that circumcised women are less prone to HIV due to the reduction in the number of Langerhans and CD4 cells. An argument that is also used to claim that male circumcision prevents HIV. Langerhands cells actually play a protective role against HIV. But as you can see the same biologic plausibility claim that exist for MGM also exists for FGM.

One study concluded:
“Risk of HIV among women who had undergone Female Circumcision is roughly half that of women who had not. Association remained significant after adjusting for region, household wealth, age, lifetime partners, and union status.”(5)

Another study concluded:
“Women who have undergone Female Circumcision have a significantly decreased risk of HIV-2 infection when compared to those who had not.”(6)

(5)Stallings et al. Female circumcision and HIV infection in Tanzania: For better or for worse? 3rd IAS conference on HIV pathogenesis and treatment International AIDS Society. 2009
(6) Kanki P, M'Boup S, Marlink R, et al. "Prevalence & risk determinants of HIV type 2 (HIV-2) and human immunodeficiency virus type 1 (HIV-1) in west African female prostitutes Am. J. Epidemiol. 136 (7): 895-90

if you like genital cutting so much why not women?

Types of FGM vary widely. The most common FGM is a "sunat" removal of the clitoral hood (female circumcision), which removes less tissue then male circumcision. infibulation or sewing the vagina shut is uncommon(1). I find it interesting that infibulation is usually the first thing that is mentioned when discussing FGM in America.

One myth that is often stated by misinformed feminist is that removing the exposed portion of the clitoris is like "removing a whole penis". Most of the clitoris is internal and it actually rivals the penis in size. The dorsal portion of the vaginal wall is actually the clitoris as its erectile tissue runs along it. (2) Hence this myth is a gross exaggeration.

It is not necessarily done with the sole intent of removing pleasure, as it very well may be in some cultures. It is often done for "hygiene", rite of passage from girl to woman, culture, tradition, religion, cosmetics, and conformity. For instance in Sierra Leone, where almost all women are circumcised with a clitoridectomy(removal of the exposed portion of the clitoris); the circumciser is always a women, It is a feminine matter, and it is governed by the women of the tribe.(3) Most circumcised women exhibit the same behavior as circumcised men including the denial of loss, and the compulsion to repeat the trauma. Myths generated by western feminism grossly over exaggerate the harms, understate the “benefits”,effectively over simplifying this very complex issue which demonstrates their true lack of knowledge regarding the issue. Truth is they do it for all the same myths and misconceptions that we use to circumcise males. No mother says, "OK, time to mutilate my daughter" if they knew it was harmful they would not do it. FGM victims often do not think of them selves as mutilated or dysfunctional. The victim defines the level of damage. Some of these women, some of which are even doctors, write articles where they claim the clitoris has no proven function, and that it looks much better with out one, and that it prevents HIV, and so on and so fourth.

In a well publicized statement ,that I encourage you to read, entitled a Statement by African Women Are Free to Choose made many interesting remarks. One of these went like this:

"That FC was designed by men to control women's sexuality is a western feminist myth constructed in a disturbing dismissal of African gender models of male and female complementarity and of our own creativity, power and agency as adult women in the social world."(3)

(1)World Health Organization. (2010). Eliminating Female Genital Mutilation: An Interagency Statement. World Health Organization. http://tinyurl.com/2nfjmq
(2)Sharon Mascall. Time for rethink on the clitoris. BBC News. June 2006 http://news.bbc.co.uk/2/hi/5013866.stm
(3)Statement by African Women Are Free to Choose (AWA-FC), Washington DC, USA February 20, 2009 http://www.thepatrioticvanguard.com/article.php3?id_article=3752

One you tube user and FGM victim who hosts a channel and goes by the name of CleanSexy experiences a strong emotional compulsion to promote FGM.(7) She is a Muslim and in her culture she has been subjected to all the same health rationalizations for FGM as we have been for MGM. Here we can observe that the same results of cultural indoctrination are applicable to both men and women. She has managed to find all the rationalizing literature she needs to back her assertions. She has been endorsing several academic publications including the ones I mentioned above. She was circumcised in a sterile hospital setting. Below is some of her quotes.

“Calling female circumcision "mutilation" only strengthens the movement for more circumcision, because nobody likes propagandistic hyperbole rhetoric. i.e., you only make it more obvious that anyone who is against circumcision is an irrational radical.
...
Don't feel sorry for me, my bits are improved and enhanced. Sex is better, I'm cleaner, and I'm safer. Your jealousy is overwhelming.
...
Yes, I was circumcised, and I'm glad. If I wasn't circumcised, I would get circumcised. The clitoris is a disgusting piece of flesh, and the labia only serves to hold in bacteria and yeast.
...
Why wait when you know it's better to be circumcised? I've yet to talk to a woman who was circumcised that wasn't glad she was circumcised. The only women I hear who are against female circumcision haven't been circumcised. How would they know if they haven't had it both ways? I was 12 when I was circumcised...
and no, it didn't hurt much, some people make a big deal out of nothing. The bottom line is, female circumcision reduces your risk of contracting HIV by at least 50%. Circumcision saves lives... MILLIONS of lives. It's irrational not to support it.
"

In a particular you-tube video, a supporter of legalizing FGM in America has reasoned that the same health,cosmetic, and hygienic myths Americans have regarding MGM can be logically applied to FGM as well.(8)

(7) http://www.youtube.com/user/cleansexy#p/u
(8) http://www.youtube.com/watch?v=9r46b-Lm25s&lc=LZeUwNIfS1RodPDDAph2-aJpJnoUlaPhFVsNpFzqFh0&lcf=cs

so what we have here bob is a circumcised man (YOU) engaging in the same behaviour as this women i just mentioned. It is very well documented in the psyc literature on circumcision.

http://knol.google.com/k/circumcision-and-human-behavior#

http://www.cirp.org/library/pain/

http://www.cirp.org/library/psych/

Craig, you wrote: "Some studies seem to suggest that circumcised women are less prone to HIV due to the reduction in the number of Langerhans and CD4 cells."

As I've explained to you previously, cherry-picking studies proves only your ability to cherry-pick. Only a small minority of studies (two of eleven) have found reduced risk in women who had undergone female genital cutting; see http://en.wikipedia.org/wiki/Female_genital_cutting#HIV

yes and as i explained to you. WHERE IS MY STUDIES ON MEDICAL FEMALE CIRC. O weight you don't have any. Wheres my RCT's Where my cotton swabs? where is my UTI studies? WHERE ARE THEY!!!!!!!!!!!

if female circ does not work also it sure as hell not helping your CD4 and Langerhans cell claim. If oyu want male circ to prevent HIV you should want it to female circ to prevent HIV also.

Female circumcision can logically be used to prevent and treat any of these aliments:

HIV( if a reduction in cd4 and langerhans cells works for men it would also work for women) ,ADHESION'S AND SMEGMA, clitorism, Vestibulitus, Vulvar Dystrophy, Melanoma cancer of the vulva, Adenocarcinoma of the vulva, Hyperplasia, Vulvar intraepithelial neoplasia, Paget's disease, Aphthous ulcers, Behçet's disease??? this one could KILL YOU!!!!!!!!!! ,

If women are getting HIV thru dirty circumcision implements then the study is garbage. we need medical female circ study's. BTW where female circ is done in unsanitary conditions female circ is also done in the same unsanitary conditions.

"If oyu want male circ to prevent HIV you should want it to female circ to prevent HIV also." -- perhaps, but wanting something won't make it happen. The way the world actually works often has little relationship to the way we'd like it to work.

doubt full. how do your let your flawed internet surveys slip by with out any critical lens. Bias much?

t is also very important to note that Langerhans cells that are present in the foreskin produce Langerin, a substance that has been proven to kill the HIV virus on contact.(2) Pro-circumcision advocates claim that Langer cells allow for the entry of the HIV virus, however Langerhans cells exist though out all the skin of the penis therefore it would not be logical to remove all the skin of the penis to prevent HIV.
(2)de Witte L, Nabatov A, Pion M, et al. Langerin is a natural barrier to HIV-1 transmission by Langerhans cells. Nat Med 2007 (Published on line ahead of print March 4).

this is the conclusion from the most recent HIV meta analysis of all available literature

"The demographic evidence indicates that the relationship
between male circumcision and HIV seroprevalence is
complex, and that both positive and negative relations can
be found for a variety of reasons. No evidence of an overall
protective effect of male circumcision was found for the
countries studied, and if there is an effect at the individual
level it is buried in a mix of many other intervening factors.
"

Michel Garenne. African Journal of AIDS Research 2008, 7(1): 1–8.

when the RCT's came out the first Cochrane Collaboration Report on circumcision cautioned about researcher bias, stating:
“Circumcision practices are largely culturally determined, so there are strong beliefs and opinions
surrounding them. It is important to acknowledge that researchers’ personal biases and dominant
circumcision practices of their respective countries may influence interpretation of findings.”13

13. Siegfried N, Muller M, Volmink J, Deeks J, Egger M, Low N, Weiss H, Walker S, Williamson P. Male circumcision for prevention of heterosexual acquisition of HIV
in men (Cochrane Review). In: The Cochrane Library, Issue 3, 2003. Oxford.

why have i never seen a Japanese or Indian, or south American researcher publish a circ study that claims benefit?

"why have i never seen a Japanese or Indian, or south American researcher publish a circ study that claims benefit?" -- my guess would be that you haven't looked hard enough. In only a few minutes of searching I found one study from each country: Favorito LA, et al. Epidemiologic study on penile cancer in Brazil. Int Braz J Urol. 2008 Sep-Oct;34(5):587-91; Hayashi Y, et al. Prepuce: phimosis, paraphimosis, and circumcision. ScientificWorldJournal. 2011 Feb 3;11:289-301; Dandona L, et al. Risk factors associated with HIV in a population-based study in Andhra Pradesh state of India. Int J Epidemiol. 2008 Dec;37(6):1274-86

what are those authors circ status? and what where thier conclusions? Do you have any thing to say about this one?

Michel Garenne. African Journal of AIDS Research 2008, 7(1): 1–8.

"what are those authors circ status?" -- I neither know nor care.

"and what where thier conclusions?" -- read the studies & find out for yourself.

"Do you have any thing to say about this one? Michel Garenne. African Journal of AIDS Research 2008, 7(1): 1–8." -- I haven't been able to find the full text of the paper; only an abstract. It appears to be a meta-analysis of observational data collected in fourteen sub-Saharan countries. As such, it is weak evidence at best: now that randomised controlled trials are available, observational studies are of limited relevance at best.

would a study on the change in sexual behaviour of men in the first 20 months after being circumcised change the value of these RCts?

I posted my RCT criticisms above in response to your first post.

It is worth noting that Hayashi's article discusses effective, less-invasive treatments rather than trying to justify circumcising children. Hayashi wrote, "Various kinds of effective alternatives to circumcision have been described, including manual retraction therapy, topical steroid therapy, and several variations of preputioplasty. All of these treatments have the ability to retract the foreskin as their goal and do not involve the removal of the entire foreskin."

Really, Bob? Your children will appreciate genital cut job? Is that because parents tell their kids to appreciate it? They are made to feel guilty if they don't appreciate their mutilation?

I am sorry that you were misinformed.

because it is genital mutilation.

Jesse, great health effects? When they get older? Huh? You actually paid for that surgery? What will you tell them when they get older and they notice foreskins on other boys? Will you tell them that you like it that way? Will you tell them they have no authority to make a decision like that about their own body when they are older? ... especially for a grown up disease like HIV...

No, Lori, I can't take the credit for all the editing; just some of it. And yes, I've edited the article on female genital cutting, too. I'm puzzled, though, by your claim that my edits make the articles unreliable. Could you name some specific inaccuracies that I've introduced? This shouldn't be difficult for you to do; the complete history of every article is publicly available, so my changes are easy to identify.

More to the point, in what specific way is the article on female genital cutting inaccurate? Since we're discussing the eleven studies of FGC and HIV, are you claiming that these studies are misrepresented? If so, which studies are misrepresented? I'm sure you will understand that it's important to provide specifics; after all it wouldn't be appropriate to try to dismiss inconvenient evidence through vague unspecified claims of unreliability.

i talk about FGC HIV studies above you can discuss them there.

knowing Jakes history his bias is obvious.

Craig:

"i talk about FGC HIV studies above you can discuss them there." -- to be perfectly honest, Craig, I skip most of your posts as they're clearly copied and pasted, being identical copies of posts that you've made in previous discussions. If you want me to address a specific point that you haven't made before, please identify the post (preferably by quoting its timestamp) and I'll be happy to respond.

1:23pm on Wednesday, March 23, 2011

Jakew: If you want evidence of your bias on wikipedia, here are a couple instances. You try to discredit every instance of the Sorells study, using your own letter to the BJU, in which you attempt to repeat the mistakes of previous studies on the subject, by ignoring the datapoints involving the foreskin. You include the silly statistic from Szabo and Short (which you've also used on this thread) which states that "An examination of 7 circumcised and 6 uncircumcised males found no difference in keratinization of the glans penis."13 men is a laughably small sample size, Szabo and Short were not actually performing a study on keratinization, and the 13 "men" were actually 60+ year old cadavers - hardly representative of the general population. That's just off the top of my head.

Hello Kyle. You've provided evidence that you disagree with two of the sources cited at Wikipedia (and apparently that you misunderstand one of those sources), but that isn't evidence of bias. It's just evidence of disagreement. For what it's worth, I disagree with plenty of sources cited by Wikipedia.

It's more than just disagreeing with the sources. By neglecting to mention that the Szabo and Short statistic was performed on 60+ year old cadavers, you are being deliberately misleading.

Come on, Kyle, such hyperbole is unnecessary. Accusations of being "deliberately misleading" are unjustified. In any article - Wikipedia or otherwise - there's only a finite amount of space, and the author(s) try to make best use of the available space to express the most important points. This is no exception.

In my personal opinion, the age of the subjects is a trivial, unimportant detail, and the fact that they were dead should surely be obvious to anyone who thinks about it (even the most cooperative living patient is unlikely to permit sections of his glans to be removed for microscope slides, at least not in the absence of disease). Unless I had a very large amount of space, then, I'd be unlikely to mention these issues, as I'd consider them unimportant trivia. Personally I'd be more likely to mention the sample size, which seems a more legitimate comment, but it would depend on available space and the appropriate level of detail for the subject matter.

Generally speaking, if you feel that Wikipedia would benefit from changing the presentation of this or other sources, make such a proposal on the 'discussion' page associated with the relevant article(s).

"there's only a finite amount of space, and the author(s) try to make best use of the available space to express the most important points." Finite amount of space, on a wiki article? I'm not sure that I understand what you mean here. It's not like you're going to run out of paper or overload disk capacity by using "60+ year old cadavers" instead of the word "males."

Jake, considering your connection to circumfetishists, any edit you make to Wikipedia should be considered to be biased and unreliable.

Kyle, it's important to take context into account. In some articles, keratinisation of the glans warrants only the briefest mention, and any more would be excessive. In any case, it seems inappropriate to continue discussion here - again, I invite you to post a proposal at the appropriate discussion pages.

Michael, don't make such ridiculous allegations.

Ridiculous allegations? What allegation? I am not alleging anything.

I think saying to someone, "considering your connection to circumfetishists" counts as an allegation. Perhaps you don't, I don't know.

My pleasure, Lori. So, are you able to identify any of these inaccuracies, Lori? Or can I presume from your silence that you cannot?

personal autonomy and the trauma involved is also part of a child's over all health. far more important then a silly and easily treatable UTI which only happens to less then 1% of children any way.

So are you claiming that the list of studies is incomplete, and that there are huge numbers of studies, *not* cited, which find a protective effect of FGC against HIV? Can you list some of these studies? Even one?

there flawed because we need study's on sterile medical female circ. if they get infected with unsterile instruments how can you analyze their risk?

Most of the early studies of (male) circumcision and HIV involved patients who had undergone "bush" circumcisions - ie., circumcisions not performed in a sterile medical environment. And yet these studies still showed evidence, for the most part, of a protective effect of circumcision. This suggests that the protective effect of circumcision was greater than the risk of infection due to lack of sterile instruments. Can you explain why female genital cutting should be different - if, as you claim, it has an equal protective effect, then shouldn't that protective effect similarly outweigh the risk due to non-sterile instruments?

well most of the observational study's as you say on wiki have no significant effect noticed. this is true for NUMEROUS observational study's on male circ as well.

how ever a different surgical procedure with different blood loss COULD place the female to exposure to HIV more then a male circ which is a quicker ritual especially for the ritual where they chop the foreskin with a knife after pulling ti forward with string. More exposure time during surgery could be greater chance of HIV contraction.

"this is true for NUMEROUS observational study's on male circ as well." -- let's look at some numbers, shall we? Of the studies listed at Wikipedia's FGC article (which is not by any stretch of the imagination a systematic review, but it's the best we have available), two find a protective effect, one finds a harmful effect, and the remaining eight find (to simplify slightly) no significant differences. Now let's look at (male) circumcision. Using Weiss et al.'s 2000 meta-analysis (since it reports on the numbers), 21 of 27 studies found a protective effect (http://www.ncbi.nlm.nih.gov/pubmed/11089625). In other words, 82% of FGC studies did *not* find a protective effect, while 78% of circumcision studies *did* find a protective effect.

there are alot more then 27 studies. Where are those?

Its also worth noting who weiss is.

these found no trend of a benefit

Michel Garenne. African Journal of AIDS Research 2008, 7(1): 1–8.

Connolly C, et al..Male circumcision and its relationship to HIV infection in South Africa: Results of a national survey in 2002. S Afr Med J 2008;98:789–94.

Talbott JR. Size Matters: The number of prostitutes and the global HIV/AIDS pandemic. PloS One. 2007;2(6): e543.

A recent study performed by researchers without any declared conflicts of interest concluded.

"Circumcision status was not associated with HIV/HSV-2 infection nor increased high risk sexual behaviors. In males, preference for being or becoming circumcised was associated with inconsistent condom use and increased lifetime number of sexual partners." (14)

This study also reveals the moral hazard this circumcision campaign has created in Africa. People may mistakenly assume circumcised men are immune to HIV infection, therefore validating reckless sexual behavior. In any event condoms have proven to be far more efficacious then circumcision could ever be.

(14)Westercamp M, Bailey RC, Bukusi EA, Montandon M, Kwena Z, et al. (2010) Male Circumcision in the General Population of Kisumu, Kenya: Beliefs about Protection, Risk Behaviors, HIV, and STIs. PLoS ONE 5(12): e15552. doi:10.1371/journal.pone.0015552 http://tinyurl.com/4tmaal8

one ought to wonder how 21/27 is possible. How/why where opposing studies excluded?

Craig, I agree that many more than 27 studies have now been published. I don't know how many studies had been published in 2000 - I'd guess more than 27, but probably not a lot more. Bear in mind that their meta-analysis only considered sub-Saharan Africa, so studies performed elsewhere would have been excluded.

All of the studies you cited were published after 2000. It should therefore be unsurprising that they were not included in Weiss' meta-analysis, which was published in 2000. In any case, the ratio observed in Weiss et al seems to hold for more recent studies, with about 4 finding a protective effect to one finding no protective effect. You can easily verify this for yourself by going to PubMed (http://www.ncbi.nlm.nih.gov/pubmed/) and searching for 'circumcision hiv'.

earlier i cited a 2008 meta analysis that found no clear association. Also sub Saharan south Africa is one of the only places in Africa where HIv is less common among circumcised men(1). Coincidence?

(1) Vinod Mishra, Rathavuth Hong, and Yuan Gu, and Amy Medley and Bryant Robe . Levels and spread of HIV seroprevalence and associates factors: evidence form national household surveys. USAID 2009 Feb; 51-53

this 2008 meta analysis was done by a non bias author using publications form both sides INCLUDING the RCTS and Weisses 2000 meta analysis. and found no clear association.

Michel Garenne. African Journal of AIDS Research 2008, 7(1): 1–8.

http://www.google.com/url?sa=t&source=web&cd=1&ved=0CBgQFjAA&url=http%3A%2F%2Fwww.circumcisionandhiv.com%2Ffiles%2Fajar2008garennelong_term_effect_of_male_circumcision.pdf&rct=j&q=Michel%20Garenne.%20African%20Journal%20of%20AIDS%20Research%202008%2C%207(1)%3A%201%E2%80%938.&ei=-HaKTeLTOIO-tgeH3Pn2DQ&usg=AFQjCNEX1CWVl3q-s3UpgUSFe4m3zH8oXA&cad=rja

Craig, your link doesn't work, but apparently you mean Garenne's "Long-term population effect of male circumcision in generalised HIV
epidemics in sub-Saharan Africa". First of all, it didn't include Weiss's meta-analysis, obviously, as it makes no sense to include a meta-analysis in another meta-analysis. Nor, reading Garenne's paper, did he include the RCT results. Instead, he included (see p3, 2nd column) data from Demographic and Health Surveys conducted in thirteen countries.

(Incidentally, I'm perplexed by your description of Garenne as a "non bias [sic] author" -- did you not know that Garenne presented a paper at NOCIRC's tenth symposium? Presenters at anti-circumcision conferences are generally anti-circumcision, I'd say... Not that it matters.)

not that it matters but

A RCT was carried out in Kenya under the supervision of North American circumcision proponent Robert C. Bailey and Stephen Moses; and a RCT was carried out in Uganda under the supervision of North American circumcision proponent Ronald H. Gray. Dr. Auvert has been a circumcision proponent since at least 2003. Professor Moses has been an advocate of circumcision at least since 1994. Professor Bailey has been a circumcision advocate since at least 1998.

its also worth mentioning this from: http://intactamerica.org/sites/default/files/DangerousMistake.pdf

A number of factors present in the studies warrant caution in extrapolating results to larger populations.
More than 700 participants were lost to follow-up, their HIV status unknown. In other words, 4.5 times
more participants were lost to follow-up than were reported to have been protected from HIV by
circumcision. Further, a number of reported HIV infections were contracted non-sexually.11 Unlike in a
real-world setting, study participants were provided free condoms, extensive education and counseling,
and they were paid—all of which could have biased the results.
All three RCTs were halted earlier than contemplated in the original study designs. In one study, the
circumcised men’s infection rates were increasing (studies terminated early tend to overestimate the
treatment effect12). All participants not initially circumcised were then offered circumcision, eliminating
the possibility of a follow-up. We will never know if the short-term effect was permanent.

The first Cochrane Collaboration Report on circumcision cautioned about researcher bias, stating:
“Circumcision practices are largely culturally determined, so there are strong beliefs and opinions
surrounding them. It is important to acknowledge that researchers’ personal biases and dominant
circumcision practices of their respective countries may influence interpretation of findings.”13 The
Cochrane Collaboration has since issued another report, which no longer warns against researcher bias,
and, rather mystifyingly, proclaimed that no more research is needed on the relationship between
circumcision and HIV.14
The only certain conclusion that can be drawn from the RCTs is that while circumcision might delay HIV
infection for circumcised males at high risk, it has no effect on infection rates for women, and is irrelevant
for children.

"More than 700 participants were lost to follow-up, their HIV status unknown. In other words, 4.5 times more participants were lost to follow-up than were reported to have been protected from HIV by circumcision" -- This is irrelevant, as there's no rational reason to suppose that drop-outs from the trials differed from non-drop outs in terms of the relationship between circumcision and HIV. In the absence of such a reason, the number lost to follow-up merely reduced the effective sample size somewhat. That's all.

"Further, a number of reported HIV infections were contracted non-sexually." -- true, but again, it doesn't matter unless there's a significant difference between the groups.

"Unlike in a real-world setting, study participants were provided free condoms, extensive education and counseling, and they were paid—all of which could have biased the results." -- this vague claim needs fleshing out. How could these have biased the results?

"The only certain conclusion that can be drawn from the RCTs is that while circumcision might delay HIV infection for circumcised males at high risk, it has no effect on infection rates for women, and is irrelevant for children." -- given that the RCTs did not study women or children, how can that be a certain conclusion from them? That's somewhere beyond illogical...

Having no effect on children is VERY logical, as children don't have sex.

What if among those 700 participants there was conveniently many HIV + circumcised males?

"this vague claim needs fleshing out. How could these have biased the results?" How much safe sex counselling was given to each group, was there more in the intervention group? What 'evidence' is there that this did not occur? Also as we have brought up the fact many times that the relationships between innumerable independent and dependent variables are near impossible to quantify. Therefore if the situation does not directly represent reality it would be difficult to assume it will work in reality by extrapolation.

i still maintain that a change in sexual behaviour in the first 20 months of being circumcised is the BIGGEST and most important variable that was not addressed in ANY WAY.

If the RCT's suggest any thing at all, it suggests that HIV acquisition is less only during the first 20 months of being circumcised.

"In one study, the circumcised men’s infection rates were increasing (studies terminated early tend to overestimate the treatment effect"

"What if among those 700 participants there was conveniently many HIV + circumcised males?" -- what if the moon's made of green cheese? Come on, is there any *rational* basis for believing that they differed from those who stayed in the studies?

"How much safe sex counselling was given to each group, was there more in the intervention group?" -- equal, according to reports.

its still a possible route to work in a bias, is all im saying.

One U.S. study showed that circumcised men were more likely to engage in riskier and "more highly elaborated" sexual practices including anal sex, and sex with multiple partners(13). These factors may not come into play for an intervention group immediately after circumcision. This also shows that sexual behaviors for those circumcised as infants may not reflect sexual behaviors of those circumcised as adults. Therefore results determined in circumcising an intervention group are not applicable to men circumcised as infants.
(13)Laumann EO, Masi CM, Zuckerman EW. Circumcision in the United States: prevalence, prophylactic effects, and sexual practice. JAMA 1997;277:1052-7.

Yes, Laumann actually found evidence indicating that this was due to cultural factors in the US, rather than an effect of circumcision per se. Take a look at the paragraphs beginning "The association between circumcision status and the various sexual practices exhibited differences across ethnic groups (Table 4). While circumcised men of all 3 ethnic groups tended to engage in more elaborated set of sexual practices, this was less true of blacks and Hispanics." and also that beginning "While we do not wish to push speculation too far, differences in the association between circumcision status and sexual practice across ethnic groups suggest that cultural, rather than physiological forces may be responsible."

true, very possible, but not proven. It certainly needs to be studied more. However assuming there is no difference is very poor presumption.

still shows you that stuff in Africa cant be extrapolated to the U.S. or vice versa. Behavioural differences could be seen due to cultural differences.

also in real world America, if intact men have less sex this will effectively protect them from STD's. Cultural factors should not be ignored.

also according to(1) intact men last longer hence they gain a longer exposure time. This could be a co-founder for studies that claim a benefit. However in the real world we know that a greater number of sexual partners is the greatest risk factor. If circumcision increases sexual behaviour in America it puts them at greater risk.

(1)K. O'Hara and J. O'Hara. The effect of male circumcision on the sexual enjoyment of the female partner. BJU International, Volume 83, Supplement 1, Pages 79-84, January 1, 1999.

increased exposure time could be especially relevant for intact Africans who have dry sex. Hence lasting longer in bed prolongs dry sex hence increasing risk for STDs due to an increased exposure time during dry sex. I doubt some newly circumcised men would resort to having dry sex soon after being cut.

from: http://www.hsrc.ac.za/Media_Release-321.phtml

"Mr Adera Osawa, the deputy secretary general of the Luo Elders - a community that do not practice circumcision – said there exist strong cultural emotions against circumcision and some ‘very derogatory words’ are used for someone who is circumcised. "

is it possible that circumcision is less accepted in these communities hence causing the newly circumcised participants to engage in less sex?

seems as tho some important cultural barriers where in place before the RCT'S :

http://www.ft.com/cms/s/0/89aa4676-dd42-11de-ad60-00144feabdc0.html#axzz1HXhBkM3R

"also according to(1) intact men last longer" -- Craig, would you please stop cherry-picking studies? It doesn't prove anything. Collins (2002) found no statistically significant difference. Likewise, Waldinger (2005), Richters (2006), Kim (2007), and Kigozi (2007) found no statistically significant differences. Senkul (2004), Shen (2004), Laumann (1997), Senol (2008), and Cortes-Gonzalez (2009) found an increase in ejaculatory latency associated with circumcision.

and what did they use, self reporting male egos?

in any event the cultural barriers could very well effect the RCT's by influencing sexual behaviour,

"is it possible that circumcision is less accepted in these communities hence causing the newly circumcised participants to engage in less sex?"

Could I ask you to read the studies yourself before asking these questions? Had you read the Kenyan study, you'd have found that:

"There was little difference between circumcised and uncircumcised men in change in sexual behaviour measures across the follow-up visits, with the exception of two or more partners in the previous 6 months (p=0·0383). There was a linear decrease across visits in the proportion of men in the control group reporting two or more partners in the previous 6 months, whereas the proportion reporting the same behaviour in the circumcision group fell from month 0 to month 6 and remained fairly stable thereafter. Focusing on change specifically from baseline to month 24, differences between the study groups were found for unprotected sexual intercourse (p=0·0349) and consistent condom use (p=0·0326), with individuals in the control group practising the safer sexual behaviours (table 4). Notably greater proportions of circumcised men reported riskier behaviours on all of the other three behavioural variables at month 24, although the differences were small and not significant."

hmm self reporting?

It is note worthy that Lou people, a population that is very prevalent in Kisumu, despise circ,

If you're so troubled by self-reporting, Craig, then why on earth did you introduce Laumann's finding, itself based on self-reported data? It doesn't seem terribly consistent or even rational to extrapolate from the results of study A (based on self-report) to a sample in study B, then reject contradictory data actually gathered as part of study B because it is gathered using self-report.

point taken, yet you have done the same.

but what about the Lou people?

speaking of self reporting:

This study suggests that adult circumcision adversely affects sexual function in a significant number of men, and the authors suggest that it may be due to loss of nerve endings in the removed skin. In addition, there was an approximately 9% incidence of severe penile scarring or uncomfortable erections from curvature or tethering after circumcision.

Kim D, Pang MG. The effect of male circumcision on sexuality. BJU International.

2007;99(3):619-22.

"point taken, yet you have done the same." -- doubtful, as I don't share your prejudice against self-reported data.

"but what about the Lou people?" -- presumably you mean Luo. What about them? Your claim that they despise circumcision is clearly wrong; a study of acceptability among Luo people reported that "Both men and women were eager for promotion of genital hygiene and male circumcision" http://www.ncbi.nlm.nih.gov/pubmed/11798403

"speaking of self reporting [...]" -- cherry-picking again?

"doubtful" you answer your own question right here "cherry-picking again". You value self reporting only when it agrees with you. Not that it would ever be worth any thing because of cognitive dissidence.

the Luo still don't traditionally do it.in the study did they tell them it would prevent HIV then ask them if they would be in favour it because that's called idea implantation.

""doubtful" you answer your own question right here "cherry-picking again". You value self reporting only when it agrees with you." -- no, I assign it equal value regardless of whether I agree or disagree. What I disagree with is cherry-picking of studies according to results that align with a particular agenda. If you want to discuss sexual sensation, let's look at *all* studies that have assessed that particular issue, not just Kim and Pang, but also Fink, Masood, Krieger, Cortes-Gonzalez, Masters and Johnson, Bleustein, Payne, Sorrells (both Sorrells' and Waskett and Morris's interpretation), Schober, and Richters. That way we can actually look at the state of scientific knowledge as a whole.

"Not that it would ever be worth any thing because of cognitive dissidence." -- so you keep saying.

"the Luo still don't traditionally do it.in the study did they tell them it would prevent HIV then ask them if they would be in favour it because that's called idea implantation." -- we can call it a lightly fried banana if you like; it doesn't really make any difference, because the fact remains that regardless of the reason they don't despise circumcision.

Lori,

I don't think I'm foisting my personal preferences on anyone: I've made it clear for some years that I'm supportive of both decisions - to circumcise or not to circumcise. I don't think I'm hiding behind Wiki, either, and am somewhat perplexed by that accusation.

As for your question as to whether other men "deserve to make the journey [I] did", which appears to be a reference to adult circumcision, I'm truly baffled. Do you mean the expense? The time off work? The period of abstinence during healing? The anxiety? The greater risk of complications? Which of these parts of adult circumcision do you imagine is the most enjoyable? It's not a lot of fun. In many respects, men who were circumcised as infants have it much easier.

Jake, you got to decide what permanent body modifications were done to your own body. Every other male has a right to make that decision for his own body.

A man with an intact foreskin can become circumcised at any time. On the other hand, a man who was circumcised as a child can never get his foreskin back. Once his foreskin is cut off it can never be restored. Foreskin restoration can never replace the nerves that were cut off by circumcision.

Because there is no compelling reason for non-Muslim and non-Jewish parents to circumcised their sons, each male has a right to make that decision for himself.

Stan:

"Jake, you got to decide what permanent body modifications were done to your own body. Every other male has a right to make that decision for his own body." -- I think we'll have to agree to disagree on that subject, Stan.

"A man with an intact foreskin can become circumcised at any time. On the other hand, a man who was circumcised as a child can never get his foreskin back. Once his foreskin is cut off it can never be restored. Foreskin restoration can never replace the nerves that were cut off by circumcision." -- no, a restored foreskin isn't identical to a natural one, but to be fair neither is the result of an adult circumcision identical to an infant circumcision either (the former invariably has more prominent scarring, for example). So it's more realistic to say that a man who is dissatisfied with his parents' choice (by which I mean either choice) will be able to do something about it, but it won't be exactly the same. It's a great shame that there isn't a single, easy choice which guarantees satisfaction, but unfortunately there isn't one.

Jake, what about forced separation. That causes damage to the glans that an adult circ would not experience.

Jake: "It's a great shame that there isn't a single, easy choice which guarantees satisfaction, but unfortunately there isn't one."

There is a single, easy choice that guarantees that every male gets to decide for himself what permanent body modifications are done to his own body.

"I think we'll have to agree to disagree on that subject, Stan."

So you SUPPORT mandatory, forced circumcisions? Surely you do not believe that a man should not have the decision for themselves! Who should have the soil decision? It really seems as though you are saying that a baby should be cut. You have rolled out all the reasons why an adult should be cut (which is fine ... perhaps) but you're saying that he should NOT have that choice.

Are you saying that we should have a government mandate? Is this Iran that we are living in?

"So you SUPPORT mandatory, forced circumcisions?" -- no, but I am supportive of parental choice, whether that is to circumcise or not to circumcise.

"Surely you do not believe that a man should not have the decision for themselves!" -- If a man should wish to be circumcised as an adult, I certainly think he should be able to do so, but otherwise I don't have strong views on the subject. I oppose those who would make adult circumcision the only option, as I think that's unjustifiable.

It is justifiable because all the alleged benefits regard STD's. Before that the harms and risks defiantly outweigh the benefits because all you really have is that silly UTI claim.

No, Craig, there are multiple non-STD benefits: reduced risk of acquired phimosis, balanitis, posthitis, and penile cancer, for example.

those are pretty lame excuses as they are not common, and easily treatable with out circumcision.

i have safety words for FGM too. failure to excise parts of the vagina can result in these aliments ADHESION'S AND SMEGMA, clitorism, Vestibulitus, Vulvar Dystrophy, Melanoma cancer of the vulva, Adenocarcinoma of the vulva, Hyperplasia, Vu...lvar intraepithelial neoplasia, Paget's disease, Aphthous ulcers, Behçet's disease??? this one could KILL YOU!!!!!!!!!! ,Eczema, Tinea, Hidradenitis suppurativa, Bacterial vaginosis, Lichen sclerosus et atrophicus, These benefits are AMAZING!! Why are women being denied these amazing benefits?

Penile cancer is so rare that it is irrational to even concern yourself with it. It is no more logical to amputate your toes to prevent toe cancer. In fact scar tissue is a known site for the development of cancerous growths. Many circumcised males that had penile cancer, had actually developed cancerous growth starting at the circumcision scar.(25) Scar tissue is known to have a tendency for cancerous growths. Speaking of toe cancer, musician Bob Marley died of cancer that developed at a scar on his toe. Why is it that people do not preemptively amputate their toes to entertain an irrational fear of toe cancer?

An unhealthy life style is the most likely cause of penile cancer. Since it is so rare it is physically impossible to acquire any statistically significant evidence that suggests penile cancer is prevented by circumcision. It is also impossible to account for the differences in life style between those who get penile cancer and those who don't, especially with such a small number of cases. Since these other factors are so much more significant, they generate tremendous experimental errors that is bigger then any claimed benefit due to circumcision. This is why outdated studies that suggest circumcision reduces penile cancer are invalid. As I discussed earlier, lower-class Americans were less likely to be circumcised then middle-class white males who were born in private hospitals where compulsory newborn circumcision had been instituted. So what ever slight relationship that was observed back then was never valid, and is even less valid for today.

Refrences:

(1)Bissada NK. Post-circumcision carcinoma of the penis. I. Clinical aspects. J Urol 1986; 135:283-5.

"those are pretty lame excuses as they are not common, and easily treatable with out circumcision." -- firstly, they're not excuses. Secondly, some are fairly common (balanitis, for example, affects about 12.5% of uncircumcised men), and thirdly we were discussing prophylactic benefits, not treatment.

"failure to excise parts of the vagina can result in these aliments" -- do you actually have *any* epidemiological studies indicating lower risk in women who have undergone FGC? Or are you speculating?

"Penile cancer is so rare that it is irrational to even concern yourself with it." -- it affects about one man in 1400 in the US. Among uncircumcised males, probably about 1 in 800-900.

"Since it is so rare it is physically impossible to acquire any statistically significant evidence that suggests penile cancer is prevented by circumcision." -- utter nonsense. It is perfectly possible to put together a case-control study providing such evidence, and several studies have done so.

"It is also impossible to account for the differences in life style between those who get penile cancer and those who don't, especially with such a small number of cases." -- it's relatively easy to do so through logistic regression models.

if the penile cancer benefit is so clear why is there no significant difference seen in the general population? By a reduction in penile cancer i presume you mean a reduction in foreskin cancer?

according to the American cancer society http://www.cancer.org/Cancer/PenileCancer/DetailedGuide/penile-cancer-key-statistics
"Penile cancer is very rare in North America and Europe. Penile cancer occurs in about 1 man in 100,000 and accounts for less than 1% of cancers in men in the United States.."
so what is 1/1400?

like i said, logistic regression model have their limits since penile cancer is so rare it is very difficult to isolate variables as lower class intact Americans who get penile cancer have confounding factors whose relationships with cancer are far to complex.

balanitis is still easily treatable, and circumcised boys are not immune to it. also, forced retracting could be a co founder here.

these are scare tactics. they overstate the dangers of these aliments to manipulate peoples fears

"do you actually have *any* epidemiological studies indicating lower risk in women who have undergone FGC? Or are you speculating?"

its reasonable to assume that missing body parts can not become cancerous

according tot he ACS: http://www.cancer.org/Cancer/VulvarCancer/DetailedGuide/vulvar-cancer-key-statistics

"in the United States, women have a 1 in 406 chance of developing vulvar cancer at some point during their life. "

according to wiki: "Most lesions originate in the labia, primarily the labia majora."

hence removing the labia would LIKELY prevent MUCH MORE CANCER THEN MALE CIRC

"if the penile cancer benefit is so clear why is there no significant difference seen in the general population?" -- What data are you referring to? The protective effect is clear in every study that has investigated.

"By a reduction in penile cancer i presume you mean a reduction in foreskin cancer?" -- I mean a reduction in any cancer affecting the penis, or any part thereof, obviously.

"so what is 1/1400?" -- one in 1,400 is the lifetime risk (to be exact, 1 in 1437; see Wingo PA, Tong T, Bolden S. Cancer statistics, 1995. CA Cancer J Clin 1995;45:8-30). The figure commonly quoted of roughly 1 in 100,000 is the annual risk -- the risk per man per year (it should therefore be no surprise that it is about 1/70th of the higher figure).

"like i said, logistic regression model have their limits since penile cancer is so rare it is very difficult to isolate variables as lower class intact Americans who get penile cancer have confounding factors whose relationships with cancer are far to complex." -- simple: include socioeconomic status in an analytical model. And contrary to your repeated claim, the rarity of penile cancer does not prevent it from being studied.

"its reasonable to assume that missing body parts can not become cancerous", true, but the scars left behind can develop cancers (as you acknowledged in your post dated 11:49am on Thursday, March 24, 2011). So the question is, would the reduction in risk due to removal of the labia be greater or less than the increase in risk due to the presence of scar tissue? Hence the need for epidemiological data.

labia cancer is still far more common then penile cancer, what is the life time risk of that?

Often those who die of penile cancer are old poverty stricken men who have had a poor lifestyle, and failed to report their developing condition for decades.. Penile cancer should be the least of their concerns. When detected early it is usually treated successfully.

even if circ did prevent penile cancer this only proves that missing body parts can not get cancer, if this is indeed the case preemptive breast amputation would be more then warranted as it is the number 3 killer of women.

well then we should get that data so that we know for sure what parts of the vagina we NEED to preemptively remove.

"labia cancer is still far more common then penile cancer, what is the life time risk of that?" -- I don't know if data are kept for cancer of the labia specifically; according to SEER the lifetime risk for all cancers of the vulva is 1 in 387.

"Often those who die of penile cancer are old poverty stricken men who have had a poor lifestyle, and failed to report their developing condition for decades.. Penile cancer should be the least of their concerns." -- there isn't a lot of evidence that this is "often" the case, though it can happen occasionally.

"When detected early it is usually treated successfully." -- this partly depends on the type of cancer. Carcinomas in situ often respond well to treatment. Invasive cancer less so, and has quite a high mortality rate.

"even if circ did prevent penile cancer this only proves that missing body parts can not get cancer" -- if the penis consisted of just the foreskin, you might have a valid point.

how many penile cancers start with carcinoma growth in the foreskin?

"how many penile cancers start with carcinoma growth in the foreskin?" -- an interesting question, but I'm getting a little tired of supplying basic information for you, so I'm afraid you'll have to find out for yourself. I'd be interested to know what you find out.

acording to the ACS

" Most of these cancers are found on the foreskin (in men who have not been circumcised) or on the glans. These tumors tend to grow slowly. If they are found at an early stage, these tumors can usually be cured."

if it works fore the foreskin i should work for the labia.

from the RACP statement
Cancer of the penis is extremely rare with an incidence of 1 in 250,000 Australian
men.[104, 105] The increased risk of cancer of the penis in uncircumcised men is strongly
associated with phimosis. A number of other factors including genital warts, smoking, past
sexually transmitted diseases, sexual relationship outside marriage, multiple sexual
partners, poor genital hygiene, previous genital conditions, penile rash (lasting longer than
1 month) or penile tear have all been identified as risk factors.[106-109] (Level 2+) A
Danish study has shown decreasing prevalence of penile carcinoma from 1.15 per
100,000 person years in 1943-7 to 0.8 per 100,000 person years in 1988-90 and given the
low and constant circumcision rates (2.3%), researchers have attributed the fall to
improved sanitary installations and associated penile hygiene.[110]

A study that concluded circumcision did not prevent penile cancer was done by Wallerstein, which reported that the risk of penile cancer in Japan, Norway, and Sweden (countries with a low rate of circumcision) is about the same (1 in 100,000 per year) as in the US.1
1. Wallerstein E (February 1985). "Circumcision. The uniquely American medical enigma". Urol. Clin. North Am. 12 (1): 123–32. PMID 3883617.

so what if circumcision prevents cancer this only suggests that if you have less body parts they can not become cancerous. that's pretty darn hysterical if you ask me.

"if it works fore the foreskin i should work for the labia." -- we've been over this already, Craig. There's no way of knowing whether the risk would be increased, reduced, or unaffected. The increased risk due to scarring might outweigh the reduced risk due to removal of the labia, or vice versa. One would need epidemiological evidence.

"A study that concluded circumcision did not prevent penile cancer was done by Wallerstein, which reported that the risk of penile cancer in Japan, Norway, and Sweden (countries with a low rate of circumcision) is about the same (1 in 100,000 per year) as in the US" -- the obvious problem with this analysis is that it compares only crude aggregate data and cannot isolate the effect of circumcision, as other differences between countries are inevitable. In epidemiology, such studies are called ecological studies, and they're considered to be one of the weakest designs. By the way, if you're going to quote Wikipedia's articles (as you've done here), could you please acknowledge the source, in accordance with the CC-BY-SA copyright license?

heres your cite http://en.wikipedia.org/wiki/Penile_cancer

well then we should get that data so that we know for sure what parts of the vagina we NEED to preemptively remove ESPECIALLY SINCE A WOMEN YEARLY RISK IS 1/470 and a mans is 1/10,000. This benefit could be immeasurable.

"ESPECIALLY SINCE A WOMEN YEARLY RISK IS 1/470 and a mans is 1/10,000." -- No, Craig, you're mixing up your figures. If we're talking about annual risk than a woman's risk of cancer of the vulva is roughly 1/27,000 (1/70th of the 1/387 figure cited above), and the risk for a man developing penile cancer is 1/100,000 (1/10th the figure you quote).

Then, Jake, why did you say that you don't agree with his assertion that a man should decide for himself? If you're going to delve into the whole "parental rights" issue then by de facto you support mercy killings, too. Parental rights is a deep, deep hole. Ask yourself how deep do you want to go? Mercy killings, cosmetic enhancements, genetic modifications, et cetera.

You do realize that most of Americans allow circumcisions to be performed on their children not for health reasons but for aesthetic reasons or because that's what my family always did in the past. Health benefit, to them, is just icing on the cake. From what you've said, not really strong evidence, though.

"Then, Jake, why did you say that you don't agree with his assertion that a man should decide for himself?" -- his implication was that *only* a man should be able to decide upon circumcision for himself.

"If you're going to delve into the whole "parental rights" issue then by de facto you support mercy killings, too." -- I'm afraid you'll have to explain the logic of that one to me.

"You do realize that most of Americans allow circumcisions to be performed on their children not for health reasons but for aesthetic reasons or because that's what my family always did in the past. Health benefit, to them, is just icing on the cake. From what you've said, not really strong evidence, though." -- it doesn't really matter very much whether health benefits are the primary objective or not; they still occur. And their existence affects the risk-benefit balance of circumcision such that (according to most reasonable observers) it is a neutral or a net benefit. And this means that, combined with non-medical benefits such as religious, social or cultural factors, the procedure is a net benefit, and therefore a legitimate choice for parents to make. If it was a net harm, it wouldn't be a legitimate choice, and indeed there would be a good case for saying that society should step in to protect the vulnerable from harm. But that's a moot point.

Jake said "There's no way of knowing whether the risk would be increased, reduced, or unaffected." Then why are you promoting circumcision as a cure if no one knows and has YET to prove effectiveness of circumcision to prevent penile cancer?

"Then why are you promoting circumcision as a cure if no one knows and has YET to prove effectiveness of circumcision to prevent penile cancer?" -- First of all, I'm not promoting circumcision as a cure, or even as a prophylactic: pointing out that it works is not the same as arguing that it should be done. Second, an important difference is that we *do* have evidence that circumcision does reduce the risk of penile cancer. That's the key distinction between that and Craig's hypothesis that FGC might prevent cancer: we have data. These data are in the form of multiple epidemiological studies, all of which have found reduced risk of penile cancer in circumcised males.

You are negating the will of a man about his own body. You are effectively saying that a man has no right to decide for himself. You are saying that a man's body is not his private property. You are saying that a man can not have private property. Do you want a doctor to override man's wishes about his own body? What about a mohel or imam? What about the trash collector or mayor? Who else do you want to make decisions on behalf of the man about his own body? Are you ok with me making decisions for you? Where does it end? What about REALLY late term abortions (after child birth)? Parental rights to do whatever they want! What about removing separated earlobes? Parental rights! What about giving neonatal girls really early boob jobs? Parental rights!

If you are saying that medical benefits are just icing on the cake then really ... What IS the real reason for your support for genital cutting?

You are stating "net benefit" as if it were fact. Prove it. AAP does not agree with you. They state that the benefits do NOT outweigh risks. Since AAP does not recommend the procedure and they say the benefits don't outweigh risks, how do you arrive at the conclusion that protecting the vulnerable from harm is a moot point?

So, back to the parental choice argument to which you are clinging. Why do you hold that so dear?

Calm down, Michael. I'm not saying that a man has no right to decide for himself: if an adult uncircumcised male wishes to get circumcised, then of course he has the right to make that choice. But I am saying that it's perfectly reasonable for parents to choose neonatal circumcision for their son. Furthermore, you mis-characterise my position by implying that I support infanticide and early cosmetic surgery; as I've already explained in my post dated 4:26am on Friday, March 25, 2011, I believe that net harms (of which these are good examples) should not be permitted. Is it necessary to misrepresent my position in order to attack it?

(continued)

"You are stating "net benefit" as if it were fact. Prove it. AAP does not agree with you. They state that the benefits do NOT outweigh risks" -- actually, they say no such thing. What they actually say is that "Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In the case of circumcision, in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, ***parents should determine what is in the best interest of the child.*** To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. It is legitimate for parents to take into account cultural, religious, and ethnic traditions, in addition to the medical factors, when making this decision" (emph added)

Now, given that the AAP say that parents should decide what is in the best interests of the child, wouldn't you agree that such a position implies that parents could reasonably conclude that circumcision actually *is* in the best interests of the child?

So it comes back down to wondering if in your studies it lists how many neonates were saved from penile cancer?

Jake, just a little Google search can tell anyone the type of documents your name is on including this one: http://www.samkuninmd.com/docinfo/GFW-EN.pdf

Which led me to read more about Brian Morris who says that circumcision should be mandated. It eventually led me to finding info about Gilgal Society. Hark! I see your name there and look what I find:

"He had not reached puberty but soon would: a few hairs were starting to grow at the base of his penis. Neil was then asked to lie on the couch for the penis to be photographed. ...the doctor tested the fit of two sizes of Gomco Clamp bell. During this procedure Neil erected, but was not embarrassed by it and made no attempt to hide it.
Mark came in next and again dropped his trousers readily. He had reached puberty and was quite well developed. ... Its like an elephants trunk was the doctors comment, to which Mark heartily agreed. ... Photographs of his penis were taken...

He had realised after sex education lessons at school that he had a problem.
...the boys were given plenty of wine to relax them. ...the discussion was about the sex lives of the boys and their school friends. The doctor asked how often the boys wanked. ... The doctor showed the boys his microscope and asked if they had ever seen sperm under one. ... He suggested to Mark that if he wanted to, he could have a quiet wank whilst Neil was being circumcised... This was eagerly accepted. ... He lay back with his eyes closed and just let the doctor get on.
He returned to the surgery and put on his underpants (tight jockey briefs). His penis was guided up against his abdomen... Photographs had been taken...
We all returned to the lounge where Mark was watching TV, having had his quiet wank. ...the doctor put some of Marks semen on a slide and put it under the microscope on high power. Each of us looked at the live sperm swimming vigorously around in the semen.
...there is hope that the circumcision will give him the confidence to overcome his enuresis [bed wetting].
The boys also looked at the book and noted a number of horrors which they would be spared now that they were circumcised.

On this occasion there were three boys to be circumcised, two of them brothers aged 8 and 10. The doctor had planned to take the younger one first... ...did not need circumcision, but it was being done for uniformity with his brother
He went down fighting and, because he had just been screaming, appeared to stop breathing. This worried his father, but the doctor said it was quite normal...
Ians foreskin was long... ...it needed to come off.
After lunch we had a five-year-old to do. ... Robert has shown his off to his school-friends. I hope some of them ask their parents if they can have their penis circumcised too.

-- Acknowledgements to VQ [Vernon Quaintance]
“”
Thomas, A. (2005). Case histories and experiences of circumcision. In V Quaintance (Ed.), Circumcision: An Ethomedical Study (pp. 191). London, England: The Gilgal Society.[6][7] Click here to download PDF"

Now how is this information unbiased that is out there on the net? It is obviously biased towards getting it done.

"Jake, just a little Google search can tell anyone the type of documents your name is on including this one: http://www.samkuninmd.com/docinfo/GFW-EN.pdf"; -- Yes, Prof Morris asked me for, and I provided, feedback on a draft of that document.

"Which led me to read more about Brian Morris who says that circumcision should be mandated." -- indeed he does. While I certainly respect him, it's not a position that I share.

"It eventually led me to finding info about Gilgal Society. Hark! I see your name there" -- what do you mean when you say you "see my name there"? I've already had several very strange conversations with people who think I'm a member of that organisation - are you another one?

"and look what I find:" -- I'm afraid I can't see how a document that I've never read could possibly have any relevance to whatever point you're trying to make here (and frankly it's a little difficult to work out what that point actually is).

I am so sorry. Thank you for writing this so others can know.

thank you

Maurene, these are almost laughably awful sources.

Maimonides lived in the 12th century, when scientific knowledge was not exactly at its strongest. Furthermore, all he had to offer were opinions - he didn't offer any evidence (even the sort of weak evidence that might be expected of the period) to back them up.

i4SkinHealth is apparently an iPhone app created by and for foreskin restorers. Surely it should be obvious that men who choose to restore their foreskins are, by definition, those who're unhappy with their circumcision status? And shouldn't it be equally obvious that men perfectly happy with their circumcisions won't bother to get involved in it? Put another way, this is a classic example of selection bias, and if you introduce such bias by sampling such men, you shouldn't be surprised to get a highly non-representative selection of negative accounts.

and men who get cut as adults are by definition not happy with their circ status. But it doesn't stop you from valuing surveys of these worthless opinions

The obvious distinction, Craig, is that I haven't used surveys of adult circumcision patients as evidence that uncircumcised men are dissatisfied with their circumcision status. I would agree that such usage would be pointless due to selection bias, but it seems a moot point.

the point is that it reinforces the idea of cognitive dissonance. People always value their end choice more then the alternatives. Yet you continue to use study's based on opinions.

actually there is many credible sources on mother infant bonding.

(26)Gunnar MR, Fisch RO, Korsvik S, Donhowe JM. The effects of circumcision on serum cortisol and behavior. Psychoneuroendocrinology 1981; 6(3):269-75.
(27) Porter FL, Miller RH, and Marshal RE. Neonatal pain cries: effect of circumcision on acoustic features and perceived urgency. Child Dev 1986;57:790-802.
(28) Gunnar MR, Connors J, Isensee, Wall L. Adrenocortical activity and behavioral distress in human newborns. Dev Psychobiol 1988;21(4):297-310.
(29) Anders TF, Chalemian RJ. The effects of circumcision on sleep-wake states in human neonates. Psychosom Med 1974;36(2):174-9.
(30) Marshall RE, Stratton WC, Moore JA, et al. Circumcision I: effects upon newborn behavior. Infant Behavior and Development 1980;3:1-14.
(31) Marshall RE, Porter FL, Rogers AG, et al. Circumcision: II effects upon mother-infant interaction. Early Hum Dev 1982; 7(4):367-74.
(32) Lee N. Circumcision and breastfeeding. J Hum Lact 2000;16(4):295.
(33) Anand KJS, Hickey PR. Pain and its effects in the human neonate and fetus. New Engl J Med 1987;317(21):1321-9.
(34) Taddio A, Katz J, Ilersich AL, Koren G. Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet 1997;349(9052):599-603.
(35) LaPrairie Jamie L. Murphy Anne Z. Neonatal Injury Alters Adult Pain Sensitivity by Increasing Opioid Tone in the Periaqueductal Gray. Front Behav Neurosci 30 September 2009.

(36) Boyle GJ, Goldman R, Svoboda JS, Fernandez E. Male circumcision: pain, trauma and psychosexual sequelae. J Health Psychol 2002;7(3):329-43.
(37) Rhinehart J. Neonatal circumcision reconsidered. Transactional Analysis J 1999;29(3):215-21.
(38) Van der Kolk BA, Perry JC, Herman JL. Childhood origins of self-destructive behavior. Am J Psychiatry 1991; 148;1665-71.
(39) Jacobson B, Bygdeman M. Obstetric care and proneness of offspring to suicide. BMJ 1998; 317:1346-49.
(40) Van der Kolk BA. The compulsion to repeat the trauma: re-enactment, revictimization, and masochism. Psychiatr Clin North Am 1989;12(2):389-411.
(41) Goldman R. The psychological impact of circumcision. BJU Int 1999;83 Suppl. 1:93-103.

Craig, at least four of these references don't even mention circumcision! Of the remainder, eight or so are (speculative) opinion pieces, and most if not all of the rest establish that circumcision without effective anaesthesia is painful (unsurprisingly), but say nothing whatsoever about mother-infant bonding. Now without trying to drown us in irrelevant or barely-relevant lists of references, please identify *one* or *two* papers that, in your opinion, best support your position.

there still all relevant and applicable to circumcision.

"It would mean that infants can legitimately refuse vaccinations, for example, which is a somewhat absurd claim."

Straw man. Vaccinations are not the same as non-reversible amputation of healthy, sensitive tissue.

"so much so that satisfaction rates are generally very high."

It's true that adult men who CHOSE the operation, often for medical reasons that would have made sexual activity painful or uncomfortable, are often satisfied with the results. Choice is an important factor here, and I hope that people don't apply the study results of adults who chose the operation to infants who did not.

"Straw man. Vaccinations are not the same as non-reversible amputation of healthy, sensitive tissue." -- can you point to the relevant part of the original claim that stated that it applied only to irreversible removal of healthy tissue? To remind you, it was:"Infants have soverign rights to do with their bodies what they choose to, just as adults do." Or are you trying to artificially limit the scope of the assertion?

"It's true that adult men who CHOSE the operation, often for medical reasons that would have made sexual activity painful or uncomfortable, are often satisfied with the results." -- sometimes for medical reasons, but not always. There is some excellent data from the RCTs, for example, in which large numbers of healthy volunteers were circumcised.

"Choice is an important factor here, and I hope that people don't apply the study results of adults who chose the operation to infants who did not." -- generally speaking there's no good reason not to, but that's not the issue here. If circumcision caused such damage, then surely it would be obvious in studies of adult circumcision patients?

Jakew: "can you point to the relevant part of the original claim that stated that it applied only to irreversible removal of healthy tissue?"

That's what neonatal circumcision is, and that's what this thread is about. If you disagree with this point as it applies to circumcision - "Infants have sovereign rights to do with their bodies what they choose to, just as adults do" - refute it as it applies to circumcision, not as it applies to vaccinations.

Jakew: "There is some excellent data from the RCTs, for example, in which large numbers of healthy volunteers were circumcised."

The circumcision researchers in Africa are trying to prove that circumcision is the answer to the AIDs crisis. To see what kind of research is being done by these teams, have a look at the Wawer study: http://tinyurl.com/mq3owu. 25 women were infected with HIV in an effort to prove that circumcising HIV-positive men would reduce the likelihood of infecting women. When the study started to show the opposite trend, it was terminated due to "futility," before the results reached statistical significance. Most, if not all all of these infections could have been prevented by providing condoms instead of circumcisions to study participants. The motivation and questionable ethics of these circumcision researchers makes it very difficult for me to take any of their studies seriously.

Jakew: "generally speaking there's no good reason not to, but that's not the issue here."

Actually, it is a part of the issue here - this thread is about neonatal circumcision after all, and an individual's right to choose is an important consideration. Many men who were circumcised as infants wish that they'd been given a choice, and this does factor into their sexual satisfaction. Parents need to consider their child's right to choose what their bodies will look like, and leaving children intact at birth is the only way to preserve that choice.

Jakew: "If circumcision caused such damage, then surely it would be obvious in studies of adult circumcision patients?"

Many studies show that there is a risk of damage. In the Fink study[1], 123 men were circumcised, the vast majority of them for medical reasons. 38% of the men reported harm, and only 62% were satisfied with having been circumcised. Circumcision was supposed to fix medical problems for most of these men, yet many of them reported harm

Another example, the Kim and Pang study[2]. After circumcision, masturbatory pleasure decreased for 48% of the men, masturbatory difficulty increased for 63% of men, and 20% of men reported a worse sex life.

In the Mastood study[3], where again most of the men were being circumcised for medical reasons, yet only 61% were satisfied.

There are other studies showing higher levels of satisfaction, but there's always a risk of harm, and the studies above clearly show that.

[1] http://www.jurology.com/article/S0022-5347(05)65098-7/abstract
[2] http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2006.06646.x/full
[3] http://www.cirp.org/library/sex_function/masood1/

Kyle, I'm not quite sure what you're trying to prove by cherry-picking studies like this. If you select just the studies that support your point of view, surely all you've proved is your ability to do so - you haven't really established any kind of scientific knowledge. (And interestingly, you even manage to misrepresent Masood's study, in which 61% judged satisfaction improved after circumcision, worse in 17%, and unchanged in 22%.)

In practice, most studies show high levels of satisfaction, which wouldn't be seen if circumcision caused the proposed damage.

"That's what neonatal circumcision is, and that's what this thread is about. If you disagree with this point as it applies to circumcision - "Infants have sovereign rights to do with their bodies what they choose to, just as adults do" - refute it as it applies to circumcision, not as it applies to vaccinations." -- either the statement is true or it is not. If it's true, it should be true in all situations. Logically, then, finding an example where it is clearly absurd demonstrates that the statement is not true. As a practical matter, it's often sensible to consider subjects other than circumcision because (as should be obvious) people have widely different viewpoints on the subject of circumcision, which often makes it difficult to agree on simple statements. Thus, moving discussion to a different, less contentious subject can make it easier to find common ground, from which it is easier to identify principles that we may agree upon.

(continued)

(part 2)

"The circumcision researchers in Africa are trying to prove that circumcision is the answer to the AIDs crisis. To see what kind of research is being done by these teams, have a look at the Wawer study[...]. When the study started to show the opposite trend, it was terminated due to "futility," before the results reached statistical significance." -- amusingly, you imply that significance would have been found had the study continued, but of course that's unlikely.

"Most, if not all all of these infections could have been prevented by providing condoms instead of circumcisions to study participants." -- in fact, the researchers did provide condoms, as you'd know if you'd taken the trouble to read it: "At every study visit, participating men and their female partners were provided with intensive education on HIV/STI prevention, including promotion of sexual abstinence, faithfulness, and consistent condom use. Additionally, both partners were offered free condoms, voluntary HIV counselling and testing, and couples' voluntary counselling and testing."

"The motivation and questionable ethics of these circumcision researchers makes it very difficult for me to take any of their studies seriously." -- doesn't make any sense, sorry. What is unethical about trying an intervention that might prevent HIV infection? It's not as though the researchers forced these couples together - they just tried something to see whether it might make a difference.

children born today will very likely have HIV VAX and treatments available by the time they are adults.

dam straight!

the type of people to dismiss human rights, infant trauma, the fact the the foreskin is the most sensitive part of the penis, to fuel their emotive drive to circumcise children. To project their own preference on the innocent, and for their fetishes

So, to summarise, you won't even try to debate the issues with me, but instead you'll rely upon argumentum ad hominem.

Okay. I'm used to that.

you would think that's a pretty simple answer.

Thx. And yes the statics mean very little to the individual.

If you dont prematurely retract and you take good care of your kids then you can easily avoid a easily treatable UTI.
Even if it does prevent UTI it hardly makes sense to subject 111 to 195 children to harmful surgery on the of chance it will prevent a single UTI.

"If a man is circumcised before he can give his own informed consent, his right to decide for himself has been take away from him." -- such a statement only makes sense if one believes that there is an absolute right to have a foreskin. For those of us who don't believe in the existence of such a right, it's a meaningless statement. One might just as easily say that vaccinating or educating a child takes away his right to decide whether he'd like to be educated or vaccinated (and before anyone says anything, I'm not saying that circumcision is the same as vaccination or education, just that most if not all parental decisions inevitably restrict the future set of possible choices, and presenting such choices as a "right" taken away isn't terribly constructive).

I think most readers of this forum can see through your sophistry. When parents decide to circumcise their son, the boy can not decide for himself whether not he wants to be circumcised. He no longer has the right to make that decision for himself.

I also think that most people understand that making the decision for a permanent body modification is the right of the person whose body is being modified. If a parent pierced their son's penis, they would go to jail. If a parent scarified their son's body, they would go to jail. Male circumcision is a more sever form of permanent body modification than genital piercing or scarification. There is no compelling medical reason for doctors to circumcise a healthy boy.

"He no longer has the right to make that decision for himself." -- No, Stan, he no longer has the *ability* to decide to be uncircumcised (though of course he has another option instead: foreskin restoration). Abilities are not the same as rights.

"I also think that most people understand that making the decision for a permanent body modification is the right of the person whose body is being modified." -- I think if that were so, infant circumcision rates would be zero or near zero everywhere, and infant circumcision would be illegal. The fact that this is not the case suggests that this "right" is a fringe belief at best.

well body rights is a relatively new concept in modern culture. as this idea continues to gain further impetus circ will decline in those respective cultures.

Perhaps. We'll see.

Stan: "I also think that most people understand that making the decision for a permanent body modification is the right of the person whose body is being modified."

Most people understand that making the decision for a tattoo is the right of the person whose body is being tattooed and making the decision for a body piercing is the right of the person whose body is being pierced. If parents were to tattoo or pierce their child's body they would go to jail. Male circumcision is a glaring exception to the ethical standards that apply to all other permanent body modifications.

Jake: "I think if that were so, infant circumcision rates would be zero or near zero everywhere, and infant circumcision would be illegal. The fact that this is not the case suggests that this "right" is a fringe belief at best.

Not long ago many people thought that the abolition of slavery or woman's suffrage was a fringe belief. We now understand that slavery is a violation of human rights and that all adults, both men and women, have a right to vote.

I am very confident that one day in the future the genital cutting of boys will be illegal in the United States just as the genital cutting of girls is now illegal. Americans are starting to realize there is no compelling medical reason to circumcise a healthy boy. They are starting to realize that each male should be allowed to decide for himself whether or not he wants to have a normal, healthy part of his own penis cut off.

In Europe the infant male circumcision rates are near zero. With few exceptions, male circumcision of children is limited to the Muslim and Jewish religious communities. If male circumcision of boys were not a Muslim and Jewish religious practice, it would probably be illegal already.

Jake, once again you take the view that a man does not have the right to his own body. Tell me, does a woman have a right to her clitoral hood?

Removal of the clitoral hood is (in the absence of special circumstances) a net harm, so society can and does step in to protect the vulnerable from it. I don't think that rights have much to do with it (but then my ethical framework is based on utilitarianism, so I generally find that "rights" are the consequence of logical reasoning rather than fundamental axioms). Interestingly, where I live (the UK), a woman doesn't have the right to choose to have her clitoral hood removed, because female genital cutting is illegal, regardless of age. If she truly had a right to it, I don't think that would be the case.

Sad that women can't choose, either. At least here in USA, if people want to modify their own bodies, it is legal.

So, if a particular right or freedom isn't useful you're ok with eliminating that right?

how do you know it is a net harm,? Were are the studies for ,ADHESION'S AND SMEGMA, clitorism, Vestibulitus, Vulvar Dystrophy, Melanoma cancer of the vulva, Adenocarcinoma of the vulva, Hyperplasia, Vulvar intraepithelial neoplasia, Paget's disease, Aphthous ulcers, Behçet's disease, Eczema, Tinea, Hidradenitis suppurativa, Bacterial vaginosis, Lichen sclerosus et atrophicus, These benefits are AMAZING!! Why are women being denied these amazing benef

is there studies for UTI what about some cotton swab cultures?

not long ago they did not have the right to it. its more of a cultural paradox then any rational thing.

how can you possibly say it is a net harm with only a tiny fraction of data compared to male circ.

Michael:

"So, if a particular right or freedom isn't useful you're ok with eliminating that right?" -- I'm afraid I don't understand why you're asking this question, and what you mean by "useful". I'm also interested in this concept of eliminating rights - if you think that a person can eliminate rights at will then I'd be interested to explore what you think a right is and how it is created. I'm not trying to criticise - I'm just genuinely interested in your model of what we're talking about.

Craig:

"how do you know it is a net harm," -- that's what available data indicates. It's always possible that new data will change that, just as it's possible that new data will change our understanding of circumcision, but this is the current state of knowledge.

"These benefits are AMAZING" -- amazingly speculative, as I've pointed out before.

"is there studies for UTI" -- I'm only aware of one study of UTI and FGC; it found greater risk in women who had undergone FGC.

"I'm only aware of one study of UTI and FGC; it found greater risk in women who had undergone FGC." what type of FGC was used?

Before male circ was fist implemented in the U.S. there was very little data.It had more to do with Judaic values the beliefs Jews where less affected with mental and physical illness was a big part of it as well. The compulsion to do it came first.

Similarly if we are to get good female circ data we need to implement it first at then gather data.

Weather the harms out weight the benefits is entirely relative. A single circumcision related death , may be worth a million UTI's. A single complication may be worth thousands of cases of easily treatable Balanitis.

"what type of FGC was used?" -- the abstract implies more than one type, but doesn't list them (possibly the full text does). If you want the ref, it's Almroth L, et al. Urogenital complications among girls with genital mutilation: a hospital-based study in Khartoum. Afr J Reprod Health. 2005 Aug;9(2):118-24.

"Similarly if we are to get good female circ data we need to implement it first at then gather data." -- which presents a catch-22 problem.

"Weather the harms out weight the benefits is entirely relative. A single circumcision related death , may be worth a million UTI's. A single complication may be worth thousands of cases of easily treatable Balanitis." -- it's probably sensible to compare like with like. Compare deaths due to circumcision with deaths due to UTIs attributable to lack of circumcision. Compare easily treatable cases of balanitis to easily treatable complications, and compare cases of balanitis more resistant to treatment with complications that are more difficult to treat.

Your comments might have more relevance, Stan, if anybody had been arguing that circumcision should be performed in order to prevent UTIs. But in fact, we were discussing the weighing of risks and benefits. Probably the most extreme of those are those relating to death or its avoidance.

When discussing non-therapeutic circumcision of children the only thing that is relevant is whether or not it is ethical to cut off a normal, healthy part of a child's body without a compelling reason to do so.

In my opinion it is not ethical for an adult to cut off a normal, healthy part of a child's body unless there is a compelling reason to do so. There is no compelling reason for non-Muslim and non-Jewish parents to circumcise their sons.

Just in case you don't want to believe what Dolores has to say, and need some objective evidence, I invite you to log into wikipedia.org. Search for circumcision. Click on 'View History' at the top of the page. You will find that Jake amended the wikipedia entry 11 times on the current page. I ask you, "Why would a man invest this kind of energy, to support an amputation on a healthy baby, for an operation which has not been proven by any medical organization to have its benefits exceed its risks?" It's a bit chilling, isn't it?
Dr. Edgar Schoen has been associated with Kaiser Permanente, the first for-profit health care organization, for 24 years. He has written a poem called "Ode to Circumcision". He held the position of Chair of the 1989 American Academy of Pediatrics Task Force on Circumcision. He calls for universal circumcision, and has written many books on the subject. Again, why is this man profiting from surgery on children, with unproven benefits?

Interesting, isn't it, that some people would rather engage in defamation than debate? While I find it saddening that anybody would stoop so low, it is mildly amusing to know that I am perceived as such a threat to anti-circumcision lobbyists that they would try such a thing...

Yes, Tom, there seem to be roughly that number of changes. You seem to be making several errors or interpretation and analysis, however.

First, you mischaracterise these edits as "to support an amputation on a healthy baby", presumably because you haven't actually looked at the changes. Had you done so, you would have seen that the vast majority were "reverts" (edits undoing changes made by another editor, rather than a new and original change); the exceptions being a maintenance edit to update a link, and the insertion of the results of a randomised controlled trial regarding HPV.

Second, you contrast these changes to the views of medical organisations regarding whether the benefits of circumcision exceed its risks. This would be a valid criticism if and only if these changes addressed the same point: for example, if I had inserted a claim asserting that the benefits of circumcision exceed the risks. But, in fact, the edits concerned are completely unrelated to that issue, so it's irrelevant. A more pertinent question is, "what do medical organisations have to say - if anything - on the specific subjects addressed by the edits?"

No, it's not a crime to wonder about a person's motives, but when making a *genuine* attempt to understand another's motives people generally try to see things from the other person's point of view. When making a personal attack, however, things are very different...

Sigh.

Tom, you're the person who claims to want to understand someone else's motives. If that's genuinely what you want, you *need* to try to see things from that person's point of view. It is completely and utterly missing the point to retort that I should try to see things from an infant's point of view (and in any case I do not think that circumcision should be performed without effective anaesthesia).

From the fact that you keep making these appeals to emotion, I'm guessing that you're angry that an intelligent person could consider all the evidence and come to a pro-parental choice position. I'm sorry that you're angry, but it's too bad. Being hostile towards me won't make me go away; in fact it tends to help motivate me to continue in debate.

Non-therapeutic circumcision of children is primarily an ethical issue. If a person only looks at medical studies and ignores or downplays the ethical issues, they have missed the point.

I don't understand how anyone can say it is ethical to cut off a normal, healthy part of a child's body when there is no compelling reason for the surgery. There is NO compelling reason for non-Muslim and non-Jewish parents to circumcise their sons.

So are you saying that something is only ethical if there is a compelling reason to do it? So if you buy your son or daughter an ice cream, say, because you think they'd enjoy it - even though there's no compelling reason - it's unethical? It seems to me that such an argument is nonsensical: such a decision is perfectly ethical, since as a parent you've judged it to be in the child's best interests to indulge him/her. (Of course, if you went to an extreme and fed your child nothing but ice-cream, it would clearly be harmful to his/her health; it would therefore not be ethical.) So it seems to me that a more rational test for ethical decisions made for a child is that a) there is no significant net harm (and yes, this requires looking at medical risks and benefits, among others), and b) that it is in the child's best interests.

I honestly can not believe that someone would compare cutting off a normal, healthy part of a child's body without a compelling medical reason with feeding a child ice cream. Shame on you!

One could also argue that there is no significant net harm in tattooing a child or in piercing a child's genitals. However those forms of permanent body modification are illegal when they are done to a child.

Your "no significant net harm" standard is not appropriate for irreversible body modifications to a child's body. Because there is no compelling medical reason to do it, non-therapeutic male circumcision is a form of permanent body modification like tattoos and genital piecing.

The only person who can legitimately say whether or not cutting off a normal part of his penis without a compelling medical reason is in his best interest is the man himself. That is why the decision should wait until a man can give his own informed consent as an adult.

"I honestly can not believe that someone would compare cutting off a normal, healthy part of a child's body without a compelling medical reason with feeding a child ice cream." -- In point of fact I did nothing of the sort. I simply used ice-cream as an *example* to show that something can be ethical even in the absence of a compelling reason. I see that Tom made the same mistake below. It's remarkable that two people independently made this basic mistake of English comprehension.

"One could also argue that there is no significant net harm in tattooing a child or in piercing a child's genitals." -- how on earth could one form a convincing argument? There's obvious risk in both cases - of bleeding and infection - and no benefits, so there's a clear net harm. I don't see how one could reach any other conclusion.

The same way advocates of male circumcision try to form a convincing argument that there is no net harm from cutting off a normal, healthy part of a boy's penis. When people come from a culture that has little know of or appreciation for normal intact genitals or have been associated with pro-circumcision advocacy groups, it is easy for them to minimize the harm and exaggerate the benefits of cutting the genital of children.

The only person who can legitimately say whether or not cutting off a normal part of his penis without a compelling medical reason is in his best interest is the man himself. That is why the decision should wait until a man can give his own informed consent as an adult.

"The same way advocates of male circumcision try to form a convincing argument that there is no net harm from cutting off a normal, healthy part of a boy's penis." -- the obvious difference, of course, is that there are well-documented benefits of circumcision, which can be weighed against the risks. But that isn't true in the case of tattooing or piercing. I'm sorry to get in the way of your speeches against circumcision, but perhaps you could address that subject?

The main reason given for male circumcision is culture or religion. One could use the same arguments that circumcision advocates use to justify male genital cutting. One could argue that incorporating a child into a community or having the boy look like his father are benefits that outweigh the risk of tattooing or body piecing.

You're comparing apples and oranges, Stan. On one hand, we have circumcision, which has some medical risks, medical benefits, and non-medical benefits as well. On the other hand, tattooing (etc) has no medical benefits, medical risks, and highly dubious non-medical benefits at best. (I say highly dubious because I've yet to see a serious argument that tattooing a child creates social or cultural benefits for him. This clearly isn't a serious argument, but rather a strained attempt at an analogy.)

There is no NET medical benefit to cutting off a normal part of a healthy boy's penis. For the benefits and risks of male circumcision to be about equal, one must ignore the value that a male may place in his own intact foreskin and the fact that he may wish to to have a normal, intact penis instead of a surgically altered penis.

The non-medical benefits of male genital cutting are also highly dubious at best. They are mostly promoted by people associated with circlist or some another circumcision fetish organization or by members of the Muslim and Jewish religious community who believe that male genital cutting is a religious requirement.

"There is no NET medical benefit to cutting off a normal part of a healthy boy's penis." -- you're free to hold that point of view, of course, but it's questionable at best. As an example of those disagreeing, in 2007 the CDC held a large consultation; one of the conclusions of this was that "Medical benefits outweigh risks for infant MC [ie., male circumcision], and there are many practical advantages of doing it in the newborn period." http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2788411/?tool=pubmed

Correction: In 2007 the CDC held a consultation with a large group of pro-circumcision advocates. Given who the CDC consulted, their conclusion is not surprising.

It seems to me that you're labelling the attendees as "pro-circumcision advocates" based on the conclusions. Which is rather circular.

No, I base it on their history of pro-circumcision evangelism.

To pick a name from the list, you're saying that Robert Van Howe has a history of pro-circumcision evangelism?

Bertran Auvert, Robert Bailey, Ronald Gray, Edgar Schoen, and Thomas Wiswell all have a history of circumcision evangelism.

"Bertran Auvert, Robert Bailey, Ronald Gray, Edgar Schoen, and Thomas Wiswell all have a history of circumcision evangelism." -- well, they've all published findings indicating positive aspects of circumcision, but that's not the same thing as evangelism. And even if we agreed, for the sake of argument, that these five individuals were pro-circumcision advocates, they only represent 5 of (if I count correctly) 51 external consultants, or about 5% of the total.

They are members of a small group of people who relentlessly promote male circumcision. Edgar Schoen and Thomas Wiswell have promoted male circumcision for decades.

With a ratio of five circumcision advocates to one genital autonomy advocate, it is not surprising the CDC issued a pro-circumcision statement.

You don't think the 45 other individuals might have had something to say?

Tom, I've addressed this question previously, possibly in this very thread, but I'll do so again.

I agree that no other body parts are ordinarily removed for non-therapeutic reasons. However, I do *not* agree that this fact makes the removal of the foreskin an exception to standards of medical ethics. Removal of a kidney, or an earlobe, would (ordinarily) constitute a clear and obvious net harm to the child, as there would be immediate risks (those of surgical complications), disfigurement and consequent psychological risks (in the case of earlobe removal), loss of important function (in the case of kidney removal particularly), and no benefits to offset these risks and harms. Society can and should protect the vulnerable from harm, through laws where necessary and through standards of medical ethics that prevent such things from taking place. But circumcision isn't a net harm (most reasonable observers agree that it's neutral or a net benefit) so by applying *exactly* the same ethical standard it's an acceptable practice.

So I think a more reasonable question to ask is this: "is there another healthy body part that could be removed with a similar risk-benefit balance to circumcision, and *if so*, does that removal ordinarily occur?" Personally, I can't think of another procedure with a similar risk-benefit balance, and consequently the second part of that question is a moot point.

Non-therapeutic male circumcision is the ONLY surgery that doctors will perform on a child where the medical benefits do not significantly out weigh the medical risks and harms or the surgery does not correct a birth defect.

The fact that Muslim and Jewish parents believe that male circumcision is a religious requirement is not a sufficiently good reason for American doctors to tolerate surgery on the genital of healthy non-Muslim and non-Jewish boys where there is no compelling medical reason for the surgery.

And as I've just pointed out, Stan, it's almost certainly the only surgery that has such a favourable risk-benefit balance - if you think of any other surgery, it will likely be a net harm. Claiming that it's the only surgery performed while overlooking this point seems a little disingenuous...

If doctors had spend a fraction of the time and effort trying to find a medical justification for cutting off a part of a girl's vulva as they have spent trying to find a medical justification for cutting off part of a boy's penis, we would be reading articles in the medical journals about the medical benefits of cutting off a girl's labia minor or the hood of her clitoris.

The risk to benefits ratio for non-therapeutic male circumcision does not even come close to meeting the standard of care required for surgery on children. The ethical standard has been lowered for this one, unique surgery in order to accommodate an outdated and harmful cultural practice.

"If doctors had spend a fraction of the time and effort trying to find a medical justification for cutting off a part of a girl's vulva as they have spent trying to find a medical justification for cutting off part of a boy's penis, we would be reading articles in the medical journals about the medical benefits of cutting off a girl's labia minor or the hood of her clitoris." -- hmm, sounds rather like the pot of gold at the end of the rainbow, then: you're claiming that people would find it if only they'd look. Not a very convincing argument, I have to say.

Doctors have been searching for a medical justification for male circumcision for decades. Instead of looking for the most effective and least invasive way to threat minor problems or prevent disease, they look for reasons to justify cutting off a normal, healthy part of a child's genitals.

After decades of research they still have not found a compelling medical reason to cut off a normal, healthy part of a boy's penis. Rather that look for more excuses to continue the practice, it is time to end it.

"And yet, you compare giving a child a circumcision with giving them an ice cream." -- I've already corrected Stan on this above, so rather than repeating myself I'll direct you to that post.

"One is a pleasant treat. The other removes half of the most sensitive skin on your body, which has to hurt, even with anesthesia" -- well, first of all "the most sensitive skin on your body" is hyperbole, nothing more and nothing less. Second, returning to the point, studies of adult circumcision have shown that a substantial number of patients (not all, but quite a few) report no pain during or after the procedure.

"Why doesn't circumcision sell in your country, Jake?" -- we have an organisation called the National Health Service, which provides the vast majority of healthcare in the country (we do have private medicine as well, but it is generally used only by the very rich). It has been underfunded almost since its creation, and like all underfunded bodies is concerned with minimising costs now, even at the risk of greater costs in future (this is particularly severe at the moment; my local branch of the NHS refuses to perform cataract or hip replacement surgery, as these are judged non-essential).

(continued)

(part 2)

"If indeed, as you are so quick to posit, circumcision has such a favorable risk-benefit balance, you must be looking the other way...ignoring [...] problems which circumcision can bring." -- no, I'm taking all complications into account. How could a comparison of risks and benefits be valid otherwise?

"Quick, someone call every medical society in the world, and let them know that the benefits now outweigh the surgical risks." -- with the exception of the Dutch, policy statements of the past few years have generally been more favourable towards circumcision. The American Urological Association added "recommends that circumcision should be presented as an option for health benefits" to their policy; the World Health Organisation recommended circumcision as an HIV preventative in certain regions; the RACP added language recognising the legitimacy of parental choice; the CDC consultation concluded that the benefits of circumcision outweighed the risks; and (according to news reports quoting Task Force members) the AAP are expected to publish a policy more favourable towards circumcision.

"Jake, what would you expect the American Urological Association to say?" -- well, before 2007 they didn't include that recommendation.

"Do any of the real medical organizations [...]" -- are you suggesting that the AUA is somehow unreal?

"If not, why do you persist? You know it is ethically wrong." -- once upon a time, I was mildly opposed to infant circumcision, but since then I've come to the conclusion that it is ethically acceptable.

"You compare your adult circumcision to an infant circumcision." -- actually I hadn't even mentioned my own circumcision.

"84% of babies in the US were getting no anesthesia, last statistics I saw." In a 1998 study, 45% of physicians used anaesthesia (http://www.ncbi.nlm.nih.gov/pubmed/9606247), but that figure is rising. In the latest study, 97% of training programmes teach the use of anaesthesia. http://www.ncbi.nlm.nih.gov/pubmed/16843252

"When their income relies on it, of course they will recommend" -- isn't that a rather odd thing to say, though, since urologists generally don't operate on children, and in any case circumcision is not generally performed by specialists? And you still haven't answered my question: are the AUA a real medical organisation or not?

"And yet, the American Pediatric Association says [...]" -- that's right, they don't think there's enough of a net benefit to warrant circumcision of all newborn boys. They go on to state that parents should decide what is in the best interests of the child, based in part on the risks and benefits, and in part on social, cultural, etc factors.

"The Canadian Paediatric Society statement is stronger" -- not really; they basically say the same thing. They don't recommend *routine* circumcision (ie., circumcision of all newborn boys), but leave the decision regarding elective circumcision to parents.

(continued)

(part 2)

"The British Medical Association's wording is even stronger" -- given that you're quoting only the parts that oppose circumcision, perhaps you want it to seem that way. The parts you choose not to quote, of course, are much more balanced. For example: "There is a spectrum of views within the BMA’s membership about whether non-therapeutic male circumcision is a beneficial, neutral or harmful procedure or whether it is superfluous, and whether it should ever be done on a child who is not capable of deciding for himself. The medical harms or benefits have not been unequivocally proven but there are clear risks of harm if the procedure is done inexpertly. The Association has no policy on these issues. Indeed, it would be difficult to formulate a policy in the absence of unambiguously clear and consistent medical data on the implications of the intervention. As a general rule, however, the BMA believes that parents should be entitled to make choices about how best to promote their children’s interests, and it is for society to decide what limits should be imposed on parental choices."

"Are you trying to tell us that you know better?" -- I have more or less the same position regarding circumcision as the AAP, so that question is perplexing, to say the least.

The British Medical Association makes a distinction between male circumcision as a medical procedure and male circumcision as a cultural and religious practice. The part of the statement that discusses male circumcision as a medical procedure says it is unethical and inappropriate to circumcise a boy when there are effective, less invasive methods available.