I'm gonna go ahead and bite too...
ml66uk: If you'd grown up in a country where non-religious infant circumcision had dropped from about 35% to 1%, chances are you'd be agreeing with me. Heck, maybe I'd be taking your side if I'd grown up where you are.
RPW: Where I grew up doesn't have anything to do with this. I'm a scientist and a student doctor, I objectively look at data and make the best decision I can based off of that. I share virtually none of the religious beliefs and "home town conservative" values of where I grew up, I'm considerably more left leaning...
Where people grew up and what they consider "normal" shouldn't affect their views on the medical benefits and risks of genital surgery, but obviously does. There are plenty of doctors and circumcised women in Egypt, Malaysia and elsewhere, that will actively promote female circumcision.
ml66uk: Part of the reason this is a big deal is that millions of baby boys are having the most sensitive part of their penis cut off for bogus medical reasons.
RPW: Its not bogus!! Data indicates that circumcision does give a health benefit (albeit not a huge one). And just how sensitive is the foreskin anyways? I'm circumcised and if my penis was anymore sensitive I wouldn't be able to wear pants, and even then a slight breeze would be more than I could handle!!!
If there are health benefits, then why do the Canadian Pediatric Society, the British Medical Association, and the Royal Australasian College of Physicians say there are none? Most of the male doctors in these countries will be circumcised themselves, so why would they not believe in the net medical benefits that many of the posters here are convinced exist?
The foreskin is the most sensitive part of the penis. It's not just there to protect the glans - it actually has a value, so you need a convincing reason to cut it off, especially if you're doing it someone that can't consent. The outer foreskin is no more sensitive than the skin lower down the penis, but the inner foreskin is packed with nerve endings, a lot more so than the glans. Other areas of the body with mucosal boundaries show the same properties (eg lips, labia minora, anus). If you're circumcised, then the most sensitive part of your penis will probably not be any part of the glans, but the scar line where you were circumcised (it could be the frenulum, but most circumcisions remove this).
It is indeed uncomfortable for an intact man to walk about with his penis flaccid, but the foreskin retracted (with or without pants). The main reason is because the inner foreskin is exposed though, not because the glans is exposed.
ml66uk: You can't deny that the reasons given to perform circumcision have changed.
RPW: Why would I? This is medical science, it changes. We get new and better information and make changes based on that. Sure those guys in the past were wrong about a lot of things and it hurt people (blood-letting, mercury drugs, cupping, etc.) but they were doing the best they could with the data they had. We're still doing the best we can with the data we have and I bet some of the stuff we do won't be looked upon to highly in the future.
If no male had ever been circumcised, we wouldn't be looking for possible benefits or reasons to justify it, and it would be viewed in the same way as female circumcision.
ml66uk: We could make a much stronger case for routine appendectomy, and it's not that long ago that preventive tonsillectomy was common (though not on newborns). Breast cancer kills one in nine women, and we could prevent it with routine mastectomy, but we wouldn't consider that. Even families with the BRCA1 and BRCA2 breast cancer genes, and family history of early onset breast cancer still let the women affected decide for themselves rather than have it done to them as children.
RPW: That's a ridiculous argument. The operations you have listed are major operations with numerous and deadly complications. Circumcision for the most part is a benign procedure with very few complications and even less major or deadly complications.
That argument might seem ridiculous to you, but it's not that long ago that kids routinely had their tonsils removed. It's very rare, but children do die and suffer amputations when circumcision goes wrong. If there is no net medical benefit, then why do it at all, especially on a child who can't make his own decision?
ml66uk: One of the African RCT's described circumcision as "comparable to a vaccine of high efficacy"
RPW: Who said this?
It's in the
Auvert study:
CONCLUSION: Male circumcision provides a degree of protection against acquiring HIV infection, equivalent to what a vaccine of high efficacy would have achieved.
Seems like a degree of researcher bias to me. It looks like they really really wanted this to work. Just imagine how badly people want to discover a vaccine for HIV.
ml66uk: Many people wanted another reason to (promote) circumcision.
RPW: I know right!!! There are so many people just dying to find reasons to chop penises off... I bet they were feminists...
Actually, most of the outspoken of proponents of male circumcision are male, but then most of the proponents of female circumcision are female.
ml66uk: Brian Morris, one of the most active and vocal proponents of infant male circumcision for many years has now described it as a "surgical vaccine", and "a biomedical imperative for the 21st century"
RPW: Yup, he's a radical... He is basically the mirror opposite to people who are radically against circumcision. There are radicals in both camps and that proves nothing.
There are indeed radicals in both camps. Some of the extreme intactivists do more harm than good. There are plenty of intelligent articulate people who are totally against circumcision though. Despite his extremism, Brian Morris gets an incredible amount of airtime in Australia, considering his message is the polar opposite of what the national medical organisation says. He isn't the only pro-circer with outspoken views who in my opinion gets more credibility than is warranted. The main reason the AAP no longer says outright that circumcision is not necessary is because of
Dr Edgar Schoen, former chair of the American Academy of Pediatrics' Task Force on Circumcision. He has his very own totally one-sided pro-circ
website, which doesn't even seem to consider the possibility that the foreskin might have any value, or that people should be able to choose for themselves whether or not part of their penis is removed. Hardly a dispassionate observer, yet he chaired the group to determine the AAP's circumcision policy.
ml66uk: You didn't say that circumcision was more effective than condoms, and I never said you had, but anyone looking at the news coming out of Africa could be forgiven for thinking so.
RPW: No, actually they couldn't...
If someone who knows nothing about all this was told that the US government is planning to spend hundreds of millions of dollars on promoting male circumcision, but not a cent on promoting condoms, that's what they'd think. There have also been a lot more press articles about circumcision in the last few years than about condoms. It's new (in this context), it gets people's attention, and perhaps most importantly, it's news that circumcised men want to spread and hear.
ml66uk: No US government funds can be used to promote condoms
RPW: Don't even get me started on how stupid the US's sex ed policy is, but that isn't the issue here.
Glad to hear we agree on something
It is relevant though, because since people can't promote condoms (which are highly effective against HIV transmission), it makes people look for alternatives, even if they are a lot less effective. The people who are against condoms will embrace anything-but-condoms, whether it makes sense or not. Most aid programs don't allow targetting sex workers either, even though one HIV+ prostitute might have sex with up to 50 (or more!) men in one day, most of the time not using condoms. Most aid workers can't focus on them though, as it's viewed as condoning prostitution.
ml66uk: The epidemiological and trial evidence is much weaker than anyone wants to admit though.
RPW: Even if circumcision decreases the odds of HIV infection by 1% then it would save thousands if not hundreds of thousands of people from getting infected.
I honestly think it will mean that more people will die from HIV, not fewer, even if not one cent and not one minute of any health professional's time is diverted from promoting ABC (Abstinence, Being faithful, Condoms).
ml66uk: No-one seems to want to talk about the fact that HIV+ men seem to be more dangerous to women if they've been circumcised, or that there are no fewer than six countries where circumcised men are more likely to be HIV+, or that circumcised virgins are far more likely to be HIV+ than intact virgins.
RPW: BULLSH*T!!! Even if this is remotely true its all do to more men being circumcised in those countries, not the fact that they are circumcised. If in fact the circumcised virgins are more often HIV+ Im gonna bet it's do to them becoming infected during birth not during circumcision. Do you know how to interpret statistics?
I understand statistics, but you seem to misunderstand these. If circumcision is so great against HIV, then regardless of the circumcision rate or the HIV rate in any given country, the circumcised men should be less likely to have HIV. The opposite is true in
Cameroon, Ghana, Lesotho, Malawi, Rwanda, and Tanzania
Cameroon http://www.measuredhs.com/pubs/pdf/FR163/16chapitre16.pdf table 16.9, p17 (4.1% v 1.1%)
Ghana http://www.measuredhs.com/pubs/pdf/FR152/13Chapter13.pdf table 13.9 (1.6% v 1.4%)
Lesotho http://www.measuredhs.com/pubs/pdf/FR171/12Chapter12.pdf table 12.9 (22.8% v 15.2%)
Malawi http://www.measuredhs.com/pubs/pdf/FR175/FR-175-MW04.pdf table 12.6, p257 (13.2% v 9.5%)
Rwandahttp://www.measuredhs.com/pubs/pdf/FR183/15Chapter15.pdf , table 15.11 (3.5% v 2.1%)
Tanzania http://www.measuredhs.com/pubs/pdf/FR173/13Chapter13.pdf not comparable
It's generally presumed that the higher HIV rates in circumcised virgin males is because of the unsanitary conditions in which circumcision is often performed, especially tribal circumcision.
ml66uk: Circumcised men also appear more reluctant to use condoms, and there's plenty of anecdotal evidence that some men believe that circumcision does make them immune
RPW: There is no cure for stupidity...
There isn't, but smart informed people don't get HIV, whether they're circumcised or not. Uninformed uneducated people who hear circumcision being described as a "vaccine" and have more unsafe sex as a result, are more likely to get HIV. Once they have it, circumcised men appear more likely to transmit the virus to women if they have unsafe sex.
ml66uk: and that it's harder for women to insist on condom use if the man is circumcised.
RPW: Why? Does having my foreskin chopped off make me that much more seductive?
The problem is that some men are saying that because they've been circumcised, they don't need to use a condom.
ml66uk: It's also much harder to stamp out female circumcision (some forms of which are truly horrific), if male circumcision is being promoted at the same time.
RPW: All forms of female circumcision are horrific. It is one of the greatest human atrocities in history, period. But that's not the issue here and your gonna have to prove the second part of this statement because I don't believe you.
Actually, some of the forms of female circumcision are very minor. Some of them involve just a symbolic nick in the clitoral hood, or even just a pinprick to remove one drop of blood. One form is the direct equivalent of the usual form of male circumcision (there are a few different forms of male circumcision too). Earlier this year, a Dutch doctor suggested promoting the "pin-prick" style of female circumcision, but despite his intentions being to protect girls from worse, he was condemned from all sides. Some of the girls he was trying to protect will be sent to Africa, and come back with their clitoris and inner labia removed.
Re you second point - I've debated with people defending female circumcision. One of their main arguments is that if it's ok for boys, why shoudn't it be ok for girls. Up until the 1950's there were still articles in the US medical press recommending female circumcision btw, and they make the same comparison. Here are two from
1958 and
1959. Blue Cross/Blue Shield had a code for clitoridectomy up until 1977, and there are western women walking round the USA today who have no external clitoris or inner labia because they were cut out by western surgeons. One victim wrote a
book about it:
Robinett, Patricia (2006). "The rape of innocence: One woman's story of female genital mutilation in the USA."
ml66uk: Twenty men died of circumcision in just one province of South Africa in this year's circumcision season btw. That's from the operation alone - it doesn't include forcible circumcisions, or people killed in the related violence that accompanies the circumcision season.
RPW: Just what in the hell is the "circumcision season", "forcible circumcisions", and what violence is related to it?
The circumcision season is a tribal thing, and generally associated with violence, often with several people dead and injured. Think last day of school, only 100 times worse. The South African Medical Journal published this
article.
By "forcible circumcision", I meant where grown men are circumcised against their will (though I suppose it could apply to children too). You can google it
here.
ml66uk: The French National Aids Council said the following:
the implementation of male circumcision as part of a raft of preventative measures could destabilise health care delivery and at the same time confuse existing prevention messages. Experience has shown that it is extremely difficult to communicate prevention using several means, and the addition of a new ‘tool' could actually cause a result opposite to that which was originally intended.
RPW: So we shouldn't do something because people are to ignorant and/or stupid to understand it??? That's not a very good stance. Perhaps we should also invest in education in Africa along with HIV prevention...
I think it's a huge mistake to be promoting circumcision rather than condoms and sex education. ABC works far better, and there are those six African countries where circumcised men are more likely be HIV+ than intact men. It's important to remember that HIV doesn't strike people at random, and circumcision can't possibly help anyone unless they have unsafe sex with an HIV+ partner. There are much cheaper and more effective ways of fighting HIV then promoting circumcision.
Oh, and just to get this out there.
I'm neither for or against circumcision. I think that it does show a small health benefit, but that it's so slight that not being circumcised or uncircumcised isn't a big deal. I also think that the operation is so benign that its completely ok for parents to have their male babies circumcised if they want too.
What I am totally against is people being radical and irrational about a single issue, especially something as unimportant as foreskin. Like my mother would say "There are murderers and rapists roaming the streets freely and they're worried about this?!?!?"
Also, I will say that in my personal experience working in a rural hospital in the southwest United States that I have personally see two men die from infected foreskins (both became septic)...
Like I said earlier, the (mostly-circumcised) doctors in Canada, the UK, and Australia think there is no net medical benefit. That being the case, children should be allowed to decide for themselves whether or not they want irreversible surgery performed on their genitals.
There seem to be a lot more problems with foreskins in the USA. In the UK, the rate of medically indicated circumcisions is only 1 in 140, and dropping as alternatives become more common. One of the problems seems to be forcible retraction, which all the medical organisations say should not happen, but which some doctors still recommend. This itself seems to cause a lot of problems. I have to say I've never heard of anyone dying from an infected foreskin. It never seems to happen in Europe, which has a heck of a lot more foreskins. Could these cases not have been prevented by hygiene rather than pre-emptive surgery? It's like the penile cancer thing - it's very rare, and there are countries which don't circumcise that have lower rates than the USA which mostly does. Vulval cancer is more common than penile cancer too, but we don't cut off parts of baby girls just in case.
Why is it OK for people to get upset about female circumcision, but somehow anyone against male circumcision is "radical" and "irrational"? Predictably, the people that defend female circumcision make similar attacks against people who are against that (try debating with them). If I replace "as unimportant as foreskin" with "as unimportant as the clitoral hood", maybe you would see things differently, even though they are anatomically equivalent. Sure, there are more important things like wars and stuff, but I happen to think it's wrong for children to have parts of their genitals cut off without their informed consent. It's become a lot more important now, because people are promoting circumcision to help prevent AIDS, and I believe that will result in more deaths from AIDS.
Hey man, poor people deserve attractive penises too.
In countries which don't circumcise, the women tend to find circumcised penises unattractive. There are also galleries of circumcisions, where there was no medical complication, but the results are just plain ugly, and in extreme cases make sex itself considerably more difficult. There are also plenty of circumcised men who are unhappy about it. All people deserve to choose for themselves if they want a cosmetic operation carried out on their penis. If you leave someone intact, they can get circumcised later - it doesn't work the other way round.
You won't be surprised to know that I get baiters and trolls when I post against female circumcision too btw.
