If the last circumcision post caused a lot of heat, this news is likely to cause even more of an uproar worldwide. From NBC News comes word that the NIH will be announcing shortly that they're stopping two trials looking at circumcision and HIV in Africa, because the intervention group (those who were circumcised) show far less HIV infections than the uncircumcised men:
NBC News has learned that the National Institutes of Health will announce at Noon ET Wednesday that two clinical trials in Africa have been stopped because an independent monitoring board determined the treatment was so effective that it would be unethical to continue the experiment.The NIH has been sponsoring two trials -- one with 5,000 men ages 18 to 49 in Uganda and a second with 2,784 men of the same age in Kenya. Half the men voluntarily underwent circumcision. The men were then monitored for about two years. Far more of the uncircumcised men became infected with HIV.
Stay tuned....
[Update: NIH press release can be found here.]
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Lovely.
I'm going to see if I can get a study funded to promote mastectomy at menopause. It'll eliminate 99% of breast cancer, a disease with an enormous mortality rate, which costs billions of dollar per year. In view of the publiuc health advantages, I can't imagine why anyone would object.
Re Harbison
The extremeism of the anti-circumcision folks is absolutely amazing. The comparison of circumcision with mastectomy is even beyond the usual insanity (i.e. comparing male circumcision with female circumcision) one expects from these folks.
Oh please, circumcision isn't even remotely like radical masectomy. Getting your whole dick cut off might be a more appropriate comparison.
These circumcisions were done in fully grown men?
I think I know why they got fewer infections: a penis in pain is a disincentive to have the sex.
I was of course expecting the emotional reaction. So let's see if we can disentangle our reason from our emotions, shall we? Why is one form of mutilation performed for public health reasons not at all comparable to another form of mutilation performed for public health reasons. Mass of tissue removed? Functionality of tissue removed?
I believe a mastectomy is the removal of the entire breast. That would certainly reduce breast cancer. Is a circumcision the removal of the entire penis?
I believe a mastectomy is the removal of the entire breast. That would certainly reduce breast cancer. Is a circumcision the removal of the entire penis?
Only occasionally ;-(
It's the removal of the entire foreskin.
Actually, I have another question that perhaps Tara can answer. Usually, when you stop a trial, it's because you can't ethically continue with the placebo once the efficacy of the treatment is proven beyond all doubt. So what are they going to do in Uganda? Offer circumcision to the entire placebo group? The entire male population?
And how did they get several thousand men to voluntarily consent to the procedure in the first place, anyway? I come from a country which does not practice routine infant circumcision, and the most common reaction to being offered one as an adult would be 'you want to do what?'
What is their reasoning behind this? I mean they must have a hypothesis as to why the circumcised group had a lower infection rate-- and what were the controls? Did they normalize for numbers of sexual encounters (hurting peenie = less sex), numbers of 'risky' encounters, etc?
I really, really am having difficulty figuring out why cutting off the foreskin would have anything to do with HIV transmission-- Positive or negative.
This is a news release, and doesn't tell us about the actual study design. It may have required that participants in the control group abstain for the same period of time that the experimental group did, and I'd bet that it included keeping a diary of sexual activity, allowing the researchers to monitor and predict relative risk. Study participants were likely given free medical care, money, or some other incentive. Beyond that, people are franticly looking for anything that could give them protection from HIV. The fact that the foreskin is enriched with cells with HIV targetted immune cells makes the foreskin an easy route of exposure, at least in some sex practices. Circumcision can not be protective for receptive sex with an HIV+ partner.
Pro-Circumcision advocates like SLC above are too narrow-minded to see anti-circumcisors' points when they compare circumcision to other amputations.
Yes - a breast is more than a foreskin, yes - female circumcision cuts more and harms more, but you don't see our point: cutting normal, natural body parts that aren't posing immediate danger is wrong. If it's a consenting adult cutting his own foreskin off, fine, but if it's a baby, wait till he's old enough to decide for himself.
Generally the argument goes like this:
A: male circumcision is like female circumcision in some ways.
B: how can you compare the two!? those are totally different things!
If I change out the objects, you can see how silly B sounds
A: a gokart is like a pickup truck in some ways.
B: how can you compare the two!? those are totally different things!
Wake up and smell the roses, Harbison was using hyperbole to show how this type of study would never get off the ground if any other body part other than the foreskin was used.
The NIH news release is now up and available here; I'll add it to the main post as well. Unfortunately, I don't have a chance to read it until later today, as it's my daughter's birthday and I'll be away from the computer for awhile.
Happy BDay to the young'n.
Iggy, hyperbole isn't rational. Science requires us to be rational.
Losing a foreskin isn't nearly as traumatic as losing a breast, as any number of circumcised men and breast cancer survivors can tell you. Men do not associate their masculinity or self worth with that tiny ring of tissue (or at least one hopes not), however, breasts are very intimately tied to a woman's self-image, and their loss is also visible and obvious to others around them. In addition a mastectomy is a much more serious surgery, the loss of lymphatics can often lead to serious side-effects, and the risk is astronomically higher than losing a small piece of skin. As far as comparing it to female genital circumcision? That's patently offensive. Female circumcision involves removal of the labia and clitoris. That's comparable to losing your penis and scrotum (they're the same tissues developmentally). The procedure is done to maintain sexual control over women, it is incredibly unsafe, and eliminates sexual pleasure in its victims.
This inability to see degree and purposeful obtuseness about the difference of the two body parts or the two procedures is not helpful and if pursued you're just being denialist troll. Get over it.
ERV asked:
I really, really am having difficulty figuring out why cutting off the foreskin would have anything to do with HIV transmission-- Positive or negative.
During sexual intercourse HIV enters through breaks in the skin. Uncircumcised men are thought to be more susceptible because of the fragility and movement of the foreskin during sex causing damage to larger surface area and more susceptible tissue for HIV entry. There are also several other reasons, possibly related to hygeine or other microscopic organisms that like to hang out under the skin that may increase susceptibility.
Seeing things as black and white yes/no isn't rational, either. We're not trying to say male circumcision is equivalent to female circumcision. We're trying to say they have similarities. We're saying they're different degrees of the same type of wrong. Maybe "Sarcasm" would be a better word than "Hyperbole".
No, I don't hinge my masculinity on a missing part of my penis, but I'm still mad that anybody would have a right to cut it off other than me. My body is my body. It didn't pose any danger to me as a baby. I'll keep HIV out with a condom, and I'm sure any safe-sex educated adult male could do the same.
A couple links from the press release, I found this...
How were the studies designed?
Both trials recruited healthy, HIV-negative uncircumcised men who planned to remain near the study site for the duration of the trial. The trial in Uganda recruited men between 15 and 49 years old; the trial in Kenya recruited men between 18 and 24 years old.
After an initial HIV screening and a medical exam, eligible men were randomly assigned either to receive circumcision immediately or to wait two years before circumcision. All participants were closely followed for two years to collect information about their health, sexual activity, and theirs and their partners' attitudes about circumcision; to counsel participants in HIV prevention and safe sex practices; and to check the HIV status of the volunteer. Participants in the Kenyan study were scheduled for six visits over the two-year follow-up, compared with four visits for the Ugandan trial participants. In addition to the study visits, men enrolled in the Kenyan trial were encouraged to receive all of their outpatient health care at the study clinics, which enabled researchers to collect information on the safety of the procedure and the number of other sexually transmitted diseases the men had during follow-up.
So they did monitor sexual activity, and with some stats work, you can get a number describing risk per person per sexual encounter. We'll have to wait for the paper to get all the info.
Um... so removing tissue and creating scar tissue helps prevent initial HIV infection. I dont have or want children, so I dont really care either way on circumcision, but this seems kinda like a non-solution to this problem.
"We cant get drugs to you.
We cant figure out a decent vaccine.
Um, cutting off your foreskin kinda helps? Maybe use a cheese-grater to get you some more scar tissue?"
I still dont get it. I guess Ill wait for the paper.
Men do not associate their masculinity or self worth with that tiny ring of tissue (or at least one hopes not), however, breasts are very intimately tied to a woman's self-image, and their loss is also visible and obvious to others around them. In addition a mastectomy is a much more serious surgery, the loss of lymphatics can often lead to serious side-effects, and the risk is astronomically higher than losing a small piece of skin.
As it happens, preventative masectomy is often recommended for women with the 'breast cancer gene'. The lifetime risks of developing breast cancer in the general propulation are only about an order of magnitude lower than the risk in the carriers of the gene, so for all the cries of hyperbole, what I proposed as a rhetorical point is no more than an order of magnitude away from an established public health practice.
The 'self-image' argument is culturally loaded. Americans see it as 'a tiny bit of skin' because it's routinely removed here; Europeans tend to be more perturbed by the practice. Those of us who have a foreskin tend not to regard them as unimportant.
Removal of the prepuce makes masturbation significantly more difficult (which is why it was adopted as a routine practice in the first place); it significantly alters the sexual experience. It is not a trivial procedure.
Moreover, the experience of 'minor' genital surgery in the third world has not been propitious. Vasectomies in India for purposes of family planning were carried out under septic conditions and frequently resulted in infection; I can't imagine Uganda would be very different. If this study is to be followed up with a policy of promoting circumcision as a routine public health procedure, it's very worrisome. If it's not, why was it done?
And finally, of course, this study, despite its irrelevance, will be used to justify the atavistic and inhumane practice of infant circumcision. And yes, I do object to that.
Re Iggy
Mr. Iggys' characterization of me as pro-circumcision is seriously in error. I have no opinion one way or the other on the subject. My only point is that Mr. Harbison was way off base in comparing circumcision with breast removal.
Re Iggy/Harbison
I would point out that Joshua of Nazereth was circumcised on the eighth day of his birth (now known as New Years Day). I am not aware that he registered any complaint on the matter nor did he threaten to sue Joseph and Mary for having the temarity to have such an operation performed, unlike some follows today who have taken their parents to court over the subject. On the list of important subjects for debate, this ranks rather low on the totem pole.
"Removal of the prepuce makes masturbation significantly more difficult (which is why it was adopted as a routine practice in the first place); it significantly alters the sexual experience."
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Of course, no study supports your second point. No study supports your first point, for that matter. 80% of adult men circumsized in one study found some additional difficulty in masturbating, but how significant it was is unknown, certainly they didn't find it a deterrant. Penile response was unchanged. I know that circumsized guys like to think they are better lovers, but if thats the case, why are all dildos lacking in those "crucial" bits?
There may be good arguments against rountine neonatal circumcision, Gerard, but those aren't them.
WHO have issued a press release about these trials. They intend to review the findings shortly, and make appropriate recommendations.
So if the trial was so successful why would the government want to stop this? It makes no sense all of the awareness that we are trying to bring to the cause finally when something seems to maybe work we stop ding it. Makes no sense at all.
Of course, no study supports your second point. No study supports your first point, for that matter. 80% of adult men circumsized in one study found some additional difficulty in masturbating, but how significant it was is unknown, certainly they didn't find it a deterrant.
My point was that circumcision makes masturbation significantly more difficult. You cite a study that found that 80% of adult men circumsized in one study found some additional difficulty in masturbating,, but that doesn't support my point!
ROFL!
Just great... What better way to get people to practice safe sex like telling them that they have a natural resistance.
Another reason I'm glad that I was born in Canada.
I have a question... Why when people disagree with FGM and MGM even being compared to each other, it's always the worse form of FGM used for the comparison?
What about removing just the clitoral hood, or maybe even just a small part of it. Is that ok?
Because they want to establish the idea that male circumcision is not only unlike female circumcision but has nothing in common, and thus they try to associate the most outrageous and offensive forms of female genital mutiliation with the term. Male circumcision already has a "normal and acceptable" tag in most people's minds, so the association causes them to reject any comparison.
"My point was that circumcision makes masturbation significantly more difficult. You cite a study that found that 80% of adult men circumsized in one study found some additional difficulty in masturbating,, but that doesn't support my point!"
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As I mentioned, your blanket characterization was of a significant difficulty, but the only study I know of relating to your point doesn't characterize whether the difficulty was temporary, intitial, minor, or what. So, it doesn't support your point. You are extrapolating beyond the conclusions of science. In addition, these men were able to masturbate and had no difference in penile response, so what is actually being measured seems to be discomfort with the change in their penis, not circumcision per se.
This is a self report on men who were circumcized as adults, and doesn't address the issue of whether men circumcized as neonates have any difficulty whatsoever masturbating (the don't) or whether they would find a foreskin inhibiting to their accustomed masturbatory technique. And your other point about foreskins altering sex in some way is utterly without evidentiary foundation.
"What about removing just the clitoral hood, or maybe even just a small part of it. Is that ok?"
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I don't know. Does it result in a tenfold decrease in risk of UTI? What are the risks?
I'm not not talking about possible benefits here Seth... Assuming it was safe, if cutting off the clitoral hood of young girls was a tradition, would you support the rights of parents to have this done?
Cost-benefit analysis of using circumcision to prevent urinary tract infections
How curious, Mr. Manapio. When I first spoke with you, you claimed to be pondering the appropriateness of circumcision and seeking information on the topic, yet your posting history here indicates you've done nothing but promote the practice from the get-go.
The comparison of mastectomy to circumcision may be hyperbole, but let's think of it in another way. Do we allow assault because murder is worse? Of course not. In essence the quantity of damage is irrelevant to the discussion. The qualitative impact of mastectomy (if done on kids, a bit more hyperbole on the earlier talk) and circumcision of infants would be the same: medically-unnecessary removal of healthy body parts from non-consenting individuals.
That's what's at stake as people grab this study and run with it to further justify circumcising children. I don't have any issue with this study, since it's adults. Let adults do whatever they want, including removing body parts if they think it'll help. (i.e., they can't be safe and monogamous, or they fear it's not enough) But respect for the rights of healthy children still matters, regardless of how effective circumcision is at reducing HIV infection once they start having sex.
Hmmm... Cost-benefit analysis
Something seems to have gone wrong with the previous linkage. I'll have to work on that.
A better comparison to male circumcision would be removing a third of the clitoris - except that women whose clitorises are damaged often experience significant sexual impairment.
I'm starting to wonder if I will even get an answer to my question. Whenever I bring up the idea of cutting off the clitoral hood, the MGM supporters suddenly grow very silent...
It's understandable though. If you say that you would support the practice then you are supporting a barbarism, illegal in most parts of the world. Of course, if you wouldn't support the practice then you are a hypocrite for all to see.
Whoops.
In addition, these men were able to masturbate and had no difference in penile response, so what is actually being measured seems to be discomfort with the change in their penis, not circumcision per se.
Now you're reading what's not there.
Some basic common sense. Handcuff a man's hands behind his back, and he'll still figure out how to masturbate. The fact that (obviously) circumcised men can masturbate does not bear on whether circumcision makes it easier or harder. That circed and uncirced men do it differently is obvious simply from the anatomy. Circed men frequently use lubricant, for example, something uncirced men don't need.
"yet your posting history here indicates you've done nothing but promote the practice from the get-go."
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Find a quote from me that shows I promote neonatal circumcision, please. Disagreeing with you or a total wacko like Van Lewis is not a sign that I promote neonatal circumcision. Its a sign that you have bad arguments.
u221e: my question to you was, does the practice that you are asking about (clitoral hood "circumcision") reduce UTI in girls by a factor of ten, like male circumcision does? Is this a very low risk procedure, with no known negative side effects (barring complications from surgery, of course).
What are the risks and benefits? Then we are comparing apples to apples, and I would probably support the right of parents to make that choice if all things were equal.
All I've asked about male circumcision from post one is "where is the harm?". It isn't my fault if you can't come up with an honest, evidence based answer. The best argument I've run into was that it doesn't confer many benefits, and its surgery and therefore risky, so why do it? And that is pretty compelling, I gotta admit, which is why I'm on the fence.
"Circed men frequently use lubricant, for example, something uncirced men don't need."
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Or, something intact men find more difficult to clean up. Or whatever. These ideas that intact men have about the circumsized penis are just weird to me, and certainly don't reflect my own experience.
In any case there is no evidence that circumcision makes it significantly more difficult to masturbate, which was your original claim.
You might as well ask what the harm of amputating the glans would be. That's not necessary for male sexual response either - no part of the genitals are. The nature and quality of the sensations leading to that response, very much so. The loss of the frenulum alone is a serious harm, given that it seems to be the most sensitive part of the penis.
Your argument seems to consist mainly of your refusal to accept that your penis might not actually work as well as it might have.
"Your argument seems to consist mainly of your refusal to accept that your penis might not actually work as well as it might have."
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Not really. I totally accept that my penis might be completely disfunctional, and I might be missing out on transports of earthly delight of which I know not. I just haven't seen any evidence that this is actually the case, or even that it is likely that this is the case.
So I could, with equal validity, suggest that your argument seems to consist mainly of insisting that your penis is better than mine. Why do you feel like you need to be superior?
For starters, I haven't told you my gender.
I'm still a bit confused as to how "cutting off a forth of the skin on a erogenous sexual organ" doesn't constitute harm in your mind, but frankly why you hold the positions you do doesn't really matter any more.
"I'm still a bit confused as to how "cutting off a forth of the skin on a erogenous sexual organ" doesn't constitute harm in your mind, but frankly why you hold the positions you do doesn't really matter any more."
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Well, as I said, thats a point. And a reasonable one. I guess my answer would be that there doesn't seem to be any detectable loss in sensation or function and there are some prophylaptic benefits. So in the net, it doesn't seem to be harmful. Convince me I'm wrong.
No problems here, but I'm a sample of n=1.
Regarding clitoridotomy, from wikipedia...
"Clitoridotomy" (which is also called "hoodectomy" as a slang term) involves the removal or splitting of the clitoral hood. The United Nations Population Fund states that this is comparable to male circumcision.
While the practice is more or less abandoned in the west, there are some who advocate it's practice in adult women who have difficulty reaching orgasm, saying it makes the clitoris more accessable.
One reason that circumcision and clitoridotomy are discussed seperately is that they are two different procedures, despite being anatomicly similar, and each procedure must be examined seperately.
Unlike circumcision, there are no studies regarding health benefits that cliterodotomy provides.
For instance, unlike circumcision, clitoridotomy is unlikely to prevent HPV infection or resulting cervical cancer, while studies do demonstrate a decrease in both penile cancer (including a decrease in the more severe invasive form) and cervical cancer in the female sexual partners of circumcised men. Similarly, it is unlikely to be protective against HIV infection, and by location in relation to the urethra, unlikely to provide any form of protection against UTIs.
Actually, Robster, I've been wondering something. Given that you're convinced circumcision has all these health benefits, what is your explanation for the general absense of the procedure throughout most of the world? It's generally only the most backward and ignorant places in the world that practice it - why hasn't it caught on like wildfire in the highly educated European countries with a long history of quality medical care?
"Circed men frequently use lubricant, for example, something uncirced men don't need."
Ciced men need lube for beating the monkey? REALLY??? Circumscised men somehow autolube? You're making this up, aren't you? Do you use lube or does yours autolube?
An article on the subject in "The Guardian":
http://www.guardian.co.uk/aids/story/0,,1971526,00.html
Don't miss the nice subtitle:
"Trial outcome could mean huge cut in infection rates"
I think that humour is such a strong part of their culture that the Brits practise it without even noticing...
Cal, so? Prevalence and efficacy aren't always linked. With these new studies, things could change.
Whenever looking at a trial for the efficacy of a treatment, as far as I've been taught, you have to look at a number of things, such as the relevance of the study population, the absolute and relative benefit of the intervention, and the harms of the intervention.
According to the description of the press release, it certainly seems like it would be quite beneficial for Ugandan men to get circumcised -- although I couldn't say for sure without knowing the possible and probable HARMS of the intervention in Uganda. And not only in the 'ideal' study setting, but the real-world Ugandan setting. As someone pointed out earlier, the harms may increase significantly under routine, not-so-aseptic clinics. Even if they don't, for informed consent, you'd have to tease out which the patient is more afraid of -- the (?big) chance of getting HIV -- which may be somewhat reduced by the procedure -- or the (I imagine) very small chance of getting an infection and losing one's penis or life (which one is worse, I wonder?).
This whole risks-benefits ratio changes, of course, when you try and apply something like this to, for example, North America. Already your risk of HIV infection is much lower, and thus the absolute benefit shrinks, while the risks would likely remain similar. That's assuming you can even apply finding from a Ugandan population, with their different genetics and cultural norms, to European or North American populations.
As a brief aside, it is the complexities above and the difficulties even a fully grown, mature adult would have in making these decisions that tend to force me to lean towards the 'no infant circumcision' camp.
Just as how circumcision is widespread in America despite there being no clear evidence of any advantages.
Unlikely. Let's hope not.
Wanting to refamiliarize myself with the positions of medical associations in places outside the US, I happened to come across some interesting points in their position statement - specifically,
Indeed, sometimes people don't let the medical statistics guide their behavior at all.
I hate long blocks of posts from a single poster, so this will be the last for tonight:
John Hawks' analysis
Interesting read. The cost/benefit analyses described all seem to come up basically scratch, it doesn't seem to much matter. Of some concern to me was this section:
Renal failure and death are pretty hardcore problems. On the other hand, the rate of problems of any kind for either group is pretty ridiculously low, so that isn't really a significant risk. It just sort of jumps out at you.
The other bit that really bothered me, was the section on pain control. I don't like the thought of complications arising from lidocaine usage, but that seems to be the only really effective pain block. And it is not recommended to forgo anesthetic, quite the contrary. So thats a real concern.
"Indeed, sometimes people don't let the medical statistics guide their behavior at all."
Caledonian, I wonder whether you understand this correctly. Context is important, but for the sake of argument, let's simplify:
1. The total rate of UTI in uncircumcised male infants is 10x that of the rate in circumcised male infants.
2. When UTIs do occur in (ritually) circumcised male infants, the timing of many of them indicates that it may be as a complication of circumcision.
Point 2 obviously does not negate point 1 (and the design of the study cited could not negate it). So how do you think these statistics should guide us?
Point 1 is unusual - most of the studies I've read indicate a much smaller difference - but the actual rate in both groups is very small.
That puts Point 2, in which the rate of UTIs is raised to nearly 50%, in stark contrast. Quite simply, some of the circumcision advocates here have suggested that cutting the UTI rate by half or two-thirds is worth cutting off parts of the penis - yet when circumcision is practiced in a particular (and fairly common way), it vastly increases the rate of UTIs by far more than a factor of two. Or three. Or ten.
Does Robster insist that Jewish parents disobey tradition and circumcisize their infants later? Hmmmm?
What are you going on about now?
Sterile procedure. Trained physician. Proper tools and techniques. Pain management. Proper care of the post op patient. Those are my reccomendations. As general anaesthesia is called for after a certain age, the risk factors associated with the procedure (still very low) increase. I'm less concerned with timing, although circumcision of neonates is preventative of UTIs in infants, so earlier is better.
I'm sure that a link to your source of info regarding STD/STIs has been posted before, but would you mind posting it again? It is different from what I am familiar with.
"Point 1 is unusual - most of the studies I've read indicate a much smaller difference - but the actual rate in both groups is very small."
It's an approximation of the value from the most recent meta-analysis. Scroll down to figure 2, and you can clearly see that this is the average. I'm aware of only a single study, by To et al, that found a significantly smaller difference.
"That puts Point 2, in which the rate of UTIs is raised to nearly 50%, in stark contrast."
You've misunderstood. In fairness though, the wording of the CPS statement isn't very clear. Here is the abstract of the study that they cited. As you can see, the study population was "169 children with UTI (56 males and 113 females) born in Israel from 1979 to 1984."
The study doesn't indicate that 48% of boys get UTIs after circumcision. It indicates that, among all boys who get UTIs for any reason, 48% of those occur in the post-circumcision period.
Now, let's ignore the fact that this seems to have something to do with the type of circumcision. Let's make the (not unreasonable) assumption that all Israeli boys are circumcised, and apply these data to UTI rates from US studies:
To quote the AAP: "Using numbers from the literature, one can estimate that 7 to 14 of 1000 uncircumcised male infants will develop a UTI during the first year of life, compared with 1 to 2 of 1000 circumcised male infants."
Uncircumcised UTI: 0.7% to 1.4%
Circumcised UTI (overall): 0.1% to 0.2%
Circumcised UTI (as complication): 0.1% x 48% = 0.048% to 0.2% x 48% = 0.096%
So the the lowest estimate (0.7%) of UTIs in uncircumcised boys is greater than the highest estimate of UTIs as complication of circumcision (0.096%). In fact, it's 7.3x greater.
"Quite simply, some of the circumcision advocates here have suggested that cutting the UTI rate by half or two-thirds is worth cutting off parts of the penis - yet when circumcision is practiced in a particular (and fairly common way), it vastly increases the rate of UTIs by far more than a factor of two. Or three. Or ten."
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I'm not sure this is true... don't all of the children in this study have a UTI? I didn't get the impression that 50% of children ritually circumcized got a UTI, which seems to be what Caledonian is implying.
Not true. It's commonly performed on adults with local anesthesia only. General is called for when the doctor doesn't think the patient will remain still.
Circumcision has traditionally not been practiced with any of the things you list as requirements, and in fact is historically associated with serious complications. Yet people still found it worth doing, somehow - and that doesn't strike you as odd one bit.
When people are satisfied with unreasonable justifications for a thing, any reasonable justifications they offer are likely to be rationalizations - just as you've rationalized away the fact that the evidence does not support the conclusion you wish to reach.
The evidence suggests that earlier is worse, not better.
As for the source - take a look at the position statements of virtually any non-USAian and non-Israeli pedatric association. Take a look at the USAian and Israeli, too, just to see how much are the same.
"The evidence suggests that earlier is worse, not better."
Incorrect, sorry. In males, UTIs become less likely as the child ages, so maximum benefit is found by circumcising early.
Incidentally, I have responded to your UTI claim in detail, but for some reason (too many links?) it must be checked before it will be posted.
Except that early circumcisions seem to trigger UTIs.
Manapio, you have once again managed to completely miss the point. Throughout the first year of life of the male infants who developed UTIs in the study, 48% of the UTIs occurred in a specific time period that represented about 4% of the total time. That pattern doesn't match the normal rates of UTI contraction, leading to the speculation that the period during which a circumcision is done matters. Parents, however, will not alter this because the child's health is not the reason why they're being circumcized in the first place - it's religious/cultural reasons, and those reasons demand that the circumcision take place at a certain time.
It has always been cultural concerns that drove circumcision. The medical concerns were just rationalizations developed afterwards - the UTI link was made by a brute-force comparision of all the differences between circumcized and uncircumcized infants. The researchers were trying to find a reason to justify the procedure, and lo and behold, they "found" one.
Of course, the rate of UTIs is so low in the first place that if even an incidental impairment results from routine circumcision, it far outweighs the possible benefits even when the most significant UTI claims are accepted.
"That pattern doesn't match the normal rates of UTI contraction, leading to the speculation that the period during which a circumcision is done matters."
Where did you get this idea, Caledonian? I presume that it must be your interpretation, because the authors of the study merely speculated that UTIs might be a complication of circumcision.
No, Jake, the onset of 50% of the cases in 4% of the time totally fits the normal pattern. Clearly the authors must have been rabid MGM opponents who created the hypothesis out of whole cloth as an excuse to denigrate the practice.
The study took place in Israel, so they were probably anti-Semitic as well.
Caledonian, please take a look at this chart. It's from a Swedish study of UTI rates, and as you can see, most UTIs in boys do indeed occur at a very young age.
I don't know whether the distribution in the Israeli study or not was normal or not. The authors suggest that it is not, and they may well be right - it seems perfectly plausible that UTIs might occur as a complication of circumcision. However, there's no indication that the age of the child at the time of circumcision makes any difference. That conclusion simply does not follow from these data.
As for your other remarks, may I suggest that you avoid the fallacy of appeal to ridicule in future.
Cal,
Circumcision has traditionally not been practiced with any of the things you list as requirements, and in fact is historically associated with serious complications. Yet people still found it worth doing, somehow - and that doesn't strike you as odd one bit.
Those were reccomendations, not requirements. When performed as a sterile procedure, by trained professionals, with proper tools and techniques, circumcision has very low adverse effects. As the above study is about ritual circumcision, associated with less advanced procedures and techniques, which increased risks, you have proven my suggested reccomendations to be solid. Should mohels change their techniques or step aside for modern medicine? They have before, and should again.
Jake's reading of the stats appears correct, making even ritual circumcision, with all it's failings, better than no circumcision when it comes to preventing UTIs.
Except, of course, the loss of sensitive penile skin, which has an 100% chance of occurring. And which you keep ignoring.
Your chart shows that the number of UTIs within the first month of life is normally significantly less than half the cases. The early circumcisions acted as triggers for the development of UTIs, infections which we might reasonably expect could be avoided if the timing were changed. But, of course, the timing will not be changed.
"The early circumcisions acted as triggers for the development of UTIs, infections which we might reasonably expect could be avoided if the timing were changed."
I don't understand. What basis do you have for thinking that the timing of the circumcision is involved? Do you have any comparable data for UTIs in which the method is unchanged but the timing of circumcision differs?
1) General knowledge that UTIs, while more likely during the period when an infants' immune system is not fully active and when breastfeeding is de-emphasized, are not so unevenly spread.
2) The researchers in the cited study speculated that timing might be an issue. (They did that for a reason.)
I could have looked for the actual data, but it wasn't necessary - and as it happens, you looked up some of the relevant data yourself. In the study you cited, what percentage of the UTIs among males took place within the first month?
"1) General knowledge that UTIs, while more likely during the period when an infants' immune system is not fully active and when breastfeeding is de-emphasized, are not so unevenly spread."
The uneven distribution might suggest that ritual circumcisions are a predisposing factor. It does not indicate that timing is an issue.
"2) The researchers in the cited study speculated that timing might be an issue. (They did that for a reason.)"
They might have done in the full text, but they did not in the abstract. If you have the full text, please quote the relevant material.
"I could have looked for the actual data, but it wasn't necessary - and as it happens, you looked up some of the relevant data yourself. In the study you cited, what percentage of the UTIs among males took place within the first month?"
I'd need the data in tabular form to be precise, but by estimating values from the chart, I estimate that in the first year, about 23% of those among boys occurred in the first month. Clearly this differs significantly from the 48% seen in the Israeli study.
However, to understand whether the timing of circumcision has any impact, I would need data for boys circumcised at, say, 2 months rather than 8 days.
"Manapio, you have once again managed to completely miss the point. Throughout the first year of life of the male infants who developed UTIs in the study, 48% of the UTIs occurred in a specific time period that represented about 4% of the total time. That pattern doesn't match the normal rates of UTI contraction, leading to the speculation that the period during which a circumcision is done matters."
-------
From the study,
Infant males in the US are commonly circumcised early, aren't they? So doesn't the "method" section there have something to do with this?
Besides, that isn't what you said, you said that "yet when circumcision is practiced in a particular (and fairly common way), it vastly increases the rate of UTIs by far more than a factor of two. Or three. Or ten."
So that implies that this is relevant to the rate of UTI in the general population. That was my question, isn't this a study of infants who ALL have UTI, and therefore not relevant to the question of UTI rates in the general population?
Since such clumping isn't found after later circumcisions, timing may be an issue. Which is what the researchers pointed out.
This is increasingly pointless.
"Since such clumping isn't found after later circumcisions, timing may be an issue."
What's your source for this?
We have data for day 8 circumcisions (Israeli study).
We have data for no circumcision (Swedish study).
Where is the data for later circumcision?
Who're you calling 'we'?
I notice that you've ignored the points about the prepuce being richly supplied with sensory nerve endings. May I ask why?
"Who're you calling 'we'?"
Readers of this thread. I've provided sources for these data, thus we all have access to it.
"I notice that you've ignored the points about the prepuce being richly supplied with sensory nerve endings. May I ask why?"
To put it bluntly, you seem to have been confused in previous posts about which poster you're replying to, and have mixed up the issues. I thought it most polite to say nothing and let you figure it out.
If you want my personal response: what of it? There's little evidence that those nerve endings correspond to a more pleasurable sexual experience, and thus there is little reason to believe that their removal is harmful in any objective sense.
Why have you repeatedly suggested that the Israeli study involved ritual circumcision?
Research in patients with spinal cord injuries (not to mention general experience) has demonstrated that males don't need genital stimulation at all to have pleasurable sexual experiences. Unlike women, who frequently need specific and direct physical stimulation, men can achieve orgasm without any genitalia at all.
Would you say that there's no objective need for the penis, then?
"Would you say that there's no objective need for the penis, then?"
====
Obviously not. It makes peeing easier.
DTABBA.
You seem to have overlooked the word "more" in "more pleasurable sexual experience," Caledonian.
"Why have you repeatedly suggested that the Israeli study involved ritual circumcision?"
"Would you say that there's no objective need for the penis, then?"
====
Point 1:
Point 2:
Obviously not. It makes peeing easier. DTABBA.
Even if circumcision reduced rates of UTIs and/or HIV, I personally don't think it makes sense to perform preemptive surgery, removing functional tissue, to slightly reduce incidence of disease. HIV transmission is easily preventable without genital modification surgery, using barrier contraception. UTIs are hardly life-shattering problems - women have to deal with them quite often.
It's a little hard to make a clear-cut case on the issue, since the common arguments compare anecdotal changes in sexual function to statistical variation in incidence of disease. But I think with the available evidence, it's simply not a medically necessary surgery in most cases. To me, it's a very odd custom, and people seem to have to struggle to justify it.
"But I think with the available evidence, it's simply not a medically necessary surgery in most cases."
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I absolutely agree, it is not a medical neccessity. However, it is also not the horrible tragedy that the anti-circ crowd claims. The costs and benefits, according to the literature, seem to cancel each other out.
How many of the children underwent the ritual, and how many the medical procedure? The study doesn't say.
Quantifying pleasure is notoriously difficult, which is probably why you're hiding behind such claims. Qualitatively?
Taking aspirin on a regular basis reduces the blood clots associated with some kinds of strokes. Do you know why doctors don't recommend taking aspirin regularly?
"Quantifying pleasure is notoriously difficult, which is probably why you're hiding behind such claims. Qualitatively?"
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Qualitatively? Look, if there is no difference in penile response to identical stimulation, time to erection, duration of erection, and time to orgasm, any claims of a qualitative difference in experience are just mojo. If there is a difference, there is a difference.
Groups like CIRP should spend less effort trying to convince me that the foreskin has magic powers and more effort funding some damn research and providing real information. But they don't, because they are afraid to put their claims on the line. They are the people who are hiding.
If I read correctly 56 of the 169 children in the study underwent ritual circumcsion, and of those, 27 developed a UTI within 12 days.
Loosing the foreskin changes the basic mechanics of sex. It's a musocal membrane for crying out loud. It has a large collection of nerve endings not found in either the rest of the penile skin or the glans, and it's normally the part in contact with the vagina. Common sense strongly suggests it's more important than you seem set on declaring it to be.
The null hypothesis is always non-intervention. If you want to be a proponent of an intervention, the burden of proof is on you to show that the intervention is worth any risks or losses involved and that the benefits cannot be attained in some other way. Even if we accept your analysis, the benefits don't outweigh the risks - so circumcision should not be performed.
Oh, and let's drop the "that's why I think parents should decide" garbage. We let parents decide whether to have their children immunized or not, and that has a greater potential impact on health than even your wildest claims about circumcision - whether parents can made medical decisions for their infant children isn't the question.
The question is whether the medical profession should offer to circumcize, or indeed when and whether it should agree to do so at all. People tend to go with what doctors recommend, so even making an offer isn't a neutral stance.
"Common sense strongly suggests it's more important than you seem set on declaring it to be."
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Alternately, based on the fact that almost all phallic sex toys, regardless of the country of origin, mimic circumcized penises, common sense could go the other way. We could argue that endlessly, and it would be pointless. As far as I have been able to determine, the foreskin is neither all that nor the accompanying bag of chips, it is neither neccesary nor terribly important for enjoyable and fulfilling sex.
Should the medical profession offer to circumcize? I can only assume that the reason they do (even in "enlightened" europe) is because it has some prophylaptic benefits that are not outweighed by the risks.
Do you have a source for that claim?
That quality of reasoning is precisely what I've come to expect from you.
"Do you have a source for that claim?
That quality of reasoning is precisely what I've come to expect from you."
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1: My source is a quick informal survey of the items offered at www.phallicsextoys.com.
2: Why is my reasoning poor? What is wrong with the theory that doctors are offering, but not recommending, a procedure because they believe the risk benefit analysis is more or less a draw?
Seth Manapio, would you mind explaining to me how you would go about making a sex toy that would mimic an intact penis? The mechanics and materials involved would be really quite complicated... Not that you would know.
Oh, and why don't the Europeans usually perform this practice on their children? Well, because it's viewed the same way as piercings, tattoos or putting a bone through your nose. All of which are perfectly fine... if it's your own choice to do so.
"Seth Manapio, would you mind explaining to me how you would go about making a sex toy that would mimic an intact penis? "
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I recommend that you try a google search for this one (I just found one on the first page of results) as I am not a sex-toy designer. As I said, my source was an informal survey of existing sex toys.
My point, however, is that there is no evidence beyond the anecdotal that the foreskin is necessary or even helpful for fulfilling, wonderful, fully satisfying sex, and equal anecdotal evidence that it hinders great sex. I doubt it matters very much, and I think the evidence is with me here.
Your second point is a better point and gets to the heart of the issue: given that circumcision is not medically neccesary, is this a decision that parents ought to make for their children? Clearly, this is not as clear cut a situation as vaccination, where there is an obvious benefit and very little risk.
But parents are not served by hysterical propaganda on either side of this issue, or by misinformation.
Since I am cut, I'll never know, but by ALL accounts the foreskin makes a huge difference in sensitivity. Despite the "anecdotal" evidence to which Seth refers, the fact is the foreskin contains hundreds of nerve endings. How could its removal NOT reduce sensitivity?
But if UNAIDS tells African men to chop it off, then certainly the AIDS industry is right there to enforce "adherence" in spite of the tremendous dangers due to infections that will ensue. Read more about male circumcision http://notaids.com/mgm.
Please educate yourself further about this important issue.
There is nothing right about male genital mutilation. I wonder if Seth would care to take this reasoning to its logical conclusion: if it is the male organ that spreads disease then why not chop the whole thing off ? We could start with Seth as our first volunteer.
Since forced circumcision is so great (or persuasion by lies) , why stop there? How about a clinical trial to see how effective removing the entire male organ is at reducing HIV! The penis which seems to be so troublesome and will likely be blamed for armageddon isn't necessary anymore.
With 10 billion people soon to inhabit the world, why do we need to propagate anyway? The earth needs time to regroup. Yeah, that's it, just cut the whole thing off. Seth could be the first human subject in this exciting clinical trial sponsored by UNAIDS and WHO.
One final note on this topic; the study which points to reduced HIV rates due to male circumcision was seriously flawed, as are most "research" studies on AIDS and HIV.
Read more at http://notaids.com/mgm.
"One final note on this topic; the study which points to reduced HIV rates due to male circumcision was seriously flawed, as are most "research" studies on AIDS and HIV.
Read more at http://notaids.com/mgm."
Why? It's mostly false.
"The association between circumcision and AIDS began in 1986, when the late California urologist and circumcision promoter Aaron J. Fink proposed that the keratinization damage caused by male circumcision would prevent HIV infection."
Incorrect. It was first proposed by Valiere Alcena.
"A number of studies on the subject have been conducted in Africa since that time."
...and India, the US...
"Although results from studies linking male circumcision and AIDS are conflicting,"
On the contrary, all randomised controlled trials have found a protective effect. The overwhelming majority of observational studies have found likewise.
"the two most recently completed studies"
Randomised controlled trials.
"in Kenya and Uganda show that male circumcision has a 48% - 53% protective effect against HIV over a 14 month period."
Correct.
"The previously published Auvert Study concluded that circumcision reduced HIV transmission in South African men by 63% over a period of 21 months, but that study was widely criticized for having a number of easily spotted flaws in methodology, and for its overly optimistic conclusions."
No serious challenges to the methodology have appeared in the publishing journal, nor indeed to any other journal, to my knowledge.
"The multi-country Mishra study concluded that circumcision may actually increase transmission of the AIDS virus,"
First, this was an observational study, not a randomised controlled trial. Second, it found no such thing. It found that "With age, education, wealth status, and a number of sexual and other behavioral risk factors controlled statistically, in only one of the eight countries were circumcised men at a significant advantage. In the other seven countries, the association between circumcision and HIV status was not statistically significant for the male population as a whole. ... We find a protective effect of circumcision in only one of the eight countries for which there are nationally-representative HIV seroprevalence data."
"however, which is what many earlier studies found."
Mishra noted the opposite: " There is a large body of literature indicating that male circumcision has a protective effect against HIV infection; however, not all studies find this effect."
http://www.iasociety.org/abstract/show.asp?abstract_id=2197431
"The relationship between female circumcision and AIDS has also been studied, with similar conflicting results. The Stallings Study found that female circumcision reduces transmission of the AIDS virus, while other studies have shown that it increases transmission."
Correct.
"The United States has one of the highest rates of male circumcision and also one of the highest rates of HIV infection in the developed world, suggesting that circumcision is having exactly the opposite effect."
Perhaps - if one were sufficiently ill-informed to put faith in such a weak methodology. Those who are aware of the relatively poor sex education and condom usage in the US would agree that no reasonable conclusion can be made.
"Circumcision of infants and boys for any reason other than a clear, compelling, and immediate medical need is sexual assault."
Hysterical claims...
"Will doctors ever begin promoting female circumcision as a way to help prevent AIDS?
It's a very real possibility. If physicians are successful in convincing governments to allow boys and infants to be forcefully circumcised as part of the war on AIDS, it may only be a matter of time before other doctors use the Stallings Study to justify circumcising girls for the same reason."
This is presumably a joke. The author acknowledged above that Stallings' (observational) study was an exception to the rule: the preponderance of evidence is that female circumcision is not protective.
Medicine traditionally holds interventions given to healthy people to a very high standard, and circumcision hasn't met that standard even if you accept the claims of the most enthusiastic circumcision supporters.
It's practiced in the U.S., the Middle East, and Africa for cultural reasons, not medical ones. The lack of medical justifications is why it never caught on in Europe and has died out in the U.K., Australia, and Canada.
"Since I am cut, I'll never know, but by ALL accounts the foreskin makes a huge difference in sensitivity."
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Actually, this isn't true. Some men in a position to know say one thing, others say another, and studies of penile response show no difference.
Can anyone give an example of any other body part that is removed on a wide scale in order to prevent an adverse medical condition? Not to prevent the spread or relapse of a condition, but just to prevent. I have seen no justification posted here which would call for routine removal of foreskin at birth. Is there anyone that can help with a rational reason for infant circumcision?
As general anaesthesia is called for after a certain age,
Not true. It's commonly performed on adults with local anesthesia only. General is called for when the doctor doesn't think the patient will remain still.
Circumcision has traditionally not been practiced with any of the things you list as requirements, and in fact is historically associated with serious complications. Yet people still found it worth doing, somehow - and that doesn't strike you as odd one bit.
When people are satisfied with unreasonable justifications for a thing, any reasonable justifications they offer are likely to be rationalizations - just as you've rationalized away the fact that the evidence does not support the conclusion you wish to reach.
http://www.zayiflanet.com