Liberté, égalité, fraternité . . . foreskin? Who knew that penises had anything to do with the French Revolution? Some historians have suggested that Louis XVI, king of France, suffered from phimosis, an uncomfortable medical condition in which it is difficult or impossible for a man's foreskin to retract. Phimosis can cause pain during sex, when the tight inelastic foreskin chokes the erect penis. So phimosis is where the foreskin is up and you can't get it down—not to be confused with paraphimosis, where the foreskin is down and you can't get it up. That's the sort of the thing that medical folks like yours truly have to worry about when doing something like inserting a catheter through the penis into the bladder. When you insert a catheter, you first pull the foreskin down; you better remember to pull the foreskin back up after the catheter goes all the way in. Otherwise, after a while, the foreskin you slid down can choke the end of the penis and cause it to swell (like putting a rubber band around your fingertip)—and you won't be able to get the foreskin back up later. This is why, in medical school when you are learning to examine the genitals, you're taught to ask every man whether he is circumcised or not. Some guys may look circumcised when they are not, and vice versa, so it is important to know where their foreskin is normally, before you start moving it around.
But back to old Louis.
Some sources claim that because King Louis suffered from phimosis, he rarely had sex with his wife. Frustrated, she indulged in all kinds of debauchery, from orgies to incestuous relations with her own son. True or not (and most likely untrue) stories like these provided fodder for rabble-rousing Jacobin revolutionaries; the anti-monarchist French press of the 1780swas full of scandalous stories of the unbecoming behavior of the (soon-to-be-headless) heads of state.
But why am I rambling on about phimosis and foreskins? Phimosis can be cured with circumcision and lately circumcision has been the subject of some cutting-edge research. (Groan, sorry, can't help myself.) Recent randomized trials in Africa found that the risk of acquiring HIV infection were 50-60% lower in circumcised men, as opposed to uncircumcised men. One theory proposed to explain this phenomenon hypothesizes that the inner aspect of the foreskin contains more cells with HIV receptors, as compared to the glans (the area of the penis that lies under the foreskin). Thus, removing the foreskin, and these cells that are extra susceptible to HIV, can have a protective effect. In addition, circumcision has been shown to reduce the risk of penile cancer, and the rate of urinary tract infection in male infants. You can read all about it in the article "Decreased Incidence of Urinary Tract Infections in Circumcised Male Infants" by Dr. T.E. Wiswell. (I swear that is really the author's name. You can look him up!)
Snip away, you say? Some folks would disagree—passionately. There is an entire community who fervently oppose circumcision, despite the pretty strong supportive medical evidence. Those who are strongly anti-circumcision may refer to themselves as followers of the "Genital Integrity" movement, or claim they support "Intactivism." Some anti-circumcision websites seek to shock with stories of what they claim is an "international foreskin-smuggling cartel". I'm not exactly sure who would be involved on the purchasing side of said cartel, but I'll leave that subject for another time . . . Other websites, seeking a visceral response from the viewer, instead rely on gory pictures of screaming babies, all bloody genitalia and tears. Some anti-circumcision believers claim that men lose sensation with the loss of the foreskin. Luckily, there is a new product on the market, great for those who feel forsaken without a foreskin —the artificial retractable foreskin, a flesh-colored latex slip-on device. (We Americans surely do not lack for ingenuity in product development.) I guess it's a good option for guys who don't have the connections to get in with those dastardly foreskin-smugglers.
So I apologize, this article won't help you make light conversation at the next office party, (unless you have very progressive and open-minded co-workers or you work for a mohel, the man whose duty it is to perform a bris, the Jewish circumcision ceremony.) But whether you are pro- or anti-circumcision (and as you may have guessed, I'm pro-, based on the medical literature) you're sure to find someone who shares your views. And if not . . . to take a French saying completely out of context—vive la difference!
Welcome to The Doctor Is In. Medicine and the biomedical sciences are chock full of the bizarre, the fantastic, and the downright disgusting. As a medical student with a peculiar sense of humor, I'd like to share some of my favorite examples of weird and wild stories of the human body, health and disease. Check out the entire series at popsci.com/thedoctor where you can also grab the RSS feed.
You said some groups are opposed to circumcision, but is there any medical or scientific research to support their claim that uncircumsized men experience more sensation than circumsized men? and are there any other legitimate reasons to oppose circumcision?
It saddens me that there are still some in the medical world who believe that circumcision for reasons other than the correction of a medical condition is acceptable. This is a part of the anatomy that has evolved for a very good reason and to remove it, especially without the owner's consent, is shortsighted at the very least and, in my opinion, bordering on abuse at worst. Although there is much more research to be done, it is clear that the foreskin serves to protect the glans from abrasion, trauma and injury and to keep it soft and moist. When it is removed, the glans becomes keratinized (it dries out, thickens and toughens) and is thought to become less sensitive during sexual activity.
As for the study mentioned, I feel it is dubious to use statistics from a region where HIV infection is rife, where many men practice unprotected sex and may have limited access to information about sexual hygene and where condoms may be difficult to obtain to support the widespread practice of circumcision.
If the harm (medical, psychological and sexual) of male circumcision is ever proven to exceed the benefit, rest assured that the procedure will be swiftly banned.
Considering that hundreds of peer-reviewed publications addressing the medical aspects of male circumcision have failed to shift medical and scientific consensus to the anti-circumcision viewpoint, it is highly unlikely that a ban will happen any time soon.
Regarding the sexual effects of male circumcision, the most well-designed study to date found that men who had the procedure done as adults "reported increased penile sensitivity and enhanced ease of reaching orgasm."
Krieger et al. 2008. Adult Male Circumcision: Effects on Sexual Function and Sexual Satisfaction in Kisumu, Kenya. J Sex Med. (e-pub; print addition pending). PubMed ID: 18761593.
HeyItsMe says: <i>If the harm (medical, psychological and sexual) of male circumcision is ever proven to exceed the benefit, rest assured that the procedure will be swiftly banned.</i>
This is an interesting reversal of the usual standards applied to most other invasive medical procedures. Surely with circumcision, as with any other operation, it should be a case of "if the potential benefit is shown to exceed the potential harm then it should go ahead", not "do it by default for religious and/or societal reasons and then if some harm is shown to come of it, stop".
The study by Krieger et al. suffers from two flaws. First, although they used randomized controlled trials, they did not use randomized <i>double blinded</i> controlled trials. Trials that are not subject to blinding are, of course, susceptible to observer bias. Second, the trials were stopped early by the authors. Such trials tend to overestimate the efficacy of the intervention [Mills E, Siegfried N. Cautious optimism for new HIV/AIDS prevention strategies. Lancet 2006;368(9543):1236.].
The paper by Krieger et al. also points out a 1.5% complication rate, including impotence, anesthetic morbidity and pubic abscess.
The fact remains that this is a highly invasive and irreversible surgical procedure that in most cases is performed without the patient's consent (i.e. on newborns). The foreskin evolved for a good reason and, except in genuine cases of medical need, there is no equally good reason for removing it, especially for those living in first world countries where hygiene standards are high and prophylactic measures against HIV infection may be readily taken. If it is to be removed, this is a decision that should be made by an adult for themselves alone.
Most people abhor female circumcision, and rightly so. Why is it, then, that male circumcision so often seems to get a free pass, especially in the US?
Facts are facts. Randomized double blind studies don't lie. Seems as if some out there are personally afraid of the truth..... There are medical benefits to being nipped and that's the story.
"Startledgnu", I like the way you consider reduced AIDS rate to NOT count, but loss of foreskin ( not glans, which WOULD be the equivalent to female "circumcision", which isn't circum-anything, it's removal of the organ itself ) to be such a horrible loss.
Your commenting that that foreskin keeps the glans more soft & permeable is exactly why HIV gets into it more.
Your argument that every element of anatomy evolves for a Reason, is IntelligentDesign/Creationism, not evolution: things evolve because That's The Way They Happened To Happen.
Ask an octopus, some time, about how "intelligent" it is for it to have located its brain around its throat, resulting in unfortunately frequent braindamage/death when eating spiny things like urchins.
Ask yourself how come men have nipples, if every element of our bodies is there for a Designed Reason.
UNanesthetized circumcision of babies is abuse. Period.
Their entire previous experience was loving embrace, and to swing 'em upside down by their ankles in a cold harshly-bright room and assault 'em, as was Traditional among western doctors, or to snip off their foreskin without anesthetic ( doctors said "babies don't really know pain", making believe that they aren't human enough to do so -- same as blacks, of course )
Anesthetized circumcision, however, benefits the life by
a) preventing that problem with too-small-foreskin.
b) reducing infection-rate of HIV/AIDS
c) reducing infection-rate of other STIs, too.
thereby reducing the infection-rate among women whom men are intimate with, AND increasing the likelyhood of their family being able to afford quality of life, long-term.
Maybe reducing the rate of infection is non-real to you?
As for it being dubious to use statistics from ACTUAL LIFE, that's daft: what more accurately represents actual life than actual life?
I hope your higher-infection-rate, and higher-disease-burden world is segregated from my suppress-disease-systematically world, so I don't have my family subject to the increased HIV pressure your religion would push on 'em.
God takes care of those who take care of their god-given worth.
Well, there is science and then there is junk science and I’d say this clearly falls into the category of junk science. What?! This is by a student and not a real doctor? Can’t Popular Science afford a real doctor to provide health care information???????
Oh well, sit by my side grasshopper, you’ve got some learning to do. So far on this paper, you’ve gotten a big red “F” for your efforts and are in great danger of being demoted to dung beetle. You have conducted your research to support your position, not to find credible scientific information.
First, phimosis. A phimotic foreskin does not “choke the penis.” A phimotic foreskin has a ring of tissue surrounding the foreskin opening that is tight and resists stretching. This is a condition that affects approximately 1 in 100 men and is most likely caused by mothers retracting the infant foreskin on instructions from an ignorant doctor for cleaning. Of those unfortunate men who suffer this condition, 99% are able to resolve the condition by simple stretching exercises. On failure of that, the men can be successfully treated by simply making a simple longitudinal cut at the tip of the foreskin that will enlarge it enough for the foreskin to slip past the glans. Circumcision is not necessary to resolve the problem and if used, is an over the top solution.
You have to ask a man whether he is circumcised or not? Isn’t it apparent? I suspect you are Jewish and have never seen a foreskin in real life so I can understand your ignorance but asking a man this question on observing his penis is likely to do your professional reputation great harm.
Now whether Louis had sex with his wives or not is very much up to question but I can assure you that men with phimosis can quite successfully engage in sex, quickly reach orgasm and procreate. As a matter of fact, these men are generally very unconcerned with their “problem” and generally do not have much concern to resolving it.
On circumcision being an effective intervention to HIV infection, you should take a look at a truly effective intervention, the polio vaccine. Polio is present in the natural environment and passes by very casual contact. The polio vaccine is 70% effective and eliminated the infection in a single generation. In contrast, HIV exists only in the body and is relatively difficult to pass requiring intimate contact and transfer of body fluids. If circumcision truly were 60% effective, the vectors of transmission would be sufficiently broken that with 80% - 85% of the male population in The US circumcised, the infection would have never survived in The US. However, The US has the highest infection rate of any industrialized country. If circumcision truly were an effective intervention, the only way we could have this infection rate would be via a massive and constant re-introduction from Africa and that is just not happening.
As a physician, your mantra is “First do no harm.” Penile cancer affects only 1 in 110,000 men. To the contrary, 3 separate studies have found that approximately 230 infants die from their circumcisions every year. That means that for every case of penile cancer averted, seven babies will die. Those are not fatal cases of penile cancer, just cases. This cancer, squamous cell carcinoma is the same type of cancer found on the face and arms and removed in the doctors office. A match head sized lesion is removed and that is the end of it.
Speaking of infant deaths, there is not a single case in medical history of a child dying simply because he had a foreskin yet every year, 230 die just because someone wanted his foreskin off. “First do no harm.”
You also need to study up on Thomas Wiswell. Ol’ Tom was on the AAP’s Taskforce on Circumcision when his study was found to be contrived and deceptive. He used all full term babies for his circumcised group and all premies for his uncircumcised group. It is well established that premies are at significantly higher risk of UTIs. Ol’Tom was removed from The Taskforce for his deception along with Edgar Schoen who vigorously defended him.
It also appears that Ol’ Tom was reacting to another study when he conceived this one. There was a study at a naval hospital in Hawaii where Tom was stationed about 1982 that found that if parents are given truthful information about circumcision, they overwhelmingly rejected it. The circumcision rate at that hospital immediately fell from 80%+ to about 20% during the study period. Tom being one of the most radical and public advocates of circumcision in the world quickly put this study together. So quickly in fact as to be impossible. The number of medical records he claims to have reviewed was simply impossible given the time he had.
In fact there is a market for foreskins although it may not be the “international cartel” you speak of. Infant foreskins are used to make replacement skin for burn victims, as testing material and for ingredients in cosmetics. The really heinous thing about this is that the foreskins can not be tainted with anesthetics that would make them useless. The babies that “donate” the foreskins suffer immeasurably to make their “donation.” That sounds like something out of Nazi Germany, doesn’t it? “Another foreskin Dr. Mengele?”
However, we can’t really go after the international cartel. Recent research shows that only 16% - 23% of infants get any pain management for the procedure and just have to bear it out with gritted teeth. (gums?) Even if the international cartel wasn’t there, babies would still be suffering needlessly. Even the AMA has recognized this problem and in 1999 issued a policy statement that analgesics should be administered for the procedure but since then, it appears that the percentage of infants receiving analgesics has actually fallen by several percentage points. The most given reason by doctors for not administering analgesics is the time required. “Dr. Mengele, your wife called and asked that you be reminded about dinner with the Fuerher. You must rush to finish!”
Grasshopper, you may want to think about a different career path. As a professional writer, you could simply make up your facts as you go and no one would refute them and cause you embarrassment. As a medical professional though, there is always going to be someone like me who has actually done their research and will call you out on misstatements and misrepresentations. As a medical professional, you literally hold the health and life of your patients in your hands. Such slip-shod knowledge and research puts those patients in jeopardy and will put your profession in jeopardy as well.
Hello StartledGnu. It's possible that I'm overlooking something, but I see no possible way that a double blind circumcision trial could even be conducted. I mean, when you remove the prepuce from a man's penis, he's bound to notice. While a fully controlled experiment is always the gold standard, sometimes it simply isn't possible. In this case, the authors did a very good job of controlling for as many confounding factors as possible.
As you indicate, the RCTs were stopped early. However, the studies were not terminated by the authors, but by their ethical boards. This, as I'm sure you are aware, was done because the protective effect of circumcision against penile HIV acquisition was so great that it was considered irresponsible to let the control group (uncircumcised men) remain at risk.
Concerns about early RCT termination and how they affect data interpretation provide a careful, and much needed, voice of moderation to the circumcision/HIV dialogue. However, it should be noted that a recent meta-analysis of the three African RCTs (11,050 total participants) found that circumcision IS an effective intervention against HIV transmission [Mills et al. 2008. Male circumcision for the prevention of heterosexually acquired HIV infection: a meta-analysis of randomized trials involving 11050 men. HIV Medicine 9(6):332-335]. All of this is besides the point though, because such concerns about early study termination have not been advanced in regard to the new Krieger et al. results.
A 1.5% complication rate is actually a bit on the low side for a surgical procedure (whether or not circumcision is "highly invasive" is debatable), and while some serious problems inevitably occurred, almost all of them were minor hemorrhage or infections.
Whether or not the foreskin confers a fitness advantage for modern man is an interesting topic to consider. Obviously, evolution made the prepuce what it is today, but its role in human male reproduction is difficult to fully ascertain. It doesn't seem to have a significant effect on reproductive success in modern man.
Finally, the WHO notes that unlike male circumcision, female circumcision has "no health benefits for girls and women." [WHO Fact Sheet on female genital mutilation] The ethics of removing healthy genital tissue must be based on a harm versus benefit analysis. It seems clear to me that the ratio of harm to benefit is MUCH HIGHER for female circumcision than male circumcision. Therefore, while there are some very general anatomical similarities between the two procedures (the male prepuce being analogous to the female clitoral hood), it is problematic to analogize the two.
Frank: Vaccines with efficacy rates much higher than 60% have been around for decades, yet we must continue to use them because the viruses and bacteria responsible for the diseases they prevent persist in the population. The concept that circumcision should have eradicated HIV in the US simply doesn't hold water. Even those with a rudimentary understanding of this disease know that transmission often doesn't involve a penis (especially in the US). Obviously, absence of a foreskin provides no protective effect for IV drug users and infants who contract the disease during childbirth or through breast milk.
Care to support any of the other claims made in your previous comment?
"[Phimosis] is most likely caused by mothers retracting the infant foreskin on instructions from an ignorant doctor for cleaning."
"Speaking of infant deaths, there is not a single case in medical history of a child dying simply because he had a foreskin yet every year, 230 die just because someone wanted his foreskin off."
"Recent research shows that only 16% - 23% of infants get any pain management for the procedure and just have to bear it out with gritted teeth."
A 1998 study by Stang and Snellman demonstrated that the rate of analgesic use WAS woefully inadequate, but nowhere near the 16 to 23% you quote (they found 45% compliance) [Circumcision Practice Patterns in the United States. Pediatrics. 101(6):e5]. Fortunately, a 2006 study by Yawman et al. found that anesthesia use had increased to 84%, and 97% of residency programs now teach effective pain control during the procedure [Pain relief for neonatal circumcision: a follow-up of residency training practices. Ambulatory Pediatrics 6(4):210–214]. Needless to say, 84% is still way too low, but increased training should make pain relief during circumcision near universal in a few years.
"That sounds like something out of Nazi Germany, doesn’t it? “Another foreskin Dr. Mengele?”"
None of the major Pediatrics groups in the world recommend circumcision. Aside from the AAP, the rest of them explicitedly say not to do it. The AAP, in a strange twist for a medical group advises one to consider culture and religion when making a surgical decision.
But you don't have to believe them. I don't do appeals to authority that well either.
Read about UTIs. Girls get far more UTIs then boys, but they're not surgically altered. They get rounds of antibiotics. Why doesn't that work for boys?
Its also common knowledge that breastfeeding makes for healthier babies, including a lower risk of UTIs.
Read about penile cancer. In first world countries, its more rare and far less deadly than male breast cancer. How often to you hear about male breast cancer cases? You don't. Do we propose surgery to protect males against breast cancer? With the female breast cancer rate at a staggering 1 in 8, do we preemptively amputate female breast buds to protect them? Of course not. Furthermore, Denmark, which doesn't circumcise, has similar rates of penile cancer to the United States.
Breast cancer rates in males: http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_are_the_key_statistics_for_male_breast_cancer_28.asp?sitearea=
Penile cancer rates in males: http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_are_the_key_statistics_for_penile_cancer_35.asp?rnav=cri
Denmark study: http://www.bmj.com/cgi/content/full/311/7018/1471
Circumcised men still get penile cancer. Example:
And then there is the HPV vaccine, Gardasil. This vaccine or similar will be available for the prevention of penile and anal cancers in men and will put an end to HPV-related cancer.
Read about HIV/STDs: In a first world country, if a man wants to be protected, he essentially has two choices if he wants full protection:
a. Get circumised and wear a condom.
b. Wear a condom.
Why would any sane man in a first world country pick anything but b?
Furthermore, the United States has one of the highest circumcision rates in the world and also the highest HIV rates in the first world.
Take that how you will. Despite generations of male circumcisions, STDs and now HIV are rampant in this country. I don't see any risk reduction in the real world.
Read about phimosis. Phimosis isn't the disaster that the article author makes it out to be. Its normal through puberty and is easily treatable using stretching methods and/or steroid cream.
Of course, if parents leave their son's penis alone and follow the AAP recomendation (don't retract), its doubtful their son will have problematic phimosis.
If you want negatives, aside from the ethics of performing surgery on a newborn for the above flismy reasons, here are some.
Read about meatal stenosis. It affects 10% of circumcisied boys and requires additional surgery to correct. Intact boys have no risk of meatal stenosis. More surgery = more risk of infection, including MRSA infection.
Read about MRSA. Its a bacterial infection that is very difficult to cure and very aggressive. Its highly communicable and prevalent in hospitals. Newly circumised boys are especially vulnerable due to their size and their fresh wound. See some pictures:
If you're considering circumcision because of UTI concerns, consider the potential alternative. Easily antibiotic treatable UTI vs. deadly MRSA.
Read the Sorrells study. They tested points on the circumcised and intact male penis and reported the results. They didn't completely ignore the foreskin as in other studies.
Amputation risk: http://www.prnewswire.com/cgi-bin/stories.pl?ACCT=104&STORY=/www/story/07-18-2007/0004628064&EDATE=
Often, no pain relief: http://www.webmd.com/content/article/95/103212.htm
Read the links. There's a reason why circumcision has practically disappeared in most of the world. Aside from countries that do it for religious reasons (i.e. Israel, Saudi Arabia), circumcision is only done in the United States. Much of the problem is that doctors don't know or don't care to know the information I presented above. The media doesn't help either. Just about every article presented is a rehash of 1950s ideas about circumcision. Its sad, but it still hasn't stopped the U.S. circumcision rate from falling from 90% in the 1970s to about 57% now.
Here is another facile, specious, and disparaging OPINION piece in another attempt to justify circumcision..
No where has this STUDENT presented any scientifically credible evidence to support her avocation--just a attempt to portray all those who disagree with HER OPINION as fanatics.
But it is really her and her medical industry that has been fanatical in trying to perpetuate that which cannot be scientifically supported. Fanaticism is best shown by the 100 years and hundreds of "studies" spent on continuing to justify what has been scientifically proven to be unnecessary, painful, and harmful. It is hardly rational to deliberately IGNORE the scientifically- credible evidence, and accept the questionable evidence...this alone shows a fanaticism.
Outside of Jews, Muslims, and Americans, no one today circumcises without an immediate and therapeutic necessity.
The American Medical industry has tried for almost 100 years to medically justify this procedure to no avail. Even assuming if all of the scientifically questionable studies were valid, the most anyone can even then come up with is that POTENTIAL BENEFITS do not justify the risk and loss. The best that can be said is the statement from the notoriously pro-circumcision AAP is that "religion and culture can be an excuse to do it". NO other medical organization tries this justification--most simply state that it is unnecessary, or condemns the practice.
"That’s the sort of the thing that medical folks like yours truly have to worry about when doing something like inserting a catheter through the penis into the bladder. When you insert a catheter, you first pull the foreskin down; you better remember to pull the foreskin back up after the catheter goes all the way in. Otherwise, after a while, the foreskin you slid down can choke the end of the penis and cause it to swell (like putting a rubber band around your fingertip)—and you won’t be able to get the foreskin back up later. This is why, in medical school when you are learning to examine the genitals, you’re taught to ask every man whether he is circumcised or not. Some guys may look circumcised when they are not, and vice versa, so it is important to know where their foreskin is normally, before you start moving it around."
Tell this specious nonsense to doctors in intact countries and you would be laughed out of the room..American medical ignorance at it's best here. No wonder Americans still circumcise when they believe nonsense that doctors in 1st world countries summarily dismiss.
A reality check from the real world is needed here"
The Finnish National Board of Health provided national case records for the year 1970 for both phimosis and paraphimosis. A total of 409 cases was reported for males 15 years and older,which represents only 2/100ths of 1% (0.023%) of the total male population in that age group. This means that 99.97% did NOT develop a problem. Moreover, according to Finnish authorities, only a fraction of the reported cases required surgery-- a number too small to reliably estimate.
Wallerstein, Edward, CIRCUMCISION: AN AMERICAN HEALTH FALLACY p.128
HINT: intact countries do NOT fiddle with non-separated foreskins--they let nature do it's thing and LEAVE it alone!
Phimosis when it rarely occurs can be EASILY remedied by stretching, steroids. Amputation is not required not recommended!
"Facts are facts. Randomized double blind studies don't lie. Seems as if some out there are personally afraid of the truth..... There are medical benefits to being nipped and that's the story."
Excuse me while I am laughing on the floor..let's look at the so-called RCT in the latest hysteric call for circumcision as a "preventative" for HIV..
In SCIENCE, a (R)andomized (C)ontrolled (T)rial is a trial where all of the factors are CONTROLLED with one,and only one factor (chosen at random) is altered and the results are examined.
For the Circumcision/HIV studies, we have the following:
None of the factors are CONTROLLED. These factors are examined only based on self-reporting (notoriously unreliable) and then examined STATISTICALLY.
The only thing that might be random were those chosen to be circumcised.
Not CONTROLLED were:
1. The time needed for healing for those circumcised BEFORE the trial was intitiated
2. Rates of exposure for each group
3. Dry sex:
4. Anal sex
5. Homosexual sex
6. Genital warts re-occurance: how they were treated, and the final efficacy of that particular treatment. (excision or chemical)
7. The accuracy of the tests to determine seroconversion--rates of false or negative determinations
8. The time needed to manifest all seroconversions
9. Any chance of a follow-up as the test was stopped early and ALL subjects were circumcised.
10 . Equal amount of "safe-sex counseling" for both groups:
A. Postoperative follow-up visits were scheduled at 24–48 hours, 5–9 days, and 4–6 weeks.
B. All participants in both groups were followed up at 4–6 weeks, and at 6, 12, and 24 months post-enrolment
Control is control, "playing with the numbers" is merely an accounting scheme.
And all of this involved nothing but statistical analysis.
Author bias is a common problem with many studies (and all authors have long been circumcision advocates):
Another shortcoming of the studies is the small sample size
Small sample size: With few subjects, the law of small numbers applies with a vengeance.
(Roughly, when you're dealing with small numbers, random variations assume disproportionate importance. IE, there might be 3 murders in a small community one year and 14 the next, but it's stupid to say "The murder rate has more than quadrupled!" and blame the difference on policing, penalties, or anything else. Next year there might be 7 or 1.)
"Anesthetized circumcision, however, benefits the life by
a) preventing that problem with too-small-foreskin.
b) reducing infection-rate of HIV/AIDS
c) reducing infection-rate of other STIs, too.
thereby reducing the infection-rate among women whom men are intimate with, AND increasing the likelyhood of their family being able to afford quality of life, long-term."
Would it be asking for too much to ask for scientifically-credible supporting evidence for these claims?
Wow who cares? I dont think there is hiding from any STD's whether your cut or not. Just stop f-ing people with STD's (or people you don't know at all.) Because I see no benefit with or without a foreskin, I go based on preference and I prefer it cut. My belly button is already an "innie" so why would I want another lint trap? If you think it's wrong to not ask the baby if he wants it, then don't cut your kid and tell them when their 18 you'll pay for it if they want it, duh. Leave the rest of us alone, we're fine without it.
Say what you will, but I am a firm believer in circumcision for health reasons regardless what anyone else says and here is why: my father at age 50 had to have his foreskin removed due to cancerous lesions, yes cancerous lesions, and the horrible pain I saw him go through, made me absolutely adamant about putting my son through that as a newborn with a tiny penis, rather than having him have to go through that as an adult when a problem developed. I was not taking any chances with my sons' life and future health. I am an absolute believer in prevention being better than the cure, assuming there is a cure! So believe what you will, I did what I felt was best for my son 35 yrs. ago, and yes I would do it again today, for his sake! Believe me, my father was wishing that his mother had done the same for him as a newborn, so that he would have been spared the cancer scare and the attempt to cure the cancer, with the removal as an adult of his foreskin! So don't even try to tell me that removal of the foreskin is not necessary!!!
-.- wow those are longggggggggg comments.
pjl, there's no guarantee that your father wouldn't have developed penile cancer if he had been circumcised as a baby. Circumcised men get penile cancer, too.
There are other factors very strongly associated with penile cancer. Did your father fail to wash himself properly? Was he a tobacco user? Did he have unresolved phimosis? Did he have a lot of sexual partners in his youth? A yes to any of these questions puts him in a higher risk category for penile cancer.
You have done your son no favors by cutting him. The science just doesn't support it. On the other hand, if you were to advise him to wash himself and check for phimosis, advise him to limit his sexual partners, and avoid smoking, then you would be doing him a huge favor.
I really dont see what the big deal is about circumcision, as a baby u get it cut off you cry for a bit then your with your mom, im kinda young now and i assure you i harbor no ill will or agression because my doctor cut of useless skin that would have had to be cleaned carefully to avoid infections. all this talk of babies suffering, how do we know the birth of the child isn't painful for the child, i'd imagine there would be pressure on the child as its coming out. Should we then start having C sections for every birth. Its sad there are orginizations for pointless things like this, hows about we focus on stuff that matter in the world instead of a foreskin. its frustrating that so much sh** is going on with the world and someone is studying foreskin.
Leinbo, most men in the world would find your view that foreskin is "useless skin" rather strange because it is the most sensitive part of their penis. They're quite fond of their foreskin.
Circumcision is a form of permanent body modification like tattoos and body piercing. If your parents had given you a tattoo and you liked it, that would be great, but that's not a good reason to tattoo babies.
Every person has a right to decide what permanent body modifications are done to his or her own body.
Heyitsme: "I see no possible way that a double blind circumcision trial could even be conducted."
Absolutely. That doesn't mean double-blinded and placebo-controlled aren't still the gold standard, from which the three African trials inevitably fell short. (They could have gone some way toward placebo control with a dummy operation, an incision in the region removing no tissue, requiring the same aftercare and imposing the same risk of infection.) We know the surgical group got safe-sex warnings the contol group didn't.
As for a meta-analysis of the three RCTs, well, garbage in, garbage out. They were hardly independent: the authors have before and since variously published together.
"such concerns about early study termination have not been advanced in regard to the new Krieger et al. results."
Hardly relevant when that was a snapshot of sexual effects before and after circumcision. The flaw with that study is that almost all the men, circumcised or not, reported virtually perfect sex both before and after. How very different from our own dear sex lives, and from every other study. (They asked questions on a five-point scale - much more, more, the same, less, much less - but reduced the answers to three points, more, the same, or less. I wonder why? Perhaps if they'd left the more sensitive outcome they might not have got a result they wanted?) Nor were the men a random sample of the population: all were paid volunteers for circumcision, who knew what the study hoped to prove.
"It doesn't seem to have a significant effect on reproductive success in modern man."
In our lifetimes, most of us have sex some thousands of times. (Weekly from 20 to 50 y o = ~1500) Our "reproductive success" is perhaps 2 or 3. Clearly that is not why we do it. In fact, hey, most of us do it because it feels good, and a foreskin, being chock-full of sensitive nerves, makes it feel even better. So cutting the foreskin off a baby is just, well, MEAN.
Captainobvious, here is something obvious for you. You wrote "Maybe reducing the rate of infection is non-real to you?"
It is a simple fact of science that pathogens (bacterials, fungals) are not gender specific. The same infectious pathogens that affect males also affect females and they are equally susceptible to the exact same medications regardless of gender. When was the last time you heard of a female being circumcised for one of these infections? Ever? Not likely! More so, why aren't we circumcising infant females as protection from these infections (which they contract at far higher rates)?
The answer is simply because male prophylactic circumcision is culturally acceptable and female circumcision is abhorent in our culture.
In the service, a buddy got an infection that required circumcision to clear up. Five years later, when it was time to decide about circumcising our newborn son, I remembered how much that friend had suffered (adult circumcisions is, um, uncomfortable) and insisted that our son be circumcised.
Now, twenty five years later, the science supporting infant circumcision is solid. It's impossible to know if infant circumcision has saved suffering for either of our sons, but I am comfortable that it was the right choice.
Circumcision of babies is child abuse in my opinion and I'm shocked that it is allowed to continue in a modern world. And what next in preventative measures? Do we remove tonsils at birth just in case they become infected in years to come, do we cut off the breasts of female infants in advance of the possibility of breast cancer? And re religion and the savage ceremonies it requires, why don't we just brand babies and then we'll know which group they belong to - before they even have the opportunity to think for themselves and decide which religion they wish to belong to - if any?! How disgusting to chop off healthy tissue in an infant. If it begins to cause a problem, THEN deal with it.