Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Wednesday, June 20, 2007

Neonatal Circumcision (Controversy? Who, Moi?)

I read an article in yesterday's paper about the decline in neonatal circumcision. Apparently fewer and fewer baby boys undergo the procedure each year, with the overall rate now standing at 57%, down from a high of nearly 90% in the early 1960's. Immigration patterns are felt to play the biggest role in the decline, but a fair number of parents who once would have had their infants circumcised routinely are re-thinking the procedure -- and refusing.

I think this is a bad thing.

For what it's worth, so do many others. Evidence is accumulating that circumcision is protective against HPV and HIV infection (and therefore against cervical dysplasia and the spread of HIV in the partners of circumcised men) in addition to penile cancer, a rare condition estimated to affect fewer than 1300 men in 2007.

Part of the problem is that several medical organizations have officially renounced neonatal circumcision, most notably the American Academy of Pediatrics:
Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In circumstances in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. If a decision for circumcision is made, procedural analgesia should be provided. (emphasis mine)
The American Academy of Family Physicians takes a more generic approach:
The decision to perform neonatal circumcision should be based on the informed consent of the parents, and requires objective, factual counseling of parents by the family physician.
The American College of Obstetricians and Gynecologists is even less definitive:
Newborn circumcision is an elective procedure to be performed at the request of the parents on baby boys who are physiologically and clinical stable.
The problem is that pediatricians don't have to deal with the repercussions of these decisions decades later. Adult circumcision required urgently or emergently for things like phimosis (a "stuck" foreskin that can't be retracted) or a paraphimosis (a foreskin stuck in the retracted position) is a huge undertaking compared to the two minute procedure for a neonate. And yet interestingly, no one seems to have thought of asking the urologists their opinion (except the pediatric ones, and by definition they don't see adults), probably because they aren't the ones doing the procedures. That's a shame, because almost all the urologists I know recognize that the overall benefits of circumcision outweigh the risks, and that the lowest risk time to undergo the procedure is in the neonatal period.

(Another thought: could the increasing incidence of cervical HPV disease in women in recent years be a consequence of the declining circumcision rates?)

Now for those of you who thought the chronic lyme community was, shall we say, passionate, let me just point out that you ain't seen nuttin'. There are multiple, well-organized groups arrayed against this "male mutilation" who are probably going to come out swinging. I've read many of their sites, as well as their criticism of some of the studies linked above, and their own "research" on the subject. They sound like alties, cherry-picking evidence and refusing to acknowledge any findings that contradict their pre-determined conclusions.

They wax eloquent about the joys of the foreskin and the alleged greater sexual pleasure provided by an intact phallus. Then again, the vast majority of circumcised men seem perfectly content with their sex lives, at least vis-a-vis their foreskin status. I am of the firm belief that the vast majority of sexual problems are due to derangements in the large head above the shoulders, not the presence or absence of tissue on the little head between the legs.

I don't have a problem with anyone disagreeing with me. I would just like to see some intellectual honesty brought to the discussion, with a response like, "I understand my little boy (and his sex partners) will be at higher risk for some health problems later in life as a result of this decision we're making for him, but it's a risk we choose to accept for him."

*stepping aside, waiting for the fur to fly*

130 Comments:

At Wed Jun 20, 09:43:00 AM, Blogger ema said...

ACOG's is the most appropriate take on the issue. [Not that I'm biased or anything, of course.]

 
At Wed Jun 20, 10:35:00 AM, Blogger MedStudentGod (MSG) said...

Personally I'm amazed that the AAP has taken such a stance when there's evidence suggesting foreskin causes more troubles in adults than in their circ'd brothers. Personally, being circ'd, I don't think there's anything wrong with it. I don't remember the procedure, don't think most babies mind much at all (a few minutes after the snip they're playing or eating happily), and believe it should be an informed decision made by the parents and doctor(s). Calling it male mutilation is simply silly.

 
At Wed Jun 20, 10:36:00 AM, Blogger FredR said...

HIV enters our blood through micro rips in the male and female prepuce from rough (dry) sex, and anal tissue, too.
The largest organ, our epidurmis has natural anti viral defence Langerhans’ cell that produce langerin proteins that kill HIV and other viruses as they enter. These cells are all over our skin and consentrated in the male and female prepuce.
There is more than one way to skin a cock. Sometime they cut the frenulum off, sometimes they cut around it. The prepucial frenular delta nerve, aka the masculine “Gee Stirng” and the feminine “G Spot”, trigger sexual arousal and erections when stroked or pulled. Causing sexual dysfunction by severing these nerves is an ancient form of eugenics on infants. Sure this will decrease the HIV rates but people won’t do it if they know what’s going on so they have to twist data around to convince people that the prepuce is the cause of HIV.

 
At Wed Jun 20, 10:37:00 AM, Blogger FredR said...

Schizophrenia is a neuro-chemical brain malfunction mostly associated with sexual TRAUMA before the brain developes language skills. Circumcision induced schizophrenia is often delussional and paranoidal, and sometimes coupled with audio and visual hallucinations due from milk allergies cause from a disruption in first mothers milk nursing caused from trauma. I had to look into this because my dad and two of my brothers, and two of my mother’s sisters sons have developed schizo-dissorders. Two of my other brothers committed suicide from sexual dysfunctions in their twenties.

 
At Wed Jun 20, 11:11:00 AM, Blogger Awesome Mom said...

I still don't think that the evidence is massively overwhelming enough to make me wish that I had circed my sons.

How ofter are some of these problems like a stuck foreskin seen? Compare those numbers to infants who have to deal with a botched circ. Which number is higher? (I am honestly asking these because I have no idea about the numbers)

Honestly if I had had a religious reason to do it the tip would have been snipped. Otherwise I think this whole debate is one big pissing contest.

 
At Wed Jun 20, 12:10:00 PM, Blogger KipEsquire said...

I would just like to see some intellectual honesty brought to the discussion, with a response like, "I understand my little boy (and his sex partners) will be at higher risk for some health problems later in life as a result of this decision we're making for him, but it's a risk we choose to accept for him."

Huh? That's about the most intellectually dishonest thing one could say on the issue.

News flash: An adult male can get circumcised too (i.e, when he and not his parents decide that it's in his best interests).

It's simply not "neonatal or nothing."

 
At Wed Jun 20, 12:32:00 PM, Blogger > ScutMonkey said...

That is great "FredR"! Exactly what we were hoping for. More schizophrenics with HIV to clog up our hospitals! I have never ONCE seen a piece of literature that even insinuated that "the foreskin was the cause of HIV". I am glad you know so much about psychiatric conditions, because we still find most of them rather mysterious. More sensational comments, please, they are the best thing I have read today!

PS: Yes, "KipEsquire" you can get a circumcision when you are an adult. Have you noticed the stats on when most kids start having sex. Oops.... Oh well, I guess 70-80% of males have had sex before the age of 18 (CDC 2003 Data). Too bad, sorry to undermine your well thought out and researched solutions to this dilemma. Perhaps we should wait and ask kids if they want to wait until they are 18 to have all their immunizations too?

 
At Wed Jun 20, 01:02:00 PM, Blogger MedStudentGod (MSG) said...

Ummm, wow. Schizo associated with sexual trauma? Really? Evidence please.

 
At Wed Jun 20, 01:14:00 PM, Blogger Beanie's Appa said...

By not circumcising my son, I understand my little boy (and his sex partners) will be at higher risk for some health problems later in life as a result of this decision we're making for him, but it's a risk we choose to accept for him.

But, I also understand that by leaving him with his appendix, tonsils, gallbladders, nipples, toenails, he will be at higher risk for some health problems later in life as a result of this decision we're making for him, but that's also a risk we choose to accept for him.

Foreskins are just starting to stay on by default, like tonsils. It's just not good medicine to cut off normal body parts that aren't diseased, yet. There's value in leaving the body whole. Would you cut out tonsils or appendices before they cause problems? I hope the answer is no.

Most foreskin problems are avoidable or treatable without circumcision. We don't plan on consenting to circumcision for him unless he somehow gets gangrene on it, or something like that. If his foreskin is tight, or has adhesions, we'd seek out doctors that will fix it without cutting it off.

 
At Wed Jun 20, 01:18:00 PM, Anonymous Anonymous said...

Dear Dinosaur,

Ok, you want to "mix things up," I'll bite.

1) Non-therapeutic circumcision without patient consent violates medical ethics. Read this if you have doubts.

2) Proxy-consent is acceptable only for the purpose of providing medical care. Infant circumcision isn't medical care any more than is a nose-job.

3) Any parent who wasn't fully informed about Sorrells (abstract,pdf) by their circumcising doctor should have a strong lawsuit against the circumciser. Sorrells was published around 3/19/2007 (IIRC). That's about 90,000 circumcisions. How many of those parents were fully informed?

Doctors have no business putting unnecessary amputations on the menu for parents to choose from. Infant circumcision is a stain on the medical profession. Clean it up, fast.

 
At Wed Jun 20, 01:27:00 PM, Blogger FredR said...

http://www.hiddenmysteries.org/health/effects/autism.html
http://www.cirp.org/library/psych/goldman1/
http://www.cirp.org/library/psych/rhinehart1/
Hope these links come through.

 
At Wed Jun 20, 01:45:00 PM, Blogger Petri said...

Has anyone done a survey of circumsized males to find out whether the vast majority regret their parent's decision and/or have ever even cared to think about it.

As I circumsized male, I have never noticed any issue, never even realized there was an issue 'till someone told me there was. And even now I really don't think there's an issue.

I have no trauma, I don't remember a thing, my sex life doesn't suffer from my lack of knowing what it could have been like. If the vast majority of those affected aren't complaining, where's the issue. Just keep it an elective procedure. If you end up angry at mom and dad I have doubts it's all stemming from their decision to circumsize you.

 
At Wed Jun 20, 01:59:00 PM, Anonymous Anonymous said...

Petri Said:

If the vast majority of those affected aren't complaining, where's the issue.

Did you know that in cultures that circumcise females, they generally feel the same way?

fgmnetwork

I understand where you're coming from, though. When your body is substantially modified at birth, but nobody tells you about it, it's hidden away, and nobody teaches you about normal male anatomy... well, then you just don't know the difference. You figure, that's just the way things are.

But now you know, there is difference. You've heard about (hopefully read) Sorrells (see link, up a few comments). You can understand that even though you've (thankfully) adapted well to your situation, it really should have been your choice to make, and not anybody else's. Normal, healthy body parts belong to the person they were born attached to.

Yes, Petri, of course circumcision should be kept as an elective procedure... just like nose-jobs... Informed and consenting adults have every right to choose it... for themselves, only!

 
At Wed Jun 20, 02:19:00 PM, Blogger KipEsquire said...

Scutmonkey,

Would you be happier if I had said "13-year olds" or "15-year olds" instead of "adult"?

Or would you find some other way to convince yourself that my factual statement was somehow not a factual statement?

Oh, and immunizations concern diseases that are casually communicable in a classroom setting -- unlike, say, HIV.

So remind me again whose posts are "thought out"?

 
At Wed Jun 20, 03:25:00 PM, Anonymous Tony said...

There's so much to deal with here. We disagree because you are wrong. But you're not wrong because of quantitative facts that you rely on. You are wrong because you ignore qualitative facts. We should start here:

They sound like alties, cherry-picking evidence and refusing to acknowledge any findings that contradict their pre-determined conclusions.

You will not find me cherry-picking any evidence. I also have no reason to deny any facts to meet any "pre-determined conclusion". I came to my anti-infant circumcision position through logic and reasoning.

For example, there is evidence that circumcision protects against HPV and HIV. I don't need to deny that. But evidence already exists that condoms (and education) work better. Why do you cherry-pick the overall reality of preventing HIV, which I assume is what you want us to infer as your goal with that example?

Of course, I could point out that you're cherry-picking the study to meet your "pre-determined conclusion" that infant circumcision is "good" without relying on the clear evidence that condoms are significantly better, with far fewer complications than circumcision. How many of the recent studies have looked at the protective effect of involuntary infant circumcision? Oh, that's right. They all looked at voluntary adult circumcision. Ooops. An oversight, I'm sure, unless you claim that the two are physically and ethically the same thing. I suspect you agree on the latter, an error I'll get to in a moment. But the former is simply undeniable, unless you cherry-pick to mislead.

And penile cancer is an interesting example, too. The incidence of penile cancer is so low as to be a laughable justification. 1,300 cases per year hardly justifies circumcising more than one million infant boys many, many decades before they're likely to encounter cancer, should they be one of the unfortunate few.

But let's look to another industrialized Western country. Denmark has virtually the same incidence of penile cancer as the United States (n/100,000). The majority of Danish males are intact. The rate is between .9 and 1.0 per 100,000 in the U.S. and .82 per 100,000 in Denmark. (link) Something other than the foreskin alone must be at work. The primary risk factors are smoking, unsafe promiscuous sex, and poor hygiene. I’d say not letting children smoke, teaching them sexual responsibility, and bathing them regularly are simpler solutions than performing genital surgery. (Equivocal but undeniable acquittal of circumcision here.)

Sure, statistics in other countries likely suggest that circumcision still affects the rate of penile cancer. I don't disagree. But the evidence is clear that there are multiple factors. One involves evolution and the others involve behavior (and a small amount of inherent risk, I presume). You'd rather attack evolution than acknowledge that males can work around the alleged defect of the foreskin's existence.

By focusing on the future demands placed on urologists in dealing with intact men, you omit one key issue. How many intact men need the services of a urologist for medical issues with a foreskin. What's the incidence of phimosis among intact men? Paraphimosis? And how exactly does the difficulty of the adult surgery matter? If something goes wrong, you deal with it. The difficulty and pain associated with medically necessary adult circumcision is an incentive to cut only when all other less invasive treatments fail. That counts.

As another commenter pointed out, any number of maladies could strike the adult male. Even breast cancer is a concern that could be addressed in infants if we rely on your penile cancer statistic as a justification for infant circumcision. Cut out almost anything and the risk of it causing problems later decreases. What other invasive, non-medically indicated procedures do you recommend we perform on more than one million boys per year? (Girls are presumably left out because ethical concerns affect them. Their bodies should always be protected.)

Your parenthetical thought further demonstrates a superficial trend in your analysis. Decreasing circumcision could be linked to increasing cervical HPV disease. Without taxing my brain, I can spot one flaw. How recent is the trend to decreasing circumcision? How recent is the trend to increasing cervical HPV disease? More importantly, how old are the females who are getting cervical HPV disease compared to the age of an abundant population of intact males?

I won't "wax eloquent about the joys of the foreskin". I can't, because my foreskin was removed at birth. I have nothing to compare. But I don't fall back onto the silly presumption that because I haven't known it that it was okay for my parents to remove it. I have a brain that can resist such simplistic cultural conditioning.

I know I wouldn't have chosen it for myself if I had the choice. I'm not interested in body modification. I have no tattoos and no piercings. I've also never chosen preventive surgery for myself. I do, however, practice safe sex, bathe regularly, eat sensibly. I also don't drink and don't smoke. I'm capable of making choices for my health, all facts considered.

You want to pretend that performing medically unnecessary surgery on an infant is a valid parental choice. When I say infant, I know you mean male infants only. Unless you want to be bold enough to break our national double standard and advocate for female genital cutting as a valid parental choice. Come on, I know you can break the double standard.

You won't, of course. Aside from the argument you'll make that female genital cutting doesn't offer the same potential medical benefits, I suspect you'll rely on ethics. Ethics that apply to girls, not boys. Ethics that say every (female) human being has an inherent right to be free from harm, a right to bodily integrity. Including the genitals.

Parents do not have the right to make such unnecessary, permanent decisions for their children. Proxy-consent does not mean the right to impose medically unnecessary cosmetic surgery on an infant. What about the news last week that several infants, previously unreported, had died or been disfigured as a result of botched circumcisions in the last few years? Those boys had/have inherent human rights that trump(ed) any illegitimate choice offered to their parents, regardless of the opinion of the AAP, AAFP, or ACOG. But hey, at least those boys have a reduced risk of becoming infected with HIV from having unsafe sex with HIV-positive women! That counts. They should thank their parents every day they're alive. Or were alive.

Relying on fancy numbers absent all context and consideration of ethics and human rights makes for a position consistent with what society accepts, but that doesn't make it correct. Your position is irrational, not mine. Science without ethics is unacceptable in a modern, civilized society. For every benefit you can offer to excuse away parents making what is not their decision, there is a less invasive prevention and/or treatment for the underlying problem.

P.S. Yes, I'll tell my hypothetical future sons and their sex partners, as well as my hypothetical future daughters and their sex partners, that I chose to not cut away part of their healthy bodies. I'll also tell them that life has risks. Some they can't avoid, no matter what. For the ones they can, I 'll tell them that if they don't take care of their bodies, which I will teach them to do, they'll face problems. I'll parent, not substitute surgery for parenting. I'm not lazy or unethical.

 
At Wed Jun 20, 03:43:00 PM, Blogger Clark Bartram said...

My circs actually take about 5-10 minutes to perform. I've seen some peds surgeons do one in 2 minutes though. Those kids tend to scream because the lidocain has not had time to kick in.

 
At Wed Jun 20, 03:45:00 PM, Blogger beajerry said...

Down with extra penis skin!

Seriously, it's much more cosmetically appealing not to have it, along with the cleanliness/disease issue.

Plus, it's no big whoop to do as an infant.

 
At Wed Jun 20, 03:58:00 PM, Anonymous Anonymous said...

Clark Bartram Said:

My circs actually take about 5-10 minutes to perform. I've seen some peds surgeons do one in 2 minutes though. Those kids tend to scream because the lidocain has not had time to kick in.

Clark, how do you know the child doesn't want his foreskin? The child didn't give consent.

Have you read Sorrells? You're removing very sensitive sections of your patient's sex organ. Did you show a copy (pdf) of Sorrells to his parents? Did you offer a more conservative treatment for your patient's condition? What condition did he have for which you offered ablative surgery?

 
At Wed Jun 20, 04:00:00 PM, Blogger Dr. Smak said...

I'll preface my comments by saying that I chose not to circumcize my son. I'm not a circum-nazi, but that was the best decision I could make in good conscious.

Here's my take:

1. The AAP statement was made prior to the new evidence regarding decreased incidence of HIV in circumcised males. It will be interesting to see if they revise their statement to reflect that. However, since preventive health measures are effective only in context of the given population's disease prevalence, I think it is an extrapolation to assume that circumcision in the developed world, given it's lower HIV rates, is indicated.

2. Though the rates of HPV have been increasing, I would be much more likely to blame that on increasing sexual partners and risky sexual behavior than a decrease in circumcisions.

3. I think the question of whether a foreskin enhances sexual experience can only be answered by an individual who has experienced sex with and without. Saying that most men still enjoy sex without a foreskin is not impressive. (Given the choice between not having sex or having sex while someone manually extracted your toenails, I believe most men would choose sex.) Does anyone know of any scientific studies regarding men with experience both with and without?

4. Let's not forget the medical downsides of circs. In my practice, I've had 4 babies within the last year require general anesthetic to get a circ revision for cosmetic reasons. Not worth it for me.

5. And for me, the biggest downside is the lack of appropriate anesthesia. You can go on all you want about EMLA cream and dorsal pudendal nerve blocks, but I've never seen an unsedated baby be circ'd without screaming in agony. True, doesn't go on forever. True, doesn't appear anyone remembers it. But if the kid had the verbal skills to say "Don't do that, it hurts" we wouldn't. If someone strapped a 12 year old to a table and forcibly circ'd him you'd be put in jail. If you can find me one grown man to get circ'd with EMLA cream as his anesthetic, I'll take it back.

6. My overall sense of why they are done at all is because "we've always done them." Which is of course untrue (until the last century), and a bad reason to continue doing something. In fact, isn't that a dino law?

I do have strong opinions about circs, but I don't bring them up in my professional life. (Except when the nurses insist that foreskins are dirty.) In my practice, I don't tend to get the wee ones until the foreskin is long gone (and the milk dried up, see a previous post of mine). I rarely counsel patients on the risks and benefits, but when I do, I try to be as unbiased as possible. I have a handout somewhere in my office (maybe by AAFP) that presents the facts well.

 
At Wed Jun 20, 04:13:00 PM, Blogger Petri said...

I'm not sure I would equate male and female circs. My understanding, and I'm sure this will be debated, is that in the male circ they remove "some" sensitive tissue, in the female circ, they remove the clitoris. They don't get the whole clitoris but from what I've read it effectively is similar to cutting off the head of the penis; all sensation is removed.

Maybe us circ-ed men feel less sensation, maybe not, but I don't lay any blame at my parents feet. Whatever their reasoning I am sure they thought it was a good decision at the time. Female circs appear a bit more insidious since they are meant to remove all pleasure from a woman. If my parents had my penis cut off, well, I'd be a little more angry about the subject.

 
At Wed Jun 20, 04:34:00 PM, Anonymous Tony said...

beajerry,

Seriously, it's much more cosmetically appealing not to have it, along with the cleanliness/disease issue.

It's more cosmetically appealing to you. That's a subjective opinion, which can't be applied to every person.

The "cleanliness" thing is nonsense. Soap. Water. They're great. And less invasive.

 
At Wed Jun 20, 05:00:00 PM, Anonymous Anonymous said...

Dr. Smak,

Thanks for sharing your inside view. The taboo atmosphere about opposing circumcision openly seems to be breaking, so hopefully you can be more active in working to stop those who stain the profession by offering circumcision when no medical condition requires it.

You asked:

Does anyone know of any scientific studies regarding men with experience both with and without?

I think Kim/Pang is just what you're looking for, published just a few months ago:

The Effect Of Male Circumcision On Sexuality

 
At Wed Jun 20, 05:05:00 PM, Anonymous Tony said...

Petri,

From a marketing standpoint, you're right, I shouldn't compare the two. People reflexively get worked up. But I'm correct on the facts.

The World Health Organization recognizes four types of female genital mutilation. Most of them are indeed far worse, quantitatively, than what is done to boys, and the forms practiced are usually the most destructive.

However... Type I without excision of the clitoris involves only removing the clitoral hood. Type IV can involve "merely" pricking or piercing the clitoris.

Should we allow a symbolic pricking of the clitoris to draw blood? What if it was a cultural or religious demand? In the U.S. we don't allow it. It's rightly prohibited under federal law. Yet, males don't get the same protection from harm because we've incorrectly decided that parents may chase a few potential medical benefits.

Qualitatively, they are the same: medically unnecessary genital cutting on a non-consenting individual. Rights and ethics matter.

P.S. Also note in the link that the reasons given for FGM are similar to what we currently excuse for male circumcision.

P.P.S. Historically, in the U.S., both male and female genital cutting began to impose sexual morals (i.e. prohibit masturbation). Boys lost their foreskin and girls had carbolic acid applied to their clitoris. Early in the promotion of circumcision, the latter became unacceptable, since girls "didn't like sex enough" and reduced sensitivity would hurt desire to procreate. Males were deemed sufficiently interested in sex that a little sensation could be lost. Not much has changed on that last point, I think.

Eventually, circumcision became a sign of hospital birth, which was a sign of class standing. Potential medical "benefits" also joined the mix of justifications. They've changed over the years, but as evidenced by this post, they continue today.

P.P.P.S. Can I be accused of cherry-picking types of FGM to make a point? In case it's not clear, all forms of medically unnecessary genital cutting on non-consenting individuals are heinous and unacceptable. We can argue the difference in degree, but they are of the same kind.

 
At Wed Jun 20, 05:36:00 PM, Blogger #1 Dinosaur said...

I'm going to jump in here and say that no comparisons between elective neonatal circumcision and any form of female genital mutilation will be tolerated in this comment trail. There is no similarity or comparability at all, despite the fact that misogynistic cultures "use the same rationale." If you don't understand why, then you are too ignorant to be a part of this discussion, and any further comments that mention it will be deleted.

Next: The "comparison" study mentioned about about sexuality pre/post adult circumcision doesn't really apply to this discussion. All it says is that sexuality can be adversely affected by adult circumcision. Doesn't really say anything about neonatal circumcision (except perhaps that those patients wouldn't then have needed circumcision as adults and therefore wouldn't have had the adverse effects from it.) Like it or not, there is no way to do a before/after with/without foreskin study, because you're only a neonate once.

Also, the Sorrells paper referenced above used a monofilament to map fine-touch pressure thresholds. So the circumcised glans was less sensitive than the circumcised one. Big whoop. (And remember, they studied ADULT penises. Bearing in mind all the changes puberty wreaks with the organ, can you prove the same for the neonatal phallus?) Besides, the circumcised glans is apparently still plenty sensitive enough to provide perfectly satisfying sex lives to millions of men.

The arguments about not removing tonsils, gallbladders and appendixes are straw man arguments. There's clearly a difference between removing internal organs via general anesthesia and major surgery, versus a minor procedure with local anesthetic.

That said, I agree this is a topic about which reasonable people can disagree. I am merely offering my opinion here, and I welcome the discussion.

 
At Wed Jun 20, 06:06:00 PM, Anonymous Anonymous said...

#1 Dinosaur said:

So the circumcised glans was less sensitive than the circumcised one. Big whoop.

A much bigger whoop is that the foreskin/frenelum/etc., which circumcision removes, are themselves very sensitive, indeed, the most sensitive parts of the organ.

The question isn't whether a male can get by with these sensitive areas from his penis missing. It's whether he should be forced to.

The first question to ask about infant circumcision is, "is there a more conservative treatment for this condition?"

 
At Wed Jun 20, 06:14:00 PM, Blogger Voter Mom said...

In South Korea and the Philippines male circumcision is traditionally done sometime during elementary or middle school age (generally before puberty) and very rarely on infants.

(Personally I don't have sons so I never had to grapple with the circ/no circ decision.)

 
At Wed Jun 20, 06:15:00 PM, Blogger Robin said...

If you choose to believe that there is a benefit in having the foreskin removed from the penis (just as removing many other body parts could theoretically provide benefits, right?), that is all fine and well for an adult male to decide for himself. However, a newborn doesn't have the ability to consent to the procedure. All of the supposed benefits of circumcision would still be there if the amputation occurred at the age of 18 instead of 2 days, correct? So why not let the boy decide for himself? Besides, 80% of the men in the world (the rest of the world besides the USA) have natural penises and seem to survive just fine with no huge epidemics of penis problems. Perpetuating a risky and damaging surgery on newborns as a prevention for the risk du jour is not good medicine.

 
At Wed Jun 20, 06:41:00 PM, Blogger Maurice Bernstein, M.D. said...

I just want to say that I am encouraged by all the comments here so far. This is the way to discuss this controversial issue rather than to write in an uncivil fashion using ad hominem remarks which happened to be the way a number of visitors wrote when I started the same topic a year or so ago on my blog. ..Maurice.

 
At Wed Jun 20, 07:01:00 PM, Blogger Alyson said...

As a mom, I would not circ another son. Primarily because we had such problems with his circ. Basically his foreskin would adhere itself to the glans of his penis and we would have to push it back at every diaper change, and every bath. We delt with a sore, angry, red penis until about his 3rd birthday. But even now, he doesn't like his penis touched by anyone else, even to bathe. He has no problem touching it himself ;) But if I had known that this complication was possible I doubt I would have agreed to the procedure.

And as far as disease prevalance, I really think that I'd rather rely on teaching my children about safe sex and respectful relationships.

~Alyson

 
At Wed Jun 20, 07:01:00 PM, Anonymous Anonymous said...

Dr. Bernstein,

Please bring the subject up again on your blog. This is a timely medical ethics discussion. Cosmetic, non-therapeutic surgery by proxy-consent makes a mockery of medical ethics.

 
At Wed Jun 20, 09:30:00 PM, Blogger The Hatchling said...

I really don't see this as an ethical dilemma. My question for those who do is are you also Pro-Life? It might seem like a stupid question, but if you believe that "proxy-consent elective surgical procedures" are an ethical violation, then one would assume terminating a pregnancy would violate the same ideal - consent of the fetus. Right?

It does never fail to amaze me how passionate some people can be about things that in the grand scheme of things (life and death) are not medically significant.

I apologize for the aside, but I feel the points, while tangential, are relevant.

 
At Wed Jun 20, 09:44:00 PM, Anonymous Anonymous said...

In the comparison study between pre and post adult circumcision only 50% of the men over 20 had had sex. Doesn't sound too similar to the population I know :)

 
At Wed Jun 20, 10:21:00 PM, Blogger > ScutMonkey said...

Recently, a landmark study discovered that 8 out of 10 Americans have discovered that a broadband internet connection and subscriptions to several ".org" websites is EQUIVALENT to the 4 years of medical education and the 4 years of post graduate medical training that most MD's here have!

I, for one, am reassured that we have so much valuable knowledge contributed by these Broadband Medical Specialists (or BM's for short) here to educate us!

Let the fur fly!

 
At Wed Jun 20, 11:54:00 PM, Blogger The Hatchling said...

so i basically just wrote an off the cuff post referencing this issue. you can read it at my blog, but my 2 sense is how does Sorrell's fine-touch/pressure sensitivity relate to the debate? I'm missing the correlation between the pressure sensitivity and anything in terms of sexual health/gratification.

 
At Thu Jun 21, 07:26:00 AM, Anonymous Anonymous said...

Consent by proxy will be used throughout childhood by the parents on behalf of the child. To imply that makes us all ethically compromised therefore suggests that any situation where informed consent is impossible is invalid. I would say that it would logically follow, according to the antivax crowd, that we shouldn't vaccinate until age 18, but someone else earlier in the thread has informed us that they don't consider vaccines an equivalent devastation (the antivax people would perhaps disagree). Very well.

Perhaps I should start complaining about the orthodontic care my parents consented me to by proxy at the tender age of nine. I certainly remember the next six years of braces, headgears, stretchers, certainly endured physical and emotional pain and trauma for an end result that (judging by my parents) might not have been too abnormal. How dare they inflict that on me when I was too young to make an informed opinion.

I would be interested in knowing the percentage of botched procedures when it is done by an untrained practitioner as opposed to in a medical facility.

 
At Thu Jun 21, 07:46:00 AM, Blogger MedStudentGod (MSG) said...

And yet another reason why I'm glad I'm not going into Peds and OB/GYN. Thanks for the comments, they've been quite interesting to read, though I'm not convinced parents should be suing based on "cosmetic surgery by proxy". Parents are allowed to make most medical decisions for their children. This is one - and it is simply not cosmetic. A face lift and breast augmentation is cosmetic whereas this has medical benefit.

Dr. Dino loves to stir the pot and watch what comes up. I wonder where all the anti-circ people came from. I never knew there was such an issue.

 
At Thu Jun 21, 08:50:00 AM, Anonymous Rocket Science said...

First, let me say I find it odd that you call yourself “Dinosaur” when you are involved in such a technology oriented profession. I also find it odd that you would reinforce the perception with support of such an outdated procedure. I hope you are not one of my physicians.

Let’s look at some of the things you write:

Immigration patterns are a ruse to scare parents into circumcising their sons. It’s similar to the patterns of the medical profession to promote circumcision for the last 80+ years. In the beginning, it was fear of being considered a country bumpkin or of meager family resources if the child wasn’t circumcised. Then it became a white vs. black issue and now, it’s being promoted as a native vs. immigrant issue. The truth is that the immigrant population would have to be 4 times larger than it is with a zero circumcision rate and with a 100% circumcision rate among all other Americans. It doesn’t take a math major to figure that one out.

Next is HPV infection. Circumcision will have no measurable effect on HPV infection. First, a study has shown that 54% of all 13 – 15 year old girls have been exposed to HPV. The conclusion of the study was that their mothers infected them as they passed through the birth canal. The infection rate among boys would be similar. The good thing is that 97% to 98% of those infected will develop a natural immunity to the virus. Circumcision to prevent this infection is an over reaction. But that is totally negating that a vaccine has been developed for the virus that will greatly reduce the effect it has to the point that it would take thousands of circumcisions to prevent one case of cervical cancer.

The studies on HIV infection are simply bad science and that is evident in the fact that not a single reputable medical journal in the world has seen them fit for publication. The only place any of them have been published is on an obscure on-line journal with the mission statement of publishing studies of dubious value. The authors even had to pay to get it published there. Some science!

But there are further problems with the studies! For instance, in a May 12 letter to The Lancet, Robert Bailey, one of the authors of the study and apparently the main publicist revealed that the condom usage among the circumcised men increased the exact percentage required to achieve the purported results. In addition, they also reported that the circumcised men significantly reduced the number who had multiple sexual partners.

The authors also ignored other little aggravating details like the prevalence of circumcision in the study area and the HIV prevalence in the area. The area where the study was conducted has an almost 100% circumcision rate. The tribe in that area circumcises as a coming of age ritual in the teens. Yet, the HIV prevalence rate in the area was 29% in the mid 1990’s, one of the highest in all of Africa. How could that be if circumcision has such a wonderful protective effect? Also, the current HIV rate is about 6%. What are they doing to have achieved that rate of reduction and why did the researchers not investigate that? Could it be that these studies were simply to promote circumcision? If you look into the researcher’s past history going back to the mid 1980’s, you will find that they all have a history of promoting circumcision.

I also find it deceptive that you even bring up penile cancer in this discussion. It is so rare that you must not be well educated on the topic. Squamous cell carcinoma in situ is so rare that in a city of 50,000 with all intact men, there would statistically be only one case every 156 years. In addition, this cancer is simply a skin cancer that is treated the same as skin cancers on other parts of the body. They are simply excised and they are done.

It is not “several” medical organizations that have renounced neonatal circumcision, every single one worldwide has renounced it. You appear to be far out of step with current knowledge and technology, Dinosaur.

“Phimosis” is not a “stuck foreskin” it is a foreskin that is non-retractile because the foreskin opening or sphincter is not elastic. This is not common except in America which leads one to believe the condition is greatly over diagnosed in America. In Scandinavia, the lifetime circumcision rate is approximately 1/18,000 so this is not a significant problem. Also, 99% of cases of phimosis is easily resolved with simple stretching exercises and no medical intervention. It appears that the vast majority of cases of phimosis are iatrogenic with Dinosaurs forcibly retracting children’s foreskin and advising mothers to retract and clean. This causes cumulative damage to the preputial sphincter resulting in phimosis and the AAP recommends against this. Circumcision is never required “urgently or emergently” to resolve phimosis. I have known men as old as 32 years old that actually had phimosis. Oddly, they were not concerned about it at all. It was their wives that were concerned. The wives felt that if the foreskin were retractile that they (the men) would have a better sexual experience. All of those men easily and quickly resolved the issue themselves with simple stretching exercises of retracting as far as painlessly possible each time they toileted or bathed. They all reported success within 2 months and one was completely resolved within 2.5 weeks.

Paraphimosis is even more rare and in virtually all cases can be resolved with simple manual techniques. As rare as paraphimosis is, it is even rarer that a child would have to be circumcised to resolve it. It is also rare that the condition happens again to the child as it is painful and scary and they avoid it happening again.

The risk is also not greater for an adult. There is only one case of an adult dieing during or immediately after the procedure but more than 200 babies die every year from the procedure. The single adult that died was a 20 year old in England. He died from anesthesia overdose.

The decline in circumcision rates has nothing to do with an increasing cervical cancer rate. Despite what the article says, the zenith of the circumcision craze didn’t come until the early 1990’s and the decline has all come since the mid 1990’s. With a latent period of 16 to 20 years from initial infection, it will be another decade or more before we see any connection between circumcision rates and cervical cancer rates.

Like you, I would also like to see some intellectual honesty (and especially some knowledge and education) in this issue. Can you admit your knowledge is severely lacking? Should you actually be charging for this education you clearly lack?

.

 
At Thu Jun 21, 09:01:00 AM, Anonymous Rocket Science said...

MedStudentGod, can you explain this mysterious "medical benfit?"

Clearly phimosis is not one of them and the same is true for penile cancer as both are extremely rare conditions. What else is there?

Oh, infections? Well, let's discuss that one. Please tell me what infections do males get that females don't get? Tell me which both get that don't respond equally to the same medications? Tell me how many females have these same infections and have to have their genital parts amputated as treatment? Show me that females don't have a higher incidence of these infections than males?

Any other justifications you want to discuss?

.

 
At Thu Jun 21, 09:31:00 AM, Anonymous rocket science's mom said...

rocket science, I told you to get off that damn computer and come eat your spaghetti-o's!

 
At Thu Jun 21, 09:56:00 AM, Anonymous Anonymous said...

Regarding HIV, I'd rather teach my boy to use condoms than cut off part of his penis, thanks.

Funny how Europe has a lower HIV rate than the United States yet circumcision is only a religious ritual over there...

 
At Thu Jun 21, 09:57:00 AM, Anonymous Anonymous said...

Dinosaur, do you perform circumcisions? If so, you have a monetary bias...

 
At Thu Jun 21, 10:02:00 AM, Anonymous Anonymous said...

The only -- and I mean ONLY -- group more rabid than the anti-circ people are the freebirthers/natural childbirth/no pain meds people.

It's all about choice and freedom to them, until you make a choice they don't agree with, and then KATY BAR THE DOOR, because the foaming spittle will fly.

 
At Thu Jun 21, 10:25:00 AM, Anonymous Anonymous said...

What other body parts can I choose to remove from my children?

After all, its just a choice and if its done at birth they won't miss it!

 
At Thu Jun 21, 10:39:00 AM, Anonymous Anonymous said...

We chose to circumcise our son for the exact reasons you detailed. I wasn't happy about doing it due to the pain factor, but having been in an extended relationship with a man whose foreskin was intact, I knew I was making the right choice. For lack of a better and more tactful way to put this... smegma grosses me out.

Problem? The doctor botched the circumcision. Badly. Now my son has so much skin and scar tissue that the skin folds over about halfway down the head of his penis. It looks like he's partially uncut. It sounds worse than it actually looks, so I don't think he'll ever be teased or have difficulties, but it pisses me off nonetheless.

The strange thing? The same exact botch job happened to his father. Thus my confidence that everything will turn out just fine.

However, the whole painful experience (and it was) makes me very, very wary of letting anyone else get near my future offspring's genitals with a scalpel.

 
At Thu Jun 21, 10:56:00 AM, Anonymous Anonymous said...

It seems our good Dinosaur doesn't like Gardasil. He thinks it is too pricey for what it provides.

http://dinosaurmusings.blogspot.com/2006/08/gardasil-argument-against.html

But somehow it is a good idea to spend $200-$400 for every newborn male to reduce the risk (not prevent) of penile cancer (much rarer than cervical cancer) and STDs that are preventable with inexpensive condoms?

Let me guess, you make money from circumcisions but not from Gardasil?

 
At Thu Jun 21, 12:07:00 PM, Blogger Tuan's Princess said...

10 reasons to leave your son intact:

1) Infant circumcision is a human rights violation: his penis - his choice.
2) Your son's foreskin has functions which are anihalated by cutting it off.
3) Infant circumcision negtively affecs the nursing relationship.
4) There are no anesthetics available to illiminate the pain of an infant circumcision.
5) Inflicting a newborn with an open wound that inevitably will come into contact with urine and feces is anything but heigenic.
6) Circumcision is risky, dangerous and can be fatal.
7) Beyond foreskin loss, an exposed penis loses sensitivity over time due to katerinization.
8) An intact penis is easier to take care of.
9)Your son's foreskin will most likely be sold and used in cosmetics, skin substitution studies and Testskin with no compensation to him.
10) Circumcision is not recommended by any medical orginization in the world on the grounds of medical benefits.

 
At Thu Jun 21, 12:13:00 PM, Blogger Tuan's Princess said...

Now for some research:

Rates of circumcision as of 20 years ago:

USA--85%
Ethiopia--~100%
Finland--<1%

Rates of HIV:
USA--0.6
Ethiopia--4.4
Finland--0.1

RATES of HIV --assuming the predicted reduction for circumcision is 50%...

USA: (0.85 X 0.5) + (0.15 X 1.00) = 0.575
Ethiopia: (1.00 X0.5) = 0.5
Finland: (0.01 X 0.5) + (0.99 X 1) = 1.00

PREDICTED Ratios of HIV where the circumcising countries SHOULD be lower

Finland/USA
1.00/ 0.575 = 1.74

Finland/Ethiopia
1.0/ 0.5 = 2.0


ACTUAL ratios:

Finland/ USA
0.1/ 0.6 = 0.167

Finland/Ethiopia
0.1/ 4.4 =0.023


DESCREPENCY from prediction

Finland/USA
1.74/.167 = 10.4 fold

Finland/Ethiopia
2.0/0.023 = 87 fold

Before one tries the "homosexual" or "IV drug" excuses, they better be able to prove that:

1. The prevalence of homosexuality is 10.4 times higher in the US than in Finland, or
2. The rate of drug usage in the US is 10.4 times higher than in Finland.

AND

1. The rate of homosexuality in Ethiopia is 87 times higher than in Finland, or
2. The rate of drug usage in Ethiopia is 87 times higher than in Finland.

Since the prevalence of homosexuality is fairly consistent in all cultures, the "homosexuality" excuse is not a viable one.

And since Ethiopians can barely find resources to feed themselves, they hardly can have a IV drug usage 87 times that of the more affluent cultures.

Unless one can prove these, then the hypothesis is not scientifically supportable, and this advocation of circumcision for HIV prevention is neither rational nor ethical

 
At Thu Jun 21, 12:34:00 PM, Blogger Elisabeth said...

I'd like to respond to this:
"The only -- and I mean ONLY -- group more rabid than the anti-circ people are the freebirthers/natural childbirth/no pain meds people.

It's all about choice and freedom to them, until you make a choice they don't agree with, and then KATY BAR THE DOOR, because the foaming spittle will fly."

This is the most bizarre and flawed logic I have ever come across in a circumcision discussion. When did choice and freedom became BAD things? When did standing up and fighting for our children's health, safety, and well-being become something we need to apologize for? Why do you care if a woman doesn't want pain meds, which are in the same class as cocaine, injected into her and her baby's body during labor? Why is it so important to you that I cut off my son's foreskin? Because, by posting the above, you show an intense disregard for those of us who DO care about those things. And you don't take into account those of us who don't give a rat's patootie what you do to your own body. THAT is what freedom and choice are all about.
Stand back from the spittle and it won't hit you. Quit yer whining. And you doctors, too. Why is it so important that you get your hands on my son's penis? Walk that middle ground all you want, but they used to "bleed the patient to relieve the build up of the humors" too, and we all know how well that cured disease *rolls eyes*
Anyone who can't see how useless this is as a routine infant procedure needs to step back for a moment and take a deep breath. Then show me ONE study--just ONE viable study-- that proves that infant circumcision prevents and/or treats a real medical condition in the majority of those to whom it was performed on. I want a 60% cure rate or better.

 
At Thu Jun 21, 01:56:00 PM, Blogger Petri said...

Tuan's Princess said...
Now for some research:

Rates of circumcision as of 20 years ago:

USA--85%
Ethiopia--~100%
Finland--<1%

Rates of HIV:
USA--0.6
Ethiopia--4.4
Finland--0.1


Gah, what does this mean exactly? Why these three disparate cherry-picked countries?

What rates of HIV are we talking about? 4.4 cases of HIV per 100 people? per 1,000? nationwide? Maybe 4.4 humans contracting HIV per fortnight. I really have no idea.

Also, can you really make the statement that HIV rates are dependent on circs as its single dependent variable? To hell with drug use and homosexual activity, there are so many other societal and cultural issues that contribute. Just because I can show you a graph that relates a declining population of pirates to increased average global temperture doesn't mean there's a relationship. Most of the "studies" and research I have seen on these posts fall victim to this "Cum hoc ergo propter hoc," fallacy.

I'm not necessarily attacking your statements in the previous post but this "research" you provide is meaningless. So far, I am yet to be convinced by either side that circs have any positive or negative benefits. As far as I'm concerned it appears to be akin to have a baby's ear pierced; maybe it prevents suicide through social acceptance, maybe it's her ear her choice, either way there's no research and no compelling arguments on either side, but people still have it done to their babies. Yet there is no issue with piercing baby's ears. Perhaps the only reason this IS such a big deal is because it involves the genitalia which for some reason in our culture continues to be a subject of perpetual taboo and polarization. Until you are 18 your parents call the shots, they don't always make perfect decisions, but I don't think parents are having their kids circ-ed out of spite, and I trust that docs aren't doing it for profit. It's just another choice out there for the making.

 
At Thu Jun 21, 02:31:00 PM, Blogger > ScutMonkey said...

I like it when people try to support a position with numbers, stats & equations without using the units, context or even references to the methods by which they were obtained:


tuan's princess...
Rates of HIV:
USA--0.6
Ethiopia--4.4
Finland--0.1


Great! "0.1"... Perhaps it is a ratio of the supportable content per number of words in the comments here?

You are grasping at straws, trying to use numbers with a veneer of scholarship to forward your opinions. At least you stated this was 20 year old data!

"Your algebra and opinionated argument skills are impressive, but they are no match for my fists of sarcasm...."

 
At Thu Jun 21, 02:51:00 PM, Anonymous Anonymous said...

i have to agree with whomever said this is one rabid group. as someone who is a)circumcised and b) the parent of 2 circumcised boys and c)the spouse of someone who happily endured childbirth with an epidural and d)the brother of a circumcised male and e)all of us function just fine and the children are healthy and CLEAN and psychologically sound,
I find you all somewhat ludicrous. how about we just let those who want it to get it and those who dont to not?

 
At Thu Jun 21, 03:24:00 PM, Blogger Noel Hastings said...

And now for some research (which is a little more recent, this month!):

The Protective Effect of Circumcision on HIV Incidence in Rural Low-Risk Men Circumcised Predominantly by Traditional Circumcisers in Kenya: Two-Year Follow-Up of the Kericho HIV Cohort Study. Shaffer at. al.

BACKGROUND: Three randomized controlled trials (RCTs) have demonstrated that male circumcision prevents female-to-male HIV transmission in sub-Saharan Africa. Data from prospective cohort studies are helpful in considering generalizability of RCT results to populations with unique epidemiologic/cultural characteristics.
METHODS: Prospective observational cohort sub-analysis. A total of 1378 men were evaluated after 2 years of follow-up. Baseline sociodemographic and behavioral/HIV risk characteristics were compared between 270 uncircumcised and 1108 circumcised men. HIV incidence rates (per 100 person-years) were calculated, and Cox proportional hazards regression analyses estimated hazard rate ratios (HRs). RESULTS:: Of the men included in this study, 80.4% were circumcised; 73.9% were circumcised by traditional circumcisers. Circumcision was associated with tribal affiliation, high school education, fewer marriages, and smaller age difference between spouses (P < 0.05). After 2 years of follow-up, there were 30 HIV incident cases (17 in circumcised and 13 in uncircumcised men). Two-year HIV incidence rates were 0.79 (95% confidence interval [CI]: 0.46 to 1.25) for circumcised men and 2.48 (95% CI: 1.33 to 4.21) for uncircumcised men corresponding to a HR = 0.31 (95% CI: 0.15 to 0.64). In one model controlling for sociodemographic factors, the HR increased and became non-significant (HR = 0.55; 95% CI: 0.20 to 1.49).
CONCLUSIONS: Circumcision by traditional circumcisers offers protection from HIV infection in adult men in rural Kenya. Data from well-designed prospective cohort studies in populations with unique cultural characteristics can supplement RCT data in recommending public health policy.

 
At Thu Jun 21, 03:50:00 PM, Blogger #1 Dinosaur said...

"Let me guess, you make money from circumcisions but not from Gardasil?"

"Infant circumcision negatively affects the nursing relationship."

"Your son's foreskin will most likely be sold and used in cosmetics, etc..."

"...I find it odd that you call yourself “Dinosaur” when you are involved in such a technology oriented profession."

"Your position is irrational, not mine."

"Schizophrenia is a neuro-chemical brain malfunction mostly associated with sexual TRAUMA before the brain develops language skills."

Oh my! Who says the fruitcakes only come out at Christmas.

 
At Thu Jun 21, 04:04:00 PM, Anonymous Anonymous said...

#1 Dinosaur, you said that it's a "bad thing" that Americans are trending towards not performing non-therapeutic, ablative, totally unnecessary and proven painful surgery on males without their consent.

Who's the fruitcake?

 
At Thu Jun 21, 04:30:00 PM, Blogger Tuan's Princess said...

Flawed research is flawed research. The study in Africa was not even concluded. Once the numbers showed what they wanted, they ended the study. Had it been allowed to continue to it's end date, the numbers would have shown little if any difference in circ'ed vs intact HIV rates.

The circ'ed men reported condom use up from 22% to 36%. That is the exact increase to gain a 61% protective factor, exactly the protective factor the study claimed circumcision provided. This indicates that the men's circumcisions played no part in the lower infection rate but instead, the condoms were the protective factor. In the later studies that reported 48% and 52% protective factors, it would indicate that circumcision actually increased the men's susceptibility to HIV/AIDS.

Additionally, the circumcised group reported that they had reduced their number of sexual partners. The percentage of men with more than two sexual partners decreased from 42% to 33%. This would put them at less risk of contracting HIV/AIDS.

This information turns the studies completely upside down and appear to strongly suggest that the circumcised men were substantially more likely to contract HIV/AIDS.

But then, both of us are using studies done on ADULT penises and dinosaur is convinced that their are no similarities between the neonatal penis and the adult penis. It's a good thing neither of us agree with that.

More recent (June 20 2007) research:
"Size Matters: The Number of Prostitutes and the Global HIV/AIDS Pandemic" - www.plosone.org/doi/pone.0000543
In new academic research published today in the online, open-access, peer-reviewed scientific journal PLoS ONE, male circumcision is found to be much less important as a deterrent to the global AIDS pandemic than previously thought.

P.S. Holes pierced in ears or elsewhere can close and heal themselves. Foreskin NEVER grows back. It is not the same thing!

 
At Thu Jun 21, 06:59:00 PM, Anonymous Anonymous said...

This comment has been removed by a blog administrator.

 
At Thu Jun 21, 07:05:00 PM, Anonymous Anonymous said...

For those whop are not able to see the significance of the 20 year rate--it is the time required for these infants to reach the age of sexuality required to get HIV.

 
At Thu Jun 21, 08:13:00 PM, Blogger #1 Dinosaur said...

(Comment removed above was a duplicate.)

 
At Thu Jun 21, 09:20:00 PM, Anonymous Tony said...

One:

If you don't understand why, then you are too ignorant to be a part of this discussion...

Two:

Oh my! Who says the fruitcakes only come out at Christmas.

Awesome. And those are just the two directed at me. I've at least learned something about debate. When confronted with challenging, complete facts, no rebuttal is necessary. Resort to a couple of ad hominem attacks and declare victory. Quite effective. Admirable, too.

 
At Thu Jun 21, 09:40:00 PM, Blogger #1 Dinosaur said...

Tony, dude: get over yourself. Neither comment was directed at you at all.

Besides, I just checked your blog and we have so much in common. (Truly: all sarcasm aside.) NaNoWriMo; Phillies; Redskins. Do you have any idea how few of us root for that particular combination of teams? What do you say; buy you a beer tomorrow night in St. Louis.

 
At Thu Jun 21, 10:15:00 PM, Blogger Elisabeth said...

Anonymous said:
'I find you all somewhat ludicrous. how about we just let those who want it to get it and those who dont to not?'

I just typed out a long rebuttal to this and lost it.

Suffice it to say that many who appear to be 'rabid' or 'crazy' about this issue, are so due to a strong conviction concerning protecting basic ethical standards in medicine, as well as a sense of duty to our children.
You fight the causes you believe in and I will fight the causes I believe in.

Had circumcision not been offered to your boys would you have sought it out? I also have a circumcised boy, and he is doing fine as well. We differ in that regardless of the outcome, I regret my decision and didn't repeat it. The fact that you don't regret your decision simply tells me this issue is not high on your priority list. I won't join PETA for the same reason, it's just not my battle to fight.

Finally, I apologize for interjecting the topic of epidurals into this argument. It doesn't belong here. I am thrilled to hear your wife had wonderful birthing experiences. I chose differently, and that's what it comes down to--the fact that we both made educated choices about our own care.

 
At Thu Jun 21, 10:16:00 PM, Blogger Tuan's Princess said...

"Neonatal circumcision negatively affects the breastfeeding relationship"

Traumatic and stressful events in infancy interfere with breastfeeding success. The AAP Policy statement on breastfeeding states that traumatic procedures should be avoided lest they interfere with breastfeeding initiation. Taddio and colleagues report that male neonatal nontherapeutic circumcision causes an "infant analogue of posttraumatic stress disorder."6 Rhinehart has clearly and indisputably documented neonatal male circumcision as a traumatic procedure.7 (source: http://www.cirp.org/library/birth/)

"Your son's foreskin will most likely be sold and used in cosmetics, skin substitution studies and Testskin with no compensation to him."

"The after market for human foreskin is where the real money is made. Foreskins are sold to biomedical companies, which use them in the manufacture of insulin. They're also sold to middlemen, who package them for sale to research companies that in turn use them for biochemical analysis. Corporations such as Advanced Tissue Sciences (ATS), Organogenesis, BioSurface Technology, Genzyme, and Ortec International are taking cells from amputated foreskins and experimenting with artificial skin. Products like Dermagraft-TC, which sells for about $3,000 per square foot, are grown from the cells in infant foreskins and used as a temporary wound covering for burn patients. One foreskin contains enough genetic material to grow 250,000 square feet of skin." Circumcision. Daecher M. Icon 1998;2(2):70-3. (source: http://www.foreskin.org/f4sale.htm)

“Organogenesis, a biotech firm in Massachusetts, has come up with [an] alternative for these tests [cosmetic tests on animals]: a lab-grown piece of human skin... Testskin is already being used by laboratories at Helene Curtis, Estee Lauder, and Mary Kay Cosmetics.”
Discover Magazine, August, 1991 (source: http://www.geocities.com/rainforest/2062/experiment.html)

I may be a fruitcake, but I am not just blowing steam out of my butt. My appologies for not supplying my sources in my original post.

 
At Thu Jun 21, 10:21:00 PM, Blogger keagirl said...

As a urologist, I will wisely refrain from speaking the truth...

I commented on a similar topic on Flea's blog a while back, and I couldn't stand the vitriolic attacks that ensued...

PS: Fruitcakes are good for any season...

 
At Thu Jun 21, 10:57:00 PM, Anonymous Anonymous said...

"As a urologist, I will wisely refrain from speaking the truth..."

What could that be? That you have a monetary incentive to encourage circumcision? How much money do you make when hackish OBs and Peds do a terrible job, even by circumcision standards? Corrections = $$$.

You would have to find a new specialty in a country that respects male genitals.

And of course I'm a fruitcake. I question the Doctor is God mentality that is drilled into you guys at med school. The arrogance...

 
At Fri Jun 22, 12:34:00 AM, Anonymous Anonymous said...

Ah, flea.... I heard he got into a little courtroom trouble lately...

I'm pretty sure Flea would admit he's arrogant.... and be proud of that.

Arrogant circumcised doctors.... maybe you need to take a step back and try to start with the basics...

... do no harm
... ethics
... if it ain't broke don't fix it
... informed consent

What other body parts do we prematurly amputate just in case of some future problem?

Isn't the re-circumcision rate the same or higher than 'medically' necessary circumcisions?

And why is the 'mecially necessary' circumcision rate so much higher in the US than in countries where intact is the norm?

What is the rate of meatal stenosis... and why is that not included in figures for circumcision complications, such as that in the AAP literature?

What is the rate of circumcision adhesions (hint, it is higher than 50%) and why is THAT not included in the figures for circumcision complications (aka AAP)?

What is the biological function of the foreskin?

Can we at least agree that removing the foreskin ALTERS the sexual experience??


Oh, I'm just a mom who tries to apply logic and ethics to MY parenting decision. It is too bad I can't expect the same out of most medical professionals.

Jessica

 
At Fri Jun 22, 01:28:00 AM, Blogger > ScutMonkey said...

This is like the fair, does anyone have any cotton candy!?

"I question the Doctor is God mentality that is drilled into you guys at med school. The arrogance..."

Have you been to medical school lately? I can tell you from experience that it is something closer to "you are a failure". Yes, to make it through we do have to believe in ourselves.

"Arrogant circumcised doctors...."

There is that word again. Perhaps the arrogance arrives later, after we realize the efficaciousness of the 7, 8 or 9 years of medical education & training we have undergone at great personal expense. Who do you call when you are bleeding?

As far as the "circumcised doctors" goes, I believe that even before women were allowed to vote (in 1920) they had already begun to enter the field of medicine (Elizabeth Blackwell, 1849). Over 50% of my class is female. I don't think they were circumcised as a condition of enrollment, but I could be wrong. Ladies?

"You would have to find a new specialty in a country that respects male genitals."

I think they have urologists in Finland... I wonder how they afford food? From what I have heard, male genitals are quite popular there too!

And finally, simply because this quote was so good it NEEDS to be repeated!

"Schizophrenia is a neuro-chemical brain malfunction mostly associated with sexual TRAUMA before the brain develops language skills."

Classic....

 
At Fri Jun 22, 01:58:00 AM, Blogger D.P. said...

This comment has been removed by the author.

 
At Fri Jun 22, 02:00:00 AM, Blogger D.P. said...

Informed consent? So, should I wait and ask my children if they want immunizations to be protected from diseases (hello, antivaxers)? Should I ask them if they want surgery for a burst appendix? Should my brother with the diabetic son ask if the son wants his insulin? Um, it is my understanding that as a parent, I am supposed to be making the informed decisions until my children are mature enough to make the decisions on their own. And yes, my son is circumcised (without any doctor twisting my arm, thank you).

 
At Fri Jun 22, 02:30:00 AM, Anonymous Anonymous said...

I always get so tired of hearing and reading how uncircumcised men are dirty and give their partners all sorts of diseases. This is simply UNtrue. And these myths always seem to be perpetuated by the medical community - those who stand to gain financially off of performing circumcision surgery.

While I don't know the status of all my friends, I will say I have a good friend whose boyfriend has herpes. He is circumcised.
I can't honestly believe if having a foreskin caused all sorts of ailments that the majority of the world would still have happy and healthy penises. And if cutting off part of a penis is the best medical intervention for preventing HIV, will someone please tell me why the USA has such a high incidence of the virus (especially since most men in the US are circumcised)?

Cut your babies or keep them natural, makes no difference to me, but stop making intact men out to be harbors of all things sexually transmitted. They are not!
Tracy B.

 
At Fri Jun 22, 08:31:00 AM, Anonymous Anonymous said...

D.P., routine infant circumcision is hardly a valid comparison to the other conditions you mentioned, but I'll bite.

Vaccines: Huge benefit with little risk and little pain. Its safe to say that a child would not want to get a disease like the measles, mumps, or polio, any of which can cause permanent damage or death. In any case, no body parts are amputated. There's no visible sign of vaccination. If there is no adverse reaction, then there really are no negatives beyond the slight sting of the needle. I consider the antivaxers to be a bit out there, myself.

You get wackier.

A burst appendix? Lets see, does my child want to die a horrible septic death? Hmm, hard call. Its a medical emergency and I'm sure the child wants to live what with a survival instinct and all.

Insulin? Again, insulin or death. Another medically neccesary decision.

On the other hand, circumcision? If you don't have it done...nothing happens. The child doesn't die or get sick. Assuming you don't have a quack MD, no infections result from premature retraction. Daddy might feel insecure because his son has more parts, but that's his problem, not his son's.

 
At Fri Jun 22, 09:47:00 AM, Anonymous Anonymous said...

Petri,

"Gah, what does this mean exactly? Why these three disparate cherry-picked countries?"

Perhaps you are unaware that the most fundamental and rigerous requirement of science is that a hypothesis or theory MUST fulfill it's prediciton 100% of the time, or it is not valid.
It only takes ONE exception to invalidate it--you were given two [if you add Japan (same as Finland), it gives you 4]

"What rates of HIV are we talking about? 4.4 cases of HIV per 100 people? per 1,000? nationwide? Maybe 4.4 humans contracting HIV per fortnight. I really have no idea."

Who cares what the absolute is since were are only making comparisons--if it makes you feel better, it is %.
https://www.cia.gov/cia/publications/factbook/rankorder/2155rank.html

"Also, can you really make the statement that HIV rates are dependent on circs as its single dependent variable? To hell with drug use and homosexual activity, there are so many other societal and cultural issues that contribute. Just because I can show you a graph that relates a declining population of pirates to increased average global temperture doesn't mean there's a relationship. Most of the "studies" and research I have seen on these posts fall victim to this "Cum hoc ergo propter hoc," fallacy."

Sorry, but science does not accept nebulous excuses for non-fulfilment of prediction.

Provide these "factors" WITH solid numbers, then put them into a model that shows that this reduction actually exists...fancy words and specious arguments certainly do not!

 
At Fri Jun 22, 09:58:00 AM, Anonymous Anonymous said...

A challenge for all of those in favor of circumcision:

Can you scientifically explain why (with proof) the rates for all of the supposed benefits for circumcision do not show up in the real world--the rates in intact Europe is LOWER (or the same as) those in circumcising USA?

WHERE in the real world are these alleged benfits? Or do they only exist in questionable studies?

 
At Fri Jun 22, 10:23:00 AM, Anonymous Anonymous said...

Concerning the sale of foreskin and profits made from them, I found this very interesting:

Well this one is a bit of a gem, from the annual stock report of Organogenesis Inc:

Organogenesis Inc Annual Report:
http://www.secinfo.com/dS997.41yp.htm
http://sec.edgar-online.com/2001/04/02/0000927016-01-001622/Section2.asp

"WE MUST BE ABLE TO OBTAIN ADEQUATE SOURCES OF SUPPLY

We manufacture Apligraf for commercial sale, as well as for use in clinical trials, at our Canton, Massachusetts facility. Among the fundamental raw materials needed to manufacture Apligraf are keratinocyte and fibroblast cells. Because these cells are derived from donated infant foreskin, they may contain human-borne pathogens. We perform extensive testing of the cells for pathogens, including the HIV or "AIDS" virus. Our inability to obtain cells of adequate purity, or cells that are pathogen-free, would limit our ability to manufacture sufficient quantities of our products. "

******************************************************************************************

I'm sure they aren't the only ones who need to "safeguard" their supplies.

Now that the rate of circumcisions are falling in the USA, I'm beginning to understand the need to export the procedure to Africa - and it just happens to "protect against HIV" ....HOW CONVENIENT.

 
At Fri Jun 22, 11:20:00 AM, Anonymous Tony said...

#1 Dinosaur,

I think those comments were directed at me, whether intentional or not. The first part about being "ignorant" if I don't understand the difference between male and female genital cutting certainly was, since I brought up the issue and provided facts to support my claim. I did not think you were calling me ignorant directly, but you did imply that if I (or anyone) disagreed with your assessment, which included no facts, then I was "ignorant".

The fruitcake comment was also directed at me, although not exclusively at me. I wrote "Your position is irrational, not mine." You quoted me and then wrote "fruitcake". How can that not be directed at me?

That said, I didn't intend my response to imply that I took offense. I've been called far worse. I was merely pointing out that there are facts with deeper, more logical analysis than you (and too many commenters) provided to demonstrate your stance on infant male circumcision. No one challenged that with anything resembling a coherent, compelling argument. Instead, we got non-arguments like "should I not give my diabetic kid insulin because he can't consent?". As an Anonymous pointed out, we shouldn't mix medically necessary decisions with medically unnecessary decisions for comparison. That's why many of us mentioned far more physically invasive preventive surgeries. The issue isn't what can be easily done, which is often given as a reason for infant circumcision. That, and it's "just a flap of skin". We need consistent principles, not a grab-bag of socially acceptable medical intervention.

And, yes, I noticed we have a lot in common. As another commenter pointed out, your position on Gardasil is logical and convincing. I agree completely. Among other things, that's why I won't attack you personally. Heck, it takes a special fortitude to be a Phillies phan, so I can assume you're not any ad hominem name I could resort to.

That's what makes your position on circumcision so frustrating to me. Where you looked at all sides of that argument, I think you've discounted anything about circumcision that doesn't point to performing it on infant males. Is that because something might go wrong? The increased pain and difficulty of adult circumcision? They're not enough.

The most important issue here is the human right to be free from harm. At birth, almost every male foreskin is healthy. Nothing needs to be done. Yes, there are potential medical benefits to the surgery. But nothing is wrong when the surgery is performed. If it were performed on someone who could consent, fine. You will hear no objection from me. Infant circumcision is not that. It is a proxy decision. We must assume a basic level of self-preservation on the part of our children. Intact adult males rarely choose circumcision, for need or choice. That tells us what a typical male would decide when confronted with all choices. Instead, we focus on our views, which are certainly conditioned by tradition, to decide that he'd probably not miss it. Maybe not, but that isn't enough.

Even if we ignore that, the risk of needing those benefits is too low to justify routine infant circumcision. How many do we have to circumcise to achieve one fewer case of X? How many complications will we encounter to achieve one fewer case of X? The utilitarian argument surrounding infant circumcision is fascinating, but we live in a society based on inherent, guaranteed individual rights. We do not get to sacrifice part of every (male) child to achieve some "greater" societal good. Anything other than immediate medical need used to justify infant male circumcision must be taken out of context to appear valid. The utilitarian argument should be considered and understood, but it can't be a factor in proxy decisions.

Life is full of risk. Bad things might happen. But we cannot ignore the decades of normal, healthy genitals he'd experience before that unlikely future malady. Instead, we're risk averse. That's a subjective choice for each person. When we apply it to our children, we've ventured into irrationality because he might not live with the same fear. He might realize that he can bathe regularly, or wear a condom during sex, or any number of prevention methods far less severe and invasive that removing part of his genitals.

At the time circumcision is performed on infants, there is no medical indication. That is all we need to know to decide whether or not to impose the surgery. It's unnecessary. It carries a risk, however small, of severe complications, and a greater risk of minor complications. Including a 100% risk of scarring. (Scars are so aesthetically pleasing. How can that not be seen as subjective preference?) Every perceived or assumed benefit is subjective at that moment of cutting. Subjective surgery on a healthy patient is not in his best interest because he can't state his agreement or disagreement with that subjective standard. Routine infant circumcision (by proxy) is medically unnecessary and therefore ethically invalid.

 
At Fri Jun 22, 01:04:00 PM, Anonymous Anonymous said...

Dinosaur,

Good posting.

One point worth making is the rates of circumcision in this country, and how the percentages are a classic example of misinformation to fuel an agenda and message that circumcision is loosing favor here.

For at least two decades, anti-circers have claimed the infant circumcision rate in the U.S. is in the 55% to 65% range. These claims are based on data from National Hospital Discharge Surveys (NHDS)that have been conducted by the federal government since 1979 and have shown an infant rate fluctuating between 55% and 65%. The problem is the NHDS surveys are very incomplete since they are limited to inpatient circs in non-federal hospitals that are recorded on the medical record face sheet. This excludes all outpatient hospital circs, all federal hospital circs (as in military hospitals), all hospital circs not recorded on the medical record face sheet, and--most importantly--all circs in private medical clinics and offices after initial infant discharge.

Today we have the National Health & Nutrition Examination Survey (NHANES)of males born in the 1980s which overlaps with a time period covered by the NHDS surveys. The NHANES found 84% of males born in the U.S. in the 1980s are circumcised even though the NHDS data for the same period showed a rate fluctuating between 60% and 65%.

Anyone basing the U.S. infant circ rate on NHDS data should immediately add twenty plus percentage points to get closer to the real U.S. infant circ rate.

This is the best example of how some use statistics and figures (or should I say smoke and mirrors) are used to misinform.

 
At Fri Jun 22, 01:35:00 PM, Anonymous Anonymous said...

Quibbling over the sources of, and the estimated rates of circumcision in the USA is the best you have to offer?

I guess obfuscation is much easier than qactually supplying credible scientific evidence for the alleged benefits in the real world?

 
At Fri Jun 22, 03:27:00 PM, Blogger CrankyProf said...

With all the histrionics and posturing, I hate to break in with a question, but:

Does the anti-circ crowd get this worked up and vitriolic over those who circumcise their sons due to religious requirement? Do you heap scorn and derision and accusations of no ethics on Muslims and Jews?

There ARE those who circ because of their beliefs -- do you get in their faces, as well?

 
At Fri Jun 22, 10:01:00 PM, Anonymous Anonymous said...

CrankyProf,

Ritual circumcision provides no ethical cover for physicians wrongfully accepting proxy-consent for non-therapeutic circumcisions, which are on par with other unnecessary surgeries like nose-jobs and breast implants.

I have no doubt that those religions which involve involuntary circumcision will slowly abandon it, since it's contradicted by modern science and ethics.

For example, by the time the American medical establishment joins the rest of the world in strongly discouraging non-therapeutic circumcision (the beginning of that revolution is taking place right now), progressive forces within Judaism will be making similar changes, as exemplified by this petition: Accept Alternative Brit Milah (Bris) Practices

 
At Sat Jun 23, 09:14:00 AM, Anonymous Anonymous said...

"Does the anti-circ crowd get this worked up and vitriolic over those who circumcise their sons due to religious requirement? Do you heap scorn and derision and accusations of no ethics on Muslims and Jews?"

This presupposes that it is required.. perhaps you might wish to look into this "requirement:

http://home.comcast.net/~consult2/index.html

And as for my personal opinion, superstitious beliefs hardly justify harming infants--especially since the FGM law does not allow mutilating female infants for them.

 
At Sat Jun 23, 10:50:00 AM, Anonymous Tony said...

Anonymous:

This is the best example of how some use statistics and figures (or should I say smoke and mirrors) are used to misinform.

If that's the best example, and I do believe your claim has some merit, the second best example is surely quoting statistical benefits of circumcision out of context. With the latest HIV approach, it's always stated that infant male circumcision reduces the risk (or "prevents") HIV infection by 50% or whatever the latest number claimed. That's fine, but it's lacking the proper context. What's the actual risk, in this case of HIV transmission from an HIV-positive female to an HIV-negative male, circumcised versus intact and with condom versus without condom? The numbers aren't quite as impressive there.

Remember, of course, that the research said nothing about infant circumcision. The studies only looked at voluntary adult circumcision. If we're going to have fun with numbers, we might as well have choose a different target audience, too. That's honest. Right?

This sort of obfuscation occurs all across the spectrum of circumcision's "benefits".

CrankyProf:

Does the anti-circ crowd get this worked up and vitriolic over those who circumcise their sons due to religious requirement? Do you heap scorn and derision and accusations of no ethics on Muslims and Jews?

There ARE those who circ because of their beliefs -- do you get in their faces, as well?


"Heap scorn and derision" and "in their faces" are stereotypes, as if the only way anti-infant circ folks can debate is through histrionics and screaming.

But to your question, yes, I will say the same to those who practice their religion by circumcising another. Parents have a right to raise their children in their religion, but that right does not include the ability to impose physical harm on a child. Courts do not recognize a right to include children in religious services that include snake handling. We can discuss the relative risk of each, but there is indeed a risk of harm in both.

Again, routine infant circumcision is not medically indicated at the time it's done. And it includes a 100% risk of scarring, among other risks of complications, up to and including death. As such, it's a violation of that child's physical body and his right to remain free from harm. We own our bodies, regardless of what our parents believe is the best way to modify a healthy body. One person's rights can never trump another's, even by proxy.

There is also research that demonstrates that the commandment for infant circumcision was inserted into the Old Testament long after the original text was written. (Read Marked In Your Flesh by Leonard Glick, among many available resources.) But even if that's not the case, how many other religious laws have been abandoned because they do not fit with the concept of modern society? Stoning adulterous women? I'm pretty sure we've discarded that. If we're going to elevate religious law above civil law, then I guess we need to bring that back. And on and on.

Don't forget, the New Testament discards the commandment to circumcise children, insisting instead on a circumcision of the heart. Yet, many Christians I've spoken to circumcise because "it's in the Bible". Am I supposed to respect the wishes of parents who can't bother to understand their religion, going so far as to slice off part of their child to adhere to a mistaken understanding?

Ultimately, don't confuse the position that the male should decide for himself with a hatred of religion or the belief that circumcision to adhere to religion is bad. If an adult male wants to have himself circumcised for his religion, as converts to Judaism must do, I don't care. I think it will happen in significant numbers, if we recognized the law's unambiguous demand with regard to infant circumcision. I also think that adult circumcision for that meaning will have more meaning to the male himself, which is what a religious practice should provide. Instead, we're left with making a community feel better by sacrificing the foreskin of a male child.

 
At Sun Jun 24, 07:37:00 PM, Blogger FredR said...

To every action there is an equal or opposit reaction. That's why cultures who practice eugenics on infants have been Holocausted by the ancient Greeks, the ancient Romans, and the Nazis. They just won't learn because of their pride and arrogence. Chozen race my ass. If everyone is forced to commit eugenics on their infants then they will Holocaust themselves (Armegedon) just as what's going on in the Islamic countries. It sets the stage for mass hysteria with mass schizophrenics hearing voices.
http://www.hiddenmysteries.org/health/effects/autism.html
http://www.cirp.org/library/psych/goldman1/
http://www.washingtonpost.com/wp-dyn/content/article/2007/03/05/AR2007030500357.html

 
At Mon Jun 25, 02:27:00 PM, Blogger Dave said...

FredR said "That's why cultures who practice eugenics on infants have been Holocausted by the ancient Greeks, the ancient Romans, and the Nazis. They just won't learn because of their pride and arrogence. Chozen race my ass."

So FredR, you're equating the Jews use of circumcision with eugenics and have determined that this is the cause of the Holocaust. Wow, probably no point in arguing with a mind capable of such arguments, but hey here we go anyway.

1)Eugenics is the attempt to remove a certain trait from the general gene pool. In its most basic form it is practiced as genocide. But its hard to argue that circumcision is an attempt to remove a trait from the gene pool (if so which one). It's also pretty hard for a people to commit genocide against themselves (though points to the shakers on there accomplishment...O

2) Could you please provide your definition of schizophrenia? Mass schizophrenia is a new term for me. Also, who told you that circumcision will lead to Armageddon (usually spelled with 2 d's by the way)? Did a voice tell you...

3) Arrogence, is spelled with 2 a's (arrogance).

4) You are an antisemitic moron.

- Dave

 
At Mon Jun 25, 09:44:00 PM, Blogger Mark said...

RE:schizophrenia.
I have it. There is no lab test for it, schizophrenia is diagnosed in only one way, the interview/conversation with a psychiatrist.

How can circumcision cause schizophrenia?
If no antipain medications are given sufficiently before and after(the circ.) the babies mind/brain endures tremendous pain. Some pass out from the pain, some become near comatose. This induced brain chemical abnormality may cause perminate changes to the brain and may increase the odds of becoming schizophrenic.

So you have that to go along with
the correct dosage of antipain medication, a bad cut, infection and blood loss that can result to death in a non-emergency cosmetic proceedure.

 
At Mon Jun 25, 10:56:00 PM, Anonymous Anonymous said...

Mark, thanks for sharing details of your schizophrenia.

I fully concur that infant circumcision quite possibly causes permanent, detectable changes to brain structure and function, which would be revealed by brain visualization studies.

Immerman proposed that theory in his 1998 paper published in the Journal of Genetic Psychology:

A Proposed Relationship Between
Circumcision and Neural Reorganization
,

But, lo and behold, there is no published record of a study ever using brain visualization to detect changes caused by circumcision!

That's right, over a million American circumcisions per year, but no effort is made to actually learn its consequences to brain structure and function.

Isn't that pretty incredible?

 
At Tue Jun 26, 09:51:00 AM, Anonymous Anonymous said...

Neonatal local noxious insult affects gene expression in the spinal dorsal horn of adult rats
Ke Ren, Svetlana I Novikova, Fang He, Ronald Dubner and Michael S Lidow*
Address: Department of Biomedical Sciences, and Program in Neuroscience, University of Maryland, Baltimore, MD 21201; USA

Animal Model Shows Pain and Tissue Injury in Newborns Alters Nerve Circuitry and Reaction to Pain
Later in Life
The National Institute of Dental and Craniofacial Research
http://www.nidcr.nih.gov/NewsAndReports/NewsReleases/Archives/NewsRelease07272000.htm

 
At Wed Jun 27, 02:22:00 PM, Blogger libby said...

This comment has been removed by a blog administrator.

 
At Wed Jun 27, 02:51:00 PM, Anonymous Anonymous said...

This comment has been removed by a blog administrator.

 
At Wed Jun 27, 03:48:00 PM, Blogger #1 Dinosaur said...

Female genital mutilation is not an acceptable topic for this comment trail. Comments deleted accordingly.

 
At Wed Jun 27, 07:25:00 PM, Blogger FredR said...

Dave says,
1)Eugenics is the attempt to remove a certain trait from the general gene pool. In its most basic form it is practiced as genocide. But its hard to argue that circumcision is an attempt to remove a trait from the gene pool (if so which one). It's also pretty hard for a people to commit genocide against themselves (though points to the shakers on there accomplishment...O


The trait circumcision is trying to remove is the worshiping of masculine gods to the point they make women, our true creators, second rate. With out Mother Nature, Our Heavenly Father would have no womb for creation. It causes men to commit suicide/ murder. Look at what is going on in Islam. It causes a subconscious need to destroy the enemy. This need can be controled and directed away from the cause by using the words of schizophrenic prophets. Since neuro- psycho-pathology had not been invented yet, many men who developed circumcision induced schizophrenia later on in life, are beleived to actually have conversations with the creator. I know the rates of schizophrenia are low, only one out of a hundred, or 1,000,000 out of 100,000,000.
Thanks for pointing out my errors in spelling.
I'm not antisemetic, just anti sexually traumatising and altering infants.
Schizo comes from schism, phrenia refers to the brain. It refers to a loss in logical thinking, where our thought processes get caught up in a loop.
No one told me that circumcision will cause the altimate Armegeddon. It's just how I interpet the last book in the new testimate called Revelations. I beleive that the author had developed circumcision induced schizophrenic savantism with the ability of historical perspicacity. Paraphrased his psycho-babble basically says that when we find the true meaning of Apocalypse then all hell will break loose. The root word calypse is the masculine tense of calyx. In botany, the study of plants, the calyx is a specialiesed leaf structure whose function is to protect the inner sensitive reproduction parts of the flower. It has another function, to enhance sexual desire. The feminine tense of calyx is calyptra. To take from the masculine calyx is called an apocalypse. To take from the feminine calyx would be called an apocalyptra, but that is illegal on humans, praise be to Mother Nature.
Go look at your man nipples. They serve no purpose but to prove that creation is a feminine quality. The masculine sex came after life was already hear. Our function is to protect the creators so they can reproduce more creators. Some people put the needs of their gods before the needs of the children, who will become us.

 
At Wed Jun 27, 07:38:00 PM, Blogger #1 Dinosaur said...

Attention all medical students:

Read the preceding comment for a true textbook example of "bizarre" (code word for schizophrenia) associations.

Note the tangentiality and loosening of associations. (No, spelling doesn't count.) This is a classic example of schizophreniform thought processes.

You will see this on your psych rotations, but it's an excellent preview. If anyone's interested, I have a much longer example (much more rambling and disconnected) posted as a comment to another entry. I deleted it from the blog, but I saved a copy specifically for educational purposes. Email me if you want to see it.

 
At Wed Jun 27, 08:26:00 PM, Anonymous Anonymous said...

#1 Dinosaur,

FredR's bizarre religious views which lead him to oppose circumcision bear some resemblance to the religious views of those who support circumcision based on a perceived divine mandate.

There are religious views on all sides of just about everything.

I hope you'd recognize, though, that religious views should be kept as far away from influencing the practice of medicine as they should be kept away from influencing the apparatus of the state.

 
At Wed Jun 27, 08:33:00 PM, Blogger #1 Dinosaur said...

Anon: I'm not talking about his religious views. I'm talking (clinically) about his bizarre thought processes.

There are plenty of examples of similar views expressed rationally further up the comment trail. This one is textbook schizoid, and therefore a valuable example to students of psychiatric pathology, completely apart from the actual topic at hand.

 
At Wed Jun 27, 08:44:00 PM, Anonymous Anonymous said...

#1 Dinosaur,

Ok. From your post here it appeared you were taking such views as emblematic of Genital Integrity Rights advocates in general, which they are not.

 
At Thu Jun 28, 02:19:00 AM, Blogger > ScutMonkey said...

Hey #1 Dino!

I would love a copy of your schizophreniform email. I just finished my psych classes and starting wards this summer. I really enjoyed psych (although I am going into emergeny, not pysch) and have found some of these comments fascinating. If you have even better examples, send one my way. Click on name above for email... Are we at 100 comments yet????

 
At Fri Jun 29, 02:42:00 AM, Blogger FredR said...

I was afraid I might develope schizophrenia because my Dad and two of my brothers and two of my mother's sister's sons did, and two of my other brothers committed suicide. I found out about the circumcision induced delayed PTSD's that may develope after puberty's brain chemistry sets in. My Jewish boyfriend sent me to a MOTT psychologist. I told him my concerns and he told me I was delussional and wanted to perscribe some psychotropic drugs. I told him that chemical restraints are illegal, and I would not let him chemically silence me.
So I went to a psychologist and told him my concerns and he gave me writen and verbal tests. He told me I'm not schizophrenic but have a habbit of putting my best face foreward, meaning he thinks I'm hiding something. Maybe I am and am subconsciously hiding it.

 
At Fri Jun 29, 11:21:00 AM, Anonymous Anonymous said...

This comment has been removed by a blog administrator.

 
At Fri Jun 29, 01:02:00 PM, Blogger libby said...

This comment has been removed by a blog administrator.

 
At Fri Jun 29, 04:18:00 PM, Anonymous Anonymous said...

"This post has been removed by a blog administrator."

Cute, delete any post that expooses your cultural double standard and hypocrisy--don't let people see it--you are the administartor, so you can just censor that which exposes it..

 
At Fri Jun 29, 05:09:00 PM, Anonymous Anonymous said...

This comment has been removed by a blog administrator.

 
At Fri Jun 29, 05:49:00 PM, Anonymous Anonymous said...

#1 Dinosaur,

I'm seriously disappointed with you. We disagree about circumcision, but that's not why. It's for choosing to delete posts which advocate, in a non-specific manner, for Genital Integrity Rights.

If this post is deleted, it will be my last one here. Maybe that's what you want, I don't know.

 
At Fri Jun 29, 06:25:00 PM, Blogger #1 Dinosaur said...

Anonymous: Don't try getting cute. "Genital Integrity Rights" is code for anti-circumcision arguments that consider neonatal circumcision comparable to female genital mutilation. The posts were removed because of this disingenuous reference to the latter irrelevant topic.

 
At Fri Jun 29, 07:26:00 PM, Anonymous Anonymous said...

This comment has been removed by a blog administrator.

 
At Fri Jun 29, 07:35:00 PM, Blogger FredR said...

Circumcision also cause dissension between the haves and the have nots. The have nots want to take away what the haves have, and the haves have to try and protect what they have from the have nots, and the unhappy have not want to stop the other have nots from halving off what we are ment to have.

 
At Sat Jun 30, 01:50:00 AM, Anonymous Anonymous said...

#1 Dinosaur,

I think you're going too far with the posts you choose to delete, but it's your blog and that is your right.

I'd like to point out that two of your Laws of the Dinosaur are especially applicable to routine circumcision without patient consent:


Eighth Law: The better the surgeon, the more reluctant s/he is to operate.

Twelfth Law: A bad idea held by many people for a long time is still a bad idea.

 
At Sat Jun 30, 09:03:00 AM, Anonymous Anonymous said...

This comment has been removed by a blog administrator.

 
At Sat Jun 30, 03:43:00 PM, Anonymous Anonymous said...

"This post has been removed by a blog administrator."

ANOTHER removed? I guess censorship is needed when your position appears threatened?

 
At Sun Jul 01, 02:49:00 PM, Blogger FredR said...

The only reason Christianity exists is because a bunch of Jews rebelled against the Semetic pharisees who altered the way circumcision was performed by law. The only way a law claimed to be by God could be changed was if the Allmighty came down to earth and was conceived by a virgin. When they found out this could happen accidently( sperm can sometimes crawl right through the hymen, known as the ultimate rip off, getting pregnant without sex) they also made a law making it legal to stone unmarried women to death, essentually making it legal to commit rape and murder. A super massive schism opened up in Judaism because of the heavy burdon imposed upon the Jews.So John the Baptist came and tryed to replace ritualized circumcision with ritual daily cleansing, called Baptism. So they had John beheaded for blasphemy to Abraham's covenent. Then Jesus and the Apostles tryed the same thing and they paid the Romans to crucify Jesus for committing blasphemy to "The Ritual". Now the Christians have taken the place of the hippocrates and pharisees that Jesus came to undo, signaling the second coming. Next, as the Shiites and the Sunis are blowing up each others Mosques, The Evangelical Christians are raising funds to supply radical Isrealis help to destroy the Mosque in Jeruselem to fullfill their own prophesies, so Jesus can return.
I'm not smart enough to make this stuff up. Most of it is what I read other's had said

 
At Sun Jul 01, 03:17:00 PM, Blogger FredR said...

There once was a king of the Jews whose name was Harrod. He was not a purebread as his Father (I think)was Roman. Harrod married a purebread Jewish princess and they had two daugthers and a son. The Jewish princess, now Queen, new that half breed males whose mothers were not Jewish could not become King by law, which left her daughters next in line for the throne. Her crones told her of the plot to reproduce a Purebread King from a virgin to over throw the existing Jewish dinasty. She persueded her husband to have all the newborn circumcised male Jewish children to be sacrifised so he wouldn't loose his power.
Later when Harrod realised his wife had tricked him because he was unfamiliar with that halfbreed law, He killed her two daughters in front of her then he had her killed, then he killed his son and he died of worms later.
This is some Jewish history I read. Anyone know it to be totaly wrong, feel free to step in and correct the errors.

 
At Sun Jul 01, 10:52:00 PM, Anonymous Anonymous said...

Another death from circumcision complications:

Baby Dies During Circumcision

 
At Mon Jul 02, 07:40:00 AM, Blogger #1 Dinosaur said...

I suppose it's asking for too much logic to recognize the difference in complication rates between surgical procedures in third world countries and here.

 
At Mon Jul 02, 02:52:00 PM, Anonymous Anonymous said...

#1 Dinosaur,

There was no implication about relative complication rates between third world countries and countries with top-notch health care in the report of the boy's death two comments above.

Speaking of which, though, as a physician in the United States, do you think we know the actual rate of complications here, or are the secondary complications not always identified as related to circumcision in those cases when they are?

Since you drew a "third-world" distinction about the boy reported yesterday to have died from blood loss complications of his circumcision in Pakistan, here's a death reported a couple weeks ago from a country which may feel less "other" to you:

Ontario boy dies after complications from circumcision

 
At Mon Jul 02, 03:00:00 PM, Anonymous Anonymous said...

Here's a link to a write-up from the Office of the Chief Coroner of Ontario, Pediatric Death Review Committee:

Circumcision: A minor procedure? (pdf)

I'll repeat that I'd appreciate your insider insight, in the United States, do you believe there is a robust accounting of complications which are attributable to circumcision?

 
At Mon Jul 02, 03:19:00 PM, Blogger #1 Dinosaur said...

All your references (both of them) refer to problems with the Plastibell. I've never used the Plastibell technique, nor seen it used. My technique of choice is the Mogen clamp. Gross malpractice involving a particular method of performing a given procedure is hardly grounds for condemning the procedure on principle.

Comparing techniques and complication rates is standard in other areas of surgery. You don't say, "Stop taking out gallbladders! Stones can be dissolved with medicine," just because overeager laparascopic surgeons nick the common bile duct from time to time.

 
At Mon Jul 02, 03:32:00 PM, Anonymous Anonymous said...

#1 Dinosaur,

The difference between death from complications of circumcision versus gallbladder surgery is a crucial one: Gallbladder surgery is performed to treat a patient with a diagnosed disease or medical indication, while circumcision is performed on (almost) any infant male upon request .

I still don't know your opinion about whether there exists a mechanism in the American health care system to accurately collect statistics on circumcision complications. You perform circumcisions, so I imagine you have some insight on this.

I'm curious how you reconcile your willingness to perform Mogen clamp circumcisions with your Eighth Law:

Eighth Law: The better the surgeon, the more reluctant s/he is to operate.

Shouldn't you be reluctant to perform them?

 
At Mon Jul 02, 04:06:00 PM, Anonymous moof said...

Wow!!!

*ducks behind a rock*

Dr. Dino, this reminds me of the mess Dr. Bernstein had in his comment section when he posted Male "Circumcision: Should it Now Be a Crime?" He got 441 comments before the thread broke down, and he wrote a new post in order to allow the comments to continue.

The thread was hijacked by a relatively small number of rabid anti-circs ... and they had a field day. Dr. Bernstein, who teaches ethics to med students, was under the impression that he was seeing a "balanced view" of the issue. I didn't agree with him, so I made a similar post - "The Ongoing Controversy on Male Circumcision" - and ensured that it didn't get hijacked, although it wasn't easy to do.

I also started a poll. With 233 votes to date (nearly a year), these are the results:

# Circumcision is necessary! (13%)
# I approve of circumcision for those who want it. (45%)
# I'm completely indifferent, or have no idea. (6%)
# I think it shouldn't be done without a reason. (22%)
# It's genital mutilation (15%)

That is balanced. Once you eliminate all of the returning IPs, allowing each person to have an honest say, but not come in like a marauding horde of Mongols and take things over, you have a better idea of how the majority actually feel.

These rabid anti-circs have no idea how they come across. They hurt their cause far more than they help it.

 
At Mon Jul 02, 06:45:00 PM, Anonymous Anonymous said...

moof,

Deliberately or not, your poll questions are a total disaster.

The answer spectrum is a total mess, and does not give choices corresponding to the various segments from one end of the opinion spectrum to the other.

For example, the choice "I approve of circumcision for those who want it" is ridiculous and misleading. People who oppose male genital mutilation (circumcision) also, nearly universally, approve of circumcision for those who want it.

It is one of the more audacious and disreputable sleights-of-mind to say "those who want it" when what you're really implying is "those whose parents want it for them."

But that's the kind of mental contortion people go though to avoid admitting that infant circumcision is a surgery that the patient doesn't need and doesn't want.

Finally, I'd like to re-iterate the following question to #1 Dinosaur: Do you believe that in the United States, the necessary statistics are collected to know the true rate of complications attributable to circumcision?

 
At Mon Jul 02, 10:06:00 PM, Anonymous Anonymous said...

#1 Dinosaur,

We occasionally hear about death associated with circumcision, but there is reason to believe there are more that we don't hear about, and which are never reported as such.

George Denniston, M.D.:

One in 500 circumcised boys has a significant complication, according to Dr. Julian Ansell, who favors the procedure.3 This means that at the very least, 2,000 significant medical complications from circumcision occur each year in America. The mortality resulting from circumcision in newborns is not available. The relationship between circumcision and infant death is usually obscured by the reporting of the immediate cause of death, like infection, and omitting the precipitating cause - the circumcision wound. Deaths associated with circumcision are rarely reported. They should be.

I'm increasingly suspicious that you'll choose to refrain from comment on this issue, but that's unfortunate, since as an "industry insider" you should have some unique insight on this issue.

 
At Tue Jul 03, 08:49:00 AM, Anonymous Anonymous said...

"I suppose it's asking for too much logic to recognize the difference in complication rates between surgical procedures in third world countries and here."

Like I suppose it is too much to recognize that deaths in the "here" occur also?

Death: While accurate data are not recorded, it has been estimated that approximately 230 boys die each year in the United States alone from circumcision-related complications.

Gellis, SS. Circumcision. Am J Dis Child 1978;132:1168.

Baker RL Newborn male circumcision:
Needless and Dangerous Sexual Medicine Today, 1979;3(11):35-36.)

"About 1,350,000 newborn American males are circumcised annually, and about 230 of them die as a result of this operation." (Sex by Prescription, by Thomas S. Szasz, MD, Syracuse University Press, 1990)

http://www.SexuallyMutilatedChild.org/deathsdo.htm
http://www.SexuallyMutilatedChild.org/deathaap.htm
http://www.SexuallyMutilatedChild.org/darker.htm
http://www.SexuallyMutilatedChild.org/deaths-d.htm
http://www.cirp.org/news/1993.06.21%3adeath
http://www.cirp.org/news/1995.07.28%3aHoustonChronicle
http://www.cirp.org/news/1992.07.10%3aboy-dies
http://www.noharmm.org/evansdeath.htm
http://www.eskimo.com/~gburlin/INTACT-L/archive/9908/msg00292.html

 
At Tue Jul 03, 08:52:00 AM, Anonymous Anonymous said...

"All your references (both of them) refer to problems with the Plastibell. I've never used the Plastibell technique, nor seen it used. My technique of choice is the Mogen clamp. Gross malpractice involving a particular method of performing a given procedure is hardly grounds for condemning the procedure on principle."

So, then are you prepared to provide accurate statistics on deaths from each technique--otherwise this is what we call a red herring.

 
At Tue Jul 03, 08:58:00 AM, Anonymous Anonymous said...

"# Circumcision is necessary! (13%)
# I approve of circumcision for those who want it. (45%)
# I'm completely indifferent, or have no idea. (6%)
# I think it shouldn't be done without a reason. (22%)
# It's genital mutilation (15%)

So, what do OPINIONS of people uneducuated have any bearing on this subject--what is about is "is it ethical to force an unnecessary, harmful, and painful procedure on infants."

And does citing questionable studies purporting a reduction not seen in the real world make it ethical?

 
At Wed Jul 04, 05:11:00 PM, Anonymous Anonymous said...

What a bunch of hard-headed people -- what part of "elective" does this subset not understand?

E-LEC-TIVE.

Not MAN-DA-TOR-Y.

This is the most useless argument on the internet today (unless one includes vaccines and natural birth).

~~Surfie~~

 
At Thu Jul 05, 08:33:00 AM, Anonymous Anonymous said...

"What a bunch of hard-headed people -- what part of "elective" does this subset not understand?"

What infant ELECTS to have this done to HIS genitals.

What mental gymnastics allows one to ignore this?

 
At Thu Jul 05, 08:36:00 AM, Anonymous Anonymous said...

"This is the most useless argument on the internet today (unless one includes vaccines and natural birth)."

What do these red herrings have to do woth the forced, ripping part, cruching and amputation of the most senstve part of an infant's genitals?

Do YOU have anything of substance and logic to the argument?

 
At Wed Jul 18, 04:26:00 PM, Blogger FredR said...

Someone should start a new pole.

Would you, as a newborn infant, male or female, want to be given the right to choose to remain intact or be circumcised?

Yes or No.

A Yes vote would mean that you as an infant would have to be physicaly developed enough to give an informed concent of your choise.

A No vote would mean that you as an infant should not have the right to choose to remain intact or be circumcised.

It works the same way for males and females.

 
At Wed Jul 18, 05:25:00 PM, Blogger #1 Dinosaur said...

FredR: If you want to start a poll (not "pole") then please do so on your own blog.

 
At Sat Sep 15, 05:33:00 PM, Anonymous Anonymous said...

I don't know what's wrong with being an "altie", whatever that is, but this debate is framed the wrong way up, beginning with circumcision as the norm, and not the foreskin. Most of the world's men have all the penis they were born with and the vast majority wouldn't have it any other way. (And not through ignorance; the rest of the English-speaking world tried circumcision and gave it up.) It's the case for cutting any of it off that has to be proved up to the hilt. Secular circumcision was introduced without scientific justification and has locked itself into position through conformity, habit and the unwillingness of cut men to admit that they are missing out on anything. Marginal reductions in this or that disease don't justify pre-emptive surgery, especially not on non-consenting newborns. We don't allow that on any other part of his body, men would yell blue murder if anyone suddenly started to circumcise them, and (I risk erasure, but here goes) even the most trivial and surgically aseptic cutting of baby girls' genitals is utterly outlawed throughout the western world, without any exception for religion or culture, (but only pressing medical need). Regardless of what you call it or what they do in Africa, the double standard is palpable.

See www.circumstitions.com

 
At Fri Sep 28, 12:40:00 PM, Anonymous Anonymous said...

I can't be the only one whose penile shaft is half covered with scar tissue instead of skin. There must be thousands of seriously damaged men in the US. Clark Bartram is flippant about his 'circs', but his knife is not immune from statistics. I knew the scar tissue was wrong when I was little, but it wasn't until I was 35 that I saw an intact penis. My blood just boils at what was done to me without my consent.

 
At Tue Dec 18, 12:52:00 AM, Anonymous Anonymous said...

Questioning Circumcision

http://www.intactivist.org/

Jen

 
At Thu Sep 18, 07:34:00 PM, Anonymous Anonymous said...

The emotional controversy about neonatal circumcision exists largely because of people who insist that it's their right to amputate normal sexual tissue from non-consenting minors. If doctors and parents weren't cutting off penile parts, there would be no outcry. Adults can get circumcised anytime to their own specification, yet few intact males choose circumcision, either for medical or psychological reasons.

Most circumcised men don't care about this issue, and even fewer intact men care (why should they?)

But what about men whose neonatal circumcision caused serious damage? Using statistics provided by circumcisers, there must be thousands of men in the U.S. whose circumcisions amount to genital mutilation, but these are washed away with soothing numbers like "0.04%"

The African HIV studies are being misused by circumcisers in the U.S. to promote neonatal circumcision. But an honest synopsis of these studies is this:

"Sexually promiscuous African men, when circumcised, acquired HIV from infected women at about half the rate of men with a whole penis."

Circumcision does not stop HIV infection, and this study was only conducted for two years. So, half those circumcised men who lucked out the first two years will get infected in the next two years. If you have unprotected sex with infected partners, you can count on getting infected, and circumcision will not save you.

 
At Fri Feb 13, 01:59:00 AM, Anonymous Anonymous said...

You're brave!
I'm too scared to go near "intactivists" they are aggresive and brutal, and generally simply anti-religion and pro-sex and base their opinions on the reduction of sensitivity to the penis rather than penile health and overall welness.

 

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