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The Ethics of Neonatal Circumcision

November 6, 2009

The last couple months have seen a flurry of reports in the media (particularly American media) regarding male circumcision and its potential health benefits. However, most of the coverage in the U.S. of male circumcision fails to discuss what I think is the most important issue, the ethics.

Before continuing, though, it is critical to discriminate between the significantly different situations under which circumcision may occur. These include therapeutic and non-therapeutic circumcisions performed on either consenting or non-consenting individuals. A therapeutic circumcision is one which is performed to treat a disease or disorder; a non-therapeutic circumcisions are those done for any other reason. Unless noted otherwise, I am only focusing on non-therapeutic, non-consensual circumcision since it’s the kind most often practiced, particularly in the United States where in my opinion the circumcision debates seem to leave out the most important question, is neonatal circumcision ethical?

One of the primary ideas that has evolved in Western law and medical ethics is the strong support of personal autonomy. Although the notions of personal autonomy developed their roots centuries ago, it has only been in the last 40 years that those ideals have made their way into the routine practice of medicine and the doctor-patient relationship. The ideas of personal autonomy have transformed the doctor-patient relationship from a paternalistic, “The doctor knows best,” model to a situation where doctors and patients work together, the patient is fully informed, and consent of the patient for treatment is obtained in all but a few, very specific circumstances such as immediate medical need.

This works well except where proxy consent is required, such as when the patient is incompetent or otherwise unable to make their own decisions (e.g. a child). In these situations, it is necessary that a proxy provide consent, but it is also necessary that other considerations be introduced into the discussion. It is necessary, for example, to examine on what basis we grant that power to make a decision for someone else and determine the additional safeguards necessary to insure that the patient gets the attention and treatment they need. There are objective limits to those powers and it’s important that these decisions made are ethical thus ensuring the best interest of the patients are maintained.

These questions have been addressed by both professional groups and ethicists. The American Academy of Pediatrics (AAP) Committee on Bioethics, for example, said in their 1995 report, Informed Consent, Parental Permission, and Assent in Pediatric Practice, that, “Parents and physicians should not exclude children and adolescents from decision-making without persuasive reasons.” The Academy goes on to say:

Such providers have legal and ethical duties to their child patients to render competent medical care based on what the patient needs, not what someone else expresses. Although impasses regarding the interests of minors and the expressed wishes of their parents or guardians are rare, the pediatrician’s responsibilities to his or her patient exist independent of parental desires or proxy consent. (emphasis added)

That is the objective needs of the child patient must be the primary focus, not the subjective preferences of his or her parents. In the context of this doctor/child/parent relationship, the doctor’s responsibility to assess the objective needs of his child patient and then present options to the child’s parents. The child’s parents can then assess those options, and using proxy consent, select what they believe is in the ‘best interest’ of the child. Indeed, the British Medical Association discussed this in, The Law and Ethics of Male Circumcision – Guidance for Doctors, where they noted:

Unnecessarily invasive procedures should not be used where alternative, less invasive techniques, are equally efficient and available. It is important that doctors keep up to date and ensure that any decisions to undertake an invasive procedure are based on the best available evidence. Therefore, to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate.

Dr. Margaret Somerville, a prominent medical ethicist at McGill University, noted in discussing circumcision that, “A medical-benefits or ‘therapeutic’ justification requires that overall the medical benefits should outweigh the risks and harms of the procedure required to obtain them, that this procedure is the only reasonable way to obtain these benefits, and that these benefits are necessary to the well-being of the child.” Does circumcision in the neonatal period:

  1. Provide benefits that exceed the risks and harms of the procedure?
  2. Provide benefits that can not reasonably be realized in some other way?
  3. Provide benefits that are necessary to the welfare of the child?

All taken together, it seems clear that from an ethical point of view, necessary qualifiers to proxy consent include objective need and utilizing proxy consent in such a way that it preserves the personal autonomy of an individual where it is practically possible. That is to say that in the case of neonatal circumcision (or any intervention performed via proxy consent), there should be an objective need and the least invasive means should be favored. If there is no objective clinical need, one cannot say that neonatal circumcision is therapeutic. And if circumcision is not therapeutic then as a medical practice, it can’t be ethical to perform.

Of all the common purported benefits, the only one relevant to an infant is a supposed reduced risk of urinary tract infection in the first year of life. An estimate by the Royal Australasian College of Physicians (RACP) shows that at least 144 circumcisions would be required to prevent one treatable UTI in the first year of life. Chronic renal disease, the more worrisome condition, occurs far less frequently, and is typically the result of abnormalities of the urinary tract. A recently written editorial to the Sydney Morning Herald by Dr. David Forbes, chairman of pediatrics and child health policy and advocacy committee for the RACP, touched on UTIs as they relate to circumcision, noting: “Our changing understanding of the relationship between urinary tract infection and chronic renal disease further weakens the case for routine circumcision.” Considering that UTIs are both rare in boys and treatable, it is difficult to see how such a benefit can justify circumcision in the neonatal period.

Perhaps this is why doctors in the U.S. have shifted their focus to STIs. However, the story here isn’t much different. Setting aside the fact that infants and children don’t need such protection, most large-scale cross-sectional studies (here, here, here, and here) have found little, if any, evidence to support the notion that circumcision is especially effective as a prophylaxis against STIs in first world countries. In fact, data derived from the same studies that have been used to demonstrated a benefit against HIV and HPV also showed no significant benefit against syphilis, gonorrhea, chlamydia, or trichomonas, each of which is treatable.

Of primary recent focus has been HIV and HPV; though, information regarding these two STIs are almost always reported without the appropriate context. For example, when discussing HPV, it is rare to note how common HPV infection is, how rare HPV related cancers are in men, the fact that of the approximately 11,000 cases of cervical cancer diagnosed in the US, over half haven’t ever had a Pap smear and up to 10% haven’t had a Pap smear in more than five years. The Pap test by itself has reduced incidence of cervical cancers by over 75% since its introduction and the incidence continues to be reduced at rate of about 4% per year; perhaps most importantly, there are now not just one but two vaccines available (one that is also available for men) which are in excess of 90% effective against the types of HPV responsible for most of these types of cancers.

The recent news about a potential HIV benefit tends to also exclude context. For example, it isn’t typically made clear that the purported benefit only affect female to male transmission which is by far the least common mode of sexual transmission in most countries outside parts of Africa. A rough estimate suggests that heterosexual American males who are not IV drug users have a lifetime chance of contracting HIV on the order of hundredths of a percent. The Australian Federation of AIDS Organization, in response to an article by Alex Wodak promoting neonatal circumcision, recently put the figure on the lifetime risk of HIV infection in a heterosexual Australian male who doesn’t use IV drugs at 0.02%, noting that, “This very low risk means that the population health benefit of an intervention like generalized circumcision programs would be negligible.” It is difficult to fathom routine infant circumcision on the basis that it might reduce the typical man’s lifetime risk of HIV infection by a few hundredths of a percent. If a male values this minor reduction, he is of course able to choose non-therapeutic circumcision for himself as an adult when the ethical complication involved in proxy consent no longer apply.

The potential benefits that American parents cite when justifying infant circumcision pertain to maladies that can be prevented with less invasive, more effective, methods or can be easily treated should they occur. As exemplified above with respect to HIV, the actual risks faced by males that can be reduced by circumcision are quite low. Whether or not the potential benefits cited are sufficient to justify an irreversible, non-indicated intervention can only be adequately evaluated against the associated risks of surgery using the subjective preferences of the individual affected by the circumcision. Were we were innocent of infant circumcision, it is difficult to believe that such a procedure would gain any support for regular use given what is known today. The lack of clear objective medical need makes routine infant circumcision simply unethical.

Joseph Peterson (Washington, D.C.) has only relatively recently become involved in this issue due mainly to what seems to be significant amount of misinformation American parents have about intact boys as well as the fact that, outside some very specific circumstances, he firmly believes that circumcision is a personal decision that can only be made by the individual. Joe is one of many regular contributors to the Case Against Circumcision forum at Mothering.com as ‘Fellow Traveler’ to provide parents with the information they need to say no to circumcision and later protect their intact boys. Joe is willing to refer or provide similar information to parents at GAB through the comments or by email: fellowtraveler@comcast.net, or through the CAC forum.

This article is apart of GAB’s Circumcision Series.

62 Comments
  1. November 6, 2009 11:09 am

    Parents would do well to ignore this article.

    As I was reading this all I could think of was ‘wow, what a lopsided & biased article’. It wasn’t until I read the last paragraph that it all made sense – the author is fanatically anti-circumcision.

    Reading back over the article the bias should have been more apparent. There were little to no references to the well-understood rule of parental responsibility in regards to infant/child health care. That is – parents have a choice for health care for their child. Parents should research medical care and make the best informed choice for their child.

    Also, providing links to well-known anti-circumcision websites (doctorsopposingcircumcision & cirp) for studies only shows the intent to provide biased information.

    Let us hope that the rest of the GAB series on male circumcision are more evenly balanced with the presentation and information provided.

    • November 6, 2009 12:13 pm

      Yes, parents are supposed to make medical decisions for their children but I think that people too often mistake this as meaning that children are parental property. The procedure is invasive and unnecessary and permanently alters the most private parts of the child’s body without his consent. I don’t understand how parents who supposedly love their children think that they have a right to alter their child’s genitals for their personal preferences or religious beliefs. You can’t have love without respect.

    • November 7, 2009 11:36 am

      Typically @Circinfo falls back on ad hominem attacks rather than actually attempting to refute any of Joseph’s arguments here.

      For someone who links regularly to Schoen and Morris and considers them objective sources of information, he doesn’t know a whole lot about what is biased and what is not. On Twitter @Circinfo linked to an article written by Morris which basically provides the other side to this argument. I’m going to write a rebuttal of this when I have time.

  2. November 6, 2009 11:46 am

    Circ Info:

    “… There were little to no references to the well-understood rule of parental responsibility in regards to infant/child health care. That is – parents have a choice for health care for their child. Parents should research medical care and make the best informed choice for their child.”

    This is detached from the essay’s content. The author clearly acknowledged proxy consent as valid. He then established necessary limits based on medical standards of need. This is the ethical argument. Your objection to that is interesting, but it’s not clear why you believe your approach is superior. Simply shouting down an alternate view to the unquestioned, undefended status quo isn’t convincing debate.

  3. November 6, 2009 12:16 pm

    More needs to be written about the ethical considerations of routine infant circumcision and maintaining genital integrity of all infants and children. The above commenter, Circ Info, who is fanatically pro-circ based on his Twitter presence, emphasizes parental choice. But, three people are involved. In addition to the parents, there is the child, who will grow up to be a man. Doesn’t the future man have the right to genital integrity?

    One point about the possible reduction of STD’s in circumcised men that needs to be made is that infants are not sexually active. Any prophylactic effect of circumcision will not come into play until the infant becomes sexually active, which will be many years after his birth. To take such drastic measures as to circumcise an infant for a potential decrease in STD risk ignores the possibility of a vaccine or cure for those STDs being developed in the intervening years. It also ignores that the person may practice safe sex and have almost no risk of acquiring an STD. After all, even the advocates of circumcision for HIV reduction admit that a condom should still be used.

    I will admit that I am a strong pro-intact advocate. I was circumcised at birth and I wish that the decision to surgically alter my genitals had been left to me. I would have chosen to remain intact. I am restoring my foreskin and I have first hand knowledge of what I have lost by being circumcised. See http://www.RestoringForeskin.org Let the adult man decide what happens to his own genitals.

    • November 6, 2009 1:24 pm

      Your argument regarding:

      One point about the possible reduction of STD’s in circumcised men that needs to be made is that infants are not sexually active. Any prophylactic effect of circumcision will not come into play until the infant becomes sexually active, which will be many years after his birth. To take such drastic measures as to circumcise an infant for a potential decrease in STD risk ignores the possibility of a vaccine or cure for those STDs being developed in the intervening years.

      I want to first point out that a man whose parents want him to “choose” whether or not get circumcised when he is older proves might be problematic: that man who chooses to get circumcised when he is an adult will experience more pain and possibly sexual dysfunction after the procedure than as an infant. Also, this is similar to the HPV debate and giving vaccinations to young women before they are sexually active. The early you can reduce the risk and do it before the child becomes sexually active, the better the results (in regards to protecting against HIV).

      Also, no one is referring to the fact that the majority of men in the U.S. are circumcised, and might come under scrutiny in the bedroom by women/men they are sleeping with, who are accustomed to circumcised penises? While I know that is no justification for getting circumcised, I believe that many circumcised men choose to circumcise their infant boys because that’s what their used to. Ethics aside, this is an interesting issue to address.

      • November 6, 2009 2:09 pm

        Emily:

        “… Ethics aside, this is an interesting issue to address.”

        You can’t leave ethics aside when discussing parents circumcising their (healthy) son to satisfy their expectation of his future partner’s preference.

        Parents cannot know what his partner(s) will prefer. If they could know, it would not matter because it’s his body. They cannot know what he will want, or whether he will accept a partner who demands he change his normal body. Circumcising removes his choice, which is the ethical question.

        Would we excuse parents forcing breast implants on their daughters because they perceive her future partners will prefer women with larger breasts? Of course not. The ethical issue is no different just because women today generally adhere to a norm. Sexuality is unique and specific to each person. Cultural circumcision can’t be justified ethically.

        As for weighing the pain and risk of adult circumcision, that is a decision for the individual male. If he values circumcision more (for HIV risk reduction, for example), he can choose it. If he values avoiding pain and risk more, he can choose to keep his foreskin. The issue is need, not mitigating factors involved with when the elective procedure is performed.

      • November 6, 2009 2:33 pm

        Obviously ethics are important part of the circumcision discussion—and I’m not discounting that. However, what I meant to say was that focusing on the health risks is an important matter, which seems to be left out of the discussion of ethics.

        You’re right; cultural circumcision can’t be justified ethically. Just in sharing what I know about the minority of men in the U.S. who are uncircumcised, I’m wondering if they feel scrutinized by women and/or society who are used to circumcised penises.

        While you pose an interesting question about breast implants and daughters, you cannot compare the two. First of all, not having breast implants does not protect against HIV (which circumcision does). Second of all, getting breast implants before breast growth is a moot point.

        Finally, while I’m all for personal autonomy (hence being a feminist), I’m also for protecting one’s health. Think about this question: should parents choose to opt out of getting vaccinations for their child, because the child cannot give consent, and hence wait until they are older?

      • Pat88 permalink
        November 6, 2009 3:36 pm

        I find funny people who are pro-circ and claim to protect their child’s health. They forget to mention that this procedure has also risks and the potential benefits are very small. The only benefits for a child are UTIs but UTIs are rare among boys and can be treated easily. Vaccines are different, they don’t amputate any part of body and are designed to protect children, most medical organizations strongly support vaccination despite there’s a lot of controversy about it. Considering there’s not even one medical organization in the world that supports routine circumcision, just imagine how useless this procedure is. Also, foreskin isn’t a useless piece of skin, it’s natural and erogenous tissues with 20,000 nerve endings. The glans is supposed to be internal organ. The penis is designed to work with a foreskin, it defies logic to claim it’s better for the child to be circumcised. How do they know ? Most parents supporting circumcision have never seen an intact penis in their entire life. Circumcision decreases sexual pleasure for the future man. African people supporting female circumcision use the same arguments : hygiene, “looks better”, culture etc…

        Circumcision has always been a cure searching for a disease, most of the time the most feared diseases of the day. It used to be masturbation, mental illness, cancer, hygiene, syphilis etc…(most of them have been debunked btw)and now HIV. USA has both the highest rate of circumcision and HIV among industrialized countries. After 200 years of pseudo scientifc reasons to support this procedure, parents should realize it doesn’t serve any purpose. It’s just cosmetic surgery.

        However, if a man wants to be circumcised later in life because he thinks it looks better or thinks it will protect him for STDs or whatever…good for him, he can have the procedure done. But performing circumcision on babies because most most men would refuse it when they are adults doesn’t seem ethical. Not to mention, there is zero evidence that it’s more painful for an adult, instead it’s quite the opposite for many reasons : it is performed under general anesthesia (so they don’t feel anything, it’s just uncomfortable ), the foreskin is already detached from the glans, the foresin is bigger so the procedure can be done with greater precision etc…

      • November 6, 2009 5:44 pm

        Emily:

        I don’t think health risks are left out of the ethical discussion. Having a foreskin involves risk, but so does having any normal human body part.  I’m sure the human mind can come up with other interventions to reduce life’s risks for children that we’d immediately and rightly dismiss as draconian if proposed today.  I have no doubt that infant male circumcision would be viewed this way if it didn’t already have a non-medicalized history.

        Personal autonomy and personal health are not mutually exclusive.  For every risk of the normal foreskin, prevention and/or treatment options exist that are both more effective and less invasive than circumcision. You mention HIV, to which I respond “condoms.”  And circumcision can still be an option for men to reduce their HIV risk, but as adult volunteers, which is what the African studies involved.

        The proper context for discussing risk is often ignored, too.  Circumcision reduces the risk of female-to-male HIV transmission by ~60%.  That is hardly impressive when considering that the actual risk (in Western nations) of female-to-male transmission is a very small percentage.  For UTIs, it’s interesting to point out that infant circumcision reduces the risk in the first year by a factor of 10 , but when the risk for intact males is only 1%, going to .1% is hardly compelling.  The risk for infant girls in the first year is roughly 3%, yet less invasive methods are sufficient.  There’s a reason the numbers are discussed as they are, rather than discussing the actual risk to any individual male.

        I’ve thought about vaccines as compared to circumcision. There are similarities for proxy consent, but there are important differences.  Vaccines are generally the most effective/least invasive method of addressing the risk involved. And the risk is generally something that I’d consider passive. I’d have a hard time avoiding measles, for example, if I hadn’t been vaccinated.  But vaccination doesn’t remove a healthy, functional body part, and better options don’t exist to address risks, unlike risks associated with the normal foreskin.

        I think the breast implant comparison is valid.  Obviously you’ve restated your scenario a bit, but my point is about the type of thinking involved, not potential benefits or when it’s done.  Parents deciding to force breasts implants on their daughter is the same prioritization of their opinion on the sexual aestethics as your scenario, as originally stated.  Given that many parents inarguably circumcise their sons based on their own aesthetic sexual preference, and this is viewed as acceptable under the guise of making a decision “that is right for their family,” there’s no difference.  Ethically, they’re both the same violation of the child’s body and rights.

        Ultimately society’s discussion in favor of infant circumcision for potential health benefits narrows to some combination of “because we can” and “because it’s culturally acceptable.”  It’s starting with the conclusion that matches current practice and working backwards to justifications.  That ignores the proper ethics of proxy consent, which must require actual need for surgical intervention, not merely the right mix of preferences and risk aversion by the parents, as implied in the first comment by Circ Info.

      • November 7, 2009 1:39 am

        THERE IS ZERO EVIDENCE THAT INFANT CIRCUMCISION PREVENTS AIDS. The evidence that adult voluntary circumcision protects Africans is weak. The researchers announced in August that the HIV+ men they cut were 50% MORE likely to transmit HIV to their partners than the HIV+ men they left intact were. Pre-sexual African boys were found MORE LIKELY to already have HIV if they had been circumcised.

        Most of the US men who have died of AIDS were circumcised at birth. The deceased US AIDS victims have the same cut/intact ratio as the general population.

        But getting back to infants – THEY DON’T HAVE SEX. There is nothing infant circumcision is alleged to prevent that can’t be treated without amputation until such time as the boy can decide for himself how much pleasure-receptive tissue to keep. For example, girls get far more UTI than even the highest estimate of an intact boys’ rate, but we treat girls’ infections not with amputation, but with antibiotics. The AAP notes that the high rate of boys’ infections turned out to be due to the incorrect practice of forcibly retracting the foreskin to clean, by the way. The AAP now says LEAVE IT ALONE.

      • November 9, 2009 2:20 pm

        “Just in sharing what I know about the minority of men in the U.S. who are uncircumcised, I’m wondering if they feel scrutinized by women and/or society who are used to circumcised penises.”

        Emily, I often defer to women in matters of the flesh and of the heart. And I’ve often been deeply moved by the common sense women bring to bear on matters sexual. But one subject where being a woman is a major handicap is knowing what it’s like to have nonconforming male genitals.

        Let me attempt an analogy. To have been a white middle class intact Baby Boomer before intactivist writings began to appear around 1980, was like being a woman with large and long inner lips who is very self-conscious about it because she insists on trimming or shaving her pubic hair. Such women are sometimes convinced that the outlines of their inner lips are on display at beach and pool. I have a very dirty mind, and I have never seen this.

        Every year, thousands of adult women in advanced countries undergo plastic surgery on their vulvas because they are ashamed of how they look. This is not only very weird sexually, but also tragic. What women should take from internet erotica is a celebration of diversity. Instead, these women form a deplorable notion of what the vulva “should” look like, and believe that they will fail to attract and keep a life partner if their vulvas do not conform to that. Similarly, in the period 1950-80, about 20-25,000 American adult men were circumcised every year. In 80-90% of the cases, no reason was listed on the chart. Investigators surmise that the reason was cosmetic. Not infrequently, the man in question was divorced or widowed and was afraid to date with a foreskin.

        We humans learned to cover our genitals, perhaps because our ancestors learned from harsh experience that failing to do so triggered all sorts of comparisons and insecurities. Cut vs. uncut is far from the worst: that dubious honour goes to breast and penis size!

        Fellow humans, let us grow up and learn accept and celebrate diversity in our intimate parts.

      • November 19, 2009 12:02 pm

        Unvaccinated children are not only at risk of disease but can also can pass on disease to someone else. Should routine neonatal circumcision be thought of as analogous to a vaccination? Many Americans used to think so, in a vague way. If routine circumcision had prophylactic value, comparing medical data from the USA and Europe would reveal it. I have been waiting 25 years for such studies. Studies performed within North America are of much less value, because routine circumcision is strongly correlated with class, and class is strongly correlated with irresponsible behaviour, and such behaviour is strongly correlated with adverse health outcomes.

        Some people are allergic to the chicken eggs or horse serums used to produce certain vaccines. Otherwise, there are no documented side effects from most vaccinations, altho some have been claimed (autism, mercury poisoning, etc.)
        Routine circumcision in practice has occasional tragic side effects. It is also a substantial alteration of a part of the human body directly involved in sexual pleasure.

        Nearly all claimed prophylactic benefits from routine circumcision address problems arising from behaviour that, under traditional sexual ethics, would have been deemed misuse of the penis. Penetrative sex between men should ALWAYS be with a condom. Casual sex of any kind should ALWAYS be with a condom. I also wonder if the risks of HIV and HPV would be substantially reduced if men would simply wash their penises before and after sex. My wife and I never have sex unless a bath is close at hand. To circumcise simply in order to reduce the risks to health from groping in the back seat of a car while parked in a lover’s lane is to ridiculous for words.

      • Frank OHara permalink
        November 22, 2009 2:58 pm

        RD wrote: “Studies performed within North America are of much less value, because routine circumcision is strongly correlated with class, and class is strongly correlated with irresponsible behaviour,”

        This is no longer true. In the early part of the 20th century, blacks normally were not circumcised. This lead doctors to admonish “You don’t want to be like them, do you?” However, by the mid 20th century, that distinction virtually disappeared and the black circumciison rate was only slightly behind whites (about 6%). But, when the Medicaid program was instituted in the mid 1960’s, the black circumcision rate raced ahead of whites and now, blacks represent the highest circumcision rate of all demographic groups.

        Circumcision promoters realized that most people were working on long obsolete information continued to work the information but with the advent of the internet, that information became public and that justification no longer held merit. But, being fleet of foot and with a growing Hispanic population that normally does not circumcise, they simply changed their target and continued saying “You don’t want to be like those Hispanics, do you?”

        Other than Hispanics and Asians who do not normally circumcise, there are no longer any demographic differences of any import in The US population.

        .

      • November 22, 2009 4:11 pm

        RD “Studies performed within North America are of much less value, because routine circumcision is strongly correlated with class, and class is strongly correlated with irresponsible behaviour,”

        This is no longer true.

        RD. Do you deny that class is strongly correlated with sexually irresponsible behaviour?? Or that circumcision WAS correlated with class? I freely grant that circumcision may be in transition to being negatively correlated with class.

        In the early part of the 20th century, blacks normally were not circumcised. This led doctors to admonish “You don’t want to be like them, do you?”
        RD. I’ve never read this. Moreover, I am skeptical of your claim here. That black johnsons were often uncut was very little known, because of school segregation, and because blacks were not allowed to participate in white sports.

        However, by the mid 20th century, that distinction virtually disappeared and the black circumciison rate was only slightly behind whites (about 6%). But, when the Medicaid program was instituted in the mid 1960’s, the black circumcision rate raced ahead of whites and now, blacks represent the highest circumcision rate of all demographic groups.
        RD. The black circ rate was definitely lower than the white one, until Medicaid began to routinely cover all childbirths that were not privately insured. The black rate may now exceed the overall white rate, but I doubt it exceeds the rate among babies whose parents grew up in the USA.

        Circumcision promoters realized that most people were working on long obsolete information continued to work the information but with the advent of the internet, that information became public and that justification no longer held merit.
        ME. I warmly agree that intactivism is a grass roots movement that relies crucially on the internet to make its case. Although I should add that the typical USA book for expecting parents now does say there is a strong case against routine circ. These books seldom speak to the sexual advantages of having foreskin though.

        But, being fleet of foot and with a growing Hispanic population that normally does not circumcise, they simply changed their target and continued saying “You don’t want to be like those Hispanics, do you?”
        RD. I doubt it. That sort of talk would rightly be dismissed as trashy and bigotted.

        Other than Hispanics and Asians who do not normally circumcise, there are no longer any demographic differences of any import in the US population.
        RD. We agree that this topic needs more data collection. That granted, I beg to differ. First, Hispanics and Asians are not demographically trivial. Another major foreskin friendly demographic is simply being born west of the continental divide.

        Intact is much higher in states where Medicaid no longer pays for cutting.

        A handful of day care and kindie teachers have posted here and there on the net about this tender topic. They say that a lot more boys are uncut nowadays, especially among the children of intellectuals and other highly educated professionals. I would not be surprised if an emerging intact demographic is “Having parents who both went to grad school.” Another demographic is having a mother who is enthusiastic about breastfeeding and natural childbirth. Nearly all such mothers are now foreskin-friendly.

        In my personal life, I have noticed that mothers can be strongly influenced by the opinions of their adult brothers. That said, my sister has never broached this tender subject with me!

      • Frank OHara permalink
        November 23, 2009 11:55 am

        RD wrote: “Do you deny that class is strongly correlated with sexually irresponsible behaviour?? Or that circumcision WAS correlated with class?”

        I don’t agree that sexually irresponsible behavior is associated with class. The sexual freedom movement was incubated on college campuses. In my experience in an upper class environment, I see a lot of sexual irresponsibility. It runs the gamut and is both males and females.

        Circumcision was once strongly associated with class and I have no doubt there are vestiges of classism left. That association really no longer exists. Before 1973 when a Jewish family sued the doctor and hospital that circumcised their son without permission denying them the ritual bris, it was common for doctors to circumcise boys even against the implicit instructions of the parents not to. This happened in my family. The primary deciding factor appeared to be the physician’s evaluation of whether the family had the financial means to pay the bill. This appears to be the reason black boys were circumcised at a lower rate before Medicaid. Of course, after Medicaid, they got paid for all they did regardless of the parents ability to pay.

        RD wrote: “I freely grant that circumcision may be in transition to being negatively correlated with class.”

        There is a movement in the transition but it is difficult to tell where the movement is going. Edgar Schoen, a radical proponent has tried to establish a connection with Hispanics and intactness but it doesn’t seem to be going anywhere. There are some who are attempting to bear his flag but it appears they are going nowhere with it.

        In fact, immigrant populations are the showing the largest increases in the neonatal circumcision rate with Hispanics up more than 300% and those from India showing a 800% increase. It is apparent they are being solicited by someone. The most likely candidate is physicians.

        RD wrote: “I’ve never read this. Moreover, I am skeptical of your claim here. That black johnsons were often uncut was very little known, because of school segregation, and because blacks were not allowed to participate in white sports.”

        Believe me! I come from an area with a relatively large black population.

        RD wrote: “The black rate may now exceed the overall white rate, but I doubt it exceeds the rate among babies whose parents grew up in the USA.”

        My figures come from The Centers for Disease Control/National Center for Health Statistics. Blacks have been the most circumcised demographic group for decades thanks to Medicaid.

        RD wrote: “I doubt it. That sort of talk would rightly be dismissed as trashy and bigotted.”

        I agree that it is trashy and bigoted but I have the testimony of a number of mothers who were told this. Of course there is less of this now and my accounts were 8 or 10 years ago. Doctors now realize this is a contentious issue and that many of their mother patients are intactivists or are familiar with the debate. They have to be careful not to offend their clientele. The father just may be Hispanic or Asian.

        RD wrote: “We agree that this topic needs more data collection. That granted, I beg to differ. First, Hispanics and Asians are not demographically trivial. Another major foreskin friendly demographic is simply being born west of the continental divide.”

        Yes, The CDC does not include any demographic groups other than blacks and whites in their data collection. This is a hold over from the 1960’s.

        In most parts of the country until relatively recently, there were few if any Hispanics or Asians. In my home town and home county, there were none at all during my school years and for a good while after.

        It is also only true of “west of the continental divide” after 1982 when California became the first state to defund Medicaid neonatal routine circumcision. After that, the infant circumcision rate dropped dramatically and eventually spread to all the west coast states.

        RD wrote: “Intact is much higher in states where Medicaid no longer pays for cutting.”

        Yes, it has been common for the circumcision rate to drop about 20 percentage points the first year after it is defunded. In a conversation with David Llewellyn, the premiere circumcision plaintiff attorney in the country about 8 years ago, he warned that this could establish classism into the issue again but with the internet, I don’t think this will happen.

        RD wrote: “They say that a lot more boys are uncut nowadays, especially among the children of intellectuals and other highly educated professionals. I would not be surprised if an emerging intact demographic is “Having parents who both went to grad school.”

        There is an established link between higher education and higher class status in the last few years and intact babies. This appears to be the result of more free time to research and the information that is available on the internet. Just the existence of intact boys in a community will cause expectant parents to investigate the issue. That highly educated and positioned parents are eschewing it has the effect of establishing a fad for others to emulate. This is after all how it became established in the first place outside the Jewish community. Boys of urban parents were born in hospitals and were circumcised. Boys born of farm families were home birthed and often it was weeks or months after their birth before they were taken to a doctor. By that time, it was too late or the parents realized there was no reason for surgery.

        RD wrote: “Another demographic is having a mother who is enthusiastic about breastfeeding and natural childbirth. Nearly all such mothers are now foreskin-friendly.”

        Yes, they have taken it up with gusto! They are most likely to evaluate all aspects of the birth process and research everything. With this research, it quickly becomes evident there is no reason to do it.

        .

      • November 23, 2009 4:44 pm

        I don’t agree that sexually irresponsible behavior is associated with class. The sexual freedom movement was incubated on college campuses. In my experience in an upper class environment, I see a lot of sexual irresponsibility. It runs the gamut and is both males and females.

        RD. Here we deeply disagree. The sexual revolution did begin in the 1960s, in elite universities, and rapidly spread from there. It soon reached the underclass, where it has done serious damage for a generation. But the nice kids from the suburbs have since moderated their act. The upshot is that today, in the USA, UK, and Australasia, irresponsible sexual behaviour is most definitely positively correlated with socioeconomic deprivation.

        Where I live, getting drunk at parties and waking up the next day, not knowing what one did sexually, is declasse behaviour. Getting an abortion after such behaviour, ditto. Coming down with an STD, ditto. Growing up comfortable, attending a good high school, doing university degrees, and pursuing a white collar career, are all very much correlated with fewer problems on the sexual front. What I say here greatly complicates epidemiological studies of circumcision. Circumcision has been linked to middle class upbringing, and such upbringings are linked with fewer STDs, more condom use, and better hygiene.

        Circumcision was once strongly associated with class and I have no doubt there are vestiges of classism left. That association really no longer exists. Before 1973 when a Jewish family sued the doctor and hospital that circumcised their son without permission denying them the ritual bris, it was common for doctors to circumcise boys even against the implicit instructions of the parents not to. This happened in my family.

        RD. When my mother gave birth to my younger brother in 1954, she was not asked whether she wanted him circumcised, which was done. That is why my brother and I are different.

        The primary deciding factor appeared to be the physician’s evaluation of whether the family had the financial means to pay the bill. This appears to be the reason black boys were circumcised at a lower rate before Medicaid. Of course, after Medicaid, they got paid for all they did regardless of the parents ability to pay.

        RD. This could well have been the case.

        Edgar Schoen, a radical proponent has tried to establish a connection with Hispanics and intactness but it doesn’t seem to be going anywhere.

        RD. What?? The Hispanic coolness to routine circumcision is well documented!

        http://www.cirp.org/library/statistics/USA/state-by-state/

        In fact, immigrant populations are the showing the largest increases in the neonatal circumcision rate with Hispanics up more than 300% and those from India showing a 800% increase. It is apparent they are being solicited by someone. The most likely candidate is physicians.

        RD. These percentages are huge because the starting values are so tiny. I have never seen nor heard of this before. That said, Indians in the USA have great respect for American medicine and doctors. The mere fact that X is standard procedure in USA hospitals elicits great respect for X. They are also keen to see their children assimilate into the American mainstream. When I tell my Indian friends that the Europeans and the Japanese do not circumcise, they go into cognitive dissonance! If what you say is true, it reveals that Hispanic and Indian mothers are susceptible to the message that the preputial sack is foul.

        RD wrote: “I’ve never read this. Moreover, I am skeptical of your claim here. That black johnsons were often uncut was very little known, because of school segregation, and because blacks were not allowed to participate in white sports.”

        Believe me! I come from an area with a relatively large black population.
        RD. The same is true of me.

        RD wrote: “The black rate may now exceed the overall white rate, but I doubt it exceeds the rate among babies whose parents grew up in the USA.”

        My figures come from The Centers for Disease Control/National Center for Health Statistics. Blacks have been the most circumcised demographic group for decades thanks to Medicaid.

        RD. See the link I posted above.

        Doctors and nurse have to be careful not to offend their clientele.

        RD. Here we agree.
        Incidentally, a Ohio intactivist told me that when she gave birth to her first son early this decade in a university teaching hospital, neonatal circumcision was simply not mentioned. It simply wasn’t an option. When she gave birth to son #2 in a conventional suburban hospital in the same city, she had to put her foot down firmly to protect her son’s foreskin. Universities are filled with foreign born academics and PhD students. University hospitals accept the foreskin. In suburban life, an uncut dick remains a Weird Dick.

        In most parts of the country until relatively recently, there were few if any Hispanics or Asians. In my home town and home county, there were none at all during my school years and for a good while after.

        RD. Hispanics and Asian immigrants are now almost everywhere, and are not demographically trivial. These facts have contributed materially to the declining circ rate.

        It is also only true of “west of the continental divide” after 1982

        RD. I know that, and was only talking of the post 1980 experience.

        There is an established link between higher education and higher class status in the last few years and intact babies.

        RD. I only conjectured this. Do you have data?

        Just the existence of intact boys in a community will cause expectant parents to investigate the issue. That highly educated and positioned parents are eschewing it has the effect of establishing a fad for others to emulate.

        RD. Here we strongly agree. Imitation of what high status families do is a very powerful motivator. It gradually turned Americans into a circumcised people, 1900-40. Today, the engine works in reverse! I am very very cynical here. All my life, I have heard unguarded remarks by children and adults, revealing that most people are slaves to conformity. Specifically, thou shalt not let a boy have a Weird Dick.

        This is after all how it became established in the first place outside the Jewish community. Boys of urban parents were born in hospitals and were circumcised. Boys born of farm families were home birthed and often it was weeks or months after their birth before they were taken to a doctor. By that time, it was too late or the parents realized there was no reason for surgery.

        RD. We do agree that if a boy exited the maternity ward with his foreskin, it was usually left alone later. Hence rural boys born at home remained intact.

        What boys see at the school urinal, in high school locker rooms, and in Army barracks shapes what they do later as fathers. That boys from comfortable families were circumcised was evident, and led to a strong desire by humbler boys to circumcise their sons. I bet an important way circ spread to rural America was the barracks experience in WWII and Korea.

        The urinals in my primary school made zero accommodation to modesty. The fact that all my school mates but one were circumcised was blatant. I was seen as weird until I learned to skin back before peeing, around age 10 or so. Whereupon I was immediately accepted!! Can’t have a Weird Dick, you know… I bet that Asian immigrant boys have had experiences in USA schools similar to mine. The sons of such boys are at serious risk of being circumcised unless there is outreach and education. I have tried to do that with non-Moslem South Asian families, whjere I have encountered surprising resistance. South Asians have immense respect for USA medicine, and I am not a doctor. I also discovered that South Asian men can be oblivious to the foreskin’s contribution to their sexual pleasure. Hence cutting it off doesn’t dismay them.

      • Frank OHara permalink
        November 20, 2009 10:18 am

        Emily wote: “Obviously ethics are important part of the circumcision discussion—and I’m not discounting that. However, what I meant to say was that focusing on the health risks is an important matter, which seems to be left out of the discussion of ethics.”

        There are no health risks that can’t be addressed by less invasive and less expensive means. In fact, the risks outweigh any potential benefits as stated by The AAP. Those risks include exsanguiation (death by blood loss), infections including potentially deadly MRSA staph infections (flesh eating bacteria), partial penile amputation and
        death.

        “You’re right; cultural circumcision can’t be justified ethically. Just in sharing what I know about the minority of men in the U.S. who are uncircumcised, I’m wondering if they feel scrutinized by women and/or society who are used to circumcised penises.”

        This may be a factor for adult men but with only slightly over half of infants being circumcised now, this will not be an issue.

        While you pose an interesting question about breast implants and daughters, you cannot compare the two. First of all, not having breast implants does not protect against HIV (which circumcision does).”

        Apparently you don’t read before you post. I have clearly illustrated that male circumcision has no effect on HIV transmission above.

        “Finally, while I’m all for personal autonomy (hence being a feminist), I’m also for protecting one’s health. Think about this question: should parents choose to opt out of getting vaccinations for their child, because the child cannot give consent, and hence wait until they are older?”

        This is a common argument proposed by advocates and fails every time. The health benefits simply do not exist. Vaccinations are minimally invasive and all show decidedly important benefits that outweigh the risks both to the individual and to society at large. This is simply not true of infant male circumcision.

        .

      • November 6, 2009 3:35 pm

        With respect to adults experiencing pain from a circumcision, I note that the first world countries manage pain very well for surgeries. Anesthesia is commonly used for all surgical procedures for adults, which is more than can be said for routine infant circumcisions. Far too many infants are circumcised with little or no anesthesia. The most common pain relief offered to infants during their circumcision is a sucrose solution (sugar water).

        The assertion that an adult will experience more sexual dysfunction after the procedure than as an infant is unsupported. There are many studies documenting adult circumcisions and none identify any significant amount of sexual dysfunction after adult circumcision.

  4. Joseph Peterson permalink
    November 6, 2009 6:14 pm

    Emily brought up a analogy to vaccinations which is very common to do in a discussion on this subject. The fact is though there is a chasm of difference between circumcision and vaccinations.

    From the SMH article I referenced, David Forbes notes, “The procedure is not to be equated with vaccination, either in its delivery or its effectiveness.” These are two very important points, considering effectiveness, vaccines that are given as a matter of routine (or even suggested) typically have efficiencies in excess of 90% and they are so efficient that they reduce the incidence of diseases they protect against from endemic/epidemic levels to spectacularly rare levels. Taking Tony’s Measles example, before the vaccine was available the US saw perhaps 500,000 case per year whereas now there are less than 100 cases a year in the US (typically far less) and they’re almost always in children or adults who haven’t been vaccinated. In some cases (such as small pox) vaccines are responsible for rendering the disease extinct in the wild. Further, as Tony pointed out, to the best of my knowledge there is no other reasonable way to protect against Measles, Polio or other diseases we vaccinate for and children are at immediate risk for those disease. Delivery wise, a vaccine is far less invasive. So it’s difficult to see how this analogy can stand scrutiny.

  5. Joseph Peterson permalink
    November 6, 2009 6:35 pm

    The front page of this series gave me the idea that I should have also included a prevalence map. Well here it is for infant circumcision for those interested:

    http://www.circumstitions.com/Maps.html

  6. Pat permalink
    November 6, 2009 8:24 pm

    I’ve always though the issue of consent or personal autonomy was a weak academic argument against circumcision. In the US, how many doctors actually care about this when it comes to babies? All they see is another routine hospital procedure that, as it turns out, is profitable. Isn’t our managed healthcare system wonderful?

    How about discussing the ethics of unnecessarily inflicting pain on children? There are hospitals in the US that still circumcise without using any sort of analgesia, and even if they do the kid is left in a lot of pain after it wears off… and then of course he’s left with the most sensitive part of his penis exposed to the open air and friction from clothing for the rest of his life.

    • November 19, 2009 11:37 am

      I’ve always though the issue of consent or personal autonomy was a weak academic argument against circumcision. In the US, how many doctors actually care about this when it comes to babies?
      ME. They don’t, because of the widespread belief that parents have a right to decide what is medically and hygienically best for a child. It is very curious that Europe and Japan have never seen routine circ as being in a child’s best interest. The UK, Canada, Australia, and New Zealand did, but changed their minds. The USA is alone here, with its cultural colony South Korea.

      All they see is another routine hospital procedure that, as it turns out, is profitable. Isn’t our managed healthcare system wonderful?
      ME. I compare routine neonatal circumcision to the whitewall tire option popular when I was a boy. A “whitewall” was on inch-wide white stripe on the outer side of a tire. You had to pay, say, 5% more to get whitewalls. But it was widely reported in consumer magazines that the added cost of making a whitewall tire was, say, a mere 25 cents. The fashion for whitewalls added substantially to the pure profit of making and selling tires. A circumcised penis is like the white stripe on a tire: a reliable source of extra money for hospitals and doctors.

      How about discussing the ethics of unnecessarily inflicting pain on children?
      ME. The circumcisionists now concede that good practice requires a prior injection of lidocaine. But it still isn’t standard practice, and this is very deplorabl. I fear that American medicine has been unconsciously influenced by the example of Jewish bris, which had been done for thousands of years without anesthesia. Urban middle class Moslem have no religious difficulty whatsoever with having their boys circumcised in a medical setting with anesthesia.

      There are hospitals in the US that still circumcise without using any sort of analgesia, and even if they do the kid is left in a lot of pain after it wears off… and then of course he’s left with the most sensitive part of his penis exposed to the open air and friction from clothing for the rest of his life.
      ME. I know of no evidence that the glans takes more than a few weeks to adapt to its exposed state. I grew up surrounded by circumcised boys with very dirty minds, and I never heard talk of discomfort in the penis. I suspect that the sexual damage from circumcision may take several decades to materialise.

      It has always astonished me how Jews and Anglo-Saxons could circumcise a baby at a time in its life when it has no control over its elimination. The circumcision wound is bathed in urine several times a day, and is at risk of exposure to feces. I am surprised that this did not lead to serious infections, including the dreaded UTI. I suppose that natural immunity is very high during the first week of life.

      Most human communities that circumcise, including the Moslems and sub-Saharan Africa, do so between the ages of 5 and 15, when wrapping up the surgical wound in diapers is out of the question. I have read over and over that the Jewish contribution was to do it in the neonatal period. The main reason why circumcising in the neonatal period became the norm is that the pain the kid was going through could be ignored, and the experience would not be remembered. Once lidocaine went mainstream in the early 1950s, doing it at age 5 or 10 became an option. No urine, no feces, the foreskin had detached from the glans, and there was less risk of a bad outcome. South Korea went down this path.

      But there was a widespread Freudian belief in my youth that to circumcise after infancy created a grave risk of “castration anxiety.” In plainer terms, the boy could not ignore that some sort of sexual violence was being done to him. So the English speaking countries never revisited doing it very early in life. But they did give it up entirely, USA excepted.

      I have never heard that South Korean men are sexually weird or psychologically damaged by having been circumcised around 12-15 years of age. I also wonder if South Korean circ has fewer tragic outcomes.

  7. Sheila permalink
    November 7, 2009 12:00 am

    The doctors patient is the newborn baby – the doctor is morally bond to do what is best for his patient…not what his patient parents want. The baby is born perfect – to surgically remove healthy tissue is not only morally, and ethically wrong, it’s illegal.
    The time is near, when young men will sue doctor’s for unnecessary surgery(circumcision.) Remember, the doctor’s patient is the baby, not the parents. Removing healthy tissue without the owner’s permission is in unethical.
    No medical organization in the world promotes male circumcision.

  8. November 7, 2009 1:26 am

    The bottom line is that foreskin feels REALLY good. It’s HIS body and morally it’s HIS decision to make.

    We protect the rest of his body – from his earlobes to his pinky toes – from cosmetic amputations at the behest of others. We protect EVERY part of a girl from even a ceremonial pin-poke to draw one drop of blood (even though studies prove female circumcision reduces HIV incidence). We need to legally protect boys too.

  9. Robert Samson permalink
    November 7, 2009 1:04 pm

    I think we all need a reality check on the claims that circumcision reduces, cures, or prevents certain problem and/or diseases.

    If we look at the US which circumcised up to 90% of it’s males and compare the rates of these conditions to those of Europe which does not circumcise, the rates are LOWER in Europe (often by many times) than those of the US. So how can one logically claim circumcision benefit claims are real?

    Now if these claims cannot be logically and scientifically supported, how can one ethically justify non-therapeutic circumcision?

  10. Sheila permalink
    November 7, 2009 11:16 pm

    Ask all the circumcised Americans who died of AIDS how much their circumcision protected them. If you have to wear a condom anyway, why lose a body part to do it? The ‘future’ CDC decision makes no sense.

  11. November 8, 2009 8:31 am

    Ms Heroy:

    I want to first point out that a man whose parents want him to “choose” whether or not get circumcised when he is older proves might be problematic: that man who chooses to get circumcised when he is an adult will experience more pain and possibly sexual dysfunction after the procedure than as an infant.

    ME. He will experience “more” pain mainly in that he will be aware of it and can talk about it. There is no evidence that adult circ causes “more” sexual dysfunction, while infant circ causes “less.” I suspect that the sexual consequences of circ at all ages have yet to be properly researched. For one thing, I think that some drawbacks of circ can take more than 30 years to manifest themselves.

    Finally, Israel has had extensive experience with adult circumcision over the past 30 years, on immigrants from the former USSR.

    Also, this is similar to the HPV debate and giving vaccinations to young women before they are sexually active. The early you can reduce the risk and do it before the child becomes sexually active, the better the results (in regards to protecting against HIV).
    ME. Circumcision retard the spread of HIV from infected women to uninfected men. Circ is not a vaccine, it is not a “cure.”

    Circ only matters with regard to STDs for those who pursue an irresponsible sex life. If sex is confined to marriage and other faithful committed relationships, or if casual sex always uses a condom, HIV, HPV, and other STDs become vanishingly rare. Circ may contribute to public health only because quite a few people insist on misusing the penis. I do not like to circ an infant because I fear he will grow up to be a lad. I would like to give him a chance to prove that he is a good and responsible person.

    Also, no one is referring to the fact that the majority of men in the U.S. are circumcised, and might come under scrutiny in the bedroom by women/men they are sleeping with, who are accustomed to circumcised penises?

    ME. Gay men are very foreskin conscious. The net has allowed many younger women to speak their mind behind the cloak of anonymity. The resulting frank talk does not make clear the extent to which women notice and care about the circumcision status of their sex partners. I think that young women are in transition on this issue, a transition caused by sexually explicit material on the internet.

    While I know that is no justification for getting circumcised, I believe that many circumcised men choose to circumcise their infant boys because that’s what their used to.
    ME. We intactivists very much believe that this is the case.

    Ethics aside, this is an interesting issue to address.
    ME. I strongly agree with you here.

  12. November 8, 2009 8:37 am

    One Benatar brother professes medicine in South Africa, the other professes ethics at the Harvard Medical School. In jointly authored work published around 2003, they concluded that routine infant circumcision had enough going for it so that parents should be allowed to opt for it, but not enough for it to be mandated for all. They also concluded that it could not be banned either.

    The Benatar brothers gave no weight to any possible sexual advantages of the foreskin and the frenulum, because these are impossible to quantify and only dimly understood. Hence I do not share their conclusion.

  13. Frank OHara permalink
    November 9, 2009 7:50 am

    Thanks Joseph for a well written evaluation. I will only expand on your writing.

    There have been more than a half dozen studies on male urinary tract infections in circumcised/intact males. Only one of these studies have shown more than a +/- 1% difference. That difference is considered insignificant as it can be due to outside uncontrolled influences. The study that showed a greater difference was supposedly conducted by Thomas Wiswell, a rabid circumcision promoter. Wiswell claims to have reviewed the records of some 450,000 infants, a task that would consume some 30 years for Wiswell and an assistant. It is also reported that Wiswell divided his participants into full term circumcised boys and premature intact boys. At the time, it was well known that premature boys are at a significantly higher risk of UTIs. Afterward, Wiswell was rewarded with membership on The AAP’s Taskforce on Circumcision but when his deception was discovered, he was removed from The Taskforce. Wiswell’s efforts appear to be aimed at reversing another study. That study was performed at a military hospital in Hawaii and evaluated the results of prospective parents being given complete and truthful information about neonatal circumcision. As a result of that study, the circumcision rate at that hospital dropped from >80% to >20% during the study. Wiswell was a military doctor stationed at that hospital during the study.

    Likewise, legitimate studies on human papilloma virus infection and circumcision show little effect. An estimated 70% of American adults have been infected by the virus. Any intervention with any level of efficacy make this infection level impossible. The same is true of HIV infection. Consider the effect of the polio vaccine which was only 70% effective yet wiped the disease from the population in a single generation. The claimed protective effect of male circumcision would have a superior effect yet The US has the highest HIV infection rate among the industrialized nations. Further, the demographic with the highest circumcision rate, African Americans, also has the highest HIV infection rate by far. It is estimated that among male victims, 48% are African American males and among females, an astounding 80% are African American females. Further proof of circumcisions ineffectiveness is demonstrated in Swaziland where 98% of males are circumcised and there is a 22% infection rate and it is increasing. If male circumcision had any significant effect, that would not be possible.

    Claims of efficacy against any STD are equally specious.

    Claims of genital infections also must be put under the microscope. This appears to be a prime motivating factor in American parent’s decision to circumcise their sons but this is equally specious. The bacteria, virals and fungals that infect males are the same exact pathogens that infect females and the exact same medications that are effective in females are equally effective in males. Circumcision of males as treatment is an over-the-top reaction and is not supported in modern medical science any more than excision of female parts is a rational response. It is only accepted for males and not females because of cultural influences.

    Male circumcision is simply warfare on the male genitals. Without significant benefits, it is unethical. This campaign against the male genitals has been going on in The US for more than 130 years and to date, there has been no evidence supporting the procedure to show it has benefits that outweigh the risks. Three separate studies over a 20 year span show that every year, more than 200 infants die of the procedure. That my friends is a gross violation of human rights without equal and the procedure should be legislatively banned without exception.

    .

  14. Frank OHara permalink
    November 9, 2009 8:09 am

    Emily Heroy wrote: [i]”I want to first point out that a man whose parents want him to “choose” whether or not get circumcised when he is older proves might be problematic: that man who chooses to get circumcised when he is an adult will experience more pain and possibly sexual dysfunction after the procedure than as an infant.”[/i”]

    There is little link with adult circumcision and sexual dysfunction more than infant circumcision. An adult getting circumcised will recieve full anesthesia and after care medications while only 16% of infants receive any pain medication for the procedure and virtually none get after care medications.

    [i]”Also, this is similar to the HPV debate and giving vaccinations to young women before they are sexually active. The early you can reduce the risk and do it before the child becomes sexually active, the better the results (in regards to protecting against HIV).”[i/]

    There is no research to support this view.

    [i]”Also, no one is referring to the fact that the majority of men in the U.S. are circumcised, and might come under scrutiny in the bedroom by women/men they are sleeping with, who are accustomed to circumcised penises? While I know that is no justification for getting circumcised, I believe that many circumcised men choose to circumcise their infant boys because that’s what their used to.”[/i]

    No doubt circumcised men choose circumcision for their sons but the justification of women being accustomed to circumcised penises is no longer valid. Currently, only slightly over 50% of infants are circumcised. That means women will be equally experienced with foreskins and if there is any preference, research shows that they will prefer the natural state. Infant male circumcision is only a passing fad much like the leisure suit. Granted, it has been a long lasting fad but unfortunately, unlike a leisure suit, you can’t send it to Goodwill when you don’t want to wear it any longer.

    .

  15. Frank OHara permalink
    November 9, 2009 8:16 am

    Emily Heroy wrote: “You’re right; cultural circumcision can’t be justified ethically. Just in sharing what I know about the minority of men in the U.S. who are uncircumcised, I’m wondering if they feel scrutinized by women and/or society who are used to circumcised penises.”

    As far as I know, there has only been one study on this topic. That study was conducted in the early 1990’s when this topic had a much lower profile. It found that only 3% of genitally intact men had ever considered having themselves circumcised and only 6/10% had acted on that compulsion. On the other side of the fence, 20% of circumcised men disagreed with their circumcisions. I suspect the figures would be much different now with more circumcised men disagreeing and fewer intact men questioning keeping their foreskins.

    .

  16. Frank OHara permalink
    November 9, 2009 8:31 am

    Shelia wrote: “to surgically remove healthy tissue is not only morally, and ethically wrong, it’s illegal.”

    That certainly may be the case. Since the passage of the 1996 FGM law, it does appear that male circumcision is illegal. The Equal Protection Clause of the 14th Ammendment to the Constitution clearly states that all laws must be equally applied to all classes of citizens. This would imply that the FGM law is unconstitutional. While this has not been tested in court yet, on the surface it appears to be the case and would invalidate the FGM law. I’m sure there would be a rush in Congress to replace the law with one that passes Constitutional muster. Unless the government can a compelling interest in continuing the discrimination, I suspect the FGM law will be declared unconstitutional.

    “The time is near, when young men will sue doctor’s for unnecessary surgery(circumcision.) Remember, the doctor’s patient is the baby, not the parents. Removing healthy tissue without the owner’s permission is in unethical.”

    Actually, this has already happened. William Stowell sued the doctor who circumcised him. Unfortunately for millions of men and babies yet to be born, Stowell settled his case out of court. A court case with Stowell winning would have set judicial predecence but a settlement only sent a warning to the medical profession that what they are doing puts them at risk. Also unfortunately, the medical profession paid little attention to the warning.

    .

  17. November 9, 2009 2:03 pm

    Frank O’Hara & Emily Heroy:

    To be North American, white, middle class, older than 30, and intact could make for a self-conscious coming of age. I speak from lived experience here. There was zero printed matter in support of intactness and the foreskin. A former lover of my wife who was a sexual free spirit after he and her parted ways, told her that he was the first intact man that 3/4 of his sex partners had ever seen.

    If you surveyed American adult women in the latter 20th century, they preferred circumcised penises. All I conclude from that is that we prefer what is familiar. That said, studies that asked wives whether their husbands were circumcised, and then examined the husbands, found weirdly high error rates. Circumcised American men, and American women whose brothers and sex partners were all circumcised, could not learn about the foreskin in any effective way until the internet was up and running. I can also attest from personal experience that middle class Americans widely believed that the preputial sack was filled with decomposing urine, smegma, and other foul smelling sexual secretions. When I would point out that pulling back the foreskin during the daily shower, and washing the foreskin and glans with soap and warm water was utterly trivial, my interlocutors would change the subject!

    I get a strong impression that younger American women who post anonymously about their sex lives on the Internet, and who vlog about their feelings on YouTube, are growing more dismayed by neonatal circumcision and foreskin friendly. I suspect that a key fact here is that most young American women who are not appearance challenged, and who are neither evangelical Christians or orthodox Jews, have pretty varied sex lives. (In my experience, women who have had dozens of sex partners before marriage can make the transition to marital fidelity.) “Varied” includes Latinos and immigrants. A fair fraction of young American women have experienced at least one intact penis during their college days. Some turn up their noses at it; others love it. In college towns, and in the Far West, there are now a lot of intact teenage middle class white boys. Most important of all, the internet and broadband make it possible for a woman to explore photographs of male genitalia, to her heart’s content in the privacy of her home office. As a result, the perceptions, expectations, and experiences of young women are in rapid evolution. Cosmo, Glamour, etc. aren’t talking about this, for fear of seeming antisemitic, and because magazines are edited by older women with cut husbands.

    Vaccination protects a child from a host of childhood diseases, some of them lethal. Before the onset of sexual activity, all that neonatal circumcision does is reduce the frequency of UTIs and balanitis. Both are readily treatable in noninvasive ways. All supposed health advantages of circumcision after the onset of sexual activity can obtained by fidelity, limiting one’s sex partners, and rigorous condom use during casual sex. I now suspect that a lot could be gained if men washed their bits before and after every partnersex session. I appreciate that this rules out sex in the back seat of a car whil parked in a lover’s lane!

  18. November 9, 2009 4:31 pm

    “The study that showed a greater difference was supposedly conducted by Thomas Wiswell, a rabid circumcision promoter.”
    ME. I’ve not heard him called that before. I may disagree with Wiswell, but I do not bash him.

    “Wiswell claims to have reviewed the records of some 450,000 infants, a task that would consume some 30 years for Wiswell and an assistant. ”
    ME. He did not “review” these records; his research assistant simply combed through computer files. Given the state of IT at that time, this exercise could have been fraught with error and misunderstandings.

    “It is also reported that Wiswell divided his participants into full term circumcised boys and premature intact boys. At the time, it was well known that premature boys are at a significantly higher risk of UTIs. Afterward, Wiswell was rewarded with membership on The AAP’s Taskforce on Circumcision but when his deception was discovered, he was removed from The Taskforce. Wiswell’s efforts appear to be aimed at reversing another study. That study was
    performed at a military hospital in Hawaii and evaluated the results of prospective parents being given complete and truthful information about neonatal circumcision. As a result of that study, the circumcision rate at that hospital dropped from 80% to 20% during the study. Wiswell was a military doctor stationed at that hospital during the study.”
    ME. Have never read any of the above. References please. Have not seen Wiswell accused of deception and bad faith. Have never read that he was removed from AAP’s panel.
    You seem to imply that most or all intact boys in Wiswell’s dataset were premies. My understanding is that they were Latinos. Also, at the time Wiswell collected his data, early 1980s, the national circ rate underwent a marked decline. The only explanation I have for this is a delayed response to the AAP’s 1975 position statement.

    “Consider the effect of the polio vaccine which was only 70% effective yet wiped the disease from the population in a single generation.”
    ME. The Salk and Sabin vaccines had an efficacy rate a lot higher than 70%.

    “The US has the highest HIV infection rate among the industrialized nations. ”
    ME. This fact is massively inconvenient for the CDC’s proposed stance.

    Further, the demographic with the highest circumcision rate, African Americans, also has the highest HIV infection rate by far.
    ME. Before the late 1960s, when Medicaid assumed the costs of hospital childbirth for almost any family that looked indigent, routine circumcision was much rarer among AAs. Also, AIDS was initially a white gay male disease.

    “It is estimated that among male victims, 48% are African American males and among females, an astounding 80% are African American females. ”
    ME. Needle drugs have a lot to do with this. There is also growing evidence that blacks are more susceptible to AIDS. Circ has nothing to do with AIDS spreading from men who behave badly, to their innocent female sex partners. If we are to believe the African clinical trials, circ matters only for transmission from infected females to clean males.

    “Further proof of circumcisions ineffectiveness is demonstrated in Swaziland where 98% of males are circumcised and there is a 22% infection
    rate and it is increasing.”
    ME. AIDS is tragically high in Swaziland, but I’ve never read that it is a circumcising culture.

    “Claims of genital infections also must be put under the microscope. This appears to be a prime motivating factor in American parent’s decision to circumcise their sons but this is equally specious. The bacteria, virals and fungals that infect males are the same exact pathogens that infect females and the exact same medications that are effective in females are equally effective in males. ”
    ME. We can say more: it is easier to clean, disinfect, and apply medicine to the preputial sack than to the vagina.

    “Circumcision… is only accepted for males and not females because of cultural influences.”
    ME. Most Western nations do not agree that male circumcision is a valid prophylactic measure, or enhances sexual expression.

    “…there has been no evidence supporting the procedure to show it has benefits that outweigh the risks. ”
    ME. The “benefit” is mainly that of allowing squeamish and prudish parents to raise a boy without having to think about his penis and its cleanliness. This was a major benefit for English speaking middle class women reared before WWII.

    “Three separate studies over a 20 year span show that every year, more than 200 infants die of the procedure.”
    ME. I would guess that the USA death rate is about 3-5 per decade. In my opinion, this death rate is high enough to put an end to the procedure. Please supply references for your claim of 200. Gairdner (1949) found a mortality rate in the UK of 10-15/year during the 1920s and 30s. This is weirdly high. Routine circ in the UK stopped immediately, before the Circumstraint was invented and before the Gomco clamp was exported to the UK.

  19. Darcy Keith permalink
    November 9, 2009 6:47 pm

    I am a Registered Nurse in the US who has assisted deliveries of a few circumcised immigrant women and I’ve also witnessed countless neonatal male circumcisions. While it certainly could be argued that the physical and sexual outcome of FGM is far worse than routine infant circumcision, the fact remains that both are done to unconsenting minors. Both procedures tend to be propagated by culturally based fears of the parents, I suppose worried of what horrors might befall their children if left whole as the way they were born. I can not say I’d ever support an outright ban on male or female genital cutting. I think it is prudent to allow a consenting adult the right to do whatever one chooses to their own body. I do, however, believe it is utterly despicable to allow a parent to cut off a healthy, natural body part without the presence of disease.
    The tide is slowly changing but those women from circumcising cultures are starting to refuse to allow the cutting to their daughters and many are starting to speak out locally and globally. This awareness will hopefully bring about rapid change. Many men harmed by circumcision are beginning to speak out as well. While I doubt the US culture will adopt a “no circumcision” policy anytime soon (due to the religious nature of the ritual), I hope that parents will explore the option of not circumcising their sons also.
    Then fact remains that no child, male or female, ever died from not having their genitals cut. But a few poor children die each year after genital cutting and many more suffer for years . Nobody has a right to alter a child’s genitals. If the child wants to do so in order to “conform” to their culture, let them do so when they are of age of consent.
    Maybe instead of looking at this issue as one that is “worse” for one gender or the other, we should look at it as a global human rights issue. After all, a parent cutting off the child’s entire leg is worse than cutting off only the toes, but the end result is a person missing a body part(s) that were rightfully theirs.

    • November 9, 2009 8:33 pm

      I can not say I’d ever support an outright ban on male or female genital cutting.
      ME. FGM is now a major crime in most western societies.

      The tide is slowly changing but those women from circumcising cultures are starting to refuse to allow the cutting to their daughters and many are starting to speak out locally and globally.
      ME. The change began a quarter century ago.

      Many men harmed by circumcision are beginning to speak out as well.
      ME. This too began a quarter century, and has been running under a full head of steam since the internet began.

      I hope that parents will explore the option of not circumcising their sons also.
      ME. Some American and Canadian parents began this mental journey in the late 1970s. Most literate parents now know that to snip a newborn boy is controversial.

      Then fact remains that no child, male or female, ever died from not having their genitals cut. But a few poor children die each year after genital cutting and many more suffer for years.
      ME. No intact girl died because. As many as 1% of girls cut in Africa die from blood loss or raging infection.

      Nobody has a right to alter a child’s genitals. If the child wants to do so in order to “conform” to their culture, let them do so when they are of age of consent.
      ME. Most genital cutting is a form of rape. The boy or teenage girl is restrained by brute strength. The legs are held apart. It can take 3-4 people to cut a Masai teenage girl.

      The worst thing is that middle aged women do this to girls. You read me correctly. In sub-Saharan Africa, a woman using an old razor blade or equivalent, will cut out the clitoris and inner labia of a girl as old as 16. Some girls who have had this done to them grow up to do it to the daughters of their contemporaries 20-30 years later.

      For years I thought that only warped men mixed lust and cruelty. That only men cultivated a hatred of the female genitalia. Men made deeply insecure by the strength of female desire, by the charms of the female body. And then I learned what was done to about hundred million African and Moslem women.

      The vulva is the gateway to life, c-sections excepted. It can give its owner powerful pleasure. The vulva is a completely essential part of the reproductive machinery. But somehow, millions of Africans want to attack the vulva, damage it, make it bleed, make it feel very intense pain. An American woman journalist did a series of photographs of tall beautiful Masai teenage girls crying their hearts out after having their clitorises cut out. The series of photographs is on YouTube. I do not know where this American woman found the emotional strength to complete this project.

      As far as genital mutilation is concerned, I am from Mars. And this Martian says some of you humans have got a huge and deep problem with sexual pleasure and your genitals.

      To all you str8 men and lovely lesbians out there. Read this, weep, throw up if you need to. Then go home, cuddle up with your SO, bury your face between her legs, and worship that which some do great violence to.

  20. Frank OHara permalink
    November 10, 2009 1:28 am

    RD wrote: “He did not “review” these records; his research assistant simply combed through computer files. Given the state of IT at that time, this exercise could have been fraught with error and misunderstandings.”

    I have not seen this. At the time, IBM had just introduced the PC jr. All other computers were mainframes and few were seen in hospitals. There was no internet and computers communicated at the rate of 300 baud over telephone lines. Just to have access to 450,000 files is highly questionable.

    “I would guess that the USA death rate is about 3-5 per decade. In my opinion, this death rate is high enough to put an end to the procedure. Please supply references for your claim of 200.”

    Gladly!

    According to Robert Leon Baker, MD, former rear-admiral in the US Navy Medical Corps, an estimated 229 babies die every year due directly or indirectly to circumcisions. (Sexual Medicine Today, Vol. 3, No. 11, November 1979).

    “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)

    Daniel Bollinger also quantified the death rate at 229 for the year 1998 using insurance industry records.

    You can find the actual reports at http://www.cirp.org. This establishes the mortality rate at approximately 1 per 7,000 procedures.

    For actual instances of death from neonatal circumcision, google these names: Eric Keef, (http://www.argusleader.com/article/20090918/UPDATES/90918015/1003/business), Christopher Dolezal, Steven Christopher Chacon, Dimetrius Mannaker, Jeremie Johnson, Allen A. Ervin, Andrew Ryan, Dustin Evans died, in 1998, Ryleigh McWillis, Jacob Christian Holliday

    “Have not seen Wiswell accused of deception and bad faith. Have never read that he was removed from AAP’s panel.”

    Wiswell was removed for deception. Edgar Schoen who was the chair of The Taskforce was very vocal in his defense and support of Wiswell was also removed from The Taskforce at the same time for being “disruptive.” Those two have gone on to have shameful careers marked by their rabid advocacy of infant circumcision. Schoen is still at it despite being almost 90 years old and is supported by Kaiser Permanente with an annual salary.

    • November 18, 2009 9:51 pm

      I have not seen this. At the time, IBM had just introduced the PC jr. All other computers were mainframes and few were seen in hospitals.
      ME. By 1980, the typical urban hospital did have a mainframe computer or time shared access to a mainframe. These mainframes massaged databases.

      There was no internet and computers communicated at the rate of 300 baud over telephone lines. Just to have access to 450,000 files is highly questionable.
      ME. I agree that consolidating databases across dozens of military hospitals was implausible. One did that sort of thing by having hospitals mail out 12″ reels of tape. I am surprised that nobody has claimed before now that Wiswell’s data collection exercise sounds implausible.

      “I would guess that the USA death rate is about 3-5 per decade. In my opinion, this death rate is high enough to put an end to the procedure. Please supply references for your claim of 200.”

      Gladly!

      According to Robert Leon Baker, MD, former rear-admiral in the US Navy Medical Corps, an estimated 229 babies die every year due directly or indirectly to circumcisions. (Sexual Medicine Today, Vol. 3, No. 11, November 1979).
      ME. How was a military doc in a position to know this? The estimate is also 30 years out of date and claims too much precision. I remain sceptical. I very much doubt that deaths resulting from neonatal circumcision exceed 2-3/year.

      “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)
      ME. Who did Szasz cite? Szasz is an exciting intellectual, and on the side of the angels. But he is no authority on the weird ways of American routine circ. The main reason he is against it is because it strikes him, a Hungarian atheist, as utterly weird.

      Daniel Bollinger also quantified the death rate at 229 for the year 1998 using insurance industry records.
      ME. I would like to see the details of this calculation. Bollinger is an interesting fellow.

      You can find the actual reports at http://www.cirp.org. This establishes the mortality rate at approximately 1 per 7,000 procedures.
      ME. If it were that high, the practice would have totally ceased by now.

      For actual instances of death from neonatal circumcision, google these names: Eric Keef, (http://www.argusleader.com/article/20090918/UPDATES/90918015/1003/business), Christopher Dolezal, Steven Christopher Chacon, Dimetrius Mannaker, Jeremie Johnson, Allen A. Ervin, Andrew Ryan, Dustin Evans died, in 1998, Ryleigh McWillis, Jacob Christian Holliday
      ME. These cases I do not doubt. But they do not amount to more than 20-40 per decade.

      Schoen is an aging fanatic, who simply cannot face the fact that our sexual and child rearing culture are changing.

      A much more common adverse consequence of the routine circumcision we middle aged Americans underwent in huge numbers, was that too much was cut off. But anecdotal evidence that has come my way suggests that the problem is corrected. Many doctors now cut so little off that one cannot be sure Junior was cut until after the puberty growth spurt. Another adverse consequence which is poorly understood is how 40-50 years of contact with underpants dries out the glans and results in a penis with little feeling.

      • Frank OHara permalink
        November 20, 2009 9:21 am

        “ME. If it were that high, the practice would have totally ceased by now.”

        We can only wish! The fact is that these figures have been compiled and tested three times. It is also a fact that few of these cases come to public light because of confidentiality agreements with medical malpractice insurers and parents. This is an ugly part of infant male circumcision that is well hidden. In medical practice, a death rate of one in 7,000 is an acceptable mortality rate. Because policy holders insisting on the “benefit” of infant male circumcision, health insurers feel they must provide coverage to compete.

        “ME. These cases I do not doubt. But they do not amount to more than 20-40 per decade.”

        These are only a few of the cases that have become public. Most likely, these cases become public because of nurses who are under no confidentiality agreements or who speak out annonymously. Rarely do parents speak before the death becomes public and the doctors are certainly not going to speak out. The circumcision procedure has been regarded as a simple “snip” and no doctor wants his professional reputation sullied by it being publicly known that he/she so seriously botched a simple procedure. The malpractice insurance companies also have a vested interest in keeping it quiet.

        “Schoen is an aging fanatic, who simply cannot face the fact that our sexual and child rearing culture are changing.”

        I couldn’t agree more!

        “A much more common adverse consequence of the routine circumcision we middle aged Americans underwent in huge numbers, was that too much was cut off. But anecdotal evidence that has come my way suggests that the problem is corrected. Many doctors now cut so little off that one cannot be sure Junior was cut until after the puberty growth spurt.”

        But, more boys are being circumcised a second time and a few even a third time that ever “required” a circumcision after being left intact before this trend.

        “Another adverse consequence which is poorly understood is how 40-50 years of contact with underpants dries out the glans and results in a penis with little feeling.”

        Yes, implicit with this is also male impotency. Two studies have shown a correlation between infant circumcison and impotency with circumcised men’s sex life being cut short by years. Additionally, anecdotal evidence supports it. American men consume 54% of the world’s supply of Viagra, (souce: Phizer Pharmaceutical annual report, 2002) Malaysian men (Muslim and circumcised) have the world’s highest per capita consumption of Viagra (Source: news reports) and Israel is the world’s leading counterfeiter of Viagra (source: news reports).

  21. Frank OHara permalink
    November 10, 2009 1:40 am

    Pat88 wrote: “But performing circumcision on babies because most most men would refuse it when they are adults doesn’t seem ethical.”

    I really think you hit on something here. I believe that infant circumcision is often a pre-emptive attack on the child. It’s the parents who want the child circumcised and intentionally don’t give any consideration to what the child may want. They want to eliminate any possibility that the child would refuse the procedure.

    • November 10, 2009 2:58 am

      I once read a rabbi quoted as saying “we can’t defer circumcision until a boy attains his majority and can make the choice for himself. It is self-evident that few men will agree to be circumcised after they become sexually active.” The spirit of he Rambam lives on down to the present day. Circumcision has a teleology: the reduction of male sexual pleasure. “Evidently,” the one person not qualified to decide what is best for a penis is the one person in the universe whose nervous system is connected to said penis, LOL!

      But the men who entrepreneured the circ meme silently assumed that women would never become clued up about all this. That there never would be a place and a time when women would sample both kinds of men before marriage. (Traditional societies tend to value bridal virginity highly.) Women who can make the comparison are blogging about it, and other women read those blog entries. More and more women will restrain the hand holding the scalpel. The operating theatre will grow still. The helmet look will fade into vintage porn, then become a genital version of the Cheshire Cat’s grin…

  22. Frank OHara permalink
    November 10, 2009 1:53 am

    Tony wrote: “I don’t think health risks are left out of the ethical discussion. Having a foreskin involves risk, but so does having any normal human body part.”

    I read something interesting last week in a news report. The cost of routine neonatal circumcisions in The US is almost $1 billion per year. The cost of corrective surgery to correct botched circumcisions increases this cost by 48%. This is a significant revenue stream for American medicine!

  23. November 10, 2009 3:16 am

    The reason why bris has persisted for thousands of years is that it made intermarriage awkward. If a Jewish young man were to walk away from his heritage and blend in with the goy world, he would be found out on his wedding night, when his shiksa bride discovered that her new hubby did not look like her younger brothers. If a Jewish girl married out, she would be reminded of that fact every time she did any foreplay on her goy husband.

    Anybody who indulges in casual sex before settling down to marry should use a condom. And cut and uncut are pretty much the same thing when the johnson’s got a condom.

    If you really must take the Pig in a Blanket into your mouth, wash it first. Or at least rinse it off. When G-d designed the penis, he did not intend for it to be taken by mouth. In fact, the natural raunch under the foreskin is probably there to encourage us to put it in the place where it’s most likely to impregnate. Because there’s no taste buds or nostrils down there.

    As for health and hygiene, hundreds of millions of Europeans and Japanese are civilized, modern, scientific, etc etc, and uncut. Where’s the cancer? The urological crash and burn? nWouldn’t we know it by now? Meanwhile a quarter million American gay men have died of AIDS over the past 30 years, and the vast majority of them were cut. Hell, quite a few of them were Jews of the Larry Kramer variety.

    Too sensitive you say? There may be some truth to that at college age. But by age 50, the extra sensitivity of the uncut number can be a plus.

    I hear that quite a few Jewish maidens think that a Walk on the WIld Side makes for a cooler rep. And so they want to taste forbidden fruit before settling down to marital contentment in Scarsdale. A handful fall into foreskin fetishism. But for the vast majority, the result must be “been there, done that, not thrilled.” As Elaine said on Seifeld, The foreskin is an Alien. Many European Jews have crossed another bridge; they have given up bris. Maybe the overriding thing is sparing your boy humiliation in the high school locker room. So here we cut ‘em and there they don’t. Our obsession with fashion and conformity extends even to the anatomy of boys. Trouble is, a cloth sleeve can be lengthened and shortened at will, after a trip to the tailor. The skin sleeve on his johnson, on the other hand…

  24. Robert permalink
    November 16, 2009 10:43 am

    RD, seems to be on a hunt for excuses and/or apologias for circumcision.

    No where is he able to provide a single proven benefit for infant circumcision, and has been presented with the proven harm and risks.

    None of the false claims of benefit can outweigh the unnecessary risks and harms harms of circumcision, so in the end there is nothing for circumcision except excuses and apologias.

    Conformity is a sad and illogical excuse for harming infants–and hardly justifies its being done–ie not an ethical excuse.

    • November 16, 2009 2:01 pm

      Robert, I fear you have misread me. We are both on the same side. I suspect that sentences I intended as sarcastic you took as literal.

      There are only four medically advanced nations whose adult men are predominantly circumcised: Australia, Israel, South Korea, and the USA. Australia is gradually leaving this club, as only 15% of Australian babies are cut, and the rate is falling over time. The USA has a growing intact minority, as 40-45% of American baby boys leave the maternity ward intact.

      If circumcised was healthier, a comparative analysis of health statistics from the advanced nations would reveal it by now. I have been waiting 25 years for such an analysis. If boys learn to clean under the foreskin, if phimosis in young men is corrected in noninvasive ways, and if condoms are a regular part of casual sex (which Europe seems to have taken on board), then intact is perfectly healthy.

      I invoke a desire to conform only to explain routine neonatal circumcision, and not to justify it. I have made a career of laughing at the American fear of nonconformity. American women fearing that their breasts and vulvas will not appeal to potential partners has had a corrosive effect on their sanity. Apparently similar fears, and similar sad emotional consequences, carry over to the male foreskin.

      • Robert permalink
        November 18, 2009 9:53 am

        MY bad, sorry I mistook a remark out of context..comes from a first time reading that too little time was spent on the reading.

  25. Robert permalink
    November 16, 2009 12:20 pm

    Re, the reliability of Wiswell and chis claims:

    Furthermore, the research supporting these potential ‘benefits’ has been criticized for numerous methodological flaws. For example, the ’10 to 1′ ratio frequently cited for UTI reduction primarily rests upon only one large-cohort medical records analysis, by Wiswell, and has wormed its way into the journalistic factsheet more through constant repetition than validity.

    A more telling example of why this research cannot be relied upon is the fact that a median year of statistics was DROPPED from the final calculations apparently because IT DID NOT SUIT THE PREJUDICES OF THE RESEARCHER, AND LESSENED THE FINAL BENEFIT ESTIMATION. In short, there are skeletons of DATA TAMPERING in Wiswell’s closet.

    http://www.cirp.org/library/disease/UTI/thompson/

    • November 18, 2009 9:58 pm

      At any rate, I would welcome a repeat of Wiswell’s exercise, done using contemporary data in a uniform microcomputer database format. Data would be collected from various hospitals using broadbank links. The fraction of the sample left intact would be larger, and the intacts would not be dominated by premies and Latinos.

      I have been an active intactivist since 1983. I have a sense that advocates of cutting no longer play up the alleged UTI reduction benefit like they used to. This may be because they know deep down that there are skeletons in the closet. But it could also be that they are counting on HIV and HPV reduction as irrefutable arguments. You and I know they aren’t.

      • Robert permalink
        November 19, 2009 10:15 am

        I wouldn’t bet on that–even though the ACS debunked the penile cancer myth years ago, it is still being used today–even by the AAP, which has been chastised by the ACS for continuing to use it.

        Circumcisers are loath to abandon any debunked myth that they believe will further their agenda. And never think for a minute that they don’t have an agenda.

      • Frank OHara permalink
        November 20, 2009 9:41 am

        “At any rate, I would welcome a repeat of Wiswell’s exercise, done using contemporary data in a uniform microcomputer database format. Data would be collected from various hospitals using broadbank links. The fraction of the sample left intact would be larger, and the intacts would not be dominated by premies and Latinos.”

        In fact, there have been about a half dozen studies regarding UTIs in intact and circumcised infants. Only Wiswell’s shows a difference of more than 1%. In medical parlance, this is regarded as insignificant as unconsidered confounders can influence the results up to 3%. In fact, Wiswell’s data fall within this confounder range at 2.5%. The way Wiswell and his supporters state the difference is never “less than 1% difference but instead “10 times more at risk” or “12 times more at risk.” This is obviously misleading and most likely either to be deceptive or repeating deceptive remarks by others.

        “I have been an active intactivist since 1983. I have a sense that advocates of cutting no longer play up the alleged UTI reduction benefit like they used to. This may be because they know deep down that there are skeletons in the closet.”

        The deceptive studies have been refuted so many times that they are a little gun shy now and tend to stay away from UTIs. Only those who are rabid promoters and inexperienced bring this up.

        “But it could also be that they are counting on HIV and HPV reduction as irrefutable arguments. You and I know they aren’t.”

        These are also immeniently refutable and are only neophytes or rabid circumcision promoters bring up.

        .

      • Frank OHara permalink
        November 20, 2009 10:05 am

        “Circumcisers are loath to abandon any debunked myth that they believe will further their agenda. And never think for a minute that they don’t have an agenda.”

        Yes! After Phizer Pharmaceutical announced and put Gardasil into distribution in 2005, I correctly predicted that advocates would be recommending infant circumcision as a preventative for HPV infection, cervical cancer and penile cancer for decades to come and I have not been disappointed. Now that Gardasil has been approved for use in boys, I suspect they will still continue to promote male circumcision for the same reasons. These are mere impediments to their advocacy. They only care about being found out and refuted. It has been a part of history of the practice to figure out what the most dread disease of the day is and then, try to claim infant male circumcision will prevent or cure it. To date, infant male circumcision has not proven to prevent anything that can not be treated or prevented by less invasive and less expensive methods.

  26. November 20, 2009 1:33 pm

    To Frank O’Hara:

    I completely that any death from routine neonatal circumcision is totally unacceptable. That said, I simply cannot agree that the death rate is one the order of 200/year.

    “ME. If it were that high, the practice would have totally ceased by now.”

    We can only wish! The fact is that these figures have been compiled and tested three times. It is also a fact that few of these cases come to public light because of confidentiality agreements with medical malpractice insurers and parents.
    This is an ugly part of infant male circumcision that is well hidden.

    ME. I doubt that these confidentiality agreements are binding on state vital statistics offices. I do agree that human weakness leads to deaths from circumcision begin recoded as “septicimia” or “shock.” But I doubt that this happens hundreds of times a year. If 200 boys were dying each year from routine neonatal circumcision, I am confident that medical mapractice insurers would demand that the practice stop.

    In medical practice, a death rate of one in 7,000 is an acceptable mortality rate.
    ME. A mortality rate that high from minor routine surgery costing only a few hundred dollars cannot be acceptable. If the mortality rate were 1 in 7000, and the payout for a death were $2.1M, the added cost per circumcision to cover the liability exposure would be $300. That would roughly double the price.

    Because policy holders insisting on the “benefit” of infant male circumcision, health insurers feel they must provide coverage to compete.
    ME. Insurers would gladly drop it, but do not fearing parental anger.
    When the North Carolina legislature voted to stop Medicaid coverage of routine circ, there were nasty editorials saying that the legislature was condemning tens fo thousands of boys from poor families to mockery in high school locker rooms. There is nothing worse in life than being told one has a Weird Dick, you know!

    “ME. These cases I do not doubt. But they do not amount to more than 20-40 per decade.”

    These are only a few of the cases that have become public. Most likely, these cases become public because of nurses who are under no confidentiality agreements or who speak out annonymously. Rarely do parents speak before the death becomes public and the doctors are certainly not going to speak out. The circumcision procedure has been regarded as a simple “snip” and no doctor wants his professional reputation sullied by it being publicly known that he/she so seriously botched a simple procedure. The malpractice insurance companies also have a vested interest in keeping it quiet.
    ME. I think that malpractice insurers have a strong vested interest in stopping routine infant circ. The incentive would be overwhelming if the death rate were as high as you claim it to be.

    “Another adverse consequence which is poorly understood is how 40-50 years of contact with underpants dries out the glans and results in a penis with little feeling.”

    Yes, implicit with this is also male impotency. Two studies have shown a correlation between infant circumcision and impotency with circumcised men’s sex life being cut short by years. Additionally, anecdotal evidence supports it. American men consume 54% of the world’s supply of Viagra, (souce: Phizer Pharmaceutical annual report, 2002) Malaysian men (Muslim and circumcised) have the world’s highest per capita consumption of Viagra (Source: news reports) and Israel is the world’s leading counterfeiter of Viagra (source: news reports).
    ME. You may have a valid point here. But the 1997 study out of the University of Chicago did a good job of obscuring this, if it is indeed true. That study found that intact men over age 50 were more likely to have sexual dysfunction problems. The cause, of course, is that having a foreskin is correlated with poverty, and poverty in turn is correlated with poor health, and poor health is correlated with erectile dysfunction. Adult onset diabetes is a major player here.

    The oldest men in the Chicago’s study random sample were 59. Hence we have no data on the sex lives of older men. My mother has told me that my cut father’s interest in sex shut down around the time he turned 50.

    This point bears out the value of cross-cultural data. A fundamental problem with North American data is that in adult men, circumcision is positively correlated with socioeconomic status. Poor unsophisticated men are much more likely to come down with STDs, for example. The best way to see that the foreskin is not unhealthy is to look at Japan and continental Europe. In those cultures, circumcision is correlated with low socioeconomic status (specifically, being from the Islamic Third World).

    If your point is valid, continental European men over 50, say, will have more active sex lives than their American counterparts. A nice thesis topic for a PhD in sexology!

  27. November 23, 2009 4:40 pm

    I don’t agree that sexually irresponsible behavior is associated with class. The sexual freedom movement was incubated on college campuses. In my experience in an upper class environment, I see a lot of sexual irresponsibility. It runs the gamut and is both males and females.

    RD. Here we deeply disagree. The sexual revolution did begin in the 1960s, in elite universities, and rapidly spread from there. It soon reached the underclass, where it has done serious damage for a generation. But the nice kids from the suburbs have since moderated their act.

    Where I live, getting drunk at parties and waking up the next day, not knowing what one did sexually, is declasse behaviour. Getting an abortion after such behaviour, ditto. Coming down with an STD, ditto. Growing up comfortable, attending a good high school, doing university degrees, and pursuing a white collar career, are all very much correlated with fewer problems on the sexual front. What I say here greatly complicates epidemiological studies of circumcision. Circumcision has been linked to middle class upbringing, and such upbringings are linked with fewer STDs, more condom use, and better hygiene.

    Circumcision was once strongly associated with class and I have no doubt there are vestiges of classism left. That association really no longer exists. Before 1973 when a Jewish family sued the doctor and hospital that circumcised their son without permission denying them the ritual bris, it was common for doctors to circumcise boys even against the implicit instructions of the parents not to. This happened in my family.
    ME. When my mother gave birth to my younger brother in 1954, she was not asked whether she wanted him circumcised, which was done. That is why my brother and I are different.

    The primary deciding factor appeared to be the physician’s evaluation of whether the family had the financial means to pay the bill. This appears to be the reason black boys were circumcised at a lower rate before Medicaid. Of course, after Medicaid, they got paid for all they did regardless of the parents ability to pay.
    RD. This could well have been the case.

    Edgar Schoen, a radical proponent has tried to establish a connection with Hispanics and intactness but it doesn’t seem to be going anywhere.
    RD. What?? The Hispanic coolness to routine circumcision is well documented!

    http://www.cirp.org/library/statistics/USA/state-by-state/

    In fact, immigrant populations are the showing the largest increases in the neonatal circumcision rate with Hispanics up more than 300% and those from India showing a 800% increase. It is apparent they are being solicited by someone. The most likely candidate is physicians.
    RD. These percentages are huge because the starting values are so tiny. I have never seen nor heard of this before. That said, Indians in the USA have great respect for American medicine and doctors. The mere fact that X is standard procedure in USA hospitals elicits great respect for X. They are also keen to see their children assimilate into the American mainstream. When I tell my Indian friends that the Europeans and the Japanese do not circumcise, they go into cognitive dissonance! If what you say is true, it reveals that Hispanic and Indian mothers are susceptible to the message that the preputial sack is foul.

    RD wrote: “I’ve never read this. Moreover, I am skeptical of your claim here. That black johnsons were often uncut was very little known, because of school segregation, and because blacks were not allowed to participate in white sports.”

    Believe me! I come from an area with a relatively large black population.
    RD. The same is true of me.

    RD wrote: “The black rate may now exceed the overall white rate, but I doubt it exceeds the rate among babies whose parents grew up in the USA.”

    My figures come from The Centers for Disease Control/National Center for Health Statistics. Blacks have been the most circumcised demographic group for decades thanks to Medicaid.

    RD. See the link I posted above.

    Doctors and nurse have to be careful not to offend their clientele.
    RD. Here we agree.
    Incidentally, a Ohio intactivist told me that when she gave birth to her first son early this decade in a university teaching hospital, neonatal circumcision was simply not mentioned. It simply wasn’t an option. When she gave birth to son #2 in a conventional suburban hospital in the same city, she had to put her foot down firmly to protect her son’s foreskin. Universities are filled with foreign born academics and PhD students. University hospitals accept the foreskin. In suburban life, an uncut dick remains a Weird Dick.

    In most parts of the country until relatively recently, there were few if any Hispanics or Asians. In my home town and home county, there were none at all during my school years and for a good while after.
    RD. Hispanics and Asian immigrants are now almost everywhere, and are not demographically trivial. These facts have contributed materially to the declining circ rate.

    It is also only true of “west of the continental divide” after 1982
    RD. I know that, and was only talking of the post 1980 experience.

    There is an established link between higher education and higher class status in the last few years and intact babies.
    RD. I only conjectured this. Do you have data?

    Just the existence of intact boys in a community will cause expectant parents to investigate the issue. That highly educated and positioned parents are eschewing it has the effect of establishing a fad for others to emulate.
    RD. Here we strongly agree. Imitation of what high status families do is a very powerful motivator. It gradually turned Americans into a circumcised people, 1900-40. Today, the engine works in reverse! I am very very cynical here. All my life, I have heard unguarded remarks by children and adults, revealing that most people are slaves to conformity. Specifically, thou shalt not let a boy have a Weird Dick.

    This is after all how it became established in the first place outside the Jewish community. Boys of urban parents were born in hospitals and were circumcised. Boys born of farm families were home birthed and often it was weeks or months after their birth before they were taken to a doctor. By that time, it was too late or the parents realized there was no reason for surgery.
    RD. We do agree that if a boy exited the maternity ward with his foreskin, it was usually left alone later. Hence rural boys born at home remained intact.

    What boys see at the school urinal, in high school locker rooms, and in Army barracks shapes what they do later as fathers. That boys from comfortable families were circumcised was evident, and led to a strong desire by humbler boys to circumcise their sons.

    The urinals in my primary school made zero accommodation to modesty. The fact that all my school mates but one were circumcised was blatant. I was seen as weird until I learned to skin back before peeing, around age 10 or so. Whereupon I was immediately accepted!! Can’t have a Weird Dick, you know… I bet that Asian immigrant boys have had experiences in USA schools similar to mine. The sons of such boys are at serious risk of being circumcised unless there is outreach and education. I have tried to do that with non-Moslem South Asian families, whjere I have encountered surprising resistance. South Asians have immense respect for USA medicine, and I am not a doctor. I also discovered that South Asian men can be oblivious to the foreskin’s contribution to their sexual pleasure. Hence cutting it off doesn’t dismay them.

  28. P D Hoath permalink
    January 18, 2010 7:23 am

    Findings from the
    National Gay Men’s
    Sex Survey 2001
    David Reid
    Peter Weatherburn
    Ford Hickson
    Michael Stephens
    Original Research Report

    Sigma Research
    Faculty of Humanities & Social Sciences
    University of Portsmouth
    Unit 64, 49 Effra Road
    London SW2 1BZ
    020 7737 6223
    http://www.sigmaresearch.org.uk

    4.5 CIRCUMCISION
    It has been suspected for some time that when uninfected men are insertive in UAI with positive
    men, whether or not the uninfected man is circumcised has a bearing on the probability of HIV
    transmission occurring. The hypothesis is that the cells of the fore-skin are more susceptible to
    infection by HIV and therefore circumcision has a protective function.
    Men were asked Are you circumcised? and were asked to tick No, Yes or Don’t Know. Overall, 0.9%
    said Don’t know by which we think they mean they do not know the word rather than not knowing
    whether they have a foreskin. Excluding this small group, 22.1% of men indicated that they were
    circumcised. The proportion rose with increasing age, from 16.1% among the under 20s, through
    18.8% (in the 20s), 21.3% (in the 30s), 24.8% (in the 40s) and 40.2% among the over 50s.
    Circumcision also significantly varied by ethnicity, being highest among Bangladeshi men
    (100%, 5/5), Pakistani men (97.5%, 39/40), other Asian men (77.3%, 68/88) and Black African
    men (76.1%, 35/46). Of all sixteen ethnic groups,White British men had the lowest level of
    circumcision (18.7%, 2201/11764).
    If circumcised men are less likely to acquire HIV than men with foreskins, then we should expect
    fewer of the circumcised men to have tested positive than the men with a foreskin. However,
    more of the circumcised men had tested positive for HIV (6.1%) than had those with a foreskin
    (5.0%). This small but significant difference is in the opposite direction than predicted if foreskins
    are contributing to transmission, and was observed in all ethnic groups and across the age range.
    The survey found no evidence to support the adoption of ‘the proportion of HIV uninfected men
    who are not circumcised’ as a population level target for HIV prevention programmes for gay and
    bisexual men.

    • January 18, 2010 1:30 pm

      Very interesting. Would this finding in the data from a 2001 survey still hold up?

      One thing should be obvious: data from the UK is hugely more relevant to the North American routine circ controversy, than data from East and South African clinical trials.

      Important fact: as native born UK white men circumcised before 1950 die, men who were overwhelmingly middle and upper class, more and more circumcised UK men will be unsophisticated immigrants and their sons. This is has always been the case on the continent. In Europe, to be circumcised is correlated with socioeconomic deprivation (especially given the declining popularity of bris among European Jews). In North America, circ is correlated with middle class respectability. Keep in mind that education, income, and class, both one’s own and that of one’s parents, are big drivers in health outcomes. Much of the data on the effects of having a foreskin on health outcomes are driven by these important sociological realities.

      One of the best academic studies on American circumcision was led by Edward Laumann of the University of Chicago, and published in the JAMA in 1997. Even though Laumann is one of the greatest living sociologists, his article strikes me as naive about the sociological realities I touch on above.

    • Frank OHara permalink
      January 18, 2010 7:34 pm

      P.D.Hoath wrote: “The hypothesis is that the cells of the fore-skin are more susceptible to infection by HIV and therefore circumcision has a protective function.”

      Well yes, Bailey, et al constantly develops hypothesis to respond to criticism but these hypothesis are not well thought out. In this case, he completely ignores that these langerhans cells are contained over the entire body. In response to that, he claims that the ones contained in the foreskin are unique in that the skin surface is not keritinized yet completely ignores that the langerhans cells on the inner lips are also not keritinized and there is no known case of oral contraction of HIV. He also claims that removing the foreskin removes the langehans cells but there is always a remnant of the foreskin after circumcision and the glans is rich in these cells.

      P.D. Hoath wrote: “Men were asked Are you circumcised? and were asked to tick No, Yes or Don’t Know. Overall, 0.9% said Don’t know by which we think they mean they do not know the word rather than not knowing whether they have a foreskin.”

      Previous research has found that up to 15% of men incorrectly identify their circumcision status. This study is well within that range. This is found even in America.

      P.D.Hoath wrote: “If circumcised men are less likely to acquire HIV than men with foreskins, then we should expect fewer of the circumcised men to have tested positive than the men with a foreskin. However, more of the circumcised men had tested positive for HIV (6.1%) than had those with a foreskin (5.0%). This small but significant difference is in the opposite direction than predicted if foreskins are contributing to transmission, and was observed in all ethnic groups and across the age range.
      The survey found no evidence to support the adoption of ‘the proportion of HIV uninfected men who are not circumcised’ as a population level target for HIV prevention programmes for gay and bisexual men.”

      The expected difference is not seen anywhere in the world. If the studies were true and correct, there would be very significant differences between circumcised and uncircumcised populations but they just do not exist. Not in gay men, not in bisexual men and not in heretosexual men. In fact, in several population demographics, just the opposite effect is found implying that circumcision fosters the acquisition of HIV/AIDS. The authors of the studies appear to be consciously ignoring this evidence implying that the studies are consciously fraudulent in an effort to expand the areas that practice circumcision. Since the researchers are epidemologists and should know this, I can only conclude this is a purposeful effort in an effort to reverse the trend of The US to abandon male circumcision. It is known that even if male circumcision were effective, it would provide an insignificant benefit in the fight against HIV.

      .

  29. P D Hoath permalink
    January 19, 2010 3:22 am

    Does anyone know if, in the Ugandan circumcision trials, the experiment started after or before the 6 week healing time for circumcision?

    If it was in the trial period, surely to have only one of the two groups not to have sex for a month and a half, in an experiment on a sexually transmitted disease, is a little silly.

    • Frank OHara permalink
      January 19, 2010 1:24 pm

      P.D.Hoath wrote: “Does anyone know if, in the Ugandan circumcision trials, the experiment started after or before the 6 week healing time for circumcision?

      If it was in the trial period, surely to have only one of the two groups not to have sex for a month and a half, in an experiment on a sexually transmitted disease, is a little silly.”

      All men started at the same time. The original study was scheduled to run 23 months but was ended at 11 months. The absolute difference reported was 1.6% of the circumcised men contracted HIV and 3.4% of the intact men contracted HIV. (I’m pulling these numbers from memory so excuse me if the numbers are not exactly correct) But the absolute difference was 1.8% or 60% as reported by the study authors. You are correct that the circumcised men would be “out of action” for about 6 weeks and that single factor could easily account for the entire difference. It has also been hypothesized that the number of HIV infections among the circumcised men were quickly catching up to those in the uncircumcised men in the study population and that this fact was the real reason the study was ended early. I have little doubt about the veracity of that charge knowing the history of promoting circumcision of the main participants in the study.

  30. P D Hoath permalink
    January 20, 2010 6:36 pm

    Has everybody else seen this video?

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