Back in August, the “Daily Telegraph” in Australia, reported on a new study by Morris and Krieger published on the “Journal of Sexual Medicine” called “Does Male Circumcision Affect Sexual Function, Sensitivity, or Satisfaction?-A Systematic Review.“. Back then, we replied: “No Morris, it doesn’t work that way“
For some reason, the Daily Mail in England has, just today, published a review of the same study, called: “It’s official: Circumcision DOESN’T affect sexual pleasure, according to biggest ever study of the issue“, authored by Anna Hodgekiss. This is interesting to the vigilant reader, as just in February 15th of this year the same newspaper published another article, this one by Claire Bates, titled: “Circumcision DOES reduce sexual pleasure by making manhood less sensitive“
Have the male genitals adapted so much in a few months, that early this year circumcision reduced sexual pleasure, but now by December it doesn’t anymore?
No, of course not. But stay with us reader, so you can see through the words of Emeritus Professor Brian Morris, who -we never get tired of repeating it- is not a medical doctor, a sexologist, an epidemiologist, a pediatrician, an urologist or anything similar, but a molecular biologist and a circumcision enthusiast, one who, apparently, manages to convince naïve or biased reporters every few months.
The one concern I have is, why is a newspaper now in December reporting about a study that was published in August? Is it just that Mrs. Hodgekiss suddenly stumbled upon it and decided to talk about it? Or is Morris trying to get his study to do a second round, perhaps frustrated about recent developments regarding his beloved mutilating surgery?
Because, unlike what Mr. Morris would like you to believe dear reader, circumcision is a multidimensional problem that can’t be simply resolved with an “evidence based appraisal”.
Circumcision, when performed for non-therapeutic reasons on non-consenting patients, becomes a human rights issue. Morris would like to cover this truth with his finger, but truth outshines him. Even the World Health Organization in its “Manual for early infant male circumcision under local anaesthesia“, an extremely pro-circ document related to the intent of circumcising 20 million African males, recognizes that:
“A concern about early infant male circumcision is that the child cannot give informed consent for the procedure. Moreover, some of the health benefits, including reducing the risk of HIV infection, will not be realized until many years later when the person becomes sexually active. If circumcision is postponed until an older age the patient can evaluate the risks and benefits and consent to the procedure himself.“
More important, just two months ago (October 1st) the Parliamentary Assembly of the Council of Europe voted on and approved a resolution that declares that:
“Despite the committed legislative and policy measures which have been taken by Council of Europe member States to protect children from physical, sexual and mental violence, they continue to be harmed in many different contexts. One category is particularly worrisome, namely violations of the physical integrity of children which supporters tend to present as beneficial to the children themselves despite evidently negative life-long consequences in many cases: female genital mutilation, the circumcision of young boys for religious reasons, medical interventions during the early childhood of intersex children …“
Where this resolution reads “religious reasons” we need to read “non-therapeutic reasons”, in other words, not with the intent of treating a condition or disease. A social or religious surgery.
A few days later, October 10th, the Nordic Association for Clinical Sexology expressed its support to the Council of Europe, and declared that:
The penile foreskin is a natural and integral part of the normal male genitalia. The foreskin has a number of important protective and sexual functions. It protects the penile glans against trauma and contributes to the natural functioning of the penis during sexual activity. Ancient historic accounts and recent scientific evidence leave little doubt that during sexual activity the foreskin is a functional and highly sensitive, erogenous structure, capable of providing pleasure to its owner and his potential partners.
As clinical sexologists, we are concerned about the human rights aspects associated with the practice of non-therapeutic circumcision of young boys. To cut off the penile foreskin in a boy with normal, healthy genitalia deprives him of his right to grow up and make his own informed decision.
Unless there are compelling medical reasons to operate before a boy reaches an age and a level of maturity at which he is capable of providing informed consent, the decision to alter the appearance, sensitivity and functionality of the penis should be left to its owner, thus upholding his fundamental rights to protection and bodily integrity.
Every person’s right to bodily integrity goes hand in hand with his or her sexual autonomy.
This statement involves two aspects: human rights, and bodily integrity. It doesn’t matter if a doctor, a researcher, or even a parent, is convinced that a part of the body of a child, a) has no function, and b) is of no value to the child. While that part is healthy and does not represent an immediate threat to the life or health of the child, it’s the child’s right to discover, explore such part, and make a determination when his mental maturity allows for it.
We mentioned back in August that Morris must have been feeling desperate with the 2011 publication of Frisch’s “Male circumcision and sexual function in men and women: a survey-based, cross-sectional study in Denmark” in 2011 and Bronselaer’s “Male circumcision decreases penile sensitivity as measured in a large cohort” early in 2013, so maybe he decided to play professor (maybe he had not retired yet at the time) and “grade” those previously published studies. Given that his coauthor, Krieger, is the author of one of such studies, it’s not surprise that Krieger’s study was the second highest graded study. We could suspect some bias.
But of course, given the recent developments in Europe, Morris and Krieger’s meta-analysis pretty much lost its momentum, so perhaps Morris found a new reporter, strategically located in Europe, with the hopes of bringing attention back to his paper and try to counter the effect of these European changes.
According to Anna Hodgekiss, the “lead author of the study, Professor Brian Morris of the University of Sydney, told MailOnline: ‘This is a ground-breaking article’“. Of course Morris would say that, given that he wrote it. One thing we know is that Morris loves to toot his own horn.
The professors found that the very high quality studies reported circumcision ‘had no overall adverse effect on penile sensitivity, sexual arousal, sexual sensation, erectile function, premature ejaculation, duration of intercourse, orgasm difficulties, sexual satisfaction, pleasure, or pain during penetration.’
In contrast, the studies which find negative effects were poor quality, Dr Morris said.
This begs the question of if the high quality studies did in fact report one way, and poor quality ones reported in a different way, or if the quality was assigned by the professors depending on what the studies reported. Furthermore, the title of “Dr” is not the appropriate one for a molecular biologist.
She continues: “He added: ‘The methodology was impeccable’” (he would say that, of course, the advantages of ranking one’s own work)
Hodgekiss provides as example the discussion of “One high-quality trial of nearly 3,000 sexually experienced men in Kenya” (surprise surprise, Krieger’s study!).
One quick observation of Krieger’s study shows three suspicious elements:
- The age range of the participants was 18 to 24 years. At this age, males are very sexually active, and even those circumcised in early infancy have not suffered the long term desensitization. Not only that, but all the participants already wanted to become circumcised, which would be a prejudice factor. This is selection bias.
- The length of the study is of only 24 months. The gradual desensitization of the glans takes much longer, which makes long term follow up almost impossible.
- One of the most surprising elements is that “For the circumcision and control groups, respectively, rates of any reported sexual dysfunction decreased from 23.6% and 25.9% at baseline to 6.2% and 5.8% at month 24“. In other words, by participating in the study, even if assigned to the control group (no treatment), the final result was a decrease of dysfunction. Exactly how is this possible?