Tag Archives: media

The Guardian censors the discussion of circumcision

As reported by inside Man, the Guardian, in an article about FGM, warned that comments about male circumcision would be removed by moderators because “although the two issues are superficially related the effects and cultural practices/significance are very, very different”.

An individual mention in the article says, of the female activist: “She is giving a voice to those who would otherwise be silenced“. The Guardian, however, will silence those who speak for the rights of male children.

The article states: “Religious dogma is one of the toughest challenges campaigners face in the Gambia.” From our experience, religious dogma is also one of the toughest challenges in the fight against genital mutilation… of boys. See the reaction of the Anti Defamation League when San Francisco was looking to vote to age restrict circumcision in the city, or the reaction of even the highest leaders of Israel when the Parliamentary Assembly of the Council of Europe defined circumcision as a procedure that violates the rights of children to physical integrity.

The Guardian may like to see these topics remain separate debates, but they are not. They are not about males or females, they are about children’s rights. When adults raise the blade, children are powerless to defend themselves.

Shame on those who would silence those who dare speak against damaging traditions and rituals affecting the health, well-being and happiness of children.

guardian

Moderator warning commenters that comments regarding male circumcision would be deleted

Mary Jane Minkin, MD, FACOG, stigmatizes men and pathologizes a normal body part

In an interview in 2Dun’s Spread, Dr. Mary Jane Minkin, MD, FACOG, clinical professor of obstetrics and gynecology at Yale School of Medicine and staff member at Obstetrics Gynecology & Menopause Physicians, violates the ethical principle of justice by stigmatizing 70% of the males in the world, those who are not circumcised, and by pathologizing a normal body part, the foreskin, in what only can be interpreted as blatant cultural prejudice.

This starts with the media circus around the CDC proposed guidelines, of which we spoke on our previous post. The Background document by the CDC also warned (page 40):

“Furthermore, recommendations to increase rates of male circumcision in the U.S. to reduce male acquisition of heterosexually acquired HIV infection may result in stigmatization of uncircumcised men or groups of men who are not routinely circumcised should they choose to not undergo circumcision.” ~ CDC

And Dr. Minkin gives us a clear example of what that meant.

Asked by 2Dun whether “doing the deed with an uncircumcised man puts you at a higher risk for contracting an STI?“, Dr. Minkin replies: ”To be exact, yes, if uncircumcised men are more likely to get infected with [an STD], then they’d be more likely to transmit“.

Dr. Mary Jane Minkin, M.D., FACOG, stigmatizes normal men

Dr. Mary Jane Minkin, M.D., FACOG, stigmatizes normal men

Dr. Minkin tells us two lies in this statement, first, that the mere presence of foreskin makes a man more likely to get infected, and second that the mere presence of foreskin makes a man more likely to transmit an infection.

But some readers will say, “the science is sound”. What the readers are forgetting, what the AAP and the CDC often would like people to forget, is that adult individuals can make lifestyle choices. Humans have a capability to make rational decisions, we are not bound by uncontrollable instincts, we can make decisions about whether to have sex or not, whether to engage in safe sex or not, whether to have multiple sex partners or follow a more monogamous lifestyle, and all those decisions are not reflected in the presence or absence of a normal part of the body.

A high risk male has a larger chance of contracting STIs than a low risk individual, regardless of their circumcision status. The risk attitude has far more priority on the chance of contracting sexually transmitted diseases than submission to circumcision.

If the presence of foreskin immediately implied a higher prevalence of HIV and STIs, how can we explain that most countries in Latin America and Europe, where circumcision is uncommon, have a lower prevalence of HIV than U.S., where circumcision rates are prevalent?

Dr. Minkin’s second implication, that uncircumcised males would be more likely to transmit an STI, is again fallacious and stigmatizing. Infected males will transmit infection no matter what, as the virus pollutes the sperm. The presence or absence of foreskin does not alter the composition and presence or absence of virus in sperm.

Dr. Minkin then re-states her lie: “The data is certainly suggestive that circumcised males are at less risk of acquiring—and then transmitting—certain STDs” and then says the only fully true statement:”but not to the point of saying it’s okay to not use a condom.”

All sexually active adolescent and adult males should continue to use other proven HIV and STI risk-reduction strategies such as reducing the number of partners, and correct and consistent use of male latex condoms, and HIV preexposure or postexposure prophylaxis among others. ” – Recommendation #2 in the proposed CDC guidelines

It is sad and corrupt when doctors and university professors, particularly in such a prestigious university, abuse their positions to pass cultural prejudice and false beliefs as science, stigmatizing in the process the vast majority of males in the world and demonizing a normal part of the body. It is simply shameful.

We recommend that Dr. Minkin takes the time to read the full Background document and review those good old ethical principles.

P.D., would it be a surprise that Dr. Minkin is originally from New Jersey, an area with high prevalence of circumcision? And why is a doctor who is “interested in all aspects of women’s health, she has a special interest in menopause” speaking about men’s health? Does she teach her students based on her beliefs on circumcision – or in real science?

Dr. Minkin, you had a chance to educate the public on the importance of safe sex and risk management, but you wasted it to promote a social surgery. We are so disappointed.

CDC, circumcision and misleading headlines

For anyone following the issue of genital cutting of minors in the United States, yesterday brought a plethora of new and misleading headlines:

The Verge: Benefits of circumcision outweigh the risks, US CDC says

NPR: CDC Considers Counseling Males Of All Ages On Circumcision

webmed: CDC Endorses Circumcision for Health Reasons – WebMD

Salon:  CDC: Circumcision is a very good idea – Salon.com

The Raw Story: CDC to parents: Consider circumcising your sons, because

UPI:  CDC recommends circumcision procedure, says benefits

NYTimes (blog):  Circumcision Guidelines Target Teenagers – NYTimes.com

But are these guidelines really such endorsement?

Or is it that the media is hungry to present benefits and call for a universal endorsement, something that really hasn’t happened?

It is our opinion that these headlines are nothing but a feeble attempt to manipulate the public opinion, under the assumption that everybody is too lazy to go to the source materials.

Anyone wishing to produce objective reporting on the CDC guidelines should start by fully reading and understanding the 8 pages draft document and the 60 pages technical report. It is unlikely that any of the reporters lending their names to the apparently carefully scripted articles, read any of the documents.

But we did, so let’s share our interpretation.

The CDC guidelines refer to counseling. Counseling does not mean immediate and universal endorsement. Counseling means aiding a person through a decision-making process, and that is what the guidelines attempt to do, to counsel patients or parents through a decision-making process.

In this decision making process, the CDC considered 3 main categories of individuals based on the age range: neonates and children, adolescents, and adults.

The CDC also considered the sexual orientation and lifestyle choices as factors to be weighted during this decision making process. And for those willing to go deep enough (as deep as page 39 of the technical report), the CDC also gave consideration to the fact that parents deciding for a newborn raise concerns about autonomy, including the argument that “a man with a foreskin can elect to be circumcised but if circumcised as a newborn, cannot easily reverse the decision“. The PHEC  (Public Health Ethics Committee) subcommittee is, however, of the opinion that “both a decision to circumcise and a decision to not circumcise are legitimate decisions“.  This is one opinion that genital integrity promoters and people for the rights of the child would oppose though.

For those saying that the CDC is fully recommending circumcision, they probably need to read in detail where the technical report indicates that “There are advantages and disadvantages to performing male circumcision at various stages of life” and one of the listed disadvantages of neonatal circumcision is that “the newborn has no ability to participate in the decision“.

The guidelines recognize that in the case of adolescents, both the adolescent and his parents should be involved in the decision-making process.

Let’s make one thing clear. One of the main reasons for the CDC’s discussion of circumcision has to do with the African trials on circumcision and HIV, considered to be evidence that circumcision could help reduce the risk of heterosexual transmission of HIV from infected females to males. The role of the CDC is not to discuss each one of those studies and their validity, strengths and flaws, but to make their recommendations based on currently accepted medical practices and standards. So of course an important premise of these guidelines is the so-mentioned potential benefit of reducing the risk of heterosexual transmission of HIV from infected females to males. As such, it is not within our current scope to discuss the African trials, something that has been already done by others in detail, but to discuss how the CDC interpreted those trials in reference to the U.S. conditions.

When discussing adult circumcision, the CDC recognizes both the documented benefits and limitations of circumcision as part of the prevention of HIV, that is:

  • that circumcision does not replace the need for condoms and safe sex,
  • that circumcision does not reduce the risk of male to female transmission
  • that circumcision does not reduce the risk or male to male transmission,
  • that circumcision does not reduce the risk of transmission through anal or oral sex, or for intravenous drug users.

In other words, that circumcision would only curb the transmission of HIV from females to males during vaginal penetration.

So, with those premises, the guidelines recommend a discussion of the person’s HIV risk behavior, HIV status, sexual preferences and gender of the sexual partner, in order to provide proper guidance depending on individual circumstances.

The PHEC subcommittee concluded that the disadvantages associated with delaying male circumcision would be ethically compensated to some extent by the respect for the integrity and autonomy of the individual.

And what are those “disadvantages”? A slightly increased risk of UTIs during the first year of life (risk of UTIs is low and they are generally easily treatable) and the possibility of the adolescent having a sexual debut prior to counseling and assessment of risks, which could potentially expose the adolescent to the risk of heterosexually transmitted HIV from infected female partners.

The CDC then states that:

The prevalence of HIV infection in the United States is not as high as in sub-Saharan
Africa, and most men do not acquire HIV through penile-vaginal sex. Targeting
recommendations for adult male circumcision to men at elevated risk for heterosexually
acquired HIV infection would be more cost effective than offering routine adult male
circumcision. Men may be targeted according to sexual practices or an elevated
prevalence of HIV within a geographic region or race/ethnicity group.

Also, regarding sexually active individuals:

“All sexually active adolescent and adult males should continue to use other proven HIV and STI risk-reduction strategies such as reducing the number of partners, and correct and consistent use of male latex condoms, and HIV preexposure or postexposure prophylaxis among others.”

So, are these guidelines an immediate and universal recommendation for circumcision? No, as much as biased media and individuals would like it to be, it is not.

The CDC gave slight consideration to sexual effects of circumcision. Again, we need to consider that they are reviewing existing medical standards, practices and publications (and it is noteworthy that proper discussion of the male foreskin is so absent from American health books that even pictorial representations of the foreskin are missing most of the times except in the context of its removal through circumcision). So, the guidelines devote the full length of a single paragraph to the discussion of sexual effects from circumcision:

The foreskin is a highly innervated structure and some authors have expressed concern
that its removal may compromise sexual sensation or function. However, in one survey
of 123 men following medical circumcision in the United States, men reported no change
in sexual activity and improved sexual satisfaction, despite decreased erectile function
and penile sensation. Furthermore, a small survey conducted among 15 men before and
after circumcision found no statistically significant difference in sexual function or sexual
satisfaction. Other studies conducted among men after adult circumcision have found
that relatively few men report that there is a decline in sexual functioning after
circumcision; most report either improvement or no change.”

This paragraph acknowledges the histological studies of John Taylor and Sorrells’ study on fine touch pressure thresholds, but not the European surveys of Bronselaer in Belgium and Frisch in Denmark (both of which showed sexual difficulties among circumcised males), preferring instead to refer to Krieger‘s Kenyan study (which does not show the same difficulties). This begs the question of why African studies are more relevant to the sexual function and satisfaction of American citizens than European studies, but we will leave such discussion for the readers to make their own conclusions.

Finally, missing from the guidelines is any discussion of the role and functioning of the foreskin, something that could be accomplished by simple observational studies of the sexual behavior of uncircumcised males. But one could argue that the role of the CDC is to counsel on control and prevention of diseases, and not on sexuality.

I can’t avoid, however, citing this quote from the late Dr. Paul Fleiss, from his 2002 book:

“Accurate information about the foreskin itself is almost always missing from discussions about circumcision. How can parents make a rational decision about circumcision when they are told nothing about the part that will be cut off?” Fleiss. What your doctor may not tell you about circumcision

Our conclusion is that the CDC draft is far from being the universal recommendation for circumcision that biased media, organizations and individuals may wish for, it is actually more balanced on its ethical aspects than the AAP’s Policy Statement, however it is not unbiased as it still gives more relevance to African studies than European, in spite of the American circumstances being more comparable to those of Europe than to Sub Saharan Africa. The media however latches to key phrases like “benefits from circumcision” ignoring the harms and collateral effects and autonomy concerns, thus distorting the message and manipulating the public opinion.

Unspoken complications of circumcision

AAP: “Male circumcision consists of the surgical removal of some, or all, of the foreskin (or prepuce) from the penis. It is one of the most common procedures in the world. [...]Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks; [...] Male circumcision does not appear to adversely affect penile sexual function/ sensitivity or sexual satisfaction. It is imperative that those providing circumcision  are adequately trained and that both sterile techniques and  effective pain management are used. Significant acute complications are rare. [...] Parents are entitled to factually correct, nonbiased information about circumcision

AAP: “The true incidence of complications after newborn circumcision is unknown,
in part due to differing definitions  of “complication” and differing standards for determining the timing of when a complication has occurred [...] Significant acute complications are rare, occurring in approximately 1 in 500 newborn male circumcisions.
Acute complications are usually minor and most commonly involve bleeding, infection, or an imperfect amount of tissue removed.[...] Late complications of newborn circumcision
include excessive residual skin (incomplete circumcision), excessive
skin removal … ”

AAP: “Based on the data reviewed, it is difficult, if not impossible, to adequately assess the total impact of complications, because the data are scant and inconsistent regarding the  severity of complications. [...] Financial costs of care, emotional tolls, or the need for future corrective surgery (with the attendant anesthetic risks, family stress, and expense) are unknown.”

Activists monitoring social networks often encounter individual cases of complications that usually go unreported, and where evidently medical staff have done as much possible to make parents feel good regardless of the negative outcome. The previous statements mention “excessive skin removal”. While this may not sound very important because, well, “it’s just skin”, truth is penile skin has an important role in sexual life and development. And while parents are not thinking about the future sexual life of their child (except in their desire to conform to a social norm by circumcising), this excessive loss of skin results in dramatic harm to the individuals sexual life.

The skin of the penis is supposed to move during sex. In fact, it is supposed to glide over the glans, something that is almost always destroyed by circumcision. But the skin also has to be able to accommodate a normal erection. In other words, when the erectile tissue inside the penis swells with blood to make the penis enlarge and become stiff, there needs to be enough skin to accommodate its length.

When there is not enough skin, many things can happen. The penis can bend unnaturally when erect. The skin can chafe and even bleed during sex due to friction. The penis may pull surrounding skin (from the scrotum and pubic area) to make for the lack of normal penile skin, resulting in pubic hair climbing up the shaft, and potentially penetrating the individual’s sexual partner, causing bruising and tears inside. Insufficient skin can also cause part of the penis to push inward during erection (because there is nowhere else for the erectile tissue to go) causing pain during erection.

Many men who experience these complications may not seek help because they assume it’s normal, it’s what an erection feels like or looks like.

In fact, the loss of tissue due to circumcision is the reason why American supermarkets and pharmacies devote shelf space to artificial lubricants, so that men who lost too much tissue can masturbate or have sex.

In a bodybuilding forum we found one such case reported by a non-activist individual asking for advice from his peers.

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What motivates this post today is a photo found by activists today on Facebook. In that photo, a relative of a newborn reports that the baby finally left the hospital. Bleeding after circumcision was stopped, but infection is still a concern. Too much skin was removed and they are going to let it heal and follow up in two weeks, and they may use skin grafts later on.

baby1baby2

This is one of those complications that barely registers with people, one that the media doesn’t care about, one of those stories that will go unreported and unnoticed. It’s just skin. Until one day, 20 or 30 years later, baby is now an adult, and finds himself wondering why he can’t masturbate or have sex without lube. Why his skin chafes and gets sore if he tries to. Why he ends in pain if he does.

Or his girlfriend, wife, etc., wonders why she ends up with pain and burning inside her vagina after intercourse.

Oh, but it was just some extra skin, wasn’t it?

Oh, but the benefits outweigh the risks, don’t they?

I’m disgusted by the comments I see. Nobody should have to refer to a baby as a “trooper” or a “fighter” just because they allowed a doctor to harm the baby.

Notice the relative’s comment: “wish it was over for him or better yet it never happened“. Well, sad to say, but it wouldn’t have happened if it wasn’t for the circumcision. This injury was 100% preventable.

Another person says “somebody needs to answer a question about removing too much skin“. Well, they did. The AAP statement mentions the risk. Most consent forms mention the risk. They just don’t tell you how bad it really is when it happens. So parents assume that removing too much tissue is just a cosmetic problem. Not that it will involve bleeding, risk of infection (weren’t they trying to prevent infections anyway?), pain, additional surgeries… And what they don’t know yet, long term pain. During sex.

Notice the person who says one of her children had the same problem and the nurses told her that it was a “French cut” and “girls loved it“. The moment when the baby’s genitalia becomes sexualized to appease adults. This again proves that American circumcision is mostly a social fetish disguised as medicine, and that doctors and nurses will say anything to make parents feel good.

In fact, Googling “French cut circumcision” reveals that it something different. What is considered a European or French style circumcision is a low and loose circumcision, not one where excessive tissue was removed.

I’ve known many cases of men harmed in this way. Some became activists. Some have been restoring their foreskins for many years to reduce the pain.

I know a mother who had her first 3 children circumcised. She used to think the right circumcision was the one they did on her first born, the one that had a tight circumcision. Until he turned 4-5 and started expressing pain when he has erections. She is now an activist against circumcision, of course, and regrets the harm that came to her child.

Seeing this photo on Facebook today I can only think: Poor hurt baby. My heart breaks for you and all the other babies and the adults they become who were and will be harmed by this mindless unnecessary, risky and damaging surgery.

Is this harm always accidental?

A number of circumcision fetishists tend to favor “high and tight” circumcisions and often fixate on the removal of the frenulum – something which is necessarily sexual harm, given the sexual sensitivity and pleasure caused by an intact frenulum. And American doctors never mention what happens to the frenulum during circumcision – in fact the word “frenulum” is not even present on the AAP Technical Report on circumcision from 2012!

In this video, the makers of a circumcision device explain how to use their device for a tight circumcision with frenulum cauterization. In other words, to cause as much harm as possible!

One can only wonder… Why?

But they won’t answer.

 

Midwest Urology Center

Midwest Urology Center is the practice of Dr. Roger Schoenfeld, DO, in Joplin, Missouri. His website was/is http://www.midwesturology.com but more recently a different url is taking precedence: http://www.mwurologycenter.com

Dr. Schoenfeld’s website was one of the few websites by U.S. doctors that was critical of circumcision, at least until January of 2014. As of May of 2014, a redesigned website removed most of the most technical content, including the two former pages on circumcision.

Dr. Roger Schoenfeld, D.O.

Dr. Roger Schoenfeld, D.O.

The information on circumcision was presented in two pages, one for pediatric circumcision and one simply circumcision. The page on pediatric circumcision was not as complete, but the other page on circumcision contained information that was more critic of circumcision, including a lot of intact-friendly information about the functions of the foreskin and the existing cultural bias.

Because we believe this information to be relevant, and in lack of a response from Dr. Schoenfeld about the reasons for not reinstating this information, and because this information is available in the WayBack Machine, we are re-posting it.

The page on pediatric circumcision, retrieved from http://web.archive.org/web/20131011000306/http://midwesturologycenter.com/kidcircumcision.htm while not as critical, in included for completeness.

Pediatric Circumcision

Circumcision for Children:

Alternative Names: excision of penile foreskin; foreskin removal; removal of foreskin

Surgical removal of the foreskin of the penis.

Circumcision of a newborn boy is usually done before he leaves the hospital. A numbing medication (local anesthesia such as Xylocaine) is injected into the penis to reduce pain. Ring-type clamps are placed around the foreskin, tightened like a tourniquet to reduce bleeding, and the foreskin is removed below the clamp. The clamp may be metal or plastic (Plastibell). The Plastibell will fall off in 5 to 8 days, after the surgical site has healed.
Circumcision of older and adolescent boys is usually done while the child is completely asleep and pain-free (using general anesthesia). The foreskin is removed and stitched onto the remaining skin of the penis. Stitches that will dissolve (absorbable sutures) are used and will be absorbed within 7 to 10 days.

The common indication for circumcision is:

  • cultural or religious desire for circumcision.

Other indications (rare):

  • treatment for inability to pull back the foreskin completely
  • infection of the penis (balanitis)

Risks

Risks for anesthesia are:

  • reactions to medications
  • breathing problems (general anesthesia)

Risks for any surgery are:

  • bleeding
  • infection

Additional risks include:

  • injury to the penis

 

The page on Male Conditions / Genitalia / Circumcision, retrieved from: http://web.archive.org/web/20131010231240/http://midwesturologycenter.com/circumcision.htm

Circumcision

Circumcision is the surgical removal of the sleeve of skin and mucosal tissue that normally covers the glans (head) of the penis. This double layer, sometimes called the prepuce, is more commonly known as the foreskin.

Parents are encouraged to read as much as possible about circumcision. They should make themselves aware of the complexities of the circumcision procedure itself. Speak to your doctor about the step-by-step procedure. If possible, ask to observe a circumcision at your hospital, so that you will know fully what is involved.

Pictures and video of a circumcision are available on the Circumcision Information and Resource Pages (CIRP) website.

What is the foreskin there for?

The foreskin serves three functions: protective, sensory, and sexual.

In most cases, the foreskin is still fused to the glans at birth and will separate over a variable period of time over the first few years. During the diaper period, the foreskin protects against abrasion from diapers and feces. Throughout life, the foreskin keeps the glans soft and moist and protects it from trauma and injury.

Parts of the foreskin, such as the mucosa (inner foreskin) and frenulum, are particularly sensitive and contribute to sexual pleasure. Specialized nerve endings enhance sexual pleasure and control [19].

The inner foreskin (mucosa) is the skin directly against the glans. Like the lining of the mouth, this tissue is thinner and of a different texture and color than the remainder of the skin covering the penis (shaft skin). The frenulum is a particularly sensitive narrow membrane that runs down the ventral groove of the glans and attaches to the inner foreskin. The frenar band is the interface between the inner foreskin (mucosa) and the shaft skin. It often “puckers” past the tip of the glans. The band contains whorled smooth muscle fibers, giving it pronounced elastic properties that allow the foreskin to be retracted. The frenar band has a tactile sensitivity equivalent to that of the lips.
The foreskin provides ample loose skin for the penis to occupy when erect. It is a movable skin sheath for the penis during intercourse, reducing chafing and the need for artificial lubricants, and allowing the glans and foreskin to naturally stimulate each other. Warren and Bigelow described some of the physiological functions of the foreskin in sexual activity.

What are some reasons that circumcision is performed?

Circumcision is primarily performed for cultural or religious reasons.

Because a large number of men in English-speaking Western countries are circumcised, many think of the foreskin as an unnecessary part of the penis. Many circumcisions are performed because a circumcised father often does not want to feel that he is different from his son.

It is often said that a circumcised penis is cleaner, or easier to keep clean, than an intact penis. Smegma (a natural substance composed of dead skin cells, normal flora, and secretions containing the natural antibacterial agent lysozyme) is more likely to accumulate when the foreskin is present.

Medical grounds for circumcision that are most commonly cited are: Reduced risk of urinary tract infections (UTI); reduced risk of penile cancer; reduced risk of cervical cancer in partners of intact males; reduced risk of sexually transmitted disease (STD).

There is contradictory evidence in the research literature as to whether circumcision reduces UTI [16,17], but this seems to be the strongest of all medical claims in favour of circumcision, because UTI can have serious consequences. These infections can, however, in most cases be treated by antibiotics. The frequency of UTI in US male infants is approximately 1%, but is higher for females. There is evidence that babies who are breastfed have a lower incidence of UTI.

Penile cancer is an extremely rare form of cancer. It occurs mostly in older men, and most doctors will not recommend infant circumcision as a preventative measure. Penile cancer can occur in both circumcised and intact men: The Maden study (an ongoing study of penile cancer at Fred Hutchinson Cancer Research Center in Seattle) observed that 37% of penile cancer cases occurred in circumcised men.

The theory that wives of men with intact foreskins are more prone to cervical cancer has been disproven. The theory that the presence of a foreskin may cause an increased risk of sexually transmitted diseases was disproved by a new study. The question of HIV warrants further study. Although there is an apparent geographical correlation between male non-circumcision and HIV infection on the African continent, this is not true globally, and the pattern seen in Africa could easily be due to other factors.

The only known effective means of preventing HIV infection are fidelity, condom use and abstinence.

Hygiene

The foreskin is easy to care for and the intact penis is easy to keep clean. The foreskin usually does not fully retract for several years and should never be forced. When the foreskin is fully retractable, boys should be taught the importance of washing underneath the foreskin every day.

Gently rinsing the genital area while bathing is sufficient. Harsh soap and excessive washing can irritate the penis, which can lead to inflammation of the glans (balanitis).

Smegma is a white waxy substance that can appear under the foreskin. It consists of natural secretions and shed skin cells. In the past it was feared that smegma might be carcinogenic, but this has been disproven. Good general hygiene and common sense are key to preventing infection and disease.

If my son isn’t circumcised, won’t it have to be done later?

Abnormalities or diseases of the foreskin can be treated conservatively, if and when they occur, on a case-by-case basis.

Probably the most common abnormality of the penis is “phimosis”, or tight foreskin. (This is not the same as the natural attachment of the foreskin to the glans in very young children, which is completely normal.) The foreskin can normally be retracted by adolescence.

If retraction is not possible, a number of newer treatments are available which do not involve circumcision: Steroid creams, stretching, and preputioplasty. Some of these treatments have only been published recently, and not all doctors are aware of them.

If your son has a serious problem with his foreskin, such as a severe infection (balanitis xerotica obliterans) or gangrene, perhaps related to diabetes, removal of the affected area may be a medically advisable option.

If my son isn’t circumcised, won’t he be teased?

Children can be cruel, and will find things to pick on another child about, whether it be his chubbiness, glasses, or freckles. Some parents think that their son should be circumcised so that he will “match” his father, brothers, or friends. As parents, we can help our children to feel good about their bodies and to respect individual differences.

Parents often express a fear that their son will “feel different in the locker room” if he is intact. There is good evidence that proper education is the answer. Boys who are taught from an early age that they are normal, whole and healthy will have a lesser chance of suffering embarrassment in the locker room, especially if some of the other boys are also intact.

Nonreligious infant circumcision is not an issue in European, Asian or South American countries. In Canada the average rate of infant circumcision for boys is roughly 25%, with large regional variations. The rate in the United States has dropped to less than 60%, and will drop below 50% in a few years if present trends continue. This is already true in the Western US (35% in 1993).

What are some reasons not to have my son circumcised?

Your son’s foreskin is a healthy, natural part of his body. It is possible, though very unlikely, that it will cause serious problems during his life. When he becomes an adult, he may prefer not to be circumcised. Leaving your baby’s foreskin alone preserves his right to a whole and intact body.

Circumcision will be painful for the baby (see below).

The medical evidence in favor of routine circumcision of healthy babies is not persuasive. If your son has a problem with his foreskin, such as a severe infection (balanitis xerotica obliterans) or gangrene, perhaps related to diabetes, your doctor may recommend partial or complete circumcision or removal of the affected area. Phimosis (nonretractable foreskin, if it persists much longer than normal) can usually be treated by gentle stretching and/or steroid creams. The vast majority of boys will never have any foreskin problems that necessitate surgery.

Is circumcision painful?

The often repeated statement that babies can’t feel pain is not true. It is documented in the medical literature that babies are as sensitive to pain as anyone else, and perhaps more so.

Most circumcisions are performed without anaesthetic, because there are risks involved with using anaesthetics on babies. Sometimes local injections are used, but this does not eliminate pain. Most babies will show signs of pain during the procedure and in the week or ten days following circumcision. Recent studies have shown that the pain is remembered long beyond the time of the procedure itself.

While pain may help parents decide against circumcision, parents should look at the long term effects of their decision first, not only during infanthood, but all the way to adulthood. Your decision will affect your son for the duration of his life.

Does infant circumcision have risks?

Circumcision is surgery, and like all surgery it has risks. These include:

  • Excessive bleeding
  • Injury to the glans
  • Infection (raw wound is exposed to feces and urine in diaper)
  • Complications from anaesthesia, if used
  • Surgical error, including removal of too much skin
  • In rare cases, complications can be life-threatening.
  • Up to 20% of circumcised males will suffer from one or more of the following complications, to some degree:

Meatal stenosis (narrowing of the urethral opening due to infection and subsequent scarring, that occurs almost exclusively in circumcised boys) extensive scarring of the penile shaft skin tags and skin bridges bleeding of the circumcision scar curvature of the penis
tight, painful erections psychological and psychosexual problems
The surface of the glans becomes dry if not protected by the foreskin. It is believed that dryness and abrasion may cause progressive loss of sensation in the glans, especially in later life. Circumcised men on the whole do enjoy sex and are able to orgasm.

What if we want to have our son circumcised?

Circumcision does not need to be done right away. There is no need to feel pressured by your doctor. Take your time.

If you intend to ask your doctor to have your son circumcised, ensure that the procedure is carried out by an experienced surgeon. Sometimes circumcision is considered “minor surgery” and inexperienced residents are given the task of performing it. This leads to a higher rate of serious errors and complications.

You may desire that your son will retain some inner foreskin, and especially the frenulum, to preserve as much sexual sensitivity and function as possible. Another method is the dorsal slit. This method does not involve the removal of tissue, but allows the glans to be exposed.

Your doctor can help you decide how much skin will be removed and how much of the glans should remain covered if desired. However, in most cases, once your signature is on the consent form, the physician has absolute license to execute the circumcision as he/she sees fit. You must ensure that your intentions are in writing before the operation occurs.

To lessen the pain, speak to your doctor about the use of an anaesthetic for your baby.

When and why was routine neonatal circumcision introduced in English-speaking Western countries?

Doctors in the English-speaking countries started circumcising babies in the mid-1800s to prevent masturbation, which some doctors claimed caused many diseases, including epilepsy, tuberculosis and insanity. Of course, these arguments are not accepted today.

Where can I get more information?

The organization NOCIRC can provide help and advice, as well as free telephone referral of physicians in your area who are trained in the proper care of the intact penis. Telephone (415) 488-9883, or write to: NOCIRC, P.O.Box 2512, San Anselmo CA 94979-2512, USA. A list of local NOCIRC centers in the USA can be found at the NOCIRC Website: http://www.nocirc.org/

CIRCUMCISION, PROSTATE CANCER, and AUTISM: Misleading Headlines and Selective Reporting

A few months ago, in reference to the publication of an article by Brian Morris on Mayo Clinic Proceedings, we argued that:

Media headlines are used to manipulate the general opinion by using the more dramatic claims from the abstract to embed them in the collective consciousness. Most people will not read past the headlines, and will reach their conclusions based on this limited information. Few reporters and authors dare to criticize peer reviewed publications.

We recently saw this phenomenon at work again,  regarding a possible link between circumcision and prostate cancer. A combination of fear-mongering and wishful thinking are being used to promote America’s favorite forced genital surgery. We are also listening to the deafening silence regarding a study that correlated the use of paracetamol during routine infant circumcisions with increasing rates of autism, arguably because the media has no interest in reporting negative side effects from circumcision procedures.

Prostate Cancer

Let’s take a look at the headlines:

June 4th, 2014. Fox News: Circumcision Linked to lower risk of prostate cancer 

May 30, 2014. Daily Mail. Circumcision reduces the risk of prostate cancer by up to 60% – but is most effective when done after the age of 35

Apr 7, 2014. Science Daily: Circumcision could prevent prostate cancer

Apr 11, 2014. Men’s Health. Should You Get Circumcised? New research suggests a surprising benefit to getting snipped—but here’s why we’re skeptical

Jun 5, 2014. Jerusalem Post: Study links circumcision, lower rates of prostate cancer

May 29, 2014. Medline Plus: Lower Risk of Prostate Cancer Seen in Circumcised Blacks: Study. But findings still preliminary, need confirmation (linked by National Institutes of Health)

Apr 8th, 2014. Prostate Cancer UK: Not enough evidence to suggest that circumcision could reduce risk of prostate cancer

All of these headlines and more, are in reference to a single paper:

March 24, 2014
BJU. Circumcision and prostate cancer: a population-based case-control study in Montréal, Canada
Spence AR1, Rousseau MC, Karakiewicz PI, Parent ME.

 

Marie-Élise Parent

Marie-Élise Parent

So, you can see, dear readers, the disparity in the headlines. “Could prevent“, “Linked“, “Reduces the risk“, “Links“, “Lower risk is seen“, “Not enough evidence“. Some of the headlines appear to be conclusive (“reduces the risk“, “linked“, “links“), some are conditional (“could prevent“) and a few are skeptical (“not enough evidence“). Depending on which media outlet you read, you may get a different impression just from reading the headline.

So what does the study really say?

The results of the study read: “Circumcised men had a slightly lower risk, albeit not statistically significant, of developing prostate cancer“. Among the conclusions: “Circumcision appeared to be protective only among Black men, a group that has the highest rate of disease.

In Sense About Science, Dr Matthew Hobbs, Deputy Director of Research at Prostate Cancer UK responded to the study saying:

Although this study appears to show that circumcision after the age of 35 could reduce your risk of prostate cancer, the evidence presented is nowhere near strong enough that men should begin to consider circumcision as a way to prevent the disease. While the total sample studied was large, the number of men who had been circumcised after the age of 35 was very small, so this should not be seen as strong evidence of an association. There was no statistically significant association between prostate cancer and circumcision for men circumcised at all other ages. No reason was collected for circumcision, so we can’t say if the association is with circumcision later in life or with whatever causes men to have circumcisions after that age. It is also highly likely that diet, lifestyle, socioeconomic status and healthcare behaviours may have played a role in skewing these results.” – See more at: http://www.senseaboutscience.org/for_the_record.php/148/quotcircumcision-cuts-risk-of-prostate-cancer-by-45quot#sthash.w3uMSk3Y.dpuf

While the main benefit boasted in the study has been for black males circumcised over the age of 35, Fox News cites Dr. Christopher Cooper, a professor and urologist at the University of Iowa, declaring that ”The number of black men studied was too small for any conclusions to be drawn. Only 103 of the participants with prostate cancer were black men, and only 75 of the healthy men in the comparison group were black.“. The Fox News article finishes quoting one of the researchers, Marie-Elise Parent, saying: “We are too early in the game to make it a public recommendation. It could be that in the future it will be confirmed that it’s a good thing and may have an added protection from other diseases“.

Being early, however, didn’t stop the media from planting the idea that circumcision prevents prostate cancer, through the use of misleading and manipulative headlines.

The Daily Mail also cites Dr. Parent saying: “We do not know why a protective effect was observed for men circumcised after the age of 35. These men may have had a pathologic condition of the foreskin that lead to them being circumcised“.

Medline Plus quotes Dr. Parent cautioning that the black men in the study, mainly of French descent, may not reflect black men as a whole. And she said the study included few men who were circumcised at a later age, so that finding is potentially questionable. (Only potentially?)

Some of the articles indicate that the researchers suspect the connection may be a “lower rate among circumcised men of sexually transmitted diseases (STD), which raise prostate cancer risk” but they are not conclusive.

To this, Fox News cites Dr. Christopher Cooper, a professor and urologist at the University of Iowa indicating that the number of black men studied was too small for any conclusions to be drawn, and saying: “The STD mechanism is possible but quite a stretch“. He pointed out that there were factors the researchers could not control in the study, such as how honest participants were about having STDs or, among the men circumcised as adults, the reason for their circumcision.

Medline Plus cites Dr. Stephen Freedland, urologist and associate professor of surgery and pathology at the Duke University School of Medicine in Durham, N.C., pointing out that men circumcised after age 35 are unusual. “They’re usually older guys who are sick and have medical problems,” he said. The study findings as a whole aren’t convincing, Freedland added, especially since it included relatively few black men — just 178 of more than 3,100 participants. “I don’t think we’ll be recommending massive circumcisions to prevent prostate cancer,” he said. “And men shouldn’t go around thinking, ‘I’m circumcised, therefore I’m safe from prostate cancer.‘”

Men’s Health adds a healthy dose of skepticism: “…if this study was done in a healthy population, you might get different results.

What is important to know is that the authors of the study do not explain why there would be such a protective effect, do not claim their results to be statistically significant, and furthermore acknowledge that the sample of black males over 35 was small. So, in other words, this study is very far from being conclusive, or even useful for the general public at all. If anything, this study could motivate further studies, but as for being applicable right now, it is not, and it would be irresponsible to act based on it. The media circus around this overall pointless study is atrociously misleading.

Autism

In the meantime, Environmental Health published a study last year about prenatal and perinatal analgesic exposure and autism. This study found correlations between indicators of prenatal and perinatal paracetamol exposure and autism/ASD. While the available data cannot provide strong evidence of causality, biologic plausibility is provided by a growing body of experimental and clinical evidence linking paracetamol metabolism to pathways shown to be important in autism and related developmental abnormalities.

While the abstract and title themselves do not specify circumcision, there is a detailed analysis of circumcision rates in the full text of the study. As our readers may remember, anesthesia during neonatal circumcisions was not common until a 1997 randomized controlled trial had to be halted due to trauma from pain. Lander et al’s early terminated study suggested that pain control should be administered prior to circumcision and that ring block was the most effective method.

Fast-forward to 2013, Bauer and Kriebel analyzed country-level data for the years 1997-2006, and found a strong correlation (r = 0.98) between circumcision and autism spectrum disorder prevalence rates for boys born after 1995, around the time when circumcision guidelines began recommending analgesia for routine infant circumcision. The slope of this trend for 9 countries with available data indicates that a change of 10% in the population circumcision rate was associated with an increase in autism/ASD prevalence of 2.01/1000 persons (95% CI: 1.68 to 2.34).

Again, when evaluating circumcision data for the United States, it is sobering to remember that approximately 1.2 million baby boys are circumcised every year. Could the use of paracetamol be causing autism and autism spectrum disorders in 2,400 baby boys annually?

A comparison of autism rates in boys and girls  found that male to female prevalence ratio increased from 3.9 to 1 prior to 1995, to 5.6 to 1 after 1995. The researchers suggested biological plausibility based on the infant’s lower capacity to metabolize drugs due to the underdevelopment of the glucuronidation pathway and inefficiency and immaturity in renal function.

So, basically we find two positions, one that circumcision without anesthetics is severely traumatic, and another one, that commonly used analgesia can increase rates of autism.

In spite of this strong data, practically no media outlets published any articles about this study and its implications on newborn circumcision.

In Summary

In summary, we have two studies that looked at correlations. One was not statistically significant; the other was. One did not offer a biological plausibility, the other one did.

And yet, which one got extensive media coverage? The one that suggested a benefit from newborn circumcision.

The Skeptic – Does science support infant circumcision?

We often criticize Brian Morris’ methods and advocacy of circumcision, particularly his underestimating of risks and complications, his denial of the harm, his overestimation of benefits, and his recurrent self-referencing.

It’s good to read others who share our concern. This is a great article by Brian D. Earp and Robert Darby, published on The Skeptic: http://www.skeptic.org.uk/magazine/onlinearticles/articlelist/711-infant-circumcision

It calls attention to an interesting contradiction. Morris argues for circumcision to avoid having to treat urinary tract infections with paracetamol (pain medication) in light of new studies that associate early exposure to paracetamol with an increase in the risk of autism… yet fails to correlate the fact that paracetamol is used after newborn circumcisions.

Anyway, great read. It’s sad that people are still being fooled by Brian Morris’ air of respectability and the scientific community continues playing his game and not exposing his pseudoscientific arguments. Really sad.

Council-of-Europe

Council of Europe says circumcision violates children’s right to bodily integrity. Reaction of biased media


In a matter of days, Norway, Denmark and Sweden expressed their intention to regulate or ban the circumcision of minors. After individual countries, the Nordic ombudspersons (Norway, Denmark, Sweden, Finland and Iceland), joined by Greenland, agreed to work with their governments to achieve a ban of non-therapeutic circumcision of underage boys.

Dorsal slit during neonate circumcision

This was followed by the council of Europe voting and approving a resolution against practices that violate children’s right to physical integrity (bodily integrity, genital autonomy), such as female genital mutilation, early surgery on intersex children, forced piercing and tattoos, and yes, circumcision of boys in lack of medical necessity.

Infant circumcision (non-therapeutic)

Genital surgeries on intersex children

Underage tattoos on Coptic Christians

Piercings on non-consenting children

Female genital mutilation

Day of Ashura

Pharaonic circumcision, one of the worst forms of female genital mutilation

 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 as well as the submission to or coercion of children into piercings, tattoos or plastic surgery.

The Parliamentary Assembly should urge member States to promote further awareness in their societies of the potential risks for children’s physical and mental health of the above-mentioned procedures. Member States should take legislative and policy measures that help reinforce child protection in this context by giving primary consideration to the best interest of the child.

Council of Europe 

I kept looking for press coverage of this resolution. The day before the debate some Jewish media reported on the upcoming vote. After the approval, there was a day of silence, followed by numerous articles in Jewish sites criticizing it for promoting racism and Antisemitism.

Some blogs, men rights groups, secular groups and atheist groups covered the topic.

The mainstream media remained silent on the topic.

One day later Reuters and Associated Press started reporting, but interesting enough, the articles were not about the resolution or about children’s right to bodily integrity. The articles were about Israel criticizing an anti circumcision resolution by an European organization.

Could this be a strange coincidence? An oversight? Or is there somebody or some organizations interested in manipulating opinion to keep the impression of legitimacy over the genital cutting of boys?

For me this was incredibly enlightening how a biased media can manipulate people’s opinions on different topics. I hope that aware readers will see behind the veil. The culture is changing and even attempts to conceal this do nothing but reveal the clues to those who keep their eyes wide open.

10 reasons German Socialists want Europe to ban circumcision of male children