Richard Dawkins tweeted:
What he is referring to is the video of Marilyn Milos about the sexual harm of circumcision, recorded by James Loewen.
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:
So, a new day and the news already report a new study. “Sydney researchers find that contrary to perception circumcision actually increases sexual satisfaction“. That Sydney researchers would seem to have nothing else to do but to research circumcision seems strange, until you find the same old name: Same old Professor Brian Morris, author of circinfo.net the most rabid fanatic pro-circumcision site on the web, and who is not a sexologist or a urologist, but a molecular biologist. Oh, also founder of the Circumcision Foundation of Australia and author of the book “In favour of circumcision“. Do we need to point any more bias?
But enough with Morris, let’s cut to the meat and potatoes and take a look at the abstract. The article is being published on the Journal of Sexual Medicine (how he gets publishers is something we can’t really understand).
And what is this “new” research, one would ask? Well, it’s nothing but a recycle of the same old papers. In his own words, “A systematic review of published articles retrieved using keyword searches of the PubMed, EMBASE, and Cochrane databases was performed.“
From this, 2,675 publications are identified (several of them authored by Morris himself, no doubt), and they are “rated” on their quality level, to conclude that “The highest-quality studies suggest that medical male circumcision has no adverse effect on sexual function, sensitivity, sexual sensation, or satisfaction.“. The problem is, what is the criteria for this rating? Which were the “low quality” studies and what did they reveal?
But, at this point we are not even really discussing the meat and potatoes of the subject, are we? Because, how can we evaluate sexual function, sensitivity, sensation and satisfaction, if we don’t start by defining what those are and how to measure them? Guess what, Morris didn’t.
For being a biologist, Morris willingly overlooks the question of what is sexual function, and skips the topic by going to statistics. Do you see anything wrong there?
Histological studies such as those by John R. Taylor (published in the British Journal of Urology) are evidently ignored, and most likely Sorrells’ “Fine-touch pressure thresholds in the adult penis” (also published in BJU) is most likely rated with low quality, given that Morris (and his friend Jake Waskett, a computer programmer) took it upon himself to criticize that paper by distorting, eliminating and reprocessing the data, as pointed out by Hugh Young. In fact in the Daily Telegraph’s article, Morris is quoted saying “There are no legitimate studies which have found a lack of sensitivity”. Sorry Morris, just because you don’t like the findings of Sorrells et al. doesn’t mean that it’s not legitimate. You can’t remove 20,000 soft-touch receptors from an organ and claim that there is no difference in sensitivity.
Circumcision promoters prefer to ignore Sorrells study while paying attention to Payne et al’s “Sensation and sexual arousal in circumcised and uncircumcised men” which was based on a similar methodology with a fatal flaw: Payne didn’t take sensitivity measures for the foreskin, only for the glans, thus ignoring the main difference between the circumcised and the uncircumcised penis in what can only be called “researcher’s bias” or “researcher’s prejudice”.
Anyway, the question of what constitutes sexual function is not even asked by Morris. Of course that would have to get him to explain about frenulum, ridged band, gliding function (described by Lakshman in the Indian Journal of Surgery in 1980), etc, things that he really doesn’t care to talk about… because he doesn’t have them.
So let’s be clear here.
If sexual function means simply being able to sustain an erection and ejaculate, then, in most cases there would be no difference… except perhaps at an older age (40, 50…) as keratinization of the glans progresses.
But if sexual function means that the penis works as it was intended to work:
But given that this is nothing but a “systematic review” of existing literature, then comes the question of what’s the relevance of this paper. Why did Morris even bothered looking for all these articles and writing a new paper based on no new research whatsoever?
Circumcision promoters have suffered some backslash in the recent years. In 2011 the International Journal of Epidemiology published Morten Frisch’s “Male circumcision and sexual function in men and women: a survey-based, cross-sectional study in Denmark” which concluded that “Circumcision was associated with frequent orgasm difficulties in Danish men and with a range of frequent sexual difficulties in women, notably orgasm difficulties, dyspareunia and a sense of incomplete sexual needs fulfilment.” In spite of the expected anonymity of reviewers, Morris outed himself as one of the reviewers, as the one reviewer opposing the publication of Frisch’s study, when he asked the members of his mailing list to write letters to the editor protesting the publication of the article. Quite unethical on his part.
In 2013 BJU published Bronselaer’s “Male circumcision decreases penile sensitivity as measured in a large cohort“, a study in Belgium, which concluded that “This study confirms the importance of the foreskin for penile sensitivity, overall sexual satisfaction, and penile functioning. Furthermore, this study shows that a higher percentage of circumcised men experience discomfort or pain and unusual sensations as compared with the uncircumcised population. Before circumcision without medical indication, adult men, and parents considering circumcision of their sons, should be informed of the importance of the foreskin in male sexuality“. Strangely for a study that suggest negative consequences of male circumcision, Reuters covered the study so it reached several global news outlets. In some of the media, particularly in American news sites, a critique by circumcision promoter Aaron Tobian (Johns Hopkins University college of Ronald Gray) was included in an attempt to “balance” the information (or reduce the impact of the study, we could say).
And this would be the reason why circumcision promoters needed some “new” publication to “find” that circumcision “does not affect -or actually increases- sexual satisfaction”, even if it means just recycling all the old articles, even the old and utterly debunked excuse of a “study” by Masters and Johnson from 1966 (here explained and refuted by Hugh Young).
So this is the issue. Awareness of the consequences of male circumcision has been growing. It was already reported in 1997-1999 by Tim Hammond. The past two years have seen two European articles denouncing the reported loss of sensitivity and sexual consequences of circumcision for European males and their partners. 2012 also saw the results of the Global Survey of Circumcision Harm. There is also growing awareness of the possibility of Non-Surgical Foreskin Restoration for men who feel harmed by their circumcision and wish to recover some of the function of their lost foreskin.
So obviously, circumcision promoters are not happy, especially when African men are not rushing to get circumcised as they expected them to. Aaron Tobian prepared the path for the AAP’s new Policy Statement on Circumcision by publishing his “findings” (actually a computer simulation applying premises from African data to the United States) that healthcare cost would increase if circumcision rates continue decreasing. Of course even if this was true, this unethical paper is only putting a price tag on a valuable part of the male genitalia, and most of the public could see through it. More was needed, so Professor Morris did what he knows how to do: review old information to produce new publications, while denying everything that doesn’t fit his model of the world.
Well, Professor Morris, it doesn’t work that way. You can’t deny the changes in function by simply refusing to discuss function. Good try though.
One thing we appreciate of Morris “study”, and it would be pointing us to his coauthor, Krieger JN. Professor John Krieger from the University of Washington. We’ll definitively be learning more about Krieger’s work, such as his previous 2008 study on “Adult Male Circumcision: Effects on Sexual Function and Sexual Satisfaction in Kisumu, Kenya“, which no doubt is one of the studies reviewed in this new publication, it’s not like Morris has been known for self-referencing his own publications, what’s the cost of sharing that trick with his coauthor?
One final thought is, why is it that European males report sexual difficulties related to their circumcision while African males don’t? And why is it that the perception of African males would be more relevant to English speaking countries than the perception of European males?
But let’s listen to Brian Morris for a moment, let his words give you an idea of his character. He would be quite amusing if he didn’t think he was being serious.