ADVERTISEMENT
  About the SA Blog Network













Bering in Mind

Bering in Mind


A research psychologist's curious look at human behavior
Bering in Mind Home

Hey, Andrew Sullivan, Stop Calling My Penis “Mutilated”

The views expressed are those of the author and are not necessarily those of Scientific American.


Email   PrintPrint



 

Photo credit: http://en.wikipedia.org/wiki/Andrew_Sullivan

Andrew Sullivan, gay political pundit and blogger at The Daily Beast, lobbed some rather nasty insinuations my way last Wednesday. He was flabbergasted that any fellow gay man could possibly think that infant male circumcision is justifiable. “The whole thing is madness,” wrote Sullivan, disgusted with the very thought of it. Now before I respond, here’s some of the context behind this spat.

Two years ago, here at my Bering in Mind column at Scientific American, I reviewed some of the science and bioethical issues associated with the always-incendiary topic of infant male circumcision. In that earlier piece, titled “Is Male Circumcision a Humanitarian Act?” I highlighted some research from the past decade elucidating the now established fact that rates of HIV acquisition are significantly lower among circumcised heterosexual males, namely because they lack the high concentration of target receptor cells for the virus found on the inner mucosal surface of the prepuce. This anti-HIV effect is dramatic; it is at least on the magnitude of a 60 percent reduction in this demographic. Most of this research was conducted with African populations, but not exclusively so, nor has every study been equally incontrovertible.

About a week ago, I was asked by Discover magazine to revisit this topic in light of the controversial revised position statement of the American Academy of Pediatrics, which had just been published in the journal Pediatrics a few days earlier. The AAP task force, comprised of an accomplished team of pediatric bioethicists, epidemiologists, urologists and anaesthesiologists, along with consultants from the Centers for Disease Control and Prevention, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists, analyzed hundreds of peer-reviewed scientific studies published between 1995 and 2010, including the HIV findings that I’d gone over in my original Scientific American piece. The consensus regarding this cascade of new datasets—all of which, they claimed, they went over methodically with a fine-toothed comb—moves the AAP away from its historically noncommittal view and towards a clear stance that the benefits of infant male circumcision now unambiguously outweigh its minimal risks when performed under sterile conditions by properly trained physicians.

The AAP has not strayed from their message that the decision is to be made by parents only. Yet the Academy’s endorsement of infant male circumcision as a minimally invasive prophylactic medical procedure offering potentially major health benefits makes it aligned—and unapologetically so—with a growing body of other formidable organizations, including the World Health Organization and UNAIDS.

In my editorial at Discover, I concurred with the AAP’s scientifically updated view. Sullivan read my piece and, in a post he chose to label with the deliberately rabble-rousing title, “Attacking Sexual Pleasure at Birth,” he cited dubious survey data suggesting negligible sexual problems in circumcised adult males, then wrote this:

Jesse Bering thinks parents should follow the American Academy of Pediatrics’s recommendation on male genital mutilation. Yes, I have seen someone slowly succumb to AIDS and it wasn’t because they were uncircumcized. It was because we had no treatments for it. The 60 percent number is from female-to-male transmission in Africa – with very very limited application in the US. It’s rare to read a gay man who still echoes the HIV-phobia of the 1980s – but Bering’s irrational panic is pretty glaring. And the notion that in order to prevent infection via a body part, you just remove that body part after birth is equally bizarre. Can you imagine … forcible prophylactic mastectomies to prevent breast cancer? This whole thing is madness. Mutilation of any part of an infant’s body should only be for vital immediate health dangers, not nebulous future threats, which the person could choose for himself later, if he so wanted. It’s only the foreskin and the clitoris that can be treated this way – and rational people defend the barbaric. And by the way, why doesn’t Bering demand his unmutilated partner to remove his own foreskin to lower the chance of HIV infection? Because this kind of barbarism could only be done to infants and be defensible.

There’s so much propaganda stuffed into Sullivan’s commentary that I’m not entirely sure where to begin. I should point out, before going any further, that my first choice in addressing this would have been to reconcile our differences privately. Having just finished a series of fun interviews for his Dish blog at the Daily Beast, I thought that Sullivan would at least respond to my friendly email about his rather personal post. Even a “well, let’s just agree to disagree” quick exchange would have gone far. But I heard only steely silence. My participation in the “Ask Jesse Bering Anything” video series was by his invitation, so if he feels so strongly about infant male circumcision, I’d have thought he’d have been aware of what I wrote on this subject two years ago (it’s been up at Scientific American all this time, after all). My Discover piece doesn’t waver from that earlier position; it’s merely a reiteration of my personal opinion that, knowing what we do now, and with a rationale no longer linked to indefensible, archaic religious customs, infant male circumcision is—to me—the more humane choice for parents facing this hard decision. Anyway, what I write below is the result of Sullivan’s revealing muteness. It’s not the way that I’d have preferred this go.

With that in mind, what on earth does my being gay—our being gay—have to do with anything at all? It certainly doesn’t affect my ability to critically evaluate cumulative, peer-reviewed studies conducted by leading specialists in their fields. Or would Sullivan prefer I do as he does, which is to skim cherry-picked abstracts through his confirmation-biased lens, something that, contrary to unfounded accusations levelled against them, the AAP did not do? Or perhaps like Sullivan, I should swallow whole the angry, emotionally flooded baby-harming message that litters intactivist websites, blog comments and Twitter feeds, all while brazenly turning a deaf ear to the measured and—more importantly—knowledgeable advice of world-renowned bioethicists serving at their own peril (given the vitriol of those like him regarding this subject) on expert panels working for the public good, and which are governed by the admirable, if impossible, goal of balancing ethics and objectivity?

Does Sullivan believe that, because I’m gay, I shouldn’t be concerned whatsoever about HIV/AIDS in heterosexual males, but rather only in gay males like us? That this is their problem and not our problem? That’s quite a limited style of humanitarianism, if so. He also apparently hasn’t read some of the latest research indicating that male circumcision may reduce the likelihood of HIV acquisition in insertive-only gay males (“tops”) similar to straight males engaging in penile-vaginal sex. Or is Sullivan saying that because there are effective treatments for HIV now, any fear of HIV in the gay male community today must therefore be “panicky” and irrational? My own fears are entirely irrelevant to the arguments that I made, but in fact Sullivan is right that, while it may no longer be the 1980s, I’m still scared shitless by HIV. I’ve written about my relationship with AIDS before, and my paranoia is something, admittedly, I’ll probably never escape entirely. But I’m also a Type I diabetic on a writer’s salary, already paying a small fortune (one that exceeds my mortgage payments) for private health insurance just to keep myself alive with insulin and other basic medical supplies. Both of my parents had heritable forms of cancer at young ages, and that places me at heightened risk of other life-threatening illnesses. Adding HIV into the mélange of my worries is, indeed, scary as hell to me. Sullivan ought to do a little navel-gazing before traipsing any further into his fury—he is exceedingly fortunate to survive as an HIV-positive Brit in the US with employee-provided healthcare.

The circumcision debate is not my cause célèbre. I’m just a science writer who was asked to weigh in on the AAP decision in an editorial. Yet I confess, this whole issue really is starting to perturb. The righteous indignation of those who casually employ such mutilation rhetoric should be turned right back against them by those of us who are, in fact, circumcised males and do not appreciate being called “mutilated” or made to feel as if we are inferior or less desirable as sexual partners simply because we lack a foreskin. Likewise, women (or men) in healthy, positive sexual relationships with circumcised men should really be speaking up more loudly on behalf of their partners.

Sure, there are circumcised men out there who wish they still had their foreskin. There are people who have issues with everything when it comes to bodily issues. There are also plenty of men who have suffered from god-awful infections and only wish today that their parents had them circumcised as infants. The vast, vast majority of circumcised men who had the procedure done in infancy feel neither “violated” nor “mutilated.” To say that it’s the least of our worries is a monumental understatement. We have zero complaints about our sexual function, we are by no means jealous of men with foreskin (and smegma), and we feel absolutely no shame about our circumcised penises, in spite of the fact that the intactivists (an aggressively vocal minority that is, incidentally, overwhelmingly comprised of women and non-circumcised men who have no insight whatsoever into what it’s like to be a man who had his foreskin removed during a developmental stage that guarantees he has no memory of it) have made it their mission in life to convince us that we should be.

Not everyone sees infant male circumcision as an important issue for our collective conscience to be grappling with. Nor do most conceptualize it as “genital mutilation,” least of all those of us who have actually been circumcised as infants and should arguably be the ones deciding whether what was done to us deserves to be classified as a human rights violation. Even if you insist on casting it in this light, parents today who opt for circumcision are saving their sons from having to decide as adult males, with adult male genitalia (and thus with much more elaborated, intricate veinal and nerve systems in their reproductive organs), whether or not to undergo a qualitatively more complicated and expensive medical procedure as a “consenting adult.”

Sullivan trots out the standard intactivist party line, which is to compare infant male circumcision with the removal of some critical body part as a pre-emptive measure. “Can you imagine … forcible prophylactic mastectomies to prevent breast cancer?” he writes, astounded by my and the AAP’s stupidity. Notice how intactivists like to sneak in loaded words like “forcible” to trump up the false horror. Nobody is “forcing” parents to circumcise their infant sons. I’ve stressed repeatedly that I am not “pro-circumcision” but “pro-parent choice,” and the AAP has emphasized the same. Sullivan would have you believe that male circumcision is now occurring by government decree. We can play runaround mind games all day long about parents being okay with the removal of some body parts in our culture and not others. Perhaps I’m just not tapped in, but I’ve certainly not seen any activist communities take on the cause of prophylactic wisdom tooth removal in adolescents, or better yet, the non-health related extraction of fully functional teeth to make way for braces and create an aesthetically pleasing smile. Like foreskin, permanent teeth are permanently removed. And guess what, also like foreskin, while the risk of complications is present for any invasive procedure, their judicious removal doesn’t really make much, if any, difference for the individual’s quality of life either.

But here’s why Sullivan’s little thought experiment really had steam coming out of my ears. When I was in elementary school, my mother had a double mastectomy—one breast contained a malignant tumor that had already metastasized to her lymph nodes and the other breast harbored a precancerous growth that may or may not have done the same, and so she followed the surgeon’s advice to have that one removed a few months later as a preventative measure, which was not an easy decision. She endured years of chemotherapy, and I have clear memories of clumps of her hair falling out in my hands while she vomited her guts out over the toilet. This was followed by the brand new trauma of deciding to undergo breast reconstruction surgery—she was still a young woman, after all—with areolas formed by skin grafts from her inner thighs. (She died of a different cancer several years later.) For Sullivan to so breezily liken my complete non-issue of being circumcised as an infant to my mother’s devastating experiences in her mid-thirties with prophylatic mastectomy is the height of an emotionally addled arrogance masquerading as “obvious” logic.

Furthermore, infant male circumcision is not, as Sullivan would have you believe, the moral equivalent of female clitoridectomy. That analogy would only apply if, say, circumcision meant the removal of the actual glans penis (the “head”) and if it were done not in the best health interest of the child, but instead to eliminate his capacity for any future sexual pleasure. So to compare removal of the male foreskin with that hideous practice of clipping off the clitoris is, at best, a show of remarkable naiveté regarding human reproductive anatomy. At worst, it is patent dishonesty by a rhetorician that is designed to exploit the emotions of more ignorant others. I’ll let you decide which of the two Sullivan is guilty of in juxtaposing foreskin with clitoris.

Even minor diminution of sexual pleasure is far from being an obvious result of male circumcision. Until some clever cognitive scientist comes up with a way to operationally define the subjective degree of “mind-blowing” sensitivity often claimed to be experienced by uncircumcised intactivist men, above and beyond that felt routinely by lifelong circumcised males, I remain thoroughly unimpressed by this particular argument. In fact, the limited data that do exist on this subject dispute such a claim. A thermal imagining study conducted in 2007 revealed no difference between the sensitivity of circumcised and uncircumcised erect penises in males between the ages of 18 and 45. In fact, this alleged difference in pleasure-qualia also fails to find much anatomical support. In a systematic critique of anti-circumcision arguments currently in press at the Journal of Law and Medicine, Richard Wamai and colleagues write that, “Of all glabrous (hairless) regions of the body, the foreskin has the lowest number and least sophisticated Meissner’s corpuscles (touch receptors). More important, though, is the fact that sexual sensations are mediated by genital corpuscles, not Meissner’s corpuscles, and these are absent from the foreskin.”

I don’t need someone else to tell me what I should be outraged by, Sullivan, thank you very much. It’s certainly not going to be in response to already stressed-out parents acting sensibly as their child’s health advocate and appealing to the ethical directives of professionals, rather than online blowhards who think that repeatedly referring to an act with an amygdala-fuelled term like “mutilation” makes it so. If you want your child to be at an increased risk of urinary tract infections, herpes, genital ulcers, HPV and HIV, that’s entirely your choice, and feel free to celebrate with other science-denialists sharing similarly misplaced passions. But spare me your righteous indignation over those parents today that fail to see their benevolent, educated decision to circumsize their infant sons as an “attack on their sexual pleasure at birth.”

Delivering upon new parents such a guilt trip is simply loathsome.

Jesse Bering About the Author: Jesse Bering is Associate Professor of Science Communication at the University of Otago in New Zealand. He is the author of The Belief Instinct (2011), Why Is the Penis Shaped Like That? (2012) and Perv (2013). To learn more about Jesse's work, visit www.jessebering.com or add him on Facebook (https://www.facebook.com/jesse.bering). Follow on Twitter @JesseBering.

The views expressed are those of the author and are not necessarily those of Scientific American.





Rights & Permissions

Comments 61 Comments

Add Comment
  1. 1. ellensandbeck 4:06 pm 09/10/2012

    I’ve been reading up on the subject of neonatal circumcision for many years, and wrote about it in my book “Green Barbarians.” I’ve married to a circumcised man (who, at age 63 is FABULOUS in bed, thank you very much) and 27 years ago our newborn son was circumcized in the hospital, by a surgeon–there was absolutely no way I would have not had any son of mine circumcised, because while growing up I had heard way too many stories from my mother about the many many soldiers during WWII who had to have emergency circumcisions because the abysmal sanitary conditions in the trenches had induced hideous infections.

    You forgot to add another disease that is prevented by neonatal circumcision (completely prevented, it never occurs in men who were circumcised as infants)—that disease is penile cancer. Sometimes the only way to save the victim’s life is complete amputation.

    Link to this
  2. 2. Ronald Goldman, Ph.D. 4:26 pm 09/10/2012

    For an insightful, surprising, and informative response to the AAP report see http://www.circumcision.org/aap.htm .

    Link to this
  3. 3. DickScalper 4:44 pm 09/10/2012

    They brand men like a herd of cows. “Neonatal post-traumatic stress disorder” — the recurrent American nightmare for boys. American men are such wimps to let their sons be subjected to this absurd surgery. If it were women tied down & cut, the Feminists would be howling all over the world. The male genitals are a cheap commodity. There is no argument too absurd for the circumcisers. They insult the appearance of the intact penis, claim that circumcision heals everything from body warts to HIV, and draw an illogical distinction between female & male genitals. Circumcision is the mark of a slave, not a free man.

    Top Ten Tortures Less Painful Than Circumcision

    10. Get waterboarded.
    9. Pull out your fingernails.
    8. Eat a pile of steaming bear crap.
    7. Skin yourself alive.
    6. Fall into a vat of molten iron.
    5. Get run over by a train.
    4. Go through a sausage grinder.
    3. Saw off your legs.
    2. Poke out your eyes.
    1. Go To Hell

    ~Dick-Scalper

    Link to this
  4. 4. Yahooey 5:29 pm 09/10/2012

    Thanks for the wonderfully rational and informative article on a sensitive subject (pun intended).

    Link to this
  5. 5. grandpagus 6:09 pm 09/10/2012

    Of much more concern is melanoma, which will kill 8000 this year.
    In a recent study of 2,785 patients, the ears were the third most frequent location for basal cell carcinomas. Of the 269 ear basal cell carcinomas, 39% (105) were located at the preauricular crest (in front of ear), 36.5% (99) on the posterior auricle (back of ear), and 24.2% (65) on the helix (rim) of the ear.

    Since men have 88% of the ear cancer, we should circumcise the exterior ear to reduce risk.

    Circumcision hurts babies. Listen to them cry when they are cut. It leaves psychological scars- why are the Jews and Muslims at war? They were all circumcised as babies and view the world as a dangerous, painful place.

    Link to this
  6. 6. Hugh77 9:06 pm 09/10/2012

    “to skim cherry-picked abstracts through his confirmation-biased lens, something that, contrary to unfounded accusations levelled against them, the AAP did not do?” Yes they did. I go into the policy in detail at http//tinyurl.com/aapanno . Examples:

    They never discuss the structure or function of the foreskin, in fact the word “remove” comes before its first appearance. (And citing a study of adult volunteers for circumcision in that sexual paradise for gay men, Uganda, which found that heterosexual satisfaction went from bloody marvellous to absolute perfertion for both intact and circumcised, does not constitute “discussing its function”.)

    The words “frenulum” “ridged band” and “condom” do not occur in the policy.

    They cite the Sorrells study on penile sensitivity – the ONLY study to specifically measure foreskin sensitivity – and ignore its main finding, that “circumcision ablates [removes] the most sensitive part of the penis”, instead quoting without attribution a critique by two circumcision fanantics, Brian Morris and Jake Waskett, about the sensitivity of the rest of the penis, that ignores the inconvenient foreskin finding.

    Penile cancer? “However, another study with fair evidence estimates that more than 322 000 newborn circumcisions are required to prevent 1 penile cancer event per year. This would translate into 644 complications per cancer event, by using the most favorable rate of complications, including rare but significant complications. The clinical value of the modest risk reduction from circumcision for a rare cancer is difficult to measure against the potential for
    complications from the procedure. [Translation: it's not worth doing.] In addition, these findings are likely to decrease with increasing rates of HPV
    vaccination in the United States.” They ignore this.

    Penile cancer is rarer than MALE breast cancer so it would make more sense to cut of male baby breast tissue than the foreskin. It’s not about your mother. Testicular cancer could be halved with little effect on fertility by routine neonatal hemiorchidectomy, but we just don’t do it.

    They repeat the common claim that adult circumcision is more risky and painful than neonatal, with no evidence. They never actually crunch the numbers of risks vs benefits, just examine all the benefits they possibly can – some not even worth mentioning – and gloss over the risks: they have no figures at all for major complications and death!

    “Nobody is “forcing” parents to circumcise their infant sons.” But the infant sons are being forcibly circumcised, so it’s just the same for them, and they are the ones most directly affected, in fact the only ones directly affected.

    All right Jesse Bering, I won’t use the M-word about your penis. Feel better now? But circumcising still cuts off the best part. It’s not us you should be angry with about that.

    Link to this
  7. 7. cdzintempe 9:32 pm 09/10/2012

    Well, here is a woman’s opinion. I am married to a circumcised man for over thirty years and our sex life has always been fantastic and satisfying for me and when asked my husband agrees (perhaps this is the answer he thinks I would like, but whatever).

    But, the real crux of this decision is, as with another hot-button issue, the power of choice. Just as those who do not believe in abortion want to take away everyone else’s ability to choose that path for whatever personal reasons they may have, those who do not believe in circumcision want to take away the ability for any parent to ever decide on that path. The ability to choose is a valuable commodity. One can not only choose to do something, but one can choose NOT to do something also. All made possible by the power of choice. Just as I would never try to convince someone who does not believe that abortion should be allowed for whatever personal reasons they may have that they should choose abortion,I do not think that someone who does not believe in the efficacy of circumcision should take away the choice from those who do.

    People will not agree on everything, ever. Even in the face of some compelling medical information people still choose not to have children vaccinated, take all or their prescriptions, etc. The power of choice is taken for granted in this country, but there are many places where people/parents do not have the ability to make choices.

    So, I would never make someone circumcise his/her son if that is what felt correct to that individual and I would allow those who wanted their male infants to be circumcised to have it done. IT ALL COMES DOWN TO THE POWER OF CHOICE.

    Link to this
  8. 8. CircEsAdreim 10:38 pm 09/10/2012

    Anti-cutters call it mutilated for a reason. That’s because it fits the definition, even though many people in our cutting culture don’t wish to accept the label.

    Mutilate: to cut up, destroy, or alter radically – in the case of circumcision, the foreskin is cut up/destroyed, and the man’s penis is radically altered from its natural state;

    Mutilation: an injury that causes disfigurement or that deprives you of a limb or other important body part – in the case of circumcision, the penis is disfigured from its natural state, it has been partially amputated, and it will never have its full functionality, as nature intended.

    Link to this
  9. 9. CircEsAdreim 10:40 pm 09/10/2012

    [quote]So, I would never make someone circumcise his/her son if that is what felt correct to that individual and I would allow those who wanted their male infants to be circumcised to have it done. IT ALL COMES DOWN TO THE POWER OF CHOICE.[/quote]

    Yes, it is a choice – for the person who owns the penis, and no one else. Children are not property.

    Link to this
  10. 10. tmtmtm 11:37 pm 09/10/2012

    You cite the African studies that show that circumcised men who have sex with HIV-positive prostitutes fare better than uncircumcised men.

    Fine, but do you know the best way to avoid getting AIDS from diseased prostitutes? Stop having sex with diseased prostitutes.

    Feel free to mutilate (yes, mutilate) your own penis. But butchering your sons in the name of religion or tradition is simply evil. Don’t try to justify it by citing African prostitute statistics.

    Link to this
  11. 11. Stormwatch 11:48 pm 09/10/2012

    If you are circumcised, you ARE mutilated. There is no escaping such an obvious, self-evident fact. I do not hesitate to say that about myself, and to pretend otherwise would be an act of self-deception.

    Link to this
  12. 12. Stormwatch 12:23 am 09/11/2012

    Oh, I must add this: the mastectomy parallel is absolutely correct. And what makes steam come out of MY ears is the double standard: people readily understand why a mastectomized woman would want a breast reconstruction, yet they give a scornful “man up, you wuss” to any similar complaints from circumcised men. Well, if you are okay about having incomplete genitals, great for you. BUT I AM NOT, DAMN IT!

    Link to this
  13. 13. Momof4 12:32 am 09/11/2012

    @Ellensandbeck Unfortunately, you have been reading outdated material. Penile cancer is so rare that a man is 16x more likely to get breast cancer. About 117 babies dies from circumcision and 312 men died from penile cancer in 2011. All you have to do is teach safe sex to your son to prevent STDs and HIV. Boys are born with a foreskin for a reason – to protect the prepuce. It contains thousands of nerve endings that are severed with circumcision. The likelihood that a boy ets a UTI is less than 1% and any infection can be cleared up with an antibiotic, just like any infection at any other part of the body. Circumcision is very painful for the baby and doctors do not know for sure if the anesthetic given even works, since the infant’s body is so tiny and they can easily be overdosed. Your type of thinking is ancient and scary. I would never subject any of my children (boy or girl) to an painful and unnecessary surgical procedure that MIGHT help prevent HIV or an infection. I would rather teach my kids to use soap and a condom.

    And for the story your mother told you: that was in the 1940′s! It is 2012! We know that antibiotics treat infections, not a scalpel!

    Link to this
  14. 14. kooch 1:22 am 09/11/2012

    It’s ridiculous to be looking at sensitivity of the foreskin. It’s the glans’ sensitivity that is grossly reduced when it is exposed and then calloused from exposure. Even if the procedure is perfectly painless this transformation of the glans tissue is the strongest impact in my view.
    If the proper analogy is with removing clitoral hood (and not clitoris) for female infants, would Jesse Bering be ok with that?
    Oh and removing one’s hair is 100% effective in preventing lice. Of course hygiene is also an option.

    Link to this
  15. 15. concerned cynic 2:25 am 09/11/2012

    In order to avoid stepping on the toes of poor souls like Jesse Bering, when thinking and writing about male circumcision, I never use any form of the verb “to mutilate.” Nor do I talk about human rights, because thank God, I am not a lawyer. More seriously, the reason I do not invoke either rhetorical strategy is that they both amount to assuming the conclusion from the outset, i.e., they beg the question. This should not be taken to mean that I agree that male circumcision for prophylactic purposes is in any way defensible.

    Mr Bering seems to think that peer-review is some guarantee of truth. Having, over the course of my career, written about 15 scientific papers and refereed about 100, I decline to partake of his optimism. Science, especially biology and medicine, is very much subject to a host of human failings, blindnesses, and biases.

    Otherwise, methinks that Jesse doth rant too much. And forgets that honey, not vitriol, is better at trapping flies. I now turn to the closing sentences of his post.

    “If you want your child to be at an increased risk of urinary tract infections, herpes, genital ulcers, HPV and HIV…”
    ME. There is no proof that any of these claims are true when comparing European and North American/Japanese subjects. Evidence gathered from Third World populations are not relevant to the decision of whether or not to circumcise a newborn American or Canadian boy.

    “…that’s entirely your choice, and feel free to celebrate with other science-denialists sharing similarly misplaced passions.”
    ME. Name calling unworthy of SA. I do not call you a sex-denialist. Therefore do not paint Sullivan (and me) with the term “science denialist.”

    “But spare me your righteous indignation…”
    ME. Sarcasm unworthy of SA.

    “…over those parents today that fail to see their benevolent, educated decision to circumsise their infant sons…”
    ME. “Benevolent” and “educated” both amount to begging the question. They are the flip side of “mutilate.”

    “…as an “attack on their sexual pleasure at birth.”
    ME. The human body is what it is, and as such deserves the benefit of the doubt. Evolution is a bit wiser than SA columnists. Hence circumcision is unethical unless it can be demonstrated that it has little or no effect on adult sexual pleasure and functionality. No one has come anywhere close to demonstrating this. With the exception of Sorrells et al (2007), all studies to date have assumed that male sexual sensation inheres in the glans. This assumes away the possibility that the inner foreskin, the ridged band, the frenulum, and the frenular delta are all players in the male sexual experience.

    Finally, there is a major factor that has been overlooked in this bunfight between two gay men: the opinions of sexually experienced women. It is easy for an American women to date a few intact men when she is a university student. These men can be Latino, foreign born, or simply part of the sizable intact contingent born west of the continental divide after 1990. A fair number of women have used internet anonymity to put in the public domain their preference for men who have all of their factory installed moving parts.

    A person who has had far more experience with a variety of penises than I ever will have, and who has seen fit to share some of the benefit of that experience with me, is my spouse. In college, she was intimate with a number of foreign born men. She concluded that circumcision had no sexual or hygienic justification. Her intact partners were less likely to turn up their noses at condoms. Every (3) man she encountered with severe premature ejaculation was cut. She says that when cut men ejaculate, the party’s over. Intact men not infrequently can keep at it even when they’re a bit spent. On balance, she climaxed more easily and more often with intact men. For her, the sexual case against routine infant circumcision is decisive.

    Link to this
  16. 16. hsextant 3:29 am 09/11/2012

    I was circumcised in 1949 as an infant as was most of the American baby boom. I won’t state how anyone else should feel about it, that is entirely up to the individual, but personally myself, yes, I feel that I was mutilated and that in some fashion my rights were violated.

    Do I enjoy sex, yes very much so. Would my wife and I enjoy it more if I were not circumcised? I don’t know for a fact, but I suspect so. The remnants of foreskin seem to be quite sensitive. From what I have read, circumcision removes about 15 square inches of enervated tissue from the adult penis. The foreskin through gliding action reduces abrasion to both the penis and vagina during coitus, to what degree, I have no idea. The foreskin serves to keep the glans moist which is also supposed to aid in the sensitivity of that tissue. Indeed there is a build up of smegma, and indeed it is easily (so I understand) removed with soap and water. From what I have read, most infections attributable to not being circumcised are due to poor hygiene.

    Do I remember being circumcised and do I have any psychological damage from it. No I don’t remember, and how would I know? Do I think the notion that infant circumcision may cause some psychological trauma is preposterous? No, I think that there is a very real possibility that there is trauma induced. To what degree, I have no idea, but my guess is that all things being equal a large sample of circumcised men may have more psychological problems than non-circumcised. But indeed that is a guess. All and all I am not in favor of male circumcision for infants.

    However my views have been cast by pre-HIV findings. I am not an expert and I have no training at statistical analysis. I can only go by what I read. There appears to be from the data in African studies some optimism that circumcision could reduce the incidence of HIV. I have also read that the African data is flawed and that the test was prematurely halted. Perhaps the jury should still be out on the African data,. So in my mind the African data is questionable.

    It was stated in the above article:

    “some research from the past decade elucidating the now established fact that rates of HIV acquisition are significantly lower among circumcised heterosexual males, namely because they lack the high concentration of target receptor cells for the virus found on the inner mucosal surface of the prepuce. This anti-HIV effect is dramatic; it is at least on the magnitude of a 60 percent reduction in this demographic. Most of this research was conducted with African populations, but not exclusively so, nor has every study been equally incontrovertible.”

    Sixty percent reduction! That is astounding. OK so lets say from flawed data and premature haltings etc. that the real effect is 40% less. Still pretty damned astounding. Why in the world are we discussing this? Yet I also have read that there is no quantifiable difference in the incidence of HIV between European men and American men. Why is that? If circumcision reduces the incidence in HIV should there not be a huge difference in a large sample of non-circumcised men (Europe) and circumcised men (US) in similar cultures. Perhaps there is a prophylactic effect, but perhaps it is most apparent in the conditions of the developing world.

    What I don’t understand is why is there any argument on this. Is not the prevention of HIV important enough that one should be able to find exactly to what degree circumcision helps to prevent HIV transmission in our culture. Why should there any question about studies?

    The next question that comes to mind. OK let’s presume that indeed circumcision affords some protection against HIV. And let’s say that indeed it is for the purpose of my argument 66%. Does that mean that all is good, worries of HIV are unwarranted if you are circumcised? Are you going to play Russian Roulette with 2 bullets in the cylinder of a six gun? Absolutely not. So in practical terms what protection does circumcision afford? If one is going to engage in sex with risky partners, condoms are still absolutely required. So in my mind circumcision may afford some degree of protection but it is limited to condom failure, or the occasional non-use of condoms. If one engages in unprotected sex with risky partners, one is putting themselves at risk. Do it often enough over some period of time and you are going to get HIV–not a 33% chance, a 100% chance. Circumcision, if beneficial, will only help to extend the average period of time before you contract it. Is there value in having additional protection in the event of condom failure or occasional non-usage? In a theoretical sense indeed, but I am not sure in a practical sense. Again why is there no difference between Europe and the US? Perhaps that statistic is invalid.

    I remember the tonsil fads from my youth it seemed that the medical opinion on tonsils flipped about every two years. Are we going to do the same thing with circumcision?

    The above article relies heavily on the AAP policy statement. Here is the first sentence of the summary of that statement:

    “Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision.”

    http://pediatrics.aappublications.org/content/103/3/686.full

    Sorry, but this is not exactly a resounding recommendation of circumcision befitting Bering’s statement in the article above:

    “If you want your child to be at an increased risk of urinary tract infections, herpes, genital ulcers, HPV and HIV, that’s entirely your choice, and feel free to celebrate with other science-denialists sharing similarly misplaced passions.”

    Like I said at the beginning of the article I was circumcised in 1949, and I signed the papers and paid to have my son circumcised in 1983. If you asked my parents or me why we agreed to have our sons circumcised we would have scratched our heads and said something vaguely about hygiene and the importance of looking like his father. Yet from what I have read, the real reason I was circumcised was because Dr. John Kellogg (of the cornflakes fame) and his Victorian cronies in the late 19th century thought masturbation was going to be the ruination of the Western world and they felt that circumcision would reduce the pleasure of the “vice”. It was especially effective when performed on young lads caught in the act. For young ladies who were so digitally inclined, the good doctor prescribed the application of pure carbolic acid on the clitoris. This particular crowd recommend the whole sale circumcision of American youth for the prevention of masturbation, but also hygiene, prevention of phimosis, and the reduction of smegma. It then quietly became routine, and nobody was sure why but it was common place. Why wouldn’t you have your child circumcised? Ninety percent of the males living in your town have been circumcised.

    So yes, in fact I do consider myself mutilated by the ideas of some nut from some 60 years prior to my birth. But that was pre-HIV. I do not consider myself a science-denialists. So I would like to offer some firm advice to my son regarding whether he should have his potential children circumcised. My gut feeling is no it is wrong, but shown some concrete evidence to the contrary, I would gladly change my opinion. The AAP statement quoted above is not sufficient for me to recommend the procedure to my son for his children.

    I have no desire to take sides in an emotional debate between Bering and Sullivan. What I would like to see is a firm recommendation from the science community regarding the merits of circumcision regarding all the factors of circumcision. Is there a psychological trauma incurred in infant circumcision. Have their been any adult studies comparing adults? Is there any effect on marriages? Is there any possibility that circumcision does lead to greater behavioral and marital problems. I have read opinions in both directions. Why do I have to rely on opinions and emotions? The question needs far less emotion and a lot more research in my opinion.

    One last comment, one hand I feel that parents do not have the right to circumcise their sons for religious and the current possible medical benefits. Yet on the other hand, is this something that one would have to face at 18 years of age for either medical or religious reasons? Now, I could see that causing some real psychological damage to teens. Ergo if the procedure must be done, I have to concur get it over with as a new born. Again I can only speak for myself, but I think having a circumcision hanging over one’s head would be onerous.

    Link to this
  17. 17. momomomo 3:43 am 09/11/2012

    Whatever your position is on this it does NOT metter! A child is sacred and not to be touched LET THEM DECIDE when they adults, when they please they can after they are 18 years old do what ever they like with there body (nobody will have sex before that age and will have a HIV or whatever sickness). And every persone who is comparing circumcision to a hair cut is a IDIOT!….

    Link to this
  18. 18. Hugh77 4:08 am 09/11/2012

    @ #14 kooch: “It’s ridiculous to be looking at sensitivity of the foreskin.”
    Why? Sorrells et al. found it is “the most sensitive part of the penis” but any man with one could have told them that. And not just “more sensitive” in any kind of uncomfortable way but conferring “a symphony of sensation”. Cutting it off has been compared with going colourblind. Men who have grown up to make do without one say they couldn’t bear any more sensitivity, but men who have always had one say no such thing.

    Link to this
  19. 19. hsextant 4:09 am 09/11/2012

    @ Concerned Cynic, I have read many declarations confirming exactly what your wife has told you regarding sex with non-circumcised men. Thank you for sharing that.

    I questioned whether sex and marriages could be better with non-circumcised men. Most men today have a better understanding today of how to bring their women to orgasm, through non-coital methods. But I believe the Concerned Cynics statement regarding premature ejaculation to be true. One has to question how many women have been frustrated by the lack of sexual satisfaction that could be directly attributed to premature ejaculation due to circumcision. There are ways around that but the couple has to be willing to explore those methods. How often does sexual dissatisfaction lead to marital dissatisfaction and divorce?

    Again I think any recommendation regarding wholesale circumcision has to look at the entire package, not just HIV transmission.

    Link to this
  20. 20. dreamer_fla 6:42 am 09/11/2012

    Let me start by disclosing that I am an intactivist, and that I am not a woman nor an uncircumcised men.

    I am sorry that Andrew Sullivan called your penis “mutilated”. The AAP stated in 2010 that “mutilation” is an inflammatory term that tends to foreclose communication and that fails to respect the experience of the many women who have had their genitals altered and who do not perceive themselves as “mutilated””, and I believe that similar courtesy should be granted to circumcised men who don’t feel that they were mutilated.

    I would expect reciprocally imilar respect for those of us who perceive ourselves as mutilated, claim that you seem to dismiss very easily in your blog.

    You seem to believe that FGM is always the removal of the clitoris. This is false. There are 4 documented kinds of FGM. The AAP themselves acknowledged, again in 2010, that “some forms of FGC [they didn't call it 'mutilation', they just called it 'cutting'] are less extensive than the newborn male circumcision commonly performed in the West”, when they were promoting the now infamous “ritual nick” for female minors.

    Again, no, some forms of FGM are just the removal of the clitoral hood (which is formed from the same basic tissue as the male foreskin) or parts of the labia. BTW, it is interesting that the typical clitoris has approximately 8,000 nerve endings, while the typical foreskin has approximately 20,000.

    Also, when we intactivists speak of “forceful circumcision”, we don’t imply that the parents are being forced to circumcise their children. We mean that children are forced into being circumcised. If you were to ask any doctor, they would tell you that circumcision is an elective surgery, but the reality is that boys have as many chances to “elect” the surgery, as the African girls have a chance to elect their genital mutilation. I never thought I would need to explain this, especially not in a blog called Scientisfic American”. There is no doubt that the parents are forcing an amputation upon their children, and less doubt that this is not an “immunization”.

    If you have read the Technical Report from the AAP, you would notice that there is no description of the anatomy and functions of the foreskin. It would make sense to study the foreskin when dedicating a Policy to its amputation, wouldn’t it?

    However, they AAP references (and yet dismiss the conclusion) a study by Sorrels et al, 2007, which “suggests that the transitional region from the external to the internal prepuce is the most sensitive region of the uncircumcised penis and more sensitive than the most sensitive region of the circumcised penis. It appears that circumcision ablates the most sensitive parts of the penis.”

    Link to this
  21. 21. dreamer_fla 7:26 am 09/11/2012

    P.S. I can’t help but notice that you linked an article on FGM that does explain the different types of FGM, but yet you assume it’s only and always the removal of the clitoris, and always with the intention of removal of pleasure.

    So, if FGM was done with the “intention” of providing a health benefit, would there be a difference? Or, if male circumcision was done with the intention of removing pleasure, would it make a difference?

    Because both actions are documented. Not only people who practice FGM argue health benefits. It also happens that women who practice the “sunat” (a less invasive form of FGM) assure that it does not reduce their sexual desire. But also Rebecca Stallings in “for better of worse: female circumcision and HIV in Tanzania” expected to find more prevalence of HIV in circumcised females, but found the opposite, conclusion that she dismissed by stating that “as no biological mechanism seems
    plausible, we conclude that it is due to
    irreducible confounding”.

    It is also worthy of notice that Male Circumcision has the intention of removing pleasure from the beginning, which has been documented by Philo (1st Century Jewish Philosopher – “circumcision represents the excision of the pleasure of sex, which bewitches the mind”), by XII Century Jewish Philosopher Moses Maimonides (“As regards circumcision, I think that one of its objects is to limit sexual intercourse, and to weaken the organ of generation as far as possible, and thus cause man to be moderate”) and by the late XIX and early XX century doctors who started the practice of “medical” circumcision in the UK and US, such as E.J. Spratling (“In all cases of masturbation circumcision is undoubtedly the physician’s closest friend and ally… the longer it takes to have an orgasm, the less frequently it will be attempted”), E. Harding Freeland (“the removal of the protective covering of the glans tends to dull the sensitivity of that exquisitly sensitive structure and thereby diminishes sexual appetite and the pleasurable effects of coitus”), L.W. Wuesthoff (“Circumcision not only reduces the irritability of the child’s penis, but also the so-called passion of which so many married men are so extreamly proud”) and R. W. Cockshut (“I suggest that all male children should be circumcised. This is “against nature”, but that is exactly the reason why it should be done. Nature intends that the adolescent male shall copulate as often and as promiscuously as possible, and to that end covers the sensitive glans so that it shall be ever ready to receive stimuli. Civilization, on the contrary, requires chastity, and the glans of the circumcised rapidly assumes a leathery texture less sensitive than skin”).

    Those who started the routine practice of circumcision knew what they were doing and knew what their goal was. It was the same goal in 1860 than it was in the first century of our era. Excision of the pleasure of sex. A leathery texture less sensitive than skin. Unnatural passion cut down by a timely circumcision. Diminishing sexual appetite and the pleasurable effects of coitus.

    It was only after the 60′s that American doctors started stating that circumcision did not change the form or function of sex. But those were doctors who had already been circumcised at birth, so they had no first person experience of the foreskin to be able to tell any different.

    Link to this
  22. 22. mfallu 7:51 am 09/11/2012

    I do rather think that this is one of those issues where people end up making arguments rather more forcibly than they otherwise would – simply because out of defensiveness.

    I have several problems with the mentioned studies as they do not include comparisons to other hygiene measures, nor do they estimate the cost of the procedure compared to the effectiveness of public health campaigns like the ones so successful in Australia.   Similarly, transmission rates in communities of high viral load individuals with virulent strains of HIV are not the same as in environments with early detection and good access to effective medication.    

    HIV in the developed world is a diabolical problem, but the cause is poverty and ignorance, not foreskins.

    Until a vaccine is available – it may well make sense to recommend this as a part of raft of other public health measures in parts of Africa.  The situation in developed countries is far less clear cut (if you will pardon the expression).

    Personally, I am appalled that such a simplistic, and reductionist measure can be advocated in isolation. But, hey, if recommending operation on middle class penises in the west is what it takes to highlight a health crisis in Africa, great. Somehow that is not what I think they were going for.   

    If a vaccine was available, I would be the first person to line up with my little boy in tow, just as I am eager for the HPV vaccine to be approved for use in boys…. In the meantime I am teaching him about hygiene, putting on a hat and sunscreen before heading out, and when the time comes, safe sex. 

    Link to this
  23. 23. ericavm 9:10 am 09/11/2012

    We just had a baby boy this June. Our solution was to put the $500 it would cost to get him circumcised into his own “body modification” fund which he can use when he is 16 to do with as he wishes. He can review the literature about the benefits of circumcision in ~2028.

    Or he can get himself whatever awesome flesh augmentation procedure that will do him good in his life. We figured it was best to let him decide, closer to the time when he would have an opinion on these matters.

    Link to this
  24. 24. ImproperUsername 9:36 am 09/11/2012

    I do not understand those people who think it is a good idea to lop off flesh from a precious baby boy’s penis. It is just wrong.

    Link to this
  25. 25. sciencefan2012 10:21 am 09/11/2012

    Basically, I don’t see Jesse’s position on circumcision as being a dispassionate, logical, science-based one, but instead as one colored by his own personal circumcision status (which he clearly defends above) and not different from any other pre-conceived cultural attitude about circumcision that many people seek data to support. Is it really science denial to look at the data comparing STIs in circumcised and uncircumcised men, see a difference of very small magnitude, and conclude that it isn’t worth doing surgery to achieve these kind of results?

    Consider these two pieces of data: a recent study by a group of researchers (Sansom et al, 2010) that actually favors circumcision as a cost effective measure estimated that by using the 60% relative reduction in female-to-male HIV transmission figure (the maximum reduction ever found in a study of circumcision as HIV prevention) and applying it to Americans, the lifetime risk of HIV infection in American males is estimated at 1.80% for circumcised males and 2.14% for uncircumcised males. For white males (the group most likely to be circumcised as infants in the USA), the difference is 0.95% for circumcised males and 1.03% for uncircumcised males. What about this data is so dazzling that Jesse thinks it not only justifies infant circumcision but that voices of dissent are unscientific and should silence themselves?

    Also in an American study, uncircumcised men were asked by Gust et al. (2011) how likely they would be to get circumcised if told by their health care professional that it would decrease their chance of contracting HIV from an infected woman. Only 13% responded that they would likely get circumcised. If adult men today do not want this intervention, why should parents assume that their infant boys will grow into men that want it?

    There is no science denial involved in questioning the utility of an ethically debatable surgical intervention on infants in order to achieve benefits of very low magnitude that can be achieved by lesser means.

    Link to this
  26. 26. SaintPiran 3:30 pm 09/11/2012

    I have the dubious advantage of having functioned sexually both as a ‘virtual-circumcisee’ and as an ‘intact’, courtesy of suffering an odious affliction called ‘Peyronie’s’ in which scar-tissues form within the body of the penis, causing it to become bent and misshapen.

    In my own personal circumstance I was comparatively lucky, insofar as the scarring was pretty equal all the way around my organ, resulting in diminution in both length and girth, but crucially little ‘elbowing’. Some sufferers experience severe bending, toward 90 degrees, in more than one dimension. Ouch!
    In practice, for several years, my prepuce became ‘stuck’ in the ‘glans uncovered position’ during the procession of the deformity… before returning later to its normal extended state.

    I can categorically state that without a shadow of doubt, ‘SEXUAL CONGRESS WITH A PERMANENTLY EXPOSED GLANS IS A VERY POOR EXPERIENCE COMPARED TO EQUIVALENT EXPERIENCE WITH A FULLY OPERATING PREPUCE’.
    And I had not even had the object under discussion physically removed, just permanently stretched-back over the penis and behind the glans for a period of near four years.
    I am extremely thankful that my condition eventually evolved to the point whereby my penis recovered the ability to allow the foreskin to again cover the glans, and over the course of many further months my experience of penile sensitivity increased back to normal levels.

    Not only had that transient exposure of my glans; over the long-term; led to a serious drop in penile sensitivity, but also it very much reduced the degree of sexual pleasure I experienced in both qualitative & quantitative terms. It further resulted in bouts of premature ejaculation, although I cannot imagine why that should be so?

    For the record. My penis is sadly a shadow of its former proud self, having lost some 7-8 cms. from erection length & about 1-3cms. in diameter at various points along its length. I appreciate that this metamorphosis (from beautiful butterfly, to base caterpillar) certainly adds certain extra variables into the equation, not the least of which would be the scarring itself… nevertheless, the account above is given in all honesty and self-evidently as an experiential example, not a rigourous scientifically analytical discourse.
    The comparisons of sensation given are meant to indicate ‘mid’ vs. both ‘before/after’.

    Link to this
  27. 27. jgrosay 5:16 pm 09/11/2012

    I’m awfully sorry: the American Academy of Pediatrics statement included the sentence: “Circumcision should not be considered a routine procedure for all male children”.

    Link to this
  28. 28. craiggarrett@gmail.com 10:01 pm 09/11/2012

    The tissue removed by circumcision is an important part of male anatomy, and male circumcision has negative impacts to male and female sexuality. A study in 2007 by Sorrells, et al., measured the fine-touch sensitivity of 19 different places on the male genitalia, both circumcised and intact. This study concluded that “circumcision ablates the most sensitive parts of [male anatomy].”
    http://www.doctorsopposingcircumcision.org/pdf/sorrells_2007.pdf

    Someone was nice enough to create color-coded diagrams using the data from this study to visually show the areas of sensitivity:
    http://www.circumstitions.com/Sexuality.html#sorrells

    Google functions of the foreskin for more information.

    Intact America has just published an excellent response in which they explain the flaws and bias in this new AAP statement.
    http://www.intactamerica.org/aap2012_response

    This is a listing of other nations’ medical statements on circumcision which show they do not agree with the AAP:
    http://www.cirp.org/library/statements/

    For example, in 2010, the Royal Dutch Medical Association said, “there is no convincing evidence that circumcision is useful or necessary in terms of prevention or hygiene” and “non-therapeutic circumcision of male minors conflicts with the child’s right to autonomy and physical integrity.”

    Finally, the following video is an excellent educational resource. It is narrated by Dr. Dean Edell (probably not best to view this at work):
    http://www.youtube.com/watch?v=h_bEBAdhjGg

    Link to this
  29. 29. tucanofulano 10:07 pm 09/11/2012

    Child abuse is child abuse even when ‘cloaked’ by a white lab coat.

    Link to this
  30. 30. tucanofulano 10:13 pm 09/11/2012

    The author is “gay” ? If so “his” opinion is without any merit whatsoever.

    Link to this
  31. 31. TLCTugger 11:57 pm 09/11/2012

    Mr. Bering, why don’t you concur with the Royal Dutch Medical Association, which assembled a panel of experts and reached the OPPOSITE conclusion – that infant circumcision has “an absence of medical benefits and danger of complications.”

    Guess how many members of the AAP’s panel actual have a foreskin. (Hint: ZERO) That must have taken some effort to rig, since most of the world is intact.

    You’re making the same mistakes they did, assuming parents have an urgent decision to make about circumcision even though the supposed benefits mostly relate to adult sexual activity, and forgetting that all the same benefits can be secured by non-destructive means. And the AAP admits they’re ignoring deaths, amputations, and botched jobs that require touch-up surgery.

    The AAP also completely ignores the human rights ramifications of removing sexually valuable parts that the boy may grow to wish he had been allowed to keep. Hundreds of thousands of men are enduring a tedious multi-year process of non-surgical foreskin restoration to undo just some of the sexual damage of circumcision.

    Foreskin feels REALLY good. HIS body, HIS decision.

    Link to this
  32. 32. Diogenes11 12:15 am 09/12/2012

    Although Bering favours “parental choice” in male circumcision, he declines to say whether he supports parental choice of female circumcision. It is worth noting that female circumcision is practised by females who themselves have been circumcised, and therefore are aware of its implications for their daughters.
    In its most radical form, female infibulation prevents HIV transmission by making intercourse impossible without incision, and removes the risk of vulval cancer (more common than penile) by removing the vulva.

    I strongly approve of infant vaccination, as it prevents potentially lethal childhood diseases like whooping cough or measles. It leaves no stigmatizing scars.

    But, by definition, no man is exposed to HIV (via his penis) until he has reached the age of consent to sexual activity, which in most countries parallels the age of consent to surgery. In Australia, a 14 year old boy can consent to circumcision, and to sex at age 16. Penile cancer is a disease of old age.

    Thus, there is no need to circumcise involuntarily at birth, when the individual concerned has plenty of time to make his own decision in his adolescence.

    I sympathize with those parents who circumcise boys for cultural reasons, and to help their health risks; just as I sympathize with those loving North African women who take a razor blade to their daughters, so they can fit in with society and be marriageable, rather than an ostracized harlot with a clitoris. However, both groups are antiquated in their thoughts, and amputating children’s genitalia to assuage their own archaic world-view.

    As to the sexual side, probably the HIV transmission is decreased by the inevitable thickening of the skin over the circumcised glans. Try this simple experiment: ask all of your male friends whether, given a guaranteed HIV-free partner, they prefer sex (vaginal, oral, anal, whatever) with or without a 0.05mm condom. Many modern condoms are less than 50 microns thick, which is much thinner than skin. Even the already-circumcised can feel the difference!

    The intact foreskin provides the best of both worlds, covering the glans against friction of clothing, and retracting during intercourse to expose the sensitive thinly-skinned glans. A virus-proof condom can be easily added for sex with an unsafe partner, just as a circumcised man should do.

    As a parallel, those who regularly wear contact lenses cause desensitization of the very delicate and sensitive cornea, compared to those whose eyeball only frictions against human tissue.

    This, folks, is the 21st century. Amputation of normal body parts in infants is wrong.

    Link to this
  33. 33. vagnry 12:16 am 09/12/2012

    I have, almost invariably, enjoyed Jesses writings, they are usually both funny, sometimes funny peculiar more than ha-ha, but this reminds me of Lord Nelsons famous saying from 1801, when he ignored admiral Parkers sign to withdraw from battle

    ‘You know, Foley, I have only one eye. I have a right to be blind sometimes.’ He raised the telescope to his blind eye, and said ‘I really do not see the signal”.

    Link to this
  34. 34. jazzer 2:31 pm 09/12/2012

    For all the medical benefits and potential diseases we may get if we are not circumcised, I present to you the billions of Indians (hindus, buddhists, sikhs, etc) and Chinese who DO NOT and have not been circumcised for hundreds of years.

    Cicumcision is a religious mandate, not a medical necessity!

    Link to this
  35. 35. cjthornby 9:48 pm 09/14/2012

    At the centre of this debate is the question of whether or not parents can legally and ethically consent to routine neonatal circumcision (RNC). If they can, it is only on the accepted basis that such an intervention is required to prevent an imminent harm, or correct an existing problem. Many problems exist with defining RNC in this way. The imminent harm would seem to me not to exist in sufficient scope to justify widespread RNC. The prevention effect for HIV and STIs is weak, but in any case only applies to sexually active males – this must then be discounted, and the owner of the foreskin allowed to choose to balance risks when they’re old enough to do so. The prevention effect for UTIs is also weak, requiring the intervention in a minimum of 100 neonates to prevent one UTI. The prevention effect for phimosis is absolute, but in any case, the prevalence of phimosis is not sufficient to justify is. Ethically, parents cannot consent to modification on social or religious bases. These are the issues we need to be thinking about – not parental ‘rights’.

    Link to this
  36. 36. hmmmmm 1:45 pm 09/15/2012

    Great discussion. I’ll add my experiential two cents about social factors unrelated to HIV.

    As a woman in the US who has enjoyed relations with a sampling of both uncircumcised and circumcised men: all other things being equal, the uncircumcised penis is definitely more satisfying to the woman (maybe has something to do with the foreskin gathering at the base near the vulva? don’t know), plus it’s more beautiful (yes, this is my scientific conclusion).

    My husband is circumcised, my son is not, and explaining the difference to our six-year-old has been a non-issue. We don’t expect our other body parts to look identical to our parents’ and this one hasn’t raised any confusion or dismay in our son whatsoever, plus there are a lot of other uncircumcised boys around these days among his peers so when it comes locker-room time, the issue of fitting in will be moot. Despite tons of naked time around other children when he was younger (swimming in mountain lakes, playing in farm sprinklers, etc.) there has not once been any sort of incident where he felt weird because of being uncircumcised. The social pressures have changed.

    As for all the disgusted smagma talk on pro-circumcision articles, I think it’s mainly a way for people to feel better about circumcision. It has never been an issue in my son’s daily life or in any man I’ve seen sexually. Basic hygiene goes a long way.

    Now toenail fungus…. a lot of people deal with that. Maybe we should yank toenails at birth to prevent it. Babies have that nifty self-protection mechanism where they scream until they pass out, and it looks so cute like they just went to sleep. So it must not hurt them the same way it hurts an adult. And toenail fungus sucks.

    Link to this
  37. 37. vdanker 12:13 pm 09/17/2012

    Bottom line is, no matter how much you sanitize it, or rationalize it, genital mutilation is genital mutilation, whether it takes place in a tribal village in Africa, or in an American hospital. Something that is completely unnecessary, and completely irreversible, should be a decision made by the individual, and not by parents or doctors.

    Link to this
  38. 38. c33704 12:49 pm 09/17/2012

    medically you can defend any procedure; no on eneeds a gall bladder everyone should have it removed at birth. #1 Female Circumcison is illegal; yet male is not WHY?
    #2 as a Man with a circumsized penis; I do not freakout when touched; it is not supersensitive when aroused and typically needs large amounts of lubricant because without foreskin I do not produce hardly any lubricant natuarally. while intact men A) are extremly sensitive to touch; B)tend to self lubricate very easily and copuluslly large amount of lubricant. and the orgasims appear to be life altering. all is all I am furious that a doctor tol mmy mother it would be best for me to have the end of my penis cut off. Doctors advising parents to amputate a body part for health reason is assinine and not to be taken truly serious.

    Link to this
  39. 39. c33704 12:51 pm 09/17/2012

    amputating body parts for medical reasons should only be in cases of life or death; not to help keep your penis clean. or to avoid diseases from not having clean sex before and after the act of sex

    Link to this
  40. 40. Bryce 12:47 pm 09/18/2012

    I LOL’ed when I saw the author is a “research psychologist”. Surely he’s familiar with COGNITIVE DISSONANCE! Glad to see the majority of the readers here at Scientific American understand forced genital cutting is genital mutilation. It’s ok Jesse, those cultural blinders can sure be tough to shake off!

    You cannot change form without altering function. Basic biology shows us the genitals are designed for pleasure. Remove part of the genitals and you remove part of the pleasure. If men were meant to have foreskin, they’d be born with it.

    Watch out Jesse, Lilli’s coming for ya…
    http://www.moralogous.com/2012/09/18/science-like-blogging-is-useless-without-ethics/

    Link to this
  41. 41. mine that bird 9:58 pm 09/18/2012

    Jesse, Sullivan’s personal attack on you was inflammatory, but your unprofessional response reeks of anger and bias, and shows he succeeded in bringing you down to his level. Your arguments are as full of logical fallacies and emotionally loaded rhetoric as Sullivan’s. Just like Sullivan you cherry-picked abstracts through your own “confirmation biased lens” as pointed out in other comments.
    You said, “Parents today who opt for circumcision are saving their sons from having to decide as adult males”. This is true, but can you also see why having this decision made for them is so disturbing to so many men? There’s something to be said for making irreversible, body-altering decisions like this as a consenting adult. And no, circumcision is not as innocuous as a tooth extraction because there’s no denying that it has much more potential to impact quality of life both physically and psychologically.

    As pointed out by others the real argument here isn’t whether circumcision is a procedure whose potential benefits outweigh its costs but whether parents should have the right to make that decision in the first place. You seem to misunderstand Sullivan’s use of the word “forcible.” He’s not referring to the parents being forced into a decision regarding circumcision. He’s referring to the fact that infants can’t elect to have a surgery of any kind.

    You say you are “pro-parent choice”, but why should anyone listen to you if you don’t at least acknowledge the “pro-child choice” point of view?

    Link to this
  42. 42. BobNSF 3:22 pm 09/20/2012

    “With that in mind, what on earth does my being gay—our being gay—have to do with anything at all?”

    Uh… we gay men encounter more penises and men attached thereto than straight men or straight women do, at least on average. We’re also FAR MORE LIKELY to discuss matters penile with each other, as heteros never seem to talk about their body parts with each other.

    Surely you pay attention when performing oral sex — or at least I hope you do — and have noticed the different reactions to touch between cut and un-cut men, no? Mind you, sometimes they’re TOO sensitive, but it’s absurd for a gay man to say he’s never noticed a difference. Unless you’re one of those “total tops”, I suppose.

    Link to this
  43. 43. that one dude 2:28 pm 09/22/2012

    I know how i can make everyone happy: If you are okay with the result it is not mutilation; but if you are displeased with the result than it IS mutilation

    Link to this
  44. 44. hsextant 5:04 pm 09/22/2012

    EDIT CORRECTION: For Comment # 16. I inadvertently referred to the previous AAP policy statement. The revised policy statement states the following:

    “Although health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it and to warrant third-party payment for circumcision of male newborns. It is important that clinicians routinely inform parents of the health benefits and risks of male newborn circumcision in an unbiased and accurate manner.”

    http://pediatrics.aappublications.org/content/130/3/585.full#abstract-1

    While the above statement is more supportive of circumcision than the previous, the AAP still does not recommend routine circumcision for all newborns.

    Take that to mean what ever you would like, but I don’t believe that I can call you a “science-denialist” if you choose not to have your son circumcised.

    I apologize for quoting the wrong policy statement in comment 16.

    Link to this
  45. 45. futuremd 5:56 pm 11/2/2012

    Let me save you some trouble: The circumcision advocates raise a lot of red flags.

    Red flag 1: The “repeat offender” flag. When HIV came out, numerous alternative medicine advocates claimed they could cure it. They couldn’t, of course, but they saw this as their last chance to prove themselves to us allopaths. Circumcision has been said to cure or prevent paraplegia (by means of energy fields), masturbation, homosexuality, tuberculosis, manic depression, schizophrenia, penile cancer, and cervical cancer. In each case, the claims deflated because 1) the disease was rare, or 2) there was no statistically significant element that couldn’t be explained by confounding factors. (Interestingly, circumcision was first popularized in America by colon-irrigation therapists.) Of course they would see HIV as their last chance before being put on the same medical table as “pox parties”.

    Red flag 2: The demographics of circumcision advocates. Most doctors range from “I don’t care” to “I wouldn’t recommend it, but I’ll do it if you ask”. The opinions in peer-reviewed journals are similar. If circumcision were so effective, why aren’t more AIDS researchers working on this? By contrast, in the popular media, opposition to circumcision consists of Andrew Sullivan and Dean Edell, while advocacy of it includes Edgar Schoen (who is an MD, but also cites pornographic sites like Circlist as serious resources), Daniel Halperin (an anthropologist), Mehmet Oz (who is an MD, but is also Dr. Oz), Oprah, and the Drs., among others. They spend more time in popular media than in medical journals. Wow, kinda like the anti-vaccine people, no?

    Red flag 3: Put an Indian on it. Another staple of the old-school medicine show was a picture of an Indian on whatever miracle cure was being sold. This explains an article in Men’s Health a few years ago, where circumcision was said to take place in “Asia, Australia, and the Americas”. Wonderful, going “by continent”, as if Israel is the same as China. They ignored Africa, because African circumcisions make the whole idea of it preventing HIV look silly. But the Americas? That little theory was discredited in…the 17th century? Back then, some liberal Christians were claiming we were lost Jews. They were, of course, wrong, and Jose de Acosta used the absence of circumcision as proof they were wrong. Indeed, no culture indigenous to the Americas practices circumcision. Which makes sense: The opium in that 19th-century miracle cure wasn’t exactly indigenous to the Americas either. None of this discredits circumcision, but one must wonder why they would be so unapologetically wrong.

    Red flag 4: Edgar Schoen cites child pornography! Circlist, an interesting (in the most ironic sense of the word) site. Schoen has cited them before, in popular media. Why is this relevant? Well, Circlist has a section of image galleries. And a collection of erotic (in the most internet sense of the word) stories, some of which have elements of incest or pedophilia. And a message board, where they discuss their fantasies of publicly circumcising boys, and lament that these stories are “merely” fictional. Another circumcision advocate, Vernon Quaintance, was arrested for possession of child pornography last April. Moral of the story: Rule 34, no exceptions.

    Red flag 5: Out of your field, in over your head. I don’t expect a physicist to understand psychology. I don’t expect an anthropologist to really get astronomy. Why would you expect Daniel Halperin (an anthropologist), Brian Morris (a molecular biologist), Barbara Kay (a professional activist), or Jake Waskett (a software engineer) to understand epidemiology? Nobel laureates, once out of their fields, tend to go nuts (See Pauling, Linus. See also Shockley, William.), so why would these people, utterly obscure in every other way, be trustworthy in medicine?

    Regarding the foreskin itself, it’s no different from any other skin. If circumcision prevents HIV infection, then I have no doubt flaying the entire skin is required to really prevent HIV. Wait, that makes no sense. I wonder why…

    So, Jesse Bering, you’re advocating alternative medicine, at best.

    (Also, every culture I’m aware of that practices clitoridectomy also practices circumcision. Halperin may not have taken medical courses, but I have taken anthropology courses, as bird courses.)

    Link to this
  46. 46. truthseeker23 11:38 pm 12/13/2012

    Heya Bering,

    I usually really enjoy your articles, but I have to say I disagree with you here, and apparently, I am not the only one!

    As a parent who chose not to circumcise my son, I feel pretty insulted by your implication that I am a science denialist.

    As far as I can tell, the science both for and against the health benefits of this procedure is still pretty hotly debated, and the ethics of it are somewhat beyond the scope of science anyway.

    I agree with the poster above who said, essentially, that the foreskin is a normal part of human anatomy, and the burden of proof should be on those who advocate it’s removal from minors who are unable to consent.

    Link to this
  47. 47. EBG78 6:44 am 02/7/2013

    I admire Mr. Bering for many of the things he says and writes about. But a scientific writer saying that removing a body part “should not be called mutilation” is ridiculous. Why the denial? It is what it is. It’ like preferring to use terms like “collateral damage” instead of calling it murder. Why remove a body part because one “may” have a problem with it? Should we remove all of our teeth because we may get cavities?
    To see two intelligent homosexuals displaying catty fights like this makes me rather disappointed in such a silly way to misrepresent us, gays. As well as the comment “smegma” making it sound as a sinister substance… this is high-school talk people… what about we embrace nature?

    Link to this
  48. 48. abolitionist 3:26 pm 02/24/2013

    “… Why remove a body part because one “may” have a problem with it? …”

    If you are unwilling to accept the argument from the people who are competent to evaluate the medical issue, have evaluated the available information and have come to the conclusion that, given the documented value of doing so, and the lack of evidence supporting the contention that the removal has real negative impact, on balance circumcision is more than justified, the question might be rephrased as “Does there exist any argument that could, in principle, get you to change your evident opposition to the procedure?”

    Link to this
  49. 49. concerned cynic 3:44 am 03/3/2013

    The AAP Task Force ignore the fact that continental Europe has never circumcised, the UK gave it up 60 years ago, New Zealand gave it up 30 years ago. In Australia and Canada, what was a majority practice is now a minority one. If circumcision were healthier, these countries could produce a lot of data bearing on that.

    Doctors are not free to remove body parts unless there is conclusive evidence that doing so is harmful. The burden of proof goes the other way: no body part can be removed unless it can be clearly shown that the benefits of removing the part clearly exceed the harms. A grave problem with routine circumcision is that there are no studies of the possible adverse effects thereof on adult sexual pleasure and functionality. We honestly don’t know the extent to which circumcised adult men have damaged penises, suffer from PE and ED. We do not know how common it is for the wives of circumcised men to suffer from vaginismus.

    The report of the AAP Task Force says that the benefits of RIC exceed the risks, when in fact the long-run risks are not known. Hence the Report is conclusive evidence of the incompetence of its members to rule on the merits and demerits of routine circumcision.

    I could be convinced of the merits of circumcision if this conclusion were based on a sample of 30,000 American and Canadian men, half circumcised, and stratified by age, education, and race. This study would include a detailed sexual history of spouses.

    Link to this
  50. 50. concerned cynic 9:01 am 03/3/2013

    Bering cites the following article, published in the September 2012 Journal of Law and Medicine.

    Criticisms of African trials fail to withstand scrutiny: Male circumcision does prevent HIV infection – Richard G Wamai, Brian J Morris, Jake H Waskett, Edward C Green, Joya Banerjee, Robert C Bailey, Jeffrey D Klausner, David C Sokal and Catherine A Hankins

    A recent article in the JLM (Boyle GJ and Hill G, ²Sub-Saharan African Randomised Clinical Trials into Male Circumcision and HIV Transmission: Methodological, Ethical and Legal Concerns² (2011) 19 JLM 316) criticises the large randomised controlled trials (RCTs) that scientists, clinicians and policy-makers worldwide have concluded provide compelling evidence in support of voluntary medical male circumcision (VMMC) as an effective HIV prevention strategy. The present article addresses the claims advanced by Boyle and Hill, demonstrating their reliance on outmoded evidence, outlier studies, and flawed statistical analyses. In the current authors’ view, their claims portray misunderstandings of the design, execution and interpretation of findings from RCTs in general and of the epidemiology of HIV transmission in sub-Saharan Africa in particular. At the same time they ignore systematic reviews and meta-analyses using all available data arising from good-quality research studies, including RCTs. Denial of the evidence supporting lack of male circumcision as a major determinant of HIV epidemic patterns in sub-Saharan Africa is unsubstantiated and risks undermining the evidence-based, large-scale roll-out of VMMC for HIV prevention currently underway. The present article highlights the quality, consistency and robustness of the scientific evidence that underpins the public health recommendations, guidance, and tools on VMMC. Millions of HIV infections will be averted in the coming decades as VMMC services scale-up to meet demand, providing direct benefits for heterosexual men and indirect benefits for their female partners.

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

    Richard G Wamai did a PhD in African-American studies, at the University of Helsinki. He is not trained in any aspect of health care or scientific method.
    Brian J Morris has been a notorious advocate of circumcision. He is a molecular biologist and not a doctor or epidemiologist.
    Jake H Waskett is a computer programmer, not trained in any aspect of health care.
    Robert C Bailey was a principal investigator in at least one African clinical trial.
    Some or all of the remaining coauthors were coauthors of other papers reporting on the RCTs.

    This article is the second response by Brian Morris and other circumcision advocates to a 2011 article by Boyle and Hill in the same journal, critiquing the design and execution of the African clinical trials (RCTs).

    Wamai et all do not reveal that there is no claim and no consensus that (RCTs) shed any light on whether prophylactic circumcision outside of the AIDS belt of Africa is desirable. Also lost in the shuffle is that the RCTs advocate voluntary adult circumcision alone as an effective HIV prevention strategy.

    Wamai et al accuse Boyle and Hill of “outmoded evidence, outlier studies, and flawed statistical analyses” and of “misunderstanding the design, execution and interpretation of findings from RCTs in general and of the epidemiology of HIV transmission in sub-Saharan Africa in particular.” Since I do not have access to the entire text of the article, I cannot comment on this accusation, except to say that many have questioned the design and execution of the RCTs. Only in the USA has it been claimed that the RCTs support the decision to circumcise boys at birth.

    Boyle and Hill stand accused of ignoring “systematic reviews and meta-analyses using all available data arising from good-quality research studies, including RCTs.” Boyle and Hill’s point was that much of the “evidence” claimed in support of prophylactic circumcision is flawed and poor scientific method. To simply assert that these studies are “good-quality” is to beg the question. Just because a paper is published in a peer reviewed journal does not assure that what that paper asserts is “evidence based” and of “good quality.” Life is not that simple.

    Wamai et al accuse Boyle and Hill of “undermining the evidence-based, large-scale roll-out of VMMC for HIV prevention currently underway.” This too begs the question, and makes sense only if one assumes that which is under debate, namely that circumcision will prove effective against AIDS, and that the epidemiology of AIDS in Africa is well understood.

    “The present article highlights the quality, consistency and robustness of the scientific evidence that underpins the public health recommendations, guidance, and tools on VMMC. Millions of HIV infections will be averted in the coming decades as VMMC services scale-up to meet demand, providing direct benefits for heterosexual men and indirect benefits for their female partners.” These two sentences amount to editorializing and proof by assertion. They do not contain one iota of scientific substance. The abstract leaves us completely in the dark as to what is allegedly wrong with the critique of Boyle and Hill.

    Because the RCTs were cut short after 18 months, they tell us nothing about risk compensation, a very real possibility in this context. Between 1975 and 2000, about 250,000 American and Canadian gay men died of AIDS. The vast majority of these men were circumcised. This proves that circumcision is ineffective against AIDS spread by male-to-male sex. Circumcision is also completely ineffective against AIDS spread by dirty needles used to inject recreational drugs, and by the reuse of medical sharps, a common practice in badly underfunded African village dispensaries.

    Link to this
  51. 51. SugarTax 9:57 pm 03/5/2013

    “… Between 1975 and 2000, about 250,000 American and Canadian gay men died of AIDS. The vast majority of these men were circumcised. This proves that circumcision is ineffective against AIDS spread by male-to-male sex …”

    No, it doesn’t. If the majority of those 250,000 men were themselves circumcised, then most of the dead would have had to have been circumcised, unless circumcision provides absolute protection, which no one has claimed.

    The plural of anecdote is not data.

    Link to this
  52. 52. bailiff 9:29 am 03/6/2013

    @49. concerned cynic,

    Your long post intrigued me, so I took the time to examine the publication that hosted the article, and the credentials of the named individuals.

    All contributions to the Journal of Law and Medicine are peer reviewed.
    http://sites.thomsonreuters.com.au/journals/category/journal-of-law-and-medicine/

    “Richard G Wamai did a PhD in African-American studies, at the University of Helsinki. He is not trained in any aspect of health care or scientific method.”
    False: http://www.northeastern.edu/daas/faculty_and_staff/richard_wamai/index.php
    http://works.bepress.com/rwamai/

    “Brian J Morris has been a notorious advocate of circumcision.”
    An irrelevant ad-hominem argument: http://www.nizkor.org/features/fallacies/ad-hominem.html
    “He is a molecular biologist and not a doctor or epidemiologist.”
    HIV is one of the viruses he has studied.
    http://www.physiol.usyd.edu.au/~brianm/

    Edward C Green, CV: http://www.newparadigmfund.org/Edward-C-Green-CV.pdf
    Joya Banerjee: http://www.researchgate.net/profile/Joya_Banerjee/
    Robert C Bailey, Professor, Epidemiology: http://www.cade.uic.edu/sphapps/faculty_profile/sphFacultyInd.asp?i=rcbailey&d=
    Jeffrey D Klausner, Professor of Medicine: http://www.globalhealth.med.ucla.edu/about/klausner.html
    David C. Sokal, CV: http://www.asiaandro.com/Editor/temp/CV_David_C_Sokal.pdf
    Catherine Hankins, MD, MSc, FRCPC: http://www.icsdp.org/network/scientific_board/CatherineHankins.aspx

    There is no obvious basis for the criticism leveled at the article, and certainly no need for the smear campaign against some of the authors.

    Link to this
  53. 53. concerned cynic 8:33 pm 03/6/2013

    Sugar Tax, I do not understand the argument you are trying to make.
    My argument is simple, and has been standard at the CDC for 20+ years. Hundreds of thousands of American and Canadian men died of AIDS. Those men were mostly circumcised. Therefore circumcision does not protect gay men from AIDS.

    The claim, based on African clinical trials whose validity I dispute, is that circumcised men are less likely to contract AIDS from infected women.

    The vast majority of HIV positive North Americans became so because of dirty needles, or male-to-male bareback sex.

    Link to this
  54. 54. concerned cynic 8:37 pm 03/6/2013

    Unless you want to argue that many more North American men would have died of AIDS had they not been circumcised. The answer to that is that the gay AIDS holocaust has not been clearly worse in Europe than in the USA. Also, the CDC has been alert to a possible correlation between circ status and HIV positivity, and said for years that it was unable to find any.

    Link to this
  55. 55. SugarTax 6:35 am 03/7/2013

    “Sugar Tax, I do not understand the argument you are trying to make.”

    OK, I’ll try to explain.

    “Hundreds of thousands of American and Canadian men died of AIDS. Those men were mostly circumcised. Therefore circumcision does not protect gay men from AIDS”

    By failing to provide the ratio of circumcised to uncircumcised in your selected sample above, you failed to show that there was no relationship between the survival rates of circumcised and uncircumcised males. Your argument is shown to be not true, and therefore the critical review published in the September 2012 Journal of Law and Medicine stands. Are you aware that the Journal of Law and Medicine is peer reviewed? I rather suspect that had the article been so flawed, it would have been identified before publication.

    “My argument is simple, and has been standard at the CDC for 20+ years.”

    While your argument may have been simple, I doubt that it has been standard at the CDC for 20+ years.

    Link to this
  56. 56. SugarTax 9:41 pm 03/7/2013

    concerned cynic,

    I hope I have been able to adequately clarify what I feel is the central failure of your critique. To take the most extreme case, if 100% of the sample of men you mention were circumcised, then inevitably 100% of the dead would have been circumcised, giving rise to “Those men were mostly circumcised”. Would that then have been a refutation of the contention that circumcision reduces the chances of contracting HIV/AIDS (for whatever reason)? No, of course not.

    If, as an alternative possibility, 50% of the sample had been circumcised, and only 25% of the dead were circumcised, it would be obvious that circumcision did afford some protection from infection. Not, I hasten to say, that these WERE the actual before and after ratios, but had they been, then your “no difference” claim would obviously be untenable.

    As you neglected to provide the ratio of circumcised to uncircumcised in the original sample, but then drew conclusions about the purported ratio of circumcised to uncircumcised in the result, your critique smacks of begging the question.

    Link to this
  57. 57. concerned cynic 1:29 pm 03/10/2013

    The CDC, the public health organisation that was the on the front line fighting the gay AIDS holocaust, denied in the 1990s that there was any correlation between circumcision status and AIDS among American and Canadian gay men. I cannot supply a link. I do not know if the CDC has changed its view or not. It is from this 1990s fact that I infer that the circ rate among American gay men who died of AIDS was not very different from the circ rate among all gay men.

    The CDC apparently did collect data on the circumcision status of AIDS fatalities. (Some USA states have death certificates that state the circ status of all deceased males.) I have never seen these data, nor seen them discussed, and I have been following the American circumcision conversation for now 3 decades.

    I assume that a large majority of the American gay men who died of AIDS in the 1980s and 1990s were born 1940-70, a time when routine circumcision was very common in USA maternity wards catering to middle class whites. I know because I am of that generation and have spent hundreds of hours in locker rooms and public showers. Most gay men are middle class and white. I assume that a large majority of American gay men of that era were circumcised, as was a large majority of the gay men who died of AIDS.

    It would be nice if the CDC were to disclose the %age of American men who are HIV+ who are also circumcised. We will never know the base rate, namely the %age of gay men who are circumcised, because of privacy concerns, and because sexual orientation is not dichotomous but a continuum. Even determining circ status via clinical examination is not always a no brainer.

    Link to this
  58. 58. concerned cynic 1:39 pm 03/10/2013

    The trouble here is that the penis and the foreskin have been very taboo topics in prudish America. Hence the lack of data. In the absence of data, we inevitably fall back on anecdote. I reject as immoral the stance that in the absence of data, we can say nothing. That plays into the hands of those wishing to continue routine infant circumcision for unsavoury reasons. The ethical default should be no circumcision until it is proved harmless, not parents are free to circumcise unless it is proved harmful.

    Since the 1980s, I have been calling for two kinds of studies:

    1. A careful comparison of data collected from urology practices in Japan, Canada, USA, and western Europe, to give us a clearer picture of foreskin problems and the sequaliae of routine circumcision.

    2. A survey of the North American penis, based on a large random sample stratified by age, race, and educational attainment. This would include a clinical examination, and taking a careful and detailed sexual history of the subjects and of their intimate partners. A major but little appeciated intact demographic in North America is French speaking Canadians.

    Link to this
  59. 59. SugarTax 5:56 am 03/11/2013

    concerned cynic,

    “The CDC, the public health organisation that was the on the front line fighting the gay AIDS holocaust, denied in the 1990s that there was any correlation between circumcision status and AIDS among American and Canadian gay men. I cannot supply a link. I do not know if the CDC has changed its view or not. It is from this 1990s fact that I infer that the circ rate among American gay men who died of AIDS was not very different from the circ rate among all gay men.”

    Both the data you question, and the study you criticized were published much more recently, 2012 in the instance of “Criticisms of African trials fail to withstand scrutiny: Male circumcision does prevent HIV infection”.

    I refer you to the story from John Maynard Keynes, who in reply to a criticism during the Great Depression of having changed his position on monetary policy, is reported to have replied, “When my information changes, I alter my conclusions. What do you do, sir?”

    As you do not know if the CDC has changed its view based on these new data (or not), you might want to to remain current with the topic.

    Your inability to supply a link means you are unable to warrant your claim, thus your inferred conclusion is unsubstantiated.

    Link to this
  60. 60. Rolf Degen 5:36 am 03/29/2013

    I wonder what would happen if Scientology Church would suddenly announce that they will have all their newborns circumcised (say, for religious reasons). Would the public accept this as they do with jews and muslims? I wonder because here in Germany there is a new law explicitely giving parents a right to have their kids circumcised. BUT, this law was specifically designed for jews and muslims, which have a “fetish” status in our country. If Scientology Church came out with this announcement in Germany, well, they would be crucified!

    http://www.amazon.com/Rolf-Degen/e/B001K1NBP4/ref=ntt_athr_dp_pel_2

    Link to this
  61. 61. Shpongleezi 12:09 am 11/14/2014

    I am so happy I’m not mutilated. It’s us uncircumcised men that see this as mutilation, just the way uncircumcised women see female circumcision as mutilation. I’m sorry but it’s the truth. Circumcision, male or female, will always be seen as mutilation by women and men with intact genitalia.

    Link to this

Add a Comment
You must sign in or register as a ScientificAmerican.com member to submit a comment.

More from Scientific American

Scientific American Holiday Sale

Give a Gift &
Get a Gift - Free!

Give a 1 year subscription as low as $14.99

Subscribe Now! >

X

Email this Article

X