What The Science Says About Circumcision: Part 2 — The Risks

There are many different techniques and mechanisms by which circumcision occurs. Since the purpose of this series of posts on circumcision is to address routine infant circumcision in the hospital environment, I will not be addressing alternate circumcision practices, including non-hospital (religious ritual) circumcision.

Photo by Robert Valette, Creative Commons

Last week, I addressed the scientific evidence as it pertained to the benefits of circumcision. My conclusion was that there was no strong scientific evidence to support routine infant circumcision in the United States.

This week, I want to address the issue of harm; that is to say, is there evidence that routine infant circumcision carries significant, scientifically documented risks?

There are four common arguments given in opposition to routine infant circumcision. These are:

1)   It is painful, and therefore cruel and/or damaging to the infant;

2)   It results in diminished sexual function;

3)   It is associated with a high rate of complications;

4)   It results in long-term psychological trauma.

In this post, I will address the evidence for each of these in turn.

At one time, it was thought that neonates didn’t experience pain, didn’t distinguish it from non-painful stimulus, or couldn’t encode it. This was used as a justification for circumcision without analgesic. Later, it was thought that the injection of analgesic would be just as painful as circumcision without analgesia. Many studies have shown these notions to be false, including a study addressed in a previous post (see, for instance, AAP Statement, Fabrizi et al, Taddio et al). Pain-relieving options include a numbing topical cream and a dorsal nerve block (Brady-Fryer et al). However, neither of these completely eliminates pain during the procedure. Another nerve block, called a ring block, appears to be quite effective (Lander et al, Shockley et al). Further, in combination with other pain-relief methods, oral sucrose (sugar) also helps reduce discomfort (Razmus et al). The Lander study points out that not only does the ring block provide very effective analgesia during the circumcision procedure, the block injection itself is significantly less painful than non-anesthetized circumcision. Other analgesic options, including oral sucrose and topical numbing creams, can reduce the discomfort associated with the nerve block injection.

With regard to the notion that circumcision results in lasting damage due to the physical pain, there is some scientific evidence to support this in the case of circumcision with no analgesic. According to Taddio et al, infants circumcised with no analgesia had a greater pain response to subsequent noxious stimulus (vaccination) than infants circumcised with topical cream pain relief, who showed a greater response to the painful stimulus of vaccination than uncircumcised infants. The study did not examine the responses of infants circumcised with a ring block, however. Neither did the study note any effect persisting beyond the neonatal period. A review of the literature suggests that there is no scientific evidence to support the notion that circumcision (with or without analgesia) causes changes to pain response that persist beyond the neonatal period. Further, while some anti-circumcision advocates (sometimes called “intactivists”) suggest that circumcision causes brain damage and/or physical changes to the brain, there is no scientific evidence to support this notion. Studies that show a correlation between neonatal pain and changes in brain structure/function (such as Anand et al) are based upon repetitive exposure to pain, and can’t be generalized to one-time medical procedures.

Some argue that circumcision results in diminished sexual sensation and/or function. This is actually an untestable claim. It’s possible to compare the sexual function of men circumcised as infants with that of men not circumcised as infants, and it’s possible to compare the sexual experience of an uncircumcised adult male with his experience post-circumcision (in the case of a man circumcised as an adult), but it’s not possible to know what a man circumcised in infancy would have experienced had he never been circumcised. As such, none of the scientific evidence regarding sexual function and infant circumcision is particularly relevant or helpful, and can’t be used to support a strong argument either for or against the statement that circumcision affects sexual function.

One study of men circumcised as adults suggests that function may be affected, but finds that more men experience improved function than diminished function after circumcision (Fink et al). Of 123 men circumcised during adulthood, 38% reported harm in the form of perceived diminished function. 50%, however, reported improved function. Unfortunately, since 93% of the study participants underwent circumcision for medical reasons, the results of this study can’t be generalized to the population.

Unbiased studies have uncovered only anecdotal accounts (Moses et al) of sexual effects, which can’t be taken as scientific evidence (see this post for an explanation of why anecdotes aren’t scientific evidence). There are men who attribute their sexual dysfunction to infant circumcision, but there is no scientific evidence to support these claims. Some “intactivist” arguments suggest that female sexual partners of uncircumcised males derive greater sexual pleasure than do the partners of circumcised males. There are no scientific studies to support this. In fact, the few scientific studies that exist suggest the opposite. Ugandan women report greater sexual satisfaction from intercourse with circumcised men, despite the fact that circumcision is not routine practice in Uganda (Bailey et al). Surveys of college-aged American women show overwhelming preference (87%) for the appearance of a circumcised penis (Williamson et al).

There are a few survey studies of sexual function and attitudes about circumcision. One such survey (Hammond) showed strong evidence of sexual dysfunction and psychological trauma as the result of infant circumcision. However, it must be noted that the Hammond study did not sample the population randomly. Instead, study participants were asked to respond to a survey from the National Organization to Halt the Abuse and Routine Mutilation of Males (NOHARMM), an organization whose very name betrays its bias. As such, it’s not reasonable to generalize the findings of the Hammond study to the population at large, since the men most likely to participate in the voluntary survey would have been those who were dissatisfied with their circumcision. A much larger survey by Laumann et al found that of 1400 American men, those who were circumcised were actually less likely than uncircumcised men to report a sexual dysfunction. While the foreskin has sensory function (Taylor et al), there is no scientific evidence to suggest that the loss of these receptors affects sexual satisfaction or the intensity of the sexual experience for men. One study even goes so far as to suggest that while there isn’t currently evidence to support the notion that circumcision somewhat desensitizes men, even if such evidence existed, it wouldn’t necessarily be a bad thing, given that more men (and their partners) complain of premature ejaculation than complain of inability to achieve orgasm (Burger et al). While Burger doesn’t go so far as to suggest circumcision to prevent problems with premature ejaculation, these observations do put into perspective the “intactivist” argument that circumcised men don’t enjoy sex as much as they otherwise would; clearly, for the vast majority of men, enjoying sex isn’t a problem. The scientific evidence does not support the notion that male circumcision diminishes sexual performance in men, nor sexual satisfaction in men or women.

Regarding the notion that routine infant circumcision is associated with a high rate of complication, this does not stand up to scrutiny. The American Academy of Physicians (AAP) has reported a complication rate of 0.2-0.6%, though it’s difficult to accurately assess the rate of complication, since different surveys include different symptoms as complications of circumcision. As such, some studies suggest higher rates of complication, though they define “complication” very differently (including aftereffects that can’t necessarily be attributed to circumcision). On the flip side, Wiswell reports that approximately 10-15% of males who are not circumcised as infants have recurrent balanitis (swelling of the foreskin) or phimosis (foreskin that doesn’t retract), and require circumcision later in life. The adult procedure is a more significant surgery than the infant procedure, leading some practitioners to view circumcision as “preventative medicine.” Not all cases of balanitis or phimosis require surgical treatment, however, meaning that Wiswell’s numbers don’t translate directly into a percentage of uncircumcised men who will require adult circumcision. Based upon the numbers, there is not adequate evidence to suggest that routine infant circumcision is particularly risky.

Finally, with regard to the argument that infant circumcision results in psychological trauma, the support for such a notion is anecdotal and unprovable. “Intactivists” argue that many (some even go so far as to say most) circumcised men are traumatized by their circumcision, and that those who don’t acknowledge the trauma are in denial. This is a spurious claim; one could just as easily make the argument that children born by cesarean section are traumatized by not having experienced a vaginal birth, and that those individuals born by cesarean who don’t acknowledge their psychological pain are “in denial.” The denial argument is a powerful-appearing one for the “intactivists,” since by definition, any man who denies being in denial is categorized as…in denial. Still, we can make an attempt to sort through the science. A very large (5000 individuals) British study showed that circumcised men scored no differently than uncircumcised men on a variety of behavioral and psychological tests (Calnan et al), indicating that if the circumcised men were at all “traumatized,” it was undetectable to psychologists and didn’t affect their behavior. In a position paper, a psychiatrist and anti-circumcision activist compares circumcision to sexual abuse and an assault on the body (Goldman), but there’s no evidence to support the validity of the former, and the latter comes from the statements of young Turkish boys ritually circumcised without analgesic in a public ceremony, so it can hardly be generalized to anesthetized neonates in a hospital setting.

Goldman continues by suggesting that infant circumcision is associated with long-term psychological effects. As evidence for this, he cites the reports of men who contacted the Circumcision Resource Center (CRC). There are two problems with using this group, and their anecdotal reports of psychological harm, as evidence that circumcision has a psychological impact upon the general population. First, the men were “self-selected,” meaning they don’t represent a random selection of the population. To consider these individuals representative of the population is tantamount to making the claim that most Americans believe in extraterrestrials on the basis of those select individuals who contact SETI (Search for Extraterrestrial Intelligence) to report them. As with people who feel strongly enough that they’ve seen an alien to warrant a call to SETI, those who contact the CRC represent the small minority who feel particularly strongly about their circumcision. While it would be wrong to discount the intensity of their individual feelings, neither can one reasonably generalize those strong feelings to circumcised men as a whole. Furthermore, though SETI may claim (or even attempt) to be impartial and scientific in their search for evidence of extraterrestrial life, they are nevertheless predisposed to a particular outcome, and therefore their conclusions may reflect a bias. Similarly, the CRC is predisposed to find evidence that circumcision leads to harm. A second important point with regard to those men who contacted the CRC (and again, this is not meant to downplay their psychological pain) is that since no man has a conscious memory of INFANT circumcision (the brain doesn’t work that way), it’s pure conjecture on the part of a man to suggest that his psychic trauma is the result of his circumcision. He might feel regretful that he was circumcised, or he might wish he hadn’t been, but these feelings could as easily be the result of events he experienced post-circumcision (the emotions conjured by which he falsely attributes to the circumcision in a post hoc ergo proctor hoc fallacy). Even Goldman, who is clearly biased toward showing that circumcision causes harm, can only conclude that “the connection between present feelings and circumcision may not be clear.” In essence, that leaves the psychological trauma argument insufficiently supported from a scientific perspective. While some men may be traumatized by circumcision (though again, whether infant circumcision was the root cause of an individual’s feelings of psychological trauma is impossible to determine), there’s no scientific evidence to suggest that routine infant circumcision has lasting psychological effects.

 

Science Bottom Line:* There is no scientific evidence that strongly links routine infant circumcision with appropriate analgesia to physical or psychological harm.** Because there are many options available for managing pain during infant circumcision, however, there’s simply no justification for medical circumcision without analgesia.

 

**Obviously, this is not to say that no one is ever hurt by circumcision, or that there are not individuals who wish they hadn’t been circumcised. However, the SCIENTIFIC EVIDENCE does not provide support for the argument that routine infant circumcision is harmful. As such, the argument AGAINST circumcision in the U.S. can’t be made on the basis of scientific evidence, and must instead be made on the basis of values and beliefs.

 

What do you think about the risks of circumcision?

 

References:

AAP. Circumcision policy statement. American Academy of Pediatrics. Task Force on Circumcision. Pediatrics. 1999 Mar;103(3):686-93.

AAP. American Academy of Pediatrics: Report of the Task Force on Circumcision. Pediatrics 1989 Nov;84(5):761.

Anand et al. Can Adverse Neonatal Experiences Alter Brain Development and Subsequent Behavior? Biol Neonate. 2000 Feb;77(2):69-82.

Bailey et al. Acceptability of male circumcision as a strategy to reduce HIV infection in Uganda. AIDS Care. 2002 Feb;14(1):27-40.

Brady-Fryer et al. Pain relief for neonatal circumcision. Cochrane Database Syst Rev. 2004 Oct 18;(4):CD004217.

Burger et al. Why circumcision? Pediatrics. 1974 Sep;54(3):362-4.

Calnan et al. Tonsillectomy and circumcision: comparison of two cohorts. Int J Epidemiol. 1978 Mar;7(1):79-85.

Fabrizi et al. Electrophysiological Measurements and Analysis of Nociception in Human Infants. J Vis Exp. 2011 Dec 20;(58). pii: 3118. doi: 10.3791/3118.

Fink et al. Adult circumcision outcomes study: effect on erectile function, penile sensitivity, sexual activity and satisfaction. J Urol. 2002 May;167(5):2113-6.

Goldman, R. The psychological impact of circumcision. BJU Int. 1999 Jan;83 Suppl 1:93-102.

Hammond et al. A preliminary poll of men circumcised in infancy or childhood. BJU Int. 1999 Jan;83 Suppl 1:85-92.

Lander et al. Comparison of Ring Block, Dorsal Penile Nerve Block, and Topical Anesthesia for Neonatal Circumcision. JAMA. 1997 Dec 24-31;278(24):2157-62.

Moses et al. Male circumcision: assessment of health benefits and risks. Sex Transm Infect. 1998 Oct;74(5):368-73.

Razmus et al. Pain management for newborn circumcision. Pediatr Nurs. 2004 Sep-Oct;30(5):414-7, 427.

Shockley et al. Clinical inquiries. What’s the best way to control circumcision pain in newborns? J Fam Pract. 2011 Apr;60(4):233a-b.

Taddio et al. Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet. 1997 Mar 1;349(9052):599-603

Taylor et al. The prepuce: specialized mucosa of the penis and its loss to circumcision. Br J Urol. 1996 Feb;77(2):291-5.

Williamson et al. Women’s preferences for penile circumcision in sexual partners. J Sex Educ Ther. 1988; 14: 8.

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129 Comments (+add yours?)

  1. Steven
    Feb 14, 2012 @ 17:57:29

    What’s your take on this recent report that the AAP is going to come out with a stronger stance in favor of circumcision?

    http://blogs.browardpalmbeach.com/pulp/2012/02/american_academy_of_pediatrics_circumcision.php

    • SquintMom
      Feb 14, 2012 @ 18:10:59

      Well, until their report comes out, we can only speculate. Still, I suspect they’ll say that there are modest benefits (which is true, if you look at my first article on this issue) and minimal risks. The modest benefits include reduced risk of HPV and HIV. I stand by my original statement (in the first article) that I don’t think either of these provide a strong enough argument for routine circumcision on their own, in the U.S., but I suspect the AAP will want to make it clear that the science DOES support the reduced risk of HPV and HIV associated with circumcision.

  2. Laney
    Feb 14, 2012 @ 18:15:53

    Hi. This is my first time commenting, but I’ve been reading your blog for a while. I am pregnant with a boy and am trying to decide whether to circumcise. I posted on the Mothering.com forums, and the women there are very anti-circumcision. It seems like they make a lot of unsupportable claims, though. For instance, they say that there’s no reason for a boy to look like his father, since they won’t be sitting around with their penises out. I think (but I don’t have the scientific evidence to back it up) that children probably get a lot of their early sense of sexual identity from comparing their bodies to those of their parents. A little girl knows she’ll GROW breasts, and a little boy will get a bigger penis like his father’s…but an uncircumcised boy knows his penis won’t look like his (circumcised) father’s penis when he gets older. Also, my understanding is that the majority of white, middle-class boys in the US are circumcised. What would be the effect on a boy’s psychology of looking around the bathroom or gym and realizing his penis is different? Also, what if he’s in high school or college and hears girls making fun of the way an uncircumcised penis looks?

    Thanks for any input.

    • SquintMom
      Feb 14, 2012 @ 18:38:44

      Thanks for your comment, and congratulations on your pregnancy. Making the to-circumcise-or-not-to-circumcise decision is a difficult one. The point of this series of posts has been to show that there’s really very little science that can go into the decision-making process. The two best medical reasons to circumcise (reducing risk of HIV and HPV) aren’t necessarily big motivators for most US parents, since HIV isn’t epidemic here, and there’s a new vaccine for HPV. In the end (and I’ll discuss this more in my next post in this series) you have to go with your values/beliefs.

      You raise some interesting points with regard to how a child develops a sense of sexual identity. I know off the top of my head that there are instances in which intact (uncircumcised) boys have self-circumcised (with predictably bad results) in response to feeling “different” or being tormented by peers. However, these case reports can’t be generalized to the population. I’ll do some digging and see whether anyone’s done any psych studies on developing sexual identity and the role of one’s same-sex parent and/or peers.

      You are right when you say that the majority of white, middle-class boys in the US are circumcised. While circumcision rates are somewhat less than they were in the 80s, they’re currently around 60% (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6034a4.htm) for in-hospital circumcisions. Many Jewish families do ritual circumcision out-of-hospital, however, so the actual circumcision rate is higher than this. Further, circumcision is most common in the US among whites (Laumann et al. Circumcision in the United States. Prevalence, prophylactic effects, and sexual practice. JAMA. 1997 Apr 2;277(13):1052-7.) It’s also associated with higher maternal education and higher socioeconomic status (Nelson et al. The increasing incidence of newborn circumcision: data from the nationwide inpatient sample. J Urol. 2005 Mar;173(3):978-81.) Therefore, you are right to assume that if your son is white and middle-class, he would be in the minority if he were uncircumcised. I was unable to find figures for the percentage of white, middle-class US boys who are circumcised, but we can say with certainty that it’s significantly higher than 60%, since 60% of ALL US boys are circumcised, and of those, white middle-class boys are disproportionately represented.

      • Sus
        Mar 02, 2012 @ 19:32:36

        You said: “You raise some interesting points with regard to how a child develops a sense of sexual identity. I know off the top of my head that there are instances in which intact (uncircumcised) boys have self-circumcised (with predictably bad results) in response to feeling “different” or being tormented by peers.” I’ve been researching genital integrity issues for many years now & have never heard of this. Would you please give me a link or more to read more about this myself?

        Thanks.

      • SquintMom
        Mar 02, 2012 @ 20:11:41

        Sure. I’ll get some sources dug up for you. I have them around somewhere…

      • Sus
        Mar 10, 2012 @ 19:44:09

        Any luck? I’m still very interested in this.

        Thanks ;-).
        Sus

      • SquintMom
        Mar 12, 2012 @ 10:29:07

        Sorry this took me so long; it’s been a hectic week. Ok, well, there are lots of reports of botched self-circumcisions in the medical literature. Here’s a short and incomplete list:

        Sagar et al. Penile skin necrosis – complication following selfcircumcision. Ann R Coll Surg Engl. 2005 Jul;87(4):W5-7.

        Natali et al. Complications of Self-circumcision: A Case Report and Proposal. J Sex Med. 2008 Dec;5(12):2970-2. Epub 2008 May 5.

        Hwang et al. Complication of Circumcision Performed with Mechanical Self-Circumcision Device: A Case Report. Korean J Urol. 1996 Sep;37(9):1031-1033.

        These reports of botched self-circs don’t all provide the motive behind the self-surgery; some men are too embarrassed to discuss it. In all cases, though, the men felt their lives would be better if they were circumcised. Again, this is a very incomplete list; there are many more references of this type.

        This is an article that talks about some of the reasons cited for self-circumcision, and specifically addresses teasing and peer pressure:

        Perera et al. Nontherapeutic male circumcision: tackling the difficult issues. J Sex Med. 2009 Aug;6(8):2237-43. Epub 2009 May 5.

        This is an article specifically addressing a case of botched self-circ due to feeling ashamed of the foreskin (looking different than peers):

        Koc. A novel complication of self-circumcision: penile skin avulsion. Turkish Journal of Urology 2011;37(2):177-179

        Hope that gets you started; there’s lots more out there. There are also many, MANY reports of men feeling ashamed of their foreskin and getting circumcised (professionally, thank goodness) as teens or grownups. A collection of anecdotes (unscientific, of course) is at http://www.circlist.com/preferences/growing_up_uncut.html. Be warned that this site contains strong language.

      • Mark Lyndon
        Mar 12, 2012 @ 11:03:38

        There are also thousands of men restoring their foreskins, and many more who are unhappy about being circumcised.

        Personally, I would pay a year’s salary rather than be circumcised or have my son circumcised. If he chooses to get circumcised though and he knows what he’s doing, I will pay for it and help him find a good surgeon. I definitely think it should be his choice though.

      • Mark Lyndon
        Mar 12, 2012 @ 10:58:42

        Small point, but I think in-hospital circumcisions are down to about 55%. Only 1.7% of Americans are Jewish, and while some other circumcisions will be performed out of the hospital, I think the overall rate will be under 60% and is declining very slowly.

        http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6034a4.htm

        The rate is higher for whites and African-Americans, but significantly lower for Hispanics. There are also big regional differences from about 33% on the west coast, to about 78% in the mid-west.

        Whether or not other people circumcise doesn’t seem to make a big difference to whether people have their own children circumcised. The rate has dropped from about 90% to 12% in Australia, but people still do it – they just don’t use the “locker-room argument” any more. Similarly, I would’t want to be circumcised or have my son circumcised, even if everyone else was, and I don’t think any of us would have our daughters “circumcised”, even if we moved to a country where it was very common.

        An intact boy with a circumcised father can still choose to get circumcised, but he may not want that. It’s not like older children are renowned for wanting to be exactly like their parents though, and no-one seems to worry about it if hair or eye color don’t match.

        It’s not like it can’t wait. It’s worth noting that only two countries in the world circumcise more than 50% of newborn boys – the USA and Israel. Other countries circumcise, but not till the boys are from seven to late puberty.

        I couldn’t say for sure whether my father was circumcised or not btw. He probably wasn’t, but I honestly don’t know for sure.

    • Rebecca
      Feb 14, 2012 @ 20:37:18

      Purely anecdotal, but my uncircumcised husband was strongly in favor of having our sons circumcised because he had a difficult time growing up due to teasing and bad reactions from women. He let me make the decision though, since he realized he would have a hard time being objective about it.

      After examining the evidence I decided the benefits outweighed the risks (though both were small), but in the end what really tipped me in favor of having it done was the social/cultural factors – I don’t want my boys to go through what husband did. FWIW we are white and middle class, and everyone we know has had their boys circumcised.

      • SquintMom
        Feb 14, 2012 @ 23:27:23

        I don’t have a son, but I believe I’d probably make the same decision you did if I had one. I know from male friends that there are social/cultural issues that can be significant. I think it’s awesome that you and your husband did your homework and tried so hard to weigh all the factors before making your decision.

      • Hugh7
        Feb 15, 2012 @ 09:37:48

        But now that the circumcision rate is about 50:50, which would you rather have to tell him – “They’re different because their parents all had part cut off of theirs, but we didn’t”? Or “You’re different because we had part of yours cut off so that you wouldn’t be different – but theirs didn’t, so you are.”?

        And as for looking like daddy, how about the little boy who said “Now I look like daddy, now I look like me! Now I look like daddy…” He was intact of course. Or see this.

      • SquintMom
        Feb 15, 2012 @ 16:24:07

        The circumcision rate is NOT 50%. It’s 60% in hospital, with additional circumcisions (largely Jewish) taking place out-of-hospital. Of the 60% of men who are circumcised, middle-class whites are particularly well represented. As such, a white, middle-class boy who was uncircumcised would be in the distinct minority.

        You can speculate about whether a boy “looking like daddy” is important. Similarly, all I can do (for right now) is speculate. I’m looking to see whether there are any studies, but until I find some, all we’ll be doing is speculating. Individuals (whether happy or unhappy with their circumcisions) aren’t meaningful, population-wise.

        I’m sorry, but after reading everything you’ve had to say, I have to stand by my original conclusion that there is neither strong scientific evidence to support, nor strong scientific evidence to oppose, routine infant circumcision. As such, the decision must be made on the basis of values.

        This is not to downplay the importance of values; they’re clearly key and central to this issue! I just think it’s important that we all realize when we’re talking about values, and when we’re talking about science. Let’s not pretend one is the other.

    • Erin
      Feb 17, 2012 @ 05:35:49

      Laney, I have a circumcised son and he has asked my his circumcised father (my husband), why his penis looks different even though both of them are cut. Go figure. Turns out a child’s penis doesn’t look like an adult’s penis. On the other hand, I also have an intact son who is nearly 3 years old. His older brother changes diapers and takes baths with his younger brother and has never noticed that his brother’s penis is “different”. They look more alike than his compared to an adult.

      As far as being made fun of — what if he is made fun of for having a scarred circumcised penis? I certainly don’t want to send the message to my son that we have cosmetic surgery when someone may make fun of our appearance. And since there is no way to know which way may be made fun of, it seems like risky business to cut the most sensitive and private part of a man’s body at birth when he can not consent.

      The decision is really not difficult. Would you have wanted your genitals to be altered surgically at birth? Probably not. I went along with it with my first out of complete ignorance. I knew absolutely nothing about the foreskin yet I allowed it to be surgically removed. I regret that deeply and there are many of us who do. You don’t want to be a member of our club.

  3. Megyn @ Minimalist Mommi
    Feb 15, 2012 @ 02:56:32

    Thank you for this! After doing my own initial research, I realized that there are so many gaps that need to be looked into on this issue. For example, if a study could be done looking at actual arousal/oxytocin during intercourse to see if there is a difference in sexual pleasure or even if they stimulate the head of the penis to test receptors. Also, if there were real, unbiased psychological studies to see the effect of circumcision and how men feel about their bodies, relationships, and sexual lives. From the simple anecdotal “study” I’ve conducted with males I know, none seem to care either way. I just keep getting the consensus that as long as it works, it’s a non-issue 🙂

    • Hugh7
      Feb 15, 2012 @ 08:42:59

      Only one study, by Sorrells et al., has studied the foreskin to test receptors. Unsurprisingly, it found that men without one have no sensation there. All the other studies (Blustein, Payne, and most famously Masters and Johnson) studiously ignored the possibility that the foreskin itself might be involved in sexual pleasure. And we know (from studies, alas, of kittens blinded in one eye) that the nerves from surviving receptors invade the part of the sensory homunculus left idle by the destruction of sensory tissue. Nerves from the frenulum and glans would have occupied, in an unpredicible way, the part of the brain that had served the foreskin. This could explain why circumcised (but not intact) men say “If I had any more sensitivity, I’d die/have a heart attack/never leave the house”. For circumcised men “it works” seems to mean they can “reach orgasm”. Intact men, with more feedback and hence more control, can slow down and enjoy the journey.

      • SquintMom
        Feb 15, 2012 @ 16:19:17

        Ah, but simply because the foreskin has receptors for sensation doesn’t mean that it’s important to the experience of sex. Neurons aren’t a “more is better” sort of thing. The studies of men who have had sex both before and after circumcision show that MORE OF THEM prefer the post-circumcision state, but that there are also those who preferred having a foreskin. Science can’t help us on this one; there is no scientific evidence either to strongly support OR refute the notion that the foreskin significantly contributes to the sexual experience.

      • JustSomeChick
        Feb 11, 2013 @ 12:08:11

        What people fail to recognize in studies regarding sexual pleasure post adult circumcision is that these men have not had the many years of keratinization of the glans that a male who was circumcised as an infant has had. A study regarding sexual experiences that adult men have post circumcision is not relevant to the issue of routine infant circumcision.

        The circumcision decision should be left to the owner of the penis in adulthood, especially since there are no compelling medical benefits.

        In regards to the idea of women making fun of intact men, my husband is intact and was never made fun. None of the intact men I know of were made fun of. But I do personally know several men who are unhappy with their circumcisions. A few of them are in the process of restoration. But then again, anecdotes are not evidence, so making such a decision based on anecdotes is to make a decision based on absolutely no science.

      • SquintMom
        Feb 19, 2013 @ 08:34:26

        You may wish to read Part 1 of this article (“The Benefits”) before you claim that there are no compelling medical benefits. In fact, the medical benefits are significant enough (and evidence for them continues mounting) that the AAP has recently formally condoned infant male circumcision as a medically-beneficial procedure (this, after decades of taking a null stance on the issue).

      • Megyn @ Minimalist Mommi
        Feb 15, 2012 @ 17:13:35

        However, what the men say pleasure is to them is purely perspective. What may be pleasurable to one man may mean pain to another, foreskin or no foreskin. Until there are actual scientific studies showing increased oxytocin, serotonin, receptor response in the pleasure center of the brain, I’m not buying your conclusion.

      • Hugh7
        Feb 15, 2012 @ 21:01:33

        This is getting silly. If a man says he feels pleasure but his oxytocin, serotonin, receptor response in the pleasure centre of his brain is not what some other study says it should be for pleasure, are you going to tell him that he doesn’t really feel pleasure?

        I have a foreskin and it, itself, gives me pleasure. I find it impossible to understand how I could get as much without it. Sure, that’s only anecdotal (and N=1 at that!) but should I listen to my moans of pleasure, or your oxytocin receptors?

        Try cutting the whole thing off and see how much pleasure a man gets from it.

      • SquintMom
        Feb 15, 2012 @ 22:22:41

        The thing is, that you derive pleasure from sexual encounters WITH a foreskin doesn’t mean you’d derive less pleasure from sexual encounters WITHOUT a foreskin. Your logic is flawed. Also, that you make an analogy between cutting off the foreskin and cutting off an entire penis is ludicrous. There is simply NO WAY TO KNOW whether a man’s sexual experience as a adult (assuming he was circumcised as an infant) is better than, worse than, or identical to what it would have been had he not been circumcised. There is no way of knowing. It’s unprovable.

      • Laney
        Feb 15, 2012 @ 22:32:26

        Actually, Hugh, what’s getting silly is your insistence that you have a “better” sexual experience than circumcised men because you have a body part they don’t. You have a penis, and I don’t. It doesn’t mean you enjoy sex more than me. Plus, notice that there was a study she cited in this article that of men who had sex both with and without foreskins (men who were circumcised as adults), fully half though the sex was better after circumcision, while only 38% thought it was better before circumcision. What that says to me is that it’s more or less a toss-up on whether a man will like sex better before or after circumcision, with the odds tipped somewhat in favor of better sex without a foreskin.

        Anyways, the other thing you are completely failing to notice is that when SquintMom says there’s no evidence to support or refute circumcision, she’s not saying she’s for circumcision. You keep arguing with her like she’s pro and you’re against, but she’s not pro. She’s saying there’s no evidence. If you want to have a logical argument with her, provide some evidence instead of just going round and round in circles and talking about your penis.

      • Hugh7
        Feb 16, 2012 @ 08:25:41

        SquintMom. I was just reducing your argument to absurdity. If cutting a little off makes no difference, how about cutting off a lot? Or the lot? There’s no dotted line. What is the threshhold? Why should there be one? Especially since, as Taylor et al.[1] showed, there is a concentration of Meissner corpuscles in a ridged band encircling the tip of the foreskin. The frenulum – which many circumcised men call their “G-spot” is just a remant of that band.

        Laney: I have body parts that you don’t (and you that I don’t) because of our genetics. Circumcised men don’t have part because somebody chose to cut it off. That is a significant difference. The Fink study was of men who needed to be circumcised, 64% of them for phimosis, so it’s hardly surprising if sex was better afterwards. A study of men who chose to be circumcised would be flawed by selection bias too. The only truly scientific way would be to grab men off the street at random and circumcise half, willy-nilly. That’s not going to happen.

        My difference with SquintMom is that she cherrypicks the evidence, reading pro-circumcision evidence uncritically and anti- hypercritically, if at all.

        Your last line is a low blow. How many posts have you seen that say nothing but “I’m circumcised and it works just fine!”? Do you berate each and every one of them for “talking about your penis”? You are talking about cutting part off babies that men who still have the part – never mind who – much enjoy having. It it a surprise that such men react vehemently?

        1. Taylor, J.P., A.P. Lockwood and A.J.Taylor
        The prepuce: Specialized mucosa of the penis and its loss to circumcision Journal of Urology (1996), 77, 291-295

      • SquintMom
        Feb 16, 2012 @ 14:09:54

        I didn’t say “cutting off a little makes no difference.” I said there was no scientific evidence that it makes a difference. Yes, it is specialized tissue. Yes, it has nerve endings. However, the human body is not set up in a “more nerve endings is better” way. It’s certainly POSSIBLE that cutting off the foreskin results in reduced enjoyment, but it’s also possible that it has no effect. It’s even POSSIBLE that the brain of a man circumcised as an infant rewires (this possibility is well supported in the literature with regard to infant brains, though hasn’t been investigated specifically with regard to the penis). The thing is, there is no way to know what a man circumcised as an infant would have experienced had he not been circumcised.

        The only thing we DO know is that of men who have had sex both ways (circ’d and uncirc’d), 50% preferred circumcised sex. Only 38% preferred uncircumcised sex. This is the closest we have to scientific evidence that sex without a foreskin can be just as satisfying (nay, BETTER, even), than sex with a foreskin.

        Hugh, I’m sorry. I appreciate your interest in discussing this, but I can no longer justify pouring time into this conversation with you, since you are not listening to me. As I’ve said repeatedly, I find ALMOST ALL of the studies on circumcision flawed, with the exception of those that show a reduction in rate of HIV and HPV (which have been repeated again, and again, and again, and which are accepted not only by the WHO, but also by the CDC and by the AAP).

      • Hugh7
        Feb 17, 2012 @ 01:21:41

        Is there any scientific evidence that cutting off toes impairs walking?
        Is there any scientific evidence that cutting off lips impairs eating (and kissing)?
        Is there any scientific evidence that cutting off earlobes impairs the wearing of clipon earrings?
        Is there any scientific evidence that cutting any part off the tongue impairs the sensation of taste?
        Does anyone ask for such evidence?
        We would not be having this conversation if a (bare) majority of US babies were not already being circumcised for the strange historical reason that a ritual was adopted by the medical profession as surgery, at a time of hatred of sexual pleasure, with the expressed intent of reducing sexual pleasure. It clung on like a bad smell, one excuse taking the place of another as each was debunked. Consider HIV. In 1981, nobody had heard of HIV, but about 70% of babies were still being circumcised.

        “The only thing we DO know is that of men who have had sex both ways (circ’d and uncirc’d), 50% preferred circumcised sex. Only 38% preferred uncircumcised sex.”

        As I told Laney in my previous messsage: “The Fink study was of men who needed to be circumcised, 64% of them for phimosis, so it’s hardly surprising if sex was better afterwards.”

        “and which are accepted not only by the WHO, but also by the CDC and by the AAP).” This is the fallacy of Appeal to Authority. I critique the HIV studies here and the HPV studies here.

        I’m not listening to you? The shoe is on the other foot. I’m tired too.

        I look forward to your third article, about the values issues involved in cutting healthy (male) babies’ genitals.

    • Erin
      Feb 17, 2012 @ 05:43:11

      Squintmom, you are talking about studies where men were circumcised for medical reasons. If a man is having a medical problem that warrants a circumcision, he is probably going to enjoy sex better when that has been relieved with surgery. Additionally, when a man chooses a circumcision for emotional reasons, same goes. If a man is made fun of or made to feel is is “dirty” by society, it stands to reason that he may enjoy sex better after making the change and fitting in. Emotions play a major role in sexual pleasure.

      That said, I think it’s kind of silly to argue that this especially with any kind of “evidence” considering the evidence is inadequate. When you take the blinders off and look at what is removed and what that tissue contains, one has to realize that it makes some kind of difference. Removing the gliding mechanism alone does change sex and that is a fact. Why should a mother or father decide to change the way their son experiences sex forever? The owner of the genitals should be the one to decide if his sexual experiences should be altered permanently. Circumcision is not time-sensitive. And with tools now such as the Prepex, there’s no harm in letting the man make the choice for himself, as an adult.

      • SquintMom
        Feb 17, 2012 @ 06:22:07

        Yes, yes I am. Know why? Because these are the only studies that even come close to giving us information about the sexual experience of men who’ve been circumcised versus those who have not been. If you want to dismiss these studies for the sake of argument, fine by me. Where does that leave us? With absolutely no information. With no evidence.

        There is no scientific evidence that circumcision negatively affects the sexual experience. NONE.

      • Hugh7
        Feb 18, 2012 @ 06:34:38

        As previously posted below:
        Frisch M, Lindholm M, Grønbæk M.
        Male circumcision and sexual function in men and women: a survey-based, cross-sectional study in Denmark.
        Int J Epidemiol. 2011 Jun 14.

        Conclusions
        Our study shows hitherto unrecognized associations between male circumcision and sexual difficulties in both men and women. While confirmatory findings in other settings are warranted, notably from areas where neonatal circumcision is more common, our findings may inform doctors and parents of baby boys for whom the decision of whether or not to circumcise is not dictated by religious or cultural traditions. Additionally, since it appears from our study that both men and women may have fewer sexual problems when the man is uncircumcised, and because preputial plasties may sometimes serve as suitable alternatives to standard circumcision, our study may stimulate a more conservative, tissue-preserving attitude in situations where foreskin pathology requires surgical intervention.

      • SquintMom
        Feb 18, 2012 @ 14:46:18

        Note authors say that more studies are warranted. One study is almost never meaningful independently. I stand by my assertion that there is not sufficient science to inform either side of the circ debate.

      • Hugh7
        Feb 19, 2012 @ 06:08:21

        But you can never again say “There is no scientific evidence that circumcision negatively affects the sexual experience. NONE.”

        Studies virtually always say “More study is warranted” – maybe it has to do with getting more funding. And one can always say “more study is warranted”. The next study might always controvert the previous ones. Science never closes the door on new findings.

        Do you have any specific objection to the Frisch study? Unlike so many others, it was large (N=5552) and som standard sampling method seems to have been used.

        Two of the usual suspects (Morris and Waskett) came up with the creative idea that because circumcision is rare in Denmark, the circumcisions might have been only partial, but as Frisch responded, that should have weakened the deleterious effect of circumcision, not caused it. See http;//www.circumstitions.com/Sexuality.html#denmark

      • SquintMom
        Feb 19, 2012 @ 17:13:45

        Actually, “scientific evidence” means more than “findings of a single study.” A single study can be wrong, so scientists don’t consider results that haven’t been reproduced to count as “scientific evidence.”

      • Hugh7
        Feb 19, 2012 @ 20:45:13

        None means none. To put it scientifically, 1>0.

        ‘scientists don’t consider results that haven’t been reproduced to count as “scientific evidence.”’ Really? I think you’ll find there have been many studies that were so conclusive, or expensive, or or one-off events (eg planentary transits proving the existence of remote planets) that they have never been reproduced.

        Or the result is so obvious that nobody bothers. Outside the USA, that is the case for circumcision impairing sexual function. After all, it was popular wisdom for millennia before the medicalisation of circumcision that it impaired sex (and it was medicalised in an era of hatred of sexual pleasure):

        “…among the love-lures of pleasure the palm is held by the mating of man and woman, the legislators thought good to dock the organ which ministers to such intercourse, thus making circumcision the figure of the excision of excessive and superfluous pleasure” – Philo Judaeus 1stC

        “The fact that circumcision weakens the faculty of sexual excitement and sometimes perhaps diminishes the pleasure is indubitable.” – Moses Maimonides

        “[God ordered circumcision for] the diminishing of fleshly concupiscence which thrives principally in those organs because of the intensity of venereal pleasure.” – St Thomas Aquinas, writing 1267-73

        “The functions of the prepuce and of the little skin … are to furnish some delight in coitus and to guard the glans from external harm.”- Jacopo Berengario da Carpi, late 15thC

        “What is done for appearance contributes also to generation and to greater pleasure therein; for the part is not itself lubricate if it has no foreskin, and yet in the venereal act it requires notable lubricity.” – Gabriele Falloppio, 16th Century (the anatomist who discovered the Falloppian tubes)

        “The circumcised are affected with less pleasure in coitus because the membrane is thickened and sensation blunted.” – William Harvey, 17th Century

        “Circumcision detracts somewhat from the delight of women by lessening their titillation.’ – John Bulwer, 17th C

        “The glans, which is at the end of the penis, [is] covered with a very thin membrane, by reason of which it is of a most exquisite feeling. It is covered with a preputium or foreskin, which in some covers the top of the yard quite close, in others not so, and by its moving up and down in the act of copulation brings pleasure both to the man and woman.” Anon, Aristotle’s Masterpiece, 1749

        “The use of the praeputium is to keep the glans soft and moist, that it may have an exquisite sense.” – Robert James, A medicinal dictionary: 1743-45

        “The pleasure of the sexual union is greatly increased by the prepuce, for which reason women prefer cohabiting with those who retain it than with the Turks or the Jews.” – John Davenport, Curiositates eroticae physiologiae, 1875

        – So it would be quite hard to get funding for a study of the effect of circumcision on sex where the scientists and the funders (or their partners) all have their foreskins and know first-hand what it contributes.

        And some more indirect scientific evidence:

        Erectile function evaluation after adult circumcision
        [Article in Chinese]
        Shen Z, Chen S, Zhu C, Wan Q, Chen Z.
        OBJECTIVE: To evaluate the erectile function of adults after circumcision.
        METHODS: Ninty-five patients were investigated on erectile function by questionnaire before and after circumcision, respectively.
        RESULTS: Eighteen patients suffered from mild erectile dysfunction before circumcision, and 28 suffered from mild or moderate erectile dysfunction after circumcision(P = 0.001). Adult circumcision appeared to have resulted in weakened erectile confidence in 33 cases (P = 0.04), difficult insertion in 41 cases (P =0.03), prolonged intercourse in 31 cases (P = 0.04) and improved satisfaction in 34 cases (P = 0.04).
        CONCLUSIONS: Adult circumcision has certain effect on erectile function, to which more importance should be attached.

        PMID: 14979200 [PubMed – in process]

        Zhonghua Nan Ke Xue. 2008 Apr;14(4):328-30
        Circumcision affects glans penis vibration perception threshold
        [Article in Chinese]
        Yang DM, Lin H, Zhang B, Guo W.

        Abstract

        OBJECTIVE:
        To evaluate the effect of circumcision on the glans penis sensitivity by comparing the changes of the glans penis vibrotactile threshold between normal men and patients with simple redundant prepuce and among the patients before and after the operation.

        METHODS:
        The vibrotactile thresholds were measured at the forefinger and glans penis in 73 normal volunteer controls and 96 patients with simple redundant prepuce before and after circumcision by biological vibration measurement instrument, and the changes in the perception sensitivity of the body surface were analyzed.

        RESULTS:
        The G/F (glans/finger) indexes in the control and the test group were respectively 2.39 +/- 1.72 and 1.97 +/- 0.71, with no significant difference in between (P > 0.05). And those of the test group were 1.97 +/- 0.71, 2.64 +/- 1.38, 3.09 +/-1.46 and 2.97 +/- 1.20 respectively before and 1, 2 and 3 months after circumcision, with significant difference between pre- and post-operation (P < 0.05).

        CONCLUSION:
        There is a statistic [significant?] difference in the glans penis vibration perception threshold between normal men and patients with simple redundant prepuce. The glans penis perception sensitivity decreases after circumcision.

      • SquintMom
        Feb 21, 2012 @ 15:43:42

        Actually, again, you’re wrong. The fact that a study exists doesn’t mean that study counts as proof. For a study to count as evidence, it needs to be a study that draws accurate, reproducible conclusions. A single study isn’t meaningful until its results have been duplicated.

        No scientist accepts the results of a single, isolated study as meaningful.

        To put it scientifically, 1>0, unless the 1 is WRONG (which we don’t know until it’s been reproduced).

      • Laurel
        Mar 01, 2012 @ 02:57:28

        Oh, Really… no evidence of the effect on sexual pleasure? If you go around wearing blinders, chances are you’re not seeing everything (I came up with these two studies in less than a minute: less time than it took to write this reply and post the links)

        http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2006.06646.x/pdf

        http://onlinelibrary.wiley.com/doi/10.1046/j.1464-410x.1999.0830s1079.x/pdf

        And do yourself a favour and consider who the pro-circ publishers are, and where their investments lie… you’ll start to see the whole picture once you start connecting the dots.

      • SquintMom
        Mar 01, 2012 @ 16:12:32

        Laurel, “No evidence” is not the same thing as “no publications.” There are some poorly-conducted studies, like the two you cite here, that attempt to show an effect of circumcision on sexual pleasure. In science, there are often studies that can be cited as support for either side of a debate. Because there are so many studies that show no effect, however, and so many studies that show improved performance post-(adult) circumcision, we simply can’t draw scientific conclusions. You’re mistaking my statement that science doesn’t support the notion that circumcision affects sexual pleasure to mean “science proves that circumcision DOESN’T affect sexual pleasure.” There is a big difference between “no proof” and “proof of the negative.”

        Further, there is no indication that any of the researchers who have conducted studies showing either benefits or lack of harm associated with circumcision have had anything to gain from their findings. Can you even suggest HOW someone could possibly benefit from showing that circumcision is a) not harmful, or b) beneficial? You’re trying to create a conspiracy theory where no plausible such theory exists.

  4. Hugh7
    Feb 15, 2012 @ 08:31:27

    Slater et al found oral sucrose did not reduce pain, it just relaxed the facial muscles. (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2961303-7/fulltext )

    “The adult procedure is a more significant surgery than the infant procedure, leading some practitioners to view circumcision as “preventative medicine.” The adult procedure is much more precise surgery than the infant procedure because the part involved has stopped growing. Very few circumcisions are followed to adulthood, so one doctor can make the same tiny mistake many times without it ever being discovered.

    The Williamsons’ study was a survey of 145 new Iowa mothers, (only 24 of whom had ever known any but circumcised penises) so it can hardly be generalised to every woman in the USA, let alone the world, and we now know it was rigged – at least one mother wasn’t asked to take part until AFTER she’d said she would have a son cut.

    Bailey et al. studied Ugandana men who had volunteered to be circumcised in the hope it would protect them against HIV – hardly a random sample of the population. Men who valued their foreskins would stay away from such a study. (They found virtually perfect sex both before and after circumcision, unlike most studies of male satisfaction. Perhaps we should all go and live in that sexual paradise, Uganda!)

    You may be determined to use only “evidence-based” medicine, but there is evidence and there is evidence, and the evidence gathered in support of circumcision has been gathered, almost in its entirety in the USA or by Americans, and therefore very probably by circumcised men. Men, it need hardly be stressed, are VERY sensitive about any suggestion that there is anything the matter with their equipment.

    • SquintMom
      Feb 15, 2012 @ 16:17:06

      There’s a HUGE error in the methodology of the Slater study, though. Analgesic drugs work in different ways. Some, like topical numbing creams, decrease the activity of the pain-sensing neurons (nociceptors). Others, like codeine, decrease the brain’s ability to interpret those signals as pain. Slater found that sucrose didn’t affect the pain signals coming into the brain. He didn’t test to see whether it decreased activity of the brain elsewhere, however. Had they done this study in the same way on codeine, they would have found that codeine didn’t reduce pain, either.

      The Williamson study was on the smaller side, but it was representative of the population. Most caucasian American women have only known circumcised penises. Most choose to circumcise their sons. Further, the Williamsons did not attempt to generalize the study to the world (and you’ll notice, neither did I). You’ll need to provide evidence for your statement that a mother was asked to take part only after stating she’d circumcise.

      With regard to Bailey et al, you are making an assumption that isn’t scientifically based (that men who “valued their foreskin” would stay away from such a study). Perhaps the men valued their foreskin, but they valued their life more. We don’t know; those attitudes weren’t tested. Also, my point with regard to the Bailey study was about WOMEN surveyed, not men.

      The “evidence” gathered in opposition of circumcision is largely very weak, with poor methodology. Neither is there much evidence in support of circumcision. If you’ll notice, this article series comes to the conclusion that there is NO STRONG SCIENTIFIC SUPPORT either way. I’m not trying to say science supports circumcision, though it seems you suggest I am.

      I have yet to see a single, well-conducted study that shows strong opposition for circumcision. If you know of such a one, please point it out!

    • SquintMom
      Feb 15, 2012 @ 22:56:38

      The other thing that I’d like to add is that even if we throw out all the findings of the Williamsons’ study (and I don’t think the study is THAT weak, but let’s say we totally disregard it), and we throw out all the findings of the Bailey study (which we shouldn’t do, because their methodology was quite reasonable), all that leaves us with is that there is no evidence that women PREFER circ’d penises. So now what we have is:

      1) There is no strong scientific evidence to support circumcision in the US
      2) There is no strong scientific evidence to oppose circumcision in the US

      That’s exactly where we were before.

      I would love to continue this conversation in a logical manner, but in order for you to weaken points 1 and 2 above, you’ll need to cite STRONG SCIENTIFIC EVIDENCE that opposes circumcision.

  5. Hugh7
    Feb 15, 2012 @ 21:25:48

    Has your critique of Slater et al. been published? (Dr Slater’s first name is Rebeccah, by the way.)

    My analysis of the Williamson study is at http://www.circumstitions.com/Iowa.html and includes the original message from the woman who was recruited only after she said she would circumcise a son (she’d had a daughter) at http://www.circumstitions.com/Iowa.html#skew. I am still in FB contact with her.

    Why do you put scare quotes about “valued their foreskin”? In cultures that do not circumcise, they do. (Do you “value your eyelids” or value your eyelids?)

    My point about the other Bailey study is that the men were all volunteers for circumcision, not a random sample of the population, which would therefore be skewed against men who get pleasure from their foreskins. This is a valid criticism of that study, not some further assumption that needs yet another “scientific” test.

    As to the Bailey study you refer to (and the Williamsons), do we ask whether men prefer sex with women who have had (any) part of their genitals cut off?

    • SquintMom
      Feb 15, 2012 @ 22:19:22

      There is no comparison between circumcision, which has proven medical benefits and no PROVEN impact upon sexual function (and which is not done to decrease sexual function) and female circumcision, which is done expressly to reduce sexual function.

      I agree with you that the Williamson study is not STRONG scientific evidence. I have said this multiple times, but I’ll say it again, since it appears you are having difficulty hearing me: there is no strong scientific evidence either to support or refute routine infant circumcision in the US. You seem to think that because I don’t think there’s strong evidence against circumcision, I somehow think there is evidence for it. This is not so.

      We do not know what motivated the volunteers in the Bailey study, since that information is not published. Eyelids are not an appropriate comparison to a foreskin, because loss of the eyelids would cause irreparable harm to the corneas. There is no evidence that loss of the foreskin causes irreparable harm to any other part of the body. Let’s take a different body part, say, the earlobes. Do I value my earlobes? HECK YES. Do I want them cut off? HECK NO. Would I volunteer for a study that would necessitate having them cut off if there was good evidence presented to me that in so doing, I would be increasing my odds of survival? ABSOLUTELY. Does that mean I don’t value my earlobes? NO. It just means I value my life more.

      Cite ONE scientific study (that means scientifically conducted, with strong methodology, by an intellectually-motivated (rather than ideological) party) that shows circumcision is harmful. Just one.

      • Hugh7
        Feb 16, 2012 @ 08:59:05

        Male circumcision was medicalised – or rather, as someone has just put it, it was a traditional practice that was taken up by doctors and characterised as a surgical operation – in order to reduce “irritation” – their euphemism for sexual stimulation. (It didn’t prevent masturbation, but the kids would make sure they weren’t caught again, so it seemed to. Yes, kids, Kellogg recommended circumcision for boys, carbolic acid for girls, but some girls also had genital surgery right up to the 1960s. Read Patricia Robinett’s “Rape of Innocence”.) Kellogg thought the pain was valuable so you may say that it went from ritual to surgery by way of torture.

        I did not refer to “female circumcision” or to why it is done. (In fact, the reasons are as wildly varied and irrational as they are for male genital cutting) I referred only to cutting (any) part of women’s genitals off. Motivation and outcome are irrelevant. My point was about the preference of the opposite sex. Many men do prefer women with bigger breasts, but we would also consider it wildly unethical to do anything to baby girls to enhance that.

        But since you raise it, Stallings found quite a robust correlation between female genital cutting in Tanzania and reduced incidence of HIV. Nobody even considered mounting controlled trials, let alone mass “circumcision” campaigns, even though some women’s attitude toward being genitally cut closely parallels some men’s.

        “There is no evidence that loss of the foreskin causes irreparable harm to any other part of the body.”

        Do we need a study to prove that loss of the foreskin causes irreparable harm to the foreskin?

        “Cite ONE scientific study (that means scientifically conducted, with strong methodology, by an intellectually-motivated (rather than ideological) party) that shows circumcision is harmful. Just one.”

        And how, pray, are we to ascertain motivation? From the way the Williamsons write, their motivation is clear, but you don’t fault theirs.

        Netto et al. J. Ped. Urol. (2010) xx, 1-6
        Prospective randomized trial comparing dissection with Plastibell circumcision
        One boy in six suffered an immediate complication and one in nine a late complication, from the sleeve procedure. More than one in 20 suffered an early complication, and another one in 20 a late complication from the Plastibell™. Nearly three in ten suffered an adhesion from a sleeve procedure, and more than one in ten from the Plastibell™.

      • SquintMom
        Feb 16, 2012 @ 13:57:58

        There are multiple flawed arguments here, and I’m not going to take the time to address them all, but I’ll address a few. First, while circumcision WAS popularized in the US as a way to (theoretically) reduce masturbation, so were Graham crackers. Circumcision is no more a mechanism for reducing masturbation than Graham crackers are. Simply because some nut-job has an idea doesn’t make that idea legitimate.

        You DO refer to female circumcision as a “Parallel Evil” on your website, which reinforces my notion of your ideology.

        Sure, loss of the foreskin is loss of the foreskin…but like the human appendix, there’s no evidence to suggest that loss of the foreskin has any effect whatsoever. Zero evidence.

        I actually DO fault the Williamson study. I think a lot of the studies, whether they purport to demonstrate that circumcision is good OR bad, are flawed. I am getting tired of saying this, but you seem to have trouble hearing me, so I’ll say it yet again: I am not pro-circumcision. I don’t think the evidence supports routine infant circumcision in the US. Neither, however, do I think the evidence opposes it.

      • Hugh7
        Feb 17, 2012 @ 02:02:52

        I do not (of course) claim that circumcision is still done to prevent, “cure” or punish maturbation. Once it was established, it could continue by custom, habit and convention. Much of the scientific “evidence” for it would not exist were it not for that. (Much of it originates in the USA, or was carried out overseas by US scientists.) Graham crackers didn’t have that advantage and are probably a lot less popular than they were (they’re not available here).

        Male and female genital cutting have parallel forms and we should compare like with like. The surgical form of FGC used to be done in the US (sometimes with a shield to protect the clitoris). The surgical form done in Malaysia and Indonesia seems to be quite minor. The tribal form of MGC causes many deaths and penile ablations.

        “there’s no evidence to suggest that loss of the foreskin has any effect whatsoever. Zero evidence.”
        Isn’t that equally (or even more) true of the female foreskin (the clitoral prepuce)?

        You are out of date with the appendix:

        “Thus … a growing quantity of evidence indicates that the appendix does in fact have significant function as part of the body’s immune system. The appendix may be particularly important early in life because it achieves its highest state of development shortly after birth and then regresses with age, eventually coming to resemble such other regions of gut-associated lymphoid tissue as the Peyer’s patches in the small intestine. The immune response mediated by the appendix may also relate to ulcerative colitis and other inflammatory conditions.”

        – Scientific American, Nov 2001, p 84

        People who have had their appendix removed are more likely to develop the digestive disorder Crohn’s disease, results of a new study suggest.

        “It’s not clear if appendicitis increases the risk of Crohn’s disease, or if people at risk for Crohn’s disease are more likely to develop appendicitis. However, the findings may help shed light on both conditions,” according to the lead author of the study, Dr. Roland E. Andersson.

        – Reuters Health

        There’s a third possibility: the appendix performs some function that tends to prevent Crohn’s disease.

        I am not at all ashamed of my “ideology”. Cutting normal, healthy, functional, integral, non-renewable body parts off non-consenting people is evil. Can you name another such part for which you do not share my “ideology”?

      • Erin
        Feb 17, 2012 @ 05:55:38

        There are no proven benefits for infant circumcision. Remember, in order to claim “benefit”, there needs to be an actual net benefit (benefits that exceed the risks).

        You can not extrapolate the short-term results of circumcision on *adult* men and assume it can be applied to the circumcision of infants which is not the exact same procedure.

        That said, there are multiple studies suggesting that FGM reduces the risk of HIV and other STIs. This does not get attention or further research because thankfully, most people realize this is not an acceptable practice.

      • SquintMom
        Feb 17, 2012 @ 06:14:23

        To the first point, I agree that there is no strong scientific evidence for routine infant circumcision in the US (see my first post in this series).

        With regard to the second point, provide citations (that make it clear that female circumcision reduce risk of HIV through a mechanism OTHER than reduced sexual activity).

    • SquintMom
      Feb 15, 2012 @ 22:27:39

      My critique of the Slater study is not published other than right here. I’m not sure why that’s relevant, however; every time a scientist reads an article, he or she critiques it. Whether or not he/she takes the time to formally write up and publish that critique is incidental and irrelevant.

      • Hugh7
        Feb 16, 2012 @ 08:41:02

        Well then, you will find my critiques of many of the pro-circumcision studies here. HIV (the RCTs). Complications. Cancer. Sex. Happy reading!

      • SquintMom
        Feb 16, 2012 @ 14:00:00

        I’m having trouble finding your credentials on your website. Could you point me in the right direction?

      • Hugh7
        Feb 17, 2012 @ 03:51:07

        My degree is in zoology, but it’s not about me.

      • SquintMom
        Feb 17, 2012 @ 06:19:48

        Actually, it is, in a way. Here’s the thing; science is tough. Scientific articles can be hard to interpret. One needs to have a certain understanding of methodology, of the scientific method, of the way in which research is conducted, and of what counts as evidence. While it’s certainly possible that someone without formal science training (that is to say, a PhD) could be adept at reading and interpreting science, it’s rare to find such an individual. It’s a little like those “secret codes” you used to get in cereal boxes; you know, the ones where there were words written in blue ink underneath red scribbles? And you needed red lenses to read the code? Formal science training is that set of red lenses, so to speak. All I’m trying to say is that while I know it can be frustrating to be told “that isn’t proof,” or “that isn’t scientific” in response to a point about which you feel strongly, my scientific background provides me with the ability to tease out the fact from the ideology…and the simple fact is, much of the pro-circumcision rhetoric is ideological.

        Simply stated, in the end, there is no strong scientific argument that can be made either FOR OR AGAINST routine infant circumcision in the US. The decision HAS to be made on the basis of beliefs.

      • Hugh7
        Feb 18, 2012 @ 03:03:53

        So only a PhD is good enough? I know people with PhDs who are utter fools.

        You’re guilty of the fallacy of Appeal to Authority. (I knew it would be that or argument ad hominem.)

        Also, and I hesitate to say this because I usually hate the term, scientism. I’d never heard of “evidence-based parenting” before your site. Evidence-based medicine, yes. But parenting as a science? I’m not sure that is even a good idea. No matter how many RCTs show that cloth diapers are 87.64% better than disposable. trial and error may show that disposable are better for THIS baby.

        “much of the pro-circumcision rhetoric is ideological.” Much of the pro-circumcision SCIENCE is ideological too. Science is a human endeavour, and scientists are fallible. Circumcised men don’t want to know there is anything the matter with circumcision, so they gently guide their science in that direction – like Wawer et al. stopping their study of HIV transmission from men to women before it could confirm (or disprove) that circumcising men increases the risk to women, after they had a strong hint in that direction. And there is a ready mechanism for that to be the case: the keratinised glans could be more likely, than the smooth intact one, to make micro-tears in the vagina.

        And while peer review is supposed to overcome personal bias, with something as deeply ingrained in the (male) psyche as circumcision as normative, even peers may overlook faults in studies that suit their prejudices. Look at David Gisselquist’s devastating critique of the ethics and methodology of the three HIV RCTs. They should have been brought to light long before now, and used to damn the trials and their conclusion and prevent the mass circumcision campaigns in Africa that have flowed from them.

        It is probably true that FGC has no health benefits (either), but those who believe in it claim it does. (One popped up this morning saying she was glad she is circumcised to “prevent risk of bacterial vaginosis”.) The science will probably never be done, but suppose it were, and suppose minimal, surgical FGC – just clitoral prepucectomy – were found to have net beenfits, would you be saying “Parents must do their research and make an informed decision for their daughers”? Or “The decision HAS to be made on the basis of beliefs.”

        I say neither decision has to be made at all. Infant circumcision was not introduced on the basis of science (except some very bad science when medical science was in its infancy). It can be abandoned and then abolished the same way.

      • SquintMom
        Feb 18, 2012 @ 14:48:30

        I didn’t say only a PhD was good enough. However, while SOME PhDs are idiots, MOST are good scientists. While SOME individuals without scientific training (MD, PhD, etc) can wade through scientific studies, MOST have trouble doing so. We credential people for a reason; the credentials aren’t a guarantee, but they’re a solid indication.

      • Hugh7
        Feb 20, 2012 @ 19:53:14

        An MD is training in science? Hardly. MDs have to do a vast amount of rote-learning (names of muscles, etc) and learn very little about the methodology or philosophy of science. In this country, they are tested on their bedside manner early on, and those who have a tendency to be impersonal or Aspergic – which can be a good thing in science – are failed.

      • SquintMom
        Feb 21, 2012 @ 15:40:54

        I’m sorry, but you’re very wrong.

  6. Jennifer
    Feb 16, 2012 @ 02:07:09

    Thank you so much for taking the time to make this series. In part three, do you think you could devote some space to talking about how partners can resolve this issue if they disagree? The problem we’re running into is that I want to circumcise for health and cultural reasons; but my husband seems to see this as some sort of judgement on him / his penis. For example he says he’s never had any trouble being uncircumcised (which is true) so why do it? I tried explaining that this is just one anecdote, but he insists on seeing it as me saying that it’s better to be circumcised, and therefore his is inferior, which I don’t think is the case at all.

    • SquintMom
      Feb 16, 2012 @ 02:12:38

      Oh, wow. That’s a great idea. I will do my best to see what sorts of resources I can find, but please be aware that since the decision to circumcise is one that isn’t really informed (either way) by science (and is informed by beliefs), my suspicion is that the resources I’ll be able to direct you to will be mostly along the lines of finding neutral ways to communicate with each other! Thanks for reading, and best of luck to you.

      One thought…what about having your husband read the posts in this series to open up a dialogue between the two of you?

    • Hugh7
      Feb 16, 2012 @ 08:44:19

      How to resolve this issue if you disagree? Do nothing. Let the owner decide (when he is old enough).

      • SquintMom
        Feb 16, 2012 @ 13:47:48

        Actually, that’s not a solution. The surgery is much more complex for an adult than it is for an infant.

      • Hugh7
        Feb 17, 2012 @ 02:05:16

        And your evidence for that claim?

      • Hugh7
        Feb 17, 2012 @ 02:23:52

        And so what if it were more complex? It’s certainly not so complex that adults don’t get circumcised, sometimes for no reason but their choice. What makes it a solution is that the vast majority of intact men choose to stay that way.

        For example, the other night on the Late Late Show, Craig Ferguson recounted how during the course of a regular physical, “my doctor….I mean he’s seen this before but today he looks at it and goes ‘You know….I can fix that up for you.’

        I’m like ‘What do you mean?’

        He said ‘You know…..tidy it up.’

        I’m like ‘Leave it alone!’

      • Erin
        Feb 17, 2012 @ 05:50:36

        Squintmom, that is incorrect. The surgery is less complex for an adult man. With an adult man, his foreskin does not have to be torn apart from the glans. It’s also larger and easier to make more precise cuts/clamps to have a better degree of accuracy as well as the option for patient input as to how much to take. And now that we have the Prepex, adult men do not even have to take a single day off of work and no anesthesia is needed. While the Prepex is currently in use primarily in Africa at this time, babies being born today in the US will have the option (and others, I’m sure) by the time they become adults.

      • SquintMom
        Feb 17, 2012 @ 06:20:19

        Citation, please. It’s impossible to have a rational, fact-based discussion without all the information on the table. Thanks.

      • Greg Hartley
        Feb 17, 2012 @ 15:29:45

        A citation for the above statement: Cold CJ, Taylor JR. The prepuce. BJU Int 1999:83 (Suppl 1): 34-44
        This article clearly explains that the infant prepuce (foreskin) is fused to the glans at birth by synnechia (similar to the connective tissue under your fingernails). This is common knowledge to most parents worldwide, where male genital cutting is uncommon. Have you seen an infant circumcision? After making a dorsal slit, the synnechia must be torn before the prepuce is cut off. Although an adult male may remember the surgery, it avoids this obviously painful step.

      • SquintMom
        Feb 17, 2012 @ 15:56:54

        Yes, this is evidence that infant circumcision is an ETHICAL issue. It’s not evidence that infant circumcision is a SCIENCE issue.

  7. Jenny F. Scientist, PhD
    Feb 17, 2012 @ 05:07:42

    Thanks for your careful consideration of the evidence. It’s actually one if the few infant-medical things I’ve never looked into because I’m an observant Jew and the choice was circumcise, or exclude my children from my religious community!

    I’m quite glad the evidence seems to suggest it’s not harmful because it’s already done (I have two little boys). 🙂

    • Jonathon Conte
      Feb 18, 2012 @ 03:16:56

      I’m glad to hear that you won’t be losing any sleep over the genital mutilation of your children. Of course there is no chance that your sons will ever resent your decision to pay someone to cut off the most erogenous parts of their penes. Way to go, mom!

      Circumcision removes the most sensitive part of a man’s penis. The five most sensitive areas of the penis are on the foreskin. The transitional region from the external to the internal foreskin is the most sensitive region of the fully intact penis, and more sensitive than the most sensitive region of the circumcised penis.
      —————————-
      Fine-Touch Pressure Thresholds In The Adult Penis
      British Journal of Urology International,
      2007, Vol. 99, No. 4, 864-869
      Sorrells et al

      • SquintMom
        Feb 18, 2012 @ 14:44:23

        You bring up an ethical issue (albeit in an inflammatory way). You might make your case more convincingly if you could avoid ad hominem arguments.

    • Hugh7
      Feb 21, 2012 @ 08:24:23

      “the choice was circumcise, or exclude my children from my religious community!”

      I wonder what they would choose, if they were allowed to experience complete genitalia, and THEN decide whether to give them up in order to be admitted to your religious community.

      Contact details for more than 60 celebrants (more than 20 rabbis) of non-surgical naming ceremonies (Brit Shalom) are here.

      • SquintMom
        Feb 21, 2012 @ 15:45:44

        It’s not just a matter of finding a rabbi who performs non-surgical ceremonies. It’s also what the parents believe.

      • JustSomeChick
        Feb 11, 2013 @ 12:20:49

        and the beliefs of the child, about HIS genitals, count for nothing?

      • SquintMom
        Feb 19, 2013 @ 08:43:36

        Parents make health decisions for a child who is unable to speak for and make decisions for him/herself all the time. For instance, meat-eating parents might feed meat to a child who will eventually be vegan for moral/ethical reasons. Is that wrong? Should parents abstain from feeding a child any animal products on the grounds that the child might grow up to feel those animal products are immoral? Parents make the best decisions they can for their child, recognizing that when the child is grown, he or she may subscribe to a different belief system.

        Now, one might argue that circumcision is a bigger deal than feeding a child meat, as it permanently changes the body. However, some truly dedicated vegans believe that incorporating ANY animal product into their body makes them less clean and/or represents a moral transgression. An even stronger example: suppose a child is very ill and requires a blood transfusion, which the parents authorize. Suppose, then, that child grows up and converts to Jehovah’s Witness, and consequently believes blood transfusions are immoral and have condemned him/her to Hell. In the child’s belief system, this is a MUCH bigger deal than a missing body part, because it represents the eternal damnation of the immortal soul. Is a (non-Jehovah’s Witness) parent supposed to prevent any medical procedure that a Jehovah’s Witness would consider damning on the off chance that the child grows up to become a JW?

        Good parents make the best decisions they can for the health of their children (given the information available to them at the time), and when a decision has an aspect of belief associated with it, most parents will act according to their belief system, assuming that the child will either share it when he/she grows, or at least respect it.

  8. Erin
    Feb 17, 2012 @ 06:03:42

    Your review of the complications is sorely lacking. What about adhesions, skin bridges, buried penis, meatal stenosis? Painful erections, erectile dysfunction, hairy shaft? These are all happening at significant rates.

  9. Laney
    Feb 17, 2012 @ 06:39:26

    Hugh, you say:

    “Your last line is a low blow. How many posts have you seen that say nothing but “I’m circumcised and it works just fine!”? Do you berate each and every one of them for “talking about your penis”? You are talking about cutting part off babies that men who still have the part – never mind who – much enjoy having. It it a surprise that such men react vehemently?”

    Actually, there’s a huge difference between a man saying “I’m circumcised and it works just fine” and a man saying “should I listen to my moans of pleasure, or your oxytocin receptors?”

    I really don’t want to hear about your “moans of pleasure.” There are ways of expressing what you’re trying to say that don’t conjure up the image of some random guy having sex.

    You know, I’m starting to get the idea that circumcision is a little like Amway. No one who doesn’t sell Amway really gives a damn about it. The people who sell it, though, are absolutely convinced it’s the best shit on the market. They tell everyone about Amway. They try to get you to give up your home cleaning (etc) products and buy Amway. They try to get you to give up your job and start selling Amway. Why do they do this? Because their sense of self-worth is tied up in Amway, and for them to feel good about themselves, they need you to agree that Amway is great stuff.

    With very few exceptions, the only people who give a damn about circumcision are the people who want to feel superior because they’re not circumcised. Got an uncircumcised penis and proud of it? Hooray for you. But don’t try to tell me that my husband is somehow inferior, in denial, or missing out because he is circumcised. Seriously, your sex life must be pretty lame if you have to spend all your time telling people how great it is.

    • Mark Lyndon
      Feb 17, 2012 @ 10:56:39

      Your Amway analogy seems to apply better to men who are circumcised. If your husband is happy to be circumcised, that’s great, but what’s wrong with letting everyone decide for themselves whether or not they want genital surgery? It’s *their* body after all.

      It’s not like it can’t wait. There are just two countries in the world where more than 50% of baby boys are circumcised – the USA and Israel. Other countries circumcised, but they typically do it around the age of 7, or more commonly puberty or adolescence.

      • Laney
        Feb 17, 2012 @ 14:20:04

        You missed the point of the Amway analogy. My husband, like many circumcised men, doesn’t spend time thinking or talking about his circumcision. The point of the Amway analogy is that it’s the uncircumcised men who seem intent on “hard-selling” it.

      • Mark Lyndon
        Feb 19, 2012 @ 15:39:22

        I beg to differ. Most intact men don’t spend time thinking or talking about circumcision either, and some circumcised men are very keen on hard-selling the procedure, especially on their sons, who don’t have much say in the matter.

        It’s worth pointing out that many intactivists are themselves circumcised. It’s really easy to find men against circumcision who are circumcised, but surprisingly difficult to find men in favor of circumcision who weren’t circumcised themselves as children.

        Most circumcised women seem to think that female circumcision (aka FGC aka FGM) is no big deal btw.

        I still don’t see any good reasons why everyone shouldn’t be able to decide for themselves whether or not they want genital surgery.

      • SquintMom
        Feb 19, 2012 @ 17:15:54

        I don’t think the comparison between circumcision and female genital mutilation (the procedure really shouldn’t be called “circumcision,” because it’s an entirely different procedure done for different reasons) is a valid one.

      • Mark Lyndon
        Feb 19, 2012 @ 23:13:17

        I don’t see how cutting parts off male genitals is an entirely different procedure from cutting parts off female genitals, and the people that cut girls certainly don’t think that. Many forms of female circumcision do considerably less damage than the usual form of male circumcision.

        The people that promote female circumcision (aka FGC aka FGM) claim the exact same reasons as are used to defend male circumcision (religious, hygiene, disease prevention, cosmetic etc).

        The American doctors that used to promote female circumcision didn’t view it as being much different from male circumcision either:

        Circumcision in the Female: Its Necessity and How to Perform It
        Benjamin E. Dawson, A.M., M.D. – Kansas City, Missouri
        American Journal of Clinical Medicine, vol. 22, no. 6, p. 520-523, June 1915
        http://www.noharmm.org/CircintheFemale.htm

        Circumcision of the Female
        (“If the male needs circumcision for cleanliness and hygiene, why not the female?”)
        C.F. McDonald, M.D. – Milwaukee, Wisconsin
        GP, Vol. XVIII No. 3, p. 98-99, September, 1958
        http://www.noharmm.org/circumfemale.htm

        Female Circumcision: Indications and a New Technique
        W.G. Rathmann, M.D.
        GP, vol. XX, no. 3, pp 115-120 , September, 1959
        http://www.noharmm.org/femcirctech.htm

        Some forms of female cutting are truly horrific, but male cutting can be pretty bad too – over 100 deaths in just one province of South Africa last year, as well as two penile amputations.

      • SquintMom
        Feb 21, 2012 @ 15:41:26

        It has to do with WHY the procedure is done.

      • Mark Lyndon
        Feb 22, 2012 @ 11:13:52

        “It has to do with WHY the procedure is done.”

        Like I already said, the people that promote female circumcision (aka FGC aka FGM) claim the exact same reasons as are used to defend male circumcision (religious, hygiene, disease prevention, cosmetic etc).

        Male circumcision was popularized to reduce sexual activity. It’s worth remembering that no-one except for Jewish people and Muslims would even be having this discussion if it weren’t for the fact that 19th century doctors thought that :
        a) masturbation caused various physical and mental problems (including epilepsy, convulsions, paralysis, tuberculosis etc), and
        b) circumcision stopped masturbation.

        Both of those sound ridiculous today I know, and I was skeptical when I first heard that. That’s how they thought back then though, and that’s how non-religious circumcision got started (and arguably religious circumcision). If you don’t believe me, then just search for references to circumcision between about 1850 and 1950 or check out this link:
        http://www.noharmm.org/docswords.htm
        (A Short History of Circumcision in North America In the Physicians’ Own Words)

        Heck, they even passed laws against “self-pollution” as it was called.

        Over a hundred years later, circumcised men keep looking for new ways to defend the practice.

      • SquintMom
        Feb 22, 2012 @ 15:05:36

        Except that now, there are social norms involved, and perceptions of attractiveness. For good or for ill, the majority of American women prefer the look of a circumcised penis. This is reason enough, in some non-Jewish, non-Muslim parents’ minds to justify the procedure in the US. Of course, in other parts of the world (like Africa), there is strong scientific support for health-related circumcision. As I mentioned before, the WHO recommends circumcision in HIV-epidemic areas of Africa and elsewhere in the world.

    • Hugh7
      Feb 18, 2012 @ 06:22:25

      Sorry Laney, but men’s experience of sex is exactly what this is about, and I was trying to make the simplest possible contrast between that and some detached, abstract measure of oxytocins. (“Spend all my time”? Hardly. I generally keep myself in the background to avoid ad hominem attacks – like yours.) If you don’t want to think about men’s experience of sex, better to avoid all circumcision threads.

      Amway is very like a religion. It is not intactness, but circumcision that is promoted, not just like a religion but as an integral part of two major religions and often with religious fervour.

      “With very few exceptions, the only people who give a damn about circumcision are the people who want to feel superior because they’re not circumcised.”

      Your cue, SquintMom: Citation please.

      In fact (pers. com.s) Intactivists are
      Men who hate being circumcised
      Men who enjoy their whole penis
      Women who enjoy its unique rolling action
      Mothers who have seen what circumcision did to their sons
      Nurses who have been told to lie to parents that “He slept right through it”
      Doctors who have to repair botches (A Richmond VA pediatrician saw 1600 in three years, suggesting a rate of more than 13%)
      Lawyers who handle botch cases
      and other people who think human rights are for all humans.

      • SquintMom
        Feb 18, 2012 @ 14:45:12

        What are you asking me to cite here? This is a response to Laney’s comment.

      • Hugh7
        Feb 19, 2012 @ 06:23:14

        Sorry, I meant Laney’s claim that “With very few exceptions, the only people who give a damn about circumcision are the people who want to feel superior because they’re not circumcised.” was your cue to demand a citation from her. But I did it for you, and provided my own for my counter-claim.

        Further, very few of the intact Intactivists I know want to feel superior. We want future generations to feel all that they were born to feel.

  10. Greg Hartley
    Feb 17, 2012 @ 15:17:34

    Male circumcision is not a scientific issue; it’s a human rights issue. Since you readily acknowledge the lack of compelling scientific evidence to excise the prepuce (foreskin), why should parents make that decision? What other healthy, functional body part do we remove from our children? I lost my prepuce shortly after birth because my parents were not fully informed of the implications (hospital circumcision was becoming very popular). I am very upset that my sex organ was irreversibly altered, but accurate information was lacking then – it isn’t now. Although sexual satisfaction is subjective, you cannot conclude that removal of the majority of specialized sensory receptors, mucosal tissue and other functions makes it better. So why not let the owner of the foreskin decide? It would cost him a few hundred dollars and involve some healing time, but at least it would be HIS decision. Excision of a healthy, functional portion of a person’s sex organ (regardless of gender) is a significant human rights violation.

    • SquintMom
      Feb 17, 2012 @ 15:56:13

      Thanks for your comment. You say that accurate information is not lacking now; I disagree. I am unable to find any convincing scientific evidence to support EITHER side of the circumcision debate. You are right that it’s a human rights issue, but it’s NOT a science issue.

      Here’s what everyone seems to be missing: it’s possible for something to be atrocious and wrong from a human rights perspective EVEN IF THERE IS NO SCIENCE to support the notion that it’s atrocious and wrong. What I’m saying here, what I’m asking, is that we all acknowledge that science currently has no place in the circumcision debate. We can debate ethics, we can debate morals, we can debate human rights. You make a very legitimate point that circumcision represents a violation of the rights of a child, because there is no medical reason to remove the foreskin.

      What bothers me, and the reason I wrote this series, is that I don’t like to see science used incorrectly. I don’t like to see people on either side of a debate try to support their arguments with science, when science has nothing to say on the matter.

      For what it’s worth, if anyone cares what I think, I DO think circumcision represents a violation of the rights of a child. It DOES make me uncomfortable from an ethical standpoint. But I have to acknowledge that my feelings are based purely upon my inner compass, my sense of ethics, my sense of morality. Because there’s not a single scientific study I can point to to “prove” that what I’m saying is right. And that’s ok. Not every decision we make has to be “scientific.” But it IS important to recognize when a decision is based on science, and when it’s based on ethics.

      Circumcision is an ETHICAL issue, and an important one. But it’s not a science issue.

  11. SquintMom
    Feb 17, 2012 @ 16:04:51

    To my readers:

    I appreciate that this topic has generated some pretty intense feelings, and am thankful to all of you who have participated in the conversation. I want to take a moment to say something before this discussion goes any further, because I think there’s a major point that’s being lost.

    The fact that science doesn’t inform the circumcision debate doesn’t mean that there is no debate, nor does it mean that, by default, circumcision is right. I agree with those of you who have said circumcision is a human rights issue. Circumcision is an ethical issue. Cutting off a part of an infant’s body, without that infant’s consent, is serious business. It’s something parents should very carefully weigh, and it definitely warrants discussion in the community. However, as important as the circumcision debate is, it’s not a matter that science can weigh in on.

    The entire point of this series of posts is that science doesn’t provide evidence to support EITHER side of the circumcision debate. This does not mean that there’s no reason not to circumcise, though.

    Think about it this way; there’s no SCIENTIFIC EVIDENCE that killing people is wrong. Doesn’t make it ok, though, does it? There are decisions we have to make as humans that are informed by science (like, should we vaccinate?). There are decisions we have to make as humans that are informed by ethics (like, should we kill people?). Neither set of decisions is any more important or weighty than the other set. I’m simply making the point that circumcision falls into the “ethics” set, not the “science” set.

    Why? Because we can’t have a meaningful conversation until we get our facts straight. If I try to explain to you that it’s wrong to kill someone by holding up a variety of scientific studies that prove nothing, and you say to me “Those studies prove nothing,” you’re not saying that it’s therefore ok to kill people! Presumably, you’re saying “The studies are irrelevant, but it’s still bad to kill people.”

    I want to make it clear that I’m not comparing circumcision to killing people, nor am I taking a moral and ethical stance on circumcision in these posts. However, just as killing people is ethically and morally debated (what one culture considers an “appropriate killing,” another might consider anathema…either on a small scale or in terms of war), so is circumcision. We can no more discuss circumcision “scientifically” than we can discuss other moral/ethical issues scientifically.

    Incidentally, Jews believe that circumcision is a religious imperative, and is part of their obligation to God. As such, for at least SOME groups that circumcise, the stakes are pretty high in their minds!

  12. Tammy
    Feb 17, 2012 @ 23:30:43

    Thanks for clarifying your statement at the end. I appreciate that you took the time to spell it out, but if the evidence for and against is a wash, then how can anyone evidence-based come to the conclusion that there is reason to circumcise? If there is no scientific evidence to support doing it, and especially if one isn’t Jewish and there is no religious argument to do it either… then why on earth do people still do it? No offense meant whatsoever to you, but why does this require such in-depth article writing? We aren’t allowed to cut anything else off, and otherwise don’t need evidence to support that “not cutting stuff off” is accepted as good thing. There isn’t really much to discuss. I guess cultural decision making doesn’t need evidence, is that the argument? But when should human rights override decisions based on cultural “norms.” I do understand a thing or two about the cultural aspect of it though, so I can’t get too angry at parents who can’t get past it. I do understand that it feels like such a big deal. I spent so much time worrying before my son was born whether I was harming him in some way… leaving him socially at a disadvantage… by leaving his body alone (though I have to admit that it sounds more than a little hollow to me now…) Once he was born however, the issue completely dissolved for me in a puff of smoke–and also for my very pro-circ husband. Once we saw the reality of it–how normal it is to just leave it alone– how little it actually meant to “look like daddy” all of the superficial arguments just crumbled. I was, and still am, very angry at the swirling cultural pressures that surround this issue in America. Why is it even an issue? By the way, my “not-circumcized British guy” friend just thinks we Americans are a little nuts 🙂

    • SquintMom
      Feb 18, 2012 @ 01:57:33

      Thanks for your comments. One of the reasons this requires such a long series of posts is that BOTH sides of the circ argument have a tendency to present “evidence” to support their assertions. My point is that, unless your evidence is humanistic, this is not an evidence-based issue.

      • Hugh7
        Feb 20, 2012 @ 19:47:26

        “…unless your evidence is humanistic, this is not an evidence-based issue.”

        Can you clarify that, please? What do you mean by “humanistic evidence”?

        A problem here is that we haven’t clarified what “this issue” is. In most of the developed world, the male (or female) foreskin is not an issue, so infant circumcision is not an issue. People are born, grow up and die with all their body parts unless and until there is some accident causing, or health issue requiring, their removal.

    • Megyn @ Minimalist Mommi
      Feb 18, 2012 @ 04:50:57

      If you look at it, many cultures alter their bodies in the name of tradition…lip disks, feet binding, etc. Also, circumcision isn’t the only case of parents altering their children’s body. Think about braces…they are generally painful and are done for cosmetic reasons (most of the time). Yet, you don’t see anyone calling that a human rights violation. I actually think braces would trump the pain of a circumcision if looking at longevity of pain.

      • Hugh7
        Feb 19, 2012 @ 06:36:42

        Would you deny that foot-binding was a human rights violation? Isn’t that why it was brought to an end? I saw a TV interview with a young woman who had decided not to wear a lip disc, and her bedisced mother seemed to accept her decision. No human rights issues there.

        Like circumcision, the rest of the world looks on in some bemusement at the United States’ fixation on straight teeth. Be that as it may, orthodontistry is only done where there is an individual need, tends to happen at an age when it can at least be explained to a child – with the child perhaps even given a right of refusal – who can understand the value of straight teeth or a better bite. Presumably a child whose braces are causing pain is given some relief.

        Again I find it amazing how readily people can find far-fetched analogies with male genital cutting, but the most obvious one is out of bounds.

      • SquintMom
        Feb 19, 2012 @ 17:14:58

        The thing is, when there are people who believe that circumcision is part of a covenant with god, far be it from me to say that it is wrong. Each family needs to have the circumcision conversation for themselves, and make a believes/values/ethics-based decision.

      • Hugh7
        Feb 19, 2012 @ 21:07:46

        What is your citation for the existence of God?
        (Sorry, I couldn’t resist.)

        SquintMom, many Muslims believe that cutting their daughters is required by Islam. (Do we need to drive a razorblade between that and “a covenant with God”) This Malaysian mother (whom I have cited before) thinks so, and took her daughter to a doctor, who took off a barely visible sliver of tissue. How far is it from you to say that that is wrong? And how very different is that from circumcision (which is what she calls it)?

        “Each family needs to have the circumcision conversation for themselves, and make a belie[f]s/values/ethics-based decision.”

        As one man said, but more colourfully –
        “My family doesn’t [urinate] with my [penis], my family doesn’t [masturbate] with my [penis] and my family doesn’t [have sexual intercourse] with my [penis], so what business did my family have to go cutting part OFF of my [penis]?”

        Actually, they don’t “need” to have any “conversation”. In most of the developed world, circumcision is not offered and not asked for. It’s a decision that is pushed on US parents (and the decision to circumcise is often pushed on them as well.)

      • SquintMom
        Feb 21, 2012 @ 15:44:35

        Hugh, you are missing the point. Because god’s existence can’t be proven, the decision to circumcise for religious reasons is made on MORAL, not scientific grounds.

      • Megyn @ Minimalist Mommi
        Feb 21, 2012 @ 17:41:03

        Hugh, as a former Muslim, I can rightfully attest that at least the Muslims in the US and their families back home do not think female circumcision is noted at all in the religion. If you feel it is, please bring the Qur’anic text or Hadith to support your claim.

      • SquintMom
        Feb 21, 2012 @ 23:36:37

        Megyn, thanks for weighing in with an informed perspective! It’s always good to hear from those who know of what they speak, since people outside a religion can only speculate as to the beliefs and motives of the faithful.

  13. Tammy
    Feb 17, 2012 @ 23:43:55

    I wanted to add that I’m angry at the cultural pressures.. not the parents!! Big emphasis there. I like making my decisions based on logic and evidence. Parenting is hard, and making decisions as a parent is hard. I had a long discussion with my friend, who is British, as mentioned, and my doctor, who is Indian. All of these pressures and “locker room” arguments surrounding this issue just don’t exist where they come from.. and without them, I feel like it would be easier to make a truly evidence-based decision.

    • SquintMom
      Feb 18, 2012 @ 01:58:07

      I agree that society definitely plays a role in helping to define “normal,” and “normal” is different everywhere.

  14. Karen Goldis
    Feb 23, 2012 @ 21:03:24

    What a waste of time and energy. One needs only common sense to understand circumcision is harmful and unnecessary. No health benefits can possibly outweigh the damage and loss done by the procedure. To trade a decrease chance of disease for a decrease in sexual pleasure just ain’t worth it. Justifying a barbaric ancient blood ritual doesn’t work, no matter how the picture is painted.

    • SquintMom
      Feb 23, 2012 @ 21:10:38

      Did you read the article? I said that science nether opposed NOR supported circumcision, and that the decision had to be made on ethical grounds. This article series is not justifying circumcision.

      It is a great mystery to me that so many of the vehement anti-circ commenters equate “no scientific evidence to support OR oppose circumcision” with “circumcision is good and we should all do it.” It’s incredibly difficult to have a logical discussion with ideologues, and even more so, with ideologues who don’t read the articles on which they’re commenting.

      A note:

      A few repeat commenters on these posts have contacted me, angry that their comments aren’t being approved. Well-argued, polite, and appropriate comments (regardless of whether they agree with or disagree with my conclusion) are always welcome. If you comment on this series of posts and don’t see your comment approved within a day or two, I deemed your comment to fall into one of the following categories:

      1) a pointless, ad hominem attack on another commenter
      2) a critique of a religion of which you are not a member
      3) an indication that you failed to read the post thoroughly, and are equating “no scientific evidence against circumcision” with “circumcision is good.”

  15. Tammy
    Feb 24, 2012 @ 02:44:10

    @Megan, I agree that there are many traditions of body modification all around the world. “Fun with the human body” is a game that has been played for a very long time, no doubt (not to go on a tangent, but I saw a tribal ritual where the men would repeatedly rake piranha teeth across their legs until they scarred, yikes!). I just feel that we should be careful about permanently altering *someone else’s* body *without their permission* (I think grown circumcised men can often be fine with it, but I would wager that 10 out of 10 baby boys would opt out, if given the chance).

    By the way, I had braces. My parents asked me first, so I went into it wanting the braces… certainly wasn’t strapped down and given braces against my will (and yes, it did cause plenty of discomfort over time, so your point about the pain has merit, but my emphasis is on the will of the person who owns the body…I wanted that fabulous straight white smile, so it wasn’t an issue 🙂

    I also agree that the culture in which one is born into and raised does have a big impact on what is viewed as “acceptable” and “unacceptable.” I know it weighs heavily on decisions because I remember the weight of it on my mind. I guess my point is that I wish we could get past all of that, because the decision might be a cultural one, but it is an irreversible medical procedure, in the end.

    I have a thought on evidence of the benefits of foreskin (from a biological rather than psychological point of view). Please share your feelings on it, and my apologies if you addressed this and I missed it, but if humans–well ALL mammals as far as I am aware of, but I could be wrong– have evolved to have foreskins (women have a clitoral hood, which, is the analogous tissue to the male foreskin, I believe) wouldn’t it make sense that it is there to serve an important function, kind of like eye lids? If this is something that is an across-the-board natural evolution of mammals, is it a stretch to conclude that maybe we shouldn’t mess with the way nature designed things? I know we humans like to try, but it seems like we mess things up about as often as we improve them!

  16. Tammy
    Feb 24, 2012 @ 03:04:32

    Oops, I always think of something after I hit the post button. (well that and I am currently avoiding work I brought home, so thank you for the excuse/distraction) I realize your article is about the scientific claims surrounding and directly related to RIC, but my point on the evolutionary connection/benefits of foreskin is related, I think. Though obviously there is no scientific study, just biological observation (ok, I grew up on a farm, so my experience with it is pretty much dogs/cats/horses/cattle etc, lol, but I was just wondering what you thought on that) Wouldn’t that be evidence of functional purpose? (i.e. though penises function without the foreskin, is that how nature intended their design?… I suppose a difficult point to prove but food for thought)

  17. Lollipop
    Feb 27, 2012 @ 03:14:49

    Dear Hugh7,

    I hope you find peace with your penis and its perceived flaw. I hope you can forgive your mother for this perceived transgression. Please be a respectful commenter. You are being a bully. Despite your very strong opinion, this is a complex decision. If you really felt strongly about your opinion, I believe you would try harder to understand the other side of the story. However, you are just arguing for the sake of arguing. It is not welcome here.

  18. Greg Hartley
    Feb 27, 2012 @ 18:18:20

    Dear Lollipop,
    As a circumcised man who has partially restored a facsimile prepuce, I can tell you that my circumcision is not merely a “perceived flaw.” The prepuce contains over 20,000 specialized sensory receptors, mucosal tissue and other important features. Its removal results in actual diminished function; it’s not just a matter of perception. My restored foreskin, although still missing the most important parts, has markedly improved my gential function. It’s only a complex decision for those who do not fully understand the impact of removing healthy, functional erogenous tissue from a non-consenting minor.

  19. Trackback: Options, Ethics, and Moral Imperatives | SquintMom.com
  20. James Mac
    Feb 29, 2012 @ 02:46:03

    That boys die from unnecessary ‘medical’ circumcisions every year is not in dispute; only the rate of boys dying that is in dispute (from a handful to over a hundred in the U.S. every year).

    I am yet to hear how the U.S. has actually benefited from generations of near-universal male circumcision. Around 110 million circumcisions over the past century and 110 million boys/men put at unnecessary risk and denied a complete penis.

    I would argue that if there’s no actual, real-world, empirical benefit, that ANY risk of physical or emotional harm makes the circumcision of minors unacceptable.

    • SquintMom
      Feb 29, 2012 @ 06:45:24

      Well, but you have to consider that to those for whom circumcision is a matter of religion, those beliefs make circumcision worth the exceedingly, EXCEEDINGLY minor risk. You put “medical” in quotes; let’s toss out circumcisions done out-of-hospital (because of the conditions); can you find a number on how many boys die each year from routine infant IN-HOSPITAL circumcision?

  21. Laurel
    Mar 01, 2012 @ 03:22:58

    “For good or for ill, the majority of American women prefer the look of a circumcised penis”

    Now, Squintmom… please cite references for the statement you made, quoted above…

    • SquintMom
      Mar 01, 2012 @ 16:07:17

      Several of your comments, I did not approve because of ad hominem attacks and/or commentary on religions of which you are not a member. However, my source for the above is Laumann et al. Circumcision in the United States. Prevalence, prophylactic effects, and sexual practice. JAMA. 1997 Apr 2;277(13):1052-7. Interestingly enough, this study also found that circumcised men had a lower incidence of sexual dysfunction than uncircumcised men. Another study, this one Australian, similarly found that women preferred a circumcised penis aesthetically. This study found that women preferred not only the look, but were less likely to be bothered by the smell (Badger, Australian Forum, 1989).

      • JustSomeChick
        Feb 11, 2013 @ 12:30:56

        Not only do I prefer an intact male, intact males do not smell if they practice proper hygiene such as daily showers.

        You know, I bet a lot of men would prefer the look of a vagina without the labia minora, and I bet it would smell better too, if you’re the type that doesn’t shower.

        That study is not at all a valid reasoning to circumcise.

      • SquintMom
        Feb 19, 2013 @ 08:35:32

        Unfortunately, speculation (“I bet a lot of men would prefer…”) does not really have a place in a scientific discussion, as it does not contribute evidence for or against the argument.

  22. April
    Jul 04, 2012 @ 10:56:49

    White middle-class female here. I have two boys and opt’d not to circumcise either of them.

    My first-born son, now 10, understands that his penis looks different from Daddy’s because we chose not to have the procedure done to him.

    I noticed that a pregnant woman found her way here when she and her husband were considering their options and trying to find the path that is right for them. I have a message to all other couples who find themselves here…

    Just remember that your baby will become a boy, and then a man. At some point in his life you will talk to him about the differences between boys and girl, adults and children, war and peace, fruits and vegtables.

    I was proud to tell my son that I chose not to allow his foreskin to be cut off. He was 6 when he came home from school asking why his was different from most of the other boys’. At the age of 6 he thanked me for not having it done. The face he made at that point told me I had made the right decision.

    Whether you decide to have it done, or not, remember that he will know the difference some day, and make sure that when that day comes you are confident enough with your decision to be able to explain your choice. If you tell him you did it when he was a tiny baby so he wouldn’t remember he’ll understand and probably thank you for having it done when he was so young. If you tell him you didn’t do it because you didn’t want to hurt him, or because you couldn’t find any reason to do it he’ll thank you. Either way you have a happy little man. 🙂

    **On a silly side note, my one year old son noticed that his penis floats in the bath and that makes him smile. Yay for buoyancy!!**

  23. Cindy Elson
    Sep 20, 2012 @ 14:10:34

    I noticed you are getting some push-back from some intactivists. But I am also an intactivist and I don’t see anything wrong with your factual analysis. I may not agree with the way you presented and framed the discussion but I do like the way you looked at and weighed the scientific literature. I am also a scientist and although I am against the promotion of non-therapeutic circumcision, I get discouraged by most inactivists’ unsophisticated take on the research. It saddens me because it hurts our credibility when intactivists cite faulty research for support and denounce studies that used good methods.

    My objection to how you framed the question is this: the default state of the body includes males being born with a foreskin. In order to justify an invasive, surgical modification of the body, I believe the onus is on pro-circumcision advocates to show _overwhelming_ benefits – additionally those benefits should not be able to be readily achieved through less invasive means. It’s not enough of a justification to say the risks of circumcision are small (which I agree with). If the medical literature leaves you at a stale mate, then that in itself is a case against circumcision.

    • SquintMom
      Sep 21, 2012 @ 20:18:01

      Thank you for your comment. I want to make a few things clear: I personally do not take a stance for or against circumcision, though many who have commented suggest that I do. Secondly, religion — the reason many people circumcise — is a force separate and apart from scientific logic. That is to say, a person who would not otherwise believe circumcision is a good idea because the natural state of the male is with a foreskin might choose to circumcise anyway if they believe that it’s a mandate from god as a result of a covenant with Moses or some such. Religion, therefore, becomes its own driving force that can neither be supported nor refuted with scientific literature. This is why, even though the literature leaves ME PERSONALLY (and anyone else looking at JUST the science) at a stalemate, circumcisions will continue to take place among those for whom the decision is a moral one rather than a logical one.

    • SquintMom
      Sep 21, 2012 @ 20:32:27

      Actually, reading your comment really made me think (enough so that I am posting a second response to it). When I wrote these two circumcision posts, having looked at all the literature, I concluded that I was at a scientific stalemate. As more and more ridiculous comments from intactivists who were citing irrelevant, poorly conducted, or faulty studies started to pour in, I believe I started to realign myself with the pro-circ group simply to distance myself from the throngs of illogicals (a cognitive bias: if they are illogical and I am not, then I must not agree with their conclusion). The ridiculous comparison of male circumcision to female circumcision is yet another failure of logic that works against the intactivists when it comes to speaking to scientists. The fact that someone randomly decided to call the two procedures by the same word makes them no more similar than “the flu” (a colloquialism for seasonal upper respiratory infections, typically rhinoviruses — the common cold) and flu (influenza, a much more serious illness), as I pointed out in an earlier comment in which I addressed the embryological origins of the tissues taken in the two cases.

      Point(s) being:
      1) Thank you once again for your comment. It’s nice to run across an intactivist who understands that the science does not come out against circumcision, even though ethics very well may.
      2) I hope you occasionally take the time (frustrating though I’m sure it is) to educate fellow intactivists about misuse and misinterpretation of science, and to explain that when a scientist says “The science can’t be used either to support or oppose circumcision in a conclusive way,” said scientist is not necessarily pro-circ, nor is said scientist necessarily saying that ETHICS can’t play a role in making the decision.

  24. Cindy Elson
    Sep 21, 2012 @ 21:57:53

    You’re welcome and all but wow, I didn’t expect this: “The ridiculous comparison of male circumcision to female circumcision is yet another failure of logic…”

    I respectfully ask you to reconsider that statement. Both are the removal of healthy sensory tissue from the genitals. There is clearly very logical room for comparison there.

    I have now read your previous comments and I can’t see how the comparison results in a “failure of logic”. I am truly interested in why you think this is so. You said in a couple of posts that the reason they can’t be compared is that they are done for different reasons. Do you have evidence for the assumption that they are done for different reasons or is it just “common sense” to you? It isn’t common sense to me and even if it was why would that preclude me from comparing the practices? I am sorry if I am coming off as defensive but it seems in a couple of paragraphs you went from thanking me for my insight to branding people like me as illogical and ridiculous.

    I respectfully suggest you research female genital cutting a little more because I suspect that you may be influenced by pervasive Western assumptions about the practices. I originally praised this article because I felt you were being successfully impartial and dispassionate. But with this stubborn refusal to accept the comparison of genital cutting between males and females, I fear your cultural bias is showing.

    • SquintMom
      Sep 25, 2012 @ 06:43:22

      I’m sorry; I didn’t mean to brand “people like you” as illogical. I didn’t realize that all intactivists make a comparison between male circumcision and female genital cutting (I prefer this term to circumcision, and I’ll explain why). If I’d know you felt this way, I wouldn’t have included my comment in a response to you; it would have been (that is to say, it was) rude, and I didn’t mean to be rude.

      The reason I dislike the comparison is that while, as you say, both are the removal of healthy genital tissue, female genital cutting includes the removal of so much tissue that it’s no more like male circumcision than, say, trimming a fingernail is the same as cutting of a digit. The foreskin of the penis is analogous, tissue-wise, to the hood of the clitoris. While female genital cutting practices vary from culture to culture, most take more than simply the hood of the clitoris. Most take at least the clitoris (analogous to the glans, or head, of the penis), and many also take the labia minora (analogous to the shaft of the penis). Some even take the labia majora (analogous to the scrotum). THIS is why I say there’s no comparison; for male circumcision to be the same as female genital cutting, doctors would be having to remove not the foreskin, but the entire penis…and in some cases, the scrotum as well.

      I’m in no way saying circumcision (male) is “good” or “ok,” while female genital cutting is bad. Rather, I’m saying that in the same way that using science inappropriately to defend what is ultimately an ethical issue is no worse than (in my mind) using vocabulary that belies a misunderstanding of biology to compare two practices that happen to occur in the same region of the body, but are on completely different scales.

      Hope that makes sense.

      • Lillian Cannon
        Sep 26, 2012 @ 04:45:32

        Genital cutting practices do vary in what they take, even among male genital cutting. Some take only a bit of the foreskin, leaving much inner foreskin and the frenulum. Others take all the foreskin and gouge out the frenulum. Some male genital cutting includes subincision (slicing open the underside of the penis into the urethra.) Female practices vary from a tiny nick on the clitoral hood, to removing the hood but not the clitoris, to removing the hood, clitoris and inner labia, to removing everything and stitching or letting it heal together (infibulation.)

        The clitoris is interesting in that it has two “legs” (the crura) that extend like a wishbone back into the body and around the outside of the vaginal barrel. Perhaps this is why many circumcised women say that they orgasm just fine and enjoy sex. Other circumcised women say that sex is always painful and never enjoyable. However, men show the same range of responses to male circumcision: some men orgasm just fine, and some men are unable to orgasm, or their shaft skin splits open when they become erect… On top of that, who says that reaching orgasm is the only purpose of sex? Are there not a lot of wonderful sensations before ejaculation or orgasm?

        Genital cutting happens both in a doctor’s office and in a dirty field in both cases, too. There are two male circumcision seasons in southern Africa, and during those months, you can read about the many young boys who die from their circumcisions. Or you can read about the baby girls being “sunat” in their doctor’s offices in Malaysia: http://www.moralogous.com/2012/02/16/aap-culturally-blind/

        Victims, or survivors, however you would like to term them, show a range of emotional responses to their cutting. Some women and men are happy to be cut and claim that it made them better in some way, including my sister, who chose to be circumcised because she is Muslim. Others of both sexes are unhappy to be cut.

        From a cultural standpoint, the motivations for female or male genital cutting are exactly the same. Both say that without being cut, the person will be unable to find a partner, will suffer from disease, and will be mocked. Both have their origins in controlling sexuality (though we have tried to forget about that in our culture, it was the original motivation, as you can read here: http://www.moralogous.com/2012/04/29/the-purpose-of-circumcision-is-to-ruin-male-sexuality/) Hanny Lightfoot-Klein has studied female genital cutting for many years and has a nice chart detailing the common attitudes in male and female cutting: http://www.fgmnetwork.org/intro/mgmfgm.html

        So, tell me again how they are not comparable? They both remove varying degrees of tissue, they both can result in a range of responses from a claim of no sexual impairment to total sexual impairment, they both involve cultural beliefs that have become medicalized, and both are often (though not always) forced on children. Those who claim that female and male cutting cannot be compared would do well to take off their own cultural blinders.

      • SquintMom
        Sep 26, 2012 @ 08:37:49

        No circumcision practice removes the glans of the penis, the shaft of the penis, or the scrotum. None. Not one. Again, I am not arguing that male circumcision is good or right, I’m arguing that it is not the same (on the same scale) as female cutting.

  25. Cindy Elson
    Sep 26, 2012 @ 01:29:28

    I do agree of course that on whole female genital cutting (FGC) is more harmful, but I don’t think the difference in scale is as vast as you think. I think a more accurate analogue for males would be removal of the foreskin, a large portion of the glans and the shaft skin of the penis (while leaving the corpus cavernosum/clitoral crura intact as most women experience).

    I don’t agree that the difference is akin to the difference between trimming a fingernail and cutting off a digit. It’s more like slicing off half of your finger pad vs. severing the finger under the knuckle.

    In the US, we culturally begin with the assumption that female genital cutting is bad no matter the severity. And male genital cutting is harmless if not beneficial. I think the vocabulary you have chosen to use in your reply to me may demonstrate that you internalized these assumptions long before you came to examine the subject. I do not like to use the word “mutilation” to refer to male genital cutting because it shocks and angers people and puts them on the defensive. It is too fraught with emotion to be accurately descriptive. It serves to undermine my credibility. I also don’t like to use it for FGC for similar reasons. Also, women from cutting cultures who are the ones who promote it’s continuation often feel the use of the word “mutilation” is culturally imperialistic and hypocritical. On the other hand, you seem angered when someone refers to female cutting as “circumcision” because the word trivializes the practice. In my effort to be as impartial as I can I do not use that word for either cutting of males or females. I noticed in your reply, you followed my lead with the phrase “female genital cutting” but you didn’t with the phrase “male genital cutting”. You continued to refer to it as “circumcision”.

    My thoughts in that paragraph trailed off because I am tired and going to bed. (It’s 3am!) Sorry it it doesn’t make sense. I am not really talking about science anymore so maybe I’ll just end it there.

    Best wishes to you, squintmom

    • SquintMom
      Sep 26, 2012 @ 08:40:37

      Actually, it wouldn’t just be shaft skin, it would be shaft erectile tissue. The labia minora are erectile, and when they’re removed (as they are in many female cuttings), it’s not just the skin, but the inner erectile tissue that’s removed.

  26. cindy elson
    Sep 26, 2012 @ 10:37:02

    Question: if I limited my comparison of genital cutting between the sexes to FGC type I and IV (with only a nick of the clitoris if at all) would that be a “logical” comparison to you? If yes, then I accept that we just have a difference of opinion on the scale of the destruction encompassed by each practice. I can respect that. If no, then I propose you are not truly weighing the two objectively.

    • SquintMom
      Sep 28, 2012 @ 08:57:00

      Assuming that FGC type I and IV involve removal of nothing more than the clitoral hood (no labial involvement), that is a fair comparison. However, I think it’s fair to say that most of the time when the female cutting/male circumcision comparison is made, there is no qualification of the sort you’ve made here. Further, the times that I’ve tried to argue that FGC is not, in most of its permutations, comparable to circumcision because of the extent of tissue taken, intactivists have argued with me that considering the function and embryological origin of tissue is not a reasonable basis for drawing conclusions, etc. Then, too, there’s the fact that most infant circumcisions in the U.S. these days are done with anesthetic and the infant does not remember the procedure, while most FGCs are ceremonial, done without anesthetic, and conducted on girls old enough to remember the procedure. Leaving aside any discussion of whether the removal of the tissue itself is ethical, the circumstances surrounding most FGCs are inherently more painful/psychologically damaging than the circumstances surrounding most circumcisions, which represents yet another way in which the comparison between FGC and infant male circumcision is flawed (though certainly a comparison between FGC and ritual male circumcision of non-infant boys has more validity). I grant that there are similarities between the procedures, but I feel that comparing the average FGC to the average infant male circumcision conducted under medical oversight in the U.S. is neither valid nor particularly useful. The procedures may not be as different as, say, black and white, but they’re two very, VERY different shades of gray.

      The other thing that is worth saying here is that ethics are not universal. We as a culture can find a practice absolutely repugnant (as I, for instance, find FGC), while another culture can believe that it’s not only ethical, it’s a moral imperative. Let’s take an example that may be a bit easier for the average Westerner to digest: Jehovah’s Witnesses will allow a child (or anyone else) to die if saving the child’s life would require a blood transfusion. To me and to most non-JW Americans, to refuse a proven, live-saving medical treatment for a child is a deep moral transgression. To JWs, to accept the blood of another person into the body is a moral transgression. Bottom line, it becomes a sticky wicket to try to condemn a practice that is undertaken by a culture on the basis of belief.

  27. Trackback: Spanking Associated With Development Of Mental Disorders, New Study Suggests | SquintMom.com
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