FGM and MGM; still a long way to go

For some time there has been an apparent hypocrisy, particularly in the United States, with regard to non-medically-necessary genital operations performed on infants and children, a subject I posted about previously.

This article is a reasonable summary for starters, apart from the perhaps over-emotive first paragraph, but to be honest I’m inclined to find it appropriate.

Girls have long been (at least officially) protected from damaging genital surgery, although along with MGM it used to be common in the developed world – for similar reasons (myths regarding hygiene benefits and the wish to reduce or destroy sexuality). Sadly, while there are laws against FGM (it is illegal in Egypt but the problem has certainly not disappeared), it is still practised not only in the developing world  but also in the UK and the US.

Boys have not been afforded the same protection, despite the fact that more than 100 boys die because of circumcision complications every year in the USA. That may not seem like a lot in terms of the population size but that’s 100 families whose lives have been shattered, 100 lives lost needlessly. One is too many.

There is an interesting Wiki article on circumcision-related law, past and present. ‘Cosmetic circumcision’ is banned in Australian public hospitals, it seems in Britain we cannot make a firm decision on the matter despite some encouraging analyses:

Fox and Thomson (2005) argue that consent cannot be given for non-therapeutic circumcision. They say there is “no compelling legal authority for the common view that circumcision is lawful.”

Finland seems to be moving towards criminalisation (see the case of a mother being fined after her son developed complications, for example) and Denmark seems to be flirting with the idea.

The American Academy of Paediatrics (AAP) has recently revised its statement on female genital mutilation (FGM). To address the hypocrisy and sexism in the USA regarding genital mutilation of children (where it’s OK to remove healthy, sexual tissue  from the penis but not the vulva), instead of doing what would seem like the sensible thing – officially stating that neither FGM nor MGM is recommended – it has actually relaxed its position on FGM. Truly astonishing.

“Ritual cutting and alteration of the genitalia of female infants, children and adolescents, referred to as female genital cutting (FGC)*, has been a tradition in some countries since ancient times and continues today in parts of Africa, the Middle East and Asia.

According to a new policy statement from the American Academy of Pediatrics (AAP), “Ritual Genital Cutting of Female Minors,” in the May issue of Pediatrics (published online April 26), the AAP opposes all forms of female genital cutting that pose a risk of physical or psychological harm, and encourages its members not to perform such procedures.

In addition, the AAP urges pediatricians and pediatric surgical specialists to actively dissuade parents from carrying out ritual FGC and provide families with education about the lifelong physical harms and psychological suffering associated with the procedure.

Many parents who request FGC do so out of tradition**, and also out of concern for daughters’ marriage ability within their culture, so physicians need to remain sensitive while informing them of the harmful and potentially life-threatening consequences.”

Intact America has released this statement in response to the AAP and Forward rightly calls it “A step backwards for women’s rights”.

* The ridiculous decision to switch to a more PC-term, ‘genital cutting’, avoiding ‘mutilation’ is analysed well by Jezebel. Mutilation is an apt term for this practice, if one looks up its dictionary definition.

** The tradition argument should NOT be acceptable for this. It’s the 21st century and we’re still accepting the most basic, childish argument as justification for such an act. ‘Well, they did it, why can’t I?’

You’re only free to do whatever you want as long as you’re not harming anyone else. Your freedom to do what you like ends when you start infringing on the freedom of others. I cannot imagine many greater infringements of personal freedom than lopping off bits of a child’s genitals, because you want to or you have some half-baked reasoning behind it (see earlier post for a few of those).

For example, I was recently quite shocked by a girl stating (after someone brought up their reasons for not particularly wanting to convert to Judaism):

Well it can be good for women, so why not! … Makes them last longer

I cannot find this sentiment anything other than disgusting. Increased male pleasure is one of the many ‘reasons’ given for severe FGM. In fact, if you talk to enough women you are likely to find that this is not the consensus opinion (anyone who’s found themselves bored, staring at the ceiling after half a repetitive hour can partly appreciate why), if it even matters; advocating unnecessary and dangerous genital surgery on minors for your own sexual gratification… well, I don’t really have the words for it. Selfish wouldn’t suffice.

For anyone who is interested, http://www.norm.org/comes highly recommended by friends who are restoring; trying to recover something of what was taken from them without their consent. Let me know if you want me to put you in touch with them.

Here are a couple of good videos I saw today:

Dr John Geisheker speaking about American physicians escaping justice after babies die as a result of cirumcision.

Steven Svoboda on the currently popular myth that circumcision is a miracle strategy to prevent HIV spread.

This page has some very good educational videos on the functions of the foreskin and consequences of circumcision (not safe for work, obviously)

Finally, the following is from Guggie Daly; a fairly comprehensive run-down of foreskin functions (for all the ‘It’s just a useless bit of skin!’ people).

All of the following comprise the foreskin and are removed in the typical American circumcision:

(1) The Foreskin
comprises up to 50% (sometimes more) of the mobile skin system of the penis . If unfolded and spread out flat the average adult foreskin would measure about 15 square inches( the size of a 3×5 inch index card). This highly specialised tissue normally covers the glans and protects it from abrasion, drying, callousing (keratinisation), and contaminants of all kinds.The effect of glans keratinisation has never been studied.

(2) The Frenar Ridged Band
The primary erogenous zone of the male body. Loss of this delicate belt of densely innervated, sexually responsive tissue reduces the fullness and intensity of sexual response.

(3) The Foreskin’s ‘Gliding Action’
– the hallmark mechanical feature of the normal natural, intact penis. This non-abrasive gliding of the penis in and out of itself within the vagina facilitates smooth , comfortable, pleasurable intercourse for both partners. Without this gliding action, the corona of the circumcised penis can function as a one-way valve, scraping vaginal lubricants out into the drying air and making artificial lubricants essential for pleasurable intercourse.

(4) Nerve Endings
Nerve Endings transmit sensations to the brain – fewer Nerve Endings means fewer sensations; circumcision removes the most important sensory component of the foreskin – thousands of coiled fine-touch receptors called Meissner’s corpuscles. Also lost are branches of the dorsal nerve, and between 10,000 and 20,000 specialized erotogenic nerve endings of several types. Together these detect subtle changes in motion and temperature, as well as fine gradations in texture.

(5) The Frenulum
The highly erogenous V-shaped web-like tethering structure on the underside of the glans; frequently amputated along with the foreskin, or severed, either of which destroys its function and potential for pleasure.

(6) Muscle Sheath

Circumcision removes approximately half of the temperature-sensitive smooth muscle sheath which lies between the outer layer of skin and the corpus cavernosa. This is called the dartos fascia.

(7) The Immunological Defense System of the soft mucosa.

This produces both plasma cells that secrete immunoglobulin antibodies and antibacterial and antiviral proteins such as the pathogen-killing enzyme lysozyme.

(click ‘more’ below the links for references)

This page with illustrations demonstrates the functions of the male prepuce:
http://www.circumcision.org/foreskin.htm

Dr. Peter Ball on the function of the foreskin:
http://www.norm-uk.org/function.html

Video showing a computer generated model of the function of the foreskin during sexual activity.
http://www.youtube.com/watch?v=wj6UjduMTiU

Contrast and compare pictures of cut and intact penises:
http://www.circumstitions.com/Restric/comparison.html

What is lost due to circumcision?
http://www.norm.org/lost.html

The three zones of penile skin:
http://www.foreskin.org/3zones-c.htm

The functions of the foreskin:
http://research.cirp.org/func1.html

(1) M. M. Lander, “The Human Prepuce,” in G. C. Denniston and M. F. Milos, eds., Sexual Mutilations: A Human Tragedy (New York: Plenum Press, 1997), 79-81.

M. Davenport, “Problems with the Penis and Prepuce: Natural History of the Foreskin,” British Medical Journal 312 (1996): 299-301.

(2) Taylor, J. R. et al., “The Prepuce: Specialized Mucosa of the Penis and Its Loss to Circumcision,” British Journal of Urology 77 (1996): 291-295.

(3) P. M. Fleiss, MD, MPH, “The Case Against Circumcision,” Mothering: The Magazine of Natural Family Living (Winter 1997): 36-45.

(4) R. K. Winkelmann, “The Erogenous Zones: Their Nerve Supply and Its Significance,” Proceedings of the Staff Meetings of the Mayo Clinic 34 (1959): 39-47.

R. K. Winkelmann, “The Cutaneous Innervation of Human Newborn Prepuce,” Journal of Investigative Dermatology 26 (1956): 53-67.

(5) Cold, C, Taylor, J, “The Prepuce,” BJU International 83, Suppl. 1, (1999): 34-44. 2. Kaplan, G.W., “Complications of Circumcision,” Urologic Clinics of North America 10, 1983.

(6) Netter, F.H., “Atlas of Human Anatomy,” Second Edition (Novartis, 1997): Plates 234, 329, 338, 354, 355.

64 Responses to “FGM and MGM; still a long way to go”

  1. Restoring Tally Says:

    I was circumcised at birth and I am restoring. I wish my parents had not decided to remove part of my sex organ. Restoring my foreskin has helped tremendously in allowing me to regain some of what I have lost. I am really surprised at the difference, all good, that the foreskin makes.

    • Steven Carter Says:

      Hey Tally

      You are right on all counts…it feels more sensative straight away and the outcomes are better!

  2. michaeleriksson Says:

    The possibly most disturbing thing is that I have repeatedly, if certainly not often, seen women on US TV-series talk of uncircumcised penises as something unusual or an aberration, e.g. on one episode of Sex and the City. Typical variations include a woman claiming never to have seen an uncircumcised penis or mocking the way it looks. (In contrast, I cannot recall one single similar reaction to a circumcised penis.)

    That laws are a bit archaic is something that I can understand (even when I disagree with them)—that is in the nature of the game. That TV spreads such ideas, OTOH, that is indefensible.

    • Steven Carter Says:

      Same with Desperate Housewives…its a matter of personal hygiene….and most programmes from Hollywood that are Jewish produced…get the connection…or cut connection.

  3. Jeremy Says:

    I’m glad someone is talking about this.

    I don’t even think the concept of MGM exists in most people’s minds. Any talk of circumcision is usually accompanied by a snigger.

    • Steven Carter Says:

      We have decided in Australia not to cut our boys…as all of us born in the 50’s and 60’s realise what we have missed out on and don’t want that to be repeated.

      Come on America see the light

  4. John Says:

    As one whos life has been badly affected by circ,I completely agree with your thoughts.

  5. My no. 1 overlooked issue in skepticism « Purely a figment of your imagination Says:

    […] a bit of stuff that had to be left on the cutting room floor; also see my earlier posts here and here for expansion. I hope to find time to do a proper post on the HIV/circ issue some time but my free […]

  6. Atheism flux | Purely a figment of your imagination Says:

    […] abusers, maybe their anti-LGBT activities, HIV-spreading tactics or misogyny; maybe it’s genital mutilation, be it boys in Muslim or Jewish families, or girls sent abroad from the UK by their parents or […]

  7. stevem660 Says:

    Unfortunately the article above uncritically parrots the exaggerations, speculations and urban myths of the intactivist movement. It cites agenda-driven websites in preference to peer-reviewed science. A bit like citing “answeringenesis.org” for information on evolution. The claim about > 100 US babies dying each year was debunked years ago. There is no scientific evidence for keratisation. None. The stuff about gliding is largely speculation – there is no credible evidence it is essential, and even some uncir’d men do not experience it as their foreskins retract and stay back during coitus. The part about nerve endings is unadulterated baloney, the figures 10,000 to 20,000 are pure fiction. Inventions of intactivists without a jot of evidence behind them and repeated uncritically until they become urban myths. It also has no comparison with other body parts. There are far more Meissner’s corpuscles in the finger tips than the foreskin, and they’re bigger too. One does not get off on rubbing finger tips. It is genital corpuscles that count, these are concentrated around the glans and underside of the shaft, not the foreskin. Why does the author not even mention genital corpuscles? I could go on but it would take too long a post to refute all the misleading pseudoscientific nonsense she writes. Thankfully, Baker was given a thorough, and well-deserved, drubbing in “The Skeptic” recently when she tried to peddle her intactivist nonsense there. See also: http://jme.bmj.com/content/39/7/429/reply “Sloppy scholarship and the anti-circumcision crusade”. Circumcision makes scant difference to sexual function or pleasure, the cherry-picked, discredited and unreliable “studies” of intactivists notwithstanding. The recent meta-analysis by Tian et al: http://www.ncbi.nlm.nih.gov/pubmed/23749001 is a good place to start. One of the things that annoys me about people like Baker is not their pseudoscience (that’s bad enough) it’s the damage it does to circ’d men. It is pernicious and malicious. By going around telling them all this garbage about them being sexually ruined she is causing them needless anguish. And that is just plain cruel. See the 1st comment here for an example of one of her victims: http://poddelusion.co.uk/blog/2013/03/08/episode-177-8th-march-2013/ To circ’d men I say relax. You are missing little. Don’t believe the bullshit of the anti-circ brigade. Intactivists lie, cherry-pick, cite discredited studies and rely heavily upon anecdote and personal testimony in the face of proper science. It suits them to portray circ as all things bad – it angers circd men and swells their ranks with motivated new recruits, but it is as much pseudoscience as the nonsense of the anti-vacs and the AIDS-deniers (many of whom are also intactivists).

    • noodlemaz Says:

      Thank you for your comment.

      There is undoubtedly a problem with pseudoscience in intactivism; that is a sad consequence of a population who cannot trust its medical system, because it is built on profit, not patient care. It often comes with anti-vax ideas, yes, with the ‘natural parenting’ stuff. But I am giving no credence to that.

      The underlying fact is that people, as parents or otherwise, do not have the right to cut off parts of healthy children. There is insufficient evidence to show benefit, and even if there were, this would not create an ethically sound argument for routine infant circumcision.

      As to the ‘drubbing’ to which you refer, it was from Morris who is a well-known circumcision activist, and his piece is full of lies, distortions, ad hominem nonsense – and a full rebuttal is on its way from a medical ethics professional. So watch out for that.

      For those who are interested, the exchange will be made available online when The Skeptic editors have time.

      • stevem660 Says:

        Whilst it is good you acknowledge intactivism is full of pseudoscience, it is telling that you do not tackle the specific examples in your own article that I pointed out. Like the urban myth about 10000 to 20000 erotogenic nerve endings. That is bollocks. If you’ve read my eLetter to J. Med. Ethics you’ll see I actually went to some time, trouble and expense to trace this one back to source. I didn’t have space to include the other source – a guesstimate by NZ intactivist Ken McGrath at a conference in the 1990s – with which the original Fleiss claim often gets conflated.
        The reason there is so much pseudoscience in intactivism is due to lack of critical thinking on the part of intactivists – including you. There is a near complete lack of fact-checking on their part. The moment they find a sound-bite that triggers their confirmation bias they run with it, and look no further. Did you ever check those 10000 to 20000 figures?
        So it is that urban myths, like the aforementioned bullshit about nerves, get parroted over and over again, the parrots never stopping for a moment to ask if the claim is actually true. Speculations (and that’s what they are) about gliding are passed off as established fact, never mind the complete absence of any experimental data behind them. Claims about keratinisation are asserted without regard to the near complete lack of actual measurements (the only attempt to do such measurements found no difference). Studies supporting the intactivists’ cause are cherry-picked out of a mass of contrary literature, while detailed rebuttals of such studies are ignored. Discredited claims are bandied about as if still valid. Comparisons between very different countries applied without regard to confounding factors (I wish I could be given £1 every time the USA/Europe comparison is made). Confounding factors are mentioned only with regard to evidence that favours circ, never when it favours intactivists. Ad hominems, guilt by association, and other logical fallacies are strewn about like confetti, and all with a belligerent, bullying, bellicose tone. It is near impossible to have a reasoned discussion on the topic without comments threads being flooded by aggressive intactivists overwhelming their opponents by sheer force of numbers, and length of their Gish gallops. Little wonder I am fed up with intactivism.
        All these criticisms are valid irrespective of the rights or wrongs of circ’ing babies. Something I do not advocate for, but won’t resist either if done medically. Which brings me to my next objection, that intactivism is based on a dogmatic moral absolutism. What if circ really does win a cost-benefit analysis? Suppose a boy really is better off without a foreskin? Why should ideology trump his health and best-interests? In high HIV countries circ wins easily and I note that infant circ is now being rolled out in Swaziland and other such blighted nations. No doubt with the approval of the local medical and health authorities, and certainly with the approval of the WHO, CDC, PEPFAR & UNAIDS. So the old canard about no medical body endorsing infant circ can now be discarded, only you can be sure that intactivists won’t discard it. They have never been ones to let the facts get in the way of a good canard.
        Which brings me to another reason intactivists make me angry – they are endangering lives. The denialism about the HIV/foreskins link is shocking, and persists despite detailed debunkings. Is this regard they are no different to HIV/AIDS deniers, and anti-vaxers, (many of whom are also anti-circ, quelle surprise). Their behaviour is reprehensible.
        They also piss me off with their attempts to make circ’d guys feel miserable. It suits their cause to exaggerate the supposed merits of the foreskin, but it is all nonsense, as I’ve said before. You are deliberately setting out to make circ’d guys feel they are missing something vital. They are not. Circ makes little, if any, difference to performance. The foreskin is not especially erogenous, it is not essential. Get used to it. If you did your homework you would know this. Yet still you and others persist in traumatising impressionable males with your nonsense. That is just mean and nasty.
        In fact it was this last which finally prompted me to write an article for the UK Skeptic, coincidentally just as yours’ was published. I came across this really callous piece of intactivist nastiness in response to a young lad who had been misled by intactivist literature and now resented his circ and his parents. Look at the first reply:

        http://answers.yahoo.com/question/index?qid=20110227140835AAsZGfE

        Now how is that poor lad going to feel? It is bad enough that he is being traumatised with this malicious bullshit, but it is just that, malicious bullshit. He is not damaged goods. He can have just as thrilling a sex life as any other man, and without the various problems that come with foreskins. Yet he is lied to and the lies are calculated to traumatise him. That is cruel, dishonest, and immoral, and for me was the final straw prompting me to write my article.
        In the end Prof Morris’ article was taken instead. Maybe mine will find another venue, meanwhile I will not stop criticising intactivism. Regardless of the rights or wrongs of trimming babies (not something I’m advocating) you people badly need to get your own house in order.
        Finally, I note that an ethicist is writing a reply to Prof Morris. Maybe he can apply his ethical skills to the ethics of the behaviours of intactivists I highlight above. I’d also like him to consider the ethics of the revolting “Foreskin Man” comic strip with its blue-eyed blond Aryan superhero versus the caricature Jew, or the ethics of the cyber-attack by intactivists against the Catalan Institute of Oncology after they published data linking lack of circ to HPV in males and cervical cancer in their female partners. As a good friend of mine recently lost his soul-mate of over 20 years to this disease, and is heartbroken, I find this latter action particularly disgusting. Don’t you?

  8. Profesor Emeritus Brian J. Morris Says:

    FAILURE to circumcise a baby boy violates his human rights and breaches the UN Convention on the Rights of the Child, which supports protection of his health against adverse medical conditions caused by lack of circumcision. Over the lifetime 1 in 2 uncircumcised males suffer one or more of a raft of medical conditions caused by their foreskin. Many will die as a result from penile cancer that affects 1 in 900 uncircumcised men but virtually no circumcised men, as well as having a 15-50% protective effect against prostate cancer, and 60% protection against heterosexually acquired HIV/AIDS. The female partners have approx. half the risk of various common sexually transmitted infections and cervical cancer if their male partner(s) are circumcised. In infancy uncircumcised males have a 10-fold higher rate of painful urinary tract infections and half get kidney damage. UTIs affect 1 in 3 uncircumcised males over their lifetime, but only 1 in 12 circumcised males. Other common conditions in childhood and later as a result of lack of circumcision are phimosis, paraphimosis, inflammatory skin conditions, poor hygiene and various infections, including common STIs (HPV, genital herpes, mycoplasma, etc) and rarer ones such as HIV. Infancy is definitely the best time to circumcise. It is safer, simpler, quick, cheaper, low risk and confers benefits immediately. There is no adverse effect on sexual function, sexual sensitivity or sexual satisfaction. if anything sex is better after circumcision. Waiting until the male can make up his own mind means financial barriers, psychological barriers and difficulty finding the time off school or work. It also means many years of suffering adverse conditions that could have been avoided. The cosmetic result is also better for an infant circumcision. Risk-benefit analyses have shown that the benefits of infant male circumcision exceed the risks by over 100 to 1. Whereas virtually all of the complications seen in an infant circumcision are very minor and easily and completely treatable, the risks of not circumcising can be extremely serious: kidney damage in infancy and death from genital cancers as referred to above.

    For the quality evidence read the following and the references cited therein or simply do a PubMed search and read all articles (over 3,000).

    American Academy of Pediatrics (AAP) 2012 evidence-based affirmative policy statement on infant male circumcision (IMC): http://www.ncbi.nlm.nih.gov/pubmed/22926175

    No adverse effect on sexual function or pleasure: http://www.ncbi.nlm.nih.gov/pubmed/23937309

    A meta-analysis of the entire medical literature shows circumcision has no adverse effect on male sexual function:

    http://www.ncbi.nlm.nih.gov/pubmed/?term=tian+circumcision+meta-analysis

    Why infancy is the best time to circumcise a boy: http://www.ncbi.nlm.nih.gov/pubmed/22373281

    Infant male circumcision (IMC) is cost-saving for prevention of infections (Johns Hopkins study): http://www.ncbi.nlm.nih.gov/pubmed/22911349

    Lack of Medicaid coverage in Florida accompanied by a decline in infant male circumcision, followed by a sharp increase in more risky circumcisions in older boys: Florida study:

    http://www.ncbi.nlm.nih.gov/pubmed/24069977

    Flaws in claims by opponents who criticized the AAP policy:

    http://www.ncbi.nlm.nih.gov/pubmed/23955288

    Why attempts by opponents to ban IMC in the USA are untenable:

    http://www.ncbi.nlm.nih.gov/pubmed/23979448

    Why it is unethical NOT to circumcise a baby boy:

    http://www.ncbi.nlm.nih.gov/pubmed/23484246

    Why a report in Tasmania to ban IMC is legally and ethically flawed:

    http://www.ncbi.nlm.nih.gov/pubmed/24010685

    The high protective effect of IMC against UTIs over the lifetime:

    http://www.ncbi.nlm.nih.gov/pubmed/23201382

    Why IMC should be advocated to protect against genital cancers in men and women

    http://www.ncbi.nlm.nih.gov/pubmed/23167429

    The strong protective effect of circumcision against cancer of the penis and a smaller effect against prostate cancer.

    http://www.ncbi.nlm.nih.gov/pubmed/21687572

    http://www.ncbi.nlm.nih.gov/pubmed/22635160

    Why male circumcision protects against heterosexual HIV infection in developed countries such as the USA, UK, Europe and Australia: http://www.ncbi.nlm.nih.gov/pubmed/22452415

    Why the arguments by opponents attacking the trials in Africa are fallacious: http://www.ncbi.nlm.nih.gov/pubmed/23156651

    http://www.ncbi.nlm.nih.gov/pubmed/22776572

    http://www.ncbi.nlm.nih.gov/pubmed/21729966

    How male circumcision protects against HIV infection (including the truth about langerin, which becomes overwhelmed at high viral loads): http://www.ncbi.nlm.nih.gov/pubmed/22581866

    Why the attack by Frisch and European medicos demonstrates cultural bias against IMC in Europe.

    http://www.ncbi.nlm.nih.gov/pubmed/23509171

    IMC — An evidence-based policy statement by the Circumcision Foundation of Australia:

    http://file.scirp.org/Html/12-1340046_17415.htm

    http://www.scirp.org/journal/PaperInformation.aspx?paperID=17415#.Ur3esigp-gE

    Why the RACP’s 2010 IMC policy is fatally flawed: http://www.ncbi.nlm.nih.gov/pubmed/22805686

    Claims denying male circumcision are unscientific: http://www.ncbi.nlm.nih.gov/pubmed/21335254

    Why circumcision: History and recent trends.

    http://books.google.com.au/books?id=w7zyKB9mdMwC&pg=PA243&dq=cox+surgical+guide&hl=en&sa=X&ei=KYnAUt6_MsnikAWu3ICoDA&ved=0CDAQ6AEwAA#v=onepage&q=cox%20surgical%20guide&f=false

    Claims That Circumcision Increases Alexithymia and Erectile Dysfunction Are
    Unfounded: A Critique of Bollinger and Van Howe’s “Alexithymia and Circumcision
    Trauma: A Preliminary Investigation”

    http://www.biomedsearch.com/article/Claims-that-circumcision-increases-alexithymia/305192594.html

    • noodlemaz Says:

      This is such a load of nonsense from the first sentence onwards.

      Circumcision Foundation of Australia is a disturbing pro-circ group, not a legitimate source on anything.

      It’s nice that you like self-referencing. More on that later.

      • stevem660 Says:

        “It’s nice that you like self-referencing”
        And your point is? Sure, the Prof is a coauthor of about ¾ of the references listed (alongside many others, sometimes as many as a dozen at a time). What does this prove? That he has written copiously on the subject. But it tells us NOTHING about the quality of his writings. Check out: http://en.wikipedia.org/wiki/Ad_hominem

      • noodlemaz Says:

        Haha, you’re linking me to ad hom definitions, after what Morris wrote in the skeptic? Let’s put the chat on hold until the comprehensive reply is out shall we – I’ll put a new post up then.

  9. Profesor Emeritus Brian J. Morris Says:

    Since the benefits of childhood male circumcision intervention outweigh the risks and similarly failure to circumcise boys in a population will create a risk for future sexual partners, the issue of the circumcision of boys would appear to be analogous to the vaccination of minors. Moreover, since infant male circumcision is not prejudicial to the health of children, but instead is beneficial, it does not violate Article 24 (3) of the United Nations Convention on the Rights of the Child.

    Some argue that parental choice of circumcision for their infant son is illegitimate, because
    the choice can be made by the boy once he is an adult. However, parents and physicians each have an ethical duty to the child to attempt to secure the child’s best interest and well-being. Since the benefits outweigh the risks and the procedure is safe, there is no reason to single out circumcision for overriding parental choice. Indeed, an article from the UCLA School of Law stated that, “a violations-only approach to human rights advocacy is unduly limiting; indeed it overlooks the duty of states affirmatively to create conditions necessary for the fulfilment of rights. In this case research now indicates that the availability of male circumcision [for HIV prevention] in some settings has the potential to serve as an important tool for realizing good health”

    Further undermining the argument for a unique right in relation to infant male circumcision is the fact that the timing of circumcision has a pronounced impact on both benefits and risks. Cultural and religious requirements of early circumcision aside, medical and practical considerations weigh heavily in favour of the neonatal period. Surgical risk is minimized and the “greatest accumulated health benefits” are attained if circumcision is effected close to birth. Benefits potentially lost include a significant reduction in urinary tract infections that in infancy may lead to kidney damage.
    Delay may also result in increased cost, longer healing time, a requirement for temporary sexual abstinence, interference with education or employment, and loss of opportunity for, or delay in, the achievement of protection from sexually
    transmitted infections (STIs) for those who become sexually active early and for those who ignore advice on abstinence, thereby exposing them to increased risk of STIs, during the healing period. At the same time, there are no long-term adverse effects of a successful medical circumcision on sexual function, sensitivity, sexual sensation or satisfaction. It is disingenuous to suggest that the procedure is comparable at both ages. An adult cannot consent to his own infant circumcision. Many nations that condemn circumcision are not as quick to condemn other comparably invasive and dangerous non-therapeutic procedures. Examples of procedures performed on children that are not medically necessary include cosmetic orthodontia, correction of harelip, surgery for ankyloglossia, treatment of short statute by growth hormone injections and removal of supernumerary digits.

    Given its substantive health benefits, it thus seems curious that circumcision seems unique among childhood procedures in attracting controversy.

    For more, including references to statements above, please see: http://www.ncbi.nlm.nih.gov/pubmed/24010685
    and http://www.ncbi.nlm.nih.gov/pubmed/23979448

  10. Professor Emeritus Brian J. Morris Says:

    The “Morris” referred to is me and I resent the slur. I am more a scientist than an activist and become quite irate when I see anti-science and outrageous fallacies promoted as propaganda to support dangerous “causes’ … whether it be antivax (eg, the false “research” by Wakefield still cited by anti-vaxers despite his work being found to be fraudulent and it and he struck off), anti-water fluoridation, homeopathy, chiropractic or anti-circumcision. Moreton presents an excellent appraisal. What he says cannot be refuted by emotive nonsense such as referring to tiny bits of skin being cut off when doing so will prevent adverse medical conditions and deaths in half of males over their lifetime, and the benefits exceed to risks of circumcision by over 100 to 1. I spoke at length about the circumcision issue to Simon Singh at a dinner arranged by the Australian Skeptics in Sydney a couple of weeks ago where he was the special speaker. He has endured years of ordeal from quacks who sued him for telling the truth. He won! And the flawed law that led to this was changed in the UK to prevent episodes such as he endured from happening again. As to the “ethicist” referred to, is it perhaps the US dancer whose outrageous, ethically flawed statements have been discredited by other ethicists? As my article stated, skeptics base their conclusions on good quality scientific research findings, not the fallacies perpetrated by fringe groups, especially when the consequences are detrimental to public health and individual well-being. Science supports infant male circumcision — so should skeptics!

    • Tante Jay Says:

      How come that a molecular biologist is so eager to circumcise infants, that he even went so far to utter the wish to make it mandatory?

      How come that you deny to be an activist, but you had once links to the Gilgal Society before it became to…smelly?

      “Brian Morris and the Gilgal Society” – yeah, you are clearly no activist.

      It’s sinister that you compare the real stupidity of the Anti-Vax-scene with the refusing to circumcise infants.

      Your arguments are long busted, the last long line of blowups for your “research” was Morten Frisch et.al.

      Please. You are retired. Would you please now so kind and keep your dirty trap shut so that the kids can grow up in peace?
      Foreskin is no birth defect, Mr. Circumcision.

    • Dorte Nielsen Says:

      Dear dr. Brian Morris,
      I am Scandinavian, and I used to be a Reference Librarian. As a reference librarian you come over all kinds of facts and figures, and there is a paradox that has been bothering me for quite a while.
      I should be most grateful if you, dr. Morris, as a scientist, could help me to explain this paradox.
      In Scandinavia approximately 95% of the sexually active men (adults) are intact.
      The HIV rate 2009 as published by CIA:
      Denmark … 0.2
      Finland … 0.1
      Norway … 0.1
      Sweden … 0.1
      In USA 90% of the sexually active men (adults) are circumcised:
      The HIV rate 2009 as published by CIA:
      USA … 0.6
      Source: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2155rank.html
      How come, that the HIV-infection rate is 300-600% higher in the circumcised USA compared to the intact Scandinavia?
      Here I have to mention 2 things:
      1. The standard og living in the USA and in welfare Scandinavia are absolutely comparable except that we have fewer very rich people, and our middle class in general are poorer than the American middle class.
      2. in welfare Scandinavia, healthcare is for free, so we don’t have a lot of poor people walking around, who cannot even effort paying for a diagnosis.
      About the global HIV epidemy WHO states:
      “About 6,300 new HIV infections a day in 2012
      • About 95% are in low- and middle-income countries”
      Source: http://www.who.int/hiv/data/2013_epi_core.ppt?ua=1
      To me it seems like poor economy and its implications more than male circumcision might influence the epidemic spreading of HIV?
      The global map in the WHO-source mentioned above reveals, that the HIV-rate seems to be relatively lower in Muslim countries than in Christian countries and in African countries south of the Sahara.
      This might indicate, that a high sexual moral will keep the HIV-rate low? Sounds reasonably and likely to me.
      But – as mentioned above – I’m grateful to have the opportunity to put this question to you as a highly regarded scientist, this paradox has been “a stone in my shoe” for a very long time.
      Kind regards
      Dorte Nielsen
      Denmark

      • stevem660 Says:

        As I said in my post above, “I wish I could be given £1 every time the USA/Europe comparison is made”. The discrepancies are easily explained, and have been explained to intactivists ad nauseam, but still they just don’t “get it” and just keep on showing off their epidemiological ignorance by repeating this poor argument over and over again. Anyway, as the question was addressed to the professor I don’t want to steal his thunder. But here are a few clues, and they all revolve around something called “confounding factors” (look up the term, please).
        Clue 1: Where, in the developed world did HIV have a huge head start?
        Clue 2: http://www.unicef-irc.org/publications/pdf/repcard3e.pdf figure 13, p. 20.
        Clue 3: http://www.cdc.gov/hiv/statistics/surveillance/incidence/
        Clue 4: http://www.cdc.gov/hiv/statistics/basics/ataglance.html combined with http://www.cdc.gov/nchs/data/hestat/circumcisions/circumcisions.htm (although it could be fairly countered that socio-economics factors could also be involved).
        Maybe when you’ve put all these simple clues together you’ll understand why inter-country comparisons are fraught with dangers, but when one looks at the data more closely it does not actually support the intactivists’ argument.
        Just to show that things are rarely simple, here are HIV rates in some other highly developed (by HDI) non-circumcising countries (from your own source):
        Bahamas 3.1 %
        Estonia 1.2 %
        Ukraine 1.1 %
        Russia 1.0 %
        Latvia 0.7 %
        Portugal 0.6 %
        Now read this: http://jid.oxfordjournals.org/content/199/1/59.full
        Hope this helps, and apologies to the professor if I’ve stolen his thunder.

      • noodlemaz Says:

        None of this suggests that cutting children should be an effective strategy. Education and barrier contraception provision provide real, measured, effective benefits. Without that, any tiny possible benefit from GM is irrelevant. How many adult men would line up to have the procedure? European men are fine with their intact anatomy and educating people about safe sex has made a huge impact. That is the sensible, safest route and respects people’s rights at the same time.

      • stevem660 Says:

        “tiny possible benefit” you say. 60 % reduction in female to male HIV transmission, rising to ca. 76 % over time is NOT tiny. Similarly for the protection against ulcerative conditions and HPV (several tens of %).
        I am all for education and promoting condoms, but alone they are not enough. HIV continues to spread in spite of vigorous condom promotion: http://www.tandfonline.com/doi/abs/10.2989/16085906.2013.815406#.UvE34KhFDIU but circ is working: http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001509
        “How many adult men would line up to have the procedure?” 4.7 million as of last December.

      • noodlemaz Says:

        1) Please read this: http://blog.practicalethics.ox.ac.uk/2012/05/when-bad-science-kills-or-how-to-spread-aids/
        And understand that quoting big relative risk reductions without quoting original absolute risks is typical of poor medical science reporting, particularly in tabloid newspapers. It is a misleading tactic that uses stats and people’s ignorance of it to manipulate and give false, or at least hugely exaggerated, impressions.

        Also: http://www.nhs.uk/news/2013/12December/Pages/your-guide-to-hitting-the-headlines.aspx (funny as well as informative).

        2) Your post above quite clearly lays out the many factors that are far more important than circumcision in the spread and control of HIV. We too have had an epidemic since the 80s, but it has been tackled with huge education and contraception drives. There is an increasing problem now, going along with meth, but this is recognised and will likely be handled in a similar manner.

        Any tiny reduction in risk such as this, that affects adults, does NOT justify an invasive, painful procedure being forced on infants, which then changes their sexual experience for life. However exaggerated oft-quoted nerve numbers are by intactivists, the bottom line is: a lot of skin is removed, nerve endings are severed – from the child’s future sex organ. That is no small thing, and ethically trying to justify it using poor quality studies from (like you said!!) unrelated countries is futile, and is what causes people to become angry and think of pro-circ advocates as questionable individuals.

        3) link for 4.7 million? How many have been followed up after 5 years? How many purely out of choice, and not a medical reason, with prior sexual experience, who can report? And how many of your confounding factors (like some Americans’ repulsive propensity to call intact men “disgusting” etc.) apply in this decision? Any comparison for countries, like here in the UK, where it is a very rare thing?

        Again, most of these points will also be addressed in the upcoming Skeptic article.

      • stevem660 Says:

        So now you finally admit that the erotogenic nerve endings figure is “exaggerated”. It is not just exaggerated, it is completely false. There is no truth in it whatever. None. Yet it is peddled ad nauseam by intactivists who don’t even bother to fact-check it first. My criticism of them in this regard is entirely justified. When I see this behaviour being repeated over and over again, repeating urban myths, making assertions for which there is no empirical evidence, passing off speculations as fact, (and it’s not just the nerve endings figure, it’s keratinisation, gliding, lubrication …) is it any wonder I have come to view intactivism as pseudoscience? It is!
        And you are just as culpable – you peddle these same myths and speculations yourself. So I am entirely right to criticise you for it. But it does not end there. There is a malicious nastiness to this pseudoscientific garbage. It is calculated to upset and traumatise circ’d males. And that is vicious and cruel. Look at the link I gave before to the case of a young lad misled by this mischievous nonsense. Look at the second reply: “Your parents tortured you, mutilated you …”. For sheer heartlessness that takes some beating. And the sadistic creep repeats the 20,000 lie, and the unproven keratinisation claim, just to rub it in and make sure the poor lad is suitably distressed. And further posts full of more of the usual callous bullshit follow. What must the poor kid have thought? What psychological state is he going to be in after having his head filled with this vindictive rubbish? I would not be surprised if he was in tears by the time he’d read it all.
        And again you are just as culpable. I have already provided a link to a comment by one of your victims. You owe that man an apology. Have you ever stopped to think what effect the intactivist falsehoods you peddle have on circ’d males? Do you really have no idea how traumatising it must be for them if they end up believing this crap? They are not damaged goods. They can have just as good a sex life as anyone else. Circ makes little, if any, difference, yet you people go around tricking them into thinking they are sexually crippled without caring a damn about the psychological distress you are causing in the process. It is a great way of drawing angry, motivated new recruits into your movement, but it is dishonest and immoral. Is it any wonder intactivism makes my blood boil?
        I also get annoyed by the way intactivists manipulate figures to suit their agenda. As you do when you try to wriggle out of the fact that 60 % + protection is not “tiny”. I thought you would fall back on the misleading ploy of turning it into an absolute value, rather than a relative one. I was right. You did. By the same argument, in a world in which polio has been reduced to a few isolated pockets, the absolute protection polio vaccine provides for most is “tiny”, in fact miniscule. So we should abandon vaccinating kids then.
        I’ve seen this argument before (e.g. Earp’s article). If we take the absolute value of 1.31 % (in that source, and for high HIV countries) over time, and across Africa, that still translates into millions of infections averted, and lives saved. That is not “tiny”. Besides, the figure is only for the 2 years duration of the trials. If maintained (and follow-up work indicates it actually rises with time) then after 20 years it will be 13.1 %. Over a lifetime even more. Not so “tiny” now is it?
        As with any other prophylaxis, from vaccines to condoms to fluoride toothpaste, the proper way to cite the level of protection is as a relative risk. You are trying to downplay the very significant 60 % + by turning it into a much smaller number that better suits your agenda.
        And please note that my criticisms of intactivism are independent of the rights or wrongs of circ’ing babies. Something I’m not advocating for, but will not oppose either, if done medically. Whatever the merits, or otherwise, of infant circ, intactivists badly need to get their house in order. They do their credibility no good at all by peddling bad arguments, and causing needless upset to circ’d males. And their irresponsible denialism (e.g. HIV) is another reason intactivism upsets me so much. It endangers lives.
        I have already seen Brian Earp’s dismal article, which relies heavily on the thoroughly debunked one by Hill & Boyle (Morris helpfully provides 3 links to rebuttals, here’s a 4th: http://www.ncbi.nlm.nih.gov/pubmed/22452415). I note I am not the only one to think Earp’s piece was badly researched: http://www.quackdown.info/article/getting-circumcision-science-right-media/
        I have engaged with Brian Earp before, both on-line, and privately. If it is he who is writing the rebuttal to the other Brian then the latter has nothing to fear.
        4.7 million African men have been circ’d so far in the anti-HIV program. (In fact it is probably higher now as the program is proceeding briskly and there is a delay in getting the data in): http://m.whitehouse.gov/the-press-office/2013/12/02/fact-sheet-shared-responsibility-strengthen-results-aids-free-generati-0 That must really piss you off. I’m just thinking of lives saved, and am thankful that those in the front line can see through the intactivists’ pernicious nonsense.

  11. noodlemaz Says:

    - “You’re infringing on my parental rights!”
    Please show me when Cutting Flesh Off Healthy Children has been recognised as a human right.
    Are children people, with full human rights, or are they parents’ property? If anyone thinks the latter, perhaps they shouldn’t be parenting at all.

    – “But parents have to make tough decisions for their kids all the time”
    Please tell me when “Should I cut my healthy baby?” became a “tough decision” for anyone, and why indeed the question is ever asked at all. Ask it of yourself, free of cultural influence (and Morris’ spiels above), and see what you think. See what your child thinks if you cut him anywhere, and see what the police think. Except for there – apparently that’s allowed.

    This is a non-question. No amount of research into tiny, tiny possible benefits offered against STDs justifies routine infant genital mutilation, none at all. It is nonsensical. It is a breach of a child’s rights.

  12. David Says:

    Marianne, while I’m sure I’m not the only one who appreciates the effort you’re making, you really needn’t put yourself through this; Morris, in particular, is clearly disturbed. No one would blame you if you just blocked these fellows and moved on. Life is too short, sometimes.

    On another note, does anyone know if Morris even attempts to get permission to list all those individuals as ‘co-contributors’? I happen to know one of them (I’ll not name her), and she was blissfully unaware of ever having ‘co-written’ a paper with Morris; how many of these academics even know who he is? Isn’t this misconduct of some kind? Journal editors (and university administrators) must be getting lazier. Oh, and Morris, if you’re reading: it’s time to update your ‘biologic plausibility’ stuff WRT the foreskin/keratinization/HIV, etc. Dinh schooled you on the idiotic letter you wrote following the publication of her first study (Dinh’s letter is here: http://journals.lww.com/aidsonline/Fulltext/2010/06010/Keratinization_of_the_adult_male_foreskin_and.22.aspx); I belly-laughed at the ‘naked eye examination’ bit. Morris still has misinformation on his site, despite Dinh’s correcting him. If anyone wants to read the follow-up paper on keratinization, just search for ‘No Difference in Keratin Thickness between Inner and Outer Foreskins from Elective Male Circumcisions in Rakai, Uganda’.

    Apropos of the Warner et al. paper mentioned above, it’s worth noting that the number of uncircumcised men with ‘known exposure’ (presumably all HIV+ individuals have such a history) who seroconverted numbered just 11. In the same population (and it’s an enormous sample), circumcised and uncircumcised men were equally likely to be HIV+ (1.00 (0.86-.1.15)), despite men in those respective populations being equally likely to visit following an exposure (roughly 1 percent, each), rather suggesting that circumcision confers no degree of protection in the US.

    Dr. Moreton, assuming you’re interested, there are quite a few papers, of varying quality, assessing HIV prevalence and its (lack of an) association with circumcision status in heterosexuals in the United States. You likely read the fairly recent Mor et al. paper (‘Declining Rates in Male Circumcision amidst Increasing Evidence of its Public Health Benefit’) finding no evidence of a protective effect in either heterosexuals or MSM. Surick et al. back in 1989, in two studies – the first case-control and the second cross-sectional in design (‘HIV infection and circumcision status’) – found no evidence of a protective effect. Thomas et al. (‘Prevalence of male circumcision and its association with HIV and sexually transmitted infections in a U.S. navy population’) too found equal prevalence; the same is true for Magnus et al. (‘Risk factors driving the emergence of a generalized heterosexual HIV epidemic in Washington, District of Columbia networks at risk’). Neither Chiasson et al. (‘Heterosexual transmission of HIV-1 associated with the use of smokable freebase cocaine (crack)’) nor Telzak et al. (‘HIV-1 Seroconversion in Patients with and without Genital Ulcer Disease: A Prospective Study’) were able to find a significant relationship. As Puerto Rico is (sort of) part of the United States, you might take a gander at Rodriguez-Diaz et al. (‘More than Foreskin: Circumcision Status, History of HIV/STI, and Sexual Risk in a Clinic-Based Sample of Men in Puerto Rico’). My file isn’t well organised, but I’m sure there are others. Perhaps Laumann covered it in his famous paper; I can’t remember.

    None of this matters in the slightest, of course – we’re talking about cutting (the best) part of a child’s genitals off, after all. While I understand that Moreton & Co. are rather down on the foreskin, I’d sooner lose a leg than get circumcised (and I play a lot of cricket); it’s been obvious to me since I was a teen that ~90% of the erogenous sensation one gets from one’s penis comes from the ridged band. How glad I was to discover Taylor’s research and exchange a few emails with him shortly prior to his death; I thought I was mad and alone before reading his work. The glans seems to be rather a dull but useful anvil against which and over which the foreskin can roll and ‘activate’. Perhaps fellows circumcised to relieve BXO have a different experience – I’d imagine losing genital tissue ravaged by such a dermatitis would be a bit like losing an eye that had long been blind. Oh, well. I think Taylor’s old site is very much worth visiting: http://research.cirp.org/index-e.html

    Thanks again, Marianne. Don’t let the strange Australian get you down.

    • stevem660 Says:

      David.
      I’ve seen the literature you cite, and know some of its shortcomings. But what really struck me about your post was the last paragraph which leaves me seriously wondering if it is your sanity, or sincerity, I should be questioning. It is so nuts I have kept a copy for future reference. Please, please, keep repeating it at every opportunity so that others, especially guys like me (circ’d as an adult) can see how completely bonkers intactivists can be, and have a good laugh at their expense. I just wish there was an equivalent to “Fundies say the darndest things” for the most outrageous remarks by intactivists.
      So the foreskin is the “best part” you say. So let’s get this straight. If you had a medical condition (cancer, gangrene, trauma, or anything else, take your pick) for which the only option was amputation, which would you rather lose? Your glans or your foreskin?
      As one who has nearly lost a leg (http://www.mindat.org/forum.php?read,6,110773,110773#msg-110773 open the pic in the 1st post) I am astounded by your claim that you’d rather lose a leg than your foreskin. Having lost my foreskin at age 30, and nearly losing a leg at age 44 (am now almost 51) I know very well which gave me vastly more worry, agony and misery at the time, and continues to be a nuisance now. It is NOT the minor procedure I underwent in 1993, and which has had absolutely no adverse effect whatsoever on any aspect of function or pleasure. On the other hand, a Gustilo 3b open compound fracture* of left tibia & fibula, leaving the fibula sticking out one side of the limb, and a rip so big in the other side one could have put a hand down it, followed by 3 surgeries, 6 weeks in hospital, an infection, a DVT, trashed veins from anti-biotic drips, 6 months off work, a year to union and two years to get rid of the limp (still returns sometimes), has had very definite adverse effects, and I have to live with them for the rest of my life. And I’ve still got the leg, and would rather still have it, scars, muscle flap, internal metalwork, skin graft, stiffness, swelling, itching, bleeding, stabbing pains, skin problems and all, than not. Yes, I have all these, will have for the rest of my life, and still I would not trade it for a prosthesis. There is NO comparison between circ and a limb loss. None. Your ludicrous comparison is an insult to anyone who has suffered a major limb trauma, let alone a leg amputation.
      You should think carefully before making stupid comparisons in future – it makes my debunking job so much easier. I may quote your post in future debates. It’s that ridiculous. Thank you.
      *http://en.wikipedia.org/wiki/Gustilo_open_fracture_classification

      • David Says:

        I think you’re being needlessly hostile, but I’ll not respond in kind; in good faith I’ll assume that this anger of yours is coming from a good place. Perhaps you’ve had negative experiences engaging with anti-circumcision individuals before. I’ll not try to make this another one.
        In response I’ll try to be brief as I can. First, sexual pleasure is extremely important to me: if I had to wake up tomorrow morning missing either my foreskin or one of my legs, I’d choose to lose the latter; if you’re interested, I’ll share that I’d sooner be circumcised than lose either of my arms, however – I imagine (perhaps erroneously) that the loss of a leg isn’t going to impact one’s quality of living too dramatically, while the loss of an arm would. You share a lot of details about your accident, and I’m very sorry to hear what you went through, but can’t see the details in your account of your experience as germane to the discussion at hand. I’m glad to hear you’ve made a good recovery, though.
        You ask an interesting question about choosing to lose either the glans or the foreskin. I think that clinicians in their arrogance have a tendency to do away with the foreskin when performing glansectomy, even when the tissue is perfectly healthy; I certainly think it would be interesting, however, to compare reports of changes in sexual pleasure in the small number of men who lose their glans but retain an intact, healthy foreskin. As I’ve said, the glans isn’t valuable in the way most tend to believe—one can see this quite clearly when one observes the way circumcised men masturbate to completion in, say, American pornography, for example. If the glans is ‘where it’s at’, why do these circumcised men pleasure themselves simply by stretching and twisting what remains of their penile skin? Uncircumcised men almost invariably masturbate by playing the foreskin up and down, working it over the glans and stretching and constricting it in an accordion-like manner up and down the shaft. These men tend to assume that they owe the pleasure they feel to their glans being rubbed by the foreskin, but in fact it’s the other way around: observe that while some circumcised men retain enough skin and motility to create for themselves this same illusion, many don’t—and yet still they derive sufficient pleasure to maintain erection and reach orgasm without stimulating the glans even indirectly. The foreskin thus has an unfortunate (if not tragic) tendency to disguise its value. I suspect that the miserable scrap of what remains of the foreskin’s ridged band is the most erogenous part of the successfully circumcised penis—note that (American) sex books will typically refer to this as ‘the frenulum’, though this is erroneous, as the frenulum is simply the little chord bridging between the foreskin and the shaft; ‘frenulum’ as the term is commonly used is just pop sexology lingo for the patch of tissue at the ventral aspect of the distal penile shaft, proximal to the glans, containing the leftovers of the ridged band (in men lucky enough to be left with any).
        The trouble I see with losing the glans and not the foreskin is that without the glans, the functionality of the foreskin is degraded, as it cannot properly be given a good ‘work out’ – the flaring of the glans stimulates the ridged band much as I’d imagine it does the mouth of the vagina. This would be particularly obvious during masturbation, but it’s also true that during erection, the natural resting place of the foreskin behind the glans puckers and ‘presents’ the exposed ridged band to the vaginal walls (or whatever else) during intromission. Without the scaffolding-like contribution of the glans, I can see the whole system of sexual response being made rather less efficient.
        The ‘sensitivity’ of the glans is also rather curious. If I moisten my fingertip and place it on one side of my glans and then shift it a cm or two, it barely registers; it must surely be one of the least sensitive parts of our anatomy in this regard—perhaps this is what Cold and Taylor (1999) meant when they wrote that ‘[t]he only portion of the body with less fine-touch discrimination than the glans penis is the heel of the foot.’ In contrast to this strange numbness, however, the glans seems to be quite incomparably sensitive to another kind of sensation: if I squeeze it by pressing my moistened fingertips, pincer-like, on opposite sides, before slipping them off the tip without relieving my grip (like I’m plucking a grape), it sends a not-very-pleasant shudder right through me, even causing my calf muscles to twitch. It’s an awkward sensation, and the closest thing I can liken it to is having the knuckle of a finger dug into one’s back, as kids did to each other when I was at school. It certainly is not an erogenous sensation. During, say, a foot massage, the difference between pleasure and pain is likely to be the amount of pressure applied. Not so with the glans, however: either it registers next to nothing at all, or it sends that not-very-nice shooting sensation. There appears to be no in-between. This not-very-desirable sensitivity of the glans is particularly obvious immediately after orgasm, when it can become unbearable for the glans to be touched at all – I’ve seen many men, circumcised and not, describe it as ‘painfully sensitive’; if circumcised men think they’re only missing more of *that* sensation, it’s no wonder there aren’t more of them out there protesting.
        The point I’m trying and probably failing to make is that however we may wish to compartmentalise the penis for the sake of making our task of labelling the respective parts that much simpler, in functional terms, the penis is a very well integrated unit and it’s difficult during the course of, as it were, ‘organic’ sexual relations, to identify specific sensations as being attributable to this or that part, alone. Things get ‘blended together’, is rather what I mean. A feeble attempt at an analogy: imagine I’m standing at the other end of a large room, clutching two speakers (one under each arm); one is playing ‘Hey Jude’ while the other plays ‘Eleanor Rigby’. Do you think you’d be able to tell which song was being played on which speaker? I know I’m making my point too awkwardly, but you can see what I’m getting at, I’m sure.
        Lest there be any ambiguity, I’ll state it plainly: it’s my contention that almost all erogenous sensation men have the capacity to feel comes from the tissue they lose to circumcision; I’ve tried to explain why many men (including the uncircumcised) may be unaware of this. Furthermore, I suspect that the most erogenous tissue that remains to successfully circumcised men is the little of the ridged band found on the underside of the penis, close to the glans; those circumcised men not left even a scrap apparently have to make do without. I feel quite confident that future science will vindicate me, but I’m saddened to think of how many boys will be irreparably damaged before we get there. Again, Dr. Moreton, I’d suggest that the site of Taylor’s I referenced might prove instructive.
        I’ve always found it quite interesting to note how surprised men often are at the dramatic loss of sensation they experience when they make the mistake of undergoing circumcision without a history of foreskin pathology; many of them simply had no idea what they’d be losing. Read this thread, for example (http://forums.anandtech.com/showthread.php?t=1769188) – this man, ‘TitanDiddly’ actually had a mild case of phimosis, so his foreskin functioning was already sub-optimal, but just look at how his sensations changed. See also the accounts of other posters in that thread, most notably ‘Lurknomore’ (http://forums.anandtech.com/showpost.php?p=20267206&postcount=750) and ‘Synomenon’ (http://forums.anandtech.com/showpost.php?p=20243098&postcount=694).
        I’m very glad you had a more positive experience, though I’ll continue to harbour a niggling suspicion that your ridged band had (always?) been ravaged by, say, lichen sclerosus, and you were simply unaware of it. Many men who have foreskin problems don’t realise it—this is a price we pay for having a culture where people are so uncomfortable talking about anything related to sex.
        We’ll likely just have to continue to disagree on this subject. All the best, though.
        (Sorry for any typos – I always find it difficult to fill in these piddling little comment forms!)

      • David Says:

        Sorry about the formatting of my last comment – the comment field was so small I typed up my response in Word; it appears that the C+P took out the lines between paragraphs. I apologise if it’s even more painful to read than it would otherwise have been.

      • stevem660 Says:

        David
        I have indeed had bad experiences dealing with intactivists. That aside, your latest effort is so at variance with my own experience and (much more importantly) the scientific data on penile innervation and erogenous zones that I am led to suspect that either you have the most freakish penis, or it’s all fantasy and delusion. The glans is central to sexual pleasure, as the great majority of men will tell you (and it’s backed up by the science, as we’ll see) and I maintain that there is no comparison between circ and even just breaking a leg, let alone losing one.
        I am not a connoisseur of porn, American or otherwise but, like many a teenage boy, was a connoisseur of my own dick, so got plenty of hands-on experience before parting from my foreskin through choice at age 30. So I know both states well, and I know full well what it is like to have a healthy, retractable foreskin, and what it is like not (don’t even have a frenulum). I never got any pleasure from mine. I always found the greatest concentration of pleasure to come from the glans, followed by the underside of the shaft. When uncir’d guys roll their 4skins back & forth over the glans they are stimulating the glans. (I used to do this, but now find that a fist banging into the corona, with nothing in the way, has its merits too). But note there are plenty of uncirc’d guys out there whose foreskins naturally retract and end as a wrinkle behind the glans. (I think it’s called “auto-circumcision”). So they cannot roll it back and forth. Do they complain? For circ’d guys like me, “stretching and twisting what remains of their penile skin” as you put it also stimulates the glans, if indirectly by tugging. It also stimulates the shaft.
        Of course, like your account and the others you cite, mine is anecdotal. If you are a skeptic you will know that anecdotes and personal testimonies are probably the poorest form of evidence there is. I could refer you to pro-circ sites with stories from happily circ’d men, done as adults and saying how wonderful it is. Just as you can refer me to similar tales purporting to be from those with opposing experiences, or who have discovered the wonders of their restored prepuce (such is the power of the placebo). Likewise proponents of assorted crackpot views can produce personal testimonies from those “cured” by homeopathy, abducted by aliens, or turned from gay to straight by Jesus. So pardon me if I don’t take personal testimonies seriously. I prefer science.
        I already know about Taylor’s site. A mixture of detail and rampant speculation about what it means. It amuses me when intactivists refer me to such and such a site or article when, in fact, I have already seen it and found problems with it. One problem with Taylor’s site is this howler: ““Meissner’s corpuscles” (also called “genital corpuscles”)” in the anatomy section. No, Meissner’s corpuscles are very distinct from genital ones. Meissner’s are the fine-touch receptors intactivists harp on about and, sure, they are sparse or absent from the glans. But they are irrelevant. They are not erogenous, or else we’d be orgasming by rubbing our finger-tips – these being the most richly innervated areas of glabrous skin with respect to these nerve endings (and they’re bigger there too). This is one reason I am unconvinced by the Sorrells study, aside from the stats. It was looking at the wrong thing, but I digress. As a further digression, Taylor (in the FAQ section) acknowledges that the glans skin does not thicken after circ, or at least “Probably not to any significant extent”. Something intactivists would do well to note before repeating the keratinisation claim.
        Sexual pleasure, or erotogenic sensations, come from genital corpuscles. Taylor claims there are genital corpuscles in the crinkly bit at the end (a more descriptive name for the ridged band) but, as he confuses these with Meissner’s corps (which really are there, though not as many as in the finger-tips), this claim must be doubted. In fact I have spent some time trying to find any evidence that there are ANY genital corps in the 4skin. It seems to rest upon two very old (around a century) German studies that found just a very few, and which could not be replicated by later workers (e.g. Winklemann).
        Genital corps (GCs) are, however, abundantly present in the glans. It’s a small sample size (n=7) but this study of the glans found GCs to be concentrated around the corona and underside (frenulum area): http://www.ncbi.nlm.nih.gov/pubmed/3697758
        Further evidence of the importance of GCs in the glans is here: http://www.ncbi.nlm.nih.gov/pubmed/10037378 Note the remark on p.99 that erection “enhances exposure of the genital corpuscles, receptors specific to the glans and presumably related to sexual function, to mechanical stimulation.”
        It is, perhaps, telling that when men are asked to rank the areas of their penis with respect to sexual pleasure, the glans comes out top, the foreskin last: http://www.ncbi.nlm.nih.gov/pubmed/19245445 The underside is particularly pleasurable.
        And then there’s all those studies that find no difference (or even an improvement) in pleasure between circ’d & uncirc’d, or between before & after. Intactivists cite studies purporting to find a negative effect (often with flaws) but, for every such study there are others that find no effect, or an improvement. Rather than list them all, see the meta-analysis: http://www.ncbi.nlm.nih.gov/pubmed/23749001
        Circ really does make little difference to pleasure or performance, and intactivists should not be deceiving and traumatising circ’d males by telling them otherwise.

      • David Says:

        “The glans is central to sexual pleasure, as the great majority of men will tell you”

        – I disagree, as I’ve explained above—and I took great pains to try to explain why men erroneously (and commonly) misattribute to the glans the sensations they owe to other penile tissue—i.e., the ridged band in uncircumcised men, and the residue of it, i.e., ‘the frenulum’ (I take it this is what you mean when you mention ‘the understand of the shaft’ as being second in erogeneity to the glans), in circumcised men.

        “[I] know both states well, and I know full well what it is like to have a healthy, retractable foreskin, and what it is like not (don’t even have a frenulum). I never got any pleasure from mine.”

        – With respect, I explained above that many men have pathology of the foreskin and remain unaware of it. This is not at all uncommon and it need not be so severe as to render the foreskin non-retractile. There are similar problems with respect to genital dermatoses in women, where studies have found a remarkable prevalence of vulvar lichen sclerosus (LS) in samples from asymptomatic women (Goldstein, 2005). One suspects that this helps to explicate the discrepant reports of sexual sensitivity and pleasure in women following labiaplasty. Self-diagnosis is inadequate, and naked-eye examination by a physician is insufficient to rule out LS; in order to be completely sure, the ablated tissue would have to sent to a competent pathologist following circumcision, vulvectomy, etc. I’m assuming your foreskin was never examined in this manner, so we’ll never know. You’re not diabetic, by any chance?

        “When uncir’d guys roll their 4skins back & forth over the glans they are stimulating the glans.”

        – This is false. While the glans is being ‘squeezed’ and making some contribution, the erogenous sensation is emanating from the ridged band, swooping, lasso-like, around the glans from its tether on the ventral side. Again, with respect, above I went to considerable trouble to explain away this misconception. It is a common misconception, one I don’t doubt is shared by the majority of even uncircumcised men, but it remains a misconception.

        “[N]ote there are plenty of uncirc’d guys out there whose foreskins naturally retract and end as a wrinkle behind the glans. (I think it’s called “auto-circumcision”). So they cannot roll it back and forth. Do they complain?”

        – Why would they complain? They have the same innervation as other uncircumcised men, just concentrated in a smaller surface area. Stimulating a longer foreskin may involve its being rolled over the glans (on the ‘upstroke’), but if the foreskin is so short as to be fully stretched and sufficiently stimulated sliding up and down the shaft without passing over the corona glandis, what’s the problem?

        “For circ’d guys like me, “stretching and twisting what remains of their penile skin” as you put it also stimulates the glans, if indirectly by tugging. It also stimulates the shaft.”

        – No, I think you’re mistaken. The glans is really only stimulated directly, either by the sheath of penile skin, or by naked contact—not by ‘tugging’ the shaft. It sounds like you’re doing what uncircumcised men do when they masturbate: treating the glans as a useful anvil against which to work. The body of the penis and the shaft skin itself is no more erogenous than the wrist.

        “Of course, like your account and the others you cite, mine is anecdotal. If you are a skeptic you will know that anecdotes and personal testimonies are probably the poorest form of evidence there is.”

        – Indeed, but not all anecdotes are equal as I’m sure you can appreciate. I’ve proposed a biologically plausible means to account for why, despite the foreskin’s importance, some men circumcised as adults (i.e., those with pathology) will not experience a diminution of sexual pleasure, and may even find sex gets better (or less bad). Can you explain why men (such as those I linked to above) can undergo successful (i.e., not ‘botched’) circumcisions, and have such negative experiences? See, for example, the study by Fink (‘Adult circumcision outcomes study: effect on erectile function, penile sensitivity, sexual activity and satisfaction’). If the foreskin is what you say it is (and the penis works as you insist it does), why were any of these men unhappy to have been circumcised? See the remark of this study participant: “I had been warned that I would lose sensitivity, but overall, I feel that I was not completely informed.” What ‘sensitivity’ does this man imagine he lost? Only some allegedly worthless Meissner corpuscles, according to you. If only he knew to rub his fingertips together…

        “I already know about Taylor’s site. A mixture of detail and rampant speculation about what it means.”

        – Again, with respect, what makes Taylor’s work any more ‘speculative’ than the research of others whom you cite so approvingly?

        “One problem with Taylor’s site is this howler: ““Meissner’s corpuscles” (also called “genital corpuscles”)” in the anatomy section. No, Meissner’s corpuscles are very distinct from genital ones. Meissner’s are the fine-touch receptors intactivists harp on about and, sure, they are sparse or absent from the glans. But they are irrelevant. They are not erogenous, or else we’d be orgasming by rubbing our finger-tips”

        – ‘Genital corpuscle’ is a non-specific (and unhelpful) term typically used to refer to sensory receptors found in the clitoris or glans penis (though occasionally the rectum, too). Often the receptor described is a bulboid corpuscle (or an end-bulb of Krause). Today, most researchers tend to be more careful and identify a receptor as being one of (or ‘resembling’—a common expression) a specific morphology: Meissner corpuscle, Vater-Pacinian corpuscle, Merkel cell, etc. Interestingly, the Halata and Munger (1986) paper you reference reports that ‘[t]he ratio of [free nerve endings] to corpuscular receptors is approximately 10:1 and a similar ratio of small to large axons is seen in dermal nerve.’ Free nerve endings are nociceptors and function primary to detect pain and temperature; most of the sensory receptors of the glans are free nerve endings, while the majority in the foreskin are Meissner corpuscles, which are highly sensitive to touch.

        – I feel your ‘fingertip’ remark is facile. It’s my understanding that the anogenital region is experienced as erogenous because its innervation is supplied by branches of nerves mapped to the specific region(s) of the brain responsible for sexual pleasure; the nerve endings in the penis, for example, stem from the pudendal nerve. Interestingly, it seems to be the case that the foreskin remains sensate despite a properly administered dorsal penile nerve block because the ventral aspect of the penis, particularly the frenulum, is innervated by the separate perineal branch of the pudendal nerve. Some researchers suspect (though haven’t yet proven) the foreskin to be supplied by the vagus nerve, also. And, incidentally, ‘genital corpuscles’ are found in the conjunctiva of the eye; I’d suggest that rubbing your eyes fails to elicit orgasm for the same reason rubbing your fingertips does.

        ‘[The finger tips] being the most richly innervated areas of glabrous skin with respect to these nerve endings (and they’re bigger there too).’

        – It’s interesting to see you repeatedly referring to the Bhat et al. paper, following in the footsteps of Waskett and Morris, whom I’m guessing are different people. Even assuming these researchers and their methods are competent (and the extremely low impact factor of the journal doesn’t inspire confidence), there are obvious problems. No details are given about whether pathology preceded circumcision in the men whose samples were used; if I’ve understood the paper, only one sample (1cm x 1cm) was taken per participant. They don’t state where on the foreskin the samples were taken. This is important, as the foreskin is not uniformly innervated—it seems probable that these researchers missed the ridged band entirely (perhaps deliberately). Furthermore, the Bhat paper conflicts with other histological research on the foreskin—most notably Taylor’s—which stress the impressive nature of its innervation.

        ‘This is one reason I am unconvinced by the Sorrells study, aside from the stats. It was looking at the wrong thing, but I digress.’

        – There was nothing wrong with ‘the stats’ in the Sorrells paper: you’d be well advised to evaluate work on its own merits without swallowing wholesale the dyspeptic rants of Morris & Co. The Waskett and Morris criticism of the Sorrells paper was incoherent—one doesn’t need even a Statistics GCSE to see through it. They pointed out that there were no significant differences in sensitivity between circumcised and uncircumcised penises at most comparison points. That’s trivial: of course shaft or scrotal measurements, say, aren’t going to differ between the groups. The key is in how the foreskin compares with the rest of the penis. (The investigators were also interested in the glans, but I’m not.) Sorrells found, unsurprisingly, that included in what’s lost to circumcision is the most impressively sensitive of any of the penile sites they tested. Waskett and Morris ramble on a bit to try to ‘do away’ with this inconvenient truth, including getting themselves (and unfortunate readers) confused as to just what a Bonferroni correction is. Hugh Young’s somewhat exasperated follow-up letter deals well with this blatant attempt at obfuscation. It was only a letter, too—not an original pierce of research. Nevertheless, Morris (as he always does) has been all over the place rubbishing the study and citing his own idiotic letter as proof of Sorrells et al. having been ‘debunked’; he did something similar with the Frisch paper, after he broke professional codes of conduct in attempting to prevent it from being published. I’m disappointed to see you parroting his crap here.

        ‘As a further digression, Taylor (in the FAQ section) acknowledges that the glans skin does not thicken after circ, or at least “Probably not to any significant extent”. Something intactivists would do well to note before repeating the keratinisation claim.’

        – Agreed, though as I say above, it’s not very interesting. I’m dismayed to see anti-circumcision activists using these arguments simply because the play into the popular misconception that the foreskin is merely ‘protective’ (if that) and the glans is the star of the show. No, the foreskin is the primary erogenous tissue. Even if the glans does become slightly less sensitive, it’s only less sensitive to the sensations it feels—it’s sensation unlikely to be missed. It might be worth pointing out, however, that the study finding no difference in glans keratinisation also found less keratin in the inner aspect of the foreskin relative to the outer aspect, a claim that has since been more thoroughly investigated and proven to be incorrect. See the two papers by Dinh—the first in AIDS and the second in PLOS ONE. Also, it’s not just intactivists making this claim—I’ve seen it appear in many papers on circumcision and STIs, for example. I’m not denying that as yet it’s unsubstantiated, mind you.

        “Note the remark on p.99 that erection “enhances exposure of the genital corpuscles, receptors specific to the glans and presumably related to sexual function, to mechanical stimulation.”

        – Indeed, the same is true for the receptors throughout the penis. In addition, the contraction of the dartos facia in combination with the expansion of the penis during erection, stiffens and tightens the penile skin, optimising activation of the ridged band—any movement of the skin, however slight, stimulates the entire ridged band. I think it’s an extremely elegant and beautiful system.

        “It is, perhaps, telling that when men are asked to rank the areas of their penis with respect to sexual pleasure, the glans comes out top, the foreskin last”

        – I disagree, as I’ve explained at length is this post and the one preceding it. My theory is that men are calling the glans ‘most sensitive’ because, leaving aside its acute sensitivity to pain (which confuses people), men are erroneously giving the glans credit for what the foreskin is doing—it seems even circumcised men do this. Again, I’m repeating myself.

        “And then there’s all those studies that find no difference (or even an improvement) in pleasure between circ’d & uncirc’d, or between before & after.”

        – And each study has to be evaluated on its own merits. In my judgement, none of them—either ‘pro’ or ‘anti’ circumcision—are very good, though some, like Fink et al. referenced above, hint at something interesting. Sex research (in any meaningful sense) is in its infancy, and it’s not just male circumcision that’s poorly studied, either. I’m reminded of the Catania paper (‘Pleasure and orgasm in women with Female Genital Mutilation/Cutting (FGM/C)’) which, using the ‘Female Sexual Function Index’ suggested that women subjected to the most extreme variety of female circumcision have sex lives which, relative to uncircumcised Italian women, appear to be rather good. Now Italian women won’t be encouraged to rush out to have their external genitalia removed because of this study, but we know that if the subject had been male circumcision the results wouldn’t have been interpreted quite so cautiously. The meta-analysis you mention by Tian et al. is worthless. Of course a meta-analysis can only hope to be as good as the studies it analyses, but this managed to be dramatically worse: to so much as attempt a meta-analysis of the extant literature is an act of intellectual dishonesty—it’s really an effort to end a debate that hasn’t yet meaningfully begun. Anyone with an idea of what meta-analyses are for (and what they can and cannot do) would never have published the paper. The Asian Journal of Andrology apparently has very low standards; I suspect the Journal of Sexual Medicine published the Morris review as clickbait—they’d cynically anticipated the popular press coverage it would get.

        “Circ really does make little difference to pleasure or performance, and intactivists should not be deceiving and traumatising circ’d males by telling them otherwise.”

        – We’ll have to continue to disagree. I think that successfully circumcised men are doing without almost all of their sexual feeling; I think their experience of sex is a severely degraded one, and, honestly, I feel for them. I think you’re deceiving men by keeping the truth from them. Men have a right to be informed of what was done to them, and it should be made clear to parents wishing to do this to their children just how damaging circumcision is. It’s for these reasons (and quite a few besides) that I’d like the practice to be prohibited. A simple motto: “No consent? No need? No circumcision.” Good enough for me. I’d be overjoyed if you’d join us.

        I hope I’ve not missed anything.

      • stevem660 Says:

        I wonder if you are trying to overwhelm me with the sheer tedious length of your posts. I’ve seen this tactic before with intactivists and creationists alike. They try to “win” by their sheer tenacity, wearing down their opponent until he/she gets fed up and goes away. Then they triumphantly conclude they’ve “won”. Well I certainly have not the time to go through your latest dissertation in detail, nor the inclination for a trial of endurance, but you continue to pour out speculations and opinion passing them off as facts. Men DO rank their glans first, in terms of sexual sensation, whether they have a foreskin or not. If foreskins were as crucial as you maintain then their loss should have immediate and dramatic effects. That does not happen. Anecdotes to the contrary are just that – anecdote – and can be countered by anecdotes from men circ’d as adults for non-medical reasons telling us how wonderful it is. Or by the African RCTs which looked at performance too, and found no problems. With around 5 million African men now circ’d I think by now there would have been mass protests at the very least, by these millions, if circ was as dire as you imagine. Foreskins are not particularly erogenous, and their loss not sexually damaging. Going around telling circ’d men otherwise is, however, damaging to their self-esteem, and is one of the things about intactivism that really irritates me. I think probably if it were not for this, and for their denialism re HIV, I probably would not have cared enough to enter the debate.
        I have come to the conclusion that your views on the wonders of the prepuce are delusional and I am wasting my time trying to persuade you otherwise. Your rejection of Tian et al is insane: “to so much as attempt a meta-analysis of the extant literature is an act of intellectual dishonesty”. What are they supposed to do a meta-analysis of, if not the extant literature? Men with foreskins that retract do not then experience them sliding up and down the shaft as they are tethered by the frenulum. They stay put.
        For the record, I am not diabetic, have good health, and terrific sensations down there which have been in no way diminished by my circ.

      • noodlemaz Says:

        “Men with foreskins that retract do not then experience them sliding up and down the shaft as they are tethered by the frenulum. They stay put.”

        Without going into detail, I have experienced enough intact penises to know that this is just a lie. Just because the skin is tethered to the glans by the frenulum, does not mean the sliding effect is prevented. It’s very much there. This is why American men tend to get through a lot of lubrication with masturbation, because they slide the hand skin over the immobile penile skin, rather than sliding the foreskin-penile skin over the shaft. Same with PIV sex. It’s not a difficult concept, really.

        It’s kind of like these ‘water wigglies’ http://www.amazon.com/American-Science-Surplus-5016-Wigglies/dp/B00000IUZU – the skin is folded back on itself so it moves. Circumcision removes a lot of that skin and “tight” circumcisions (where the maximum amount of skin that can be removed, is, or worse – more) cause men pain, as well as skin that should not be on the shaft migrating upwards, causing the ‘hairy trunk’ effect.

        It doesn’t take much to find accounts of hundreds and hundreds of men who experience these problems. It doesn’t matter how many people are fine, or how many people elect to have the surgery as adults. The risks are very real and no parent should be allowed to take that risk with their healthy child. Sex is a big part of many people’s lives, and there is no parental right to alter or damage that.

        It’s far too early to assess the potential damage of mass-circ drives in Africa.

        It’s nothing to do with ‘damaging circ’d men’s self esteem’ – people who are healthy have no need to worry. But again, tell the men who suffer that they are lying and see how they feel about it. I would never shame someone for a choice their parents made for them, for a decision they had no say in. That is absurd.

        Funny how you criticise other people’s post lengths, when yours have been similar.

      • stevem660 Says:

        You’re a fine one to talk about “lies”: 20,000 erotogenic nerve endings.
        I meant that those whose foreskins tend to retract and wind-up as a wrinkle behind the glans will not experience anything like the degree of up and down sliding than does a guy with a foreskin that does not thus retract (but isn’t tight). It is tethered by the frenulum so up and down motion will be constrained. And they certainly won’t experience it sliding over their glans (which David dismisses as some sort of inert “anvil”). So it hardly compares with the very much greater movement from a long and slack skin. Even circ’d guys normally have a couple of cm, or so, of up and down motion, which is all they need for a good time. I see you trot out the old “Americans need lube” myth again. I don’t. And I’ve discussed this with other circ’d guys and they don’t either. Ah but I’m Scottish and my circ was done in England, so that must be it. Here’s an alternative explanation. Perhaps many (maybe most) of those circ’d guys who use lube don’t do so because they have to. They do so because it feels great and one doesn’t get the full effect with a foreskin in the way.
        “accounts of hundreds and hundreds of men” is not many out of the millions who are circ’d. Nor does anyone deny there are risks, the question should be whether the risks outweigh the benefits. In high HIV countries yes. Elsewhere maybe but it’s not settled. That is one reason I do not advocate for infant circ (at least outside of high HIV countries).
        In Africa circ is working and saving lives big-time. Condoms are failing. I provided the links in a post of Feb 4. I am a pragmatist, not an idealist. I will not sacrifice African (or any) lives on the altar of “genital integrity”. Intactivists would, and that disgusts me.
        You are damaging the self-esteem of circ’d men. Did you ever check out the link I provided to one of your victims? Telling men they are missing all this wonderful gliding, zillions of nerves, super-duper sensations etc., etc., cannot be anything other than deeply distressing to those men who have never experienced a foreskin and so are in a poor position to know that these claims are male bovine excrement. You never did comment on the example I gave of that poor lad told that his parents tortured and mutilated him and left him with a dysfunctional penis. I had been following the debate on and off for years, with only an occasional letter to the editor, or on-line post. But then I read that malevolent piece of malice. For me that particular post was the last straw, and is what triggered me to take a more active role in countering this intactivist crap. It was pure nastiness but is, sadly, all too common.
        Unlike David’s long essays, at least my posts are not a load of rubbish, but I doubt you’ll ever see that, you are so wedded to your nonsense. I hope Brian Earp is more objective, but I’m not sure, although I’ve noticed him make a few token nods towards counter-arguments, or the sensibilities of circ’d men – but only AFTER I’d said he should. If it is he who is writing the rebuttal to Prof Morris then I await it with interest. If he relies on your, or David’s, arguments here then debunking him should be straightforward – assuming the editor allows it. I have deliberately refrained from commenting on some errors and dodgy citations made here in hope that he will repeat them. It will be a test of how well he has done his homework.
        I’m signing off now. But before I go I will remark that I have had a look around the rest of your website and think we’d probably agree on most other things. You’ve just gone well off the rails on this one. I think part of the problem is that circ is often a religious thing, so there’s a tendency for us atheists to dismiss it as just more religious nuttiness. It triggers our confirmation bias. If there is anything you should learn from this exchange then please at least make it this: Telling circ’d men rubbish about function, sensitivity etc. is hurtful. Even the Danish researcher Frisch, no fan of circ, and whose study is a favourite of intactivists, said this on a BBC radio 4 interview: “I want to stress to avoid some stigmatisation of circumcised men that most circumcised men and most spouses of circumcised men did absolutely well in their sex lives.” Please take note. And for goodness sake tell your fellow intactivists to stop repeating that silly 20,000 number. On second thoughts don’t. It make my job so much easier.

      • noodlemaz Says:

        I have internally questioned the number, as I’m also interested twin the paucity of research on female sexual anatomy and function. From what I’ve seen I think it’s a genera confusion of nerve types.
        Whatever the true number, again, parents and hospitals should not have licence to remove them from children for no reason. And there is no reason. I do not have time to get into the Africa debate for a third time this week here, it deserves a separate discussion. It’s nice that you agree on RIC, which the majority of my reading, writing and anger pertains to.
        I’m sure we can all take a break now. Thanks all for remaining civil.

      • David Says:

        Marianne, we’ve been wasting our time.

        Dr. Moreton, I can’t say I appreciate these little digs you’ve repeatedly taken at me; clearly I’ve shown more respect than you deserve. If you had nearly the evidence to justify this stridency of yours, you’d actually address my specific points; instead you seem to enjoy hyper-focusing on trivial details like ‘the keratinisation myth’ and this stuff about ‘thousands of nerve endings’ in order that you can avoid the woods for the trees. You’ve repeatedly lied and repeated the lies of others—my favourites being the nonsense about ‘genital corpuscles’, and Sorrells et al. having being ‘debunked’—so perhaps you’re as guilty as a few intactivists of spewing propaganda. You seem to only pick the fights you can win–none of which relate to matters of any real importance, only the ethics of activism. Can you really not see the glass house from which you throw your stones?

        “I meant that those whose foreskins tend to retract and wind-up as a wrinkle behind the glans will not experience anything like the degree of up and down sliding than does a guy with a foreskin that does not thus retract (but isn’t tight). It is tethered by the frenulum so up and down motion will be constrained. And they certainly won’t experience it sliding over their glans (which David dismisses as some sort of inert “anvil”). So it hardly compares with the very much greater movement from a long and slack skin.”

        – Yes, you continue to confuse yourself. In a man with an ample foreskin, the foreskin will be slid up and down to fully stretch and constrict it, thus stimulating its abundance of mechanoreceptors. If the foreskin is less ample (‘a wrinkle behind the glans’), less luxurious movement will be possible and necessary for the up-down motion to be fully stimulating. I addressed this above, and it’s getting tiresome repeating it.

        “Even circ’d guys normally have a couple of cm, or so, of up and down motion, which is all they need for a good time.”

        – Yes, which they stretch in the up-down motion, sometimes with a twist; those with enough slack to make use of the glans (as an ‘inert anvil’–very well put) will do just that, and those without, won’t.

        “I see you trot out the old “Americans need lube” myth again. I don’t. And I’ve discussed this with other circ’d guys and they don’t either.”

        – I really hope you’re not insinuating that this ‘lube thing’ is some evil intactivist propaganda intended to make circumcised men feel inadequate. It’s a fact that a great many (not all, and perhaps not even the majority) of circumcised men do indeed use lube to masturbate. Some require it, while others simply prefer to use it. A smaller number of uncircumcised men appear to, too. The use of lubrication as a masturbation aid is referenced abundantly in American sitcoms, teen comedies and the like—but conspicuously absent from their European counterparts. A quick browse of discussions on internet fora will reveal to you that some men have masturbation practices that differ from your own.

        “Perhaps many (maybe most) of those circ’d guys who use lube don’t do so because they have to. They do so because it feels great and one doesn’t get the full effect with a foreskin in the way.”

        – Many uncircumcised men enjoy lube—it’s one of the reasons why vaginas enjoy such a positive reputation. The foreskin cannot ‘get in the way’ as its erogenous value in healthy males far surpasses that of the glans, as I’ve already explained. Furthermore, even assuming for the sake of argument that the glans were the primary erogenous zone, to the glans, how do lubricated fingers feel any different than a lubricated foreskin?

        “Accounts of hundreds and hundreds of men” is not many out of the millions who are circ’d.”

        – Indeed, so I’ll ask you: where are the studies of the sexual effects of female circumcision that have you (and the rest of the western world) so convinced that it’s a sexually damaging (if not devastating) practice? Doesn’t Catania et al. ‘debunk’ such a contention?

        ‘Nor does anyone deny there are risks, the question should be whether the risks outweigh the benefits.’

        – There is no ‘risk’ of losing the best part of one’s penis: it’s a guarantee. Your lot seem to wish to frame the debate as though the foreskin were ‘a mistake of nature’, and the only question is whether the ‘risks’ associated with ‘unburdening’ a boy (and it must be a boy, not a man, for some reason) of his foreskin outweigh or are outweighed by the ‘benefits’ of living one’s life ‘unburdened’ by one’s foreskin. This is a quite pathological way of formulating things, and one can’t avoid the observation that those who’ve framed the issue this way tend, almost without exception, to be men who had the misfortune of being circumcised when they were minutes old. And people like you, of course, who appear a little too eager to tell people all over the internet how utterly fantastic and most definitely not damaged your penis is.

        ‘[t]he question should be whether the risks outweigh the benefits. In high HIV countries yes. Elsewhere maybe but it’s not settled.’

        – But people like you love to talk about ‘high HIV countries’ as though the whole world were a brothel in Zambia and every vulnerable little boy were one of its bareback-seeking patrons; your peculiar line of reasoning seems to be: if any man, anywhere, would take five additional minutes to screw himself to death were he circumcised, then no boy, anywhere, has the right not to be circumcised. No doubt that if you read Japanese you’d be arguing against Japanese intactivists and selectively citing African studies, taking their findings as unassailable (because they’re pleasing to you) and then generalising them to a society with an HIV rate of, what, 1 in 10,000? You are utterly transparent, and I’ll request that you and your ‘pro-circ’ comrades quit dining out on the AIDS catastrophe in south and south-eastern Africa in order to push your perverted agenda. Consider that you risk contributing to ‘HIV/AIDS fatigue’ by so repeatedly and unscrupulously banging the alarm bell. No one cares if African men (or men anywhere else, for that matter) wish to have their genitals altered as they please; while some of us may be a bit confused as to why a man so concerned about his sexual health that he’s prepared to cut part of his penis off wouldn’t instead choose to make use of barrier methods (which one rather hopes he’d continue using anyway), none of us see an ethical issue in it, though its enthusiastic embrace in the hardest-hit countries seems depressingly fatalistic.

        ‘Unlike David’s long essays, at least my posts are not a load of rubbish, but I doubt you’ll ever see that, you are so wedded to your nonsense. I hope Brian Earp is more objective, but I’m not sure,’

        – You’re clearly a coward. What have I said that’s ‘rubbish’? You’ve not so much as attempted to correct me on a single point I’ve made–you choose instead to continue making points no one cares about. If you mention ‘the keratinisation myth’ one more time, I’ll drift off to sleep. I’ll repeat: it does not matter—in fact, it hurts the anti-circumcision case by perpetuating misconceptions about the sexual centrality of the glans and the relatively minor ‘protective’ function of the foreskin. And ‘objective’ means in agreement with you, right? Like ‘debunking’ a study means being critical of a study (or the authors of a study) whose findings you dislike, right? Like how Morris ‘debunked’ Sorrells, right? Let’s hope Morris doesn’t repeat the misinformation he penned in that letter to Dinh I referenced earlier. Moreton, do you disapprove of Morris putting misinformation on his website, and in his papers? Just look at the company you’re keeping.

        ‘If there is anything you should learn from this exchange then please at least make it this: Telling circ’d men rubbish about function, sensitivity etc. is hurtful. “

        – You seem really upset about this, but refuse to consider either the possibility that you’re wrong about the sexual effects of circumcision, or the consequences of your arguing in defence of the practice. Circumcisions are indeed severely damaging, and if you have your way (and this evil movement of intactivism is defeated), untold numbers of boys will continue to be subjected to it. Does the thought of it not give you pause? Open your mind to the possibility that you’re wrong, and I’m not lying about my foreskin for the sheer pleasuring of arguing about it with a strange Scotsman on the internet.

        “Even the Danish researcher Frisch, no fan of circ, and whose study is a favourite of intactivists, said this on a BBC radio 4 interview: “I want to stress to avoid some stigmatisation of circumcised men that most circumcised men and most spouses of circumcised men did absolutely well in their sex lives.”

        – They did ‘well’ according the measures Frisch used, just as the circumcised women in the Catania paper did even better than the uncircumcised women, according to the measures used. Measurement matters, Moreton: circumcised men doing ‘well’ according to Frisch doesn’t rule out the possibility that their experiences are severely degraded ones. It’s dishonest of you to pretend otherwise, and you know it.

        ‘And for goodness sake tell your fellow intactivists to stop repeating that silly 20,000 number.’

        – Agreed – they shouldn’t do it. I’m not aware of any quantitative estimations, either; I’ve looked for similar studies of the female anatomy (8,000 is the often-repeated claim there) and I’ve not seen anything. What we do know is that the impressive innervation of the foreskin has incontrovertibly been attested to in peer-reviewed histological research. What we know of the glans informs us that it isn’t (and can’t be) that impressive sensory structure you and others argue it to be.

      • noodlemaz Says:

        David,
        “we’ve been wasting our time” – yes, to an extent. I agree. However, hopefully some will read bits of this and see a fairly measured discussion and continue to look into it. It’s a good record, Morris is here repeating some nonsense, it should be addressed in due course.

        I replied previously on my phone, on my way to bed – I don’t spend too much time on here (as is clear from the intermittent posts) so am extremely grateful for all of the time and effort you have put into comprehensive replies.

        I do think it’s time to leave it for now, and when I have the Skeptic pieces to post, we can perhaps start a new discussion underneath those. I can send out some email notifications (or you can sign up on the main page!).

        Thanks again
        M

      • David Says:

        OK, Marianne, I’ll not litter up your blog any more than I have; I didn’t miss your HPV comment at the bottom of the page, by the way – I simply hadn’t gotten around to typing up a response. I know quite a bit about the HPV literature–it’s really a pretty shameful story of often deliberately shoddy scholarship and the self-promotion of researchers, along with the usual problem of only positive findings being published in high-impact journals and garnering much popular press attention. Literally dozens of studies finding no association have been published and never acknowledged, including, of course, by the AAP gang in 2012.

        Anyway, I do hope it’s not been too much of a pain ‘moderating’ us; I’ll try to be less prolix if I post again.

        Cheers.

      • noodlemaz Says:

        Please don’t take the previous comment as a “shut up now” type order!
        I think all of us have reached a stage where we’re not covering new ground, is all. I don’t mind long comments, and all (well most…) comments are good. Genuine thanks for taking the time to leave them.

      • David Says:

        Oh, OK–sorry for having misunderstood. Thanks a lot for the kind words, too.

    • David Says:

      Fair enough if you don’t wish to continue, Dr. Moreton; I replied to you comments at length out of respect for your arguments, not because I wanted ‘win by sheer tenacity’. I’ll ignore the insults simply to clarify a few things.

      “Men DO rank their glans first, in terms of sexual sensation, whether they have a foreskin or not.”

      – You appear not to be a careful reader: I didn’t argue against your view that most men (circumcised or not) will ‘rank their glans first’; I only argued that they are mistaken for so doing, and I laboured to offer an explanation for just how and why that’s the case. I’ll not repeat myself.

      “If foreskins were as crucial as you maintain then their loss should have immediate and dramatic effects. That does not happen. Anecdotes to the contrary are just that – anecdote – and can be countered by anecdotes from men circ’d as adults for non-medical reasons telling us how wonderful it is.”

      – It does happen, and you don’t seem to appreciate the hypothesis-generating value of anecdotes; the men in Fink et al. provide a reasonably good example. I challenged you to offer an explanation as to why—if the foreskin is as worthless as you insist—a man can undergo a successful (not ‘botched’) circumcision, and experience it adversely. How many men ‘circ’d as adults for non-medical reasons’ sent their foreskins to pathology to confirm the absence of pathology? Did you? This hypothesis of mine can be falsified easily enough—I’m really not asking for much.

      “Or by the African RCTs which looked at performance too, and found no problems.”

      – The Kigozi (2008) and Krieger (2008) papers are extremely problematic. As I pointed out above with the Catania paper on FGC, ‘[finding] no problems’ doesn’t mean there aren’t any problems—I’m sure even you aren’t going to argue that women don’t enjoy (and benefit from) their external genitalia, say. The obvious problem with the Kigozi paper is the fact that none of the men were prepared to disclose anything. Perhaps Ugandan men aren’t comfortable discussing their sexual problems in face-to-face interviews with strangers? Face-to-face interviews are not known for promoting maximum disclosure, even when the subject matter is of a far less sensitive nature; as Hugh Young has pointed out on his page, the lowest measure of anything in this cohort was 98.4%, while Laumann (1997) ‘found a 39-46% incidence of sexual dysfunction in this age group in the US’.

      – Krieger appeared not to consider that the participants, many of whom regard circumcision as a ‘life-saving’ procedure (and are also benefiting from the free healthcare funded by the study projects), will simply give the most positive answers possible in an effort to please their interviewer—a kind of social desirability or acquiescence bias. It would have been wise to include ‘internal controls’, like asking the men who weren’t circumcised how their ‘penile sensitivity’ changed. If those men reported an improvement, then the study belongs down the toilet. They might also have asked the circumcised men even more obviously stupid questions, like whether they ejaculate more copiously post-circumcision, for example. Or if their eye-sight improved. It’s worth noting that simply for participating in the study, rates of ‘sexual dysfunction’ dropped dramatically (even in the control group) between baseline and month 24, suggesting that these men were telling their interviewers whatever they believed they’d be pleased to hear—and that doesn’t bode well for the reliability of the self-reported sex behaviour on which the results of these trials rely.

      – Given the gratitude felt by many of these men for their ‘life-saving’ treatment, I think this quote from Adams and Moyer (‘Sex is Never the Same: Men’s perspectives on refusing circumcision in Swaziland’) well illustrates the difficulty in conducting sex research of this kind in a population of men with such ambivalent feelings about their circumcisions:

      – “I now take longer to ejaculate. And sometimes you can end the sex session while you have not even ejaculated. I am talking through experience and this is painful (a painful experience). Sometimes by the time you finish you find that the woman is already too tired because of my delayed ejaculation. So I would say that the foreskin has a role during sex. My main complaint is delayed ejaculation or not ejaculating at all. But I do not regret too much because I am safer from STIs and I can now easily clean myself.”

      – Does this man sound like he’d complain about his sexual difficulties to the people who made him ‘safer from STIs’? Perhaps, but perhaps not—and any honest person can acknowledge that these are poor conditions in which to explore the questions of interest to us.

      “With around 5 million African men now circ’d I think by now there would have been mass protests at the very least, by these millions, if circ was as dire as you imagine.”

      – I’m not sure men in these populations are so comfortable sharing intimate and embarrassing details of their sexual lives. None of my friends or acquaintances share their sexual problems with me, but I’d not assume that they don’t have any.

      “Foreskins are not particularly erogenous, and their loss not sexually damaging. Going around telling circ’d men otherwise is, however, damaging to their self-esteem, and is one of the things about intactivism that really irritates me.”

      – Circumcisions are indeed extremely sexually damaging; you don’t seem at all concerned about your own conduct in encouraging people to circumcise small boys.

      “Your rejection of Tian et al is insane: “to so much as attempt a meta-analysis of the extant literature is an act of intellectual dishonesty”. What are they supposed to do a meta-analysis of, if not the extant literature?”

      – I’ll apologise for not making myself clear: by ‘extant’ I simply meant the body of literature ‘as it stands’; as I’ve stated, I don’t consider any of the studies to be very good. Meta-analyses are (erroneously, in my view—but never mind) perceived to have a great deal of authority. Thus a meta-analysis will be seen as providing answers to questions which, in this case, haven’t really been asked. The popular press response to the Morris dross illustrates the perils inherent in this; an honest researcher wouldn’t attempt to meta-analyse literature as poor (and diverse) as exists in this subject.

      “Men with foreskins that retract do not then experience them sliding up and down the shaft as they are tethered by the frenulum. They stay put.”

      – I don’t know what to say to that. And I’m finding it more and more difficult to believe that you were ever familiar with your (or anyone else’s) foreskin. Rather than try to explain the mechanics, why not just look up some European porn?

      It was pleasant to engage with you, anyway. All the best.

  13. David Says:

    P.S. If ever I have a daughter, I’d like to call her Marianne; it is such a beautiful name.

    (Your random comment of the day! Have a good one.)

  14. Dorte Nielsen Says:

    @ Dr. Brian Morris
    Above you write:
    “Many will die as a result from penile cancer that affects 1 in 900 uncircumcised men but virtually no circumcised men”

    Yet, the American Society writes:
    “What are the key statistics about penile cancer?
    The American Cancer Society estimates for penile cancer in the United States for 2013 are:
    About 1,570 new cases of penile cancer will be diagnosed
    About 310 men will die of penile cancer
    Penile cancer is very rare in North America and Europe. Penile cancer occurs in less than 1 man in 100,000 and accounts for less than 1% of cancers in men in the United States. Penile cancer is, however, much more common in some parts of Asia, Africa, and South America, where it accounts for up to 10% of cancers in men.”
    Last Medical Review: 12/06/2013
    Source: http://m.cancer.org/cancer/penilecancer/detailedguide/penile-cancer-key-statistics

    Like HIV, Penil cancer definitely seems to be influenced by socioeconomic factors, that is: by hygiene and cleanliness more than by circumcision, as the rates of penil cancer in North America and Europe seem to be very much the same?

  15. Dorte Nielsen Says:

    @ Stevem660
    Thank you for your answer on behalf of Dr. Morris.
    Yet I must say, that I was never used to receive such angry answers nor so bad references in a discussion about science.
    Now to your arguments and your documentation.

    Clue 1.​instead of insinuations: Inform me, and tell me why?
    Actually Europe and the Scandinavian countries are so much closer to Africa than the USA, and I’m convinced we travel more, and work more in Africa than the Americans do.
    Clue 2.​ Your reference is not about circumcision. It is about: “Teenage brides in rich nations” / published by The United Nations Children’s Fund, 2001
    Figure 13 on page 20 exists all right, but it’s about, quote:
    “Figure 13 Birth and abortion rates
    The table shows the number of births (dark half of bar) and of abortions (pale half of bar) to women aged below 20, expressed per 1,000 women aged 15 to 19. (Data are for 1996.)”
    Do you read your own references?
    Clue 3.​Your reference is only about the conditions in USA and givs no explanation about the difference between Europe and USA
    Clue 4​. Still nothing about Europe, only about USA and the former Soviet possessions.
    You write:
    “although it could be fairly countered that socio-economic factors could also be involved”.
    Yes indeed, as cited above about the global HIV epidemic, WHO states:
    • About 6,300 new HIV infections a day in 2012
    • About 95% are in low- and middle-income countries
    Source: http://www.who.int/hiv/data/2013_epi_core.ppt?ua=1
    The former Soviet possessions are exactly low income countries, and have been so since the Russian Revolution in 1917. The populations in general by no means have a living standard which can be compared to neither the Scandinavian Countries nor to the USA.
    About your last reference, again nothing about the issue I asked Professor Morris about.
    Living standards in Africa south of the Sahara can’t be compared to living standards in the USA – nor can the sexual morality.

    The discrepancies were not that easily explained.

    Since your posting not in any single case has helped to answer the questions I politely asked Dr. Morris, I’ll be looking forward to Dr. Morris’ polite and cultivated answers. Thunder has no place – neither in science nor in science communication.
    Thunder is a sign of powerlessness and takes over where words fall short.
    Yours sincerely
    Dorte Nielsen

    • stevem660 Says:

      Dorte
      Sorry if the tone of my post made you uncomfortable. I did not think it was angry, just frustrated at the repetition of a bad argument that has been answered repeatedly. Compared to the tone of many intactivists (your good self excepted of course) it was polite. I have seen intactivists throw the most appalling abuse at opponents, calling them offensive names (paedophiles is a common one) and deliberately misrepresenting their words. I do, however, confess to getting irritated at the repetition of an argument (the USA/Europe comparison) that is so obviously misguided, and which has been answered over and over again. As I said before, I wish I could be given £1 every time this comparison was made. I could be well on the way to paying off my mortgage by now, it is repeated that often.
      I had hoped that by replying as a series of clues, which I thought were quite obvious, it would encourage you to think about the subject, but instead you seem to have missed the point of each. So I guess I’ll just have to spell it out clearly and simply. But first, note that the countries I listed (including Bahamas & Portugal) are all ranked as being highly, or very highly, developed on the Human Development Index. I could have included Switzerland, France and Spain, rich non-circumcising countries with HIV rates of 0.4 %, catching up on the USA’s 0.6. This alone should alert you to the naivety of making comparisons between very different countries.
      I told you the main reason why such comparisons are dangerous to make: confounding factors. You even seem to have some awareness of this issue as you correctly point to other factors, like socio-economic ones, or (in your first post) sexual morality. These are examples of confounding factors. Therein lies the explanation for the differences observed. No one, not even Prof Morris, claims that circ is the only factor influencing HIV rates. It is one of many. By comparing different countries you are introducing all sorts of confounding factors that can hide the effect of the one of interest (in this case circ).
      Turning to the clues I gave you, the first was about where the epidemic began (in the developed world). It can be traced back to the 1960s in the US, but took off in the 80s, in the gay community, in which it was first identified. It appears to have entered the USA via Haiti, which in turn got it from Africa. In short it had a head start in the US. Looking at the report on teenage pregnancies (yes I do try to read the references I cite, unlike many intactivists who rarely get past the abstract) did you note the disparity between the USA and the rest of the developed world? It leaps right off the page, it is huge. The USA has about 4 or 5 times the teenage pregnancy rate of Europe (Scandinavian countries come out well in this regard – congratulations). Similar data exists for STIs. This proves there exist major differences in sexual behaviour between USA and Europe – like differences in promiscuity and condom use – which must also have a big effect on HIV transmission. Those are very big, and obvious, confounding factors. I am amazed you did not spot this.
      Turning to the other clues, look at how HIV is distributed in the US. Even after all these years it still remains largely confined to the high risk groups, overwhelmingly gays. There is little evidence that circ makes a difference for this mode of transmission, just as it can’t for needle sharing by drug users. It is only protective in female to male transmission.
      When it is transmitted heterosexually, look at how it is distributed by race. Blacks and Hispanics are disproportionately represented. Now look at how circ is distributed by race. The groups least likely to be circ’d are blacks and Hispanics. It matches the HIV racial distribution (although blacks have caught up with whites recently for circ, this was not so for the generations born a few decades ago who are now sexually active).
      Of course this racial correlation could be due to confounding factors – like socio-economics. Confounding factors cut both ways. But the data, although not proving that circ protects, does not fit the intactivists’ desired position of no such protection either. Does it? And the comparison between USA and Europe collapses when confounding factors are considered.
      Finally, look at the Baltimore study. That found roughly 50 % protection by circ in heterosexual transmission, consistent with the data from the African trials – the whole point of which was to eliminate confounding factors. That is why they were done. Prior to them all we had was epidemiological studies, and whilst many did show an association, there was enough confusion from confounding factors, and countries that seemed to be contrary, that the only way to settle it was by a randomised controlled trial. Now we have three of these, and they prove that circ really does protect against HIV. Intactivists need to stop denying this, and stop making naïve inter-country comparisons, whilst ignoring the details.

  16. David Says:

    The evidence on penile cancer isn’t compelling, as anyone who’s read the papers can appreciate. The assumption that circumcision confers protection against penile cancer rests upon the results of just three studies, all conducted in the United States, and all of the case-control design – a study design highly susceptible to confounding, and rather notorious for throwing up spurious relationships. The studies by Maden (1993) and Daling (2005) used random digit dialing (RDD) to recruit controls. When one considers that circumcision status in older generations is strongly correlated with socioeconomic status (SES) in the United States, with men of the lowest strata least likely to be circumcised, this becomes problematic, as research has consistently shown that individuals of higher SES are more likely to participate in scientific studies (see review in Galea and Tracy, ‘Participation Rates in Epidemiologic Studies’); this has been shown to be a problem with RDD: see Wang (‘Validity of random-digit-dialing in recruiting controls in a case-control study’) and Bailey (‘Representativeness of child controls recruited by random digit dialling’), for examples. The risk profile for penile cancer patients (a high number of sexual partners and a history of smoking, etc.) is more common in low-SES men, thus when one combines the high probability of an excess of high-SES (circumcised) men amongst the controls with the low-SES (uncircumcised) cases, one has the ingredients of a spurious relationship.

    Interestingly, the one case-control study with a different method of control selection, Tseng et al., which instead used neighbourhood controls, reported a reduction in risk (of invasive cancer) that was not statistically significant (0.41 (0.13-1.1)). I appear to be the only person on earth to have noticed this. Incidentally, even this less biased technique appears not to have overcome the difficulties in finding truly representative controls, as controls were only about half as likely to be Catholic, for example – probably because of the refusals of the first eligible matches.

    In addition, none of this touches on the influence of SES on treatment-seeking behaviour. There is some confusion as to whether in situ and invasive penile cancer are different conditions, or simply represent different stages of the same disease. If the latter is the case, SES may further bias the findings, as low-SES men (reminder: less likely to be circumcised) may be more likely to delay treatment and eventually present when the disease has reached a more advanced (or ‘invasive’) stage. Some recent research hints at this as a possibility – Skeppner et al. ‘Initial symptoms and delay in patients with penile carcinoma’, for example.

    Calling phimosis a risk factor for penile cancer seems a good example of backward causation; phimosis, usually defined, simply, as a non-retractile foreskin, will likely result from penile cancer, which typically first makes its appearance at the distal penis. Naturally, if you have a foreskin, penile cancer will make it difficult for the foreskin to retract. I’m not aware of a penile cancer study where cases were asked if their foreskins had *ever* been retractile, as opposed to ‘up until recently’ – i.e., when the cancer began to develop. I’d expect some men with lifelong phimosis among the cases, but I’d be surprised if they were out of proportion with the controls.

    ___

    Oh, the three case-control studies are:

    (1993) Maden et al. History of Circumcision, Medical Conditions, and Sexual Activity and Risk of Penile Cancer

    (2001) Tseng et al. Risk factors for penile cancer: results of a population-based case-control study in Los Angeles County (United States)

    (2005) Daling et al. Penile cancer: importance of circumcision, human papillomavirus and smoking in in situ and invasive disease

    Worth reading, if that’s your thing!

  17. Dorte Nielsen Says:

    Dear David,
    I don’t think it’s worth wasting any time on Mr. stevem660.
    He is a fictive character pretending to be a kind of scientist.
    He confuses arguments with insinuations. He doesn’t unfold his arguments: he makes insinuations, and expects the readers to guess, what he means.
    He has no idea of what a reference is. But he does know how to copy-paste a link.

    In top of the very strange ‘arguments’ and ‘references’ in his answer to me, where he reveals his lack of knowledge in geography and political history, let me give you another example:
    Stevem660 claims being circumcised in 1993, id est: he’s around 20 years old. He – almost? – lost a leg under such terrible and traumatic conditions, that he probably was set back a year in his studies.
    Never the less he published an eLetter in a peer reviewed journal, that he suggets the readers of this blog to read. But he doesn’t mention the full title. I presume he’s referring to Journal of Medical Ethics? He doesn’t inform the readers of volume, issue, page or publication year, nor title, nor autors nor authors’ affiliations. Is it plausible that JME, an esteemed peer reviewed journal under BMJ should publish an eLetter from a 20 years old man who almost lost his leg under such dramatic circumstances, that he probably was set back one year in his studies?
    I’ve seen many bad references in my life, but nothing like this:
    If you read my eLetter, in JME – guess title, author, volume, issue, page, matter, publication year, written by anonymous 20 years old stevem660 – you would know … know what??? Please help us Mr. stevem660. At least give us a link to the article you are referring to.
    Being a reference librarian, of course I read the JME feature issue about circumcision in the summer 2013 (July). And I have no idea of which article you are referring to?
    I feel sorry for you, that you were circumcised in 1993, I feel sorry for your handicap loosing/ almost loosing your leg – but please don’t waste our time with your look-alike-science-communication.
    I think Dr. Morris can answer for himself. If not, I hope he can find better adjutants than you.

    • stevem660 Says:

      Dorte, your reply illustrates the futility of trying to reason with intactivists. You clearly have not read my earlier posts properly. I wish I was 20 again, but am not, I am almost 51 years old. I said before that I was circ’d as an adult and I stated my age. Like a typical intactivist you ignore all this. I am a scientist, although not in any field directly relevant to circ. But nor are most intactivists. In fact 3 of the 5 officers of “Doctors Opposing Circumcision” (DOC) are not medical doctors either. In a post of 29 January I gave a link to one of my JME eLetters. Here it is again: http://jme.bmj.com/content/39/7/429/reply “Sloppy scholarship and the anti-circumcision crusade”. There is also another: http://jme.bmj.com/content/39/7/431/reply in which I reply to George Hill of DOC. No replies to these have been published, but I see Svoboda & Van Howe (prominent activists) have replied to Morris et al. Their reply (http://jme.bmj.com/letters) is largely based on personal attacks and ad hominems, with little discussion of the technical evidence. As is typical of intactivists.

  18. David Says:

    Damn, now I’m paranoid that my comment has gotten lost down the ‘awaiting moderation’ vortex. I don’t understand this commenting system!

  19. David Says:

    Oh, Marianne, you might care to tweet this study, the provisional pdf of which just appeared in BMC Infectious Diseases a few hours ago: [http://www.biomedcentral.com/1471-2334/14/75/abstract]. It’s the largest study to date to examine HPV incidence and clearance, and found that circumcision had no effect. Brian Earp might be interested to hear about it. Cheers!

    • noodlemaz Says:

      Interesting how even in the abstract they seem to be assuming there is an effect, just one they haven’t found because of the sampling method. Think they’re biased or just writing it in such a way that it sounds like that?

  20. Lawrence Newman Says:

    Professor Brian Morris should be sacked and put on a paedophile watch list. He is a member of the circumfetishist organisation, the Gilgal Society. He goes to great length to point out he is a ‘heterosexual’, happily married man on his website. This along with his desperate, relentless campaign to get all baby boys’ foreskins chopped off is compelling evidence that this man is a sadistic gay paedophile. I have come across similar repressed homosexuals online with circumfetishes who heavily promote circumcision. If you are in any more doubt, just look at the ghoul’s face–clearly the face of a paedo.

    The sad, depraved loser hasn’t been able to give one convincing, conclusive piece of evidence that circumcision has a medical benefit., And that’s because circumcision is not a medical procedure, but a barbaric blood sacrifice that contravenes medical ethical codes. It is more sexually damaging than the most common form of FGM in terms of the number of nerves excised. It was brought to the West to ‘cure’ masturbation and control male sexuality. Any alleged medical reason is a post hoc rationalisation to keep this practice alive. From it curing epilepsy to it reducing UTI’s to it reducing HIV, all are lies with no convincing proof outwith methodologically flawed studies.

    As a man who was duped into being circumcised at 14 (for ‘phimosis’, which, as I now know, NEVER requires circumcision), and who has experienced the delights of a foreskin, I can tell the Grand High Paedo, Brian Morris, that circumcision destroys sexual pleasure–pretty much all sexual sensation comes from the frenulum, ridged band, frenular delta and inner foreskin. My name is Lawrence Newman. I am 35 years old and live in Perth, Scotland. I am suicidal over what the UK’s NHS did to me because I have never been able to get sexual enjoyment since the operation was performed. The only reason more men don’t speak out is because most are mutilated as babies and know no better, but it’s also a taboo for men to discuss such matters and they are mocked when they do. Just as African women who’ve been FGM’d in their pre-teen years don’t speak out as they know no better.

    So, Mr gay paedophile, Brian Morris, you know my name and where I live. If you’re so sure of yourself, come and sue me. I’ll see you in court and some lowly man without a degree can intellectually destroy you in public. Do you think he’ll take me up on my offer?

    This book has just been released. It includes the accounts of 50 men affected by circumcision and includes my own story. This is enough proof in itself that male genital mutilation should be banned now. It is child abuse, it is torture, it is rape, it is mutilation and it is, as a consequence, a human rights abuse.

    Brian Morris, does your wife know that you don’t find women attractive but, in fact, fancy males but specifically young boys? Don’t you think you should tell her? Maybe I should, you paedophile cunt.

  21. Lawrence Newman Says:

    As someone who was duped into circumcision without my informed consent at 14 yrs of age for phimosis, I can tell everyone with 100% certainty that circumcision destroys sexual pleasure. It turns a wonderfully sensitive, functional sex organ into a numb dildo. There are zero health benefits to circumcision, and even if there were, it would never justify genital mutilation, just as FGM is never justified. I could, factually, make the argument that cutting off girls’ clitorises would lower their risk of clitoral cancer considerably, and it would–it’s impossible to deny because cutting off any tissue lowers the risk of cancer to zero as that tissue is no longer on the body. But nobody would ever suggest we do this to girls. All of these supposed health benefits are post hoc rationalisations. For instance, at one time the quacks were saying it cured epilepsy and prevented tuberculosis, but now they’re making up stuff about UTI and HIV rate reduction, despite every study being biased and flawed methodologically.

    The people pushing circumcision in the medical community are largely men circumcised at birth who know no better and possibly desire revenge for what they’ve lost. IT becomes an obsession, as you can quite clearly see from the most infamous circumfetishist of them all, Brian Morris.

    If a parent is allowed to strap his/her baby boy down and destroy his future sex life via circumcision, then why is that boy not entitled to grow up, anaesthetise his parents and circumcise them in their sleep?

    There are no rational arguments for circumcision. All rational arguments are on the side of the intactivists because it IS a human rights abuse, just as FGM is. The debate is over.

  22. Seth Devendra Says:

    FGM activists have made inaccurate and hyperbolic statements against FGM as well.

    And I don’t give a shit because anything that stops FGM is justified.


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