If the WHO says that circumcision helps halt HIV transmission, I'm not going to challenge them on the science or take issue with African groups who decide that they need to encourage circumcision, but I have to agree with Dana Goldstein that there's something preposterous about the idea that the US government would be promoting circumcision as a solution while still not encouraging condom use, given that the latter approach is clearly more efficacious.
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Circumcision and AIDS
07 Sep 2007 02:19 pm
Comments (49)
I find it rather interesting that people with ethnic backgrounds like Mr. Yglesias and Mr. Goldstein appear less then positive about the virtues of circumcision.
As an uncircumcised male, promoting abstinence-only education is like promoting AIDS. Shield the gator, no regrets later! Don't be a hater, sheathe AC Slater. If you don't want a crater, don't piss off Darth Vader.
Here's the issue. In long-term relationships, condom use (at least, 100% condom use) is highly unlikely. In many parts of South and East Africa, the practice of long-term concurrent partnerships is common (2, 3, or 4 partners at a time over a couple of years). In such relationships, condom promotion has not proven as effective as one might believe... because long-term partners are unlikely to always use condoms.
See Helen Epstein's most recent book for more.
But yes, of course, condoms should be promoted but they won't be as effective as say in the U.S., where serial monogamy is more common. And even though the number of sexual partners for men/women in the U.S. is similar to that in sub-saharan Africa, the practice of concurrent relationships is less common.
"But yes, of course, condoms should be promoted but they won't be as effective as say in the U.S., where serial monogamy is more common."
To clarify... here I mean a condom-strategy (or a strategy highly dependent on the use of condoms)
Most likely its the policy of some Fundy closet case that just craves the bulbous tip of circumcised, African pecker.
Do the cost benefit on this argument. Cost = male circumcision is tantamount to genital mutilation that results in decreased sexual pleasure etc etc (Andrew has written/reported extensively on this matter). Benefit = a minor reduction in HIV transmission (if we are to believe the data*). Surely there are better means of preventing the spread of HIV without such costs?
* studies that link items to human health that are non-interventional are dubious science at best. Why? For example finding a correlation being circumcision and HIV transmission does NOT imply causality. That is there is any number of other possible explanations that are NOT explored (i.e. circumcised men in this study happen to be more health concious or anything else NOT measured in the study). However, if you had a group of men and measured the HIV transmission rate before and after circumcision and notice a significant difference you would be much more confident that it was circumcision that results in the change in HIV transmission. The rub: the ethical dilemma of such an intervention.
Why are condoms not being promoted by the Bush administration?
1) The magnitude of the effect of circumcision is *not* minor. Other than prior infection with herpes, it's perhaps the largest predictor of transmission rates controlling for sexual behavior (i.e. using a condom, number of partners, sexual frequency).
2) Unlike condom use, circumcision is compatible with the desire to have children.
That's not to say that the administration's reluctance to promote condoms isn't appalling. But it is to say that, in the absence of a cure, a vaccine, or microbicides, it would be deeply irresponsible *not* to include circumcision as a major pillar of HIV prevention. We can safely assume that whole continents of people aren't going to spend their whole lives abstaining and using condoms, because they want children. At that stage, circumcision is one of the only highly-effective policies that can come into play.
Even if the U.S. promotes the use of contraception and the practice of circumcision in countries deeply affected by HIV, nobody is willing to do what's really necessary to make the outlook of these countries significantly less bleak, which may not even be feasible. Regardless, just because a problem is insurmountable doesn't mean absolutely nothing should be done, so cuts and rubbers for all, I say!
I have to agree with Dana Goldstein that there's something preposterous about the idea that the US government would be promoting circumcision as a solution while still not encouraging condom use, given that the latter approach is clearly more efficacious
Why is it preposterous? We ALWAYS weigh the effectiveness of an approach to a public policy problem against the drawbacks. To the extent that people think that condom use has drawbacks, it is perfectly natural to weigh its effectiveness as an anti-AIDS strategy against those drawbacks. Indeed, I can think of many far more effective anti-AIDS strategies than promoting condom use, but when weighed against their drawbacks are not as preferable as promoting condom use.
"But Tom Elkins, Senior Policy Officer at the National AIDS Trust warned: "There is a real danger in sending out a message that circumcision can protect against HIV. This is not the case and could lead to an increase in unprotected sex."
"There is still a long way to go in providing comprehensive prevention programmes in many countries, and resources should go into normalising the use of condoms, which are the most effective method currently available for preventing HIV."
http://news.bbc.co.uk/1/hi/health/6176209.stm
Promoting condom usage as the prime method of AIDS prevention in Africa is to assume most Africans think like Mr. Yglesias or Ms. Goldstein. Reading reports from Africa such as Time's Death Stalks a Continent, gives a different impression. Consider the truck driver named Louis Chikoka they profile:
"What he likes best is dry sex. In parts of sub-Saharan Africa, to please men, women sit in basins of bleach or saltwater or stuff astringent herbs, tobacco or fertilizer inside their vagina. The tissue of the lining swells up and natural lubricants dry out. The resulting dry sex is painful and dangerous for women. The drying agents suppress natural bacteria, and friction easily lacerates the tender walls of the vagina. Dry sex increases the risk of HIV infection for women, already two times as likely as men to contract the virus from a single encounter. The women, adds Chikoka, can charge more for dry sex, 50 or 60 rands ($6.46 to $7.75), enough to pay a child's school fees or to eat for a week.
Chikoka knows his predilection for commercial sex spreads AIDS; he knows his promiscuity could carry the disease home to his wife; he knows people die if they get it. "Yes, HIV is terrible, madam," he says as he crooks a finger toward the businesswoman whose favors he will enjoy that night. "But, madam, sex is natural. Sex is not like beer or smoking. You can stop them. But unless you castrate the men, you can't stop sex — and then we all die anyway."
I guess we also need to promote wet vaginas.
Fred,
That's something I wish I could un-know.
I find it rather interesting that people with ethnic backgrounds like Mr. Yglesias and Mr. Goldstein appear less then positive about the virtues of circumcision.
Ascribing political or ideological views to people based on their ethnicity is, of course, virulently bigoted, and in this case, anti-Semitic.
Now I wonder what would happen if someone in this space said that Matthew, as a Jew, should have certain positions on money or wealth? What would SLS say? I have a funny feeling...
To the extent that people think that condom use has drawbacks, it is perfectly natural to weigh its effectiveness as an anti-AIDS strategy against those drawbacks.
But the ideas behind that conception of condom's drawbacks is nonsense. The pro-abstinence only crowd has littered the discourse with flat lies about the effectiveness of condoms. It is not true that condoms often fail, despite what those groups have done to distort the statistics. Used properly condoms are extremely effective.
Maybe this misguided focus on condoms as a solution to African AIDS is a result of the lack of diversity in American journalism that Dana Goldstein lamented (and Megan McArdle commented on in her post White as the Driven Snow.). Had there been a Sub-Saharan African truck driver on the staff of The American Prospect, he could have shared his diverse viewpoints on this subject with Dana.
Fred's story is correct, by the way. Another reason for the high rate of HIV infection in heterosexual Africans is the extremely high rate of other STDs, which produce open sores that greatly increase the risk of infection.
they all have AIDS cos Jeezus gave those oversexed hottentots enormous spears that penetrate deeper and tap the GRID-juice right out of the colon.
Circumcision? You mean "Islamo-Judeo genital mutilation?" Ask Sullivan. He'll tell you all about it! Over. And over. And over.
It is genital mutilation and its ironic that we're encouraging Africans to mutilate their men at the same time we're telling them that it's a violation of human rights to mutilate their women.
The only reason that people don't think it's mutilation is because it's so common and because those mutilated don't themselves recognize that it's not merely cosmetic and does involve in the loss of sensitive nerve tissue, just like FGM. Sure, FGM is more radical. But women do still get some stimulation from the nerves around the mouth of the vagina, as well as in the g-spot area. Thus, while FGM results in a serious reduction in stimulation, it's not complete. Well, MGM results in less of a reduction in stimulation than FGM and so the men concerned, like the women who've had FGM, don't think of it as that big of a deal.
But where, as in hereabout, women's clitorises aren't regularly cut-off, then that practice seems barbaric and inhumane. And where, as in hereabout, a large portion of the sensitive skin at the end of men's penises are cut-off, it seems like it's no big deal. One of these two point of view is wrong. I'm pretty sure that history will agree with me that both MGM and FGM are wrong. Worse, if you look at the idea of white Westerners encouraging black Africans to circumcision, you see something that is arguably ugly and, even if you think it isn't, is arguably a cultural error that we will be vilified for in the future when black Africans look upon it from a different perspective than ours.
What none of you guys seem to be addressing is that circumcision offers no protection to a woman where the man has HIV. Also, we know from behavioural research such as that carried out by Dr Laumann, that circumcision makes a man more likely to demand anal sex (probably because he's desensitised)- putting his partner at greater risk. Circumcised men -for the same reason - are also often reluctant to use condoms.
So this African circumcision promotion is very flawed - it's very unethical too, to suggest defenceless babies have their foreskin ripped away on a presumption about their future sexual behaviour.None of the men promoting the cut have ever known the joy of a foreskin so they could perhaps be forgiven for their lobbying. The ones i can't forgive are the women. We have foreskins too and we know they give delicious pleasure...how people like Catherine Hankins of UNAIDS can compare genital cutting to a vaccination i just don't know.
Interestingly female circumcision has been shown in a large Tanzanian study to offer protection to women against HIV. Yet no one is saying even foreskin or labia removal (type 1 cut) should be offered let alone forced on women or girls, despite the fact it would also reduce vulval cancer (twice as common as penile cancer). This demonstrates the huge gender anomaly in the US-led promotion of infant male circumcision. The message is: a girl owns her genitals: a boy's belong to his parents, or even the state.
Men out there wake up! It's time you got angry about this
Another reason for the high rate of HIV infection in heterosexual Africans is the extremely high rate of other STDs, which produce open sores that greatly increase the risk of infection.
Actually, Freddie, while this was a standard part of the public-health received wisdom as of 2000 or so, nobody has really been able to substantiate that it plays any important role; countries with higher HIV rates don't have higher rates of other STDs.
I would second the recommendation to read Helen Epstein's recent book, "The Invisible Cure". It makes extremely uncomfortable reading for a pro-condom liberal like myself, and it's pretty convincing. It's increasingly irrefutable that the big difference in Africa has to do with acceptance of long-term concurrent partnerships, rather than higher rates of prostitution or promiscuity in general (which no one has been able to demonstrate). That is the only explanation that accounts for the dramatic difference in HIV rates between southern Africa and countries like Thailand, with high rates of prostitution (not to mention the difference between southern Africa and West Africa). It also explains why the public health community's focus on "risk groups" (prostitutes, truckers etc.) has failed: average people with two long-term concurrent partners are just as much "at risk". (Epstein cites one mining community where the HIV rate among average local women was HIGHER than among prostitutes, the so-called risk group.) It accords with the fact that HIV is not easily transmissible: you have to have vaginal intercourse dozens and dozens of times with an HIV-infected person before infection becomes probable. And finally, it explains why Uganda succeeded: the homegrown response to AIDS there in the late '80s and early '90s, without any international public health advice, was to cut down to just one sexual partner at a time. At a population level, that cut prevalence from double digits to single digits, which is more success than any other approach has ever had.
And the most uncomfortable conclusion, which goes to the heart of Matthew's post, is that the Western approach to treating HIV as a disease of promiscuity best attacked through condom use among prostitutes and truckers may have partially backfired, by exacerbating the disease's association with gross promiscuity in societies which stigmatize such behavior. And in that sense, promoting circumcision may indeed be a better call, at least in countries where circumcision is culturally appropriate. In societies where it isn't, obviously, you really don't want to be giving a lot of people the impression that America is trying to cut off their men's foreskins.
And to Laura McDonald: have you reflected on the fact that virtually all societies which practice female circumcision also practice male circumcision? The implication of your argument here is that female circumcision is not actually misogynistic, since the men in such societies are also involuntarily mutilated and suffer reduced sexual enjoyment as a result.
The idea that a huge number of patriarchal societies, which have taken care to guarantee male rights to polygyny and to restrict women's ability to refuse sex, have been doing something for the last 2000 years that dramatically reduces male sexual pleasure seems pretty unlikely to me.
Someone posted: "Do the cost benefit on this argument. Cost = male circumcision is tantamount to genital mutilation that results in decreased sexual pleasure etc etc. Benefit = a minor reduction in HIV transmission."
What is it about foreskins that motivates people to bend the truth so outrageously? Is it the product of psychosexual baggage they carry?
A link to a report on a study that has finally debunked the contrived nonsense about a physical (as opposed to a psychosexual) sexual function for the foreskin has been posted in a comment above. For the record, here it is again: http://www.medicalnewstoday.com/articles/7805
The protective effect of male circumcision against HIV infection as a result of female to male heterosexual transmission has been pegged at 60% and these findings have been accepted by UNAIDS and WHO ( http://tinyurl.com/32g7ga )
What drives these foreskin orientated people and groups to distort the truth in this matter? I believe this to be a valid psychological question. Any takers?
Joshua,
...the contrived nonsense about a physical (as opposed to a psychosexual) sexual function...
How do intact males masturbate? Circumcised males? There's a physical difference. This difference will also appear during intercourse, as the intact penis can move within the foreskin sheath while the circumcised penis cannot.
But I'll move beyond mechanics. Are you suggesting that there are the same number of nerve endings remaining in the circumcised penis that were in the original intact penis? What was the purpose of those nerve endings?
The foreskin and glans are also mucous membrane, which means they're meant to be covered (protected). Just like the nose, mouth, and vagina. One of the stated "benefits" of circumcision is that it toughens the remaining skin, making it less susceptible to infection. The value of that is subjective and debatable, but it clearly demonstrates a change in the penis and a function for the foreskin.
Joshua you may as well call someone who is against female circumcision 'vulva orientated' the point would be equally ridiculous. The psychological problems are all YOURS - you have (presumably without consent) had your penis surgically reduced and are now driven to justify the status of your organ. I sympathise with your feelings but at the same time am hugely angry that you're trying to deny other men the joy of a foreskin just because this was done to you.
I couldn't link to that article which apparently debunked the value of the foreskin but I'd guess it was the study by Kimberley Payne, Yitzchak Binik and colleagues which tested the glans and shaft of 20 circumcised men and compared it against the glans and shaft of 20 intact men. They deliberately avoided testing the sensitivity of the foreskin - guess why? Because this part is known to contain the richest variety and greatest density of nerve endings of any part of the penis.
This may be uncomfortable reading for all of you who were deprived of a foreskin at birth and for those women posting her who've torn this part from their son, believing it best for him. But just like female genital cutting (which i do not approve and never implied i did) we need to face up to the horror of an ingrained cultural tradition before we can change it - this means cut men and cut women will have to face up to having the surgery they had come to terms with being called 'mutilation'. But we must do this, because it IS mutilation, and international law and ethics says children must be protected from harm. Adults on the other hand should be free to change their bodies as they wish.
efficacious or effective?? 'pedanticious' or pedantic?
...
Yes, condom use is more effective.. but comdom + circumcision is even more effective...
and whenever you don't have access to condoms, circumcision is more effective than not being circumcised...
efficacious or effective?? 'pedanticious' or pedantic?
...
Yes, condom use is more effective.. but comdom + circumcision is even more effective...
and whenever you don't have access to condoms, circumcision is more effective than not being circumcised...
Laura,
...whenever you don't have access to condoms, circumcision is more effective than not being circumcised...
Whenever you don't have access to condoms, abstinence is more effective than not being circumcised.
So why aren't condoms available? Wouldn't it be more cost effective to make condoms available rather than spending scarce resources on circumcision?
As for condoms + circumcision, with the high effectiveness rate of condoms, what's the actual added benefit of the circumcision, statistically? I suspect the marginal gain of circumcision isn't as significant as you believe.
I think some of you are missing the point. Let me break it down for you:
Apparently, for a significant percentage of sub-Saharan Africans, having unprotected sex with multiple concurrent sex partners is like Americans eating at McDonald's. We know it's not good for us, but most of us don't care. Same with the Africans. At this late date, Africans know that having lots of unprotected sex puts them at risk of AIDS. A significant percentage of them clearly don't care.
You can't help people who care less about their own health than you do. Why not focus on helping someone who wants to be helped?
Whenever you don't have access to condoms, abstinence is more effective than not being circumcised.
Abstinence is even more effective than condoms, providing a total protection. However asking people to practice abstinence is surrealistic.
So why aren't condoms available? Wouldn't it be more cost effective to make condoms available rather than spending scarce resources on circumcision?
Ideally, both condoms and circumcision should be readly available.
As for condoms + circumcision, with the high effectiveness rate of condoms, what's the actual added benefit of the circumcision, statistically? I suspect the marginal gain of circumcision isn't as significant as you believe.
It is intuitively clear that condoms + circumcision is more effective than condoms alone, or circumcision alone. It is fairly easy for a condom to tear or break while in use, in that case, circumcision will definitely prove to be helpful.
However asking people to practice abstinence is surrealistic.
Of course. I didn't mean to imply that people would. But to then argue that we should advocate circumcision to mitigate risky behavior is silly. Have sex without a condom with a high rate of infection in your partner population and you will get HIV, sooner rather than later, circumcised or not. That message is getting lost.
Which leads to...
Ideally, both condoms and circumcision should be readly available.
Of course. And I don't specifically have a problem with circumcision as a way to reduce HIV risk. But funding is going to circumcision instead of a more effective, cheaper, safer strategy.
And worse, WHO and UNAIDS are advocating cutting children first, then moving on to teens and adults. Ignoring the obvious ethical dilemma for a moment of choice versus force, that's not smart. Infants aren't sexually active. Adults are.
It is intuitively clear that condoms + circumcision is more effective than condoms alone, or circumcision alone.
Again, of course. But I asked a question. What's the actual added benefit of circumcision when a condom is used? It's higher, but by how much? Is that increase significant? I suspect not, since condoms are already extremely effective.
There is a study, but Im having trouble finding it at the moment, that highlights the ways that certain forms of female circumcision reduce the transmission of HIV.
This is just an attempt by the US to export its favorite genital mutilation. If clitorectomys were still in vogue then Im sure wede be trying to send that somewhere as well.
In addition, the effects of circumcision become moot when you have sex over and over and over and over and over and over, and then some more. The percentage of risk reduction eventually becomes pointless. Not to mention that indeed, this proposition doesnt care about women, why you say, because its not about health.
Circumcision is genital mutilation, period.
"Circumcision is genital mutilation, period."
Glad that's resolved. Care to pontificate on any other subject?
Not that your opinion is particularly relevant to the situation of sub-Saharan Africans. They have their own opinions about what constitutes mutilation. Consider their zeal for decorative scarring, piercing, clitorectomies, etc. More relevant, there isn't exactly a surfeit of qualified medical personnel to safely perform circumcisions in sub-Saharan Africa.
More broadly, this whole thread is reminiscent of Rudyard Kipling's "White Man's Burden". Do you think sub-Saharan Africans sit around worrying about the obesity epidemic in America?
Tony posted: "Are you suggesting that there are the same number of nerve endings remaining in the circumcised penis that were in the original intact penis? What was the purpose of those nerve endings?"
What was the purpose indeed. Now I assume that you are educated enough to understand that all nerves are not equal. In other words they don't all have the same function.
The recently published study ( http://www.medicalnewstoday.com/articles/7805 ) has found that there is no difference in the sexual sensations experienced on an erect penis of circumcised and uncircumcised men on the head (glans) and on the shaft (where the foreskin ends up on an erect penis).
Now with the science and the jury in on the matter we still have people like Tony putting up a spirited defense of the smelly old foreskin.
Why you doing this Tony? Have you got a psychosexual thingy about the foreskin that (in your mind at least) trumps the science? Very sad to see.
Chris,
I think you're looking for this.
Joshua,
Your claim that science and the jury are in on the matter is untrue. You ignore parts of the news report you link (the correct link):
The authors note that the presence of scar tissue formation from circumcision, as well as functional and mechanical changes related to sexual activity, are factors that may have secondary effects on genital sensitivity and should be considered in future research.
They should be considered because the researchers did not study them. So why do you dismiss* my facts without evidence to support your dismissal? I did not mention scar tissue, although it's a valid question. But allow me to repeat what I did mention:
How do intact males masturbate? Circumcised males? There's a physical difference. This difference will also appear during intercourse, as the intact penis can move within the foreskin sheath while the circumcised penis cannot.
Those are mechanical changes related to sexual activity.
... Are you suggesting that there are the same number of nerve endings remaining in the circumcised penis that were in the original intact penis? What was the purpose of those nerve endings?
This was the offending quote you challenged with "All nerves are not equal." I have no qualms with your statement. But you're not providing evidence that you have the right answer regarding the nerves that are clearly removed during circumcision. The only link you provide is a study that specifically states it didn't study this and someone should in the future.
Nor could it study this, since it did not look at men circumcised during the study, with measurements taken before and after the surgery. On different men, the same nerves cannot be compared because one group is missing a specific, identifiable subset of foreskin nerve endings.
The foreskin and glans are also mucous membrane, which means they're meant to be covered (protected). Just like the nose, mouth, and vagina. One of the stated "benefits" of circumcision is that it toughens the remaining skin, making it less susceptible to infection.
Those are functional changes related to sexual activity.
I also wrote about the value of such changes being subjective and debatable. I'm not interested in convincing you (or anyone) that circumcision's value is negative for you. You're entitled to whatever opinion you want to have about your body. But others may and do hold that circumcision's value is negative. It's rational to believe that the healthy foreskin is worth keeping.
As an extenuation that may be lost here, I don't care if adult men choose circumcision for themselves. If African men believe getting circumcised will prevent HIV, let them. If American men want to get circumcised to avoid being laughed at in bed, let them. It doesn't matter how irrational I find that reasoning. It's only when it gets applied to infants who can't explain whether or not they approve of an unnecessary surgery that it matters. One person's subjective reasoning is not a valid justification to impose circumcision on another in the absence of need.
* Your immature implication that I have a "psychosexual thingy" about the "smelly old foreskin" is duly noted. Also, if you're going to address me, please show enough respect to address me directly throughout your response rather than veering off into preaching to everyone else by speaking of me in the third person. Thanks.
Tony pulls a comment (note a comment not a finding) from a footnote about POSSIBLE secondary effects. Well Tony I suppose if you lose on the primary effects then you have to cast around for 'possible' secondary effects. I feel so sorry for you.
This is the key:
"This study suggests that preconceptions of penile sensory differences between circumcised and uncircumcised men may be unfounded," says Kimberley Payne, Ph.D, principal author of the study.
This finding provides all with the following:
1. That the disinformation that the head (glans) of the penis on a circumcised man is less sensitive than that on an uncircumcised penis is comprehensively debunked.
2. That the foreskin when laid back down the shaft of an erect penis is no more sensitive than (remnant fore)skin on the shaft of a circumcised penis. So it doesn't really matter how much foreskin there is and how many of that type of nerves there are, now does it.
You talk of masturbation as if it is really important. I must say that I have a great sense of sadness for men whose primary source of sexual pleasure is derived through masturbation. I hope they can one day they can graduate onto sexual intercourse, it is so much better.
So why do the uncircumcised have such a need to present their member as being superior in the area of sexual sensation and get so bent out of shape when studies like this get published which trash their dreams?
Perhaps it is because with a hideously ugly member with unfortunate negative hygiene attributes they have a emotional and psychological need to feel in some way (any way) good about their penis. When studies shatter their carefully constructed fantasy world it is understandable that they will respond badly.
Tony boldly states: "I don't care if adult men choose circumcision for themselves"
And I ask Tony how many people does he think really give a rats ass about what he cares about on this matter?
If you're going to address what I write, please show enough respect to address me directly throughout your response rather than veering off into preaching to everyone else by speaking of me in the third person. Thanks.
"This study suggests that preconceptions of penile sensory differences between circumcised and uncircumcised men may be unfounded," says Kimberley Payne, Ph.D, principal author of the study.
Those bold non-committal words hardly amount to "comprehensively debunked".
I'm not denying the parts of the research that "hurt" my position, although I will challenge any assumption that conclusiveness on this finding - if it actually existed - would be sufficient to excuse circumcision. Here I'm merely echoing the call from the researchers themselves for further research into this topic.
You seem intent on ignoring anything that challenges your view. Why?
You talk of masturbation as if it is really important.
Why shouldn't it be? Or, similar to my point on choice, are you any more qualified than others to decide for everyone which form of sexual activity a male should find most satisfying, to the exclusion of all others?
But even if we throw it out per your belief that only partnered sex is worth having, you ignore that the intact male's partner could find the foreskin's mechanical function useful for certain comparable activities. But we can throw that out, too, just to get to your point. If you're specifically claiming that only intercourse is worth "graduating to", you haven't answered the mechanical function of the foreskin during said intercourse. This is a glaring omission.
...hideously ugly member* with unfortunate negative hygiene attributes...
I hope you agree that "hideously ugly" is subjective. I know the audience you were preaching to isn't supposed to "give a rat's ass," but as I described, subjective reasons for circumcision are irrelevant to this discussion. For infant circumcision, it's an unacceptable imposition because he might not agree with this subjective evaluation. For an adult male, he's free to use this subjective reason for his penis, if he deems it hideously ugly. Therefore, such fact-free terms have no bearing here.
On your point, we could assign "negative hygiene attributes" to the vagina, since both have that potential. Anything left unwashed will become dirty, but we have soap and water. The surgical knife is unnecessary for basic hygiene.
* "Member"? This is an adult topic, not a romance novel or eighth-grade locker room.
Tony strikes back!
Clutching at straws Tony tries to spin the conventional words used in studies to read a non conclusive finding.
They are sure getting desperate over in the foreskin promotion camp.
What is more to be said other than they found no difference in the sensitivity of the head (glans) of either the circumcised or uncircumcised penis or on the shaft skin of erect penises. That debunks the pro foreskin myths in my book. Sorry Tony.
On masturbation. My comment that I feel very sad for anyone whose primary source of sexual enjoyment is masturbation.
I acknowledge that there would be a percentage or two of females whose interest in 'playing' with a foreskin was enough to override her revulsion to the smell. Fetish is as fetish does.
I see Tony introduces another myth into the debate of the mechanical action of the foreskin during intercourse. Desperate is as desperate does.
All foreskins are not equal. There are stats available which would indicate that there is a very wide variety of foreskin tightness and lengths. This together with the wide variation of penis and vagina sizes indicates that no matter how nice the idea of a loose sock flapping up and down the shaft of the penis during intercourse may sound the wide variations render it just another desperate attempt by the foreskin obsessed to spread disinformation. Naughty boy, Tony.
The difference between the "negative hygiene attributes" of the uncircumcised penis and the vagina is that women are acutely aware of the unfortunate phenomenon and make no excuses for it and certainly don't try to deny it.
Isn't it funny how Tony continues to make emphatic statements about male circumcision as if his opinion on the matter actually matters?
Joshua,
I've asked twice, but you refuse to act like an adult and show even a modicum of respect. It's been interesting, but I'm not interested in finding out how much more juvenile you can get. No doubt you'll take this as an opportunity to continue your mockery. Have fun.
I'm sorry Tony, but its time people stood up to the crap about the foreskin being spread on the net by you and your ilk. One can only speculate upon what kind of weird psychosexual motivation drives this deliberate and relentless spreading of disinformation on the net. I for one have had enough. More and more people who believe that male circumcision is a perfectly acceptable parental decision as a result of religious, cultural and medical considerations have had enough. Go and see a shrink to deal with your hang-ups Tony.
Joshua,
This approach by you is one I would interact with. It's questionable to say things like "your ilk" and to determine that I have psychosexual hang-ups in need of psychiatric attention because I disagree with you, but that's not a big deal. I'll let the facts I've provided stand as a sufficient defense against such claims.
If you want to continue debating facts with this new approach, I'm willing to resume. There's plenty to be said against the validity of routine circumcision as an acceptable parental decision. If you don't want to debate facts, and do so with this new approach, then I'm done with our discussion.
It's your call. What will it be?
Tony, it is questionable whether you have any incontrovertible facts at your disposal to support your desperate defense of the foreskin. Maybe I missed them? But then I know enough about skin freaks and anti-male circumcision activists to know just what a crock they are trying to sell the unwary and the dull and ignorant. You have opinions on the matter as you are entitled to but surely you are intelligent enough to realize that because you feel strongly about an issue it does not mean you are correct and that you are in sole possession of the truth. i would love to know you opinion on the forced immunization of infants and the associated pain. Maybe you are just narrowly focussed on the smelly old foreskin to the exclusion of all else? Couch time, Tony, you need to invest in a little couch time!
Joshua,
You have opinions on the matter as you are entitled to but surely you are intelligent enough to realize that because you feel strongly about an issue it does not mean you are correct and that you are in sole possession of the truth.
I haven't claimed otherwise. I'd like to assume that you fit your assumption, as well. You have not demonstrated this yet, as you've resorted to wild claims about my mental state and irrational hyperbole about what kinds of sexual activity are worth graduating to.
I've stated the facts. I've been open to a debate where you may challenge these facts. "Couch time" is not a refutation of what I've written. "Smelly old foreskin" isn't particularly compelling, either. As we've agreed, vaginas can smell, too, if not cleaned regularly. You believe that awareness of the issue should spare women from surgical intervention while males should have it forced upon them. That's irrational. That irrationality is magnified by assuming that all women are aware and all men are unaware that they need to wash regularly.
Your assumption also requires acceptance that men won't wash if prompted by a partner and that his potential partner can't/won't refuse sex if she's repulsed by his foreskin. If women won't sleep with him, his incentive would be to wash and/or have himself circumcised. The exceptionally low adult circumcision rate among intact males and continued presence of new children born to those intact fathers "suggests" that men are washing regularly and/or women aren't repulsed by the foreskin. What you believe about women isn't as widespread in reality as you imagine.
As for forced immunizations, surely you're not comparing the pain of a needle to the pain of crushing/slicing a portion of skin packed with nerve endings? Claim whatever purpose for those nerve endings you wish, but they exist. The pain of immunization is also over quickly, while the pain from circumcision lingers through the healing process.
To your point, though, there is a public health case to be made for immunization. A child is susceptible to diseases like polio or measles without any effort or specific behavior. Transmittal of these can then be passed around with as much ease and lack of intent as the disease was received.
Do you support immunization only for boys, or is there some underlying principle that is blind to gender?
Tony you are going to have to remind me of the case you have supposedly made. I see no credible case, only your obvious mindless anti-male circumcision activism.
Pain is controllable. But if you think that no one is concerned about immunization pain you are mistaken:
Effective Pain Reduction for Multiple Immunization Injections in Young Infants
http://archpedi.ama-assn.org/cgi/content/abstract/157/11/1115
But then your interest is not in pain that neonates suffer is it, but rather only to use a specific instance to support your anti-circumcision agenda. I can see through it, others should also be able to do so.
Again you choose to deliberately miss the principle. If it is , in your opinion, wrong to circumcise a male infant without his consent why would it be acceptable to immunize the hell out of kids without their consent?
There is a growing anti-immunization lobby, perhaps larger than the fringe anti-circumcision group put together, who are also making a similar argument to that of the anti-male circumcision activists.
Why do anti-circumcision activists not endorse the concerns of the anti-immunization lobby?
Perhaps the focus is narrowly and psychosexually on the foreskin to the exclusion of all else?
Oh yes and the saying "smelly old foreskin" is pretty accurate. read this and weep for the uncircumcised and their partners who are on the receiving end of the toxic rod:
Association between the intact foreskin and inferior standards of male genital hygiene behaviour: a cross-sectional study.
Joshua,
I've made my case. You've pretended that I've offered only "mindless anti-male circumcision activism". You're free to believe that, but you should at least demonstrate why you believe I'm wrong. You haven't done that. You've dodged repeatedly, usually with something about "psychosexual" hangups. Aren't you bored with that childish insinuation yet?
Read what I've written. You'll find that I'm not arguing based on some notion of a supreme, all-powerful foreskin, or that it must never be removed. I'm arguing that every boy should keep his choice. If he's like you, he'll get rid of his foreskin. If he's like me, he'll keep it. I don't care which he chooses for himself, only that he gets to decide. You're the only one with a fixation on making a permanent decision immediately, and backing it up with justifications based on claims of odor if not washed properly.
Oh yes and the saying "smelly old foreskin" is pretty accurate. read this and weep for the uncircumcised and their partners who are on the receiving end of the toxic rod:
"Toxic rod"? Your juvenile euphemisms are fascinating, but they ultimately serve only to demonstrate your lack of maturity on this issue. Why should anyone trust you when you can't engage an adult topic without resorting to a schoolyard taunt over the correct word?
Now about that study... The title claims an "[a]ssociation between the intact foreskin and inferior standards of male genital hygiene behaviour". That study hardly indicates anything as compelling as that title's implication, which you happily approve of to meet your bias. It states:
Not always washing the whole penis, including retracting the foreskin in non-circumcised men every time they washed (defined as inferior genital hygiene behaviour) was more common in non-circumcised (26%) than circumcised men (4%) ... and those with balanitis (42% and 5%, P=0.036).
Intact men are more likely than circumcised men to not wash completely, according to this study of self-reporting men. It's ridiculous to conclude that this indicts the foreskin rather than the man doing the incomplete washing. The study doesn't say these men can't wash completely, only that 26% of them don't. The solution is for men to wash completely, 74% of whom already do. You wouldn't cut your kid's ears off if he didn't wash them every time he showered. You'd teach him to wash completely. It's called parenting. Surgery is not a replacement for that, even if he might grow up and ignore the lessons. Should we cut more from the circumcised men until we get that "washes incompletely" number to 0%?
As I wrote before, if women refuse sex with him because of his foreskin, his incentive would be to wash and/or have himself circumcised. The undeniable reality that the majority of the world's males remain intact throughout their lives and continue to father children suggests your opinion isn't the dominate position. Either they wash or their partner(s) don't care. Please confront that before you accuse me of mindless activism.
But to your red-herring. We agree, pain is controllable. So what? The intensity and duration of the pain differs between the two, which was my clear point. But even if we provide complete pain relief, we're still back to the fundamental absence of any medical need for routine circumcision.
But then your interest is not in pain that neonates suffer is it, but rather only to use a specific instance to support your anti-circumcision agenda.
I'm not sure I follow your point here. How do you conclude that I'm not interested in neonate pain? My primary stance is the basic lack of any medical need for circumcision. It shouldn't be done. Hence, in my position, the child is spared pain by virtue of not having unnecessary surgery performed on him. It's weak to assume any of this means I don't care about pain. Let me be clear. If you're going to violate medical ethics, the boy's rights, and common sense by circumcising a healthy child, the safest, most effective pain relief should be used. That goes for any procedure, not just circumcision. But that doesn't excuse the violation.
Again you choose to deliberately miss the principle. If it is , in your opinion, wrong to circumcise a male infant without his consent why would it be acceptable to immunize the hell out of kids without their consent?
I haven't missed the principle. I stated it indirectly in my response, so allow me to state it clearly. There is a public health case to be made for immunization that doesn't exist for circumcision. The diseases for which we immunize are communicable without effort or intent. A person may become infected and infect without specific, identifiable action(s). Nothing anyone proposes as a justification for circumcision meets that.
Many people are both anti-circumcision and anti-immunization. So? I'm not. It's possible for me to think independently and draw different conclusions, based on evidence. But the immunization issue is a red-herring.
Comments closed September 21, 2007.
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Heads in the Sand
That's not quite what Dana wrote. She wrote that it's dispiriting that the Bush administration is still ignoring the condom issue but encouraging that it's promoting circumcision in Africa.
Not quite the same as "preposterous."
And I don't disagree with her (or your larger point), but given that making condoms widely available is not so easy, and, even if you do, compliance is difficult to obtain, it's not absolutely clear that condoms are so much more efficacious than circumcision, which, if performed at birth, is really not so hard to accomplish.
The larger point, though, of course, is that BOTH should be promoted.
Posted by Adam | September 7, 2007 2:29 PM