Circumcision, +or- ?

Factual Questions
81

I humbly accept your apology, APB9999. I can’t help but respect your integrity and candor in offering it. I guess we were each overreacting to what we perceived as deliberate misunderstandings of our positions. Believe it or not, APB, my statement:

was meant not only to acknowledge that I’d gone a bit overboard myself, but in its own way was also meant as an apology…

In my defense, let me assure you that I understand your point perfectly, it’s just that I strongly disagree with it and find your absolute ethical pronouncement to be rather abrasive. I can’t help thinking that if I made a similar moral proclamation that contradicted what you held to be proper behavior, you would be equally vexed (for example, if I claimed it was absolutely immoral not to circumcise your child as an infant). And although my language may have been unpalatable at times, I don’t think I’ve misrepresented your position at all.

Let me point out that if you had simply said: “I feel the decision on circumcision should be postponed until the child has reached adulthood and can choose for themselves”, we wouldn’t be having this argument!

But you didn’t say that. Intentionally or not, you impugned the motives and ethics of anyone who would choose to have any beneficial but not absolutely essential surgical procedure performed on their child (not just circumcision). That’s what really got my goat! The extreme nature of your blanket ethical censure unjustly castigates parents who act out of a deep, thoughtful, and genuine concern for their child’s best interests, which seems manifestly unfair.

And I’ve never tried to “psychoanalyze” you, APB – I simply disagree with you.

82

APB9999 wrote:

It’s clear that you missed the reference. Look back at my post of 06-09-99 11:26 PM. I wrote:

“While wandering through the archives, I found this reference to the substantially greater dangers of HIV infection for uncircumcised men.”

Perhaps your browser doesn’t show links very well. The specific quote was well down in the article: “… male circumcision (prevalence of HIV infection is 1.7 - 8.2 times a high in men with foreskins as in circumcised men)”

What?? A reference to a Straight Dope article is not a valid citation for The Straight Dope message boards? Maybe you should “turn in [y]our Straight Dope badges to Uncle Cecil right now”! :wink:

My initial web search failed to find the (sole) reference you listed claiming increased HIV infection rates for cut men (6% if I understand correctly). The overwhelming majority of hits were little more than cheerleaders for the anti-circumcision movement, which I naturally don’t trust (this is a political movement, and in politics science is often bent to conform to the movement’s agenda). This movement has been attacked by scientific and medical professionals “for their use of ‘distortions, anecdotes and testimonials to try to influence professional and legislative bodies and the public, stating that in the past few years they have become increasingly desperate and outrageous as the medical literature has documented the benefits.”

All the other hits I found backed up my claim of substantially greater risks for uncut men (some of which I’ll cite below).

I note that the study you cite is one of those dreaded “meta-analyses”. I’m certainly in no position to mathematically challenge their statistical validity, but I have no confidence whatsoever in the technique. After all, meta-analyses of ESP research have magically converted a large body of studies – which failed to find statistically significant evidence for psi – into studies that did find such evidence!! To my mind, at least, a technique that can take a set of all “falses” and come up with a “true” is certainly not to be relied upon! I can’t help thinking that’s probably what happened here.

In rebuttal to your single HIV citation, let’s start out with this:

Moses S, Plummer FA, Bradley JE, et. al.
The association between lack of male circumcision and risk for HIV infection: a review of the epidemiological data.
Sex Transm Dis 1994 Jul-Aug;21(4):201-10

I quote from the abstract: "Thirty epidemiological studies identified in the literature that investigated the association between male circumcision status and risk for HIV infection were reviewed. RESULTS: Eighteen cross-sectional studies from six countries reported a statistically significant association, four studies from four countries found a trend toward an association. Four studies from two countries found no association. Two prospective studies reported significant associations, as did two ecological studies. In studies in which significant associations were demonstrated, measures of increased risk ranged from 1.5 to 8.4. … Because a substantial body of evidence links noncircumcision in men with risk for HIV infection, consideration should be given to male circumcision as an intervention to reduce HIV transmission." [emphasis mine]

With due apologies for straining the patience of the reader, permit me to bombard APB’s position with even more citations:
Seed J, Allen S, Mertens T, et. al.
Male circumcision, sexually transmitted disease, and risk of HIV.
J Acquir Immune Defic Syndr Hum Retrovirol 1995 Jan 1;8(1):83-90

“Despite the low-risk profile, uncircumcised men had a higher prevalence of HIV infection than circumcised men”
Hunter DJ, Maggwa BN, Mati JK, et. al.
Sexual behavior, sexually transmitted diseases, male circumcision and risk of HIV infection among women in Nairobi, Kenya.
AIDS 1994 Jan;8(1):93-9

“Women whose husband or usual sex partner was uncircumcised had a threefold increase in risk of HIV, and this risk was present in almost all strata of potential confounding factors.”
Urassa M, Todd J, Boerma JT, et. al.
Male circumcision and susceptibility to HIV infection among men in Tanzania.
AIDS 1997 Mar;11(3):73-80

“CONCLUSION: Male circumcision has a protective effect against HIV infection”
Kreiss JK, Hopkins SG
The association between circumcision status and human immunodeficiency virus infection among homosexual men.
J Infect Dis 1993 Dec;168(6):1404-8

“HIV infection was significantly associated with uncircumcised status (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.2, 3.8)”
Tyndall MW, Ronald AR, Agoki E, et. al.
Increased risk of infection with human immunodeficiency virus type 1 among uncircumcised men presenting with genital ulcer disease in Kenya.
Clin Infect Dis 1996 Sep;23(3):449-53

“A logistic regression model adjusted for behavioral and historical showed that HIV-1 positivity was independently associated with being uncircumcised (adjusted odds ratio [OR], 4.8; 95% confidence interval [CI], 3.3-7.2) … Male circumcision should be considered as an intervention strategy for AIDS control.”
Schoen EJ
Benefits of newborn circumcision: is Europe ignoring medical evidence?
Arch Dis Child 1997;77:258-260

“DISCUSSION AND CONCLUSIONS: The decision to discourage newborn circumcision in the UK and the resultant decrease in the number of circumcised males occurred before the accumulation of this evidence about the protective effect of circumcision against UTI and HIV infection. Particularly in the face of an expanding worldwide AIDS epidemic, these benefits are a powerful argument in favour of encouraging universal newborn circumcision.”
Jessamine PG, Plummer FA, Ndinya Achola JO, et. al.
Human immunodeficiency virus, genital ulcers and the male foreskin: synergism in HIV-1 transmission.
Scand J Infect Dis Suppl 1990;69:181-6

“Over 95% of attributable risk in men with STD was either genital ulceration or the presence of a foreskin.”
Cook LS, Koutsky LA, Holmes KK
Circumcision and sexually transmitted diseases.
Am J Public Health 1994 Feb;84(2):197-201

“CONCLUSIONS. Uncircumcised men were more likely than circumcised men to have syphilis and gonorrhea…”
Niku SD, Stock JA, Kaplan GW
Neonatal circumcision.
*Urol Clin North Am *1995 Feb;22(1):57-65

“The medical benefits of circumcision appear to exceed the risks of the procedure.”
Serour F, Samra Z, Kushel Z, et. al.
Comparative periurethral bacteriology of uncircumcised and circumcised males.
Genitourin Med 1997 Aug;73(4):288-90

*“It has been established that lack of circumcision increases the risk of urinary tract infection in infants. … Our results also support the role of the prepuce as a reservoir for sexually transmitted organisms.” *
Weiss GN, Weiss EB
A perspective on controversies over neonatal circumcision.
Clin Pediatr (Phila) 1994 Dec;33(12):726-30

*"Controversy continues to surround the issue of male circumcision, especially in the United States. … **It is our conclusion that, as the safest and most commonly performed surgical procedure in this country, the benefits of posthetomy (circumcision), which include a reduction in some kinds of cancer and sexually transmitted diseases, well outweigh the risks cited by those who op

83

Okay, I lied. One more post. I can’t help myself.

First,

Well, for Pete’s sake, that’s what I HAVE been saying, again and again and again! And the reason for this position - which I was compelled to provide, because the position was challenged - is because I think it is UNETHICAL to take the decision out of the child’s hands. Enough. I think we’ve both made our thinking on that clear to any reader.

As to the references, the one you couldn’t find came from PubMed, which is sometimes a bit inconsistent in what it produces; I don’t know why. PubMed is NOT a political group. I purposely avoided any home pages of anyone in the anti-circumcision movement, to avoid that very accusation.

You produce some good references (and I hate to suggest it, but I DO think the primary literature trumps TSD. Heresy!). I saw many of them when I did my search, but of course I wasn’t going to do your job for you. :wink:

I’m glad we’ve finally got the discussion around to facts (face it - we were BOTH remiss). But the conflicting literature is just that - conflicting. I could say that you do have a few recent articles, but most of mine are more recent. Still, they are all more-or-less recent enough to be considered current thinking.

So, the last part of my earlier post stands:

The field seems to be in the process of changing its thinking. The foreskin is, after all, healthy tissue, and what is the first precept in the Hippocratic Oath?

At any rate, people can now look up the references we’ve given and decide for themselves. I’m satisfied. You?

84

“CONCLUSIONS: Prepubertal circumcision is associated with reduced HIV risk, whereas circumcision after age 20 years is not significantly protective against HIV-1 infection.”
—ambushed

Now just a minute here, ambushed. How can this be?
Gone is gone. What possible difference could it make when the foreskin was cut? Do only men below the of 20 get AIDS?
Smells like faulty data.
Reminds me of an old quip I read once;
“Use your branes”
Peace,
mangeorge

85

sigh… forget it.

In some places, they call that “selective reporting of data”! :wink: (But I guess I can’t claim pure and absolute impartiality either).

C’mon, APB; be fair. This forum isn’t a refereed scientific journal. I could have listed all those citations earlier, but I just didn’t think this was an appropriate place for them. Instead, I referenced what many here would consider a source of fact far better suited to the informal nature of this message board: The Straight Dope. Just because it didn’t come in the form of a formal scholarly citation doesn’t make it any less a fact! So I resent the claim that my arguments weren’t factual until yesterday.

Ah, yes: the lofty and respected old “nyah nyah nyeh-nyah nyah” argument. Can I play too? I cited eleven papers that concluded there is a substantial increased risk for HIV infection directly associated with being uncircumcised. You cited only one claiming the opposite. So, who’s is bigger? :wink:

Besides, the dubious history of meta-analysis calls your single citation into grave doubt. A lone researcher’s cold mathematical legerdemain is no match for the cumulative weight of the findings of the overwhelming majority of medical scientists who’ve examined the question directly, even though some of them were done way back in the prehistoric days of the early to mid 1990’s. :wink: (I couldn’t resist the sarcasm; I concede that you already agreed that they were recent enough to be considered current thinking).

Also, many (nearly half) of the citations you selected were little more than scare tactics. Yes, problems can arise from circumcision; is there anything – surgical or otherwise – that carries zero risk? Are you so naive as to think that there are no risks from failing to circumcise one’s son? Hah!

The only honest question is: which carries the greater risk? To cut, or not to cut? And the overwhelming preponderance of the scientific evidence concludes: there are greater risks from not circumcising! I can list over one hundred formal scientific citations backing this up (but in deference to the other participants, I won’t).

Even if you ignore the dramatically increased risks of HIV and other STD infections (and why would you?), even if you ignore the increased risks of urinary tract infections, even if you ignore the increased risks of penile cancer (talk about scary stories!), the risks of complications from failing to circumcise your son are almost twice as great as circumcising him! (I’m not going to list another raft of citations here. Look up Wiswell, et. al., if you want confirmation).

So, for a doctor to honestly follow the Hippocratic Oath, he’d have to strongly recommend circumcision for every male infant. Just like most of the authors of the studies I cited do.

So why do some of the papers you cite fail to do this? The answer – as in so many cases – is primarily money. For example, the positions of some groups like the American Academy of Pediatrics are usually based on (of all things) a cost-benefit analysis. They’ve merely concluded that routine infant circumcision would be more expensive than the cost of treating the potentially life-threatening illnesses and complications arising from the failure to perform circumcisions.

This is the same logic Ford used in making the Pinto!

There is no record of any deaths resulting from complications due to circumcision, but people have died as a direct result of not being circumcised!

Face it, if you’re cut, your folks did you a favor. Do your kids a favor, too, and have them circumcised as infants. It’s well worth the small risk that they’ll resent it when they grow up; at least they’ll reach adulthood to bitch about it!

86

mangeorge, I agree that the statement you quote seems lacking in the “brane” department, but perhaps you should blame that more on the extreme brevity of the conclusion (or rather, my quotation from it) and less on the study itself.

But I agree: the claim that 20+ year olds don’t benefit from circumcision is suspicious. It’s extremely doubtful, actually.

But this is the way I interpreted it:

  • Assume children (at least in that culture) start having sex at or around puberty (or at least before reaching 20 years of age).

  • If you’re not circumcised by this time, you are much more likely to be infected by HIV as a result.

  • Consequently, the majority of HIV infections in that environment occur in uncircumcised men younger than 20.

Thus, it would only appear that circumcision after age 20 has little benefit. The real explanation might be no more complicated than that 20+ year olds are much more likely to use condoms or other safe sex practices than are the randier and less cautious pubescents.

Another thing to consider is that maybe an intact foreskin increases the risks of HIV infection from all sources, not just sexual relations, and those risks are greater for children and those under 20 years of age. You might also factor in the lower average life expectancy.

On the other hand, the latter part of this study’s conclusion could simply be wrong – just like those very few studies that didn’t find the protective effect of circumcision.

But to sum up: I dunno!

87

Now you’re saying that uncut, celibate, male intravenous drug users are at higher risk of HIV infection than cut, celibate, male intravenous drug users? (I’m trying to very specific here.)
You’re making a mountain out of a molehill, ambushed.
If you use a condom, your risk of infection (Any STD’s) is practically nil.
If you’re in a monogamous relationship, Same.
Don’t inject drugs, ditto.
And on, and on.
In the real adult world cut or uncut makes little difference.
Except to one’s male ego.
Peace,
mangeorge

88

mangeorge writes:

Where in the hell did you get that from!! I never claimed anything of the kind!

That’ll teach me to try to calmly speculate with you, mangeorge! Boy, ya try to give a guy a break…

Good god, man, there’s no justification for such reckless flippancy! Talk about selecting data! Where in the hell have you been? Haven’t you been paying attention? Just how many more studies concluding that being uncut increases your odds by up to 820% for contracting HIV – not to mention UTI and penile cancer – do you need! Hello?? Is this thing on?

Sheesh!

89

From the book In Favour of Circumcision by Dr. Brian Morris, ISBN 0-86840-537-X, published 1999 (emphasis mine):

“It is argued by opponents of circumcision that the male himself should be allowed to make the decision about whether he does or does not want to be circumcised. However, there are problems with this argument, not the least of which is the fact that the greatest benefits accrue the earlier in life the procedure is performed. If left till later ages the individual has already been exposed to the risk of urinary tract infections, the physical problems and carries a residual risk of penile cancer [not to mention a vastly increased risk of contracting HIV]. Moreover, it would take a very street-wise, outgoing, adolescent male to make this decision and undertake the process of ensuring that is done. Most males in the late teens and 20s, not to mention many men of any age, are reticent to confront such issues, even if they hold private convictions and preferences about their penis. Moreover, despite having problems with this part of their anatomy, many will suffer in silence rather than seek medical advice or treatment. Really, though, parental responsibility must over-ride arguments based on ‘the rights of the child’. Think what would happen if we allowed children to reach the age of legal consent in relation to, for example, immunization, whether they should or should not be educated, etc, etc. A period of great benefit would have been lost, to the potential detriment of the person concerned.”

Thanks for the assist, Doc!

90

APB9999 writes:

Not so – you’re the one behind the curve on this. True, there was a fairly recent trend that, while certainly not opposing circumcision, backed away from recommending it (to withhold recommendation for something is not quite the same as recommending its opposite). This trend was largely based on those cost-benefit analyses I mentioned earlier (which do not take into account the cost of AIDS treatment!)

But the latest trend is actually toward a return of favoring routine infant circumcision. I quote from an article dated March 3, 1999 by Dr. Morris:

“However, a reversal of this trend [against circumcision] is starting to occur. In the light of an increasing volume of medical scientific evidence pointing to the benefits of neonatal circumcision a new policy statement was formulated by a working party of the Australian College of Pediatrics in August 1995 and adopted by the College in May 1996 … The American Academy of Pediatrics has moved far closer to an advocacy position and many recognised authorities in the USA strongly advocate circumcision of all newborn boys.”

91

I hope you’ve all had a chance to digest my last few posts, because here comes one more! mangeorge wrote:

Well, I’m not a woman, but here are some fascinating facts from the scientific medical literature, as compiled by Dr. Morris in his previously mentioned new book (see his bibliography for specific references). I thought they might be of interest to everybody…

(Consider the following items to be in quotation marks; I didn’t write them.)

  • In 5 major series in the USA since 1932, not one man with penile cancer had been circumcised neonatally.

  • Of 33 cross-sectional studies, 22 have reported statistically significant association, by univariate and multivariate analysis, between the presence of the foreskin and HIV infection (4 of these were from the USA). 5 reported a trend (including 1 US study). The 6 that saw no difference were 4 from Rwanda and 2 from Tanzania. In addition there have been 5 prospective studies and 2 from Kenya and 1 from Tanzania reported statistically significant association. The increased risk in the significant studies ranged from 1.5 to 9.6 [or 960%!].

  • 18% of uncircumcised males underwent circumcision later in life anyway.

  • 21% of uncircumcised men who didn’t, nevertheless wished they were circumcised. (There were also almost as many men who wished they hadn’t been circumcised and it could be that at least some men of either category may have been seeking a scapegoat for their sexual or other problems. In addition, this would no doubt be yet another thing children could blame their parents for, whatever their decision was when the child was born.)

  • Clinical and neurological testing has not detected any difference in penile sensitivity between men of each category.

  • Slightly higher sexual activity in circumcised men.

  • Women with circumcised lovers were more likely to reach a simultaneous climax.

  • Women who failed to reach an orgasm were 3 times more likely to have an uncircumcised lover.

  • Circumcision was favoured by women for appearance and hygiene.

  • The circumcised penis was favoured by women for oral sex (fellatio).

  • Even women who had only ever had uncircumcised partners preferred the look of the circumcised penis. Only 2% preferred an uncircumcised penis for fellatio, with 82% preferring the circumcised variety. Preference for intercourse for circ. vs uncirc. was 71% vs 6%, respectively; manual stimulation, 75% vs 5%; visual appeal, 76% vs 4%.

  • The National Health and Social Life Survey in the USA found that uncircumcised men were more likely to experience sexual dysfunctions. This was slight at younger ages, but became quite significant later in life and included finding it twice as difficult to achieve or maintain an erection. It was also discovered that circumcised men engaged in a more elaborate set of sexual practices. Not surprisingly, in view of the findings above, circumcised men received more fellatio.
    And if that isn’t a good enough reason to favor circumcision, what the hell is!

92

mangeorge writes:

Yeah, right.

Read my last post and say that!

93

I understand he’s making wallets from them. When you rub them, they turn into a suitcase.

President of the Vernon Dent fan club.

94

Once more ambushed, let people read the references themselves and decide whether the issue is as clear-cut (haha) as you assert.

95

I can’t believe that you people took my name in vain and I didn’t notice bacause you hid it on a curcumcision thread.
I just say “If it was good enough for Jesus, Sammy Davis, and John Holmes; then It’s good enough for me and any of my offspring”

<insert witty sig here>

96

So, APB9999… No thoughtful rebuttal to my “06-17-99 03:36 AM” post about the serious flaws in your argument? No apology for falsely accusing me of previously not using facts? No acknowledgement of the overwhelming preference among women for circumcised men? No gratitude to your parents for dramatically improving your sex life?

One might conclude that your silence speaks volumes…

97

“Where in the hell did you get that from!! I never claimed anything of the kind!”
—ambushed

Well, ambushed, maybe I misunderstood this;

“Another thing to consider is that maybe an intact foreskin increases the risks of HIV infection from all sources, not just sexual relations, and those risks are greater for children and those under 20 years of age.”

“That’ll teach me to try to calmly speculate with you, mangeorge! Boy, ya try to give a guy a break…”
—ambushed

I asked for a break?

Good god, man, there’s no justification for such reckless flippancy!
—ambushed

Cut or uncut, the virus won’t just appear out of nowhere. If you avoid the risk factors, the virus itself, you won’t get AIDS.
Staying away from IV use, unprotected sex, and multiple partners is far from “reckless flippancy”

“Just how many more studies concluding that being uncut increases your odds by up to 820% for contracting HIV --”
—ambushed

I know this is an unfair question, but how many people contracted AIDS in 1998 as a direct result of being uncut?
I searched this thread and other sources and couldn’t find the answer.
Bottom line is your stat (820%) means that for every cut male who has HIV, 820 uncut men have it. (Other factors being equal)
I find that a little hard to believe. Cites or no.

I’m not even going to address your post regarding women’s preferences. Except for one point. How the hell can an uncut penis cause male sexual dysfunction?
You really blew me away with that one. :slight_smile:
Peace,
mangeorge

98

ambushed, don’t be childish. There are references posted, we’ve both made our points, and we’re obviously not going to convince each other. We could go back and forth endlessly, and indeed I find your “new” arguments as highly questionable as I did before. But we’ve stopped progressing and frankly I’m getting bored with this thread.

99

mangeorge writes:

You’re misinterpreting that number. It doesn’t refer to the number of men infected, but the chance that a man randomly selected from that group is infected. In the USA, there will obviously be more circumcised men with HIV than uncircumcised ones, because there are so many more circumcised men in general.

One simulation for this statistic would be to imagine two boxes filled with marbles. One box is labelled “cut” and the other “uncut”. There are one million marbles in each box. In the “cut” box, I have placed 1 black marble and 999,999 white ones. In the other box, there are 820 black marbles, and 999,180 white ones. You must pick one box, and draw a marble at random. If you draw a black marble, you die. Which box would you choose?

100

I understand the probabilities, Aura. I was playing games with ambushed’s numbers. One would be 8.2 times more likely to get a black marble from the “uncut” box. His entire post was written to greatly exaggerate the risks of being uncut, so I exaggerated the flaws.
If you were to use a flashlight (condom) to look in the boxes, your chance of grabbing a back marble would be practically nill. In either box.
Or you could reach into the “cut” box with one hand, and into a “IV drug user” box with the other, and still get a black marble. The drug user box would have a lot more than 820 marbles. And the “uncut” box would in reality have fewer.
Advocates use percentages rather than ratios to state their case because of the psycholigical impact on the reader. 820% more likely is more impressive than 8.2 times as likely.
You could reach into the “cut” box once and get a black marble.
You could reach into the “uncut” box 999,180 times and not get a black marble.
My point is if you’re going to be a promiscous IV drug user, use condoms and clean needles. Whether or not you’re cut is of little concern.
Peace,
mangeorge