Pro circumcision views challenged

The mainstream media sadly keeps disseminating the steady output of pro circumcision writing that comes from a very few authors who swamp publications with promotional material. One such example is below from The New York Times

Circumcision Benefits Outweigh Risks, Study Reports.

A review of studies has found that the health benefits of infant male circumcision vastly outweigh the risks involved in the procedure.

But the study, published online in Mayo Clinic Proceedings, also found that while the prevalence of circumcision among American men ages 14 to 59 increased to 81 percent from 79 percent over the past decade, the rate of newborn circumcision has declined by 6 percentage points, to 77 percent, since the 1960s.

The authors conclude that the benefits — among them reduced risks of urinary tract infection, prostate cancer, sexually transmitted diseases and, in female partners, cervical cancer — outweigh the risks of local infection or bleeding. Several studies, including two randomized clinical trials, found no long-term adverse effects of circumcision on sexual performance or pleasure.

One cost-benefit analysis that considered infant urinary tract infections and sexually transmitted diseases found that if circumcision rates were decreased to the 10 percent typical in European countries, the additional direct medical costs over 10 years of births would be more than $4.4 billion.

“Male circumcision is in principle equivalent to childhood vaccination,” said the lead author, Brian J. Morris, emeritus professor of medical sciences at the University of Sydney. “Just as there are opponents of vaccination, there are opponents of circumcision. But their arguments are emotional and unscientific, and should be disregarded.”

DSC_0018-crop219wAn excellent letter in response has been written by Steven Svoboda (left),  Attorneys for the Rights of the Child.

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Dear Editor:
We were disappointed to see the New York Times publish an article (“Circumcision Benefits Outweigh Risks, Study Reports,” by Nicholas Bakalar; April 8, 2014) so strongly at odds with the Times’ generally high standards.  A team of mostly European physicians recently concluded that the only arguable medical benefit of male circumcision is a slight reduction in urinary tract infections, but these can more cheaply and less painfully be treated with antibiotics.

Claims regarding prostate cancer and cervical cancer were disproven decades ago.  Studies have suggested that female circumcision may help prevent HIV but everyone correctly avoids proposing this on grounds of medical ethics and physical integrity.  The same principles bar male circumcision, as has been recently concluded by the Council of Europe and the Royal Dutch Medical Association.

No objective person could seriously question what the vast majority of studies have documented, that removal of half the surface skin of the penis seriously impacts sexuality.  The vaccination analogy is incoherent as unlike circumcision, vaccination doesn’t remove functional tissue.
The New York Times should know better.

Different, yes. Acceptable? No

The fact that there are differences between male and female genital mutilation is usually used as a trump card by those arguing for the different treatment of males and females. The argument used is “you cannot compare apples and pears” and that is supposed to be the end of the matter.

apples+pearsLet us leave aside the fact that certain types of FGM have a damaging effect on the birth process, which is the essence of the trump card. No one is arguing that as long as you do not adversely affect the birth process all other forms of FGM are permissible.

girls-bufferEveryone would, hopefully, agree that the female genitals should be protected. If we look at the functions of the external female genitals that are protected we might come up with a list like this; the mechanical comfort of loose skin to aid intercourse, the mucosal function of lubrication and protection from infection, also the function in the case of the clitoris to initiate a deeper level of sexual arousal.

Some of the functions of the male foreskin that have been identified can easily be seen as parallels to the functions found in the external female genitalia.
The mechanical comfort of loose skin to aid intercourse, the mucosal function of lubrication and protection from infection, also the function in the case of the ridged band to initiate a deeper level of sexual arousal.
boys-sign-bufferAnatomical studies have shown that the foreskin is not spare skin and is in fact a specialised structure richly supplied with nerves that provide sensation during sexual intercourse and masturbation. The Sorrells study [3] from 2006 showed that the foreskin has the most sensitive locations on the penis. Those areas are removed by the act of circumcision. Cold and Taylor in their anatomical study “The Prepuce” [15] analyse the foreskin at a cellular level revealing a complex structure of nerves and blood vessels. They say in the discussion section at the end of their paper that “Excision of normal, erogenous genital tissue from healthy male or female children cannot be condoned, as the histology confirms that the external genitalia are specialized sensory tissues.”

To excise tissue that will develop into 15 square inches, or 90 square centimeters, of healthy erogenous tissue is bound to have consequences. The nerves and blood vessels severed during genital cutting do not join up across the scar line. The lifelong after effects of circumcision are poorly studied, it seems that no one wants to know what happens to the large number of men and intersex children whose sex lives are probably impaired by genital modification. It is the proponents of the practice of cutting children’s genitals who have to prove that their activities are as harmless as they claim. The fact that men who have been cut as children for the most part think they are normal is just not valid evidence. This organisation is contacted from time to time by men who have known what sex with a foreskin was like before being circumcised for a minor problem. Their correspondence is often graphic leaving little doubt that their is a major difference between the normal state and the circumcised state.

No legal basis for cutting children’s genitals

There has been a lot of correspondence in The Independent concerning genital cutting; it is approaching the long summer holidays a time favoured by adults for cutting the genitals of girls and boys. Much of the fuss has been, quite rightly, focused on the fate of girls but all children have the same rights.

The letter reproduced in part below from Vera Lustig, writing to The Independent, on the 2nd of July contains a common myth about the genital cutting of little boys; namely that male circumcision is legal. Thankfully The Independent did not let her get away with it and published my response.




DSC_0879-cropThe BBC’s “Casualty” (13/04/2013) tackled the subject of female circumcision. The motives of the programme makers were laudable. Men Do Complain is in favour of the cessation of forced or coerced genital cutting of children or any other vulnerable group. The encouraging thing about this programme is that the silence is broken about a subject that has been in the past largely ignored.

tritych-a-n-e-jpgThe question is when will the BBC and other organisations pluck up the courage to recognise that boys are also admitted to casualty departments after circumcision? The writers of “Casualty” should have no difficulty in finding research material on which to base such a story. Birmingham hospitals have revealed, following a freedom of information request, that two boys a week are being admitted as casualties and one boy a month comes close to death after male circumcision.

Society through the media should be helped to understand that non-therapeutic genital modification harms all children subjected to such treatment. All mutilated children have to live with the frustration of knowing that their sexual health has been compromised and all face similar risks following any unnecessary cut through the full thickness of the skin. All children should be afforded equal protection from what is essentially an assault.

How many men do complain?

Three questions that are apparently difficult to answer. Very careful study might answer the first question. Research over time will answer the other two questions. Few circumcisions are recorded in medical notes and very few men are followed up into adult life, to see how or if circumcision has affected them.

Physical harm
That circumcision is physically damaging is now beyond doubt. Embryology shows us that the same tissue that becomes the foreskin in males develops into the clitoris in females. The anatomical work of Taylor, Lockwood and Taylor tells us that the foreskin is composed of highly specialised cells with neurological and immunological functions. The work of Sorrells and his team demonstrates that circumcision removes the parts of the penis that are most sensitive to fine touch pressure. So circumcision is only beneficial when it treats a specific and relatively severe problem.

No benefits to children
There is not a single medical association in the world that recommends the routine circumcision of children since there is no benefit to children. A child’s foreskin is physiologically phimotic, not retractable, it should be cleaned like a finger, rinsed on the outside and left alone to develop and separate from the glans naturally. When the young man has gone through puberty he may, rarely, be left with a phimotic, non retractable, foreskin but this can almost invariably be treated conservatively, without circumcision. Education and safe sex in later life will provide more than adequate protection from any of the other problems circumcision is claimed to prevent.

Psychological harm
The silence of men is mistaken for satisfaction. This site and others are collecting data that is likely to reveal that men are psychologically harmed by non-therapeutic circumcision.
One example of the psychological damage unnecessary circumcision can cause is alexithymia; a disorder where people have difficulty identifying and expressing their emotions [13]. Those affected become less able to empathize with others. Sufferers of severe alexithymia are so removed from their feelings that they view themselves as being robots. If acquired at an early age, such as from infant circumcision, alexithymia might limit access to language and impede the socialization process that begins early in life.

Cosmetic outcome
A paper titled “The long term outcome of severe hypospadias“[5] may seem unrelated but this paper is about the surgical repair of an abnormality seen at birth when the tube that should close to convey urine along the penis does not close completely leaving an opening on the underside of the shaft of the penis, through which urine can pass. The repair of the abnormality if it is severe often involves the use of the foreskin as replacement tissue. This long term follow up study asked the men for their views on the cosmetic outcome of the surgery and got the following response.

“Of those who consider their penile appearance to be ‘abnormal’, this is owing to the absence of foreskin in four cases”

The total number of men whose foreskins were used to effect the repair was 27, a small sample size, fortunately hypospadias is a rare condition,  4 men out of 27 works out at 14.8%. Fifteen percent of all the men who have been circumcised and therefore have had their foreskins removed may well feel that the appearance of their penis is “abnormal”. The resulting calculation works out as a very big number that represents a lot of men unhappy with the cosmetic outcome, never mind any other problems.

Follow up
So if a long term follow up approach was used on the male population who have been subjected to non-therapeutic excision of their foreskins what would be the results?  Sadly this work has never been done. Perhaps no one wants to know the answer.