To cut or not to cut

When my son was born, I agonized a lot about circumcising him.  As a Jew, I felt it was appropriate.  However, as someone horrified by female circumcision (which I do know is a much more extreme procedure), I wondered how I could justify cutting into a new baby's healthy flesh to satisfy a cultural practice.  I feel much better now about my decision:

For well over a decade, southern Africans have battled the spread of H.I.V. with everything from condoms and abstinence campaigns to doses of antiretroviral drugs for pregnant women — and yet the epidemic continues unabated.

Now a growing number of clinicians and policy makers in the region are pointing to a simple and possibly potent weapon against new infections: circumcision for men.

***

The most striking studies suggest that men can lower their own risk of infection by roughly two-thirds, and that infected men can reduce the odds of transmitting the virus to their partners by about 30 percent, simply by undergoing circumcision. Research suggests that the cells on the underside of the foreskin are prime targets for the virus and that tears and abrasions in the foreskin can invite the infection.

You can read more here, including the usual caveats to these stunning, albeit preliminary, research results. 

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  • http://OgBlog.net Earl

    The New Republic published a piece several years ago about circumcision (male), and a doc wrote in with his “favorite statistic” — out of 50,000 cases of penile cancer in a recent study, 49,990 were uncircumcised males. I have not checked this out, and there are lots of uncircumcised males who don’t get cancer — the moral I pass along to my students is that if they decide not to circumcise, they need to emphasize good hygiene to their boys. Tying your arm down and not washing under it carefully for 50 years would probably produce an epidemic of armpit cancer, after all!!

  • http://wwwjackbenimble.blogspot.com/ Jack

    I had a bris for my son and never looked back. Now 5.5 years later I can assure you that he is just fine.

  • http://bookwormroom.wordpress.com/ Bookworm

    My son, too, is in perfect shape, Jack. And Earl’s point may explain one of the facts that helped tip me towards circumcision for my son: the female sexual partners of circumcised males have lower incidences of cervical cancer. Coincidence? I don’t think so.

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  • Jorge

    Cervical cancer is caused by HPV, not foreskins. Google “Gardasil”, the cervical cancer/HPV vaccine.

    Penile cancer is a disease of old men. When the circumcised population starts getting really old, you’ll see way a lot more penile cancer among circumcised men. Besides, a man is more likely to get breast cancer than penile cancer. Why didn’t you get your son a mastectomy at birth? Why not your daughters, since women get breast cancer at a rate of 1 in 9 or so?

    And HIV. Did you know that the United States has the highest HIV infection rate in the industrialized world? And, of course, the United States has the highest circumcision rate in the industrialized world. So why should I believe that circumcision prevents AIDS? The circumcised American men who died of AIDs would take issue with that conclusion, that’s for sure!

    And circumcision lowering the rate of transmission to partners??? Idiocy! In infected men, HIV is present in semen and circumcised men still ejaculate semen, right? So why would it make a bit of difference?

  • http://bookwormroom.wordpress.com/ Bookworm

    From a critical appraisal of Castellsagué X, Bosch X, Munoz N, Meijer C, Shah K, De Sanjosé S, et al. Male circumcision, penile human papillomavirus infection, and cervical cancer in female partners. N Engl J Med 2002;346:1105-12

    Overall prevalence of circumcision was 19.3%; circumcised men had higher levels of education and reported less frequent genital washing compared with uncircumcised men (40.5% vs 23.0%). In all groups, circumcised men had lower prevalence of HPV (5.5% vs 19.6%). With circumcision, the odds ratio (OR) for penile HPV was 0.37 (95% confidence interval [CI] 0.16 to 0.85) after adjusting for age, level of education, age at first intercourse, lifetime number of sexual partners, and frequency of genital washing after sex. This result persisted whether or not female partners had cervical HPV or cancer. Apart from being uncircumcised, the only other significant risk factor for penile HPV was the number of men’s sexual partners.

    Female partners of circumcised men had a moderate but nonsignificant decrease in risk of cervical cancer (OR 0.72, 95% CI 0.49 to 1.04). This inverse association was not changed by any of the women’s variables. Monogamous female partners of circumcised men at high risk of HPV (intercourse before age 17, six or more sexual partners, and history of contact with prostitutes) had a significant reduction in risk of cervical cancer (OR 0.18, 95% CI 0.04 to 0.89). If both male and female partners were at low risk of infection, the women’s risk of cervical cancer was similar whether their partners were circumcised or uncircumcised (OR 1.61, 95% CI 0.86 to 3.02)

  • Jorge

    Regarding cervical cancer, I’d prefer vaccination to painful, nonconsensual penile reduction surgery, but maybe I’m just weird like that! :)

  • http://OgBlog.net Earl

    Relax, brother — no one wants to circumcise you!! :-)

    It’s just that there was a lot of really inflammatory nonsense out arguing against circumcision with stuff like “mutilation”, and “no medical reasons”, etc. I don’t think there’s enough on either side for folks to go against their cultural norms, and certainly not for the kind of pressure that has been put on people by the politically correct.

    By the way, speaking of breast cancer in males — in the U.S., if you’re a straight male and not a drug abuser, you have a better chance of getting breast cancer than AIDS. Whether you’re circumcised or not.

  • http://ymarsakar.blogspot.com/ Ymarsakar

    You should read John Ross’s article on this, Book. He introduced the logic about circumcision.

    http://www.john-ross.net/aids.htm

    Ross is a true liberal, so you might like some of his other insights. He’s one of those smart liberals that also went wise, and he did this before 9/11.

    Smart as in IQ 150 plus and wise as in, street smarts.

  • http://www.katapaltes.com Katapaltes

    Bookworm,
    As a hopeful future parent, and one that would hate to do something terribly wrong in my child’s upbringing, it gives me no pleasure to tell you that circumcision is obsolete and, in fact, harmful.

    The severity of female gential cutting is often broken down into three or four catagories, or “levels”, with 1 being the “mildest” (removal of some/all clitoral tissue) and 3 or 4 being the worst (complete removal of the vulva, plus “infibulation”, or sewing almost completely shut the vaginal opening). Physiologically speaking, male circumcision lies somewhere between level 1 and 2 in terms of pain, injury to the genitals, and life-long consequences.

    Circumcision removes 1/3 to 1/2 of the mobile skin system that is the foreskin+shaftskin of the penis. 10,000 to 20,000 nerve endings are also removed along with some delicate and useful muscle tissue. Because most of the nerve endings in a male are in the foreskin, not the head, removal of the foreskin results in dramtically reduced pleasure. Note: In women, these nerve endings are split equally between the clitoris and clitoral hood. Removing the clitoral hood from a girl/woman is nowhere near as bad as removing the foreskin of a man not only in terms of nerve loss, but in the amount of genitalia removed.

    Since you mentioned potential protection of female partners of circumcised men, Bookworm, I have one question for you and I’d like you to think about it: If it could be proved tomorrow that some form (*any* form) of circumcision of your daughter could protect her and her future *male* partner, would you cut your daughter’s genitals?

    When circumcision was introduced in this country over a century ago, most convervatives rejected it as unnecessary and radical. I hope conservatives today, along with all Americans, will hasten the demise of this obsolete procedure.

    -kat

  • http://bookwormroom.wordpress.com/ Bookworm

    To your question, Katapaltes: Yes, I’d definitely protect my daughter if it was a fairly limited cutting akin to a circumcision — and if it was done humanely (unlike the female circumcisions in Africa). Frankly, sexual pleasure has to be balanced against all the other things in life. To me, it’s fairly telling that, in our hedonistic culture, which places little emphasis on male monogamy, this battle would still be raging on despite fairly incontrovertable evidence that, as to one of the most significant disease scourges of our time, circumcision matters lots. To me, the balance of a slight loss of pleasure (and recall that the penis doesn’t stand alone as a conveyor of pleasure, because there are a few other nerves in the body, not to mention the effective processing center in the brain) against dealing a blow to a killer disease (or many diseases) is a no-brainer. I would also suspect, Kat, that, as a hopeful future parent, you’re perhaps a 20 something — a time in life when sex ranks higher on your list of what’s important than it will for the bulk of your life.

  • http://OgBlog.net Earl

    I always smile a bit when the argument from reduced sensitivity is brought up against circumcision — isn’t it true that one of the biggest complaints men have (ooops! I think it’s their wives) about sex is that of premature ejaculation?

    Well…….?

    It would be hard to ajudicate this dispute fairly — unless there is someone who was sexually active intact, and then underwent circumcision and after healing, carried on. Perhaps THAT gent could tell us what we’re wondering about. But, I’d not be satisfied until we had a thousand or so in the pool — so we could do a bit of statistical analysis of the results.

    I’m not honestly sure what I’d do with MORE sexual pleasure, in any case — at almost 60, it sometimes makes me worry about a heart attack now….but what a way to go!

    :-)

  • http://ymarsakar.blogspot.com/ Ymarsakar

    I think women are advantaged towards quality sex while men are designed to benefit from multiple sex. The sensitivity is not quite the issue with men as it is with women.

    The foreskin isn’t all that sensitive. It really doesn’t matter how many nerve endings there are in the foreskin, the foreskin was designed to protect the head, probably from cold/heat. In actual fact, there’s almost like no feeling at the portion of the foreskin where it opens up, compared to the skin on the shaft. Whatever nerve endings exist, are inside, not outside.

  • http://www.katapaltes.com Katapaltes

    I would disagree with your statement “Fairly limited cutting, akin to circumcision”. As I’ve stated, circumcision removes 1/3 to 1/2 of the penile skin. I take it you would allow removal of 1/3 to 1/2 of your little girl’s inner labia and clitoral hood? (The shaftskin+foreskin of the penis corresponds roughly to the female inner labia/clitoral hood.)

    As to circumcision preventing AIDS, I’d like to know why this recent African AIDS story is getting so much traction when you consider that Europe, a much better analogue to the United States than Africa could hope to be. (Predominantly white, predominantly Christian, 300+ million people in 41 countries…. sound familiar? I could almost be describing the U.S.) They have *very low* circumcision rates and their AIDS rates are *lower* than ours. Clearly, circumcision does not lower the spread of AIDS in Europe. Remember now, foreskins have been blamed by doctors for everything from epilepsy to insanity to rickets to feeble-mindedness (no, I’m not making this up – check it out yourself). AIDS is just the latest scourge to excuse a procedure (circumcision) looking for a rationale.

    It is also not a “slight loss of pleasure”, I assure you, for reasons I’ll explain in my next paragraph.

    As to your guess about my age, I am not a 20-something, but in my late thirties. I know all too well the reduction in sensitivity caused by the build-up of dead skin cells on the glans and on what remains of my foreskin (the process is called keratinization). So there are, in fact, more important and engaging things on my mind than sex at the moment, like my job, thoughts of home ownership, marriage, and protecting children from unnecessary surgery.

    Earl, you don’t have to be first uncut, then cut to experience some of the pleasure denied by circumcision. All you have to do is take “the test”. Push the glans of your penis down into your [remaining] shaft skin and keep it there with medical tape for four days (you’ll need to loosen this arrangement at night if you experience nocturnal erections as you don’t want to stress the skin too much). After four days, you should experience color and sensitivity change (for the better). I did. I too thought all this talk about circumcision being bad was silly too until I did this test, then I came to understand it completely. I’m happy for your abundance of pleasure, Earl, and I wish I had it. I cannot climax with my girlfriend and she and I both know the reason why. If she and I are to have children later on, this will be a major problem. I don’t want the conception story of my future daughter or son to involve a turkey baster when it didn’t have to be that way.

    As for Ymarsakar, I’m not sure what he’s talking about… The foreskin “remnant” (the skin between the circumcision scar and the glans or “head” of the penis) is the most sensitive part of the penis on most circumcised men. The foreskin is also the most sensitive part of the intact penis.

    Many people simply cannot come to grips with the harms of circumcision and you may not be immune to this. It’s difficult to admit that your parents who loved you let you be harmed or that you, in turn, harmed your child. I know I won’t convince you with my statements tonight, but you’ll be hearing more and more about this with circumcision rates dropping fast across the country as parents who thought it was necessary discover it’s unnecessary and parents that thought it was unneccessary discover that it’s harmful.

    The circumcision rate in this country is down to 56% from a high of 90% in 1970. It’s only 35% in the western states where, as we all know, trends often start in this country. Soon, circumcised baby boys will be in the minority, and they’ll be a disadvantaged minority at that. Who knows? Maybe they’ll be able to turn that into a advantage when they apply for minority business status… because they sure won’t be advantaged in the bedroom.

    -kat

  • http://ymarsakar.blogspot.com/ Ymarsakar

    They have *very low* circumcision rates and their AIDS rates are *lower* than ours.

    That has to do with the fact that Europeans use condoms and Africans rape virgin children because they superstitiously believe they either won’t get AIDs that way or that it is a cure.

    AIDS is just the latest scourge to excuse a procedure (circumcision) looking for a rationale.

    There really is no excuse in saying that AIDs is transmitted through the bloodstream, and unlike other venereal diseases, it requires an actual cut in your skin to get through to your bloodstream. (one reason why Africans have higher rates, there’s a lot of sex with underaged and virgin children) When the foreskin opens, it has to expand around the blood engorged head. Without lubrication, there’s a lot of chaffing and stretching, dryness of the skin, and a tear will develop.

    The skin, if you recall, is wrapped around a penis while it is not erect, so it grows around a small circumference. It’s just simple physics and biological adaptation.

    The foreskin “remnant” (the skin between the circumcision scar and the glans or “head” of the penis) is the most sensitive part of the penis on most circumcised men. The foreskin is also the most sensitive part of the intact penis.

    It may be sensitive cause it is a remnant, something not designed to be a layer. I’m uncircumcised and the foreskin is not the most sensitive part of the intact penis. That would make little biological sense given that the purpose of the foreskin is to protect the most sensitive part of your reproductive organs, aside from the balls of course. Pretty sure cave man going through bushes needed something for all those leaves hitting him in the privates.

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  • Sabba Hillel

    Actually, the only reason that I consider legitimate for circumcision is that we are commanded to do so (on the eighth day) by G-d. Yes there are health arguments for it, but those arguments are strictly for nonJews. We should do it (properly with a mohel) for the one reason that applies to Jews alone.

    In any case, I can confirm, that after my bris I was unable to walk or talk for a year. My sons and grandsons also were not able to walk for almost a year after this operation.

    I would love to see someone try to use that as an argument against it.


    Sabba Hillel | Said the fox to the fish, “Join me ashore.”
    SabbaHillel@gmail.com | The fish are the Jews, Torah is our water.
    http://photos1.blogger.com/blogger/7637/544/640/SabbaHillel.jpg

  • Ben-David

    Bookworm: Welcome to the wonderful world of anti-circumcision activism! So far this thread seems to have gotten off lightly, and to remain relatively civil.

    Some pertinent points – especially from a Jewish perspective:

    1) Jewish circumcision is not the same as hospital circumcision, which is a far more radical procedure. Specifically, Jewish circumcision technique preserves the erotically responsive layer of the foreskin, while removing the outer layer of skin. Traditionally circumcised men will be able to identify this band of pinker, finer, more sensitive skin (hey, come back and finish reading my post… hey!…)

    So all the data quoted by the anti-circers here is irrelevant to Jewish circumcision – nowhere near 1/3 of the skin is removed, there are far fewer complications, etc.

    In addition, the procedure is performed by a well-trained practitioner, rather than by an inexperienced intern as it is in most hospitals. And Jewish circumcision is quicker and less painful compared to hospital methods.

    2) Regarding sexual enjoyment: Israel has absorbed over a million Soviet immigrants – tens of thousands of them have undergone circumcision in adulthood.

    Some years ago, Israeli doctors surveyed these men. On the matter of sexual pleasure, the responses were equally divided between “no change” “now it’s worse” and “now it’s better”.

    Immediately the anti- and pro-circumcisioniks tried to spin this survey – the antis claiming that the “no change” group were being defensive, the pros claiming that 2/3 of the men experienced positive results.

    So the researchers went back to the data – and found that the “now it’s worse” group was largely made up of men who cited external pressure by peers or lady-friends as their motivation for getting cut… and we all know that the nerves between the ears are as important to arousal as the nerves between the legs…

    3) Several posters have defended circumcision on health grounds. This is not the Jewish approach. Certainly billions of non-Jewish men get along just fine without circumcision.

    Jews circumcise because we are in a binding covenenant with G-d.
    Not because it’s healthier.
    Not because it looks nicer.
    Not because it’s more or less pleasurable.

    Perhaps knowing that the actual technique is very simple and non-invasive will remind Jews that this is not a medical procedure for us…

    Our father Abraham turned away from the selfish, exploitative paganism of his time and, sensing the unity of G-d, asserted the brotherhood of humanity. And he – and we! – further assert that this unity must be expressed in this world, through justice and kindness in human affairs.

    By choosing this path, Abraham and his children became partners with G-d in the creation of the world – through these teachings the world will be brought to perfection, and G-d will dwell among us. That is why the sign of this covenant is placed at the point where the spark of new life issues into the world. (At least, that’s one reason – there is never just one reason for anything after 3000 years of Judaism…)

    This is all the rationale that is needed for this simple, benign procedure.

  • old fahart

    The truth about the seneitivity is true as one that was circ. as an adult..at 45… I can say cadigoricaly you do loose a good bit of sensitivity!! Premature ejaculation has allmost never been an issue except in my most impetouse youth…controle is a learned skill…. as a father had there been male childeren I would not have had this done.Those who dont know will never understand.The pleasure is unfortunatly permently deminished. On a 1-10 scale 1 a little diminished I am about a 7.5 I still enjoy but the earth shaking 9.8 orgasms are gone forever but I will servive. J

  • http://remeron.wordpress.com/ remeron

    your blog is a gold mine of info, thx

  • Kyle

    hey u kinda freaked me out now im an uncircumsized male teen and i like the way i am but how can i properly clean how do i do it? i dont want to cause pain and i want to feel pleasure not to mention ur numbers are frightning

  • http://ymarsakar.blogspot.com/ Ymarsakar

    What happens is that the foreskin prevents desensitivization of the head of the male member. You don’t hit it against underwear, jeans, and sheets and therefore the skin under the foreskin is more sensitive.

    Cleaning is not a big deal, practical hygiene like taking a shower should be enough.

  • Kyle

    ok thank you