Saturday, May 29, 2010

Crazy Dutch Want to Ban Male Circumcision

At a time when much of the world is embracing the life-saving and healthy practice of male circumcision, Radio Netherlands is reporting that the Royal Dutch Medical Society wants to ban all male circumcisions in that country.

What's wrong with these Dutch doctors? What studies have they failed to read? What recommendations of the World Health Organization do they reject? What makes them incapable of seeing the benefits of a clean-cut penis?

My own view is that they have a deep cultural bias against the clean-cut penis, given that circumcision is so rare in that country. Now I know the anti-circ fanatics in USA will say this mirror our own cultural biases in favor of newborn circumcision, but the situation here is more nuanced than that. After all, we do have a strong anti-circumcision propaganda machine here that exerts inordinate pressure on medical societies and government agencies. In short, the USA has a national debate -- at least among the passionate -- on male circumcision.

That is apparently not true in Holland, where the uncircumcised doctors are simply rejecting, for their own cultural reasons, all the medical studies and evidence from around the world that support male circumcision. Forget the evidence. They want everyone to be uncircumcised because they are.

This blog supports the universal circumcision of all males, not because of any cultural norm, but because it is a medically proven way to protect not only the male but all his partners. If all males were circumcised, we would see a reduction in HIV, HPV, cancer, and so many other ailments directly linked to the useless foreskin. This is not a cultural argument; it's a medical one.

Here is an except from the Radio Netherlands report:

"The circumcision of boys is reportedly almost always unnecessary and medically risky. The Royal Dutch Medical Society (KNMG) has published recommendations advising doctors to discourage parents from having their sons circumcised. Jewish and Islamic organisations have reacted angrily."

"The KNMG would really like to ban the circumcision of boys altogether, but the organisation feels a legal ban would only lead to circumcision going underground, increasing the risks."

"More than 46,000 Dutch doctors and trainee doctors are members of the society. They call circumcision for non-medical reasons “an infringement of a child’s right to autonomy and the right to bodily integrity”. And they say there are unnecessary risks."

"However, the doctors are willing to take the cultural and religious sensitivities of parents into account. Which is why doctors, parents and religious groups plan to engage in a dialogue. And yet, Rasit Bal, chairman of the interest group Muslims and Government, was unpleasantly surprised by the advice of the medical community:

“I have noticed that it is becoming increasingly difficult to publicly display one’s religious identity. Things like this make it difficult. This is one of those issues that make life difficult for people who practice a religion”

"About 10,00 to 15,000 circumcisions are performed each year, most of them on Jewish and Muslim boys. Rabbi Raphael Evers says this figure includes about 80 Jewish boys. He argues peer pressure does not play a role in the decision to have one’s son circumcised. The rabbi says it’s the wish of the parents. He brushes aside any medical risks and even claims the surgery brings health benefits."

“Agitation against circumcision as a perceived threat against public health has been going on for quite some time, and it’s just nonsense. I have personally made extensive inquiries into both the physical and psychological problems of circumcision but never heard about any.”

"The growing number of circumcisions among boys has not led to any kind of serious discussion in the Netherlands, in marked contrast with the circumcision of the daughters of African immigrants. The excision of girls’ labia minora and/or clitoris is almost universally condemned as genital mutilation.

"So now the doctors have set their sights on the circumcision of boys. Medical ethicist Gert van Dijck says doctors will invoke children’s rights to emphatically discourage parents from requesting the procedure."

“We are asking doctors to actively and urgently warn parents that there are no medical advantages to circumcision and that there is a risk of complications. This way, we are hoping to achieve a culture change via the parents, so that they will eventually stop doing it.”

65 comments:

  1. So you also disagree with The Royal Australasian College of Physicians, The Canadian Paediatric Society and The British Medical Association?

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  2. Aren't alot of these organizations rethinking their position in light of recent medical studies showing how good circumcision really is? The American Academy of Pediatrics and the National Center for Disease Control are doing that now I think. Alot of these groups have outdated views on circumcision. They need to get into 21st century.

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  3. Anon 2 makes a good point. I really don't know how old the statements from Australia, Britain, and Canada are. At least the AAP is taking time to review its "neutral" position in light of all the positive medical findings on the health value of a circumcised penis. Of course, the polemics of the anti-circ crowd may make the AAP retreat from doing what is medically right. We shall see.

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  4. The statements from Australia, Britain, and Canada were published in 2009.

    They do not recommend routine infant circumcision.

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  5. Even if you were a medical doctor, which you are not, what you say flies in the face of a national medical body composed of 48,000 doctors and students. Hum?, Who to believe?! You say it's medical not cultural. The Royal Dutch Medical Association says:
    "There is no convincing evidence that circumcision is useful or necessary in terms of prevention or hygiene. Partly in the light of the complications which can arise during or after circumcision, circumcision is not justifiable except on medical/therapeutic grounds. Insofar as there are medical benefits, such as a possibly reduced risk of HIV infection, it is reasonable to put off circumcision until the age at which such a risk is relevant and the boy himself can decide about the intervention, or can opt for any available alternatives."
    So non therapeutic circumcision has no "convincing" medical grounds. You are thus too not "reasonable" not letting circumcision be decided later at a time the male can access his risks. Further:

    "Contrary to what is often thought, circumcision entails the risk of medical and psychological complications. The most common complications are bleeding, infections, meatus stenosis (narrowing of the urethra) and panic attacks. Partial or complete penis amputations as a result of complications following circumcisions have also been reported, as have psychological problems as a result of the circumcision."
    You being cut, I believe you fall into the category of psychological problems. Seek help.

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  6. The statements from Australia, Britain, and Canada were published in 2009.

    It might be a good idea to check your facts in future. The current BMA statement is dated Nov 2007, that of the RACP is dated 2004, and that of the CPS is dated 1996.

    They do not recommend routine infant circumcision.

    True, but the issue being discussed is elective infant circumcision (that is, circumcision at the discretion of parents), not routine infant circumcision (circumcision of all newborn males). And none of these organisations are opposed to elective infant circumcision.

    To respond to KOTFrank:

    Even if you were a medical doctor, which you are not, what you say flies in the face of a national medical body composed of 48,000 doctors and students. Hum?, Who to believe?!

    Let's be realistic here. This particular statement is at odds with statements from many other professional bodies, so it would be very disingenuous to portray this as a case of 48,000 doctors vs one. Perhaps you'd like that to be the case, but it isn't.

    So non therapeutic circumcision has no "convincing" medical grounds.

    Um, no, this particular organisation believes that circumcision has no convincing medical grounds. There is a difference between the two statements.

    You are thus too not "reasonable" not letting circumcision be decided later at a time the male can access his risks.

    Here you're making the mistake of reasoning from an opinion as though it were a universal truth.

    You being cut, I believe you fall into the category of psychological problems. Seek help.

    Frankly this comes across as a very thinly veiled personal attack, but if we give you the benefit of the doubt and assume that you're being sincere, the mistake you're making here is to assume that because psychological problems are possible they must be automatic. That's not very rational, is it?

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  7. "True, but the issue being discussed is elective infant circumcision (that is, circumcision at the discretion of parents), not routine infant circumcision (circumcision of all newborn males). And none of these organisations are opposed to elective infant circumcision."

    A recommendation is not a mandate. For instance, the AAP recommends routine vaccinations, and recommends that all babies be breastfed. Do they mandate these things? Of course not. A recommendation is still a decision to be made at the "discretion of parents". So why, then, does not a single medical organization recommend neonatal circumcision? If the general consensus is that the benefits outweigh the risks (as you have previously stated) why recommend that it not be done routinely? That would be a very strange position indeed- to believe that the operative benefits outweigh the risks but still not recommend the procedure. Incidentally, not a single western medical association has stated they believe the benefits outweigh the risks, as you believe they do. For example, the Royal Australasian College of Physicians asserts: "Review of the literature in relation to risks and benefits shows
    there is no evidence of benefit outweighing harm for circumcision as a routine procedure in the neonate."

    Recommending the procedure is in no way taking away a parent's right to choose one way or the other.

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  8. At least Jake has the honesty to define the dishonest term "elective" in the context of circumcision. If circumcision were elected by the person whose penis is affected, there really wouldn't be much debate.

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  9. A recommendation is not a mandate. For instance, the AAP recommends routine vaccinations, and recommends that all babies be breastfed. Do they mandate these things? Of course not. A recommendation is still a decision to be made at the "discretion of parents".

    From the parents' point of view, perhaps so, but from the point of view of the organisation making the recommendation there is a difference between "we recommend that X should be done to all babies" and "we recommend that parents should decide re X".

    So why, then, does not a single medical organization recommend neonatal circumcision? If the general consensus is that the benefits outweigh the risks (as you have previously stated) why recommend that it not be done routinely?

    Allow me to quote from a letter to Pediatrics by the 1999 AAP Task Force: "There is no disagreement between the Task Force and the authors over the fact that there are potential medical benefits to circumcision. There is disagreement over the magnitude of these beneficial effects. The Task Force found the evidence of low incidence, high-morbidity problems not sufficiently compelling to recommend circumcision as a routine procedure for all newborn males. However, the Task Force did recommend making all parents aware of the potential benefits and risks of circumcision and leaving it to the family to decide whether circumcision is in the best interests of their child."

    In other words, they're saying that although there are benefits, they felt that there wasn't enough of a benefit to recommend circumcision as a routine procedure for all baby boys.

    Incidentally, not a single western medical association has stated they believe the benefits outweigh the risks, as you believe they do.

    Wouldn't you describe the CDC as a medical association? See Page 79: "Medical benefits outweigh risks for infant MC, and there are many practical advantages of doing it in the newborn period."

    For example, the Royal Australasian College of Physicians asserts: "Review of the literature in relation to risks and benefits shows there is no evidence of benefit outweighing harm for circumcision as a routine procedure in the neonate."

    That might mean that they believe the procedure to be neutral.

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  10. Didn't the American Academy of Pediatrics at one time "recommend" routine infant circumcision? And then they took a "neutral" stance outlining its benefits but saying circumcision was not "necessary?" Now they are reviewing -- in light of all the medical studies -- whether to "recommend" that all baby boys be circumcised. I hope they do. But that can't make it a requirement. So why all the fuss among those who don't want to circumcise their sons? They can still leave their kids uncircumcised. I feel like these anti circumcision people are trying to push their uncircumcised views on the rest of us.

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  11. "In other words, they're saying that although there are benefits, they felt that there wasn't enough of a benefit to recommend circumcision as a routine procedure for all baby boys."

    Right. The benefits don't outweigh the risks.

    "Wouldn't you describe the CDC as a medical association?"

    I don't consider the CDC or WHO a western specific medical organization, no. In any case, since 2007, many researchers from the CDC have been quoted stating they believe circumcision would only have a limited impact in the US. One such quote: "But circumcision may not make much difference in transmission among men in Western countries for a number of reasons, according to Deborah A. Gust and her colleagues at the CDC.

    One factor could be the fact that many HIV-positive people in developed countries are on powerful HIV drugs that reduce the chances of transmission, and may outweigh any effects of circumcision. In addition, Gust and her colleagues point out, circumcision would not affect HIV risk from receptive anal sex -- and that, again, could outweigh any protective effect of circumcision during insertive sex." They also state that they may just "...simply recommend that health-care providers educate parents about the potential benefits and risks to ensure that parents have the information they need to make an informed decision."

    Jake says "That might mean that they believe the procedure to be neutral."

    So, if they believe the benefits do not outweigh the risks why should they recommend surgery? The usual standard for an irreversible surgery performed without the consent of the patient is that the patient is receiving a large benefit, or at the very least that the benefits outweigh the risks. Any other surgery would have to fall within those logical guidelines.

    In response to Anonymous:

    "Now they are reviewing -- in light of all the medical studies -- whether to "recommend" that all baby boys be circumcised. I hope they do. But that can't make it a requirement. So why all the fuss among those who don't want to circumcise their sons? They can still leave their kids uncircumcised. I feel like these anti circumcision people are trying to push their uncircumcised views on the rest of us."

    Similarly, recommending that it not be done routinely is not a requirement that parents must follow (at least not yet). " So why all the fuss among those who (want) to circumcise their sons? They can still (circumcise) their kids. I feel like these (pro circumcision) people are trying to push their (pro circumcision) views on the rest of us."

    See what I did there?

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  12. " The usual standard for an irreversible surgery performed without the consent of the patient is that the patient is receiving a large benefit, or at the very least that the benefits outweigh the risks. Any other surgery would have to fall within those logical guidelines."

    I meant to add healthy, normal children.

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  13. "In other words, they're saying that although there are benefits, they felt that there wasn't enough of a benefit to recommend circumcision as a routine procedure for all baby boys."

    Right. The benefits don't outweigh the risks.


    Wrong. They're not saying that the benefits don't outweigh the risks. They're saying that the difference between the two (the magnitude of the net benefit) is not large enough to recommend it as a routine procedure for all infant boys.

    I don't consider the CDC or WHO a western specific medical organization, no.

    Hmm, that seems a little odd, but ... okay.

    In any case, since 2007, many researchers from the CDC have been quoted stating they believe circumcision would only have a limited impact in the US.

    In global terms, that's undoubtedly true. With an adult prevalence of HIV of about 0.6%, it stands to reason that the impact of circumcision in the US will be smaller than, say, sub-Saharan African countries with HIV prevalence of 10% or more.

    So, if they believe the benefits do not outweigh the risks why should they recommend surgery?

    The RACP don't recommend surgery in this context. I thought we had established that.

    The usual standard for an irreversible surgery performed without the consent of the patient is that the patient is receiving a large benefit, or at the very least that the benefits outweigh the risks. ... I meant to add healthy, normal children.

    Usual standard according to whom? I would think that a more reasonable standard is the avoidance of harm; that is, if a procedure would be harmful then it should be avoided. If a procedure would be strongly beneficial from a medical perspective then one would expect it to be strongly encouraged. In the middle is the roughly neutral area in which parental discretion seems reasonable.

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  14. "In global terms, that's undoubtedly true. With an adult prevalence of HIV of about 0.6%, it stands to reason that the impact of circumcision in the US will be smaller than, say, sub-Saharan African countries with HIV prevalence of 10% or more."

    "The researchers also note, however, that other CDC scientists have concluded, based on their own studies, that circumcision would likely have only a "limited" impact on HIV transmission in the U.S.

    Read more: http://www.vancouversun.com/health/Circumcision+spread+among/2662721/story.html#ixzz0pRFbulMt"

    A statement from the WHO:

    "In countries where the HIV epidemic is concentrated in specific population groups such as
    sex workers, injecting drug users or men who have sex with men, there would be limited
    public health impact from promoting male circumcision in the general population."

    Jake says: "In the middle is the roughly neutral area in which parental discretion seems reasonable."

    I don't consider permanently altering the genitals of children "neutral" surgery, nor do I agree that parental discretion is reasonable in the case of circumcision. In any case, courts have agreed with my assessment in the past. Instances where a parent wanted their child to get circumcised but the child did not want the procedure, the courts have ruled in favor of the child.

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  15. "In global terms, that's undoubtedly true. With an adult prevalence of HIV of about 0.6%, it stands to reason that the impact of circumcision in the US will be smaller than, say, sub-Saharan African countries with HIV prevalence of 10% or more."

    "The researchers also note, however, that other CDC scientists have concluded, based on their own studies, that circumcision would likely have only a "limited" impact on HIV transmission in the U.S.


    I don't quite understand why you're adding further quotes. I've already agreed that the impact of circumcision in the US is relatively small in global terms.

    I don't consider permanently altering the genitals of children "neutral" surgery, nor do I agree that parental discretion is reasonable in the case of circumcision. In any case, courts have agreed with my assessment in the past. Instances where a parent wanted their child to get circumcised but the child did not want the procedure, the courts have ruled in favor of the child.

    As seems right and proper — after all, if a child expressed a wish not to be circumcised and was circumcised anyway, it would likely have negative psychological consequences. But the situation with infants, who can neither form nor express such a wish, is clearly different.

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  16. "As seems right and proper — after all, if a child expressed a wish not to be circumcised and was circumcised anyway, it would likely have negative psychological consequences."

    Likewise, an adult who was circumcised against his will as an infant and wishes he hadn't been can suffer from negative psychological consequences, as it is an irreversible procedure.

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  17. Likewise, an adult who was circumcised against his will as an infant and wishes he hadn't been can suffer from negative psychological consequences, as it is an irreversible procedure.

    As I've already pointed out, infants can neither form nor express such a wish, so it is inaccurate to claim that an infant can be circumcised against his will. It is true, though, that some men do indeed resent being circumcised as infants, and other men resent not having been circumcised as infants. If infants were capable of expressing their wishes, it would certainly facilitate decision making, but unfortunately they can't, and we have to rely instead upon guesswork, which is sometimes wrong.

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  18. Pro-circumcision people are just jumping around the facts the same way many people do with all other arguments like this one that place importance on individual thought and/or opinion...what it boils down to is:

    CIRCUMCISION IS NOT NECESSARY except in a few rare cases. If you'd look it up, the number of corrective surgeries needed for circumcised boys is actually greater than the number of boys who get a UTI who are left uncircumcised! ...so that argument doesn't hold up as much as the HIV one, etc...

    The only benefit of circumcision is aesthetic appeal. That's it. If that's why you are circumcising your son (or self) that's fine! ...but given the information that's out there and given that there is always a risk with surgery and given that this procedure isn't medically necessary, IT'S JUST A DUMB DECISION. We embrace many dumb decisions in our country, for example, the decision for many to consume large amounts of fast food resulting in obesity. Again, people can argue that obesity is genetic, blah blah blah, but the simple fact is that the individual made a choice to consume the unhealthy food and, in doing so, went against proven facts about health and nutrition. ...which, like circumcision, is fine! ...but stupid.

    (And, in my opinion, routine infant circumcision is also ethically wrong because the child has no say.) And that's why I'm not in favor of it.

    I've posted a link to this before on this blog, I believe, but still check this out:

    http://expansionofspace.blogspot.com/2010/03/study-finds-that-cutting-off-fingers.html

    I just can't agree with any of the statments made on this blog. They violate evidence and often violate common sense. ...to the point that some of it sounds as though it was meant to be comedy. I may just have to stop checking in lol...I'm not sure it matters what I have to say. Unlike what I write, this blog is written as definitive, final opinion and not something which is meant to broaden horizons, be intellectually argued, and then perhaps be altered. Which is fine...but just a little dumb. lol

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  19. I am still convinced this is a troll blog. I never see PD post on other articles or blogs. Not only that, he hardly ever responds to posts made in the comments.

    EVEN JAKE isn't insane enough to think that circumcising every baby boy should be made mandatory.

    This is the land of the free, afterall.

    Maybe he should try and live in North Korea for a year or two and see how much he likes the way of life there.

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  20. You are all missing the point of this ban, the real reason behind the proposed circumcision ban is a swipe at Islam. Ever since the Van Gogh murder by an Islamo-facist, Holland, as well as several other European countries have been cracking down on the ever-growing Muslim population. Note the recent ban of the Burkha in France. I am quite sure that this is another way to perhaps pursuade a population, who generally has not, to assimilate and accept the European way of life. I do not think there is much revulsion against circumcision amongst the general population (from my own experiences travelling the continent as a cut American).

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  21. Chris, thanks for an interesting post. Yes, you could be right. By attacking circumcision, the Dutch are really attacking their growing Muslim population, hoping all the Muslims move out of their country. But don't the Dutch exercise some kind of border control? As far as I can tell, the only country that does NOT control its own border is the USA. (But that's another debate).

    Anon, not exactly sure what you mean by "troll blog" but I choose not to engage in debate on other sites. On my own blog, the whole point is to provide a forum for others to debate all aspects of circumcision as raised in my occasional posts. The fact that so many of you, on all sides, participate is proof that my goal is being met.

    As far as universal circumcision is concerned, nothing I have seen convinces me that we wouldn't be better off if every boy was circumcised. To the contrary, if I had my way, no male newborn would leave the hospital with a filthy disease-generating foreskin (except in rare medically required cases or, perhaps, with some strong conscientious parental objection). I just honestly believe a circumcised society offers the best medical protection for both men and women. Obviously, others disagree. Again, that debate is part of the reason for this blog.

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  22. Yeah, except none of the top 10 healthiest countries in the world are circumcising countries.

    The US ranks the lowest of all the Western countries, doesn't seem to have done much for us.

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  23. Yes, I know that some Western countries have adult circumcision rates similar to ours... the point is that whether a country is circumcised has little to do with the overall health of its people.

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  24. Yeah, except none of the top 10 healthiest countries in the world are circumcising countries. ... The US ranks the lowest of all the Western countries, doesn't seem to have done much for us.

    What hypothesis are you actually trying to test? That circumcision has such a huge effect on general health that it outweighs the effect of anything else?

    That doesn't seem like a very realistic hypothesis to test. Realistically, it would be reasonable to expect circumcision to have an effect on population health, but it would be one of many factors to do so, and so the effect of differences in circumcision rates might not always be apparent due to comparison between apples and elephants.

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  25. To respond to im_a_creator:

    If you'd look it up, the number of corrective surgeries needed for circumcised boys is actually greater than the number of boys who get a UTI who are left uncircumcised!

    No, it isn't.

    There are relatively few statistics available on circumcision revisions. Probably the largest survey is a national UK study by Cathcart et al, found that 303 of 66,519 boys (0.46%) required revision. But complication rates are known to be inversely correlated with operator experience, so it is probable that the actual rates are lower where circumcision is more frequently performed.

    In contrast, even the most conservative figures that consider only the first year of life find UTI rates of 1-2% among uncircumcised boys. More realistic figures, including all of childhood, would put this figure at 3-4%, and for a lifetime perhaps 20%.

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  26. "What hypothesis are you actually trying to test? That circumcision has such a huge effect on general health that it outweighs the effect of anything else?"

    My point is that whether or not half of a country's population has their foreskin has little to do with the overall health of that country. If many many non circumcising countries can achieve much better overall health than a predominately circumcising one, then the differences that don't involve the foreskin are what should be looked at.

    Better health care, healthy eating, and exercise will play a predominant role in overall healthiness of a country, not foreskins.

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  27. Hey Jake, Tony at rollingdoughnut.com has responded to you. He says:

    My statement that circumcision alters the functional process of sexual activities is not questionable. I used the word alters with a purpose. It is not about a subjective call on better or worse. It is a factual statement about process.

    An example: For IVF treatment, part of the process is obviously sperm collection. The sample must be collected without benefit of a lubricant. For an intact male, this is unlikely to be a problem. For a circumcised male, this is a painful problem. The functional process of sexual activities is different with and without circumcision. QED

    Note, too, that I did not state that any permanent change settles the question. I stated that any permanent change to healthy children settles the question. That is with respect to circumcision, as I thought we'd agreed that there are differences between circumcision and vaccination. I know you'll reject my view on the differences, but it's clear that Joe's assessment is correct. The differences between non-therapeutic circumcision and vaccination are not trivial, unless, for example, you think transmission of HIV and measles is the same. Do you?

    Jake said: "On the subject of risk, I believe it would be foolish to consider only risks associated with circumcision and not risks associated with non-circumcision. ..."

    On the subject of risk, I believe it would be foolish to consider only risks associated with female genital cutting and not risks associated with non-female genital cutting. On the subject of risk, I believe it would be foolish to consider only risks associated with infant mastectomy and not risks associated with non-infant mastectomy. On the subject of risk, I believe it would be foolish to consider only risks associated with appendectomies and not risks associated with non-appendectomies.

    That framing is a useless turn away from reality. Life involves risk. If we take your angle as valid, especially given how we (stupidly) value parental whim with male circumcision, then any intervention that might have an effect can be considered and applied, whether necessary or not, and without regard for the absolute risks of the "non" surgically-altered state. Subjective weighting can get anyone to any conclusion.

    That framing also ignores the difference between circumcision and the application of circumcision. I don't value the risk reduction I received, although I recognize that some level of risk reduction likely occurred. I genuinely do not care that I'm x% less likely to become HIV positive should I ever have sex with an infected woman, or that I'm n times less likely to develop a UTI. So, contrary to your assumption, I have considered the risks of "non-circumcision". I choose differently than you for myself. That's why you're wrong on how to apply circumcision. I'm correct because I consider each individual, too.

    Jake said: "On a related note, you ask: "Which of the potential benefits you favor are not preventable or treatable with less invasive, non-permanent bodily alteration?" I don't believe that this question is even relevant. Whether it can be prevented with other means is a moot point unless it actually is prevented with other means. ..."

    This works against you as much as it works for you. Circumcision's prophylactic benefits are a moot point unless it actually prevents what it allegedly protects against. You can't prove that, of course, so touting the benefits to a healthy child is mere speculation. That's not an ethical or medical standard for proxy consent for an objectively healthy child.

    You also ignore that treatment is a valid consideration. I'd rather treat a UTI and have my foreskin than not have a UTI or my foreskin. Etc.

    (continued)

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  28. "... If it is not, then the risk exposure must still be counted. ..."

    You assume I haven't counted it? Circumcision has potential benefits, whether or not I agree with you on the magnitude of those benefits. But I factor the risk exposure as it applies to me. I'd risk my health by the small measure associated with the foreskin to have my normal, healthy genitals (and autonomy). You're demanding that I substitute your judgment for mine as it applies to me. You have a certain risk aversion and you expect me to share it. I do not.

    Jake says: "Also, methods of risk reduction are rarely mutually exclusive, so one might also consider circumcision plus other methods, which may be expected to reduce risk further. The simplistic view in which there is circumcision on one hand and something "less invasive, non-permanent" on the other has little, if any, connection with reality."

    This is a useful point. But it doesn't change the difference between circumcision and applying circumcision. Touting it as a complementary method relies on the former, while ignoring the latter. Whether an individual wants or needs potential extra benefit from circumcision (e.g. condoms for HIV prevention versus condom and circumcision for HIV prevention) is subjective to him. If an adult male values it and chooses circumcision voluntarily after assessing his risks, wants, and needs, there's no issue. But in applying it to a child, parents weight their guesses more than his lack of need. They've applied it incorrectly (i.e. unethically).

    Jake said: "There are men who weren't circumcised as infants who similarly curse their parents' decisions. I'm sorry that you feel the way you do. I'm sorry that those men do, too. But I don't accept your view that you were wronged."

    Do you lack the empathy to understand that other people think differently about themselves than you think about yourself?

    Everything else you've said is fine, a difference of opinion at best, a misunderstanding of certain facts at worst. I'm mature enough to understand that I'm not always right and that I'm not always going to convince everyone when I am (as I am here). And I've worked on this topic long enough to understand the usual blinders.

    But forget that. Your rejection of my view about me pisses me off. It's arrogant of you to think you know better about my body than I do. (Or that my parents knew better than I do.) Men who curse their parents' decision to leave them intact have a solution to make their normal body reflect their preference. I do not have my normal body. My choice is gone. My right to be free from harm was violated. Upset intact men do not have a "right" to grow up circumcised. Equating the two, as you implicitly do, is ridiculous.

    My parents had me mutilated. It is definitionally true, and anecdotally verifiable every time I see my penis. Intent, potential benefits, cultural inclusion or any other nonsense used to excuse circumcision (mine or otherwise) does not alter that fact or magically render it acceptable. You might recognize that if you stopped elevating the subjective to the same level of the objective and stopped viewing the collective as a suitable substitute for the individual.

    At its core, your conclusion treats children as property. It means that my body belonged to my parents until I became an adult, and the only thing that saved me from other abuses was my "good luck" to be born into flawed American societal norms rather than some other country's whose lack of protections was worse. That's offensive. My body was and is mine, from birth until death. There rests the difference between circumcision and the application of circumcision."

    ReplyDelete
  29. My point is that whether or not half of a country's population has their foreskin has little to do with the overall health of that country.

    You haven't proved that point, though. How do you know that there isn't some difference that counteracts the effect of circumcision? To show that circumcision rates have no effect on the overall health of a country you'd have to first produce a mathematical model allowing you to predict the general health of a country from factors excluding circumcision, then show that adding circumcision to that model makes no change.

    ReplyDelete
  30. Hey Jake, Tony at rollingdoughnut.com has responded to you. He says:

    What relevance does this have to this thread?

    ReplyDelete
  31. "What relevance does this have to this thread?"

    Umm it has to do with circumcision? and he discusses the belief that healthy children shouldn't be circumcised because it is a violation of a person's autonomy, a view shared by the medical organization that wrote the paper and also a view that PD criticizes?

    Plus, it's nice for other readers of this blog to see someone else counter the many arguments you continue to make over and over?

    ReplyDelete
  32. I am certain that readers here are perfectly capable of clicking on a link, so why not provide that instead of quoting the full text? That way readers can enjoy both halves of the conversation together, rather than just one side.

    ReplyDelete
  33. I specifically wrote "Tony at Rollingdoughnut.com" for that reason.

    They can read it here if they like- or they can go to his site.

    ReplyDelete
  34. To show that circumcision rates have no effect on the overall health of a country you'd have to first produce a mathematical model allowing you to predict the general health of a country from factors excluding circumcision, then show that adding circumcision to that model makes no change.

    Just as important, you'd have to do the same thing to show that circumcision has a positive health effect.

    At any rate, Jake puts too much trust in mathematical modeling. I am not aware of any observational study that proves circumcision improves overall health or longevity in a population. The only way to get proof is to do the 20-year study: segment the population into circumcised and intact, and follow the outcomes.

    At this point, circumcision advocates like Jake will point out that circumcision *has* been shown to decrease the risk of HIV infection. But that does *not* mean circumcision will extend life, improve life, or change the morbidity statistics in a population.

    It's always more complicated than that.

    A common example is in the field of cancer treatment. A novel drug causes tumors to shrink, or grow slower than in a control group. And yet too often, there's no difference in survival time between the intervention and control groups. Companies sometimes spend millions of dollars developing drugs that work in the test tube and the individual, only to find they have no effect on health or longevity.

    ReplyDelete
  35. Just as important, you'd have to do the same thing to show that circumcision has a positive health effect.

    You would, if you wanted to use between-country comparisons to show such a thing. But since ecological analyses are regarded as one of the weakest of all study methodologies, why would you want to do that? Wouldn't it be more sensible to use data from more reliable studies instead?

    At any rate, Jake puts too much trust in mathematical modeling. I am not aware of any observational study that proves circumcision improves overall health or longevity in a population.

    Studies have shown that it improves specific aspects of general health, but maybe you need to define what you mean by general health and how it ought to be measured.

    ReplyDelete
  36. Jake! Tony has responded to you!

    Heres the link for anyone who wants to read the response, since Jake gets his panties in a bundle when the conversation is posted here.

    http://www.rollingdoughnut.com/2010/05/the_facts_although_interesting_1.html#comments

    ReplyDelete
  37. Studies have shown that it improves specific aspects of general health, but maybe you need to define what you mean by general health and how it ought to be measured.

    Studies have also shown that it damages specific aspects of health under the euphemism of circumcision "complications." Botched circumcision are especially galling when they occur from elective surgery done without your election. That's a totally different thing from accepting what nature doles out to you at birth.

    But, to get back to your question, it's pretty easy to decide if circumcision increase general health:

    Do circumcised men live longer?. Not made-up statistics from models, but actual data taken from death statistics. I think the answer is either "no, they don't live longer" or "nobody knows." Either way, it doesn't add up to a medical imperative as our blog host PD would have it.

    Life expectancy, by the way, is the ultimate measure of general health. It is the integral of all the beneficial and damaging forces of life. If a putative medical benefit doesn't measurably increase life expectancy, there either isn't any benefit, or it's not worth taking any risk to obtain it.

    ReplyDelete
  38. Do circumcised men live longer?. Not made-up statistics from models, but actual data taken from death statistics. I think the answer is either "no, they don't live longer" or "nobody knows." Either way, it doesn't add up to a medical imperative as our blog host PD would have it.

    I'm not aware of any statistics on the subject, but one could reasonably extrapolate from the relative risks for various diseases, which are known.

    ReplyDelete
  39. This is nice- a fact sheet from the Children's Hospital in Australia. Doesn't look like they'll be adopting universal circumcision anytime soon, or recommending it to parents... too bad PD and Jake :(

    http://www.chw.edu.au/parents/factsheets/circumj.htm

    ReplyDelete
  40. That one has been around for some time, actually. :-)

    ReplyDelete
  41. Good :) The longer the better.

    ReplyDelete
  42. @Anonymous: "Yes, I know that some Western countries have adult circumcision rates similar to ours..." That depends on, west of where? Those "western" countries are Israel, the Philippines, South Korea and the Islamic world. The rest of the English-speaking world now has adult circumcision rates (and incidences*) well below that of the US, and Europe, Scandinavia, South and Central America always have had.

    * rate: proportion of adult men getting circumcised per unit time (typically one in hundreds per year, lower outside the US, where they value intactness)
    incidence: proportion of adult men who have ever been circumcised

    As for the claim that the Dutch doctors want to get at Islam, they've never circumcised gentile/infidel children in Holland, so it's true that the majority of those affected will be Muslim, but their concern is medical ethics. Why should doctors perform someone else's religious ritual when it's not medicine? The policy is actually very sensitive towards religious circumcision and quite unequivocal about the lack of medical benefits - like those of all national medical bodies outside the USA.

    ReplyDelete
  43. Well this is promising :

    "It has been reported in the New York Times by Pam Belluck that doctors have reversed their stance on the circumcision.

    Following the policy statement that provoked the scandal, AAP's Committee admitted to the fact that circumcision was more extensive than the clitoris pinprick.

    Taking a strong stand, the Dutch Royal Association of Medicine also issued a policy statement that strongly discouraged circumcision.

    Reports claim that the official viewpoint of KNMG and other related medical/scientific organizations is that non-therapeutic circumcision of male minors is not only a violation of children’s rights to autonomy and physical integrity but also detrimental to the children.

    KNMG publicizes that contrary to the popular belief, circumcision does cause complications like bleeding, infection, urethral stricture and panic attacks. Thus, KNMG is urging a strong policy of deterrence of the gross tradition.

    It is reported that “KNMG is calling upon doctors to actively and insistently inform parents who are considering the procedure of the absence of medical benefits and the danger of complications".

    Reports suggest that AAP is also advising its members against the non-medical circumcision."

    ReplyDelete
  44. Well this is promising :

    Misleading might be a better choice of word.

    "It has been reported in the New York Times by Pam Belluck that doctors have reversed their stance on the circumcision.

    The FGC policy has been reversed, not the circumcision policy.

    Following the policy statement that provoked the scandal, AAP's Committee admitted to the fact that circumcision was more extensive than the clitoris pinprick.

    Following it? No, the AAP policy explicitly stated that circumcision is more extensive than the pinprick proposed. See here.

    Taking a strong stand, the Dutch Royal Association of Medicine also issued a policy statement that strongly discouraged circumcision.

    They did.

    Reports suggest that AAP is also advising its members against the non-medical circumcision

    Evidence?

    ReplyDelete
  45. "The FGC policy has been reversed, not the circumcision policy."

    They meant the FGC policy, not the male circumcision policy.

    http://topnews.us/content/221510-non-medical-circumcision-can-cause-complications

    ReplyDelete
  46. They meant the FGC policy, not the male circumcision policy.

    Yes, that's what I said.

    ReplyDelete
  47. Jake, Tony has responded to you!

    http://www.rollingdoughnut.com/2010/05/the_facts_although_interesting_1.html#comments

    I am especially intrigued with jake's assessment that children have a "right" to grow up circumcised. I am glad Tony addressed it in his response, for anyone who cares to read it.

    ReplyDelete
  48. I am especially intrigued with jake's assessment that children have a "right" to grow up circumcised

    I'd be rather surprised if I'd made that assessment, too. :-)

    ReplyDelete
  49. It makes the penis look really ugly and scarred and dries out the head. When you get to about 40 years old you lose most sensitivity. It's a stupid idea. Not natural. Also it compromises sex and masturbation. So why do it? Cruelty I guess. Most civilized, educated cultures have banned it.

    ReplyDelete
  50. Mike. Please provide proof that you were cut at the age of 18 as you claim. A most unlikely prospect.
    "Just a university academic"...this redundancy suggests that you think cleaning the bathrooms at moody bible college counts. What is your doctorate in and where can we read what you bave published? Until then it is safe to call you a liar.

    ReplyDelete
  51. Dude, your an idiot!!!

    All the so called benefits of circumcision have been proven FALSE by modern science. There is NO reason to SEXUALLY MUTILATE an infant child. There is a REASON we are born with a foreskin.

    ReplyDelete
  52. See below the Wikipedia overview of laws in various countries, especially attempts to ban non-therapeutic circumcision (sexual mutilation) as a form of battery.

    IF (and it's a big if) circumcision can be said to be protective against HIV transmission, I'd like to see how many circumcised men would be happy to sleep with the same HIV-infected prostitute as non circumcised men. Good luck to you. Wouldn't making more responsible sexual choices provide a surer form of protection?

    At the current rate of HIV transmission in the United States, 23,148 infants would have to be circumcised (with all the attendant risks) to prevent just ONE case of AIDS — infants who might never engage in risky sex as adults.

    Only the PATIENT can give INFORMED consent for elective surgery (not the parents or religious community), especially for something which forever diminishes the sexual experience.

    Frankly, the age of consent should be 25, which is when the frontal lobes are fully developed (ask any car rental or auto insurance company at what age people are most apt to understand the consequences of their behavior -- certainly not 18).

    http://en.wikipedia.org/wiki/Circumcision_and_law

    ReplyDelete
  53. To expand on my previous post:

    MALE CIRCUMCISION IN THE US BY THE NUMBERS:

    1) Only 23 out of 144 cultures listed in the anthropological Human Relations Area File database practice genital cutting in some form (including the US) making it a minority practice across the world.

    2) Mutilation of females occurs only in cultures that also practice male circumcision.

    3) For every girl who is genitally mutilated, six boys are mutilated worldwide, at various ages.

    4) In the United States, every 26 seconds another infant’s penis is diminished, desensitized, denuded of its most erogenous tissue — that’s between 1.25 and 1.4 million each year.

    5) Congress banned female genital mutilation (FGM) in 1997, but it has extended no explicit protection to males, so that only children who are males are subject to involuntary surgical alteration of the genitals in the US, which is a violation of the 14th Amendment of the US Constitution. Congress's failure to protect male infants also violates the 1st and 9th Amendments.

    6) Non-therapeutic circumcision contravenes Articles 12, 14(1) & (3), 16, 19(1) and 24(3) of the UN Convention on the Rights of the Child (UNCRC); Article V of the Universal Declaration of Human Rights; and the four cardinal principles of medical ethics (autonomy of the patient, beneficence of the intervention, non-maleficence of the intervention, and justice).

    7) To prevent one death from penile cancer (a disease of elderly men), 100,000 infants must be circumcised, 1,000 of whom will suffer an adverse event, and 18 die.

    8) While circumcision rates in the US have fallen to about 60% as a national average, some 80% of sexually active males today were circumcised. Yet the rate of HIV and STD infection in the US is the highest in the developed world.

    9) If there is any connection at all between circumcision status and HIV infection, at the current rate of infection in the US, 23,148 infants would have to be circumcised to prevent just one case of AIDS — infants who might never engage in risky sex as adults.

    10) The foreskin in the adult male represents 12-15 square inches of specialized tissue, with 3 feet of blood vessels, 240 feet of nerves and up to 20,000 erotogenic nerve endings.

    11) 70% of routine medical circumcisions in the US are performed by obstetricians, who are not specialists of the male genitalia. Only 25% of obstetricians use any form of pain relief.

    12) Cortisol level in the blood (indicator of stress) rises from a baseline of 5.2 micrograms per deciliter to a mean of 14 micrograms or more in infants receiving some form of pain relief (depending on type and combination, and circumcision method), and 17 micrograms in infants receiving no pain relief at all. Pain is not eliminated by any method.

    13) The serial amputation of healthy functional tissue from newborns is a multi-billion dollar a year industry, which includes fees paid by parents or insurers ranging between $100 and $400, hospital supplies, and the lucrative trade in foreskins for skin grafts and medical research, making newborns exploitable as involuntary organ donors.

    14) Men circumcised as infants may sue for damages within one year of turning 18 or, after that, within one year from the time they became aware that they had been harmed.

    ReplyDelete
  54. To expand on my previous post:

    MALE CIRCUMCISION IN THE US BY THE NUMBERS:

    1) Only 23 out of 144 cultures listed in the anthropological Human Relations Area File database practice genital cutting in some form (including the US) making it a minority practice across the world.

    2) Mutilation of females occurs only in cultures that also practice male circumcision.

    3) For every girl who is genitally mutilated, six boys are mutilated worldwide, at various ages.

    4) In the United States, every 26 seconds another infant’s penis is diminished, desensitized, denuded of its most erogenous tissue — that’s between 1.25 and 1.4 million each year.

    5) Congress banned female genital mutilation (FGM) in 1997, but it has extended no explicit protection to males, so that only children who are males are subject to involuntary surgical alteration of the genitals in the US, which is a violation of the 14th Amendment of the US Constitution. Congress's failure to protect male infants also violates the 1st and 9th Amendments.

    6) Non-therapeutic circumcision contravenes Articles 12, 14(1) & (3), 16, 19(1) and 24(3) of the UN Convention on the Rights of the Child (UNCRC); Article V of the Universal Declaration of Human Rights; and the four cardinal principles of medical ethics (autonomy of the patient, beneficence of the intervention, non-maleficence of the intervention, and justice).

    7) To prevent one death from penile cancer (a disease of elderly men), 100,000 infants must be circumcised, 1,000 of whom will suffer an adverse event, and 18 die.

    8) While circumcision rates in the US have fallen to about 60% as a national average, some 80% of sexually active males today were circumcised. Yet the rate of HIV and STD infection in the US is the highest in the developed world.

    9) If there is any connection at all between circumcision status and HIV infection, at the current rate of infection in the US, 23,148 infants would have to be circumcised to prevent just one case of AIDS — infants who might never engage in risky sex as adults.

    10) The foreskin in the adult male represents 12-15 square inches of specialized tissue, with 3 feet of blood vessels, 240 feet of nerves and up to 20,000 erotogenic nerve endings.

    11) 70% of routine medical circumcisions in the US are performed by obstetricians, who are not specialists of the male genitalia. Only 25% of obstetricians use any form of pain relief.

    12) Cortisol level in the blood (indicator of stress) rises from a baseline of 5.2 micrograms per deciliter to a mean of 14 micrograms or more in infants receiving some form of pain relief (depending on type and combination, and circumcision method), and 17 micrograms in infants receiving no pain relief at all. Pain is not eliminated by any method.

    13) The serial amputation of healthy functional tissue from newborns is a multi-billion dollar a year industry, which includes fees paid by parents or insurers ranging between $100 and $400, hospital supplies, and the lucrative trade in foreskins for skin grafts and medical research, making newborns exploitable as involuntary organ donors.

    14) Men circumcised as infants may sue for damages within one year of turning 18 or, after that, within one year from the time they became aware that they had been harmed.

    ReplyDelete
  55. Mike. Please provide proof that you were cut at the age of 18 as you claim. A most unlikely prospect.
    "Just a university academic"...this redundancy suggests that you think cleaning the bathrooms at moody bible college counts. What is your doctorate in and where can we read what you have published? Until then it is safe to call you a liar. STILL WAITING

    ReplyDelete
  56. the World Health Organization is actually still not definative on this matter... and the real point is that circumcision reduces HIV by 55% of WHAT??? Actually, it is 50% of 0.6%-0.7%. because that is the actual difference in the HIV prevalance rate in Africa between circ's and uncirc'd males, if you believe the studies. So you want to circumcise millions of boys to to get a 0.35% difference in 18-20 years from now. Also note that there are >$140 million dollars U.S. on the table for the circumcisers working on these projects... You THINK that might have some influence???

    ReplyDelete
  57. The Circumcision Industry is 'alive and well'.
    The Dutch University Medical researchers actually found that the 'inner foreskin' - Langerin Cells - destroy the hiv-virus...
    it does not enter the body as purported by
    the pro-mutilation lobby... circumcision interferes with the male body's natural processes. Circumcision is a life-sentence.
    85% of the world's males are intact...
    and as for penile cancer, etc, we have to mutilate 100,000 males to save 1 !! ??????
    Fear and scare-tactics are used to convince parents to mutilate their sons.
    The foreskin is not a birth defect!
    Stop this barbaric practice now... the jews and muslims can follow their religious practices...
    leave the rest of the world alone.

    ReplyDelete
  58. Anonymous No one if forcing you to have your sons circumcised.
    As far as the Dutch.... Well I live here. I do not think it is medical reasoning they are calling it Male mutilation. I think it is good old fashion bigotry. From a society that still calls third generation Nederlanders Moroccan, Buitenlanders or Allochtoon just based on the color of their skin.

    I am not Jewish or Muslim and I see it almost every day. Then you have Geert Wilders and his hatred of the Muslims.....

    This is just a way of the Dutch to split an already divided country and make a group of people feel more like they are not wanted.

    Nothing personal but I am so sick of a society of about 17M people 40% of which come from outside of the country and from areas where Circumcision (Not Male Mutilation) Is common practice.

    Look at the US (where I come from) When you have a society of 311 + Million a vast majority of which are circumcised I think they would have more medical data than the Dutch. Even though the Dutch would like to think everything stems from their society and all things dutch to include medical advise is better.

    What is barbaric is that in this modern age a society that still chooses to have home births when all the medical statistics show that home births pose a higher risk to the mother. ridiculous.

    I just had a baby 6 days ago. I am going to get him circumcised. I asked about it in the hospital and as the look of shock drained from my midwifes face. (That is right no even a doctor) She hands me a pamphlet with a picture of a nice Acidic Jew father and son on the cover.... Enough said.

    ReplyDelete
  59. Great comments from the Dutch correspondent.
    Good work Jake. There is no answering the foreskin defenders. The rubbish about yards of foreskin, miles of nerve endings and the Langerhans cells actually defending the penis- it doesn't for HIV, where the usual mechanism backfires!- ridged bands and endless other tripe needs to be constantly debunked.
    Any male who has witnessed a circumcised male having sex, solo or with a partner (as in porn, eg) will know that these men are having as good a time as any uncircumcised male. There are enough studies to prove that men cut as adults find it either the same or better by an overwhelming majority, but who needs those studies when common observation- and commonsense- show exactly how good these men feel!
    We don't need more medical proof- it's enough that the improved penis is funtionally and aesthetically better as far as I am concerned.

    I get to examine enough uncut men in my medical practice to know that there is nothing salubrious about a wrikled end and a moist sticky interior underneath. I can't tell you how often that there is crud and a smell to boot when i retract the foreskin!
    I keep seeing images of the kinds of bacterial colonization that I know are there and am glad I no longer have the same condition myself!!!

    It just doesn't compute with the anti-circers that the improved penis is, well, improved. Any person viewing an adult male cut at birth can see that there is very little difference visually in the two except for folds-- a little less inner layer and of course a lot less of the outer layer. But what begs discussion is how the penis functions during sex. Take masturbation.
    Men simply do not stimulate the glans directly, if left to their own devices but apply a gripping hold on the shaft. If the sensitivity of the glans is so superior and the foreskin is light years better, why aren't the uncircumcised men stimulating the daylights out of these regions???
    If he's uncut, the foreskin might ride up over the glans or might not, but direct foreskin, frenulum or glans stimulation is hardly ever done. The circumcised male does much the same except that he has the advantage now of actually being able to apply friction to the inner layer and frenulum --if he wants to! I like the choice.
    During intercourse the uncut man has the disadvantage of the foreskin riding up and down over the glans and there is no friction whatsover to the shaft. The cut man has all of that happening and constant direct stimulation to the glans-- in addition to the most important sensations being transmitted to the glans via deep pressure receptors. This is no different than is the case for the uncircumcised male.

    In short, the foreskin has little if any value in sex, mostly is a hindrance, looks and can smell awful. That's why I get angry when the anticircers want to prevent my family members, friends and patients from having a healthier and better sex life.

    I wonder if the vitriol coming from the anti-circers is mostly clip-envy --knowing they don't have the balls to improve themselves and they want ME to be as disadvantaged as they are!

    There is no comparison to my previous uncut state. I wouldn't take it back for a million bucks! Rob

    ReplyDelete
  60. I am from the Netherlands and I definitely think male circumcision should be mandatory.

    ReplyDelete
  61. I thanks to my parents that i already circumcision!! it's so awful if you're not!! i got experience before removed the foreskin and it very difficult to clean inside or else very stinky, ichy and painful!!very irritating!! i strongly circumcision is much much better 100% clean!!There is no risk at all!! whatever risk given by whoevers really Bullshits!! i don't want to have smelly,ichy and dangling winkles foreskin!!!

    ReplyDelete
  62. the dutch stink anyway

    ReplyDelete
  63. I do not like it that my parents didn't circumcise me.

    ReplyDelete
  64. Circumcision is no longer recommended by ANY major health organization in the world, it increases some risks and decreases the others so the benefits are a mixed bag, on the other hand the sexual drawbacks are going to be there no matter what.

    The foreskin contains more nerve endings than any other part of the penis, that's just fact.
    "In the largest study on circumcision in South Korea, Seoul University found 33% of men who were circumcised reported difficulty attaining sexual gratification, 63% said masturbation less enjoyable, and 11% had "frequent" orgasm difficulties.
    (Kim, Peng et all, Seoul University)"

    ReplyDelete
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    ReplyDelete