Friday, May 7, 2010

US Pediatrician Group Okays "Minor Circumcision" of Girls

Anti-circumcision fanatics have long argued that if female circumcision is outlawed, then male circumcision should be, too. Of course, this argument assumes that both types of circumcision are the same -- which they are clearly not.

Female circumcision has never been proven to offer any health advantage to the circumcised girl. It is solely a cultural tradition embraced by many around the world. In contrast, in one medical study after another, male circumcision offers positive benefits to the male and his partners. That should end the discussion, but it never does with the anti-circs.

Sure to complicate the debate is an apparent position change by the American Academy of Pediatrics in support of a "nick" or "minor circumcision" of a girl, as a means by which to discourage a full-scale removal of female genital parts. The New York Times below reports the story, and I invite your comments.

While I find female circumcision abhorrent as a practice because it has no medical benefits, I recognize the cultural myopia that we Americans have on this issue. Maybe the AAP is right. If a nick or little cutting makes parents feel comfortable that they do not need to remove the clitoris, labia, or whatever else is involved in full female circumcision, I suppose it is an option that should be considered carefully -- without American cultural blinders affecting our vision.

One thing is certain. The anti-circumcision fanatics will try to use this debate over female circumcision to denounce the obviously beneficial removal of the foreskin from males. Watch my words. I guarantee it.

NewYorkTimes: Group Backs Ritual ‘Nick’ as Female Circumcision Option
By PAM BELLUCK
Published: May 6, 2010

"In a controversial change to a longstanding policy concerning the practice of female circumcision in some African and Asian cultures, the American Academy of Pediatrics is suggesting that American doctors be given permission to perform a ceremonial pinprick or “nick” on girls from these cultures if it would keep their families from sending them overseas for the full circumcision."

"The academy’s committee on bioethics, in a policy statement last week, said some pediatricians had suggested that current federal law, which “makes criminal any nonmedical procedure performed on the genitals” of a girl in the United States, has had the unintended consequence of driving some families to take their daughters to other countries to undergo mutilation."

“It might be more effective if federal and state laws enabled pediatricians to reach out to families by offering a ritual nick as a possible compromise to avoid greater harm,” the group said.

102 comments:

  1. If anything, I think this will help the intactivist movement.

    Almost everyone, pro infant circumcision or not, are against any type of female genital cutting in the United States, even a "nick".

    People that are against this "nick" can no longer say " well, the AAP recommends infant circumcision so it MUST be ok" because now, the AAP is backing female genital cutting as well.

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  2. That argument seems a bit of a stretch to me, Anonymous.

    Anyway, whether it helps or hurts the anti-circumcision lobby is beside the point. What is more important is whether this is sensible policy, and I think it probably is. I'm pleased to see the AAP oppose forms of FGC that cause harm, as that is ultimately the fundamental issue here. Of course, since FGC has no benefits then the smallest risk will cause it to be a harm on balance, but where the harm is sufficiently small the procedure still falls into the region in which procedures are acceptable. And the potential harm of subjecting a child to lay practitioners might well be greatest.

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  3. Yes Jake, lets also allow men living here from the middle east to hit their wives " just a little bit." Not enough to cause any real harm, maybe just a small bruise on the arm or so. It's better it be done a little bit than allow it to escalate to something worse.

    I think one only has to look up the definition of "nick" to see the slippery slope this has the potential to cause.

    As far as I know, removing the entire clitoral hood alone has not been shown to be harmful, at least certainly not here in the US. Neither has removing extra folds of skin that cause the female "meat curtain" men hate so much.

    Genital integrity and autonomy for all, I say.

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  4. Genital integrity and autonomy for all, I say.

    And I think that's the reason why anti-circumcision activists are so upset about this policy change.

    Previously, the AAP opposed all forms of FGC. The anti-circumcision lobby explained this by creating a notion which they call "genital integrity" — the belief that there is a fundamental right to be free from any form of genital surgery. Conveniently for the anti-circumcision lobby, of course, this "right to genital integrity" also condemned circumcision.

    But of course, there is another explanation for opposition to FGC, one that has nothing to do with "genital integrity", but instead has to do with the standard wishes of civilised society to protect the vulnerable from harm. On this basis, it is vital to ask whether, and by how much, a given procedure causes harm, and to adapt one's opposition in response.

    For some years (on this blog as well as elsewhere) I have argued with anti-circumcision activists about their concept of "genital integrity", showing them that it is merely a fiction. Instead, I have shown that it's all about whether the net effect is a benefit or a harm. To quote one of my posts on my own blog:

    Consider the following illustration:

    A--------|-----B-----|--------C

    This "line" is intended to show the full range of possible procedures (medical or otherwise) that could be performed on a child.

    At one end (labelled "A") are those procedures that are extreme net harms (for example, murdering a child). At the other end ("C") are those procedures that are extreme net benefits (for example, giving a child urgent medical care).

    It is important to stress that so far I've just discussed the extreme ends of the spectrum. As we move towards point "B" we find increasingly neutral procedures. There comes a point (which I've labelled with "|" symbols) at which a procedure is sufficiently harmful that we, as a society, say "this must not be done, regardless of what parents think". Similarly, there is also a point at which we find that denial of extreme benefits is likewise unacceptable.

    In the centre, around point "B", is a kind of "neutral zone", in which parental discretion holds sway.


    And that's precisely what the AAP are saying now. They're stressing in their policy that they oppose harmful forms of FGC. But they're saying, in effect, that a nick, while harmful (it must carry a non-zero risk of infection, for example), is of a sufficiently small harm that it probably falls in the neutral zone.

    I think that anti-circumcision activists are so upset about this change in the AAP's policy because it cannot be interpreted in terms of the "genital integrity" model, but must be understood in terms of the "harm prevention" model. And anti-circumcision activists hate the harm prevention model because under such a model it is obvious that circumcision and FGC must be treated differently.

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  5. I am on a cell phone so I can't copy and paste your post.

    As far as the "harm prevention" model, I have not seen any evidence that parents from other cultures would even consider this a compromise. There is the one case in the Seattle compromise, but that is hardly evidence.

    For example, I don't ever see Jews compromising and being satisfied with a pin prick to the foreskin, instead of the complete removal. Let's also, for the sake of argument, take a couple of young parents who have no idea medical benefits exist in male circumcision. They are wanting it done because they think it looks better or bacause the father is. ( Sadly, those reasons are legitamite reasons to perform this surgery on infants in this country). Now ask yourself if you think those parents would be satisfied with a pin prick to the foreskin and nothing else. I think almost all certainly would not be.

    The AAP is recommending this because of pressure to treat infant boys and infant girls equally. Of course, as even the AAP recognizes, male circumcision is much more invasive.

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  6. For example, I don't ever see Jews compromising and being satisfied with a pin prick to the foreskin, instead of the complete removal.

    Indeed. But, of course, since circumcision is a net benefit, a pin prick would actually be less beneficial (or more harmful), on balance, so what would be the rationale for offering it?

    The AAP is recommending this because of pressure to treat infant boys and infant girls equally

    You seem very confident in this assertion, so I wonder: How do you know? Do you have evidence or are you just speculating?

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  7. "Indeed. But, of course, since circumcision is a net benefit, a pin prick would actually be less beneficial (or more harmful), on balance, so what would be the rationale for offering it?"

    Right... since Jews have only been circumcising the last 50 years.

    My statement would still stand 50 years ago when there weren't any legitimate health benefits, and it would still stand if, tomorrow, every country in the world could prove beyond a shadow of a doubt that every and all study performed on the benefits of circumcision were fake and there were zero health benefits to the procedure.

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  8. What's wrong with parents or doctors drawing a little blood from a girl's clitoris? The skin covering the clitoris is just the same useless junk known as the foreskin on men. There's no right to a prepuce.

    I agree with PD that extreme forms of female circumcision shouldn't be allowed, but we're talking about a pin prick, or at worst, snipping a tiny useless flap of skin. In neither case is much harm done if any. Like male circumcision, a girl might resent not being cut if her culture demands it.

    I applaud the AAP's bold move!

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  9. I don't know how Jake's "harm prevention model" works for my penis, which has large irregular scarring, part of which is hypertrophic. I did not consent to the destruction of part of my penis. I didn't sign any forms. There's nobody to sue. There's nothing to be done. Jake sees a net benefit - how convenient a way to dismiss the harm.

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  10. Regarding Jews, even if there was no benefit they would still do it.

    So Jake, and the author of this blog, would you condemn Jews for doing it if there was no health benefits?

    Anonymous, don't except a response from Jake. He doesn't answer the questions he cannot win an argument with. You have summed up what genital integrity is. This harm-prevention model of Jakes totally discounts everyone's right to autonomy over their own body - especially when the intervention has such negative effects. The only way the circumcision harm-prevention model would be worthwhile is if things were , as hey are now, ambiguous regarding the net benefit of infant circumcision. For instance, if circumcision was required to keep the child alive.
    Given that in the UK, where I am from, and in other European countries we hardly suffer much harm without undergoing infant circumcision, it seems that infant circumcision should follow the genital integrity model. And genital integrity isn't invented Jake - it is just a more specific form of bodily integrity or bodily autonomy.
    If someone got into an adults bed while he was sleeping and circumcised him - that would be wrong because he violated the person's bodily autonomy. The attacker couldn't argue, as you are doing, that circumcision benefits the man so he should be left off from criminal proceedings.

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  11. Given that in the UK, where I am from, and in other European countries we hardly suffer much harm without undergoing infant circumcision, it seems that infant circumcision should follow the genital integrity model.

    That makes no sense whatsoever. In effect, you're applying the harm prevention model to the option of non-circumcision, asking whether it causes significant harm. Having concluded that it does not, you conclude that you should abandon this model and instead use a completely different model for assessing the inverse.

    And genital integrity isn't invented Jake - it is just a more specific form of bodily integrity or bodily autonomy.

    As I say, it's an invention.

    If someone got into an adults bed while he was sleeping and circumcised him - that would be wrong because he violated the person's bodily autonomy. The attacker couldn't argue, as you are doing, that circumcision benefits the man so he should be left off from criminal proceedings.

    That would be common assault.

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  12. "You seem very confident in this assertion, so I wonder: How do you know? Do you have evidence or are you just speculating?"

    From a recent Times article :

    "The AAP also concedes that it is unknown how many families take their girls overseas for FGC, and that the policy statment had been prepared without consulting communities that practice FGC about whether a ritual nick would be considered a viable alternative."

    Read more: http://www.time.com/time/health/article/0,8599,1988434,00.html#ixzz0ndtA6ljn "

    This seems a pretty radical move for the AAP to make without any kind of evidence WHATSOEVER on how many, if any at all, female genitals would be "saved" by proposing this alternative. They also have no idea whatsoever if anyone from those cultures would even consider this a compromise. Like I said before, Jews would not consider a pin prick to the foreskin a compromise, and would likely be insulted more than anything else, even if there were not any health benefits.

    Hmmm.....

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  13. This seems a pretty radical move for the AAP to make without any kind of evidence WHATSOEVER on how many, if any at all, female genitals would be "saved" by proposing this alternative.

    First of all, why do you describe it as a "pretty radical move"? This "radical" move consists of essentially one sentence in their policy statement, in which they tentatively suggest: "It might be more effective if federal and state laws enabled pediatricians to reach out to families by offering a ritual nick as a possible compromise to avoid greater harm." It's not unusual for circumcision-related discussions to seem rather surreal, but to describe that as a radical move seems rather extreme.

    Second, they do indicate that there is some evidence that such a compromise is effective (though perhaps not formally quantified): "In some countries in which FGC is common, some progress toward eradication or amelioration has been made by substituting ritual "nicks" for more severe forms.2"

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  14. "First of all, why do you describe it as a "pretty radical move"? "

    I think one look at recent news articles and magazine articles shows how it was a "radical move"

    Radical- One who advocates fundamental or revolutionary changes in current practices, conditions, or institutions

    Another quote from the Times article : "We knew that it was a controversial idea," says the report's lead author, Dena Davis, a professor at Cleveland-Marshall College of Law at Cleveland State University. "We knew simply making the language more neutral was highly controversial."

    So yes, they knew it was a big change considering how anti FGM the West is. They are proposing a change in the law. "...the AAP raises the idea of legalizing a less-severe ritual cutting..."

    The length of the sentence makes no difference whatsoever, so I am not sure why you brought that point up. They go into much more detail than that one sentence, anyway.

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  15. Controversial, yes, but radical? Come on, all they're suggesting (and this is why I quoted that particular sentence, rather than background material) is that a very small change in the law might be worthwhile.

    As for the language, in adopting the term "Female Genital Cutting" they've actually brought themselves into alignment with many national and international bodies, including the UN, who have used the term FGC since the early 2000s.

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  16. A change in the law based on no real evidence whatsoever, for a procedure they have notoriously been apposed to in all forms for years and years, that most Americans are opposed to... is radical in my opinion. And a very strange move, indeed.

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  17. A change in the law based on no real evidence whatsoever, for a procedure they have notoriously been apposed to in all forms for years and years

    In point of fact they continue to oppose, and explicitly state their opposition, to all harmful forms of the procedure. All that has changed is opposition to the most trivial form imaginable. By analogy, it's like an anti-smoking organisation agree that growing Nicotiana tabacum as a decorative herb in one's own garden is probably okay. Let's keep this in proportion!

    that most Americans are opposed to

    That's not and should not be relevant. If you want to know what the majority of Americans think, consult an opinion poll. The AAP are not merely voices for whatever happens to be popular; they're influential members of the scientific community. And you don't become influential by saying whatever people want to hear. You become influential through good scholarship, evidence-based decision making, and thoughtful, careful, reasoned argument.

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  18. "That's not and should not be relevant. If you want to know what the majority of Americans think, consult an opinion poll. The AAP are not merely voices for whatever happens to be popular; they're influential members of the scientific community. "

    The point was not that they shouldn't recommend it because Americans are opposed to it- the point was that part of what makes it a radical change is that so many oppose it. I daresay if they introduced a policy statement that said they believed a specific law should be introduced prohibiting parents from causing intentional paper cuts to their children, it would not be considered radical or controversial, as almost everyone would agree that it is wrong to intentionally cut babies- of course except when it comes to the penises of little boys.

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  19. What the AAP and Jake are saying is that there are harmless forms of genital mutilation, and therefore the people performing these mutilations should be given special protection if they are parents or doctors. That is, if I were to nick Jake's penis, it would be common assault, but if Jake's parents were to nick his penis when he was a baby, he would find no problem.

    The AAP is engaging in sophistry. Mutilations are by definition harmful, especially when conducted on minors who have no power to stop them or undo the damage when they are adults. If anything, minors should be given special protection, but the AAP and the law has turned this on its head, allowing adults to do things to children that would be serious criminal offense if done to adults.

    Parents who mutilate their children should be prosecuted with no less force than if they were to mutilate children not their own. In the case of female genital mutilation, the U.S. should vigorously oppose all forms using the full force of the law, including imprisonment, loss of parental rights, and when possible deportation.

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  20. What the AAP and Jake are saying is that there are harmless forms of genital mutilation,

    No, I'm not talking about genital mutilation at all. I'm talking about genital cutting (or genital pin pricks, perhaps). And yes, there are forms of genital cutting that are harmless, or of such little harm that it is insignificant.

    and therefore the people performing these mutilations should be given special protection if they are parents or doctors.

    Nobody's talking about introducing special protection. What the AAP are suggesting is that the law that was introduced a little over a decade ago might be slightly too far reaching, and it might be worthwhile to address this.

    That is, if I were to nick Jake's penis, it would be common assault, but if Jake's parents were to nick his penis when he was a baby, he would find no problem.

    Not quite. In both cases it would depend on whether adequate consent were obtained.

    The AAP is engaging in sophistry. Mutilations are by definition harmful,

    So one wonders why you are using the term without first demonstrating that the procedure you're talking about qualifies as a "mutilation".

    Parents who mutilate their children should be prosecuted with no less force than if they were to mutilate children not their own. In the case of female genital mutilation, the U.S. should vigorously oppose all forms using the full force of the law, including imprisonment, loss of parental rights, and when possible deportation.

    I find it saddening to see such intolerance for other cultures and other values. No doubt some of the things you do offend the values of those you despise. I just hope they're more tolerant than you are.

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  21. Not quite. In both cases it would depend on whether adequate consent were obtained.

    This makes no sense in the context I gave. Informed consent makes no sense when used as cover for genital mutilation.


    So one wonders why you are using the term without first demonstrating that the procedure you're talking about qualifies as a "mutilation".

    Where I come from, putting holes in little girls' genitals, without their permission, for no medical reason, is easily called mutilation. What do you mean by demonstrating? Do you seriously think that pricking neonatal clitorises is some experiment that should be tried, to see if it's mutilation or not?

    No doubt some of the things you do offend the values of those you despise.

    Crocodile tears. Saying that I despise people and that I'm not tolerant is a pretty weak way to end your defense of genital mutilation. And at any rate, the Congress of the United States doesn't see it your way. Nicking your daughter's clitoris, slitting it, or any other despicable act is a felony, regardless of cultural or religious cover.

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  22. This makes no sense in the context I gave. Informed consent makes no sense when used as cover for genital mutilation.

    We're not talking about genital mutilation: just nicking a penis.

    Where I come from, putting holes in little girls' genitals, without their permission, for no medical reason, is easily called mutilation.

    Is it?

    What do you mean by demonstrating? Do you seriously think that pricking neonatal clitorises is some experiment that should be tried, to see if it's mutilation or not?

    You could start by showing that it meets the dictionary definition of mutilate:

    1. To deprive of a limb or an essential part; cripple.

    Evidently a pin prick to the genitals would not meet this sense.

    2. To disfigure by damaging irreparably: mutilate a statue. See Synonyms at batter1.

    It's difficult to see how this sense would apply. Pin pricks would be unlikely to leave a visible sign, let alone cause irreparable harm.

    3. To make imperfect by excising or altering parts.

    Again, it's difficult to see how this sense would apply.

    So if it doesn't meet any of the senses of the word "mutilate", then how can it be a form of mutilation? I put it to you that something is only mutilation if it actually mutilates, and anyone using the term "mutilation" to describe a pin prick is misusing the English language.

    Crocodile tears. Saying that I despise people and that I'm not tolerant is a pretty weak way to end your defense of genital mutilation.

    It's not a defense, just a comment. I find intolerance deeply saddening.

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  23. You just selected some definitions that suit your argument, and got the result you wanted, which is the usual pathetic ploy when the dictionary is hauled out. Read a little farther, Jake:

    vandalize, damage, deface, ruin, spoil, destroy, wreck, violate, desecrate; informal trash.

    Sticking pins in your children's genitals, slitting them, or worse, easily fits within the meaning of mutilation. You stopped reading your dictionary too soon.

    Intolerance for culturally despicable acts like rape and genital mutilation is, in my opinion, a virtue.

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  24. If you believe the reference from Wikipedia, the World Health Organization calls it mutilation. That's what the "M" in FGM means.

    Type IV: Other types

    There are other forms of FGM, collectively referred to as Type IV, that may not involve tissue removal. The WHO defines Type IV FGM as "all other harmful procedures to the female genitalia for non-medical purposes, for example, pricking, piercing, incising, scraping and cauterization."[23] This includes a diverse range of practices, such as pricking the clitoris with needles, burning or scarring the genitals as well as ripping or tearing of the vagina.[23] Type IV is found primarily among isolated ethnic groups as well as in combination with other types.[citation needed]

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  25. You just selected some definitions that suit your argument, and got the result you wanted, which is the usual pathetic ploy when the dictionary is hauled out. Read a little farther, Jake:

    vandalize, damage, deface, ruin, spoil, destroy, wreck, violate, desecrate; informal trash.


    Firstly, I quoted all three senses from the first dictionary (The American Heritage Dictionary of the English Language, Fourth Edition) listed on that page, which makes your accusation of cherry-picking rather laughable.

    Secondly, you're not quoting senses from a dictionary at all. You're quoting thesaurus entries instead. I don't know if you're familiar with thesaurus entries, but rather than being definitions they're words with similar or related meanings. Often a word suggested by a thesaurus is inappropriate for the meaning you need to convey; that's why you also need a dictionary, to discover what words actually mean.

    Thirdly, "vandalize" doesn't even appear on that page at all, so it is unclear how much further you expect me to read!

    Sticking pins in your children's genitals, slitting them, or worse, easily fits within the meaning of mutilation. You stopped reading your dictionary too soon.

    Then show me a dictionary definition of "mutilate" that fits. Simply asserting that it does falls short of being an argument.

    Intolerance for culturally despicable acts like rape and genital mutilation is, in my opinion, a virtue.

    Oh well.

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  26. You're an idiot.

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  27. It's not a defense, just a comment. I find intolerance deeply saddening.

    No Jake, you do not find intolerance deeply saddening. You have never objected to any of PD's intolerant anti-foreskin diatribes. Your only goal here is to defend/promote circumcision. Since you see a weakening of the law against FGM as supporting the legal position of male circumcision, you're in favor of weakening the law.

    We aren't idiots. Don't treat us as such.

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  28. Hmm, I see the problem with anonymous posting: after having a vigorous discussion about dictionaries with Jake, I did not make the last (idiotic) posting.

    So Jake, what about the the definition from the WHO? Seems like they're on-board with the notion that pricking genitals is a type of mutilation.

    Speaking of dictionary definitions, mutilate comes from the Late mutilat meaning lopped off. That's a narrower meaning than we use today, but it is exactly applicable to male circumcision, which lops off the foreskin. Even so, I have seen discussions where proponents of male circumcision refuse to admit that it's mutilation.

    The main problem with mutilation is when somebody does it to you without your consent. Our laws need to protect minors to a high standard, at least as high as adults, and in many ways they do, for example criminal law. Some injustices that don't meet that standard of protection, like neonatal circumcision, can't be totally undone in a culturally diverse society, but there is no reason in the U.S. to cede moral or legal ground to allow any form of female genital mutilation, including pricking, nicking, slitting, and all other euphemisms for genital mutilation.

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  29. Interesting new case : A man who knew he was HIV positive and had receptive anal sex with a man who did not know about his status will not be prosecuted because an insertive partner "is not placed at 'a significant risk of serious bodily harm' if they are the insertive partner in unprotected anal intercourse with an HIV-positive man. According to a statement from the Canadian HIV/AIDS Legal Network this "reinforces the basic point that not every risk of transmission will be considered 'significant', and illustrates the importance of ensuring that courts consider carefully the scientific evidence before them in determining when there is a 'significant risk' of harm, rather than simply criminalising non-disclosure in all circumstances."

    It goes on further to say : " The prosecution's expert witness, Dr Richard Matthias, testified that the per-act risk of HIV transmission for the insertive partner was similar for both unprotected anal and vaginal intercourse and estimated the risk to be 0.04%, or 4 in 10,000.

    An equally important part of Justice Fenlon's decision was that she found the harm of HIV infection to be less than it was perceived to be in 1998.

    "It's no longer the case that people infected with HIV will develop AIDS and die prematurely," she said. "HIV, while still a deadly virus, can generally be treated and held in check."

    This is relevant, explains the Canadian HIV/AIDS Legal Network, which worked closely with defence counsel Jason Gratl of the BC Civil Liberties Association and provided expert testimony at trial, "because, as the severity of the possible harm decreases, the higher the risk of harm must be in order to warrant criminal prosecution."

    I think people really need to take a step back and think about the reasons they want to circumcise their baby boys. Their risk of contracting HIV through vaginal intercourse is minuscule in developed countries, and the fact that most HIV positive people living with AIDS are on powerful drugs that further reduce their transmission needs to be taken into consideration, as even the CDC has noted.

    It is absurd to consent to unnecessary surgery for your infant for a disease that is excruciatingly rare for a heterosexual man to ever get, when there are less invasive ways to achieve better results.

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  30. No Jake, you do not find intolerance deeply saddening. You have never objected to any of PD's intolerant anti-foreskin diatribes. Your only goal here is to defend/promote circumcision. Since you see a weakening of the law against FGM as supporting the legal position of male circumcision, you're in favor of weakening the law.

    It's always amusing to be told what I think, Anon, but — to be blunt — I'm in a far better position to know what I think than you are.

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  31. So Jake, what about the the definition from the WHO? Seems like they're on-board with the notion that pricking genitals is a type of mutilation.

    Hmm. It seems a little ambiguous to me. Here's their definition of Type IV FGM: "All other harmful procedures to the female genitalia for non-medical purposes, for example: pricking, piercing, incising, scraping and cauterization."

    I've added emphasis to that quotation to show the key words. On one hand, they include pricking among the list of examples, which might suggest that they consider pricking a form of mutilation. On the other hand, they explicitly state that only harmful procedures qualify. So the question is, if a prick doesn't cause any harm, does it qualify? There doesn't seem to be a clear answer.

    But I'm not sure that their definition is intended to be used in this way. I don't think it's meant as a declaration of what is and what isn't mutilation. I think it's meant as a classification scheme for a set of procedures that can affect the female genitals, and which the WHO opposes. For convenience, the WHO collectively calls these procedures FGM, but I don't think they mean to suggest that each and every procedure technically meets the definition of the word "mutilation". Actually, I doubt that they care very much about definitions. They oppose the practice, and words are just tools in their opposition.

    Speaking of dictionary definitions, mutilate comes from the Late mutilat meaning lopped off. That's a narrower meaning than we use today, but it is exactly applicable to male circumcision, which lops off the foreskin. Even so, I have seen discussions where proponents of male circumcision refuse to admit that it's mutilation.

    Well, circumcision doesn't meet any of the senses of "mutilation".

    The main problem with mutilation is when somebody does it to you without your consent

    Now, I would have said that's a problem with harmful procedures, whether or not they technically constitute "mutilation".

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  32. Well, circumcision doesn't meet any of the senses of "mutilation".

    Oh well. That's only your opinion, and not one that I and many others share. In my particular case, the ritual circumcision practiced on my penis certainly meets the definitions of mutilation, even though the kind of scarring I have is not common. Somehow, that doesn't make me feel better about it.

    No need to respond to that, Jake. You have already expounded many times on your theory of "net benefit", which sadly ignores the many cases where circumcision is unequivocally harmful. That's your particular brand of intolerance to which you are blind.

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  33. Huh- looks like large labia lips trap moisture and cause infections- just like foreskin. So much so, that insurance companies are even covering the procedure for many women. Labiaplasties for all infant girls then, I say! Not.

    "Labiaplasty, a plastic surgery procedure to reshape the inner vaginal lips, may be considered medically necessary when large or uneven labia minora are causing recurrent infections or problems with urination or feminine hygiene.

    New statistics from the American Academy of Cosmetic Surgery reveal a 100.7% increase in the number of vaginal rejuvenation procedures performed on American women from 2008 to 2009. One of the most popular of these procedures is labiaplasty.

    "For women who suffer from large or uneven labia minora--a condition known as labial hypertrophy--labiaplasty can give the inner vaginal lips a more trim, youthful look"

    "Like any plastic surgery, labiaplasty may be covered by health insurance when it is deemed medically necessary--not simply cosmetic surgery," says Dr. Parungao. "Of course, whether a patient's labiaplasty procedure is covered by insurance also depends on the terms of her policy.

    "Labial hypertrophy is considered a medical problem when it causes recurrent infections and irritation," he explains. In cases like this, Dr. Parungao's office writes letters and submits documentation to the patient's insurer--and often gets the procedure approved for coverage.

    This was the case with "Jennifer," a 30-year-old newlywed from New Jersey who recently traveled to Chicago for labiaplasty. Like thousands of women with large or uneven labia, Jennifer had been silently enduring:


    -Painful sex and embarrassment in intimate relationships

    -Persistent moisture, chafing, irritation and recurrent infections

    -Embarrassment and discomfort when wearing a bathing suit or tight-fitting jeans

    "Now I'm so comfortable in my jeans!" says Jennifer. "Things feel so much better--and it looks cute now," she adds. "It feels like what it always should have felt like."

    (http://www.prweb.com/releases/labiaplasty/insurance/prweb3962734.htm)

    Wow- you could pretty much substitute labia for foreskin and you would have an almost identical case used to recommend infant male circumcision! Infections, moisture, painful sex, embarrassment in intimate relationships...

    Insanity!

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  34. There's a thing called "human rights". Ever hear of it? It's this silly idea that each individual has the right to their bodily integrity. That goes for both men and women

    Oh, I know that doesn't jive well with your agenda. Human rights never jives well with despots. That's why you're such a monster, sweety! You have no regard for human rights. :)

    So you get off on the idea of controlling men's sexuality. Well that's lovely. Say, how would you feel if a man took it upon himself to restore his foreskin? Would that threaten you? Does a male exercising agency and taking control over his own body frighten you? I hope it does, sweety, because that's exactly what I'm doing. :) Society violated my body once already and I'm taking my power back. Society will never take it away again. I know how much this pisses you off and dear god how I enjoy it. :)

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  35. There's a thing called "human rights". Ever hear of it? It's this silly idea that each individual has the right to their bodily integrity. That goes for both men and women

    "Bodily integrity" is considered a human right by some, but not all, authorities. The Universal Declaration of Human Rights, for example, does not mention it.

    But what, in any case, is meant by "bodily integrity"? There are two applicable dictionary definitions; let's consider each in turn:

    the state of being whole, entire, or undiminished

    So, does a circumcised male possess "integrity" in this sense? Is a circumcised male whole, entire, and undiminished? I would say so.

    a sound, unimpaired, or perfect condition

    Again, does a circumcised male possess "integrity" in this sense? I would say so.

    So how would you say that circumcision violates bodily integrity, exactly?

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  36. I was using general terms with out any regard to any specific declaration of human rights. Exactly what right it is called depends upon the context. But I was appealing, in spirit, to the right that each individual has the freedom from having their body molested by other people against their consent. In this context, that means the freedom from others hacking away at body parts with no just cause.

    Billions of people in the world are not circumcised and they all get along just fine. There's no immediate threat to society or bodily harm by not being circumcised. Most all problems with the foreskin can be fixed with non-invasive intervention. Some are as simple as daily hygiene and using condoms.

    So, yeah, sorry, but those who feel they have the right to dictate to other men what their penis should look like have no leg to stand on.

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  37. So, does a circumcised male possess "integrity" in this sense? Is a circumcised male whole, entire, and undiminished? I would say so.

    And clearly others would say not so. Who are some of these people? When neonatal circumcisions go horribly wrong, causing permanent disfigurement and functional damage, it's hard for the victim to adopt Jake's happy attitude about circumcision, especially when he finds out Jake chose as an adult to get circumcised. How nice for him.

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  38. When neonatal circumcisions go horribly wrong, causing permanent disfigurement and functional damage, it's hard for the victim to adopt Jake's happy attitude about circumcision

    One would imagine that their feelings would be much like those males who suffer permanent disfigurement and functional damage due to conditions that might have been prevented by circumcision...

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  39. One might also imagine that treating foreskin problems as they occur, rather than circumcising everyone on the off-chance that some might benefit, would result in far fewer disfigurements and injuries. This is, in fact, the way the rest of medicine operates.

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  40. One might also imagine that treating foreskin problems as they occur, rather than circumcising everyone on the off-chance that some might benefit, would result in far fewer disfigurements and injuries

    Though it wouldn't exactly be an evidence-based approach, would it? :-)

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  41. "One would imagine that their feelings would be much like those males who suffer permanent disfigurement and functional damage due to conditions that might have been prevented by circumcision..."

    Most uncircumcised penises are normal and function just fine and are not in need of removal. Any reasonable human being in your scenario Jake would understand that he is an outlier and it's not fair or moral to force the rest of the male population to have the same procedure as him just because he had a rare disorder.

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  42. Most uncircumcised penises are normal and function just fine and are not in need of removal.

    Likewise, most circumcised penes are normal and function just fine. It's true that there are rare cases in which circumcision can lead to disfigurement and functional harm, but to consider that without considering the rare cases in which lack of circumcision can lead to disfigurement and functional harm would be misleading.

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  43. but to consider that without considering the rare cases in which lack of circumcision can lead to disfigurement and functional harm would be misleading.

    What's misleading is Jake's purely utilitarian viewpoint of circumcision. There's a world of difference between 'disfigurement from lack of circumcision' and the disfigurement from sexual surgery done without your consent. This is a crucial distinction that many people understand, and it's also one that Jake repeatedly says he doesn't care about.

    But Jake's utilitarian calculations, which I find dubious, seem to end with the tip of the penis. There are many other utilitarian surgeries we could perform without consent of the 'patient' whose net benefit could be calculated as positive, even though there would be rare complications. Of course, rare means when it happens to somebody else.

    It's amazing to consider that the entire circumcision debate would vanish overnight if circumcision - male or female - were a decision to be made only by adults. But Jake is an advocate of neonatal circumcision. And that's evidence based.

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  44. This comment has been removed by the author.

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  45. What's misleading is Jake's purely utilitarian viewpoint of circumcision. There's a world of difference between 'disfigurement from lack of circumcision' and the disfigurement from sexual surgery done without your consent.

    The primary difference, it would seem, is that you appear to wish to pretend that one is fine but the other darkest evil. :-)

    But Jake's utilitarian calculations, which I find dubious, seem to end with the tip of the penis. There are many other utilitarian surgeries we could perform without consent of the 'patient' whose net benefit could be calculated as positive, even though there would be rare complications.

    Many others? I have trouble thinking of one surgery that would have a comparable net benefit. Please, do list a few.

    It's amazing to consider that the entire circumcision debate would vanish overnight if circumcision - male or female - were a decision to be made only by adults.

    You think it's amazing to consider that a debate would vanish if the demands of one side of the debate became mandatory? "Amazing" is not a term that I'd have chosen. "Blindingly obvious" springs to mind.

    But Jake is an advocate of neonatal circumcision.

    No, I'm an advocate of informed parental choice. There is a difference.

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  46. You think it's amazing to consider that a debate would vanish if the demands of one side of the debate became mandatory?

    In what world are you living where it's a 'demand' to keep perfectly normal tissue from being amputated without consent of the patient? Not my world.

    The primary difference, it would seem, is that you appear to wish to pretend that one is fine but the other darkest evil.

    No, the primary difference is one recognized all over the world: injuries and damage that you are born with or develop, are fundamentally different from those caused by others, done without your consent. :)

    You got your foreskin removed on your demand, and that's fundamentally different from having it taken without permission.

    Your claim to be an advocate of parental choice does not match the rest of your rhetoric. It comes across to me, and many others, as nothing but a foil to keep ownership of your Wikipedia article on circumcision.

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  47. In what world are you living where it's a 'demand' to keep perfectly normal tissue from being amputated without consent of the patient? Not my world.

    Are you saying that it isn't a demand? The impression that I had was that you were demanding that parents do not choose (or possibly shouldn't be allowed to choose) circumcision for their infant sons. If I'm wrong, and that isn't what you're demanding, I apologise.

    No, the primary difference is one recognized all over the world: injuries and damage that you are born with or develop, are fundamentally different from those caused by others, done without your consent.

    So, one is a special kind of injury/damage that isn't real injury/damage?

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  48. So, one is a special kind of injury/damage that isn't real injury/damage?

    I'm not saying that at all. For example, if you are born with a cleft lip, this injury may be functionally the same as if your lip were surgically altered to look and behave like a cleft lip. And if you consented to have your lip altered, I guess that might be your business. But if you were strapped down without your consent and surgically altered, that's another matter. Wouldn't you agree :)

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  49. I'm not saying that at all. For example, if you are born with a cleft lip, this injury may be functionally the same as if your lip were surgically altered to look and behave like a cleft lip. And if you consented to have your lip altered, I guess that might be your business. But if you were strapped down without your consent and surgically altered, that's another matter. Wouldn't you agree :)

    Either way I'd probably wish I didn't have a cleft lip, so I wouldn't agree that it's a completely different matter.

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  50. Well, you seem to agree with me completely: some men wish they didn't have a missing foreskin! Of course some men are born without a foreskin, which like cleft lip, is a rare congenital condition. But there's a world of difference between having the congenital condition and somebody forcing you to have the appearance and functionality of the congenital condition.

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  51. Well, you seem to agree with me completely: some men wish they didn't have a missing foreskin

    True, and others wish they'd been circumcised as infants. You can't please everybody all of the time, unfortunately. But, to remind you, we're discussing exceptional situations when "neonatal circumcisions go horribly wrong, causing permanent disfigurement and functional damage" - not ordinary circumcisions. That should correctly be compared with situations in which uncircumcised males develop disfigurement and functional damage due to conditions that circumcision might have prevented.

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  52. "Likewise, most circumcised penes are normal and function just fine."

    Not necessarily. Removing the foreskin removes the body's natural ejaculatory response thus rendering the circumcised penis damaged. That's a problem that happens with *all* circumcisions since *all* circumcisions remove the foreskin.

    "It's true that there are rare cases in which circumcision can lead to disfigurement and functional harm, but to consider that without considering the rare cases in which lack of circumcision can lead to disfigurement and functional harm would be misleading."

    It's not misleading at all. It's simply understood by any rational and logical human being that removing *all* foreskin to prevent *rare* diseases is unreasonable and unnecessary.

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  53. "True, and others wish they'd been circumcised as infants. You can't please everybody all of the time, unfortunately."

    I'm sorry, but it just doesn't go both ways. We're all born with a foreskin and once it's gone it can't be fully replaced. Because of that, every man's right to bodily autonomy must be respected. Since it can't be predicted who will want to be cut later in life, all must be left uncut so the choice can be made by the individual if he so chooses. If a person is left disappointed, wishing he were cut neonatal then tough beans. Life sucks. His wishes can't be granted at the expense of other people's human rights.

    "But, to remind you, we're discussing exceptional situations when "neonatal circumcisions go horribly wrong, causing permanent disfigurement and functional damage" - not ordinary circumcisions. That should correctly be compared with situations in which uncircumcised males develop disfigurement and functional damage due to conditions that circumcision might have prevented."

    You are incorrect. The error in your reasoning is assuming a circumcision went normally only *after* it happened. But before it ever happens all males face the risk of permanent and sever damage. It's not right to put all males at that risk when there is no medical necessity for circumcision to begin with all because a minority will wish they were cut as infants.

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  54. This is a different anonymous.

    "might have been prevented" is the key word there, Jake. Except for a couple minor conditions, circumcision only provides a risk reduction. There is no gauranteee a man would have not gotten the condition had he been circumcised. Especially in the case of HIV, as getting AIDS from a few isolated incidents of unprotected sex is virtually unheard of. The CDC does not even have a category of non high risk heterosexual men. If a man is classified as high risk, odds are circumcision *might* prolong the inevitable by a few months.

    In contrast, if a baby suffers partial loss of glans, horrific scarring, or painful erections due to lack of skin after a circumcision- that is a direct result of the operation. That person would not have had a partial glansectomy had he been left intact. Unless you know of some spontaneous disease that makes parts of the glans fall off of uncircumcised penises.

    "...but to consider that without considering the rare cases in which lack of circumcision can lead to disfigurement and functional harm would be misleading."

    You could use that argument for any number of diseases and infections. Like lack of mastectomies and breast cancer, lack of appendectomies and appendicitis, vulvar cancer in woman... Etc.

    It's asinine to guarantee a surgery and all its risks because a very small percentage of men might have to have surgery later on. Not one other body part or organ is treated in the same way foreskin is treated, even body parts that are more prone to problems than the foreskin.

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  55. Not necessarily. Removing the foreskin removes the body's natural ejaculatory response thus rendering the circumcised penis damaged. That's a problem that happens with *all* circumcisions since *all* circumcisions remove the foreskin.

    Are you seriously suggesting that circumcised males cannot ejaculate? Come on, keep it plausible, please!

    It's not misleading at all. It's simply understood by any rational and logical human being that removing *all* foreskin to prevent *rare* diseases is unreasonable and unnecessary.

    Apparently not.

    I'm sorry, but it just doesn't go both ways. We're all born with a foreskin and once it's gone it can't be fully replaced. Because of that, every man's right to bodily autonomy must be respected. Since it can't be predicted who will want to be cut later in life, all must be left uncut so the choice can be made by the individual if he so chooses.

    Let's see how well that logic works in other situations, shall we? Hmm. Vaccines interfere with the immune system: once a person has been vaccinated, he can never have his original immune system back. Therefore, children must not be vaccinated. Sensible? No, it's obviously a ludicrous argument.

    You are incorrect. The error in your reasoning is assuming a circumcision went normally only *after* it happened. But before it ever happens all males face the risk of permanent and sever damage. It's not right to put all males at that risk when there is no medical necessity for circumcision to begin with all because a minority will wish they were cut as infants.

    The trouble is, if you don't circumcise a child, then he then faces increased risk of diseases such as UTI, balanitis, STDs, etc. It's impossible to make a choice that completely avoids risk.

    "might have been prevented" is the key word there, Jake. Except for a couple minor conditions, circumcision only provides a risk reduction.

    No argument from me there. It's a decrease in risk.

    In contrast, if a baby suffers partial loss of glans, horrific scarring, or painful erections due to lack of skin after a circumcision- that is a direct result of the operation.

    Indeed, it's a (small) increase in risk.

    Unless you know of some spontaneous disease that makes parts of the glans fall off of uncircumcised penises.

    Untreated paraphimosis can have that effect, in extreme cases. The strangulation causes necrosis of the glans, which will eventually slough off.

    You could use that argument for any number of diseases and infections. Like lack of mastectomies and breast cancer, lack of appendectomies and appendicitis, vulvar cancer in woman... Etc.

    Yes, you could, though in fairness the benefits of circumcision are much better established.

    It's asinine to guarantee a surgery and all its risks because a very small percentage of men might have to have surgery later on. Not one other body part or organ is treated in the same way foreskin is treated, even body parts that are more prone to problems than the foreskin.

    I know of no surgery comparable to circumcision in terms of risk-benefit balance.

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  56. Wrong again Jake. Circ'd men can still ejaculate, but they have to compensate. Plus, the majority of their sexual pleasure is removed with the removal of the foreskin.

    "Apparently not."

    You're so dense you didn't even get the association I was making. I'm saying all people who -don't- think it's over reacting and over-the-top to remove all foreskins to prevent rare conditions are not logical and are not rational people. Including you Jake. :)

    Vaccines prevent infectious diseases which otherwise have no other effective form of treatment from spreading. Circumcision does not fit that criteria.

    UTI and all that stuff are relatively rare, or the consequence of personal choices, and can be treated non-invasively or by practicing safe sex. Ergo, no circ necessary.

    "Untreated paraphimosis can have that effect, in extreme cases."

    That's why you don't leave diseases untreated. Treatment for paraphimosis are advanced enough that circ is pretty much unheard of as a treatment in countries which don't routinely cut their babies.

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  57. Wrong again Jake. Circ'd men can still ejaculate, but they have to compensate.

    And your evidence for this is...?

    Plus, the majority of their sexual pleasure is removed with the removal of the foreskin.

    You say this despite evidence showing that sexual sensation is not harmed by circumcision?

    You're so dense you didn't even get the association I was making.

    That must be it. :-)

    I'm saying all people who -don't- think it's over reacting and over-the-top to remove all foreskins to prevent rare conditions are not logical and are not rational people.

    I see. So first you define logical and rational people as, essentially, those who agree with you. Then, having done this, you declare those who disagree with you to be illogical and/or irrational. It's a neat trick, but do you really think it's likely to persuade anybody?

    Vaccines prevent infectious diseases which otherwise have no other effective form of treatment from spreading. Circumcision does not fit that criteria.

    Your point being what, exactly? You didn't mention this criteria earlier on, so from my perspective it looks as though you're desperately trying to save a broken argument.

    UTI and all that stuff are relatively rare, or the consequence of personal choices, and can be treated non-invasively or by practicing safe sex. Ergo, no circ necessary.

    Nobody has claimed that circumcision is necessary; the question is whether it is beneficial. Incidentally, UTIs affect nearly 14% of males over a lifetime (see here). I wouldn't say that's particularly rare.

    That's why you don't leave diseases untreated.

    I agree. To remind you, I mentioned it in response to this: "Unless you know of some spontaneous disease that makes parts of the glans fall off of uncircumcised penises."

    Treatment for paraphimosis are advanced enough that circ is pretty much unheard of as a treatment in countries which don't routinely cut their babies.

    Your evidence for this is...?

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  58. "Vaccines interfere with the immune system: once a person has been vaccinated, he can never have his original immune system back. Therefore, children must not be vaccinated. Sensible? No, it's obviously a ludicrous argument."

    I find this to be an incredibly weak argument. No one can ever have their "original immune system back." Please site evidence of a case where an adult that has not been vaccinated has the exact same immune system he did as a child. Or even a week ago. "Careful investigations have shown absolutely no evidence for any 'weakening'(of the immune system). The vaccines are a 'drop in the bucket' compared to what one's immune system is exposed to every day."

    Incidentally, I could not find a single example of an adult who, medically speaking, had a normal response to vaccinations and wishes they could go back in time and be unvaccinated, thus its invasion on human rights is negligible at best. In contrast, there are thousands and thousands of men who, by medical standards, had a successful circumcision without any complications but still wish they had their foreskins.

    "Untreated paraphimosis can have that effect, in extreme cases. The strangulation causes necrosis of the glans, which will eventually slough off."

    I hardly consider a condition that has several known preventable risk factors,at least six less invasive and preferred methods of treatment, and must be left "untreated" to escalate to the point of emergency surgery a "spontaneous disease that makes parts of the glans fall off of uncircumcised penises." Indeed, circumcision is listed as a "last resort" method of treatment.

    "Yes, you could, though in fairness the benefits of circumcision are much better established."

    Yet, not one medical association in the world recommends neonatal circumcision. In fact, almost all conclude that neonatal circumcision is not recommended.

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  59. Meant to link (http://emedicine.medscape.com/article/777539-treatment) after the paragraph on paraphismosis.

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  60. [Re vaccines] I find this to be an incredibly weak argument.

    Likewise. That was my point. :-)

    No one can ever have their "original immune system back." Please site evidence of a case where an adult that has not been vaccinated has the exact same immune system he did as a child. Or even a week ago.

    Good point — let me put it another way. A person cannot say "hey, I might like polio," and have that opportunity. There is not (usually) a way of un-vaccinating a person. Once he's vaccinated, he's vaccinated. Is that a reason not to perform vaccination? No, of course not. So irreversibility is not, by itself, a compelling case that something shouldn't be done.

    Incidentally, I could not find a single example of an adult who, medically speaking, had a normal response to vaccinations and wishes they could go back in time and be unvaccinated, thus its invasion on human rights is negligible at best. In contrast, there are thousands and thousands of men who, by medical standards, had a successful circumcision without any complications but still wish they had their foreskins.

    Hmm, I've heard similar guesses, but they're really only guesses. I wonder whether the true number is so high. More to the point, I wonder how the numbers compare with those who wish they had been circumcised as infants. In either case, no human rights have been violated: they're just resentful. It's unfortunate that that's the case, but sadly some dissatisfaction is unavoidable. Sometimes we aren't happy with events in our lives, but it seems rather immature to rant about violations of human rights. I wouldn't put it quite as harshly as Eimos ("tough beans. Life sucks"), but I'd agree with the general idea.

    I hardly consider a condition that has several known preventable risk factors,at least six less invasive and preferred methods of treatment, and must be left "untreated" to escalate to the point of emergency surgery a "spontaneous disease that makes parts of the glans fall off of uncircumcised penises."

    We're obviously talking at cross purposes, then. When you asked this question, I assumed (naturally enough) that you meant what you said: a disease that could cause the glans (or part thereof) to fall off. And so I described such a disease. I can't really see how you can justify adding requirements at this stage that (apparently) it shouldn't be preventable and that it should be untreatable. Is it common? I doubt it. But it's what you asked for.

    Yet, not one medical association in the world recommends neonatal circumcision. In fact, almost all conclude that neonatal circumcision is not recommended.

    Incorrect: most generally judge the benefits insufficient to recommend routine infant circumcision (that is, circumcision of all newborn boys), but instead recommend that parents should make the decision on behalf of their sons. Well, this was the case in the late 1990s, but things may have changed now that many countries have introduced circumcision programmes with the support of their medical associations.

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  61. "Good point — let me put it another way. A person cannot say "hey, I might like polio," and have that opportunity."

    No reasonable person would ever want polio, but making the claim that no reasonable person likes or wants their foreskin is a utilitarian way of coming to that conclusion, and not evidence based.

    "More to the point, I wonder how the numbers compare with those who wish they had been circumcised as infants. In either case, no human rights have been violated: they're just resentful."

    If, as you have claimed, there does not need to be any HIV studies done on the efficacy of neonatal circumcision because infant and and adult circumcision are analogous- there should not be any real reason a person should wish they had been circumcised as an infant- since the option of getting circumcised is still available to them, and the only condition whose risk is supposedly reduced by neonatal and not adult circumcision is incredibly rare and has other known preventable risk reductions. Sure, there may be pain involved, but "tough luck" right? If they want it badly enough, they'll put up with it. Seems you only think men circumcised as infants against their will should tough it out, for the off chance someone somewhere may wish they had been circumcised as a baby, and that uncircumcised men (who can choose to get circumcised) somehow shouldn't be expected to "tough it out" if they want to slice the skin off their penis.

    "When you asked this question, I assumed (naturally enough) that you meant what you said: a disease that could cause the glans (or part thereof) to fall off. And so I described such a disease."

    Except, unlike neonatal circumcision, there are avoidable risk factors. An amputated glans as a result from circumcision does not have any avoidable risk reductions other than not circumcising. You can't control a doctor that sneezes and slips the blade, or an accidental cut to glans hidden under the foreskin. Those are all freak accidents. A case of paraphismosis that is severe enough to cause necrosis of the glans is caused by an irresponsible patient not seeking medical attention. One does not have a normal foreskin one minute and necrosis the next. In comparison, there is nothing an infant can do to lower their risk of having a botched operation.

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  62. No reasonable person would ever want polio, but making the claim that no reasonable person likes or wants their foreskin is a utilitarian way of coming to that conclusion, and not evidence based.

    Doesn't matter. Eimos' argument did not refer to whether a "reasonable" person would want a foreskin, but just to the possibility that someone (reasonable or otherwise) might: "We're all born with a foreskin and once it's gone it can't be fully replaced. Because of that, every man's right to bodily autonomy must be respected. Since it can't be predicted who will want to be cut later in life, all must be left uncut so the choice can be made by the individual if he so chooses." So either the same argument holds for polio, or the argument is absurd.

    If, as you have claimed, there does not need to be any HIV studies done on the efficacy of neonatal circumcision because infant and and adult circumcision are analogous- there should not be any real reason a person should wish they had been circumcised as an infant- since the option of getting circumcised is still available to them, and the only condition whose risk is supposedly reduced by neonatal and not adult circumcision is incredibly rare and has other known preventable risk reductions.

    No real reason why a person should wish they had been circumcised as an adult? Greater risk of complications? Greater cost? Loss of work/education days? Loss of sexual activity during healing period? Embarrassment & anxiety before & after? Poorer cosmetic outcome due to scarring? Greater lifetime risk of UTI, balanitis & posthitis, acquired phimosis, penile cancer, and HIV & other STDs that might have been acquired by the time that he's circumcised?

    Sure, there may be pain involved

    Generally the fear of pain is worse than any actual pain, but yes, that too.

    but "tough luck" right? If they want it badly enough, they'll put up with it. Seems you only think men circumcised as infants against their will should tough it out

    On the contrary, as I've repeatedly explained, there is no way to make a decision that will please everybody. So whatever decision you make will mean that (statistically) somebody will have to "tough it out", as you put it. That's not an argument for circumcision, it's a counterargument against the notion that boys shouldn't be circumcised because they might resent it. In effect, both groups of males will have to "tough it out" some times, and I wish that could be avoided, but it can't.

    Except, unlike neonatal circumcision, there are avoidable risk factors. An amputated glans as a result from circumcision does not have any avoidable risk reductions other than not circumcising. You can't control a doctor that sneezes and slips the blade, or an accidental cut to glans hidden under the foreskin. Those are all freak accidents. A case of paraphismosis that is severe enough to cause necrosis of the glans is caused by an irresponsible patient not seeking medical attention.

    Not necessarily. He might be unable to seek medical attention. Or he might not realise that paraphimosis is a medical emergency. Regardless, the fact is that there is a very small risk of loss of the glans due to circumcision, and a small (probably comparably so) risk of loss of the glans due to lack of circumcision.

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  63. "No real reason why a person should wish they had been circumcised as an adult?" in the post immediately above should read "No real reason why a person should wish they had been circumcised as an infant?"

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  64. "Doesn't matter... either the same argument holds for polio, or the argument is absurd."

    Of course it matters. You are comparing a debilitating and deadly disease to normal functioning tissue. Apples and corvettes. Should any logical person use that argument for any other body part? Lets cut the pinky toes off of babies in case a tiny minority wished it had been done as an infant. You can't argue that people should have a choice because a person can't go back in time and be un vaccinated.

    It should also be noted that millions and millions of competent adults voluntarily get the flu shot every year. If a needle prick is worth not getting the flu to those millions of people- one can make the logical assumption that a needle prick would also be worth it to those, and many additional adults, in preventing far more deadly conditions such as polio and small pox.

    The same cannot be said for circumcision. Millions and millions of American men are not voluntarily wanting to get circumcised to reduce their risk of an already rare disease. As the CDC and WHO have already noted, circumcision is likely only to have a limited impact on HIV transmission in the US. "According to a study in the Journal of the American Medical Association, men almost never get HIV from women. A healthy man who has unprotected sex with a non drug-using woman has a one in 5 million chance of getting HIV. If he wears a condom, the odds drop to one in 50 million." "Just to put this in perspective, the chances of someone in your family getting injured next year in a bubble bath are 1 in 1.3 million (source: The Odds on Virtually Everything, Heron House, 1980). You're in much greater danger of being struck by lightning (1 in 600,000), having your house bombed (1 in 290,000), or being murdered (1 in 11,000)."

    "No real reason why a person should wish they had been circumcised as an adult?"

    Yet all of those conditions have less invasive treatment and prevention methods and only effect a tiny minority of uncircumcised men and an even smaller percentage of 18 and 20 year olds, who are old enough to consent to surgery. Indeed, most Americans prefer to choose the less invasive methods of treating and preventing conditions than resort to surgery.

    "On the contrary, as I've repeatedly explained, there is no way to make a decision that will please everybody. So whatever decision you make will mean that (statistically) somebody will have to "tough it out", as you put it. That's not an argument for circumcision, it's a counterargument against the notion that boys shouldn't be circumcised because they might resent it. In effect, both groups of males will have to "tough it out" some times, and I wish that could be avoided, but it can't."

    Group A toughs it out but can still never have their desired result- and uncircumcised penis, or group B toughs it out and can have their desired result- a circumcised penis.

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  65. Why not reply to Tony over at rollingdoughnut.com? He says:

    "Jake,

    When I described the harm of bypass surgery, I did not intend to imply that I believe it to be a net harm. It is not, by some objective measure. (I assume the number of individuals who reject bypass to be greater than zero when some form of need exists, which is useful to the issue at hand.) But that conclusion of net benefit relies on the underlying need addressed, unless you believe some healthy individuals choose elective bypass surgery for some reason. There is no underlying need to non-therapeutic circumcision. When decisions are made for another, it's a reasonable minimum standard to expect some medical need before intervening with surgery for that person. I don't believe you'd defend non-therapeutic bypass surgery on a healthy child via proxy consent.

    I know you think one would have to consider the benefits and risks together, though, which justifies circumcision for you. I agree with you that the benefits and risks must be factored as a whole. (You won't see me outright deny potential benefits.) The problem is who decides. You've decided that there is a net benefit, for you. I have decided the opposite, for me. Only the individual can accurately decide for himself, so the decision must be left to him where need is absent. I would not choose circumcision for myself, if I had my decision. I don't, because my parents took it from me. That was, and is, wrong because I was healthy at the time and circumcision is a permanent altering of my body and how it functions. No matter how many times we go back-and-forth on this, I'm going to remain correct on this point.

    As for what the AAP believes, I'm arguing that they understand male circumcision perfectly well. This is why I used the word indirectly in my footnote. It is why I wrote my initial entry on the revised policy the way I did. The AAP are not explicit in showing their understanding, but they grasp the concepts. A single read-through of the document demonstrates that. So, I'm not saying that the AAP are imbeciles. I'm saying they do not put forth equal defenses for the rights and needs of girls and boys. The AAP are cowards."

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  66. Cut men thrust more and are more rough than uncut men. Uncut men are more gentle. They reach orgasm much more gently because they don't need to compensate.

    Evidence has already proven that uncut penises are more sensitive.

    "So first you define logical and rational people as, essentially, those who agree with you."

    They wouldn't agree with me because I said it, but because my reasoning and logic is correct.

    "Your point being what, exactly?"

    That your analogy is incorrect, thus dismantling your entire refutation to be useless.

    "Nobody has claimed that circumcision is necessary; the question is whether it is beneficial."

    Beneficial is not an appropriate criteria to justify removing a part of someone else's body against their will. It's the very fact that the neonatal circumcision isn't necessary that makes it wrong.

    "Incidentally, UTIs affect nearly 14% of males over a lifetime"

    It says nothing about foreskin and neonatal babies.

    "Your evidence for this is...?"

    European sources which are hard to find in America due to our anti-foreskin bias.

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  67. "So either the same argument holds for polio, or the argument is absurd."

    Incorrect. Vaccines treat a whole other form of problem that circumcision doesn't. The analogy is a false analogy plain and simple.

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  68. Of course it matters. You are comparing a debilitating and deadly disease to normal functioning tissue.

    I'm not comparing anything to anything. I'm saying that, if a line of reasoning is valid, then it's valid in every situation. Thus, by showing a situation in which it produces ridicuous results, I'm showing that it isn't a valid line of reasoning. This type of argument is called reductio ad absurdum, and it dates back thousands of years.

    You can't argue that people should have a choice because a person can't go back in time and be un vaccinated.

    I agree completely.

    It should also be noted that millions and millions of competent adults voluntarily get the flu shot every year. ... The same cannot be said for circumcision.

    Want to bet? (Those are just three articles documenting substantial and growing demand for circumcision services.)

    Yet all of those conditions have less invasive treatment and prevention methods and only effect a tiny minority of uncircumcised men and an even smaller percentage of 18 and 20 year olds, who are old enough to consent to surgery.

    Together they probably affect 10% of males, by the time they're 18-20. And as soon as they're affected it's too late for them to receive maximum benefit from circumcision.

    Group A toughs it out but can still never have their desired result- and uncircumcised penis, or group B toughs it out and can have their desired result- a circumcised penis.

    Actually, that's a misrepresentation. Group A have the option of foreskin restoration. It isn't exactly the same as an uncircumcised penis, true, but it is an option. Group B have the option of adult circumcision, but this isn't exactly the same as infant circumcision either. As I pointed out, there's generally a poorer cosmetic outcome due to scarring. So neither group can get exactly what they want, but both groups have the option of an approximation, if they want it.

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  69. "So irreversibility is not, by itself, a compelling case that something shouldn't be done."

    Irreversibility is legitimate you dope. We're talking about a body part that has an important role in the person's sexuality. There is no logical correlation between the immune system and sexual function that makes your false analogy legitimate.

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  70. "Want to bet? (Those are just three articles documenting substantial and growing demand for circumcision services.)"

    The only reason why those people are demanding circumcision is because they're from poor, impoverished nations who are being fool heartedly mislead by American anti-foreskin misinformation.

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  71. Cut men thrust more and are more rough than uncut men. Uncut men are more gentle. They reach orgasm much more gently because they don't need to compensate.

    Evidence?

    Evidence has already proven that uncut penises are more sensitive.

    You mean like Masood, who reported that 38% of men circumcised as adults reported improved sensation, vs 18% who reported worse sensation? Or do you mean Krieger, who reported that 64% of men circumcised as adults described their penis as "much more sensitive" after circumcision? Or do you mean Cortes-Gonzalez, who reported a statistically significant improvement in perception of sexual events following circumcision?

    That your analogy is incorrect, thus dismantling your entire refutation to be useless.

    Please point to the part of your argument in which you specified that it was necessary to "prevent infectious diseases which otherwise have no other effective form of treatment from spreading". If, indeed, you did specify this in advance, then my example may be invalid. If not, not.

    Beneficial is not an appropriate criteria to justify removing a part of someone else's body against their will. It's the very fact that the neonatal circumcision isn't necessary that makes it wrong.

    I disagree.

    It says nothing about foreskin and neonatal babies.

    Could you explain how you managed to read "14% of males over a lifetime" as an assertion about neonates?

    European sources which are hard to find in America due to our anti-foreskin bias.

    So, are you going to cite any of these "hard to find" sources?

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  72. "So neither group can get exactly what they want, but both groups have the option of an approximation, if they want it."

    If it's my body, I get to choose if I want 100% the real thing or an approximation. Human rights are non-negotiable and not subject to compromise.

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  73. Irreversibility is legitimate you dope. We're talking about a body part that has an important role in the person's sexuality.

    So you claim, though oddly you haven't been able to substantiate your claims...

    There is no logical correlation between the immune system and sexual function that makes your false analogy legitimate.

    Either irreversibility is a valid argument or it isn't. Which is it?

    The only reason why those people are demanding circumcision is because they're from poor, impoverished nations who are being fool heartedly mislead by American anti-foreskin misinformation.

    Ah, so it's all a big conspiracy, then? :-)

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  74. If it's my body, I get to choose if I want 100% the real thing or an approximation. Human rights are non-negotiable and not subject to compromise.

    Very funny.

    Realistically, since the law doesn't currently favour your position, you're not in a very good position to be making non-negotiable demands.

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  75. "Evidence?"

    It's common knowledge.

    "You mean like Masood, who reported that 38% of men circumcised as adults reported improved sensation, vs 18% who reported worse sensation? Or do you mean Krieger, who reported that 64% of men circumcised as adults described their penis as "much more sensitive" after circumcision? Or do you mean Cortes-Gonzalez, who reported a statistically significant improvement in perception of sexual events following circumcision?"

    Studies done by anti-foreskin biased doctors? Please.

    "If, indeed, you did specify this in advance, then my example may be invalid. If not, not."

    I think you quoted me verbatim, so thanks for proving yourself wrong for me.

    "I disagree."

    Well guess what. Human rights aren't subject to your agreement or disagreement. It's wrong whether you like it or not.

    "Could you explain how you managed to read "14% of males over a lifetime" as an assertion about neonates?"

    Well, if it's an American study then the majority are likely to be cut. So are you saying being cut increases the risk of UTI later in life?

    "So, are you going to cite any of these "hard to find" sources?"

    European family physicians. Spend some time in Europe, talk to people and learn how they do things differently.

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  76. "So you claim, though oddly you haven't been able to substantiate your claims..."

    It's already been substantiated. The foreskin is full of sensory nerves that enhance sexual pleasure and protect the penis glands from constant exposure and abrasion.

    "Very funny.

    Realistically, since the law doesn't currently favour your position, you're not in a very good position to be making non-negotiable demands."

    The laws are unjust and are in violation of human rights. Even though slavery used to be legal, that doesn't mean it was right. Existence of laws doesn't automatically mean they're just.

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  77. "I'm not comparing anything to anything. I'm saying that, if a line of reasoning is valid, then it's valid in every situation."

    In that case, circumcision is removing normal healthy functioning tissue to prevent a possible and unlikely condition. Right? That same argument does not legally work for any other body part or organ. Removing normal healthy functioning breasts to prevent possible breast cancer? Nope. Removing normal healthy appendixes to prevent possible appendicitis? Nope. Seems your logic only works with foreskins, Jake. Mastectomies and appendectomies are both extraordinarily safe and routine procedures when performed in western countries.

    "Want to bet? (Those are just three articles documenting substantial and growing demand for circumcision services.)"

    Your response was to this statement I made: "The same cannot be said for circumcision. Millions and millions of American men are not voluntarily wanting to get circumcised to reduce their risk of an already rare disease."

    I clearly said American men. Those studies you linked were of men in Africa, where HIV is not a rare disease and where the main means of transmission is the complete opposite main means of transmission for the United States. Those two very important differences have a huge impact on the need and desire of men wanting to get circumcised in an American context, as it should. The epidemic and environmental circumstances are completely different.

    "Together they probably affect 10% of males, by the time they're 18-20. And as soon as they're affected it's too late for them to receive maximum benefit from circumcision."

    Exactly what percentage of children under the age of 18 do you think has AIDS in this country? STDs can all be better prevented with consistent condom use and regular bathing. Most logical human beings would wait and see if a UTI actually develops (a small chance)and treat it with antibiotics. Antibiotics work worlds better than circumcision, anyway. Again, I don't see how any logical person could think that recommending the most invasive prevention method for all those conditions for every male when only a small percentage will ever get said condition is a good idea.

    "Actually, that's a misrepresentation. Group A have the option of foreskin restoration. It isn't exactly the same as an uncircumcised penis, true, but it is an option. Group B have the option of adult circumcision, but this isn't exactly the same as infant circumcision either. As I pointed out, there's generally a poorer cosmetic outcome due to scarring."

    I am not aware of any American adult male that has died as a result of circumcision. Sadly, the same cannot be said of American infants. I am assuming your evidence that there is a generally poorer outcome due to scarring in adult vs infant circumcision is from an African study? Considering there has not been any kind of real study that shows what percentage of men circumcised as babies in the US have abnormal scarring, skin tags, bent penises during erections, or tight erections due to too much skin being removed-I find your conclusion misleading. Indeed, most studies done on the complication rate of neonatal circumcision only look at immediate complications. Many of the complications I listed above would not surface until years and years later.

    If a competent doctor with knowledge on foreskins examined 200 men- half of which had their original foreskins and half of which had restored foreskins-that doctor could determine which was which in a matter of seconds during an examination.

    In group B if a competent doctor examined 200 men- half of which were circumcised as infants and half of which were circumcised as adults- I am fairly certain that doctor would not be able to determine which men belonged in which category.

    Looks like group A has the shorter end of the stick, there.

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  78. It's common knowledge.

    In other words, you haven't any evidence.

    Studies done by anti-foreskin biased doctors? Please.

    Please provide proof that these authors are "anti-foreskin biased doctors".

    I think you quoted me verbatim, so thanks for proving yourself wrong for me.

    I asked whether you specified it in advance.

    Well guess what. Human rights aren't subject to your agreement or disagreement.

    Nor yours. So while I believe that you believe it's wrong, you haven't proved that it actually is.

    Well, if it's an American study then the majority are likely to be cut. So are you saying being cut increases the risk of UTI later in life?

    No, in a society with a lower circumcision rate the lifetime risk of UTI is doubtless higher.

    European family physicians. Spend some time in Europe, talk to people and learn how they do things differently.

    For crying out loud, I live in Europe! Stop wasting time and cite some of these "European sources".

    It's already been substantiated. The foreskin is full of sensory nerves that enhance sexual pleasure and protect the penis glands from constant exposure and abrasion.

    Proof?

    The laws are unjust and are in violation of human rights. Even though slavery used to be legal, that doesn't mean it was right. Existence of laws doesn't automatically mean they're just.

    Ah, so the laws are wrong as well. :-)

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  79. In that case, circumcision is removing normal healthy functioning tissue to prevent a possible and unlikely condition. Right?

    Occasionally, perhaps, but I would estimate that relatively few circumcisions are performed on the basis of prophylaxis alone. Most are performed for various social, religious, or cultural reasons. What is unusual about circumcision is that, when the risks are weighed against the benefits, there is a net benefit. And for that reason it's generally left to parents.

    Your response was to this statement I made: ... I clearly said American men.

    No, you said "The same cannot be said for circumcision". After that, as an illustration, you discussed American men. But we were discussing circumcision in general, not just in the US.

    Exactly what percentage of children under the age of 18 do you think has AIDS in this country?

    I presume that by "this country" you mean the US, and I don't know. It's probably a fairly small proportion. Other STDs would probably be a little higher (though probably still not a huge number). Balanitis and posthitis would probably be 3-5%. UTIs another 3-4%. Hence my estimate of 10%.

    I am assuming your evidence that there is a generally poorer outcome due to scarring in adult vs infant circumcision is from an African study?

    No, it's from my own observations & discussions with men circumcised as adults.

    If a competent doctor with knowledge on foreskins examined 200 men- half of which had their original foreskins and half of which had restored foreskins-that doctor could determine which was which in a matter of seconds during an examination.

    Possibly, though I have seen men proudly claiming in restoration fora to have fooled their doctors.

    In group B if a competent doctor examined 200 men- half of which were circumcised as infants and half of which were circumcised as adults- I am fairly certain that doctor would not be able to determine which men belonged in which category.

    You think so? I wonder why you'd think that a scar that's had at least 18 years longer to fade would appear identical? Especially when that scar was performed on an infant penis that has a) enjoyed the quick and thorough healing characteristic of infants, b) has been stretched and smoothed through growth of the organ, and c) had no suture marks.

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  80. "Occasionally, perhaps, but I would estimate that relatively few circumcisions are performed on the basis of prophylaxis alone. Most are performed for various social, religious, or cultural reasons. "

    So then ANY surgery that can be said to be performed for social, religious, or cultural reasons should be allowed correct? Only, that isn't the case. Parents recently got prosecuted and charged for child abuse for tattooing a small cross on their children. Likewise, any female genital cutting is still currently illegal in the United States. Parent's would not be able to surgically remove earlobes if their religion mandated it. Arranged marriages for children and polygamy are illegal as well. Your statement of "...if a line of reasoning (circumcision should be allowed for cultural and religious reasons) is valid, then it's valid in every situation." doesn't seem to be working out to well.

    "No, you said "The same cannot be said for circumcision". After that, as an illustration, you discussed American men. But we were discussing circumcision in general, not just in the US."

    It was not my intention to use American men as an illustration. My previous statement on the need and cost benefit of American vs African circumcision still stands.

    "No, it's from my own observations & discussions with men circumcised as adults."

    Oh, how scientific of you! This wouldn't be so comical except for the fact that I have seen you type " Evidence?" "Evidence?" "Where's your evidence?" half a dozen times at least in this blog post alone. "Discussions with men" is hardly evidence.

    "Possibly, though I have seen men proudly claiming in restoration fora to have fooled their doctors."

    I said doctors that are familiar with foreskins for that specific reason- most American doctors are not. I also assume those men you are discussing meant they could not tell just by looking at the restored foreskin. Indeed, restored foreskin looks much like a natural foreskin on the surface. Likewise, an uncircumcised penis looks much like a circumcised one when the foreskin is pulled back. Again, any competent doctor from a non circumcising country would know the difference after an examination, which was my previous statement. There is no ridge band, the foreskin is not attached in the same way, there is no mucus membrane, etc.

    "You think so? I wonder why you'd think that a scar that's had at least 18 years longer to fade would appear identical? Especially when that scar was performed on an infant penis that has a) enjoyed the quick and thorough healing characteristic of infants, b) has been stretched and smoothed through growth of the organ, and c) had no suture marks."

    I never said identical- I said nearly impossible for a competent doctor to determine. The look and feel of scar tissue differs depending on the person whether they are circumcised as infants or not. There is no universal scar tissue that men who were circumcised as infants have. Lets also, for the sake of argument, the 100 out of 200 men who were circumcised as adults could only be included in the study if they had been circumcised for at least 18 years. The other half are 18 year old men who were circumcised as infants. The doctor would have a difficult time determining which group went into which category. Now, for the sake of argument, lets say the 100 men who had restored foreskins could only be included in the experiment after their restoration process had been completed for 18 years. Or 30. Or 40. It doesn't matter- it will never be the same.

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  81. So then ANY surgery that can be said to be performed for social, religious, or cultural reasons should be allowed correct?

    Incorrect, I'm afraid. Most surgeries, if performed without pre-existing conditions, are net harms, and consequently they cannot be left to parental discretion.

    Your statement of "...if a line of reasoning (circumcision should be allowed for cultural and religious reasons) is valid, then it's valid in every situation." doesn't seem to be working out to well.

    It seems to be working just fine from where I'm sitting, but perhaps the problem is that you haven't actually identified an explicit line of reasoning.

    Oh, how scientific of you! This wouldn't be so comical except for the fact that I have seen you type " Evidence?" "Evidence?" "Where's your evidence?" half a dozen times at least in this blog post alone. "Discussions with men" is hardly evidence.

    It is evidence, but admittedly it is a weak form of evidence.

    I said doctors that are familiar with foreskins for that specific reason- most American doctors are not.

    Ah, another assertion without evidence. Given that about 20-30% of the adult male population of the US are uncircumcised, it would be surprising if that were the case.

    There is no ridge band, the foreskin is not attached in the same way, there is no mucus membrane, etc.

    Circumcisions that remove all of the mucosa are fairly rare; most preserve an inch or so, and (at a guess) about two thirds preserve the frenulum, so most noticeable difference is the presence of the scar, which may not be all that noticeable. The ridged band is not normally very obvious to the naked eye unless one looks very closely — the bunching of tissue due to uneven tension from the frenulum is often mistaken for the ridged band, but it is not the same thing.

    I never said identical- I said nearly impossible for a competent doctor to determine.

    And I still disagree.

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  82. "Ah, another assertion without evidence. Given that about 20-30% of the adult male population of the US are uncircumcised, it would be surprising if that were the case."

    And how many of those 20 percent do you think are doctors? I did not say ALL were unfamiliar- I said most.

    "Circumcisions that remove all of the mucosa are fairly rare; most preserve an inch or so, and (at a guess) about two thirds preserve the frenulum, so most noticeable difference is the presence of the scar, which may not be all that noticeable. The ridged band is not normally very obvious to the naked eye unless one looks very closely — the bunching of tissue due to uneven tension from the frenulum is often mistaken for the ridged band, but it is not the same thing."

    The underside of natural foreskin has mucosa membrane that the underside of restored foreskin does not. Restored foreskin is, essentially, just skin that is stretched out over the glans. As much as some pro circumcision advocates try to convince themselves and others that the foreskin that is removed at birth is "just skin"- it is much more. A frenulum that has a natural foreskin attached looks very different from one that has had the skin severed from it and then grown over it. The ridge band may be hard to notice just from glancing, but I have explicity said multiple times that in this hypothetical study doctors are not merely glancing at the penises.

    "And I still disagree."

    Well, until solid evidence is found one way or the other we are just going to have to agree to disagree. As a woman living in the United States I have only ever seen circumcised penises, in the flesh that is. Looking at before and after pictures of men circumcised as adults I can see no difference, and I am guessing unless maybe the doctor is a specialist in scar tissue, he won't be able to either.

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  83. And how many of those 20 percent do you think are doctors? I did not say ALL were unfamiliar- I said most.

    I can't see that it matters. Any doctor working in any applicable field will see hundreds if not thousands of patients' penes during the course of his/her work, so his own circumcision status (if he's male) seems almost irrelevant.

    The underside of natural foreskin has mucosa membrane that the underside of restored foreskin does not

    It's a little difficult to understand what you mean. Do you mean the underside of the penis? Or do you mean the interior surface of the foreskin?

    Restored foreskin is, essentially, just skin that is stretched out over the glans.

    Yes, but part of that skin is mucous membrane: the skin between the glans and circumcision scar, which is often paler or pinkish in comparison with the skin of the shaft, is mucosal tissue. So when the skin is stretched, the interior surface of the foreskin is mucosa, just as it is with an uncircumcised penis.

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  84. Jake, why not reply to Tony over at rollingdoughnut.com? He says:

    "Jake,

    When I described the harm of bypass surgery, I did not intend to imply that I believe it to be a net harm. It is not, by some objective measure. (I assume the number of individuals who reject bypass to be greater than zero when some form of need exists, which is useful to the issue at hand.) But that conclusion of net benefit relies on the underlying need addressed, unless you believe some healthy individuals choose elective bypass surgery for some reason. There is no underlying need to non-therapeutic circumcision. When decisions are made for another, it's a reasonable minimum standard to expect some medical need before intervening with surgery for that person. I don't believe you'd defend non-therapeutic bypass surgery on a healthy child via proxy consent.

    I know you think one would have to consider the benefits and risks together, though, which justifies circumcision for you. I agree with you that the benefits and risks must be factored as a whole. (You won't see me outright deny potential benefits.) The problem is who decides. You've decided that there is a net benefit, for you. I have decided the opposite, for me. Only the individual can accurately decide for himself, so the decision must be left to him where need is absent. I would not choose circumcision for myself, if I had my decision. I don't, because my parents took it from me. That was, and is, wrong because I was healthy at the time and circumcision is a permanent altering of my body and how it functions. No matter how many times we go back-and-forth on this, I'm going to remain correct on this point.

    As for what the AAP believes, I'm arguing that they understand male circumcision perfectly well. This is why I used the word indirectly in my footnote. It is why I wrote my initial entry on the revised policy the way I did. The AAP are not explicit in showing their understanding, but they grasp the concepts. A single read-through of the document demonstrates that. So, I'm not saying that the AAP are imbeciles. I'm saying they do not put forth equal defenses for the rights and needs of girls and boys. The AAP are cowards."

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  85. Jake, why not reply to Tony over at rollingdoughnut.com? He says:

    You've already posted that, Anonymous, in a comment dated May 18, 2010 12:58 PM. Maybe it's just me, but it seems inappropriate to quote lengthy extracts from another discussion elsewhere once, let alone twice.

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  86. This blog is waaaaay past being appropriate. With the constant calling of foreskins as filthy, diseased, smelly etc.

    This is a drop in the bucket compared to that.

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  87. Tony from rollingdoughnut.com has responded to you, Jake.

    He says:

    "This conversation is interesting, but I don't wish to circle the core question: who should make unnecessary medical decisions?

    That you believe there's any other answer than that which I state is mind-boggling. I know we've had the discussion before, and I'm certain you're not going to change your mind. But the facts do not change, no matter how many new studies or extensions of prior studies you quote. Circumcision is permanent. It carries risk. It alters the functional process of sexual activities. Any one of these individually settles the question as it pertains to healthy children. Only the person affected by the decision may legitimately decide. I know you disagree with that. But you're wrong. Being witty in your rebuttal won't change the facts or the singular conclusion.

    But you want to include potential benefits. Fine, let's do so, although I'd also like to avoid the standard debate on circumcision and vaccination. It's tedious and distracting. I'll leave it at your assessment that there are relevant differences, since I'm sure you realize those aren't trivial.

    But it's useful to consider the extent of parental consent and obligation. Which of the potential benefits you favor are not preventable or treatable with less invasive, non-permanent bodily alteration? Which of the potential drawbacks of leaving a child uneducated are avoidable without an education? The difference in the nature of these questions is the gap that forms your error.

    As for it being "just bad luck" that my parents circumcised me, I reject that. Growing up poor as a result of their choices was just bad luck that I was able to overcome based on my ability and willingness to work hard. Their decision to circumcise me as a healhty infant was based on their own ignorant, selfish reasons. It was a violation of my body that I can't overcome. It was objectively offensive."

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  88. Looks like AAP has reversed it's decision on the "nicking" of females.

    Too bad, Jake. You must be disappointed.

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  89. Since you didn't cite any evidence, Anon, I looked for some.

    The first article I found appears to be mistaken: if you follow the link it provides to the "revised policy statement", you'll see that it is dated 1998!

    The next article I read appears to support your claim, though. I await further information, but my impression is that the AAP have backed down under political pressure. If that's the case, yes, I am disappointed. If, on the other hand, they've found some flaw in their earlier logic, I'm curious to know what that is.

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  90. I think their quote speaks for itself.

    "We retracted the policy because it is important that the world health community understands the AAP is totally opposed to all forms of female genital cutting, both here in the U.S. and anywhere in the world."

    Since they never had any real evidence to support their earlier position in the first place, I find it extremely unlikely that some sort of "new" evidence made them change their mind. Their quote above seems to show they did not want to hurt their image and caved in to political pressure. Whatever the reason, it was a good thing. Victory for the intactivists!

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  91. Time to edit the title of your post, PD.

    Hop to it!

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  92. "AMSTERDAM (Reuters Life!) - The Royal Dutch Medical Association on Thursday suggested a possible ban on elective circumcisions for young boys, saying they were medically unnecessary and violated children's rights.

    The 161-year-old organization, which represents more than 46,000 doctors and students, called the procedure "a violation of the integrity of the body.

    In a column on the KNMG's website, chairman Arie Nieuwenhuijzen Kruseman said some 80 percent of the group's members agreed circumcision should be discouraged."

    Woot!

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  93. The Netherlands has just released an official stance against infant circumcision.

    http://www.davidwilton.com/files/knmg-viewpoint---circumcision---netherlands.pdf

    Some main points they make :

    "The reason for our adoption of an official viewpoint regarding this matter is the increasing emphasis on children’s rights. It is particularly relevant for doctors that children must not be subjected to medical proceedings that have no therapeutic or preventative value. In addition to this, there is growing concern regarding complications, both minor and serious, which can occur as a result of circumcising a child. A third reason for this viewpoint is the growing sentiment that there is a discrepancy between the KNMG’s firm stance with regard to female genital mutilation and the lack of a stance with regard to the non-therapeutic circumcision of male minors, as the two have a number of similarities."

    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.

    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.

    Non-therapeutic circumcision of male minors is contrary to the rule that minors may only be exposed to medical treatments if illness or abnormalities are present, or if it can be convincingly demonstrated that the medical intervention is in the interest of the child, as in the case of vaccinations.

    Non-therapeutic circumcision of male minors conflicts with the child’s right to autonomy and physical integrity.

    The KNMG calls on (referring) doctors to explicitly inform parents/carers who are considering non-therapeutic circumcision for male minors of the risk of complications and the lack of convincing medical benefits. The fact that this is a medically non-essential intervention with a real risk of complications makes the quality of this advice particularly important. The doctor must then record the informed consent in the medical file.
    The KNMG respects the deep religious, symbolic and cultural feelings that surround the practice of nontherapeutic circumcision. The KNMG calls for a dialogue between doctors’ organisations, experts and the religious groups concerned in order to put the issue of non-therapeutic circumcision of male minors on the agenda and ultimately restrict it as much as possible.


    This is what they say about HIV and other STDS:

    "In the past, circumcision was performed as a preventative and treatment for a large number of complaints,
    such as gout, syphilis, epilepsy, headaches, arthrosis, alcoholism, groin hernias, asthma, poor digestion,
    eczema and excessive masturbation.10 Due to the large number of medical benefits which were wrongly ascribed
    to circumcision, it is frequently asserted that circumcision is ‘a procedure in need of a justification’.11
    In recent decades, evidence has been published which apparently shows that circumcision reduces the risk
    of HIV/AIDS12, but this evidence is contradicted by other studies.13

    (continued)

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  94. Moreover, the studies into HIV prevention were carried out in sub-Saharan Africa, where transmission mainly
    takes place through heterosexual contact. In the western world, HIV transmission is much more frequently
    the result of homosexual contact and the use of contaminated needles.14 That the relationship between circumcision
    and transmission of HIV is at the very least unclear is illustrated by the fact that the US combines
    a high prevalence of STDs and HIV infections with a high percentage of routine circumcisions.15 The Dutch
    situation is precisely the reverse: a low prevalence of HIV/AIDS combined with a relatively low number of
    circumcisions. As such, behavioural factors appear to play a far more important role than whether or not
    one has a foreskin.
    Further, there is apparent evidence that circumcision offers protection against complaints such as HPV
    infection, urinary tract infections and penis cancer. However, these studies, too, are controversial.16
    Moreover, urinary tract infections can be successfully treated with modern healthcare. Children with inborn
    abnormalities to the urinary tract can generally be successfully helped by a foreskin-widening operation,
    which makes the foreskin easier to clean.


    This must upset you greatly, Jake and PD. Shame you can't see and recognize something that is so blatantly obvious to the majority of the world.

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  95. Yes, it is deeply concerning that a reputable medical organisation would publish such nonsense. I've just finished reading their statement. It gives the strong impression that the author read a bunch of anti-circumcision websites and unquestioningly accepted their assertions without taking the trouble to investigate further. (I've no way of knowing whether that is actually the case, but it certainly seems that way.) Indeed, in many cases the author does not appear to have even thought about the claims at all, to consider whether they actually make sense as an argument. As I say, deeply concerning.

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  96. "I've no way of knowing whether that is actually the case, but it certainly seems that way."

    Of course it seems that way to you. Fortunately, the majority of us don't live in Jake Land where cutting the genitals of healthy babies somehow seems like a good idea.

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  97. Of course it seems that way to you. Fortunately, the majority of us don't live in Jake Land where cutting the genitals of healthy babies somehow seems like a good idea.

    To remind you, I'm pro-parental choice. My position, which is shared by almost every medical association, is that circumcision is a perfectly acceptable parental decision. The obvious exception to that is this Dutch statement, which - as I say - does give the strong impression that it was written by someone browsing anti-circumcision websites.

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  98. ***************************************
    BTW, they withdrew their statement:

    http://www.nytimes.com/2010/05/27/health/27brfs-DOCTORSREVER_BRF.html?ref=todayspaper
    ***************************************

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  99. and another:
    http://www.prnewswire.com/news-releases/american-academy-of-pediatrics-withdraws-policy-statement-on-female-genital-cutting-95029069.html

    *****************************

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  100. Mike. Please provide proof that you were cut at the age of 18 as you claim. A most unlikely prosepect.
    "Just a university academic"....this redudnacy suggests you think cleaning the bathrooms at the moody bible college counts. What is your doctorate in and where can we read what you have published. Until you respond with proof all will consider you a liar.

    ReplyDelete
  101. Mike. Please provide proof that you were cut at the age of 18 as you claim. A most unlikely prosepect.
    "Just a university academic"....this redudnacy suggests you think cleaning the bathrooms at the moody bible college counts. What is your doctorate in and where can we read what you have published. Until you respond with proof all will consider you a liar.

    ReplyDelete