Disclaimer

Some parts of this blog may contain adult-oriented material. (It is NOT porn or erotica, but some of the content is inappropriate for children). If you are under your country's legal age to view such material or find it to be "objectionable", please leave this page now. Reader discretion is advised...but if you couldn't infer from the title that this may be an adult-oriented blog, then you shouldn't be on the Internet at all.

Everything on the Evil Slutopia blog is copyrighted by the E.S.C. and ESC Forever Media and may not be used without credit to the authors. But feel free to link to us as much as you want! For other legal information, disclaimers and FAQs visit ESCForeverMedia.com.

November 5, 2009

Sexual Mutiliation or Routine Medical Procedure?

I don't have any sons... so I have been lucky enough that I didn't have to make a decision about circumcision. If I did... I would probably decide against it.


I personally don't think there's any medical need. There have been some studies that may suggest slight health benefits, but then there are plenty of studies disproving this theory. I find it very odd that people in the U.S. are so outraged by female circumcision done in other cultures, but don't even bat an eye at male circumcision done here in our own country. Why is one mutilation and the other a routine medical procedure? I don't judge anyone for making that choice - be it for medical, religious or purely aesthetic reasons - but I don't think I could do it because I believe that the cons outweigh the pros.

Of course when I flipped open the October 26, 2009 issue of New York magazine, I was intrigued to find that they had devoted several articles and features to this topic. (If this was Cosmo they would've called it "The Foreskin Issue!") The more I read, the more disappointed I grew. The articles - even the so-called "anti-circumcision" ones - were pretty biased and slanted toward the pro-circumcision stance. So I decided to write them a little letter:

Dear New York Magazine,

I think it was a great idea to weigh the pros and cons of circumcision in your October 26, 2009 issue, however the feature was unfairly slanted toward the "pro" stance. Anti-circumcision activists and parents were negatively portrayed as squeamish, anti-religion, overly "child-centric", suspicious of mainstream medicine and even just plain old trendy. (Circumcision was even described as a growing blue-state-red-state issue. Really?)

Unproven medical theories were repeatedly presented as fact (such as the alleged benefits suggested by studies done in sub-Saharan Africa being used to support circumcision in developed countries like the U.S.) with one author even going so far as to refer to the foreskin as a "public-health menace". Even the sections that were seemingly "pro-foreskin" didn't give the actual, compelling reasons not to circumcise, instead harping on the religious aspects or downplaying the risks.

Perhaps the most misleading was Hugo Schwyzer's before-and-after accounts of his own adult circumcision. The foreskin tearing issues he suffered pre-circumcision are relatively uncommon so his opinion is hardly objective enough to merit much weight in the overall decision-making process.

Thank you for addressing the issue of circumcision and attempting to show both sides. Unfortunately your apparent biases showed through just a little too much.

Although the New York article suggested that there were vast health benefits of circumcision, medical experts are actually torn on the issue. The American Academy of Pediatrics found both potential benefits and risks, coming to the decision that there was insufficient data to recommend it. The American Urological Association has basically the same stance: there are benefits and risks.

The Canadian Paediatric Society does not recommend routine newborn circumcision. According to the College of Physicians and Surgeons of British Columbia, current understanding of the benefits, risks and potential harms no longer support the practice of preventive infant male circumcision. They consider it a "non-therapeutic, medically unnecessary intervention" when performed on a healthy infant.

The STD studies can be misleading. Some research has suggested that male circumcision reduces the risk of acquiring HIV by men during penile-vaginal sex. It seems that the reason uncircumcised men are more susceptible is because the foreskin has a higher density of Langerhans cells (target cells for HIV infection). There's also a risk of tearing the foreskin during intercourse.

However, many doctors feel the circumcision-prevents-infection claims have been exaggerated. The American Urological Association has stated that evidence associating neonatal circumcision with "reduced incidence of sexually transmitted diseases is conflicting". It's important to remember that the bulk of the studies on the subject were done on adults in sub-Saharan Africa, so the results aren't exactly comparable to infants in more developed nations, where there is better education on and access to contraception and healthcare.

It's also worth nothing that male circumcision might only reduce infection in female-to-male heterosexual transmission, so the overall influence on the HIV epidemic (in Africa or otherwise) would at best, be slight. In fact, some studies have suggested that circumcision may increase the risk of female HIV infection (due to reduced lubrication and increased friction) especially in sub-Saharan Africa where "dry sex" is practiced.

The U.S. is the second highest circumcising country in the world, next to Israel. The U.S. also has one of the highest HIV infection rates of all the industrialized countries. So while the science might suggest that circumcision prevents HIV infection, the numbers just don't add up in reality.

The more these "circumcision prevents HIV" claims are exaggerated, perhaps the more likely it is for men who have been circumcised to develop a false sense of security. There is also evidence that circumcision causes a loss of sexual sensitivity and function (as it removes nerves from the penis) so some have made the claim that circumcision may reduce condom use and therefore have an adverse effect on the the overall incidence of HIV infection. It's important to remember that condom use is effective at preventing HIV transmission for both partners, regardless of whether or not a male is circumcised.

Even though we think of infant circumcision as a routine medical procedure, it's important to remember that it is surgery: the use of local anesthetic in and of itself can be a risk for infants and any open wound is at risk for infection. And then there's the pain...

Circumcisions are painful. (One study on infant circumcision was actually stopped before completion because of the amount of trauma they witnessed the babies going through.) Some research has suggested that newborns feel pain more intensely and for longer periods of time than adults. In fact, some studies have suggested that intact boys and girls have higher threasholds of pain than circumcised boys. Even with anesthesia, we still do not know the full permanent, psychological and emotional impact of infant circumcision.

I don't expect everyone to make the same decision that I would make and I'm certainly not discounting the importance of religion in people's lives. (Not in my life, but to each their own.) I just think that if a magazine is going to publish an entire section on the "pros and cons" of any topic, they should show the pros and the cons.

27 comments:

Kt said...

The U.S. is the second highest circumcising country in the world, next to Israel. The U.S. also has the second highest infection rate, next to Africa. So while the science might suggest that circumcision prevents HIV infection, the numbers just don't add up in reality.

I'm undecided on this issue, personally. Fascinating to see an analysis like yours. But having read you gals (and guys) for a year or two, I KNOW you know better than this. Correlation/Causation, etc, etc. This post was really interesting, but it's hard to take the rest of what you're saying seriously (and don't get me wrong, I VERY much want to) when something like this is stabbing out at us from the middle of the piece. :) C'mon, now.

Caroline said...

Thank you so much for writing those guys at the NY Post a letter. Their spread was extremely biased in all the ways you described. Hopefully they got lots of letters like yours.

sexgenderbody said...

Great piece, great topic and long overlooked. Thank you.

-arvan

Lilith said...

Kt, first off, I'm so glad you quoted that section because there was a typo in there that we hadn't corrected yet. (Sometimes on these research-heavy blogs we get a little lost in all the text, oops.) I fixed it.

But the point I was trying to make is still true. What exactly bothered you about that claim?

The studies may suggest that circumcision prevents HIV infection, but there are so many other factors at play. The fact is that while the science may make sense, the "benefits" of circumcision might not necessarily make that much of a difference in the real world.

Rosemary said...

Here in Ontario, circumcision was not covered by the government health care plan when my son was born 11 years ago, I assume it's the same now. When a doctor in the hospital asked if I wanted it done (it's available to parents willing to pay for it), I vehemently said no and he agreed that was for the best. To me the idea of cutting off part of my newborn baby's body was unthinkable--I actually had a nightmare about it while I was pregnant.

Muffinman said...

The lower rate of AIDS transmission statistic comes up quite often, but I think it was a correlation due to high religiosity in the circumcised group. The more religious males tended to engage less in sex with multiple partners and were more likely to practice safe sex (mainly due to a lower likelihood of alcohol abuse). Both of these would lead to lower HIV transmission, and could explain why it would not be a factor in homosexual sex. The fact that it only works in vaginal sexual situations is clearly indicative of at least some cultural influences.

Restoring Tally said...

The NY Mag series was terribly biased, just as you write. It is surprising that the rate of routine infant circumcision is falling in the US with such writers and publishers offering such biased information and advocating circumcision.

I was circumcised at birth and have since restored my foreskin. I can attest that sex is much better with a foreskin, even a restored foreskin. I describe the benefits of restoring in my blog www.RestoringTally.com

Thanks to the Internet and posts like yours, I believe that routine infant circumcision will be as low as other Western nations in my lifetime.

sfcuties said...

Can we have look at the elephant in the room? The entire original idea behind circumcision is to decrease sexual pleasure, for purely religious reasons.

They have been chopping wieners since way before HIV was discovered.

For the non-religious people there is no need for this.
For the religious ones, I would say: "Does this mean that you think god made a mistake when he designed your son?"

Nines said...

Poss. surgical triggers below

On female "circumcision": the term itself is misleading. A more accurate term for what is commonly referred to as female circumcision is female genital mutilation; the procedure can include a full clitoridectomy, involving removal of the clitoris. Sometimes the women this is done to are sewn up afterwards, so that their husbands can cut them open on their "wedding" night and know they are still virginal.

So, yeah, there are problems with circumcision as standard- it's unnecessary- but it's nowhere near as bad as what's commonly termed "female circumcision".

Kt said...

Lilith -

Thanks for responding! There are a couple of holes in that statement, as far as I see it.

How's Israel's rate, for example, as compared to America? High circumcision levels there, too. Someone else already brought up the religious factor that you overlooked. Then, the other comparison is between America and Africa - a country and a CONTINENT. A developed country versus an entire continent, most of which does not have access to good healthcare, medical knowledge, or sanitation. Their high rates are due to a lot of factors not present at all in America.

It's simply apples to oranges. America's high HIV infection rates, for example, include large numbers of IV drug users, which has little directly to do with circumcision (sex workers being a primary expection, who frequently use both), whereas Africa doesn't have nearly as many infections from IV drug use. The CDC currently has IV drug use HIV rates in America at 25-35%, whereas Africa's are much, much lower, at about ~5-10% overall (individual countries are higher).

I guess my point is this: Saying that circumcision probably doesn't prevent HIV, because America does it and we still have a high HIV rate, is assuming a simple correlation equals causation.

Sex is only one of many ways to transmit the virus, and America definitely has other primary modes of transmission. Like you said, there are so many factors in play. I'm definitely not arguing that circumcision DOES help prevent the spread of HIV - I'm only saying that this claim isn't valid, and only hurts your argument. :)

Lilith said...

Kt-

First off, the Africa comparison was a mistake. We had rewritten those paragraphs a few times and cut/pasted facts and rearranged and it ended up like that by accident. I noticed the typo because you quoted it (so thanks) but I've corrected it since then.

The fact still remains that we have one of the highest rates of circumcision and one of the highest rates of HIV infection. All of the factors you brought up to "refute" my point, actually help prove what I was saying.

Like I said in my last comment to you, there are too many other factors at play to put so much emphasis on circumcision as a method HIV-prevention. Yes, the preliminary science suggests that it prevents infection, but in the real world it doesn't necessarily make much of a difference.

What I'm saying is that even if it does prevent HIV transmission, it still doesn't make sense to recommend it for every healthy baby boy based that reason alone.

What I definitely wasn't saying was this:

Saying that circumcision probably doesn't prevent HIV, because America does it and we still have a high HIV rate

The HIV rate doesn't disprove the science. It simply puts it in real world perspective.

Kt said...

Ah, OK. I think I was just misunderstanding your phrasing, then. 'Cause the paragraph still says to me, when I read it: "US has a high rate of circumcision. US has a high rate of HIV. Doesn't look like circumcision prevents HIV." Which, obviously, comes off as a silly argument.

I think that I understand what you're trying to say now. And I don't disagree - I've never heard any legitimate science-y types exaggerate the HIV-prevention benefits, only lay(wo)men. It is just the nature of a three-sentence paragraph with Point A, Point B, and Conclusion C that made it seem like you were trying to say that A+B = C. That's where I balked.

Circumcision *might* be helping, or it might only be helping a small percentage, or it might not be helping at-bloody-all. The science definitely isn't there yet, you're right. But to say it's NOT helping is also unfair, as there isn't a solid study that I've seen that shows what our rates would be like if we stopped doing it. Country-to-country comparison is a decent attempt, but the variable factors (drug use, cultural norms, etc) there get out of hand very quickly. Even comparing to the EU or Britain leaves a lot to be desired.

The science types have weighed in, I'm waiting for the behavioral health kids to do the same - and those studies are on the way. Once I see some longitudinal cohort data on whether actually having a circumsion puts you at more/less risk in America itself, I'll feel a lot more comfortable with the issue.

But, like I said, I'm not pro/anti anything, and it does seem a little hasty to chop up newborns based on what we know. I just want to make sure we're not over-hasty to stop a practice that might be helping, without fully analyzing what might happen if we actually did so. It's an interesting debate.

KOTFrank said...

What pro-circs are not saying can hurt you. Old Jewish saying "A half truth is a whole lie". Langerhans cells secrete langerin which kills HIV. The fact remains the scientists doing the African studies do not KNOW how the HIV virus is transmitted. Langerhans cell are located in the mucosa located throughout the body. The tonsils have much more Langerhans than the foreskin but no one is advocating tonsillectomy. Circumcision removes most of the mucosa in which the Langerhans cells are located, thus making one more vulnerable to HIV infection. This is why circumcision increases the risk of HIV and why Langerin may be increased to fight HIV.

The US has the highest HIV infection rate of the G7 and is the only one to practice RIC. Pakistan's HIV infection rate is four times that of India.

(Lot de Witte, 2007) Langerin is a natural barrier to HIV-1 transmission by Langerhans cells

Human immunodeficiency virus-1 (HIV-1) is primarily
transmitted sexually. Dendritic cells (DCs) in the subepithelium ransmit HIV-1 to T cells through the C-type lectin DC-specific intercellular adhesion molecule (ICAM)-3-grabbing nonintegrin (DC-SIGN). However, the epithelial Langerhans cells (LCs) are the first DC subset to encounter HIV-1. It has generally been assumed that LCs mediate the transmission of HIV-1 to T cells through the C-type lectin Langerin, similarly to transmission by DC-SIGN on dendritic cells (DCs). Here we show that in stark contrast to DC-SIGN, Langerin prevents HIV-1
transmission by LCs. HIV-1 captured by Langerin was
internalized into Birbeck granules and degraded. Langerin
inhibited LC infection and this mechanism kept LCs refractory to HIV-1 transmission; inhibition of Langerin allowed LC infection and subsequent HIV-1 transmission. Notably, LCs also inhibited T-cell infection by viral clearance through Langerin.

Thus Langerin is a natural barrier to HIV-1 infection, and
strategies to combat infection must enhance, preserve or, at the very least, not interfere with Langerin expression and function.

KOTFrank said...

It would appear the African studies's scientists are wrong about Langerhans cells being the ominous portal of entry for HIV. This makes all else suspect.

http://www.bio-medicine.org/medicine-news/Protein-Blockade-For-HIV-Infection-
18798-1/

Excerpt:
Scientists have found out that langerin, a protein produced by the human genitalia may have contained the spread of HIV infection//. New transmission can be brought under control by augmenting the activity of langerin. This
research was conducted by Teunis Geijtenbeek and his team at Vrije\ University Medical Center in Amsterdam which was published in March 4 online issue of Nature Medicine.

Langerin is a protein produced by langerhans cells which form a web like network in skin and mucosa. Viruses in the surrounding area has been hunte by langerin cells preventing infection. This sort of action by the langerin
can be attributed to the relative inefficiency in the spread of HIV infection when compared with the 100% infection in Human Papilloma Virus which causes cervical cancer.

The dutch study was conducted in the laboratory using langerhans cells from 13 human donors. According to this study, the HIV uses langerhans cells to carry itself to the T cells which are present in the lymph. It has always been believed that HIV infects langerhans cells. But the presence of the protein langerin is found to have a blockading effect on HIV.

According to Geijtenbeek, langerhans cells act more like a virus vacuum cleaner which captures HIV 1 and destroys them. HIV infection occurs when there is an increased level of HIV or when the langerin activity is weak.
This clearly explains why HIV is very difficult to contract.

Geijtenbeek said this research opens up the possibilities of increasing langerin activity to combat HIV transmissions. The functioning of langerin could be attributed to the extent of HIV infection. A weak langerin is more vulnerable to HIV infection and vice versa. He also felt that this finding could influence the discovery of a microbicide which will give protective cover to women against HIV infection.
JYT

TLC Tugger said...

Hey Kt,

Causation/correlation is not the issue. The fact that we in the US (where 80% of adults were cut at birth) have three times the HIV incidence that Europe (where cutting is very rare) has is proof positive that circumcision is not needed to thwart HIV. Whatever the true causation of their success, we could be pursuing that.

A published study from the last year showed that condoms are 95 times as cost effective as circumcising for fighting AIDS in Afirca, even if you take the flawed Africa/Circumcision research at face value. And as the blogger wrote, the Africa researchers finally admitted in August that the HIV+ men they cut were 50% MORE likely to transmit HIV to their monogamous partners than the HIV+ men they left intact were.

But NONE of this has anything to do with circumcising babies, who DON'T HAVE SEX. Let him decide when he's older; A) amputate over half the sensual nerve endings in hopes of thwarting HIV even though Americans are equally likely to die of AIDS if cut or intact, or B) use safer sex practices, or C) employ whatever miracle has been developed in the meantime and thank his lucky stars nobody mutilated him based on decades-old science.

SaynaTheSpiffy said...

The thing that bothers me here is that people ignore the fact that it's the child's body, not the parents'. Children are not property. I will never understand what makes a parent think that they should have any right to alter their child's genitals for purely cosmetic/traditional reasons without their consent. Even if they say that they're doing it for a medical reason the fact of the matter is that they are removing a piece of the most private and sensitive part of their son's body before he can have any say in it. This will affect his genitals and his sexual pleasure for the rest of his life. It is an absolute violation of his right to control his own body.

KOTFrank said...

Anyone in the USA can stand up for equality of the sexes and would do so by supporting MGMbill. Bills submitted to congress to give equal rights to boys as girls now enjoy simply by placing "boys" alongside where "girls" are listed.

Kt said...

TLC Tugger -

I think you're missing my point. You're making the same incorrect assumption as I was balking at before - "Europe doesn't cut, Europe's HIV rates are lower, looks like the two things are related." You are seeing a correlation, and assuming it means a causative factor! This is "proof positive" of nothing.

ECDC and WHO data show new HIV infection rates in Western Europe for IV drug users at 8%. Only EIGHT percent. As compared to the US's 25%-35%. So no, you CANNOT make a basic comparison between the HIV numbers in Europe vs the US w/o controlling for MASSIVE discrepancies between transmission pathways.

People - you simply can't compare two vastly different areas of the world, with vastly different HIV problems, without controlling for all the differences (heck, even something as simple as the number of incarcerated prisoners in the US vs Europe is going to have an effect that has NOTHING directly to do with circumcision).

Eastern Europe, for example, is having an increasingly ugly trend of HIV contraction due to IV drug use - up to 57% of new cases, in some countries! Low rates of circumcision there. Should I be allowed to say "Low rates of circumcision and high rates of new HIV infections? Proof positive that circumcision is protective!"

No. I can't say that. Because of the differences in IV drug use, among MANY other things, that I'm not accounting for. Does that make my point clearer? I'm not sure how else to say it.

Lilith said...

I don't know Kt, I think you might be the one missing the point. NO ONE is saying that the HIV rates proves or disproves the science.

What we - and it seems TLC as well - are saying is that no matter how effective circumcision may or may not be at preventing HIV infection (still up for debate), it obviously isn't having much a real world effect on the overall epidemic.

The HIV rates being higher or lower in certain areas no doubt is related to other factors.

So instead of pushing parents to circumcize infants - a practice that many doctors say has no medical benefits - why not take circumcision out of the HIV equation altogether and take a look at what is causing these disparate rates.

You made the case yourself several times... if high rates of HIV infection are due to IV-drug use, then circumcision has no effect on that. You keep talking about making assumptions, but no one is actually making the assumptions you think we're making.

Kt said...

Lilith -

I think this might be my last post on this topic, I'm out of ways to explain myself. That's not a slam on you ladies and gents, just an admission of failure on my part. But here goes. :)

You say "obviously", but it's not obvious to me. I'm saying that those rates that are SO high in the US, are ~20% higher than Western Europe purely due to IV drug users in the equation. IV drug users ALONE. If you then add in all those other factors that we agree on, you might see that the US rates are equal to that of Western Europe. Or even higher.

Or, and here's the kicker, you might see that the rates here are LOWER after all factors other than circumcision are controlled for. The science shows there might be a benefit. And the behavioral health/epidemiological research doesn't yet EXIST that shows validly whether or not it's actually happening. The biobehavioral health scientists are working on that, but there aren't any conclusions yet!

Saying that it's "obvious" that the US's circumcision practices don't help in the HIV epidemic just because the real world impact isn't immediately obvious in the NUMBERS isn't good science. You're looking at the pure data, and not taking into account the factors that manipulate that data. Does that make any more sense?

Again, I'm probably with you. I don't think the science will show that it has a major effect on HIV transmission. I'm just saying that this statement is a leap I'm not comfortable with. That's all.

Jess said...

I think Kt is right, y'all. Our rates are higher in the US because of other factors, not because circumcision isn't effective enough. We don't have any studies controlling for the myriad other factors to show us how effective circumcision is in preventing HIV.

I'm really not sure where the communication breakdown is happening here. Correlation isn't proving anything. Higher HIV rates don't mean anything when it comes to the benefits of circumcision at a societal level in the US.

Lilith said...

It's just my opinion that the benefits of circumcision - at a societal level or a personal one - are minimal at best.

Even the data suggesting that circumcision reduces HIV transmission is sketchy. In addition to other 'issues' with the studies, the real issue is that they were based on adult circumcision in Africa. It's extremely misleading to use those findings to promote infant circumcision in the U.S.

No one is saying it might not be helpful, or contribute to the epidemic on some level, but there isn't any evidence yet to support the claim that circumcision is necessary to save our babies' lives.

That is the claim (made by people in the NY article and by other pro-circ advocates) that we're trying to refute by bringing up the HIV rates. We're not making any assumptions about correlation or causation. We're simply pointing out the likelihood that contraception use, drug use, and other factors probably play a much bigger role in the HIV epidemic than a little piece of foreskin does.

Melissa said...

In other words:

If the bulk of new HIV infections are from using IV drugs, not using condoms, or some other cause, then whether or not the guy is circumcised becomes a moot point.

That is the message I got out of the paragraph that this sub-debate stemmed from. It's true: According to the studies, circumcision might prevent HIV infection, but when you look at the actual numbers in real world terms, it's all moot.

KOTFrank said...

I propose another dynamic effect of circumcision and HIV in the US. I experienced and observed that many gays choose to use crystal meth above other drugs for better sex in duration, heightened sensations and desire. Because circumcision removes the most sensitive parts of the penis and as the removal of 65%-85% of the erogenous sexual receptors (Sorrells et al.), sensation is lost. I believe circumcised men are using meth knowingly and instinctively to compensate lost receptors. Gays observe the difference in intact men's sexual response by copious precum, more and forceful ejaculate, facial expressions and sounds. A meth induced response seems to equate to an intact response. (There is a Turkish study done that showed circumcised men are encouraged by their women to use hashish so the men would last longer and be more interested in sex.) Meth use is also the fastest growing drug problem especially in the Midwest among straights. Here, the circ. rate is the highest in the nation overall. The latest news though shows women are on the road to equal men's meth use. I believe women are introduced to meth use by associating sexually with meth using men.

http://www.chain.net.cn/wzhg/14327.htm : HIV/AIDS became a major headache for China in the 1980s and 1990s, when hundreds of thousands of impoverished farmers became infected through botched blood-selling schemes. Although this practice has since been stopped, it has left behind some 75,000 orphans, some of whom are infected. (snip) 48 percent of those who were
newly infected contracted the disease from sex,

Lilith - you said "a little piece of foreskin does." I'm alarmed because this is what a pro-circ'r says. Circumcision removes half (3"x5") of mucosa and true skin not to mention 75% sexual receptors.
BTW- "uncircumsied" is also pro-circ'rs language to promote circumcision. Means needs to be circumcised. Uncircumcised says nothing of the nature of the penis in is true form. Better to say natural or intact. I also have problems with the word "circumcision". Sounds too soft and pretty for what amounts to genital mutilation done to day for the most part without anesthetics, so it's also torture.
(http://bit.ly/mMoZR 3,928 island villagers males&females all ages forced circ'd into Islam by Muslim clerics) and Nelson Mandela said his circ. was blinding white light of painful electrical burning throughout his whole body.

Lilith said...

That's an interesting theory. I'd love to see more studies to prove or disprove it.

LOL, but as for the "little piece of foreskin", I meant that in relation to the role it plays in the HIV epidemic. I didn't mean to imply that the foreskin (or removal of) is insignificant in any other ways.

Anonymous said...

I decided against circumcision for both of my sons. The first time (1984) I was actually accused of being too cheap to pay the $50 the hospital wanted. The second time (1987), the hospital insisted that I would have to watch a child being circumcised before they would "allow" me to refuse the procedure. (I explained that I couldn't imagine why they thought witnessing a surgical assault on a screaming infant would sway me and they let it drop.)

Over the years, I've had the to-circumcise or not-to-circumcise conversation with dozens of expectant parents. In all those years, not one that I can recall ever brought up HIV as a factor nor, in fact, any STD. Overwhelmingly, the decision hinged on three ideas: (1) wanting the child to look like dad and/or everyone else in the locker room; (2) some mistaken (holdover) notions about routine hygiene - not disease, just cleanliness; and (3) it's better to do when they're young because it's painful but they'll forget. In other words, circumcision doesn't look right, it might be inconvenient to retract and wash, and really, removal is a foregone - no pun intended - conclusion.

This is all anecdotal, I know, but I think the real debate - as it happens out here in middle America among new parents - won't be much affected by research regardless of what it proves with regard to transmission of viruses. It's an interesting argument, but largely academic. I believe that the American public simply has a foreskin-phobia - an ick factor based on preconceptions about how a penis is or is not supposed to look.

Hugh7 said...

All those people (such as Nines) who said "You mustn't compare Male Genital Cutting with Female Genital Cutting, FGC is much worse," you can stop now. The AAP wants doctors to be able to perform a "ritual nick" on girls, and that's not nearly as harsh as male circumcision. So if you object to that on principle, you must logically object to non-therapeutic circumcision as well.