Circumcision the AAP and some data....

Your usual Feckblog post. The reason I am chiming in is this current development:

American Academy of Pediatrics - POLICY STATEMENT Circumcision Policy Statement - 2012

In 2007, the American Academy of Pediatrics (AAP) formed a multidisciplinary task force of AAP members and other stakeholders to evaluate the recent evidence on male circumcision and update the Academy’s 1999 recommendations in this area. Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks and that the procedure’s benefits justify access to this procedure for families who choose it. Specific benefits identified included prevention of urinary tract infections, penile cancer, and transmission of some sexually transmitted infections, including HIV. The American College of Obstetricians and Gynecologists has endorsed this statement. [...]

Although health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it and to warrant third-party payment for circumcision of male newborns. It is important that clinicians routinely inform parents of the health benefits and risks of male newborn circumcision in an unbiased and accurate manner

Sigh...before we continue with the above, some data on health benefits:

USING MALE CIRCUMCISION TO UNDERSTAND SOCIAL NORMS AS MULTIPLIERS - Sarah E. Waldeck - 2003

1. Urinary Tract Infection (UTI)

The AAP estimates that noncircumcision means a four- to ten-fold increase in risk during the first year of life. However, the actual incidence of UTI is low, even for uncircumcised boys. According to the AAP, at most approximately one percent (1 out of 100) of uncircumcised males contract UTI during their first year. Since publication of the Task Force's report, a new study reports that among uncircumcised boys, the actual incidence of UTI is 2.15 percent. But even if this new statistic is correct, less than 3 out of every 100 uncircumcised males will contract UTI, and most who do can be easily treated with antibiotics.

2. Penile Cancer

[W]hile penile cancer is serious, it is also exceedingly rare, even for uncircumcised men. [...M]ost cases of penile cancer occur in uncircumcised males, who have an incidence rate of 2.2 per 100,000.

3. HIV

The connection between HIV and circumcision has not been heavily studied in the United States. [...] The only random population study conducted in the United States found no correlation between circumcision status and the rate of HIV. What is undoubtedly true is that behavioral factors are "far more important risk factors in the acquisition of HIV infection than circumcision status." The United States itself illustrates this point: it has both the highest rate of circumcision and the highest rate of HIV infection in the Western world.

4. Other Sexually Transmitted Diseases (STDs)

If circumcision makes a difference, it is probably for reasons that are similar to why noncircumcision is a risk factor for HIV: the moist environment under the foreskin and the susceptibility of particular cells in the foreskin. In addition, the foreskin may be prone to small abrasions during intercourse, which would facilitate transmission of STDs. Importantly, as with HIV, behavioral factors are far more significant than circumcision status in determining whether a person contracts an STD. Again, the United States has both the highest rate of circumcision and the highest rate of STDs in the Western world.

5. Cervical Cancer

In sum, more research needs to be done before prevention of cervical cancer can be added to the list of circumcision's potential health benefits. But because of the issue of distributional fairness, as well as the dubiousness of the parent's ability to consent to circumcision when its purpose is to benefit adult women, we should view with caution any argument that promotes the prevention of cervical cancer as a justification for routine circumcision.

Let me summarize the health benefits of circumcision for you: It helps with 2 rare medical problems, UTIs and Penile Cancer. With HIV and STDs, behavior is far more important (the US has the highest rates of circumcision and STDs in the western world). Cervical Cancer / HPV....there is a vaccine for that:

In 2010, 49% of teenage girls in the US got the HPV vaccine, while in comparison around two-thirds of teens have gotten shots for meningitis and DPT vaccine.

Not even talking about complications here or other negative effects of circumcision. It just seems the argument for medical benefits does not have much meat. The AAP says:

It is important that clinicians routinely inform parents of the health benefits and risks of male newborn circumcision in an unbiased and accurate manner.

This however does not really matter as circumcision in the USA is not about health benefits.

From the Waldeck paper:

If routine circumcision is not medically recommended, is painful, and carries the risk of complications, why do more than 65 percent of American parents choose to do it? While there is no simple answer to this question, the existing social science research shows that the procedure is highly path dependent: in large part, parents circumcise because their parents did it and because their peers are doing it. Indeed, surveys of parental decisionmaking reveal that the single most prominent factor is usually what researchers term "social concerns," that is, the desire for the boy to look like his peers or his father. With regard to the former, parents worry that a boy whose penis is different from others will be ridiculed by his schoolmates, or that his sex life will be negatively affected in later years. In other words, parents perceive that the presence or absence of a foreskin is a basis for what McAdams describes as esteem-based sanctions. And there is room here for Posner's signaling theory as well. With no medical reason for the procedure, the circumcision decision is wholly arbitrary and an opportunity to signal a "good type."

Another study I came across:

Factors Affecting the Circumcision Decision - Jeffrey D. Tiemstra MD - 1999

Although this study is clearly limited by the small and heterogenous sample, the findings are consistent with those from studies from 15 years ago, which showed that (1) that the circumcision decision is most often made before parents discuss the issue with their care providers, (2) that social concerns are more important than medical ones, and (3) that providers' discussions have limited impact on the decision made. Medical benefits were cited more frequently in this study than in past studies, although medical issues remain secondary to hygience and convenience. Given the limitations of this study, the minor increase in parents citing medical issues might or might not be important. The study design could have contributed to this finding as well, because the mere presence of this item on the survey could have prompted parents to choose it. [...] In summary, then, this study suggests that parents continue to have preformed decisions regarding circumcision based primarily on non-medical concerns, which are unlikely to be changed by attempting neutral discussion of the relative risks and benefits.

There was one thing that was missing from all of this and it can be said in one short sentence:

It is his body, it should be his choice.

Another interesting article on the circumcision ruling in Germany

Pretty good reasoning:

After much deliberation, it concluded that a circumcision, "even when done properly by a doctor with the permission of the parents, should be considered as bodily harm if it is carried out on a boy unable to give his own consent". It ruled the child's body would be "permanently and irreparably changed", and that this alteration went "against the interests of a child to decide for himself later on to what religion he wishes to belong".

Also, feminist fail *sigh*

Women's rights groups and social policy makers also condemned the decision, but for the reason that it would have the effect of putting male and female circumcision on the same footing, when they were "in no way comparable", said Katrin Altpeter, social minister in the state of Baden-Württemberg. Female circumcision she said, was a far more drastic act. It is already outlawed in Germany.

I don't even...

Germany: Who cuts boys for religious reasons is liable to prosecution for assault. This decided the regional court in Cologne in a landmark judgment...

That one took my by surprise. Your turn USA.

I’m not buying the argument that banning circumcision is a violation of religious freedom, because such freedom must involve being able to choose for themselves.

Title says it all. Apparently Norway is about to ban non-medical circumcision of infant boys. Good for them. Here is the article.

FGM vs NTC

This is one very controversial topic. So I offer the following disclaimer. All forms of non-therapeutic circumcision / genital cutting is wrong and violates the bodily integrity of the victim. I do support genital integrity for everyone. Now, obvious female genital mutilation (FGM) and non-therapeutic circumcision (NTC) done one male minors have some things in common and there also are differences. Both are a violation of bodily integrity and often both differ in terms of severity. This post is more about the similarities between the too as well as similarities in the discussion around these two issues. We start with the Royal Dutch Medical Association (KNMG) that has a good summary for this post

Position of the KNMG with regard to non-therapeutic circumcision of male minors - 2010

FGM vs NTC (Page 10)

FGM and NTC are generally seen as two separate practices, which need to be evaluated differently. For example, doctors’ organisations often devote different statements to the two practices. In the literature, little attention is given to legitimating the different treatment given to the two practices: apparently the difference is regarded as self-evident.45 FGM is generally viewed as a serious violation of the rights of the child, while NTC is seen as something which parents may decide on for themselves. In the literature that exists, a number of arguments are made which are intended to justify a different evaluation of FGM and NTC.

At first they cover the argument about severity. That MGM heavily impairs the victims...

FGM takes many forms. There is the most severe form, infibulation, in which the inner and outer labia are stitched together and the clitoris is removed. However, there are also much milder forms of FGM, in which only the foreskin of the clitoris is removed. However, sunna light, as proposed by Mulder and previously proposed by Bartels, in which no tissue is removed, is also universally rejected. The WHO also rejects all forms of FGM: ‘Female genital mutilation of any type has been recognized as a harmful practice and a violation of the human rights of girls and women’. The WHO explicitly includes in this the mild forms of FGM, in which no tissue is removed. So the argument for rejecting FGM is not that FGM interferes with female sexuality, but that it is a violation of the rights of the woman.

‘The guiding principles for considering genital practices as female genital mutilation should be those of human rights, including the right to health, the rights of children and the right to non-discrimination on the basis of sex’. (Eliminating Female genital mutilation: an interagency statement, WHO, 2008)

and that NTC has little to no effect on male sexuality.

The foreskin is regarded as a part of the body that has no function at all in male sexuality. Many sexologists contradict this idea: in their view, the foreskin is a complex, erotogenic structure that plays an important role ‘in the mechanical function of the penis during sexual acts, such as penetrative intercourse and masturbation’. The many attempts by men to restore their foreskins by mechanical or surgical means also contradict the idea that the foreskin is a useless part of the body.

NTC is sometimes compared to interventions such as tattoos and piercings. On this view, Jews and Muslims see NTC not as an infringement of physical integrity, but as an innocent perfectioning of the body, comparable to tattoos and piercings. However, an important legal distinction between NTC in children and piercings and tattoos is that it is prohibited to tattoo or pierce children under the age of 16. In other words, tattoos and piercings can only be done if a child is old enough to ask for them itself.

Next comes the feminist argument that FGM is a form of oppression and that therefor FGM is worse, as men are not oppressed.

[T]he historical background of NTC is extremely complex, and is in any case rooted in the desire to control male sexuality. Thus NTC was deployed in the past to combat excessive onanism, and it was also used to ‘brand’ slaves. So the background to NTC is not as unambiguous as is often thought. There is another reason why the argument does not hold. The reason why FGM is condemned is not because it comes forth from a theory of female oppression but because it is harmful to them and represents a violation of their physical integrity. FGM would also be condemned if it were done out of aesthetic considerations or as a way of ‘venerating’ women. Even if women were to want FGM themselves at a later age, doctors would probably not be permitted to meet their request.

The right to physical integrity is an inalienable human right, like the right to life and the right to personal freedom. These are inalienable rights, which is to say that the patient’s permission does not offer sufficient justification to be allowed to perform the intervention. Besides permission, there must also always be an additional reason, such as a medical interest. From this it follows that even if women did not regret the intervention, doctors would not be permitted to commit serious infringements of the integrity of the body, such as FGM.

And finally the cultural/religious argument:

[B]oth NTC and FGM have been practised for centuries by many different peoples and for many different reasons. And FGM also has an important ritual, religious and identifying significance for many peoples. So it cannot be said with certainty that NTC is older than FGM. Even if it were, it is still questionable whether this argument is morally relevant. It is not the history of a practice which is of decisive importance, but whether a particular practice is a violation of the rights of the child.

A good summary. Now, as someone on reddit did point out, the supporters of FGM argument similarly to the supporters of NTC (which sounds like another good reason to ditch that custom):

Disputing the myth of the sexual dysfunction of circumcised women - An interview with Fuambai S. Ahmadu by Richard A. Shweder - ANTHROPOLOGY TODAY VOL 25 NO 6, DECEMBER 2009

[Speaking about a Documentary about the Kono in Sierra Leone]

So, contrary to much of the rhetoric of the anti-FGM campaigns, the female sex and female sexuality are not oppressed in, through or by these ritual practices. On the contrary, female sexuality and reproductive powers are celebrated and reified in the masquerades, as the origins of creation, of nature and of culture, and feared as potent weapons of death and destruction. This cultural and symbolic context of female initiation and excision explains how it could be that Kono girls and women in the film were speaking in positive, almost reverential terms, about the practice, their bodies and the experience of womanhood. There are different types of female genital cutting practices that are performed for many different reasons, and these practices prevail in diverse sociocultural contexts, so not all women who are affected necessarily support these practices or view them as empowering to girls and women.

She goes on to cite studies (Obermeyer 1999, Linda Morison et. al. 2001, Johnsdotter and Essen 2004, Birgitta Essen et al. 2002, 2005) that show that the health hazards of FGM have been exaggerated and that circumcised women have sexual pleasure (Ahmadu 2000 & 2007, Lightfoot-Klein 1989, Catania et al. 2007). From what she says, the society of the Kono does not seem to be a society that dominates women. A critic of the western view on FGM is brought forward, also in regard to NTC:

Circumcised African women, according to this view, are in a permanent condition of ‘pain’ and ‘suffering’ from which, Goldberg would argue, only other enlightened African women (with the indirect but certain guidance of Western women) can provide escape. Of course, I find this view patronizing and infantilizing of adult African women who, like Western women who opt for cosmetic genital surgeries, should be free to decide for themselves what to do with their own bodies.

Another point I made that Goldberg overlooked is that supporters of female circumcision justify the practice on much of the same grounds that they support male circumcision. The uncircumcised clitoris and penis are considered homologous aesthetically and hygienically. Just as the male foreskin covers the head of the penis, the female foreskin covers the clitoral glans. Both, they argue, lead to build-up of smegma and bacteria in the layers of skin between the hood and glans. This accumulation is thought of as odorous, susceptible to infection and a nuisance to keep clean on a daily basis. Further, circumcised women point to the risks of painful clitoral adhesions that occur in girls and women who do not cleanse properly, and to the requirement of excision as a treatment for these extreme cases. Supporters of female circumcision also point to the risk of clitoral hypertrophy or an enlarged clitoris that resembles a small penis. For these reasons many circumcised women view the decision to circumcise their daughters as something as obvious as the decision to circumcise sons: why, one woman asked, would any reasonable mother want to burden her daughter with excess clitoral and labial tissue that is unhygienic, unsightly and interferes with sexual penetration, especially if the same mother would choose circumcision to ensure healthy and aesthetically appealing genitalia for her son?

She closes with:

I write and teach about different cultural perspectives on female circumcision with regard to pleasure, hygiene and genital aesthetics, not to insist that uncircumcised Western women opponents have it wrong and circumcised African women proponents are right (such stereotypical categorizations are never quite so neat anyway) but to point out that there are different and contested views and experiences and that no one is more right than the other. So it is my opinion that we need to remove the stigma of mutilation and let all girls know they are beautiful and accepted, no matter what the appearance of their genitalia or their cultural background, lest the myth of sexual dysfunction in circumcised women become a true self-fulfilling prophecy, as Catania and others are increasingly witnessing in their care of circumcised African girls and women.

Now apparently, things are not that easy, still the right to bodily authority would mean everybody needs to be able to make informed decisions about modifying their genitals. What is also apparent after reading the above is that Ahmadu points out the hypocrisy of the approach towards FGM while tolerating NTC. Again, I am opposed to both forms of genital cutting and can offer no opinion on the studies brought forward by Ahmadu, but of course one can view every issue from more than one side. But still, bodily integrity, people, tops everything.

The discussion on Reddit was interesting as well, pointing out that many women can only have clitoral orgasms and also still enjoy intercourse. It is similar to the NTC argument, how can you know if you miss something out if you can not compare?

basically, the clit isn't the only way for a woman to orgasm. it's just that in an intact woman, it's the most sensitive area, so intact women learn to rely on it. but in women with clitorectomy, it's gone, so they learn to rely on orgasm from other areas. g-spot, cervix, vaginal, etc. For women especially, reaching orgasm has a strong psychological component, which is why a number of studies show a woman who'sin an unhappy relationship often has trouble, while a man in such a relationship is less likely to have difficulty.

just like in men: in an intact man, the foreskin moves over the head during masturbation and sex, stimulating his glans and foreskin, this being his major source of pleasure. (look at a jerk off video on xtube or something if you're curious) If a man's foreskin is amputated, this normal stimulation is impossible, so he learns to reach orgasm by stimulating in other ways, mainly by squeezing tighter and moving skin along the shaft, or by using lube to rub the head.

The following sums it up pretty well:

Again, I'm opposed to FGC and MGC (Male Genital Cutting); my point in this post is to show how they are both human rights violations. essentially what I'm saying is, some activists against FGC have exaggerated some of it's negatives in order to make sure Americans won't look at male circumcision and say, "well we are doing this, so I should support both." [..]

It IS a big hypocrisy for us to get riled up over FGM in some other country that we have no authority over yet allow MGM (Male Genital Mutilation) to go on in our own. That doesn't make the two procedures analogous though. There are clear distinctions between the two.

Circumcision....another collection of links

We start with a piece about Circumcision and HIV.

The Use of Male Circumcision to Prevent HIV Infection - A statement by Doctors Opposing Circumcision


Both the public and the medical community must guard against being overwhelmed by the hyperbolic promotion of male circumcision and must receive these new studies with extreme caution. There is contradictory evidence that male circumcision is not as effective as proponents claim. One study found that male circumcision had no protective effect for women51 and another study found that male circumcision increased risk for women.52 Grosskurth found more HIV infection in circumcised men.53 Barongo et al. found no evidence that lack of circumcision is a risk factor for HIV infection.54 A study from India found little difference between circumcised and non-circumcised men in the conjugal relationship.55 A study carried out in South Africa found that male circumcision offered only a slight protective effect.56 A study carried out among American naval personnel found no difference in the incidence of HIV infection between non-circumcised and circumcised men.57

[...]

The RCTs on which the current claims are based have been carried out by men who have a previous history of promoting circumcision. DOC has little confidence in such studies, especially since contradictory evidence exists.

Male circumcision may increase male-to-female transmission of HIV and mitigate any reduction in female-to-male transmission. A preliminary report confirms the increased risk to women.65

Instituting a program of male circumcision is of dubious value. It will divert resources from proven methods of epidemic control and it may generate a false sense of security in males who have been circumcised. The desensitization of the penis that frequently results from male circumcision is likely to make men less willing to use condoms. A program of male circumcision very likely may worsen the epidemic.

The epidemic in Africa may have little to do with lack of circumcision and everything to do with the percentage of the female population engaged in female sex work. Talbot (2007) has established a correlation between the number of female sex workers in the population and the level of HIV infection.66

Calls are being heard for the circumcision of children although (assuming that male circumcision is effective at controlling female-to-male infection) this could not be helpful until the child becomes sexually active. As previously stated, the non-therapeutic excision of healthy body parts from non-consenting children is a violation of human rights44 and medically unethical.45 Therefore, the true motivation of the circumcision proponents must be questioned.46 It may be perpetuation of neonatal circumcision, not control of HIV.

DOC believes that more emphasis on education, behavior change—such as abstinence before marriage and fidelity after marriage, provision of condoms, treatment of other sexually transmitted diseases, treatment of genital ulcer disease, control of malaria, and provision of safe healthcare would be more likely to produce beneficial results. The ultimate answer is likely to be one or more of the vaccines now in development.

We continue with an piece about the foreskin:

The Case Against Circumcision - Paul M. Fleiss, MD

The foreskin has numerous protective, sensory, and sexual functions.

Protection: Just as the eyelids protect the eyes, the foreskin protects the glans and keeps its surface soft, moist, and sensitive. It also maintains optimal warmth, pH balance, and cleanliness. The glans itself contains no sebaceous glands-glands that produce the sebum, or oil, that moisturizes our skin.11 The foreskin produces the sebum that maintains proper health of the surface of the glans.
Immunological Defense: The mucous membranes that line all body orifices are the body's first line of immunological defense. Glands in the foreskin produce antibacterial and antiviral proteins such as lysozyme.12 Lysozyme is also found in tears and mother's milk. Specialized epithelial Langerhans cells, an immune system component, abound in the foreskin's outer surface.13 Plasma cells in the foreskin's mucosal lining secrete immunoglobulins, antibodies that defend against infection.14
Erogenous Sensitivity: The foreskin is as sensitive as the fingertips or the lips of the mouth. It contains a richer variety and greater concentration of specialized nerve receptors than any other part of the penis.15 These specialized nerve endings can discern motion, subtle changes in temperature, and fine gradations of texture.16, 17, 18, 19, 20, 21, 22, 23
Coverage During Erection: As it becomes erect, the penile shaft becomes thicker and longer. The double-layered foreskin provides the skin necessary to accommodate the expanded organ and to allow the penile skin to glide freely, smoothly, and pleasurably over the shaft and glans.
Self-Stimulating Sexual Functions: The foreskin's double-layered sheath enables the penile shaft skin to glide back and forth over the penile shaft. The foreskin can normally be slipped all the way, or almost all the way, back to the base of the penis, and also slipped forward beyond the glans. This wide range of motion is the mechanism by which the penis and the orgasmic triggers in the foreskin, frenulum, and glans are stimulated.
Sexual Functions in Intercourse: One of the foreskin's functions is to facilitate smooth, gentle movement between the mucosal surfaces of the two partners during intercourse. The foreskin enables the penis to slip in and out of the vagina nonabrasively inside its own slick sheath of self-lubricating, movable skin. The female is thus stimulated by moving pressure rather than by friction only, as when the male's foreskin is missing.

Circumcision is almost unheard of in Europe, South America, and non-Muslim Asia. In fact, only 10 to 15 percent of men throughout the world are circumcised, the vast majority of whom are Muslim.29 The neonatal circumcision rate in the western US has now fallen to 34.2 percent.30 This relatively diminished rate may surprise American men born during the era when nearly 90 percent of baby boys were circumcised automatically, with or without their parents' consent.

Mensactivism.org had a piece up with several interesting tidbits:

The Finnish Medical Association takes the stand that child circumcisions are in conflict with medical ethics. (source)

Circumcision of young boys for religious and non-medical reasons ought to be banned in Sweden, urged the Swedish Paediatric Society (Svenska barnläkarföreningen, BLF). In a statement submitted to the National Board of Health and Welfare (Socialstyrelsen), the society called the procedure an assault. "We consider it to be an assault on these boys," Staffan Janson, chairman of BLF's committee for ethical issues and childrens' rights, said to newspaper Göteborgs-Posten (GP). (Source)

The Royal Dutch Medical Association (the KNMG) has published a ground breaking position paper on non therapeutic male child circumcision which calls for a "powerful policy of deterrence", if not an outright ban. The paper states that non therapeutic circumcision is an infringement of a child's rights to bodily integrity and personal autonomy, that its risks are underplayed, and that to reject all forms of forced female genital cutting while allowing forced male genital cutting is ethically inconsistent. [...] The position of the KNMG is jointly endorsed by: The Netherlands Society of General Practitioners, The Netherlands Society of Youth Healthcare Physicians, The Netherlands Association of Paediatric Surgeons, The Netherlands Association of Plastic Surgeons,The Netherlands Association for Paediatric Medicine, The Netherlands Urology Association, and The Netherlands Surgeons’ Association. (Source)

The above had a link to a position paper of the KNMG which summarizes more official positions on circumcision, which makes a nice list:

In 2003, the British Medical Association stated: ‘The medical benefits previously claimed have not been convincingly proven. (…) The British Medical Association considers that the evidence concerning health benefits from non-therapeutic circumcision is insufficient for this alone to be a justification for doing it.’25

The American Academy of Pediatrics stated in 1999: ‘Existing scientific evidence … [is] not sufficient to recommend routine neonatal circumcision.’26 The American Medical Association endorsed this position in December 1999 and now rejects circumcision for medical/preventative reasons. The AMA further states: ‘parental preference alone is not sufficient justification for performing a surgical procedure on a child’.27

Other doctors’ organisations in Australia and Canada have taken similar positions.28 For example, the Royal Australasian College of Physicians asserts: ‘Review of the literature in relation to risks and benefits shows there is no evidence of benefit outweighing harm for circumcision as a routine procedure in the neonate.’29 In its viewpoint, the Australasian Association of Paediatric Surgeons states: ‘the AAPS does not support the routine circumcision of male neonates, infants or children in Australia. It is considered to be inappropriate and unnecessary as a routine to remove the prepuce, based on the current evidence available’.

The Canadian Paediatric Society states: ‘The overall evidence of the benefits and dangers of circumcision is so evenly balanced that it does not support recommending circumcision as a routine procedure for newborns’.30

The American Academy of Family Physicians believes that the medical benefits of circumcision are ‘conflicting or inconclusive’. The decision should therefore be left to parents: ‘The American Academy of Family Physicians recommends physicians discuss the potential harms and benefits of circumcision with all parents or legal guardians considering this procedure for their newborn son’.31

The position paper of the KNMG sums circumcision up pretty well:

Position of the KNMG with regard to non-therapeutic circumcision of male minors - 2010

- 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.

And finally, another large overview resource paper, this time by ICGI. This is just way too much to summarize, so I will just dot out the summary:

Position Paper on Neonatal Circumcision and Genital Integrity - 2007

The foreskin is a multifunctional structure that has physiological value and is worthy of retention. Considerable cultural controversy surrounds neonatal circumcision, including medical, legal,
and ethical considerations. Non-therapeutic circumcision of male children has been shown to be ineffective at improving health, and as such, it falls outside acceptable standards of care. This
places physicians in a precarious position when they are expected to perform the surgery. Medicalization of circumcision, beginning over one-hundred forty years ago, has resulted in a circumcision cycle where “American parents have been conditioned to request it, that physicians perform it, and that insurance companies pay for it, helps to reinforce the aura of legitimacy surrounding circumcision.”411

The International Coalition for Genital Integrity recommends against circumcising infants. Appropriate physician action includes not initiating circumcision discussions, because infant circumcision is not indicated and non-therapeutic. However, since many parents—and other physicians such as pediatricians and obstetricians—are not yet aware of these facts, physicians should provide information during prenatal care appointments explaining that the benefits do not outweigh the risks, according to our current understanding, and that the procedure is not recommended for infants. Physicians should provide specific information on the potential harm and disadvantages of circumcision, including requesting that the parents witness a circumcision, either live or on
video.

Finally, physicians should provide all parents with verbal and written information on the care of the intact penis.

Circumcision and the hygiene argument....

Oh my....(found via reddit):

Variability in penile appearance and penile findings: a prospective study - R.S. VAN HOWE - Department of Pediatrics, Marshfield Clinic, Lakeland Center, Minocqua, Wisconsin, USA - 1997

The circumcised penis requires more care than the intact penis during the first 3 years of life. Parents should be instructed to retract and clean any skin covering the glans in circumcised boys, to prevent adhesions forming and debris from accumulating. Penile inflammation (balanitis) may be more common in circumcised boys; preputial stenosis (phimosis) afects circumcised and intact boys with equal frequency. The revision of circumcision for purely cosmetic reasons should be discouraged on both medical and ethical grounds. [...] One of the most frequently cited reasons for neonatal circumcision in the USA is for a boy to ‘look like his father’ [Brown MS, Brown CA. Circumcision decision: prominence of social concerns. Pediatrics 1987; 80: 215–9]. [...] When discussing the advantages and disadvantages of neonatal circumcision, parents need to know that the circumcised infant requires more attention and penile hygiene than the uncircumcised infant; circumcision does not prevent phimosis and circumcised boys are more likely to develop balanitis, meatitis, coronal adhesions and meatal stenosis.

Because Circumcision is cheaper....

Oh my. Found via reddit, here one of the proponents of circumcision as a means to fight HIV in Africa uses flawless logic in one of her arguments:

As Dr. Essex has indicated, male circumcision is much cheaper than condoms + education (one male circumcision in southern Africa is < U$100 and each condom costs almost U$1.00

So the argument for circumcision against condoms is that it is cheaper...keeping in mind that

-- although circumcised men should still use condoms consistently).

I rest my case...

And clearing up the rest of my Circumcision articles for now...

Too much stored away on google reader and here. Something more about circumcision:

“Can 20,000 nerve endings be amputated without loss of sensitivity?” asks ICGI director Dan Bollinger. “Circumcision advocates want parents and circumcised men to believe the truncated penis has not lost sensitivity. Genital integrity advocates such as ourselves want men to experience the full range of sexual pleasure possible. Studies have been published that demonstrate from no apparent sensitivity loss to significant sensitivity loss. They cannot both be true.”

For instance, the recent Payne et al. study in the Journal of Sexual Medicine says penile sensitivity is no different between intact and circumcised men. This is the opposite of the Penile Touch-Test Sensitivity Evaluation study by Sorrells et al. published in the British Journal of Urology International, saying intact men have four times the penile sensitivity of circumcised men. Sorrells says circumcision removes the most sensitive parts of the penis, while Payne chose to ignore the hyper-sensitive foreskin altogether, as well as failing to reference the earlier Sorrells study.

Both studies employed the same testing method using a standard monofilament skin sensitivity measuring device. The Sorrells study tested 161 men at 17 locations (2157 tests) along the penis, including the circumcision scar, and inner and outer parts of the foreskin. The Payne study tested 20 men at 2 locations (40 tests), but inexplicably did not measure foreskin sensitivity.

The foreskin has long been identified as the most sensitive portion of the penis, and Payne admitted that, “it is possible that the uncircumcised penis is more sensitive due to the presence of additional sensory receptors on the prepuce and frenulum.” And, yet, omitted testing any part of the foreskin because, “this cannot be compared with the absence of such structures in the circumcised penis.” Their circumcision-centric perspective defies common sense, which says the sensitivity of the lost foreskin in circumcised men is simply nonexistent, and should have been recorded as zero, and then test the foreskin’s sensitivity in intact men. What Payne did was side-step this thorn in their hypothesis by ignoring it altogether. Ignorance may be bliss, but it isn’t science.

“The difference in the findings in these two studies indicates the need to include the foreskin as an integral part of the penis when testing penile sensitivity,” says Bollinger. “Selective testing should be declared ‘junk science’ and remain unpublished.”

And finally, one blog where I did borrow steal some stuff for my previous post from. It seems to be a quite good blog about genital integrity. Check it out:

On September 30, 1996, a law was passed that would prohibit any form of female genital cutting on non-consenting minors. Even the mildest form of female genital cutting is condemned as "female genital mutilation," and it is prohibited under federal law, without exception for religious rituals. The law, of course, allows for medically indicated procedures, and would not criminalize a doctor if the procedure were medically or clinically warranted.

Last year, the AAP tried to endorse a "ritual nick" in girls, under the pretext that doing so might dissuade parents from taking their daughters abroad to other countries to have more severe forms of female genital cutting performed. The AAP admitted that the proposed "ritual nick" would dwarf in comparison with male infant circumcision. May 2010 would not end before there was a world outcry, and an embarrassed AAP was forced to retract their statement. The message was clear; under absolutely no circumstances were medical professionals ever to come near a girl's vulva with a knife, not even for a "ritual nick."

The establishment of such a law would seem like a noble gesture, were it not for a glaringly obvious inconsistency; the federal ban on female genital cutting (AKA female genital mutilation) protects members of only one sex against the needless cutting of their genitals, defying the 14th amendment, which says that citizens shall not be deprived of the equal protection of the law. While "religious freedom" and "parental choice" would never be enough to justify the slightest "ritual nick" in girls, for whatever reason, these are acceptable alibis for the circumcision of healthy, non-consenting boys.

To human rights activists who see the genital cutting of healthy, non-consenting individuals of either sex as mutilation, also known as "intactivists," it seemed only logical that such a law which offered protection to only one sex ought to be challenged. If neither "religious freedom" nor "parental choice" are enough to justify the slightest "ritual nick" in girls, then it only follows that the same applies to boys. A law that views the genital cutting of one sex as "mutilation" regardless of "religious importance" but not the other is not only sexist, bigoted and self-serving in nature, but also unconstitutional. Boys deserve the same protection under the law.

Circumcision in Africa to reduce HIV transmission

I think I blogged about this before. Anyhow there seems to be evidence, that those studies, used to justify the circumcision of men to reduce HIV transmission is not that great:

new research has cast doubt on the supposed efficacy of the procedure with an article in the December Australian Journal of Law and Medicine citing numerous flaws in the Kenya, South Africa and Uganda studies.

Researchers Gregory J. Boyle and Gregory Hill claimed the 60 percent reduction in transmission was only relative with the absolute reduction rate actually no more than 1.3 percent.
Boyle and Hill said: “What does the frequently claimed ‘60 percent relative reduction’ in HIV infections actually mean?

“Across all the three female-to-male trials, of the 5,411 men subjected to male circumcision, 64 (1.18 percent) became HIV positive while among the 5,497 controls 137 (2.49 percent) became HIV positive.
“So the absolute decrease in HIV infection was only 1.31 percent, which is statistically not significant.”

The authors of the article insisted that the WHO/UNAIDS recommendation “uncritically accepted” the findings of the Kenya, South Africa and Uganda trials, in the process ignoring a vast body of contradictory evidence.

“Examination of epidemiological data shows that male circumcision does not provide protection against HIV transmission in several sub-Saharan African countries including Cameroon, Ghana, Lesotho, Malawi, Rwanda and Tanzania all of which have higher prevalence of HIV infection among circumcised men,” they said.

“In Malawi, the HIV prevalence rate is 13.2 percent among circumcised men and 9.5 percent among those who are intact. (Again) in Cameroon prevalence among those circumcised is 5.1 percent compare to 1.5 percent for those who are intact.

“If male circumcision reduces HIV transmission as the trials claim then why is HIV prevalence much higher in the United States (where most men are circumcised) than in developed countries where most men are intact (such as Europe, the United Kingdom and Scandinavia)?”

The article warns that relying on male circumcision in the fight against HIV/AIDS is especially dangerous for sub-Saharan Africa women because circumcised men could still acquire and transmit the virus to their sexual partners.

“Evidence suggests that mass circumcision programs may exacerbate the HIV epidemic among women (and) under these circumstances it would be irresponsible and unethical to advocate mass circumcision programmes in southern Africa,” the article concludes.

“Male circumcision is a dangerous distraction and a waste of scarce resources that should be used for known preventive measures (such as condoms which are 80 percent effective.” - Source

An article in the December Journal of Law and Medicine cites numerous flaws in three African studies that claim male circumcision reduces transmission of HIV. (see: the article here)

According to the article, the studies, which are being used to promote the circumcision of up to 38 million men in Africa, had selection bias, inadequate blinding, problematic randomization, experimenter bias, lead time bias, supportive bias, participant expectation bias, time-out discrepancy, and lack of investigating of non-sexual HIV transmission among other confounding factors and problems.

The absolute reduction in HIV transmission associated with male circumcision for the three studies was only about 1.3%. The African studies had cited the relative reduction in HIV transmission, a misleading figure. Reports in the popular press have been even more misleading. Furthermore, there are at least 17 observational studies that have not found any benefit from male circumcision in reducing HIV transmission. Since condom use after male circumcision is essential to prevent sexual transmission of HIV, circumcision does not have any additional value. - Source

From the linked Article in the above:
Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission:
Methodological, ethical and legal concerns - Gregory J Boyle and George Hill
In 2007, WHO/UNAIDS recommended male circumcision as an HIV-preventivemeasure based on three sub-Saharan African randomised clinical trials (RCTs) into female-to-male sexual transmission. A related RCT investigated male-to-female transmission. However, the trials were compro-mised by inadequate equipoise; selection bias; inadequate blinding; problem-atic randomisation; trials stopped early with exaggerated treatment effects; and not investigating non-sexual transmission. Several questions remain unanswered. Why were the trials carried out in countries where more intact men were HIV-positive than in those where more circumcised men were HIV-positive? Why were men sampled from specific ethnic subgroups? Why were so many participants lost to follow-up? Why did men in the male circumcision groups receive additional counselling on safe sex practices? While the absolute reduction in HIV transmission associated with male circumcision across the three female-to-male trials was only about 1.3%, relative reduction was reported as 60%, but, after correction for lead-time bias, averaged 49%. In the Kenyan trial, male circumcision appears to have been associated with four new incident infections. In the Ugandan male-to-female trial, there appears to have been a 61% relative increase in HIV infection among female partners of HIV-positive circumcised men. Since male circumcision diverts resources from known preventive measures and increases risk-taking behaviours, any long-term benefit in reducing HIV transmission remains uncertain.

The over-emphasis on sexual transmission modes of HIV infection has fostered the implementation of unsafe and unethical mass circumcision programmes in Africa in order to "prevent" HIV. Tens of thousands of men have already lined up to get circumcised, after three studies purportedly showed a 60% protection benefit.

These mass circumcision campaigns continue to receive millions in funding from leading organisations, including WHO and UNICEF. These health aid organisations have received strong criticism from human rights organisations and experts who question the ethics and the purported health benefits of male circumcision.

Organisations such as Attorneys for the Rights of the Child, Doctors Opposing Circumcision, and Jews for the Rights of the Child have worked tirelessly to stop the practice of child circumcision in the US and around the world. These organisations have repeatedly called upon the UN to recognise the practice of male circumcision as a form of genital mutilation.

While these organisations are not opposed to adult circumcision, there are at least three grounds for opposition to the current mass circumcision campaigns in Africa. First, mass circumcision campaigns are based on misinformation, as men are not being informed of the functions of the foreskin.

Second, many countries are being pressured to draft plans for routine infant circumcision. Earlier this year, the South African Medical Association called these plans to circumcise infants for HIV prevention “unethical” and “illegal”. In addition to the dangers of circumcision, cells from "donated" foreskins are used to manufacture a wide range of biomedical products, ranging from skin grafts to facial beauty creams. (Oprah featured SkinMedica's TNS Recovery Complex on her show, a product which contains foreskin fibroblasts.)

Third, the three studies which purportedly show that male circumcision protects against HIV by up to 60% have several flaws. According to a UNAIDS demographic survey, 10 out 18 countries have higher HIV prevalence amongst circumcised males. Furthermore, the reported 60% protection benefit is for male acquisition only: studies show that male circumcision increases female acquisition of HIV by up to 50%. - Source

Not many Rwandan men are circumcised, but in the latest figures available for HIV prevalence among circumcised men (2005, later figures are yet to be released), the operation would appear to increase transmission. This is nothing unusual; in many countries HIV prevalence is higher among circumcised men; prevalence for circumcised Rwandan men is 3.8%, compared to 2.1% for uncircumcised men. So what evidence is the country using to persuade men to undergo this operation when they will still have to use condoms, which could protect them from HIV, unplanned pregnancy and a whole host of sexually transmitted infections in one go?

Indeed, national HIV prevalence in Rwanda is relatively low, at 3%. But female prevalence is 3.6%, whereas male prevalence is only 2.3%. As in all medium and high prevalence countries, rates are far higher among women, especially urban dwelling women, wealthy women and women with the highest levels of education. And it is not even clear if transmission from men to women is reduced by male circumcision. There is evidence that transmission from men to women may increase as a result of a mass circumcision program.

It is often claimed that HIV prevalence among Muslim populations is lower and it is even stated or implied that this is because Muslim men tend to be circumcised. In Rwanda, HIV prevalence is indeed lower among Muslim men than any other religious group. But Muslims as a whole have by far the highest HIV prevalence because female rates stand at 11.4%, compared to less than 4% for every other religious group. (It could be argued that polygamy, said to be common among Muslims, results in higher HIV rates; but rates are often lower where polygamy is common; besides, many non-Muslim groups practice polygamy, even if they identify themselves as Christian.) - Source

The study findings also show although men may be willing to be circumcised, and women approve, there are very real dangers associated with promoting MMC as an HIV prevention approach. Responses from study participants reveal myths and wrongly held beliefs about MMC – that it protects fully against HIV when it does not, that other prevention methods are not necessary when they are, that it allows men to have more sexual partners without increased risk, and that women are protected when they are not. - Communication Challenges in HIV Prevention: Multiple Concurrent Partnerships and Medical Male Circumcision - Panos Eastern Africa - Source

THE Ministry of Public Health and Sanitation in conjunction with the National Male Circumcision taskforce have expressed concern over reports of multiple sex partners among those who recently underwent male circumcision.

Nyanza provincial director of publichealth and sanitation, who is also the task force chairman Jackson Kioko, said therehave been reports that those who have been circumcised are taking it as immunity againstHIV.

Speaking during the launch of the resultsof the third rapid results initiative on male circumcision, Kioko said the taskforce will conduct a study to ascertain post-male circumcision sexual behaviour. During the launch of the exercise, itscritics including the Luo Council of Elders said the programme will be disastrous if not well packaged and the beneficiaries sensitised on itsimplication.

The council of elders argued that marketing male circumcision on the platform of preventing HIV was going to erode the overallgoal since many men will take it as complete immunity. - Source

The University of Illinois' Chicago School of Public Health study of 51 young women - presented in December 2011 in Addis Ababa, Ethiopia, at the 16th International Conference on AIDS and Sexually transmitted infections in Africa - found that most women were happy with the appearance of their partner's penis and enjoyed sex more after circumcision.

However, the study also revealed that more women than men were likely to perceive HIV as a less serious threat - 51 percent of men compared with 76 percent of female participants, and to feel that condoms were less necessary following circumcision - 4 percent of men compared with 51 percent of female participants.

A greater number of women than men said after circumcision, they were more likely to have more than one sexual partner - 22 percent compared with 2 percent of men, and to have sex without a condom - 28 percent against 2 percent of men.

The study was conducted in Nyanza Province, home to the Luo, Kenya's largest non-circumcising ethnic community and the focus of the country's male circumcision programme. Since 2008, more than 350,000 men have been circumcised in Nyanza alone; the government aims to circumcise 1.1 million men by 2013. - Source

The most obvious smoking gun: The United States of America
Circumcision hasn't stopped HIV in our own country.
http://data.unaids.org/pub/Report/1998/19981125_global_epidemic_report_en.pdf

And, it hasn't stopped other STDs either.
http://www.reuters.com/article/2009/01/13/us-infections-usa-idUSTRE50C5XV20090113?pageNumber=1&virtualBrandChannel=0

In America, the majority of the male population is circumcised, approximately 80%, while in most countries in Europe, circumcision is uncommon. Despite these facts, our country does poorly.
http://www.advocatesforyouth.org/index.php?option=com_content&task=view&id=419&Itemid=177

In fact, AIDS rates in some US Cities rival hotspots in Africa. In some parts of the U.S., they're actually higher than those in sub-Saharan Africa. According to a 2010 study published in the New England Journal of Medicine, rates of HIV among adults in Washington, D.C. exceed 1 in 30; rates higher than those reported in Ethiopia, Nigeria or Rwanda.
http://www.nejm.org/doi/full/10.1056/NEJMp1000069

The Washington D.C. district report on HIV and AIDS reported an increase of 22% from 2006 in 2009.


"[Washington D.C.'s] rates are higher than West Africa... they're on par with Uganda and some parts of Kenya."

Shannon L. Hader, HIV/AIDS Administration, Washington D.C., March 15, 2009.
She once led the Federal Centers for Disease Control and Prevention's work in Zimbabwe.

http://www.washingtonpost.com/wp-dyn/content/article/2009/03/14/AR2009031402176.html

One would expect for there to be a lower transmission rates in the United States, and for HIV to be rampant in Europe; HIV transmission rates are in fact higher in the United States, where most men are circumcised, than in various countries in Europe, where most men are intact. It is telling that the HIV epidemic struck in our country in the 1980s, 90% of the male population was already circumcised. Somehow, we're supposed to believe that what didn't worked in our own country, or anywhere else, is going to start working miracles in Africa.

Studies With Contrary Conclusions


According to USAID, "there appears no clear pattern of association between male circumcision and HIV prevalence—in 8 of 18 countries with data, HIV prevalence is lower among circumcised men, while in the remaining 10 countries it is higher."
http://www.measuredhs.com/pubs/pdf/CR22/CR22.pdf

"Conclusions: We find a protective effect of circumcision in only one of the eight countries for which there are nationally-representative HIV seroprevalence data. The results are important in considering the development of circumcision-focused interventions within AIDS prevention programs."
http://www.iasociety.org/Default.aspx?pageId=11&abstractId=2197431

Results: ...No consistent relationship between male circumcision and HIV risk was observed in most countries.
http://apha.confex.com/apha/134am/techprogram/paper_136814.htm

"Conclusions: ...[M]ale circumcision... is not associated with HIV or STI prevention in this U. S. military population."
http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102282676.html

One study which aimed at measuring male to female HIV transmission was ended early, because the results were not looking favorable. The Wawer study showed a 54% higher rate of male-to-female transmission in the group where the men had been circumcised. The figures were too small to show statistical significance, but there will be no larger scale study to find out if circumcising men increases the risk to women. Somehow that's considered unethical, yet it's considered ethical to promote male circumcision while not knowing if the risk to women is increased (by 54%?, 25%?, 80%? - who knows?)
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2809%2960998-3/fulltext

The latest study in Kenya finds no association between male circumcision and lowered HIV rates:
'Using a population-based survey we examined the behaviors, beliefs, and HIV/HSV-2 serostatus of men and women in the traditionally non-circumcising community of Kisumu, Kenya prior to establishment of voluntary medical male circumcision services. A total of 749 men and 906 women participated. Circumcision status was not associated with HIV/HSV-2 infection nor increased high risk sexual behaviors. In males, preference for being or becoming circumcised was associated with inconsistent condom use and increased lifetime number of sexual partners. Preference for circumcision was increased with understanding that circumcised men are less likely to become infected with HIV.'
http://www.plosone.org/article/info%3Adoi/10.1371/journal.pone.0015552?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed:+plosone/PLoSONE+%28PLoS+ONE+Alerts:+New+Articles%29

Conclusion
A few select studies show a prevalence of HIV transmission in uncircumcised men, but real world empirical data shows that circumcision hasn't stopped HIV in countries where there is already a prevalence of the practice of circumcision, nevermind the United States. Yet, for whatever reason, leaders at the WHO continue to endorse it as HIV prevention policy and millions are being spent on so-called "mass circumcision campaigns," even in countries where HIV transmission was shown to be prevalent among the circumcised. - Source

And this huge source.

Clinton, Circumcision, Confused....

Here is what always struck me as blatant hypocrisy. The support of the USA for circumcision and at the same time condemning female genital cutting. Here is what Clinton said recently.

“We cannot excuse this as a cultural tradition. There are many cultural traditions that used to exist in many parts of the world that are no longer acceptable. We cannot excuse it as a private matter because it has very broad public implications. It has no medical benefits. It is, plain and simply, a human rights violation”

Pretty much the same can be said about circumcision, only that Clinton supports this in Africa to fight HIV. Oh my.

Circumcision to reduce HIV in Africa....well maybe not that good idea

We talked about it here before. It seems some of the worries here are becoming true:

Male circumcision is becoming a canal for new HIV infections as men are now reluctant to use condoms on the basis that they are 60 percent safe, a government official has said. [...] “We have a huge challenge where male circumcision has created a canal to those who do not want to use condoms. [...] According to Khumalo, Sub-Sahara Africa still records the highest figures of new infections with about 7 000 estimated infections despite the increase in the numbers of men who are getting circumcised.

*Sigh*

Besides that there is a lot going on with circumcision:

More than 40 000 Zimbabwean adult men, according to reports, have been circumcised since the programme began in 2010 and 100 000 more are expected to undergo circumcision by the end of 2012.

Zimbabwe has set a goal of circumcising 1,2 million men by 2015.

Sinokuthemba Xaba, Zimbabwe’s national male circumcision co-ordinator told the state media that approximately 11 000 men were circumcised by December 2010, with over 20 000 having been circumcised this year alone.

He said preparations were under way for the launch of a neo-natal circumcision programme, where the medical procedure will be performed free of charge on male babies as soon as they are born.

In August, government started an ambitious programme aimed at male cabinet ministers, MPs and councilors to undergo circumcision.

Oh my....

Circumcision.....a huge sigh

Kind of funny, it is Clinton again, this time with something different:

Secretary of State Hillary Clinton recently announced that 1 million circumcisions have been performed over the last 4 years, three-quarters funded by the U.S. government. This is just 4% of the number of circumcisions needed in sub-Saharan Africa.

This is just sad.

Circumcision is Africa’s best weapon against AIDS

No you idiots, condoms are. Oh my...

EDIT: User ml66uk makes a good case in the comments:

NO NO NO. Condoms are the best weapon against AIDS for Africans as well as for everyone else.

From the USAID report “LEVELS AND SPREAD OF HIV SEROPREVALENCE AND ASSOCIATED FACTORS: EVIDENCE FROM NATIONAL HOUSEHOLD SURVEYS”
“There appears no clear pattern of association between male circumcision and HIV prevalence—in 8 of 18 countries with data, HIV prevalence is lower among circumcised men, while in the remaining 10 countries it is higher.”
http://www.measuredhs.com/pubs/pdf/CR22/ CR22.pdf

The South African National Communication Survey on HIV/AIDS, 2009 found that 15% of adults across age groups “believe that circumcised men do not need to use condoms”.
http://www.info.gov.za/issues/hiv/survey _2009.htm

From the committee of the South African Medical Association Human Rights, Law & Ethics Committee :
“the Committee expressed serious concern that not enough scientifically-based evidence was available to confirm that circumcisions prevented HIV contraction and that the public at large was influenced by incorrect and misrepresented information. The Committee reiterated its view that it did not support circumcision to prevent HIV transmission.”

The one randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised btw:
http://www.thelancet.com/journals/lancet /article/PIIS0140-6736(09)60998-3/abstr act

ABC (Abstinence, Being faithful, and especially Condoms) is the way forward. Promoting genital surgery will cost African lives, not save them.

Sexual Dysfunction and Circumcision

Intact News gives us some interesting studies:

This preliminary study investigates what role early trauma might have in alexithymia acquisition for adults by controlling for male circumcision. Three hundred self-selected men were administered the Toronto Twenty-Item Alexithymia Scale checklist and a personal history questionnaire. The circumcised men had age-adjusted alexithymia scores 19.9 percent higher than the intact men; were 1.57 times more likely to have high alexithymia scores; were 2.30 times less likely to have low alexithymia scores; had higher prevalence of two of the three alex-ithymia factors (difficulty identifying feelings and difficulty describing feelings); and were 4.53 times more likely to use an erectile dysfunction drug. Alexithymia in this population of adult men is statistically significant for having experienced circumcision trauma and for erectile dysfunction drug use.

- from here

METHODS: This prospective study was conducted in the Bungoma district, Kenya, where male circumcision is universally practised. Young males intending to undergo traditional or clinical circumcision were identified by a two-stage cluster sampling method. During the July-August 2004 circumcision season, 1007 males were interviewed 30-89 days post- circumcision. Twenty-four men were directly observed during and 3, 8, 30 and 90 days post-circumcision, and 298 men underwent clinical exams 45-89 days post-procedure. Twenty-one traditional and 20 clinical practitioners were interviewed to assess their experience and training. Inventories of health facilities were taken to assess the condition of instruments and supplies necessary for performing safe circumcisions. FINDINGS: Of 443 males circumcised traditionally, 156 (35.2%) experienced an adverse event compared with 99 of 559 (17.7%) circumcised clinically (odds ratio: 2.53; 95% confidence interval: 1.89-3.38). Bleeding and infection were the most common adverse effects, with excessive pain, lacerations, torsion and erectile dysfunction also observed. Participants were aged 5 to 21 years and half were sexually active before circumcision. Practitioners lacked knowledge and training. Proper instruments and supplies were lacking at most health facilities.

- from here

METHODS: Ninty-five patients were investigated on erectile function by questionnaire before and after circumcision, respectively. RESULTS: Eighteen patients suffered from mild erectile dysfunction before circumcision, and 28 suffered from mild or moderate erectile dysfunction after circumcision(P = 0.001). Adult circumcision appeared to have resulted in weakened erectile confidence in 33 cases(P = 0.04), difficult insertion in 41 cases(P = 0.03), prolonged intercourse in 31 cases(P = 0.04) and improved satisfaction in 34 cases(P = 0.04). CONCLUSIONS: Adult circumcision has certain effect on erectile function, to which more importance should be attached.

- from here

METHODS: The vibrotactile thresholds were measured at the forefinger and glans penis in 73 normal volunteer controls and 96 patients with simple redundant prepuce before and after circumcision by biological vibration measurement instrument, and the changes in the perception sensitivity of the body surface were analyzed. RESULTS: The G/F (glans/finger) indexes in the control and the test group were respectively 2.39 +/- 1.72 and 1.97 +/- 0.71, with no significant difference in between (P > 0.05). And those of the test group were 1.97 +/- 0.71, 2.64 +/- 1.38, 3.09 +/-1.46 and 2.97 +/- 1.20 respectively before and 1, 2 and 3 months after circumcision, with significant difference between pre- and post-operation (P < 0.05). CONCLUSION: There is a statistic difference in the glans penis vibration perception threshold between normal men and patients with simple redundant prepuce. The glans penis perception sensitivity decreases after circumcision.

- from here

SUBJECTS AND METHODS: Adult male volunteers with no history of penile pathology or diabetes were evaluated with a Semmes-Weinstein monofilament touch-test to map the fine-touch pressure thresholds of the penis. Circumcised and uncircumcised men were compared using mixed models for repeated data, controlling for age, type of underwear worn, time since last ejaculation, ethnicity, country of birth, and level of education. RESULTS: The glans of the uncircumcised men had significantly lower mean (sem) pressure thresholds than that of the circumcised men, at 0.161 (0.078) g (P = 0.040) when controlled for age, location of measurement, type of underwear worn, and ethnicity. There were significant differences in pressure thresholds by location on the penis (P < 0.001). The most sensitive location on the circumcised penis was the circumcision scar on the ventral surface. Five locations on the uncircumcised penis that are routinely removed at circumcision had lower pressure thresholds than the ventral scar of the circumcised penis. CONCLUSIONS: The glans of the circumcised penis is less sensitive to fine touch than the glans of the uncircumcised penis. The transitional region from the external to the internal prepuce is the most sensitive region of the uncircumcised penis and more sensitive than the most sensitive region of the circumcised penis. Circumcision ablates the most sensitive parts of the penis.

- from here

Methods.  This cross-sectional study was conducted at a primary care clinic over a 3-month period in 2008. Men aged 18–70 years attending the clinic were recruited, and they completed self-administered questionnaires that included the Premature Ejaculation Diagnostic Tool (PEDT), International Index of Erectile Function, sociodemography, lifestyle, and medical illness. The operational definition of PE included PE and probable PE based on the PEDT. Main Outcome Measure.  Prevalence of PE. Results.  A total of 207 men were recruited with a response rate of 93.2%. There were 97 (46.9%) Malay, 57 (27.5%) Chinese, and 53 (25.6%) Indian, and their mean age was 46.0 ± 12.7 years. The prevalence of PE was 40.6% (N = 82) (PE: 20.3%, probable PE: 20.3% using PEDT). A significant association was found between ethnicity and PE (Indian 49.1%, Malay 45.4%, and Chinese 24.6%; χ2 = 8.564, d.f. = 2, P = 0.014). No significant association was found between age and PE. Multivariate analysis showed that erectile dysfunction (adjusted odds ratio [OR] 4.907, 95% confidence interval [CI] 2.271, 10.604), circumcision (adjusted OR 4.881, 95% CI 2.346, 10.153), sexual intercourse ≤5 times in 4 weeks (adjusted OR 3.733, 95% CI 1.847, 7.544), and Indian ethnicity (adjusted OR 3.323, 95% CI 1.489, 7.417) were predictors of PE. Conclusion.  PE might be frequent in men attending primary care clinics. We found that erectile dysfunction, circumcision, Indian ethnicity, and frequency of sexual intercourse of ≤5 times per month were associated with PE. These associations need further confirmation.

- from here Also, that study

MATERIALS AND METHODS: Men 18 years old or older when circumcised were identified by billing records during a 5-year period at an academic medical center. Medical charts were reviewed for confirmation of the procedure and to identify the indication(s). These men were surveyed to assess erectile function, penile sensitivity, sexual activity and overall satisfaction. Data were analyzed using paired t tests to compare category scores before and after circumcision. RESULTS: A total of 123 men were circumcised as adults. Indications for circumcision included phimosis in 64% of cases, balanitis in 17%, condyloma in 10%, redundant foreskin in 9% and elective in 7%. The response rate was 44% among potential responders. Mean age of responders was 42 years at circumcision and 46 years at survey. Adult circumcision appears to result in worsened erectile function (p = 0.01), decreased penile sensitivity (p = 0.08), no change in sexual activity (p = 0.22) and improved satisfaction (p = 0.04). Of the men 50% reported benefits and 38% reported harm. Overall, 62% of men were satisfied with having been circumcised.

- from here

Of the 200 men who underwent urethroplasty 152 who were 17 to 83 years old (mean age 45.7) completed the questionnaire. Average followup was 36 months (range 3 to 149). Overall there was a similar incidence of sexual problems after urethroplasty and circumcision. Penile skin flap urethroplasty was associated with a slightly higher incidence of impaired sexual function than other procedures (p > 0.05). Men with a longer stricture were most likely to report major changes in erectile function and penile length (p < 0.05) but improvement was evident with time in 61.8%.

- from here Other points made by the article:

Eighteen percent of adult American men—three-fourths of whom are circumcised—have ED, affecting 18 million men. Circumcision’s role as a risk factor may be reflected in ED drug sales; while the United States represents 5% of the world’s population it also accounts for 46% of Viagra sales. [...] A fourth before-and-after study found that 35% of participants had a worsened sex life after circumcision and that their partners had a 46% reduction in satisfaction. The study implicated loss of nerve endings as a reason—addressed below. The true dissatisfaction rate is probably higher than these failure rates since all of the men elected circumcision, and would naturally be biased toward the outcome being beneficial even when it wasn’t.

It is certainly a good read and another argument against circumcision.

Something more about circumcision

From Mensactivism.org:

The harm caused by circumcision

Circumcision removes the most sexually sensitive parts of a boy’s penis, including the foreskin, the frenulum, and the ridged band of nerves [1]. The male foreskin is also designed to protect the glans of the penis throughout a man’s life, ensuring that the internal mucosal tissue remains moist and sensitive (much the same way that a woman’s clitoral hood protects the clitoris). In addition, the foreskin acts as a natural gliding mechanism to reduce chafing and dryness during intercourse [2].

Regardless of whether it is performed in a medical or non-medical setting, a significant number of boys subjected to the practice of circumcision will later fulfill the DSM-IV criteria for a diagnosis of Post-Traumatic Stress Disorder [3].

No national medical association in the world recommends that boys be forcefully circumcised for preventive health reasons, not even in Israel, where the Journal of the Israeli Medical Association published an article highlighting the high prevalence of urinary tract infections among boys who had undergone ritual circumcision [4].

The Royal Dutch Medical Association's very up-to-date policy on circumcision states that "KNMG is calling upon doctors to actively and insistently inform parents who are considering the procedure of the absence of medical benefits and the danger of complications", and that there is a good case for making it illegal [5].

1. Morris L. Sorrells, James L. Snyder, Mark D. Reiss, Christopher Eden, Marilyn F. Milos, Norma Wilcox, Robert S. Van Howe Fine-touch pressure thresholds in the adult penis British Journal of Urology International, Volume 99 Issue 4 Page 864 – 869 April 2007 http://www.nocirc.org/touch-test/bju_6685.pdf

2. Taylor, J.P., A.P. Lockwood and A.J.Taylor The prepuce: Specialized mucosa of the penis and its loss to circumcision Journal of Urology (1996), 77, 291-295 http://www.cirp.org/library/anatomy/taylor/

3. Samuel Ramos and Gregory J. Boyle. Ritual and Medical Circumcision among Filipino boys: Evidence of Post-traumatic Stress Disorder Humanities & Social Sciences papers (2000). Available at: http://epublications.bond.edu.au/cgi/viewcontent.cgi?article=1120&context=hss_pubs

4. Toker O, Schwartz S, Segal G, Godovitch N, Schlesinger Y, Raveh D (2011) A costly covenant: ritual circumcision and urinary tract infection. Isr Med Assoc J. 2010 May;12(5):262-5 http://www.ncbi.nlm.nih.gov/pubmed/20929075

5. KNMG (2010) Non-theraputic circumcision of male minors http://knmg.artsennet.nl/web/file?uuid=579e836d-ea83-410f-9889-feb7eda87cd5&owner=a8a9ce0e-f42b-47a5-960e-be08025b7b04&contentid=77976

The effect of male circumcision on sexuality - Kim - 2006

Found via Mensactivism.org, another study about circumcision:

In South Korea, many men are circumcised as adults, after they have led active sex lives; these men can compare their sex lives before and after circumcision. This is because circumcision in South Korea is a relatively recent event, having reached >100% circumcision rate (compared with the male birth population) in the last 20 years. This unique situation, in terms of research on circumcision’s effect on sexuality, contrasts with other cultures where adult circumcision is rare, simply because circumcision is practised on neonates or pre-teens. Even when such men have been found and interviewed, they do not represent the general population, but those with medical indications or religious convictions about circumcision. In this sense, South Korea provides a unique opportunity to study the effect of circumcision on sexual activity in a truly general population.

[...]The effect of circumcision on masturbation is interesting, as preventing masturbation was one of the main original reasons often cited for the popularity of circumcision in America. The frequency of masturbation seems to have decreased only slightly after circumcision, but there was a striking difference in the pleasure of masturbation, with 48% reporting less pleasure from masturbation after circumcision, in contrast to 8% who reported more pleasure. We think that this is one of the most important findings of the present study. This is consistent with more men finding masturbation more difficult after circumcision, possibly because of the loss of the foreskin.

Of the 138 men aged >30 years who could compare their sex lives before and after circumcision, >70% (102) reported that there was no difference. However, circumcised men were more than three times more likely to report less enjoyable sex lives after circumcision than better sex lives (28 vs eight men). While decreased sensation was the most frequently cited reason (21 of 28 men) for a less enjoyable sex life, complaints about the physical effects of circumcision on their penises and consequent adverse effects on sex life were also prominent (13 of 28; multiple complaints were separately counted). While this is consistent with our earlier study, it suggests that more attention should be given to anatomical alteration of the male genitalia by circumcision. This conclusion is supported by the reports of major scars by ≈ 9% of the circumcised men in the present study.

In summary, we studied the effects of circumcision on sexuality. There were no differences in sexual drive, erection and ejaculation, but circumcised men reported decreased masturbatory pleasure and sexual enjoyment. We conclude that adult circumcision adversely affects sexual function in a significant number of men, possibly because of loss of nerve endings. In addition, ≈ 9% of the circumcised men reported severe scarring of their penises, and this population probably overlaps with those who reported insufficient skin resulting in uncomfortable erections, penile curvature from uneven skin loss, and pain and bleeding upon erection/manipulation.

Official Medical Society Statements on Newborn Circumcision

Via nocirc:

Canadian Paediatric Society:

"Recommendation: Circumcision of newborns should not be routinely performed."

The Royal Australasian College of Physicians:

"After extensive review of the literature the RACP reaffirms that there is no medical indication for routine neonatal circumcision."

British Association of Paediatric Surgeons:
"The practice [of male circumcision] should be discouraged by education."

British Medical Association:

"The BMA considers that the evidence concerning health benefit from non-therapeutic circumcision is insufficient for this alone to be a justification for doing it."

College of Physicians and Surgeons of British Columbia:

"Current understanding of the benefits, risks and potential harm of this procedure, however, no longer supports this practice for prophylactic health benefit. Routine infant male circumcision performed on a healthy infant is now considered a non-therapeutic and medically unnecessary intervention."

American Medical Association:

The AMA calls infant circumcision "non-therapeutic." Regarding penile cancer, the AMA states "...because this disease is rare and occurs later in life, circumcision as a preventive measure is not justified."

American Academy of Family Physicians:

"While routine circumcision is widely practiced, the small medical benefits of circumcision lead many to consider routine circumcision to be a cosmetic procedure. This leads to questions regarding medical ethics..."

American Academy of Pediatrics:
“Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision.”

American Cancer Society:

“Most public health researchers believe that the penile cancer risk among uncircumcised men without known risk factors living in the United States is extremely low. The current consensus of most experts is that circumcision should not be recommended as a prevention strategy for penile cancer.”

Free exercise rights end where another’s body begins

Spot on Mr Flynn:

Leave aside the question whether it should be described as mutilation; leave aside the question whether circumcision has incidental health benefits or risks. It’s a surgical procedure whose mark the recipient will carry for life, but had no meaningful chance to opt in to or out of. In other words, infant circumcision is something a secular society would never allow if it weren’t associated with religious traditions.

[...]Banning circumcision raises church-state issues, to be sure, as it forces society into the declaring certain sacred practices illegal. To me, however, aggrieved believers’ free-exercise rights end where another person’s health of bodily integrity begins.

States Drop Circumcision Funds From Medicaid - The latest, Colorado, will save $186,500 a year

Who would have thought, sounds like the end to circumcision in the Us is near:

A nationwide debate about circumcisions for newborn boys, combined with cash-strapped public health budgets, has Colorado taking sides with 17 other states that no longer fund Medicaid coverage of the once widely accepted procedure. For years, Colorado lawmakers considered doing away with funding for circumcisions under Medicaid—a move that would save the state $186,500 a year. Now facing a budget shortfall estimated to be $1 billion at the beginning of this year, lawmakers finally approved the change, which takes effect July 1. [...] The matter of circumcisions has gotten contentious in California, where San Francisco will be the first city to hold a public vote in November on whether to ban the practice.

Danish Study on Circumcision

Found via Mensactivism.org. I cite:

Male circumcision and sexual function in men and women: a survey-based, cross-sectional study in Denmark.

Frisch M, Lindholm M, Grønbæk M.

Source
Department of Epidemiology Research, Statens Serum Institut, DK-2300 Copenhagen S, Denmark and National Institute of Public Health, DK-1353 Copenhagen K, Denmark.

Abstract
BACKGROUND:
One-third of the world's men are circumcised, but little is known about possible sexual consequences of male circumcision. In Denmark (∼5% circumcised), we examined associations of male circumcision with a range of sexual measures in both sexes.

METHODS:
Participants in a national health survey (n = 5552) provided information about their own (men) or their spouse's (women) circumcision status and details about their sex lives. Logistic regression-derived odds ratios (ORs) measured associations of circumcision status with sexual experiences and current difficulties with sexual desire, sexual needs fulfilment and sexual functioning.

RESULTS:
Age at first intercourse, perceived importance of a good sex life and current sexual activity differed little between circumcised and uncircumcised men or between women with circumcised and uncircumcised spouses. However, circumcised men reported more partners and were more likely to report frequent orgasm difficulties after adjustment for potential confounding factors [11 vs 4%, OR(adj) = 3.26; 95% confidence interval (CI) 1.42-7.47], and women with circumcised spouses more often reported incomplete sexual needs fulfilment (38 vs 28%, OR(adj) = 2.09; 95% CI 1.05-4.16) and frequent sexual function difficulties overall (31 vs 22%, OR(adj) = 3.26; 95% CI 1.15-9.27), notably orgasm difficulties (19 vs 14%, OR(adj) = 2.66; 95% CI 1.07-6.66) and dyspareunia (12 vs 3%, OR(adj) = 8.45; 95% CI 3.01-23.74). Findings were stable in several robustness analyses, including one restricted to non-Jews and non-Moslems.

CONCLUSIONS:
Circumcision was associated with frequent orgasm difficulties in Danish men and with a range of frequent sexual difficulties in women, notably orgasm difficulties, dyspareunia and a sense of incomplete sexual needs fulfilment. Thorough examination of these matters in areas where male circumcision is more common is warranted.

And there is nothing more to say, besides, stop that shit!