Sex In The Public Square - consent - Comments

Tugger

Lou FCD — Sun, 10 Aug 2008 14:20:00 -0700

I actually read that statement as cautiously critical, with maybe a pressured nod to "benefits", to appease someone. I didn't give the "benefits" any serious weight, given the phrasing.

Hugh

Lou FCD — Sun, 10 Aug 2008 14:14:51 -0700

Thank you for that.

Benefits as meant in Policy Statements

TLCTugger — Sat, 09 Aug 2008 21:41:20 -0700

When you read a medical policy statement referring to "potential benefits" of circumcision you need to understand that the statement ignores the fact that a benefit of remaining intact is having an exquisitely delightful foreskin that feels REALLY good.

Benefits - the way they seem to be defining them - are very nebulous. If they were writing about head injury, one of the potential benefits of having all your teeth knocked out would be no cavities nor need to brush your teeth.

There is a commentary ...

Hugh7 — Sat, 09 Aug 2008 16:34:25 -0700

There is an interleaved commentary on the AAP's policy statement here.

I just have to ask: How

Visitor — Sat, 09 Aug 2008 11:26:00 -0700

I just have to ask: How would you conduct a double-blinded, placebo-controlled circumcision experiment? We aren't talking about sugar pills here.

Behavioral Factors Far More Important

Lou FCD — Sat, 09 Aug 2008 05:28:00 -0700

Regarding specifically the efficacy of circumcision in prevention of HIV from the aforementioned statement from the American Academy of Pediatrics (emphasis mine):

"There does appear to be a plausible biologic explanation for this association in that the mucous surface of the uncircumcised penis allows for viral attachment to lymphoid cells at or near the surface of the mucous membrane, as well as an increased likelihood of minor abrasions resulting in increased HIV access to target tissues. However, behavioral factors appear to be far more important risk factors in the acquisition of HIV infection than circumcision status. "

Also note the mention of a possible mechanism, about which I inquired.

(OK, I totally give up on understanding why the blockquote function works sometimes and not others.)

Circumcision Policy Statement

Lou FCD — Sat, 09 Aug 2008 05:17:51 -0700

Following some links, beginning here, then to Elizabeth's old WordPress blog, then hither and thither, I came across this, full text at the link:

AMERICAN ACADEMY OF PEDIATRICS:
Circumcision Policy Statement

Abstract:

Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In circumstances in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. If a decision for circumcision is made, procedural analgesia should be provided.

Although the exact frequency is unknown, it is estimated that 1.2 million newborn males are circumcised in the United States annually at a cost of between $150 and $270 million. This practice has been advocated for reasons that vary from symbolic ritual to preventive health measure. Until the last half century, there has been limited scientific evidence to support or repudiate the routine practice of male circumcision.

Over the past several decades, the American Academy of Pediatrics has published several policy statements on neonatal circumcision of the male infant.1-3 Beginning in its 1971 manual, Standards and Recommendations of Hospital Care of Newborn Infants, and reiterated in the 1975 and 1983 revisions, the Academy concluded that there was no absolute medical indication for routine circumcision.

In 1989, because of new research on circumcision status and urinary tract infection (UTI) and sexually transmitted disease (STD)/acquired immunodeficiency syndrome, the Academy concluded that newborn male circumcision has potential medical benefits and advantages as well as disadvantages and risks.4 This statement also recommended that when circumcision is considered, the benefits and risks should be explained to the parents and informed consent obtained. Subsequently, a number of medical societies in the developed world have published statements that do not recommend routine circumcision of male newborns.5-7 In its position statement, the Australian College of Paediatrics emphasized that in all cases, the medical attendant should avoid exaggeration of either risks or benefits of this procedure.5

Because of the ongoing debate, as well as the publication of new research, it was appropriate to reevaluate the issue of routine neonatal circumcision. This Task Force adopted an evidence-based approach to analyzing the medical literature concerning circumcision. The studies reviewed were obtained through a search of the English language medical literature from 1960 to the present and, additionally, through a search of the bibliographies of the published studies.

Inactivism

Lou FCD — Sat, 09 Aug 2008 05:02:18 -0700

Thank you for the link to The Inactivism Pages , Hugh. There is quite a bit of information there.

I'm looking now for some published research on the issue, as I found the results of the papers I cited above rather surprising and perplexing. If circumcision does in fact reduce HIV infection, I'd be very interested to know the mechanism, something I'm either not seeing or not understanding in those papers.

HIV prevention is dubious, to say the least

Hugh Young — Thu, 07 Aug 2008 17:53:45 -0700

Fascinating and sad to read the accounts of normal, whole, natural male Americans conditioned to think there was something the matter with them. The Intactivism Pages cover all aspects of circumcision from the point of view that intact is the norm (as it is: at least 75% of the world's men are intact). They include pages of intact celebrities and pages for intact boys and young men to underline this. The Intactivism Shop offers goods celebrating intactness, such as "Anteater Pride" t-shirts, and garments for babies and toddlers with messages to protect them from circumcision and forcible foreskin retraction.

The claim that circumcision prevents HIV is dubious, to put it mildly. (It's notable that the same few people write all the studies claiming its benefits.) The three trials fell far short of the gold standard for clinical trials: they were not double-blinded; not placebo-controlled; they had a significant drop-out rate - 5 times as many as were known to be infected. (And if you had endured a painful and marking operation "to protect against AIDS" and then found you had it, would you go back to the people who had done that to you?) So it's very likely that many more circumcised men had HIV than they claim. (They were encouraged to get tested elsewhere, because it was considered "unethical" to tell them they were HIV+. It was considered "ethical" to let them go home and infect their partners. These studies would never have gained ethical approval in the developed world.)

Non-sexual transmission - common in Africa - was ignored. The circumcised experimental group was given more safe sex warnings than the non-circumcised control group. One of the three trials used a method that removed significantly less tissue than the others, yet the "protection" found was the same.

In several African countries, the HIV rate is higher among circumcised men than non-circumcised, according to the National Demographic and Health Surveys.

For some reason, the idea of circumcision makes people lose their critical faculties. There has been far too little criticism of the lemming-like rush to circumcise, instead of using means that are known to work.

Reference Article

Lou FCD — Wed, 06 Aug 2008 10:25:00 -0700

The article referenced by the above paper:

Male circumcision and risk of HIV infection in sub-Saharan Africa: a systematic review and meta-analysis.

Weiss HA, Quigley MA, Hayes RJ

Medical Research Council Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, UK.

OBJECTIVE: To systematically review studies of male circumcision and the risk of HIV-1 infection in men in sub-Saharan Africa, and to summarize the findings in a meta-analysis.

DESIGN: A meta-analysis of observational studies.

METHODS: A systematic literature review was carried out of studies published up to April 1999 that included circumcision as a risk factor for HIV-1 infection among men in sub-Saharan Africa. A random effects meta-analysis was used to calculate a pooled relative risk (RR) and 95% confidence interval (CI) for all studies combined, and stratified by type of study population. Further analyses were conducted among those studies that adjusted for potential confounding factors.

RESULTS: Twenty-seven studies were included. Of these, 21 showed a reduced risk of HIV among circumcised men, being approximately half that in uncircumcised men (crude RR = 0.52, CI 0.40-0.68). In 15 studies that adjusted for potential confounding factors, the association was even stronger (adjusted RR = 0.42, CI 0.34-0.54). The association was stronger among men at high risk of HIV (crude RR = 0.27; adjusted RR = 0.29, CI 0.20-0.41) than among men in general populations (crude RR = 0.93; adjusted RR = 0.56, CI 0.44-0.70).

CONCLUSION: Male circumcision is associated with a significantly reduced risk of HIV infection among men in sub-Saharan Africa, particularly those at high risk of HIV. These results suggest that consideration should be given to the acceptability and feasibility of providing safe services for male circumcision as an additional HIV prevention strategy in areas of Africa where men are not traditionally circumcised.

Full text as html is here and as a .pdf is here, from AIDS (Journal of the International AIDS Society)

Published in PLoS ONE

Lou FCD — Wed, 06 Aug 2008 10:21:58 -0700

Estimating the Resources Needed and Savings Anticipated from Roll-Out of Adult Male Circumcision in Sub-Saharan Africa

Bertran Auvert, Elliot Marseille, Eline L. Korenromp, James Lloyd-Smith, Remi Sitta, Dirk Taljaard, Carel Pretorius, Brian Williams, James G. Kahn

The abstract reads as follows:

Abstract
Background

Trials in Africa indicate that medical adult male circumcision (MAMC) reduces the risk of HIV by 60%. MAMC may avert 2 to 8 million HIV infections over 20 years in sub-Saharan Africa and cost less than treating those who would have been infected. This paper estimates the financial and human resources required to roll out MAMC and the net savings due to reduced infections.

Methods

We developed a model which included costing, demography and HIV epidemiology. We used it to investigate 14 countries in sub-Saharan Africa where the prevalence of male circumcision was lower than 80% and HIV prevalence among adults was higher than 5%, in addition to Uganda and the Nyanza province in Kenya. We assumed that the roll-out would take 5 years and lead to an MC prevalence among adult males of 85%. We also assumed that surgery would be done as it was in the trials. We calculated public program cost, number of full-time circumcisers and net costs or savings when adjusting for averted HIV treatments. Costs were in USD, discounted to 2007. 95% percentile intervals (95% PI) were estimated by Monte Carlo simulations.

Results

In the first 5 years the number of circumcisers needed was 2 282 (95% PI: 2 018 to 2 959), or 0.24 (95% PI: 0.21 to 0.31) per 10 000 adults. In years 6–10, the number of circumcisers needed fell to 513 (95% PI: 452 to 664). The estimated 5-year cost of rolling out MAMC in the public sector was $919 million (95% PI: 726 to 1 245). The cumulative net cost over the first 10 years was $672 million (95% PI: 437 to 1 021) and over 20 years there were net savings of $2.3 billion (95% PI: 1.4 to 3.4).

Conclusion

A rapid roll-out of MAMC in sub-Saharan Africa requires substantial funding and a high number of circumcisers for the first five years. These investments are justified by MAMC's substantial health benefits and the savings accrued by averting future HIV infections. Lower ongoing costs and continued care savings suggest long-term sustainability.

Circumcision Is Expected

Lou FCD — Wed, 06 Aug 2008 07:39:34 -0700

I was circumcised at birth (1967), and never thought much about it, honestly. I think I was probably in my late teens when I first heard that the procedure was not universal in today's world. It had always been presented to me as a historically religious practice that had become widespread for medical reasons, namely cleanliness and infection prevention.

I was asked when my son was born if I wanted to have him circumcised, and I found the question absurd. "Of course I do. What kind of question is that?" I then hesitated. The conversation went something like this:

"Aren't pretty much all boys circumcised?"

"Well, yes. The vast majority are."

"Some don't?"

"Some, for religious reasons, don't."

"Is it best to have it done?"

"Yes. It's cleaner and helps prevent UTIs. It's best to have it done now, and he won't even remember it."

In there somewhere was also a comment about embarrassment in a locker room about not being like the other boys, and something about the psychological issues that might cause.

Thus the medical professional (I hesitate to use 'nurse' or 'doctor' because I don't know which he was) reinforced the belief I already held. The way it was presented to me, it sounded like it was the sensible, medically important thing to do, and only people with backward religious objections declined the procedure. It was phrased in such a way that it correlated in my mind with religious objections to vaccinations, birth control, or other modern medicine.

I can't honestly say I resent being circumcised, as I don't have any other experience with which to compare. I'm not even terribly upset about it having been done without my consent, because in all likelihood it was presented to my parents the same way.

What I absolutely do resent is the manner in which I was misled into having the procedure done on my son. I don't know if I'd make the same choice now that I made then, but there is absolutely no excuse for a medical professional to spin a conversation that way. I gave consent for my son to be circumcised, but I most definitely did not give informed consent.

When I gave birth to twin

Visitor — Tue, 05 Aug 2008 11:18:00 -0700

When I gave birth to twin boys, one of them had a natural circumcison. I was unaware of this and when I took them in at two weeks of age to get them both circumcised, the doctor informed me that one of them would not require it. Years later at the age of 14 yrs. that same sone expressed his desire to be circumcised, so that he would not look different. Upon taking him to a urologist, I discovered that he was born with hypospadia, thankfully, they were able to use the foreskin to correct the defect. Thank God we had not gone ahead with circumcision. He is of completely normal now, the defect corrected and he is circumcised. I don't remember thinking we even had a choice, it was just what was expected.

Foreskin + condom = little understood

Intact Yank — Sat, 02 Aug 2008 19:57:33 -0700

Intact Yank here.

The intact penis was not at all respected 30-50 years ago in the US of A. During much of the 20th century, American medical texts depicted the penis as having no foreskin. I am happy to report that the American foreskin appears to be making something of a comeback. Granted, quite a few web posts describe teenage and college girls as having attitudes that leave something to be desired. (A few articles in Cosmo and Glamour could change that in short order, LOL!) On a more positive note, about 45% of American boy babies now leave the maternity ward intact. The Wikipedia articles on circumcision, foreskin, and penis are far more objective than anything in print before 1980. YouTube is overwhelmingly foreskin friendly.

An easily retractable foreskin is not a major alteration of the appearance of the penis. In fact, it takes a skilled eye to distinguish cut from uncut but rolled back. I suspect that many women do not know how to tell whether the man bonking them is equipped with a foreskin or not. The foreskin is visually and sexually blatant to a woman if she retracts it herself during foreplay. This is often unnecessary: by the time most men pull off their underpants, they are fully hard with no evident foreskin. The handjob is the only sexually act that makes the foreskin evident. I suspect that millions of American women during the 20th century never performed a handjob in their lives.

I submit that the foreskin matters most when a condom is involved. Only quite recently have I read on the web instructions on how to put a condom on without first fully retracting the foreskin, and I have yet to try this myself. Otherwise, we uncuts have to be able to bare the glans fully without discomfort. Then the condom has to be rolled on from the tip of glans. This has to be done slowly and carefully to avoid painful tugging on the frenulum. When I used condoms frequently 15-20 years ago, it would take my partner at least 2 minutes of fiddling to get one on. This was not trivial, was also deadly to spontaneity. After I came and became soft, she and I both worried that the condom would slide off. I recently read that condom breakage is more common with intact men, though that has never happened to me.

My better half (BH) fully agrees that a condom obliterates the sexual advantages of intactness. Cut and uncut are truly indistinguishable when both wear a condom. Also, my BH also tells me that vaginal intercourse with a foreskin and without a condom is in a category by itself. Quite a few web testimonials concur. Unfortunately, outside of a monogamous relationship, this is the riskiest sort of intercourse. Hence the following unsolved problem in biomedical engineering: to invent a device that protects like a condom, while preserving much of the pleasure derived from a movable foreskin.

Post transferred from the

Sun, 11 Nov 2007 06:54:41 -0800

Post transferred from the other blogsite:

I am an American male, son of an immigrant (and uncut) father, and I deeply resent being cut. (It was done in the 70’s without any parental notification; welcome to the USA.) To be totally frank, it is the one ‘body issue’ image that I have - and I really do suffer from it. I don’t like to see myself naked in the mirror because of it. My penis doesn’t look “right” to me - and I can accept all the other differences that I have from other folks, except that one. I’d do just about anything to change what happened - wish I could go back in time or something. I’m middle-aged now, and growing old with style - don’t mind my greying hair or slight pauch, any of that. But what I do mind - and have minded since the time I was a little boy and discovered it - is that someone took off part of my body for no reason, and without even asking.

I am in a supportive, settled relationship with a great woman who’s had lovers of both varieties, and tells me not to worry - though if we have any children, they are remaining uncut (as we both agree). I think I’d kill anyone who tried to harm my child in this way.

To all those folks, cut and otherwise, who think it’s not a “big deal,” I say fine - for you it may not be. But if there’s a small chance that your kid will have a reaction like mine, you shouldn’t play with fire. It’s just not fair to him - if he wants to be cut later, he can go ahead and do it, no big deal - I WISH I could reverse the process and heal the scar so easily. But he can’t get back what you take from him as a baby, and he may decide that he wants it back very much.

Our feelings about our genitals are such basic, private, and personal matters. Even family members will never really understand what’s at stake for any individual, and parents shouldn’t be so arrogant as to imagine otherwise. You feed your child; you don’t feel for him, certainly not once he’s grown up and out of the house. But your actions can have continuing consequences. Parents, doctors and religious leaders are merely guardians for us while we’re small; they won’t ultimately live in the bodies they are supposed to look after. It seems painfully obvious that they should do no harm while they have power over smaller people.

It’s too late for me - I realize that I will probably die unhappy about the fact of my circumcision (even though happy about many other things - my wife, job, etc.). There’s just no way I can easily get over this in my head, though believe me, I’ve tried. Don’t do that to anyone else, even if it’s only a small risk they’ll end up feeling like I do.