Gene Expression

Circumcision – HIV vs. pleasure?

James Hrynyshyn has a post up about circumcision and its relevance to cutting the risk of HIV infection & loss of pleasure. There are a priori reasons to believe that circumcision could reduce the risk of catching diseases through intercourse & that pleasure might be curtailed, ceteris paribus of course in both cases.1 Assuming a straightforward acceptance of the likelihood of the possibility of both which factor should be taken into consideration when making a decision regarding male circumcision? That decision must be, I believe, conditioned upon the prior facts in a particular circumstance and include both variables appropriately weighted. For example, in Africa where HIV infection rates can be as high as 30-40% among the young adult population the trade off might be judged acceptable because of the risk of infection. In contrast, in Japan where the HIV infection rate is very low the trade off might not be deemed acceptable (as a matter of fact South Korea has about the same rate of infection though in that nation the vast majority of young adult males are circumcised). In this case the cost vs. benefit calculus doesn’t seem to be invariant as a function of location.

1 – I am qualified about this because pleasure is not simply a function of the number of sensory cells generating inputs. One can imagine for example that those circumcised in youth go through physiological and neurological changes which might close the gap. Additionally, if the gap in pleasure is not closed one can also imagine circumcised males engaging in higher risk activities like anal sex to heighten sensation and excitement, and yet in the process mitigate or eliminate the reduced risk of infection.

Comments

  1. #1 jason
    June 15, 2007

    Castration also would reduce the likelihood of passing on or catching infectious diseases, but we don’t do that to all newborn male children. Sorry, but I find circumcision to be a rather distasteful and abusive procedure, and using disease as an excuse to continue manhandling male children before they can understand or consent to any such procedure seems, to me at least, a violation of all we preach about underage humans.

  2. #2 razib
    June 15, 2007

    Sorry, but I find circumcision to be a rather distasteful and abusive procedure, and using disease as an excuse to continue manhandling male children before they can understand or consent to any such procedure seems

    it isn’t really relevant if you find it distasteful. but abusive certainly matters. so in light of your objection to circumcision without consent it seems that you would have no problem with the recommendation of adult circumcision in much of southern africa?

    p.s. in much of the world circumcision is not performed upon newborns. i believe in turkey for example they often perform it when a boy reaches 12 or 13.

  3. #3 dc
    June 15, 2007

    It may well be that circumcision can be shown to have benefits, but these could not have been known when the practise became ritualised in human societies. Most of the problems which circumcision was intended to avoid have since disappeared because of more effective treatments. Similarly tonsillectomies were once much more common. Circumcision as currently pracised is a form of ritual mutilation. It also has connections with the obsession of the religious with controlling sexuality.

  4. #4 razib
    June 15, 2007

    Circumcision as currently pracised is a form of ritual mutilation. It also has connections with the obsession of the religious with controlling sexuality.

    not in the united states, where most males are circumcised for ‘health’ reasons.

  5. #5 colpen
    June 15, 2007

    Razib,

    One of your more interesting points is drawing a distinction between sensory input (i.e. what you have less of when you remove sensitive tissue) and the perception of pleasure.

    The problem with splitting that hair is, where does it end? It’s not such a stretch of imagination to envision some culture in which, for example, they remove the upper lip of each child. Or both lips. Arguing about quality of sensory experience is muddy, and thus useful for rationalization purposes.

    But even if it’s true that a person with sensory parts removed at birth experiences some degree of re-calibration such that their experience of maximal pleasure feels natural to them, again, it’s still a slippery slope that could justify removing other body parts that would outrage those without a cultural bias towards accepting it.

    Nobody in their right mind would even think of cutting penises to stop HIV… except the same types who favored circumcision before anyone every heard of HIV. It’s only because Westerners abhor FGM that they they don’t conduct flawed studies proving that can help prevent HIV too.

    I fear that Africans will not be fully informed as Westerners come to convert them to American Style Penises. That’s wrong, and a form of colonialism.

    Even worse is taking these flawed conclusions further out of context and using them to justify infant circumcision (I see it all the time). That’s disingenuous and quite disgusting.

  6. #6 razib
    June 15, 2007

    I fear that Africans will not be fully informed as Westerners come to convert them to American Style Penises. That’s wrong, and a form of colonialism.

    most africans already sport ‘american style’ penises ;-) e.g., most west africans and east africans and all muslim africans. some groups, like the zulus of south afica, gave up circumcision because of an injunction by fiat from the 19th century warlord shaka.

    in any case, the thing with slippery slopes is that we all draw our lines somewhere. i don’t think that male circumcision of the foreskin is analogous to castration or removal of the penis because of the magnitude of the transformation is so great in comparison. you may disagree, but in that case our differences arise upstream in our constellation of axioms or perhaps downstream in our assessment of the practice and its implications.

  7. #7 colpen
    June 15, 2007

    i don’t think that male circumcision of the foreskin is analogous to castration or removal of the penis

    Fair enough. But neither is punching a man in the jaw and breaking it analogous to bashing his skull with a baseball bat or a bullet to the head, but that’s hardly an argument in its favor.

    When you strip away the myths, what’s left is unethical sexual reduction surgery (when done without consent).

  8. #8 Ruchira
    June 15, 2007

    On this subject, I recommend reading Leonard Glickman’s Marked in Your Flesh: Circumcision from Ancient Judea to Modern America. Glickman is Jewish and a physician. It is quite an eye opener to find out what the so called health reasons truly amount to in order to promote circumcision of American infants for non-religious reasons. Consumer health advocate and radio doctor, Dr. Dean Edell (he too is Jewish, I think) speaks sharply and critically on this matter.

    Having grown up in a non-circumcizing culture, I find it appalling that so many go along with this practice without a question. Some of the older Indian Hindu boys born in the 1970s and early 80s were circumcized in US hospitals after their parents were convinced (coerced?) by doctors that it was “good” for their health and it would be awkward for the boys to look “different” from others in the locker room ! A case of blatant medical malpractice if ever there was one. I have learnt that now many non-Muslim and non-Jewish parents have learnt to put their foot down and say “no.”

  9. #9 razib
    June 15, 2007

    ruchira,

    circumcision rates in the USA are declining. in the pacific northwest of the USA only a minority of boys are circumcised now (a friend who works in day care said she believed it, most of the little boys whose diapers she changed had foreskins). it seems likely that among westerners circumcision is going to become a minority practice, as it is the USA is the last redoubt (canada’s rates are lower, though not as low as england or oz). once the USA stops circumcising i predict that nations which picked it up in imitation of american practice, the philippines & south korea, will also drop it. i have seen/read articles in jewish magazines worrying about the rise of anti-semitism with the decline of circumcision. i really think that jews need to remember that this isn’t the classical world and they aren’t required to exercise naked in the gymnasium anymore to be full citizens in the culture ;-) i don’t think it will make a big difference.

    p.s. this is little known, but it is not a sacrament for muslims as it is for jews. rather, it is simply an arab custom which has become a tradition by which muslism demarcate themselves off from non-muslims. it is not in the koran, though it is in some hadiths (but then, so is female circumcision).

  10. #10 Caledonian
    June 15, 2007

    not in the united states, where most males are circumcised for ‘health’ reasons.

    That’s just the excuse. Most males are circumcised because it’s normative.

  11. #11 razib
    June 15, 2007

    That’s just the excuse. Most males are circumcised because
    it’s normative.

    that’s why i had the ‘quotation marks.’ ;-)

  12. #12 Caledonian
    June 15, 2007

    But the statements you were denying – that circumcision “currently pracised is a form of ritual mutilation. It also has connections with the obsession of the religious with controlling sexuality” – are clearly correct in American culture.

  13. #13 razib
    June 15, 2007

    - are clearly correct in American culture.

    not today. most people don’t know the origins of circumcision. as you said, it’s normative. it is what a “normal penis” looks like to americans (as talking to american women who date europeans often suggests).

  14. #14 Caledonian
    June 15, 2007

    Doctors might reasonably be expected to know better.

    Why, then, do they repeat the thoroughly-debunked health claims?

    I’m less concerned with the origins of circumcision in the past than I am with the origins of the behavior in the present.

  15. #15 John Emerson
    June 15, 2007

    The sexual pleasure thing might be a wash. The doctor who delivered my son told us that the uncircumcised sometimes have a problem with premature ejaculation.

  16. #16 Jeb, FCD
    June 16, 2007

    Why are people so crazy about circumcision? I don’t quite understand the vehement anti-circ crowd. Those who are circed don’t know what they are missing. Sex still feels good for them, I am quite sure.

    I’m pretty sure no anti-circ fanatics have taken care of demented 80 year old guys with infected uncut phalluses. It’s quite disgusting.

    Get off your high horses. If you don’t like it, don’t get your kids cut. If you want your foreskin back, support stem cell research.

    They’re too many other matters of consequence in the world to worry about a centimeter or two of anteater mouth.

  17. #17 Ruchira
    June 16, 2007

    i have seen/read articles in jewish magazines worrying about the rise of anti-semitism with the decline of circumcision.

    So, as I see it, the vast majority of males of the world must get maimed in order that a minority group is not persecuted? !!! This is what I think Caledonian is referring to as cultural and religious tyranny. Is this also what was behind the popularity of circumcision in the US, disguised as health benefit? How about a simple solution? Don’t circumcize your own boys if you are living in a culture which doesn’t practice it if you are afraid of being singled out. That would go a long way towards blending in. Can’t complain if the rest of the unconvinced world is not going to accommodate your peculiar and outmoded beliefs.

    As for the recent enthusiastic drumbeat regarding circumcision and HIV, the same claims have been made in the past about other sexually transmitted diseases, including cervical cancer in women. The fact is that this too is blown out of proportion. Circumcision reduces but doesn’t eliminate HIV (and other) infections. In fact, if this is touted as the silver bullet to prevent HIV infection, the stupid will stop using condoms.

    A cousin of mine lives in Botswana (nearly 25% adults are HIV infected). He volunteers in villages as an advocate of AIDS prevention. Often he is accompanied by college students who act as translators. Some of the young men who spend the day teaching condom use, reduction in promiscuity etc., have unprotected sex with the village girls at night! I have heard similar stories about UN volunteers in sub-Saharan Africa. Circumcision is not going to save those girls or boys.

    this is little known, but it is not a sacrament for muslims as it is for jews. rather, it is simply an arab custom which has become a tradition…

    All the more reason that the religious / personal hygiene choice of an ancient desert peoples is not the answer to modern day health concerns. Access to soap, water, condoms and EDUCATION is the answer.

    I’m pretty sure no anti-circ fanatics have taken care of demented 80 year old guys with infected uncut phalluses. It’s quite disgusting.

    Well, get him cut then – at 80 when he is demented. Besides it is not the anti-circs who are fanatic. They rarely go around singing the praise of the foreskin or assign religious meaning to the retention or loss of it. Quite the opposite.

  18. #18 razib
    June 16, 2007

    So, as I see it, the vast majority of males of the world must get maimed in order that a minority group is not persecuted?

    well, only 30% of the world’s males are. 70% of them are muslim, and i don’t think jews have anything to do with that. even in the anglo-saxon world i don’t think circumcision was primarily about the jews, but rather late victorian ‘medical’ fads, right?

    have unprotected sex with the village girls at night! I have heard similar stories about UN volunteers in sub-Saharan Africa. Circumcision is not going to save those girls or boys.

    uh, my understanding is that circumcision is a pretty big impediment toward female to male transmission of HIV in the case of vaginal intercourse. it may not save the girls from men who are HIV positive, but it may save the boys from the inverse. and of course, the data from sub-saharan africa compares across ethnic groups. if, for example the xhosa have a 15% serpositivity rate and the zulu 30%, obviously circumcision isn’t a ‘silver bullet,’ but there is a pretty big difference between 15% and 30%.

    Access to soap, water, condoms and EDUCATION is the answer.

    which of course is why no one is arguing for mass circumcision in the modern world. but it is one thing to SAY that we should educate the men of africa, but another thing to actually engage in the proactive steps to facilitate the spread of schools. in the mean time HIV is reducing life expectancy from 60 to 30 years.

  19. #19 js
    June 16, 2007

    i really think that jews need to remember that this isn’t the classical world and they aren’t required to exercise naked in the gymnasium anymore to be full citizens in the culture

    I’m sorry, did you go to elementary or high school in the U.S.? Are you claiming that unusual physical features would not be a basis for persecution among adolescent and pre=adolescent boys? I don’t think that preventing a rise in anti-Semitism is a sufficient reason to force circumcision on the entire public. But I do think your dismissal of the argument that decreased overal circumcision rates could lead to such a rise in anti-Semitism is naive.

    I also find your language (“that jews need to realize”) itself to be on the verge of racism. Consider: “I think that blacks need to realize that inner city jobs aren’t going to create themselves.” Racism?

  20. #20 Caledonian
    June 16, 2007

    The doctor who delivered my son told us that the uncircumcised sometimes have a problem with premature ejaculation.

    The circumcised sometimes have a problem with premature ejaculation.

  21. #21 Caledonian
    June 16, 2007

    uh, my understanding is that circumcision is a pretty big impediment toward female to male transmission of HIV in the case of vaginal intercourse.

    ‘Pretty big’? Your understanding is wrong.

  22. #22 razib
    June 16, 2007

    But I do think your dismissal of the argument that decreased overal circumcision rates could lead to such a rise in anti-Semitism is naive.

    I also find your language (“that jews need to realize”) itself to be on the verge of racism. Consider: “I think that blacks need to realize that inner city jobs aren’t going to create themselves.” Racism?

    i really don’t give a shit if you think my language is racist. stop being a pussy. as for my dismissal, we already have a situation where the circumcised and uncircumcised mix in high schools. and yes i went to high school in the USA, i find your implication that didn’t go school here racist, did you by chance see my “foreign” name and stereotype me? oh sorry, joke, i’m not a pussy like you ;-0) no worries.

    ‘Pretty big’? Your understanding is wrong.

    thanks oh god of all knowledge. now where the fuck is your blog so i can see your citation?

  23. #23 dougjnn
    June 16, 2007

    Caledonian said–

    ‘Pretty big’? Your understanding is wrong.

    Wikipedia’s HIV entry says by up to 60% and cites this pub med source.

  24. #24 razib
    June 16, 2007

    my cite isn’t wikipedia, and it says the same. perhaps 60% isn’t a big reduction in some quarters. that’s fine, but let’s at least get the numbers out there.

  25. #25 dougjnn
    June 16, 2007

    js said:

    I don’t think that preventing a rise in anti-Semitism is a sufficient reason to force circumcision on the entire public.

    How generous of you. Though you don’t sound entirely sure.

  26. #26 Caledonian
    June 16, 2007

    razib, I’m disappointed in you. The failings of the recent HIV-and-circumcision research have been dealt with extensively on various ScienceBlogs. The expected reduction in HIV infection over an extended period is far less than 60%.

  27. #27 razib
    June 16, 2007

    The expected reduction in HIV infection over an extended period is far less than 60%.

    what is off the top of your head?

  28. #28 Brian
    June 16, 2007

    I’m pretty sure no anti-circ fanatics have taken care of demented 80 year old guys with infected uncut phalluses. It’s quite disgusting.

    And demented 80 year old ladies’ infected uncut vaginas aren’t any more disgusting?

    If you’re going to cut infant boys so that nurses won’t be disgusted 80 years from now, why not cut infant girls, too? Why are underaged girls protected by law from circumcision, but boys aren’t?

  29. #29 Caledonian
    June 16, 2007

    A very important point that I think deserves more recognition is that, due to societal differences, we already have a wide-scale natural experiment as to the health benefits of circumcision, complete with controls.

    There is a very long history of people making claims about benefits that later research not only showed weren’t there but that the existing data was sufficient to show that they weren’t there. If people do a thing for a reason, and that reason is shown to be invalid, they stop. It follows that since people readily accepted fallacious and inaccurate claims about circumcision, and merely switched their justifications when those claims became widely recognized as false, those weren’t their reasons for maintaining the tradition.

    Given that people in cultures where circumcision isn’t practiced often find the practice horrifying and barbaric, it is remarkable how blase people in cultures where it is practiced are about the whole thing. Given also that even when the practice is associated with significant morbidity and even mortality, it is still practiced, and that the justifications usually offered for the practice are only excuses, it is likely that the cause is a psychological defense.

    razib is quite correct: his position is utterly untenable. Note that even while explicitly recognizing this, he doesn’t change it.

  30. #30 razib
    June 16, 2007

    If you’re going to cut infant boys so that nurses won’t be disgusted 80 years from now, why not cut infant girls, too? Why are underaged girls protected by law from circumcision, but boys aren’t?

    yeah, these arguments are pretty dumb.

    Given also that even when the practice is associated with significant morbidity and even mortality

    where are you numbers? stop asserting and start citing. also, please tell me exactly what my position is again. your mastery of the english language or my abilities to comprehend leave me a bit confused as to the origin of the last sentence.

  31. #31 Caledonian
    June 16, 2007

    where are you numbers? stop asserting and start citing.

    It’s pretty common knowledge among people who have actually studied circumcision as a sociological phenomenon, even if only casually. The serious morbidity rates of circumcision in Africa are often cited as a justification for having the procedure done in hospitals instead of as a tribal ritual.

    If even people supporting and trying to facilitate circumcision in Africa acknowledge that, as practiced, it carries serious health risks, I find it odd that you should find the idea unfamiliar.

    your mastery of the english language or my abilities to comprehend leave me a bit confused as to the origin of the last sentence.

    Oh, brother. Let’s take a look at the next post you put up on the topic, shall we?

    I stand in the untenable position of neither believing that circumcision should be promoted by the authorities as a “health” precaution in the modern world, but also not considering it an abomination in the eyes of the Lord.

    ‘Untenable’: incapable of being defended, as an argument, thesis, etc.; indefensible.

  32. #32 Caledonian
    June 16, 2007

    Since it seems razib is too busy to do even rudimentary research himself, here are a few links I produced in about two minutes’ searching on the BBC news website.

    There seems to be a problem posting the links, so here are the addresses by themselves:

    http://news.bbc.co.uk/2/hi/africa/813699.stm
    http://news.bbc.co.uk/2/hi/africa/3745513.stm
    http://news.bbc.co.uk/2/hi/africa/2067235.stm

  33. #33 razib
    June 16, 2007

    ‘Untenable’: incapable of being defended, as an argument, thesis, etc.; indefensible.

    i didn’t mean untenable on the merits. don’t be so literal. i’m saying that i’m standing between two camps, one which believes circumcision is a human rights crisis and another that thinks it can justify it because uncircumcised penises are icky.

    If even people supporting and trying to facilitate circumcision in Africa acknowledge that, as practiced, it carries serious health risks, I find it odd that you should find the idea unfamiliar.

    the health risks have to be weighed in total (as i think i’ve made clear). so tell me about the sociological literature which i’m unfamiliar with.

  34. #34 razib
    June 16, 2007

    http://news.bbc.co.uk/2/hi/africa/813699.stm

    http://news.bbc.co.uk/2/hi/africa/3745513.stm

    http://news.bbc.co.uk/2/hi/africa/2067235.stm

    the first link was about 1 boy dying and 24 injured. the second was about 12 deaths and 92 hospitalizations among the xhosa. the last was about 5 deaths and 51 injuries due to initiation rituals with included circumcision and beating. these aren’t data, they’re incidents. is this a joke? it’s tragic, but it doesn’t give us a a sense of proportion (i assume this is a small subset, but how small?).

  35. #35 Caledonian
    June 16, 2007

    I do not have immediate access to statistics, which in most cases don’t exist, as circumcisions performed ritually – in tribal villages – don’t involve the sort of record-keeping that they do in hospitals. Imagine that. But they also tend to be done by untrained individuals with crude tools in terribly unsanitary conditions, so we can reasonably presume that negative consequences are fairly common.

    The 24 injured were so badly hurt that it was thought they would have their penises amputated. Completely. It’s a sufficiently large problem that South African authorities were considering instituting a five-year stint in prison.

    If you want more data on the subject, you might consider performing even a cursory search yourself. I recognize the importance of providing substantiation for claims, but when the claims in question are common knowledge to people who have looked into the matter even casually, I’m not so patient. Either you’ve done your homework, and you’re demanding cites as a means of inhibiting discussion, or you’re so deeply ignorant on the matter that you have no place holding any opinion on it.

    I hate to break it to you, razib, but you’re not a middle moderate. It is remarkable how many IQ points are lost when psychological defense mechanisms come into play. I take it you don’t agree that male circumcision is a rights crisis – what is your opinion of the people who want physicians to stop altering the genitalia of female infants born with unusually large clitoral organs?

  36. #36 razib
    June 16, 2007

    caledonian, your arguments would be more on point if i was actually promoting ritual circumcision. since i’m not, i don’t see what relevance your citations have. thanks for keeping the high ground by making insults about how many IQ points i’ve lost. really adds to your credibility.

    what is your opinion of the people who want physicians to stop altering the genitalia of female infants born with unusually large clitoral organs?

    depends on the nature of the alteration.

  37. #37 colpen
    June 16, 2007

    i’m saying that i’m standing between two camps, one which believes circumcision is a human rights crisis and another that thinks it can justify it because uncircumcised penises are icky.

    Non-therapeutic infant circumcision is a medical ethics crisis. If doctors treated any other part of normal human anatomy the way they treat an infant’s prepuce, their license to practice would be at risk. Cosmetic surgery is for adults who can consent for themselves. There are no potential health benefits to circumcision which come even close to medically justifying a prophylactic amputation.

  38. #38 Caledonian
    June 16, 2007

    caledonian, your arguments would be more on point if i was actually promoting ritual circumcision. since i’m not, i don’t see what relevance your citations have.

    You can’t even recall a point made less than three hours ago and that’s still present in the thread seven posts above you? Yeesh.

    If you actually think anyone who tells you things you don’t want to hear loses their credibility in the process, you have problems greater than I can possibly address.

    depends on the nature of the alteration.

    Reduction.

  39. #39 razib
    June 16, 2007

    Non-therapeutic infant circumcision is a medical ethics crisis. If doctors treated any other part of normal human anatomy the way they treat an infant’s prepuce, their license to practice would be at risk. Cosmetic surgery is for adults who can consent for themselves. There are no potential health benefits to circumcision which come even close to medically justifying a prophylactic amputation.

    i generally agree with that.

    If you actually think anyone who tells you things you don’t want to hear loses their credibility in the process, you have problems greater than I can possibly address.

    i invite you never to read my blogs again. get it?

  40. #40 colpen
    June 16, 2007

    colpen:
    Non-therapeutic infant circumcision is a medical ethics crisis. If doctors treated any other part of normal human anatomy the way they treat an infant’s prepuce, their license to practice would be at risk. Cosmetic surgery is for adults who can consent for themselves. There are no potential health benefits to circumcision which come even close to medically justifying a prophylactic amputation.

    razib:
    i generally agree with that.

    Good to hear!

    Frankly, I don’t know how they get away with it. Accepting proxy-consent for a non-therapeutic circumcision is a serious breach of the doctor-patient relationship. I suppose they’ll keep doing it until such time as they perceive their own careers to be at risk. Once the age of majority is reached, teenagers can hold them accountable. Or, parents can help get things started earlier. If, for example, parents were not fully informed about results from Sorrells, the case could be pretty easy to win.

  41. #41 Caledonian
    June 16, 2007

    Accepting proxy-consent for a non-therapeutic circumcision is a serious breach of the doctor-patient relationship.

    That’s precisely why doctors are so adamant on insisting that circumcision has clear and direct medical benefits, and why so many continue to believe that the surgery is completely benign.

  42. #42 Torbjörn Larsson, OM
    June 16, 2007

    The WHO and UNAIDS recommendations of circumcision are for areas where condoms are scarce and HIV rampant. IIRC circumcision may also increase the frequency of chlamydia in males according to a small study. In any case condoms are preferable AFAIK.

    There are a priori reasons to believe that circumcision could reduce the risk of catching diseases through intercourse

    Why would circumcision a priori be believed to reduce risk of infections?

    A posteriori, the amputated tissue is part of a system that presents antigens to the immune system. As mentioned above it may in some cases be beneficial (chlamydia), and in others be non-beneficial (HIV).

    (Speculating, it may be part of the system helping prepare perhaps sperm and probably ova for successful implantation. We know or suspect that the female system rely on sperm introduction for this, by means of the immune system.)

    & that pleasure might be curtailed, ceteris paribus of course in both cases.

    It is important to distinguish between physiological and neurological & learned response, as the poster does.

    But then we must add that the mechanics of circumcised sex is different, and reportedly women prefer the evolved mechanics… (Again, IIRC a small study. Sheesh! Since it is such a common amputation, one would think that it would be studied more.)

  43. #43 Torbjörn Larsson, OM
    June 16, 2007

    Non-therapeutic infant circumcision is a medical ethics crisis. If doctors treated any other part of normal human anatomy the way they treat an infant’s prepuce, their license to practice would be at risk. Cosmetic surgery is for adults who can consent for themselves.

    I agree with this. The WHO and UNAIDS recommendations are, other reasons aside, a measure of desperation. But most or all medical measures that are beneficial have side effects. The circumcision measure isn’t especially provoking as such.

    What is special is that it is an operation and amputation of (poly-)functional tissue, and that it is known to be beneficial in this case only due to rampant cultural, ethically suspect, use. (I doubt no one would have looked at this procedure otherwise.) It is akin to surgically remove the appendix, wisdom teeth, or unnecessary toes and fingers that could cause problems later – except that HIV is more severe. And the procedure and its side effects are very poorly researched AFAIK.

  44. #44 Torbjörn Larsson, OM
    June 16, 2007

    And the procedure and its side effects are very poorly researched AFAIK.

    That should of course be the evasive procedure. It is an operation after all.

  45. #45 spacediver
    June 16, 2007

    A good way to think about this is to ask the following question:

    Under what conditions would we condone the removal of sexual tissue from a female infant.

    We can sharpen the question to include removal of labia minora, and partial clitoridectomy, since this is likely the best comparison to the ablation of the male prepuce.

    I am open, in principle, to the idea of using genital cutting as a means of stemming a pandemic in extreme circumstances, if it can be shown, to the best of our abilities, that such a practice will most likely save a large amount of suffering.

    I am even potentially open to doing this upon nonconsenting infants.

    However, my openness extends equally to both sexes. It would take an extreme circumstance to justify the removal of sexual tissue from a female or male infant.

    As for routine neonatal genital cutting of boys and girls in general, I am absolutely against it, unless it is absolutely medically necessary, which it rarely is (hence the terms routine, and nontherapeutic).

  46. #46 spacediver
    June 17, 2007

    and just a comment about the 60% figure. Admittedly, I haven’t read the primary sources (or the lancet review), but my understanding, based on secondary sources, was that the 60% figure is PER sexual encounter.

    If it were a 60% LIFETIME protection, that would be a wholly different issue.

    Someone correct me if I’m wrong.

  47. #47 DuWayne
    June 17, 2007

    Non-therapeutic infant circumcision is a medical ethics crisis. If doctors treated any other part of normal human anatomy the way they treat an infant’s prepuce, their license to practice would be at risk. Cosmetic surgery is for adults who can consent for themselves.

    Here is the problem with that. As an infant, the penis is not nearly as sensitive, as it will be later in life. Even with that aside, an infant won’t possibly remember the trauma. On the flip side, I have known two people who were circumcised later in life, my father when he was twelve and a friend when he was in his late teens. Both of them were circumcised due to infections, both of them found the experience extremely traumatic.

    I am not trying to argue that it should be done, I have a son who is uncut and if the next one (due in December) is a boy, he will be uncut too. I figure that it’s really not necessary, as long as they are taught to keep it clean. But if it is likely that it will be done, or if there is a good chance that it should be done, doing it in infancy, is doing them a favor.

    And I really have a hard time buying that it has any significant effect on pleasure. Not having had the chance to have sex uncut, I can’t really say for sure, but I certainly don’t feel like I have any issues with sensitivity. In fact, if being uncut makes one more sensitive, I am glad that I was, much more sensitivity and sex would become quite uncomfortable.

  48. #48 Caledonian
    June 17, 2007

    As an infant, the penis is not nearly as sensitive, as it will be later in life.

    How in the world could you justify that claim?

  49. #49 spacediver
    June 17, 2007

    DuWayne, it’s not that the intact penis is necessarily more sensitive (though it is), but that the richness and complexity of sensation is greater. This is one reason why circumcision may be associated with premature ejaculation – with less complexity, the pathway to orgasm may be narrower, resulting in threshold being reached too fast. (this is speculation on my part).

    Essentially, the intact penis has more neural modulators which contribute to pleasure and orgasm. The sensory topography of the intact penis is quite complex, and there is preliminary evidence that the ridged band area and the glans communicate with each other in interesting ways, providing for a remarkable sexual dynamic.

    It is also instructive to learn that the vast majority of circumcised women feel they are missing nothing, and claim to enjoy sex.

  50. #50 spacediver
    June 17, 2007

    For a primer on the anatomy and physiology of the prepuce, I recommend the following video lecture:

    http://opposingdigits.com/vlog/?p=1708 (it’s the top video)

  51. #51 DuWayne
    June 17, 2007

    How in the world could you justify that claim?

    Because after observing my own infant son, twisting, stretching and really pulling on it, I asked his pediatrician about it. She explained to me that when babies are born, their penises aren’t very sensitive at all, slowly becoming more sensitive, until it reaches full sensitivity when they are about six or seven. As I don’t share your apparent extreme distrust of doctors, I rather believed her. As well, what I have observed in my own son, seems to confirm what I was told by his doctor.

  52. #52 spacediver
    June 17, 2007

    DuWayne’s most likely right. The sexual hardware probably hasn’t fully differentiated at birth, and the brain probably hasn’t yet learned how to organize these incoming signals into a coherent sexual experience.

    I still don’t see how this fact in any way rebuts the point made by colpen, which is that non-therapeutic circumcision is a medical ethics crisis.

    The clitoris and labia are probably not very sensitive at birth, and even if the baby didn’t remember the trauma of having her genitals sliced apart, it would most certainly be a medical ethics crisis if hospitals performed the procedure (as they do in other countries).

    Perhaps, DuWayne, you’re misunderstanding the term “sensitive” here. Sensitive doesn’t just mean sensitivity to a knife while you’re strapped down, but sensitivity to erogenous stimulation while you’re making love.

  53. #53 DuWayne
    June 17, 2007

    spacediver -

    I still don’t see how this fact in any way rebuts the point made by colpen, which is that non-therapeutic circumcision is a medical ethics crisis.

    I guess that would depend on what is being defined as non-therapeutic. I wouldn’t really consider it to have been therapeutic, when it was done to me, but I am glad that it was done. Due to my personal habits, I probably would have needed to have it done later. Now I have my partner to help me remember to do things. But when I lived alone, I had a tendency to forget such things as cleaning and eating. I am quite glad that I had it done as an infant – again, knowing people that had it done later, I am glad not to remember, the pain or the healing.

    At the same time, I understand that there is little evidence that it is really important, as long as it is kept clean. Thus why I opted not to have it done to my child. If however, there is potential for serious benefit, then I think it is necessary to consider doing it. If it is worth doing, I don’t see an ethical dilemma to doing it to when they’re an infant, indeed, I think it is cruel to wait until they are older.

    Perhaps, DuWayne, you’re misunderstanding the term “sensitive” here. Sensitive doesn’t just mean sensitivity to a knife while you’re strapped down, but sensitivity to erogenous stimulation while you’re making love.

    In the context of the conversation with my son’s doctor, the sensitivity was to pain.

    The clitoris and labia are probably not very sensitive at birth, and even if the baby didn’t remember the trauma of having her genitals sliced apart, it would most certainly be a medical ethics crisis if hospitals performed the procedure (as they do in other countries).

    Again, I am not advocating for, or against circumcision. The only point that I am making, is that if it is going to be done, having it done as an infant is preferable.

  54. #54 colpen
    June 17, 2007

    Who here has actually read the Sorrells study, the origin of this story?

  55. #55 Torbjörn Larsson, OM
    June 17, 2007

    Admittedly, I haven’t read the primary sources (or the lancet review), but my understanding, based on secondary sources, was that the 60% figure is PER sexual encounter. If it were a 60% LIFETIME protection, that would be a wholly different issue.

    I vaguely remember the discussion with the studies which precipitated the WHO/UNAIDS recommendations, and I’m too disinterested to google right now. Their model indicated that millions of individuals would be saved from HIV infections. (Though I can’t remember the time horizon.)

    All in all a worthwhile endeavor AFAIU, though sponsoring and distributing condoms is preferable. One question to ask if that alternative is unrealistic. I don’t think so, and I’m not sure that crass economics are acceptable as the sole guideline in a partly moral issue.

  56. #56 Caledonian
    June 17, 2007

    Infants being circumcised without proper anesthetic show all the classic signs of pain – it seems to indeed hurt very much. (Who’d have thought?) Quite frankly, your doctor’s statements seem awfully similar to the excuses made when it was considered appropriate to not use anesthetic at all.

    I don’t doubt that infants’ peripheral nervous systems aren’t very well put together, but that doesn’t constitute a reason to have them circumcised.

  57. #57 Caledonian
    June 17, 2007

    As I don’t share your apparent extreme distrust of doctors, I rather believed her.

    Nice… that poisoning-the-well attempt was very smooth. I congratulate you.

    Young infants have no coordinated movements and cannot direct their motor activity. Any flinching away from painful stimuli is the result of local reflexes. Skepticism requires that assertions be analyzed, not accepted on trust or faith. Are you seriously suggesting that your doctor’s statement, as you presented it here, is the best and most plausible explanation for your son’s behavior?

  58. #58 spacediver
    June 17, 2007

    At the same time, I understand that there is little evidence that it is really important, as long as it is kept clean. Thus why I opted not to have it done to my child. If however, there is potential for serious benefit, then I think it is necessary to consider doing it. If it is worth doing, I don’t see an ethical dilemma to doing it to when they’re an infant, indeed, I think it is cruel to wait until they are older.

    DuWayne, suppose there was a procedure where you scraped away the inner walls of an infant’s vagina with a scalpel. Due to the keratinization and toughening of the walls after this procedure, the person was rendered significantly more immune to transmission and reception of STDs than infants who were left alone.

    Suppose further that in order to reduce the risk of bacterial infection, the vulva is trimmed down. After all, the vulva is a moist environment, and produces smegma, just like in males.

    Furthermore suppose that this procedure is done using the latest in surgical and anaesthetic technology, so relatively little pain is felt.

    Also suppose that if she were to do this as an adult, the pain, trauma, and risk of complications would be significantly increased.

    As a result of this procedure, suppose the female is still able to derive orgasm, and having never experienced sexual stimulation as an intact woman, she doesn’t know what she’s missing.

    There are clear medical benefits to this procedure, if it is done safely.

    Would you hold the same attitude towards it as you do neonatal male circumcision? If not, why not?

    Do you not think that a female who had undergone this procedure, and then later on in life, claimed that she was grateful it was done to her, was displaying a form of ignorance?

    You may be absolutely correct in stating that circumcision done as an infant has a lower associated medical risk than circumcision done as an adult.

    You would also be absolutely correct in stating that if circumcision is medically necessary, you should do it to an infant who can’t consent.

    Where you go wrong, in my opinion, is ignoring the fact that circumcision is rarely medically necessary, and while there are benefits associated with it, there are also risks, and great harms, just as in the case with removal of sexual tissue from a female infant.

    I gather that you do not think circumcision to be associated with harm, as you personally do not feel you are missing anything. I would caution you to think carefully on this matter: the vast majority of circumcised women do not think they have been harmed. They are happy to be circumcised, and most of them go on to have their daughters cut. Many of these women voluntarily get cut as adults.

    I would gather that the reason they do not think they are harmed is due to ignorance about the sexual function of the intact female genitalia. And until they educate themselves about this function, they are not really in a position to make a responsible claim.

    DuWayne, how much do you understand about the anatomy and physiology of the intact male genitalia? Did you watch that video I posted?

    And even if a circumcised woman fully understood what she was missing, but was still okay with it, don’t you think that other women should be given the choice to make an informed decision about whether or not to have erogenous tissue removed from their bodies, even if the risks of complication are increased by the time they’re able to make such a choice?

    (btw your doctor was misinformed about the pain issue – up until the 80′s most doctors believed that infants couldn’t really experience pain. Nowadays nobody believes that, due to some very solid research.)

  59. #59 J. Harrison
    June 17, 2007

    When I first read the study released by the UN and the subsequent recommendations that all men be circumcised, a couple of things jumped out at me:

    1. Most Americans are circumcised and that did not stop the HIV epidemic that devastated the homosexual community in the 80s. Ergo, circumcision is not a guarantee, and if fact, under certain circumstances appears to be irrelevant to the rate of infection.

    2. Many African men believe in superstition, like screwing a virgin cures you of HIV. Judging from the alleged queue of men to get cut, I bet that many think circumcision endows one with some kind of immunity, perhaps leading to more partners and dampening any positive benefit that may have been envisaged.

    3. Male circumcision does nothing for the woman. We are to hope that infections rates reduce and pandemic subsides.

    All in all, it seems to me to be a decidedly shakey proposal and quite dismaying that education of the masses has failed so drastically.

  60. #60 spacediver
    June 17, 2007

    Actually, if I’m not mistaken, followup data showed that male circumcision actually increased the rate of HIV in women who came into contact with these circumcised males.

  61. #61 David B
    June 17, 2007

    The evidence suggests strongly that circumcison reduces the risk of HIV infection, per sexual event. Does this make circumcision desirable as an anti-HIV measure?

    This depends on how it affects behaviour. If it increases the number of high risk events proportionately more than it reduces the risk per event, then the net effect is negative. E.g. it could reduce the use of condoms, or encourage people to have sex with high-risk partners. Certainly it looks like a second-best measure, as compared to using condoms. It would be like playing Russian Roulette with three bullets in the chamber, instead of one.

  62. #62 Spacediver
    June 17, 2007

    David, would you say that female circumcision would be desirable if it were shown that it had a similar protective effect against HIV?

  63. #63 Ruchira
    June 17, 2007

    Exactly right. Agree with J. Harrison and spacedriver above. The reduction in HIV transmission (60%?) by circumcision refers to a single sexual contact. Over time, with multiple contacts and a heightened sense of false security, the risk is the same to circumcized and intact men. For women, it probably increases due to reasons mentioned above by “spacedriver.” As of now, absent a workable vaccine, there is not much choice except to go the tired old route of education (condom use and reduced promiscuity) and the HAART regimen.

    Which is why this dancing in the streets in certain quarters about HIV and circumcision is so disturbing. I recently saw the same smug (and ill informed) argument put forward by a literary reviewer who critiqued Christopher Hitchens’ book, God Is Not Great which apparently contains negative views of male circumcision. The practice of circumcision is so emotionally charged in the minds of some due to thousands of years of entrenched religious dogma that every dubious “health benefit” that is reported, becomes a screaming headline. Surprisingly enough, intelligent and rational folks who are quick to dismiss with derision the irrational (and harmful) superstitions of others, themselves become cagey and defensive about this brutal (and unethical) procedure which they deem as sacred. They clutch at every straw to keep alive the notion of circumcision as a means to “cleaner” and “healthier” lives.

  64. #64 colpen
    June 17, 2007

    The right way to look at this whole issue is this:

    What are we going to do to preserve the rights of young males to choose fully intact genitals?

    Unfortunately, most people (Americans, anyway) who recognize the harm and rights violation of infant circumcision still choose to do nothing about protecting our fellow humans.

    Infants can’t protect themselves (and doctors, apparently can’t figure out what proxy consent is, and isn’t, acceptable for). They both need help.

  65. #65 DuWayne
    June 17, 2007

    Caladonian -

    Infants being circumcised without proper anesthetic show all the classic signs of pain – it seems to indeed hurt very much. (Who’d have thought?) Quite frankly, your doctor’s statements seem awfully similar to the excuses made when it was considered appropriate to not use anesthetic at all.

    She didn’t say that it doesn’t hurt at all, she said that it is considerably less painful for an infant, because they haven’t developed as much sensitivity to pain there, as will exist later.

    Nice… that poisoning-the-well attempt was very smooth. I congratulate you.

    Not an attempt to poison the well, just a point of observance.

    Skepticism requires that assertions be analyzed, not accepted on trust or faith.

    I accepted based on both trust, and what I observed my own son doing to his penis. The way he played with it and yanked on it, make it easy to accept that he probably didn’t experience the same pain that you or I would, of we did the same thing to our own penises.

    Are you seriously suggesting that your doctor’s statement, as you presented it here, is the best and most plausible explanation for your son’s behavior?

    I am not suggesting anything of the sort. If I were presented with reasonable evidence to contradict what she said, I would change my assesment. As it stands, I have no reason to question it. He did things to his penis, that no adult or young adult, could possibly do to their penis without inducing excruciating agony. As he has gotten older, he has become, over time, far more gentle with it. I have also talked about this with other parents who have observed similar behaviors in their own children. Given the circumstances, why shouldn’t I believe her? What she said, coupled with what I have observed, makes sense.

  66. #66 DuWayne
    June 17, 2007

    spacediver -

    Would you hold the same attitude towards it as you do neonatal male circumcision? If not, why not?

    Absolutely.

    But please keep in mind, that I am not saying that I do support any sort of circumcision. I am not for it, nor do I really know enough to be entirely against it. My whole point and only point, is that if it is going to be done, if the benefit is real and substantial enough, then it is better to do it in infancy. And even if it is just as painful then, as it would be later, I still support it, as it would be entirely forgotten by the child.

  67. #67 spacediver
    June 17, 2007

    Thanks for replying DuWayne.

    If you are against female circumcision (which also has medical benefits), then you should be against male circumcision.

    The removal of a healthy body part without consent is a crime.

    The removal of healthy sexual tissue without consent is a horrifying crime.

    When you say you do not know enough to be entirely against it, are you saying that you’re not convinced that circumcision removes erogenous tissue?

    (i’m not trying to be a prick here, I’m just genuinely interested in understanding your thoughts on this issue)

    cheers.

  68. #68 ristin
    June 17, 2007

    I am sick of this urban myth. It is as pointless as it is dangerous.

    Protected sex is safe. Use a condom.
    If you want to have unprotected sex, then get STD tests all-round first.

    Those methods work. Accept it and move on.

    Fairytail solutions like circumsision do not work, and give a false sense of security.

  69. #69 DuWayne
    June 17, 2007

    If you are against female circumcision (which also has medical benefits), then you should be against male circumcision.

    I was actually meaning that I feel the same of both.

    When you say you do not know enough to be entirely against it, are you saying that you’re not convinced that circumcision removes erogenous tissue?

    I mean that I am not sure that there really are that many potential benefits. And being a very big safe sex advocate, I am leery of giving anyone a false sense of security. Especialy as it seems to me, that all this does is offer a modicum of protection to the man, leaving the women wide open to potential transmission from the man.

    As far as whether or not it removes erogenous tissue, I honestly don’t know – I mean, I am sure it removes some, I just don’t necessarily buy the notion that it makes that big a difference. I know that I have never missed it, but then I have never had it. And I have given my reasons for being glad of that. Which by the way, I don’t wish to leave the impression that I am just a huge pig. I am ADHD and bi-polar. I have gone days at a time without eating or washing, or sleeping, because I get hyper-focused, not because I enjoy being dirty – I just don’t notice.

  70. #70 spacediver
    June 17, 2007

    cool. thanks for the thoughtful response. Check out that video sometime if you’re up for it. it’ll give you some insight into the structure and function of the missing parts.

    http://opposingdigits.com/vlog/?p=1708 (it’s the top video)

  71. #71 David B
    June 18, 2007

    “David, would you say that female circumcision would be desirable if it were shown that it had a similar protective effect against HIV?”

    - I would say that for both males and females it should be a matter of choice for informed adults.

  72. #72 spacediver
    June 18, 2007

    I completely agree with you.

  73. #73 Jack
    June 18, 2007

    Someone expressed the idea that uncirced guys are too sensitive and that this results in remature ejacultaion (P.E.).

    Circed guys tend to have more P.E. problems. The idea viz. uncirced guys is a myth. Many docs in the US have bought into this myth and there is the concept thrown around that men are sensitive enough when circed. This is BS, probably from Drs that try to justify the circ. culture. Circumcision causes sexual dysfunction and not the other way. Intact guys have better control and enjoy the full experience.

  74. #74 spacediver
    June 18, 2007

    Jack, while anecdotal evidence evidence tends to agree with your statements, they haven’t been fully researched. The research that does exist does seem to suggest that P.E. is associated with circumcision, though as I said, it hasn’t been thoroughly examined to my knowledge.

    There are a couple possible reasons that circumcision is associated with less orgasmic control, and i’ve alluded to them earlier in this thread.

    The first is that with less of the frenular tissue (which contains high density distributions of meissner corpuscles – essentially a high resolution sensory platform), there is less neural modulation of the sexual response, and therefore less control.

    Another likely candidate is that due to the drying out and keratinization of the glans, the glans becomes less sensitive. Anecdotal reports suggest that the warm, rich, deep-body tickle sensations arising from glans stimulation actually buffer the signals coming from the frenular region.

    I’m not sure if this is a mutually inhibitory relationship, whereby frenular stimulation can buffer glans stimulation.

    The point is, with a more sensitive glans, you can actually prevent threshold from being reached too fast, which is what seems to happen when you stimulate only the foreskin.

    Of course, this is all anecdotal, and partly speculative, although there is some preliminary lab work being done investigating orgasmic reflexes involving frenular and glans signals.

  75. #75 Caledonian
    June 18, 2007

    - I would say that for both males and females it should be a matter of choice for informed adults.

    Just as long as the choice is for people to make about themselves, not their children.

  76. #76 Ruchira
    June 19, 2007

    A related news story from MSNBC.

  77. #77 Rivensteel
    June 19, 2007

    An aspect of circumcision that has not been discussed here, as far as I am aware, is the public health implication of circumcision. For the purposes of containing illnesses like measles, mumps, tetanus, hepatitis, and many more, we have widespread programs of immunization. It is not so far fetched to think of the practice of circumcision in similar terms. Decreasing the rate of transmission decreases the number of victims, making the disease easier to track, control, and contain. I don’t disagree that condom usage or abstinence would work better. However, I believe the tone of the discussion regarding AIDS demonstrated in the thread above has been highly disappointing. Such a lax attitude has resulted in infection rates climbing again after the success of antiretrovirals (and HAART most recently). HIV being a lifelong and potentially devastating diagnosis, it is best to use every tool at our disposal. Condom usage is the best way to prevent transmission of HIV during intercourse, but people being only human, correct condom usage rates are not 100%. Microbicides, circumcision, anything we have should be there in the gaps. Preventing a single man from infection may save multiple others from infection.

    In that vein, how is vaccinating a child different from circumcision? I know of no function performed by this tissue, so removing it could be something like preemptive vermiform appendectomy. But we inject children without consent and often without assent, because we know that their health and the health of society depend on a high level of protection and immunity. This provides safety, in the form of herd immunity, for everyone, even the freeloaders who do not participate in the prevention but still reap the benefits.

    P.S.: What’s the take rate of vaccinations? Always significantly less than 100%.

  78. #78 colpen
    June 19, 2007

    Rivensteel,

    Read this:

    http://www.cirp.org/library/ethics/hodges3

    There are stringent ethical standards applied before removing body parts from people. They are more stringent still when the patient can’t speak in their own interest. The standards for all body parts and all sexes should be consistent.

    If adults choose to get circumcised thinking they’ll be less likely to get HIV, they are adults free to do so. Anyone providing such services should give full information, including a copy of Sorrells in their own language.

    Since American infants aren’t having heterosexual sex in Africa, or anywhere for that matter, they would be in no need of such protection anyway. After all, this supposed protection costs a sensitive body part, right?

    What would the child choose, when he becomes sexually active? Condoms, or circumcision and condoms? A circumcised man who regrets the loss has been seriously harmed. Surely to him, it’s a mutilation. How many does it take to make it unethical? 10% regret? 20%? 50%?

  79. #79 spacediver
    June 19, 2007

    I know of no function performed by this tissue, so removing it could be something like preemptive vermiform appendectomy.

    read back through this thread – the foreskin has multiple sexual functions. For one, it’s the most sexually sensitive part of the male penis…

  80. #80 jono
    June 20, 2007

    ==In that vein, how is vaccinating a child different from circumcision?==

    …well, and i guess how is a golf ball different from a goldfish?

    …. also, who deleted my other posts? jesus h christ.

  81. #81 commenter
    June 22, 2007

    Razib wrote:
    i really think that jews need to remember that this isn’t the classical world and they aren’t required to exercise naked in the gymnasium anymore to be full citizens in the culture
    =================================
    yet.
    get back to us in 5-10 years….
    =================================

  82. #82 Joshua Amos
    July 23, 2007

    The foreskin has multiple sexual functions? Because some psychosexually motivated anti-circumcision website says so? Get real. The human male foreskin is vestigial and as such is irrelevant.

    We are looking at preventing 5.7million HIV infections, and 3 million deaths in Africa through the promotion of male circumcision and here you whine on about a myth?

    Do you care about the deaths of three million Africans and the massive human tragedy 5.7 million additional HIV infections will bring or… is the foreskin more important than millions of lives and countless human suffering?

  83. #83 Caledonian
    July 23, 2007

    Vestigial? With all those sensory neurons? Unlikely. You might as well argue that the penis is vestigial, since reproduction can be accomplished without it.

    What next? Will you claim that the abolishment of DDT is responsible for countless deaths and much suffering from malaria?

  84. #84 Joshua Amos
    July 24, 2007

    The so-called sensitivity of the male foreskin is a myth as per this study:

    http://allcircumcision.blogspot.com/2007/07/sensation-and-sexual-arousal-in.html

    and these:

    http://www.circs.org/library/i_sex.html

    The foreskin is a public health risk and that is all there is to it.

  85. #85 niles
    August 12, 2007

    “The foreskin is a public health risk and that is all there is to it.”

    That’s got to be the dumbest thing I’ve read. Joshua, what’s your obsession about this really about?