Circumcision: chopping that loving feeling

Remember a few months ago, when the news came that circumcision can cut the risk of contracting HIV through sex by 60 percent ... at least, in males, in some parts of Africa? Now we get the bad news. A study just published in the British Journal of Urology finds that what boys lose in the process turns out to be the most sensitive part of the penis. This consequence, one would assume, is universal.

Such conclusions have been elusive until now. Most studies in the past were based on questionnaires, not physical investigation. Which is problematic because most males that do undergo the knife do so when only a few days old, and so are unable to compare sensations before and after.

But now the evidence looks solid: lose the foreskin, and lose the feeling -- at least, some of it. From Live Science's coverage:

Morris Sorrells of National Organization of Circumcision Information Resources Center and colleagues created a "penile sensitivity map" by measuring the sensitivity of 19 locations on the penises of 159 male volunteers. Of the participants, 91 were circumcised as infants and none had histories of penile or sexual dysfunction.

For circumcised penises, the most sensitive region was the circumcision scar on the underside of the penis, the researchers found. For uncircumcised penises, the areas most receptive to pressure were five regions normally removed during circumcision--all of which were more sensitive than the most sensitive part of the circumcised penis.

No doubt there will be much argument over the validity of this particular study. What's really interesting is that one member of the study team was willing to criticize the HIV-risk reduction theory.

Robert Van Howe, a study team member at Michigan State University, thinks such claims are somewhat overblown. "The [health benefits] that have been consistently shown are very small, and there are less aggressive, less invasive, less expensive ways of dealing with the problems [circumcision] is supposed to address," Van Howe told LiveScience.

All of which is quite probably true. In addition, the HIV study was conducted on men living in a much different environment in terms of hygiene, exposure risk and general health conditions than most males in the developed world.

But still, the science is in. Parents, at least those considering what is essentially genital mutilation on another human too young to decide for himself, will have to choose between reducing the child's risk of HIV infection or losing a little bit of pleasure.

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Parents, at least those considering what is essentially genital mutilation on another human too young to decide for himself, will have to choose between reducing the child's risk of HIV infection or losing a little bit of pleasure.

You're wrong on several accounts:

1) The sensitivity loss is severe. It's not "a little bit".
2) Circumcision does not affect "the child's risk of HIV infection" since children are not sexually active.
3) Even in African areas with high HIV and poor health care, the science blaming foreskins for HIV is weak and flawed, popular beliefs notwithstanding. (learn more)

Mr. Hrynyshyn,

Much of your coverage here is fair, but as noted above there are some flaws. Have you read the full study by Sorrells, on which you are writing?

I don't know how anyone could read that study and then use the phrase "losing a little bit of pleasure".

The study talks of number of sensitivity points, not quantitative measurements of total pleasure. There is enough information out there to assume that the loss of the foreskin does not reduce pleasure by a great deal.

In addition, the HIV study was conducted on men living in a much different environment in terms of hygiene, exposure risk and general health conditions than most males in the developed world.

The HIV study was conducted on men in a much different environment in terms of hygiene, exposure risk and general health conditions than most males in the underdeveloped world too.

The HIV circumcision 'studies' are a perfect example of why I hate MDs that try to do research.

The fact that circumcision removes significant amounts of the most sexually sensitive tissue that a male has should be enough to cause an outrage.

We would never condone the removal of sexual tissue from a female infant, unless absolutely medically necessary, even if doing so rendered her less vulnerable to STD.

By Spacediver (not verified) on 15 Jun 2007 #permalink

The study talks of number of sensitivity points, not quantitative measurements of total pleasure. There is enough information out there to assume that the loss of the foreskin does not reduce pleasure by a great deal.

Mr. Hrynyshyn,

You are correct that the study measures sensitivity, not pleasure. However it's missing the point to not acknowledge what they found when they measured sensitivity in many different points: They found that the parts cut off in a circumcision are not only highly sensitive, they are even more sensitive than the parts not cut off. The affect on pleasures after removing the most sensitive parts of the sex organ is not addressed in this particular study, but we don't need a study to prove that anymore more than we needed this sensitivity study to prove that the foreskin is sensitive. The foreskin produces sexual pleasure, and the billions of men who have them know that.

Circumcised men can ask themselves this: Since every circumcision is different, with a differing amount of skin cut off, why is it that the circumcision scar and surrounding it is sexually sensitive? Why are these fabled and hypothesized non-sexually sensitive bits ever accidentally left on? It's patently ridiculous, and emblematic of the mental contortions necessary to justify one's own circumcision.

Honestly, from this write-up, it is not at all clear that you've read the full study. Just say the word and I'll help you locate a full copy to read.

Parents, at least those considering what is essentially genital mutilation on another human too young to decide for himself, will have to choose between reducing the child's risk of HIV infection

The WHO and UNAIDS recommendations of circumcision is 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.

And it is important to distinguish between physiological and neurological 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.)

By Torbjörn Larsson, OM (not verified) on 15 Jun 2007 #permalink

On the contrary, Mr. Larsson, that is precisely why it would be unlikely to be studied.

By Caledonian (not verified) on 15 Jun 2007 #permalink

Caledonian, isn't it enough that it is a sad circumstance, did you have to circumcise my joke too? :-)

But as in everything sexual, there seems to be a lot of prejudicial practices around. While males usually are the norm, in the study of sexuality it doesn't seem to be so.

Some of it is because of the phenomena called pregnancy, others because plastic and other surgery on secondary sexual characteristics got a long head start in women. But the rest feels like a cultural phenomena, as is still circumcision predominantly.

So I am a bit grumpy about the lack of hard facts, especially when it will affect so many individuals.

By Torbjörn Larsson, OM (not verified) on 15 Jun 2007 #permalink

"No doubt there will be much argument over the validity of this particular study."

No doubt at all.

The June 2007 issue of BJU International included a critique of this study, which included a re-analysis of the data. It concluded:

"In conclusion, despite a poorly-representative sample and a methodology prone to exaggerating the sensitivity of the prepuce, NOCIRC's claims remain unproven. When the authors' data are analysed properly, no significant differences exist. Thus the claim that circumcision adversely affects penile sensitivity is poorly supported, and this study provides no evidence for the belief that circumcision adversely affects sexual pleasure."

What an interesting study! I had no idea. Although, I have read about the studies on HIV. One would think that if circumcision was the cure-all to preventing HIV that the US wouldn'thave such a high rate of HIV. Also interesting that the scar of a circumcised man would be the most sensitive. Personally, I'd think a scar wouldn't have any sensation at all.
I'm going to go ahead and think it's better to leave well enough alone and just circumcise if there is a real medical reason causing a problem.

By Eleanor Jeter (not verified) on 16 Jun 2007 #permalink

Jake [June 16, 2007]: "No doubt at all".

so Jake, if somebody says one thing and somebody else says the opposite, there is no doubt?

not that you or Brian Morris would have any particular position of circumcision that might affect an impartial evaluation of the research.

frankly, i don't see how either the sensitivity of the prepuce or prophylaxis against HIV transmission have an iota of relevance to the real question of consent raised by RIC, and until this question is seriously addressed by proponents of circumcision, without their needing to hide behind parental coat tails or appeals to 'tradition', i will not be trusting anything they have to say -- in journals or on blogs.

jono

Jake [June 16, 2007]: "No doubt at all".

so Jake, if somebody says one thing and somebody else says the opposite, there is no doubt?

not that you or Brian Morris would have any particular position on circumcision that might affect an impartial evaluation of the research.

frankly, i don't see how either the sensitivity of the prepuce or prophylaxis against HIV transmission have an iota of relevance to the real question of consent raised by RIC, and until this question is seriously addressed by proponents of circumcision, without their needing to hide behind parental coat tails or appeals to 'tradition', i will not be trusting anything they have to say -- in journals or on blogs.

jono

Jake quoted:

"In conclusion, despite a poorly-representative sample and a methodology prone to exaggerating the sensitivity of the prepuce, NOCIRC's claims remain unproven. When the authors' data are analysed properly, no significant differences exist. Thus the claim that circumcision adversely affects penile sensitivity is poorly supported, and this study provides no evidence for the belief that circumcision adversely affects sexual pleasure."

This quote displays a stunning ignorance, or at best is completely out of context. The foreskin is sensitive! Circumcision removes it! If there were "no significant differences," then circumcised males would still have feeling in their missing foreskins!! This is a science blog, don't treat us like we're idiots.

Is this the same Jake that's prolonging a months-old circumcision discussion thread over at Pharyngula?

By Caledonian (not verified) on 16 Jun 2007 #permalink

Jake, would you agree that circumcision removes sexually sensitive tissue?

By spacediver (not verified) on 16 Jun 2007 #permalink

an iota of relevance to the real question of *consent* raised by RIC, and until this question is seriously addressed by proponents of circumcision

Ordinarily I wouldn't comment on what seems to be a troll's comments, but in this case I want to dispel a possible misconception: the WHO/UNAIDS recommendations concerns (or should concern) sexually active individuals.

No a priori reason to put preadolescents in the situation of choice, nor is there any obligate hurry (since presumably youngsters mostly engage other youngsters first time). Of course prior habits and other cultural problems will distort a consensual practice, but that will be coincidental and hopefully not general.

By Torbjörn Larsson, OM (not verified) on 16 Jun 2007 #permalink

This quote displays a stunning ignorance, or at best is completely out of context. The foreskin is sensitive! Circumcision removes it! If there were "no significant differences," then circumcised males would still have feeling in their missing foreskins!! This is a science blog, don't treat us like we're idiots.

The context is, of course, the claims made by NOCIRC in their study. They did not test whether the foreskin is sexually sensitive, nor did they assess overall sensation.

Two specific claims are of interest. First, that there is a significant difference in sensitivity between locations on both the circumcised and the uncircumcised penis. Second, that any locations on only the uncircumcised penis are significantly more sensitive than any location on the circumcised penis.

In the case of both claims, sufficient data are available in NOCIRC's study to apply appropriate statistical tests. And, in both cases, the claims are incorrect: no statistically significant differences exist.

Two specific claims are of interest. First, that there is a significant difference in sensitivity between locations on both the circumcised and the uncircumcised penis. Second, that any locations on only the uncircumcised penis are significantly more sensitive than any location on the circumcised penis.

I asked you (Jake) to stop treating us like idiots. The study shows clearly that the foreskin is very sensitive. Every man with a foreskin knows it is sensitive. If you prick it with a needle, does it not feel pain? If you treat it nicely, does it not feel pleasure? You would have us believe it's dead-weight, lifeless like a window curtain. But then again, you insist on treating us like idiots.

If you think that "no statistically significant difference exists" between sensation in a live, attached, living foreskin, versus one cut off and discarded (or sold), then you are delusional.

The fact that I can derive orgasm from stimulation of the remnants of my prepuce (in region of scarline, ventral area), without any glans stimulation alone, is proof enough that the foreskin is sexually, rather than merely tactilely, sensitive.

Most intact males will also attest to the fact that stimulation of the frenular region can result in orgasm, due to the sexually pleasurably sensations arising from such stimulation.

It is an abuse of science to claim that since we have not scientifically tested this claim, we should not act as if it were true. I do not need scientific evidence to demonstrate that the labia minora and clitoris are erogenous structures, rather than simply "sensitive" structures. The testimony of many intact women, and my own experiences with these structures is enough for me.

Granted, is scientific evidence strongly demonstrates that these areas are not sexually sensitive, I may have to re-examine my beliefs. But without that evidence, I'd be a fool to say:

"we do not know whether the labia and clitoris are sexually sensitive".

By spacediver (not verified) on 17 Jun 2007 #permalink

"I asked you (Jake) to stop treating us like idiots. The study shows clearly that the foreskin is very sensitive."

The study does indicate that the foreskin is able to sense very light touch. We can't extrapolate from that to all types of sensation, and since there is no statistically significant difference between the foreskin and other locations, your use of the term "very" is unjustified.

"You would have us believe it's dead-weight, lifeless like a window curtain."

This, together with your final paragraph, indicates that you have completely failed to read and/or understand my arguments. May I respectfully suggest that you try again.

Jake, over the last few months, i've noticed a tendency of you to ignore certain questions when you're challenged.

So I'm going to ask you a simple question, and I want you to answer it:

Do you think that circumcision removes any amount of erogenous tissue?

By spacediver (not verified) on 17 Jun 2007 #permalink

Ordinarily I wouldn't comment on what seems to be a troll's comments

not a troll Torbjörn. i asked the webmaster to delete the extra posts. sorry, i had trouble with my post..

, but in this case I want to dispel a possible misconception: the WHO/UNAIDS recommendations concerns (or should concern) sexually active individuals.

so all this hoopla about adults seeking circumcision? i doubt it. we all know its really about RIC, which raises ethical questions that need addressing. questions about sensitivity and/or HIV transmission are irrelevant to this ethical debate.

besides, if you refer to the original blog, it says A study just published in the British Journal of Urology finds that what boys lose in the process turns out to be the most sensitive part of the penis. i assume by 'boys' James Hrynyshyn is referring to children, so that is the frame of reference i will address.

presumably Brian Morris and Jake Waskett are pushing infant circumcision because they think it is the best thing for baby boys. fair enuf, they're entitled to their opinion, but they have an obligation to answer the ethical questions raised when you amputate part of a child's body for marginal, if any, benefit.

The whole conversation being tossed about by the commenters is childish and totally unanswerable. How could there be any resolution to the argument 'My orgasm is better than yours'? It's like saying 'I can see green and red better than you so I appreciate nature more'.
Has anyone thought to ask some (ahem) experienced women the question? Perhaps circumcised men, being "less sensitive" than their foreskinned counterparts, are better lovers because they are less prone to pre-mature ejaculation.

By HPLC_Sean (not verified) on 18 Jun 2007 #permalink

Few things Sean:

-yes a study has been done investigating the effects of male circumcision on women's sexual experience. The results indicate that women were more likely to experience an orgasm with intact males. There may be problems with the methodology of this study, however, as I understand that the women surveyed may have been biased against circumcision.

That said, there are a couple good reasons to suppose why intact males make better lovers:

-Less prone to P.E.

-If male enjoys experience more, it'll show in his body language and expression of passion, which in turn may enhance the experience for the male. In my personal experience, it's way more exciting having sex when I can see my partner is visibly enjoying herself.

-the foreskin, in a snug vaginal environment, can act as a second skin, allowing the shaft and glans to rub within this skin, thus reducing the abrasive friction between glans and inner vaginal wall, and preserving lubrication longer. The coronal sulcus of the glans of a circumcised penis (that ridge beneath the head) may draw out the lubrication on each outstroke.

Secondly, most of us take for granted that female circumcision reduces the pleasure in the female (even though studies are mixed about this, probably due to the bias of the "victims". most victims of FGM claim that they enjoy sex fully). Why do we take this for granted? Because it is blindingly obvious that the removal of sexual hardware diminishes the range of sexual sensation available, and we understand this as a negative thing. The same cannot be said for our cognitions around the removal of sexual tissue from a male, probably because we, as circumcised males, suffer similar biases.

The last point is that while no study, as far as I'm aware, has measured sexual pleasure directly (rather, they've inferred it from surveys/questionnaires), it is in principle possible to study this. I actually have a research proposal that would do exactly this.

It would involve examining physiological markers during arousal and orgasm, yielding an orgasmic profile over time.

You could measure things like heart rate, blood pressure, skin conductance, strength and # of orgasmic contractions, volume of ejaculation, etc.

A more ambitious study could measure, post-coitus, biochemical markers associated with orgasm and bonding, including oxytocin and prolactin.

By spacediver (not verified) on 18 Jun 2007 #permalink

Sorry - that line above should read:

"...which in turn may enhance the experience for the female.

By spacediver (not verified) on 18 Jun 2007 #permalink

"That said, there are a couple good reasons to suppose why intact males make better lovers:"

Unfortunately, all you seem to have done is to state some assumptions.

More accurately put:

If uncircumcised males were less prone to premature ejaculation, then they might be better lovers. However, since available evidence indicates that they are no less prone - and the reverse may be true - this hardly seems relevant.

If uncircumcised males enjoyed sex more, then they might be better lovers (...). However, the same problem exists.

And then we come to...

"Secondly, most of us take for granted that female circumcision reduces the pleasure in the female (even though studies are mixed about this, probably due to the bias of the "victims". most victims of FGM claim that they enjoy sex fully)."

There is little point in gathering evidence if we only reject it because it disagrees with our prejudices. If there is genuine reason to believe that women who have undergone FGC are biased, then we should design studies to avoid such bias.

"Why do we take this for granted? Because it is blindingly obvious that the removal of sexual hardware diminishes the range of sexual sensation available, and we understand this as a negative thing."

This strikes me as a classic case of rejection of logic and of evidence because it doesn't fit with our prejudices.

Eppur si muove!

Unfortunately, all you seem to have done is to state some assumptions.

And I never stated otherwise. Indeed, in the other thread on this site, I wrote:

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.

[Jack had made the claim that circumcision causes premature ejaculation]

There are a couple possible reasons that circumcision is associated with less orgasmic control, and i alluded to them earlier in the other 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.

There is little point in gathering evidence if we only reject it because it disagrees with our prejudices. If there is genuine reason to believe that women who have undergone FGC are biased, then we should design studies to avoid such bias.

Couldn't agree with you more. My point is that there are huge inconsistencies in the way the general public thinks about male circumcision versus female circumcision. My point is that if we are to be consistent, we should hold the same "blindingly obvious" biases in the case of male circumcision as we do in female circumcision.

Or, alternatively, we could be consistent by not simply assuming that female circumcision reduces pleasure.

That said, there are excellent prima facie reasons to suppose that the amputation of erogenous tissue has a negative effect upon sexual experience. I think we can both agree that the studies that examine this issue thus far are limited, in that they rely on the testimony of the subjects of the procedure. Those who claim that their sex lives have improved or remained unaltered may be biased since they were pressured into the procedure.

Alternatively, those who claim their sex lives suffered may be biased in other ways.

In my view, a careful reading of the literature reveals a trend towards circumcision having a negative effect, though, as I've said before, more rigorous research needs to be done (examining physiological markers of orgasm, etc.).

Ethically, I think it's obvious that the removal of healthy tissue from a nonconsenting human, unless medically necessary, is a big no no.

By spacediver (not verified) on 18 Jun 2007 #permalink

"[Jack had made the claim that circumcision causes premature ejaculation]"

Ok. I was mistaken. I apologise.

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

It occurs to me that, before trying to explain a phenomena, it is wise to check that the phenomena actually exists. Of about seven studies to date, five have found no significant difference in P.E. between circumcised and uncircumcised males, and two have found results that are the opposite of your assumption.

"Another likely candidate is that due to the drying out and keratinization of the glans, the glans becomes less sensitive."

Available evidence (five or so studies) indicates that this desensitisation does not occur (nor does keratinisation, for that matter).

"Or, alternatively, we could be consistent by not simply assuming that female circumcision reduces pleasure."

That seems wise.

"In my view, a careful reading of the literature reveals a trend towards circumcision having a negative effect,"

Having studied some 50 or so papers on the subject in depth, I'm perplexed that you could have such an impression.

"Ethically, I think it's obvious that the removal of healthy tissue from a nonconsenting human, unless medically necessary, is a big no no."

I respectfully disagree.

jono:

not a troll Torbjörn. i asked the webmaster to delete the extra posts. sorry, i had trouble with my post..

Sorry. Sure, I made a snap judgement from the sheer amount of comments, but also on the focus on child circumcision. Nothing you say dispel the later basis, instead it reinforces it.

Since you made some points, I feel I must answer them. Sigh!

we all know its really about RIC, which raises ethical questions that need addressing.

I assume you mean Routine Infant Circumcision ( http://acronyms.thefreedictionary.com/RIC ).

No, we don't know that.

I haven't read the research, but I assume that most of the HIV transmission data in this case (not mother-child transmission) is on sexual active adults. So the recommendations are likely to be based on adults.

Note that the first linked press release claims "Circumcising adult men may reduce by half their risk of getting the AIDS virus through heterosexual intercourse, the U.S. government announced Wednesday, as it shut down two studies in Africa testing the link". Likewise the offered circumcisions and noted side effects were on adults, which supports that the study were based on models of adult circumcision and not RIC.

besides, if you refer to the original blog, it says A study just published in the British Journal of Urology finds that what boys lose in the process turns out to be the most sensitive part of the penis.

I assume you mean "original blog post", since the referenced links aren't blogs. Again, the study was done on adults, whether they were circumcised as adolescents or not.

In conclusion, I don't see why the hangup on IC, the only ones suggesting that this should be done or would assuredly be done is the poster and you.

I hope there will be no more misunderstandings here - it is likely that RIC will be a problem, but I doubt you can find anything in the mentioned research or recommendations that supports your view.

What you need to do IMO is to bring new data or arguments to the table. For example, what would a comprehensive program for condom supply cost relative to other costs of HIV?

By Torbjörn Larsson (not verified) on 19 Jun 2007 #permalink

spacediver:

the foreskin, in a snug vaginal environment, can act as a second skin

IIRC that was a finding (or a speculation) of the study, the mechanics is much different and probably results in less wear for both partners.

I am glad someone else has noted that study, which I never bookmarked. And your thorough proposal is exactly what I (grumpily) asked for. Great! I do hope you can compensate or get around the other methodological problems too, when/if it becomes realized.

By Torbjörn Larsson (not verified) on 19 Jun 2007 #permalink

thanks for the thoughtful response Jake. Your post deserves a thoughtful reply, and I will do my best to have one as soon as I can (am tied up right now).

By spacediver (not verified) on 19 Jun 2007 #permalink

Haven't forgotten this thread. Am at a conference for next 3 days, and have manuscript deadlines hounding me. Watch this space after the next few days.

By spacediver (not verified) on 20 Jun 2007 #permalink

Jake -

What you appear to be saying is that no consent should be required for medical procedures, even if those procedures have no discernable effect. Even with parental consent, you are essentially of the position that parents can request any amount of cosmetic surgery on their infant.

Circumcision is obviously a cultural thing - if it didn't exist, I can't imagine anyone even considering it or studying it. Indeed, if it was merely the practice of, for instance, a small west african tribe, and a couple of members of that tribe had a child in a western country and asked for the procedure, they would no doubt be turned down flat.

By Andrew Dodds (not verified) on 22 Jun 2007 #permalink

Parents can request however much surgery they like. It is the duty and obligation of the physician to refuse.

Sadly, medical ethics tend to be honored more in the breach than in the keeping.

By Caledonian (not verified) on 22 Jun 2007 #permalink

"What you appear to be saying is that no consent should be required for medical procedures, even if those procedures have no discernable effect. Even with parental consent, you are essentially of the position that parents can request any amount of cosmetic surgery on their infant."

I'm afraid you've misunderstood, and I apologise for this because I didn't express myself clearly.

When I disagreed with the statement that "Ethically, I think it's obvious that the removal of healthy tissue from a nonconsenting human, unless medically necessary, is a big no no", I did not mean that the exact opposite is true: that it is always ok to perform procedures in such circumstances.

Rather, I disagreed with what I feel to be too broad a statement.

In the case of consent by proxy, the most important ethical principle, to my mind, is the person's best interests.

Imagine, if you will, a horizontal line. At the far left are very harmful actions. At the far right are very beneficial actions. In the centre, neutral actions.

I think most would agree that actions to the right of the centre are acceptable. For example, few would argue with feeding a child a healthy meal.

The same is doubtless true of actions in a band around the centre, even if these are a little negative. For example, while we're aware that it may be a little harmful, we probably wouldn't think that giving chocolate to a child is so bad that it should be outlawed.

Actions that are to the left of the band are clearly unacceptable.

Medical procedures are no different. Vaccinations, although they involve some risk, have a net benefit. Thus, they are to the right of center. In some societies, certain vaccinations are judged to be so beneficial that they are mandatory (or effectively so), to the right of the 'parental discretion' band.

In the case of purely cosmetic surgery, as in your question, there would be no benefit and some risk. Thus, the procedure would certainly be the the left of centre, perhaps beyond parental discretion.

There is, of course, some debate about where circumcision falls. While a few anti-circumcision zealots insist that there are no benefits, most credible observers acknowledge that there are benefits, and place it somewhere in the neutral-to-beneficial category.

Torbj�rn Larsson: I don't see why the hangup on IC, the only ones suggesting that this should be done or would assuredly be done is the poster and you.

I hope there will be no more misunderstandings here - it is likely that RIC will be a problem, but I doubt you can find anything in the mentioned research or recommendations that supports your view.

i don't know what you're talking about. the entire debate is about circumcising children. who would have a problem with adults deciding to have the procedure? i would be against soldiers being circumcised against their will, which is happening now in africa, but i am less concerned about it than i am about RIC.

i know how easily stupidity takes root, and i am doing my best to engage peoples thought processes on routine circumcision of baby boys. if you don't think what's being discussed here is relevant to that, fine, but you're in over your head Torbj�rn. don't you know what Jake's agenda is?

the problems with RIC are obvious and this latest offensive, launched on the basis of faulty studies into HIV transmission, is just the latest in a long line of misinformation. when the dust has settled you will be able to see that. just to help you, here are a couple of links:

http://www.sciencedaily.com/releases/2007/06/070620085239.htm
http://www.biologynews.net/archives/2007/06/21/male_circumcision_overst…

thanks for your time.

There is, of course, some debate about where circumcision falls. While a few anti-circumcision zealots insist that there are no benefits, most credible observers acknowledge that there are benefits, and place it somewhere in the neutral-to-beneficial category.

here is what i know. when i was a defenceless infant, in response to ideas promoted by people whose principles i profoundly reject, a well meaning GP took a pair of surgical scissors and removed a significant, integral component of my genital anatomy.

as a trained biologist i know that component to be both functional and life enhancing, not some vestigial remnant of an uncivilised past. i am more than angry about this, i am incandescant. i feel violated! what's more, i felt violated when, as a child and realising i didn't have a foreskin like my friends, i discovered why.

the more i learn about circumcision, the more violated i feel, and the more viscerally i reject the entire edifice of rationalizing built to support it. the neolithic origins, the overtones of religious authority and conformance, the pseudo-medical campaign against masturbaton, the profit motive, the sale of infant prepuces to cosmetic manufacturers.. everything about it makes me feel ill with revulsion. and you place it somewhere in the neutral-to-beneficial category do you Jake? how nice.

the ad hominem characterization of anybody who disagrees with you as a 'zealot' is tired and pathetic as well.

Jake -

I'm sorry, I just don't see how giving a child a sweet has anything to do with the ability of a child to give consent.

In the canse of vaccination, the benefits are large and importantly, free of long term side effects. This cannot be compared with the removal of part of a person't body without their consent. Exactly how many babies suffer life threatening conditions prior to puberty because they have not been circumcised? As far as I can tell the answer in none.

I am yet to see any evidence of tangible benefits of infant circumcision - Sexually transmitted diseases do not apply to infants.

As I said, it's purely a cultural thing which people attempt to justify scientifically. It is not a procedure that would ever be invented or accepted were it not already widely practiced.

By Andrew Dodds (not verified) on 25 Jun 2007 #permalink

"Exactly how many babies suffer life threatening conditions prior to puberty because they have not been circumcised? As far as I can tell the answer in none."

A few do, unfortunately, due to urinary tract infections.

"I am yet to see any evidence of tangible benefits of infant circumcision - Sexually transmitted diseases do not apply to infants."

You think that infants never grow up?

"It is not a procedure that would ever be invented or accepted were it not already widely practiced."

Probably not, for if it were not widely practiced then there would be no means of observing its effects.

==I'm sorry [Jake], I just don't see how giving a child a sweet has anything to do with the ability of a child to give consent.==

LOL

Jake -

How many life threatening and/or perminant damage UTIs are we talking about, exactly? Indeed, is this a real effect or based on an old and flawed study?

http://www.cirp.org/library/disease/UTI/

Infants do indeed grow up. When they are grown up they are able to give consent. Hence 'Age of Consent'.

*If* it were not a cultural thing it would be regarded as obviously a severe breach of medical ethics.

By Andrew Dodds (not verified) on 27 Jun 2007 #permalink