12.24.47.10/Medical analysis of circumcision
Current US medical opinion about Free ringtones circumcision is highly controversial. Many major medical groups now no longer recommend, and some even discourage, routine infant circumcision (see below), because the risks are either perceived greater than the benefits (if any), or the benefits are not believed to have been sufficiently substantiated, or to be too small to justify recommending the procedure.
Complications of the uncircumcised penis
Numerous medical studies have tried to assess the beneficial effects (if any) of circumcision. Others focus on the harmful effects (if any) of not circumcising. The studies regarding these effects (or finding their absence) are discussed below.
Phimosis and paraphimosis
There are a number of circumstances where doctors sometimes recommend circumcision. An overtight foreskin(Majo Mills phimosis) can cause problems in sex, as the foreskin may become trapped behind the glans of the penis and restrict blood flow (Mosquito ringtone paraphimosis). Circumcision is the recommended remedy for this condition, which typically arises in Sabrina Martins teenagers experimenting with sex. It can be treated by a program of stretching and use of topically applied Nextel ringtones steroid creams, but this is generally considered less effective and risks later Abbey Diaz relapse. As a result, in the Free ringtones NHS of the U.K. it is only recommended to patients who wish to retain their foreskin for religious or sexual reasons. A newer, experimental, procedure is minor surgery to make a small slit in the foreskin without removing any tissue.
Recent studies from Europe demonstrate the prevalence of Majo Mills balanitis and Mosquito ringtone phimosis due to the low rate of circumcision. Doctors at Royal Liverpool Children’s Hospital diagnosed over 100 cases (a 4% rate) of balanitis in a 3 ½ year survey of English boys. (Source: Escala JM, Rickwood AMK. Balanitis. Brit J Urol 1989;63:196-197). Doctors from the Children’s Hospital, Sheffield found a prevlance of phimosis among uncircumcised English boys. (Source: Rickwood AMK, Hemalatha V, Batcup G, Spitz L. Phimosis in Boys. Brit J Urol 1980;52:147-150). A study conducted in Denmark examined 9,545 Danish boys between 6 and 17 years of age, and found that 4% had phimosis, (incidence of 8% among 6 year olds), 33% had preputal adhesions (63% among 6 year olds), and 5% had smegma. (Source: Øster J. Further fate of the foreskin. Arch Dis Child 1968; 43:200-203.)
Another condition that can only occur in uncircumcised males is Sabrina Martins phimosis, the inability to retract the prepuce over the glans penis. It is generally acknowledged that circumcision prevents both conditions. According to some researchers, however, a lack of understanding of the natural development of the penis has led to many misdiagnoses of phimosis. Rickwood ''et al.'' write in their 2000 paper "Towards evidence based circumcision of English boys" in the ''British Medical Journal'' [http://bmj.com/cgi/content/full/321/7264/792]:
:Too many English boys, especially those under 5 years of age, are still being circumcised because of misdiagnosis of phimosis. What is phimosis? At birth, the foreskin is almost invariably non-retractable, but this state is transient and resolves in nearly all boys as they mature. Such normality, with an unscarred and pliant preputial orifice, is clearly distinguishable from pathological phimosis, a condition unambiguously characterised by secondary cicatrisation of the orifice, usually due to balanitis xerotica obliterans. This problem, the only absolute indication for circumcision, affects some 0.6% of boys, peaks in incidence at 11 years of age, and is rarely encountered before the age of 5. (...) Strictly, only some 0.6% of boys with pathological phimosis need to be circumcised, although more relaxed criteria would allow for a similar proportion affected by recurrent balanoposthitis.
A 1968 Danish study of 9,545 boys, which distinguished between phimosis and preputial adhesion (a weaker condition which can lead to phimosis), found both conditions in measurable amounts. The overall incidence of phimosis was 4% - it was highest (at 8%) among 6-7 year olds, and lowest (at 1%) among 16-17 year olds. The overall incidence of preputial adhesion was 33% - it was highest (at 63%) among 6-7 year olds, and lowest (at 3%) among 16-17 year olds. The author, Jakob Øster, characterized the 4% rate as “uncommon” and in the almost universally uncircumcised society of Denmark, did not indicate circumcision, concluding: "Phimosis is seen to be uncommon in schoolboys, and the indications for operation even rarer if the normal development of the prepuce is patiently awaited. When this policy is pursued, in the majority of cases of phimosis, it is seen to be a physiological condition which gradually disappears as the tissues develop." (Source: Øster J. Further fate of the foreskin. Arch Dis Child 1968; 43:200-203.) [http://www.cirp.org/library/general/oster/]
In a 1980 study, doctors from the Children’s Hospital, Sheffield found a prevlance of phimosis among uncircumcised English boys. (Source: Rickwood AMK, Hemalatha V, Batcup G, Spitz L. Phimosis in Boys. Brit J Urol 1980;52:147-150).
Balanitis
Cingular Ringtones Balanitis is inflammation of the glans penis and may occur both in circumcised and in intact males. It can lead to adhesion of the prepuce to the inflamed glans. It is generally believed to be more frequent in uncircumcised boys, even though a 1997 study by R.S. Van Howe concluded that "circumcised boys are more likely to develop balanitis"
http://www.cirp.org/library/complications/vanhowe/].he risk in any individual, uncircumcised boy appears to be no greater than 4% ... A policy of routine neonatal circumcision to avoid these preputial complaints of childhood would be difficult to justify. We found no evidence that balanitis causes phimosis." [http://www.cirp.org/library/disease/balanitis/escala1/]
Skin diseases
Researchers from the Imperial College School of Medicine, Chelsea & Westminster Hospital, London, England reported the results of their study of 357 patients referred for genital skin disease:
: The most common diagnoses were psoriasis (n=94), penile infections (n=58), lichen sclerosus (n=52), lichen planus (n=39), seborrheic dermatitis (n=29), and Zoon balanitis (n=27). Less common diagnoses included squamous cell carcinoma (n=4), bowenoid papulosis (n=3), and Bowen disease (n=3). The age-adjusted odds ratio for all penile skin diseases associated with presence of the foreskin was 3.24 (95% confidence interval, 2.26-4.64).All patients with Zoon balanitis, bowenoid papulosis, and nonspecific balanoposthitis were uncircumcised. Lichen sclerosus was diagnosed in only 1 circumcised patient. Most patients with psoriasis, lichenplanus, and seborrheic eczema (72%, 69%, and 72%, respectively) were uncircumcised at presentation. The majority of men with penile infections (84%) were uncircumcised.
:(Source: Eleanor Mallon, MRCP; David Hawkins, FRCP; Michael Dinneen, FRCS; Nicholas Francis, FRCPath; Louise Fearfield, MRCP; Roger Newson, DPhil; Christopher Bunker, FRCP, Circumcision and Genital Dermatoses, Arch Dermatol. 2000;136:350-354.) [http://archderm.ama-assn.org/cgi/content/abstract/136/3/350]
In "Medical Department, United States Army, Surgery in World War II, Urology", links observed by clinicians in the field were surveyed and compiled. In it, the author notes that “hospital admissions for paraphimosis, phimosis, balanitis, and selling them condyloma acuminata during 1942-1945 totaled 146,793.” (Source: JF Patton, Medical Department, United States Army, Surgery in World War II, Urology, p. 145). The author also notes the increased seriousness of genital infections in the uncircumcised:
:A word should be said here about circumcision. Any penile lesion in the presence of a redundant prepuce may present a problem and also invites secondary infection. Phimosis was a common complication of chancroid, and dorsal slits were often necessary, followed by circumcision after the local infection subsided. Phimosis and paraphimosis unrelated to veneral disease were also encountered frequently. Soldiers in combat were seldom able to practice personal hygiene. Higher headquarters sometimes questioned the number of circumcisions performed in the theater, with emphasis on days lost from duty. But all were performed from medical necessity, and none were done electively, to the author’s knowledge. Many circumcisions, performed because of necessity in the active theaters, should have been done prophylactically before the soldier left the zone of interior."
:(Source: JF Patton, Medical Department, United States Army, Surgery in World War II, Urology , p. 64)
Circumcision and cancer
Studies finding a reduced risk of country most penile cancer in circumcised males have a long history. (Sources: Abraham Wolbarst, ''The Lancet'' 1932;1:150-3; AJ Dean, J Urol. 1935; 35:252.) Recent studies appear to confirm that view. Dr. Schoen has reviewed the results of published material relating to penile cancer and circumcision and has quantified the risk of not circumcision a newborn boy:
:The evidence that circumcision protects against penile cancer is overwhelming. In the US, incidence of penile cancer in circumcised men is essentially zero (about one reported case every five years), but it is 2.2 per 100 000 in uncircumcised men (about 1000 cases are reported annually). On the basis of life table analysis, Kochen and McCurdy estimated that an uncircumcised man in the US has a lifetime risk of penile cancer of one in 600.
:During the last 50 years in the US, six major series of cancer of the penis encompassing more than 1600 cases have been reported; none of these cancer patients was circumcised in infancy. Human papilloma virus and smegma have been implicated in the aetiology of penile cancer.10 Of the approximately 50 000 cases of cancer of the penis that have occurred in the US since the 1930s (and which resulted in about 10 000 deaths), only 10 were reported in circumcised men. Newborn circumcision virtually eliminates this devastating threat.
:(Source: Edgar J Schoen, Benefits of newborn circumcision: is Europe ignoring medical evidence?, Arch Dis Child 1997;77:258-260 ( September ); footnotes deleted.) http://adc.bmjjournals.com/cgi/content/full/archdischild%3B77/3/258] (see also: Schoen EJ. The relationship between circumcision and cancer of the penis. CA Cancer J Clin 1991;41:306-309). [http://caonline.amcancersoc.org/cgi/reprint/41/5/306.pdf]
Dr. Schoen and colleagues also conclude that newborn circumcision provides protection against penile cancer in situ and a greater protection against invasive penile cancer. (Source: Edgar J. Schoen, Michael Oehrli, Geoffrey Machin, The Highly Protective Effect of Newborn Circumcision Against Invasive Penile Cancer, Pediatrics 2000; 105: e36)
Opponents of neo-natal circumcision, metaphor commonly Paul M. Fleiss and battles against Frederick Hodges dismiss modern studies, but attack Wolbarst’s 1932 studies, writing in a 1996opinion letter to the ''British Medical Journal'' in response to a recent paper on circumcision that relied on Wolbarst [http://bmj.com/cgi/content/full/312/7033/779/c]:
:Wolbarst invented this myth and was directly responsible for its proliferation; he based it on unverifiable anecdotes, ethnocentric stereotypes, a faulty understanding of human anatomy and physiology, a misunderstanding of the distinction between association and cause, and an unbridled missionary zeal. It was not based on valid scientific and epidemiological research.
:Epidemiological studies disproved Wolbarst's myth long ago. In North America the rate of penile cancer has been estimated to be 1 in 100000 (...). Maden ''et al.'' reported penile cancer among a fifth of elderly patients from rural areas who had been circumcised neonatally and had been born at a time when the rate of neonatal circumcision was about 20% in rural populations. Their study also shows that the rate of penile cancer among men circumcised neonatally has risen in the United States relative to the rise in the rate of neonatal circumcision.
This anti-circumcision movement has been gaining ground, and has influenced the english invariably American Cancer Society to issue a statement in 1998: [http://www.cancer.org/docroot/nws/content/nws_1_1x_misleading_information.asp] that "the practice of circumcision is strongly associated with socio-ethnic factors, which in turn are associated with lessened risk. The consensus among studies that have taken these other factors into account is circumcision is not of value in preventing cancer of the penis."
Doctors and researchers on the other side of the debate are active too. Dr. Dagher in an article detailing the high mortality of penile cancer (1/3 of the surveyed patients died), noted:
:Despite overwhelming evidence from urological surgeons that neoplasm of the penis is a lethal disease that can be prevented by removal of the foreskin, some physicians continue to argue against routine neonatal circumcision in a highly emotional and aggressive fashion.
:(Source: Dagher, R., et al., Carcinoma of the cervix and the anti-circumcison crusade. J. Urol. 110:79-80, July 1973)
Women with circumcised sex partners also have lower risk of guangzhou reported cervical cancer.
(Dagher, R., et al., Carcinoma of the cervix and the anti-circumcison crusade. J. Urol. 110:79-80, July 1973). Cervical cancer has been related to the presence of middleburg and HPV infection. On this basis, an alternative hypothesis for the reduction of cervical cancer through circumcision has been proposed; namely, that there is a higher HPV infection rate among uncircumcised men. An international group of researchers conducted a study published in the New England Journal of Medicine that concluded:
: Male circumcision is associated with a reduced risk of penile HPV infection and, in the case of men with a history of multiple sexual partners, a reduced risk of cervical cancer in their current female partners. [http://content.nejm.org/cgi/content/short/346/15/1105]
Researchers from the Danish Cancer Registry, Copenhagen, studied women with only one lifetime sexual partner to determine which male factors had an influence on a woman’s risk for contracting cervical cancer and found that her partner’s lack of circumcision was such a factor. (Source: Kjaer SK, de Villiers EM, Dahl C, Engholm G, Bock JE, Vestergaard BF, Lynge E, Jensen OM, Case-control study of risk factors for cervical neoplasia in Denmark. I: Role of the "male factor" in women with one lifetime sexual partner, INTERNATIONAL JOURNAL OF CANCER, Volume 48, Number 1: Pages 39-44, April 22, 1991.) The study has elicited a strong response from lay anti-circumcision advocates. A detailed analysis from the Internet group "Circumstitions" [http://www.circumstitions.com/Cancer-cervNEJM.html], for example, criticized especially the pooling of data from countries with very different circumcision rates. The only country with a high circumcision rate in the sample were the Philippines, so that the comparison of circumcision rate and HPV rate is also a comparison of HPV rate in the Philippines and HPV rate in other countries. According to critics, this makes it crucial to examine other social, economic, demographic and environmental factors on the Philippines that might explain the lower HPV infection rate.
There was no statistically significant risk of cervical cancer for partners of uncircumcised men; there was a 0.23 to 0.79 risk (CI 95%) for partners of uncircumcised men with a history of multiple partners (the population of women was previously limited to those with few partners). Media commentator Dr. Dean Edell summarized the study like this: "If you are an intact male, have had lots of unprotected sex with lots of different women and marry a virgin, your wife may have a real but statistically insignificant increased chance of getting HPV."
Circumcision and denver on Urinary tract infection (UTI)
The American Medical Assocation states:
:There is little doubt that the uncircumcised infant is at higher risk for urinary tract infection (UTI).
:(Source: American Medical Assocation, Report 10 of the Council on Scientific Affairs on Neonatal Circumcision)
Infections of the urinary tract (kidneys, ureters, bladder and urethra) can lead to kidney damage if undetected, but can generally be treated effectively with antibiotics. Recent studies find a ten to fifteen times increased risk of uncircumcised UTIs in male infants within the first year of life. (Source: Behrman, Nelson Textbook of Pediatrics, 16th ed. 2000.) Other studies show that the increased risk is three to seven times increased risk of uncircumcised UTIs in male infants within the first year of life. A 1998 Canadian population based cohort study by To et al. [http://www.cirp.org/library/disease/UTI/to2/], for example, reported a relative risk of 3.7. The overall incidence of UTIs in infants was low, 1.88 and 7.02 per 1000 respectively.
These studies have been criticized for their methodology. The biological arsenal American Academy of Pediatrics noted in its 1999 circumcision policy statement:
: Few of the studies that have evaluated the association between UTI in male infants and circumcision status have looked at potential confounders (such as prematurity, breastfeeding, and method of urine collection) in a rigorous way. For example, because premature infants appear to be at increased risk for UTI, the inclusion of hospitalized premature infants in a study population may act as a confounder by suggesting an increased risk of UTI in uncircumcised infants. Premature infants usually are not circumcised because of their fragile health status. In another example, breastfeeding was shown to have a threefold protective effect on the incidence of UTI in a sample of uncircumcised infants. However, breastfeeding status has not been evaluated systematically in studies assessing UTI and circumcision status. [http://www.aap.org/policy/re9850.html]
UTI is usually detected through urine tests. Depending on the method of urine collection, there is a varying risk of false positives through contamination. The bacteria detected may in fact come from the foreskin itself,indicating foreskin infection not the urinary tract infection. In spite of this,even anti-circumcision advocatesconcede that an increased risk of UTI in uncircumcised males is generally considered plausible, a higher likelihood of bacterial colonization being the proposed mechanism.
On his website, Dr. Schoen, a circumcision advocate, states:
:Uncircumcised boys are about 10 times as likely to get serious kidney infections in the first year of life as are circumcised infants; uncircumcised older boys and men are more likely to get UTIs as well. These kidney infections are most dangerous in the first 3 months, during which time they often lead to hospitalization and can result in overwhelming blood infection and other serious infections. Kidney scarring has been shown to occur later. There is concern that future kidney failure and high blood pressure may follow infantile UTIs. Abnormal kidney function and hormonal secretion can occur with infant UTIs. Fecal contamination of the moist inner foreskin layer with bacterial attachment leads to these kidney infections.
:(Source: http://www.medicirc.org/meditopics/uti/more_info_uti.html)
Researchers from the University of Texas and Southwestern Medical School surveyed the incidence of UTIs in young children. They found that 95% of boys with UTIs were uncircumcised among a predominantly circumcised populace (Dallas, Texas in 1982). (Source: Ginsberg CM, and McCracken GH: Urinary tract infections in young infants. Pediatrics 69:409, 1982)
Other researchers have reported similar results. (Source: Wiswell TE, Prepuce presence portends prevalence of potentially perilous periurethral pathogens, The Journal of Urology, 1992; 148: 739-42) One textbook notes:
:It has become apparent that uncircumcised newborns are predisposed to urinary tract infections (UTIs) in the neonatal period. For example, in a study of 100 neonates with UTIs, Ginsburg and McCracken (1982) found that only 3 of the 62 males (5%) who developed a UTI were circumcised. Subsequently, Wiswell and colleagues (1985) studied more than 2500 male infants and found that 41 had symptomatic UTIs; of these 88% were uncircumcised. In that study, uncircumcised males were nearly 20 times more likely to develop UTIs than circumcised neonates. Other studies of larger groups of infants have corroborated these reports (Wiswell, 1992)
:(Source: Walsh, Campbell's Urology, 7th ed. 1998) (Accord: Behrman, Nelson Textbook of Pediatrics, 16th ed. 2000: “UTIs are 10 to 15 times more common in uncircumcised infants than in circumcised infants”)
Critics of the studies point out that they do not classify groups of circumcised males according to their mothers' handling of the foreskin, making it impossible to infer to link the UTIs with foreskins or to the fault of the mother. It is generally recommended not to retract the foreskin of an infant during hygiene [http://www.cirp.org/library/normal/aap/]. Hodges and Fleiss claim that "it has been proven that retraction and washing of the infant foreskin can cause urinary tract infections by irritating the mucous membranes and destroying the naturally occurring beneficial flora which protects against pathogens." They do concede, however, that no analogous risk is present in circumcised infants.
If circumcision does indeed reduce the incidence of UTIs, To et al. estimate that 195 circumcisions would be needed to prevent one hospital admission for UTI in the first year of life. Extrapolations from the Dallas survey would indicate for each 20 circumcisions a hospital admission for UTI in the first year of life is prevented.
Circumcision and come too HIV/here everyday AIDS
In 1986, Dr. tour though Aaron J. Fink, proposed that circumcision might prevent the distribution of when kitano AIDS. He hypothesized that the keratinization of the circumcised penis might prevent HIV infection. Other researchers soon investigated the question whether there is a link between circumcision and HIV infection.
Several studies of African populations found a significantly reduced risk of HIV transmission in circumcised males. In a study published in the where judge New England Journal of Medicine, researchers studied patients appearing at a Nairobi, Kenya, STD clinic. The researchers, JN Simonsen, DW Cameron, MN Gakinya, JO Ndinya-Achola, LJ D'Costa, P Karasira, M Cheang, AR Ronald, P Piot, and FA Plummer, found “[m]en who were uncircumcised were more likely to have HIV infection (odds ratio, 2.7; P = 0.003).”
:(Source: Human immunodeficiency virus infection among men with sexually transmitted diseases. Experience from a center in Africa, JN Simonsen et al., The New England Journal of Medicine, Volume 319:274-278, August 4, 1988) [http://content.nejm.org/cgi/content/abstract/319/5/274]
In a study published in convalescence home Lancet in 1989, researchers studied possible risk factors in female-to-male HIV transmission. The researchers found that uncircumcised men (29.0%) were ten times more likely to acquire HIV from a single sexual encounter than circumcised men (2.5%). Uncircumcised men with genital ulcers (52.6%) were four times more likely to become infected than circumcised men with genital ulcers (13.4%).
:(Source: Cameron DW, Simonsen JN, D’Costa LJ, Ronald AR, Maitha GM, Gakinya MN, et al. Female to Male Transmission of Human Immunodeficiency Virus Type 1: Risk Factors for Seroconversion in Men. Lancet 1989; 2:403-27.) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2569597&dopt=Abstract]
Another set of researchers concluded that “In the AIDS belt, lack of male circumcision in combination with risky behavior, such as having multiple sex partners, engaging in sex with prostitutes and leaving chanchroid untreated has led to rampant HIV transmission.”
:(Source: "The African AIDS Epidemic," by J. C. Caldwell and Pat Caldwell,
Scientific American, March 1996, p. 62)
Researchers from the University of Manitoba also studied heterosexual HIV transmission in Africa. The researchers concluded that: “There is substantial evidence that circumcision protects males from HIV infection, penile carcinoma, urinary tract infections, and ulcerative sexually transmitted diseases. We could find little scientific evidence of adverse effects on sexual, psychological, or emotional health.”
:(Source: S Moses, RC Bailey and AR Ronald, Male circumcision: assessment of health benefits and risks, Sexually Transmitted Infections, Vol. 74, Issue 5, p. 368-373) [http://sti.bmjjournals.com/cgi/content/abstract/74/5/368]
Another publication in the New England Journal of Medicine found that “Male circumcision consistently shows a protective effect against HIV infection” and noted that HIV prevalence was 1.7 to 8.2 times higher among uncircumcised heterosexual men than among circumcised heterosexual men. The study faulted the Langerhans cells in the foreskin and a “receptive HIV environment between foreskin and glans” for the increased risk.
:(Source: Rachel A. Royce, Ph.D., M.P.H., Arlene Seña, M.D., Willard Cates, M.D., M.P.H., and Myron S. Cohen, M.D, Sexual Transmission of HIV, The New England Journal of Medicine, Volume 336:1072-1078, April 10, 1997)
A group of researchers from the University of Washington studied truckers in Kenya who used the services of prostitutes. They found that a trucker’s uncircumcised status was associated with a four-fold increased risk of contracting HIV even after eliminating behavior, religion, or other factors.
:(Source: Lavreys L; Rakwar JP; Thompson ML; Jackson DJ; Mandaliya K; Chohan BH; Bwayo JJ; Ndinya-Achola JO; Kreiss JK; Effect of circumcision on incidence of human immunodeficiency virus type 1 and other sexually transmitted diseases: a prospective cohort study of trucking company employees in Kenya, J Infect Dis. 1999 Aug;180(2):330-6) [http://www.aegis.com/pubs/aidsline/1999/nov/a99b0715.html]
In the Lancet, researchers at the University of California, San Francisco (“UCSF”) and the University of Illinois, Chicago, published the results of their review of over 30 studies on the association between circumcision and HIV. The researchers concluded that circumcision “could potentially save millions of men and their partners” and were sufficiently motivated to cause UCSF to issue a press release announcing the discovery. [http://www.circumcisioninfo.com/halperin_bailey_press.htm] The report contains tables showing the significantly higher HIV infection rate among countries with non-circumcised majorities.
:(Source: Daniel T Halperin, Robert C Bailey, Viewpoint: Male Circumcision and HIV Infection: 10 Years and Counting, The Lancet, 354 (9192): pp. 1813-15.) [http://hivinsite.ucsf.edu/InSite.jsp?doc=2098.4613]
Tying AIDS/HIV rates to circumcision status in the abstract has been eschewed by careful scientists and statisticians. One must correct base data that may tend to favor societies that practice other behavior regardless of circumcision or whose behavior in transmission of HIV has less to do with heterosexual sex, wherein the vulnerability of men with foreskins to female-to-male transmission may be demonstrated to anal or oral homosexual sex wherein the mode of transmission of tears in the colon or gums are the primary vectors of spread of the virus.
The ongoing research has been extensively methodologically criticized. The main criticism is that past studies have ignored substantial confounding variables. Perhaps most notably, most studies have not controlled for different socio-sexual behaviors. In their meta-analysis of related studies [http://www.cirp.org/library/disease/HIV/vincenzi/], Vincenzi and Mertens note that "circumcision is not performed randomly". Circumcision in central Africa is primarily a Muslim practice, and Islam requires ritual washing, marital fidelity and periodic abstinence from sex.
Those opposed to the practice claim that similar relationships have been found in other cultures that practice male circumcision http://violence.de/prescott/truthseeker/genpl.html].
Among industrialized nations, AIDS rates are highest in the three countries that still practice routine infant circumcision at substantial levels (table 1). Some circumcision critics point to the data as evidence of relationship between circumcision and HIV/AIDS. Others express concern that misconstruction of the data blunts the message that use of safe sex practices far outweighs any beneficial effect circumcision may or may not have. Critics also warn that advertising circumcision as a way to prevent AIDS (e.g. "could potentially save millions of men and their partners", as a http://www.circumcisioninfo.com/halperin_bailey_press.htm claims) might be used to promote and justify the belief that safe sex practices are unnecessary.
The position of the circumcision critics has been criticized by circumcision proponents because the predominant modes of HIV/AIDS transmission in industrial societies is not heterosexual intercourse, but through homosexual sex, blood transfusions, needle sticks or sharing needles, which are not addressed in the HIV/AIDS rates. Contrary to the data on the industrial world (table 1), the studies linking circumcision with lower HIV/AIDS incidence in the developing world have mostly focused on the female-to-male heterosexual transmission (tables 2-5). It is axiomatic that possession (or not) of a foreskin does not influence transmission rates associated with the non-insertional partner's acquisition of HIV/AIDS through anal, vaginal, or oral sex, or any partner through pregnancy, nursing, blood transfusions, needle sticks or sharing needles.
'''Table 1evening after World Health Organization data of AIDS rates for 1995'''
Nation
AIDS cases per 100,000 pop.
USA16.0
Australia4.5
Canada3.8
France3.5
Netherlands3.1
United Kingdom2.4
Germany2.2
Sweden2.0
Norway1.6
New Zealand1.2
Finland0.9
Japan0.2
'''Table 2child williams World Health Organization data of HIV infection rates for 1998'''
Nation
HIV infections per 100,000 pop. in African countries with under 20% circumcision rate
Zimbabwe25,840
Botswana25,100
Namibia19,940
Zambia19,070
Swaziland18,500
Malawi14,920
Mozambique14,170
Rwanda12,750
'''Table 3worst books World Health Organization data of HIV infection rates for 1998'''
Nation
HIV infections per 100,000 pop. in Asian countries with under 20% circumcision rate
Cambodia2,400
Thailand 2,230
Myanmar1,790
India820
Nepal240
'''Table 4institute spirit World Health Organization data of HIV infection rates for 1998'''
Nation
HIV infections per 100,000 pop. in African countries with over 80% circumcision rate
Kenya11,640
Congo (Brazzaville)7,640
Cameroon4,890
Nigeria4,120
Gabon4,250
Liberia3,650
Sierra Leone3,170
Ghana2,380
Gambia2,240
Guinea2,090
Benin2,060
'''Table 5beautiful teen World Health Organization data of HIV infection rates for 1998'''
Nation
HIV infections per 100,000 pop. in Asian countries with over 80% circumcision rate
Pakistan90
Philippines 60
Indonesia50
Bangladesh30
[http://hivinsite.ucsf.edu/InSite.jsp?doc=2098.4613]
Medical complications of circumcision
While all benefits associated with circumcision are controversial, the procedure has risks. The quantification of these risks is also controversial, though most agree that complications of circumcision are relatively rare. They range from bleeding and infections to (in few cases) disfigurement, scarring and sexual dysfunction through severe mutilation of the penis, and even death.
:In general, neonatal circumcision is safe, although there is a complication rate of 0.2% to 3% (Ross, 1995). Dorsal penile nerve block with either lidocaine or bupivacaine significantly reduces the pain associated with the procedure (Ryan et al, 1994)
:(Source: Walsh, Campbell's Urology, 7th ed. 1998)
Williams and Kapila observe: “Some authors have reported a complication rate as low as 0.06 per cent while at the other extreme rates of up to 55 per cent have been quoted. This reflects the differing and varying diagnostic criteria employed; a realistic figure is 2-10 per cent. Although haemorrhage and sepsis are the main causes of morbidity, the variety of complications is enormous. The literature abounds with reports of morbidity and even death as a result of circumcision.”
Meatal stenosis is a condition that is "exceedingly rare" in uncircumcised males, yet occurs in 9-10% of males who are circumcised at birth. It is caused by exposure of the meatus to urine or by rubbing against the diaper. The disorder "is characterized by an upward deflected, difficult-to-aim urinary stream and, occasionally, dysuria and urgent, frequent, and prolonged urination. Surgical meatotomy is curative." [http://www.emedicine.com/ped/topic2356.htm] Meatal stenosis usually occurs too late to be registered as a circumcision complication. Meatitis (inflammation of the meatus) is also more common in circumcised boys.
It has been claimed that deaths that are the indirect result of a circumcision (e.g. infections of the circumcision wound) are often not registered as a complication. The overall number of deaths from circumcision per year is unknown, but it has been estimated by circumcision-critical health professionals to be over 200 per year in the United States [http://www.cirp.org/library/general/baker1/],[http://www.cirp.org/library/general/gellis1/].
Circumcision advocates dispute these numbers and claim that if they were true, a large outcry would already have resulted. There were approximately 4,026,000 births in the United States in 2001 [http://www.infoplease.com/ipa/A0005074.html], approximately half male and approximately 55.1% of these were circumcised, yielding approximately 1,109,000 circumcisions. If ‘over 200’ deaths were believed to have resulted from these, the death rate would appear to be 1 in every 5,500. There are no published studies that confirm this alarm.
In countries with lower medical standards, complication rates are higher, and historically, circumcision has not been a risk-free procedure. The quantification of the risks is both controversial and the subject of few research studies. The Talmud grants an exemption from circumcision if the first three sons died from it [http://www.cirp.org/library/cultural/neusner1/].
Several extreme cases of circumcision complications have been documented in the scientific literature. Perhaps best known is the case of "Bruce/Brenda/David", an infant whose genitalia were amputated after a botched circumcision and who was then raised as a girl, with severe traumatic consequences. The case has been documented by John Colapinto in the book ''As Nature Made Him''. Circumcision proponents note that the extreme cases of complications are documented precisely because their rarity makes them newsworthy, and in the case of Bruce/Brenda/David, that the circumcision was not a routine neo-natal circumcision and the doctor used a highly unusual method involving electrical cauterizing equipment rather than a scalpel.
Effects of circumcision
Medical authorities are generally in accord that possession or absence of a foreskin does not affect sexual pleasure in the male. Recent studies published in the Journal of Urology studied men who were circumcised as adults, and found the majority reported no significant difference in sex drive, erection, ejaculation, or sexual satisfaction.
:(Source: Collins, S, et al., Circumcision and Male Sexual Function, Journal of Urology 2002;167:2111-2116)
However, circumcisions done to correct Phimosis and Paraphimosis, conditions that only occur in uncircumcised men, tend to enable sexual functioning that was previously painful or impossible. Neo-natal circumcision absolutely prevents Phimosis and Paraphimosis.
Circumcision as an indication of elite status
Due to pressures brought to bear by the anti-circumcision movements, health care systems have been refusing to pay for neo-natal circumcision. Circumcision is fast becoming a mark of the elite – a status it enjoyed prior to the 19th Century.
Famous circumcised men include virtually a who’s who of thinkers: Sigmund Freud, Albert Einstein, Jesus of Nazereth, Moses Maimodes, Erasmus, Franz Kafka, Karl Marx, Nostradamus, Allen Ginsburg, Pythagoras, Zoroaster, Muhammad, Neils Bohr, the authors of the Bible, Saint Peter, Saint Paul, Stephen Jay Gould, Ernest Hemmingway and Benjamin Cardozo.
Famous circumcised men also comprise a varied cross-section of important persons in history, culture, or simply, modern celebrities, including:
Bryan Adams, Canadian singer
Muhammad Ali, African-American boxer
Woody Allen, American film impresario
The Allman Brothers, American singers
Prince Andrew, English royal
Kofi Annan, UN secretary general
Yassir Arafat, Palestinian leader
Oscar Arias, Costa Rican president
Ed Asner, American actor
Hafiz Assad, Syrian president
Tony Bennett, American singer
Jack Benny, American comedian
Milton Berle, American television pioneer
Yogi Berra, American baseball figure
Leon Blum, French prime minister
Robert Briscoe, Irish politician
Tom Brokaw, American newsman
Jackson Browne, German singer
Art Buchwald, American humorist
George Burns, American actor
Rod Carew, Panamanian baseball star
Jimmy Carter, American president
Marc Chagall, Russian-French artist
Prince Charles, English royal
Tom Cruise, American actor
Eric Delvalle, Panamanian president
Neil Diamond, American singer
Walt Disney, American cartoonist
Benjamin Disraeli, English prime minister
Kirk Douglas, American movie star
Edward VII, English king
Edward VIII, English king
Sergei Eisenstein, Russian movie maker
Errol Flynn, Tasmanian movie star
Harrison Ford, American movie star
Gerald Ford, American president
Muammar Gaddhafi, Libyan leader
Boutros Boutros Galli, UN secretary general
Art Garfunkel, American singer/songwriter
George V, English king
George VI, English king
Richard Gere, American movie star
Mel Gibson, Australian movie star
Cary Grant, English movie star
Alan Greenspan, American economist
Wayne Gretzky, Canadian hockey star
Mark Hamill, American actor
Jascha Heifetz, Israeli musician
Edmund Hillary, New Zealander mountain climber
Dustin Hoffman, American actor
Vladimir Horowitz, Russian pianist
Englebert Humperdinck, Indian singer
King Hussein, Jordanian king
Isaac Isaacs, Australian governor general
Kareem Abdul Jabbar, American basketball star
Michael Jackson, American singer
Mick Jagger, English singer
Billy Joel, Cuban-American singer
Danny Kaye, American actor
John F. Kennedy, American president
Henry Kissinger, Austrian-American diplomat
Bruno Kreisky, Austrian prime minister
Lorenzo Lamas, Mexican-American actor
Greg Louganis, American diver
King Louis XVI, French king
John Malkovitch, American actor
Nelson Mandela, South African president
Marcel Marceau, French actor
Groucho Marx, American actor
Paul McCartney, English singer/song-writer
Pierre Mendes-France, French prime minister
Joe Montana, American football star
Yves Montand, French actor
Lord Mountbatten, Indian viceroy
Hosni Mubarak, Egyptian president
Perwez Musharraf, Pakistani president
Ralph Nader, American politician
Joe Namath, American football star
Leonard Nimoy, American actor
Richard Nixon, American president
Yannick Noah, French tennis star
Ken Norton, American boxer
Al Pacino, American actor
Itzhak Perlman, Israeli violinist
Peter the Great, Russian czar
Prince Philip, English royal
Brad Pitt, American actor
Roman Polanski, Polish movie director
Eusebio Poncela, Italian actor
Yevgeny Primakov, Russian prime minister
Robert Redford, American movie star
Christopher Reeve, American actor
Hyman Rickover, American admiral
Geraldo Rivera, Puerto Rican newsman
Wallace Rowling, New Zealander diplomat
Arthur Rubinstein, Russian pianist
Carl Sagan, American astronomer
Jorge Sampaio, Portuguese president
Arnold Schwarzenegger, Austrian actor
Peter Sellers, English actor
Omar Sharif, Egyptian actor
William Shatner, Canadian actor
Neil Simon, American playwright
Paul Simon (musician)/Paul Simon, American singer/song-writer
Christian Slater, American actor
Steven Spielberg, American movie maker
Mark Spitz, American swimmer
Rick Springfield, Australian singer
Bruce Springsteen, American singer
Sylvester Stallone, American actor
Ringo Starr, English singer
Rod Stewart, English singer
Alan Thicke, Canadian television pioneer
John Travolta, American actor
Leon Trotsky, Russian revolutionary
Allan Turing, American mathematician
King Tut, Egyptian pharaoh
Peter Ustinov, Russian-English actor
Gore Vidal, American author
Mike Wallace, American newsman
Andy Warhol, American artist
Elie Wiesel, Romanian author
Gene Wilder, American actor
Tennesee Williams, American playwright
Warren Zevon, American singer
Effects on masturbation and sex
Various benefits and harms in sexual feeling have been ascribed to circumcision.
The process of keratinization after circumcision is well known and negatively affects the sexual sensitivity of the glans to stimulation. This effect of the procedure is sometimes presented as an advantage (prolonging the sexual act) or as a disadvantage (decrease in sensation). In a study of adult males who decided to become circumcised (in 84% cases due to medical conditions), 38% reported negative outcomes such as decreased sensitivity and erectile dysfunction [http://www.cirp.org/library/sex_function/fink1/]. Of course, circumcisions to correct severe phimosis and paraphimosis tend to enable sexual functioning that was previously painful or impossible.
Because the foreskin acts as a natural lubricant, uncircumcised men and boys can usually masturbate without any external aids by simply sliding the foreskin back and forth over the glans. Circumcised men frequently have to resort to using a lubricant and other techniques. http://www.cirp.org/library/psych/boyle5/]
The primary source for the argument that women prefer uncircumcised partners is O'Hara and O'Hara, who conducted a survey among 138 women who had sex with both circumcised and uncircumcised males, and found that 85.5% preferred uncircumcised partners. Women reported having had more single and multiple orgasms with uncircumcised men, and less vaginal discomfort. Specifically regarding the loss of vaginal secretion in partners of circumcised men, the authors write [http://www.cirp.org/library/anatomy/ohara/#n2]:
: When the anatomically complete penis thrusts in the vagina, it does not slide, but rather glides on its own 'bedding' of movable skin, in much the same way that a turtle's neck glides in and out of the folder layers of skin surrounding it. The underlying corpus cavernosa and corpus spongiosum slide within the penile skin, while the skin juxtaposed against the vaginal wall moves very little. This sheath-within-a-sheath alignment allows penile movement, and vaginal and penile stimulation, with minimal friction or loss of secretions.
This study has been criticized for several reasons. The authors are not doctors and have no formal medical training, and the study was limited to only 138 participants. They also, prior to the study, had indicated a strong anti-circumcision bias, writing a book entitled “Sex as Nature Intended It” which they and anti-circumcision advocates promote as the “most important book on sexuality ever written,”[http://www.sexasnatureintendedit.com/] the journal in which the article was written is not peer reviewed, and because the article itself is based on a false premise, displayed in the first sentence of their introduction, that circumcision removes 33 % to 50% of penile skin. Most commonly, circumcision is the removal of the prepuce only; O’Hara and O’Hara have focused on the extraordinary case rather than the norm.
Other studies – published in peer reviewed journals – come to a contrary conclusion.
Williamson and Williamson also studied 145 women and found that 71% of them preferred circumcised partners for sexual intercourse while only 6% preferred uncircumcised partners; the remainder had no preference. The disproportion increased when the women were questioned about fellatio to an 83% to 2% preference for circumcised. The absence of smegma in the circumcised penis was noted as a major reason behind the preference. (Source: Williamson, Marvel L., Ph.D., R.N. and Williamson, Paul S., M.D., Women's Preference for Penile Circumcision in Sexual Partners, Journal of Sex Education and Therapy, Vol. 14, No. 2 (Fall/Winter 1988): pp. 8-12.)
Laumann et al. studied 1410 men and found that circumcised men were more likely to a variety of sexual practices, notably in oral sex, in part because women were more welcoming of circumcised penises. (Source: Laumann, E. et al., Circumcision in the United States: Prevalence, Prophylactic Effects, and Sexual Practice, JAMA 277 (1997): 1052–57.)
Circumcision without anaesthesia is believed by many child psychologists and neurologists to have severe long term traumatic effects. [http://www.cirp.org/library/pain/] However, circumcision is usually practiced today with local anaesthesia.
Statements by health groups
The American Academy of Pediatrics created a Task Force on Circumcision, which issued an official policy statement. The abstract of their statement reads:
:"Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In circumstances in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. If a decision for circumcision is made, procedural analgesia should be provided."
The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists issued a statement in 1997 that "newborn circumcision is an elective procedure to be performed at the request of the parents on baby boys who are physiologically and clinical stable."
The American Academy of Family Physicians Reference Manual states: "Current medical literature regarding neonatal circumcision is controversial and conflicting. The decision to perform neonatal circumcision should be based on the informed consent of the parents, and requires objective, factual counseling of parents by the family physician."
In recent years the American Cancer Society has not endorsed routine circumcision. "We would like to discourage the American Academy of Pediatrics from promoting routine circumcision as a preventive measure for penile or cervical cancer...Perpetuating the mistaken belief that circumcision prevents cancer is inappropriate." [http://www.cirp.org/library/statements/letters/1996.02:ACS/] The American Academy of Pediatrics no longer promotes routine circumcision.
The American Medical Assocation states:
:There is little doubt that the uncircumcised infant is at higher risk for urinary tract infection (UTI), although the magnitude of this risk is debatable... Despite the increased relative risk in uncircumcised infants, the absolute incidence of UTI is small in this population... One model of decision analysis concluded that the incidence of UTI would have to be substantially higher in uncircumcised males to justify circumcision as a preventive measure against this condition.
:The data on circumcision status and susceptibility to HIV infection and other sexually transmissible diseases have been recently reviewed. Five of 7 prospective studies involving heterosexual transmission of HIV-1 found a statistically significant association between lack of circumcision and elevated risk for acquisition of HIV... At least 16 studies have examined the relationship between circumcision and sexually transmissible diseases other than HIV. In general, circumcised individuals appear to have somewhat lower susceptibility to acquiring chancroid and syphilis, possibly genital herpes, and gonorrhea compared to individuals in whom the foreskin is intact... Regardless of these findings, behavioral factors are far more important risk factors for acquisition of HIV and other sexually transmissible diseases than circumcision status.
:(Source: American Medical Assocation, Report 10 of the Council on Scientific Affairs on Neonatal Circumcision)
''This article was previously posted at Medical analysis of circumcision by 12.24.47.10. It includes content contributed by other people, as well as by 12.24.47.10.''
Complications of the uncircumcised penis
Numerous medical studies have tried to assess the beneficial effects (if any) of circumcision. Others focus on the harmful effects (if any) of not circumcising. The studies regarding these effects (or finding their absence) are discussed below.
Phimosis and paraphimosis
There are a number of circumstances where doctors sometimes recommend circumcision. An overtight foreskin(Majo Mills phimosis) can cause problems in sex, as the foreskin may become trapped behind the glans of the penis and restrict blood flow (Mosquito ringtone paraphimosis). Circumcision is the recommended remedy for this condition, which typically arises in Sabrina Martins teenagers experimenting with sex. It can be treated by a program of stretching and use of topically applied Nextel ringtones steroid creams, but this is generally considered less effective and risks later Abbey Diaz relapse. As a result, in the Free ringtones NHS of the U.K. it is only recommended to patients who wish to retain their foreskin for religious or sexual reasons. A newer, experimental, procedure is minor surgery to make a small slit in the foreskin without removing any tissue.
Recent studies from Europe demonstrate the prevalence of Majo Mills balanitis and Mosquito ringtone phimosis due to the low rate of circumcision. Doctors at Royal Liverpool Children’s Hospital diagnosed over 100 cases (a 4% rate) of balanitis in a 3 ½ year survey of English boys. (Source: Escala JM, Rickwood AMK. Balanitis. Brit J Urol 1989;63:196-197). Doctors from the Children’s Hospital, Sheffield found a prevlance of phimosis among uncircumcised English boys. (Source: Rickwood AMK, Hemalatha V, Batcup G, Spitz L. Phimosis in Boys. Brit J Urol 1980;52:147-150). A study conducted in Denmark examined 9,545 Danish boys between 6 and 17 years of age, and found that 4% had phimosis, (incidence of 8% among 6 year olds), 33% had preputal adhesions (63% among 6 year olds), and 5% had smegma. (Source: Øster J. Further fate of the foreskin. Arch Dis Child 1968; 43:200-203.)
Another condition that can only occur in uncircumcised males is Sabrina Martins phimosis, the inability to retract the prepuce over the glans penis. It is generally acknowledged that circumcision prevents both conditions. According to some researchers, however, a lack of understanding of the natural development of the penis has led to many misdiagnoses of phimosis. Rickwood ''et al.'' write in their 2000 paper "Towards evidence based circumcision of English boys" in the ''British Medical Journal'' [http://bmj.com/cgi/content/full/321/7264/792]:
:Too many English boys, especially those under 5 years of age, are still being circumcised because of misdiagnosis of phimosis. What is phimosis? At birth, the foreskin is almost invariably non-retractable, but this state is transient and resolves in nearly all boys as they mature. Such normality, with an unscarred and pliant preputial orifice, is clearly distinguishable from pathological phimosis, a condition unambiguously characterised by secondary cicatrisation of the orifice, usually due to balanitis xerotica obliterans. This problem, the only absolute indication for circumcision, affects some 0.6% of boys, peaks in incidence at 11 years of age, and is rarely encountered before the age of 5. (...) Strictly, only some 0.6% of boys with pathological phimosis need to be circumcised, although more relaxed criteria would allow for a similar proportion affected by recurrent balanoposthitis.
A 1968 Danish study of 9,545 boys, which distinguished between phimosis and preputial adhesion (a weaker condition which can lead to phimosis), found both conditions in measurable amounts. The overall incidence of phimosis was 4% - it was highest (at 8%) among 6-7 year olds, and lowest (at 1%) among 16-17 year olds. The overall incidence of preputial adhesion was 33% - it was highest (at 63%) among 6-7 year olds, and lowest (at 3%) among 16-17 year olds. The author, Jakob Øster, characterized the 4% rate as “uncommon” and in the almost universally uncircumcised society of Denmark, did not indicate circumcision, concluding: "Phimosis is seen to be uncommon in schoolboys, and the indications for operation even rarer if the normal development of the prepuce is patiently awaited. When this policy is pursued, in the majority of cases of phimosis, it is seen to be a physiological condition which gradually disappears as the tissues develop." (Source: Øster J. Further fate of the foreskin. Arch Dis Child 1968; 43:200-203.) [http://www.cirp.org/library/general/oster/]
In a 1980 study, doctors from the Children’s Hospital, Sheffield found a prevlance of phimosis among uncircumcised English boys. (Source: Rickwood AMK, Hemalatha V, Batcup G, Spitz L. Phimosis in Boys. Brit J Urol 1980;52:147-150).
Balanitis
Cingular Ringtones Balanitis is inflammation of the glans penis and may occur both in circumcised and in intact males. It can lead to adhesion of the prepuce to the inflamed glans. It is generally believed to be more frequent in uncircumcised boys, even though a 1997 study by R.S. Van Howe concluded that "circumcised boys are more likely to develop balanitis"
http://www.cirp.org/library/complications/vanhowe/].he risk in any individual, uncircumcised boy appears to be no greater than 4% ... A policy of routine neonatal circumcision to avoid these preputial complaints of childhood would be difficult to justify. We found no evidence that balanitis causes phimosis." [http://www.cirp.org/library/disease/balanitis/escala1/]
Skin diseases
Researchers from the Imperial College School of Medicine, Chelsea & Westminster Hospital, London, England reported the results of their study of 357 patients referred for genital skin disease:
: The most common diagnoses were psoriasis (n=94), penile infections (n=58), lichen sclerosus (n=52), lichen planus (n=39), seborrheic dermatitis (n=29), and Zoon balanitis (n=27). Less common diagnoses included squamous cell carcinoma (n=4), bowenoid papulosis (n=3), and Bowen disease (n=3). The age-adjusted odds ratio for all penile skin diseases associated with presence of the foreskin was 3.24 (95% confidence interval, 2.26-4.64).All patients with Zoon balanitis, bowenoid papulosis, and nonspecific balanoposthitis were uncircumcised. Lichen sclerosus was diagnosed in only 1 circumcised patient. Most patients with psoriasis, lichenplanus, and seborrheic eczema (72%, 69%, and 72%, respectively) were uncircumcised at presentation. The majority of men with penile infections (84%) were uncircumcised.
:(Source: Eleanor Mallon, MRCP; David Hawkins, FRCP; Michael Dinneen, FRCS; Nicholas Francis, FRCPath; Louise Fearfield, MRCP; Roger Newson, DPhil; Christopher Bunker, FRCP, Circumcision and Genital Dermatoses, Arch Dermatol. 2000;136:350-354.) [http://archderm.ama-assn.org/cgi/content/abstract/136/3/350]
In "Medical Department, United States Army, Surgery in World War II, Urology", links observed by clinicians in the field were surveyed and compiled. In it, the author notes that “hospital admissions for paraphimosis, phimosis, balanitis, and selling them condyloma acuminata during 1942-1945 totaled 146,793.” (Source: JF Patton, Medical Department, United States Army, Surgery in World War II, Urology, p. 145). The author also notes the increased seriousness of genital infections in the uncircumcised:
:A word should be said here about circumcision. Any penile lesion in the presence of a redundant prepuce may present a problem and also invites secondary infection. Phimosis was a common complication of chancroid, and dorsal slits were often necessary, followed by circumcision after the local infection subsided. Phimosis and paraphimosis unrelated to veneral disease were also encountered frequently. Soldiers in combat were seldom able to practice personal hygiene. Higher headquarters sometimes questioned the number of circumcisions performed in the theater, with emphasis on days lost from duty. But all were performed from medical necessity, and none were done electively, to the author’s knowledge. Many circumcisions, performed because of necessity in the active theaters, should have been done prophylactically before the soldier left the zone of interior."
:(Source: JF Patton, Medical Department, United States Army, Surgery in World War II, Urology , p. 64)
Circumcision and cancer
Studies finding a reduced risk of country most penile cancer in circumcised males have a long history. (Sources: Abraham Wolbarst, ''The Lancet'' 1932;1:150-3; AJ Dean, J Urol. 1935; 35:252.) Recent studies appear to confirm that view. Dr. Schoen has reviewed the results of published material relating to penile cancer and circumcision and has quantified the risk of not circumcision a newborn boy:
:The evidence that circumcision protects against penile cancer is overwhelming. In the US, incidence of penile cancer in circumcised men is essentially zero (about one reported case every five years), but it is 2.2 per 100 000 in uncircumcised men (about 1000 cases are reported annually). On the basis of life table analysis, Kochen and McCurdy estimated that an uncircumcised man in the US has a lifetime risk of penile cancer of one in 600.
:During the last 50 years in the US, six major series of cancer of the penis encompassing more than 1600 cases have been reported; none of these cancer patients was circumcised in infancy. Human papilloma virus and smegma have been implicated in the aetiology of penile cancer.10 Of the approximately 50 000 cases of cancer of the penis that have occurred in the US since the 1930s (and which resulted in about 10 000 deaths), only 10 were reported in circumcised men. Newborn circumcision virtually eliminates this devastating threat.
:(Source: Edgar J Schoen, Benefits of newborn circumcision: is Europe ignoring medical evidence?, Arch Dis Child 1997;77:258-260 ( September ); footnotes deleted.) http://adc.bmjjournals.com/cgi/content/full/archdischild%3B77/3/258] (see also: Schoen EJ. The relationship between circumcision and cancer of the penis. CA Cancer J Clin 1991;41:306-309). [http://caonline.amcancersoc.org/cgi/reprint/41/5/306.pdf]
Dr. Schoen and colleagues also conclude that newborn circumcision provides protection against penile cancer in situ and a greater protection against invasive penile cancer. (Source: Edgar J. Schoen, Michael Oehrli, Geoffrey Machin, The Highly Protective Effect of Newborn Circumcision Against Invasive Penile Cancer, Pediatrics 2000; 105: e36)
Opponents of neo-natal circumcision, metaphor commonly Paul M. Fleiss and battles against Frederick Hodges dismiss modern studies, but attack Wolbarst’s 1932 studies, writing in a 1996opinion letter to the ''British Medical Journal'' in response to a recent paper on circumcision that relied on Wolbarst [http://bmj.com/cgi/content/full/312/7033/779/c]:
:Wolbarst invented this myth and was directly responsible for its proliferation; he based it on unverifiable anecdotes, ethnocentric stereotypes, a faulty understanding of human anatomy and physiology, a misunderstanding of the distinction between association and cause, and an unbridled missionary zeal. It was not based on valid scientific and epidemiological research.
:Epidemiological studies disproved Wolbarst's myth long ago. In North America the rate of penile cancer has been estimated to be 1 in 100000 (...). Maden ''et al.'' reported penile cancer among a fifth of elderly patients from rural areas who had been circumcised neonatally and had been born at a time when the rate of neonatal circumcision was about 20% in rural populations. Their study also shows that the rate of penile cancer among men circumcised neonatally has risen in the United States relative to the rise in the rate of neonatal circumcision.
This anti-circumcision movement has been gaining ground, and has influenced the english invariably American Cancer Society to issue a statement in 1998: [http://www.cancer.org/docroot/nws/content/nws_1_1x_misleading_information.asp] that "the practice of circumcision is strongly associated with socio-ethnic factors, which in turn are associated with lessened risk. The consensus among studies that have taken these other factors into account is circumcision is not of value in preventing cancer of the penis."
Doctors and researchers on the other side of the debate are active too. Dr. Dagher in an article detailing the high mortality of penile cancer (1/3 of the surveyed patients died), noted:
:Despite overwhelming evidence from urological surgeons that neoplasm of the penis is a lethal disease that can be prevented by removal of the foreskin, some physicians continue to argue against routine neonatal circumcision in a highly emotional and aggressive fashion.
:(Source: Dagher, R., et al., Carcinoma of the cervix and the anti-circumcison crusade. J. Urol. 110:79-80, July 1973)
Women with circumcised sex partners also have lower risk of guangzhou reported cervical cancer.
(Dagher, R., et al., Carcinoma of the cervix and the anti-circumcison crusade. J. Urol. 110:79-80, July 1973). Cervical cancer has been related to the presence of middleburg and HPV infection. On this basis, an alternative hypothesis for the reduction of cervical cancer through circumcision has been proposed; namely, that there is a higher HPV infection rate among uncircumcised men. An international group of researchers conducted a study published in the New England Journal of Medicine that concluded:
: Male circumcision is associated with a reduced risk of penile HPV infection and, in the case of men with a history of multiple sexual partners, a reduced risk of cervical cancer in their current female partners. [http://content.nejm.org/cgi/content/short/346/15/1105]
Researchers from the Danish Cancer Registry, Copenhagen, studied women with only one lifetime sexual partner to determine which male factors had an influence on a woman’s risk for contracting cervical cancer and found that her partner’s lack of circumcision was such a factor. (Source: Kjaer SK, de Villiers EM, Dahl C, Engholm G, Bock JE, Vestergaard BF, Lynge E, Jensen OM, Case-control study of risk factors for cervical neoplasia in Denmark. I: Role of the "male factor" in women with one lifetime sexual partner, INTERNATIONAL JOURNAL OF CANCER, Volume 48, Number 1: Pages 39-44, April 22, 1991.) The study has elicited a strong response from lay anti-circumcision advocates. A detailed analysis from the Internet group "Circumstitions" [http://www.circumstitions.com/Cancer-cervNEJM.html], for example, criticized especially the pooling of data from countries with very different circumcision rates. The only country with a high circumcision rate in the sample were the Philippines, so that the comparison of circumcision rate and HPV rate is also a comparison of HPV rate in the Philippines and HPV rate in other countries. According to critics, this makes it crucial to examine other social, economic, demographic and environmental factors on the Philippines that might explain the lower HPV infection rate.
There was no statistically significant risk of cervical cancer for partners of uncircumcised men; there was a 0.23 to 0.79 risk (CI 95%) for partners of uncircumcised men with a history of multiple partners (the population of women was previously limited to those with few partners). Media commentator Dr. Dean Edell summarized the study like this: "If you are an intact male, have had lots of unprotected sex with lots of different women and marry a virgin, your wife may have a real but statistically insignificant increased chance of getting HPV."
Circumcision and denver on Urinary tract infection (UTI)
The American Medical Assocation states:
:There is little doubt that the uncircumcised infant is at higher risk for urinary tract infection (UTI).
:(Source: American Medical Assocation, Report 10 of the Council on Scientific Affairs on Neonatal Circumcision)
Infections of the urinary tract (kidneys, ureters, bladder and urethra) can lead to kidney damage if undetected, but can generally be treated effectively with antibiotics. Recent studies find a ten to fifteen times increased risk of uncircumcised UTIs in male infants within the first year of life. (Source: Behrman, Nelson Textbook of Pediatrics, 16th ed. 2000.) Other studies show that the increased risk is three to seven times increased risk of uncircumcised UTIs in male infants within the first year of life. A 1998 Canadian population based cohort study by To et al. [http://www.cirp.org/library/disease/UTI/to2/], for example, reported a relative risk of 3.7. The overall incidence of UTIs in infants was low, 1.88 and 7.02 per 1000 respectively.
These studies have been criticized for their methodology. The biological arsenal American Academy of Pediatrics noted in its 1999 circumcision policy statement:
: Few of the studies that have evaluated the association between UTI in male infants and circumcision status have looked at potential confounders (such as prematurity, breastfeeding, and method of urine collection) in a rigorous way. For example, because premature infants appear to be at increased risk for UTI, the inclusion of hospitalized premature infants in a study population may act as a confounder by suggesting an increased risk of UTI in uncircumcised infants. Premature infants usually are not circumcised because of their fragile health status. In another example, breastfeeding was shown to have a threefold protective effect on the incidence of UTI in a sample of uncircumcised infants. However, breastfeeding status has not been evaluated systematically in studies assessing UTI and circumcision status. [http://www.aap.org/policy/re9850.html]
UTI is usually detected through urine tests. Depending on the method of urine collection, there is a varying risk of false positives through contamination. The bacteria detected may in fact come from the foreskin itself,indicating foreskin infection not the urinary tract infection. In spite of this,even anti-circumcision advocatesconcede that an increased risk of UTI in uncircumcised males is generally considered plausible, a higher likelihood of bacterial colonization being the proposed mechanism.
On his website, Dr. Schoen, a circumcision advocate, states:
:Uncircumcised boys are about 10 times as likely to get serious kidney infections in the first year of life as are circumcised infants; uncircumcised older boys and men are more likely to get UTIs as well. These kidney infections are most dangerous in the first 3 months, during which time they often lead to hospitalization and can result in overwhelming blood infection and other serious infections. Kidney scarring has been shown to occur later. There is concern that future kidney failure and high blood pressure may follow infantile UTIs. Abnormal kidney function and hormonal secretion can occur with infant UTIs. Fecal contamination of the moist inner foreskin layer with bacterial attachment leads to these kidney infections.
:(Source: http://www.medicirc.org/meditopics/uti/more_info_uti.html)
Researchers from the University of Texas and Southwestern Medical School surveyed the incidence of UTIs in young children. They found that 95% of boys with UTIs were uncircumcised among a predominantly circumcised populace (Dallas, Texas in 1982). (Source: Ginsberg CM, and McCracken GH: Urinary tract infections in young infants. Pediatrics 69:409, 1982)
Other researchers have reported similar results. (Source: Wiswell TE, Prepuce presence portends prevalence of potentially perilous periurethral pathogens, The Journal of Urology, 1992; 148: 739-42) One textbook notes:
:It has become apparent that uncircumcised newborns are predisposed to urinary tract infections (UTIs) in the neonatal period. For example, in a study of 100 neonates with UTIs, Ginsburg and McCracken (1982) found that only 3 of the 62 males (5%) who developed a UTI were circumcised. Subsequently, Wiswell and colleagues (1985) studied more than 2500 male infants and found that 41 had symptomatic UTIs; of these 88% were uncircumcised. In that study, uncircumcised males were nearly 20 times more likely to develop UTIs than circumcised neonates. Other studies of larger groups of infants have corroborated these reports (Wiswell, 1992)
:(Source: Walsh, Campbell's Urology, 7th ed. 1998) (Accord: Behrman, Nelson Textbook of Pediatrics, 16th ed. 2000: “UTIs are 10 to 15 times more common in uncircumcised infants than in circumcised infants”)
Critics of the studies point out that they do not classify groups of circumcised males according to their mothers' handling of the foreskin, making it impossible to infer to link the UTIs with foreskins or to the fault of the mother. It is generally recommended not to retract the foreskin of an infant during hygiene [http://www.cirp.org/library/normal/aap/]. Hodges and Fleiss claim that "it has been proven that retraction and washing of the infant foreskin can cause urinary tract infections by irritating the mucous membranes and destroying the naturally occurring beneficial flora which protects against pathogens." They do concede, however, that no analogous risk is present in circumcised infants.
If circumcision does indeed reduce the incidence of UTIs, To et al. estimate that 195 circumcisions would be needed to prevent one hospital admission for UTI in the first year of life. Extrapolations from the Dallas survey would indicate for each 20 circumcisions a hospital admission for UTI in the first year of life is prevented.
Circumcision and come too HIV/here everyday AIDS
In 1986, Dr. tour though Aaron J. Fink, proposed that circumcision might prevent the distribution of when kitano AIDS. He hypothesized that the keratinization of the circumcised penis might prevent HIV infection. Other researchers soon investigated the question whether there is a link between circumcision and HIV infection.
Several studies of African populations found a significantly reduced risk of HIV transmission in circumcised males. In a study published in the where judge New England Journal of Medicine, researchers studied patients appearing at a Nairobi, Kenya, STD clinic. The researchers, JN Simonsen, DW Cameron, MN Gakinya, JO Ndinya-Achola, LJ D'Costa, P Karasira, M Cheang, AR Ronald, P Piot, and FA Plummer, found “[m]en who were uncircumcised were more likely to have HIV infection (odds ratio, 2.7; P = 0.003).”
:(Source: Human immunodeficiency virus infection among men with sexually transmitted diseases. Experience from a center in Africa, JN Simonsen et al., The New England Journal of Medicine, Volume 319:274-278, August 4, 1988) [http://content.nejm.org/cgi/content/abstract/319/5/274]
In a study published in convalescence home Lancet in 1989, researchers studied possible risk factors in female-to-male HIV transmission. The researchers found that uncircumcised men (29.0%) were ten times more likely to acquire HIV from a single sexual encounter than circumcised men (2.5%). Uncircumcised men with genital ulcers (52.6%) were four times more likely to become infected than circumcised men with genital ulcers (13.4%).
:(Source: Cameron DW, Simonsen JN, D’Costa LJ, Ronald AR, Maitha GM, Gakinya MN, et al. Female to Male Transmission of Human Immunodeficiency Virus Type 1: Risk Factors for Seroconversion in Men. Lancet 1989; 2:403-27.) [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2569597&dopt=Abstract]
Another set of researchers concluded that “In the AIDS belt, lack of male circumcision in combination with risky behavior, such as having multiple sex partners, engaging in sex with prostitutes and leaving chanchroid untreated has led to rampant HIV transmission.”
:(Source: "The African AIDS Epidemic," by J. C. Caldwell and Pat Caldwell,
Scientific American, March 1996, p. 62)
Researchers from the University of Manitoba also studied heterosexual HIV transmission in Africa. The researchers concluded that: “There is substantial evidence that circumcision protects males from HIV infection, penile carcinoma, urinary tract infections, and ulcerative sexually transmitted diseases. We could find little scientific evidence of adverse effects on sexual, psychological, or emotional health.”
:(Source: S Moses, RC Bailey and AR Ronald, Male circumcision: assessment of health benefits and risks, Sexually Transmitted Infections, Vol. 74, Issue 5, p. 368-373) [http://sti.bmjjournals.com/cgi/content/abstract/74/5/368]
Another publication in the New England Journal of Medicine found that “Male circumcision consistently shows a protective effect against HIV infection” and noted that HIV prevalence was 1.7 to 8.2 times higher among uncircumcised heterosexual men than among circumcised heterosexual men. The study faulted the Langerhans cells in the foreskin and a “receptive HIV environment between foreskin and glans” for the increased risk.
:(Source: Rachel A. Royce, Ph.D., M.P.H., Arlene Seña, M.D., Willard Cates, M.D., M.P.H., and Myron S. Cohen, M.D, Sexual Transmission of HIV, The New England Journal of Medicine, Volume 336:1072-1078, April 10, 1997)
A group of researchers from the University of Washington studied truckers in Kenya who used the services of prostitutes. They found that a trucker’s uncircumcised status was associated with a four-fold increased risk of contracting HIV even after eliminating behavior, religion, or other factors.
:(Source: Lavreys L; Rakwar JP; Thompson ML; Jackson DJ; Mandaliya K; Chohan BH; Bwayo JJ; Ndinya-Achola JO; Kreiss JK; Effect of circumcision on incidence of human immunodeficiency virus type 1 and other sexually transmitted diseases: a prospective cohort study of trucking company employees in Kenya, J Infect Dis. 1999 Aug;180(2):330-6) [http://www.aegis.com/pubs/aidsline/1999/nov/a99b0715.html]
In the Lancet, researchers at the University of California, San Francisco (“UCSF”) and the University of Illinois, Chicago, published the results of their review of over 30 studies on the association between circumcision and HIV. The researchers concluded that circumcision “could potentially save millions of men and their partners” and were sufficiently motivated to cause UCSF to issue a press release announcing the discovery. [http://www.circumcisioninfo.com/halperin_bailey_press.htm] The report contains tables showing the significantly higher HIV infection rate among countries with non-circumcised majorities.
:(Source: Daniel T Halperin, Robert C Bailey, Viewpoint: Male Circumcision and HIV Infection: 10 Years and Counting, The Lancet, 354 (9192): pp. 1813-15.) [http://hivinsite.ucsf.edu/InSite.jsp?doc=2098.4613]
Tying AIDS/HIV rates to circumcision status in the abstract has been eschewed by careful scientists and statisticians. One must correct base data that may tend to favor societies that practice other behavior regardless of circumcision or whose behavior in transmission of HIV has less to do with heterosexual sex, wherein the vulnerability of men with foreskins to female-to-male transmission may be demonstrated to anal or oral homosexual sex wherein the mode of transmission of tears in the colon or gums are the primary vectors of spread of the virus.
The ongoing research has been extensively methodologically criticized. The main criticism is that past studies have ignored substantial confounding variables. Perhaps most notably, most studies have not controlled for different socio-sexual behaviors. In their meta-analysis of related studies [http://www.cirp.org/library/disease/HIV/vincenzi/], Vincenzi and Mertens note that "circumcision is not performed randomly". Circumcision in central Africa is primarily a Muslim practice, and Islam requires ritual washing, marital fidelity and periodic abstinence from sex.
Those opposed to the practice claim that similar relationships have been found in other cultures that practice male circumcision http://violence.de/prescott/truthseeker/genpl.html].
Among industrialized nations, AIDS rates are highest in the three countries that still practice routine infant circumcision at substantial levels (table 1). Some circumcision critics point to the data as evidence of relationship between circumcision and HIV/AIDS. Others express concern that misconstruction of the data blunts the message that use of safe sex practices far outweighs any beneficial effect circumcision may or may not have. Critics also warn that advertising circumcision as a way to prevent AIDS (e.g. "could potentially save millions of men and their partners", as a http://www.circumcisioninfo.com/halperin_bailey_press.htm claims) might be used to promote and justify the belief that safe sex practices are unnecessary.
The position of the circumcision critics has been criticized by circumcision proponents because the predominant modes of HIV/AIDS transmission in industrial societies is not heterosexual intercourse, but through homosexual sex, blood transfusions, needle sticks or sharing needles, which are not addressed in the HIV/AIDS rates. Contrary to the data on the industrial world (table 1), the studies linking circumcision with lower HIV/AIDS incidence in the developing world have mostly focused on the female-to-male heterosexual transmission (tables 2-5). It is axiomatic that possession (or not) of a foreskin does not influence transmission rates associated with the non-insertional partner's acquisition of HIV/AIDS through anal, vaginal, or oral sex, or any partner through pregnancy, nursing, blood transfusions, needle sticks or sharing needles.
'''Table 1evening after World Health Organization data of AIDS rates for 1995'''
Nation
AIDS cases per 100,000 pop.
USA16.0
Australia4.5
Canada3.8
France3.5
Netherlands3.1
United Kingdom2.4
Germany2.2
Sweden2.0
Norway1.6
New Zealand1.2
Finland0.9
Japan0.2
'''Table 2child williams World Health Organization data of HIV infection rates for 1998'''
Nation
HIV infections per 100,000 pop. in African countries with under 20% circumcision rate
Zimbabwe25,840
Botswana25,100
Namibia19,940
Zambia19,070
Swaziland18,500
Malawi14,920
Mozambique14,170
Rwanda12,750
'''Table 3worst books World Health Organization data of HIV infection rates for 1998'''
Nation
HIV infections per 100,000 pop. in Asian countries with under 20% circumcision rate
Cambodia2,400
Thailand 2,230
Myanmar1,790
India820
Nepal240
'''Table 4institute spirit World Health Organization data of HIV infection rates for 1998'''
Nation
HIV infections per 100,000 pop. in African countries with over 80% circumcision rate
Kenya11,640
Congo (Brazzaville)7,640
Cameroon4,890
Nigeria4,120
Gabon4,250
Liberia3,650
Sierra Leone3,170
Ghana2,380
Gambia2,240
Guinea2,090
Benin2,060
'''Table 5beautiful teen World Health Organization data of HIV infection rates for 1998'''
Nation
HIV infections per 100,000 pop. in Asian countries with over 80% circumcision rate
Pakistan90
Philippines 60
Indonesia50
Bangladesh30
[http://hivinsite.ucsf.edu/InSite.jsp?doc=2098.4613]
Medical complications of circumcision
While all benefits associated with circumcision are controversial, the procedure has risks. The quantification of these risks is also controversial, though most agree that complications of circumcision are relatively rare. They range from bleeding and infections to (in few cases) disfigurement, scarring and sexual dysfunction through severe mutilation of the penis, and even death.
:In general, neonatal circumcision is safe, although there is a complication rate of 0.2% to 3% (Ross, 1995). Dorsal penile nerve block with either lidocaine or bupivacaine significantly reduces the pain associated with the procedure (Ryan et al, 1994)
:(Source: Walsh, Campbell's Urology, 7th ed. 1998)
Williams and Kapila observe: “Some authors have reported a complication rate as low as 0.06 per cent while at the other extreme rates of up to 55 per cent have been quoted. This reflects the differing and varying diagnostic criteria employed; a realistic figure is 2-10 per cent. Although haemorrhage and sepsis are the main causes of morbidity, the variety of complications is enormous. The literature abounds with reports of morbidity and even death as a result of circumcision.”
Meatal stenosis is a condition that is "exceedingly rare" in uncircumcised males, yet occurs in 9-10% of males who are circumcised at birth. It is caused by exposure of the meatus to urine or by rubbing against the diaper. The disorder "is characterized by an upward deflected, difficult-to-aim urinary stream and, occasionally, dysuria and urgent, frequent, and prolonged urination. Surgical meatotomy is curative." [http://www.emedicine.com/ped/topic2356.htm] Meatal stenosis usually occurs too late to be registered as a circumcision complication. Meatitis (inflammation of the meatus) is also more common in circumcised boys.
It has been claimed that deaths that are the indirect result of a circumcision (e.g. infections of the circumcision wound) are often not registered as a complication. The overall number of deaths from circumcision per year is unknown, but it has been estimated by circumcision-critical health professionals to be over 200 per year in the United States [http://www.cirp.org/library/general/baker1/],[http://www.cirp.org/library/general/gellis1/].
Circumcision advocates dispute these numbers and claim that if they were true, a large outcry would already have resulted. There were approximately 4,026,000 births in the United States in 2001 [http://www.infoplease.com/ipa/A0005074.html], approximately half male and approximately 55.1% of these were circumcised, yielding approximately 1,109,000 circumcisions. If ‘over 200’ deaths were believed to have resulted from these, the death rate would appear to be 1 in every 5,500. There are no published studies that confirm this alarm.
In countries with lower medical standards, complication rates are higher, and historically, circumcision has not been a risk-free procedure. The quantification of the risks is both controversial and the subject of few research studies. The Talmud grants an exemption from circumcision if the first three sons died from it [http://www.cirp.org/library/cultural/neusner1/].
Several extreme cases of circumcision complications have been documented in the scientific literature. Perhaps best known is the case of "Bruce/Brenda/David", an infant whose genitalia were amputated after a botched circumcision and who was then raised as a girl, with severe traumatic consequences. The case has been documented by John Colapinto in the book ''As Nature Made Him''. Circumcision proponents note that the extreme cases of complications are documented precisely because their rarity makes them newsworthy, and in the case of Bruce/Brenda/David, that the circumcision was not a routine neo-natal circumcision and the doctor used a highly unusual method involving electrical cauterizing equipment rather than a scalpel.
Effects of circumcision
Medical authorities are generally in accord that possession or absence of a foreskin does not affect sexual pleasure in the male. Recent studies published in the Journal of Urology studied men who were circumcised as adults, and found the majority reported no significant difference in sex drive, erection, ejaculation, or sexual satisfaction.
:(Source: Collins, S, et al., Circumcision and Male Sexual Function, Journal of Urology 2002;167:2111-2116)
However, circumcisions done to correct Phimosis and Paraphimosis, conditions that only occur in uncircumcised men, tend to enable sexual functioning that was previously painful or impossible. Neo-natal circumcision absolutely prevents Phimosis and Paraphimosis.
Circumcision as an indication of elite status
Due to pressures brought to bear by the anti-circumcision movements, health care systems have been refusing to pay for neo-natal circumcision. Circumcision is fast becoming a mark of the elite – a status it enjoyed prior to the 19th Century.
Famous circumcised men include virtually a who’s who of thinkers: Sigmund Freud, Albert Einstein, Jesus of Nazereth, Moses Maimodes, Erasmus, Franz Kafka, Karl Marx, Nostradamus, Allen Ginsburg, Pythagoras, Zoroaster, Muhammad, Neils Bohr, the authors of the Bible, Saint Peter, Saint Paul, Stephen Jay Gould, Ernest Hemmingway and Benjamin Cardozo.
Famous circumcised men also comprise a varied cross-section of important persons in history, culture, or simply, modern celebrities, including:
Bryan Adams, Canadian singer
Muhammad Ali, African-American boxer
Woody Allen, American film impresario
The Allman Brothers, American singers
Prince Andrew, English royal
Kofi Annan, UN secretary general
Yassir Arafat, Palestinian leader
Oscar Arias, Costa Rican president
Ed Asner, American actor
Hafiz Assad, Syrian president
Tony Bennett, American singer
Jack Benny, American comedian
Milton Berle, American television pioneer
Yogi Berra, American baseball figure
Leon Blum, French prime minister
Robert Briscoe, Irish politician
Tom Brokaw, American newsman
Jackson Browne, German singer
Art Buchwald, American humorist
George Burns, American actor
Rod Carew, Panamanian baseball star
Jimmy Carter, American president
Marc Chagall, Russian-French artist
Prince Charles, English royal
Tom Cruise, American actor
Eric Delvalle, Panamanian president
Neil Diamond, American singer
Walt Disney, American cartoonist
Benjamin Disraeli, English prime minister
Kirk Douglas, American movie star
Edward VII, English king
Edward VIII, English king
Sergei Eisenstein, Russian movie maker
Errol Flynn, Tasmanian movie star
Harrison Ford, American movie star
Gerald Ford, American president
Muammar Gaddhafi, Libyan leader
Boutros Boutros Galli, UN secretary general
Art Garfunkel, American singer/songwriter
George V, English king
George VI, English king
Richard Gere, American movie star
Mel Gibson, Australian movie star
Cary Grant, English movie star
Alan Greenspan, American economist
Wayne Gretzky, Canadian hockey star
Mark Hamill, American actor
Jascha Heifetz, Israeli musician
Edmund Hillary, New Zealander mountain climber
Dustin Hoffman, American actor
Vladimir Horowitz, Russian pianist
Englebert Humperdinck, Indian singer
King Hussein, Jordanian king
Isaac Isaacs, Australian governor general
Kareem Abdul Jabbar, American basketball star
Michael Jackson, American singer
Mick Jagger, English singer
Billy Joel, Cuban-American singer
Danny Kaye, American actor
John F. Kennedy, American president
Henry Kissinger, Austrian-American diplomat
Bruno Kreisky, Austrian prime minister
Lorenzo Lamas, Mexican-American actor
Greg Louganis, American diver
King Louis XVI, French king
John Malkovitch, American actor
Nelson Mandela, South African president
Marcel Marceau, French actor
Groucho Marx, American actor
Paul McCartney, English singer/song-writer
Pierre Mendes-France, French prime minister
Joe Montana, American football star
Yves Montand, French actor
Lord Mountbatten, Indian viceroy
Hosni Mubarak, Egyptian president
Perwez Musharraf, Pakistani president
Ralph Nader, American politician
Joe Namath, American football star
Leonard Nimoy, American actor
Richard Nixon, American president
Yannick Noah, French tennis star
Ken Norton, American boxer
Al Pacino, American actor
Itzhak Perlman, Israeli violinist
Peter the Great, Russian czar
Prince Philip, English royal
Brad Pitt, American actor
Roman Polanski, Polish movie director
Eusebio Poncela, Italian actor
Yevgeny Primakov, Russian prime minister
Robert Redford, American movie star
Christopher Reeve, American actor
Hyman Rickover, American admiral
Geraldo Rivera, Puerto Rican newsman
Wallace Rowling, New Zealander diplomat
Arthur Rubinstein, Russian pianist
Carl Sagan, American astronomer
Jorge Sampaio, Portuguese president
Arnold Schwarzenegger, Austrian actor
Peter Sellers, English actor
Omar Sharif, Egyptian actor
William Shatner, Canadian actor
Neil Simon, American playwright
Paul Simon (musician)/Paul Simon, American singer/song-writer
Christian Slater, American actor
Steven Spielberg, American movie maker
Mark Spitz, American swimmer
Rick Springfield, Australian singer
Bruce Springsteen, American singer
Sylvester Stallone, American actor
Ringo Starr, English singer
Rod Stewart, English singer
Alan Thicke, Canadian television pioneer
John Travolta, American actor
Leon Trotsky, Russian revolutionary
Allan Turing, American mathematician
King Tut, Egyptian pharaoh
Peter Ustinov, Russian-English actor
Gore Vidal, American author
Mike Wallace, American newsman
Andy Warhol, American artist
Elie Wiesel, Romanian author
Gene Wilder, American actor
Tennesee Williams, American playwright
Warren Zevon, American singer
Effects on masturbation and sex
Various benefits and harms in sexual feeling have been ascribed to circumcision.
The process of keratinization after circumcision is well known and negatively affects the sexual sensitivity of the glans to stimulation. This effect of the procedure is sometimes presented as an advantage (prolonging the sexual act) or as a disadvantage (decrease in sensation). In a study of adult males who decided to become circumcised (in 84% cases due to medical conditions), 38% reported negative outcomes such as decreased sensitivity and erectile dysfunction [http://www.cirp.org/library/sex_function/fink1/]. Of course, circumcisions to correct severe phimosis and paraphimosis tend to enable sexual functioning that was previously painful or impossible.
Because the foreskin acts as a natural lubricant, uncircumcised men and boys can usually masturbate without any external aids by simply sliding the foreskin back and forth over the glans. Circumcised men frequently have to resort to using a lubricant and other techniques. http://www.cirp.org/library/psych/boyle5/]
The primary source for the argument that women prefer uncircumcised partners is O'Hara and O'Hara, who conducted a survey among 138 women who had sex with both circumcised and uncircumcised males, and found that 85.5% preferred uncircumcised partners. Women reported having had more single and multiple orgasms with uncircumcised men, and less vaginal discomfort. Specifically regarding the loss of vaginal secretion in partners of circumcised men, the authors write [http://www.cirp.org/library/anatomy/ohara/#n2]:
: When the anatomically complete penis thrusts in the vagina, it does not slide, but rather glides on its own 'bedding' of movable skin, in much the same way that a turtle's neck glides in and out of the folder layers of skin surrounding it. The underlying corpus cavernosa and corpus spongiosum slide within the penile skin, while the skin juxtaposed against the vaginal wall moves very little. This sheath-within-a-sheath alignment allows penile movement, and vaginal and penile stimulation, with minimal friction or loss of secretions.
This study has been criticized for several reasons. The authors are not doctors and have no formal medical training, and the study was limited to only 138 participants. They also, prior to the study, had indicated a strong anti-circumcision bias, writing a book entitled “Sex as Nature Intended It” which they and anti-circumcision advocates promote as the “most important book on sexuality ever written,”[http://www.sexasnatureintendedit.com/] the journal in which the article was written is not peer reviewed, and because the article itself is based on a false premise, displayed in the first sentence of their introduction, that circumcision removes 33 % to 50% of penile skin. Most commonly, circumcision is the removal of the prepuce only; O’Hara and O’Hara have focused on the extraordinary case rather than the norm.
Other studies – published in peer reviewed journals – come to a contrary conclusion.
Williamson and Williamson also studied 145 women and found that 71% of them preferred circumcised partners for sexual intercourse while only 6% preferred uncircumcised partners; the remainder had no preference. The disproportion increased when the women were questioned about fellatio to an 83% to 2% preference for circumcised. The absence of smegma in the circumcised penis was noted as a major reason behind the preference. (Source: Williamson, Marvel L., Ph.D., R.N. and Williamson, Paul S., M.D., Women's Preference for Penile Circumcision in Sexual Partners, Journal of Sex Education and Therapy, Vol. 14, No. 2 (Fall/Winter 1988): pp. 8-12.)
Laumann et al. studied 1410 men and found that circumcised men were more likely to a variety of sexual practices, notably in oral sex, in part because women were more welcoming of circumcised penises. (Source: Laumann, E. et al., Circumcision in the United States: Prevalence, Prophylactic Effects, and Sexual Practice, JAMA 277 (1997): 1052–57.)
Circumcision without anaesthesia is believed by many child psychologists and neurologists to have severe long term traumatic effects. [http://www.cirp.org/library/pain/] However, circumcision is usually practiced today with local anaesthesia.
Statements by health groups
The American Academy of Pediatrics created a Task Force on Circumcision, which issued an official policy statement. The abstract of their statement reads:
:"Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In circumstances in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. If a decision for circumcision is made, procedural analgesia should be provided."
The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists issued a statement in 1997 that "newborn circumcision is an elective procedure to be performed at the request of the parents on baby boys who are physiologically and clinical stable."
The American Academy of Family Physicians Reference Manual states: "Current medical literature regarding neonatal circumcision is controversial and conflicting. The decision to perform neonatal circumcision should be based on the informed consent of the parents, and requires objective, factual counseling of parents by the family physician."
In recent years the American Cancer Society has not endorsed routine circumcision. "We would like to discourage the American Academy of Pediatrics from promoting routine circumcision as a preventive measure for penile or cervical cancer...Perpetuating the mistaken belief that circumcision prevents cancer is inappropriate." [http://www.cirp.org/library/statements/letters/1996.02:ACS/] The American Academy of Pediatrics no longer promotes routine circumcision.
The American Medical Assocation states:
:There is little doubt that the uncircumcised infant is at higher risk for urinary tract infection (UTI), although the magnitude of this risk is debatable... Despite the increased relative risk in uncircumcised infants, the absolute incidence of UTI is small in this population... One model of decision analysis concluded that the incidence of UTI would have to be substantially higher in uncircumcised males to justify circumcision as a preventive measure against this condition.
:The data on circumcision status and susceptibility to HIV infection and other sexually transmissible diseases have been recently reviewed. Five of 7 prospective studies involving heterosexual transmission of HIV-1 found a statistically significant association between lack of circumcision and elevated risk for acquisition of HIV... At least 16 studies have examined the relationship between circumcision and sexually transmissible diseases other than HIV. In general, circumcised individuals appear to have somewhat lower susceptibility to acquiring chancroid and syphilis, possibly genital herpes, and gonorrhea compared to individuals in whom the foreskin is intact... Regardless of these findings, behavioral factors are far more important risk factors for acquisition of HIV and other sexually transmissible diseases than circumcision status.
:(Source: American Medical Assocation, Report 10 of the Council on Scientific Affairs on Neonatal Circumcision)
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