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It's said that a little knowledge is a dangerous thing, and there's nothing like a conversation about male circumcision and sexual health to prove the point.
Consider my contribution to the problem. Every time the subject of circumcision has arisen, whether at a wedding, a funeral or a bris, I've always brought up the study they did showing that the female partners of uncircumcised men were significantly more likely to wind up with cervical cancer. I long ago forgot, if I ever knew, who did the study, or when, but nobody ever asks. In casual chit-chat — most people's source of medical information — "they" is an authority beyond
dispute.
Whoever was behind the research, it served admirably as a conversation stopper. If I were debating a circumcision opponent (which describes most of my friends and acquaintances under fifty), the words "cervical cancer" would fry their argumentative circuits; you could almost smell their liberal pieties about respecting the integrity of the human body being incinerated by their liberal pieties about men's responsibility for protecting their partners' sexual health. As the circumcision opponent fell mute, I'd go on to explain the study results, how nearly all cervical cancers were caused by varieties of the human papillomavirus, or HPV, and that the research demonstrated that intact foreskin played a role in transmitting the lethal virus.
In fact, the research linking HPV infection to intact foreskin is highly controversial and its conclusions muddy. A paper in August's British Journal of Infection looked at sixteen papers on this subject, found serious methodological problems with most of them and concluded from the salvageable data that there was "no significant association between genital HPV infection and circumcision status." So whether or not circumcisions are protecting men and their sex partners from viral infection, I've apparently been spreading something else to my conversation partners over the years: medical misinformation.
The link between circumcision and sexually transmitted disease is a hot topic this year, and, according to circumcision opponents, misinformation is playing a key role in the debate. Three papers published in 2007 claimed to demonstrate that male circumcision significantly reduced female-to-male AIDS transmission in South Africa, in Kenya and in Uganda. The studies instantly became a rallying cry for circumcision proponents around the world, and not just on behalf of African populations. In New York, the health department said it may recommend adult circumcision as a way to help slow the spread of AIDS there.
"The efficacy of male circumcision in reducing female-to-male HIV transmission has now been proven beyond reasonable doubt," the World Health Organization and the United Nations' AIDS program declared this year.
But circumcision opponents fault the African studies on methodological grounds. They say the African subjects and the
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"Male circumcision has long been an operation in search of a disease," wrote members of a doctor's group.
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researchers studying them had a so-called expectation bias that influenced the results. While researchers told both the circumcision and control groups to practice safer sex, the circumcision group was told to abstain from sex altogether or use condoms while their circumcisions healed, a period of safe sex that study critics say would likely skew the rates of HIV infection. And because the studies were concluded early, after eighteen months, critics say the effect of that lead-time bias would be magnified.
Circumcision opponents complain more generally that the procedure has attached itself to medical justifications with some promiscuity over the years. When circumcision was first promoted in English-speaking countries in the nineteenth century, it was as a prophylaxis against masturbation, which in turn was thought to cause such disorders as TB, epilepsy, insanity and hip dysplasia.
"Male circumcision has long been an operation in search of a disease," wrote members of the group Doctors Opposing Circumcision in the May 12th edition of The Lancet.
In the twentieth century, as claims about masturbation and mental illness started sounding quaint and then downright wacky, circumcision transformed itself into a shield against STDs, urinary tract infections and cancer. "A clear pattern has emerged," wrote circumcision opponents introducing a study in the November 2005 Journal of the Royal Society for the Promotion of Health. "Any incurable disease that happens to be the focus of national attention at any given time will be used by U.S. circumcision advocates as an excuse for the continued imposition of mass circumcision."
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Comments ( 9 )
I can state from first-hand experience that the most sensitive parts of the penis are the head and particularly the ridge around the head. These are not cut off in a circumcision. You'll excuse the pun, but am I missing something here?
I'd take this guy's analysis of medical literature a lot more seriously if his bio picture had hair and a shirt.
If you cut off your balls then you can reduce your odds of getting testicular cancer to zero. Or have your breasts removed at puberty to eliminate the danger of breast cancer. This is no more a rational case for ritual genital mutilation than reduced risk of HIV possibly resulting from circumcision.
To AWF: Following circumcision, the skin on the head of the penis gets thicker and thus less sensitive. Normally the foreskin protects the head most of the time. Without that protection, the skin just has to toughen up. Men who have been circumcised just have no idea what they are missing. The result is no less a form of sexual dysfunction than what women in some third world countries experience when their clitoral hoods are removed in one of 5 basic forms of female circumcision. Yet the former is practiced every day in the US while the latter is reviled and banned by law. Because somehow it is supposed to be less wrong to mutilate a male baby's genitals without sound medical reason or consent than it is to mutilate what amounts to the exact same tissue on girls. And before anybody jumps on me over the female circumcision thing, please not that not all female circumcision involves a clitorectomy.
Excellent summary. You can find more detail on the HIV (dis)connection here. Not only is circumcision a cure looking for a disease, but there are literally hundreds of other crackpot reasons for doing it, so it is not just a personal attack to look at the motivations of its advocates - first and foremost, that they may be fighting to justify what was done to them.
(One thing in the article I find puzzling: "this lower HIV prevalence may simply be because a significant number of men who were circumcised as boys in Kenya, Lesotho and Tanzania didn't survive their circumcisions long enough to be studied" - sounds a bit like the Vatican having as a relic the skull of John the Baptist as a boy. Seriously, though, men who were circumcised and got HIV would be much less inclined to go back and be counted.)
OK, this site doesn't take HTML. More detail on the circumcision-HIV (dis)connection at https://www.circumstitions.com/HIV.html . Literally hundreds of other crackpot reasons for circumcising at https://www.circumstitions.com/Stitions.html
AWF, if you are circumcised, you are missing almost everything. An analogy is at https://www.circumstitions.com/Pleasure.html#music
Hey everyone--
Great to read your comments on the story. Since so much of this discussion is about the effects of circumcision on sensation, I wanted to flag this other Hooksexup story (linked to in "Foresight") about the recent study that sought to objectively evaluate circumcision-related sensation loss through touch-test sensitivity testing. The study was meant to address just the problem AWF raises--nobody can feel another's toothache. By testing sensitivity to various gauges of monofilament (a method developed to evaluate people with peripheral neuropathy), researchers determined that circumcision does indeed remove the most sensitive parts of the penis. Here's the link:
https://hooksexup.com/dispatches/festa/howinsensitive/
Thanks for the response, Paul. It's always nice to know, through actual demonstration, that a journalist is paying attention to his readers.
As far as the actual argument itself goes, though, I believe it's over. Not, as one might think, because of the Sorrels research documenting the serious sensory detriments caused by male prepucectomy, but because of the fundamental medical and legal standards.
That's because all normal, healthy, functional human body parts -- the male foreskin included -- are automatically assigned a basic, inherent, fundamental value by medical ethics and relevant law. And this standard value precludes their amputation without a direct medical health necessity.
Unfortunately, for the proponents of routine and ritual male prepucectomy, there exists no authoritative article, legislation, or other source providing a valid and supportable justification for uniquely and singularly denying the male prepuce that basic, inherent, fundamental value.
In short, circumcision proponents must necessarily assert that the male prepuce is uniquely and singularly to be excluded from the basic standards of ethics and law, but they cannot cite any authoritative grounds for doing so. Thus, pro-prepucectomy advocacy fails from the very outset.
There simply is no rational justfication for the procedure. The same standard which invalidates potential prophylaxis as a pretext for the amputation of any healthy, normal, functional human body part applies every bit as much to the healthy, normal, functional body part classified as the male prepuce.
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