Tuesday, March 25, 2008

Circumcision and Medical Ethics

Ah, the circumcision debate.

I've been reading a lot about it lately, which probably isn't good for me, but oh well. I've analyzed both sides of the issue, I watched Penn and Teller's Bullshit on it, I read the medical literature. My conclusion is physically, it's not necessary-- but it doesn't harm them, either.

Circumcision has been consistently proven to not decrease fertility (clearly, Eritrea has a 95% rate of circumcision and they have a population growth rate of 2.5% with 33.97 births per 1000 population), it has been proven to have no effect or a positive effect on sex enjoyment and ability to have sex repeatedly, with all studies stating it had no effect on sex drive, two studies saying it improved and two studies saying it decreased erectile function, with three more claiming no difference, most studies claiming it prevented premature ejaculation, of seven studies, only one claimed it decreased penile sensation, and absolutely no studies claiming it decreased overall satisfaction.

In other words, no impact on sex. At all. No impact on fertility. Complications are very rare (comes from practice all these years) and they can be performed under local anesthesia to prevent pain (and should be, after all, we numb ears before piercing). There's some evidence that they reduce the risk of STDs, including AIDS, but there haven't been enough studies for me to comfortably say that is the case, and anyway, condoms do a much better job. The truth is, medically, there's not really any reason to bother circumcising, and it's just a body modification which we perform for aesthetic and cultural reasons. At the same time, though, it's not actually doing any long-term damage. I think the closest real comparison we have is the idea of piercing ears. Pierced ears are incredibly common, they show up in many cultures, and piercing usually happens when the person is still a child or a teen (ie not a legal adult). They are socially acceptable, and yet, they are body modification-- it is punching holes in a child's body and forcing the skin to grow back around a metal object to produce a permanent hole. They also hurt like all hell if you don't get numbed first.

So the question-- medically, neonate circumcisions (usually, barring complications) aren't needed; thus, are they ethical? Well, pierced ears aren't considered unethical. I don't think I'd want to pierce a baby's ears myself, but I wouldn't stop someone who did so to their kid, and it's quite common. And since there is no long-term pain or disability, there's nothing unethical about doing it as an initiation into a religion or something. People do all kinds of weird shit to their kids in the name of religion, and body modification is a common religious practice, so as long as the kid's life isn't really impacted, I see no objection to that. Provided, naturally, that the religious official performing the circumcision is trained, licensed, and willing to use anesthetic.

But what about people who simply think the circumcised penis looks better? Is it ethical for a doctor to circumcise a boy?

Honestly? I don't think so. I don't really like the idea of doctors doing it. However, at the same time, I think we should have people who are licensed and trained to perform circumcisions for anyone who wants it for their son or themselves. The trouble with doctors doing it is it becomes about "healing" the kid somehow. I say take medicine out of the equation, except in the sense that a person performing a circumcision should have training and licensing, same as someone who does tattoos or piercings, and more so because a mistake could be problematic. Or perhaps list it as a form of plastic surgery or something. I think it should be made quite clear to parents that it is an aesthetic/religious, not medical, choice for them to make.

But ethically, I see no problem with them making that choice. It's not like FGM, where a woman can no longer enjoy sex because her sexual organs have been cut out. The foreskin is a small and relatively insignificant part of the genitalia. Losing it does not cause lasting pain, it does not decrease sexual abilities, nothing. In other words, yes, it is a body modification, yes, it is unnecessary, no, doctors should never suggest it or encourage it for medical reasons (unless there actually IS a medical reason, like phimosis), though they should answer any questions as free from personal bias as possible. At the same time, I think that it is still firmly the choice of the parents and there is nothing unethical about allowing parents to choose to do so to their son. If it bothers him that much, he can have it restored as an adult, same as the girl whose ears are pierced can let them grow back together.

And me personally? I don't really care. I don't practice a religion that cares about foreskins, and while I find circumcision more aesthetically pleasing myself, my opinion on the appearance of my son's penis is irrelevant, what matters is what his future girlfriends/spouse thinks of it. What I find more attractive shouldn't really apply to my son's genitals. So I'll probably defer to my husband on the subject.

56 comments:

Ian Thomas Healy said...

I'm clipped - my parents decided that for me when I was born.

We chose not to circumsize my firstborn son, because I didn't see any need to. However, he had some medical problems with his bladder/kidneys/urethra when he was only a few months old which required surgery, and the urologist recommended circumcision because it would help reduce the risk of infections. We talked it over and decided to go with it. He's had no problems since. We opted to go ahead and circumsize my lastborn as well, simply because we didn't want him to feel weird and different and out of place since his daddy and his brother were both clipped. Is that a fair reason in your mind? It was to us.

Ian

TLC Tugger said...

I would quarrel with your conclusion that circumcision has no effect on sexuality. It certainly hampers sensation in the hundreds who die every year.

Aside from that, you need to be careful about the reports and their sources. The first link you give cites a study where every single cut man CHOSE to get circumcised for cultural reasons. I think you'd be hard pressed to find a man admitting that something he went out of his way to do to make himself a "true man" among his peers was a mistake.

It would be more relevant to look at the data from the Korean study where men were cut as adults for medical reasons. You might expect since they were suffering some affliction that they would universally see the after effect as welcome relief, but in fact 4 times as many said sex got worse as said sex got better.

Your second link is a survey of studies, many of which were very shoddy (and I would argue deliberately misleading to re-inforce the culture of the person writing up the results). For example, you'd need to know how long after the amputation were men asked about sensitivity. Abrasion and drying of the glans in the absence of foreskin can take years to manifest as numbness. Men in their 30s who were cut at birth can wake up one day and realize they just don't feel much anymore. That is unnatural. Sex (all of it, not just climax) can and does feel really good for intact males well into old age.

Since the amputated part of the foreskin includes about half the sensual nerve endings and over half of the sexual interface surface area, it is really wishful thinking to say circumcision doesn't affect sex.

No national medical association on earth (not even Israel's) recommends routine circumcision. It is a cosmetic procedure, and therefore since it is HIS body it is morally HIS decision.

Mark Lyndon said...

The effect of circumcision on sexual enjoyment is very controversial. There's a good review of the data here:

href="http://en.wikipedia.org/wiki/Sexual_effects_of_circumcision

Personally, I don't see how cutting off the most sensitive part can make things better (the foreskin is not just there to protect the glans). There are studies that claim to show no difference in sensitivity, but they almost always focus on sensitivity of the glans. That's a bit like comparing vaginal sensitivity between women who've had their clitoris removed or not. Circumcised women usually claim it's improved their sex lives btw.

I think it's wrong to see a fundamental difference between male and female circumcision. Many forms of female circumcision do less damage than male circumcision, and one form is the exact equivalent. It's not always some medically untrained woman hacking away with a shard of glass - in Egypt 90% of girls are circumcised by surgeons in operating theatres.

I think the fastest way to end female circumcision will be to end male circumcision at the same time.

From the summary statement of the paediatric policy on circumcision of the Royal Australasian College of Physicians:
"After extensive review of the literature the RACP reaffirms that there is no medical indication for routine neonatal circumcision." (those last 9 words in bold on their website).
RACP Policy Statement on Circumcision

Most of the people responsible for this statement will be circumcised themselves or married to circumcised men, since the circ rate in Australia was 90% in 1950 (down to 12.6% now). Now why would a bunch of circumcised doctors say that routine circumcision was unnecessary?

Routine male circumcision is now *banned* in public hospitals in all Australian states except one. The children's commissioner in Tasmania wants to ban it there altogether.

Ian, it sounds like your firstborn had a UTI. Only in the USA would this be seen as a problem requiring circumcision. A European doctor wouldn't even have considered it, but US doctors seem to look for reasons to circumcise. Circumcised boys get UTI's too, and girls get them four times as often, yet the treatment then is antibiotics, not surgery.

Less than 1 in 150 males in the UK is circumcised for a medical reason. Even then, the treatment is simply circumcision at a later age, which is safer, hurts less, and results in better cosmetic results.

If my son wants to be circumcised when he's 18 (16 if he knows what he's doing), I'll willingly pay for it, and help him find the best surgeon around. Until then, it's his body, and I don't have the right to have part of his genitals cut off.

Basiorana said...

I don't think, and have never claimed to think, that circumcision particularly improves matters, I simply have found very few studies indicating that it makes things worse. Most agree no difference.

The biggest problem with all the studies is that they are all about circumcision as adults. There just aren't enough studies on the effect of neonatal circumcision. Meanwhile, there are some medical advantages to it. As far as I can tell the risks and the benefits weigh out about equally, so it's a purely cosmetic procedure.

tlc tugger, there are other studies that say older circumcised men have less sexual dysfunction, so the jury's still out on that one. The truth is, millions of men worldwide are circumcised and if the procedure was performed correctly by someone with proper training and tools, they feel absolutely no difference in their satisfaction and have no trouble with sex. Complications, even years later, from circumcision are VERY rare.

I don't like the idea of routine "medical" circumcision, as I said, but I understand the cultural and aesthetic reasons for it. Plenty of parents pierce their baby's ears, which is a cosmetic procedure on the baby's body. Until we say that a parent can't make any cosmetic decisions like that, we can't ban male circumcision.

mark lyndon: The difference between a female and male circumcision is that a female circumcision removes the clitoris, which is akin to removing the GLANS of the penis. I actually don't care if someone removes the clitoral hood, it's like a tiny little flap that no one would notice. The truth is, female circumcision usually varies between removing the glans and removing all the erectile tissue. The most similar procedure in a man would be to cut off the glans or the entire penis, not the foreskin. And it's a lot easier to measure sexual pleasure on men than it is on women, especially when you consider that most uncircumcised women in cultures that circumcise women are ostracized and do not marry at all.

FGM cannot be considered the same thing as male circumcision until we start lopping off the entire penis or the entire glans on a man.

ian: I see no problem with why you chose to circumcise your second son, but there's really not a lot of medical reasons to circumcise, even with infections. There are alternatives; I'm kind of surprised that the doctor suggested circumcision rather than something less invasive.

Just to be clear to everyone: I do NOT think circumcision is medically neccessary and I do NOT think doctors should recommend circumcision unless the boy has phimosis (and if I go into medicine I will never recommend it nor misrepresent it as a medical procedure). However, I DO think that since most current evidence says that males who are circumcised don't really have that much of a different sex life than men who are intact, it should be considered a cosmetic procedure that parents should have the right to chose for their child until we ban all cosmetic body modification procedures on minors even with parental consent.

Mark Lyndon said...

It's simply not true to say that female circumcision always involes removing the clitoris. I agree that that is far worse than regular male circumcision, but many forms of female circumcision do a lot less damage. Even making an incision without removing any tissue (typically splitting the clitoral hood), is a crime, but does a lot less damage than male circumcision.

Guji said...

"it should be considered a cosmetic procedure that parents should have the right to chose for their child until we ban all cosmetic body modification procedures on minors even with parental consent."

It is not, in practice, generally the case that doctors may perform cosmetic body modification procedures on minors. When there is a genuine birth defect or abnormality, then yes. But you can't just go to a doctor and ask her to remove a finger, because the doc would think you're crazy and wouldn't do it.

In practice, male circumcision is totally unique, and it is only be devaluation of the foreskin, the (false) belief that the part is superfluous, that allows one to put it in the same category as an ear piercing, which does not excise tissue.

I appreciate the fine line you're walking here. You recognize there's no medical justification, but you aren't convinced of the harm. You are uncomfortable with the role doctors are playing, but you figure the parental right of body modification trumps any individual right of a child to have his body preserved for him to take custody of as he matures.

I disagree with your conclusion (and I've experienced circumcision personally), but I appreciate your choice to think this through and publish your thoughts.

Estherar said...

Ah, I see the Mutilated Male brigade came over to "educamate" you already. LOL!

My boys were circ'd for religious reasons by a mohel, but I see an advantage to MD's performing non-religious circumcisions because they can better address the pain control issue. And no, there is no real evidence that circumcision negatively affects sexuality (I'm suspending judgement about the 2007 study by a bunch of NOCIRC officials, one of whom has already been caught fudging stats in a previous paper, until a less biased team of researchers duplicates their results).

BTW, the one group of boys which really *would* benefit medically from a circumcision are children like Mr. Healy's youngest, with urogenital malformations. A recent study has shown that prophylactic abx against UTI's are not all they're cranked up to be, whereas circ has been shown to reduce the incidence and recurrence of UTI's in these children. Telling parents they're mutilating their sons and ruining their future sex lives ine these cases is not only false, it's downright cruel.

Love your blog, too. Keep up the good work!

Basiorana said...

mark lyndon: I do not favor criminalizing nicking/splitting the prepuce of the clitoris. I have no problem with that, as I mentioned, since if done correctly it causes no long-term damage. My objection to FGM tends to be only to procedures that remove all or part of the clitoris itself or of course anything involving infibulation.

guji: There are lots of cosmetic procedures performed on kids that aren't medically needed. I knew a girl who had a large birthmark removed from her face when she was an infant (purely aesthetic reasons). Not to mention removing extra fingers and toes from polydactyl kids, or vestigial tails. Those don't really give a medical advantage, they just ensure the kid fits in better or looks more aesthetically pleasing.

Whether body modification is acceptable or not (and what level is acceptable) is a cultural thing, and culturally, circumcision is acceptable. Of course, the distinction is if something will negatively impact the child's life. The evidence seems to indicate that that is not the case, that children who are circumcised have no negative impact to their life. Thus, if it is also culturally acceptable and thus the child will not be ostracised for it, I see no reason to object to it.

I wonder, would you want a child with six fingers to be left that way until he was an adult, so he could chose to keep them or not? I know that that isn't a great analogy because foreskins are almost universal and polydactyly is comparatively rare, but the point remains-- it is a cosmetic procedure done on a child (by a doctor, even) that removes natural, healthy tissue.

Esther: I did think about the pain control issue, though I had read that because traditional mohels don't do the clamping thing, there is less pain and a topical anesthetic cream is sufficient. Dunno how true that is.

guji said...

"I wonder, would you want a child with six fingers to be left that way until he was an adult, so he could chose to keep them or not? I know that that isn't a great analogy because foreskins are almost universal and polydactyly is comparatively rare, but the point remains-- it is a cosmetic procedure done on a child (by a doctor, even) that removes natural, healthy tissue."

Using your example, we can see that there is a significant difference between removing a rare sixth finger (a congenital abnormality) versus removing a finger from a normal hand. One obvious difference is that in the latter, a doctor would be seriously concerned about the ethics of removing a healthy, normal body part and refuse.

Congenital defects/abnormalities are certainly a more complicated issue.

For example, some people are born with ambiguous genitalia. Is it ethical to modify them to fit the mold of male or female? Again, this is a question of what to do about the unusual cases on the margin. There will always be a gray area in ethics.

But ordinary circumcision isn't in that category. It's much more like removing the fifth finger than removing the sixth.

If removing perfectly normal, healthy body parts is acceptable, then to be consistent you need to either open the floodgates and allow children to be sculpted at will, or make a special exception for circumcision.

The former would be a disaster, the latter is what seems to have happened.

But when you need special exceptions, you know there is something amiss.

Anonymous said...

I think it is interesting that it appears very few females have actually had something to say...hmmm :-)

This is a pleasing occurence to someone intereseted in the role of gender in society :-)

-vivacia

Basiorana said...

Actually, polydactyly is a genetic trait, and a person can have six fingers and be perfectly healthy and never have any problem at all with the extra ones. A doctor wouldn't remove a normal finger because fingers are necessary for normal function; even if you assume the finger was, say, the smallest finger, and not as essential, such an act would not be accepted by society and the child would suffer for it. The acceptance of society is also an important factor.

If there was a society where everyone lost a pinkie finger, and thus they did not have either a stigma attached on the loss or an culture designed for five fingers as ours is, and the surgery was performed under sterile conditions, then while I would be a little repulsed at the idea myself, I would not say it was unethical. A person could live a very successful life without a pinkie finger if they were in a culture that accepted it.

However, there is no such culture, and it WOULD be unethical to perform that kind of surgery in our own culture because such a child would not be accepted. Same thing for why doctors shouldn't bifurcate children's tongues or anything.

To be ethical, a body modification must not impact the person's life for the worse, and be culturally acceptable enough that the likelihood of the child later regretting for social reasons is negligible. Circumcision certainly falls into those categories; random body sculpting does not.

(And yes, molding people of ambiguous genitalia into the closest gender is both standard and very ethical, because almost universally that's the gender they wind up identifying with. Rare is the intersex individual who is truly equally half and half in that region and trying to raise them in the wrong gender, or worse, no gender, can really mess up their life. That, however, is a different matter and I could write about three blog posts on assholes who destroy their children's lives in that manner.)

Mark Lyndon said...

mark lyndon: I do not favor criminalizing nicking/splitting the prepuce of the clitoris.

It's already illegal. The exact equivalent of male circumcision is removing the clitoral hood (or prepuce), and that of course is also illegal.

Ah, I see the Mutilated Male brigade came over to "educamate" you already. LOL!

Actually, I'm intact, but then so is almost everyone in the UK.

You might be interested in the rates of male circumcision in some other countries:
Canada: 14% (was 47%)
UK: about 3% (was 35%) (less than 1% among those not Muslim or Jewish)
Australia: 12.6% (was 90%)
New Zealand: below 3% (was 95%) (mostly Samoans and Tongans, less than 1% among whites)
South America and Europe: never above 3%

Basiorana said...

mark lyndon: Simply because other people believe that that form of female circumcision is wrong doesn't mean that I agree with them, or that you should chastise me for this inequality considering I think it unfair as well-- I just favor allowing it, while you favor criminalizing the male version.

Also, why is there such concern about the horrors of routine male circumcision considering that by your own admission it is rare and mostly occurs among those who consider it a religious necessity?

Mark Lyndon said...

It's rare to find someone western who will defend any form of female circumcision, but at least you're consistent.

I just think it's a fundamental right of everyone not to have parts of their genitals cut off without medical need, and it seem a glaring inequality that girls are protected, but not boys. If someone chooses to have it done to themselves, that's up to them, but the decision should not be made for them.

Personally, I find it very hard to imagine that I could enjoy sex anywhere near as much if I'd been circumcised. It's the most sensitive part that gets cut off - it's not just there to protect the glans.

Basiorana said...

The truth is, boys that are circumcised as children very rarely have a problem as an adult. If it was done right and there were no complications, they enjoy sex perfectly fine, and never have any problems until they are told they should have problems (then you can get psychosomatic issues). If someone enjoys sex, doesn't have any more problems than their peers, and has no unusual level of sexual dysfunction, why should we speculate about whether they might have possibly had an even BETTER sex life if they hadn't? They enjoy sex a great deal, they can have sex, they have no pain or discomfort, no reduced fertility. What, then, is the problem?

I think what we need is a study on sexual response comparing men who were circumcised as infants to men who are intact. Most studies deal with men who are circumcised as adults. If such a study comes out and they have a reasonably objective way of measuring sexual satisfaction and success (not just based on what the men say, but rather measuring serotonin/oxytocin levels and that sort of thing), and such a study can prove that there is ANY significant difference between a circumcised and an intact man, I might change my mind.

The burden of proof is on the medical community to prove that it is worthwhile to do it routinely for medical reasons; thus far, no such evidence exists, so I think it's safe to say that routine circumcision should not be performed. However, the burden of proof is on circumcision opponents to prove that there is any real harm done, and until they can prove so through valid scientific studies, with large sample sizes and accurate measurements of results, and those results can be repeated by an independent agency, circumcision should stay legal.

It is always best to err on the side of greater freedom and less legislation until we can conclusively prove that there is definite harm occurring.

Guji said...

"If there was a society where everyone lost a pinkie finger, and thus they did not have either a stigma attached on the loss or an culture designed for five fingers as ours is, and the surgery was performed under sterile conditions, then while I would be a little repulsed at the idea myself, I would not say it was unethical."

I find this reasoning troubling because it's self referential: It's okay to do because we do it. That is problematic in part because circumcision was introduced by the medical community under pretenses now discredited. Once the supposed medical reasons have evaporated, why would it be ethical to continue the procedure on grounds that it is now a cultural thing? Isn't that a perversion of medical ethics when the surgery is on a child who cannot consent or refuse?

"However, the burden of proof is on circumcision opponents to prove that there is any real harm done, and until they can prove so through valid scientific studies, with large sample sizes and accurate measurements of results, and those results can be repeated by an independent agency, circumcision should stay legal."

What of the argument that loss of sensation is a form of harm (proportional to the degree lost)?

To illustrate, imagine some new drug made it to market after which we discover that 14% of intact males using it experience a permanent loss of all sensation of the foreskin. What was previously tissue sensitive to touch is now devoid of sensation. Could the drug company claim the drug did not harm these men?

Basiorana said...

"That is problematic in part because circumcision was introduced by the medical community under pretenses now discredited."

Circumcision was introduced by the Jews, and also independently by several African tribes. It's hardly a new practice. Culturally, still, most people who continue to circumcise their children are of Jewish, Muslim, or African ancestry; circumcisions for those who have no religious obligation (or who are part of that culture) are increasingly rare.

It's not okay because we do it, it's okay because it causes no lasting physical harm, and because there is no reason to expect that a circumcised child will be ostracized, have difficulty with normal life, etc on account of the fact that he is circumcised. If it is done at a young age he won't even miss it, unless he is convinced that he should for some reason.

"What was previously tissue sensitive to touch is now devoid of sensation."

Surely you see the difference between having the foreskin there, but unable to perceive stimuli and thus simply blocking stimuli to the glans, and having it missing all together. Also, men who either want to be circumcised or who have been circumcised since birth and accept it as normal are not nearly as likely to react badly to their lack of foreskin as a man who was not used to the idea would react to a part of his genitalia losing all sensation.

A person who wants or is used to the idea of themselves as circumcised will have a perfectly normal, enjoyable sex life and will never miss the loss of sensation. To prove harm, you would have to prove that it either impacted the sex life, impacted the physical health, or impacted the emotional health of a greater number of individuals than who would have those problems in the normal population, and prove that there was a significantly higher rate of whatever condition you found.

Guji said...

"Circumcision was introduced by the Jews, and also independently by several African tribes."

Documentary evidence shows that circumcision dates at least as far back as 2345-2181 BCE in ancient Egypt.

"Culturally, still, most people who continue to circumcise their children are of Jewish, Muslim, or African ancestry; circumcisions for those who have no religious obligation (or who are part of that culture) are increasingly rare."

In the United States, circumcision was introduced by the medical profession under pretenses now discredited. The rate has dramatically fallen, but still over half of boys are circumcised shortly after birth, and very few of those are due to Jewish or Muslim religious requirements. In America (and only in America) it is a secular custom.

"It's not okay because we do it"

When you assert that social acceptance can justify it, then that is "doing it because we do it." It's self referential. You're saying it's okay because it is "normal."

"If it is done at a young age he won't even miss it, unless he is convinced that he should for some reason."

This is just an appeal to a supposed normalcy. You're saying that since it's common, he won't think twice about it, but that is pure speculation and is far less true than it once was due to dramatic changes in the world. 30 years ago, one could be fairly ignorant about normal male anatomy. But today, with the internet, you can expect people to learn the truth.

"Surely you see the difference between having the foreskin there, but unable to perceive stimuli and thus simply blocking stimuli to the glans, and having it missing all together."

You seem to be implicitly admitting that yes, if 14% of intact men experienced permanent loss of sensation of the foreskin due to a drug, that would be considered harmful, and the drug company would probably be liable for large sums of money.

Now, you ask, isn't that worse than having no foreskin at all? I doubt it. Men "restore" their foreskins even though they can never regain the nerves that were cut off precisely because they regain the protective glans covering that nature settled on after millions of years of evolution. The glans is exposed when it needs to be, during intercourse.

"Also, men who either want to be circumcised or who have been circumcised since birth and accept it as normal are not nearly as likely to react badly to their lack of foreskin as a man who was not used to the idea would react to a part of his genitalia losing all sensation."

That's probably true, but since when did "not knowing any better" make something okay? That sounds so callous. If a man would be upset to lose sensation in his foreskin, that suggests that a man who never gets the chance to have it in the first place was denied something important.

"A person who wants or is used to the idea of themselves as circumcised will have a perfectly normal, enjoyable sex life and will never miss the loss of sensation."

Again, that depends on ignorance. That depends on men being fooled into not knowing what was taken from them. That's just not practical anymore. Accurate information obtained in private (as private as web surfing) is too accessible now. It is unreasonable to think a child born today will not learn the truth.

"To prove harm, you would have to prove that it either impacted the sex life, impacted the physical health, or impacted the emotional health of a greater number of individuals than who would have those problems in the normal population, and prove that there was a significantly higher rate of whatever condition you found."

The criteria for justifying a surgery is not lack of proof of harm, it's proof that it has benefits in excess of the risks and the non-existence of less invasive options. Circumcision fails that test. Doctors fail the medical ethics test when they perform it merely because parents ask for it.

In those cases when there are complications, and there are many, then the harm is obvious.

In those cases when men grow up to regret their loss, which again is sure to increase with better access to accurate information, the harm is obvious.

When any form of normal human sensory capability is lost, even if before one knows what they lost, the harm should be obvious.

The way medicine works is NOT to permit a surgery until it is proven not harmful. Except, perversely, with circumcision.

Basiorana said...

Simply knowing that they were born with a foreskin and that that is normal is not enough to make a man without one feel abnormal or mutilated. Circumcision is sufficiently common worldwide that it would be a rare man who would feel unusual because of it it.

It's okay because it's accepted, because there will be no social repercussions for the act. A person who is missing, say, a finger in Western society may also not have any physical problems, but they would have emotional problems because it would be obvious, exposed, and clearly very unusual. Not so for circumcised men. The lack of the emotional difficulty (except for men who become convinced that circumcision is to blame for every failure they've ever had) makes circumcision acceptable, because it isn't causing that level of harm.

Most men wear clothing all the time, they aren't exactly running naked through the brush. They don't require the same level of protection our ancestors did. And besides, if the foreskin is so sensitive and crucial to sex, it is hardly advantageous to have it as protection.

Also, most men who restore seem to believe it will improve their sex life somehow, not that they will get some protection that underwear can't bestow.

Without the psychological affects of coming to believe that circumcised men can't enjoy sex as well, or that their sex lives would be better were they intact, men would hardly regret circumcisions. As soon as that factors in, it becomes a self-fufilling prophecy with psychosomatic symptoms. The truth is, the brain is the most important sexual organ and if a man believes a circumcision will improve his sex life, it will; if he thinks it will hurt it, it will; and if he thinks it will make no difference it will make no difference. It is not the nerves themselves that are significant, but rather the emotional response to having or not having them. More or less nerves don't matter all that much compared to the overall amount of nerves in the penis.

You assume that all men will read online that being intact is normal and circumcision will destroy their sex life and they will not only believe it, but hold it as gospel. Some do; they then start psyching themselves out. Most men, however, look at that, think, "Hmm, my sex life's perfectly fine, I've never had any more problems than the next guy, they're full of shit" and move on.

And your criteria for surgery completely ignores millions of cosmetic surgeries performed every single year for aesthetic reasons. Often those surgeries are even performed on minors, some on young children. Those confer advantages that are purely psychological and/or aesthetic in nature. Why are those acceptable and widely practiced when it is not okay for circumcision to be?

Mark Lyndon said...

1) it's the inner foreskin that's so sensitive. The outer foreskin doesn't feel too different from the skin along the shaft. I would find it very uncomfortable to be retracted for too long. Men with loose circumcisions sometimes get to keep the most important parts (the frenulum btw, and the part of the inner foreskin closest to the corona).

2) we know that most men who were circumcised as babies don't have a problem with it. That doesn't make it right - most women who've been circumcised want it done to their daughters. That applies even with some of the extreme forms of female circumcision. Some men choose to be circumcised as adults, and I think that should be their choice. They don't have that choice if it's already been made for them though.

3) I'm not really interested in trying to make circumcised men feel bad about themselves, and I hope they have great sex lives. I still feel sorry for them, and think they should leave their children intact though.

All four of my male Australian cousins are circumcised btw, (and probably the husband of my female cousin), but none of the 5 boys in the next generation were circumcised.

4) Most cosmetic surgery doesn't involve cutting off highly sensitive tissue, and the risks, though very small are real. Even in the west, there are deaths most years, and the occasional amputation.

I would love to see the results of a study comparing rates of ED for intact and circumcised men, and I hope it may one day be possible for some kind of scan to show where the orgasm takes place. The most intense part for me takes place on a part that could have been cut off.

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