Open Thread

7 thoughts on “Open Thread”

1. Christian,
   On the claim that “male circumcision eliminates the possibility of at least one disease,” that disease isn’t obvious. What disease do you mean?

2. Thank you for taking me up on this request!
   Diseases prevented or reduced by circumcusion include:
   1. Balanitis. Circumcision remains the single most effective and most commonly treatment for some forms of this disease, including plasma cell balanitis, lichen sclerosus, balanitis xerotica obliterans, and BXO. In fact, circumcision is the *ONLY* effective remedy for the balanitis xerotica obliterans and BXO!
   2. Human papilloma virus HPV. Circumcision significantly reduces these genital warts in both their harmless variety and also reduces the cancerous manifestation of HPV.
   3. paraphimosis (completely eliminated by circumcision)
   4. phimosis (completely eliminated by circumcision)
   5. urinary tract infactions (90% reduction in male newborns)
   Other links shown by studies but not solidly quantified yet:
   *HIV: Reduced by circumcision, as you conceded in the previous thread.
   *Penile Cancer: “Some” reduction, according to AMA and AAP. AMA thinks that the decreased risk is too slight to justify circumcision; the AAP (American Academy of Pediatrics) disagrees.

3. I’m not going to contradict anything in your list. As you point out, I conceded the HIV reduction in the previous thread. I have no problem accepting that circumcision does what you say it does. But conceding these points amounts to nothing when faced with the glaring weakness in the assumption that these potential benefits are enough to justify non-therapeutic circumcision on a minor. (As I mentioned in the previous thread, I don’t care what adults do to themselves or the reasons they use.)
   Ultimately, the key that is lost in assumptions that deem male circumcision acceptable is that the benefits, in most cases, are potential. Balanitis? Treat it when it arises, not before. Paraphimosis? Same thing. Phimosis? Same thing. UTI? Same thing. Treating disease when it occurs is the way we react to every other disease* in children. The American medical community is far too quick to remove foreskins for diseases that can be treated with less invasive measures.
   HPV and HIV require a different analysis because they’re acquired differently. They don’t just happen. They are diseases with a behavioral cause. I’m not silly enough to believe that all children will behave responsibly. But most will. They should not be punished with removal of healthy body parts because the actions of a few are reckless. I’ve never engaged in risky behavior. Circumcision hasn’t helped me. Also, as I mentioned on the previous thread, the HIV argument only holds if men intend to engage in unprotected sex with HIV-positive women. Would we recommend that? The reduced infection is significant, but only for a tiny portion of sexual encounters. The overall effect is very minor, at best. Circumcising more than 1 million infant males in the U.S. every year to save a few (irresponsible) men from HIV is a gross overreaction.
   Back to the more traditional explanations for circumcision. Phimosis, for example, is too often diagnosed early in childhood. Because the foreskin takes years to separate from the glans, it’s logical to realize that full retraction will not occur immediately. Even in cases where phimosis legitimately exists, there are methods to relieve the problem without circumcision. Using the least invasive method available on a person who can’t consent should be the basic standard.
   With UTIs, sure circumcised boys get fewer. Big deal. Girls get more than intact boys. We don’t treat those with genital cutting, and definitely not pre-emptively. Why should there be a different standard, especially when the frequency for girls is greater? There shouldn’t be one.
   This is important for several reasons. The foreskin serves many functions. You mentioned earlier that I said the foreskin’s main purpose is sexual pleasure. I don’t think I said that, but it makes little difference. That is a significant purpose. There is also a basic function for intercourse that the circumcised penis can’t accomplish.
   But the foreskin’s primary purpose with respect to infant circumcision is to protect the glans and the inner foreskin. Those are mucous membrane just like female genitalia. As I said and I’m sure you’re aware, the foreskin adheres to the glans at birth. To circumcise, this bond must be forcibly broken. Harm will result. Noticeable harm will not necessarily occur in every male, but the persistence of skin bridges, bleeding, and remnant foreskin that reattaches to the glans can’t be predicted or prevented. The latter can be prevented by taking too much skin, but that’s a poor, cruel solution. Causing any of this for strictly potential benefits makes no sense.
   The entire penis should be left alone until the boy is old enough to choose for himself or a specific medical condition arises that can be treated with no less invasive treatment. His body will mature and, if he decides he wants circumcision, his surgeon will have a better understanding of how much to take. The important addition is that it will be with the man’s input. Parents, if they express a wish, get to decide how the boy should like his penis. That’s ridiculous.
   There are also basic human rights issues that I’d love to address. That’ll carry us into the male versus female genital cutting issue, which I want to return to. But I’ve said enough for now. We’ll steer it there later, if you’re still interested.
   * The vaccination argument is different. Those diseases are communicable, which poses a separate public health question. UTIs, for example, do not fall into this category. The analysis for preventive treatment is different. For what it’s worth, I think parents should vaccinate their children. (No, Gardasil does not fall into that category.)

4. I want to add that I don’t concede circumcision’s HIV prevention abilities on the basis that the science is compelling or insightful. It’s not. Langerhans cells are conducive to HIV transmission. Okay, so what? Females have plenty of Langerhans cells in their genitals, but we don’t advocate cutting them. Even the mention of studying the possible benefits is met with outraged resistance. (Rightfully so.) But the analysis ultimately narrows to one point. The less skin there is to become infected, the less infection you’ll see.
   The specific reduction based on the amount of skin removed will have some skewing to an “optimal” point based on some cost-benefit (that usually excludes the foreskin owner’s input) analysis. But the logical conclusion is to remove as much foreskin as possible. That should be seen as insane. Taking less skin is still on that insane thought, only to a lesser degree. That doesn’t rescue it.

5. “Females have plenty of Langerhans cells in their genitals, but we don’t advocate cutting them.”
   That’s a matter of diminishing returns. You may disagree with whether MC is worth the benefits conveyed, but that’s a matter of interpretation; I can’t say that you’re wrong about that. It’s still different in kind as well as in degree from FGM, since there is some medical benefit. People use FGM to cripple the woman’s capacity to enjoy sex. That’s not why people in the US today use MC.

6. But the medical benefit you’re discussing is preventive, not therapeutic. That opens the discussion to more than just the parental intent. The result of the surgery outside of the potential benefits must be factored in. We’re talking about unnecessary surgery on the genitals of non-consenting infants.
   That makes the difference only one of degree. From what I mentioned in the previous thread, male circumcision was originally performed to inhibit male sexuality. Applying carbolic acid to the clitoris was also practiced to inhibit girls. The attitude shifted to believe that women don’t have much sexual interest so they need all the sensitivity they can get. That ended the regular practice in the U.S.
   But males were deemed to have an abundant sex drive, so removing a little sensitivity was okay. It could be overcome. Then, as medical practice “advanced”, circumcision’s miraculous abilities were promoted. Nevermind that many of these benefits have been discredited or proven to be not nearly as effective or compelling. But it’s entrenched in the American mindset.
   The same could’ve happened with FGM with an realization that women enjoy sex. There might’ve been research to find medical benefits from the procedure to justify it. Now, even if FGM might provide potential benefits, we wouldn’t consider researching them. We understand that they’re pointless to the truth that women have rights to an intact body. Rather than an accurate understanding of genital cutting, one flawed premise saved generations of women in America.
   This gets back to my earlier point about a pinprick, which you referred to as sophistic and sadistic. I’m not imagining a scenario to make a point, nor am I advocating it. But a pinprick is a form of FGM. We don’t allow even this, as an example in Seattle a few years ago showed. But it’s intent is clearly not to cripple a woman’s capacity to enjoy sex.
   Results matter. Male circumcision impacts a man’s ability to enjoy sex. He will probably still enjoy sex, but not in the way his normal, intact body would. No one has the right to take that away from him without an immediate medical need.
   Since MC and FGM are the removal of healthy genital tissue for non-medical reasons froma non-consenting individual, they’re the same. It’s the difference between assault and murder. The latter is significantly worse, but that doesn’t negate the unacceptability of the former. Harm is harm.

7. Did you know the bug that causes staph infections is very dangerous and can inflict serious damage on the human body?
   Did you also know that studies have consistently shown that circumcised infants suffer from a much higher rate of staph infections than intact infants?
   It should be illegal for anyone to claim that circumcision prevents UTIs or other infectious diseases without mentioning this fact.

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