Dr Rick

I apologize, MrDarwin; the tone of my reply to you was impolite.

Rick

Dr Rick

...besides, I thought posting that circumcised men get more blowjobs would be all the convincing you need...

Rick

[ August 21, 2002: Message edited by: rbochnermd ]</p>

nyx

Hi Rick,

Conspiracy might not be the right word. I was thinking, and probably didn't express it well, that as you said, decision to circumcise routinely, is most likely a reflection of society, not medical benefits. It would be helpful if the medical community emphasized the belief that routine circumcision provides the greatest benefit in countries affected by HIV, based on these studies you've mentioned.

nyx

nyx

What evidence do you have to support the blow job theory?

Nyx

tronvillain

rbochnermd:
Well, circumcision causes a mucous membrane to dry out and keratinize, and it is difficult to see how the same sensitivity could be retained afterwards (see my answer to your earlier question). Given this, a likely explanation of circumsized men engaging in sexual practices such as oral and anal sex would seem to be that they are not getting all of the stimulation they want from vaginal sex. What explantion would you offer?

Here is the abstract from <a href="http://www.cirp.org/library/sex_function/fink1/" target="_blank">ADULT CIRCUMCISION OUTCOMES STUDY: EFFECT ON ERECTILE
FUNCTION, PENILE SENSITIVITY, SEXUAL ACTIVITY AND
SATISFACTION</a>, JOURNAL OF UROLOGY, Volume 167, Number 5: Pages 2113-2116, May 2002:
Granted, improved satisfaction was reported, but most of the men had problems. It would be interesting to find out what the numbers were for the seven percent that were elective.

Well, if they merely get more blowjobs because the decrease in sensation drives them to more actively pursue blowjobs, is it really worth it?

It seems entirely possible that drying out and keratinizing a mucouc membrane would reduce the transmission of STDS, but since STDs are not a problem encountered by newborns, I think it would be a good idea to let people decide for themselves whether the decrease in risk is worth having part of themselves removed. Oh, there is the supposed decrease in UTI in infants, but those studies I've seen had serious flaws.

Anyway, while the male neonatal circumcision rate here in BC peaked at nearly sixty percent in the seventies, it has steadily declined since then - was all the way down to six percent in ninety-seven. Of course, Quebec was way below that even back in the eighties, but hopefully we'll catch up.

Oh, and here's an interesting <a href="http://www.intact.ca/saskmemo.html" target="_blank">memo</a> from the College of Physicians and Surgeons of Saskatchewan:
Pretty recent memo too. Interesting, if it is genuine.

One of the last sane

I think arguing about the slight benefits of circumcision ignores or evades the real issue, which is an ethical one. Is it ethical to perform a non-essential surgical procedure on a minor who is too young to give any sort of consent?

Looking at it as an issue of medical ethics and according to current standards of informed consent, it seems like a no-brainer to me: Boys should make their own decision when they are old enough to make it. If that reduces the beneficial effect, it also reduces the chance that the boy will become a man who feels that he has been deprived of a body part against his will.

Dr Rick

Not likely, just conceivable. We don't know what the mechanism is that underlies the findings of the study, so it's hard to see the utility of ad hoc explanations such as the one you offer or how we could possibly determine that the probability of it being correct is "likely." There are other possibilities, and we have no way of knowing for sure if they are any more or less likely than the speculation you offer: perhaps the study participants' partners found a circumcised phallus more palatable than a foreskin, perhaps the circumcised phallus caused changes in the participants approach and philosophy to life and/or sex after years of having a foreskin; who knows?

What we have are simply the study results, and further questions about it require either re-analyzing the raw collected data or conducting new studies to address any questions that arise from the results of this one. The results don't call for unsubstantiated, unverifiable speculation

<strong> None; I feel no compulsion to read into a study beyond what it can show. The study was not designed to answer the questions you ask, and I see no point in making up explanations.

<strong> The response rate of less than half from the intended responders strongly suggests that something is amiss and that there is a real possibility of selection bias amongst the responders. We don't even have the responses of the majority of the patients under study, so what conclusions can we draw about them other than that they didn't respond. Were they so estatically happy with the results that they didn't want to take time-out from their lives to answer the survey, were they so angry with the outcomes that they didn't want anything to do with the survey, or were they dead? These different possibilities could have very different effects upon the study outcomes.

Good retrospective study coordinators will go to great lengths to get follow-up from all of the intended participants; some have even hired detective agencies to track-down intended participants and as a result have input from 90% or more of the subjects.

I'm impressed that you would question the results off the elective sub-group; most of the guys in the study had a medical conditon which could have biased their responses in favor of circumcision.

Unfortunately, the retrospective nature of the study without any analysis of the subjects prior to circumcision makes it impossible to know what impact their pre-procedure health and biases had upon the outcomes.

Just how the reported decrease in sensitivity and erectile function was translated into improved satisfaction by the study participants is beyond me; however, the retrospective nature of the study and the dismal participation rate in the study may have severely limited the objectivity of the respondents.

<strong> Hell yes!

By the way, I have no idea if the circumcised men in the study I quoted were having more or less oral sex or anal sex and/or hand jobs following the procedure. I really don't know what the authors meant by "more elaborated sexual practices." so I just threw in "blowjobs."

<strong> Fisrt-off, you're speculating, and are very possibly wrong. It was at one time thought that mechanical changes in the glans following circumcision could account for the differences in STD rates; that may be correct, but more recent laboratory studies suggest cellular changes in specialized leukocytes within the glans and the abscence of others once the foreskin is excised may be responsible for the observed differences.

Secondly, you're ignoring the accumulating body of evidence, some of which I posted on this thread, that the protection circumcision offers against malignancies and infections may be markedly diminished if the procedure is delayed into adulthood.

Finally, the prevention of neonatal UTI's by circumcision has been well-documented, and I would certainly like to see and discuss what specific flaws you have found in the more recent studies.

Again, I'm pleased to see that you are looking at studies for yourself instead of automatically accepting the interpretations from the anti-circ sites or from me.

<strong> You mean: it's not?!

Rick

[ August 21, 2002: Message edited by: rbochnermd ]</p>

Dr Rick

How about great benefits, then? There are studies demonstrating that the risk of HIV acquistion in some endemic areas can be cut in half with prepubertal, but not adult, circumcison. Is it ethical to deprive a child of the chance to reduce his and his future wife's and childrens' risk of HIV infection (which in some areas of sub-Saharan Africa approach an prevalence of 25% or more) by two-fold?

Where is the "no-brainer" ethics line drawn? At 50%, or 100%, or 25%, or 5% or 1% risk reduction? Does it not matter at all, perhaps: should neonatal circumcison be prohibited even if it can save lives? What ethical standard are you employing that at some point values a small piece of tissue over the lives of many people that may die from diseases that could have been prevented? Should we decide, for their own good, that African boys, because their risks are higher, are not entitled to the same "rights" of choice as North American and European boys, or should we let many of them die from preventable causes?

Rick

[ August 21, 2002: Message edited by: rbochnermd ]</p>

mibby529

Geez, if infant circumcision can prevent AIDS, then why were the first recorded AIDS cases among white American males born in the 50s - the most likely group to be circumcised?

Circumcision is a classic example of ad hoc hypothesis. In America, it was originally done to prevent masturbation.

beoba

I'm uncut, thats about all I have to say.

One thing I really like about this forum is how threads like this are able to come up and not be censored by some offended moderator.