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Old 02-19-2002, 03:35 PM   #161
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Cool

** was going to say something... but just walks away shaking his head slightly.... finds the whole situation.... rather bizarre.... **

Possibly I'm wierd..... but this just disturbs me on SO many levels that I'm not sure where to start exactly......

[ February 19, 2002: Message edited by: Corwin ]</p>
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Old 02-19-2002, 11:38 PM   #162
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Smile

It looks better cut, you last longer due to decreased sensitivity, and girls are more willing to put it in their mouth....

All the reasons I need! Glad my parents did it to me, and will be doing it to any boy my beautiful cut cock may produce
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Old 02-20-2002, 12:03 AM   #163
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Well, I can't say I don't find that disturbing. Of course, I've never had difficulties in any of those areas.
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Old 02-20-2002, 06:44 AM   #164
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I think ear rings are barbaric. I think sticking bones through your nose, (as some tribes do), is barbaric. I think the Burmese women with their long necks are barbaric. I think the Mayans? or Aztecs?, who would gradually disfigure the shape of their heads were barbaric. That chinese feet mutilation thing was/is! barbaric. FGM is barbaric. That thing with sticking a plate in your lower lip in African tribes is barbaric.
All these barbaric customs are/were considered
beautiful in the cultures they were practiced in.
(Except FGM which I think is just to make sure women don't enjoy sex.)

Circumsision is our own little barbaric custom.
It is wrong.
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Old 02-20-2002, 03:30 PM   #165
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Quote:
Originally posted by alek0:
<strong>American cancer society are experts on cancer. If they do not recognise circumcision as preventive measure, I think that there is good reason to beleive that they know better than some bogus researcher from India.</strong>
That the ACS has not established a position on circumcision does not disprove its benefits. At issue is whether or not circumcision's benefits exceed its risks, and the AAP policy statement makes very clear that this issue has yet to be resolved. You have erroneously concluded that this must mean that there is no benefit to circumcision, but you are wrong. This important distinction has been stated for you several times on this thread.

Just because researchers are from India does not mean that they are "bogus." On the contrary, another poster fallaciously complained that most of the researchers were biased because they were Americans or Christians. The reason that these two positions are both wrong is that they are both prejudiced.

<strong>
Quote:
I have also quoted studies which give large p values and large confidence intervals.</strong>
In other words, prejudice is not the only flaw in your arguement; you're also citing bad data.

Quote:
<strong>As I have said before, you can always find papers to support your point of view. This is What is necessary is to do critical analysis of those results. If there is a paper which claims that there is protective effect of circumcision in cities but not in rural areas and islands, there is something strange in those results, don't you think?</strong>
Something is strangely wrong with your ability to critically analyze data and your understanding of population-based studies. People in cities have lifestyles that are different from those of rural dwellers; that is why many epidemiologic studies including the one you cited distinguish study groups on this basis. Prostitution, drug abuse, and numbers of available partners are just some of the variables that could differ between these two groups and account for the differences observed.

Circumcision confers a protective effect on the transmission of certain viral STD's, but this effect may not be detectable in a population that otherwise has relatively lower risk factors for these illnesses. That is why it is appropriate to consider demographics in analyzing data from this type of study.

<strong>
Quote:
It is ridicilous to rely only on statistics, and good scientific study should also give a valid and supportable explanation of the observed results.</strong>
First of all, a statistically valid observation is valid even if the observation is at first difficult to explain. Secondly, there are several explanations in the literature as to why circumcision protects against certain cancers and infections. These include decreased susceptiblity to glans "micro" trauma and hygiene issues.

<strong>
Quote:
I have also quoted a paper on surgical correction of phimosis without circumcision. On which you've had no comment.</strong>
You previoiusly said that phimosis can be corrected with topical creams; this paper does not support your spurious claim.

<strong>
Quote:
...if the estimates of risk are made on the basis of self-reported factors such as number of partners, it is very relevant to ask how reliable that is.</strong>
There might be a reporting bias, but you've done nothing to show that there is one or that it has affected any results. A reporting bias, if one exists, could make the protective effect of circumcision appear either greater or lower than it really is, or have no effect at all. Which effect it has would depend on the way the putative bias affects the reporting.

<strong>
Quote:
Also, amount of foreskin removed is very relevant if Langerhan's cells play a role in virus transmission.</strong>
This is a non sequitor. You have been arguing against the protective effects of circumcision, but now you're speculating on the mechanics of its protective effects.

Quote:
<strong>I have also posted papers on complications of circumcision, which you have decided to ignore.</strong>
That there are risks associated with circumcision has been acknowledged repeatedly on this thread; the question is, "do the benefits of circumcision outweigh the risks?" Once again, this important distinction has been stated for you several times.

<strong>
Quote:
But the most important question is how STD risk justifies circumcision of infants?</strong>
You were previously claiming it doesn't decrease the risk of STD transmission or the risk of cancer.

[ February 20, 2002: Message edited by: rbochnermd ]</p>
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Old 02-21-2002, 02:45 AM   #166
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Rbochnermd,

I have claimed and still claim that phimosis can be corrected without circumcision either with foreskin preserving surgery as described in previously quoted article, or with topical steroids, see following refs:

TITLE: The treatment of childhood phimosis with topical steroid.
AUTHOR: Wright,-J-E
SOURCE: Aust-N-Z-J-Surg. 1994 May; 64(5): 327-8.

[Phimosis in boys can be treated by a steroid ointment]
AUTHOR: Jorgensen,-E-T; Svensson,-A
SOURCE: Lakartidningen. 1994 Mar 30; 91(13): 1291.

TITLE: The treatment of phimosis in boys, with a potent topical steroid (clobetasol propionate 0.05%) cream.
AUTHOR: Jorgensen,-E-T; Svensson,-A
SOURCE: Acta-Derm-Venereol. 1993 Feb; 73(1): 55-6.

TITLE: Phimosis: is circumcision necessary?
AUTHOR: Dewan,-P-A; Tieu,-H-C; Chieng,-B-S
SOURCE: J-Paediatr-Child-Health. 1996 Aug; 32(4): 285-9.

TITLE: The conservative treatment of phimosis in boys.
AUTHOR: Golubovic,-Z; Milanovic,-D; Vukadinovic,-V; Rakic,-I; Perovic,-S
SOURCE: Br-J-Urol. 1996 Nov; 78(5): 786-8.

TITLE: Conservative treatment of phimosis in children using a topical steroid.
AUTHOR: Orsola,-A; Caffaratti,-J; Garat,-J-M
SOURCE: Urology. 2000 Aug 1; 56(2): 307-10.

TITLE: Topical steroid treatment of phimosis in boys.
AUTHOR: Chu,-C-C; Chen,-K-C; Diau,-G-Y
SOURCE: J-Urol. 1999 Sep; 162(3 Pt 1): 861-3.

TITLE: Medical management of phimosis in children: our experience with topical steroids.
AUTHOR: Monsour,-M-A; Rabinovitch,-H-H; Dean,-G-E
SOURCE: J-Urol. 1999 Sep; 162(3 Pt 2): 1162-4.

[Topical steroids in the treatment of phimosis in children]
AUTHOR: Pless,-T-K; Spjeldnaes,-N; Jorgensen,-T-M
SOURCE: Ugeskr-Laeger. 1999 Nov 22; 161(47): 6493-5.

TITLE: Effect of topical steroid on non-retractile prepubertal foreskin by a prospective, randomized, double-blind study.
AUTHOR: Lund,-L; Wai,-K-H; Mui,-L-M; Yeung,-C-K
SOURCE: Scand-J-Urol-Nephrol. 2000 Aug; 34(4): 267-9.

Or non steroidal topical cream:
TITLE: A nonsurgical approach to the treatment of phimosis: local nonsteroidal anti-inflammatory ointment application.
AUTHOR: Atilla,-M-K; Dundaroz,-R; Odabas,-O; Ozturk,-H; Akin,-R; Gokcay,-E
SOURCE: J-Urol. 1997 Jul; 158(1): 196-7.
------------------------------------------------

Concerning circumcision and HIV, the case is not as clear cut as you would like to present it, see for example metanalysis by Van Howe

TITLE: Circumcision and HIV infection: review of the literature and meta-analysis.
AUTHOR: Van-Howe,-R-S
SOURCE: Int-J-STD-AIDS. 1999 Jan; 10(1): 8-16.
JOURNAL NAME: International-journal-of-STD-and-AIDS;
INTERNATIONAL STANDARD SERIAL NUMBER: 0956-4624
LANGUAGE: English
ABSTRACT: Thirty-five articles and a number of abstracts have been published in the medical literature looking at the relationship between male circumcision and HIV infection. Study designs have included geographical analysis, studies of high-risk patients, partner studies and random population surveys. Most of the studies have been conducted in Africa. A meta-analysis was performed on the 29 published articles where data were available. When the raw data are combined, a man with a circumcised penis is at greater risk of acquiring and transmitting HIV than a man with a non-circumcised penis (odds ratio (OR)=1.06, 95% confidence interval (CI)=1.01-1.12). Based on the studies published to date, recommending routine circumcision as a prophylactic measure to prevent HIV infection in Africa, or elsewhere, is scientifically unfounded.

I've raised the objections to some of the studies on this topic, which you have chosen to ignore.

Now, even if we decide to ignore all the problems with studies on circumcision and HIV/STDs and assume that there is protective effect, this leaves us with the need to establish exact mechanism how that works. If Langerhan's cells are the problem, how much foreskin one needs to remove to see the benefit and how does this affect risk vs. benefit analysis for neonatal circumcision since it is difficult to judge how much to remove on infant's penis.

And finally, and most importantly, even if there is a protective effect, what is ethical justification on performing this procedure on infants, which are certainly not going to be at risk before the age at which they can understand the risks and benefits. So why neonatal circumcision at all?

Finally, any comments on the following paper:

Circumcision and infectious diseases revisited

ROBERT S. VAN HOWE, MD

From the Department of Pediatrics, Marshfield Clinic-Lakeland Center, Minocqua, WI.

THE PEDIATRIC INFECTIOUS DISEASE JOURNAL 1998;17:1-6

Key words: Circumcision; medical history; schistosomiasis.

The recently published Opinion and Analysis piece by Gerald Weiss1 invites rebuttal. On the basis of his previous publications, Weiss is unabashedly procircumcision.2-4 He has made unsubstantiated claims in the past and as recently as 1994 still believed that neonates do not feel pain.2,5 Although Dr. Weiss is entitled to his viewpoint, the editorial structure of well-respected and mainstream medical journals such as The Pediatric Infectious Disease Journal® should permit factual refutation of what I believe are the many erroneous statements and assumptions in Weiss's article.

HYPERBOLE
The opening paragraph by Weiss, pointing out the prevalence and mortality of infectious diseases, has very little to do with infectious diseases involving the penis. He tries to create an urgency to intervene where no intervention is needed. To make this argument cogent, he would need to demonstrate that the penis is a common focus of serious infection and disease. He never does. While "half the people on this globe live in fear of plagues," only a small percentage of males ever have penile-associated infections.

Weiss describes the preputial cavity as a "cesspool," demonstrating his ignorance of this cavity. The wetness found in this space is made up of prostatic, seminal vesicular and urethral secretions. The prostatic and seminal vesicular secretions are rich in lytic material, which have an immunoprotective function.6 Weiss mentions Tyson's glands, which we today know do not exist,7-11 and propagates the notion that a male with a foreskin must clean his preputial cavity at least three times daily or have odoriferous consequences.4 Actually the penis with a foreskin can be self-cleaning with micturition, because sterile urine flushes out the preputial cavity before the urine is eliminated.8 Weiss repeatedly refers to "the foreskin allowing for a pooled pocket of infected water to harbor" various pathogens. There is no research to support such a claim. The normal newborn phallus is equipped with a prepuce that contains smooth muscle arranged in a whorled pattern near the tip that acts as a muscular one-way valve, which allows urine out, but does not allow contaminants in.12,13 This pattern of smooth muscle fibers gives the distal infant prepuce its typical puckered appearance. Attempts to retract the prepuce prematurely violate the integrity of this natural valve and allow the influx of bacteria. While Weiss et al.14 failed to find Langerhans cells in the mucosa of the newborn prepuce, these immunoprotective cells are present in older males.15 Because boys are born with the preputial mucosa and the penile glans mucosa fused and because the uterus is a sterile environment, immunoprotection is initially not an issue at this location.

THE ROLE OF THE PREPUCE IN INFECTIOUS DISEASES
Although Weiss is correct in pointing out the role of human papillomavirus (HPV) as an etiologic factor in the development of genital cancers, he fails to point out that circumcised males are significantly more likely to have genital warts16,17 or that the foreskin is not a factor in other clinical HPV-associated lesions.18 Citing a 1947 paper as evidence that horse smegma was carcinogenic in mice, he ignores the studies that attempted to replicate this result and failed,19-21 or that horse smegma differs significantly from human smegma.22 Intuitively it does not make sense that a natural body secretion produced in normal amounts would be carcinogenic. The rate of collected smegma in the preputial cavity is low, given that only 6% of men with preputial stenosis have collected smegma.23 If smegma were carcinogenic, one would expect men circumcised later in life to have lower rates of penile cancer than those never circumcised, but several studies have demonstrated the opposite.24-26 Although several studies have suggested a role of "phimosis" in the development of penile cancer,24,26-28 until a clear definition of phimosis emerges it is difficult to interpret this finding. Eighty percent of patients circumcised for phimosis have normal histology.29-34 It is difficult to hypothesize how the removal of histologically normal tissue can lead to later malignancy. The remainder have balanitis xerotica obliterans, the cancer potential of which is unclear.30,35 Of the etiologic factors for penile cancer, smoking26-28 and HPV infection26,27 emerge as the greatest risk factors, not the prepuce.

Perhaps the most egregious and potentially damaging statement made by Weiss is, "No patient circumcised at birth in the United States has been reported to have developed carcinoma of the penis." There have been at least 39 such cases reported in the medical literature and untold cases that have gone unreported.26,36-50 Weiss listed a study with 22 such cases as one of his references,26 demonstrating his unfamiliarity with the materials cited.

The author provides a laundry list of infections and problems prevented by neonatal circumcision without providing any supporting evidence. The entire premise of the article rests on the notion that neonatal circumcision has a prophylactic benefit in preventing infectious diseases. A careful review of the medical literature demonstrates that it does not. Although some studies have found that circumcision lowers the incidence of urinary tract infections, significant factors such as rooming-in,51 breast-feeding,52-54 parental education and social status, hygienic practices,55-58 race,59-61 urine collection method62 and diagnostic criteria63 have never been controlled for. Any one of these factors could explain the less than 1% difference in urinary tract infections between boys with and without a prepuce seen in these studies. More importantly the incidence of asymptomatic bacteriuria is between 0.7% (95% confidence interval, 0.2 to 1.64%)64 and 2.0%.65 This rate of "background noise," which is nearly identical with the urinary tract infection rate in noncircumcised boys, makes assessment of the significance of these findings difficult. Hoberman and Wald63 found that in the absence of pyuria, a positive urine culture most likely represents incidental bacteriuria. Nearly one-half of the infants diagnosed with urinary tract infection in past studies did not have pyuria,66-68 implying that all of these studies are either invalid or require reanalysis.

There is strong evidence in four studies from Israel that neonatal circumcision increases the incidence of urinary tract infection.69-72 A prospective study of 603 noncircumcised Japanese boys failed to find any urinary tract infections where 6 to 24 would have been expected.73 Based on this, it is unclear whether the foreskin has a prophylactic effect on urinary tract infection.

Although it has been speculated that circumcised males are less likely to develop sexually transmitted diseases, five studies in the past 5 years have found circumcised males to have an overall greater incidence of sexually transmitted diseases.16,74-77 Likewise previous studies have found no difference in the rates of penile infection or inflammation between males with and without foreskins,78-79 but comparison of data from prospective studies73,80 strongly suggests that young circumcised males are more likely to develop balanitis. This has also been demonstrated in adults.81 Finally the data regarding HIV infection have been inconsistent, but large random cross-sectional studies, which have the least degree of bias, have found that circumcised men are more likely to develop or transmit HIV infection.77,82-85

SURGICAL PROPHYLAXIS
The lamentations of Weiss over Americans' reluctance to circumcise are misplaced. The current rate of neonatal circumcision continues to be more than 90% in the midwest.80,86 Weiss blames the separation of church and state for the lack of acceptance of "medical" circumcision in the United States. This does not explain why in Europe, where state religions are the norm, circumcision rates approach zero, with no measurable difference in penile problems.

He bemoans our inability to embrace the surgical prophylaxis concept but fails to note that no one is willing to initiate surgical prophylaxis unless there is a compelling risk or medical factor. Indeed the only exception to this is the American fixation with altering male genitalia.87 Recently the value of prophylactic oophorectomy and mastectomy in women with genetic mutations of BRCA1 and BRCA2 was evaluated. Although removal of the breasts and ovaries at 30 years of age in women without increased risk would increase life expectancy by an average of 8 months, the authors concluded that "Prophylactic surgery is obviously unreasonable for these women." Removing healthy tissue in women at increased risk is considered a "highly personal decision" made only after clear discussion of the effects of prophylactic surgery on medical outcomes takes place.88

When the cost utility of neonatal circumcision is calculated, it has an overall negative effect on health89 or little effect at all.90 All analyses published have found neonatal circumcision to be cost-ineffective.90-92

Strabo, the 1st century B.C. Greek geographer, documented that Jews circumcised girls as well as boys.93 If the Egyptians were right about the males, they might also be right about the females. Because females have a greater incidence of fungal infections, urinary tract infections, genital cancers and smegma production, they are more likely to benefit from prophylactic surgical alteration of their genitalia than are males.

If Weiss is truly interested in expanding the surgical prophylactic paradigm, a number of other possibilities exist. All breast tissue can be excised from males at birth. More men die of breast cancer than penile cancer94 and breast tissue has no useful purpose in males. The left testis can be removed at birth, cutting the incidence of testicular cancer and testicular torsion by more than half. Toenails can be unsightly and can ingrow and become infected, so they too should be dispensed with. All of these would decrease disease risk without altering function: which is Weiss's stated goal. To paraphrase Weiss's hero, John Arderne, "What's holding us back? This will help people!"

REVISING HISTORY TO SUPPORT A MODERN AGENDA
Most of Weiss's paper is taken up with a justification that the ancients instituted circumcision for its health benefits. There is no direct evidence that this occurred. To make his case Weiss cites a number of speculative pieces written around the turn of the century. During that era the medical profession was promoting circumcision as a preventive and treatment for masturbation, which was thought to be the source of a long list of maladies.95 To convert circumcision from a religious blood ritual to a medical practice, many physicians were compelled to speculate that circumcision had a medical intent since its inception. When one looks at the primary sources, there is no evidence that it does. Although both the Old and New Testaments make numerous references to circumcision, none relates to health. In keeping with this Rabbi Moses Maimonides (1135-1204), the famous physician and philosopher, does not mention any medical purpose to circumcision, although he was 800 years closer to the source than any 20th century speculators. The only benefit Maimonides could find for circumcision was that it weakened the penis and made men more temperate sexually. He stated that the noncircumcised penis was so sexually superior that if a Jewish woman had intercourse with a noncircumcised man, she would not separate from him.96 By contrast American women have little chance of having intercourse with a complete penis.

Relying on ancient scholars such as Philo of Alexandria(1st century A.D.)97 and Herodotus (ca. 484 to 425 B.C.)98 is ill-advised because their writing represent opinions and impressions from an era that predates the development of the scientific method.

Wallerstein points out four elements of circumcision that suggest that it was never thought of as a medical procedure.

(1) If a child dies before it is 8 days old, the corpse must be circumcised before it can be interred in a Jewish cemetery. The ritual takes place at the cemetery, just prior to burial. (2) If a child is born without a foreskin or if no blood is shed during circumcision (both exceedingly rare occurrences), a drop of blood must be drawn from the glans as a symbolic circumcision. (This is known in Hebrew as hatafath dam berith.) The nicking of the glans may be done "with a knife, a needle or even the sharpened fingernails." (3) Such a symbolic circumcision is also performed when a convert to Judaism has been previously circumcised. Reform rabbis have tried to abolish this practice. (4) Up to a century or two ago, the linen cloth used in circumcision, presumably stained with blood, was retained and exhibited at the boy's Bar Mitzvah and wedding as proof of his circumcision.99

Although Jews have been reassured and comforted by attempts to attribute health benefits to the rite, it is purely a religious exercise. The Jewish practice influenced non-Jewish acceptance of circumcision, which reinforced the Jewish ritual.99 Erich Isaac stated, "Its presumed medical and physiological advantages are said to be at best unproven and at worst illusory."100

The section on schistosomiasis is irrelevant and unfounded. The author admits that there have been no studies linking the foreskin to schistosomiasis. Weiss makes the assumption that circumcision was a health measure before it was transformed into a religious blood ritual. To make this statement convincing, he needs to demonstrate that the ancient Egyptians had the wherewithal to notice the small differences in health between men with and without foreskins that we have not been able to document consistently in the modern era. If it was a health measure, why is there no documentation of it as such? Why should we consider circumcision "surgical prophylaxis" in the ancient setting when no one at the time thought of it as such? Making the leap from the Egyptian Code of Cleanliness to ascribing a medical significance to a blood ritual is unfounded historically and scientifically. Weiss's reasoning then takes a circular turn. After assuming that the Egyptians instituted circumcision as a medical intervention, he uses this "fact" to prove that circumcision had medical origins.

There are several historical facts inconsistent with Weiss's interpretation that he fails to address. It is not clear from the Bible whether Moses was circumcised. Some have speculated that the reason Zipporah circumcised their son was that Moses was not circumcised and like most genitally intact males did not want his son circumcised.101-103 If Moses had been circumcised on the eighth day, he would have been killed by the Egyptians instead of being allowed to be raised in the palace. Speculating that Abraham had preputial problems that affected his ability to procreate is inconsistent with his siring Ishmael.

The ritual cutting as begun by Abraham was markedly different from what is performed today. Originally the operation consisted of cutting off only the very tip of the prepuce. This fact seriously undermines Weiss's speculation about decreasing the amount of mucosa through which schistosomes could pass. This practice persisted until the Hellenistic period(ca. 300 B.C. to 1 A.D.), which may explain why David, as depicted by Michelangelo, has most of his foreskin. To fit in with the Greeks, Jews obliterated the evidence of their circumcision by blistering the tip of what remained of their foreskin to enlarge it. This practice became so popular that the rabbinate altered the surgery to make it impossible for a circumcised male to appear noncircumcised. Thereafter the entire foreskin was to be ablated, and the inner lining and frenulum excised by the mohel's fingernail, specially sharpened for this purpose. The next change,Metzitzah, occurred during the Talmudic period (ca. 500 to 625 A.D.) and consisted of moistening the lips with wine and taking the bleeding penis into the mouth and sucking the blood.104 If circumcision was seen as a health measure, why were these unsanitary elements added?

If Weiss wishes to be taken seriously, he needs to address these issues and attempt to refute them.

RELYING ON THE STANDARD CIRCUMCISION MYTHS
Weiss would like to blame operator inexperience for the horrific complications of neonatal circumcision. Although many have expressed this opinion,105 it has never been proved. To the contrary a retrospective study found no difference in complication rates seen among physicians of differing experience levels.106

"Speed is essential in eliminating pain," is also espoused by Weiss. Nothing eliminates the pain of neonatal circumcision.107 A poster presentation has suggested that crying is decreased when the Mogen clamp is used,108 but the adhesions still must be broken, and postoperative pain has yet to be addressed adequately.

Weiss, citing a number of opinion pieces, states that later circumcision has increased mortality and morbidity than neonatal circumcision. This is not true. Reported retrospective complication rates include 2.0%,105 3.1%109 and 6.4%.106 The only prospective study documented hemorrhage after 9.9% of neonatal circumcisions.110 These rates are higher than those documented in retrospective studies of circumcisions performed later in life (1.7%).111,112

WHERE ARE THE PRIMARY REFERENCES?
An examination of the references used by Weiss is revealing. Of the 91 references cited 27 were procircumcision opinion pieces, 17 were textbooks(mostly outdated) and 12 were secondary articles. The 5 World Wide Web sites Weiss refers to cannot be considered serious resources. The majority of the citations are more than 10 years old. More than one-third are from before 1980. Instead of citing ancient sources, turn-of-the-century opinion pieces are used. The standard for review articles is to avoid citing opinion pieces, review articles or textbooks. Readers should expect review articles to be written by knowledgeable individuals who have taken the time to research primary sources of information.

CONCLUSION
Weiss is correct. Schistosomiasis, HPV and HIV do have something in common: none has been clearly shown to be reduced by circumcision. A careful examination of the medical literature would have revealed his faulty premise. He never establishes the premise that circumcision is effective or that any of the ancient authorities considered circumcision to be medical. He fails to acknowledge or address dissenting information. His arguments are disjointed, illogical and difficult to follow. For these reasons it is very difficult to take his call for neonatal prophylactic surgery seriously.

REFERENCES

Weiss GN. Prophylactic neonatal surgery and infectious diseases. Pediatr Infect Dis J 1997;16:727-34.
Weiss GN, Weiss EB. A perspective on controversies over neonatal circumcision. Clin Pediatr (Phila) 1994;33:726-30.
Weiss GN. Neonatal circumcision. South Med J 1985;78:1198-200.
Weiss GN. Neonatal circumcision is necessary. Fort Collins, CO: Personal brochure, 1985.
Weiss GN. Local anesthesia for neonatal circumcision. JAMA 1988;260:637-8.
Prakash S, Rao R, Venkatesan K, Ramakrishnan S. Subpreputial wetness: it nature. Ann Natl Acad Med Sci (India) 1982;18:109-12.
Hyman AB, Brownstein MH. Tyson's "glands": ectopic sebaceous glands and papillomatosis penis. Arch Dermatol 1969;99:31-7.
Lakshmanan S, Prakash S. Human prepuce: some aspects of structure and function. Indian J Surg 1980;42:134-7.
Parkash S, Jeyakumar S, Subramanyan S, Choudhuri S. Human subpreputial collection: its nature and formation. J Urol 1973;110:211-2.
Keith A, Shilltoe A. The prepucial or odoriferous glands of man. Lancet 1904;1:146-8.
de Sousa OM. Sur la presence de glandes sebacées au niveau de gland chez l'homme. C R Soc Biol 1931;108:894-7.
Barreto J, Caballero C, Cubilla A. Penis. In: Sternberg SS, ed. Histology for pathologists. New York: Raven Press, 1992:721-30.
Woolsey G. Applied surgical anatomy. New York: Lea Brothers, 1902:405-7.
Weiss GN, Westbrook KC, Sanders M. The distribution and density of Langerhans cells in the human prepuce: site of a diminished immune response? Isr J Med Sci 1993;29:42-3.
Van Howe RS. An objective assessment of neonatal circumcision. Presented at American Academy of Pediatrics Task Force on Circumcision, Rosemont, IL, June 8, 1997.
Cook LS. Koutsky LA. Holmes KK. Clinical presentation of genital warts among circumcised and uncircumcised heterosexual men attending an urban STD clinic. Genitourin Med 1993;69:262-4.
Cook LS, Koutsky LA, Holmes KK. Circumcision and sexually transmitted diseases. Am J Public Health 1994;84:197-201.
Aynaud O, Ionesco M, Barrasso R. Penile intraepithelial neoplasia: specific clinical features correlate with histologic and virologic findings. Cancer 1994;74:1762-7.
Fishman M, Shear MJ, Friedman HF, Stewart H. Studies in carcinogenesis. XVII. Local effect of repeated application of 3,4-benzpyrene and of human smegma to the vagina and cervix of mice. J Natl Cancer Inst 1942;2:361-7.
Heins HC, Dennis EJ, Pratt-Thomas HR. The possible role of smegma in carcinoma of the cervix. Am J Obstet Gynecol 1958;76:726-35.
Reddy DG, Baruah IKSM. Carcinogenic action of human smegma. Arch Pathol 1963;75:414-20.
O'Neill HJ, Gershbein LL. Lipids of human and equine smegma. Oncology 1976;33:161-6.
Parkash S. Phimosis and its plastic correction. J Indian Med Assoc 1972;58:389-90.
Brinton LA, Li JY, Rong SD, et al. Risk factors for penile cancer: results from a case-control study in China. Int J Cancer 1991;47:504-9.
Windahl R, Hellsten S. Laser treatment of localized squamous cell carcinoma of the penis. J Urol 1995;154:1020-3.
Maden C, Sherman KJ, Beckmann AM, et al. History of circumcision, medical conditions, and sexual activity and risk of penile cancer. J Natl Cancer Inst 1993;85:19-24.
Harish K, Ravi R. The role of tobacco in penile carcinoma. Br J Urol 1995;75:375-7.
Hellberg D, Valentin J, Eklund T, Nilsson S. Penile cancer: is there an epidemiological role for smoking and sexual behavior? Br Med J 1987;295:1306-8.
Clemmensen OJ, Krogh J, Petri M. The histologic spectrum of prepuces from patients with phimosis. Am J Dermatopathol 1988;10:104-8.
Meuli M, Briner J, Hanimann B, Sacher P. Lichen sclerosus et atrophicus causing phimosis in boys: a prospective study with 5-year followup after complete circumcision. J Urol 1994;152:987-9.
Kristiansen VB, Sorensen C, Kryger AI, Nielsen JB, Mejdahl S. Genital lichen sclerosus et atrophicus hos drenge. Ugeskr Laeger 1989;151:1111.
Bale PM, Lochhead A, Martin HC, Gollow I. Balanitis xerotica obliterans in children. Pediatr Pathol 1987;7:617-27.
Flentje D, Benz G, Daum R. Lichen sclerosus et atrophicus als Ursache der erworbenen Phimose: Zirkumzision als Praventivmassnahme gegen das Peniskarzinom? Z Kinderchir 1987;42:308-11.
Chalmers RJ, Burton PA, Bennett RF, Goring CC, Smith PJ. Lichen sclerosus et atrophicus: a common and distinctive cause of phimosis in boys. Arch Dermatol 1984;120:1025-7.
Campus GV, Ena P, Scuderi N. Surgical treatment of balanitis xerotica obliterans. Plast Reconstr Surg 1984;73:652-7.
Dean AL. Epithelioma of the penis in a Jew who was circumcised in early infancy. Trans Am Assoc Genito-Urin Surg 1936;29:493-9.
Reitman, PH. An unusual case of penile carcinoma. J Urol 1953;69:547-9.
Marshall VF. Typical carcinoma of the penis in a male circumcised in infancy. Cancer 1953;6:1044-5.
Paquin AJ, Pearce JM. Carcinoma of the penis in a man circumcised in infancy. J Urol 1955;74:626-7.
Ledlie RCB, Smithers DW. Carcinoma of the penis in a man circumcised in infancy. J Urol 1956;76:756-7.
Amelar RD. Carcinoma of the penis due to trauma occurring in a male patient circumcised at birth. J Urol 1956;75:728-9.
Kaufman JJ, Sternberg TH. Carcinoma of the penis in a circumcised man. J Urol 1963;90:449-50.
Melmed EP, Pyne JR. Carcinoma of the penis in a Jew circumcised in infancy. Br J Surg 1967;54:729-31.
Rogus BJ. Squamous cell carcinoma in a young circumcised man. J Urol 1987;138:861-2.
Boczko S, Freed S. Penile carcinoma in circumcised males. NY State J Med 1979;79:1903-4.
Loughlin KR. Psoriasis: association with 2 rare cutaneous urologic malignancies. J Urol 1997;157:622-3.
Girgis AS, Bergman H, Rowenthal H, Solomon L. Unusual penile malignancies in circumcised Jewish men. J Urol 1973;110:696-702.
Leiter E, Lefkovits AM. Circumcision and penile cancer. NY State J Med 1975;75:1520-2.
Malek RS, Goellner JR, Smith TF, Espy MJ, Cupp MR. Human papillomavirus infection and intraepithelial, in situ, and invasive carcinoma of penis. Urology 1993;42:159-70.
Cold CJ, Storms MR, Van Howe RS. Carcinoma in situ of the penis in a 76 year old circumcised man. J Fam Pract 1997;44:407-10.
Winberg J, Bollgren I, Gothefors L, Herthelius M, Tullus K. The prepuce: a mistake of nature? Lancet 1989;1:598-9.
Pisacane A, Graziano L, Zona G. Breastfeeding and urinary tract infection. Lancet 1990;336:50.
Pisacane A, Graziano L, Mazzarella G, Scarpellino B, Zona G. Breast-feeding and urinary tract infection. J Pediatr 1992;120:87-9.
Coppa GV, Gabrielli O, Giorgi P, et al. Preliminary study of breastfeeding and bacterial adhesion to uroepithelial cells. Lancet 1990;335:569-71.
Malleson P. Prepuce care. Pediatrics 1986;77:265.
Harkavy KL. The circumcision debate. Pediatrics 1987;79:649-50.
Watson SJ. Care of the uncircumcised penis. Pediatrics 1987;80:765.
Cunningham N. Circumcision and urinary tract infections. Pediatrics 1986;77:267-9.
Herzog LW. Urinary tract infections and circumcision. a case-control study. Am J Dis Child 1989;143:348-50.
Skoog SJ, Belman AB. Primary vesicoureteral reflux in the black child. Pediatrics 1991;87:538-43.
Askari A, Belman AB. Vesicoureteral reflux in black girls. J Urol 1982;127:747-8.
Schlager TA, Hendley JO, Dudley SM, Hayden GF, Lohr JA. Explanation for false-positive urine cultures obtained by bag technique. Arch Pediatr Adolesc Med 1995;149:170-3.
Hoberman A, Wald ER. Urinary tract infections in young febrile children. Pediatr Infect Dis J 1997;16:11-17.
Edelmann CM, Ogwo JE, Fine BP, Martinez AB. The prevalence of bacteriuria in full-term and premature newborn infants. J Pediatr 1973;82:125-32.
Saez Llorens X, Umana MA, Odio CM, Lohr JA. Bacterial contamination rates for non-clean-catch and clean-catch midstream urine collections in uncircumcised boys. J Pediatr 1989;114:93-5.
Crain EF, Gershel JC. Urinary tract infections in febrile infants younger than 8 weeks of age. Pediatrics 1990;86:363-7.
Krober MS, Bass JW, Powell JM, Smith FR, Seto DS. Bacterial and viral pathogens causing fever in infants less than 3 months old. Am J Dis Child 1985;139:889-92.
Bonadio WA. Urine culturing technique in febrile infants. Pediatr Emerg Care 1987;3:75-8.
Amir J, Varsano I, Mimouni M. Circumcision and urinary tract infection in infants. Am J Dis Child 1986;140:1092.
Amir J, Alpert G, Reisner SH, Nitzan M. Fever in the first year of life. Isr J Med Sci 1984;20:447-8.
Goldman M, Barr J, Bistritzer T, Aladjem M. Urinary tract infection following ritual Jewish circumcision. Isr J Med Sci 1996;32:1098-102.
Cohen HA, Drucker MM, Vainer S, et al. Postcircumcision urinary tract infection. Clin Pediatr(Phila) 1992;31:322-4.
Kayaba H, Tamura H, Kitajima S, Fujiwara Y, Kato T, Kato T. Analysis of shape and retractibility of the prepuce in 603 Japanese boys. J Urol 1996;156:1813-5.
Seed J, Allen S, Mertens T, et al. Male circumcision, sexually transmitted disease, and risk of HIV. J Acquir Immune Defic Syndr Hum Retrovirol 1995;8:83-90.
Donovan B, Bassett I, Bodsworth NJ. Male circumcision and common sexually transmissible diseases in a developed nation setting. Genitourin Med 1994;70:317-20.
Laumann EO, Masi CM, Zuckerman EW. Circumcision in the United States: prevalence, prophylactic effects, and sexual practice. JAMA 1997;277:1052-7.
Urassa M, Todd J, Boerma JT, Hayes R, Isingo R. Male circumcision and susceptibility to HIV infection among men in Tanzania. AIDS 1997;11:73-9.
Herzog LW, Alvarez SR. The frequency of foreskin problems in uncircumcised children. Am J Dis Child 1986;140:254-6.
Fergusson DM, Lawton JM, Shannon FT. Neonatal circumcision and penile problems: an 8-year longitudinal study. Pediatrics 1988;81:537-41.
Van Howe RS. Variability in penile appearance and penile findings: a prospective study. Br J Urol 1997;80:776-82.
Birley HDL, Walker MM, Luzzi GA, et al. Clinical features and management of recurrent balanitis: association with atopy and genital washing. Genitourin Med 1993;69:400-3.
Grosskurth H, Mosha F, Todd J, et al. A community trial of the impact of improved sexually transmitted disease treatment on the HIV epidemic in rural Tanzania: 2. Baseline survey results. AIDS 1995;9:927-34.
Barongo LR, Borgdorff MW, Mosha FF, et al. The epidemiology of HIV-1 infection in urban areas, roadside settlements and rural villages in Mwanza Region, Tanzania. AIDS 1992;6:1521-8.
Van de Perre P, Carael M, NzVanaramba D, Zissis G, Kayihigi J, Butzler JP. Risk factors for HIV seropositivity in selected urban-based Rwandese adults. AIDS 1987;1:207-11.
Chao A, Bulterys M, Musanganire F, et al. Risk factors associated with prevalent HIV-1 infection among pregnant women in Rwanda: National University of Rwanda-Johns Hopkins University AIDS Research Team. Int J Epidemiol 1994;23:371-80.
Mansfield CJ, Hueston WJ, Rudy M. Neonatal circumcision: associated factors and length of hospital stay. J Fam Pract 1995;41:370-6.
Van Howe RS, Cold CJ. Sex reassignment at birth: long-term review and clinical implications. Arch Pediatr Adolesc Med 1997;151:1062.
Schrag D, Kuntz KM, Garber JE, Weeks JC. Decision analysis: effects of prophylactic mastectomy and oophorectomy on life expectancy among women with BRCA1 or BRAC2 mutations. N Engl J Med 1997;336:1464-71.
Ganiats TG, Humphrey JB, Taras HL, Kaplan RM. Routine neonatal circumcision: a cost-utility analysis. Med Dis Making 1991;11:282-93.
Lawler FH, Bisonni RS, Holtgrave DR. Circumcision: a decision analysis of its medical value. Fam Med 1991;23:587-93.
Cadman D, Gafni A, McNamee J. Newborn circumcision: an economic perspective. Can Med Assoc J 1984;131:1353-5.
Chessare JB. Circumcision: is the risk of urinary tract infection really the pivotal issue? Clin Pediatr (Phila) 1992;31:100-4.
Strabo. Geography. 17.2.5. In: The geography of Strabo. vol. 8. Jones L, trans. Cambridge, MA: Harvard University Press, 1982:152-3.
Wingo PA, Tong T, Bolden S. Cancer statistics 1995. CA Cancer J Clin 1995;45:8-30.
Hodges F. A short history of the institutionalization of involuntary sexual mutilations in the United States. In: Denniston GC, Milos MF, eds. Sexual mutilations: a human tragedy. New York: Plenum, 1997:17-40.
Moses Maimonides (1135-1204). The guide for the perplexed. New York: Dover Publications, 1956:378.
Philo. The special laws. 1.1.1-4. In: Philo VII. Colson FH, trans. Cambridge, MA: Harvard University Press, 1984:101-3.
Herodotus. History 2.37. in: Herodotus I. Books I-II. Godley AD, trans. Cambridge, MA: Harvard University Press, 1920:319.
Wallerstein E. Circumcision: an American health fallacy. New York: Springer, 1980.
Isaac E. The enigma of circumcision. Commentary 1967;43:51.
Brown MS, Brown CA. Circumcision decision: prominence of social concerns. Pediatrics 1987;80:215-9.
Bean GO, Egelhoff C. Neonatal circumcision: when is the decision made? J Fam Pract 1984;18:883-7.
Stein MT, Marx M, Taggart SL, Bass RA. Routine neonatal circumcision: the gap between contemporary policy and practice. J Fam Pract 1982;15:47-53.
Weiss C. A worldwide survey of the current practice of milah (ritual circumcision). Jewish Soc Stud 1962;1:30-47.
Gee WF, Ansell JS. Neonatal circumcision: a ten-year over-view: with comparison of the Gomco clamp and the Plastibell device. Pediatrics 1976;58:824-7.
Moreno CA, Realini JP. Infant circumcision in an outpatient setting. Tex Med 1989;85:37-40.
Cold CJ, Van Howe RS, Storms MR. Anesthesia for neonatal circumcision. J Am Board Fam Pract 1997;10:310-1.
DeSilva H. Pediatric academic societies, cited in Childs ND. Physician's choice of clamp may cause more pain. Pediatr News 1997;31(8):40.
O'Brien TR, Calle EE, Poole WK. Incidence of neonatal circumcision in Atlanta, 1985-1986. South Med J 1995;88:411-5.
Sutherland JM, Glueck HI, Gleser G. Hemorrhagic disease of the newborn: breast feeding as a necessary factor in the pathogenesis. Am J Dis Child 1967;113:524-33.
Walfisch S, Ben-Zion YZ, Gurman G. [Circumcision of new immigrants.] Harefuah 1994;126:119-21, 176.
Wiswell TE, Tencer HL, Welch CA, Chamberlain JL. Circumcision in children beyond the neonatal period. Pediatrics 1993;92:791-3.
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Old 02-21-2002, 09:32 AM   #167
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Quote:
Originally posted by Daggah:
<strong>Is it actually possible to be circumcised at the age of 19? I'm not, and I'm kinda concerned that the extra skin is interfering both with my orgasms and urination. When I urinate, if I pull the foreskin back, the stream becomes smaller but comes out at a much higher pressure, which I assume is normal for circumcised men? But the bigger issue to me is ejaculation - it sort of just dribbles out, and I've been under the impression that it was supposed to be a bit more forceful. Won't this interfere with my sex life? Is all of this normal? </strong>
As others have said, circumcision is a drastic step. I'm not a doctor, but nothing you've said sounds abnormal in the least. Again, as has been said before, if you're really concerned see a urologist.

I've been with my fair share of men. Some men have forceful ejaculations but most I have been with (including myself) do not. I also love amateur porn--especially cum shots--and from all I've seen, the average Joe ejaculating isn't anything spectacular. The guys in the films with massive ejaculations that hose all that the eye can see are pretty rare. I doubt that you are abnormal in the slightest.

-Jerry

Oh, just to be "on topic" I'm against circumcision, especially routine infant circumcision; if there isn't a problem then it should be left alone--it isn't your penis, so it isn't your decision.

And I completely disagree with the sentiment that cut penises are more attractive. Nothing turns me on more than the sight of a natural penis, foreskin in tact.
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Old 02-21-2002, 09:34 PM   #168
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Thanks you guys, I feel much better about it now.

This is the first (and most likely the last) forum I would ever ask such questions on. Thanks.
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Old 02-22-2002, 10:59 PM   #169
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I realize I'm jumping into this late, but here goes.

Quote:
Originally posted by Frogsmoocher:
<strong>Circumcising 100,000 newborn boys to save one old man from cancer is ludicrous.</strong>
The actual rate of penile cancer in the U.S, where most males are already circumcised and thus afforded whatever protection circumcision might provide against penile cancer, is ~1/100,000/year, not 1/100,000 per lifetime. The figure you quote (which you probably got from one of the many fanatical anticircumcision websites where the "per year" is left off), is simply inaccurate.

This is not to say that circumcision is justified on the grounds of offering, say, a 70% protection against penile cancer (as some studies have found) rather it is to say that judgements about any subject, circumcision included, should be made on the basis of accurate information, not biased misinformation from a web site with an obvious agenda.

Quote:
Originally posted by Baloo:
<strong>Although, before moving on, does anyone want to offer an explanation as to why NONE of the anti-circumcision sites even MENTION either of these two anesthetic methods, yet they are willing to actually offer, in three different formats, video footage, surrounded by graphic descriptions, and coupled with mulitple freeze-frame images of operations where these common methods are not used? Could it be because they have an agenda, and they aren't going to let such annoying things as facts get in the way?</strong>
Sure. I will. Generally speaking, those sites are run be a bunch of anti circ zealots who are very religious in their zealotry. Some of them blame darned near every psychological and physical problem imaginable on circumcision. CIRP has some good information mixed in with the misinformation, but some of the others such as NOHARMM are downright ludicrous.

Quote:
Originally posted by Anunnaki:
<strong>My circumcision was too tight and has caused my penis to develop a downward bend when erect. I assure you that not only can I answer the question,but can tell you that my life would indeed be different if I was not circumcised.</strong>
This is not likely the result of circumcision. The skin is simply too elastic to actually cause a curvature of the erect penis. Chordee or peyronies disease, or just the way you are made, are much more likely the real cause.

Quote:
Originally posted by alek0:
<strong>What that has to do with curving of the penis, which is a known complication of circumcision?</strong>
Not according to my urologist, it isn't.

Quote:
Originally posted by Corwin:
<strong>And what information do we have about any of these studies? What exactly were their criteria? Did they look at other factors? Such as condom use? How did they pick their cohort? What men exactly WERE their sample group? Notice also that while they state clearly that uncircumcised males are 12 times as likely to develop a UTI during the first year of life... (12 times jack shit, is still jack shit...) they also mention increased rates of cervical cancer.... yet they don't say what those rates are. Possibly these rates are.... unimpressive compared to one and a half million baby boys circumcised a year?</strong>
Typical anti circ BS. Accept any old study that shows no advantage to circumcision but question every study that does.

Quote:
Originally posted by rbochnermd:
<strong>There are medical reasons in favour of male circumcision which include decreased risks of malignancies and infection transmission, but there are also risks. The real question is not, "are there any benefits?" to the procedure but rather, "do the benefits outweigh the risks?"
</strong>
Well said.

As one who underwent a circumcision as a pre-teen, I can honestly say that I wish that I had been circumcised as an infant, especially since all of my friends were anyway.

Betz
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Old 02-23-2002, 07:34 AM   #170
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Originally posted by BetzAza:
Quote:
The actual rate of penile cancer in the U.S, where most males are already circumcised and thus afforded whatever protection circumcision might provide against penile cancer, is ~1/100,000/year, not 1/100,000 per lifetime. The figure you quote (which you probably got from one of the many fanatical anticircumcision websites where the "per year" is left off), is simply inaccurate.
From the American Cancer Society website:
"The American Cancer Society estimates that in 2002 in the United States about 1,200 new cases of penile cancer will be diagnosed and an estimated 200 men will die of penile cancer. Penile cancer occurs in about 1 man out of 100,000 in the United States."

Please explain how you interpret this to mean 1/100,000/year. And do you consider the American Cancer Society to be a fanatical anticircumcision organization?

More info on penile cancer and circumcision from the same source:
<a href="http://www.cancer.org/eprise/main/docroot/CRI/content/CRI_2_4_2X_Can_penile_cancer_be_prevented_35" target="_blank">Can Penile Cancer Be Prevented?</a>

Quote:
This is not likely the result of circumcision. The skin is simply too elastic to actually cause a curvature of the erect penis. Chordee or peyronies disease, or just the way you are made, are much more likely the real cause.
First of all, it is very likely the result of circumcision. When circumcising a newborn, the physician has no idea how large the penis will be in adulthood. There are many documented cases where too much skin was taken, causing the scrotal skin to actually climb the penile shaft upon erection.

Chordee is a very well-known complication of circumcision, btw. Relatively few intact men suffer from chordee.

As for you being glad you were circumcised because all your friends were, I certainly can't understand why the status of your peers' penises was such a concern for you.

You rant and rave about anti-circ bias, but you are just as biased.... just re-read what you've written and you should be able to see that. I will gladly admit that I'm biased. I think that routine circumcision is a barbaric custom. I'm assuming that you were circumcised for some sort of medical reason. I don't think anybody here is complaining about that. What I have a problem with is removing a perfectly healthy body part from someone who has no say in the matter.
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{Fixed long URL - Pantera}

[ February 24, 2002: Message edited by: Pantera ]</p>
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