Male Circumcision and HIV

NEW STUDY: Call for participants to assess which areas of male genitals influence body image and self-esteem

2010-03-03T19:03:03-08:00

Laurence Dinh-Williams and Seth Davis, a team of McGill University researchers, contacted me recently with a request to post a call for participants for a study to assess male body image with a particular focus on the genitals. More precisely, Mr. Dinh-Williams seeks to assess "which features of the male genital area are important for one's 'genital self-esteem' and body image, and which factors tend to influence these evaluations." There is a section "where we ask whether they have been circumcised, at what age, and whether they are satisfied with the results (their current circumcision status), and allow for comments if they have anything to add!"

Mr. Dinh-Williams provides further:

MCGILL MALE BODY IMAGE STUDY
Thus far, the study of men's body image has been largely restricted to the dimensions of adiposity and muscularity. Recent research has found that features such as head hair, body hair, height and penis size may be important in one's evaluation of self, with penis size satisfaction being highly correlated to overall appearance self-esteem.
However, little is known about the specific role that 'male genital satisfaction' plays in male body image concerns, and which aspects of the genital area, beyond size, may be important for these 'genital perceptions' (satisfaction with one's genital area).

We are a team of researchers at McGill University in Montreal, Canada, investigating this issue. This study will determine which features of the genital area are important for 'genital perceptions' and male body image, and further investigate the factors that may influence one’s evaluations and perceptions (ex: sexual experience, erectile dysfunctions, premature ejaculation, STD's etc.). To do this, we need you to take this short 20 minute survey assessing your level of satisfaction regarding your body in general and various aspects of the genital area.
Your participation in this study will help health professionals better understand the factors involved in male body concerns and further on, their relation to sexuality (given the presumed central role of the genitals in a sexual context), guiding future research and treatment.
By participating, you will also be able to enter a draw for one of three $100 prizes to spend at amazon.com!
Please note that you will asked to measure the length and girth (circumference) of your flaccid AND erect penis, and asked to estimate the angle of penile curvature and direction of your erect penis, thus it may preferable to assess these features before starting this survey. Please click on the following link in order for a description of the measurements and protocol to follow: http://www.surveymonkey.com/s/penilemeasurement
This study is only for men 18 years of age and older.
Survey link: http://www.surveymonkey.com/s/genitalperception
For further information, you may email us at mcgill.urology@gmail.com
Your help would be greatly appreciated!

We also thank you for taking the time to read about our study.

Mr. Dinh-Williams contacted me unsolicited. I presume he knows the focus and slant of MC_HIV. Therefore, for the many loyal readers who have strong opinions on HIV prevention, genital integrity, and informed consent, this is your chance to be heard on the circumcision issue as it relates to "genital self-esteem."

Brian Morris, the Fred Phelps of the Pro-Circumcision Lobby

2010-02-23T16:43:53-08:00

Brian Morris is a well known circumcision obsessed fanatic. He is known to employ name calling, personal attacks, mischaracterization, lies, and slander in his responses to individuals espousing thoughtful objections to the practice. And as if that isn't enough, he uses a heaping helping of hyperbole in praise of infant circumcision.

One wonders if the various media outlets and policy bodies that have suffered his intrusions (in the form of playing the imposter of an expert) are aware that Brian Morris has also advocated female genital mutilation. Morris's obsession with penises has obscured his truer obsession, which is cutting genitals of either sex.

Anecdotally, true female circumcision (= removal of the clitoral hood) is said to increase sexual sensitivity and frequency of orgasm. This claim awaits research support, however. - Brian Morris

From Morris's Circumcision, whose responsibility? ... Legal (See sixth full paragraph from the bottom)

While the comparison hasn't been made anywhere else, I see him as the Fred Phelps of the pro-circumcision lobby.

Brian Morris asks, "Does God also hate clitoral hoods?"

Lest anyone doubt that Morris is advocating felony behavior, see the World Health Organization's own paper [pdf] on the issue wherein the definition of female genital mutilation is clearly laid out and various legal injunctions against it around the world are discussed. Morris would appear to advocate Type 1a.

From a genuine Fred Phelps "protest"

"Aurora’s ‘Society for Creative Anachronisms.’ I’d hoped it would improve my chances. Just my luck to have found one anachronism she doesn’t appreciate."

2010-02-22T16:05:51-08:00

3001, the Final Odyssey,

by Arthur C. Clarke

Excerpts from the book, Chapters 11 and 12

Frank Poole became aware that he was not alone in the sky. Something else was approaching, and it was certainly not a human flyer….it seemed much too large for that…. A pterodactyl was not a bad guess, maybe eight points out of ten. What was approaching him now, with slow flaps of its leathery wings, was a dragon straight out of Fairyland. And to complete the picture, there was a beautiful lady riding on its back. At least, Poole assumed she was beautiful. The traditional image was spoiled by one trifling detail: much of her face was concealed by a large pair of aviator’s goggles that might have come straight from the open cockpit of a World War I biplane….

And then he forgot about the dragon, for the rider removed her goggles. The trouble with clichés, some philosopher remarked, probably with a yawn, is that they are so boringly true. But “love at first sight” is never boring….

Indra, however gave him the answer he needed right away.

“So you’ve met the Dragon Lady!”

“Is that what you call her? What’s her real name, and can you get me her Ident?”

“Of course – no problemo.”…

Her name’s Aurora McAuley; among many other things, she’s President of the Society for Creative Anachronisms….

This is too good to be true, thought Poole. I am the biggest anachronism on Planet Earth.

To Poole’s delight, Mistress McAuley’s Ident conveyed the information that she was currently between lovers, and he wasted no further time in contacting her……

I believe I’ve passed another test, he told himself smugly. Riding on Draco must have been the first. How many more, I wonder?….

But there were no more, and the answer to the immemorial “Your place or mine?” was – Poole’s.

The next morning, shaken and mortified, he contacted Professor Anderson.

“Everything was going splendidly,” he lamented, “when she suddenly became hysterical and pushed me away. I was afraid I’d hurt her somehow –

Then she called the roomlight – we’d been in darkness – and jumped out of bed. I guess I was just staring like a fool…” He laughed ruefully. “She was certainly worth staring at.”

“I’m sure of it. Go on.”

“After a few minutes, she relaxed and said something I’ll never be able to forget.”

Anderson waited patiently for Poole to compose himself.

“She said, ‘I’m really sorry, Frank. We could have had a good time. But I didn’t know that you’ve been – mutilated.’”

The professor looked baffled, but only for a moment.

“OH, I understand. I’m sorry too, Frank – perhaps I should have warned you. In my thirty years of practice, I’ve only seen half a dozen cases – all for valid medical reasons, which certainly didn’t apply to you…

“Circumcision made a lot of sense in primitive times – and even in your century, as a defense against some unpleasant, even fatal, diseases in backward countries with poor hygiene. But otherwise there was absolutely no excuse for it – and several arguments against, as you’ve just discovered!”

“I checked the records after I’d examined you the first time, and found that by mid-Twenty-First Century there had been so many malpractice suits that the American Medical Association had been forced to ban it…..”

“In some countries, it continued for another century; then some unknown genius coined a slogan – please excuse the vulgarity – “God designed us: Circumcision is blasphemy.’ That more or less ended the practice…..”

Poole found himself laughing.

“Now what, Frank?”

“Aurora’s ‘Society for Creative Anachronisms.’ I’d hoped it would improve my chances. Just my luck to have found one anachronism she doesn’t appreciate.”

PEDIATRIC SURGERY INTERNATIONAL: Common circumcision complications are best avoided by making the practice uncommon

2010-02-21T20:20:52-08:00

Working hard to cut through the email back log related to MC_HIV. However, this one jumps to the head of the line.

Late complications of newborn circumcision: a common and avoidable problem

Journal: Pediatric Surgery International
Publisher: Springer Berlin / Heidelberg
ISSN: 0179-0358 (Print) 1437-9813 (Online)
Category: Original Article
DOI: 10.1007/s00383-010-2566-9
Subject Collection: Medicine
SpringerLink Date: Sunday, February 14, 2010

Rafael V. Pieretti¹, Allan M. Goldstein² and Rafael Pieretti-Vanmarcke³

(1)	Section of Pediatric Urology, Massachusetts General Hospital, Boston, USA

(2)	Department of Pediatric Surgery, Massachusetts General Hospital, Boston, USA

(3)	Department of Surgery, Massachusetts General Hospital, Boston, USA

Accepted: 1 February 2010 Published online: 14 February 2010

Abstract

Purpose:

The purpose of this paper is to study the types of operative and post-operative late complications resulting from newborn circumcisions and to make recommendations to prevent them.

Methods:

After obtaining IRB approval, a retrospective review of the late complications resulting from newborn circumcisions treated at the MassGeneral Hospital for Children from January 2003 to December 2007 was undertaken. The source used was the consultation notes and operative reports of affected patients. Additionally, cases seen in the outpatient Pediatric Urology Clinic from April 2007 to April 2008 were reviewed.

Results:

A total of 8,967 children were operated during the study period, of which 424 (4.7%) were for complications resulting from previous neonatal circumcision. Penile adhesions, skin bridges, meatal stenosis, redundant foreskin (incomplete circumcision with uncircumcised appearance), recurrent phimosis, buried penis and penile rotation were the most frequent complications. At the outpatient clinic of the Section of Pediatric Urology, 127 boys with concerns following newborn circumcision were evaluated, representing 7.4% of the total volume of cases seen in this clinic.

Conclusions:

Our results indicate the need to undertake a collaborative study to define the incidence of complications following newborn circumcisions, which should be performed by practitioners with adequate training in the technique of their choice and its post-operative care.

Keywords Circumcision - Complications - Newborn

Rafael V. Pieretti
Email: rpieretti@gmail.com

My response:

Dear Dr. Pieretti,

A radical but 100% effective approach to eliminating late complications from newborn circumcision is a concerted effort to avoid doing them in the first place. The simplest, most direct, and the least invasive approach to surgical complication has always been to reduce or eliminate the need for surgery. In this instance, there is no need in the neonatal period for circumcision. Therefore, the choice should be easy. If you believe otherwise, you are trapped in a mind set that encourages waste and clinging to tradition at the expense of the defenseless.

Best,

DAVID WILTON
(415) 669-4059 - text or voice
http://www.davidwilton.com/

DIGEST: RN magazine reports with blinders on, conflicts of interest plague medical field concludes the NIH, Muslim leaders work to correct the lie that circumcision makes men immune to HIV, and finally a couple of John Travis interviews

2010-02-18T06:00:00-08:00

Drawn from over 200 unread emails, this edition of the digest contains some old stuff. I've apparently become mostly a link archive and chronicler rather than a full-on blogger or commentator. I suppose that's ok. With some very good generalists out there posting here and here, I'm not too worried that the world lacks intelligent commentary on HIV or circumcision.

True to medical norms (and form)

From the mailbag of a year ago comes this scan of a nursing article [pdf] in the print version of RN magazine that addresses newborm circumcision with zero discussion of ethics. True to form in the medical field, nurses are given decontextualized information, much of it incorrect, without the slightest guidance as to whether the procedure is warranted. Nurses are expected, one could conclude from the article, to follow doctors' orders or to accede to the wishes of parents no matter how misguided or in contravention of the Hippocratic oath to do no harm.

Conflicts of interest plague medical device and pharmaceutical field

Much like the rest of American society and government, conflicts of interest have grown steadily more common in the medical field, concludes the National Institutes of Medicine Health. Intactivists, of course, have long known of the corrupting influence of money. ScienceNews.org reports:

The pharmaceutical and biomedical-devices industry preferentially targets the most senior medical researchers — especially ones who publish prolifically — in its efforts to influence what information is collected, whether it is published, and how it will be portrayed (as in spun). Or so concludes a new National Institutes of Health-funded study that surveyed researchers from the 33 U.S. universities receiving the most funding for biomedical and clinical studies.

Link: Industry Attempts to Influence Medical Care

Good money and effort after bad?

Musitwa of the Muslim Youth League says recent researches (sic) showing circumcision helps to protect men from HIV infection has confused some Muslims to go on rampage having multiple sexual relationships without any protection hoping that they are safe because of being circumcised.

He says the campaign will among others convince Muslims that circumcision is not a guaranteed protection against HIV infection.

Link: Uganda Health News: Muslim youth launch campaign against HIV/AIDS [and circumcision misperceptions]

John Travis speaks to KindredMedia.com.au viz the new push to circumcision

Apologies to John Travis and Kindred Media. This comes from an email dated June of 2009.

At the risk of multimedia overload, Dr. Travis is further interviewed in the video below.

More to come ...

MOMVERSATION.COM: Is circumcision wrong?

2010-02-17T11:19:07-08:00

This video is great. It's not particularly substantive, but it puts on display the emotional struggle infant circumcision inflicts on thoughtful mothers.

Alice Bradley (finslippy.com) looks pained by her decision despite her protests to the contrary. I see her defense of her child's circumcision as strained and reluctant. I think her words demonstrate the power of peer pressure to force reflection. Of course, that power is just as strong to do the wrong thing when the winds are blowing in the other direction.

Bravo for Daphne Brogdon (coolmom.com) and Maggie Mason (mightygirl.net) for their thoughtfulness.

See more on Momversation.com.

DIGEST: A Tale of Two Technologies, Circumcision Deserves Circumspection, and National Coalition For Men urges the AAP to consider boys' rights

2010-02-02T17:15:05-08:00

Playing a little catch up with three items in this post.

A Tale of Two Technologies: HPV Vaccination, Male Circumcision, and Sexual Health

Does it really take something called "feminist science and technology studies" to get us to a place where we can discuss the sexism inherent in the involuntary roll out of a particular prevention technology applicable to only one of the sexes?

For years, infant boys have had the most sensitive part of their penis lopped off to protect some theoretical female partner of the distant future from cervical cancer. So why is it suddenly so urgent to discuss the sexism in mandating vaccination for HPV in girls, the REAL cause of cervical cancer?

Laura M. Carpenter of Vanderbilt University and Monica J. Casper of Arizona State University aim to tell us in A Tale of Two Technologies: HPV Vaccination, Male Circumcision, and Sexual Health. Unfortunately, one must subscribe to get the full article, and the abstract is so abstract that I remain clueless on what they intend to say. Any readers out there have it? If so, pass it along and I'll do another post later.

Citation Reference:

Gender & Society, Vol. 23, No. 6, 790-816 (2009)
DOI: 10.1177/0891243209352490

Circumcision Deserves Circumspection

Elizabeth Reis, an associate professor of women’s and gender studies at the University of Oregon and the author of Bodies in Doubt: An American History of Intersex, writes at The Bioethics Forum on her regret at circumcising her son and asks the AAP to consider the ethics of any recommedation they may make.

Even in the world of medical ethics, circumcision is a subject that is largely ignored. Several of the major medical ethics textbooks don’t even include it in their indexes. And this is what I object to. I think that circumcision needs to be recognized as most parents’ first ethical decision that they make about and for their child. Parents should be informed of what the procedure actually entails. Remember that video of the birth process that many of us had to watch in prenatal classes? Why not see a video of a circumcision? I am convinced that most people do not know what they are consenting to, and if they did they would avoid the procedure like the plague.

...

Even if all the studies on the spread of HIV in Africa are valid and we all agree that circumcision prevents HIV, I think there are solutions other than surgery that would work to decrease the spread of the disease. Condoms also prevent HIV, and in fact they’re still necessary to avoid the virus even if men are circumcised. Fewer sexual partners would also help. Babies circumcised now won’t be having sex for several years, when we hope to have new and more effective strategies for preventing HIV. Avoiding HIV in adults simply isn’t a good enough reason to recommend cutting off a perfectly healthy, useful, and pleasurable part of infants’ bodies.

If men want to make this decision for themselves, for public health or personal reasons, then let them. The American Academy of Pediatrics should elevate the principle of autonomy and encourage parents to let their male children make the choice about circumcision when they’re all grown up.

Some excellent comments are appended to Elizabeth Reis's piece. Worth a read for sure.

National Coalition For Men addresses the AAP viz infant circumcision in a press release

The National Coalition For Men urges the AAP to consider human rights implications of any recommendation to circumcise infant boys. Read their press release here.

Male Circumcision | The Frisky

2010-01-27T21:14:20-08:00

Lifted in full. Apologies to John DeVore.

Mind Of Man: I Want All Of My Penis Back!

Posted by: John DeVore Filed in: guys
11:30AM, Wednesday January 27th 2010

Comments (67)

If a hood is good enough for Batman, it’s good enough for my penis. Uncircumcised joints look gross, like a cross between a tentacle and a trunk. But the word on the street is that it feels better to have a foreskin. My zipper cudgel is cut, and therefore less sensitive than a man who’s packing a frightful sex nozzle. I mourn the loss of that little flap of skin. I think I would have preferred to have had the choice to be circumcised or not.

I get that thousands of years ago, soap wasn’t readily available. And maybe, after a few months of sweating in the fields, it was possible to get an infection in the pants. Circumcising was a way of preventing such unfortunate ouchies. But we have soap now. Tons of it.

The idea that my penis could have had more nerve endings is erotically intriguing. I’m curious as to how dulled my love prong is as a result of my foreskin having been removed. I’m not even sure I believe any of the negative reasons for being uncircumcised. It’s a bunch of hype. First of all, I have always been under the impression that penises were not exactly attractive human appendages. I have never met a woman who was all, “There is NOTHING more beautiful than a ween.” Whether it’s a helmet or an anteater, male genitals are not aesthetically attractive. Unlike boobs, they are not triumphs of natural wonder.

And there’s the health reason for circumcision, which all boys learned about in junior high sex education class. It seems that uncircumcised men have wangs that ooze a terrible, disgusting substance known as “smegma.” It might or might not be toxic. Smegma has the distinction of being the human secretion with the most disgusting name. The runners-up: mucous, pus, and bile.

From what I know, it serves as a lubricant between the head of the penis and the foreskin. Poor smegma, you are tragically misunderstood! During sex education classes, we all felt relieved, thankful even, for being circumcised. We were told that smegma was basically some kind of social disease, that men with uncut clangs were always itching, and stinking, and generally uncomfortable. It never occurred to me that uncircumcised penises could be unhygienic … if you never bathed.

There are religious reasons for circumcision, and hey, I respect religious beliefs. Sort of, kind of. I mean, my religion believes that every time I masturbate, I’m consigning millions of potential babies to Death by Kleenex. I respect that some people believe that; I don’t.

I’ve even been to a Bris, the Jewish circumcision ritual. The smoked salmon was delish. The baby cried, but babies always cry. Everybody seemed really happy. But what I didn’t appreciate was that the infant’s cries, if one were to translate them from the baby to the adult, went something like this: “HOLY F**K, STOP SLICING INTO MY DINKY! SOMEBODY F**KING HELP ME! THIS CRAZY SON OF A BITCH IS TAKING A SHARP OBJECT TO MY DELICATE BITS!”

I get that thousands of years ago, soap wasn’t readily available. And maybe, after a few months of sweating in the fields, it was possible to get an infection in the pants. Circumcising was a way of preventing such unfortunate ouchies. But we have soap now. Tons of it. Think about it: after water, it’s the one fluid that’s pretty much free. Just pop into any public toilet and Shazam! Soap!

The decision to remove my foreskin was made for me. Like millions of men, my tip was snipped without my consent. There are solutions to this, but they all seem extreme. There are surgical and non-surgical ways to restore or reattach foreskin to the glans of the penis. There are actual skin grafts, and procedures that stretch and grow skin. All of these solutions promise improved sexual pleasure for dudes. As well as increased pride: why not walk around with a swinging, all-natural, all-sheathed gorilla bazooka. Join me, as I mourn the long-ago loss of my foreskin.

I have seen an uncircumcised penis in the wild once in my life. I was in the locker room of the local pool with my dad. I must have been all of 7 or so. Some hairy butterball of a grown man was sauntering around naked, like some European shipping magnate. Sprouting from his gross man nest was a hooded penis. I made a sound I imagine an astronaut would make if his spaceship was punctured and all his oxygen was sucked out into space. I almost cried: Human beings were not supposed to look like swamp beasts. I asked my dad later why that man was horribly deformed and he explained to me why his penis looked that way. He then told me about circumcision: it had been done to him, to me, and to my little brother. This process sounded more terrifying than the man with the werewolf tube. My dad was a cigar smoker, and I pictured the mini-guillotine he used to cut off the ends of his cigar as the device doctors used when removing the foreskin.

The next day, I reported all I knew to my friends at recess. We huddled in fear of the adult world. One of my friends asked where the foreskins went after they were cut off.

I responded swiftly, if slightly sarcastically: “The Penis Fairy! The doctor tucks them under his pillow, and The Penis Fairy comes in the night and leaves a quarter!” We laughed at this joke, and then debated the actual worth of a human foreskin. A quarter? No … that’s the standard rate for a tooth. Fifty cents? A dollar? We concluded that the princely sum of five dollars was the amount The Penis Fairy would leave for a scrap of skin.

Of course, we didn’t believe this. But at the same time, we sort of did.

Anyway, Dear Penis Fairy: Please return my foreskin. I’d like to know what it feels like to have it back.

via www.thefrisky.com