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Rapid Responses: Rapid Responses published:
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One-sided picture
- Dennis Harrison (9 June 2000)
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Read this paper
- James Gregory (9 June 2000)
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Implications for adults, rather than infants
- Colette Chalier (9 June 2000)
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Irresponsible and misleading
- Christopher Price (10 June 2000)
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Writer seriously questions HIV study recommendations
- John Sawkey (10 June 2000)
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Data not enough
- L G Shah (11 June 2000)
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Acculturation vs. medical indoctrination
- Theron L Gibbons (11 June 2000)
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Misuse of the Medical Circumcision Literature: Psychological Factors
- George Hill (11 June 2000)
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Another silly article probably written on April's fool day
- Jacqueline Maire (11 June 2000)
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Re: One-sided picture
- Guy Cox (11 June 2000)
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What has happened to peer review?
- David J Wilson (12 June 2000)
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Infant Circumcision not Warranted by Study
- Lawrence Barichello (12 June 2000)
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Nothing new under the sun
- Pierre Delaurent (12 June 2000)
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Re: Re: One-sided picture
- Dennis Harrison (12 June 2000)
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One-third were already infected
- Hugh Young (12 June 2000)
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CIRCUMCISION OF CHILDREN: CRIMINAL ASSAULT
- G Boyle (12 June 2000)
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Re: Re: One-sided picture
- David Wilson (12 June 2000)
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Re: Re: One-sided picture
- Gary L Harryman (12 June 2000)
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Circumcision: Not The Way To Prevent AIDS
- Tony Shale (13 June 2000)
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More of the One-sided picture
- Guy Cox (13 June 2000)
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Re: More of the One-sided picture
- David Wilson (13 June 2000)
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Re: More of the One-sided picture
- Steve Wilder (14 June 2000)
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Re: More of the One-sided picture
- Dennis Harrison (14 June 2000)
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Re: More of the One-sided picture
- Gary L Harryman (14 June 2000)
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Circumcision Complication Rate
- Erick L Gustavson (14 June 2000)
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Why wait till puberty?
- John Smith (14 June 2000)
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Re: More of the One-sided picture
- John Antonopoulos (15 June 2000)
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Re: Solidarity with Victoria
- Brian Morgan (16 June 2000)
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Down under = below the belt
- Jacqueline Sonnendrücker (17 June 2000)
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To the circumcisers of all backgrounds, religions, colours and creeds.
- Julie Filliatre (17 June 2000)
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Penis epithelium
- Peter Morrell (18 June 2000)
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A superstitious rite
- John Dalton (18 June 2000)
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Solidarity with Victoria
- Rio Cruz (19 June 2000)
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Dangerous Recommendation
- Amber Craig (19 June 2000)
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Prepuce:Anatomy and Functions
- Rio Cruz (20 June 2000)
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Mass Circumcision: Crime Against Humanity?
- Jerry Warner (21 June 2000)
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The Ghosts of Abraham Wolbarst and Aaron Fink
- George Hill (22 June 2000)
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Questions
- M van der Veer (25 June 2000)
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Study of FGM and AIDS
- Brian A Waldman (26 June 2000)
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A Procrustian Solution
- Jerad Lee (26 June 2000)
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An Anonymous Missive
- M van der Veer (3 July 2000)
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Circumcisers: Penis Paracites
- Eileen Marie Wayne (10 July 2000)
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ETHICAL IMPLICATIONS OF MALE CIRCUMCISION AND HIV IN DEVELOPING NATIONS
- Adrian Viens (11 July 2000)
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Ethical Nightmare
- Sadira Bolt (17 July 2000)
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A little bit of science wouldn't have gone amiss
- Robert S Van Howe (19 July 2000)
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Warped!
- Kevin Elks (22 July 2000)
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Male circumcision and protection against HIV infection.
- R T D Oliver (22 August 2000)
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Not all male circumcisions are the same.
- Judith E Brown (4 January 2001)
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Cultural imperialism should be recognised for what it is
- John D Dalton (28 May 2001)
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Safe Circumcisions in Africa ? When ?
- Jean-Jacques, A. GUILBERT (30 April 2007)
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Dennis Harrison, Concerned citizen Vancouver, British Columbia
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Szabo and Short present a one-sided picture of circumcision. In stating that male circumcision protects against sexually transmitted diseases such as syphilis and gonorrhoea, the authors are ignoring substantial evidence to the contrary. Laumann et al. concluded on the basis of a nationally representative probability sample that "circumcision provides no discernible prophylactic benefit and may in fact increase the likelihood of STD contraction."(1) Similarly, when the authors assert that neonatal circumcision has a low incidence of complications, they seem to be disregarding studies that have found complication rates of 2 to 10 percent(2) and 55 percent.(3) Griffiths et al. found that childhood circumcision "has an appreciable morbidity."(4) References: 1. Laumann EO, Masi CM, Zuckerman EW. Circumcision in the United States: Prevalence, Prophylactic Effects, and Sexual Practice. JAMA 1997;277:1052-1057. 2. Williams N, Kapila L. Complications of Circumcision. Brit J Surg 1993;80:1231-1236. 3. Patel H. The problem of routine infant circumcision. Can Med Assoc J 1966;95:576-581. 4. Griffiths DM, Atwell JD,Freeman NV. A prospective survey of the indications and morbidity of circumcision in children. European Urology 1985;11:184-7. |
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James Gregory
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http://www.cirp.org/library/disease/HIV/vanhowe4/ Circumcision and HIV infection: review of the literature and meta-analysis R. S. Van Howe MD FAAP Department of Pediatrics, Marshfield Clinic, Lakeland Center, USA "Summary: 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." In the developed world (1) the USA has one of the highest circumcision rates and the highest HIV rates and (2) the Scandinavian coutries have the lowest circumcision rates and the lowst HIV rates. Circumcision is still a procedure in search of validation. |
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Colette Chalier, Technical Services Librarian Winnipeg, Manitoba, Canada
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This article fails to point out that the implications discussed are for adults, not infants. While this may seem obvious to some, it will be overlooked by others. Male infant circumcision is a human rights violation in most parts of the world, however, adults can choose to have preventive amputations based on risk factors (ie, mastectomy). As no infant is at-risk for developing HIV through intercourse, the relevance of these findings is limited to adults, and should be clearly stated as such. |
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Christopher Price, Writer Self-employed
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Szabo and Short's claim,1 using a selective bibliography and speculation for foundation, that circumcision represents an effective new strategy for combatting AIDS is highly irresponsible, particularly when a rise in unprotected gay sex is being reported on both sides of the Atlantic.2 It is likely to discourage even further the practice of safe sex by circumcised men who are liable, as a result, to believe that their circumcision is all the protection they need. Indeed, Halperin (commenting on the article cited by them) was quoted in an interview to the Californian newspaper, The Bay Area Reporter, on Nov 24, 1999 as saying "If I were a top [insertive partner in anal intercourse], and I didn't like to use condoms, I would consider getting circumcised". Their article is also misleading, relying on selection, and misrepresentation, of the corpus of the literature, and on highly flawed and tendentious studies out of Africa whose authors, with clear cultural bias, ignore the confounding factors, and also the failure of circumcision to prevent the HIV pandemic in the United States that is on a par with the incidence documented in sub-Saharan Africa. In sharp contrast, the largely uncircumcised Europe has rates one quarter of the US.3 Szabo and Short assert that circumcision "also protects against other sexually transmitted infections, such as syphilis and gonorrhoea"; however, they conspicuously fail to cite Laumann et al4, who found "circumcision status does not appear to lower the likelihood of contracting an STD. Rather, the opposite pattern holds. Circumcised men were slightly more likely to have had both a bacterial and a viral STD in their lifetime." The theory that Langerhans' cells provide the mechanism for infection by HIV has yet to be properly substantiated, and appears to suffer from the fallacy of 'post hoc, propter hoc' by suggesting that infected Langerhans' cells are the cause, rather than simply the result of HIV infection. Szabo and Short's bald assertion that the keratinised, stratified squamous epithelium of the penile shaft "provides a protective barrier against HIV infection" is without a scintilla of substantiation or evidence; and the loss of specialised nerve-endings in the prepuce6 along with the desensitisation of the circumcised glans and foreskin remnant by keratinisation is likely to make circumcised men even less willing to suffer the further desensitisation of a condom. Equally, their suggestion that neonatal circumcision is "easy to perform, and has a low incidence of complications" cites a populist pamphlet, which is notorious for its highly selective and discredited5 propagandising of neonatal circumcision, and fails to reflect more scholarly assessments of the complications.6, 7, 8, 9 Routine circumcision might justly be seen as a remedy still looking for a disease process, which is why a succession of scare tactics (each then soundly refuted) has cynically been used over the decades. Szabo and Short are thus in a long and discreditable line of those who, typically coming from countries where routine circumcision is prevalent, seek to promote this damaging mutilation as a panacea for the latest illness 'de nos jours' by preying on current popular fears. References 1 Szabo R, Short RV. How does male circumcision protect against HIV infection? BMJ 2000;320:1592-1594. 2 Dodds JP, Nardone A, Mercey DE, and Johnson AM. Increase in high risk sexual behaviour among homosexual men, London 1996-8: cross sectional, questionnaire study. BMJ 2000; 320: 1510-1511. 3 World Health Organization. Global Programme on AIDS: The Current Global situation of the HIV/AIDS Pandemic, Quarterly Report. 3 July, 1995. 4 Laumann EO, Masi CM and Zuckerman EW. Circumcision in the United States, prevalence, prophylactic effects, and sexual practice; JAMA 1997;277(13):1052-1057. 5 Dewan P. Book lacks scientific evidence. Australian Medicine 1999;11(11):18 (Review of "In Favour of Circumcision" by Brian Morris). 6 Taylor R, Lockwood AP and Taylor AJ. The prepuce: specialized mucosa of the penis and its loss to circumcision. Br J Urol 1996;77(2):291 -295. 7 Patel H. The problem of routine circumcision. Canadian Medical Association Journal 1966;95:576-81. 8 Kaplan GW. Complications of circumcision. Urol Clin N Amer 1983;10:543-549. 9 Williams N, Kapila L. Complications of circumcision. Br J Surg 1993;80:1231-1236. |
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John Sawkey, Retired teacher/principal . Currently a writer. Home
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I would like to comment on the article "How does male circumcision protect against HIV infection?" by Robert Szabo and Roger V. Short. I find the conclusions reached by these Australian researchers incredible. It is difficult to believe that intelligent individuals would reach such preposterous conclusions that mass circumcisions would eliminate or prevent a variety of diseases including the spread of the HIV virus. It is clearly another study designed to promote and legitimize circumcision. It is an attempt to save the albatross of which so many males have become victims over the decades. The practice of circumcision is rapidly declining and falling into disrepute. The end of this dehumanizing and barbaric practice is long overdue. One can only conclude that the study is a catharsis providing the authors with a means to vindicate their own circumcision. Intact males do not have the need to validate their wholeness. Perhaps the authors of the study would state why they did not carry out their study in the USA or Israel where the majority of men are circumcised. Why didn't they research why circumcision has not prevented the spread of AIDS in these two countries? And if it did, how great an effect did it have? Recently, the Center for Disease Control in Atlanta stated that the USA had the greatest rate of increase and most rapid spread of AIDS in the developed nations, surpassing many European countries where circumcision rates are only a fraction of what they are in the USA. Several studies in the state of New York and a recent study done by the University of Chicago found no correlation between the spread of AIDS and circumcision. Several years ago, an Israeli newspaper reported that a hooker spread AIDS to thousands of men, in Israel where most men are circumcised. Circumcision should have prevented large numbers of these men from getting the AIDS virus, as we are told by the Australian researchers. Perhaps the researchers would explain why circumcision hasn't prevented the spread of AIDS in Israel, if circumcision is such an important factor, as we are lead to believe? Would not warning males to take precautionary measures be more effective and logical? Do Robert Szabo and Roger Short really believe that millions of males should be circumcised and lose vital erogenous tissue in order to prevent a few cases of AIDS? Are they suggesting that all teenage or adult males will be promiscuous, become drug users or engage in practices which may put them at risk of contacting AIDS? Males who engage in practices which put them at risk - in whatever situation - are aware of the risks that they are taking. If they are not, would not logic dictate that an effective education program is more desireable than mass amputations? We are plagued by studies which seek to legitimize circumcision. For years we were told that circumcision would prevent prostate cancer. Today it is the second leading cause of death in Canada and the USA. Circumcision would prevent penile cancer, we were told. Today statistics in the USA have shown that penile cancer is an age related disease and is also found in circumcised men even though they were circumcised as infants. Urinary tract infections are deadly for males, but easily treated in females. These are just a few examples of scare tactics used to persuade parents into circumcising their sons. All very convincing - but none of them legitimate. For more than a century males have become victims of a practice for which there were plenty of excuses - but no valid medical reasons. It is not circumcision which needs to be studied, but rather the advocates of circumcision and why their desire to mutilate another's genitals never ceases. We live in a civilized and democratic society where most of us have the intelligence to decide what is in our own best interests. If we decide to engage in practices which may put our lives at risk - so be it . How many decisions are these researchers prepared to make on our behalf? How many body parts need to be amputated? We do not need some totalitarian grand daddy researchers making decisions for us. In a democracy each individual has the right to choose what he wants to do with his/her own body, not Robert Szabo nor Roger Short. Sincerely, John Sawkey
John Sawkey is a retired teacher/ principal. |
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L G Shah, Primary Care Physician India
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Dear Sir, The conclusion is hasty. What needs to be done is study of incidence in large population eg. muslim community in Indian Subcontinent. Here neonatal and 1st year of life circumcision is almost compulsory for followers of Islam. Regarding sexually transmitted disease, one does see enough incidence in circumcised men. Therefore more data is needed. Thanks. No conflict of interest. |
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Theron L Gibbons, Head Writer Elucid Press
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This article does not take into consideration international statistics regarding HIV transmission and cultural behaviors. Nobody seems to like to admit it in the medical community, but monogomy is still the best protection against all forms of sexually transmitted diseases, including HIV. The penis is as much a transmission point for disease as is the vagina. Separating the issue by gender and using surgery in place of education about behavioral choices is ludicrous. Examples that support this are culturally definable. The US has the highest circumcision rate, and the highest HIV growth rate of any country in the industrialized west. HIV is currently spreading quite quickly through our 50-70 year old generation, these people being of a group who are nearly 90 percent circumcised. In contrast, our high school youth, less of whom are being circumcised with each year that passes, are at a lower risk of contracting HIV than they have been in nearly a decade -- primarily because they are educated on disease prevention and are making safe personal decisions when engaged in sexual relations. In Eastern industrialized countries, a stronger support of culture vs cutting exists. Japan has an incredibly low incidence of HIV. They are as a nation uncircumcised, but as a culture support monogomous behavior. Thailand, another island culture that is uncircumcised, was sitting at around 85 percent of the population being HIV positive two years ago. They as a culture support sex from roughly the onset of puberty, multiple sex partners, and have a strong prositution market. In using a global view, one obvious corolary becomes apparent: Individual behavior and cultural attitudes about sex, and not the practice of circumcision, is the key to limiting the spread of HIV. |
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George Hill, Retired
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To the Editor:
Misuse of the Medical Circumcision Literature: Psychological FactorsMale circumcision removes about 1/2 of the skin and mucosa from the penis.1 This lost skin is actually specialized mucosa that contains a concentration of erogenous nerve endings1 that provide sexual ecstasy to the owner of the foreskin when they are stimulated by sexual activity.Persons who have lost body parts to surgery must grieve the loss of their function.2 Men who have lost their prepuce to circumcision must grieve their loss of function and erogenous pleasure.3 Men who have failed to grieve their loss of sexual ecstasy usually are in denial of their loss. Men who are in denial of their loss use a variety of mental gymnastics to avoid feeling the pain of their loss. Male medical doctors who are circumcised are not immune from this phenonenon.4 Such medical doctors tend to misuse the medical literature to justify their loss.4 Goldman states: "Among physicians, support for circumcision has been based on supposed 'rational' factors, but as psychiatrist Wilhelm Reich wrote, 'Intellectual activity has often a structure and direction that it impresses one as an extremely clever apparatus precisely for the avoidance of facts, as an activity which distracts from reality'. This appears to have been the case in those advocating circumcision. Science has been adopted as the great arbiter between fact and fiction. This systematic approach to evaluating experience is of value, especially as research has shown that a surprising number of adults do not reason logically. The scientific method is designed to help protect the scientific community and the public against flawed reasoning, but it is the flawed reasoning of supposedly reputable scientific studies that has contributed to the confusion on the circumcision issue.4Goldman concludes: "Defending circumcision requires minimizing or dismissing the harm and producing overstated medical claims about protection from future harm. The ongoing denial requires the acceptance of false beliefs and misunderstandings of facts. These psychological factors affect professionals, members of religious groups and parents involved in the practice. Cultural conformity is a major force perpetuating non-religious circumcision, and to a greater degree, religious circumcision. The avoidance of guilt and the reluctance to acknowledge the mistake and all that that implies help to explain the tenacity with which the practice is defended."4There have been many claims made for circumcision through the more than a century of its medicalization.5 The benefit claimed is the disease most feared at the moment. In the 19th century when the cause of mental disease was unknown, circumcision was claimed to prevent mental illness which supposedly was caused by masturbation. At the time of the first World War, circumcision was claimed to protect against venereal disease. In the 1930-50 era, when cancer was the dread disease, claims were made that circumcision offered protection against cancer. All these claims have been disproved.6 Editors of medical journals seem to be unaware of the psychological impact of circumcision on medical doctors and frequently allow such articles written by circumcised male doctors 7-12 to slip through the peer review process. The opinion piece by Szabo and Short13 seems to be of this genre. It appears to be a psychological manifestation of the circumcised male.4 Turning to the merits of the work, Szabo and Short claim that most men are infected with HIV through the penis.13 However they offer no supporting citation. In reality, the path of entry of HIV has never been established. Dezzuti states that "the data suggest that the in vivo mucosal epithelial barrier protects against HIV transmission."14 Short and Szabo claim that keratinization of the glans penis in the circumcised male provides protection against HIV infection.13 This is a much repeated claim but there is no evidence to support it.6 This claim originated with a letter by a noted circumcisionist that was published in the New England Journal of Medicine in 1986.6,15 Short and Szabo suggest that the presence of Langerhans cells in the mucosa make it susceptible to penetration by HIV and that circumcision would remove the Langerhans cells and offer protection against HIV.13 Cold and Taylor, however, state that: "Circumcision has been justified by some because it removes the Langerhans' cells of the prepuce and therefore supposedly decreases the risk of HIV infections. This theory is flawed, as even after circumcision, there is residual penile mucosa of the glans, and there are Langerhans' cells in the penile shaft epidermis. Surgical removal of the Langerhans cells in all mucosa and skin to prevent infections is not feasible, nor rational. In addition, the aggressive circumcision campaign in the USA has not prevented sexually transmitted infections, including HIV. Therefore, Langerhans cells of the prepuce should be understood as normal mucosal immune cells, rather than a pathological entity requiring excision."16 While the entry path of the HIV has never been definitely established much attention has been focused on genital ulcer disease (GUD) which is caused by pre-existing STD, usually syphilis and chancroid, as probable points of entry.17 Female sex workers in Africa continue to ply their trade even with GUD.18 Short and Szabo propose that circumcision would somehow prevent GUD and stop HIV transmission. Circumcision cannot prevent or cure GUD. Nor can it stop the female sex workers from having sex with GUD. Only antibiotics can do this. Short and Szabo repeat the medical myth that the prepuce is prone to tearing during sexual intercourse.13 In reality in the intact complete non-circumcised male, the penile shaft moves within its sheath during sexual intercourse. The rolling/sliding lubricating action of the moist prepuce makes the intact non-circumcised penis much less susceptible to trauma such as tearing or abrasions.6,16 Lauman et al. report that 77% of U.S. born men are circumcised.19 This has not prevented the United States from having the highest incidence of STD infection amongst the industrial nations.20 In spite of the high incidence of male circumcision in the U.S., the incidence of HIV infection in the U.S. is more than 6 times that of the U.K.21 Two meta-analyses of the medical literature regarding HIV and male circumcision have been published.22,23 De Vincenzi and Mertens found that: "[the] major criticism of most of the studies preformed to date is the lack of attention given to potential confounding factors, which could be related to both circumcision status and risk of sexually transmitted infections, such as sexual behaviour or differences in hygienic practices, or differential use of specific health facilities….As the safety, expected benefits, feasibility and acceptability of mass circumcision are all questionable, neither public-health interventions nor intervention studies appear to be defensible options before there is stronger evidence from observational studies in different settings that show lack of male circumcision may be a genuinely independent risk factor for the transmission of HIV."Van Howe is even more emphatic. Van Howe conducted a statistical meta-analysis of all published data. Base on the published data, Van Howe concluded: "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."" Recently, the African cultural practice of "dry sex" has been identified as a confounding factor in the study of HIV transmission.24 Nevertheless, not a single one of the more than 40 studies on which Short and Szabo13 rely control for this confounding factor. Short and Szabo propose child circumcision as an immediate step to prevent HIV infection.13 However, children are legally incompetent persons who are unable to grant consent for invasive surgical procedures.25 Male circumcision is a violation of the child's legal right to bodily integrity. Furthermore, lawyers note that, since minors are unable to grant consent for such a non-therapeutic amputation of healthy tissue, child circumcision is probably unlawful assault.26 Short and Szabo have made numerous errors of fact which suggests that they are more interested in promotion of circumcision than the advancement of medical science or the prevention of HIV infection. Promotion of circumcision as an alternative to safe sexual practices could easily create a false sense of security in the minds of circumcised men. Such behavior is irresponsible from a public health standpoint and should not be condoned. At the present time, the notion that circumcision can prevent the transmission of HIV remains an unproven hypothesis. Medical decisions should not be based on such dubious evidence. NOCIRC of LousianaP. O. Box 88 Port Allen, Louisiana 70767-0088 USA E-mail to iconbuster{at}eatel.net References:
1 Taylor JR, Lockwood AP, Taylor AJ. The prepuce: specialized mucosa of the penis and its loss to circumcision. Br J Urol 1996;77:291-295.
2 Maguire P, Parks CM. Coping with loss: surgery and loss of body parts. BMJ 1998; 316(7137):1086-1088.
3 Denniston GC. An Epidemic of Circumcision. Paper presented at the Third International Symposium on Circumcision, University of Maryland, College Park, Maryland, May 22-25, 1994. http://www.nocirc.org/symposia/third/denniston3.html
4 Goldman R. The psychological impact of circumcision. BJU International 1999; 83, Suppl. 1:93-102. /
5 Gollaher DL. From ritual to science: the medical transformation of circumcision in America. Journal of Social History 1994;28(1):5-36.
6 Fleiss P, Hodges F, Van Howe RS. Immunological functions of the human prepuce. Sex Trans Inf 1998;74:364-367.
7 Wiswell TE, Smith FR, Bass JW. Decreased incidence of urinary tract infections in circumcised male infants. Pediatrics 1985, 75: 901-903.
8 Schoen EJ. The status of circumcision of newborns. N Engl J Med 1990; 322: 1308-1311.
9 Schoen EJ. Is it time for Europe to reconsider newborn circumcision (letter)? Acta Paediatr Scand 1991;80;573-5.
10 Schoen EJ. Benefits of newborn circumcision: Is Europe ignoring medical evidence? Arch Dis Child 1997;77:358-60.
11 Moses S. Bailey RC, Ronald AR. Male circumcision: assessment of health benefits and risks. Sex Transm Infect 1998:74:368-73.
12 Halperin DT, Bailey RC. Male circumcision and HIV infection: 10 years and counting. Lancet 1999;354:1813.
13 Szabo R. Short RV. How does male circumcision protect against HIV infection? BMJ 2000,320:1592-94.
14 Dezzutti CS. Mechanisms of HIV Transmission through Epithelial Cell Barriers. 12th World AIDS Conference. Geneva, June/July 1998 [abstract 278/32124.
15 Fink AJ. A possible explanation for heterosexual male infections with AIDS. N Engl J Med 1986;315:1167.
16 Cold CJ, Taylor JR. The prepuce. BJU International 1999;83 Suppl. 1:34-44.
17 Pepin J, Quigley M, Todd J, et al. Association between HIV-2 infection and genital ulcer diseases among male sexually transmitted disease patients in The Gambia. AIDS 1992;6:489-493.
18 Kaul R, Kimani J, Nagelkerke NJ, et al. Risk factors for genital ulcerations in Kenyan sex workers. The role of human immunodeficiency virus type 1 infection. Sex Transm Dis 1997;24(7):387-92.
19 Laumann, EO, Masi CM, Zuckerman EW. Circumcision in the United States. JAMA 1997; 277(13):1052-1057.
20 Tanne JH. US has epidemic of sexually transmitted disease. BMJ 1998;317:1616.
21 World Health Organization. The Current Global Situation of the HIV/AIDS Pandemic. World Health Organization. Geneva: (3 July 1995).
22 de Vincenzi I, Mertens T. Male circumcision: a role in HIV prevention? AIDS 1994;8(2): 153-160.
23 Van Howe RS. Circumcision and HIV infection: review of the literature and meta-analysis. Int J STD AIDS 1999;10:8-16.
24 Baleta A. Concern voiced over "dry sex" practices in South Africa. The Lancet 1998;352:1292. /
25 Lynn E. Lebit. Compelled Medical Procedures Involving Minors and Incompetents and Misapplication of the Substituted Judgment Doctrine. Journal of Law and Health 1992;7:107-130 (1992).
26 Gregory J Boyle, J Steven Svoboda, Christopher P Price, J Neville Turner. Circumcision of Healthy Boys: Criminal Assault? J Law Med 2000; 7;301-310.
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Jacqueline Maire, retired nurse, ETHIC (End The Horror of Infant Circumcision) Vancouver
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Incredibly funny those Australians and no short (no pun intended) of ideas to get some publicity!!! Circumcision, a condom for life against AIDS ... Ha! Ha! Who is gullible enough to swallow that one? (again no pun intended). To verify this statement, let's all the intact white male population above the age of 25 get circumcised and live the life of promiscuity, at random, preferably in Africa. Then let's have some real statistic, based on facts. Cowardly attacking newborn to promote such an insane theory is nothing short (again no pun intended) of criminal. The clowns who promote and endorse these beliefs won't be around to verify their stories themselves ..., no more than the avid ablationists who promoted circumcision against kleptomania, tuberculosis, cancer, are here today to see how ridiculous they were. Meantime they make money Money MONEY. Show me one of those jerks (no pun intended) riding a bus, living in the poorest section of town, lining up at the food bank ... I tell you: circumcision is MONEY. The sad part ... those unfortunate babies who have no say in the matter, mutilated in their beautiful bodies by unscrupulous doctors with no respect for human rights. Shame to B.M.J. for printing such hogwash and make civilization take a back seat just because troubled scientists are making fun of babies and their parents. Parents should be aware that M.D. stands for Morally Disabled, more often than they care to know. |
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Guy Cox, Senior Lecturer University of Sydney
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Your correspondent Harrison is effectively misquoting the excellent and thorough study carried out by H. Patel (CANADIAN MEDICAL ASSOCIATION JOURNAL,95: 576-581) in claiming that it reports a complication rate for infant circumcision of 55%. Patel's study recorded in detail the postoperative history of 100 infant circumcisions. I quote: "Slight bleeding, consisting mainly of oozing, occurred in 31 ..... In four there was moderate bleeding, sutures being necessary in one of them. .... In no case was bleeding so severe as to require a blood transfusion." Clearly the line at which 'complications' can be cited is flexible, but few would refer to postoperative oozing as a complication. Patel reported eight minor infections only one of which required antibiotic treatment. In only one case - secondary phimosis following inadequate removal of the prepuce complicated by postoperative infection - was further intervention needed. Hence we have one need for suturing, one antibiotic case, and one case requiring surgical intervention (the latter two may have been the same infant) - a complication rate of 2% or 3% by the criteria used in other studies. Patel also points out that no deaths occurred at Kingston General Hospital over a 10-year period from circumcisions of infants (6753 operations) or older children (589 operations). Thus infant circumcision remains a safe procedure. The risk of serious complications when it is carried out as a medical (rather than ritual) procedure remains almost too low to estimate. In Australia there were two deaths attributable to circumcision in the period 1960-66. (IOW Leitch, 1970. Circumcision, a continuing enigma. Australian Pediatric Journal, 6, 59-65). 840,000 boys were born in that time and if we (conservatively) assume a circumcision rate of 70% this translates to a death rate of one in 290,000 circumcisions. Over the same period 78 Australians died from carcinoma of the penis (Leitch, op cit.), a condition which affects only uncircumcised men. Assuming that at that time the Australian population contained 2.25 milion uncircumcised men (30% of a male population of 7.5 million) we find that the risk of death from penile carcinoma is 1 in 28,800 in a seven-year period or approximately 1 in 2,900 in a lifetime. Hence the risk of death, from cancer alone, in being uncircumcised is 100 times higher than the risk of death from being circumcised. While AIDS is making headlines at the moment, it is as well to remember that the prophylactic value of circumcision against penile carcinoma has been well known for at least 50 years. |
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David J Wilson, Patent Agent Medlen & Carroll, LLP
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In response to Robert Szabo and Roger V Short's very skewed article "How does male circumcision protect against HIV infection?", one has to ask what has happened to peer review of articles and to the integrity of the publishing entity. Szabo and Short disregarded a substantial body of scientific evidence that throws into serious doubt their speculative conclusions. Unfortunately, this article has been picked up by press service organizations and has been disseminated as the medical establishment's vindication of circumcision as a method to reduce or inhibit HIV transfer. In fact, many large studies have shown the exact opposite to be true. By publishing an article that suggests the lack of a foreskin offers any protection from HIV, the BMJ has taken an irresponsible action that may lead to reduced condom use and reduced safe sex practices by circumcised men thus increasing their risk of HIV infection. Additionally, the money that Szabo and Short would like to spend on circumcisions would be better spent on education programs and condom distribution, which could result in benefits quickly. The foreskin has been demonized to cause or contribute to a surprising long list of medical and psychological conditions, all of which have been disproved. HIV transmission is the latest in this long list. However, by choosing HIV as the current disease to be benefited by circumcision, the authors may actually be contributing to the spread of HIV. The BMJ should take pains to ensure this doesn't happen again. |
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Lawrence Barichello, Executive Director, Intact Intact
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I have no objection to any young man of the age of majority having his foreskin removed if he perceives that this will prevent some disease that he feels he is at risk of developing, just as some healthy women have their breasts removed because they are worried that they might get breast cancer. This recent study does not, however support *infant* circumcision as a desireable procedure to prevent AIDS, and in fact, the authors contradict themselves in saying so. By the time today's infants reach the age of sexual activity, AIDS may cease to exist or may be curable, or, as the authors mention, HIV blockers may have been developed which prevent the spread of the disease much more effectively than they suppose circumcision does. Circumcising infants is also dangerous because it makes unwarranted assumptions about the infants behaviour fifteen or twenty years in the future: After all, the circumcised infant may grow up to marry his high- school sweetheart and not be in any danger whatsoever of contracting HIV. In any of the above scenarios, the infant has been circumcised against his will and contrary to his human rights-and his full sexual sensitivity has been sacrificed for nothing. What if he would have preferred to have an intact penis? What if his lover prefers the advantages of a foreskin? Infant female mastectomy would also be an effective prophylactic against breast cancer. But, then, wouldn't that be contrary to a little girl's human rights? Lawrence Barichello
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Pierre Delaurent, retired engineer Vancouver, Canada
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Those two researchers Szabo and Short remind me of a research done by a professor of sort somewhere in Europe. He had trained fleas to jump, then cut their legs and told them to jump. They did not. Conclusion they had become deaf ... As well intentioned as the researchers are, their conclusion is faulted. Less is never better than more. And until they give me proof: a) of their circumcised state and b) that they have intercourse with multiple HIV+ partners, I won't believe their speculations. Neither professionanal nor lay men should. One thing that those researchers promoting circumcision against AIDS fail to say is: what is the percentage of circumcised men in the 10+ million people sexually infected with AIDS worldwide? I bet they don't say it because it is widely over 50%. |
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Dennis Harrison
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As Guy Cox correctly points out, weighing the risks of surgery is not an exact science. One thing, however, is clear: in societies where genital mutilation is socially sanctioned, the harms associated with performing this surgery are underreported. It is in the nature of human society to bring pressure to bear against anyone who would discredit an established practice. Cox's claim that the "prophylactic value of circumcision against penile carcinoma has been well known for at least 50 years" is not recognized by the American Cancer Society, which advises: "circumcision is not of value in preventing cancer of the penis." 1. ( http://www2.cancer.org/ezineCFML/dsp_storyIndex.cfm?fn=/001_11051998_0.html) |
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Hugh Young, Private Pukerua Bay, New Zealand
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Drs Szabo and Short make much of the circumcised men who did not contract HIV during the course of the Uganda study 1. Why do they not mention the one-third of circumcised candidates (29 out of 79) who were already infected, and therefore excluded from it? 2 They make much of the mucosa of the foreskin, yet the much greater area of the vagina is also lined with mucosa and Langerhans' cells. Why are women not infected at a much greater rate than men? Their small histological study was conducted entirely on men aged 60 and over. Would the keratinsation of their glanses be the same as that of younger men? Circumcision is nearly universal in Ethiopia, yet HIV/AIDS is rampant there. How do Drs Szabo and Short explain this? Circumcision does not take place in a social vacuum, and here as everywhere, correlation need not mean causation. Religion, sexual practice and circumcision are all interlinked, and those links need to be untangled before it can be concluded that any correlation between circumcision and HIV infection is causal. Circumcision is a quick fix of slight efficacy if any, but one that will promote a false sense of security and do irreparable damage to real safe-sex campaigns. The lethal sexism of promoting a prophylaxis against HIV infection that protects men (if it does) while leaving women defenceless - compared to condoms, which protect both equally - ought to be an outrage to women and fair-minded men everywhere. We should be very suspicious of new claims for medical benefits of circumcision in view of its tawdry history as a panacea against masturbation, epilepsy, club foot, paralaysis and tuberculosis, to name but a few. Prevention of HIV infection is only the latest in a long list of bad reasons to circumcise. Clearly, something else is going on. That is what really needs to be investigated. Hugh Young 1. Quinn TC, Wawer MJ, Sewankambo N, et al., for the Rakai Project Study Group. Viral load and heterosexual transmission of immunodeficiency virus type 1. N Engl J Med, 2000;342:921-9. 2. The Rakai Study: Risk Factors for Heterosexual Transmission. Commentary by Laurence Peiperl, MD, HIV InSite Journal Club, April 14, 2000. Discussion of study by Quinn et al., New England Journal of Medicine, March 2000. |
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G Boyle, Professor of Psychology Bond University, Gold Coast, Australia
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Szabo and Short claim that male circumcision reduces the transmission of HIV/AIDS. This proposition is based on a study in Uganda. Yet, in Ethiopia, where the circumcision rate is high, there is also a high rate of HIV/AIDS infection. Why are these "researchers" so selective in their reporting? What motivates them psychologically to push their pro- mutilation opinions? Are they perhaps both circumcised men who seek to employ the well-known Freudian defence mechanisms of denial and rationalisation to reduce their own feelings of penile inadequacy? Studies based on idiosyncratic African samples are not applicable to the industrialised world, where modern standards of hygiene and education apply. Why did Szabo and Short fail to examine the epidemiological evidence in the industrialised world? In the USA where most males are circumcised, the HIV/AIDS infection rate is many times higher than in Europe (where most males are intact). A recent meta-analysis based on no fewer than 29 separate studies (VanHowe) showed that circumcision if anything increases the risk of HIV infection. Why do Szabo and Short fail to cite this reference in their paper? Why are they so selective? As concluded by Boyle, Svoboda, Price & Turner (2000), in their article entitled "Circumcision of Healthy Boys: Criminal Assault?" JOURNAL of LAW & Medicine, Vol. 7, 301-310, there are legal grounds now indicate that "enforced or involuntary circumcision must now be considered as an assault causing grievous bodily harm (genital mutilation). Doctors contemplating the circumcision of healthy unconsenting minors should be warned that they are likely to face prosecution in the future. Recently, a young man was paid about $360,000 (Australian) in an out of court settlement--from the doctor who circumcised him in infancy, for the resultant physical, sexual and psychological harm. |
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David Wilson, Patent Agent Medlen & Carroll
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In regards to Dr. Cox's response wherein he states that penal cancer is unheard of in circumsised men and indicates that he believes that circumcision is preventative of penal cancer, I quote the American Cancer Society's position on circumcision and penal cancer. "Circumcision is the removal of a part or all of the foreskin at birth or later on in life. This practice has been suggested as conferring some protection against cancer of the penis by contributing to improved hygiene. However, the penile cancer risk is low in some uncircumcised populations, and the practice of circumcision is strongly associated with socio-ethnic factors which in turn are associated with lessened risk. The consensus among studies that have taken these other factors into account is that circumcision is not of value in preventing cancer of the penis. It is important that the issue of circumcision not distract the public's attention from avoiding known penile cancer risk factors -- having unprotected sexual relations with multiple partners (increasing the likelihood of human papillomavirus infection) and cigarette smoking." and "In the past, circumcision has been suggested as a strategy for preventing penile cancer. This suggestion is based on studies that reported much lower penile cancer rates among circumcised men than among uncircumcised men. However, most researchers now believe those studies were flawed, because they failed to consider other factors that are now known to affect penile cancer risk. For example, some recent studies suggest that circumcised men tend to have certain other lifestyle factors associated with lower penile cancer risk -- they are less likely to have multiple sexual partners, less likely to smoke, and more likely to have good personal hygiene habits. Most public health researchers believe that the penile cancer risk among uncircumcised men without known risk factors living in the United States is extremely low. The current consensus of most experts is that circumcision should not be recommended as a strategy for penile cancer prevention." Based on the foregoing, Dr Cox's statements are erroneous and misleading. The removal of healthy tissue from infants in anticipation of acquiring cancer has no precedent in medical science. Additionally, penal cancer is easily treatable if detected early. Therefore, instead of advocating circumcision to prevent penal cancer, the prudent choice would be to advocate education programs and promote self exams. |
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Gary L Harryman, retired
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I have no competing interests Guy Cox claims -- "....carcinoma of the penis, a condition which affects only uncircumcised men." That statement is quite simply false. Surely Cox knows you cannot prevent cancer of the glans or any other part of the penis by amputating the prepuce any more than cancer of the tongue could be prevented by amputating the lips. Then Cox finishes his letter with -- "While AIDS is making headlines at the moment, it is as well to remember that the prophylactic value of circumcision against penile carcinoma has been well known for at least 50 years." Evidently Cox stopped reading the medical literature at that point because according to the American Cancer Society (ACS) data, we have known that statement to be false for the last 40 years. This headline-generating "The-male-foreskin-causes-AIDS" scare is just the latest myth capping 150 years of equally outrageous myths and lies regarding the pleasure-producing penile foreskin that has been perpetrated by members of the medical community with a hidden sexual, or anti-sexual agenda. Obviously Cox, Szabo, and Short are not interested in science, but in politics. And just as obviously, it is politics with a hidden agenda. Dragging out past lies to prove current lies is a crafty old politician's trick. Its use exposes an intent to deceive. If we are going to cite cancer rates in this "The-male-foreskin- causes-AIDS" dialogue, let's get some perspective from the source. The ACS does not have separate data on labia and foreskin cancer. However, I have just copied the following table directly from the American Cancer Society web site: Total Est. New Cancer Cases and Deaths, United States, 1999 Cancer Sites New Cases Deaths Vagina & other genital 2,300 600 Vulva 3,300 900 Testis 7,400 300 Penis & other genital 1,400 200 From this data, and depending on how the numbers are skewed, it appears that women are either three or four times more likely to get genital cancer than men. Does this mean that Cox, Szabo, and Short will soon be recommending that women be surgically altered at birth to protect them from cancer? Of course not. Is it because they know they would be justly garroted before sunset by feminists? Or is it because they have no interest in amputating female genitalia? Why then do they make such absurd suggestions regarding little boy's penises? Is it just because the boys cannot defend themselves? Or is it because they know men will not defend little boys? Whatever the hidden agenda of the "The-male-foreskin-causes-AIDS" crowd, torturing numbers to justify mutilating little boy's penises is not medical science, it is quackery -- shameful perverse sadistic quackery. The male foreskin has been blamed for every disease du jour for 150 years. Is it fair to ask why? |
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Tony Shale, layman not of relevance
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In what I consider an illogical position, a professor of medicine at the University of Melbourne in Australia claims there’s mounting evidence that male circumcision can prevent the spread of the virus that causes AIDS. Roger Short, M.D., says an analysis of 40 studies shows that circumcised males are two to eight times less likely to become infected with HIV because the surgery removes many of the receptor cells in the penis where the virus can penetrate. He argues that it’s best to circumcise babies, but adds that since it would be about 20 years before infants become sexually active, it might be more effective to do the surgery during a boy’s teenage years, according to a paper published in the British Medical Journal. This doesn’t make sense to me at all since here in America most men who get AIDs are circumcised. How does he explain that? And circumcising teenage boys would result in pain, bleeding and psychological trauma that isn’t necessary. Short says that of the estimated 50 million people infected with HIV worldwide, about half are men. Of these, about 70 percent have become infected through their penises and 30 percent through anal sex. I don’t see how being circumcised makes any difference because AIDS is caused by a specific sexually-transmitted virus and people who are exposed are those who get the disease. This is usually through high-risk sexual behavior where the skin can be ruptured. To protect against AIDS, we need to educate men and women to use condoms and practice safe sex. There are also new spermicides and ointments coming onto the market to help prevent sexually transmitted diseases. It’s flawed logic to think circumcision will prevent the spread of AIDS. I certainly can’t see putting all boys through the trauma of circumcision based on this faulty line of reasoning. |
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Guy Cox, Senior Lecturer University of Sydney
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My previous posting generated a number of responses which perhaps do not require detailed responses, but I must comment on the striking claim made by David Wilson, PhD: "For example, some recent studies suggest that circumcised men tend to have certain other lifestyle factors associated with lower penile cancer risk -- they are less likely to have multiple sexual partners, less likely to smoke, and more likely to have good personal hygiene habits." If circumcision really makes men less likely to smoke and more faithful to their partners there would seem to be an overwhelming case in favour of the operation. Sadly, I fear this isn't so. One can bring up confounding factors as much as one likes - that there are other contributory factors is not in doubt - but the fact remains that men circumcised in infancy do not contract this most unpleasant disease at any statistically measurable rate. So far as I know there has been just one report in the medical literature of one man circumcised in infancy contracting penile carcinoma (VF Marshall, 1953, Typical carcinoma of the penis in a male circumcised in infancy. Cancer, 6, 1044-1045). It is almost exclusively a disease of the uncircumcised. This applies in Scandinavia just as much as in the USA, UK or Australia. (I do not believe that comparing countries is a very fruitful exercise, but nevertheless if one compares countries which are culturally similar but differ in circumcision rate, such as UK vs Australia or Bali vs Java, the rate of penile carcinoma accurately reflects the proportion of circumcised men in the population.) |
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David Wilson, as above
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In regards to Dr. Cox's response to the American Cancer Society's position on circumcision and penal cancer, Dr. Cox has misinterpreted the ACS statement. By analogy, just as certain groups of people tend to buy certain styles of automobiles (families may have a preference for minivans, for instance), certain groups of people may select to circumcise their children. Those same groups of people may show other life style preferences that limit their exposure to penal cancer "compounding factors" including practicing better hygiene and not smoking. This correlation may be especially true if the reason these people chose to circumcise was because they believed it to be more hygienic. The ACS did not state, as Dr. Cox claims, that circumcision prevents one from taking up smoking or makes one less promiscuous. Dr. Cox's gross misinterpretation of the ACS statement is gratuitous. Additionally, the incidence of penal cancer in circumcised men is well documented in the literature. See, for example: Ross BS, Levine VJ, Dixon C, Ashinoff R. Squamous cell carcinoma of the penis in a circumcised man: a case for dermatology and urology, and review of the literature. Cutis. 1998 Jan;61(1):41-3. Review. Kanik AB, Lee J, Wax F, Bhawan J. Penile verrucous carcinoma in a 37- year-old circumcised man. J Am Acad Dermatol. 1997 Aug;37(2 Pt 2):329-31. Review. Cold CJ, Storms MR, Van Howe RS. Carcinoma in situ of the penis in a 76-year-old circumcised man. J Fam Pract. 1997 Apr;44(4):407-10. Review. |
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Steve Wilder, Software Developer Stanford University
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Guy Cox really doesn't understand cause and effect. To propose that circumcision prevents people from getting cancer is as silly as saying that circumcision prevents people from smoking. Circumcision serves as an indicator for smoking, social class, and affluence. While the risk of damage to the penis from cancer is very slight, circumcision damages the penis in 100% of all cases. |
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Dennis Harrison
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The idea that circumcision protects against cancer of the penis may have originated with Abraham L. Wolbarst.(1) A member of the American Society of Sanitary and Moral Prophylaxis, Wolbarst argued that adult masturbators should be sterilized and forbidden to marry.(2) He also believed that circumcision protects against epilepsy.(3) The American Cancer Society advises that circumcision is not of value in preventing cancer of the penis. (1) Wolbarst A. Circumcision and penile cancer. Lancet 1932;1:150-3. (2) Wolbarst A. Persistent masturbation. JAMA 1932;90:154-5. (3) Wolbarst A. Universal circumcision as a sanitary measure. JAMA 1914;62:92-7. |
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Gary L Harryman, As above
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Well, there he goes again. No matter how many times a lie is stated, it will never become the truth. "...but the fact remains that men circumcised in infancy do not contract this most unpleasant disease at any statistically measurable rate. So far as I know there has been just one report in the medical literature of one man circumcised in infancy contracting penile carcinoma (VF Marshall, 1953, Typical carcinoma of the penis in a male circumcised in infancy. Cancer, 6, 1044-1045). It is almost exclusively a disease of the uncircumcised." If Mr.Cox would read again what I previously posted, but will repeat here -- The American Cancer Society states in plain language that it does not separate out the locations of penile cancers. Never has. Therefore, from the ACS data one could just as honestly state that --"All of the 400 cases of penile cancer in 1999 occured in circumcised males." Since penile cancer is a disease of old men, and since the circumcision fad in the US did not begin in earnest until the 1940's and reached its apex in the late 1980's one would have to assume that almost all 60 and 70-year old men alive in the US today are intact. Therefore, one would expect most of the cases of penile cancer in the US to be in intact men. And one can also expect to see an ever-increasing ratio of circumcised men to get penile cancer until the year 2050 when 90% of the penile cancer cases will be circumcised men. For Cox to suggest that this phenomenon has anything to do with the foreskin per se is more dishonest claptrap. More incantation of the 150- year legacy of shame and myths and lies regarding the magical powers of routine neonatal penis mutilating. Since Mr. Cox is obviously learned enough to know these things, perhaps he would now like to explain to us what his real agenda is for falsly claiming circumcision prevents cancer and AIDS. |
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Erick L Gustavson, Human Rights Activist
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I would like to emphasise that a procedure carried out with no pathology ( indications ) is immoral AND illegal. The complication rate for those penile reductions is at a rate of 100%. In order for a procedure to be termed as surgery, a known immediate and long-term benefit to the patient must have pathology. A qualifying point of interest would be: When the ablated tissue is sold to Organogenisis, the pirated tissue MUST be certified as pathalogen free and free of contaminates, such as some type of pain relief. A logical question would then come to mind: If the ablated, pirated tissue is pathology free, why was it ablated in the first place? My next question would be: How do companies like Revlon, Estee' Lauder, Apligraf and Organogenisis purchase "donated" tissue from an infant? What ever happened to the Uniform Anatomical Gift Act? Besides a genital mutilation, assault and battery, and Slavery come to mind. Erick L. Gustavson egustav435@erols.com |
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John Smith, Dental student Liverpool
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Dear Author I wonder why the author assumes that circumcision at the age of puberty would be most effective as practicsed by Muslims. Doesn't the author think this would be vary barbaric and not all teenagers would agree to it - at the same time creating many major ethical problems. Would it not be more sensible to circumsize EVERY male born on the eigth day, or abit later if the baby is jaundice; like the Jewish religion practices |
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John Antonopoulos, President Circumcision Information Resource Centre, Montreal, Canada
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One of the most frequently trotted-out health myths relating to infant male circumcision is that cancer of the penis (one of the rarest of cancers in developed nation settings in any case, rarer even than male breast cancer) affects virtually no circumcised males. Yet in 1993, Christopher Maden et al. reported that of 110 men diagnosed with penile cancer between January 1979 and July 1990, 22 (or 20%) had been circumcised as infants, 19 later in life. So much for circumcision and penile-cancer immunity. With the advent of increasing bathing facilities in homes in Denmark, the incidence of penile cancer in that country (having a virtually non- circumcised male population) has decreased to an incidence lower than that in the U.S. (which has a majoritarily circumcised male population). In this same journal, in 1995, Frisch, Friis, Kjear and Melbye stated: "[T]he declining incidence of penis cancer in Denmark [from 1940 to 1990] cannot reasonably be attributed to an increased practice of neonatal circumcision...During the period under study, the proportion of Danish dwellings having a bath increased gradually from 35% in 1940 to 90% in 1990. It seems plausible that better penile hygiene resulting from this improvement in sanitary installations might have contributed to the observed trend." [2] As for the once-current claim that removal of the prepuce in males lowers the risk of cervical cancer in female partners, the American Academy of Pediatrics Task Force on Circumcision, having plowed laboriously through forty years of literature on circumcision, does not even mention cervical cancer in connection with circumcision, in its most recent 1999 statement.[3] [1] Maden C, Sherman KJ, Beckmann AM, et al. History of circumcision, medical conditions, and sexual activity and risk of penile cancer. Journal of the National Cancer Institute 1993;85(1):19-24. http://www.cirp.org/library/disease/cancer/maden/ [2] Frisch M, Friis S, Kjear SK, Melbye M. Falling incidence of penis cancer in an uncircumcised population (Denmark 1943-90). British Medical Journal 1995;311(7018):1471. http://www.cirp.org/library/disease/cancer/frisch/ [3] American Academy of Pediatrics Task Force on Circumcision. Circumcision policy statement. Pediatrics 1999;103(3):686-693. http://www.cirp.org/library/statements/aap1999/ |
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Brian Morgan, Freelance Journalist Cardiff
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I hate to jump in on a debate with which I have only a slight connection - having being circumcised as a baby 60 years ago, and neither suffering any grief nor thinking to ask my parents why they had this done to me before sadly they shuffled off their own mortal coils, but I do have to question one of Rio Cruz's points - about the perfection of the human form and after millions of years of evolution that no part of it might be redundant. I'm not suggesting the prepuce is redundant for one moment, I don't know enough about the argument - but I was always told in my biology classes that the vermiform appendix really is a redundant organ which we share with rabbits who make good use of it as well as their prepuces, as possibly other mammals may do too. |
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Jacqueline Sonnendrücker, Retired R.N. Vancouver, Canada
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Cox, Short, Szabo and many others are not above unscrupulous bluffs and blenches to promote themselves. They are succeeding! like arsonistes watching the fire they started or street urchin coming back to look at their graffitis ... I bet they're jumping up and down and wetting their underwear with excitement.
Who is to blame for this neurotic behaviour? No one else but the Medical Profession! If doctors in high position want to regain the confidence of the public at large, they'll need to get a psychological profile of each candidate to the Hippocratic Oath and make careful assessment of men and women who think that an M.D. certificate is a ticket to act out all of their sadistic impulses. Of course, it takes courage to impose such regulations. In the name of the children, find it! Many nurses and midwives have, a long time ago ... Hello sisters! Jacqueline Sonnendrücker, Retired R.N. |
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Julie Filliatre, member of ETHIC Vancouver
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To the circumcisers of all backgrounds, religions, colours and creeds. Look at your handa
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