Are you for or against circumcision?

@MeisterAndrew The effect of circumcision on sexual function is unknown because that effect has yet to be studied.
Doing it on the 8th day may reduce bleeding in a world where sutures and aseptic surgery were unknown. But it botches still happen, when too much skin or a piece of glans is cut off.

@consa01 BS. There's been plenty of studies and none have shown a clear difference in sexual satisfaction. That translates into there being no measurable effect. Understandable as the glans will only be exposed while aroused and if you have an erection it's likely your glans gets exposed whether circumcised or not.

Botches aren't supposed to happen if done medically by a good surgeon. Shouldn't be done a general pediatrician. It certainly beats traditional with a half blunt knife on a rock resulting in quite a few deaths each year not to mention other complications.

@MeisterAndrew There are no studies of sexual satisfaction, because it cannot be measured. The sensitivity of the glans to being tickled by a filament has been tested a number of time. The problem is that only one study has tested the sensitivity of that which is lost to circumcision. That study found that those parts are the most sensitive of all.
The glans of the intact penis is protected from contact with anything when the penis is not erect. Nevertheless, it has not been confirmed that the glans of intact men is more sensitive than that of circumcised men.
Only one study has made all penises erect before testing their sensitivity. I agree that erect sensitivity should be the focus.
Botches happen regardless of the competence of the surgeon. Nowadays, many circumcisions in North America are performed by pediatricians, because a growing number of obgyns decline to perform them.
South African data prove that traditional circ methods are fraught with risk.

@consa01 Nonsense. There has been plenty but you're reading the data of being unable to measure a difference to us being unable to tell. Actually it's the opposite, unable to measure a difference means there likely isn't one.

Traditional circumcision is what I'm against and infant circumcision among these groups will drastically cut down on these botches even if done by GPs. Most "botches" by doctors are after the fact in any case due to improper aftercare which is why the CDC and WHO doesn't include them.

@MeisterAndrew There is no way, at present, of reducing a sexual experience to a data file. Hence scientific studies of whether the absence of the foreskin and frenulum matter for sex, are impossible to carry out.
By "tradtional circumcision", do you mean circumcisions carried out as rites of passage into manhood, under septic conditions?
By "botched" circumcisions, I mean cutting too much off, serious postop bleeding, slicing through the glans, healing resulting in a tangle of scar tissue, the inability to enjoy sex, and so on.
The CDC and WHO are not guilty of ignoring some complications of infant circumcision; they and USA medicine don't bother counting any long term complications of routine infant circumcision. Hence we have no way of knowing if RIC is safe or not.

@consa01 That's not what the studies say.

[quote]By "tradtional circumcision", do you mean circumcisions carried out as rites of passage into manhood, under septic conditions?[/quote]
Yes

[quote]By "botched" circumcisions, I mean cutting too much off, serious postop bleeding, slicing through the glans, healing resulting in a tangle of scar tissue, the inability to enjoy sex, and so on.[/quote]
Why I have never been in favour of it being done by pediatricians or GP's.

[quote]The CDC and WHO are not guilty of ignoring some complications of infant circumcision; they and USA medicine don't bother counting any long term complications of routine infant circumcision. Hence we have no way of knowing if RIC is safe or not.[/quote]
You can't count complications resulting from improper aftercare. The solution to that is better aftercare. It's still better than the result of the AIDS epidemic.

@MeisterAndrew
Please supply links to the studies you have in mind.
We fully agree that traditional circumcision is a deplorable practice.
GPs do not do circumcisions, to my knowledge. Circumcisions have been botched by obgyns who perform as many as 250 routine infant circumcisions a year. Urologists only do adult circumcisions.
Aftercare is seldom implicated by any story I've read of a botched or lethal outcome. We can wish for better aftercare until the cows come home, but that will not deliver better aftercare. The only reliable way to reduce botched and lethal outcomes is to abandon routine infant circumcision.
No one in the first world dies of AIDS anymore. There is a cocktail of drugs that puts HIV in Mexican standoff. The USA is tied with Portugal for the highest rate of HIV+ in the first world. This is so even though American adult men are about 80% circumcised, a rate exceeded only by Israel. (Most intact American men are foreign born or Latino or were born before Medicaid.)

@consa01 You know the studies since you seem to have seen them. I'm not going to play that game here as I provide a study you provide a study and nobody wins. What's important is that the medical community is almost unanimous on the meta analysis showing there is no real world difference in sensitivity.

You apparently don't know the life of someone on ARVs. It is no real life as it only delays the inevitable while suppressing the immune system and causing side effects such as depression. They are still dying and many die each year. Then there is the economic impact of 10% of the population (mostly HIV free) supporting the 90% where it is rampant. There is no HIV vaccine yet and it's not certain there will ever be an effective one.

You actually don't know what the rate of HIV infection would be if U.S. men weren't circumcised. It might be worse as it is worse in third world countries without circumcision.

@MeisterAndrew There is, at present, no scientific way of studying what people experience during sexual activity.
Extant studies find little difference between cut and intact men in the sensitivity of the glans to filament stimulation (it is not clear that this sensitivity is relevant to sexual pleasure). Only one study (Sorrels et al 2007) examined the sensitivity of the bits lost to circumcision, and that study found that those bits are the most sensitive parts of the entire male genitalia. Only one student has focused on erect penises, which is the correct way to proceed here. That study did not look at the foreskin and frenulum.
The upshot is that there have been 1-2 dozen studies over the past 25 odd years, but we have learned little from them.

@consa01 Learning little from a study can also mean there's nothing to learn.

You're still not addressing the issue and keep referring to "first world" countries. Not to even address that you don't know what the HIV rate would really be without circumcision, it may be having an effect you just don't know about, AIDS is running rampant in most of the world.

@MeisterAndrew Learning little from a study mainly means that the study was badly designed or executed, or that the data was incompetently analysed.

The first world countries are different, in that access to health care, sex education, and condoms is comparatively good.

Only 3 first world countries still circumcise a majority of boys: South Korea, Israel and the USA. Circumcision is common among middle aged men in Australia, Canada and New Zealand. This cross-sectional variation in the incidence of circumcision among adult men can be used to think about the possible effect of circumcision on the prevalence of HIV+.
AIDS is NOT rampant anywhere in any first world country taken as a whole.
https://en.wikipedia.org/wiki/List_of_countries_by_HIV/AIDS_adult_prevalence_rate

Please supply me with data on the frequency of death from AIDS this decade in the first world. I am well aware that there is no vaccine against HIV.

A controlled experiment on circumcision and HIV in a large representative random sample of first world subjects, would never pass muster with the Human Ethics people.

There is only one African country where the data show that the HIV prevalence is materially higher among intact men than among circumcised men. That country is Kenya. In quite a few African countries, the prevalence is higher among circumcised men.

@consa01 No learning little can also mean there isn't anything to learn. In my interactions with people I've come to see that most people who refer to studies don't really know how to read and interpret them which is key.

And here is your problem. You keep referring to first world only. The terms are actually political so shouldn't be used in any real sense to divide countries. But even if we ignore that the data does show the rate of STDs (not just HIV) is lower in circumcised men. May not be much in countries with a low incidence but it's certainly significant in those with a higher one.

But this also relates to education. It isn't going to work when there's a general perception that circumcision is fail proof so one can live more recklessly. It isn't going to work among people like president showerhead who thinks water can prevent AIDS.

@MeisterAndrew
Most people are not qualified to interpret studies of circumcision, circumcision harm, and the effect of circumcision on public health -- agreed. For starters, lay people seldom appreciate the importance of a stratified random sample. But the vast majority of USA medical researchers have no business studying circumcision because they are either circumcised men, or the wives thereof, and because they have no experience analysing and interpreting observational data. The problem is not confined to lay people; I have read many stupid statements about circumcision and sex and public health, made by professors of medicine or public health.

"Learning little can also mean there isn't anything to learn."
I deeply disagree that anything of that nature is going on. In my opinion, a great deal could be learned from the scientific study of how the moving foreskin enhances masturbation, foreplay and penetrative sex. I have been following the medical literature on circumcision since 1983, and that literature has failed to ask many questions whose import strikes me as common sense evident. Example: are circumcised men more or less reluctant to use condoms during casual sex?

"And here is your problem. You keep referring to first world only. The terms are actually political so shouldn't be used in any real sense to divide countries."
Not a problem; first versus third world is a well accepted dichotomy in social science. A necessary condition for a study to be relevant to the decision of whether or not to circumcise your son or mine, is that the study have been conducted using a representative sample of one or more first world countries.

"But even if we ignore that the data does show the rate of STDs (not just HIV) is lower in circumcised men."
Not true. In the first world, the USA has the second highest incidence of circumcision in adult men (after Israel). The USA also has, by far the highest rates of STDs.

"May not be much in countries with a low incidence but it's certainly significant in those with a higher one."
I do not understand this sentence.

"[Circumcision] isn't going to work when there's a general perception that circumcision is fail proof so one can live more recklessly."
This is an imprecise way of describing the phenomenon of risk compensation. Look it up in Wikipedia. No extant study of HIV and circumcision has done justice to the possibility of risk compensation.

[quote]For starters, lay people seldom appreciate the importance of a stratified random sample.[/quote]
Why we leave it up to professionals to do the interpretation and refer to that. The conclusion is nearly unanimous, circumcision has no discernible effect on sex.

[quote]"And here is your problem. You keep referring to first world only. The terms are actually political so shouldn't be used in any real sense to divide countries."
Not a problem; first versus third world is a well accepted dichotomy in social science. A necessary condition for a study to be relevant to the decision of whether or not to circumcise your son or mine, is that the study have been conducted using a representative sample of one or more first world countries.

"But even if we ignore that the data does show the rate of STDs (not just HIV) is lower in circumcised men."
Not true. In the first world, the USA has the second highest incidence of circumcision in adult men (after Israel). The USA also has, by far the highest rates of STDs.[/quote]
And you continue to be fixated on first world, USA in particular. Science doesn't work like that and correlation isn't causation.

@MeisterAndrew
The first world differs in major ways from the third world. The first world has much better sex education, health care, condom access (in SSA cities, there are supermarkets stock condoms, and some supermarkets are open 24/7). In the first world, everyone has access to soap and hot tap water, and a sewer connection. A daily shower does much to reduce the risk of STDs and penile infections.
Infant circumcision is controversial primarily in the first world, and in the USA most of all. That is why evidence relevant to that controversy has to come from subjects residing in the first world.
Correlation isn't causation is why randomised clinical trials are desirable. But RCTs can be badly designed, badly executed and badly analysed, which is the case with the RCTs designed to shed light on a possible circumcision - HIV connection. Such trials are uninformative unless carried out in the first world. But no human ethics panel would approve such RCTs in any first world country, because circumcision is irreversible.

The writings of so-called professionals on circumcision and foreskin leave a great deal to be desired. The professor of medicine who is the most ardent defender of prophylactic circumcision, has no clinical experience and gave up his licence to practice medicine in 1992. He did not train as either a urologist or a pediatrician. He is not an authority on STDs or on human sexuality. His writings betray a simplistic understanding of the mechanics of sex. I can think of only one circumcised male author who wrote wisely about how the foreskin and frenulum enhanced sex -- Edward Wallerstein, the author of a short but intense book that more or less began the intactivist movement.

One cannot say that circumcision has no discernible effect on sex, because sexual sensation cannot be measured, and sexual function is nearly always self-reported. How many studies of circumcision and sex included a clinical examination of the penis? Finally, much of the adverse effect of circumcision on sex emerges after the 40th birthday, and I know of no study designed to shed light on that possibility. I know of no study of circumcision and sex that included careful interviews of a large and representative random sample of women, especially North American women.

@consa01 You don't know anything about the subjects you're talking about. It's like me bringing up an argument and you answering banana. Sorry but that's the best and most lenient way I can state it.

You can't make an extrapolation that you see no effect in a 1st world country so it has no effect. That's not how science works. You have to know something about the situation to make a determination if any can be made at all since it isn't a study.

There could be many reasons why HIV and STDs are more prevalent in the U.S. It can be that Americans are more reckless. It can be that the sex education isn't up to standard or takes place too late. It can be that while contraceptives are more widely available free ones aren't. It can also simply be that Americans are more susceptible. You can't exclude any of these or take them into account by looking at a group as a whole.

@MeisterAndrew What do you know that I don't know?
The work of Kinsey is now in disrepute. The work of Masters and Johnson is no longer authoritative. I conclude that there is no firm academic understanding of human sexual behaviour.
How can you know whether or not I am a working scientist?

It is not the case that I claim that circumcision has no effect. I claim that it can have deleterious effects, based on anecdotal evidence that people have seen fit to share with me. I am keen to see the hypothesis of deleterious effects subjected to careful scientific scrutiny.

The findings of a study whose subjects were recruited in third world villages does not inform us about what is or is not the case in the first world, especially the middle class first world.

The weirdly high rates of STDs in the USA are inconsistent with the claim, derived from a number of studies, most of them conducted in either the third world or in first world slums, that circumcised men are less likely to catch STDs from infected women. (No one claims that circumcision reduces HIV transmission arising from MSM or from infected men having sex with clean women.) There is zero evidence bearing on your claim that Americans are more susceptible to STDs.

Any hypothetical recklessness of Americans in the bedroom has a deeper cause. A candidate deeper cause is my hypothesis that Circumcised Penis + Condom = Boring Sex. There is anecdotal evidence favouring this hypothesis, in the form of women who reveal in closed Facebook groups that their circumcised partners firmly refuse to use condoms.

I am sceptical that defective sex ed is at fault. I am old enough to have been spared any formal sex ed. The teen male culture of 50ish years ago that shaped my outlook emphasised two things: (1) it was easy to catch the clap, and doing so was seen as humiliating; (2) condoms pretty much extinguish the risk of getting the clap.

Contraceptives are not relevant to our discussion, but condoms are. In the 1960s, condoms were stocked in every pharmacy, and were beginning to be stocked in supermarkets. Starting in the early 1970s, STDs in the USA went through the roof. No one knows why that is. We do know that in the 1960s and 70s, routine infant circumcision became common among the poorest of the poor, because Medicaid started paying for it.

In 1997, the world's leading social scientist specialising in human sexuality, Edward Laumann of the Sociology Dept. at the University of Chicago, published an article in JAMA based on a stratified random sample of 1500 men, 1100 circumcised and 400 intact. All subjects were screened for a number of STDs. 26 circumcised subjects tested positive for one or more STDs. The number of intact subjects who tested positive was... zero. Based on that finding, Laumann lost all interest in the hypothesis that the human foreskin promotes STD transmission.

[quote]The weirdly high rates of STDs in the USA are inconsistent with the claim, derived from a number of studies, most of the conducted in either the third world or in first world slums, that circumcised men are less likely to catch STDs from infected women. (No one claims that circumcision reduces HIV transmission arising from MSM.) There is zero evidence bearing on your claim that Americans are more susceptible to STDs.[/quote]
No they are not and this is what I keep telling you. Leading me to believe that you can't be a scientist and if you are one you are a very poor one that can't even see the common mistakes in studies or when trying to apply them.

You can't say that Americans aren't more susceptible to STDs. Just as you can't say that any of the other factors don't have an effect. That is why you need studies to rule out effects which you can't know to have an effect or which aren't even known. Comparing Americans to other 1st world countries isn't even a study.

This is why I can't debate with you as you have no idea how these things work. You haven't derived you position from medical science. You have simply taken a position for who knows what reason and are grabbing at straw helms to try and argue it. This is common among those who are so dead set against it. I have yet to meet one who knows how science works and applies it correctly.

And condoms are contraceptives btw. Where contraceptives are more readily and cheaply available condoms are generally used more often as well.

@MeisterAndrew
I have dipped into the scholarly literature on circumcision since 1983, and am not impressed with its quality. Laumann et al (1997) is an exception.

Contraceptives other than condoms are not relevant to this discussion. A number of conversations I had in the 1970s, convinced me that oral contraceptives encouraged young people having casual sex, to dispense with condoms. Hence your hypothesis strikes me as radically implausible.

You seem to think that my reading of academic studies is naive and gullible, when in fact I incline to the cynical and sceptical. When Aaron Tobian of Johns Hopkins University publishes studies that include extrapolations of the claimed finding of the African randomised clinical trials, to the entire American population, I throw up my hands at his appalling naivete.

"You can't say that Americans aren't more susceptible to STDs."
Can you say that they are? I claim that there is no evidence either way.

"Just as you can't say that any of the other factors don't have an effect."
Just what are these other factors?

"That is why you need studies to rule out effects which you can't know to have an effect or which aren't even known."
That which is not known cannot be studied. Just where are the studies of the sort you advocate?

"Comparing Americans to other 1st world countries isn't even a study."
I know of no study the rate of HIV+ that controls for the prevalence of circumcision, condom use, MSM, and injected drugs. I bet that such a study would find a small or insignificant effect of circumcision.

I have encountered the claim, forcefully made in Disqus discussions, that the more "diverse" a society is, the higher its rate of HIV+. I would gladly look into this if there were an agreed scalar measure of social diversity.

Anecdotal conversations mean nothing. What the stats show is the opposite of what you claim. Contraceptives, condoms and education all go hand in hand. The focus isn't just on one and then telling people go and have sex. It would be irresponsible to provide contraceptives and not the education that condoms are the only form of safe sex if there is such a thing. Where oral contraceptives are more freely available condoms usually are as well leading safer sex.

[quote]"You can't say that Americans aren't more susceptible to STDs."
Can you say that they are? I claim that there is no evidence either way.

"Just as you can't say that any of the other factors don't have an effect."
Just what are these other factors?

"That is why you need studies to rule out effects which you can't know to have an effect or which aren't even known."
That which is not known cannot be studied. Just where are the studies of the sort you advocate?[/quote]
That is not the point. A real proper study would take all those factors into account including known and unknown ones. For some reason you think that isn't possible when it's what studies are usually designed to do. That's what leads me to believe you either don't know enough about interpreting the scientific literature or you have a fundamentalist attitude that would ignore such glaring omissions despite actually knowing better.

@MeisterAndrew Anecdotes form the backbone of social life as I've always known it. And anecdotes are important motivators hypotheses to be researched.
There is no good data on circumcision and sexual sensation, because good data would require a kind of biomedical instrumentation that does not yet exist.
In the USA, condoms can be bought in any supermarket, but oral contraceptives require a script. This state of affairs breaks down the correlation you allege, between condom availability and oral contraceptic use. I am confident that the USA is not unique in this regard.
Again, factors that are unknown cannot be researched.
Trust me, I am a published scientist (albeit not in human sexuality) and have peer reviewed about 100 manuscripts.
The "real proper" studies of the sort you advocate, simply do not exist. I find it very curious that the Kinsey Institute, and Masters & Johnson in no way did justice to the prevalence of circumcision in the USA. This is consistent with the fact from my baby boom youth, namely that almost all males were circumcised, but the fact was never joked about in gentile society.

@consa01 Anecdotes aren't studies. The data goes against what you claim about contraceptive use and safe sex. You still don't understand the difference between condoms being sold in supermarkets and them being freely available. The two aren't the same and have vastly different effects.

And you are still wrong, the purpose of a study is to do a proper comparison by accounting for known and unknown factors. They ARE indeed accounted for and so "researched" as you call it.

@MeisterAndrew Anecdotes are not studies, but they are still important motivators of research questions. Many aspects of human sexuality have yet to be researched, and sex research is not free of the long shadow of prudishness, finger wagging and, increasingly, political correctness. Where there is no research, we have to pay some attention to anecdotes. if the research ever comes out, we can, of course, retire the anecdotes. Life is a battle, and when in battle you use whatever weapons are at hand. When you lack studies, you fall back on anecdotes. I cannot imagine life in any other way.

Tell me what you mean by "freely available". I am a baby boomer. 50-60 years ago, the main drawback of condoms was that young men were very embarrassed to take a pack of condoms through a checkout line. This is why dorms and gas station bathrooms began featuring condom machines. I see no problem of condom availability, but strongly suspect that there is a widespread refusal to use easily available condoms. And my candidate explanation for condom reluctance is circumcised penis + condoms = boring sex.

Unknown factors cannot be accounted for, simply because they are unknown. "Controlling for" known factors, involves limitations in data and statistical methodology. Empirical social science often requires strong assumptions and compromises with data, and entails measurement problems and a host of issues arising from the use of observational over experimental data. Controlled experiments are best, but are often unethical where human subjects are involved. The African randomised clinical trials that resulted in the (doubtful) claim that circumcised men are less likely to contract HIV, would not have passed ethical muster anywhere in the first world.