Friday, April 18, 2014

"Infant circumcision is becoming less common in the US, but why?" comments regarding Brian Morris' latest piece on Mayo Clinic Proceedings

A couple of weeks ago, intactivists gathered in Washington D.C. for Genital Integrity Awareness Week. Upon their return home, some of them found that a reporter for a news outlet had contacted them asking some questions regarding the upcoming publication of an article by Brian Morris on Mayo Clinic Proceedings. Unfortunately the coincidence of these two events meant that the intactivists lost their chance to provide input to a genuinely interested journalist.

I had the chance to discuss with one such intactivist the journalist's message, hoping to provide a late answer to the questions. I will reserve the name of the news outlet and journalist, but will include here parts of the email and some thoughts around it:

The Journalist's message

Hello there, I’m the **** of the **** website, and we’re running a new article on the latest piece of research by Brian Morris that will be published tomorrow in association with Mayo Clinic Proceedings. 
As the findings could be considered controversial, we are interesting in including some alternative viewpoints. I happened across the Whole Network and anti-Brian Morris Facebook pages and I’ll love to include your perspective in the piece. 
I’m on a fairly tight deadline, but if you are able to provide me with responses by ***  then I will be able to include your answers in my piece, along with links to the sites. 
1) Dr Morris has carried out a risk-benefit analysis suggesting that risks from not circumcising add up to a 1 in 2 risk of a medical condition caused by retention of the foreskin. He lists these conditions as: UTI, kidney damage (infancy), candidiasis, prostate cancer, penile cancer, balantitis, phimosis, paraphimosis, oncogenic HPV, genital herpes, genital ulcer disease, Trichomanas vaginalis, Mycoplasma genitalum, chancroid, syphilis, and HIV. He also lists the following conditions that foreskin retention can result in for female partners: cervical cancer, Chlamidya trachomatis, genital herpes, Trichomanas vaginalis, bacterial vaginosis.
The risk figure of 1 in 2 seems alarming, and he also claims the benefits exceed the risks by over 100 to 1. Do you understand why people - including medical professionals and organizations such as the Mayo Clinic - therefore find Dr. Morris and the pro-circumcision argument convincing? What counter-argument would you provide that could change people’s minds? 
2) Dr. Morris claims that circumcision has zero adverse effect on sexual function, sensitivity or pleasure. Do you believe this will ease the public’s concerns over circumcision? A large part of the public’s reticence towards it as a procedure seems to stem from the Victorian belief that circumcision could be used to prevent masturbation. 
3) Prevalence of circumcision in adult men in the US has risen to 81% in the last decade, but fallen to 77% in infants and boys - why do you think this is? 
4) Accompanying the new study, Brian Morris makes this statement: “It would be unethical for a male not to be circumcised owing to the fact that it would increase his risk of an adverse medical condition and the fact that circumcision is such a safe procedure. Effectively, it’s akin to vaccination.” What would your response be?

So, here are some thoughts about it

First, Brian Morris is not a medical doctor. He is a molecular biologist who for some reason has been strongly inclined to promote circumcision since 1995. His publications are usually not original research, but meta-analysis and other reviews of existing literature, generally grading with low quality those studies that do not support his views. In fact since the Royal Australasian College of Physicians rejected his views on circumcision, he joined a small number of circumcising physicians to create the "Circumcision Foundation of Australia" with the purpose of presenting a Policy Statement on circumcision that would present a more affirmative position than the one by the RCPA. Of course the CFA is not a recognized medical organization.

The risk figure of 1 in 2 seems alarming, but it is also a very generic number, considering that this would include everything from a mild infection, a mild irritation, an inflammation, to more serious conditions such as real phimosis during adulthood. It is likely that he is also including STDs as conditions resulting from foreskin retention, which would certainly be a stretch.

Very few conditions actually warrant a "medically necessary" circumcision. Edward Wallerstein (an American circumcised Jewish man, author of "circumcision: an American health fallacy", 1980) showed that men in Finland had to undergo medically necessary circumcisions at a rate of 1 in 16,667. Many conditions traditionally treated with circumcision in our countries, respond well to conservative treatments without loss of tissue.

The benefits/risks ratio of 1 to 100 is a claim that he has often repeated without proper quantification. The AAP, in stating that "the benefits outweigh the risks", did not quantify the benefits nor the risks, recognizing that the real rate of complications is unknown, especially because many complications may not be even detected until many years later.When you say that medical organizations find the pro-circumcision argument convincing, this may be truth in places where circumcision as a cultural custom is already established (the U.S., Israel, many Islamic countries and some parts of Africa), but it is not the case for the rest of the world. Last year, Pediatrics published a letter by 38 European and Canadian physicians, heads of real medical organizations, criticizing the AAP's Policy Statement on Circumcision as being culturally biased and lacking solid science. Many European medical associations moved during 2013 to call for a ban on circumcision of minors. It is only in the American media and American medical organizations, where we see this tendency to support circumcision, and it is likely the result of cultural bias - an established custom, and the fact that most American doctors were circumcised at birth themselves, so they lack personal experience of the foreskin.

Also consider the fact that the American biomedical industry uses discarded foreskins from neonatal circumcisions for research and manufacturing processes, such as stem cell research, culturing skin to test makeup products as a "humane" (or human) alternative to animal testing, obtention of byproducts of cell culturing (growth factors) for anti-wrinkle creams, hair growth, etc., and the collected fees from 1.2 million yearly neonatal circumcisions, and you have a good financial incentive to maintain the practice of neonatal circumcision.

Professor Morris previously published a meta-analysis to "prove" that circumcision has no adverse sexual effects. In his study, he rated as "poor quality" those studies that actually show adverse sexual effects (Sorrells 2007, Kim 2007, Frisch 2011, Bronselaer 2013) while rating as high quality those that didn't show such effects, in spite of sampling bias and methodological flaws. His co-author in this study was Krieger, author of one of those studies. No conflict of interest was declared, in spite of Krieger's own study being reviewed and graded as "high quality". Brian Morris reduces the problem of sensibility and sexual satisfaction to statistics, ignoring the observable functions of the foreskin, something that may fool a mostly circumcised population but not the rest of the world. I would recommend you to read about the triple whammy of circumcision - this is the part of the issue that Brian Morris will never discuss since there is no way to refute it..

There are several factors to account for the reduction in circumcision rates. More available information through the internet and social media. Circumcised males expressing their dissatisfaction with their circumcision status. Awareness of the practice of foreskin restoration by circumcised males who wish to approximate what the original foreskin would have been. Activism, as a grassroots movement by normal people, circumcised and uncircumcised males, parents who regret circumcising their babies, physicians, lawyers, etc. Growing awareness of cases of severe complications, such as the baby from Memphis and the baby from Pittsburgh who had their penis amputated last year, one in a clinic and one in a religious ceremony.Circumcision cannot be considered a vaccine. It does not change the immunological system of the individual. All the infectious conditions that can affect an uncircumcised male can also affect a circumcised male. Even the touted 60% risk reduction of HIV during heterosexual relations is barely significant in the Western context.

Furthermore, circumcision is a permanent alteration of the form and function of the penis. The complication rate is high, with many low impact complications and some high impact complications. Many males are not even aware that their "normal" experience is the result of circumcision complications (skin bridges, painful erections, ripped skin, having to use lubricants for sexual activity).

Brian Morris would like us to see the foreskin as a birth defect. This is simply not supported based on observations of countries where circumcision is not performed - most of Latin America, Europe and Asia. When it comes to removing normal healthy tissue from another person's body, it doesn't matter if the doctor or the parents believe that the tissue has no value; what matters is the opinion, the informed opinion of the person whose body will be altered. Removing normal healthy tissue from the genitals of a minor is a violation of human rights and the children's right to physical integrity.

Friday, April 11, 2014

Response by Ayaan Hirsi Ali to the Statement from Brandeis University

Yesterday Brandeis University decided to withdraw an honorary degree they were to confer upon me next month during their Commencement exercises. I wish to dissociate myself from the university’s statement, which implies that I was in any way consulted about this decision. On the contrary, I was completely shocked when President Frederick Lawrence called me—just a few hours before issuing a public statement [read more]

Thursday, April 10, 2014

Part 3: Video responses to Brian Morris' article on Mayo Clinic Proceedings: Circumcision Rates in the U.S.: Rising or Declining

Part 3

Brian Morris recently published a paper in the Mayo Clinic Proceedings Journal claiming significant benefits to routine infant circumcision while dismissing the risks and complications to health. In his paper, he presents a twisted vision of human rights, saying that it is unethical not to circumcise healthy male children. Brian Morris also published a 6-minute video statement on the Mayo Clinic Proceedings Youtube page repeating his claims.

Brian Morris' field of specialty is in molecular biology - not urology or sexology - and his claims are not based upon original research. His claims fly in the face of what Europeans are concluding about forced infant circumcision: it impairs sexual function and violates human rights.

Now that Brian Morris' claims have been published by the Mayo Clinic and the mainstream American media, it's time for us to respond!

More responses coming soon!





Part 2

Part 1

Monday, April 7, 2014

Male genital mutilation


When you hear anyone saying that male circumcision is nothing like female circumcision...

How it's done without anesthesia on kids who can remember, held by the family while they scream

remember this:



and when you hear about using glasses, scissors, blades...

remember this (forward to minute 8)



Or this


Part 2: Video responses to Brian Morris' article on Mayo Clinic Proceedings: Circumcision Rates in the U.S.: Rising or Declining

Part 2

Brian Morris recently published a paper in the Mayo Clinic Proceedings Journal claiming significant benefits to routine infant circumcision while dismissing the risks and complications to health. In his paper, he presents a twisted vision of human rights, saying that it is unethical not to circumcise healthy male children. Brian Morris also published a 6-minute video statement on the Mayo Clinic Proceedings Youtube page repeating his claims.

Brian Morris' field of specialty is in molecular biology - not urology or sexology - and his claims are not based upon original research. His claims fly in the face of what Europeans are concluding about forced infant circumcision: it impairs sexual function and violates human rights.

Now that Brian Morris' claims have been published by the Mayo Clinic and the mainstream American media, it's time for us to respond!

More responses coming soon!

 







Click here for Part 1

Part 3

Friday, April 4, 2014

Video responses to Brian Morris' article on Mayo Clinic Proceedings: Circumcision Rates in the U.S.: Rising or Declining

Brian Morris recently published a paper in the Mayo Clinic Proceedings Journal claiming significant benefits to routine infant circumcision while dismissing the risks and complications to health. In his paper, he presents a twisted vision of human rights, saying that it is unethical not to circumcise healthy male children. Brian Morris also published a 6-minute video statement on the Mayo Clinic Proceedings Youtube page repeating his claims.

Brian Morris' field of specialty is in molecular biology - not urology or sexology - and his claims are not based upon original research. His claims fly in the face of what Europeans are concluding about forced infant circumcision: it impairs sexual function and violates human rights.

Now that Brian Morris' claims have been published by the Mayo Clinic and the mainstream American media, it's time for us to respond!

More responses coming soon!




Click here for part 2

Part 3

Saturday, March 29, 2014

Things I've learned through foreskin restoration

Through foreskin restoration I have learned many things about the penis that I did not know, and which I presume many uncircumcised males are not even aware of, since they take their experience for granted.

The foreskin does not end at the "tip". The foreskin covers the glans, and then at the apparent tip, it folds inside and covers the glans again, and ends just behind the glans (at the sulcus).

There are particularly sensitive areas on the foreskin: the inside, which is a mucosa, the "apparent" tip, the mucocutaneal transitional area (ridged band, per the research of John Taylor), which are loaded with Meissners corpuscles, and the frenulum, which attaches the bottom of the glans to the ridged band..



The frenulum looks like a seam that fixes the outer skin to the bottom of the glans. Most circumcised males are either missing the frenulum, or the frenulum has been detached from the glans and stitched later, turning it into scar tissue. It takes particular effort on the part of a doctor performing a circumcision to not harm the frenulum, and creates an extra challenge because the frenulum will be too long in comparison to the tissue removed. When I realized how damaged my frenulum was in comparison to a non-altered frenulum, I felt angry and sad at the same time. Before that moment I was under the impression that my frenulum was unharmed, given how pleasurable it is.



Circumcion is often described as removing the skin that covers the tip of the penis, or as removing the tip of the foreskin. Both descriptions are wrong. What is cut is not the tip of the foreskin, since the foreskin doesn't end at its apparent tip. So, what circumcision really removes, is something like an inner section of a tube, and then the two portions at each side of that section are stitched together so that they attach (forming the circumcision scar).



In clamp circumcisions (most of the neonatal procedures), the clamp takes care of sealing those areas of tissue. The tissue on the outside of the clamp loses circulation and is cut off. The two portions of tissue on the inside area of the clamp become sealed to each other, forming the scar. In non-neonatal circumcisions, after cutting the circular portion of tissue, the skin of the shaft becomes loose from the glans, and the glans retains some inner mucosa. Those two sections of tissue are then stitched (with self-dissolving stitches nowadays), forming the scar. These non-neonatal circumcisions tend to leave more ragged and asymmetrical scars.

The tissue removed by circumcision is likely sufficient to cover most or all the flaccid shaft. The typical restoration requires growing 3 to 4 linear inches of skin or more, in order to cover the glans two times (inner and outer layer) and retain a small overhang.

While a restored foreskin is not the same as the original, missing some of its special structures (ridged band, frenulum) and its balance of inner mucosa/outer skin, the experience of this restored foreskin is as close as we can get to the ideal situation in which we were never circumcised.




It is often possible to tell if the glans is covered, partially covered or uncovered, by the sensations coming from the penis - or by consciously putting attention to those sensations. In other words, it is possible to use the sensations from the foreskin or the glans, to know in what position they are.

The length of the flaccid penis is not necessarily constant. Since the penis is not anchored directly on the surface of the skin, nor anchored to the underlying bone, but the corpora (inner bodies of the penis) are held by ligaments, it is possible for the corpora to be pulled inside or pushed outside changing the apparent length of the penis temporarily. This is common when we start restoring pulling skin over the glans without having enough skin - the penis moves inside and it looks almost like it's gone - but there is no way for it to go inside and get lost, since the glans itself is anchored to the end of the skin of the shaft.



The penis is not a "single unit", in other words the skin is not attached to the inner body (the corpora) of the penis. All the skin of the penis is loose to facilitate movement. So you can imagine the penis as an arm inside a sleeve, attached only at the wrist. The arm can move forward or back, or the sleeve can be pulled up or down separately. For circumcised males, this process takes time as the skin, due to the lack of mobility, seems to attach, but within a few weeks from starting restoration this movement starts being possible.



When I was a teen, I thought that the shaft of uncircumcised boys was something like a fixed length tube (think of the barrel of a gun), and the glans was somehow  inside and it would "pop out" during arousal. In reality, this barrel analogy would describe better the inner corpora, but having the glans already attached at the tip. The skin of the penis, including the foreskin, covers the harder inside part (corpora plus glans) and can be pulled back to expose the glans. Nothing "pops out", the skin just rolls back.

While the glans is generally wider than the opening of the foreskin, the opening is elastic enough to allow the glans through. As a teen I couldn't imagine that this tissue is elastic, so I couldn't even start to understand how the glans was capable of "popping out" through this opening.



The restored foreskin is at least as sensible as the rest of the penis - which is to say, it's very sensible. To pleasure. To pain. To pleasure! Every part of the restored foreskin feels pleasure. There is really no difference in the skin area of the foreskin and the skin area of the shaft. Every part of the foreskin is alive, just like our fingers, our nipples, our lips, our ears are alive.

Those who describe the foreskin as just "a fold of skin" fail to understand how the skin even works. Rub the tip of two fingers softly in circular motion and perceive the tingling sensation. This is sensitive skin alive, sending signals to the brain. The same would be true of the foreskin, if it had not been removed by the person performing a circumcision. Imagine now if you were missing the nerves at the tip of those fingers, if this was just a numb area, or if that tip of the finger was no longer in place. Now you have an idea of the loss.

Even then, the foreskin is more than skin. Consider that the inner side is mucosa, consider that there is a layer of muscular tissue inside (dartos fascia). If it was simple delicate skin, it wouldn't resist the tension that we subject it to during restoration, or the use of weights. While I personally have used weight in a very limited way (about 1.5 pounds), some restoring men hang up to 10 pounds or more from their foreskins for a few minutes to give their foreskins a workout.

The muscular tissue inside the foreskin reacts to temperature. In cold mornings, when the penis is somewhat pulled inward, the foreskin contracts its opening and keeps everything inside like a nice jacket. For restoring men this means that in order to achieve what we call "full flaccid coverage", we need to have enough skin to fully cover the glans without reducing the length of the penis and leaving some overhang, so that the skin can contract at the "apparent tip" and keep the glans hugged inside.



The glans and the foreskin are meant to interact. This is the gliding action. Visualize an elastic ring traveling over the glans, adjusting its size to the width of the glans, and you have an idea of the sensation caused by the gliding skin. It is difficult to separate what part of the sensation is perceived by the glans and what part is perceived by the foreskin - which is possibly why some uncircumcised males are not aware of the role of the foreskin in their sensation.



While direct stimulation of the bare glans can be uncomfortable (unless done with hand lotion or lubricant), stimulation of the glans through the foreskin is extremely pleasurable. It's like a tingling pulse traveling through the skin.



Pre-ejaculate fluid has a function! While in us circumcised males it seems to fall hopelessly due to gravity, in uncircumcised males it flows through the subpreputial space and fills it, to lubricate the glans and the mucosa, prior to penetration.