Tuesday, September 18, 2012

When the studies skip discussing the benefits of not being circumcised

The fact that there are studies that show benefits from being circumcised doesn't mean that being circumcised is a good thing, especially when the studies skip discussing the benefits of not being circumcised.

Being dead prevents all kinds of infections and diseases... but we wouldn't advocate dying as preventive medicine.

Please note: I'm not advocating an anti-scientifc position. What I'm advocating is balance. The equation is not just benefits of circumcision vs. risks. There are 2 states: circumcised and intact. Each state could potentially have pros and cons. Then there is the risk of transitioning from intact to circumcised, and the impossibility of transitioning back, and we have 6 variables to take into consideration. If we ignore 4 of those variables our equation is out of balance.

There is really no such thing as unbiased information about circumcision. There are scientific studies that prove both sides of the equation, but scientific studies sometimes are only as good as the people performing the studies, and a professional title does not constitute proof of being unbiased.

Why is nobody objecting to or trying to promote say, heart surgeries, liver transplants and other medical interventions? Because those interventions are performed when they are needed. In particular, amputations are normally performed when a part of the body is so sick and damaged that it constitutes an immediate threat to the rest of the body.

There is no denying that circumcision is an amputation, not an immunization. It removes a part of the body. Immunizations strengthen the immune system and motivate the generation of antibodies that protect from different viruses.

Circumcision can be therapeutically performed in cases of necessity, such as a severe phimosis, repetitive paraphimosis, balanitis xerotica obliterans (BXO) and it wouldn't be a cause for any controversy.

What makes circumcision controversial is its application as a preventive or prophylactic procedure, and even more, circumcision as a social or religious custom.

Do you know of any other amputation of healthy tissue that is performed as a prevention, and particularly on non-consenting individuals who do not have the age to provide informed consent?

This becomes even more critical due to the voices of men who feel physically and psychologically damaged by their circumcision, whether by surgical mishap, improper healing, secondary effects and the simple realization that they were subjected to an unnecessary amputation before they were even aware of their own bodies. This phenomenon has been generally dismissed by the medical community.

While most circumcisions turn out okay (and the individuals circumcised at birth are not usually aware of any ill effects even if there are any), some circumcisions turn to the worse, causing severe damages to the genitalia, sometimes making a normal sexual life impossible.

The document "Neonatal Male circumcision global review" of UNAIDS (the organization promoting voluntary male circumcision in Africa as prevention of HIV) states that "some of the serious complications that can occur during the procedure include death from excess bleeding and amputation of the glans penis. Postoperative complications include the formation of skin bridges between the shaft and the glans, infection, urinary retention (this has caused deaths), meatal ulcer, impetigo, fistulas, loss of penile sensitivity, sexual dysfunction and oedema of the glans." They also acknowledge that the frequency of complications is "underestimated because events occuring after the discharge are not captured [in the discharge sheet]" and sometimes are treated at a different hospital.


 Please note that there is a difference between sexual function and reproductive function. Being able to orgasm, to impregnate a woman and make her pregnant, or the female ability to become pregnant, do not necessarily mean that the sexual function is complete.

I don't mean this to belittle anyone - I am circ'ed myself. We all would like to think that we have the best penis and that sex as we experienced it is as good as it gets. But only keeping an open mind we can understand what was done, and the reason to do it is really to evaluate whether the act itself is positive or detrimental, before we decide to impose the same act upon our own children.

Consider one analogy. Imagine that you take these 3 guys to watch the most recent 3D movie: a colorblind guy, a guy who lost one eye shortly after birth, and a deaf person. They arrive at the theater and put their 3D glasses on. Do you think they enjoyed the movie?

The answer is yes, each one of them enjoyed the movie.

However, the colorblind guy won't be able to tell you anything about the colors of the film. The guy with just one eye won't be able to tell anything about the 3D effects. And the deaf guy won't know anything about the soundtrack and dialogues. Each one enjoyed the film in spite of the limitations of their sensory organs.

A man who is circumcised at birth looses approximately 20,000 nerve endings. This is 2.5 more than the number of nerve endings in a typical clitoris. The rigged band also serves a purpose of stimulating the glans during sexual activity, whether masturbation or intercourse, producing circular pressure over the glans. Those functions are removed by circumcision, so the perception of sex is definitively altered.

That doesn't mean that a circumcised man won't enjoy sex. It only means that he will enjoy it to the extent allowed by the lack of sensory input. Which for some men is fine, and for some it is more like a 75% reduction. And some men have reported a strong decline in sensation at 40 to 55 years of age, which has often been improved by foreskin restoration.

The AAP has denied this, stating that "There is both good and fair evidence that no statistically significant differences exist between circumcised and uncircumcised men in terms of sexual
sensation and satisfaction" and "There is fair evidence from a crosssectional study of Korean men of decreased masturbatory pleasure after adult circumcision". However it is noteworthy that both, Jew philosophers of antiquity (Philo, 1st century, and Moses Maimonides, 12th century) along with the doctors that started medical circumcision back in the late XIX century as a form to curb masturbation, agreed that circumcision reduced pleasure.

One of these doctors stated: "I suggest that all male children should be circumcised. This is "against nature", but that is exactly the reason why it should be done. Nature intends that the adolescent male shall copulate as often and as promiscuously as possible, and to that end covers the sensitive glans so that it shall be ever ready to receive stimuli. Civilization, on the contrary, requires chastity, and the glans of the circumcised rapidly assumes a leathery texture less sensitive than skin. Thus the adolescent has his attention drawn to his penis much less often. I am convinced that masturbation is much less common in the circumcised. With these considerations in view it does not seem apt to argue that 'God knows best how to make little boys.'" R.W. Cockshut. Circumcision. British Medical Journal, Vol.2 (1935): p.764. There are plenty of similar quotes.

Only since the 60s, American doctors started denying any effect on sexuality from circumcision. However, doctors in the 60s were most likely circumcised at birth themselves, so they were lacking first person experience of the foreskin.

The problem with circumcision of minors is that this is the result of a parental choice, not a personal choice, and that the affected individual most of the times is not even aware of the effect that it has.

How do we know that men feel more when uncircumcised?

Let me start with anecdotal information:

My best friend, intact, made an experiment at some point of keeping hi
s glans uncovered. He acknowledges quick loss of sensation.

I've read direct messages from at least 3 men who got circumcised during adulthood for aesthetic concerns. The 3 of them regretted it due to the loss of sensation afterwards.

I'm also part of the foreskin restoration forum. I know there several guys (including one who invented one of the most common restoration devices), who at age 40 to 55 had a strong decline in sensation, to the point where sex was no longer fun. After a few months of restoration all of them reported improvement.

Personally, I have been restoring for 6 months. One thing I learned is that the foreskin and the glans interact. The foreskin (the rigged band) produces circular pressure over the glans during sex, as it glides up and down. This circular pressure is the perfect way to stimulate the glans, sorry if this is TMI, but it works like a small mouth giving oral all the time during sex. This is lost to circumcision, but restoration partially restores this even though the rigged band cannot be recreated.

Further up in the thread I posted an analogy of 3 men watching a 3D movie: one who is colorblind, one who is missing an eye, and one who is deaf. My opinion is that the 3 men will enjoy the film, but each one is missing something due to limitations on their sensory organs. The colorblind guy won't know about the colors, the guy without one eye won't see the 3D effects, and the deaf guy won't know anything about the soundtrack. Likewise, I don't imply that we circ'ed men do not enjoy sex, we do of course. But we don't feel everything that could be felt because we are lacking a sensory organ of the penis (the 20,000 nerve endings - 2.5 times that of a clitoris), and the rigged band (which stimulates and perceives stimulation at the same time).

Knowing this, I don't care about any study comparing the sensitivity of circumcised and uncircumcised males. They normally ignore the foreskin and then conclude that there is no difference in sensation or satisfaction. That's like comparing a guy with one hand and a guy with two hands, and stating that the two can do the same tasks as long as the two-hands guy keeps his extra hand tied to his back. The only real good study I've seen in sensation is Sorrells (2007). It concludes that "the transitional region from the external to the internal prepuce is the most sensitive region of the uncircumcised penis and more sensitive than the most sensitive region of the circumcised penis. It appears that circumcision ablates the most sensitive parts of the penis." http://www.medicalnewstoday.com/releases/74475.php

Somebody tried to debunk it and readjusted the data, ignoring all data related to the foreskin because it's not present in the circumcised guys. Just like I said: the two guys can do the same tasks as long as the two-hands guy keeps his extra hand tied to his back.

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