Thursday, September 21, 2023

Links - 21st September 2023 (2 - Genital Mutilation/Circumcision)

Effects of Adult Male Circumcision on Premature Ejaculation: Results from a Prospective Study in China - "The purpose of this study is to investigate the effects of adult male circumcision on premature ejaculation (PE). Therefore, between December 2009 and March 2014, a total of 575 circumcised men and 623 uncircumcised men (control group) were evaluated. Detailed evaluations (including circumcision and control groups) on PE were conducted before circumcision and at the 3-, 6-, 9-, and 12-month follow-up visits after circumcision. Self-estimated intravaginal ejaculatory latency time (IELT), Patient-Reported Outcome measures, and 5-item version of the International Index of Erectile Function were used to measure the ejaculatory and erectile function for all subjects. The results showed that, during the one-year follow-up, men after circumcision experienced higher IELT and better scores of control over ejaculation, satisfaction with sexual intercourse, and severity of PE than men before circumcision (P < 0.001 for all). Similarly, when compared with the control group, the circumcised men reported significantly improved IELT, control over ejaculation, and satisfaction with sexual intercourse (P < 0.001 for all). These findings suggested that circumcision might have positive effects on IELT, ejaculatory control, sexual satisfaction, and PE severity. In addition, circumcision was significantly associated with the development of PE."
This suggests that male genital mutilation reduces sensitivity in healthy men

Does Male Circumcision Affect Sexual Function, Sensitivity, or Satisfaction?—A Systematic Review - Morris
Some guy who was spouting all the usual points about dick cheese (i.e. probably American) cited this 2013 article claiming that the best evidence showed that male circumcision didn't affect male sexual function, sensitivity, sexual sensation or satisfaction. But Morris really puts on the kid gloves when looking at pro-circumcision studies, but of course he takes them off when looking at anti-circumcision ones. For example, improvement in quality of sexual intercourse by Mexican men was cited as evidence for circumcision - but most of them were circumcised for medical reasons.The fact that if you get circumcised for a *medical* reason, the circumcision would be expected to have improved your quality of sexual intercourse. was ignored. And while he criticises Kim and Pang 2007 (anti-circumcision) for "the presentation of data on masturbation but not sexual intercourse", he approvingly cites Senel et al 2012 - even though the sexual function inventory didn't ask specifically about sexual intercourse.
Even his own paper contradicts itself. In the abstract he claims that "The 1++, 2++, and 2+ studies uniformly found that circumcision had no overall adverse effect on... premature ejaculation", but later on he reports that "A SIGN level 2++ study of men who have sex with men in Sydney found that circumcision later in life, but not in infancy, was associated with lower PE prevalence", "A Mexican study (level 2+) of 22 men circumcised... found a reduction of PE" and that a SIGN 2+ study from Turkey "found an increase in ejaculatory latency time that was considered an advantage by participants because they could prolong intercourse". Ironically, we know that reducing sensation is one prescription for managing premature ejaculation.

Rebuttal to Brian Morris
Copious evidence that Morris has a history of lying about circumcision

The effect of male circumcision on sexuality - "There was a decrease in masturbatory pleasure and sexual enjoyment after circumcision, indicating that adult circumcision adversely affects sexual function in many men, possibly because of complications of the surgery and a loss of nerve endings."

Does circumcision have a relationship with ejaculation time? Premature ejaculation evaluated using new diagnostic tools - "The volunteers’ mean and median IELT before were 104.36±66.21 and 88 (26–307) seconds, whereas mean and median IELT after circumcision were 123.56±54.44 and 107.5 (67–300) seconds, respectively. The increase after circumcision was statistically significant (P=0.001). The mean and median PEDT score were 4.26±2.91 and 3 (1–12) before, and 2.63±1.82 and 2 (0–7) after circumcision. Improvement was statistically significant (P<0.0001)"

I didn’t circumcise my son, and I’m terrified I made the wrong choice. - "When I was pregnant with my son 18 years ago, my husband (circumcised) and I decided we would forgo this particular procedure for our son. Our religion does not require it, and after seeing the place at the hospital where doctors did the procedure, I couldn’t imagine doing that to our tiny baby. At that time, I felt comfortable in our decision... Over the years, I have struggled with periods of doubt about having made the right decision for my son. Different things would push me over the edge: My parents could not believe we would not circumcise our baby; we finally had to beg them not to talk about it. When my son was 2, another boy pointed at his penis and laughed, and I freaked out at the kid. Once, I read an article about how people with uncircumcised penises have all sorts of horrible problems with hygiene and asked my son if he wished he were circumcised (eyeroll, “No, Mom, it’s fine”). Most recently, I have read in this column that wearing a condom is difficult with an uncircumcised penis. By not circumcising my son, have I made a horrible mistake?...
Stoya: Can I wax poetic about foreskins?... They’re great. They’re so sensitive. It’s fun to rub the skin back-and-forth across. They’re fun to pinch and pull. They slide nicely in and out of an anus. They generally need less lube.
Rich: I really like the glide action. It’s just so … primal. It’s like its own sort of balanced biological mechanism. It all makes sense. Very similar to a vagina.
Stoya: Foreskinned dicks do feel more feral.
Rich: Yeah. You lose some of that visceral biology when they’re cut...
Stoya: Besides, this way the son has the option to get circumcised later if he really wants. He won’t end up like those guys who are stretching their skin trying to form a foreskin...
Rich: I think she absolutely did the right thing; her son confirmed it. A foreskin may be intimidating to the uninitiated, but there’s a rather mild learning curve to loving uncut dick. Take it from me, as someone who went through the process and came out a foreskin enthusiast. And remember, of this club I’m not only a client—I’m also the president."
Apparently men are incapable of getting circumcised as adults and you should circumcise boys even if later on they don't want to be circumcised

Estimation of country-specific and global prevalence of male circumcision - "The present study provides the most accurate estimate to date of MC prevalence in each country and territory in the world. We estimate that 37–39 % of men globally are circumcised."
Even in the US it's only 71.2%

Does Female Genital Mutilation Have Health Benefits? The Problem with Medicalizing Morality - "The term “FGM” is likely to bring to mind the most severe forms of female genital cutting, such as clitoridectomy or infibulation (partial sewing up of the vaginal opening). But the World Health Organization (WHO) actually recognizes four main categories of FGM, covering dozens of different procedures.  One of the more “minor” forms is called a “ritual nick.” This practice, which I have argued elsewhere should not be performed on children, involves pricking the foreskin or “hood” of the clitoris to release a drop of blood.  Healthy tissue is not typically removed by this procedure, which is often done by trained clinicians in the communities where it is common. Long-term adverse health consequences are believed to be rare...  It is not actually implausible that certain “mild” forms of FGC, such as neonatal labiaplasty, could reduce the risk of various diseases...  If convicted, the Muslim minority defendants face 10 years to life in prison for allegedly practicing a form of FGM that is less physically invasive than other forms of medically unnecessary genital cutting that are legally tolerated in Western countries.  I have already mentioned male circumcision. There is also intersex genital “normalization” surgery (which has been brilliantly discussed in this context by Nancy Ehrenreich); supposedly virginity-signaling hymen “repair” surgeries (which I have written about elsewhere); and at least some so-called “cosmetic” female genital operations, which are increasingly being carried out on minors...  Unlike the “ritual nick,” which does not typically alter the form or function the external (female) genitalia, male circumcision permanently alters both...  Even ultra-Orthodox Jews who perform an unhygienic “oral suction” form of circumcision, in which the circumciser takes the boy’s penis into his mouth and sucks the wound to staunch the bleeding, are legally permitted to do so without state certification or oversight. This is despite confirmation of more than a dozen cases of herpes transmission, two cases of permanent brain damage, and two infant deaths likely caused by the practice between 2004 and 2012.  Those are just the figures for New York City. But still there are no legal restrictions. As the bioethicist Dena Davis has pointed out, “states currently regulate the hygienic practices of those who cut our hair and our fingernails, so why not a baby’s genitals?”  She means “baby boy’s” genitals; baby girls’ genitals are protected by law...  It is true that female circumcision is not mentioned in the Koran; but neither is male circumcision. And yet the latter is widely regarded as a “religious” practice not only within Judaism but also Islam. As Alex Myers notes, “if we defer to religious justifications, we shall find that in many cases, the circumcision of female as well as male children could be permitted on this basis.”  How could that be so? In her landmark paper entitled, “Male and Female Genital Alteration: A Collision Course with the Law,” Dena Davis notes that “binding religious obligations” can stem from oral traditions and other “extrabiblical sources,” such as rabbinic commentaries or papal encyclicals in the case of Judaism or Christianity. Likewise, “Islam looks to other sources to interpret and supplement Koranic teachings.”  One such source is the Hadith—the sayings of the Prophet Mohammed—which is the other major basis for Islamic law apart from the Koran...  In the West, we seem more or less unfazed by the religiously sanctioned cutting of boys’ genitals; but we go into a panic over less severe procedures performed on the genitals of girls by equally pious parents.  In fact, we bend over backwards to convince ourselves that the latter procedures are “not actually religious” by selectively citing scholars who agree with us—as though not being “religious” somehow made a practice less worthy of being respected, or being “religious” made it morally OK. Neither of those propositions follow.  Finally, we attribute evil motives to the parents who circumcise their daughters, when the same parents almost invariably also circumcise their sons, sometimes more invasively, and often for identical reasons. (The stereotype that female circumcision is “all about” misogyny and sexual control, while male circumcision is about neither, is one that I, and many other scholars, have deconstructed elsewhere: see here for a fairly short summary. Suffice it to say the claim is not true.)    So who are we kidding? The overwhelming majority of American parents who circumcise their sons do it for “cultural” rather than religious reasons, and few seem concerned to bat an eye. Even many Jews who circumcise are committed atheists (and for all I know, so are many Muslims). Although the law may treat “religion” as a special, separate category, the religious versus “cultural” status of male or female genital cutting is not what drives our different moral judgments...  Most of the decent-quality data showing health benefits for male circumcision (primarily, a modest reduction in the absolute risk of some sexually transmitted infections) come from surgeries performed on adults in Africa, not babies in the United States or Europe. The findings cannot be simply copy-pasted from one context and age range to another.  But even if you could just copy and paste, you would still have to factor in the risks and harms of circumcision, which are not trivial. In fact, most national medical associations to have issued formal policies on the question have found that the benefits of childhood male circumcision are not sufficient to outweigh the disadvantages of the surgery in developed countries...  Removing any healthy tissue from a child’s body will confer “some” health benefits: tissue that has been excised can no longer host a cancer, become infected, or pose any other problem to its erstwhile owner. But as the bioethicist Eike-Henner Kluge has noted, if this logic were accepted more generally, “all sorts of medical conditions would be implicated” and we would find ourselves “operating non-stop on just about every part of the human body.”  Alarmingly, one place we might start operating is the pediatric vulva. Compared to the penis, the external female genitalia provide if anything “an even more hospitable environment to bacteria, yeasts, viruses, and so forth, such that removing moist folds of tissue (with a sterile surgical instrument) might very well reduce the risk of associated problems.”  In countries where female circumcision is relatively common, this is exactly what is claimed for the procedure. Cited health benefits include “a lower risk of vaginal cancer … fewer infections from microbes gathering under the hood of the clitoris, and protection against herpes and genital ulcers.”  Moreover, at least two studies by Western scientists have shown a negative correlation between female circumcision and HIV. The authors of one of the studies, both seasoned statisticians who expected to find the opposite relationship, described their findings as a “significant and perplexing inverse association between reported female circumcision and HIV seropositivity.”...  The WHO steadfastly refuses to connect the dots. In her words, they seek to “medicalize male circumcision on the one hand” by promoting it, over the objections and reservations of many outside experts, as a form of prophylaxis against HIV. But they “oppose the medicalization of female circumcision on the other, while simultaneously basing their opposition to female operations on grounds that could legitimately be used to condemn the male operations.” The problem with appeals to “health benefits,” then, is that they are disingenuous and inconsistently applied. As Robert Darby has argued, “official bodies working against FGC have condemned medicalization of the procedure and funded massive research programs into the harm of the surgery.” The irony, as he sees it, is that the WHO “also frames male circumcision as a public health issue—but from the opposite starting point.” Thus, we see that  instead of a research program to study the possible harms of circumcision, it funds research into the benefits and advantages of the operation. In neither case, however, is the research open-ended: in relation to women the search is for damage, in relation to men it is for benefit; and since the initial assumptions influence the outcomes, these results are duly found...  At least one female Muslim gynecologist—from Khartoum University in the Sudan—has been reported as saying: “if the benefits [of female circumcision] are not apparent now, they will become known in the future, as has happened with regard to male circumcision.”  (Perhaps she will be inspired by the websites of American plastic surgeons, who already claim all manner of physical and mental health benefits for elective labiaplasty – and other purported “cosmetic” operations)...  If anti-FGM campaigners and organizations such as the WHO continue to play the “no health benefits” card as a way of deflecting comparisons to male circumcision, it will not be long before medically-trained supporters of the practice in other countries begin to do the necessary research.  The history of male circumcision shows how this could happen. Alongside female genital cutting, male genital cutting originated in African prehistory as a ritual practice, and was later adopted by various Semitic tribes. For most of its existence, the only claimed advantages of the procedure were social or metaphysical in nature—identifying the boy as a member of a particular group, for example, or sealing a divine covenant, as in Judaism.  In the physical realm, by contrast, circumcision was largely believed to have negative effects, including on sexual feeling and satisfaction. By “dulling” the sexual organ of male children, parents believed that their sons would pay more attention to important “spiritual” matters and be less tempted by the pleasures of the flesh.  It was only in recent times that religious supporters of male circumcision began to argue that it was “physically” beneficial—recasting the procedure as a secularly defensible measure of individual or even public health, as opposed to solely a cultural or religious practice.  In the United States, for example, circumcision was adopted in part as an anti-masturbation tactic in the late 1800s (masturbation, at the time, was thought to cause not only moral but medical ills; see here for a video introduction). The resulting shift from “religious” to “medical” proved strategically important in Christian-majority societies, where genital cutting of children had otherwise been seen as barbaric.  The medical historian David Gollaher has argued that Jewish physicians, whose “attitudes toward circumcision were partly shaped by their own cultural experience,” found the late 19th century evidence of health benefits “especially compelling.” Most of it was later debunked.  Nevertheless, the search for “health benefits” continues to this day. A large proportion of the current medical literature purporting to show health benefits for male circumcision has been generated by doctors who were themselves circumcised at birth—often for religious reasons—and who have cultural, financial, or other interests in seeing the practice preserved.  Science and medicine are not immune from such agendas or biases. In 2012, the American Academy of Pediatrics (AAP) controversially concluded that the health benefits of newborn male circumcision outweighed the risks (this is the “glaring exception” I said I’d come back to). Their conclusion was puzzling, since they did not have a method for assigning weights to individual benefits or risks, much less an accepted mechanism by which the two could be compared.  They were also missing the denominator to their equation. On page 772 of their report they state that, due to limitations with the existing data, “the true incidence of complications after newborn circumcision is unknown.”  So how could we know they are outweighed by the benefits?  In an unprecedented move, the AAP was rebuked by senior physicians, ethicists, and representatives from national medical societies based in the UK, Canada, and mainland Europe, who argued that the findings were likely culturally biased. The AAP Circumcision Task Force later acknowledged that the benefits were only “felt” to outweigh the risks. It came down to a subjective judgment."

Why was the U.S. ban on ‘female genital mutilation ruled unconstitutional, and what does this have to do with male circumcision? - "There are now legally prohibited forms of medically unnecessary female genital cutting—including the so-called ritual nick—that are less severe than permitted forms of medically unnecessary male and intersex genital cutting. Attempts to discursively quarantine the male and female forms of cutting (MGC, FGC) from one another based on appeals to health outcomes, symbolic meanings, and religious versus cultural status have been undermined by a large body of recent scholarship. Recognizing that a zero-tolerance policy toward ritual FGC may lead to restrictions on ritual MGC, prominent defenders of the latter practice have begun to argue that what they regard as “minor” forms of ritual FGC should in fact be seen as morally permissible—even when non-consensual—and should be legally allowed in Western societies. In a striking development in late 2018, a federal judge ruled that the longstanding U.S. law prohibiting “female genital mutilation” (FGM) was unconstitutional on jurisdictional grounds, while also acknowledging the relevance of arguments concerning non-discrimination on the basis of sex or gender. It now appears that anti-FGM laws in other Western countries similarly risk being struck down. To resist this trajectory, feminist scholars and advocates of children's rights now increasingly argue that efforts to protect girls from non-consensual FGC must be rooted in a sex- and gender-neutral (that is, human) right to bodily integrity, if these efforts are to be successful in the long-run."
It's notable that the "my body, my choice" crowd for abortion oppose female genital cutting for adults

Meme - "GUYS WHO ARE CIRCUMCISED
HAVE LESS NERVES IN THEIR PEEN
NEED LUBE TO GET YOU WET
LITERALLY HAVE LESS PEEPEE
GUYS WITH FORESKIN
LITERALLY MORE PEEN
HAVE NATURAL LUBE FROM THEIR GLANDS
WASN'T MUTILATED AT BIRTH"

Meme - "Dude why would you wash your dick, just cut off your foreskin"
"Every uncircumcised penis I’ve had the pleasure of pleasing, the owner of said dick always took the time to make sure they were clean and fresh before copulation. Every gross penis I’ve ever encountered was circumcised. (My testing group is about 100 subjects)
Don’t let ancient religious infant genital mutilation make you think that a natural penis is gross."
This supports my theory that circumcised American men don't wash their penises, so they imagine that uncircumcised penises are gross and have dick cheese, since they think uncircumcised men are like them and don't wash

Study Finds that Some Women Prefer Circumcised Penises - "Women tend to prefer circumcised penises over uncircumcised penises, according to a recent Sexual Medicine review article, though the authors acknowledged several limitations and recommended further research.  For centuries, aspects of the penis, such as size, have been associated with male attractiveness. The practice of male circumcision – the removal of the foreskin that covers the head of the penis – is thought to have originated in Africa about 220,000 years ago. Nowadays, the global prevalence of circumcision is estimated to be between 37% and 39%."

Sex and Male Circumcision: Women’s Preferences Across Different Cultures and Countries: A Systematic Review
One guy promoting male genital mutilation kept posting this paper, but almost all the studies were from the US and Africa. Excluding North America and Africa, in Denmark the women preferred uncut men, in Australia the women preferred cut men, but the sample size was small and in Mexico the women had no preference

Meme - *Angry* "IS THIS THE HOSPITAL WHERE THEY DO GENITAL SURGERY ON KIDS?"
"ONLY CIRCUMCISIONS."
"OH."
*Happy*

Medical male circumcision: is the HIV prevention claim wrong? - "Circumcision is a proven intervention that reduces the chance of contracting HIV by 60%, but to scientists’ surprise, a study has found that medically circumcised older men in Mpumalanga had a higher rate of HIV than uncircumcised men...   The researchers proposed several theories to explain the unexpected finding, including the possibility that HIV positive men are opting for circumcision at higher rates and that men engage in riskier sexual behavior after circumcision."
From South Africa. When theory and practice collide. Or, there could be flaws in the original [American] studies claiming circumcision reduces HIV risk. So much for risk compensation being a myth

HIV risk perception and behavior among medically and traditionally circumcised males in South Africa - "voluntary medical male circumcision (VMMC) has recently been implemented as a strategy for reducing the risk of heterosexual HIV acquisition among men. However, there is some concern that VMMC may lead to low risk perception and more risky sexual behavior. This study investigated HIV risk perception and risk behaviors among men who have undergone either VMMC or traditional male circumcision (TMC) compared to those that had not been circumcised... relative to uncircumcised males, males who reported VMMC were significantly more likely to have had more than two sexual partners (RRR = 1.67, p = 0.009), and males who reported TMC were significantly less likely to be low risk alcohol users (RRR = 0.72, p < 0.001)."

Circumcision and HIV | Studies Shows It's A Dangerous Mistake - "In only three highly controversial, short-term clinical trials, circumcision was purportedly shown to reduce risk of HIV transmission by 50–60% in heterosexual males engaging in male/female intercourse. The results did not show that females had any protection from HIV as a result their partners being circumcised, nor was transmission prevented in same sex partners. Infection from injectable drug use and other non-sexual vectors of HIV infection are not prevented by circumcision. The vast majority of other studies on the relationship between circumcision and HIV have shown either that circumcision offers no protection, or the results are inconclusive.  The results of three randomized clinical trials (RCTs) are often presented as proof beyond a reasonable doubt that male circumcision prevents HIV infection...  All three studies suffered from the same error in methodology for circumcision and HIV... All had expectation bias (both researcher and participant), selection bias, lead-time bias, attrition bias, duration bias, and early termination that favored the treatment effect the investigators were hoping for. All three studies were overpowered such that the biases alone could have provided a statistically significant difference... A basic assumption adopted by the investigators was that all HIV infections resulted from heterosexual transmission, so no effort was made to determine the source of the infections discovered during the trial. There is strong evidence that this assumption was not valid. In the three trials in Kenya, Uganda, and South Africa that are the basis for the HIV claims, the researchers assumed in their calculations they had 0% gay men in their studies.  It is important to note that Bailey failed in 2010 to find a protective effect in another study in Kenya.  Also, in 2009 Gray saw  a 50% higher male-to-female HIV transmission rate among the Ugandan men they circumcised... The ability to have unrestricted sex is the subtle message behind the African circumcision marketing campaigns. Meanwhile the drastic reduction in sensitivity caused by circumcision due to the loss of 20,000 penile nerve endings will make African men engage in riskier behavior to achieve sexual gratification. These factors will lead to an increase in unwanted pregnancies. Pro-circumcision propaganda will encourage decreased use of contraception... Recent studies in Africa and other countries found circumcision and HIV did not significantly reduce HIV infections... The New York Times reports that the infection rates in Uganda from 2005-2012 have increased while the United States, through its AIDS prevention strategy known as PEPFAR, or the President’s Emergency Plan for AIDS Relief, spent $1.7 billion in Uganda to fight AIDS. The results raise questions about the efficacy of a U.S. strategy largely based on circumcision... More studies from around the world found no benefit to circumcision and HIV...        Male circumcision also places women at greater risk of unsafe sex practices if they or their circumcised male partners wrongly believe they are immune to HIV. Female partners may become less insistent on use of condoms when they believe circumcision offers protection. Men who “had the cut” can become more aggressive in their demands for sex because they believe they are immune from HIV infection."

How the circumcision solution in Africa will increase HIV infections - "The World Health Organization and UNAIDS have supported circumcision as a preventive for HIV infections in regions with high rates of heterosexually transmitted HIV; however, the circumcision solution has several fundamental flaws that undermine its potential for success. This article explores, in detail, the data on which this recommendation is based, the difficulty in translating results from high risk adults in a research setting to the general public, the impact of risk compensation, and how circumcision compares to existing alternatives. Based on our analysis it is concluded that the circumcision solution is a wasteful distraction that takes resources away from more effective, less expensive, less invasive alternatives. By diverting attention away from more effective interventions, circumcision programs will likely increase the number of HIV infections."

African HIV infection rate higher on circumcised men - "The HIV prevalence rate among circumcised males between the ages of 15 and 49 in Zimbabwe is higher than that of the uncircumcised males owing to the misconception that circumcision completely shields people from HIV infection.  According to the latest Zimbabwe Health Demographic Survey (ZHDS 2010/2011), the prevalence rate among the circumcised is 14 percent while that of the uncircumcised is 12 percent...   National Aids Council (Nac) public health officer Dr Blessing Mutede said authorities were concerned about the high rate of infection among the circumcised.  He said it was largely a result of “risk compensation behaviors”.  Most men, after circumcision, harbor the false impression that they have been equipped with an invisible condom"

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