Sunday, November 04, 2007

The Vulnerability of Men

By Vincent Bach
Also available as a printable Word Document
Original location: udonet.com
Additional Readings by Bach


I have been gathering my thoughts on what I think is the primary force behind circumcision in our culture - circumcised men. I’m not discounting secondary forces such as Medicaid and other health insurance providers, kooky doctors, foreskin aftermarket, etc. However, if there weren’t so many circumcised males running around, I think the secondary forces would quickly disappear.

I see on the boards many times where a pregnant wife is frustrated when attempting to discuss the issue with her circumcised husband. She wants to leave her son intact but he won’t listen to reason. Well, the rest of this article is written specifically to try and offer some insight and suggestions for those ladies. I hope it helps someone.

As an intact man who grew up and has lived among circumcised men, I think I have some insight into what drives their behavior on the issue of circumcision. Of course this doesn’t apply to all of them, but I think my generalizations may be useful for you in dealing with this issue with your husband.

First of all, you need to understand that circumcised men are cornered on this issue. They were circumcised without their consent and have no inherent knowledge of what being intact is like. Even though they rarely will discuss the issue, they are keenly aware that they have been surgically altered in a very private way. There are several ways for a man to deal with this issue but the safest way, psychologically speaking, is to believe at all cost that the surgery performed on them was an enhancement and is preferred by women. Confirmation of this belief is essential to their sexual self-image. Do I need to tell you that sexual self-image is a major issue for men? Didn’t think so.

Now put yourself in the shoes of the circumcised man. He asks for very little. All he wants is football on Sunday and to be assured that there is nothing wrong with his package. A nice bonus would be that women actually prefer it the way it is. Then along comes the newly pregnant wife and the issue of circumcision is no more personal to her than a peanut butter and jelly sandwich, and she starts openly discussing it with him with the casualness that she would with her gal pals down at the salon. Yikes! Batten down the hatch. Incoming torpedo!!!! At first the strategy is to dismiss her without appearing to be alarmed. He’ll probably toss back the usual, "It's not clean" or "That could cause health problems" hoping this will scare her off since he assumes she’s heard those things before. He won’t seem particularly disturbed at first. It's part of being a man to not show vulnerability.

If this doesn’t work and the wife mentions that she heard otherwise, he’ll be shifting uncomfortably in his chair just a little but still keep his cool. At this point he may try Plan B which is to make fun of you for your silly ideas. Maybe make a joke about turtlenecks. If you persist, he’ll bring out the ol’ "I want him to be like me" knowing you women are suckers for us men when we talk of bonding and emotional attachment - of any kind.

Finally, if this doesn’t work, he’s probably going to relate some made up or exaggerated story from his school days when some intact kid at school was teased mercilessly until he circumcised himself right in the middle of Shop class. The resulting low mark the kid received in Shop kept him out of Harvard and he had to settle for a life as a carnival worker. Do you REALLY want that for your son?

If you haven’t given in by this time, he is probably now showing signs of agitation. You’re close to getting the ol’ "I have the penis so I have the last word!" Most men won’t go beyond this point in the discussion. They will clam up and refuse to discuss it any more. If he’s particularly panicked, he’ll probably enlist the help of sympathetic family members or friends to weigh in on what a mistake it would be not to circumcise your son.

I think it's important to acknowledge that it's perfectly understandable that our circumcised friends react this way. Men who have been circumcised have an extremely difficult dilemma. For them to acknowledge that the practice is unnecessary and harmful means that they must acknowledge a painful personal reality. For that reason circumcised men can be forgiven if they don't want to lead the parade in the fight against routine infant circumcision. I can empathize, and therefore understand completely, why so many men will voluntarily offer their sons up for the same procedure without giving it a second thought. To do otherwise opens them up to some vulnerable feelings that can be most unpleasant.

Society puts lots of expectations on women but it also puts a couple on men. One of them is that he be sexually virile. You know - masculine, strong, potent, GRRRRR!! I think many circumcised men accept without question and perpetuate the myths regarding the intact penis in order to cope with this particular expectation.

So, the problem is how do we save our sons' genitals without psychologically emasculating their fathers?

Hmm...well I think the first step is having a better understanding of just how personal an issue this is for him. The reason I spent so long discussing it is because it's extremely important and he’s not going to tell you about it.

Going into the discussion, you’ll be much better off knowing what’s really bothering him. Trust me, he really doesn’t give a hooey whether his son’s penis looks like his. What is important is that his bulb is not dimmed. Probably not a good idea to refer to the practice of circumcision in initial discussions as 'genital mutilation' (although it certainly is that). The thing that you need to get across to him with all your female charm is that you love him EXACTLY the way he is and wouldn’t change a thing. In other words, I think the best strategy is probably to build him up as high as you can before lowering this bomb on him. The ship can only take a hit so big before going under. So get your armor out and start fortifying his self-image. What means everything to him is that he is the best lover and provider that you could ever hope for.

Please don’t use my lame words exactly. I ain’t got no feminine charm. :-)  I suspect you get it and can take it from here. Ironically, if you succeed, you’ll be giving your man a huge future reward in that his son will someday be a man and will know all too well the tremendous courage it took for his father to break with this barbaric custom and leave him intact. With circumcision rates falling drastically and routine infant circumcision possibly even being illegal by then, I predict he’ll be forever thankful to the both of you. Good luck! Your son and family deserve your best effort.


Read more from Vincent Bach:

Regarding circumcision and intactness

You Want to Cut Off What?

The Science of Circumcision

The Bias of the American Academy of Pediatrics

More Skewering of the AAP


Eddy Cameron montage with phrases, "I Didn't Consent" and "Men Do Complain"


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Friday, November 02, 2007

The Truth About Circumcision Within Christianity

By Daisy May
Source: Yahoo Voices!


As a mother in the early 1990s, the choice to circumcise my newborn son was made like most other teen mothers - blindly. The hospital nurse came in, told me the procedure needed done to keep my son healthy, and to sign the paper. Without knowledge of what I was agreeing to put my new baby through, I signed, believing that I was doing what every loving parent did. As I was not Jewish but Christian raised, circumcision was not a choice to be made through religion.

Over a decade later, I still remember how my son looked when I saw him afterward. His eyes, previously peaceful and dreamy, were now wet and wild with terror. I didn't understand it. I was told that babies didn't feel much pain during circumcision. I was told the pain that was felt would be instantly forgotten a couple moments after the surgery was done. I was told a lot of things by nurses and family except the things that I had needed to know.

Without resistance, thousands of parents for several decades followed what medical authority recommended. However, there may have been considerably less parents choosing circumcision if the facts were made public knowledge:

  • Circumcision was not a necessary surgery to keep boys healthy.
  • Circumcision did inflict major pain on the baby.
  • Often anesthesia is not used, and when it is used the medicine does not provide enough relief, and can cause death.
  • A newborn baby will very likely tremble, wail, vomit and hold his breathe due to pain from the surgery.

Due to these terrible truths, many mothers are now suffering guilt over what they allowed to be done to their sons. Unfortunately, there is another truth that many don't realize. The truth about circumcision within Christianity.

Circumcision in the beginning was not the removal of the foreskin, but a cut of the foreskin. The modern circumcision was integrated into society as a 'cure for masturbation.'

Jewish circumcision started about 2,000 years before Jesus came. This was so the people would understand the purpose of the Old Covenant before the New Covenant came into being. When Jesus came, he was circumcised and it was the beginning of his sacrifice.

After Jesus fulfilled the Old Covenant, the New Covenant became the law for Christians. The time of Jewish circumcision and animal sacrifices was ended. Circumcision of a male child born in the New Covenant is blasphemous and macabre torture.

There are many passages in the Bible that explain God's stance on circumcision. The following are the most relevant to today's society.
Colossians 2: 8-11:  Beware lest any man spoil you through philosophy and vain deceit, after the tradition of men, after the rudiments of the world, and not after the Christ. For in him dwelleth all the fulness of the Godhead bodily. And ye are complete in him, which is the head of all principality and power: In whom also ye are circumcised with the circumcision made without hands, in putting off the body of the sins of the flesh by the circumcision of Christ:

Rom. 3:29-30:  Is God the God of Jews only? Is He not the God of Gentiles, also? Yes, of Gentiles also. Since the God who will justify those of the circumcision out of faith, and those of the uncircumcision through faith, is One. 
Gal. 3:13:  Christ redeemed us from the curse of the Law, having become a curse for us.  
Matt. 9:13:  I desire mercy and not sacrifice.
God abhorred the ancient circumcision but used it as a tool, and he most assuredly abhors the mutilation of modern circumcision.

There is nothing that parents who have chosen to circumcise in the past can do now. That is, except tell others about the grisly details of circumcision and broadcast the truth about God's position on circumcision. Circumcision is a heinous act, and not to circumcise is a religious one.


Related Reading:

Christianity and Circumcision Resource Page

I Circumcised My Son: Healing From Regret

Whole Christian Network (Public Page)

Whole Christian Network (Private Discussion Group)

Keeping Future Sons Intact (Public Page)

Keeping Future Sons Intact (Private Discussion Group)


~~~~

Thursday, November 01, 2007

Routine Circumcision: The Opposing View

By Andrew E MacNeily, MD, FRCSC, FAAP
Source: Can Urol Assoc J. 2007 November; 1(4): 395–397




For millennia, routine newborn male circumcision has been endorsed for a variety of purported benefits. Over the ages, claimed advantages have included the formation of a covenant with god, the enhancement of sexual pleasure, the reduction of sexual pleasure, and a cure for bedwetting, syphilis, penile cancer, mental illness and masturbation. In more modern times, some advocates of circumcision have equated the procedure to a form of vaccination. Circumcision is thus depicted as protective against future problems of the foreskin such as phimosis and recurrent balanitis as well as neonatal urinary infection (UTI), cervical carcinoma and HIV/AIDS. Do these potential advantages justify routine circumcision of healthy newborn males on a widespread scale? Should public policy dictate that health care resources be redirected to this procedure when all but 1 province in Canada has delisted newborn circumcision from the schedule of insured services? Let's look at the evidence.


Prevention of urinary tract infection

It is well established from epidemiological studies first carried out by Wiswell and colleagues that the incidence of febrile UTI in otherwise anatomically normal males in the first year of life is lower in circumcised, compared with intact, males. The exact risk reduction varies somewhere between 4-fold and 12-fold depending on the study one chooses to quote. However, the actual incidence of UTI in the first year of life is low. Even a 10-fold reduction in infection rates equates to changing the incidence of UTI from 1 in 100 to 1 in 1000 male babies. It has been calculated that the rate of UTI among infant boys with foreskins must equal or exceed 29% for neonatal circumcision to be cost effective. Conversely, for neonatal circumcision to be cost- neutral, each patient hospitalized for UTI would need to cost $229 564! In 2004, it is estimated that approximately 1.2 million newborn circumcisions were performed in the United States. The estimated direct cost of these procedures was $1.2 billion, a large sum of health care funds that could be directed toward more effective preventative and therapeutic interventions.


Prevention of HIV/AIDS

A complete discussion of the relation of male circumcision and HIV is beyond the scope of this paper. Some studies conducted in Africa have shown that HIV is more common in uncircumcised males, while others have shown the opposite or no difference. Despite the fact that the evidence indicating a protective effect of circumcision is based on observational studies of adult circumcision in a developing country, there is now a ground swell of support for considering the procedure as a viable strategy for preventing sexually acquired infections. A recent Cochrane systematic review found insufficient evidence to support an interventional effect of male circumcision on HIV acquisition in heterosexual men. The authors noted that individual “researcher's personal biases and the dominant circumcision practices of their respective countries” complicated the interpretation of the existing data on the effect of circumcision on HIV transmission rates. Three randomized controlled trials (RCTs) have subsequently been published on heterosexual female-to-male transmission of HIV in high-risk areas of sub-Saharan Africa.,,, All 3 supported adult circumcision as a protective measure. However, these trials were all terminated early, a characteristic that tends to overstate the effect of an intervention. In North America, where HIV rates are much lower, transmission is primarily by homosexual contact and intravenous drug use, making these RCTs inapplicable to this jurisdiction. Further, based on 1998 WHO data of developed countries, the United States has the highest rate of HIV and also the highest rate of infant circumcision.This alone casts doubt on the utility of routine circumcision in preventing HIV infection in developed countries.


Prevention of cervical carcinoma

It has been observed that the prevalence of cervical cancer is low where male circumcision is practised. Historically, this has been attributed to a decreased prevalence of human papilloma virus (HPV) on the circumcised penis. However, a recent meta-analysis on HPV and circumcision concluded that the medical literature does not support the claim that circumcision reduces the risk of genital HPV infection. Even if circumcision conferred a reduction of HPV, does that indicate that routine circumcision should be advocated to reduce the prevalence of the vector for cervical cancer? The use of surgery for disease prevention is an unusual public health intervention. It would seem a more prudent health care policy to offer the recently available HPV vaccine against oncogenic strains of the virus to young females before the onset of sexual activity than to perform surgery on all males in the neonatal period.


Prevention of penile carcinoma

Over the last 75 years, many case series showing that most penile cancers occurred in uncircumcised individuals have been published. Does that indicate that all males should be circumcised to prevent this rare cancer? It is notable that the incidences of penile cancer in Denmark, Finland, Norway and Japan, where less than 1.5% of men are circumcised, are lower than in the United States, where the majority of men are still circumcised.,,,, If circumcision is believed to decrease the risk of developing cancer, why do these noncircumcising countries with similar standards of living and hygiene have lower incidences of penile cancer?
The American Academy of Pediatrics policy notes that 9–10 cases of penile cancer are diagnosed each year per 1 million men, indicating that, although the risk is higher for uncircumcised men, the overall risk is extremely low. Because this disease is rare and occurs later in life, advocating circumcision as a preventive practice is difficult to justify.


Prevention of future foreskin problems

One of the difficulties in assessing the incidence of foreskin problems in the non-circumcised male is that of defining “phimosis.” All newborn males have a physiologic phimosis, with the glans adherent to the inner mucosal surface of the prepuce. Gradual separation of the glans from prepuce takes place spontaneously over many years, often not being complete until puberty. Referrals for circumcision later in childhood because of an asymptomatic non-retractile foreskin, possibly with some ballooning upon voiding, are commonly made in error. Usually, in this setting, anxious parents and referring physicians require education on the care of the normal foreskin and the patient does not require an operation. The Canadian Pediatric Society states that no more than 1% of boys will require post-neonatal circumcision, and Australian reports indicate that normal preputial adhesions are often misdiagnosed as phimosis, leading to unnecessary circumcisions., The rate of true pathological phimosis is less than 1% and this usually responds to a short course of topical steroid ointment.Occasionally, uncircumcised boys experience an episode of balanitis requiring oral antibiotic therapy. The rate of this is estimated at 1%–2% and does not justify prophylactic or therapeutic circumcision.An analogous situation would be to recommend myringotomy and tubes in every child who suffers an episode of otitis media.


Complications of newborn circumcision

Health is not only about disease prevention, but also about well-being and the avoidance of harm. How harmful is routine non-therapeutic circumcision? The overall rate of immediate and long-term complications arising from newborn circumcision is a matter of debate and in truth unknown. The estimated rate of complication worldwide has been reported as lying between the extremes of 0.1% and 35%. Minor complications such as bleeding, infection and prolonged hospitalization are thought to occur in less than 5% of cases. Tragic partial or complete penile amputation, urethral injury and even the rare death have been reported. Meatal stenosis requiring intervention occurs in 5%–10% of males circumcised in the newborn period. This is believed to be secondary to dermatitis of the unprotected glans exposed to wet diapers. Circumcision revision under anesthetic for penile concealment, skin bridges or an unacceptable cosmetic result is probably the most common long-term complication prompting a urological referral: in one survey, fully one-third of pediatric urologists in the United States reported experience as an expert witness in circumcision litigation cases.


Conclusion

Newborn circumcision remains an area of controversy. Social, cultural, aesthetic and religious pressures form the most common reasons for non-therapeutic circumcision. Although penile cancer and UTIs are reduced compared with uncircumcised males, the incidence of such illness is so low that circumcision cannot be justified as prophylaxis. The role of the foreskin in HIV transmission in developed countries is unclear, and safe sexual practice remains the cornerstone of prevention. There remains a lack of knowledge regarding what constitutes the normal foreskin both among parents and among primary care providers. This lack of knowledge results in a burden of costs to our health care system in the form of unnecessary urological referrals, expansion of wait times and circumcisions. Routine circumcision of all infants is not justified from a health or cost-benefit perspective.


Footnotes

This article has been peer reviewed.
Competing interests: None declared.


References

1. Dalton JD. Male circumcision – see the harm to get a balanced picture. JMGH 2007;4:312-7.
2. Schoen EJ. Circumcision as a lifetime vaccination with many benefits. JMHG 2007;4: 306-11.
3. Wiswell TE, Smith FR, Bass JW. Decreased incidence of urinary tract infections in circumcised male infants. Pediatrics 1985;75:901-3. [PubMed]
4. Chessare JB. Circumcision: is the risk of urinary tract infection really the pivotal issue? Clin Pediatr (Phila) 1992;31:100-4. [PubMed]
5. Van Howe RS. A Cost-utility analysis of neonatal circumcision. Med Decis Making 2004;24:584-601.[PubMed]
6. Hill G. The Case Against Circumcision. JMHG 2007;4:318-23.
7. Siegfried N, Muller M, Volmink J, et al. Male circumcision for prevention of heterosexual acquisition of HIV in men. Cochrane Database Syst Rev 2003; CD003362. [PubMed]
8. Denniston GC. Hill G. Male circumcision in HIV prevention. Lancet 2007;369:1598. [PubMed]
9. Bailey RC, Moses S, Parker C, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomized controlled trial. Lancet 2007;369:643-56. [PubMed]
10. Gray RH, Kigoze G, Serwadda D, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet 2007;369:657-66. [PubMed]
11. Auvert B, Taljaard D, Lagarde E, et al. Randomised controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 trial. PLoS Med 2005;2:e298. [PMC free article][PubMed]
12. Van Howe RS. Human papillomavirus and circumcision: A meta-analysis. J Infect 2007;54:490-6.[PubMed]
13. Rambout L, Hopkins L, Hutton B, et al. Prophylactic vaccination against human papillomavirus infection and disease in women: a systematic review of randomized controlled trials. CMAJ2007;177:469-79. [PMC free article] [PubMed]
14. Frisch M, Friis S, Kruger-Kjaer S, et al. Falling incidence of penis cancer in an uncircumcised population (Denmark 1943-90). BMJ 1995;311:1471. [PMC free article] [PubMed]
15. Iverson T, Tretli S, Johansen A, et al. Squamous cell carcinoma of the penis and of the cervix, vulva and vagina in spouses: is there any relationship? An epidemiological study from Norway, 1960-92. Br J Cancer 1997;76:658-60. [PMC free article] [PubMed]
16. Maiche AG. Epidemiological aspects of cancer of the penis in Finland. Eur J Cancer Prev1992;1:153-8. [PubMed]
17. Muir CS, Nectoux J. Epidemiology of cancer of the testis and penis. Natl Cancer Inst Monogr1979;53:157-64. [PubMed]
18. Wingo PA, Tong T, Bolden S. Cancer statistics, 1995. CA Cancer J Clin 1995;45:8-30. [PubMed]
19. Hirji H, Charlton R, Sarmah S. Male circumcision: a review of the evidence. JMHG 2005;2:21-30.
20. Cold CJ, Taylor JR. The prepuce. BJU Int 1999;83(suppl 1):34-44. [PubMed]
21. McGregor TB, Pike JG, Leonard MP. Phimosis-A diagnostic dilemma? Can J Urol 2005;12:2598-602. [PubMed]
22. Canadian Paediatric Society. 2007. A:vailable: www.caringforkids.ca/babies /circumcision.htm (accessed 2007 Sept 20).
23. Spilsbury K, Semmens JB, Wisniewski ZS, et al. Circumcision for phimosis and other medical indications in Western Australian boys. Med J Aust 2003;178:155-8. [PubMed]
24. Shankar KR, Rickwood AM. The incidence of phimosis in boys. BJU Int 1999;84:101-2. [PubMed]
25. Ashfield JE, Nickel KR, Siemens DR, et al. Treatment of phimosis with topical steroids in 194 children. J Urol 2003;169:1106-8. [PubMed]
26. Escala JM, Rickwood AM. Balanitis. Br J Urol 1989;63:196-7. [PubMed]
27. Christakis DA, Harvey E, Zerr DM, et al. A trade-off analysis of routine newborn circumcision.Pediatrics 2000;105:246-9. [PubMed]
28. Van Howe RS. Incidence of meatal stenosis following neonatal circumcision in a primary care setting. Clin Pediatr (Phila) 2006;45:49-54. [PubMed]
29. Gibson DM. Re: cost analysis of neonatal circumcision in a large health maintenance organization. J Urol 2006;175:2316-7. [PubMed]

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