Benefits of male circumcision reconfirmed as rates

[ringstrue]

Aug 21, 2012 6:58:51 GMT -5 @bunnybean said:

I was just thinking about this last night, and it occurred to me that I'm confused about a few things. Circumcision isn't like an appendectomy, where all of the appendix is removed and there is no ambiguity. Circumcision varies from man to man. Some men are very tightly circumcised so that when you're trying to work the shaft, you need lube or something because there is no skin left to move it. Some men still have the frenulum and some skin. Is there a magic amount to remove to reduce HIV rates? All of it? Some of it? Would a loosely circumcised man and a tightly circumcised man contract HIV at the same rate?

I don't think that would make a difference. I think it has to do with not having enough skin to have a fold where disease can hangout more easily, if acquired.

[pixy0stix]

Aug 21, 2012 7:34:32 GMT -5 aw said:

These poor boys could have decreased sexual sensation one day because we didn't leave them intact.

Except there's some research (again from Uganda), that men get *more* pleasure when they're circumcised.

Also, I'm a bit lol that this is called "new and untried" research. This type of thing has been going back and forth for decades now. It's like the great egg debate (it's good, no it's bad, no it's good!).

Also, I'm not opposed to Ugandan medical research being used. They seem to be the first large scale group that is taking a large data pool and processing it.

[Deleted]

If I ever have a child, I am going to cut off its fingers. This way I protect from the possibility of it ever getting a splinter which goes septic and kills them. Sure, I could make them wear gloves, but this way is safer. Anyway, shut up, its a parents decision.

[summer]

Tons of people here don't circ and AIDS and UTIs don't seem to be running rampant or breaking the system. I still don't know why we'd give more weight to Uganda.

I don't doubt their research and I'm glad they've shared it with us but I don't see the sky falling where people don't do it.

[karinothing]

Also, another thing I don't get. Haven't these studies shown that circumcision doesn't have an impact on the rate of HIV transmisson in male on male sex? Since sadly, this still encompasses the majority of infections in the US would an increase in circumcision in the US really have that much of an impact on US HIV infection rates?

[heyjude]

Aren't we close to developing a HIV vaccine or cure? And what if we? What then for the pro circ recommendations?

[karinothing]

Aug 21, 2012 8:48:14 GMT -5 heyjude said:

Aren't we close to developing a HIV vaccine or cure? And what if we? What then for the pro circ recommendations?

This is a good point. I know a lot of those studies mention HPV rates too, but we have a vaccine for that. I would hope a vaccine prevents more infections than circing does.

[pixy0stix]

Aug 21, 2012 8:48:14 GMT -5 heyjude said:

Aren't we close to developing a HIV vaccine or cure? And what if we? What then for the pro circ recommendations?

There's an HIV vaccine in the trial period right now. There is no cure, nor are they close to a cure. Just a large cocktail of drugs that keeps you alive.

[pixy0stix]

Aug 21, 2012 9:16:47 GMT -5 asdfjkl said:

Aug 21, 2012 7:48:10 GMT -5 pixy0stix said:

Except there's some research (again from Uganda), that men get *more* pleasure when they're circumcised.

Also, I'm a bit lol that this is called "new and untried" research. This type of thing has been going back and forth for decades now. It's like the great egg debate (it's good, no it's bad, no it's good!).

Also, I'm not opposed to Ugandan medical research being used. They seem to be the first large scale group that is taking a large data pool and processing it.

I think the pleasure issue is kind of like arguing about what air tastes like. Or more, I think of the old, "Duuuuudde, Is my green actually YOUR purple? MIND. IS. BLOWN." I mean, you only know what *you* know.

I agree with this to a point. However, the study asked adult males what their pleasure level was before and after adult circumcision.

This study says there is no loss of sensation: www.ncbi.nlm.nih.gov/pubmed/18086100

And the original article I read stating that +80% have greater pleasure levels:
www.google.com/hostednews/afp/article/ALeqM5jRB3dphp7c5vBO7FY7hb9fn_-sLg?docId=CNG.d81a9121385076139720a70c94b6e3f2.d1

ETA: The reason I bring it up is because the non-circ group is so adamant that it harms a male's sexual experience, when the research coming out says that's not true. So yes, bunny, it *is* up for debate.

[ringstrue]

Aug 21, 2012 8:12:16 GMT -5 @bunnybean said:

Aug 21, 2012 7:46:31 GMT -5 ringstrue said:

I don't think that would make a difference. I think it has to do with not having enough skin to have a fold where disease can hangout more easily, if acquired.

But circumcisions could be done to have still enough skin to fold.

No not that was capable of being folded - but enough that there was a substantial fold of skin that stayed in place. I mean, I think that's the goal from a *sanitation* perspective. No crevices.

[karinothing]

Aug 21, 2012 9:11:06 GMT -5 pixy0stix said:

Aug 21, 2012 8:48:14 GMT -5 heyjude said:

Aren't we close to developing a HIV vaccine or cure? And what if we? What then for the pro circ recommendations?

There's an HIV vaccine in the trial period right now. There is no cure, nor are they close to a cure. Just a large cocktail of drugs that keeps you alive.

To be fair, I think they have sort of found a cure, although not an easy one or one that they can give to everyone. I still find it fascinating though.

www.foxnews.com/health/2010/12/14/doctors-claim-hiv-positive-man-cured-stem-cell-transplant/

[pixy0stix]

Aug 21, 2012 9:46:47 GMT -5 asdfjkl said:

It's nearly impossible to create the kind of randomized study you would need to evaluate it.

Whoah, I almost modified your post instead of quoting it.

I think the studies need to continued past what is already recorded.

However, I'm perfectly willing to drop the sexual pleasure aspect from either side of the debate, because as you've said, it's completely subjective.

[pixy0stix]

Aug 21, 2012 9:46:47 GMT -5 asdfjkl said:

Not to mention that any man who is undergoing an adult circumcision was probably having some problems with his penis that is resolved by the circumcision so how much of his pleasure sensation is the result of no longer being in pain?

I missed this the first time around. I think most of the males who had it done (in Uganda at least) did it as part of the HIV transmission study, with no underlying causes. You're reading more into the study than what is there.

[pixy0stix]

Aug 21, 2012 9:59:45 GMT -5 asdfjkl said:

Aug 21, 2012 9:56:05 GMT -5 pixy0stix said:

I missed this the first time around. I think most of the males who had it done (in Uganda at least) did it as part of the HIV transmission study, with no underlying causes. You're reading more into the study than what is there.

I thought the studies released in Rome pertaining to sexual pleasure were NOT Ugandan studies. Did I read that wrong?

Oh, no, I read it wrong. I have read yet another study regarding self reported Ugandan males and sexual pleasure, which I didn't link. I'm smooshing them all together in my brain.

[epphd]

Aug 21, 2012 8:19:17 GMT -5 asdfjkl said:

Aug 20, 2012 23:10:18 GMT -5 epphd said:

Uganda also has one of the most research universities in Africa, complete with an incredible repository of patient data. Some of the most important discoveries in cancer research came out of Uganda; Makere University is very well regarded. It's not to say that Uganda is no different than the US, but by no means is it some sort of backwater. Like I tell people who want to know why we are investing in cancer research there, you go where the disease burden is highest.

Also, I've never been to Uganda (maybe moxie has and could comment), but wiki makes it sound pretty backwater if you travel much outside the primary cities. You get into rural Uganda and it makes rural US look like Manhattan.

I haven't been either but I know well enough from working with a research program and scientists who work there that FOR RESEARCH PURPOSES it is a phenomenal location. Parts of FLA are pretty freaking backwater too by this definition, but no one would say that research coming out of Scripps or Moffitt Cancer Center should be doubted.

Bunny, thanks for the call out - I can't say that my professional or personal opinion are all that respected in this debate, but I stand by the decision we made and do not begrudge the decisions of others, even when the debate devolves into deliberate hyperbole.


EDIT: also, it's worth noting that the totality of studies on the protective benefits of circumcision extend to not just HIV, but also herpes, HSV (which is still a huge problem and for which the vaccine does not protect against every strain - and which now is thought to underlie not JUST cervical cancer but also several head and neck cancers), and possibly other transmitted diseases.

Does circumcision entirely protect against all STDs? No.
Does circ entirely protect against cancers or UTIs? No.
Is circ an entirely cosmetic procedure performed by parents with no regards to their child's well being? NO.

My personal and professional belief is that as time goes on, we will see more protective benefits of circumcision. Will that supplant the need for safe sex practices and common sense? Again, NO. BUT... I do believe that weighing the pros and cons that the decision we made for Sam was the right one. Like choosing to breast feed or choosing to feed him foods with HFCS or choosing to send him to day care or not baptizing him - it is possible that one day he will be terribly traumatized and resent the hell out of us for making the decision we did. It's a risk I accept.

[heyjude]

I get that there is interesting research coming out of Uganda that suggests a link between circ and lowered spread of HIV. But why aren't these studies coupled with data from Europe or Latin America? Why aren't other regional experiences added to the mix? Wouldn't that create a more complete picture?

[mexicali]

Aug 21, 2012 8:12:16 GMT -5 @bunnybean said:

Aug 21, 2012 7:46:31 GMT -5 ringstrue said:

I don't think that would make a difference. I think it has to do with not having enough skin to have a fold where disease can hangout more easily, if acquired.

But circumcisions could be done to have still enough skin to fold.

This is very true. Z was circumcised at birth. He had tons of extra skin and we were worried. We are still unsure of how much was taken off, if he had more than expected or if it was ever really done. We were told he would grow into. At his 2 year appointment we decided to see a urologist. The extra skin was over his penis/pee hole. If he was erect it would not go back all the way.

When we went to the appt the dr. suggested that he had extra skin and we could have it removed. We were uncertain at the time since he would have to go under anesthesia. That is when the dr also discovered Z had penile torsion. It's when the penis is crooked or comes in at an angle. There were a lot of ifs about what could happen if we didn't fix both issues. Erection issues, urinary issues/infections and sensations. In the end we decided to have the surgery. He had it last Tuesday.

Wow, I just went off there. My point is even after a circ there can still be issues with extra skin. We made the circ decision after months of research and felt there wasn't a bigger impact on one side or another. It ended up being a personal decision. We are still happy with the decision and we are even happier with the follow up surgery. Z is still smart as all hell after the anesthetics. . We are comfortable with the decision we made and hope that he is also when he is older.

[aw]

Aug 21, 2012 8:15:55 GMT -5 @bunnybean said:

Aug 21, 2012 7:34:32 GMT -5 aw said:

But dyl, it's GENITAL MUTILATION. These poor boys could have decreased sexual sensation one day because we didn't leave them intact. We MUST PROTECT THE PENII!!! It's totally different from vaccination. And we all know teenagers are responsible enough to just wear a condom instead.

(I'm kidding. I totally mutilate my boys' genitals.)

This skeeves me out, and I am never skeeved out by your opinions.

First of all, it IS totally different from vaccination. I don't get HIV from standing next to an uncircumcised penis with HIV. I DO get pertussis from standing next to a person with pertussis.

And they do have decreased sexual sensation. Thousands of nerve endings are removed. That's not really up for debate.

Why are you so flippant about this? And why wouldn't we expect our teenagers to use condoms? Don't you expect your children to live the values you teach them for the most part?

The reason circ is similar to vaccines to me is because I view it as a preventative measure against life-threatening diseases. I vaccinate because it decreases my child's chance of contracting diseases. I circ my boys because studies show it can decrease their chances of contracting certain diseases and infections. People give their children a vaccine to prevent HPV, so what's the difference here.

I guess I'm being defensive because too many people in threads like these have accused moms like me of mutilating our children's genitals. I threw those terms out flippantly because I think it's stupid to call it that.

As for the decreased sexual sensation. Meh. DH had the final call on the circ and he isn't complaining in that department.

I do hope that my children live out the values I teach them, but as so many people here have pointed out, they may not. People here often ask me how I would feel if my kids don't live my lifestyle one day. Should I just respond by putting my fingers in my ears and saying "lalalala can't hear you" or should I anticipate that teenagers rebel and often don't use their brains. Yes, I hope my kids use condoms. In fact, I have higher aspirations. I hope they save themselves for marriage. But just in case they don't (and stats prove that most teens aren't going to use the condoms), I guess this is something I can do to prevent some of the potential consequences of their stupidity.

If that skeeves you out, I'm sorry. I'm not going to go back and forth about this with you, though, because I think we both know it gets us nowhere.

[heyjude]

Who in this thread has called it mutilation?

[pixy0stix]

Aug 21, 2012 11:57:45 GMT -5 heyjude said:

Who in this thread has called it mutilation?

If there was early, but not wide spread, research suggesting a potential medical benefit to clipping off a piece of the clitoris, would you have it done to yourself? Would you have it done to your daughter?

A somewhat veiled reference to female genital mutilation.

[epphd]

Aug 21, 2012 11:59:06 GMT -5 @mx said:

FFS I can take a lot of stupid assumptions and half baked opinions about Uganda. But to make the claim that Ugandans don't be access to condoms is downright uninformed and simply untrue. I have better access to codoms when I am in Uganda than I do in DC. There is a lot of data about knowledge of HIv transmission and prevention in Uganda. Generally speaking, Ugandans perform better than Americans (and things people have posted about HIV on this board in the past anecdotally support that) when given tests of knowledge on key HIV issues.

I don't see why a rigorously designed "gold standard" randomized clinical trial conducted there would be anything but generalizable. The human body is the human body. Even in KONYland. Unless you also believe that a cancer treatment regimen found successful in US clinical trials would not be applicable in Uganda.

:Y:

Look, the only scientifically based arguments with these findings that I can accept are (1) they pertain to adult circumcision and not RIC. I (personally) think it's reasonable to draw conclusions from one to the other, but can accept that it is possible that there are differences in the development of microflora over adolescence that would influence disease transmission (2) the dominant mode of transmission of HIV is different (not 180 degrees different, but statistically speaking HIV is more likely transmitted in the MSM population here in most places (not all)). However, I venture that the dominant mode of transmission of every other disease is the same.

[heyjude]

Aug 21, 2012 12:05:04 GMT -5 pixy0stix said:

Aug 21, 2012 11:57:45 GMT -5 heyjude said:

Who in this thread has called it mutilation?

If there was early, but not wide spread, research suggesting a potential medical benefit to clipping off a piece of the clitoris, would you have it done to yourself? Would you have it done to your daughter?

A somewhat veiled reference to female genital mutilation.

Not at all actually. The question had nothing to do with FGM. There is no medical benefit to FGM. I tried to keep the hypo as neutral as possible and mirror it to the male circ situation to see what the response would be. In no way was I trying or intending to bring FGM into this.

[heyjude]

Oh I'm fine with the Ugandan studies. They are interesting. But you can't look at Uganda in isolation. You can't ignore, as if it's not happening, the fact that HIV rates are not going up in places where circ is not common.

Maybe the risks of circ do not outweigh the benefits but I don't think the African studies prove that conclusively.