Male Genital Mutilation

[ProfessorDavey]

It would appear banning infant circumcision, apart from medical necessity, is the way to go.

Strange how the advocates fail to tell you about the 9 actual deaths per 100,000, while waxing lyrical about marginal and hypothetical/theoretical health benefits decades down the line.

The HIV stuff is very interesting as most of the evidence comes from studies that have looked at associations between circumcision rates and HIV infection rates in various countries. And association does not mean causation and there are potentially significant additional cultural differences that may play a role.

More careful cohort studies conducted more recently in single areas (most notably Rwanda) where other cultural differences can be minimised have failed to demonstrate similar findings - indeed one study found significantly greater infection rates in the circumcised group.

[Harrowby Hall]

It is the Sahara where water is scarce.

No Floo (and also Robinson who started this particular hare running). It is not. It is the whole of the rest of the African land mass which lies south of the Sahara Desert down to the Cape of Good Hope. It includes savannah and rain forest. It is a huge area - why not check it out in Wikipedia?

[Nearly Sane]

No Floo (and also Robinson who started this particular hare running). It is not. It is the whole of the rest of the African land mass which lies south of the Sahara Desert down to the Cape of Good Hope. It includes savannah and rain forest. It is a huge area - why not check it out in Wikipedia?

I may be wrong but I read Floo's post as saying that water is scarce in the Sahara as opposed to sub Saharan Africa, and effectively agreeing with you.

[Robbie]

Yes she was agreeing.
Sorry about my bad.

[Harrowby Hall]

Oh, I see. Well, that may be the case - if so, Floo I apologise.

However, that interpretation would be out of context with my point which was with the Australian (presumably gynaecologist) who wrote the 2004 paper which Rose referenced. He was delivering "statistics" about Sub-Saharan Africa, arguing that circumcision would reduce the incidence of HIV infection. Hence my comment:

"This simple procedure is a lifesaver." But then, in Sub-Saharan Africa so would enhanced levels of personal hygiene.

Robinson replied, misunderstanding the area concerned, and Floo's comment seemed to agree with her. There is plenty of water in most of the area concerned.

[Bubbles]

Interesting that you did not chose to post the balancing ant-circumcision article quoted in the first paragraph.

Note too this article is from 2004 - things have moved on significantly.

Nothing in this persuades me of any health benefit that outweigh medical risks. And that is the elephant in the room - although people often glibly refer to neonatal circumcision as simple and safe the risks aren't zero.

http://www.academia.edu/6394940/Lost_Boys_An_Estimate_of_U.S._Circumcision-Related_Infant_Deaths

This article should pull people up short. For every 100,000 circumcisions there are about 250 incidences of complications and about 9 deaths - yes that's right 9 baby boys dead due to complications from circumcision. And this study is in the USA so a first world developed country with high quality medical care. Every one of those deaths is entirely preventable.

So you need to be convinced of stunning health benefits to justify those 9 deaths. So let's look at those - there tend to be three areas typically cited. HIV transmission, penile cancer and cervical cancer in women partners. Remember we are talking about circumcision here in the UK not in sub-Saharan Africa where there may be some value.

So let's assume all baby boys born this year (about 350,000) are circumcised - what would be the effect.

1. HIV transmission - the only effect reported in observational studies is on infection of men in heterosexual relationships - there is no effect on homosexual sex or on women becoming infected in heterosexual relationships. And even then most recent studies imply this effect to be largely due to cultural effect other than circumcision.

But let's work with a 50% reduction - annually in the UK across the whole population about 1500-2000 men become infected with HIV due to heterosexual sex. So that might equate to 8 less people contracting HIV - note that HIV is now readily manageable with just 600 people dying of AIDS-related illness last year. Also HIV transmission rates are falling in the heterosexual population and have been for years. Finally about 95% of the new infections were from unprotected sex - wearing a condom almost totally eradicates transmission - so much, much more effective than circumcision.

2. Penile cancer - issue is that penile cancer is ver rare - so the balancing article indicates that 300,000 cicumcisions would be required to reduce penile cancer incidence by just 1 - that's one diagnosis not one death.

3. Cervical cancer due to human papilloma virus infection - sounds compelling (bar the medical ethics issue or elective surgery on a non consenting patient that does not benefit them but does benefit others). Ah but there is a problem - all girls aged 12 and 13 in the UK are now routinely immunised against human papilloma virus. So there is unlikely to be any benefit due to improvement in medical treatment.

So to summarise - were we to circumcise all baby boys in the UK born this year the health effects would be:

300 cases of circumcision rated complications this year
30 deaths of baby boys due to circumcision rated complications this year
Possibly 8 fewer HIV infections in perhaps 20-40 years time (but medical treatment may have moved on so perhaps much less)
Possibly one less case of penile cancer in perhaps 40-70 years time (but medical treatment may have moved on so perhaps much less)
Likely no change in cervical cancer in  perhaps 40-70 years time as immunisation is now routine

And that's without bringing in the loss of penile function and detrimental effect on sexual health.

So no there aren't compelling health arguments - and those that make them need to recognise that if they argue for universal infant circumcision in the UK then they are arguing for about 30 dead baby boys a year that died needlessly.

2004 is more up to date the 1940's, interesting that you didn't pick up on that.

[floo]

No Floo (and also Robinson who started this particular hare running). It is not. It is the whole of the rest of the African land mass which lies south of the Sahara Desert down to the Cape of Good Hope. It includes savannah and rain forest. It is a huge area - why not check it out in Wikipedia?

I was agreeing with you HH!

[Harrowby Hall]

2004 is more up to date the 1940's, interesting that you didn't pick up on that.

Absolutely true.

But then 2010 is more up to date than 2004.

Why are you so aggressively in favour of male genital mutilation, Rose? My observation (and I suppose experience) of prepuce removal is that it was an almost totally female activity. Women conspired with women - mothers and midwives. Does your stance come from being a woman?

I would be interested in seeing a comparison in the number of such mutilations between home births and hospital births in, say, the late 1940s. After all, in hospitals there were doctors around who may have been unhappy about midwives practising surgery.

[Bubbles]

The idea of others forcing their viewpoints on other people disturbs me, mainly because it doesn't seem to have any reasoning behind it, other than a desire to force something on everyone.

Now that can be a ban on male circumcision or its opposite, of circumcision being forced on babies even when the parents are totally against it.

There seems to be a lot of cases around  where parents have requested it not be done,  and the medical profession has done it anyway.

Of people being harassed and told up scare stories so they conform.

Although you all think I am in favour of it, in many ways you are wrong, what I am in favour of is being allowed a different POV and being listened too.

Not " everyone male has to be circumcised no matter what"

Because a lot of you see things in black and white, there is no middle ground for you.

But there is for me.

I'm not into forcing anyone to do anything, my opinion is my own, but that's all it is. 

I'm a believer in the choice being left to parents, even in some cases vaccinations, it all comes down to risk.

http://www.telegraph.co.uk/news/uknews/3336455/Secret-report-reveals-18-child-deaths-following-vaccinations.html

There is more chance of your baby coming to harm in a car crash, doesn't stop us driving though, when babies are small.

For some people the tiny risk involved in male circumcision is worth it.

I never had my boys circumcised because as I said, I'm not so much for it as  I am more opposed to things being forced on people. It could be forcing values on someone else like vegetarianism, veganism, or even eating meat.
I'm as opposed to male circumcision becoming standard practice as I am forcing everyone to live by non religious standards.

Those who think it is important should be free to make up their own minds and live by their values and those that don't like it, should be free to live by theirs.

We all risk babies and children by driving a car, but because we want to get around we consider it an acceptable risk ( until it happens).

So we all participate in decisions that have a small risk, every day.

How many people drive quickly around 30 mph places where children play?

How many of us, " take risks" because we don't believe it will happen to us?

Lots of people do.

How many drive over the speed limits? Take chances? A baby could be in the car that gets hit as a result.

There are lots of things people do now that could reduce the mortality rate in children, but they don't do it.

Much easier to target others, point the finger and say..... look what that group is doing to endanger children, what a bunch of superstition barbaric religious people.

As they jump in their car and drive like a bat out of hell, dealing with other road users with impatience, taking risks, or using their mobile phone while hammering around a residential area.

I think we need to keep male circumcision in the very small numbers it would be performed (in those that want their sons circumcised) and concentrate on our own lives where driving our cars slowly could make a huge difference to child mortality rates.

[floo]

Should we allow parents to have their young children tattooed because they wish it? 

[Harrowby Hall]

Floo has beat me to it.

The nub of your argument appears to hinge around a view that the parents of a baby boy will always act in his best interest and they should not be prevented from doing so. Therefore, if they think that mutilating his penis is in his best interest they should be permitted to do so.

If follows, therefore, using precisely the same logic, the parents of a little girl should have the freedom to have her external genitals mutilated if they think it is in her best interests.

Had your parents, believing it to be in your best interests, at the age of two days had the words "mild" and "bitter" tattooed on your chest just below your nipples, they should have been free to do so.

Your comparison of genital mutilation with vaccination is a poor one. There is a clear clinical argument for vaccination. Even if the child will never be exposed to whatever disease is involved, the population in general acquires "herd immunity". It is done for the greater good of the community.

For your information - I would not have wanted to suffer any kind of mutilation at birth. It was not a parental decision anyway - my father was away at WW II. It was my mother simply following the fashion. There was no clinical imperative, it was just what her friends had done, in collusion with a willing midwife. It didn't even qualify as "informed consent". I have carried the sign of that decision and have suffered the physiological consequences of penile mutilation for the whole of my life. With your approval.

[ProfessorDavey]

2004 is more up to date the 1940's, interesting that you didn't pick up on that.

What are you on about? Where did I post anything from 1940.

My study on death rates following infant circumcision was from 2010.

And when I said 2004 was some while ago I was talking about research on HIV transmission and circumcision which has moved on significantly since then, with the evidence based much less clear cut than it was. Increasingly the very clear differences in the early observational studies are being demonstrated causally to be more associated with compounding cultural/societal differences (most obviously between muslim and christian cultural groups) and less to do with circumcision per se.

[ProfessorDavey]

The idea of others forcing their viewpoints on other people disturbs me,

But that is exactly what you are arguing for, not us - you do see that don't you. You do understand that a parent and a child are not the same person.

Unlike most of us here you are arguing that one person (in this case a parent) should be able to force their view on another person (their child).

[Rhiannon]

HH, I've been following your story with interest and sadness. My feeling - and I may be wrong - is that it was down to the power of the midwives. I have seen mums even today convinced of all kinds of shit by midwives, especially first time around when you are scared and unsure - they are almost godlike. I'm not exaggerating when I say that the woman who 'looked after' me made me feel like the most shit mother because I couldn't live up to her standards (i.e. deliver naturally and breastfeed). I guess women who fought against getting their boys 'done' back in the day had the same kind of pressures.

It doesn't excuse any of it. I don't get it and I'm glad it doesn't happen now. I'm sorry, HH.

[Nearly Sane]

2004 is more up to date the 1940's, interesting that you didn't pick up on that.

What relevance has this to Prof D's post?

[Gordon]

The idea of others forcing their viewpoints on other people disturbs me, mainly because it doesn't seem to have any reasoning behind it, other than a desire to force something on everyone.

Now that can be a ban on male circumcision or its opposite, of circumcision being forced on babies even when the parents are totally against it.

There seems to be a lot of cases around  where parents have requested it not be done,  and the medical profession has done it anyway.

Of people being harassed and told up scare stories so they conform.

Although you all think I am in favour of it, in many ways you are wrong, what I am in favour of is being allowed a different POV and being listened too.

Not " everyone male has to be circumcised no matter what"

Because a lot of you see things in black and white, there is no middle ground for you.

But there is for me.

I'm not into forcing anyone to do anything, my opinion is my own, but that's all it is. 

I'm a believer in the choice being left to parents, even in some cases vaccinations, it all comes down to risk.

http://www.telegraph.co.uk/news/uknews/3336455/Secret-report-reveals-18-child-deaths-following-vaccinations.html

There is more chance of your baby coming to harm in a car crash, doesn't stop us driving though, when babies are small.

For some people the tiny risk involved in male circumcision is worth it.

I never had my boys circumcised because as I said, I'm not so much for it as  I am more opposed to things being forced on people. It could be forcing values on someone else like vegetarianism, veganism, or even eating meat.
I'm as opposed to male circumcision becoming standard practice as I am forcing everyone to live by non religious standards.

Those who think it is important should be free to make up their own minds and live by their values and those that don't like it, should be free to live by theirs.

We all risk babies and children by driving a car, but because we want to get around we consider it an acceptable risk ( until it happens).

So we all participate in decisions that have a small risk, every day.

How many people drive quickly around 30 mph places where children play?

How many of us, " take risks" because we don't believe it will happen to us?

Lots of people do.

How many drive over the speed limits? Take chances? A baby could be in the car that gets hit as a result.

There are lots of things people do now that could reduce the mortality rate in children, but they don't do it.

Much easier to target others, point the finger and say..... look what that group is doing to endanger children, what a bunch of superstition barbaric religious people.

As they jump in their car and drive like a bat out of hell, dealing with other road users with impatience, taking risks, or using their mobile phone while hammering around a residential area.

I think we need to keep male circumcision in the very small numbers it would be performed (in those that want their sons circumcised) and concentrate on our own lives where driving our cars slowly could make a huge difference to child mortality rates.

This is no more than rambling fallacious nonsense.

[ProfessorDavey]

http://www.telegraph.co.uk/news/uknews/3336455/Secret-report-reveals-18-child-deaths-following-vaccinations.html

Have you read that article and worked it through (even if is actually true).

So let's do the maths.

This article suggests 18 deaths over 4 years. Just about every child is vaccinated, so this is about 600,000 a year or 2.6 million over 4 years. So that's one death per 144,000 vaccinations approx.

Compare that with death rate for infant circumcision reported in the article I linked to, which was one death in every 11,000 circumcisions approx. which is 13 times greater risk of death.

But you also have to weigh against the benefits. The Telegraph article indicates that vaccinations save 66 lives due to prevention of death due to measles and meningitis C - that's 264 lives saved over a four year period compared to potentially 18 deaths due to adverse reactions. While you never want any deaths due to adverse reactions (and I'm sure there is continuous improvement to improve safety) that remains  a significant net positive in terms of lives saved.

Compare that with the 13 times higher risk of death from circumcision with effectively zero gain (see my earlier post in terms of health benefit in a country such as the UK.

[ProfessorDavey]

How many people drive quickly around 30 mph places where children play?

How many drive over the speed limits?

But the whole point is that these people are breaking the law, and they should be legally held to account for their unlawful and risky behaviour.

The equivalent situation would be if circumcision (also harmful and risk and performed with the consent of the person being circumcised) were illegal but some people chose to ignore the law and continued to engage in behaviour that put their child at risk.

[Robbie]

An informative article, without looking at every link posted on this thread I don't think this one has been posted before:-

http://www.cirp.org/library/death/

This is a really horrific exposition of a practice considered to be 'as old as Africa':-

https://www.theguardian.com/commentisfree/2014/aug/25/male-circumcision-ceremonies-death-deformity-africa

[Rhiannon]

But the whole point is that these people are breaking the law, and they should be legally held to account for their unlawful and risky behaviour.

The equivalent situation would be if circumcision (also harmful and risk and performed with the consent of the person being circumcised) were illegal but some people chose to ignore the law and continued to engage in behaviour that put their child at risk.

It's a ludicrous comparison anyway. You can't say 'x people do risky things so it's ok for y people to do risky things too'.

[ProfessorDavey]

It's a ludicrous comparison anyway. You can't say 'x people do risky things so it's ok for y people to do risky things too'.

Quite.

But Rose's argument goes further - in effect it is 'people x engage in risk behaviour and are breaking the law so lets allow the risky behaviour of people y to be legal'.

And the death rates for circumcision and road traffic accidents don't come close.

As pointed out previously the datas suggest one death per 11,000 child circumcised.

The most recent data (2015) that I can find indicates 50 deaths in road traffic accidents for children under 15. That's about 12 million children - so a fatality rate of one death per 245,000 children approx. So circumcision is about 22 times riskier in terms of likelihood of death than road traffic accidents.

[Bubbles]

This link is interesting, it's written by someone Jewish and goes into the history and why an attack on male circumcision is seen as an attack on Judaism.

I think that deals with it quite compassionately and I think changes in attitude to circumcision needs to come within the Jewish community itself.


http://www.cirp.org/library/cultural/goodman1999/

I don't feel people stomping around,  claiming Judaism is barbaric and backwards,  is at all helpful.

[Bubbles]

This is no more than rambling fallacious nonsense.

Sigh!

 

[Bubbles]

Absolutely true.

But then 2010 is more up to date than 2004.

Why are you so aggressively in favour of male genital mutilation, Rose? My observation (and I suppose experience) of prepuce removal is that it was an almost totally female activity. Women conspired with women - mothers and midwives. Does your stance come from being a woman?

I would be interested in seeing a comparison in the number of such mutilations between home births and hospital births in, say, the late 1940s. After all, in hospitals there were doctors around who may have been unhappy about midwives practising surgery.

I'm not aggressively in favour of circumcisions.

I'm wary of the motivations of some people.

[ProfessorDavey]

I'm not aggressively in favour of circumcisions.

You could have fooled us.

I'm wary of the motivations of some people.

And what is that, pray tell.

My motivation is entirely driven by a respect for autonomy - in other words that the decision to lop off the end of a penis should be the decision of the owner of that penis and them alone. That's what consent is all about.