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So, do foreskins turn you off?

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Lysis said:
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------line of super srs
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Never even entered mine or my ex's mind to get our son circumcised. SRS talk :|

herbavore said:
I wish there weren't such prejudice against guys that aren't circumsized. I would never have dreamed of having my sons circumsized. I know that in the U.S. in general it is still uncommon but in my area (west coast) it is actually very common. I think some heartless girl must have made a negative comment when Caleb was young because he briefly wanted to check into getting circumsized. Fortunately, he got over that.

For myself, the guy attached to the penis is the main thing, but if I had to state a preference it would be in favor of foreskin. It's there for a reason.:)
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<3 for herbavore

One Thousand Words said:
Wrong. My son was circumcised with a ligature and anaesthetised with a emla patch hours before. I took the day off and he sat on my lap happy as pie and watched the cricket with me all day. A couple of days latter it fell off. No fuss, no blood and no pain. My son is a wuss, be is quick to cry and come for a cuddle when he is upset and I can assure you he was not affected by the procedure in the slightest.

By the way labiaplasty is not illegal. It is a common plastic surgery for women.
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OK busty keep telling yourself that, let your son's knob rub against his pants all day long so every hour the sensitivity in it decreases, sounds like fun in the long run. It's so hard to clean to 8) considering they all look uncircumcised when a dick is hard anyway, fuck circumcision, unless you have a ridiculous amount of excess skin or if you're this dude http://efukt.com/20872_Smegma_Makes_Her_Gag.html
 
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I like lasting longer than 5 seconds. If my penis were anymore sensitive I am not sure I would enjoy sex very much as it is. It is particularly notable after I've ejaculated when it is almost painful to pullout. Would it make a difference to me if I were uncircumcised? I'm not sure, though much like any other sensation, I assume neural adaption will work itself out. Should circumcision be considered legal in the U.S.? I honestly don't care. Penises aren't that important to me I guess.
 
Apostacious said:
I like lasting longer than 5 seconds. If my penis were anymore sensitive I am not sure I would enjoy sex very much as it is. It is particularly notable after I've ejaculated when it is almost painful to pullout. Would it make a difference to me if I were uncircumcised? I'm not sure, though much like any other sensation, I assume neural adaption will work itself out. Should circumcision be considered legal in the U.S.? I honestly don't care. Penises aren't that important to me I guess.
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I'm amazed that some basic issues are still overlooked.

1) There is no thing as a standardized "circumcision". The foreskin is integral to the penis (even fused in childhood) and there's no dotted line along which to cut. It's not like tonsils or the appendix which are identifiable structures. Circumcision is just less penile skin; unfortunately, it's a pretty evolved, vascular and innervated part of the penis that's surgically removed.

No two American guys have the same circumcision, so it's ridiculout to talk about it as if it's 2 camps: intact and circumcised. It's more like intact and a few million ways to have less penis. Some guys have "loose cuts" and some are cut so tight you want to cry for them. Some have straight cuts, and some have dark, jagged scars. Several have skin tags and skin bridges from the operation. Most circumcised men have meatal stenosis. The great news is that the penis is so fundamental to how we function that it bounces back from even the most savage mutilation. Isn't that comforting to know?

2) Debates about sensitivity are bullshit, and fortunately there wasn't much of that here. Yes, the foreskin is sensitive and provides a vast amount of sensory feedback, when healthy and understood, but sensation shouldn't be confused with sensitivity. It is entirely possible for a circumcised guy to be more sensitive, because he lacks the mediating feedback from the foreskin. It's like the intact penis provides a balance of sweet and sour, high notes and low notes, while a penis lacking foreskin can be too "sweet" or too "sour". So I tend to believe guys who say they couldn't stand any more sensitivity; they'd probably have a more fulfilling and balanced sexual experience if they weren't cut.

Also the reason why a lot of men in the United States are impotent or have problems with ED is because they are circumcised.

A guy who connects well to his intact penis would never want to be circumcised; one who never had a foreskin beyond Day 2 or who never learned to read the biofeedback from his prepuce is more inclined to be undaunted about circumcision. As it is, intact men overwhelmingly vote to stay that way... only about 6 per 100,000 Finnish men (a very intact society) opt to get cut.
 
Here's the basic scoop from a buddy of mine, a university professor of neuranatomy:

Circumcision cuts into and cuts off metres of important veins (blood return) and occasionally an artery (in the frenulum; blood supply). This alters the normal vascularity and ultimately the physiology of the penis, forcing a complex healing by putting capillaries into different duty. This affects the amount of blood that reaches the meatus -- likely an important component of meatal stenosis and the chief reason almost all intact men have functional meatal lips and most circumcised men don't. The meatal lips are the culmination of the raphe and are direct beneficiaries of the frenular artery. The lips, of course, are what close tightly together to keep pathogens out of the urethra. Another marvel of nature.

Also, the veins running through the foreskin ensure that in its relaxed, forward position the prepuce is not just a blanket, but a heated blanket. This in turn regulates the temperature of the glans, which in turn helps determine how close to the body the testicles ride (cool=closer to body=less sperm produced). Most circumised males have a consistently colder glans than intact males; some have an uncomfortably cold glans, particularly after sitting for long periods or after sports.

The efficiency of bloodflow through the foreskin & glans is a factor in proper tumescence and detumescence, though the body works mightily to overcome the vascular obstacles posed by the severing of a significant chunk of the venous system of the penis through circumcision. The alternate "mapping" the body is forced to do after iatrogenic injury is a marvel of nature, but never quite as effective as the original.

One of the foreskin's primary functions is to serve as an "early alert" system to tumescence; it is ultra-sensitive to any change in diameter of the glans and lets a male know well in advance of any change. Obviously, without a foreskin there is no monitoring of the glans and some circumcised males joke that they are well on their way to erection before they realize it. Not a big problem in most settings, but also not the way the body was designed to work.

The skin of the penis is unique on all the body, in that it is not attached to the underlying fascia. You can actually roll the tip of the foreskin all the way down to the pubic bone (depending on the elasticity of the frenulum). The body achieves this through a complexly-evolved nerve system that does not have the nerve endings run down from layer to layer as on the rest of the body; but rather, laterally in a specialized structure that allows complete freedom of the gliding top layer of skin. This means that the nerve endings are in fact attached to the body only at their extreme ends -- the pubis, and where the foreskin doubles back again and "ends" at the sulcus behind the glans. Since the rested foreskin is doubled-over, any cut that "shortens" it in this doubled state actually removes a cylindrical section from this sleeve, short-circuiting the complex nerve structure. Again, the body springs into action to repair this injury by having nerve endings attach over time to whatever nerves are nearby; but the section of the brain that corresponds to the nerve endings severed through circumcision go "black" and remain that way.

Circumcision, as a wound, also lays down a complex and irrreversible system of fibroblasts at the site of the circumcision scar, between layers of skin and the underlying fascia. Invisible to the naked eye, this dense web of cells defeats the purpose of the unique outer skin structure of the penis by creating an "anchor" which limits the mobility of the shaft skin and its gliding mechanism so important to sex. It is also why so many men at some point encounter difficulty with foreskin restoration, as these fibroblasts first need to break down before progress in stretching can be made.

My take on it is that some people don't care about any of this. They just like circumcision because they think cut cocks are "prettier". 8)
 
How the circumcision solution in Africa will increase HIV infections

Robert S. Van Howe, Michelle R. Storms

Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, Marquette, MI, USA

Correspondence: Dr. Robert S. Van Howe, Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, 413 E. Ohio Street, Marquette, MI 49855, USA.
Tel. +1.906.2287454 - Fax: +1.906.4852726. E-mail: [email protected], [email protected]

Key words: circumcision, HIV infection, risk compensation.

Conflict of interest: the authors report no conflicts of interest.

Received for publication: 25 October 2010.
Accepted for publication: 9 December 2010.

This work is licensed under a Creative Commons Attribution 3.0 License (by-nc 3.0).

©Copyright R.S. Van Howe and M.R. Storms, 2011
Licensee PAGEPress, Italy
Journal of Public Health in Africa 2011; 2:e4
doi:10.4081/jphia.2011.e4

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Abstract

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.


Introduction

At the XVIII International AIDS conference held in Vienna, there was a strong push to gather funding to circumcise 38 million men in sub-Saharan Africa within the next five years. The belief is that male circumcision provides the best hope of decreasing the spread of HIV infection there. We believe these efforts are misguided.
Although the World Health Organization (WHO) and UNAIDS have supported circumcision as an HIV preventive in regions with high rates of heterosexually transmitted HIV, the circumcision solution has several fundamental flaws that have been glossed over by its proponents within these organizations. These proponents, who have been touting the “benefits” of circumcision for decades, have developed plans to circumcise Africa on behalf of WHO and UNAIDS.1 If their goal is to prevent the spread of HIV in Africa, circumcision will only serve to divert resources away from effective measures.
In this paper, we will expose the lack of scientific evidence, biological plausibility, and epidemiological evidence that provides the foundation for the circumcision solution. We will demonstrate how circumcision will likely increase the number of heterosexually transmitted HIV infections. Finally, we will discuss how poorly circumcision compares with other interventions.
Lack of scientific evidence

The results of three randomized clinical trials (RCTs) are often presented as proof beyond a reasonable doubt that male circumcision prevents HIV infection.2 After all, RCTs are the gold standard of medical experimentation. However, such accolades only apply to well-designed, well-executed trials. The three RCTs were neither.
The trials were nearly identical in their methodology and in the number of men in each arm of the trial who became infected. The trials shared the same biases, which led to nearly identical results. 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.3 All three studies were overpowered such that the biases alone could have provided a statistically significant difference.
The common hypothesis for these trials was that male circumcision would decrease the rate of heterosexually transmitted HIV infections. 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 South African trial, men who reported at least one episode of unprotected sex accounted for 2498 person-years and 46 HIV infections during the trial. Among the remaining men, who accounted for 2076 person-years, 23 become infected although they either had no sexual contact or always used a condom. These men, who had infection rate of 1.11/100 person-years (95%CI=0.74-1.67), presumably became infected through non-sexual means. The men at sexual risk of infection had an infection rate of 1.84/100 person-years (95%CI=1.38-2.46). It would be expected that all men in the trial shared the same baseline risk of non-sexual transmission and any additional risk could be attributed to sexual transmission. The infections attributed to sexual contact would be the difference between the total rate and the non-sexually transmitted rate (0.73/100 person-years). Consequently, only 18 (0.0073 infections per person-year * 2498 person-years) of the 69 infections in the South African trial can be attributed to sexual transmission.4
Similarly, in the Ugandan trial, men who consistently used condoms had the same rate of infection as those who never used condoms (Consistent condom use: 1.03/100 person-years; No condom use 0.91/100 person-years; RR=1.13, 95%CI=0.54-2.38, P=0.74). Men who reported no sexual partners for the duration of the trial accounted for 1252.1 patient-years and 6 infections (0.48/100 persons-years, 95%CI=0.22-1.07). If this rate is subtracted from the rate in sexually active men, at most 35 of the 67 infections in the Ugandan trial can be attributed to sexual transmission.5
Finally, in the first three months of the Kenyan trial, five men became HIV-positive who reported no sexual activity in the period before the seroconversion (0.73/100 person-years, 95%CI=0.30-1.76). If this rate is subtracted from the overall rate of infection in the trial, at most 36 of the 69 infections in the Ugandan trial can be attributed to sexual transmission.6 Conservatively for the three trials, 89 of the 205 infections (43.1%) were sexually transmitted. Without knowing which infections were sexually transmitted, it is impossible to test the hypothesis of whether circumcision reduces the rate of sexually transmitted HIV. Basing policy on studies that were unable to answer their own research question is unwarranted.
Lack of biologic plausibility

How does cutting off the foreskin prevent the transmission of HIV? This question remains unanswered. Proponents of the circumcision solution have speculated that the interior mucosa of the prepuce is thinner and more prone to tearing, but mucosa of the inner and outer prepuce have been shown to be of the same thickness.7 Proponents also speculate that HIV is more likely to be transmitted through the foreskin because it has a high concentration of Langerhans cells, which they believe are the entry point for HIV. Research has shown that Langerhans cells are quite efficient in repelling HIV and explains why the transmission rate of HIV is one per 1000 unprotected coital acts.8 The inner foreskin secretes langerin, which kills viruses.9 Langerhans cells also protect against other sexually transmitted infections (STIs), which may explain why circumcised men are at greater risk for getting an STI (unpublished data). In general, mucosal immunity provides a stronger barrier to infection than the skin. Finally, to support their plausibility argument, circumcision proponents have identified the sub-preputial space as a harbor for sexually transmitted viruses. Meta-analyses assessing the susceptibility to genital infections with herpes simplex virus and human papilloma virus have not shown an association with circumcision status.10,11,12 Unfortunately, these speculations have been repeated so often in the medical literature that many physicians and public health officials consider them factual. There is, however, no direct scientific evidence to support the hypothesis that the foreskin is a predisposing factor for infection.
Lack of consistent epidemiological evidence

If the RCTs are to be believed and circumcision provides 50% to 60% protection from sexually transmitted HIV infection, then the impact of circumcision should be readily apparent in the general population. This is not the case. In Africa, there are several countries where circumcised men are more likely to be HIV infected than intact men, including Malawi, Rwanda, Cameroon, Ghana, Zimbabwe, Lesotho, Swaziland, and Tanzania.13,14,15 Even in South Africa, where one RCT was undertaken, 12.3% of circumcised men were HIV-positive, while 12.0% of intact men were HIV-positive.16 If the national survey data that are available from 19 countries are combined in a meta-analysis (Table 1) the random-effects model summary effect for the risk of a genitally intact man having HIV is an odds ratio of 1.10 (95%CI=0.83-1.46), indicating that on a general population level, circumcision has no association with risk of HIV infection. Among developed nations, the United States has the highest rate of circumcision and the highest rate of heterosexually transmitted HIV.17 Within the United States, blacks have the highest rate of circumcision18,19,20,21 and the highest rate of heterosexually transmitted HIV.22 Among English-speaking developed nations there is a significant positive association between neonatal circumcision rates and HIV prevalence (data currently under submission, Scot Anderson). On a population level, circumcision has not been found to be an effective measure and may be associated with an increase in HIV risk.
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Table 1. Meta-analysis of population survey results from 19 countries15,16 comparing HIV prevalence based on circumcision status using fixed-effects and random-effects models on exact odds ratios and confidence intervals.11


Risk compensation

Risk compensation occurs when people believe they have been provided additional protection (wearing safety belts) they will engage in higher risk behavior (driving faster). As a consequence of the increase in higher risk behavior, the number of targeted events (traffic fatalities) either remains unchanged or increases.23,24 When modeling HIV infections in San Francisco, Blower and McLean found that if an HIV-vaccine offered 50% protection, but reduced condom usage, or increased other risky behaviors, it would likely result in higher HIV infection rates.21
Risk compensation will accompany the circumcision solution in Africa. Circumcision has been promoted as a natural condom,25 and African men have reported having undergone circumcision in order not to have to continually use condoms. Such a message has been adopted by public health researchers. A recent South African study assessing determinants of demand for circumcision listed “It means that men don’t have [to] use a condom” as a circumcision advantage in the materials they presented to the men they surveyed.26 If circumcision results in lower condom use, the number of HIV infections will increase.
African men, on average, have coitus once a week,27 and use condoms in 48% of their sexual encounters with women.5 Assume that 20% of sexually active women are HIV-positive, partners were contacted randomly, condoms are 98% effective when used, the baseline circumcision rate is 5%, and circumcision reduced the transmission rate of HIV infection by 50%. Since the transmission rate of HIV from females to males is one per 1000 unprotected coital acts, the HIV infection rate in men in this scenario would be 0.537 per 100 person-years (which is far below the rate reported in the three RCTs). If the circumcision rate increases from 5% up to 75%, the infection rate would decrease to 0.344 per 100 person-years. If in the baseline scenario with a 5% circumcision rate condom use increased from 48% up to 67.9% of sexual encounters, the infection rate would be 0.344 per 100 person-years. Consequently, the impact of a fifteen-fold increase in the rate of circumcision could be accomplished by a relative 41% increase in the use of condoms.
The leap of faith

Interventions and medications that demonstrate efficacy in a research setting are often failures in a clinical setting. Circumcision will provide another example of this. The results from the RCTs are of questionable value, and it is unknown how they will translate to the real world. Numbers gathered from general populations are outside the 95% confidence intervals generated by the RCTs.
Research results often fail to translate to other settings because the research population differs considerably from the targeted population. For example, to save money in a trial of a new antihypertensive medication, participants with the highest blood pressure will be recruited for the trial, because it is easier to show effectiveness in those with more severe disease. The new medication may do well with the participants, but when the medication is released for general use, it may not be beneficial for those with mild hypertension, let alone those who are normotensive.
The men attracted by a free circumcision to enroll in the RCTs are not representative of the general population. The RCT participants were required to want to be circumcised. A faithful monogamous man with a faithful spouse would have little motivation to seek a free circumcision. This selection bias may have resulted in enrollment of men more likely to engage in high-risk behaviors. The free circumcision and financial inducements may have added to the selection bias.
If the selection bias resulted in more men at high risk of infection being in the trial, then the results would apply only to men who engage in high-risk behaviors. This would be consistent with the observational studies finding that the association between circumcision status and HIV infection was present primarily in studies of high-risk men.
Instead of targeting sexually active men at high risk of HIV infection, the circumcision solution proposes circumcising all males (of all ages), which would be equivalent to recommending the above antihypertensive medication to everyone regardless of their blood pressure. In addition to the national survey data (Table 1), observational studies of general populations have for the most part failed to show an association between circumcision status and HIV infection.28,29,30 There is no scientific reason to believe that the RCT results would necessarily apply to the general population. It is quite likely that applying research results from a high risk population to the general population will lead to failure. Using the scenario above, if it is assumed that circumcision has only a 10% protective in the general population then increasing the circumcision rate from 5% up to 75% would decrease the infection rate from 0.548 to 0.509 per 100 person-years. Increasing condom use from 48% up to 51.8% would result in the same gains. So a fifteen-fold increase in the circumcision rate would have the same impact as a 3.8% absolute increase in the use in condoms.
Attractive, less invasive, less expensive, more effective alternatives

Before Africans address sexually transmitted HIV, a concerted effort to eliminate the iatrogenic spread of the virus is needed. As the numbers from the RCTs indicate, most infections can be attributed to non-sexual transmission. While this indictment of the medical system is unsettling, ignoring iatrogenic sources of infection will only allow the African epidemic to flourish.31
When it comes to sexually transmitted HIV infections, proponents of circumcision have consistently failed to compare the effectiveness and cost of circumcision to currently available alternatives, which include condoms, aggressive surveillance and treatment of STIs, and antiretroviral therapy (ART).
ART is a secondary preventive measure. When those infected with HIV are treated with ART, the viral counts can decrease to where the patient is no longer contagious. HIV-infected patients on ART with no currently active STI no longer need to use condoms to protect their partners.32 A recent model predicted that a “test and treat” model in a sub-Saharan setting could reduce the number of new HIV infections by 55-73.2%,33 making this approach attractive in Africa, San Francisco, and Washington, DC.34 This intervention directs prevention at those most likely to benefit: those exposed to the virus. With the circumcision solution, the vast majority of men who are circumcised will not benefit from the procedure (Figure 1). Secondary prevention is a more efficient use of resources and many HIV experts consider primary prevention extremely wasteful and ineffective.8 The “test and treat” approach is effective regardless of whether the infection was sexually or iatrogenically transmitted. Such an approach would not be limited to ART, as the use of other medications proven to decrease viral counts, such as decitabine and gemcitabine, may also become available.35
Aggressive surveillance and treatment of STIs has been shown to reduce the number of HIV infections by 40%36 at a cost of $217.62 per HIV-1 infection averted.37 This is more cost-effective than models for circumcision, which extrapolate the data collected from the 21 to 24 months of the RCTs to over 20 years, have predicted. These models, which incorporated major assumptions of questionable validity, presented circumcision as favorably as possible. In addition to being more cost-effective, aggressive surveillance and treatment of STIs have the advantage of treating and preventing the spread of STIs and avoiding the damage caused by removing the most sensitive portion of penis.38 Part of the success of STI treatment research may be due to a reduction of iatrogenically transmitted HIV, as the STIs were treated in research facilities.
In studies of discordant couples, condoms have been shown to be more than 99% effective in preventing infection.39 Condoms, in a public health setting, cost 2.5¢ each.40 A safe circumcision performed under sterile conditions in Africa using local anesthetic costs approximately $75,41 so for the cost of an adult circumcision, 3000 condoms, at 2.5¢ per condom, can be purchased. The nearly complete protection provided by condoms is a bargain compared with circumcision. In the first hypothetical scenario outlined above, the 0.193 infections per 100 person-years decrease in HIV infection rate brought by circumcision costs $52.50 per person. The cost per person of the additional condoms (at 2.5¢ each) for one year to achieve the same impact on the infection rate would total 25.87¢. To have the same effect for one year, circumcision costs 202.9 times more than condoms. Proponents for circumcision would argue that circumcision is a one-time expenditure, while condoms would be an ongoing expense. Using the scenario above with 3% discounting and assuming an average of weekly sexual contact over 45 years, the lifetime difference in the cost of condoms would be $6.13 per person. With 5% discounting the lifetime difference in cost would be $4.83. If circumcision is only 10% effective, with a 3% discount, the lifetime difference in cost of condoms would be $1.25.
One complaint has been that the 2.5¢ condoms are not attractive, which may explain why they are underused. Based on this analysis, if a man is having sex weekly for 45 years, an upgrade to condoms that cost ten times as much would be cost neutral (assuming a discount rate of 3%). Of course, if sexual contact was less frequent or a man was in a mutual monogamous relationship, further condom upgrades could be justified.
This is, however, a false comparison because, unlike circumcision, condoms can provide nearly complete protection.
Circumcision proponents believe that circumcision is the only proven effective preventive tool for HIV infection and have argued that condoms are ineffective.42,43 Condoms would be expected to be ineffective in regions where the majority of infections are from non-sexual transmission. Abstinence, be faithful, and condoms (ABC) should remain the focus of primary prevention for sexually transmitted HIV, but more resources need to be focused on the non-sexually transmitted infections, which is a much more efficient means of transmission.31
How rational is it to tell men that they must be circumcised to prevent HIV, but after circumcision they still need to use a condom to be protected from sexually transmitted HIV? Condoms provide near complete protection, so why would additional protection be needed? It is not hard to see that circumcision is either inadequate (otherwise there would be no need for the continued use of condoms) or redundant (as condoms provide nearly complete protection). The argument that men don’t want to use condoms needs to be addressed with more attractive condom options and further education that sex without a condom and without a foreskin is potentially fatal, while sex with a condom and a foreskin is safe. No nuance is needed. Offering less effective alternatives can only lead to higher rates of infection.
Rather than wasting resources on circumcision, which is less effective, more expensive, and more invasive, focusing on iatrogenic sources and secondary prevention should be the priority, since it provides the most impact for the resources expended. The second tier would be primary prevention that focuses on the ABCs.
Resources are not unlimited. With the push for circumcision, public health workers in Africa are finding that resources that previously paid for condoms are now being redirected to circumcision. With every circumcision performed, 3000 condoms will not be available. For every circumcision performed, a health care provider is prevented from caring for someone in need of medical care. With trained medical providers busy performing circumcisions, patients will be forced to seek medical care provided in settings where sterility of equipment is less likely and HIV is more likely to be spread iatrogenically. For every circumcision performed, there are fewer resources that can be put into ART and other chemotherapies. Male circumcision is an unnecessary distraction that depletes the limited resources available to address the HIV epidemic. It also fails to address the underlying causes for the epidemic in Africa.
 
References from study in previous post:

References

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3. Halperin DT, Bailey RC. Male circumcision and HIV infection: 10 years and counting. Lancet 1999; 354:1813-5.
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20. Mor Z, Kent CK, Kohn RP, Klausner JD. Declining rates in male circumcision amidst increasing evidence of its public health benefit. PLoS ONE 2007;2:e861.
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Each and every single day, thousands of innocent, helpless, newborn baby boys are taken into an operating room, strapped onto a restraining table, arms and legs firmly bound, and literally have their penises 'skinned alive'.

First, surgical instruments are used to tear the skin loose from the head of the penis. This delicate, highly-innervated, extremely erogenous tissue is then peeled back from the helpless baby's tiny penis, like ripping a fingernail off a finger.

The peeled-back tissue is then placed in a vise-clamp, and the tissue is crushed for approximately 10 to 20 minutes, while the baby screams in abject horror, his poor body twisting and convulsing from the pain. His tiny heart nearly explodes as his heartbeat soars to a staggering two hundred or more beats per minute.

Then, as shock begins to set in, his breathing stops and his body turns blue. A doctor then takes a knife and amputates all this exquisite tissue from the baby's penis, forever altering that innocent child's life.

There are no painkillers, no sedatives, no anesthesia - the baby is wide awake through the entire horrific experience. All the while, the unrelenting, inescapable pain permeates every fiber of that little baby's mind. If he's one of the more fortunate ones, he'll lapse into a comatose, catatonic state as his body shuts down while trying to escape the bombardment of his senses with unimaginable pain.

After the amputation, there are no sedatives, no painkillers, no magical soothing ointments, lotions, or salves. His tiny, bloodied, nearly-skinless penis is a giant open wound - raw, bleeding, and extremely painful - and it is left in agony, to 'heal itself' over the course of the next several weeks or months.

And while the penis heals, each and every time the baby urinates he is subjected to incredible pain, as the uric acid comes in contact with the exposed flesh.

This 'procedure' is euphemistically referred to as a 'simple circumcision'.

Every year more than a million and a half helpless baby boys are sexually mutilated in North America. These children have the most private and personal parts of their bodies amputated for the sole purpose of depriving them of their natural right to experience the exquisite range of sensual pleasure God intended them to have. All other excuses put forward in the hopes of justifying this butchery, whether medical, religious, or otherwise, are lies designed to perpetuate the mutilations.

Society will not permit circumcision of a girl's clitoris, but the foreskin is a man's clitoris ... they are sexually analogous. The foreskin is the primary erogenous zone on a man's body! It is an abomination that this atrocity continues to be perpetrated in every hospital in North America, day in and day out, with such impunity!
 
The circumcisors within the medical profession offer various and sundry lies in order to promote circumcision, and they denounce any ill-effects. But one only has to look at what is happening in society to see the consequences of circumcision. The facts cannot be hidden by the lies.

First, the vast majority of circumcised men are NOT AWARE of the PHENOMENAL LOSS their bodies have been subjected to. This is not the same as saying that the vast majority of circumcised men do not have problems with their circumcised penises. In fact, quite the contrary is true. 20/20 News (ABC TV) featured a special segment in their March 20th, 1998 telecast. They reported the current statistics that over 18 million men‡ in the United States suffer from impotence, and that tens of millions of other men suffer from various other sexual dysfunctions. The facts clearly indicate that millions of men are indeed experiencing sexual problems because of their circumcisions. The problem is that men do not talk publicly about these problems - except of course to their doctors, who are busy either denying that any problem exists or blaming it on "old age".
‡ Note: The January 2003 issue (pp. 51-52) of Good Housekeeping magazine reports it's now estimated that between 20 and 30 million men in the U.S. are affected by Erectile Dysfunction (impotence).

Such overwhelming numbers of sexual dysfunction are unique to North America. Statistics from European countries where circumcision is virtually non-existent are minuscule in comparison.

Comparisons of statistics for violent crime, especially rape and other violence directed towards women, reveal the same lopsided proportions when evaluating crime in North America compared to European nations.

Divorce rates in North America have exploded over the past 20 years and incompatibility (ie: problems in the bedroom) heads the list of reasons given. Certainly it is much easier to get a divorce than it was 20 years ago. Prior to that, people stuck it out (amicably or not) primarily because of the stigma associated with divorce. So the ease of getting a divorce accounts for the rise in the number of divorces - but doesn't answer why so many people are seeking a divorce. While this might sound sexist, the majority of divorces are the direct result of the males seeking out new female sexual partners. And they're seeking those partners because sex is not satisfying with their current partner - and they blame that current partner for the problem. In reality, it is the male who has the problem: his lack of a foreskin results in an inability to fully sexually bond with his mate, the inability to become aroused as he gets older because of the keratinization of his penis, and because the sexual orgasm pleasure center in his brain has atrophied he is unable to ever be fully satisfied in his sexual couplings.

The inability of his body to feel sexual satisfaction leads to compulsive sexual behavior. One example of this behavior is the insatiable consumption of pornography in North America. Tens of millions of the American population are sex addicts, and more than 520 chapters of Sex Addicts Anonymous have been founded in the United States and Canada. This is indicative of the serious and significant neuropsychological problems which result from circumcision. Despite the staggering odds of contracting aids or some other sexual disease, millions of men make use of the services of prostitutes every year. The need to fill that unsatisfied sexual craving within the brain is extremely powerful. It's like an itch that can't be scratched, and it overrides normal, rational thought. Even Presidents are not immune to this fundamental psychophysical need.

When the drug Viagra was introduced to the American public, sales went ballistic. In less than a month, over 900,000 prescriptions for the drug were issued. Sales are expected to exceed 1 BILLION dollars the first year in the U.S. alone. Obviously there are a LOT of men out there who are experiencing serious sexual functionality problems. Unfortunately, Viagra will only provide the man with an erection - it will not increase the sensitivity of his penis, nor will it restore any of the amputated erogenous nerve tissue. In addition, Viagra poses serious health risks to a large percentage of the men who will use it, and it is going to lead to extremely serious health problems down the road for all of those users.

And still the doctors claim "there is no problem with circumcision".
 
No caring, loving, normal human being could possibly inflict such destructive injury such as circumcision or male genital mutilation upon a helpless baby.

Only the truly sociopathic can do such a horrific thing or decide to have it done to their children under the ruse of health/hygiene, an outdated religion or religious text, because they think that their sons will be "freaks in the locker room", because of societal pressure, so the boy will have a penis that looks like his father's (Can you say Daddy issues?! ), because they think that mutilating their son's genitals will somehow protect him as an adult from HIV and other STDs better than condoms and teaching him about safer sex and HIV/STDs ever will, or because a doctor or nurse recommended it and they're too incompetent to do their own research which even the American Medical associations have said how there is not recommendation or reason for infant male genital mutilation or circumcision.
 
A new study published yesterday in Thymos: Journal of Boyhood Studies estimates that more than 100 baby boys die from circumcision complications each year, including from anesthesia reaction, stroke, hemorrhage, and infection. Because infant circumcision is elective, all of these deaths are avoidable.

The study concluded: “These boys died because physicians have been either complicit or duplicitous, and because parents ignorantly said ‘Yes,’ or lacked the courage to say ‘No.’” And called the deaths “an unrecognized sacrifice of innocents.”

The study found that approximately 117 neonatal (first 28 days after birth) circumcision-related deaths occur annually in the United States, one out of every 77 male neonatal deaths. The study also identified reasons why accurate data on these deaths are not available, some of the obstacles to preventing these deaths, and some solutions to overcome them.

what your repeated objections to the word "mutilation" ignore is the botched circumcisions which result in mutilation. For example, when part or all of the glans is removed "accidentally" during routine circumcision, that's mutilation, and removal of the foreskin itself on infants is a mutilation because the infant boy cannot consent at all.

Since I was a horny young man living in San Francisco in the early through late 1970s, I had the opportunity (and took it) to play with a lot of men. So I know from personal experience that there are plenty of botched infant circumcisions, with various degrees of botchedness. And some of them definitely DO rise to the level of mutilation, even if you don't agree that cutting off pleasurable, sensitive skin is mutilation. It's safe to argue that I know what I'm talking about.

Another point to remember is that an erect penis will often show problems that are not apparent when it's flacid. Most doctors see flacid, not erect penises. They don't see the skin that's so tight that it pulls the head of the penis almost flat, or damage to the glans that is not evident until it tries to expand when aroused, or places where the cut skin didn't grow together properly, and has pockets where bacteria can cause serious problems. So medical opinions that are based on visible damage to flaccid penises are inadequate - it's erect penises that show the damage most clearly.

It's men with backgrounds like mine who have seen the unfortunate, sometimes mutilated, results of botched circumcisions.

Men who are intact with a foreskin get way more sexual pleasure and give women more sexual pleasure than men who are cut or mutilated can imagine or perceive since they've never had a foreskin with its sensitive nerve endings that was taken away from them moments after they were born without their consent at all. That my dear is mutilation even if you want to wish and claim that it is not.

The overwhelming majority of males on this planet are intact or uncircumcised without and are living perfectly fine without HIV/STDs, penile cancer, or the other dire problems that circumcision proponents declare happen to all or most men who have foreskins that simply don't happen at all to men who are cut.
 
From my perspective, it doesn't matter a damn bit what women think about a circumcised or natural penis with a foreskin. This is not about women and their bodies nor does it have to do with any mutilation of female bodies other than to show the hypocrisy of a double standard due to cultural differences and flat out denial. It is a man's body that is mutilated in infancy by his parent or not mutilated. Using such words as "mutilate" and the furthering of information about the sensual nerve fibers in the foreskin will eventually stop this act on males who are not given the right to decide about their own body.
 
I've discovered that if one has to keep repeating oneself, chances are, no one cares about what you're saying.
 
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