Circumcision

[James]

Steve, I am not sure I understand what you are talking about with regards to philosophies creeping up? My point was that circumcision’s supposed benefits are so minimal that many medical associations consider it a cosmetic move rather than a medical one. Circumcision is also a permanent move. My point was that given those two premises, parents should consider allowing their child to make his own choice.
“There are many things that a child does not decide. Parents must make choices and strive to do the best they can.”

Agreed. But circumcision does not need to be one of those things that a child does not decide, unless it is justified for medical reasons. I don’t think the circumcision issue (it isn’t even an issue in most of the world) is a smokescreen to hiding true problems of our day.

Ian said, “the AAP is the largest pediatric organization in the world.”

Being the largest doesn’t make it the best, or the most correct.

Ian said, “based on years of scientific research, they concluded that “the health benefits of newborn male circumcision outweigh the risks.”

They are selective in what studies they focus on and what studies they ignore.

Ian said, “this appears to reflect the majority scientific view”

The majority of the worlds medical community does not recommend circumcision. But I think that the majority does agree that the procedure is quite low risk.

“where’s the science?”

It’s everywhere.

First I address HIV. As mentioned previously, the HIV studies probably don’t apply in America, but rather are local to Africa. Also, the AAP fails to mention condom use. Are we all aware that the best way to avoid spreading HIV if one chooses to have a sexual encounter is to use a condom?
From my previous post:

“It admits the African HIV findings may not be applicable to the USA, but applies them anyway. It admits that many of the diseases studied vis à vis circumcision are rare in the USA, but nonetheless cites these to pad its ‘benefits’ discussion.
In three pages discussing STIs and HIV, it fails to mention the word “condom” as a preventative even once.

It cites a study (Science) suggesting circumcising men increases the HIV risk to women, and ignores that finding in its risk: benefit conclusion.”

Also:

“It exaggerates the benefits of circumcision and minimizes its risks and harms. It selectively cites or emphasizes studies that favor circumcision, and omits or rejects those that disfavor it, e.g.:
It citesSorrells et al.’s (2007) penile touch-testing study, but ignores its key finding that “circumcision ablates [removes] the most sensitive parts of the penis.”
It fails to cite Taylor’s (1996) groundbreaking anatomical paper, “The prepuce: specialized mucosa of the penis and its loss to circumcision.”

There’s some science, two more examples of it. I found it by copying and pasting from my last post.

In fact, the websites I have relied on the most, the NHS and drs opposing circumcision, are peppered with references to science. One thing I like about the NHS website is that on their infant circumcision page they integrate information on how to care for the infants genitals.

I think we all know that the procedure is pretty low risk. Instances of infection, accidentally amputating the glans, etc. are pretty low. What exactly are the benefits? Lower HIV transmission that could be prevented with a condom anyway. Slightly lower instances of an already rare penile cancer. Slightly lower rates of rare childhood UTIs that can be treated in less invasive ways than circumcision anyway. These are the benefits. These are the things that are being compared to the risks. Also, risk benefit comparison is narrow in scope. The risk side only looks at the actual procedure and recovery. It does not examine long-term effects of not having an intact penis. The physiology of the foreskin is ignored by the largest pediatric organization in the world, the AAP. The foreskin is a functioning anatomical unit. Aside from counting nerve endings and a few other things it is perhaps difficult to quantify its function, but that does not mean that it does not have function, or that its function shouldn’t be studied. The AAP does not enage with the potential range of foreskin function. In this way the AAP ignores science. If there is a foreskin function then circumcision inhibits the subjects natural genital function and leaves a permanent scar on the penis.

My opinion: if the foreskin has a natural function then it should be allowed to perform that function, rather than be removed to 1. reduce HIV risk that is better prevented in other ways. 2. reduce the slim chance of penile cancer. 3. reduce childhood UTIs that are prevented by proper care and usually treatable with antibiotics. Any potential foreskin function is greater than the circumcision benefits cited by the AAP.

The medical organizations in other countries do not recommend infant circumcision. The AAP says, “the benefits outweigh the risks.” Look at what those benefits really are. Look at what they ignore. Medical organizations in other developed countries do not recommend circumcision from a medical perspective. The procedure is low risk, so if a Jewish or Muslim person wants to go for it, that’s fine. But none of these countries is recommending non-therapeutic circumcision.

[Ian]

i'm not aware of any medical organization that currently “recommends” circumcision. the AAP, for example, announced in 2012 that: “new scientific evidence shows the health benefits of newborn male circumcision outweigh the risks of the procedure, but the benefits are not great enough to recommend routine circumcision for all newborn boys.” they also stated: “although health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it.”

in other words, this is a decision to be made by parents, not by doctors. i believe that parents should weigh the evidence. current scientific evidence shows that the benefits of circumcision outweigh the risks. this view is shared by most of the largest medical organizations in the world that have published statements regarding circumcision, including the AAP, AMA, ACOG, AUA, CDC and WHO.

the evidence comes from numerous scientific reviews, particularly those conducted over the past decade or so. for example, a 2010 review conducted by experts at johns hopkins university school of medicine and the national institutes of health found “mounting evidence that male circumcision decreases viral STIs, genital ulcer disease, and penile inflammatory disorders in men, and bacterial vaginosis, T vaginalis infection, and genital ulcer disease in their female partners.”

i would put greater weight on this kind of evidence (peer-reviewed literature from reputable international scientific journals, etc.) than i would put on individual opinions (such as george denniston at doctorsopposingcircumcision.org). at least i would consider opinions coming from different perspectives. for example, see brian morris’s website at circinfo.net for a thorough evidence-based review from another perspective.

[James]

Ian said, "i'm not aware of any medical organization that currently “recommends” circumcision. the AAP, for example, announced in 2012 that: “new scientific evidence shows the health benefits of newborn male circumcision outweigh the risks of the procedure, but the benefits are not great enough to recommend routine circumcision for all newborn boys.” they also stated: “although health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it."

Well when you put it that way!

I am personally most interested in the medical aspects of circumcision. My interest in the human rights aspect is primarily within the scope of parenting options (if I as a parent realize that my son might prefer his genitals to be intact, then that is an important part of my consideration of whether or not to circumcise him).

Ian said, "current scientific evidence shows that the benefits of circumcision outweigh the risks. this view is shared by most of the largest medical organizations in the world that have published statements regarding circumcision, including the AAP, AMA, ACOG, AUA, CDC and WHO."

The benefits outweighing the risks statement has been repeated many times. My previous post detailed some of those benefits, and the lack of risks. Regardless of the size of the medical organizations that say it, the risk benefit statement ignores foreskin function and is padded by such benefits as slightly lower HIV transmission rates to males in Africa (When a condom is extremely effective).

Ian said "...than i would put on individual opinions (such as george denniston at doctorsopposingcircumcision.org)."

The doctors opposing circumcision team (not doctor opposing circumcision) refers to scientific information numerous times.

Pointing out padding of the benefit analysis and bringing up foreskin function are important considerations and are completely neglected by the AAP.

I reviewed some of the circinfo site. one of my favorite scientific moments on that site is, "Such a high rate for elective surgery involving the genitalia suggests important net benefits."

As I see it, the minimal benefits (minimal because they are sometimes padded, and similar benefits are often achieved by ways other than circumcision) are dwarfed by the natural function of the foreskin, regardless of the low degree of risk involved in the procedure.

[Ian]

actually, the AAP analyzed function in their 2012 technical report. they determined that the scientific literature “does not support the belief” that circumcision adversely affects function.

from a scientific standpoint, the foreskin may play a role during the fetal period, but it has no known function after birth.

if you can find good evidence that foreskin has a useful function after birth, based on actual scientific research, and published by reputable peer-reviewed sources over the past decade, then please share.

[Steve]

James: My point was that circumcision’s supposed benefits are so minimal that many medical associations consider it a cosmetic move rather than a medical one. Circumcision is also a permanent move. My point was that given those two premises, parents should consider allowing their child to make his own choice.

And my point was that you're saying that permanent cosmetic changes are only to be made by individuals and not by their parents—to which I responded, by way of example, with the fact that parents make several permanent cosmetic decisions about the child even prior to their birth. We don't need to be alarmed by this.

What's more, approximately 80% of males in the USA have been circumcised. It's not without precedent, and it seems logical that there would have to be compelling evidence to proceed contrary to a simple procedure with a long historical track record. It's interesting that authors from Johns Hopkins, the Mayo Clinic, and the AAP (along with many other large, reputable organizations) reviewed over 500 studies regarding circumcision and would publish bold statements like "...the benefits of newborn circumcision exceed the risks by at least 100 to 1"—and that anyone would dismiss this outright because of a small volunteer website or some indignation from the Huffington Post. If I learned from respected sources that "half of all uncircumcised males will contract a medical condition related to their foreskin," and made a decision based on that, I wouldn't be too worried about retribution from my son that I had done him irreparable cosmetic harm (for something that will never be seen). As a sidenote, some of these same organizations suggest that a global decline in circumcision likely has more to do with finances than medical evidence. That pattern is readily seen here in the USA as well and is often linked to a drop in Medicaid assistance available for circumcision.

At any rate, doesn't it seem a little "pick-and-choosy" when citing science and research in one thread to support your opinion, then dismissing it outright in another thread?

I might also add as the thought occurs to me, for the sake of the naturalist who reads this thread and cringes at the notion of taking proactive measures against a "natural" order of sorts, that we rightly interfere with nature all the time. Nature is not some kind, romantic influence that consistently operates in man's best interest. We constantly oppose, resist, and battle against natural forces and tendencies.

Mosiah 3:19 (a scripture mastery scripture) clearly states:

For the natural man is an enemy to God, and has been from the fall of Adam, and will be, forever and ever, unless he yields to the enticings of the Holy Spirit, and putteth off the natural man and becometh a saint through the atonement of Christ the Lord, and becometh as a child, submissive, meek, humble, patient, full of love, willing to submit to all things which the Lord seeth fit to inflict upon him, even as a child doth submit to his father.

We constantly resist and tame natural appetites and inclinations with which our natural bodies come predisposed. We brush our teeth. We clip our nails. We wash our bodies. We expend energy learning through texts and transcripts instead of simply swinging from trees. We kill bacteria. We wear clothing. We hold our tongue rather than saying the first thing that comes to our mind. We plow fields. We bake bread. We trim hair. We hold currency and form governments. We hire orthodontists. We place contact lenses on our eyeballs. We dust the furniture. We prune trees. We help someone at inconvenient times. We learn multiple languages. We fly to a moon. We worship God.

I could go on and on. Leaving something in its natural state is not always the right answer.

[Edward]

Natural state? So should I understand this to mean that we should never color our hair, or that women should never pierce their ears, or that we should never shave anything? There is a difference between respect for the bodies we have been given, and the proper care and management of them, which is an important stewardship that we need to acknowledge and live up to.

[Steve]

EDIT: ...though, for the record, I'm not a proponent of piercing ears or dying hair.

[James]

“What's more, approximately 80% of males in the USA have been circumcised. It's not without precedent, and it seems logical that there would have to be compelling evidence to proceed contrary to a simple procedure with a long historical track record”

It’s easy to just do what everyone does because it’s the norm.

“It's interesting that authors from Johns Hopkins, the Mayo Clinic, and the AAP (along with many other large, reputable organizations) reviewed over 500 studies regarding circumcision and would publish bold statements like "...the benefits of newborn circumcision exceed the risks by at least 100 to 1"—and that anyone would dismiss this outright because of a small volunteer website or some indignation from the Huffington Post. If I learned from respected sources that "half of all uncircumcised males will contract a medical condition related to their foreskin," and made a decision based on that, I wouldn't be too worried about retribution from my son that I had done him irreparable cosmetic harm (for something that will never be seen)”

Benefits, they may be large or small. Significant health indicators or insignificant. All they have to do to make their statement true (the benefits outweigh the risks) is outweigh the risk of performing circumcision, a quick bedside procedure.

I wonder what foreskin conditions they are? How severe must a condition be to get counted in this “half of all males statement?”

“retribution from my son that I had done him irreparable cosmetic harm (for something that will never be seen)”

Well there is the scar, he’ll see that. And part of the pain is that it will never be seen. Circumcision permanently changes the way the genitals will look.

“At any rate, doesn't it seem a little "pick-and-choosy" when citing science and research in one thread to support your opinion, then dismissing it outright in another thread?”

I don’t know what you are talking about.

I choose not to interpret Mosiah to deal with the physical make up of our bodies. That is a slippery slope. Does the AAP get to decide what parts of our bodies are enemies to God? Also, this is a discussion on circumcision, not ear piercing or hair dye. There are important differences between these different body modification practices.

You mention money. Are drs in other countries just wishing they could circumcise more? Are they anxious that their patients are not getting the benefits of circumcision? Or are they, and the children they treat, generally doing just fine? But yeah, money. Americans spend more on health care than any other country but our health outcomes remain lower than many other countries. I think the WHO ranks our healthcare system something like 37th in the world. I’d prefer to spend my healthcare dollars on really important medical issues, rather than the minimal benefits that will apparently help half of men if they’d just snip off their foreskins.

Ian said, “actually, the AAP analyzed function in their 2012 ‪technical report‬. they determined that the scientific literature “does not support the belief” that circumcision adversely affects function”

I stated earlier that I think it is difficult to quantify some of the foreskin’s functions. I value even the chance of function over the minimal and padded benefits of circumcision. Ian referenced, “scientific literature “does not support the belief” that circumcision adversely affects function.” I take their statement to mean that the function of the penis (urination and ejaculation) is not ruined by circumcision. But this is for me not whether it affects function, but that it is itself a functioning unit. Potential functions could include such things as protecting the extremely sensitive glans. I’ve heard that the uncircumcised penis deals with less friction during intercourse because the skin is not pulled as tight. This may effect the experience for the woman and the man. It is these kinds of things I am talking about when I say that the foreskin itself is a function anatomical unit. It has nerve endings. They may say, “So do other parts of the penis and Ejaculation is still possible without a foreskin, so the function of the penis is not ruined.” But that does not mean that the foreskin has no function.

Wikkipedia page on foreskin talks about its function and mentions the WHO’s debate. IMO, if its debatable then avoid unnecessary amputation until the debate is settled.

From the dro opposing page,
““We justify male infant circumcision by pretending that the babies don’t feel it because they’re too young and it will have no consequences when they are older. This is not true. Women who experience memories of abuse in childhood know how deeply and painfully early experiences leave their marks in the body. Why wouldn’t the same thing apply to boys?”
”
Christiane Northrup, M.D

The Psychological Impact of Circumcision

The psychological effects of circumcision on the child – and the man he will become – are an often overlooked harm of the practice, with serious implications for mental health, emotional and relational well-being, and the health of society.
Psychological effects
Evidence indicates that the ability to learn and remember is present from before birth [1,2] and that newborn infants have fully functioning pain pathways.[3] Therefore, one would expect to find psychological effects associated with genital cutting of newborns.
Changes in infant-maternal interaction have been observed after circumcision, including disrupted feeding and weaker attachment between the infant and mother.[4,5] The American Academy of Pediatrics Task Force on Circumcision (1989) noted behavioral changes resulting from circumcision in their report.[6] The behavior of nearly 90 percent of circumcised infants has been found to be significantly changed after the circumcision.[7] Differences in sleep patterns and more irritability – both signs of stress – have been observed among circumcised infants [8,9,10].
Post-traumatic stress disorder (PTSD) is a normal response to an event in which a person’s physical integrity has been threatened or violated. Forced genital cutting is a direct experience of sexual violence, so it fulfills the criteria as a psychogenic cause for PTSD.[11] Taddio et al. studied the behavior of babies at first vaccination. They found that circumcised boys have a much stronger reaction to the pain of vaccination than do girls and intact (non-circumcised) boys, which the authors suggested is an “infant analogue” of PTSD.[12] Other authors also have reported PTSD in circumcised males.[13] Rhinehart reported on four cases of PTSD connected with neonatal circumcision in middle-aged men that he encountered in his psychiatric practice.[14] Ramos and Boyle reported PTSD in 70 percent of Filipino boys who experienced ritual circumcision and 51 percent of Filipino boys who experienced medical circumcision.[15]
Cansever tested young boys before and after ritual circumcision and reported that these children had a tendency to seek safety afterwards through emotional withdrawal.[16] Based on relevant literature, clinical experience, and statements from circumcised men, Goldman suggests that reduced emotional expression is the primary potential long-term psychological effect of circumcision.[17] A subsequent study found that circumcised men had significantly increased alexithymia (difficulty identifying and expressing feelings) compared to intact men.[18]
A large Danish study found that circumcised boys may have a greater risk of developing autism spectrum disorder before age ten and a higher risk for infantile autism before age five. Circumcised boys were also more likely to develop hyperactivity disorder.[19] While, causally, autism is considered to be a multifactorial disorder,[20] the link with circumcision may in part explain why the incidence of autism is almost five times more common in boys in the United States.[21] Hyperactivity disorder (attention deficit disorder) is about three times more common in boys.[22] More research is needed to replicate and better understand the Danish findings.
Based on growing reports from circumcised men, other potential long-term psychological effects of circumcision include excessive or inappropriate anger, shame, shyness, fear, powerlessness, distrust, low self-esteem, and decreased ability for emotional intimacy.[14,17,13-25] Because circumcision is generally performed shortly after birth, it is a perinatal trauma, and several authors report that perinatal trauma may contribute to self-destructive behavior in adult life.[26-30] Lack of awareness and understanding of circumcision, emotional repression, fear of disclosure, and nonverbal expression explain why we do not hear from more circumcised men about how they truly feel.[17,31,32]
Van der Kolk reports that trauma often results in a compulsion to reenact or repeat the trauma on others.[26] For example, a circumcised father often irrationally insists that a son undergo circumcision, even against a spouse’s wishes and knowing that there is no medical necessity.[33] As another example of the compulsion, a survey of randomly selected physicians showed that circumcision was more often supported by doctors who were older, male, and circumcised.[34,35] In addition, some American doctors have apparently tried to coerce parents to circumcise their sons.[36,37] Circumcision status and its associated psychological and social factors may also bias circumcision studies and circumcision policy statements in favor of circumcision.[38]
With increased awareness of the psychological effects of circumcision, there is a growing need for some circumcised men to seek professional psychological help. Clinicians who are themselves circumcised, deny their own harm and associated effects, and/or have chosen circumcision for their sons may be less likely to be empathetic to men in distress about circumcision harm, in order to avoid the discomfort of cognitive dissonance.[39] Clinicians should regard circumcision-related feelings and behaviors seriously and refer clients as appropriate.[40]
Broader social implications
Laumann reported that 77 percent of the American adult males in the 1992 National Health and Social Life Survey were circumcised.[41] The effects of this sexual wounding – both neonatal and lifelong, intra- and interpersonal – have been discussed above. Goldman argues that having so many emotionally and sexually injured males in a culture could potentially produce undesirable social outcomes.[17] Despite many disquieting indications,[17,23,42,43] there has been but limited longitudinal research – and remarkably little professional concern – about the potential social effects of circumcision.
““What’s done to children, they will do to society.”
”
Karl A. Menninger, M.D.


References
1. Hepper PG. Fetal memory: Does it exist? What does it do? Acta Pædiatr (Stockholm). 1996;416:16-20.
2. James DK. Fetal learning: a critical review. Infant Child Dev. 2010;19(1):45-54.
3 Anand KJS, Hickey PR. Pain and its effects in the human neonate and fetus. New Engl J Med 1987;317(21):1321-9.
4. Marshall RE, Porter FL, Rogers AG, Moore J, Anderson B, Boxerman SB. Circumcision: II. effects upon mother-infant interaction. Early Hum Dev. 1982:7(4):367-374.
5. Dixon S, Snyder J, Holve R, Bromberger P. Behavioral effects of circumcision with and
without anesthesia. J Dev Behav Peds. 1984;5:246-250.
6. American Academy of Pediatrics Task Force on Circumcision. Report of the Task Force on Circumcision. Pediatrics. 1989;84(2):388-391.
7. Marshall RE, Stratton WC, Moore JA, Boxerman SB. Circumcision I: effects upon newborn behavior. Infant Behav Dev. 1980;3:1-14.
8. Brackbill Y. Continuous stimulation and arousal level in infancy: effects of stimulus
intensity and stress. Child Dev. 1975;46:364-9.
9. Emde RN, Harmon RJ, Metcalf D, Koenig KL, Wagonfeld S. Stress and neonatal sleep. Psychosom Med. 1971;33:491-7.
10. Anders TF, Chalemian RJ. The effects of circumcision on sleep-wake states in human neonates. Psychosom Med. 1974;36:174-9.
11. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, Fifth edition. Arlington, VA: American Psychiatric Association; 2013. p. 272
12. Taddio A, Katz J, Ilersich AL, Koren G. Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet. 1997;349(9052):599-603.
13. Boyle G, Goldman R, Svoboda S, and Fernandez E. Male circumcision: pain, trauma and psychosexual sequelae. J Health Psychol. 2002;7:329-343.
14. Rhinehart J. Neonatal circumcision reconsidered. Transactional Anal J. 1999;29(3):215-21.
15. Ramos S, Boyle GJ. Ritual and medical circumcision among Filipino boys: evidence of post-traumatic stress disorder. Humanities and Social Science Papers. 2000; Paper 114. Available at: http://epublications.bond.edu.au/hss_pubs/114
16. Cansever G. Psychological effects of circumcision. Brit J Med Psychol. 1965;38:321-31.
17. Goldman R. Circumcision: the hidden trauma. Boston: Vanguard Publications; 1997.
18. Van Howe R, Bollinger, D. Alexithymia and circumcision trauma: a preliminary investigation. Int J Mens Health. 2011;10(2):184-195.
19. Frisch M, Simonsen J. Ritual circumcision and risk of autism spectrum disorder in 0- to 9-year-old boys: national cohort study in Denmark. J R Soc Med. 2015;108(7):266-79.
20. Amaral D, Dawson G, Geschwind D, editors. Austism spectrum disorders. New York: Oxford University Press; 2011.
21. CDC. Prevalence of autism spectrum disorder among children aged 8 years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2010. MMWR Surveill Summ. 2014;63(SS02);1-21.
22. Singh, I. Beyond polemics: science and ethics of ADHD. Nat Rev Neurosci. 2008;9(12):957-64.
23. Hammond T. A preliminary poll of men circumcised in infancy or childhood. BJU Int. 1999; 83(Suppl 1):85-92. See also: http://circumcisionharm.org/ and https://www.youtube.com/watch?v=v_ht2CRTdbo.
24. Gemmell T, Boyle GJ. Neonatal circumcision: its long-term harmful effects. In: Denniston GC, Hodges FM, Milos MF, editors. Understanding circumcision: a multi-disciplinary approach to a multi-dimensional problem. New York: Kluwer/Plenum; 2001. p. 241-252
25. Watson, LR. Unspeakable mutilations: circumcised men speak out. CreateSpace Independent Publishing Platform; 2014.
26. van der Kolk BA. The compulsion to repeat the trauma: re-enactment, revictimization, and masochism. Psychiatr Clin North Am. 1989;12(2):389-411.
27. Salk L, Lipsitt LP, Sturner WQ, Reilly BM, Levat RH. Relationship of maternal and perinatal conditions to eventual adolescent suicide. Lancet 1985;1(8429):624-7.
28. Jacobson B, Eklund G, Hamberger L, Linnarsson D, Sedvall G, Valverius M. Perinatal origin of adult self-destructive behavior. Acta Psychiatr Scand. 1987;76(4):364-71.
29. Jacobson B, Bygdeman M. Obstetric care and proneness of offspring to suicide. BMJ. 1998;317:1346-9.
30. Miller A. Appendix: The newly recognized, shattering effects of child abuse. In: The untouched key: tracing childhood trauma in creativity and destructiveness. New York: Anchor Books (Doubleday); 1991.
31. Ritter TJ, Denniston GC. Say no to circumcision: 40 compelling reasons. Marketscope Books; 1996.
32. Goldman R. The psychological impact of circumcision. BJU Int. 1999;83(Suppl 1):93-103.
33. Rediger C, Muller AJ. Parents’ rationale for male circumcision. Can Fam Physician. 2013;59(2):e110-5.
34. Stein MT Marx M, Taggert SL, Bass RA. Routine neonatal circumcision: the gap between contemporary policy and practice. J Fam Pract. 1982;15:47-53.
35. Muller, A. To cut or not to cut? Personal factors influence primary care physicians’ position on elective circumcision. Am J Mens Health. 2010;7(3):227-232.
36. AAP Task Force on Circumcision. Circumcision policy statement. Pediatrics. 1999;103(3):686-693.
37. Coercion to circumcise. The Intactivism Pages website. Last updated 2015 Nov 5.
38. Goldman, R. Circumcision policy: a psychosocial perspective. Paediatr Child Healt . 2004;9:630-3.
39. Cooper J. Cognitive dissonance: 50 years of a classic theory. London: Sage Publications; 2007.
40. The Circumcision Resource Center (Boston, MA) offers psychological support to circumcised men. See: http://www.circumcision.org
41. Laumann EO, Masi CM, Zuckerman EW. Circumcision in the United States. JAMA. 1997;277(13):1052-7.
42. Laibow, R. Circumcision and its relationship to attachment impairment. In: Syllabus of abstracts, Second International Symposium on Circumcision, San Francisco (CA); 1991. Available from info@nocirc.org.
43. Main M, Hesse E, Kaplan N. Predictability of attachment behavior and representational processes at 1, 6, and 19 years of age – The Berkeley Longitudinal Study. In: Grossmann KE, Grossman K, Waters E, editors. Attachment from infancy to adulthood: the major longitudinal studies. New York: Guilford Press; 2005. p. 245-304

from wikkepedia
In male human anatomy, the foreskin is the double-layered fold of smooth muscle tissue, blood vessels, neurons, skin, and mucous membrane part of the penis that covers and protects the glans penis and the urinary meatus. It is also described as the prepuce, a technically broader term that also includes the clitoral hood in women, to which the foreskin is embryonically homologous. The highly innervated mucocutaneous zone of the penis occurs near the tip of the foreskin. The foreskin is mobile, fairly stretchable, and acts as a natural lubricant.
The foreskin of adults is typically retractable over the glans. Coverage of the glans in a flaccid and erect state varies depending on foreskin length. The foreskin is attached to the glans at birth and is generally not retractable in infancy.[1] The age at which a boy can retract his foreskin varies, but research found that 95% of males were able to fully retract their foreskin by adulthood.[2] Inability to retract the foreskin in childhood should not be considered a problem unless there are other symptoms.[3]
The World Health Organization debates the precise functions of the foreskin, which may include "keeping the glans moist, protecting the developing penis in utero, or enhancing sexual pleasure due to the presence of nerve receptors".[4]
The foreskin may become subject to a number of pathological conditions.[5] Most conditions are rare, and easily treated. In some cases, particularly with chronic conditions, treatment may include circumcision, a procedure where the foreskin is partially or completely removed.

Also from drs opposing,

“Anatomical considerations
The prepuce is an integral part of the penile skin system and has been characterized by anatomical researchers as “primary erogenous tissue necessary for normal sexual function.”[1] Amputation of the prepuce (foreskin) by circumcision alters the anatomy of the penis from its natural design in a number of fundamental ways. Form and function go hand in hand in anatomy. Thus the alterations that circumcision causes in the natural mechanical and sensory capacities of the penis inevitably affect the sexual experience of both the man and his partners.
Loss of penile surface area – The foreskin is not just a “flap” of skin, but a double-layered fold of densely innervated skin and mucosa, of considerable area. Circumcision ablates what will become, in the adult, up to 90cm2 (~14in2) of tissue,[2] approximately half of the skin the penis.[3]

In the flaccid penis, this tissue folds over on itself, covering the glans to varying degrees in each individual. As the penile shaft elongates with erection, the foreskin fold everts and is taken up along the shaft, while still retaining enough slack to maintain mobility of the penile skin sheath. With circumcision, however, the extensive loss of penile skin leaves insufficient tissue for comfortable expansion of the penis with erection. This can result in tight, painful, or bowed erections; tearing or bleeding at the scar site or on the shaft skin; or pulling of hairy skin from the scrotum and pubic area onto the shaft of the erect penis.[4-8] Australian researchers found that circumcised men had shorter erect penises by a mean length of 8mm than intact men (p<0.05),[9] which may be due to tethering of the penis by excess skin tension.
In the case of heterosexual intercourse, once the intact penis is inserted, the vaginal walls hold the skin of the penis relatively stable, allowing the shaft of the penis to glide in and out of its own skin sheath. In contrast, the taut, immobile skin of the erect circumcised penis lacks this natural gliding action with the motions of intercourse, creating an excess of friction directly on the vaginal walls, and potentially causing increased discomfort for both partners.[10] These dynamics also apply to anal intercourse.
The mobility of the intact penile skin also plays a facilitative role in foreplay, masturbation, and intromission (insertion of the penis), all of which are adversely impacted by circumcision.(8,11) One physician described the latter function in this way: “Penetration in the circumcised man has been compared to thrusting the foot into a sock held open at the top, while, on the other hand, in the intact counterpart it has been likened to slipping the foot into a sock that has been previously rolled up.”[12] Several researchers have noted that circumcision causes compensatory changes in masturbatory technique.[13,14] Whereas the intact male can slide the touch-sensitive foreskin back and forth over the glans to self-stimulate, the circumcised male must apply friction directly to the less sensitive glans and shaft of the penis. When masturbating, circumcised men have been found to significantly more often require the use of artificial lubrication, and stimulation to the point of pain to achieve ejaculation.[14]
Loss of nerve endings – In the 1950s, Winkelman noted the dense innervation of the prepuce, and classified the prepuce as a “specific erogenous zone,” along with other mucocutaneous regions (such as the lips, nipples, and vulva), areas in which the anatomy is specifically organized to “favor acute sensation.”[15,16] In the 1980s, Moldwin and Valderrama documented “an extensive neuronal network within prepucial tissue.”[17] Taylor et al. (1996) documented dense concentrations of fine-touch-sensing Meissner’s corpuscles in a band of ridged mucosa encircling the preputial outlet, and identified the prepuce as a “a large and important platform” for input into the nervous system.[3] Sorrells et al. (2007), using micro-filament touch-testing on 19 points on the penises of intact versus circumcised men, found that the most fine-touch-sensitive regions of the penis are those removed by circumcision.[18]
The several sensory testing studies that claim to have found no difference between the sensitivity of the intact and the circumcised penis have significant methodological limitations. Some only tested the glans, but failed to test sensation in the prepuce itself.[19,20] Anatomically, the glans has been shown to have primarily protopathic sensitivity (able to feel only crude, poorly localized sensations),[21,22] and is the least light-touch-sensitive part of the penis in both circumcised and intact men.[18] While sensory differences are already less likely to be detectable in such a low sensitivity area, ignoring any comparison with the sensitivity of the foreskin itself is a crucial oversight.
Two studies that reported no difference in sensitivity did test, in addition to the glans, a single point on the dorsal midline of the outer foreskin.[23,24] This point is an area that Sorrells et al. found to be the least sensitive to fine touch compared to other parts of the foreskin (such as the preputial outlet, the frenulum, and the inner foreskin).[18] Testing only the least sensitive part of the foreskin inaccurately weights the results against finding any difference between the sensitivity of the foreskin and parts of the parts of the penis that remain after circumcision.
Perhaps surprisingly then, the authors of one of these studies, Bossio et al., still found that the foreskin of intact men was more sensitive to tactile stimulation than any other part of the penis (circumcised or not), and also that it was more sensitive to warmth than the glans (both results statistically significant).[24] However, ignoring their own findings, these authors reported the contradictory conclusion that neonatal circumcision has “minimal long-term implications for penile sensitivity.”[24] This pronouncement further ignores the fact that static, single-point testing in a laboratory may be very different from real-life sexual stimulation, in which all parts of the foreskin are likely to be stimulated via moving, rather than static, gestures. Bossio et al.’s study has been critiqued in detail elsewhere.[25,26]
Anatomically, excision of the foreskin by circumcision removes the majority of the fine-touch range of the penis’s sensory spectrum, an important component of sexual experience. In an online survey, intact males predominantly identified the foreskin, not the glans, as the main site of sexual pleasure.[27] Cold and Taylor state that “the complex interaction between the protopathic sensitivity of the corpuscular-receptor-deficient glans penis and the corpuscular-receptor-rich ridged band of the male prepuce is required for normal copulatory behavior.”[1]
Nerve damage – Beyond the simple loss of nerve endings, several other forms of neuronal damage can occur with circumcision, due to the severing of nerves. Circumcision scars have been shown to contain amputation neuromas (tangles of nerve tissue resulting from abnormal regrowth) which do not transmit normal sensations, but typically produce pain.[1] In animal studies, extirpation of the external genitalia has been found to result in acute retrograde degeneration of the sexual nerve axons back to the spinal cord.[1]
Podnar found a significantly reduced ability to elicit the penilo-cavernosus reflex (muscle contractions associated with the ejaculation reflex [28]) in circumcised men compared to intact men.[29] Measurement of this reflex is widely used to diagnose underlying neurogenic disorders in erectile dysfunction.[28] Podnar was able to elicit the reflex in 92% of intact men, but only in 27% of circumcised men (p<0.001). A survey by Meislahn and Taylor similarly found that stretching of the penile skin in intact men (which includes the foreskin) more often produced erection and contractions of the bulbo-cavernosal muscle, as compared with stretching the remnant skin in circumcised men.[27]
Keratinization – Circumcision permanently exposes the normally covered, mucosal surface of the glans to air and friction, causing the glans to become abnormally dried out and thickened.[1] Sorrells et al. found the already light-touch-insensitive glans to be significantly less sensitive (p=0.040) in the circumcised male, an adverse effect that was found to increase over time.[18]
Summary – The anatomical effects of circumcision alter the mechanical dynamics of erection and intercourse, and produce an abnormal and deficient sensory input into the nervous system. Given this, it is hard to imagine that one would not find changes in sexual function and experience. A number of studies have found this to be the case, showing statistically significant evidence of degradation of male sexual performance and satisfaction, as discussed in the next section.
Impact on sexual performance and satisfaction
Besides anatomical studies and those testing penile sensory capacities such as those discussed above, further evidence on the sexual functionality of the foreskin comes from others types of investigations. Among others, these include surveys of adult men before and after circumcision;[8,30-39] surveys comparing circumcised and intact populations;[40,41] surveys of circumcision harm reported by circumcised men;[6,7] surveys on the sexual experiences of women with circumcised versus intact partners;[10,14,42,43] studies of effects on lubrication and intromission;[10,11,14] and collections of personal reports from men who have non-surgically restored their foreskins, thereby regaining coverage of the glans and mobility of the penile skin.[4,44]
Before and after studies of adult circumcision – Studies of sexual outcomes before and after adult circumcision are subject to several methodological limitations that may bias the results toward an underestimation of harm.
First, men who choose to be circumcised as adults are already predisposed to view the outcome as positive, either because they have a physical problem that circumcision resolves, or because they are seeking circumcision out of a pre-existing preference. The limited length of follow-up of before and after studies is another potential source of underestimation of harm. If circumcision has a desensitizing effect on the glans (whether due to keratinization or some other process [41]), and the desensitizing effect is progressive with age,[18] the 24 months or less of typical follow-up time might not be sufficient to detect a difference.[45] For this latter reason, studies finding no difference in penile sensitivity after adult circumcision cannot appropriately be extrapolated to individuals circumcised as infants, in which there is a much longer period before sexual debut than is ever studied in adults.[46]
Despite these built-in biases, a Korean survey found that a man was twice as likely to report diminished rather than improved sexuality after adult circumcision.[47] Overall, a worsening in sex life has been found in about one third of reported adult circumcision cases.[48]
Studies of men’s sexual performance and satisfaction before and after adult circumcision reveal an array of possible negative effects. Statistically significant increases have been found after adult circumcision in problems with erection,[30,32,33,49] prolonged time to ejaculation,[33,34,36,39,49-51] penile sensation,[32] difficult intromission,[33] and masturbatory ease and pleasure.[8]
Two before and after studies, carried out in conjunction with the African HIV trials, claim to have found no difference in sexual satisfaction and performance.[37,38] While these studies are initially suspect due to the implausibly low rates of sexual dysfunction found both before and after circumcision (much lower than studies performed outside of Africa [52]),[40] nonetheless they have been accorded particular attention and credibility,[53,54] presumably because of their randomized controlled design. However, RCTs are not immune to various sources of bias, for example:
• A strong study design does not eliminate the need for high-quality questionnaires. In one of these studies, the survey questions were so poorly designed that they could not have detected a difference in sexual outcomes, even if one existed.[55]
• The studies were carried out by the same researchers who ran the HIV trials in which the subjects had already participated, i.e. they were not impartial, independent investigators, nor blinded to the circumcision status of the subjects.
• The subjects themselves may have tended towards socially desirable responding, the tendency to provide answers that make one look good in relation to social norms and expectations, especially with self-reporting of sex data in face-to-face interviews.[56,57]
• Drop-out rates were significant for the HIV trial populations,[58] which could have affected the outcome results if men who experienced sexual problems after circumcision, or were reluctant to report them, were disproportionately present in the drop-out group.[40]
Large European surveys – Two large surveys recently compared sexual outcomes for circumcised versus intact men. Frisch et al. found that circumcised men in Denmark were more likely to report frequent orgasm difficulties than intact men.[40] In a survey from Belgium, Bronselaer et al. found that circumcised men reported decreased sexual pleasure and lower orgasm intensity at the glans compared to intact men, more effort required to achieve orgasm, and a higher percentage experienced unusual penile sensations (such as burning, prickling, itching, tingling, numbness, or pain).[41]
Premature ejaculation (PE) – A survey of men circumcised as adults in the UK about their sexual function before and after circumcision found no difference in premature ejaculation rates overall, however, the subjects were almost 3 times as likely to report worsening of PE after circumcision than improvement.[35] A study examining the correlates of premature ejaculation found that having been circumcised was significantly associated with PE among Malaysian men (OR=4.881).[59] However, other PE studies have not shown this association, reporting, instead, reduced rates of PE and longer time to ejaculation following adult circumcision.[60-62]
Effect on male sexual behavior
Several large surveys point to behavioral differences between circumcised and intact men. Laumann et al. found among circumcised American males a “more highly elaborated set of sexual practices,” including more frequent masturbation and a greater preference for oral sex.[63] The British National Survey of Sexual Attitudes and Lifestyles reported that circumcised males were more likely to report homosexual partners and partners from abroad.[64] Frisch et al. found that circumcised men were more likely to have had ten or more sexual partners compared to intact men.[40] Several studies have shown significantly lower rates of condom usage in circumcised men.[14,65]
Effect on partners of circumcised men
Circumcision not only impacts the sexual experience of the man himself, but also has appreciable effects on the experience of his sexual partners.

Circumcision has been found to significantly increase vaginal dryness during intercourse (Cortés-González, p=0.004).[10,14,42] As described above, in the intact penis, once inserted, the penile skin sheath stays relatively stable as it is held in place by the friction with the vaginal walls, while the shaft glides in and out of its own skin sheath. On the outstroke, the foreskin bunches up in a cuff around the glans, acting as a dam to retain natural lubrication, followed by redistribution of lubrication with the inward stroke. In the circumcised penis, without the foreskin cuff, the exposed coronal rim acts as a one-way valve to pull lubrication out of the vagina, while the taut shaft skin carries moisture out of the body with each outstroke where it is repeatedly exposed to air drying. One group of researchers advises “it is imperative that future studies of female arousal disorder report and control [for] the circumcision status of male sexual partners,” and suggests that ‘female arousal disorder’ may be a normal response to sex with a circumcised partner.[66]
The loss of the gliding action of the foreskin can lead to difficulties with intromission,[33] with an increased amount of force required for penetration.[11] The loss of gliding action can also lead to greater discomfort with intercourse due to the application of friction directly to the vaginal walls.[10] Discomfort from friction would be exacerbated by loss of natural lubrication or the presence of scrotal or pubic hair drawn onto the shaft by too tight an erection. These factors may have a particularly significant impact on women’s comfort during menopause,[66] when reduced natural lubrication and tissue atrophy commonly result in dyspareunia (painful intercourse).[67]
O’Hara et al. surveyed women with sexual experience with both circumcised and intact partners.[10] While this survey may have some limitations due to selection bias (since the participants were in part recruited through an anti-circumcision newsletter), participants’ responses did not differ with the source of recruitment. Participants overall reported, with circumcised partners as compared to intact, a decreased ability to experience orgasm with vaginal intercourse, decreased experience of multiple orgasms, decreased enjoyment of prolonged intercourse, and a decreased sense of intimacy with the partner. Even women who expressed a preference for circumcised partners reported more frequent experience of discomfort and progressively decreasing vaginal lubrication with intercourse.
The survey also found a difference in the mechanics of intercourse with circumcised versus intact partners. Participants reported that circumcised men “tend[ed] to thrust harder and deeper, using elongated strokes,” while intact men “tended to thrust more gently, to have shorter strokes, and tended to be in contact with the mons pubis and clitoris more.”[10] This dynamic reflects the self-stimulating action of the light-touch sensitive foreskin, which does not have to move very far back and forth to generate pleasurable sensations. The closer contact with the female pubic area may explain the association of greater ease of orgasm for women during intercourse with intact partners.
O’Hara’s qualitative results have been confirmed by subsequent studies. The large survey of the effects of circumcision on sexual function in Denmark, by Frisch et al., found circumcision significantly associated with a range of frequent sexual difficulties in women, notably orgasm difficulties, dyspareunia (OR=8.45), and “incomplete sexual needs fulfilment”.[40] A survey of Greek men circumcised as adults found that 46% of participants reported a worsened sex life for their female partner compared to 33% who reported an improvement for their partner.[36] Bossio et al., surveying Canadian and American women, found that women with a current intact partner reported higher levels of sexual satisfaction than women with a current circumcised partner, independent of whether they reported a preference for the circumcised penis for selected sexual acts.[43] On the other hand, a study based on the African HIV RCTs claimed similar or greater levels of sexual satisfaction among female partners after the spouse’s circumcision,[68] however, some of the same methodological limitations exist here as in the sexual satisfaction study in the same population of circumcised men, discussed above.
Studies claiming to show a preference of women for one or the other circumcision status have reported differing results, and results appear to be related to pre-existing experience with and beliefs about the circumcised or intact penis.[10,14,43,69]
Few studies have examined the effects of circumcision on the partners of gay men. In an Australian survey, gay men reported a progressive decline in the sensitivity of the glans more often in their circumcised partners, and reported that their circumcised partners were less likely to ask respondents to be gentler on their penis during sex.[14] In a survey of American and Canadian populations, gay men preferred an intact partner for all sexual activities, and held more positive beliefs about the intact penis than did women in this population.[43]
Summary
It is incontestable that circumcision eliminates from a man’s sexual experience any sensation in the foreskin itself, as well as any sexual functions that involve the manipulation of the foreskin, such as during foreplay or masturbation. That such pleasurable activities might have significant subjective value to genitally intact men and their partners is also uncontroversial.[70] Therefore, according to one commentator, to say that circumcision has little or no effect on sexual experience is to adopt “an extremely narrow conception of that term.”[45]
The contention that circumcision causes deficits in sexual sensation and function is supported by the fact that several products have been developed specifically for circumcised men to help overcome problems with penile sensation and function (e.g. Manhood®, Sensum+®, Senslip®);[71-73] by the association of circumcision with the need for artificial lubrication and erectile dysfunction drugs;[74] and by the fact that many circumcised men have sought out foreskin restoration techniques.[75,76]
Scientific evidence points to numerous deleterious effects of circumcision on the sensory and mechanical dimensions of sexuality, both for the man and for his sexual partners. For this reason, a number of authors have concluded that fully informed consent for circumcision must include disclosure of its potentially harmful effects on sexual satisfaction and performance.[14,35,41] The highly personal and subjective nature of sexuality argues all the more against irreversibly altering the genitals of children, before an age at which they are able to judge their own preferences and make their own mature decisions.
References
1. Cold CJ, Taylor JR. The prepuce. BJU Int. 1999;83(Suppl 1):34-44.
2. Werker PMN, Terng ASC, Kon M. The prepuce free flap: dissection feasibility study and clinical application of a super-thin new flap. Plast Reconstr Surg. 1998;102(4):1075-82.
3. Taylor JR, Lockwood AP, Taylor AJ. The prepuce: specialized mucosa of the penis and its loss to circumcision. Br J Urol. 1996;77:291-5.
4. Bigelow J. The Joy of Uncircumcising!, 2nd edition. Aptos (CA): Hourglass Book Publishing; 1995.
5. Fleiss PM, Hodges FM. What your doctor may not tell you about circumcision. New York: Warner Books; 2002.
6. Hammond T. A preliminary poll of men circumcised in infancy or childhood. BJU Int. 1999;83(Suppl 1):85-92.
7. Summary of findings. Global Survey of Circumcision Harm website; 2012.
8. Kim D, Pang M. The effect of male circumcision on sexuality. BJU Int. 2007;99(3):619-22.
9. Richters J, Gerofi J, Donovan B. Are condoms the right size(s)? A method for self-measurement of the erect penis. Venereology. 1995;8(2):77-81.
10. O’Hara K, O’Hara J. The effect of male circumcision on the sexual enjoyment of the female partner. BJU Int. 1999;83(Suppl 1):79-84.
11. Taves D. The intromission function of the foreskin. Med Hypotheses. 2002;59(2):180.
12. Morgan WKC. The rape of the phallus. JAMA. 1965;193:123-4.
13. Money J, Davison J. Adult penile circumcision: erotosexual and cosmetic sequelae. J Sex Res. 1983;19:289-92.
14. Bensley GA, Boyle GJ. Physical, sexual, and psychological effects of male infant circumcision: an exploratory survey. In: Denniston GC, Hodges FM, Milos MF, eds. Understanding circumcision: a multi-disciplinary approach to a multidimensional problem. New York: Kluwer Academic/Plenum Publishers; 2001. p. 207-39.
15. Winkelmann RK. The cutaneous innervation of the human newborn prepuce. J Invest Dermatol. 1956;26(1):53-67.
16. Winkelmann RK. The erogenous zones: their nerve supply and significance. Mayo Clin Proc. 1959;34(2):39-47.
17. Moldwin RM, Valderrama E. Immunochemical analysis of nerve distribution patterns within prepucial tissue. J Urol. 1989;141(4). Part 2:499A.
18. Sorrells ML, Snyder JL, Reiss MD, Eden C, Milos MF, Wilcox N, et al. Fine-touch pressure thresholds in the adult penis. BJU Int. 2007;99:864-9.
19. Masters WH, Johnson VE. Human sexual response. Boston: Little, Brown and Co.; 1966. p. 189-91
20. Payne K, Thaler L, Kukkonen T, Carrier S, Binik Y. Sensation and sexual arousal in circumcised and uncircumcised men. J Sex Med. 2007;4(3):667-74.
21. Halata Z, Munger BL. The neuroanatomical basis for the protopathic sensibility of the human glans penis. Brain Res. 1986;371:205-230.
22. Halata Z, Spaethe A. Sensory innervation of the human penis. Adv Exp Med Biol. 1997;424:265-6.
23. Bleustein CB, Fogarty JD, Eckholdt H, Arezzo JC, Melman A. Effect of neonatal circumcision on penile neurologic sensation. Urology. 2005;65(4):773-7.
24. Bossio JA, Pukall CF, Steele SS. Examining penile sensitivity in neonatally circumcised and intact men using quantitative sensory testing. J Urol. 2015 Dec 24. pii: S0022-5347(15)05535-4. doi: 10.1016/j.juro.2015.12.080. [Epub ahead of print]
25. Jennifer Bossio confirmed: foreskin most sensitive part of the penis. CircWatch website. 17 Apr 2016. 26. Earp BD. Infant circumcision and adult penile sensitivity: implications for sexual experience. Trends Urol Mens Health. 2016;7(4):17-21.
27. Meislahn HS, Taylor JR. The importance of the foreskin to male sexual reflexes. In: Denniston GC, Hodges FM, Milos MF, eds. Flesh and blood: perspectives on the problem of circumcision in contemporary society. New York: Kluwer Academic/Plenum Publishers; 2004. p. 27-43.
28. Assessment: neurological evaluation of male sexual dysfunction. Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 1995;45(12):2287-92.
29. Podnar S. Clinical elicitation of the penilo-cavernosus reflex in circumcised men. BJU Int. 2011;109;582-585.
30. Coursey JW, Morey AF, McAninch JW, Summerton DJ, Secrest C, White P, et al. Erectile function after anterior urethroplasty. J Urol. 2001;166(6):2273-6.
31. Collins S, Upshaw J, Rutchik S, Ohannessian C, Ortenberg J, Albertsen P. Effects of circumcision on male sexual function: debunking a myth? J Urol. 2002;167(5):2111-2.
32. Fink KS, Carson CC, DeVellis RF. Adult circumcision outcomes study: effect on erectile function, penile sensitivity, sexual activity and satisfaction. J Urol. 2002;167(5):2113-6.
33. Shen Z, Chen S, Zhu C, Wan Q, Chen Z. [Erectile function evaluation after adult circumcision]. Zhonghua Nan Ke Xue. 2004;10(1):18-9. Chinese.
34. Senkul T, IşerI C, Şen B, Karademir K, Saraçoğlu F, Erden D. Circumcision in adults: effect on sexual function. Urology. 2004;63(1):155-8.
35. Masood S, Patel HR, Himpson RC, Palmer JH, Mufti GR, Sheriff, MK. Penile sensitivity and sexual satisfaction after circumcision: are we informing men correctly? Urol Int. 2005;75(1):62-66.
36. Solinis I, Yiannaki A. Does circumcision improve couple’s sex life? J Mens Health. 2007;4(3):361.
37. Krieger JN, Mehta SD, Bailey RC, Agot K, Ndinya-Achola JO, Parker C, et al. Adult male circumcision: effects on sexual function and sexual satisfaction in Kisumu, Kenya. J Sex Med. 2008;5911:2610-22.
38. Kigozi G, Watya S, Polis CB, Buwembo D, Kiggundu V, Wawer MJ, et al. The effect of malecircumcision on sexual satisfaction and function, results from a randomized trial of male circumcision for human immunodeficiency virus prevention, Rakai, Uganda. BJU Int. 2008;101:65-70.
39. Senol MG, Sen B, Karademir K, Sen H, Saraçoğlu M. The effect of male circumcision on pudendal evoked potentials and sexual satisfaction. Acta Neurol Belg. 2008;108(3):90-3.
40. Frisch M, Lindholm M, Grønbæk M. Male circumcision and sexual function in men and women: a survey-based, cross-sectional study in Denmark. Int J Epidemiol. 2011;40(5):1367–81.
41. Bronselaer GA, Schober JM, Meyer-Bahlburg HF, T’sjoen G, Vlietinck R, Hoebeke PB.Male circumcision decreases penile sensitivity as measured in a large cohort. BJU Int. 2013;111(5):820-7.
42. Cortés-González JR, Arratia-Maqueo JA, Gómez-Guerra LS. [Does circumcision has [sic] an effect on female’s perception of sexual satisfaction?] Rev Invest Clin. 2008;60(3):227-30. Spanish.
43. Bossio J, Pukall CF. You either have it or you don’t: the impact of male circumcision status on sexual partners. Can J Hum Sex. 2015;24(2):104-119.
44. Men speak about foreskin restoration. National Organization of Restoring Men website; 1997-2006.
45. Earp BD, Darby R. Does science support infant circumcision? The Skeptic. 2015;25(3):23-30.
46. Earp BD. Sex and circumcision. Am J Bioethics. 2015;2:43-45.
47. Pang MG, Kim DS. Extraordinarily high rates of male circumcision in South Korea: history and underlying causes. BJU Int. 2002;89:48-54.
48. Dalton JD. Effect of circumcision on intromission and sexual satisfaction [rapid response letter]. Br Med J. 2008 Jan 7.
49. Dias J, Freitas R, Amorim R, Espiridião P, Xambre L, Ferraz L. Adult circumcision and male sexual health: a retrospective analysis. Andrologia. 2014;46(5):459-64.
50. Thorvaldsen MA, Meyhoff H. Patologisk eller fysiologisk fimose? Ugeskr Læger. 2005;167(17):1858-62.
51. Gao J, Xu C, Zhang J, Liang C, Su P, Peng Z, et al. Effects of adult male circumcision on premature ejaculation: results from a prospective study in China. Biomed Res Int. 2015;2015:417846.
52. Van Howe RS. A CDC-requested, evidence-based critique of the Centers for Disease Control and Prevention 2014 draft on male circumcision: how ideology and selective science lead to superficial, culturally-biased recommendations by the CDC. Academia website. January 2015.
53. American Academy of Pediatrics, Task Force on Circumcision. Male circumcision. Pediatrics. 2012;130:e756-e785.
54. Background, methods, and synthesis of scientific information used to inform the “Recommendations for providers counseling male patients and parents regarding male circumcision and the prevention of HIV infection, STIs, and other health outcomes.” Division of HIV/AIDS Prevention National Center for HIV/AIDS, Viral Hepatitis, STD, TB Prevention Centers for Disease Control and Prevention. ID: CDC-2014-0012-0001
55. Frisch M. Author’s response to: Does sexual function survey in Denmark offer any support for male circumcision having an adverse effect? Int J Epidemiol. 2012;41(1):312-4.
56. Earp BD. The need to control for socially desirable responding in studies on the sexual effects of male circumcision. PLoS One. 2015;10(9):1-12.
57. Meston CM, Heiman JR, Trapnell PD, Paulhus DL. Socially desirable responding and sexuality self-reports. J Sex Res. 1998;35(2):148-157.
58. Boyle GJ, Hill G. Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: methodological, ethical and legal concerns. J Law Med. 2011;19(2):316-34.
59. Tang WS, Khoo EM. Prevalence and correlates of premature ejaculation in a primary care setting: a preliminary cross-sectional study. J Sex Med. 2011;8(7):2071-8.
60. Shaeer O. The Global Online Sexuality Survey (GOSS): The United States of America in 2011 Chapter III–Premature ejaculation among English-speaking male Internet users. J Sex Med. 2013;10(7):1882-8.
61. Alp BF, Uguz S, Malkoc E, Ates F, Dursun F, Okcelik S, et al. Does circumcision have a relationship with ejaculation time? Premature ejaculation evaluated using new diagnostic tools. Int J Impot Res. 2014;26(4):121-3.
62. Gao J, Xu C, Zhang J, Liang C, Su P, Peng Z, et al. Effects of adult male circumcision on premature ejaculation: results from a prospective study in China. Biomed Res Int. 2015;2015:417846.
63. Laumann, EO, Masi CM, Zuckerman EW. Circumcision in the United States. JAMA. 1997;277(13):1052-7.
64. Dave SS, Johnson AM, Fenton KA, Erens B, Wellings K, Johnson AM. Male circumcision in Britain: findings from a national probability sample survey. Sex Trans Infect. 2003;79:499-500.
65. Crosby R, Charnigo RJ. A comparison of condom use perceptions and behaviours between circumcised and intact men attending sexually transmitted disease clinics in the United States. Int J STD AIDS. 2013;24(3):175-8.
66. Bensley GA, Boyle GJ. Effects of male circumcision on female arousal and orgasm. N Z Med J. 2003;116(1181):595-6.
67. Kingsberg SA, Kellogg S, Krychman M. Treating dyspareunia caused by vaginal atrophy: a review of treatment options using vaginal estrogen therapy. Int J Womens Health. 2009;1:105-111.
68. Kigozi G, Lukabwe I, Kagaayi J, Wawer MJ, Nantume B, Kigozi G, et al. Sexual satisfaction of women partners of circumcised men in a randomized trial of male circumcision in Rakai, Uganda. BJU Int. 2009 Dec;104(11):1698-701.
69. Williamson ML, Williamson PS. Women’s preferences for penile circumcision in sexual partners. J. Sex Educ Ther. 1988;14:8-12.
70. Darby R, Cox L. Objections of a sentimental character: the subjective dimensions of foreskin loss. In: Zabus C, ed. Fearful symmetries: essays and testimonies around excision and circumcision. Amsterdam and New York: Rodopi; 2008.
71. Manhood®- The world’s first foreskin substitute. Manhood® website. 2016. Available at: http://www.manhood.mb.ca
72. Innovus pharmaceuticals announces successful top line clinical results from Sensum+® in diabetic and non-diabetic circumcised men with low penile sensitivity. Marketwired website. 19 Nov 2015. Available at: http://www.marketwired.com
73. SenSlip® foreskin. SenSlip Website. Available at: http://www.senslip.com
74. Bollinger D, Van Howe RS. Alexythmia and circumcision trauma: a preliminary investigation. Int J Mens Health. 2011;10(2):184-195.
75. Swanson J. Uncut: a look at the wacky, wrinkly world of foreskin restoration. The Village Voice website. 2015 Oct 6.
76. Foregen – Promoting genital integrity through regenerative medicine. Foregen website. 2016. Available at: http://www.foregen.org
Published May 2016

The WHO, who deals with the HIV epidemic Africa debates the function of the foreskin, and other groups have stated that general penile function is not inhibited by the loss of foreskin. This does not mean that it is a functionless tissue. I’d rather take my chances with an easily treatable “medical condition” than remove a functional anatomical unit- even if the general functions of the penis are not inhibited.

https://www.facebook.com/TheOnion/video ... 793959497/

[James]

from "americas finest news source"

https://www.facebook.com/TheOnion/video ... 793959497/

[Steve]

James: It’s easy to just do what everyone does because it’s the norm.

It's been the norm for millennia, not just the norm in today's world. It's also been the norm for some of the best men to ever live across those centuries, so it's not just some fashionable trend among the worldly. It was even an ordinance established by the Lord (see Genesis and Acts). So your protests to my statement about precedent may be unnecessary.

James: Benefits, they may be large or small. Significant health indicators or insignificant. All they have to do to make their statement true (the benefits outweigh the risks) is outweigh the risk of performing circumcision, a quick bedside procedure.

So would you say that these organizations have conspired to spread false information? I really appreciate this discussion, as you've raised questions about the trustworthiness of even the most reputable medical institutions. This will be a useful reference in many other threads that currently exist, and will likely exist in the future of this forum.

James: Well there is the scar, he’ll see that. And part of the pain is that it will never be seen. Circumcision permanently changes the way the genitals will look.

Genital vanity is probably not the most pressing influence for a parent's decision-making process.

You then go on to post a single doctor's paper—in order to oppose several respected institutions (filled with renowned doctors) and their reviews of hundreds of studies—Wikipedia, and the single "doctors opposing" site.

I mentioned money because there is a strong correlation between lower circumcision rates among individuals with fewer financial resources. It's an observation that is worth noting when citing lower rates as evidence of scientific advancement.

I mentioned the natural state of things because you seem to believe that the default "do nothing" response is the best approach when grappling with uncertainty. I'm only suggesting, with many examples, that this is not always true.

My principal argument is actually that we spend too much time worrying about an issue that I am confident holds little bearing in the eternities. I believe this is true because of its lack of coverage by the Lord in these latter days. There are thousands of issues that should be of greater concern. Fighting circumcision is a red herring in the grand scheme of causes. I can literally think of thousands of things a parent can do that will impact their son in far more significant and enduring ways—emotionally, mentally, spiritually, physically, you name it—than circumcision.

EDIT: That is not said to begrudge the choice of topic. We talk about many trivial things on this forum. I'm simply saying that if a parent is feeling a sense of urgency and deep concern about circumcision, I would suggest (as you alluded to with your healthcare dollars comments) spending the urgency and concern on more pressing matters. For conversation, sure, it's an interesting topic. As a cause that you dedicate yourself to researching for fear of unleashing some drastic consequence on the children of the world? Not so much.

[James]

Steve said, "It's been the norm for millennia, not just the norm in today's world. It's also been the norm for some of the best men to ever live across those centuries, so it's not just some fashionable trend among the worldly. It was even an ordinance established by the Lord (see Genesis and Acts). So your protests to my statement about precedent may be unnecessary"

It is only the norm for millennia in Jewish and Islamic circles. Abraham Lincoln and George Washington were not circumcised. Also, look at the Vitruvian man! His genitals were intact. Why mention degrees of greatness? You and Ian both mentioned that some of the best men to ever live were circumcised. Circumcision does not necessarily have bearing on a man's character and a man's degree of a man's greatness may come from any number of sources. Lets not judge mens characters in connection to their circumcision. The Jewish ritual does not pertain to us. Ive been told by Jewish sources that circumcisions symbolism is about sacrificing some of your pleasure in the name of God. It is a reminder that God is more important than our pleasure. Yes Steve there is precedent, but I am not sure it is really relevant in todays world.

Steve said, "So would you say that these organizations have conspired to spread false information? I really appreciate this discussion, as you've raised questions about the trustworthiness of even the most reputable medical institutions. This will be a useful reference in many other threads that currently exist, and will likely exist in the future of this forum."

I am unaware of the degree of their conspiracy. Perhaps a combination of influences effects circumcision rates in America. 1. tradition 2. parents who think it is hygienic even though its not. 3. money 4. other things. And its not surprising that such things happen from time to time. The tobacco industry paid doctors to make false claims about smoking. More recently we were told for decades that fat is bad. The low fat diet was promoted by drs, our government, and the food industry. We invented margarine and consumed trans fatty acids. My dads doctor reccomened margarine to him back in the 90s. Recently these promotions were debunked. It turns out the sugar industry had stakes in that story. Even though its been debunked we are still affected by low fat fad. Last time I was at the grocery store I could not find full fat yogurt. But there were hundreds of fat free options. Exxon Mobile had information about climate change in the 1980s. They used money and power to hide the truth and promote fake science and lies. Those unfortunate positions regarding climate change still ripple through our country and even in our government.

But look closely. even the AAP does not recommend routine circumcision. Ian referenced that a post or 2 above. Even though they pad the benefits they don't really lie. I outline it in detail above. The risk is now because they use a little clamp at your bedside. The benefits are slightly lower rates of certain rare cancers etc. Some of the benefits apply more in localized situations such as Africa.

Steve said, "You then go on to post a single doctor's paper—in order to oppose several respected institutions (filled with renowned doctors) and their reviews of hundreds of studies—Wikipedia, and the single "doctors opposing" site."

I have posted references to multiple dr papers and several respected institutions filled with renowned doctors. Wikipedia is a useful reference for general information because false information is quickly debated and removed. Doctors opposing is a team of professionals and they cite hundreds of high quality references. I also rely on the NHS website (NHS is Great Brittains healthcare system). The WHO debates what the function of the foreskin is, and thinks it good for Africa. The WHO also ranks the USA healthcare system as 31st in the world. But we do have a huge AAP!

Steve said, "I mentioned money because there is a strong correlation between lower circumcision rates among individuals with fewer financial resources. It's an observation that is worth noting when citing lower rates as evidence of scientific advancement."

Actually the highest circumcision rates are in Africa, where there are often fewer financial resources. The lowest circumcision rates are found in such places as Europe, where we find the best, and most universally delivered healthcare systems. In such developed countries as Great Britain, France, Germany, Denmark, Norway, etc. we find that almost nobody is circumcised. Are these countries running wild with UTIs, yeast infections, and penile cancers? No. They are doing fine.

Steve said, "My principal argument is actually that we spend too much time worrying about an issue that I am confident holds little bearing in the eternities. I believe this is true because of its lack of coverage by the Lord in these latter days. There are thousands of issues that should be of greater concern. Fighting circumcision is a red herring in the grand scheme of causes. I can literally think of thousands of things a parent can do that will impact their son in far more significant and enduring ways—emotionally, mentally, spiritually, physically, you name it—than circumcision.

EDIT: That is not said to begrudge the choice of topic. We talk about many trivial things on this forum. I'm simply saying that if a parent is feeling a sense of urgency and deep concern about circumcision, I would suggest (as you alluded to with your healthcare dollars comments) spending the urgency and concern on more pressing matters. For conversation, sure, it's an interesting topic. As a cause that you dedicate yourself to researching for fear of unleashing some drastic consequence on the children of the world? Not so much."

I think there is a niche for the circumcision debate in our society. I think that as it is discussed more, people will begin to understand the AAPs position more clearly and will make more informed decisions for their sons. While I grant that there are thousands of really important issues I do not underestimate the emotional effects that may or may not result from circumcision. With circumcision I have a strong position but generally do not feel urgency and concern much. This discussion has caused me to have more strong feelings about circumcision than I would have otherwise had. HFW has been the single greatest provocation of unbridled passion I've ever had in my life. I have lost many nights sleep, have pumped up my blood pressure, and have seen tears fall, and have spent countless hours processing stuff from HFW. While this website has caused me to learn a ton about some subjects, it has also brought out the worst in me on several occasions. It is with great effort that I restrain myself from such trivial topics and focus on the most important things in life.

[Steve]

James: Yes Steve there is precedent, but I am not sure it is really relevant in todays world.

But you're also not sure it isn't really relevant either.

James: Perhaps a combination of influences effects circumcision rates in America. ... 2. parents who think it is hygienic even though its not.

...or parents who think it is not hygienic even though it is. The word "perhaps" is key here. For the record, I actually approved of your distrust of scientific publication as the "end-all" authority. Far too many rely on the philosophies of men rather than relying on the Spirit of Truth (the Holy Ghost) and the Savior (John 14:6).

James: Are these countries running wild with UTIs, yeast infections, and penile cancers? No. They are doing fine.

Are nations with high circumcision rates running wild with major related problems? No. Are nations with high rates of pornography consumption and infidelity and fatherlessness running wild with major related problems? Yes. Hence, the reason this will probably be my last reply to this thread, as I think I've expended my concern for this particular issue.

James: This discussion has caused me to have more strong feelings about circumcision than I would have otherwise had.

That is the entrenching effect of these sorts of discussions. Rarely do people switch sides on issues they feel strongly about, particularly when those issues are fueled by speculation on both sides and lack authoritative certainty.

James: HFW has been the single greatest provocation of unbridled passion I've ever had in my life. ... It is with great effort that I restrain myself from such trivial topics and focus on the most important things in life.

It's a shame that some may feel this way. I think that may be one of the topics we should focus on here, as opposed to expending so much energy on the periphery. As it stands, family members express grave concerns about guns, circumcision, BYU policies, presidential candidates, and a whole slew of other topics, rather than working through the matters concerning communication and relationships. The way I see it is that all other discussions prove somewhat fruitless when the means by which they are discussed prevent anyone's words from getting through to the other parties with love and genuine interest. Generating ideas for and contributing to the best of a family forum will probably improve discussion of any topic.