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Understanding the psychological harm of male circumcision: Workshop at Keele University to enable counsellors to recognise specific symptoms not always acknowledged by the client and others, and to help professionals provide an appropriate response. Details and registration
Health related and sexual consequences of non-therapeutic male circumcision in children. Presentation by Dr. Morten Frisch at the World Association for Sexual Health Congress. video
Long-term adverse outcomes from neonatal circumcision in a survey of 1,008 men: an overview of health and human rights implications. Hammond & Carmack, International Journal of Human Rights. View Abstract | Download PDF
Male circumcision greatly increases risk of urinary problems read moreDr. Adrienne Carmack discusses facts, myths and harms of circumcision hear podcast
Millennial Men Rush to Restore Their Foreskins, ‘Feel Whole Again’ video here
2016 Nov: Canada's Children's Health & Human Rights Partnership has launched a harm survey (until 30 April 2017) for men circumcised in Canada read more
Male circumcision and male suicide: is there a link? read more
The harm of the U.S. and W.H.O. led 'Voluntary Medical Male Circumcision' program in Africa (PDF)
Intactivist Jonathon Conte (1981-2016) speaks about circumcision harm
Tim Hammond presents Global Survey of Circumcision Harm findings at the International Conference on Men's Issues - London, England video here
2016 Jan: Circumcision-Your Son's First Shared Sexual Experience, Marilyn Milos, R.N. explains (1994) video here
2015 Sep: Canadian Research Confirms Dissatisfaction in Circumcised Men (esp. Ch. 5) paper here
2015 May: Tim Hammond presents Global Survey of Circumcision Harm findings at the International Genital Autonomy Conference (Frankfurt, Germany) video here
Dr. Morten Frisch discusses damage caused by infant circumcision (Christiansborg, Denmark) YouTube video here2016 Sep 14:
"Healing the Wounds of Circumcision" (six week support group - Vancouver, Canada) view flyer
Female genital mutilation and male circumcision: Time to end the double standard [Practical Ethics, Univ of Oxford]
Researchers and the academically inclined may want to examine recent published research on natural penile anatomy, foreskin physiology, harm caused by circumcision, specious claims of circumcision for HIV reduction, and policies of world medical associations that are beginning to recognize the human rights implications of circumcising unconsenting children. If you know of other related research that we should post here, please contact us to suggest it.
Members of the general public wanting to know more about the benefits and functions of the foreskin and the inherent harm of childhood circumcision, will find these videos helpful in explaining these issues in visual terms.
Whose Body, Whose Rights? Cut: Slicing through the Myths (Jewish perspective) Circumcision: The Whole Story (as told by an M.D.)
Members of the news media can delve further into the circumcision debate and stay better informed through these sites.
News-media organization connecting all facets
of the genital integrity movement
Learn about those who fund, promote,
and profit from circumcision
Attorneys for the Rights of the Child
Learn how infant circumcision violates a child's basic human rights and why doctors can be sued if they admit it's not medically necessary
Healing Resources for men seeking to overcome the physical, sexual or psychological consequences of circumcision.
Emotional/psychological support for men
dealing with the damaging effects of circumcision.
Restoration Videos & Devices
Learn about foreskin restoration
and available devices.
Connect with and learn from other men pursuing foreskin restoration.
ARTICLES pull-quotes in italics [Programmer comments in brackets]
Male Circumcision decreases penile sensitivity as measured in a large cohort (Bronselaer, et al /2013)
This study confirms the importance of the foreskin for penile sensitivity, overall sexual satisfaction, and penile functioning. Furthermore, this study shows that a higher percentage of circumcised men experience discomfort or pain and unusual sensations as compared with the uncircumcised population. Before circumcision without medical indication, adult men, and parents considering circumcision of their sons, should be informed of the importance of the foreskin in male sexuality.
Study links circumcision to personality disorder and erectile dysfunction (Bollinger, Van Howe /2011 - article PDF)
Circumcised men are 60% more likely to suffer from alexithymia, the inability to process emotions, and have a 4.5 times greater chance of suffering from erectile dysfunction than intact men. Psychologists counseling alexithymic patients should investigate the patient’s childhood and neonatal history for possible traumatic events, including circumcision. Another study also found a
high incidence of alexithymia in patients with erectile dysfunction, and went on to surmise that alexithymia contributed to the origin of the dysfunction. Infant circumcision is a confounder for research studies in general and might be skewing
gender studies. Controlling for circumcision status is key in gender studies say the authors of one study, who effectively argued that what some researchers are measuring as gender differences is really an aftermath of circumcision experiences
Male circumcision and sexual function in men and women: a survey-based, cross-sectional study in Denmark (Frisch, et al/2011)
Circumcision was associated with frequent orgasm difficulties in Danish men and with a range of frequent sexual difficulties in women, notably orgasm difficulties, dyspareunia and a sense of incomplete sexual needs fulfilment. Thorough examination of these matters in areas where male circumcision is more common is warranted. related news story at Science Nordic
Fine-touch pressure thresholds in the adult penis (Sorrells, et al/2007)
The fine-touch sensitivity of 19 locations on the penis was measured using Semmes-Weinstein monofilament touch-test sensory
evaluators to create a penile sensitivity map. ...Locations 2–5 and 13–16 were measured only in uncircumcised men because these locations are ablated by circumcision.
When compared to the most sensitive area of the circumcised penis, several locations on the uncircumcised penis (the rim of the preputial orifice, dorsal and ventral, the frenulum near the ridged band, and the frenulum at the muco-cutaneous junction) that are missing from the circumcised penis were significantly more sensitive.
The glans of the circumcised penis is less sensitive to fine touch than the glans of the uncircumcised penis. The transitional region from the external to the internal prepuce is the most sensitive region of the uncircumcised penis and more sensitive than the most sensitive region of the circumcised penis. Circumcision ablates the most sensitive parts of the penis.
The effect of male circumcision on sexuality (Kim & Pang/2006)
There was a decrease in masturbatory pleasure and sexual enjoyment after circumcision, indicating that adult circumcision adversely affects sexual function in many men, possibly because of complications of the surgery and a loss of nerve endings.
The Prepuce: Anatomy, Physiology, Innervation, Immunology and Sexual Function (Cold & Taylor/1999)
The complex anatomy and function of the prepuce, along with the fused prepuce/glans penile mucosa in the immature penis, dictates that neonatal circumcision be strictly avoided, as recommended by the Australasian Paediatric surgeons, Canadian Paediatric Society, and a paediatric urology textbook. Removal of normal genital anatomy in children and infants should be deferred until the individual can make an informed decision.
Anatomy and Histology of the Penile and Clitoral Prepuce in Primates: An Evolutionary Perspective of the Specialised Sensory Tissue of the External Genitalia (Cold & McGrath/1999)
The prepuce provides a complete or partial covering of the glans clitoridis or penis. For over a hundred years, anatomical research has confirmed that both the penile and clitoral prepuce are richly innervated, specific erogenous tissue with specialised encapsulated (corpuscular) sensory receptors, such as Meissner's corpuscles, Pacinian corpuscles, genital corpuscles, Krause end bulbs, Ruffini corpuscles, and mucocutaneous corpuscles. These receptors transmit sensations of fine touch, pressure, proprioception, and temperature.
Although Taddio's work suggests a central nervous system change, it is unclear whether circumcision alters sexual behaviour by central nervous system changes, local sensory alterations of the external genitalia or a combination of both central and peripheral nervous system changes. [Survey Programmer: see hypotheses below by Immerman & Mackey]
The reproductive advantages provided by the prepuce during the last 65 million years should not be taken lightly. The results of this study demonstrate that the human prepuce is not "vestigial" but is, in fact, an evolutionary advancement over the prepuce of other primates.
A Preliminary Poll of Men Circumcised in Infancy or Childhood (Hammond/1999)
An estimated 650 million males and 100 million females living today were genitally altered as children. Annually, 13 million boys and 2 million girls in developing and developed nations undergo customs of genital cutting.
Uncritical acceptance of circumcision in youth may fade as the person becomes better informed.
Without appropriate research into outcomes, presumptions of beneficial or even benign results from childhood circumcision are unjustified. Respondents reported wide-ranging physical consequences from their circumcisions. Among the most significant were prominent scarring (33%), insufficient penile skin for a comfortable erection (27%), erectile curvature from uneven skin loss (16%), pain and bleeding upon erection/manipulation (17%), painful skin bridges (12%), other, e.g., beveling deformities of the glans, meatal stenosis, recurrent non-specific urethritis (20%).
The reported sexual consequences included: progressive sensory deficit in the preputial remnant and glans (61%), causing sexual dysfunction (erectile problems, ejaculatory difficulties and/or anorgasmia); extraordinary stimulation required for orgasm (40%), with many respondents reporting that vaginal sex offered inadequate stimulation for pleasure and/or orgasm; and sexual dysfunction resulting from emotional distress. [Survey Programmer: this perhaps explains the earlier similar findings by Laumann]
Anxiety, depression and sexual problems relate to the magnitude and type of loss. All respondents described emotional suffering after realizing they had been dispossessed of an irreplaceable part of their body. Some revealed violent attitudes toward their circumciser and/or suicidal/homicidal feelings.
These potent views...are a reminder of how assaults on male genitalia reflect misandry, the origins of which are found in society and religion.
Religion can be a powerful influence in suppressing knowledge, and in promoting denial of sexual functioning and the consequences of circumcision.
Perhaps like no other surgery, circumcision produces patients who later invest time, money and effort to 'undo' the effects.
Respondents may not currently represent the average male circumcised in childhood, but they may be a vanguard. Surveys of body image consistently reveal significant dissatisfaction with circumcision. One report suggested that 20% of circumcised men were dissatisfied with their condition, while 18% of them would rather not have been circumcised.
A Proposed Relationship Between Circumcision and Neural Reorganization (Immerman & Mackey/1998)
http://www.cirp.org/library/psych/immerman1/A Biocultural Analysis of Circumcision (Immerman & Mackey/1997)
It is hypothesized that circumcision reorganizes the male's sensory somato-cortex to raise the threshold of sexual excitability/distraction. This threshold shift thereby allows the young men of a social group (a) to be slightly more tractable in executing corporate activities beneficial to the community and (b) to be slightly more restrained sexually and more cooperative in the pair bond.
Sensation is localized within the brain. If circumcision affects the sensory pathways of the brain, then the implication should be strong that subsequent sexual sensations will also be affected. Studies on the triangulation of the foreskin, the central nervous system, and circumcision have yet to be conducted or, at least, are not easily located. Nonetheless, inferential evidence is available.
It appears that any sensory deprivation of a system can also lead to cortical changes. ...The earlier in the male's life the circumcision occurs, the more impact the ablation would be expected to have on his nervous system and, hence, his behavioral tendencies. Thus, we argue here that removal of an individual's foreskin has consequences in that person's brain.
The argument put forward by this thesis is that imaging of the brain via positron emission tomography (PET) and/or magnetic resonance imaging (MRI) could detect differences in the somato-sensory cortex when it receives stimuli from the genitalia of circumcised men compared with similar cortical areas of uncircumcised men. These differences ought to be structural as well as functional.
[Survey Programmer: see our comments under the 1997 Immerman & Mackey article below]
Neurological data suggest that early lesions of the prepuce/foreskin tissues would generate a reorganization/atrophy of the brain circuitry. This re-organization/atrophy, in turn, is suggested to lower sexual excitability. Epithelial data indicate that keratinization of the more exposed glans penis would lower the sensibility, hence sexual excitability of the circumcised males' genitalia. In addition, circumcision removes the foreskin-prepuce which by secreting smegma, would also minimize any pheromonic qualities which the smegma may generate. Inferential data support the hypothesis that a practical consequence of circumcision, complementary to any religious-symbolic function, is to make a circumcised male less excitable and distractible, and, hence, more amenable to his group's authority figures.
[Survey Programmer: If these hypotheses were to be scientifically proven as suggested in the authors' 1998 article, say through dissection of the brains of circumcised and intact corpses, or by PET or MRI scans of brain activity during sexual stimulation of living circumcised and intact males, this may substantiate the increasingly held belief about the earliest anti-sexual motivations for circumcision, at least among Jews, Moslems and some African, Aboriginal and other tribes. Those anti-sexual motivations resurfaced under the guise of 'medicine' during the Victorian Era among 'modern' English-speaking nations of the West. Today's practice of medicalized non-religious circumcision is the progeny of those earlier sex-negative beliefs. With the original intent long-forgotten, the practice finds current acceptance under the guise of medicine, religion and social conformity. Perhaps just as male rape of females is not about sex but about individual power and violence, forced circumcision of male minors can be viewed as being less about health and spirituality than about the dynamics of male group power and control.]
Circumcision in the United States: Prevalence, Prophylactic Effects, and Sexual Practice (Laumann/1997)
NHSLS data indicate that circumcised men engage in a somewhat more elaborated set of sexual practices than do men who are not circumcised. For each of the practices examined, lifetime experience of various forms of oral and anal sex and masturbation frequency in the past year, circumcised men engaged in these behaviors at greater rates. The difference between circumcised men was greatest for masturbation - ironically, a practice that circumcision was once thought to limit. A total of 47% of circumcised men reported masturbating at least once a month vs 34% for their uncircumcised peers.
[Survey Programmer: Results from this Global Survey of Circumcision Harm, and the earlier work of Hammond, indicate that significant percentages of circumcised survey respondents report needing more stimulation to achieve orgasm and are less satisfied after orgasm, which leads them to seek sex more frequently (compulsivity and/or promiscuity). This could explain why Laumann's subjects appeared to be less satisfied with traditional vaginal intercourse and needed to find more stimulative and more frequent means of seeking sexual satisfaction (oral sex/anal sex/masturbation). Circumcised women have been found to exhibit similar compensatory behaviours and alternative sexual practices - see Sexual Effects at Wikipedia. Circumcision imposed on unconsenting males may even have a link (as yet unstudied) to increased satyriasis and "violent concupiscence" (rape) that the 13th Century Jewish philosopher Maimonides claimed circumcision would allegedly 'diminish'.].
The prepuce: Specialized mucosa of the penis and its loss to circumcision (Taylor/1996)
The prepuce provides a large and important platform for several nerves and nerve endings. The innervation of the outer skin of the prepuce is impressive; its sensitivity to light touch and pain are similar to that of the skin of the penis as a whole. The glans, by contrast, is insensitive to light touch, heat, cold and, as far as the authors are aware, to pin-prick. Le Gros Clark noted that the glans penis is one of the few areas on the body that enjoys nothing beyond primitive sensory modalities.
...the 'ridged band' with its unique structure, tactile corpuscles and other nerves, is primarily sensory tissue and that it cooperates with other components of the prepuce. In this model, the 'smooth' mucosa and true skin of the adult prepuce act together to allow the 'ridged band' to move from a forward to a 'deployed' position on the shaft of the penis. In short, the prepuce should be considered a structural and functional unit made up of more and less specialized parts.
Complications of Circumcision (Williams & Kapila/1993)
Some authors have reported a complication rate as low as 0.06 per cent, while at the other extreme rates of up to 55 per cent have been quoted. This reflects the differing and varying diagnostic criteria employed; a realistic figure is 2-10 per cent. Although haemorrhage and sepsis are the main causes of morbidity, the variety of complications is enormous. The literature abounds with reports of morbidity and even death as a result of circumcision.
The Universality of Incest (DeMause/1991)
The mutilation of children's genitals is such a important need in humans that whole religions and state systems have been founded upon the practice. Yet when scholars attempt to explain why almost everyone since the beginning of recorded history has massively assaulted the genitals of their children, they assiduously deny that it is a sexual perversion or that those who do it ever mean any harm to the children.
There is hardly an imaginable form of genital assault that is not regularly performed on children. Girls' genitals are tattooed, cut off, sewn up, burned off, and ripped open with the fingers. Boys' genitals are pierced by objects, sewn up, burned, cut off, flayed, "gashed open [so that] wedges of flesh are removed."
Maimonides Part III, Ch. 49 [13th Century Jewish rabbi; perhaps the first written hypothesis of the intentional damaged inflicted by circumcision]
http://www.cirp.org/library/cultural/maimonides/ and http://www.jewsagainstcircumcision.org/jewish.htm
The bodily pain caused to that member is the real purpose of circumcision. None of the activities necessary for the preservation of the individual is harmed thereby, nor is procreation rendered impossible, but violent concupiscence and lust that goes beyond what is needed are diminished. The fact that circumcision weakens the faculty of sexual excitement and sometimes perhaps diminishes the pleasure is indubitable. For if at birth this member has been made to bleed and has had its covering taken away from it, it must indubitably be weakened. The Sages, may their memory be blessed , have explicitly stated: It is hard for a woman with whom an uncircumcised man has had sexual intercourse to separate from him. In my opinion this is the strongest of the reasons for circumcision.
May the Foreskin be With You: Why Circumcision Makes No Sense and What You Can Do About It
Publication Date: Oct 16, 2012
Orders accepted at Amazon: U.S. Orders Canadian Orders
Circumcision: The Hidden Trauma
Ronald Goldman, PhD
(if the link doesn't bring you to the Symposia books, go to www.springer.com, type circumcision in the search box and click GO.)
Sex As Nature Intended It [reveals the effects of male circumcision on female sexual experience]
STATEMENTS OF WORLD LEGAL & MEDICAL ASSOCIATIONS
A growing number of world legal and medical associations recognize the human rights implications of - and the need for a higher standard of medical ethics related to - circumcision of unconsenting children. No U.S. medical association is yet on board [Feb 2012].
Denmark's chapter of Save the Children, the world's largest independent children's rights organization, issued a strong condemnation of infant circumcision (February 11, 2014) https://scontent-a-iad.xx.fbcdn.net/hphotos-frc3/t1/1549200_273560646134430_63028508_n.jpg
Circumcision Divide between Denmark and Israel (Copenhagen Post January 24, 2014)
In two fresh statements, Danish doctors express deep concern over ritual circumcision of boys. The Danish Society of Family Physicians, whose 3,000 members include two thirds of all general practitioners in Denmark, announced in December that circumcision of underage boys with no proper medical indication is nothing short of mutilation. In a separate statement, the overarching Danish Medical Association recommended earlier this week that non-therapeutic male circumcision should wait until the boy or young man is old enough to provide informed consent. An editorial in Jyllands-Posten, the second largest national newspaper in Denmark, urged the Danish government yesterday to ban ritual circumcision of underage boys, and a result poll among readers of BT, another large national newspaper, showed that 87 percent of well over 26,000 votes were in favour of such a ban.
A 2012 report from the International NGO Council on Violence Against Children clearly states (pages 21 and 22) that the circumcision of boys constitutes a "gross violation of their rights."
German court declares religious circumcision illegal assault [translated excerpts from Financial Times/Deutschland, 25 June 2012]
deutschland/:illegale- prozedur-gericht-stellt- religioese-beschneidung-unter- strafe/70054618.html
A judgment by the Regional Court of Köln (Cologne) refers to a widespread medical procedure carried out for religious reasons: The circumcision of boys now has to be regarded as assault.
Whoever circumcises boys for religious reasons is liable to prosecution for assault. ...Neither the parents nor the right to freedom of religion guaranteed in the Constitution can justify this procedure, the court reasoned in its ruling.
For decades, doctors in Germany had acted in a legal gray area if they cut boys for purely religious reasons when it was not a medical necessity. Until now, they could claim not to have had any knowledge of the criminality of religious circumcisions. ...With the Cologne verdict this possibility is now gone.
"The verdict is very important, especially for doctors, because they now have legal certainty for the first time," states Holm Putzke of the University of Passau. ..."The court has - unlike many politicians - not been deterred by the fear of being criticized as anti-Semitic and anti-religious," praised Putzke. "This decision could not only shape future law, but in the best case scenario could lead among the concerned religions to a shift in consciousness to respect fundamental rights of children.”
... The district court evaluated it now as a "serious and irreversible impairment of physical integrity."
Swedish Paediatric Society/Svenska barnläkarföreningen, BLF [19 February 2012]: Swedish docs in circumcision protest "We consider it to be an assault on these boys," Staffan Janson, chairman of BLF's committee for ethical issues and childrens' rights. After discussing the matter for several years, BLF has now concluded that the procedure ought to be banned on the grounds that the children are unable to form a decision in the matter. "It's a mutilation of a child unable to decide for himself."
Royal Australian College of Physicians [October 2010]: says the foreskin has functions, including protection and sexual sensation. It does not recommend circumcision to prevent HIV, recognizes doctors may conscientiously object to circumcision, and says parents should be told they can wait until the child can decide for himself, saying, “The potential harms include contravention of individual rights, loss of choice, loss of function, procedure and psychological complications.”
Royal Dutch Medical Association/KNMG [May 2010 - Position Paper and Press Release]: Position paper on circumcision calls for a “powerful policy of deterrence,” claiming it is an infringement of a child’s right to bodily integrity and personal autonomy, that its risks are underplayed, and that rejecting FGM while allowing MGM is ethically inconsistent.
The official standpoint of KNMG and other related medical/scientific organisations is that ‘non-therapeutic circumcision of male minors is a violation of children’s rights to autonomy and physical integrity’. They urge doctors ‘to actively and insistently inform parents who are considering the procedure of the absence of medical benefits and the danger of complications’.
‘The rule is: do not operate on healthy children’, says Arie Nieuwenhuijzen Kruseman, chairman of the KNMG. ‘The reason for the adoption of an official standpoint regarding this matter is the increasing emphasis on the protection of children’s rights. Contrary to popular belief, circumcision can also cause complications - bleeding, infection, urethral stricture and panic attacks are particularly common. Full or partial penile amputations have also been reported as a consequence of complications'.
South African Children’s Rights Act [1 April 2010]: Amendments went into effect making circumcision for frivolous reasons more difficult, requiring informed consent of both parents and the boy, if he is old enough, and the signature of the circumciser to be kept on record until the boy is 21—old enough to sue if he is not satisfied with the outcome.
College of Physicians and Surgeons of British Columbia/Canada [September 2009 - Position Paper]: “The College is issuing this guide...in light of evidence based medicine and contemporary principles in ethics, law and human rights...[R]outine infant male circumcision, i.e., routine removal of normal tissue in a healthy infant, is not recommended...proxy consent by parents is now being questioned. ...Under the Canadian Charter of Rights and Freedoms and the United Nations Universal Declaration of Human Rights, an infant has rights that include security of person, life, freedom and bodily integrity. Routine male circumcision is an unnecessary and irreversible procedure. Therefore many consider it to be “unwarranted mutilating surgery”.
Tasmanian Law Reform Institute/Australia [June 2009]: found criminal and civil law lacked certainty, and circumcision may abuse the rights of a child. Their paper, “Non-Therapeutic Male Circumcision,” states, “Even if a court considers the physical loss following circumcision negligible, the social and psychological effects of a wrong decision can be devastating” and circumcision might be considered assault or a wounding. “There is uncertainty whether parental consent...is sufficient to allow a circumciser to legally perform the procedure.”
South African Medical Association [4 February 2005]: Letter to Nocirc of South Africa (NOCIRC-SA), signed by Professor Ed Coetzee, Chairperson of the SAMA Education, Science and Technology Committee, stating: “After lengthy DISCUSSION on the matter, the Committee RESOLVED that it be conveyed to NOCIRC-SA that, from a medical viewpoint, there is no medical justification for routine circumcision in males and children.”
Classifications of Male and Female Genital Mutilation ["circumcision" is only one form of male genital mutilation in the world]
Learn how methodologically flawed "junk" science was used by circumcision advocates to lobby the World Health Organization (WHO) to endorse mass circumcision campaigns in Africa, funded by foundations of former president Bill Clinton and Bill Gates. Circumcision has little relevance to HIV prevention in developed Western nations and is a dangerous threat to the health of millions of African men and women and to the rights of children.
HIV and Circumcisi
on: Attorneys for the Rights of the Child (Adler and Svoboda) writes letter that National Coalition For Men
sends to Gates Foundation (National Coalition for Men, July 16, 2014) read letter here
Circumcision as AIDS Prevention? When Bad Science Kills (Intact America, May 26, 2012)
Earlier this week, blogger and intactivist Andrew Sullivan posted a short piece titled Circumcision Spreads HIV? on his blog, the Daily Beast. Sullivan’s post is brief, but his message is critically important: the “African studies” being used as “evidence” to promote circumcision as HIV prevention are bogus, and the promotion of circumcision will actually increase HIV deaths. Sullivan cites an excellent new article by Oxford University’s Brian Earp, titled A fatal irony: Why the “circumcision solution” to the AIDS epidemic in Africa will increase transmission of HIV. Earp calls the pro-circumcision camp’s African trials “bad science at its most dangerous.” (read more)
Denied, withheld, and uncollected evidence and unethical research cloud what really happened during three key trials of circumcision to protect men (Don't Get Stuck with HIV, February 2012)
Response from Doctors Opposing Circumcision to the African circumcision campaign (January 2012)
Even if one were to accept the conclusions of the African Random Controlled Trials (and the statistical sleights-of-hand suggest wariness), that does not necessarily make Voluntary Medical Male Circumcision (VMMC) good epidemiology. There is a melancholy list of contraindications which transcend computer modeling:
• Risk avoidance by circumcised men who will now feel ‘invulnerable’ and will avoid condoms. This is especially true where the men feel a western ‘surgery’ confers extra immunity over tribal rituals.
Example: Experts are also concerned men who get circumcised will mistakenly think they are immune to HIV. That was the case for Samson Agalo, a bicycle taxi operator from Kisumu, Kenya, who recently had a circumcision — and has been having sex with multiple partners ever since. "After going for the cut, you don't need condoms," he said. [http://www.msnbc.msn.com/id/
35407224/ns/health-aids/t/] circumcision-ring-cuts-aids- risk-africa/#.TwkmnlauSSo
• That trend, already identified, endangers millions of women and may even worsen the epidemic.
• VMMC will inevitably ensnare minors. In no world culture is MC entirely voluntary, that is, for consenting adults only. VMMC has always been a stalking horse for unconsented infant circumcision.
• In cultures which value displays of masculine bravery, MC will veer toward the gruesome rather than stay within clinical standards. South Korea is an example of this phenomenon.
• The initial clinical standards will soon decline in village settings where even clean water is a luxury. Indeed one of the unaccounted for factors in the RCT’s is the vector of iatogenic transmission via contaminated medical equipment.
• Once introduced, MC will prove difficult to eradicate when an HIV immunization is eventually found, as genital mutilations are self-replicating and self-sustaining. They need no reason other than, “They did it to me.” The Cut always become Cutters.
• An AIDS vaccine has already been found -in HAART- which reduces infection rates to near zero between discordant partners. HAART will surely prove less expensive than huge VMMC campaigns in the long run.
• VMMC will firmly plant the notion that amputations are the preferred solution to disease processes, a giant step backwards in both human rights and medical science.
• VMMC will slow attempts to control FGC, female genital cutting, and may introduce FGC, unbidden, where it is now unknown. Blaming female mucosal tissue is a small step away from VMMC.
• VMMC may pit tribe against tribe. In Kenya, the Luo (the tribe of Barack Obama’s father), do not engage in MC. But the Kikuyu, who blame the Luo for HIV /AIDS at the urging of researchers, do so. This has led to kidnapping and forced MC of the Luo. This will surely escalate in multiple cultures across Africa, creating a fertile ground for regional conflicts.
John V. Geisheker, J.D., LL.M. - Executive Director, General Counsel - DoctorsOpposingCircumcision.org - Seattle, WA
28,000,000 African men to be coerced by U.N. to make 'the cut' (A Voice for Men, January 2012)
Australia/New Zealand Reject Circumcision as HIV Prevention (Australian and New Zealand Journal of Public Health, 2011)
How the circumcision solution in Africa will increase HIV infections (Journal of Public Health in Africa, 2011)
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.
Sub-Saharan African randomized clinical trials into male circumcision and HIV transmission: Medical, Legal and Ethical Concerns (Journal of Law and Medicine, 2011)
What then should we think of researchers who...misinterpret their results, report their results selectively, cite the literature selectively, and draw unjustified conclusions?
Male circumcision is not the HIV 'vaccine' we have been waiting for! (Future Medicine, 2008)
Campaigns to promote safe-sex behaviors have been shown to accomplish a high rate of infection reduction, without the surgical risks and complications of circumcision, and at a much lower cost. For the health community to rush to recommend a program based on incomplete evidence is both premature and ill-advised. It misleads the public by promoting false hope from uncertain conclusions and might ultimately aggravate the problem by altering people’s behavioral patterns and exposing them and their partners to new or expanded risks. Given these problems, circumcision of adults, and especially of children, by coercion or by false hope, raises human rights concerns.
Langerin is a natural barrier to HIV-1 transmission by Langerhans cells (Nature Medicine, 2007)
HIV-1 captured by Langerin was internalized into Birbeck granules and degraded. Langerin inhibited LC infection and this mechanism kept LCs refractory to HIV-1 transmission; inhibition of Langerin allowed LC infection and subsequent HIV-1 transmission. Notably, LCs also inhibited T-cell infection by viral clearance through Langerin. Thus Langerin is a natural barrier to HIV-1 infection, and strategies to combat infection must enhance, preserve or, at the very least, not interfere with Langerin expression and function.
[Webmaster note: Male and female genitalia are rich in Langerhans cells (LC). Rather than facilitate HIV infection, LC attract and destroy HIV. Male circumcision removes these important disease-fighting cells. Research used for promotion of circumcision was conducted on severed ('dead') foreskins and only showed HIV being attracted to LC in those foreskins. Therefore, they fail to account for how the LC in intact ('living') foreskins defends the body. Even if excising LC-rich genital tissue were an effective HIV prevention strategy, should public health intervention strategies not also include surgical removal of vulnerable female genital tissues?]
Scientist Denounces Flawed Studies Used by CDC to Promote Circumcision (video)
Circumcision and HIV Infection
HIV Statement by Doctors Opposing Circumcision
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