The Circumcision Discussion

I don't understand your point. What research are you speaking of and what is the amount of reduction in HIV spread? If you can, please post a link to the study here because I would like to see it. Jubilayhee, if I could prove that by removing the labia and/or clitoral hood from newborns I could reduce the spread of AIDS in U.S. women by 50%, do you think that would be a good enough reason for me to advocate such an operation? Suppose the rates of abstinence/monogamy went way up and the STD/STI/AIDS transmission rate went way down in "lightly" circumsised females. As with the male group you mentioned, in the case of the females, do you believe what is good for the goose is good for the gander?

Speaking of studies, tell me what you think of this number crunching from a very intelligent person on this same thread. I think it is very well laid out.

"4. The HIV, STD issue. This is just ridiculous. There is a WHO recommendation but the WHO recommendation applies only to countries with high prevalence and not to countries like the US. And let me just explain to you why especially in the US, and other first world countries, the HIV argument is pretty much BS. It's also a stupid policy in Africa and will almost certainly be a long term failure but for other reasons and as others have said would require a different thread.

Anyway, to determine the probability of not becoming infected you can use the following formula:

(1 - [chance of transmission from sex])^[sexual encounters]

Now for the estimates, let's assume that there is a risk reduction of 50% for circumcised men. This is the number most often banted around by the popular media and those clowns at the UN and WHO in their reports from Africa. The probability of infection in any one encounter with an HIV positive partner varies depending on viral load, co-infection, and numerous other reasons. For example, people are most infectious soon after being infected. Infectiousness lessens after a few weeks which is one reason HIV spreads so fast in Africa, read The Invisible Cure: Africa, the West, and the Fight Against AIDS, by Helen Epstein, to find out why it's so infectious in Africa but not anywhere else.

Anyway, I've seen numbers for women infecting men range from 1/700 - 1/2500 and interestingly enough, a recent publication in the Lancent of Infectious Diseases and reported at Aidsmap, put the risk of an HIV infected woman infecting her male partner at 0.04%.

From Aidsmap:

Researchers conducting a meta-analysis of studies of the risk of HIV transmission during heterosexual sex have found that, in high-income countries prior to the introduction of combination therapy, the risk per sexual act was 0.04% if the female partner was HIV-positive, and 0.08% when the male partner was HIV-positive. However these rates were considerably higher in lower-income countries, if the source partner was in either the very early or the late stage of HIV infection, or if one partner had genital ulcer disease, write the researchers in the February issue of The Lancet Infectious Diseases.

They continue:

Pooling the data from studies in high-income countries, the researchers calculated that the risk of transmission from an HIV-positive man to his female partner was 0.08% per sexual act: in other words, it was likely to occur once every 1250 sexual acts. When it was the female partner who was HIV-positive, the male partner’s risk of acquiring HIV was 0.04% per sexual act – in other words, once every 2500 sexual acts.

I bolded the last, though it isn't pertinent to the discussion, I might come back to it later. I'll only say that is so obvious I don't know why they made a point of it. It was been well known that people were more infectious in early and late stages or if they had genital ulcer diseases. Also note that they said prior to the introduction to therapy which means the true rate may actually be lower now but we'll go with it.

So based on that, we'll start the estimate that the chance of infection is 0.06% a bit higher than published in the Lancet article. That means a male having unprotected sex with an HIV positive women has about a bit more than 1 in 1800 chance of being infected. Base line risk intact men vs circumcised men 1 random heterosexual contact with an HIV+ partner.

[1 - 0.0006]^1 99.94% ~= 0.06%
[1 - 0.0006 * 0.5]^1 ~=99.97% ~= 0.03%

But the HIV distribution in the US population is about 5 in 1000 or 1/200 so, in general, there is only a 1 in 200 chance that I'll encounter someone who is HIV positive. Actually the risk is much lower but we'll discuss that in a bit. Given that as a fact, a closer estimate of the risk of becoming HIV infected after the 1 encounters is more like:

The chance of event A (encountering an HIV positive individual in the general population) * the chance of event B the likely hood of getting infected during that encounter.

1/200 * 0.0006 = 0.000003 --- 1 - 0.000003 = 99.9997% = 0.0003%
1/200 * 0.0003 = 0.000006 --- 1 - 0.0000015 = 99.99985% = 0.00015%

Of course, the number of sexual encounters is important too. For 1,000 encounters, the difference is 1.5 hundreths of a percent. That's is what circumcision bought you, big deal. Over the course of 1,000 random encounters an intact guy has 1.5 hundreths of a percent larger chance of becoming HIV positive. Circumcised guys, party on!

Of course there are some caveats to this. First, your per-exposure risk might change based on other factors and the 1/200 is quite high since 75% of the HIV positive population are men. If women only account for about 1/4 of the total, this reduces the 1/200 to between say 1/700 or 1/1000. This is what it looks like when we adjust the prevelence among women:

1/700 * 0.0006 = 0.0000008571 --- 1 - 0.0000008571 ~= 99.99992% = 0.00008%
1/700 * 0.0003 = 0.0000004286 --- 1 - 0.0000004286 ~= 99.99996% = 0.00004%

That's a whole order of magnitude. Now we're talking about a difference of 4 thousandths of a percent if we have 1,000 random partners. Party on.

For Doctors, especially in the US, to entertain the notion that circumcision is going to in anyway impact a boys chances of acquiring HIV is very misleading, not truthful, or ethical. The commonly cited 50% has to be understood in context. Circumcision as a prophylaxis for any STD is, if it is even true, over stated especially in first world countries like the US. I find courious though that it keeps getting pushed, consider HPV. Now here is something that we've been vaccinating against for over three years yet people still try and tie circumcision to HPV, why?"

Go back and read my post the pertinent section of which dnp2008 has quoted and tell me if reducing ones chance on the order of a few hundredths or thousandths of a percent (assuming he had about 1000 partners figure in the fact that the average number for a man in the US is 7 and condoms are available which I didn't figure in), of a disease that is easily avoidable anyway, is worth the risk to that part of his body. Regardless of what you may have read, 50% is a relative reduction and isn't all it's cracked up to be. So it's a question of how does that information apply in the US context.

ETA: Here is an interesting article (press) just published in Australia assessing the situation there after someone else suggested circumcision might be a useful tool in Australia. It's interesting because anthropologically speaking the US and Australia are very similar (much more than the US and parts of Africa) and epidemiologically the HIV situation between the US and Australia is very similar. Some key differences:

1. Circumcision was essentially dumped in the very early 80s. The rate of circumcision in Australia today is about 10% and has been stuck there for some time.

2. The epidemic in Australia is largely driven by homosexually acquired HIV. According to the article with a population of 21 million, Australia only recorded 850 new cases of HIV in 2006 Only about 9% (77) of which were heterosexually acquired by men. Testing, tracking and treating are probably as good if not better than in the US, this is a first world country after all.

3. According to the article, the average age of HIV infection by heterosexual sex for men was 46 (in the US it's early 30s) and no man under 24 acquired HIV by heterosexual sex in 2006 however 10 men over 60 did which accounts for the increase in heterosexual male infection experienced since the 2000 numbers. This is interesting because with Australia dumping circumcision in the early 80s one might expect this group to be 'especially vulnerable' men over 60 on the other hand are proabably circumcised. It doesn't seem that it is necessarily the case that circumcision was very useful in predicting infection.

4. For purposes of comparison the US with a population of 300 million (15x Australia) picked up about 40,000 additional cases (more than 40x) in 2006. Of which it's estimated that about 10% were heterosexually acquired by men (numbers available at avert.org). Very much like Australia in terms of proportion but it's strange that with the highest rate of circumcision in the first world we would have numerically far more new infections per year than our population would suggest. But the group that circumcision is supposed to protect proportionally gets the same number of infections.

5. I think what the differences is in how we approach sexual matters as perhaps they do in Australia and certainly Europe. Europe also shames the US with numbers that are far lower too (about the same as Australia). Having lived in Europe I know that they are far more open about sexual matters with their children and the children seem better prepared to protect themselves. I am not sure it's that way in Australia but I bet it is. HIV is a social problem not something that necessarily needs a biomedical solution to curb it. If we were to stop cutting and start talking I think we'd do much better. Cutting doesn't really add much to the equation.

It seems to me the practice of circumcision is largely driven by fear not rational thinking. And mating circumcision with HIV was inevitable.

"Research has proven thet circumcision reduces the spread our aids in hetersexuals. No lie. Is that a good enough reason for ya'll."

You mean that flawed and questionable statistical studies SUGGEST that..

but the critical question is, is there scientifically credible evidence that it does..

The most fundamental and critical criteria for scientific validity are:

All conclusions based on known flawed data cannot be considered valid,

A hypothesis MUST fulfill its prediction every time to be considered credible.

Reality:

Every study on HIV and circumcision have many known flaws.

Many circumcising countries have HIGHER rates of HIV than intact countries...The US has the highest rates of HIV of all of the industrialized countries ( all intact).

So, yes, a lie.

No offense but that is one of the most ignorant things I have read in this entire thread....That IS A BLATANT LIE....you obviously haven't done your research...you obviously DON'T know what the heck you are talking about!!!!!



Joe12...you are the BEST...I love your informative posts!!!!! Keep them coming!!!!!!!!!!!!!!!!!!!!!!!!! I hope that maybe YOU will change the warped views of many!!! Thanks!

Heck no!

I know many Jews. My husband is a Jew. While many parents find the bris a joyful time, I have spoken to a few Jewish women who found the bris to be a traumatic experience for them. Many have not stayed to watch. One woman told me she was completely hormonal and locked herself in her bedroom, cried her eyes out and and wished everyone would just leave the house!

Jews do have a choice whether to circumcize or not. There is a strong pressure to circumcize but whether you are circumcized or not does not make you a Jew. You don't get thrown in jail if you don't circumcize your child and you don't get "kicked out." That's not to say not circumcizing isn't seriously frowned upon. It is.

Strangely, circumcision is obligatory only if you are not born to a Jewish mother and wish to convert.

Many Jews now are choosing not to circumcise and many secular Jews do not have a traditional bris but just get the baby circumcized in the hospital. It really depends what kind of Jew you are, also. An orthodox Jew would have a more difficult time not circumcizing. A secular or reform Jew might get some crap from grandmom and grandpa but mostly no one is going to bust their chops about it.

US has the highest rates of STD transmission. The circ rate among sexually active men in our country is still at around 86%. Circ rates have only recently began to drop in the last 10 years so those men are still not sexually active. This alone should tell you that circ does NOT protect against the transmission of STDs and/or HIV. I have read studies that suggest a genetic tendency to becoming infected with HIV. Though I have not had the opportunity to investigate that study in depth, it seems far more plausible and more viable than any study I have read about circumcision. Though many are unaware, there have been equal studies showing that circ has no effect on HIV transmission and that circ can potentially increase the risk. Due to the loss of the functional foreskin and its 20,000 nerve receptors, blood supply, protective function, gliding function, etc, circed men are much more likely to forego wearing a condom which increases their risk. In our country it is estimated that 1 in 3 people has an STD.

But I will play along...
Even if circ somewhat reduced the spread of STD/HIV, it still would not endorse routine infant circumcisions. By the time a boy reaches an age where he is sexually active he can make the decision for himself about his penis. If a boy would choose circumcision at that age he could undergo a general anesthetic and receive all the GOOD pain meds in the world. In addition, the risks of the surgery would be far less b/c there man would be fully grown so it would be less likely for the surgeon to take too much skin (a common complication of infant circ) Also, the foreskin would already be separated from the glands in adulthood, unlike an infant foreskin so there would be no risk of skin bridging. Infant foreskin is fused to the glands of it must be forcibly separated during circumcision which can cause damage to the glands, increases blood-loss, and can result in bridging. Finally, if the glands have been protected by the foreskin in childhood, they would have less loss of sensitivity after circumcision than if they were exposed all throughout childhood.

Bottom line. There are always "potential" benefits to amputating a part of the body b/c it eliminates the possibility of something going wrong with that particular part. For example: 1-8 women will get breast cancer yet we don't go removing the breast buds of baby girls to prevent that. The foreskin itself is not pathological and is a functional part of the male sex organ. To remove it during infancy is completely unnecessary, is harmful, and is a violation of a boy's right to choose over his own body. When a boy reaches consenting age, he should have the choice over his most intimate part of his body, just as girls do. Every child regardless of gender, age, culture, religion, or race has the right to genital integrity.

So my question is... why are Americans so bent on protecting a parent's right to circumcise boys when every single medical association has classified it as medically unnecessary? We legally protect girls from this very same harm yet we strap our sons to tables in the first days of their life as if a foreskin is some type of birth defect.

And for those who say that their sons are "happy" about being circed, how can they know? They have never experienced a foreskin. If the only car you ever saw or drove was a Pinto, then you wouldn't miss a Lexus now would you? Yeah, a Pinto will get you from point A to point B, but shouldn't the individual have the choice? You can always take away, but you can never put back.

HIS body, HIS choice.

I just wanted to build on this for interested parties.

In my previous post I cited an article in this weekend's Australian which can be read here. This article is a response to another opinion submitted to the Australian in January, it can be read here. Now I think it's important to read the January article (second cited) closely.

The author, Mr. Wodak, in addition to trotting out the usual excuses (all of which are typical BS), begins to cite the changing trends in Australia's HIV epidemic. Specifically focusing on the increasing numbers of heterosexually aquired HIV among men between about the years 1999 and 2006. Without proper context, it seems he might have something to talk about though he isn't really specific. He notes a rise in overall infections and he notes a rise in heterosexual infection but it isn't clear how it breaks down, in which direction the infections are going. There are other problems too, but they aren't necessary to make the point.

Now compare that with Mr. Murray's article. Yes, there was a rise in the number of HIV cases, 854 among men. Of which only 77 (9%) were for men who were infected through sex with women. Yes, that is an increase among heterosexual men, 15 more than in 2000 of which 10 were in men over 60. The average age of infection was 46 and no man in Australia under 24 was diagnosed with HIV through heterosexual contact in 2006.

So this is what I mean when I say that circumcision is largely driven by fear. It's the same for all the other purported benefits. If they do exist, they're down in the noise and quite trivial. So why would Mr. Wodak try to ring the alarm bell and want to start encouraging circumcision again when a more rational look at the information (like the break down I provided in a previous post), provide by Mr. Murray, shows that such a move is entirely without merit. Does someone want to take a shot?

Here's a theory:

http://kvetcher.net/2009/01/2438/jew...-of-australia/

I am absolutely NOT an anti-semite. In fact, I'm married to a Jew and my two boys have very Jewish names (and gentile foreskins) and I hold a disproportionate number of Jews in high regard. But when I brought up the circumcision issue with my Jewish pediatrician she definitely did not take my concerns seriously and pushed for the circumcision.

However, not all Jewish doctors are narrow minded about this particular issue. Dr. Paul Fleiss is Jewish and is against circumcision. (Yes, I know he is Heidi's dad and a tax evader but that doesn't make his arguments invalid.)

I wish I had that power but we can all only do so much. Many of you who post here are in a unique position to help and it is really only through those in the medical community that we will succeed in ending routing circumcision. So I hope everyone does at least a little something as often as they can. Learn more, educate others, and talk about it make people look at this from a rational and ethical perspectives.