How Circumcision Broke the Internet

pdilly2b · September 2013

I realize we just discussed this, but thought some might be interested in a new article in Slate today on circumcision, or more about how the "intactivist" movement is driving the circumcision debate on the internet. I really like this because it has lots of links to studies/summaries of studies from reputable sources (starting paragraph 7 or so):

https://www.slate.com/articles/health_and_science/medical_examiner/2013/09/intactivists_online_a_fringe_group_turned_the_internet_against_circumcision.html

I thought I was pretty educated about this issue, but learned a few things myself so far (still more links to read). Mainly that the reduction in penile cancer risk is because of lower transmission of HPV and the reason they think circumcision reduces HIV transmission so much (~70%) is due to changes in the microbiota between uncircumcised penises and circumcised ones. To me, these are clear medical benefits, though of course routine and consistent condom use helps these for individuals (more difficult to implement on public health scales). Also glad to see studies have been done about sexual pleasure differences, and found there really aren't any.

I hope some others find this useful too.

Marusika · September 2013

I think that everyone is free to make that decision for their baby, but first, it`s much better to read about it to be sure that the decision is the best.

Andrewsgal · September 2013

Wouldn't the HPV argument be null now that kids are receiving the HPV vax?

Sarahjess06 · September 2013

Interesting.... Makes me want to leave those mom fb groups, where all thu do is talk about anti-ric. This article described them to a T

Andrewsgal · September 2013

I just wasted time reading that article it is very biased. Also anyone who has done research on the HIV vs circ debate knows those studies were done in third world countries that don't have access to healthcare or condoms like in the us.

Rrrrrachel · September 2013

The research showing reduction in HIV risk comes from Africa, where aids is endemic and follows a very different pattern of transmission than the us in Europe (there transmission is primarily man to woman, here it is not). It's not entirely clear if that benefit applies outside of the context of the study. It's also causing problems because (some) men in Africa think if they're circumcised they don't need to use condoms.

The risk of HIV in the us is very low, and can be reduced to essentially zero using the risk free strategy of condoms. Same with hpv.

Rrrrrachel · September 2013

And while I don't like the term intactivist, parents who choose not to circumcise are hardly fringe extremists. They're increasingly the majority.

pdilly2b · September 2013

Andrewsgal said:

I just wasted time reading that article it is very biased. Also anyone who has done research on the HIV vs circ debate knows those studies were done in third world countries that don't have access to healthcare or condoms like in the us.

I don't think the article is biased at all (though I could do without the bitching that takes up the first few paragraphs). It clearly links to studies and those studies clearly state the populations. As I mentioned in the post, condoms can take care of it. But HIV is transmitted the same way regardless of where men who come into contact with it live and circumcision lowers the transmission rate by a lot. I find this a compelling reason in my decision-making, while others may not and rely on the relative scarcity of HIV in this country and that their sons will chose condoms.

Hopefully the HPV vaccine will help too. I intend to have DS vaccinated for HPV when he is eligible. It would be great if they came out with a herpes vaccine too, though none in the works that I know of.

maelic · September 2013

I would prefer not to circumcise my child and I can honestly say that I've never heard of this organization before. I'm just... European living in the US. It's a very biased screed of an article.

Also, I'd rather expend my energy fighting to get the HPV vaccine routinely administered to boys as well if we're talking about decreasing the odds of penile cancer.

pdilly2b · September 2013

I think the "intactivist" term refers to the people who refer to it as "genital mutilation" and the like (we saw one of them here the other day), not all people who choose not to circumcise.

For the record, we thought circ was right for our family, but I really don't care what other people do. It does piss me off when people say there is no medical benefit. There is, even if it is somewhat minor and you don't find it personally compelling. The fact that I do find it compelling does not mean I'm an uneducated sheep. Quite the contrary.

CandaceMarie321 · September 2013

When we were first deciding to circ. our now 8-year-old we could not find any compelling information either way, pro-circ sites focused more on cleanliness than what were considered minor medical advantages. Ultimately we did not feel the very minor risk of complications was worth the very minor medical benefit.
One thing we agreed on was that all our boys would be the same, so we have not had to choose again. I don't know if I would make the same choice again, but I have zero regrets over the choice we made.

SeattleMomma · September 2013

I've made a finally decision already.

katieharpiceland · September 2013

In Europe they circ a lot less. I mean, a lot less. Wouldn't it then stand to reason that if it was true that circing did lower HIV, that HIV would be rampant in Europe and almost nothing in the U S? I mean, we live in industrialized nations with easy access to condoms. I would guess, more than anything, this lowers our HIV rates. That argument just doesn't fly with me, sorry.

Rrrrrachel · September 2013

HIV is not always transmitted the same way. In places like Africa it is primarily transmitted manto woman. In the us it is primarily transmitted man to man. There is a looooooooong list of studies in other populations that have found no protective effects of circumcision. A cochrane review found no evidence that circumcision did more good than harm with regards to HIV transmission (the harm being from men not using condoms because of a false sense of security from circumcision). IMO if you're getting your son circumcised to protect them from HIV you're pretty foolish.

AcaAwkward · September 2013

Full disclosure: haven't read the article...BUT!

AIDS/HIV is SUCH a different animal in Africa* -- in many different aspects (how it's spread, how incredibly prevalent it is, how it's dealt with culturally, education-wise, etc). Because of how incredibly different AIDS/HIV presents in Africa, I'd be very hesitant to apply the findings from a study completed in Africa to the United States (or almost any other country in the world). There are just too many factors that make our experiences / interactions with the virus so different.

*obviously I am aware this is a generalization of an entire continent, and my statements don't apply to every single African nation or population , bla bla bla gotta CYA, it's my knee-jerk attorney reaction

Andrewsgal · September 2013

pdilly2b said:

Andrewsgal said:

I just wasted time reading that article it is very biased. Also anyone who has done research on the HIV vs circ debate knows those studies were done in third world countries that don't have access to healthcare or condoms like in the us.

I don't think the article is biased at all (though I could do without the bitching that takes up the first few paragraphs). It clearly links to studies and those studies clearly state the populations. As I mentioned in the post, condoms can take care of it. But HIV is transmitted the same way regardless of where men who come into contact with it live and circumcision lowers the transmission rate by a lot. I find this a compelling reason in my decision-making, while others may not and rely on the relative scarcity of HIV in this country and that their sons will chose condoms.

Hopefully the HPV vaccine will help too. I intend to have DS vaccinated for HPV when he is eligible. It would be great if they came out with a herpes vaccine too, though none in the works that I know of.

I am honestly shocked that we read the same article and you claim there is no bias.

kwolslager · September 2013

I am against circumcision, but my husband is for it. We have two girls so we haven't needed to decide yet. But it's something that we do argue over when we discuss the fact that this baby could be a boy. It's pretty frustrating, I'm beginning to feel like a broken record, explaining the reasons why I think we shouldn't do it over and over again. His main argument is that he is circumcised so his boys should be too.

Does anyone have any particularly good articles that explain with facts why circumcision is unnecessary and dangerous?

pdilly2b · September 2013

Rrrrrachel said:

HIV is not always transmitted the same way. In places like Africa it is primarily transmitted manto woman. In the us it is primarily transmitted man to man. There is a looooooooong list of studies in other populations that have found no protective effects of circumcision. A cochrane review found no evidence that circumcision did more good than harm with regards to HIV transmission (the harm being from men not using condoms because of a false sense of security from circumcision). IMO if you're getting your son circumcised to protect them from HIV you're pretty foolish.

@Rrrrrachel

The studies cited clearly state that the reduction in HIV transmission is for heterosexual sex. I do not know that DS will be heterosexual, but I'm going on that assumption now until I know otherwise. They are doing randomized studies with large samples sizes in populations where condom use is not prevalent - i.e. a perfect group to test the effect of circumcision on people likely exposed to HIV without other confounding factors.

As I've said multiple times, condom use can make this moot, if you think condoms will always be used by your son. I hope they are for my DS, but I'm not going to be naive. It's a small chance that he will come into contact with a woman with HIV and then not use a condom with her, but that chance is not 0 and circumcisions will reduce his risk of contracting it should this unlikely event occur. The reduced transmission rate is for HIV (most studied) but also for other STDs, for which there is a higher prevalence in our society. Again, I hope he uses condoms, but I'm not taken it as a given.

Not to get too much into my own medical history, but I contracted an STD when I was younger from oral sex with a partner who I was in a long term relationship with who did not have any prior risky behavior. I don't really know anyone who uses condoms for oral sex*. So you may think I'm foolish for trying to protect my son from an unlikely event, but I've been burned by unlikely events before. Shit happens, and not always to the people that you expect. This is not the only reason we chose to circumcise, but you can be damn sure it informs my view on the whole idea of "that will never happen".

*Admittedly, I have not seen studies on STD transmission via oral sex in the context of circumcision vs. not, but I don't think it's unrealistic to conclude there may be a difference, especially considering it's the microbiota that's affected.

Again, I think not circumcising is a perfectly legitimate decision. But so is deciding to circumcise.

We all have our own risk-benefit calculations to consider be it circumcision, amnio, epidurals, pitocin, c-sections, vaccinations, how we choose to feed our children, how we diaper them, tv watching, etc. Some of these have stronger scientific/medical evidence than others, but there are 2+ sides to each.

Rrrrrachel · September 2013

Too many people make decisions on personal feelings or anecdotes without doing any kind of meaningful risk benefit analysis at all.

pdilly2b · September 2013

That's the same response I feel to the other side, especially when the "risks" associated with sexual pleasure and botched procedures are trotted out.

Though honestly, the fact that I come to a different conclusion from my risk-benefit analysis than you do from yours does not mean that I didn't do one (or that you didn't). Especially considering the risk we assign to our children having unprotected sex isn't a known quantity. Or anticipated STD prevalence in our society in 15+ years for that matter.

Rrrrrachel · September 2013

The "risk" that I see is subjecting your newborn child to extreme and unnecessary pain. That's enough for me.

Rrrrrachel · September 2013

There is a higher risk of uti in the first year if life, not beyond that, and either way the risk is significantly less than for girls.

Andrewsgal · September 2013

ImnAtari said:
Though I think the HIV thing is kind of silly seeing as they we're using studies from third world countries (as others have said), there is a correlation between American males and other sexually transmitted diseases including syphilis, herpes, and gonorrhea. Also, for woman who are parents with uncircumcised males there is an increase in incidence of BV (Tobian, Gray & Quinn, 2010). Also, there is a higher incidence of urinary tract infections in uncircumcised males.

Personally, (and mostly where my own personal view points stem from) I've known adult males who were circumcised for developed medical conditions that would have been avoided being circumcised as a neonate, and the recovery time was weeks and the emotional trauma involved was high...

Using your logic my infant might have to have his tonsils out so I guess we should just yank them now! Doesn't sound very logical that way huh?

pdilly2b · September 2013

mummyofsix said:

The difference Rachel is talking (correct me if I am wrong, Rachel) about is that in Africa the vast majority of HIV is spread by heterosexual sex (as you stated). In the USA its most often transmitted by homosexual males and shared needle use. So the incredibly high rates of HIV in Africa and the percentage of those HIV positive men who are circed or intact doesnt apply in the same way here in the US.

The fact that we are applying sexual health/ research in AFRICA to infant american males is beyond mind blowing to me. Its like me taking a two automatic weapons to my grandma's house in the countryside because in Compton crime is high.

To study the effect of circumcision on HIV transmission via unprotected heterosexual sex, a population with a high incidence of HIV, high incidence of unprotected heterosexual sex, and the ability to assign men to groups (uncir, circ) is the perfect population to study. This population exists in Africa, not in the United States.

The results of the African studies are directly applicable if you want stats on how circumcision affects HIV transmission via unprotected heterosexual sex. That is what these studies are trying to assess.

If you want stats on US-specific socio-economic factors related to HIV transmission, the effect of condoms or sex education on HIV transmission rates, or how HIV is spread via other routes in developed countries, then the African men would be a horrible population to study. That is not what the authors are trying to assess.

The rates and routes of transmission vary greatly between the US and Africa. But how circumcision affects transmission for unprotected heterosexual sex will be the same between the two populations.

Rrrrrachel · September 2013

No, they're not directly applicable. Many studies have tried to replicate the results of the studies in Africa in other groups and have failed. Those studies were observational, anyway, which automatically mean you should be careful about generalizing from them, even ignoring other potential flaws.

Even assuming they're true, you have around a 2% chance of contracting aids in the us. Around a quarter of those are from heterosexual sex. So your child's risk would go from .5% to .15% from heterosexual sex, at best. That's ignoring that some of those studies put the risk reduction at something like 25% instead of 70%. It's also ignoring that the risk from aids is likely to be drastically lower by the time your child is sexually active.

We have many industrialized countries with far lower circumcision rates than the us. Comparing the rates of stds among them and us would be more meaningful, IMO.

Meanwhile, there's a 100% risk that your child will be put through a painful procedure if you choose to circumcise, even ignoring the other risks.

Rrrrrachel · September 2013

Only around half of circumcisions are done with any effective pain management at all. No form of pain management eliminates the pain of the procedure.

Andrewsgal · September 2013

ImnAtari said:

Andrewsgal said:

Though I think the HIV thing is kind of silly seeing as they we're using studies from third world countries (as others have said), there is a correlation between American males and other sexually transmitted diseases including syphilis, herpes, and gonorrhea. Also, for woman who are parents with uncircumcised males there is an increase in incidence of BV (Tobian, Gray & Quinn, 2010). Also, there is a higher incidence of urinary tract infections in uncircumcised males.

Personally, (and mostly where my own personal view points stem from) I've known adult males who were circumcised for developed medical conditions that would have been avoided being circumcised as a neonate, and the recovery time was weeks and the emotional trauma involved was high...
Using your logic my infant might have to have his tonsils out so I guess we should just yank them now! Doesn't sound very logical that way huh?

While I commend you for this argument, it doesn't particularly make any sense. As a tonsillectomy requires general anesthesia and is never considered elective. Even as an adult, a circumcision is done under local anesthetic and done with procedural sedation (both of which are offered for neonates)

But, if that was the case... sure... you can have my tonsils...

Now, did you get your wisdom teeth out prior to medical complications caused by impacted teeth and infection? If so, same idea.

But the point you used was that circumcision in adults that had to have it don't for medical reasons just like a tonsillectomy. So the only difference is the type of anesthesia? That makes my argument invalid? The bottom line is that in infants is is an unnecessary procedure that causes pain. The chance that my son will one day actually need to be circumcised is extremely low.

Andrewsgal · September 2013

Everyone is entitled to thier own opinion and like I have said before I don't care what choices people make in regards to their sons penis. That being said please don't try to back up your choice with irrelevant data or non exsistant facts.

Rrrrrachel · September 2013

If circumcision was a procedure done to an older person, like wisdoms teeth removal, who could understand and participate in the decision I would feel differently about it, fwiw. But then I've decided not to have my wisdom teeth removed prophylactically, so maybe I'm a bad example

alexisjo88 · September 2013

poru said:

Just to spice up the circumcision conversation a bit.... My husband is not cut. Do you know how much easier it is to give him a handjob or a blowjob?! No gallons of slobber or spit required. The foreskin takes care of that for you. And when he is soft, the skin keeps his sensitive head covered. When he is erect, the skin naturally comes back and sits like a collar which can stretch up and over.

Sorry Lurking from Nov13, I just got to ask why this is important to think about when deciding for your son?

myschlove · September 2013

When trying to make this decision when I was pregnant with my DS I came across a wonderful article that was actually not biased either way. And I just can't find it now I'll keep looking ... it basically concluded that if you choose to circumcise it's okay and if you choose not to it's okay!

Be very careful about looking on the Internet because there's a lot of non-medical "professionals" who are only trying to scare you… And they do a good job at it!

fireflygirl12 · September 2013

myschlove said:

When trying to make this decision when I was pregnant with my DS I came across a wonderful article that was actually not biased either way. And I just can't find it now I'll keep looking ... it basically concluded that if you choose to circumcise it's okay and if you choose not to it's okay! Be very careful about looking on the Internet because there's a lot of non-medical "professionals" who are only trying to scare you… And they do a good job at it!

It doesn't make sense to me that there would be a completely non-biased article on a medical procedure. If the author is saying that there are no advantages to getting circumcised over not getting circumcised, then why would someone elect to have it done? Even if it didn't hurt the baby during the procedure, then there is still the fact that it's an extra thing to deal with while it's healing and it's not exactly free. I would sure hope that people who choose to circumcise do so for some reason other than the flip of a coin. If you legitimately thought it was fine either way, then wouldn't everybody choose not to have it done?

This is not against you personally @myschlove, but I really hope that people would not choose to do medical procedures just for the heck of it.

fireflygirl12 · September 2013

poru said:

alexisjo88 said:

poru said:

Just to spice up the circumcision conversation a bit.... My husband is not cut. Do you know how much easier it is to give him a handjob or a blowjob?! No gallons of slobber or spit required. The foreskin takes care of that for you. And when he is soft, the skin keeps his sensitive head covered. When he is erect, the skin naturally comes back and sits like a collar which can stretch up and over.

Sorry Lurking from Nov13, I just got to ask why this is important to think about when deciding for your son?

A) I was primarily trying to divert rehashing a conversation we had yesterday for 10 pages.

Circumcision is the discussion of whether or not to remove part of your son's major sex organ. And if you are going to cut off a piece of your son's main sex organ, please consider the ramifications it may or may not have on his sex life. If it's too gross for you to think about whether your son will one day have sex and whether it will be good for him and his partner, then you really shouldn't have a say in any decisions about whether or not part of his sex organ is removed or not. In addition to the medical benefits/risks that you weigh, his sex life has to be taken into consideration. Just because he is a newborn today, doesn't mean he will be a newborn 30 years from now.

Personally, I think the US trend to circumcise is doing a disservice to sex all around the country (I say that only half facetiously). Yes, there are currently studies showing conflicting evidence about whether foreskin adds feeling to the owner or not -- so its hard to weigh in on that. But from my personal anecdotal evidence (very subjective admittedly), I actually think foreskin is a benefit to the man's partner. And in all the to circ/ not circ bump arguments everyone always mentions "ewwww i don't want girls to be grossed out by his uncut penis." So I think its applicable.

I'm pretty sure I was grossed out the first time I saw one IRL. And it was circ'd.

Serenla · September 2013

mummyofsix said:
More than anything else, the title alone is annoying as hell. Circumcision broke the internet? Really?

Everyone knows that gifs of cats broke the internet. JFC.

I always thought it was caturdays fault.

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