Flu Shot Thoughts

Rynleigh · October 2013

A bit of hijacking, here, because you do take the position that you want to do things based on the truth of how beneficial they are; if you are attempting to justify circumcision because you quietly believe that it is a commandment established in your religious practices, then this information probably isn't important to you. But if this is not a religious issue, please read and at least take this post as reason to renew your research... I am not an "intactivist", in fact, I was pro-circ only two years ago because I erroneously believed the exaggerations about how beneficial it was. I've come to understand, now, that my perspective was flawed and based on skewed data.

URINARY TRACT INFECTIONS

This is true; though the benefits of preventing UTIs is very exaggerated.

Approximately 1% of boys in the US will get a UTI *requiring treatment* by the time they are two years old (these are the years during which the highest rate of UTI exists - this number decelerates as children age, stop wearing diapers, and learn hygiene skills). This is an average. Circumcised boys have a rate of only 0.20% infection, intact boys have a 1.40% rate of infection. While this is a significant difference, we are still talking fewer than 2% of intact boys contracting an infection that actually needs to be treated... and treatment? Treatment generally includes antibiotics and lots of fluids. "Serious" complications from UTIs are uncommon.

To put this into further perspective, the rate of UTIs among boys by the age of 6 is still only an estimated 1.80% - while the rate of UTIs among girls by the age of 6 is 6.60% - more than three times as common. Yet, we do nothing more to prevent UTIs in girls than teach parents to wipe from front to back and not let them sit in soapy bath water too long... Medical doctors who specialize in labiaplasty state that surgery to alter female genitalia will recommend reconstructive surgery or removal in order to reduce not only the occurrence of UTIs, but also of yeast infections and sexual discomfort (this is among the main reasons many women seek the surgery as adults). Yet, despite these claims and the tripled rate of urinary tract infections in females, we wouldn't for a moment consider female circumcision to be an appropriate response to combating those infections - because it is not a common practice in our culture.

On top of all of that, the rate of men contracting UTIs after the age of six is extraordinarily low... while women continue to develop these infections well into adulthood (peaking during sexually active years). A lifetime incidence of *twenty times* that of a male's lifetime incidence. 10% of women will contract at least one UTI per year from their mid teens through their mid thirties. 60% of women will have had at least one UTI in their lifetime.

Conclusion: It is my opinion that the incidence of UTIs does not warrant surgical removal of the foreskin of a child unless the frequent recurrence of those infections for that individual child cause significant disruption of his normal activities and his general wellbeing.

HIV/AIDS

Regarding HIV, even the most pro-circ studies performed have been done in places like Kenya and Uganda - those studies showed approximately 50% higher likelihood to contract HIV when uncirc'd than circ'd. That is a significant difference. But the number of people who contracted HIV at all showed that the approximate benefit is 1 prevented case of HIV for every 72 infants circumcised. This is in countries where HIV is extremely prevalent, and every evaluation of theses studies I've found estimates that the mathematical correlation for the rate of HIV in the US - where the primary mode of HIV transmission is to individuals who receive anal sex from infected men, not from vaginal penetration - is so low that it becomes insignificant and considered irrelevant in justifying routine infant circumcision in the US.

HPV/CANCER

Regarding penile cancer, an uncircumcised man has a 1 in 600 chance of developing penile cancer in their life time, vs a 1 in 1000 chance for circumcised men. That does nearly double the risk and I do consider penile cancer - unlike UTIs - to be a significant pressing factor. This is among the very few medical reasons that does make me uncomfortable, because cancer in general is very prevalent in my family (four members of my family have been killed by cancers, three of them before the age of 55). The 5yr survival rate for penile cancer is 65%, which does mean that a third of men who contract this cancer will die from it within 5yrs. From the research I've done further into those statistics, they've found more and more in recent years that the majority of penile cancers are caused by HPV, just like many cervical cancers are. I've confirmed that my sons are covered for the HPV vaccine, just like my daughters are - and I will be vaccinating all four of my children against this cancer causing threat. Most other major causes of penile cancer are untreated conditions (like Phimosis or Balanitis) which would already justify the choice to circumcise my boys if they developed such problems and other treatment methods did fail.

On top of all of that, breast cancer is far more common than penile cancer is - 90x as common here in the states, in fact - but we still do not go about removing our daughter's breast tissue as a preventative measure, despite the fact that it is *proven* to reduce the risks of developing breast cancer.

Several studies over the last decade or so have found greater volumes of HPV cells on male genitalia of uncircumcised men than on those of circumcised men. There have since been further studies showing that there was no significant difference between the two groups in rate of infection, and several researchers have pointed out that when you have studies saying that their two groups of infected men, circumcised and intact, all of whom carry the virus, and your data suggests that there are greater volumes of the virus cells on the scrotum, anus, and shaft of the penis of uncircumcised men than circ'd men is reason for great scrutiny of those studies, since the presence of a foreskin has no scientific rationale for higher volumes on other regions of the genitals when both groups are infected.

Morality and the ethical perspective

One of the things I did not address in my review of medical examination was "sensitivity" and "pleasure". This is because, in my opinion, whether or not someone might be able to retain feeling or comfort is something to be considered *after* you've come to the conclusion that a surgery is necessary in order to decide whether the consequences of that surgery are worth the benefit - not something that should factor into whether or not the surgery is necessary in the first place. We don't sit about saying, "Well, you can still swallow without your tonsils - score one for tonsillectomy!!" or, "There is no change in one's ability to taste if you snip the connective tissue under the tongue - cut ALL the lingual frenulum!!"... unless there is already a medical justification for removing your tonsils or snipping a tongue tie because they are creating trouble swallowing or speaking.... but, just because it may have bearing on the choices that other people make, study including male sensitivity is included at the end...

The general conclusion is that in uncomplicated circumcisions, there is no difference in sensitivity of the *glans* of the penis - but that there is an entire loss of sensitivity of the foreskin, the penile frenulum, and other connecting tissues - because all of these parts have either been removed, severed, or scarred during the process of circumcision. TO make the claim that there is no change in sensitivity is a wild overstated generalization that requires a compartmentalized conclusion wherein the individual making or accepting the claim chooses to omit all facts regarding these missing and damaged parts. It is as misleading as saying that sewing your nose shut will have no impact on your ability to breathe through your mouth.

My ethical and intellectual position is that the *need* for circumcision must be clear before we can even begin to justify it. This is not an issue that should be worked backward from an existing conclusion. We should not be thinking, "Circumcision is an option, so what are the pros and cons" - we should be identifying problems that already exist, like, "My child has problem X" or "There is a very strong genetic history of Y in my family", and asking whether circumcision is an appropriate method of treatment or prevention of those problems - and, if so, whether it is the most effective, practical, and sensible action to take.

This is not like vaccines - which simply trigger a normal and natural function of the body while preventing disease... this is modification of a human organ, causing it to do something that it has not evolved to do on its own.

I firmly believe that a child's right to health and safety (components of the Right to Life) will always trump their Right to Liberty - this is why we have rules about where our children can play, what they may eat... it is why we have laws requiring parents to seek medical attention for their children if they are at risk of serious injury or death... it is why we do not let children run about being the sole individuals responsible for their own care.

But I also believe that decisions that will have a permanent and irreversible impact on their personal liberty need to be just and rational. I believe that there needs to be an actual threat that outweighs that freedom to make the choice, themselves, later in life.

Is there evidence that there are some potentially positive effects from circumcision, in particular populations? Yes. But, honestly? No more so than the positive effects of removing any other non-vital organ or mechanism of the body.

It might have taken me a few years to really get it - but the evidence I have available to me does not compile the necessary evidence to allow me to logically and morally conclude that circumcising infants, outside of true, immediate medical emergencies, is proper or OK. It does not meet my personal standards of what is reasonable nullification of my children's right to liberty over such a personal part of their bodies.

https://www.ncbi.nlm.nih.gov/pubmed/15890696

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2878423/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3139859/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3210112/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2422896/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2422979/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3654279/

https://www.ncbi.nlm.nih.gov/pubmed/23374102

wifeofadam · October 2013

Rynleigh - thank you very much for all of the information. I truly appreciate the time it took to research and write all of that. I learned a lot from it and it gave me much to think about.

I do, however, respectfully disagree with some of what you wrote.

#1 - You talk about the very low chances of getting a UTI or penile cancer (for example, the UTI was 1% for babies) and that means it really isn't a good reason to circ. The argument for the flu vaccine is how dangerous the flu can be and how you can die from it, but I just want to point out that the risk of dying from the flu is less than a thousandth of a percent for children under the age of five. They are more likely to get a UTI that will require treatment than get a serious case of the flu.

#2 - The reason why we aren't chopping off the breasts of little girls to prevent cancer is because breasts serve a functional purpose. Women require breasts in order to feed their children (and luckily, breastfeeding their children decreases their risk of getting breast cancer). I don't think this is a good comparison to circumcision at all because foreskin serves no functional purpose (I would argue that a slight decrease in sensation is not functional). There really isn't a comparable organ to the foreskin that I can think of to make this argument, because the rest do serve a purpose. You could maybe say labia, but the removal of the foreskin is a very simple procedure where you get a benefit for very little medical risk. Removal of the labia is not the same type of procedure. There are way too many risks.

#3 - There are many modifications on a child's body that a parent will choose to do in order to make it function in ways it wouldn't on it's own. My friend is currently having her daughter's adenoids removed. My sister removed her son's tonsils. All of us will probably at some point consider serious orthodontic work on our children. Every parent weighs the benefits and risks of each of these decisions and all of them involve the modification of normal, God-given body design in order to have better health outcomes, whether preventative (in the case of circumcision or orthodontic work to hopefully help prevent heart disease) or not.

#4 - I would argue that vaccines, in many cases, are very much the same thing. One big one is the Vitamin K shot given at birth. If our bodies were designed perfectly, in a way that doesn't require any modification in order to obtain optimal health, why would that shot be necessary? By your logic one of our organs should have evolved to make that amount of Vitamin K. If it hasn't, we shouldn't be giving the shot at all. But the reason we do is that medicine often aims to improve on nature.

#5 - You said "Is there evidence that there are some potentially positive effects from circumcision, in particular populations? Yes. But, honestly? No more so than the positive effects of removing any other non-vital organ or mechanism of the body. " I'm glad that you agree that there are potential positive effects. And I'm also glad that you said in your last statement that this is all your personal moral decision. Because another person may find those positive effects to be worth it and since their decision IS based on evidence, I don't think it is fair to call it immoral or unethical. I disagree that there is any other non-vital organ that we can compare this to, because there is nothing like the foreskin on the human body - it serves no real purpose. I'd be interested to hear what organs you're thinking of. Like I mentioned above, breasts serve a purpose. They aren't vital, but they're functional. Foreskin is not.

Like I said, I truly appreciate and respect your very thoughtful argument. I enjoyed reading through it and thinking about it. I think it is well presented and makes some really great points. You and I just disagree on a few points - points that are a vital part of our decision-making. Ultimately, it comes down to whether or not we feel a parent has the right to make this decision for a child. I do, and I hope people can respect that.

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