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"History of Circumcision in the U.S."
#1
This one is dedicated to supra's quest for foreskin restoration so the he and others understand why this happened in the first place.

The U.S. is the only Western nation that surgically alters its males in this manner.

In the U.S. there was a myth that the natural human penis is a self-destructing time-bomb, ready to go off at any time in an explosion of disease, filth, and horrible stenches, an inevitable disaster which only immediate surgery at birth could prevent. Why and how this practice of routine infant circumcision began in the United States?

In the U.S. on a very small scale in the 1860s for a single purpose-to stop masturbation. Circumcision was used as a deliberate surgical intervention to debilitate and desensitize the penis. During the Victorian era, physicians began to believe that all sexual activity was dangerous to physical and emotional health and was named as the cause of every known disease, from blindness to nervousness, insanity, venereal disease, tuberculosis, and death.

Religious leaders believed that masturbation, a form of self-indulgence was a sin against God. The church embraced the practices for different reasons. In the bible, the Hebrew Abraham was given a circumcision due to a covenant with God, by doing this, he would be given a child with Sarah, his wife.

The American doctor and medical association endorsed any steps taken towards its eradication and prevention of masturbation was deemed justified.

By the turn of the century, circumcision had become a panacea. Amputation of the foreskin was "scientifically proven" to cure and prevent diseases ranging from insanity to epilepsy, malnutrition, hip-joint disease, paralysis, eczema, tuberculosis, headache, hysteria, alcoholism, criminality, and heart disease. In 1928, the American Medical Association published an editorial in its journal calling for the routine circumcision of all male infants at birth. The primary justification for routine circumcision was the prevention of masturbation.

During World Wars I and II, many soldiers were forcibly circumcised by military doctors under threat of court martial. Returning WWII veterans were now conditioned to believe that circumcision was the correct thing to do. They were told it was hygienic, that it prevented disease, and that conformity was necessary. Young parents did not object when their newborn boys were automatically circumcised.

In the late 1960s and early 1970s, this abusive situation was reformed. Hospitals and doctors were required to obtain informed consent from patients for any medical or surgical procedure. Yet still in the early 1970s, over 90% of newborn boys were still automatically circumcised.

In the 1980s, an awakening began with American men. Many began to realize that they had been alienated from their bodies. Many began to question the myths, which told them that their genitals were inherently "dirty" and in need of surgical reduction and an increasing numbers are becoming aware that they had a right to all of their reproductive organs and that no one had the right to remove part of their body.

American men are beginning to realize the truth that nature knows more about designing the penis than do American doctors. Parents do not have the right to force circumcision on their sons. The only person who has the right to consent to the amputation of a normal, healthy, functioning body part is the person who must live with the consequences.

Many organizations have formed to fight for the freedom of American males to keep the sexual organs nature intended them to have, to stop the mutilation of the male penis. Parents have nothing to lose and everything to gain by leaving their sons intact. Permitting their offspring the dignity of an intact body and protecting the basic human right to self-autonomy is both good and noble. Everyone has the right to an intact body.

Today the American Medical Association advocates leaving the Penis intact. Hospital studies have confirmed that almost 50% of the newborn males now leave the hospital intact and the numbers are growing every year. According to recent studies, circumcision is not a benign surgery. Besides destroying a significant segment of the male's sexual equipment, it has a significant complication rate. According to an important medical study, one serious complication-severe hemorrhage, infection, loss of entire penis, or death-occurs in every 500 circumcisions (approximately 3,700 in 1993).1 According to another study, "Death as a complication from newborn circumcision has been estimated to occur in from 1 in 24,000 to 1 in approximately 500,000.
 

wants9

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"History of Circumcision in the U.S."
#2
The church embraced the practices for different reasons. In the bible, the Hebrew Abraham was given a circumcision due to a covenant with God, by doing this, he would be given a child with Sarah, his wife.
Speaking directly to this point, no where in the New Testiment is it commanded that Gentile converts be circumsised. In fact, it's specifically stated that it's unnecessary here, and in various other places.


For full disclosure, I am a Christian and was circumcised shortly after birth.
 
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"History of Circumcision in the U.S."
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wants9 said:
Speaking directly to this point, no where in the New Testiment is it commanded that Gentile converts be circumsised. In fact, it's specifically stated that it's unnecessary here, and in various other places.


For full disclosure, I am a Christian and was circumcised shortly after birth.
No arguement there, I pointed it out only as a reference in the bible. It is small part of the evolution of circumcision. Some used this as a weapon in the fight against mastrubation, but the main fault lay with the medical community and the absurd justifications that were used by them in practicing this. As I recall there was a fee involved for doing this proceedure when my children were born in the 70's. A hundred dollars or so.If you are interested in this topic there are page upon page of documentation on it's history. This was just a short redition of the history, it gets much deeper than that. Use google and research the topic.
 
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"History of Circumcision in the U.S."
#4
The Circumsion was a coventate that was made with the Isreal and was part of the old testament. That does not apply to us anymore
 

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"History of Circumcision in the U.S."
#5
Did you know that the trama to a new born baby from circumsision is so severe that it casn casue Brain Damage. I am totally against this. I dont care what anyone says, it is the way Gog desigened the body, and that is how all of us are still being born, there is no more law, or anything.

It is not the parents right, privalage or antyhing else to take this from the baby, even if they think that it is in there best intereset. The old testament is over, WWII is over, we are so advanced in medical feild that this crude meathod is complety wong.

Teaching a child to clean his penis is no different than tell him to wash behing his ears and brush his teeth. It is a simple task to pull the skin back and clean the penis.

What the Experts are Saying
"My own preference, if I had the good fortune to have another son, would be to leave his little penis alone."

Benjamin Spock, M.D.
author, Baby and Child Care

"...no one is aware of the deep implications and life-lasting effect (of circumcision). The torture is experienced in a state of total helplessness which makes it even more frightening and unbearable."

Dr. Frederick Leboyer
author, Birth Without Violence

"All of the Western world raises its children uncircumcised and it seems logical that, with the extent of health knowledge in those countries, such a practice must be safe."

C. Everett Koop, M.D.
former Surgeon General

"SuBathmateitting your son to the procedure to prevent urinary infections makes only a little more sense than buying insurance against being gored by a unicorn in Riverside."

Eugene Robin, M.D.
Stanford University Medical School

"...there are now serious concerns that this routine procedure may actually deprive adult men of a vital part of their sexual sensitivity."

Dean Edell, M.D.
Radio and TV Physician

"The risks of newborn circumcision are an underreported and ignored factor in this argument. Most often a poor surgical result is not recognized until years after the event."

James Snyder, M.D.
Past President, Virginia Urologic Society

"I'm opposed to inflicting an (elective) operation on an individual without his permission."

Howard Marchbanks, M.D.
Family Practitioner
 
T

TheExecutioner

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"History of Circumcision in the U.S."
#6
Circumcision, Hydromaxm Heres my situation, I as a young child at age of 3 noticed that it was beggining to hurt or cause a slight pain when i had to go to the toilet. Being the young child i was i went and told my mum and dad that when i took a piss it hurt. I remember a brief discussion to go see a doctor. Next thing i remeber i was booked in at the hospital and didnt really understand what was going on. My Mum and dad said everything would be fine. so as i trusted them i had nothing to worry about. The Nurses came and Put me on some heavy anasthetic and i was out like a light (that is good shit by the way) :)
So i Remember coming around from the anasthetic wearing off with my anxious pareants waiting by my bed. I Remember waking up with the most Hurrendous Pain i had ever felt, i remember it from this day. The pain is develish!
Some days after i noticed my penis was so much different as there was something missing, i used to ask alot of the time "Will it grow back" and for years they said yes dont worry about it. As i grew older i asked the question again, and one day they turn around and say to me no. I was very dissapointed and almost depressed. It was Pretty Traumatising but i dont know if the reason was totally justified, but the fact they lied to me and told me it would come back really angers me. I cannot remember fully but i think it was explained to me before hand what was going to happen, yet they said even before the Op that it would grow back, which kind of pissed me off when i realised it wouldnt :(, also i may have been 5 years old i cant remember the exact time. I have noticed my head of penis is now pretty rough like hard wearing skin becomes and i am not happy, although In my eyes i think it looks better and is of course 'Cleaner' but i would rather have my foreskin back. I Now moisturize my knob with Vaseline every day through Jelqing which i think will keep the head more 'tender'. My hands ache from typing so i will shutup now.
 
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"History of Circumcision in the U.S."
#7
Man circumsision is so wrong. I am so sorry you had to go through that. I am going to help anyone I can to restore there foreskin. This is so nessasary. This has to be stoped. To think that humans no better than how we were made is mockery. I am so sorry to hear this sad sad story. You my freind I comfort and if you want to restore let me know and we will do this.
 

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"History of Circumcision in the U.S."
#9
Look at those pictures, HOW CAN Penis EnlargementOPLE THINK THAT IS RIGHT!!!! THAT IS MUTILATION OF THE HUMAN BODY. Looking at those pictures I am so sorry that people have to go through this, my self included. Why should a new born baby have to be cut up? WHY? This is a abomination of the human body and I for will will not accept it as thats the way it is. That will stop here and now with my blood line.

Thank you so much for showing me this, my eyes have been opened ever more than before. Did you get my PM?
 
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"History of Circumcision in the U.S."
#10
Everything presented so far has been completely Anti-circumcision...to shed some light on the other side http://www.circinfo.net/ this is not the whole thing, just parts

WHY THE FORESKIN INCREASES INFECTION RISK
It has been suggested [31] that the increased risk of infection in the uncircumcised may be a consequence of the following:


The foreskin presents the penis with a larger surface area.
The moist inner lining of the foreskin represents a thinner epidermal barrier than the more cornified outer surface of the foreskin and the rest of the penis, including the glans of both circumcised and uncircumcised penis, which have been found recently to have the same amount of keratin (i.e., similar skin thickness and protection from invasion of microorganisms) [210]. This means that the inner lining is a potential entry point into the body for viruses and bacteria. (A photograph of a histological section illustrates this later, in the section on the AIDS virus.)
The presence of a prepuce is likely to result in greater microtrauma during sexual intercourse, thereby permitting an entry point into the bloodstream for infectious agents.
The warm, moist mucosal environment under the foreskin favours growth of micro-organisms (discussed later). This "preputial sac" has even been referred to by Dr Gerald Weiss, an American surgeon, as a 'cesspool for infection' [230], as its unfortunate anatomy wrapped around the end of the penis results in accumulation of secretions, excretions (urine), dead cells and growths of bacteria. Parents are told not to retract the foreskin of male infants, which makes cleaning difficult. Even if optimal cleansing is performed there is no evidence that it confers protection [243, 244].

HISTORY AND RECENT TRENDS
Dr Edgar Schoen, Chairman of the 1989 Task Force on Circumcision of the American Academy of Pediatrics, has stated that the benefits of routine circumcision of newborns as a preventative health measure far exceed the risks of the procedure [188]. He has continued to this day to campaign for public education of the benefits of circumcision. During the period 1985-92 there was an increase in the frequency of post-newborn circumcision (to over 80% in one study [248]) and during that same time Schoen points out that the association of lack of circumcision and urinary tract infection (UTI) has moved from "suggestive" to "conclusive" [188]. Moreover, this period heralded the finding of associations with other infectious agents, including HIV. In fact he goes on to say that "Current newborn circumcision may be considered a preventative health measure analogous to immunization in that side effects and complications are immediate and usually minor, but benefits accrue for a lifetime" [188].

Some of the health benefits were:

Decrease in physical problems involving a tight foreskin [153].
Lower incidence of inflammation of the head of the penis [56, 59, 62].
Reduced urinary tract infections.
Fewer problems with erections, especially at puberty.
Decrease in certain sexually transmitted diseases (STDs) such as HIV.
Elimination of invasive penile cancer.
Decrease in urological problems and infections [reviewed in 4, 11, 64, 115, 182, 186].
Therefore the benefits are different as the human male progresses through life. Each of these benefits will be reviewed in more detail in this website.

BENEFITS OUTWEIGH THE RISKS
Dr Tom Wiswell, a respected authority in the USA was a strong opponent, but then switched camps as a result of his own research findings and the findings of others. This is what he has to say: "As a pediatrician and neonatologist, I am a child advocate and try to do what is best for children. For many years I was an outspoken opponent of circumcision ... I have gradually changed my opinion" [240, 241]. This ability to keep an open mind on the issue and to make a sound judgement on the balance of all available information is to his credit ... he did change his mind!

Wiswell looked at the complication rates of having or not having circumcision performed in a study of 136,000 boys born in US army hospitals between 1980 and 1985. 100,000 were circumcised and 193 (0.19%) had complications, mostly minor, with no deaths, but of the 36,000 who were not circumcised the problems were more than ten-times higher and there were 2 deaths [248]. A study by others found that of the 11,000 circumcisions performed at New York's Sloane Hospital in 1989, only 6 led to complications, none of which were fatal [182]. An early survey saw only one death amongst 566,483 baby boys circumcised in New York between 1939 and 1951 [147]. (There are no deaths today in developed countries.)

Problems involving the penis are encountered relatively frequently in pediatric practice [118]. A retrospective study of boys aged 4 months to 12 years found uncircumcised boys exhibited significantly greater frequency of penile problems (14% vs 6%; P < 0.001) and medical visits for penile problems (10% vs 5%; P < 0.05) compared with those who were circumcised. In infants born in Washington State from 1987-96, 0.2% had a complication arising from their circumcision, i.e., 1 in every 476 circumcisions [36]. It was concluded that 6 urinary tract infections could be prevented for every circumcision complication, and 2 complications can be expected for every penile cancer prevented [36].

PAIN AND MEMORY
No adverse psychological aftermath has been demonstrated [185]. A longitudinal study in the UK, beginning in 1946, involving over 5000 individuals followed from birth to age 27 found no difference in developmental and behavioural indices between circumcised and uncircumcised males [32]. Long term psychological, emotional, and sexual impediments from circumcision are anecdotal [141,236] and can be discounted. It must be recognized that there are many painful experiences encountered by the child before, during and after birth [134]. Circumcision, if performed without anaesthetic is one of these. Cortisol levels, heart rate and respiration have registered an increase during and shortly after the procedure [211, 213], indicating that the baby is not unaware of having had something painful done in instances when circumcision has been carried out without anaesthesia. It is therefore generally advised that local anesthetic be used for all circumcisions on infants (more on anesthesia later). The response is variable and, even without anesthetic, some babies show no signs of distress at all. Most do, however, and this may be contributed by the restraining procedure, as well as the surgery itself. In the past doctors and parents had to weigh up the need to inflict this short-term pain in the context of a lifetime of gain from prevention or reduction of subsequent problems. Use of anesthetic for circumcision makes it virtually pain-free.

Penis EnlargementNILE HYGIENE
The proponents of not circumcising nevertheless stress that lifelong penile hygiene is required. This acknowledges that something harmful or unpleasant is happening under the prepuce. Studies of middle class British [97, 182] and Scandanavian [157] schoolboys concluded that penile hygiene, as such, is at best poor and at worst non-existent. Furthermore, Dr Terry Russell, an Australian medical practitioner and circumcision expert states "What man after a night of passion is going to perform penile hygiene before rolling over and snoring the night away (with pathogenic organisms multiplying in the warm moist environment under the prepuce)" [182]. The bacteria start multiplying again immediately after washing and contribute , along with skin secretions, to the whitish film, termed 'smegma', that is found under the foreskin. Bacteria give off an offensive odour. Men differ in their sensitivity to this smell and some shower several times a day as a result. Some uncircumcised men, and/or their partners, find the stench so unpleasant that the smell has caused these men to seek a circumcision on this basis alone. Penile hygiene is often difficult to achieve and attempting a very high degree of hygiene in uncircumcised men can result in new dermatological problems. For mothers and fathers, it is far easier to maintain cleanliness of their son's penis if it is circumcised. If their son isn't the messages are confusing: should they clean under the foreskin or leave it alone?

Anti-circ activists make unusual claims about the smegma and even claim there are glands under the foreskin that secrete pheromones important in sexual attraction. There is no support for such claims and all of their statements should be regarded as fantasies unless proved otherwise by credible scientific evidence. The wet tip of an uncircumcised penis could permit quicker penetration. However, the requirements of the modern woman generally differ somewhat from this kind of sex, which might have had some benefit for primitive humans who may have wanted to complete the sex act quickly to minimize the time they were vulnerable to predators.

PHYSICAL PROBLEMS
These were more than twice as frequent in uncircumcised boys [71]

Phimosis (inability to retract the foreskin) is normal in very young boys, but is gone by age 3 in 90%. If still present after age 6 it is regarded as a problem and affects 2-10% of uncircumcised males. The narrow foreskin opening causes urinary obstruction that can be partial or complete. Backward pressure to the kidney may impede its function and lead to high blood pressure, which is associated with increased risk of heart attack and stroke. Phimosis also increases risk of penile cancer (discussed later) and treatment by complete circumcision to prevent this outcome is advocated [14].

Paraphimosis (where the retracted foreskin cannot be brought back again over the glans) is a very painful problem, relieved by circumcision or slitting the dorsal surface of the foreskin.

Zipper injury In uncircumcised boys the foreskin can become accidentally entrapped in zippers, resulting in pain, trauma, swelling and scarring of this appendage. Foreskin accidents in men can also occur.

Elderly men In elderly men, infections and pain from balanoposthitis, phimosis and paraphimosis are seen and carers report problems in achieving optimal hygiene in uncircumcised men. The need for an appliance for urinary drainage in quadraplegics and in senile men is facilitated if they are circumcised. Nursing home staff have particular difficulty performing their duty of washing the genital area of uncircumcised elderly men, particularly with the onset of dementia. Such men can react violently towards staff or family during attempts to wash under the foreskin. This is an under-recognized problem and far from the mind of a parent or neonatologist when considering circumcision for an infant and information on the gerontological perspective should also be given [69].

Bathroom 'splatter' Boys and men who are not circumcised can be a source of irritation if they do not retract the foreskin when they urinate, as 'splatter' will occur. Although not a medical problem, it is a source of annoyance for other people (such as a parent or partner) if it is they who have the job of cleaning the bathroom.

The foreskin problems referred to above also mean intercourse is painful.

Another condition, Frenular chordee , results from an unusually thick and often tight frenulum and prevents the foreskin from fully retracting, being present in a quarter of all uncircumcised males [78]. The frenulum then tears during intercourse or masturbation. Since scar tissue is generally more fragile and less elastic than normal tissue, the tear often re-occurs causing pain, bleeding and is an impediment to sexual activity. This problem can be solved by excising the frenulum during a circumcision. Frenoplasty (removing just the tight frenulum) is also possible.

Psychological sequelae Follow-up 5 years later of 117 boys circumcised for phimosis, balanitis scarring of the prepuce, or ballooning when urinating found that 95% expressed complete satisfaction and the only psychological effect was slight shyness in the school change-room in 9% of boys in this Swedish study [207, 208]. The study showed that parents had nothing to fear for their son's psychological well-being from circumcision.

INFLAMMATORY DERMATOSES
To paediatric surgeons, the most obvious medical reasons for circumcision are balanitis (inflammation of the glans) and posthitis (inflammation of the foreskin). Both are very painful conditions. The latter is limited to uncircumcised males. Balanitis is seen in 11-13% of uncircumcised men, but in only 2% of those who are circumcised [62,110]. In uncircumcised diabetic men it is 35% [110]. In boys the incidence of balanitis is twice as high in those who are uncircumcised [70,86]. In babies, balanitis is caused by soiled diapers, playing and sitting in dirty areas, antibiotic therapy, as well as yeast and other micro-organisms. Balanitis caused by the group A haemolytic variety of Streptococcus is present exclusively in uncircumcised boys [155]. Mycobacterium smegmatis has been implicated in plasma cell (Zoon) balanitis [57]. Typical symptoms include erythrema (100%), swelling (91%), discharge (73%), dysuria (13%), bleeding (2%) and ulceration (1%) [110]. Balanoposthitis (inflammation of the foreskin and glans) is common in uncircumcised diabetic men, owing to a weakened shrunken penis [62] and such men also have more intercourse problems. Diabetes is common, inherited and rising in incidence, so this, as well as a family history of this disease may add to considerations about whether to circumcise at birth.

Most cases of inflammatory dermatoses are diagnosed in uncircumcised men (overall odds ratio 3.2). Thus circumcision is protective [128]. The disorders include psoriasis, penile infections, lichen sclerosus, lichen planus, schorrheic dermatitis, and Zoon balanitis (referred to above). All patients with Zoon balanitis, bowenoid papulosis, and nonspecific balanoposthitis were uncircumcised. Lichen sclerosis is found in 4-19% of all foreskins [54]. In older patients progressive Lichen sclerosis or other inflammatory changes lead to phimosis [14]. For a more extensive account on diseases of the penis see [57, 110]

URINARY TRACT INFECTIONS
The association of lack of circumcision with infections of the urinary tract is unequivocal. Most of the evidence has emerged over the past 20 years.

In 1982 it was reported that 95% of UTIs in boys aged 5 days to 8 months were in uncircumcised infants [75]. This was confirmed by Wiswell [249] and a few years later Wiswell and colleagues found that in 5261 infants born at one US Army hospital, 4% of UTI cases were in uncircumcised males, but only 0.2% in those who were circumcised [250]. This relatively captive population in Hawaii was said to be more reliable than the rate reported for hospital admissions [246]. Wiswell then went on to examine the records for 427,698 infants (219,755 boys) born in US Armed Forces hospitals from 1975-79 and found that the uncircumcised had an 11-fold higher incidence of UTIs [247]. During this decade the frequency of circumcision in the USA decreased from 84% to 74% and this decrease was associated with an increase in rate of UTI [251]. Reviews by others in the mid-80s concluded there was a lower incidence in circumcised boys [125, 177]. The rate in girls was stable during the period it was increasing in boys, in whom circumcision was in a decline. In a 1993 study by Wiswell of 209,399 infants born between 1985 and 1990 in US Army hospitals worldwide, 1046 (496 boys) got UTI in their first year of life [253]. The number was equal for boys and girls, but was 10 times higher for uncircumcised boys. Among the uncircumcised boys younger than 3 months, 23% had bacteremia, caused by the same organism responsible for the UTI.

In a study of 14,893 male infants aged < 1 year who had been delivered during 1996 at Kaiser Permanente hospitals in Northern California, with 65% circumcised, 86% of the UTIs occurred in the uncircumcised boys [191, 192]. The mean cost of management in the boys was US$1111, being twice that of girls (US$542), reflecting a higher rate of hospital admission in uncircumcised males with UTI (27%) compared with females (7.5%). Mean age at admission also differed: 2.5 months for uncircumcised boys vs 6.5 months for girls. Total cost was 10-times higher for uncircumcised boys vs girls ($155,628 vs $15,466). There were 132 episodes of UTI in uncircumcised males, but only 22 in those who had been circumcised. Hospital admissions were 38 vs 4, respectively. Incidence during the first year of life was 2.2% in uncircumcised boys and just 0.22% in circumcised (odds ratio = 9:1). The incidence in the girls was 2%. In a commentary to this article, Wiswell points out that half of infants with acute pyelonephritis get renal scarring that then goes on to pedispose to serious, life threatening conditions later in life, meaning also a large, ongoing cost [246]. UTIs are thus far from benign disorders of infancy. Moreover, the AAP Subcommittee on Urinary Tract Infections recommends a urine culture for any child under 2 with unexplained fever.

It should be noted that these studies gave figures for infants admitted to hospital for UTI, so that the actual rate would undoubtedly have been higher.

The infection can travel up the urinary tract to affect the kidney and a higher rate of problems such as pyelonephritis and renal scarring (seen in 7.5% [173]) is reported in uncircumcised children [180, 209]. These and other reports [e.g., 42, 75, 85, 180, 197, 209] all point to the benefits of circumcision in reducing UTI.

Wiswell performed a meta-analysis of all 9 studies that had been published up until 1992 and found that every one had observed an increase in UTI in the uncircumcised [248]. The average was 12-fold higher and the range was 5- to 89-fold, with 95% confidence intervals of 11-14 [248]. Meta-analyses by others have reached similar conclusions.

A large study in Canada of equal numbers of neonatally circumcised and uncircumcised boys saw rates of UTI and hospital admissions for UTI that were 4-fold higher in the uncircumcised [217]. In Australia, a relatively small study in Sydney involving boys under 5 years of age (mean 6 months) found that 6% of uncircumcised boys got a UTI, but only 1% of circumcised [41].

The benefit appears to extend beyond childhood and into adult life. In a study of men aged, on average, 30 years, and matched for race, age and sexual activity, the circumcised had a lower rate of UTI [203].

The fact that fimbriated strains of the bacterium Escherichia coli which are pathogenic to the urinary tract and pyelonephritogenic, have been shown to be capable of adhering to the foreskin, satisfies one of the criteria for causality [71, 77, 98, 99, 209, 251, 252]. Thus in infancy and childhood the prepuce becomes colonized with bacteria. Fimbriated strains of Proteus mirabilis , non-fimbriated Pseudomonas , as well as species of Klebsiella and Serratia also bind closely to the mucosal surface of the foreskin within the first few days of life [71, 77, 251]. Circumcision prevents such colonization and subsequent ascending infection of the urinary tract [177].

A recent report found that swabs taken of the periurethral area (the region of the penis where urine is discharged) in 46 circumcised and 125 uncircumcised healthy males (mean age = 27; range = 2 to 54 years) showed a predominance of Gram positive cocci in both groups, facultative Gram negative rods in 17% of uncircumcised males, but in only 4% of circumcised ( P = 0.01). Streptococci, strict anaerobes (bacteria that can grow without oxygen) and genital mycoplasms (bacteria that lack a cell wall) were found almost exclusively in uncircumcised males over the age of 15 years (82% of the study group) [196]. Since these organisms are common inhabitants of the female genital tract, acquisition via sexual transmission was suggested. These latter categories of bacteria, unlike the Gram positive cocci, are potential pathogens capable of causing UTIs. It was speculated that when Gram negative organisms are the only colonizers of the preputial space they achieve higher concentrations and that the quantitative difference may contribute to the development of UTI. The findings of this study provide a microbiological basis for the observed higher risk of UTI in uncircumcised adult men. The authors also concluded that their results pointed to a role for the prepuce as a reservoir for sexually transmitted organisms [196]. Another study, conducted in Dublin, involving swabs from the periurethral area, found that antibiotic prophylaxis in boys with vesicoureteral reflux was not effective in reducing the bacterial colonization of the prepuce, and recommended circumcision to reduce UTIs [35]. Vesicoureteral reflux increases risk of UTI, putting those boys in great danger from renal damage [66]. Salmonella typhimurium has also been found (in a 10 month old boy) and circumcision not only prevented further UTI, but also the spread of this organism to the general public [202].

Since the absolute risk of UTI in uncircumcised boys is approx. 1 in 25 (0.05) and in circumcised boys is 1 in 500 (0.002), the absolute risk reduction is 0.048. Thus 20 baby boys need to be circumcised to prevent one UTI. However, the potential seriousness and pain of UTI, which can in rare cases even lead to death, should weigh heavily on the minds of parents. Obtaining a midstream urine sample for culture from a circumcised boy is easy [19]. However, valid urine samples from uncircumcised boys requires invasive techniques such as urethral catheterization and suprapubic bladder catheterization [19]. The complications of UTI that can lead to death are: kidney failure, meningitis and infection of bone marrow. The data thus show that much suffering has resulted from leaving the foreskin intact. Lifelong genital hygiene in an attempt to reduce such infections is also part of the price that would have to be paid if the foreskin were to be retained. However, given the difficulty in keeping bacteria at bay in this part of the body [157, 188], not performing circumcision would appear to be far less effective than having it done in the first instance [180].

SEXUALLY-TRANSMITTED DISEASES
Ulcerative STDs (chancroid, syphillis) are associated with lack of circumcision, as seen in over 11 studies (for review see [141]). For other STDs the overall picture indicates greater prevalence in uncircumcised men, but there studies that show no difference (reviewed in [141])

One of the earliest large studies, reported in 1947, involved 1,300 consecutive patients in a Canadian Army unit. This showed that being uncircumcised was associated with a 9-fold higher risk of syphilis and 3-times more gonorrhea [238]. Work in the mid-70s showed higher chancroid, syphilis, papillomavirus and herpes in uncircumcised men [214]. At the University of Western Australia a 1983 study showed twice as much herpes and gonorrhea, 5-times more candidiasis and 5-fold greater incidence of syphilis [160]. Others have reported higher rates of nongonococcal urethritis in uncircumcised men [201].

In South Australia, a study in 1992 showed that uncircumcised men had more chlamidia (odds ratio 1.3) and gonoccocal infections (odds ratio 2.1). Similarly in 1988 a study in Seattle of 2,800 heterosexual men reported higher syphilis and gonorrhea in uncircumcised men, but no difference in herpes, chlamidia and non-specific urethritis (NSU). Like this report, a study in 1994 in the USA, found higher gonorrhea and syphilis, but no difference in other common STDs [34]. In the same year Dr Basil Donovan and associates reported the results of a study of 300 consecutive heterosexual male patients attending Sydney STD Centre at Sydney Hospital [53]. They found no difference in genital herpes, NSU, seropositivity for HSV-2 and genital warts (i.e., the benign, so-called 'low-risk' human papillomavirus types 6 and 11, which are visible on physical examination, unlike the 'high-risk' types 16 and 18, which are not). As mentioned earlier, 62% were circumcised and the two groups had a similar age, number of partners and education. Gonorrhea, syphilis and hepatitis B were too uncommon in this Sydney study for them to conclude anything about these other STDs. Similar findings were obtained in the National Health and Social Life Survey in the USA, which asked about gonorrhea, syphilis, chlamidia, nongonoccocal urethritis, herpes and HIV (a virus more often acquired intravenously in heterosexual i.v. drug-using men in the USA) [120], although some under-reporting by uncircumcised men was likely as they tended to be less educated. Also, circumcision at birth was assumed, so that the number who sought circumcision later in life for problems, such as STDs and/or other infections, and therefore had switched group, was not taken into account. In a cross-sectional and cohort study from a multicentre controlled trial involving 2021 men in the USA from 1993 to 1996, and using multiple logistic regression to compare STD risk among circumcised and uncircumcised men adjusted for potentially confounding factors, uncircumcised men were significantly more likely to have gonorrhea in the multivariate analysis adjusted for age, race and site (odds ratio 1.3 and 1.6 for each respective study) [50]. this was also the case for syphilis (odds ratios 1.4 and 1.5), but not chlamydia.

Design aspects of a number of the studies have been criticized. As a result there is still no overwhelming agreement. Nevertheless, on the bulk of evidence, it would seem that at least some STDs could be more common in the uncircumcised. This conclusion is, however, by no means absolute in Western settings, and the incidence may be influenced by factors such as the degree of genital hygiene, availability of running water and socioeconomic group being studied. In some more recent studies in developed nations, in which hygiene is good, little difference was apparent.

CANCER OF THE Penis EnlargementNIS
Incidence

The incidence of squamous cell carcinoma of the penis in the USA is 1 per 100,000 men per year [43] (i.e., 750-1000 cases annually). Mortality rate is 25-33% [109, 127]. Statistics on the American Cancer Society web page [8] show 1300 cases annually with 220 fatalities (1997 data). Penile cancer represents approximately 0.1-1% of all malignancies in men in the USA and other western countries. Neonatal circumcision virtually abolishes the risk [168, 189]. The rate data in the USA has to be viewed, moreover, in the context of the high proportion of circumcised men in the USA, especially in older age groups, and the age group affected (mean age at presentation = 60 years), where older men represent only a portion of the total male population. Thus the incidence of 1 in 100,000 men per year of life translates to 75 in 100,000 during each man's lifetime (assuming an average life expectancy of 75 years). However, penile cancer occurs almost entirely in uncircumcised men. If we assume that these represent 30% of males in the USA, the chance an uncircumcised man will get it would be (very approximately) 75 per 30,000 = 1 in 400. Perhaps not surprisingly this accords with the incidence that is actually seen (see below).

In 5 major series in the USA since 1932 [253], not one man with invasive penile cancer had been circumcised neonatally [127], i.e., this disease is almost completely confined to uncircumcised men. It is very much less common in circumcised men. In fact penile cancer is so rare in a circumcised man, that when it does occur it can even be the subject of a published case report [100]. The finite residual risk appears to be greater in those circumcised after the newborn period.

Lifetime risk in the total population of circumcised men is only 1 in 50,000 to 1 in 12,000,000 [242, 243]. In a study of 213 cases in California only 2 of 89 men with of invasive penile cancer was circumcised in infancy, so that uncircumcised men were stated to have 22 times the risk [192]. Of 118 with the localized, and thus more easily curable, variety of penile cancer, namely carcinoma in situ (which is not lethal), only 16 had been circumcised as newborns, i.e., incidence was 3-fold higher in the uncircumcised [127, 192].

Overall there were 50,000 cases of penile cancer in the USA from 1930 to 1990 and these resulted in 10,000 deaths. Only 10 of these cases were in circumcised men [187], and these had been circumcised later in life. The predicted lifetime risk for an uncircumcised man has been estimated as 1 in 600 in the USA and 1 in 900 in Denmark [109]. In Denmark (circumcision rate = 2%), penile cancer has been decreasing steadily [68] in parallel with an increase in indoor bathrooms. Urban unmarried men were more likely to get it. Since the rate of penile cancer in Denmark is lower than in the USA other factors besides circumcision are also at work in these climatically, genetically and culturally different countries. The statistics for Denmark have been used by anti-circ advocates to draw a sweeping and fallacious conclusion about lack of circumcision per se in penile cancer. The Danish themselves have concluded that although their uncircumcised men are at lower risk, this is only 1 in 900 as opposed to 1 in 600 in the USA, as stated above [109]. A study in Spain concluded that "circumcision should be performed in childhood [as a] prophylactic [to penile cancer] [183].

In underdeveloped countries the incidence is higher: approx. 3-10 cases per 100,000 per year [109]. In those underdeveloped countries where circumcision is not routinely practiced it can be ten times more common than in developed countries, representing 11% to 12% of all male cancers [146]. In Uganda and some other African countries it is the most common malignancy in males, leading to calls for greater circumcision in that country [51]. Enormous differences are, moreover, seen in third world nations such as Nigeria (circumcised; low rate) when compared with Uganda, Puerto Rico [255] and Brazil [224], where most males are uncircumcised.

In Australia , figures from the New South Wales Cancer Council show 28 cases per year (including one in a child), with 5 deaths (1993 figures), which is similar to the 1 in 100,000 figure above and applies to a population in which the majority of the older men are circumcised. The rate could be set to escalate, however, as more of the males who were not circumcised during the period after the mid 1970s reach the ages when this cancer generally begins to present.

In Israel , where almost all males are circumcised, the rate of penile cancer is extremely low: 0.1 per 100,000, i.e., is 1/10th that of Denmark [255].

Cause

The so-called 'high-risk' human papillomavirus types 16 and 18 (HPV 16/18) are found in a large proportion of cases and there is good reason to suspect that they are involved in the causation of penile cancer [133], i.e, the same virus is responsible as is the case for most, if not all, cases of cervical cancer in women (see below). HPV 16 and 18 are, moreover, more common in uncircumcised males [110, 149]. These high-risk types of HPV produce flat warts that are normally only visible by application of dilute acetic acid (vinegar) to the penis. The majority of infections are subclinical, being more prevalent in uncircumcised men with balanoposthitis [110]. The data on high-risk HPVs should not be confused with the incidence figures for genital warts, which are large and readily visible, and are caused by the relatively benign HPV types 6 and 11 [104]. Smegma (found only under the foreskin) was implicated in an early study [168]. Itis not clear, however, what component was responsible, and could have been HPV present in the smegma. Interestingly, 93% of men whose female partner was positive for early signs of cervical cancer (cervical intra-epithelial neoplasia, CIN) had the male equivalent, penile intra-epithelial neoplasia (PIN) [13]. This reflects the fact that the disease, via HPV, is sexually transmitted. Oncogenic HPV was present in 75% of patients with PIN grade I, 93% with PIN grade II and 100% of PIN grade III, which is one step before penile cancer itself [13]. Moreover, the rate of PIN was 10% in uncircumcised men cf. only 6% in circumcised men [13]. Phimosis is strongly associated with invasive penile carcinoma (adjusted odds ratio = 16) [219]. Other factors, such as smoking, poor hygiene and other STDs have also been suspected as contributing to penile cancer as well [20, 127], but it would seem that lack of circumcision is the primary prerequisite, with such other factors adding to the risk in the uncircumcised man. Indeed, there is no scientific evidence that improved penile hygiene is effective in reducing the risk in an uncircumcised man [141].

Treatment

Complete or partial surgical amputation is the traditional treatment. Radiation is an alternative (or additional) therapy and in early-stage disease can preserve function of the organ. In a retrospective study in Switzerland of 41 consecutive patients with non-metastatic invasive carcinoma of the penis 44% underwent surgery (to remove all or part of the penis, as well as lymph nodes in one third), followed by radiation therapy (in three-quarters) and the rest (56%) had just radiation therapy [256]. Over the median 70 months of follow-up 63% relapsed. For all patients 5-year survival rate was 57% and 10-year survival was 38%. Local relapse rate was lower in those who underwent surgery. However, there was no difference in survival when compared with radiation therapy, either alone, or in conjunction with salvage surgery. The psychosexual implications to a man are, understandably, not inconsequential [154].

Cost

Financial considerations are, moreover, not inconsiderable. In the USA it was estimated that the cost for treatment and lost earnings in a man of 50 with cancer, even in 1980, was $103,000 [82]. The amount today is very much higher.

Deaths from penile cancer vs. circumcision

In Australia between 1960 and 1966 there were 78 deaths from cancer of the penis and 2 from circumcision. (Circumcision fatalities today are virtually unknown.) At the Peter McCallum Cancer Institute 102 cases of penile cancer were seen between 1954 and 1984, with twice as many in the latter decade compared with the first [184]. Moreover, several authors have linked the rising incidence of penile cancer to a decrease in the number of neonatal circumcisions [44, 184]. It would thus seem that "prevention by circumcision in infancy is the best policy". Indeed it would be an unusual parent who did not want to ensure their child was completely protected by this simple procedure.

PROSTATE CANCER
Prostate cancer accounts for 27% of new cancers in males and 7% of deaths [148]. Uncircumcised men have twice the incidence of prostate cancer compared with circumcised [10, 61], and this cancer is rare amongst Jews [3]. No association has been seen between rate of prostate cancer and rate of cervical cancer in different geographic localities [179]. However, in a study of 20,243 men in Finland, infection with HPV18 was associated with a 2.6-fold increase in risk of prostate cancer ( P < 0.005) [48]. For HPV16 the increased risk was 2.4-fold.

CERVICAL CANCER IN FEMALE PARTNERS OF UNCIRCUMCISED MEN
A number of studies have documented higher rates of cervical cancer in women who have had one or more male sexual partners who were uncircumcised. These studies have to be looked at critically, however, to see to what extent cultural and other influences might be contributing within groups that have different circumcision practices. Of interest in studies conducted in India and Pakistan, premarital sex is uncommon in the various religious groups in these and surrounding countries, where in general Muslims are circumcised and Hindus are not. In a study of 5000 cervical and 300 penile cancer cases in Madras between 1982 and 1990 the incidence was low amongst Muslim women, when compared with Hindu and Christian, and was not seen at all in Muslim men [72]. In a case-control study of 1107 Indian women with cervical cancer, sex with uncircumcised men or those circumcised after the age of 1 year was reported in 1993 to be associated with a 4-fold higher risk of cervical cancer. This figure was, moreover, obtained after controlling for factors such as age, age of first intercourse and education [2]. Another study published in 1993 concerning various types of cancer in the Valley of KasHydromaxir concluded that universal male circumcision in the majority community was responsible for the low rate of cervical cancer compared with the rest of India [45]. In Israel, a 1994 report of 4 groups of women aged 17-60 found that Moshav residents with no gynaecological complaints had no HPV 16/18 and healthy Kibbutz residents had a 1.8% incidence [93]. Amongst those who had a gynaecological complaint HPV 16/18 was found in 9% of Jewish and 12% of non-Jewish women. Thus the causative agent (high-risk HPV) can be found in Jewish women, where the lifestyle and contact with non-Jewish men (some of whom may be uncircumcised) would likely have been higher in the Kibbutz dwellers. The source of this (circumcised vs. uncircumcised partners) was not explored.

So-called 'high-risk' HPV types 16, 18 and some rarer forms are responsible for virtually every case of cervical cancer [164, 225, 226]. These same high-risk HPVs also cause penile intra-epithelial neoplasia (PIN), which is the precursor to penile cancer and is the male equivalent of cervical intra-epithelial neoplasia (CIN), which is the precursor to cervical cancer. In a study published in the New England Journal of Medicine in 1987 it was found that women with cervical cancer were more likely to have partners with PIN [21]. A study in 1994 found that in women with CIN, PIN was present in the male partner in 93% of cases [13]. This is consistent with the known sexual transmission of this cancer-causing virus. The abnormality termed CIN may progress to cancer or, more often, it will go away. Thus co-factors are suspected. Interestingly, smegma (the film of bacteria, secretions and other material under the foreskin), obtained from human and horse has been shown to be capable of producing cervical cancer in mice in one study [165], but not in another [175]. Differences in exposure time in each study could account for this difference.

In 2002, a large, well-designed multinational study by the International Agency for Research on Cancer published in the New England Journal of Medicine has irrefutably implicated the foreskin in cervical cancer [35a]. This involved 1913 couples in 5 global locations in Europe, Asia and South America. Penile HPV was found in 20% of uncircumcised, but only 5% of circumcised men (odds ratio = 0.37). The women were more 5.6 times more likely to have cervical cancer if their partner was uncircumcised. Penile HPV infection was associated with a 4-fold increase in the risk of cervical HPV infection in the female partner, and cervical HPV infection was associated with a 77-fold increase in the risk of cervical cancer. In an accompanying editorial it was suggested that "reduction in risk among female partners of circumcised as compared with uncircumcised men may well be more substantial than reported" in this study [1a]. This may be because skin-to-skin contact that does not extend to sexual intercourse with the uncircumcised penis could infect the woman. Indeed, condom use had NO protective effect! Genital HPV types can in fact infect skin throughout the genital region. Interestingly, the uncircumcised men washed their genitals more often after intercourse, but the circumcised men had better penile hygiene, when examined by a physician. So why are uncircumcised men much more highly infected? One suggested reason was that the more delicate, easily-infected, mucosal lining of their foreskin is pulled back during intercourse, and so is wholly exposed to vaginal secretions of an infected woman, so infecting them, and increasing risk of infection to any future woman the uncircumcised man has sex with.

Thus the epidemic of cervical cancer worldwide would appear to be contributed, at least in part, by the uncircumcised male. In countries that have experienced a downturn in circumcision rate one might therefore expected to see the incidence of cervical cancer get even worse. This could apply particularly in regions where neonatal circumcision decreased in the late 1970s and 1980s, meaning men that were born then and not circumcised will now have reached sexual maturity and be increasingly putting at risk women today.


HIV: THE AIDS VIRUS
HIV infection is via the foreskin


Over 50 million people are infected with HIV. Half of these are men, most of whom have been infected through their penises [210]. Over 70% of these infections have arisen from vaginal intercourse [96]. How then does HIV enter a man's body in this way? Epidemiological data from more than 40 studies (discussed below) shows that HIV is much more common in uncircumcised, as opposed to circumcised, heterosexual men [66]. A wealth of evidence indicates that male circumcision protects against HIV infection, as acknowledged in the major journals Science [95] and Nature [232].

During heterosexual intercourse the foreskin is pulled back down the shaft of the penis, meaning that the whole of its inner surface is exposed to vaginal secretions [210]. An early suggestion that attempted to explain the higher HIV infection in uncircumcised men was that the foreskin could physically trap HIV-infected vaginal secretions and provide a more hospitable environment for the infectious inoculum [33]. It was also suggested that the increased surface area, traumatic physical disruption during intercourse and inflammation of the glans penis (balanitis) could aid in recruitment of target cells for HIV-1. Initial thoughts were that the port of entry could potentially be the glans, sub-prepuce and/or urethra. It was suggested that in a circumcised penis the drier, more keratinized skin covering the penis may prevent entry. However, more recent studies showed that the glans of the circumcised and uncircumcised penis were in fact identical in histological appearance, having exactly the same amount of protective keratin [210]. In contrast, the inner lining of the foreskin is a mucosal epithelium and lacks a protective keratin layer [17; see picture below taken, with permission, from 17]. The foreskin's inner epithelium thus resembles histologically the lining of the nasal passages and vagina. All such mucosal epithelia are major targets for infection by micro-organisms (colds, flu, STDs, etc). The inner lining of the adult foreskin is rich in Langerhans cells and other immune-system cells. The mucosal inner lining of the adult foreskin is rich in Langerhans cells and other immune-system cells (22.4, 11.5 and 2.4% of total cell population is represented by CD4+ T cells, Langerhans cells and macrophages) [161a]. (This contrasts with the neonate, where the foreskin is deficient in such cells [229], the proportion being instead 4.9, 6.2 and 0.3%, respectively [161a]). The respective percentages for immune-system cells in the cervical mucosa are: 6.2, 1.5 and 1.4% [161a]. In the external layer of the foreskin, which is like the rest of the penis, the proportions are very much lower: 2.1, 1.3 and 0.7%, respectively [161a]. Although the urethra is also a mucosal surface, it lacks Langerhans cells, so is not likely to be a common site of HIV infection [133]. The immune cells of the inner lining of the foreskin help fight bacteria and viruses that accumulate under it. However, in the case of HIV, they act as a "Trojan horse' and in fact serve as portals for uptake of HIV into the body. This has been shown by direct experimentation [17, 23, 161a]. Punch biopsies were taken from fresh foreskin obtained immediately after circumcision of an adult male. Cultures were made of cells from the external surface (which resembles the rest of the penis) and from the inner mucosal surface of the foreskin. Live HIV tagged with a fluorescent marker was then applied. Within minutes the HIV entered the Langerhans cells [see picture above - obtained, with permission, from 17 {similar images can be seen in 161a}]. No uptake occurred for cultured epithelium of the keratinized outer surface of the foreskin, i.e., the part that resembles the skin of the circumcised penis. The mean number of HIV copies per 1000 cells (determined by quantitative PCR) one day after infection was 301 for the mucosal inner foreskin, but was undetectable in the outer, external, foreskin [161a]. For cervical biopsies mean HIV copy number was 30, showing that the mucosal inner foreskin is 10-times more susceptible to HIV infection than the cervix [161a]. Also, the HIV receptor CCR5 was especially prevalent on foreskin tissue cells [161a]. This biological work thus nicely confirms the epidemiological evidence below. It is furthermore supported by experiments in which SIV (the monkey equivalent of HIV) has been applied to foreskin of monkeys, that then became infected [137]. The monkey work also showed infected Langerhans cells. Antigen presenting cells in the mucosa of the inner foreskin [92] are a primary target for HIV infection in men [210]. The foreskin is thus the weak point that allows HIV to infect men during heterosexual intercourse with an infected partner. A circumcised man with a healthy penis is thus very unlikely to get infected. However, ulcerations or abrasions on the penis will allow infection and a circumcised man with these will continue to be at risk of HIV, as well as some other STDs. Thus condom use is strongly advocated in an attempt to make absolutely sure that infection will not occur. Condoms are not, however, a panacea, and a man with a foreskin can still be infected even if using a condom during intercourse, if infected fluids come into contact with the inner foreskin, for example during foreplay.


SOCIO-SEXUAL ASPenis EnlargementCTS
Perhaps the first, albeit small and restricted, but interesting survey of circumcised vs uncircumcised men and their partners was conducted by Sydney scientist James Badger [15, 16] (who regards himself as neutral on the issue of circumcision). It involved responses to a questionnaire placed in clinics of the Family Planning Association in Sydney. This led to 180 participants (79 male, 101 female) who were aged 15-60. The women were mainly (50%) in the 20-30 year-old age group cf. 25% of the men, more of whom (33%) were aged 30-40. It found that:


18% of uncircumcised males underwent circumcision later in life anyway.

21% of uncircumcised men who didn't, nevertheless wished they were circumcised. (There were also almost as many men who wished they hadn't been circumcised and it could be that at least some men of either category may have been seeking a scapegoat for their sexual or other problems. In addition, this would no doubt be yet another thing children could "blame" their parents for, whatever the decision was when their child was born.)

No difference in sexual performance (consistent with Masters & Johnson).

Slightly higher sexual activity in circumcised men.

No difference in frequency of sexual intercourse for older uncircumcised vs. circumcised men.

Men who were circumcised as adults were very pleased with the result. The local pain when they awoke from the anaesthetic was quickly relieved by pain killers (needed only for one day), and all had returned to normal sexual relations within 2 weeks, with no decrease in sensitivity of the penis and claims of "better sex". (Badger's findings are, moreover, consistent with every discussion the author has ever had with men circumcised as adults, as well as an enormous number of email messages received from many such men. The only cases to the contrary were a testimonial in a letter sent to the author from a member of UNCIRC and a very brief email message that didn't say why.)

Women with circumcised lovers were more likely to reach a simultaneous climax - 29% vs. 17% of the study population grouped across the orgasmic spectrum of boxes for ticking labelled 'together', 'man first', 'man after' and 'never come'; some ticked more than one box. (Could this involve mental factors? ... Could it be that more circumcised men have a better technique? ... Or could other factors be involved?)

Women who failed to reach an orgasm were 3 times more likely to have an uncircumcised lover. (These data could, however, possibly reflect behaviours of uncircumcised males that might belong to lower socio-economic classes and/or ethnic groups whose attitudes concerning sex and women may differ from the better-educated groups in whom circumcision is more common.)

A circumcised penis was favoured by women for appearance and hygiene. (Furthermore, some women were nauseated by the smell of the uncircumcised penis, where, as mentioned earlier, bacteria and other micro-organisms proliferate under the foreskin.)

An uncircumcised penis was found by women to be easier to elicit orgasm by hand.

An circumcised penis was favoured by women for oral sex (fellatio).
A survey of 5000 men aged 16-49 (78% circumcised, 19% not, 3% "don't know") was subsequently conducted by Badger. This was open to all, and so included men who were anti-circumcision activists and those who were not. Circumcision was at birth in 72%, before puberty in 12% and after puberty in 16%. Of those who said someone else decided for them that they should be circumcised, only 16% said they were unhappy to be circumcised; 46% were happy and 38% didn't care. Overall only 11% said they would not circumcise any son(s).

These findings are consistent with later studies. In a survey of new mothers in the USA, hygiene and appearance were the two major reasons for choosing to have their newborn son circumcised [237]. There was a strong correlation between their son's circumcision status and the woman's ideal male partner's circumcision status for intercourse. Thus by being circumcised they thought that their sons would likewise be more attractive to a future sexual partner (with the implication that they would be at an advantage in passing on their, and therefore the mother's, genes to the subsequent generation). Their own preference thus affected their choice for their sons. 92% said the circumcised penis was cleaner, 90% said it looked 'sexier', 85% it felt nicer to touch and 55% smelled more pleasant. Even women who had only ever had uncircumcised partners preferred the look of the circumcised penis. Only 2% preferred an uncircumcised penis for fellatio, with 82% preferring the circumcised variety. Preference for intercourse for circ. vs uncirc. was 71% vs 6%, respectively; manual stimulation, 75% vs 5%; visual appeal, 76% vs 4%. What then is sexier about a circumcised penis? Quite likely it is that the glans is exposed in both the erect and un-erect state.

In Africa, women preferred men who were circumcised because they considered they were at less risk of STD [128]. The foreskin was also regarded as a source of a bad smell and men too thought it was cleaner. Increased sexual pleasure to both partners was also stated [150].

Many surveys have been carried out by women's and men's magazines over the years and all report a preference by women for a man with a circumcised penis. One in Sydney by Men's Health (July 2001 issue) found that only 16% of women preferred the uncircumcised penis. 46% preferred the circumcised, 31% didn't care (6% had never seen an uncircumcised penis and 1% had not seen a circumcised penis).

A survey by anti-circ activists of female members of their anti-circumcision organization, not surprisingly, found the opposite. Moreover, apart from the fact that it was not published in a proper scientific journal, bias arising from the seriously flawed study design causes it to lack credibility.

In the visual arts, for scenes involving the naked male it is quite plausible that American producers of erotic films and publishers of photographic works choose circumcised men, or at least uncircumcised men whose foreskin is smooth and free from loose, wrinkled skin, as the latter lacks visual appeal, especially to those who are not used to seeing an uncircumcised penis. Societal attitudes, at least in the USA, are reflected in the entertainment industry, such as TV shows. With apologies for introducing anecdotal material, a few examples are nonetheless potentially illuminating and amusing to many. For example, the character 'Elaine', in an episode of the TV sitcom 'Seinfeld' stated that "[the uncircumcised penis] looks like an alien!" Similarly in an episode of 'Sex in the City', also set in New York, one character recoiled in shock on seeing her new boyfriend was uncircumcised. It was clear that the quite sexually experienced 30-something women in this show were unused to the foreskin, describing it as resembling a Shar Pei (a dog breed with excessive rolls of skin). The new boyfriend's status had been bothering him anyway so he got circumcised, and liked his new look and sex so much he dumped the new girlfriend so he "could take the doggy for a walk", i.e to try it out on other women around town. The moral: "You can take the Shar Pei out of the penis, but you can't take the dog out of the man". In the TV cartoon series 'South Park' the boys were alarmed to hear a new baby was going to be circumcised, thinking the penis was going to be cut off. Later when told it made the penis bigger they all wanted it. (Being set in America's heartland it is certain they already were circumcised (and didn't know what it was) - that is if one can apply this kind of rationale.) These illustrations involve of course actors or characters who are following a script, and is therefore not scientific by any means, but do reflect thinking and behaviors in these US settings.

Interestingly, in other cultures, for example in Africa, women from tribes that do not practice circumcision report deriving greater sexual pleasure from circumcised men [141].

As far as performance during sex is concerned, the National Health and Social Life Survey (NHSLS) of over 1400 men in the USA found that uncircumcised men were more likely to experience sexual dysfunctions [121]. This was slight at younger ages, but became quite significant later in life and included finding it twice as difficult to achieve or maintain an erection. It was also discovered that circumcised men engaged in a more elaborate set of sexual practices. Not surprisingly, in view of the findings above, circumcised men received more fellatio. However, they also masturbated more, a finding that, ironically, contradicts the apparent wisdom in Victorian times that circumcision would reduce the urge to masturbate. (Contrary to anti-circ. propaganda, circumcision was not used to reduce masturbation in that era, but rather to prevent smegma and itching, so stopping males scratching their genitalia, which co-incidentally sometimes led to arousal.) As noted in other studies, circumcision rates were greatest among whites and those who were better educated, reflecting their exposure to and ability to evaluate and respond to scientific information about circumcision. There was little difference between different religious groups.

The foreskin contains sensory nerve receptors as are prevalent over the rest of the penis. There is no scientific evidence that the extra complement of these in uncircumcised men leads to greater sexual pleasure. Uncircumcised men often complain that their penis is too sensitive, leading to pain, and seek circumcision to relieve this. Diminishing sensitivity is in fact desired by many men and women in order to prolong the sex act by preventing premature ejaculation [29]. Orgasm, the culmination of the sex act, is not related to the foreskin. It should also be added that anecdote needs to be translated into science, however, and more research is required in this contentious area.

In Britain a class distinction is associated with circumcision. The Royal Family and the upper classes are circumcised and the lower classes less so. Queen Victoria believed her family descended from King David (of the Biblical Old Testament) and sanctioned circumcision. Prince Charles was circumcised by a mohel (a rabbi who specializes in circumcision). Princess Diana decided that Princes William and Harry would go uncircumcised. The NHSLS in the USA saw greatest rates among whites and the better educated. There was little difference between different religious groups. Some ancient cultures and some even today practice infibulation (drawing a ring or similar device through the prepuce or otherwise occluding it for the principal purpose of making coition impossible) [195]. This is the opposite of circumcision. It was, moreover, espoused in Europe and Britain in previous centuries as a way of reducing population growth amongst the poor and to prevent masturbation [195]. Times have changed fortunately for most.

Consistent with the accounts above of men circumcised as adults, clinical and neurological testing has not detected any difference in penile sensitivity between men of each category [129a]. Sexual pleasure also appears to be the same.

Two US studies published in 2002 both found similar or greater sexual satisfaction in men circumcised as adults [37a, 65a]. The mean age of the men in each study was 37 and 42, respectively. In the smaller survey [37a] there was no difference in sexual drive, erection, ejaculation, problem assessment or satisfaction compared with what the men recalled sex being like prior to foreskin removal. Penile sensitivity was the same, consistent with Masters & Johnson, who found no difference by neurological testing of the ventral and dorsal surfaces, as well as the glans [129a]. They state that their study was prompted by reports by proponents of "foreskin restoration", in particular the "disparity between the mythology and medical reality of circumcision regarding male sexuality" [37a]. In the other study, of 123 men [65a], 62% of men said they were satisfied with having been circumcised (they liked their new look) and 50% reported benefits. There was no change in sexual activity. Penile sensitivity, although not tested directly, was thought by the men to be slightly lower (but not statistically so), which may have contributed to their claims of better sex. Some men thought erectile function was slightly less (category scores: 12.3 vs 11.1, P = 0.05), which is the opposite of the very much larger National Health and Social Life Survey [121]. Moreover, the authors point out that this would have to be confirmed by duplex Doppler ultrasound before a definitive conclusion could be made. Both the men and their partners preferred the appearance of the penis after it had been circumcised. As in other studies [121] oral sex became more frequent, but there was no change in anal sex or masturbation [65a]. Their partners were also more likely to initiate sex with them.




RISKS
Having described the benefits, let's look at the risks. As listed in [241-243], these are:


Excessive bleeding: Occurs in 1 in 1000. This is treated with pressure or locally-acting agents, but 1 in 4000 may require a ligature and 1 in 20,000 need a blood transfusion because they have a previously unrecognized bleeding disorder. Hemophilia in the family is of course a contra-indication for circumcision.

Infection: Local infections occur in 1 in 100-1000 and are easily treated with local antibiotics. Systemic infections may appear in 1 in 4,000 and require intravenous or intramuscular injection of antibiotics.

Subsequent surgery: Needed for 1 in 1000 because of skin bridges, or removal of too much or too little foreskin. Repair of injury to penis or glans required for 1 in 15,000. Loss of entire penis: 1 in 1,000,0000, and is avoidable by ensuring the practitioner performing the procedure is competent. Injuries (rare) can be repaired [18] and in the infinitely remote instance of loss of the penis it can be reattached surgically [158].

Local anaesthetic: The only risk is when the type of anaesthetic used is a dorsal penile nerve block, with 1 in 4 having a small bruise at the injection site. This will disappear.

Death : Data in the records show that between 1954 and 1989, during which time 50,000,000 circumcisions were performed in the USA there were only 3 deaths. (But there were 11,000 from penile cancer, a disease essentially confined to the uncircumcised [243].)
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WHY ARE HUMAN MALES BORN WITH A FORESKIN?
One function of the foreskin was probably to protect the head of the penis from long grass, shrubbery, etc when humans wore no clothes, where evolutionarily our basic physiology and psychology are little different than our savhana-wandering or cave-dwelling ancestors tens to hundreds of thousands of years ago. Also, the moist tip would facilitate quick penetration of a female, where lengthy foreplay and intercourse would be a survival disadvantage, since the risk to the copulators from predators and human enemies would be greater the longer they were engaged in sex.

Dr Guy Cox from The University of Sydney has suggested that the foreskin could in fact be the male equivalent of the hymen, and served as an impediment to sexual intercourse in adolescent primeval humans before the advent in our species of civilization and cultures [40]. Way back then Cox says the foreskin would have reduced 'successful' sexual acts in those too young to adequately care for any offspring that might arise. With civilization, control of the sexual behaviour of the young by society made the physical mechanism redundant and society introduced circumcision to free the individual from the impediment of having a foreskin. Interestingly, the physical difficulties experienced by the uncircumcised may explain why the word for uncircumcised in Hebrew means 'obstruction' or 'to impede', so explaining the Biblical term 'uncircumcised heart' when referring to obstructionism.
 

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"History of Circumcision in the U.S."
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That really needs to be split up into different posts
 
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"History of Circumcision in the U.S."
#12
Very Interesting read Xulf. Particularly the end paragraph.
 
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"History of Circumcision in the U.S."
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Supra said:
That really needs to be split up into different posts
Its too late for me to edit and i didnt realize it was so long, but you or any other mods, feel free to split it up
 

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"History of Circumcision in the U.S."
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I dont care what anyone says, it is wrong and its not a parents or doctors right to do this to a helpless baby. We can dicuss the pro's and cons all day long till we are blue in the face.

The fact and truth is its not your decision or anyone elses descicion to do this. It is the humans own descision. And that is that. We can say this and that, this and that. If people are so "Pro Choice" and "Pro thisand Pro that" why not let the person decided for Gods sake and stop bending the rules
 
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"History of Circumcision in the U.S."
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I believe some of this may be true also, but several points in this article point to bias studies. 1st about 90% or more of the worlds population is uncircumcised, so the aids arguement can not be fairly disputed. Other issues fall into this but I do not want to get into a debate over this.

By the way the $500.00 fee that is added to the cost of childbirth couln't possibly one of the reasons behind his motivation for this study or the millions recieved to do it. Take this away and how many millions of dollars do they lose. In the United States that is a multi-million dollar bonus. And of those numbers of injures each year, how much money is made off that? It's the medical community reteric all over again. Millions upom millions are made with this simple 2 minute proceedure. Hell, an asprin in the hospital is $30.00 each tablet. It can cost a lifetime of problems for those that suffer from incompetence.

My only hope is that if you have male children, they do not have to go through any problems in life for deciding to do something to alter what God has given us.
 

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"History of Circumcision in the U.S."
#17
Circumsiosion is just a money maker. Fuck those hosptials. If a doctor ever touched my son with a knife. I would take that knife and show him a thing two about what I know about knifes
 
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"History of Circumcision in the U.S."
#18
You just have to make it clear prior to delivery and during the birthing process as to what your wishes are. They are now forced by law to ask if you want this proceedure done. You also need to have the mother in agreement, she would have the ulitmate say in this I believe. She can sign the consent without your permission.
 

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"History of Circumcision in the U.S."
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Yea and If she did that, she would not be very happy with the outcome, no one is touching my son no matter what. Since when do women know what is good for a mans penis? They dont.
 

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