Tag Archives: circumcision

Why I Don’t Go With The Flow

Interestingly, you would think this blog would be a hub for parent’s choice advocates, parents who are upset about being bullied, and people looking for some information about intactivist claims.  Instead, it’s usually a hate read, or a way for certain intactivists (like Brother K, for example) to pretend to be victimized.  It’s a place to solidify outrage.  But why?  I’m not lying about anything.  The questions about Carol weren’t an attack, merely someone finally asking the questions a lot of people have quietly been asking each other (and by the way…a picture of a sandwich and a video of a male and female voice with the camera pointed at a Facebook page?? L.O.L) for awhile now. The bad behavior shown here is not photoshopped, or made up.  It’s just a light shined.  Yes it’s a one-sided story.  But a lot of the time, there really is no excuse for that bad behavior.  And it shouldn’t be excused.

This is a legitimate advocacy.  I want to see it succeed.  I know some people will say that I’m some sneaky snake or an intactocop (a word used to prevent self-correcting).  That’s because I’m not going with the flow, I’m not sitting down and shutting up, and I refuse to.  Anti-circumcision advocacy should be better than this.  Those voices shouldn’t be the overwhelming voices, shouting down the more reasonable advocates.  Read nearly any mainstream media piece about intactivism (or the comments section in any story about circumcision) and intactivists look unhinged.  Why would I want to be a part of or excuse that kind of behavior?

When an advocacy has more in common with extremist anti-abortion advocates, including threats of violence, that’s an advocacy I’m not ashamed to speak out against.  And the thing is?  That kind of advocacy isn’t the majority of anti-circumcision voices.  If I’m not highlighting your behavior, I’m not talking about you.  If you’re getting offended on behalf of someone else because they’re ‘saving babies’, you need to really consider that.  Really think about it.  Sure, it does work sometimes.  But it certainly hasn’t done much to change the numbers significantly over the last decade, which is about the point the advocacy got really aggressive.  Keep in mind, the majority of your audience is simply reading silently.  It’s only a small portion of the people that are actually reading that will be interacting with you.  How do you think most people react to people raging at them, threatening them, calling them ‘cutters’, telling them their abusing their children, raping their children, that they themselves should be mutilated and raped, and ascribing essentially every negative action by a person to them being circumcised?  Yes there is room for aggressive advocacy, but there isn’t room for it to be shouting down more moderate, information-based advocacy.

We also know that fear-based approaches don’t work.  Over-emphasizing risks and minimizing benefits (to the point that many claim there are none) is a fear-based approach. It’s also not a truthful approach.  The best evaluation of the current science is that there are few benefits, fewer risks, and it is unnecessary.  That is hard to hear when you’re being told over and over and over that circumcision is the biggest atrocity perpetuated on helpless infants, that doctors are just out for your money and don’t care about their patients, and that there’s some big conspiracy to keep circumcising infants to steal their foreskin for face creams.

Finally, there is the all-too-common anti-Semitic attacks on Jews.  Claiming that because members of the AAP taskforce were Jewish that they are biased, for example.  Well, Jews don’t proselytize.  They don’t want Goyim circumcising.  That is their covenant with their G-d.  It is an important covenant that cannot be replaced with a made up ceremony.  And yes, some very ultra-orthodox Jews engage in a practice called metzizah b’peh.  This is oral suctioning of the blood from the infants penis.  Yes I find it abhorrent.  But presenting it as a common practice in Brit Milah is bullshit.  And that doesn’t even begin to address the claim of the ‘traditional Jewish circumcision’.  Most intactivists don’t know anything at all about Judaism, but they want to tell Jews how to be Jews.

Lastly, the constant comparison to FGC.  It is done to shock, because most people know the picture painted by anti-FGM advocates instead of those who study it.  They picture a 14 year old girl thrown down and having her genitals cut out and sewn up shut, leaving only a small hole for menses and urine, for her husband to cut open when he takes her virginity.  Then the intactivists yell about how that’s not the most common type.  But that’s the reason they use the comparison, because they want to transfer that same horror onto infant circumcision in the US, which really isn’t comparable and which really is less invansive.  But yes, there are methods of FGC that are less invasive, like in Malaysia.  Yes, that is true.  And yes, people are still horrified by even that, despite it being less invasive.  Because they are trained not to think critically when it comes to FGC.  Trying to take the horror from a procedure that is, in most ways, completely incomparable to male circumcision in the US, is disingenuous.

These are my biggest issues with the advocacy.  Not the basis of the advocacy.  The attitude.  The aggression.  The parroting of information (accurate or not).  The lack of self-correction.  The lack of critical thought.  The constant confirmation bias.  The Dunning-Kruger effect. The threats.  The echo-chamber.  The refusal to converse with people who don’t agree with their tactics.  The labeling and shunning of ‘other’.  The violent language.  The willingness to lie.  The bullying.  The harassment.  Not the fact that they are against infant circumcision.

Because I am against infant circumcision.  I want it to be widespread knowledge that infant circumcision isn’t necessary.  I want people to willingly choose not to do it, not have their hand forced because advocates are impatient.  I want advocates to leave Judaism and Brit Milah alone, no matter how much they don’t agree with it (AND NO, THERE IS NO RELIGIOUS REQUIREMENT TO CUT A GIRL).  I want solid science used.  I want advocates to know how to understand the science, and how to use it effectively, not to parrot what they see on Dr. Momma.  Not to post idiotic memes.  Not to regurgitate un-sourced claims.  Not to repeat lies pulled straight out of the ass of Dr. Fleiss.  Not to rely on the well-meaning-but-erroneous math of Dan Bollinger.  Not to bully well-meaning parents or cuss out well-meaning doctors.  Not to threaten people or use violent language.

I want to see anti-circumcision advocates to use critical thinking, including critical thinking of their information and their tactics.  Because I think what they are doing now is failing to accomplish anything.  That makes me angry and sad.  I want them to succeed.  But that isn’t going to happen through fear, and anger, and lies.  Please.  You are better than this.

The Dehuminization of Mr. and Mrs. ‘Cutter’

When I read intactivism threads, which isn’t often lately, I noticed a near constant trend of dehuminization of the ‘other’.  It does tend to occur mostly, but not exclusively, by intactivists against parents who circumcise, parents choice advocates, and anti-intactivism advocates like myself.  (I do tend to stay off of other websites lately but not exclusively,  however, because the sheer amount of advocacy on Facebook by people using their real names the time spent is much greater there).


There have been a lot of posts lately, that have addressed intactocopping.  That is when one intactivist tells another what to do.  In true hypocritical fashion, it is completely acceptable when levelled against someone telling an aggressive intactivist to quit calling well-meaning parents rapists, but totally and completely UNacceptable when levelled against someone aggressive telling an intactivist working together with non-intactivists they’re ‘sleeping with the enemy’ (yes someone keeps being told that only because they are actually willing to have a conversation with people who think differently).  In other words, aggressive behavior is groomed by those who are fond of the term, and working together is sharply frowned upon and those doing it are to be shunned.


How does that relate to this post? Because that is the other group of people that are dehumanized by these aggressive intactivists.  If you are not using their tactics, not only do they now consider you against them, but also a full-fledged target.    A shorter way to say this is that any who do not think of this as a war are NOT welcome by these types of intactivists…brother k, holly de leon, brian herrity, william ortega, etc.   You join, you ‘fight’, or you are a target.


The intactivists who do not want to be in a war, they are supporting the now-targeted.  And they themselves, in doing this, will become targeted too.  But they have INTEGRITY.  They know this is not what they support and they will not cross that line just to increase their status.


This must stop.  This kind of activism accomplishes nothing.  They form multiple groups soley for talking about this or that other group of activists, again, dehumanizing them.  Trying to shore up their position above or better than that group.


They set up secret ‘boot camp’ groups whose goal is literally to make men hate their body in order to recruit them into intactivism.  They teach other activists how to overcome men to make them loathe their own bodies, just to bulk up their numbers.


They lie.  They ostracize.  They rob you of your self-esteem and then they demand you do it their way.  And if you will not?   You are a target.


Tell me, activists.  Is this what and who you want to be?

The Only Thing Intactivists Have in Common with Integrity are the Letters I-N and T


Editors note – this blog was a team effort between myself and another prominent parents choice advocate, though the other author doesn’t want to be named, even with a pseudonym.  

PART 1 –

So I’ve been quiet lately.   Been busy keeping my eye on a few developments in the intactivist world, and taking my regular intactibreak.  Seen a lot lately that’s disturbed me.  All things considered that’s fairly tough, considering what I’ve seen from the intactivists, including, but not limited to:
Threatening to rape, beat, mutilate or kill their mother.
Threatening to rape, beat, mutilate or kill anyone that doesn’t agree with them.
Ask to see photos of children’s genitals.
Handing out intactivist propacandy to children.
Carrying around bloody baby dolls (Just like the anti-abortion activists they’re not supposed to be like!!)
Lie about creating a database of circumcised men and boys (to intimidate parents who do it)
Lie about teaming up with Anonymous against ‘cutters’ (to intimidate parents and anti bullying advocates)
Lie about The 2015 Lawsuit (Apparently many don’t know it’s a lie, some do though.  I’ll tell you why it wouldn’t work in three words – Phyllis Schlafly ERA)
Endless antisemitism and non-Jews who know nothing of Judaism ‘educating’ Jews.
Continuously shaming circumcised men until they feel broken and inadequate (If you didn’t feel that way before becoming an intactivist, you didn’t feel that way.  If you functioned perfectly fine and dandy before, then became ‘educated’ by intactivist propaganda and bullshit, and suddenly you have 600 complaints about your penis and you are a LOUD ANGRY BLOODSTAINED MAN, it’s more likely the intactivism did that to you than the circumcision).

But all that…well, all that is pretty par for the course.  But I keep watching.  They do this all publicly.  What they don’t do publicly is even worse.  Secret groups like ‘The Dream Team’, where one set of intactivist Queen Bees talk shit about another set of Intactivist Queen Bees.  Guess what intactivists?  If you don’t intactivate aggressively in the exact manner that Brian Herrity (AKA Brother K’s bulging left testicle), he’s talking shit about you.  So when another Intactivist and her friend (another, less prominent intactivist) started a group to try to find out from Parents Choice advocates what they were actually doing wrong, and going in willing to talk and listen, well, that was just not ok.  See, if you’re an intactivist, you are 100% absolutely not allowed to talk to ‘cutter trolls’ unless it’s spitting the maximum allowable vitriol with high potential for arrest.  That is just not ok.  You step out of that Echo Chamber and suddenly, even if you aren’t ok with circumcision, you yourself are now a ‘cutter troll’.  The only time it IS acceptable is if you cultivate trust with the ‘cutter trolls’, and then screen cap everything they say, spill all their secrets, laugh at them behind their back and basically act like as shitty a human as possible.  Integrity, thy name is most definitely not intactivism.

So when this intactivist and a select group of other intactivists and ‘cutter trolls’ got together, oddly, they discovered they had more in common than they originally thought.  It turns out they weren’t monsters, slavering to get at ALL TEH BABIEZ and cut them wide open!  Some of them didn’t even like circumcision!  But they liked bullying and harassment and crazy and lying and ESPECIALLY assholes even less.  The group was actually getting on like gangbusters.  I’ve seen the screen caps.  So then the Intactivist took a chance on one of her friends.  She talked to him carefully, let him know what happened in the group, and let him in.  He immediately treated her like the ‘cutter troll’ I’m sure he considered her as.  He worked his poor little dinky brain all into a sweat trying to find a way to screen cap the group to make it look bad.  And of course, to the Brian Herrity’s of the intactivist world (of which there are many, and yet still only one) ANY contact with the ‘cutters’ that doesn’t involve screaming, threats of violence, overwrought hyperbole and declarations of one’s ability to “End Circumcision and END IT NOW” is as bad as it gets.  He called on every other intactivist to shun this intactivist.  Oddly, help came from a corner I wouldn’t expect, and Hollie Redinger managed to well up a bit of integrity and put those dipshits in their place.  FSM only knows how.  I’d give her a huge round of applause and a pat on the back, but then Brian would just pissy his panties all over again.

But that was just one, sad, sad example of my point.  And of course the take home lesson here is that any intactivist who has the integrity and ethics they feel they can school others on, can’t actually have them.  And most certainly cannot be seen approaching this topic with anything even remotely resembling rationality.  Because despite having people with a different perspective, but maybe a similiar goal, working with you (instead of against you) being a possibility, in their minds, it is betrayal.  Betrayal, I think, is forcing everyone to think what you do, think how you do, talk how you do, and demanding that loyalty mean only thinking, acting and associating with the proper people in the proper ways.  Change never happens in that environment.  Change only happens, good change, the kind of change that makes you better and stronger, when you can truthfully examine your actions.  And that’s completely impossible when doing so makes you an ‘intactocop’.  That’s completely impossible when betraying people you’ve been friends for headpats from idiots with an over inflated sense of ego and importance is MORE valuable to you than being your own good person.

PART 2 – 

Now this part is actually sort of disturbing.  I’ve got multiple sources telling me multiple things (Oh yes, intactivists, I have multiple little birdies amongst you, and none of them are who you’d expect) but no matter what, this is a disturbing betrayal to the intactivist community from many people, not the least of which is the person at the center of it.
PART 2A – As many of you probably know, a young boy (C, because I respect his privacy enough NOT to use his name or photo) was caught in the middle of a nasty custody battle.  Neither parent should really have the kid, as it’s apparent that A) they’re only trying to get back at each other and B) both of them are fighting for their fucked up ideologies and not in their child’s best interest and C) since the court battle was lost and the boy will be circumcised, chances are good that his mother will damage him deeply because of her association with intactivism, while his father will probably damage him deeply because of his conflict with his mother.  I truly feel for this child.  He will probably spend his entire life being held up by the intactivist community, encouraged to become dark and angry because of his ‘mutilation’ and that sucks.  Intactivists, please take heed, leave the kid alone.  He doesn’t deserve to have his mother weeping over him and apologizing constantly, putting him in a position of power over her he shouldn’t have, and he doesn’t deserve to have the intactivist community indoctrinating him into hating himself and his body.

PART 2B –  So C has a community of intactivists that have sprung up around him, trying (and I actually support this, the kid is too old, the father is not doing anything to help him) to prevent his circumcision.  They’ve hired an attorney they have tried to help mom fight in appeals, and unfortunately, they’ve lost.  Hopefully they’ll set aside the donations they’ll need for a trust for C or to help fund the mental health help he’ll need for the rest of his life.  Who knows.  I do know that the intactivists have protested outside of the father’s place of business, doxxed him, doxxed the physician who is going to perform the procedure, and attempted to threaten and intimidate them into not doing it, which is just not how to accomplish anything other than restraining orders and arrests.

Regardless, a prominent ‘Bloodstained Man’, Jonathan Friedman, has either had a complete break with reality (telling people the CIA is watching him.  Who knows, maybe they are.  I can see why they would.) or a complete break with integrity, and posted that Dr. F had called him (breaking HIPAA) and told him he’d SEEN THE LIGHT PRAISE CHEEBUS, and he would NOT perform the circumcision!  Further, the father had only 8 days to find a doctor and have the procedure done, so if they could only intimidate all the other pediatric urologists in the area, C WOULD BE SAVED!

The FB page that was the hub for the community posted that that night they’d post a DETAILED summary of events.  Instead, there was hemming and hawing, and Jonathan Friedman was not actually named until a person unaffiliated with the page named him, and some mealy mouthed excuses were given.

Because preserving the public front is far better than being honest and forthright with your community and donors, who deserve to know who and what they’re donating to, and what exactly is going on with their community.  Instead, they’re betrayed, because it is more important to maintain a public front than it is to maintain integrity and ethics.  And that thread was drowned by introductions from the admins, and the page was further drowned in posts that had nothing to do with this HUGE betrayal.  Just as many intactivists don’t actually know that their planned 14th ammendment lawsuit was never going to work, many intactivists probably still don’t know that this was all a lie.

So in the end, I’ve had many intactivists come here and complain that I’m painting with a broad brush.  But how can I not, when intactivists themselves insist on maintaining a united public front?  If you insist on standing next to slime, chances are you’ll get some on you.  If you want to be viewed as the serious, ethic group with integrity that I think many of you think you are, YOU ARE DOING IT WRONG.  Open your ears and eyes.  This isn’t a sewing circle, but it’s not a war either, and you CAN talk to people who disagree with you.  During WWI, a truly horrendous war, soldiers from opposing sides would crawl out of their trenches on Christmas and exchange gifts with the enemy.  If they can do that, why can intactivists and pro parents choice people not talk without it being considered a betrayal?  Ironically, most parents choice don’t agree with ROUTINE circumcision, they just don’t think it should be banned or made illegal.  And it won’t.  It won’t.  Drop that fight because you’ll lose it.  Instead, focus on changing the cultural conversation.  And that won’t happen if you make people too angry and defensive to listen.  And finally, quit fucking eating your own, quit lying, quit backstabbing and telling the person you’re backstabbing that you’re doing it because THEY betrayed YOU by simply talking to someone who disagree with.

There are so many moderate intactivists, intactivists who actually have integrity.  And they’re getting drowned in the ocean of shit being produced by asshole extremists.  Moderate intactivists, you are the future.  And you are the people who will accomplish this thing.  Keep on keepin’ on, and don’t let the assholes pull you down to their level.


Ahhhh Halloween! That special time of year when children dress up as their favourite superheroes, cartoon characters, ghouls and goblins and then embark on a door-to-door journey to gather candy. Sure, adults and teens use it as a convenient excuse to dress up, party and binge drink, but kids tend to be the main revellers with their sugar filled goodie bags and the excitement of getting to stay up late.
Despite Halloween being about costumes, candy and the veil lifting between the living and the spirit worlds, there exists a special breed of asshole that also emerges this wonderful time of year.
I’m not talking about the people who give out mini toothpastes, raisins or those gross molasses candies (seriously. People actually like those?!). Nor am I referring to the people who don’t turn off their porch light or put up a sign indicating they’re not participating in giving out candy, and then react rudely when people ring their bell. No, I’m talking about those assholes who slip bible verses, pro life pamphlets or other political propaganda into young children’s loot bags.
This is nothing new, of course. Growing up, it seemed like every town had that one house that parents and their trick or treaters would skip past. Thanks to social media today though, a lot more attention has been brought around these proselytizing idiots who use Halloween to push their cause du jour.
What was once mainly the domain of relgious fundamentalists, handing out propaganda has been adopted by everyone from anti-vaxxers to PETA activists. And now, intactivists are getting in on it, too. You know, because it works so


Yes, much like how anti-choice protestors think they are “counselling” the women they scream at, harass, shame and bombard with blatantly false information, intactivists are “educating” young children and their parents by handing out “information”. Said information procured, no doubt, from biased intactivist websites that cite no credible studies, facts or resources. Not that hardcore intactivists like Hollie Redinger are concerned with facts, mind you, but who needs facts when you have hysteria and hyperbole? Loling forever at 50% of your penis missing..image

Speaking of Hollie, it seems as though her idea to use a much loved holiday to push her cause onto young children has caused a stir on her page. When one of her followers informed her (correctly) that people would get upset at her putting intactivist shit in kids bags, she threw a tantrum and flooded the thread with memes and berated the dissenter. Telling the poster she wasn’t a REAL activist (only a “hobby” intactivist) and then another follower accusing her of trying to tell her there was only one right way to be an intactivist (the hypocrisy is truly stunning). All because the poster didn’t think it was doing the cause any good to emulate rabid bible thumpers by handing out bullshit on Halloween.

Hilariously enough, Hollie used a meme that featured Albert Einstein, a circumcised Jewish male. Oh the irony.image

The poster is right, though. Parents don’t appreciate strangers putting political garbage in their child’s treat bags. Let alone strangers putting pamphlets talking about penis, foreskin and sexual function in the bags of young children. This is grossly inappropriate, and the excuse that it’s “for the parents” doesn’t fly. That’s bullshit. Intactivists push the importance of targeting young people and “planting the seed.”image

They target kids in particular like most fundamentalist fucksticks do, because kids don’t have the means to think critically about these issues and often believe most anything adults tell them. As opposed to adults, who ask for evidence backing up your claims. Gee whiz. Sounds kind of exploitive, manipulative and cowardly when you put it that way. Adults are about as likely to take your stickers and pamphlets on circumcision as seriously as they would pro life junk mail. Which is to say they won’t, and suddenly you wake up to a well deserved egged house. You’re not going to convince anyone, even if some people agree with the sentiment I guarantee they still don’t appreciate activists using Halloween as a platform. So if you think putting stickers on candy,image

posting inflammatory signs aimed at children in your yard,image

or doxxing/harassing people on the streets or internetimage

will change the hearts and minds of your target audience, then you’re as delusional as those people who think doing the same shit will lead others to God.
So hand out the goddamned candy, and for just one day keep the political bullshit to yourself. Don’t be a Halloweenie.

NCFM refutation

Stephen Moreton, PhD guest post

In July the National Coalition For Men (NCFM) sent an open letter to the Bill and Melinda Gates Foundation attacking the Foundation’s support for circumcision in Africa as part of the drive against HIV there.  The letter was co-authored by Peter Adler and Steven Svoboda of “Attorneys for the Rights of the Child”, though signed only by Harry Crouch of the NCFM.  You can see a copy here:




It is bad even by intactivists’ standards (assuming they have standards, not so sure having read this latest effort).  They say it took months of painstaking research to write.  It took me about ten hours spread over a week to demolish.  Naturally I have sent a copy to the Foundation but am not optimistic they will take much notice (their website actually says not to send them unsolicited materials).  As intactivists have begun linking to the NCFM open letter in forums there is a need for an on-line rebuttal.

Annotated version of the NCFM’s open letter to The Bill and Melinda Gates Foundation.  Original text in normal font, annotations in bold.

Everyone should applaud how your Foundation is funding proven methods to slow the spread of HIVand AIDS in sub-Saharan Africa, including testing, teaching the so-called ABC’s (Abstinence, Be Faithful, and Condoms), retroviral therapy, treating schistosomiasis (which causes vaginal bleeding) and STDs, and helping to lead the search for an HIV vaccine. It is time, however, for your Foundation to stop funding the scientically, morally, ethically, and legally unjustified program to circumcise 38 million African men as an HIV preventive strategy. After seven years and 6 million circumcisions, your program has failed.

On the contrary, it is working (Auvert et al, 2013).


Biased, Deeply Unethical Trials and Buried Results. The mass male circumcision program is being justified based on four random controlled trials (RCTs) conducted in sub-Saharan Africa. The RCTs suffered from numerous ethical, scientific and methodological flaws that render the results meaningless. 1,2,

Here the author ignores multiple debunkings of these criticisms. They have been answered in painstaking detail by authorities in the field, and to the satisfaction of all professional bodies involved. For examples of comprehensive debunkings see Halperin et al (2008) and Morris et al (2012). Tellingly, some of the articles cited in the open letter at this point attracted debunkings specific to those articles. Thus Green et al (2010) in ref. 2 was refuted by two separate letters to the editor: Banerjee et al (2011) and Wawer et al (2011); Boyle & Hill (which the author neglects to provide the full reference for) were refuted by Wamai et al (2011); and Van Howe & Storms (2011) in ref. 2 were refuted by Morris et al (2011). Ignoring criticisms, and citing discredited studies, is a pattern in Harry Crouch’s open letter, as we shall see.

Worse, one of the RCTs produced evidence that was quickly buried suggesting that circumcision may increase male to female transmission of HIV by 61%.3

The reference given (no. 3) merely refers the reader to the list of discredited studies above it, leaving the reader with the tedious task of searching through them to find the primary source. (Bad referencing is a problem with this open letter). Presumably it is Wawer et al (2009) who found that the female partners of recently circumcised HIV positive men had a higher risk of becoming positive themselves. This was because some men resumed sex before they had completely healed. So it is really an argument for educating men about the need to wait for complete healing before resuming sex, rather than an argument against circumcision per se. Of course this problem would not arise if the men were circumcised at birth. It has just been announced at the recent International AIDS Society conference that circumcising men reduces the risk to their female partners by about 20 % (Jean et al, 2014).

Moreover, the African circumcision program may be completely unnecessary, as a Ugandan RCT4 showed that intact men who wait at least ten minutes to clean their penis after sexual intercourse are 41% less likely to contract HIV than circumcised men.5

Here the author refers to a study which found that men who were quick to wash themselves after intercourse were more at risk than those who took their time and eventually merely wiped themselves with a cloth. Intactivists have enthusiastically seized on this curious finding and promoted it as an HIV-prevention strategy. This is premature as it is not proven why waiting and wiping should be of benefit. Speculations about enzymes in vaginal fluids have been made but the truth may be far more mundane. If a man has sex with a stranger, a prostitute, or someone else he considers to be at high risk of having HIV, then he will be far more likely to wash thoroughly and quickly as soon as proceedings have concluded. On the other hand, if he is with his regular partner, or someone he knows to be at low risk, he will be relaxed, and may take some time before merely reaching for a cloth and drying himself off. In short, the difference is simply a reflection of the accuracy of the men’s perception of risk (Ndebele et al, 2013). In light of this simple, prosaic explanation, it is reckless and irresponsible to promote “wait and wipe” as an HIV prevention strategy.

Thus, the program’s targets could be achieved without a single circumcision and at minimal cost versus a projected cost for the current program of $16 billion. African men and women should have been informed of these facts critical to their health and safety.

As the author’s basis for this comment comprises discredited studies and an irresponsible instruction about waiting and wiping, it can be dismissed. What the author is presenting is not factual at all, but dangerously misleading pseudoscience.


Circumcision Offers Men Little or No Protection From HIV.

About 60 % reduction in female to male transmission as indicated by three randomised controlled trials, rising with time to around 76 % in the S. African trial, putting it on a par with influenza vaccine.

Some Africans are being told, and many will reasonably assume (why else are they being circumcised?) that circumcision will protect them from HIV, but that is false. Circumcision is no vaccine. Circumcised or not, men who have sex with HIV infected females risk becoming HIV positive. Africans should be informed as follows: “For highly exposed men, such as men living in southern Africa, the choice is either using condoms consistently, with extremely low risk of becoming infected, or being circumcised, with relatively high risk of becoming infected.”6

Getting African men to use condoms at all, let alone consistently, has proved very challenging despite massive condom promotion. Circumcision provides added protection for when condoms fail (as sometimes they do) and for those who don’t or won’t use them. The reference cited (no. 6) refers one to no. 5 above, which is a duplicate of no. 4, and is not the source of the quote. More sloppy referencing. Presumably it is intended to be Garenne (2006).

Even if circumcision did reduce the relative risk by 50%, Garenne concluded,” a 50% reduction in risk [if true] is likely to have only a small demographic effect. “Observational studies of general populations have for the most part failed to show an association between circumcision status and HIV infection.”7

Again the reference is wrong.  In fact it comes from Van Howe and Storms (2011) in ref. 2 which, as explained previously, was discredited by Morris et al (2011).

Thus, the true protection that circumcision provides to men from HIV infection is negligible or nil.8

False, for reasons stated above.


Ironically, Circumcision Will Likely Increase HIV Infections Among African Men and Women. Experts have concluded that “circumcision programs will likely increase the number of HIV infections.”9

The reference given here is to husband and wife Van Howe and Storms, although confusingly it says “Supra n.12” which means “note 12 above”, when 12 is actually below. It should be n.2. Such repeated careless referencing does not inspire confidence in the author’s academic skills. And, as Van Howe and Storms have no relevant research background in African HIV, but are in fact prominent intactivists, and Van Howe has a history of shoddy scholarship (see below), the description of them as “experts” is misleading. As stated before, the article in question has been debunked (Morris et al, 2011). Some of the co-authors of the debunking were involved in the African trials – real experts.

First, only 30%-35% of HIV in African men is attributable to sexual transmission, not 90% as experts initially claimed.10 HIV in Africa is often blood borne, spread by contaminated needles.

Once again the author makes a bogus claim from a discredited source. In this instance he cites Gisselquist whose ideas about African HIV being mostly spread by vaccinations were thoroughly debunked in 2004 by the WHO (Schmid et al 2004). Gisselquist continues to be cited by anti-vaccination groups, HIV/AIDS deniers and, it seems, intactivists, but amongst the scientific community he has no credibility.

 Circumcision surgery in Africa often causes HIV.

Having been regaled with discredited studies, and fringe sources like Gisselquist, we now have the other stock-in-trade of the pseudoscientist – the half-truth. Traditional African-style circumcision, by a shaman with a razor blade and no regard to hygiene, pain control or cosmetic outcome, does spread HIV (not “cause” it, how do you “cause” a virus?) This has been known for years (e.g. Brewer et al 2007) and is why in some African countries (e.g. Lesotho, Cameroon & Tanzania) circumcision actually correlates with HIV (something intactivists never tell their audiences when they gleefully point to such countries).

The problem will much worse when millions of Africans are circumcised in multiple, often unsterile venues on a rush basis by poorly trained workers.

Then see that they are trained and have the time and resources to do the job properly.

Second, volunteers, reasonably believing that they are completely or substantially protected from HIV, are less likely to use condoms,11,12 and circumcised men are less likely to use condoms anyway.

This is the “risk compensation” argument. As usual the references cited are both discredited studies by the unreliable Robert Van Howe. No. 12 in particular became a textbook example – literally – of how NOT to do a meta-analysis (Borenstein 2009). Undeterred, Van Howe went on to do a second meta-analysis (on circumcision & HPV) that was so bad that when experts from the Catalan Institute of Oncology examined it they concluded it ought to be retracted from the literature (Castellsagué et al 2007). But Van Howe didn’t learn and when his third meta-analysis came out (on circumcision & STIs) it was again found to be so bad as to merit retraction (Morris et al 2014). Whenever Van Howe gets on his anti-circumcision hobby-horse he attracts criticisms. These episodes are just a sampling of the impressive tally of rebuttals and critiques he has clocked up over the years. And he was described earlier in Crouch’s open letter as an “expert”! Readers are advised to be deeply wary of anything bearing the name Van Howe.

Of course the notion of risk compensation has already been well examined and found not to be an issue when men are given proper counselling. Here are the studies demonstrating this which Crouch ignores: Mattson et al (2008), Reiss et al (2010), L’Engle et al (2014), Westercamp et al (2014).

Third, mass circumcision diverts resources from the proven methods of HIV prevention listed in the introduction. Thus, your mass male circumcision program will not only fail but will backfire.


Circumcision Is Also Painful, Risky, and Harmful. Africans report surprised at how painful circumcision is. Even if local anesthetics are used and given time to work, they are largely ineffective, and pain continues during the healing period.

This is just false as millions of men circumcised in this way know. Where is Crouch’s evidence?

Even the American Academy of Pediatrics ‘Task Force on Circumcision concedes that circumcision risks a long list of minor injuries , serious injuries (including hemorrhage, infection, deformed penis, and loss of all or part of the glans or of the entire penis) and death. In the United States, the risk of injury is estimated to be between 2% and 10%.

In the largest study yet (n = 1.4 million) the CDC have determined the risk of all complications, whether serious or not, from infant medical circumcision to be 0.5 %, and about 10 to 20 times higher for those carried out later (Bcheraoui et al 2014).

In Africa, the risk of injury is much higher, estimated to be 17.7% clinically and 35.2% for traditional circumcisions.13

As usual Crouch does not tell the whole story. The clinical practitioners in the study had not the training or equipment to conduct circumcisions safely. Great efforts have since been put into developing safe methods and providing resources so it is misleading to base a complaint on one study of one district in one country which identified issues that have since been addressed. And to compare medical circumcision with crude traditional circumcision by a shaman is just absurd.

As the AAP conceded in its 2012 policy statement, the true extent of the risks associated with circumcision is unknown.

Bcheraoui et al 2014.


Circumcision Diminishes Every Man’s Sex Life. Circumcision removes one-half of the penile covering, the size of a postcard in an adult.

There is such variation in penile sizes and proportions it is not possible to give a “one size fits all” figure. Intactivists also count both inner and outer surfaces to make it seem larger.

The foreskin is replete with blood vessels and specialized nerves such as stretch receptors. The foreskin is, and circumcision removes, the most sensitive part of the penis.14

Here Crouch cites another dubious work by intactivists. Aside from the round of criticism (Waskett & Morris 2007), counter-criticism (Young 2007) and further criticism (Morris & Krieger 2013) it attracted, the study looked only at one kind of sensitivity – fine touch. But is this the right kind of sensitivity? Fine touch comes from nerve endings called Meissner’s corpuscles which are present in the foreskin, but even more so in the fingertips (Bhat et al 2008), and we do not consider fingertips erogenous. Pleasurable erotic sensations come from genital corpuscles which are concentrated around the glans, not the foreskin. So the whole study may be a red herring. It is certainly cherry-picked. Other studies find no difference between the circumcised and the uncircumcised. Like Bleustein et al (2005) who tested a broader range of sensation types (vibration, pressure, spatial perception and temperature) and found no difference between circumcised and uncircumcised. For every study the intactivists cherry-pick to suit their agenda, another can be found that contradicts it. Tellingly, the only meta-analysis to date, on the ten best studies, found that circumcision makes no difference to male sexual function (Tian et al 2013). An independent review found the same (Morris & Krieger 2013).

African men will be outraged to learn that circumcision not only has failed to protect them from HIV but has forever diminished their sex lives. Female partners of circumcised men also report reduced sexual satisfaction.15

More cherry-picking. There are studies which found that women report a preference for circumcised partners (e.g. Williamson & Williamson 1988) including a randomised controlled trial (table 2 in Krieger et al 2008).


Africans Are Being Misinformed, Coerced, and Exploited. African men are not being informed of the truth, that circumcision is painful, risky, and harmful; that in itself it gives little to no protection from HIV, and the surgery itself may infect them with HIV. Serious ethical violations are occurring as usually poor Africans are being offered valuable incentives to volunteer such as free medical care.16 Boys as young as fifteen years old are being coerced, such as being offered team uniforms and equipment in exchange for being circumcised.

As usual the reference Crouch cites here (no. 16) is one that was comprehensively debunked, as mentioned earlier.


Call For Action. Your Foundation’s mass circumcision program violates science, medical ethics, and the law. Your Foundation should immediately terminate its misplaced support of the African mass circumcision program. Your Foundation should also immediately initiate a comprehensive investigation into the program led by unbiased experts, ethicists, and of course Africans. Otherwise, the legacy of the Gates Foundation, and inevitably your personal legacy, will be that you and your Foundation funded one of the most harmful medical programs in human history, and also that you and your Foundation failed to stop it after being informed that it had failed.

Respectfully submitted,

Harry Crouch

Harry Crouch’s letter violates truth and reason. Although there is plenty of evidence in it for scholarly incompetence (such as the garbled referencing), the ignoring of detailed debunkings and the use of discredited studies, are so systematic from start to finish that it is difficult to see this as being due to mere ineptitude. The selectivity and use of fringe sources like Gisselquist add to the charge that Crouch’s open letter is agenda-driven anti-medical pseudoscience. I urge the Foundation to disregard it, and any future pressure from anti-circumcision groups, and to continue to back scientifically proven interventions, including circumcision, in the face of a deadly epidemic that has killed millions.

1 G.W. Dowsett and M. Couch, “Male circumcision and HIV prevention: is there really enough of the right kind of evidence?,” Reproductive Health Matters, 15, no. 29 (2007): 33-44; L.W. Green, R.G. McAllister, K.W. Peterson, and J.W. Travis, “Male circumcision is not the HIV ‘vaccine’ we have been waiting for!,” Future HIV Therapy, 2, no. 3 (2008):193-99; D. Sidler, J. Smith, and H. Rode, “Neonatal circumcision does not reduce HIV/AIDS infection rates,”. South African Medical Journal, 98, no. 10 (2008):762-6.

2 Robert S. Van Howe and Michelle R. Storms, “How the circumcision solution in Africa will increase HIV infections”, Journal of Public Health in Africa, Vol. 2, No. 1 (2011)

(http://www.publichealthinafrica.org/index.php/jphia/article/view/jphia.2011.e4/html_9 ); Boyle & Hill, supra n.1; D.D. Brewer, J.J. Potterat, and S. Brody, “Male circumcision and HIV prevention,” Lancet, 369 (2007): 1597; L.W. Green, J.W. Travis, R.G. McAllister et al., “Male circumcision and HIV prevention: insufficient evidence and neglected external validity,” American Journal of Preventive Health, 39 (2010): 479-82.

3 Id.

4 F.E. Makumbi, R.H. Gray, M. Wawer et al., “Male post-coital penile cleansing and the risk of HIV acquisition in rural Rakai district, Uganda,” abstract from presentation at Fourth International AIDS

Society Conference on HIV Pathogenesis, Treatment and Prevention, Sydney, 2007, available at


5 F.E. Makumbi, R.H. Gray, M. Wawer et al., “Male post-coital penile cleansing and the risk of HIV acquisition in rural Rakai district, Uganda,” abstract from presentation at Fourth International AIDS

Society Conference on HIV Pathogenesis, Treatment and Prevention, Sydney, 2007, available at:


6 Id.

7 Id.

8 M. Garenne, A. Giamland, and C. Perrey, “Male Circumcision and HIV Control in Africa: Questioning

Scientific Evidence and the Decision-making Process,” in T. Giles-Vernick and J.L.A. Webb Jr., eds., Global Health in Africa: Historical Perspectives on Disease Control (Athens, Ohio: Ohio University Press, 2013): 185-210, at 190 (“Garenne Male Circumcision and HIV Control”).

(http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.0030078 ).

9 Van Howe & Storms, supra n.12.

10 Gisselquist D, Potterat JJ. Heterosexual transmission of HIV in Africa: an empiric estimate. Int J STD

AIDS 2003;14:162-73 (www.rsm.ac.uk/new/std162stats.pdf ).

11 Van Howe & Storms, supra n.12.

12 Van Howe RS. “Circumcision and HIV infection: review of the literature and meta-analysis”. Int J STD AIDS 1999;10:8-16.

13 Bailey RC, Egesah O, Rosenberg S. “Male circumcision for HIV prevention: a prospective study of

complications in clinical and traditional settings in Bungoma, Kenya”. Bull World Health Organ 2008; 86: 669-77.

14 Sorrells et al. “Fine-touch pressure thresholds in the adult penis”, BJU Int. 2007 Apr;99(4):864-9 at

http://www.ncbi.nlm.nih.gov/pubmed/17378847 .

15 Frisch et al, “Male circumcision and sexual function in men and women: a survey-based, crosssectional study in Denmark” (2011), at http://ije.oxfordjournals.org/content/early/2011/06/13/ije.dyr104.full ; and “Effects of male

circumcision on female arousal and orgasm”, New Zealand Medical Journal, Vol. 116, No. 1181: 595-96, September 12, 2003.

16 Boyle & Hill, supra n.1.

References for the annotations

Auvert, B., Taljaard, D., Dino Rech, D., Lissouba, P., Singh, B., Bouscaillou, J.,

Peytavin, G., Mahiane, S.G., Sitta1, R., Puren, A., Lewis, D. (2013) Association of the ANRS-12126 Male Circumcision Project with HIV Levels among Men in a South African Township: Evaluation of Effectiveness using Cross-sectional Surveys. PLoS Med., 10(9), e1001509.

Banerjee, J., Klausner, J.D., Halperin, D.T., Wamai, R., Schoen, E.J., Moses, S., Morris, B.J., Bailis, S.A., Venter, F., Martinson, N., Coates, T.J., Gray, G., Bowa, K. (2011) Circumcision Denialism Unfounded and Unscientific. Am. J. Prev. Med., 40(3), e11-e12

Bcheraoui, C.E., Zhang, X., Cooper, C.S., Rose, C.E., Kilmarx, P.H., Chen, R.T. (2014) Rates of Adverse Events Associated With Male Circumcision in US Medical Settings, 2001 to 2010. JAMA Pediatrics, E1-E10.

Bhat, G.M., Bhat, M.A., Kour, K., Shah, B.A. (2008) Density and Structural Variations of Meissner’s Corpuscle at Different Sites in Human Glabrous Skin. J. Anat. Soc. India., 57(1), 30-3.

Bleustein, C.B, Fogarty, J.D., Eckholdt, H., Arezzo, J.C., Melman, A. (2005) Effect of neonatal circumcision on penile neurologic sensation. Urology, 65(4), 774-7.

Borenstein, M., Hedges, L., Higgins, J.P.T., Rothstein, H.R. (2009) Introduction

to Meta-Analysis, John Wiley and Sons, West Sussex.

Brewer, D.D., Potterat, J.J., Roberts, J.M., Brody, S. (2007) Male and Female Circumcision Associated With Prevalent HIV Infection in Virgins and Adolescents in Kenya, Lesotho, and Tanzania. Ann. Epidemiol., 17(3), 217-26.

Castellsagué, X., Albero, G., Cleries, R., Bosch, F.X. (2007) HPV and circumcision: A biased, inaccurate and misleading meta-analysis, J Infect., 55, 91-3.

Garenne M (2006) Male Circumcision and HIV Control in Africa. PLoS Med 3(1), e78-e79.

Halperin, D.T. & 47 others (2008) Male circumcision is an efficacious, lasting and cost-effective strategy for combating HIV in high-prevalence AIDS epidemics. Future HIV Therapy, 2(5), 399-405.

Jean, K., Lissouba, P., Taljaard, D., Taljaard, R., Singh, B., Bouscaillou, J., Peytavin, G., R. Sitta, R.,  Mahiane, S.G., D. Lewis, D., A. Puren, A., B. Auvert, B. (2014) “HIV incidence among women is associated with their partners’ circumcision status in the township Orange Farm (South Africa) where the male circumcision roll-out is ongoing (ANRS-12126)”. 20th International AIDS Conference; Abstract FRAE0105LB.

Krieger, J.N., Mehta, S.D., Bailey, R.C., Agot, K., Ndinya-Achola, J.O., Parker, C., Moses, S. (2008) Adult male circumcision: Effects on sexual function and sexual satisfaction in Kisumu, Kenya. J Sex Med., 5, 2610-2622.

L’Engle, K., Lanham, M., Loolpatit, M., Oguma, I. (2014) Understanding partial protection and HIV risk and behavior following voluntary medical male circumcision rollout in Kenya. Health Education Research. 29(1), 122-130.

Mattson, C.L., Campbell, R.T., Bailey, R.C., Agot, K., Ndinya-Achola, J.O., Moses, S. (2008) Risk Compensation Is Not Associated with Male Circumcision in Kisumu, Kenya: A Multi-Faceted Assessment of Men Enrolled in a Randomized Controlled Trial. PlusOne, 3(6), e2443.

Morris, B.J., Bailey, R.C.,  Klausner, J.D.,  Leibowitz, A., Wamai, R.G., Waskett, J.H., Banerjee, J., Halperin, D.T., Zoloth, L., Weiss, H.A., and Hankins, C.A. (2012) A critical evaluation of arguments opposing male circumcision for HIV prevention in developed countries. AIDS Care. 24(12), 1565-1575.

Morris, B.J., Hankins, C.A., Tobian, A.A.R., Krieger, J.N.,  Klausner, J.D. (2014) Does Male Circumcision Protect against Sexually Transmitted Infections? Arguments and Meta-Analyses to the Contrary Fail to Withstand Scrutiny. ISRN Urology, Article ID 684706.

Morris, B.J. and Krieger, J.N. (2013) Does Male Circumcision Affect Sexual Function, Sensitivity, or Satisfaction? – A Systematic Review. J. Sex. Med., 10(11), 2644-57.

Morris, B.J., Waskett, J.H., Gray, R.H., Halperin, D.T., Wamai, R., Auvert, B., Klausner, J.D. (2011) Exposé of misleading claims that male circumcision will

increase HIV infections in Africa. J. Public Health in Africa, 2(e28), 117-122.

Ndebele, P., Ruzario,S., Gutsire-Zinyama, R. (2013) Point of View: Interpreting and dismissing the relevance of the “wait and wipe” finding from the circumcision studies conducted in Africa. Malawi Medical Journal, 25(4), 113-115.

Riess, T.H.,  Achieng’, M.M., Otieno, S., Ndinya-Achola, J.O., C. Bailey, R.C. (2010) ‘‘When I Was Circumcised I Was Taught Certain Things”: Risk Compensation and Protective Sexual Behavior among Circumcised Men in Kisumu, Kenya. PlusOne. 5(8), e12366.

Schmid, G.P., Buvé, A., Mugyenyi, P., Garnett, G.P, Hayes, R.J., Williams, B.G., Calleja, J.G., De Cock, K.M., Whitworth, J.A., Kapiga, S.H., Ghys, P.D., Hankins, C., Zaba, B., Heimer, R., Boerma, J.T. (2004) Transmission of HIV-1 infection in sub-Saharan Africa and effect of elimination of unsafe injections. The Lancet, 363, 482-8.

Tian, Y., Liu, W., Wang, J.Z., Wazir, R., Yue, X. & Wang, K.J. 2013. Effects of circumcision on male sexual functions: a systematic review and meta-analysis. Asian J. Androl., 15, 662-6.

Wamai, R.G., Morris, B.J., Waskett, J.H., Green, E.C., Banerjee, J., Bailey, R.C., Klausner, J.D., Sokal, D.C. & Hankins, C.A. 2012. Criticisms of African trials fail to withstand scrutiny: Male circumcision does prevent HIV infection. J Law Med., 20(1), 93-123.

Waskett, J.H., Morris, B.J. (2007) Fine-touch pressure thresholds in the adult penis. BJU Int., 99(6), 1551-2.

Wawer, M.J., Gray, R.H., Serwadda, D., Kigozi, G., Nalugoda, F., Quinn, T.C. (2011) Male Circumcision As a Component of Human Immunodeficiency Virus

Prevention. Am. J. Prev. Med. 40(3), e7-e8.

Wawer M.J., Makumbi F., Kigozi G., et al. (2009) Circumcision in HIV-infected

men and its effect on HIV transmission to female partners in Rakai,

Uganda: a randomised controlled trial. The Lancet, 374, 229-237.

Westercamp, N., Agot, K., Jaoko, W., Bailey, R.C. (2014) Risk Compensation Following Male Circumcision: Results from a Two-Year Prospective Cohort Study of Recently Circumcised and Uncircumcised Men in Nyanza Province, Kenya. AIDS Behav. Epub ahead of print.

Williamson, M.L., Williamson, P.S. (1988) Women’s preferences for penile circumcision in sexual partners. J Sex Educ Ther., 14(2), 8-12.

Young, H. (2007) Fine-touch pressure thresholds in the adult penis. BJU Int., 100(3), 699.

AIDS workers baby rapists

Screenshot_2014-07-18-14-08-10Screenshot_2014-07-18-14-26-24 Screenshot_2014-07-18-14-27-07 IMG_159939358271360



Any questions?



I suppose it’s obvious that I don’t feel that it’s necessary to post any commentary on this.  However, I am shocked that so little response was given to such a heinous thread.  Why is this ok, intactivists?  Sure, a few prominent intactivists distanced themselves FROM THIS POST.  FROM THIS OPINION.  But not THIS PERSON.  To me, that is an EXPLICIT acceptance of this behavior.

This is not ok.

What More Can I write

I don’t know.  At this point it sorta feels like chasing my own tail to update this blog.  There really is only so much that can be said on this topic.  Despite the Google Alert Brigade posting endlessly, they’re also repeating themselves over and over.  In amusingly pseudo-intelligent language.  Quite hilarious, that.   In any case, the Intactivism blogs tend to post updates of what Slate or The Baskerville Times said about circumcision that they think was wrong (BTW did you see that piece from Slate?  It really was a good piece!).  So THEY have stuff to write about, but I don’t really want to update multiple times a day to complain about what the Intactivism blogs are doing.  After all, it might end up just giving them more traffic.   No thank you.  Also I’m just not into that kind of minutia.

So I suppose I have a few topics that were promised to be addressed, so I could address those.  Religious Circumcision (though really, I’d prefer someone much more educated on myself to write on that particular topic, and you bet your cutie mark the comments will be closed on THAT blog), more on the AAP, maybe about how next year there’s not going to be some mind blowing ruling outlawing circumcision (and yeah the misunderstanding of the 14th Amendment in that manner makes me chuckle).  But honestly that’s still really not that much to write about.

Oh but I do have an idea.  I definitely have an idea. So for tonight, let’s just leave you guys with this little bit of positivity, from the totally sane, not fucked up or obsessed Intactivism crowd.  L’Chaim!

“My heart sure doesn’t break for her. On the contrary, she got exactly what she deserved. If every baby who was mutilated died, it might put a stop to the practice. This so-called tragedy is good publicity for outlawing genital mutilation. I hope she feels guilty for the rest of her miserable life & my sympathy for her is ZERO.”

“They didn’t care. It was more important that his penis be cut up than he live.”

“The doctors are trying to feed them the lie that the circumcision didn’t kill their son. This is why, even though it doesn’t seem ‘compassionate,’ people need to let’er rip on her. No, people should not be silent and ‘compassionate.’ While everyone is feeling sorry for the mother, what about the child?”

Can’t you just take antibiotics? Circumcision and UTIs.

One of the most well grounded benefits of neonatal circumcision is a 90% reduction in the incidence of urinary tract infection (UTI) in boys in the first year of life. This benefit seems to raise a lot of questions for anti-circumcision advocates. One example can be seen in this response to the new AAP guidelines,

The AAP report inflates the benefits by stating in its summary, for example, that circumcision “prevents” urinary tract infection (UTI). The report text states, “Given that the risk of UTI among this population [boys under age 2] is approximately 1%, the number needed to circumcise to prevent UTI is approximately 100.” Therefore, 99 boys out of 100 receive no UTI “benefit” from circumcision. UTI is treatable with antibiotics. Good medical practice requires the least intrusive form of effective treatment. All the claimed “preventive health benefits” are debatable and insignificant.

There are numerous other arguments made against circumcision to prevent infection, one common claim is that that UTIs are “several times commoner” in girls, yet we aren’t considering surgical alteration to prevent their rate of infection. Sometimes the grounds for the claim in reduction itself are challenged, although this has become less frequent as the claims have become better and better supported by evidence. Do these arguments undermine this benefit?

The first thing to establish is what exactly we are talking about when we speak of a UTI in an infant boy. A UTI in an infant is a very different beast to a bladder infection in an older child or adult. The primary symptoms are not burning pain and discomfort, but instead a prolonged fever and irritability with no other obvious cause. The majority of UTIs in infancy involve the upper urinary tract, the kidneys, and not merely the bladder as is more common in older children and adults. It poses the very real risks of kidney damage or the development of sepsis, a blood infection, although these have become less common as better antibiotics have been developed.  Mortality was once a real danger from a UTI in infancy although this is now extremely rare. While antibiotics are an essential part of the treatment of such a urinary tract infection, treatment is not as easy as going and taking an oral medication. Hospitalization and the use of IV antibiotics are common  and unfortunately antibiotic resistance is becoming common among the pathogens in these UTIs. Even if response to the antibiotics is good, imaging follow up to look for urinary tract abnormalities and damage will often be necessary.

Contrary to the repeated claims that UTI is more common in girls, in early infancy it is in fact several times more likely in an uncircumcised boy than in a girl. This early period, under three months or so, is also the time of greatest risk overall for a febrile UTI. Within a few months, the prevalence of UTI in an uncircumcised boy is equal to that in girls, and soon the risk in girls surpasses the risk in boys. The most prevalent form of UTI also changes, as bladder infections become more common than the more serious kidney infections that are seen in early infancy.

Studies consistently show that circumcision reduces the risk of UTI significantly, with an overall reduction in risk of nearly 90%. Considering that what is being prevented is a serious infection and not a minor issue, is this alone sufficient reason to circumcise? A recent review determined that it would require 111 circumcisions to prevent one urinary tract infection, and assuming that the complications of circumcision are about 2%, concluded that this wasn’t sufficient to recommend routine circumcision. However, for certain subpopulations at greater risk of infection, the benefits would more clearly outweigh the risks. Moreover, if any of their assumptions about the complication rate of circumcision or the severity of the morbidity associate with UTI or circumcision were wrong, the numbers needed to treat might be quite different. The review didn’t consider any other potential benefits of circumcision besides the risk of UTI, so this might be only one piece to consider when making this decision.

Some New Stuff!

Ok ok ok, first things first.  We have two new contributors to the blog, and a part time author.  One contributor will be working with me on the issues with intactivism specifically, with occasional commentary on other topics of woo, and the other will give us a weekly blog about various topics of woo interest, sure to piss off those in the homebirth movement, anti-vaccination movement and the uber boobers.

Unfortunately, most of my comments are coming from the same people or same kinds of people.  People who, when I look up their email address, are active in assaulting virtually any web page, article or blog post that has anything remotely to do with circumcision.  I honestly wish I would hear more from other people, but perhaps it’s because I’m not writing in a way that seems inviting to parents who are questioning this issue.

With the new statement out from the AAP, I think it’s more clear than ever that the decision to circumcise or not circumcise is really up to the parents.  There are risks and benefits to either decision, and while for me, I don’t find the procedure necessary and therefore decline it, I’ve been moving further and further away from the idea that circumcision causes harm (other than the immediate harm of the procedure).

I know that intactivists are really banking on the coming-of-age of the boys circumcised after the anti-FGM legislation, but I really don’t think that equal protection can or would be applied in that way.  They’re very very convinced of this, but I think that’s a product of their echo chamber.  When you choose to surround yourself only with those of a like mind and a like opinion, who’ve accepted the same assertions as facts, then those assertions start to look more and more rock solid, as though they’re indisputable, widely known facts.  The truth is that this is an illusion, caused by limiting yourself to those sources of information.  As you become more and more involved, it becomes harder and harder to to accept any outside or dissenting source of information.  The fact is that the only people who consider FGM and RIC comparable ARE intactivists.  Virtually everyone else sees this for the nonsensical gross over-reaction that it is.  They’re hardly comparable, except on levels that enormous mental gymnastics are required to reach.  I’ll write a new blog post about this tomorrow, cross my heart and hope to die.

I also recently saw a post in STFUParents with a woman whose husband said he was thankful for all the babies who still had their foreskins left.  I think, to me, this is so absurdly representative of the movement and how it’s just really missing the mark.  Though again, it goes back to the echo chamber environment, and the almost religious zeal it causes.   Are children who are kidnapped and sold into slavery EVEN MORE victimized if they were subject to RIC?  Should they be thankful all they have to deal with is daily rape, and not the horror that their most intimate parts were hacked away at birth by a doctor who only cared about the paycheck (rhetoric of the movement, not my opinion).

I recognize this blog post is sort of all over the place, there’s not much of a unifying theme to it, other than my belief that the online communities of intactivism are innately crippling.  If you were truly interested in the truth and empirical, evidence-based information, then you absolutely would not dismiss EVERYTHING that doesn’t bolster your viewpoint.  The only intellectually honest position is one that recognizes that there are pros and cons, or at the least that there is compelling information in the decision to circumcise; after all, if there wasn’t, why would anyone choose to?

Does the AAP Really Have “No Ethics”?

In the September issue of their journal Pediatrics, the American Academy of Pediatricians published a newly revised policy statement on circumcision. This was the first new statement on circumcision since 1999, and it took a much more strongly procircumcision stance, arguing that the benefits of circumcision outweighed the risk, and that the procedure should be covered by medical insurance so that parents were free to choose it regardless of their finances. The outcry from the intactivist community was loud indeed. Critiques were written of the policy, it was criticized as unethical and unscientific and the AAP was accused of being biased. See here, and here. In addition an initiative was begun which collected pictures of individuals with the phrase “AAP No Ethics” written on their palms.

I hope to devote future blog posts to a more thorough critique of each of the arguments against the AAP’s statement. There are so many allegations that I can’t address them all in one blog post, and I hardly know where to begin. Suffice to say that I don’t find the arguments against the science convincing; the evidence has been growing for real but moderate benefits to circumcision. Many of the criticisms show an ignorance about common scientific language or technique that invalidates their arguments. Some  don’t seem familiar with the AAP’s accompanying technical report which explained their reasoning and fleshed out the recommendations in the official policy statement. I plan to go through some of these objections to the statement in later posts, and point out where the objections are flawed and why. However, I want to start by touching on where I agree with the intactivist criticisms. This doesn’t mean that I think the AAP statement is invalidated, but I do think there are some legitimate complaints about it.

So, some criticisms which I believe have some merit:

The AAP has a cultural bias. 

Now, some of these criticisms claim that the AAP committee has a bias due to a reliance on scientific thinking, which I do think is absurd. In contradiction to the Circumcision Resource Center’s post, I think that the possible benefits and harms of circumcision are absolutely discernible through scientific inquiry, and controlled, replicable and falsifiable studies are a much better gauge of the truth than either feelings or common sense, which are far more subject to cultural bias. However, the researchers DO have a cultural bias: circumcision and the circumcised state are viewed as normal and acceptable, unless there are proven harms. I think that intactivists are somewhat correct in saying that scientists wouldn’t even be investigating circumcision and possible benefits if it weren’t already acceptable to a degree in Western society. However, just because this preexisting bias makes American doctors more willing to consider circumcision doesn’t mean that it doesn’t have real benefits, it just means that the researchers are more open to those benefits. And while there might be concern that this normalcy encouraged the researchers to be more procircumcision in their review of the scientific data, it is also possible that the cultural distaste for circumcision leads other groups to overlook or minimize possible benefits of circumcision. Bias goes both ways. It is definitely possible, however, that this bias influenced how much benefit the committee believes that one needs to see before circumcision is justifiable, and that leads to my next point.

The AAP placed no value on bodily integrity.

I think that this statement is true. I have seen this stated in a few sites or a few different ways, some more inflammatory than others. I agree that the AAP seemed to place no value on keeping the child’s body whole, rather they looked only for objective evidence of harms and benefits. Since the committee members view circumcision as normal and the circumcised state as normal as the intact state, they didn’t seem to require a large benefit to justify the procedure, evidence of  greater lifetime benefits than lifetime harms seems to be sufficient for them. However, in this document they also stress parental choice, and acknowledge that different parents will bring different values to their decision making. I also do not believe that this means that the AAP does not care about ethics or about the well being of boys, it just means that in their decision making system the presence or removal of the foreskin had no value, no decision making weight, in and of itself. The value was determined solely on the effects, positive and negative, on the child’s health and well being. This is certainly different to the philosophy of ethics of intactivists, but it is not an absence of ethics. It is perhaps a more utilitarian ethics.

The AAP does not make clear the magnitude of the benefits of circumcision.

Although the AAP does try to quantify the magnitude of any benefits and likewise the magnitude of any risks, I don’t believe that it provides sufficient evidence for parental decision making.  The most useful number is the “number needed to treat,” which indicates how many circumcisions are necessary to prevent one negative outcome in comparison to the intact state. This could be more easily compared with the numbers available on complication rates. The AAP technical report provided numbers needed to treat for the issues of urinary tract infection and penile cancer. For most other benefits, it provided information on relative risk ratios only. For instance, the report cites a CDC study which estimated a 15.7% reduction in the individual’s lifetime risk of HIV with neonatal circumcision but doesn’t provide information on the absolute risk of infection. A 16% reduction in a 1.87% absolute risk of contracting HIV may seem much less than persuasive to many. The CDC study did provide estimated numbers, which vary based on race. “The number of circumcisions needed to prevent one HIV infection was 298 for all males, and ranged from 65 for black males to 1,231 for white males.” This is the kind of information that is truly needed for a decision on the benefits of this procedure, and they suggest that the benefits for each individual are far from equal.

These listed criticisms are not minor. They are not, however, criticisms of the science itself, which I believe the AAP Technical Report shares in a fair manner. They are instead related to the application of those scientific findings to the decision of whether or not to circumcise. If one is going to argue against routine circumcision, then I feel that these are the points to focus on. I think it is important, however, to keep in mind that the question of “how much benefit is necessary to justify circumcision” is a question based on the parents’ own philosophy, and that different parents can make different decisions based on the same evidence, all while desiring the best for their son’s well being.