A Crucial Health Update from Andrew Sullivan

Good grief, Andrew. Don't you have better things to worry about than the "pleasure maps" of penises? Some might argue that taking the edge off the male sexual drive is a good thing. And since when do we take it for granted that pleasure is an unqualified good, or even a qualified good? How about injecting a little ethical argument into your posts? A little more thought and a little less fetishism, please.

#1 Samuel Klein on 2007-06-20 15:30 (Reply)

The man is totally and completely crackers. Will somebody please tell him to get back on the protease inhibiters?

#2 rightguy on 2007-06-20 15:33 (Reply)

"Andrew Sullivan is now equating the circumcision of male infants with "child abuse." You read that correctly."

Like it or not he's right. You can deny or say that it's just the way things are done, but the simple fact of the matter is that parents who do this to their sons (well intentioned though they may be) are destroying much of the penis to fit a cultural 'norm'.

And #2... wow, advocating destroying a child's future adult sex drive as a good thing... nice. Real classy. So I take it you're in favor of chopping off young girl's clitoral tissue as well? It's the same thing.

#3 Dustin (Homepage) on 2007-06-20 16:16 (Reply)

Calling the circumcision of male infants 'child abuse' is absurd.

Equating male infant circumcision with the sexual mutilation of young girls is a false dichotomy, and completely ridiculous on its face.

Male circumcision does not "destroy" the male sex drive, while the hideous practice of female sexual mutilation does precisely that.

#3.1 Tom Elia on 2007-06-20 16:27 (Reply)

No-one would seriously claim that circumcision "destroys" the male sexual drive - but it certainly reduces sexual pleasure. It was originally introduced for non-religious reasons in an effort to curb masturbation in young men. There really is no excuse for this sort of mutilation and it IS child abuse to cut the member of an infant unable to give informed consent. If people wish to have it done as adults, then fine. Otherwise it is an unnecessary fetishised ritual which should be outlawed in any civil society.

#3.1.1 englishman on 2007-06-22 02:46 (Reply)

One can not help but note that not actual argument has been made against the studies which he linked to...

As an intact man myself I must say that I concurr utterly with their findings. The most sensitive areas of the penis are those which are removed during a circumcision and I could not envision doing without and pity those who have been forced to.

#4 James on 2007-06-20 16:30 (Reply)

I can't help but note that male infant circumcision, no matter what one thinks of the practice, is not 'child abuse.'

#4.1 Tom Elia on 2007-06-20 16:33 (Reply)

Hi Tom -

Male infant circumcision is indeed classified as child abuse by The Canadian Council for Children's Rights, which monitors compliance with UN policies here in Canada.

Other human rights groups world-wide have a similar take on the issue, and the practice has also been made illegal in one part of the world already.

#4.1.1 Kira on 2007-06-20 21:29 (Reply)

Well ... The Canadian Council for Children's Rights says it's "child abuse," so that must settle it!

What unmitigated nonsense.

#4.1.1.1 Tom Elia on 2007-06-20 22:15 (Reply)

That's all fine & good that everybody thinks he's a wacko. Unfortunately, you also have nothing relevent to say.

There is no serious defense of genital mutilation. There's absolutely no logic in it. You're mutilating your children for no reason, or worse, because you think it "looks better."

It's stupid and pointless. I'd challenge anyone who thinks Sully is being over the top to come up with a single good reason to circumsive their child (other than the one inconclusive study Sully mentioned in his article). And please, something that hasn't been debunked a million times on other websites.

#5 pointless on 2007-06-20 17:22 (Reply)

As another "intact male" I guess I wouldn't know the difference anyways, except that through conversations with friends and doctors, I clearly have the advantage, being left with the apparently unnecessary (and disease-prone) flap of skin that God forgot to leave off.

If your son is living a lifestyle that puts him at risk of sexually contracting HIV, then whether or not he has his foreskin isn't really the problem.

I think Sullivan's point is that a surgery is being performed that permanently alters a man's sexual organ for the worse, according to the link he provided and many others. Why not let the child decide for himself, when he is of an age to understand such things? Isn't it in the child's best interest to give him the option? It can only be to his advantage to be given a choice, and I am sure he would be grateful.

I sense the outrage over Sullivan's "child abuse" label is more a reaction of the bruised ego of parents who circumsized their child, than a calm and rational assesment of the facts.

#6 D.H. on 2007-06-20 17:36 (Reply)

I do not have kids.

I object to the use of the over-the-top hyperbole, a very bad habit of Mr. Sullivan's, in my view.

#6.1 Tom Elia on 2007-06-20 19:25 (Reply)

I have been waiting to see press on the study Andrew Sullivan references since it was published in the BJU International (British Journal of Urology.) It's a new study, published April, 2007. Which means, this information wasn't available in this form to any parents who made the decision to have their sons circumcised earlier. But we now have evidence that demonstrates objectively, unequivocally, that when you circumcise, you are cutting off the most sensitive part of a boy's penis.

The abstract and citation: http://www.blackwell-synergy.com/doi/abs/10.1111/j.1464-410X.2006.06685.x

The full text (pdf) http://www.icgi.org/touch-test/touch-test-article.pdf

Graphics available for media reporting: http://www.icgi.org/touch-test/

This recent study was the first time that the intact and circumcised penis were thoroughly, systematically and scientifically tested for sensitivity. The method was monofilament testing, the same method used in assessing peripheral neuropathy, such as lack of feeling in the feet of diabetics. The resulting measurements of sensitivity are quantifiable and reproducible. The study was submitted for peer review before being approved for publication.

The study's objective was to map the fine-touch pressure thresholds of the adult penis in circumcised and uncircumcised men, and to compare the two populations.

The conclusion, from the abstract, was: (*The glans of the circumcised penis is less sensitive to fine touch than the glans of the uncircumcised penis.*) The transitional region from the external to the internal prepuce is the most sensitive region of the uncircumcised penis and more sensitive than the most sensitive region of the circumcised penis. (*Circumcision ablates the most sensitive parts of the penis.*)

This is the real issue, aside from any shock text ("child abuse") or perceived hyperbole you are reacting to in Sullivan's article.

Rather than thinking of your own adequate functioning and sexual satisfaction "despite" your circ'd status, think about what this information means when facing the decision for a newborn boy from now on. Having this information now frames things differently.

In light of this information, do you think a parent has a right to reduce the sexual sensitivity of his or her child's genitals?

You can look at the graphic representations. They are representive of a (*75% loss of sensitivity*) in the areas shown.

The bar graph is easiest to interpret: http://www.icgi.org/touch-test/touch-test%20bar%20chart.jpg

Compare that with the kinds of statistics we're talking about when it comes to the "potential medical benefits" of circumcision (UTIs- risk reduction of ~1%, penile cancer- absolute risk reduction of less than 0.2%, STDs- suggested reduction in rate of acquiring STDs while CAREFUL SEXUAL PRACTICES AND HYGIENE MAY BE JUST AS EFFECTIVE, cervical cancer- any association between cervical cancer and a woman's partner's circ status is inconclusive.

How does looking at slim potential benefits compared to a known and definite loss of sensitivity impact the whole issue of giving consent for a (*non-therapeutic procedure*) on an infant's body, when it is KNOWN to significantly reduce the male child's sexual sensitivity??

We're not talking about justifying or defending past decisions to circumcise, made without this information. We're talking about how this information sheds light on the issue now.

#7 Amy on 2007-06-21 00:52 (Reply)

"But we now have evidence that demonstrates objectively, unequivocally, that when you circumcise, you are cutting off the most sensitive part of a boy's penis."

Interesting, then, that a critique of NOCIRC's study was published in the June 2007 issue of BJU International. It included a reanalysis of data presented in the study, and found that the authors had made some serious errors in interpretation. It concluded:

In conclusion, despite a poorly-representative sample and a methodology prone to exaggerating the sensitivity of the prepuce, NOCIRC's claims remain unproven. When the authors' data are analysed properly, no significant differences exist. Thus the claim that circumcision adversely affects penile sensitivity is poorly supported, and this study provides no evidence for the belief that circumcision adversely affects sexual pleasure.

"The conclusion, from the abstract, was: (*The glans of the circumcised penis is less sensitive to fine touch than the glans of the uncircumcised penis.*)"

Yes. Here is what the critique had to say: "in their Table 2 they fail to compare the same points on the circumcised and uncircumcised penis. Using their data we find no significant differences (Table 1), consistent with previous findings [2,3]"

(continuing) "The transitional region from the external to the internal prepuce is the most sensitive region of the uncircumcised penis and more sensitive than the most sensitive region of the circumcised penis. (*Circumcision ablates the most sensitive parts of the penis.*)"

And the critique noted: "They claim that several locations on the uncircumcised penis are significantly more sensitive than the most sensitive location on the circumcised penis (the ventral scar), yet their Table 2 shows this applies only to their position 3, the orifice rim of the prepuce. However, after we used the Bonferroni method to correct for multiple comparisons, this significance disappeared."

#7.1 Jake on 2007-06-21 16:07 (Reply)

"Interesting, then, that a critique of NOCIRC's study was published in the June 2007 issue of BJU International."

A critique co-written by you {or a name-sake with identical views on this issue and a similar writing style} and another circumcision advocate without medical training. Apologies for the motivational fallacy but I thought that readers of this blog ought to be informed of that.

"In conclusion, despite a poorly-representative sample and a methodology prone to exaggerating the sensitivity of the prepuce, NOCIRC's claims remain unproven."

Surely that ought to be "Due to"? Although, given the type of science your viewpoint depends upon I can appreciate you getting confused there.

"When the authors' data are analysed properly, no significant differences exist."

Apart from the ones that clearly do...

"Thus the claim that circumcision adversely affects penile sensitivity is poorly supported, and this study provides no evidence for the belief that circumcision adversely affects sexual pleasure."

Apart from the evidence that it does provide.

"Yes. Here is what [my] critique had to say: "in their Table 2 they fail to compare the same points on the circumcised and uncircumcised penis. "

The...Same points? Uh, Jakey, really even by your standards this is a stretch: it is clearly IMPOSSIBLE to compare the points since some are NO LONGER THERE. They were removed during the circumcision.

"Using their data we find no significant differences (Table 1), consistent with previous findings [2,3]"

Yes, well you wouldn't. I'm sure if I was told to go to a jail-house unescorted I would be incapable of finding it and get "Lost" too.

"And [my] critique noted: "They claim that several locations on the uncircumcised penis are significantly more sensitive than the most sensitive location on the circumcised penis (the ventral scar), yet their Table 2 shows this applies only to their position 3, the orifice rim of the prepuce. However, after we used the Bonferroni method to correct for multiple comparisons, this significance disappeared.""

Yay, typical substitution of jargon for scientific validity! No need to actually provide calculations or anything, just shove out some estoeric words and hope that the ignorant lap it up and keep their eyes tight shut.

#7.1.1 Revamp on 2007-06-23 13:11 (Reply)

"A critique co-written by you {or a name-sake with identical views on this issue and a similar writing style}"

Interesting guess.

"and another circumcision advocate without medical training. Apologies for the motivational fallacy but I thought that readers of this blog ought to be informed of that."

Presumably you are equally concerned about the motivation of the anti-circumcision lobby group which organised the study in the first place?

You should also apologise for the ad hominem fallacy and the appeal to authority fallacy, by the way.

"Surely that ought to be "Due to"?"

No, "despite" is the correct term. As is clearly explained in the letter, the results were not statistically significant.

"Apart from the ones that clearly do..."

None were in the published data.

"Apart from the evidence that it does provide."

Care to explain? I can't help but wonder whether you actually understand the critique.

"The...Same points? Uh, Jakey, really even by your standards this is a stretch: it is clearly IMPOSSIBLE to compare the points since some are NO LONGER THERE. They were removed during the circumcision."

Points 1, 6-12, and 17 were present on both types of penis.

"Yes, well you wouldn't. I'm sure if I was told to go to a jail-house unescorted I would be incapable of finding it and get "Lost" too."

Table 1 of the critique contained statistical tests between each point, and demonstrated that there were no significant differences.

"Yay, typical substitution of jargon for scientific validity! No need to actually provide calculations or anything, just shove out some estoeric words and hope that the ignorant lap it up and keep their eyes tight shut."

The Bonferroni correction is a fairly well-known method for compensating for the increased chance of a false positive result when multiple significance tests are made. In effect, you divide the ordinary significance level (usually 0.05) by the number of tests. You may find this

#7.1.1.1 Jake on 2007-06-23 13:33 (Reply)

"Interesting guess."

"Jake H. Waskett"? That is not a guess, it is the name provided with the critique.

"Presumably you are equally concerned about the motivation of the anti-circumcision lobby group which organised the study in the first place?"

As far as I am aware the person who actually performed it was not a member of NOCIRC or any similar group. Arrangement is one thing, execution quite another.

"You should also apologise for the ad hominem fallacy and the appeal to authority fallacy, by the way."

Sure. As long as people are aware of the bias that is all that matters.

"No, "despite" is the correct term. As is clearly explained in the letter, the results were not statistically significant."

"None were in the published data."

Yes they were.

"Care to explain?"

Sort of self-explanatory really. ^.^ You claimed that they were absent and they aren't.

"Points 1, 6-12, and 17 were present on both types of penis."

Yes?

"Table 1 of the critique contained statistical tests between each point, and demonstrated that there were no significant differences."

And table 2 of the study shows that there were.

"The Bonferroni correction is a fairly well-known method for compensating for the increased chance of a false positive result when multiple significance tests are made. In effect, you divide the ordinary significance level (usually 0.05) by the number of tests. You may find this this (http://www.childrens-mercy.org/stats/ask/bonferroni.asp) page helpful. There are eight p values in Sorrells' Table 2, so to see whether any are significant, just test whether any are less than 0.05/8=0.00625."

And you used the method that would get you the result you wanted.

#7.1.1.1.1 Revamp on 2007-06-23 14:48 (Reply)

"As far as I am aware the person who actually performed it was not a member of NOCIRC or any similar group. Arrangement is one thing, execution quite another."

I'm afraid you're incorrect. Morris Sorrells and Mark D. Reiss are both directors of Doctors Opposing Circumcision (see DOC's press release). James Snyder presented at NOCIRC's first symposium. Norma Wilcox attended NOCIRC's sixth. Marilyn Milos founded NOCIRC. Robert Van Howe has presented at numerous NOCIRC symposia. I'm afraid I don't know about Eden.

"Yes they were."

No, they were not. If you have difficulties reading statistical data, I will gladly assist.

"Sort of self-explanatory really. ^.^ You claimed that they were absent and they aren't."

See above.

"Yes?"

Yes. And since these points are common to both the circumcised and uncircumcised penis, it is reasonable to test them for significant differences. When we do so, we find that, as with other studies, there were no significant differences in sensitivity.

"And table 2 of the study shows that there were."

No it does not. Read more closely. Table 2 of Sorrells' paper contains comparisons between different points, not the same points.

"And you used the method that would get you the result you wanted."

Why don't you have a look at the link I provided? You might learn something.

#7.1.1.1.1.1 Jake on 2007-06-23 15:05 (Reply)

Sorry Jake but there is no way that I will trust the "Testing" of one man who is a member of CircList, a group whose membership consists of circumcision lovers who write "Erotic" fiction about circumision including a man being cut by naught nurses and a young girl being turned into a "Circumcision slut" by watching her ten year old brother being unconsentfully circumcised and then started to give him "Regular blowjobs" (don't believe me? Read it here: http://www.circlist.com/preferences/matriarchslut.html) and has expressed considerably admiration for that group in the past and another man who has made a site which refers to the "Aesthetic superiority" of the circumcised penis and is willing to distribute such blatant misinformation as:

"Circumcision confers a lifetime of medical benefits. 1 in 3 uncircumcised boys will develop a condition requiring medical attention."

which any Englander is aware is an utter lie.

Any research created by such a pair of men is unreliable and I can not depend upon their/your calculations.

#7.1.1.1.1.1.1 Revamp on 2007-06-24 01:54 (Reply)

"... I can not depend upon their/your calculations."

Happily, statistical testing is independently verifiable, so even if Genghis Khan himself did a calculation you can check whether he was correct.

To verify the data, you will need the total participant figures and some data from Sorrells' Table 2.

Let's take point 9 (middle of glans) as an example:

Uncircumcised:
N = 68
Mean = 1.141
SEM = 0.163

Circumcised:
N = 91
Mean = 1.180
SEM = 0.117

Now, test for a significant difference using an unpaired t test. For
convenience, there is an online tool here:
http://www.graphpad.com/quickcalcs/ttest1.cfm?Format=SEM

Result: p = 0.8420, not statistically significant.

Now repeat the procedure for every point or, if you prefer, see the table
presented in the letter. As you will see, none of the results are significant.

#7.1.1.1.1.1.1.1 Jake on 2007-06-24 06:04 (Reply)

Which is just totally ignoring the fact that the most sensitive areas identified by the study are entirely missing from the circumcised penis.

Which is a very convenient omission for those that regularly associate with fetishisers of circumcision and {for quite possibly inter-connected reasons} wish to do everything they can to discredit any and all data displaying how harmful it is but unwise for anyone who is actually concerned about their child's wellbeing.

#7.1.1.1.1.1.1.1.1 Revamp on 2007-06-24 07:10 (Reply)

"Which is just totally ignoring the fact that the most sensitive areas identified by the study are entirely missing from the circumcised penis."

Ok, now please look at the p values in Sorrells' Table 2. Applying Bonferroni's correction, you are looking for a p value less than 0.00625. Can you see any? If not, then one cannot call these "more sensitive", since there is no statistically significant difference.

#7.1.1.1.1.1.1.1.1.1 Jake on 2007-06-24 07:27 (Reply)

Applying what to what? There is nothing to compare quite a few of those areas to owing to them being removed during the circumcision.

#7.1.1.1.1.1.1.1.1.1.1 Revamp on 2007-06-24 12:35 (Reply)

Each p value in that table is a comparison of that point on the uncircumcised penis with the most sensitive point on the circumcised penis. So, if the most sensitive parts are removed by circumcision, then at least one of those p values should be significant (less than 0.00625).

None are significant, however.

#7.1.1.1.1.1.1.1.1.1.1.1 Jake on 2007-06-24 13:00 (Reply)

Hello there Jake,

I sent off an email about this one to the appropriate parties and received an email from somebody involved in this study. Apparently an errata page has been sent off the BJU that should clear this up as has a letter from Hugh Young and I'm not sure when those will be published but hopefully soon.

Furthermore it would seem that there is a counter-critique upon the BJUI website that I shall check out shortly.

#7.1.1.1.1.1.1.1.1.1.1.1.1 Revamp on 2007-06-24 14:11 (Reply)

An errata page, eh?

Well, that should be interesting. I'll look forward to it.

#7.1.1.1.1.1.1.1.1.1.1.1.1.1 Jake on 2007-06-24 15:00 (Reply)

Likewise!

Nice talking to you again Jake. Judging by our past form I suppose we may well once more once it gets released.

#7.1.1.1.1.1.1.1.1.1.1.1.1.1.1 Revamp on 2007-06-24 16:58 (Reply)

Oops - half a post!

this (http://www.childrens-mercy.org/stats/ask/bonferroni.asp) page helpful. There are eight p values in Sorrells' Table 2, so to see whether any are significant, just test whether any are less than 0.05/8=0.00625.

#7.1.1.2 Anonymous on 2007-06-23 13:35 (Reply)

Confirms my suspicion that a course in statistical methods should be part of every university degree. The paper by Sorrels has issues with interpreting statistical significance upon multiple significance tests. This is one of the few instances in which you can say "wrong" without having to resort to any empassioned arguments--just do the calculations yourself.

#7.1.1.2.1 baudknight on 2007-06-24 04:22 (Reply)

I couldn't agree with you more. Interestingly, Sorrells et al also seem to have had issues with interpreting any significance tests. In the text, they claim that "When compared with the most sensitive area of the circumcised penis, several locations on the uncircumcised penis, which are missing from the circumcised penis, were significantly more sensitive (Table 2)." Yet even if we use no correction at all for multiple significance tests, we can clearly see in their Table 2 that not five but only one p value is below 0.05; the lowest of the other four is 0.5991!

It would appear that they performed significance tests and then ignored the (inconvenient) results. Whether this is an indication of incompetence or scientific fraud is an interesting question.

#7.1.1.2.1.1 Jake on 2007-06-24 07:54 (Reply)

Really, folks, if there was a biologically significant sensual deficit caused by male circumcision, a procedure performed on a mass scale going back centuries, then there would be a longstanding pandemic of sexual problems referable to the effects of circumcision. (My own experience indicates that I would do better with even less sensation in the area of the turtleneck)

I find all these arguments against circumcision to be specious.

And Sullivan is still crackers.

#8 rightguy on 2007-06-21 11:03 (Reply)

There are certain phrases that are too important to be watered down for the sake of making a point.

'Child abuse' is one.
'Female genital mutilation' is another.

Usually I'd reply directly to the comment I'm arguing with, but in this case, a disturbing number of people have made this mistake.
Language is important, and has to be used responsibly in debate. Pull something murderous and horrific out of the drawer to make a point, and not only do you steal from those other tragedies, you make your own issue seem trivial in comparison.

I might have taken the study about male circumcision seriously, until it was compared to FGM, and I was reminded about the number of girls who die of horrific infections from an unnecessary surgery intended to keep them from getting any pleasure from sex. That kind of thing makes 'a decrease in sensitivity' seem downright charming.

#9 some girl from Chicago on 2007-06-21 22:36 (Reply)

Boys die too. At least two in the last couple of years in Canada according to the coroner's report - and their circ rate is way down on the US, it's only about 10% now I think. The difference is that US deaths are generally hushed up and put down as something else (MRSA, reaction to anaesthesia, "infection", septicaemia, etc.).

The reason the UK stopped doing it was because of so many unnecessary deaths. Scaled up, the rate would be over 200 in the States per year. 10% of boys end up with meatal stenosis as a direct result of their circ and need painful surgery to correct it, cases of buried penis are tragically common, and "adhesions" are almost ubiquitous, 71% of circ'd children get them and are subject to further trauma and abuse as misinformed doctors and parents constantly pull the adhesions apart causing yet more scarring, injury and excrutiating pain.

There are many complications to circumcising, just because you think you escaped the bullet, doesn't mean that others do.

#10 Anne on 2007-06-23 08:41 (Reply)

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A Crucial Health Update from Andrew Sullivan

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