Male Circumcision and HIV

NEW STUDY: Call for participants to assess which areas of male genitals influence body image and self-esteem

Laurence Dinh-Williams and Seth Davis, a team of McGill University researchers, contacted me recently with a request to post a call for participants for a study to assess male body image with a particular focus on the genitals. More precisely, Mr. Dinh-Williams seeks to assess "which features of the male genital area are important for one's 'genital self-esteem' and body image, and which factors tend to influence these evaluations." There is a section "where we ask whether they have been circumcised, at what age, and whether they are satisfied with the results (their current circumcision status), and allow for comments if they have anything to add!"

Mr. Dinh-Williams provides further:

MCGILL MALE BODY IMAGE STUDY

Thus far, the study of men's body image has been largely restricted to the dimensions of adiposity and muscularity. Recent research has found that features such as head hair, body hair, height and penis size may be important in one's evaluation of self, with penis size satisfaction being highly correlated to overall appearance self-esteem.

However, little is known about the specific role that 'male genital satisfaction' plays in male body image concerns, and which aspects of the genital area, beyond size, may be important for these 'genital perceptions' (satisfaction with one's genital area).

We are a team of researchers at McGill University in Montreal, Canada, investigating this issue. This study will determine which features of the genital area are important for 'genital perceptions' and male body image, and further investigate the factors that may influence one’s evaluations and perceptions (ex: sexual experience, erectile dysfunctions, premature ejaculation, STD's etc.). To do this, we need you to take this short 20 minute survey assessing your level of satisfaction regarding your body in general and various aspects of the genital area.

Your participation in this study will help health professionals better understand the factors involved in male body concerns and further on, their relation to sexuality (given the presumed central role of the genitals in a sexual context), guiding future research and treatment.

By participating, you will also be able to enter a draw for one of three $100 prizes to spend at amazon.com!

Please note that you will asked to measure the length and girth (circumference) of your flaccid AND erect penis, and asked to estimate the angle of penile curvature and direction of your erect penis, thus it may preferable to assess these features before starting this survey. Please click on the following link in order for a description of the measurements and protocol to follow: http://www.surveymonkey.com/s/penilemeasurement

This study is only for men 18 years of age and older.

Survey link: http://www.surveymonkey.com/s/genitalperception

For further information, you may email us at mcgill.urology@gmail.com

Your help would be greatly appreciated!

We also thank you for taking the time to read about our study.

Mr. Dinh-Williams contacted me unsolicited. I presume he knows the focus and slant of MC_HIV. Therefore, for the many loyal readers who have strong opinions on HIV prevention, genital integrity, and informed consent, this is your chance to be heard on the circumcision issue as it relates to "genital self-esteem."

PEDIATRIC SURGERY INTERNATIONAL: Common circumcision complications are best avoided by making the practice uncommon

Working hard to cut through the email back log related to MC_HIV. However, this one jumps to the head of the line.

Late complications of newborn circumcision: a common and avoidable problem

Journal: Pediatric Surgery International
Publisher: Springer Berlin / Heidelberg
ISSN: 0179-0358 (Print) 1437-9813 (Online)
Category: Original Article
DOI: 10.1007/s00383-010-2566-9
Subject Collection: Medicine
SpringerLink Date: Sunday, February 14, 2010

Rafael V. Pieretti¹ , Allan M. Goldstein² and Rafael Pieretti-Vanmarcke³

(1)	Section of Pediatric Urology, Massachusetts General Hospital, Boston, USA

(2)	Department of Pediatric Surgery, Massachusetts General Hospital, Boston, USA

(3)	Department of Surgery, Massachusetts General Hospital, Boston, USA

Accepted: 1 February 2010  Published online: 14 February 2010

Abstract

Purpose:

The purpose of this paper is to study the types of operative and post-operative late complications resulting from newborn circumcisions and to make recommendations to prevent them.

Methods:

After obtaining IRB approval, a retrospective review of the late complications resulting from newborn circumcisions treated at the MassGeneral Hospital for Children from January 2003 to December 2007 was undertaken. The source used was the consultation notes and operative reports of affected patients. Additionally, cases seen in the outpatient Pediatric Urology Clinic from April 2007 to April 2008 were reviewed.

Results:

A total of 8,967 children were operated during the study period, of which 424 (4.7%) were for complications resulting from previous neonatal circumcision. Penile adhesions, skin bridges, meatal stenosis, redundant foreskin (incomplete circumcision with uncircumcised appearance), recurrent phimosis, buried penis and penile rotation were the most frequent complications. At the outpatient clinic of the Section of Pediatric Urology, 127 boys with concerns following newborn circumcision were evaluated, representing 7.4% of the total volume of cases seen in this clinic.

Conclusions:

Our results indicate the need to undertake a collaborative study to define the incidence of complications following newborn circumcisions, which should be performed by practitioners with adequate training in the technique of their choice and its post-operative care.

Keywords  Circumcision - Complications - Newborn

---

Rafael V. Pieretti Email: rpieretti@gmail.com

My response:

Dear Dr. Pieretti,

A radical but 100% effective approach to eliminating late complications from newborn circumcision is a concerted effort to avoid doing them in the first place. The simplest, most direct, and the least invasive approach to surgical complication has always been to reduce or eliminate the need for surgery. In this instance, there is no need in the neonatal period for circumcision. Therefore, the choice should be easy. If you believe otherwise, you are trapped in a mind set that encourages waste and clinging to tradition at the expense of the defenseless.

Best,
 
DAVID WILTON
(415) 669-4059 - text or voice
http://www.davidwilton.com/

DIGEST: RN magazine reports with blinders on, conflicts of interest plague medical field concludes the NIH, Muslim leaders work to correct the lie that circumcision makes men immune to HIV, and finally a couple of John Travis interviews

Drawn from over 200 unread emails, this edition of the digest contains some old stuff. I've apparently become mostly a link archive and chronicler rather than a full-on blogger or commentator. I suppose that's ok. With some very good generalists out there posting here and here, I'm not too worried that the world lacks intelligent commentary on HIV or circumcision.

True to medical norms (and form)

From the mailbag of a year ago comes this scan of a nursing article [pdf] in the print version of RN magazine that addresses newborm circumcision with zero discussion of ethics. True to form in the medical field, nurses are given decontextualized information, much of it incorrect, without the slightest guidance as to whether the procedure is warranted. Nurses are expected, one could conclude from the article, to follow doctors' orders or to accede to the wishes of parents no matter how misguided or in contravention of the Hippocratic oath to do no harm. 

Conflicts of interest plague medical device and pharmaceutical field

Much like the rest of American society and government, conflicts of interest have grown steadily more common in the medical field, concludes the National Institutes of Medicine Health. Intactivists, of course, have long known of the corrupting influence of money. ScienceNews.org reports:

The pharmaceutical and biomedical-devices industry preferentially targets the most senior medical researchers — especially ones who publish prolifically — in its efforts to influence what information is collected, whether it is published, and how it will be portrayed (as in spun). Or so concludes a new National Institutes of Health-funded study that surveyed researchers from the 33 U.S. universities receiving the most funding for biomedical and clinical studies.

Link: Industry Attempts to Influence Medical Care

Good money and effort after bad?

Musitwa of the Muslim Youth League says recent researches (sic) showing circumcision helps to protect men from HIV infection has confused some Muslims to go on rampage having multiple sexual relationships without any protection hoping that they are safe because of being circumcised.

He says the campaign will among others convince Muslims that circumcision is not a guaranteed protection against HIV infection. 

Link: Uganda Health News: Muslim youth launch campaign against HIV/AIDS [and circumcision misperceptions]

John Travis speaks to KindredMedia.com.au viz the new push to circumcision

Apologies to John Travis and Kindred Media. This comes from an email dated June of 2009.

At the risk of multimedia overload, Dr. Travis is further interviewed in the video below.

More to come ...

MOMVERSATION.COM: Is circumcision wrong?

This video is great. It's not particularly substantive, but it puts on display the emotional struggle infant circumcision inflicts on thoughtful mothers.

Alice Bradley (finslippy.com) looks pained by her decision despite her protests to the contrary. I see her defense of her child's circumcision as strained and reluctant. I think her words demonstrate the power of peer pressure to force reflection. Of course, that power is just as strong to do the wrong thing when the winds are blowing in the other direction.

Bravo for Daphne Brogdon (coolmom.com) and Maggie Mason (mightygirl.net) for their thoughtfulness.

See more on Momversation.com.

DIGEST: A Tale of Two Technologies, Circumcision Deserves Circumspection, and National Coalition For Men urges the AAP to consider boys' rights

Playing a little catch up with three items in this post.

A Tale of Two Technologies: HPV Vaccination, Male Circumcision, and Sexual Health

Does it really take something called "feminist science and technology studies" to get us to a place where we can discuss the sexism inherent in the involuntary roll out of a particular prevention technology applicable to only one of the sexes? 

For years, infant boys have had the most sensitive part of their penis lopped off to protect some theoretical female partner of the distant future from cervical cancer. So why is it suddenly so urgent to discuss the sexism in mandating vaccination for HPV in girls, the REAL cause of cervical cancer? 

Laura M. Carpenter of Vanderbilt University and Monica J. Casper of Arizona State University aim to tell us in A Tale of Two Technologies: HPV Vaccination, Male Circumcision, and Sexual Health. Unfortunately, one must subscribe to get the full article, and the abstract is so abstract that I remain clueless on what they intend to say. Any readers out there have it? If so, pass it along and I'll do another post later.

Citation Reference:

Gender & Society, Vol. 23, No. 6, 790-816 (2009)
DOI: 10.1177/0891243209352490

Circumcision Deserves Circumspection

Elizabeth Reis, an associate professor of women’s and gender studies at the University of Oregon and the author of Bodies in Doubt: An American History of Intersex, writes at The Bioethics Forum on her regret at circumcising her son and asks the AAP to consider the ethics of any recommedation they may make.

Even in the world of medical ethics, circumcision is a subject that is largely ignored. Several of the major medical ethics textbooks don’t even include it in their indexes. And this is what I object to. I think that circumcision needs to be recognized as most parents’ first ethical decision that they make about and for their child. Parents should be informed of what the procedure actually entails. Remember that video of the birth process that many of us had to watch in prenatal classes? Why not see a video of a circumcision? I am convinced that most people do not know what they are consenting to, and if they did they would avoid the procedure like the plague.

...

Even if all the studies on the spread of HIV in Africa are valid and we all agree that circumcision prevents HIV, I think there are solutions other than surgery that would work to decrease the spread of the disease. Condoms also prevent HIV, and in fact they’re still necessary to avoid the virus even if men are circumcised. Fewer sexual partners would also help. Babies circumcised now won’t be having sex for several years, when we hope to have new and more effective strategies for preventing HIV. Avoiding HIV in adults simply isn’t a good enough reason to recommend cutting off a perfectly healthy, useful, and pleasurable part of infants’ bodies.

If men want to make this decision for themselves, for public health or personal reasons, then let them. The American Academy of Pediatrics should elevate the principle of autonomy and encourage parents to let their male children make the choice about circumcision when they’re all grown up.

Some excellent comments are appended to Elizabeth Reis's piece. Worth a read for sure.

National Coalition For Men addresses the AAP viz infant circumcision in a press release

The National Coalition For Men urges the AAP to consider human rights implications of any recommendation to circumcise infant boys. Read their press release here.

INTERVIEW: Maureen Cavanaugh interviews Matthew Hess of MGMBill.org on KPBS

This interview aired Jan 25, 2010, on KPBS in San Diego, California. Dave Maas, Dr. Mohamed "Mo" Bidair, and Matthew Hess were interviewed by Maureen Cavanaugh on the issue of infant circumcision.

Dave Maass was fairly non-committal on the issue while expressing an enthusiastic interest in the topic. He misstates the evidence on penile sensitivity. Maureen Cavanaugh was sensitive and fairly compassionate.

Dr. Mohamed Bidair has a practice centered on adult circumcision. He repeated cancer myths and overstated the benefits of HIV risk reduction as would be expected from someone with a financial conflict of interest.

Matthew Hess sounded confident and presented a well-informed defense of intactivism.

Download KPBS's These Days episode on Circumcision (Jan 25, 2010)

Click through to visit MGMBill.org.

Likewise visit KPBS's These Days with Maureen Cavanaugh.

INTERVIEW: Shelton Walden interviews Georgeanne Chapin of Intact America on WBAI's Walden's Pond

The following aired Sunday, Jan 24, 2010, in New York. The miracle of the internet allows you to listen to it here on demand. Click through to visit Shelton Walden's WBAI program page. Unfortunately, you'll have to suffer through several minutes of local programming announcements before the show gets started.

Only one little quibble. Georgeanne says that American involvement in South Korea and The Philippines has resulted in those two countries taking up circumcision. This is largely true in South Korea although the practice is done in adolescence rather than in infancy. However, The Philippines have circumcised since prehistory. The practice has more recently moved into the period of infancy for a minority of the country's males most likely due to American influence. But for the majority, it is still a practice of late pre-adolescence unrelated to the American experience. Secular Israel is probably the closest in similarity to the American practice of infant circumcision outside of other English-speaking countries of 25 or more years ago. 

Download this episode of Walden's Pond (Jan 24, 2010)

INTERVIEW: Stephen Svoboda of Attorneys for the Rights of the Child talks about HIV and infant circumcision

Link: Attorneys for the Rights of the Child

INTERVIEW: Male Circumcision & HIV blogger speaks on his involvement in the twin issues of HIV Prevention and Genital Integrity