Research on Male Circumcision

[romamama]

Two collegues and I are presenting a new theory on male and female Circumcision on March 28 in Memphis at the Society for Applied Anthropology. We determined that circumcision should be conducted when the child can choose. However, here are some statistics from both sides of the issue:

Pro infant circumcision:
1)Circumcision lowers STD rates and the rate of cervical cancer in women.Explaining the Claims of Medical Benefits. Circumcision Resource Center. 8 April 2002. <http://www.circumcision.org/benefits.htm>.

2)According to a meta-analysis, circumcision reduced the risk of developing UTI in the first year of life by a factor of 12, and the absolute risk of a genitally intact boy developing UTI was approximately 1 in 100 [10].
3)Reports of several case series noted a strong association between lack of circumcision and penile cancer [18]. Advocates believe that "invasive penile cancer could be virtually eliminated in the United States by routine newborn circumcision
4)Based on a meta-analysis of published studies, genitally intact men had approximately 3 times the relative risk for HIV infection and increased risk for genital ulcer disease
5)Circumcision reduced the risk of genital ulcer disease, including syphilis and chancroid
6)In a national survey, circumcised men reported less sexual dysfunction than genitally intact men [28]. Women prefer circumcised sexual partners. Psychological effects are not recognized
7)Circumcision has low risk, less than 1% [6]. Most complications are bleeding and infection
NOte: most studies with STIs and AIDS have not been accepted internationally because they do not meet all conditions for a quality study.

Anti infant circumsicion:
American Academy of Pediatrics states:
Circumcision is not essential to a child's well-being
It is an elective procedure
Medical professionals should not coerce parents into choosing circumcision
Parents should make a fully informed decision that is in the best interest of the child
There is no evidence of increased infection of circumcised vs. uncircumcised babies; hygiene or the lack of hygiene is responsible for infections.

[carriebft]

STD research from last month:

http://www.ncbi.nlm.nih.gov/pubmed/1...?dopt=Abstract

CONCLUSIONS: These findings are consistent with recent population-based cross-sectional studies in developed countries, which found that early childhood circumcision does not markedly reduce the risk of the common STIs in the general population in such countries.

Meatal Stenosis 7-10% risk with circumcision:

http://www.emedicine.com/PED/topic2356.htm

A recent thread with mothers whose son's are suffering from this under-recognized side effect of circumcision:

http://www.mothering.com/discussions...d.php?t=865907

Adhesions 70% risk with circumcision:

http://www.kidsgrowth.com/resources/...il.cfm?id=3420



I'm too tired to refute all the others, but more later....

[romamama]

I am so Glad that there are people willing to stand up for not circing!

From all that i read and thru the interviews, there have not been any solid and conclusive studies about the benefits of circ. I am glad to hear that there are parents willing to stand up for non-circ. I personally believe that the child should have the right to choose any type of cosmetic surgery. And that is exactly what circ is. My collegues and I coined the term MGS or male genital surgeries in order to disconnect the practice from the power relationships brought to the term circumsicion.

[glongley]

Hi Romamama:

Good for you for doing a presentation on this. However, you are barking up the wrong tree to be arguing only the medical rationales. Each one of the points you make above can be argued against - either weaknesses in the methodology, or countervailing evidence, etc.

The bottom line is, however, not whether there might or might not be some medical benefits to cutting off the male foreskin. The bottom line is the ethical conditions under which this could be justified. Have a look at this quote from Margaret Sommerville, bioethicist at McGill University in Montreal:

>>>>sxcerpt from Margaret SOmmerville>>>>

A common error made by those who want to justify infant male circumcision on the basis of medical benefits is that they believe that as long as some such benefits are present, circumcision can be justified as therapeutic, in the sense of preventive health care.

This is not correct.

A medical-benefits or 'therapeutic' justification requires that:

1) overall the medical benefits sought outweigh the risks and harms of the procedure required to obtain them,
2) that this procedure is the only reasonable way to obtain these benefits, and
3) that these benefits are necessary to the well-being of the child.

None of these conditions is fulfilled for routine infant male circumcision.

If we view a child's foreskin as having a valid function, we are no more justified in amputating it than any other part of the child's body unless the operation is medically required treatment and the least harmful way to provide that treatment.

From: The Ethical Canary: Science, Society and the Human Spirit by Margaret Somerville. Toronto, 2000

Margaret Sommerville is a lawyer and bioethicist, and is the founding director of the Centre for Medicine, Ethics, and Law at McGill University, Montreal, Canada.

>>>>>end quote>>>>>>>>>

For infant circumcision, in relation to the above criteria: The potential benefits do not outweigh the risks. The medical conditions for which circumcision is sometimes pushed as prophylaxis are either rare, conservatively treatable, and/or more easily and less invasively prevented by attention to proven behavioral risk factors. And most of the touted benefits would not be realized till adulthood, so circumcision does not have to be done to a newborn baby.

The bottom line is: no one has the right to cut a normal, healthy, body part from another person without their permission. The foreskin is no different in that regard from any other body part. In the absence of a compelling medical necessity, circumcision should only be done when the person who owns the penis gives his fully informed permission, when he is old enough to weigh the evidence of potential risks and benefits for himself.

Gillian

[Blarg]

There's also the matter of the sexual sensitivity of the foreskin. The only study I can recall that tested the sensitivity of the foreskin itself (as opposed to other parts of the penis) found that the most sensitive parts of the foreskin were four times as sensitive to light touch as any part of the circumcised penis.
http://www.nocirc.org/touch-test/touchtest.php

Many other studies have been done on penile sensitivity in circumcised vs intact penises. However, (if I recall correctly) all of them failed to measure the sensitivity of the foreskin itself, and only compared the sensitivity of parts of the penis present in both circumcised and intact men. Unsurprisingly, they found little difference.

[Fellow Traveler]

Well I'll help you with some research. I just realized you are doing an anthropology paper so you should enjoy the last pdf (Darby et al) especially. I don't think that much of your pro column holds water. Let me know if this information is useful to you. I did this fast so don't read any tone it is only informational.

Originally Posted by romamama

Two collegues and I are presenting a new theory on male and female Circumcision on March 28 in Memphis at the Society for Applied Anthropology. We determined that circumcision should be conducted when the child can choose. However, here are some statistics from both sides of the issue:

Pro infant circumcision:
1)Circumcision lowers STD rates and the rate of cervical cancer in women.Explaining the Claims of Medical Benefits. Circumcision Resource Center. 8 April 2002. <http://www.circumcision.org/benefits.htm>.

Circumcision lowers STD rates. False. A study just published in the March 2008 Journal of Pediatrics, "Circumcision and Risk of Sexually Transmitted Infections in a Birth Cohort" by N. P. Dickson, T. Van Roode, P. Herbison and C. Paul, J Pediatr 2008;152:383-7, shows that circumcision does NOT prevent STDs. These findings are consistent with recent population-based cross-sectional studies in developed countries [such as the Australian Study (International Journal of STD & AIDS August 1, 2006; 17(8): 547-54.) of about 10,000 men and the British Study (STI 2003 Volume 79: Pages 499-500, December 2003) of approximately 2,000 men] which found that early childhood circumcision does not markedly reduce the risk of the common STIs in the general population in such countries.

Cervical cancer is also not really supported by the research. In 2002, the NEJM published research performed by Castelsagué et al which tried to show a link between intact men and cervical cancer however it was severely criticized, in the same issue it was published I believe. You can read about this and other research on cancer and intact men here. A critique of the study can be found here. More recently, according to Dr. Joseph Menczer's article: "The Low Incidence of Cervical Cancer in Jewish Women: Has the Puzzle Finally Been Solved?" published in The Israel Medical Association Journal, Volume 5: Pages 120-123, February 2003, Dr. Menczer says:

Although the dispute over the association of circumcision and cervical cancer in various populations is still ongoing [23,24], there seems to be no hard evidence that circumcision prevents its occurrence in Jewish women, and it is no longer considered to play a protective role.

and goes on to conclude in part:

These findings support the possibility that the low prevalence of the homozygous arginine polymorphism may play a role in determining the low incidence of cervical cancer in Jewish women and may also explain the differences between the ethnic groups. If these observations are confirmed, then the low incidence of cervical cancer in Jewish women is genetically determined, and an explanation for the ethnic incidence pattern of cervical cancer in Jewish women has also finally been found.

Full article can be found here if you want to read it. Plus we can vaccinate against HPV now too.

Originally Posted by romamama

2)According to a meta-analysis, circumcision reduced the risk of developing UTI in the first year of life by a factor of 12, and the absolute risk of a genitally intact boy developing UTI was approximately 1 in 100 [10].

This may or may not be true (there are studies that suggest circumcised boys are more prone to UTI) but if we consider this benefit at face value, it has been shown that this protection exists only for boys between about 2 and 6 months. After which girls will catch up with intact boys. However, a UTI is treatable with antibiotics. A UTI argument might work if there was a truly recurrent problem in a specific boy, which isn't easily treated with antibiotics, but the problem with that idea is that it is unlikely that a circumcision would fix the problem as in this situation, there is a high chance that there is a anatomical or functional problem which means circumcision proabably wouldn't help.

Taking it a step further, again taking the benefit at face value, one would have to circumcise at least 200 boys to prevent one easily treatable UTI. The Royal Australasian College of Physicians breaks it down in section 5.1 one of their statements:

On the other side of the equation, taking a mid-range figure of 2% (20 per 1,000) for major complications from circumcision, mainly from haemorrhage and infection (see earlier section), for every 1,000 infants circumcised, about eight fewer will develop a UTI but 20 will develop a significant complication. Assuming that the “harm” of a UTI is about
the same as a complication, routine circumcision is difficult to advocate as a public health measure.

Originally Posted by romamama

3)Reports of several case series noted a strong association between lack of circumcision and penile cancer [18]. Advocates believe that "invasive penile cancer could be virtually eliminated in the United States by routine newborn circumcision

This is false. In 2006, the American Cancer Society published a statement that said in part:

The consensus among studies that have taken these other factors into account is circumcision is not of value in preventing cancer of the penis.

Originally Posted by romamama

4)Based on a meta-analysis of published studies, genitally intact men had approximately 3 times the relative risk for HIV infection and increased risk for genital ulcer disease

Genital ulcer is discussed in the first question, here I'll focus on HIV. While there have been studies that show a slight relative risk reduction in Africa the number is 1/2 not 3xs. Other studies conducted on subjects in industrialized countries don't show any statistically significant effect. Like this recent
larger study published in September 2007 which reviewed all electronic records of males attending the San Francisco municipal STD clinic between 1996 and 2005 which amounted to some 58,598 patients. Although the study authors don't bother to run the numbers, two of the respondents did; there is enough information there for you to cross check it if you are so inclined. In this case, 58,000 men in San Francisco, over 10 years there was no significant statistical difference found between circumcised or intact men with regard to HIV or Syphilis for any sexual orientation. Which seemed to confirm results from a smaller study of the US Navy population published at the XV International AIDS Conference in 2004 which also found no significant difference in the HIV rates between intact and circumcised men.

A second wrinkle is that I haven't seen any reasonable explaination as to why the US has both the highest rate of HIV in the west while at the same time having one of the highest rates of circumcised men. There is evidence that the foreskin might provide a protective role. Last March there was a research paper published concerning this in Nature Medicine, Volume 13: Pages 367-371, de Witte et al. which concluded in part that:

Notably, LCs also inhibited T-cell infection by viral clearance through Langerin. Thus Langerin is a natural barrier to HIV-1 infection, and strategies to combat infection must enhance, preserve or, at the very least, not interfere with Langerin expression and function.

What might that say about circumcision? Hint: The foreskin is rich in Langerhans cells. Perhaps (and this is just a theory) perhaps in western countries the Langerin mechanisms are functioning better than in populations like Africa. Perhaps it is a genetic thing or perhaps a weakened immune response due to living conditions? Or perhaps we don't know the long term effects. Perhaps when circumcised as an infant by the time one begins sexual activity the head of the penis is sufficiently kerinalized to increase abrasiveness thus spreading HIV more easily? So the thing is we really don't know what is going on but even if there was a protective effect it wouldn't justify infant circumcision as a boy can make a decision based what he believes is in his interests when he is old enough.

Again, the Royal Australasian College of Physicians discusses this in their statements,
perhaps predicting the possible up selling of circumcision as a prophylactic for HIV, The Royal Australasian College of Physicians (RACP) included the following statement in Section 5.2 of their 2005 statement:

However, how much circumcision could contribute to ameliorate the current epidemic of HIV is uncertain. Whatever the future direction of this debate it can not be seen as an argument in favour of universal neonatal circumcision in countries with a low prevalence of HIV.

Even offering it to an adult doesn't make much sense. The biggest problem when considering adult circumcision as an HIV prophylactic is that, as Alexander Sanger said in his recent article: The No-Brainer Syndrome,

It is difficult to imagine an effective public health campaign that urged circumcision and continued condom use – why should a man go through circumcision if he still has to wear a condom’s?

This smacks of common sense and echos a similar statement from the Australian Federation of AIDS Organization's. The AFAO published a very interesting statement in July 2007 which the followed with this one that was distributed at at last year's International AIDS Society Conference. The second said in part:

How a man factors the known risk reduction alongside the unknown variables into his sexual decision-making is the important thing. Unless he opts to use condoms with all sexual partners whose HIV status is positive or unknown, he remains at risk of acquiring HIV (and if he does this, there is no need to be circumcised for added protection).

The French have released a similar statement I can dig it up if you want.

Originally Posted by romamama

5)Circumcision reduced the risk of genital ulcer disease, including syphilis and chancroid

This is the same as question 1.

Originally Posted by romamama

6)In a national survey, circumcised men reported less sexual dysfunction than genitally intact men [28]. Women prefer circumcised sexual partners. Psychological effects are not recognized

I am not aware of the first study but perhaps you should consider that the male foreskin is profusely innervated especially near the tip. In fact, Sorrells et al, Fine-touch pressure thresholds in the adult penis BJU International 99 (4), 864-869 (British Journal of Urology International, Volume 99 Issue 4 Page 864 - April 2007) showed that the foreskin is actually the most sensitive part of the penis and therefore circumcision clearly ablates it. A separate Korean study found:

Analysis of the results showed that there were no significant differences in sexual drive, erection, ejaculation and ejaculatory latency time between circumcised and uncircumcised men. Masturbatory pleasure decreased after circumcision in 48% of the respondents, while 8% reported increased pleasure. Masturbatory difficulty increased after circumcision in 63% of the respondents but it was easier in 37%. About 6% answered that their sex lives improved, while 20% reported a worse sex life after circumcision.

The second study you mention would show subjectiveness in a culture and should have little weight.

Originally Posted by romamama

7)Circumcision has low risk, less than 1% [6]. Most complications are bleeding and infection
NOte: most studies with STIs and AIDS have not been accepted internationally because they do not meet all conditions for a quality study.

Not according to most sources, if you read the RACP statement and the AFAO publications they cite complication rates in the range of 2% - 10%. As for the studies I think they are largely not accepted because many of them occur in Africa and it is difficult to draw strong conclusion between two disparate populations that are significantly different from just about any anthropological context. Those that have been done on western population by and large show little if any significant difference.

Originally Posted by romamama

Anti infant circumsicion:
American Academy of Pediatrics states:
Circumcision is not essential to a child's well-being
It is an elective procedure
Medical professionals should not coerce parents into choosing circumcision
Parents should make a fully informed decision that is in the best interest of the child
There is no evidence of increased infection of circumcised vs. uncircumcised babies; hygiene or the lack of hygiene is responsible for infections.

There are many more reasons not to circumcise; I suggest checking out this page, this page, and this article to start.

Hope this helps you.

Routine Infant Circumcision: No rational thinker can defend it.

ETA: Glongley quoted Sommerville, here is a link to the whole article.

[Frankly Speaking]

Originally Posted by romamama

Two collegues and I are presenting a new theory on male and female Circumcision on March 28 in Memphis at the Society for Applied Anthropology. We determined that circumcision should be conducted when the child can choose. However, here are some statistics from both sides of the issue:

Congratulations on being able to present this information to such an august group!

Glongley and JWhispers have done an admirable job in addressing these issues and I have little to add but I'll add what I can:

Pro infant circumcision:

1)Circumcision lowers STD rates and the rate of cervical cancer in women.Explaining the Claims of Medical Benefits. Circumcision Resource Center. 8 April 2002. <http://www.circumcision.org/benefits.htm>.

There have been a number of studies trying to find a connection between the intact penis and cervical cancer but all to date have been seriously methodologically flawed. The first compared the rates between Swedish (IRC) women and Israeli women. The problem is that the Israelis tend to be an insular culture and only if the HPV rates were similar would this study be conclusive. Later research showed that Israelis have a significantly lower HPV rate.

The most recent study to try to make this connection excluded all study candidates who had fewer than 6 lifetime sexual partners and only considered the circumcision status of their last sexual partner. There was no possible way to determine which sexual partner was responsible for the infection.

However, this whole discussion is turned upside down. It is advocating that men be ultimately responsible for women who do not take responsibility for their own health. Further, in a paper on medical ethics, it was advanced that a prophylactic procedure should not be performed unless it benefited at least 29% of the patients. The benefits of circumcision in preventing cervical cancer in women is exactly zero percent.

This discussion is also now moot with the introduction of the HPV vaccine. It is advocating that all men be circumcised to protect women who don't take responsibility for their own health. The best way to prevent infection is to limit sexual partners. However, a study of 13 to 15 year old girls showed that 54.6% of them had already been exposed to the virus! The researchers concluded that they had been infected as they passed through their mother's birth canal. The fact is that 97% - 98% of people infected with HPV develop a natural immunity. The circumcision experiment has certainly been a dismal failure in The United States. With an 80% circumcision rate in sexually active men and and an estimated 70% to 80% HPV infection rate, circumcison has failed miserably in preventing HPV infections.

2)According to a meta-analysis, circumcision reduced the risk of developing UTI in the first year of life by a factor of 12, and the absolute risk of a genitally intact boy developing UTI was approximately 1 in 100 [10].[/quote]

This indicates the rate of UTI infections in both circumcised and intact boys is within the range of 1%. Even if this is true, it has to be balanced against the risks of the procedure. Clearly, the risk of meatal stenosis is far higher and the biggie, circumcision deaths is a more grave risk. The risk of death from the circumcision procedure is approximately 1:7,000 procedures. Only if circumcision prevents more deaths from UTIs is it an acceptable risk. That will be difficult to support.

3)Reports of several case series noted a strong association between lack of circumcision and penile cancer [18]. Advocates believe that "invasive penile cancer could be virtually eliminated in the United States by routine newborn circumcision

The risk of penile cancer in intact males is 1:110,000. Penile cancer is an easily treatable condition if treated early. Only in cases where the man ignores the obvious symptoms does it become deadly. Compare that to the death rate of circumcison at 1:7,000. Clearly, circumcision is not an effective prophylaxis in preventing deaths.

4)Based on a meta-analysis of published studies, genitally intact men had approximately 3 times the relative risk for HIV infection and increased risk for genital ulcer disease

JWhispers addressed this well but I will add that there is a just released study from New Zealand that found no significant difference between intact and circumcised men.

6)In a national survey, circumcised men reported less sexual dysfunction than genitally intact men [28]. Women prefer circumcised sexual partners. Psychological effects are not recognized

This appears to be the 1997 Laumann study. This study was not controlled to produce these results and as a result, Laumann repeated this part of the study in 1999 and found that the circumcised men suffered sexual impotence significantly earlier than the genitally intact men. Further, Bleustein conducted a similar study reported in 2005 that also found that circumcised men suffered impotency 7 years earlier than intact men. That's about 18% of a man's sexual life expectancy.

The women preferring circumcised partners is the Williamson & Williamson study conducted by the husband and wife team of Paul and Marvella Williamson at The University of Iowa Medical Center in the early 1980's. Of their study census, ~80% of the respondents were women who had given birth to boys and had them circumcised. Extrapolating from circumcision rates of the area, 85% - 90% of the fathers were circumcised and it is unlikely that most of the women had ever experienced an intact penis to make the determination. The O'Hara Study of women who had actually experienced sex with intact partners found just the opposite results. Those women overwhelmingly preferred genitally intact men.

7)Circumcision has low risk, less than 1% [6]. Most complications are bleeding and infection
NOte: most studies with STIs and AIDS have not been accepted internationally because they do not meet all conditions for a quality study.

Just a perusal of this forum will clearly dispute the 1% figure.


Frank

[Night_Nurse]

Originally Posted by Frankly Speaking

This appears to be the 1997 Laumann study. This study was not controlled to produce these results and as a result, Laumann repeated this part of the study in 1999 and found that the circumcised men suffered sexual impotence significantly earlier than the genitally intact men. Further, Bleustein conducted a similar study reported in 2005 that also found that circumcised men suffered impotency 7 years earlier than intact men. That's about 18% of a man's sexual life expectancy.


Frank

Thank you! I was wondering what the op meant about the sexual dysfunction. I had always heard/read that circumcised men were more prone to impotency than intact men.

[romamama]

All of this is wonderful. I have alerted my collegue, Christina, as she is the main researcher for male circ which we have termed MGS (male genital surgeries). She is excited about of the comments.

The poster presentation is about the medicalization of the US with MGS in contrast to the ritualization of FGS (female genital surgeries). SO that is why we did focus on medical reasoning for the MGS. When we interviewed about 100 men, medical was the only reason given for their GS (genital surgery).

Both of my collegues and I agree that the medical studies done in favor of MGS are poor quality and lack so much.

Thank you again for all of the great comments!

[thixle]

Quick question, romamama.
Why the new term MGS? Or FGS?
It has been pretty acceptable since the 1990s to call it Female Genital Mutilation, even when it is simply a pinprick... I realize you will be giving the talk in a high circ area, but the double standard (mutilation for girls, surgery for boys) just rubs me the wrong way.

[romamama]

We agree thixle.After doing all of our research (which is never really done), we wanted to escape the following connotations:
-Circumcision implies relativistic tolerance
-Mutilation implies moral outrage

However, Male and Female Genital Surgeries is more conducive in respecting culture and escaping power relationships. Also, there is a classification system with circumsicion that includes piercing the genitals and tattooing them, so we wanted to be able to include those practices (which are not traditionally called circing but are in the classifications).

This presentation is very anthropologically based and we felt is was only honorable for cultural respect to be shown to an adult who chooses to undergo genital surgeries.

[glongley]

Originally Posted by romamama

All of this is wonderful. I have alerted my collegue, Christina, as she is the main researcher for male circ which we have termed MGS (male genital surgeries).

I have seen the term MGA and FGA for male/female genital alteration used in scholarly literature. Your term seems to be a new variant. I like the word alteration better, because as you say there are other practices like tattooing, or stretching of the genital skin, that do not fall into the definition of "surgery". Also the word "surgery" in itself implies a degree of medicalized legitimation, where as "alteration" recognizes that something natural and normal is being tampered with.

Please keep us in the loop about your work and your presentation!

Gillian

[Microsoap]

I'm still on the side of calling it what I feel it is-- mutilation. Yes, it's a surgery, but it's a 100% totally unnecessary surgery for both genders. Some extreme people like to preform such surgeries like splitting the tongue to make it forked like a snake. Such an act to me is unnecessary mutilation... but at least this is an act of mutilation done BY the person's choice TO the person's body in adulthood! Forced genital mutilation is just that-- a permanent sexual assault.

[Quirky]

Weighing in on the terminology, I personally like MGC and FGC -- male and female genital cutting. Avoids the mutilation bomb, doesn't medicalize it quite like "surgery," and calls a spade a spade, because you can't circ without cutting.

also, I think you could write a very interesting anthropological paper on why Western medical professionals have devoted paper after paper to the benefits of male circ and very few -- only a handful -- to the harms, while conversely devoting paper after paper to the harms of female circ and none if any to the benefits.

As Margaret Mead said about fish and water, etc. but it is truly astounding when you realize the entirely unexamined biases of Western researchers who assume that the foreskin is only researched in the context of whether it promotes disease or not, and it is always assumed that its removal is harmless.

As far as the structure and function of the foreskin go, i.e. proving that it's a necessary body part and integral to the functioning of the penis, you should read the Taylor et al. papers from the British Journal of Urology available at

www.cirp.org

and the website based on these papers,

http://research.cirp.org

as well as the video available at www.doctorsopposingcircumcision.org on The Prepuce

because as Gillian stated above, you cannot understand the so-called "pros" and "cons" of circumcision without understanding what the foreskin is and what it does. It is not a disposable body part.

[Fellow Traveler]

Originally Posted by Quirky

also, I think you could write a very interesting anthropological paper on why Western medical professionals have devoted paper after paper to the benefits of male circ and very few -- only a handful -- to the harms, while conversely devoting paper after paper to the harms of female circ and none if any to the benefits.

I think that would be very interesting too. I think the reasons may differ. Consider that researchers who are circumcised, or come from circumcising cultures, are going to lean toward showing there was a reason for it. So out of them you'll get a lot of work straining to show the benefits. Whereas an intact research, or one who comes from an intact culture, is not likely to research it either way; doing so is absurd in the same sense that researching why my earlobes are beneficial and why I shouldn't cut them off is.

Correct me if I am wrong but there wasn't a lot of FGM research in either direction until it bubbled up as a social issue. Why? because in industrialized countries that might do that kind of research they didn't practice FGM so of course it was not seriously research.

If all that makes sense.

[Frankly Speaking]

Originally Posted by romamama

All of this is wonderful. I have alerted my collegue, Christina, as she is the main researcher for male circ which we have termed MGS (male genital surgeries). She is excited about of the comments.

The poster presentation is about the medicalization of the US with MGS in contrast to the ritualization of FGS (female genital surgeries). SO that is why we did focus on medical reasoning for the MGS. When we interviewed about 100 men, medical was the only reason given for their GS (genital surgery).

I just realized that this is a poster project and not a speech presentation and that changes the whole ballgame. I have a background in advertising and equate this with billboards in so far as "catching eyes." With billboards, you have to have an eye catching visual image and a short and complete message that communicates your thoughts within a few seconds or you completely lose the reader.

To that end, I would recommend sticking with circumcision. While it may not imply the message you want, it is quickly comprehended and there is no question about what it means.

I would also recommend telling as much of your story as possible with pictures and re-inforce those pictures with bold verbage graphics that can easily be read from a distance. There is simply too much information in your outline to communicate on a poster or even a series of posters. To give you an example, a billboard for Toyota automobiles would logically show one vehicle in a picture, not their entire line of sedans, sportscars, minivans, SUVs and pick-ups. Lets say the picture is of a Toyota SUV. The picture could include a large family implying that it is a family vehicle and that it can accomodate up to 8 or 9 people. The picture could also include lots of sporting gear implying that this SUV has a large carrying capability. It could also include a large boat implying that it is a heavy duty vehicle capable of towing large loads. Finally, the family would be engaged in playing sports and they would all be laughing and smiling implying that this will be a wise investment for the family and a enjoyable purchase. All that is said without any words. The verbage could say something about "Legendary Toyota Quality and Dependability" which completes the complex message with only a few words.

That is what you want to do. Communicate as much of your message as possible in the first few seconds. You can't depend on the reader to stand in front of your poster and read all of it. You have to approach a poster project as if your reader has a single digit IQ even though your audience is all pHds. A couple of years ago, I worked a baby fair with the circumcision message. The organizers of our booth spent laborious hours putting together several posters of information. There were at least a thousand attendees that passed our booth and there was not a single one of them that read a significant portion of the posters. There were probably a dozen small photographs and graphs with none of them being larger than a half page and there was pages and pages of text, virtually none of it larger than bold typewriter print. It was both visually confusing and intimidating to the viewer. Don't make that mistake!

Also, there is a classification system with circumsicion that includes piercing the genitals and tattooing them, so we wanted to be able to include those practices (which are not traditionally called circing but are in the classifications).

This is an example of where I think you may be trying to go too far afield. People don't generally associate piercings and tattoos with circumcision. I think you should also either limit your message to procedures done to children or procedures done to adults. While they are the same, there is an obvious disconnect in the brains of people. I don't think in poster format, you can effectively make the connection.

I think you need to condense your message, depend on pictures and graphics to convey most of your message and keep it visually simple. For example, if you wanted to quantify the areas where the practices are prevalent, you could list each nation in the world with checks beside each one for the practices they engage in. A simpler and more effective format would be a world map with areas that practice male circumcision in red, the areas that practice female circumcision in blue and areas that practice both in purple. The only verbage that would be needed is a headline reading "Prevalence of Male and Female Circumcision" and a legend at the bottom explaining the colors. The map is going to communicate your message in a matter of a few seconds and with practically no words.


Frank

[thixle]

Originally Posted by Frankly Speaking

I just realized that this is a poster project and not a speech presentation and that changes the whole ballgame.

Yeah, what Frank said ^^^
I have an art degree and visually, you have to focus intently on one specific message, otherwise, people are just going to keep walking.

[romamama]

Conference

Everyone was very supportive at the conference! It was well received, So yay!

[Papai]

Nice. Give us more details!

[perspective]

Originally Posted by romamama

Two collegues and I are presenting a new theory on male and female Circumcision on March 28 in Memphis at the Society for Applied Anthropology. We determined that circumcision should be conducted when the child can choose. However, here are some statistics from both sides of the issue:

Pro infant circumcision:
1)Circumcision lowers STD rates and the rate of cervical cancer in women.Explaining the Claims of Medical Benefits. Circumcision Resource Center. 8 April 2002. <http://www.circumcision.org/benefits.htm>.

2)According to a meta-analysis, circumcision reduced the risk of developing UTI in the first year of life by a factor of 12, and the absolute risk of a genitally intact boy developing UTI was approximately 1 in 100 [10].
3)Reports of several case series noted a strong association between lack of circumcision and penile cancer [18]. Advocates believe that "invasive penile cancer could be virtually eliminated in the United States by routine newborn circumcision
4)Based on a meta-analysis of published studies, genitally intact men had approximately 3 times the relative risk for HIV infection and increased risk for genital ulcer disease
5)Circumcision reduced the risk of genital ulcer disease, including syphilis and chancroid
6)In a national survey, circumcised men reported less sexual dysfunction than genitally intact men [28]. Women prefer circumcised sexual partners. Psychological effects are not recognized
7)Circumcision has low risk, less than 1% [6]. Most complications are bleeding and infection
NOte: most studies with STIs and AIDS have not been accepted internationally because they do not meet all conditions for a quality study.

Anti infant circumsicion:
American Academy of Pediatrics states:
Circumcision is not essential to a child's well-being
It is an elective procedure
Medical professionals should not coerce parents into choosing circumcision
Parents should make a fully informed decision that is in the best interest of the child
There is no evidence of increased infection of circumcised vs. uncircumcised babies; hygiene or the lack of hygiene is responsible for infections.

This is actually a very good example of a modern main stream discussion on circumcision. They discuss the benefits of circumcision (how very small they are, they do exist) and then the anti- side is basically "you dont have to do it." and "not all medical professionals agree anymore" and last one is almost always "this is why parents need to sit down and think what is best for their family"

The problem with this discussion is thats not a real discussion instead one side supports the old beliefs and the other side just says not everyone values those pro side anymore.

A real discussion on the anti-side would say things like "While yes circumcised boys face less UTI's then uncircumcised ones, but girls chances of contracting a UTI are doubled that of even uncircumcised boys. Yet they are fine because treatments to cure UTI's exist that are less invasive, less expensive, and more effective then circumcision.

A real discussion would put more pressure on the STI discussion as well. They would say "While there could be real truth in some of the studies that link circumcision status to high risk of AIDS infection, at this point there is not enough data collected to really say any significant benefit exists."

Also while many arguments go into possible problems a man with a foreskin MIGHT have, they hardly ever mention any of the many possible (but also not highly likely) complications a man with a circumcised penis might have. ie, like a urethra opening that is narrowed due to scar tissue.

A real discussion would present the two sides equally, but they generally dont. I think this often is caused because we still exist in a fairly procircumcising culture, where we want to believe we are all even minded about this issue, but in reality we are colored by our culture and blind to the truth.