Bad Medicine

There's been alot of buzz lately around the news that circumcision reduces the chance to get the HPV virus - warts (in this case, genital warts). This is not news, people. The basic idea here is that if you cut off a body part it won't get sick.

DUH!

We don't need scientists wasting money with studies to find these things out. So now it's even quantified how much. Guess what? There's already a vaccine for that. Condoms work, too.

So now you can see what I mean in the post title, "Bad Medicine". First of all, cutting off body parts that aren't sick yet is immoral, unethical ("first, do no harm"). But beyond that, the vaccine and condoms should suffice for HPV. No dongle truncating required.

Intactivism update

I haven't forgotten that I hate circumcision. I just haven't been a frequent blogger. I still read everything that comes up online. There are a few good recent posts out there. I find some of them by just searching "circumcision" on blogsearch.google.com. Rolling Doughnut is a favorite spot that I go back to time and again.

Is Promoting Male Circumcision as Prevention ethical?

If circumcision was virtually unknown in the United States as it is in other areas around the Globe, we would not be having this debate.

Religion by Scapel is not a Parental Right

If it's wrong for parents to mutilate a child for no good reason, and it unequivocally is, permitting an exception for parents to mutilate their children because their god says they must mutilate their children only legalizes no good reason.

Awhile back (longer than a fullterm pregnancy) I had a karma explosion at reddit.com when I submitted a story here about Denmark debating outlawing male circumcision on minors.

I failed to stop my brother from circumcising my nephew. My sister doesn't have any kids yet, but she's married now. I know I should probably be working on bringing her over to my camp, but she just rolls her eyes and calls me things like "obsessed" whenever I bring it up. Yeah, discovering you're missing half of the skin off your dick and that the rest of the world enjoys having it might do that to you..

"I'm too tired for sex" the recap

My "too tired for sex" post gathered the most comments of any post on my sparse blog, so I want to reiterate my point. Hopefully, It'll be a little more clear now.

I love my wife very much, but she causes me great pain when she rejects me sexually, especially since I cannot understand her explanations.

I married her for a couple reasons:
I enjoyed being around her all the time - we like the same kinds of games, movies, activities, foods, and can talk to each other for hours on end.
I wanted to have children with her.
I enjoyed having sex with her, and I was truly sexually satisfied with her.

After marriage, we were having the best sex of my life, but then she got pregnant with our first child, and her sex drive went to zero. It stayed at zero all the way until she stopped breastfeeding. We wanted another pretty soon, so we started trying, and she got pregnant again immediately. This time she promised some sexual activity during pregnancy and breastfeeding instead of outright drought, and barely kept that promise. Meanwhile, my brother left his wife, but wouldn't tell anybody why. I told my wife my guess was that his wife was not having sex with him. They also had two kids, but unlike my wife, his wife worked, so her "too tired for sex" reasons would be stronger. My wife only half believed, and my brother and sister-in-law got back together.

I cannot survive a sexless marriage. For that and several other reasons (financial, etc), I got a vasectomy.

After weaning our second child, my wife's libido has risen to about 10% its original levels. That's not the biggest problem. The biggest problem is that she thinks nothing's wrong. She thinks that it's perfectly normal for wives/mothers to just not enjoy sex more than once every 2 or 3 months. Every time I ask that she see a doctor to check her hormones or that we go together to a sex therapist she gets extremely upset, saying that I should stop telling her she has a problem.

The problem is, having kids did not change my sex drive, but it wiped hers out. I came into our marriage expecting her to satisfy me sexually for the rest of my life, and now I'm spanking my monkey by myself every day as if I'm in highschool again. If she had told me before having kids that she didn't expect to be sexual after kids, I would have told her we would adopt a child after she goes through menopause. We're at extremes now. I want sex every day, and she did too when we were newlyweds. Now she won't touch me lovingly, she won't kiss me passionately, and when we do end up having sex, she's limp, lifeless, acting like she's just doing a favor for me to keep me from leaving her. That's not what I want. That hurts me to my core every time. It makes me feel like all the sex we had before kids was a lie and a trap, a bait and switch marriage. What I need is for her to desire and enjoy sex like she used to. I want her to see sex as adult playtime, as important to do with your husband daily as playtime with your kids is. I want her to know that daily sex is good for you. It's healthy, just let go and enjoy it.

I feel very used, because I earn all the money, I let her buy whatever food she wants, I give her plenty of Friday nights Ladies' night out where I watch the kids and she gets drunk with a group of moms to gossip about why the hell their husbands expect sex out of them. I give her everything, but she does not give me the one thing I want - sexual satisfaction.

Was I always just an ATM and a sperm bank for her? It's crazy, when she tries to give me other stuff, like my favorite food, my favorite beer, letting me watch whatever on tv, it shows that she just doesn't get it - you can't say "sorry I've been torturing you by being your spouse but making you go without sex" with anything but sex. It's gotten to where, Christmas, my birthday, Father's day, whatever the occasion where she should give me a gift, I ask for willing, enjoyable sex. I did not expect any of this before asking her to marry me. I expected children to make our sex go from daily to 3 or 4 days a week. The level of sexual activity we have now I wasn't expecting until at least our seventies. I don't believe I should even have to ask for sex with my spouse. We should just be doing it. She should be initiating sex, like she used to, to show her affection.

Literally, everything else I need, I can just pay someone or get it from someone else for free. But with sex, I'm only allowed to get it from my wife. I truly feel like she has either a physical problem like hormone imbalance, or a psychological problem like bad thoughts and misconceptions about sex. So I'm trying to convince her to see a doctor or a sex therapist to work out the problems. But she won't admit there's a problem so she refuses to get help. She just says "oh, I'm too tired for sex". Then just let go and enjoy! I can do all the physical work. If she is truly just plain tired, then being too tired for sex says that she doesn't care about our relationship. Reprioritize your daily tasks so that there is enough energy at the end of the day for sex with your spouse. Sex is the keystone of marriage, it may be a small part, but without it, the whole thing comes toppling down.

I married a sexual person, but when she became a mom she lost all her libido, leaving me searching for it on my own.

obscure foreskin use #1001

I found a new reason why I would be better off not circumcised. The other day I was chopping jalapenos and habaneros when I needed a bathroom break. I must have not washed my hands enough before going because my glans burned like fire until I took a cold bath to cool it down.

Where circumcision comes in is I noticed my glans and circumcision scar were glowing beet red, but none of my shaft skin was affected. The glans and inner foreskin are mucous membrane. The outer foreskin and shaft are more like regular skin. My theory is that had I not been circumcised, I would not have gotten pepper oils on mucous membrane since I could pee without touching them, and wouldn't have been burned.

To properly test my theory I would need to rub a freshly cut chili up and down my dick and see where it burns and where it doesn't, but unfortunately for you, I'm not willing to torture myself for science's sake.

Religious Rights on Trial?

Just a quick post, there's a recent news story here about a case moving up the Oregon court system where a custodial father wants to circumcise his 12 year old because he (the father) has converted to Judaism. The ex-wife/mother is suing to stop it.

What I find stupefying is the title of the news "Religious Rights on Trial as Circumcision Case Reaches Oregon’s High Court"

You couldn't find a better spin doctor. Let's step back out of the box and put it in plain terms: the dad is whining his religious rights are impeded by people wanting to stop him from getting his son's penis cut. People like the boy's mother.

I just hope the case either drags on till the boy is 18, or the judge finds, like a similar recent case in Chicago, that the boy will choose for himself at 18.

Male Circumcision Overstated as Prevention Tool Against AIDS

People have noticed that some circumcising countries have lower AIDS rates than non circumcising countries in Africa. However comparing USA (a circumcising country) to Europe, Japan, Australia (non circumcising regions) you get an opposite result.

Finally someone has made some sense of all this here.

It's a classic causation vs correlation confusion. Circumcision advocates were touting it as a great way to prevent the spread of HIV, seeing the correlation. However, in this study, they find that the biggest driver of HIV spread is really the infection rates of prostitutes, and the percentage of the population prostituting and patronizing prostitutes. The causation of the circumcision correlation is revealed to be that circumcising countries are generally more religious, so less women prostitute and less men patronize them, per capita.

So treating, educating, protecting prostitutes will net a far greater gain in HIV control than mass circumcision.

Lesson on Confounds: When comparing circumcised to intact, don't forget the foreskin

Confound (freedictionary.com):

1. To cause to become confused or perplexed.
2. To fail to distinguish; mix up: confound fiction and fact.
3. To make (something bad) worse: Do not confound the problem by losing your temper.
4. To cause to be ashamed; abash: an invention that confounded the skeptics.

The first time I heard the word "confound" was in a graduate class where the professor was teaching us to be critical of published papers. She was talking about how to look for "confounds" which would render the results of the studies or experiments in the papers to be caused by something other than what the authors listed in their conclusions.

What makes me think of confounds today is the sudden appearance of news articles saying "Scientists Disagree about Circumcision Sensation" quoting two recent studies that contradict each other on whether or not a circumcised penis has less sensation than an uncircumcised one. Since I have a healthy distrust of the news media (they are trained and paid to find sensational stories, not be critical thinkers), I decided to go straight to the sources.

First, the news clip:

Kimberley Payne of the Riverside Professional Centre in Ottawa, Canada, and her colleagues tested the sensitivity of 20 intact
and 20 circumcised men's penises as they watched erotic movie
clips, by touching the penises with filaments that press down
with predetermined amounts of pressure.... They found no
difference in penile sensation between circumcised and
uncircumcised men.
However, when Robert Van Howe of Michigan State University used a similar method to measure sensitivity at 19 points along the penises of 163 men, he found that the five most sensitive points were all in portions of the penis removed by circumcision,
especially those in folds exposed as the penis becomes erect....

Something should already be fishy: Howe used more subjects, and we know how many points along the penises he measured. The reporter tells us how Payne measured sensitivity, but was that 1 point? 3? 10?

Now for the first study:

Sensation and Sexual Arousal in Circumcised and
Uncircumcised Men.
Kimberley Payne , Lea Thaler , Tuuli Kukkonen , Serge Carrier
, Yitzchak Binik
Introduction. Research, theory, and popular belief all suggest
that penile sensation is greater in the uncircumcised as
compared with the circumcised man. However, research involving
direct measurement of penile sensation has been undertaken only
in sexually functional and dysfunctional groups, and as a
correlate of sexual behavior. There are no reports of penile
sensation in sexually aroused subjects, and it is not known
how arousal affects sensation. In principle, this should be
more closely related to actual sexual function. Aim. This
study therefore compared genital and nongenital sensation as a
function of sexual arousal in circumcised and uncircumcised
men. Methods. Twenty uncircumcised men and an equal number of
age-matched circumcised participants underwent genital and
nongenital sensory testing at baseline and in response to
erotic and control stimulus films. Touch and pain thresholds
were assessed on the penile shaft, the glans penis, and the
volar surface of the forearm. Sexual arousal was assessed
via thermal imaging of the penis.
Results. In response to the erotic stimulus, both groups
evidenced a significant increase in penile temperature, which
correlated highly with subjective reports of sexual arousal.
Uncircumcised men had significantly lower penile temperature
than circumcised men, and evidenced a larger increase in
penile temperature with sexual arousal. No differences in
genital sensitivity were found between the uncircumcised and
circumcised groups. Uncircumcised men were less sensitive to
touch on the forearm than circumcised men. A decrease in
overall touch sensitivity was observed in both groups with
exposure to the erotic film as compared with either baseline
or control stimulus film conditions. No significant effect
was found for pain sensitivity. Conclusion. These results
do not support the hypothesized penile sensory differences
associated with circumcision. However, group differences in
penile temperature and sexual response were found.

OK, so Payne measured two points on the penis and one on the forearm (?) at different stages of arousal, also measuring temperature on the penis. They measured sensitivity on the shaft and head, but hmmmm, isn't there another part of the penis? the foreskin? isn't that cut off with circumcision? why not measure that, Ms. Payne?

Now for the other study:

Fine-touch pressure thresholds in the adult penis.

Morris L Sorrells , James L Snyder , Mark D Reiss ,Christopher Eden , Marilyn F Milos , Norma Wilcox , Robert S Van Howe

OBJECTIVE To map the fine-touch pressure thresholds of the adult
penis in circumcised and uncircumcised men, and to compare the
two populations.
SUBJECTS AND METHODS Adult male volunteers with no history
of penile pathology or diabetes were evaluated with a
Semmes-Weinstein monofilament touch-test to map the
fine-touch pressure thresholds of the penis. circumcised
and uncircumcised men were compared using mixed models for
repeated data, controlling for age, type of underwear worn,
time since last ejaculation, ethnicity, country of birth,
and level of education.
RESULTS The glans of the uncircumcised men had significantly
lower mean (sem) pressure thresholds than that of the
circumcised men, at 0.161 (0.078) g (P = 0.040) when
controlled for age, location of measurement, type of underwear
worn, and ethnicity. There were significant differences in
pressure thresholds by location on the penis (P < 0.001).
The most sensitive location on the circumcised penis was the
circumcision scar on the ventral surface. Five locations on
the uncircumcised penis that are routinely removed at
circumcision had lower pressure thresholds than the ventral
scar of the circumcised penis. CONCLUSIONS 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.

Ouch, the most sensitive parts are cut off in circumcision and the circumcision scar is the most sensitive part left over? That's not very nice. They measured many locations on the penis, seeming to use the same method as Ms. Payne. But first, they eliminated all volunteers with penis problems. And then they ask how old they are, when they last ejaculated, what kind of underwear they had, their country of birth, education level, ethinicity.. dang they really want to make sure that nothing can confound their results. And by the way, those P values are results of statistical tests to prove the data is statistically significant, i.e. it's not a result of random chance.

Although, I do see one confound - Howe doesn't tell us what state the penis is in. Was it soft, hard, both? Looks like both parties may need further research.

And that, folks, is the lesson in confounds. If you don't control for everything that might change your results, critical thinkers won't believe your assertions. Since Ms Payne's group didn't measure sensitivity on the portions of the penis that are removed in circumcision, can she really say that circumcised penises have the same sensitivity? The only thing I get from her study is that the shaft and head of the penis feel the same, but I'm still curious about the foreskin. Hell, she didn't even say whether she turned away volunteers that had penis problems, but she did have age matched volunteers.

When using research to guide serious decisions, like whether or not to cut off the end of your newborn son's penis, you might want to look for confounds before you form your final opinion.