Circumcision - Lets not Derail the UK Politics thread.

[The BlackBear]

Ok, so on my in case comments: I am 1. not planning on having any children, and certainly not anytime soon. 2. I'd obviously get a doctors opinion first. If there's no proven genetic link then, sure. I just kind of assumed there was one.

[Which Tyler]

You'd be far from the first to confuse familial/household links with genetic ones. There's also the element that the causative factors can have genetic traits (as well as environmental ones).

It's an understandable concern (significantly more so than cultural / dogmatic ones IMO); but I don't think it's valid. Nor do I necessarily think it's the place of the parent tommake that decision on behalf of someone who would be basically adult bynthe time the decision needs to be be made (again, if in your family it needs to be made before that age of 10, then that changes, but I understand that phimosis usually starts from the mid-teens. It's also easier for a grown adult tomorrow their junk clean than a baby in nappies, where it's sharing close proximity to... the reasons for nappies). I reserve the right to be wrong though.

[The Marquis de Leech]

Apparently circumcision was pretty much unknown here in the early twentieth century, became very common in the immediate post-WWII period (due to returning servicemen's experience in North Africa), then disappeared again (as a child of the 1980s, I'm intact). It's apparently very difficult to find a doctor here willing to do it. 

[Ormond]

On 4/7/2018 at 3:34 PM, TrueMetis said:

 

Also circumcision rates and HIV infection rates don't correlate at all, now this doesn't disprove circumcision's effect on HIV infection, but it does suggest to me the effect isn't truly that great.

Within Africa, it is simply not true that circumcision rates and HIV infection "don't correlate at all."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5422680/

Quote

The prevalence of HIV infection has been reported to correlate with the rate of male circumcision. The HIV prevalence rate in sub-Saharan African countries with a high (>80%) prevalence of male circumcision was reported as 2.98%±0.002% compared to 16.48%±0.002% in countries with a low (<20%) prevalence of male circumcision, P<0.001 (6). In that study, each categorical increase in the prevalence of male circumcision was associated with a 2.3-fold (95% CI: 1.5–3.4, P=0.001) decrease in the prevalence of HIV among adult males (6).

 

[TrueMetis]

Okay, don't see how that matters since I wasn't talking about just Africa and I was pointing out that if there isn't an across the board correlations that suggests that any effects are easily overridden by other factors.

Even the correlation in Africa doesn't mean much, as has been pointed out circumcision also correlates with learning about condoms.

[Larry of the Lawn]

I'm happy with my circumsized penis but it would have been nice of someone had asked me before they removed part of it because everyone else was doing it.

If I have a son there's no way that kid is getting circumsized unless there's a solid medical reason for it or he wants it done.  And 'its easier to clean' isn't a solid medical reason in my book.

[Ormond]

26 minutes ago, TrueMetis said:

Okay, don't see how that matters since I wasn't talking about just Africa and I was pointing out that if there isn't an across the board correlations that suggests that any effects are easily overridden by other factors.

Even the correlation in Africa doesn't mean much, as has been pointed out circumcision also correlates with learning about condoms.

Your last statement again is not true. Circumcision only correlated with "learning about condoms" in the three experimental studies that were referenced before. Male circumcision is very common in many African cultures where it is part of puberty rites where condoms are never mentioned. The correlations by country have nothing to do with the specific experimental studies. 

 

[TrueMetis]

44 minutes ago, Ormond said:

Your last statement again is not true. Circumcision only correlated with "learning about condoms" in the three experimental studies that were referenced before. Male circumcision is very common in many African cultures where it is part of puberty rites where condoms are never mentioned. The correlations by country have nothing to do with the specific experimental studies. 

 

Are the majority of circumcisions in Africa done traditionally and by people who wouldn't talk about condoms? I don't think we can conclude that.

The study you linked talks about how since those experimental studies were done there's been a lot of effort into increasing the number of circumcisions performed. And the Scientific American talks about 13 countries trying to increase numbers of circumcised males to 80% (And also how this has allowed more access to speak about condoms). And both mention work to train people on how to perform the procedure in a more medically safe way, including those that do the traditional circumcisions. If they aren't including mentioning condoms in that that's really fucked up.

More over there are some numbers given, 85% of boys in Nigeria are circumcised, but only 9% are done by traditional practitioner's. The rest are done by Nurse's and doctors. Am I to assume those doctors and nurse's are not bringing up condom with the child's parents? I would hope not when Nigeria has an HIV prevalence of 2.9%. Uganda has a traditional rate of 20%, if it reaches 80% as desired will the extra 60% be done by people who won't speak of condoms? Tansia is 33% traditional, same question applies.

Now perhaps I'm wrong in my interpretation of what that means, but to me that suggests that an increasing number of circumcisions now are being done by people who are, if not professionals themselves, are professionally trained. And would certainly include some discussion of condoms. And that for most of these people traditional circumcision isn't what would be happening. Because if traditional circumcision was at 80% across Africa no such program would be necessary.

[Ormond]

13 minutes ago, TrueMetis said:

Are the majority of circumcisions in Africa done traditionally and by people who wouldn't talk about condoms? I don't think we can conclude that.

The study you linked talks about how since those experimental studies were done there's been a lot of effort into increasing the number of circumcisions performed. And the Scientific American talks about 13 countries trying to increase numbers of circumcised males to 80% (And also how this has allowed more access to speak about condoms). And both mention work to train people on how to perform the procedure in a more medically safe way, including those that do the traditional circumcisions. If they aren't including mentioning condoms in that that's really fucked up.

More over there are some numbers given, 85% of boys in Nigeria are circumcised, but only 9% are done by traditional practitioner's. The rest are done by Nurse's and doctors. Am I to assume those doctors and nurse's are not bringing up condom with the child's parents? I would hope not when Nigeria has an HIV prevalence of 2.9%. Uganda has a traditional rate of 20%, if it reaches 80% as desired will the extra 60% be done by people who won't speak of condoms? Tansia is 33% traditional, same question applies.

Now perhaps I'm wrong in my interpretation of what that means, but to me that suggests that an increasing number of circumcisions now are being done by people who are, if not professionals themselves, are professionally trained. And would certainly include some discussion of condoms. And that for most of these people traditional circumcision isn't what would be happening. Because if traditional circumcision was at 80% across Africa no such program would be necessary.

I am amazed that you think doctors and nurses would bring up condoms with the parents of a CHILD who is being circumcised. How often do you think that happens in any country when a child is being circumcised? 

I am sure that the rate of circumcision has increased recently in most African countries. But the article on the correlation between circumcision in African countries and rates of HIV infection was published in 2006. The three "randomized control" studies were published in 2005, 2007, and 2007. The WHO recommendation that circumcision be promoted as an HIV preventative in Africa was a result of these studies. So any big increase in circumcision in Africa came AFTER the correlation between national rates and HIV infection rates was already known. Your interpretation does not work chronologically. 

I myself don't think the African research on HIV and circumcision is a very good argument for promoting circumcision in the UK or the USA. I think you get the strong correlation in Africa because of the difficulty of bathing there. But that doesn't mean the African data can be "explained away" by the recent increase in circumcisions done by professionals in African countries. 
 

[TrueMetis]

Just now, Ormond said:

I am amazed that you think doctors and nurses would bring up condoms with the parents of a CHILD who is being circumcised. How often do you think that happens in any country when a child is being circumcised?

Why would you find that amazing? These are countries with high HIV rates where circumcision is being pushed specifically as a preventative measure. Why wouldn't a doctor or nurse speak about the other preventative measures?

Quote

I am sure that the rate of circumcision has increased recently in most African countries. But the article on the correlation between circumcision in African countries and rates of HIV infection was published in 2006. The three "randomized control" studies were published in 2005, 2007, and 2007. The WHO recommendation that circumcision be promoted as an HIV preventative in Africa was a result of these studies. So any big increase in circumcision in Africa came AFTER the correlation between national rates and HIV infection rates was already known. Your interpretation does not work chronologically.

I totally missed that that reference was a 2006 study.

 

[Ormond]

24 minutes ago, TrueMetis said:

Why would you find that amazing? These are countries with high HIV rates where circumcision is being pushed specifically as a preventative measure. Why wouldn't a doctor or nurse speak about the other preventative measures?

I totally missed that that reference was a 2006 study.

 

I would expect physicians to talk about preventative measures with a sexually active adult. I would not expect them to talk about them with the parents of a child who was years away from sexual activity.

By the way, I have just gone and looked at the original research reports for the three randomized control studies and I cannot find any place where it says that they talked about condom used with the circumcised men but did NOT give the same advice to the uncircumcised control group. That would have been a rather amazing research mistake if they did. The research reports do state that condoms were provided free of charge to all participants in both groups, and that reported condom use by the participants at follow-up sessions did not explain the lower rates of HIV infection in the circumcised group. 

[TrueMetis]

2 minutes ago, Ormond said:

I would expect physicians to talk about preventative measures with a sexually active adult. I would not expect them to talk about them with the parents of a child who was years away from sexual activity.

By the way, I have just gone and looked at the original research reports for the three randomized control studies and I cannot find any place where it says that they talked about condom used with the circumcised men but did NOT give the same advice to the uncircumcised control group. That would have been a rather amazing research mistake if they did. The research reports do state that condoms were provided free of charge to all participants in both groups, and that reported condom use by the participants at follow-up sessions did not explain the lower rates of HIV infection in the circumcised group. 

Yeah, I'm seriously questioning my recollection as the studies I remember being the basis for this were older than the studies referenced, but I can't seem to find those studies. This is what I get for assuming my memory was accurate.

[maarsen]

14 minutes ago, Ormond said:

I would expect physicians to talk about preventative measures with a sexually active adult. I would not expect them to talk about them with the parents of a child who was years away from sexual activity.

By the way, I have just gone and looked at the original research reports for the three randomized control studies and I cannot find any place where it says that they talked about condom used with the circumcised men but did NOT give the same advice to the uncircumcised control group. That would have been a rather amazing research mistake if they did. The research reports do state that condoms were provided free of charge to all participants in both groups, and that reported condom use by the participants at follow-up sessions did not explain the lower rates of HIV infection in the circumcised group. 

Correlation does not mean causality. Uncircumcised men may enjoy sex more and hence have more partners and thus a higher  risk of HIV than men circumcised as boys. 

 

[IheartIheartTesla]

Well, regardless of the robustness of the study, that is sort of a red herring in the discussion on the very personal choice of whether one should circumcise their male child. To me its a bit like "executing criminals for minor offenses has strong correlation with lowering recidivism rate". Yes, that correlation may well be very true, but we should also perhaps consider the cost of the 'cure'.

Also, unlike vaccines for say polio, circumcision is not a necessary condition for prevention of HIV. There are alternate routes that can be considered when it comes to individuals.  Therefore, I would and do ignore all these studies for the individual.

[Jo498]

To my knowledge there is no relevant correlation between circumcision rates and HIV rates outside of Africa. Apart from the  confounding factors already mentioned, I am pretty sure that a main factor is not hygiene but simply square centimeters of skin. Quite a bit less after circumcision and therefore a considerably reduced risk.  (I might remember incorrectly, but I think I even saw a criticism of circumcision as anti-HIV policy that pointed out that circumcised men may think that they don't risk much (and there used to be superstitions about avoiding infection with far less of a factual basis) and so the policy could backfire because they think they do not need condoms and avoid risky behaviour. Or maybe there were already indications for such.)

[IheartIheartTesla]

The reason, I think, is because the tip of the penis is more sensitive for uncircumcised males, while for those circumcised I believe the skin becomes 'keratinized' and more resistant to abrasions (and the inner part of the foreskin is also more susceptible to abrasions because the keratin layer is thinner).

However, it is also true that all the correlations are more robust for heterosexual males, and much less so for homosexual males. That is because they dont always check sexual practices in these studies, and the scientific reason above may not hold, for instance, for 'receiver' males. Again, you'd have to ask yourself about a procedure that may not even protect your male child against certain situations that may occur later in life (for instance, them being gay).

There are certain recommendations you might be able to give for group cohorts which I sort of may agree with, but for individuals, no way should circumcision ever be a mandate.