UCSF team investigates cases and outcomes.
Benjamin Breyer and colleagues at the University of California, San Francisco, have used a legal database to investigate circumcision-related lawsuits from 1939 to 2021. They only found 77 - in 82 years. Given the millions of circumcisions carried out in those years that makes these cases extremely rare. The majority of these cases (59%) were resolved in favour of the physicians but where they were not the typical payout (covered by medical indemnity insurance) was $175,000. Lawsuits claiming faulty surgical practice were more likely to favour the plaintiff than those claiming lack of informed consent.
The paper, in Urology, is behind a paywall but the abstract at PubMed actually has all the key results. Thanks to JH for the link.
Prize-winning device offers 1-minute circumcisions.
Malaysian surgeon Datuk Dr Siow Kuang Ling recently won the gold medal at the 6th annual International Invention Innovation Competition (iCAN) 2021 in Toronto, Canada for his invention Circumstar-1. It promises 1-minute circumcisions with no risk.
The device is not totally new - the Circumstar instrument has been around for 10 years and has won previous awards - see our Instruments and Techniques page. It isn't clear from the newspaper report how Circumstar-1 differs from the original Circumstar but the reduction in time from 3 minutes to 1 minute suggests that the considerable complexity of the original design has been reduced. Read the story in The Star
Thanks to MP for the story.
The baby sues!
Nirvana's 1991 album 'Nevermind' must have one of the most famous covers of all time. Kirk Weddle, the photographer, has written about creating it in Flashbak. The fish-hook and dollar bill were added later. The very obviously circumcised baby boy is Spencer Elden, and his father Rick was paid $200 for the shoot. On his first birthday, by which time Nevermind was a mega hit, Spencer was presented with a platinum record - and a teddy bear.
Even back in 1991 the photo caused some controversy, with some US record stores putting a sticker over the offending part, and some countries reputedly insisting the photo must be modified. No such problems here in Australia, and for a while that little dick was prominent in all record shops. (Of course back in the '70s nobody would have batted an eyelid). Spencer seemed to enjoy the publicity, to the extent of having 'Nevermind' tattoed across his chest.
Now, 30 years on, he seems to have changed his tune. He is suing a whole raft of people including the surviving members of the band, Kurt Cobain’s widow Courtney Love, and the record labels which distributed the album, claiming it was child sexual exploitation. He says he has suffered “lifelong damages” from the 1991 album cover, including “extreme and permanent emotional distress with physical manifestations”, plus loss of education, wages, and “enjoyment of life”. It is kind of hard to equate that with the tattoo on his chest, and the fact that he re-created the image at age 10 (for Rolling Stone) and again at 25 (for the New York Post). It looks more like a grab for money. Kirk Weddle probably summed it up back in 2019 when he said: "...he’s conflicted about the picture. He feels that everybody made money off it and he didn’t. I think he deserves something. But it’s always the record labels that make the money.”
a Japanese book on circumcision
A bit left-field, but it's been a quiet news month. A 1976 book 'Circumcision' (割礼, Katsurei) by Goichi Matsunaga - in Japanese - is offered for sale on the web site AbeBooks. If any Japanese-speaking reader buys it, please let us know what it says!
Thanks to regular correspondent AM for the link.
on First Date
No, not on her first date but on the British version of the reality TV show First Date (UK Channel 4). And not actually on her date, but on a banana! (She was explaining, prior to the actual date, what a urologist does.) British viewers were reported to be 'shocked' and 'stunned'! The way reality TV is going maybe we'll see the real thing before long!
A feminist scholar examines its origins and impact
Tomomi Shibuya, a female associate professor at Tokyo Keizai University, has been researching this question for 12 years. She has now produced a book "Nihon no houkei, otoko no karada no 200 nenshi - Japan's uncircumcised penises: A 200-year history of men's bodies."
The trouble is that there is a big translation problem here. "Houkei" - "covered penis" doesn't really mean 'uncircumcised'. Both medical literature and personal accounts explain that Japanese men like, and expect, to have a naturally uncovered penis. (What we used to call 'naturalised' in my schoooldays). See our Japan page. Visible circumcision is regarded as cheating which is why Japanese clinics have devised 'invisible' circumcision techniques.
The book is. of course, in Japanese but there is a very interesting article about it in the English edition of The Mainichi. Japan's national daily. Thanks to Brian Morris for the link.
Does the pandemic have unexpected symptoms?
Harry Jenkins found that Covid had a symptom he hadn't expected, so he made an appointment with his GP. ‘OK,’ says a politely interested Dr McCall. ‘What’s precisely wrong with your cock?’
Now a crisis of confidence. ‘Well… ever since I’ve had Covid… Every time things are feeling like they’re beginning to get going… It now feels a bit like it’s wearing a polo neck which is several sizes too small.’
Needless to say, Dr McCall recommended circumcision. Whether Harry Jenkins took this advice is not recorded. Is this a hitherto unreported consequence of the pandemic? Read the story at The Spectator.
Thanks to SM and Professor Brian Morris for the link
Andy Lee is circumcised.
Comedian Andy Lee hosts 'The Hundred', a humorous quiz programme about current news, on Australia's Channel Nine. There is a small panel of fellow comedians - the 'Hundred' refers to members of the public, who now have to appear via Zoom during lockdown. It is a very big screen!
A wrong answer by one of the panel members led to a very amusing admission by Andy - I'm not going to give a spoiler, just go to The Hundred where you can both read a transcript and watch the segment.
Thanks to Professor Brian Morris for something rather different from his usual contributions.
Delayed for more than a year by Covid.
Filipino boys are traditionally circumcised around age 10. (See our page on The Phillipines.) Many are done in mass centres run by governments or local councils during the summer 'circumcision season'. Last year a volcano erupted, delaying the season, and then the Covid pandemic caused it to be cancelled. This year it has cautiously been resumed, much to relief of many frustrated young boys.
Caspien Gruta is now 12, and has been teased because he is still uncircumcised. "I worry if I don't get circumcised now, I will be shamed" he said. You can read much the same story, originating from AFP, in either Channel News Asia or the South China Morning Post.
Thanks to Tom for the links. Photo courtesy AFP.
A detective story
Last month Robert van Howe, a well-known opponent of circumcision, published an analysis in Canadian Journal of Urology which purported to demonstrate that circumcision increased the risk of prostate cancer - contrary to generally received opinion.
Brian Morris and colleagues were suspicious of this. Running their own anaysis on van Howe's figures they got the same result. However, when they went back to van Howe's original data sources and analysed them they found the opposite - circumcision did offer protection. Comparing numbers, they found that in van Howe's data table the columns for circumcised and uncircumcised men had been swapped - naturally reversing the conclusion. The journal published the response from Morris and colleagues this month along with a corrected table and an editorial. An unfortunate accident?
Thanks to JH who actually got the story to me before Professor Morris did!
Medical association abandons proposed ban
The College of Physicians & Surgeons of Manitoba issued a draft policy that various minor procedures could only be performed in a hospital or clinic. This included circumcisions.
This would have left Jewish families who want to have a traditional home ceremony only able to use a mohel who was not a medical doctor. Does that meake sense? The state's chief mohel, who is a member, didn't think so, and neither did other Jewish community leaders. The policy has now been changed.
Read the story on Arutz Sheva, Israel National News. Thanks to DP for the link.
In spite of their efforts the circumcision rate remains high.
A contributor who wishes to renain anonymous has drawn our attention to a press release from Intact America - "Having a baby boy? Get ready for the circumcision sellers". It makes rather nonsensical claims about mothers being given a 'hard sell' for circumcision.
Our correspondent has analyzed their data.
According to their survey, over the past 4 years in the US:
94% of mothers were asked about circumcision for their newborn son
78% of those asked chose to circumcise
45% of those not asked chose to circumcise
71% of mothers said they would have asked about circumcision without prompting
This equates to roughly a 76% Circumcision rate in the past 4 years across all American states
This is much higher than the 50% figure widely quoted. And note that in spite of the hard sell claim, the vast majority of mothers would have sought advice anyway.
The Complete Jewish History of the World's Greatest Hero
This new book, by Roy Schwartz, looks at the Jewish origin of Superman, created in 1938 by two Jewish teens, Jerry Siegel and Joe Shuster. Superman was destroying Nazi tanks years before the US entered WWII. Schwartz draws parallels between Jewish history (both Biblical and mythical) and the Superman story.
um, err, well ........
|A group of medical scientists in Shenzen, China, have developed what they call a "phimosis dilatation retractor for children". This Heath Robinson (or Rube Goldberg) device appears to be made from a tap washer and bent paper clips.|
In use the prongs are inserted under the foreskin to stretch it. "Children suffering from phimosis should wear the retractor for at least seven to fourteen days, with 1 to 2 h each day. Besides, these children should pull back their foreskins to the point that the corona of glans penis is exposed each day." But if they can do that why do they need the retractor? Nevertheless the device has been patented and is apparently going to be manufactured.
The paper, in the World Journal of Clinical Cases, is open access. You can read the PubMed abstract here or the full paper here. Thanks to JH for the link.
an antique Aboriginal Australian circumcision knife.
We have run items about circumcision devices for sale on ebay before, but this is something different, a knife used in tradiitional initiation ceremonies.
The knife is made of quartz, coloured with red ochre and with a handle of tree resin. It is being advertised on ebay and at the time of posting bidding is at $AU122.50 - about $90 US. There are four and a bit days to go so it is likely to go higher. If one of our readers buys it please let us know using the link at the top of this page.
Circumcision was practised over most of Australia except for the south-east corner (where Sydney and Melbourne are today). It was (and in some places still is) carried out when a boy was about 10 years old. Take a look at our page about Australia, ancient and modern.
Thanks to regular correspondent AM for alerting us to this item.
How about a temporary circumcision?
Remember 'Feelcut'? This was a procedure of taping up the penis to mimic circumsion, promoted on this site under the previous editor. Now a German company has commercialised the idea with Yvex, a sleeve that you put on your penis to hold the foreskin back. The promise is longer-lasting sex. It claims to offer the benefits of circumcision while being totally reversible.
The Yvex site promises "Naturally longer sex through glans desensitisation" but in fact there is no solid evidence that circumcision has any such effect. The site is in German but here is a translation of the introduction:
Being able to have longer sex through natural desensitization
By wearing yvex® love longer, the foreskin of the penis is kept in a retracted state during the day. Thus, the glans is exposed and is no longer covered by the foreskin. This can be compared to the anatomical condition of a circumcised man. The glans, which is covered with numerous nerve endings, is now exposed to minor but constant stimuli, for example through contact and friction with clothing.
The reduction of the hypersensitivity of the glans achieved after a few days of wearing leads to a lasting delay in the climax during the act of love.
So what is the device? It's a latex sleeve that you roll over your retracted foreskin to keep it back. You wear it only during the day and use a fresh one next day. One has to wonder how long it takes before the expense equals the cost of circumcision.
Thanks to Dutch correspondent Woody for the link.
You are in luck if you are a boy in Cavite Province, Phillipines.
The most popular way to boost morale in the Phillipines seems to be to announce a free circumcision project and the governor of Cavite province has announced just that. Cavite is these days mostly a dormitory area for Manila's sprawl and has a population of over 3 million so there should be plenty of boys keen to take up the offer.
“This afternoon I will call all mayors to organize a free circumcision drive. This will follow anti-COVID guidelines such as social distancing, crowd control, and the rule that children below 18 years old are not allowed to leave their homes,” Governor Remulla said. (The prohibition on children leaving their homes seems a bit strange given that they are at the lowest risk of contracting COVID, but the Phillipines is having a surge in cases.) Probably these circumcisions will be done in dedicated circ-mobiles (see our item on 1st July, 2020) rather than in the boys' homes.
The report comes from Coconuts. Thanks to DC for the link.
we assume it failed. Confirmed - it was rejected.
There has been a move in Denmark to ban non-therapeutic (i.e. religious) circumcision, and it has been covered in this column before (see our item on 1st January). In Denmark if a borgerforslag (citizens' petition) gets 50,000 signatures Parliament is obliged to debate it. This finally happened on Monday May 10th. (Coincidentally the 76th anniversary of VE Day, the day when surviving Jews in German-occupied Europe were formally freed). Since the major parties were all voting against the bill it was expected to have no chance of passing. We have delayed posting this item in the hope of confirming this, but have heard nothing. If any reader has information please contact us by the link above. However, if it had passed there would surely have been a storm of protest.
The latest report we have is The Local, posted just before the vote. You can read an older, but more detailed, article in CPH Post. Thanks to Tom for the links and Michael Barrett, editor of The Local, for the confirmation.
How much for a pill - or a circumcision?
The Centers for Medicare & Medicaid Services (CMS) now require US hospitals to make public their standard charges (known as chargemasters) for routine items. The hospitals are obviously not happy since they deliberately use varying names for the same procedure to hinder automatic comparison. One can see why. A group of academics at the University of Texas set out to do a manual comparison and the results defy belief. How about a difference of 18,617% between prices for one pill (5-mg tablet of amlodipine: $0.23-$43.05)? For circumcision charges ranged from $252 to $7,532.10, a 2,889% difference. Understand that this is just within Dallas County Tx! Not surprisingly, the authors conclude "Refining the minimum requirements for publishing chargemaster data could increase their utility." Obliging hospitals to use a standard list of items would seem to be the obvious step.
Read the abstract at PubMed. The full text requires payment but really it's all there in the abstract. Thanks to JH for the link.
Moroccan man presents with necrotic foreskin
A 30-year-old man suffered from phimosis. He was unable to have sex but too embarrased (and impecunious) to see a doctor. So he decided on a self-circumcision despite never having never seen the operation performed, and having no idea how it was done. A month later he fronted up to hospital. Fortunately the doctors were able to salvage the situation and the man ended up with a nice two-tone circumcision. (He is very dark-skinned, obviously originally from somewhere further south).
Bulgarian Muslims hold their pre-Ramadan feast.
Bulgarian Muslims decided that despite COVID they could hold their traditional 4-day festival before the beginning of Ramadan, since most of the festivities take place outdoors. Hundreds gathered in the picturesque mountain village of Ribnovo for feasting, singing, dancing - and circumcision. Bulgarian Muslims circumcise their sons in infancy, and 80 baby boys lost their foreskins - with much ceremony - this year.
Read the full story at Associated Press. Thanks to Tom for the link.
Three million circumcisions.
Phase 1 of the Zambian VMCC rollout circumcised three million men between 2007 and 2020. Health Minister Jonas Chanda estimated that this prevented 26,000 new HIV infections in his speech lauching the next phase of the rollout.
To put this in perspective, while we in the West are all concerned about the COVID pandemic, in Zambia AIDS is the major killer with a death rate of about 20,000 per annum. In Zambia there have been 87,872 cases of COVID and just 2,100 deaths. (Incidentally a fatality rate of 1.36% - much lower than in the UK. So much for the NHS.)
Read the report in the Zambia Daily Mail. Thanks to regular contributor DC for the link.
He reintroduced cirumcision to the Zulu people.
King Goodwill Zwelithini, the hereditary ruler of the Zulu people, died on 12th March from complications of diabetes. He was 72 and had ruled for almost 50 years. He had no formal authority in South Africa but wielded huge influence over his people, with whom he was extremely popular. He leaves behind 6 wives and 28 children (!)
The Zulu nation had traditionally practiced circumcision but King Shaka banned it in the early 19th century - see our South Africa page. Faced with the HIV crisis King Goodwill removed the ban, but only allowed medically performed circumcisions, which were strongly promoted.
A recent paper by Christina Oetzmann von Sochaczewski (there's a name to conjure with) looks at trends in circumcision and other foreskin operations in Germany. (Other operations include dorsal slit, plasties, cutting the frenulum and separating adhesions.) The overall trend for all operations was down, though infant circumcisions (a small proportion of the total) were pretty constant and, curiously, non-circumcision operations on infants under 1 year increased substantially. Another interesting point was that circumcision was the preferred option for boys under 5 and over 15, while the conservative options were more common in boys aged 5-14. Like the US study we featured on January 28th, this paper only covers hospital operations and the authors admit that many others take place in clinic and office settings.
The paper is open access at BMC Urology. Thanks to JH and JT for sending in this one - on the same day.
what would you like cut, your hair or your penis?
Panglao Island in the Phillipines is suffering. Its main income is from tourism and COVID means that this has pretty much dried up. To provide some cheer on Valentine's Day the 47th Infantry Battalion of the Philippine Army paid the island a visit giving food and gifts to children and also offering free haircuts and circumcision to the boys. The team was able to distribute food packs and gift treats to 200 children and 40 youngsters were circumcised with the help of Dr. Estrella Lim.
Read the story at Page One. Thanks to DC for the link.
seems to be missing its target.
A February 2021 article in UNAIDS bemoans the fact that the 2020 target of 25 million circumcisions in the 15 priority African countries is not going to be met. The program started off well but is now faltering. They point out that male circumcision provides 60% protection against female-male transmission of HIV. That's as good as some of the COVID vaccines - ed.
Thanks to DC for the link.
would you like your penis enlarged at the same time?
A group of Italian urologists and plastic surgeons have developed a method of adult circumcision which takes only a few minutes longer than the standard operation and - they claim - gives a modest, but significant, increase in penis size. The idea is that after cutting off the foreskin they completely retract the shaft skin, exposing Buck's fascia (the inner penis shaft) and severing all the loose connections between the shaft and the skin. The skin is then pulled forward again and sutured in the normal way. Of the 36 patients, one apparently gained 2 cm in length but the mean was just 7 mm. 5 gained only in girth. A complication rate of 13 patients out of 36 seems a bit worrying, though all resolved spontaneously.
Slight decline - but that's not the whole story
A recent paper in the Journal of Urology looks at circumcision rates before and after 2012, when the American Academy of Pediatrics changed its position and recommended the procedure. Overall 55% of boys were circumcised, with a decrease over time though there was no significant difference before and after the AAP policy change. "The rate of neonatal circumcision varied widely by region, race and socioeconomic status" being highest among whites with private health insurance. The authors comment "Among some populations access to neonatal circumcision has become increasingly limited despite evidence of its benefits."
To put this into perspective Medicaid, the public insurance system in the US, is administered by state governments and some have decided to remove benefits for neonatal circumcision. This doesn't mean that infants in those states don't get circumcised, just that those without private insurance tend to get it done as an outpatient procedure after discharge. See our news item for 18th October 2020 (scroll down to find it).
The paper is Nationwide Circumcision Trends 2003-2016 and you can read the abstract at the Journal of Urology - access to the full text requires payment. Thanks to our regular correspondent JT for the link.
VR headsets as distraction during circumcision - for the mother!
In Turkey boys are circumcised some time after age 5. Apparently this is more stressful for the mother than the child - really? An article in the International Journal of Nursing Practice "The effect of virtual reality on mothers' anxiety during children's circumcision: ..." describes an experiment where 30 mothers were shown video on VR headsets during their sons' circumcision while 30 others were not. One one measure the 'VR mothers' showed less signs of stress, on another there was no difference. One might think that if the mothers were not going to see the procedure a sweet cup of Turkish coffee and a cake would have been better stress relievers than a video. Also, a video might have been an effective distractor for the boy.
You can read the abstract at PubMed. The full paper is behind a paywall. Thanks again to both JH and Brian Morris for sending in this item.
Comprehensive African study debunks the myth
One line peddled by opponents of the African VMCC programme is that the sense of immunity that circumcision confers will lead young men to take more risks in their sex lives. This is really extraordinarily demeaning to Africans, implying they are little better than animals. Previous studies have suggested that this was untrue, and now a substantial, prospective, study in the South African Journal of HIV Medicine: "Sexual risk compensation following voluntary medical male circumcision: Results from a prospective cohort study amongst human immunodeficiency virus-negative adult men in Botswana" by Lisa Spees and colleagues confirms that the myth is just that.
Now there is a split in the neo-Fascist DF party
A Danish task force was set up to report on guidelines for infant and child circumcisions, but the Danish Pediatric Association withdrew from it for strange reasons. Surely they should be promoting circumcision? Do they like seeing baby boys suffering from urinary tract infections? More cynically, perhaps they see more money in treating UTIs than in performing circumcisions. Now the citizen petition to ban circumcision of under-18s, first launched some years ago, has finally reached parliament. But the far-right populist DF party has split, since some members want to permit Jews to follow their religion, but not Muslims! The mainstream Social Democrat party opposed the ban, so it will not pass.
Read the whole sorry story in the Fair Observer. Thanks to DC for sending in this item.
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