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18th July 2024. Forcible circumcision in Zambia.

Forty-eight boys in Zambia have been rescued from an illegal male circumcision camp, after desperate complaints by some parents that their children had been abducted. One of the boys was on HIV medication and had not taken his anti-retroviral (ARV) drugs for two weeks, officials confirmed to the BBC.

Secretive traditional rite-of-passage ceremonies see boys aged between 10 and 17 spending up to six months in seclusion in the bush. Often boys are forcibly taken from school classrooms. Three of the rescued boys were briefly admitted to hospital – some for treatment from complications after undergoing circumcision typically done using razor blades.

Read the full story, with pictures, at the BBC. Thanks to AK for the story.

22nd June 2024. Penile cancer in Brazil - 6,500 amputation in a decade

Penile cancer only affects uncircumcised men. Brazil, where circumcision is relatively uncommon, has one of the world's highest rates of the disease. The figure is often quoted as the annual incidence rather than the lifetime incidence - probably deliberately to downplay the problem. In reality the lifetime risk is between 1 in 1,000 and 1 in 1,5000 for uncircumcised men. In Brazil the annual rate is given as 2.1 per 100,000 men, which translates (assuming a life expectancy of 70 years) to 1.46 per 1,000. However this ignores the fact tha more that 5% of Brazilian men are circumcised (see our Brazil page) so the rate among uncircumcised men is somewhat higher.

A recent BBC news item highlights the problem, along with the harrowing story of one elderly sufferer. Caught early, the problem can sometimes be treated conservatively but the fact remainss that 650 Brazilians lose their manhood every year.

Thanks to regular correspondent AK for the link.

8th June 2024. Circumcision training.

A survey of doctors in Chicago who perform circumcisions found that they were rather unhappy about the level of training they got. Apparently the prevailing idea is (and I quote) "see one, do one, teach one". It was a small survey but there was strong support for a more structured approach. The brief paper, by Jennifer Rosen et al. in Hospital Pediatrics (2024) 14 (6): e249–e253 is behind a paywall but the very extensive probably tells you all you need to know.

Thanks to BM (you know who he is) for the link.

8th June 2024. Acceptance of circumcision in China.

We are a bit late in picking up on this one, but a paper by Menghan Zhang and others explores the reasons why China has a much lower rate of circumcision than other countries. The paper "Zhang, M., Chen, Z., Liu, X. et al. Influencing factors of Chinese male circumcision acceptance willingness: a health belief model approach. Current Psychology 43, 18474–18486 (2024)" is behind a paywall and sadly the abstract is rather brief but it does seem that a lack of faith in the health system is a factor.

Thanks to reader RF for the link

29th May 2024. A record foreskin stone.

A record what? It seems that in men suffering from phimosis 'preputial calculi' - similar to kidney stones - can occasionally form under the foreskin. This paper reports the case of a 65-yeqr-old man who presented with severe difficulties in urination. On circumcision, a huge collection of stones was found beneath his foreskin, including one which was the "largest preputial stone in an elderly man in any rural setup of central India". The paper: Surya D, Gharde P, Reddy K, (2024) Preputial Calculus: Unveiling a Rare Encounter and Treatment Journey. Cureus 16(4): e58968 is open access and you can read it here or the abstract at PubMed.

Be warned, both contain images which are, to put it mildly, pretty confronting. Thanks to JH for the link.

26th May 2024. Another comparison of techniques.

Back on March 26th we reported on a comparison of neonatal circumcision techniques. Now we have another comparison, from China, about childhood circumcisions. They compared Plastibell against conventional cutting and found that Plastibell reduced operation time but post-operative swelling was very significantly greater in boys circumcised with Plastibell. They seemed to come to a neutral conclusion but, honestly, how can you ethically justify shorter operation time against a child's suffering?

The paper, in Current Urology Reports,, is behind a paywall but you can read a very extensive abstract at PubMed. Thanks to JH for the link.

7th May 2024. Infant circumcision in Scotland

It seems that the infant Plastibell circumcision scheme introduced by the Glasgow and Clyde NHS has been so successful that they will now introduce it to satellite sites with which they have service level agreements - Lanarkshire, Forth Valley, Ayrshire and Arran, Dumfries and Galloway and Western Isles. Those covers quite a wide area. There are suggestions that NHS Grampians might soon follow sute. So maybe before long infant circumcision, by parental choice, will become widely available in Scotland,

Thanks to the indefatigable JLC for this information.

22nd April 2024. Korean circumcision

An article in the English language Korean newsapaper Korea JoongAng Daily "To snip or not to smip - Korean society and circumcision" gives a fascinating insight into Korean practice even though it is written from a rather anti-circ point of view.Amusingly, it is illustrayed with a picture of Michelangelo's David - but not mentioning that the biblical David was circumcised.

Read the article here. Thanks to Brian Morris for the link

21st April 2024. Australian policy.

A recent paper by (familar names) Brian Morris and Jeffrey Klausner critiques the Royal Auustralian College of Physicians policy on circumcision. Frankly, they put it rather mildly given the extraordinary misleading statements in the policy document. For example, they quote a complication rate of up to 16% but that figure is from Pakistan where circumcision is carried out in later childhood, not neonatally, and often by unqualified practioners. A study in the UK and US found a complication rates in neonatal circumcision (which is the topic under discussion) of 0.20% and 0.19% respectively. Extraordinarily, while they cite this paper, they fail to report these figures. One has to regard that as deliberate deception.

The paper "Detrimental to public health: Royal Australasian College of Physicians's recent policy on infant circumcision" is open access and you can read it at Pediatrics Research. Three readers sent this in but LX got there first.

1st April 2024. A fascinating look at Chinese college boys.

A paper in the (Chinese) Journal of Modern Urology reports on a survey sent to 3,800 male college students. 94.7% responded (only in China!) "The detection rate of redundant prepuce, phimosis, foreskin adhesion, occult penis and cryptorchidism were 58.7%, 1.8%, 0.7%, 1.6% and 0.3%, respectively." Fortunately for the boys' sex lives phimosis was relatively rare but a substantial majority reported redundant prepuce. These last were most likely to report recurrent UTIs and balanitis, and those with those conditions were most likely to receive circumcision, but the authors clearly felt that many more boys really needed to be circumcised.

The paper is "Investigation on the current situation and related factors of redundant prepuce and phimosis in male college students" by Tian et al, Journal of Modern Urology,2022(03):248-252. You can read the abstract (English) here. No link to the full paper but I suspect it is in Chinese.

26th March 2024. Neonatal circumcision - comparison of techniques.

In Nigeria, neonatal circumcision of boys is normal. In a paper in African Journal of Pediatric Surgery, Ibiyeye et al report on a randomly controlled trial of 3 circumcision techniques, Gomco, Plastibell and 'conventional dissection'. (It seems that the last term means what we would call freehand, not the 'dissection' technique described in our Techniques page). The authors are all based in two major teaching hospitals, and all the operations were carried out by specialists.

Results were judged by speed of healing, post-operative pain, and cosmetic outcome. Plastibell easily came bottom of the list - much more post-op pain and worst cosmetic outcome. Cosmetic outcome was judged both by parents and a plastic surgeon - and they didn't always agree. The key factor for parents was no free skin - circumcisions had to be thorough. Clicking on the paper at AJPS will bring up the abstract, and clicking on the 'download' button on the sidebar will get you the whole paper as a pdf. And the whole paper really is worth reading. Thanks to JH for the link.

20th March 2024. A circumcision competition? Only in China.....

More than 100 doctors took part in a live-streamed circumcision contest before a panel of judges and a 'serious' audience last December. The winner was urologist Jiang Qiqi. A 6-minute presentation from each doctor was subsequently (last month) posted on social media with the aim of correcting the idea that circumcision is shameful. Read the story in the South China Morning Post for 18th March.

Thanks to Professor Brian Morris for the link.

20th March 2024. Foreskin adhesions? Women can have them too.

This not exactly breaking news - it appeared in July 2022 - but reader Jerry Diamond has just brought it to our attention. It also serves to make the point that Circlist is not just for men.

The fact that some boys have adhesions between the foreskin and the glans is well known. These are either cleared as part of the circumcision operation or just separated to make the foreskin retractable. The paper "A Retrospective Case Series on Patient Satisfaction and Efficacy of Non-Surgical Lysis of Clitoral Adhesions" by Myers et al showed that simply separating these adhesions greatly improved women's sex lives. Read a summary on senior author Rachel Rubin's web page or the full paper in Journal of Sexual Medicine.

15th March 2024. Natural development of the foreskin during childhood.

In Turkey ritual circumcision can be carried out at any time from neonatally up to age 9. So a group of Turkish medical scientists realized that this gave them the chance to study a topic that had apparently hitherto been neglected - the natural development of the foreskin during the pre-pubertal years. One interesting finding was that there were fewer nerves in the neonatal prepuce, which gives some credence to the idea that neonatal circumcision without anaesthesia, as carried out in the past, is less painful than later circumcision.

The paper, "Histological and morphological development of the prepuce from birth to prepubertal age" by Erdem et al is in the journal Investigative and Clinical Urology. Read the abstract at PubMed or the full paper (open access) at Icurology. Thanks to Professor Brian Morris for the link,

7th March 2024.The weird world of the intactivists.

"Inside the bizarre world of the 'intactivists': 'Bloodstained Men' claim circumcision is 'evil' as they protest outside Super Bowl" - reported in the UK Daily Mail last month. Men with blood-stained crotches protested at the Superbowl final. Err, why? Do they think that American Football players somehow promote circumcision? (I'm sure most of them are circumcised but that's not quite the same thing.) The article is long, and quite hilarious, including images of restoration devices and concerned emails from restoring men.

Memo to any Circlist readers who wish to regain a foreskin - do not go down this track! It can easily be done with a skin graft, and far more effectively.

Read the story at the Daily Mail. Thanks to JLC for the link.

26th February 2024.What is the best way to deal with adult phimosis?

A recent Italian paper 'Phimosis in Adults: Narrative Review of the New Available Devices and the Standard Treatments' by Eleanora Rosato and colleagues adresses this question. They do not come to a clear conclusion - their view is that it will depend on the case. But they do seem to have some enthusiams for the (Italian) Phimostop stretching device, which we reported on back on January 6th 2022 - and which seems to be not too successful. If circumcision is the best option they strongly favour laser circumcision, which seems sensible.

Read the abstract at PubMed or the full paper (open access) in Clinical Practice. Thanks to JH for the link.

25th February 2024. Circumcision: Beneficial for Public Health or an Ethical Dilemma?

A new paper by Brian Morris and colleagues, published on 23rd February, tackles the prickly question of whether the health benefits of neonatal outweigh potential ethical issues that have often been raised about "a boy's right to gential integrity". One point the authors make is that the the United Nationa statement on Rights of the Child stongly emphasizes the right to health. The paper: "Neonatal Male Circumcision: Clearly Beneficial for Public Health or an Ethical Dilemma? A Systematic Review" is open access at the the journal Cureus.

Thanks (obviously) to Professor Brian Morris for the link.

22nd February 2024. Fun new T-shirts.

A regular contributor to the Inter-Circ discussion group, who goes by the nickname of NelsonsColumn (!) posted these pictures and with his permission (and that of his model) I'm reproducing them here. Do I detect a Roy Lichtenstein influence?. No information on whether thay are available for sale - maybe they are just one-offs but if I find out that you can buy them I'll post details. (Sorry, no, they are one-offs).

21st February 2024. Your son is getting circumcised- - there's an app for that.

OK, now there is an app for absolutely anything! The rather cumbersome-named paper "An Intelligent Customer-Driven Digital Solution to Improve Perioperative Health Outcomes Among Children Undergoing Circumcision and Their Parents: Development and Evaluation.", with authors from Singapore and Scandinavia, evaluates two smartphone apps - "BuddyCare app and Triumf Health mobile game app. The former provides a day-by-day perioperative guide for parents whose children are undergoing circumcision, while the latter provides emotional support and distraction to children." Conclusion - useful but could be improved.

Read the abstract at PubMed or the full paper (open access) at JMIT Formative Research. Thanks to JH for the link.

13th February 2024. How Many Nerve Fibers Innervate the Human Glans Penis:?

Apparently "The mainstream media has frequently quoted that the penis has "half as many" nerve fibers as the human clitoris." Something your editor hadn't encountered! However, P.C. Ferrin and colleagues at Oregon Health and Science University and UCSD decided to count them. Dorsal penile nerves were obtained from 5 'freshly frozen' cadavers and examined under the microscope. Needless to say they used software to do the counting and they report that "the mean total number of axons innervating the human glans penis was 7,688 +/- 1,762", though there was considerable variation. They do not mention what is claimed for the clitoris but this is much higher than previous claims for the penis.

This is a conference paper, reference: 'The Journal of Sexual Medicine, Volume 21, Issue Supplement_1, February 2024' and is open access. Read it here. Thanks to Prof. Brian Morris for the link.

12th February 2024. Petition to ban circumcision in Scotland.

A petition to ban male circumcision (with a meagre 398 signatures) was submitted to the Scotish Parliament by one Taylor Rooney, back on 3rd October 2023. Needless to say there was opposition from Jewish and Muslim groups, and indeed from the Parliament itself. The petition was rejected and the case was closed on 24th January.

Read the petition here. If you want more details go to Scottish Parliament and enter 'circumcision' in the search box. Thanks once again to JLC for the information.

4th February 2024. RIC in Glasgow - update.

Back on 13th August 2023 we reported that Glasgow and Clyde NHS were offering Plastibell circumcision of infants up to 8 weeks old 'on demand' - cultural or religious reasons quite OK. This was a radical change on two fronts, since most NHS hospitals in the UK only circumcise older infants, using a general anaesthetic, and only for medical reasons.

Regular correspondent JLC was keen to find out the uptake of this and submitted a 'Freedom of Information' request. He reports "for the year 1st January 2023 to 31st December 2023 FOUR religious and cultural circumcisions were performed using General Anaesthetic and ONE HUNDRED AND THIRTEEN religious and cultural circumcisions were performed using local anaesthetic plastibell service." This is fewer than some reports which have been been circulated, but still encouraging. He also mentions that, contrary to the original brochure, the procedure is available for infants up to 12 weeks old. (But it must be said that the earlier the better both in terms of medical benefits and speed of healing).

2nd February 2024. Turkish circumcision.

A new book came out late last year by Turkish-born American professor Oyman Basaran "Circumcision and Medicine in Modern Turkey" in which he discusses how traditional / religious circumcision has become increasingly medicalized (and. to be honest, why not?) He also makes the amusing comment about his own circumcision that while pain management was by then pretty well managed, fear management was not! But he seems unaware that circumcison in Turkey predates Islam by some 10,000 years (see our Art page.)

Read about it at Circumcision: A Changing Rite of Passage for Turkish Males. Thanks to Mike C for the link.

11th January 2024. Sensitivity of the glans penis.

A very recent paper in JSM Sexual Medicine argues that historical measurements of the touch and temperature sensitivity (NB - NOT sexual sensitivity) of the glans, based on minimum perceptible threshholds, are not relevant. They show no difference between the glans and other skin, whereas most men would tell you different. Hence a proposed method for measuring real-world sensitivity.

The paper is Cox G (2023) Penile Sensitivity - Are We Measuring the Wrong Property? JSM Sexual Med 7(4): 1120. (In spite of the date it only appeared this week!) The author may be familiar. The link is Cox - Sexual Medicine. It is open access - not yet indexed on PubMed.

9th January 2024. Art funding in Berlin (Updated 25th Jan)

This is a bit left-centre but a recent government decision in Berlin has banned funding to artists who will not sign up to an 'anti-semitism' clause. Given what Hitler did in the 1930s and 40s (and from which your editor's cousin escaped by a hair's breadth), what's not to like? The detail is in the fine print, which bans any criticism of the state of Israel. Since Israel is commiting atrocities on a Nazi scale in Gaza this is a hard pill to swallow, and the artists will not swallow it. (The government recently banned a Jewish ptotest against these atrocities!) Incidentally, anti-Muslim views - far more prevalent in Germany - do not get a mention.

OK, now as of 24th January this clause has been deleted thank goodness.

Read the story at Artnet.

7th January, 2024. (updated 9th January) British Medical Association guidelines on male circumcision.

Rebuttal of an objection to the policy.

Welcome to the new year, and sorry that we have been a bit quiet - your editor has been travelling on family business with rather limited Internet access.

A recent paper by a familiar team (Brian Morris and colleagues) was a rebuttal of criticisms of the BMA's male circumcision policy (which, it must be said is hardly favourable). Read the abstract at PubMed or the full paper at World Journal of Clinical Pediatrics.

There is a glich in the link to Ref 1 - the BMA guidelines. The correct link is BMA.

The main objector was an anti-circumcision activist called Anthony Lempert, a doctor with no academic position (see the reference in the above paper). Since then he has published in Medical Ethics a paper attacking all religious circumcision. I guess we are rather used to such calls from neo-Nazis in northern Europe but it seems from his name that Lempert is Jewish!

Thanks to BM and JH for the links.

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