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10th May, 2022. Touch receptors in the foreskin increase in adolescence -

is this to encourage a boy to play with his penis?

A long-term problem for anatomists was that there didn't seem to be enough Meissner's corpuscles (touch receptors) in the foreskin to account fot its sensitivity to touch. What they hadn't realised was that they were counting Meissner's corpuscles in foreskins from infant circumcisions but measuring sensitivity in young men! Two recent papers have shown that Meissner's corpuscles become much more numerous in the foreskin in adolescence. Once the foreskin becomes retractable the number decreases. If phimosis persists the neumber rermains high.

This led to a short note from two researchers (who may be well-known to Circlist readers) suggesting that the increase in sensitivity was intended to encourage a boy to play with his penis and make the prepuce retractable. Once that is accomplished the receptors disappear - the boy is ready for the next stage of his journey. The (very) short piece is in the May edition of the Journal of Anatomy. You can read it here.

20th April, 2022. Where to draw the line?

'High' vs 'Low' circumcisions.

A very recent paper "Where to draw the line? Understanding preferences in mucosal collar length after circumcision: A crowdsourced survey from the U.S. general population" looks at the anount of inner skin ("mucosal collar") that should be left after circumcision. The findings are intriguing. Respondents with a postgraduate education and ones with no religious affiliation preferred a short collar (ie a low cut) while participants reporting a religious affiliation preferred longer mucosal collars (a high cut). Less surprising is that women preferred circumcised men. Read the abstract at PubMed. The full paper is available at the Canadian Urology Association Journal.

Thanks to Brian Morris for the link. Updated 23/4/2022.

13th April, 2022. NATSAL 4 underway

National Survey of Sexual Attitudes & Lifestyles

After a considerable delay due to Covid, the British NATSAL 4 survey began in February 2022 and some 9000 British citizens will take the survey between then and 2023. There was an extended consultation period, as part of which the insertion of new topics or the removal of some of those included in NATSAL 3, were debated. Removing the question of circumcision was proposed, but this was overruled, and the question is included as it was in NATSAL 3. There are many quite wide ranging estimates of prevalence of male circumcision in the UK, but the NATSAL 3 finding of 20.7% is undoubtedly the most reliable. Further details at NATSAL.

Thanks to Tom for this. The sections of previous NATSAL reports which cover circumcision can be found in our UK page.

12th April, 2022. When the mohel leaves too much....

Should your son have revision surgery?

It seems that even in Israel mohelim don't always do a good job, and if they leave too much skin the baby won't look like a proper Jewish boy. Some parents therefore seek circumcision revisions. A study of all such revisions carried in a Tel-Aviv children's hospital between 2010 and 2016 has just been published. (No idea why it took so long). The patients were aged 12-36 months (median 18 months). The same operation technique was used on all. Using a well-validated questionnaire parents were subsequently asked if they regretted having the procedure done. The sample was small - only 40 - and 28% reported some degree of regret. Nine were mild (23%) and 2 were moderate-to-strong (5%). Curiously no reason for the regret is given. Was it an unsatisfactory cosmetic outcome or the distress caused to the child?

You can read the abstract at PubMed. The full paper, in Frontiers in Pediatrics, is open access and there are links to the full text there. Thnaks to Professor Brian Morris for the link.

13th March, 2022. 'Non-therapeutic' circumcision on the NHS?

Seems so, in Scotland.(Modified March 14th)

NHS Scotland currently offers male circumcision, under general anaesthesia, for religious, cultural and belief reasons for children between six and nine months old at four paediatric centres in Scotland, the exception being NHS Greater Glasgow and Clyde which currently only offers male circumcision at 12 months. This may satisfy Muslims and West Africans but it makes a nonsense of circumcision as prophylaxis. One of the key benefits of circumcision is protection from infant urinary tract infections. Uncircumcised boys are between 11 times and 20 times more likely to suffer from infant UTIs, and the effects can be serious.

NHS Greater Glasgow and Clyde are now planning to change their policy to nurse-led Plastibell circumcisions under local anaesthesia for babies under six weeks of age. This is a major policy shift and should make circumcision more affordable. However all elective surgery is currently on hold during the Covid pandemic.

Information obtained by contributor JLC through an FOI request. You can read the full response here.

24th February, 2022. The solution is a solution -

.... or is it?

Ultra-Orthodox Jews still practice Metzitzah Be'Peh - sucking the baby's penis by mouth after circumcision. This infects many baby boys with genital herpes. In the USA Ultra-Orthodox mohelim are supposed to get tested but sadly they don't. They see it as their divine right to give baby boys a lifetime infection.

A solution? A recent paper suggests that using Listerine mouthwash reduces the risk of infection substantially. Will the Ultra-Orthdox mohelim follow this advice? Dream on ...

Read the abstract at PubMed. The full article is available at the Israeli Medical Journal. Thanks to JH for the link.

15th February, 2022. Genital lichen sclerosus

Is it caused by urine trapped beneath the foreskin?

Lichen sclerosus is an unpleasant disease affecting the inner foreskin and glans of uncircumcised men. It is uncomfortable and can make the foreskin non-retractable, and even make urination impossible. A new paper by Georgios Kravvas and colleagues (University of London) argues that it is caused by 'micro-incontinence', by which they mean a drop or two coming out after you finish peeing. The 10 cases they studied all reported that this happened. Only thing is, I think almost any 10 men would report the same! There is an old saying 'it doesn't matter how much you shake, the last drop always goes down your trouser leg'. Which is not surpring, since the sphincter that stops the flow is at your bladder and then there is about 20 cm of urethra to empty.

The paper is behind a paywall but you can read the abstract at Pub Med. Thanks to JH for the link.

21st January, 2022. What effect does circumcision with local anaesthetic have on babies aged up to 4 months?

Does it affect sleep, feeding, and maternal attachment?

This has been a topic of some debate over the years. Now a Turkish study of 75 infants - the first to look at all three criteria - has found that sleep and breastfeeding were unaffected. Maternal bonding was significantly improved post-circumcision. This will be good news for many parents - and will doubtless stir up some intactivists!

The paper, in the Journal of Pediatric Surgery, is behind a paywall but the abstract in PubMed is quite comprehensive. Thanks to JH for the link.

21st January, 2022. Kenyan Kalenjins keep up their traditions overseas.

Circumcision ceremony goes ahead in Australia, streamed online.

The Kalenjin people come from the Rift Valley in Kenya, and are determined to preserve their culture even overseas. The community in Perth, Western Australia, organised a group circumcision ceremony for boys aged 13-15 on the 19th of January. Because Covid restrictions limited who could attend it was streamed live to other family members, both in Australia and Kenya. The boys were dressed in traditional animal skins but some local substitutions for traditional herbs had to be made.

Read the story in the Kenyan Standard. Thanks to Brian Morris for the link.

6th January, 2022. Can circumcision be avoided in an adult male with phimosis?

The Phimostop - yet another patent stretching device.

From an Italian team in Rome comes this patented device. The upper row shows the increasing sizes of the device, which you wear under your foreskin. The 'flaps' are taped down to keep it it place. The lower row shows sleeves which are slipped over to provide half size increments.

The process takes, on average, two months, and is only suitable for relatively mild phimosis (grade 2, where part of the glans can be exposed). From a sample of 85 patients, 71 completed the treatment and 37 of those no longer needed circumcision.

However, at 2-year follow-up it appears that phimosis had recurred in 7 of the 37. You would really have to be desperate to avoid circucision to try a treatment with such a poor success rate.

The paper is in 'Translational Andrology and Urology' and the very full abstract is available on PubMed. Thanks to JH for the link.

5th January, 2022. Nirvana - Nevermind

The baby sues - and loses!

Back in October 2021 we ran the story that Spencer Elden, the baby on the famous record sleeve, was suing the record company and the surviving members of Nirvana claiming that he was exploited. It seemed like a grab for money - and after all the band and the record label made much more from it than he did.

A judge has now dismissed the case. The band's lawyers said "Elden had spent three decades profiting from his celebrity as the self-anointed 'Nirvana Baby', recreating the image on the album's 15th and 20th anniversaries, and tattooing the album's title on his chest." Elden's lawyers failed to meet the deadline to file an opposition to the case, but they do have until 13th January to refile.

Nirvava's lawyers stated that the statute of limitations on such a case expired more than a decade ago, and that Elden's claims that the image constituted child sexual abuse were spurious.

"A brief examination of the photograph, or Elden's own conduct (not to mention the photograph's presence in the homes of millions of Americans who, on Elden's theory, are guilty of felony possession of child pornography) makes that clear."

Read the story in The Guardian. Thanks to JH for the story.

PS. January 13th As I write this it is 7pm in the eastern US and no news as the whether Elden's lawyers did deliver their submission. But news from Artnet adds more to the story. It seems that Elden, an artist, got the brush-off when he wanted Nirvana to contribute a work to a show he was organizing and that was when relations soured.

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