and went very public about it.

TV anchorman Tommaso Zorzi (on left) was circumcised last Wednesday, 16th November, and made sure all his Italian followers knew about it. It was posted on YouTube and Instagram - both in Italian, of course and there are no dick pics! Thanks to Italian correspondent PG, who sent the news via Brian Morris. Maybe it's time for someone to resurrect the defunct site circoncisi.it.

UK health system in crisis

In 1948 the Labour government introduced a free healthcare system into the UK. It was part of the grand plan for a brave new postwar world where life would be better and healthier. Free milk for schoolkids was another part of the plan - axed by hardline Tory Maggie Thatcher in the 1970s. From the outset the NHS never funded infant circumcision because circumcision was something the middle and upper classes did and Labour was the party of the working class. A short-sighted decision because the cost of treating the diseases prevented by infant circumcision far exceeded the cost of the operation.

For several years the NHS has been in financial trouble as a succession of right-wing governments refused to increase its budget to match rising costs. In 2018 tonsillectomies and varicose vein surgery were axed. Now a new round of cuts will eliminate 31 more procedures, including imaging for lower back pain and - circumcision. Understand that circumcision was only ever funded when medically necessary. This latest round of cuts will eliminate about 2.7 million procedures per year.

Read the story in The Daily Mail. Thanks to LX for the link.

There are more benefits than we thought.

It has long been known that having a circumcised partner hugely reduces the risk of cervical cancer in the female, and once it was known that circumcised men were less likely to get infected with HIV it seemed obvious that they were less likely to infect a female partner. A new review by Supriya Mehta of Rush University and the University of Illinois (both in Chicago) shows that the benefits are much greater than this. Most seem to be related to a healthier vaginal biome. Mehta also notes that "MC has positive effects on women's perceptions of sexual function and satisfaction, and perceptions of disease risk and hygiene".

Read the abstract at PubMed ot the full paper in (as yesterday's) Current HIV/AIDS Reports. It is open access. Once again, thanks to JH for the link.

A major multinational study.

The fact that male circumcision protects against HIV infection, at least in heterosexual intercourse, is well established and some sites of infection on the foreskin have been identified. Now a major international collaboration (USA, Canada & Uganda) has looked at the issue in detail. It found that as well as the inner foreskin having a high density of susceptible 'CD4 + T' cells, the bacterial microbiome made a big difference. In particular anaerobic bacteria (bacteria which live without oxygen), while not causing any disease themselves, facilitated HIV entry. Anaerobic bacteria cannot be present in the absence of a foreskin, since oxygen kills them.

Read the abstract at PubMed ot the full paper in Current HIV/AIDS Reports. Once again, thanks to JH for the link.

Wide variations between states

A recent study by a team of authors from Cornell, Harvard and UCSF used insurance records to study the incidence of, and reasons for, adult circumcisions. The results were published in the open-access journal PLOS One on October 17th. The most common reasons were phimosis (52.5%), followed by routine/ritual circumcision (28.7%) (whatever that means), and then infections. There were huge variations between states with the highest incidence in the north-east. (This is a bit surprising since one might expect that the warmer climate of the southern states would cause more foreskin problems).

Read the abstract at PubMed or the full paper (which is short and well worth reading in full) at PLOS One. Thanks to JH for the link.

A modified Mogen Clamp vs traditional techniques

Safe, simple and aesthetically pleasing circumcision is naturally very important in Turkey, as in other Muslim countries. A recent paper compares a newly-developed variant of the well-known Mogen Clamp with the common 'dorsal slit' technique. (NB, this is not the simple dorsal slit of Polynesia, it is a dorsal slit followed by cutting around the foreskin.) They did not compare it with the tradition Muslim 'tug and chop' technique - I suppose they considered that too declassé for a hospital environment.

The modified Mogen made the operation time shorter and gave a better cosmetic result. However excess skin remaining after circumcision was more common with the clamp. Other complications were similar in both groups. Read the abstract at PubMed or the full paper (open access) at Current Urology. Thanks to JH for the links.

Could the Shang Ring be the answer?

The Shang Ring device is currently used for teenage and adult circumcisions. In the roll-out of circumcision for HIV prevention in southern and eastern Africa the question has arisen as to whether RIC, as practised in the USA and elsewhere, could be the answer. If so, a simplifed approach could be very useful. In a large randomised controlled trial Spyridon Basourakos and a huge number of co-authors compared the new technique of infant Shang Ring circumcision (which requires only topical anaesthetic) with the long-established Mogen Clamp. The result was that the Shang Ring was as safe, or safer, than the Mogen. Read their report as an abstract in Pubmed, or in full at Lancet Global Health. There is also an opinion piece about this by Stephanie Davis and Robert Bailey, who have a long involvement in the rollout of circumcision for HIV prevention in Africa, in the same issue of Lancet Global Health.

Thanks to JH for the links

Don't go to YouTube!

A new study in the Journal of Pediatric Urology has assessed the reliability of circumcision advice offerred to new parents on YouTube. Results were not inspiring! "56% of videos were neutral and 44% were biased, of which 30% being anti-circumcision and 14% being pro-circumcision." The neutral ones, mostly from medical sources, also were less popular than biased ones. "Information pertaining to NMC on YouTube is generally of low quality and has a high potential for bias." Don't go there.

The abstract is available at PubMed. The full paper is behind a paywall. Thanks to JH for the story.

Not exactly breaking news, but worth reporting. German reader AH sent in a link to a 2021 thesis about a trial of tissue glue vs sutures for circumcision. Not the first such study, but very strictly randomized and so an important contribution. The patients were children and adults, not neonates. The thesis is in German but the English abstract on page 5 gives the basic information. Glue significantly reduced operation time and gave a better cosmetic outcome. Reported post-op pain was lower for the glue patients, but not significantly so. Complications were similar in both groups.

Read the pdf at the University of Dusseldorf document server.

Plaintiffs had no legal standing.

A court case brought (originally in 2020) by anti-circumcision activist Robert Goldman to ban Medicaid payments for circumcision has failed because the plaintiffs didn't have "standing" to bring the case in part because none could meet a legal requirement that they be directly harmed by whatever they were complaining about.

But the court also noted that the Supreme Court has ruled that individuals can't sue over Medicaid reimbursement rates set by states and ruled that while a Massachusetts law allows taxpayers to sue state agencies over spending that exceeds their "legal and constitutional right and power to expend money," circumcision doesn't fall under that criterion.

Read the story at Universal Hub. See another version at Boston site Patch. Thanks to Brian Morris for the story.

This can rob a man of his penis.

An article in the British Daily Mail reports that many GPs fail to recognize the early signs of penile cancer, instead mistaking it for a sexually transmitted disease. When not treated early this cancer may require amputation of the penis. Infant circumcision is virtually 100% protective against penile cancer. Read the story in the Daily Mail.

Thanks to JLC and Prof. Brian Morris for the link.

until you had a baby boy.

Young mother Caroline had had two daughters but when she then had a son she realized that there was a whole lot of extra work involved at each diaper (nappy) change. After his circumcision she had to apply a very messy gauze and Vaseline dressing which tended to fall apart in her hands. So, initially for her own use, she found a non-waven gauze which didn't fall apart and made up a stash of ready-made dressings. Apparently after that even her husband could do diaper changes (ahem - I've changed lots of nappies in my time).

Anyway, she then decided to market the ready-made gauze and Vaseline dressings - Circure. Apparently they are also very good for nappy rash. See the details at the Circure site. It also has a link to the very anusing story of how she came to develop this product. Thanks to JLC for the link.

An exhaustive investigation.

I suppose most of us, knowing how much happier, more confident and more self-assured circumcised boys were when we were were growing up, will see the queation as absurd. But then, we also know of a minority who resent being circumcised. This multi-author study examines the question in depth. The conclusion? There is no evidence of psychological harm.

The paper is open-access, read it in the Journal of Evidence-based Medicine. Thenks to BM, JH & GC for the link.

Silver pendant unearthed in Kent

Retired real estate agent Wendy Thompson was searching farmland near Gravesend with a metal detector when she found this silver pendant, which is about 3cm long. It depicts a penis with the foreskin fully retracted, which was quite indecent in public in Roman times. No man would appear in such a state at the baths or gymnasium. In other words, it indicates sexual excitement.

Curiously, such pendants were commonly worn by children on a cord round the neck, to bring them luck. Mostly they were copper, but this is the upmarket version. It seems that the modern idea of keeping children ignorant of sex had no counterpart in Roman times.

Read the full story, and see more pictures, at Live Science or The Daily Mail.

A Sydney story

OK, this sort of story is common enough in our pages but it's nice to see it more widely publicised. This story is based on the account of a man just known as Jack who called into a talkback session on Sydney youth radio station Triple J. He suffered from phimosis and sex was painful - no girl could make him come - until he finally took the plunge and got cut.

Read his story in the online men's magazine Dmarge. Thanks to Tom for the story.

Interesting newspaper article.

The British tabloid The Daily Star (which tends to be at the raunchy end of the spectrum) published an article with the above title on June 10th. The benefits are: "1) Reduces risk of infection for men 2) Reduces risk of infection for women as well 3) Makes sex more satisfying for women 4) Makes sex more satisfying for men". Well, that's said it - but the author (who from his name appears to be Turkish) does back it up with research.

Read the article (and some predictable comments from the antis) at The Daily Star. Thanks to JLC for the link.

A major paper from the Circumcision Academy of Australia

A monumental paper with 10 authors, led by the indefatigable Professor Brian Morris, making the case for neonatal circumcision in Australia. "A risk-benefit analysis found benefits exceeded procedural risks, which are predominantly minor, by approximately 200 to 1. It was estimated that more than 1 in 2 uncircumcised males will experience an adverse foreskin-related medical condition over their lifetime. An increase in early MC in Australia to mid-1950s prevalence of 85% from the current level of 18.75% would avoid 77,000 cases of infections and other adverse medical conditions over the lifetime for each annual birth cohort."

The paper is open-access and you can read it in the Journal of Men's Health. No prizes for guessing who sent the link.

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27th May, 2022. Timing of circumcision -

does it affect breastfeeding?

Back up to date now with an article in the 16th May issue of Hospital Pediatrics. Several studies have shown that circumcision doesn't seem to affect breastfeeding but this one went into the fine detail. Mothers and babies were put at random into 3 different groups. In group 1 boys were circumcised within 24 hours of birth, in group 2 they were circumcised between 24 and 72 hours old, and in group 3 they were ciecumcised 1 to 3 weeks after birth. Breastfeeding was assessed at 2 months and the middle group were found to be faring worse than the early and late groups. Frankly it's hard to undderstand why, but as the authors say it certainly shows that there is no downside to early postnatal circumcision. It should also give comfort to observant Jews who perform circumcision at 1 week old. The paper is open access and you can reead it at Hospital Pediatrics

There is also an opinion piece relating to this article in the same issue but, frustratingsly (and ridiculously) it is not open access. You can, if you want, read the first paragraph here but it gives no clue as to the authors' views. Thanks to Brian Morris and JH who both sent in these links.

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26th May, 2022. Toy trapped under the foreskin -

not new but too good to miss.

Reader Harry sent in a link to a 2012 paper which we simply had to post. A 10-year-old boy was playing in the bath and inserted a toy figure under his foreskin - then couldn't get it iut. This was in Saudi Arabia which raises the question of how a 10-year-old still had a foreskin. I suppose he was an expat. The boy's attempts get it out had made it so firmly trapped that it was finally extracted under a general anaesthetic. The toy visible through the stretched foreskin The copiously illustrated case report by Madani Essa is open access and you can read it in Annals of Pediatric Surgery

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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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