Tuesday 12 July 2011

The so-called "lost list"

Although less prominent these days, I still find that people occasionally cite the "lost list", seemingly unaware of its inaccuracies. For those unfamiliar with it, this is a list of structures or functions supposedly lost through circumcision.

A number of different versions can be found on the Internet, but they're very similar. The text below is taken from NORM-UK. My comments are in italics.

The Foreskin which comprises up to 50% (sometimes more) of the mobile skin system of the penis. If unfolded and spread out flat the average adult foreskin would measure about 15 square inches( the size of a 3x5 inch index card).

This is a gross exaggeration. First, one study has actually measured the surface area of the adult foreskin; it found an average surface area of 36.8 square centimetres (that's 5.7 square inches). (I previously stated that this was the only study. I was mistaken. A second study, with a small sample size, does exist. It reported an average surface area of 46.7 square centimetres, or 7.2 square inches.) Second, as I recently showed in my critique of Barefoot Intactivist's propaganda, it is reasonable to estimate that the foreskin constitutes 14% of the penile skin system. Using the surface area figure from Werker et al., that's 18% — still less than half of the extraordinary 50% figure.

This highly specialized tissue normally covers the glans and protects it from abrasion, drying, callusing (also called keratinization), and contaminants of all kinds.The effect of glans keratinisation has never been studied.

This sentence is dubious in many ways. The most obvious is the statement that the foreskin protects the glans from keratinisation — the only study in the literature to have examined keratinisation by circumcision status found no differences between the level of keratinisation of the circumcised and uncircumcised glans. Less obvious, but still troubling, is the implication that the circumcised glans is susceptible to abrasion or "contaminants". No evidence is cited in support.

[1. M. M. Lander, "The Human Prepuce," in G. C. Denniston and M. F. Milos, eds., Sexual Mutilations: A Human Tragedy (New York: Plenum Press, 1997), 79-81. 2. M. Davenport, "Problems with the Penis and Prepuce: Natural History of the Foreskin," British Medical Journal 312 (1996): 299-301.]

Note that only two sources are cited. One (Davenport) is peer-reviewed but does not support any of the claims attributed to it. The other (Lander) is a non-peer-reviewed paper presented at an anti-circumcision conference, which doesn't inspire confidence.

The Frenar Ridged Band, the primary erogenous zone of the male body.

When I see a claim like this, I immediately wonder: who established this, and what was the study methodology? The cited source (Taylor, see below) established nothing of the sort. While a small number of studies have investigated sensitivity to non-sexual stimulus, only one study, to my knowledge, has investigated the relative degree of sexual pleasure produced by various parts of the anatomy. That study (which was unfortunately limited by the small number of uncircumcised men) found that the foreskin actually produces the least sexual pleasure of any part of the penis.

Loss of this delicate belt of densely innervated, sexually responsive tissue reduces the fullness and intensity of sexual response.
[Taylor, J. R. et al., "The Prepuce: Specialized Mucosa of the Penis and Its Loss to Circumcision," British Journal of Urology 77 (1996): 291-295.]

Note that the cited source says nothing of the sort! Its authors merely "postulate" that the "ridged band" is sensory tissue. They don't attempt to prove it, nor do they evaluate the effects of its removal on the "fullness and intensity" of sexual response.

The Foreskin's 'Gliding Action' - the hallmark mechanical feature of the normal natural, intact penis. This non-abrasive gliding of the penis in and out of itself within the vagina facilitates smooth , comfortable, pleasurable intercourse for both partners. Without this gliding action, the corona of the circumcised penis can function as a oneway valve, scraping vaginal lubricants out into the drying air and making artificial lubricants essential for pleasurable intercourse.
[P. M. Fleiss, MD, MPH, "The Case Against Circumcision," Mothering: The Magazine of Natural Family Living (Winter 1997): 36-45.]

Note that the only source cited for this claim is an opinion piece published in a magazine. It's an interesting hypothesis, but little or no credible evidence supports it.

[Indented box] Nerve Endings transmit Sensations to the Brain - Fewer Nerve Endings means Fewer Sensations

This simplistic model is faulty because the presence of nerve endings do not create sensations by themselves. Likely as not, your genitals are not buzzing with sensations as you read this, because they're not being stimulated. This means that the method and degree of stimulation is as important as the number of nerve endings. Put simply, a smaller number of nerve endings can produce just as much stimulation as a larger number, if stimulated more effectively. And this is effectively what circumcision achieves, by exposing the glans (especially the sensitive corona) to direct stimulation during intercourse, sensation is increased, compensating for the loss of sensation from the foreskin itself.

Circumcision removes the most important sensory component of the foreskin - thousands of coiled fine-touch receptors called Meissner's corpuscles.

Most important? Who established this, and what was the study methodology?

Also lost are branches of the dorsal nerve, and between 10,000 and 20,000 specialized erotogenic nerve endings of several types.

What is the source for this number? Neither of the two cited sources support it. In fact, having researched this in some depth, I feel quite confident in stating that no study has ever counted the number of nerve endings in the foreskin.

Together these detect subtle changes in motion and temperature, as well as fine gradations in texture.
[1. R. K. Winkelmann, "The Erogenous Zones: Their Nerve Supply and Its Significance," Proceedings of the Staff Meetings of the Mayo Clinic 34 (1959): 39-47. 2. R. K. Winkelmann, "The Cutaneous Innervation of Human Newborn Prepuce," Journal of Investigative Dermatology 26 (1956): 53-67.]

Again, the sources fail to support the claims attributed to them.

The Frenulum[.] The highly erogenous V-shaped web-like tethering structure on the underside of the glans; frequently amputated along with the foreskin, or severed, either of which destroys its function and potential for pleasure.
[1. Cold, C, Taylor, J, "The Prepuce," BJU International 83, Suppl. 1, (1999): 34-44. 2. Kaplan, G.W., "Complications of Circumcision," Urologic Clinics of North America 10, 1983.]

Neither of the cited sources actually supports these claims. This isn't terribly surprising because a) the frenulum's potential for pleasure is speculative, and b) the function of the frenulum, such as it is, is to hold the foreskin in place over the glans. Without a foreskin, then, it has no function.

Muscle Sheath[.] Circumcision removes approximately half of the temperature-sensitive smooth muscle sheath which lies between the outer layer of skin and the corpus cavernosa. This is called the dartos fascia.
[Netter, F.H., "Atlas of Human Anatomy," Second Edition (Novartis, 1997): Plates 234, 329, 338, 354, 355.]

"Approximately half" is of course an exaggeration, but it is true that the foreskin does contain this layer.

The Immunological Defense System of the soft mucosa. This produces both plasma cells that secrete immunoglobulin antibodies and antibacterial and antiviral proteins such as the pathogen-killing enzyme lysozyme.
[1. A. Ahmed and A. W. Jones, "Apocrine Cystadenoma: A Report of Two Cases Occurring on the Prepuce," British Journal of Dermatology 81 (1969): 899-901. 2. P. J. Flower et al., "An Immunopathologic Study of the Bovine Prepuce," Veterinary Pathology 20 (1983):189-202.]

The cited sources utterly fail to support these claims. The second is not even a study of the human prepuce, but rather that of the cow! While the foreskin doubtless contains the immunological functions of any skin, no special mechanisms are known.

Lymphatic Vessels[.] the loss of which reduces the lymph flow within that part of the body's immune system.
[Netter, F.H., "Atlas of Human Anatomy," Second Edition (Novartis, 1997): plate 379.]

This is really scraping the bottom of the barrel, but yes, removing skin does remove the lymph vessels within it.

Oestrogen Receptors The presence of estrogen receptors within the foreskin has only recently been discovered. Their purpose is not yet understood and needs further study.
[R. Hausmann et al., "The Forensic Value of the Immunohistochemical Detection of Oestrogen Receptors in Vaginal Epithelium," International Journal of Legal Medicine 109 (1996): 10-30.]

If confirmed, for that matter.

[Indented box] The Body is Well Designed - Altering it Surgically can only Disrupt it's Natural Function

This is more a statement of faith than a serious claim, but we can transform it into a scientifically testable hypothesis: surgical alteration of the body cannot produce positive effects. It seems almost trivial to show that it is false.

The Apocrine Glands of the inner foreskin, which produce pheremones -nature's powerful, silent, invisible behavioural signals to potential sexual partners. The effect of their absence on human sexuality has never been studied.
[A. Ahmed and A. W. Jones, "Apocrine Cystadenoma: A Report of Two Cases Occurring on the Prepuce," British Journal of Dermatology 81 (1969): 899-901.]

A serious problem with this claim is that apocrine glands are absent in the inner foreskin. Amusingly, one of the sources cited above (Taylor et al) says this: "the mucosal surface of the prepuce is completely free of lanugo hair follicles, sweat and sebaceous glands". Similarly, Parkash et al report: "Multiple small pieces were taken from the inner lining of the circumcised prepuce [...] A special search was made for glandular tissue. No such tissue was found in the material".

Sebaceous Glands which lubricate and moisturise the foreskin and glans, normally a protected and internal organ-like the tongue or vagina. Not all men have sebaceous glands on their inner foreskin.
[A. B. Hyman and M. H. Brownstein, "Tyson's Glands: Ectopic Sebaceous Glands and Papillomatosis Penis," Archives of Dermatology 99 (1969): 31-37.]

In fact, according to the studies cited above, no men have sebaceous glands on their inner foreskin.

Langerhans Cells Specialised epithelial Langerhans cells, a first line component of the body's immune system in a whole penis.
[G. N. Weiss et al., "The Distribution and Density of Langerhans Cells in the Human Prepuce: Site of a Diminished Immune Response?" Israel Journal of Medical Sciences 29 (1993): 42-43.]

The cited source actually states the opposite: that the foreskin is deficient in Langerhans cells.

Colouration[.] The natural coloration of the glans and inner foreskin (usually hidden and only visible to others when sexually aroused) is considerably more intense than the permanently exposed and keratinized coloration of a circumcised penis. The socio-biological function of this visual stimulus has never been studied.

Ignoring the keratinisation error, this seems to be rather desperate. The appearance of the penis is changed, so this is a loss?

Some of the penis length and circumference because its double-layered wrapping of loose and usually overhanging foreskin is now missing, making the circumcised penis truncated and thinner than it would have been if left intact.
An Australian survey in 1995 showed circumcised men to have erect penises an average of 8mm shorter than intact men.
[1. R. D. Talarico and J. E. Jasaitis, "Concealed Penis: A Complication of Neonatal Circumcision," Journal of Urology 110 (1973): 732-733. 2. Richters J, Gerofi J, Donovan B. Why do condoms break or slip off in use? An exploratory study. Int J STD AIDS. 1995; 6(1):11-8. ]

It should be noted that this Australian study is in fact the only study to report such a difference.

Blood Vessels[.] Several feet of blood vessels, including the frenular artery and branches of the dorsal artery are removed in circumcision. This loss of the rich vascularity interrupts normal flow to the shaft and glans of the penis, damaging the the natural function of the penis and altering its development. [1. H. C. Bazett et al., "Depth, Distribution and Probable Identification in the Prepuce of Sensory End-Organs Concerned in Sensations of Temperature and Touch; Thermometric Conductivity," Archives of Neurology and Psychiatry 27 (1932): 489-517.� 2. Netter, F.H., "Atlas of Human Anatomy," Second Edition (Novartis, 1997): plates 238, 239.]

It is quite likely that several feet are lost, as the human body has an extraordinary number of blood vessels (a typical estimate is that the adult human body contains 100,000 miles of blood vessels). The claimed consequences, however, are unsupported by the references cited.

Dorsal Nerves The terminal branch of the pudendal nerve connects to the skin of the penis, the prepuce, the corpora cavernosa, and the glans. Destruction of these nerves is a rare but devastating complication of circumcision. If cut during circumcision, the top two-thirds of the penis will be almost completely without sensation. [1. Agur, A.M.R. ed., "Grant's Atlas of Anatomy," Ninth Edition (Williams and Wilkins, 1991): 188-190. 2. Netter, F.H., "Atlas of Human Anatomy," Second Edition (Novartis, 1997): plate 380, 387.]

One wonders why such extremely rare, albeit possible complications are included, then. To pad out the list, perhaps?

Complications Every year boys lose their entire penises from circumcision accidents and infection. They are then "sexually reassigned" by castration and "transgender surgery" and expected to live their lives as "females". [1. J. P. Gearhart and J. A. Rock, "Total Ablation of the Penis after Circumcision with Electrocautery: A Method of Management and Long-Term Followup," Journal of Urology 142 (1989):799-801. 2. M. Diamond and H. K. Sigmundson, "Sex Reassignment at Birth: Long-Term Review and Clinical Implications," Archives of Pediatrics and Adolescent Medicine 151 (1997): 298-304.]

It may be an exaggeration to claim that this happens "every year", but cases have been reported, unfortunately.

Death Every year many boys lose their lives from the complications of circumcision, a fact the billion-dollar-a-year circumcision industry in the U.S. routinely obscures and ignores.
[1. G. W. Kaplan, "Complications of Circumcision," Urologic Clinics of North America 10 (1983): 543-549. 2. R. S. Thompson, "Routine Circumcision in the Newborn: An Opposing View," Journal of Family Practice 31 (1990): 189-196.]

Again, death does occur, albeit rarely. However, it would be foolish to consider such deaths in isolation. They should be weighed against deaths attributable to lack of circumcision. That is, if a million boys are circumcised, does this result in more or fewer deaths than if those boys are not circumcised. The evidence indicates that lives are saved.

Emotional Bonding[.] Circumcision performed during infancy disrupts the bonding process between child and mother. There are indications that the innate sense of trust in intimate human contact is inhibited or lost.

Who established this, and what was the study methodology?

It can also have significant adverse effects on neurological development. Additionally, an infant's self-confidence and hardiness is diminished by forcing the newborn victim into a defensive psychological state of "learned helplessness" or "acquired passivity" to cope with the excruciating pain which he can neither fight nor flee.

Who established this, and what was the study methodology? (How on Earth would one be able to prove such a thing? It looks suspiciously like an unfalsifiable statement: a product of pseudoscience, not science.

The trauma of this early pain lowers a circumcised boy's pain threshold below that of intact boys and girls. [1. R. Goldman, Circumcision: The Hidden Trauma (Boston: Vanguard Publications, 1997), 139-175. 2. A. Taddio et al., "Effect of Neonatal Circumcision on Pain Responses during Vaccination in Boys," Lancet 345 (1995): 291-292.]

Neurological Sexual Communication[.] Although never studied scientifically, contemporary evidence suggests that a penis without its foreskin lacks the capacity for the subtle neurological "cross-communication" that occurs only during contact between mucous membranes and which contributes to the experience of sexual pleasure.

What utter nonsense! How on earth would non-scientific evidence suggest such a thing? This appears to be nothing more than a wild theory, dishonestly presented as something suggested by evidence.

Amputating an infant boy's multi-functional foreskin is a "low-grade neurological castration" [Immerman], which diminishes the intensity of the entire sexual experience for both the circumcised male and his partner.)

So prove it. Should be trivial. Except, of course, that scientific studies of satisfaction, etc., don't support this claim.

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