CIRCUMCISION IS NO CURE FOR HIV/AIDS PART 3

•October 11, 2008 • Leave a Comment

Do Not Cloud the Message!

Following some African countries government’s advice that circumcision lessened chances of contracting HIV/Aids, many young men formed very long lines outside health centers to have their foreskins severed. Innocent “Onyango” had just given the nod to circumcision when he acknowledged that he has been made a ware that, men who are circumcised are 60% more likely to be protected against HIV during sexual intercourse.

The response to the circumcision program has been vigorous, and sometimes spontaneous, that it should get most people worried, instead of exciting them. Until u meet the freshly circumcised young men dressed up in a loose garments –as regular clothing is mostly out of the question at this time of healing.

Young men like “Onyango” point out that, these Aids people(activists) have spoken for long about fighting the disease, but they had never come up with a practical solution as good as this one(circumcision). Don’t have sex, don’t do this, don’t do that. Eh, man, how can a young man such as I forfeit sex, eh? And the condoms – where is the sense in putting on a condom when you are having sex? Sex is about feeling, and so no young person likes them!”
You can view it from young men’s side and be humbled by it, but you should be doubly afraid for the future as far as the hydra known as HIV/AIDS is concerned, and its potential to wreak more havoc against a young population that loves and values fun more than security of life.

There you have it!- whatever sensitization programs that might have been done about ways of protecting oneself against HIV/AIDS infection would be headed to the drain and thrown to the wind, because circumcision would now provide full coverage! NO WORRIES!

It is appalling, to say the least as this explains the long circumcision lines in front of the health centers – young men and women were now going to indulge in all the sex they wanted without any inhibitions, any fears about HIV/AIDS infection.
Anything that will give a person a chance to escape HIV/AIDS infection is gladly welcomed.

The efforts should be to urge the governments, the entire public and in your own communities to step up the campaign against HIV/AIDS. And by taking counseling to another level, who knows that the World Health Organization and Unaids’ statistics might not have taken every single factor into consideration?
It is counseling that will help those young men who are rushing to get circumcised in order to ‘enjoy’ their sex unhindered, to get informed that there are many things to consider before they place their unprotected little friends into the mouth of infected vessels, placing all their faith in their circumcision hype. This is not bashing circumcision per se but rather looking at things in perspective.

Therefore, HIV/AIDS fight should not follow the line of least resistance blindly. Fighting HIV needs discipline, and so an undisciplined person will not manage to walk within the strictures of Abstinence, Faithfulness, Condoms, etc …etc – all of which give high chances, but only when one sticks to them religiously.

And look now; there is another group that has grown into maturity and is infected, but without ever having had sexual contact with any member of the opposite sex – or of the same sex. There are many unfortunate children who were just born with the HIV virus. The level of resistance of these people and many others is quite different from Adults, just as it is different in a general sense. So, it is always a danger to indulge in the kind of sex that the young men want – wild and unprotected – when it is your resistance that is weak and therefore your life is put in uncalled for danger.

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CIRCUMCISION IS NO CURE FOR HIV/AIDS PART 2

•October 11, 2008 • Leave a Comment

Do Not Cloud the Message!

Let’s be realistic and brutally honest about most of the western countries, especially US view towards Africa and other developing countries.

Polygamy and other cultural/[religious-as is the case with Muslim faith] practices such as “wife inheritance- (the way its being put/addressed” without actually trying to understand what at all their deeper meanings are to those communities)- is and has been a cultural practice in many societies including most of African countries.

And as usual, whenever there is a belief system or cultural norms that are at odds with the western cultures- the action is to demonize and expunge the practice and inject the western-friendly culture/practice into the vacuum created. This time the tactics are no different. By looking at any possible link that may exist between HIV/AIDS and these customs, aiming to “tie” the disease with these cultural practices that run counter to theirs. Several means/tactics had to be tried for example blaming it to the “toxic mix” of factors that has fueled the HIV/AIDS epidemic, cultures that “condones, even encourages” polygamy but denies women the right to negotiate condom use, as the women in these societies are perceived to hold “less power”, some in the west argue.

This changes the subject to an equality and human rights issue, hence getting the subject more broad and appealing world over. And their answer is CIRCUMCISION?

The fact is, foreskins are the least of these countries problems and the pushers of circumcision in lieu of dealing with the real issues do nothing but displace the focus from where it should be and put lives at risk thereby.

Development and proper[appropriate]education programs are some of the only solution to these countries’ HIV crisis. And development realistically will only come from within AND only when/if the underlying causes of corruption and cultural issues acting as a platform from which the disease spreads unchecked are addressed.

If you think for a moment about the above realities, you will eventually want to ask why anyone would focus on circumcision at all — at least until these severe barriers preliminary to any prevention campaign are addressed.

The answer is probably a cultural one. For example American culture, the place from which this campaign originates, has more to do with it than any of these problematic studies do. As usual, and in accordance with the observations of many, the West, particularly the United States, is following its own well-worn path in the crusade to save Africa for example, from itself without understanding a thing about the place it seeks to help. Never mind that places like Lesotho and Swaziland, as just one example, share similar rates of HIV and economic pain while one is largely circumcised and the other is not.

The target here bears the appearance of being not just Africa, but America’s own slipping rates of neonatal circumcision. Whether this is true or not is another matter, but the possibility cannot be discounted after the recent discussions at the CDC and among the vaccine initiatives’ leadership.
The future is more chilling than ever and the politicization of HIV/AIDS has never been so far advanced and confused.

****TO BE CONTINUED****

CIRCUMCISION IS NO CURE FOR HIV/AIDS PART 1

•October 5, 2008 • 1 Comment

Do Not Cloud the Message! – Kenyan politicians hailing from Lake Region.

There has been some excitement at international conferences around the globe on HIV/Aids like the one held in Mexico and others that, male circumcision can help prevent the spread of the pandemic.
Regrettably, some false hope is thus being indirectly cultivated that the cut is the means to keep the virus at bay.

The emerging statistics clearly call for caution. If the infection rate among circumcised men has declined from, say 7.5 to 6.5 per cent, on average, it is scant comfort, indeed. This means clearly that there is only one percent difference! As debate on whether circumcision reduces the risk of HIV infection or not rages, it is amazing how each side of the divide is getting carried away by emotions to the extent of losing sight of the available evidence.

This reminds one of the saying that “a good slogan can stop analysis for years”.
It is true that there is evidence that HIV prevalence is lower among communities that practice male circumcision than among those that do not.
But there is also evidence to the contrary: that HIV prevalence is higher among communities that practice male circumcision than among those that do not.

This sounds somehow confusing, one would say. But in a nutshell, it shows that the evidence on whether male circumcision protects one against HIV infection is mixed.
Unfortunately, both the proponents and the opponents of the protective role of male circumcision have refused to soberly confront this reality, and thus think through an appropriate prevention strategy.

Since so much has been said about studies that show the protective role of male circumcision, Lets talk about the evidence that shows the contrary.
Two data sets from Malawi (the 2004 Malawi Demographic and Health Survey (MDHS) and the 2004 and 2006 Malawi Diffusion and Ideational Change Project (MDICP)) show that HIV prevalence was highest in the Southern region than in the Central or Northern regions.

Yet, a higher proportion of men from the Southern region, compared to those from the other regions, reported having been circumcised.
In contrast, individuals from the other regions were less likely to report multiple life-time sexual partners than those from the Southern region.
They were also more likely to report condom use during the 12 months preceding the survey than those from the Southern region.
At the individual level, HIV prevalence was higher among circumcised than among uncircumcised men. Among circumcised men, those who were HIV-positive were more likely to report multiple life-time sexual partners than their HIV-negative counterparts.

Similarly, among married women with circumcised husbands, HIV prevalence was higher among those whose spouses reported multiple life-time sexual partners than among their counterparts whose spouses reported one life-time sexual partner.
At a recent meeting when engaging a fellow participant on this exceptional evidence from Malawi, one of the participants got carried away and branded opposing view a circumcision-basher. Is circumcision some tender pet or victim whose feelings we ought to respect?

That one of the participants did not even stop to listen to what the opposing side had to say. Yet, the intention was to see whether, given the two sets of contrasting evidence, that there could be a way of thinking through a better way of confronting the HIV and Aids scourge.

It was surprising at to how low some scholars have sunk, to the extent of reducing the debate to “us versus them”. It left one, wondering how the so-called circumcision-bashers refer to those on the other side of the divide.

In any case, HIV and Aids should concern everyone and any effort aimed at combating it is laudable.

However, aware of the two sets of contrasting evidence, the concern has always been the manner in which male circumcision is being presented to the public, as if it is the ultimate method of protection against HIV/AIDS infection.
The ultimate view should be, the promotion of male circumcision should be accompanied by riders encouraging people to use other means of protection even after the cut.

Otherwise we run the risk of creating the false impression that once a man is circumcised, he can start sleeping around without any care in this world.
Given the evidence from Malawi, one can only shudder at what this might lead to. The Malawi exception also brings into focus the issue of the position of the woman.
It suggests that we can circumcise the men alright, but as long as they remain promiscuous and do not use any protection, their women are still at risk. The question then is; how do we protect the women?

It is against this backdrop that a new way of thinking has started gaining ground within program circles, what is known in program parlance as MC-plus (Male Circumcision plus other preventive methods). Isn’t this what we ought to be promoting?

The grave danger still lurks out there, and it must be made clear to all that circumcision is no panacea.
There is need to continue waving the banners of abstinence, being faithful to one’s partner or using condoms, because the naked reality is that no cure for Aids has been found.

Circumcision is thoroughly unhelpful if one’s partner is infected or if its taken for immunization. It’s no good reason for people to dance around, clouding the message that the scourge is curable.AS OF NOW IT IS NOT!

****TO BE CONTINUED****

CIRCUMCISION AND HIV/AIDS AS A CURE OR PREVENTIVE?–CONT. PART 7

•October 5, 2008 • 1 Comment

NO.CIRCUMCISION IS NOT THE ANSWER OR CURE FOR HIV/AIDS.

WHY? (3)-CONTINUED-Uncircumcised men are thought to be more susceptible to AIDS because the underside of the foreskin is rich in Langerhans’ cells, which attach easily to the virus. The foreskin may also suffer some small tears during intercourse, making it more susceptible to infection.

New factors to consider

Scientists Discover ‘Natural Barrier’ to HIV
E.J. Mundell of HealthDayNews reported that;

Researchers have discovered that cells in the mucosal lining of human genitalia produce a protein that “eats up” invading HIV — possibly keeping the spread of the AIDS more contained than it might otherwise be.
Even more important, enhancing the activity of this protein-(Langerin) could be a potent new way to curtail the transmission of the virus that causes AIDS, the Dutch scientists added.

Langerin is produced by Langerhans cells, which form a web-like network in skin and mucosa. This network is one of the first structures HIV confronts as it attempts to infect its host.
However, “we observed that Langerin is able to scavenge viruses from the surrounding environment, thereby preventing infection,” said lead researcher Teunis Geijtenbeek, an immunologist researcher at Vrije University Medical Center in Amsterdam.

And since generally all tissues on the outside of our bodies have Langerhans cells, we think that the human body is equipped with an antiviral defense mechanism, destroying incoming viruses,” Geijtenbeek said.
The finding, reported some time ago in an online issue of Nature Medicine, “is very interesting and unexpected,” said Dr. Jeffrey Laurence, director of the Laboratory for AIDS Virus Research at the Weill Cornell Medical College, in New York City. “It may explain part of the relative inefficiency of HIV in being transmitted.”
Even though HIV has killed an estimated 22 million people since it was first recognized more than 25 years ago, it is actually not very good at infecting humans, relatively speaking.

For example, the human papillomavirus (HPV), which causes cervical cancer, is nearly 100 percent infectious, Laurence noted. That means that every encounter with the sexually transmitted virus will end in infection.
“On the other hand, during one episode of penile-vaginal intercourse with an HIV-infected partner, the chance that you are going to get HIV is somewhere between one in 100 and one in 200,” Laurence said.

Experts have long puzzled why HIV is relatively tough to contract, compared to other pathogens. The Dutch study, conducted in the laboratory using Langerhans cells from 13 human donors, may explain why.
When HIV comes in contact with genital mucosa, its ultimate target — the cells it seeks to hijack and destroy — are immune system T-cells. But T-cells are relatively far away (in lymph tissues), so HIV uses nearby Langerhans cells as “vehicles” to migrate to T-cells.

For decades, the common wisdom was that HIV easily enters and infects Langerhans cells. Geijtenbeek’s team has now cast doubt on that notion.
Looking closely at the interaction of HIV and Langerhans cells, they found that the cells “do not become infected by HIV-1, because the cells have the protein Langerin on their cell surface,” Geijtenbeek said. “Langerin captures HIV-1 very efficiently, and this Langerin-bound HIV-1 is taken up (a bit like eating) by the Langerhans cells and destroyed.”
In essence, Geijtenbeek said, “Langerhans cells act more like a virus vacuum cleaner.”

Only in certain circumstances — such as when levels of invading HIV are very high, or if Langerin activity is particularly weak — are Langerhans cells overwhelmed by the virus and infected.

The finding is exciting for many reasons, not the least of which is its potential for HIV prevention, Geijtenbeek said.
“We are currently investigating whether we can enhance Langerin function by increasing the amount of Langerin on the cell surface of Langerhans cells,” he said. “This might be a real possibility, but it will take time. I am also confident that other researchers will now also start exploring this possibility.”

The discovery might also help explain differences in vulnerability to HIV infection among people.
“It is known that the Langerin gene is different in some individuals,” Geijtenbeek noted. “These differences could affect the function of Langerin. Thus, Langerhans cells with a less functional Langerin might be more susceptible to HIV-1, and these individuals are more prone to infection. We are currently investigating this.”
The finding should also impact the race to find topical microbicides that might protect women against HIV infection. Choosing compounds that allow Langerin to continue to work its magic will enhance any candidate microbicide’s effectiveness, the Dutch researcher said.

Laurence did offer one note of caution, however.
“In the test tube, this is a very important finding,” he said. “But there are many things in the test tube that don’t occur when you get into an animal or a human. Having said that, this is a very intriguing finding, he said.”

WHY?(4)-Other factors also to consider:

Kebaabetswe et al obviously believe the conventional wisdom that heterosexual sex is the major vector for the transmission/reception of HIV, and that male circumcision is an effective deterrent to infection. Based on that belief, they have constructed an elaborate and impressive study of the acceptability of circumcision as a prophylactic measure in Botswana. Furthermore, they argue for a programme of neonatal circumcision in Botswana in the hope of reducing the HIV infection rate 15 years later.

Discussion

It has been believed since about 1988 that heterosexual coitus accounts for 90% of the HIV infection in Africa.
Many studies do argue that circumcision can reduce the transmission of HIV through heterosexual coitus. The quality of these studies has been criticized for their methodological flaws, including their failure to control for numerous confounding factors.

Gray et al found that transmission by coitus ‘‘is unlikely to account for the explosive HIV-1 epidemic in sub-Saharan Africa.’’ It now appears that these studies have not accounted for the largest confounding factor of all—iatrogenic transmission of HIV. Sometimes back, the International Journal of STD & AIDS published a trilogy of articles.

These articles strongly argue that unsafe health care practices, especially non-sterile injections, not heterosexual intercourse, are the principal vectors by which HIV is transmitted. A program of mass circumcision would be ineffective against iatrogenic transmission of HIV through unsafe health care. Heterosexual transmission of HIV that one sees in Africa also cannot explain the incidence of HIV in children. Circumcision has some little known effects that may promote rather than deter HIV infection. The human foreskin has physiological functions designed to protect the human body from infection. The sub-preputial moisture contains lysozyme—an enzyme that attacks HIV. Circumcision destroys this natural protection.
Circumcision removes erogenous tissue, desensitizes the penis, changes sexual behavior, and makes males more likely to engage in unsafe sex practices. Circumcised males, therefore, are less willing to use additionally desensitizing condoms.

Male circumcision produces hardened scar tissue that encircles the shaft of the penis. The scar scrapes the inside of the partner’s vagina during coitus and, therefore, may enhance the transmission/reception of HIV. A program of mass circumcision would expose African males to unsafe genital cutting, would destroy the natural protection of the foreskin, would not be effective against iatrogenic unsafe health care, would divert scarce medical and social resources from measures of proved effectiveness, and, therefore, is likely to increase the transmission of HIV. The proportion of HIV infection attributable to heterosexual intercourse has been placed at 90%. Gissellquist and Potterat now estimate the proportion attributable to heterosexual intercourse at only about 30%—only a one third of the previous estimate.
Circumcision has not yet been shown to be an effective deterrent against HIV infection. The Council on Scientific Affairs of the American Medical Association says that ‘‘circumcision cannot be responsibly viewed as ‘protecting’ against such infections.’’ The Task Force on Circumcision of the American Academy of Pediatrics identifies behavioral factors, not lack of circumcision, as the major cause of HIV infection. The article by Kebaabetswe et al seems to show a strong cultural bias on the part of the authors in favor of circumcision. This may be due to their desire to preserve their culture of origin.

WHY?(5)-Bioethics and human rights-Finally, to address the legal and ethical issues. As noted above, male circumcision excises a large amount of functional healthy erogenous tissue from the penis. It is a clear violation of the basic human right to security of the person.

Several authorities report that circumcision degrades the erectile function of the penis. Circumcision, therefore, must be regarded as degrading treatment. Degrading treatment is an additional violation of human rights.
The leading international statement of medical ethics is the European Convention on Human Rights and Bioethics. Article 20(1) prohibits non-therapeutic tissue removal from those who do not have the capacity to consent. Children have a right to the protection of the security of their person and to protection from degrading treatment. Circumcision would violate those human rights. Doctors must respect patient human rights. Prophylactic circumcisions ethically may not be carried out on minors. Circumcisions, therefore, would have to be limited to adult males who legally may give informed consent.

WHY?(6)-Political factors

Ntozi warns-He says-It is important that, while circumcision interventions are being planned, several points must be considered carefully. If the experiment fails, the groups(Africans and others being used in these experiments) are likely to feel abused and exploited by scientists who recommended the circumcision policy. In a region highly sensitive to previous colonial exploitation and suspicious of the biological warfare origin of the virus, failure of circumcision is likely to be a big issue. Those recommending it should know how to handle the political implications.

Approval of circumcision by the surveyed Botswana people apparently is based on their belief that circumcision is efficacious in preventing the spread of HIV. If circumcision fails to control HIV, there would be disillusionment and anger. African and others- males would have sacrificed their erogenous tissue for a false hope of preventing HIV infection. There is no evidence that Kebaabetswe et al have considered the political issues that would arise if a circumcision experiment should fail.

Conclusion

Kebaabetswe et al propose the universal circumcision of male children in Botswana. They accept without question that HIV is primarily sexually transmitted in Africa and other areas by heterosexual coitus and that circumcision reduces or prevents the transmission of HIV; however, medical authorities do not accept the evidence of this. Kebaabetswe et al propose to provide in-hospital circumcision of male children in Botswana. However, there is already a substantial incidence of infection among children in South Africa as a result of iatrogenic infection from non-sterile injections, etc. They have not shown that safe, aseptic circumcisions can be delivered in Botswana. A program of mass circumcision would destroy the natural protections of the foreskin, further expose children to an apparently unsafe health care system, and would be more likely to increase than decrease infection.
Even if circumcision eventually should be shown to provide some protection against HIV infection, that protection could only work to reduce the 30% of infections that now are attributed to sexual activity. It would have no effect on the other 70%. Its effect, therefore, would be minimal at best and could not have an effect for the first 15 years during which time behavioral changes could be introduced into society through education, and a HIV vaccine could be developed to provide immunity.
Circumcision of male children with the intent of reducing an epidemic not of their making is unacceptable from medical, ethical, and legal perspectives. As a public health measure, male neonatal circumcision fails all tests.

US FIRST PRESIDENTIAL DEBATE

•September 29, 2008 • Leave a Comment

TEXAN JOKE ABOUT SERAH PALIN

while suturing a cut on the hand of a 75-year old Texas rancher whose hand was caught in a gate while working cattle, the doctor struck up a conversation with the old man.
Eventually the topic got around to Sarah Palin and her bid to be a heartbeat away from being President.
The old rancher said, ‘Well, ya know, Palin is a post turtle.’
Not being familiar with the term, the doctor asked him what a post turtle was.
The old rancher said, ‘When you’re driving down a country road and you come across a fence post with a turtle balanced on top, it’s a post turtle.’
The old rancher saw a puzzled look on the doctor’s face, so he continued to explain.
‘You know she didn’t get up there by herself, she doesn’t belong up there, she doesn’t know what to do while she is up there, and you just wonder what kind of dumb a*s put her up there to begin with.

***********************************************************************************

IMPRESSION ON FIRST DEBATE:

After listening and reading most of the reactions from news pundits, blogs, news-both cable and e-news and having watched the debate live as it proceeded. It became increasingly clear that the Democratic candidate did a good job! And maybe-just maybe this country could be ready for a change and make history while at it.

At this point I am willing to bet a democratic presidency this time around. I usually don’t bet and as a matter of fact, I am anti-betting. But history is looking at me in the face and I want to be a tiny part of it, even if it means breaking my own rules.

Having said the above, given that the “right leanings” said the debate was a tie and the “left leanings” and “in-betweens” said Obama won I am going to go with Mr. Mark Halperin’s of US TIMES grading. I think he summed it up pretty good-What do you think!

Here we go….

John McCain
Substance: His arguments were hard to follow at the beginning, but he found his voice as the debate progressed, although he never seemed fully in control of his message. He had plenty to say about the economy, Iraq, Afghanistan, and Russia, but often bogged down his own answers when trying to unfurl quips and sound bites. Stuck with bumper sticker slogans on the economy, and while he got a bit more detailed on foreign policy, he stayed at his usual level of abstraction. If he truly knows more about the world than Obama, he didn’t show it in this debate.
Grade: B-

Style: Cluttered, jumpy, and often muddled. Frequent coughing early on helped neither his arguments nor his image. Jokes about being deaf and anecdotes about Normandy and George Shultz seemed ill-advised — even his pen was old. His presentation was further hindered by his wandering discussion of the differing heights of North and South Koreans and his angry assertion about how well he knows Henry Kissinger. Fell into the classic politician’s trap of inserting familiar stump speech applause lines into debate responses — which only works if done with enthusiasm and clarity (and if received by applause — a big No-No in Lehrer’s auditorium, which the audience obeyed seriously and silently). Keenly aware of the grand, grave occasion, McCain wavered between respectful and domineering, and ended up awkward and edgy.
Grade: C-

Offense: Emphasized his bread and butter issues of taxes and spending, and hit Obama on his failure to visit Iraq and his expressed willingness to meet with dictators. But while mocking his opponent on a few occasions, which reflected his acute disrespect for Obama, he did so in an insufficiently sharp and detailed manner — and unevenly worked elements of his rival’s record into his attacks. Still he was utterly confident about his own experience, knowledge, and policies, even when tripped by his own tongue and distracted by the strains of debate practice. The main problem: Obama’s obvious preparation and sharp answers contradicted McCain’s frequent claims that the Democrat was uninformed and “didn’t understand” key issues.
Grade: C+

Defense: He managed to ignore most of Obama’s jibes, but was eventually baited into giving an extended answer about his policy differences with President Bush, after his opponent repeatedly mentioned McCain’s regular support of Bush’s budgets. Was visibly riled when clashing with Obama over a variety of issues, including Iraq, sanctions, and spending. He also chose to boast about Sarah Palin (although not by name) as his maverick partner, who, after her shaky week, may no longer be his ace in the hole.
Grade: B-

Overall: McCain was McCain — evocative, intense, and at times emotional, but also vague, elliptical, and atonal. Failed to deliver his “country first versus Obama first” message cleanly, even when offered several opportunities. Surprisingly, did not talk much about “change,” virtually ceding the dominant issue of the race.
Overall grade: B-

Barack Obama
Substance: Quite manifestly immersed in the past, present, and future details of policy, and eager to express his views, which have been expanded, honed, and solidified during the last 18 months of hard campaigning. Still, he did avoid the nitty-gritty details of policy positions in favor of broad principles and references to working Americans, thereby not presenting the kind of specifics that some voters are waiting to hear from him.
Grade: B+

Style: Polished, confident, focused. Fully prepared, and able to convey a real depth of knowledge on nearly every issue. He was unhurried, and rarely lost his train of thought even when the debate wended and winded — and uttered far fewer of his trademark, distracting, “ums.” At times, however, Obama revealed the level of his preparation by faltering over a rehearsed answer. He seemed to deliberately focus on the moderator and the home audience, with McCain as an afterthought — except when on the attack. Chose to avoid humor, for the most part, in favor of a stern demeanor, and in the process, came off as cool as a cucumber.
Grade: A

Offense: Linking McCain to Bush in his very first answer, he kept it up as his primary line of attack. Forcefully hit McCain for his early support of the Iraq War. Though he never drew blood, he did keep McCain a bit off balance, often with clever references to McCain’s recent statements.
Grade: B

Defense: Had a reasonable answer for every charge that came his way — with little anger, bluster, or anxiety. Often interrupting McCain attacks with swift explanations and comebacks, he managed to spin accusations of being liberal as evidence of his relentless opposition to George Bush (in replies that were clearly planned). Offered a rather clumsy alternative to McCain’s well-known, moving story of wearing the bracelet of a soldier lost in Iraq (a gift from the soldier’s mother), with a story about a bracelet of his own. Fearless, without condescension, he attempted the gracious move of agreeing with or complimenting a McCain position, occasionally to his own detriment.
Grade: A-

Overall: Went for a solid, consistent performance to introduce himself to the country. He did not seem nervous, tentative, or intimidated by the event, and avoided mistakes from his weak debate performances during nomination season (a professorial tone and long winded answers). Standing comfortably on the stage with his rival, he showed he belonged — evocative of Reagan, circa 1980. He was so confident by the end that he reminded his biggest audience yet that his father was from Kenya. Two more performances like that and he will be very tough to beat on Election Day.
Overall grade: A-

CIRCUMCISION AND HIV/AIDS AS A CURE OR PREVENTIVE?–CONT. PART 6

•September 27, 2008 • 1 Comment

**WHY CIRCUMCISION MAY NOT BE THE ULTIMATE SMOKING GUN ON HIV/AIDS-GIVEN IT’S HISTORY? CONTINUED**

NO.CIRCUMCISION IS NOT THE ANSWER OR CURE FOR HIV/AIDS.

Why? (1)-In most of the western countries-Circumcision has sometimes been described as a solution in search of a problem. In the mid-19th century the problem was masturbation. Towards the end of that century it was syphilis. In the 1930s it was penile cancer. In the 1950s it was cervical cancer. 1980s – Urinary tract infections. And don’t forget the phimosis, the balanitis, and the cleanliness part.

For example, outside the Jewish community, where it’s a religious rite, circumcision was practically unheard of in America until 1870, when Lewis Sayre, M.D., claimed to have cured a 5-year-old boy of paralysis by stretching out his foreskin and snipping it off. For the next two decades, Dr. Sayre and his associates crusaded for circumcision, claiming it could cure hip-joint disease, epilepsy, hernia, convulsions, elephantiasis, poor eyesight, tuberculosis, and rectal prolapse, among other things. This was all disproved, of course, and circumcision would probably have vanished from the American medical scene had its backers not found a compelling new way to sell it: as a cure for masturbation. To the publicly puritanical but privately lascivious Victorians, masturbation was the root of numerous social maladies and physical illnesses, including blindness and even insanity. Naturally, they believed, if circumcision could prevent masturbation, it would prevent other diseases as well.

Doctors of the time reported that “removal of the protective covering of the glans tends to dull the sensibility” of the penis and “thereby diminishes sexual appetite.” In 1888, John Harvey Kellogg, M.D., of cereal fame, summed up the medical profession’s opinion and gave justification for the next 60 years of foreskin removal. “A remedy for masturbation which is almost always successful in small boys is circumcision. The operation should be performed by a surgeon without administering an anesthetic, as the pain attending the operation will have a salutary effect upon the mind since the infant wouldn’t be able to remember anything at this stage in his life-meaning-infants don’t feel pain.” By the end of World War II it was clear that circumcision was not stopping men from masturbating; but, by then, the procedure was institutionalized in America’s medical system. It had become the norm for white, middle-class American men. The uncircumcised were often recent immigrants or “African-Americans”. Probably as a result of racial prejudice, the uncircumcised penis was viewed as unhygienic and unclean. But this, too, turns out to be false.

It seemed that with the passing of time, the purported problems had gotten more trivial. It’s no Small wonder then that circumcision’s on the wane. But suddenly, there comes another big one–HIV/AIDS! Several eminent scientists and medical researchers have determined that a link exists between circumcision status and the rate of HIV transmission and they are urging universal adults/infants circumcision to help combat the disease. Circumcision promoters appear to have suddenly and finally found the mother of all problems’ solution. Regrettably, Smoke-screens, half truths and flat out lies have ensured. The issue is so enmeshed in emotion and advocacy that it’s hard to know/tell where the truth is.
“The uncircumcised penis is self-cleaning,” explained Robert Van Howe, M.D., a pediatrician from Wisconsin who had been studying the causes of circumcision for 20 Years. “Every time you urinate, you flush out the preputial cavity. The hygiene issue was just another excuse. Since its inception, circumcision has been a surgery looking for a rationale. First it was disease, then masturbation, then hygiene; now it’s back to disease.” In 1971 the American Academy of Pediatrics (AAP) stated that circumcision was medically unnecessary. At the time more than 80 percent of American baby boys were circumcised. Then in 1989, the AAP released a new position paper that equivocated: “Newborn circumcision has potential medical benefits, as well as disadvantages and risks.” Still, by the following year, the rate was down to 59 percent.

Dr. Schoen chaired the AAP task force that made that reversal. He still stands by the position, claiming that the foreskin is the genital equivalent of the appendix, and that newborn circumcision is “a preventive health measure analogous to immunization.”

“The most important health benefit of circumcision is the decreased risk of urinary-tract infections,” explains Dr. Schoen, citing a well-known 1985 study, which he said has since been “overwhelmingly confirmed” by other studies. But Martin Altschul, M.D., a pediatrician and M.I.T.-trained mathematician, has reexamined the evidence and finds it fraught with problems “The whole body of research on this issue is a how-to-lie-with-statistics classic,” argues Dr. Altschul. “Depending on how you collect the data, you can get almost any result you want.” Dr. Altschul’s own research also found that many of the urinary-tract infections in uncircumcised boys were “attributable to congenital anomalies.” Recently, several studies have suggested that neonatal circumcision may actually increase the infection rate.
Dr. Schoen cited two other medical benefits of circumcision, namely decreased risks of developing penile cancer and contracting sexually transmitted diseases, such as HIV and syphilis.

“You’re more likely to be struck by lightning than to suffer from penile cancer,” counters Dr. Van Howe. “Japan, Norway, Finland, and Denmark all have lower rates than the United States, and they don’t circumcise their boys.”
In fact, in 1996, representatives of the American Cancer Society wrote a letter to the AAP in which they pointed out that “fatalities caused by circumcision accidents may approximate the mortality rate from penile cancer.” The letter also stated that “perpetuating the mistaken belief that circumcision prevents cancer is inappropriate.” Altschul. “It’s preposterous to even suggest that because we have some minuscule risk of disease, we should cut off the foreskin of every little boy.”

“Breast cancer in women is common,” says Dr. Denniston, “more common than all the purported health risks of the foreskin combined. Does that justify cutting off all breasts at puberty?”

What about circumcised men and STDs? A study published in the Journal of the American Medical Association around that time found that circumcised men did have a lower incidence of syphilis and HIV. But they had a higher rate of infection with herpes, hepatitis, and Chlamydia. Overall, the study authors wrote, “We found no evidence of a prophylactic role for circumcision, and a slight tendency in the opposite direction.”

“The bottom line,” says Dr. Denniston “is that the alleged benefits of circumcision don’t approach the risks.”

“Penile cancer is extremely rare-less than one case for every 100,000 men,” adds the Dr.
“Why is this procedure still covered by HMOs and health-insurance companies in America? The simple answer is, because parents want it,” says Patricia Wald, M.D., regional coordinating chief of pediatrics for Kaiser Permanente Medical Center in southern California. The doctors counsel parents so they’re making an informed decision, and don’t perform the operation unless asked. “We cover it as a courtesy. But to me it’s cosmetic surgery, like ear piercing.”

“After you counsel the parents appropriately and do the procedure,” Dr. Shoemaker explained, “it’s not a profitable use of time.”
Circumcision is the only surgery in America routinely performed without anesthesia. Sixty-four to 96 percent of circumcised infants endure the procedure with nothing to deaden the pain. Until recently, doctors often told parents they didn’t feel the same pain as adults.

“I didn’t know what circumcision really was when I consented to have my three sons circumcised,” says Marilyn Milos, founder and executive director of the National Organization of Circumcision Information Resource Centers (NOCIRC). “My doctor told me it was necessary, that it didn’t hurt, and that it took only a moment to perform-like cutting the umbilical cord, I thought.”
Ten years after her last son was born, Milos went back to school to become a registered nurse. As a student, she was asked to assist at a circumcision. “To see a part of a baby’s penis being cut off – without an anesthetic – was devastating.” Later, while working as a nurse, she made a videotape of the procedure and called it Informed Consent.

“Parents had no idea what was happening to their baby boys,” she explains. “The point was to show them what circumcision really entailed.” The hospital, Marin General in California, refused to allow expectant parents to view the tape. “They said it was too much for parents to see. I said, ‘then perhaps it’s too much for babies to experience.’”

In 1985, Milos founded NOCIRC. “It’s all such an unspeakable cover-up. The doctors are in denial, so the hospitals are in denial, so the parents are intentionally, illegally uninformed. Circumcision is the worst fraud in American medical history.” Recent studies support Milos’ gut reaction to unanesthetized circumcision. A issue of the Journal of the American Medical Association reported that “newborns…who did not receive an anesthetic suffered great distress during and following the circumcision, and they were exposed to unnecessary risk (from choking or apnea).” The report goes on to say that the skill of the surgeon did not reduce the pain, and that infantile amnesia (the “he-won’t-remember-it-anyway” argument) can’t justify it.
But even if doctors did use anesthesia, the reduction in pain would have to be measured against other concerns, such as the danger of using potent painkillers on day-old babies.

Then there is the question about how long the hurt lasts. “Circumcision causes such traumatic pain in newborns that it may have damaging effects upon the developing brain,” says James Prescott, Ph.D., director of the Institute of Humanistic Science in Long Beach, California. A psychologist who has written extensively on childhood trauma and its long-term effects, Prescott says the stress of circumcision damages the neural systems that mediate genital pleasure. In effect, he says, the baby’s brain is encoded to associate pain with pleasure. In fact, the pain is so severe that it’s not unusual for babies to go into a kind of shock, suddenly becoming silent and ceasing to struggle.

Most of the world’s leading medical establishments have come out against this surgery. “Circumcision of newborns should not be routinely performed,” says the Canadian Pediatric Society. “To circumcise…would be unethical and inappropriate,” says the British Medical Association. The Australasian [Australia and New Zealand] Association of Pediatric Surgeons states: “Neonatal male circumcision has no medical indication. It is a traumatic procedure performed without anesthesia to remove a normal, functional and protective prepuce.”

Kent Kleppinger, M.D., a pediatrician who performs circumcisions, says, “I tell parents circumcision is cosmetic surgery. It isn’t difficult to dissuade the mothers, but the fathers generally override their decisions. They want their boys to look like other boys in the locker room. They want their boys to look like them.”
Like father, like son. This may be one of the hidden reasons why infant boys are still being circumcised in America and may be a round the globe!

It may all come down to the basic human rights of the child. In 1996, the Canadian Medical Association approved a code of ethics that instructs doctors to “refuse to participate in or support practices that violate basic human rights.” This suggests that, in the case of circumcision, parental preference should not override the child’s physical rights to his body.

Margaret Somerville, professor of law and medicine at McGill University in Montreal –Canada and founding director of the Centre for Medicine, Ethics and Law, raised eyebrows at all North American pediatricians by declaring circumcision “technically criminal assault.”
“Once you decide that circumcision is not medically necessary, you take away the therapeutic intent. Take away therapeutic intent, and circumcision becomes an unjustified wounding,” she said.

Leo Sorger, M.D., writing in ObGYN News, is even more explicit: “Circumcision causes pain, trauma, and a permanent loss of protective and erogenous tissue. Removing normal, healthy, functioning tissue [for no medical reason]… violates the United Nations Universal Declaration of Human Rights (Article 5) and the United Nations Convention on the Rights of the Child (Article 13).”
In September 1996, the United States Congress passed a law banning the mutilation of female genitalia. “Americans are horrified by female genital mutilation,” said attorney Svoboda, “but they somehow don’t/didn’t recognize the routine torture going on in their own culture.” He acknowledged that a clitoridectomy is a more serious and detrimental surgery than circumcision, but he argued that “human-rights law doesn’t say if you cut off four toes, it’s a human rights violation, but if you cut off only three, it’s okay. That’s not how human-rights law works. If it’s wrong, it’s wrong. Involuntary circumcision is wrong.”

Why?-(2) Research studies-the most cited studies and probably the most referenced to date. As proving to have broken the camel’s back on circumcision – HIV/AIDS correlation are the two “researches” done in East Africa (Kenya and Uganda). The reports go like this: Adult Male Circumcision Studies-One study included nearly 5,000 men in Rakai, Uganda; the other almost 2,800 men in Kisumu, Kenya. Both were funded by the U.S. National Institute of Allergy and Infectious Diseases (NIAID). The NIAID should ring a loud bell here for those who are interested in looking at its affiliations/intentions and the facts thoroughly!

None of the study participants had been circumcised before the studies started. The report notes. The Ugandan men were 15 to 49 years old; the Kenyan men 18 to 24. They were randomly assigned to get circumcision (surgical removal of the foreskin) right away or after a two-year delay. Both studies enrolled participants by September 2005 and were scheduled to last until the middle of 2007.
That plan changed on Dec. 12, 2006, when researchers reviewed the studies’ interim results, which showed that the men who had gotten circumcised were about half as likely to contract HIV. In the Ugandan study, the circumcised men were 48% less likely to acquire HIV. In the Kenyan study, they were 53% less likely.
Based on those results, the trials were stopped early so any participant who wanted to could get circumcised.

Let’s start with the evidence. Several other studies carried out in Africa including the above two examples are reported to have found a positive correlation between HIV infection and non-circumcised status. Of note is that there are also some studies that have found a negative (read circumcision to increasing the risks of contracting HIV/AIDS) correlation. None of these studies are flawless, however. In some cases the sample size are either too small to give meaningful conclusions, or in some, the methodology are suspect and in others the logical inferences are unsupported by the evidence. That doesn’t mean these studies are without merit. In the best of situations it’s very difficult to conduct a controlled experiment with living human beings. People lie, change/modify their behavior, move, quit, die and worst of all for experimenters – people have rights.

An “ideal” experiment would be to randomly select a large sample of uncircumcised, non-HIV positive participants, circumcise half of them, force them all to repeatedly have sex with HIV infected partners, then conduct tests to see which group (circumcised or uncircumcised) has the highest rate of infection. That would be definitive. This is the only way we could confidently assert that a correlation exists. Alas, any conclusions drawn from any study that falls short of this “ideal” will have to be taken with at least some degree of analytic skepticism i.e. a pinch of salt-maybe?

The studies which allegedly show a reduction in HIV among circumcised men are highly questionable. Not one of them was finished, despite the protective affect appearing to decline well below the often-reported 65%, and several of the subjects disappearing. The fact that one study described circumcision as “comparable to a vaccine of high efficacy” seems to show clear bias. They appear to have been seeking a certain result. One has to wonder how many of the people promoting circumcision in Africa are themselves circumcised. Daniel Halperin is the grandson of a mohel, and seems to think that “maybe in some small way (he’s) destined to help pass along (circumcision)” so his objectivity is questionable.
Other epidemiological studies have shown no correlation between HIV and circumcision, but rather with the numbers of sex workers, or the prevalence of “dry sex”.

The two continents with the highest rates of AIDS are the same two continents with the highest rates of male circumcision. Rwanda has almost double the rate of HIV in circumcised men than the uncircumcised men, yet they’ve just started a nationwide circumcision campaign. Other countries where circumcised men are “more” likely to be HIV+ are Cameroon, Ghana, Lesotho, Malawi, and Tanzania. That’s six countries where men are more likely to be HIV+ if they’ve been circumcised.

Something isn’t right somewhere. Or could it be that these people aren’t interested in fighting HIV, but in promoting circumcision (or sometimes anything-but-condoms), and their actions will cost lives not save them in the long run? Think about it. Given the fact that NIAID doesn’t think there are any implications for U.S. Thus the “African studies will likely not have a large impact on the incidence of HIV/AIDS in the United States or Europe, where heterosexual transmission is low compared with areas like sub-Saharan Africa and parts of Asia,” Bailey one of the two groups who conducted the East Africa “researches” said.

**Below are some of the lists of those who conducted the much cited “African experiment-research”**

1) Weiss HA, Quigley M, Hayes R. [Male circumcision and risk of HIV infection in sub-Saharan Africa: a systematic review and meta-analysis. AIDS 2000; 14:2361-70.]

2) Bailey C, Moses S, Parker CB, et al. [Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomized controlled trial. Lancet 2007; 369: 643-56.]

3) Gray H, Kigozi G, Serwadda D, et al. [Male circumcision for HIV prevention in young men in Rakai, Uganda: a randomized trial. Lancet 2007; 369:657-66.]

4)Auvert B, Taljaard D, Lagarde E, et al. Randomized, controlled intervention trial of [male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS Med 2005; 2(11):e298.]

**Remember the CDC clarifies that it hasn’t made any recommendations on male circumcision to reduce HIV transmission and is studying risks and benefits of circumcision as an HIV prevention strategy.***

If you read those reports, the level of knowledge about HIV is quite frightening. In Malawi for instance, only 57% know that condoms protect against HIV/AIDS, and only 68% know that limiting sexual partners to only trusted and with known HIV negative status protects against HIV/AIDS. There are people who haven’t even heard of condoms. It just seems really misguided to be hailing male circumcision as the way forward. It would help if some of the aid donors didn’t refuse to fund condom education, or work that involves talking to prostitutes. There are prostitutes that sleep with 20-50 men a day, and some of them say that hardly any of the men use a condom. If anyone really cares about men, women, and children dying in Africa, they’d be focusing on education as a toll to teach about safe sex rather than surgery that offers limited protection at best, and runs a high risk of risk compensatory behavior.

**Somebody needs to tell politicians to stick to what they know and do best and not misguide the citizens about health issues. It is not helping, especially Kenyan’s politicians hailing from around the Lake Region- when they promote something that they seem not to have knowledge about or careless to know without consideration of cultural/customs ramifications attached. It is reckless! Hon., the PM. Raila Odinga and others promoting circumcision as a cure/prevention of HIV/IDS. I have to say respectfully , here you are wrong! Citizens need proper and appropriate measures/programs-educational, cultural or otherwise and safe ways to prevent and contain this tragedy. Stop the gimmick already! ****

Some findings have suggested that circumcised male virgins are more likely to be HIV+ than intact male virgins, as the operation sometimes infects men. The latest news is that circumcised HIV+ men appear more likely to transmit the virus to women than intact HIV+ men (even after the healing period is over). Eight additional women appear to have been infected during that study, solely because their husbands were circumcised. This is not the first time that HIV in women has been linked to partner circumcision.
ABC works against HIV. Circumcision appears not to. Remember that circumcision won’t make any difference unless someone isn’t having unsafe sex with an HIV+ partner.

******Why? (3)- TO BE CONTINUED*********

CIRCUMCISION AND HIV/AIDS AS A CURE OR PREVENTIVE?–CONT. PART 5

•September 21, 2008 • 2 Comments

CIRCUMCISION-THERAPEUTIC/NON THERAPEUTIC CONT.

Circumcision -The practice has been performed since ancient times, when it was done as a religious rite or as an initiation of boys into adulthood. Most Jewish and Muslim parents throughout the world today continue to have their sons circumcised for religious and cultural reasons. In the United States overall, the practice is somewhat less common today than it was 50 years ago, but is still done almost routinely with parental consent of course. In the 1800s, it was believed that circumcision helped prevent masturbation. Any circumcised man, however, will tell you this is not true.

Health Issues:

Researchers have attempted to learn more about whether circumcision prevents infection and certain types of cancer, but more studies need to be done to answer these questions. It is known that circumcision prevents infection and inflammation of the foreskin. It seems to decrease the risk of cancer of the penis. This disease occurs in less than one of every 100,000 men in the United States. But there has been a lot of argument in the medical community about circumcision and the risk of cancer.

Some reports quote studies having shown a greater risk of cervical cancer in female sexual partners of uncircumcised men who are infected with human papillomavirus. Circumcision might also have a role in reducing the risk of sexually transmitted diseases. But using a condom is a far more important factor in preventing these diseases than whether a man is circumcised or not!

Cleanliness

Some physicians say circumcision makes it easy to keep the end of the penis clean and easier for the parents of infant boys to keep them clean also. This may be one reason why so many parents were told to circumcise their sons. (This is nothing but, just another speculation)

Other Reasons

Circumcision is often chosen by parents so that their son will not “look different” from his father or peers. The belief is that an intact (uncircumcised) boy will feel uncomfortable if he does not “match” or look-like his others. Many parents say they don’t want their son to feel “strange” or “weird” in the locker room at school.

Phimosis

Phimosis –a condition where the male foreskin cannot be fully retracted from the head of the penis. As most boys are born with a non-retracting foreskin, the term is confusing because it denotes both a normal stage of development, and a pathological condition (i.e. a condition that causes problems for a person). This confusion is particularly pronounced in regard to infants. Conflicting incidence reports and widely varying post-neonatal circumcision rates reflect looseness in the diagnostic criteria Phimosis has become a topic of contention in circumcision debates. It is normal for a baby’s foreskin not to retract, but as the child grows the foreskin is expected to become retractable. Some have suggested that physiological infantile phimosis be referred to as developmental nonretractility of the foreskin to more clearly distinguish this normal stage of development from pathological forms of phimosis. Different management is appropriate. In other words, there are different degrees of phimosis, and treatment may vary on the degree of phimosis.
Women also can suffer from clitoral phimosis.

Infantile or congenital phimosis

For most of the Twentieth Century, most of the medical profession had recognized that most male infants have foreskins which are still attached to the epithelium of the glans penis and cannot easily be retracted. There have been four types of medical responses and attitudes toward this fact:

1.In the first half of the Twentieth Century, some physicians recommended that the foreskin be repeatedly retracted, if necessary with some force, to free it from the glans. It was thought that this could prevent later (pathological) phimosis and urinary problems in older boys by permitting washing of the glans and foreskin. Poor hygiene was thought to predispose to pathological phimosis. This approach has not been recommended by physicians for many decades.
2.Particularly in the middle of the Twentieth Century, some physicians promoted routine neonatal circumcision to avoid phimosis. While circumcision prevents phimosis, at least 10 to 20 infants must be circumcised to prevent each case of potential phimosis according to some incidence statistics. If one believes even lower phimosis incidence estimates, far more must be circumcised to prevent each case of phimosis. While some still promote this view, most pediatricians do not considered it a compelling argument for routine neonatal circumcision.
3.In the last three decades, as the circumcision rate in North America has declined, the most common official recommendations and guidelines from medical societies, as well as infant care books written by experts, have emphasized that it is normal not to be able to retract an infant’s foreskin fully and that it need not be done. The American Academy of Pediatrics recommends gentle soap and water cleaning, but specifically recommends against forcible retraction. There is now some suspicion that forceful retraction that results in inflammation may actually contribute to pathological phimosis at an older age. Although the rate of surgical treatment of phimosis (usually circumcision) is falling, some pediatric urologists have argued that many physicians continue to have trouble distinguishing developmental non-retractility from pathological phimosis, and that phimosis is over diagnosed. Phimosis is sometimes used as a justification for circumcision, so that it will be covered by a national health system or insurance plan. The definition may be stretched by a physician for an older child; particularly where (as in North America), post-neonatal circumcision is usually outpatient surgery by a pediatric urologist, more expensive than the neonatal procedure. Most infantile phimosis is simply physiological.

Though uncommon, phimosis can occasionally lead to urinary obstruction or pain. Causes of pathological phimosis in infancy are varied. Some cases may arise from balanitis (inflammation of the glans penis), perhaps due in turn to inappropriate efforts to separate and retract an infant foreskin. Other cases of non-retractile foreskin may be caused by preputial stenosis or narrowness that prevents retraction, by fusion of the foreskin with the glans penis in children, or by frenulum breve, which prevents retraction. In some cases a cause may not be clear, or it may be difficult to distinguish physiological phimosis from pathological if an infant appears to be in pain with urination or has obvious ballooning of the foreskin with urination or apparent discomfort. However, even ballooning does not always indicate urinary obstruction. There are several management approaches to infant phimosis. Most cases of simple physiological phimosis need no “management” but will disappear with time or simple stretching of the foreskin. Various topical steroid ointments have been effective at hastening separation without surgery. Several surgical techniques have been devised, which range from simple slitting of a segment of the foreskin to removal of it (circumcision).

Acquired phimosis

Phimosis in older children and adults can vary in severity, with some men able to retract their foreskin partially (“relative phimosis”), and some completely unable to retract their foreskin even in the flaccid state (“full phimosis”).
Because of the “elasticity” of the diagnostic criteria, there has been considerable variation in the reported prevalence of pathological phimosis. An incidence rate of 1% to 2% of the uncircumcised adult male population is often cited, though some studies of older children or adolescents have reported higher rates. Relative phimosis is more common, with estimates of its frequency at approximately 8% of uncircumcised men. When phimosis develops in an uncircumcised adult who was previously able to retract his foreskin, it is nearly always due to a pathological cause, and is far more likely to cause problems for the man.
An important cause of acquired, pathological phimosis is chronic balanitis xerotica obliterans (BXO), a skin condition of unknown origin that causes a whitish ring of indurated tissue (a cicatrix) to form near the tip of the prepuce. This inelastic tissue prevents retraction. Some evidence suggests that BXO may be the same disease as lichen sclerosus et atrophicus of the vulva in females. Infectious, inflammatory, and hormonal factors have all been implicated or proposed as contributing factors. Circumcision is usually recommended though alternatives have been advocated.
Phimosis may occur after other types of chronic inflammation (e.g., balanoposthitis), repeated catheterization, or forceful foreskin retraction. Phimosis may also sometimes be brought on by diabetes, due to high levels of sugar being present in the urine of some diabetics, which creates the right conditions for bacteria to breed, under the foreskin.

Potential complications of acquired phimosis

Chronic complications of acquired (pathological) phimosis can include discomfort or pain during urination or sexual intercourse. The urinary stream can be impeded, resulting in dribbling and wetness after urination. Harmful urinary obstruction is possible but uncommon. Pain may occur when a partially retractable foreskin retracts during intercourse and chokes the glans penis. A totally non-retractable foreskin is rarely painful. There is some evidence that phimosis may be a risk factor for penile cancer. The most acute complication is paraphimosis (Paraphimosis image). In this acute condition, the glans is swollen and painful, and the foreskin is immobilized by the swelling in a partially retracted position. The proximal penis is flaccid. Paraphimosis is considered an emergency.

Treatment of phimosis

Phimosis in infancy is nearly always physiological, and needs to be treated only if it is causing obvious problems such as urinary discomfort or obstruction. In older children and adults phimosis should be distinguished from frenulum breve, which more often requires surgery, though the two conditions can occur together.
If phimosis in older children or adults is not causing acute and severe problems, nonsurgical measures may be effective. Choice of treatment is often determined by whether the patient (or doctor) views circumcision as an option of last resort to be avoided or as the preferred course. Some adults with nonretractile foreskins have no difficulties and see no need for correction.
•Circumcision is the traditional surgical solution for pathological phimosis, and is effective. Serious complications from circumcision are very rare, but minor complication rates (e.g., having to perform a second procedure or meatotomy to revise the first or to re-open the urethra) have been reported in about 0.2-0.6% in most reported series, though others quote higher rates. Preputioplasty, in which a limited dorsal slit with transverse closure is made along the constricting band of skin, can be an effective alternative to full circumcision. It has the advantage of only extremely limited pain and a very short time of healing relative to the rather more traumatic circumcision, together with no cosmetic effects.

There is a school of opinion among the medical profession that advocates and promotes a number of alternative methods where surgery, with all the attendant risks, can be avoided.

High rates of success have been reported with several nonsurgical measures:
•Application of topical steroid cream for 4-6 weeks to the narrow part of the foreskin is relatively simple and less expensive than surgical treatments. It has replaced circumcision as the preferred treatment method for some physicians in the U.K. National Health Service. Stretching of the foreskin can be accomplished manually, sometimes with masturbation, also known as the Beaugé method. The stretching can also be accomplished with balloons placed under the foreskin skin under anaesthesia, or with a tool. The tissue expansion promotes the growth of new skin cells to permanently expand the narrow preputial ring that prevents retraction.

Dilation and Stretching

Skin that is under tension expands by growing additional cells. A permanent increase in size occurs by gentle stretching over a period of time. The treatment is non-traumatic and non-destructive. Manual stretching may be carried out without the aid of a medical doctor. The treatment is inexpensive. Relief of phimosis by a stretching technique has the advantage of preserving all foreskin tissue and the sexual pleasure nerves. The Beaugé Method has proved successful for many and also this method was elected the most efficient method by several physicians.

Incidence

A number of medical reports of phimosis incidence have been published over the years. They vary widely because of the difficulties of distinguishing physiological phimosis (developmental nonretractility) from pathological phimosis, definitional differences, ascertainment problems, and the multiple additional influences on post-neonatal circumcision rates in cultures where most newborn males are circumcised. A commonly cited incidence statistic for pathological phimosis is 1% of uncircumcised males. When phimosis is simply equated with nonretractility of the foreskin after age 3 years, considerably higher incidence rates have been reported. Others have described incidences in adolescents and adults as high as 50%, though it is likely that many cases of physiological phimosis or partial nonretractility were included.

Phimosis in some historical references

•According to some accounts, phimosis prevented Louis XVI of France from impregnating his wife, Marie Antoinette, for the first seven years of their marriage. She was 14 and he was 15 when they married in 1770. However, the presence and nature of his genital anomaly is not considered certain, and some scholars (Vincent Cronin and Simone Bertiere) assert that surgical repair would have been mentioned in the records of his medical treatments if it had occurred
•US President James Garfield was assassinated by Charles Guiteau in 1881. The autopsy report for Guiteau indicated that he had phimosis. At the time, this led to the simplistic speculation that Guiteau’s murderous behavior was due to phimosis-induced insanity.

Balanitis

Balanitis- is the inflammation of the glans penis. When the foreskin (or prepuce) is also affected, it is termed balanoposthitis. This may be due to the lack of aeration and irritation because of smegma and discharge surrounding the glans penis causes inflammation and edema.
Inflammation has many possible causes, including irritation by environmental substances, physical trauma, and infection by a wide variety of pathogens, including bacteria, virus, or fungus—each of which require a particular treatment.

Prevalence

Escala and Rickwood, in a 1989 examination of 100 cases of balanitis in childhood, concluded that the risk “in any individual, uncircumcised boy appears to be no greater than 4%.”Oster reported no balanitis in 9545 observations of uncircumcised Danish boys. Balanitis in boys still in nappies must be distinguished from the normal redness seen in boys caused by ammoniacal dermatitis. While any man can develop balanitis, the condition is most likely to occur in men who have a tight foreskin that is difficult to pull back, or who have poor hygiene. Diabetes can make balanitis more likely, especially if the blood sugar is poorly controlled.

Circumcision

Some studies indicate balanitis to be more common in uncircumcised boys but, Van Howe found balanitis only in circumcised boys. Van Howe’s study has been criticized for the fact that few boys were uncircumcised.

Genital washing

Many studies of balanitis do not examine the subjects’ genital washing habits. However, O’Farrell et al. report that failure to wash the whole penis, including retraction of the foreskin in uncircumcised men, is more common among balanitis sufferers. Birley et al., however, found that excessive genital washing with soap may be a strong contributing factor to balanitis.
Diagnosis
Diagnosis may include careful identification of the cause with the aid of a good patient history, swabs and cultures, and pathologic examination of a biopsy.

Complications

Balanitis may cause edema, resulting in phimosis, or inability to retract the foreskin from the glans penis. Adherence of the foreskin to the inflamed and edematous glans penis is the cause.

Zoon’s balanitis

Zoon’s balanitis also known as Balanitis Circumscripta Plasmacellularis or plasma cell balanitis (PCB) is an idiopathic, rare, benign penile dermatosis for which circumcision is often the preferred treatment. Zoon’s balanitis has been successfully treated with the carbon dioxide laser and more recently Albertini and colleagues report the avoidance of circumcision and successful treatment of Zoon’s balanitis with an Er: YAG laser. Another study, by Retamar and colleagues, found that 40 percent of those treated with CO2 laser relapsed.

Circinate balanitis

Circinate balantitis (also known as balanitis circinata) is a serpiginous annular dermatitis associated with Reiter’s syndrome.

Frenulum Breve

Frenulum Breve – is the condition in which the frenulum preputii penis, which is an elastic band of tissue under the glans penis that connects to the prepuce (foreskin) and helps contract the prepuce over the glans, is short and restricts the movement of the prepuce. The frenulum should normally be sufficiently long and supple to allow for the full retraction of the prepuce so that it lies smoothly back on the shaft of the erect penis. The frenulum is comparable to the small band between the tongue’s lower surface and the lower jaw.

Frenulum breve is often complicated by tearing of the frenulum during sexual activity. The torn frenulum results in healing with scar tissue which is less flexible after the incident causing further difficulties.

The diagnosis of frenulum breve is frequently confounded with that of phimosis (an occurrence as well as phimosis is however possible). The condition may be easily treated without major surgery by threading a suture through the lower membrane, and then tying a tight knot around the frenulum itself. After a few days the frenulum will weaken and eventually break apart to allow the prepuce to fully retract. Stretching exercises and steroid creams may also be helpful. Alternatively, it may be treated by a reparative plastic surgery operation called a frenuloplasty, or by complete circumcision including removal of the frenulum (frenectomy).

Masturbation:

It was once believed that circumcision would prevent masturbation, in the 1800s when masturbation was not looked upon as a healthy thing to be doing. Circumcision does not prevent masturbation or increase fertility. The belief that circumcision enhances the sexual experience for men or for their sexual partners may not necessarily be true, either. I can’t confirm or deny this as I am not the only one born with a penis, but many men would say or attest to the fact that they believe they are more ‘sensitive’ because of having a foreskin.

Cancer Risk

It is widely and falsely believed that uncircumcised men stand a greater risk of penile cancer. A big surprise- to many in the medical community who thought otherwise. But, In March of 1999, the American Academy of Pediatrics revised its circumcision policy statement and concluded that there is not sufficient data to support the supposed potential health benefits of circumcision. The organization no longer advocates routine neonatal circumcision. And after the analysis of almost 40 years of available medical research on circumcision in the US, the American Academy of Pediatrics (AAP) issued new recommendations stating that the benefits are not significant enough for the AAP to recommend circumcision as a routine procedure.

The new policy statement was published in the month’s issue of Pediatrics, the journal of the AAP. “Circumcision is not essential to a child’s well-being at birth, even though it does have some potential medical benefits. These benefits are not compelling enough to warrant the AAP to recommend routine newborn circumcision. Instead, we encourage parents to discuss the benefits and risks of circumcision with their pediatrician, and then make an informed decision about what is in the best interest of their child,” says Carole Lannon, M.D., MPH, FAAP, chair of the AAP’s Task Force on Circumcision. The policy concluded, however, that it is legitimate for parents to take into account cultural, religious and ethnic traditions, in addition to medical factors, when making this decision. It states that to make an informed choice, parents of all male infants should be given accurate information and be provided the opportunity to discuss this decision with their pediatrician.” That was their conclusion at that time.

Either way, the eyelid/foreskin is naturally designed to protect the head of the penis from abrasion and infection. Its surface represents 50 percent of all penile skin, and folds around the opening of the penis. Its inside surface is composed of a soft mucosa that secretes antibacterial and antiviral lubricants called smegma, which further protect the glans from friction and infection. Because the glans is sheathed in this moist envelope, it retains its sensitivity. During sex, the foreskin glides along the penile shaft, providing lubrication and stimulation. And some spouses married to uncircumcised husband would say- “There’s a big industry in this country selling lubricants and jellies to enhance sex, but they’re unnecessary for those of us lucky enough to have married an uncircumcised man. An intact man’s glans is naturally moist and juicy.”

*****WHY CIRCUMCISION MAY NOT BE THE ULTIMATE SMOKING GUN ON HIV/AIDS-GIVEN IT’S HISTORY? TO BE CONTINUED**********