Frank, I am quite pleased that you have finally introduced yourself by name and obviously gender. What is nice Frank is that we both live in a society that still allows people to have the forum to agree to disagree, unlike some other societies miles away. I think we should stop shooting bullets at each other and not only continue to agree to disagree, but understand that you will never get a consensus regarding this subject even if you interview 10,000 scientists, doctors, epidemiologists, researchers, nurses, mothers, and even men themselves.
From your tone, it could be surmised that you yourself are not a "victim" of circumcision. Is that true?? It really doesn't matter, except that I know many Irish Catholics that are circumcised, and admit I don't know as many Irish Protestants to speak with certainty. It doesn't really matter. What really matters is that you sound angry, frustrated, and offensive. I'm not sure if it is your nature or just brought out here with such exclamation. Yes, I am a urologist with over 28 years of both academic, clinical and research experience. I am also one of the few integrative medical urologists in the USA.
Actually, amongst my peers nationwide, I performed less surgery on prostate cancers and question men extensively before they desire vasectomies and even circumcision. When asked upfront by a patient, my usual retort is that if you can keep proper hygiene, which even when instructed is not easy for a lot of men, and if you can easily retract the foreskin for sufficient cleansing, then the need for circumcision is unnecessary.
I am not trying to insult you, but what is your field of interest? You appear to be well-informed and I am curious only.
Some of the arguments that Shaina Gaul originally made in her initial report are flawed. I think that although well-intended, the amount of research that she undertook may have been insufficient. Having said that, the proof is certainly, "in the pudding," as we say. I have interviewed hundreds of patients post operatively, even years after the procedure, and I can count on just a few fingers how many thought that their sexual sensitivity and pleasure in general had changed for the worse. If anything, by and large, the indication for their procedures which I don't want to reiterate again, but found in previous posts, by itself created such a clinical state of improvement in their general genital well-being, not only a better sexual experience. You, Shaina, and I, can cite as many articles asserting both sides of the coin, but like I said, you would be more greatly advantaged if you could clinically interview a great number of these patients for real objectivity. Polls, at best, through research compilation have inherent flaws in subjectivity.
Regarding Jews being insular, the only offense that I felt, my friend, was that you made a generalized statement, too broad and inaccurate. This may speak for the orthodox sect, but not necessarily for all Jews in the US nor around the world. I would also go so far as to allege that Israeli women are not so insular today as they have been culturally portrayed historically. A lot of western influence there. Essentially, yes I am Jewish, and it may come as a shock to you, but we actually don't keep to ourselves in ghettos much anymore.
When you try to make an analogy of the clitoral and penile foreskin being so similar and having same bacterium, you're not entirely wrong. However, if you really take the time to think about it more deeply, the foreskin or distal preputial skin on the male is much more redundant and elongated. Therefore, this makes even the same or similar bacteria vulnerable to being trapped deep within these spaces, especially in tight phimotic states. For this reason alone, many couples fail to be able to stop the spread of yeast infections, historically many years ago a dilemma to practioners. That's not to generalize and say that every man with recurrent yeast infections needs to have a circumcision. Specifically, immunocompromised individuals, ie: diabetics, are so very much more prone to recrudescence of their infections from the sugar rich urine, which is why we are so adamant about controlling their diet and habits.
Each clitoris too is different in anatomical variance. Some have more redundancy to the clitoral hood, and some trap infections more readily due to the inability to retract the redundancy of the tight skin to adequately cleanse. That is why precisely some women are easier to treat than others and also not a rare cause of dyspareunia (painful intercourse). By the way, we don't refer in the Western Hemisphere at least, to cirumcision as "amputation," and certainly no one in their right mind, outside of Africa and some other third world countries, consider amputation of the clitoris other than for purposes of keeping their wives at close bay and not wandering..
What exactly is your extensive experience in counselling young boys, adolescents and adults with regards to "stretching of the frenulum" ??? Please I am not asserting that I know everything about everything, but please point me to some academic journal citations (peer reviewed), describing this alternative procedure to "enlighten me." Thanks.
Once again your over-generalization and taking too many comments out of context is a not so noble trait. Specifically, I have never asserted that to prevent HIV or HPV in men that I personally recommend circumcision. Where did I say that? I only made reference to journal articles. By the way Frank, the vaccines are absolutely worthless for many women that obviously have reached a certain age and will not be benefited what so ever in prevention once already exposed. How are they best counselled? And what about their partners if they are both seen clinically to repetitively bounce back the virus to each other? I am curious,what do you advise this group, besides condom usage, which by the way doesn't protects all genital skin surfaces ?
I glean from your words that you might be a practitioner of homeopathic medicine. I have no problem with that and incorporate this in my practice much more than main stream urologists. I just think that we might be looking at disease from two different perspectives, neither wrong, but different.
When you stated that a 97% figure of patients will develop a "natural immunity," where did you get the figures? Gardasil has only been out for less than four years. It would be too short of an interval, even if you include the R and D studies that preceded this implementation to make such an observation valid. Also is that to state that the need for pap tests in this population therefore would be also, "money driven" ?? or inefficient use of health care dollars? Obama may certainly like your argument after tomorrow. I mean, if far in the majority will develop such a "natural immunity," why should we be so concerned as clinicians???
With respect to HPV and cancers, obviously the money should be spent on education and prevention and not just treatment. The viral strains of HPV, 16 and 18, are the most implicated in the more important epidemiologic problem, that of cervical cancer. If you can change your mindset for a moment about "Jews being so insular around the world," I noticed that you didn't answer my observation completely about the greatly lower incidence of cervical cancer of Jewish wives married to Jewish husbands?? If we can assume that in today's modern society there are cross cultural sexual practices (outside of the ghettos of course).... that would expose this subset population to HPV, why is the incidence of cervical carcinoma so much lower in this population??
IF you know Frank what the mons pubis is actually, then why did you describe it anatomically for men ???????
Continuing to imply that you are narrow-minded or need to get out more often doesn't mean that I am "running out of arguments," trust me. You perhaps need to expand your social-cultural horizons more. Ignorance is bliss. Why don't we stop shooting bullets at each other and concentrate instead on working together as health care providers for the betterment of our patients?? I wonder if Shaina Gaul might reply to our posts? She is actually the originator of the discussion. This will be my last response to this issue. I wish you good luck and health.
Comment Reply
Frank, I am quite pleased that you have finally introduced yourself by name and obviously gender. What is nice Frank is that we both live in a society that still allows people to have the forum to agree to disagree, unlike some other societies miles away. I think we should stop shooting bullets at each other and not only continue to agree to disagree, but understand that you will never get a consensus regarding this subject even if you interview 10,000 scientists, doctors, epidemiologists, researchers, nurses, mothers, and even men themselves.
From your tone, it could be surmised that you yourself are not a "victim" of circumcision. Is that true?? It really doesn't matter, except that I know many Irish Catholics that are circumcised, and admit I don't know as many Irish Protestants to speak with certainty. It doesn't really matter. What really matters is that you sound angry, frustrated, and offensive. I'm not sure if it is your nature or just brought out here with such exclamation. Yes, I am a urologist with over 28 years of both academic, clinical and research experience. I am also one of the few integrative medical urologists in the USA.
Actually, amongst my peers nationwide, I performed less surgery on prostate cancers and question men extensively before they desire vasectomies and even circumcision. When asked upfront by a patient, my usual retort is that if you can keep proper hygiene, which even when instructed is not easy for a lot of men, and if you can easily retract the foreskin for sufficient cleansing, then the need for circumcision is unnecessary.
I am not trying to insult you, but what is your field of interest? You appear to be well-informed and I am curious only.
Some of the arguments that Shaina Gaul originally made in her initial report are flawed. I think that although well-intended, the amount of research that she undertook may have been insufficient. Having said that, the proof is certainly, "in the pudding," as we say. I have interviewed hundreds of patients post operatively, even years after the procedure, and I can count on just a few fingers how many thought that their sexual sensitivity and pleasure in general had changed for the worse. If anything, by and large, the indication for their procedures which I don't want to reiterate again, but found in previous posts, by itself created such a clinical state of improvement in their general genital well-being, not only a better sexual experience. You, Shaina, and I, can cite as many articles asserting both sides of the coin, but like I said, you would be more greatly advantaged if you could clinically interview a great number of these patients for real objectivity. Polls, at best, through research compilation have inherent flaws in subjectivity.
Regarding Jews being insular, the only offense that I felt, my friend, was that you made a generalized statement, too broad and inaccurate. This may speak for the orthodox sect, but not necessarily for all Jews in the US nor around the world. I would also go so far as to allege that Israeli women are not so insular today as they have been culturally portrayed historically. A lot of western influence there. Essentially, yes I am Jewish, and it may come as a shock to you, but we actually don't keep to ourselves in ghettos much anymore.
When you try to make an analogy of the clitoral and penile foreskin being so similar and having same bacterium, you're not entirely wrong. However, if you really take the time to think about it more deeply, the foreskin or distal preputial skin on the male is much more redundant and elongated. Therefore, this makes even the same or similar bacteria vulnerable to being trapped deep within these spaces, especially in tight phimotic states. For this reason alone, many couples fail to be able to stop the spread of yeast infections, historically many years ago a dilemma to practioners. That's not to generalize and say that every man with recurrent yeast infections needs to have a circumcision. Specifically, immunocompromised individuals, ie: diabetics, are so very much more prone to recrudescence of their infections from the sugar rich urine, which is why we are so adamant about controlling their diet and habits.
Each clitoris too is different in anatomical variance. Some have more redundancy to the clitoral hood, and some trap infections more readily due to the inability to retract the redundancy of the tight skin to adequately cleanse. That is why precisely some women are easier to treat than others and also not a rare cause of dyspareunia (painful intercourse). By the way, we don't refer in the Western Hemisphere at least, to cirumcision as "amputation," and certainly no one in their right mind, outside of Africa and some other third world countries, consider amputation of the clitoris other than for purposes of keeping their wives at close bay and not wandering..
What exactly is your extensive experience in counselling young boys, adolescents and adults with regards to "stretching of the frenulum" ??? Please I am not asserting that I know everything about everything, but please point me to some academic journal citations (peer reviewed), describing this alternative procedure to "enlighten me." Thanks.
Once again your over-generalization and taking too many comments out of context is a not so noble trait. Specifically, I have never asserted that to prevent HIV or HPV in men that I personally recommend circumcision. Where did I say that? I only made reference to journal articles. By the way Frank, the vaccines are absolutely worthless for many women that obviously have reached a certain age and will not be benefited what so ever in prevention once already exposed. How are they best counselled? And what about their partners if they are both seen clinically to repetitively bounce back the virus to each other? I am curious,what do you advise this group, besides condom usage, which by the way doesn't protects all genital skin surfaces ?
I glean from your words that you might be a practitioner of homeopathic medicine. I have no problem with that and incorporate this in my practice much more than main stream urologists. I just think that we might be looking at disease from two different perspectives, neither wrong, but different.
When you stated that a 97% figure of patients will develop a "natural immunity," where did you get the figures? Gardasil has only been out for less than four years. It would be too short of an interval, even if you include the R and D studies that preceded this implementation to make such an observation valid. Also is that to state that the need for pap tests in this population therefore would be also, "money driven" ?? or inefficient use of health care dollars? Obama may certainly like your argument after tomorrow. I mean, if far in the majority will develop such a "natural immunity," why should we be so concerned as clinicians???
With respect to HPV and cancers, obviously the money should be spent on education and prevention and not just treatment. The viral strains of HPV, 16 and 18, are the most implicated in the more important epidemiologic problem, that of cervical cancer. If you can change your mindset for a moment about "Jews being so insular around the world," I noticed that you didn't answer my observation completely about the greatly lower incidence of cervical cancer of Jewish wives married to Jewish husbands?? If we can assume that in today's modern society there are cross cultural sexual practices (outside of the ghettos of course).... that would expose this subset population to HPV, why is the incidence of cervical carcinoma so much lower in this population??
IF you know Frank what the mons pubis is actually, then why did you describe it anatomically for men ???????
Continuing to imply that you are narrow-minded or need to get out more often doesn't mean that I am "running out of arguments," trust me. You perhaps need to expand your social-cultural horizons more. Ignorance is bliss. Why don't we stop shooting bullets at each other and concentrate instead on working together as health care providers for the betterment of our patients?? I wonder if Shaina Gaul might reply to our posts? She is actually the originator of the discussion. This will be my last response to this issue. I wish you good luck and health.
March 21, 2010 - 1:18amThis Comment
Reply