Foreskin and the molecular politics of risk.

In this paper, I examine disputes over recent claims that male circumcision reduces HIV risk to suggest a complicated relationship between risk individualization and categorization. Whereas randomized controlled trials (RCTs) conducted in sub-Saharan Africa appear to have provided key evidence for the World Health Organization's endorsement of male circumcision as an HIV prevention strategy, RCTs alone did not provide evidence for the underlying causal mechanism. For that, medical authorities have turned to histo-immunological studies of the foreskin's biomolecular vulnerability to HIV, thus molecularizing risk. Some actors used these studies both as a way of shoring up results of RCTs conducted in sub-Saharan Africa and as an important rationale in arguments for making neonatal circumcision more widely available. Others, however, resisted this move to generalize the RCT results to other parts of the world, citing both contextual differences in HIV transmission patterns and conflicting scientific details regarding the biomolecular basis of the foreskin's susceptibility. Nevertheless, by locating an abstract notion of relative risk in the body itself, I argue that histological studies of foreskin have played a key role in stabilizing male circumcision status as a new risk category, largely independent of a given individual's risk profile.

Risks, benefits, complications and harms: neglected factors in the current debate on non-therapeutic circumcision.

UNLABELLED: Much of the contemporary debate about the propriety of non-therapeutic circumcision of male infants and boys revolves around the question of risks vs. BENEFITS: With its headline conclusion that the benefits outweigh the risks, the current circumcision policy of the American Academy of Pediatrics [AAP] (released 2012) is a typical instance of this line of thought. Since the AAP states that it cannot assess the true incidence of complications, however, critics have pointed out that this conclusion is unwarranted. In this paper it is argued that the AAP's conclusion is untenable not only for empirical reasons related to lack of data, but also for logical and conceptual reasons: the concept of risk employed-risk of surgical complications-is too narrow to be useful in the circumcision debate. Complications are not the only harms of circumcision: the AAP and other parties debating the pros and cons of circumcision should conceptualize their analysis more broadly as risk of harm vs. prospect of benefit, thereby factoring in the value of the foreskin to the individual and the physical and ethical harms of removing it from a non-consenting child.

Why circumcision is a biomedical imperative for the 21(st) century.

Circumcision of males represents a surgical "vaccine" against a wide variety of infections, adverse medical conditions and potentially fatal diseases over their lifetime, and also protects their sexual partners. In experienced hands, this common, inexpensive procedure is very safe, can be pain-free and can be performed at any age. The benefits vastly outweigh risks. The enormous public health benefits include protection from urinary tract infections, sexually transmitted HIV, HPV, syphilis and chancroid, penile and prostate cancer, phimosis, thrush, and inflammatory dermatoses. In women circumcision of the male partner provides substantial protection from cervical cancer and chlamydia. Circumcision has socio-sexual benefits and reduces sexual problems with age. It has no adverse effect on penile sensitivity, function, or sensation during sexual arousal. Most women prefer the circumcised penis for appearance, hygiene and sex. Given the convincing epidemiological evidence and biological support, routine circumcision should be highly recommended by all health professionals.

Female circumcision in Egypt: social implications, current research, and prospects for change.

PIP: The social implications of the practice of female circumcision in Egypt are examined in this paper. Female circumcision is defined as the partial or complete removal of the external female genitalia, varying from removal of the prepuce of the clitoris only to the full excision of the clitoris, the labia minora, and the labia majora. Most Egyptian women are circumcised in the first or second degrees. The practice probably originated in Pharaonic Egypt, in which it was invested with mythological significance. Islamic tradition has reinforced the practice because of the belief that it attenuates sexual desire in women. The legal status is ambiguous. Current research shows that women, especially among lower socioeconomic groups, often do not understand the danger of the operation, which mothers usually cause to be performed on their daughters between the ages of 6 and 10, before the girl reaches puberty. Interviews conducted by the author in a pilot study in 1979 suggest that even in the absence of social and economic change, many uneducated women, given information, will question the validity of female circumcision. This questioning, and the uneducated woman's rejection of the practice, are based on new and emerging values such as respect for modern concepts of health and an enhanced definition of women's identity and roles. Moreover, in most cases, the memory of the operation is sufficiently traumatic so that mere questioning by a trusted service-provider or a friend would receive a positive response. The paper concludes with detailed responses of 4 women interviewed in the pilot study.^ieng