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Circumspection on Circumcision – Lessons for India

Byoliveridley

Circumcision May Help Protect Against HIV – washingtonpost.com

Getting circumcised may reduce men’s risk of acquiring HIV, according to a study conducted in Africa. “Our study shows that circumcised men had 53 percent fewer HIV infections than uncircumcised men,” lead study author Robert Bailey, professor of epidemiology at the University of Illinois at Chicago (UIC), said in a prepared statement.

This study, published in The Lancet (registration and kidney donation required!) adds to the growing body of research suggesting that circumcision significantly reduces the incidence of HIV infection. The doubts on circumcision as a protective factor against HIV are falling away.

But, is this a viable public health strategy? In context, the US health and human services reports an 85% reduction in HIV risk through condom usage. This is probably a conservative estimate. There’s no indication yet that the gains from circumcision and condom use together are multiplicative.

Let’s look at India, for instance. Circumcision is not practiced among Hindus. There is no history of circumcision, and when I was growing up, it was clear that circumcision was for Muslims and Muslims only. It was often laughed about and there was a sense of superiority about not having to mutilate. It was a clear distinction setting difference between “us” and “them”. This article by Jaishanker and Haldar provides some perspective on Hindu-Muslim identities.

Apart from that, the other important identity of Muslim males is circumcision. It is found in many riots that Muslims were victimized based on their religious identity. In the riots if the perpetrators or the police are not able to identify victims with their religion they forcefully remove the pants of the victims to check whether they are circumcised or not. Once they find that the victim is circumcised he is targeted without further analysing which community he belongs to.

For example in Bombay riot (1992) there is a case of man who was frisked by the police for assessing whether he was a Muslim. However, out of fear he gave his name as Raju (a Hindu name) the officer made him take out his trousers and, noticed that he was a circumcised Muslim, and fired at him.

No Hindu parent in their right mind would circumcise their male child. It’s that simple. It’s part of the ingrained Hindu psyche that having an uncut member sets us apart from our Muslim brethren.

Nothing has changed about AIDS prevention strategies. But it’s boring to study the same variables all the time, let’s recap them one more time, shall we!

Education and awareness: Look at this picture from India (from the NFHS Survey):
Now tell me that increasing awareness among women and empowering them is not the most important thing you can do!

Condom use = 85% risk reduction

Nothing more to say. Continuing to improve access to condoms is important. Avert indicates that condom use is very state dependent, especially among sex workers, with Tamil Nadu having an 80-90% use rate and Mysore in neighboring Karnataka having a 9% use rate.

Access to antiviral therapy

India is in a lucky position here with a very well established pharmaceutical industry. So, drugs are likely to be available (patent issues notwithstanding). The issue however is with infrastructure, getting the drugs to the right people at the right time. This 2004 paper from the Indian Journal of Medical Ethics indicates that coverage is spotty at best. India’s National AIDs Control Organization (NACO) recognizes this, but in my opinion does not go far enough to provide free/affordable drugs to infected people, especially to prevent mother-child transmission.

So, to cut a long story short, circumcision in India is not likely to be a factor in the pantheon of choices available. We have a long way to go with our other major AIDS prevention challenges, and I hope this circumcision issue does not become an increasing distraction.

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  • | | |

    Shaming People into Pooping Indoors

    Byoliveridley

    Meanwhile, in the other India, people still poop outdoors…

    Using shame to change sanitary habits – Los Angeles Times

    Every morning before sunrise, Ravi Shankar Singh, a cheerful man known to his neighbors as “Luv” Singh, sets out to patrol the potholed roads and rice fields of this north Indian village. He carries a whistle and a flashlight. He sings while he walks. The village’s self-appointed sanitation guardian, Singh is on the lookout for anyone squatting in the fields or alleys, using the cover of darkness to do what millions of people have always done across India: defecate outdoors. After years of programs to increase the number of latrines in villages, the government still has not managed to eradicate a practice that is cited in the spread of water-borne illnesses and parasites, such as diarrhea and hookworms. Critics say the obstacle is not so much the shortage of latrines, though that, too, remains a problem for nearly half of India’s rural population. The main challenge is getting people to use the facilities they have. Singh says he’s found a way. When he spots someone squatting, he lets loose with a blast on his whistle. Or shines his light on the offender. Or both.

    This is clearly a serious public health issue and one that is linked to many avoidable deaths from disease. I am not sure if blowing whistles at people is an ethical way to do it. In a country where actual toilet facilities are still rare, and the people who grew up in this scarcity have internalized the fact that they have to “externalize” their poop, just providing facilities and shaming them is not enough.

    Just as with most things in India, no easy answers, I guess the right combination of education (especially targeting the young), enforcement through fines, and most importantly, saturation coverage of clean and easily available toilets would eventually work.  But it will take time, and of course, public urination is a completely  different beast!

  • |

    Snake Oil Comes a Full Circle

    Byoliveridley

    Ah, back to the good old days of snake oil..

    ScienceDaily: Snake Venom As Therapeutic Treatment Of Cancer?

    This certainly sounds unusual, but Dr. Son and colleagues report on the effectiveness of the snake venom toxin (SVT) Vipera lebetina turanica in the inhibition of androgen-independent prostate cancer (AICAP) in the journal Molecular Cancer Therapeutics.

    These novel findings suggest that SVT can inhibit the growth of AICAP through the induction of cell death.

    I am glad they put the question mark at the end, lest people extrapolate from a few cells in a petri dish (or a small animal study) to a cancer cure, as happened recently with dichloroacetate! Health reporting is very tricky because the average reader cannot understand much more than the headline. It almost seems like every health article should have the following things clearly labeled:

    1. Human, animal or cell?
    2. Clinically tested, or anecdotal?
    3. Double blinded, controlled, etc, or not?
    4. Any chance that this result applies to people?
    5. How far away are we from a real cure?
    6. DO NOT TRY THIS AT HOME!

    At least viper venom is hard to find! The Madras crocodile bank helped start a venom extraction cooperative run by the Irula Tribe, so I’ve seen viper venom being extracted, pretty cool. India is home to two vipers, the Russell’s and the Saw Scaled vipers.

    Russell's
    Russell’s viper

    saw scaled
    Saw scaled viper.

    The Russell’s is 3-5 feet long, and slow, but a big hisser! The saw scaled viper is tiny, a feet or two, but aggressive and very venomous. One of my favorite wild snake sightings was a saw scaled viper, looked very innocuous curled up in a parking lot in Pondicherry.

    Cool, snake oil and venom for all…

  • |

    You breathe in toxic chemicals too.

    Byoliveridley

    Behind a frigging pay wall, as usual! Kelly et al. argue in Science that hydrophobicity, the tendency to favor oil over water (to break it down to the simplest explanation) is not the only factor that explains biomagnification. The underlying theory used to be that compounds that can dissolve in water would swiftly degrade (either chemically or biologically) and not be of any concern to humans. Compounds like dioxins, PCB’s, DDT, etc. accumulated in fat tissue of aquatic animals and these were the compounds that would biomagnify through ingestion (eating!). Kelly et al. uncover another pathway that probably made every scientist go “D’uh”! – Apparently, chemicals animals breathe in can also bioaccumulate if they are not cleared efficiently by the lungs. So, air breathing cows, chickens and pigs can also cause significant bioaccumulation of certain compounds. Which ones? I guess you’ll have to pay to find out more, but this Scientific American article adds some context. Turns out, it is about 10000 chemicals, not all of them known to be harmful, but because they were never suspect, their metabolism is unknown.

    Well, if anything, it will keep the biomonitoring folks busy for a while!

    Chemical Consequences — 317 (5835): 165g — Science

    Global regulators of commercial chemicals apply a scientific paradigm that relates the biomagnification potential of the chemical in food webs to the chemical’s hydrophobicity. However, Kelly et al. (p. 236; see the news story by Kaiser) show that current methods fail to recognize the food web biomagnification potential of certain chemicals. Certain chemicals do not biomagnify in most aquatic food chains, but biomagnify to a high degree in air-breathing animals, including humans, because of low respiratory elimination. Thus, additional criteria for evaluating biomagnification and toxicity in chemicals that biomagnify are required.

  • AARP – Selling to you AND advocating for you at the same time

    Byoliveridley

    Am I just slow on the uptake? How can you simultaneously be an advocate for someone, and also sell them something very expensive and important? If at some point in time, these two tasks conflict, will AARP drop out of the healthcare industry to ensure that its role as advocate does not get compromised? I think not, the conflict of interest simply boggles the mind. How can you write a whole article about this issue and not have CONFLICT OF INTEREST flashing in big bold letters!!

    For example, if it is proven that single payer, universal healthcare was the most effective way to ensure that people 50-64 (before they hit medicare, which used to work very much like single payer healthcare without drug coverage until a really complex and crazy drug insurance was written on top of it) were insured and healthy, how would this affect the AARP? They are now in the business of selling you the health insurance that would be rendered less necessary by said policy, what would the AARP do? Somehow, I don’t see them saying “Yeah, we’ll close our multimillion dollar profit making business because it is the right thing to do”.

    This is ridiculous!

    AARP Says It Will Become Major Medicare Insurer While Remaining a Consumer Lobby – New York Times

    AARP, the lobby for older Americans, announced Monday that it would become a major participant in the nation’s health insurance market, offering a health maintenance organization to Medicare recipients and several other products to people 50 to 64 years old.

    The products for people under 65 include a managed care plan, known as a preferred provider organization, and a high-deductible insurance policy that could be used with a health savings account.

    When the new coverage becomes available next year, AARP will be the largest provider of private insurance to Medicare recipients. In addition to the new H.M.O., AARP will continue providing prescription drug coverage and policies to supplement Medicare, known as Medigap coverage.

    William D. Novelli, the chief executive of AARP, said, “In launching these initiatives, we are driven by our mission to create a healthier America.”

    The group also said it would use its leverage to reshape the health insurance market. The organization has 38 million members, and Mr. Novelli said it hoped to have 50 million by 2011.

    The new Medicare product will be marketed with UnitedHealth Group. Policies for people under 65 will carry the AARP name and will be marketed with Aetna.

  • |

    FDA decides to breed super bugs

    Byoliveridley

    Well, what else can you say about it. This is insanely moronic. Read this sierra club release about the overuse of antibiotics brought on by the overcrowding of animals in food production factories (aka “farms”). Read the whole article and see how much everyone will be endangered so that Intervet, Inc. can make money.

    FDA Rules Override Warnings About Drug – washingtonpost.com

    The government is on track to approve a new antibiotic to treat a pneumonia-like disease in cattle, despite warnings from health groups and a majority of the agency’s own expert advisers that the decision will be dangerous for people. The drug, called cefquinome, belongs to a class of highly potent antibiotics that are among medicine’s last defenses against several serious human infections. No drug from that class has been approved in the United States for use in animals.

    Note, a powerful and potent antibiotic that works well, but is not used much because it’s the last line of defense. But the drug company that manufactures this product cares little about long term efficacy. Their only goal is to maximize short term shareholder value. I don’t blame them, I blame the government for not doing its job, that is, to balance these short term and long term goals and protect the people that pay them a lot of money for this protection.

    The wording of “Guidance for Industry #152” was crafted within the FDA after a long struggle. In the end, the agency adopted language that, for drugs like cefquinome, is more deferential to pharmaceutical companies than is recommended by the World Health Organization.

    Cefquinome’s seemingly inexorable march to market shows how a few words in an obscure regulatory document can sway the government’s approach to protecting public health.

    There’s a reason this present U.S government works in secrecy, so these “obscure” (I am sorry, but nothing that directly affects human health can be called obscure) rule changes will not hit the public eye before it’s too late. Apparently, the FDA can now only consider resistance to food borne diseases in considering an application. That’s like saying that a hospital will only treat victims of food borne diseases, so if you catch the cold, we won’t treat you! This is the Food and Drug Adminstration (all food and all drugs), not the food borne disease protection council.

    This drug is absolutely unnecessary for the following reasons:

    1. The disease it treats (respiratory distress in cows) is brought about by insane levels of animal overcrowding
    2. There are currently a dozen antibiotics for this particular problem, none of which are considered susceptible to resistance
    3. The FDA has previous history with similar public health threats with fluoroquinolones
    4. This drug is considered a last resort drug for antibiotic resistant strains of diseases in cancer patients – So strains resistant to this drug will evolve shortly after the antibiotic is overexposed . This is a death sentence for a lot of very vulnerable people.
    5. A similar drug used in Europe for the last 10 years has resulted in an increase in resistant strains of bacteria.

    This is what you get when you vote for an ideology that hates government. You get a government that hates itself and is busy pawning parts of itself off to its cronies.

  • | |

    Colonialism: Environmental Edition

    Byoliveridley

    Does put recycling in context…

    Independent Online Edition > Environment

    Regardless of how carefully you separate your waste, there is a good chance a disposal firm will dump it all in together with other kinds of plastic trash and ship it to the developing world to be dealt with by a family of migrant workers earning a pittance. They will deal with the salad-bar container, the pistachio ice-cream container and the superfluous bag for carrots in your shopping basket in a variety of different ways – it may be recycled, it may become landfill or it may simply be burnt. Whatever happens, it is generally not a priority for the waste disposal company. Britain dumps around two million tonnes of waste in China every year, everything from plastic mineral water bottles to shopping bags and other forms of superfluous packaging from some of the country’s biggest supermarkets.

    Same for India as well. The article says that all of this “recycling” is illegal. But how do you hide 200,000 tonnes of plastic waste?

    Read the whole article, it is tragic. Some highlights:

    So too are the many and varied health complaints suffered by the local population, who risk multiple skin ailments and exposure to potent carcinogens as they touch the contaminated materials. Poisonous chemical effluents stream into their water supply, turning it black or lurid red, and studies by Greenpeace show that acid rain is the norm in this region. Children are prone to fevers and coughs. Their skin is often disfigured by the toxic plastic waste they have to process.

    A report by the University of Shantou on the town of Guiyu, another Guangdong recycling hub, showed that more than 80 per cent of local children suffer from lead poisoning.

41 Comments

  1. I hope circumcision will become an increasing solution for the extremely serious AIDS problem that India has.

  2. Nice piece on circumcision, HIV and India: I stumbled upon it today AFTER writing something on the issue on my own blog (I am a bioethicist with an interest in the use of circumcision as HIV prevention strategy). And I live in Chapel Hill!

  3. Stuart:

    Thanks, and nice article on your part.

    “The foreskin has geopolitical significance”

    That’s funny and has all kinds of visualization potential! My concern is that this particular debate is too toxic to be touched in India right now, and it detracts from all the other major infrastructure building India has to do to combat the epidemic. I do not want AIDS prevention efforts to be derailed by the circumcision debate. Believe me, words don’t adequately describe how most Hindus feel about this. It is almost like making one eat beef!

  4. Pingback: HIV, male circumcision and India

  5. i think female doc or nurse should not perform in circumcision.in ind there have many muslims.n there hav enough lady doctors who can perform circumcise.max r hindus.so it should be avoideded by muslims to go hindu lady docs

  8. hindu log bina wajah khatna se dar rahe hai khatna ke baad penis kafi achcha dikta hai aur mahilao ko khatna purush zyada pasand haote hai ye mai ek sarve ke baad keh raha hoo

  9. khatna ek bahut hi saral surjery hai or 5 ya 6 din baad zakhm bhar jata hai or zindagi bhar ke lie life aids se siqure ho jati hai to friends be circumsied and save your life , just like me

  10. khatna ke baad ling pehle se jada behtar ho jata hai kyunki bina khatna ling ke niche jo bandh hota hai usse bahut dikkato ka samna karna padta hai meri girl friend mujhe ab pehle se jada pasand karti hai

  11. pata nahi bharat me hi kyu log khatna ke fayde nahi jaante america jaise desh me to har aadmi khatna hai , bina khatna ke waha majaak udaya jata hai

  12. i think circumcision should be must for every man in india, it is the best option fo decrees the rate of hiv aids, and it solved all penis problen

  13. i dont understand , why are indian not being circumcision they are accepting h.i.v but not circumcision

  14. India should adopt infant circumcision at the time of birth for Boys. This will help to fight against HIV.

    1. what a bunch of idiots..blurting some nonsense ….”india should adopt infant circumcision for boys”.

  15. Indian Govt must adopt infant circumcision for boys to curbe HIV and it must be encourage by religious leaders of Hinduism.
    Otherwise unwantedly accepting hiv and dying is not a good thing.

  18. I believe in science than any religion and i wont circumcise my son just to be different from Muslims. There are many advantages of keeping the skin intact our bodies have evolved many millions of years to be what we are and its just the way nature made us. As far Aids and STD’s are concerned just practise safe sex that will provide you 90% immunity .Even if i was circumscised i wont have risky sex the risk chances are far too great.Remember that the % is for only one intercourse. If a circumscised man has two intercourses then then he is equally probable to get Aids

  20. Pingback: Circumcision and AIDS - Revisited « The Olive Ridley Crawl

  22. Mai ek Hindu larki hu maine ek muslim larke se shadi ki hai jub maine usko dekha to uska ling different laga maine poocha to usne subkutch bataya SUTCH ME LING KHATNE KE BAAD BAHUT SUNDER HO JATA HAI.Aur oral sex me bahut anand aata hai, parantu ye prakiriya me kast bahut hota hai.

  25. I do believe that circumcision is more of a hygienic practice. It helps to stop HIV, STDs, and more importat cervical cancer aong women. I would recommend it to eveery mom having a male child.

  26. I think circumcision not make people Hindu or Muslim.Today i want to say to all people that they pramote this in hindu’s men and boyes.It is necessory today to prevent many sexual transmited disease as AIDS GONORRHIA SIPHILIS BREAST CANCER ect.it is simple sergery.Never affraid done it. i am hindu but circumcise.but it not mean i made a Muslim.from this penis make so cute .It also remove the your condom coating problem.which is caused by long prepus.

  27. The question is not values of circumcision, the question is Are hindus aware of it? I am a hindu, while I was a child I had a typical disorder called “Phimosis”, in which the foreskin was tightly attached to my penis. The result was I had fever every month. I was always sick. Upon inspection it was found that bacterial and fungul infections occur when I urinate causing fevers.

    As a child more than me my parents and panel of doctors wanted to save me than hink about religion or other invaluable things in their world. I was circumcised to be saved. Honestly after that I grew to be a healthy boy.

    As for sex, masturbation and erectile functions, I can assure I am as much sexually active as my friends.

    Now, so whats the fear? During riots, like it happened in mumbai, I can be shot. And everyone might think I am muslim. There lies the answer, we hate muslims and they hate us.

    Facts show that circumcised penis not only decreases sexual transmitted disease risks but also acts as a pain comforter while having sex, i never had any pains while having sex. The reason is while intercourse sometimes the foreskin turns over which doesn’t happen if circumsised.

    Also female counterparts are less in agony due to less friction.

    Also a question arises here, is India scientifically backward? I love my India and am sure it’s much more developed than it was in past. We dont talk about circumcision because it’s a ritual common in muslims. But if it’s based on medical surgery, we should not have a problem. As long as we don’t enlighten ourselves without fearing our religious leaders … anyway we are brain dead, what’s the use?

    Think about it, today i can die being shot at by some religious slave (chance is rare though, unless communal riot occurs) after he opens my pant (again a rare chance) who thinks I am a muslim. But again if I was not circumsised, I would have already been dead by the age of 13-14 with bacterial infections and sexually transmitted diseases.

    Thank heavens, I am healthy and I am still living.

    1. Akash it’s the same case with me. No one in my family is cut. I try to hide my penis while peeing in public good to know that i have a cut hindu friend(you). Plz reply soon

      1. Hi Amit. I’m also hindu and circumcised, nobody in my family knows except parents and brother (he is not circumcised). I had same condition of tight foreskin, and when i pulled it back it always bleed around top and bottom, (didnt pull back hard) but could be contributed to my birth. My parents told me the doctor accidentally cut my penis when cutting the cord. I was born in India.

        Anyways I was circumcised in America where I live so I don’t feel that bad. But I always wonder what Hindu women may think about my story?

  28. mughe aapni ek kidney bechna hai . jo aachha paisa de sake jaldi email kare mughe paiso ki sakht jarurt hai. mukesh mo-9540587746

  29. i think khatna male ko to karani chahiye par female ko bhi karani chahiye isse uski vagina kasha aur bhara bhara sa dikhta hai. aur ye jaruri honi chahiye. kyonki bina khatna ke vagina latki aur ghin sa dikhta hai. maie apni aur apni girfriend ko khudse khatna kar di. ab use bhi achchha lagta hai aur mujhe bhi. aur sex mein bhi bahoot maza aata hai

    so femal ko bhi khatna karni chahiye.

    1. To Vinod,
      You must be crazy to think that females should get circumcised as, just because you like the way the vagina looks after the process, that doesn’t mean that you should have told your girlfriend to get circumcised. The vagina is made that way for certain reasons, and if you think that ur girlfriends vagina is loose and hanging, buy her some kind of vaginal cream. I hope you know what complications can be faced for a women if she is circumcised. Just for your pleasure and enjoyment you cannot ask anyone to be circumcised.

      1. Nandini i support u. I am too vehemently against female circumcision. But i am a circumcised hindu male. Do u like a circumcised penis? Do u think a hindu girl will like me?

  30. if it is so necessary then y dont u practise it on both gender its lyk trimming the ears of ur child so he cant wear spectacles it means if a person dont have ears dn he cant wear spects so his eyesight is perfect. It sud b considered as genetial mutilation. if circumscion in gals is considered as mutilation dn y not in boys .it is most disgusting practise ever. it is the reason y men needs viagra in usa cause these deformed mens cant manage a erection themselves due numbness of their glans. If u r doin a circumcision to a male then also ripp off a girl clit and labia cause it will drop her sexual desire and she will never cheat thus aids rate will also decrease and circision trends are decreasin in usa their r a lot complications wid it. Pls dont deform ur child. ab bakchodo hindi me ata hu ye btao agar kat do lund ko bachega kya waise bhi india me hygeine rate low hm angrenjo ki tarah garm pani ke bath tub nange let ke lund nhi dho sakte hain. Foreskin amare lund ko guard krti hai dirt and bacterial infection se nami bana ke rkhti hai warna lund sookh gya to ghanto chuswaoge to bhi khada nhi hoga dats y oral is popular i america . arey bakchodo tm ye sab sirf islie krna chahte ho kyo ki usa me krte hai arey usa me shit sex popular hai to kya sex ke nam pe goo bhi khaoge. Ar maderchodo kisi lund kat ke jindgi kyo barbad kr rhe ho.ar jo ldkia kahti hai kata lund khoobsurat hota hai to jake apni choot ke all external organ hatwa lo badi chikni aur saaf lgegi .usa me gaand merna islie popular ke sale lund pe feel kr nhi pate choot ki tightnees ko islie gand me dale hain extra tightness ke lie india na hi aise facility hain safely kia ja sake ye sb ar agar galti ho gyi to kisi ke bap victim ko apna lund udhar nhi denge ar ye natural hi rhne do. kal ko ldkia apne woobs remove krwa le nhi to ldke attract honge unsafe sex hoga aids rate high ho jayenge. Betichodo free me nirodh milta hai, nhi to aukat ho luxury condome le lo lund katne ki kya jarrorat hai hiv se bachne ke lie?

    I m feeling proud dat i have n intact one not a deformed and mutilated.

  31. There is NO formal evidence that circumcision prevent HIV or other STDs. 75% of the HIV positive men in the US were circumcised as this is a routine practice in big parts of USA. Someone will contract HIV regardless if they are mutilated at birth or not intact if they don’t show cautiousness. The only way to securely avoid HIV is to wear contraception and also test before entering a relationship with someone new. If we stay faithful to our loved one, get tested and engaging in safe sex. Mutilating our children will NOT prevent diseases.

    This is propaganda from the medicine industry to justify their barbaric approach towards infants and children. If someone by the age of 18 decide to do this by own free will or it is medically necessary (such as phimosis treatment, skin infection etc) then its a whole different story. Don’t fix something that’s not broken.

    Let humankind be born the way they are born by the grace of god. Just because Abraham was 99 years old and had a “call from god” to circumcise himself, his sons and every other male i think it’s time to think about the CONS if circumcision as well. In islam it’s more a cultural thing over a religious thing.

  32. india me circumcision turant chalu karna chahiye .aur aids ke prati iske faede se avagat karay jana chahiye.hum samagh dar hai.mai samaghta hun har hindu circumcise hona chahata hai.mai hindu hun aur aids se aur std disease se bachav ke liye maine circumcision karvaya. aur aage iseke badhane ki hardam kosis karunga

  33. Crcumcision has not only advantages but a lot of disadvantages also.Mutilation of a very sensitive and useful body part causes the loss of a large number of nerves and blood vesseles.Erectile dysfnction of the penis is more among circumcised as seen in literatures and uncircumcised people enjoy sex better.That is why in UK and USA infant circumcision rates are rapidly declining.The Govt of Canada and Germany are thinking about banning unnecessary circumcision..
    I was circumcised for medical reasons but dont find anything great out of it.

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