Acupuncture may help some men overcome infertility problems by improving the quality of their sperm, according to a new study.
Researchers found five weeks of acupuncture treatment reduced the number of structural abnormalities in sperm and increased the overall number of normal sperm in a group of men with infertility problems.
They say the results suggest that acupuncture may complement traditional infertility treatments and help men reach their full reproductive potential.
Acupuncture May Ease Male Infertility
An estimated 10% of men are infertile, and the male partner is a factor in up to 50% of infertile couples, write the researchers. In many cases, the cause of male infertility is unknown.
Previous studies of acupuncture and male infertility have suggested that acupuncture can improve sperm production and motility (a measure of sperm movement).
In this study, researchers looked at the effects of acupuncture on the structural health of sperm in men with infertility of unknown cause. The findings appear in the July issue of Fertility and Sterility.
Twenty-eight infertile men received acupuncture treatments twice a week for five weeks, and 12 received no treatment and served as a comparison group.
Researchers analyzed sperm samples at the beginning and end of the study and found significant improvements in sperm quality in the acupuncture group compared with the other group.
Acupuncture treatment was associated with fewer structural defects in the sperm and an increase in the number of normal sperm in ejaculate.
But other sperm abnormalities, such as immature sperm or sperm death, were unaffected by acupuncture.
The researchers write that acupuncture treatment is a simple, noninvasive method that can improve sperm quality.
Tuesday, March 27, 2007
PSA Screening Fails Says Creator
"My one wish with prostate cancer," says Dr. Thomas Stamey, a veteran researcher at Stanford University, "is that before a doctor does anything aggressive, he would tell his patient that all men will develop the disease eventually." He pauses to let the bad news sink in. "The good news," he wants doctors to add, "is that the rate of dying from prostate cancer is infinitesimal."
Stamey has been in a reflective mood of late because of the growing realization, by him and others, that the screening test he helped discover is far less useful for detecting prostate cancer than many had once believed. In 1987, a team led by Stamey found that high levels of prostate-specific antigen (PSA) circulating in the blood were a strong indication of prostate tumors.
Before then, the only way to detect prostate cancer was with a painful biopsy, and this is still used to confirm the disease. But with a simple PSA test , doctors thought they could weed out men who don't need the more invasive procedure, as well as spot tumors at an earlier, more treatable stage.
The test has proven a powerful draw: about half of all men over the age of 50 get annual PSA tests. Now, Stamey hopes that men will be open to the older means of screening for prostate cancer.
"I don't think PSA adds very much," he says.
The End of the PSA Era?
These second thoughts stem from a troubling variety of evidence that suggests widespread testing is possibly causing more harm than good. Although death rates from prostate cancer are lower than they were before PSA screening, these rates have also declined in countries where this type of testing is not commonly used.
If one were to randomly biopsy men, as Dr. Wael Sakr of Wayne State University did on a group who were accidentally killed on the streets of Detroit, about 8 percent of those in their 20s would have prostate cancer, with the rates steadily increasing as men age. Indeed, about 80 percent will develop the disease by the age of 70.
Some of these tumors are clearly dangerous. But most are slow moving, and many prostate cancer patients can go 20 years without any need for treatment, according to a recent study led by Dr. Peter Albertson. With widespread PSA screening picking up these relatively benign tumors, Stamey fears that the tests are leading to unnecessary treatment and worry.
"I've been as guilty as anyone else," he says.
Not everyone is willing to give up on PSA screening quite yet.
"We know it's not a perfect test," says Jamie Bearse, a spokesperson for National Prostate Cancer Coalition, which advocates annual PSA screening for men 40 years and older. Bearse is hopeful that newer screening tests will prove more discerning. In the meantime, he says, the PSA test is the best early detection option men have. "They would rather know, than not know."
Normal vs. Abnormal PSA
Yet it is increasingly hard to determine even a broad risk prediction from PSA testing. Traditionally, doctors used a PSA measurement of 4 as a key cut off point: lower than 4 nanograms per milliliter (ng/mL) in the blood meant that men were considered cancer free, whereas higher or equal to 4 suggested the need for a biopsy to confirm the disease.
But looking at nearly 5,500 men who had a PSA test and then at least one biopsy, researchers found this cutoff point often missed tumors or implied that men had cancers that weren't in fact really there, according to recent results published in the Journal of the American Medical Association.
Indeed, a PSA level of 4.1 ng/mL accurately predicts only 20 percent of prostate cancers and leads to false alarms about 6 percent of the time. Lowering the threshold will detect more cancers, but at the price of causing men to undergo biopsies for no reason or finding many benign tumors that only need to be monitored. A PSA cutoff of 2.1, for example, would yield false readings more than 85 percent of the time to catch only slightly more than half of all tumors.
The authors of the study, led by Dr. Ian Thompson of the University of Texas Health Science Center in San Antonio, call for a substantial "reeducation" effort on the increasingly murky role of PSA. "It will be a challenge to the medical community to change the long held notion that there is a 'normal' PSA level," the authors write.
Researchers still hold out hope for measuring PSA velocity, the rise of PSA over time that gives an indication if the tumor is growing. As an initial detection tool, Stamey says that doctors should return to looking at increasing age, along with a family history of the disease, as a way of determining who may be at greater risk for prostate cancer and in need of a biopsy to catch tumors early.
Other than that, he adds, "We have as much a way of predicting who will need a biopsy based on looking at someone's eyes." Ongoing studies are continuing to look at whether PSA testing saves lives, and the American Cancer Society and other test supporters urge men to discuss the pros and cons of screening with their doctors. But the creator of the PSA test is calling for the end.
"All men will develop a prostate cancer," says Stamey. "That's a given."
Stamey has been in a reflective mood of late because of the growing realization, by him and others, that the screening test he helped discover is far less useful for detecting prostate cancer than many had once believed. In 1987, a team led by Stamey found that high levels of prostate-specific antigen (PSA) circulating in the blood were a strong indication of prostate tumors.
Before then, the only way to detect prostate cancer was with a painful biopsy, and this is still used to confirm the disease. But with a simple PSA test , doctors thought they could weed out men who don't need the more invasive procedure, as well as spot tumors at an earlier, more treatable stage.
The test has proven a powerful draw: about half of all men over the age of 50 get annual PSA tests. Now, Stamey hopes that men will be open to the older means of screening for prostate cancer.
"I don't think PSA adds very much," he says.
The End of the PSA Era?
These second thoughts stem from a troubling variety of evidence that suggests widespread testing is possibly causing more harm than good. Although death rates from prostate cancer are lower than they were before PSA screening, these rates have also declined in countries where this type of testing is not commonly used.
If one were to randomly biopsy men, as Dr. Wael Sakr of Wayne State University did on a group who were accidentally killed on the streets of Detroit, about 8 percent of those in their 20s would have prostate cancer, with the rates steadily increasing as men age. Indeed, about 80 percent will develop the disease by the age of 70.
Some of these tumors are clearly dangerous. But most are slow moving, and many prostate cancer patients can go 20 years without any need for treatment, according to a recent study led by Dr. Peter Albertson. With widespread PSA screening picking up these relatively benign tumors, Stamey fears that the tests are leading to unnecessary treatment and worry.
"I've been as guilty as anyone else," he says.
Not everyone is willing to give up on PSA screening quite yet.
"We know it's not a perfect test," says Jamie Bearse, a spokesperson for National Prostate Cancer Coalition, which advocates annual PSA screening for men 40 years and older. Bearse is hopeful that newer screening tests will prove more discerning. In the meantime, he says, the PSA test is the best early detection option men have. "They would rather know, than not know."
Normal vs. Abnormal PSA
Yet it is increasingly hard to determine even a broad risk prediction from PSA testing. Traditionally, doctors used a PSA measurement of 4 as a key cut off point: lower than 4 nanograms per milliliter (ng/mL) in the blood meant that men were considered cancer free, whereas higher or equal to 4 suggested the need for a biopsy to confirm the disease.
But looking at nearly 5,500 men who had a PSA test and then at least one biopsy, researchers found this cutoff point often missed tumors or implied that men had cancers that weren't in fact really there, according to recent results published in the Journal of the American Medical Association.
Indeed, a PSA level of 4.1 ng/mL accurately predicts only 20 percent of prostate cancers and leads to false alarms about 6 percent of the time. Lowering the threshold will detect more cancers, but at the price of causing men to undergo biopsies for no reason or finding many benign tumors that only need to be monitored. A PSA cutoff of 2.1, for example, would yield false readings more than 85 percent of the time to catch only slightly more than half of all tumors.
The authors of the study, led by Dr. Ian Thompson of the University of Texas Health Science Center in San Antonio, call for a substantial "reeducation" effort on the increasingly murky role of PSA. "It will be a challenge to the medical community to change the long held notion that there is a 'normal' PSA level," the authors write.
Researchers still hold out hope for measuring PSA velocity, the rise of PSA over time that gives an indication if the tumor is growing. As an initial detection tool, Stamey says that doctors should return to looking at increasing age, along with a family history of the disease, as a way of determining who may be at greater risk for prostate cancer and in need of a biopsy to catch tumors early.
Other than that, he adds, "We have as much a way of predicting who will need a biopsy based on looking at someone's eyes." Ongoing studies are continuing to look at whether PSA testing saves lives, and the American Cancer Society and other test supporters urge men to discuss the pros and cons of screening with their doctors. But the creator of the PSA test is calling for the end.
"All men will develop a prostate cancer," says Stamey. "That's a given."
Jerry Lewis Tells of Four-Decade Battle with Chronic Pain
Comic legend Jerry Lewis showed his serious side when he spoke to a rapt audience in Manhattan this week. In fact, he had something in common with almost everyone who came to see him: life-shattering chronic pain. Lewis had an important message: chronic pain is a horrendous burden, but it can be vanquished with the help of a doctor specializing in pain management and the right treatment. A panel of pain management specialists and patients followed Lewis’ emotional presentation.
Lewis explained that his trademark falls, a stunt that made audiences laugh throughout his career, took a terrible toll on his back. Over the years, it kept getting worse, but the “adrenaline rush” made it possible for him to perform. “From 1965 to two years ago, I had the kind of excruciating pain that drove me one minute away from suicide.” If his daughter hadn’t found him with a gun and stopped him, it would all be over, he said.
Dr. Philip Wagner, a pain management specialist at the Hospital for Special Surgery in Manhattan who was on the panel, says chronic pain is grossly undertreated in the United States. And when people fail to find the right doctor and continue to suffer, many feel suicide is their only escape.
Chronic pain is defined as pain that recurs or persists for at least six months. Experts believe it affects 70 million Americans. “For many, it really is a tragedy,” Wagner says. “Advances in the understanding and treatment of chronic pain can significantly improve quality of life, but many people don’t get the help they need. It is important for them to find a caring physician specializing in pain management.”
Most doctors receive little training in the area of pain control, according to Wagner. Pain management is a licensed medical subspecialty that requires extra training. Wagner is an anesthesiologist and internist with a special credential in pain management.
Of the 150 people who came to the conference, many carried canes to help them walk. Others arrived in wheelchairs. Loved ones attended to get information for family members. There seemed to be a sad solidarity among the people in the audience. Some of those who asked questions of the speakers seemed resigned to their suffering, others had a quiet desperation in their voices.
But Jerry Lewis gave them a message of hope and said he was at the conference “to give something back.” After 37 years of suffering and countless doctors’ visits, he finally found relief in the form of a device called a neurostimulator. Permanently implanted near his spine, the device sends mild electrical impulses to the spinal cord to prevent pain signals from traveling to the brain. Lewis controls the electrical impulses by pressing a button. “My whole body tingles… and it opens my garage door,” he joked.
Fifty-three year-old Susan Herfield of Woodbury, Long Island, also told the audience she was helped by the neurostimulator. But not before six years of suffering, after she tripped on a curb and broke her foot. Herfield has a disease called reflex sympathetic dystrophy or RSD. Most often, it develops after an injury and leads to unrelenting pain. After the initial injury heals, the body plays a cruel trick. Nerves misfire and pain signals go awry, continuing to travel to the brain from the injury site. Herfield says excruciating pain tormented her day and night, bringing her to the brink of suicide. “If I didn’t have a family, I would have killed myself,” she said. “It was raw nerve-ending pain – the worst pain that anyone could ever feel.” She said the neurostimulator gave her life back to her.
Wagner cautioned that although many people are helped by the neurostimulator, not everyone is a candidate. It is generally used to treat pain in the back or limbs. But numerous other treatments are available, including pain medications, nerve blocks and complementary therapies, such as relaxation techniques. “People with chronic pain should find a caring doctor with whom they feel comfortable and who acts as a partner in their care,” he said.
Although chronic pain cannot always be completely eliminated, the idea is to help people become more functional and have the life they want to live, according to Wagner. Unfortunately, misconceptions about chronic pain prevent many people from getting the help they need.
Contrary to popular belief, pain medications are not addictive in appropriate cases and help many people to lead satisfying lives, Wagner says. Other myths about chronic pain can be just as damaging, he says. “Sometimes, if the precise medical cause can’t be found, there’s this erroneous notion that the pain is not real. Any time a doctor tells a patient that the pain is ‘in their head,’ he should look for another physician.” Wagner says anyone who believes chronic pain is something they’ll just have to live with is also mistaken. It is not a sign of weakness to seek treatment, and people should not stop until they find a doctor who helps them. Jerry Lewis would surely agree.
Lewis explained that his trademark falls, a stunt that made audiences laugh throughout his career, took a terrible toll on his back. Over the years, it kept getting worse, but the “adrenaline rush” made it possible for him to perform. “From 1965 to two years ago, I had the kind of excruciating pain that drove me one minute away from suicide.” If his daughter hadn’t found him with a gun and stopped him, it would all be over, he said.
Dr. Philip Wagner, a pain management specialist at the Hospital for Special Surgery in Manhattan who was on the panel, says chronic pain is grossly undertreated in the United States. And when people fail to find the right doctor and continue to suffer, many feel suicide is their only escape.
Chronic pain is defined as pain that recurs or persists for at least six months. Experts believe it affects 70 million Americans. “For many, it really is a tragedy,” Wagner says. “Advances in the understanding and treatment of chronic pain can significantly improve quality of life, but many people don’t get the help they need. It is important for them to find a caring physician specializing in pain management.”
Most doctors receive little training in the area of pain control, according to Wagner. Pain management is a licensed medical subspecialty that requires extra training. Wagner is an anesthesiologist and internist with a special credential in pain management.
Of the 150 people who came to the conference, many carried canes to help them walk. Others arrived in wheelchairs. Loved ones attended to get information for family members. There seemed to be a sad solidarity among the people in the audience. Some of those who asked questions of the speakers seemed resigned to their suffering, others had a quiet desperation in their voices.
But Jerry Lewis gave them a message of hope and said he was at the conference “to give something back.” After 37 years of suffering and countless doctors’ visits, he finally found relief in the form of a device called a neurostimulator. Permanently implanted near his spine, the device sends mild electrical impulses to the spinal cord to prevent pain signals from traveling to the brain. Lewis controls the electrical impulses by pressing a button. “My whole body tingles… and it opens my garage door,” he joked.
Fifty-three year-old Susan Herfield of Woodbury, Long Island, also told the audience she was helped by the neurostimulator. But not before six years of suffering, after she tripped on a curb and broke her foot. Herfield has a disease called reflex sympathetic dystrophy or RSD. Most often, it develops after an injury and leads to unrelenting pain. After the initial injury heals, the body plays a cruel trick. Nerves misfire and pain signals go awry, continuing to travel to the brain from the injury site. Herfield says excruciating pain tormented her day and night, bringing her to the brink of suicide. “If I didn’t have a family, I would have killed myself,” she said. “It was raw nerve-ending pain – the worst pain that anyone could ever feel.” She said the neurostimulator gave her life back to her.
Wagner cautioned that although many people are helped by the neurostimulator, not everyone is a candidate. It is generally used to treat pain in the back or limbs. But numerous other treatments are available, including pain medications, nerve blocks and complementary therapies, such as relaxation techniques. “People with chronic pain should find a caring doctor with whom they feel comfortable and who acts as a partner in their care,” he said.
Although chronic pain cannot always be completely eliminated, the idea is to help people become more functional and have the life they want to live, according to Wagner. Unfortunately, misconceptions about chronic pain prevent many people from getting the help they need.
Contrary to popular belief, pain medications are not addictive in appropriate cases and help many people to lead satisfying lives, Wagner says. Other myths about chronic pain can be just as damaging, he says. “Sometimes, if the precise medical cause can’t be found, there’s this erroneous notion that the pain is not real. Any time a doctor tells a patient that the pain is ‘in their head,’ he should look for another physician.” Wagner says anyone who believes chronic pain is something they’ll just have to live with is also mistaken. It is not a sign of weakness to seek treatment, and people should not stop until they find a doctor who helps them. Jerry Lewis would surely agree.
Saturday, March 17, 2007
Peyronie's Disease
Peyronie's disease, a condition of uncertain cause, is characterized by a plaque, or hard lump, that forms on the penis. The plaque develops on the upper or lower side of the penis in layers containing erectile tissue. It begins as a localized inflammation and can develop into a hardened scar.
Peyronie's disease often occurs in a mild form that heals without treatment in 6 to 15 months. But in severe cases, the hardened plaque reduces flexibility, causing pain and forcing the penis to bend or arc during erection.
The plaque itself is benign, or noncancerous. A plaque on the top of the shaft (most common) causes the penis to bend upward; a plaque on the underside causes it to bend downward. In some cases, the plaque develops on both top and bottom, leading to indentation and shortening of the penis. At times, pain, bending, and emotional distress prohibit sexual intercourse.
One study found Peyronie's disease occurring in 1 percent of men. Although the disease occurs mostly in middle-aged men, younger and older men can acquire it. About 30 percent of people with Peyronie's disease develop fibrosis (hardened cells) in other elastic tissues of the body, such as on the hand or foot. A common example is a condition known as Dupuytren's contracture of the hand. In some cases, men who are related by blood tend to develop Peyronie's disease, which suggests that familial factors might make a man vulnerable to the disease.
Men with Peyronie's disease usually seek medical attention because of painful erections and difficulty with intercourse. Since the cause of the disease and its development are not well understood, doctors treat the disease empirically; that is, they prescribe and continue methods that seem to help. The goal of therapy is to keep the Peyronie's patient sexually active. Providing education about the disease and its course often is all that is required. No strong evidence shows that any treatment other than surgery is effective. Experts usually recommend surgery only in long-term cases in which the disease is stabilized and the deformity prevents intercourse.
A French surgeon, François de la Peyronie, first described Peyronie's disease in 1743. The problem was noted in print as early as 1687. Early writers classified it as a form of impotence. Peyronie's disease can be associated with impotence; however, experts now recognize impotence as one factor associated with the disease--a factor that is not always present.
Course of the Disease.
Many researchers believe the plaque of Peyronie's disease develops following trauma (hitting or bending) that causes localized bleeding inside the penis. A chamber (actually two chambers known as the corpora cavernosa) runs the length of the penis. The inner-surface membrane of the chamber is a sheath of elastic fibers. A connecting tissue, called a septum, runs along the center of the chamber and attaches at the top and bottom.
If the penis is abnormally bumped or bent, an area where the septum attaches to the elastic fibers may stretch beyond a limit, injuring the lining of the erectile chamber and, for example, rupturing small blood vessels. As a result of aging, diminished elasticity near the point of attachment of the septum might increase the chances of injury.
The damaged area might heal slowly or abnormally for two reasons: repeated trauma and a minimal amount of blood-flow in the sheath-like fibers. In cases that heal within about a year, the plaque does not advance beyond an initial inflammatory phase. In cases that persist for years, the plaque undergoes fibrosis, or formation of tough fibrous tissue, and even calcification, or formation of calcium deposits.
While trauma might explain acute cases of Peyronie's disease, it does not explain why most cases develop slowly and with no apparent traumatic event. It also does not explain why some cases disappear quickly, and why similar conditions such as Dupuytren's contracture do not seem to result from severe trauma.
Treatment.
Because the plaque of Peyronie's disease often shrinks or disappears without treatment, medical experts suggest waiting 1 to 2 years or longer before attempting to correct it surgically. During that wait, patients often are willing to undergo treatments that have unproven effectiveness.
Some researchers have given men with Peyronie's disease vitamin E orally in small-scale studies and have reported improvements. Yet, no controlled studies have established the effectiveness of vitamin E therapy. Similar inconclusive success has been attributed to oral application of para-aminobenzoate, a substance belonging to the family of B-complex molecules.
Researchers have injected chemical agents such as collagenase, dimethyl sulfoxide, steroids, and calcium channel blockers directly into the plaques. None of these has produced convincing results. Steroids, such as cortisone, have produced unwanted side effects, such as atrophy, or death of healthy tissues. Perhaps the most promising directly injected agent is collagenase, an enzyme that attacks collagen, the major component of Peyronie's plaques.
Radiation therapy, in which high-energy rays are aimed at the plaque, also has been used. Like some of the chemical treatments, radiation appears to reduce pain, yet it has no effect on the plaque itself and can cause unwelcome side effects. Currently, none of the treatments mentioned here has equalled the body's natural ability to eliminate Peyronie's disease. The variety of agents and methods used points to the lack of a proven, effective treatment.
Peyronie's disease has been treated with some success by surgery. The two most common surgical methods are: removal or expansion of the plaque followed by placement of a patch of skin or artificial material, and removal or pinching of tissue from the side of the penis opposite the plaque, which cancels out the bending effect. The first method can involve partial loss of erectile function, especially rigidity. The second method, known as the Nesbit procedure, causes a shortening of the erect penis.
Some men choose to receive an implanted device that increases rigidity of the penis. In some cases, an implant alone will straighten the penis adequately. In other cases, implantation is combined with a technique of incisions and grafting or plication (pinching or folding the skin) if the implant alone does not straighten the penis.
Most types of surgery produce positive results. But because complications can occur, and because many of the phenomena associated with Peyronie's disease (for example, shortening of the penis) are not corrected by surgery, most doctors prefer to perform surgery only on the small number of men with curvature so severe that it prevents sexual intercourse.
Peyronie's disease often occurs in a mild form that heals without treatment in 6 to 15 months. But in severe cases, the hardened plaque reduces flexibility, causing pain and forcing the penis to bend or arc during erection.
The plaque itself is benign, or noncancerous. A plaque on the top of the shaft (most common) causes the penis to bend upward; a plaque on the underside causes it to bend downward. In some cases, the plaque develops on both top and bottom, leading to indentation and shortening of the penis. At times, pain, bending, and emotional distress prohibit sexual intercourse.
One study found Peyronie's disease occurring in 1 percent of men. Although the disease occurs mostly in middle-aged men, younger and older men can acquire it. About 30 percent of people with Peyronie's disease develop fibrosis (hardened cells) in other elastic tissues of the body, such as on the hand or foot. A common example is a condition known as Dupuytren's contracture of the hand. In some cases, men who are related by blood tend to develop Peyronie's disease, which suggests that familial factors might make a man vulnerable to the disease.
Men with Peyronie's disease usually seek medical attention because of painful erections and difficulty with intercourse. Since the cause of the disease and its development are not well understood, doctors treat the disease empirically; that is, they prescribe and continue methods that seem to help. The goal of therapy is to keep the Peyronie's patient sexually active. Providing education about the disease and its course often is all that is required. No strong evidence shows that any treatment other than surgery is effective. Experts usually recommend surgery only in long-term cases in which the disease is stabilized and the deformity prevents intercourse.
A French surgeon, François de la Peyronie, first described Peyronie's disease in 1743. The problem was noted in print as early as 1687. Early writers classified it as a form of impotence. Peyronie's disease can be associated with impotence; however, experts now recognize impotence as one factor associated with the disease--a factor that is not always present.
Course of the Disease.
Many researchers believe the plaque of Peyronie's disease develops following trauma (hitting or bending) that causes localized bleeding inside the penis. A chamber (actually two chambers known as the corpora cavernosa) runs the length of the penis. The inner-surface membrane of the chamber is a sheath of elastic fibers. A connecting tissue, called a septum, runs along the center of the chamber and attaches at the top and bottom.
If the penis is abnormally bumped or bent, an area where the septum attaches to the elastic fibers may stretch beyond a limit, injuring the lining of the erectile chamber and, for example, rupturing small blood vessels. As a result of aging, diminished elasticity near the point of attachment of the septum might increase the chances of injury.
The damaged area might heal slowly or abnormally for two reasons: repeated trauma and a minimal amount of blood-flow in the sheath-like fibers. In cases that heal within about a year, the plaque does not advance beyond an initial inflammatory phase. In cases that persist for years, the plaque undergoes fibrosis, or formation of tough fibrous tissue, and even calcification, or formation of calcium deposits.
While trauma might explain acute cases of Peyronie's disease, it does not explain why most cases develop slowly and with no apparent traumatic event. It also does not explain why some cases disappear quickly, and why similar conditions such as Dupuytren's contracture do not seem to result from severe trauma.
Treatment.
Because the plaque of Peyronie's disease often shrinks or disappears without treatment, medical experts suggest waiting 1 to 2 years or longer before attempting to correct it surgically. During that wait, patients often are willing to undergo treatments that have unproven effectiveness.
Some researchers have given men with Peyronie's disease vitamin E orally in small-scale studies and have reported improvements. Yet, no controlled studies have established the effectiveness of vitamin E therapy. Similar inconclusive success has been attributed to oral application of para-aminobenzoate, a substance belonging to the family of B-complex molecules.
Researchers have injected chemical agents such as collagenase, dimethyl sulfoxide, steroids, and calcium channel blockers directly into the plaques. None of these has produced convincing results. Steroids, such as cortisone, have produced unwanted side effects, such as atrophy, or death of healthy tissues. Perhaps the most promising directly injected agent is collagenase, an enzyme that attacks collagen, the major component of Peyronie's plaques.
Radiation therapy, in which high-energy rays are aimed at the plaque, also has been used. Like some of the chemical treatments, radiation appears to reduce pain, yet it has no effect on the plaque itself and can cause unwelcome side effects. Currently, none of the treatments mentioned here has equalled the body's natural ability to eliminate Peyronie's disease. The variety of agents and methods used points to the lack of a proven, effective treatment.
Peyronie's disease has been treated with some success by surgery. The two most common surgical methods are: removal or expansion of the plaque followed by placement of a patch of skin or artificial material, and removal or pinching of tissue from the side of the penis opposite the plaque, which cancels out the bending effect. The first method can involve partial loss of erectile function, especially rigidity. The second method, known as the Nesbit procedure, causes a shortening of the erect penis.
Some men choose to receive an implanted device that increases rigidity of the penis. In some cases, an implant alone will straighten the penis adequately. In other cases, implantation is combined with a technique of incisions and grafting or plication (pinching or folding the skin) if the implant alone does not straighten the penis.
Most types of surgery produce positive results. But because complications can occur, and because many of the phenomena associated with Peyronie's disease (for example, shortening of the penis) are not corrected by surgery, most doctors prefer to perform surgery only on the small number of men with curvature so severe that it prevents sexual intercourse.
Circumcision. A Barbaric Practice, A Human Rights Violation
I'm going to raise an issue a lot of women and men would rather not think about. Circumcision (also known as male genital mutilation, or "MGM"). I think there are several reasons it's difficult to talk about. First of all, it involves male genitals, which we don't usually like to discuss in polite society. Secondly, it involves a very painful operation done to children, and we would probably rather not think too much about that. Finally, I think many of us aren't quite sure why we do it, and feel the easier option is just not to discuss it. But I think it's important to look at because in many ways it's revealing about the differences between how we view women and men in this culture, differences which in varying ways harm and limit all of us. Male circumcision is closely connected with is closely connected with other forms of male oppression and has much to teach us about our condition. The simple fact that circumcision can happen in this country is astounding. When we are days old, doctors cut off the most sensitive part of our body without anesthesia. The operation is very violent, performed without anesthesia, and unspeakably painful to the infant. The screams, shaking, and frantic attempt by the newborn to escape this unexpected and unbearable pain can be truly horrible to watch, let alone experience. Concrete medical evidence demonstrates that relative to an adult, the circumcision experience is significantly MORE traumatizing to an infant, who has not yet developed methods to cope with pain and whose neurological pathways are not yet fully developed. Researchers found that circumcised boys exhibited, 4-6 months after their circumcisions, heightened physiological pain responses to inoculation shots as compared to girls and boys who had not had the experience of circumcision. The procedure also can cause a broad range of traumas including serious harm to infant neurological development and memory capability, learned helplessness, weakening of the ego, disturbance of sexual identification, disruption of maternal bonding, distrust, suppression of pain and empathy, damage caused by memories of the procedure, and later damage to self-esteem and body image as well as post-traumatic stress disorders. While societies tend to be blind to the horrors they create themselves, anyone must concede that this is brutal and an act of mutilation. This pain in turn causes permanent and irreversible changes in the developing brain, altering portions of the brain responsible for perceiving pain. Developmental neuro-psychologist James Prescott found that domestic levels of violent crime, particularly violent sex-related crimes such as rape, grew in direct proportion to the rise in the number of sexually active circumcised males in American society.
It is worth remembering that the two developed countries in which circumcision is most widely practiced, Israel and the United States, have what many consider to be two of the most violent governments in the world. On a criminal level, we are probably the most violent developed country. Research has suggested that these facts are connected and not simple coincidence. Psychobiological studies support this theory. Circumcision dates from an age when babies were believed not to feel pain. We now know that this is utter nonsense. Concrete medical evidence demonstrates that relative to an adult, the circumcision experience is significantly more traumatizing to an infant, who has not yet developed methods to cope with pain and whose neurological pathways are not yet fully developed. The harm circumcision causes to babies by the severe levels of pain has been repeatedly documented. As developmental neuro-psychologist James Prescott has documented, the rise in violence in our country, particular sex-related violence such as rape, has occurred in proportion to the increase in the number of sexually active circumcised males in American society. As discussed below, the brutality of the early circumcision strongly appears to be one of many factors affecting men who grow up and eventually give this violence back to society. Research also suggests that circumcision causes behavioral changes and that some reported gender differences may actually be a result of circumcision. As is clear from statements by doctors from that period, circumcision of non-Jews started in this country around 100 years ago as a technique to stop young boys from masturbating by reducing our ability to feel. The pain of the operation was explicitly cited by doctors as one "positive" byproduct of the operation. John Harvey Kellogg, creator of Kellogg's Corn Flakes, originally developed as another measure to stop masturbation (!), said of circumcision, "The operation should be performed without anesthetic, as the pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment." By Reducing masturbation, circumcision would supposedly cure a range of diseases including seizures, hip trouble, imbecility, paralysis, epilepsy, etc. As time went on, whenever any new disease would become a subject of social concern, circumcision would be proposed as a cure. Penile cancer, urinary tract infections, venereal disease, AIDS, even uterine cancer in women having sexual relations with men--there was no limit to what this procedure could supposedly cure. Under standard medical practice, amputation is of course the treatment of last resort, only appropriate when other, more conservative measures have failed to correct an actual disease which threatens survival of the organ or the patient. We should be guided by the sort of abhorrence we would have to a suggestion that, for example, a woman's breasts be lopped off due to the high incidence of breast cancer. The foreskin should not receive any less protection under this principle than is enjoyed by every other organ and tissue of our bodies. In order to examine our society's form of childhood genital cutting, we must know what it is that circumcision actually does. American beliefs that circumcision destroys little tissue, and that the tissue lost is of no particular value, are not confirmed by medical research. Medical researchers recently documented that the average circumcision removes over half the genital tissue and many specialized nerve endings, thereby substantially curtailing sexual sensitivity. We should not forget that circumcision, like any medical procedure, also has complications. These occur at a rate of 2-10% depending on the definition of "complication." At least dozens of baby boys needlessly die in the United States every year due to this procedure. This number cannot be precisely determined due to the medical community's practice of attributing circumcision-caused deaths to other reasons such as "hemorrhage."
Circumcision thus causes harm and carries risks. However, unlike other medical procedures, it does not offer any genuine health benefits. All suggested justifications for routine circumcision throughout its 100-year history in the US have failed, including prevention of alcoholism, epilepsy, plague, paralysis, rheumatism, polio, lunacy, tuberculosis, syphilis, cancer, urinary tract infections, and AIDS. The British Medical Association, Canadian Paediatric Society, Australian College of Paediatrics, and even the American Academy of Pediatrics have stated that there is no justification for routine circumcision. Science has thus begun to turn its attention to male circumcision and has corrected many prior misconceptions which are holdovers from the Nineteenth and early Twentieth Centuries. The procedure causes serious harm and lacks medical justification; it should not be tolerated in any civilized society. But it is a money-making operation here and continues despite many doctors' personal disapproval of the procedure. As medical student Franc Garcia has discussed, male circumcision destroys a male's capacity for certain sexual sensations and dulls other sensations. Doctors and medical students have documented the "triple whammy" of lost sexual sensitivity resulting from circumcision. 1. Loss of the foreskin nerves. The inner foreskin possesses a greater density of nerve endings and is probably more erogenous than even the glans. This tremendous amount of sensitivity is lost completely when the foreskin is amputated. Also, the most sensitive part of the penis, the frenulum of the foreskin, is removed in most infant circumcisions. The frenulum is the continuation of the inner foreskin which attaches to the underside of the glans. Thus, circumcision robs us of a large percentage, if not the majority, of erogenous nerve endings to the penis. 2. Damage to the glans. The erogenous sensitivity that remains after circumcision is primarily in the glans. This is further reduced by the removal of the protective foreskin which leaves the glans permanently exposed. The penis head developed over millions of years of evolution as an internal organ, meant to be safely enclosed by the prepuce. The skin covering of the glans IS the foreskin. The glans becomes artificially keratinized (dry, hardened, discolored, and wrinkled) as a result of permanent exposure, and thus significantly less sensitive. 3. Loss of skin mobility. The nerve endings in the glans are best stimulated by a rolling massage action. Direct friction tends to fire off pain receptors causing irritation and also causes further keratinization of the glans. With the skin system of the penis significantly reduced by circumcision, the mobility is essentially gone and now the penis is a static mass with no dynamic self stimulation mechanism. Direct friction is now the primary form of stimulation. So circumcision further reduces erogenous sensitivity in the penis by reducing skin mobility and thus the ability to use the foreskin to massage the glans. Men circumcised in adulthood have summed up the overall difference in sensation as similar to the contrast between seeing in color and seeing in black and white. There is reason to think the loss may be even greater for men circumcised as infants, as most of us were. Sexual pleasure continues to be reduced as circumcised men age until, in many cases, we are left with relatively little sensation. Like many men in their late thirties or early forties, every day I rediscover firsthand the horror of this procedure. I have noticed a dramatic and heartbreaking loss of sensitivity over the last couple of years. This is due to the continual buildup of layers of keratin over the mucous membrane which remains on our penises after the foreskin is removed. Such damage to the penis as described above has a profound impact on a man's well-being and sense of self. Some men who feel mutilated by their circumcisions have reported feeling depressed to the point of suicidality. Some men who understand themselves to be harmed by their circumcisions report deep rage at their parents and/or physicians. Men experiencing these profound feelings of loss and anger generally have little social support, since circumcision is viewed as benign by most American. Some men, upon revealing their distress at having lost a body part they value, have received cruel responses from counselors. Male and societal denial regarding harm does not negate the harm. There are at least two reasons we have not heard a great deal from men angry about or physically damaged by their circumcision. First, the millions of circumcised men who hate what was done to them do not speak out for fear of ridicule. The second reason is that most men are unaware of what they lost. It is important to remember that not only the male victims but society as a whole is denying the existence of harm, a problem which does not, for example, face incest victims. While there is no intent to compare the incest trauma with the trauma of circumcision, at least as a society we have come to recognize the horror of the former. In societies that cut girls' genitals, there are very few women who object to the cutting. Widespread ignorance of the value and function of the destroyed genital parts, combined with culturally conditioned abhorrence of natural genitalia, perpetuate women's silence. Parallel psychosocial dynamics keep men silent in our culture. Circumcision is one more form of institutionalized violence against men. It is, of course, a myth that violence against women is tolerated while violence against men is opposed by society. If anything, the opposite is true; our legislature has passed the astoundingly sexist Violence Against Women Act. When is the last time you heard a politician proposing legislation to stop violence against men? When did you last hear anyone in power even acknowledge that most violence happens to men? Domestic violence occurs roughly equally between the sexes, and yet the disparities in available support are shocking. When you raise these issues, as I have done in my performance pieces, many people rush to "justify" them since men supposedly commit most of the violence. Such blaming of the victim would scarcely be tolerated in a discussion of violence among blacks or poor people, for example. Why is such victim-blaming more acceptable when its target is men? Astoundingly, talk show hosts like Oprah Winfrey can decry female circumcision while somehow believing that male circumcision is all right. I recently lunched with a well-known human rights attorney and law professor in her fifties who had never considered the fact that male circumcision might also be a human rights violation. The denial of male pain and male feelings cuts that deep. Any violation of a woman's genital integrity is recognized as unconscionable violence. How can it possibly be defended as any less reprehensible when carried out against a man? While feminists rightly ask for our support and cooperation in their struggles to stop female circumcision and other abuses, they should correspondingly make common cause with us here to stop mutilation of our bodies. We should demand this minimal support. Many laws against female genital mutilation (FGM) exist around the world, while no law anywhere forbids MGM. Statutes forbidding FGM have become law in California, Delaware, Minnesota, North Dakota, Rhode Island, Tennessee, Wisconsin, Egypt (by decree), Kenya, New Zealand, the Sudan, Sweden, the United Kingdom, New South Wales, Quebec, and Ontario. Recently both this country and Canada passed national legislation criminalizing FGM. These laws are clearly unconstitutional under principles of equal protection enshrined in international human rights law as well as the national law of the United States. Our state and federal laws against female genital mutilation, and the discriminatory failure to outlaw and vilify male genital mutilation, violate equal protection under both international human rights law and the American Constitution. The double-think at play here is breathtaking. Human rights treaties forbid FGM and MGM alike based on such important principles as the rights of the child, the right to freedom of religion, the right to the highest attainable standard of health, and the right to protection against torture. Activists who oppose the horrors of FGM are correct when they introduce absolutist, human rights principles that any violation of genital integrity is a crime and morally indefensible. Human rights principles are indeed absolute ones not subject to a balancing in the scales of international justice relative to other violations. And yet somehow it is still permissible when we do it to boys. The real reason for this double standard lies deep in our different socializations and genetic heritages from thousands of years ago. Men and women are hard-wired to serve different functions. Men have greater upper-body strength and endurance to enable us to serve as hunters and protectors of our people, while women have more connections between the spheres of the brain to link their emotional and thinking sides and facilitate their caring for the young, protecting the hearth and gathering food. Evolution is not destiny, but we are still influenced by this genetic legacy even though in modern society, it no longer serves us well. In addition, certain forms of violence against men are tolerated and even structurally incorporated into our society. Men around the world are systematically compelled to give our bodies and our lives in armed conflict. We are also economically compelled to give our bodies and our lives in the workplace; 94% of all American workplace deaths occur to men. The numbness in our penises resulting from circumcision here in the US parallels the emotional numbness which those in power need for us to have so we will continue to fulfill our roles as producers. If we all get in touch with our feelings and discover our own strength and desires, we may not want to keep working at our often unsatisfying, low-paying and hazardous jobs to produce more profits for those at the top. Circumcision is one of many societal factors helping to keep us disempowered and out of touch with our sexuality and our own great potential. I believe a complementarity of men's and women's oppressions exists, both sides of the same coin impeding us from becoming full beings. As men, we are encouraged to be emotionally and physically numb. We must make war, must not cry or express feelings at work, and are not supposed to be househusbands or even custodial fathers.
We are so accustomed to men being the disposable sex that it has become an invisible cultural assumption. "Women and children first." Women's pain is simply viewed as more important than men's pain, and so we can tolerate a cultural practice of cutting baby boy's genitals. Or of drafting men and not women for war. It is no accident that the same gender which must fight the wars is the one which suffers a childhood slash to the genitals. Historians have documented that in primitive societies circumcision served the explicit goal of preparing young boys to grow up and sacrifice their bodies in battle. In some cultures, boys are forced to cut their penis themselves and must not even grimace as the knife slices through the flesh. Cross-cultural studies demonstrate that the earlier and more violently the circumcision ritual occurs, the more violent is the society. Cultural blindness frequently colors perceptions of human rights issues. Throughout history a broad range of body mutilation practices have been accepted, including footbinding, placing growing children in vases so their bones would be bent to the shape of the vase, and many other forms of genital mutilation of both sexes. As with infant male circumcision, all these practices were carried out without the victim's consent. Circumcision may be facilitated by our culture's myths about men and masculinity. Like women, men grow up in a culture which holds a set of degrading myths about them. We may uncover embedded in American beliefs about circumcision these "original myths" about males: 1) Males are inherently pathological, requiring correction at birth. 2) Male genitalia are not worthy of preservation. 3) Natural male genitalia are a health hazard. 4) Natural male genitalia are inherently unclean. 5) Males do not experience pain; they require no anesthesia.
6) It is better to cut away part of a boy's penis than to give a parent the task of cleaning it. 7) A male's body does not belong to him, but to some social group (religion or medicine) which acts "for his own good." 8) Restraining a male and cutting his genitals is good for him. Feminists have uncovered and worked to correct damaging mythology regarding women's bodies. They also have gathered together libraries of evidence and information regarding women's unique needs from clinicians based on their gender needs and their needs as survivors of female-specific traumas. This feminist work has deeply impacted society at large and clinical practice particularly, resulting in women receiving much more respectful and appropriate therapy. Men suffer a dramatically less recognized, but no less insidious and damaging set of denigrations and false beliefs regarding their bodies and their roles in society. If we listen carefully and heartfully to men's stories, we may discover the destructive impact on male mental health of circumcision and other myths which degrade men. As societal and personal denial about circumcision fades, men may evoke a more compassionate response from their brothers and sisters. Some of us are working to stop this act of violence against our male children. Four organizations in the Bay Area are concerned with circumcision. NOHARMM is a men's awareness and activism organization (PO Box 460795, San Francisco, CA 94146). NORM works to support men who are seeking to restore their foreskin nonsurgically (3205 Northwood Drive #109, Concord, CA 94520, 510- 827-4077). A nurse who was fired years ago for refusing to perform the operation has started a very successful informational and organizing organization, NOCIRC (PO Box 2512, San Anselmo, CA 94979, 415-488-9883). The author recently founded Attorneys for the Rights of the Child (2961 Ashby Avenue, Berkeley, CA 94705, 510-848-4437) to coordinate attorneys around the world in developing legal approaches to stopping circumcision and all other forms of childhood genital mutilation. Other organizations exist around the country. Others of us are using slow skin stretching techniques to "restore" our foreskins. Actually this process only partially heals one of the three harmful effects of circumcision discussed above, namely the loss of covering of the glans. Nevertheless, successful restoring men report significantly improved sensitivity of their glans. Jim Bigelow's excellent book "The Joy of Uncircumcising" (available at bookstores) discusses foreskin restoration techniques and also documents the problems caused by this barbaric practice, as do other books such as Ronald Goldman's ("Circumcision: The Hidden Trauma, $21.95 postpaid from Vanguard Publications, 888-445- 5199), Billy Ray Boyd's ("Circumcision: What it Does," $6.95 plus postage to C. Olson, Box 5100-CB, Santa Cruz, CA 95063-5100) and a poll conducted by the activist organization NOHARMM (Awakenings: A Preliminary Poll of Circumcised Men"; $25 to NOHARMM, PO Box 460795, San Francisco, CA 94146).
Steven Svoboda is a 38-year-old attorney who has reorganized his work life to devote the majority of his time to men's work. He is founder and director of Attorneys for the Rights of the Child, an organization devoted to developing legal approaches to stopping circumcision. He cofounded and serves as Secretary/Treasurer of the Northern California Chapter of the Coalition of Free Men, as well as Archivist and Board Member for the national parent organization. He is writing a book as well as regular articles and letters about men's issues, writing and performing solo theater pieces illustrating men's issues, and doing legal and human rights work on behalf of men.
It is worth remembering that the two developed countries in which circumcision is most widely practiced, Israel and the United States, have what many consider to be two of the most violent governments in the world. On a criminal level, we are probably the most violent developed country. Research has suggested that these facts are connected and not simple coincidence. Psychobiological studies support this theory. Circumcision dates from an age when babies were believed not to feel pain. We now know that this is utter nonsense. Concrete medical evidence demonstrates that relative to an adult, the circumcision experience is significantly more traumatizing to an infant, who has not yet developed methods to cope with pain and whose neurological pathways are not yet fully developed. The harm circumcision causes to babies by the severe levels of pain has been repeatedly documented. As developmental neuro-psychologist James Prescott has documented, the rise in violence in our country, particular sex-related violence such as rape, has occurred in proportion to the increase in the number of sexually active circumcised males in American society. As discussed below, the brutality of the early circumcision strongly appears to be one of many factors affecting men who grow up and eventually give this violence back to society. Research also suggests that circumcision causes behavioral changes and that some reported gender differences may actually be a result of circumcision. As is clear from statements by doctors from that period, circumcision of non-Jews started in this country around 100 years ago as a technique to stop young boys from masturbating by reducing our ability to feel. The pain of the operation was explicitly cited by doctors as one "positive" byproduct of the operation. John Harvey Kellogg, creator of Kellogg's Corn Flakes, originally developed as another measure to stop masturbation (!), said of circumcision, "The operation should be performed without anesthetic, as the pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment." By Reducing masturbation, circumcision would supposedly cure a range of diseases including seizures, hip trouble, imbecility, paralysis, epilepsy, etc. As time went on, whenever any new disease would become a subject of social concern, circumcision would be proposed as a cure. Penile cancer, urinary tract infections, venereal disease, AIDS, even uterine cancer in women having sexual relations with men--there was no limit to what this procedure could supposedly cure. Under standard medical practice, amputation is of course the treatment of last resort, only appropriate when other, more conservative measures have failed to correct an actual disease which threatens survival of the organ or the patient. We should be guided by the sort of abhorrence we would have to a suggestion that, for example, a woman's breasts be lopped off due to the high incidence of breast cancer. The foreskin should not receive any less protection under this principle than is enjoyed by every other organ and tissue of our bodies. In order to examine our society's form of childhood genital cutting, we must know what it is that circumcision actually does. American beliefs that circumcision destroys little tissue, and that the tissue lost is of no particular value, are not confirmed by medical research. Medical researchers recently documented that the average circumcision removes over half the genital tissue and many specialized nerve endings, thereby substantially curtailing sexual sensitivity. We should not forget that circumcision, like any medical procedure, also has complications. These occur at a rate of 2-10% depending on the definition of "complication." At least dozens of baby boys needlessly die in the United States every year due to this procedure. This number cannot be precisely determined due to the medical community's practice of attributing circumcision-caused deaths to other reasons such as "hemorrhage."
Circumcision thus causes harm and carries risks. However, unlike other medical procedures, it does not offer any genuine health benefits. All suggested justifications for routine circumcision throughout its 100-year history in the US have failed, including prevention of alcoholism, epilepsy, plague, paralysis, rheumatism, polio, lunacy, tuberculosis, syphilis, cancer, urinary tract infections, and AIDS. The British Medical Association, Canadian Paediatric Society, Australian College of Paediatrics, and even the American Academy of Pediatrics have stated that there is no justification for routine circumcision. Science has thus begun to turn its attention to male circumcision and has corrected many prior misconceptions which are holdovers from the Nineteenth and early Twentieth Centuries. The procedure causes serious harm and lacks medical justification; it should not be tolerated in any civilized society. But it is a money-making operation here and continues despite many doctors' personal disapproval of the procedure. As medical student Franc Garcia has discussed, male circumcision destroys a male's capacity for certain sexual sensations and dulls other sensations. Doctors and medical students have documented the "triple whammy" of lost sexual sensitivity resulting from circumcision. 1. Loss of the foreskin nerves. The inner foreskin possesses a greater density of nerve endings and is probably more erogenous than even the glans. This tremendous amount of sensitivity is lost completely when the foreskin is amputated. Also, the most sensitive part of the penis, the frenulum of the foreskin, is removed in most infant circumcisions. The frenulum is the continuation of the inner foreskin which attaches to the underside of the glans. Thus, circumcision robs us of a large percentage, if not the majority, of erogenous nerve endings to the penis. 2. Damage to the glans. The erogenous sensitivity that remains after circumcision is primarily in the glans. This is further reduced by the removal of the protective foreskin which leaves the glans permanently exposed. The penis head developed over millions of years of evolution as an internal organ, meant to be safely enclosed by the prepuce. The skin covering of the glans IS the foreskin. The glans becomes artificially keratinized (dry, hardened, discolored, and wrinkled) as a result of permanent exposure, and thus significantly less sensitive. 3. Loss of skin mobility. The nerve endings in the glans are best stimulated by a rolling massage action. Direct friction tends to fire off pain receptors causing irritation and also causes further keratinization of the glans. With the skin system of the penis significantly reduced by circumcision, the mobility is essentially gone and now the penis is a static mass with no dynamic self stimulation mechanism. Direct friction is now the primary form of stimulation. So circumcision further reduces erogenous sensitivity in the penis by reducing skin mobility and thus the ability to use the foreskin to massage the glans. Men circumcised in adulthood have summed up the overall difference in sensation as similar to the contrast between seeing in color and seeing in black and white. There is reason to think the loss may be even greater for men circumcised as infants, as most of us were. Sexual pleasure continues to be reduced as circumcised men age until, in many cases, we are left with relatively little sensation. Like many men in their late thirties or early forties, every day I rediscover firsthand the horror of this procedure. I have noticed a dramatic and heartbreaking loss of sensitivity over the last couple of years. This is due to the continual buildup of layers of keratin over the mucous membrane which remains on our penises after the foreskin is removed. Such damage to the penis as described above has a profound impact on a man's well-being and sense of self. Some men who feel mutilated by their circumcisions have reported feeling depressed to the point of suicidality. Some men who understand themselves to be harmed by their circumcisions report deep rage at their parents and/or physicians. Men experiencing these profound feelings of loss and anger generally have little social support, since circumcision is viewed as benign by most American. Some men, upon revealing their distress at having lost a body part they value, have received cruel responses from counselors. Male and societal denial regarding harm does not negate the harm. There are at least two reasons we have not heard a great deal from men angry about or physically damaged by their circumcision. First, the millions of circumcised men who hate what was done to them do not speak out for fear of ridicule. The second reason is that most men are unaware of what they lost. It is important to remember that not only the male victims but society as a whole is denying the existence of harm, a problem which does not, for example, face incest victims. While there is no intent to compare the incest trauma with the trauma of circumcision, at least as a society we have come to recognize the horror of the former. In societies that cut girls' genitals, there are very few women who object to the cutting. Widespread ignorance of the value and function of the destroyed genital parts, combined with culturally conditioned abhorrence of natural genitalia, perpetuate women's silence. Parallel psychosocial dynamics keep men silent in our culture. Circumcision is one more form of institutionalized violence against men. It is, of course, a myth that violence against women is tolerated while violence against men is opposed by society. If anything, the opposite is true; our legislature has passed the astoundingly sexist Violence Against Women Act. When is the last time you heard a politician proposing legislation to stop violence against men? When did you last hear anyone in power even acknowledge that most violence happens to men? Domestic violence occurs roughly equally between the sexes, and yet the disparities in available support are shocking. When you raise these issues, as I have done in my performance pieces, many people rush to "justify" them since men supposedly commit most of the violence. Such blaming of the victim would scarcely be tolerated in a discussion of violence among blacks or poor people, for example. Why is such victim-blaming more acceptable when its target is men? Astoundingly, talk show hosts like Oprah Winfrey can decry female circumcision while somehow believing that male circumcision is all right. I recently lunched with a well-known human rights attorney and law professor in her fifties who had never considered the fact that male circumcision might also be a human rights violation. The denial of male pain and male feelings cuts that deep. Any violation of a woman's genital integrity is recognized as unconscionable violence. How can it possibly be defended as any less reprehensible when carried out against a man? While feminists rightly ask for our support and cooperation in their struggles to stop female circumcision and other abuses, they should correspondingly make common cause with us here to stop mutilation of our bodies. We should demand this minimal support. Many laws against female genital mutilation (FGM) exist around the world, while no law anywhere forbids MGM. Statutes forbidding FGM have become law in California, Delaware, Minnesota, North Dakota, Rhode Island, Tennessee, Wisconsin, Egypt (by decree), Kenya, New Zealand, the Sudan, Sweden, the United Kingdom, New South Wales, Quebec, and Ontario. Recently both this country and Canada passed national legislation criminalizing FGM. These laws are clearly unconstitutional under principles of equal protection enshrined in international human rights law as well as the national law of the United States. Our state and federal laws against female genital mutilation, and the discriminatory failure to outlaw and vilify male genital mutilation, violate equal protection under both international human rights law and the American Constitution. The double-think at play here is breathtaking. Human rights treaties forbid FGM and MGM alike based on such important principles as the rights of the child, the right to freedom of religion, the right to the highest attainable standard of health, and the right to protection against torture. Activists who oppose the horrors of FGM are correct when they introduce absolutist, human rights principles that any violation of genital integrity is a crime and morally indefensible. Human rights principles are indeed absolute ones not subject to a balancing in the scales of international justice relative to other violations. And yet somehow it is still permissible when we do it to boys. The real reason for this double standard lies deep in our different socializations and genetic heritages from thousands of years ago. Men and women are hard-wired to serve different functions. Men have greater upper-body strength and endurance to enable us to serve as hunters and protectors of our people, while women have more connections between the spheres of the brain to link their emotional and thinking sides and facilitate their caring for the young, protecting the hearth and gathering food. Evolution is not destiny, but we are still influenced by this genetic legacy even though in modern society, it no longer serves us well. In addition, certain forms of violence against men are tolerated and even structurally incorporated into our society. Men around the world are systematically compelled to give our bodies and our lives in armed conflict. We are also economically compelled to give our bodies and our lives in the workplace; 94% of all American workplace deaths occur to men. The numbness in our penises resulting from circumcision here in the US parallels the emotional numbness which those in power need for us to have so we will continue to fulfill our roles as producers. If we all get in touch with our feelings and discover our own strength and desires, we may not want to keep working at our often unsatisfying, low-paying and hazardous jobs to produce more profits for those at the top. Circumcision is one of many societal factors helping to keep us disempowered and out of touch with our sexuality and our own great potential. I believe a complementarity of men's and women's oppressions exists, both sides of the same coin impeding us from becoming full beings. As men, we are encouraged to be emotionally and physically numb. We must make war, must not cry or express feelings at work, and are not supposed to be househusbands or even custodial fathers.
We are so accustomed to men being the disposable sex that it has become an invisible cultural assumption. "Women and children first." Women's pain is simply viewed as more important than men's pain, and so we can tolerate a cultural practice of cutting baby boy's genitals. Or of drafting men and not women for war. It is no accident that the same gender which must fight the wars is the one which suffers a childhood slash to the genitals. Historians have documented that in primitive societies circumcision served the explicit goal of preparing young boys to grow up and sacrifice their bodies in battle. In some cultures, boys are forced to cut their penis themselves and must not even grimace as the knife slices through the flesh. Cross-cultural studies demonstrate that the earlier and more violently the circumcision ritual occurs, the more violent is the society. Cultural blindness frequently colors perceptions of human rights issues. Throughout history a broad range of body mutilation practices have been accepted, including footbinding, placing growing children in vases so their bones would be bent to the shape of the vase, and many other forms of genital mutilation of both sexes. As with infant male circumcision, all these practices were carried out without the victim's consent. Circumcision may be facilitated by our culture's myths about men and masculinity. Like women, men grow up in a culture which holds a set of degrading myths about them. We may uncover embedded in American beliefs about circumcision these "original myths" about males: 1) Males are inherently pathological, requiring correction at birth. 2) Male genitalia are not worthy of preservation. 3) Natural male genitalia are a health hazard. 4) Natural male genitalia are inherently unclean. 5) Males do not experience pain; they require no anesthesia.
6) It is better to cut away part of a boy's penis than to give a parent the task of cleaning it. 7) A male's body does not belong to him, but to some social group (religion or medicine) which acts "for his own good." 8) Restraining a male and cutting his genitals is good for him. Feminists have uncovered and worked to correct damaging mythology regarding women's bodies. They also have gathered together libraries of evidence and information regarding women's unique needs from clinicians based on their gender needs and their needs as survivors of female-specific traumas. This feminist work has deeply impacted society at large and clinical practice particularly, resulting in women receiving much more respectful and appropriate therapy. Men suffer a dramatically less recognized, but no less insidious and damaging set of denigrations and false beliefs regarding their bodies and their roles in society. If we listen carefully and heartfully to men's stories, we may discover the destructive impact on male mental health of circumcision and other myths which degrade men. As societal and personal denial about circumcision fades, men may evoke a more compassionate response from their brothers and sisters. Some of us are working to stop this act of violence against our male children. Four organizations in the Bay Area are concerned with circumcision. NOHARMM is a men's awareness and activism organization (PO Box 460795, San Francisco, CA 94146). NORM works to support men who are seeking to restore their foreskin nonsurgically (3205 Northwood Drive #109, Concord, CA 94520, 510- 827-4077). A nurse who was fired years ago for refusing to perform the operation has started a very successful informational and organizing organization, NOCIRC (PO Box 2512, San Anselmo, CA 94979, 415-488-9883). The author recently founded Attorneys for the Rights of the Child (2961 Ashby Avenue, Berkeley, CA 94705, 510-848-4437) to coordinate attorneys around the world in developing legal approaches to stopping circumcision and all other forms of childhood genital mutilation. Other organizations exist around the country. Others of us are using slow skin stretching techniques to "restore" our foreskins. Actually this process only partially heals one of the three harmful effects of circumcision discussed above, namely the loss of covering of the glans. Nevertheless, successful restoring men report significantly improved sensitivity of their glans. Jim Bigelow's excellent book "The Joy of Uncircumcising" (available at bookstores) discusses foreskin restoration techniques and also documents the problems caused by this barbaric practice, as do other books such as Ronald Goldman's ("Circumcision: The Hidden Trauma, $21.95 postpaid from Vanguard Publications, 888-445- 5199), Billy Ray Boyd's ("Circumcision: What it Does," $6.95 plus postage to C. Olson, Box 5100-CB, Santa Cruz, CA 95063-5100) and a poll conducted by the activist organization NOHARMM (Awakenings: A Preliminary Poll of Circumcised Men"; $25 to NOHARMM, PO Box 460795, San Francisco, CA 94146).
Steven Svoboda is a 38-year-old attorney who has reorganized his work life to devote the majority of his time to men's work. He is founder and director of Attorneys for the Rights of the Child, an organization devoted to developing legal approaches to stopping circumcision. He cofounded and serves as Secretary/Treasurer of the Northern California Chapter of the Coalition of Free Men, as well as Archivist and Board Member for the national parent organization. He is writing a book as well as regular articles and letters about men's issues, writing and performing solo theater pieces illustrating men's issues, and doing legal and human rights work on behalf of men.
A Key To Male Fertility
Until now, mutations of the LH hormone receptor were the only explanation known for sexual precocity in boys. A team at the Institute of Genetics and Molecular and Cellular Biology (IGBMC, CNRS / Inserm / Université Louis Pasteur de Strasbourg)), in collaboration with researchers at the University of Dallas and the University of Louvain, has just identified a key regulator of male fertility, the SHP protein, bringing to light the major role it plays in controlling the synthesis of testosterone and in differentiation of germ cells in mouse testes. This work, published in the journal Genes & Development, suggests that it is worth exploring the signalling pathways controlled by SHP in men suffering from fertility disorders.
Puberty is the result of endocrine alterations programmed from the moment of sexual differentiation in the embryo and fetus. It is characterized by anatomical alterations: the maturation of primary sexual characteristics (penis, scrotum and testes) and the appearance of secondary sexual characteristics (hair growth, breaking of the voice, growth, etc). Such changes are caused by processes within the brain, and in particular by a neuroendocrine gland, the pituitary gland, which secretes two hormones, FSH and LH. Both these hormones act on the testes, causing the production of sperm as well as the secretion of testosterone. Testosterone in particular is responsible for the development of secondary sexual characteristics in boys. At the current time, mutations of the LH receptor are the only known causes of sexual precocity in boys, which shows the important role that this signaling pathway plays in the control of the endocrine system.
At the Institute of Genetics and Molecular and Cellular Biology, a new player which is involved in the sexual maturation of male mice, the SHP protein, has been identified. The team led by Johan Auwerx decided to study the role of this protein in order to obtain a better understanding of the triggering of testosterone synthesis in the testes.
Two models of mouse were used, those which had SHP protein and those that did not. The result was astonishing. The mice without SHP were able to reproduce about a week earlier than the controls. This is a considerable difference since, as a general rule, male mice are sexually mature at 7 or 8 weeks. In addition, regardless of increased activity in the pituitary gland, mice without SHP produce more testosterone prematurely, leading to premature maturation of primary sexual characteristics. At the same time, the SHP protein controls the timing of the differentiation of the germ cells by inhibiting the metabolism of retinoic acids (see illustration). It should therefore be possible to look for mutations of SHP in order to improve our understanding of certain kinds of sexual precocity whose causes are as yet unexplained. It should also be pointed out that, because of the family that it belongs to, SHP is a potential therapeutic target, thanks to the development of new synthetic ligands. This work therefore opens up new prospects for research aimed at improving the production of sperm in men suffering from fertility disorders.
Further research is vital if we are to understand the overall mechanisms involved in sexual maturation in boys. However, these findings mean that we can now identify a new player involved in the control of male fertility.
Puberty is the result of endocrine alterations programmed from the moment of sexual differentiation in the embryo and fetus. It is characterized by anatomical alterations: the maturation of primary sexual characteristics (penis, scrotum and testes) and the appearance of secondary sexual characteristics (hair growth, breaking of the voice, growth, etc). Such changes are caused by processes within the brain, and in particular by a neuroendocrine gland, the pituitary gland, which secretes two hormones, FSH and LH. Both these hormones act on the testes, causing the production of sperm as well as the secretion of testosterone. Testosterone in particular is responsible for the development of secondary sexual characteristics in boys. At the current time, mutations of the LH receptor are the only known causes of sexual precocity in boys, which shows the important role that this signaling pathway plays in the control of the endocrine system.
At the Institute of Genetics and Molecular and Cellular Biology, a new player which is involved in the sexual maturation of male mice, the SHP protein, has been identified. The team led by Johan Auwerx decided to study the role of this protein in order to obtain a better understanding of the triggering of testosterone synthesis in the testes.
Two models of mouse were used, those which had SHP protein and those that did not. The result was astonishing. The mice without SHP were able to reproduce about a week earlier than the controls. This is a considerable difference since, as a general rule, male mice are sexually mature at 7 or 8 weeks. In addition, regardless of increased activity in the pituitary gland, mice without SHP produce more testosterone prematurely, leading to premature maturation of primary sexual characteristics. At the same time, the SHP protein controls the timing of the differentiation of the germ cells by inhibiting the metabolism of retinoic acids (see illustration). It should therefore be possible to look for mutations of SHP in order to improve our understanding of certain kinds of sexual precocity whose causes are as yet unexplained. It should also be pointed out that, because of the family that it belongs to, SHP is a potential therapeutic target, thanks to the development of new synthetic ligands. This work therefore opens up new prospects for research aimed at improving the production of sperm in men suffering from fertility disorders.
Further research is vital if we are to understand the overall mechanisms involved in sexual maturation in boys. However, these findings mean that we can now identify a new player involved in the control of male fertility.
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