Separated at Birth: The Benefits and Detriments of Male Circumcision

As far back as 3000 BC, Egyptians and Aztecs began performing circumcision for purposes of hygiene (Circumcision - History and Recent Trends). A few centuries later, the Old Testament (Genesis 17:10-11) proclaimed “…You shall be circumcised in the flesh of your foreskin, and it shall be a sign of the covenant between [God] and you” (Reading the Old Testament). Then, the procedure gained popularity as a routine surgery in America in the late nineteenth century when in 1896 a very popular parenting book entitled All About Baby recommended circumcision for most boys to “halt the vile habit of masturbation” (Mothers Who Think). Nowadays, sixty percent of American males are circumcised in the United States (Infant Male Circumcision is not in the Best Interests of the Health & Rights of the Child). While there are some minor arguable benefits to circumcision such as reduced risks of urinary tract infections, cancer of the penis, transmitting STDs, there is the possibility of trauma to the infant, infection, and deformities not to mention sex and health risks as adults.

In the U.S., over 1.25 million [male] infants are annually circumcised; that’s more than 3,300 babies each day and one child every 26 seconds (Infant Male Circumcision is not in the Best Interests of the Health & Rights of the Child). In males, circumcision is a surgical procedure that removes some or the entire foreskin from the penis. Most male infants are circumcised at birth in the hospital where they are born. Others are circumcised as part of a religious ceremony. Possible benefits to circumcision are reduced risks of urinary tract infections, reduced risk of penile cancer, and reduced risk of transmitting STDs.

Firstly, it is true that circumcision does reduce the risks of urinary tract infections; however, studies find that urinary tract infections are only reduced during the infant’s first year of life. Secondly, it is proposed that circumcision reduced the risk of penile cancer. According to VHI Healthcare, penile cancer is an “extremely rare cancer” (VHI Healthcare). Also, VHI Healthcare goes on to state that “good personal hygiene is equally protective [against penile cancer as circumcision]” (VHI Healthcare). And thirdly, it is believed that men who are circumcised have less of a chance of transmitting and contracting STDs. This theory is true to a certain extent because according to Maggie Fox of Reuters.com, “sexual intercourse may cause tiny tears in the foreskin, allowing [viruses] into the bloodstream” (Fox). However it is also stated that if a man uses condoms or not is more “important in STD prevention than whether or not he is circumcised.” So while these benefits to a certain extent are valid, the American Academy of Pediatrics states that “the benefits of circumcision are not significant enough to recommend circumcision as a routine procedure” (VHI Healthcare).

In addition to the benefits of circumcision, there are also a number of detriments. Some of the detriments include trauma and shock to the infant, irritation and infection, deformities of the penis, and absence of normal function of the penis. First of all, one major detriment of circumcision is trauma and shock to the infant. A recent study conducted by a group of Canadian researchers concluded that circumcision has “long lasting traumatic effects” on the infant. Researchers “tested 87infants at 4 months and 6 months of age. The boys who had been circumcised were more sensitive to pain than the uncircumcised boys. Differences between groups were significant regarding (1) facial action, (2) crying time, and (3) assessments of pain.” The researchers believe that "neonatal circumcision may induce long-lasting changes in infant pain behavior because of alterations in the infant’s central neural processing of painful stimuli” (Taddio). After being circumcised, the open wound is left confined inside a diaper. The diaper prevents proper airflow to the wound which can interfere with the healing process. Furthermore, the diaper gets filled with urine and feces more than a couple times a day, which can lead to irritation and infection if any of the urine and/or feces gets inside the open wound. Also, due to complications and/or a lack of proper training, batched circumcisions can lead to penile deformities. Most deformities include portions of the foreskin that needed to be removed but were not which can cause psychological issues and self-consciousness. The psychological problems can lead to erectile dysfunction. However, some batched circumcision requires the male to have corrective surgery in order to be able to obtain an erection. Furthermore, a few cases have been so extreme that the entire penis has needed to be surgically removed.

In addition to the trauma and shock to the infant, irritation and infection, and deformities of the penis there is also an absence of normal function of the penis with circumcision. The first function of the foreskin is in protection. Like the female clitoris, the head of the penis is intended by nature to be a protected internal organ. When the foreskin is removed, the head of the penis is no longer protected so keratinization (callusing) occurs which causes a loss of sexual sensation and pleasure.

Also, gliding action is affected when the foreskin is removed. During sexual activity, the foreskin and glans work in together to create a complete sexual response. So a normal sexual response is not happening. Normal functioning also includes the non-abrasive gliding of the penis in and out of itself within the vagina which facilitates smooth and gratifying intercourse. Furthermore, without this gliding action, the corona of the circumcised penis can function as a one-way valve, dragging vaginal lubricants out into the drying air and making artificial lubricants essential for non-painful intercourse.
Thirdly the frenulum connects the inner foreskin to the underside of the glans of the penis. For many intact men, the penile frenulum is a male "G-spot" that is highly pleasurable when repeatedly stretched and relaxed during sexual activity. Depending on the surgical method used, the frenulum is partially to completely destroyed by circumcision

And finally, the foreskin contains several feet of blood vessels, including the frenular artery and branches of the dorsal artery. The loss of this rich vascularization interrupts normal blood flow to the shaft and glans of the penis, damaging the natural function of the penis and altering its development
According to VHI Healthcare, medically, the only valid reasons for male circumcision are Phimosis, Paraphimosis, and Balanitis which are all disorders where the foreskin hinders proper blood flow throughout the penis. Also, penile cancer that affects the foreskin is cause for removal of the foreskin. And finally painful sex due to improper retraction of the foreskin is also means for circumcision (VHI Healthcare). But usually these are not the reasons that male circumcisions are performed. The detriments of male circumcision vastly outweigh the benefits. Furthermore male circumcision is a procedure that should not be performed on all males. The procedure should only be performed if there is a problem affecting the foreskin and the blood flow of the penis, penile cancer, or if there is pain caused by the foreskin. More information should be brought to the parents’ attention as to what exactly they are agreeing when they decide to have their son circumcised.

Going Green: Saving the Planet one Car at a Time

For the past couple of years, global warming has become an important issue in today’s society. Throughout the United States, the Going Green Campaign draws more attention to the detriments global warming brings to the balance of our eco system. As the Earth’s average temperature is rising, glaciers are liquefying, hurricanes are hitting more frequently, and droughts and floods are destroying the land, and global warming is the culprit behind these environmental disasters (Allianz). With this newfound conviction to end global warming, many new innovations are available to aid in conserving energy. One major contribution from car manufacturers has been the introduction of the Hybrid car. Hybrid car engines reduce contaminants that contribute to global warming by one-third (National Resource Defense Council). With the Hybrid being a cross between a gasoline-powered car and an electric car, this technological novelty produces less pollution for the environment by reducing tailpipe emissions and improving mileage which contributes to the efforts to end global warming (How Hybrid Cars Work).

Remarkably, the Hybrid car gets around twenty to thirty more miles per gallon than standard automobiles. With the Hybrid car, mileage efficiency can be enhanced by having a smaller engine, lighter parts, and by reducing the number of cylinders. According to Nice and Layton, “composite materials like carbon fiber or lightweight metals like aluminum and magnesium can be used to reduce weight” in the Hybrid car’s structure (How Hybrid Cars Work). “A lighter vehicle” like the Hybrid “uses less energy each time you accelerate or drive up a hill” (How Hybrid Cars Work) which in turn will increase gas mileage. Also, the Hybrid car has a smaller engine which helps extend mileage. Most automobiles need a moderately large engine to create a sufficient amount of energy in order to rapidly accelerate. By making the engine smaller, it is more energy efficient. Furthermore, larger engines usually have additional cylinders, and each cylinder uses fuel every time the engine fires, even if the car is not in motion. So by constructing the Hybrid car with a smaller engine, making it have lighter parts, and lessening the number of cylinders, less gas per mile is achieved. By being able to use less gas per mile because of their design, Hybrid cars add to the fight against global warming.

While the Hybrid car gets more miles to the gallon, it also reduces tailpipe emissions such as carbon dioxide. According to Nice and Layton, the only requirements an automobile must meet to be marketed is it has to (1) “drive at least three hundred miles before re-fueling,” (2) “be refueled quickly and easily,” and (3) “keep up with the other traffic on the road” (How Hybrid Cars Work). While a gasoline-powered automobile meets these standards, it generates a hefty amount of pollution. An electric automobile, on the other hand, produces almost no pollution; however, it only can reach between fifty and one-hundred miles between recharges. By combining the gas-powered and electric car, the Hybrid is a “compromise.” It attempts to considerably “reduce the emissions of a gas-powered car while overcoming the shortcomings of an electric” (How Hybrid Cars Work). This is vital because from their tailpipes, cars release a pollutant called carbon dioxide. Scientists believe that the carbon dioxide emitted from cars contributes to global warming. Furthermore, an automobile that burns two times as much gas adds twice as much carbon dioxide in to the environment (How Hybrid Cars Work). So, Hybrid cars are aiding in the stop of global warming by reducing carbon dioxide tailpipe emissions by having a more energy efficient car.

In order to help cut global warming pollution, it is vital to incorporate conserving energy into a daily routine. Nowadays, the total carbon dioxide annually dumped into the atmosphere is one ton per person (Global Warming). Every time a more eco friendly product is purchased, it is contributing to the fight against global warming. Biodegradable and reusable products, even though small steps, assist the fight. Even a compact fluorescent light bulb when chosen over an incandescent bulb, keep nearly seven hundred pounds of carbon dioxide out of the atmosphere (Natural Defense Council). Like the compact fluorescent light bulb, Hybrid cars are just one more step toward helping the eco system and one more step toward immensely contributing to the efforts to end global warming.

Brain Dysfunction: Left Syndrome Hemineglect

Suppose one morning mom wakes up and noises indicate that she is primping herself in the bathroom. The blow-dryer flips on and off, her lipstick opens and closes, and scurrying through the make-up bag indicates that once again mom can not find her waterproof mascara. When she exits the bathroom and sits down to a plate of warm breakfast in front of her, horror is the only reaction. Mom’s hair is only brushed and styled on the right side—the left is still mangled and dripping wet from her shower. Mom has also only applied blush, lipstick, mascara, and eye shadow to right side of her face as well. Upon closer inspection she has also finished her breakfast and the left side is untouched. Mom gets up to leave the table not noticing a single difference between today and any other day. A short jaunt to the doctor, and a few psychological tests later, it is revealed that grandma has not gone crazy but is suffering from Hemineglect (Blakeslee & Ramachandran, 1998).

What is Left Hemineglect Syndrome?

In order to understand this condition, let’s break down the word. “Left” refers to the fact that this ailment directly affects the right hemisphere of the brain because the right brain controls the left area of the body. Hemineglect refers to “half” being neglected which is literally what happens. An entire half of the body (the left half) is neglected and neglect is, according to Meyers and Bierig, “…the inability of a patient to report or respond to a stimulus presented contralateral to the damaged hemisphere.”

However, Hemineglect presents itself in different intensities. “Left Hemineglect syndrome can range in severity from a simple rightward attentional bias to an inability to recognize one’s extremities are actually a part of one’s own body” (Bierig & Meyers, 2000).

What causes Hemineglect?

Hemineglect occurs when there is damage to the right hemisphere of the brain, often times following a stroke. The right hemisphere is now known to be central in (1) emotional behavior, (2) paralinguistic tasks, (3) facial recognition and most importantly (4) spatial attention (Bierig & Myers, 1998). Spatial attention with hemineglect patients is geared toward making all the attention focus in on the right of the visual field making it as if the left side is gone.

Signs of Hemineglect

There are a few exercises that will reveal the presence of hemineglect. One exercise is drawing. In pictures copied by a patient with hemineglect, there will be a tendency for leaving the left side of the drawing to be absent as seen in the figure to the right. The picture to the left is the original. The picture to the right is the drawing a patient with hemineglect created based off the original. As one will notice, the original clock includes all 12 numbers spaced equally around the circle whereas the patient’s drawing only includes numbers 1-7 and a good majority on the patient’s clock left side is blank. In regard to the houses, it is almost identical to the clocks; the right side of the drawing is packed with a mirror image of the original but the left side is again absent (Blakeslee & Ramachandran, 1998).

Elderly stroke Patients: Evaluation of a test battery for Hemineglect

This study was put together to (1) “measure performance of healthy elderly subjects on a better of validated tests for hemineglect in order to establish appropriate cut-off score” and (2) “to assess performance of a large sample of elderly stroke patients in a rehabilitation unit, using the same battery” (Bailey, et al., 2000).

The sample size had suffered from a stroke with in the past twelve months. There were 23 men and 23 women. 10 of those patients had brain damage to the right side, and 34 patients had left-sided damage, and 2 had bilateral damage. Within the control study there was another 43 non-brain damaged subjects willing to participate. Each subject was given the battery of tests which took twenty minutes per person. There were seven tests total. The tests consisted of star cancellation, line bisection, copy-a-daisy, the baking tray task, draw-a-clock, exploratory motor task, and personal neglect (Bailey, et al., 2000).

In the star cancellation, the subject was given a pen in which he/she was to cancel out as many stars as they could. There were “52 large stars on a page, 10 short words and 13 letters, randomly positioned with 56 small stars interspersed. The subjects were instructed to cross out…all the small starts” (Bailey, et al., 2000).

Next, the subjects were given 24 lines to bisect. The idea of this test was to see how close the subjects could get to the middle of the line.

Then, the subjects were instructed to copy-a-daisy. This was a task where they had to copy an image of a flower.

Next, the baking tray was a whiteboard that was about the size of a real baking tray where the subject had to, as symmetrically as they could, place fake buns across the white board. After, they were asked to draw a clock. In order to standardized this, a point scale was instituted ranging from 4 -1.

Then, the exploratory motor task was a blind-folded task. The subjects had a certain number of objects put on a board. They were not instructed as to how many objects there actually were. Once they believed they were done, they had to say “finished.”

And finally, the “subjects were presented with 3 objects, on at a time: (1) comb; (2) razor (for men), powder compact (for women); (3) spectacles.” Subjects were asked to show the instructors how each item was used. Scoring was on a scale from 0-3.

The results revealed that, “hemineglect is not a single entity and requires a range of tests to be used to maximize the possibility of identifying neglect disorder and to distinguish the selective impairments” (Bailey et al., 2000). This battery of tests paved the way for more precise treatment options and a better understanding of hemineglect and what exactly it affects (Bailey et al., 2000).

Treatment: Optokinetic Stimulation

A study was put together to show the potential of Optokinetic Stimulation (OKS). Ten participants with left-sided chronic neglect were given a batter of tests. The neglect screening broke the ten participants into two groups of five each. The first group of five was to receive the OKS. The other group of five was used as a control group to compare the success of the treatment (Keller & Kerkhoff, 2006).

The participants were put through a series of tests which included cancellation tests, reading tests, and line bisection. During the cancellation test, participants were instructed to use a pen to cancel out numbers “1” and “9” from a total of 200 numbers ranging from 0-9. Then, the reading test was screening for neglect dyslexia. The patients were asked to read 55 words. The text was located in the center of a monitor at a distance of 0.4 m. The test giver was looking for words that were left out and if the patient substituted all or part of certain words. And finally, the last task was line bisection where they were instructed to put a mark where they thought the line’s middle is located (Keller & Kerkhoff, 2006).

Next, OKS was administered to the first group of five participants. Thirty to seventy dots appeared on a 17” screen. The dots kept moving slowly more and more to the left. No movement of their head was allowed. Speed of the dots was constantly varied depending on the attention span of the patients. The participants completed the OKS exercise four times each session with ten minute breaks (Keller & Kerkhoff, 2006).

Then, the second group of five, which was the control group, was given the same OKS treatment only the dots that were on the screen remained still instead of moving to the left. They were also given this exercise four times a session with ten minute breaks (Keller & Kerkhoff, 2006).

According to Keller and Kerkhoff, OKS directs “attention towards neglected regions of space. This improved attention allocation lead to subsequent improvements in all visual neglect tasks requiring systematic leftward exploration, as in cancellation, reading, size comparisons or line bisection” With the limited amount of resources available to treat

Treatment: Virtual Reality (VR)

Developed by the Kaiser Rehabilitation Center, a Virtual Reality system assesses the severity of Left Hemineglect Syndrome and offers possible treatment with their new technology design. The Virtual Reality uses a tracking and cueing program which gauges the individual’s responses within the VR environment. The new Virtual Reality innovation offers “accurate and consistent assessment, therapy, and outcome measurements.” The Virtual Reality simulation is made up of a three room home and a backyard. Kaiser’s Virtual Reality Tracking and Cueing Program (VRTC) “measures (1) maximum angle of head rotation to the left and to the right; (2) the time to maximal angle in each direction (3) in the case of a patient who ignores the left hemifield, the number of cues the patient requires to turn to the left” (Bierig & Meyers, 2000). Beirig and Meyers states that “Because this technology is computer-based, the interactions can be accurately qualified (Bierig & Meyers, 2000).

While many neglect patients can not recover enough to fully continue an independent lifestyle nor go back to their previous vocation (Keller & Kerkhoff, 2006), The Kaiser Rehabilitation Center offers promising treatment for Left Hemineglect Syndrome patients. It offers “the ability to immerse the patient in a carefully planned and controlled environment, the ability to quantify responses in a bias-free manner, the ability to track and measure head movement and the opportunity to use the cueing capabilities of the VRTC program as a therapeutic adjunct” (Beirig & Meyers, 2000).