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Culture War Roundup for the week of June 24, 2024

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How do you gatekeep medical procedures against the well resourced?

Well, first, you can't. But second, who cares?

I don't mean that in a dismissive way--I mean, has "but that law seems difficult to enforce" ever been a legible reason for striking down (or refusing to adopt) a law against something dangerous? There are countless laws against illicit drug use. Many of them are, at least arguably, stupid, but their stupidity is a political question, not a question for the courts. (At least until an activist court decides to get fancy with "arbitrariness," I suppose...) People use drugs, and it's bad for them, and explicit government disapproval of their activity does seem to actually reduce those harms (see: Oregon) even when it can't be said that the relevant harm can be eliminated entirely.

Ultimately, if enough people are down with transing the kids, the kids are gonna get transed. The threshold of "enough" is simply a question of power: if you've got a lot of money, then just knowing one willing (or venal) doctor will probably suffice. But if you're a middle class parent hoping to engage in a little light Munchausen's by Proxy for internet karma and GoFundMe credit, you're going to need some extra assistance via e.g. insurance, tax subsidies, and maybe some government bullying of recalcitrant health professionals. Conversely, simply making a law against transing the kids will suffice for 99% of the population, just like all the other laws that rich people so often find themselves free to disregard.

At best we can rely on professional ethics, but, you know, lol. What's the strategy here?

Sending a message. Having a government that doesn't directly contribute to harming children based on dubious pop culture trends and the elevation of mental illness to a virtue. Protecting children from abusive parents. "But they don't think it's abuse!" Fucking tough; I'm happy to outlaw genital mutilation (including male circumcision), too, because my conception of child abuse is unmoved by appeals to moral relativism. If states can't outlaw transing kids, then they can't outlaw the genital mutilation of infants, either--not in any principled way.

In addition to the natural law questions, outright banning circumcision pokes some very interesting (and difficult) questions of religious freedom. As a cultural practice for some groups, it long predates pretty much all written law.

While I'm against the practice generally, the thought of banning it (even just for minors) gives me pause.

This isn't directly on point, but I think the case against male circumcision has been overstated by advocates and adopted by guys who were circumcized as infants and wouldn't know the difference. A friend of mine nixed his foreskin at age 23 and said there was no real difference once he recovered from surgery. Contrast that with the experience of my mother, who spent 30 years as an outpatient surgery nurse and said the number of guys who come in for surgery do to recurring problems (usually UTIs), is enough for her to put the anti-circumcision crowd on the same level as anti-vaxxers.

While I'm skeptical of the uncutactivists -- and oh boy are they annoying in gay porn land -- my understanding of their thesis is that a lot of the impact comes during prepuberty or early puberty, or from the slow acclimatization over time. I think this has the separate problem of being unfalsifiable and depending on a lot of data that has too many alternative explanations, but it's not as overtly incoherent.

((Conversely, I do think the UTI risk is overstated. A lot of the studies for infants and younger kids are very streetlight-effect prone, in no small part because it's such a known impact; such a wide majority of UTIs clear up without medication that it seems likely to have underreporting among people who think they're immune. I've known more than a couple cut guys who only found out that they've been having repeated UTIs for the better part of a decade when they went to get tested for STIs.))

In the UK, where non-Jewish boys are not circumcised, they explicitly tell parents that they don't need to worry about UTIs in boys. It isn't a big risk. I did frequent urology clinics back in my mis-spent youth (I smashed up my dick in a cycling accident). Invariably I was the only man under 75in the waiting room.

A friend of mine nixed his foreskin at age 23 and said there was no real difference once he recovered from surgery.

I believe the common complaint is that your glans becomes less sensitive due to chafing in time, so presumably you wouldn't feel the difference right away.

Contrast that with the experience of my mother, who spent 30 years as an outpatient surgery nurse and said the number of guys who come in for surgery do to recurring problems (usually UTIs), is enough for her to put the anti-circumcision crowd on the same level as anti-vaxxers.

You're obviously going to get a lopsided picture if your job only brings you to contact with special cases.

I also had an adult circumcision. Sensitivity does definitely reduce over the long term.

...I think the case against male circumcision has been overstated by advocates and adopted by guys who were circumcized as infants and wouldn't know the difference.

It is certainly my belief that most, maybe all advocates are in the business of overstating their case, whether to make it seem more urgent, or to demand X in hopes of at minimum securing something less than X as a "compromise." In this particular case, botched circumcisions are sufficiently horrifying that the severity is difficult to overstate--but the incident rate is probably not.

This isn't directly on point...

Still, it's relevant. "Preventing children from having their properly functioning bodies interfered with, even when the adults in their lives are totally cool with it," is one of those things I think the law--judicial, legislative, and executive all--must be empowered to do, if it is empowered to do anything at all. If the law cannot protect the bodily integrity of minors, even against their own expressed wishes, much less the wishes of their parents, it's hard for me to imagine how the law can be permitted to paternalistically protect minors from anything at all.

And maybe that's the right answer, certainly I know some anarcho-libertarians who would bite that bullet. But despite the occasional temptation I have never really been able to get excited about governance quite that small.

Sure, there’s a natural law argument against circumcision. The petty annoyance of chafing against boxers and the risk of botching are both underrated. A man with normal hygiene has no real advantages from it. Etc, etc.

But it’s massively, massively overstated by advocates to the point of being an entirely different argument than the one reflected in reality, not merely exaggerated.

And I agree with you about circumcision- I don’t think it should be widely available. But that’s from natural law, not due to arguments about the disadvantages.

said there was no real difference once he recovered from surgery.

In Ancient Greece I am sure I could find at least one 12 year old boy who said he didn't feel worse off for being bummed by his mentor. Such a testinomy, given that it confirms that prejudices of its society, would be inherently problematic. Soeaking badly of some common practise, particurly a sexual one, is in all societies stigmatized and one is less likely to do is, even if one feels it to be wrong.

[anecdote about mother]

Every human rights is inalienable, causing minute harm in a some small fraction of those who exercise it, is no excuse to derogate. I am sure plenty of doctors or coroners have seen the consequences of people using the second amendment against themselves, people injured or killed by traveling by means faster than foot, people and gay men in particular suffering due to their promiscuity.

Edit: You may argue that you didn't argue making it illegal to posses intact male genitalia. However you made the comparison of vaccines v circumcision, and in many countries vaccines are mandatory.

The question about any surgery is whether the benefits outweigh the costs. If the worst thing about circumcision is that it violates some inalienable right to a foreskin then the argument against it falls flat. By that measure, tonsilectomies are also inhumane in that they aren't strictly medically necessary in most cases. My problem isn't so much with people who choose to forego the procedure but those who act like it's causing some great harm and should be prohibited in all but the most dire cases.

who spent 30 years as an outpatient surgery nurse and said the number of guys who come in for surgery do to recurring problems (usually UTIs), is enough for her to put the anti-circumcision crowd on the same level as anti-vaxxers.

I'll see your anti-vaxxer comparison, and raise your mom a "NO, U". If there was any truth to this you'd see a massive difference in UTIs between Europe and the US.

And you're assuming there aren't? The studies I've seen of circumcized vs. uncircumcised show a 10x increased risk among infants, 6x among children, and 4x among adults. I don't know what your definition of massive is, but these aren't numbers that can be waved off.

Yes. Last I checked (ages ago) the rates were essentially the same throughout the western world. I don't care about individual studies - population level data, or it didn't happen.

Is it perhaps driven by the population which doesn’t circumcise in America- I could well see hippies and/or Latinos having higher rates of UTI than the genpop.

Almost no one in Europe gets circumcised, though. When you have something between 50% (the number I recall from when I looked it up) to 30% (I believe the current rate), and a supposed 6x-10x advantage for circumcission, I'd say there's no way for it to not show up on the population level.

Yeah, that’s what I’m saying. It’s entirely possible that Latino or hippie parenting, or both, have some feature driving more UTI’s, and those are the main groups not circumcising in America.

I got the snip when I was just about old enough to remember it, maybe at the age of 6 or 7. It was intended as a medical intervention for phimosis, not that I remember it ever being an actual issue, in all likelihood, my parents were overzealous and it would have just gone away when I got a little older.

It makes little difference, the glans is probably less sensitive than it used to be, but I'll be damned if that matters, and there are some minor practical benefits anyway. Overall, my approach to circumcision is a resounding meh, I wouldn't get it done to my kids without a good reason, but there's not much reason for me to look at it and think that it ruins one's QOL or ability to enjoy sex. Just look at the TFR in most Islamic countries for one.

It honestly shouldn't be that big of an issue, I know lots of people on both sides of the snip. If anything you can last longer without a foreskin which increases sexual performance.

I'd rather live in a country where women merely expect me to wash my dick, not to have had plastic surgery on it. Seeing American anecdotes of women being creeped out by uncut dicks feels like the reverse of that thing where men want women to replicate hardcore porn acts and looks in bed.

I've never actually encountered one of those in the wild, I think at this point they're both the reverse of those men and equally mythical as most feminist strawmen.

I don’t think most people care, if they did exotic European guys would surely be considered unattractive in the US when often the opposite is true.

It seems like women did once, or at least men thought they did. It used to be a stock raunchy comedy plot, "Oh man has a foreskin! What do you do with it?!" And it's something the weird obsessive activists complain about regularly.

I've never had a single partner say anything negative. Given, that's weak evidence, maybe the rest of the package covered up the problems with the package as it were; and I trust little of the rest of what they said.

On the other hand, male friends who see me naked in a locker room etc have been like wow that's weird.

What about all the other countries in the world where it is a strange and abhorrent practice? If you're not a dirty retard you're not going to get a UTI from being uncircumcised, who is your mom interacting with? I take it you got clipped and have some motivated reasoning going on here.

Numbers I've seen show that the risk of UTI in uncircumcised infants is 10× that of circumcised infants. The numbers drop to 6× in childhood and 4× in adulthood. The infant number is what they're most worried about, though, since infants can't exactly communicate symptoms easily and untreated UTIs at that age can cause kidney damage and all sorts of other problems. I'm not that motivated on either side of things, but I'm irritated with the activists out there who act like circumcision is mutilation akin to sexual anesthesia. There are clear benefits, and whether those benefits outweigh the disadvantages is something to take into consideration, but the disadvantages are often overstated.

I know for my mother the risk of severe complications from the surgery (very rare approx 2-6/1000) was decisive in deciding against it.

Don't women get a lot more UTIs than men? I don't think it is as big a deal as many do, I know tons of people both circumcised and not, it hasn't impacted anyone's life that much. The ultra online people crazy about it are often damaged in a lot of other ways, and this is an easy thing to fixate on. Very Freudian really. You should see some of the crazy Propecia related ED forums, the insane corners of the internet are insane. But anti snip part of your peen off people are not in line with anti-vaxxers. The gripe they have is legit medically speaking, humans don't need to have their foreskin removed.

Maybe the most charitable way to interpret this is that since the well resourced have no problem overcoming laws; not having any at all levels the playing field.