Chickenpox and Shingles Vaccines SHORT

This is the short version. For the long version with references, click here.

Varicella virus

What are chickenpox and shingles?

Chickenpox is a highly contagious rash caused by varicella zoster virus. Chickenpox infection generally confers lifelong immunity. You may develop an infection without symptoms, and this also generally confers immunity. It is normally a very mild rash illness and only very rarely causes serious complications; children with eczema are not at increased risk of complications. Death is very rare. However, in otherwise healthy adults, the chickenpox complication rate is 15-25 times higher and the death rate is 20 times higher.

After a chickenpox infection, the virus hibernates in a nerve. In times of stress or immune suppression, the virus may reawaken and cause shingles. (You cannot catch shingles. You can catch chickenpox, which might later develop into shingles if your immunity is low.) Shingles is associated with 4-5 times higher complication rate and medical costs than chickenpox.

Chickenpox vaccines are typically given twice in early childhood in North America, Germany, and Australia. The shingles vaccine is given to older adults. Most of the developed world does not use these vaccines.

How can I prevent or treat chickenpox and shingles in my child?

Because chickenpox is mild in childhood but potentially serious in adulthood, many people choose to intentionally expose their child and get it over with in childhood. If you choose to do this, avoid people with immune suppression, pregnant women, and infants during the contagious period. Do not mail infectious material and do not intentionally expose others without their knowledge and consent.

It takes about 10-21 days after exposure for the first spots to appear. Chickenpox is contagious from about 2 days before the spots appear to as much as 7 days later, when the spots are all crusted over. A fever often occurs for one or two days before the first spots appear. To prevent infection, avoid children with chickenpox, fever, or unidentified rash.

The vaccine contains a live virus. There have been several reports of people developing chickenpox with vaccine-strain virus shortly after a close contact was vaccinated. To prevent infection, avoid people who have recently been vaccinated against chickenpox or shingles.

Exposure to chickenpox acts as a natural “booster shot” to protect adults against shingles. If you or your child have had chickenpox or the vaccine, prevent shingles by seeking exposure to chickenpox.

You can treat chickenpox with calamine lotion and daily baths with soap and water. Do not use aspirin, Tylenol, or Benadryl (diphenhydramine), and do not use lotions that have diphenhydramine in them. Use ibuprofen to lower a fever only if the fever is over 106°F (41.1°C). You should generally not take steroids during a chickenpox infection; if your child is on steroids, talk to your doctor about whether to stop the steroids until he recovers. Use anti-infectives such as silver nitrate and essential oils on the spots to prevent bacterial infection. If he develops a secondary fever after the spots have appeared, seek immediate medical attention.

How effective are the vaccines at preventing asymptomatic carriage?

Vaccinated people can have asymptomatic infections with both vaccine-strain and wild-type varicella viruses, and have proven to be contagious during that time. However, whether the vaccine reduces, increases, or has no effect on the degree or duration of asymptomatic carriage is unknown.

How effective are the vaccines?

The chickenpox vaccine is more effective when fewer children receive it because natural exposure to chickenpox boosts immunity, so vaccinated children get a natural “booster shot” from their unvaccinated friends. However, in communities where chickenpox vaccination is widespread, effectiveness drops to very low levels within a few years. A few studies found it to be completely ineffective or even reverse-effective (increased the chickenpox rates). When the vaccine fails, people tend to get chickenpox at an older age, when it is more dangerous.

Since exposure to chickenpox boosts immunity and prevents shingles, researchers predicted that widespread chickenpox vaccination would increase shingles rates. They were proven right by numerous studies in many countries using the vaccine. Because shingles is much more dangerous than chickenpox, the vaccine results in overall increased complication rate and medical costs, so the vaccine is neither effective nor cost-effective. Furthermore, the addition of new booster shots and shingles vaccines to fix this problem is not cost-effective and is associated with a higher complication rate than if children had been permitted to get chickenpox naturally.

The shingles vaccine may be as much as 51% effective and last 1 month to 5 years, necessitating numerous booster shots. It is less effective in people over 70 and completely ineffective in people over 80. Exposure to a child with chickenpox would be much more effective and much safer.

Are there other infectious diseases related to chickenpox/shingles vaccination?

MMR vaccination indirectly resulted in increased severity of chickenpox. This increased severity is part of why the CDC recommends chickenpox vaccination. However, most of Europe still agrees that the risks of chickenpox vaccination far outweigh any possible benefit.

What are the risks of the vaccines?

Adverse reactions to the chickenpox vaccine are at least equal to, and some research shows is greater than, adverse reactions to chickenpox infection. The combination MMR and chickenpox vaccine causes a higher fever and more seizures than MMR and chickenpox vaccines given separately. Chickenpox vaccination increases the risks of shingles, multiple sclerosis, heart disease and heart attacks, and brain tumors.

The shingles vaccine is associated with a very high rate of adverse reactions, especially in the oldest groups. The vaccine also causes severe autoimmune reactions, including a doubled risk of arthritis and tripled risk of alopecia.

So what’s the bottom line?

Chickenpox is very mild in childhood and has some long-term health benefits (e.g., decreased risk of multiple sclerosis, heart disease/heart attack, brain tumors), but poses much greater risk and fewer benefits in adulthood. Vaccination may merely delay chickenpox infection until adulthood, when it has considerably more risk. Natural chickenpox infection and repeated exposure to chickenpox decreases the risk of shingles. Conversely, chickenpox vaccination has very low effectiveness against chickenpox, increases the risk of shingles, and results in more severe shingles occurring at younger ages. Shingles is much more dangerous than chickenpox. The shingles vaccine does not appear to be very effective, but research is very limited; it is not effective in the oldest groups and is not yet approved for people under 50. Both vaccines are associated with some serious adverse effects, especially the shingles vaccine.

 

 

Chickenpox and Shingles Vaccines

This is a continuation of a series I’ve been helping to write for an education forum. This is the LONG version. For the short version, click here.

Image result for chickenpox virus

Varicella virus

What is chickenpox? What is shingles?

Chickenpox (varicella) is a highly contagious illness caused by a virus known as varicella zoster virus. Cases tend to peak in winter and spring. You can also have chickenpox and develop immunity without ever developing symptoms. Generally speaking, chickenpox infection confers lifelong immunity. In children, chickenpox is generally very mild and only very rarely causes serious complications. However, in otherwise healthy adults, the complication rate is 15-25 times higher. Childhood chickenpox causes death in roughly 1 per 40,000 infections, so the risk of death from chickenpox in the U.S. is lower than the risk of death by lightning strike. However, the death rate from adulthood chickenpox infection is 20 times higher. In fact, even though children make up over 98% of chickenpox cases, adults make up almost half of chickenpox deaths [1-3]. Children with eczema are not at increased risk of complications [1].

After a chickenpox infection, the virus hibernates in a nerve. In times of stress and immune system dysfunction, the virus may reawaken and cause shingles. Shingles is associated with 4-5 times higher complication rate and medical costs than chickenpox [3].

In the U.S., the chickenpox vaccine is given at 12-15 months and again at 4-6 years [4]. The shingles vaccine is recommended for people over the age of 60 [5].

In Canada, the chickenpox vaccine is given alone or with the MMR at 12 mo, 15 mo, 18 mo, and/or 4-6 years, depending on the province [6]. The shingles vaccine is recommended for adults aged 50 and over [7].

 

How can I prevent chickenpox and shingles in my child?

A longstanding practice is to intentionally expose children to chickenpox because the infection is almost always harmless in children, but much more serious in adults. This practice is regarded as rarely harmful, but poses some risk of exposing immunocompromised people, with the exception that children with a planned exposure can have planned isolation during the potentially contagious period while children with an accidental exposure cannot. If you plan to intentionally infect your child, you should avoid immunocompromised people, pregnant women, and people with severe lung disease until you know for certain that your child is not contagious [1-2]. Also, if you choose to intentionally infect your child, be aware that mailing infectious material is highly illegal, in part because it is unknown how many people might be unknowingly exposed. Exposure is therefore best done in person.

It takes about 10-21 (usually 14-15) days after exposure to chickenpox before you develop the first spots; fever often occurs before the spots appear. The spots disappear within 7-10 days. Chickenpox is most contagious between 2 days before and 3 days after the start of the rash; but it is generally considered that children with chickenpox are contagious until at least 5 days after the onset of the rash or until all of the spots are dry and crusted. It is mainly contracted by direct contact with the spots, but it can be airborne as well. You can also catch chickenpox from direct contact with shingles lesions, but shingles is far less contagious. (You cannot catch shingles from shingles. But you can catch chickenpox from shingles. This is because the first time the virus causes an outbreak in you, it’s always chickenpox.) [1] To prevent chickenpox, avoid exposure to children with chickenpox, fever, or unidentified rash.

The chickenpox vaccine is a live virus vaccine, meaning the virus in the vaccine is capable of causing a chickenpox infection. There have been reported cases of people contracting the disease from a recently-vaccinated individual. For example, one pregnant woman contracted vaccine-strain chickenpox after her child was vaccinated [8]. In another case, an adult woman received the vaccine and both she and her children shortly afterward developed vaccine-strain chickenpox [9]. In yet another very alarming case, a woman who did not develop any symptoms, such as the characteristic rash, passed the vaccine-strain virus on to her newborn, who developed chickenpox [10]. The shingles vaccine is also a live virus [11] and so can be presumed to shed as well. To prevent chickenpox, you should also avoid individuals who have recently received the chickenpox or shingles vaccines, as they should be considered just as contagious as someone who has an asymptomatic chickenpox infection.

However, ironically, the exact opposite should be done to prevent shingles. Regular exposure to chickenpox acts as a natural “booster shot” to protect adults against shingles [12-15]. In fact, working in childcare reduces your chances of developing shingles by 94% [12]! (That’s FAR more effective than the vaccine, as you’ll see later.) If you have been infected with the chickenpox virus in the past, then to prevent shingles, you should seek exposure to chickenpox.

 

How can I treat chickenpox and shingles in my child?

Even though exposure to chickenpox boosts immunity, and exposing a child with an active infection to people who are already immune would boost their immunity and benefit them by reducing their risk of shingles, it is considered unethical to intentionally expose someone without their knowledge. Thus, you should isolate your child during the contagious period, except to people who are aware of your child’s contagiousness and willing to expose themselves. You should also keep your child away from people who are at higher risk of complications, such as infants, pregnant women, and immunocompromised people.

Generally speaking, you can give anti-fever medicine if your child develops fever. However, research has shown that Tylenol is not effective for chickenpox [1]. Other research has shown that anti-fever medicine degrades some of the immune response and makes the illness last longer, and so giving anti-fever medicine may be counterproductive [16, 17]. Do not give aspirin, which may cause a serious disorder called Reye’s syndrome in children with chickenpox. If you do give aspirin and your child develops vomiting, go to the emergency room, as this is a sign of Reye’s syndrome [1]. In short, Tylenol doesn’t work, ibuprofen might be counter-productive, and aspirin might be dangerous. In other words, it’s probably best not to use anti-fever medicine unless the fever is over 106°F (41.1°C) [18].

Do not give Benadryl, including any creams that have Benadryl in them, because Benadryl toxicity has often been reported in children with chickenpox [1]. Calamine lotion can give effective symptom relief, but make sure it doesn’t have Benadryl (diphenhydramine) in it. Daily baths with soap and water can also help destroy the virus and prevent bacterial infection [1].

Children with eczema are not at increased risk of complications. However, it’s important to note that a steroid cream should not be used during chickenpox, so if a child’s eczema is being treated with a steroid cream, you should stop using the cream while he has chickenpox [1].

An antiviral drug called acyclovir may shorten the length of the illness and reduce its severity, but does not reduce contagiousness. However, it does not reduce complications and has to be started no later than the first day of the rash because if it is started on or after the second day, it is ineffective [1]. Acyclovir also does not reduce complications in adults [2].

The most common complication, occurring in 1-4% of chickenpox infections, is a bacterial infection of the spots [1]. This should be prevented by keeping the spots clean, not breaking them open, and treating them with an anti-infective such as silver nitrate or certain essential oils. A brief fever before the spots appear is common. But if a second fever occurs several days after the spots appear, your child may have a serious bacterial infection and you should seek immediate medical attention [1].

Chickenpox may rarely cause pneumonia. You can prevent this by boosting your child’s immune system during the outbreak and having him breathe in an anti-infective such as certain essential oils. However, if your child develops difficulty breathing or starts looking sicker after he had started to get better (e.g., tired/lethargic, feverish, etc.), you should seek immediate medical attention [1].

 

How effective are the vaccines at preventing asymptomatic carriage?

Some studies have found that children who were vaccinated may develop shingles with the wild-type virus [19-20]. In other words, even though they never had symptomatic chickenpox, they apparently had an asymptomatic infection with the wild-type virus. This means vaccinated individuals can have asymptomatic infections with the wild-type virus in spite of having been vaccinated. Furthermore, as mentioned earlier, there has been at least one recorded case of an asymptomatic individual passing on vaccine-strain virus to her newborn child [10].

So, in short, vaccinated people can have asymptomatic infections with both the wild-type and the vaccine-strain virus, and can be contagious during that time. However, whether the vaccine affects the degree or duration of asymptomatic contagiousness has not to my knowledge been studied with the chickenpox vaccine. (Other studies have found that some vaccines increase or decrease, but do not eliminate, the length of asymptomatic carriage, as discussed in my previous posts on pertussis, meningococcal, HiB, and pneumococcal.)

Until proven otherwise, vaccinees should be considered at equal risk of asymptomatic carriage.

 

How effective are the chickenpox and shingles vaccines?

The chickenpox vaccine has highly disputed effectiveness. Because natural exposure to children with the infection boosts immunity, the vaccine is more effective when fewer children receive it [12-15, 21]. We also know, for example, that vaccinees can get both chickenpox [8-9] and shingles [19-20, 22] from the vaccine virus.

A Japanese study reported that 34.2% of chickenpox-vaccinated children developed symptomatic chickenpox within 7 years after vaccination. The study did not continue after 7 years, but it can presumably affect more children who are further away from the date of their vaccine. The study also did not look for evidence of asymptomatic infection. The authors concluded that the vaccine may reduce the severity of the symptoms but is not strong enough to prevent infection [23]. A South Korean study found that chickenpox cases actually increased after the vaccine was introduced, and that symptoms were not milder in vaccinated children [24].

Since exposure to chickenpox boosts immunity and prevents shingles, researchers had long predicted that a decrease in chickenpox might cause an increase in shingles, estimating that it would result in an overall increased mortality rate (because shingles is more dangerous), with the increased disease and complications from shingles cancelling out any benefit from decreased chickenpox [12, 25-26]. In fact, this was the primary reason why nearly all European countries have chosen to forgo chickenpox vaccination. Some researchers even argued that it is unethical to vaccinate children against chickenpox, knowing that it will result in increased overall morbidity and mortality [27].

The researchers who predicted an increase in shingles were proven right when numerous studies in multiple countries using the chickenpox vaccine (including North America, Southeast Asia, and Australia) found that shingles cases increased and occurred in younger and younger ages, that cases of severe complications from shingles increased and occurred in ever younger ages, that chickenpox also occurred at younger and younger ages, and that chickenpox vaccination overall increased complications and medical costs—in other words, it was neither effective nor cost-effective [14-15, 21, 28-34].

Because the vaccines had very little effectiveness and also increased the incidence of shingles, it was necessary to add a booster shot [21] and later a shingles vaccine. The addition of these new vaccine doses is not cost-effective and is associated with a higher rate of complications than if vaccination had never been started [21].

According to CDC, the shingles vaccine lasts 5 years [5]. However, the research is less than inspiring. The study conducted by the shingles vaccine manufacturer, Merck, found that it was at best 51% effective, but many of the patients were only followed for 31 days [11], so all we know for certain is that it might cut your risk in half for the first month after receiving it. Furthermore, they found it to be less than 40% effective for those aged 70 and older, while in people over 80 years old, the vaccine was only as effective as placebo—in other words, completely ineffective [11, 35]. It is also not effective at preventing postherpetic neuralgia (i.e., shingles pain) [35].

 

Are there other infectious diseases related to chickenpox and shingles vaccination?

After the MMR (measles-mumps-rubella) vaccine was introduced, cases of encephalitis (serious brain inflammation) due to measles, mumps, and rubella essentially disappeared. However, it was replaced with an even greater number of encephalitis cases by other bacteria and viruses that both had and had not been previously associated with encephalitis, including chickenpox encephalitis. Furthermore, these new cases of encephalitis occurred in younger age groups, which post more serious risks [36]. In other words, MMR vaccination triggered more dangerous chickenpox infections, and one of the CDC’s cited reasons for chickenpox vaccination is the potential for severe complications like encephalitis [37]. In most of Europe, it is still argued that because chickenpox is very mild in childhood and very severe in adulthood, and the increased shingles risk offsets any potential benefit, there is no justification for routine childhood chickenpox vaccination [38].

 

What are the risks of the vaccines?

Chickenpox

Some research suggests that adverse events from varicella vaccination are at least equal to the adverse events of chickenpox infection that the vaccine prevented—in other words, there is no net change in adverse events between nearly 100% natural infection rate and nearly 100% vaccination rate [14].

In one study, systemic adverse reactions occurred in 11.9% of the vaccinated children [24]. The manufacturer reports that the vaccine has caused some of the same serious side effects associated with the wild-type disease, such as pneumonitis [10]. There is a combination MMR and chickenpox vaccine called ProQuad which is associated with higher fever and seizure rates compared to children who get MMR and chickenpox vaccination separately [39].

Shingles. Non-immunocompromised individuals can also develop vaccine-strain shingles as shortly as 2 years after vaccination [19-20, 22].

Indirect risks include the following:

Multiple Sclerosis. There is an increased risk of MS in people who contract measles, mumps, rubella, or chickenpox at a later age [40]. Because the vaccines wear off and therefore put the individual at increased risk of infection at a later age, there is an indirectly increased risk of MS in children who receive the vaccine at a young age.

Heart Disease/Attacks. There is a decreased risk of heart disease such as coronary artery disease (CAD) and heart attacks in people who had chickenpox in childhood. Chickenpox reduces the risk of heart disease and heart attacks by 33% [41]. Thus, indirectly, chickenpox vaccination may increase the risk of heart disease and heart attacks.

Brain Tumors. People who have had chickenpox in childhood have a lower risk of certain aggressive brain tumors called gliomas [42-44]. Thus, indirectly, chickenpox vaccination may increase the risk of brain tumors.

 

Shingles

One study by the manufacturer of the shingles vaccine, Merck, reported a relatively high adverse reaction and severe adverse reaction rate following shingles vaccination. The complication rate was especially high in those over 80 years old [11, 35].

The shingles vaccine has been noted to cause severe autoimmune reactions, including a doubled risk of arthritis and a tripled risk of alopecia [45]. The manufacturer study also found that people who received the shingles vaccine at the same time as the pneumonia vaccine had less of an immune response [11].

Another study of a newer shingles vaccine that is not currently available in the U.S. found that adverse reactions occurred in 84% of vaccine recipients within 7 days, and adverse reactions that were severe enough to prevent daily activities occurred in 17% of vaccinees [46].

 

What vaccines are offered against chickenpox and shingles?

(NOTE: These ingredients lists are not complete; they only list the most alarming ingredients.)

Chickenpox (Varicella)

  • ProQuad (U.S.). MMRV (measles-mumps-rubella-varicella) vaccine. Contains live measles, mumps, rubella, and varicella viruses. Ingredients include chick embryo, aborted human fetus lung cells (WI-38), aborted human fetus cells (MRC-5), cow serum, human albumin, monosodium L-glutamate (MSG), human albumin, and neomycin [39].
  • Varivax (U.S.). Varicella-only vaccine. Contains live varicella virus. Ingredients include human embryonic cells, aborted human fetus lung cells (WI-38), guinea pig cells, DNA and protein from aborted human fetus cells (MRC-5), monosodium L-glutamate (MSG), EDTA, and neomycin [10].
  • Varilrix (AU). Varicella-only vaccine. Contains live varicella virus. Ingredients include aborted human fetus cells (MRC-5), human albumin, lactose, cow products, and neomycin [47].

 

Shingles (Herpes Zoster)

  • Zostavax (U.S.). Contains live varicella virus. Ingredients include porcine (pig) gelatin, monosodium L-glutamate (MSG), residual DNA and protein from MRC-5 (aborted human fetus) cells, neomycin, and calf serum [11].

 

So what’s the bottom line?

Chickenpox is very mild in childhood and has some long-term health benefits (e.g., decreased risk of multiple sclerosis, heart disease/heart attack, brain tumors), but poses much greater risk and fewer benefits in adulthood. Vaccination may merely delay chickenpox infection until adulthood, when it has considerably more risk. Natural chickenpox infection and repeated exposure to chickenpox decreases the risk of shingles. Conversely, chickenpox vaccination has very low effectiveness against chickenpox, increases the risk of shingles, and results in more severe shingles occurring at younger ages. Shingles is much more dangerous than chickenpox. The shingles vaccine does not appear to be very effective, but research is very limited; it is not effective in the oldest groups and is not yet approved for people under 50. Both vaccines are associated with some serious adverse effects, especially the shingles vaccine.

 

References

[1] http://sci-hub.cc/10.1016/S0163-4453(98)80154-0

[2] http://sci-hub.cc/10.1016/S0163-4453(98)80155-2

[3] http://www.vaccinationcouncil.org/wp-content/uploads/2012/07/Goldman-SummaryofChickenpoxVaccine1.pdf

[4] https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf

[5] https://www.cdc.gov/vaccines/vpd/shingles/public/index.html

[6] https://www.canada.ca/en/public-health/services/provincial-territorial-immunization-information/provincial-territorial-routine-vaccination-programs-infants-children.html

[7] http://immunize.ca/uploads/printed-material/shingles/hz_2014_brochure_e.pdf

[8] http://www.sciencedirect.com/science/article/pii/S0022347697701409

[9] https://academic.oup.com/jid/article/176/4/1072/883761/Transmission-of-Vaccine-Strain-Varicella-Zoster

[10] https://www.merck.com/product/usa/pi_circulars/v/varivax/varivax_pi.pdf

[11] https://www.merck.com/product/usa/pi_circulars/z/zostavax/zostavax_pi2.pdf

[12] http://websenti.u707.jussieu.fr/sentiweb/1260.pdf

[13] http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0066485

[14] http://www.sciencedirect.com/science/article/pii/S0264410X12007761

[15] http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0077709

[16] http://www.nytimes.com/2011/01/11/health/11klass.html

[17] https://academic.oup.com/cid/article/31/Supplement_5/S185/333528/Physiological-Rationale-for-Suppression-of-Fever

[18] http://www.seattlechildrens.org/medical-conditions/symptom-index/fever/

[19] http://europepmc.org/abstract/med/21346684

[20] https://academic.oup.com/jid/article/208/11/1859/852912/Incidence-and-Clinical-Characteristics-of-Herpes

[21] http://www.ozbyte.com/medicalveritas.com/R0010.pdf

[22] https://www.ncbi.nlm.nih.gov/pubmed/23358727

[23] http://onlinelibrary.wiley.com/doi/10.1111/j.1442-200X.1997.tb03664.x/full

[24] http://cvi.asm.org/content/21/5/762.full

[25] http://www.sciencedirect.com/science/article/pii/S0264410X02001809

[26] https://www.researchgate.net/profile/Marc_Brisson/publication/11032443_Varicella_vaccination_a_double-edged_sword/links/545b9ba20cf249070a7a77b3.pdf

[27] http://vaccineliberationarmy.com/wp-content/uploads/2015/08/Varicella-Shingles.pdf

[28] http://www.sciencedirect.com/science/article/pii/S0264410X03008776

[29] https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-5-68

[30] http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.1003.8925&rep=rep1&type=pdf

[31] https://elifesciences.org/content/4/e07116

[32] https://www.researchgate.net/profile/Hassan_Vally/publication/45797722_Herpes_zoster_in_Australia_Evidence_of_increase_in_incidence_in_adults_attributable_to_varicella_immunization/links/5653f07f08aefe619b1978c9.pdf

[33] https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/div-classtitleherpes-zosterrelated-hospitalizations-and-expenditures-before-and-after-introduction-of-the-varicella-vaccine-in-the-united-statesdiv/763A3D016D7E1A5527BF0CA375BC686B

[34] http://eurosurveillance.org/images/dynamic/EE/V19N41/art20926.pdf

[35] http://www.nejm.org/doi/full/10.1056/NEJMc1310369#SA3?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed

[36] https://link.springer.com/article/10.1007/s004310050658

[37] https://www.cdc.gov/chickenpox/about/complications.html

[38] http://www.nhs.uk/Conditions/vaccinations/Pages/chickenpox-vaccine-questions-answers.aspx

[39] https://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM123796.pdf

[40] http://www.karger.com/Article/Abstract/26167

[41] http://www.sciencedirect.com/science/article/pii/S0021915006002723

[42] http://onlinelibrary.wiley.com/doi/10.1002/cncr.23741/full

[43] https://academic.oup.com/aje/article/154/2/161/80528/Prevalence-of-Antibodies-to-Four-Herpesviruses

[44] https://academic.oup.com/aje/article/145/7/581/94598/Familial-and-Personal-Medical-History-of-Cancer

[45] http://europepmc.org/abstract/med/26151783

[46] http://www.nejm.org/doi/full/10.1056/NEJMOA1501184#t=article

[47] https://au.gsk.com/media/265139/varilrix_pi_008_approved.pdf

 

Chiropractors in a Fallen World

When I was 18, I woke up one morning with severe pain in my sacrum, the lowest part of my back. I found that I couldn’t walk, sit, crawl, kneel, or do anything comfortably except lie down. At the age of 18, you shouldn’t wake up one morning unable to walk.

Image result for chiropractor

I called a chiropractor I had recently met. She and I both specialized in maternity and newborns, so it was an eagerly-anticipated meeting, though honestly, it went nowhere because we had almost no professional need for each other. But now I found I had a personal need for her.

It took a few days to get in to see her, during which time I tried every recommended treatment she offered, from heat to cold, from massage to drugs. After the first adjustment, the pain almost completely vanished. After the second, it was entirely nonexistent. Initially, I saw her twice a week, then once a week, then once every other week, and finally once a month.

Having visits once a month was sufficient to control my pain. As long as I saw her once a month, the pain was gone. However, I struggled to square the idea that I, a healthy 18-year-old who had never experienced any injuries and didn’t have any musculoskeletal diseases, could be living in chronic pain. When the first chiropractor moved away, I tried another. After she moved away, I tried another and another. They all kept me out of pain, but I was frustrated by the need to seek chronic care. Would I need to use chiropractors for the rest of my life?

Image result for chiropractor

The second chiropractor introduced me to Foot Levelers. These eliminated my pain for a year at a time or more. However, they are expensive and only cover the pain. I thought surely there must be a permanent fix somewhere.

I haven’t found that permanent fix. And I’m having to accept the idea that I will simply live with chronic pain for the rest of my life. It seems like it shouldn’t be that way, but however you look at it, that’s sort of a fact of life. From the evolutionary perspective (specifically, the Laws of Thermodynamics), everything runs down over time. From the creationist perspective, sickness entered the world after the Fall. We live in a Fallen world, and my chronic pain is one of many symptoms of our world’s sickness.

It may seem hopeless when I phrase it like that. But let me put it this way…

With chiropractors, I experienced complete or nearly complete symptom relief with completely non-invasive and relatively inexpensive regular adjustments and/or Foot Levelers.

With mainstream medical doctors, I would possibly undergo surgery with the promise of more chronic pain (just a different kind) and no assurance of cure, and physical therapy to somewhat ameliorate the problems caused by the surgery. I would also receive pain medication, which would become less and less effective over time, a pharmacological fact known as “tolerance,” which would lead to more and more use of heavier and heavier drugs until I was popping tens of pills per day, many of them narcotics, and likely developing dependence and even addiction.

Without either chiropractors or medical doctors, I would experience crippling pain every day of my life.

I choose the better option. And I am eternally grateful to my chiropractors for keeping me out of pain.

Is Circumcision Cosmetic?

A philosophical question sometimes raised is the following:

“Is circumcision cosmetic?”

The answer is YES and NO.

baby-boy

Definition of Cosmetic

The term “cosmetic” comes from the Greek kosmetikos, which comes from kosmein (“arrange” or “adorn”), which comes from kosmos (“order” or “adornment”). Thus, “cosmetic” would refer to anything that restores or improves the appearance of something. However, “cosmetic” is also very much subjective.

For example, a very decorative bridle has both the non-cosmetic function of controlling the horse and the cosmetic function of improving the horse’s appearance. However, to an animal rights activist who sees any form of animal bondage as ugly, the bridle would not serve a cosmetic purpose. Obviously, it also serves no cosmetic purpose to the horse himself, either. As in this situation, almost anything may be either cosmetic or non-cosmetic depending on the subjective feelings of the audience.

 

Cosmetic, Medical, or Both?

When something is referred to as “purely cosmetic” or “only cosmetic” or “solely cosmetic,” the implication is that it serves no purpose other than to improve the appearance.

For example, breast augmentation is purely cosmetic. However, breast reduction surgery may be cosmetic or it may be a combination of medical and cosmetic because reducing the size of the breasts reduces strain on the upper back, posing health benefits.

It is also possible for something to have medical purpose without being cosmetic, and this is, by far, the most common reason for a given surgery.

For example, a mastectomy for breast cancer serves medical purpose, but does not improve the woman’s appearance (in any culture) and thus is not cosmetic. If, however, the woman and her physician opted for a combination mastectomy and breast reconstruction surgery, it would be both medical and cosmetic since the mastectomy is purely medical and the breast reconstruction is purely cosmetic.

 

So What About Circumcision?

Even intactivists must admit that there are times when circumcision poses medical benefits. Anti-circumcision physicians around the globe admit that prophylactic (preventive; i.e., before there’s a problem) newborn circumcision poses medical benefits; the disagreement is whether the medical benefits outweigh the cultural, cosmetic drawbacks to circumcision in anti-circumcision cultures where the foreskin is highly valued. Nonetheless, it is undeniable that circumcision does have medical benefits, and so newborn circumcision cannot sincerely be labeled “purely” or “only” or “solely” cosmetic.

Furthermore, circumcision may not be cosmetic at all. If you consider a circumcised penis to be more attractive than an uncut penis, then circumcision would be cosmetic for you. If, however, you consider an uncut penis to be more attractive, then circumcision, like a mastectomy, would not be cosmetic. Thus, whether circumcision is cosmetic depends entirely on the subjective feelings of the people who would be affected by, and must make decisions regarding, that penis—e.g., the parents, the child, and his future partners. If the parents oppose circumcision for cultural reasons (e.g., most Western Europeans), then their choice is solely cosmetic. If the parents or the individual choose(s) circumcision for cultural reasons without regard for the proven health benefits (e.g., certain tribal circumcisions), then their choice is purely cosmetic, but the procedure itself is not purely cosmetic because the procedure still has health benefits.

Parents in developed nations rarely make the decision to circumcise based on a desire for their child’s penis to be “attractive.”* Rather, nearly all parents in developed nations choose circumcision at least in part due to a belief in the medical benefits. Thus, it cannot be argued that the choice is cosmetic in all, or even most, cases. In fact, because the medical benefits are cited even by those making a primarily religious choice, one would be hard-pressed to find a pro-circ parent (i.e., one who currently identifies as pro-circumcision, regardless of the choice they ended up making for financial or other reasons) whose reason was entirely cosmetic.

 

The Bottom Line

So in short, because it has health benefits, the circumcision procedure cannot be considered “purely” cosmetic. Furthermore, circumcision is almost never a cosmetic choice in the developed world because it is not made based on a belief in the greater attractiveness of the circumcised penis. However, the end-result may be cosmetic if the people involved generally consider it to be more attractive. Thus, circumcision is either: (1) purely medical and non-cosmetic, or (2) a combination of medical and cosmetic. However, circumcision cannot sincerely be labeled “purely cosmetic.”

 

Side Notes

*However, intactivists’ projection of this (the belief in the circumcised penis’s attractiveness) on pro-circ parents as their primary reason for choosing circumcision strongly implies that intactivists’ choice not to circumcise is largely based on a belief that the uncut penis is attractive—which, frankly, is quite disturbing—as demonstrated by their inability to conceive of people choosing circumcision for any other reason and projection of their own reasons onto others.

Why Most Scientific Research is False

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Sparks’ Notes Version (A Summary of This)
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Most science is false. Why?
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1. Statistics. Even if your test is 99% accurate, if there are only 100 possibilities to test, the chances that your test result will be correct is less than 50%. This is because there are so many possible wrong answers that several wrong answers are certain to incorrectly test positive, so your positive test result is more likely to be wrong (a false-positive) than to be right. For example, if testing 20,000 genes for a possible link to Alzheimer’s and only one is a true link, and your test is 99% accurate, you will likely get 200 false positives in addition to the 1 true positive. Unfortunately, a “good” level of accuracy on a test is lower than 99%, more like 95%, so statistically speaking, most scientific research results today are false. See John P Ioannidis’s paper Why Most Published Research is False.
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2. Researcher Bias. Research has shown that when a scientist expects a certain result, he’s more likely to get the result he expects. Part of this is accident, such as mathematical errors that he’s less likely to discover because he got the expected result. Probably a bigger part of it is outright fraud. Research has shown the majority of researchers admit to committing various degrees of fraud. This makes it even less likely that a positive result is a true positive. It’s also extremely easy to manufacture a certain result without committing massive, blatant fraud by simply using a different data analysis method or selecting a small group out of a larger population for analysis, making it harder for honest scientists to detect the false-positive.
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3. Publisher Bias. Publishers are in competition with each other and so they want flashy results. Therefore, they are extremely unlikely to publish boring results such as “X is not the cause of Y.” Therefore, among 20 studies on the subject, the one that falsely says X *does* cause Y is highly likely to get published while the 19 that say X doesn’t cause Y are extremely unlikely to be published.
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4. Cultural Bias. Both the broader popular culture and the scientists’ own micro-culture affect the results. If a research result was considered exciting, scientists in that field are less likely to want to prove it wrong and research proving it wrong is more likely to get intentionally buried. Furthermore, if something is considered ridiculous or unacceptable in the scientific or popular culture, scientists are less likely to pursue or publish research in that area because it may mean the ends of their careers. (Example: Dr. Semmelweis suggested a very unpopular theory–that doctors can carry disease on their unwashed hands–and studied it and ultimately recommended hand washing to prevent the spread of disease. It was an unpopular idea, and so he was ostracized in the scientific community and ultimately lost everything.)
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5. Sucky Peer-Review. Research is peer-reviewed prior to publication. In theory, this means other highly educated researchers in the same field comb the article for flaws and make recommendations for changes to improve the article or correct errors. In reality, research has shown that peer review fails to do its job. In one study, even when told they were part of a study and that they might find something “off” about an article submitted for publication, peer reviewers on average only caught one of eight *major* errors intentionally added to the paper and only 30% recommended rejecting the paper for publication. Peer review also has the tendency to reject unpopular ideas, making peer review switch from useless to actively harmful in a shockingly high proportion of cases.
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6. Failure of Self-Correction. In theory, science is self-correcting, meaning that over time, enough evidence will accumulate to replace a wrong theory with a right one. But there are many cases in human history where the correct theory was replaced with a wrong theory, even for over 1,000 years, before being replaced again with the right theory–for example, vitamin C deficiency as the cause of scurvy and geocentric theory (the belief that the sun revolves around the earth). How many correct theories have been replaced with a wrong theory and we just don’t know it yet?
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7. When Theory Becomes “Fact.” Often, new theories are proposed and bad science published at such a great speed today that a false theory quickly outpaces the natural self-correction of science, and new theories, subspecialties, careers, and grants spring up based on this bad science before it has a chance to naturally self-correct. At that point, a powerful barrier to self-correction has arisen. The old theory is treated like fact, and research that is unpopular due to popular or scientific cultural bias is rejected in the peer review process, while biased research that aligns with cultural bias is accepted in the peer review process. Sadly, one study found that bad cancer research that could not be reproduced was cited hundreds of times more frequently than was good, reproducible research in part because it had spawned new branches of research, along with their associated careers, grants, and prestige.
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8. Peer Pressure. Publishing something critical to a theory that is the foundation of your colleagues’/mentors’ careers is not going to endear you to them. If your colleagues/mentors don’t like you, that can interfere with your ability to get a job. Thus, the micro-culture of your scientific field and, more specifically, peer pressure prevents criticism of widely accepted ideas.
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9. Careerism and Opportunism. The present culture is such that scientists are lauded as heroes and science is held up as the only legitimate basis for policy making. Once upon a time, scientists were generally poorly-reimbursed for their efforts and so the profession attracted those earnestly interested in genuine scientific advancement. When suddenly given incredible influence, as science has today, any discipline will become flooded with opportunists and charlatans.
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10. The Religion of Science. The popular culture treats science as though it is the greatest truth and its practitioners as though they are infallible. They treat science as the greatest aim and scientists as the best advisors in all areas of life. Some refer to this as “scientism” or “The Cult of Science.” At best, it encourages a love of science without teaching adherents to distinguish between good and bad science. At worst, it actively fights against unpopular theories, impeding the progress of science.
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A final note…
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Proof by Replication/Reproducibility. Theoretically, if a certain result can be replicated/reproduced (i.e., other scientists running the same experiment get the same result), it’s more likely to be true. Groups that repeat published experiments have found at least 65% were not reproducible and many of the remainder were less effective than the original results showed them to be in social sciences, and at least 75% of drug research was false. Another study of cancer research found 89% could not be reproduced.

Does Forced Retraction Cause Phimosis?

In short: No. Not only is there NO evidence that forced retraction DOES cause phimosis, there is actually POSITIVE evidence–cataloged on intactivists’ own websites–that forced retraction DOES NOT cause phimosis.

What are Adhesions?

The foreskin is naturally stuck to the glans by what we call “adhesions.” Virtually 100% of uncut boys have adhesions that prevent the foreskin from retracting. In fact, because circumcision often doesn’t remove the entire foreskin, adhesions occur in 45% [Van Howe, 2001] to 71% [Ponsky et al, 2000] of circumcised boys as well. Breaking the adhesions by retracting the foreskin before it’s ready—called “forced retraction”—is very painful and has no known medical benefits. In order to circumcise, these adhesions must be broken, but the boy receives highly effective numbing medicine beforehand [Shockley & Rickett, 2011]. However, there’s no numbing medicine in day-to-day life, and there’s no evidence that forced retraction is beneficial to the boy’s health. So… cut or uncut… don’t do it.

Why Do We Forcibly Retract?

Intactivists claim that Americans retract the foreskin because of cultural ignorance of proper care of the foreskin due to unfamiliarity with the foreskin thanks to the relatively low number of uncut males in our society—in other words, cultural ignorance. However, this argument is false. In reality, retraction of the foreskin even in infants is a hold-over from early 1900s medicine which has not yet been fully dropped, and this practice was common in Europe, as demonstrated by a landmark British Medical Journal article (archived in intactivists’ own websites in full text format) wherein the (anti-circumcision) author stated, “mothers and nurses are often instructed to draw the child’s foreskin back regularly” [Gairdner, 1949, p. 1435]. At that time, the American newborn circumcision rate was very low—lower, in fact, than the British newborn circumcision rate. Furthermore, in spite of the vast majority of American boys being circumcised, most physicians don’t know how to properly care for the circumcised penis, either, and thus retract the skin, breaking the adhesions, and causing pain [Ponsky et al, 2000]. It’s not cultural ignorance. It’s prehistoric medicine.

Does Forced Retraction Cause Medical Problems?

Intactivists claim that forced retraction causes tiny, microscopic tears in the delicate inner skin of the foreskin, causing infection and scarring. The scarring then allegedly results in phimosis, for which the treatment is often circumcision. So it’s considered ironic that “most” medically-necessary circumcisions are necessary only because the foreskin was not properly cared for in the first place. Intactivists make this claim as a matter of fact, so I believed it was actually based in fact. However, what I found was that their own sources say the exact opposite.

I wanted to have a primary source for articles like this, rather than a heavily biased secondary or tertiary source, so I searched all of the intactivist websites for all their articles on forced retraction in order to farm their resources. For their theory that forced retraction causes infections and scarring, they almost exclusively cited tertiary sources—predominately, old pediatric textbooks. (For those who don’t know, textbooks often don’t differentiate between theory and proven fact, so a textbook should never be taken as an authoritative source.) However, one article in Psychology Today actually provided a tertiary resource that was published in a medical journal. So I used the anti-circumcision online Circumcision Resource Library to look it up.

A Psychology Today Blog post, which originated from another blog post by a Ms. Cannon, instructs parents not to retract the foreskin and states that forcibly retracting the foreskin “tears the foreskin and the tissue… that connects it to the head of the penis, leading to scarring and infection” [Nervaez, 2011]. It provided no reference for the claim that retraction causes scarring, but for the instruction not to retract, it provides as its reference a 2002 article, which states, “Parents should be educated to avoid forcible retraction of the prepuce; the tearing that may result could lead to fibrosis [scarring] and subsequent true phimosis…” [Camille, Ramsay, & Wiener, 2002] For this claim, it provided a 1998 reference, which I followed, and which states, “True pathologic phimosis occurs when fibrosis, induration and scarring occur in the tip of the foreskin usually secondary to inflammation or trauma” [Simpson & Baraclough, 1998]. For this claim, it provided a 1980 reference [Rickwood et al, 1980], which I followed, and which turned out to be the primary source I’d been looking for.

The primary source was a study of phimosis in boys aged 4-11 years undergoing a medically-necessary circumcision for scarring on the tips of their foreskins, resulting in pathological phimosis. Cross-sections of their foreskins were compared to cross-sections of the foreskins of non-phimotic boys circumcised for religious reasons. Their histories of infection, forced retraction, and other foreskin or penile issues (even their fathers’ histories of phimosis in search of a potential genetic basis) were also gathered and compared. The authors discussed three previous theories from the 1950s-1960s of the causes of phimosis, that it is caused by forced retraction [Twistington Higgins, Williams, & Ellison Nash, 1951], or by repeated bacterial infection [Campbell, 1951], or by irritation caused by ammonia (present in urine) [Robarts, 1962]. Ultimately, they could find no correlation between phimosis and any of these theoretical causes and concluded, “There was little to support the contention that the condition is caused by trauma, or by ammoniacal [urine-caused] or bacterial inflammation of the prepuce…” and “Our data do not support previous contentions that it is due to forcible retraction, ammonia dermatitis or recurrent balanoposthitis [infection of the glans and foreskin].”

Interestingly, what they did find was that balanitis xerotica obliterans (BXO) was present in almost every case (20 of 21 specimens) [Rickwood et al, 1980]. This was similar to another British study by the same author, which found that 84% of pathological phimosis specimens had BXO [Shankar & Rickwood, 1999]. As I’ll discuss further in a later post, we don’t know the cause of BXO and therefore don’t know how to prevent it, and the treatment is typically circumcision. Perhaps if certain intactivists could get off their high horses and stop fallaciously insisting that the only cause of circumcision is forced retraction (due to its falsely alleged causal relationship with phimosis), we could get some real research done to find out what causes BXO, realizing that BXO may be the primary—or even the only—cause of phimosis. Then, perhaps we could prevent phimosis from ever occurring, and thereby prevent the most common cause of medically-necessary circumcisions. Personally, I believe this theory has significant merit because it has even been demonstrated in women, where the cause of clitoral phimosis (where the clitoral hood is too tight) has been demonstrated to be caused primarily by BXO and secondarily by surgical trauma [Flynn et al, 2015].

At any rate, the very interesting, but not completely surprising, part is that these secondary sources I found cited this primary source as evidence that phimosis is caused by trauma, specifically forced retraction, yet the primary source they’re citing says the exact opposite. In other words, the authors either didn’t check the sources they were citing or were intentionally lying.

Conclusion

So to sum up, there’s actually no evidence that forced retraction causes any medical problems whatsoever.

However…. That being said… It’s still painful to forcefully retract a boy, cut or uncut, so it’s probably best to just leave it alone.

 

References

Camille, C.J., Ramsay, L.K., & Wiener, J.S. (2002). “Caring for the uncircumcised penis: What parents (and you) need to know.” Contemporary Pediatrics, 11:61. http://www.cirp.org/library/hygiene/camille1/

Campbell, M. (1951). Clinical Pediatric Urology. Philadelphia: Saunders. Cited in: Rickwood, A.M.K., Hemalatha, V., Batcup, G., & Spitz, L. (1980). “Phimosis in boys.” British Journal of Urology, 52L147-150. http://www.cirp.org/library/treatment/phimosis/rickwood/

Flynn, A.N., King, M., Rieff, M., Krapf, J., & Goldstein, A.T. (2015). “Patient satisfaction of surgical treatment of clitoral phimosis and labial adhesions caused by lichen sclerosus.” Sexual Medicine, 3(4):251-255. doi: 10.1002/sm2.90. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4721030/

Gairdner, D. (1949). “The fate of the foreskin: A study of circumcision.” British Medical Journal, 2(4642):1433-1437. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2051968/

Nervaez (2011). “More circumcision myths you may believe: Hygiene and STDs.” Psychology Today Blog. https://www.psychologytoday.com/blog/moral-landscapes/201109/more-circumcision-myths-you-may-believe-hygiene-and-stds

Ponsky, L.E., Ross, J.H., Knipper, N., & Kay, R. (2000). “Penile adhesions after neonatal circumcision [Abstract].” Journal of Urology, 164(2):495-496. doi: http://dx.doi.org/10.1016/S0022-5347(05)67410-1. http://www.ncbi.nlm.nih.gov/pubmed/10893633

Rickwood, A.M.K., Hemalatha, V., Batcup, G., & Spitz, L. (1980). “Phimosis in boys.” British Journal of Urology, 52L147-150. http://www.cirp.org/library/treatment/phimosis/rickwood/

Robarts, F.H. (1962). “Penis and prepuce.” In Surgery of Childhood, ed. Mason Brown, J.J. Chapter 39, pp. 1159-1181. London: Edward Arnold. Cited in: Rickwood, A.M.K., Hemalatha, V., Batcup, G., & Spitz, L. (1980). “Phimosis in boys.” British Journal of Urology, 52L147-150. http://www.cirp.org/library/treatment/phimosis/rickwood/

Shankar, K.R., & Rickwood, A.M. (1999). “The incidence of phimosis in boys [Abstract].” BJU International, 84(1):101-102. http://www.ncbi.nlm.nih.gov/pubmed/10444134

Shockley, R.A., & Rickett, K. (2011). “What’s the best way to control circumcision pain in newborns?” The Journal of Family Practice, 60(4):233-234. http://www.jfponline.com/specialty-focus/pain/article/whats-the-best-way-to-control-circumcision-pain-in-newborns/d9d56c4483f56e3d0f9b55d68dc49985.html

Simpson, E.T., & Baraclough, P. (1998). “The management of the paediatric foreskin.” The Australian Family Physician, 27(5):381-383. http://www.cirp.org/library/hygiene/simpson1/

Twistington Higgins, T., Williams, D.L., & Ellison Nash, D.F. (1951). The Urology of Childhood. London: Butterworths. Cited in: Rickwood, A.M.K., Hemalatha, V., Batcup, G., & Spitz, L. (1980). “Phimosis in boys.” British Journal of Urology, 52L147-150. http://www.cirp.org/library/treatment/phimosis/rickwood/

Van Howe, R.S. (2001). “Re: Penile adhesions after neonatal circumcision.” The Journal of Urology, 165(3):915. doi: http://dx.doi.org/10.1016/S0022-5347(05)66571-8. http://www.jurology.com/article/S0022-5347(05)66571-8/fulltext

Toward Understanding: Circumcision Terminology

There’s an issue in conversations about male circumcision today. Well, there are a lot of issues, such as the complete shutting down of opposing viewpoints and slinging of ad hominems and cyber bullying. But the one out of the dozens of issues that I want to address in this post is terminology.

The United Nations’ official term “Female Genital Mutilation” (FGM) refers to the cultural practice that involves removing part or all of a girl or woman’s clitoris, clitoral hood, and labia, and sometimes sewing her vagina closed [1] (see Footnote 1). It’s a horrific practice, and so “mutilation” seems fitting. However, they discovered that when discussing the practice with natives and trying to educate them about how harmful the practice really is, the term “mutilation” is so emotionally-charged that it tends to shut down conversation entirely and do more harm than good in advancing their anti-FGM cause (see Footnote 2). Thus, when conversing with natives and educating them about the harms of the practice, the WHO advocates the use of the emotionally neutral and anatomically accurate term “Female Genital Cutting” (FGC). [1]

A very similar thing is happening in online conversations about circumcision. I would like us to advance toward a better understanding of each other and an improved ability to communicate effectively, and this may be one small part of that.

I apologize if this makes your eyes glaze over.

Terms for the Penis

If a penis has been circumcised, there are a number of terms used to describe it. The most common are “circumcised” and “cut.” People who are very against circumcision often use the term “mutilated.” Obviously, that’s intentionally inflammatory and offensive to males who are circumcised. Circumcised men sometimes refer to their penis as “clean” or “clean-cut.” Obviously, that’s offensive to males who are not circumcised. Therefore, I recommend the terms “circumcised” and “cut.”

If a penis has not been circumcised, there are also a number of terms used to describe it. The most common is “uncircumcised.” I’m going to take a slight rabbit trail for a moment. My children are not vaccinated. Anti-vaxxers often take offense at the term “unvaccinated” because, they argue, “you can’t un-vaccinate a child.” To me, this has always demonstrated a profound misunderstanding of the English language. If I am “unlicensed,” that doesn’t necessarily mean I once was licensed but now am not (that would be “de-licensed”). It simply means I am not licensed. The English prefix “un-” simply means “not.” Ergo, “unlicensed” means “not licensed,” “unvaccinated” means “not vaccinated,” and “uncircumcised” means “not circumcised.” So this whole argument doesn’t make any sense to me, but in the same way that anti-vaxxers often take offense at the term “unvaccinated,” people who are opposed to circumcision often take offense at the term “uncircumcised.” My children are not vaccinated and I use the term unvaccinated. I don’t understand the offense at the terms “unvaccinated” or “uncircumcised.” In fact, I think it’s stupid in both situations. But I’m going to respect that opinion by not using the term “uncircumcised” in conversations where people opposed to circumcision might be involved.

Another term for a penis that is not circumcised is “intact.” This is the term those who oppose circumcision most often use. However, it’s insulting to circumcised males because the term was first used in animal husbandry to mean an animal that has not been neutered or castrated. Thus, using the term “intact” for a man who is not circumcised implies that a man who is circumcised has been castrated and/or emasculated. For this reason, some men take offense to the term. In fact, an acquaintance of mine calls himself “intact” even though he’s circumcised. So in conversations with people from both groups, I recommend against the use of the term “intact.” Other terms used include “natural” and “normal,” which are also obviously insulting to circumcised men and intentionally inflammatory; and “anteater,” which is obviously insulting to men who are not circumcised and intentionally inflammatory. The only completely neutral term* I can find that isn’t highly medico-lingal, and which people on both sides use, is “uncut.” So that’s the term I recommend.

Two completely neutral medico-lingal terms are “prepucal” and “aprepucal.” The “prepuce” is the foreskin, so a “prepucal” penis is one that has a prepuce and an “aprepucal” penis is one without a foreskin. However, I thought these terms were too difficult to catch on with non-medical persons.

Therefore, I recommend “circumcised” or “cut” versus “uncut.”

Terms for People

People who support circumcision typically use the terms “pro-circumcision,” “pro-circ,” or “PC.” People opposed to circumcision call them “pro-cutters.” Although the term is technically somewhat neutral, it is always used in a derogatory way, so it’s considered offensive by pro-circs. People opposed to circumcision also call them “pro-mutilators,” “pedophiles,” “child abusers,” “child molesters,” etc. For obvious reasons, I recommend avoiding those terms as well and sticking with “pro-circumcision,” “pro-circ,” or “PC.”

People who oppose circumcision call themselves “intactivists,” which is a combination of “intact” and “activist.” Pro-circs sometimes call them “intactonuts” or “intactic*nts,” which are obviously offensive, so I won’t use those terms. Because the term “intactivist” comes from the offensive use of the word “intact,” it could be argued that “intactivist” shouldn’t be used, either. However, “anti-circumcision activists” is too long and pro-circs most often use the term “intactivist” anyway, so I recommend “intactivist.”

A somewhat neutral term is “PPC” or “pro-parental-choice.” This refers to people who support a parent’s right to choose whether to circumcise, even if they disagree with their choice. Typically, intactivists believe that circumcision is evil and should be completely abolished, so it will be very rare for you to find an intactivist who is also PPC. Therefore, PPC typically only refers to people who are neutral on circumcision or are pro-circ. I have yet to meet a person who actually believes that circumcision should be mandated, but most intactivists believe that circumcision should be legally prohibited.

Conclusion

To help us move toward a better understanding and more fruitful conversations on the topic of circumcision, I recommend the use of emotionally neutral terminology, including “uncut” versus “cut”/”circumcised” and “intactivist” versus “pro-circ”/”PC.” You don’t advance your cause by insulting the other side, and anyone can see that you’re being a jerk. If you really care about helping boys to live healthier, fuller lives, you should consider reaching their parents in the most effective way possible.

 

*Well, I thought it was completely neutral. I’ve seen it used almost exclusively in a positive light. But just today, after writing this but before publishing it, I discovered that there are even people opposed to that term as well. At any rate, it’s still the least offensive term I can find.

 

Footnote 1

A brand new and exceedingly rare version of this involves removing only the clitoral hood, but this is not a traditional practice [1]. Because removing only the hood is similar to removing only the foreskin in the man, it is accurate to call it “female circumcision.” However, this is distinct from the practice of FGM, which has never traditionally involved only the hood but rather has always involved some degree of harm to the clitoris and almost always removal of some portion of the labia minora. Some may argue that female circumcision can also be performed for genuine medical reasons such as the treatment of clitoral phimosis [2].  However, in that case, if you read the entire study, you’ll find that the treatment involves cutting a slit in the hood, not removing the entire clitoral hood. Therefore, the only accurate use of the term “female circumcision” is in reference to a new, rare practice that is most common in Egypt and is only one small part of traditional FGM.

 

Footnote 2

From Reference [1]:

“The language used to describe these practices remains controversial and requires careful ethical consideration. The term ‘Female Genital Mutilation,’ formerly adopted by the United Nations (UN) calls attention to the gravity of the harm caused by FGC practices. ‘Female Genital Mutilation (FGM)’ is the terminology used within campaigns to end these practices by anti-FGC advocates from practicing countries of origin and the western world. FGM terminology positions the practice of FGC as an extreme human rights violation. This term is often perceived as inflammatory, judgemental and stigmatising, particularly for women previously exposed to the practice who do not view their bodies, or the bodies of their daughters, as mutilated [3]. The implication within this terminology is that FGC is practiced as an act of intentional violence against female children, adolescents and women. Those who do not understand FGC as such an act, but as a valued cultural tradition, may experience the language of “mutilation” as alienating [7,911]. The delicate challenge of reconciling respect for cultural values associated with these practices and addressing their perceived harmful effects on health is evident in this discrepancy between the intent and impact of language.

” ‘Traditional women’s practices,’ ‘Traditional health practices,’ and ‘Initiation,’ are some of the preferred terms identified by individuals who subscribe to the socio-cultural benefits from these practices. Chalmers & Omer Hashi [10] as well as Vissandjée et al. [7] conducted focus groups with overall 600 women from different practising countries living in Canada which revealed “circumcision” to often be the preferred terminology. Several other authors have also identified “circumcision” as an alternative term, yet this term has been argued to trivialise the procedure, falsely attributing to FGC the legitimacy afforded to male circumcision within the West [12,13]. “Female Genital Cutting (FGC)” and “excision and infibulation” have been identified as more neutral, ethically sensitive terminology [4,6]. For the purpose of this chapter, we will use FGC as a term comprising procedures which alter the female genital organs for cultural or non-therapeutic reasons.”

References

[1] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4012131/

[2] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4721030/