If Circumcision Rates Keep Falling, Health Costs and Infections Will Spike

As more and more states' Medicaid programs cut coverage for circumcision, researchers take a look at the potential fallout

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If rates of circumcision among infant boys continue to drop in the U.S., it could lead to billions of dollars in added health care costs and increases in sexually transmitted infections among men, according to a recent study by Johns Hopkins researchers.

Studies link circumcision with numerous health benefits: the procedure is associated with lower risks of urinary tract infections in babies and young boys, and reductions in men’s risk of contracting HIV, genital herpes and human papillomavirus (HPV); it may also help reduce the odds of penile and prostate cancers. By reducing the burden of sexually transmitted infections among men, it may also help keep more women infection-free as well.

If circumcision rates were to drop from the current 55% to 10%, urinary tract infections in baby boys may rise a whopping 212%, and in men, HIV infections could increase by 12%, HPV infections by 29% and herpes simplex virus type 2 by 20%. In women, dropping rates of male circumcision could increase cases of bacterial vaginosis by 18% and low-risk HPV by 13%.

(MORE: Study: Uncircumcised Boys Have a Higher Risk of UTI)

As gaps in insurance coverage increasingly lead parents to opt out of circumcision, the researchers say a drop to 10% is not unlikely — that’s in line with circumcision rates in Europe, where the procedure is typically not covered by insurance. Medicaid programs in many states have eliminated coverage of the procedure: currently, 18 states no longer pay for it, with South Carolina and Colorado most recently ending coverage last year. According to the study authors, the rate of circumcision rates had remained steady at about 79% between 1970 and ’80, but fell to 63% in 1999 and then dropped again to 55% in 2010.

To assess the estimated health-care costs of not circumcising, the researchers create an economic model. Their program included 4 million babies, equal to the number of kids born in the U.S. each year. Each circumcision costs insurers about $250 to $300, the researchers figured, but each time the procedure is avoided, $313 in illness-related costs can be added for doctor’s appointments, medications and other treatment for men who contract infections or develop disease as result of not being circumcised.

The authors calculate that if the circumcision rate dropped to 10%, it would increase lifetime health care costs by $407 per man and $43 per woman. Over 10 years, total additional health care costs would exceed $4.4 billion. “By health policy analysts and government officials thinking they can save money by eliminating Medicaid coverage of male circumcision, they are actually in the long run increasing the costs overall,” says study author Dr. Aaron Tobian.

But large medical bills are not the authors’ greatest concern. “We have a trillion dollar health care system, so the numbers are not huge,” says Tobian. “The bigger problem is that [without Medicaid coverage] and with private insurance carriers following the government’s rules, we are implying there are no medical benefits to this procedure.”

(MORE: How 11 New York City Babies Contracted Herpes Through Circumcision)

In addition, the authors note that populations that are most likely to qualify for Medicaid coverage currently have the lowest rates of male circumcision and often the highest rates for infections. “By decreasing Medicaid coverage for circumcision, we may be exaggerating these racial and socioeconomic disparities,” says Tobian.

He believes all state Medicaid programs and private insurers should cover circumcision, so that families can discuss the pros and cons of the procedure with their doctor, without having to worry about cost. For its part, the American Academy of Pediatrics currently says there isn’t enough evidence of the health benefits to recommend routine circumcision of infant boys. However, the pediatricians group is about to issue an updated policy statement on the issue soon, and is expected to recognize newer evidence of the benefits of the procedure.

In an editorial accompanying Tobian’s study, Dr. Arleen Leibowitz and Katherine Desmond from the University of California, Los Angeles, argue the federal Medicaid program should consider reclassifying circumcision as a required benefit, so that states facing budget constraints won’t drop the procedure. By doing so, states can reduce rates of HIV and other sexually transmitted infections, and avoid rises in medical expenses.

The study is published in Archives of Pediatrics & Adolescent Medicine.

MORE: Battle of the Bris: A Move to Outlaw Circumcision in San Francisco

102 comments
Rob_L
Rob_L

I seriously can not believe this is considered journalism.

http://pediatrics.aappublications.org/content/early/2013/03/12/peds.2012-2896.full.pdf+html

This pretty much covers everything that is argued in favor of circumcision.  STI rates are pretty much equal in Europe and the US and in some instances we have more, circumcision is preventing nothing.  Don't forget to throw more of the AIDS myth out there.

http://www.amfar.org/about-hiv-and-aids/facts-and-stats/statistics--worldwide/

That's right, your chance of getting AIDS/HIV in America from a random sexual encounter and unprotected is less than getting struck by lightning.  69% of the worlds HIV cases are in subsaharan africa.

Stop trying to scare people into harming their children with bogus facts and bloating up fake stats about health care increases.  I can't believe you wasted anyone's time writing this trash of an article, or at least try writing one that required more than 5 minutes of pretend research.

As a man that lives everyday with a botched childhood circumcision from the 70's, I make sure everyone I know hears about how stupid this procedure is.  You aren't protecting your children from anything, it isn't any cleaner and baby girls get UTI's at a much higher rate than boys and they just give them antibiotics.

Estimated botched circumcisions range from 1-5% because it's truly unknown and generally not reported, because heaven forbid parents be informed about the complications of cosmetic procedure.

The reason the rates are dropping is because America is slowly waking up to the fact that 75% of the world leaves their children intact and without any problems.  Teach your children safe sex and not to go out and have sexual encounters with hookers and every promiscuous girl they find in a bar and if they do.. .wrap it up!  The chance of getting HIV/AIDS if you use a condom is so statistically small it's insane.  (from a random encounter) Even if you had sex directly with someone that had HIV and you were protected with a condom it's still very small.

Stop writing circumcision propaganda and  write some real news.

MarkDavenport
MarkDavenport

Much miss information in this article. I am in the UK were 99 percent of men are intact.No problems here, no more infections, no less hygiene. The forskin is a functional part of the body just like any other. This is a pure culture and bad science. Why don't we remove our ears at birth? We can live with out them and won't have to wash behind them.

RoodToodDood
RoodToodDood

I was born in the mid-70's and thankfully was not cut, which is amazing since about 90% of males born then in the US were. My father refused to allow the procedure and basically had to remove me from the hospital to avoid it. I've never had an issue and cannot imagine why this barbarism is done outside of Judaism.

HayleyDawnKolarik
HayleyDawnKolarik

Infant Circumcision- why you think it's done: 

1. God wants it done. FALSE. "God made you perfect and in his image." God wouldn't give it to us if he didn't want us to have it. Disfiguring the body is prohibited in many religions including Judaism, Islam, and Christianity. 

2. Foreskin serves no purpose. FALSE. Millions of years of evolution have given foreskin to every man and most mammals. Evolution doesn't make mistakes like that.

3. Babies don't feel pain. ARE YOU RETARDED? Babies feel pain more intensely than adults. 

4. Babies won't remember. YES AND NO. 'Repressed memory' is a more appropriate description: and some do remember. 

5. Circumcision reduces risk of std's. FALSE It INCREASES the risk. Foreskin is a mucus membrane. Mucus TRAPS pathogens - it HELPS prevent disease. 

6. For hygiene. MAKES NO SENSE. How lazy can you possibly be? Taking care of a bloody wound in a diaper is easier? What else shall we amputate to stay clean - perhaps the labia? 

7. A deluge of other equally random and ridiculous excuses. -Circumcision has probably had more claims of benefit than any other medical procedure in history: that alone should tell you something. 

Infant Circumcision - Why it's actually done: 

1. Infants cannot defend themselves. - How many sane men would submit to cutting off healthy bits of themselves (some of the most sensitive bits no less..) for no benefit and without painkillers? 

2. The circumcision room is one of the most profitable areas in a ho$pital. 

3. Shame / Guilt / Maintaining an image / Stockholm syndrome. - It is easier to maintain a lie, than to admit having done harm to your child (or one of your parents having done harm to you).

CH
CH

LOL! skin 'er back and let mommy check before you go on your date. Knowing boy's and their irresponsibility with cleanliness, I can see the issues with being uncircumcised.  Of course all of you poster's know different, because if it didn't happen with your son in your home, it surely couldn't happen anywhere else. Your experts at Google and not medical professionals.... and I feel sure some of you will come back and claim you are, because you said so.

LauraIvansons
LauraIvansons

Your statistics are bunk! UNLESS men in America grow a different penis and foreskin than the rest of the world! Five intact boys in my home and a husband...never an infection, never a std, never a cancer...because all the statistics are LIES to make money. The rest of the world is mostly intact and it is a non-issue. The thing that MOST of these studies have in common are they are done by ignorant, American- trained doctors that have no education on the function of the foreskin in FIGHTING infection!

alexwpartridge
alexwpartridge

I would like to ask you, Alexandra Sifferlin, would you mind it if your clitoral hood was taken away? Because that is your prepuce (foreskin), and under US law you are protected from forced genital cutting of any sort. 

American men are not given the same protection over their own bodies. This is quite a shame. 

Circumcision is very invasive, excruciatingly painful, and unnecessary. This removal of 20,000+ nerve endings is also irreversible. Thankfully, my British father and wise American mother did not fall victim to this harsh American cultural "norm" and protected me and my brothers. We are all very grateful and have never had any problems with our whole penises.

Please, take the time to do research on the male anatomy and why everyone deserves his or her genitals how they are meant to be. I would not get circumcised for any amount of money.

CatherineSchau
CatherineSchau

Good lord,  not this stupidity again. Only in the anti-foreskin US is this considered a problem.   The low rates of circumcision in places like Finland and Denmark have not caused this "increase" in health care costs.  This is a horrible article full of misinformation.

Mommyof4WeeOnes
Mommyof4WeeOnes

Funny. Neither of my intact sons have incurred our family, or the state, any "extra" charges due to being intact. They are 3 and 5 years old. Neither has my whole husband, ever. He is 30. Curious...

How about these same researchers do a study on how much money the country would SAVE if we allowed girls to be circumcised legally? C'mon! You can't fight in favor of one cosmetic surgery only to turn your nose up to another... just sayin'.

Allerchick
Allerchick

Very disappointed in this article, and in Time Magazine.  This is alarmist pseudoscience masquerading as real journalism; an editorial masquerading as a factual article.  Most men in the world are intact, and we don't see Scandinavia, Asia, Australia, Canada or South America rampant with HIV and STDs, and drowning in healthcare costs.  Do your research, Ms. Sifferlin.  If you are a serious journalist, don't just repeat what you hear from sources that clearly have a pro-circumcision bias.  

The HIV studies in Africa, in addition to being highly flawed, do not translate into a necessity for routine infant circumcision in the first world.  Further, a little girl has a 1 in 8 chance of developing breast cancer in her life.  If we remove the breast buds of all little girls as soon as they're born, we can decimate the incidence of breast cancer in our population.  Shall we do it?  Little girls get urinary tract infections at a higher rate than little boys.  If a little girl gets one, do we say, "What a shame we didn't remove her clitoral hood at birth..it's so dirty and nasty down there; no wonder she got an infection!"  No, we treat with antibiotics.  Seriously, circumcision is a solution looking for a problem.  Our bodies are fine just the way they are; no need to mess with what Mother Nature gave us.  This is a highly irresponsible article that benefits nobody but the doctors who make $$ performing circumcisions.

circesadreim
circesadreim

This is SUCH a load of rubbish. No such thing has happened to other developed countries that don't routinely mutilate their babies. Goodness, but the cutting culture is strong with some in the media here. Sad that they're rather spout off the same myths rather than do actual, you know, research ...

KellyChapmanBurns
KellyChapmanBurns

So... can anyone just write anything and it's ok? You are TIME magaine... what I thought was a well respected, reputable, and truth delivering source. GUESS NOT.

I'm confused about something... well, everything, because this was just a bunch of nonsense trying to scare people into cosmetic surgery, but whatever. insurance typically doesn't cover unneccessary crap, so... hello? That's why they are no longer convering genital cutting. There is a reason it was made illegal for girl in 1997, but you know... they're obviously more important than boys.

If I  were to get circ'd and have my clitoral hood removed, would that lessen my chances or ovarian cancer? um. no. So how does foreskin amputation reduce the risk of prostate cancer?

I had a uti once. Man, if only my parents had "ordered" genital cutting, maybe that could have been prevented.

You know what I learned when I was informed of sex? SAFE SEX helps prevent STD's...not genital cutting. You are nuts. get a clue.

JamesLoewen
JamesLoewen

Scare mongering headline: "If Circumcision Rates Keep Falling, Health Costs and Infections Will Spike." What  utter NONSENSE! Most of the world's men (80%) have their whole penis (complete with a moveable foreskin, as nature intended) and guess what? They are perfectly healthy! The whole penises of the world have NOT caused "health cost and infections to spike." Utter nonsense! And propaganda for the sick circumcision industry in the USA.


The damages caused to children and the adults they become when circumcisions are botched means in some cases totally ruined lives, and deaths.


Your pathetic headline pales when you start looking at the casualties, the untold damages of circumcision forced upon children.


Why don't you look into this issue Alexandra Sifferlin and report on it in a way that wold actually protect children instead of subjecting them to an imposed, sexually mutilating surgery which resultants in loss of normal, healthy sexual anatomy. Why don't you go back to your editor and pitch a story that actually does some good?



JeffGraw
JeffGraw

Oh, I forgot one last point. The HIV and SDT epidemics in the circumcision-happy US are almost entirely due to anal sex. Look it up on the CDC webpage and you will see that for men you are over 80 times more likely to get infected with HIV if you have anal sex, and there are many studies showing that circumcision does NOT protect gay men from HIV. 

Journalism is dead.

JeffGraw
JeffGraw

Time magazine too? You had to help spread the propaganda; very disappointing. Apparently your writing staff needs a clue. 

First statistics from malaria-infested (40% infection rate) hell-holes in Aftrica are not reliable statistics for here. Malaria and TB are cofactors for the transmission of HIV and other STDs. Second, no studies from the US show these benefits. Third, statistics from Europe show much lower HIV rates (500% lower in Germany), lower STD rates, lower UTI rates, and lower cancer rates. Fourth, the ARV trails had much better results at stoppng HIV transmission than circumcisions. Fifth, the long Langerhans theory just exploded, now we are being told the next theory is bacteria, even though there is no evidence that this is a problem. Sixth, Johns Hopkins has invested 30 years of research into biomedical applications for cells harvested from neonatal foreskins. (I can keep going, but you wouldn't understand anyway.)

You guys are idiots

markace
markace

It disgusts me that this article is all about saving money allegedly. Do you not see? THis should be about human beings and the right to keep their body the way it was intended. It is not even mentioned in the article whether the boy/man wants to keep his foreskin. Remember it is not a dollar sign, it is a baby.

FelixAndersen
FelixAndersen

Why is the media so biased towards circumcision? Well, the US media - I'm from Europe, we have circumcision rates low as 1.6% and everybody is doing just fine in regards to health and sex life. Apart from a Penn & Teller episode on circumcision, most of the media seems to favor it - why? Is it because - at least print - media is targetted mainly at women and they don't really know what this is about? I mean, there are A LOT of women talking about circumcision as if they had any idea about what it really is or how it feels like to have one. So the only sensible thing for them is to advocate for the child to decide himself later in life, after THOROUGHLY researching the matter. I think it's great the rates are declining in the US, it's another step towards a civilized nation. Even Jews start to abandon it, and that should tell you something. I guess the US doctors are fearing for their multimillion dollar business and now have to fight back.

Brinxster
Brinxster

You know we have a cure for urinary tract infection, it's called antibiotics. Did you know we have prevention methods, it's called soap and water. 

Maybe instead of spreading propaganda about the mythical benefits of genital cutting you should just teach parents how to clean their child's body, so he too can be taught how to clean himself, so he won't get infections. 

That would be the responsible thing to do. You don't cut off children's ears because they get ear infections! You should not amputate perfectly healthy body parts off of children! 

Athiest
Athiest

This article makes me sick - google "Foreskin Cosmetics"...

CHA CHING, John Hopkins.. scare parents into mutilating their baby boys so you can make a buck.

SICKOS.

Athiest
Athiest

Chopping off the heads of all the John Hopkins idiots who did this study could reduce brain cancer for all of them.

Stop mutilating children.

Roger DesMoulins
Roger DesMoulins

"If circumcision rates were to drop from the current 55% to 10%, urinary

tract infections in baby boys may rise a whopping 212%, and in men, HIV

infections could increase by 12%, HPV infections by 29% and herpes

simplex virus type 2 by 20%. In women, dropping rates of male

circumcision could increase cases of bacterial vaginosis by 18% and

low-risk HPV by 13%."Note the weasel words "may" and "could," easily overlooked in a cursory reading.

Japan, Europe and New Zealand do not practice routine infant

circumcision. In Canada and Australia, it is a minority practice. Condom

access, personal hygiene and sexual sophistication of these countries

are comparable to that of the USA. The only studies relevant to

the claims made in the preceding paragraph are those whose subjects are drawn from these countries. Studies whose subjects are drawn from Third World populations have no bearing on whether or not an American baby boy should be circumcised. The most dramatic reports of that nature are the African clinical trials claiming that circumcision is prophylactic against AIDS. On why those trials were badly conducted and badly analysed, see:www.salem-news.com/fms/pdf... These assertions also cannot be true if people remain faithful or use condoms. Therefore routine circumcision is predicated on a cynical and patronising view of sexual morals, especially those of the slum underclass. The quotes by Aaron Tobian are very revealing of the true agenda here: to get Medicaid and private insurance to cover the cost of RIC, and then to have physicians lean hard on underclass mothers to allow the circumcisions of their infant sons. Tobian and his ilk have silently written off educated white middle class parents as lost to the sexual siren song of intactivism.

1 Bad Mom
1 Bad Mom

My first was circumcised, but my 2nd wasn't...and our doctors agreed that it wasn't medically necessary to do it for him.  I understand some people end up with problems, but should we circumcise everyone just because some people get sick? That's like suggesting that we should take out everyone appendix just in case they might get appendicitis (oh wait, we did that, and it turned out we were wrong).  Should we take every woman's breasts away from her just in case she might get breast cancer, too?  No.

Bottom line - it should be the parents' choice.  And insurance should probably cover it, too.

Jack Page
Jack Page

I don't think circumcision is useful as I can see more and more new members 

at HIVMatching,com, a dating and support community for people with HIV that 

I joined several years ago.

gouzgounis72
gouzgounis72

Attaching price tags (or body counts) to everything is at the core of modern public health. Many diseases have complex, multifactorial causes - so its impossible to single out one factor as the cause of that disease under all conditions or even within a popualtion.  Studies have shown that circumcision may haveprotective effect in AFrica but not in the US. In any case, it is preventable by wearing a condom and being circ'd does not provide absolute protection against any disease. But stating the truth will not get your next grant funded or grab headlines.

Always Sick Chick
Always Sick Chick

Bad bad article. There is no medical benefit to circumcision.  Even my OBGYN agreed with me, and the pediatrician said that as long as my kid cleans himself properly and we show him how to do it, he'll be fine.

Not very unbiased reporting here.

Mike Elliott
Mike Elliott

What some people will come up with to hide their personal embarrassment of they, their doctors or male relatives being disfigured at birth and then following that up by advocating it's continued acceptance through hygienic brainwashing! They will continue to believe they have the right to make their little boys (and other little boys) LESS than what was originally called for by natural design. This attitude seems so tribal-like and you would think we would have grown out of it by now, especially with the advent of running water. Let the little boys be as God/Nature made them out to be, and DO NOT become overly focused on infant-penile hygiene as that will only bring on unwarranted infections. Do not rip the foreskin back but simply wash around the area with water! Other than that, leave the little fellow's foreskin alone, Mom. They will grow to LOVE you for it.

DavidBusi
DavidBusi

@Mommyof4WeeOnes except - who is going to clean under there when your husband or sones are in nursing homes in old age and can not do so themselves?  

Mommyof4WeeOnes
Mommyof4WeeOnes

@Brinxster D-Mannose. It's a sugar, safe for everyone, and attaches itself to bacteria and comes on out with the urine. Easy! No abx! :)

JeffGraw
JeffGraw

@Brinxster Good points, but actually UTIs are largely preventable anyway. One UK doctor wrote in 1997 that eyedrops work just as well for infections without antibiotics. Extracts from cranberries have been studied and the results are published in medical journals as well. Breastfeeding significantly reduces the UTI rate for boys and girls. And there are people who say if the baby's body makes contact with the mother's body, the necessary bacteria are transferred to help reduce the bacteria populations that cause infections. 

Also, many of the UTI in the US are caused by the dcotors themselves. They don't know what they are doing, and so advise parents to retract and clean. This tears the tissue and causes infactions.

Finally, in the widely quoted Canadina study where the 4x higher UTI figure comes from; if you read the conclusions the authors say the real rate is actually only about 2x.

Pen15
Pen15

Also, insurance doesn't cover it because it's NOT MEDICALLY NECESSARY.

Pen15
Pen15

@1 Bad Mom NO!!!!  It should not be the parents' choice.  And legally, it isn't.  Parental rights END when they infringe upon the rights of the child.  Not your penis, not your choice.  get a clue!!

CatherineSchau
CatherineSchau

@1 Bad Mom Nope. Parents don't own their children and they certainly don't own their child's genitals. Not their penis, not their choice.

circesadreim
circesadreim

@1 Bad Mom Your post is a contradiction. 


First you say, "Should we take every woman's breasts away from her just in case she might get breast cancer, too?  No."


Then you say, "Bottom line - it should be the parents' choice.  And insurance should probably cover it, too."


Fundamentally, it shouldn't be a parent's choice to cut off healthy body parts from their children. And insurance should never have to cover non-therapeutic genital cutting. 


Better yet, ban all cases of such cutting. Boys deserve the same protection that girls currently receive.

Brinxster
Brinxster

They should also be WELL INFORMED to make such a big decision. If all they are exposed to is propaganda then they won't know what's true and what's false. They literally are taught nothing about the purpose of the foreskin, making it impossible for them to make an educated decision. Even most circumcised doctors are painfully ignorant on the topic.

danlunche
danlunche

Come on, what boy wants that floppy bunch of skin on his pkr. A friend of mine had a circumcision in his late 30s - "most painful thing I ever went through" he said. Think about what the boy has to live with the rest of his life. Not having circumcision must be coming from the same liberals who said let the child do what they want - it won't hurt 'em. Look where we are today.

Pen15
Pen15

@gouzgounis72 Actually, HIV and AIDS rates are going UP in Africa since the cutting campaign began.  Men are NOT being informed that they still need to wear condoms. 

MarkDavenport
MarkDavenport

If they are unable to clean their forskin. I would say they are pretty much paralysed and need a carer who will clean them. By the way stop insulting most of the un mutilated planet by suggesting they are un hygienic when they know dam well they are clean. Shall I suggest you are unhygienic because you did not have your finger nails removed at birth?

ml66uk
ml66uk

@danlunche That "floppy bunch of skin" just to happens to contain the most sensitive and pleasurable parts down there.  I'd pay a year's salary rather than be circumcised.

KellyChapmanBurns
KellyChapmanBurns

exactly... the most painful thing he ever went through... so lets to it to babies for no reason whatsoever.

good logic.

kendrik.pmc
kendrik.pmc

You would be surprised how many boys would prefer to have an intact genital.

 This is how circumcision is perpetuate in the US, do it when they are young as when they grow up, most of them will realize what a sick procedure this is. This article is nothing but scare-mongering and will never be allowed to published in Europe.

Rob_L
Rob_L

@DavidBusi @HayleyDawnKolarik @Mommyof4WeeOnes

http://www.amfar.org/about-hiv-and-aids/facts-and-stats/statistics--worldwide/

Except that the majority of circumcisions don't use anesthesia.  And as a man that was on the receiving end of a botched circumcision, I find it offensive that you call people against it Drama Queens.

Foreskins are neither dirty or irrelevant.  We get it , you were circumcised and you see fine, because you've never known better in your entire life.  Just keep preaching all the crap you hear because eventually this procedure will go by the wayside much like electroshock therapy and bleeding people back in the 1800's.

I can't believe you choose to be so offensive DavidBusi when 75% of the men in the world are intact and you and I are in fact not normal being circumcised.  Think about it, the U.S. isn't even remotely close to the world's best healtchare and yet you prance around all high and mighty on an internet forum like you know everything about intact penises of which you don't even have.  If there was true actual medical merit to circumcision, the rest of the world would follow suit to the U.S. like everything else, but they aren't.

DavidBusi
DavidBusi

@HayleyDawnKolarik @DavidBusi @Mommyof4WeeOnesThere is no brutality - no abuse - you know NOTHING of how circumcisions are done.  I can post a video of two circumcisions being done for the benefit of infants with pain control if you like to display your ignorance. of the matter.  There is no drama no emotion no dribble like the adjectives you use - just a nice clean circumcision a moment of effort for a life time of benefits.  No drama.  lower levels of disease, cleaner, lower maintenance, no women retching at the sight or smell of a smegma stinking penis - yes increased sexual options not decreased ones.  How do I know that it works just fine - I make love with my Wife EVERY single day and we are pretty darn good at it too.  My penis works just fine without a dirty foreskin.   Freaking drama Queen - Can you say you actually let him put this thing in your mouth?  

Katjavan
Katjavan

@kendrik.pmc 
As much as I agree I'm curious as to why your comment was sent to me as an email.