A Cut Too Deep: A case study in bias

If I were to create Francis Walker’s Rules of Using Statistics, Rule #1 would probably be this:

1. You are not allowed to use a statistic in an argument unless you have read the underlying research

This rule would also have a sub-part:

1a. Do not skip from the “Introduction” section to the “Results” section, you must also read the “Methods” section

In each of the posts I’ve written so far, bias has played a role, and by reading the “Methods” section of research you can get an understanding of what type of bias might be influencing a particular research study.  The other week I read an article on Ars Technica that reminded me of the first time I realized just how critical the “Methods” section really was.  What was said Ars article about? Digital Security? Space Travel? General Technology, perhaps?  Nope – it was about circumcision.

While admittedly I have not done very much research on the subject, on balance it seems like whichever decision a parent makes, their son is probably going to turn out just fine. For some people though, the issue of circumcision is highly contentious.  In fact, I’ve often found it kind of amusing how passionate people can get about the subject and the Ars article reminded me of a comment thread I remembered reading years ago.  In that thread, one of the arguments used by an adamant anti-circumcision advocate was a somewhat strange sounding statistic – A US study on the matter had found that 6 out of 7 women preferred sex with men with an uncircumcised penis.  This struck me as odd.  Growing up in the US where many men are circumcised, I’d heard of women either not caring one way or the other, or preferring a circumcised penis as that is what they were used to.  I certainly never got the impression that there was an overwhelming preference for an uncircumcised penis. So I decided to read the underlying research.

The study in question was The effect of male circumcision on the sexual enjoyment of the female partner from the January 1999 edition of BJU International1. I found the article on the site I linked to and sure enough, there was the stat right at the top of the “Results” section.

CIRP Note: The results of this survey are somewhat obscurely stated. This survey surveyed 138 women. Of that group 20 (14.5%) preferred non-intact circumcised sexual partners while 118 or (85.5%) preferred intact non-circumcised sexual partners. This means that about 6 out of 7 women preferred intact non-circumcised partners while about 1 out of seven preferred non-intact circumcised partners.

If true, that certainly seems like a pretty convincing argument against circumcision. There is a slight problem though.  Below is the first paragraph of the methods section, let’s see if you can figure out what might be distorting the results:

Women having sexual experience with both circumcised and anatomically complete partners were recruited through classified advertisements in magazines and an announcement in an anti-circumcision newletter. Respondents to the advertisements were mailed a survey to complete and return, the comments then compiled and the responses analysed statistically. The survey is continuing and this article reports the preliminary results.

Did you catch that?  They recruited participants from an anti-circumcision newsletter 2 and got survey results 3 saying that women prefer an uncircumcised penis.  Funny how that works, huh? Now they do at least acknowledge this in the study and attempt to address the issue:

While this study shows clearly that women prefer the surgically unaltered penis, it does have shortcomings. The respondents were not selected randomly and several were recruited using a newsletter of an anti-circumcision organization. However, when the responses from respondents gathered from the mailing list of the anti-circumcision organization were compared with those of the other respondents, there were no differences. This selection bias may be compensated to the degree that each respondent acted as her own control, using her subjective criteria on both types of penises. The findings cannot be completely attributed to selection bias.

My first reaction to this was,”Wait a minute, if the results from each pool of respondents were the same, that means that 15% of the women who subscribe to the anti-circumcision newsletter prefer sex involving a circumcised penis.”  A bit of a head scratcher there.  The authors also neglect to mention what portion of the respondents come from the anti-circumcision newsletter, what the the other magazines they advertised in were, or how they advertised the study.  In the absence of this information we are left to trust the they are unbiased and that these factors don’t affect the survey’s results.  So are the authors unbiased?  If you’ve read my earlier posts, you can probably guess what the answer to that question is.

“Hold on,” you may be saying to yourself, “just how biased could someone be on the topic of circumcision?” Oh just you wait.

At this point, you may have noticed that the website I linked to had another note at the top of the study:

CIRP note: The authors of this article have written a book entitled Sex As Nature Intended It. The book has a website at www.sexasnatureintendedit.com.

Oh boy 4. I now direct your attention to Chapter 11: Kristen O’Hara’s Personal Story5. You should really read the whole thing, but allow me to provide you with a brief synopsis:

  • Kristen falls for, and starts having sex with, Tom a married co-worked, who is not circumcised
  • Soon after, Kristen also starts seeing Mike, who is circumcised
  • Sex with Tom is awesome, sex with Mike is not
  • Things end with Mike, continue with Tom, and then Kristen meets future husband and study co-author Jeff who is also circumcised
  • Kristen ends affair with Tom so that she can pursue things with Jeff
  • Kristen doesn’t feel as strongly for Jeff as she did for Tom or enjoy sex with him as much, but they get married anyway
  • A few years into marriage, Kristen resumes affair with Tom due to sweet, sweet, uncut penis sex, which continues for years
  • Kristen develops vaginismus which she believes is due to Jeff’s uncircumcised penis and mentions to Jeff that she thinks his penis is the cause of their sexual problems
  • Jeff “inadvertently came across an article on foreskin restoration”6
  • Jeff has foreskin restoration surgery 7
  • All problems solved

Here are some choice quotes that I found particularly enlightening:

The one thing that stands out most in my mind about circumcised intercourse is its complete lack of connectedness — like I was just using his penis as a masturbating object without being emotionally and physically connected to the penis and the person on the other side of it. My vagina seemed to have the attitude, “ Let’s have our orgasms and get this over with. ”

I didn’t realize that the frustration I was experiencing between the sheets, due to the inadequacies and displeasurements of circumcised sex, was being carried far beyond the bedroom door into our everyday relationship. His surgically altered penis was inhibiting us from developing a meaningful love bond.

How much power did the penis wield over my adorations — and how much of it was the man? In all honesty, a little of both, for this was truly an exceptional man. But would I have thought him so charming if he had been circumcised? I’m certain that I would not have.

I would say that the circumcised experience is like being repeatedly penetrated in an annoying way, even though simultaneously there is pleasure. And the penis feels too hard, almost foreign-like — you want it, but don’t want it, at the same time, driven onward only in hopes of achieving orgasm, the sooner the better. Whereas with natural, the vagina totally surrenders to the soft sensuousness of lingering ecstasy, as it hungrily caresses and lovingly responds to the erotic movements of the softly-stiff penis, and the penis adores and gently strokes the vagina in return.

I submit that many, perhaps most, cases of vaginismus are an involuntary vaginal reflex reaction related to repeated exposures to the circumcised penis, which traumatizes and assaults the woman’s vaginal entrance and walls with its hardness, friction, and scraping action. With time, the vagina begins to recognize and “remember” the abuse it is receiving. Over time, it takes its toll, and the woman may suddenly develop spontaneous vaginismus.

Much to my surprise and delight, when his penis head approached the vaginal opening, the vagina gave a split-second wince and then accepted his penis easily and willingly. Incredibly, the vaginal opening could somehow tell the difference between Tom’s natural penis head and Jeff’s circumcised penis head.

And with that, rules 1 and 1a were born.

  1. You really have to give the brits credit on this one, BJU is a great name for a urology journal
  2. This is a thing? There are anti-circumcision newsletters? There are women who subscribe to anti-circumcision newsletters?
  3. Also of note is the fact that this was a mail in survey, which could make it fairly difficult to verify the gender of the person filling it out.  And I mean, no man would ever try to influence a survey so that the results say “My penis is the best penis.” Right?
  4. The website design alone really conveys the “I’m a subject matter expert and should be trusted on this issue” message
  5. This is the wife in the husband and wife team that authored the study in case that wasn’t clear
  6. You know, like you do
  7. You can read about Jeff’s experience in Chapter 12.  You can also read about the particular procedure he had done here, but you’re likely to regret clicking that particular link.  Some things you can’t unsee/unread.

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