Gimme Some Skin

J.W. Proctor

In defense of the foreskin: One writer argues that using circumcision to combat AIDS gives prevention the shaft.

Try this exercise: Find a 3×5 index card. One side, 15 square inches, equals the average surface area of a man's foreskin — about half of the total surface area of his penis.

Now fold the card in half lengthwise and bring the two short ends together to form a cylinder. The outside of the cylinder represents the external foreskin, a more sensitized, retractable extension of the skin on the penile shaft. The inside represents the delicate, lubricating mucosal lining that sheathes the glans, or head, of the penis.

These outside and inside folds are comparable to the external and internal aspects of the foreskin's closest anatomical analog, the eyelid. And, like the eyelid, the foreskin bristles with nerve endings: about 36% of the total penile allotment.

With this simple overview, you probably already know more about the foreskin than your doctor does. What most American health professionals are taught about it is even more succinct: It's the part of the male anatomy removed in a circumcision.

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Despite its highly articulated, specialized physiology, the foreskin is commonly considered as disposable as the paper version you've just created. Every year the foreskins of an estimated 1 million U.S. infants end up in the trash.

Medical arguments for circumcision have always centered on hygiene and prophylaxis. Victorian-era authorities associated carnality with a wide range of mental and physical disorders; the pain of unanesthetized circumcision (for infants of both sexes) was deemed salutary "aversion therapy" against masturbation.

Morals shifted, but the foreskin became implicated in a new set of perils: renal cancer; urinary tract infections; cervical cancer in the female partners of uncircumcised men.

Today the main argument against the foreskin is its supposed correlation to sexually transmitted disease, especially AIDS. And especially AIDS in Africa.

With American funding, thousands of adult African males have recently undergone circumcision to study their subsequent HIV infection rates compared with those of uncircumcised counterparts. HIV infection rates among uncircumcised control groups (often before studies had run their course) led researchers to conclude that the foreskin significantly contributes to seroconversion.

There is ample cause to question this conclusion.

First, a hard reckoning: Several African countries with some of the highest rates of HIV/AIDS in the world (Nigeria, Ethiopia, the Ivory Coast, Gabon) already circumcise at rates exceeding that of the United States.

Moreover, efforts to export American genital norms expose a glaring hypocrisy: The United States has both the highest HIV infection rate and the highest circumcision rate of any industrialized nation. By comparison, Australia, New Zealand and the Netherlands could take a more plausible "intactivist" stance. Their predominantly uncircumcised men have some of the world's lowest HIV infection rates.

Many developing countries, such as India, Thailand and Brazil, have successfully combated AIDS not through circumcision but through aggressive health- and condom-education programs. While hardly rid of HIV, these nations have dodged the devastating mortality rates of, say, Uganda or Botswana.

Surely there is as much to learn from intact Dutch and Thai men as there is from circumcised Ugandan men, but American medical/cultural bias has preempted this line of scientific inquiry. Indeed, the zeal to circumcise has eclipsed the study of whole categories of prophylaxis that may be as effective as circumcision-or even more so. Some of the most promising HIV preventives in development are microbicides administered topically—to the very type of mucosal tissue that circumcision destroys.

How circumcision bears on long-established safer sex guidelines is uncertain, but consider the basics: The procedure slices off more than one third of the penis' nerve endings, toughens the unnaturally exposed glans and negates built-in lubrication and stimulation. Is it logical to expect enthusiasm among circumcised men for further— desensitizing latex barriers?

No one is promoting circumcision as a license for unprotected sex, but inevitably, in Africa and elsewhere, circumcision will be used not in concert with condoms but instead of condoms, potentially wiping out more than two decades' worth of safer-sex intervention. Also, in an environment where "cut" = "clean," women, who already constitute the majority of AIDS deaths in Africa, will have far less bargaining power to insist on safer sex with circumcised partners, and may seroconvert in even greater numbers.

Ironically, all arguments for prophylactic circumcision as a successful harm-reduction strategy may be built on a fundamental diagnostic flaw. Existing scientific data demonstrate that adult circumcision typically causes a marked overall decrease in sexual pleasure and erectile function. Statistics citing circumcision's efficacy against HIV may not reflect the foreskin's contribution to infection so much as demonstrate its contribution to sexual performance—and the potential risks therein. (Chalk one up for the Victorians.)

Confronted with complex, real-world dynamics, the limited scope of circumcision research may not help to stem HIV infection rates at all, but may actually sustain or even accelerate them. The president of Uganda and the Brazilian secretary of health have already reached this conclusion, denouncing recommendations for adult circumcision in their respective countries.

Even American public health officials admit that the arguments for circumcision are, at best, debatable. Still, proponents believe that they are doing something to counter AIDS. Bucking America's frustratingly puritanical aversion to condom-based HIV education, they may even feel comparatively progressive for taking a pro-circumcision stance. Nonetheless, most, if not all, of these proponents don't know what they themselves are missing, cannot understand what is lost to circumcision, and cannot appreciate how this loss may compromise other HIV prevention strategies. For them, the procedure is quick, easy, cheap—a potentially major impact derived from minor surgery.

But how minor, exactly? Look again at your index card, and imagine that amount of tissue being cut from anywhere on your body.

Minor surgery, so the quip goes, is surgery performed on somebody else.

From POZ, July/August 2007. Reprinted with permission. Copyright 2007 CDM Publishing, L.L.C.

News Health Systems

Texas Anti-Choice Group Gets $1.6 Million Windfall From State

Teddy Wilson

“Healthy Texas Women funding should be going directly to medical providers who have experience providing family planning and preventive care services, not anti-abortion organizations that have never provided those services," Heather Busby, executive director of NARAL Pro-Choice Texas, said in a statement.

A Texas anti-choice organization will receive more than $1.6 million in state funds from a reproductive health-care program designed by legislators to exclude Planned Parenthood

The Heidi Group was awarded the second largest grant ever provided for services through the Healthy Texas Women program, according to the Associated Press.

Carol Everett, the founder and CEO of the group and a prominent anti-choice activist and speaker, told the AP her organization’s contract with the state “is about filling gaps, not about ideology.”

“I did not see quality health care offered to women in rural areas,” Everett said.

Heather Busby, executive director of NARAL Pro-Choice Texas, said in a statement that it was “inappropriate” for the state to award a contract to an organization for services that it has never performed.

“The Heidi Group is an anti-abortion organization, it is not a healthcare provider,” Busby said.

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State lawmakers in 2011 sought to exclude Planned Parenthood from the Texas Women’s Health Program, which was jointly funded through federal and state dollars. Texas launched a state-funded version in 2013, and this year lawmakers announced the Healthy Texas Women program.

Healthy Texas Women is designed help women between the ages of 18 and 44 with a household income at or below 200 percent of the federal poverty level, and includes $285 million in funding and 5,000 providers across the state.

Bubsy said the contract to the Heidi Group was “especially troubling” in light of claims made by Everett in response to a recent policy requiring abortion providers to cremate or bury fetal remains. Everett has argued that methods of disposal of fetal remains could contaminate the water supply.

“There’s several health concerns. What if the woman had HIV? What if she had a sexually transmitted disease? What if those germs went through and got into our water supply,” Everett told an Austin Fox News affiliate.

The transmission of HIV or other sexually transmitted infections through water systems or similar means is not supported by scientific evidence.

“The state has no business contracting with an entity, or an individual, that perpetuates such absurd, inaccurate claims,” Busby said. “Healthy Texas Women funding should be going directly to medical providers who have experience providing family planning and preventive care services, not anti-abortion organizations that have never provided those services.”

According to a previous iteration of the Heidi Group’s website, the organization worked to help “girls and women in unplanned pregnancies make positive, life-affirming choices.”

Texas Health and Human Services Commission spokesperson Bryan Black told the Texas Tribune that the Heidi Group had “changed its focus.”

The Heidi Group “will now be providing women’s health and family planning services required by Healthy Texas Women, including birth control, STI screening and treatment, plus cancer screenings to women across Texas,” Black said in an email to the Tribune.

Its current site reads: “The Heidi Group exists to ensure that all Texas women have access to quality health care by coordinating services in a statewide network of full-service medical providers.”

Everett told the American-Statesman the organization will distribute the state funds to 25 clinics and physicians across the state, but she has yet to disclose which clinics or physicians will receive the funds or what its selection process will entail.

She also disputed the criticism that her opposition to abortion would affect how her organization would distribute the state funds.

“As a woman, I am never going to tell another woman what to tell to do,” Everett said. “Our goal is to find out what she wants to do. We want her to have fully informed decision on what she wants to do.”

“I want to find health care for that woman who can’t afford it. She is the one in my thoughts,” she continued.

The address listed on the Heidi Group’s award is the same as an anti-choice clinic, commonly referred to as a crisis pregnancy center, in San Antonio, the Texas Observer reported.

Life Choices Medical Clinic offers services including pregnancy testing, ultrasounds, and well-woman exams. However, the clinic does not provide abortion referrals or any contraception, birth control, or family planning services.

The organization’s mission is to “save the lives of unborn children, minister to women and men facing decisions involving pregnancy and sexual health, and touch each life with the love of Christ.”

Culture & Conversation Media

From ‘Mouseburger’ to Media Icon: Bio Traces Rise of Cosmo Editor Helen Gurley Brown

Eleanor J. Bader

Helen Gurley Brown was a publishing giant and pop-culture feminist theorist. But according to her latest biographer, she was a mass of insecurities even as she confidently told single people, especially women, to take charge of their sex lives.

Like all of us, Cosmopolitan magazine’s longtime editor Helen Gurley Brown lived with conflicting drives and desires. But Gurley Brown’s ideas and insecurities had a public platform, where she championed sex for singles while downplaying workplace sexual harassment and featured feminist voices while upholding the beauty ideals that made her own life difficult.

A workhorse who played hard, Gurley Brown, who died in 2012, is presented as an often contradictory heroine and an unexpected success story in journalist Gerri Hirshey’s new 500-page biography, Not Pretty Enough: The Unlikely Triumph of Helen Gurley Brown.

Helen Gurley Brown’s life and example—almost a classic Horatio Alger “rags to riches” tale—affirms that the American idea of surmounting humble origins is sometimes possible, if improbable. But Gurley Brown’s story also illustrates both personal grit and endurance. Wily, willing to take risks, and sexually audacious, she might be a questionable role model for 21st century women, but her amazing story, as told by Hirshey, will nonetheless inspire and entertain.

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Born in 1922, Gurley Brown led Cosmopolitan for 32 years. She moved the magazine, which had been published continuously since 1886, from relative obscurity into the limelight. Known for its brash cover chatter and how-to articles on heterosexual man-pleasing, Cosmo is the world’s highest-selling women’s magazine, with 61 print editions. Its long history—alongside Helen Gurley Brown’s personal story—offers a fascinating window into the intersection between U.S. publishing and burgeoning 20th-century feminist ideologies.

Hirshey (whose earlier books include Nowhere to Run: The Story of Soul Music and We Gotta Get Out of This Place: The True, Tough Story of Women in Rock) presents Gurley Brown as a mess of pushes and pulls: insecure, brilliant, bold, self-effacing, loyal, independent, jittery, and frugal to the point of deprivation. Indeed, Hirshey’s revealing and detailed biography describes the pioneering editor as someone hungry for experiences; a sophisticated New Yorker with deep roots in rural America; and a writer of guidebooks who had trouble taking advice. In short, Helen Gurley Brown was limited by a host of personal issues, but that did not stop her from trying to push societal boundaries and shatter sexual propriety.

A native of small-town Arkansas, Helen’s childhood was marred by tragedy. Her father died in an accident when she was 10; several years later, her older sister, Mary, contracted polio, which left her partially paralyzed. Helen’s mother, Cleo, was overwhelmed and often depressed. Nonetheless, she scrambled to keep the creditors at bay, and the family lived in numerous decrepit rentals during Helen’s childhood.

Poverty was not the only obstacle Helen faced. According to Hirshey, “By the time Mary and Helen were school age, Cleo had begun her steady warnings that pretty girls got the best in life.” While Cleo never used the word “plain” to describe her offspring, it was clear that she did not think them comely. Helen was devastated. What’s more, the fear of being unattractive dogged her for her entire life and she had multiple surgeries to correct “flaws.” She also starved herself and exercised compulsively—and would likely now be labeled as having an eating disorder—to keep her weight at an unwavering 105 pounds.

Her success, Hirshey writes, was the result of luck, tenacity, and sheer chutzpah.

It started in the 1940s, shortly after she finished high school and secured the first of a string of secretarial jobs. During her tenure as a typist and stenographer, Helen cozied up to her male bosses and slept with some of them.

“It was the first time she truly observed and understood that sex is power,” Hirshey writes. “Helen had come to realize that sex was a surprising and thrilling equalizer between the sheets.” Gurley Brown pooh-poohed the idea that people should wait until marriage to have sex and had no problem dating men who were cheating on their wives. The same went, Hirshey writes, for racists and overt anti-Semites. Since she was giving a large part of her earnings to her mother and her sister, it was the size of a man’s bank book, rather than his politics, that evidently curried her favor.

Nevertheless, being a mistress had a downside, and Helen’s diary reveals that she felt like a “little bird … expected to stay in her cage, always available yet always alone.”

Her fortunes turned shortly after her 26th birthday, when she became secretary to Don Belding, chairman of the board at prestigious ad agency Foote, Cone, and Belding. Belding paid Helen $75 a week and treated her like a long-lost daughter; she considered him a surrogate father.

Alice Belding, Don’s wife, took a particular interest in Helen and, after reading something she’d written, persuaded her husband to give Helen a chance as a copywriter. He did, making her one of the first women to break into the field.

Meanwhile, there were men. Lots of men. “Certainly, men love beautiful women,” Hirshey writes. But Helen realized that when “the lights went out, Miss Universe might just as well be the poor, sooty match girl if she couldn’t make him shout hallelujah.” She loved the power sex gave her, but was hurt during a group therapy session when another participant dubbed her a slut. “Spoken with venom, it had the effect of a gut-punch,” Hirshey writes.  Still, it proved clarifying for Helen, allowing her to formulate the idea at the heart of her 1962 book, Sex and the Single Girl: There is nothing shameful about unmarried people having sex as long as it’s consensual.

Helen met David Brown, a high-profile movie executive, in 1958, when she was 36. David was 42, twice married and twice divorced, and had no interest in returning to the altar anytime soon.  This was fine with Helen. Nonetheless, as they spent more and more time together, they formed a strategic partnership. Yes, there was love, but Helen Gurley craved financial security, which David could provide. They wed in September 1959.

At that point, David suggested that Helen take a professional detour and write “a guidebook of sorts for single women.” Hirshey reports that he envisioned “something along the lines of ‘How to Have a Successful Affair’” and ticked off possible subjects, including how to snare a guy and dress for conquest. He also wanted the manual to include concrete sex tips. Helen loved the idea and the pair began to work on it, she as writer, he as editor.

Sex and the Single Girl told the truth as Helen saw it. Hirshey notes that the book was meant as a practicum, “and was never intended as an overtly feminist tract. Systemic change was not at all on her radar; she addressed herself to bettering the small, quotidian lives toiling within the status quo, of those, herself included, she would come to call ‘mouseburgers.’ Sexism was not even in her vocabulary.”

Her message was quite simple: Sex needed to be decoupled from marriage. As for gender roles, she was fine with women playing coy. In fact, she explicitly advised women to go out with men only if they could pay for everything, from dinner and drinks to “prezzies.”

There were of course, detractors, but Sex and the Single Girl sold millions of copies and made Helen Gurley Brown a household name. She appeared on countless TV talk shows and was the first woman featured in Playboy’s famous centerpiece interviews.

In the throes of her success, however, David was offered a job in New York and the couple decided to leave California, where they’d both lived for decades. David, Hirshey reports, knew that Helen needed to work, “that Helen unemployed would be Helen unhinged.” Together, they developed a prototype for a monthly women’s magazine that would popularize and expand upon the ideas in Sex and the Single Girl. They called it Femme and floated the idea to every publisher they knew. No one liked it.

Eventually, Hearst Corporation suggested “superimposing” the format on one of the corporation’s least successful publications, Cosmopolitan, with Helen Gurley Brown at the helm.

It worked, not only boosting sagging sales but catapulting “The Cosmo Girl” to prominence. Sexual freedom, Gurley Brown enthused, was in–but apparently only for heterosexuals, since the magazine rarely acknowledged the existence of same-sex relationships or bisexuality.

Nonetheless, the first few issues tackled then-risqué themes, as these titles suggest: “The Bugaboo of Male Impotence”; “I was a Nude Model (and This is What Happened)”; “Things I’ll Never Do with a Man Again”; “The Astonishingly Frank Diary of an Unfaithful Wife”; and “How to Make a Small Bosom Amount to Something.”

As the “sexual revolution” of the 1960s took hold, Cosmo flourished, albeit steering clear of covering racial unrest, the Vietnam War, or the counterculture and anti-militarism movements. Likewise, if Gurley Brown had any thoughts about the civil rights or peace movements, Hirshey neglects to mention them. She does note that for Helen, “readers of color scarcely registered.” It’s too bad this is not probed more deeply in Not Pretty Enough, and why the editor remained above the fray—was it fear, disinterest, or hostility?—remains unclear.

The women’s movement of the 1960s and 1970s did capture Helen’s interest, though, and she considered herself a devout feminist, with a particular passion for promoting reproductive rights. She wrote numerous articles about the need to overhaul abortion policies pre-Roe v. Wade, openly declaring that “it’s a shame that girls have to go to Mexico or Europe to be operated on.” At Cosmo, she cheered the arrival of the birth control pill in 1960; hailed the 1965 Supreme Court decision in Griswold v. Connecticut that gave married heterosexuals access to birth control; and was exuberant when Eisenstadt v. Baird gave unmarried couples the same right to control their fertility in 1972.

Sexual harassment, on the other hand, was befuddling to her. Remembering her days as a secretary, she dubbed slaps on the ass and sexually suggestive comments to be harmless fun. “When a man finds you sexually attractive, he is paying you a compliment,” she wrote in a monthly Cosmo column. “When he doesn’t, that’s when you have to worry.”

Small wonder that Kate Millett picketed Cosmo for its “reactionary politics” or that Betty Friedan slammed it for its sexism and preponderance of inane articles on keeping men happy.

Despite disagreeing with these thinkers, Helen Gurley Brown marched down New York City’s Fifth Avenue to celebrate the 50th anniversary of women’s suffrage in August 1970 and published articles written by prominent feminists as the 1970s unfolded.

Then, at the height of the AIDS crisis, Gurley Brown stepped in it. In early 1988, Cosmo ran an article that minimized the possibility of heterosexual transmission of HIV and made it sound as if straight women were immune from infection. Equally horrifying, the author, psychiatrist Dr. Robert E. Gould, was overtly racist. “Many men in Africa take their women in a brutal way,” he wrote, “so that some heterosexual activity regarded as normal by them would be close to rape by our standards.”

Oy. Readers were aghast, and Gurley Brown was roundly and deservedly criticized. Even Surgeon General C. Everett Koop weighed in, saying the article did “such a disservice” by suggesting that the risk of contracting the virus was low for heterosexual women. Hirshey reports that, inexplicably, the article was never retracted or corrected.

By this point, however, Helen was showing signs of dementia—she had periodical temper tantrums in public and was becoming less reliable and sharp—so Hearst Corporation brought in several new editors, albeit without firing Helen. She continued going into the office until shortly before her 2012 death. She had done paid work for 71 years.

Hirshey’s sources range from primary documents and in-person interviews with people who knew Gurley Brown, including Gloria Vanderbilt and Barbara Walters. Correspondence and recorded talks between her and friends such as Jacqueline Susann and Joan Rivers provide incisive, funny, and poignant anecdotes. These interviews give the book reportorial gravitas and intimacy. And although Hirshey had only a passing acquaintance with her subject—she had interviewed Gurley Brown decades earlier for an article about marriage proposals—she nonetheless manages to show Gurley Brown as a regular Jane who spoke openly about her nagging doubts.

Many readers will feel as if they can relate to Gurley Brown’s struggles and triumphs. Throughout the book, I felt sad for her, but also wished we’d met.

In fact, I closed the book wanting more; among other things, I wanted to better understand what it was like for her to move between near-poverty and the upper crust. Did she feel like an impostor? Did her lifelong conviction that she was not pretty enough or smart enough keep her from feeling connected to others? Did she ever feel truly secure?

Perhaps Gurley Brown’s self-doubts are what kept her from becoming arrogant or abusive to others; even those who hated Cosmopolitan or were frustrated by her racial and political blind spots admired her kindness. Similarly, these doubts did not prompt her to disguise her eccentricities—among them, pilfering from petty cash and always taking public transportation rather than cabs. Indeed, whatever Gurley Brown felt about her own appeal, Hirshey’s biography presents Helen Gurley Brown the woman as quirky, humble, and utterly fascinating.

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