Circumcision for baby boys back in vogue?

[AmberGretchen]

Date: 4/2/2009 1:44:53 AM
Author: LaraOnline
Just mentioned this topic to my workmate. She told me that a good family friend of hers'' had mentioned to her once that every single one of his grandsons - all seven of them - had had to go through circumcision at an older age (from age 4 through to teenage years) as they had an hereditary tendency towards urinary tract infections and other problems related to having a foreskin....

I really had no idea that troubles like this were so common.

Interesting historical fact - it is thought that one of the reasons why Marie Antoinette and Louis XVI of France took a while to properly consummate their marriage and to conceive children was because of penile discomfort and/or infection that Louis had due to his foreskin, and this apparently ran in his family as other male members of the French royal family at and around that time experienced similar problems, as far as can be deduced from the available historical record.

 

[Haven]

Date: 4/2/2009 8:13:15 AM
Author: swimmer
Has anyone seen a circumcision? I go to a lot of Bris events these days and the little fellow cries for about a minute. More if he is being held by strangers. Yes, this is an anecdote, but I keep reading words like ''trauma'' and ''incredible pain'' to describe the procedure. Babies are a versatile bunch. Heck, their skulls are still soft at that point and faces are a bit distorted from the birth canal. In looking around for any hard research to cite concerning middle class developed nations and circumcision, I just found pablum. Some of the anti-circ websites look a great deal like the pro-breastfeeding ones. And even as a pro-breastfeeding person, I think much of that bullies women and doesn''t allow people to make individual choices. We all see children all the time being raised in ways we are not so sure of (in the grocery knocking things down with mom smiling and ignoring, you know what I mean). But hey, it takes all kinds. I am still stuck on Cara''s CDC info that more than 50% of teens didn''t know if they were circumcised or not. Guess its not that much of a snip.

I agree, swimmer. I have yet to see a baby cry for longer than even a half a minute at a brit milah. Perhaps it is done differently in a hospital, but I''ve never seen a moyel inflict trauma or incredible pain on a baby boy.

 

[Dreamer_D]

Date: 4/1/2009 11:45:50 PM
Author: iluvcarats
An anecdote is a ''short, amusing account''. He sees this several times a week. It is not a little story, but a fact. His partners see it several times a week too.
He sees more infections on uncircumcised men. That is a fact. He has only seen penile carcinoma on uncircumcised men. Also a fact. I have a 10 year old daughter and a 6 year old son. He had a circ because we believe it is healthier, and we are jewish and it is a tradition. He has no recollection of it. Yes he cried, and I felt bad. But he cried just as hard when he got all of his immunizations, and I would do that again too, because I believe I am keeping him healthy. Do what you will, and believe what you want, it is your business. But please don''t trivialize what I said, because they are facts.

I am not disagreeing with your personal position, but I think the main point is that as a urologist, your husband *will* see these issues! This is where men go for treatment. This is the same way that a dentist sees all the patients with tooth decay. One cannot draw conclusions about the prevelence of a particular disease in the general population based on how often the specialists who treat that disease see patients with said disease. (well you can sort of, but my general point stands).

 

[Dreamer_D]

Date: 4/2/2009 1:47:45 AM
Author: kennedy
...
Perhaps I didn''t make myself clear. I''m not questioning the veracity of your husband''s reports nor am I suggesting that what he sees is trivial. I know someone who needed to have a circumcision at 60 and it was a very painful, difficult experience for him. When I said that anecdotes don''t make a science, I was referring to the rhetorical fallacy of using a story or stories (even ones that are true) to stand in for evidence-based scientific research. For obvious reasons, we wouldn''t make public health recommendations for the general public based on one doctor''s medical practice. I was also pointing out that a urologist is likely to see all kinds of penile problems because that is where people go when they have problems. I''m sure a gastroenterologist sees a lot of appendicitis -- does that means we should take out everyone''s appendix as a prophylactic measure?
...

Whoopsie, should read it all before replying!

 

[Dreamer_D]

Date: 4/2/2009 8:13:15 AM
Author: swimmer
Has anyone seen a circumcision? I go to a lot of Bris events these days and the little fellow cries for about a minute. More if he is being held by strangers. Yes, this is an anecdote, but I keep reading words like ''trauma'' and ''incredible pain'' to describe the procedure. Babies are a versatile bunch. Heck, their skulls are still soft at that point and faces are a bit distorted from the birth canal. In looking around for any hard research to cite concerning middle class developed nations and circumcision, I just found pablum. Some of the anti-circ websites look a great deal like the pro-breastfeeding ones. And even as a pro-breastfeeding person, I think much of that bullies women and doesn''t allow people to make individual choices. We all see children all the time being raised in ways we are not so sure of (in the grocery knocking things down with mom smiling and ignoring, you know what I mean). But hey, it takes all kinds. I am still stuck on Cara''s CDC info that more than 50% of teens didn''t know if they were circumcised or not. Guess its not that much of a snip.

Good points about the rhetoric and pablum... much ado about nothing?? I guess in the end it should be a personal choice, and so I guess I like the way it is handled in Canada. As a personal choice, you can have it done but you pay for it as an elective procedure. Yet at the same time there is no censure when you seek it out, and no censure if you choose not to have it done.

I don''t think comparing it to vaccinations is valid, as the evidence for the benefits of vaccinations for briader population health are generally irrefutable (issues of vaccine ingredients not withstanding) whereas the evidence for the benefits if circumcision are less iron clad. And yes, they are less iron clag because if the evidence were compelling, it would be a medically necessary or highly recommended procedure here in Canada--or perhaps I trust my government too much

 

[iluvcarats]

Date: 4/2/2009 1:29:22 PM
Author: dreamer_dachsie

Date: 4/1/2009 11:45:50 PM

Author: iluvcarats

An anecdote is a ''short, amusing account''. He sees this several times a week. It is not a little story, but a fact. His partners see it several times a week too.

He sees more infections on uncircumcised men. That is a fact. He has only seen penile carcinoma on uncircumcised men. Also a fact. I have a 10 year old daughter and a 6 year old son. He had a circ because we believe it is healthier, and we are jewish and it is a tradition. He has no recollection of it. Yes he cried, and I felt bad. But he cried just as hard when he got all of his immunizations, and I would do that again too, because I believe I am keeping him healthy. Do what you will, and believe what you want, it is your business. But please don''t trivialize what I said, because they are facts.

I am not disagreeing with your personal position, but I think the main point is that as a urologist, your husband *will* see these issues! This is where men go for treatment. This is the same way that a dentist sees all the patients with tooth decay. One cannot draw conclusions about the prevelence of a particular disease in the general population based on how often the specialists who treat that disease see patients with said disease. (well you can sort of, but my general point stands).

Of course he is the one who will be seeing the disease. My point is that he sees infection more often in uncircumcised men, especially when they are older. And he only has seen penile carcinoma in uncircumcised men, and not any in men who are circumcised. He "sees it all" so to speak, but some problems are more frequent and only pertaining to uncircumcised men.

 

[Ellen]

Wow. I have found this thread very interesting. I never would have guessed there would be such a profound differing of opinions on this! I certainly respect each individuals decision. And just to throw in my own decision/experience, I have 3 boys, all circumcised. They were over it almost immediately, and most importantly, none of them haver ever come and questioned me/complained about the fact that I had it done. That''s not to imply those who don''t have it done are wrong, it''s just me musing out loud that it''s one decision I made that nobody''s coming back to blame me for.

 

[vespergirl]

I read the article, but I haven''t read through everyone''s posts. I wanted to share my family''s experiences with circumcision, for anyone who''s interested.

My parents are immigrants from a Catholic country in Europe, where no one is circumcised. So, they decided not to have my two brothers (born in the US) circumcised, even though their doctors suggested they have it done.

My older brother had no problems, but my younger brother had so many infections that he eventually had to be circumcised at the age of 2. After the circumcision, no more infections.

My older brother, who was never circumcised, married a European immigrant, so they also decided not to circumcise their son. However, after years of infections, he was circumcised at the age of 5, which my brother says he wished they had done much sooner.

My husband is circumcised, and when our son was born, we decided to circumcise at birth after researching for ourselves. He is now 2 1/2 and has never had any type of infection. He healed beautifully, and had no complications. He was also anaesthesized during the procedure, as explained in the article.

I think it''s up to each set of parents, but after hearing my family''s history of infections in uncircumcised boys, and my husband not having any history of infection, we decided that circumcision was the better choice for our son.

 

[canuk-gal]

Date: 4/2/2009 1:46:24 PM
Author: iluvcarats

Date: 4/2/2009 1:29:22 PM
Author: dreamer_dachsie

Date: 4/1/2009 11:45:50 PM

Author: iluvcarats

An anecdote is a ''short, amusing account''. He sees this several times a week. It is not a little story, but a fact. His partners see it several times a week too.

He sees more infections on uncircumcised men. That is a fact. He has only seen penile carcinoma on uncircumcised men. Also a fact. I have a 10 year old daughter and a 6 year old son. He had a circ because we believe it is healthier, and we are jewish and it is a tradition. He has no recollection of it. Yes he cried, and I felt bad. But he cried just as hard when he got all of his immunizations, and I would do that again too, because I believe I am keeping him healthy. Do what you will, and believe what you want, it is your business. But please don''t trivialize what I said, because they are facts.

I am not disagreeing with your personal position, but I think the main point is that as a urologist, your husband *will* see these issues! This is where men go for treatment. This is the same way that a dentist sees all the patients with tooth decay. One cannot draw conclusions about the prevelence of a particular disease in the general population based on how often the specialists who treat that disease see patients with said disease. (well you can sort of, but my general point stands).

Of course he is the one who will be seeing the disease. My point is that he sees infection more often in uncircumcised men, especially when they are older. And he only has seen penile carcinoma in uncircumcised men, and not any in men who are circumcised. He ''sees it all'' so to speak, but some problems are more frequent and only pertaining to uncircumcised men.

HI:

A lot of MD''s do not publish--do not have time. Hence their valuable, albeit anectdotal, facts/information stays with them inside their heads and private practice. We''d have more "evidence" if more MD''s publsihed retrospecitve and longitudinal studies.

I have seen a few circ''s in my worklife--and did not experience any horrendous frantic screaming babies either--that was the parents domain!

BTW, I appreciate the level of civility this thread has maintained. It is an emotionally labile topic and could easily get out of hand.

cheers--Sharon

 

[diane5006]

This is a tricky subject...

I wasn''t going to post...but...I had some thoughts...

Oddly cicrumcisn in the US while more common than in other countries perhaps...is perhaps less common than we think...

I have done hundreds if not thousands of Male Health Exams...on US men...in my practice...and suprisingly large number of them were uncirc...these are men that have ranged in age from 18-88...I haven''t seen any greater incidence of UTI''s or problems...I seen phimosis which you can only get if you have a foreskin...but it was not painful for that person...and surg was not needed at the time he was seen by surgery

I have seen circumcisions done

I haven''t read any recent research...but a lot of the original ''claims'' have been disproved

As for the "africa" study It is not a generalizable result...the conditions that exist there do not exist elsewhere...HIV/AIDS is basically endemic there

Here is some info

What is the foreskin there for?
The foreskin serves three functions: protective, sensory, and sexual.

In most cases, the foreskin is still fused to the glans at birth and will separate over a variable period of time over the first few years. During the diaper period, the foreskin protects against abrasion from diapers and feces. Throughout life, the foreskin keeps the glans soft and moist and protects it from trauma and injury.

Parts of the foreskin, such as the mucosa (inner foreskin) and frenulum, are particularly sensitive and contribute to sexual pleasure. Specialized nerve endings enhance sexual pleasure and control [19].

The inner foreskin (mucosa) is the skin directly against the glans. Like the lining of the mouth, this tissue is thinner and of a different texture and color than the remainder of the skin covering the penis (shaft skin).
The frenulum is a particularly sensitive narrow membrane that runs down the ventral groove of the glans and attaches to the inner foreskin.
The ridged band is the interface between the inner foreskin (mucosa) and the shaft skin. It often "puckers" past the tip of the glans. The band contains whorled smooth muscle fibers, giving it pronounced elastic properties that allow the foreskin to be retracted. The ridged band has a tactile sensitivity equivalent to that of the lips.
The foreskin provides ample loose skin for the penis to occupy when erect. It is a movable skin sheath for the penis during intercourse, reducing chafing and the need for artificial lubricants, and allowing the glans and foreskin to naturally stimulate each other. Warren and Bigelow described some of the physiological functions of the foreskin in sexual activity. [1]
What are some reasons that circumcision is performed?
Circumcision is primarily performed for cultural or religious reasons.

Because a large number of men in English-speaking Western countries are circumcised, many think of the foreskin as an unnecessary part of the penis. Many circumcisions are performed because a circumcised father often does not want to feel that he is different from his son.

It is often said that a circumcised penis is cleaner, or easier to keep clean, than an intact penis. Smegma (a natural substance composed of dead skin cells, normal flora, and secretions containing the natural antibacterial agent lysozyme) is more likely to accumulate when the foreskin is present.

Medical grounds for circumcision that are most commonly cited are: Reduced risk of urinary tract infections (UTI); reduced risk of penile cancer; reduced risk of cervical cancer in partners; reduced risk of sexually transmitted disease (STD).

There is contradictory evidence in the research literature as to whether circumcision reduces UTI [16,17], but this seems to be the strongest of all medical claims in favour of circumcision, because UTI can have serious consequences. These infections can, however, in most cases be treated by antibiotics. The frequency of UTI in US male infants is approximately 1%, but is higher for females. There is evidence that babies who are breastfed have a lower incidence of UTI. [8]

Penile cancer is an extremely rare form of cancer. It occurs mostly in older men, and most doctors will not recommend infant circumcision as a preventative measure. Penile cancer can occur in both circumcised and intact men: The Maden study (an ongoing study of penile cancer at Fred Hutchinson Cancer Research Center in Seattle) observed that 37% of penile cancer cases occurred in circumcised men. [2]

The theory that wives of men with intact foreskins are more prone to cervical cancer has been disproven [12]. The theory that the presence of a foreskin may cause an increased risk of sexually transmitted diseases was disproved by a new study [22]. The question of HIV warrants further study [20], [7]. Although there is an apparent geographical correlation between male non-circumcision and HIV infection on the African continent, this is not true globally, and the pattern seen in Africa could easily be due to other factors.

The only known effective means of preventing HIV infection are fidelity, condom use and abstinence.

I am neither for nor against...it is a personal choice made by the parents...and/or adult...if it is done there should be no reason not to use anesthesia

 

[luckystar112]

Date: 4/2/2009 1:46:24 PM
Author: iluvcarats

Date: 4/2/2009 1:29:22 PM
Author: dreamer_dachsie

Date: 4/1/2009 11:45:50 PM

Author: iluvcarats

An anecdote is a ''short, amusing account''. He sees this several times a week. It is not a little story, but a fact. His partners see it several times a week too.

He sees more infections on uncircumcised men. That is a fact. He has only seen penile carcinoma on uncircumcised men. Also a fact. I have a 10 year old daughter and a 6 year old son. He had a circ because we believe it is healthier, and we are jewish and it is a tradition. He has no recollection of it. Yes he cried, and I felt bad. But he cried just as hard when he got all of his immunizations, and I would do that again too, because I believe I am keeping him healthy. Do what you will, and believe what you want, it is your business. But please don''t trivialize what I said, because they are facts.

I am not disagreeing with your personal position, but I think the main point is that as a urologist, your husband *will* see these issues! This is where men go for treatment. This is the same way that a dentist sees all the patients with tooth decay. One cannot draw conclusions about the prevelence of a particular disease in the general population based on how often the specialists who treat that disease see patients with said disease. (well you can sort of, but my general point stands).

Of course he is the one who will be seeing the disease. My point is that he sees infection more often in uncircumcised men, especially when they are older. And he only has seen penile carcinoma in uncircumcised men, and not any in men who are circumcised. He ''sees it all'' so to speak, but some problems are more frequent and only pertaining to uncircumcised men.

Does he have any studies to reference regarding the penile carcinoma? The only reason I ask is because according to Wiki (I know, not the most valid source), the opinion that circumcised men suffer from it less is unjustified:

"The American Medical Association and the Royal Australasian College of Physicians say the use of infant circumcision in hope of preventing penile cancer in adulthood is not justified.[6][7] The American Cancer Society has said that the suggestion that circumcision reduces penile cancer rates, were based on studies that were flawed because they failed to consider other factors that are now known to affect penile cancer risk. It concluded: "The current consensus of most experts is that circumcision should not be recommended as a prevention strategy for penile cancer."[8]

One study reported a lifetime risk of a man in the United States developing invasive penile cancer (IPC) to be 1 in 600 if he is uncircumcised.[9] though this study has been criticised.[10] Several studies report that the risk is higher if a male was not circumcised neonatally, with relative risk estimates including 3.2[11] and 22[12] associated with the presence of a foreskin, and 0.41 associated with its absence.[13] Several authors also state that there is a lower incidence of penile cancer in circumcised men.[14][14][15][16][17] A few studies suggested that circumcision decreased the risk of HPV infection in males.[18][19][20] A study that concluded circumcision did not prevent penile cancer was done by Wallerstein, which reported that the risk of penile cancer in Japan, Norway, and Sweden (countries with a low rate of circumcision) is about the same (1 in 100,000 per year) as in the US."

 

[LaraOnline]

Ultimately, all sexual diseases, including the types of cervical cancer that one can have a vaccine for, could be prevented by safe sex and abstinence.
If we all had only one sexual partner for life, what a different world we would live in.
But back in the real world....

Many parents choose not to vaccinate their children, because they consider that the risk of their child contracting polio, whooping cough, whatever, to be remote (ironically, largely because most other members of a population vaccinate their children against the diseases)

I feel that the argument against circumcision has been an emotive one, and stories of parents being 'forced to watch videos of the procedure' before being 'allowed' to proceed with an operation that is basically medically NON harmful (I guess in a most trivial sense, a bit like piercing the ears) is, in a sense, a moral judgement that has been made by the medical establishment. In Australia, the procedure is basically no longer available to the general population. This is an incredible change from, say, 30 years ago, when 'most' children had it done almost automatically.

If the jury is still out (and figures of 30% to 60% protection against contracting HIV in any one unprotected sexual encounter with HIV don't look like soft figures to me) then I want my child, and his future partners, to be protected!

Additionally, because only recently has it been firmly established that cervical cancer is often caused by exposure to genital wart virus, hence the development of the vaccine, it seems logical to me that any link between circumcision and protection against the passing on of wart virus may warrant a closer look. So few women get married early in their sexual lives these days, that the link between 'wives' and 'non-circumcised men' seems almost quaint to me. Being a wife, in itself, offers protection against cervical cancer!

 

[LtlFirecracker]

Date: 4/2/2009 9:25:08 PM
Author: LaraOnline
Ultimately, all sexual diseases, including the types of cervical cancer that one can have a vaccine for, could be prevented by safe sex and abstinence.

If we all had only one sexual partner for life, what a different world we would live in.

But back in the real world....

Many parents choose not to vaccinate their children, because they consider that the risk of their child contracting polio, whooping cough, whatever, to be remote (ironically, largely because most other members of a population vaccinate their children against the diseases)


I feel that the argument against circumcision has been an emotive one, and stories of parents being ''forced to watch videos of the procedure'' before being ''allowed'' to proceed with an operation that is basically medically NON harmful (I guess in a most trivial sense, a bit like piercing the ears) is, in a sense, a moral judgement that has been made by the medical establishment. In Australia, the procedure is basically no longer available to the general population. This is an incredible change from, say, 30 years ago, when ''most'' children had it done almost automatically.


If the jury is still out (and figures of 30% to 60% protection against contracting HIV in any one unprotected sexual encounter with HIV don''t look like soft figures to me) then I want my child, and his future partners, to be protected!


Additionally, because only recently has it been firmly established that cervical cancer is often caused by exposure to genital wart virus, hence the development of the vaccine, it seems logical to me that any link between circumcision and protection against the passing on of wart virus may warrant a closer look. So few women get married early in their sexual lives these days, that the link between ''wives'' and ''non-circumcised men'' seems almost quaint to me. Being a wife, in itself, offers protection against cervical cancer!

Overall, some very good points made, expecially about the moral judgement doctors are making by forcing parents to watch the videos. I totally agree.

Just to throw a wrench into that last sentence. Marriage does not guarantee one sexual partner and automatic protection against cervical cancer. The AIDS epidemic is such a problem because men were cheating on their wives with prostitutes. I have had several mothers tell me they are not going to vaccinate their daughter against HPV because she is a "good girl" and is "waiting till marriage." Well, even if she is an angel, how do they know her future husband has been an angel? This is a potential cure for cancer! If this was breast cancer, or another cancer without a social stigma attached to it, more people would be lining up for it.

Also cervical cancer is caused by the same virus that causes warts, but it is a different strain, and that strain its self does not cause warts. The strains that cause warts are pretty harmless when it comes to the cervix. The best prevention for cervical cancer right now is the vaccine, not circumcision. Circumcised males can still pass on the virus.

I have seen many procedures on newborn babies and have done many circumcisions. It is by far one of the more benign ones.

I have no problem with a family who wants to circumcise their child for cosmetic reasons, that is their decision. However, I do not feel right now the "medical benefits" should be used to justify it. Yes, a small percentage of the population have an increased risk of infection, but does that justify removing the foreskin on everyone? The data does not show that (of course, more studies are needed on the STD issue). As someone said before, that is like removing tonsils on everyone because a small percentage of children get sleep apnea from large tonsils. It doesn''t make sense.

 

[iluvcarats]

Date: 4/2/2009 7:16:13 PM
Author: luckystar112

Date: 4/2/2009 1:46:24 PM

Author: iluvcarats

Date: 4/2/2009 1:29:22 PM

Author: dreamer_dachsie

Date: 4/1/2009 11:45:50 PM


Author: iluvcarats


An anecdote is a ''short, amusing account''. He sees this several times a week. It is not a little story, but a fact. His partners see it several times a week too.


He sees more infections on uncircumcised men. That is a fact. He has only seen penile carcinoma on uncircumcised men. Also a fact. I have a 10 year old daughter and a 6 year old son. He had a circ because we believe it is healthier, and we are jewish and it is a tradition. He has no recollection of it. Yes he cried, and I felt bad. But he cried just as hard when he got all of his immunizations, and I would do that again too, because I believe I am keeping him healthy. Do what you will, and believe what you want, it is your business. But please don''t trivialize what I said, because they are facts.

I am not disagreeing with your personal position, but I think the main point is that as a urologist, your husband *will* see these issues! This is where men go for treatment. This is the same way that a dentist sees all the patients with tooth decay. One cannot draw conclusions about the prevelence of a particular disease in the general population based on how often the specialists who treat that disease see patients with said disease. (well you can sort of, but my general point stands).

Of course he is the one who will be seeing the disease. My point is that he sees infection more often in uncircumcised men, especially when they are older. And he only has seen penile carcinoma in uncircumcised men, and not any in men who are circumcised. He ''sees it all'' so to speak, but some problems are more frequent and only pertaining to uncircumcised men.

Does he have any studies to reference regarding the penile carcinoma? The only reason I ask is because according to Wiki (I know, not the most valid source), the opinion that circumcised men suffer from it less is unjustified:


''The American Medical Association and the Royal Australasian College of Physicians say the use of infant circumcision in hope of preventing penile cancer in adulthood is not justified.[6][7] The American Cancer Society has said that the suggestion that circumcision reduces penile cancer rates, were based on studies that were flawed because they failed to consider other factors that are now known to affect penile cancer risk. It concluded: ''The current consensus of most experts is that circumcision should not be recommended as a prevention strategy for penile cancer.''[8]


One study reported a lifetime risk of a man in the United States developing invasive penile cancer (IPC) to be 1 in 600 if he is uncircumcised.[9] though this study has been criticised.[10] Several studies report that the risk is higher if a male was not circumcised neonatally, with relative risk estimates including 3.2[11] and 22[12] associated with the presence of a foreskin, and 0.41 associated with its absence.[13] Several authors also state that there is a lower incidence of penile cancer in circumcised men.[14][14][15][16][17] A few studies suggested that circumcision decreased the risk of HPV infection in males.[18][19][20] A study that concluded circumcision did not prevent penile cancer was done by Wallerstein, which reported that the risk of penile cancer in Japan, Norway, and Sweden (countries with a low rate of circumcision) is about the same (1 in 100,000 per year) as in the US.''

Here you go Lucky
Circumcision
Body_ID: HC126005
In pediatrics, few topics generate as much controversy as whether the newborn boy should undergo a circumcision, perhaps because it is the most common surgical procedure in the United States and because it is usually performed for cosmetic reasons. There are several recent reviews of the issues (Christakis et al, 2000; Alanis and Lucidi, 2004; Hutcheson, 2004). Although some have alleged that neonatal circumcision can lead to sexual dysfunction, long-term studies have not supported this view (Fink et al, 2002; Bleustein et al, 2005). A hospital-based study demonstrated that 61% of male neonates in the United States undergo circumcision and that the incidence is increasing (Nelson et al, 2005).
Body_ID: P126008
In support of circumcision is the prevention of penile cancer, urinary tract infection (UTI), sexually transmitted disease including human immunodeficiency virus (HIV) infection, and phimosis as well as lessening of the risk of balanitis.
Body_ID: P126009
Carcinoma of the penis develops almost exclusively in men who were not circumcised at birth. Schoen and coworkers (2000b) reported that of 89 men in a large health maintenance organization with invasive penile cancer, only 2 (2%) had been circumcised at birth. Furthermore, of 116 men with penile carcinoma in situ, 16 (14%) had had a neonatal circumcision. Phimosis is a significant risk factor (Tsen et al, 2001). On the other hand, although carcinoma of the penis develops primarily in uncircumcised men, in Scandinavian countries, where few men are circumcised and genital hygiene is excellent, the incidence of penile cancer is low.
Body_ID: P126010
Uncircumcised newborns and infants are predisposed to UTI (Singh-Grewal et al, 2005). In a study of 100 neonates with UTI, Ginsburg and McCracken (1982) found that only 3 (5%) of the 62 boys who developed a UTI were circumcised. Subsequently, Wiswell and colleagues (1985) studied more than 2500 male infants and found that 41 had symptomatic UTIs; of these, 88% were uncircumcised. In that study, uncircumcised boys were almost 20 times more likely than circumcised neonates to develop a UTI. Other studies of larger groups of infants have confirmed these reports (Wiswell, 2000; Zorc et al, 2005) and have demonstrated that neonatal circumcision is less costly than treating UTIs in uncircumcised boys (Schoen et al, 2000a). The increased risk seems to affect boys at least through 5 years of age (Craig et al, 1996), and the incidence of epididymitis is reduced (Bennett et al, 199. The increased risk of UTIs can be attributed to colonization of the prepuce by urinary pathogens (Gunsar et al, 2004; Bonacorsi et al, 2005). It has been calculated that it takes 111 neonatal circumcisions to prevent one UTI (Singh-Grewal et al, 2005).
Body_ID: P126011
Whether circumcision reduces the risk of sexually transmitted diseases has been controversial. An increased risk has been attributed to minor frenular injuries acquired during intercourse and to the larger surface area of the penis in uncircumcised men. In some studies, however, an increased incidence of sexually transmitted diseases in uncircumcised men has been attributed to demographic factors. Nevertheless, Lavreys and associates (1999) studied 746 men who were seronegative for HIV-1 infection and found that uncircumcised men were four times more likely to become HIV-1 positive and 2.5 times more likely to develop genital ulcers compared with circumcised men. However, there was not an increased incidence of genital warts in uncircumcised men. Currently, three clinical trials in South Africa, Kenya, and Uganda are studying whether circumcision reduces this rate of HIV infection. Preliminary unpublished results of the South African study demonstrated that circumcision reduced the risk of HIV infection by 70% (Schoofs et al, 2005), and reportedly this trial has been stopped.
Body_ID: P126012
In 1989, the AAP concluded, "Newborn circumcision has potential medical benefits and advantages as well as disadvantages and risks. When circumcision is being considered, the benefits and risks should be explained to the parents and informed consent obtained" (AAP Task Force on Circumcision, 1989). More recently, the AAP again updated its policy statement (AAP Task Force on Circumcision, 1999; Lannon et al, 2000). Its position was essentially unchanged, with the exception that it emphasized the importance of local anesthesia for the procedure. The AAP does not endorse routine circumcision.
Body_ID: P126013
When neonatal circumcision is performed, local anesthesia is recommended. Available options include the topical application of a cream containing eutectic mixture of local anesthetic (EMLA; lidocaineView drug information and prilocaine), a dorsal penile nerve block, and a penile ring block (Hardwick-Smith et al, 199. Randomized controlled trials have demonstrated that a dorsal penile nerve block is more effective than EMLA cream (Howard et al, 1999; Taddio et al, 2000). In addition, the prilocaine in EMLA cream poses a risk for methemoglobinemia (Couper, 2000), although the risk is low. Consequently, a dorsal penile nerve block or ring block at the base of the penis with 1% lidocaineView drug information is preferred. Circumcision can be performed under local anesthesia even in older boys. For example, Jayanthi and colleagues (1999) reported a series of 287 infants aged 3 days to 9 months (20% older than 3 months) who underwent office circumcision with local anesthesia. At that time, the mean cost (excluding professional fees) was $196 for office circumcision, compared with $1805 for circumcision under general anesthesia.
Body_ID: P126014
page 3747
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page 3748
Body_ID: P3748
Circumcision should not be performed in neonates with hypospadias, chordee without hypospadias, dorsal hood deformity, webbed penis, or small penis (Fig. 126-1). In addition, many neonates with a large hydrocele or hernia are more likely to develop secondary phimosis and a buried penis if circumcision is performed (see Fig. 126-1). In a report by Williams and associates (2000), 8% of boys referred for initial circumcision had an "inconspicuous penis" (see later discussion), as did 63% of boys referred for circumcision revision.
Body_ID: P126015
KEY POINTS: CIRCUMCISION
Body_ID: B126001
Body_ID: TI126001
▪ The AAP does not endorse routine circumcision.
Body_ID: TI126001.50
▪ Potential benefits of circumcision are the reduced risk of UTI in an infant and the prevention of carcinoma of the penis, balanitis, phimosis, and possibly sexually transmitted disease.
Body_ID: TI126001.100
▪ By 3 years of age, in uncircumcised boys, 90% can retract the foreskin.
Body_ID: TI126001.150
▪ In boys with phimosis, topical application of corticosteroid cream loosens the phimotic ring in 70% to 80%; the cream does not cause separation of preputial adhesions.
Body_ID: TI126001.200
▪ Circumcision should not be performed in neonates with hypospadias, chordee without hypospadias, dorsal hood deformity, webbed or hidden penis, or micropenis.
Body_ID: TI126001.250
▪ In neonatal circumcision, the AAP recommends use of local anesthetic.
Body_ID: TI126001.300
▪ The complication rate of neonatal circumcision is 0.2% to 3%. Early complications include bleeding, wound infection, penile adhesions, skin bridge, removal of excessive or insufficient skin, secondary phimosis, and penile injury. The most common late complication is meatal stenosis.

 

[diane5006]

Lara your defination of recent may be different than mine...but the link to human papilloma virus (HPV) and gential warts and cervical cancer has been long established...also do you know how long it takes to develop and get FDA approval for a vaccine...were not talking weeks, months or a year here (also the link to increased risk from uncircumcised men has been disproved)

FYI on HPV...there are over 100 strains of HPV...

only a few of which cause genital warts or cervical cancer...

The strains that cause genital warts ARE NOT the same ones that cause Cervical cancer.

Human papilloma virus types 6, 11, 16, 18, 31 and 35 are sexually transmitted.

The strains of hpv most commonly involved in sexually transmitted infection are types 6 and 11 (genital warts).

HPV virus types 16, 18, 31, 33 and 35 are significantly associated with cervical and rectal cancer.

The new (at least 3 years old) Gardisil...protects against 4 of those 6, 11, 16, 18

To me circumcisision it a personal choice...I don''t think it is neccessarily barbaric...nor do I think it is medically necessary...

Also the second to last line in my last post was supposed to be deleted...I couldn''t edit...not quite what I wanted to put across

 

[LaraOnline]

Date: 4/2/2009 9:57:30 PM
Author: LtlFirecracker

Date: 4/2/2009 9:25:08 PM

Just to throw a wrench into that last sentence. Marriage does not guarantee one sexual partner and automatic protection against cervical cancer.

Well, yes, I wholeheartedly agree with you!! Just did not want to complicate the issue by discussing marriage behaviours... although to those observant of marriage, there would be a reduced exposure to STDs in general... but overall I thought that the point of checking 'wives' of non-circumcised men was, in itself, not a way of proving or disproving a connection between STIs and circumcision...

Also, while the label 'genital warts' (as opposed to HPV) is colloquial, I don't personally feel it is an important difference in relation to this discussion, which really should be kept simple and low-key in the interests of human interest!

Finally, I wholeheartedly agree that vaccines against STDs should be made widely available, and that they are most likely to provide a best protection against diseases. Circumcision, if it offers any proven protection, is likely to be a rather paltry protection in comparison with a vaccine! However, even a protection rate, of, say 10% would be likely to have me interested in circumcising my boy child. I do not want him to contract AIDS (or other STDs), and I would take what steps were available to me to increase his chances of not contracting the disease if he was ever exposed throughout his life.

 

[kennedy]

I don''t think anyone is saying that there aren''t some medical benefits associated with circumcision. We can all find data on the internet to support our respective positions, but the question is whether the benefits outweigh the risks. For instance, the AAP states that uncircumcised men are at a greater risk of developing penile cancer, but notes that, in the United States, only 9 to 10 cases are diagnosed per year per 1 million men, indicating that while the risk is higher for uncircumcised men, their overall risk is extremely low, especially if proper hygiene is observed. Conversely, complications occur in 1 in 200 circumcised newborns (also very low, but much higher than the risk of penile cancer). The reason that nearly every legitimate medical organization (AAP, AMA, Canadian Pediatric Society, RACP, the list is endless) has recommended against routine circumcision is because it''s simply not essential to a child''s well-being. That doesn''t mean there''s anything wrong with deciding to circumcise one''s child for religious reasons or because the benefits seems compelling, but parents shouldn''t feel they have to if it doesn''t feel right to them. The foreskin does serve a function and, personally, I would feel badly altering my child''s penis if there isn''t convincing evidence to suggest that it is in his best interest.

 

[LtlFirecracker]

Date: 4/2/2009 10:20:05 PM
Author: LaraOnline

Date: 4/2/2009 9:57:30 PM

Author: LtlFirecracker

Date: 4/2/2009 9:25:08 PM


Just to throw a wrench into that last sentence. Marriage does not guarantee one sexual partner and automatic protection against cervical cancer.

Well, yes, I wholeheartedly agree with you!! Just did not want to complicate the issue by discussing marriage behaviours... although to those observant of marriage, there would be a reduced exposure to STDs in general... but overall I thought that the point of checking ''wives'' of non-circumcised men was, in itself, not a way of proving or disproving a connection between STIs and circumcision...


Also, while the label ''genital warts'' (as opposed to HPV) is colloquial, I don''t personally feel it is an important difference in relation to this discussion, which really should be kept simple and low-key in the interests of human interest!


Finally, I wholeheartedly agree that vaccines against STDs should be made widely available, and that they are most likely to provide a best protection against diseases. Circumcision, if it offers any proven protection, is likely to be a rather paltry protection in comparison with a vaccine! However, even a protection rate, of, say 10% would be likely to have me interested in circumcising my boy child. I do not want him to contract AIDS (or other STDs), and I would take what steps were available to me to increase his chances of not contracting the disease if he was ever exposed throughout his life.

I see where you are coming from. You are trying to figure out what is best your your children, and protect them every way you can, and you are looking at all the facts. That is an admirable feature in a parent IMHO. Just realize this is a heated topic even in the medical field, and you will not get one straight answer. More learning needs to be done on the topic. The best thing that parents can do is make a decision based on the data that is available and their own cultural beliefs.

 

[Dancing Fire]

WOW!! i''m surprise some americans decided not to circumcise their sons.

 

[cara]

The WHO now recommends circumcision for men as a component of HIV-prevention programs in countries with high HIV rates and heterosexual transmission. If you are going to look up guidelines on the web, try to find ones issued after the critical studies on circumcision and HIV infection were published (in 05-06.) We discussed these earlier but here is a review: These were randomized, controlled studies in African coutries - the researchers randomly assigned a participant to either circumcision or a "wait list" and then monitored their HIV status over time. Those that were circumcised were 60% less likely to become infected with HIV as compared to those that were wait listed. The results were compelling enough in favor of the health benefits of circumcision that the studies were halted and all men on the wait list were offered the procedure.

It is important to note that these were not correlation studies, which are harder to properly control. (However, the reason the randomized trials were done at all was because prior correlation studies had suggested a possible benefit to circumcision in regards to HIV status - correlation studies are not all bad.) Some of the objections mentioned on this thread pertain to correlation studies, such as if you do a retrospective analysis and look at men that are either already circumcised or not. If you find that circumcised men are more likely to be HIV-negative, it might be because those men are culturally different than the uncircumcised men and thus have different sexual practices that affect their risk of being infected. A randomized trial removes those hidden variables by randomly assigning men to receive circumcision or not, rather than allowing them to self-select which group they are in.

I wrote this all out because it is unlikely that a similar randomly controlled study could be performed in the US. For one, the HIV infection rate is much lower, so you would need a much more powerful study to see an effect (ie. more people monitored for a longer period of time.) As well, heterosexual transmission is only a small component of HIV transmission in the States, and it is unclear if circumcision offers protection for, say, men engaged in anal sex, which is a more common method of transmission here. Also, the study requires a supply of uncircumcised adult men willing to be circumcised for science! (How many do you know?)

Without such a study, it will be hard to collect compelling data on an appropriate population for making recommendations for most of the people that post here on pricescope. However the US guidelines on circumcision at least are being reevaluated in light of the new scientific information on HIV transmission... it seems unlikely they would recommend routine circumcision for all but they may adjust their position on medical benefits slightly.

In this light, I do see circumcision as being more similar to a vaccine. No point in getting circumcised AFTER you have been infected with HIV, while waiting until after your kid gets a bunch of throat infections seems more appropriate for the tonsilectomy (sp?). Yet, rather than an old school vaccine like polio or measles with decades of safety and efficacy data to support it, circumcision is more similar to gardasil for HPV for even the TB vaccine. Both are not 100% effective (or 99% or 98%... much less). The HPV vaccine is very new and has limited lifetime data to support it. The TB vaccine is not even routinely administered here, only people at high risk of exposure like medical personnel are given it. But in coutries with higher TB rates, TB shots are standard for everyone.

But then when you throw in the fact that circumcision is not a standard shot but rather a surgical procedure on a very sensitive and symbolic part of the male anatomy, a procedure with clear cultural bias both for and against it, and it becomes easy to see how people have strong opinions and grab at the available data from both sides. Anywho. Time for more sleep, less treatise.

 

[Dreamer_D]

Date: 4/2/2009 11:42:53 PM
Author: kennedy
I don''t think anyone is saying that there aren''t some medical benefits associated with circumcision. We can all find data on the internet to support our respective positions, but the question is whether the benefits outweigh the risks. For instance, the AAP states that uncircumcised men are at a greater risk of developing penile cancer, but notes that, in the United States, only 9 to 10 cases are diagnosed per year per 1 million men, indicating that while the risk is higher for uncircumcised men, their overall risk is extremely low, especially if proper hygiene is observed. Conversely, complications occur in 1 in 200 circumcised newborns (also very low, but much higher than the risk of penile cancer). The reason that nearly every legitimate medical organization (AAP, AMA, Canadian Pediatric Society, RACP, the list is endless) has recommended against routine circumcision is because it''s simply not essential to a child''s well-being. That doesn''t mean there''s anything wrong with deciding to circumcise one''s child for religious reasons or because the benefits seems compelling, but parents shouldn''t feel they have to if it doesn''t feel right to them. The foreskin does serve a function and, personally, I would feel badly altering my child''s penis if there isn''t convincing evidence to suggest that it is in his best interest.

This s exactly what I was talking about when I said we need to know prevalence rates to really assess risk.

Cara Very good post and a nice summary.

 

[Jas12]

Cara--well put. I certainly agree that we look to science to support our cultural position and hope that they match up. After some reading the objective side of me knew there were no significant health benefits, but the social being that i am wondered if we should still do it so Dad and son would match.

 

[Pandora II]

In the UK, around 400 men a year are diagnosed with penile cancer (0.31 cases per 100,000) - and we have very low rates of circumcison - this is far, far less than the numbers who have complications from circumcision (around 10%). Research here has shown that the risk of developing penile cancer are no different for circumcised men than non circumcised. However circumcised men have a higher chance of contracting genital warts and urethritis. The complication rates may be higher in the UK as circumcision is not available except for bonafide medical conditions on the NHS, so parents would need to seek private treatment. In the USA I believe it is around 1.7%.

Interestingly, the rates of penile cancer are higher in the US (1 in 100,000) than in the UK and other European countries where circumcision rates are far, far lower. Not smoking, condom use, good hygiene and being married are far more important risk reducers than circumcision.

One of the UK articles I was reading suggested that infections and other problems with small boys who are not circumcised is often because parents don''t realise that the foreskin should not be retracted as it is actually attached to the penis Forcibly retracting it, for cleaning etc is potentially very dangerous. About 50 per cent of one-year-old boys will have a non-retractable foreskin, 30 per cent of two-year-olds, about 10 per cent of four-year-olds and about 5 per cent of 10-year-olds.


People who hold strong views one way or another will rarely be persuaded to change their minds. I just hope that those who are undecided take the time to properly consider the implications and don''t just do it because it''s a cultural practice in their area.

 

[LaraOnline]

Date: 4/3/2009 8:46:42 AM
Author: dreamer_dachsie For instance, the AAP states that uncircumcised men are at a greater risk of developing penile cancer, but notes that, in the United States, only 9 to 10 cases are diagnosed per year per 1 million men, indicating that while the risk is higher for uncircumcised men, their overall risk is extremely low, especially if proper hygiene is observed. Conversely, complications occur in 1 in 200 circumcised newborns (also very low, but much higher than the risk of penile cancer).


Another aspect of this ''risk comparison'' is that the complications of circumcision are actually usually incredibly minor, (as in much more minor than penile cancer or venereal disease) are they not?

 

[kennedy]

Date: 4/5/2009 5:08:48 AM
Author: LaraOnline

Date: 4/3/2009 8:46:42 AM

Author: dreamer_dachsie For instance, the AAP states that uncircumcised men are at a greater risk of developing penile cancer, but notes that, in the United States, only 9 to 10 cases are diagnosed per year per 1 million men, indicating that while the risk is higher for uncircumcised men, their overall risk is extremely low, especially if proper hygiene is observed. Conversely, complications occur in 1 in 200 circumcised newborns (also very low, but much higher than the risk of penile cancer).



Another aspect of this 'risk comparison' is that the complications of circumcision are actually usually incredibly minor, (as in much more minor than penile cancer or venereal disease) are they not?

The risk of penile cancer for any man, circumcised or not, is EXTREMELY low. And it's not even clear whether circumcision actually lowers the risk (I've seen data supporting and refuting that claim), especially if proper hygiene is observed. There are other "non-essential" body parts (such as breasts) that are MUCH more prone to developing cancer. Do we recommend routine mastectomies for all women past the age of breastfeeding? I'm being hyperbolic here, but you get my point. Yes, penile cancer is certainly more serious than the routine complications resulting from circumcision, but there are also some rare, not-so-minor complications associated with circumcision such as disfigurement, urethral damage, hemorrhage.

I think the point is that it's very rare for someone to suffer serious consequences either way. Based on the research I've done (before I found out we were having a girl), it seems that the vast majority of children will gain no medical benefit nor will they suffer any complications as a result of circumcision. So, it just comes down to individual choice. There's no absolute right answer because the benefits and risks sort of cancel each other out.

 

[iluvcarats]

Date: 4/5/2009 12:44:23 PM
Author: kennedy

Date: 4/5/2009 5:08:48 AM

Author: LaraOnline

Date: 4/3/2009 8:46:42 AM


Author: dreamer_dachsie For instance, the AAP states that uncircumcised men are at a greater risk of developing penile cancer, but notes that, in the United States, only 9 to 10 cases are diagnosed per year per 1 million men, indicating that while the risk is higher for uncircumcised men, their overall risk is extremely low, especially if proper hygiene is observed. Conversely, complications occur in 1 in 200 circumcised newborns (also very low, but much higher than the risk of penile cancer).




Another aspect of this 'risk comparison' is that the complications of circumcision are actually usually incredibly minor, (as in much more minor than penile cancer or venereal disease) are they not?

The risk of penile cancer for any man, circumcised or not, is EXTREMELY low. And it's not even clear whether circumcision actually lowers the risk (I've seen data supporting and refuting that claim), especially if proper hygiene is observed. There are other 'non-essential' body parts (such as breasts) that are MUCH more prone to developing cancer. Do we recommend routine mastectomies for all women past the age of breastfeeding? I'm being hyperbolic here, but you get my point. Yes, penile cancer is certainly more serious than the routine complications resulting from circumcision, but there are also some rare, not-so-minor complications associated with circumcision such as disfigurement, urethral damage, hemorrhage.


I think the point is that it's very rare for someone to suffer serious consequences either way. Based on the research I've done (before I found out we were having a girl), it seems that the vast majority of children will gain no medical benefit nor will they suffer any complications as a result of circumcision. So, it just comes down to individual choice. There's no absolute right answer because the benefits and risks sort of cancel each other out.

I agree that there is no right answer.
I found this that I think expains the pros and cons of both sides very well.

As far as proper hygiene is concerned, I also agree that is the key.
My son is 6, and I taught him proper hygiene.
Every time he uses the potty I ask "Did you wash your hands?" 2 times out of 3 he sheepishly turns around and goes back to wash his hands.
I also taught him the proper way to wipe his tushy, but sometimes when I am doing laundry, I notice that he could put a bit more attention to that too.
When he is home, I can be on top of it, but when he is at school I have to cross my fingers and hope for the best.

 

[partgypsy]

My husband discussed it when planning to have kids that we were in agreement that they would be circumcised and I have to say for tradition/cultural reasons, that''s what his father and his father''s father did. He or any his cohorts growing up did not have any untoward effects from it, on the contrary the occasional guy who was uncircumcised relating to my husband how he felt uncomfortable and different. We had two girls so this didn''t come up. One time this came up in conversation with some friends/neighbors and we expressed if we had a boy we would have them circumcised and boy did we get an earful! Pretty much yelling at us and how barbaric it is etc. Did it change our mind? No, but we decided that if we ever had to make that decision that we would do it and just not tell people about it.