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Looking for guidance on circumcision? You’re on your own

January 13, 2010 |  7:00 am

Baby1 Circumcision. It’s a delicate procedure and a loaded word, filled with connotations of pain, religious significance and hotly debated health benefits.

Some commentary in the current issue of the Archives of Pediatrics and Adolescent Medicine shows that medical professionals are not quite ready to come down on one side or the other. “Recommendations for routine newborn circumcision will need to wait for well-designed studies that verify its cost-effectiveness for the individual and/or society,” the editorial said.

But another paper in the same issue pointed to three recent studies that found circumcision helped reduce HIV acquisition by up to 60%.

In this L.A. Times story, writer Marnell Jameson highlighted the dilemma for many parents looking to circumcise:

Those who strongly oppose infant circumcision believe the procedure violates a child's human rights. …

The downside of letting the child make the decision later is that adult circumcision is more expensive, painful and extensive. During an infant circumcision, practitioners numb the site with local anesthesia, then attach a bell-shaped clamp to the foreskin and excise the skin over the clamp. The clamp helps prevent bleeding. In adults, the procedure involves two incisions, above and below the glans (tip of the penis), stitches and a longer recovery. The cost is about 10 times that of a newborn procedure.

Bottom line: In the delivery room or afterward, no one’s going to be providing some infallible rules on circumcising your child. Do your homework before you have to decide. Here’s a brief description from the American Urological Assn. and some very helpful information from KidsHealth. Should you choose not to make the cut, the American Academy of Pediatrics has a guide on caring for an uncircumcised penis.

-- Amina Khan

Photo credit: Annie Wells / Los Angeles Times

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Comments (9)

The difference between doing the procedure as a child versus as an adult is minor compared to the advantage of giving your child the choice.

Cutting off part of the penis of someone else -- nerves, blood vessels, protective covering and pleasure zones is just wrong. The dynamics of the penis is changed for good. The US medical professionals have an obsession with boy genital cutting. There is a need for us to join the rest of the advanced world and stop this abusive practice. The foreskin parts feel really good -- his body, his right to experience the pleasure of his natural penis.

Unfortunately, the main risk of circumcision is fully ignored. There is 100% chance that circumcision will damage the male genitals as to function and pleasure. Not mentioning this fact is tantamount to spreading misinformation. This surgery takes away main male pleasure zones including the mechanism to gain and maintain an erection.

The foreskin is not just skin and does not just protect the glans (head). Circumcision is now known to ablate the most sensitive parts of the male genitals. This surgery takes away the main male pleasure zones with about 20000 fine touch and stretch nerve endings amputated. The foreskin has several parts including the ridged band that is great for ones pleasure (that is why nutters like Kellogg wanted to chop em off, to curtail masturbation), Masturbation is important for a mans physical and mental health. The ridged band directly contacts the vagina for very great pleasure all around. The dynamics of sex and the actual mechanism of the penis are drastically changed by circumcision. The foreskin can normally be slipped all the way, or almost all the way, back to the base of the penis, and also slipped forward beyond the glans. This wide range of motion is the mechanism by which the penis and the orgasmic triggers in the foreskin, frenulum, and glans are stimulated. The only touch organ possessing as rich erogenous innervation as the foreskin is the clitoris. Circumcision deprives man of 2/3ds of the main erogenous zone constituted of the foreskin and the glans.

BTW, the other risks (besides loss of sexual function, ED, PE and loss of PLEASURE) include curved or misshapen erection, painful erection, botches of all sorts (many requiring redo) and death. Boys dies each year in the US from this sick practice.

It's questionable whether adult circumcision is more painful than infant circumcision as adults can have general anesthetic, and don't need the foreskin to be separated from the glans, which is the most painful part for babies. In countries which don't circumcise, only about 1 in 100 people actually need to have it done anyway though.

The pain isn't really the main issue though. Everyone should be able to choose for themselves whether or not they want part of their genitals cut off or not. Girls are legally protected - why not boys?

All these medical society quotes can be found at their own websites:

Canadian Paediatric Society
"Recommendation: Circumcision of newborns should not be routinely performed."
"Circumcision is a 'non-therapeutic' procedure, which means it is not medically necessary."
"After reviewing the scientific evidence for and against circumcision, the CPS does not recommend routine circumcision for newborn boys. Many paediatricians no longer perform circumcisions."

Royal Australasian College of Physicians
"After extensive review of the literature, the Paediatrics & Child Health Division of the Royal Australasian College of Physicians has concluded that there is no medical reason for routine newborn male circumcision."
(almost all the men responsible for this statement will be circumcised themselves, as the male circumcision rate in Australia in 1950 was about 90%. "Routine" circumcision is now *banned* in public hospitals in Australia in all states except one.)

British Medical Association
"to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate."

Circumcision is a dangerous distraction in the fight against AIDS. There are six African countries where men are *more* likely to be HIV+ if they've been circumcised: Cameroon, Ghana, Lesotho, Malawi, Rwanda, and Swaziland. Eg in Malawi, the HIV rate is 13.2% among circumcised men, but only 9.5% among intact men. In Rwanda, the HIV rate is 3.5% among circumcised men, but only 2.1% among intact men. If circumcision really worked against AIDS, this just wouldn't happen. We now have people calling circumcision a "vaccine" or "invisible condom", and viewing circumcision as an alternative to condoms.

The one randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised btw.

ABC (Abstinence, Being faithful, Condoms) is the way forward. Promoting genital surgery will cost African lives, not save them.

Here's a helpful guide to people who need guidance on circumcision.
To the parents:
Who gets to live with the results?
What percentage of your genitals would you like to have, optimally?
Are their any proven health benefits, other than 3 poorly designed African studies?
If the child was a girl, how would I be considering this issue?
Does removing or damaging the two most erotically responsive parts of the penis, the frenulum and inner foreskin, benefit the boy, or simply limit his pleasure for life?

To the doctors:
Did you take an oath to "first, do no harm"?
Is there any other operation which removes healthy body parts from an unconsenting person?
Is this ethical, from the point of actually working for the patient?
Why is this almost never done in Europe, South America, Asia, Australia, etc?
Why is there never a study in the US, on the effectiveness of circumcision?
Is there another operation, in which the doctor can sell the part removed to a biogen company, and turn a profit twice, without the parents or guardian being informed?
Do the risks, which never seem to get mentioned, such as hidden penis, MRSA, meatal stenosis, painful erection, excessive bleeding, etc, outweigh the potential benefits, such as being less likely to contract HIV without using a condom, for a longer period of time (delaying the inevitable)?
How much money does circumcision bring in annually?
Why are there no figures available from the CDC? No death rates, no rates of unintended consequences, not even how many circumcisions are performed.

Food for thought.

I wish to concur with what all previous commenters have written above. The article in the Archives of Pediatrics and Adolescent Medicine is seriously flawed.

The "three recent studies" mentioned above, reviewed in the Archives article, reported on clinical trials carried out in parts of Africa where heterosexually transmitted AIDS is rampant. The way these studies were designed and carried out, and the way in which the data from them were analyzed, left a good deal to be desired. The subjects were adolescents and young men, not infants. It is invalid to extrapolate such studies to the First World. Specifically, they do NOT tell us whether it is appropriate to routinely circumcise a North American newborn North American.

It is high time that youth culture take on board the fact that it is extremely irresponsible to have causal sex without a condom. Condom use fully prevents the transmission of HIV. Circumcision does not.

Infant circumcision is quicker and cheaper than adult circumcision because it is done in an unethical manner. Doctors exploit the fact that a 2 day old child can neither complain nor remember. Contrary to what this story states, routine neonatal circumcision is still quite often performed without any anesthesia whatsoever. This is baldly unethical.

The size of an infant penis makes it difficult to operate on. It is also difficult to estimate how much skin should be left behind to accommodate the adolescent growth spurt, during which the penis grows more than the foreskin. The infant foreskin must be forcibly separated from the glans, something adult circ never requires. Infant circumcision sometimes results in a damaged penis; this is much rarer with adult circ. At least 1-2 North American babies die every year from the tragic consequences of a routine circ.

Circumcision is nontrivial urological surgery. The way adult circs are done fully takes that fact on board; infant circ ducks that fact by cutting corners, including ethical corners.

Western Europe and Japan enjoy a high economic and medical but do not circumcise routinely. In Australia and Canada, only 15% and 10% of infant boys are routinely circumcised. New Zealand went from 80-90% circumcised in the 1950s, to Moslems and Pacific Islanders only today. There is no evidence that those nations are experiencing higher rates of STDs or of male urological problems than the USA does.

Finally, this article, like most of the American academic literature on this tender subject, is silent about the sexual advantages of men keeping all the tender bits Mother Nature sees fit to hand them. What circumcision discards (foreskin, frenulum, frenular delta) are the most erogenous parts of the male body. This is a major reason why a male has a fundamental right to decide whether or not to keep those bits.

Male circumcision has always been promoted as a "cure all" for males but evidence shows otherwise. A study published just this week from Australian researchers reviewed all current information and found "A paucity of evidence" that male circumcision is beneficial in any way. This confirms a review of evidence by The American Academy of Pediatrics Taskforce on Circumcision in 1999 where they reviewed 672 research projects on male circumcision and could not find sufficient evidence to recommend the procedure. This reflects the policy statements of all of the policy statements of the world's advanced nations.

But, along comes the African studies on circumcision and HIV to muddy the waters. This study claimed to find a prophylatic effect superior to other interventions of known efficacy, for example the polio vaccine that eliminated the disease in a single generation. Instead of this same expected result, male circumcision has shown no effect in protecting the US population from this disease. Instead, The US has the highest HIV infection rate among the industrialized nations. Furthermore, the demographic with the highest circumcision rate also has the highest HIV infection rate, African Americans! It is estimated that 48%of all male infectees are African Americans and 80% of all female infectees are African Americans. Even in Africa, the expected benefit is not seen. There are 6 African nations that virtually circumcise all of their males that have higher infection rates than those who don't. For example, Swaziland circumcises 98% of it's males but has a 22% and growing HIV infection rate. If circumcision were beneficial as claimed, there would be significant differences in the HIV rates between the circumcising and non-circumcising nations. This difference is not observed anywhere in the world. The African studies are obviously fraudulent.

We can look at the history of the researchers to have a clue why this is. Robert Bailey, Daniel Halperin and Ronald Gray are all on the public record as being rabid circumcision promoters for more than 25 years, long before anything was known about HIV. This is just part of a long term trend. It has always been advanced that circumcision could prevent or cure the most dread disease of the day and HIV fills that bill.


It is a well established fact that babies feel more pain than adults do, doctors cannot use strong pain medication on infants like they can with adults, babies urinate in their diapers causing them pain and the infant circumcision requires the foreskin be forcibly separated from the child's glans which would be like someone ripping a finger nail off, so saying it hurts less when it is done to an infant is untrue. Further more even if it was true it wouldn't change the fact that circumcision for any other reason besides addressing a current problem of a life threatening nature is a violation of a child's human rights such as freedom of harm and body integrity.

Well said...I agree with all of you!


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