The Circumcision Discussion

[jmspeach]

I know this can be a HUGE debate, and I'm not looking to start any arguments. I was just wondering as you are OB nurses. I'm expecting a boy in July and not sure if we should circ. or not. My husband says yes, it's better medically in the long run. My gpa who just turned 70 had to have a circ. due to endless complications lately.

As nurses in this area, is the medication that they use good? And what are some questions to ask my Dr. about it. I already know that my hospital i'll be at uses a med. when they perform it, I"m just wondering what you all think.

Thanks

Jen :)

[Elvish, BSN, DNP, RN, NP]

You cannot prevent HIV or HPV by circumcision alone and it would be foolish for anyone to think that you could.

Telling a parent that the chances are REDUCED versus PREVENTED is not the same thing.

What I see is this: as soon as you mention to parents about 'reducing the chances of HIV/HPV transmission', what they hear is 'if we have him circumcised, he won't get HIV.' That is what I'm referring to. Rightly or wrongly, it is what many parents in my daily practice say. IF it does indeed reduce transmission chances (which I think has been talked about ad nauseum in this thread, and the studies were flawed), there's still no need to circumcise a newborn baby.

Using a condom doesn't guarantee that you won't get an STD either....surely you don't tell patients that do you???? You also are not considering the fact that not everyone in the world is sexually faithful...if your partner cheats on you, and you think you are in a monogomous relationship...not much you can do about it.

Using a condom doesn't *guarantee* that you won't get an STD either - but it is about as effective as anything out there, and surely is more effective than circumcision at reducing HIV transmission. I am well aware of the fact that not everybody is faithful to their partner; however, why is the incidence of HIV transmission higher in the circ-happy US than in, say, European countries, where the circ rate is extremely low or nonexistent outside Jewish or Muslim communities?

I stil haven't heard anyone mention doing appys on newborn babies because it will virtually eliminate their chances of getting appendicitis later on...

[consult2]

"There benefits that are medically documented for circumcision...such as a lowered chance of HPV and HIV infection."

Really? Science demands that a theory fulfill its prediction every time, however the rates of both of these are HIGHER in circumcising countries than intact countries. HOW and Why is this possible IF circumcision reduces them?

Logic and even common sense should be applied when looking at claims for benefits.

[consult2]

"The links ARE my sources...and they are from the CDC and well recognized professional medical journals with CURRENT RESEARCH."

Thoise are the OPINIONS of medical organizations--not proven facts--and are contradicted by empirical evidence in the real world.

"Appeal to authority" is not a valid argument especially when those organizations have a bad track record.

"I graduated in May and the same information appeared in our textbooks as well as the teaching literature we give to parents at my hospital who inquire about circumcision."

That is a sad commentary on the state of our medical education--stating unproven claims as scientific fact.

[consult2]

"I tell them that there is a risk to permanent damage to the member from the procedure, infection that can have a major impact on urination, appearance, and future sexual performance."

Do you tell them that there is a 100% chance of the loss of erogenous tissue and various rates of meatal stenosis-- removal of too much tissue, iatrogenic phimosis, glans amputation, and even death?

[consult2]

"ETA - the actual number of intact men that end up 'having' to get circumcised as adults in the US is about 1 in 100. So we're circing, on average, 99 newborns who otherwise would have no problems, to save one person who *might* have problems that truly need fixing with circumcision."

Actually the rate in foreskin-educated countries is a LOT less:

First of all, for a man who was not circumcised as an infant the chances of him having to get circumcised as a adult are extremely rare. In fact it's only 6 in 100,000. (0.006%)

Health officials of each Scandanavian country were queried about adult circumcision.. None of the health officials could provide precise data, because the numbers were so small that they weren't worth compiling. Each official stressed that foreskin problems were present but said they were largely treated medically-surgical solutions were extremly rare.

"in Oslo, Norway, over a 26-year period in which 20,000 male babies were cared for, 3 circumcisions were performed-a frequency rate of 0.02%.

In Denmark. 1968 children up to the age of 17 were examined over a period of several years. In this group, 3 circumcisions were performed-a frequency of 0.15%. In this study, in retrospect, the physicians believed that all three operations might have been avoided. Both of these studies related to the infrequency of circumcision and puberty, they did not deal with the issue in adulthood.

Wallerstein, Edward, Circumcision: An American Health Fallacy. pg 128

In Finland -- a non-circumcising country -- the operative rate is only a tiny fraction of this percentage. A male's risk of being circumcised for any reason during his entire lifespan is less than one in 16,000.

http://www.fathermag.com/health/circ/circumcision/circumcision4.shtml

The Finnish National Board of Health provided national case records for the year 1970 for both phimosis and paraphimosis. A total of 409 cases was reported for males 15 years and older,which represents only

2/100ths of 1% (0.023%) of the total male population in that age group. This means that 99.97% did NOT develop a problem. Moreover, according to Finnish authorities, only a fraction of the reported cases required surgery- a number too small to reliably estimate.

Wallerstein, Edward, CIRCUMCISION: AN AMERICAN HEALTH FALLACY p.128

http://www.sciencebasedmedicine.org/?p=269

[allikatRN]

I just recently completed my rotation in OB. I saw a few doctors perform circ and each had a different way. Some used lidocaine, some used the plastibell or whatever. The nurses would use sugar water to distract the infant by placing a gloved finger into the infants mouth with the sugar water. After being strapped in most of the infants did not cry during the procedure as they were sucking the sugar water. Some cried for a few minutes and then stopped. To me it did not seem that the lidocaine made much of a difference because that hurts being injected. It seems that they cried just as much either way. My ex-boyfriend was not circ. and he was embarrased about it when we first got together. Since most men are circ. when you are one of the few that are not I think it can be embarassing for you. He always said that he wished it would have happened when he was a baby because now it would be a big ordeal.

[Elvish, BSN, DNP, RN, NP]

Actually the rate in foreskin-educated countries is a LOT less:

I know...:) I was referring to the US, although I may not have made that clear.

[morte, LPN, LVN]

well, consult.....i was waiting for you, and you didnt disappoint.....i really wasnt looking forward to going back thru all the posts to find the info....lol

[lamazeteacher]

"There benefits that are medically documented for circumcision...such as a lowered chance of HPV and HIV infection."

Really? Science demands that a theory fulfill its prediction every time, however the rates of both of these are HIGHER in circumcising countries than intact countries. HOW and Why is this possible IF circumcision reduces them?

Logic and even common sense should be applied when looking at claims for benefits.

Here's some common sense:

Since countries where circs are routinely done, are more developed (except for the Scandinavian countries) stats are available, as record keeping is better, and computerized.

In underdeveloped countries doing circs, less reliable data is stored and availability of it is difficult to obtain, especially in most African countries. Anecdotal information changes the way things are done there, and that takes much more time.

[BabyLady, BSN, RN]

it is earlier in the thread, that is where the study was done, in africa

I listed SEVERAL sources of DIFFERENT studies that were done.

None of them were done in Africa.

You are posting that as if all of the research is based on a single study done in Africa...and there is simply, no truth to that whatsoever.

[BabyLady, BSN, RN]

What I see is this: as soon as you mention to parents about 'reducing the chances of HIV/HPV transmission', what they hear is 'if we have him circumcised, he won't get HIV.' That is what I'm referring to. Rightly or wrongly, it is what many parents in my daily practice say. IF it does indeed reduce transmission chances (which I think has been talked about ad nauseum in this thread, and the studies were flawed), there's still no need to circumcise a newborn baby.

Using a condom doesn't *guarantee* that you won't get an STD either - but it is about as effective as anything out there, and surely is more effective than circumcision at reducing HIV transmission. I am well aware of the fact that not everybody is faithful to their partner; however, why is the incidence of HIV transmission higher in the circ-happy US than in, say, European countries, where the circ rate is extremely low or nonexistent outside Jewish or Muslim communities?

I stil haven't heard anyone mention doing appys on newborn babies because it will virtually eliminate their chances of getting appendicitis later on...

You are comparing apples to oranges.

I cannot control what parent hears or how they interpret the information. All I can do is present it to them, assess their level of understanding, and ask if they have any questions. Once they leave the hospital, it's up to them, not me, to raise and parent that child.

I don't care what they teach or the circ rate or HPV, STD rate or anything else in the UK, etc....I don't live in those countries...I live and practice healthcare in the USA. I don't live in a geographical area with a transient population.

Therefore, my job as a nurse is to practice objectively and non-judgmentally on FACT-BASED PRACTICE. The literature at our hospital that we provide to parents supports what I teach.

An circumcision...is done with a lidocaine, does not cut into muscle, does not cut through a protective membrane that would expose major organs to possible infection and has minimal blood loss. It is considered a minor surgical procedure.

An appendectomy, is considered major surgery. It is done through general anesthesia and all of the risks of intubation, cutting through major muscles of the abdominal cavity, thus, placing the body at risk for adhesions, major infection, stitches, etc.

I cannot believe any intelligent healthcare worker could think the two are even remotely related.

[BabyLady, BSN, RN]

"The links ARE my sources...and they are from the CDC and well recognized professional medical journals with CURRENT RESEARCH."

Thoise are the OPINIONS of medical organizations--not proven facts--and are contradicted by empirical evidence in the real world.

"Appeal to authority" is not a valid argument especially when those organizations have a bad track record.

"I graduated in May and the same information appeared in our textbooks as well as the teaching literature we give to parents at my hospital who inquire about circumcision."

That is a sad commentary on the state of our medical education--stating unproven claims as scientific fact.

Well, I guess the CDC, World Health Organization, Unicef, and other, internationally recognized organizations that are dedicated to the PREVENTION of disease, are all wrong.

Better send them a letter and tell them that the tons of studies that they are posting on their websites, published in the most widely accepted medical journals, are all one big conspiracy theory.

I am glad that instead of citing personal opinion, I have written facts, backed up by current research as well as my employer, to present to parents.