The Circumcision Discussion - page 111

by jmspeach 187,817 Views | 1299 Comments

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... Read More


  1. 0
    Quote from consult2
    http://www.emedicine.com/med/topic2874.htm

    Paraphimosis is a relatively uncommon condition and occurs less often than phimosis.
    Paraphimosis is almost always an iatrogenically or inadvertently induced condition. The condition occurs more often in hospitals and nursing homes than in the private community. In the private community, either the affected individual or a parent often retracts the prepuce and then inadvertently leaves it in its retracted position. In most cases, the foreskin reduces on its own and therefore precludes paraphimosis; however, if the slightest resistance to retraction of the prepuce is present, leaving it in this state predisposes it to paraphimosis. As edema accumulates, the condition worsens.
    According to the National Hospital Discharge Survey, a trend in the United States over the last 30-40 years has been toward noncircumcision. Circumcision rates, which were at an all-time high of 78-80% in the mid-to-late 1960s, decreased to 55-60% in 2003. With more uncircumcised individuals, paraphimosis has the potential to become more common. Because paraphimosis is a condition that is almost always iatrogenically or inadvertently induced, simple education and clarification of proper prepuce care to parents, the individuals themselves, and health care professionals may be all that is required to prevent this problem.
    I saw this condition once. The man had fluid building up in his retracted foreskin. It was like a big bubble on one side and to a lesser extent, all the way around like a donut. I told the MD right away because I had never seen anything like this. When the urologist came in later that day he was mad that no one had called him earlier. He said that the man's penis could have become necrotic and possibly... I shutter to think.
    He ended up squeezing the poor pt penis and pulling the foreskin back down. Judging by the way the man yelled, it was very painful. The poor guy had had a stroke and couldn't take care of his own br/hygiene needs.
  2. 0
    Quote from Joe12
    I don't think I agree with this. Premature retraction by Doctors and other medical staff, which is any retraction that occurs before the child knows he can do it himself, can cause tears and scaring which may cause problems for him down the line. In most cases, staff should not do any retraction of an intact boy.
    I'm not talking about children-

    I had posted that I have had a number of elderly, male nursing home pts who been circumcised as elderly, adult males- due to problems woth foreskin strictures. One poster reponded that the problems were probably due to lack of care by nursing home staff. This was not the case. Many alert, male nursing home pts refuse hygeine care- it has always been a battle with many of them.
    Seeing (and smelling) an 80+ yr old man with his foreskin stuck to him in a layer of filth is a memorable event. Trying to clean it up is even more memorable.

    I also had a male family member who got circumcised @ age 34 because of problems with strictured foreskin.
    I've known of pts who've beed cicumcised as adults because of recurrent yeast infections. Some people have this problem, despite good hygeine.
  3. 3
    ... You're saying that the problem was that they refused care. This is not a problem with the foreskin- it is a problem with staff being unable to effectively encourage cooperation with basic hygeine requirements. (They may not be doing anything wrong- or neglecting the resident- but the point is that infection is caused by care not given. The care isn't being given if the care is refused.)What policies/procedures are there for residents who refuse *other* hygeine requirements? The combative resident who is laying in excrement, or who keeps refusing mouth care, for example. The problem IS with lack of proper hygeine care by nursing home staff- as the smegma and possible infection buildup due to lack of hygeine provided is what causes the strictures in most cases in nursing home residents. Does the resident have a right to refuse? Sure. But at the same time- there are ways to encourage acceptance of care. The concern can also be raised by the nurse to the doctor who can consider various other methods of gaining compliance if the nurse is having difficulty. In MOST cases the foreskin need never be removed. In young adults with strictured foreskin, MOST cases are easily correctible via non-surgical means. Recurrent yeast infections can often be cured by dietary changes, possible supplementation, medication etc. Also, it is not only intact males who can acquire yeast infections. If a person suffers from recurrant untreatable yeast infections- they may be predisposed to it and circumcision may not cure the problem. I'd first pursue all NON-surgical methods before removing a body part due to a yeast infection. MHO. (Infections can also be caused by leaving a bit of soap in between the foreskin/penis- or in women not cleaning all soap from the labia- which is VERY easy to do if one isn't very careful about it.) In residents who are elderly and lacking manual dexterity- this can be a very big issue. (They may be alert, but that doesn't necessarily mean that they are cleaning properly)

    Quote from Valerie Salva
    I'm not talking about children-

    I had posted that I have had a number of elderly, male nursing home pts who been circumcised as elderly, adult males- due to problems woth foreskin strictures. One poster reponded that the problems were probably due to lack of care by nursing home staff. This was not the case. Many alert, male nursing home pts refuse hygeine care- it has always been a battle with many of them.
    Seeing (and smelling) an 80+ yr old man with his foreskin stuck to him in a layer of filth is a memorable event. Trying to clean it up is even more memorable.

    I also had a male family member who got circumcised @ age 34 because of problems with strictured foreskin.
    I've known of pts who've beed cicumcised as adults because of recurrent yeast infections. Some people have this problem, despite good hygeine.
    UTVOL3, Smurfette752, and morte like this.
  4. 2
    Quote from Valerie Salva
    I'm not talking about children-

    I had posted that I have had a number of elderly, male nursing home pts who been circumcised as elderly, adult males- due to problems woth foreskin strictures. One poster reponded that the problems were probably due to lack of care by nursing home staff. This was not the case. Many alert, male nursing home pts refuse hygeine care- it has always been a battle with many of them.
    Seeing (and smelling) an 80+ yr old man with his foreskin stuck to him in a layer of filth is a memorable event. Trying to clean it up is even more memorable.

    I also had a male family member who got circumcised @ age 34 because of problems with strictured foreskin.
    I've known of pts who've beed cicumcised as adults because of recurrent yeast infections. Some people have this problem, despite good hygeine.
    Keep in mind that in the US circumcision is our first solution to problems with the intact penis. In countries with lower circumcision rates, health care providers are more accustomed to working with a normal penis and do not jump to circumcision as a first line cure. Oddly, the rate of adult circumcision is LOWER in countries where infant circumcision is not the norm, which is the opposite of what I would expect. It's all about perspective.
    UTVOL3 and Equinox_93 like this.
  5. 2
    "I also had a male family member who got circumcised @ age 34 because of problems with strictured foreskin.
    I've known of pts who've beed cicumcised as adults because of recurrent yeast infections. Some people have this problem, despite good hygeine."

    The most common cause of phimosis in America is premature retraction--in intact countries it is a VERY rare condition. And when it occurs, they don't jump to circumcision--they treat it by stretching and/or steroids.

    As for yeast infections:

    There is no significant difference between carriage rate in circumcised and uncircumcised male although the chance of symptomatic infection is higher in the uncircumcised men.

    Circed men are just as likely to have a yeast infection as intact men, they just don't know it, whereas an intact man's yeast infection might show itself on his very sensitive glans. What this says to me is that women are more likely to receive a yeast infection from a circed man since he probably would have no idea that he has it and probably would not seek any treatment.


    http://www.hkmj.org.hk/skin/balaniti.htm

    Handbook of Dermatology & Venereology
    (Social Hygiene Handbook - 2nd Edition )
    Smurfette752 and Equinox_93 like this.
  6. 3
    "Oddly, the rate of adult circumcision is LOWER in countries where infant circumcision is not the norm, which is the opposite of what I would expect. It's all about perspective."

    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...mcision4.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
    UTVOL3, Smurfette752, and Equinox_93 like this.
  7. 0
    Quote from consult2
    "Oddly, the rate of adult circumcision is LOWER in countries where infant circumcision is not the norm, which is the opposite of what I would expect. It's all about perspective."

    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...mcision4.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
    I think you are trying to argue with me, but please reread my post and notice that we are agreeing I was saying that I am surprised by the lower adult rates in countires where infact circ is not the norm simply due to the difference in raw number of people who could potentially be circed.
  8. 6
    If a yeast infection on the foreskin means we have to surgically remove the foreskin in order to cure the infection and prevent future infections, what about all the breastfeeding moms with thrush (yeast infection of the nipple)? Do we just whack off their nipples and tell them that we "cured their problem for them" and they'll never have to deal with thrush again??????
    JanisM, deege58, SecuredFloorNurse, and 3 others like this.
  9. 1
    Quote from brillohead
    If a yeast infection on the foreskin means we have to surgically remove the foreskin in order to cure the infection and prevent future infections, what about all the breastfeeding moms with thrush (yeast infection of the nipple)? Do we just whack off their nipples and tell them that we "cured their problem for them" and they'll never have to deal with thrush again??????
    No, but many will tell the mom to wean. (I of course do NOT agree with that approach!)
    Equinox_93 likes this.
  10. 0
    "I think you are trying to argue with me, but please reread my post and notice that we are agreeing I was saying that I am surprised by the lower adult rates in countires where infact circ is not the norm simply due to the difference in raw number of people who could potentially be circed."

    Not at all, I am agreeing with you--I am just just supporting your assertion with hard numbers..some need the numbers to reinforce the facts.


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