The Circumcision Discussion - page 18

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... Read More

  1. by   Spidey's mom
    Quote from phriedomRN
    Most younger docs will attempt to place a local block. A lot of older ones still don't because "it's quick and he won't remember it anyway" I've heard docs tell parents they always use anesthetics to get the consent signed and watched them go right into the circ room and start chopping away without so much as EMLA, much less the lidocaine nerve block they said would be used. I wrote up incident reports each time, but I doubt anything's changed.
    One of our docs refuses to use lidocaine . . . I refuse to assist him.


    steph
  2. by   nursejohio
    Good for you! I was brand new to L&D, only doing a couple weeks in the nursery to get used to normal babies and had the misfortune to be working while a few were done. The ones with anesthesia weren't as horrendous, but still... didn't create a happy baby
  3. by   mvanz9999
    lol! read below what i have already stated in various ways. invalid study!!!!!!

    *********

    intactivism

    the uganda and kenya studies claim to find that circumcised men are less likely to contract hiv than intact men. now the head of unaids, dr peter piot, is reported to have said, given the grim hiv situation in southern africa, it was important to promote the idea of widespread circumcision. he said baby boys should be targeted first but then attention should switch to adolescent boys and adult men.


    this is utter folly, a waste of resources and a dangerous distraction from the real issues of hiv/aids (as well as a human rights violation). at the moment we can only hope dr piot has been misquoted.
    • babies do not have sex. any benefit of infant circumcision in preventing the spread of hiv/aids will not take effect until they reach puberty.
    • the studies were of volunteers. infant circumcision raises ethical issues. it can certainly be argued that it breaches
      • the united nations universal declaration of human rights,
      • the international covenant on civil and political rights, and
      • the united nations convention on the rights of the child.
    • the studies were cut short. over a longer period of time, the supposed benefit of circumcision will be reduced. in particular
      • the circumcised group was told to abstain from sex for six weeks, or use condoms. the control group was not.
    • circumcision is not cost-free or risk-free. even if the studies are correct, is 56 circumcisions to prevent one man getting infected with hiv the most effective way of spending the money, time and expertise?
    • circumcising men disempowers women important co-factors of hiv/aids are of course condomless sex and "dry sex". circumcising men makes it harder for women to refuse these, and no less risky to accept them.
    ******************

    [color=#dd0000]you would have to circumcise 56 men to prevent one of them contracting hiv in one year.
    and the number needed to prevent hiv longer term is higher.
    doctors could spend their time better spent treating people with ulcerative disease and malaria, which make hiv transmission easier
    and using the money saved to promote safer sexual practices.
    few accepted medicines have such a high nnt.
    on this basis, the nnt in developed countries such as the usa, where the hiv rate is relatively low (0.6% compared to 4.1% in uganda), would be much higher - it would take 380 circumcisions in the us to prevent one case of hiv.

    circumcision and hiv
    Last edit by mvanz9999 on Dec 21, '06
  4. by   TrudyRN
    I have absolutely no faith that circumcision has anything whatsoeve to do with HIV prevalence but thank you for an interesting topic.
  5. by   TrudyRN
    Quote from phriedomRN
    Most younger docs will attempt to place a local block. A lot of older ones still don't because "it's quick and he won't remember it anyway" I've heard docs tell parents they always use anesthetics to get the consent signed and watched them go right into the circ room and start chopping away without so much as EMLA, much less the lidocaine nerve block they said would be used. I wrote up incident reports each time, but I doubt anything's changed.
    I seriously hope that you will report this physician to the appropriate hospital committees and to the licensing body, as he is guilty of malpractice, I believe and certainly of ethical violation. Lying to a patient's parent????? How often has this happened? Does he put his promise in writing? How do you know he does this? This is a complete outrage and I wonder if you have any liability if you know he does this but don't step in and report him.
  6. by   TrudyRN
    Quote from onehusbandsevenkids
    one more and then I'll leave it alone because the entire issue raises by BP.

    "I think this child has an infected penis after neonatal circumcision;" Fournier's gangrene.

    6 day old baby with infection from circ and the horrifying consequences

    very graphic.

    This is horrible! I hope the parents got an excellent lawyer. And I hope they became very verbal proponents of not circumcising. I regret so much having our kids circ'd. We did it for religious reasons but I think it is barbaric, religion or not.

    God put the foreskin there and it should be left. Why, I wonder, did He tell Abraham to remove part of it? Or did he say to remove it or just cut it? Or what???
  7. by   onehusbandsevenkids
    Quote from phriedomRN
    Most younger docs will attempt to place a local block. A lot of older ones still don't because "it's quick and he won't remember it anyway" I've heard docs tell parents they always use anesthetics to get the consent signed and watched them go right into the circ room and start chopping away without so much as EMLA, much less the lidocaine nerve block they said would be used. I wrote up incident reports each time, but I doubt anything's changed.
    Exactly. My best friend said this happens with several of the docs in her facility. She's intervened several times and stood there insisting that something be used appropriately. The parents are assured by the doc that lidocaine will be used and it is not used.
    Another doesnt say anything about pain relief, my friend says the parents assume that something will be used and that they have to specifically request pain relief or the doc will not use it.
    Crazy.
  8. by   Indy
    I'm not going any further with the circ debate ... there's enough information out there for anyone to see.

    But, circs aside, attitudes will or won't change the fate of people in africa where HIV is concerned. Attitudes like those of the libyan public that, it seems, are really going to execute those nurses for simply trying to help their people. Attitudes like their famous double standard of expecting faithful wives, yet the men get their pleasure whenever they want, however they want. Attitudes like those of the south african men who like "dry sex" so the women stuff all manner of drying agents up their genitals, in order to make an extra buck... of course predisposing them to vaginal tearing and hastening the inevitable process of picking up a disease.

    And then there's my attitude problem. I am having a problem caring about the whole mess, which is sad, because there was a time when I was all about getting some nursing experience and going to do missions. Why bother? People want to avoid changing sexual practices, ooh it's taboo let's not talk about it, we need someone else to blame for the fact that we gave our wives and children HIV. So who do they pick? The nurses, who else?

    They can circ or not circ, IMHO it wouldn't matter if they had working parts or not, they'd still manage to be sick and treat the mission workers like dogsh*t.
  9. by   Mexarican
    Quote from ZASHAGALKA
    A perfectly catched argument by those that oppose circumcision for asthetic/hygienic reasons. I could debate some of the points, but, since it is obviously, by your choice of words, a very personal matter to you, there is no point.

    It is also not at issue here.

    Circumcision to protect against life depriving and society wrecking disease processes is NOT about asthetics. This is not about a newfound Western athetics debate, but about saving lives in areas of the world that don't have the luxuries at their disposals that would lead to cultures that can afford to spend their time arguing asthetics. The SAME luxuries that allow us to spend our time arguing these asthetics also afford us the medications and treatments to NOT have to consider the costs of such positions, if our morality is enforced on other parts of the world.

    For the record: I'm HIGHLY educated and all 3 of my boys are circ'd, but again, that's not the point; saving lives is the point. Just because someone disagrees with you does not mean that they are ignorant and just need more education. That rationale only supports positions where there is a need, within the argument, to deny a valid, if opposite, point of view. In this case, the need comes directly from the position being a minority position. Ultimately, it becomes a circular argument: I'm right because those that disagree with me are wrong.

    ~faith,
    Timothy.


    Although in this case it may not be for asthetics but is it ethical? If we allow genital mutilation just to curb disease at what point do we stop. Why not advocate performing mastectomies to curtail breast cancer? Today breast implants are so common could we not remedy the mastectomies with breast implants? Does that sound barbaric? Just think about the dangers of reasoning of advocating for circumcision. Any man who has been circumcised does not know what he is missing therefore cannot formulate an intelligent argument as to the importance of the foreskin. That is similiar to a man advocating for broad mastectomies as a primary form of treatment for breast cancer. Those men who have NOT been ciurcumcised know all too well why the foreskin is there. There is, and i repeat, there is no medical reason for circumcision. if you choose it for religious reasons then it is a personal matter and that jumps off this argument on to another and therefore i will not address that. But if you choose it for asthetics then it still is your personal decision, although a pretty shallow one at that. When organizations or studies start advocating gential mutilation in order to curtail a disease, it is unethical. REGARDLESS of what disease we are talking about! HIV and all STDs for that matter are spread because of behaviors regardless of ignorance, lack of knowledge or simple irresponsibility. Behavior is what passes HIV not uncircumcised penuses, sexual preference or any other biological reason.
    Last edit by Mexarican on Dec 21, '06
  10. by   nickola
    Quote from zenman
    Finally..."proof" that God made a mistake!
    it's not that God made a mistake, it's that HUMANS do, and the bouncing baby boy of today may be tomorrow's promiscuous college student!
  11. by   RN mom of 2
    I just want to thank everyone for their input into this discussion. I have found it very interesting and thought provoking.

    During my own research to decide whether or not to circ my son, I spent a lot of time in discussions just like this one. Often I didn't get involved, but just read what both sides of the debate had to say, and sometimes I asked questions. These type of discussions helped me a lot in making my final decision not to circ. I found the cons to be greater than the pros, and I came to the realization that newborn circumcision is a human rights violation.

    You never know who's lurking, and some people may decide to do further research based on what they read here.
  12. by   onehusbandsevenkids
    Quote from RN mom of 2
    and I came to the realization that newborn circumcision is a human rights violation.
    Yes, that really is the bottom line, isn't it?
  13. by   jjjoy
    Before I jump on the "let's mutilate baby boys for the sake of infections they may or may not ever be exposed to" bandwagon, I'd have to see more research.
    intact... Just a few points to ponder before jumping into the 'boys should all be cut' or 'boys should all be left as god made them' debate
    I don't think anyone here has argued that circumcision should definitely be promoted as a means of decreasing HIV infection or that all boys should be circ'd in all cases. As stated, there are many factors to consider in addition to critically assessing the research that started this discussion. IF circ'ing DOES in fact decrease HIV transmission then I think it's something to CONSIDER. Clearly, there are some who wouldn't support elective circumcision in ANY situation.

    So, let's get on with the issue at hand...

    * Babies do not have sex. Any benefit of infant circumcision in preventing the spread of HIV/AIDS will not take effect until they reach puberty.
    * Circumcision is not cost-free or risk-free. Even if the studies are correct, is 56 circumcisions to prevent one man getting infected with HIV the most effective way of spending the money, time and expertise?
    * Circumcising men disempowers women Important co-factors of HIV/AIDS are of course condomless sex and "dry sex". Circumcising men makes it harder for women to refuse these, and no less risky to accept them..
    1) Very true. IF circ'ing could substantially lower HIV transmission rates, it might be worth the wait; circ'ing as an infant may involve lower risks than as an adult - anyone have info on this? It certainly increases compliance but there are still ethical issues to consider. Grown men electing to be circ'd is less controversial though there are still some ethical issues to consider.

    2) Circ'ing might be cost-effective versus the cost of caring for an infected patient, decreased further transmission, and the cost to society of the death of so many, especially mothers.

    3) I haven't heard that uncirc'd men are more likely to use condoms than circ'd men. I have heard that sensation is decreased in circ'd men which means that a condom would only further decrease sensation but that doesn't mean than uncirc'd men are willing to use condoms more consistently than circ'd men. In regard to dry sex, I don't see how circumcision would make a difference in regard to the woman's empowerment. Maybe you can expand on this argument.

    # The studies were of volunteers.

    Infant circumcision raises ethical issues.

    The studies were cut short. Over a longer period of time, the supposed benefit of circumcision will be reduced. In particular the circumcised group was told to abstain from sex for six weeks, or use condoms. The control group was not.
    1) Kinda hard to have an ethically done research study without volunteers. Research does have limits in being able to answer questions for us.

    2) Infant circ'ing DOES raise ethical issues. Most of the discussion here has been on that.

    3) I'd need more info on the study to judge whether or not that six weeks would likely have made a significant impact in the results of the study. If so, that's important to know.

    You would have to circumcise 56 men to prevent one of them contracting HIV in one year.
    And the number needed to prevent HIV longer term is higher.
    Doctors could spend their time better spent treating people with ulcerative disease and malaria, which make HIV transmission easier
    and using the money saved to promote safer sexual practices.
    Few accepted medicines have such a high NNT.
    On this basis, the NNT in developed countries such as the USA, where the HIV rate is relatively low (0.6% compared to 4.1% in Uganda), would be much higher - it would take 380 circumcisions in the US to prevent one case of HIV.
    The number needed to treat (NNT) is a useful figure in weighing information. For comparison, here is one figuring of the number needed to vaccinate against chickenpox to prevent one complicated case: 550-1180 (Varicella vaccination---a critical review of the evidence S A Skull, E E L Wang).

    If HIV transmission could be equally decreased over time through treating other illnesses that contribute to vulnerability, then that's also something to consider. I think the issue is that circ'ing is a one off expense versus other on-going health interventions. Certainly the ideal solution is great on-going health care and health promotion for all, and if that were an option, it would win hands down.
    Last edit by jjjoy on Dec 21, '06

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