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]

One of the reasons that the term was changed from "circumcision" to "mutilation" (for some, but not all cases, as you stated in the different types, there are different ways to perform them), sometimes the labia is actually scraped and sewn together...so this too must be cut open each time the woman gives birth and then sewn BACK together again...and this process is repeated over and over again with each birth.

Yes.....it is done that way. We've dealt with this multiple times at work.

However, AWHONN's preferred term is Female Genital Cutting, because after multiple studies on the subject, it was found that many women who've undergone the procedure don't consider themselves to have been mutilated. Regardless of how it is viewed by others.

We are actually being taught in school that there is scientific evidence (we even had test questions on it) that uncircumcised males are at a higher risk for HIV and other sexually transmitted diseases because the foreskin can serve as a warm harbor and create the "nest" effect for the virus or bacteria.

http://www.medpagetoday.com/HIVAIDS/HIVAIDS/5121

These studies have been done mostly in Africa...and may change the way the medical profession looks at it in the future.

The studies that supposedly showed the HIV-circumcision link were flawed. 1) During the course of the study, the circumcised group was advised to abstain from sex for six weeks of healing. The intact group didn't have that. Of course, if you're going six weeks, or even half that, with fewer sexual partners, you're going to transmit/receive less HIV. 2) I'm not really sure that implementing surgical procedures widespread on newborns in Africa is the way to reduce HIV. We're talking about governments that cannot even assure their population a clean water supply - and now we want them to perform sterile surgical procedures on newborns on a massive scale? 3) Male circumcision is performed under the same level of anesthesia and sterility as FGC in countries where FGC is practiced. 4) If there is a link between circumcision and HIV, then let men/older boys get circumcised when they decide to become sexually active. I have no problem with adult men deciding to have this done for themselves. 5) Considering the US has the highest circ rate in the industrialized world along with a higher STD transmission rate than Europe (very few circs), we might want to consider other avenues to prevent STD transmission....like monogamy, abstinence, and safer sex.

It bears repeating....everybody in this thread needs to read Warrior Marks by Alice Walker.

[BabyLady, BSN, RN]

Yes.....it is done that way. We've dealt with this multiple times at work.

However, AWHONN's preferred term is Female Genital Cutting, because after multiple studies on the subject, it was found that many women who've undergone the procedure don't consider themselves to have been mutilated. Regardless of how it is viewed by others.

The studies that supposedly showed the HIV-circumcision link were flawed. 1) During the course of the study, the circumcised group was advised to abstain from sex for six weeks of healing. The intact group didn't have that. Of course, if you're going six weeks, or even half that, with fewer sexual partners, you're going to transmit/receive less HIV. 2) I'm not really sure that implementing surgical procedures widespread on newborns in Africa is the way to reduce HIV. We're talking about governments that cannot even assure their population a clean water supply - and now we want them to perform sterile surgical procedures on newborns on a massive scale? 3) Male circumcision is performed under the same level of anesthesia and sterility as FGC in countries where FGC is practiced. 4) If there is a link between circumcision and HIV, then let men/older boys get circumcised when they decide to become sexually active. I have no problem with adult men deciding to have this done for themselves. 5) Considering the US has the highest circ rate in the industrialized world along with a higher STD transmission rate than Europe (very few circs), we might want to consider other avenues to prevent STD transmission....like monogamy, abstinence, and safer sex.

It bears repeating....everybody in this thread needs to read Warrior Marks by Alice Walker.

I'm sure you've probably read along your studies that the practice of circumcising infants shortly after birth (less than 8 days) had to do with a former medical belief (that we all know now in modern medicine...was sooooo not correct), was that the infant could not feel pain in the first few days of life. Seriously...what did they expect the little guy to do...sit up on the board and say, "Dude...you know...that kind of hurts when you are messing with my boy down there."

I am SO with you on the fact that in some areas, cultures shouldn't be circumcising anyone (male or female), even for religious reasons, unless pain control is used or the procedure can be performed clean.

I think we can agree that Africa...is a whole other thread.

The circumcision debate will probably continue as long as I am breathing on this earth, but each of us have our own reason for doing so. Religion, cost, nor "looking like Dad" were factors in my decision to circ my son. It did have to do with how I interpreted research (and for every pro-circ article, you can always find an anti-circ article) was that I came to the personal decision that it was better for my son's health..again, based on my personal belief.

I insisted on pain control, I insisted on a plastibell and I was meticulous about the wound being covered with protective gel until it could heal so he wouldn't scream every time he urinated or had a bowel movement. I was informed that he didn't even cry when put on the board and rested comfortably through the procedure.

However, had a I run into a Pediatrician that didn't think pain control was important...no way would I have put my son through that...I would have got someone else or it just wouldn't have been done.

[lamazeteacher]

Quote from Baby Lady's post : "I am SO with you on the fact that in some areas, cultures shouldn't be circumcising anyone (male or female), even for religious reasons, unless pain control is used or the procedure can be performed clean."

Jews have anaesthetized male infants for circumcision with wine (not to unconsciousness), throughout their history. Also the ritual "briss" (a party during which a circumcision is done with granbdad holding the infant, by a well trained holy person, on the 8th day of life, as long as the baby is well, then) is a happy occasion. I've been to many of them, and always admired the modern, aseptic techniques. I also appreciated the feelings in the room of love for the baby, which I think are responsible for his having less crying during the procedure (than those in the hospital), and quick return to calm. Meanwhile attendees munch on honey cake and other sweets prepared by family and friends. Not even the most attention seeking, obnoxious attendee would suggest that he/she is in disagreement with circumcision.

I agree that pain relief is important, and recommend the application of EMLA patches on top of the vaseline dressing, to forestall what must be a burning type of pain when the baby urinates. Frequent breast feeding or giving water between bottle feedings will dilute the urine, making it less concentrated and therefore causing less pain.

Believe me, you'll never convince practising Jews that circumcision should be avoided! It is a part of the "Covenant with God". There have been no reports of life threatening infections due to circumcision, (when done as described above)and the Bible (Old Testament) has no reference to illness following a "briss".

Just as any procedure done to a child must be approved by his parents, that is so for circumcision. When parents disagree, it might be best if counselling occur (my vote would be by a marriage and family one) to allow them to examine facts and feelings and come to an agreement each can live with.

[lamazeteacher]

You are entitled to your opinion, and those who wish to have their sons circumcised have to be respected, too.

[BabyLady, BSN, RN]

Quote from Baby Lady's post : "I am SO with you on the fact that in some areas, cultures shouldn't be circumcising anyone (male or female), even for religious reasons, unless pain control is used or the procedure can be performed clean."

Jews have anaesthetized male infants for circumcision with wine (not to unconsciousness), throughout their history. Also the ritual "briss" (a party during which a circumcision is done with granbdad holding the infant, by a well trained holy person, on the 8th day of life, as long as the baby is well, then) is a happy occasion. I've been to many of them, and always admired the modern, aseptic techniques. I also appreciated the feelings in the room of love for the baby, which I think are responsible for his having less crying during the procedure (than those in the hospital), and quick return to calm. Meanwhile attendees munch on honey cake and other sweets prepared by family and friends. Not even the most attention seeking, obnoxious attendee would suggest that he/she is in disagreement with circumcision.

I agree that pain relief is important, and recommend the application of EMLA patches on top of the vaseline dressing, to forestall what must be a burning type of pain when the baby urinates. Frequent breast feeding or giving water between bottle feedings will dilute the urine, making it less concentrated and therefore causing less pain.

Believe me, you'll never convince practising Jews that circumcision should be avoided! It is a part of the "Covenant with God". There have been no reports of life threatening infections due to circumcision, (when done as described above)and the Bible (Old Testament) has no reference to illness following a "briss".

Just as any procedure done to a child must be approved by his parents, that is so for circumcision. When parents disagree, it might be best if counselling occur (my vote would be by a marriage and family one) to allow them to examine facts and feelings and come to an agreement each can live with.

Uh...I never stated in any of my posts that I disagreed with the practice of Jewish circumcisions, however, it doesn't matter how many thousands of years the procedure has been performed..pain is pain.

My statement was in response to (if you read the post that I responded to) was a response to areas where crude and unsanitary instruments are used to perform a circumcision.

However, on a side note, If you are stating that there has never, in the history of medicine, an infant that did not get an infection from a Jewish briss, then I would say that would not be a medical fact and I wouldn't use the Bible as medical evidence that it's impossible or even improbable, no matter what religion you are.

"Less crying" isn't better than "no crying"...I have had the opportunity to witness, many, many circumcisions where the infant not only didn't cry, but didn't even flinch....have you ever been to a Jewish briss and saw that?

Here is an article on pain in newborns, pain assessment in newborns, and the old beliefs that used to be "medical fact" that we now know are no longer true.

http://www.vachss.com/guest_dispatches/neonatal_pain.html

Even the "female genital mutilations" in Africa are seen as a happy occasion because they are considered a rite-of-passage into womanhood...but the fact that they hold these girls down and cut them with crude objects in the name of "tradition" make it right to continue to do it in this manner?

I'll agree, I'll never convince a practicing Jew not to circumcise their infant. However, even Jewish folks are still parents, and the job of a parent is to protect your child, first and foremost...dismissing pain control (FULL pain control..not half-way, not part-of-the-way, FULL pain control) is what is barbaric about the practice...not the circumcision itself.

Just because the little guy can't speak for himself, doesn't invalidate what he feels.

[BabyLady, BSN, RN]

You are entitled to your opinion, and those who wish to have their sons circumcised have to be respected, too.

My son is circumcised, again, if you read my post.

He also had full pain control when it was performed.

[firstyearstudent]

To me, the issue of whether pain control is used when people are making permanent, unnecessary alterations to another persons genitals is only a small part of the equation. I don't get people who think circ with anesthetic is a-okay but think circ without is an evil. The baby will get over the pain and probably even any trauma caused by the experience. The circumcision, however, is permanent. If I had to make a theoretical choice to have my son undergo the pain of a unanesthtetized circumcision and get to magically keep his foreskin, or have his foreskin magically disappear without any pain or even his knowledge, I'd pick the former! No question. Pain isn't that big of deal to me. In the right circumstances, it can even be growth promoting. (Violence, on the other hand, is a whole 'nother story.)

I guess when it comes down to it, we can only use the golden rule when making these kind of decisions and, if I was a man, I don't think I would have wanted my parents to circumcise me. I'd rather make up my own mind about it based on facts and my own preferences, not theirs. Circ can be performed at any time in a person's life. There's no reason it has to be done when the person is an an infant. I don't think it's more traumatic for a consenting adult. (If it is, I think we ought to be questioning why we perform a procedure an adult would find unthinkable on a child.) Perhaps circ on an infant would be less sexual damaging than circ on an adult since sexual response could be rewired better, so maybe circing an an infant over an adult would be preferable if it was necessary or highly benefital. It may be more traumatic for an young boy, but the odds that you will need to get a little boy circumcised, say for a medical reason, are too rare to perform this procedure prophylactically in infancy.

I guess why most people have it done is because they believe that the foreskin is unimportant and unnecessary (based on the fact that a circumicized member functions and that circumcized men seem to enjoy sex as much as uncircumcized men, I suppose) and that removing it can be painless and provide a small medical benefit or a cultural benefit, so why not do it on a baby who will never know the difference and it will only take a few minutes, especially if insurance is paying for it. But, personally, I cannot get see how a piece of tissue which is that sensitive cannot be a significant benefit in sexual functioning. Maybe I'm wrong. Maybe it isn't. But I just don't know, so I didn't want to remove healthy, sensitive tissue from my sons' memberes that may be as much or more of a benefit to them than a risk (in a first world country, at least).

Many people think circumcising older boys as part of a "rite of passage" into manhood is more cruel, but that actually seems less cruel to me. At least it is something the boy is participating in (even if not necessarily consenting to) and has some cultural meaning for him at the time (as opposed to a day's old infant who is completely passive).

One poster suggested that female circumcision on women is different from male circumcision because female circumcision was originally performed with the intention of curbing female sexuality. But I have heard that this is one likely reason that male circumcision was originally performed.

[Spidey's mom, ADN, BSN, RN]

to me, the issue of whether pain control is used when people are making permanent, unnecessary alterations to another persons genitals is only a small part of the equation. i don't get people who think circ with anesthetic is a-okay but think circ without is an evil. the baby will get over the pain and probably even any trauma caused by the experience. the circumcision, however, is permanent. if i had to make a theoretical choice to have my son undergo the pain of a unanesthtetized circumcision and get to magically keep his foreskin, or have his foreskin magically disappear without any pain or even his knowledge, i'd pick the former! no question. pain isn't that big of deal to me. in the right circumstances, it can even be growth promoting. (violence, on the other hand, is a whole 'nother story.)

.

i'm not quite sure what you mean by the blue above.

no anesthesia circ and somehow magically keeps the foreskin . . ?

anyway - i used many examples with my first husband regarding pain because he had the same reaction . . "the baby won't remember the pain".

i said "well, then we can burn him with cigarettes because he won't remember it" or "it is ok if we break his arm because he won't remember it", etc.

just because someone won't remember the pain, doesn't make it ok to inflict pain.

the one doc we have who won't use anesthetic tells a story of a baby who lost his member due to an injection of lidocaine . . so this doc makes a decision based on an extremely rare occurrence.

and i still would refuse to help this guy.

i don't think circs are necessary but i won't chastise those parents who chose to have it done, with proper pain control.

(i also don't like piercing babies ears . . . . what is the point of that?? plus, you cheat little girls of the fun of having their ears pierced as a young teen . . i loved that time - it was a rite of passage into adulthood. )

steph

[firstyearstudent]

I don't know, maybe I'm just not being clear. I guess what I am trying to convey is that I think losing your foreskin is worse for a person than having circumcision pain. Pain is temporary, the foreskin is gone forever.

[BabyLady, BSN, RN]

I don't know, maybe I'm just not being clear. I guess what I am trying to convey is that I think losing your foreskin is worse for a person than having circumcision pain. Pain is temporary, the foreskin is gone forever.

I'm a female...so obviously I can't speak for how men feel about their "boy".

I have just never heard of or read an article where a man wished he had never been circumcised (assuming there was no damage or done when he was older, etc).

The few guys that I have known that have mentioned it, ranked it with the importance of "I have brown hair, blue eyes, and I'm circ'd."

I'm not saying that is the case for every guy...not at all.

[Elvish, BSN, DNP, RN, NP]

I don't go around asking random strangers about it, but I have met several men who wished they had been allowed to make the choice for themselves rather than have the choice taken from them as newborns. (I work in OB, so this kind of stuff often comes up in conversation....and I work with a male secretary who is quite vocal about this.)

I think it comes down (in many cases, at least) to what someone is used to. If you've never had a foreskin that you remember, you might not know nor care about what you're missing....and if you've got one, you might or might not feel strongly about it being removed.

[GooeyRN, ADN, BSN, CNA, LPN, RN]

There are a lot of men who wish they were never circ'd. They go through great measures to attempt to restore their foreskin.