The Circumcision Discussion - page 9

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   sbic56
    Not that I think it's a good enough reason to circumcize, but men who aren't do tend to get yeast infections alot easier. Also, I would think removing the vulva would increase the chance of UTI, since the urethra is short and the vulva may protect it from micro organisms. Feminine hygeine products are bunk in my book anyway.
  2. by   Anagray
    according to AMA article, it takes 100 to 200 infant circs to prevent 1 UTI.
    The risk of "complications" from having a foreskin is low, so is the risk from the surgery. This is what a study published on AMA website says about complications from the surgery:
    <<Complications of Circumcision

    Two large series detected a complication rate between 0.2% and 0.6% in circumcised infants.28,29 Bleeding and infection, occasionally leading to sepsis, are the most common adverse events requiring treatment. In the majority of cases, bleeding is minor and hemostasis can be achieved by pressure application. Other untoward events can result from taking too much skin from the penile shaft causing denudation or rarely, concealed penis, or from not removing sufficient foreskin, producing an unsatisfactory cosmetic result or recurrent phimosis.30,31 Other postoperative complications include formation of skin bridges between the penile shaft and glans, meatitis and meatal stenosis, chordee, inclusion cysts in the circumcision line, lymphedema, hypospadias and epispadias, and urinary retention.32 Case reports have associated circumcision with other rare but severe events including scalded skin syndrome, necrotizing fasciitis, sepsis and meningitis, urethrocutaneous fistulas, necrosis (secondary to cauterization), and partial amputation of the glans penis. >>

    An occasional UTI or a yeast infection ( which healthy men do not usually get) is treatable, but how do u "treat" a disfiguring surgery?

    The possible sideffects of the surgery were good enough reason for us to pass.

    I actually worked with a man, whose son almost died from circumcision complications. Needless to say that the rest of his boys were left intact.
  3. by   fergus51
    I don't think a vulvectomy would help either. I think the point is would we encourage surgical procedures on girls if they reduced the number of yeast infections? Probably not, so it isn't a super compelling reason to do it for men. I still think circumcision is a personal choice dictated by emotions or customs. The scientific argument isn't really relevant.
  4. by   sbic56
    Originally posted by fergus51
    I still think circumcision is a personal choice dictated by emotions or customs. The scientific argument isn't really relevant.
    Agreed.
  5. by   nursee
    You know, I think it's so funny how people view the sexes differently. If you're a woman and you get an infection it's no big deal. You get your antibiotics, cream or whatever you need. If an intact male gets an infection it's "Oh my God! That foreskin has to go!" I know so many women who get UTI's or yeast infections almost every month. I haven't heard any suggestion of getting part of her body cut off. I'm sure if my uncircumcised brother ever had a problem (which he hasn't, I asked before the birth of my boys) the first thing a dr. would recomend is circumcision.
  6. by   AHarri66
    I know an intact male who occasionally gets "yeasties" under the foreskin. He buys some Monistat, applies it for the required time, and *Viola!* Yeasties are gone.

    Same bug, same drug.

  7. by   ZASHAGALKA
    http://today.reuters.com/news/articl...src=rss&rpc=22

    "A U.S. National Institutes of Health study in Kisumu, Kenya, involving 2,784 men aged 18 to 24 showed a 53 percent reduction of HIV infections in circumcised men compared to uncircumcised men. A parallel study involving 4,996 men aged 15 to 49 in Rakai, Uganda, showed circumcised men were 48 percent less likely than uncircumcised men to become infected."


    "Researchers previously had noticed that in places where circumcision is common, HIV was less common."

    This might explain why heterosexual transmission is much less rampant in the United States specifically, and West generally. There is a much higher incidence of circumcision here.

    ~faith,
    Timothy.
    Last edit by ZASHAGALKA on Dec 13, '06
  8. by   TazziRN
    I knew there was a reason I wanted the baby circ'd if it was a boy!
  9. by   zenman
    Finally..."proof" that God made a mistake!
  10. by   ZASHAGALKA
    Quote from zenman
    Finally..."proof" that God made a mistake!
    Sarcasm aside, the issue isn't to revisit 25 yrs of the politics of AIDs in America but how to address its current and future rampant spread in Africa and Asia.

    All I said is that these results clicked with an observation of mine: why is heterosexual HIV rates much more rampant there than here. My previous personal musings on the topic was a supposition of relative lack of nutrition or hygiene.

    If circumcision reduces transmission, it's a far better option then what has been offered Africa and Asia to date. Maybe a reduction in rates could allow for a better targeting of antiretrovirals. As it is, those ARVs in those countries are teaspoons to a lake. A good drought could do lots more to intervene then a rationed number of teaspoons could on their own.

    I wonder how this concept works w/ other viruses. I wonder if there is any relationship between circumcision and herpes or hpv.

    ~faith,
    Timothy.
    Last edit by ZASHAGALKA on Dec 13, '06
  11. by   Josh L.Ac.
    Since I haven't looked at the actual study, does anybody know if it is actually the circumcision that cuts the rate of infection, or is it some other cultural factor of which circumcision is an aspect of? Or is it a bit of both?
  12. by   ayndim
    Population in
    Circumcision AIDS prevalence thousands
    Country rate(%) per 100,000 (1990)

    --------------------------------------------------------------------------------

    Japan 1 0.2 123,638
    Finland 1 0.9 4,984
    Norway 1 1.5 4,247
    Sweden 1 2.0 8,527
    Germany 1 2.2 63,237
    France 1 3.5 56,367
    Mexico 1 4.2 88,598
    Denmark 1.6 4.4 5,135
    Italy 1 8.9 57,664
    Spain 1 14.2 39,405
    UK 7 2.4 57,410
    Canada 30 3.8 26,560
    New Zealand 40 1.2 3,296
    Australia 40 4.5 17,083
    USA 85 16.0 251,398
    Israel 95 0.5 4,586

    Sorry about the chart but it is in the doc. 1st no,. is circ rate, 2 hiv rate/100,000
    American men are reluctant to use condoms. Studies indicate a considerably higher acceptance and usage rate for condoms in Europe and Japan, where circumcision is almost never practised. Some have suggested that American men are resisting a layer of latex that would further decrease sensation from a glans already desensitized from the keritinization following circumcision. Moreover, condoms are more likely to fall off the circumcised penis78. This low acceptance of condoms may be responsible for the high rate of STD and teenage pregnancy rates in the United States--the only industrialized country that has failed to control bacterial STDs during the AIDS era79.



    Hmmm! That would explain the above results. Behavior, not circumcision, is the major player in your HIV risk. And weren't the first round of African studies already proven to be flawed? Why not study it here or in Europe?

    Circumcised men are at greater risk of HIV infection
    Last edit by ayndim on Dec 13, '06 : Reason: chart
  13. by   ZASHAGALKA
    Quote from ayndim
    Sorry about the chart but it is in the doc. 1st no,. is circ rate, 2 hiv rate/100,000
    American men are reluctant to use condoms. Studies indicate a considerably higher acceptance and usage rate for condoms in Europe and Japan, where circumcision is almost never practised. Some have suggested that American men are resisting a layer of latex that would further decrease sensation from a glans already desensitized from the keritinization following circumcision. Moreover, condoms are more likely to fall off the circumcised penis78. This low acceptance of condoms may be responsible for the high rate of STD and teenage pregnancy rates in the United States--the only industrialized country that has failed to control bacterial STDs during the AIDS era79.

    Hmmm! That would explain the above results. Behavior, not circumcision, is the major player in your HIV risk. And weren't the first round of African studies already proven to be flawed? Why not study it here or in Europe?
    The above is not only a 7 yr old article, it is one from an anti-circumcision site. It's expressed purpose seems to be to rebut evidence, even then, that circumcision was noted to decrease HIV transmission.

    At first glance, the article (it can't really be called a study) mentions its specific biases against circumcision. It tries to overfit direct and simplistic correlations into its analysis: for example, that the U.S. has higher HIV rates than Europe because circumcision leads to less sensation and so, less use of condoms. But, that simplistic correlation ignores that fact that Israel, with even HIGHER circumcision rates, have far less percentages of HIV rates - so, the direct comparison the article tries to force with the U.S. doesn't hold. Obviously, there are other cultural issues at play in the use of condoms. For example, one could be religious: the Catholic church has a principled stance against the use of condoms and Israel doesn't have nearly as large Catholic populations.

    The article specifically leaves out areas where HIV is rampant. While it might be nice to compare Western nations and HIV rates, that says NOTHING about HIV rates and Africa and Asia. Indeed, the argument the poster makes is why not study it in the West? Increased access to condoms, privacy concerns, and aggressive treatment regimens make it more difficult to study in the West. In any case, the BEST place to study any epidemic is in epidemic areas.

    Finally, I'll take an unbiased, contemporary, controlled study over a 7 yr old analysis by a vested party, any day.

    From the FAQ on the site quoted above's main webpage: "Although there is an apparent geographical correlation between male non-circumcision and HIV infection on the African continent, this is not true globally, and the pattern seen in Africa could easily be due to other factors."

    Fine, I'll accept the above reasoning. I'm not on a campaign to increase the number of circumcisions performed in the U.S. IF the above statement from CIRP is correct then, lacking evidence of the 'other factors' that reduce HIV transmission, circumcision in those nations seems like a prudent method to facilitate those 'other factors'.

    This finding is not at issues or odds with the 'circ or not circ' debate in the States. Whatever the reasons for not circ'ing a child, those reasons do not compare with saving the lives of children (and adults) in nations where HIV remains epidemic and where the resources (ARVs) to treat it simply aren't available.

    ~faith,
    Timothy.
    Last edit by ZASHAGALKA on Dec 14, '06

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