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 :)

[consult2]

"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 )

[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/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

[CEG]

"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/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

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.

[brillohead, ADN, RN]

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??????

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

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!)

[consult2]

"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.

[CEG]

"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.

Ahh, then thanks for the backup!

[consult2]

welcome

[UTVOL3]

Hey...we're not loggers and we (well, they) still pee outside. Especially the little one. The 36yo, not so much.

Even now they have contests to see who can get to the bathroom the fastest and who can be done peeing first. But I digress.....

I'm glad we are having this discussion, especially with some new members aboard = new perspectives...though it can be passionate at times. I'm getting ready to do a project about it at work. I hypothesize that we're losing money since Medicaid & some insurances don't pay for it in our state, and I wonder just how many people are actually paying for it after the fact. I think it will be interesting to see.

How did you get him to quit? (Peeing outside...)

I find your project idea really intriguing. This is something that has crossed my mind as well. Many anti-circ proponents make the claim "foreskins are big business" but come on. Seriously. It is not enough to keep even the old guard at my hospital doing them. They figure it is a waste of time and refer to the pediatrician. So it can't be that much that they get reimbursed. Does anyone know?

As some of you know I am on a somewhat "extended" maternity leave. Being home with my babies all day has given me loads of time to speculate on issues like this. You know, spend any time at all on a parenting board and the topic comes up.

Anyway, I am interested in knowing if the procedure is really still going on in hospitals (newborn nursery/NICU) without some type of anesthetic. (not counting sucrose on the paci.) I am really only interested in hearing 1st person accounts within say, the last 2 ys. Please no "well my 7 y/o..." or "my sister's cousin's friend is a nurse in the ER and she said..."

That kind of thing is what I am trying to address. You can PM me if you'd rather.

[consult2]

Well, with ~1,000,000 circumcisions a year at a average cost of $400 (excluding hospital costs and followup for botched procedures, we have 1/2 BILLION dollars.

This does not include the follow-up profits from the foreskin harvesting--biologicals, cosmetics, drug and cosmetic testing estimated at another 2 billion..there's big bucks in harvesting infant body parts.

Here are the latest stats I have on rates of pain relief used:

A recent retrospective study was performed at a top hospital in Chicago.

Publlshed October 11, 2004, by Peggy Peck, this study is titled "Analgesia Underused for Management of Circumcision Pain".

In this study, a researcher went back through 5 years (1999-2004) of hospital records and checked whether anesthetic use had been recorded.

Out of 108 circumcisions, only 8 were marked for anesthetic.

The researcher couldn't believe it, so they checked the pharmacy charts to see whether anesthetic had been ordered.

They found that anesthetic had been ordered from the pharmacy, for only 35%-40% of circumcisions.

An excerpt from the study:

Of 191 male infants identified in the review of 400 charts, "56% underwent circumcision," .....

.....

All circumcisions were performed by obstetricians. "Dorsal penile block was used in seven infants and subcutaneous ring block was used in one infant,"...

....Another telling finding, he said, was that the medical charts indicated no discussion of circumcision pain management with parents.

If you want to view it instead of just taking my word for it, first you must register here:

https://profreg.medscape.com/px/registration.do?cid=med

Then click this link:

http://www.medscape.com/viewarticle/491035

[UTVOL3]

Is the whole study there? I am wondering if they have an option to email the author.

Just wondering if they entertained the idea that the lidocaine might have been unit stock. If the documentation was poor enough that could very well make it look as if they hadn't sdone a block.

Thanks for the link!

NM. Just looked at it. Perhaps with some digging I could find the original article. I agree the results from one hospital could be misleading.

Oh, and I am in the process of trying to find this out too but I am just wondering exactly what the physician's charge of the 400$ you mentioned would be.

[firstyearstudent]

From the admitted limited experience I have with this (clinicals, two sons) the doctors I have dealt with advised AGAINST pain management for circumcision because it "can lead to complications."

Think about it, you have a patient who is strapped down and who can only complain by crying (isn't going to jump up and slap you) and isn't going to sue you. Also, the parents are totally uneducated about this and seldom are there to see what goes on.

Why would the doctor recommend pain medications? It's a (small) risk that there will be a side effect and it's just going to take more time to complete the procedure. It's not in their interest. Only doctors who are educated about the pain of circumcision and who really care about the infant's pain are going to recommend it.

And Mohels almost never use anesthesia. When we were considering a religious circumcision for our son, we had to look for a pediatrician who was also a Mohel and would come to our home and do the circ with pain meds. When the MD/Mohel found out the baby was older than two weeks she then declined, which I ended up being grateful for and my son is still intact at 8 years and husband (who is Jewish) no longer even cares if he is circumcised. We didn't even consider it with our second son.