CDC rec to counsel all males about benefits of circumcision

lifelearningrn, BSN, RN · Dec 7, 2014

To me there is an incredibly huge difference between chopping off something that cannot be replaced and a cosmetic piercing that can heal. If a girl grows up and chooses not to wear earrings, she does not have to, and more often than not the holes do heal up. If a boy grows up and decides he'd like to have his foreskin, it's not possible. You are free to disagree with me, but this is my view on it.

I've known people to have trouble getting an earring through when they haven't worn any for a while, but never have the holes disappeared completely. It's purely cosmetic. There will be visible holes in your earlobes. If some completely heal, no hole and no scar, it's RARE. Personally, I think earrings look ridiculous on an infant, but to each his own, lots of cultures do it and it's their choice.

klone, MSN, RN · Dec 7, 2014

Are those against circumcision for infant boys also against ear piercing for infant girls? I'm just curious.

Late to the party on this one, but yes, I am. Be that as it may, I don't find it quite as horrible because I've never heard of cases of infants dying as a result of complications from ear piercing. But yes, I am against any permanent body modification done for cosmetic purposes to an infant/child who cannot consent.

klone, MSN, RN · Dec 7, 2014

Women elect to have mastectomies prior to diagnosis of cancer all the time based on genetic workups and family history. .

And therein lies the rub. WOMEN make the decision. For THEMSELVES. Their parents do not make that decision for them when they're 1 day old.

lifelearningrn, BSN, RN · Dec 7, 2014

Does anyone really think most parents circ'd their boys due to fear of penile cancer or infections?
At least acknowledge that nearly everyone you know is influenced and makes the decision based on aesthetics and/or religion, but heavily weighted on aesthetics. And then maybe refers to a scientific article in defense, if they even care.

The moment I found out I was having my oldest son I began researching this topic. I spent months on the fence, reading both sides, asking other parents their opinions and weighing the risks and benefits. My husband (who is circ'ed) said he didn't care either way so the decision really was all mine. I considered everything from 'looking like dad' to the locker room, to him being one of those men who will have PTSD and hate me because I cut off his foreskin. In the end I decided to go with my gut, which was in line with the recommendations of the pediatrician I had carefully chosen to be his provider, and have him circumcised. The health benefits were the bottom line in my decision. My second son got circumcised for the same reason, only with him, I didn't spend months torturing myself making the choice.

klone, MSN, RN · Dec 7, 2014

Female circumcision will prevent clitoral hood cancer.

(this is in response to WBTCRNA's statement that there is no medical or health benefit to female circumcision)

allnurses Guide · Dec 7, 2014

And therein lies the rub. WOMEN make the decision. For THEMSELVES. Their parents do not make that decision for them when they're 1 day old.

So again back to the whole crux of the thread, are you saying you are against the CDC providing unbiased information to HCPs on the risk and benefits of male circumcision.

The consent argument invalidates the greatest benefit to public/medical health from circumcision, which is prior to the infant/child becoming an adult/having sexual intercourse (25% of teenagers will have had sex by the time they are 15). It also makes it very difficult for the subset of young adult men who aren't circumcised to become circumcised when they are also the most likely to not have insurance when they are the highest health risk to the public.

The consent argument also discounts the fact that AAP, ACOG, WHO, and CDC consider that male circumcision benefits outweigh the risks.

It should be left up to the parents whether they want their child to be circumcised, and it is the duty of HCPs to provide factual unbiased information to parents on circumcision.

IrishIzCPNP, MSN, RN, APRN, NP · Dec 7, 2014

So the CDC is also just basing their tentative decision on out dated information too.? Is that what you are trying to imply?

I believe they are doing it based on poorly data. The issues they are trying to prevent are minimal issues and some based on studies that aren't relevant to the United States.

I believe there should be education but saying "reduces UTI" isn't enough. They need to ensure they add on the risk of UTI...which happens to be quite low.

allnurses Guide · Dec 7, 2014

Female circumcision will prevent clitoral hood cancer.
(this is in response to WBTCRNA's statement that there is no medical or health benefit to female circumcision)

Provide a research article to substantiate your claim, since it is well documented that female genital mutilation often causes infection along with many other problems.

I provided the WHO page on FGM as the source for this information, which concluded that there was no health benefits for FGM.

klone, MSN, RN · Dec 7, 2014

Actually ACOG does NOT recommend routine circumcision. Their current policy statement specifically states:

ome research suggests that circumcision may decrease the risk of a man getting human immunodeficiency virus (HIV) from an infected female partner. It is possible that circumcision may decrease the risk of passing HIV and other sexually transmitted diseases from an infected man to a female partner. At the present time, there is not enough information to recommend routine newborn circumcision for health reasons.

Provide a research article to substantiate your claim,

You cannot get cancer of a body part that isn't there. Ergo, removal of the clitoral hood prevents clitoral hood cancer later in life. Just like removal of the foreskin prevents foreskin cancer in males. And routine removal of infant girls' breast buds will prevent breast cancer, something that is a MUCH more common and serious health concern.

Libby1987 · Dec 7, 2014

I really didn't mean that no one researched the health aspects, I was more referring to people like your spouse who didn't have an opinion and the common parents who are personally grossed out by foreskin. Growing up and even up to more recently I have known many non healthcare types who still find it gross. Women who would be repulsed, and men fearful of that. They're either not making the decision based on health considerations or they are so relieved to have a dr tell them the positives of circumcision so they can stick with their perspective of aesthetics. We have all known them, haven't we?

allnurses Guide · Dec 7, 2014

I believe they are doing it based on poorly data. The issues they are trying to prevent are minimal issues and some based on studies that aren't relevant to the United States.
I believe there should be education but saying "reduces UTI" isn't enough. They need to ensure they add on the risk of UTI...which happens to be quite low.

Then prove this research/evidence. I provided one systematic review and one meta-analysis to support the view that male circumcision has many public/medical benefits. I also provided the AAP position statement, which has its' own set of references on the benefits of male circumcision. It also important to note the not only the AAP, but ACOG, WHO, and CDC all agree that circumcision has positive medical/public health benefits.

[h=2]"Cost-benefit[/h]A cost-effectiveness study that considered only infant urinary tract infections and sexually transmitted infections (STIs) found that if male circumcision rates were to decrease to the levels of 10% typically seen in Europe, the additional direct medical costs in infancy and later for treatment of these among 10 annual birth cohorts would exceed $4.4 billion, even after accounting for the cost of the procedure (average, $291; range, $146-$437) and treatment of complications (average cost, $185 each [range, $130-$235]; prevalence, 0.4% [range, 0.2%-0.6%]).52 Each forgone infant circumcision procedure was estimated to lead to an average of $407 in increased direct medical expenses per male and $43 per female.52 This analysis did not consider other conditions, and neither did it consider the indirect costs. It seems logical then that this analysis might have greatly underestimated the true cost. The study adds to one by the CDC that found that neonatal male circumcision was cost-saving for HIV prevention, at least in black and Hispanic males, in whom HIV prevalence is highest.42 An Australian analysis of genital cancer prevention found that neonatal circumcision provides at least partial cost savings for these.53

A study of a Medicaid birth cohort of 29,316 found that for every year of decreased circumcision due to Medicaid defunding there would be more than 100 additional HIV cases and $30 million in net medical costs as a result of these.54The cost to circumcise males in this birth cohort was $4,856,000. Modeling has found that cost savings initially generated by noncoverage of elective circumcisions by Medicaid in Louisiana55 and Florida56 was mitigated by increases in the rate and expense of medically indicated circumcisions. The Louisiana study considered only the costs of these for boys aged 0 to 5 years. Lifetime costs would represent a much greater financial impact on health care systems. The Florida study involved males aged 1 to 17 years undergoing circumcision between 2003 and 2008 and found that Medicaid defunding was followed by a 6-fold rise in publicly funded circumcisions (cost = $111.8 million)".56

http://www.mayoclinicproceedings.org/article/S0025-6196(14)00036-6/fulltext

http://well.blogs.nytimes.com/2014/04/07/circumcision-benefits-outweigh-risks-study-reports/?_r=0

Libby1987 · Dec 7, 2014

The moment I found out I was having my oldest son I began researching this topic. I spent months on the fence, reading both sides, asking other parents their opinions and weighing the risks and benefits. My husband (who is circ'ed) said he didn't care either way so the decision really was all mine. I considered everything from 'looking like dad' to the locker room, to him being one of those men who will have PTSD and hate me because I cut off his foreskin. In the end I decided to go with my gut, which was in line with the recommendations of the pediatrician I had carefully chosen to be his provider, and have him circumcised. The health benefits were the bottom line in my decision. My second son got circumcised for the same reason, only with him, I didn't spend months torturing myself making the choice.

I really didn't mean that no one researched the health aspects, I was more referring to people like your spouse who didn't have an opinion and the common parents who are personally grossed out by foreskin. Growing up and even up to more recently I have known many non healthcare types who still find it gross. Women who would be repulsed, and men fearful of that. They're either not making the decision based on health considerations or they are so relieved to have a dr tell them the positives of circumcision so they can stick with their perspective of aesthetics. We have all known them, haven't we?