CDC rec to counsel all males about benefits of circumcision

allnurses Guide · Dec 7, 2014

Yep, pretty much.
I think we can probably let the lifeless equine rest now.

That would be BS, and you have yet to provide one research article to prove there is no medical/public health benefits to male circumcision.

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

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

What do you want me to prove? That the risk of UTI is minimal? That the U.S. isn't Africa?

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

And with that, I'm out. I have a busy day planned of cleaning my young son's foreskin, since it's such an arduous and time consuming task.

I have 3 of them...imagine my day of dread. ;0)

allnurses Guide · Dec 7, 2014

What do you want me to prove? That the risk of UTI is minimal? That the U.S. isn't Africa?

Both are untrue. UTI risk is statistically significant, and several of the studies were not done in Africa, but I guess the billions of dollars that it would cost for a 10% drop in circumcision rates is just insignificant to by your accounts at least.

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

Both are untrue. UTI risk is statistically significant, and several of the studies were not done in Africa, but I guess the billions of dollars that it would cost for a 10% drop in circumcision rates is just insignificant to by your accounts at least.

The studies they primarily use are from Africa. The risk of UTI in males is significantly smaller than the risk for a female. So what are we doing to prevent this horrid condition? People are allowed to get sick and we are allowed to treat issues. The idea that we have to prevent everything known to man is getting out of hand...especially when it comes to removing body parts. I need to have a current medical issue for a hysterectomy and can't have on to prevent cancers. But I can remove the foreskin of an infant to prevent STIs (because we certainly don't want to relay on education) and reduce the risk of UTIs because that's so hard to treat.

I don't believe we have the right to use infant males as a sacrifice to reduce health care costs. We have better places to save money than removing body parts. The foreskin is part of the body. It isn't there by accident. How about we take off some fingernails mainly the nails on the toes because the risk of ingrown toe nails is quite significant? There is nothing that makes removing part of the body of a health newborn reasonable to me.

allnurses Guide · Dec 7, 2014

The studies they primarily use are from Africa. The risk of UTI in males is significantly smaller than the risk for a female. So what are we doing to prevent this horrid condition? People are allowed to get sick and we are allowed to treat issues. The idea that we have to prevent everything known to man is getting out of hand...especially when it comes to removing body parts. I need to have a current medical issue for a hysterectomy and can't have on to prevent cancers. But I can remove the foreskin of an infant to prevent STIs (because we certainly don't want to relay on education) and reduce the risk of UTIs because that's so hard to treat.
I don't believe we have the right to use infant males as a sacrifice to reduce health care costs. We have better places to save money than removing body parts. The foreskin is part of the body. It isn't there by accident. How about we take off some fingernails mainly the nails on the toes because the risk of ingrown toe nails is quite significant? There is nothing that makes removing part of the body of a health newborn reasonable to me.

That is only half-true. The studies on HIV and male circumcision have mainly been done in Africa that isn't true for the rest of the studies on the benefits of male circumcision.

Male circumcision decreases UTI rates in males and female partners of circumcised males. Male circumcision also decreases the rates bacterial vaginosis, trichomoniasis, HPV, and cervical cancer rates in female partners.

Your argument is ignorant at best. The cost benefit analysis disputes every argument that you have come up with. You have not provided any scientific literature to support any argument that you have. All you can state is that you have personal bias against male/infant circumcision that has no basis in public health benefits that male circumcision has.

Parents need to be offered unbiased information on the risks and benefits of male circumcision. Where the parents take it from there should be totally up to them.

Risk-Benefit

The AAP Task Force did not conduct a risk-benefit analysis. Because it considered the literature only to 2010, it did not capture risk-benefit analyses published in 2012.15, 16 Table 4 provides an updated risk-benefit analysis drawing on literature cited in the latter studies and in the AAP report14 and on data in more recent reviews and meta-analyses. This analysis shows that over the lifetime, benefits exceed risks by at least 100 to 1. If one considers the seriousness of some conditions that circumcision protects against, the benefit would actually be much greater. Based on risk-benefit considerations, neonatal circumcision might rationally be considered in the same light as childhood vaccination.

[TABLE=width: 100%]

[TR]

[TH]Condition[/TH]

[TH]Fold increase in risk (95% CI)[/TH]

[TH]Rating of evidenceb[/TH]

[TH]Percentage affected[/TH]

[TH]Reference, year[/TH]

[/TR]

[TR]

[TD=colspan: 5]Risks of not circumcisingc[/TD]

[/TR]

[TR]

[TD] Urinary tract infection: age 0-1 y[/TD]

[TD]9.9 (7.5-13)[/TD]

[TD]1++[/TD]

[TD]1.3d[/TD]

[TD]Morris and Wiswell,17 2013[/TD]

[/TR]

[TR]

[TD] Urinary tract infection: age l-16 y[/TD]

[TD]6.6 (3.3-13)[/TD]

[TD]1++[/TD]

[TD]2.7d[/TD]

[TD]Morris and Wiswell,17 2013[/TD]

[/TR]

[TR]

[TD] Urinary tract infection: age >16 y[/TD]

[TD]3.4 (0.92-50)[/TD]

[TD]1+[/TD]

[TD]28d[/TD]

[TD]Morris and Wiswell,17 2013[/TD]

[/TR]

[TR]

[TD] Urinary tract infection: lifetime[/TD]

[TD]3.6 (1.8-5.7)[/TD]

[TD]1+[/TD]

[TD]32d[/TD]

[TD]Morris and Wiswell,17 2013[/TD]

[/TR]

[TR]

[TD] Pyelonephritis (infants)[/TD]

[TD]10[/TD]

[TD]2+[/TD]

[TD]0.6d[/TD]

[TD]Zorc et al,18 2005; Rushton and Majd,19 1992; Rushton,20 1997; Elder,21 2007[/TD]

[/TR]

[TR]

[TD]With concurrent bacteremia[/TD]

[TD]20[/TD]

[TD]2+[/TD]

[TD]0.1d[/TD]

[TD]Zorc et al,18 2005; Rushton and Majd,19 1992; Rushton,20 1997; Elder,21 2007[/TD]

[/TR]

[TR]

[TD]Hypertension in early adulthood[/TD]

[TD]–[/TD]

[TD]2–[/TD]

[TD]0.1d[/TD]

[TD]Jacobson et al,22 1989[/TD]

[/TR]

[TR]

[TD]End-stage renal disease in early adult[/TD]

[TD]–[/TD]

[TD]2–[/TD]

[TD]0.06d[/TD]

[TD]Jacobson et al,22 1989[/TD]

[/TR]

[TR]

[TD] Candidiasis[/TD]

[TD]2.5 (1.7-3.7)[/TD]

[TD]2+[/TD]

[TD]10d[/TD]

[TD]Richters et al,23 2006[/TD]

[/TR]

[TR]

[TD] Prostate cancer[/TD]

[TD]1.2-2[/TD]

[TD]2+[/TD]

[TD]2-10d[/TD]

[TD]Wright et al,24 2012; Morris et al,252007; Morris et al,26 2011; Morris and Waskett,27 2012[/TD]

[/TR]

[TR]

[TD] Balanitis[/TD]

[TD]3.1 (1.9-5.0)[/TD]

[TD]1+[/TD]

[TD]10d[/TD]

[TD]Morris et al,16 2012[/TD]

[/TR]

[TR]

[TD] Phimosis[/TD]

[TD]100[/TD]

[TD]1++[/TD]

[TD]10d[/TD]

[TD]Morris,28 2007[/TD]

[/TR]

[TR]

[TD] High-risk HPV infection[/TD]

[TD]1.5 (1.1-2.0)[/TD]

[TD]1++[/TD]

[TD]6d[/TD]

[TD]Tobian et al,29 2009; Auvert et al,302009[/TD]

[/TR]

[TR]

[TD] [/TD]

[TD]2.7 (1.2-6.3)[/TD]

[TD]1+[/TD]

[TD]10d[/TD]

[TD]Morris et al,26 2012; Castellsagué et al,31 2002; Miralles-Guri et al,322009; Albero et al,33 2012[/TD]

[/TR]

[TR]

[TD] Herpes simplex virus type 2[/TD]

[TD]1.4 (1.0-2.5)[/TD]

[TD]1++[/TD]

[TD]4d[/TD]

[TD]Tobian et al,29 2009; Sobngwi-Tambekou et al,34 2009; Tobian et al,35 2009[/TD]

[/TR]

[TR]

[TD] [/TD]

[TD]1.1 (1.0-1.3)[/TD]

[TD]1–[/TD]

[TD]1d[/TD]

[TD]Weiss et al,36 2006[/TD]

[/TR]

[TR]

[TD] Genital ulcer disease[/TD]

[TD]2.0 (1.4-2.3)[/TD]

[TD]1+[/TD]

[TD]2d[/TD]

[TD]Gray et al,37 2009[/TD]

[/TR]

[TR]

[TD] Trichomonas lady partslis[/TD]

[TD]1.9 (1.0-3.6)[/TD]

[TD]1+[/TD]

[TD]0.5d[/TD]

[TD]Sobngwi-Tambekou et al,38 2009[/TD]

[/TR]

[TR]

[TD] Mycoplasma genitalium[/TD]

[TD]1.8 (1.0-3.4)[/TD]

[TD]1++[/TD]

[TD]1d[/TD]

[TD]Mehta et al,39 2012[/TD]

[/TR]

[TR]

[TD] Chancroid[/TD]

[TD]0.1-1.1[/TD]

[TD]1++[/TD]

[TD]Lowd[/TD]

[TD]Weiss et al,36 2006[/TD]

[/TR]

[TR]

[TD] Syphilis[/TD]

[TD]1.9 (1.2-2.9)[/TD]

[TD]2+[/TD]

[TD]Lowd[/TD]

[TD]Weiss et al,36 2006[/TD]

[/TR]

[TR]

[TD] HIV (acquired heterosexually)[/TD]

[TD]2.4 (1.8-3.2)[/TD]

[TD]1++[/TD]

[TD]0.3d[/TD]

[TD]Siegfried et al,40 2009; Weiss et al,412008; Sansom et al,42 2010; Morris et al,43 2012[/TD]

[/TR]

[TR]

[TD] Penile cancer (lifetime)[/TD]

[TD]>20[/TD]

[TD]1++[/TD]

[TD]0.1d[/TD]

[TD]American Academy of Pediatrics,142012; Morris et al,26 2011[/TD]

[/TR]

[TR]

[TD] In female partner[/TD]

[TD][/TD]

[/TR]

[TR]

[TD]Cervical cancer[/TD]

[TD]2.4 (1.3-4.3)[/TD]

[TD]2++[/TD]

[TD]NA[/TD]

[TD]Castellsagué et al,31 2002; Bosch et al,44 2009[/TD]

[/TR]

[TR]

[TD]Chlamydia trachomatis[/TD]

[TD]5.6 (1.7-20)[/TD]

[TD]2+[/TD]

[TD]NA[/TD]

[TD]Castellsagué et al,45 2005[/TD]

[/TR]

[TR]

[TD]Herpes simplex virus type 2[/TD]

[TD]2.2 (1.4-3.6)[/TD]

[TD]2+[/TD]

[TD]NA[/TD]

[TD]Cherpes et al,46 2003[/TD]

[/TR]

[TR]

[TD]Trichomonas lady partslis[/TD]

[TD]1.9 (1.0-10)[/TD]

[TD]1++[/TD]

[TD]NA[/TD]

[TD]Gray et al,47 2009[/TD]

[/TR]

[TR]

[TD]Bacterial vaginosis[/TD]

[TD]1.7 (1.1-2.6)[/TD]

[TD]1++[/TD]

[TD]NA[/TD]

[TD]Gray et al,47 2009[/TD]

[/TR]

[TR]

[TD=colspan: 5]Risks associated with neonatal circumcisione[/TD]

[/TR]

[TR]

[TD] Local bruising at the site of injection of local anesthetic (if dorsal penile nerve block used)[/TD]

[TD]NA[/TD]

[TD]25f[/TD]

[TD]NA[/TD]

[/TR]

[TR]

[TD] Infection, local[/TD]

[TD]NA[/TD]

[TD]0.2f[/TD]

[TD]NA[/TD]

[/TR]

[TR]

[TD] Infection, systemic[/TD]

[TD]NA[/TD]

[TD]0.02f[/TD]

[TD]NA[/TD]

[/TR]

[TR]

[TD] Excessive bleeding[/TD]

[TD]NA[/TD]

[TD]0.1f[/TD]

[TD]NA[/TD]

[/TR]

[TR]

[TD] Need for repeat surgery (if skin bridges or too little prepuce is removed)[/TD]

[TD]NA[/TD]

[TD]0.1f[/TD]

[TD]NA[/TD]

[/TR]

[TR]

[TD] Loss of member[/TD]

[TD]NA[/TD]

[TD]0.0001f[/TD]

[TD]NA[/TD]

[/TR]

[TR]

[TD] Death[/TD]

[TD]NA[/TD]

[TD]0.00001f[/TD]

[TD]NA[/TD]

[/TR]

[TR]

[TD] Loss of penile sensitivity[/TD]

[TD]NA[/TD]

[TD]0f[/TD]

[TD]NA[/TD]

[/TR]

[/TABLE]

aHIV = human immunodeficiency virus; HPV = human papillomavirus; NA = not applicable.

bRating of evidence was based on the Scottish Intercollegiate Guidelines Network grading system for evidence-based guidelines48: high-quality meta-analyses, systematic reviews of randomized controlled trials (RCTs), or RCTs with very low risk of bias (1++); well-conducted meta-analyses, systematic reviews of RCTs, or RCTs with low risk of bias (1+); meta-analyses, systematic reviews of RCTs, or RCTs with high risk of bias (1–); high-quality systematic reviews of case-control or cohort studies or high-quality case-control or cohort studies with a very low risk of confounding, bias, or chance and a high probability that the relationship is causal (2++); well-conducted case-control or cohort studies with a low risk of confounding, bias, or chance and a moderate probability that the relationship is causal (2+); and case-control or cohort studies with a high risk of confounding, bias, or chance and a significant risk that the relationship is not causal (2–); reports with lower ratings, such as case reports and case series (3) and expert opinion (4), were not considered.

cThese data show that the risk to an uncircumcised male of developing a condition requiring medical attention during their lifetime is approximately 1 in 2. Values shown are mostly based on statistics for the United States unless RCT data were available from other countries. State-of-the-art reviews are shown where possible rather than individual studies. Information on sexually transmitted infections applies to those acquired in heterosexual males.

dThe percentage of uncircumcised affected is the inverse of the number needed to treat value, which is the approximate number of males who need to be circumcised to prevent 1 case of each condition associated with lack of circumcision.

eThese data show that risk of an easily treatable condition is approximately 1 in 200 and of a serious complication is 1 in 5000. Estimates are taken from American Academy of Pediatrics,14 2012; Wiswell and Geschke,49 1989; and Ben Chaim et al,50 2005.

fPercentage affected is the inverse of the number needed to harm value, which is the approximate number of males who need to be circumcised to see one of each particular (mostly minor) adverse effect. The item “local bruising” is not included in the overall calculation of easily treatable risks because this phenomenon disappears naturally without any medical intervention.

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

Cost-benefit

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

macawake, MSN · Dec 7, 2014

It might also be helpful to read the commentary from the AAP before making a one-sided decision on male circumcision. The original author "cherry-picked" his articles to support his/her view on circumcision, which is obvious since there is no methods section in the article telling the readers how the author systematically chose these articles.
Cultural Bias and Circumcision: The AAP Task Force on Circumcision Responds

You could just as easily have worded that as a question, instead of assuming that I make "one-sided" decisions. "Have you read the commentary from the AAP?" would have worked just fine. You don't have to agree with my opinion but please credit me with at least a minimum of scientific integrity and a reasonably well-functioning intellect :)

Of course I read it. I just didn't arrive at the same conclusion as you did.

In the ethical issues paragraph the AAP authors themselves say "Although task force members did not find the data sufficiently compelling to justify a recommendation for routine neonatal circumcision, we did find that the benefits are substantial enough to allow parents to make this decision for their male children".

Well, I have studied the available evidence to the best of my ability and I don't find the evidence compelling enough to justify circumcisions in infants, as opposed to delaying the decision to an age where the young male can decide for himself. Contrary to what you might believe I actually am willing to change my mind, if compelling scientific evidence came to light showing that the health gains to be made without a doubt surpassed in magnitude the child's right to autonomy.

Since I put a very high value on every individual's autonomy the health gains would have to be substantial. I'd have to see evidence that clearly shows that circumcising an infant male in a western country is more beneficial healthwise than having in done at a later age. Taking away an individual's autonomy is not a decision to be taken lightly. You are taking away a body part that the child can never get back. The foreskin isn't a design flaw, it has a function.

I don't know how to make my objections any more clear. I don't think that the available evidence shows significant health gains that can't be attained through less invasive measures (education, condoms and hygiene), can be made in a western country by circumcising an infant as opposed to delaying the decision. (Much of the available research has been done in Africa on adults and I remain unconvinced of its' generalizability to western world children and teens).

"Cost-benefit

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.

I'm not sure why you included this cost-benefit analysis? If we're to base decisions on what parts of an infants' body we should remove shortly following birth based on future healthcare costs, then there are much larger monetary gains to be made by removing other body parts. We're back to for example female breast buds. I'm sure that the cost of treting breast cancer in the US is large, just as it is in my country. You could save a significant amount of money by minimizing the risk of breast cancer through surgery in infancy. (Horrendous concept by the way).

(UTI's can in the vast majority of cases be treated successfully with antibiotics and they are more common in females than in males. Antibiotics are less invasive than surgery and it doesn't permanently change a child's body. To me treating a patients if and when they contract a UTI makes more sense than circumcision-profylaxis).

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

A whole lot of random thoughts on the subject:

I was absolutely dismayed when a poster called the normal male body bizarre and horrendous. Really? Viewing your own body the way it was designed (by Nature or God, depending on your beliefs) as horrendous seems almost phobic.

Personally I think the male body is a materpiece, but that's just me

Someone made the comment that a man's uncircumcised member smells.

I honestly didn't know if I was supposed to laugh or cry. If it smells, there's either an infection or it's not clean :facepalm:

If a woman doesn't clean all her nooks and crannies, she will likely smell. If you don't brush your teeth for an extended period of time, your breath will likely not be your most attractive feature.. And I swear, if you neglect to properly clean your belly button, odoriferous aliens will take up residence in it's murky depths :nailbiting:

Just as a parent tells/teaches a young girl in which direction to wipe the toilet tissue, they should teach a young boy how to properly clean his member. It's not rocket science.

If circumsicion of infant males is a successful way of combating STI's, why are STI's more common in the US where circumcisions are more common, than in my country where circumcisions are rare? Of course I realize that there are many factors that affect this, but it's still another point in my book against circumcisions of infants.

Here are some numbers from Sweden: (I believe that they're not that dissimilar from US statistics).

Penile cancer

Incidence: 2/100 000

Percentage of total cancer cases:

Average age at diagnosis: 65

Testicular cancer

Incidence: 6/100 000

Percentage of total cancer cases: 1%

Average age at diagnosis: 30-35

(Testicular cancer is the most common form of cancer in males aged 20 - 40).

I've mentioned it before. To promote sexual/reproductive health in youths I support educating our teens in how to manage their hygien, to use condoms and for males to perform monthly testicular self-examinations.

The masturbation issue. It seems to me that the only truly meaningful comparisons could be made if a male was circumcised (but not for medical reasons since that might affect sensation and or have other physiological or psychological impacts) after he became sexually active, and then could compare the two experiences.

My personal reflection is that since the foreskin is a moving part involved both in masturbation and intercourse and that it serves to keep the glans moist/lubricated and that there are many nerves in the area, it would surprise me deeply if the removal of it wouldn't have any effect at all.

The other night I was attending my weekly poker game with seven of my former male coworkers. (I'm female). I asked them how they feel about the subject of circumcision. I'm quite good at reading body language and tells but this time I didn't really have to be very adept at it :lol2: Seven rapidly whitening faces and three of them instinctively let go of their cards/chips/whatever and covered their groin with their hands. The guy whose place we were at ran quickly to secure the kitchen knives, all of them wondering what was wrong with me :sarcastic:

The cultural divide on this issue is huge. I still firmly believe that culture, not medicine, is the prime motivator for circumcisions of infant males.

To the relief of many of you, this shall be my last post in this thread. (One small caveat, if someone posts something I feel that I absolutely must respond to I might drum up the energy to do so, but likely not).

If you made it all the way here, you've got admirable stamina :)

allnurses Guide · Dec 7, 2014

You could just as easily have worded that as a question, instead of assuming that I make "one-sided" decisions. "Have you read the commentary from the AAP?" would have worked just fine. You don't have to agree with my opinion but please credit me with at least a minimum of scientific integrity and a reasonably well-functioning intellect :)
Of course I read it. I just didn't arrive at the same conclusion as you did.
In the ethical issues paragraph the AAP authors themselves say "Although task force members did not find the data sufficiently compelling to justify a recommendation for routine neonatal circumcision, we did find that the benefits are substantial enough to allow parents to make this decision for their male children".
Well, I have studied the available evidence to the best of my ability and I don't find the evidence compelling enough to justify circumcisions in infants, as opposed to delaying the decision to an age where the young male can decide for himself. Contrary to what you might believe I actually am willing to change my mind, if compelling scientific evidence came to light showing that the health gains to be made without a doubt surpassed in magnitude the child's right to autonomy.
Since I put a very high value on every individual's autonomy the health gains would have to be substantial. I'd have to see evidence that clearly shows that circumcising an infant male in a western country is more beneficial healthwise than having in done at a later age. Taking away an individual's autonomy is not a decision to be taken lightly. You are taking away a body part that the child can never get back. The foreskin isn't a design flaw, it has a function.
I don't know how to make my objections any more clear. I don't think that the available evidence shows significant health gains that can't be attained through less invasive measures (education, condoms and hygiene), can be made in a western country by circumcising an infant as opposed to delaying the decision. (Much of the available research has been done in Africa on adults and I remain unconvinced of its' generalizability to western world children and teens).
I'm not sure why you included this cost-benefit analysis? If we're to base decisions on what parts of an infants' body we should remove shortly following birth based on future healthcare costs, then there are much larger monetary gains to be made by removing other body parts. We're back to for example female breast buds. I'm sure that the cost of treting breast cancer in the US is large, just as it is in my country. You could save a significant amount of money by minimizing the risk of breast cancer through surgery in infancy. (Horrendous concept by the way).
(UTI's can in the vast majority of cases be treated successfully with antibiotics and they are more common in females than in males. Antibiotics is a less invasive than surgery and it doesn't permanently change a child's body. To me treating a petients if and when they contract a UTI makes more sense tha circumcision-profylaxis).
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A whole lot of random thoughts on the subject:
I was absolutely dismayed when a poster called the normal male body bizarre and horrendous. Really? Viewing your own body the way it was designed (by Nature or God, depending on your beliefs) as horrendous seems almost phobic.
Personally I think the male body is a materpiece, but that's just me
Someone made the comment that a man's uncircumcised member smells.
I honestly didn't know if I was supposed to laugh or cry. If it smells, there's either an infection or it's not clean
If a woman doesn't clean all her nooks and crannies, she will likely smell. If you don't brush your teeth for an extended period of time, your breath will likely not be your most attractive feature.. And I swear, if you neglect to properly clean your belly button, odoriferous aliens will take up residence in it's murky depths
Just as a parent tells/teaches a young girl in which direction to wipe the toilet tissue, they should teach a young boy how to properly clean his member. It's not rocket science.
If circumsicion of infant males is a successful way of combating STI's, why are STI's more common in the US where circumcisions are more common, than in my country where circumcisions are rare? Of course I realize that there are many factors that affect this, but it's still another point in my book against circumcisions of infants.
Here are some numbers from Sweden: (I believe that they're not that dissimilar from US statistics).
Penile cancer
Incidence: 2/100 000
Percentage of total cancer cases:
Average age at diagnosis: 65
Testicular cancer
Incidence: 6/100 000
Percentage of total cancer cases: 1%
Average age at diagnosis: 30-35

(Testicular cancer is the most common form of cancer in males aged 20 - 40).
I've mentioned it before. To promote sexual/reproductive health in youths I support educating our teens in how to manage their hygien, to use condoms and for males to perform monthly testicular self-examinations.
The masturbation issue. It seems to me that the only truly meaningful comparisons could be made if a male was circumcised (but not for medical reasons since that might affect sensation and or have other physiological or psychological impacts) after he became sexually active, and then could compare the two experiences.
My personal reflection is that since the foreskin is a moving part involved both in masturbation and intercourse and that it serves to keep the glans moist/lubricated and that there are many nerves in the area, it would surprise me deeply if the removal of it wouldn't have any effect at all.
The other night I was attending my weekly poker game with seven of my former male coworkers. (I'm female). I asked them how they feel about the subject of circumcision. I'm quite good at reading body languages and tells but this time I didn't really have to be very adept at it Seven rapidly whitening faces and three of them instinctively let go of their cards/chips/whatever and covered their groin with their hands. The guy whose place we were at ran quickly to secure the kitchen knives, all of them wondering what was wrong with me
The cultural divide on this issue is huge. I still firmly believe that culture, not medicine, is the prime motivator for circumcisions of infant males.
To the relief of many of you, this shall be my last post in this thread. (One small caveat, if someone posts something I feel that I absolutely must respond to I might drum up the energy to do so, but likely not).
If you made it all the way here, you've got admirable stamina :)

The myriads amount of scientific data don't persuade you that HCPs should be given unbiased information about the risks and benefits of male circumcision. That is the whole point.

Why shouldn't unbiased information about male circumcision, without discussion of FGM and male "mutilation", be available to HCPs to provide their patients/parents of patients from a panel of trained researchers who have systematically reviewed all the scientific literature on male circumcision and came to consensus of all the available scientific references for HCPs to review further if they so wish?

"Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks and that the procedure’s benefits justify access to this procedure for families who choose it. Specific benefits identified included prevention of urinary tract infections, penile cancer, and transmission of some sexually transmitted infections, including HIV. The American College of Obstetricians and Gynecologists has endorsed this statement." http://pediatrics.aappublications.org/content/130/3/585

onedayitllbeme · Dec 7, 2014

I was actually happy to see u can infer from this new CDC information that a teen boy could consider circumcision if he wants and a parent doesn't have to make this choice for an n unconsenting newborn. My son is intact and I always felt it was his choice when he is older.

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

You seem to be missing that I believe the body is meant to be left alone. Removing working parts for possible issues because of cost turns my stomach.

onedayitllbeme · Dec 7, 2014

Up to this point there was this fake fear that somehow this procedure was so dangerous if u weren't a newborn because of the sedation which never made sense to me.

allnurses Guide · Dec 7, 2014

You seem to be missing that I believe the body is meant to be left alone. Removing working parts for possible issues because of cost turns my stomach.

You are missing the point. HCPs should be given unbiased information based on scientific literature about male circumcision personal beliefs are not important, and neither are mine.

Our individual beliefs on male circumcision should stop as soon as we go to work. It should be totally up to the parents on what they decide about the circumcision status for their child. Our job as a nurse is to provide parents unbiased health information that is based in science not opinion.