CDC rec to counsel all males about benefits of circumcision

lifelearningrn, BSN, RN · Dec 7, 2014

Adult Circumcision Stories - Men Circumcised As Adults Tell It As It Is...

Why don't we ask men who have had it done as adults? I've seen a lot of people argue here that the child can decide for himself when he is older.

allnurses Guide · 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.

Anesthesia is extremely safe, but a newborn male circumcision is considerably less complicated than male circumcision done when older. The rate of complications increases with age.

There are numerous studies on the effect of anesthesia on developing brains. We also know that post operative cognitive dysfunction happens to pretty much everyone that undergoes general anesthesia and probably to some extent in sedation cases to. Anesthesia is not a benign process, and has many potential complications. In the last year I have had a dentist accidentally breach the barrier to the frontal sinus on a child. The child's face and head blew up like a balloon when he started crying on wake up. I had a venous air embolism on insufflation that managed to go directly to the left side of the heart. I have had two cases of asystole during laparoscopic cases. Several cases of residual muscle paralysis over the last five years. Luckily, the only significant complication I have seen from circumcision in the OR is excessive bleeding.

onedayitllbeme · Dec 7, 2014

But I'm not an adult male deciding whether to circumcise myself. I don't need to read to read that. I'll certainly encourage my son to read up in that if he ever asks me. I'm b sure there will be benefits and disadvantages. I dont go much for anecdotal accounts anyway.

allnurses Guide · Dec 7, 2014

Adult Circumcision Stories - Men Circumcised As Adults Tell It As It Is...
Why don't we ask men who have had it done as adults? I've seen a lot of people argue here that the child can decide for himself when he is older.

It has been asked, and there are studies out there. There has not been shown to have any significant differences being uncircumcised versus circumcised.

There are some studies that show an increase in certain sexual functions when males are circumcised though.

lifelearningrn, BSN, RN · Dec 7, 2014

But I'm not an adult male deciding whether to circumcise myself. I don't need to read to read that. I'll certainly encourage my son to read up in that if he ever asks me. I'm b sure there will be benefits and disadvantages. I dont go much for anecdotal accounts anyway.

Actually, there is a lot of research based information on that site. Lots of anecdotes, yes, but if you're going to push the decision on your son to make when he is older, don't you want to read about some issues older males experience?

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

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.

And i have said that I believe providers should be prepared to give information about the procedure...

But I will tell my patients about where some of these studies came from and what is found in other countries as well.

allnurses Guide · Dec 7, 2014

Actually, there is a lot of research based information on that site. Lots of anecdotes, yes, but if you're going to push the decision on your son to make when he is older, don't you want to read about some issues older males experience?

How do you know the reliability of any of the information on that website?

It is more important to utilize peer-reviewed scientific literature when making an EBP decision than website that does not adhere to any systematic scientific process to distribute information.

Adult Male Circumcision: Effects on Sexual Function and Sexual Satisfaction in Kisumu, Kenya

"Effects of Male Circumcision on Penile Sensation and Sexual Function

Well-designed studies of sexual sensation and function in relation to male circumcision are few, and the results present a mixed picture.

Taken as a whole, the studies suggest that some decrease in sensitivity of the glans to fine touch can occur following circumcision [48].

However, several studies conducted among men after adult circumcision suggest that few men report their sexual functioning is worse

after circumcision; most report either improvement or no change [49-52]. The three African trials found high levels of satisfaction among

the men after circumcision [16, 17, 18, 46]." http://www.cdc.gov/hiv/pdf/prevention_research_malecircumcision.pdf

allnurses Guide · Dec 7, 2014

And i have said that I believe providers should be prepared to give information about the procedure...
But I will tell my patients about where some of these studies came from and what is found in other countries as well.

That is my gripe. You do not have the training, unless there is something you haven't shared, to determine (which is also the same for most HCPs) may or may not be valid based on where it was done. You therefore are sharing your bias to patients by giving the impression that you somehow know more than the CDC, WHO, AAP, and ACOG (whom endorsed the AAP statement on circumcision).

RNsRWe, ASN, RN · Dec 7, 2014

Adult Circumcision Stories - Men Circumcised As Adults Tell It As It Is...
Why don't we ask men who have had it done as adults? I've seen a lot of people argue here that the child can decide for himself when he is older.

Thank you for the link, VERY eye-opening! To be honest, while I found their discussions of the malodorous/hygienic condition unpleasant, I was glad to hear that those who had to deal with what was obviously a gross situation to them be able to correct it later :)

Not that I needed any reassurance, but I am SO glad to know my sons won't suffer in the way that some of those poor fellow did.

Red Kryptonite · Dec 7, 2014

Adult Circumcision Stories - Men Circumcised As Adults Tell It As It Is...
Why don't we ask men who have had it done as adults? I've seen a lot of people argue here that the child can decide for himself when he is older.

You should know that the man who runs that site (Brian J. Morris) has in the past said that circumcision should be compulsory and has been derided by intactivists as a "circum-fetishist."

You probably don't want to rely on him too much. Even some who support circumcision regard him as a bit of a ghoul.

http://www.skeptic.org.uk/magazine/onlinearticles/711-infant-circumcision

For well over a decade, Professor Morris has been waging a quixotic campaign against the foreskin.[2] Although he has "no involvement in clinical medicine"[3] and "cannot claim any more expertise on the topic of male circumcision than any other scientist,"[4] Morris has sought to demonize the humble prepuce. So dangerous is this particular part of the normal male anatomy, according to Morris, that it must be removed from a child's body before he can form his own opinion.[5]
This argument is not new. It can be found in Morris's 1999 trade book, In Favour of Circumcision,4 as well as in numerous additional publications rehearsing the same perspective. In this book--just as in his piece for The Skeptic--Morris draws on the highest possible extremes of available morbidity statistics, and describes them "in their grimmest possible light."2 According to Professor Basil Donovan, a leading sexual health researcher, the book was so "unbalanced" in this respect, and even "dangerous" in its misleading assertions, that it provided "sufficient grounds for the publishers to withdraw [it]."
There is also a series of pamphlets by Morris,[6],[7] published in 2006 and 2007 with the controversial circumcision advocacy group, The Gilgal Society.[8] These pamphlets, designed to convince expecting parents to circumcise, openly extol the virtues of foreskin-removal while trivializing drawbacks and risks. Circumcision should be "made compulsory,"[9] according to Morris, and "any parent not wanting their child circumcised really needs a good talking to."

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

That is my gripe. You do not have the training, unless there is something you haven't shared, to determine (which is also the same for most HCPs) may or may not be valid based on where it was done. You therefore are sharing your bias to patients by giving the impression that you somehow know more than the CDC, WHO, AAP, and ACOG (whom endorsed the AAP statement on circumcision).

I will tell them what the recommendations are (and no those agencies don't all recommend it). I will also ensure they know the risks of UTI. I will also tell them most of the studies referenced by these agencies for their recommendation were done in Africa. Simple. I have the training to state all of that.

allnurses Guide · Dec 8, 2014

I will tell them what the recommendations are (and no those agencies don't all recommend it). I will also ensure they know the risks of UTI. I will also tell them most of the studies referenced by these agencies for their recommendation were done in Africa. Simple. I have the training to state all of that.

You pushing your biases. The two agencies most affiliated with newborn care in the U.S. have agreed that the benefit outweighs the risk for male circumcision.

This is actually what is available from the CDC on male circumcision that so many people on here are throwing a fit about. I listed both the positive and mediocre parts on male circumcision as it relates specially to the circumcision in U.S.

"Cost-Effectiveness and Ethical Issues for Neonatal Circumcision in the United States

A large, retrospective study of circumcision in nearly 15,000 infants found neonatal circumcision to be highly cost-effective, considering the estimated number of averted cases of infant urinary tract infection and lifetime incidence of HIV infection, penile

cancer, balanoposthitis (inflammation of the foreskin and glans), and phimosis (a condition where the male foreskin cannot be fully retracted from the head of the member). The cost of postneonatal circumcision was 10-fold the cost of neonatal circumcision [63]. There

are also studies showing very marginal cost-effectiveness.

A 2010 study estimated that newborn circumcision reduces a U.S. male’s lifetime risk of HIV acquisition through heterosexual contact by 15.7% overall, by 20.9% for black males, 12.3% for Hispanic males, and 7.9% for white males. In this model, the number of

circumcisions needed to prevent one case of HIV was 298 for all males and ranged from 65 for black males to 1,231 for white males. Based on these estimates, the study concluded that newborn male circumcision was a cost-saving HIV prevention intervention [64].

Little has been published on the cost-effectiveness of adult circumcision among MSM. A study in Australia found that although a relatively small percentage of HIV infections would be prevented, adult circumcision of MSM could be cost effective or cost saving in

some scenarios [65].

Many parents now make decisions about infant circumcision based on cultural, religious, or parental desires, rather than health concerns [66]. Some have raised ethical objections to parents making decisions about elective surgery on behalf of an infant, particularly when it is done primarily to protect against risks of HIV and STDs that do not occur until young adulthood. But other ethicists have found it an appropriate parental proxy decision [67].

Considerations for the United States

A number of important differences from sub-Saharan African settings where the three male circumcision trials were conducted must be considered in determining the possible role for male circumcision in HIV prevention in the United States. Notably, the overall risk

of HIV infection is considerably lower in the United States, changing risk-benefit and cost-effectiveness considerations. Also, studies to date have demonstrated efficacy only for penile-lady partsl sex, the predominant mode of HIV transmission in Africa, whereas the

predominant mode of sexual HIV transmission in the United States is by penile-anal sex among MSM. There are as yet no convincing data to help determine whether male circumcision will have any effect on HIV risk for men who engage in anal sex with either a

female or male partner, as either the insertive or receptive partner. Receptive anal sex is associated with a substantially greater risk of HIV acquisition than is insertive anal sex. It is more biologically plausible that male circumcision would reduce HIV acquisition risk for

the insertive partner rather than for the receptive partner, but relatively few MSM engage solely in insertive anal sex [68]. In addition, although the prevalence of circumcision may be somewhat lower in U.S. racial and ethnic groups with higher rates of HIV

infection, most American men are already circumcised; and it is not known whether men at higher risk for HIV infection would be willing to be circumcised or whether parents would be willing to have their infants circumcised to reduce possible future HIV infection

risk."

http://www.cdc.gov/hiv/pdf/prevention_research_malecircumcision.pdf

Here is breakdown from one of the references from a reference list from the CDC on male circumcision.

Association of male circumcision and HSV‐2 seropositivity

Ten eligible studies of HSV‐2 seropositivity were identified; eight from Africa, one from India, and one from the United States

Association of male circumcision and syphilis seropositivity

Fourteen studies examined the association between male circumcision and serological evidence of syphilis infection (table 22),), from sub‐Saharan Africa (nine studies), the United States (two studies), Australia, India, and Peru.

Association of male circumcision and chancroid

Seven studies examined the association between male circumcision and chancroid (table 33).). Three were from Kenya and the remainder from the United States, United Kingdom, and the US and Australian military.

Weiss HA, Thomas SL, Munabi SK, Hayes RJ. Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis. Sex Transm Infect. 2006 Apr;82(2):101-9; discussion 10.

There are numerous male circumcision studies done in the U.S. and outside of Africa. There is more than enough studies to show the health benefits from male circumcision.