CDC rec to counsel all males about benefits of circumcision

[sistrmoon]

Wasn't sure the best place to put this, but here's the article:

CDC Considers Counseling Males Of All Ages On Circumcision : Shots - Health News : NPR

What do you think of this? Have you read the African studies and do you think they translate to our population? Do you think it's a good idea from a public health standpoint?

[Red Kryptonite]

There is plenty of information on how to take care of circumcised males in the U.S. There is no lack of information on this subject. Where is your research to back up your opinions?

Most HCPs could care less if your son is circumcised or uncircumcised or any other male for that fact.

You've clearly never been the parent of an intact son. I've had to tell doctors and PAs to get their hands off both my sons because they were about to forcibly retract their foreskins when they were infants and toddlers. The information on how to properly care for intact boys is readily available, yet they hadn't seen it or didn't care. I told one of them to his face, after he tried to retract my son, and instructed me to get under the foreskin with qtips to clean it, that everything he was telling me was wrong. His response? According to who? Um, how about every medical organization in the world? My younger son needed a hernia repair at age 2. The urologist, at the first visit, matter of factly informed me that he could circumcise my son during the surgery since he'd be under anyway. As if I had just forgotten to get it done or something. I told him no, to just fix what was actually wrong and leave the rest alone. He then proceeded to argue with me and try to convince me to allow him to circumcise my son. I told him that he was intact for a lot of good reasons and I was not changing my mind. I thought we had reached the end of the subject. On surgery day when I went to sign the consents, what was in the list if procedures but CIRCUMCISION? I pitched one almighty fit and told the nurse to get the doctor to me that minute or we were leaving. He came over asking what was going on, and I told him I didn't appreciate dishonesty and trickery and pointed out the offending paragraph. He told me it was a mistake. Yeah sure. He said he'd cross it out. I said no way was I signing anything with that on it. I made them print me new consent forms, and wrote under my signature that under no circumstances was my son to be circumcised.

Please don't talk about what you know nothing about!

[macawake, MSN]

I really would appreciate a well thought-out reply from someone who has something to say about what I have brought up because lately, good points are ignored because of the lack of substance in rebuttal.

I'll give it a try.

But the main concern I see is that the infants do not get to choose for themselves whether they are circumcised or not.

This is my main concern, in fact it's the entire basis for my objection to circumcisions of male infants. I said in my very first post in this thread "if a grown-up man wants to have it done, that should in my opinion be his decision". So I'm not against male circumcisions, I'm against one person having the right to make the decision about a body that isn't their own.

I asked a question in my very first post and as of yet, no one has answered it. The question was "what other healthy parts of an infant's body would we find it acceptable for parents to decide to have surgically removed?" I was really hoping that someone/anyone who thinks that it's acceptable to remove the foreskin would answer that question.

So I have a hard time believing that the real reason they do not circumcise their child is because they want the child to decide for themselves. From the responses on this thread, it's pretty clear that some do not believe any health benefits are associated with circumcision, thus the real reasoning hiding behind "I want my child to decide".

I'm not hiding behind anything. I have pierced ears, so I have no problems with pierced ears. Still, I would never have the ears of my children pierced.

Not because I'm against pierced ears since I'm not, but since I don't think that I have the right to alter their bodies in this way just because I happen to believe that earrings look good. In my opinion it's their body, their decision.

So whatever reservations I might have about the actual health benefits of performing a circumcision at a very young age don't really have a bearing on

my reasoning here.

My feelings are that I don't think that I have the right to make a decision for someone else about surgery that once it's done, can never be undone.

So to be super clear. What I personally think of an intervention isn't what guides me, I treat interventions that I approve of and ones that I'm unconvinced about, in the exact same way. If it's possible (i.e. no medical necessity exists), I feel that I have an ethical obligation to leave the decision to the person who has to live with the consequences, whatever they may be.

Feeling the way I do, it becomes problematic for me to understand that other people feel that it's acceptable to make decisions about other people's bodies.

I never claimed that there aren't any health benefits for anybody from circumcisions. There clearly seems to be health benefits for adults in Africa. What I'm claiming is that the available evidence is in my opinion insufficient to suggest that there are substantial health gains to be made if you circumcise an infant in a Western country, compared to if you postpone that decision until the boy is old enough to make the decision for himself.

In my opinion the money spent on treating a UTI that could be saved, if the child should contract it is nowhere good enough a reason to have surgery performed on an infant. Surgery is a pretty invasive UTI prophylaxis when we have access to antibiotics.

When I weigh the possible health gains against a child's autonomy the evidence in support of infant circumcisions to me comes up short.

The global scientific community haven't reached a concensus on this issue. Medical professionals in the US and in Europe have interpreted the available evidence quite differently, and the subject remains controversial. I wouldn't be suprised if cultural bias affects how the data is interpreted, on both sides of the debate.

[wtbcrna, MSN, DNP, CRNA]

You've clearly never been the parent of an intact son. I've had to tell doctors and PAs to get their hands off both my sons because they were about to forcibly retract their foreskins when they were infants and toddlers. The information on how to properly care for intact boys is readily available, yet they hadn't seen it or didn't care. I told one of them to his face, after he tried to retract my son, and instructed me to get under the foreskin with qtips to clean it, that everything he was telling me was wrong. His response? According to who? Um, how about every medical organization in the world? My younger son needed a hernia repair at age 2. The urologist, at the first visit, matter of factly informed me that he could circumcise my son during the surgery since he'd be under anyway. As if I had just forgotten to get it done or something. I told him no, to just fix what was actually wrong and leave the rest alone. He then proceeded to argue with me and try to convince me to allow him to circumcise my son. I told him that he was intact for a lot of good reasons and I was not changing my mind. I thought we had reached the end of the subject. On surgery day when I went to sign the consents, what was in the list if procedures but CIRCUMCISION? I pitched one almighty fit and told the nurse to get the doctor to me that minute or we were leaving. He came over asking what was going on, and I told him I didn't appreciate dishonesty and trickery and pointed out the offending paragraph. He told me it was a mistake. Yeah sure. He said he'd cross it out. I said no way was I signing anything with that on it. I made them print me new consent forms, and wrote under my signature that under no circumstances was my son to be circumcised.

Please don't talk about what you know nothing about!

Do you any non-anecdotal evidence to support a lack of information available on how to care for uncircumcised males?

[sistrmoon, BSN, RN]

Holy moly, 260 posts! Guess I should have checked back sooner:)

Neither of my boys are circumcised(my husband is.) Neither have had a UTI. I've done papers on the subject, but my tipping point was assisting with circumcisions during my ob rotation.

I don't think this type of counseling is appropriate though(especially to my minor sons!), and I don't think the African studies are applicable in such a radically different social and sexual environment.

I know plenty of circumcised males who have contracted STIs. Condom use should be encouraged. Equating STIs with "dirtiness" with "uncircumcised" just perpetuates the stigma of both STIs and lack of circumcision, neither of which is appropriate or productive.

[Red Kryptonite]

Do you any non-anecdotal evidence to support a lack of information available on how to care for uncircumcised males?

Your statements that most HCPs couldn't care less (that's the correct way to state it) if a man/boy is circumcised, and that intact care information is readily available so there must be no problem with ignorance of it, hardly call for rebuttal with peer-reviewed journal articles. The fact is that parents of intact children are forced to protect them everyday in this country from people who claim to be medical authorities yet lack even the most basic knowledge and don't care to seek it out.

[wtbcrna, MSN, DNP, CRNA]

I'll give it a try.

This is my main concern, in fact it's the entire basis for my objection to circumcisions of male infants. I said in my very first post in this thread "if a grown-up man wants to have it done, that should in my opinion be his decision". So I'm not against male circumcisions, I'm against one person having the right to make the decision about a body that isn't their own.

I asked a question in my very first post and as of yet, no one has answered it. The question was "what other healthy parts of an infant's body would we find it acceptable for parents to decide to have surgically removed?" I was really hoping that someone/anyone who thinks that it's acceptable to remove the foreskin would answer that question.

I'm not hiding behind anything. I have pierced ears, so I have no problems with pierced ears. Still, I would never have the ears of my children pierced.

Not because I'm against pierced ears since I'm not, but since I don't think that I have the right to alter their bodies in this way just because I happen to believe that earrings look good. In my opinion it's their body, their decision.

So whatever reservations I might have about the actual health benefits of performing a circumcision at a very young age don't really have a bearing on

my reasoning here.

My feelings are that I don't think that I have the right to make a decision for someone else about surgery that once it's done, can never be undone.

So to be super clear. What I personally think of an intervention isn't what guides me, I treat interventions that I approve of and ones that I'm unconvinced about, in the exact same way. If it's possible (i.e. no medical necessity exists), I feel that I have an ethical obligation to leave the decision to the person who has to live with the consequences, whatever they may be.

Feeling the way I do, it becomes problematic for me to understand that other people feel that it's acceptable to make decisions about other people's bodies.

I never claimed that there aren't any health benefits for anybody from circumcisions. There clearly seems to be health benefits for adults in Africa. What I'm claiming is that the available evidence is in my opinion insufficient to suggest that there are substantial health gains to be made if you circumcise an infant in a Western country, compared to if you postpone that decision until the boy is old enough to make the decision for himself.

In my opinion the money spent on treating a UTI that could be saved, if the child should contract it is nowhere good enough a reason to have surgery performed on an infant. Surgery is a pretty invasive UTI prophylaxis when we have access to antibiotics.

When I weigh the possible health gains against a child's autonomy the evidence in support of infant circumcisions to me comes up short.

The global scientific community haven't reached a concensus on this issue. Medical professionals in the US and in Europe have interpreted the available evidence quite differently, and the subject remains controversial. I wouldn't be suprised if cultural bias affects how the data is interpreted, on both sides of the debate.

What other piece of infant's skin has been shown to reduce penile cancer, cervical cancer, and reduce STIs including HIV when removed prior to sexual intercourse. The majority of males will have had sexual intercourse before they can legally consent as adults to male circumcision not to mention they are also unlikely to be insured/able to afford circumcision as an young adult in the U.S. So your attempt at asking is there any other part on an infant that we routinely remove has no basis in realistic terms when you are discussing potential multi-modal infection prevention measures in public health.

Autonomy is only one issue with male circumcision, and the public health aspect cannot be just dismissed because some people disagree with infant circumcision. In a perfect society there would be no cancer or STIs, and everyone would wait to have intercourse until they were married in totally monogamous relationship. That is not the real world though and in the real world we need to consider real world solutions to problems. Male circumcision can be one of those solutions since it offers minimal risks and significant benefits to both males and female sexual partners of circumcised males.

I call BS to the claim with Africa again. Africa is hardly the only country that has shown positive health benefits from male circumcision. I have provided several links with studies outside of Africa showing similar results. The only comparison that is difficult to make with Africa and male circumcision is decrease in HIV rates. It can still be done statistically, but there are many variables to consider when making these comparisons. It can be stated that no matter what the country that male circumcision has been shown to reduce HIV rates. What anyone cannot say is because the study was done in Africa that male circumcision will not decrease HIV rates. That is BS.

There is 100:1 decrease in male UTIs in infants who have been circumcised. The idea that these could just be treated with antibiotics is ridiculous. It has been shown that RIC in the U.S. is a cost effective public health measure, and antibiotic resistance is one of major public health issues in today's medicine. I guess those things are just irrelevant to you. That doesn't even account for the decreases in penile and cervical cancer, the decreases in STIs or the decreases in infections among females with circumcised male sexual partners.

The majority of the global scientific community agree that there are several medical and public health benefits to male circumcision, and that those benefits are most apparent before a male becomes sexually active, which again for the majority of teenagers is going to be before 18 years of age.

[sistrmoon, BSN, RN]

Also, a great irony:

http://abcnews.go.com/Health/herpes-strikes-nyc-babies-ritual-circumcisions/story?id=18890284

But that would make me agree with those who say they'd rather it be done in a hospital.

[canigraduate]

Your statements that most HCPs couldn't care less (that's the correct way to state it) if a man/boy is circumcised, and that intact care information is readily available so there must be no problem with ignorance of it, hardly call for rebuttal with peer-reviewed journal articles. The fact is that parents of intact children are forced to protect them everyday in this country from people who claim to be medical authorities yet lack even the most basic knowledge and don't care to seek it out.

To paraphrase: no.

[wtbcrna, MSN, DNP, CRNA]

Holy moly, 260 posts! Guess I should have checked back sooner:)

Neither of my boys are circumcised(my husband is.) Neither have had a UTI. I've done papers on the subject, but my tipping point was assisting with circumcisions during my ob rotation.

I don't think this type of counseling is appropriate though(especially to my minor sons!), and I don't think the African studies are applicable in such a radically different social and sexual environment.

I know plenty of circumcised males who have contracted STIs. Condom use should be encouraged. Equating STIs with "dirtiness" with "uncircumcised" just perpetuates the stigma of both STIs and lack of circumcision, neither of which is appropriate or productive.

This is all anecdotal evidence. What every anti-choice and anti-circumcision person on this thread has failed to provide is an factual scientific evidence that would preclude the CDC from providing unbiased peer-reviewed scientific evidence geared towards HCPs on the risks and benefits of male circumcision.

Here is another example of anecdotal evidence: I have assisted and/or done the anesthesia for male circumcisions from new borns to geriatrics. I have helped with infant circumcisions before local anesthesia was routinely given and after local anesthesia was commonly used. I prefer the later, but personally I could not tell a difference in how the infant did subsequently between the two. All these times of assisting and doing anesthesia for male circumcisions has done nothing to change my mind. It has actually reinforced my personal opinion that RIC should be done more often. That is probably due to the fact that I see more complications from non-circumcised males having to come to the OR for circumcisions than the ordinary public. I have seen very few uncircumcised males with STIs, but considering that most of the U.S. and especially the U.S. military are circumcised that is hardly surprising.

Male circumcision statistically decreases STIs it does not eliminate them as your post would seem to suggest. Male circumcision is only part of a multi-modal solution to help prevent disease and infection rates. It does not supersede the need for sex education, condom use, or basic hygiene.

[wtbcrna, MSN, DNP, CRNA]

Your statements that most HCPs couldn't care less (that's the correct way to state it) if a man/boy is circumcised, and that intact care information is readily available so there must be no problem with ignorance of it, hardly call for rebuttal with peer-reviewed journal articles. The fact is that parents of intact children are forced to protect them everyday in this country from people who claim to be medical authorities yet lack even the most basic knowledge and don't care to seek it out.

I disagree. You provide a point of view and sound like you are speaking for a significant portion of the general public with no evidence to support your view.

I at least try to point out when something is my personal view, and I try to provide peer-reviewed scientific evidence whenever possible. You have yet to provide any valid research on this subject. All you have done is pass off your personal opinions as representative of significant portion of the public.

[sistrmoon, BSN, RN]

It does not change the fact that pathological phimosis occurs before puberty no matter if the rate is 0.1% or 20%. It is a real diagnosis that occurs before puberty, and it does not change because you deny it. I have seen elective circumcisions and medically necessary circumcisions in boys and adult males. I have seen several cases of adhesions too, which depending on the age still sometimes have to be taken to the OR for deep sedation.

Male circumcision has medical benefits to deny that is a lie. You can post all day long, but that is the simple truth.

Nurses should not be pushing their personal opinions and beliefs on patients especially when there is clear evidence to support another view.

Adhesions can happen with or without circumcision. One of my boys had one. It required no intervention after a visit with a pediatric urologist.

The cdc should also not be pushing anyone. I work adult oncology so my beliefs on this are pretty much not applicable in my field(not that I would offer it up anyway.) I also would not want any agenda "counseled" to my minor boys on this topic.

[wtbcrna, MSN, DNP, CRNA]

Also, a great irony:

Herpes Strikes Two More NYC Babies After Ritual Circumcisions - ABC News

But that would make me agree with those who say they'd rather it be done in a hospital.

I try to respect people's religion as much as possible, but to me that is just disgusting and plays no part in modern day society.