The Circumcision Discussion

RN mom of 2 · Dec 19, 2006

:yeahthat:
In my opinion; that is what this thread should be discussing. We've done the circumcision thing to death on the OB/mother/baby site.
Oh, and NICU nurse here; have seen literally dozens of circs. I've never seen a baby "pass out" from pain. And I'm sure the babies I've seen circ'd are far more fragile than the typical nursery infant. But, I digress, this is not the topic.

I'm really glad to hear this. Maybe your babies are treated better, because they are already in a fragile state? Do the docs wait until the local takes effect? I still don't think it's right even with proper use of anesthesia, it's just that the procedure is more humane. That is a very good thing. I'm curious to know if NICU nurses have to assist in a circ, even if they don't agree with it?

I realize this topic was originally about HIV and circ'ing in Africa, but I think with a topic like circ'ing, one has to expect that it will take other turns. It's all part of the discussion, even if it's not the main topic. I actually find topics that take a few turns more interesting than most, but maybe that's just me?

mvanz9999, RN · Dec 19, 2006

^^^^^

Exactly. My issue is with the end effect of the procedure, not the carrying out of procedure or whether there is anesthesia or not. I don't care about that, but the end result.

RN mom of 2 · Dec 19, 2006

^^^^^
Exactly. My issue is with the end effect of the procedure, not the carrying out of procedure or whether there is anesthesia or not. I don't care about that, but the end result.

Yes, I agree that the end result is the main issue.

Since circs are still accepted and routinely performed, I feel it should be done as humanely as possible. Sadly, no one knows for sure what the pain level is, as we can not question a newborn, or show them a picture of the pain scale and ask them, which one are you? Due to this, pain relief should always be administered, and an ample amount of time should pass in order for the local to properly take effect. Some pain relief is always better than none.

RunningWithScissors · Dec 20, 2006

Your uncircumcised son may one day have another sensitive body part pierced; seems they don't mind the discomfort to have tongues and other body parts pierced with metal objects hanging out of them for the sake of style.

For the record, I have 2 sons; one circumcised, one not.

alexillytom · Dec 20, 2006

Kudos to you Sharon! If the research is there that proves this may be a viable way to decrease the spread of AIDS in any country, it deserves further investigation. My cousin died from this horrible disease and my uncle suffers from it today. As Sharon stated, it is truly a long and painful death.

I am currently a nursing student and have witnessed a few circumcisons. I have never seen a baby pass out. As a matter of fact, they barely even whimpered. The babies went immediately to their mothers. A couple of those mothers were breastfeeders and had no problems nursing their babies afterwards.

I am also a mother of two wonderful boys. They were both circumcised. They were happy and content babies and are extremely happy and well adjusted boys.

Works2xs · Dec 20, 2006

"lack of male circumcision has also been associated with sexually transmitted genital ulcer disease, infant unrinary tract infections, penile cancer, and cervical cancer in female partners of uncircumcised men. (emphasis mine) The latter two infections are related to human papillomavirus (HPV) infection. Transmission of this virus is also associated with lack of male circumcision."
from CDC HIV/AIDS science facts "Male Circumcision and Risk for HIV Transmission: Implications for the United States, December 2006.
http://www.cdc.gov/hiv/resources/factsheets/pdf/circumcision.pdf
Cervical cancer has been referred to as "a developing epidemic" with high rates in sub-Saharan Africa. http://www.paho.org/English/DD/PIN/pr041220.htm
Naturally, the HPV vaccination will most likely bring those rates down the most dramatically in developing nations. However, this news about circumcision is very promising--a relatively simple procedure that can potentially reduce HIV rates and oh yeah by the way reduce cervical cancer rates is exciting.
Again, thanks, Timothy,
Rebecca

Seems odd that the most vociferous voices against circumcision seem to ignore these non-trivial health impacts. Having undergone the procedure in my infancy, I can say that just for the reasons noted above, I'm glad it was done. Also, since these issues do have potential impacts to the health and well being of my kids, I don't have a problem "making the decision" for them. I'd go as far as to say that it's less of an impact on my kids that the battery of injections I ensured they received to fend off numerous maladies. Speaking of mental impacts...

Before anyone asks...I have seen circ's done. And what struck me the most was that the child protested the most during the process of putting them in the restraint. When it came to the procedure itself, they couldn't seem to care less. As far as "passing out" - I don't doubt the veracity of the poster's observation. I've also seen kids get quite agitated at the Vitamin K or Hep injections they got. Are you suggesting that we stop these sorts of procedures based on the same criteria? I'd have to agree with Timothy in that these illustrations are more of a play on emotion as well as a being a "red herring" than any meaningful argument against totally stopping the practice.

Regarding any notion that "I was robbed" of some meaningful piece of my anatomy. I can't say as I've ever heard of a man suffering from "phantom foreskin pain" as a result of a childhood circumcision. I don't put this on any trauma level above having ears pierced. Equating the loss of this small piece of skin to the loss of a limb is just silly hyperbole.

Regarding sensitivity - Ok, I won't argue. However, for me at least it's a big "so what." As I noted to the ladies in one of my nursing classes a little while ago, it's like saying my 90 ft tsunami is somehow less of an event than a 100 ft one. To the people living on the coast, they're equally affected. I also seem to remember numerous discussions during the "sexual revolution" about how to stave off the big moment so your partner can reach hers. So I'll just say the sacrifice of my small skin fragment was done to help in the fight to help women realize their unlimited capacity for reaching the big moment.

... back to our regularly scheduled programming....

Works2xs · Dec 20, 2006

The idea of having circumcision as an item in the orificenal for fending off HIV infection rates in high rate areas is tempting. However, I think some fairly big problems would have to be wrestled with before getting aggressive about putting this out there in those areas.

First one, as others have mentioned, is the potential health risks associated with doing the circumcisions in the first place. While reading a completely unrelated article in "Fast Company" (Nov 2006), I came across this tidbit:

"Tanzania has only one physician for every 20,511 people, a ratio typical of sub-Saharan Africa. Ipuli's [village in central Tanzania] women in labor have been trundled 37 miles by wheelbarrow to reach the nearest clinic." (Ok, I can't vouch for the scientific accuracy of the author's statement.. but it does illustrate a point). If this procedure were to become more standardized in these areas, would it be done with the edge of a rusty razor blade or hunting knife? How much would such conditions contribute to other mortality and morbidity issues for these children? Would they just trade adult deaths for childhood deaths?

Second, I get a bit nervous at suggesting such measures for poor populations. We've seen just in this thread the level of emotion associated with circumcision. I'd imagine similar objections would arise in the heavily affected areas. There'd be numerous moral implications associated with "marketing" this idea, regardless of any practical considerations. I'm sure a Nobel Prize awaits anyone who could overcome those sorts of issues. Of course, doing nothing is equally steeped in moral damnation as well.

Interesting discussion.

allnurses Guide · Dec 20, 2006

Why is it that the only response for circumcision that we are hearing is "Oh well I had my son circumcised and when I asked him he didn't mind." Come on now, are you serious?
I imagine if you asked victims of female genital mutilation in Africa if they "minded" the procedure, they would tell you no. They are products of social conditioning. They are taught to believe it is a necessary procedure.
The same applies to males. Parents of circumcised children obviously believe it is the right thing to do, and they indoctrinate their children with that same belief. I doubt anyone has ever explained what was lost during that procedure to them and they will never understand because they won't know what they lost. They can't miss something that they never had, but that doesn't mean that they never needed it in the first place.
Just because a circumcised child doesn't think that he "misses" his foreskin later in life doesn't justify cutting it off as a child.

I had to chuckle - I"M THE ONE who thinks my sons should not have been circ'd and I didn't do any "social conditioning" or "indoctrination". I didn't even talk about it until recently during one of these discussions.

And I don't think it justifies circumcision either - I just thought it was interesting that most of the folks here talking about this are women and MEN would rather be circ'd . .. for the most part anyway.

steph

rnin02 · Dec 20, 2006

I've seen a number of circumcisions done in the past few months, and while I've never seen a baby pass out, most cry and are uncomfortable, although the lidocaine, sweetease and tylenol help, for a little bit anyway. Then they spend the next 24+ hours fussy, not wanting to eat, and screaming (not crying) during diaper changes.. I'm glad other nurses have babies that sleep thru the whole procedure. I think more research, testing, etc should continue, and definitely increasing the amount of education regarding STDs, etc is the best answer. Its a complicated situation however, with no easy answer.

ZASHAGALKA, RN · Dec 20, 2006

Science & Medicine | Routine Male Circumcision in Sub-Saharan Africa Could Prevent 6M New HIV Infections, 3M Deaths Over 20 Years, Report Says - Kaisernetwork.org

"Routine male circumcision across sub-Saharan Africa could prevent up to six million new HIV infections and three million deaths in the next two decades, according to a report published in the July 11 edition of PLoS Medicine, Toronto's Globe and Mail reports. The report is based on an analysis of findings from a recent study in South Africa that indicates that male circumcision significantly reduces HIV transmission (Gandhi, Globe and Mail, 7/11). According to the South Africa study, which was published in the November 2005 issue of PLoS Medicine, male circumcision might reduce by about 60% the risk of men contracting HIV through sexual intercourse with women. The randomized, controlled clinical trial enrolled more than 3,000 HIV-negative, uncircumcised men ages 18 to 24 living in a South African township. Half of the men were randomly assigned to be circumcised and the other half served as a control group, remaining uncircumcised. For every 10 uncircumcised men who contracted HIV, about three circumcised men contracted the virus. Researchers believed the findings were so significant they deemed it was unethical to proceed without offering the option to all males in the study. Two similar studies examining the effect of male circumcision on HIV transmission currently are underway in Kenya and Uganda (Kaiser Daily HIV/AIDS Report, 6/29). "

~faith,

Timothy.

mvanz9999, RN · Dec 20, 2006

Science & Medicine | Routine Male Circumcision in Sub-Saharan Africa Could Prevent 6M New HIV Infections, 3M Deaths Over 20 Years, Report Says - Kaisernetwork.org

This doesn't give enough information on variables, I believe. Does this take into account other factors? Do the two sets of men have the same frequency of sex with the same number of partners, or do the circumcised men have less sex because they are experiencing a higher percentage of erectile dysfunction?

I'm not going to take either side, because there isn't any data to support this.

"....the virus' chances of survival might be higher in a warm, wet environment like the one under the foreskin"

Hm? Just like it was designed to be. Not the dry, keratinized cells of the circumcised male?

****

Lastly, how could this possibly even be implemented? Earlier it was posted that Africans have, in general, resisted the use of condoms. Why would anyone assume a surgical procedure would be more widely accepted than latex? This would be far more work than condoms. I guess if the reduced risk of death gained by the use of condoms is not effective, I doubt a more painful and/or questionable procedure such as surgery would be any more effective.

I don't claim to have an answer, but I suspect this is not it. I just don't see any way to effectively implement it. It would require the citizens to actually go to a center and seek treatment. There is no way to enforce this. In those regions where it is not already considered routine, I do not think it will be accepted.

onehusbandsevenkids · Dec 20, 2006

The Politics and Motivation behind the African “Research” on Male Circumcision and HIV Infection

By: Dr. Paul Tinari Ph.D.,

Research Epidemiologist

For more than fifty years, the circumcision industry in North America

has reaped windfall profits by use of a clever combination of

disinformation, lies and fear. By carefully targeted lobbying,

selective funding of political campaigns and by playing the

“religious freedom” card, the industry assured that laws were passed

banning all forms of genital mutilation in females (even with

consent), but shamefully and in blatant violation of both Charter and

Constitutional guarantees of gender equality, permitted the genital

mutilation of males (without consent).

In the last ten years, the pharmaceutical industry has discovered a

universe of profitable products that can be manufactured from stolen

foreskins. Even though the trade in human organs and tissues,

especially those taken without consent, is universally banned as an

affront to human dignity (starting with the Nuremberg Laws passed in

the 1940’s), the circumcision industry has once again exempted itself

from any restrictions that would hinder the profit of its

operations. As a result, each pilfered foreskin can be worth tens of

thousands in commercial products – not bad for a product that they

get paid to steal, despite the protestations of its rightful owner.

Gandhi once said that the truth can never be suppressed for ever,

and the carefully crafted façade constructed by the circumcision

industry has begun to crumble in the face of successful assault by

scientific and ethical facts. Parents are now, in a powerfully

rising tide, rejecting the lies and deceit of the baby mutilators,

and increasing embracing the axiom that if males were meant to have a

foreskin, then they would be born with one. And as such, it makes

sense to believe that his creator gave a foreskin to its male owner

because the intent was for him to keep it.

As parents are now increasingly responding to scientific fact and

reason instead of to hysterical claims and superstition, circumcision

rates have plummeted to single digit percentages in many

jurisdictions. This is most worrying to the circumcision industry,

because their profits have begun to suffer. Seeing no hope of

increasing supplies from North America or Europe, the industry has

now targeted Africa as a brand new “virgin” source of foreskins to be

harvested for luxury pharmaceutical products for well heeled

consumers in the developed world. Let there be no mistake: The

circumcision industry does not give a damn about the health of

African children – they are only seen as a new - and more gullible -

resource to exploit.

If the industry truly cared about the health of Africans, then it

would be funding proper epidemiological studies, not the severely

flawed, politically motivated “research” that has just been

selectively made public. Why the obsession with ONLY studying male

circumcision and HIV infection? Why has no work been done or even

proposed on studying the link between female circumcision and HIV

infection? After all, the female labia has exactly the same cellular

receptors as the male foreskin. If it were discovered that

circumcised females have a lower risk of HIV infection than intact

ones, then would the researchers then be demanding large scale

circumcision of females in North America? And if not, why not? Why

has no study been conducted on the link between “dry” intercourse and

HIV infection? Dry intercourse, popular with many African men,

consists of drying out the lady parts before intercourse by using harsh

astringents. The dry, irritated and cracked lady partsl tissues are far

more prone to tearing, bleeding and hence, to HIV infection. Why

have no studies been made on the link between malaria infection and

HIV susceptibility? Hundreds of millions of Africans are infected by

the malaria parasite. Certainly it is of interest if this increases

a person’s risk of HIV infection. And what about the known links

between the prevalence of other STDs and HIV infection? Antibiotic

resistant gonorrhoea and syphilis are epidemic throughout Africa, and

it is well known that their presence greatly facilitates HIV

transmission to an infected individual. For that matter, any

systemic infection that compromises the immune system including

tuberculosis, sleeping sickness and many parasitical worms (all of

which are endemic throughout Africa), will all greatly facilitate HIV

infection. It is scientifically criminal that none of these factors

was controlled for in the recently published “research.” Yet each

of these factors is potentially a far greater contributor to ease of

HIV infection in males than the presence or absence of a foreskin.

To be blunt – these research results are scientific garbage and

should be treated as such.

In conclusion, the sad truth is that these were not professional,

objective scientific researchers who were conducting an unbiased

study whose goal was the improvement of human welfare. Rather, these

are little more than amateur hacks, with at best a poor understanding

of elementary epidemiological or statistical principles who were

willing to do anything to prove their pre-supposed dogma – that male

circumcision prevents HIV infection. Why is the inconvenient fact

ignored that the lowest rates of HIV infection in the world are found

in the Scandinavian nations, countries where circumcision is

virtually unknown? Why is it ignored that the Western nation with

the highest circumcision rates, the United States, also has the

highest rates of HIV infection?

The truth can be obtained by asking the innocent question: “Who

sponsored this highly flawed research and for what political

purpose?” The true intent of the study organizers can be deduced by

their boastful claim that the results of this research would have all

African men “lining up” to get circumcised. As usual, the African

get conned while the Western multinational corporations laugh all the

way to the bank.

A little digging will reveal that this research was paid for the same

sponsors who soon hope to richly profit from harvesting a huge new

supply of African foreskins. After all, the same poverty stricken

Africans were easily conned by Western multinationals into buying

expensive formula (diluted with contaminated water) for their

children, instead of using free, healthy and sterile breast milk.

Paul Tinari

Pacific Institute for Advanced Study