The Circumcision Discussion

Specialties Ob/Gyn

Published

I know this can be a HUGE debate, and I'm not looking to start any arguments. I was just wondering as you are OB nurses. I'm expecting a boy in July and not sure if we should circ. or not. My husband says yes, it's better medically in the long run. My gpa who just turned 70 had to have a circ. due to endless complications lately.

As nurses in this area, is the medication that they use good? And what are some questions to ask my Dr. about it. I already know that my hospital i'll be at uses a med. when they perform it, I"m just wondering what you all think.

Thanks

Jen :)

Specializes in ICU, telemetry, LTAC.

I'm not going any further with the circ debate ... there's enough information out there for anyone to see.

But, circs aside, attitudes will or won't change the fate of people in africa where HIV is concerned. Attitudes like those of the libyan public that, it seems, are really going to execute those nurses for simply trying to help their people. Attitudes like their famous double standard of expecting faithful wives, yet the men get their pleasure whenever they want, however they want. Attitudes like those of the south african men who like "dry sex" so the women stuff all manner of drying agents up their genitals, in order to make an extra buck... of course predisposing them to lady partsl tearing and hastening the inevitable process of picking up a disease.

And then there's my attitude problem. I am having a problem caring about the whole mess, which is sad, because there was a time when I was all about getting some nursing experience and going to do missions. Why bother? People want to avoid changing sexual practices, ooh it's taboo let's not talk about it, we need someone else to blame for the fact that we gave our wives and children HIV. So who do they pick? The nurses, who else?

They can circ or not circ, IMHO it wouldn't matter if they had working parts or not, they'd still manage to be sick and treat the mission workers like dogsh*t.

Specializes in Pediatric Intensive Care, Urgent Care.
A perfectly catched argument by those that oppose circumcision for asthetic/hygienic reasons. I could debate some of the points, but, since it is obviously, by your choice of words, a very personal matter to you, there is no point.

It is also not at issue here.

Circumcision to protect against life depriving and society wrecking disease processes is NOT about asthetics. This is not about a newfound Western athetics debate, but about saving lives in areas of the world that don't have the luxuries at their disposals that would lead to cultures that can afford to spend their time arguing asthetics. The SAME luxuries that allow us to spend our time arguing these asthetics also afford us the medications and treatments to NOT have to consider the costs of such positions, if our morality is enforced on other parts of the world.

For the record: I'm HIGHLY educated and all 3 of my boys are circ'd, but again, that's not the point; saving lives is the point. Just because someone disagrees with you does not mean that they are ignorant and just need more education. That rationale only supports positions where there is a need, within the argument, to deny a valid, if opposite, point of view. In this case, the need comes directly from the position being a minority position. Ultimately, it becomes a circular argument: I'm right because those that disagree with me are wrong.

~faith,

Timothy.

Although in this case it may not be for asthetics but is it ethical? If we allow genital mutilation just to curb disease at what point do we stop. Why not advocate performing mastectomies to curtail breast cancer? Today breast implants are so common could we not remedy the mastectomies with breast implants? Does that sound barbaric? Just think about the dangers of reasoning of advocating for circumcision. Any man who has been circumcised does not know what he is missing therefore cannot formulate an intelligent argument as to the importance of the foreskin. That is similiar to a man advocating for broad mastectomies as a primary form of treatment for breast cancer. Those men who have NOT been ciurcumcised know all too well why the foreskin is there. There is, and i repeat, there is no medical reason for circumcision. if you choose it for religious reasons then it is a personal matter and that jumps off this argument on to another and therefore i will not address that. But if you choose it for asthetics then it still is your personal decision, although a pretty shallow one at that. When organizations or studies start advocating gential mutilation in order to curtail a disease, it is unethical. REGARDLESS of what disease we are talking about! HIV and all STDs for that matter are spread because of behaviors regardless of ignorance, lack of knowledge or simple irresponsibility. Behavior is what passes HIV not uncircumcised penuses, sexual preference or any other biological reason.

Finally..."proof" that God made a mistake!

it's not that God made a mistake, it's that HUMANS do, and the bouncing baby boy of today may be tomorrow's promiscuous college student!

I just want to thank everyone for their input into this discussion. I have found it very interesting and thought provoking.

During my own research to decide whether or not to circ my son, I spent a lot of time in discussions just like this one. Often I didn't get involved, but just read what both sides of the debate had to say, and sometimes I asked questions. These type of discussions helped me a lot in making my final decision not to circ. I found the cons to be greater than the pros, and I came to the realization that newborn circumcision is a human rights violation.

You never know who's lurking, and some people may decide to do further research based on what they read here. :nuke:

and I came to the realization that newborn circumcision is a human rights violation.

Yes, that really is the bottom line, isn't it?

Before I jump on the "let's mutilate baby boys for the sake of infections they may or may not ever be exposed to" bandwagon, I'd have to see more research.

intact... Just a few points to ponder before jumping into the 'boys should all be cut' or 'boys should all be left as god made them' debate

I don't think anyone here has argued that circumcision should definitely be promoted as a means of decreasing HIV infection or that all boys should be circ'd in all cases. As stated, there are many factors to consider in addition to critically assessing the research that started this discussion. IF circ'ing DOES in fact decrease HIV transmission then I think it's something to CONSIDER. Clearly, there are some who wouldn't support elective circumcision in ANY situation.

So, let's get on with the issue at hand...

* Babies do not have sex. Any benefit of infant circumcision in preventing the spread of HIV/AIDS will not take effect until they reach puberty.

* Circumcision is not cost-free or risk-free. Even if the studies are correct, is 56 circumcisions to prevent one man getting infected with HIV the most effective way of spending the money, time and expertise?

* Circumcising men disempowers women Important co-factors of HIV/AIDS are of course condomless sex and "dry sex". Circumcising men makes it harder for women to refuse these, and no less risky to accept them..

1) Very true. IF circ'ing could substantially lower HIV transmission rates, it might be worth the wait; circ'ing as an infant may involve lower risks than as an adult - anyone have info on this? It certainly increases compliance but there are still ethical issues to consider. Grown men electing to be circ'd is less controversial though there are still some ethical issues to consider.

2) Circ'ing might be cost-effective versus the cost of caring for an infected patient, decreased further transmission, and the cost to society of the death of so many, especially mothers.

3) I haven't heard that uncirc'd men are more likely to use condoms than circ'd men. I have heard that sensation is decreased in circ'd men which means that a condom would only further decrease sensation but that doesn't mean than uncirc'd men are willing to use condoms more consistently than circ'd men. In regard to dry sex, I don't see how circumcision would make a difference in regard to the woman's empowerment. Maybe you can expand on this argument.

# The studies were of volunteers.

Infant circumcision raises ethical issues.

The studies were cut short. Over a longer period of time, the supposed benefit of circumcision will be reduced. In particular the circumcised group was told to abstain from sex for six weeks, or use condoms. The control group was not. [/Quote]

1) Kinda hard to have an ethically done research study without volunteers. Research does have limits in being able to answer questions for us.

2) Infant circ'ing DOES raise ethical issues. Most of the discussion here has been on that.

3) I'd need more info on the study to judge whether or not that six weeks would likely have made a significant impact in the results of the study. If so, that's important to know.

You would have to circumcise 56 men to prevent one of them contracting HIV in one year.

And the number needed to prevent HIV longer term is higher.

Doctors could spend their time better spent treating people with ulcerative disease and malaria, which make HIV transmission easier

and using the money saved to promote safer sexual practices.

Few accepted medicines have such a high NNT.

On this basis, the NNT in developed countries such as the USA, where the HIV rate is relatively low (0.6% compared to 4.1% in Uganda), would be much higher - it would take 380 circumcisions in the US to prevent one case of HIV.[/Quote]

The number needed to treat (NNT) is a useful figure in weighing information. For comparison, here is one figuring of the number needed to vaccinate against chickenpox to prevent one complicated case: 550-1180 (Varicella vaccination---a critical review of the evidence S A Skull, E E L Wang).

If HIV transmission could be equally decreased over time through treating other illnesses that contribute to vulnerability, then that's also something to consider. I think the issue is that circ'ing is a one off expense versus other on-going health interventions. Certainly the ideal solution is great on-going health care and health promotion for all, and if that were an option, it would win hands down.

Specializes in Accepted...Master's Entry Program, 2008!.
2) Circ'ing might be cost-effective versus the cost of caring for an infected patient, decreased further transmission, and the cost to society of the death of so many, especially mothers.

Is there actually any cost associated with the "care" of an infected patient? What is the standard African treatment?

3) I haven't heard that uncirc'd men are more likely to use condoms than circ'd men. I have heard that sensation is decreased in circ'd men which means that a condom would only further decrease sensation but that doesn't mean than uncirc'd men are willing to use condoms more consistently than circ'd men. In regard to dry sex, I don't see how circumcision would make a difference in regard to the woman's empowerment. Maybe you can expand on this argument.

Well, this is not my finding. But I digress: from what I read into this, an uncirc'd man will more readily force the issue of condomless sex, as condoms will further decrease an already desensitized member.

I postulate that circumcision would have the opposite effect on dry sex - decreasing or ending it completely. I can see how an intact male could have dry sex, I cannot fathom how a circumcised male would physically be able to do this. Unless I'm missing something, this finding tends to find in favor of circumcision.

1) Kinda hard to have an ethically done research study without volunteers. Research does have limits in being able to answer questions for us.

I still think it is a valid point. It indicates that volunteers may have been more concerned about HIV transmission to begin with - after all, they are volunteering for a HIV study. They may have been more careful than the average African in regards to disease prevention. It shouldn't be hard to do an "involuntary" study to see if this single factor affects the outcome.

Specializes in Critical Care.

OK, I haven't weighed in on this thread in awhile in the hopes that it would right itself back into a discussion of reducing HIV. However, I feel the need to debunk some of the anti-circ propaganda. Some of what I'm going to say might be a tad graphic, but not crude, and we are all grownups.

1. The idea of selling foreskins for mass profit is patently silly. It doesn't pass the smell test. A. Give me something besides anecdotal evidence that doctors are getting a large 'cut' of the profit from aftermarket selling of foreskins. B. Many of you witness circs everyday as part of your jobs: how many of you have outlined procedures for the handling and packaging of foreskins for later resell? C. Even presuming there is more than silliness to the claim, how many of you that strongly disapprove of such uses for non-essential parts support the use of embryonic stem cells, a procedure known to absolutely destroy its donor? It's silly to claim that doctors are making huge profits by performing a procedure that is being performed simply because it's in high demand. Not only that, but it is downright slanderous to state that so many doctors view their bottom line so much more valuable then their patient advocacy. In fact, I would go so far as to say that most doctors today completely yield the decision to parents, and STILL, a majority of them opt for circumcision.

2. The whole human rights violation argument is rubbish. As a parent, I have an obligation to determine what is in the best interests of my child. There ARE benefits to being circ'd, reduction of infections, cancer, etc. While it IS true that many professional organizations now advocate that the risk/benefit is a wash, it is NOT true that there is no benefit at all. That's a parent's decision to make, in the best interest of their children. It's no different then giving your child immunizations, and I don't see many arguing THAT is a human rights violation. Combine this with the fact that memory of pain is a strong inducement against the performance of such a procedure as an adult (along with several others, including embarrassment to undergo such a procedure as an adult, missed work/healing time, gossip, and observable body image differences) and the argument that a child should be able to make that decision, AS AN ADULT can be viewed as a form of abuse - if you, as a parent, feel that the procedure is in their best interests.

3. The argument that the risk is too great doesn't bear fruit. Even if you take the oft cited stat of 1/500,000 mortality, that still not only falls well below the incidence of death by penile cancer and other diseases such as UTIs and STDs that could be prevented to make this argument unsubstantiated against a real measure of risk/benefit.

4. The whole sensitivity debate is a wash. Those that have not been circ'd cannot compare their experience to those that have anymore than the other way around: it's altogether subjective. For those that have been circ'd as an adult, the real studies of their preferences have been completely conflicting in their data. While some studies show a decrease in sensitivity, other studies show an increase in overall sexual satisfaction.

5. What CAN be proven in studies is that circ'd men have more varied sexual experiences. 71% of women in a study by a national urology assoc. preferred circ over non-circ and circ'd men were 1.44 times more likely to be offered to be engaged in oral sex. In fact, contrary to popular imagery about the original purpose of circs, circ'd males are much more likely to masturbate, another greater avenue to 'varied sexual experiences'. In addition, circ'd males are much less likely to be subject to premature ejaculation - widely considered a sexual disfunction: especially if you are that male's female mate.

6. Comparisons with female mutilation are completely specious. The purpose of female mutilation is to deprive a person of sexual gratification. The purpose of circ'ing a male is hygiene and/or religious reasons. In fact, male circ cannot be proven to deprive either a sexual drive or sexual sensation. There is absolutely no proof of this oft repeated claim. Given the fact that circ'd males have a greater variety of sexual experiences, the issue, absent any real evidence of sensation differences has to give an advantage to being circ'd for the numerical and variety differences.

7. Survey's of male adolescents have found that there are more uncirc'd males stating that they wished they had been circ'd then the other way around.

The are benefits to being circ'd. Whether those benefits outweigh the extremely small risks involved is a parental decision. If you don't want your child circ'd simply put: don't do it. But absent any clear contraindication -and there is none, it is simply not anybody's place to force their belief system wholesale on others. There IS no great and pressing moral rationale to browbeat parents about their legitimate healthcare decisions regarding their children.

Those against circs have no more right to force their belief system on others then to have their child being circ'd forced on them. The problem with trying to force YOUR belief system on others is that you open the avenues for having the belief systems of others forced upon you. Once you concede that this is a 'pressing moral issue' that requires an enforced outcome, you open up the possibility that, should concensus decide that the moral issue is in favor of circumcision, that you also must yield to the pressing moral tide, should that tide someday turn.

Bottom line, the risk/benefit plays out differently for those with different belief systems. The RIGHT to exercise YOUR beliefs on the matter is contingent upon those that hold a different belief system having an equal RIGHT. It simply isn't a moral issue. There is a danger to either side of the debate when we make it an emotionally packed, moral issue. The danger is in the way the tide blows in.

It simply isn't wise to charge such an issue with such emotion and passion unless you are also willing to concede to whatever direction such emotion and passions steers the debate.

Sex and Circumcision – how circumcision impacts physical sexual sensitivity

Debunking the Anti-Circumcision myths

Sex and Circumcision - Impact of Circumcision on Sexual Pleasure

I highly recommend reading the below article for a full round debate on the issue:

How not to argue about circumcision

~faith,

Timothy.

Specializes in Accepted...Master's Entry Program, 2008!.
The idea of selling foreskins for mass profit is patently silly. ......how many of you that strongly disapprove of such uses for non-essential parts support the use of embryonic stem cells, a procedure known to absolutely destroy its donor?

I have no doubt that the foreskins are being sold and used. I doubt that it involves "mass profits" or that any doctor is performing such procedure for profit (hospitals are a completely different story). However, hospitals or other providers certainly could charge whatever they want. After all, this cannot be made in a lab. It is human tissue that carries a relatively high price.

Careful with the use of non-essential parts. While it's true that it will not kill you, the same could be said of the ears, nose, eyebrows, or various fat deposits about the body. While not essential, I would not approve of the removal of ears or a nose, just because said removal does not kill the patient.

This company uses foreskins: CCR: Neonatal Foreskin Epidermal Keratinocytes

Ethical use of human tissue, see page 23, section 4.3

http://www.nuffieldbioethics.org/fileLibrary/pdf/human_tissue.pdf

2. The whole human rights violation argument is rubbish. As a parent, I have an obligation to determine what is in the best interests of my child. There ARE benefits to being circ'd, reduction of infections, cancer, etc. While it IS true that many professional organizations now advocate that the risk/benefit is a wash, it is NOT true that there is no benefit at all. That's a parent's decision to make, in the best interest of their children. It's no different then giving your child immunizations, and I don't see many arguing THAT is a human rights violation. Combine this with the fact that memory of pain is a strong inducement to the performance of such a procedure as an adult and the argument that a child should be able to make that decision, AS AN ADULT can be viewed as a form of abuse - if you, as a parent, feel that the procedure is in their best interests.

Incorrect, IMO. It is not the parents' responsibility to determine the removal of a body part. As you are aware, the foreskin contains a very high amount of nerve cells, including the frenulum - a very nerve dense area that contributes greatly to the sensation felt. By the same argument, would you say that it is fair for adults who have a family history of breast cancer to remove the breasts as a prevention?

In addition, men who have undergone one of the many foreskin restoration methods have reported a restoration of feeling that they didn't know existed (Myself included. This is not anecdotal, it is my own personal experience.)

Finally, I have never used pain in my discussions. I do not think that is relevant. My issue is not with pain, but with the loss of the tissue itself. Pain is temporary, the tissue and associated nerves can never be replaced.

4. The whole sensitivity debate is a wash. Those that have not been circ'd cannot compare their experience to those that have anymore than the other way around

In my own personal experience, there is a huge difference. While I can never be truly restored, simply restoring what I can makes a HUGE difference.

5. What CAN be proven in studies is that circ'd men have more varied sexual experiences. 71% of women in a study by a national urology assoc. preferred circ over non-circ and circ'd men were 1.44 times more likely to be offered to be engaged in oral sex. In fact, contrary to popular imagery about the original purpose of circs, circ'd males are much more likely to masturbate, another greater avenue to 'varied sexual experiences'. In addition, circ'd males are much less likely to be subject to premature ejaculation - widely considered a sexual disfunction: especially if you are that male's female mate.

There are a host of problems associated with circumcision, including ED. I have also experienced this. Note that the US has one of the world's highest circumcision rates, and also is the largest user of ED drugs. In respect to the "varied sexual experiences", I postulate that if NO males were circumcised, an intact member would be considered a "normal" member, rather than a bizarre oddity.

6. Comparisons with female mutilation are completely specious. The purpose of female mutilation is to deprive a person of sexual gratification. The purpose of circ'ing a male is hygiene and/or religious reasons. In fact, male circ cannot be proven to deprive either a sexual drive or sexual sensation. There is absolutely no proof of this oft repeated claim.

I personally have experienced some benefit from restoration. I can only imagine being fully intact. As you know, both female and male genitalia come from the same group of cells and cannot be distinguished in the earliest stages. Removal of the foreskin is akin to removing the clitoral hood. Wouldn't removing the hood result in the exact same benefits as circumcision? Reduced infections, cancer, etc. Why then, do we not remove the hood in females?

7. Survey's of male adolescents have found that there are more uncirc'd males stating that they wished they had been circ'd then the other way around.

I wish I had not (and I suspect that more men feel the same way - but will not admit and/or discuss it). If I had not been, I would be able to make that decision on my own. You can be circumcised at any stage of life. You can never be uncircumcised.

Again, I wonder whether this would be true if there were NO circumcised men? I think not.

The are benefits to being circ'd. Whether those benefits outweigh the extremely small risks involved is a parental decision. If you don't want your child circ'd simply put: don't do it. But absent any clear contraindication -and there is none, it is simply not anybody's place to force their belief system wholesale on others.

.....

~faith,

Timothy.

My concern has nothing to do with the risk of infection or death (driving a car daily is far more dangerous than any circumcision), and everything to do with an irreversible decision not made by the person, but by someone else.

I argue that performing a circumcision without a child's consent is forcing the belief of the parents and society as a whole on the child. The child has no say in the matter and is therefore subject to someone else's belief. The very point that you are arguing against.

It seems to me that none of the "benefits" can really be proven. This includes the ambiguous claims of reduced infection or cancer rates. It seems to me the entire issue of circumcision really revolves around aesthetics. "So he looks like his dad" or "So he is the same as everyone else". I cannot recall a great deal of staring at my childhood friends' genitals, nor do I recall ever seeing my father's. The idea of "looking like everyone else" is absurd and incomprehensible to me. And why this idea focuses on genitals is even more silly. We don't walk around nude, and staring at another's "privates" is a social faux pas. I would worry more about height and/or weight (and judging by America's ever expanding waistline, this just isn't the case).

I think the practice is silly, worthless, and generally causes more problems than it allegedly solves. This doesn't even take into account the senseless claim that it would resolve much of the HIV problems in Africa.

4. the whole sensitivity debate is a wash. those that have not been circ'd cannot compare their experience to those that have anymore than the other way around: it's altogether subjective. for those that have been circ'd as an adult, the real studies of their preferences have been completely conflicting in their data. while some studies show a decrease in sensitivity, other studies show an increase in overall sexual satisfaction.

speaking as a woman who used to be a teenager and hung around with teenage boys and had a teenage boyfriend and as a woman who has been married a couple of times and who has never seen an uncircumcised man and as the mother of 3 boys (granted one is 5 but he found his member at a young age while in the bathtub like most young boys but two of my sons are adults) . . . . . . . .. i'd have to say that hormones which determine sexual attraction and sexual gratification have more to do with sexual satisfaction than whether a guy has a foreskin or not.

those teenage boys were and still are "randy" . . . . . so to speak. having a foreskin or not makes no difference . . . look at an attractive woman - a man's best friend stands to attention. :monkeydance: and in my experience as a married woman, that continues to be the case even at my advanced age. ;) keep in mind i didn't want to have my boys circ'd - both my ex and my now dh made that choice.

as to restoration - docs cannot reattach nerves can they? how do you have any feeling in restored skin? just asking . . . .

"pain is temporary, the tissue and associated nerves can never be replaced."

as others have mentioned, circumcision probably isn't the best way to go about making a sea change in behavior in africa . . . .

steph

it seems to me that none of the "benefits" can really be proven. this includes the ambiguous claims of reduced infection or cancer rates. it seems to me the entire issue of circumcision really revolves around aesthetics. "so he looks like his dad" or "so he is the same as everyone else". i cannot recall a great deal of staring at my childhood friends' genitals, nor do i recall ever seeing my father's. the idea of "looking like everyone else" is absurd and incomprehensible to me. and why this idea focuses on genitals is even more silly. we don't walk around nude, and staring at another's "privates" is a social faux pas. i would worry more about height and/or weight (and judging by america's ever expanding waistline, this just isn't the case).

hi again - i had to smile when i read the above because in my experience, boys do look.

during potty training it is daddy who shows son how to pee in the toilet. we've also been known to pee in the woods while cutting firewood - both dad and sons together.

my #2 son used to "pee for distance" by standing against the wall in the bathroom and aiming for the toilet. both my sons' have written their names in the snow.

at a dinner at a friend's home, their 3 year old son needed to pee and daddy took him and must have gone pee too because the 3 year old came back to the table and said "my daddy has a big member". ;):D

we took my youngest son and his friend to a logging show last year and dh took them both to the bathroom and while they were peeing they looked at each other and one child said to the other "my who-who is bigger than yours". competition starts early with boys . . . :rolleyes:

our policy is to not make a big deal out of this stuff - it is normal and natural to wonder about that thingamabob between their legs . . . and wonder they do.

i have three sons . . . and one daughter . . . .

steph

Specializes in Accepted...Master's Entry Program, 2008!.

as to restoration - docs cannot reattach nerves can they? how do you have any feeling in restored skin? just asking . . . .

no. in fact, the nerve tissue has been discarded. you can opt for surgery if you are very wealthy, but if not, one must resort to stretching, which uses a variety of techniques to increase the surface area of the skin on the shaft to cover the glans. that is all either option does. cover the glans.

this results in a couple things. the surface of the glans but a moist mucous membrane. without the foreskin, the glans becomes dried, toughened, and has decreased sensitivity. stretching the skin and allowing it to cover the glans once again results in thinner skin over the glans as well as moisture retention. in my experience, this results in a much stronger sensation, which really wasn't a problem until i got into my 30s.

you can definitely see (and feel) the dramatic softening and thinning of the skin. reportedly the slackness generated increases pleasure for both partners.

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