The Circumcision Discussion

[jmspeach]

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 :)

[jncRN]

"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.

As a woman who has been diagnosed with HPV and, since then, pre-cancerous cervical cells, and who has had only ONE sexual partner, who is a CIRCUMCISED male, I just want to remind everyone that circumcising males is not going to wipe out HPV or HIV, there will still be transmission regardless.

I agree with one of the previous posters: that the risk of infants being circumcised by people with questionable credentials/experience and in possibly unsanitary conditions, and the consequent risks of infection and mortality, (not to mention the question of who would pay for these procedures in the impoverished countries of which we are speaking), need to be carefully considered before we start making decisions.

I also find it worth noting that the poster who began this thread started out by touting statistics to make his case for circumcision, but his argument, when followed throughout the thread, seems to have become more and more personal -- culminating in more of a defensive stance based on the fact that he himself is circumcised and chose to have his sons circumcised, rather than based on any scientific "proof" of the superiority of the circumcised member.

Not to insinuate that the original poster is not entitled to his opinion. We all are. But let's be honest about where our opinions are coming from...are they based in actual credible, reproducible research findings...or are they based on societal norms and/or personal preferences?

[carolinapooh, BSN, RN]

http://news.yahoo.com/s/ap/20070223/ap_on_he_me/aids_circumcision;_ylt=AqxyqaUoyWJNngKD1epBWPJa24cA

23 Feb 2007:

"LONDON - Scientists say conclusive data shows there is no question circumcision reduces men's chances of catching HIV by up to 60 percent — a finding experts are hailing as a major breakthrough in the fight against AIDS. The question now is how to put that fact to work to combat AIDS across Africa."

~faith,

Timothy.

I still wonder about the whole condom issue - I just did a massive research presentation for my fundamentals theory class last semester on AIDS in Africa and did an extensive (actually EXHAUSTIVE) literature review on prevention. I never found one article touting circumcision as a preventative factor, nor did I find any literature (and I mean peer reviewed reputable research journals) on any studies done to this effect. With all due respect, any organization can say "scientists/experts state"; we see this all the time on everything from the theory of global warming to predicted stock market trends. Just because "experts" say so doesn't make the issue being discussed solid, verifiable fact, nor does it make any "study" conducted reliable or reproducible.

The main problem that kept coming up, over and over again in the literature during my research, was a reluctance of men in Africa to use condoms due to cultural pressures and beliefs. Again, I did not see one article on any circumcision research; I cited articles and read journals from as many as ten years ago and never found this subject.

So I would question the validity of this supposed research, both statistically and empirically.

[ZASHAGALKA, RN]

As a woman who has been diagnosed with HPV and, since then, pre-cancerous cervical cells, and who has had only ONE sexual partner, who is a CIRCUMCISED male, I just want to remind everyone that circumcising males is not going to wipe out HPV or HIV, there will still be transmission regardless.

I agree with one of the previous posters: that the risk of infants being circumcised by people with questionable credentials/experience and in possibly unsanitary conditions, and the consequent risks of infection and mortality, (not to mention the question of who would pay for these procedures in the impoverished countries of which we are speaking), need to be carefully considered before we start making decisions.

I also find it worth noting that the poster who began this thread started out by touting statistics to make his case for circumcision, but his argument, when followed throughout the thread, seems to have become more and more personal -- culminating in more of a defensive stance based on the fact that he himself is circumcised and chose to have his sons circumcised, rather than based on any scientific "proof" of the superiority of the circumcised member.

Not to insinuate that the original poster is not entitled to his opinion. We all are. But let's be honest about where our opinions are coming from...are they based in actual credible, reproducible research findings...or are they based on societal norms and/or personal preferences?

No one is arguing that circumcision will prevent either. In fact, the statistic is a 60% reduction. 2 millions lives in Africa over the next decade is not a cure-all, but it's a potent cure, if you are one of the 2 million.

In actuality, if you followed my arguments, you would find that throughout the first part of the thread, I tried to keep steering this debate to its usefulness in third world nations and specifically pointed out that, due to the availability of anti-retrovirals and better healthcare, this concept was not on point in our society.

I also pointed out that our societal norms were not at issue in third world nations.

I pointedly DIDN'T steer this discussion towards the personal, or even, towards our culture. I did however, succumb to defending the practice culturally and locally because that is where the thread went.

As far as reproducible research, the research has been carried out by the UN and supported and corroborated by the U.S. NIH. I didn't quote Mother Jones or Matt Drudge, I cited articles that discussed the research of the most powerful governmental research arms at work in the third world.

From the linked article in post #154:

"The full data from the trials, carried out by the U.S.

National Institutes of Health, were published Friday in The Lancet.

"This is an extraordinary development," said Dr. Kevin de Cock, director of the World Health Organization's AIDS department. "Circumcision is the most potent intervention in HIV prevention that has been described."

And for the record, I certainly didn't pick the World Health Org guy that is the UN representative on this discussion.

~faith,

Timothy.

[ZASHAGALKA, RN]

I still wonder about the whole condom issue - I just did a massive research presentation for my fundamentals theory class last semester on AIDS in Africa and did an extensive (actually EXHAUSTIVE) literature review on prevention. I never found one article touting circumcision as a preventative factor, nor did I find any literature (and I mean peer reviewed reputable research journals) on any studies done to this effect. With all due respect, any organization can say "scientists/experts state"; we see this all the time on everything from the theory of global warming to predicted stock market trends. Just because "experts" say so doesn't make the issue being discussed solid, verifiable fact, nor does it make any "study" conducted reliable or reproducible.

The main problem that kept coming up, over and over again in the literature during my research, was a reluctance of men in Africa to use condoms due to cultural pressures and beliefs. Again, I did not see one article on any circumcision research; I cited articles and read journals from as many as ten years ago and never found this subject.

So I would question the validity of this supposed research, both statistically and empirically.

You should really look at the UN World Health Organization and the U.S. NIH for any 'exhaustive' research projects related to health. But let me point out, since your research was on condoms, it is highly possible that you DID miss subject matters related to circumcision.

And the Lancet, is, the last time I checked, a 'peer-reviewed' Journal.

I will grant you this, the biggest news on these issues were first discussed last December, and confirmed yesterday. But, nevertheless, the UN concluded a large study on this in 2004. The current research is important because it is independent confirmation of the UN's original research by the NIH.

In any case, here's a detailed NIH discussion, in conjunction with John Hopkins, on the issue, written a year ago (complete with html representation of powerpoints). This was a presentation to the 13th Annual Conference on Retroviruses and Opportunistic Infections:

http://www.natap.org/2006/CROI/CROI_55.htm

It discusses both the 2004 UN S. African trials AND the current NIH Uganda and Kenya trials. Although, this presentation, being a year old, points to the NIH research as being ongoing - the point of bringing this thread back up is that the NIH concluded its research and released its findings in the Lancet, yesterday.

Let me also point out that the 'expert' I quoted in the last post was NOT just any 'organization' or any 'expert'; he is the World Health Organization's point man on AIDS. It was THAT expert that said yesterday, "Circumcision is the most potent intervention in HIV prevention that has been described."

~faith,

Timothy.

[cbr600]

Don't you love America? " Freedom of Opinion!!!" Timothy, I thought the information you shared was interesting! I also understand Jilli Billi point of view. But I have worked in LTC for 14 Years and I have seen alot of men that are not circumsied and I will tell you they have a lot of problems, infections.. and this is my own study.. This is not based on religion, but health issues...

[bookwormom]

This is perhaps a change of focus, but here is a quote from an article in the most recent issue of Africa Journal of Nursing and Midwifery. Kip, Ehlers and van der Wal summarize research on behaviors of HIV+ people. In their conclusions they state the need to address beliefs about HIV:

"sustained and effective health education must emphasise that condoms do not cause HIV infections; and that HIV/AIDS cannot be cured nor prevented by having sex with a virgin or an elderly woman (grand mother)"

I can see why circumcision is being considered as a means of prevention, but clearly this is a very complicated issue.

[GardenDove]

I doubt if people engaging in promiscuous sex are much interested in following Church teaching on condoms. That's one of the most far-fetched arguments yet, to blame Catholic teaching on contributing to AIDS! LOL!

I can see it now, you're fornicating, but you say"Oh, Catholic teaching now allows me to use a condom to prevent disease, I think I'll put one on!"

LOL:clown: :chuckle

[bookwormom]

I'm not quite sure what post you are referring to about condom use, but I have read some discussion about whether an HIV+ husband would be encouraged to use condoms when he is with his uninfected wife. I recall a Catholic bishop in Africa making a case for condom use in such cases. As it stands, a devout Catholic wife might not feel that condom use would be acceptable.

[GardenDove]

I'm not quite sure what post you are referring to about condom use, but I have read some discussion about whether an HIV+ husband would be encouraged to use condoms when he is with his uninfected wife. I recall a Catholic bishop in Africa making a case for condom use in such cases. As it stands, a devout Catholic wife might not feel that condom use would be acceptable.

This is a rare circumstance, and indeed the wife should be able to protect herself. But, the Church okaying this officially isn't going to make much of an impact on the statistical rates of HIV. The problem is a much, much wider one, rooted in poverty, culture, and epidimiology. As one poster pointed out, circumsized countries don't really have strikingly identifiable HIV rates that corelate with circumcision rates.

In my opinion, the whole thing about memberes and circumcision is entirely emotional and psychological. Something about it makes people very opinionated. I think it's a member thing myself, lets face it, many men have what might be termed 'hang ups' about their memberes. Also, women can get pretty opinionated about memberes. They are extremely important to the whole world in fact. They have so much significance to the human race, going back to cavemen and their phallic artwork.

[bookwormom]

I don't have statistics on the prevalance of different Christian denominations in African countries, but I believe that the church in Africa, as in North America, can have an influence on health beliefs and behavior. My understanding is that women in some African countries really have limited self determination in sexual issues such as requesting condom use by their spouses. Any support the church can give to women has to be considered important.

I think it was pointed out before, that circumcision, at best, may decrease the number of men becoming HIV+. Women married to men who are not monogamous, female sex workers, and women who are raped, may continue with the same incidence of HIV.

I agree that much of the problem is culture, etc, but I do think that the church has a role.

[RN mom of 2]

"But I have worked in LTC for 14 Years and I have seen a lot of men that are not circumcised and I will tell you they have a lot of problems, infections.. and this is my own study.. "

When you say, "LTF, " I assume you mean majority elderly? If this is the case, we have all seen the way many of these places are run. The elderly often have physical/mental ailments that make it difficult to care for themselves properly, and the care they get in some of these facilities is criminal, IMO. I've seen feces under the nails, dirty hair, clothing, smelly skin infections, etc. It's no wonder the intact men are getting penile infections. Also, elderly are more susceptible to infections, due to the breaking down of body systems and lower immunity. So, IMO, the above statement does not qualify as a good argument for circing.

Someone mentioned how focused we are on male genitalia, and while I agree to an extent, my choice to leave my boys intact had nothing to do with this. I just felt (especially as a woman who will never know what it's like to be in a man's body) that it was not my right to take a perfectly healthy functioning body part (which serves a purpose) away from my children. The foreskin is not discardable, just because our culture says it is. I wasn't going to do it just because it's "the norm."

Timothy, I'm curious to know who funded this study. Do you have that info? I'm not saying that the WHO doesn't want to find a way to stop the spread of HIV, but I am wondering if people who may profit from the foreskins are involved in funding these studies.

[ZASHAGALKA, RN]

I doubt if people engaging in promiscuous sex are much interested in following Church teaching on condoms. That's one of the most far-fetched arguments yet, to blame Catholic teaching on contributing to AIDS! LOL!

I can see it now, you're fornicating, but you say"Oh, Catholic teaching now allows me to use a condom to prevent disease, I think I'll put one on!"

LOL:clown: :chuckle

I can completely see people engaging in sex and still respecting the Church's teaching on condoms.

Stigmas are powerful, as they are intended to be. Granted, the urge to have sex is also quite powerful, possibly (probably) powerful enough to overcome the stigma against sex. But, at THAT point, that does not mean that a person throws their whole religion out the window.

Because you lied, does that mean that your stigma against murder is now meaningless?

I think what is more far fetched is the other way around, that merely succumbing to one break in a person's morals means that all the others become suspect as well. I would not think that to be the case.

I don't think the Catholic Church is to blame at all for this epidemic. However, if the Catholic Church sees that a minor alteration in a Church teaching that doesn't change its underlying message (birth control is a sin) could help eradicate an epidemic, then I'm glad the Catholic Church is considering it. It's not that they bear blame; it's that they potentially have the power to assist.

~faith,

Timothy.