Survey on infant male circumcision

klone, MSN, RN · Dec 9, 2014

Polydactyly is an abnormality. A foreskin is not. If every single infant was born with extra digits and the extra digits provided a function. then no, I would not consider removing them.

Esme12, ASN, BSN, RN · Dec 9, 2014

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SubSippi · Dec 9, 2014

Polydactyly is an abnormality. A foreskin is not. If every single infant was born with extra digits and the extra digits provided a function. then no, I would not consider removing them.

I think that is definitely a valid differentiation, and is why I can say I would not hesitate to elect having extra digits...or a tail...removed from my baby, while at the same time being undecided in any future decisions I may make regarding circumcision of my fictional male newborn.

However, my question wasn't solely looking for reasoning that could qualify these procedures for separate categories (i.e. the morally right and the morally wrong categories, as opposed to lumping them together because they are all body parts). I was interested to see what people had to say in regards to the argument that a parent should not have their newborn circumcised because it is not a part of the parent's body, it is a part of the baby's body, and that baby deserves the right to be the one to make that decision.

allnurses Guide · Dec 9, 2014

Do you give parents who have their girls "circumcised" the same pass? Because they claim all the same reasons and excuses for having that done, and really, they're just trying to do their best....

This has already been discussed. There is absolutely no comparison between male circumcision and Female genital mutilation. The WHO states there are several medical and public health benefits from male circumcision and none from FGM.

allnurses Guide · Dec 9, 2014

Having seen this procedure performed and the bleeding that can occur afterward (had an emergency during my preceptorship r/t circ), not to mention the risks and the minimal long term benefits, I have strong feelings I would never tell my patients. However, when I was pregnant with my son, I spoke with my brother about this topic, because he considered circumcision as an adult. He had hypersensitivity issues during sex when he didn't use a condom, to where it was painful. I remember him going through the consults and such. He ultimately decided not to go through with it, and has since managed to survive sex without a condom (AEB his daughter, a planned pregnancy). I also spoke with other men in my life who are or aren't circ'ed. At the time, and APA recommended against it. It seems like every few years they go from one side to the other and back again.
While I recognize that the procedure is more complex as an adult, I believe that it's a decision that should generally be left to the owner of said member. I will, however, support a patient's decision for how they choose to parent their child. As I work in a birth center and plan to be a CNM, this is a very relevant topic for me.

The research doesn't support differences in sexual function between circumcised or uncircumcised men, but I am sure for some people that have this done as adults it can take a long time adjust. Does male circumcision affect sexual function, sensitivity, or sati... - PubMed - NCBI

allnurses Guide · Dec 9, 2014

I don't think its a major issue either way but I think it's non sensical to use circumsicon as a way to avoid a relatively small number of preventible conditions. We'd do more for the individual (off the top of my head, just making this up here) by performing preemptive appys and choles then circ's. Or for for public health by banning fast food including Starbucks and all,of their addictive sugar than lives changed and improved removing a natural body part.
And I still strongly believe that many just want to circ because they find foreskin unappealing, or are worried about those that do.

There will always be a cultural and religious aspect to male circumcision no one is denying that, but trying to deny that there is obvious significant medical and public health benefits from male circumcision isn't true. These differences cannot be made for by further health education or hygiene either.

[h=2]"Cost-benefit[/h]A cost-effectiveness study that considered only infant urinary tract infections and sexually transmitted infections (STIs) found that if male circumcision rates were to decrease to the levels of 10% typically seen in Europe, the additional direct medical costs in infancy and later for treatment of these among 10 annual birth cohorts would exceed $4.4 billion, even after accounting for the cost of the procedure (average, $291; range, $146-$437) and treatment of complications (average cost, $185 each [range, $130-$235]; prevalence, 0.4% [range, 0.2%-0.6%]).52 Each forgone infant circumcision procedure was estimated to lead to an average of $407 in increased direct medical expenses per male and $43 per female.52 This analysis did not consider other conditions, and neither did it consider the indirect costs. It seems logical then that this analysis might have greatly underestimated the true cost. The study adds to one by the CDC that found that neonatal male circumcision was cost-saving for HIV prevention, at least in black and Hispanic males, in whom HIV prevalence is highest.42 An Australian analysis of genital cancer prevention found that neonatal circumcision provides at least partial cost savings for these.53

A study of a Medicaid birth cohort of 29,316 found that for every year of decreased circumcision due to Medicaid defunding there would be more than 100 additional HIV cases and $30 million in net medical costs as a result of these.54The cost to circumcise males in this birth cohort was $4,856,000. Modeling has found that cost savings initially generated by noncoverage of elective circumcisions by Medicaid in Louisiana55 and Florida56 was mitigated by increases in the rate and expense of medically indicated circumcisions. The Louisiana study considered only the costs of these for boys aged 0 to 5 years. Lifetime costs would represent a much greater financial impact on health care systems. The Florida study involved males aged 1 to 17 years undergoing circumcision between 2003 and 2008 and found that Medicaid defunding was followed by a 6-fold rise in publicly funded circumcisions (cost = $111.8 million).[COLOR=#336699]" http://www.mayoclinicproceedings.org/article/S0025-6196%2814%2900036-6/fulltext

"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]."

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

Jump to SectionWhat the Latest Rates Data ShowPediatric RecommendationRisk-BenefitAccess and FundingCost-benefitEthical and Legal IssuesConclusionSupplemental Online Material

Red Kryptonite · Dec 9, 2014

The research doesn't support differences in sexual function between circumcised or uncircumcised men, but I am sure for some people that have this done as adults it can take a long time adjust. Does male circumcision affect sexual function, sensitivity, or sati... - PubMed - NCBI

If there are no differences, then exactly to what are they adjusting?

allnurses Guide · Dec 9, 2014

If there are no differences, then exactly to what are they adjusting?

Okay, let's see you have surgery then you have to heal. That is the adjustment. That area is going to be tender until it is completely healed.

"Conclusion: The highest-quality studies suggest that medical male circumcision has no adverse effect on sexual function, sensitivity, sexual sensation, or satisfaction."

Libby1987 · Dec 9, 2014

There will always be a cultural and religious aspect to male circumcision no one is denying that, but trying to deny that there is obvious significant medical and public health benefits from male circumcision isn't true. These differences cannot be made for by further health education or hygiene either.
"Cost-benefit
A cost-effectiveness study that considered only infant urinary tract infections and sexually transmitted infections (STIs) found that if male circumcision rates were to decrease to the levels of 10% typically seen in Europe, the additional direct medical costs in infancy and later for treatment of these among 10 annual birth cohorts would exceed $4.4 billion, even after accounting for the cost of the procedure (average, $291; range, $146-$437) and treatment of complications (average cost, $185 each [range, $130-$235]; prevalence, 0.4% [range, 0.2%-0.6%]).52 Each forgone infant circumcision procedure was estimated to lead to an average of $407 in increased direct medical expenses per male and $43 per female.52 This analysis did not consider other conditions, and neither did it consider the indirect costs. It seems logical then that this analysis might have greatly underestimated the true cost. The study adds to one by the CDC that found that neonatal male circumcision was cost-saving for HIV prevention, at least in black and Hispanic males, in whom HIV prevalence is highest.42 An Australian analysis of genital cancer prevention found that neonatal circumcision provides at least partial cost savings for these.53
A study of a Medicaid birth cohort of 29,316 found that for every year of decreased circumcision due to Medicaid defunding there would be more than 100 additional HIV cases and $30 million in net medical costs as a result of these.54The cost to circumcise males in this birth cohort was $4,856,000. Modeling has found that cost savings initially generated by noncoverage of elective circumcisions by Medicaid in Louisiana55 and Florida56 was mitigated by increases in the rate and expense of medically indicated circumcisions. The Louisiana study considered only the costs of these for boys aged 0 to 5 years. Lifetime costs would represent a much greater financial impact on health care systems. The Florida study involved males aged 1 to 17 years undergoing circumcision between 2003 and 2008 and found that Medicaid defunding was followed by a 6-fold rise in publicly funded circumcisions (cost = $111.8 million).[COLOR=#336699]" http://www.mayoclinicproceedings.org/article/S0025-6196%2814%2900036-6/fulltext
"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]."
http://www.cdc.gov/hiv/pdf/prevention_research_malecircumcision.pdf
Jump to SectionWhat the Latest Rates Data ShowPediatric RecommendationRisk-BenefitAccess and FundingCost-benefitEthical and Legal IssuesConclusionSupplemental Online Material

I didn't deny that there are benefits. I also haven't said that I think the decision should be taken away from the parents.

I would like like to be able to express an obvious personal opinion that isn't veiled as fact (I even included "I was making this up") without being rebutted.

allnurses Guide · Dec 9, 2014

I didn't deny that there are benefits. I also haven't said that I think the decision should be taken away from the parents.
I would like like to be able to express an obvious personal opinion that isn't veiled as fact (I even included "I was making this up") without being rebutted.

I agree it should be up to the parents to make that decision. What I disagreed with was your assumption that there was minimal/ "small number" of benefits.

I don't think its a major issue either way but I think it's non sensical to use circumsicon as a way to avoid a relatively small number of preventible conditions.

I think there is more than enough scientific literature to show that there are significant medical and public health benefits from male circumcision.

Red Kryptonite · Dec 9, 2014

Whew, wtbcrna, your absolute dedication to defending the slicing up of memberes is impressive. I mean you just always come back and answer every post that even mildly suggests that perhaps the benefits sought through circumcision are better achieved in other, less invasive ways.

Libby1987 · Dec 9, 2014

I agree it should be up to the parents to make that decision. What I disagreed with was your assumption that there was minimal/ "small number" of benefits.
I think there is more than enough scientific literature to show that there are significant medical and public health benefits from male circumcision.

Speaking theoretically there would be multi fold more benefits to removal of fast food since education isn't working for most of us (2/3rds?) if we can't get the very low numbers of foreskin related preventable conditions (hygiene and safe sex practices) lowered with education and the conclusion is removal of the secondary cause, then why don't we don't take away processed food and cigarettes from those who can't seem to be educated, a whopping 2/3rds of us including a significant number of nurses on this board (statistically) ? ..If that's how we're going to implement significant public health benefits and really irradiate disease.

We want to give up our boys' foreskin but not our Starbucks, that's how it's non sensical to me, regardless of how many studies are posted.

Survey on infant male circumcision

Do you agree with AAP's policy statement on male circumcision?