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 :)

[Elvish, BSN, DNP, RN, NP]

The arguments I've seen most people give for FGC being so horrible (and it is) is that 1) it's done with no anesthesia; 2) it's done in less-than-sterile condition; 3) it's done for removal of sexually functioning organs; and 4) it leaves women crippled for life.

I would encourage any of you in this debate to read the book Warrior Marks by Alice Walker (author of The Color Purple). She traveled to Africa and talked with people associated with FGC. She talked with mothers, fathers, daughters, husbands, doctors, and the people doing the cutting. It is very interesting and shocking. And most unnerving perhaps is that the same reasons people give for having their daughters cut are exactly the same reasons folks here give for having their sons cut.

Here, if you even make a ceremonial pinprick in your daughters' labia you're in the pokey for child abuse, rightly so.

[MIcrunchyRN]

FYI, the AAP does not recommend circ to prevent penile cancer. Here is a link to their policy statement: http://aappolicy.aappublications.org/cgi/content/full/pediatrics%3b103/3/686

They discuss that cases of penile cancer may be higher in uncircumcised men, but that reliable data does not exist to be sure. Also, due to the fact that the rate of penile cancer is around 9 per 1 million men in the US it really isn't even a consideration.

Ah yes that is their current stance...it didn't use to be that way. I will have to ask our ped about it tho, because the ped who we seen that night (diff doc in practice) said AAP says "____" .

Our ped says the rates of non-circ's is on the rise and that half of the patients in her practice are not circ'd. Will be interesting to see if the US slowly starts to move out of having circs done so regularly.

Off topic... any L&D nurses have circ talks with new parents? Or do you feel that is over the line?

[MIcrunchyRN]

The arguments I've seen most people give for FGC being so horrible (and it is) is that 1) it's done with no anesthesia; .

I think the reason some people compare circ to FGC is because many circs are still practiced on newborns without anesthesia and just sugar water and a finger or pacifyer.

[Elvish, BSN, DNP, RN, NP]

Off topic... any L&D nurses have circ talks with new parents? Or do you feel that is over the line?

I don't do L/D per se. I do high-risk antepartum and mother/baby/newborn nursery. I have that talk w/ parents all the time. It's about 50/50 whether I initiate it or they do. I don't initiate unless I've got a rapport already. I'm not a 'You are horrible parents because you've chosen circ' sort of nurses. I just say, 'Ya know, there's a lot of misinformation floating around out there, and most of the rest of the world doesn't circ...'. and go from there. I can't think of a time when it hasn't gone positively, even though parents don't normally change their minds.

[BlueRidgeHomeRN]

so it's ok to mutilate a boy's member but not a woman... biased much?

.

ah, stanley, king of the biting riposte...

fgm does not remove just the clitoral hood--if so, there would be a comparison. since it involves removal of the entire privy parts and sewing of labia together, i will concede a analogy when circumsion involves penile amputation with surgical closure of the new wound..at age five or so.

[Spidey's mom, ADN, BSN, RN]

ah, stanley, king of the biting riposte...

fgm does not remove just the clitoral hood--if so, there would be a comparison. .

i dunno . . . removing the clitoral hood = no orgasm.

removing the foreskin is not the same.

i'm not an advocate for circumcision (elvish - we violated our rule about posting:coollook:). however all 3 of my boys are circ'd but that is due to the father, not the mother.

i am an advocate of education and then letting the parents make the choice.

i see no comparison between fgm and circumcision.

steph

[AirforceRN, RN]

so what prompted our choice? prior to the birth of our first son (and back then gender was unknown until birth barring an amniocentisis) one of my husband's young soldiers required a circumcision for phimosis and chronic uti's--at age 20. the mental trauma was awful, and since sutures were required, medical intervention (not sure what, guessing now antihypertensives or a nerve block) was required to prevent physiological nocturnal erections.

my wife's mother suffered horribly during her illness and subsequent treatment with breast cancer. my best friend when i was a kid spent over a week in the hospital and almost went septic with appendicitis. my grandmother had a dvt which caused an awful lot of pain and almost took her life.

if we followed the same logic you did we would have a pretty funny looking kid. why is it wrong to do it with breasts, appendixes, arms, legs etc but its okay to do it with a member? granted the surgery for circumcision is less involved but it still presents certain risks including infection and poor healing.

your husband's soldier is by far the minority in this circumstance.

[AirforceRN, RN]

The WHO breaks female genital mutilation into 3 categories, Types I, II and III, depending on the amount of genital tissue removed. Type I is further subdivided into Ia and Ib. Ia is defined as removal of the clitoral prepuce only...so it does happen.

[Elvish, BSN, DNP, RN, NP]

There was a really interesting article in AWHONN's magazine last year about female genital cutting.

Some really interesting things I took away from it:

1) As barbaric as we think it is, a more proper term to use is female genital cutting (FGC) versus 'mutilation'. This is because many women who have undergone this type of thing don't consider themselves to be 'mutilated.' (Sound familiar?)

2) The different types of FGC, which have already been alluded to.

Type I - removal of the clitoral prepuce, with or without the privy parts.

Type II - removal of of the privy parts with some or all of the labia minora removed as well

Type III - Removal of all the external genitalia sewing the lady partsl introitus shut (infibulation).

Then there is the 'unclassified' stuff - pricking, cauterizing, making ceremonial cuts in the tissue without actually removing anything. It is all considered in the category of FGC.

[secretspectrum]

There are many similarities between female circumcision and male circumcision, in regards to culture's justification for both of them. In both cases the reasons for doing so is cited as hygiene, appearance, and decrease in sexual pleasure. (Decrease in sexual pleasure is one major reason male circumcision was popularized in the U.S. in Victorian times.They thought it would stop males from masturbating, and they mistakenly believed masturbation caused a lengthy list of ailments, including blindness) In both cases is it is done on unconsenting children, often without anesthesia. The patients themselves are not consenting to these surgeries.

"Circumcision is a procedure that medical associations worldwide agree is not justified. It is a culturally sanctioned cosmetic amputation. Circumcision forever excises a normal body part with several functions: protecting the member, enhancing the body's immunological resources, and providing specialized erogenous tissue. Parents cannot really know what their son would want, so the best decision is to leave the healthy foreskin alone. For parents to take away so intimate a part of their son's body without his consent, barring true medical need, is wrong."—Steven Svoboda the founder of Attorneys for the Rights of the Child

[Southernurse]

when it came time for our newborn son to be scheduled for a circ, my husband and i spoke to his pediatrician. we left the decision up to her, and would have done whatever she told us. thankfully, she said that it was not a medically necessary procedure. she told us that there has been and forever will be conflict over it, but without medical necessity, that sealed it for us. my husband was dead against it anyway, and i saw no real need to do it either. i would also like to say that my son has never had any issues. there has been no infection, not even any redness. he is scrupulously clean. as for any diseases that may have more susceptibility, i must side with the behavior factor. sex is a dangerous game nowadays, and a person with or without surgery can get sick or die. if we don't want to be responsible for our actions concerning sex and depend on surgery as our panacea, maybe all our parts should be removed that we cannot be trusted with. makes no sense does it?

[Aislstarfish]

http://today.reuters.com/news/articlenews.aspx?type=healthNews&storyid=2006-12-13T205927Z_01_N13463413_RTRUKOC_0_US-AIDS-CIRCUMCISION.xml&src=rss&rpc=22

"A U.S. National Institutes of Health study in Kisumu, Kenya, involving 2,784 men aged 18 to 24 showed a 53 percent reduction of HIV infections in circumcised men compared to uncircumcised men. A parallel study involving 4,996 men aged 15 to 49 in Rakai, Uganda, showed circumcised men were 48 percent less likely than uncircumcised men to become infected."

"Researchers previously had noticed that in places where circumcision is common, HIV was less common."

This might explain why heterosexual transmission is much less rampant in the United States specifically, and West generally. There is a much higher incidence of circumcision here.

~faith,

Timothy.

Has it occurred to anyone that the countries that circumcise their children more often also have more money, education and access to prophylactics.. and that THAT could be the reason HIV is less prevalent????

I mean, come on... a foreskin is NOT going to increase the probability of getting HIV. That is absolutely ridiculous! It's a piece of skin, that's SUPPOSED to be there. HIV is transmitted through bodily fluids, not foreskins, hahah.