Under what circumstances (no pun intended) is circumcision acceptable? - Page 3

Boris Godunov · February 28, 2003, 18:08

Quote:

Originally posted by SlowwHand

If that's your best pickup line, you better count on some lonely nights.

You don't know gay men very well.

Asher · February 28, 2003, 18:09

Quote:

Originally posted by Boris Godunov
You don't know gay men very well.

SlowwHand · February 28, 2003, 18:14

I can't tell you how glad I am you took it in the manner I meant it.
I appreciate that.

lord of the mark · February 28, 2003, 18:17

Quote:

Originally posted by Eli
As long as it's performed by certified doctors, I dont care.

Currently in Israel most of the circumcisions are performed by Rabbies. The are trained for this, but still.

here we have some doctors who are also trained as mohelim. General impression is that mohelim have at least as good success rate as docs, since this is their specialty, they do it all the time, but i have no stats on this.

MichaeltheGreat · February 28, 2003, 18:29

Quote:

Originally posted by Stuie
And for the record, I feel that circumcision of newborns is unwarranted mutilation of the genitals. None of my sons has been circumcized; if that is a choice they make later in life so be it. I feel that my parents made a completely uninformed decision when they had my foreskin lopped off.

The medical benefit to male circumcision no longer exists in areas of the world where biologically safe water supplies for washing are available.

In areas of the world where the biological water quality is questionable, studies still indicate a reduced level of foreskin and urethral infection.

Imran Siddiqui · February 28, 2003, 18:45

Quote:

Besides, you may have gotten laid more than you would have otherwise, because of the common prejudice against the uncut.

Right on

In many parts of the US, it is 'wierd' to be uncut, and many women (if that is your preference) think it is nasty.

If your society does it, I don't see what is so wrong with it? It is unnecessary and causes as much pain as cutting off the umbilical cord or getting an earring (later on in life).

I was cut, and I ain't missing anything.

Asher · February 28, 2003, 18:47

It's an unnecessary surgery, and it's gotten to the point where one of the main reasons it's done is cosmetics (even though it looks worse after

) but because everyone is "used" to it in a region...

If a woman think uncuts are nasty, I'd demand they go get breast implants. Although, most women think they're nasty because they've probably never really experienced one before. From the gay men I've talked to, that's usually the case. Fear of the unknown, in a way.

And I think it's shameful to mutilate children on the basis of some girls thinking cut looks better. They're wrong, anyway.

Imran Siddiqui · February 28, 2003, 18:51

Quote:

It's an unnecessary surgery, and it's gotten to the point where one of the main reasons it's done is cosmetics

So? Getting an earing is an unnessary mutilation of your earlobes for cosmetics (as is any type of piercing). Tatoos is unnessary mutiliation for cosmetics.

Are you going to ban them too?

Guynemer · February 28, 2003, 18:51

Circumcision reduces the risk of penile cancer, and may also reduce the risk of certain STDs.

It most certainly provides health benefits.

Asher · February 28, 2003, 18:53

Quote:

Originally posted by Imran Siddiqui
So? Getting an earing is an unnessary mutilation of your earlobes for cosmetics (as is any type of piercing). Tatoos is unnessary mutiliation for cosmetics.

Exactly, Imran.
So by the same token, I don't think we should be giving newborns tatoos and getting their ears pierced...

If they want either of those, they can get them later in life.

Quote:

Are you going to ban them too?

Who said anything about banning?

Asher · February 28, 2003, 18:54

Quote:

Originally posted by Guynemer
Circumcision reduces the risk of penile cancer, and may also reduce the risk of certain STDs.

It most certainly provides health benefits.

Not to contradict a med student, but: http://www.cirp.org/library/disease/cancer/

Quote:

The alleged relationship between "lack of circumcision" and genital cancers formerly implicated smegma or smegma-borne pathogens as the causative agent. Only two histologic studies of human smegma ever have been conducted, both of which found it to be perfectly harmless. Smegma is composed of secretions of ectopic sebaceous glands in the prepuce mixed with secretions of the prostate, seminal vesicles, mucin from the urethral glands, and desquamated epithelial cells.10,12

The hypothesis that human male smegma is carcinogenic was first formulated in 1932 by circumcision promoter Abraham L. Wolbarst, M.D.1. Wolbarst also believed that circumcision prevented epilepsy. (In the early part of the 20th Century, the paroxysm of masturbation in children was often misidentified as an epileptic seizure.) Wolbarst wrote: "[Circumcision] diminishes the tendency to masturbation, convulsions and other reflex phenomena of local irritation." Wolbarst's beliefs about circumcision were shared by other writers, such as Peter Remondino and Abraham Ravich.

No laboratory or clinical research had been done on the subject at the time. Regardless, Wolbarst's hypothesis about smegma and cancer found its way into early medical textbooks. In the 1950s a few experiments were done to test the hypothesis by injecting horse smegma into wounds made in the backs of mice. There were clinical studies that attempted to induce cancer by introducing smegma subcutaneously and intravaginally: No carcinomas could be induced.

The smegma hypothesis was finally disproven by an exhaustive study by Reddy2 in 1963. His results were: "The conviction that human smegma is a carcinogen could not be substantiated."

And what's more:

Quote:

Post-circumcision cancer may occur at the circumcision scar.13,19 The cause is unknown. One may hypothesize that the circumcision scar tissue is less resistant to penetration of HPV which then transfers DNA to the human cell and starting the growth of the neoplasm. More research is needed to determine the etiology of post-circumcision cancer.

and

Quote:

American Cancer Society. The American Cancer Society issued a five part advisory statement on penile cancer in June 1999. Circumcision is not considered to be beneficial in preventing or reducing the risk of penile cancer.

Boris Godunov · February 28, 2003, 18:55

Quote:

Originally posted by Imran Siddiqui
So? Getting an earing is an unnessary mutilation of your earlobes for cosmetics (as is any type of piercing). Tatoos is unnessary mutiliation for cosmetics.

I believe most people get earrings and tattoos voluntarily.

Guynemer · February 28, 2003, 18:57

All that proves is that smegma doesn't cause cancer. Whoop-de-doo.

According to every urologist I've talked to, circumcision still reduces the risk.

Asher · February 28, 2003, 18:58

Quote:

Originally posted by Guynemer
All that proves is that smegma doesn't cause cancer. Whoop-de-doo.

According to every urologist I've talked to, circumcision still reduces the risk.

Well...
The American Cancer Society disagrees.

Quote:

American Cancer Society. The American Cancer Society issued a five part advisory statement on penile cancer in June 1999. Circumcision is not considered to be beneficial in preventing or reducing the risk of penile cancer. The ACS indentifies HPV, smoking, and phimosis as risk factors. Sexually active adult males with a non-retractable foreskin should have the phimotic condition treated. (See phimosis for conservative treatment options. Circumcision is outmoded as a treatment for phimosis.)

The ACS states that penile cancer is extremely rare in Europe and North America. The cancer only occurs in 1 in 100,000 men. Penile cancer usually occurs well beyond age 50, although it can occur earlier.

Guynemer · February 28, 2003, 19:05

Fair enough; different medical groups often disagree on these things, I wasn't aware of the ACS's stance.

Let me clarify my position--it (possibly) reduces the risk of penile cancer. However, penile cancer is so rare that it is rather a moot point. On the other hand, there is no significant damage as a result of circumcision. (Anecdotally, if being uncut makes everything even more sensitive and whatnot, frankly, I'd never get anything useful done--the damn thing is too dangerous as it is.) So, really, it boils down to--who cares?

Female "circumcision", on the other hand...

Asher · February 28, 2003, 19:09

I never knew about phimosis before this, and I have met someone who has it. He claims it didn't really affect anything, but apparently it increases infection rates.

I should let him know he can get it treated.

The internet.

SuperSneak · February 28, 2003, 19:23

Here's a few more reasons to consider both sides of the issue. Being uncut seems to have a variety of potential liabilities:

Quote:

Normal
The normal foreskin is adherent to the glans and is non-retractile in most newborns. Over time the adhesions disappear, the foreskin separates and becomes retractile. The proportion of boys with retractile foreskins is: 40% at 1 year, 90% at 4 years and 99% at 15 years.

Non-retractile foreskin is a normal variant and needs no intervention. It is different from true phimosis (see below).
The foreskin should never be forcibly retracted for cleaning. Once it becomes freely retractile naturally then the boy should retract it as part of routine bathing.
See parent leaflet on care of the normal uncircumcised penis.

Adhesions
Sometimes the normal process of separation is uneven and the foreskin becomes partially retractile but with a residual adhesion to the glans. This is normal and needs no intervention. It will resolve spontaneously by the time of puberty.

Sometimes the normal separation of an adhesion between the foreskin and glans will lead to a day or two of soreness and dysuria.

Smegma
Before the foreskin becomes separate and retractile, it is common for smegma to collect in small yellow / white lumps which may be visible or palpable through the foreskin. These are normal, and need no intervention.

Discharge of smegma from the foreskin opening is sometimes mistaken for pus.

Minor inflammation
Minor redness / soreness of the tip of the foreskin is very common. A number of factors may contribute, including: irritation from wet / soiled nappies, inappropriate attempts at retracting the foreskin for cleansing, bubble bath, soap residue etc. Avoiding these factors, reassurance, and application of a napkin barrier cream to the tip of the foreskin will help. See also napkin rash guidelines.

Hydrocortisone 1% cream or ointment may help.

Balanitis
More severe inflammation of the glans penis +/- foreskin is often due to infection and is usually termed balanitis. It is common, affecting around 6% of uncircumcised and 3% of circumcised males.

Soaking in a warm bath with the foreskin retracted (if retractile and not too painful) will help with cleaning and urination may be easier in the bath. Topical hydrocortisone 1% cream or ointment may help in mild cases. Topical antibiotics creams are sometimes used but are of unproven efficacy.

Candida infection may be responsible in some infants. It is usually associated with more generalised napkin candidiasis and the presence of satellite lesions. Topical anti yeast creams (eg nystatin, clotrimazole, miconazole) will be helpful. See also napkin rash guidelines.

Bacterial infection
If there is significant cellulitis of the whole of the foreskin or the skin of the penile shaft then bacterial infection is likely and antibiotics should be given. Pain and swelling sometimes produce marked dysuria.

Streptococci (including Group A), staphylococci, and gram negative organism are most often responsible.
Swabbing the discharge is unhelpful because the normal foreskin is usually colonised with multiple organisms.
Most cases respond to oral antibiotics (eg Co-trimoxazole 4/20 mg/kg (max 160/800) 12 hourly or Amoxycillin 15 mg/kg (max 500 mg) 8hourly).
Analgesia is important, and sitting in a warm bath may ease dysuria.
Occasional cases require admission for parenteral antibiotics, and rarely urgent surgery (eg dorsal slit / circumcision) is indicated.Significant recurrent balanitis may be an indication for circumcision. Also, true phimosis may lead to recurrent balanitis and should be treated (see below).

Zipper Injury
The tip of the foreskin or other skin (eg scrotum) may become entrapped in the teeth of a zipper. This is painful.

Treatment options include:
Prior to these procedures, adequate analgesia +/- sedation should be given. See sedation Guidelines Liberal application of topical anaesthetic cream may work or local infiltration may be necessary (never use local agents with adrenaline on the penis).

If trapped between teeth below the slider (see figure):

Cutting the median bar of the zipper with wire cutters. The median bar is the part at the top of the slider which joins the front and back plates of the slider. Once cut, the slider falls off and the zipper can be separated (see figure).
Cutting through the material either side of the zipper below the entrapped skin and then cutting across the zipper with wire cutters / strong scissors. Then the zipper can then be separated from below (see figure).
If trapped between slider and teeth of zipper:

Liberal application of topical anaesthetic cream, then ease slider down.
Always check for injury to urethral meatus.

Phimosis
Non-retractile foreskin is a normal variation (see above). (Confusingly some refer to this as "physiologic phimosis").

True phimosis is when scar tissue is present in the distal foreskin and this prevents retraction. It may result from attempts to forcibly retract the foreskin before it has become naturally retractile.

Indicators of true phimosis (rather than simple non-retractile foreskin):
Foreskin not retractile by the time of established puberty.
Previously retractile foreskin becomes non-retractile.
Obvious ring of scar tissue visible at foreskin opening
Inability to visualise urethral meatus when foreskin opening is lifted away from glans.
Ballooning of foreskin on micturition, with pinhole foreskin opening, and very narrow urinary stream. (Note: minor ballooning may occur in normal non-retractile foreskin).
Treatment options:
Application of topical steroid creams: 0.05% betamethasone cream should be used twice daily for 2 to 4 weeks.
Gently retract foreskin without causing any discomfort and apply a thick layer of cream to the tightest part of the foreskin.
Steroid creams ofhigher potency may be tried if this fails.

Circumcision (if significant phimosis and steroid creams fail)

Paraphimosis
This occurs when the foreskin is left in the retracted position. The the glans and the foreskin distal to the tight area become oedematous and swollen. Pain and swelling make it difficult to return the foreskin to the non-retracted position.

Paraphimosis can usually be corrected without surgery:
Adequate analgesia +/- sedation should be given. Liberally covering the entire foreskin and glans in topical anaesthetic cream & Gladwrap for 1 hour may be effective. Local infiltration of anaesthetic is best avoided as it increases the swelling.
The swollen area is gently but firmly compressed within one hand, for a few minutes, to squeeze out the oedema fluid. The glans may then be pushed back and the foreskin returned to the normal position.
If manual reduction fails, consult surgical registrar immediately. Surgical options include needle puncture to release oedema fluid or incision of the tight band of the foreskin.Once reduced, a single episode of paraphimosis is not an indication for circumcision. If the child has significant phimosis then it should be treated as above.

Asher · February 28, 2003, 19:26

What's that from? About half of them are the same thing in different words (non-retractible), and some of them are very questionable:

Quote:

Zipper Injury
The tip of the foreskin or other skin (eg scrotum) may become entrapped in the teeth of a zipper. This is painful.

in particular...

Cut and uncut are two versions of the same organ, each one has their own set of quirks.

The difference being, of course, everyone starts out uncut and we go through a surgical operation (with risks) to make them cut.

SuperSneak · February 28, 2003, 19:27

And, of course, a recent article espousing circumcision as a way to reduce HIV transmission.
The jury is still OUT folks.

Quote:

Circumcision may reduce HIV transmission

United Press International - June 1, 2002
Ed Susman, UPI Science News

--------------------------------------------------------------------------------
New cellular research suggests performing circumcision might help protect men -- and possibly their partners -- from contracting AIDS, researchers told United Press International.
The research examined laboratory specimens of healthy human foreskin -- the covering of the penis often removed in an operation, usually soon after birth -- and specimens of cervical tissue from women undergoing surgery. They searched for CD4 T-cells, macrophages and Langerhan's cells, all of which are targets for the human immunodeficiency virus, or HIV -- the virus that causes AIDS.

"We determined that the target cells that HIV infect are found in far greater numbers in the foreskin than in the cervix," said Dr. Carlos Estrada, a urologist at Rush-Presbyterian-St. Luke's Medical Center in Chicago. Estrada and colleagues presented a paper on their findings at the recent American Urological Association annual meeting in Orlando, Fla.

"Overall, the inner, mucosal surface of the foreskin had a seven-fold greater susceptibility to HIV infection than did cells in cervical tissue infected under the same conditions," Estrada said. The interactions between the cells were studied in culture dishes in the laboratory.

"The issue here is that epidemiologic data strongly suggests that circumcision protects against HIV," said Dr. John Krieger, professor of urology at the University of Washington at Seattle.

"These authors looked at pediatric and adult foreskins (and) ... found ... that foreskins have a lot of HIV target cells. So the increased risk of HIV infection in uncircumcised men is likely caused by large numbers of target cells in the foreskin. (Therefore circumcision) "is biologically plausible as a way to reduce HIV infection risk."

Estrada suggested reduced infection rates in men due to circumcision also should reduce HIV infections in women.

"There has been a lot of controversy over whether circumcision prevents infection with HIV or is simply a marker of more rigorous religious practices," Estrada told UPI.

"We think that our findings may show that the reason populations in Africa where Islam is practiced have lower HIV infections rates than in areas where circumcision is not practiced may be biological rather than faith-based."

Circumcision is routinely performed after birth in the United States and is required for males by Jewish and Muslim religious laws. Several studies have shown in African nations where Islam is predominant, rates of HIV infection can be one-tenth that of nations where circumcision is not practiced or its practice has been abandoned -- as in some of the nations of southern Africa, where AIDS has reached epidemic proportions.

In Nigeria, for example, where circumcision is routinely performed, United Nations AIDS Programme, or UNAIDS, data suggests the HIV infection rate is about 5 percent of adults. In Botswana, however, where circumcision is not widely practiced, the adult HIV infection rate has approached 40 percent.

Researchers and social commenters have been arguing both sides of this issue for some time. For example, at the 2000 World AIDS Conference, held in Durban, South Africa, some speakers argued the difference in rates has nothing to due with circumcision, but everything to do with religious requirements for general cleanliness and monogamy. Other speakers countered that even in heavily Islamic areas, adherence or non-adherence to religious prohibitions against sex outside of marriage parallels behavior in regions dominated by other faiths.

The new cellular research probably will not resolve the question. Dr. Thomas Brady, adjunct professor of urology at the University of Nevada-Reno, and chairman of the media committee of the AUA, said, "I'm not sure that I buy this explanation that more cells in the foreskin increase the risk of transmission of HIV. Just because there are more cells doesn't mean that there is a greater transmission risk."

Brady told UPI, however, he was not discounting the possibility circumcision could inhibit HIV transmission.

"I think it is far more logical to assume that during intercourse the penis suffers microabrasions and microscopic tears," he said.

In uncircumcized men, fluids that come in contact with the penis during intercourse can be trapped under the foreskin, which may make it easier for the virus to infect men through the organ's microscopic openings, Brady suggested.

020601
UP020601

Asher · February 28, 2003, 19:29

Quote:

Originally posted by SuperSneak
And, of course, a recent article espousing circumcision as a way to reduce HIV transmission.
The jury is still OUT folks.

Even if this were true (even though there are just as many studies contradicting it), isn't that what a condom is for...

SuperSneak · February 28, 2003, 19:32

Quote:

Originally posted by Asher
What's that from? About half of them are the same thing in different words (non-retractible), and some of them are very questionable:

It's just a simple informational bit from a hospital site: http://www.rch.unimelb.edu.au/clinic...ges/penis2.php

I noticed that the risk for bacterial infection of a more than mildly unpleasant type was twice as much for the uncircumsized.

I'm not going to get into this again, and, actually, the last time had nothing to do with the topic, per se.

I think this particular issue is one that will only be iron-clad one way or the other far in the future.
In any case, it is not an easy decision at all and one that should not be taken lightly. Son #2 is coming in April and I haven't decided yet...our last go around didn't help my confidence in the procedure, but as all the evidence seems to be in the unverified stage, I will most likely err on the side of caution in regard to HIV transmission and infections of a more garden variety.

Asher · February 28, 2003, 19:34

Quote:

Son #2 is coming in April

Congrats

SuperSneak · February 28, 2003, 19:59

Thanks...we're naming him Dave.

Asher · February 28, 2003, 20:03

Really?

molly bloom · February 28, 2003, 20:12

Quote:

Originally posted by Boris Godunov

I think male circumcision may be medically necessary on rare occasions (Louis XIV, if I recall correctly, had it done as an adult because sex was somehow very painful for him).

Louis Seize, I believe you mean:

http://www.circumstitions.com/Misc.html

http://www.observer.co.uk/Print/0,3858,4475359,00.html

In Australia even now it is noticeable if you are uncut- it marks you out as a recent arrival from somewhere circumcision is not carried out routinely.

Ben Kenobi · February 28, 2003, 20:16

Interesting. I don't think I've heard the baptism analogy used in reverse against circumcision, to let the child decide for himself. Very effective argument IMO.

However, that won't work for Jewish people.

Female 'circumcision' wasn't permitted by the Jews, so this doesn't fly with me either.

Male circumcision should be permitted only for religious reasons, where health does not intervene. Hemophilia carriers, as even Jews recognise, should not circumcise their children.

MtG:

What's the solution for poor sanitary conditions? Lop off foreskins?

tandeetaylor · February 28, 2003, 20:25

To all the people who think that women won't sleep with you if they see your uncircumsized penis: If a woman is looking at your unerect penis, chances are you won't be sleeping with her anyway.

molly bloom · February 28, 2003, 20:36

As practised in some Koori societies in Australia:

http://www.bmezine.com/news/ritcircs.html

Female circumcision, including removal of the labia minora and majora and radical clitoridectomy has no health benefits, and can result in prolonged illness and death. It may also lead to life long health problems, involving amongst other things, urinary tract infections, pelvic infections, septicaemia, and surgical intervention is sometimes required to allow intercourse.

http://www.nocirc.org/symposia/first/duffy.html

http://www.amnesty.org/ailib/intcam/femgen/fgm1.htm

Alexander's Horse · February 28, 2003, 22:31

Great - another circumcision thread

I had all my 4 boys circed shortly after birth.

Why did I do it? Because I'm evil.

Spiffor · February 28, 2003, 22:37

Erm, I thought circumcision was only a religious ritual in Judaism and Islam... Do you Americans actually circumcise just for the heck of it, even without religious obligation ?