Male circumcision reduces HIV risk by half

[Faebinder]

This is a new article put up on the CNN.... will all those who claimed no medical benefit for circumcision stand by their opinion still?

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[Fermata]

I bet that practicing safe sex reduces the risk by a far greater amount.

At the end of the day you are still cutting off the most sensitive part of a man's body.

 

[fightingspirit]

I bet that practicing safe sex reduces the risk by a far greater amount.

At the end of the day you are still cutting off the most sensitive part of a man's body.

you're absolutly right

 

[MiesVanDerMom]

no reason a man can't make this decision himself. if he wants to reduce his HIV risk, that's his choice. It's no reason for me to cut off part of my son's body as in infant without his consent. I think educating him on safer sex practices will be a far better solution though.

 

[Faebinder]

no reason a man can't make this decision himself. if he wants to reduce his HIV risk, that's his choice. It's no reason for me to cut off part of my son's body as in infant without his consent. I think educating him on safer sex practices will be a far better solution though.

Just wanted to state something that some med students might not know.

As a newborn, the procedure is a second long and hardly requires much resources/attention and the recovery is quick, and is cheap.

When you are older you need to be put to sleep, it will take longer to recover with weeks of pain in the sensitive area, the procedure is a lot more extensive since there is a lot more skin to cut and the procedure becomes expensive and may be unaffordable to some.

Hence the concern of doing it later in life.

 

[AzMichelle]

Just wanted to state something that some med students might not know.

As a newborn, the procedure is a second long and hardly requires much resources/attention and the recovery is quick, and is cheap.

When you are older you need to be put to sleep, it will take longer to recover with weeks of pain in the sensitive area, the procedure is a lot more extensive since there is a lot more skin to cut and the procedure becomes expensive and may be unaffordable to some.

Hence the concern of doing it later in life.

I disagree. I think giving adults anesthesia is a waste of time and resources. Just do to them what is done to newborns. Just tie them down and force it upon them. Their opinion means nothing and anesthesia is silly.

Com'on guys, be MEN for God's sakes!

 

[ny skindoc]

Just wanted to state something that some med students might not know.

As a newborn, the procedure is a second long and hardly requires much resources/attention and the recovery is quick, and is cheap.

When you are older you need to be put to sleep, it will take longer to recover with weeks of pain in the sensitive area, the procedure is a lot more extensive since there is a lot more skin to cut and the procedure becomes expensive and may be unaffordable to some.

Hence the concern of doing it later in life.

This is quite true.Adult males rarely have circumcision unless they have a compelling medical indication such as phimosis with acute recurrent skin problems or other issues.As an infant the procedure is quite minimal.

 

[MichiMO]

This is quite true.Adult males rarely have circumcision unless they have a compelling medical indication such as phimosis with acute recurrent skin problems or other issues.As an infant the procedure is quite minimal.

Minimal from who's standpoint? The only reason it is regarded as this is because an infant can't tell us how much pain he is in. From observing the procedure during my clinicals, it is something I would not even consider doing to my child. It does not take a few seconds...it takes several minutes and the entire time the child is screaming bloody murder. The area takes several days to recover and is certainly very sore...for those that have ever changed the diaper of a newly circumcized little boy.
I found the new WHO recomendations interesting...but keep in mind, this recomendation is being put forward for purely PUBLIC HEALTH reasons....meaning when you have thousands upon thousands of people being infected with HIV, the 1% difference (or whatever small percentage it is that being circumcizes lowers the risk of transmission) equates to a lot of lives saved. However, in this country, on an individual basis, that percentage does not convince me to recommend routine torture of infant boys for cosmetic reasons. The WHO reconized this and is only putting forth that recommendation for places where HIV rates are soring (from what I read...correct me if I am wrong).

Just out of curiosity, do we have to perform circumcisions in OB residency?

 

[GynGirl2008]

The OB/Gyn residents at my school do most of the circumcisions.

 

[Leukocyte]

Is there any circumcised male here who remembers the trauma of his own circumcision? I certainly do not remember it. You can argue that the "memory" could be supressed in the subconscious, but that is a real streach. Is there a study that compares the personalities of cut vs. un-cut men? Does circumcision affect how successfully a male can live his life?

And by the way, they do give the babies Tylanol!

 

[Leukocyte]

Just out of curiosity, do we have to perform circumcisions in OB residency?

The obs do all the circumcisions here also. But I guess if your beliefs forbid you from doing them, then you can try to use it as an excuse (but I am not sure if it is ok). I am against elective abortions, for example, but If my attending tells me to perform one, I will suck it up and do it in the name of education. When I become an attending, and have full control over what I do, then it will be a different story.

 

[MichiMO]

Is there any circumcised male here who remembers the trauma of his own circumcision? I certainly do not remember it. You can argue that the "memory" could be supressed in the subconscious, but that is a real streach. Is there a study that compares the personalities of cut vs. un-cut men? Does circumcision affect how successfully a male can live his life?

And by the way, they do give the babies Tylanol!

Okay, with this logic, you could justify child abuse of any kind under a certain age where they wouldn't remember it!

Also, I'd like to see if you felt Tylenol was adequate pain control for a tooth extraction, let alone having a sensitive part of your male anatomy sliced off!

As for the whole refusing to do them thing, does anyone have any experience with this? I really am opposed to the whole idea...not just because I think routine circumcision is stupid, but because I don't like doing an procedure on an infant with no training in pediatrics outside my third year clerkship...it is a strange concept to me.

(also...I don't think anyone should feel like they had to do an elective abortion just because their attending told them so...this is a totally different ball of wax)

 

[Faebinder]

I found the new WHO recomendations interesting...but keep in mind, this recomendation is being put forward for purely PUBLIC HEALTH reasons....meaning when you have thousands upon thousands of people being infected with HIV, the 1% difference (or whatever small percentage it is that being circumcizes lowers the risk of transmission) equates to a lot of lives saved. However, in this country, on an individual basis, that percentage does not convince me to recommend routine torture of infant boys for cosmetic reasons. The WHO reconized this and is only putting forth that recommendation for places where HIV rates are soring (from what I read...correct me if I am wrong).

did you read the article? It's 60% not 1%. That's a lot especially in a continent like Africa where HIV is widely spread. Here it is straight out of it..

The link between male circumcision and HIV prevention was noted as long ago as the late 1980s. The first major clinical trial, of 3,000 men in South Africa, found last year that circumcision cut the HIV risk by 60 percent.

 

[ny skindoc]

There are various reasons parents may be interested in circumcision and as in any elective surgery the risks and benefits need to be discussed. There are some medical advantages in later life to it and there are negatives.Some parents want their sons circumscized if the father has been,and it is integral to certain cultures. In our society circumcision is a legal,common procedure and physicians need to be able to cousel regarding it objectively without accusing the parents of abuse.If they cant do that they should refer the parents elswhere.

 

[MichiMO]

did you read the article? It's 60% not 1%. That's a lot especially in a continent like Africa where HIV is widely spread. Here it is straight out of it..

The 1% I was referring to was the risk of transmission with any one sexual act with an infected person...The risk of transmission is actually less than 1% in this country and only 2-3% in countries in which the disease is endemic and where the baseline rate of other STD's is higher. Thus, a risk reduction of 60% of a risk that was only initally 2-3% or less is not hugely significant when we are talking about ONE person's INDIVIDUAL risk. Now, from a public health standpoint it is incredibly significant, but lets not kid ourselves...circumcizing every male will not cut HIV rates in half and I don't think that this should be the basis for routinely circumcizing every male child in this country. Once again, people can have a different opinion on this, but it is not something I would personally do.

 

[Spittz03]

"The 1% I was referring to was the risk of transmission with any one sexual act with an infected person...The risk of transmission is actually less than 1% in this country and only 2-3% in countries in which the disease is endemic and where the baseline rate of other STD's is higher."

Hmmm … 1 sexual act =1% transmission? (How many sexual acts does an average teen have per week?)

Part of the reason why this country has reduced transmission, is since most of us are circumcised, some are better educated, and some have better health coverage.

Circumcision has lots of benefits for a male partner besides decreasing HIV transmission rates (although this is very appealing for developing countries). In addition, it has many benefits for the female partner.

If you have done a thousand of these procedures you would know that they are not painful unless you wait for an infant to turn into adult at which point it will be painful and more difficult.

Finally, do whatever you want to your kid ... more business for Urology

 

[tiredmom]

I've been asking about who does the circs at each of my interviews - only New Hanover in Wilmington do we not do them (some programs only do them on the NICU rot though).
As far as anesthesia goes, most I've seen also do a local nerve block at the base of the penis also, which if done properly, they can nearly sleep through (most woke up from the moving around of the penis, not of the cutting).
In practice, most ob/gyns do the circs 'cause the pediatricians say "we aren't surgeons" (and they don't want their malpractice insurance premiums raised).

Interesting article, thanks for posting it.

 

[MiesVanDerMom]

Just wanted to state something that some med students might not know.

As a newborn, the procedure is a second long and hardly requires much resources/attention and the recovery is quick, and is cheap.

When you are older you need to be put to sleep, it will take longer to recover with weeks of pain in the sensitive area, the procedure is a lot more extensive since there is a lot more skin to cut and the procedure becomes expensive and may be unaffordable to some.

Hence the concern of doing it later in life.

Still doesn't justify me mutilating my son without his consent. Probably easier to do a lot of things to a newborn than an adult. Not really a justification for it.

"The 1% I was referring to was the risk of transmission with any one sexual act with an infected person...The risk of transmission is actually less than 1% in this country and only 2-3% in countries in which the disease is endemic and where the baseline rate of other STD's is higher."

Hmmm … 1 sexual act =1% transmission? (How many sexual acts does an average teen have per week?)

Part of the reason why this country has reduced transmission, is since most of us are circumcised, some are better educated, and some have better health coverage.

Circumcision has lots of benefits for a male partner besides decreasing HIV transmission rates (although this is very appealing for developing countries). In addition, it has many benefits for the female partner.
If you have done a thousand of these procedures you would know that they are not painful unless you wait for an infant to turn into adult at which point it will be painful and more difficult.

Finally, do whatever you want to your kid ... more business for Urology

Well for one, the circucision rate fell to 50% several years ago so not sure about this "most" men being circumcised bit. Secondly, way to ignore the role of imperialism and racism in the spread of AIDS in Africa. "better health coverage"? Yeah, let's just sign Africa up for Blue Cross Blue Shield

And as for side benefits, sex is more pleasurable for uncirc men and as a woman married to an uncirc man, I have no idea what benefits for women you're talking about.

I just don't understand the ease with which so many doctors put children through painful procedures and tests. I have seen my son go through too many and I am glad I at least spared him the pain of circumcision.

 

[PhDCandidate]

probably reduces HIV risk even more than circumcision.

 

[Quynh2007]

well, I know that it used to be thought that CIR was statistically signficant shown to be healthier than UNCIR, but recently, although the #'s are better, it isnot longer statistically significant.

Personally, I don't like CIR unless it was a decision made after knowing all the facts rather than because it was the norm. This quote really got to me, although I doubt it's still relevant:

"For premature babies, expectations of sentience have been even lower; thought, feeling--even the capacity for pain--was dismissed in the baby born early. since the advent of neonatal intensive care units in the late 1960s through the late 1980s, breathing tubes, suction tubes, feeding tubes, and shunts were routienly installed WITHOUT ANY ANESTHESIA. Shrieks of pain and terror were discounted by medical professionals as being reflexive and without meaning....

A 1993 survey showed that 12 percent of doctors performing circumicisions believed that babies do not feel pain, 35% believe they will not remember it even if they do; and only half used any form of anesthesia....

for babies born to loving, welcoming, nurturing families, these early rituals have been a rude shock but have been ameliorated by parental handling and family support. But for babies born into negative or compromsied family circumstances where stress has been and will continue, this awakening to life as a painful and discounting experience provides the first factors in the violence equation"

 

[DMBmatty08]

I disagree. I think giving adults anesthesia is a waste of time and resources. Just do to them what is done to newborns. Just tie them down and force it upon them. Their opinion means nothing and anesthesia is silly.

Com'on guys, be MEN for God's sakes!

How would you feel if you had to have the prepuce of your clitoris lopped off as an adult?? Doesn't sound to fun now does it??

 

[MichiMO]

How would you feel if you had to have the prepuce of your clitoris lopped off as an adult?? Doesn't sound to fun now does it??

I don't think I would like it any more or less than I would like it as an infant...I think that was the poster's point.

And as for comparisons between adults and children...children are much more sensitive to pain than adults. I know if I even bump my daughter she screams like you wouldn't believe. The whole idea that doing circumcison in infancy is somehow more humane is ridiculous. People may have their reasons for doing it, which I guess they are entitled to, but why not wait until the child is older and can be given the decent sedation. If you would not take the risk of proper sedation for a painful procedure then I think you should really reexamine your views and think about whether this is truely a NECESSARY procedure. If not, then it is cosmetic and you do not have the right to inflict serious pain on your children for cosmetic reasons.

I am against ear piercing of young children for the same reason.

 

[TPBC]

I had a friend who had to be circumsized when he was about 37 or 38 because tearing of the foreskin caused sex to be painful (I'm not exactly sure what started the tears). He said recovery was somewhat painful but he is fine today. His message: If you were circumsized as an infant, thank your parents profusely!!!

 

[Mr. McDuck]

Okay, with this logic, you could justify child abuse of any kind under a certain age where they wouldn't remember it!

Also, I'd like to see if you felt Tylenol was adequate pain control for a tooth extraction, let alone having a sensitive part of your male anatomy sliced off!

As for the whole refusing to do them thing, does anyone have any experience with this? I really am opposed to the whole idea...not just because I think routine circumcision is stupid, but because I don't like doing an procedure on an infant with no training in pediatrics outside my third year clerkship...it is a strange concept to me.

(also...I don't think anyone should feel like they had to do an elective abortion just because their attending told them so...this is a totally different ball of wax)

Erm, I had a tooth extracted without any anesthesia. I've had a few dental procedures done without anesthesia, in fact (root canal, some cavity fillings). Yeah, it hurt, but it's just a temporary pain--it goes away.

Anyway, I don't remember my circumcision at all, and I'm very thankful it was done when I was an infant. I definitely would want to have it done now, but would have to think about it because of the anesthesia and surgical factors.

 

[Spittz03]

Confirmed Sq Cell CA of the penis this past Friday in Clinic in a 35 y.o. uncircumcised AAM. Fun case , but sucks to be the guy

 

[cv580]

Is there any circumcised male here who remembers the trauma of his own circumcision? I certainly do not remember it. You can argue that the "memory" could be supressed in the subconscious, but that is a real streach. Is there a study that compares the personalities of cut vs. un-cut men? Does circumcision affect how successfully a male can live his life?

And by the way, they do give the babies Tylanol!

You might be interested in this article:

http://www.math.missouri.edu/~rich/MGM/primer.html#MB

Another interesting article:
Summary of evidence that the foreskin and
lysozyme may protect against HIV infection
By George Hill

This file contains a summary of the evidence that the foreskin and the sub-preputial wetness under the foreskin (prepuce) may protect against human immunodeficiency virus.
Lysozyme is an enzyme with anti-bacterial action that is found in body fluids. (An enzyme is a protein or conjugated protein produced by a living organism and functions as a biochemical catalyst.1) Lysozyme breaks down cell walls and kills bacteria.
Prakash and others reported in 1983 that sub-preputial wetness contains lysozyme2 and Lee-Huang finds lysozyme in human urine.3 Lee-Huang et al. report that lysozyme is also an effective agent for killing HIV in vitro.3
Laumann et al. report that about 77 percent of adult American males are circumcised. 4 Thus, these circumcised males have no sub-preputial wetness and no lysozyme protection. Laumann finds that circumcised men are slightly more likely to have both a bacterial and a viral STD in their lifetime.4
World Health Organization data show that the incidence of HIV infection in the United States is four or more times greater than in any other advanced industrial nation.5 Other advanced nations either do not circumcise males or have a very low incidence of circumcision compared to the United States.6
Chao reports that a circumcised husband is a risk factor for HIV infection amongst pregnant women in Rwanda.7 Grosskurth et al. find a higher incidence of HIV infection in circumcised men in Tanzania.8
The high incidence of HIV in the United States and its correlation with the high rate of circumcision has been noted by Storms9 and Nicoll. 10 Furthermore, Tanne reports a general epidemic of STD, including chlamydia and HIV, in the United States.11
Moreover, Fleiss and others report that the increased friction and more vigorous and prolonged thrusting required to achieve orgasm with a circumcised penis may be more likely to cause "breaks, tears, microfissures, abrasions, and lacerations through which HIV in semen can enter the receiving partner's bloodstream."12
More research is needed to verify the protective effect of lysozyme and the foreskin in vivo.
References
The American Heritage Dictionary of the English Language, 3rd edition. Houghton Mifflin Company, Boston: 1992.
Prakash S, Rao R, Venkatesan K, et al. Sub-preputial wetness--its nature. Ann Nat Med Sci 1982:18:109-112.
Lee-Huang S, Huang PL, Sun Y, et al. Lysozyme and RNases as anti-HIV components in beta-core preparations of human chorionic gonadotropin. Proc Natl Acad Sci (U S A) 1999 (Mar 16);96(6):2678-2681.
Laumann EO, Masi CM, Zuckerman EW. Circumcision in the United States: prevalence, prophylactic effects, and sexual pratice. JAMA 1997;277:1052-1057.
World Health Organization. The Current Situation of the HIV/AIDS Pandemic, Quarterly Report. World Health Organization, Geneva: July 3, 1995.
Wallerstein, E. Circumcision: the uniquely American medical enigma. Urologic Clinics of North America 1985;12(1):123-132.
Chao A, Bulterys M, Musanganire F, et al. Risk factors associated with prevalent HIV-1 infection among pregnant women in Rwanda. National University of Rwanda-Johns Hopkins University AIDS Research Team. Int J Epidemiol 1994; 23:371-380.
Grosskurth H., Mosha F, Todd J, et al. A community trial of the impact of improved sexually transmitted disease treatment on the HIV epidemic in rural Tanzania: 2. Baseline survey results. AIDS 1995;9(8):927-934.
Storms MR. AAFP fact sheet: a need for updating. Am Fam Physician 1996;54:1216,1218.
Nicoll A. Routine male neonatal circumcision and risk of infection with HIV-1 and other sexually transmitted diseases. Archives of Disease in Childhood (London) 1997;77(3):194-195.
Tanne JH. U.S. has epidemic of sexually transmitted disease. BMJ 1998;317:1616.
Fleiss P, Hodges FM, Van Howe RS. Immunological functions of the human prepuce. Sex Trans Inf 1998;74(5):364-367.
19 March 1999

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[DoulaMD]

But how are cosmetic companys to make wrinkle cream for women with out all that lovely forskin?

 

[univlad]

I had a friend who had to be circumsized when he was about 37 or 38 because tearing of the foreskin caused sex to be painful (I'm not exactly sure what started the tears). He said recovery was somewhat painful but he is fine today. His message: If you were circumsized as an infant, thank your parents profusely!!!

As someone before said, most uncircumcised men will not require a circumcision for medical reasons. Most uncircumcised men likely don't remain uncircumcised because they fear pain--they remain uncircumcised because they enjoy having a foreskin.

 

[cv580]

FGM, circumcision "likely to spread HIV"
afrol News, 26 February - New research dramatically contradicts the popular conclusions of recently published reports, holding that male circumcision protects against contracting AIDS. Scientists looking at male circumcision and female genital mutilation (FGM) practices in Kenya, Lesotho and Tanzania found that the cut in itself was causing many new AIDS cases among adolescents.
The research, published in the March issue of the scientific journal 'Annals of Epidemiology', was carried out by a team of researchers led by Devon Brewer, director of the research firm Interdisciplinary Scientific Research. "We found that circumcised virgins and adolescents in Kenya, Lesotho, and Tanzania were consistently and substantially more likely to be infected with HIV than their uncircumcised counterparts," Mr Brewer said.

The researchers analysed data from the 'Demographic and Health Surveys', which are based on nationally representative samples of adolescents and adults. In the three African countries studied, circumcision is typically performed in adolescence or early adulthood and often in unhygienic circumstances where many individuals are circumcised with shared, unsterilised cutting instruments.

"Sexually experienced male adolescents were no more likely to be infected than adolescent virgins, further highlighting how HIV may be spreading by means other than sex," the researchers concluded.

Mr Brewer said "a key problem with nearly all prior research on circumcision in Africa is that researchers have treated circumcision only as an anatomic characteristic, and not also as a potential exposure to others' blood during the circumcision operation." He continued, "this is striking, because over the last 20 years, many Africans, including children, have warned that HIV can spread through circumcision procedures."

The new results in particular raise questions about how to understand the recent randomised trials of male circumcision in South Africa, Kenya, and Uganda. These studies, in which some uncircumcised men were randomly assigned to be circumcised in presumably sterile conditions and others were not circumcised, showed that male circumcision reduced HIV acquisition.

The popular news reporting of these findings has been widespread in Africa. And the basic message in African media has been that circumcising young boys - and sometimes girls - will protect them from contracting HIV-AIDS. The new study however shows that this conclusion is not only wrong, but also a dangerous message, due to the poor hygienic standards normally applied at circumcision ceremonies.

Mr Brewer said, "If we had known several years ago what we know now from the national surveys, there would not have been a good empirical basis even to conduct the trials. Therefore, it is crucial to investigate thoroughly the possible mechanisms - which are speculative at this point - for the protective effect observed in the trials."

The US researcher and his colleagues finally called for more intensive study of HIV transmission in the context of both traditional and medical circumcision in sub-Saharan Africa.


By staff writer
© afrol News

http://www.afrol.com/articles/24469