Thoughts on circumcision?

[cfdavid]

Just curious on peoples thoughts/opinions on this topic.

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[ceg]

I am not a student doctor but a student nurse midwife. I feel that if they asked me about some other cosmetic procedure for their child that would not confer real benefits, medical or otherwise, I would discourage it, so the same should go for circumcision.

 

[mysophobe]

Circumcision has no benefits?

 

[Faebinder]

HUH? Circumcision is reported to have multiple benefits.

http://www.ncbi.nlm.nih.gov/entrez/...uids=16724395&query_hl=10&itool=pubmed_docsum

http://www.ncbi.nlm.nih.gov/entrez/...uids=16601492&query_hl=10&itool=pubmed_DocSum

http://www.ncbi.nlm.nih.gov/entrez/...uids=16581731&query_hl=10&itool=pubmed_DocSum

http://www.ncbi.nlm.nih.gov/entrez/...uids=16488287&query_hl=10&itool=pubmed_DocSum

http://www.ncbi.nlm.nih.gov/entrez/...uids=16231970&query_hl=10&itool=pubmed_DocSum

I am not an expert but plenty of published articles out there show reduced risk of UTI, HIV, Syphilis, Chancroid, Herpes (which can lead to cervical cancer in female partner) and finally squamous cell carcinoma of the penis.

 

[burlypie]

I think it's preference (often religious), and would discuss it objectively, but I was struck in my board review the other day -- going over male repro path the book (BRS) kept repeating itself: decreased incidence with circumsision. Lower incidence in circumcised men. That being said, much of the pathology that becomes troublesome seems to be linked to hygiene. So circumcise or don't but either way you teach the boy to wash himself properly and use condoms!

 

[ceg]

Sorry to type a curt answer and duck out. I should have said no "proven" or "significant" benfits. Most of the current studies on circumicision (pro and against) are flawed in some way. Most notably a recent one claiming lowered HPV/Cervical cancer rates for partners of circed men. The circed men in the study were middle-aged orthodox jewish men- less likely than your average joe to bring HPV home to the wife. Also- penile cancer is extremely rare and the majority of cases are in elderly and uncirmcised men- probably the reason for that result.

Anyway, based on my readings of the studies and critiques of the studies and the fact that the AAP does not recommend circ, I formed my opinion.

I acknowledge that it is a choice based on appearance and tradition (religious or otherwise). So, I would be respectful of the patients personal views, but I would certainly not hesitate to present the AAP recommendations as they are.

 

[Scottish Chap]

Just curious on peoples thoughts/opinions on this topic.

It's totally unecessary. I was horrified when I heard this was common practice in the U.S.

 

[IdiotBoxen]

It depends on the patient...

Generally speaking, I try to advise them of the benefits and the risks of the procedure. However, the way things go most of the time is that when the husband is circumcised, they generally want circumcision done.

The only thing that bugs me is that some of the obs/gyn I work with are getting the plastic surgeons to do it... I don't understand it, but, hey... whatever works.

 

[klmr]

I guess I'm confused as to the problem with having a plastic surgeon do it? I can only assume from the posts here that wherever you guys are, the OBs are doing the circs. At my med school and now residency (which, incidentally, are in 2 different states), the pediatricians do the circs. I guess I don't get why it would fall to the OB? We don't really do any other pediatric procedures, unless there is a need for some emergent resuscitation. Are other OBs out there doing circs?

 

[tiredmom]

Back home, all the circs were done by the ob's in practice - they also were teaching the FP residents to do them. We had 1 pediatrician who did them. Now at med school... all are done by peds.

 

[mysophobe]

The OBs do them here. I'd think it'd be a peds thing. I can't understand why anyone would choose to not have this, save for religious reasons.

 

[Doula-2-OB]

I won't do circs. I'll counsel patients as fairly as I humanly can and if they elect to have the procedure I will send them to someone who can do it for them. I won't do it.

There are plenty of reasons to not circ outlined in this thread.

 

[pruritis_ani]

I won't do circs. I'll counsel patients as fairly as I humanly can and if they elect to have the procedure I will send them to someone who can do it for them. I won't do it.

There are plenty of reasons to not circ outlined in this thread.

In my reading of that thread, I sure didn't come across "plenty" of reasons not to do them. In fact, it appears that the evidence is slightly in favor of circs, medically.

I don't understand why you are so opposed to them. Have you seen one? They are pretty mild, and certainly not traumatic to the child. 90% of the kids slept through the ones I have done, they just chill with a pacifier dipped in glucose soln. Once the numbing is done, there was rarely any crying.

More power to you, if you don't want to. But, I do hope that you at least see one before you get to freaked about it. And, no matter how you feel about it, you owe an unbiased, scientific explanation to the parents. It is their decision to make, not yours.

 

[Doula-2-OB]

I don't understand why you are so opposed to them. Have you seen one? They are pretty mild, and certainly not traumatic to the child. 90% of the kids slept through the ones I have done, they just chill with a pacifier dipped in glucose soln. Once the numbing is done, there was rarely any crying.

More power to you, if you don't want to. But, I do hope that you at least see one before you get to freaked about it. And, no matter how you feel about it, you owe an unbiased, scientific explanation to the parents. It is their decision to make, not yours.

I'm opposed because it is cosmetic surgery. As I stated before (do we really want to do this all again on a whole separate thread?), if we started routine circumcision of female infants, I'm sure 100 years later we could find some positive arguments to continue the practice. It doesn't make it RIGHT. I'm opposed to it because it suggests that babies come out needing surgical intervention to survive. Barring true medical need, this is not the case. Are American babies somehow less functional than our European counterparts? Are we flawed, somehow, and need to be 'repaired'? I don't think so. I can't be convinced of that.

Regardless of my opinions I will (and have always, to my doula clients) present both sides of the issue to let the client decide. I feel the same way about circumcision, that just like feeding methods or where the baby sleeps, the parents have every right to choose. I support that vehemently. I just advocate for the baby's right to not have his penis cut open a few days after birth by choosing not to participate. I may have to watch this procedure in med school, it will be very difficult but I realize I might have to do it. But I refuse to hold the knife. My choice. Doesn't affect anyone but me. I have yet to hear of a physician truly providing both sides of the issue. Even my own ped (who said there was no medical benefit) left it at that - no applicable medical benefit to my boys, no reason but parent preference to do it. That's not both sides of the issue. I want to give better care than just pushing my agenda. But because I am human and have limits, I can choose not to participate. As an OB, I'm hardly an expert in baby penises, they are far better left to a pediatric surgeon or something similar if they must be cut.

I have two sons- I have seen far too many photos and videos online of circumcisions. Crying is not the only way that babies demonstrate trauma. The argument that babies 'don't remember it' is a ludicrous justification for cutting off a healthy body part. A healthy, normal body part. Why is a child's ability to remember a justification for cutting on their bodies?

I find it amazing that grown men are rarely interested in the adult side effects of infant circumcision. I raised the issue in the other thread and only one person seemed at all interested and even that was relatively remote. Whatever.

At the end of the day, I have learned as a doula to put my opinions aside and support my client's choice, even if I wouldn't choose it, or disagree, or don't like it, whatever. I still stand for my CLIENT, for her right to choose for herself, for her baby. I stand by that. Personally, I feel that a human male should get to choose for his own penis, but that is not the culture we live in. I'll do the best I can with what I have.

 

[pruritis_ani]

If you consider preventing life threatening cancer (ie penile and cervical) cosmetic surgery, then I am a bit concerned....

There is some evidence supporting this medical therapy. It is certainly not such strong evidence of benefit that it should be adamantly advocated, but there appears to be a medical benefit.

There are lots of examples of how we humans emerge from the womb and go through life in sub-optimal shape to weather all of what may come our way. From vitamin K injections in the newborn, on to immunizations for children and adults, there are a lot of medical interventions that enable us to better deal with what life may throw at us.

Nobody is suggesting that babies need sugical intervention to survive. However, there are a multitude of interventions performed on a newborn to optimize his chances at a long, healthy life. Do we need these to survive? Not all of us. But, medical benefit is clearly documented for these interventions.

I certainly support your right to your views, and I have zero problem with that. I just have a feeling that they are based on emotion much more than science. And, as a doctor, I hope that you will look more to the science, at least when discussing options with patients.

 

[Doula-2-OB]

Penile/cervical cancer... my sons will have their foreskins as they enter into adulthood and can decide for themselves if their risk is worth removing their foreskin. I wouldn't remove my infant daughter's breasts because we had breast cancer in the family, I would leave her body intact so that she could decide how to proceed as an adult.

I would really love to engage in a debate with someone who is pro-circ and have us switch sides. I'd like someone to convince me about anti-circ, and I would like to try to convince that person to be pro-circ. I think that would encourage a lot of learning on both sides.

 

[pruritis_ani]

Penile/cervical cancer... my sons will have their foreskins as they enter into adulthood and can decide for themselves if their risk is worth removing their foreskin. I wouldn't remove my infant daughter's breasts because we had breast cancer in the family, I would leave her body intact so that she could decide how to proceed as an adult.

I would really love to engage in a debate with someone who is pro-circ and have us switch sides. I'd like someone to convince me about anti-circ, and I would like to try to convince that person to be pro-circ. I think that would encourage a lot of learning on both sides.

Sounds like a reasonable choice for your family. Other families may choose different....btw, if you are comparing mastectomy to circ...well, lets just say it is VERY clear that you have not participated in both of these procedures. I think you will be very surprised when you witness a circ. It is far from a brutal, painful procedure...

I do remember the old switch side debate technique from undergrad. Learned a lot that way, but it typically was used to enhance your ability to rebut the opposing view by being able to anticipate what they would say. Sad to say, but once opinions are formed, rarely are they changed.

I am not pro-circ by any means. I think it is fine for those who want it, and has some benefit which certainly justifies its place in medicine. There are very reasonable social reasons for it as well. But, I could really care less either way. I am just not a big fan of emotional reasoning based on pre-concieved notions when it is used in the realm of patient care/advising.

 

[mysophobe]

Uh...wow. Just. Wow.

 

[Slitherin]

Penile/cervical cancer... my sons will have their foreskins as they enter into adulthood and can decide for themselves if their risk is worth removing their foreskin. I wouldn't remove my infant daughter's breasts because we had breast cancer in the family, I would leave her body intact so that she could decide how to proceed as an adult.

I would really love to engage in a debate with someone who is pro-circ and have us switch sides. I'd like someone to convince me about anti-circ, and I would like to try to convince that person to be pro-circ. I think that would encourage a lot of learning on both sides.

"my sons will have their foreskins as they enter into adulthood" I hope your sons don't have to experience a foreskin adhesion and have to have a circumcision under general anasthesia when they are 5 y/o like my son did, it was quite traumatic and it convinced me to have our next son circumcised the usual time/way. And I think refusing to do a widely accepted procedure is a little overboard. I can see a Doc refusing to do an abortion, but refusing to do a circumcision? I was a little upset that our OB/GYN did not mention the problems associated with not circumcising. I would have liked to be informed about the possible problems.

 

[ceg]

"my sons will have their foreskins as they enter into adulthood" I hope your sons don't have to experience a foreskin adhesion and have to have a circumcision under general anasthesia when they are 5 y/o like my son did, it was quite traumatic and it convinced me to have our next son circumcised the usual time/way. And I think refusing to do a widely accepted procedure is a little overboard. I can see a Doc refusing to do an abortion, but refusing to do a circumcision? I was a little upset that our OB/GYN did not mention the problems associated with not circumcising. I would have liked to be informed about the possible problems.

Well episiotomy used to be a widely accepted procedure too. Still is in some places. Not exactly evidence-based and now falling out of favor. Obviously many people are refusing to perform them.

Another interesting thing is that the United States also has higher rates of circumcision in older children and adults. One reason for this is that many people don't know how to care for the uncircumcised penis and will retract the foreskin, causing adhesions. Another one is that practitioners just plain don't know how to care for uncirced penises and jump to circumcision when there is a problem.

 

[s42brown]

The reason Obs do the circs instead of the peds docs is a malpractice thing. My peds doc told me his insurance is about 5k higher to do the circs.

 

[APGAR10/10]

Penile/cervical cancer... my sons will have their foreskins as they enter into adulthood and can decide for themselves if their risk is worth removing their foreskin. I wouldn't remove my infant daughter's breasts because we had breast cancer in the family, I would leave her body intact so that she could decide how to proceed as an adult.

Although I see your point, I would have to argue that circumcision and mastectomy are two completely different procedures from a scientific and social perspective. The female breast is necesary for feeding offspring, as well as an important social "marker" of femininity. Women who must have mastectomies for cancer are scarred both emotionally and physically because of the lack of one or both breasts, and these psycological impacts are well studied and documented.

Circumcision procures neither of these harmful consequences. Circumcised men suffer no loss of function nor are they in any way "different" from the norm. Psycologically, they have no loss of self in any way, unlike post-mastectomy patients.

I just think the distinction between the two procedures is important. I also think that it is important that circumcision offers a wide array of health benefits. A recent study in Africa shows that the risk of contracting HIV drops 70 percent in circumcised men. That's a rather substantial decrease.

http://www.cnsnews.com/news/viewstory.asp?Page=\Culture\archive\200507\CUL20050714a.html

Seriously, it's a little piece of skin. Like the appendix, yes, it's "natural." Also like the appendix, sometimes we are better off without it.

 

[Flopotomist]

HUH? Circumcision is reported to have multiple benefits.

http://www.ncbi.nlm.nih.gov/entrez/...uids=16724395&query_hl=10&itool=pubmed_docsum

http://www.ncbi.nlm.nih.gov/entrez/...uids=16601492&query_hl=10&itool=pubmed_DocSum

http://www.ncbi.nlm.nih.gov/entrez/...uids=16581731&query_hl=10&itool=pubmed_DocSum

http://www.ncbi.nlm.nih.gov/entrez/...uids=16488287&query_hl=10&itool=pubmed_DocSum

http://www.ncbi.nlm.nih.gov/entrez/...uids=16231970&query_hl=10&itool=pubmed_DocSum

I am not an expert but plenty of published articles out there show reduced risk of UTI, HIV, Syphilis, Chancroid, Herpes (which can lead to cervical cancer in female partner) and finally squamous cell carcinoma of the penis.

Do any of these articles suggest that the benefits of circumcision are only available if the procedure is performed on an infant? It would seem to me that an adult could read up on the risks and benefits and then make an INFORMED decision.

 

[71263]

Sounds like a reasonable choice for your family. Other families may choose different....btw, if you are comparing mastectomy to circ...well, lets just say it is VERY clear that you have not participated in both of these procedures. I think you will be very surprised when you witness a circ. It is far from a brutal, painful procedure...

I do remember the old switch side debate technique from undergrad. Learned a lot that way, but it typically was used to enhance your ability to rebut the opposing view by being able to anticipate what they would say. Sad to say, but once opinions are formed, rarely are they changed.

I am not pro-circ by any means. I think it is fine for those who want it, and has some benefit which certainly justifies its place in medicine. There are very reasonable social reasons for it as well. But, I could really care less either way. I am just not a big fan of emotional reasoning based on pre-concieved notions when it is used in the realm of patient care/advising.

This has nothing to do with anything, but you have the BEST USERNAME EVER!!! When I found out what that actually means, I was laughing my ass off

Anyway, back to your discussion.

 

[beetlerum]

Circumcision is such an obvious example of how culture will make anything acceptable. I swear, if it were culturally accepted to cut off a baby's right foot, people would find reasons to justify that too. Imagine circumcision didn't exist and I said that I planned to remove portions of my baby's penis, including the protective (and highly sensitive) covering of one of the most sensitive parts and undetermined portions of another highly sensitive part (the frenulum), leaving the glans of the penis hardened and desensitized. You would think I was a monster.

Every man has the right to determine for himself whether he would like to significantly lessen the pleasure of sex for a lifetime so he can decrease his chance of getting a rare form of cancer. Or possibly, since the medical benefits are unproven.

I also don't understand how you can be pro-choice and pro-circumcision at the same time (as I imagine many of you are). Shouldn't the right of autonomy over your body extend to significant alteration of your genitals?

By the way, any other examples of body parts that should be routinely removed at birth? Or is the foreskin the only one that evolved despite apparently having a net negative effect on health?

 

[pruritis_ani]

Puhlease. Easy on the drama. Circumsision is NOT some bizzare, life alterering, disfiguring operation. How do I know? I had one, I have done several.

Are there medical reasons for it? Sure, there are some weak ones. Are there cultural/social reasons for it? Plenty of those too. Are these reasons big enough to require every newborn male infant get circed? Nope, and nobody is after that.

The point is that it is a very minor procedure, removing a piece of skin. The risks are very small. If parents want it, fine. We let them clip toenails too, right?

Making this into some huge argument about disfiguring a baby, comparing it to mastectomy, saying that these infants are doomed to a miserable sex life with a desensitized penis is ridiculous. Bringing in autonomy is also a bit ridiculous, as children typically have little autonomy anyhow. Should we wait til they reach adulthood to get consent before braces? How about haircuts?

It is a small procedure, easily done, with little distress on the part of the infant. If parents want it, great. If not, also great. I cannot believe how some people want to make the biggest issue out of nothing.

 

[Doula-2-OB]

Puhlease. Easy on the drama. Circumsision is NOT some bizzare, life alterering, disfiguring operation. How do I know? I had one, I have done several.

It is disfiguring. That's why there's a *scar*. You're removing healthy tissue. Where else can you remove skin where it's not changing the normal, healthy appearance of the anatomy? That's why there are consequences for adult men like a bent penis, hairy shaft, skin bridges, etc. I'd call that disfiguring. I hope that when you do them that you give adequate pain relief (I'm sure you do, but there are still docs out there who give NONE). If you feel competent at it then you'll be the guy I send my patients to when they want it done. I won't do them.

The point is that it is a very minor procedure, removing a piece of skin. The risks are very small. If parents want it, fine. We let them clip toenails too, right?

Are you seriously comparing removing a foreskin, containing thousainds of nerves which could be used for its owners sexual enjoyment, containing structures that are essential to the NORMAL function of the penis, to a toenail? To a haircut???

Would you be willing to entertain the idea that it's something more than that- would you be willing to think of it as important? As not 'incidental'? It's not extra skin, it's necessary skin. It's MORE than skin. Please- click the link. If you do, and you watch it and find *no new information* from what you new before, I promise I won't post on this thread again. But at least, please, give it a chance. Take the chance to learn something new- which is what we're all in school/med school to do, right? It's my respectful request, from me- to you.

 

[pruritis_ani]

You know, I can tell you are passionate about this. Fantastic. But, passion is the WRONG thing to base patient advice on.

I watched your video, and was unimpressed. Fantastic. Anatomy. Took it in med school. The fact is, circumsision is a simple procedure. The babies SLEEP through it. A circumsised penis functions normaly in all ways.

Are there risks? Sure, minimal. Are there benefits? Sure, minimal.

The point is, it is NOT YOUR PLACE to be imposing your PERSONAL BELIEFS onto your patients. When you can come up with valid science that clearly states circumsision is harmful and should be discontinued, advise your patients to not have it done. When the pro-circ folks find valid scientific evidence that it should be done always, then advise your patients to have it done.

In the meantime, given the clear lack of prevailing medical evidence either way, given the fact that there is little harm or benefit in either way, it seems clear that the right thing to do is to advise patients about what little we know in terms of benefits, advise them that there are some rare risks, and allow the parents to make the decision based on their own theological/cultural beliefs.

I purposely drew the comparison of the foreskin with a toenail or hair to emphasize how ridiculous your early comparisons with a mastectomy were. And, to answer your question, I do not think the foreskin is important or neccesary. It is simply (again) a small piece of skin. Skin does have nerves, sure. But, believe me, a circumsised penis is still a very sensitive thing.

Anyhow, the point I am trying to make remains that our OPINIONS mean squat. It is a small procedure. It is a VERY safe procedure. It is a procedure that removes NOTHING neccesary. If mom and dad want it, they should get it. If mom and dad want info, they should get ACCURATE info, not some biased propaganda based on some extremist view.

 

[Doula-2-OB]

The point is, it is NOT YOUR PLACE to be imposing your PERSONAL BELIEFS onto your patients.

Agreed. I don't do it now, I won't do it when I am a physician. I don't tell my clients what to do with their baby's foreskins. When they ask me what I think, I tell them that there are arguments for both sides and that it is a family decision. When they ask me what we did with our boys, I tell them that my sons are intact. I offer myself as a resource for any questions they have about the care of an intact son. We talk about many things from where baby sleeps to vaccinations to breastfeeding to sex after baby. I am pretty anal about giving all sides because I believe in giving parents the information they need, or a direction in which to find it. I might not agree, and I don't have to- but I dont' have to participate. If a parent comes in and wants a circ done, I will refer them to someone who can do it. I won't do it, and that is MY right. Where I live OBs don't do circs anyway, babies go to their pediatrician 3-8 or so days after the birth for the procedure.

On everything else you said- well, we reach an impasse.

 

[pruritis_ani]

I am fine with being at an impasse, no problem there. Do whatever procedures you want, great.

What I have issues with are pretty simple. The biggest problem I have is with anybody who voted in the poll to influence the patients decisions. I can sort of get behind the subtle influence for circs, because that is where the most medical evidence is. To those that voted for anything but the first option (ie, non-biased discussion), I would say that it appears that you value your opinions more than you value good patient care.

No matter what you may have heard, the reality is that a circumsision is a simple, very low risk procedure. Babies are not brutalized. When they grow up, they do not miss their foreskins. Sure, there are rare exceptions to this, but for every person with an issue with circumsision, there is a person that wishes they had it done. No matter what we do, it won't be perfect. I would encourage you to see this procedure for what it is, not what you imagine it to be.

 

[Doula-2-OB]

What I have issues with are pretty simple. The biggest problem I have is with anybody who voted in the poll to influence the patients decisions. I can sort of get behind the subtle influence for circs, because that is where the most medical evidence is. To those that voted for anything but the first option (ie, non-biased discussion), I would say that it appears that you value your opinions more than you value good patient care.

Then your problem isn't with me.

I would encourage you to see this procedure for what it is, not what you imagine it to be.

I do see it for what it is. Just because our perceptions do not line up does not make me wrong, or misguided, or extremist. Good luck to you in your journey.

 

[pruritis_ani]

Then your problem isn't with me.

I agree, I have no problems with you

I do see it for what it is. Just because our perceptions do not line up does not make me wrong, or misguided, or extremist. Good luck to you in your journey.

Hmmm...well, I question how you can see it for what it is if you have never seen it...experience may change some of your views, as it certainly has changed mine. I think you will experience many, many alterations in your view of medical care in general and obstetric/perinatal care specifically in your future training. Best to keep an open mind.

 

[beetlerum]

Puhlease. Easy on the drama. Circumsision is NOT some bizzare, life alterering, disfiguring operation. How do I know? I had one, I have done several.

Are there medical reasons for it? Sure, there are some weak ones. Are there cultural/social reasons for it? Plenty of those too. Are these reasons big enough to require every newborn male infant get circed? Nope, and nobody is after that.

The point is that it is a very minor procedure, removing a piece of skin. The risks are very small. If parents want it, fine. We let them clip toenails too, right?

Making this into some huge argument about disfiguring a baby, comparing it to mastectomy, saying that these infants are doomed to a miserable sex life with a desensitized penis is ridiculous. Bringing in autonomy is also a bit ridiculous, as children typically have little autonomy anyhow. Should we wait til they reach adulthood to get consent before braces? How about haircuts?

It is a small procedure, easily done, with little distress on the part of the infant. If parents want it, great. If not, also great. I cannot believe how some people want to make the biggest issue out of nothing.

This is ridiculous.

First, the complexity of the procedure is irrelevant to its impact. It is also relatively simply to remove or disfigure a clitoris. Does that mean that female circumcision has little impact.

Second, you are not just removing a piece of skin that happens to be sensitive. The most sensitive parts of the penis are the foreskin, the frenulum, and the glans. You are completely removing one, removing parts of another, and leaving the third part significantly changed. Perhaps this does not result in a significant loss of sensitivity, but given what you are doing, the burden is sure as hell on those who say it does not result in a loss. Also, many men report a substantial loss of sensitivity shortly after adult circumcision, and it is probably worse when you are talking about the result many many years later of an infant circumcision. Given even the possibility of a significant loss of sensation and the weak evidence benefits, wouldn't it be better to let the person decide for himself?

Third, are you saying that you had an adult circumcision? If not, then you have nothing to compare it to.

Fourth, I do not get this thing about not imposing your personal beliefs on your patients. I believe it is morally wrong to circumcise someone without their permission. I will not participate in that. Would you be neutral if a parent wanted to remove their girl's clitoris? Or her leg? You may feel that circumcision is different morally, and that is fine, but hopefully this comparison shows why it is not an answer to say that you should not be imposing your personal beliefs.

Also, importantly, the patient cannot decide for himself. We are not talking about the personal choice of the patient. Parents do not have the right to make this kind of decision for their child. They do not get to decide whether to remove significant portions of the most erogenous tissue of their child's penis.

Fifth, it is outrageous to say effectively, as you did, that the burden of stopping should fall on the anti-circ people to show the bad consequences. So the default is to remove a part of the body unless proven otherwise?

 

[pruritis_ani]

This has turned into an absolute waste of time. If you want to get worked up over this, fine. Enjoy yourself.

Some people just love turning every little thing into such a big deal. Thank god fanatics such as yourself are the exception rather than the rule.

 

[beetlerum]

This has turned into an absolute waste of time. If you want to get worked up over this, fine. Enjoy yourself.

Some people just love turning every little thing into such a big deal. Thank god fanatics such as yourself are the exception rather than the rule.

So instead of responding to my arguments you're just resulting to name calling?

Look, it is beyond dispute that circumcision removes significant portions of the erogenous tissue of the penis. In countries where it is rarely done (most, that is), people widely regard it as a barbaric practice. It was started only to stop boys from masturbating. You would think that would be enough to at least warrant serious debate, but never for a second did you consider changing your culturally determined view.

You should know better.

 

[pruritis_ani]

So instead of responding to my arguments you're just resulting to name calling?

Look, it is beyond dispute that circumcision removes significant portions of the erogenous tissue of the penis. In countries where it is rarely done (most, that is), people widely regard it as a barbaric practice. It was started only to stop boys from masturbating. You would think that would be enough to at least warrant serious debate, but never for a second did you consider changing your culturally determined view.

You should know better.

Fantastic.

My view is based on the fact that circumsision has some medical benefit, has very few side effects and a great risk profile. Do I advocate it for everyone? Nope. Do I think it is inappropriate for everyone? Nope.

To me, the fact that there ARE medical benefits, and the fact that it is a significant cultural/social issue is more than enough to justify it's continued use.

All of your information is basically useless. You "feel" it is barbaric, so you are against it. You want to get consent from minors before doing it, so I would assume that you also want to delay braces or any non-essential medical treatment until the child can make a decision for himself. Again, ridiculous. THIS IS A SMALL, SIMPLE, SAFE PROCEDURE. There is no reason to not offer it, or to force somebody to go through it as an adult. I, personally, trust the parents to make a better decision for their child far more than I trust you to do so.

Your point about it being sensitive tissue is meaningless to me. In fact, it adds merit to the argument for this being done in childhood, so nerves can regenerate...given a modicum of knowledge about physiology of tissue repair, you would be able to deduce that it is logical for adults to have the problems you cite (ie, decrease in sensitivity), whereas children would tend to recover some sensitivity. And, further, you ignore all those men that are out there having wonderful sex without their foreskins. As evidenced by the many of us that still enjoy intercourse, we can still have a very sensitive experience sans foreskin. If you can find some way to quantify and compare sensitivity between men who were and were not circumsized as infants, I would look at the results. But, I am pretty sure you won't be able to do that. So, your point is basically that you think a circumsised penis lacks some sensitivity. Well, frankly I don't care what you think, AND I disagree. More importantly, when it comes to medicine, I advise patients on the best data available, not what I think may be true. IMHO, there is simply no data that support your claims of terror about circs, and in fact there is data that support it's continued availability.

Fact is, you are trying to make an emotional argument against a very minor procedure, and it is not even worth my time to post a rebuttal.

Reasons to offer a circ: medical, social, cultural. So, the choice is there for parents to make. I have yet to see a valid reason to not offer this choice to parents. Side effects? Minimal and rare. In fact, there are plenty of negative results when the foreskin is not removed.

So, if you don't want to do them, great. If you can go out and provide me with some science that justifies your position, great. Until then, keep your fanatical theories about brutal procedures and terrible adverse effects to yourself, and spare your patients the realization that their caregiver is an emotional zealot.

My "culturally determined view" is that the procedure has some small benefit, and some small risk. It is also such a benign procedure that there is absolutely no reason parents cannot decide this for their children.

I think this thread has turned into a freak show, frankly, and I don't want to get involved any further. So, excuse me if I decline to reply to your fanatical observations and zealotry.

 

[beetlerum]

Fantastic.

My view is based on the fact that circumsision has some medical benefit, has very few side effects and a great risk profile. Do I advocate it for everyone? Nope. Do I think it is inappropriate for everyone? Nope.

To me, the fact that there ARE medical benefits, and the fact that it is a significant cultural/social issue is more than enough to justify it's continued use.

All of your information is basically useless. You "feel" it is barbaric, so you are against it. You want to get consent from minors before doing it, so I would assume that you also want to delay braces or any non-essential medical treatment until the child can make a decision for himself. Again, ridiculous. THIS IS A SMALL, SIMPLE, SAFE PROCEDURE. There is no reason to not offer it, or to force somebody to go through it as an adult. I, personally, trust the parents to make a better decision for their child far more than I trust you to do so.

Your point about it being sensitive tissue is meaningless to me. In fact, it adds merit to the argument for this being done in childhood, so nerves can regenerate...given a modicum of knowledge about physiology of tissue repair, you would be able to deduce that it is logical for adults to have the problems you cite (ie, decrease in sensitivity), whereas children would tend to recover some sensitivity. And, further, you ignore all those men that are out there having wonderful sex without their foreskins. As evidenced by the many of us that still enjoy intercourse, we can still have a very sensitive experience sans foreskin. If you can find some way to quantify and compare sensitivity between men who were and were not circumsized as infants, I would look at the results. But, I am pretty sure you won't be able to do that. So, your point is basically that you think a circumsised penis lacks some sensitivity. Well, frankly I don't care what you think, AND I disagree. More importantly, when it comes to medicine, I advise patients on the best data available, not what I think may be true. IMHO, there is simply no data that support your claims of terror about circs, and in fact there is data that support it's continued availability.

Fact is, you are trying to make an emotional argument against a very minor procedure, and it is not even worth my time to post a rebuttal.

Reasons to offer a circ: medical, social, cultural. So, the choice is there for parents to make. I have yet to see a valid reason to not offer this choice to parents. Side effects? Minimal and rare. In fact, there are plenty of negative results when the foreskin is not removed.

So, if you don't want to do them, great. If you can go out and provide me with some science that justifies your position, great. Until then, keep your fanatical theories about brutal procedures and terrible adverse effects to yourself, and spare your patients the realization that their caregiver is an emotional zealot.

My "culturally determined view" is that the procedure has some benefit, and some small risk. It is also such a benign procedure that there is absolutely no reason parents cannot decide this for their children, based on the principle of beneficence.

I think this thread has turned into a freak show, frankly, and I don't want to get involved any further. So, excuse me if I decline to reply to your fanatical observations and zealotry.

Dude, you cannot regrow a frenulum you don't have. Your glans will be keratinized regardless of the age at which you get the procedure. Many women say that they notice a difference. Please do not compare this to getting braces. Your arguments against the sensitivity issue are weak, though at least you are addressing the issue. But it is clear that culture is still at work here, in what is probably the sole example of a body part that you would permit parents to remove.

I assume that if parents wanted to remove a portion of their girl's clitoris, you would have no objection.

 

[pruritis_ani]

Dude, you cannot regrow a frenulum you don't have. Your glans will be keratinized regardless of the age at which you get the procedure. Many women say that they notice a difference. Please do not compare this to getting braces. Your arguments against the sensitivity issue are weak, though at least you are addressing the issue. But it is clear that culture is still at work here, in what is probably the sole example of a body part that you would permit parents to remove.

I assume that if parents wanted to remove a portion of their girl's clitoris, you would have no objection.

a few points, and I am out...

1. My glans, keratinized or not, feels fantastic inside of a vagina. If it was any more sensitive, I would be even more horny, which would significantly cut into my other interests, thus depriving society of a decent doctor. Therefore, you can argue that circumsision benefits society. (note sarcasm)
2. Who cares if "many women say they notice a difference"??? Is that your argument against it? That somebody ELSE may notice a difference? Strong argument...
3. My arguments "against sensitivity" address the science of the issue. Yours involve what you THINK is the case. Many millions of men disagree with your opinion, and know that they have fully sensitive and functioning penis. Are you saying that we are wrong?
4. I am not sure why you bring up removing a portion of the girls clitoris here. Is there any evidence that that is medically beneficial? Is it a safe procedure with few side effects? Have millions of women undergone it with no problems? Nope. It appears that you are trying to mislead people over to your side via a visceral, emotional reaction to an unrelated procedure. Nice try, but stick to the issue at hand.

I think there are a lot of procedures that parents can get for their children. All of them are either very small and relatively risk free (ie get their ears pierced, or a circ), medically neccesary for life (ie appendix or tumor removal), or medically justifiable (ie braces). So, no, a foreskin is not the only thing I approve of parents having operated on. It is one of many, many justifiable procedures.

Again, you are letting your fanaticism cloud your thinking. This is a benign procedure we are discussing. Millions of men had it, and still enjoy sex, killing your idea that circs will ruin the sensitivity of the penis. It is a very safe procedure, with a complication rate that is similar to that of NOT being circumsised. It is a procedure with some small evidence of medical benefit, which may well prevent deadly disease. All of that SCIENCE flies directly in the face of your weakly thought out OPINION, which has been fed by propaganda.

 

[Flea girl]

a few points, and I am out...

1. My glans, keratinized or not, feels fantastic inside of a vagina. If it was any more sensitive, I would be even more horny, which would significantly cut into my other interests, thus depriving society of a decent doctor. Therefore, you can argue that circumsision benefits society. (note sarcasm)
2. Who cares if "many women say they notice a difference"??? Is that your argument against it? That somebody ELSE may notice a difference? Strong argument...
3. My arguments "against sensitivity" address the science of the issue. Yours involve what you THINK is the case. Many millions of men disagree with your opinion, and know that they have fully sensitive and functioning penis. Are you saying that we are wrong?
4. I am not sure why you bring up removing a portion of the girls clitoris here. Is there any evidence that that is medically beneficial? Is it a safe procedure with few side effects? Have millions of women undergone it with no problems? Nope. It appears that you are trying to mislead people over to your side via a visceral, emotional reaction to an unrelated procedure. Nice try, but stick to the issue at hand.

I think there are a lot of procedures that parents can get for their children. All of them are either very small and relatively risk free (ie get their ears pierced, or a circ), medically neccesary for life (ie appendix or tumor removal), or medically justifiable (ie braces). So, no, a foreskin is not the only thing I approve of parents having operated on. It is one of many, many justifiable procedures.

Again, you are letting your fanaticism cloud your thinking. This is a benign procedure we are discussing. Millions of men had it, and still enjoy sex, killing your idea that circs will ruin the sensitivity of the penis. It is a very safe procedure, with a complication rate that is similar to that of NOT being circumsised. It is a procedure with some small evidence of medical benefit, which may well prevent deadly disease. All of that SCIENCE flies directly in the face of your weakly thought out OPINION, which has been fed by propaganda.

Hello there Ani,

Now normally we tend to agree on most on these here boards....However, I do have to state that I am completely againist Circs. Yes, I have done a few and hated doing them. Unlike you none of my baby boys were sleeping, crying their poor little heads off and trying to move away. I personaly think that there is no real proven benefit. Yes, I know there are studies out there but
1) If having unprotected sex.. you deserve to get an STD(everyone knows the risk)
2) Penile CA not real prevenlent here in the US, so does it really make a dif?
3) Cervical CA transmission, well hell we are getting the vaccine and again can we say condoms? If not get your paps!
My son is not Circ'd. I left the decsion up to my husband and he choose not to do it. He felt that even though it is a minor procedure, it still possed a risk and just felt it was unneccessary. Though we found it amusing when people said "Don't you want your son to look like his father?" Funny thing is that both his dad and my dad are uncirc'd! It is amazing what people will tell you these days! That being said I would be impartial to my patients that I counseled. This even though I am morally againist them and think that it is unethical to do them on a baby that can not consent for the procedure. It is not my right to unload my hang ups on my pts . Though I will definately NOT do after residency and NEVER do more than is required of me.
Have you started residency yet P. Ani? I got first call on Sat !

 

[nimbus]

Puhlease. Easy on the drama. Circumsision is NOT some bizzare, life alterering, disfiguring operation. How do I know? I had one, I have done several.

Are there medical reasons for it? Sure, there are some weak ones. Are there cultural/social reasons for it? Plenty of those too. Are these reasons big enough to require every newborn male infant get circed? Nope, and nobody is after that.

The point is that it is a very minor procedure, removing a piece of skin. The risks are very small. If parents want it, fine. We let them clip toenails too, right?

Making this into some huge argument about disfiguring a baby, comparing it to mastectomy, saying that these infants are doomed to a miserable sex life with a desensitized penis is ridiculous. Bringing in autonomy is also a bit ridiculous, as children typically have little autonomy anyhow. Should we wait til they reach adulthood to get consent before braces? How about haircuts?

It is a small procedure, easily done, with little distress on the part of the infant. If parents want it, great. If not, also great. I cannot believe how some people want to make the biggest issue out of nothing.

Well said. Clearly circumcision is more of a cultural procedure than a medical one.

If and when my little girl wants her ears/navel/etc pierced, I will take her to the local tattoo/piercing shop. This is where circumcision belongs, not in a hospital and not sanctioned by the medical establishment. We are all fooling ourselves if we call this form of body modification a medical procedure.

 

[pruritis_ani]

Hello there Ani,

Now normally we tend to agree on most on these here boards....However, I do have to state that I am completely againist Circs. Yes, I have done a few and hated doing them. Unlike you none of my baby boys were sleeping, crying their poor little heads off and trying to move away. I personaly think that there is no real proven benefit. Yes, I know there are studies out there but
1) If having unprotected sex.. you deserve to get an STD(everyone knows the risk)
2) Penile CA not real prevenlent here in the US, so does it really make a dif?
3) Cervical CA transmission, well hell we are getting the vaccine and again can we say condoms? If not get your paps!
My son is not Circ'd. I left the decsion up to my husband and he choose not to do it. He felt that even though it is a minor procedure, it still possed a risk and just felt it was unneccessary. Though we found it amusing when people said "Don't you want your son to look like his father?" Funny thing is that both his dad and my dad are uncirc'd! It is amazing what people will tell you these days! That being said I would be impartial to my patients that I counseled. This even though I am morally againist them and think that it is unethical to do them on a baby that can not consent for the procedure. It is not my right to unload my hang ups on my pts . Though I will definately NOT do after residency and NEVER do more than is required of me.
Have you started residency yet P. Ani? I got first call on Sat !

Hey there! Well, I don't think we disagree here either. The medical benefits are small, but there. There is certainly enough evidence to offer them, and certainly the procedure is small enough that cultural/social reasons are good enough. As for side effects, well, people WITHOUT circs tend to have as many or more complications as those that were circumsised.

Either way, I could care less who wants one done, or who doesn't. I could also care less who does them. (As a matter of fact, at my current program, I do not do them, and won't likely be doing them when I finish....Peds get them). I just think all patients should be counseled based on the best medical information in an unbiased manner. Simple, right?

(BTW, first call Sat. for me too! Yikes!! Good luck with that....)

 

[beetlerum]

a few points, and I am out...

1. My glans, keratinized or not, feels fantastic inside of a vagina. If it was any more sensitive, I would be even more horny, which would significantly cut into my other interests, thus depriving society of a decent doctor. Therefore, you can argue that circumsision benefits society. (note sarcasm)
2. Who cares if "many women say they notice a difference"??? Is that your argument against it? That somebody ELSE may notice a difference? Strong argument...
3. My arguments "against sensitivity" address the science of the issue. Yours involve what you THINK is the case. Many millions of men disagree with your opinion, and know that they have fully sensitive and functioning penis. Are you saying that we are wrong?
4. I am not sure why you bring up removing a portion of the girls clitoris here. Is there any evidence that that is medically beneficial? Is it a safe procedure with few side effects? Have millions of women undergone it with no problems? Nope. It appears that you are trying to mislead people over to your side via a visceral, emotional reaction to an unrelated procedure. Nice try, but stick to the issue at hand.

I think there are a lot of procedures that parents can get for their children. All of them are either very small and relatively risk free (ie get their ears pierced, or a circ), medically neccesary for life (ie appendix or tumor removal), or medically justifiable (ie braces). So, no, a foreskin is not the only thing I approve of parents having operated on. It is one of many, many justifiable procedures.

Again, you are letting your fanaticism cloud your thinking. This is a benign procedure we are discussing. Millions of men had it, and still enjoy sex, killing your idea that circs will ruin the sensitivity of the penis. It is a very safe procedure, with a complication rate that is similar to that of NOT being circumsised. It is a procedure with some small evidence of medical benefit, which may well prevent deadly disease. All of that SCIENCE flies directly in the face of your weakly thought out OPINION, which has been fed by propaganda.

1. It is amusing that you claim to address the science of the issue, whereas I do not. Your sole argument is based on your own personal experience with your penis. You made no attempt to counter my arguments based on the anatomical alternation (i.e. removing significant portions of the erogenous tissue), except for your preposterous comment about regrowing the nerve endings (last i checked, men don't regrow foreskins or frenulums).

Furthermore, the weight of the science does not support your opinion. I don't know where you're getting the idea that the weight of the science clearly shows a lack of loss of sensitivity, and I stand behind my earlier comment that, given the anatomical changes, the burden is squarely on the shoulders of those who say it does not reduce sensitivity.

Hell, even the pro-circ groups admit a loss of sensitivity. They argue that it helps men last longer and thus has net benefits for sex. Perhaps it does allow men to last longer, but they should get to choose later in life themselves whether they want to trade sensitivity for performance.

2. Millions of women have undergone female circumcision. I am pretty sure that female circumcision has been shown to be safe and easy to do if carried out in sanitary conditions. Many groups, however, oppose any alteration of the clitoris and external female genitalia on moral grounds. I doubt you would deem me a fanatic if I opposed all female circumcision. Nothing but cultural differences could explain that fact.

3. It is absurd to compare circumcision to getting your ears pierced. C'mon now. Though I suspect that if parents wanted to pierce their infant's ears just because the baby's father also had pierced ears, you would strongly counsel them not to. Yet I am a fanatic for wanting to do the same for removing a portion of the baby's penis. And no parent can decide to have their baby's appendix removed for cultural reasons.

4. By the way, sensitivity is a bell curve obviously and it appears that you have a pretty sensitive penis for a circumcized man. I suspect you also have a nearly intact frenulum. (Despite the fact that when you do a circumcision, you probably make no attempt to preserve as much of the frenulum as possible). Good for you. But you cannot generalize from your personal experience. If you looked at the long thread on circumcision, you would see there are men there who say they clearly have less sensitivity than their uncircumcized friends, based on discussions, and also have problems with chafing during running, etc.

Anyway, if you look at these posts, I do not think I am the one who comes off as the fanatic.

 

[RossFamily]

I think...this horse is dead.

 

[beetlerum]

I think...this horse is dead.

Agree. But I persist because it is not just a theoretical issue. Oh well.

 

[ilovepubmed]

here's an idea! let the kid grow up, when he turns 18 we can just ask him, "what do you think of cutting off part of your penis? if you never plan on bathing or using condoms, there might be some health benefits!" what do you think the kids going to say?

 

[beetlerum]

here's an idea! let the kid grow up, when he turns 18 we can just ask him, "what do you think of cutting off part of your penis? if you never plan on bathing or using condoms, there might be some health benefits!" what do you think the kids going to say?

Hah, though even I will admit it is not totally a fair comparison because he would then have to go through the unpleasantness of the procedure. And perhaps it is less unpleasant when you are an infant. Maybe. I believe there is some contrary evidence actually.

Consider the same scenario, however, and imagine that the part of the penis could be removed painlessly. What will he say then? He will probably still say "get the hell away from my dick, you lunatic."

 

[joshmir]

in the discussion about how it effects sex, the point was made that it enables men to have less premature ejaculation

what is the female take? *all things being equal*, would intercourse be more pleasing to the woman with that extra foreskin, or not? I have heard that it is...

that is a difficult question for a husband to ask his wife, sister, female friends etc, but it is something he may want to know to make an informed decision (son's penis has many functions--->sexual pleasure for himself and his partner---->which way feels better for women, on average?)

seriously, what is the opinion of the women on this thread? most men (who may have to share in that decision one day for their sons) would like to know...and it is a difficult poll to conduct anywhere but here

 

[AndrewB]

"my sons will have their foreskins as they enter into adulthood" I hope your sons don't have to experience a foreskin adhesion and have to have a circumcision under general anasthesia when they are 5 y/o like my son did, it was quite traumatic and it convinced me to have our next son circumcised the usual time/way. And I think refusing to do a widely accepted procedure is a little overboard. I can see a Doc refusing to do an abortion, but refusing to do a circumcision? I was a little upset that our OB/GYN did not mention the problems associated with not circumcising. I would have liked to be informed about the possible problems.

I had this when I was a toddler. Would have been easier if it had just been done at birth. Instead I was put under with a general anesthetic for the circ.

 

[Doula-2-OB]

I had this when I was a toddler. Would have been easier if it had just been done at birth. Instead I was put under with a general anesthetic for the circ.

Foreskin adhesions happen when someone ****s around with the foreskin and doesn't leave it alone, as they should. You don't pull on a child's foreskin, or, guess what- you get ADHESIONS!

I'm sorry that these boys had to go through circs for this purpose. Americans just don't know how to deal with intact penises.

 

[RossFamily]

I think...this horse is dead.

This horse is so far past dead, there's hardly an ounce of flesh left on the bones after being beaten so heartily.