Surgery on normal newborns besides circumcision?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
OK, I am going to cite a professional source on this matter. It is from Dave Barry's book, Dave Barry is Not Making This Up. On pages 59-61 he addresses the issue of male infant circumcision and how most guys move forward in life. However, back in 1994, when this book was written, there was a support group out in CA (go figure) for men who were traumatized over being circumcised. The name of the group was RECAP (ReCover A Penis).

The group dedicated themselves to restoring themselves to their pre-circumcised state. Here is a quote from page 61 from Dave's interview with one of the group's members:

"There are a lot of men who are enraged that they were violated without their consent and they want to do something about it. I've always been fascinated by intact men. I just thought it looked nice. I had friends growing up who were intact. I thought, 'Gee, that's what I'd like to be.'"

The article states that, to become intact again, Griffiths invented a 7 1/2 ounce skin-stretching device that "looks like a tiny steel barbell," which he taped to the end of his Oregonian (Dave substituted the name of newspapers for penis) and wore for "four to 12 hours every day, except weekends, for a year." Using this method, he grew himself an entirely new Post-Dispatch." Other RECAP members are involved in similar efforts. They met regularly to discuss technique and review their progress.
Members don't see this ad.
 
fab4fan said:
OK, I am going to cite...
Click to expand...

Yes, some men attempt to partially restore a foreskin. The numbers are not insignificant. For each one that does, several others also regret what was done to them but do not restore.

This should factor into the ethical debate about non-therapeutic newborn circumcision, as should the fact that the rate of intact men choosing circumcision is tiny.
 
Members don't see this ad :)
Will anyone comment, in all seriousness, on to what degree their medical school did or did not teach about the actual anatomical structures which are present in intact men but absent in circumcised men?
 
Kai Zhur said:
Will anyone comment, in all seriousness, on to what degree their medical school did or did not teach about the actual anatomical structures which are present in intact men but absent in circumcised men?
Click to expand...

In my best Nelson Muntz voice:

"Ha ha! No one cares!"
 
Kai Zhur said:
Will anyone comment, in all seriousness, on to what degree their medical school did or did not teach about the actual anatomical structures which are present in intact men but absent in circumcised men?
Click to expand...

Why don't you just check with your own school?

Oh yeah, you're not involved with medicine, you're a single-issue weirdo.
 
ml66uk said:
Like I said before, adult circumcision hurts less, is less dangerous, and the results are cosmetically better.
Click to expand...

On what data do you base this statement? I looked through all of your posts and didn't see anything about this. Let me tell you from having performed elective circs on both babies and 16-18 year olds, the older kids cried a lot longer than the babies and required much more pain medicine (we're talking a little tylenol compared to narcotics). I also challenge the notion that the cosmetic results are better on older individuals because it is a much more infrequently performed procedure (at least in the US), which generally means the cosmetic appearances are worse.

I'm with the majority here in that I don't really care either way. I just don't understand the fanatical way some people are against circumcision. Do I feel I was robbed of great sexual pleasure because I was circumcised as a kid? Not really; sex is pretty fantastic as it is.

The continuously repeated argument (by Kai Zhur) is that there is all of this extra sensation to be had in this bit of tissue that has been removed for no real health benefit. So what? Sex is just peachy without it, and that appears to be the only real benefit you are claiming. All this stuff on the other thread about touch sensitivity, enhanced gliding action and glans protection is nonsense in the modern world. Personally, I don't go around, naked, trying to read the braille on the elevator or find the homerow on my keyboard with my penis, and I don't think I would if I had a foreskin.

I completely understand your point about the ethics of performing a circumcision. You are correct in that no other surgical procedure is electively performed on a "normal" child (although, as Tired points out, there are no functional impairments to most hemangiomas and cleft lips. Arguing that they are considered "malformations" puts you on the same slippery slope that you are arguing against, as many people in the ethical community consider "malformation" a four-letter word and would say that benign hemangiomas are variants of normal and that cleft lips shouldn't be considered "malformations," either, as that classification carries with it a social stigma). If you want to say that is why it shouldn't be done, that is fine. However, that puts you on the same platform as (and this is also something you may support) anti-abortionists (potential child's right to life), anti-amniocentesis/chorionic villus sampling and even anti-IUDs.
 
Last edited:
SocialistMD said:
The continuously repeated argument (by Kai Zhur) is that there is all of this extra sensation to be had in this bit of tissue that has been removed for no real health benefit. So what?
Click to expand...

I appreciate your honest approach to this. And if I recall correctly, nobody else here has argued there is a net health benefit, either. "So What?" about lost sensation is a question not easily answered by someone circumcised shortly after birth. Many people choose to avoid even thinking about it, and when confronted, will not even concede (as you appear to) that sensation is lost. Once we agree that there is no net health benefit, and that sensitivity is reduced, "So what?" becomes almost a philosophical question. It may be easiest to imagine how you'd feel if parts of your body which you are accustomed to having were lost. Earlobes, for example. Maybe they don't seem to do much, but they do produce sensation, perhaps sensation that you enjoy. Of course, one's genitals tend to be a more central focus than one's ears.

"So what?" about lost sensation, when so much remains, is just one component of the ethical issues surrounding the surgery.

SocialistMD said:
I completely understand your point about the ethics of performing a circumcision. You are correct in that no other surgical procedure is electively performed on a "normal" child (although, as Tired points out, there are no functional impairments to most hemangiomas and cleft lips. Arguing that they are considered "malformations" puts you on the same slippery slope that you are arguing against, as many people in the ethical community consider "malformation" a four-letter word and would say that benign hemangiomas are variants of normal and that cleft lips shouldn't be considered "malformations," either, as that classification carries with it a social stigma). If you want to say that is why it shouldn't be done, that is fine. However, that puts you on the same platform as (and this is also something you may support) anti-abortionists (potential child's right to life), anti-amniocentesis/chorionic villus sampling and even anti-IUDs.
Click to expand...

Again, I appreciate your nuanced approach. There is not an a perfect definition for "birth defect" or "malformation." Still, from the macro view, there is an unambiguous difference between the normal (males having a foreskin) and instances of the unusual (cleft lips, etc.). The gray area of the later does not include the former. It's not a slippery slope any more than the "self defense" exception for killing a person is a slippery slope which could permit murder of a random person without any cause. The existence of some gray areas does not mean all areas are gray.

SocialistMD said:
I'm with the majority here in that I don't really care either way. I just don't understand the fanatical way some people are against circumcision.
Click to expand...
Do you care about what your child-patient would want for himself? It is reasonable to assume that any patient wants what is their best interests medically, but circumcision provides no net health benefit. Furthermore, we know that intact adults rarely choose circumcision for themselves.
 
Kai Zhur said:
Do you care about what your child-patient would want for himself? It is reasonable to assume that any patient wants what is their best interests medically, but circumcision provides no net health benefit. Furthermore, we know that intact adults rarely choose circumcision for themselves.
Click to expand...

What about what God wants? Because I'm pretty sure circumcision is in the bible.
 
Tired said:
What about what God wants? Because I'm pretty sure circumcision is in the bible.
Click to expand...

Maybe you should take this comment to a religion forum.

Here, it is customary to discuss health care, and to remain on-topic.
 
Kai Zhur said:
Earlobes, for example. Maybe they don't seem to do much, but they do produce sensation, perhaps sensation that you enjoy.
Click to expand...

:confused::confused:

That's the weirdest thing I've read on SDN in a while.

Kai Zhur said:
Furthermore, we know that intact adults rarely choose circumcision for themselves.
Click to expand...

Because the surgery for an adult is longer, more painful, and has more bleeding. Most adults are afraid to go under any kind of surgery anyway, particularly any surgery that requires general anesthesia.

Circumcision in a neonate is a short procedure, not as painful (as SocialistMD pointed out), and doesn't require general anesthesia.

They're not really comparable situations.

Kai Zhur said:
Do you care about what your child-patient would want for himself? It is reasonable to assume that any patient wants what is their best interests medically, but circumcision provides no net health benefit.
Click to expand...

Parents make MANY decisions for neonates without consulting them. Do you ask a fetus, "Hey, baby, do you want to be breast fed or formula fed? Your mom wants an epidural while you're trying to push your way out - are you okay with that? Your mother wants to deliver you in a birthing tub in her home, as opposed to a room in the hospital? It's a little more dangerous if your heart were to stop beating, but do you mind?"

If circumcision at a younger age means less blood loss, shorter recovery time, and avoidance of general anesthesia, then why wait to "consult" your kid? He'll be able to procreate and have enjoyable sex either way.

And we've already established that, actually, circumcision can provide some net health benefit.

SocialistMD said:
Personally, I don't go around, naked, trying to read the braille on the elevator or find the homerow on my keyboard with my penis, and I don't think I would if I had a foreskin.
Click to expand...

:laugh::laugh::laugh: :thumbup:

Kai Zhur said:
Here, it is customary to discuss health care, and to remain on-topic.
Click to expand...

You haven't been on SDN for very long, have you?
 
Members don't see this ad :)
Kai Zhur said:
Maybe you should take this comment to a religion forum.

Here, it is customary to discuss health care, and to remain on-topic.
Click to expand...

Given that God makes doctors, I think it's very relavent.

Perhaps if you read the Bible more, you could learn to think less about children's penises.
 
smq123 said:
Because the surgery for an adult is longer, more painful, and has more bleeding. Most adults are afraid to go under any kind of surgery anyway, particularly any surgery that requires general anesthesia.

Circumcision in a neonate is a short procedure, not as painful (as SocialistMD pointed out), and doesn't require general anesthesia.
Click to expand...

Show me a study which finds circumcision is less painful for a neonate than an adult. I don't think you can back up this claim.

Adults, if they choose, can benefit from general anesthesia, which provides more complete pain relief. Neonates, unlike adults, have their foreskins separated with a probe.

You cite a fear of surgery in adults. That reinforces my point. Most adults prefer to avoid surgery. Most children who understand it prefer to avoid surgery. Clearly the only difference in the neonatal period is an inability to conceptualize and express a preference prior to surgery. Your argument fails because if it were valid, it could justify doing anything to a neonate simply because they cannot understand what you plan to do.

The more reasonably logic is that since people who understand circumcision usually decide against it for themselves, then a neonate would probably decide against it if they could.

By the way, adult circumcision does not require general anesthesia, and many neonates receive little or no anesthesia whatsoever.

smq123 said:
Parents make MANY decisions for neonates without consulting them. Do you ask a fetus, "Hey, baby, do you want to be breast fed or formula fed? Your mom wants an epidural while you're trying to push your way out - are you okay with that? Your mother wants to deliver you in a birthing tub in her home, as opposed to a room in the hospital? It's a little more dangerous if your heart were to stop beating, but do you mind?"
Click to expand...

Parents do NOT decide on cosmetic surgery, particularly involving the excision of healthy tissue, on their normal children (special exception made only for circumcision). They do decide on food, mother's pain relief, and location of birth, for reasons that should be obvious (but since you brought it up, maybe not).

smq123 said:
And we've already established that, actually, circumcision can provide some net health benefit.
Click to expand...

Once again, you are making an unsubstantiated claim. None of the medical associations make that claim. None of the medical associations recommend circumcision. If you're going to make a major claim like this, back it up.
 
Tired said:
You're right, I'm unwilling to have a serious discussion. I just think it's funny when folks like you get worked up over things that are entirely unimportant.

By the way, I'm still right, repair of cleft lips is done entirely for cosmetic reasons. The fact that you find an uncircumcised penis attractive, but a cleft lip unattractive, is entirely beside the point.
Click to expand...
I've heard from plenty of sources that males who are not circumcised have more pleasureful intercourse, as the skin enveloping the glans penis is more sensitive. It makes me wish I hadn't been circumcised. But, to be fair, it was my decision at 11 years old. My parents had drilled into me that I was at risk of an infection if I didn't clean well under the prepuce and I was unwittingly caught off guard by puberty pains that I mistook for an infection. Damn. One of the most painful experiences of my life.
 
1 Up said:
I've heard from plenty of sources that males who are not circumcised have more pleasureful intercourse, as the skin enveloping the glans penis is more sensitive. It makes me wish I hadn't been circumcised. But, to be fair, it was my decision at 11 years old. My parents had drilled into me that I was at risk of an infection if I didn't clean well under the prepuce and I was unwittingly caught off guard by puberty pains that I mistook for an infection. Damn. One of the most painful experiences of my life.
Click to expand...

The only examples of anyone who could confirm this would be someone who was circumcised after puberty and had already had intercourse. This of course highly confounds any sort of credible evidence as to what specifically happens in individuals who are circumcised in infancy and any subsequent adaptation. It is impossible to say that it feels better or worse while circumcised versus not, as no one who has had a circumcision in infancy has had intercourse with a true foreskin.
 
EBMtriad.jpg
Please note the part that says: 'patient values'


For pediatrics, this means parental values. Time and time again, the courts, society and medical boards have supported parental values in determining care issues. (vaccinations +/-, circumcision +/-, transfusions +/-, etc etc).

Note that in the pyramid, the PHYSICIANS personal belief does not come into play.

If you do not believe in circumcision as an MD, do not perform them.

If you are upset with your parents decision to circumcize you, take it up with your parents.

Critical appraisal of the literature alone (the EBM part of that triad) is INCONCLUSIVE on either side.

Dogma is not medicine, nor is it evidence. It rarely changes anyone's opinion and accomplishes very little.

I think you have established your point and really should either join an organization where people share similar beliefs and move along.
 
fab4fan said:
I work in a surgical setting, and we see younger men electing this procedure. No defect--purely elective.
Click to expand...

Some men do elect this procedure. The percentage is very small. Correct me if you have better data, but I think intact men in the United States elect circumcision sometime throughout their lives at a rate of around 0.2%-0.3%. This is a strong argument against circumcision before the individual is capable of choosing for himself. It suggests that intact men, who know exactly which parts they have to lose, overwhelmingly prefer to remain intact.
 
Miami_med said:
The only examples of anyone who could confirm this would be someone who was circumcised after puberty and had already had intercourse. This of course highly confounds any sort of credible evidence as to what specifically happens in individuals who are circumcised in infancy and any subsequent adaptation. It is impossible to say that it feels better or worse while circumcised versus not, as no one who has had a circumcision in infancy has had intercourse with a true foreskin.
Click to expand...

You are right. So we need to focus, instead, on what we can measure and compare. We can measure touch sensitivity, and those measurements show that the parts excised by circumcision are as or more sensitive than any other part. Self-reporting (not sure if this has been formally studied) indicates that the sensitivity in those parts contributes to pleasure. We know that many signals to the brain are severed by circumcision.

The evidence we have is more than enough to demonstrate that those components of the human body are valuable. How well a person can adapt to its loss, and what effect it has on pleasure notwithstanding. Only if there were a compelling medical reason to remove them would such a calculation be necessary to help choose the more preferable of two unfortunate options.

The extreme difficultly of measuring what you would have experienced, if not circumcised as a newborn, adds nothing to an argument for the permissibility of performing non-therapeutic circumcision on a patient who cannot give his own informed consent.
 
roja said:
Please note the part that says: 'patient values'

For pediatrics, this means parental values. Time and time again, the courts, society and medical boards have supported parental values in determining care issues. (vaccinations +/-, circumcision +/-, transfusions +/-, etc etc).
Click to expand...

Your argument here (generally well thought out) rests on the assumption 'patient values' are equivalent to 'parental values'. However, this is overly simplistic, and breaks down in many real-world cases. If proxy consent were equivalent to an adult's informed consent, then all manner of elective cosmetic surgeries which adults may choose for themselves would be permitted on children. Everything from rhinoplasty to labiaplasty. To emphasize my point, there is even a law against cosmetic labiaplasty on minors, but not on informed and consenting adults.

It is well understood that parents have authority to give proxy consent for medical procedures in the best interest of the child. That is a more limited authority than they have for themselves. So while parents are indeed given wide latitude to determine what is in the best interests of their children, children also have rights independent from their parents.

Parents may not arbitrarily remove parts from the bodies of their children (however presently, there is a special exception made for the male foreskin). This exception is facilitated by physicians and the medical community in general, so responsibility cannot be placed exclusively with parents.
 
Miami_med said:
The only examples of anyone who could confirm this would be someone who was circumcised after puberty and had already had intercourse.
Click to expand...

You know what's funny? My father got circumcised at the age of 35, and my step-father got circumcised at the age of 27. So I guess I'm just the man to be talking to. I got circumcised at the age of 11, though I regret to inform you that I had not yet had sexual intercourse.

Believe it or not, circumcision has been a pretty big part of my life and I know a little bit about what I'm talking about. ;) So you can try to dance around common sense and say thing like "Well... we don't really know so..." or you can accept the argument as a good one.

But hey! On the flip side, circumcision may equal less accidental pregnancy! Okay, now that's stretching it.
 
1 Up said:
So you can try to dance around common sense and say thing like "Well... we don't really know so..." or you can accept the argument as a good one.
Click to expand...

If a newborn loses sight in one eye, will he really enjoy looking at a great painting any less, as an adult? If we can't prove so, does that mean it doesn't matter?

More importantly, it's the wrong question. If sensory function was lost, then the goal of preserving normal function was missed. If the loss was inflicted intentionally, unless a compelling benefit was traded for it, then the physician has failed his patient.
 
Kai Zhur said:
If a newborn loses sight in one eye, will he really enjoy looking at a great painting any less, as an adult? If we can't prove so, does that mean it doesn't matter?

More importantly, it's the wrong question. If sensory function was lost, then the goal of preserving normal function was missed. If the loss was inflicted intentionally, unless a compelling benefit was traded for it, then the physician has failed his patient.
Click to expand...

So when are you going to get around to telling us why you're so interested in baby wee-wees anyway? Recovered memories? Were you a moil whose hand slipped at the wrong moment?
 
Tired said:
Were you a moil whose hand slipped at the wrong moment?
Click to expand...

It's "mohel", actually. This thread reminds me of an anecdote.

A doctor enters the hospital room of a family that has just had a baby boy.

Doctor: "I'm afraid I must tell you that your son was born without eyelids"
Father: "What can be done?"
Doctor: "I have good news and bad news"
Father: "Well, what's the good news?"
Doctor: "Good news is, after his circumcision, I can use his foreskin to reconstruct his eyelids. It will work like a charm!"
Father: "and the bad news?"
Doctor: "He'll be cock-eyed."

:laugh::laugh::laugh:
 
Tired said:
So when are you going to get around to telling us why you're so interested in baby wee-wees anyway?
Click to expand...

Some people (but certainly not all) in the medical field support needlessly cutting parts off them. It's their behavior that interests me. It anomalous because in general docs do their very best to promote the health of their young patients. They practice medicine which they expect to be beneficial, not cultural rites. To their credit, many docs will not perform a non-therapeutic circumcision. For those that do, your above-quoted question would be apt.
 
Kai Zhur said:
Some people (but certainly not all) in the medical field support needlessly cutting parts off them. It's their behavior that interests me. It anomalous because in general docs do their very best to promote the health of their young patients. They practice medicine which they expect to be beneficial, not cultural rites. To their credit, many docs will not perform a non-therapeutic circumcision. For those that do, your above-quoted question would be apt.
Click to expand...

Then I'd say you've got your answer:

1) Many of us are swayed by the research showing a medical benefit

2) Most of us recognize this as a pretty benign procedure

3) Even those who don't perform it don't really think it's a big deal either way

FWIW, I still think you had some bad experience or something. Nobody gets this excited over a nothing issue like circumcision unless there's a personal reason behind it.
 
Tired said:
Then I'd say you've got your answer:

1) Many of us are swayed by the research showing a medical benefit

2) Most of us recognize this as a pretty benign procedure

3) Even those who don't perform it don't really think it's a big deal either way

FWIW, I still think you had some bad experience or something. Nobody gets this excited over a nothing issue like circumcision unless there's a personal reason behind it.
Click to expand...

It is well established that neonatal circumcision is a cultural practice lacking evidence of medical justification. That is the clear consensus of the medical community, even in the United States which leads the world in non-therapeutic physician practiced circumcision.

Surely you understand that in medicine, potential benefits and risks are weighed against each other. Your notable failure to mention risks, and dropping of the prudent adjective "potential" before "benefits" (used by the AAP) suggests that something is preventing you from making an objective assessment. This lack of objectivity regarding circumcision seems to disproportionally occur in men who are themselves circumcised. Your disposition may reflect something besides the underlying medical facts and sound reasoning. Hill describes this as one of the behavioral consequences of neonatal circumcision:

Behavior of circumcised medical doctors
Medical doctors in Australia, Canada, and the United States practiced circumcision in the twentieth century, so these nations have a heavy proportion of circumcised men, some of whom become medical doctors. These circumcised male doctors share the same bias in favor of male circumcision as do other circumcised males.[7] [31] [43] Male doctors who were circumcised as infants are more likely to recommend circumcision of infants to parents.[44]
Click to expand...
Behavior of circumcised medical authors
The high proportion of circumcised males in the medical community create a distorted, biased medical literature.[47] Goldman (1999) writes:

"One reason that flawed studies are published is that science is affected by cultural values. A principal method of preserving cultural values is to disguise them as truths that are based on scientific research. This 'research' can then be used to support questionable and harmful cultural values such as circumcision. This explains the claimed medical 'benefits' of circumcision."[31]

Hill (2007) writes:

"The medical literature on circumcision is voluminous and contentious. Circumcised doctors create papers that overstate benefits and minimize harms and risks. When these doctors publish such claims, other doctors come forward to refute them....The result is an unending debate driven by the emotional compulsion of circumcised men."[43]


Female doctors from a circumcising culture of origin have been known to contribute pro-circumcision pieces.

Most American medical editors are circumcised men. They share the pro-circumcision bias of other circumcised men. They tend to select papers for publication that conform to their bias. The literature, therefore, is filled with pro-circumcision papers written by circumcised doctors. The behavior of these circumcised doctors has served for a century to prolong the practice of a nineteenth century surgical operation that has no medical indication and is injurious to infants and children.
Click to expand...
It is certainly not the case that "Even those who don't perform it don't really think it's a big deal either way." You haven't surveyed all of them, so you can't make that claim. Without doubt, some refuse to do them because they apply the same ethical standard that they apply to every other surgery on a newborn. That is, they won't perform medically pointless surgeries on perfectly normal and healthy children.
 
Usually at some point in these kind of discussions :)beat:) the interested parties just agree to disagree. Clearly that’s not happening here. In this case it’s because of the two parties in the discussion one is a single issue crusader who has no interest in the debate and is just here to win converts to his side. The other just likes poking the hornet’s nest with sticks.

I do think that it’s interesting how the anti-circumcision crowd has crafted an issue that turns them from generally disgruntled folks with no particular villain to blame for their problems into bona fide victims, wronged at birth, with a unifying call to action to save the next generation for meeting the same cruel fate. While the claim of victimhood is the Holy Grail of new American society’s power structure the really cruel truth for the crusaders is that very few people will be rallied to this cause. The vast majority don’t care. Many will think that the discussion is downright weird. As the crusader is sure to point out I don’t have hard data to quantify “majority” or “many” but any readers not already firmly in one camp or the other knows these statements to be true.

I now return you to the windmill jousting.
 
docB said:
As the crusader is sure to point out I don’t have hard data to quantify “majority” or “many” but any readers not already firmly in one camp or the other knows these statements to be true.
Click to expand...

Nobody has evidence as good as him.

Hell, his sources know what their opponents' penises look like. ("Circumcised doctors create papers that overstate benefits and minimize harms and risks.")

You can't top that.
 
docB said:
While the claim of victimhood is the Holy Grail of new American society’s power structure the really cruel truth for the crusaders is that very few people will be rallied to this cause. The vast majority don’t care. Many will think that the discussion is downright weird.
Click to expand...

Why wouldn't we see the same trend towards low rates of non-therapeutic circumcision that we've seen in Canada, Britain, and Australia? We're already seeing the same trend, only more gradually. It seems almost certain to continue as the higher rates of intact young people grow up and have their own children.
 
I don't have anything to say, just thought I'd stop in for my daily giggle.
 
Far be it from me to play Thought Police, but am I the only one who thinks using "intact" for a guy who has his foreskin a loaded term? It's not incorrect, but it has the connotation of "better, not deficient".

I'm not saying it's wrong, I just wanted to point out some clever marketing.
 
PeepshowJohnny said:
Far be it from me to play Thought Police, but am I the only one who thinks using "intact" for a guy who has his foreskin a loaded term? It's not incorrect, but it has the connotation of "better, not deficient".

I'm not saying it's wrong, I just wanted to point out some clever marketing.
Click to expand...

I prefer the term "floppy".
 
ml66uk said:
Why don't we just let the owner of the genitals decide for themselves? Like I said before, adult circumcision hurts less, is less dangerous, and the results are cosmetically better.
Click to expand...

SocialistMD said:
On what data do you base this statement? I looked through all of your posts and didn't see anything about this. Let me tell you from having performed elective circs on both babies and 16-18 year olds, the older kids cried a lot longer than the babies and required much more pain medicine (we're talking a little tylenol compared to narcotics). I also challenge the notion that the cosmetic results are better on older individuals because it is a much more infrequently performed procedure (at least in the US), which generally means the cosmetic appearances are worse.
Click to expand...

It hurts less for two main reasons:
1) you can use general anaesthetic
2) you don't have to separate the foreskin from the glans. This is the most painful part of the operation - not dissimilar to having your thumbnails ripped out. If you wait a few years, then the foreskin separates naturally.

It's less dangerous because :
1) what you're working with is larger. It's rare, but babies have died or suffered amputation because of circumcision. I'm not aware of this happening with adult circumcision in a western setting.
2) Adults also have a developed immune system. A baby died after circumcision in New York recently of the coldsore virus for instance, and another got brain damage.

The results are cosmetically better because :
1) again, what you're working with is larger. There have been some horrific cases where babies' penises have been degloved, or left lop-sided, or with severe chordee. You can look up galleries of botched circumcisions, but none of the bad ones will have been performed on adults.
2) Separating the foreskin from the glans before it's ready causes problems. Neonatal circumcisions can result in adhesions, skin tags and skin bridges. Again you can look up galleries of these, and they don't happen with adult circumcisions.

They were still saying till about ten years ago that neonates didn't feel pain. Ludicrous I know, but that's what they said. Recent research seems to show that they're actually more sensitive to pain than adults. They're easy to ignore though. They can't talk and they cry half the time anyway. If you had an adult male with a baby's penis, and you circumcised him without general anaesthetic, you'd need bodyguards not Tylenol.

Even if I thought circumcision was a good idea, doing it right after birth would be the worst time to do it. The USA and Israel are the only countries in the world where more than half boys are circumcised within a month after birth. Other countries wait till the boys are anywhere from 8-18 years, and most countries don't do it at all.

Only about 1% of males in the UK are ever circumcised later in life, so it's obviously not medically necessary, and the medical societies of Canada, the UK and Australia are all against routine medical circumcision (even though most of the doctors were circumcised themselves). What's the problem with giving people the choice about whether or not they want part of their penis cutting off? If my son wants to be circumcised when he's 18 (16 if he knows what he's doing), I'll pay for it, but I don't think I have the right to have living tissue cut off his body without his consent. The fact that's it's the most sensitive part of his penis only makes it more important that it should be his choice.

Kai's original point is valid. Circumcision is totally unique in that a physician cosmetically alters a normal newborn based exclusively upon parental preference.
 
ml66uk said:
The USA and Israel are the only countries in the world where more than half boys are circumcised within a month after birth.
Click to expand...

They also get the most *****.

It's a scientific fact.
 
muslim males are circumcised- mostly as babies
 
Raggaman said:
muslim males are circumcised- mostly as babies
Click to expand...

Muslim males in the USA are mostly circumcised as babies, but I think that's unusual elsewhere. I know that some Muslim countries wait till puberty, or until the child can recite the Quran.
 
ml66uk said:
They were still saying till about ten years ago that neonates didn't feel pain. Ludicrous I know, but that's what they said. Recent research seems to show that they're actually more sensitive to pain than adults. They're easy to ignore though. They can't talk and they cry half the time anyway. If you had an adult male with a baby's penis, and you circumcised him without general anaesthetic, you'd need bodyguards not Tylenol.
Click to expand...

Please do not perpetuate the myth that infants are widely circumcised in the US these days without anesthetic. Every one I've done and every one my colleagues have done is with a regional block. This is standard of care. There is also no need for an adult male to have general anesthesia for this procedure; it can easily be done with a regional block (and probably some sedation).

Only old timers still believe that infants don't feel pain.
 
Winged Scapula said:
Please do not perpetuate the myth that infants are widely circumcised in the US these days without anesthetic. Every one I've done and every one my colleagues have done is with a regional block. This is standard of care. There is also no need for an adult male to have general anesthesia for this procedure; it can easily be done with a regional block (and probably some sedation).

Only old timers still believe that infants don't feel pain.
Click to expand...

Before 1999, the AAP did not recommended using anesthetics to reduce newborn pain resulting from circumcision. What data can you cite (beyond your anecdote) regarding how often a regional block is used to reduce the pain?
 
Last edited:
Winged Scapula said:
Please do not perpetuate the myth that infants are widely circumcised in the US these days without anesthetic. Every one I've done and every one my colleagues have done is with a regional block. This is standard of care. There is also no need for an adult male to have general anesthesia for this procedure; it can easily be done with a regional block (and probably some sedation).

Only old timers still believe that infants don't feel pain.
Click to expand...

I believe that most US neonatal circumcisions are performed with local anesthetic, and this has been AAP policy since 1999. I'm glad that you and your colleagues always use a block. There are plenty of places that still don't though. I saw one estimate that only about 55% of neonatal circumcisions used any form of anesthetic. Heck, some people swear by sugar water, despite AAP recommendations that this should not be used as the sole analgesia. Some doctors just don't care. I don't have the link to hand, but I read a recent message from a nurse who said that the peds at her practice didn't use any anesthetic unless the parents specifically asked. She said they were all young, and knew it wasn't "recommended practice", but said it didn't make much difference and took too long. They can only get away with that because they're operating on babies and not adults, and the person actually having the surgery gets no choice. It's kind of like that dentist joke:

The Smiths were shown into the dentist's office, where Mr. Smith made it clear he was in a big hurry. "No fancy stuff, Doctor," he ordered, "No gas or needles or any of that stuff. Just pull the tooth and get it over with." "I wish more of my patients were as stoic as you," said the dentist admiringly. "Now, which tooth is it?" Mr. Smith turned to his wife... "Show him, honey."

The only reason general anesthetic isn't used though is because they're too young. You can use local anesthetic for an adult circumcision, but it must be rare. The anesthetic issue is only one of the reasons to delay circumcision though, even if anyone accepts there is a reason to do it at all. Circumcisions are performed on the NHS (National Health Service) in Scotland, but not on babies under six months old, specifically so that general anesthetic can be used.

( The main reason that the NHS performs non-therapeutic circumcisions at all is to prevent back-street operations. In one of the worse cases, a 29 day old baby died in Waterford, Republic of Ireland after being circumcised on a kitchen table. Amazingly, he was found not guilty of reckless endangerment http://www.freerepublic.com/focus/f-news/1498531/posts He'd have got ten years if he'd killed a baby girl. )
 
ml66uk said:
I believe that most US neonatal circumcisions are performed with local anesthetic, and this has been AAP policy since 1999. I'm glad that you and your colleagues always use a block.
Click to expand...

You don't seem to understand that the "local anesthetic" you refer to is actually a regional block using a local anesthetic.
 
Kai Zhur said:
Before 1999, the AAP did not recommended using anesthetics to reduce newborn pain resulting from circumcision. What data can you cite (beyond your anecdote) regarding how often a regional block is used to reduce the pain?
Click to expand...

I have no data other than anecdotal. You are welcome to do a literature search if it is so important to you.

However, 1999 was nearly 10 years ago. Most practicing physicians, especially those who have trained in the last decade would presumably be up on the current data and standard of practice.
 
Tired said:
You don't seem to understand that the "local anesthetic" you refer to is actually a regional block using a local anesthetic.
Click to expand...

Exactly. The local is used as a regional block.

And don't confuse the lack of general anesthesia during circumcision as because it "isn't safe". GA is used frequently when we have to operate on neonates for serious defects; these children are usually already intubated and sedated. It is not necessary for a small procedure like a circ where a regional block is sufficient.
 
Tired said:
You don't seem to understand that the "local anesthetic" you refer to is actually a regional block using a local anesthetic.
Click to expand...

?! Of course I understand that. My original post (#88) was talking about general anesthetic though. I wasn't suggesting that no anesthetic was used, though this was common practice ten years ago, and does still take place.

Winged Scapula said:
And don't confuse the lack of general anesthesia during circumcision as because it "isn't safe". GA is used frequently when we have to operate on neonates for serious defects; these children are usually already intubated and sedated. It is not necessary for a small procedure like a circ where a regional block is sufficient.
Click to expand...

But that's exactly the reason that neonates don't have GA. You wouldn't circumcise a one-year old or a five-year old without GA, so why is it OK on a neonate? GA for newborns is a big deal. It's not that long ago that neonates would have abdominal surgery without GA. It's specifically to wait till GA can be used that the NHS in Scotland won't circumcise boys under six months.

I still don't know of a good reason why a child should have genital surgery before they're old enough to decide for themselves, and there's no way that straight after birth is the right time. Any other non-urgent operation would be delayed, but for some reason, boys need to get circumcised asap. Even if it didn't hurt, even if there was zero risk of complications, even if none of the other reasons I gave in post 88 to wait applied, we just shouldn't be cutting off parts of people's penises before they're old enough to give their informed consent. It's not like too many people given the choice, either choose to be circumcised, or actually need to be circumcised. It's about 1 in 140 in the UK - the other 139 seem to manage just fine.
 
The medical establishment, well represented by medical associations, have a lot of explaining to do on their former and current stance on circumcision. The issue of pain is illustrative.

Only in the last decade have physicians groups started to take circumcision pain seriously. Circumcisions were routinely done with little or no pain relief. Now they recommend analgesia, but there is no requirement it be used. There are no fines, no disciplinary action for circumcising with no analgesia whatsoever, or with nothing more than the distraction of a sweetener.

Now that analgesia is recommended by physicians groups, one might imagine that it always or nearly always used. But where is the data to back up this assertion?

Analgesia Underused for Management of Circumcision Pain
Oct. 11, 2004 (San Francisco) — Results of a retrospective study of neonatal circumcisions performed at a large academic medical center suggest that most procedures are performed without periprocedural or postprocedural analgesia, according to Praveen Kumar, MD, an associate professor of pediatrics at Northwestern University Memorial Hospital and Children's Memorial Hospital in Chicago, Illinois.

Dr. Kumar reported his findings in a poster here at the American Academy of Pediatrics (AAP) 2004 National Conference & Exhibition.

In a 1999 policy statement, the AAP recommended that "adequate analgesia should be provided if neonatal circumcision is performed." Yet, a review of medical charts done four years later "found that of 107 circumcisions performed, analgesia was used in only eight infants," Dr. Kumar said.

That rate was so low that Dr. Kumar said he has done additional analysis using both pharmacy records and nursing records to determine if "physicians were actually using more analgesia, but not documenting the results." The additional analysis indicated that "analgesia was ordered in 35% to 40% of procedures and nursing records indicated it was used in 29%," he said. "So, I estimate that analgesia is actually used in about a third of procedures."
Click to expand...
This is four years after the AAP said adequate analgesia should be used, and just four years ago.

Does the AAP discipline physicians who perform surgery on newborns with no analgesia, or with a substandard topic cream? No.

In any case where a circumcision is performed, a regional block is certainly the "standard of care."

But does non-therapeutic circumcision, itself, meet the "standard of care"?

Prevention and Management of Pain and Stress in the Neonate (RE9945)
Pain is managed most effectively by preventing, limiting, or avoiding noxious stimuli and providing analgesia.
Click to expand...
Unnecessary noxious stimuli (acoustic, visual, tactile, vestibular) of neonates should be avoided.
Click to expand...
The AAP readily admits that circumcision is unnecessary, and therefore by these standards should be avoided.

The pain of circumcision surgery and the several days afterwards can, and should be completely avoided by avoiding non-therapeutic circumcision.

Think about it. A surgery which is not medically justified. A surgery that is painful, but for which analgesia was not even recommended a decade ago, and which is still used inconsistently. Will non-therapeutic circumcision be specifically recommended against a decade from now? If the well-being of patients is put first, then it will be.
 
RPW said:
So, I just kinda skimmed this whole thing and it seems like you guys are mostly talking about infant pain issues and lack of consent.

But what about increased rates of penile cancer in uncircumcised men? Also, I'm pretty sure I recently read some studies by the Joint United Nations Programme on HIV/AIDS and the CDC that seemed to show that it was harder for circumcised men to contract HIV.

Don't either of those two reasons alone justify the practice? I'm gonna bet that the "pain" I experienced as an infant getting circumcised is nothing compared to the guys out there who have penile cancer or HIV...
Click to expand...

This thread changed course, and the pain is a side issue. We only started talking about it, because I suggested there was no need for children to be circumcised before they could give their consent, as circumcision later in life hurts less, is safer, and gives better cosmetic results. However, in answer to your post:

Vulval cancer is more common than penile cancer, but we don't cut parts off baby girls.
There are several countries which do not circumcise that have lower rates of penile cancer than the USA.
The NNT to prevent a death from breast cancer is 9, but we don't routinely operate on baby girls' breast buds. In fact, with the exception of circumcision, we don't routinely remove living tissue from anyone, which was the original point made to start this thread.

Circumcision can't possibly help anyone that doesn't have unsafe sex with an HIV+ partner. It's certainly nowhere near as effective as condoms - not even close.
The two continents with the highest rates of HIV also have the highest rates of male circumcision.
Six African countries have higher HIV rates in circumcised men than in intact men. In four of those countries, the rate is substantially higher - in Cameroon, a circumcised man is almost four times as likely to be HIV+ than a man who has not been circumcised.
Circumcised male virgins are more likely to be HIV+ then intact male virgins (the operation itself infects some people).
HIV in women has been linked to circumcision of their partners in at least two studies.
There is strong evidence that female circumcision protects against HIV, but no westerner would dream of suggesting that we promote that.

The main reasons that circumcision is being promoted in Africa are:
1) some people are more interested in promoting circumcision than in fighting HIV
2) the religious right are very keen to avoid promotion of condoms (or talking to sex workers), so any possible alternative is welcomed with open arms, and funded with open wallets. Meanwhile there are people dying in Africa who don’t know anything about safe sex. In Malawi for instance, 43% don't know that condoms protect against HIV/AIDS, and 32% don't know that limiting sexual partners protects against HIV/AIDS. There are people who haven't even heard of condoms. It just seems really misguided to be hailing male circumcision as the way forward.

You might also want to check out the following:

Canadian Paediatric Society
http://www.cps.ca/english/statements/fn/fn96-01.htm
Recommendation: Circumcision of newborns should not be routinely performed.

http://www.caringforkids.cps.ca/babies/Circumcision.htm
Circumcision is a "non-therapeutic" procedure, which means it is not medically necessary. Parents who decide to circumcise their newborns often do so for religious, social or cultural reasons. To help make the decision about circumcision, parents should have information about risks and benefits. It is helpful to speak with your baby’s doctor.

 After reviewing the scientific evidence for and against circumcision, the CPS does not recommend routine circumcision for newborn boys. Many paediatricians no longer perform circumcisions.
Royal Australasian College of Physicians Policy Statement on Circumcision
http://www.racp.edu.au/download.cfm?DownloadFile=A453CFA1-2A57-5487-DF36DF59A1BAF527
"After extensive review of the literature the Royal Australasian College of Physicians reaffirms that there is no medical indication for routine neonatal circumcision."
(those last nine words are in bold on their website, and almost all the men responsible for this statement will be circumcised themselves, as the male circumcision in Australia in 1950 was about 90%. “Routine” circumcision is now *banned* in public hospitals in Australia in all states except one.)

http://www.bma.org.uk/ap.nsf/Content/malecircumcision2006?OpenDocument&Highlight=2,circumcision#Circumcisionformedicalpurposes
British Medical Association: The law and ethics of male circumcision - guidance for doctors
"to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate."

National Health Service (UK)
http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=649
”Many people have strong views about whether circumcision should be carried out or not. It is not routinely performed in the UK because there is no clear clinical evidence to suggest that it is has any medical benefit.”

The College of Physicians & Surgeons of British Columbia
https://www.cpsbc.ca/cps/physician_resources/publications/resource_manual/malecircum
Circumcision is painful, and puts the patient at risk for complications ranging from minor, as in mild local infections, to more serious such as injury to the penis, meatal stenosis, urinary retention, urinary tract infection and, rarely, even haemorrhage leading to death. The benefits of infant male circumcision that have been promoted over time include the prevention of urinary tract infections and sexually transmitted diseases, and the reduction in risk of penile and cervical cancer. Current consensus of medical opinion, including that of the Canadian and American Paediatric Societies and the American Urological Society, is that there is insufficient evidence that these benefits outweigh the potential risks. That is, routine infant male circumcision, i.e. routine removal of normal tissue in a healthy infant, is not recommended."

 It's worth remembering that we wouldn't even be having this discussion if it weren't for the fact that 19th century doctors thought that :
a) masturbation caused various physical and mental problems (including epilepsy, convulsions, paralysis, tubercolosis etc), and
b) circumcision stopped masturbation.

Both of those sound ridiculous today I know, but if you don't believe me, then check out this link:
A Short History of Circumcision in North America In the Physicians' Own Words

Over a hundred years later, circumcised men keep looking for new ways to defend the practice.
 
You must log in or register to reply here.
Next unread thread

Similar threads

J
Study suggests women plastic surgery residents rate their performance harsher than men rate their own
Replies
0
Views
2K
johnfree7
J
cdmguy
NJ Nursing Board allows Noctor to own medical clinic
Replies
46
Views
7K
cdmguy
cdmguy
M
Technology Reusable medical instruments that need to stay sharp?
Replies
0
Views
2K
MedicalDevice15
M
Lost in Translation
Halyard Health MICROCOOL gowns under (more) fire.
Replies
2
Views
1K
WedgeDawg
WedgeDawg
E
surgeon who has been accused of performing unnecessary surgeries for financial gain
Replies
1
Views
1K
NeuResurgens
NeuResurgens
Top