Circumcision in the Family Practice

[mestielest]

I have no interest in discussing legality outside the US.

So, can you carry out sex-reassignment in a healthy newborn because the parents want to change the sex?

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[deleted87716]

So, can you carry out sex-reassignment in a healthy newborn because the parents want to change the sex?

I'm a family physician. We don't do that. Maybe try another forum?

 

[mestielest]

SRSLY...? Can you provide a link, or did you just pull that out of your...er, ear?

Now we don't have such a belief. However, we have some belief that looks weird. In future we may face with it

Anatomically, what is the difference between cutting an ear-lobe or prepucium?

 

[deleted87716]

Now we don't have such a belief. However, we have some belief that looks weird. In future we may face with it

Anatomically, what is the difference between curring the ear-love or prepucium?

 

[mestielest]

I'm a family physician. We don't do that. Maybe try another forum?

I have to wait for an allied forum of pediatric surgeons and endocrinologist, unfortunately.

So, will you come to Turkey

 

[deleted87716]

I have to wait for a allied forum of pediatric surgeons and endocrinologist, unfortunately.

So, will you come to Turkey

They make some good inexpensive shotguns (Huglu) so...maybe.

 

[mestielest]

They make some good inexpensive shotguns (Huglu) so...maybe.

We have a lot of circumcisions as well as a beatiful seaside, a reasonable dollar-to-lira ratio, direct flights from the US. There are some good weapons out there however it may be problematic taking them on board

 

[mestielest]

@Blue Dog owww I was nearly forgetting to ask...

Are you circumcised? If yes how old were you?

How many circumcisions have you carried out?

 

[deleted87716]

We have a lot of circumcisions as well as a beatiful seaside, a reasonable dollar-to-lira ratio, direct flights from the US. There are some good weapons out there however it may be problematic taking them on board

True, that. It's easier to buy them over here. I have nothing against Turkey, I just don't know anything about their medical-legal system.

 

[deleted87716]

@Blue Dog owww I was nearly forgetting to ask...

Are you circumcised? If yes how old were you?

How many circumcisions have you carried out?

LOL..!

Yeah, I'm circ'd. (in infancy - no regrets, FWIW). And, I did a couple dozen (the exact number has been lost to history) circs during residency. Not sure how that's relevant, though.

 

[mestielest]

In Turkey, one can easily obtain a hunting rifle. For guns it is harder to get allowed. I'm talking for legal obtaining. It is easier to obtain something illegaly.

 

[deleted87716]

It is easier to obtain something illegaly.

Same over here. If only our lawmakers realized this!

 

[mestielest]

LOL..!

Yeah, I'm circ'd. (no regrets, FWIW). And, I did a couple dozen circs during residency. Not sure how that's relevant, though.

The circumcision age is relevant. Because we experience what we do. Or at least, we know what is the result and how can it affect.
The numbers are relevant I think. The distribution of the age as well. In the US, most of the circumcisions are newborn cases, there are some adult cases also. However in Turkey, school-child circumcision is also very popular. Cosmetic results and the follow-up changes. I can better describe with photos, which I can share via e-mails.

 

[mestielest]

It's midnight here I'm sleeping. I hope some penis would not come to my dream

 

[deleted87716]

It's midnight here I'm sleeping. I hope some penis would not come to my dream

Ditto, that!

 

[SLC]

...However in Turkey, school-child circumcision is also very popular. Cosmetic results and the follow-up changes. I can better describe with photos, which I can share via e-mails.

Things just got weird folks!

No mestielest, keep your emails to yourself thank you!

 

[Hamhock]

Huh...? If you aren't aborting a human life, what exactly are you aborting...?

I'm less interested in "categorizing" people or ideas than I am in people being able to logically and rationally explain their reasoning for believing or doing something.

Now I have time to respond (I hope.

It seems you want to have a discussion about abortion or what defines human life. We can do that, if you want; but it is way off topic for this circumcision thread.

For now, let's agree that we are likely talking past each other. I am not interested in abortion or circumcision as much as I am interested in rational thought and reasoned dialogue/discourse in my communities (local, medical, volunteer, online, etc.). I have been responding to comments made by you and other posters who tried to link or treat circumcision and abortion as related topics. I was particularly concerned after these two topics were linked by another poster, when you (BD) and others stated that people opposed to circumcision but OK with abortion showed "***ked up" logic or that their choices were "ass backwards".

Most pertinently, I was responding to your comment that it "makes no sense" for someone "who morally objected [to circumcision of neonates] who were hard core pro choice" (the bold was from another poster).

Such thinking/ethical analysis clearly makes sense, as I have said, as soon as you "un-link" abortion and circumcision. These are not related technically, ethically, morally, or otherwise [yes, I know they are both medical procedures]-- to any extent that should, using logic and reason, cause surprise when encountering another person who supports one and opposes the other.

Now, if you still want to have a discussion regarding what defines human life or regarding the complexities of abortion, we can...but that's not what my posts have been about.

Genuinely, HH

 

[deleted87716]

Now I have time to respond (I hope.

It seems you want to have a discussion about abortion or what defines human life. We can do that, if you want; but it is way off topic for this circumcision thread.

For now, let's agree that we are likely talking past each other. I am not interested in abortion or circumcision as much as I am interested in rational thought and reasoned dialogue/discourse in my communities (local, medical, volunteer, online, etc.). I have been responding to comments made by you and other posters who tried to link or treat circumcision and abortion as related topics. I was particularly concerned after these two topics were linked by another poster, when you (BD) and others stated that people opposed to circumcision but OK with abortion showed "***ked up" logic or that their choices were "ass backwards".

Most pertinently, I was responding to your comment that it "makes no sense" for someone "who morally objected [to circumcision of neonates] who were hard core pro choice" (the bold was from another poster).

Such thinking/ethical analysis clearly makes sense, as I have said, as soon as you "un-link" abortion and circumcision. These are not related technically, ethically, morally, or otherwise [yes, I know they are both medical procedures]-- to any extent that should, using logic and reason, cause surprise when encountering another person who supports one and opposes the other.

Now, if you still want to have a discussion regarding what defines human life or regarding the complexities of abortion, we can...but that's not what my posts have been about.

You still haven’t answered the question.

 

[Hamhock]

Again..."pathology" isn't relevant. PARENTAL CONSENT.

I disagree...as do the legal and medical ethics worlds.

Parental consent is disregarded when mystical or religious beliefs threaten the well being of children. The best example I can think of currently is blood transfusion in pediatric patients who have parents who believe in the Jehovah's Witness interpretation of Christianity. Not only is this well-established in case law, it nearly universally accepted by medical ethicists (and I would hope physicians).

HH

 

[Hamhock]

You still haven’t answered the question.

Which question? The abortion question?

Are you asking to have a discussion about abortion?

These short replies seem only to distract and disregard all points of the previous discussion. I just detailed my entire thought process and my response to your prior comments -- and it seems you won't even acknowledge my response or engage in the discussion.

So, if this is really just about abortion, just say so...and I guess I will talk about it for a bit...but I doubt, based on this thread alone, that a reasoned discussion can be had.

HH

 

[deleted87716]

Which question? The abortion question?

Are you asking to have a discussion about abortion?

HH

I didn't ask for it. You did. Apparently, you're either reluctant or unable to defend your position (e.g., circumcision is more objectionable than abortion).

 

[Hamhock]

I didn't ask for it. You did. And, you're apparently either reluctant or unable to defend your position.

Oh, my position has nothing to do with abortion. Nothing.

This is becoming frustrating. It seems you just want to talk about abortion.

I'll give it some time. What is your question specifically? I'll try my best to answer it.

HH

 

[deleted87716]

Oh, my position has nothing to do with abortion. Nothing.

This is becoming frustrating. It seems you just want to talk about abortion.

I'll give it some time. What is your question specifically? I'll try my best to answer it.

Dude, SRSLY...? Maybe you should re-read the entire thread and get back to me (hint: start with post #19 - yours).

 

[Hamhock]

Dude, SRSLY...? Maybe you should re-read the entire thread and get back to me (hint: start with post #19 - yours).

I just took your advice and re-read through post 25. I carefully read my post 19. I honestly don't see what I am saying in that post other that the fact that I don't think that circumcision and abortion are linked...and I have defended that viewpoint extensively in my posts afterwards.

I am honestly confused here. I don't know what else to say. I guess we will just have to walk away mutually confused.

Is any other reader able to point out to me what viewpoint in post 19 I haven't defended? Perhaps you could help Blue and I, since we can't seem to help ourselves! (or maybe it's just me...I'd be happy for another reader to review post 19 and tell me what viewpoint I am making there...I fully admit that I could be blind here)

HH

 

[deleted87716]

I just took your advice and re-read through post 25. I carefully read my post 19. I honestly don't see what I am saying in that post other that the fact that I don't think that circumcision and abortion are linked...and I have defended that viewpoint extensively in my posts afterwards.

I am honestly confused here. I don't know what else to say. I guess we will just have to walk away mutually confused.

Is any other reader able to point out to me what viewpoint in post 19 I haven't defended? Perhaps you could help Blue and I, since we can't seem to help ourselves! (or maybe it's just me...I'd be happy for another reader to review post 19 and tell me what viewpoint I am making there...I fully admit that I could be blind here)

HH

You used a lot of words to say that you can’t defend your position. Noted.

 

[deleted87716]

IParental consent is disregarded when...religious beliefs threaten the well being of children. The best example I can think of currently is blood transfusion in pediatric patients who have parents who believe in the Jehovah's Witness interpretation of Christianity. Not only is this well-established in case law, it nearly universally accepted by medical ethicists (and I would hope physicians).

OK...so, refusing blood transfusion can potentially kill a child. Removing their foreskin cannot. You appear to be proving my point. If we followed your logic to its conclusion, abortion should be illegal.

 

[birchswing]

Removing their foreskin cannot.

Except when it does. It's often not listed as the cause of death.

Also this is specious logic. One is a case of arguing against life-saving surgery for the sake of religious freedom. One is arguing for cosmetic genital alteration for the sake of religious freedom. Removing foreskin is non-therapeutic. Emergency surgery that requires transfusion likely is. (Ironically the cases involving neonatal death from circumcision are often from hemorrhage. The other recent cases I'm aware of involved transmission of herpes leading to death by HSE. You can even argue the suicide of David Reimer stemmed from circumcision.)

 

[deleted87716]

You can even argue the suicide of David Reimer stemmed from circumcision.

That case implicates childhood sex-reassignment surgery more than it does circumcision, IMO.

 

[birchswing]

Dude, SRSLY...? He had sex-reassignment surgery. Again, thanks for proving my point.

He had sex reassignment surgery because his penis was destroyed during a circumcision.

You said that circumcision doesn't result in death. His resulted in SRS and eventual suicide.

That doesn't begin to account for infants who bleed to death or the hundreds who die in initiation season every year (which the US helps fund) or those in the pockets of the US where oral suction is practiced who die of HSE or develop long-term permanent brain damage from it.

I'm not sure how I proved your point.

 

[mestielest]

Things just got weird folks!

No mestielest, keep your emails to yourself thank you!

Ok SLC, be sure I will not forward my self-penis-photo

 

[mestielest]

So, anyone who is interested in high-volume circumcision practice can get into our association group via WhastApp (I see e-mail looked a little frightening )

 

[Gos81238ia]

Dear colleagues, what is the contemporary place of circumcision in the family practice in the US? Do FM residency includes training on circumcision? May anyone get interested if a training module is offered in another country (say Turkey)?

Depends where you end up working. Some hospitals have strict policies that they are done either by OBGYN or pedi only, other hospitals don’t do them inpatient at all so the FM docs in the community do a ton outpatient.

 

[deleted480308]

OK...so, refusing blood transfusion can potentially kill a child. Removing their foreskin cannot. You appear to be proving my point. If we followed your logic to its conclusion, abortion should be illegal.

Elective Abortion should be illegal. But that’s irrelevant to the circumscision discussion

 

[SLC]

...Removing foreskin is non-therapeutic...

This phrase tells us all we need to know about your knowledge when it comes to circumcision.

 

[birchswing]

This phrase tells us all we need to know about your knowledge when it comes to circumcision.

I think that's a bit of a leap. I could have qualified what I wrote more carefully, but the vast majority of circumcisions are chosen for non-therapeutic reasons and serves no therapeutic purpose. The word therapeutic suggests a treatment of a disease, and it can be categorically stated that in the neonatal period the near totality of circumcisions are not for the treatment of a disease. When you discuss medicines and use the word therapeutic, it wouldn't make sense to discuss a therapeutic dose of birth control, for example (unless it were being used to treat something other than the prevention of pregnancy).

 

[deleted480308]

I think that's a bit of a leap. I could have qualified what I wrote more carefully, but the vast majority of circumcisions are chosen for non-therapeutic reasons and serves no therapeutic purpose. The word therapeutic suggests a treatment of a disease, and it can be categorically stated that in the neonatal period the near totality of circumcisions are not for the treatment of a disease. When you discuss medicines and use the word therapeutic, it wouldn't make sense to discuss a therapeutic dose of birth control, for example (unless it were being used to treat something other than the prevention of pregnancy).

maybe let's use preventative then...they can be preventative

 

[SLC]

I think that's a bit of a leap. I could have qualified what I wrote more carefully, but the vast majority of circumcisions are chosen for non-therapeutic reasons and serves no therapeutic purpose. The word therapeutic suggests a treatment of a disease, and it can be categorically stated that in the neonatal period the near totality of circumcisions are not for the treatment of a disease. When you discuss medicines and use the word therapeutic, it wouldn't make sense to discuss a therapeutic dose of birth control, for example (unless it were being used to treat something other than the prevention of pregnancy).

As sb247 above me said, neonatal circs are largely elective, and data suggests there is some (albeit small) preventive value as well. But you are on record in this thread as saying they’re “cosmetic”; implying they’re merely done for the sake of “religious freedom” and that they’re “non-therapeutic”.

I took exception to the non-therapeutic claim, because the majority of circs done later in life (beyond the first few months) are for therapeutic purposes.

Anyway, each of your takes regarding circumcision are demonstrably false, and a 30min literature search can easily show you that. It’s something you should seriously consider doing!

I’d be happy to discuss this more in the future. How about you come back to this thread when you’ve obtained a more nuanced grasp of the topic.

And maybe the OCP topic too... Because OCP’s are used therapeutically all the time. I use them as treatment way more than as contraception.

 

[birchswing]

As sb247 above me said, neonatal circs are largely elective, and data suggests there is some (albeit small) preventive value as well. But you are on record in this thread as saying they’re “cosmetic”; implying they’re merely done for the sake of “religious freedom” and that they’re “non-therapeutic”.

I took exception to the non-therapeutic claim, because the majority of circs done later in life (beyond the first few months) are for therapeutic purposes.

Anyway, each of your takes regarding circumcision are demonstrably false, and a 30min literature search can easily show you that. It’s something you should seriously consider doing!

I’d be happy to discuss this more in the future. How about you come back to this thread when you’ve obtained a more nuanced grasp of the topic.

And maybe the OCP topic too... Because OCP’s are used therapeutically all the time. I use them as treatment way more than as contraception.

I am very familiar with the research on circumcision and the small potential health benefits regarding UTIs and the two controversial sub-saharan African studies with regard to male contraction of HIV (in which the control group did not receive counseling regarding safe sex practices and the active group did—as well as being told to abstain from sexual activity during healing). I can't recall the statistic off the top of my head, but there was a study done on the number of Finnish men who ever needed circumcision later in life, and it was microscopic. Regarding my use of the word cosmetic, is there any doubt that circumcision is performed for cosmetic reasons? I'm not sure what more there is to discuss. The conversation in which you quoted me about the non-therapeutic nature of circumcision was me to responding to a discussion about neonatal circumcision. I understand that in refractory cases of phimosis or balanitis, circumcision is a therapeutic measure. With regard to OCP, I stated "unless it were being used to treat something other than the prevention of pregnancy." I am familiar with its other uses.

I think there is generally a shared knowledge base on this subject of circumcision, but obviously individuals, societies, and medical associations come to very different decisions on what is acceptable. I know you think I am not nuanced, but if you think that you should read some of the strong statements regarding circumcision from Nordic pediatric and medical associations. They are rather unequivocal in their stances on the permissibility and ethics of non-therapeutic circumcision (if that terms rankers I am not sure what else to call it and maintain nuance; some medical societies call it mutilation but I am trying to stay more dispassionate).

 

[smq123]

The discussion of this topic is no longer appropriate to the Family Medicine forum, which is designed for physicians, residents, and students to discuss professional issues. Please feel free to make a new thread in the Topics in Healthcare forum if desired.

Closing.