I absolutely will not...

[LifetimeDoc]

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You have to admit the risks in male circ don't even come close to female circ.

Mutilation is mutilation. Besides, robbing a male of part of his sex organs is not the job of a doctor. And trying to justify one unnecessary medical procedure because it's less risky than another doesn't make any logical sense. There already is one poster here that is in favor of male circumcision so that it reduces the sex drive in the male. So doctor's should participate in such a thing? I'm astounded to believe people would think of such a thing these days in the USA.

 

[Law2Doc]

Mutilation is mutilation.

It's all good. 🙂

 

[Sol Rosenberg]

That's not the same at all. As was well cited above, uncircumcised people with poor hygeine run a risk of a variety of infections and can pass infections on to partners. By contrast, although obesity is a real problem, most people simply will not become obese regardless of having bad nutritional skills.

Same with STDs. MOST people will not contract STDs, circumcised or not.

(Again, I am assuming we are talking about the US, not a place like Africa.)

 

[Doula-2-OB]

You implied earlier that you would indeed hold the knife if there was a "medical reason". So why not do it to respect the wishes of the mother??

Because I respect a woman's right to have an elective surgery. I respect her RIGHT to choose to have a cosmetic surgery on her infant. But I won't be the one to do the cutting. Personal boundaries. I'm not asking anyone here to like them or agree- I have to live with my choices and I could not strap a helpless infant to a circumstraint and rip his foreskin from his glans for the sake of 'how it looks'. If there was a medical reason, then it would be a treatment, not a cosmetic procedure.

on't you think you're going to instill a high degree of worry in the mothers who would like this procedure done when you tell them there is no way you will do that procedure.

No, I don't. What would the worry be? I wouldn't say to them, "There's no way I'm cutting your child's penis, so go somewhere else, you wacko!" I'd say, "For my patients who elect to have circumcision, they are referred to ____. I want to make sure you have the best person for the job, and I know my limits!"

 

[Carmenita79]

Mutilation is mutilation. Besides, robbing a male of part of his sex organs is not the job of a doctor. And trying to justify one unnecessary medical procedure because it's less risky than another doesn't make any logical sense.

Oh please, cutting off the foreskin is not exactly castration.

 

[Rafa]

Mutilation is mutilation.

If you're comparing the outcomes of female circumcision to those of male circumcision, then...wow. This is like comparing breast cancer to prostate cancer, and advocating men should get mammograms and women should get prostate examinations, because "cancer is cancer".

 

[Doula-2-OB]

You have to admit the risks in male circ don't even come close to female circ.

That doesn't justify it though.

 

[Rafa]

That doesn't justify it though.

The only people trying to justify male circumscision by female circumcision are the people on your side. Everyone else is talking about the benefits of male C. No one here is advocating female C as a proven way of reducing chances of cervical or penis cancer development, or as a proven means of reducing rates of HIV transmission among partners.

 

[LifetimeDoc]

I've got to head on to other things, but I'll just leave this discussion with this thought...

Why do a medically unnecessary procedure on a patient without that patient's conscent that is irreversable, may cause pain, discomfort, and loss of function later in life when it's not necessary? Is that good medicine? Or should we just keep doing things without regard to science, believe in faith and old/flawed studies, and just trust that if our parents did it it must be alright.

 

[DropkickMurphy]

There are no less than two links to Pubmed on the first page of this thread, along with a 2006 link to a news article on HIV transmission. If you choose to ignore the science, that's your deal. But have the gonads (I assure you, no one's trying to remove those) to admit that there *is* evidence out there, and you're choosing to disregard it.

Just because it's on Pubmed doesn't mean it's worth trusting. I have a link to an article that sings the praises of women swallowing semen to avoid preeclampsia.

 

[breck]

"There's no way I'm cutting your child's penis, so go somewhere else, you wacko!"

Yeah, I pretty much assumed this.


"For my patients who elect to have circumcision, they are referred to ____. I want to make sure you have the best person for the job, and I know my limits!"

What happens when patient replies "Gee, my sisters gynecologist did both of my nephews". "Come to think of it I also have two very good friends whose gynecologist performed a circumsicion on their sons". So why don't you do it? You say you are not the best person for the job. I thought all gynes did these procedures. Is there anything else about my pregnancy and birth that you aren't the best person for??? You can see how it starts to raise questions.

 

[Sol Rosenberg]

Just because it's on Pubmed doesn't mean it's worth trusting. I have a link to an article that sings the praises of women swallowing semen to avoid preeclampsia.

That's one that I'll have to remember!

 

[Doula-2-OB]

I have a link to an article that sings the praises of women swallowing semen to avoid preeclampsia.

That article is true, my husband says so.

No, seriously.

 

[Doula-2-OB]

What happens when patient replies "Gee, my sisters gynecologist did both of my nephews". "Come to think of it I also have two very good friends whose gynecologist performed a circumsicion on their sons". So why don't you do it? You say you are not the best person for the job. I thought all gynes did these procedures. Is there anything else about my pregnancy and birth that you aren't the best person for??? You can see how it starts to raise questions.

I feel comfortable with that. I also rest on the fact that OBs where I live don't do circs, as I've previously mentioned. They aren't done in the hospital *at all*. Parents must make an appointment with their pediatricians to have the procedure done. So assuming I work here, I'd be insulated from having that discussion. And just because one patient has the procedure done by their GYN doesn't mean I won't be able to explain why I don't do them. I'm pretty eloquent in the moment (even if that doesn't come across here ) so I am not worried about explaining why I don't do them to my patients.

 

[Empress]

My husband is uncirc'd. No infections to date, nor have I developed cervical cancer. But I agree the sexual sensitivity part is too subjective to really know.

There is a reason health insurance companies don't cover it anymore, because it is elective and cosmetic. The health benefits to circing are neglible. (sp?) You want it, go ahead. You don't want it, that's fine, too.

BTW I had a doula for my son's birth. She was wonderful. I don't remember any circ conversations.

 

[Callogician]

What happens when patient replies "Gee, my sisters gynecologist did both of my nephews". "Come to think of it I also have two very good friends whose gynecologist performed a circumsicion on their sons". So why don't you do it? You say you are not the best person for the job. I thought all gynes did these procedures. Is there anything else about my pregnancy and birth that you aren't the best person for??? You can see how it starts to raise questions.

I don't agree with this. A male OB-GYN professor once told me that admitting a lack of expertise in a particular area is a great way to build rapport with a patient because it demonstrates...

1) Honestly
2) Modesty
3) A dedication to excellence in delivering health care

 

[Doula-2-OB]

BTW I had a doula for my son's birth. She was wonderful. I don't remember any circ conversations.

I do discuss circ with my clients in that I ask this: "Do you plan to circ or leave intact? If you would like information on either side please let me know. My boys are intact so I can give more information on that side of things. Please don't hesitate to ask me anything and if I don't have an answer I will do my best to find one or refer you to a resource where you can find it."


MOST of the time, women want to know 'what it's like' to care for an intact boy. They want to know how many intact boys I know, or what I thought the first time I saw an intact penis. I don't give information (at their request) more than I give personal information, my own experience, and sort of demystify it. But I don't encourage them to not circ. I encourage them to research it and I provide resources as requested. There are people who are far more versed in the ins and outs (so to speak) of the penis. LOL

 

[riff raff]

Who knew penis foreskin would be such a hot topic amongst pre-meds?

 

[Callogician]

---

 

[Callogician]

There's a difference between supporting a client's right to choose (which I absolutely do, to lengths you would be shocked to hear), and holding the knife.

There is a difference, but it is a very superficial one. Personally, I feel that it is the health outcome that matters most. If I was a surgeon highly skilled at performing a safe clitorectomy and was asked to perform a clitorectomy on a female child in India knowing that my refusal would simply cause the parents to seek another surgeon, I would do it (or maybe try to fake it).

By refusing, I might manage to fool myself into thinking I've held to high moral ground, but I would be doing no service to the young girl.

 

[Rafa]

There is a difference, but it is a very superficial one. Personally, I feel that it is the health outcome that matters most. If I was a surgeon highly skilled at performing a safe clitorectomy and was asked to perform a clitorectomy on a female child in India knowing that my refusal would simply cause the parents to seek another surgeon, I would do it (or maybe try to fake it).

By refusing, I might manage to fool myself into thinking I've held to high moral ground, but I would be doing no service to the young girl.

👍

 

[Psycho Doctor]

I will not ever perform an abortion.

Neither will I,

I also wouldn't kill a dog in lab either or any other animal, and I can't believe any med school would make their students do that.

 

[Empress]

I do discuss circ with my clients in that I ask this: "Do you plan to circ or leave intact? If you would like information on either side please let me know. My boys are intact so I can give more information on that side of things. Please don't hesitate to ask me anything and if I don't have an answer I will do my best to find one or refer you to a resource where you can find it."

I think that speech as a client would turn me off a little.

I am asking for your help in my birth, because as a pregnant woman I am crazy and it's all about me me me. That's why I hired a doula, so someone could be focusing more on me. I don't really care what you decided in regards to circing. Mentioning your intact sons can be directly construed what your beliefs are in that area, and there is a potential for judgement if the client doesn't have that same belief.

 

[Doula-2-OB]

If I can refer my patient on to a provider who I know will be compassionate to the family, to the baby, then I can make some tiny difference. Some docs do circs w/o anesthesia at all, which is horrifying and archaic. I could at least make sure that the person to whom I was referring the patient to used adequate anesthesia, allowed parents to be present, educated parents about care, etc.

I hope that those docs who go on to do circs in their practice also educate themselves about the intact penis. Far too many stories of mothers taking their intact sons into the pediatrician and having the doctor RIP back the foreskin!!!

There is a difference, but it is a very superficial one. Personally, I feel that it is the health outcome that matters most. If I was a surgeon highly skilled at performing a safe clitorectomy and was asked to perform a clitorectomy on a female child in India knowing that my refusal would simply cause the parents to seek another surgeon, I would do it (or maybe try to fake it).

By refusing, I might manage to fool myself into thinking I've held to high moral ground, but I would be doing no service to the young girl.

 

[Nutmeg1621]

My goodness I feel like I am back on the BBC message board. Soon you will all be debating which car seat is the safest.

There are "supposed" pros and cons for both. A parent does not do something that they think will hurt their child. All parents look out for their child's best interest. If it is cosmetic reasons or religious reasons or so they can look like daddy then it's fine. It is a personal choice left up to the family and that is the way it should be. The fact that the child can not speak for himself does not mean anything to me. That is why he has parents. Even later down the road he can not recieve surgical procedures without parental consent. Now when he turns 18 if he chooses to hate the world b/c mom and dad said put a helmet on that solidier then that is his own affair and he'll get over it. If he wants to look like his friends then when he turns 18 he can. Parents make the best decisions they can and unfortunately there is no handbook and the answers are not always black or white.

If it is against your beliefs to do something then stand your ground. Now my obgyn was going to circumsise my son if I had one, but I had a girl. It was an extra fee not covered by insurance b/c it is considered a cosmetic procedure. If you don't want to do it then do exactly what you said and refer them to someone else. Maybe their ped will do it or the on call ped will.

I think you can all tell that I don't mind doing it. I will never perform an abortion unless it is needed (ectopic) and I don't really want to do eye surgery b/c it grosses me out.

 

[Doula-2-OB]

Here's another one for discussion along this same line...

Would you perform vaginal exams on an unconcious patient? I would have to refuse unless the patient had expressed her consent in something other than a blanket consent statement.

 

[karirunner]

I wouldn't perform an abortion unless the mother's life was endangered by the pregnancy....I'm a flaming liberal, support women's right to choose, and am not particularly religious but the idea of performing the procedure myself makes me uncomfortable. I also wouldn't do FGM, though I know it is accepted in some cultures. (Anything that makes peeing excruciating and sex incredibly painful does not seem like a good idea.)

As to circumcision, I thought it was the norm in the US and generally a benign procedure. Am I wrong?

 

[Doula-2-OB]

I wouldn't perform an abortion unless the mother's life was endangered by the pregnancy....I'm a flaming liberal, support women's right to choose, and am not particularly religious but the idea of performing the procedure myself makes me uncomfortable. I also wouldn't do FGM, though I know it is accepted in some cultures. (Anything that makes peeing excruciating and sex incredibly painful does not seem like a good idea.)

As to circumcision, I thought it was the norm in the US and generally a benign procedure. Am I wrong?

Read through the thread! Lots of info and perspectives. Also check out this link.

 

[Nutmeg1621]

Some docs do circs w/o anesthesia at all, which is horrifying and archaic.

I heard that a lot of doctors don't use anesthesia and that you need to specifically ask for it. I also was horrified by this.

 

[superman1969]

Okay,

I couldn't read every reply, so I'm unsure it this was stated yet.

The sad truth is that US parents are stupid! Dads don't know why their dicks were chopped (even before they knew they had them), and when they have sons, they want their sons to 'look' like them, and thus, have their sons chopped, too. And the cycle continues.

It is interesting though that the educated society of the US are actually beginning to figure this one out are are NOT chopping their sons' dicks!

Read it and wake up!

 

[Brickhouse]

Here's another one for discussion along this same line...

Would you perform vaginal exams on an unconcious patient? I would have to refuse unless the patient had expressed her consent in something other than a blanket consent statement.

you have a patient unconscious due to shock from a Staph aureus infected tampon - you would wait to see if she wakes up to ask if you can do a pelvic to remove the infected tampon fragment? I'm missing something I think.

 

[Sol Rosenberg]

Read through the thread! Lots of info and perspectives. Also check out this link.

Yikes! Even though we didn't circ. I never even thought of the increased risk to MRSA infection as one of the reasons.

 

[Empress]

Here's another one for discussion along this same line...

Would you perform vaginal exams on an unconcious patient? I would have to refuse unless the patient had expressed her consent in something other than a blanket consent statement.

Depends on the circumstances. For just a general look around, of course not. I take it you're referring to an older news item about med students doing vag exams on patients in surgery?

 

[Sol Rosenberg]

you have a patient unconscious due to shock from a Staph aureus infected tampon - you would wait to see if she wakes up to ask if you can do a pelvic to remove the infected tampon fragment? I'm missing something I think.

I'm with you on this one. A pelvic exam is a medical diagnostic procedure. If it was medically necessary to perform the exam, I would perform the exam, even if the patient had not given explicit consent. This is one of the duties of the doctor, to do what needs to be done to treat a patient's condition.

 

[Psycho Doctor]

As an OB I won't perform them (why would an OB do circs anyway... what do they know about a penis? LOL). If my patients want it done I'll refer them to their pediatrician or a urologist.

many pediatricians aren't trained in surgery as are OB?GYNs, so often it is the mother's OB?GYN doc that does the circumcision, not the pediatrican who delievered the baby.

 

[DropkickMurphy]

That's one that I'll have to remember!

Here you go:

J Reprod Immunol. 2000 Mar;46(2):155-66. Related Articles, Links


Correlation between oral sex and a low incidence of preeclampsia: a role for soluble HLA in seminal fluid?

Koelman CA, Coumans AB, Nijman HW, Doxiadis II, Dekker GA, Claas FH.

Department of Immunohematology and Blood Bank, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, The Netherlands.

The involvement of immune mechanisms in the aetiology of preeclampsia is often suggested. Normal pregnancy is thought to be associated with a state of tolerance to the foreign antigens of the fetus, whereas in preeclamptic women this immunological tolerance might be hampered. The present study shows that oral sex and swallowing sperm is correlated with a diminished occurrence of preeclampsia which fits in the existing idea that a paternal factor is involved in the occurrence of preeclampsia. Because pregnancy has many similarities with transplantation, we hypothesize that induction of allogeneic tolerance to the paternal HLA molecules of the fetus may be crucial. Recent data suggest that exposure, and especially oral exposure to soluble HLA (sHLA) or HLA derived peptides can lead to transplantation tolerance. Similarly, sHLA antigens, that are present in the seminal plasma, might cause tolerance in the mother to paternal antigens. In order to test whether this indeed may be the case, we investigated whether sHLA antigens are present in seminal plasma. Using a specific ELISA we detected sHLA class I molecules in seminal plasma. The level varied between individuals and was related to the level in plasma. Further studies showed that these sHLA class I molecules included classical HLA class I alleles, such as sHLA-A2, -B7, -B51, -B35 and sHLA-A9. Preliminary data show lower levels of sHLA in seminal plasma in the preeclampsia group, although not significantly different from the control group. An extension of the present study is necessary to verify this hypothesis.

PMID: 10706945 [PubMed - indexed for MEDLINE]

Why do I have a feeling more than one member of this forum will attempt to use the line: "Swallow, it's good for you! Doctor's orders! No, seriously....I read it on PubMed!"

 

[Brickhouse]

Depends on the circumstances. For just a general look around, of course not. I take it you're referring to an older news item about med students doing vag exams on patients in surgery?

Unless you're a med student learning physical diagnosis, you never do an exam "just to have a look around", it's not somebody's summer cottage in the hamptoms, for god's sake. The exam is to discover the pathology. I wouldn't go looking around in someone's vagina unless I had a suspicion that I needed to.

 

[DropkickMurphy]

it's not somebody's summer cottage in the hamptoms, for god's sake.

 

[Psycho Doctor]

Goddamit. There are many pro-life OB/Gyns who will have nothing to do with elective abortion. There is no requirement at most OB/Gyn programs that residents perform elective abortions if they have moral objections. Some abortions are medically necessary. (Ectopic pregnancy, etc.) Additionally, the procedure for a D & C is the same whether it is an elective abortion or treatment for an incomplete spontaneous abortion. Therefore you will learn appropriate surgical techniques without having to murder babies in the process.

Now, you may find yourself ostracized by your collegues so you need to shop around for programs that are more accepting of diverse points of you (in this case the conservative one).

Please visit my blog at this link for the December archive where you may read an article called "A Subversive Thought" for the true facts about this issue and how it affects physicians.

http://pandabearmd.blogspot.com/2005_12_01_pandabearmd_archive.html

excellent blog entry, thanks so much. I feel infinitely better already. 👍

And I saved your blog under my favorites to refer to it often, thanks for the service; it appears very helpful to those of us not quite there yet.

 

[Empress]

Unless you're a med student learning physical diagnosis, you never do an exam "just to have a look around", it's not somebody's summer cottage in the hamptoms, for god's sake. The exam is to discover the pathology. I wouldn't go looking around in someone's vagina unless I had a suspicion that I needed to.

The vagina is just another medicine cabinet for people to peek in when you're not looking.

I think she's referring to this. http://www.cnn.com/2003/HEALTH/03/11/pelvic.exams.ap/index.html

 

[Psycho Doctor]

I'm uncirc. and I love my turtleneck. I've thought about getting the circ. done, even had people try to talk me into it, but I just couldn't part with that part of my body. I guess I just have a fear of commitment. Anyway, my parent never taught me how to clean it and I learned on my own. I doesn't take that long to clean. I mean jeez you're already cleaning the outside. What's so hard about peeling back the skin. IT DOESN'T TAKE HOURS!!! That being said if the parents want it done fine, if a woman wants an abortion, then that's her choice and I would have no problems doing it. Basically, I would have no problem doing almost anything. Anyone have any thoughts about assisted suicide?

I'd take a brain dead patient off a respirator or not perform any extreme measure to keep them alive but I would not do something to deliberately "make them die".

 

[Empress]

What exactly would you define as "make them die?" Would you not honor a DNR?

 

[Psycho Doctor]

Are you serious? My sons are uncirced and their father is cut. They've seen him naked and it's never even occurred to them yet that he is different. And when they do realize it, I will explain that some boys have had part of their penis removed, and that they have not. I'm betting it's not trauma they'll experience, but gratitude and relief at having all of their body parts.

As it stands, I know very few little boys today who have been circed. The intact boys FAR outnumber the circed in my circles. It's anecdotal but the circ rate is declining nationally.

Has anyone seen Doctors Opposing Circumcision?

obviously many of us hang out in different circles than you do....you're probably not American.

 

[DropkickMurphy]

Having watched someone burn alive after a car accident (we arrived to find the car fully involved, driver pinned inside screaming), I would have to say in a situation like that....I would have shot him to put an end to his suffering if it were not for the legal issues.

Now on the medical side of things, I don't see why some gorked out patient is any different that a beloved family pet, or why we should expect to let another human being suffer through some painful form of cancer just so a percentage of us don't violate their belief in a higher diety. Sorry, it should be the patient's choice, not anyone elses.

 

[Doula-2-OB]

you have a patient unconscious due to shock from a Staph aureus infected tampon - you would wait to see if she wakes up to ask if you can do a pelvic to remove the infected tampon fragment? I'm missing something I think.

That's not what I mean- I mean med students lining up to do a vaginal exam on an unconscious woman for the sake of learning, not a necessary medical procedure.

There was a lot of controversy about this- has it changed?

 

[breck]

I don't agree with this. A male OB-GYN professor once told me that admitting a lack of expertise in a particular area is a great way to build rapport with a patient because it demonstrates...

1) Honestly
2) Modesty
3) A dedication to excellence in delivering health care

Admitting a lack of expertise in a particular area definitely demonstrates honesty, modesty, and a dedication to excellence in delivering health care. Admitting a lack of expertise in your field of medicine demonstrates incompetence. Imagine taking your baby, who has an inguinal hernia, to a pediatric surgeon and being told that you need to take your baby to someone who is familiar with that operation 😱

This reminds me of the Seinfeld episode where Kramer finds a suspicious mole on George's boss and then George tells him to refer him to another doctor. Kramer says (i'm paraphrasing here) why would I, a well known dermatologist, refer him to someone else???

 

[jbone]

Why do I have a feeling more than one member of this forum will attempt to use the line: "Swallow, it's good for you! Doctor's orders! No, seriously....I read it on PubMed!"

Drop, you really are a sick S.O.B.
(where did you find that article again? )

 

[Psycho Doctor]

Oh, I agree. Any medical procedure has risks. That's why I don't think circumcision should be preformed unless it's medically necessary. But, the other cosmetic procedures either just cost extra money for the parents or don't cause a lasting deficit for the patient. The patient isn't harmed by having straight teeth, infection-free toes, or a more pleasing appearance. But if you have part of your body lobbed off, you can't replace it without expensive, painful reconstructive surgery. All of the aforementioned procedures are "low risk", but you also have to consider the eventual consequences of the procedure. And, yes, infections are one if hygiene is not strictly followed, but so are a host of other infections for hygiene if you are circumcised.

no medical reason???

"Causes of penis cancer
The cause of penis cancer unknown but there is a higher incidence of penile cancer in uncircumcised men and men who do not keep the area under the foreskin clean. The presence of smegma, the cheese-like secretion under the foreskin, appears to increase the risk."

http://menshealth.about.com/cs/menonly/a/cancer_penis.htm

 

[Doula-2-OB]

Admitting a lack of expertise in a particular area definitely demonstrates honesty, modesty, and a dedication to excellence in delivering health care. Admitting a lack of expertise in your field of medicine demonstrates incompetence. Imagine taking your baby, who has an inguinal hernia, to a pediatric surgeon and being told that you need to take your baby to someone who is familiar with that operation 😱

How much of an OB's job is circumcision? If I don't spend the bulk of my time caring for vaginas and uteri and their neighbors, then I'm apparently looking at the wrong specialty.

 

[Psycho Doctor]

I'm sorry to hear that, DropkickMurphy. There are some wacky doulas out there, but every profession has its nutters.

excuse my ignorance but what is a doula? Is it the same as midwives?