Is circumcision in line with the Hippocratic Oath?

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Medical decisions for infants are made by their parents. No hospital will circumcise an infant against their parents wishes.

Just a side note, from a personal source. My partner's older brother was born in the 70s, and his mother had to be sedated. When she woke up from sedation her son was circumcised (something she and her husband were very much against-they are german). It was definitely done without consent, and she had her next two children at home.
 
[/B]Finally, you are absolutely allowed to have your own believes but the fact that you have the "balls" to constantly compare female mutilation or the premeptive removal of breast tissue to male circumsion is terrible. These are extremely traumatic events for women to go through with life long changes that I'm sure you cannot begin to understand. It in no way can compare to a male circumcision. Grow up.

This really pisses me off. I'm going to assume you're female, because the only people who have ever used this argument with me are female, but you may not be. Here's what *you* don't understand. I am circumcised. It is traumatic, still at 27, to know that my parents willfully cut off a piece of my body because their god told them to. I am not a christian, and it is a daily reminder of a religion that has only shown me hate. The reason most people give for male circumcision are the same reasons people give for female circumcision; health, hygiene, religion, looks, and ability to find a willing sexual partner are given for both. It most definitely *is* a valid comparison. It decreases sexual function and can cause complications. Most men in the US are circumcised, so most women are accustomed to it, but the fact that women have come on this site and argued that foreskin is "gross" and comparing it to "skin tags" enrages me. This isn't a random birth defect, it's a protective covering that most mammals have evolved. It *should* be entirely for the person circumcised to decide. It is a religious practice that scientists only recently have tried to find reasons for. That's ass backwards and we all know it.

Most men don't know the difference, so they don't regret that it was done, but there are plenty of people like me. There are plenty of men that are horrified by what their parents did to them as infants. You won't find any men that are pissed off that they weren't circumcised though, and you know why? They can *choose* to have it done whenever they want.
 
Also, when the penis is erect, the foreskin is stretched out fully and it tends to slide back, away from the glans, during sex. Since the foreskin protects the glans throughout the day, the skin there is more sensitive than it would be in an uncircumcised male. It is probably more able to absorb enhancins, protein products in vaginal fluid that increase sexual pleasure.

The downside is this softer tissue is more vulnerable to stds and the foreskin itself has lymph nodes that give HIV a foothold.

For the Western world, the OP is probably correct. HIV+ partners are rare enough that the marginal benefits of increased protection for the few men who grow up to have unprotected sex with an HIV+ partner may be outweighed by the risks of circumcision itself to everyone who receives the procedure.
 
So you're prepared to have cosmetic surgery to remove parts of your son's genitals. How about any daughters? There are plenty of people in the world who find intact female genitalia unpleasant. Should they have the right to have their daughters' labia minora, prepuce or external clitoris removed if they consider them to be "sick growths".

And how do you know what his future girlfriends/wife will prefer? I can put you in touch with several women who resent their parents-in law for having had their husbands circumcised.

How about letting your son decide? It's his body.

It is my job to make decisions on behalf of my future son. I think it is in his best interest to have his foreskin removed because it is unattractive and increases disease transmission, mostly because it is unattractive. It is in his interest to have a circ at a young age where he won't have to worry about his pending surgery and recovery as he would at a later date. The trauma of grossing out his future girlfriends and the complex he could develop about an already sensitive subject is greater than that of a procedure he won't even remember. If he was having a circ as a teenager, he would probably, justifiably be pissed that it wasn't done earlier.

It is also my job to make decisions on behalf of my future daughter. I wouldn't have her labia or clitoris operated on because that is not in her best interest. I don't care what barbarians think about intact female genitals. They also don't think they are gross, they are just brainwashed religiously into thinking that it is preferable to female sexual pleasure. Their view that they are acting in their daughters' interest is based on a fantasy. It's totally unrelated to male circumcision.

If you are embarrased that your junk is gross, don't go on a crusade to end a positive practive. Make an appointment with your local urologist. That isn't directed at anyone in particular, just at anti-circumcision crusaders in general.

If you are gay and you wish you hadn't had a circ because lots of gay dudes dig on foreskin, then sorry, but we shouldn't stop having circs just in case the kid turns out to be gay.
 
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It is my job to make decisions on behalf of my future son. I think it is in his best interest to have his foreskin removed because it is unattractive and increases disease transmission, mostly because it is unattractive. It is in his interest to have a circ at a young age where he won't have to worry about his pending surgery and recovery as he would at a later date. The trauma of grossing out his future girlfriends and the complex he could develop about an already sensitive subject is greater than that of a procedure he won't even remember. If he was having a circ as a teenager, he would probably, justifiably be pissed that it wasn't done earlier.

It is also my job to make decisions on behalf of my future daughter. I wouldn't have her labia or clitoris operated on because that is not in her best interest. I don't care what barbarians think about intact female genitals. They also don't think they are gross, they are just brainwashed religiously into thinking that it is preferable to female sexual pleasure. Their view that they are acting in their daughters' interest is based on a fantasy. It's totally unrelated to male circumcision.

If you are embarrased that your junk is gross, don't go on a crusade to end a positive practive. Make an appointment with your local urologist. That isn't directed at anyone in particular, just at anti-circumcision crusaders in general.

If you are gay and you wish you hadn't had a circ because lots of gay dudes dig on foreskin, then sorry, but we shouldn't stop having circs just in case the kid turns out to be gay.


Oh god. I LOL'd so hard at this post. So hypocritical.:laugh:
 
Please link to literature regarding botched medical student circumcisions. I've never seen a medical student allowed to perform a circumcision.

Circumcision is certainly justifiable as long as parents are informed of the risks and benefits of the procedure. Risks include screw-ups requiring skin grafts, infection, hemorrhage, even loss of penis and death. Minor complications of circumcision are rare, and severe complications are extremely rare. Benefits are reduced risk of UTI, reduced risk of penile cancer (although this is exceedingly rare to begin with), decreased risk of HIV, and cosmetic.


not true i know a med student who was posting all over her facebook how she performed her first cicumcision
 
not true i know a med student who was posting all over her facebook how she performed her first cicumcision

Is it possible to flat out refuse to perform one on an infant without getting totally reamed for it?

I feel like if people can get out of performing certain other procedures under personal ethical concerns, this one should be covered as well...Then again, I know it's probably necessary to at least know how to do it...


It is my job to make decisions on behalf of my future son. I think it is in his best interest to have his foreskin removed because it is unattractive and increases disease transmission, mostly because it is unattractive. It is in his interest to have a circ at a young age where he won't have to worry about his pending surgery and recovery as he would at a later date. The trauma of grossing out his future girlfriends and the complex he could develop about an already sensitive subject is greater than that of a procedure he won't even remember. If he was having a circ as a teenager, he would probably, justifiably be pissed that it wasn't done earlier.

Are you trying to claim low European birthrates are due to women refusing to screw men with foreskins? Because I'm pretty sure European men (almost all of whom are uncut) have no more trouble scoring a girl than circumcised American dudes. I'm not sure why you think a foreskin is going to be some major sexual impediment. I'm a girl, and yes, we talk about guys, and no, I've never heard anyone talk about foreskins the way you do.

It's kind of odd how absolutely fixated you are on them and how SURE you are that you know how women feel about them. Are you male or female?
 
I think the heart of this argument is the fact that every single healthy male child that is born has a foreskin.

Hemangiomas, poly/syndactyly, etc -- are all abnormal. These come from mistakes in the genome. Foreskin is coded for; it is normal.

Condoms and safe sexual practices do much, much more in terms of decreasing STI transmission than circumcision; this is not debatable. It is incomprehensible to me how anyone sitting in their armchair can declare a part of the body that EVERY male is born with "abnormal" and is ready to remove it for cultural reasons (cultural? really? you'd cut off a normal body part because he'll get made fun of? do you realize how ridiculous that sounds?) and an extremely modest medical benefit that is more than compensated for via other, not invasive means. It's absurd.
 
Why can't parents give consent for this? It doesn't harm you. The Hippocratic oath states "I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion." and "I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art." So no surgery should be performed by practitioners who have taken this. Also aren't religious reasons or cosmetic reasons good enough?
 
Are you trying to claim low European birthrates are due to women refusing to screw men with foreskins? Because I'm pretty sure European men (almost all of whom are uncut) have no more trouble scoring a girl than circumcised American dudes. I'm not sure why you think a foreskin is going to be some major sexual impediment. I'm a girl, and yes, we talk about guys, and no, I've never heard anyone talk about foreskins the way you do.

It's kind of odd how absolutely fixated you are on them and how SURE you are that you know how women feel about them. Are you male or female?

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I think the heart of this argument is the fact that every single healthy male child that is born has a foreskin.

Hemangiomas, poly/syndactyly, etc -- are all abnormal. These come from mistakes in the genome. Foreskin is coded for; it is normal.

Condoms andsafe sexual practices do much, much more in terms of decreasing STI transmission than circumcision; this is not debatable. It is incomprehensible to me how anyone sitting in their armchair can declare a part of the body that EVERY male is born with "abnormal" and is ready to remove it for cultural reasons (cultural? really? you'd cut off a normal body part because he'll get made fun of? do you realize how ridiculous that sounds?) and an extremely modest medical benefit that is more than compensated for via other, not invasive means. It's absurd.

This is very true. Condoms #1.

But, people in this thread seem to be on a "crusade" (I've also noticed the majority of them are not medical studnets, attendings etc (besides yourself)), and are trying to "smear" circumcision.

The literature is very clear as was already stated with circumcision:

1) Decreased HIV transmission rate
2) Decreased penile cancer (also rare)

The studies already posted about this were very well done (especially compared to the "counter studies" posted).

If you are going to argue, at least use good science.

Bottom line, if you don't want your son to be circumcised. Fine, no problem. But, don't go around spreading "lies" about the science (this is honestly, the only thing that angered me).

But, in the US at least, when our children are young, we decide what's best for them (getting vaccinated, circumcision, etc). I will choose that for my son and you can choose it for yours. Others don't need to be force-fed your garbage believes, and if you want to stick your fingers in your ears and say "lalalla your wrong". By all means.
 
This really pisses me off. I'm going to assume you're female, because the only people who have ever used this argument with me are female, but you may not be. Here's what *you* don't understand. I am circumcised. It is traumatic, still at 27, to know that my parents willfully cut off a piece of my body because their god told them to. I am not a christian, and it is a daily reminder of a religion that has only shown me hate. The reason most people give for male circumcision are the same reasons people give for female circumcision; health, hygiene, religion, looks, and ability to find a willing sexual partner are given for both. It most definitely *is* a valid comparison. It decreases sexual function and can cause complications. Most men in the US are circumcised, so most women are accustomed to it, but the fact that women have come on this site and argued that foreskin is "gross" and comparing it to "skin tags" enrages me. This isn't a random birth defect, it's a protective covering that most mammals have evolved. It *should* be entirely for the person circumcised to decide. It is a religious practice that scientists only recently have tried to find reasons for. That's ass backwards and we all know it.

Most men don't know the difference, so they don't regret that it was done, but there are plenty of people like me. There are plenty of men that are horrified by what their parents did to them as infants. You won't find any men that are pissed off that they weren't circumcised though, and you know why? They can *choose* to have it done whenever they want.

You have a problem with your religion. Not circumcision. This is suppose to be a medical debate. Your personal "hatred" toward Christianity, should not play a role (remember leaving your biases at the door, "Mr. Soon to be Doc", right?).

Btw, I'm a dude. Epic fail in your argument.

And no, its not a valid comparison to female circumcision. If you were educated about this ,medical subject (not your biases), you would know that.
 
But, in the US at least, when our children are young, we decide what's best for them (getting vaccinated, circumcision, etc). I will choose that for my son and you can choose it for yours. Others don't need to be force-fed your garbage believes, and if you want to stick your fingers in your ears and say "lalalla your wrong". By all means.

The thing for me is that I can accept that current research does indicate circumcision provides protection against HIV...BUT that reason alone is not enough to justify it being done to an INFANT. At least not until infants are regularly engaging in sex with HIV+ folks. The average boy isn't going to be sowing his wild oats until he's at least 14. Is it really that important to get it done early, when the decision could be left for later? I'm talking about boys from developed countries with lower HIV rates, not Botswana.

I DON'T think this can just be dismissed as being a parental right. We're talking about a (nearly?) IRREVERSIBLE procedure done on an infant that removes a piece of skin that grows naturally on the human body and has done so for millennia. It's totally different than consenting to a procedure that will cure or alleviate a condition, or a vaccine that can be given later anyway. Circumcision is permanent and affects an extremely sensitive, important area of the body - a part of the body most guys I know would consider the MOST important area of their body outside of the brain. This is obviously a special case and should be treated as such.
 
There are significant advantages to infancy as the time for circumcision. No general anesthesia is required. The patient has no memory of the procedure. Pain is generally well tolerated with no need for opioid analgesia. The patient enjoys added benefits of circumcision (reduced risk of pediatric UTI). Personally, I would want to be circumcised in infancy or not at all.

Yes the foreskin is normal anatomy, and most uncircumcised men will never have difficulties associated with their foreskin. That said, there are clear health benefits to circumcision, and few risks associated with the procedure. If parents want to circumcise, they should be allowed to. I also think it can be a valid part of an HIV prevention strategy, provided that proper technique and education are provided.

If circs are to be a part of HIV prevention, it is another argument in favor of infant circumcision, as it is best to have the preventative measure in place well before the time of risk exposure. It's the same reason we need to vaccinate girls against HPV well before coitarche. I don't really see the advantage of waiting until a boy is 13 or 14 to circumcise him. He is still incapable of making the decision for himself at that age, and the procedure will be a lot more traumatic for him. There is evidence out there I believe, that circumcision is beneficial for HIV prevention, at least from a public health standpoint, even in areas with low incidence. The costs associated with HIV are so high, that prevention of 60% of male heterosexual contraction is worth it. I will try to find the study to post.
 
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The thing for me is that I can accept that current research does indicate circumcision provides protection against HIV...BUT that reason alone is not enough to justify it being done to an INFANT. At least not until infants are regularly engaging in sex with HIV+ folks. The average boy isn't going to be sowing his wild oats until he's at least 14. Is it really that important to get it done early, when the decision could be left for later? I'm talking about boys from developed countries with lower HIV rates, not Botswana.

I DON'T think this can just be dismissed as being a parental right. We're talking about a (nearly?) IRREVERSIBLE procedure done on an infant that removes a piece of skin that grows naturally on the human body and has done so for millennia. It's totally different than consenting to a procedure that will cure or alleviate a condition, or a vaccine that can be given later anyway. Circumcision is permanent and affects an extremely sensitive, important area of the body - a part of the body most guys I know would consider the MOST important area of their body outside of the brain. This is obviously a special case and should be treated as such.

A vaccine that can be given later anyway? This go with this example:

The biggest Risk factor for contracting HPV 16,18 is early sexual contact--this specific virus serotype that can cause cervical cancer. We now have a vaccine against this virus.

If you waited till a women was of legal age to administer the vaccine (aka 18), this person has likely had multiple exposures to the virus if they'd have significant sexual contacts by that point, now with a risk of developing cervical cancer.

Could they decide to get the vaccine, now? Sure. But good chance damage has been done.

When that same patient is 13-16 (still very immature), do you think many (though I am sure there are some) teenagers are going to go out of their way to get vaccinated? This is the job of the parent, when the teen mind is still growing, impulsive, and leads to risk taking behavior (Should the parent force the teenager to get the vaccine? No. But, it is unlikely a teenager even has a little understanding of the repercussions of that decision). (hence, parents "pushing" them in the right direction).

But, if the parents had just made the vaccination part of their vaccinations at a young age (10-12), this patient may have been protected (notice, the parent making the decision).

Both AIDS and penile cancer can be devastating. You can obviously wait to get circumcised at 18. But, if you do have a homosexual son (and often, many parents are unaware of the sexual behaviors of their children), they are going to be a higher risk individual by 18 for HIV (see the analogy above). Are they going, at 13-18 going to to think to go get circumcised? Unlikely (just as a teenager is unlikely to go out of their way to get a vaccination--of course there are exceptions).

It is going to be difficult to push a male teen to get a circumcision at that age (again, impulsive, illogical--"this will never happen to me").

.. by the time they are "older" the damage may have been done.


Is it really worth the risk? This is an individual decision.

However, we cannot deny the science and reality because of our biases.

Ex: People are absolutely convinced vaccines cause Autism due to mercury. HUGE cohort studies have been to prove this is invalid. Does it matter? No. Some are so completely convinced of their position, that they are unable to adapt to logic and reason, and this is dangerous in medicine if you perpetuate that bias on patients as "medical advice"

Finally, this might not be "Bosnia" but there are about 1 million people in the US with HIV (http://www.cnn.com/2008/HEALTH/conditions/08/02/hiv.cdc/index.html) / 40,000 New cases in the US a year (if you think the AIDS epidemic is over in this country, you are sadly mistaken)
 
"No general anesthesia is required."

The reason general anesthesia isn't used is because it's too dangerous rather than because it's not necessary. In Scotland, the NHS won't perform circumcisions before the age of six months specifically so that the child is old enough for GA to be used. The RACP says "To reduce the risks and the discomfort for the child, the operation is best performed under a general anaesthetic after the age of six months." It's possible to perform adult circumcisions with local rather than general anesthetic too, but since it's harder to strap them down, and they actually have a say in the matter, GA is almost always used.

"Personally, I would want to be circumcised in infancy or not at all."

Even if I knew that I or my son or any future sons would need to be circumcised at some point in their life, I would leave it till as late as possible. The risks are less, GA can be used, and the person whose body it is can get to choose what kind of circumcision they want. The RACP has said that "One reasonable option is for routine circumcision to be delayed until males are old enough to make an informed choice." There are plenty of countries which circumcise, but don't do it till the boys are over ten years old btw.

With a neonate:
a) you have to separate the foreskin from the glans (probably the most painful part of the procedure). This also results in adhesions, skin tags and skin bridges. If you wait a few years, then the foreskin separates naturally.
b) the penis is much smaller so there's more chance of a seriously botched job. It's very rare, but some babies die or suffer amputations because of circumcision. David Reimer is the most famous example, but there are several others. The record payout for a botched circumcision is $22.8 million. It was said at the time that the victim "will never be able to function sexually as a normal male and will require extensive reconstructive surgery and psychological counseling as well as lifelong urological care and treatment by infectious disease specialists." In April last year, a jury in Atlanta awarded $1.8 million to a boy whose penis was severed in a botched circumcision five years earlier. Another child lost part of his glans within the last 12 months. Sure, cases like that are very rare, but why should they happen at all?
c) there's more chance of a slightly botched job too. If you look up the galleries of botched jobs, one thing that may surprise you is just how many jobs were botched cosmetically, rather than medically. Skin bridges, penile varicose veins, and hair growing half way up the shaft are not normal, but would not be counted as medical complications.
d) you can't use GA, so it's more painful. Medical students were still being taught until the 80's that newborns didn't feel pain, despite the obvious evidence to the contrary. A couple of recent studies suggest that neonates may actually be hyper-sensitive to pain. Just because babies don't remember, it doesn't mean it hasn't affected them. They have more problems breastfeeding, and also show more reaction to injections years later.
The problems with breastfeeding are mentioned in an AAP policy statement:
"Available research indicates that newborn circumcisions are a significant source of pain during the procedure and are associated with irritability and feeding disturbances during the days afterward."

e) newborns don't have much of an immune system, so they can die of things that are harmless to adults or older children. A baby died after circumcision in New York a few years ago after contracting HPV from the mohel for instance, and another got brain damage.
f) neonatal circumcision is strongly linked with meatal stenosis.
g) neonatal circumcision often needs a second operation. The revision rate seems to be around 5%, though figures from 1% to 9.5% have been reported.
h) a newborn can't tell you if he actually wants to have the most sensitive part of his penis removed or not. It's HIS body after all.

"That said, there are clear health benefits to circumcision, and ..."

The Canadian Paediatric Society, Royal Australasian College of Physicians, British Medical Association, and Royal Dutch Medical Association all disagree with you in their official position statements on male circumcision. Around 50% of male doctors in Canada and the UK will be circumcised, and over 80% of male doctors in Australia and New Zealand. Why would circumcised male doctors be against circumcision? Why is it so easy to find doctors who were circumcised as infants, but are opposed to infant circumcision, but almost impossible to find doctors who weren't circumcised as infants, but are in favor of infant circumcision?

That last paragraph is by far the most important. If you respond to any of this, please explain why those four medical organizations have such a different view of circumcision.
 
The reason general anesthesia isn't used is because it's too dangerous rather than because it's not necessary. In Scotland, the NHS won't perform circumcisions before the age of six months specifically so that the child is old enough for GA to be used. It's possible to perform adult circumcisions with local rather than general anesthetic too, but since it's harder to strap them down, and they actually have a say in the matter, GA is almost always used.



Even if I knew that I or my son or any future sons would need to be circumcised at some point in their life, I would leave it till as late as possible. The risks are less, GA can be used, and the person whose body it is can get to choose what kind of circumcision they want. The RACP has said that "One reasonable option is for routine circumcision to be delayed until males are old enough to make an informed choice." There are plenty of countries which circumcise, but don't do it till the boys are over ten years old btw.

With a neonate:
a) you have to separate the foreskin from the glans (probably the most painful part of the procedure). This also results in adhesions, skin tags and skin bridges. If you wait a few years, then the foreskin separates naturally.
b) the penis is much smaller so there's more chance of a seriously botched job. It's very rare, but some babies die or suffer amputations because of circumcision. David Reimer is the most famous example, but there are several others. The record payout for a botched circumcision is $22.8 million. It was said at the time that the victim "will never be able to function sexually as a normal male and will require extensive reconstructive surgery and psychological counseling as well as lifelong urological care and treatment by infectious disease specialists." In April last year, a jury in Atlanta awarded $1.8 million to a boy whose penis was severed in a botched circumcision five years earlier. Another child lost part of his glans within the last 12 months. Sure, cases like that are very rare, but why should they happen at all?
c) there's more chance of a slightly botched job too. If you look up the galleries of botched jobs, one thing that may surprise you is just how many jobs were botched cosmetically, rather than medically. Skin bridges, penile varicose veins, and hair growing half way up the shaft are not normal, but would not be counted as medical complications.
d) you can't use GA, so it's more painful. Medical students were still being taught until the 80's that newborns didn't feel pain, despite the obvious evidence to the contrary. A couple of recent studies suggest that neonates may actually be hyper-sensitive to pain. Just because babies don't remember, it doesn't mean it hasn't affected them. They have more problems breastfeeding, and also show more reaction to injections years later.
The problems with breastfeeding are mentioned in an AAP policy statement:
"Available research indicates that newborn circumcisions are a significant source of pain during the procedure and are associated with irritability and feeding disturbances during the days afterward."

e) newborns don't have much of an immune system, so they can die of things that are harmless to adults or older children. A baby died after circumcision in New York a few years ago after contracting HPV from the mohel for instance, and another got brain damage.
f) neonatal circumcision is strongly linked with meatal stenosis.
g) neonatal circumcision often needs a second operation. The revision rate seems to be around 5%, though figures from 1% to 9.5% have been reported.
h) a newborn can't tell you if he actually wants to have the most sensitive part of his penis removed or not. It's HIS body after all.



The Canadian Paediatric Society, Royal Australasian College of Physicians, British Medical Association, and Royal Dutch Medical Association all disagree with you in their official position statements on male circumcision. Around 50% of male doctors in Canada and the UK will be circumcised, and over 80% of male doctors in Australia and New Zealand. Why would circumcised male doctors be against circumcision? Why is it so easy to find doctors who were circumcised as infants, but are opposed to infant circumcision, but almost impossible to find doctors who weren't circumcised as infants, but are in favor of infant circumcision?

That last paragraph is by far the most important. If you respond to any of this, please explain why those four medical organizations have such a different view of circumcision.

First of all, your writing is incomprehensible. Secondly, are you even someone involved in medicine? You seem completed uneducated on this. I just spent TWO seconds, glancing over one of your references:

http://www.cps.ca/english/statements/FN/fn96-01.htm

Canadian Pediatric Society


Conclusions

We undertook this literature review to consider whether the CPS should change its position on routine neonatal circumcision from that stated in 1982. The review led us to conclude the following.


  • There is evidence that circumcision results in an approximately 12-fold reduction in the incidence of UTI during infancy. The overall incidence of UTI in male infants appears to be 1% to 2%.
  • The incidence rate of the complications of circumcision reported in published articles varies, but it is generally in the order of 0.2% to 2%. Most complications are minor, but occasionally serious complications occur. There is a need for good epidemiological data on the incidence of the surgical complications of circumcision, of the later complications of circumcision and of problems associated with lack of circumcision.
  • Evaluation of alternative methods of preventing UTI in infancy is required.
  • More information on the effect of simple hygienic interventions is needed.
  • Information is required on the incidence of circumcision that is truly needed in later childhood.
  • There is evidence that circumcision results in a reduction in the incidence of penile cancer and of HIV transmission. However, there is inadequate information to recommend circumcision as a public health measure to prevent these diseases.
  • When circumcision is performed, appropriate attention needs to be paid to pain relief.
  • The overall evidence of the benefits and harms of circumcision is so evenly balanced that it does not support recommending circumcision as a routine procedure for newborns. There is therefore no indication that the position taken by the CPS in 1982 should be changed.
  • When parents are making a decision about circumcision, they should be advised of the present state of medical knowledge about its benefits and harms. Their decision may ultimately be based on personal, religious or cultural factors.
They In NO WAY state, they are against circumcision--they clearly state its a cost/benefit analysis and an individual decision (if they were against it, they would advise against it). You clearly are just constantly making things up.

Stop lying. Stop spreading bias. Make the decision for yourself and no one else.

By the way, for anyone else, I have no idea about the legitimacy of this agency. I just picked out one random one from the posters list.
 
...

I just spent TWO seconds, glancing over one of your references:

http://www.cps.ca/english/statements/FN/fn96-01.htm

...

They In NO WAY state, they are against circumcision--they clearly state its a cost/benefit analysis and an individual decision (if they were against it, they would advise against it). You clearly are just constantly making things up.

Stop lying. Stop spreading bias. Make the decision for yourself and no one else.

...

They did advise against it. If you spend two more seconds glancing over that reference, you'll see the following:

"Recommendation: Circumcision of newborns should not be routinely performed."
 
A vaccine that can be given later anyway? This go with this example:

The biggest Risk factor for contracting HPV 16,18 is early sexual contact--this specific virus serotype that can cause cervical cancer. We now have a vaccine against this virus.


If we were talking about permanently removing part of the vagina to prevent HPV, I would be saying the exact same thing. You cannot equate the permanent removal of a piece of an infant's penis to choosing to give your daughter a vaccine. The vaccine adds, it does not take away (forever.) Find a different analogy. If we could prevent HPV (or HIV) by removing just a bit of the vagina - and not the clitoris - would you support it? Personally I would be EXTREMELY angry if I had a nonessential bit of my genitalia removed as a baby in order to protect me from myself as an adult.

I'm perfectly aware that kids may engage in risky sexual behaviors. Condoms and sex ed are still generally preferable to cutting off a part of your penis, IMO.

I've been trying to find statistics on adult circumcision for cosmetic or HIV-prevention purposes in the US or Europe. As far as I'm aware, it's difficult to convince almost any man in a developed nation with a low HIV rate to get a circumcision outside of medical necessity. So it's not just adolescents - it's men in general, adults and adolescents. What you're really saying is adults are too stupid to do what is best for them and circumcize, so their parents should be allowed to make this (eternal) decision when they're infants.

Also...I said Botswana, not Bosnia.

Stop lying. Stop spreading bias. Make the decision for yourself and no one else.
The thing is that you are advocating that people make the decision for other people.

I'm curious - how old can the child be before the parent is not allowed to force the circumcision? How old before you're not comfortable saying parents should be making the decision and the kid should have no say whatsoever? 6? 10? 13? 15? 17? If parents bring an unwilling 13 year old in for a circumcision, does that fall under parental rights?
 
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Both AIDS and penile cancer can be devastating. You can obviously wait to get circumcised at 18. But, if you do have a homosexual son (and often, many parents are unaware of the sexual behaviors of their children), they are going to be a higher risk individual by 18 for HIV (see the analogy above).

The last time I checked there have been five or six studies which have consistently pointed to "no difference" when looking at the question of M->M HIV transmission and circumcision. One of the larger ones was performed by CDC. So I am not sure what homosexuality has to do with this.

Are they going, at 13-18 going to to think to go get circumcised? Unlikely (just as a teenager is unlikely to go out of their way to get a vaccination--of course there are exceptions).

And for the most part someone who is older than 18 wouldn't get circumcised for a vanishingly small (potential) relative risk reduction that you would expect in most first world countries; though most would get a vaccine.

It is going to be difficult to push a male teen to get a circumcision at that age (again, impulsive, illogical--"this will never happen to me").

Two adjectives (among others) I would use to describe neonatal circumcision.

.. by the time they are "older" the damage may have been done.


Is it really worth the risk? This is an individual decision.

I agree with the you here. It's my individual decision for me and it should be your individual decision for you and an individual decision for each man. BTW, I would have said no but I didn't have the dignity of a decision.

However, we cannot deny the science and reality because of our biases.

Ex: People are absolutely convinced vaccines cause Autism due to mercury. HUGE cohort studies have been to prove this is invalid. Does it matter? No. Some are so completely convinced of their position, that they are unable to adapt to logic and reason, and this is dangerous in medicine if you perpetuate that bias on patients as "medical advice"

Finally, this might not be "Bosnia" but there are about 1 million people in the US with HIV (http://www.cnn.com/2008/HEALTH/conditions/08/02/hiv.cdc/index.html) / 40,000 New cases in the US a year (if you think the AIDS epidemic is over in this country, you are sadly mistaken)

Most of those cases are among MSM for whom circumcision has never really shown a protective effect.
 
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for those arguing that the foreskin is a natural part of the body, I will just point out that there are many vestigial parts that once had an important function but in current society/lifestyles of humans no longer have any known function. This includes several muscles (the platysma for example), organs (the appendix), etc... Now, these are not routinely removed due to invasiveness and difficulty, but many times when I have seen an unrelated abdominal surgery I have seen the surgeons remove an appendix to prevent future complication. The major function of the foreskin was protection of the glans, but since pretty much everyone wears 1-2 layers of protection over the genitals each day, the need for protection is essentially vestigial. The heightened sexual function/pleasure I suppose is still a vital function, and since I haven't seen the research on it, won't dispute or dismiss that as truthful or not.

If your child (up to age 18 in the US) needs any surgery or treatment, it is the parent, not the child, who makes the decision. So a 17 year old with appendicitis, a 9 year old with a hernia, a 3 month old with a congenital heart defect, its all parential consent. So it is up to the parent to decide what to do about it.
 
for those arguing that the foreskin is a natural part of the body, I will just point out that there are many vestigial parts that once had an important function but in current society/lifestyles of humans no longer have any known function. This includes several muscles (the platysma for example), organs (the appendix), etc... Now, these are not routinely removed due to invasiveness and difficulty, but many times when I have seen an unrelated abdominal surgery I have seen the surgeons remove an appendix to prevent future complication.

Maybe they are vestigial and maybe they aren't we're always learning new things about these parts of the body. Clearly you can live with out some of these but one could also live without many other parts of the body too.

If your child (up to age 18 in the US) needs any surgery or treatment, it is the parent, not the child, who makes the decision. So a 17 year old with appendicitis, a 9 year old with a hernia, a 3 month old with a congenital heart defect, its all parential consent. So it is up to the parent to decide what to do about it.

  • Heart Defect
  • Appendicitis
  • Hernia
All good reasons for surgical intervention and when a minor is involved, the input (consent) of the parent. What though is the indication for circumcision on an otherwise healthy, normally developed child?
 
for those arguing that the foreskin is a natural part of the body, I will just point out that there are many vestigial parts that once had an important function but in current society/lifestyles of humans no longer have any known function. This includes several muscles (the platysma for example), organs (the appendix), etc... Now, these are not routinely removed due to invasiveness and difficulty, but many times when I have seen an unrelated abdominal surgery I have seen the surgeons remove an appendix to prevent future complication. The major function of the foreskin was protection of the glans, but since pretty much everyone wears 1-2 layers of protection over the genitals each day, the need for protection is essentially vestigial. The heightened sexual function/pleasure I suppose is still a vital function, and since I haven't seen the research on it, won't dispute or dismiss that as truthful or not.

If your child (up to age 18 in the US) needs any surgery or treatment, it is the parent, not the child, who makes the decision. So a 17 year old with appendicitis, a 9 year old with a hernia, a 3 month old with a congenital heart defect, its all parential consent. So it is up to the parent to decide what to do about it.

Can we stop pretending the genitalia is just like any other part of the body? I dunno about you, but I consider mine pretty damn important, whereas I don't give a flying fig about my appendix.
 
Maybe they are vestigial and maybe they aren't we're always learning new things about these parts of the body. Clearly you can live with out some of these but one could also live without many other parts of the body too.



  • Heart Defect
  • Appendicitis
  • Hernia
All good reasons for surgical intervention and when a minor is involved, the input (consent) of the parent. What though is the indication for circumcision on an otherwise healthy, normally developed child?

Post the actual study, not the ABC report please.

What about a cleft lip? If the hard palate is intact (or repaired), why mess with the lip? Its a cosmetic procedure. It can wait til the kid is old enough to make his/her own decisions, right?
 
Well, I still find extremely interesting at this point is that everyone "against" circumcision are not attendings, residents, or medical students (basically all premeds)

Maybe a few of you just haven't actually seen the literature on this?

I mean how many times do we have to repeat this:

Cpants even put it up for you (some of the evidence), that it protects against penile cancer and AIDS. This is tested on exams in medical school and the boards. This is just not us just "throwing around" our wild opinions. I think some of you need to get past your emotional reaction and take a closer look at the SCIENCE.
 
Post the actual study, not the ABC report please.

I believe this was the paper:

Randal Bollinger R, Barbas AS, Bush EL, Lin SS, Parker W. Biofilms in the large bowel suggest an apparent function of the human vermiform appendix. J Theor Biol. 2007 Dec 21;249(4):826-31.

This is a bit of a diversion though.

What about a cleft lip? If the hard palate is intact (or repaired), why mess with the lip? Its a cosmetic procedure. It can wait til the kid is old enough to make his/her own decisions, right?

Cleft lip is considered a birth defect isn't it?
 
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Well, I still find extremely interesting at this point is that everyone "against" circumcision are not attendings, residents, or medical students (basically all premeds)

Maybe a few of you just haven't actually seen the literature on this?

I mean how many times do we have to repeat this:

Cpants even put it up for you (some of the evidence), that it protects against penile cancer and AIDS. This is tested on exams in medical school and the boards. This is just not us just "throwing around" our wild opinions. I think some of you need to get past your emotional reaction and take a closer look at the SCIENCE.

Actually, I've read just about all the literature on the matter. Which is why, for example, I know there are at least four or five studies which have not demonstrated any meaningful risk reduction between MSMs while you suggest:

But, if you do have a homosexual son (and often, many parents are unaware of the sexual behaviors of their children), they are going to be a higher risk individual by 18 for HIV (see the analogy above).

I don't ignore the science, please show me where I've explicitly refuted the specific findings as they are currently presented. Rather, I look at the knowledge and understand how that can be applied in context; much like the French,the Dutch, and others. Do you disagree with, for example, the conclusion of the French National Council on Aids that:

The same measures are not applicable to the Northern countries. The recommendations of the WHO state that this strategy is aimed at countries with high prevalence, and not at countries with low prevalence or in countries where it relates specifically to one part of the population such as in France or the United States.

I find it interesting, personally, that doctors from cultures that circumcise tend to be the strongest promoters of it, don't you?
 
Well, I still find extremely interesting at this point is that everyone "against" circumcision are not attendings, residents, or medical students (basically all premeds)

Maybe a few of you just haven't actually seen the literature on this?

I mean how many times do we have to repeat this:

Cpants even put it up for you (some of the evidence), that it protects against penile cancer and AIDS. This is tested on exams in medical school and the boards. This is just not us just "throwing around" our wild opinions. I think some of you need to get past your emotional reaction and take a closer look at the SCIENCE.

I thought this was an "individual's" decision to make for their son, not a doctor's decision. If it's silly for a pre-med or a medical student to be against circumcision, how is it any less silly for a parent? Only doctors can make this decision? You're contradicting yourself. First you say parents should be making this decision, then you totally dismiss anyone who isn't a resident or attending having an opinion - which, by the way, disqualifies you as well.

This is a fallacious argument anyway, because only one person who has posted on this thread is marked as an attending, and I think two residents. So one attending arguing against circumcision on an internet forum is "extremely interesting"? If you're basing anything off of that, it falls apart if an attending comes here to argue against circumcision - and I guarantee you there are attendings and residents that are against it. Finding debate activity on one thread of an almost completely overlooked SDN forum section "extremely interesting" indicates to me that you might need a better hobby :d

Should I point out that the Canadian Pediatric Society "does not support recommending circumcision as a routine procedure for newborns"? Or that the American Academy of Pediatrics says that "existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision."?

You never answered my question, either. Would you perform a circumcision on an unwilling 13 year old, brought in kicking and screaming? Or a 15 year old? Or a 17 year old? If none of them were sexually active yet, you'd still have a chance to save them from adult misadventures. You believe that we need to make these decisions for infants because they will be too stupid and irresponsible to make good choices as adults, so how old is too old for you to force a minor into a circumcision? After all, a 17 year old has a LOT of life left in him and a lot of plowing left to do, so if you get that circumcision done...


Post the actual study, not the ABC report please.

What about a cleft lip? If the hard palate is intact (or repaired), why mess with the lip? Its a cosmetic procedure. It can wait til the kid is old enough to make his/her own decisions, right?


Penis >>>>>>>>>>>>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>>> >>>>>>>>>>>>>>>>> >>>>>>>>>>>>>> >>>>>>>>>>>>>>>> Lip

Are we seriously stuck on this point? Obviously the penis is an extremely important and unique part of a person's anatomy, above and beyond the lips. It's not like it's a crime to touch a kid's lip. We don't freak out and throw a niqab over their face if they expose their lips in public. We don't teach them not to expose their lips to strangers. We don't obsess constantly over the shape of a kid's lips. If you're trying to pretend that repairing a cleft lip is ANYTHING like cutting off a non-essential part of a VERY essential organ, you are waaaaay out of the realm of reality.

If you don't see the difference between the genitals and, say, an appendix...there's really no discussion that can be had here.
 
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