Would you perform non-necessary circumcisions?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

Snip snip snip. Would you do it?

  • Yes.

    Votes: 158 71.5%
  • No.

    Votes: 63 28.5%

  • Total voters
    221

ILikeDrugs

pre-attending
10+ Year Member
15+ Year Member
Joined
Jul 20, 2008
Messages
1,793
Reaction score
11
I'm not talking about circumcisions for legitimate medical reasons I'm talking about circumcisions based on the neurotic belief that was set forth by some delusional guy 3500 years ago; "the voice in my head told me to... or else!" or cicrcumcisions because some parents heard it helps prevents this and that -- for every study that shows some positive finding there is a study that shows opposite or insignificant results. According to this hospitalists's (http://thehappyhospitalist.blogspot.com/2008/01/get-yer-snips-at-12-price.html) RN wife, a hospital can charge up to $1600 per circumcision. Let's say you had a practice, or worked in a hospital, and could make money off of this mutilation procedure, would you do it? I wouldn't. The whole idea of circumcising baby boys because of some crazy, supersticious, belief is just plain crazy to me. This procedure is mostly done by ob/gyn, fm, and peds. Let's pretend for the sake of this poll that any MD/DO can do it. Would you do it?

BTW: are any types of docs (ones who work in hospitals) required to perform this procedure?

In before: probationary status, anti-semite, culturally insensitive.
 
I want my contribution to the world to be keeping the "anteater" look from catching on.
 
Why are you (proverbial "you," as the doctor, not "you" specifically) the one who gets to define what makes it "necessary"? Perhaps it IS necessary, but for cultural/traditional/family/whatever reasons, rather than solely physical.

PS. I didn't think the question was insensitive or offensive (though maybe the phrasing was, lol). It is actually a really important question that many new parents debate constantly.
 
If the patient wants it I would do it. Although I know my views have been shaped by society, I think it looks better. I'll probably have my kid circumsized, not because I think it's commanded by some god but because I wouldn't want to cause him undue anxiety with the ladies. Shallow I know.
 
Lol, fortunately for the jewish community they are able to take care of that themselves if necessary. Also, I believe that the data for circumcision is still in favor of it. That's what my infectious disease attending said at least.
 
I'd prefer to let kids keep the best parts of their penises, whether some people think it looks weird or not. That said, I'd do it. It's a quick, easy, and relatively expensive procedure for the time you spend on it.
 
From Archives of Pediatriatric Adolescent Medicine. 2010;164(1):78-84

In considering the issue from an infectious disease point of view, it's interesting that studies cited show that in men circumcision reduces
-human immunodeficiency virus acquisition by 53% to 60%
-herpes simplex virus type 2 acquisition by 28% to 34%
-human papillomavirus prevalence by 32% to 35%

Also, among female partners of circumcised men
-bacterial vaginosis decreased by 40%,
-Trichomonas vaginalis infection decreased by 48%.

Genital ulcer disease was also reduced among males and their female partners.

http://archpedi.ama-assn.org/cgi/content/abstract/164/1/78
 
Some moderate medical benefit (reduced STD transmission rate + avoidance of future medical issues like phimosis), very minimal risk, it makes the patient (or at least the patients parents) happy, and it makes $$. I'd do it.
 
I'll be honest, I don't know much about it, so correct me if I'm wrong. Isn't circumcision more hygienic/more likely to prevent the spread of disease? Or so I've heard anyways...

Does it make sex any worse. Hmmmm
 
I'll be honest, I don't know much about it, so correct me if I'm wrong. Isn't circumcision more hygienic/more likely to prevent the spread of disease? Or so I've heard anyways...

Does it make sex any worse. Hmmmm

I think it does carry some benefit. A few have mentioned possible advantages in this thread. I've heard that circumcision reduces sensitivity, which I guess could be a good or bad thing. :shrug:
 
Catalystik noted above that it reduces the risk of STD and bacterial infection. However, one could argue that condoms offer greater protection against such diseases and require no surgical intervention.

I'm on the fence as to whether I would perform them. I think what I'm most conflicted with is that the parents are making a decision for their child to perform a surgery that is arguably unnecessary, and unlikely to confer any particular benefit to the child until after he would have been old enough to make the decision himself. It's a personal choice, that can be held off until later in life with minimal risk (I'm assuming no more risk than for a newborn, perhaps there is data stating otherwise?) The hygiene argument will likely come up, but I think that can be easily remedied by teaching proper hygiene to the child.
 
No, I would not. I don't believe in the benefits of circumcision, nor do I agree with the procedure itself (i.e. no analgesic). To me, it makes absolutely no sense to cut off a part of a newborn's genitals, no matter how many studies you can cite showing reduced transmission/infection of or by blah blah.
 
No, I would not. I don't believe in the benefits of circumcision, nor do I agree with the procedure itself (i.e. no analgesic). To me, it makes absolutely no sense to cut off a part of a newborn's genitals, no matter how many studies you can cite showing reduced transmission/infection of or by blah blah.

You don't believe in scientific literature stating reduced infection transmission rates? Do tell, what are your problems with the studies?

If you want to make the argument that the procedural risks and morbidity don't justify the decrease in infection transmission, or that reduced transmission generally benefits sexual partners, while the procedural risk is on the child, etc. then by all means go ahead. This is a website for student doctors, and the level of discourse should be above gut reactions about junk mutlation.

Using your gut reaction is no different then saying that "to me, it makes no sense to inject bacteria or virus bits into a newborn for vaccination, no matter how many studies you can show me saying reduced transmission or blah blah"
 
And abstinence would be practically foolproof and wouldn't require acquisition of barrier protection. Both good arguements, but insufficiently utilized.

Especially by members of BYU basketball team.
 
No. I wouldn't. And I won't have my children snipped either. They can make that decision themselves.

Circumcision is the only routinely practiced procedure in which there are no proven benefits. In fact, I'm pretty sure it is the only routinely practiced procedure in which the risks outweigh the benefits.
 
You don't believe in scientific literature stating reduced infection transmission rates? Do tell, what are your problems with the studies?

If you want to make the argument that the procedural risks and morbidity don't justify the decrease in infection transmission, or that reduced transmission generally benefits sexual partners, while the procedural risk is on the child, etc. then by all means go ahead. This is a website for student doctors, and the level of discourse should be above gut reactions about junk mutlation.

Using your gut reaction is no different then saying that "to me, it makes no sense to inject bacteria or virus bits into a newborn for vaccination, no matter how many studies you can show me saying reduced transmission or blah blah"
Yes, but vaccination is a well-established practice with extremely clear benefits. I don't think you'll find many physicians who will doubt that. I was always under the impression that the pros of circumcision were either minor or negligible, and not widely accepted within the medical community. However, I'm far too lazy to find/cite articles, so...yea.
 
Being that I don't want to be a surgeon.. no :laugh:... Actually a slightly off topic question... what type of doctor preforms circumcisions? Pediatric surgeons? Urologists? Or just straight up pediatricians?
 
Being that I don't want to be a surgeon.. no :laugh:... Actually a slightly off topic question... what type of doctor preforms circumcisions? Pediatric surgeons? Urologists? Or just straight up pediatricians?
Janitors. One quick swipe of the scalpel is all.
 
Yes, I would, and I'd have my son circumcised as well (with analgesia). There are shown benefits to circumcising, many of which Cata listed above, but the argument is that a lot of the benefits decrease the risk of things that aren't very common to begin with (like penile cancer), which I'd guess is why the AAP's stance on it is not to condemn it, just not recommend it as a routine procedure.

"Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In the case of circumcision, in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. It is legitimate for parents to take into account cultural, religious, and ethnic traditions, in addition to the medical factors, when making this decision. Analgesia is safe and effective in reducing the procedural pain associated with circumcision; therefore, if a decision for circumcision is made, procedural analgesia should be provided. If circumcision is performed in the newborn period, it should only be done on infants who are stable and healthy."

You can read the entire policy statement here.

Sidenote - I've heard some pretty unsettling stories of men, including elderly men, having to be circumcised later in life thanks to things like phimosis, and I get the impression (as I do not have a penis myself) that is a much more traumatic procedure later in life.
 
Being that I don't want to be a surgeon.. no :laugh:... Actually a slightly off topic question... what type of doctor preforms circumcisions? Pediatric surgeons? Urologists? Or just straight up pediatricians?

I believe if my daughter was a boy my Ob/Gyn would have done it at my request, but I think I'd request a urologist, if they would oblige. I believe you can also hire a mohel to circumcise you're child, even if you're not Jewish.
 
"Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision.
This is an odd statement. I can't image how this would confuse lay people. I'm guessing that most lay people ask for the doctors advice, so spending on how the doctor feels personally (versus medically) is whats really going to dictate whether the procedure is carried out or not.

Are there any other medical procedures that lack significant data but are routinely practiced anyway?
 
Sidenote - I've heard some pretty unsettling stories of men, including elderly men, having to be circumcised later in life thanks to things like phimosis, and I get the impression (as I do not have a penis myself) that is a much more traumatic procedure later in life.

One of my colleagues had a patient on service years ago, a teenage male, who had to be circumcised out of medical necessity (I cannot recall the precise reason). Being a teenage male, the day after the procedure he began developing good ol' morning wood, which, in combination with the freshly stitched wound... well, let's just say you could hear the screaming down the hall.
 
One of my colleagues had a patient on service years ago, a teenage male, who had to be circumcised out of medical necessity (I cannot recall the precise reason). Being a teenage male, the day after the procedure he began developing good ol' morning wood, which, in combination with the freshly stitched wound... well, let's just say you could hear the screaming down the hall.
:scared: :scared: :scared: :scared: :scared:
 
Most of plastic surgery? 😉
I have no idea why, but this conversation is making me crave PF Chang's spring roll. OMG. and they don't open for another three hours.


But seriously (even thorough I am being serious about Chang's), this is just another reason why I could not work with babies. I'd probably close my eyes while performing the procedure and....well, never mind, lets not go there.


How old are Jewish boys when they get cut? like 7 or 13 or something?
 
I have no idea why, but this conversation is making me crave PF Chang's spring roll. OMG. and they don't open for another three hours.


But seriously (even thorough I am being serious about Chang's), this is just another reason why I could not work with babies. I'd probably close my eyes while performing the procedure and....well, never mind, lets not go there.


How old are Jewish boys when they get cut? like 7 or 13 or something?
Boys have a bar mitzvah (sp? I'm not Jewish) at 13 (girls have a bat mitzvah), but they have a bris, which is like a welcoming the baby celebration as well as the circumcision, not long after birth.
 
I have no idea why, but this conversation is making me crave PF Chang's spring roll. OMG. and they don't open for another three hours.


But seriously (even thorough I am being serious about Chang's), this is just another reason why I could not work with babies. I'd probably close my eyes while performing the procedure and....well, never mind, lets not go there.


How old are Jewish boys when they get cut? like 7 or 13 or something?

Jew's circumcise at around birth or so. I believe some African tribes circumcise as a right of passage.
 
Sidenote - I've heard some pretty unsettling stories of men, including elderly men, having to be circumcised later in life thanks to things like phimosis, and I get the impression (as I do not have a penis myself) that is a much more traumatic procedure later in life.

I've heard such stories as well, but I'm wondering whether it is just as painful experience for a newborn, but their lack of memory surrounding the event prohibits it from being traumatic. Whereas an older man, or even adolescent boy would be able to remember and vocalize his discomfort, perhaps leading to the perception that is a more painful or traumatic experience when performed later in life. Something to consider, I'm not sure there will ever be a clear cut answer (pun intended 😛).
 
Yes, I would, and I'd have my son circumcised as well (with analgesia).
GC, are you sure this is an option?


...and I'm glad you don't have a penis.
😉
 
It's a safe procedure with both cultural and medical implications. Yes, there are proven benefits to circumcision. Whether you think those benefits are worth it or not is not up to you as a doctor.
 
GC, are you sure this is an option?


...and I'm glad you don't have a penis. 😉
I'm pretty sure they usually give a local or apply a topical anesthetic as well as give the baby a sugar-dipped pacifier.
 
It's a safe procedure with both cultural and medical implications.
says who, you?
Yes, there are proven benefits to circumcision.
wheres the data?
Whether you think those benefits are worth it or not is not up to you as a doctor.
This is the problem. you shouldn't influence people based off your own beliefs. You should advise people based off evidence based outcomes.
 
I would never perform such a quick, safe, and cost effective procedure at the parents wishes.....
 
says who, you?

wheres the data?

This is the problem. you shouldn't influence people based off your own beliefs. You should advise people based off evidence based outcomes.

Just read post 7 by Catalysk.

I thought future doctors would have read the literature about circumcision.
 
I'm pretty sure they usually give a local or apply a topical anesthetic as well as give the baby a sugar-dipped pacifier.
whaaaa? for real?

lidocaine is weak sauce. if its topical, its not doing a damn thing. and if its injected (sweet, shot in the wang) than its probably more to control bleeding.

There is a reason babies cry during/after circ.
 
says who, you?

wheres the data?

This is the problem. you shouldn't influence people based off your own beliefs. You should advise people based off evidence based outcomes.

Both the risk and benefits to circumcision are listed pretty thoroughly in the link I posted earlier to the AAP policy statement. ETA: The methods of analgesia are listed there as well.
 
Just read post 7 by Catalysk.

I thought future doctors would have read the literature about circumcision.
Read post 23 by GeekChick.
 
Both the risk and benefits to circumcision are listed pretty thoroughly in the link I posted earlier to the AAP policy statement.
correct me if I am wrong, but your link says that there is not enough evidence to support it either way.

"Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In the case of circumcision, in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information..."
 
The part that I posted is not the only part of that website, just the summary at the end.
 
Some FYIs

1) Every Peds residency I've looked at requires you to do a certain number of circumcisions to graduate. This isn't like abortions on an OB rotation, which are almost always optional. You'd need to get some kind of waiver to skip them and still finish residency

2) Someone mentioned analgesia earlier. What I've heard (never actually confirmed it) is that while non medical practicioners can perform a circumcision only a physician can perform a nerve block. If you don't do it then the procedure goes to a less trained professional, the kid gets to feel everything, and the circumcision happens with the kid trying to wriggle off the table in pain. Meanwhile the circumcisions I saw with the nerve block seemed completely painless: the kid didn't even cry and babies cry for everything.

3) I've never heard of a $1600 circumcision, if for no other reason than that you need to pay cash for the procedure. At our hospital the average is $150-250, depending on the doctor.

Catalystik noted above that it reduces the risk of STD and bacterial infection. However, one could argue that condoms offer greater protection against such diseases and require no surgical intervention.

When every baby in the nursery is going home to a 23 year old unemployed mother of seven with a tattoo on her face it's REALLY hard to convince yourself that, down the line, that kid is going to use condoms regularly.
 
"Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In the case of circumcision, in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. It is legitimate for parents to take into account cultural, religious, and ethnic traditions, in addition to the medical factors, when making this decision. Analgesia is safe and effective in reducing the procedural pain associated with circumcision; therefore, if a decision for circumcision is made, procedural analgesia should be provided. If circumcision is performed in the newborn period, it should only be done on infants who are stable and healthy."

You can read the entire policy statement here.

Sidenote - I've heard some pretty unsettling stories of men, including elderly men, having to be circumcised later in life thanks to things like phimosis, and I get the impression (as I do not have a penis myself) that is a much more traumatic procedure later in life.

Read post 23 by GeekChick.

I did read it and highlighted the the part that proves my point.

Never did I recommend routine circumcision. I said there are medical benefits and cultural/social factors. Due to this, the parents can elect whether or not they want to circumsize their child.

You as the doctor can tell them the risks (minimal) and benefits (arguably minimal but still there and then cultural/social factors play a role). But you cannot make that decision to circumsize for them. I disagree with the people on this board that say you can or say they would refuse to perform the procedure.
 
Personally I wouldn't. Let the guy decide later on in life if he wants his D chopped off.
 
I did read it and highlighted the the part that proves my point.

Never did I recommend routine circumcision. I said there are medical benefits and cultural/social factors. Due to this, the parents can elect whether or not they want to circumsize their child.

You as the doctor can tell them the risks (minimal) and benefits (arguably minimal but still there and then cultural/social factors play a role). But you cannot make that decision to circumsize for them. I disagree with the people on this board that say you can or say they would refuse to perform the procedure.
I was just about to post something like this, but you worded it better than I think I would have. I agree completely.
 
Wow, this thread is PROFOUNDLY irritating.

To see so many people make claims about how circumcision is "awful" without having the FIRST IDEA of how the procedure is even actually PERFORMED, is really annoying.

No, I would not. I don't believe in the benefits of circumcision, nor do I agree with the procedure itself (i.e. no analgesic). To me, it makes absolutely no sense to cut off a part of a newborn's genitals, no matter how many studies you can cite showing reduced transmission/infection of or by blah blah.

Let me make this very clear. Circumcisions ARE done with analgesia!!! It's a local injection of lidocaine AROUND the base of the shaft (not IN the penis itself) for a penile block. It's not a topical medication.

And for those who say that "lidocaine is weak sauce" 🙄, it's not. It's the same stuff I'd inject in you to suture you up after a laceration. It's similar to the stuff that dentists use before working on your teeth.

Yes, babies cry during circs. That being said, most of the reason why they're crying is because they are cold, and being prodded/poked when they'd rather be asleep. Once you cover them up, inject the lidocaine, and pop a pacifier in their mouth (with or without the sugar syrup), they quiet down.

Being that I don't want to be a surgeon.. no :laugh:... Actually a slightly off topic question... what type of doctor preforms circumcisions? Pediatric surgeons? Urologists? Or just straight up pediatricians?

In the north east, OB/gyns and Family Medicine does circumcisions.

In other parts of the country, it's pediatricians and Family Medicine.

Urology only does the circ if the penis is abnormal (i.e. the urethral opening is in an unusual location).

How old are Jewish boys when they get cut? like 7 or 13 or something?

No, they're usually a few days old.

No. I wouldn't. And I won't have my children snipped either. They can make that decision themselves.

No, no, no, no, no. Circumcisions become a HUGE deal for anyone past the newborn stage. Newborns heal up from the circ on their own. It's a very routine procedure.

Anyone past the newborn stage? REQUIRES SUTURES. The remaining piece of foreskin will not heal and re-attach to the skin without being sutured in place.

A urologist once told me that the BEST time to circumcise a child is at birth. Anything past that requires GENERAL anesthesia (I guess you could do a spinal, though), an OR, and suturing the remaining foreskin back to the shaft.

And I would not say that there is no benefit to circumcision. If you've ever had a patient come to your office or the ER with phimosis (or, worse PARAphimosis :scared:), you will see the benefits to circumcision!

I've heard such stories as well, but I'm wondering whether it is just as painful experience for a newborn, but their lack of memory surrounding the event prohibits it from being traumatic.

Like I said, I've had babies contentedly lie back, sucking on the pacifier, while I did their circ. A good penile block is all that you need.
 
whaaaa? for real?

lidocaine is weak sauce. if its topical, its not doing a damn thing. and if its injected (sweet, shot in the wang) than its probably more to control bleeding.

There is a reason babies cry during/after circ.

:scared: OH MY GOD.

If you are injecting lidocaine "in the wang" to "control bleeding", then you're using lidocaine with epinephrine. The epinephrine is what controls the bleeding, not the lidocaine.

You do not want to inject the penis with anything containing epinephrine. The reason why the epi controls bleeding is that it clamps down the vessels in the area where it's been injected. That's fine for, say, a forearm. In the penis (along with the fingers, toes, nosetip, and earlobe) there is a risk of necrosis. It's probably more of a theoretical risk, but, to be safe, you shouldn't inject lido with epi in the penis, of all places.

Please stop conjecturing and assuming about things that you clearly do not know anything about.

Babies cry after the circ because they're uncovered and cold. Once you cover them up, tickle their chin, and make sure they're warm, they stop crying.

When every baby in the nursery is going home to a 23 year old unemployed mother of seven with a tattoo on her face it's REALLY hard to convince yourself that, down the line, that kid is going to use condoms regularly.

:laugh::laugh:
 
I did read it and highlighted the the part that proves my point.
Does it not also prove my point? I am aruging against it because there is lack of sufficient and consistent evidence that proves its of any real benefit.
I said there are medical benefits and cultural/social factors.
And I said there are medical risks. Are you really going to routinely perform a procedure in which the overall risk outweighs any benefit because its socially favorable?
You as the doctor can tell them the risks (minimal) and benefits (arguably minimal but still there and then cultural/social factors play a role). But you cannot make that decision to circumsize for them.
The risks are just as great as the benefits (if not more). You keep trying to down play the risks because you obviously are pro circumcision. That's not being unbiased and its a disservice to your patients.
I disagree with the people on this board that say you can or say they would refuse to perform the procedure.
perhaps people on this board don't agree with performing a procedure that isn't medically indicated? You argue earlier that doctors cannot make the decision to circumsize independent of the parents and here you are saying that doctors shouldn't be allowed to refuse. In other words, parents can force the doctor to perform a procedure that is not shown to be of any medical need. Makes perfect sense. 😕
 
Top