FAQ -- circumcision

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Dave Gross

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Jan 10, 1992, 2:48:43 PM1/10/92
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The Circumcision Decision
by Dave Gross

Having a baby boy today means having to face an important decision:
Should your son be circumcised. Only 25 years ago, in the United States
anyway, it was an easy decision to make -- 95% of baby boys born in this
country were circumcised, and the operation was considered a necessity.
But then the American Academy of Pediatrics (AAP) declared circumcision
unnecessary, and today only about 60% of American boys are circumcised
at birth.

That still makes circumcision the most common surgical procedure in
the United States. Over one million baby boys were circumcised this year.
Worldwide, the practice is much less common. Only about 20% of the world's
male population is currently circumcised, and the United States is the
only nation to continue routine circumcision for other than religious
reasons.

For some parents, the choice to circumcise is a religious one. In
Jewish and Moslem custom, circumcision is evidence of a covenant with God.
Other parents have more vague reasons for deciding on circumcision for
their boys. Some believe that there are health benefits. Others want
their sons to look the same as the circumcised father. Others see the
circumcised penis as a cultural norm, and more aesthetically appealing.
Still others see circumcision as a cure for masturbation in youths or for
premature ejaculation later on in life.

In the last few years, there has been a great deal of controversy about
circumcision. About two years ago, the AAP declared that there were some
medical benefits as well as risks to circumcision. Most of this change of
policy came from studies showing lower rates of penile cancer and urinary
tract infection in circumcised men and boys. Although the AAP stopped well
short of endorsing circumcision, many people interpreted this change in
policy as an absolute reversal of the previous AAP stand. Not so, says
Donald W. Schiff, M.D., president of the AAP, "We have not reversed our
position. We've changed it a bit, but it's really just a bit."

Circumcision foes compare removing the foreskin to prevent penile
cancer or urinary tract infections in infants to pulling teeth at birth to
prevent cavities. One doctor, in a presentation to the California Medical
Association, wondered why, if circumcision was justified to prevent penile
cancer, nobody was suggesting infant breast removal in girls to prevent the
more-common breast cancer in women.

Groups opposed to circumcision warn that not only are the benefits
dubious, but the risks are very real. Edward Wallerstein, author of the
award-winning Circumcision: An American Health Fallacy, found that one in
500 circumcisions result in significant complications and that possibly 225
deaths per year can be attributed to the circumcision operation.

In one of many such horror stories, an Arizona boy has had to undergo surgery
eight times since a botched circumcision. He was awarded $1.5 million dollars
in damages last August, but it is unknown whether he will ever have normal
sexual functioning. For another boy, whose penis was completely burned off in
a 1985 circumcision accident, there is little hope of a normal sex life.

And new studies on infant pain have breathed new life into the debate over
whether even a successful operation can harm a child physically or psycho-
logically. In October, Los Angeles Times writer Ann C. Roark reported that for
many operations, including circumcision, infants are not given any pain-
killers or anesthetics. Doctors feel that the risks of giving these drugs
to infants outweigh the benefits. In addition, many doctors are skeptical
that infants do in fact feel pain, or if they do, that they remember it.

New studies challenge this view. Ann Roark quotes Dr. Myron Yaster, an
expert on pediatric pain at Johns Hopkins Medical Institutions in Baltimore,
as saying that "most adults would be shocked if they saw what was done to
children in hospitals without anesthetics. It's like roping and holding
down a steer to brand it."

Studies now show that infants do feel pain and that their bodies go
through the same sorts of changes that adults' bodies go through when they
experience pain. Circumcised boys are more irritable, eat less, have
disrupted sleeping patterns and crying patterns, and show changes in infant-
mother interaction. In addition, infants who have been anesthetized during
surgery seem to recover more quickly and have fewer post-operative
complications than those who have not.

But circumcision appears to be a dying custom in the United States. Since
the 60's, the rate of circumcision has been dropping, and insurance
companies are increasingly refusing to cover the operation. Since care of
the uncircumcised penis is simple, the only remaining reasons seem to be
custom and conformity -- this last reason diminishing in value as fewer boys
become circumcised.

And ultimately, as Dr. James L. Snyder said in a presentation to the
California Medical Association, a boy's penis is his own. "The part of the
baby we have been throwing out with the bathwater is the birthright of the
child and should not be destroyed by the collusion of physicians and
parents."


--
=-=-=-=-=-=-=-=-=-=-=-=- dgr...@polyslo.CalPoly.EDU -=-=-=-=-=-=-=-=-=-=-=-=-=-
"Some radical feminists regard rape as so heinous a crime that even
innocence should not be a defense."

Mike Oliver

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Jan 13, 1992, 11:53:27 PM1/13/92
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I'm cross-posting to sci.med in the hope of provoking comment from someone
who actually knows what he/she's talking about.

> About two years ago, the AAP declared that there were some
>medical benefits as well as risks to circumcision. Most of this change of
>policy came from studies showing lower rates of penile cancer and urinary
>tract infection in circumcised men and boys.

Now, what I remember from that time frame (I don't know whether from the
AAP or not) was evidence of lower rates of cervical cancer in the sexual
partners of circumcised men. Cervical cancer is a much more serious problem,
because it's more common, shows up younger, and is much more likely to
be lethal. Of course penile cancer is a horrible thought, but I believe
that it's quite rare and that even if you get it you have a pretty good
chance of keeping not only your life but most of your penis. (Sci.med,
correct me if I'm wrong, this is just my general vague impression.)
I suppose this would depend on early detection, but for obvious reasons
that should be easy.

The theory, if I remember correctly, was that uncircumcised men were
more susceptible to HPV infection because of the constant moistness of
the tissues (NOT because of "poor hygiene").

If this is in fact true, then the issues are perhaps even more complicated
than if it's purely for the boy's benefit. One would hope that one's
son would see value in not giving others cancer, but one might still
be reluctant to make that decision for him. It seems to depend on
many things to which I don't know the answer, for example:

How late could one wait to do it, and still get the
benefit? I.e. is there any significant chance that
a boy would be exposed to a carcinogenic serotype
of HPV before beginning socio-sexual activity? (For
example, the common wart viruses found on people's
hands, are they dangerous?)

--
------------------------------------------------------------------
Mike Oliver
UUCP:...!{ucbvax,{hao!cepu}}!ucla-cs!math.ucla.edu!oliver
ARPA: oli...@math.ucla.edu

Charles Herrick

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Jan 14, 1992, 12:59:00 PM1/14/92
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Mike Oliver writes
* I'm cross-posting to sci.med in the hope of provoking comment from someone
* who actually knows what he/she's talking about.
[...]
* How late could one wait to do it, and still get the
* benefit?

A friend of mine is a professor at a University, and recently underwent surgery
for circumcision.

Chuck Herrick

Jim Haynes

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Jan 14, 1992, 6:49:39 PM1/14/92
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In article <1992Jan14....@math.ucla.edu> oli...@oak.math.ucla.edu (Mike Oliver) writes:
> How late could one wait to do it, and still get the
> benefit?
The current belief is that infant circumcision significantly reduces the
incidence of urinary tract infection in baby boys. This is the reason
the pediatricians' academy changed its position from "no medical reason"
to "some medical benefits". [quotes are very approximate]

After that age most boys/men who were not circumcised as infants will
get along all right without it; but some 5 or 10 percent (and 75% of
all statistics are made up) will have/devlop conditions for which
circumcision is necessary or at least highly advisable. The urologists,
tend to be more strongly pro-circumcision than the pediatricians because
urologists see all the cases where problems would have been prevented if
circumcision had been done earlier. These range from simple things like
recurrent infections or painful erections to incurable cancer because a
man could not or would not clean beneath his foreskin and didn't notice
anything wrong until the cancer had spread. Or the simple but emergency
situation where the foreskin is retracted but is too tight to get back
down, resulting in swelling and pain and need for immediate medical help.

So it's very controversial whether to circumcise in infancy when the need
is not apparent, or wait and see if it's needed, knowing that it probably
won't be, but if it is it will be more serious and costly and frightening
and memorably painful. Outside of the cases where it's clearly needed
I don't believe there is clear agreement that it does or does not help to
prevent cervical cancer or transmission of other diseases. Then there
are all the nonmedical controversies, such as whether it's important for
a boy to resemble his father or his peers, or whether the foreskin is
an important contributor to the enjoyment of sex. Perfectly reasonable
people can and do disagree. And then for some reason this seems to be
a controversy that often gets beyond the bounds of reasonable disagreement,
with partisans screaming at each other and throwing horror stories around.
--
hay...@cats.ucsc.edu
hay...@cats.bitnet

"Any clod can have the facts, but having opinions is an Art."
Charles McCabe, San Francisco Chronicle

D. C. Sessions

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Jan 14, 1992, 5:59:12 PM1/14/92
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For a supposed FAQ file entry, this sure was one-sided. I don't want
to start the flamewar again, but could we at least leave the pseudo-
FAQhood out?
--
| The above opinions may not be original, but they are mine and mine alone. |
| "While it may not be for you to complete the task, |
| neither are you free to refrain from it." -- R. Tarfon |
+-=-=- (I wish _this_ were original!) D. C. Sessions -=-=-+

Robert Hartman

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Jan 15, 1992, 12:30:55 AM1/15/92
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In article <26...@darkstar.ucsc.edu> hay...@cats.ucsc.edu (Jim Haynes) writes:
>
>In article <1992Jan14....@math.ucla.edu> oli...@oak.math.ucla.edu (Mike Oliver) writes:
>> How late could one wait to do it, and still get the
>> benefit?
>The current belief is that infant circumcision significantly reduces the
>incidence of urinary tract infection in baby boys.

A less invasive procedure is to make sure that proper cleanliness
techniques are taught to the boy's parents, and then to the boy.

>the pediatricians' academy changed its position from "no medical reason"
>to "some medical benefits". [quotes are very approximate]

>So it's very controversial whether to circumcise in infancy when the need


>is not apparent, or wait and see if it's needed, knowing that it probably
>won't be, but if it is it will be more serious and costly and frightening
>and memorably painful.

Well, there is no need for it to be painful for either an older child
or an adult. Local anasthetic is available and advisable. There is
also no reason to believe that the procedure isn't painful or
traumatic for an infant. It is. The thinking that an infant's nervous
system isn't developed enough to feel the pain has recently been
disputed by a study (sorry, can't cite it) in which babies
undergoing major surger with only local anasthesia (yes kids, that
has been the established medical practice) fared worse than infants
who were given a general anasthetic. A much higher pecentage of
those who weren't given a general anasthetic died, apparently
from the trauma and resulting shock.

I see no reason to perpetuate such a barbaric custom. Routine
circumcision is no way to greet a new a human being into this world.
And they wonder why men can be so emotionally brittle and prone
to sexualized violence!

I also find it unbelievable that we won't at least give crack babies
a good month before putting them into withdrawal. Can you imagine what
some of those kids are going to turn out like?

-r

timothy.d.acton

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Jan 15, 1992, 10:47:57 AM1/15/92
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Chuck,

Please follow up on this thread. I remember the question being asked
in the Circumcision Thread awhile back that we need a more objective
view on someone having the circumscision done late in life.

Is sexual sensitivity different, what does the partner think, was
the the circumcision due to health reason - despite proper hygiene?
Why did he decide to do it?

Tim Acton

Helen Cunningham

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Jan 17, 1992, 1:11:29 AM1/17/92
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This thread reminds me of a similar thread on Stanford's su-etc bboard
a few years back. At one point a contributor wrote:

"I've always read that circumcision has no negative effects on
sexual pleasure, but whoever is writing that hasn't asked any women!"

The contributor was male, but his comment prompted several women to
write that, yes, there is a difference and it is in favor of the
uncircumcised. I've since checked Masters & Johnsons' various works
on human sexuality and found no mention of this issue. Anyone out
there know anything?

-Helen


Maurice E. Suhre

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Jan 17, 1992, 8:30:29 PM1/17/92
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In article <1992Jan17.0...@leland.Stanford.EDU> he...@matia.Stanford.EDU (Helen Cunningham) writes:
=At one point a contributor wrote:
=
="I've always read that circumcision has no negative effects on
=sexual pleasure, but whoever is writing that hasn't asked any women!"
=
=The contributor was male, but his comment prompted several women to
=write that, yes, there is a difference and it is in favor of the
=uncircumcised. I've since checked Masters & Johnsons' various works
=on human sexuality and found no mention of this issue. Anyone out
=there know anything?

I don't know anything, but I got an e-mail in response to my query for
information. The lady claimed that the skin on the shaft of a
circumcised erect penis was stretched tighter than that of an
uncircumcised erect penis and hence was more abrasive during
intercourse. Said abrasion was undesirable.

Usual disclaimers and, of course, one anecdote doesn't prove anything.
--
Maurice Suhre
su...@trwrb.dsd.trw.com

Bob Waltenspiel

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Jan 20, 1992, 7:26:51 PM1/20/92
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/ hpsad:soc.men / act...@cbnewse.cb.att.com (timothy.d.acton) / 7:47 am Jan 15, 1992 /

>Please follow up on this thread. I remember the question being asked
>in the Circumcision Thread awhile back that we need a more objective
>view on someone having the circumscision done late in life.

My brother was circumcised(sp?) when he was 13. He chose to do it
then because he wanted to look more like his older brother (me) and
our dad. He had some complications when he was born and the doc's
recommended at that time to not add to his problems. When my son was
born, my brother was 22 and I asked him if he thought it was worth it
and he said it wasn't. I was leaning against it and that decided
it. My son is not circumcised.

-Bob

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