Circumcision...The Science

[JTalbain]

2. Are there negitives of circumcision? and..
3. Is infant circumcision a human rights breach?

Answer 2: Most definitely yes. Circumcision completely removes parts of the penis, changes its mechanics, and has complications which can create unintended harms as well.
A Cost-Utility Analysis of Neonatal Circumcision - Concluded that circumcision caused more harm than good based purely on medical cost-benefit analysis.
Fine-touch pressure thresholds in the adult penis - Sorrells - 2007 - BJU International - Wiley Online Library - Concluded that the most sensitive parts of the penis are routinely removed by circumcision, and that circumcised men are also noticeably less physically sensitive in the parts that remain than their intact counterparts.
The effect of male circumcision on sexuality - Kim - 2006 - BJU International - Wiley Online Library - Concluded that men circumcised as adults were much more likely to self-report decreased sexual pleasure, decreased masturbatory pleasure, increased masturbatory difficulty, and over 3x as likely to report a worsened sex life.
Frisch, M., Lindholm, M., and Gr�nb�k, M., "Male Circumcision and Sexual Function in Men and Women: A Survey-based, Cross-sectional Study in Denmark," International Journal of Epidemiology (2011);1�15. - Correlated sexual difficulties, including notable difficulty with achieving orgasm in both genders, with male circumcision.

Bollinger, D. and Van Howe, R. , "Alexithymia and Circumcision Trauma: A Preliminary Investigation," International Journal of Men's Health (2011);184-195 - Aside from all of the emotional stuff that people in the debate may or may not care about, the study also found that circumcised men were 4.5 times as likely to be using drugs to treat erectile dysfunction.

Taylor, J. et al., "The Prepuce: Specialized Mucosa of the Penis and Its Loss to Circumcision," BJU 77 (1996): 291�295 - Concluded that circumcision removes, on average, half of the erogenous tissue from the penis.

Lander, J. et al., "Comparison of Ring Block, Dorsal Penile Nerve Block, and Topical Anesthesia for Neonatal Circumcision," JAMA 278 (1997): 2157�2162 - Study of infant pain due to unanesthetized circumcision. States as many as 95% of babies in some parts of the US are circumcised this way. Study was halted, when it was determined the babies were choking and had difficulty breathing.

Van Howe, R., "Variability in Penile Appearance and Penile Findings: A Prospective Study," BJU 80 (1997): 776�782 - Noted more care was required for circumcised penises for 3 years post-op in young boys to prefent medical complications.

Hammond, T., "A Preliminary Poll of Men Circumcised in Infancy or Childhood," BJU 83 (1999): suppl. 1: 85�92 - A poll of circumcised men published in the British Journal of Urology describes adverse outcomes on men�s health and well-being. Findings showed wide-ranging physical, sexual, and psychological consequences. Some respondents reported prominent scarring and excessive skin loss. Sexual consequences included progressive loss of sensitivity and sexual dysfunction. Emotional distress followed the realization that they were missing a functioning part of their penis. Low-self esteem, resentment, avoidance of intimacy, and depression were also noted.

I could continue, but I think the point's kinda made there. I can post more later if need be. I'll cover Question 3 in my next post.

 

[mm_mm]

I agree that this is a problem, but this is not a problem that needs to affect the medical community. It is the job of the medical community to provide the best medical advice, not provide cultural commentary. They do not, and should not, bow down to a religious organization when presenting good science. If a religion is ordering its followers to do something that medicine has stated is hazardous to their health, either that religion will change its stance, or those followers will leave.

I agree with you as far as to say that it is the job of the medical community and to provide the best medical advice, and not provide cultural commentary. However in reality, especially when certain cultural groups are large within a society, and their practices are deemed to be medically unsafe, Medicine will often compromise and provide a service that is best for that situation, but ideally would not occur in the first place. The most glaring example I can think of in Australia is due to our growing migrant African population. A lot of these migrants are Islamic, and for some of them it is required that young girls be circumcised. There are 4 types of female circumcision, each involving more progressive removal of the female genitalia. In Australia (I am sure that examples like this happen in migrant populations all around the world, but I can only speak for Australia), backyard circumcisions of girls occur amongst these migrant groups with broken glass, knives etc used to remove the genitalia.

Now The Royal Australian New Zealand College of Obstetricians and Gynaecologists (RANZCOG) was reviewing their policy with a view to allow their doctors to perform female circumcision. This isn't because we deemed female circumcision as a necessary procedure, but rather that in order to prevent the complications associated with backyard circumcisions it would be best to perform the procedure in a safe, sterile hospital environment under anesthetic and where complications can be managed and follow-up care can be arranged. I mean people are going to do it anyway. So its not always the best medical advice, but we try to provide the best treatment for the situation. But this is an example where Medicine has bended or at least considered compromise because of a religious/cultural tradition, even though 'good science' says leave the female genitals as is in the first place.

NB/ As far as I am aware, RANZCOG decided against performing female circumcisions, however I am sure it will increasingly be talked about and done eventually as this practice continues to increase in prevalence.

I think you'll find that parents give much more thought to the idea of circumcising or not circumcising their baby then just the cost. I think beyond the cost, the main contributing factor is that many urologists in Australia refuse to circumcise infants and even some adults unless it is medically indicated ie phimosis, balanoposthitis and balanitis xerotica obliterans. This is because as you have discovered the science behind routine circumcision is dodgy, and it is a very tenuous link between the procedure and so called 'benefits'. Then of course there is the risk of litigation in any medical procedure. And the last reason I can think of, is that as a urologist there are so much more cool things you could be doing then chopping off foreskins ie removing a massive testicular hydrocele.

 

[JTalbain]

3. Is infant circumcision a human rights breach?

And finally, the issue of bioethics. I'll start off by stating my own personal observation. Most people grow up to be satisfied with their circumcision status, regardless of what it is, and the issue is whether or not people will be able to be satisfied with what they have, or at least make the choice to become so. That said....

Circumcision Status.........Circ Preference.........Result.........
Circumcised......................Circumcised................Happy
Uncircumcised...................Uncircumcised............Happy
Uncircumcised...................Circumcised................Unhappy, but can seek circumcision as adult
Circumcised......................Uncircumcised.............Unhappy, restoration can restore some, but not all, of desired status

So the only people ever truly denied what they want are circumcised men who desire otherwise. Therefore, if patient choice is at the heart of the ethics debate, then circumcision of children is unethical. This of course is only an observation for RIC, adults can choose to do whatever procedure suits their fancy.

Fairly good comprehensive argument here- NOCIRC - Informed consent One of the key points is that non-therapeutic circumcision is classified as an "elective procedure", and hence is not medically necessary. Proxy consent is intended to be heavily restricted, only applying in cases of medical need, and is not proper to be used in cases where the procedure is not urgent and the result is irreversible.

U.S. FGM Law - This is the text of the bill which makes Female Genital Mutilation illegal in the US. The reasons listed for the bill include that FGM has been shown to create physiological and psycological harm, as has male circumcision, as evidence by the numerous sources in my previous post. It is clear that the intent of the bill is to prevent harm from being inflicted on females that can't defend themselves from it or consent to the procedure. Why should such a thing be legal when it applies to males instead?

The First Amendment protects Freedom of Religion, which is one of the reasons why many say a law banning circumcision could never come to pass. However the US Supreme Court has repeatedly ruled in the past that the First Amendment only protects rights so long as they do not interfere with the rights of others. For instance, if your religion requires human sacrifice, it interferes with the rights of others to not be murdered, therefore your religion is restricted. Some restrictions are even made on the grounds of social order, for instance there is no polygamy exceptions for Mormons, despite the fact that it is part of their religion. So there is precedence for this. One of the defining interpretations of Freedom of Religion however, is that it is also freedom from the religious beliefs of others. (the human sacrifice example comes from this) Circumcision is a religious belief of Jews and Muslims, however circumcising the child in infancy or childhood forever gives them a religious branding that they were not free to choose against for themselves. Additionally, claims for necessity of circumcision are exaggerated, as neither religion has near a 100% circumcision rate, and Judaism even has an equivalent ceremony (brit shalom) which does not require cutting of the child. http://en.wikipedia.org/wiki/Brit_shalom_(naming_ceremony)

In general, there are many, many sources which can be cited to prove harm to those circumcised, and the evidence in favor of the procedure is flimsy at best. There is no major medical organization in the world which favors it (Circumcision Policy Statements) based on a review of the evidence. Human beings deserve the right to autonomy of their bodies and making such a decision violates this permanently, at no proven net gain to the male. Therefore, in the absence of favorable evidence in support of circumcision, and in the presence of overwhelming evidence against it, factoring in the fact that the choice to circumcise is irreversible and that consent of the patient is not considered, I think circumcision of infants can be deemed to be a human rights violation.

 

[JTalbain]

I think you'll find that parents give much more thought to the idea of circumcising or not circumcising their baby then just the cost. I think beyond the cost, the main contributing factor is that many urologists in Australia refuse to circumcise infants and even some adults unless it is medically indicated ie phimosis, balanoposthitis and balanitis xerotica obliterans. This is because as you have discovered the science behind routine circumcision is dodgy, and it is a very tenuous link between the procedure and so called 'benefits'.

I can't speak for the reasons behind the decision making of parents in Australia, but I can say that I've provided my advice about the subject to friends and coworkers in the past, and most of them had never even paid it a second thought. It was just assumed that, since Dad was circumcised, the baby would be too. Not one person I talked to actually knew much of anything about it, and 100% of them thought it was recommended to prevent disease. I wasn't able to convince them all, but I convinced a few. It didn't take a torrent of information to convince them, I just got them to give it some serious thought.

 

[Mastur]

Common sense should suffice.

Way too novel an idea, I'm afraid...

 

[JTalbain]

The thread has plenty of studies which speak out against circumcision. Anyone contribute anything significant speaking in favor of it?

 

[JTalbain]

Funny how none of the frequent defenders of circumcision come onto a thread that asks you to provide evidence to back up their stance. I really wish there was a formal, public debate held on the subject, because it would go about the same way. :wink:

 

[JTalbain]

A study from 2009 which was conducted in 18 different countires.
http://www.measuredhs.com/pubs/pdf/CR22/CR22.pdf

One of the key takeaways for this thread. "There appears to be no clear pattern of association between male circumcision and HIV prevalence. In 8 of 18 countries with data, as expected, HIV prevalence is lower among circumcised men, while in the remaining 10 countries HIV prevalence is higher among circumcised men."

So this study was performed after the HIV/circumcision studies. Checking their work. What did they find? No correlation whatsoever. You'd have about as good a chance at guessing whether cut or uncut populations were more infected by flipping a coin.

 

[mandoman]

And in that article is the telling paragraph:

The slide portrays a precipitous drop in circumcision, to just 32.5 percent in 2009 from 56 percent in 2006. The numbers are based on calculations by SDI Health, a company in Plymouth Meeting, Pa., that analyzes health care data; they do not include procedures outside hospitals (like most Jewish ritual circumcisions) or not reimbursed by insurance.

So that 32% doesn't include those done in hospital and paid for, nor those done outside of a hospital and ether covered or not covered.

So, parents whose insurance doesn't cover circumcision would have to pay some amount to get their son circumcised, and this would not be included in that study.

So the drop in numbers may reflect more the drop in insurance coverage than the actual drop in circ rates.

Nobody has it done in the hospital, and pays cash. They let their insurance, or Medicaid, pay for it. As usual, your content is fact free.
If you have a better way of figuring out how many American babies get circumcised than the CDC does, we'll welcome it.