Freethought & Rationalism Archive

Dr Rick · 09-09-2002, 04:05 PM

Quote:

Originally posted with one hand by Mark_Chid:
The main benefit of NOT being circumscised - masturbate is possible without lubrication -indeed without a foreskin I cannot imagine that masturbation is a fraction as enjoyable. I thank my parents HUGELY that they did not deny me this!

Finally, some hard evidence; something to chew upon.

This poster demonstrates the stiff resolve and unbending thoughts that leave most of us limp.

Who could possibly argue against such a sudden spurt of reasoning? Many of us are surely spent and left dripping with praise.

Rick

ybnormal · 09-09-2002, 04:27 PM

Quote:

<a href="http://www.medem.com/search/article_display.cfm?path=n:&mstr=/ZZZ6HG9QE8C.html&soc=AAP&srch_typ=NAV_SERCH" target="_blank"> AAP Circumcision Policy Statement</a>

American Academy of Pediatrics

Task Force on Circumcision

CIRCUMCISION STATUS AND UTI IN INFANT MALES

In summary, all studies that have examined the association between UTI and circumcision status show an increased risk of UTI in uncircumcised males, with the greatest risk in infants younger than 1 year of age. The magnitude of the effect varies among studies. Using numbers from the literature, one can estimate that 7 to 14 of 1000 uncircumcised male infants will develop a UTI during the first year of life, compared with 1 to 2 of 1000 circumcised male infants. Although the relative risk of UTI in uncircumcised male infants compared with circumcised male infants is increased from 4- to as much as 10-fold during the first year of life, the absolute risk of developing a UTI in an uncircumcised male infant is low (at most, ~1%).

SUMMARY AND RECOMMENDATIONS

Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision.

UTI Risk... (at most, ~1%).

Struggling to find a medical reason...

ybnormal · 09-09-2002, 04:55 PM

I know the Doc ignores all these anti-circ sites, but there's just too many to ignore.

Quote:

<a href="http://familydoctor.org/handouts/042.html" target="_blank">American Academy of Family Physicians</a>

Are there any benefits from circumcision?

Studies about the benefits of circumcision have provided conflicting results. Some studies show certain benefits, while other studies do not. The American Academy of Pediatrics (AAP) says the benefits of circumcision are not significant enough to recommend circumcision as a routine procedure and that circumcision is not medically necessary.

A recent AAP report stated that circumcision has little or no benefit in preventing urinary tract infections and penile cancer. Circumcision may reduce the risk of sexually transmitted diseases (STDs) in men. A man's sexual practices (e.g., if he uses condoms, if he has more than one partner, etc.) has more to do with STD prevention than whether or not he is circumcised.

Study results are mixed about whether circumcision may help reduce the risk of cervical cancer in female sex partners, and whether it helps prevent certain problems with the penis, such as infections and unwanted swelling. Some studies show that keeping the penis clean can help prevent these problems just as well as circumcision. Infections and unwanted swelling are not serious and can usually be easily treated if they do occur.

IF infections do occur...

alek0 · 09-09-2002, 05:29 PM

RbochnerMD,

about NEJM study - since you have quoted this study in support of circumcision, would you care to explain since there is benefit only in case of high risk behavior, how does that justify circumcising all babies?

Another question - what is your reason for ignoring studies which show that circumcision has no effect or has opposite effect?

Another question - if the RR is 0.7 with CI (0.5-1.1) how can you draw a conclusion that there is protective effect when your actual RR value can be 1.0 with 95% probability?

Another question - what estimate of circumcision complications you think is valid? AAP gives 0.2-0.3% based on 2 studies from 80s while there are a number of studies giving estimate over 1%.

Another question - why do you think that potential benefits outweigh the risks if the conditions with reduced risk are either easily treatable (UTIs, phimosis) or avoidable by lifestyle choices (STDs, HIV, HPV caused cancers) while the possible complications such as necrotizing fasciitis, amputation of a glans or entire penis etc. are not easily treatable.

Another question - since you like quoting Schoen, would you agree with him on this:

AMERICAN JOURNAL OF DISEASES IN CHILDREN, Volume 141: Page 128,
February 1987.

Sir.-- Before the mid-1980s, the American standard of care included neonatal circumcision, a minor surgical procedure that promoted genital hygiene and prevented later penile cancer as well as cervical cancer in female sexual partners. More recently, evidence has suggested that adequate hygiene is all that is needed and that circumcision is an unnecessary and traumatic procedure. In 1983, the American Academy of Pediatrics and the American College of Obstetrics and Gynecology jointly agreed that routine circumcision is not necessary,1 and third-party payers are increasingly refusing to pay for the procedure. Whether recent evidence of a decreased incidence of urinary tract infections in circumcised male infants 2 can stem the anticircumcision tide is questionable.

The purpose of this communication is to offer some solace to the generations of circumsed males who are now being told they have undergone an unnecessary and deforming procedure, which may also have been brutal and psychologically traumatic. To them I offer these lines:

Ode to the Circumcised Male

We have a new topic to heat up our passions --
the foreskin is currently top of the fashions.
If you're the new son of a Berkeley professor,
your genital skin will be greater, not lesser.
For if you've been circ'ed or are Moslem or Jewish,
you're out side the mode; you are old-ish not new-ish.
You have broken the latest society rules;
you may never get into the finest of schools.
Noncircumcised males are the "genital chic"--
if your foreskin is gone, you are now up the creek.
It's a great work of art like the statue of Venus,
if you're wearing a hat on the head of your penis.
When you gaze through a looking glass,
don't rue that you suffered a rape of your phallus.
Just hope that one day you can say with a smile
that your glans ain't passe; it will rise up in style.

Edgar J. Schoen, MD

Department of Pediatrics
Kaiser Permanente Medical Center
280 W MacArthur Blvd
Oakland, CA 94611

American Academy of Pediatrics and American College of Obstetrics and Gynecology: Guidelines for Perinatal Care. Evanston, Illinois, AAP/ACOG, 1983.

Wiswell TE, Smith FR, Bass JW: Decreased incidence of urinary tract infections in circumcised male infants. Pediatrics 1985; 75: 901-903.

Dr Rick · 09-09-2002, 07:06 PM

Quote:

Originally posted by alek0:
about NEJM study - since you have quoted this study in support of circumcision, would you care to explain since there is benefit only in case of high risk behavior, how does that justify circumcising all babies?

It doesn't, I haven't argued that it does, nor is it the only evidence that disproves your contention that here is no medical benefit to circumcision.

Quote:

Concerning NEJM study, here is an interesting quote from it:

"Male circumcision was associated with a moderate, but nonsignificant, decrease in the risk of cervical cancer in the men's female partners "

Overall the findings did not reach statistical significance with regards to the group as a whole and the risk of cervical cancer, but they were statistically significant for the risk of HPV infection and cervical cancer among partners of men with several partners.

Quote:

Another question - why do you think that potential benefits outweigh the risks

A pointless strawman attempting to draw attention away from the evidence that circumcision has medical benefits

Quote:

Another question - what is your reason for ignoring studies which show that circumcision has no effect or has opposite effect?

Another lie; I have posted responses on this thread that show that the old studies you have posted have been supplanted by more recent and better studies.

Quote:

And since the study also found that relative risk for women who had sex after age 19 is 0.84, while for those who had sex before age 18 is 0.54, Maybe we should encourage teenagers to have sex? It reduces cervical cancer risk! Isn't that marvellous?

The others posting here may not appreciate it, yet, but you and I both can both glean from the results that this specific finding was not statistically significant.

In other words, age of first sex had no significant impact on the results, no statistically valid conclusions regarding the impact one way or the other of age at first sex can be made from the study, and you are misrepresenting the data.

Quote:

those with lifetime number of sexual partners >=2 had RR 0.55 while those with only one partner had RR 0.75? So as long as partners are circumcised, we should encourage girls to have sex young and have sex with many to lower further their cancer risk? Does this make sense?

...ditto; there's no statistical difference between the two groups.

Quote:

Now lets look at the results according to characteristics of men. Men with 1-5 partners, relative risk for monogamous women is 1.4! For over 6 partners is reduced, 0.42. Sexual intercourse with prostitutes: No RR=1.39, Yes RR=0.52. Low risk sexual behavior, RR=1.61, high risk sexual behavior RR=0.50.

...and again; ditto

Quote:

So, circumcision has protective effect only in cases of large number of sexual partners and sexual intercourse with prostitues. For low risk behavior, circumcision has the opposite effect.

The study found no significantly negative impact by circumcision on low risk behavior.

Quote:

So how does this add to the welath of data supporting circumcision?

It does so more than your posts of poetry and misrepresentation of the data.

Rick

[ September 10, 2002: Message edited by: rbochnermd ]

Plebe · 09-10-2002, 01:21 AM

OPERANUT wrote: There are websites where they talk about stretching the skin over the glans and putting a weight on it....sounds painful. I have no idea if it works or not.
BTW, I have a sweet, smart, nice stud muffin already, in a stable relationship, thank you. We met at a U-U church of course. I wish he hadn't been trimmed but there is nothing I can do about it.

You can check out a website called <a href="http://www.bmeworld.com" target="_blank">http://www.bmeworld.com</a> and I find it interesting that an uncircumsized male would cause that much irritation, never noticed a difference before and even then, when fully erect, looks about like an uncircumcised! You might want to try that nice liquid stuff known as "Astroglide" and maybe a visit to your gynecologist and Dr. for a little more thorough check up than usual if this irritation has been more noticeable in the last couple of years- certain hormonal conditions-ie: low-thyroid and perimenopause [a decrease in hormones] can result in thinning and reduction in the resilience of vaginal tissue.

Ted Hoffman · 09-10-2002, 06:00 AM

Poor Rick,
See, even if statistical surveys were carried out to find out whether baptism has any effect on rates of one suffering from heart disease, there will be findings and they can be interpreted every which way.

Circumcision initially was done to save people from Gods wrath - God wanted blood, and circumcision was done to draw the blood. Then it stuck. Some silly, superstitious, useless practice stuck and now you are sitting there, an MD, telling us it has health benefits.

Exodus 4:24-26:

Quote:

24 And it came to pass by the way in the inn, that the LORD met him, and sought to kill him.
25 Then Zipporah took a sharp stone, and cut off the foreskin of her son, and cast it at his feet, and said, Surely a bloody husband art thou to me.
26 So he let him go: then she said, A bloody husband thou art, because of the circumcision.

Here, circumcision was done to save the father's life.
Did Zipporah know she was radically reducing the chances of the boy getting UTIs?

What a bunch of hokum!

[ September 10, 2002: Message edited by: Intensity ]

Mageth · 09-10-2002, 06:54 AM

ybnormal:

So, uh, you are claiming that it is NOT common procedure here, for one to provide a link to contested claims, in order for skeptics to examine more than a few well-chosen excerpts.

No. I'm claiming it's not "common procedure" to declare a study which one has not reviewed unfounded. The proper response would be to ask for links and/or more info (and Rick later posted why links weren't provided, and did post more info).

And yes, on many threads I've seen members post briefs and abstracts of articles with proper citations and recommend anyone who wishes to learn more to do a little legwork themselves.

Is that correct? And further, that it is the duty of any of the 7,000+ interested forum members to go search for evidence that supports your claim? Evidence that you claim to have at your fingertips?

Not correct. Rick originally posted title, author and publication for information to which there is no public link, and as much material from the studies as he thought necessary. Later he posted more.

Please feel free to let me know if I failed to restate your position properly

Yes, you failed.

brighid · 09-10-2002, 07:07 AM

It has been my experience that medical journal articles are not always readily available online, one must be a member of said group and pay a fee for each article (generally at the fee of $7.00 or more per article). One may find those articles in a library, and some articles are available on line. I am not sure what copywriting issues exist for those articles that one cannot link to. Therefore, it may not be possible to provide a link to said article to allow in easy review for the many posters who aren�t members of that association.

B

Mageth · 09-10-2002, 07:30 AM

Lest any of you firebrands blast me more, I'll recap what I've gleaned from this dicussion and briefly state my position on circumcision:

1) As Dr. Rick has pointed out, there is substantial evidence to back the claim that neonatal circumcision has some long-term health benefits.
2) Undoubtedly, circumcision poses some risk to the neonate.
3) There is a valid question as to whether it is moral to perform the procedure on an infant who obviously cannot give consent.
4) Stating the obvious, some have moral (read "religious") reasons for circumcision, some have no moral problem with circumcision, some do, and some are ambivalent.

At present, I'd classify myself as "ambivalent," but leaning towards thinking circumcision is not justified.

There is some parallel between the male circumcision issue and abortion, IMO. I think male circumcision, like abortion, is a moral question that is best left to the parents (who hopefully are well-informed about the pros and cons), and perhaps that is the best we can do.

Does anyone think the government should ban male circumcision? Or do you think it should be left to the parents to decide?

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09-09-2002, 05:29 PM	#204
alek0 Senior Member Join Date: Feb 2002 Location: Hong Kong Posts: 640	RbochnerMD, about NEJM study - since you have quoted this study in support of circumcision, would you care to explain since there is benefit only in case of high risk behavior, how does that justify circumcising all babies? Another question - what is your reason for ignoring studies which show that circumcision has no effect or has opposite effect? Another question - if the RR is 0.7 with CI (0.5-1.1) how can you draw a conclusion that there is protective effect when your actual RR value can be 1.0 with 95% probability? Another question - what estimate of circumcision complications you think is valid? AAP gives 0.2-0.3% based on 2 studies from 80s while there are a number of studies giving estimate over 1%. Another question - why do you think that potential benefits outweigh the risks if the conditions with reduced risk are either easily treatable (UTIs, phimosis) or avoidable by lifestyle choices (STDs, HIV, HPV caused cancers) while the possible complications such as necrotizing fasciitis, amputation of a glans or entire penis etc. are not easily treatable. Another question - since you like quoting Schoen, would you agree with him on this: AMERICAN JOURNAL OF DISEASES IN CHILDREN, Volume 141: Page 128, February 1987. Sir.-- Before the mid-1980s, the American standard of care included neonatal circumcision, a minor surgical procedure that promoted genital hygiene and prevented later penile cancer as well as cervical cancer in female sexual partners. More recently, evidence has suggested that adequate hygiene is all that is needed and that circumcision is an unnecessary and traumatic procedure. In 1983, the American Academy of Pediatrics and the American College of Obstetrics and Gynecology jointly agreed that routine circumcision is not necessary,1 and third-party payers are increasingly refusing to pay for the procedure. Whether recent evidence of a decreased incidence of urinary tract infections in circumcised male infants 2 can stem the anticircumcision tide is questionable. The purpose of this communication is to offer some solace to the generations of circumsed males who are now being told they have undergone an unnecessary and deforming procedure, which may also have been brutal and psychologically traumatic. To them I offer these lines: Ode to the Circumcised Male We have a new topic to heat up our passions -- the foreskin is currently top of the fashions. If you're the new son of a Berkeley professor, your genital skin will be greater, not lesser. For if you've been circ'ed or are Moslem or Jewish, you're out side the mode; you are old-ish not new-ish. You have broken the latest society rules; you may never get into the finest of schools. Noncircumcised males are the "genital chic"-- if your foreskin is gone, you are now up the creek. It's a great work of art like the statue of Venus, if you're wearing a hat on the head of your penis. When you gaze through a looking glass, don't rue that you suffered a rape of your phallus. Just hope that one day you can say with a smile that your glans ain't passe; it will rise up in style. Edgar J. Schoen, MD Department of Pediatrics Kaiser Permanente Medical Center 280 W MacArthur Blvd Oakland, CA 94611 American Academy of Pediatrics and American College of Obstetrics and Gynecology: Guidelines for Perinatal Care. Evanston, Illinois, AAP/ACOG, 1983. Wiswell TE, Smith FR, Bass JW: Decreased incidence of urinary tract infections in circumcised male infants. Pediatrics 1985; 75: 901-903.

09-10-2002, 01:21 AM	#206
Plebe Regular Member Join Date: Aug 2002 Location: Contra Costa County Posts: 168	OPERANUT wrote: There are websites where they talk about stretching the skin over the glans and putting a weight on it....sounds painful. I have no idea if it works or not. BTW, I have a sweet, smart, nice stud muffin already, in a stable relationship, thank you. We met at a U-U church of course. I wish he hadn't been trimmed but there is nothing I can do about it. You can check out a website called <a href="http://www.bmeworld.com" target="_blank">http://www.bmeworld.com</a> and I find it interesting that an uncircumsized male would cause that much irritation, never noticed a difference before and even then, when fully erect, looks about like an uncircumcised! You might want to try that nice liquid stuff known as "Astroglide" and maybe a visit to your gynecologist and Dr. for a little more thorough check up than usual if this irritation has been more noticeable in the last couple of years- certain hormonal conditions-ie: low-thyroid and perimenopause [a decrease in hormones] can result in thinning and reduction in the resilience of vaginal tissue.

09-10-2002, 06:54 AM	#208
Mageth Contributor Join Date: Jul 2001 Location: Deep in the heart of mother-lovin' Texas Posts: 29,689	ybnormal: So, uh, you are claiming that it is NOT common procedure here, for one to provide a link to contested claims, in order for skeptics to examine more than a few well-chosen excerpts. No. I'm claiming it's not "common procedure" to declare a study which one has not reviewed unfounded. The proper response would be to ask for links and/or more info (and Rick later posted why links weren't provided, and did post more info). And yes, on many threads I've seen members post briefs and abstracts of articles with proper citations and recommend anyone who wishes to learn more to do a little legwork themselves. Is that correct? And further, that it is the duty of any of the 7,000+ interested forum members to go search for evidence that supports your claim? Evidence that you claim to have at your fingertips? Not correct. Rick originally posted title, author and publication for information to which there is no public link, and as much material from the studies as he thought necessary. Later he posted more. Please feel free to let me know if I failed to restate your position properly Yes, you failed.

09-10-2002, 07:07 AM	#209
brighid Veteran Member Join Date: Apr 2001 Location: somewhere in the known Universe Posts: 6,993	It has been my experience that medical journal articles are not always readily available online, one must be a member of said group and pay a fee for each article (generally at the fee of $7.00 or more per article). One may find those articles in a library, and some articles are available on line. I am not sure what copywriting issues exist for those articles that one cannot link to. Therefore, it may not be possible to provide a link to said article to allow in easy review for the many posters who aren�t members of that association. B

09-10-2002, 07:30 AM	#210
Mageth Contributor Join Date: Jul 2001 Location: Deep in the heart of mother-lovin' Texas Posts: 29,689	Lest any of you firebrands blast me more, I'll recap what I've gleaned from this dicussion and briefly state my position on circumcision: 1) As Dr. Rick has pointed out, there is substantial evidence to back the claim that neonatal circumcision has some long-term health benefits. 2) Undoubtedly, circumcision poses some risk to the neonate. 3) There is a valid question as to whether it is moral to perform the procedure on an infant who obviously cannot give consent. 4) Stating the obvious, some have moral (read "religious") reasons for circumcision, some have no moral problem with circumcision, some do, and some are ambivalent. At present, I'd classify myself as "ambivalent," but leaning towards thinking circumcision is not justified. There is some parallel between the male circumcision issue and abortion, IMO. I think male circumcision, like abortion, is a moral question that is best left to the parents (who hopefully are well-informed about the pros and cons), and perhaps that is the best we can do. Does anyone think the government should ban male circumcision? Or do you think it should be left to the parents to decide?

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