Corwin

And what information do we have about any of these studies? What exactly were their criteria? Did they look at other factors? Such as condom use? How did they pick their cohort? What men exactly WERE their sample group? Notice also that while they state clearly that uncircumcised males are 12 times as likely to develop a UTI during the first year of life... (12 times jack shit, is still jack shit...) they also mention increased rates of cervical cancer.... yet they don't say what those rates are. Possibly these rates are.... unimpressive compared to one and a half million baby boys circumcised a year?

alek0

Rbochnermd,

if you look at the history of circumcision in US, you'll see that "medical benefits" have been suggested from the very begining and most of them (like circumcision preventing masturbation and thusly curing paralysis ) have been disproven. As someone has aptly described it, circumcision is a cure in search of disease.

Wiswel's article is ridicilous. Sure, by amputating foreskin you "prevent" the problem of nonretractable foreskin. Ironically, phimosis can be easily resolved by steroid creams and surgical correction without foreskin removal (see TITLE: Lateral preputioplasty for phimosis.
AUTHOR: Lane,-T-M; South,-L-M
SOURCE: J-R-Coll-Surg-Edinb. 1999 Oct; 44(5): 310-2.).

Would you care to explain why American cancer society does not recongize circumcision as a method of cancer prevention, neither for penile cancer nor cervical cancer in women?

BTW, whatever you decide to beleive in, you can always find medical studies supporting your point of view.
AUTHOR: Aynaud,-O; Piron,-D; Bijaoui,-G; Casanova,-J-M
SOURCE: BJU-Int. 1999 Jul; 84(1): 57-60.
" There was no significant difference in the incidence of HPV infection (58% vs 42%, odds ratio, OR, 1.8; 95% confidence interval, CI, 0.98-3.62) between uncircumcised and circumcised men"

Circumcision status does not increase risk of bacterial infections in women
TITLE: Bacterial vaginosis is not associated with circumcision status of the current male partner.
AUTHOR: Zenilman,-J-M; Fresia,-A; Berger,-B; McCormack,-W-M
SOURCE: Sex-Transm-Infect. 1999 Oct; 75(5): 347-8.

Concerning AIDS, there are also studies which show no association:
TITLE: The epidemiology of HIV-1 infection in urban areas, roadside settlements and rural villages in Mwanza Region, Tanzania.
AUTHOR: Barongo,-L-R; Borgdorff,-M-W; Mosha,-F-F; Nicoll,-A; Grosskurth,-H; Senkoro,-K-P; Newell,-J-N; Changalucha,-J; Klokke,-A-H; Killewo,-J-Z; et-al.
SOURCE: AIDS. 1992 Dec; 6(12): 1521-8.

Finally, I would really like to know the logic behind circumcising infants to reduce likelihood of STDs. Why not let them choose for themselves when they enter puberty?

Many of the studies concerning HIV and circumcision have been heavily criticized by other medical researches. Example:
BMJ 2000;321:1467 ( 9 December )

EDITORWhile a number of studies suggest an association between the foreskin and HIV infection, a simple tallying of studies, such as performed by Szabo and Short,1 is unscientific and misleading. Meta-analysis suggests that men engaging in high risk behaviours may be placed at further risk by having a foreskin, but in the general population circumcision status is not a significant factor. It also showed an important degree of heterogeneity between studies, calling into question the validity of the summary results.2 The multiple confounding factors influencing sexual behaviour and HIV susceptibility make it irresponsible to place blame on normal anatomy.

Langerhans' cells in the preputial mucosa are nothing new: all mucosal tissues have Langerhans' cells. Szabo and Short did not report Langerhans' cell concentrations in comparison with other mucosal tissues, their concentration in the glans, foreskin remnant, and circumcision scar in circumcised men, the presence of associated T cell infiltration (which may be necessary for viral transmission), or how findings in elderly cadavers correlate to sexually active young men. Szabo and Short state that the inner surface of the foreskin and the frenulum must be regarded as the most probable sites for viral entry of primary HIV infections in men; but without quantitative comparative data their statements are pure speculation.

The only reports of preputial Langerhans' cells have been in specimens from neonates3 and elderly cadavers. If normal genital mucosa is at risk, we need to know the concentration of Langerhans' cells in healthy men, men with multiple sexual partners, men with genital infections, men with HIV, and men of differing races and ages before any recommendations can be made.

Szabo and Short dismiss the complications of circumcision as having a low incidence; but the rate of immediate complications in the United States is between 3.1% and 9%,4 and another 5% will later develop meatal stenosis.5 A higher rate of complications is believed to follow circumcisions performed in the developing world, where circumcision has been linked to tuberculosis, tetanus, penile amputation, and death.

HIV transmission is heavily dependent on certain sexual behaviours, not anatomy. The authors have not provided any new information to alter this fact but have taken the discussion off on a needless tangent. Indiscriminate mass circumcision, which is currently popularised by some Western researchers, is unproved and does not address the core behavioural issues that have fuelled this pandemic. Therefore, it will not alter the course of AIDS in Africa.

Robert S Van Howe, doctor, department of pediatrics.
Marshfield Clinic, Lakeland Center, Minocqua, WI 54548-1390, USA vanhower@dgabby.mfldclin.edu

Christopher J Cold, doctor, department of pathology.
Marshfield Clinic, Marshfield, Wisconsin, USA

Michelle R Storms, family practitioner.
Hazelhurst, Wisconsin, USA

Competing interests: None declared.


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1. Szabo R, Short RV. How does male circumcision protect against HIV infection? BMJ 2000; 320: 1592-1594[Full Text]. (10 June.)
2. O'Farrell N, Egger M. Circumcision in men and the prevention of HIV infection: a "meta-analysis" revisited. Int J STD AIDS 2000; 11: 137-142[Medline].
3. Hussain LA, Lehner T. Comparative investigation of Langerhans' cells and potential receptors for HIV in oral, genitourinary and rectal epithelia. Immunology 1995; 85: 475-484[Medline].
4. Sutherland JM, Glueck HI, Gleser G. Hemorrhagic disease of the newborn: breast feeding as a necessary factor in the pathogenesis. Am J Dis Child 1967; 113: 524-533[Medline].
5. Van Howe RS. Variability in penile appearance and penile findings: a prospective study. Br J Urol 1997; 80: 776-782[Medline].
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If you look at the complications of circumcision, many authors obtain much higehr risk estimate than Wiswell and other pro-circumcision authors.

Take for example:
Williams N, Kapila L. Complications of circumcision. Br J Surg 1993; 80: 1231-1236

2-10% risk of complications

Complication rate as high as 55% has been claimed.

Necrotising fasciitis as a complication of circumcision has been reported:
TITLE: Necrotizing fasciitis after Plastibell circumcision.
AUTHOR: Bliss,-D-P; Healey,-P-J; Waldhausen,-J-H
SOURCE: J-Pediatr. 1997 Sep; 131(3): 459-62.

TITLE: Plastibell circumcision: a novel complication.
AUTHOR: Fisher,-R-G
SOURCE: J-Pediatr. 1998 Sep; 133(3): 468.

Gangrene after circumcision has been reported:
TITLE: Acute gangrene of the scrotum in a one month old child.
AUTHOR: Evbuomwan,-I; Aliu,-A-S
SOURCE: Trop-Geogr-Med. 1984 Sep; 36(3): 299-300.

Total loss of penis has also been reported:
TITLE: Total ablation of the penis after circumcision with electrocautery: a method of management and long-term followup.
AUTHOR: Gearhart,-J-P; Rock,-J-A
SOURCE: J-Urol. 1989 Sep; 142(3): 799-801.

And so on.... List of complications from circumcision is much longer than the risk of "potential benefits". BTW, curious how AAP statements mentions only potential benefits. Last time I looked in a dictionary, potential dud not mean anything certain or proven.

Finally, recommended reading if you speak Swedish or German:

TITLE: Rituell omskarelse av smapojkar ar barbari.
[Ritual circumcision of small boys is barbaric]
AUTHOR: Carlsson,-E; Nilsson,-G-D
SOURCE: Lakartidningen. 1998 Apr 29; 95(18): 2107-8.

[Circumcision--criticism of the routine]
AUTHOR: Stehr,-M; Schuster,-T; Dietz,-H-G; Joppich,-I
SOURCE: Klin-Padiatr. 2001 Mar-Apr; 213(2): 50-5.
JOURNAL NAME: Klinische-Padiatrie;
INTERNATIONAL STANDARD SERIAL NUMBER: 0300-8630
LANGUAGE: German; Non-English
ABSTRACT: Circumcision is one of the most frequent operative procedures done in males. About 120 circumcisions are performed every 5 minutes over the world [14]. Three different reasons lead to circumcision: 1) Medical reasons in present of a pathologic phimosis. 2) Circumcisions done due to religious, social or cultural rea-reasons. 3) Finally in many countries circumcision is performed as "routine-circumcision" in the newborn period. While in the United States the number of routine-circumcisions decreases (about 60% of all male newborns) South-Korea has a rate near to 100%. Even with no religious or cultural background in Germany circumcision often is performed without scrutinizing medical indication. Circumcision is regarded as an procedure with no complications and no disadvantage for the patient. In general circumcision has no medical benefit neither in decreasing the incidence of urinary tract infections nor of sexual transmitted diseases nor of neoplasias. Medical indication for circumcision is given in present of pathologic phimosis in 4% of all males. Postoperative complications range up to 2% and "circumcision is the amputation of the prepuce from the rest of the penis, resulting in permanent alteration of the anatomy, histology and function of the penis...". There are many reports about having discomfort and disadvantages after circumcision as well to the males as to the sexual partners. This challenge the legality of neonatal involuntary circumcision because legality is based on saving the children's best interests.

HeatherD

Breast cancer is a significant problem in the US and the risk of death is still very high.

I wonder how many people would support routine radical double mastectomies in order to greatly reduce the risk. Should a parent be able to have a child's breasts removed because of the potential risk?

The reason I bring this up is that some women who know they are at a greater risk are opting for this amputation in order to reduce the risk. At least in their case they are making the choice themselves.

Regardless of the potential benefits, the 'neonate' is in no immediate life-threatening danger. Routine circumcision of children without their consent (which they cannot give) is wrong regardless of the long term medical benefits.

Once the child is older he can be apprised of the potential benefits and decide for himself.

GunnerJ

Last time I checked, circumcision doesn't remove the WHOLE penis. Can we cut the bad analogies out, please?

Krieger

"While it is true that it is the responsibility and right of the parent (or legal guardian) to make medical decisions on behalf of their children, they are limited in those decisions. After all, parents do not have the right to decide to have the genitals of their daughters mutilated. Why they should be permitted that right when it comes to the genitals of their sons when the justificaitons for it are so flimsy is beyond me."

Its because circumcision is a religious ritual/tradition. The majority of doctors are Xians anyway, so it would not surprise me that a lot of them would support/promote the circumsion of infant boys. Even including a lot of cheesy statistics, as "evidence" of its usefulness. The same way the Creationism "scientists" promote their bible beliefs of the origins of the earth and none of us here agree with their views on that.

MrDarwin

I haven't had time to read the entire thread, but please note that I'm on your side. I'm not disagreeing with you.

My point was that men assume their circumcisions haven't caused them any harm, but they have no basis for comparison. Most men have no idea what being uncircumcised would be like because they have never experienced it (that they can remember). For the majority of men, perhaps it hasn't caused any significant harm (we can't really know, can we?) but for those who have had bad circumcisions, we know that it has caused harm, sometimes quite significant, and for me this alone is reason enough to oppose the practice.

Dr Rick

Arch Dis Child 1997;77:258-260 ( September )
Benefits of newborn circumcision: is Europe ignoring medical evidence? Edgar J Schoen

"The prevalence of true phimosis (anatomic constriction of the preputial opening, which must be distinguished from adherent foreskin) in published studies varies from 0.3% to 0.9%,5 but true phimosis requires circumcision later in life, when the procedure is more difficult, risky, and expensive. Balanoposthitis has been estimated to occur in 4% of uncircumcised boys, and incidence peaks at age 2 to 5 years.3 Although treatment can be conservative, late circumcision is often necessary for recurrent cases, and medical management requires additional physician visits and treatment."

[ February 16, 2002: Message edited by: rbochnermd ]</p>

Dr Rick

ibid

"...A meta-analysis of the nine major studies relating UTI to circumcision showed a mean 12-fold increased risk of UTI in uncircumcised boys.14 These worldwide studies indicated that between 0.9% and 4.2% of uncircumcised infant boys have a symptomatic UTI in the first year of life.14

UTI is particularly dangerous in the first months of life, during which 36% of uncircumcised boys with UTI were found to have bacteraemia, 3% to have meningitis, and 2% acute renal failure; moreover, 2% died.19 Further, most uncircumcised boys with UTI in the first six months of life show renal parenchymal damage,17 and in 10% to 15% of those aged less than 1 year, renal scarring develops, which can result in systemic hypertension."

Dr Rick

Sex Transm Dis 1994 Jul-Aug;21(4):201-10
The association between lack of male circumcision and risk for HIV infection: a review of the epidemiological data.
Moses S, Plummer FA, Bradley JE, Ndinya-Achola JO, Nagelkerke NJ, Ronald AR.
Department of Community Health, University of Nairobi, Kenya.

BACKGROUND AND OBJECTIVES: Whether male circumcision reduces the risk of acquiring human immunodeficiency virus (HIV) infection remains controversial. STUDY DESIGN: As there have now been a number of studies conducted that have examined this issue, we undertook to review their findings. Thirty epidemiological studies identified in the literature that investigated the association between male circumcision status and risk for HIV infection were reviewed. RESULTS: Eighteen cross-sectional studies from six countries reported a statistically significant association, four studies from four countries found a trend toward an association. Four studies from two countries found no association. Two prospective studies reported significant associations, as did two ecological studies. In studies in which significant associations were demonstrated, measures of increased risk ranged from 1.5 to 8.4. The groups in which positive associations were found included sexually transmitted disease (STD) clinic and hospital patients, outpatient clinic and HIV screening clinic attenders, long-distance truck drivers, and general community members. CONCLUSION: Potential sources of error, assessment of causality, implications of the findings, and future research needs are discussed. Because a substantial body of evidence links noncircumcision in men with risk for HIV infection,[emphasis added] consideration should be given to male circumcision as an intervention to reduce HIV transmission.

AIDS 1994 Jan;8(1):93-9

Sexual behavior, sexually transmitted diseases, male circumcision and risk of HIV infection among women in Nairobi, Kenya.
Hunter DJ, Maggwa BN, Mati JK, Tukei PM, Mbugua S.
Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115.
OBJECTIVE: To study risk factors for HIV infection among women in Nairobi, Kenya, as the epidemic moves beyond high-risk groups. DESIGN: A cross-sectional case-control study among women attending two peri-urban family planning clinics. METHODS: A total of 4404 women were enrolled after giving written informed consent. Information on risk factors was obtained by interview using a structured questionnaire. Blood was taken for HIV and syphilis testing, and genital specimens for gonorrhea and trichomoniasis screening. RESULTS: Two hundred and sixteen women (4.9%; 95% confidence interval, 4.3-5.5) were HIV-1-positive. Although risk of HIV was significantly increased among unmarried women and among women with multiple sex partners, most seropositive women were married and reported only a single sex partner in the last year. Women with a history or current evidence of sexually transmitted disease were at significantly increased risk; however, the prevalence of these exposures was low. Women whose husband or usual sex partner was uncircumcised had a threefold increase in risk of HIV, and this risk was present in almost all strata of potential confounding factors[emphasis added]. Only 5.2% of women reported ever having used a condom. CONCLUSIONS: These data suggest that, among women who are not in high-risk groups, risk of HIV infection is largely determined by their male partner's behavior and circumcision status. Interventions designed to change male sexual behavior are urgently needed.

[ February 16, 2002: Message edited by: rbochnermd ]</p>

Krieger

As I stated in a previous post, we should be very skeptical of these "studies" and "statistics" that are done by the medical field regarding this issue, because doctors are like 90-95% Xian in the US, unlike most other science research fields. Obviously they're going to want to make circucision look like it has real health benefits, because they're god advocated its use in their Xian bible. Its the same way Xian geologists/others and others want us to believe in their "creation story".

Aren't you glad the majority of the other science fields are not dominated by Xians?

By the way, the Europeans and Asians seem to be getting by just fine without mutilating their infants. The main places where circumcision is commonly practiced is the US and Israel.