queries about circumcision

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Posted by: Purple | 2012/08/08

Q. queries about circumcision

Hi Doctor,

Would you be so kind as to provide some clarity with regard to cleaning of a baby''s penis when they are circumcised and uncircumcised.

In response to a question where a mom asked about retracting the foreskin, where you answered it wasn''t necessary, someone has posted some information that I''''ve understood has been discredited medically - about the single study on lowered rates of transmission of HIV in circumcised males. What I''ve read on Science Based Medicine and other reliable sites is that this study wasn''t the final say as confounding factors weren''t taken into consideration.

Also, my understanding was that until the foreskin fully detaches that the penis is self cleaning and doesn''t need any special care and that tearing the foreskin off forcibly can lead to infections and requiring circumcision for medical reasons.

I know there are some medical conditions that require circumicision and some religions that require it, and that furthermore its parents choice, but it would be really nice to have a sound medical opinion on what the various studies tell us.

There is a bit of a debate raging and I was accused of being an " intactivist" . Lol. I''m so mainstream I nearly choked on my tea.

My son is uncircumcised as my husband and I felt that as we are atheist we had no cultural reason for doing so. If he doesn''t like it he can lop it off later. His pre-primary teacher told me that it was about half and half in the class (I asked as he told me some boys willies were funny).

As us mums don''t actually know anything about penis care before we have boys, it would be really nice to know how to care for both options. I think there are lots of people who want to ask, but those of us in the middle ground do get a bit scared because of the two extremes who tend to type up nasty messages in response - those who think nobody should ever be circumcised and those who feel that the foreskin should always be removed because its dirty and causes problems.

Thanks so much.
Purple

All Experts Paediatrician

Expert's Reply

A.

Paediatrician

You are correct, there is no need to push back a baby boy's foreskin when bathing him. As for circumcision this is only recommended for definite medical reasons such as repeated infections known as 'phymosis' or a small opening due to a tight foreskin that causes the baby to have difficulty in passing urine.The AIDs issue is not a factor in deciding about circumcison in infants. You have already mentioned the religious reasons.

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C.

Posted by: David | 2012/08/20

My husband was ciucsmcired six months after we got married due to my yeast infections. I had never had yeast infections or any other problems until we got married. My Ob/Gyn recommended that he be checked and get ciucsmcired. I also experienced a couple of bad pap smears which showed cervical dysplasia which is a condition in which the cells of the inner lining of the cervix have precancerous changes before my husband was ciucsmcired. After his circumcision have not experienced any other problems and he was ciucsmcired 25 years ago.Before my husband was ciucsmcired, he had an excessive amount of foreskin which resulted in some problems for us. During sex, there was so much foreskin that glans stayed covered, creating frustration and not much feeling for me. This situation had a negative impact on our sexual relationship.Since my husband has been ciucsmcired his penis is cleaner, and is more aesthetically pleasing. The glans on his penis is permanently externalized and exposed the appearance of the skin looks better, and I find the penis more attractive. I feel increased internal stimulation, the entire glans and, particularly the rim during intercourse. I am also able to feel the full length of his penile thrusts without loose foreskin impeding my pleasure. His circumcision ultimately gives me more sexual pleasure and helps me to achieve orgasm more easily. This procedure has definitely improved our sexual experience. In my opinion, the circumcision has been a vast improvement in every way.I love my husband''s ciucsmcired penis and think that all males should be ciucsmcired at birth. Based on my experience I feel women should be the strongest advocates for universal male circumcision.

Reply to David

Posted by: Nella | 2012/08/14

Purple, I have a son that had to be circumcised at 3 and switched doctors due to him not recommending or wanting my son circumcised due to phimosis. After 6 months of fighting with the doctor, we changed doctors and the new one recommended a urologist on the very first visit who circumcised him within a few days. My regret is not following my gut to have it done when my son was born. My husband was circumcised as a teenager with the same problem as my son, but it was not recommended and we believed like you to let him make his own decision. We are expecting another little boy in a month and he will be circumcised at birth. The more I questioned my friends regarding penis problems I found out that at least 5 of my friend''s husbands or sons had some form of penis issues where 3 had to get circumcised of which one was an emergency op. Foreskin problems are not reported in any statistics the way newborn circumcisions are and per the urologist who circed my son, he stated that he is doing as many as 10-12 circumcisions due to some or other issues a month. Clearly foreskins are not nearly as trouble free as we would want them to be.

The nurse''s comments above made me realize yet again, that circumcision has way more benefits than keeping a foreskin

Reply to Nella

Posted by: AJ | 2012/08/14

Purple, I too abhor stupid short sighted people who twist facts and then make real stupid statements that only select some facts to suit their outlook. You may not come across as an extremest, but you are quick to put someone down that has a different perspective from your own. Based on your statement, I am going to assume that you have never had firsthand experience with a circumcised penis. Am I right? Its very ironic that women that have experienced both normally are way less critical one way or the other, but are also sensitive to what they say in front of their husbands based on his circumcision status. Once you''ve had experience with both, done some homework on the pro and cons of both, you may have a very different outlook. Having worked in a lab where we used newly circumcised foreskins to determine exactly how the HIV virus enters into the inner foreskin, really opened up my eyes on circumcision.

So let see, can you with 100% clarification ensure that your uncircumcised boy will always practice safe sex his entire life??????? I dont believe so. Just knowing HOW HIV enters and where it enters the male penis - specifically through the inner foreskin that covers the glans - is enough to make me think real hard regarding circumcision. So as a parent, you would consider ways to keep your son as safe as you possibly can where you have control. Unless your son is a real mama''s boy, you will not control who he sleeps with or when. Girls can lie just as much as men can about their sexual health when horny. If your son is a mama''s boy then no girl should marry him, because he will never be able to satisfy two women in his life at the same time. Blunt, but a fact.

So what Anon said that I dont think you understood is that his doctor was hell bent on him not getting circumcised at any cost. Anon was the one suffering, not the doctor. The doctor was pushing his own beliefs on a patient, not using his medical background to advise an alternative treatment or solution to the problem. There I would too would have called the doctor an intactivist because he failed in his medical duties to prevent pain, damage and problems for his patient knowing what needed to be done the first time. As a nurse, I have seen firsthand what uncircumcised boys and men go through with foreskin problems. Old men that battle diabetes have it the worst if they have to be circumcised at that time of their lives. It is very unpleasant and very painful not even to mention the time involved that it takes to heal (if ever in some cases).

Having experienced both circumcised and uncircumcised men in my life and being a caregiver to both as well in my career, I highly recommend circumcision for lifelong health issues. Stop for one moment and think about your son having to go through what Anon went through. Dont think that it will not leave him with emotional scars. While I am willing to guess that Anon clearly has some himself, he views the final outcome as positive. By making the statement of your son''s foreskin, if he doesn''t like it he can lop it off later is a cop out of you being a parent. Yes thats right, push the responsibility to him. Did you do the same regarding his vaccinations? Why not, they too have a lifelong effect on his health.

My husband was not circumcised when we got married. While having no problems himself, he heard too many of my horror stories in the ER, hospital and geriatric care of men that were unable to care for themselves due to health related situations such as strokes, diabetes etc, where he made the decision to have it done while he was still in his 20s after we were married. He was present when our sons were circumcised and explained why we had it done. Both our sons were thankful that we as parents made that decision for them and did not have them go through what their father went though, which was very painful and a lengthy healing period of about 6-8 weeks as compared to about 5-8 days when done as a newborn not to mention the cost difference either.

As for that friend of yours who now has once circumcised son, he is the lucky one in the long run from a health perspective with probably little or no side effects. As a mom, I am proud that both my sons are circumcised and would recommend any parent think through all the facts, not just the one that suit us and make a decision. Yes there is cost involved, but that cost is nothing compared to a life long sentence of being HIV infected or having some other STD that potentially could have been prevented by a man being circumcised. Yes I have been challenged by many intactivists over my years of being a nurse. Almost all of them ignore the facts, research, medical and scientific evidence when challenged, which I have challenged them on frequently and will continue to do so. They have a real tough time with facts and common sense unless it suites their selected beliefs.

Reply to AJ

Posted by: Purple | 2012/08/14

It sounds like you had a clear medical reason for requiring a circumcision as a child.

I still fail to see evidence for routine circumcision of all boys, however, some people do and I hardly think that any form of judgement of whether someone wishes to circumcise their son or not is anyone elses business.

We didnt''circumcise and my son has not had any problems. I know someone with four boys, all uncircumcised, one developed phimosis and was circumcised at age 5, the rest remain uncircumcised and problem free.

Safe sex is still more of a preventative of STD''s than circumcision.

Reply to Purple

Posted by: Purple | 2012/08/14

Peole on either extreme of a debate are very off putting. You abhor intactivists - well those of us in the centre feel the same way about bombastic people like you as we do about the intactivists. Nobody listens to the people on either extreme.

Reply to Purple

Posted by: Anon | 2012/08/14

Ladies and moms. The intent was not to attack and I am sorry if it came across that way. The intent was to provide you information. Please see below on why you may want to still consider it. This is from the National Institutes of Health in the US where the World Health Organization actually disputed but then overwhelmingly supported their input and recommendations.

Three randomized controlled trials in sub-Saharan Africa have shown that circumcision reduces the risk of acquiring HIV infection in men by approximately 60%. In this paper, we review the evidence that male circumcision protects against infection with HIV and other sexually transmitted infections (STIs) in men and their female partners. Data from the clinical trials indicate that circumcision may be protective against genital ulcer disease, Herpes simplex type 2, Trichomonas vaginalis and human papillomavirus infection in men. No evidence exists of a protective effect against Chlamydia trachomatis or Neisseria gonorrhea. There is significant evidence that circumcision has a direct protective effect on HIV infection in women, although there is likely to be an indirect benefit, since HIV prevalence is likely to be lower in circumcised male partners. Following the publication of the clinical trial results in early 2007, the World Health Organization/UNAIDS has advised that promotion of male circumcision should be included as an additional HIV strategy for the prevention of heterosexually acquired HIV infection in men in areas of high HIV prevalence. As circumcision services are expanded in settings where resources are limited, non-physician providers including nurses will play an important role in the provision of services. It is recommended that circumcisions be performed after birth where possible to obtain maximum benefit both from a cost and health perceptive. The results are much better as well overall and healing is a few days vs. a few months for an adult circumcision. Further in this report there is additional support that addresses other benefits as well. These include: A decreased risk of urinary tract infections. Reduced risk of sexually transmitted diseases in men. Protection against penile cancer and a reduced risk of cervical cancer in female sex partners. Prevention of balanitis (inflammation of the glans) and balanoposthitis (inflammation of the glans and foreskin). Prevention of phimosis (the inability to retract the foreskin) and paraphimosis (the inability to return the foreskin to its original location).

While this does not address cleaning of an uncircumcised penis, I was not circumcised until later in life. My foreskin problems started when I was about 3 years of age when my foreskin got very narrow and urination became painful and a problem. I developed kidney and bladder infections from not being able to empty my bladder and toxins continued to accumulate in my body. At that point the doctor forcibly stretched and tore back my foreskin, found a lot of smegma built up and told my mom all things would be resolved. Fast forward to when I was a teenager. This issue had continued for years. About 4-5 times a year the doctor would stretch my foreskin and move it back as it was so tight I could not get it to budge at all. The foreskin started tearing and bleeding over time. I had scars on my glans from repeated forceps insertion and damaging the glans under my foreskin. All because this doctor was an intacitivist and stated that there was no medical reason for circumcision under any condition. Those were some of the most painful experiences I have ever had in my life. My parents could not afford having me circumcised when I was a child. Medical went by the doctor''s word. So I was stuck for a few years. Long term issues from my foreskin. Very small urinary tract, scars on my glans from the doctor''s actions and a smaller glans that was constricted from growth by a tight foreskin. Once circumcised, life has been great, sex even greater. Please rethink the long term outlook for your sons. You cant manage his sex life, but you can give him the maximum health protection known at this time, which includes having him circumcised. As a parent, we want what is best and safest for our children. My own son was circumcised at birth, without any complications and has thanked me for not leaving him with a foreskin and said it was better that I made that decision for him.

Reply to Anon

Posted by: Purple | 2012/08/08

Sorry to hear you felt so attacked Seth''s mom. I felt so too.

The world has place for so many different opinions, and so long as nothing is done to purposefully or harm or neglect - does it really matter if one parent thinks one way and another a different way.

I also felt attacked and hurt by anon''s comments and felt it would be nice to have a proper medical opinon on this. I don''t think anon read either what you posted or what I posted - as neither of us was in any way inflamatory or rude, we just shared information as parents do.

I don''t find circumcision barbaric either - but I do agree with you, ripping bakc a foreskin to clean it does sound rather barbaric.

Reply to Purple

Posted by: Seths mom | 2012/08/08

I am the one who posted about getting my son circumcized.

I was asking for a sound medical opinion which is why I am glad you have posted this Purple!

I must admit I was actually hurt by Anon comments - we did not get my son circumsized as we do not have the money, I was all set to do it when he was six weeks old (as his dad is also circumsized) but I got retrenched and we have been struggling just to keep our house.

I did not say that circumsicion itself was barbaric, I said hearing that one had to pull back the skin every day of my poor little boy would be barbaric. I personally would like to have him circumsized and I really did not appreciate the the lecture I got.

My husband and I decided that at the first sign of a medical reason we would get it done as the hospital would then not consider the operation as us just wanting it done ''for asthetic reasons'' and they would then do it for free. Other than that if he wants it done as he gets older then he has the option.

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Posted by: Purple | 2012/08/08

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