Circumcision - advice sought

Great Debates
41

Allow me to put on pediatrician hat - actually its the goofy tie that does it - ah there …

There is really no particular good medical reason to get or to not get a baby circumcised. The benefits are real but very small and the risks are real and also very small. Pretty much a wash. My boys were circumcised as a matter of religious obligation but if not for that we would have opted out as my personal basic belief is that the burden of proof of benefit is on the doing rather than on the not doing. Even for a minor surgical procedure like this one.

The AIDS risk reduction is real and possibly significant given the African location albeit discretion and condoms are a much better option.

lee actually one of the small benefits of circumcision is a lower risk of UTIs.

As for effect on sexual function, we actually know very little. In general circ’ed males have a more varied sex life but that might be sociocultural selection bias. And some circ’ed adult males with sexual dysfunction blame their dysfunction on their circumcision status whereas uncirc’ed adult males with sexual dysfunction have to find something else to blame. Studies of adult males circumcised as adults for medical reasons show no consistent pattern other than lasting a bit longer.

42

I think it’s pretty horrible to make a permanent decision for him. If he truly thinks it is important, let him elect to get it once he’s old enough to decide.

43

First of all, congratulations on thinking ahead. We had the son cut because we hadn’t made a choice ahead of time. When the doctor asked it was time to make the call so I went with what I knew.

I never got the “doesn’t look like daddy” thing. I can tell you, Daddy’s thing looks nothing like son’s, cut or uncut, so that just isn’t an issue. Once he reaches age 7 or so he isn’t going to want you to see it anyway and he shouldn’t taking any close looks at yours either.

If you choose to leave him natural you will need to do some reading and talk to him about his penis - could that be a bad thing? In the end, I don’t think it’s a big deal either way. If my parents had left me intact who would have commented? One or two guys in the locker room, maybe, and the women in my life. I wish I knew those women’s opinions but during the birth of my child was the wrong time to start calling all my old girlfriends.

44

Can you explain the last sentence? What do you mean by lasting a bit longer? And also your opinion on “restoring” foreskin.

45

I’m not DSeid, but I think “lasting a bit longer” goes with less sensitivity (mentioned upthread, as one consequence of getting cut, that I’ve (anecdote!) heard from other sources as well). I don’t have any view on the restoration, although the ads on the SDMB seem to be all for it.

46

This.

As far as “restoring foreskin” I think that some men with sexual dysfunction will find something to blame, need to find something to blame, and then get fixated on fixing it. But there is no evidence that circumcision causes any sexual dysfunction and even less (if possible) that recreating a faux foreskin would resolve any dysfunction.

47

Umm, bullshit. My son was circumsized a few weeks ago and they most certainly used anesthesia, starting with a topical so he didn’t even feel the shot.

We chose to get our boy circumsized because:

-I am, and sex is still pretty intense for me
-It’s maintenance-free
-It can prevent problems down the road
-Most girls see it as the “normal”, and MANY girls are freaked out by a foreskin
-His doctor recommended it

48

I am puzzled why any parent wouldn’t get this done. The medical literature has pretty well established the benefits, and they involve fatal illnesses like cancer and AIDS, not to mention issues with UTI, skin infections and things of that nature.

My son was circumsized, and they used anesthesia as described above. It was no big deal at all. And honestly, if they were able to demonstrate that hitting my baby in the head with a stick would help to prevent a possible fatal illness down the road, I’d do that as well. Better a few minutes of discomfort than a few rounds of chemo.

49

My personal feeling is that if my hypothetical kids want to join some tribe who are all circumcised, then they can. I’m not wedded to such a Semitic religious identity, so it seems to me like wearing a cross without being a Christian. A cross you can’t take off. Even though no one can see it under my clothes.

That said, if you don’t snip 'em, expect that you’ll have to teach them a more fastidious & involved cleaning regimen than you’ve ever needed yourself. And they gotta keep that foreskin stretched out so it doesn’t turn constrictive in adulthood.

50

."…suggest that circumcision reduces a man’s risk by as much as 65 percent."
(from a quote above, sorry I don’t know how to code it)

I’ve always wondered just how stats like this are measured and what they mean.

Does it mean that for every 100 uncircumcised men catch aids, only 35 circumcised do?

Or does it mean that if 200 men, (100 cut, 100 uncut) sleep with an HIV positive lady (for simplicity won’t look at anything else), all 100 uncut would get HIV, while only 35 cut would?

It always seems to me that figures like this are used as somewhat scare tactics.

I am uncut, in a monogamous and committed relationship. My chances of catching HIV (absent any other factors) are basically neglible (maybe 0.01%?) a 65% reduction of 0.01% doesn’t matter to me.

Even if I was talented and attractive enough to play the field, I know enough to use condoms. So if you worked it out, in a random selection maybe 1 in 3 chance of “choosing” a woman with HIV, of that maybe 1 5% chance of condom failure, of that maybe 1 in 2 chance of actually being infect. Reducing the resultant chance of infection by 65% doesn’t matter too much.

What I am trying to say is that you focus on the top line risks with things like STDs, this is how you keep yourself safe - cut or uncut is not gonna make any (measurable to an individual) difference if you are engaging in risky behaviour.

To those that talk about penile cancer and UTI, I would just say that you be very careful to do a close comparison between the incidence and impact of this vs the incidence and impact of botched circumcisions. As already mentioned (by a doctor) it is pretty much statistically a wash.

And BTW - the canard about having ladies prefer a cut one. What about all those european women, they don’t have sex? This idea is (to me) pure ignorance and a case of simple familiarity. There have been cases mentioned on this board where the lady didn’t even realise her hubby was cut.

51

http://www.cdc.gov/hiv/resources/factsheets/circumcision.htm

That’s a direct link to the CDC that discusses the studies on the subject.

52

Do you have a daughter? You can opt to have both her breasts removed and reduce her risk of breast cancer to zero. And lemme tell ya breast cancer is many times more common than the increased risk of AIDS, penile cancer, male UTI, or other things of that nature. No? Why not?

The benefits and the risks are both pretty well established, both tiny, and getting it done and not getting it done are both rational decisions.

53

Thanks - I will take a look at this out of interest.

Although I was also speaking of similiar studies in general. Not just for aids circumcision, but we often hear such things bandied about a lot. Such as: eating pumpkin increases the risk of catching dengue in minnesota by 50%. And then we find that you chances of catching dengue in minnesota are 1 in 25,000. So by eating pumpkin your personal risk goes from like 1 in 25,000 to 1 in 17,000. The overall point being is that studies like to throw around scary figures, but we should be careful to understand the mathematics behind what is being said…

54

Completely different cost:benefit ratio there. On the other hand, if I could have a small piece of her breast removed which would completely eliminate her risk of breast cancer and have a negligible effect on its function as a breast (perhaps even making it easier to care for), I’d be all over that.

I agree though that, in the case of circumcision, both decisions are rational and it’s six of one vs a half dozen of the other.

55

Jophiel I apologize if my point was unclear. Sateryn76 was stating that since there is a benefit that it is a no brainer choice without any consideration of how big or small the benefit and how big the potential cost.

For sure the benefits and costs are bigger for elective mastectomy: 12% of all women get breast cancer and it is the cause of death in 3% of all women. Penile cancer OTOH is so rare as to be well nigh unmeasurable, about 1/1000th of the breast cancer rate (yes, in uncircumcised males). Yeah, a more invasive step but a much much bigger benefit … the actual ratio may be similar … yet there are few who would elective subject their newborn girls to elective removal of their prepubescent breast tissue - even if they were BRCA + which translates to an extremely high probability of developing breast cancer later in life. Knowing that there is a benefit isn’t enough in the absence of understanding the cost/risk and the magnitude of each side of that equation.

56

No, you misunderstand me. What I was trying to say is that I don’t understand why people feel so strongly about not circumsizing their boys, because the cost of the procedure is so small compared to the potential costs of the future illness.

Could someone explain to me why you wouldn’t get the circumsizing done? I think the pain factor is moot, since anesthesia is used regularly. Is it some kind of issue with the “earthy-ness” of that little flap of skin?

57

Both my boys are circumcised even though I’m not sure that I should have had it done. My thinking at the time is that I knew a few parents whose sons had to have it done later, one adult who had to have it done and a relative who remembers having it done at the age of 6. They all said it was horrible and they wish they had been circumcised as infants.

Also, seeing how well boys keep up with hygiene in general (can’t find his toothbrush 2 weeks after camp because he didn’t unpack it yet?) I am thinking it was a good idea. I can’t imagine nagging an older child/ teen to keep up with his foreskin maintenance I still feel somewhat guilty though and can’t imagine how I would feel if something had gone wrong.

58

Potential loss of sensitivity (minor reason), inflicting unnecessary surgery on a child unable to make an informed decision for himself (major reason), combined with the fact that the increased risks you mention are extremely small. (Also, as I believe someone said up-thread, uncircumcised men appear to actually have decreased risk of UTIs, so you can strike that one from your list. )

I wouldn’t cut off my child’s earlobes to reduce his risk of earlobe cancer by .1%, either. Or his pinky toe, or any other body parts deemed to be unnecessary. Besides which, the accounts of men who are uncircumcised themselves, and of men who were circumcised when they were old enough to remember the difference, leave me convinced that the foreskin does serve a purpose. I believe that I would not care to slice off a sensitive portion of my own genitalia, even if it left the genitalia still able to perform its basic function. So I chose not to do it to my sons, and MrWhatsit concurred.

Since you asked. :slight_smile:

59

Because the benefit is about as small as the cost. Penile cancer? Again one of the rarest of all cancers. AIDS risk reduction? Maybe significant for an African population but in North America less so and again no substitute for the much more effective tactic of discretion and condoms. Prevention of male UTIs? Very few males get UTIs in any case and doing many surgical procedures to possibly save having an episode of antibiotic use once or twice seems extreme. Avoiding the more psychologically traumatic experience of having it done later if there are later episodes of balanitis or if there is phimosis? Yeah there is that, but also a smallish benefit.

OTOH, the cost is also small but real. Anesthesia prevents pain during the procedure but the most common one used, a dorsal penile nerve block, involves two injections of anesthetic at the base of the penis, which hurts some too. (I have to admit that I’ve been impressed how well the traditional bris technique of sucking on sweet wine works. Especially if the child has been well fed immediately before the procedure.) There are very rare surgical complications, infections, excess bleeding, etc. There is the dollars and cents involved too.

Again the balance is hard to measure as each side of the equation is so slight, so it boils down to what you default to - and my take is to default to the not doing unless the balance of evidence is clear that a net benefit gained - or if there is a sociocultural reason such as the religious obligation for my boys. But either choice is valid.

All that said, I also do not understand why some feel so strongly about this. In past threads we have those come along who argue that circumcision is genital mutilation and should be outlawed.

60

Yes, I want to make clear that I am absolutely not in the “you are mutilating your child if you choose circumcision!!!” anti-circ camp. I saw someone the other day with an anti-circ bumper sticker, for crying out loud. Do what y’all want to do. I will explain my position on the topic when asked to do so, but otherwise try to stay out of the heated debates.