circumcision

Speaking of phimosis, this just out in Medscape Pediatric News: http://www.medscape.com/viewarticle/462893 (have to register to read, but registration is free):

Triple Incision Surgery May Avoid Circumcision for Phimosis

NEW YORK (Reuters Health) Oct 13 - Triple incision surgery is a simple, fast, and safe treatment for phimosis in children that could represent a viable alternative to circumcision, according to Austrian researchers.

BJU Int 2003;92:459-462.

(link for the whole text, but basically, three incisions, no more phimosis, high degree of satisfaction with the results.)

I was circumsized as an infant. My paternal grandfather was circumsized as an adult, and reported that sex was better afterward.

This seems like a decent reason to me, though this may fall into the family history category rather than a general case.

:rolleyes: Noooo. I’m comparing the arguments.

It’s even more ridiculous than that. How many infants do you know that ‘look like Dad’? I’d say that if they do either junior is remarkably mature for his age or Dad is medically unlikely to be Dad at all. :slight_smile:

"Dorothy stepped slowly from her house, blinking against the light and the bright colors outside.

"She saw a trio of small men cowering behind a nearby bush. As she decided how she should greet them, they suddenly stepped out with astonished expressions. Then, to Dorothy’s surprise, they jumped up and down, clapping and laughing.

"‘My goodness,’ she said to herself. ‘What are you celebrating?’

"‘You have killed him!’ they crowed. ‘You have freed us!’ And then they pulled out tall pink hats and plopped them on their tiny heads, and danced in circles.

"‘What?’ said Dorothy. ‘I haven’t killed anybody.’

"The small men pointed at her house. Dorothy looked, and saw that at the bottom edge of the house, where it had landed in the bright green grass, a large ugly penis protruded from underneath.

"‘Oh no!’ she said. ‘Who is that?’

“‘The tyrant of these lands, the mad circumsisor, the organ-snipping fiend who has taken away our manhoods,’ said the small men, their voices suddenly solemn. ‘You have killed The Wicked Briss of the West.’”

The Foreskin of Oz by JDT

**MC ** queries:

I believe the stats quoted in my last post said that in the US “…the rate is less than 1 per 100,000 men per year” and “the number needed to treat was about 909 circumcisions to prevent a single case of invasive penile cancer.” Rare? Yes. Incredibly so? No.

And MC espouses:

Some studies say there is, some say there is not. Dr. Alexander Walker, chairman of the Department of Epidemiology at the Harvard School of Public Health, looked at studies supporting both conclusions and said “Overall, the medical literature comes down pretty strongly and pretty consistently on the side of net benefit for routine circumcision in newborns,…”. It’s simply not as “cut and dry” as you’d like to make it.

Futile Gesture and Hedra, I’ll not even respond to your “comparisons” because the logical fallicy is stunning. To address other points you raise:

F.G. remarks:

Apparently it is part of the issue for TVAA and Kris because they brought it up. I merely posted published studies that say it ain’t so.

Hedra posits correctly:

And other equally respected medical doctors and organizations do reccomend the procedure based on careful review of the research.

Look, folks, I’m not lobbying for all males to be circumcised. My only point is that intelligent people can disagree on the current data and justify their position. 12 years ago I made a decision based on the best medical information I could acquire. I do not regret the decision (nor do I regret the decision my parents made in my case). It was not made for cultural or religious reasons. It was not an abiding bias. It was a medical decision. I just get very irritated when people ignore either side of an issue in what should be a factual forum. Lay out the facts, not opinions and leaps of logic, and let the reader decide.

I take that as you having no answer to them.

But I agree with your facts. Your facts say “cut it off or wash it”. I choose wash, it just seems to be much more obvious and preferable for all parts of my body. I’m going to be in the shower anyway, you know? Besides, if foreskins were an evolutionary step good enough for the last million generations of mammals there’s got to be something useful about them, nor are they overly likely to hurt me any.

However, I agree that this is always a sore topic on the SDMB, and never, ever going to end with agreement. So dragging it out won’t achieve anything. :slight_smile:

Isn’t it interesting that after reviewing all the literature, one country (US) advocates circumcision and yet most other western countries advocate not circumcising. Isn’t this indicating a cultural norm?

Oh and BTW, I have just found a recent study in USA Today 4/10/03 indicating a reason to snip (sorry, don’t know how to link):

"The new report is based on 1,913 couples in five countries. All were married or in a stable relationship for at least six months. Half of the women had cervical cancer, and 370 of the men were circumcised. Worldwide, an estimated one in four men are circumcised.

Researchers interviewed all of the men and got samples of penile cells from 1,524. The scientists tested the samples for HPV.

After accounting for such factors as age at first intercourse and lifetime number of sexual partners, circumcised men were only about a third as likely as uncircumcised men to test positive for HPV. The authors speculate that circumcision, which involves removal of the foreskin, minimizes the area of the penis vulnerable to HPV infection.

On the whole, partners of circumcised men were about 25% less likely to have cervical cancer than partners of uncircumcised men, a difference that was not statistically significant. But among women in relationships with men at high risk for HPV, those with circumcised partners were 80% less likely to have cervical cancer.

Co-author Keerti Shah, a virologist at the Johns Hopkins Bloomberg School of Public Health in Baltimore, notes that other research suggests that circumcision also reduces men’s risk of infection with HIV, the virus that causes AIDS."

You should not consider surgery for future risky behavior that a neonate might engage in.

Besides condoms offer almost 100% less chance of contraction of HPV and HIV,this is a no brainer.

I see. You are equating, or trying to equate, cutting off something useful (feet) to possibly prevent a benign and treatable ailment (bunions) with cutting off something useless (foreskin) to possibly prevent a potentially fatal disease (cancer).

Circumcision has an estimated fatality rate of 1 per 24,000. This doesn’t include non-fatal complications, including amputation. I find it hard to believe that the reduced risk of penile cancer, if any, outweighs the additional risk of the circumcision.

fixed link.

Useless by your definition.
Some women have their labia shortened or removed,therefore are labia useless?
I can think of a lot of “useless” parts,once you start saying that there is no where to quit.

Definitely not. I’ve been circumsized for medical reasons, and it was no big deal. Beside, even if it was actually that painful, then it would be as painful for the baby, it it would be a good reason not to circumsize anybody except when medically necessary.

I watched a 39 y/o circumcised the other week because of persistent tearing of the frenulum (I’m a medical student, I was on a urology rotation, it’s all above board and non perverted, promise).
It didn’t look fun.

If you have diabetes, phimosis might just “set in”, I also saw a 69 y/o man who was recently circumcised for that reason. He was one unhappy bunny.

Ireland generally won’t circumcise for any reason except for purely medical and religious ones. Cultural reasons are starting to be taken into account, but basically, it’s not seen as a worthwhile thing to do.

And a family history of diabetes is something to consider when deciding about circumcision, as sugar in the urine is one of the main causes of inflammation of the foreskin, IIRC, meaning you might want to consider the risk of repeated problems. On the other hand, that triple-incision preputial plasty also prevents the phimosis problem without removing the foreskin. Back to the baseline again, then.

Doctor Jackson - The logical fallacy is only in using one if-then as a proof or disproof of another if-then… as PROOF. It was using it as an analogy, not evidence (sorry if that wasn’t obvious). As an analogy, can you show me how they are not the same pattern? Can you show me how removing a body part prophylactically to prevent cancer in one case is fundamentally different from removing a body part prophylactically to prevent cancer in another case, as a standard practice? There simply is no other procedure that uses that pattern, none that would be considered rational medical practice … other than female circumcision (clitoral hood only, not talking excision or enfibulation here), which has the same reasons given for performing it (cleanliness, health, culture). Do you also support that practice as medically sound? There, the example is EXACTLY functionally the same - removing a ‘useless’ part, which has similar consequences for the individual (bleeding, infection, rare long-term pain or physical/sexual consequences, even rarer death), without consent of the individual in question. Same pattern, also just fine, without consent as a ROUTINE procedure?

A lot of the argument either way is based on an opinion about whether the parts in question are ‘useful’ or ‘useless’ - that is a value judgement on the part of the parents/adults/specialists. It has nothing to do with whether the parts have a function (which both do, even if we generally survive quite well without them), it has to do with how you esteem the parts (and the function), yourself.

The fact that no western (and few other) medical body(ies) considers routine prophylactic removal of any body part for prevention of cancer (or infection) a normal reaction in any other disease process makes the circumcision argument ‘for preventing cancer’ rather weak, IMHO. (Can you come up with one example otherwise? I couldn’t.) Especially when national cancer associations consider it an inappropriate prophylaxis, too. There isn’t any other routine procedure for infection prevention, either, that requires surgical intervention as a routine practice. That makes me wonder about the logical fallacies involved in promoting routine infant circumcision, myself.

BTW, I have absolutely no problem with individual people reviewing the research and deciding what is important to them, rationally and scientifically. And yes, that means that some people will chose other than what is recommended by the specialists, because they have specific concerns that are weighted differently (through personal experience, fear/anxiety, family history, or plain old ick-factor) than the weightings used by the ‘experts’. They may still make the decision based on factors that the child in question later finds apalling, but they are at least making a considered, informed decision. Quite honestly, I’ve never been horrified at someone making an informed decision, even if I’d tend the other direction, and I have provided research links for several friends to help them make up their own minds - some chose one way, others the other, based on what they considered risks they were willing to live with personally. I am puzzled by the ‘look like dad’ reason, that’s all. Deciding on a non-routine basis that circumcision is the appropriate choice for your child is not something that disturbs me (though I do want people to follow the recommendations for pain management, and it does disturb me rather a lot if they don’t…).

As for the groups who reviewed the research one way, and the groups that reviewed the research and came to the other conclusion, for pediatric standards, I tend to go with pediatric specialists, thanks. That makes the AAP a fairly rational group to side with (and the pediatric group in Canada, and all of the ones in Europe, etc.). Of course, siding with any expert just because they are experts is a logical fallacy, too…

Dr. J, I would rather that you had stated your position as clearly the first time (that you felt that examining the research and coming to your own conclusions for your own case was a rational approach), rather than it coming off as you supporting blanket circumcision for all and providing research to back that up, as if that was the answer for everyone. That is how it came across, if you weren’t aware.

Honestly, I don’t think we’re in fundamental disagreement - I don’t think (given your later responses) that you are espousing that everyone should have it done, just that there are enough medical plusses in some areas under some conditions that considering those areas more strongly than the negative issues as an individual does not make you irrational or stupid. That’s not quite how you came across the first time, though… And I’m afraid that I also didn’t come across accurately, either, partly because I thought I was responding to someone whose base assumption was that circumcision should be a routine procedure for everyone to have done in infancy. Unless I’ve misread you twice, and that really is your position?

Back to the OP. You asked where all the circumcised folks are? They’re in the US, or they are in areas with Jewish and Muslim populations. The rest of the world considers us strange, I think. But then, many days, so do I. :wink:

Please refer to hedra’s excellent explanation on the use of analogies. It’s the art of taking an idea and extrapolating it to an extreme to make the flaws in the underlying principle more obvious.

And “useless” is your definition. What you mean is ‘possible to live without’. If a foreskin is useless so is hair, teeth, septums and earlobes, to name a few.

I think that posters need to clarify whether they are talking about circumcision preventing cancer of the penis or cervical cancer in their partners. There seems to be little evidence supporting the need for the former, whereas there is much support for the latter.

Sorry, Hedra, I thought I made it clear in my initial post that I based my decision on the advice of my child’s pediatrician, her advice as both as a doctor and a parent. My only point was that there is not a concensus among medical professionals on this issue. I only made that point because some posters went ballistic that I would dare make such a decision for my child.

Futile Gesture, I still refuse to respond to a post that equates a foreskin with a foot. And that’s all I have to say about that.

My wife loves it :D…I’m sure it compensates for the pain 30 years ago and other women have told they like a circumcised penis better.

At least in our (western ) culture female circumcision is a strawman. I know I’m not wholly consistent but…

I’m sure somewhere there is a good analogy with abortion, but I don’t want to hijack this thread.