What
and why?
Soo, here I am going to look
at the medical side of circumcision, however, this will be done
differently then what is more traditionally done on pro/anti circ
pages. Yea, people love to throw out percentages and numbers,
but there are so many contradicting studies that it is hard for
people to decide which ones are accurate, if any. Breaking down
the studies and analyzing piece by piece isn't for me anyways,
I'm not that ambitious. Don't get me wrong, I will still reference
studies, but instead of arguing merits or methodology of specific
studies, I am going to look at this in a more "what if"
type of way. What if this is true, what if this is false, what
if its somewhere in the middle, etc.
Be
wary when looking for information because of the contradicting
studies, but not only that, some sites will display the information
in ways that best support their "cause". By this I don't
simply mean by their choice of words, "that benefit is HUGE!",
"there is risk, but less if the doctor is competent",
"the study was done by someone strongly for/against",
the last one is kinda funny actually..... someone will to do a
study will probably have some bias, which is why you have to look
at how the study was done, not just dismiss it because it wasn't
done by "your people". But anyways, I am talking
about referencing studies in a way that doesn't show the whole
picture. Such as using studies that: are old/outdated, are controversial
or misleading or flawed, and a more common thing is to use studies
done in 3rd world/foreign cultures to show a negative/positive
side and ignoring studies done in the same culture, while
also breaking down the positive/negative side to show a seemingly
large list while compressing the other side (and using foreign
studies to minimize the opposing side), the list could go on...
and frankly, this is getting a bit to technical for me.... which
is why I will take the "what if" approach mentioned
above.
One
thing I want to mention though, is despite the fact that medical
reasons should be the most influential reason for people
to decide, it often isn't looked in to... aside from maybe a pamphlet.
The more common reasons given are things like, it's more attractive,
the father is already done, the brother is already circumcised,
the mother/father prefers it, friends/family are doing it, its
a right of passage, reduces genital odor and improves cleanliness.
The interesting thing is the same reasons are also used by those
practicing female circumcision. All FGM is of course banned in
the US, the most common form, clitoridectomy, is definitely worse
then male circumcision, but the less common sunna circumcision
cuts away similar structures (clitoral hood) as those removed
in male circumcision. What I am trying to say here, is that using
those cultural/conformity reasons to have an infant circumcised
is venturing in to dangerous territory, whose body is it? Should
your preference be pushed? Don't think those cultural/personal
reasons affect you? What if the medical things we talk about here
applied to a sunna circumcision (such as phimosis, which is actually
prevented, along with a reduction in smegma) as well, would it
be something you would consider for your daughter? With no/insufficient
pain medication? Can you really picture yourself not letting her
have a choice, picture treating her wound with gauze and vaseline,
picture removing urine/feces from around/in the wound? I would
think the first thing you would do is make for damn sure
those medical benefits are good enough to warrant having it done
before any kind of problem shows up.
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Benefits/Drawbacks:
Soo
all that said, lets look at the supposed benefits and drawbacks.
I actually used many percents and studies from pro-circ sites.
The benefits for an infant should be the largest right? He cant
consent, so shouldn't the majority of issues be while he is to
young to make the decision himself? Well, lets give it a look.
Benefits:
HIV (adults
only):
The
biggest benefit talked about, as of now, is the reduction in
the chance of catching HIV. I will go in to a touch of studies
since this something many people wonder about. According to
a study done in Africa, there is around a 50% reduction in the
chance of a heterosexual male catching HIV. However,
various other studies done in different places in Africa actually
show no
benefit for circumcision, actually just a higher risk
when circumcised. And if you are like me and don't live in Africa,
you might be thinking, "Wait, are these studies even applicable
to me?", the short answer is no. And if you happen to be
homosexual then also, no. And if you happen to be a woman, then
a big no (another African study shows a higher chance
of catching HIV from circumcised men). For those of you in the
US... a study done in San Francisco shows no statistical benefit,
regardless of orientation and circumcision status. A US Navy
study also showed no benefit. Clearly the bigger issue is not
circumcision status, but sexual practices.
But
wait, I reaally like the sound of HIV protection, what
if it was true? Ok, lets say you did get that 50% reduction,
great. Now, the next time you have sex, will you take that gamble?
Would you risk your life thinking you are much more protected
then an intact guy? Will you risk it a second time? Third? I
think you can see where I am going here, not only would it promote
a more risky behaviour, it still only takes one
time to get infected. Wearing a condom and practicing safe sex
is still the best choice. And what if this 50% we are assuming
is true across all cultures, ethnicities, etc (despite data
otherwise), is really only 30%, 15%, less, or maybe in some
situations even an increase in occurrence? I certainly wouldn't
take that gamble, nor make that decision for my son.
UTIs (infants
only):
The
benefit for reduction in urinary tract infections you might
have heard about is actually for an infant in the first
year of life. Depending on where you read, you will find .4%-2%
of intact males will get a UTI during that first year, while
.1%-.4% of circumcised males will. So lets take the "worst
case" for intact of 2%, heck, lets even double the risk
just in case. So now around 4% of intact males will get a UTI
in that first year... however, around the same percentage of
girls will get a UTI during that time. I am sure we could find
something to remove from girls to reduce that chance... but
of course that would be crazy, no one would want to do that,
the meds are a much better option then performing surgery with
its own set of complications.
Phimosis:
This
benefit isn't considered a problem until later unless it is
really serious. Phimosis is essentially a foreskin whose frenar
band/elastic skin is to tight. Some places will say around
age 6 is when it can be diagnosed, some say closer to puberty...
some of this varies because it depends on when the foreskin
becomes retractable (the head/foreskin are "fused"
together at birth) and because it isn't until after puberty
is the penis done/mostly done growing. However, like UTIs, phimosis
can be treated successfully with other methods then circumcision.
Including stretching, steroid creams, or a combination. The
actual percentage is varies, but one study reports 2%. So again,
lets double this %. Now, using the mentioned treatments (stretching/creams),
around 90% of this 4% can be treated, leaving .4%. Of this .4%,
75% can be treated using local anesthesia and manual stretching
or with a "balloon". So that leaves .1% (1 in 1000)
that will need a cut in the foreskin, circumcision, or if not
causing pain, can also be left alone. A more extreme study reports
10% risk, but using the same treatments from above, that only
leaves .25% (1 in 400).
Penile Cancer:
Sooo,
this benefit seems to still linger around, but the chance of
having it in a developed country is around 1 in 100,000, When
compared to all other male cancers, .167% are penile
cancer. Note, the national cancer institute grouped all genital
cancers in this percent, so not all would be penile cancer,
but lets just assume they were. But wow, that sure is a small
chance, 1 in 100,000, no wonder NCI agrees circumcision isn't
important for this. There are more cancers of the eye, then
the penis. I am sure there is a much less personal part of my
body I could cut off/remove that is much more dangerous then
1 in 100,000. Also, the mortality rate is 20%.
Drawbacks:
Meatal Stenosis
(mostly infants):
Meatal
Stenosis is one of the more common drawbacks to circumcision.
Essentially it is a narrowing of the opening of the urethra,
said to be caused by the head coming in to contact with urine/feces
and diapers. Remember, the foreskin is suppose to be attached
and protecting the glans at this time. This can cause discomfort
during urination, incontinence, bleeding, frequent urination,
and/or infection. I have seen a large range of % risk listed
for this, but more commonly 7-10% risk for infants. If circumcised
later in life, around 2-3 years old, the risk drops to around
1% (less kids in diapers). A surgery to widen the opening will
usually remedy this problem. Even if the risk here was found
to be 2-3% it would still affect a large number of circumcised
infants.
Infections:
Ironically
enough, a drawback to circumcision is a infection. This is usually
an infection at the wound, but can also be systemic (rare) and
affects 1 in 100-200, 1-.5%. So the whole UTI thing is mostly
negated since circumcision will cause its own infections. However,
both can still be treated with antibiotics. MSRA infections
are also more likely.
Additional
Surgery (mostly infants):
Sometimes
there are complications with the amount of skin removed and/or
skin bridges. More commonly referred to as a "re-circ".
Of course, if to much skin is removed that is a worse situation...
cant exactly reattach the needed skin. About 1-1000 will have
to undergo the additional surgery. The skin bridges are easier
to fix, but is something that actually doesn't affect an adult
circumcision. Remember from other pages that, for an infant,
the skin is attached to the glans. Although circumcision breaks
the attachment, the remaining foreskin will still try to reattach
itself after the procedure.
Excessive
Bleeding:
Another
drawback is excessive bleeding. This will occur in approximately
1-1000 circumcisions, and is treated by applying pressure, and
of course, requires extra gauze.
Death:
The
least common, but most severe. Studies in the US range from
a little as 2 deaths per year to 230. A recent study shows 117...
out of 2 million boy births lets say 1.2 million were circumcised,
that means 1-12000... even if we say only 50 deaths, it would
still be 1-24000.... such a horrible thing to happen as a result
of an elective procedure. Notice how death from circ is way
more common then from penile cancer... at least those that die
from penile cancer have a chance to live their lives.
Other:
Hygiene,
Appearance, Sensitivity:
Analysis
- Personal/Function : Other benefit/drawbacks talked about
here. Summed up here.
Hygiene:
The cleaner benefit of circumcision is more a misconception
then anything, a simple wash during a shower is all that needs
to be done, retract, rinse, replace (as an infant, only the
outside should be washed because of the attached skin).
Appearance:
This is a personal preference... the decision shouldn't
be made for you. You will only know what you want,
never what your kid will want, especially with the 50% circumcision
rates.
Sensitivity:
A large section of specialized skin and nerves is removed during
circumcision and the head is left exposed. The head will need
to build up resistance of its own for wear and tear. However,
if circumcised as an adult more sensitivity will remain.. as
an infant, it will be 15-20 years before the exposed glans will
even be used, which gives alot of time for wear and tear to
take its effect.
Medical
Knowledge:
As mentioned on the Adult vs
Infant page, new studies and medical information is found
all the time. By the time your boy would be able to make a decision
on the whole circumcision thing, it will be 15-20 years. From
what is listed here, there really is no huge, nor even small
medical rush to get your infant circumcised. Even if the HIV
study is true, that is something an adult should look at and
decide.
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