US draft guidance on circumcision at odds with trends overseas

[bemildred]

U.S. health officials have released a draft of what is likely to become the first ever federal guidelines on circumcision, stating that the benefits of the procedure "outweigh the risks" — a position that runs counter to medical advice in other countries and is likely to enrage advocacy groups that believe the surgical procedure is in large part unnecessary and comes with risks.

The Centers for Disease Control and Prevention (CDC) on Tuesday suggested that parents of newborn males, and all uncircumcised men who are at risk of becoming infected with HIV, should receive “comprehensive counseling” on circumcision. The CDC advised similar counseling for sexually active adolescents who haven’t undergone the procedure.

"The benefits of male circumcision have become more and more clear over the last 10 years," said Dr. Aaron Tobian, a Johns Hopkins University researcher involved with the CDC's research on circumcision and HIV transmission.

But there are health risks involved with the practice such as bleeding, inflammation and reports of reduced sensations of sexual pleasure of circumcised men, according to advocacy groups such as Mothers Against Circumcision. And a study conducted released in 2010 said that every year more than 100 babies in the United States die from the circumcision complications.

http://america.aljazeera.com/articles/2014/12/4/cdc-circumcisionhivtransmission.html

It seems obvious to me the the exposed epidermis of the glans of the circumsized penis would "generally" present a more difficult route for infection than with an uncircumsized penis, which is admitted to be a good place for things to grow, and that therefore this study says very little.

That said, it also seems most unlikely that a foreskin, from an evolutionary standpoint, is actually on balance bad for you, and most likely it is there for a reason, since exposed penises can be quite sensitive. So maybe we should show a little more respect and leave it be.

[DetlefK]

1. A 10-year-old study in POOR, RURAL sub-Saharan Africa. Surely that counts EVERYWHERE.

Quotes from article:

"The studies the CDC cites in its report were conducted in poor rural areas of sub-Saharan Africa nearly a decade ago, said Georganne Chapin, executive director of Intact America, a group that opposes circumcision.

“These studies have never been replicated elsewhere — let alone in the United States — and have no relevance to children or men in the developed world,” she said in a statement. “There have been no systematic studies conducted anywhere about the short- or long-term adverse consequences resulting from circumcision."

“In the U.S. circumcision is very culturally ingrained into us. It is something that’s never discussed. It’s something that is just done,” said Sarah Kuester, spokesperson at the WHOLE Network, a U.S.-based advocacy organization.

Kuester, who traces the roots of the practice to Colonial America, said speaking out against circumcision has become taboo. The silence persists, she added, even in the face of studies that contradict the CDC's findings. One International AIDS Society study found that in only one of eight African countries surveyed did circumcised men run a lower risk of incurring HIV if they had their foreskin removed."

[bemildred]

3. Well the AIDS excuse is contrived, IMHO.

You have rare deaths from circumsion and rare deaths from AIDs transmission that would not have occurred had the dick in question only been circumisized first. If you believe that will protect you, I have a bridge ...

It seems at best a meataxe approach to what is an ambiguous problem

I am circumsized. I have 5 brothers, 3 cut, 3 not cut. I have 3 sons, 1 cut, 2 not cut. I have never seen that it makes a lick of difference, but you will find people who will swear up and down it's a big deal. In retrospect, I would prefer they had left my dick alone, but it's more a matter of taste, not an issue with pragmatic consequences. You can see the change in my views on the subject in that I had them leave my sons alone once I gained the confidence to tell them "No."

That said, I would never criticize anyone who chose it freely, in the same way they do all sorts of other things to their genitals, for any reason or no reason.

[Orrex]

2. One thought about that.

That said, it also seems most unlikely that a foreskin, from an evolutionary standpoint, is actually on balance bad for you, and most likely it is there for a reason, since exposed penises can be quite sensitive. So maybe we should show a little more respect and leave it be.

It seems likely that the foreskin played a larger role in protecting the penis in the days before men wore pants, etc., particularly shielding the glans from abrasion and sunburn.

Since these threads tend to turn into a parade of people ridiculing me for failing to acknowledge that my sadistic parents abused me, this is all I'll say on the matter.

[bemildred]

4. Quite right about the clothes. nt

[DemocratSinceBirth]

5. It served a purpose when man was running through the brush with nothing but a loincloth.

Most men today are no longer running through the brush with nothing but a loincloth.

[bemildred]

7. Well, the quesion is how bad can it really be to keep it?

If it was really a serious defect, would natural selection not edit it out, once we started wearing clothes?

[Orrex]

8. Did you hear the one about the guy who told the mohel to cancel the bris?

Said the mohel: "So you're saying fie, Moses?"

Said the father: "I hope not."

[bemildred]

10. Never heard of it, though I have read my share of Mohel jokes. nt

[Orrex]

11. Add that one to the pile

Guaranteed to bring the house down.

[bemildred]

13. Seemed kind of stupid to me.

He wants the money so he appeals to religious dogma. Does he think Moses is going to do something about it?

[Orrex]

16. Well, it's a pun.

Sort of hinges on the man's response.

[bemildred]

18. Yeah, I don't have much luck with puns either. nt

[Orrex]

19. Last clue:

It's a pun on a medical condition that a circumcised male doesn't need to worry about.

[bemildred]

21. Something Latin perhaps? nt

[DemocratSinceBirth]

9. Natural selection isn't perfect or we wouldn't have wisdom teeth

I'm not a dentist, of course, but I suspect a review of the literature suggests wisdom teeth serve no useful purpose and do more harm than good.

BTW, I'm not comparing the foreskin to wisdom teeth, just pointing out that if not perfect natural selection takes time.


I'm with Orrex...There is so much passion on this issue that little light is found in these discussions.

[bemildred]

12. Natural selection works great, it has done things we still have no clue about.

But it takes time and it's approach is heuristic, ad hoc, and never done. You cannot change just one thing.

Wisdom teeth are a good example, another once useful feature that now cause problems because of the hypertrophy of our skulls and the flattening of our faces, the cooking and cleaning of our food.

[DemocratSinceBirth]

17. I had impacted wisdom teeth.

I thought it was TMJ. I would literally keel over from the pain. It was wisdom teeth that became infected. Upon removal I had dry sockets. The best cure for that is putting cotton soaked in clove in your mouth. Of course you don't want to eat with cotton in your mouth. I lost twenty pounds in a month.

...


Here's a peer reviewed article by the NIH. It addresses circumcision's critics and is heavily footnoted:


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3663581/

[bemildred]

20. Right, I have two out, two left.

We had all my kids out, too, I know all about it, and I read all the handouts.

The NIH would do better not to try to instruct people about what to do with their dicks. They aren't going to listen anyway, it's a very personal issue, and statistical differences in future "risks" are not going to convince anybody, but you will get into very long arguments.

[DemocratSinceBirth]

27. Dry sockets are the worst.

it's akin to an open wound. Oral surgeons must have a protocol because mine came into the office after hours to repack the dry sockets.

[bemildred]

30. A good reason to leave them in if you can, in my view.

And yeah, it's traumatic, having teeth ripped out.

[yellowcanine]

25. Master's Thesis Title: "The connection between wisdom teeth and foreskins."

At least you would be guaranteed a lot of citations if you could get it published.

[bemildred]

28. Actually, I didn't say that, I said they are similar issues.

Both "diseases of civilization" so to speak. But otherwise, quite different, the dangers from untreated wisdom teeth can kill you, the dangers of an uncircumsized penis, as this ongoing dispute on the subject shows, are much more ambiguous. The foreskin is argued to be obsolete, wisdom teeth are sometimes detrimental. I do question the tendency to just rip them all out, impacted or not, I like the two I still have left, they are handy for chewing. I think it is a form of laziness not to keep the ones that are well placed.

It's not what I do, but I would not be at all surprised to find such topics in academic literature now, I didn't invent those ideas.

And yeah, you are right, it has real possibilities. "Group Theory in the Bedroom"and "Stress Anslysis of a Strapless Evening Gown" would have company.

But but I can see where this is going, and I think not ...

[yellowcanine]

31. I know you didn't but some topic lines just write themselves....

[bemildred]

33. Yes. nt

[FLPanhandle]

15. How long have we been wearing clothes from an evolutionary standpoint?

Modern civilization has from an evolution time frame happened in the last couple of seconds.

[bemildred]

23. Man has been creating and living in his own environment since we won control of fire.

Last edited Fri Dec 5, 2014, 12:02 PM - Edit history (1)

And weapons.

And that is about as long as we now choose to call our forebears "man", so the issue of evolutionary problems arising from our technological success goes back about that far, which is in the millions of years.

Modern civilization arose as a consequence of the adoption of intensive agriculture. Once we did that, we almost immediately became too populous to survive as hunter gatherers, it was a trap door.

But anyway, evolution and natural selection do not stop depending on your cultural state, although the selective pressures change. Nearsightedness for example is most likely something that evolved since we became "civilized", it sure as hell is not going to help out hunter-gatherers. Once you have a developed technical culture however, it becomes very useful to be able to do close work, essential even.

[DemocratSinceBirth]

35. I believe most dentists take a wait and see approach to wisdom teeth

Some times common sense is right...I suspect that if you have wisdom teeth that are causing you problems and other wisdom teeth that aren't they will remove all of them on the common sense assumption the remaining "good" ones will cause you problems in the future. The surgery is pretty dramatic for some. i needed IV sedation. Going through it multiple times doesn't seem prudent.

[bemildred]

41. That's what they did to my kid. All four, sedation, etc.

Yeah, it's tramautic. I think inflicting present trauma on the speculation that it may prevent some worse future harm is irresponsible, at best.

In my kids case, I saw the X-rays, and I know of his mother's issues with teeth not fitting in her jaw, so we did it. But I made them show me, because I did the opposite, kept as much as possible right along, and it's worked great. I still have all but three, two wisdom teeth and one canine I knocked off in a motorcycle accident.

[yellowcanine]

24. Speak for yourself. I am not giving up my loincloth run just because most men don't do it.

[DemocratSinceBirth]

29. Sounds like something they do at Bohemian Grove or Skull and Bones./NT

[yellowcanine]

34. The loincloths have to be made of hemp.

[DemocratSinceBirth]

37. They look pretty cool ...If I was twenty years younger it might have made a good Halloween costume.

But in deference to modesty I would have worn the smallest briefs I could find under it.

[bemildred]

36. Loincloth running helps you understand what this is all about:

[DemocratSinceBirth]

39. Oy vey./NT

[yellowcanine]

40. Note that just like guns and cars, some guys go for the biggest gourds.

[bemildred]

42. Like with the big cars, I think it's all about feeling "well-protected".

Some of them do look a lot more well-protected than the others, eh? I mean, on a good brush run, a big one can come in handy, you could bat small trees aside with that one on the right.

[yellowcanine]

44. I am guessing the idea is to make the opposite sex think that "size of gourd equals size of penis."

[Orrex]

47. It's all right as long as someone else's ox is getting gourd

Wait. Wrong thread.

[bemildred]

50. OK, I got that one. nt

[belzabubba333]

6. when i said i would rather have it done as a child causei dont

remember any of it this is what one poster said to me

"The fact that you think injury to an infant is OK if they don't remember it is disgusting, I hope you realize this. Any number of horrors could be justified based on your argument "

[BlindTiresias]

54. Yep

And I stick by my statement. Your criteria should be harm reduction, not whether or not they remember it.

[nichomachus]

26. Then, let's get rid of pants

They actually cause problems by creating a perfect environment for all sorts of problems -- yeast infections, jock itch. Keeping your junk tightly bound in a warm, moist environment isn't good for you.

Kilts!

[bemildred]

32. Good point. nt

[yellowcanine]

38. Not to mention sterility because the testicles overheat.

Seriously. At least go commando or wear boxers. No tighty whiteys.

[bemildred]

45. There's your declining sperm counts, right there.

All those little guys strangling and dying of heatstroke in there, men need to dangle to be healthy. As my old friend Dick used to say when discussing boxers vs briefs, "dangling is where it is at." The Scots had it right all along.

https://pneumatikos93.wordpress.com/269-2/

[FLPanhandle]

14. Circumcised or not; who cares?

Unless you are running around naked, it's not needed in a modern civilization.

[GGJohn]

22. Meh!!!!

It's nobody's business.

[killbotfactory]

43. I didn't realize circumcision makes you immune to aids. Awesome! nt

[Orrex]

46. I didn't realize that any medical professional anywhere had ever made that claim.

[yeoman6987]

52. Well according to one of our own,

Believes being a vegan cures HIV.

http://www.democraticunderground.com/?com=view_post&forum=1002&pid=5902483

[subterranean]

48. For more on this contentious topic (a LOT more), see this recent thread:

http://www.democraticunderground.com/?com=view_post&forum=1002&pid=5899228

[bemildred]

49. Yeah, you notice I started a new one.

No accident either. However there are some good points made there that are not made here.

[subterranean]

51. Sorry, didn't mean to take away from your OP.

I happen to agree with your point of view. I just thought I'd mention the other thread for those who interested.

[bemildred]

53. You did well, not to worry.

[Albertoo]

55. The AMA took a positive stance on circumcision only recently, and for wrong reasons.

One of the key principles in medicine is: don't cut the body, unless you really have to. (and as the thread poster put it, if evolution put that piece there, why cut?)

Recommending to cut 100% of male babies on the grounds of the not-too-well documented benefit vs HIV/AIDS in the case a baby would grow into an adult male having unprotected sex at a time when there will probably be an HIV vaccine/treatment sounds to me as nuts.

And I strongly suspect the AMA and CDC to have taken that stance to pander to the prejudices of Christian fundamentalists who probably believe anything remotely mimicking Judea first century CE rituals will help hasten a return of the Messiah (or some other crackpot theory)

[bemildred]

56. Well said. nt

[subterranean]

57. Actually, it was the AAP, not the AMA, but you're right...

they have always ignored the ethical aspect of cutting off a normal, healthy, functional part of the body.

I believe the real reason for the updated policy is that some insurance companies and Medicaid in some states had stopped paying for infant circumcision because it's medically unnecessary. The new policy provides greater legitimacy for doctors to continue performing the procedure and, more important, for insurers to continue paying for it.

[Albertoo]

58. quite possibly nt