AAP Continues Circumcision Recomendation

I was flipping through the stations in the car the other day and heard this story on NPR.

http://www.npr.org/blogs/health/2012/08/27/159955340/pediatricians-decide-boys-are-better-off-circumcised-than-not

The American Society of Pediatrics has come out with a report that boys are better off circumcised in the long run. I know some boys and men require circumcision for medical reasons, but I'm slightly at a loss with these findings. Widespread circumcision in the US was a development of the 20th Century. (It also spread to South Korea after the Korean War because of the heavy American influence). From my understanding, there was a belief that circumcising boys would prevent masturbation and so the rate of circumcisions in the US skyrocketed. Obviously more modern science has disproved that. Over the last couple decades the circumcision rate for newborn boys in the US dropped from 80% to around 55%. Most of Europe, Latin America and non-Muslim majority nations in Africa and Asia mostly remain under 20% circumcision rate (search prevalence of circumcision on wikipedia for the map). Besides my own tight foreskin (which corrected itself without medical intervention), none of my brothers or I have had any problems with our health from being uncircumcised. I know three boys aren't a representative sample, but I just don't see what the AAP is getting at here.

I want to open this up to as many people as possible for comment. Any men who want to chime in with their thoughts on your own experience please do so. Also parents who have sons and might want to add in how you came to the decision whether to circumcise your son(s) or not, and whether that decision has led to any health complications down the road. Finally for everyone without a son, would you circumcise your boys?

Would you circumcise your boys? No, I was circumcision, and suffer from complications from the circumcision to this day.

I do not have any boys, and I am a chick, but I would absolutely without a doubt circumcise my boys if I had them. And still would should I have to cross that bridge.

And aside from that, as a woman I like my man to be cut. In my opinion they look 100 percent better, smell better, taste better, and absolutely without a doubt feel 100 percent better. That might just be me though, and I mean no offence.

Mashie

I agree with Mashie. Circumcised penises look much better. I like a circumcision that removes absolutely all the foreskin so that there is no roll of skin behind the head even when the penis is flaccid.

But I just don't see what the AAP is getting at here.

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Try thinking ´loss of income´ - in some articles on the American practice, prices for circumcision at birth, figure from $400 to $600. That´s a nice supplement to add to a delivery of a male baby, especially since it involves little work as such.

So when American (not European btw) articles on circumcision talk about slight advantages and savings in health costs later (without giving a breakdown how this is computed) and when this is not repeated or confirmed in studies in other countries, then something else than a strictly medical issue may be in play.

A professional organization that also defends the financial interests of its members is not a neutral organization in this instance. Of course they are going to argue from their financial interest and will try and maximize income for their members.

And there are always the socio-cultural aspects to the practice of circumcision. After a while it becomes an accepted practice, which is not even though about, it is just something that one does as a matter of course. Maybe because everyone else seems to be doing it, because the father or other male relatives are also circumcised, from peer pressure so as not to stand out during sports or later when looking for a sexual partner ... in short because people do not think about it to any degree.

Not that it is such a life-defining thing, I would hope not. But ... there does seem to be this predisposition for those in favor of circumcision to constantly proselytize the procedure and sing its praises. This is what happened in certain religions and I would think the same impulses that drive religious proselytizers to push for universal circumcision among their believers is also at work in the secular world.

You could also put it down to an uncharitable reflex on the part of the circumcised: to do unto others as has been done to them - namely to perform a genital alteration (to a minor no less) without consent. It´s a way of getting back for being circumcised without consent. There may not be any overt malice involved, it is probably more like: it being good enough for me, then good enough for my offspring.

But for the professional organizations - I´d go with the old investigative technique: follow the money. Lower circumcision rates = loss of income.

And just to be clear - I am not talking about looks or the cosmetics of circumcision. That is up to individuals, just like tattooing or piercing. But it is up to adult individuals. Not to their parents.

Agracier,

Thank you for your insights. I think you laid out the non-medical reasons for the prevalence of circumcision in America quite well. In regards to the AAP, you're probably correct that there are financial implications at play. I was not thinking along financial lines when I posted. I was thinking of medical reasons, or lack thereof. If there were such significant medical benefits, why is the rate of circumcision for non-religious purposes so rare in the rest of the world? Your point about conformity in terms of older male relatives or other boys in school is well taken. I experienced that a bit in school. There were a few of us who were uncircumcised, but we were definitely the minority. At the end of the day, I don't know any parent who would allow their child to remain uncircumcised if circumcision had life changing medical benefits for all boys. In the interest of full disclosure, being uncircumcised I am biased against circumcision. I just don’t see it having universal benefits for all boys, being done at birth for medical reasons. Later on there are some boys and men who require circumcision, but circumcision at birth, I just don’t see the medical benefits.

Here in Australia circumcision was very common until about 1970 but nowadays fairly rare.

I was born in the 1960s but I was not cut, because my father was in the medical field and had read up on what a ridiculous fallacy the whole thing is. I guess he was ahead of his time.

Growing up, I felt a bit self conscious, since nearly all my class mates were cut. But later as an adult I felt very grateful to my father for leaving me intact. I don't have sons (only daughters) but if I did there is absolutely no way I would agree to them being cut. I really don't understand why so many Americans still do it.

I wish i was uncut. Boys should be given a chance to chose. I cant believe its allowed when female circumcision isnt. Its a religious double standard

I have to come out in defense of physicians.

First, anyone who understands the risk of malpractice suits in OB/GYN knows that a doctor does not do anything without clear consent from the patient, (ps boys, a parent is totally responsible for their child until they reach the age of consent and has a right and responsibility to have done what they think is best for their child), unless the procedure is medically necessary and the great preponderance of medical research and evidence supports performing the procedure.

Second, even though a circumcision looks like a simple procedure it is SURGERY and carries risks which must be considered.

Third, reviewing peer reviewed medical literature shows that circumcision significantly reduced the lifetime risk of multiple medical conditions, greater and lessor.

Fourth, the small amount of money a physician will realize from performing a circumcision is hardly enough to motivate all but the most money driven doctors to do the procedure unless asked by the responsible party, (the parent). Insurance companies, (those poor, starving businsses), take a dim view of performing add on non medically necessary procedures and cut their payments to the bone for such activities!

If I had a son, I would not have had him circumcised. The first reason is that I am not circumcised, and if you teach the child proper penile hygiene, he should not have a problem.

Another reason is that when I was a young Navy Hospital Corpsman, (19) I worked in the newborn/NICU nursery, and had to prep boys for circumcision. This entailed me strapping them to a "body board," (The board had a depression in the shape of a spread eagled baby.) The doctors would come in, cut away the foreskin, then wrap the end of the penis with iodaform gauze. I then had to unstrap the baby, diaper them, then I would rock them until they screamed themselves to sleep. No anesthetic of any kind was used.

Years ago, the practice of circumcision for non-religious reasons came into being because of a number of (erroneous)reasons. One was mentioned that it was thought to prevent masturbation. Another is that it was believed that it would prevent penile cancer and other medical problems. All are false. As I said before, if you teach the child proper hygiene, he should have no problems.(I'm 50 years old and never had a problem, even in the field.) AAP is constantly going back and forth on the value of routine circumcision. Other than cosmetic reasons, I see no use for it unless there is a true medical reason.

Also, you are, ultimately, robbing the child of a very pleasurable sex life. The glans of the penis, when protected by the prepuce is more sensitive than one that has been circumcised because the glans that has been circumcised looses senesitivity from constant contact with clothing.

Just saying...

A doctor does not do anything without clear consent from the patient,

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I´d like to give an example in which the wishes of the parent were not respected.

My younger brother was born in the 1950´s in NY and my mother did not wish a circumcision, she being from Europe where it is definitively not the custom. Even so, as part of a routine post-natal care given to male babies after delivery, he was circumcised without it being discussed. It was simply considered a normal and routine thing to do back then.

The same happened many times in the US military, back when circumcision was officially not considered to be mandatory, but which in practice it usually was, many medical officers taking delight in forcing uncut draftees to ´consent´ to the procedure by various less than honorable means.

Now in the case of my brother, this was done in the 1950´s - a time when all boys were expected to be clean-cut Americans. But this mind set is just what is so insidious about the practice. A religious (which in this case it was not) or a cultural bias that becomes so prevalent is never even thought about or discussed. It just is. Everyone does it. Or such is the expectation at any rate.

And when the practice is recognized for mainly being a cosmetic and culturally determined preference, then instead of falling back on the old 19th century masturbation scare, other medical reasons are trotted out - the biggest scare being penile Cancer (the C word being especially potent in mid century) along with hygiene and also the enforced uniformity of military service, then still near-universal in the US.

There is this thing about circumcision that seems to make those cut, into proselytizers for the practice, insisting that it become a universal practice. This has happened in several religions and seemed to have happened in early and mid 20th century USA.

Now if there were indeed such obvious medical benefits, why do not other countries adopt the practice? I´ve never understood the American obsession with circumcision. And certainly not the haste to apply the procedure to minors. It seems as if they are scared that if babies are not circumcised when they have no say over the matter, they might choose not to do so when they are old enough to think things over for themselves. It is after all a part of their own body.

Fourth, the small amount of money a physician will realize from performing a circumcision is hardly enough

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$400 to $600 is not enough? Maybe someone can give the average number of deliveries of males that a typical OB-GYN will handle over a year´s time and then multiply it by the above amount. I bet you will be surprised and wish you could add it to your yearly income, even if only a percentage is clear profit.

Where I live, doctors give consults at 25 euros a patient and are considered to make a good living out of the proceeds if they have an average number of patients. They would jump at being paid rates as those above ...

I'm a very mild manner person, but as a man and particularly as a father this subject makes me very angry, and I mean very. Men are meant to have foreskins, that is normal and natural.

I'm not really sure what this has to do with medfet but there you are,it keeps rearing it's ugly head and I guess that is significant. And very many thanks to agracier for his very intelligent and eloquent posts. They are spot on the money.

This procedure was authorised in the past by well meaning parents who thought it was a good idea at the time, but things move on and people are much more enlightened nowadays.

Blame the zealot Dr Kellogg the corn flake guy, or even Dr Benjamin Spock who actually changed his tune and saw the light.

I'm very happy to listen to reasonable debate as to why this is a good idea going forward, but I've heard absolutely none so far. Looking 'nice' is not a good reason for imposing this on a non-consenting child, basically. And non-consenting is a very very key word.

I've checked this out on the AAP website and their reasons are just ifs,buts and maybes, nothing concrete. Penile cancer...I've never ever heard of any one getting that, must be rarer than hens teeth, sledge hammer to crack a nut. Hey why don't we cut off girl's breasts at 13 in case they might get breast cancer later in life, total nonsense.

Might help to prevent HIV infection, well that's unlikely and your sexual partners are your choice as an adult and that's your call...

I'd really like to hear from some of the pros as to why this is a brilliant idea...Any takers?

Dr Philip - The UK Play Doctor.

The circumcision debate(and it is as old as time)boils down to what Stephans said. It is the responsibility of the parent.

There are different customs and norms in each country. In fact here in the USA it varies by region.

The whole argument is one person trying to force their views and what they belive on someone else.

Let the parent decide they are responsible for their son and no one else.

One more thing. This does not mean the doctor can do it without the parents concent.

Money is also not a factor. Find out what malpractice insurence costs.

The whole argument is one person trying to force their views and what they belive on someone else.

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Indeed so. That is ever so right: Circumcision is a parent forcing their views about a cosmetic genital alteration on a minor. On someone who has absolutely no say in the matter at all.

It is like tattooing a baby or flattening their forehead or stretching the neck because of the perceived aesthetic beauty of the alteration. None of this seems like a sound valid reason to apply it to minors. Especially since the modern nations we are talking about are no longer tribal entities. Diversity is something that is now (hopefully) no longer seen as threatening to social values. Which is why it is so insidious to trot out unverified ´medical´reasons for performing circumcisions, when it has mainly become a matter of custom, of cultural bias, of cosmetic preference (aside from religious reasons which I do not think it wise to address at all). Of course medical reasons are given because the old masturbation excuse no longer flies as a valid excuse. It is just too silly and repressed for words anymore. Which is why the ´medical´aspect is trotted out. The reason has to sound halfway believable and not just be presented as a cosmetic preference.

It should be remembered that parents do not own children, they are merely temporary custodians. I wonder what would happen if there were some parents who started tattooing them at birth?

Okay okay boys, I am the one that made the comment that "I" like a circumcised penis better because of the look, smell, taste and etc. That is what I like. I didn't say it should be done because that's the way I like them. I was just stating my own personal view on it. It's no different than a guy wanting a blond, or a BBW, it's what you like, what you prefer.

As far as my medical opinion goes there are pro's and con's. Some men never experience penis issues, some do. Most men when they get older who have not been circumsized will most likely experience some sort of issue or another. For some it might be a severe case of head cheese and a whopping case of yeast. For others it might be a tasty case of e-coli, and for the lucky few for them it will be a strangulated penis.

And before you boys all say, "well if they are taught from the begining to care for it properly none of those things would happen". Ahhhh, but here in lies the problem, could be that you may not be able to care for yourself until you die and will have to rely on someone else. Ever see a guy with a strangulated penis? I have far more than I would like to remember. It isn't pretty, trust me. These men are in severe pain, screaming out in pain and for help, some of them have tried to kill themselves, others have begged me to do so for them. It about makes me cry actually. I can't help them, and there is nothing I can do, that really pisses me off.

I think the real issue at least here in the United States is that at one time, most of our boys were circumcised, and now only 50 percent of them are. If I had to render a guess, I would say that our medical care staff needs better educated on how to care for the foreskin/penis. If you boys are going to be keeping your skin, then we need to know how to take care of it properly. THat is where you guys in other countries have the advantage. Because so many of you already over the years have kept your skin, your health care providers see it all the time and are trained accordingly. It's just a guess on my part, but it would make sense. Again, education is the key here, on all levels.

Mashie

Lifted from their official website today...Here's the good old NHS, not motivated by profits, stance here in England...

'Most health professionals in England would argue that there are no medical reasons why an otherwise healthy baby boy should be circumcised'

'Critics have also argued that routinely circumcising baby boys on medical grounds violates the principle of consent to treatment. They say that circumcision should only be performed when a boy is old enough to make an informed decision about whether he wishes to be circumcised.'

'NHS availability

The majority of PCT's do not fund routine circumcision or circumcision that is carried out for religious reasons.

The NHS mainly funds circumcision that is used to treat a small number of medical conditions (see below). In such cases, circumcision is usually regarded as a "treatment of last resort", when all other treatment options have failed'

I was reading today that California was trying to ban the practice...Good job too I say...

Dr Philip - The UK Play Doctor.

I really do not believe the American Academy of Pediatrics issued its position statement for financial reasons. Personally, I do not buy the data that show health benefits, but I think there are data that can reasonably support AAP's position. For one thing, in many areas of the U.S., pediatricians are not the specialists who perform neonatal circumcision, the obstetricians do them. Americans tend to view circumcision through the bias of circumcision being a cultural norm for several generations. It's a bit of a crazy view, like all biases tend to be, but it is so ingrained in our society that it is difficult to change. The British and Europeans may have a bias in the opposite direction and I can definitely understand why they may think Americans are weird to have such strong pro-circumcision views. Personally, I hope parents will not all take the AAP position too seriously as I really do not want to see the circumcision practices in the U.S. change since I find it much more interesting if an American man's penis is a little unpredictable with regard to circumcision status.

Agraicer, you prove my point well.

What you believe and what is normal for Belgum is not necessarily what goes on here in the States.

Lets put the shoe on the other foot. You brought up tattooing. If your eight year old child asked for a tattoo would you let them get one because "It is their right to decide"?

As far as the medical benefits are concerned, do you remember Polio. I do very well. I grew up less than a mile from a childrens hospital that was a Polio ward. This was still the days of the iron lung.

My high school graduating class was the last that had children in leg braces and crutches and wheel chairs from this dreaded Disease.

And yet my childrens doctor questioned me when I asked about their vaccinations. He told me there were some possible side effects. A lot of doctors don't recomend the Vaccinations because they aren't necessary anymore. I told him the benefits far out weighed the risk. He told me I had made a wise choice.

And yes Polio is still very real. A few years back there was an outbreak in the Amish community in Lancaster PA. They do not believe in Vaccinations. My brother in law , a GP was involved in treating them. He was finally able to convince them to get Vaccinations.

As long as my children were under my roof I made the decisions about their health care.

So if in your eyes I"OWN" them then I guess you are correct.

If your eight year old child asked for a tattoo would you let them get one because "It is their right to decide"?

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An eight year old - no way. And I´m certain that everyone else here would think the same.

When stating ´their right to decide´ it is (axiomatically I´d say) a given that adults are meant, not minors and certainly not infants.

Of course once children start approaching 18 years, it does become difficult to want to decide everything for them. If you try, it will mean lots of arguments and hard times in the family.

And to continue the question - why would an 8 year old even wish to get a tattoo unless he saw it on someone else of his age group or unless a parent or authority figure tried to urge it on them in the first place? Which means someone gave a very bad example.

Besides, with tattooing and polio, it is like comparing the proverbial apples and pears. A tattoo is a fashion or tribal adherence statement. Preventing polio is a true medical question. The two cannot be compared.

And moreover, a tattoo is a permenant fashion alteration. Just like circumcision. Not to be undertaken lightly, just because others are doing it.

What you believe and what is normal for Belgum is not necessarily what goes on here in the States.

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I know that things are different in the US. Aside from muslim countries, it is the only one that seems to embrace circumcision as a wholesale blanket procedure. Or used to at any rate. And which still counts a vocal portion of the citizenry who seem to think it should be imposed universally on infants.

Why is it the only other country to do so? Why does this seem to exercise such an attraction in the US?

I often think it has to do with not being willing to look at medical problems in an individual manner. Phismosis? Circumcize! And while you´re at it, let´s do it to all newly born. Problem solved once and for all. Sort of like banning alcohol because some indivduals make abuse of drink. Ban it for everyone, another problem solved.

Or so it seems. Because it´s a ´solution´for which a problem had to be invented. First as an anti-masturbation measure, then as blanket prevention for rarely occuring medical problems, or problems that can helped in other ways.

By the same token why are Europeans not circumcised? And what is their fascination with condemning us because we do?

We all come from different backgrounds. I may not agree with what you and your country do but as long as it doesn't affect me it's none of my business.

By the same token why are Europeans not circumcised? And what is their fascination with condemning us because we do?

We all come from different backgrounds. I may not agree with what you and your country do but as long as it doesn't affect me it's none of my business.

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I would wager that not only European countries but others as well (once again with exception of Muslim countries) do not practice wholesale circumcision because it is not medically necessary. Muslim countries do so for religious reasons of course and with that there is no arguing at all, there is no beginning to because it is based on what they believe to be reveled supernatural will. But aside from faith or tribal tradition or other such cosmetic reasons, there is no medical reason to do so, and to argue so is not honest.

If people were to argue that they want every male to be a ´clean-cut American boy´ because they think it looks better, or because everyone is doing it and they don´t want to stick out as being different, or because of tradition or whatever, then that is fine and well and at least an honest reason - making up wholesale, blanket medical reasons for circumcising infants is not. That is just coming up with a plausible excuse that will be accepted at face value and being in accord with the spirit of the times.

And just again, to repeat, I care not a whit if adults circumcise themselves. Good for them if they´ve thought it through and come to their own informed decision as informed adults. Nor does anyone ´condemn´ anything. Infant circumcision is however a question that often arises in forums, it does seem to be at odds with the idea of safeguarding the bodily integrity of the under-aged.

The original question in the thread was why the AAP recommends circumcision. And from there it goes to why it is so in the US and not in other countries.

I wager/think that the first question has to do with money. It´s a nice source of income. But to justify it wholesale, physicians needed to come up with medical reasons. Or rather, I´d wager that when self help medical and marriage books began to be published in the early 1800´s which contained dire and very false warnings about the dangers of masturbation, there were doctors who jumped on the bandwagon and got themselves into the circumcision business. A century later, that kind of reason for circumcising doesn´t fly anyway, so others were thought up - some sounding quite plausible perhaps.

This then became a tradition of sorts, very forcibly reinforced with the mass drafting of military men during the many 20th century wars - Great War - WWII - ideological and proxy Cold War.

And now it´s become an article of faith in a way. A tradition.

And besides, I relish a good historical discussion. For this is what this is as well. How did this all come about, with Americans so emphatically embracing circumcision from the late 19th century onwards? Why did the practice take root there and not elsewhere in similarly developed countries?

This thread is a good occasion to weld history and medical fetish in a lively and vivid discussion. I grew up in both the US and Europe and the differences, small at times, are interesting to study and try and figure out why they came about. I don´t like to take things on faith, but prefer to try and figure out the underlying reasons.

And things in the present world are so often interconnected, whether we wish it be so or not or if it is for better or for worse. Aside from the so obvious subject of economics, as an example, the kind of entertainment made in Hollywood does indeed influence the mind set of youngsters and adults in Europe and the world round. Several decades ago no one outside the US had even heard of all the varieties of unbelievably violent vigilante and quite inane superheros that populate the fantasy world of US comics and therefore of youngsters. Now they are part of the popular culture here as well - alas ... ha ha.

And this goes for so many things. To give an example related to sexuality and therefore tangentially related to this forum, porn made in the US (California mainly I suppose) will undoubtedly give the impression that males are not only unbelievably well-endowed, but also invariably circumcised ... so there we go again. Interconnected whether we want it or not.

There´s nothing personal at all about this for me ... consider it being on a debating team.

When my son was born in 1990 his mom and I asked the doctor his opinion on circumcision. The doctor's opinion was that our son didn't need to be circumcised at birth so our son was left uncut. When my son was about 8 years old the foreskin was constricted and would not expand to allow the glans to extend beyond the foreskin causing him pain. His mom took him to the doctor and had him circumcised. He is now 21 and had no complications from the circumcision.

Jhenson16

'By the same token why are Europeans not circumcised? And what is their fascination with condemning us because we do?

We all come from different backgrounds. I may not agree with what you and your country do but as long as it doesn't affect me it's none of my business.'

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Just quick one as I am off again for a few days.....

The point here is that an American started this thread and asked for input,therefore we all give our honest opinions. Non- medical circumcision of infants is a very contentious subject for very obvious reasons, and will always cause heated debate.

Europeans are not generally circumcised because it is not necessary, it is natural and normal for a man to have a foreskin, simple as that.

Dr Philip - The UK Play Doctor.

Europeans are not generally circumcised

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The point is also that not only does this apply to Europeans, but to virtually all other countries in the world (outside of Muslim and one Jewish nations where the reasons are religious).

In no other countries is general non-medical infant circumcision practiced - or advised. This goes for such populous countries as India, China, the Russian Federation, Japan, Vietnam and others ...

So, aside from the religiously skewed countries, it does beg the question: why the US? And certainly why is it so zealously embraced? It has almost become an article of faith.

So it should not come as a surprise that people keep asking why? What are the reasons that make infant circumcision so attractive in the US? Why do parents do it? Or rather, why DID so many parents in the US allow it?

I think ther is no reason whatsoever to circumcise boys at birth.. Good hygeine & practicing safe sex is a much better deterrent to STDs & AIDS.