American Academy of Pediatrics: Benefits of Male Circumcision Outweigh Risks

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    Default American Academy of Pediatrics: Benefits of Male Circumcision Outweigh Risks

    Quote Originally Posted by CBS News
    The health benefits from male circumcision outweigh the risks, says the American Academy of Pediatrics in its latest guidelines on the controversial procedure published Monday.


    In its first policy statement on the subject since 1999, which was later reaffirmed in 2005, the academy stops short of recommending routine circumcision for males, but adds that based on the current evidence, insurers should cover its costs.

    The group's previous stance said the procedure can prevent bladder infections and sexually transmitted diseases like HIV/AIDS, but also carried potential downsides like reduced sensation and infection.


    "In 1999, there was some data suggesting that there were some small medical benefits to circumcision but, at the time, there was not a compelling medical reason to recommend circumcision. So the previous policy didn't argue for or against circumcision," Dr. Douglas S. Diekema, a member of the circumcision task force behind the new statement, told AAP News. "However, now there is much stronger evidence about protective medical benefits associated with circumcision, so the tone of this policy statement has changed."

    For the new policy statement, researchers formed a task force in 2007 to review evidence from 1,000 studies that took place between 1995 and 2010. They found that the procedure had preventive benefits, including a major risk reduction for male urinary tract infections - especially during the first year of life - and a lower risk of cancer, and heterosexual acquisition of HIV and other sexually transmitted diseases. Specifically, risk for herpes was 28 to 34 percent lower for circumcised men and risk for HPV was reduced by 30 to 40 percent.

    The new policy is published in the Aug. 27 issue of the academy's journal, Pediatrics.

    The task force members also said the procedure is safe when performed by trained professionals in a sterile environment, and complications are rare and much lower for newborns - less than 1 percent - compared with adult males who get the procedure.

    However the group said the health benefits are not great enough to recommend routine circumcision.

    "Ultimately, this is a decision that parents will have to make," Dr. Susan Blank, chair of the task force that authored the policy statement and corresponding technical report, said in a written statement. "Parents are entitled to medically accurate and non-biased information about circumcision, and they should weigh this medical information in the context of their own religious, ethical and cultural beliefs.

    Based on current rates, it appears an increasing number of parents are opting to skip the procedure. A recent analysis from the Centers for Disease Control and Prevention found the U.S. circumcision rate fell from about 63 percent of newborn boys in 1999 to 55 percent in 2010. In the 1980s, the U.S. circumcision rate was about 79 percent of newborn boys.

    A study in last week's Archives of Pediatrics and Adolescent Medicine found the 20-year decline may have already contributed to about $2 billion in additional medical costs, for care related to treating urinary tract infections and sexually transmitted diseases throughout a male's lifetime. The researchers say if the trend continues to where only 10 percent of U.S. males are circumcised - rates similar to Europe - the country could face about $4.4 billion in health care costs - an added $407 per man.

    That's in part because 18 states have already abolished Medicaid coverage for male circumcision. In the new policy statementt, the American Academy of Pediatrics says the procedure's benefits warrant third-party payment by insurers should parents opt for the procedure for their kids.

    "It's a good idea to have this conversation during pregnancy, and to learn whether your insurance will cover the procedure, so you have time to make the decision," said Dr. Blank.

    Psychologist Ronald Goldman, director of an anti-circumcision group, the Circumcision Resource Center, told the Associated Press that studies show circumcision causes loss of sexual satisfaction -- a claim the academy said is not supported by the research it reviewed -- and can be psychologically harming. Goldman says medical studies showing benefits are flawed and that the academy's new position is "out of step" with international opinion on male circumcision.

    Controversy over circumcision has ramped up in recent years, highlighted in the U.S. last year when a male circumcision ban almost made the November ballot in San Francisco. A judge eventually ruled such a decision should be a state matter, rather than decided by a city election.

    In Cologne, Germany, a court ruled this July that circumcision went against the "fundamental right of the child to bodily integrity," and should be decided by the child himself once he gets older. The German government is currently working with the German Medical Association to clarify the ruling to ensure religious freedoms.

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    Default Re: American Academy of Pediatrics: Benefits of Male Circumcision Outweigh Risks

    The ruling is completely biased and based off junk research.
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    Default Re: American Academy of Pediatrics: Benefits of Male Circumcision Outweigh Risks

    Quote Originally Posted by SmearglePaints View Post
    The ruling is completely biased and based off junk research.
    Your word is completely fair and based off sound inquiry. Well, I'm sure.

    Anyway, should we also be so crediting to CBS News and/or this article, I find it disgusting that an "anti-circumcision group" is meanwhile named "the Circumcision Resource Center." I'm disgusted because it's one of my mere principles, me being no personal advocate of circumcision. (Imagine an anti-Romney group being called "The Romney Resource Center," or an anti-Obama group being called "The Obama Resource Center," or an anti-Ron Paul group being called "The Ron Paul Resource Center," and I'm sure you can see the nature of my disgust, no matter your political angle.) Most people who circumcise their children are doing it for reasons more religious, but they should have this right anyway (and this right shouldn't be removed on grounds relating to health, or so this finding evinces). (Also odd though is the fervor and anti-speech nature of the [social] scientist director of the "Center" who flaunts "international opinion" [the words of the article, deemed by them to be an accurate paraphrase] against new positions and findings.
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    Default Re: American Academy of Pediatrics: Benefits of Male Circumcision Outweigh Risks

    The only actual "scientific proof" of there being decreased sensation is the fact that the foreskin has more nerves inside, which doesn't make much, if any, difference. Plus even if it is true, circumcised penises have been shown to maintain erections twice as long, so I guess it evens out anyways.
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    Default Re: American Academy of Pediatrics: Benefits of Male Circumcision Outweigh Risks

    I don't need science to tell me what a woman wants. Circumcised or get out. Just sayin'.

    >.>

    <.<

    *feels awkward*
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    Default Re: American Academy of Pediatrics: Benefits of Male Circumcision Outweigh Risks

    Evolution would have destroyed foreskins, if there were more benefits to a penis without one, so I remain skeptical.
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    Default Re: American Academy of Pediatrics: Benefits of Male Circumcision Outweigh Risks

    Quote Originally Posted by Continent Turtle View Post
    Evolution would have destroyed foreskins, if there were more benefits to a penis without one, so I remain skeptical.
    Right, like what happened to the appendix. And the tail bone.

    Not that I'm saying how I feel either way on this matter, just playing the Devil's Advocate.
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    Default Re: American Academy of Pediatrics: Benefits of Male Circumcision Outweigh Risks

    Quote Originally Posted by Elite Four Lugion View Post
    Quote Originally Posted by Continent Turtle View Post
    Evolution would have destroyed foreskins, if there were more benefits to a penis without one, so I remain skeptical.
    Right, like what happened to the appendix. And the tail bone.

    Not that I'm saying how I feel either way on this matter, just playing the Devil's Advocate.
    Except those had a purpose in our ancestors. If having no foreskin were better than having one, we would have already lost it.
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    Let's get funky! Gama's Avatar Former Head Administrator
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    Default Re: American Academy of Pediatrics: Benefits of Male Circumcision Outweigh Risks

    Right, lots of ignorance in this thread, including in the article, so let me clear a few things up before I actually say what I think.

    Quote Originally Posted by SmearglePaints View Post
    The ruling is completely biased and based off junk research.
    Well, in fairness, I think most of what they say is true. I'm going to discuss below what the issues with the article are. I think it's more misleading than it is based off junk research. There are elements of bias, though, you're right there. Generally it is medical authorities that have an interest in finding circumcision to be beneficial (those associated with religion being big contributors) that do so. You might not see it at first in this case, but American medical authorities make a huge amount of money out of circumcisions as the whole of America's medical system is privatised. While they don't have an interest to completely make shit up, this does make them more likely to conclude things that are more likely to make people give them money when it's something of a grey area. Always remember the biases and vested interests of the people who are telling you things.

    Quote Originally Posted by smaug85 View Post
    The only actual "scientific proof" of there being decreased sensation is the fact that the foreskin has more nerves inside, which doesn't make much, if any, difference. Plus even if it is true, circumcised penises have been shown to maintain erections twice as long, so I guess it evens out anyways.
    Not exactly true, on both counts. No, there's pretty much no scientific proof either way. However, there are things which studies show to be likely. One of the main reasons for decreased sensitivity being posited as a consequence of circumcision is that as the head of the penis is extremely sensitive, it being constantly touched (by underwear etc.) dulls its sensitivity. Protecting this sensitive area is actually the main function of the foreskin, much like the clitoral hood in females. There is significant evidence that suggests, though not conclusively, that this is an issue. Unfortunately, the vast majorities of studies on the matter document the difference between in various things for an uncircumcised adult who gets a circumcision, and then reports on the differences. This does not account for differences that are accrued as a result of circumcision from the age of a few months until adulthood. Of course, a test that did would be incredibly hard to control variables, so it might not even be that helpful then.

    Several studies have shown, although unfortunately again not conclusively, that uncircumcised men may ejaculate quicker than circumcised men. May sound like a good thing, increased sexual performance and all that, but assuming these studies were properly controlled for external variables (and I don't know whether they were, though suspect they were) it would also suggest that uncircumcised men have greater sensitivity in their penis, and are thus able to experience greater sexual pleasure. After all, if a group of people are likely to ejaculate slower for reasons other than experience and learning to understand and control your own body better, then it can only be because there is less of an urge to ejaculate. Ejaculation being caused by sensitivity in the penis and sexual pleasure... You get the picture, I hope.

    Quote Originally Posted by Caitlin View Post
    I don't need science to tell me what a woman wants. Circumcised or get out. Just sayin'.
    Actually, you kinda do. As an individual woman, you can only say what you want, and not what women want. Scientific research has shown that women from countries were circumcision is very common (such as the USA, where you're from) are far more likely to prefer a circumcised penis, usually because they either consciously believe or subconsciously feel that it's a lot cleaner (of course, I'm sure people have told you plenty of times that this isn't true - with the most basic of genital hygiene they're equal. It's true that if a circumcised guy and an uncircumcised guy both never washed their penises, the uncirc. would be truly gruesome whereas the circumcised would just be highly unpleasant, but I'm guessing that you probably also wouldn't want a guy who never washed his penis to come anywhere near you either...)

    On the other hand, in countries were circumcision is not common, women are far more likely to prefer an uncircumcised penis. I guess partly because they're more likely to be used to uncirc. ones from early ages of sexual activity and the circ. ones are more likely to seem "unusual". It's interesting that it's usually whatever is uncommon that is reported to be less sexually pleasurable and to cause more discomfort when entering the vagina. Just shows you how much of sex is actually mental and not physical, really.

    Quote Originally Posted by Continent Turtle View Post
    Evolution would have destroyed foreskins, if there were more benefits to a penis without one, so I remain skeptical.
    Simply not true. Lugion points out cases where this isn't true already. If there are reasonably minor benefits for something in both directions, but one outweighs the other, particularly if the larger one is more long term, it is completely feasible that evolution could have resulted in the less desirable option. As it is, I don't actually think this is true, but that is something that could have happened.


    Now, after that wall of text, here comes another one: my actual opinions.

    The fact is no medical authority in the entire world recommends routine circumcision for medical reasons. This is not because, as this article makes it sound, this would mean removing the autonomy of the parents or some crap like that. Doctors make recommendations about routines etc. all the time that some people just choose not to follow and it isn't considered denying them their autonomy. The reason is because the benefits are actually so marginal, particularly compared to the risks and adverse side effects, that it just isn't clear enough that it is a good idea. Even the medical authority in the article don't dare to say that, they just want to make it sound like it's a benefit, probably partially because, as I said and explained near the top of this post, it is actually in their benefit to do exactly that.

    To go through what they claim the benefits are:

    *STI contraction, specifically mentioning HIV and herpes. All studies that I have seen in the past only show that large a difference in risk of infection in unprotected sex. That's why in countries like Nigeria, where condom use is incredibly low, the difference in chance between you getting HIV if you're circumcised is something ridiculous like 60% (I don't have the figures to hand, but it really is in that region). This is not the same in developed countries where sex education is much better and protected sex is much more common, particularly with strangers, from whom you're much more likely to contract HIV. That's why HIV rates in developed countries are actually really low nowadays (as opposed to in the 60s/early 70s when there was less awareness around that sort of stuff).
    *Less chance of UTI. Note that they say "particularly in the first year of life". That's because the chances of contracting UTI beyond the first year of life is, for males (different story for females) almost nil. This is actually a pretty minor condition anyway. It is true, however, that in the first year of life you're much less likely to get it if you're circumcised. That's a win for circumcision, though, in my opinion, a pretty marginal one.
    *Less chance of cancer. I'd like to see more detailed data on this one. I suspect the difference in likelihood of contracting cancer is extremely small, and possibly a conclusion reached due to problems with sampling. I'm calling BS on this one being anything of any real significance. Less of a win than UTI or STIs.

    As for the risks and adverse side effects. I've already talked about reduced sexual pleasure. Often poo-poo'd by institutions who have an interest in saying circumcision is the best human enhancement since haircuts, but there is evidence to suggest there is truth to it. There's also the fact that the procedure can go wrong. Of course, it's rare, but it's pretty horrific when it does go wrong. Less than 1% of millions of men is still thousands of men who may have total loss of the use of their penis, significant damage to their penis, or no penis at all for the rest of their life.

    Personally, I'm more concerned by the moral issue of the fact that you are cutting up the genitals of a perfectly healthy baby boy who is completely unable to give any kind of consent or not. I honestly think the only reason that this isn't considered genital mutilation is because of religious and cultural norms saying that it is a natural and good thing to do. In this article they say it is a decision best left to parents, but personally I really don't think that's acceptable. I know I probably sound like a crazy liberal to most of you, but I really think it encroaches on someone's bodily autonomy to be cutting bits off without their consent for medical benefits that have never been shown to actually definitely outweigh the risks, and actually it's usually not done for that reason anyway, in spite of what people like to say. When it's not done for religious reasons, it's typically done for cultural reasons, in other words "Uncircumcised penises are icky."

    That's my contribution. Let me say congratulations to all of you who made it to the end, and I hope it has been at least interesting.
    Last edited by Gama; 3rd September 2012 at 08:28 AM.
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    Default Re: American Academy of Pediatrics: Benefits of Male Circumcision Outweigh Risks

    I think this thread has too many people making strong claims without providing respectable sources (or any sources, actually) to back them up. In particular:

    Quote Originally Posted by SmearglePaints View Post
    The ruling is completely biased and based off junk research.
    A dismissive one-liner from a single forum-goer with no evidence vs. a well-respected scientific institution that has undertaken painstaking research and been completely transparent about it's findings: I wonder who we should believe ...

    Quote Originally Posted by G-Mama View Post
    Generally it is medical authorities that have an interest in finding circumcision to be beneficial (those associated with religion being big contributors) that do so. You might not see it at first in this case, but American medical authorities make a huge amount of money out of circumcisions as the whole of America's medical system is privatised. While they don't have an interest to completely make shit up, this does make them more likely to conclude things that are more likely to make people give them money when it's something of a grey area. Always remember the biases and vested interests of the people who are telling you things.
    Are you accusing the AAP of more or less twisting results for profit? Because that's a serious claim, which you should really have some kind of proof to back up, if that's the case. You can't just disregard research because of bias. Everyone's biased, one way or another, but it doesn't mean we can't get good scientific evidence.



    To go through what they claim the benefits are:

    *STI contraction, specifically mentioning HIV and herpes. All studies that I have seen in the past only show that large a difference in risk of infection in unprotected sex. That's why in countries like Nigeria, where condom use is incredibly low, the difference in chance between you getting HIV if you're circumcised is something ridiculous like 60% (I don't have the figures to hand, but it really is in that region). This is not the same in developed countries where sex education is much better and protected sex is much more common, particularly with strangers, from whom you're much more likely to contract HIV. That's why HIV rates in developed countries are actually really low nowadays (as opposed to in the 60s/early 70s when there was less awareness around that sort of stuff).
    Well, I can't speak for those other studies since I don't know what they are, but the AAP report, which does reference a number of studies, says that:

    • studies suggest lower risk of syphilis for circumcised males
    • there is a large body of evidence linking noncircumcision with increased HIV risk
    • the above increased HIV risk is correlated independently of the increase HIV susceptability seen with the presence of STD-related genital ulcers


    It also says that:

    Quote Originally Posted by AAP Circumcision Policy Statement
    There does appear to be a plausible biologic explanation for this association in that the mucous surface of the uncircumcised penis allows for viral attachment to lymphoid cells at or near the surface of the mucous membrane, as well as an increased likelihood of minor abrasions resulting in increased HIV access to target tissues. However, behavioral factors appear to be far more important risk factors in the acquisition of HIV infection than circumcision status
    So yes, circumcision isn't the be all and end all of sexual health, but it does seem to be able to contribute.


    Quote Originally Posted by G-Mama
    *Less chance of cancer. I'd like to see more detailed data on this one. I suspect the difference in likelihood of contracting cancer is extremely small, and possibly a conclusion reached due to problems with sampling. I'm calling BS on this one being anything of any real significance. Less of a win than UTI or STIs.
    As for the risks and adverse side effects. I've already talked about reduced sexual pleasure. Often poo-poo'd by institutions who have an interest in saying circumcision is the best human enhancement since haircuts, but there is evidence to suggest there is truth to it. There's also the fact that the procedure can go wrong. Of course, it's rare, but it's pretty horrific when it does go wrong. Less than 1% of millions of men is still thousands of men who may have total loss of the use of their penis, significant damage to their penis, or no penis at all for the rest of their life.
    Well, according to the actual report, they'e referring to penile cancer, for which the risk of development is 0.0009-0.0010% annually. So, yes, the risk is low. However, they do still say that the risk of contracting penile cancer is three times as great for an uncircumcised penis than a circumcised one, so the risk is still increased, even if it is still low, and given the large sample size present in the Earth, I think that may be a valid cause for consideration for some, just as you were saying with regards to the chance of complications. However, it should be noted that the most frequent (and vast majority of) complications are bleeding and infection, both easily handled, and all other types, such as removing too much of the penis, are so rare they are only known to exist as isolated case studies, though I've never heard (in the report or elsewhere) of an entire penis being accidentally removed during a circumcision. Therefore, the risk of penile cancer arguably holds more weight than the risk of complications in the decision to circumcise or not.



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    Let's get funky! Gama's Avatar Former Head Administrator
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    Default Re: American Academy of Pediatrics: Benefits of Male Circumcision Outweigh Risks

    Quote Originally Posted by Green Zubat View Post
    Are you accusing the AAP of more or less twisting results for profit? Because that's a serious claim, which you should really have some kind of proof to back up, if that's the case. You can't just disregard research because of bias. Everyone's biased, one way or another, but it doesn't mean we can't get good scientific evidence.
    Actually, I didn't say they are doing that. I was merely pointing out that they do have a very clear incentive to find results that weigh on the side that they have. It is also the case that almost every authority (medical or otherwise) that finds in favour of circumcision actually has an incentive: with medical institutions, it's typically the privatised ones that find this where state funded are much less likely to do so. I'm not saying this means their findings are bogus. I'm saying we should be aware of people's biases when reading what they've written. In this case we should be aware that they are more likely to find circumcision good than bad because that's what they want to find. I didn't say it's out-and-out comprehensively proved bias, but I did say they have pretty high pay off and pretty small risk for finding circumcision to be positive since it's such a grey area. I hope that's clear.


    So yes, circumcision isn't the be all and end all of sexual health, but it does seem to be able to contribute.
    I'm not sure if this is supposed to be disagreeing with something I've said. I did say that it does make a difference. All I said was that in countries were sexual health and awareness are high (such as the US where this study has been carried out) the difference is pretty minor. My opinion is that the difference is minor enough that the benefits don't actually outweigh the harms. In fact, the vast majority of research into circumcision suggests that neither the harms nor the benefits of circumcision really outweighs the other. I explained in my last post why I think this means infant circumcision is bad (I have nothing against adult circumcision), but I'll reiterate it at the end of this post.



    Well, according to the actual report, they'e referring to penile cancer, for which the risk of development is 0.0009-0.0010% annually. So, yes, the risk is low. However, they do still say that the risk of contracting penile cancer is three times as great for an uncircumcised penis than a circumcised one, so the risk is still increased, even if it is still low, and given the large sample size present in the Earth, I think that may be a valid cause for consideration for some, just as you were saying with regards to the chance of complications. However, it should be noted that the most frequent (and vast majority of) complications are bleeding and infection, both easily handled, and all other types, such as removing too much of the penis, are so rare they are only known to exist as isolated case studies, though I've never heard (in the report or elsewhere) of an entire penis being accidentally removed during a circumcision. Therefore, the risk of penile cancer arguably holds more weight than the risk of complications in the decision to circumcise or not.
    First of all, if the risk of cancer is already 0.001% (to generously use your higher figure) and circumcision reduces it to somewhere around 0.0003% then that's a 0.0007% reduction in that risk. The chances of complications are "less than 1%", which in a study that is trying to show that circumcision is a good thing (which the conclusion of this study indisputably is - that's not a bias concern, that's a fact) basically means 0.5% at the very least, but probably more. Assuming (again generously) that it's closer to 0.5% than 1%, that's still a 0.5% increase in the chance of damage of some kind to the penis in exchange for a 0.0007% reduction in the chance of penile cancer.

    I suppose your point lies more, however, in the suggestion that the most likely negative effects on the penis are much less serious than the most likely forms and severities of penile cancer. I have actually heard of cases of penises being entirely or almost entirely removed by accident in circumcision, though I don't have statistics for it, and I suspect you are correct that this is in a minority of cases. I am concerned by your trivialisation of the majority of complications in circumcision. Even minor infections and damages can lead to serious problems later in life. There's also an enormous spectrum between complete loss of the penis and tiny amounts of damage - as infant penises are generally very small, so larger mistakes than you would assume can be made with very small slips. That's why it's always recommended that a very experienced surgeon performs these procedures.

    Additionally, penile cancer ranges enormously in severity. Generally cancers of extremities (such as the penis) are the easiest to deal with. Of course, severe penile cancer is still really really bad, but most penile cancer is not severe penile cancer. Most penile cancer is reasonably mild, which is one of the easiest cancers to treat (though, of course, still pretty unpleasant).

    I'm also guessing that you have no objection to what I've said about the evidence that circumcision is likely to lead to reductions in sexual pleasure later in life, which is obviously a harm.

    I'm not trying to suggest that circumcision is a medically negative procedure to perform. All I'm saying is that this article has not convinced me that the benefits outweigh the harms by any meaningful amount. That's not that controversial. Even in light of this evidence, it still remains the case that every single medical authority in the world, including this one, advise against routine infant circumcision. This does not mean (as this article kind of makes it sound) that they advise against the decision being taken out of the hands of parents. It means that they advise against infant circumcision in every case without unusual circumstances. This clearly means that the benefits don't outweight the risks by the amount that this article suggests.

    For me, the negligible difference between benefits and harms is enough to say that infant circumcision should not be performed. I simply don't think it's right that a perfectly healthy baby boy (and I think "perfectly healthy" is important here) should, before he is able to give any consent, have his genitalia cut apart. Having bits of you removed without your permission is a harm in itself (unless those bits are shown to be actively harmful to you, which is not the case here), and so is the fact that there is long term pain. (I'm talking a couple of weeks here, I don't mean long term like in later life.) There's also the fact that there could be complications (let's remember that statistics mean nothing for the individual - your son could be the one in 1000 who ends up living the rest of his life with moderate to severe damage to his penis) and that it is likely to result in a reduction in sexual pleasure. I don't think this is a choice that someone should have made for them. I do not think it is right that babies should have bits of them cut off unless not doing so would cause them real and significant harm (enough harm for the global medical consensus to be that the procedure should be performed routinely, in fact).

    As I said before, it's also simply true that most infant circumcisions are not performed on the basis of a medical balance of harms. Most of them are performed because cultures where they are common are often disgusted by foreskins, and parents find the idea of their son having a foreskin gross.
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  12. #12
    Registered User SmearglePaints's Avatar
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    Default Re: American Academy of Pediatrics: Benefits of Male Circumcision Outweigh Risks

    Quote Originally Posted by Green Zubat View Post
    A dismissive one-liner from a single forum-goer with no evidence vs. a well-respected scientific institution that has undertaken painstaking research and been completely transparent about it's findings: I wonder who we should believe ...
    The study behind the African research into the subject has been shown to be faulty and biased. There really is no evidence whatsoever that circumcision is in any way significantly beneficial to one's health.
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    Have a pancake. Green Zubat's Avatar
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    Default Re: American Academy of Pediatrics: Benefits of Male Circumcision Outweigh Risks

    Quote Originally Posted by G-Mama View Post
    Quote Originally Posted by Green Zubat View Post
    Are you accusing the AAP of more or less twisting results for profit? Because that's a serious claim, which you should really have some kind of proof to back up, if that's the case. You can't just disregard research because of bias. Everyone's biased, one way or another, but it doesn't mean we can't get good scientific evidence.
    Actually, I didn't say they are doing that. I was merely pointing out that they do have a very clear incentive to find results that weigh on the side that they have. It is also the case that almost every authority (medical or otherwise) that finds in favour of circumcision actually has an incentive: with medical institutions, it's typically the privatised ones that find this where state funded are much less likely to do so. I'm not saying this means their findings are bogus. I'm saying we should be aware of people's biases when reading what they've written. In this case we should be aware that they are more likely to find circumcision good than bad because that's what they want to find. I didn't say it's out-and-out comprehensively proved bias, but I did say they have pretty high pay off and pretty small risk for finding circumcision to be positive since it's such a grey area. I hope that's clear.
    Just checking.

    So yes, circumcision isn't the be all and end all of sexual health, but it does seem to be able to contribute.
    I'm not sure if this is supposed to be disagreeing with something I've said. I did say that it does make a difference. All I said was that in countries were sexual health and awareness are high (such as the US where this study has been carried out) the difference is pretty minor. My opinion is that the difference is minor enough that the benefits don't actually outweigh the harms. In fact, the vast majority of research into circumcision suggests that neither the harms nor the benefits of circumcision really outweighs the other. I explained in my last post why I think this means infant circumcision is bad (I have nothing against adult circumcision), but I'll reiterate it at the end of this post.
    Well, according to the actual report, they'e referring to penile cancer, for which the risk of development is 0.0009-0.0010% annually. So, yes, the risk is low. However, they do still say that the risk of contracting penile cancer is three times as great for an uncircumcised penis than a circumcised one, so the risk is still increased, even if it is still low, and given the large sample size present in the Earth, I think that may be a valid cause for consideration for some, just as you were saying with regards to the chance of complications. However, it should be noted that the most frequent (and vast majority of) complications are bleeding and infection, both easily handled, and all other types, such as removing too much of the penis, are so rare they are only known to exist as isolated case studies, though I've never heard (in the report or elsewhere) of an entire penis being accidentally removed during a circumcision. Therefore, the risk of penile cancer arguably holds more weight than the risk of complications in the decision to circumcise or not.
    [ ... ]

    I suppose your point lies more, however, in the suggestion that the most likely negative effects on the penis are much less serious than the most likely forms and severities of penile cancer. I have actually heard of cases of penises being entirely or almost entirely removed by accident in circumcision, though I don't have statistics for it, and I suspect you are correct that this is in a minority of cases. I am concerned by your trivialisation of the majority of complications in circumcision. Even minor infections and damages can lead to serious problems later in life.

    There's also an enormous spectrum between complete loss of the penis and tiny amounts of damage - as infant penises are generally very small, so larger mistakes than you would assume can be made with very small slips. That's why it's always recommended that a very experienced surgeon performs these procedures.
    With regards to infection, the report notes that "most of these infections are minor and are manifest only by some local redness and purulence", the latter of which--I imagine--is easily handled. Also, I think it is worth noting that the most common complication of circumcisions (bleeding) has an estimated incidence rate of "~0.1%". Anaesthesia awareness, in which one wakes up on the operating table, and can occur with even the most minor operations requiring general anaesthesia, has an estimated incidence rate of 0.13-0.0068, a 0.0684% incidence rate on average. Considering that many people are happy to take the latter risk, even for operations they can live happily without, I think it's understandable that some may choose to take the risk of infection, which is much more minor and of a very similar incidence.

    I'm not trying to suggest that circumcision is a medically negative procedure to perform. All I'm saying is that this article has not convinced me that the benefits outweigh the harms by any meaningful amount. That's not that controversial. Even in light of this evidence, it still remains the case that every single medical authority in the world, including this one, advise against routine infant circumcision. This does not mean (as this article kind of makes it sound) that they advise against the decision being taken out of the hands of parents. It means that they advise against infant circumcision in every case without unusual circumstances. This clearly means that the benefits don't outweight the risks by the amount that this article suggests.
    Well, to me it seems that both the risks and potential benefits are small enough to be left up to the parents.

    For me, the negligible difference between benefits and harms is enough to say that infant circumcision should not be performed. I simply don't think it's right that a perfectly healthy baby boy (and I think "perfectly healthy" is important here) should, before he is able to give any consent, have his genitalia cut apart. Having bits of you removed without your permission is a harm in itself (unless those bits are shown to be actively harmful to you, which is not the case here), and so is the fact that there is long term pain. (I'm talking a couple of weeks here, I don't mean long term like in later life.) There's also the fact that there could be complications (let's remember that statistics mean nothing for the individual - your son could be the one in 1000 who ends up living the rest of his life with moderate to severe damage to his penis)
    I think that's a large exaggeration, given how many circumcisions have been performed over the centuries, and how few of those have ended in such complications (isolated cases versus billions of circumcisions). And statistics can mean a lot to the individual. They'd mean a lot to me, that's for sure. See above.

    As I said before, it's also simply true that most infant circumcisions are not performed on the basis of a medical balance of harms. Most of them are performed because cultures where they are common are often disgusted by foreskins, and parents find the idea of their son having a foreskin gross.
    I don't think that their motivations don't matter in this case. Either choice is acceptable with regards to the previous discussion of harms vs. benefits, IMO.

    I'm also guessing that you have no objection to what I've said about the evidence that circumcision is likely to lead to reductions in sexual pleasure later in life, which is obviously a harm.
    and that it is likely to result in a reduction in sexual pleasure.
    Well, I was only addressing the points I was particularly bothered by. But for what it's worth, I'm sceptical of the veracity of this claim. Whilst I could understand the logic behind this, there are billions of men who have lived perfectly happy lives circumcised. The AAP report notes that this is a poorly researched area, with conflicting evidence. The examples they give are: a self-report survey, which reported more varied sexual practice and lowered sexual dysfunction for circumcised men; anecdotal evidence of reduced penile sensation & sexual satisfaction in circumcised men. THey also referenced a book (Human Sexual Response, 1966, by WH Masters & VE Johnson), which reported no difference in sensation upon light tactile stimulation between circumcised and uncircumcised males. A study I came across from Hawaii University confirmed all of this, but also added that (for what it's worth) this may be advantageous towards "men and women more troubled by premature ejaculation than concerned with increased penile sensitivity".

    To conclude, it appears that there is currently not enough evidence to make a case for or against circumcision, with regards to penile sensation.

    Quote Originally Posted by SmearglePaints View Post
    Quote Originally Posted by Green Zubat View Post
    A dismissive one-liner from a single forum-goer with no evidence vs. a well-respected scientific institution that has undertaken painstaking research and been completely transparent about it's findings: I wonder who we should believe ...
    The study behind the African research into the subject has been shown to be faulty and biased.
    You keep saying this, but still do not provide evidence or references ...

    There really is no evidence whatsoever that circumcision is in any way significantly beneficial to one's health.
    Well, the AAP report (which, according to the article, is a review of over 1000 different studies, and hence should be very reliable) begs to differ.
    Last edited by Green Zubat; 10th September 2012 at 03:58 PM.



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  14. #14
    Let's get funky! Gama's Avatar Former Head Administrator
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    Default Re: American Academy of Pediatrics: Benefits of Male Circumcision Outweigh Risks

    @Green Zubat;

    I'm not going to address all of what you've said individually because we actually seem to agree on the main body of what's been said: there's not a massive harm or benefit on either side.

    I will note that when I say "statistics mean nothing for the individual", what I mean is that even if there is only a 1 in 1000000000 chance of something happening, it doesn't actually mean anything for an individual. As long as the chance is not zero, you can be that one. My point was merely that people often read "low chance" as "no chance", which simply isn't true.

    I would also like to point out that you refer to the fact that there are "billions of men who have lived perfectly happy lives circumcised". Well, of course there are. I never claimed that any of the effects of circumcision would be enough to ruin your life. All I said was that it could be enough to have a distinct negative effect on your life. Some forms of female circumcision have little effect other than reducing sexual pleasure later in life, but they're still pretty much universally regarded as abhorrent. The fact is that it is pretty much impossible to carry out a scientifically accurate study on whether circumcision does reduce sexual pleasure or not: most studies have documented the difference between men before and after they are circumcised, which means it's adult circumcisions. Otherwise they'd have to test between the sexual pleasure of different men, which is pretty damn difficult to do accurately, even with an enormous sample size. The fact is there is evidence to suggest that it does have an impact, although it is very far from conclusive evidence it should not be ignored.

    My concern is more that I don't think it is right that someone else should make this kind of decision for you, even if they are your parents. I don't think parents should put their children forward for any kind of surgery that is not actively recommended doctors, rather than just not advised against, so I don't think the fact that people are willing to put themselves forward for other unnecessary surgery makes it OK to put your children forward for infant circumcision. Sure, if you're an adult and you wanna get circumcised - why would I object to that? It's your penis, do what you want with it. (As far as it concerns only you, obviously, I'm not advocating rape here.) I don't think parents have the right to make this choice for their child. Why should they?

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    Fairy Queen Kaori's Avatar Forum Head
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    Default Re: American Academy of Pediatrics: Benefits of Male Circumcision Outweigh Risks

    As I have maintained in discussions about this otherwise, when the margin between the benefits and risks are so small and there is no proven need for circumcision to take place on healthy boys I find it incredibly wrong that parents are permitted and even encouraged to make decisions about the condition of their child's genitalia for no considerable and proven reason other than cosmetic standards they were conditioned with. The idea that I could have a son one day and decide to have his foreskin removed for no necessary reason honestly alarms and sickens me. Whether it's safer young than old or not, genitalia are, as we currently stand, very personal and private body parts and I'm pretty sure consent of the person in question should be required before anything is done to their genitalia unless it is a proven matter of health, especially if it is a cosmetic matter. Until I see a clear, large and otherwise unavoidable risk in leaving boys uncircumcised I refuse to believe that is it acceptable for parents to remove a part of their child's body for reasons that aren't crucial to health.
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