AT LAST! THE AAP STATEMENT ON CIRCUMCISION

Avatar for geedee99
iVillage Member
Registered: 07-07-2003
AT LAST! THE AAP STATEMENT ON CIRCUMCISION
13
Tue, 08-28-2012 - 5:27am

Abstract

Male circumcision is a common procedure, generally performed during the newborn period in the United States. In 2007, the American Academy of Pediatrics (AAP) formed a multidisciplinary task force of AAP members and other stakeholders to evaluate the recent evidence on male circumcision and update the Academy's 1999 recommendations in this area. Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks and that the procedure's benefits justify access to this procedure for families who choose it. Specific benefits identified included prevention of urinary tract infections, penile cancer, and transmission of some sexually transmitted infections, including HIV. The American College of Obstetricians and Gynecologists has endorsed this statement.
 
Policy Statement 

Systematic evaluation of English-language peer-reviewed literature from 1995 through 2010 indicates that preventive health benefits of elective circumcision of male newborns outweigh the risks of the procedure. Benefits include significant reductions in the risk of urinary tract infection in the first year of life and, subsequently, in the risk of heterosexual acquisition of HIV and the transmission of other sexually transmitted infections.

The procedure is well tolerated when performed by trained professionals under sterile conditions with appropriate pain management. Complications are infrequent; most are minor, and severe complications are rare. Male circumcision performed during the newborn period has considerably lower complication rates than when performed later in life.
 
Although health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it and to warrant third-party payment for circumcision of male newborns. It is important that clinicians routinely inform parents of the health benefits and risks of male newborn circumcision in an unbiased and accurate manner.

Parents ultimately should decide whether circumcision is in the best interests of their male child. They will need to weigh medical information in the context of their own religious, ethical, and cultural beliefs and practices. The medical benefits alone may not outweigh these other considerations for individual families.

This gives me all I could wish for, all I've believed in and been preaching for many years. It flattens for good the claim that; 'there are no benefits from circumcising baby boys'. At the same time it acknowleges that, for a variety of reasons, circumcision may be an anathema to some parents and I've always allowed for that.

Circumcise if you believe it is best for your boys and don't if you don't.

It is a good day for us all. Peace at last on this issue I hope!

Tony

 

 

 

 


 

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Avatar for islaywhisky
iVillage Member
Registered: 01-06-2002
Fri, 09-21-2012 - 10:35pm

Tony,

"How about the 30,000 or so who have circumcisions on the NHS (as a last resirt) and 'refugees' from it who go privately because they are refused on NHS or put on an eternal waiting list?"

Misdiagnosed phimosis, mainly - plus others who seek circumcision for themselves. Also there are GPs and urologists who have a predilection for circumcised penises who will insist on surgery rather than attempt less invasive methods first.

Of the 30+ million males in the UK, 30,000 is a very small percentage.

As for 'self-cleaning', yes of course, we will agree to differ as usual.

I did get your PM - and your email. I will reply to the latter as soon as I can.

Christopher

"Education is the discovery of our own ignorance." Will Durant


"Almost any manmade phenomenon i

Avatar for geedee99
iVillage Member
Registered: 07-07-2003
Fri, 09-21-2012 - 3:45am

 

Christopher

At the risk of continuing a debate, you said: 

"If even a small but significant number of boys grew up with penile adult problems in the manner you described, I would give it food for thought."

How about the 30,000 or so who have circumcisions on the NHS (as a last resirt) and 'refugees' from it who go privately because they are refused on NHS or put on an eternal waiting list?

You've made your case in favour of 'self cleaning', I've made mine opposing it. Let's amicably agree to differ as usual.

Tony

PS did you get my PM in reply to yours? 

Avatar for islaywhisky
iVillage Member
Registered: 01-06-2002
Fri, 09-21-2012 - 12:41am

Tony, I thoroughly enjoyed your reply and thank you for  taking the time to do so. I will leave it for others to read and assimilate all you said, also. :smileyhappy:

The main point I feel free to discuss (because it does not directly oppose circumcision) is the concept of a self-cleaning, intact penis. You know as well as I that British boys are not taught by their parents to match the American notion of genital 'cleanliness' for intact boys (or men) by the three Rs rule - "retract, rinse, replace". It's the single concept I take issue with among American parents bringing up intact boys. It gives fuel to the idea that a penis with a foreskin is somehow 'dirty'.

Our Brtish boys live their lives with never a thought to a 'three Rs' rule! Why? Because nature designs their penises perfectly to self-clean. How? Fresh smegma... translucent, odourless and with anti-bacterial properties which fight infection. It is replenished in a continual cycle to keep the penis healthy.

If even a small but significant number of boys grew up with penile adult problems in the manner you described, I would give it food for thought. But we all have age-related anatomy issues as time goes by. The penis is the least of them. 

Christopher

"Education is the discovery of our own ignorance." Will Durant


"Almost any manmade phenomenon i

Avatar for geedee99
iVillage Member
Registered: 07-07-2003
Re: AT LAST! THE AAP STATEMENT ON CIRCUMCISION
Thu, 09-20-2012 - 5:17am

Hi Christopher

Sorry this reply to an earlier message from you in this tread has taken a while 

I'll follow up by paste and reply too

CHRISTOPHER: "The NHS has never been 'national' always a postcode lottery..."

ME: "I used that as a current figure of speech - I know postcodes didn't arise until the 1960s but the NHS was never regionally consistent. Pre NHS, every town had its own locally run and funded hospital and vied with its neighbours to be the best. Lot's of people gave their time free; professionals like accountants would do audits or architects, surveyors and builders would carry out maintenance. The whole community were involved in fund-raising activities. Relatives provided food for patients to augment the basic diet. The result of this was that some hospitals were better than others and practices and procedures varied. The NHS absorbed this overnight but inconsistencies continue to the present day. 

I loved your story about communications by wire' and single digit telephone numbers. Life moved at a different pace then. You travelled by ship today you would fly. Pre war when the Royal Mail was efficient, people regularly sent post cards in the morning advising relatives they would be visiting for tea that same day!" 

ME: "It is an interesting speculation as to how you would have coped with circumcision aged six and whether it would have given you a different perspective on its efficacy? Who knows you may have ended up on the support side as CL at iVillage. ;-)"

CHRISTOPHER: "Did you mean when I was older, overhearing my parents' conversation? At six years old in South Africa I suffered abuse that has lived with me ever since and was the catalyst behind my present advocacy for genital integrity. (Google 'The Whole Network a Child's Cry'). If you meant the conversation years later to have me circumcised when I was still a boy... well, who knows (as you said). But through no fault of my own, I didn't have a perfect penis. It was damaged. Do you see?"

ME: "No, I meant if you had been circumcised at six, once over it, you would not have had the years to dwell on your problem with an adult's mature perspective. In middle age we start to look back and speculate on what might have been if life had taken even a minor different turn. The physical problem was only settled much more painfully for you in adulthood. This surely amplified your distress and created your anti-circumcision mindset - the mental aspect lingers on. Young developing children mostly seem to cope with and accept their circumcision, put it behind them and get on with their lives. They forget about it because there are many more exciting things happening to them in formative years.. Some become proud and pleased with their 'new wilily' - as I did even without parental explanation. I'm fine with being circumcised, glad it happened and therefore recommend it to anyone who asks. But I do allow there are those like yourself who don't share my enthusiasm and give negative advice. As long as people and especially parents have CHOICE.

CHRISTOPHER: "How have others PMd you? I have tried to do just that, but you aren't 'clickable'. I need to PM you, Tony."

ME: This was before the board was revamped and also on other parenting sites where I have posted my advocacy of circumcision. I have my profile ticked to receive PM (just checked it!) but have never received any PMs since the board makeover. Obviously, as you have now discovered, it is not working. I'll have to ask iVillage to investigate. UPDATE "Now partially fixed by iVillage - we are in touch but issues remain with PM. They are still working on it"

ME: "When I asked the nurse 'Why?' she just said "It's better for you like that because that part (pointing to the glans) now gets washed every time you have a bath." Later, I remember feeling a bit weepy and falling asleep."

CHRISTOPHER:: "I presume your parents were able to have you circumcised privately, 

ME: "No - I was circumcised under the NHS whilst conveniently in hospital recovering from pneumonia. I imagine the hospital recommended it when my tight and hitherto un-retracted foreskin was discovered during bath time. In those days if there was any suspicion the foreskin was likely to 'give trouble later on' they didn't leave it to chance, they just circumcised you.. In a textbook of the time it is described as 'a trivial operation, taking only a few minutes.'  The other possibility is that my parents had been unable to get me circumcised as a baby - anti circ GP or they had a change of heart when I was already in hospital and seized the opportunity to ask for it, the nurse/doctors being more compliant in this matter. As I said the NHS is inconsistent I'd bet some parents have still got it done today on a referral from a pro circa doctor (and there are a few!) who could pull strings with a like minded surgeon.'

CHRISTOPHER: "In any event, it surprises me that an English nurse would tell you that. Unlike American nurses, she should have known that a normal penis is is self-cleansing. 

ME: "Not so back then, These opinions only formed gradually. Remember, even today, nurses see a lot of cases where the foreskin is infected and fails to function properly. Circumcision is still one of the most frequently performed simple day case male procedures. Also from my observation. all who encounter and suffer from foreskin problems suggest it is far from self-cleansing. A doctor I encountered who worked in a genitro-urinary clinic said  he saw many patients who left the area under the foreskin unwashed and retraction revealed things in a disgusting state. Likewise a nurse I knew who worked on a 'Men's Ward'. She said no self respecting woman should be required to accommodate such an organ.  So we'll have to differ on that one"  

CHRISTOPHER: Your last sentence, above, touched me."Not only did it look better but, like them. I could now pee in a neat jet instead of spraying all over the place. This suggests your foreskin had not yet retracted naturally... some boys, as you know, do not reach this stage until puberty. Did your foreskin 'balloon'?  

ME: I don't remember. I don't think so"….

 

Tony

Avatar for islaywhisky
iVillage Member
Registered: 01-06-2002
Wed, 09-12-2012 - 8:58pm

Applesaws, would you be willing to copy/paste your post onto the Circumcision Debate section of this board (bar your last paragraph of course)?

It would be greatly appreciated and you can be assured of polite responses in an atmosphere of healthy debate which need not be prolonged unless you feel content to visit more than a couple of times.

Tony and I are co-CLs of the 'Circumcision' board. We have exchanged views and comments in this Support section which we both hope are of interest to parents and others who advocate circumcision. I understand that you may consider my input an intrusion, but I have been very careful to take a disinterested stance - coupled with my belief that every caring parent makes decisions in love for their children.

Any visitor looking for answers and/or support will find it here. Tony is a fund of knowledge. And those with valuable input of their own to add will give weight and influence to the purpose of this section under its overall 'Circumcision' heading. It was the absence of participation that prompted Tony and me to give it a kick up the backside! The more input from others, the less you will see of me, I promise - unless it's to say an honest, "Well done!"

Christopher

"Education is the discovery of our own ignorance." Will Durant


"Almost any manmade phenomenon i

Avatar for islaywhisky
iVillage Member
Registered: 01-06-2002
Wed, 09-12-2012 - 7:25pm

Hi Tony,

I know how day-to-day commitments inevitably take precedence. I look forward to your reply regarding my last post; thank you.

Yes, it's very strange that neither of us can PM each other! Before I contact iVillage technical support I will double check my profile to confirm my preference for PM contact hasn't inadvertently changed without my knowledge.

Best wishes,

Christopher

"Education is the discovery of our own ignorance." Will Durant


"Almost any manmade phenomenon i

Avatar for geedee99
iVillage Member
Registered: 07-07-2003
Re: AT LAST! THE AAP STATEMENT ON CIRCUMCISION
Wed, 09-12-2012 - 11:37am

Hi Christopher.

Sorry I haven't been around for a few days - busy with the 'day job' which I can't give up.

I would be happy to receive a PM from you through which we could exchange e-mail addresses for direct contact. I really don't know why you can't PM me because this box inviting PMs is checked on my profile. Likewise I have clicked your live name link and cannot find anywhere on your profile page indicating I can send a PM to you.

I'm going to contact iVillage moderators about this anomally. Perhaps you could do the same. Mention me in so doing if you wish.

I've replied to questions in your last long post which I will put up on the board later when I've checked it out.

Regards, Tony

 

 

 

Avatar for geedee99
iVillage Member
Registered: 07-07-2003
Sat, 09-01-2012 - 6:18am

Hi Christopher

Thank you for your interesting response and points you made - some of which I was aware but didn't want to make my long post any longer as readers might lose interest. Now as I check read this I realise I've written another long epistle!

I was circumcised on the NHS at the age of eight and I think it took a good many years after Gairdner's paper before circumcision on parental request ended finally ended everywhere. The NHS has never been 'national' always a postcode lottery with veering standards and practices. In fact one mother I know locally had three boys done soon after birth during the nineteen sixties - without any problem. Compliant GP I believe. 

It is an interesting speculation as to how you would have coped with circumcision aged six and whether it would have given you a different perspective on its efficacy? Who knows you may have ended up on the support side as CL at iVillage. ;-)

Over the years, several moms, knowing my story, have PMd me for advice when having boys who needed to be circumcised in childhood. I have always encouraged them to go for it sooner, rather than later. IMHO the gamble of 'growing out of it' often ends in disappointment and pain - as it did for you. These moms have frequently updated me and, having followed my age related advice; especially about being honest but positive in explanation, most seem to have come through the experience far better the mom feared.

My recall of my own experience wasn't particularly traumatic partly because neither parents nor hospital explained anything before hand. I guess each left it to they other. So no anticipatory fear. The nurses just wheeled me into a treatment room gave me a local - the only 'ouch!' I remember feeling, but memories of more may have faded. 

Shortly afterwards I was back on the ward, sitting on the side of my bed with a nurse urging me to pass water into a bowl. Looking down at my strange penis with its mauve bullet head came as quite a shock. Whilst I'd seen circumcised penises on many school friends and my dad. The consensus was that you were born that way…or not. Because my dad was circumcised, I guess it never occurred to my parents to teach me about retraction and hygiene. They were always also very reticent about talking about private parts. Consequently, I'd never seen my glans before and it was another shock when I peed and it was tinged with blood. I realised I'd been cut! When I asked the nurse 'Why?' she just said "It's better for you like that because that part (pointing to the glans) now gets washed every time you have a bath." Later, I remember feeling a bit weepy and falling asleep. 

Walking out next day when my parents came to collect me was very uncomfortable but I never mentioned it. By then I was happily accepting my 'new' willy which now matched those I'd admired on my friends. Not only did it look better but, like them. I could now pee in a neat jet instead of spraying all over the place.  Subsequently when I addressed the same question 'Why?' to my mother it was deflected with; "You'll understand when you are older!" I never dared ask my dad about it. I instinctively knew they were too embarrassed to discuss it.

As a result of this I think parents who circumcise their boys have a duty to explain what has been done to them as soon as they are able understand the simplest detail; that they look different from some boys and both are OK. Ideally, before they encounter it. This basic stuff should be augmented later always putting a positive spin on the benefits - now made a whole lot easier because of the AAP statement. This should help them come to terms with not having had a say in the matter and make them comfortable with this aspect of body image their parents chose for them.

Christopher, I was aware that those NHS hospitals who offer a circumcision service* for muslims africans and jews, did charge an 'at cost fee' in the range of £60-£120 (one in Birmingham of which I read, does them free!) As a taxpayer and highly impressed recent user of our local NHS, I've no quibble with this charge - even at the top end, but especially in light of AAP and future treatment cost savings, they should offer it ALL on maternity wards. This should be followed up with posters and leaflets in GP family health centres. Unfortunately such information is currently targeted only at ethnic information areas. Presumably, in the name of equality, these circumcision clinics could not refuse this service to white indigenous parents with no religious or culture tribal reasons to do it. Maybe 'successive family preference' is also covered by the latter? I wonder and I'm tempted to call and ask.

 

Tony

 

* And the reason: To avoid these boys being circumcised at 'uncle the barbers' in back street non sterile conditions without any appropriate or  sterilised equipment. These procedures often ended up with complications and poor results which the NHS is obliged to deal with free of a charge. It should be here be said that the jews do train their circumcisers to a very high standard before they are qualified. Many are also medical professionals. So Jewish circumcision complications are rare. These servants are called môhels or if female, môhelets - though let's be clear, both only operate on boys! There's no FGM (Female Genital Mutilation.) in Judaism 

 

 

 

 

 

  

Avatar for islaywhisky
iVillage Member
Registered: 01-06-2002
Fri, 08-31-2012 - 8:40pm

Tony...

Thank you for your lengthy reply. It will give visitors to this board an insight into the UK's history of circumcision together with a potted history of our NHS. We are blessed with a national health service second to none, for which the huge majority of our population are eternally grateful.

Unsurprisingly, you and I share a similar knowledge of events which I have also used on internet circumcision discussion boards. I should mention, though, that the NHS in its infancy actually did provide free circumcision surgery for several months before Dr Gairdner's classic article was published and turned the practice on its tail in 1949.

[As a by-the-by, it was in that interim period that I overheard a short conversation between my parents which has stayed in my memory ever since.. You are aware, I think, that it was a severe acquired phimosis following abuse and subsequent injury to my foreskin as a 6 year old in South Africa, that led to my circumcision in adulthood. Well, I heard  Mum ask my Dad, "Should we circumcise Christopher?" I was older by then but I had no idea what she meant except it had something to do with my 'willy'. He replied, "No, I don't think so. He may grow out of it," or words to that effect. I do wonder now if it was the right decision - though the trauma for me at that age would have been far in excess of that I suffered as an unwilling but understanding adult.]

The ethnic groups who receive a circumcision service from the NHS have to pay for the operation, albeit at a lesser rate than a private hospital would charge. And the reason it's given is to offset the incidence of non-professional surgery and it's consequent dangers.

Antibiotics work for the rare occasions when penile infection occurs, circumcised or not. It did for me - after circumcision.

I'm not holding my breath, either. We would both be in pickle!

Christopher

"Education is the discovery of our own ignorance." Will Durant


"Almost any manmade phenomenon i

Avatar for geedee99
iVillage Member
Registered: 07-07-2003
Fri, 08-31-2012 - 3:44am

Christopher - Long answer to your question.

It comes as no surprise to me that the media in the UK are deathly silent on the AAP statement.

Pre 1948 and the advent of the NHS, circumcision was a fashionable prophylactic procedure and the obvious simple cure for foreskin infections and phimosis. Remember, no antibiotics, no steroid creams, no 'wait and see' back then. Doctors were busy people. They did their surgery either in the home or at their premises, also known as the 'surgery' (or their 'office' for our US readers.) In either case he/she would often be assisted by the Midwife or District Nurse. Doctors charged patients for their services and practised 'social discretion' - often reducing their fee or 'forgetting' to bill poor patients and charging wealthy patients more. Aspiring middle class parents were sometimes pleased to announce they'd had their son circumcised as it was a proof of status, ie, they could afford it. 

The NHS ended all that. All surgery was moved into hospitals A&E where doctors were required to put in a few hours every week doing their minor work as before. This service was free for all who attended and doctors weren't paid directly for it but given an annual per capita fee for every patient registered with them, regardless of whether they ever saw or treated them. This killed any incentive for some to do more than was required, so they ceased to recommend prophylactic circumcision. For parents, circumcisions were no longer done in the home on a doctor's round. Now it often meant trekking across town to attend the hospital's crowded, chaotic AE department. Such appointments were often never made, missed, delayed or forgotten about, so far fewer boys were circumcised. This saved the cash-strapped NHS money in busy A&E (or 'casualty') departments who were slowly adjusting to this sensational revolution

All this chimed with Gairdner's famous paper in 1949: 'The Fate of the Foreskin*'. His contention was that phimosis was frequently misdiagnosed in infants and many boys were being circumcised unnecessarily. Medical schools took this 'latest thinking' on board and as the new generation of doctors gradually emerged, who didn't do any minor surgery, and the old school who did, slowly retired, circumcision came to be seen as 'outdated and unnecessary.'  

(* Google it for info. and, BTW, I agree with his findings but there are many other good reasons to circumcise anyway, as the AAP has now belatedly acknowledged)

Whilst in the USA, circumcision has continued as 'the thing to do', for the majority of parents, UK parents didn't have the option because our NHS delisted prophylactic circumcision on parental request from their treatments and doctors would only sanction circumcision if necessary. It should be said that this process took several decades to be almost universal. A few older and wiser doctors and dissenters from this policy would still continue to oblige parents by referring their sons for circumcision where the hospital surgeon was compliant and didn't question its validity.

About twenty years ago, the American anti-circumcision movement sent missionaries to UK shores where they had more success in reinforcing the anti consensus which had arisen. In many cases they were pushing at an open door and the media trumpeted their propaganda on receptive ears. This has continued to the present day. Their hysterical talk about 'mutilation' and the emotional idea that it is unfair to make this choice for a boy at an age when he has no say in it, has created a mindset that circumcision is a terrible misfortune to befall him - even when it is, in the extreme, necessary to avoid suffering.

But for the increasing muslim, African and Jewish people in our population, the circumcised male would have become an endangered species. But, thanks to a growing demand from these ethnic groups, which has been met by the NHS in some areas, (not widely advertised) and the private clinics set up to meet their need, this trend has been reversed. White indigenous believers in the benefits of circumcision (like me) are also availing themselves of these services but I don't see it becoming a mainstream trend any time soon.

With the number of boys circumcised on the NHS (30,00 pa.) and the fact this must indicate many times that number who consult with GPs and are sent away with antibiotics and creams or told to wait and see, you would think doctors and the cost conscious NHS would be looking into the recent studies examined by the AAP. Instead, there seems to be a studied dismissal of anything which suggests routine infant circumcision has merit. There seems to be an arrogant expression of superiority in proclaiming 'Not done here!' and that countries like the US or ethnic groups worldwide who circumcise are 'behind the times.' Any supportive evidence is deemed not worthy of scrutiny.

That may change, but I'm not holding my breath!

Tony

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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