Our children deserve to live in a world where they have a reduced chance of contracting HIV, herpes, genital warts, bacterial infections and urinary tract infections.

James_Miller · 2012-08-24T08:10:39+00:00

If you circumcise your male children, they will have a reduced chance of contracting all of these sexually transmitted diseases. Do you really want your child...

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Royal Australasian College of Physicians

After reviewing the currently available evidence, the RACP believes that the frequency of diseases modifiable by circumcision, the level of protection offered by circumcision and the complication rates of circumcision do not warrant routine infant circumcision in Australia and New Zealand. (Page 5)

[download link to PDF file] http://www.racp.edu.au/index.cfm?objectid=65118B16-F145-8B74-236C86100E4E3E8E

British Medical Association

The medical evidence about its health impact is equivocal.

[..]

Nevertheless, normal anatomical and physiological characteristics of the infant foreskin have in the past been misinterpreted as being abnormal. The British Association of Paediatric Surgeons advises that there is rarely a clinical indication for circumcision.

[..]

The medical benefits previously claimed, however, have not been convincingly proven, and it is now widely accepted, including by the BMA, that this surgical procedure has medical and psychological risks. It is essential that doctors perform male circumcision only where this is demonstrably in the best interests of the child.

[..]

Best interests

-Doctors must act in the best interests of the patient.

-Even where they do not decide for themselves, the views that children express are important in determining what is in their best interests.

-The BMA does not believe that parental preference alone constitutes sufficient grounds for performing a surgical procedure on a child unable to express his own view. Parental preference must be weighed in terms of the child’s interests.

-The courts have confirmed that the child’s lifestyle and likely upbringing are relevant factors to take into account. The particular situation of the case needs to be considered.

-Parents must explain and justify requests for circumcision, in terms of the child’s interests.

http://www.bma.org.uk/ethics/consent_and_capacity/malecircumcision2006.jsp

Canadian Pediatric Society

Recommendation: Circumcision of newborns should not be routinely performed.

Validation: This recommendation is in keeping with previous statements on neonatal circumcision by the Canadian Paediatric Society and the American Academy of Pediatrics. The statement was reviewed by the Infectious Disease Committee of the Canadian Paediatric Society. The Board of Directors of the Canadian Paediatric Society has reviewed its content and approved it for publication.

http://www.cps.ca/english/statements/FN/fn96-01.htm

Koninklijke Nederlandsche Maatschappij tot bevordering der Geneeskunst (Royal Dutch Medical Society) or KNMG

This viewpoint by the KNMG is jointly endorsed by the following scientific associations:

The Netherlands Society of General Practitioners
The Netherlands Society of Youth Healthcare Physicians
The Netherlands Association of Paediatric Surgeons
The Netherlands Association of Plastic Surgeons
The Netherlands Association for Paediatric Medicine
The Netherlands Urology Association
The Netherlands Surgeons’ Association

There is no convincing evidence that circumcision is useful or necessary in terms of prevention or hygiene. Partly in the light of the complications which can arise during or after circumcision, circumcision is not justifiable except on medical/therapeutic grounds. Insofar as there are medical benefits, such as a possibly reduced risk of HIV infection, it is reasonable to put off circumcision until the age at which such a risk is relevant and the boy himself can decide about the intervention, or can opt for any available alternatives.

[..]

Non-therapeutic circumcision of male minors conflicts with the child’s right to autonomy and physical integrity.

[..]

Non-therapeutic circumcision of male minors is contrary to the rule that minors may only be exposed to medical treatments if illness or abnormalities are present, or if it can be convincingly demonstrated that the medical intervention is in the interest of the child, as in the case of vaccinations.

[..]

The fact that this is a medically non-essential intervention with a real risk of complications makes the quality of this advice particularly important.

[download link to PDF file] http://knmg.artsennet.nl/web/file?uuid=579e836d-ea83-410f-9889-feb7eda87cd5&owner=a8a9ce0e-f42b-47a5-960e-be08025b7b04&contentid=77976&elementid=771754

Also reported by BBC News

http://www.bbc.co.uk/news/world-europe-15486834

National Coalition for Men, America comments:

"Throughout the world, medical associations have found no medical justification for male circumcision. The British, Canadian, South African, Australian, Dutch, and New Zealand medical associations all found the purported medical benefits to be unfounded, and that the risks and complications outweigh any benefits. The Dutch and South African medical associations even declared infant male circumcision to be harmful, unethical, and a violation of a child's right to bodily integrity....... Religious, cultural, and parental rights end when it comes to someone else's bodily integrity. It's his body, and his choice."

The circumcision as AIDS prevention tool myth has been debunked outside of USA --->

"Our conclusion is that such proposals ignore doubts about the robustness of the evidence from the African random-controlled trials as to the protective effect of circumcision and the practical value of circumcision as a means of HIV control; misrepresent the nature of Australia's HIV epidemic and exaggerate the relevance of the African random-controlled trials findings to it; underestimate the risks and harm of circumcision; and ignore questions of medical ethics and human rights. The notion of circumcision as a ‘surgical vaccine’ is criticised as polemical and unscientific..... Circumcision of infants or other minors has no place among HIV control measures in the Australian and New Zealand context; proposals such as these should be rejected." - Public Health Association of Australia

"That the relationship between circumcision and transmission of HIV is at the very least unclear is illustrated by the fact that the US combines a high prevalence of STDs and HIV infections with a high percentage of routine circumcisions. The Dutch situation is precisely the reverse: a low prevalence of HIV/AIDS combined with a relatively low number of circumcisions. As such, behavioural factors appear to play a far more important role than whether or not one has a foreskin." - Royal Dutch Medical Association

Source: both quotes published in Australian and New Zealand Journal of Public Health

The Journal of Law and Medicine also trashed those studies - claiming selection bias, inadequate blinding, problematic randomization, experimenter bias, lead time bias, supportive bias, participant expectation bias, time-out discrepancy, and lack of investigating of non-sexual HIV transmission among other confounding factors and problems.

[–]thrway_1000 4 points5 points6 points 13 years ago (0 children) | Copy Link

Circumcision Resource:

Videos:

Information About the Cons of Circumcision:

For Jewish Readers:

Jewish Alternative to Circumcision:

Brit Shalom

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[–]James_Miller[S] -5 points-4 points-3 points 13 years ago (0 children) | Copy Link

I'm going to go with, you know, "credible" medical associations. But I would like to know more about the circumcision cabal in your links.

Decline In Circumcisions Could Prove Costly

by Scott Hensley

NPR

August 21, 2012

Fewer boys are being circumcised these days, and that could add to health costs down the road.

Over the past two decades, circumcision rates in the U.S. have fallen to 55 percent from a peak of about 79 percent. Insurance coverage for the procedure has also fallen — particularly under Medicaid — and is a factor in the decline.

Yet three separate studies have found that circumcision reduces the risks of infection with HIV, leading the World Health Organization to recommend it in places where HIV risk runs high. Kenya, for one, is turning to circumcision of adult men to curb the spread of the virus there.

Circumcision also reduces the risk of infection with genital herpes virus and human papillomavirus. The practice can also reduce urinary tract infections in young boys. Later on, men's female sex partners are less likely to develop some infections if the guys are circumcised.

Johns Hopkins researchers analyzed how declines in circumcision would affect future health care costs, including what would happen if the rate fell to 10 percent, which is the average in Europe. The change — up or down — in HIV infections is the biggest factor.

So what's the tab? If the circumcision rate fell to 10 percent, the annual net increase in health care costs would be about a half-billion dollars a year. The findings appear in the latest issue of Archives of Pediatrics and Adolescent Medicine.

Johns Hopkins pathologist Aaron Tobian, senior author on the paper, tells Shots an increase in health costs tied to less frequent circumcision is already happening. He lays some of the blame on the American Academy of Pediatrics, whose 1999 policy statement says the "data are not sufficient to recommend routine neonatal circumcision."

Tobian says that data gathered since then show that position is wrong. "The trials were amazingly consistent," he says.

The American Academy of Pediatrics declined to comment. But we won't have to wait too long for more from the group. Next Monday, a long-awaited update to the group's circumcision policy is set to be published.

Of course, complications from circumcision are possible, though most, such as bleeding, are mild and don't last long. Critics of circumcision dispute the benefits and say it can lead to sexual problems. "There's no hard evidence circumcision is causing problems with sexual function or satisfaction," Tobian says.

Medicaid programs in 18 states no longer cover circumcision. Short-term cost savings is one reason. Tobian says the lack of a statement in favor of circumcision from the pediatricians' group is another factor. The absence suggests circumcision is "an elective procedure without benefit." And, he says, that's untrue.(http://www.npr.org/blogs/health/2012/08/20/159389031/decline-in-circumcision-could-prove-costly)

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Sexually transmitted diseases

There is strong evidence that circumcision reduces the risk of HIV infection in heterosexual men in populations that are at high risk.[16][61][62] Evidence among heterosexual men in sub-Saharan Africa shows a decreased risk of between 38 percent and 66 percent over two years[16] and in this population studies rate it cost effective.[17] There is little or no evidence that it protects against male-to-female HIV transmission,[63][64] and whether it is of benefit in developed countries and among men who have sex with men is undetermined.[65][66][67]

Human immunodeficiency virus

More than forty observational studies have been conducted to investigate the relationship between circumcision and HIV infection.[68] Reviews of these studies have reached differing conclusions about whether circumcision could be used as a prevention method against HIV.[69][70][71][72]

Experimental evidence was needed to establish a causal relationship between lack of circumcision and HIV, so three randomized controlled trials were commissioned as a means to reduce the effect of any confounding factors.[72] Trials took place in South Africa, Kenya and Uganda.[16] All three trials were stopped early by their monitoring boards on ethical grounds, because those in the circumcised group had a lower rate of HIV contraction than the control group.[16] The results showed that circumcision reduced vaginal-to-penile transmission of HIV by 60%, 53%, and 51%, respectively.[16] A meta-analysis of the African randomised controlled trials found that the risk in circumcised males was 0.44 times that in uncircumcised males, and that 72 circumcisions would need to be performed to prevent one HIV infection. The authors also stated that using circumcision as a means to reduce HIV infection would, on a national level, require consistently safe sexual practices to maintain the protective benefit.[73]

As a result of these findings, the WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) stated that male circumcision is an efficacious intervention for HIV prevention but should be carried out by well trained medical professionals and under conditions of informed consent.[4][18][74] Both the WHO and CDC indicate that circumcision may not reduce HIV transmission from men to women, and that data are lacking for the transmission rate of men who engage in anal sex with a female partner.[74][75] The joint WHO/UNAIDS recommendation also notes that circumcision only provides partial protection from HIV and should never replace known methods of HIV prevention. The Male Circumcision Clearinghouse website was formed by WHO, UNAIDS, FHI and AVAC to provide current evidence-based guidance, information and resources to support the delivery of safe male circumcision services in countries that choose to scale up male circumcision as one component of comprehensive HIV prevention services.[76][77]

Circumcision has been judged to be a cost-effective method to reduce the spread of HIV in a population,[4][78] though not necessarily more cost-effective than condoms.[4][79] Some have challenged the validity of the African randomized controlled trials, prompting a number of researchers to question the effectiveness of circumcision as an HIV prevention strategy.[80][81][82]

In addition to the studies which provided information about female-to-male transmission, some studies have addressed other transmission routes. A randomised controlled trial in Uganda found that male circumcision did not reduce male to female transmission of HIV. The authors could not rule out the possibility of higher risk of transmission from men who did not wait for the wound to fully heal before engaging in intercourse.[83] A meta-analysis of data from fifteen observational studies of men who have sex with men found "insufficient evidence that male circumcision protects against HIV infection or other STIs."[84]

Human papilloma virus

A 2007 meta-analysis of eight observational studies found no protective effect against human papillomavirus (HPV);[85] critics reported that reanalysis of the same data showed a protective effect.[86] A later analysis of 14 studies, by Bosch et al, found a protective effect.[87] In 2011, a meta-analysis of 23 studies (including both randomised controlled trials and observational studies) found reduced risk of prevalent HPV and (though the evidence was less strong) some evidence of reduced risk of new HPV infections.[88] In another analysis, in which 21 studies were included, there was a statistically significant reduction in prevalence of HPV, but no statistically significant association with new acquisitions was observed.[89]

A 2009 meta-analysis of multiple studies found a significant association between genital warts and HPV and the presence of a foreskin, as well as HPV alone. While circumcision was associated with a lesser risk of genital warts alone, the association did not reach statistical significance.[87] However, later analyses found no association between circumcision and penile warts.[88][89]

Other sexually transmitted infections

Studies evaluating the effect of circumcision on the incidence of other sexually transmitted infections have reached conflicting conclusions. A 2006 meta-analysis of observational data from twenty-six studies found that circumcision was associated with lower rates of syphilis, chancroid and possibly genital herpes.[90] More recently, a 2010 review of clinical trial data found that circumcision reduced the incidence of HSV-2 (herpes simplex virus, type 2) infections by 28%. The researchers found mixed results for protection against Trichomonas vaginalis and Chlamydia trachomatis, and no evidence of protection against gonorrhea or syphilis.[19] Among men who have sex with men, reviews have found insufficient evidence of an effect against sexually transmitted infections other than HIV,[66][84] with the possible exception of syphilis.[66]

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Hygiene, infection, chronic and skin conditions

The American Academy of Pediatrics (1999) stated: "Circumcision has been suggested as an effective method of maintaining penile hygiene since the time of the Egyptian dynasties, but there is little evidence to affirm the association between circumcision status and optimal penile hygiene."[7] Circumcision is used therapeutically, as one of the treatment options for balanitis xerotica obliterans, phimosis, balanitis, posthitis and balanoposthitis.[14][15]

An inflammation of the glans penis and foreskin is called balanoposthitis; that affecting the glans alone is called balanitis. Both conditions are usually treated with topical antibiotics (metronidazole cream) and antifungals (clotrimazole cream) or low-potency steroid creams. Although not as necessary as in the past, circumcision may be considered for recurrent or resistant cases.[91][92] Most cases of these conditions occur in uncircumcised males,[93][94] and affect 4 to 11% of uncircumcised boys.[95] The moist, warm space underneath the foreskin is thought to facilitate the growth of pathogens, particularly when hygiene is poor. Yeasts, especially Candida albicans, are the most common penile infection, and are rarely identified in samples taken from circumcised males.[94]

Phimosis is the inability to retract the foreskin over the glans penis; authors frequently distinguish between "physiologic" phimosis (or developmental non-retractility) and "pathological" phimosis.[95] The latter is most commonly caused by balanitis xerotica obliterans, for which circumcision is the preferred treatment.[96] The American Medical Association states that circumcision, properly performed, protects against the development of phimosis.[22] Rickwood and other authors have argued that many infant circumcisions are performed unnecessarily for developmental non-retractability of the prepuce rather than for pathological phimosis.[97][98] Metcalfe et al. stated that "Gairdner and Oster made a strong case for leaving boys uncircumcised, allowing the natural separation of the foreskin from the glans to take place gradually, and instructing boys in proper hygiene. This obviates the need for 'preventive' circumcision."[99] In a study to determine the most cost-effective treatment for phimosis, Van Howe concluded that using cream was 75% more cost-effective than circumcision at treating pathological phimosis.[100]

Urinary tract infections

Circumcision is associated with a reduced risk of urinary tract infections (UTIs) however the magnitude of this benefit is likely to outweigh the risk only in those at high risk of UTIs.[20]

Some UTI studies have been criticized for not taking into account a high rate of UTI's among premature infants, who are usually not circumcised because of their fragile health status.[7] The AMA stated that "depending on the model employed, approximately 100 to 200 circumcisions would need to be performed to prevent 1 UTI," and noted one decision analysis model that concluded that circumcision was not justified as a preventative measure against UTI.[22]

Cancers

The American Academy of Pediatrics (1999) stated that studies suggest that neonatal circumcision confers some protection from penile cancer, but circumcision at a later age does not seem to confer the same level of protection. Further, because penile cancer is a rare disease, the risk of penile cancer developing in an uncircumcised man, although increased compared with a circumcised man, remains low.[7]

Micali et al (2006) describe penile cancer as an "emerging problem", noting that "public health measures, such as prophylactic use of circumcision, have proven successful".[101] The American Cancer Society (2012) stated, "Most experts agree that circumcision should not be recommended solely as a way to prevent penile cancer."[102]

A 2011 meta-analysis concluded that childhood or adolescent circumcision substantially reduces the risk of invasive penile cancer. It was suggested that this may be due, in part, to reduced risk of phimosis, a predisposing factor for penile cancers.[103] While the same study found "some evidence" of an association between adult circumcision and an increased risk of invasive penile cancer, the authors suggested this may have been due to adult circumcisions being used as a treatment for penile cancer or a condition that is itself a precursor to cancer, rather than a direct result of the procedure itself. With respect to the quality of the studies included in the meta-analysis, the overall risk of bias was evaluated as "high", leading to a possibility that the protective effect of circumcision was underestimated.[103]

In 2012, Morris et al. reported that there is some evidence, albeit mixed, that circumcision may protect against prostate cancer; they called for more extensive research into the matter.[104]

There are mixed interpretations regarding cervical cancer in female partners. Rivet (2002) summarising a meta-analysis by Bosch et al. in which seven studies were included, notes a "moderate but nonsignificant decrease in risk of cervical cancer", with a statistically significant reduction in partners of men at high-risk of HPV.[105] In contrast, Van Howe (2009) stated that only one of sixteen studies found a statistically significant association remarking that "a positive association in 1 study out of 16 studies is what would be expected by chance alone."[106]

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