Tuesday, February 21, 2012

Circumcision - I Wouldn't Do It To My Child If You Paid Me - Part Five

I surely hope you aren't fed up with me by now!  Up to last night, we saw that 1. Medical Professions do not advocate routine circumcision for newborns, 2. Circumcision is painful in the extreme and 3.  It is dangerous to administer anaesthetic to very young babies, 4. There are adverse complications and even death associated with circumcision and 5. There is no significant reduction in UTI's for circumcised neonates.

There are many myths about the operation and I am surely not going to cover them all, especially in depth, as it is just too much.  There are a couple of myths that are dangerous ones, and which have recently been disproven and it is these I am going to address here.

The myth that circumcision prevents STD's and HIV-AIDS

World Health Organization (WHO) stated:

There is compelling evidence that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%. Three randomised controlled trials have shown that male circumcision provided by well trained health professionals in properly equipped settings is safe. WHO/UNAIDS recommendations emphasise that male circumcision should be considered an efficacious intervention for HIV prevention in countries and regions with heterosexual epidemics, high HIV and low male circumcision prevalence. Male circumcision provides only partial protection, and therefore should be only one element of a comprehensive HIV prevention package which includes: the provision of HIV testing and counselling services; treatment for sexually transmitted infections; the promotion of safer sex practices; the provision of male and female condoms and promotion of their correct and consistent use.

There has been no convicing evidence that the incidence of infection with STDs is reduced by circumcision.  The HIV and STD studies are normally done in poor and under-developed countries, and are not relevant to Australia, UK or USA.

Furthermore, circumcising an infant to reduce the risk of HIV and STDs is not justifiable - infants are not sexually active!
Myth - Circumcision prevents penile and cervical cancer

If you are exposed to strains of human papilloma virus through unprotected sex with multiple partners, or you smoke, these are the main risk factors for cervical and penile cancer.   Penile cancer is very extremely rare, there is less than 1 case in 100,000 men, and the median age of diagnosis is 64 years.   Circumcised men do develop cancer of the penis, and this can develop on the scar from the circumcision!  Strangely, breast and testiticular cancer is more common in men than is penile cancer.

From Wiki Commons - Prevalence of Circumcision by country

Myth - Circumcision is necessary to prevent phimosis and paraphimosis

The condition known as phimosis is where the foreskin can't be fully drawn back to uncover the glans.  Almost all infants and young boys have phimosis, which is normal for the infant and juvenile penis.   As discussed previously, the foreskin usually becomes retractable between ages 3 to 13, and nothing need be done unless the child is having discomfort or pain.  Phimosis does not need surgery unless conservative treatment fails.

Paraphimosis is a condition where the retracted foreskin has become stuck behind the glans, and cannot be brought forward again.  Using cold water and gentle compression this problem can usually be remedied.  In rare instances, where the skin is very tight, urgent medical attention is needed.

I do hope I have given a broad outline of the myths about circumcision, and the extremely strange reason why many still insist on circumcising their boys.   One aspect that keeps being dragged up is cleanliness - a good bath or shower with soap is all that is needed for cleanliness and hygeine.  When a boy is old enough he will normally pull back the foreskin and clean around under it himself.  
According to advocates of circumcision, there are many health benefits for the infant.  If this is so, if we are circumcising because way in the future this might prevent penile cancer - why then are we not operating on little girls to remove tiny breast buds?  The risk of a woman developing breast cancer is about 12% over her lifetime, which is a much higher risk than a man developing penile cancer.

Strangely enough, "the Australian Institute of Health and Welfare has found that Australian children have become significantly healthier as the incidence of circumcision has declined."  (Circinfo.org)   So much for circumcision having health benefits for the child.

There are psychological factors to consider as well, with circumcising infants - although I have actually seen these brushed aside as being unfounded, and anecdotal.  Of course evidence of psychological harm will be anecdotal - after all, the man is telling us of the harmful effect his circumcision has had on his mental wellbeing.  In a survey reported by Circumcision Information, they state that over 80% of 300 self-selected circumcised men said they had been harmed emotionally by infant circumcision.   Responses showed that at least one of the following feelings were reported:  anger, resentment, rage, hate, revenge, a sense of deficiency or loss, a diminished body image.  Disbelief, confusion, shame, embarrassment, feeling victimised, robbed, cheated, raped, violated, abused, mutilated, deformed.  They experience fear, distrust, withdrawal, sadness, pain and grief.   Some men have commited suicide.   Others have successfully sued for pain and suffering.

And a little fact that horrified me?  We saw before that the prepuce is rich in blood vessels.  This makes it likely to haemorrhage when it is cut.  The frenular artery is also at risk of being cut during the procedure.   An infant has only a very small volume of blood. For example a 4kg baby has only 340ml (or 11.5oz) of total blood at birth.   That is 85ml per kilo of weight.  An infant only needs to lose 68ml (2.3oz - about half a cup - go measure it) and he has lost 20% of his total blood volume - this is about all they can tolerate before hypovolemic shock sets in (shock from blood loss), which is quickly followed by death.  This has happened on many occasions.  A frightening fact is that the volume of blood loss that might kill a baby, which is 85ml, is easily concealed by disposable nappies (diapers).   You would not even know your baby was bleeding to death.

It seems to me that here we are in the year 2012, and for some unfathomable reason we are STILL following the dictates of some half-baked, unscientific and uneducated theory dreamed up by a long-forgotten prudish and sadistic doctor in the early 1800's - to stop men masturbating!   Sheer superstition still rules the day!  We may as well start burning witches again.

The phrase that keeps running through my head is the medical ethic "first, do no harm"  -

Nonmaleficence, which derives from the maxim, is one of the principal precepts of medical ethicsthat all medical students are taught in medical school and is a fundamental principle for emergency medical services around the world. Another way to state it is that "given an existing problem, it may be better not to do something, or even to do nothing, than to risk causing more harm than good." It reminds the physician and other health care providers that they must consider the possible harm that any intervention might do. It is invoked when debating the use of an intervention that carries an obvious risk of harm but a less certain chance of benefit.

Thank you for staying with me on this very long blog. 

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