Circumcisions & cervical cancer - whats the greater good?

[curious Al]

Hey, over the past 2 years I've been slightly considering a circumcision. I started some research and came across some reports of how a circumcised penis can reduce the risk of cervical cancer in women. In a report by the BBC, it states that "a general adoption of circumcision could cut cervical cancer rates by 20%."

Many of the senior members, who actually know what they are talking about, generally say that a circumcision shouldn’t really be undertaken without a medical reason. Many points are given against circumcisions i.e.; discomfort and psychological problems. These all seem very valid reasons as to not forego a circumcision. However studies also state that infections and even HIV risks are reduced by up to 50% with a circumcision.

My question is: If the general adoption of circumcisions could reduce cervical cancer by up to 20% and risk of infection in men by up to 50% why aren't circumcisions encouraged to young men who want to undergo this procedure, even for cosmetic reasons?

Surely this procedures pro's massively outweigh its con's.

[sera300]

Most likely what you read was the study put out by the World Health Organization (WHO). There are direct correlations of decreased risks of disease presence in those who are circumcised. Additionally, good hygiene is easier in a circumcised male beginning at birth to geriatric age. Many of the WHO studies also cite third world countries as part of reduction in their stats. Overall, in all Country's it has been clinically correlated.

Furthermore, to really help reduce HPV & future c.cancer for young women in the US there is a big push to get vaccinated with Gardasil--a series of injections prior to the onset of sexual exploration which prevents against the 4 major known viruses which are linked to c. cancer from HPV. To me; gardasil should be a must as Hep B vaccinations should be a must--MMR & Polio vaccinations are mandatory. Now The Chickenpox vaccination is & still gardasil is not. I'd rather my child have active chicken pox since lesser incidences of death and long term disease issues than with HPV.

There is a debate among a few men here about being circumcised at birth, feel they might have lost some sensitivity secondary to having it performed.

Where I am; it's done routinely the day post-birth unless the parents decline. Having it done as an adult? I doubt I would wish to place that choice on a young male; I am not certain he would be really able to make the right choices & for the right reasons. Later in life? I know it is quite uncomfortable.

I always use the tonsil analogy although there is quite a difference [two ends] kids/small children recover faster post-op than an adult does. However, with tonsils and young children there is a risk of excessive bleeding [decompensation] which can be substantial post-op; circumcisions the risks are not even close.

Hence, the reason it is standard practice here, at birth, to be done unless a parent objects.

The main debate remains for those who feel they are loosing something & within EU from what I have read--it's not standard practice as in the US. I had been a nurse for years; thought everyone was circumcised; even worked in the City Hospital's. Never realized the number of men who were not.

[Brandye]

I encourage young men to have the procedure. Look up lots of circumcision threads. I am a woman and a physician. In both roles, I encourage circumcision and will no have an uncovered, uncircumcised penis in me.

In those cultures where circumcision is regularly practiced, cervical cancer rates are up to fifty percent lower than those societies where circumcision is uncommon. The advantage to men is that they are less susceptible to a variety of STDs.

The arguments presented here have been that circumcised is unnatural and the circumcised penis less sensitive and less pleasureable.

A medical reality is that circumcision in the adult male is mush more uncomfortable, and there are possibilities of infection, than in a newborn.

I am a rather senior member and know what I am talking about (mostly). Perhaps the voices of us in favor are lost in the more emotional rants of those who oppose.

[Mr. Saint]

I know that I am disagreeing with a very senior member. But in this case I strongly disagree with Brandye. I already said this on another thread. If you bath daily and wash under your foreskin, there are no higher rates of HPV and other STD, between circumcised and uncircumcised men. Where these statistics come in about 50% decrease rates of HIV, are in countries that do not have easy access to soap and water. You can not use studies that are about Africa and say the same is true about the US. On average there are slightly higher rates of STD in uncircumcised men in the US, but this is only because a lot of men bath properly. If you (or your partner) wash under your foreskin daily then you and your partner are at no higher risk.

The physics behind the STD and foreskin is that bacteria can get trapped under the foreskin and if not washed can stay there and incubate. I am not a doctor but this is from both my human sex professor (20+ years experience and PhD) and my friend who is a NP with 10 years experience. I am also a mathematician and have looked at these studies personally. I will try to post some of these studies but can’t promise anything. If you are not having any problems, wash don’t cut.

[Brandye]

Feel free to disagree. The facts remain that in Israel and most Islamic nations the incidence of cervical cancer is much lower than in Europe, China and Japan. In North America and Europe, the incidence is lower among the wives of circumcised males than those with uncut husbands. I am not citing stuff from the third world; these are comparisons made within advanced industrial nations and nations where bathing is regular or, even, ritualistic.

Although circumcision is very uncommon throughout Asia, there is great discussion in both Japan and China about encouraging parents of newborn males to consider the procedure, specifically to slow the spread of HIV.

"If you are not having any problems, wash don't cut," is definitely a phallo-centric and not very helpful statement. The man can be experiencing absolutely no problems and his partner can develop cervical cancer twenty years later.

You are correct that proper hygiene is a major step in the right direction but studies of wives quite well matched in control and test subject socio-economic circumstances indicate that even the best hygiene might not be enough. I wonder how many men spend as much time washing the penis as brushing the teeth. To be truly hygienic that would be a good measure. Add to this varying degrees of phimosis, and the number of young men who post here with this condition, and I stand by my position.

You are mathematically competent. Great, so am I. And I also (cited months ago in another thread) look a 29 yo mother in the eye and tell her she has Stage 4 cervical cancer.

[ml66uk]

Originally Posted by Brandye

A medical reality is that circumcision in the adult male is mush more uncomfortable, and there are possibilities of infection, than in a newborn.

I am a rather senior member and know what I am talking about (mostly). Perhaps the voices of us in favor are lost in the more emotional rants of those who oppose.

Senior member or not, describing opposing views as "emotional rants" diminishes your own credibility.

Being circumcised as an adult hurts less not more. You can use general anaesthetic, and you don't need to separate the foreskin from the glans (probably the most painful part of the procedure). It's safer too. I'm not aware of any cases in north America where an adult died from medical circumcision.

Even if circumcision was a good idea, doing it right after birth is the worst possible time since :
a) you have to separate the foreskin from the glans (think of removing your thumbnails only more painful). This also results in adhesions, skin tags and skin bridges. If you wait a few years, then the foreskin separates naturally. This also results in better cosmetic results.
b) it's smaller so more chance of a seriously botched job. It's very rare, but some babies die or suffer amputations because of circumcision (google "David Reimer" and read about his/her story if you don't know what I'm talking about)
c) you can't use general anaesthetic on a newborn, so it hurts more. Watch a video of an operation if you don't know how much it hurts. Just because babies don't remember, it doesn't mean it hasn't affected them. They have more problems breastfeeding, and also show more reaction to injections years later.
d) newborns don't have much of an immune system, so they can die of things that are harmless to adults or older children. A baby died after circumcision in New York recently of the coldsore virus for instance, and another got brain damage.
e) a newborn can't tell you if he actually wants to have the most sensitive part of his penis removed or not. It's HIS body after all.


Non-religious circumcision is on the decline:
USA: from 90% to 56%
Canada: from 47% to 14%
UK: from 35% to about 3% (less than 1% among non-Muslims)
Australia: 90% to 12.6% ("routine" circumcision has recently been banned in public hospitals in all states except one, so the rate will now be a lot lower)
New Zealand: 95% to below 3% (mostly Samoans and Tongans)
South America and Europe: never above 5%

I could go through some of the other pro-circ arguments one by one, but I think I'd prefer to point out what the Royal Australasian College of Physicians says in the summary statement of their paediatric policy on circumcision :
"After extensive review of the literature the RACP reaffirms that there is no medical indication for routine neonatal circumcision." (those last 9 words in bold on their website).
http://www.racp.edu.au/download.cfm?...36DF59A1BAF527

Most of the people responsible for this statement will be circumcised themselves or married to circumcised men, since the circ rate in Australia was 90% in 1950 (down to 12.6% now). Now why would a bunch of circumcised doctors say that routine circumcision was unnecessary? There's no corresponding group of intact doctors recommending male circumcision.

Routine circumcision is now *banned* in public hospitals in all Australian states except one.

[Brandye]

But still available on request of the parents. I am quite familiar with the Australian policy. It has been debated within my NHS.

You have read, perhaps, one thread here this Board regarding circumcision. There are dozens. When men argue against circumcision "because of diminished sexual satisfaction" I have difficulty accepting that as other than emotional.

You state that circumcision hurts less than as an infant. How many men with a two day old circumcision have you asked? The infection rate is higher and that is documented.

I have difficulty with the Australian position because the long term consequences to women have not been measured. And as is so often the case with medical procedures and their consequences, it will be decades before those consequences are known. Hence, the WHO position based on cervical cancer in Islam and Jewish cultures as a baseline for the developed world.

[sera300]

Really huh? All they use in a newborn is a topical anesthetic...the healing is faster than any adults. A grown man will hurt more--this is medical common sense.

Men choose to go for general anesthesia which leads to a higher rate of mortality.

Yeah, I trust a young man to make the right choice...Parents have the right to do it in the US at birth. And it is pretty common & since a child under the age of 18 has no right to consent to treatment, unless raped, potentially pregnant, emancipated minor, or has a std; it falls upon a parent. This comparison of yours is much like saying my toddler has strep throat but refuses to take his antibiotic...its the baby's right to refuse. Or to refuse a tonsillectomy. Or better yet...my child went over the handlebars and ruptured his spleen--he refuses the surgery & it's his right to die.

You must be into Scientology. Practice medicine a good long time and the concepts fit.

[ml66uk]

"Routine" circumcision is banned in public hospitals in Australia, in all states except for Queensland. Parents can still have it done, but they have to go to a private hospital. The Children's Commissioner in Tasmania wants to ban it there altogether, and has the support of the head of AMA.

You know as well as I do that basing a circumcision policy on prevalence of cervical cancer in Islam and Jewish cultures doesn't make sense. They kill people for pre-marital sex or adultery in some Islam countries, so it's not a comparison that can be taken seriously. There actually appears to be a genetic component to the lower rate of cervical cancer in Jewish women btw.

You state that circumcision hurts less than as an infant. How many men with a two day old circumcision have you asked? The infection rate is higher and that is documented.

Just because they can't talk doesn't mean they can't feel pain. Just because they won't remember doesn't mean it hasn't affected them, as I already said.

I'd be interested to see a link or reference for the infection rate being higher. I'm fairly sure no adult has died or suffered brain damage following circumcision, because of the coldsore virus, yet this has happened with neonates.

Is anyone here aware of any cases of death following adult circumcision (in a western medical environment). How about gangrene? How about any cases that needed to be revised/repeated? Those complications only seem to occur with newborns.

Even if I knew that my son was at some point in his life going to need to be circumcised, doing it straight after birth would still be the worst possible time. I'd probably wait till he was over ten, or at least until the foreskin had separated from the glans.

And I also (cited months ago in another thread) look a 29 yo mother in the eye and tell her she has Stage 4 cervical cancer.

You're using scare tactics. How about having to tell someone that their son has died or developed gangrene, or suffered penile amputation because of circumcision? It's very rare, but it does happen.

Let's say we could cut cervical cancer deaths by 20% by circumcising all men. What then if we could cut them by 40% by removing the inner labia? They're not strictly necessary, and there are some diseases of the labia that you just can't get if they're not there. This is not just hypothetical - penile cancer has been put forward as a resaon to circumcise newborns, yet vulval cancer is more than twice as common (even breast cancer in men is more common).

You must be into Scientology. Practice medicine a good long time and the concepts fit.
You too lose credibility, on this and other threads when you attack people and oversimplify issues. I'm not into Scientology at all, and believe that their children should be taken away if at significant risk. Allowing parents to have parts of their children's genitals cut off on what I consider to be bogus medical grounds is equally troubling. This has nothing to do with antibiotics or vaccination.

[sera300]

I really do not care about your health care practice thoughts in Austria; they are irrelevant to me. I look at the diseases which are rampant in the US & the causes. Decreasing mortality rates in the US is what is of concern.

I could not careless what you think about my credibility; practice medicine and then discuss the matter.

Make your choices for yourself and your family then deal with them. Argue your points to the WHO. Apparently a few men here have chosen later in life to become circumcised; it's their choice not yours, mine, or Brandye's. And yes, tell a few younger women congratulations you are dying--if that does not move you, nothing will. Spew your facts to them; if they are not dead yet. Better yet, come to the US and talk to the Pediatricians and the MALE Gyn Docs why they are wrong and should not doing circumcisions--perhaps you might be of interest to them.

Oversimplify issues? Yes, sure. Treat enough STD's and bad outcomes which were preventable then we can talk.