Tuesday, April 2, 2013

Assumed Medical Benefits of Circumcision

As I stated I would, I have taken some time to gather some information for you regarding the supposed "health benefits" of routine infant circumcision.  

One thing to consider, is that there can be some benefits to something, but an important factor to consider is this: do the reported or hoped for benefits justify the risks. In another post, I will outline the risks.  First and foremost to consider is death.  Over 100 baby boys die each year from complications of their unnecessary circumcision surgery.  This is more baby boys in the initial 6 week newborn period than die from SIDS.  

The  American Academy of Pediatrics admits that “Existing scientific evidence demonstrates potential benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision”

One helpful informational source that outlines a number of these issues is a presentation by Ryan McCallister, PhD, a research professor in the areas of oncology and Physics at Georgetown University.  

The entire presentation is available for viewing here: http://www.youtube.com/watch?v=Ceht-3xu84I. 

As a warning, there are some slides on this educational presentation (given in a college seminar class) that include medical pictures of the male genitalia. A video of an infant circumcision is also shown. The professor gives warning before any of these slides, so that viewers may choose to turn their heads if desired.

The following are the most used "medical reasons" that parents believe are prevented by circumcision.

1. Urinary Tract Infection

This is from the American Academy of Family Physicians regarding Urinary Tract Infections in Children (2011): (1)

"Acute UTIs are relatively common in children. By seven years of age, 8 percent of girls and 2 percent of boys will have at least one episode."

"Routine circumcision in boys does not reduce the risk of UTI enough to justify the risk of surgical complications"

"Boys are at increased risk of UTI if younger than six months, or if younger than 12 months and uncircumcised. Girls are generally at an increased risk of UTI, particularly if younger than one year." 

The above quote is of note, as it shows that  

A boy being left intact is only at increased risk of UTI (over the circumcised boy) from the ages of 6 months to 1 year. Otherwise, the risks of developing a UTI are the same for a circumcised or intact boy.

Yes, UTI's do happen in children. However, for girls, the treatment is antibiotics, not the removal of body parts. The removal of the female labia could actually reduce the number of UTI's in women and girls.  UTI's occur because of bacteria being introduced to the genitals.  Typically, the bacteria is from the rectal area.  Removal of the labia would reduce the risks of UTI's, as the labia can catch and hold bacteria.  Obviously, this would be an over the top (and illegal) way to prevent a relatively minor health concern.

For males, a UTI, in an intact boy, or a circumcised boy, antibiotics are completely appropriate treatment.  Surgery for a UTI, or for the prevention of a UTI is not necessary. 

A study done in the UK in 2005, states the following: (2) 

"Singh-Grewal et al concluded that 111 circumcisions would be required to prevent one UTI,... It is doubtful that a cost–benefit analysis could ever justify routine circumcision under those circumstances."

2. Cervical Cancer:
A position statement by the National Organizations of Circumcision Information and Resource Centers, and Doctors Opposing Circumcision clearly and thoroughly outlines the history, studies, flaws with studies, new findings, updated information regarding HPV and cervical cancer, and health measures to treat and prevent cervical cancer. The statement is highly referenced, and cross referenced. (3)

To quote the study, Male Circumcision and Cervical Cancer (2010):

"Male circumcision does not insure protection from HPV infection. The possible reduction in risk is slight at best. Along with education, and the introduction of HPV testing, the best hope of bringing cervical cancer under control may be introduction of a vaccine.  HPV vaccine is now in stage 3 trials" *note, the vaccine is now available and part of the CDC recommended vaccines for all children*

Cervical Cancer is most often caused by HPV, which is a sexually transmitted disease. The Center for Disease Control provides information about HPV, cervical cancer, and the vaccine (4)

From that information, it is notable that more than half of sexually active men and women are infected with HPV at some time in their life.  This is with the fact that currently, the majority of adult American men are circumcised.  Circumcision is NOT preventing HPV or cervical cancer. The CDC materials promoting the Gardasil vaccine do NOT mention circumcision as a preventative for HPV or cervical cancer.

Also noted, is that  "Condoms may lower the risk of HPV infection....But HPV can infect areas that are not covered by a condom-so condoms may not fully protect against HPV. People can also lower the risk of HPV by being in a faithful relationship with one partner; limiting their number of sex partners and being with a partner who has no or few prior sex partners".  If HPV can be caught from areas not covered by a condom, this eliminates the foreskin as the biggest problem, as it would be covered by a condom.
 The best prevention for sexually transmitted disease is to minimize sexual partners, and to use protection with sexual partners.  Even a circumcised man can and does spread sexually transmitted disease, and the United States, while having one of the highest circumcision rates also has one of the highest Sexually Transmitted Disease rates in the first world.  Circumcision as a means to reduce STD's is clearly not working. Abstinence, monogamy and condom use outside of monogamy are the best ways to reduce the spread of STD's.

On the medical front, however, there is now a vaccine (Gardasil) that prevents HPV in both males and females.  If you are interested in promoting the avoidance of STD's, I would suggest that monogamy, limited sexual partners, and condom use outside of monogamy would, as always, be good choices.  Researching and considering the Gardasil vaccine also is an option. 

If your son was circumcised, would you tell him to have unprotected sex with partners who are known to have HPV or HIV? Or who might have HPV or HIV? Of course not.  Everyone knows that being circumcised does not make one safe from sexually transmitted disease.

Circumcision is NOT STD prevention.  Circumcised men are spreading STD's at an alarming rate in the United States.  

3.Penile Cancer: 

Penile Cancer affects less than 1% of men in the United States. 

The American Cancer Society has this to say about preventing penile cancer (last revised 1/17/2013): (5)

"In the past, circumcision has been suggested as a way to prevent penile cancer.  This was based on studies that reported lower penile cancer rates among circumcised men than among uncircumcised men.  But in many of those studies, the protective effect of circumcision was no longer seen after factors like smegma and phimosis were taken into account.  Most public health researchers believe that the risk of penile cancer is low among uncircumcised men without risk factors living in the United States.  Men who wish to lower their risk of penile cancer can do so by avoiding HPV infection and not smoking. Those who aren't circumcised can also lower their risk by practicing good hygiene.  Most experts agree that circumcision should not be recommended solely as a way to prevent penile cancer.  The most important factor in preventing penile cancer is good genital hygiene. "
Seems simple enough.  Wash the body. 

As a thought, I encourage you to consider, would you recommend that all baby girls have their breast buds removed at birth? Breast Cancer affects and kills many more women in the United States than penile cancer affects men, yet we do not remove healthy tissue from baby girls in order to prevent the possibility of Breast Cancer.

4. Bacteria: The foreskin is fused to the glans of an infant, and it helps to prevent foreign bodies from entering the body through the urethra, which is an entry point to the body.   As the child ages, and naturally retracts, the child can be taught to wash his penis, including under his foreskin.  All body parts can become infected, or grow bad bacteria.  Ears, throats, skin, female genitalia, male genitalia, rectums, eyes, mouths, teeth, breasts, etc. etc.  Some of these parts are necessary for survival, some are not.  However, none of them (including the male genitalia, or parts thereof) are recommended to be routinely removed from infants due to the fact that they could one day contain bacteria.  Teaching boys proper hygiene is preferable to removing a healthy and functional part of their body.

 I do want to mention, again, that washing under the foreskin is not necessary and SHOULD NOT be attempted until the boy retracts on his own, which typically happens during puberty if not before.  The premature retraction of the foreskin causes pain as well as medical problems.
Studies Referenced:
1. http://www.aafp.org/afp/2011/0215/p409.html#afp20110215p409-b32
2.  http://adc.bmj.com/content/90/8/773.full
3. http://www.drmomma.org/2010/04/male-circumcision-cervical-cancer.html
4.  http://www.cdc.gov/hpv/prevention.html
5.  http://www.cancer.org/cancer/penilecancer/detailedguide/penile-cancer-prevention

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