Circumcision and trans puberty blockers in children

It's more of a dire need in places with a lot of HIV. But it's beneficial in general for reducing the transmission of STDs. So it's rather like giving kids the anti-HPV shot. Other benefits and harms are pretty trivial/cultural. I'm glad I am. Wouldn't want to deal with keeping that clean is another reason.

 

Those who say you shouldn't assume your child's gender, but then think it's okay if parents assume the child will be okay with part of their genitals being permanently cut off.

Seems very inconsistent, to say the least.

 

And female circumcision in certain Muslim African countries helps prevent adultery. So what?

 

Agreed. I was just being a little cheeky.

As far as circumcision goes the fact that we don't practice it in the traditional way shows how cruel it is.

Traditionally it was not practiced on infants as operating on an infant and the time period it was conceived of would be deadly. It was typically done to a child between the ages of 9 and 13 and it was done to try and stop them from masturbating.

We don't do that to kids because it's a criminal offense so we abhor the practice of circumcision traditionally speaking.

Doing it to babies seems cruel and bizarre to me.

 

either should only be allowed when the child is old enough they can choose for themselves

 

Jews and Muslims circ their boys.

 

Some Muslims also practice female circumcision. But in lots of places that's illegal.

Why is it okay to molest a boy but not a girl?

 

I’m no advocate for religious practices such as this.
“A special clamp or plastic ring will be attached to the penis, and the foreskin will be removed. Afterward, the penis will be covered with an ointment, such as a topical antibiotic or petroleum jelly, and wrapped loosely with gauze. The procedure generally takes about 10 minutes.”

no mention of anaesthetic.

 

I would say it's perverted. I don't care what religious excuse people use for their perversion it's not okay.

 

It's not very similar. Everybody wants to be more resistant to STDs, and have an easier time keeping clean, and it comes with no downside ~99% of the time.

 

Traditionally it didn't, but these days the standard of care is to provide anesthesia. From UpToDate (wikipedia for doctors) article Neonatal circumcision: Techniques:

"
Since analgesia reduces procedural pain with minimal risk, it is routinely provided when neonatal circumcision is performed [3,4]. Effective analgesic options for neonatal circumcision include topical agents and injected nerve blocks [3,6]. As no technique is clearly superior, selection depends on the training of the clinician and the availability of agents.

Our approach — We have found that the combination of oral sucrose and dorsal penile nerve block provides excellent analgesia, and thus we use this approach in our practice.
"

Here the link but it probably won't fully work for you: Neonatal circumcision: Techniques - UpToDate

And again, male circumcision is beneficial because it reduces STD transmission and less importantly makes hygiene easier.

 

Condoms reduce STD transmission and surely hygiene isn’t that difficult?
Having the baby “ look like Dad” is no good reason for circumcision either.

 

You're just going to assume people will do what they should? That's like saying there should be no HPV shot for kids because teens shouldn't be having sex anyway. The fact of the matter is that they don't all (or even mostly) take care of hygiene optimally, and some people will have sex without condoms sometimes, and so there is a benefit for very little risk.

 

Condoms are a birth control measure as well. If a man doesn’t clean under his foreskin he’ll stink and he may repel partners.

“The claim that circumcision reduces the risk of sexually transmitted infections has been repeated so frequently that many believe it is true. A systematic review and meta-analyses were performed on studies of genital discharge syndrome versus genital ulcerative disease, genital discharge syndrome, nonspecific urethritis, gonorrhea, chlamydia, genital ulcerative disease, chancroid, syphilis, herpes simplex virus, human papillomavirus, and contracting a sexually transmitted infection of any type. Chlamydia, gonorrhea, genital herpes, and human papillomavirus are not significantly impacted by circumcision. Syphilis showed mixed results with studies of prevalence suggesting intact men were at great risk and studies of incidence suggesting the opposite. Intact men appear to be of greater risk for genital ulcerative disease while at lower risk for genital discharge syndrome, nonspecific urethritis, genital warts, and the overall risk of any sexually transmitted infection. In studies of general populations, there is no clear or consistent positive impact of circumcision on the risk of individual sexually transmitted infections. Consequently, the prevention of sexually transmitted infections cannot rationally be interpreted as a benefit of circumcision, and any policy of circumcision for the general population to prevent sexually transmitted infections is not supported by the evidence in the medical literature.”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3654279/

 

A systematic review by one guy, will have to look at it closer later, but for now here's highlights from UpToDate:

"
Circumcision has been associated with a number of medical benefits, including lower rates of urinary tract infection (UTI), penile cancer, penile inflammation, penile dermatoses, and sexually transmitted infections [14-18]. A lower rate of UTI is the major benefit during infancy.

In the uncircumcised male, the preputial space provides a warm moist environment that both traps pathogens and bodily secretions and is favorable to their survival and replication, while the foreskin itself is susceptible to microabrasions that are thought to facilitate acquisition and transmission of infection. In contrast, the keratinized glans of the circumcised male is thought to create an unfavorable environment for these processes.

Reduction in urinary tract infection — UTI is uncommon in males at any age. The effect of circumcision on UTI has been studied primarily in infants because they have a higher prevalence of UTI than older males. UTIs in infants can result in pyelonephritis requiring hospitalization and, rarely, septicemia and death. In infants with congenital uropathy, UTI can have serious sequelae, such as renal scarring and lifelong renal insufficiency. If the urinary tract is normal, long-term sequelae from UTI are unlikely.

Comparative studies consistently report that circumcised male infants have significantly fewer UTIs than uncircumcised male infants [15,16]; however, there are no data from a large randomized trial [19]. In a systematic review of 12 studies including data on over 400,000 males primarily under 1 year of age, circumcision reduced the risk of UTI by almost 90 percent (odds ratio [OR] 0.13, 95% CI 0.08-0.20) [16]. Another meta-analysis found that among febrile male infants less than 3 months of age, the prevalence of UTI in circumcised and uncircumcised infants was 2.4 and 20.1 percent, respectively [15]. It is estimated that 7 to 14 of 1000 uncircumcised male infants will develop a UTI during the first year of life, compared with 1 to 2 of 1000 circumcised male infants [5]. As discussed above, long-term sequelae from UTI are unlikely if the urinary tract is normal.
"

...

Cervical cancer in partners — Cervical cancer is more common in the sexual partners of uncircumcised men...

In a study that pooled data from 1913 couples enrolled in one of seven case-control studies, circumcised men were less likely than uncircumcised men to have HPV infection (OR 0.37, 95% CI 0.16-0.85 after adjustment of confounders)... Among monogamous women, the reduced risk of cervical cancer was statistically significant when the male partner had engaged in high-risk sexual behaviors (early age at first sexual intercourse, a high lifetime number of sexual partners, sexual intercourse with prostitutes) (OR 0.18, 95% CI 0.04-0.89) [39]. (See "Cervical intraepithelial neoplasia: Terminology, incidence, pathogenesis, and prevention", section on 'Role of human papillomavirus'.)

As discussed above, these data were obtained prior to widespread use of the HPV vaccine for girls, as well as boys (see "Human papillomavirus vaccination"). Vaccination may reduce the prevalence of HPV related disease, diminishing the role of circumcision in prevention of these diseases.

...

Reduction in HIV and other sexually transmitted infections — There is high-quality evidence that circumcision protects against acquisition of HIV, HPV, and probably herpes simplex virus type 2 (HSV-2), and also some evidence that it may protect against trichomonas and chancroid infection (see "Prevention of sexually transmitted infections", section on 'Male circumcision'). Circumcision does not protect against infection from gonorrhea, chlamydia trachomatis, or syphilis.

The effects of male circumcision on preventing HIV transmission from men to women and on acquisition of other STIs are discussed elsewhere. (See "Prevention of sexually transmitted infections", section on 'Other STIs' and "Prevention of sexually transmitted infections", section on 'HIV infection'.)

Easier hygiene — Genital hygiene (washing the entire penis, including the glans, with soap and water while bathing) is important for all males and is generally easier in the absence of a foreskin.

Uncircumcised boys should be taught the importance of washing beneath the foreskin on a regular basis when the foreskin is fully retractable. Good hygiene may prevent many problems associated with the foreskin [32], but can be difficult to maintain in uncircumcised boys, even in developed countries. Studies of middle class British and Scandinavian schoolboys concluded that penile hygiene is usually not well-maintained [48,49]. Care of the uncircumcised penis is described separately. (See "Care of the uncircumcised penis in infants and children".)

REFERENCES
Neonatal circumcision. Report 10 of the Council on Scientific Affairs (I-99). www.ama-assn.org/ama/pub/category/13585.html (Accessed on September 14, 2006).
Waldeck SE. Social norm theory and male circumcision: why parents circumcise. Am J Bioeth 2003; 3:56.
Xu B, Goldman H. Newborn circumcision in Victoria, Australia: reasons and parental attitudes. ANZ J Surg 2008; 78:1019.
Morris BJ, Bailis SA, Wiswell TE. Circumcision rates in the United States: rising or falling? What effect might the new affirmative pediatric policy statement have? Mayo Clin Proc 2014; 89:677.
American Academy of Pediatrics Task Force on Circumcision. Male circumcision. Pediatrics 2012; 130:e756.
Halperin DT, Timberg C. Update of chart in 'Male Circumcision and HIV Prevention: 10 Years and Counting' Circs.org. 2012. www.circs.org/library/HalperinTimberg (Accessed on December 14, 2006).
Binner SL, Mastrobattista JM, Day MC, et al. Effect of parental education on decision-making about neonatal circumcision. South Med J 2002; 95:457.
Wang ML, Macklin EA, Tracy E, et al. Updated parental viewpoints on male neonatal circumcision in the United States. Clin Pediatr (Phila) 2010; 49:130.
Adler R, Ottaway MS, Gould S. Circumcision: we have heard from the experts; now let's hear from the parents. Pediatrics 2001; 107:E20.
Tiemstra JD. Factors affecting the circumcision decision. J Am Board Fam Pract 1999; 12:16.
Walton RE, Ostbye T, Campbell MK. Neonatal male circumcision after delisting in Ontario. Survey of new parents. Can Fam Physician 1997; 43:1241.
Turini GA 3rd, Reinert SE, McQuiston LD, Caldamone AA. Circumcision: a study of current parental decision-making. Med Health R I 2006; 89:365.
Morris BJ, Waskett JH, Banerjee J, et al. A 'snip' in time: what is the best age to circumcise? BMC Pediatr 2012; 12:20.
Mallon E, Hawkins D, Dinneen M, et al. Circumcision and genital dermatoses. Arch Dermatol 2000; 136:350.
Shaikh N, Morone NE, Bost JE, Farrell MH. Prevalence of urinary tract infection in childhood: a meta-analysis. Pediatr Infect Dis J 2008; 27:302.
Singh-Grewal D, Macdessi J, Craig J. Circumcision for the prevention of urinary tract infection in boys: a systematic review of randomised trials and observational studies. Arch Dis Child 2005; 90:853.
Larke NL, Thomas SL, dos Santos Silva I, Weiss HA. Male circumcision and penile cancer: a systematic review and meta-analysis. Cancer Causes Control 2011; 22:1097.
Fergusson DM, Lawton JM, Shannon FT. Neonatal circumcision and penile problems: an 8-year longitudinal study. Pediatrics 1988; 81:537.
Jagannath VA, Fedorowicz Z, Sud V, et al. Routine neonatal circumcision for the prevention of urinary tract infections in infancy. Cochrane Database Syst Rev 2012; 11:CD009129.
Günşar C, Kurutepe S, Alparslan O, et al. The effect of circumcision status on periurethral and glanular bacterial flora. Urol Int 2004; 72:212.
Aridogan IA, Ilkit M, Izol V, et al. Glans penis and prepuce colonisation of yeast fungi in a paediatric population: pre- and postcircumcision results. Mycoses 2009; 52:49.
Wiswell TE, Miller GM, Gelston HM Jr, et al. Effect of circumcision status on periurethral bacterial flora during the first year of life. J Pediatr 1988; 113:442.
Circumcision policy statement. American Academy of Pediatrics. Task Force on Circumcision. Pediatrics 1999; 103:686.
Pisacane A, Graziano L, Mazzarella G, et al. Breast-feeding and urinary tract infection. J Pediatr 1992; 120:87.
Morris BJ, Wiswell TE. Circumcision and lifetime risk of urinary tract infection: a systematic review and meta-analysis. J Urol 2013; 189:2118.
Spach DH, Stapleton AE, Stamm WE. Lack of circumcision increases the risk of urinary tract infection in young men. JAMA 1992; 267:679.
Fakjian N, Hunter S, Cole GW, Miller J. An argument for circumcision. Prevention of balanitis in the adult. Arch Dermatol 1990; 126:1046.
Celis S, Reed F, Murphy F, et al. Balanitis xerotica obliterans in children and adolescents: a literature review and clinical series. J Pediatr Urol 2014; 10:34.
Folaranmi SE, Corbett HJ, Losty PD. Does application of topical steroids for lichen sclerosus (balanitis xerotica obliterans) affect the rate of circumcision? A systematic review. J Pediatr Surg 2018; 53:2225.
Barnholtz-Sloan JS, Maldonado JL, Pow-sang J, Giuliano AR. Incidence trends in primary malignant penile cancer. Urol Oncol 2007; 25:361.
Frisch M, Friis S, Kjaer SK, Melbye M. Falling incidence of penis cancer in an uncircumcised population (Denmark 1943-90). BMJ 1995; 311:1471.
Krueger H, Osborn L. Effects of hygiene among the uncircumcised. J Fam Pract 1986; 22:353.
Wiswell TE, Geschke DW. Risks from circumcision during the first month of life compared with those for uncircumcised boys. Pediatrics 1989; 83:1011.
Christakis DA, Harvey E, Zerr DM, et al. A trade-off analysis of routine newborn circumcision. Pediatrics 2000; 105:246.
Learman LA. Neonatal circumcision: a dispassionate analysis. Clin Obstet Gynecol 1999; 42:849.
Albero G, Castellsagué X, Giuliano AR, Bosch FX. Male circumcision and genital human papillomavirus: a systematic review and meta-analysis. Sex Transm Dis 2012; 39:104.
Aynaud O, Piron D, Bijaoui G, Casanova JM. Developmental factors of urethral human papillomavirus lesions: correlation with circumcision. BJU Int 1999; 84:57.
Davis MA, Gray RH, Grabowski MK, et al. Male circumcision decreases high-risk human papillomavirus viral load in female partners: a randomized trial in Rakai, Uganda. Int J Cancer 2013; 133:1247.
Castellsagué X, Bosch FX, Muñoz N, et al. Male circumcision, penile human papillomavirus infection, and cervical cancer in female partners. N Engl J Med 2002; 346:1105.
Herzog LW, Alvarez SR. The frequency of foreskin problems in uncircumcised children. Am J Dis Child 1986; 140:254.
..." more sources truncated for post length Neonatal circumcision: Risks and benefits - UpToDate

 

Circumcision for non religious reasons seems to be a mostly US habit now. Not routine elsewhere.

 

It's most common in parts of Middle East and Africa. For Africa both HIV and religion likely play a role. From Wikipedia:


Rate of male circumcision by country in 2007[9]
red >80%
orange 20–80%
yellow <20%
grey N/A

Circumcision - Wikipedia

 

Wikipedia is a variably reliable source.
Note the Muslim countries in the map, mostly red.



“- Circumcision remains one of the most common private surgeries performed in Australia, and the single most common surgery performed worldwide. - Globally, approximately 39 per cent of males are circumcised. - America's circumcision rate is 81 per cent. - Australia's circumcision rate is approximately 15 per cent.2 May 2022”

Circumcision still common in private hospitals, despite ... - RACS
https://www.surgeons.org › News › media-releases › Cir...

 

Wikipedia is good, but it's true the map data is a little old (same kind of issue you often run into with a traditional encyclopedia). US went up, Australia went down. But in any case, the prevalence isn't going to solve whether the benefits outweigh the risks.

 

The benefits are minimal.

 

The risks are even more minimal, and it depends on a lot of factors. Not a good idea to just assume boys will be good with their hygiene and condoms though. Good to encourage. Bad to depend on. Sort of like abstinence in health education. But it's true the magnitudes of the risk and benefits are not so large that it must be always strongly encouraged or prohibited, except maybe in Africa.

 

Should we be depending on a surgical intervention, when regular washing and condom use will suffice?

 

You should think from a public health perspective or sociological one, in which it's about numbers and not what people should do but what they actually will do. What is the actual effect of your intervention? You tell people to be clean and wear condoms. Will they actually do it? Sure they should. And in a perfect world everybody would be uncircumsized and have perfect hygiene, but in the real world the average male won't maintain his hygiene or wear condoms reliably, and they will be harmed, on average, by being uncircumcised.

 

Okay, got through some of it, didn’t look at methods in detail so far. But it’s misleading because it leaves off hiv, still the most important one for consequences and the one with the best evidence for circumcision being therapeutic. UpToDate acknowledges that it is not for reduction of chlamydia, gonorrhea. The main actual conflict is hpv (important regarding cervical dysplasia/cancer in partners, though hopefully less so in future due to vaccines). UpToDate and this review disagree on that. I am not sure if maybe things were lumped together and drown out by chlamydia, or what, but no time to figure it out atm. Hpv is a bit tricky since there are many strains, very high prevalence, and only some cause dysplasia.

 

Having no foreskin isn’t a guarantee of HIV prevention and circumcising the whole male population is a ridiculous waste of health resources.