"Forced Genital Cutting," and Jewish circumcision

[DallasApple]

Sure, cutting the foreskin is "mutilation"

Just remember than putting shoes on your kids is "deforming" their feet BTW.

No its not.

 

[DallasApple]

Barbaric? Nope. This gross exaggeration which likely stems from your guilt and biases, does not make circumcision any more or less legal.

Nope its barbaric.Guilt or otherwise.That's my opinion.

And I will work to make it illegal,...I think its mostly men though that will get that job done..I will support the men.

 

[Terrywoodenpic]

Few British doctors are trained to do circumcisions. If they do them privately they are paid for the service, the BMA do not recommend routine circumcisions.
The health service neither recommends nor pays for routine circumcisions. ( they do so in medical need cases).

There are insignificantly low incidences of any problems related to uncircumcised men in the UK or Europe.

What is it about the the doctors, and their professional bodies, in the USA that is so different....?
The obvious one is that they are highly paid for the procedure. The health risks for and against are unlikely to be any different to those in Europe.

The Health professionals in the USA depend on the personal sales of their services. This is rarely the case in Europe, where demand is balanced by need not the ability to pay.

 

[Aquitaine]

I would hope that lurkers have enough common sense to seek unbiased, professional, sources, not the opinions of people on this forum, to be honest.

And herein lies the issue. Americans (for example) will consult the AAP/CDC, Canadians the CPS, and Brits the NHS.

It appears that in-relation to "non-urgent" infant male circumcision, the AAP/CDC and the CPS/NHS aren't necessarily on the same team, so to speak. So the problem still persists, because we're all referring to different "unbiased" (no such thing) professional sources.



It's essentially a deadlock.

 

[Aquitaine]

The way I see it if it is one of the least complained thing about "how my parents **** me up" then it aint important.

Seriously, parents make too many decisions for kids. This is just nothing. Their nutritional habits are way more important than this. Forcing a teen into heels is more grave than this, forcing a kid to shoes is more grave than this, simply not saying enough "I love you" or "you did a good job" is thousands times more important than this.

This is truly unimportant.

If you feel it is unimportant for yourself, then fine. But that doesn't mean it's unimportant for everyone else.

Also, if you're going to go down the road of "but there's worse things out there" then fine, but be careful because the next time you complain about something in your life, someone else will just say "get over yourself, there's more important things to worry about!".

 

[dawny0826]

Few British doctors are trained to do circumcisions. If they do them privately they are paid for the service, the BMA do not recommend routine circumcisions.
The health service neither recommends nor pays for routine circumcisions. ( they do so in medical need cases).

There are insignificantly low incidences of any problems related to uncircumcised men in the UK or Europe.

What is it about the the doctors, and their professional bodies, in the USA that is so different....?
The obvious one is that they are highly paid for the procedure. The health risks for and against are unlikely to be any different to those in Europe.

The Health professionals in the USA depend on the personal sales of their services. This is rarely the case in Europe, where demand is balanced by need not the ability to pay.

Many infant circumcisions are performed in hospitals by pediatrians, who in the US or specialist-types. Circumcisions are not ther primary job. So, I'm not convinced that that this is a money-driven procedure, particularly when the numbers of the procedure are on the decline and there isn't a push by the AAP to offer the procedure routinely.

 

[Terrywoodenpic]

Many infant circumcisions are performed in hospitals by pediatrians, who in the US or specialist-types. Circumcisions are not ther primary job. So, I'm not convinced that that this is a money-driven procedure, particularly when the numbers of the procedure are on the decline and there isn't a push by the AAP to offer the procedure routinely.

I would suggest that it is a money driven procedure,endorsed by custom.
When there is a down turn in car sales, it is not because the makers to not want to make and sell them. It is because of their customers lack of desire, or when lack of cash, prospects or other needs take priority.

The peoples priority that is given to circumcisions in the USA seem to be reducing, "for what ever reason". It is certainly not caused by the lack of desire of doctors to perform them, or for a change in their professional opinion or advice.

I would not expect the AAP to push any procedure; and more especially one, that on a world scale, is so controversial as circumcision. The reason might be that more doctors are coming to the position that the procedure is far from essential and that it may not have a real cost/ benefit to their clients.

This would seem to be the position in Europe's health services.

 

[dawny0826]

And herein lies the issue. Americans (for example) will consult the AAP/CDC, Canadians the CPS, and Brits the NHS.

It appears that in-relation to "non-urgent" infant male circumcision, the AAP/CDC and the CPS/NHS aren't necessarily on the same team, so to speak. So the problem still persists, because we're all referring to different "unbiased" (no such thing) professional sources.



It's essentially a deadlock.

I'm sure you can understand why I trust the AAP over the CPA as an American. Though I don't mean any disrespect, I am of an opinion (emphasis on opinion) that America, as a blanket label, is better skilled at infant, male circumcision than Canada and the UK, considering the fact that our pediatricians and physicians are performing more procedures. I don't intend that to be a statement of arrogance. My opinion would apply the same, if Canada and/or the UK were performing more circumcisions.

Earlier this year, the CPA was actually considering taking a more neutral stance on infant male circumcision and releasing a modified position statement. In the article below, the AAP is referenced. The AAP changed its policy statement in 2012. They still do not recommend the procedure as routine, but, claim that health benefits outweigh risks. Ultimately they encourage parents to make the decision.

It doesn't appear that the CPA has made any sort of revision to their policy statement, but, I find it interesting. Another interesting point were these comments made in the article:

Any shift in policy would have to ensure, “are there enough skilled professionals around to do this, so that we don’t have a complication rate that is unacceptable and so that we’re not seeing males being significantly harmed by not having the properly trained people to do it,” Stanwick said.
The new policy statement is expected to be released before the pediatric group’s annual meeting in June.
“It would be great if we had absolute answers, but on this one, I don’t think we will,” Stanwick said.
“At the end of the day . . . it will very much be influenced by dad’s status, as well as the cultural and religious issues.”

Canada’s pediatricians set to reveal new policy on circumcision | canada.com

Whether or not Canada decided to follow suit in revising their statement is beyond me. Doesn't appear to be so. But, clearly, the CPA hasn't dismissd the statements made by the AAP. And the AAP does not downplay risks. It presents risks, potential benefit and says...here...you decide if this is right for your child.

 

[dawny0826]

I would suggest that it is a money driven procedure,endorsed by custom.
When there is a down turn in car sales, it is not because the makers to not want to make and sell them. It is because of their customers lack of desire, or when lack of cash, prospects or other needs take priority.

The peoples priority that is given to circumcisions in the USA seem to be reducing, "for what ever reason". It is certainly not caused by the lack of desire of doctors to perform them, or for a change in their professional opinion or advice.

I would not expect the AAP to push any procedure; and more especially one, that on a world scale, is so controversial as circumcision. The reason might be that more doctors are coming to the position that the procedure is far from essential and that it may not have a real cost/ benefit to their clients.

This would seem to be the position in Europe's health services.

I can't really speak to the motivation of individual health professionals. But, I do know that an infant male circumcision is significantly less expensive vs. an older child-adult male circumcisions as far less anethetic is needed. Adults are typically put under anethesia, which is incredibly costly, regardless the procedure.

My health care insurance would cover circumcision.

 

[Curious George]

And herein lies the issue. Americans (for example) will consult the AAP/CDC, Canadians the CPS, and Brits the NHS.

It appears that in-relation to "non-urgent" infant male circumcision, the AAP/CDC and the CPS/NHS aren't necessarily on the same team, so to speak. So the problem still persists, because we're all referring to different "unbiased" (no such thing) professional sources.



It's essentially a deadlock.

I am not so sure there is a different page. Don't all of these medical associations support the parental right to choose. It seems the discrepancy is only whether the risk slightly outweighs the harm or vice versa.

 

[9-10ths_Penguin]

I'm sure you can understand why I trust the AAP over the CPA as an American. Though I don't mean any disrespect, I am of an opinion (emphasis on opinion) that America, as a blanket label, is better skilled at infant, male circumcision than Canada and the UK, considering the fact that our pediatricians and physicians are performing more procedures. I don't intend that to be a statement of arrogance. My opinion would apply the same, if Canada and/or the UK were performing more circumcisions.

So you think that being more personally invested in circumcision makes a group of doctors more reliable? I think it would be the opposite: the more circumcisions they perform, the greater their conflict of interest on the issue.

As Terry pointed out, these doctors stand to gain financially from keeping circumcision going. In most other professions, that fact alone would be enough to make the professional duty-bound ethically not to try to shape public policy on the issue.

And if American doctors reflect the American populace as a whole, they're much more likely to have chosen circumcision for their own children or been circumcized themselves. Doctors are human beings, too; what parent would want to admit that they hurt their child needlessly? What man would want to imply that there's something wrong with his own penis?

The one country whose medical association has the biggest conflict of interest on the issue is the only one that advocates the practice. I think this is very telling.

 

[dawny0826]

So you think that being more personally invested in circumcision makes a group of doctors more reliable? I think it would be the opposite: the more circumcisions they perform, the greater their conflict of interest on the issue.

I'm of the opinion that a physician who is more experienced in infant circumcision is more apt to yield better results with a procedure as a result of their experience and skill. I don't believe that we can measure the emotional and opinional investment of our physicians in either country and how those thoughts and emotions impact practice.

]As Terry pointed out, these doctors stand to gain financially from keeping circumcision going. In most other professions, that fact alone would be enough to make the professional duty-bound ethically not to try to shape public policy on the issue.

I think that ultimately parental desire for the procedure will dictate whether or not circumcisions continue, and again, even the CPA has paused and considered within the last year a more neutral stance on the circumcision issue. Did you mention that in this thread?

The AAP and American pediatricians are not attempting to shape public policy. Your own family pediatrician or a pediatrician from your chosen pediatric practice are likely to perform the procedure in America unless you didn't choose a pediatrician prior to birth. A parent can discuss the procedure in advance with those who may perform it.

Again, it's an opt-in/out procedure.

Women are encouraged to submt detailed delivery and recovery plans to their obstetricians and include their pediatricians in plans, prior to giving birth to ensure that their wishes regarding such procedures are known ahead of time (I'm not excluding Dads from this...I'm just mentioning Mom as a lot of the birth and recovery plan are specific her needs and preferences).

Afer a rough experiece in recovery after my first baby (c-section), I knew what needed not be repeated the second go around and I pre-planned for it, which is what you're supposed to do.

You have to advocate for yourself and for your children and in my opinion, you disserviceyourself and your child if you're approaching an issue like infant circumcision for the very first time, days after your baby is born, when you may not be feeling 100% and may have regrets later.

Educaton, planning and placing that effort to make the type of decisons that you can be confident in are so important.

And if American doctors reflect the American populace as a whole, they're much more likely to have chosen circumcision for their own children or been circumcized themselves. Doctors are human beings, too; what parent would want to admit that they hurt their child needlessly? What man would want to imply that there's something wrong with his own penis?

An American doctor does not reflect the American populace as a whole. Regardless as to a doctor's opinion on circumcision, American parents still must legally consent to the procedure, which places responsibility and burden on them to eduate themselves and make decisions that they can live with.

Again, I contend that parents should be able to make this choice on their own. That's all that the APA states really. These are the risks. These are the possible heath benefits. You decide.

The one country whose medical association has the biggest conflict of interest on the issue is the only one that advocates the practice. I think this is very telling.

You're being dishonest, Jeff. The AAP neither endorses or advocates it. They simply changed their policy statement - acknowleding that there are over 1,000 studies that support that the procedure yields greater benefit over risk. However they DO NOT recommend this as a routine practice as it is not medically necessary to a child's health and leave the decison to parents, encouraging educated choices.

What conflict of interest therein lies, beyond your personal objections to it?

 

[Terrywoodenpic]

I can't really speak to the motivation of individual health professionals. But, I do know that an infant male circumcision is significantly less expensive vs. an older child-adult male circumcisions as far less anethetic is needed. Adults are typically put under anethesia, which is incredibly costly, regardless the procedure.

My health care insurance would cover circumcision.

That is two differences to the UK
such elective surgery along with cosmetic surgery is not covered by by most private insurance.
Circumcisions are done under local anethetic.
Even hip operations are mostly done under local anethics now, as recovery and healing is so much quicker, and the dangers so much lower.

 

[dawny0826]

That is two differences to the UK
such elective surgery along with cosmetic surgery is not covered by by most private insurance.
Circumcisions are done under local anethetic.
Even hip operations are mostly done under local anethics now, as recovery and healing is so much quicker, and the dangers so much lower.

Circumcision isn't considered cosmetic surgery, of course, in the US.

In the US, the type of insurance that you have and the type of surgery you're undergoing dictates whether or not insurance will cover it.

In example, my own insurance policy will not cover tests or any type of procedure that my attending physician doesn't sign off on as being necessary, outside the auspices of cancer...let's say I had breast cancer and had a masectomy. My insurance does cover at least a portion of reconstructive surgery. But, that's a restoring procedure. I would not have required it, had I not lost my breast to cancer.

Circumcision, like immunizations are not all required, but, many do deem them necessary. As there are medical benefits attached, many insurances cover them.

If I elected to have my breasts enlarged for cosmetic reasons, most insurance companies don't cover that, unless you have a health or medical condition for which the surgeon would be correcting,but, even then, insurace companies may itemize those costs which are medically necessary and those costs which are related to the cosmetic procedure.

Another example, at 27, my sister had multiple cosmetic surgeries done and her primary reason for having it done was because of her dissatisfaction with her appeaance, but, she would not have considered it, had she not had a legitimate health concern with her ab muscles - which were damaged during child birth. Her insurance covered a portion of the procedure. She was required to cover everything else.

 

[DallasApple]

The way I see it if it is one of the least complained thing about "how my parents **** me up" then it aint important.

Seriously, parents make too many decisions for kids. This is just nothing. Their nutritional habits are way more important than this. Forcing a teen into heels is more grave than this, forcing a kid to shoes is more grave than this, simply not saying enough "I love you" or "you did a good job" is thousands times more important than this.

This is truly unimportant.

But two can play at that game.I have absolutely zero issue with the fact my parents put shoes on me in fact Im grateful.That is a non issue for me.

 

[DallasApple]

I would suggest that it is a money driven procedure,endorsed by custom.
When there is a down turn in car sales, it is not because the makers to not want to make and sell them. It is because of their customers lack of desire, or when lack of cash, prospects or other needs take priority.

The peoples priority that is given to circumcisions in the USA seem to be reducing, "for what ever reason". It is certainly not caused by the lack of desire of doctors to perform them, or for a change in their professional opinion or advice.

I agree.I think its awareness.More and more parents like me are realizing its not the right thing to do.It certainly not the doctors trying to talk parents out of it.

 

[9-10ths_Penguin]

I'm of the opinion that a physician who is more experienced in infant circumcision is more apt to yield better results with a procedure as a result of their experience and skill. I don't believe that we can measure the emotional and opinional investment of our physicians in either country and how those thoughts and emotions impact practice.

So... because it's difficult to measure, it's unimportant?

I think that ultimately parental desire for the procedure will dictate whether or not circumcisions continue, and again, even the CPA has paused and considered within the last year a more neutral stance on the circumcision issue. Did you mention that in this thread?

It's good for organizations to review their policies from time to time on any issue. They reviewed the matter and didn't change their policy.

The AAP and American pediatricians are not attempting to shape public policy.

Of course they are. Not governmental policy necessarily, but they know that this is an issue where what they say will have widespread implications in terms of things like whether parents will choose the procedure and whether insurance companies will cover it.

My point was that when a professional is doing research on an issue, or is making recommendations on an issue based on the recommendation of others, there is at least a potential conflict of interest if the research conclusions or recommendations if the person making them stands to be benefitted or harmed financially by them.

An American doctor does not reflect the American populace as a whole.

Are male American doctors not likely to have been circumcised themselves?

Are American doctors of either gender not likely to have chosen circumcision for their children?

If they are, then my point stands. If they're not, then it creates a whole other set of questions.

Regardless as to a doctor's opinion on circumcision, American parents still must legally consent to the procedure, which places responsibility and burden on them to eduate themselves and make decisions that they can live with.

And those parents' opinions will be informed by the recommendations of medical professionals. You yourself have said that the APA's position on the issue was a key factor in your own opinion. Even when the parent has a free choice, the APA's recommendations will carry influence.

Again, I contend that parents should be able to make this choice on their own. That's all that the APA states really.

Yes... and in that regard it goes against the consensus of other similar bodies in other countries. For the APA to recommend against circumcision, it would have to clear several hurdles:

- it has a significant proportion of members who are circumcised themselves, and as I pointed out earlier, men generally don't like to imply that there's something wrong with their penises.

- it has a significant proportion of members who will benefit financially by not recommending against circumcision. If they recommend against circumcision, this would likely lead to fewer parents choosing circumcision and potentially it being de-funded by health insurance plans. This has the potential to reduce the future earnings for many doctors.

- it has a significant proportion of members who have done many circumcisions in the past. Not only would recommending against circumcision be difficult in terms of social dynamics (since it could be taken as a condemnation of doctors with very high levels of stature and influence in the medical community), it could expose those doctors who have done circumcisions in the past (or those who would choose to keep doing them in future) to lawsuits.

Since any of these reasons could potentially sway the APA's opinion on circumcision, I don't think it's reasonable for you to assume that their position is based on an objective, unbiased analysis of the facts.

These are the risks. These are the possible heath benefits. You decide.

There's also one medical association who claims that the risks don't outweigh the benefits. Some people will take this seriously.

You're being dishonest, Jeff. The AAP neither endorses or advocates it. They simply changed their policy statement - acknowleding that there are over 1,000 studies that support that the procedure yields greater benefit over risk. However they DO NOT recommend this as a routine practice as it is not medically necessary to a child's health and leave the decison to parents, encouraging educated choices.

What conflict of interest therein lies, beyond your personal objections to it?

Do you really think that there can't be a conflict of interest if they don't come out with a specific recommendation for or against?

They've made explicit claims about circumcision (e.g. that the benefits outweigh the risks), and they've issued a position on it (i.e. that they leave the decision about whether to do it to the individual practitioner and the patient's parents).

The AAP has a stance on the issue. They also have a conflict of interest: the personal interests of the researchers and AAP leadership would tend to pull them to one side of the issue and not the other. How much has this conflict of interest affected their decision? Would they have recommended against circumcision if not for these conflicts? I don't know and neither do you.

The presence of a conflict of interest is enough to call their conclusions into question. There are factors at play that could have affected the AAP's position. Until we can dig deeper and figure out how much they did affect their position, I don't think it's reasonable to consider it reliable... to say nothing of considering them even more reliable than other associations who have access to the same research but don't have these conflicts of interest.

... but those other associations generally recommend against circumcision, so they wouldn't serve your purposes, would they?

 

[9-10ths_Penguin]

Another thought: I think that it's important to remember that this debate isn't just a matter of "circumcision: yes or no". There's some gradation here. There's a range of ages when circumcision could occur:

- old enough for the person being circumcised to freely consent to the circumcision (i.e. adulthood).
- young enough that the procedure's done before the boy becomes sexually active.
- old enough that the child can voice an opinion on the matter, even if the parents have a legal right to override that opinion.
- old enough that the child can follow instructions to help care and recovery.
- old enough that the child is toilet trained.
- old enough that the prepuce has separated naturally.
- immediately after birth.

I'm in favour of the first option. Even if we take dawny's claims at face value, most of them speak in favour of the second (i.e. before sexual activity), but she's arguing for the last one: immediately after birth. But let's consider this:

- if we wait until the prepuce has separated naturally, outcomes improve. In some cases, the prepuce has separated before birth. Sometimes, it separates as late as five years after. In any case, studies have found that outcomes improve significantly if circumcision is delayed until at least 30 days after birth.

- if we wait until the boy is toilet trained, then I think it stands to reason that outcomes would improve further. I don't have any studies to back this up, but I suspect that wounds tend to heal quicker and with less chance of infection when they aren't being smeared with excrement on a regular basis. YMMV.

- if we wait until the boy can follow instructions regarding his care (i.e. things like "don't touch your bandages", "keep your pee-pee clean", and "tell me if it starts to really hurt"), then again... while I have no studies to back it up, it seems to me that outcomes would likely improve.

So basically, I just want to remind people that this thread is about infant circumcision, and that "before sexual activity" does not necessarily mean "infant":

Thus the important question for these pediatric societies is not about a change in infant circumcision recommendations, but rather the need to address whether there would be merit in routine peripubertal male circumcision.

The evidence for risks and benefits of circumcision in this age group has not been assessed in the same rigorous manner as those for infant circumcision. Modelling of potential benefits and cost-effectiveness studies would also need to be done. For example HPV vaccine for males in this age group might be a better strategy for prevention of HPV than circumcision.

Some adult males may squirm at the very thought of routinely offering circumcision to peripubertal males, possibly because of perceived pain and discomfort. But infant circumcision also causes pain and discomfort.2,4 Indeed it’s curious that a painful elective procedure of no major benefit to the infant until years later would ever be deemed more acceptable than the same procedure for a peripubertal boy.

The adolescent scenario would also have an additional advantage: the opportunity for informed choice by the proposed recipient of the procedure. The boy can give assent, while a neonate cannot. As well, this would provide a prime opportunity to discuss other ways to decrease risk of sexually transmitted infections whether or not the peripupertal male agreed to be circumcised.

Male circumcision: get the timing right

 

[dawny0826]

So... because it's difficult to measure, it's unimportant?

I suppose it's contingent upon the individual, Jeff. I'm much more interested in a pediatrician's reputation as a surgeon, than their personal views on circumcision.

I'm direct enough as a person that I wouldn't hesitate to ask personal questions regarding my pediatrician's opinions, if it was important to me, but my greatest concern revolves around her abilility and the ability of those within her practice.

It's good for organizations to review their policies from time to time on any issue. They reviewed the matter and didn't change their policy.

What if the CPA does revisit their policy again and make revisions - changing their stance to more of a neutral stance? Will your thoughts remain the same if the CPA adopts a more comparable policy to that of the APA?

Of course they are. Not governmental policy necessarily, but they know that this is an issue where what they say will have widespread implications in terms of things like whether parents will choose the procedure and whether insurance companies will cover it.

Okay. Fair enough. I suppose I cannot argue with you, here, however, what I intended to convey there, was that they are not pushing a particular agenda in terms of - "yes, do this" or "no, do not do this".

My point was that when a professional is doing research on an issue, or is making recommendations on an issue based on the recommendation of others, there is at least a potential conflict of interest if the research conclusions or recommendations if the person making them stands to be benefitted or harmed financially by them.

I think this depends solely upon the individual medical professional, Jeff. While yes, I agree that there must be some who would allow financial incentive to sway their decisions, a good doctor will provide unbiased information. I do believe that there are good doctors out there.

And regardless as to our personal opinions on this subject matter, we cannot possibly know the personal motivations of our doctors outside the auspices of what we see through their works. They do take oaths not to do harm and again, when you establish a trusted relationship with your doctor, which I've been fortunate to do with both my girls' former pediatrician and with my present PCP, you assume as a patient, that unless your medical professional gives you reason to doubt, you're being given credible information and guidance.

Ultimately, you have to advocate for yourself and your own family. There's always option for second opinion and additional research.

Are male American doctors not likely to have been circumcised themselves?

Are American doctors of either gender not likely to have chosen circumcision for their children?

If they are, then my point stands. If they're not, then it creates a whole other set of questions.

I get your point, Jeff. But, you need to take this down to the couple who is making decisions for their child. Again, if they are proactive in contemplating a decision before giving birth, they approach this multi-faceted decision and provide themselves ample opportunity to weigh risks and benefit.

Ultimately, it's not going to matter what their doctor chose for his/her child. It's going to matter what they choose for their child. More importantly, if they choose incorrectly for their child.

They aren't meeting with the entire populace of physicians. They are meeting with perhaps the 1-2 pediatricians within their own chosen pediatric practice.

And those parents' opinions will be informed by the recommendations of medical professionals. You yourself have said that the APA's position on the issue was a key factor in your own opinion. Even when the parent has a free choice, the APA's recommendations will carry influence.

Many of my decisions and opinions were formed while pregnant with my first baby, before I knew of the APA website. I did however, keep my nose buried in pregnancy and parenting books, which contained a lot of great information on infant circumcision. Additionally, I come from a family of medical professionals, and I can freely bounce questions off of them. My ex-husband's situation was rather unique. He was circumcised at 16 and resented his parents for not having him circumcised as a baby. He did not regret his circumcision and true story, said he preferred the feel of it after the procedure, but, he did regret the pain and embarassment of having it done in his teens.

I've always researched. I've always asked questions. And I found an excellent pediatrician that I trusted.

Lo and behold, I'm a mother to two beautiful little girls. I've never had to make that decision and probably will never have to.

But, if FH and I were to have a son, I would do things the same way - hit the books - revisit these websites - go back to my pediatrician and we'd sit and talk about it. Ultimately, it would need to be a decision that we could live with.

Since any of these reasons could potentially sway the APA's opinion on circumcision, I don't think it's reasonable for you to assume that their position is based on an objective, unbiased analysis of the facts.

The AAP has a stance on the issue. They also have a conflict of interest: the personal interests of the researchers and AAP leadership would tend to pull them to one side of the issue and not the other. How much has this conflict of interest affected their decision? Would they have recommended against circumcision if not for these conflicts? I don't know and neither do you.

Dear God, man, you are relentless.

By your logic, the very same can be said about ANY organization that is participating in study regarding circumcision. I'm sure there's bias and persuasive power within the CPA and NHS too. Don't front as if the APA doesn't contain solid information to rely upon. In fact, there are a plethora of resources to pull from which would support a person staunchly against the procedure as well as someone more neutral.

We don't know for sure what conflicts of interest may have influenced the policy statement. But again, the policy statement hasn't really changed in a ground breaking enough way to make that much of a difference. Okay, I agree with you on one point - pediatric groups (APA included) are pushing for insurance companies to cover circumcision. But, the procedure is not deemed medically necessary to where it's offered routinely at birth. The risks of the procedure are still clearly outlined and it's a very much a choice, not much unlike some immunizations. This just happens to yield much greater risk and requires much greater contemplation.

At the end of the day - individual people are held accountable for their decisions, though. That doesn't change.

 

[dawny0826]

Another thought: I think that it's important to remember that this debate isn't just a matter of "circumcision: yes or no". There's some gradation here. There's a range of ages when circumcision could occur:

- old enough for the person being circumcised to freely consent to the circumcision (i.e. adulthood).
- young enough that the procedure's done before the boy becomes sexually active.
- old enough that the child can voice an opinion on the matter, even if the parents have a legal right to override that opinion.
- old enough that the child can follow instructions to help care and recovery.
- old enough that the child is toilet trained.
- old enough that the prepuce has separated naturally.
- immediately after birth.

I'm in favour of the first option. Even if we take dawny's claims at face value, most of them speak in favour of the second (i.e. before sexual activity), but she's arguing for the last one: immediately after birth. But let's consider this:

- if we wait until the prepuce has separated naturally, outcomes improve. In some cases, the prepuce has separated before birth. Sometimes, it separates as late as five years after. In any case, studies have found that outcomes improve significantly if circumcision is delayed until at least 30 days after birth.

- if we wait until the boy is toilet trained, then I think it stands to reason that outcomes would improve further. I don't have any studies to back this up, but I suspect that wounds tend to heal quicker and with less chance of infection when they aren't being smeared with excrement on a regular basis. YMMV.

- if we wait until the boy can follow instructions regarding his care (i.e. things like "don't touch your bandages", "keep your pee-pee clean", and "tell me if it starts to really hurt"), then again... while I have no studies to back it up, it seems to me that outcomes would likely improve.

So basically, I just want to remind people that this thread is about infant circumcision, and that "before sexual activity" does not necessarily mean "infant":



Male circumcision: get the timing right

Jeff, my argument is that parents should have the right to choose what's best for their children. I'm a proponent of educated decision making and feel that the APA provides a plethora of resources to explore.

I have presented evidence provided through sources from the APA, CDC and other sites throughout this thread, which conflict with the claims provided in the OP.

I respect that you would opt for option #1 for your male child.

I find the statements of the APA to be quite reasonable as a parent:

New scientific evidence shows the health benefits of newborn male circumcision outweigh the risks of the procedure, but the benefits are not great enough to recommend routine circumcision for all newborn boys, according to an updated policy statement published by the American Academy of Pediatrics (AAP). The revised policy, like the previous one from the AAP, says the decision whether or not to circumcise should be left to the parents in consultation with their child’s doctor.

The policy statement and accompanying technical report from the AAP will be published in the September 2012 issue of Pediatrics (published online Monday, Aug. 27). The documents update the previous policy that the AAP published in 1999 and reaffirmed in 2005.

Since the last policy was published, scientific research shows clearer health benefits to the procedure than had previously been demonstrated. According to a systematic and critical review of the scientific literature, the health benefits of circumcision include lower risks of acquiring HIV, genital herpes, human papilloma virus and syphilis. Circumcision also lowers the risk of penile cancer over a lifetime; reduces the risk of cervical cancer in sexual partners, and lowers the risk of urinary tract infections in the first year of life.

The AAP believes the health benefits are great enough that infant male circumcision should be covered by insurance, which would increase access to the procedure for families who choose it.

“Ultimately, this is a decision that parents will have to make,” said Susan Blank, MD, FAAP, chair of the task force that authored the AAP policy statement and technical report. “Parents are entitled to medically accurate and non-biased information about circumcision, and they should weigh this medical information in the context of their own religious, ethical and cultural beliefs.”

The medical benefits alone may not outweigh other considerations for individual families. The medical data show that the procedure is safest and offers the most health benefits if performed during the newborn period. The AAP policy recommends infant circumcision should be performed by trained and competent providers, using sterile techniques and effective pain management.

The policy has been endorsed by the American College of Obstetricians and Gynecologists (the College). “This information will be helpful for obstetricians who are often the medical providers who counsel parents about circumcision,” said Sabrina Craigo, MD, the College’s liaison to the AAP task force on circumcision. “We support the idea that parents choosing circumcision should have access to the procedure.”

Parents who are considering newborn circumcision should speak with their child’s doctor about the benefits and risks of the procedure, and discuss who will perform the circumcision. “It’s a good idea to have this conversation during pregnancy, and to learn whether your insurance will cover the procedure, so you have time to make the decision,” said Dr. Blank.

Source: New Evidence Points to Greater Benefits of Infant Circumcision, But Final Say is Still Up to Parents, Says AAP