I saw this earlier today. I'm still cool with our decision. I'm not sure what it would take for me to be on board with removing a healthy part of my child but this isn't it.
I'm fairly circ ambivalent. When DD was born, if she had been a boy, we would not have circed (based on the research at the time). We did end up doing it with DS, however.
But to me its comparable to any prevention procedure. Your wording seems weird to me. I get why people do not circ and I have no problem with that. But your wording seems to imply you would be pretty anti most things that are prevention related.
I'm big on bodily autonomy. I just don't feel comfortable removing the body part of an infant that is healthy. I'm not sure I know of another similar procedure but if there were one, yes I'd probably be equally as uncomfortable.
Do people talk about this in real life? I am asking because this issue gets a lot of attention on the boards but it is not something that I have ever talked about with anyone.
My husband and I decided what to do with ds but I never felt pressure from anyone.
they do when you're pg wirh a boy. In my family it's assumed that every boy is circed. It's extremely uncomfortable.
Post by lyssbobiss, Command, B613 on Dec 3, 2014 14:07:09 GMT -5
Yes, I had to explain my decision to basically everyone including the nursing staff when Babycakes was born. As if I were dooming him to a life of an unattractive penis and God knows there's nothing worse than that.
"This prick is asking for someone here to bring him to task Somebody give me some dirt on this vacuous mass so we can at last unmask him I'll pull the trigger on it, someone load the gun and cock it While we were all watching, he got Washington in his pocket."
Yes, I had to explain my decision to basically everyone including the nursing staff when Babycakes was born. As if I were dooming him to a life of an unattractive penis and God knows there's nothing worse than that.
dh and I really agonized over the decision but once we made it we felt confident. The pedi doing rounds the day after stealthson was born gave me pushback and I was furious. I gave her my best back the fuck off look when I had to reirerate we had made our decision.
I was afraid of a repeat with stealthbaby but it wasn't an issue. I suppose it was a very thin silver lining to having a preemie.
Yes, I had to explain my decision to basically everyone including the nursing staff when Babycakes was born. As if I were dooming him to a life of an unattractive penis and God knows there's nothing worse than that.
I have discussed and done circ three different ways... I'm not sure I'm super anti circ, but I do regret some of my (our) decisions WRT circumcism and my kids. And yes, my friends and family have all discussed the benefits/negatives of circ at dinners and on the phone. It was just part of having kids and the discussion around that.
Frist DS = uneventful circ in the hospital - let my DH decide since I wasn't leaning no-circ, but he was leaning yes.
Second DS = partial circ post birth and discovery of mild hypospadias made worse by partial circ since they would need the foreskin to repair and some was gone. So he ended up being partially circ'd for 6 months until we could put him under GA and have the pediatric urologist fix everything (make his penis longer, straighter, fix the hypospadias and circ). I wish we would have never started the circ post birth. Yes, he may have still had partial hypospadias that we wouldn't have see until the foreskin retracted, but without circ, that doesn't often need repair and does not affect urination or sexual function of the penis. It's crazy that b/c people circ so much and that hypospadias is one of the most common birth defects in infant boys that we are essentially making more surgeries/repairs needed b/c we circ. That means many more little boys, like my kid and my nephew and a friend's kid all end up with a circ AND a hypospadias surgery when they really didn't need either.
Third DS = no circ and so far no problems. Easy no circ decision and if anyone asks, I tell them, I wish I would have just never circ'd.
Yes, I had to explain my decision to basically everyone including the nursing staff when Babycakes was born. As if I were dooming him to a life of an unattractive penis and God knows there's nothing worse than that.
We live in a pro-circ area and when the (very young) PP nurse told me that "oh the circ will be done on the day of discharge" I told her that we wouldn't doing that. She got all red and didn't know what to say. It was all very awkward.
Post by irishbride2 on Dec 3, 2014 16:42:57 GMT -5
Our hospital was great about it. I remember them asking "are you going to circ" and not assuming. And then when I said yes they asked if I wanted it there or if I wanted to wait until his two week appointment. So I think it would have been nbd if we had said no.
We never had anyone ask us about it one way or another. I had said in my birth plan that we weren't doing it, and that was it. Of course, he was in the NICU for a day or two, and then in the nursery with jaundice, so maybe no one thought to ask about it, since there were other issues.
I was particularly glad that no family members got on us for it. Apparently, DH's grandfather wasn't circ'ed and had problems all his life, so he finally had to have it done a few years ago (in his 70s), so now Dh's grandmother is very pro-circ. In fact, when she heard we were having a boy, she said to my ILs, "Oh, I hope they make sure they have him circumcised!" Fortunately, she never said a word about it to us.
Post by karinothing on Dec 3, 2014 18:20:18 GMT -5
Just heard cdc is weighing advising all non-circd men/boys about the heath benefits of being circd. I have no problem with this but hope they explain the stats better than news organizations do.
...backs out of thread, horrified that a scientist I respect compared circumcision risk to gum disease.
I didn't compare circumcision to gum disease. I compared how I feel about the decision of other people to do it or not. It's not my call. It's not my cross to die on. I actually struggled to come up with an appropriate analogy because I wholly respect that it's a personal decision that should be made by families and that has, at best, modest public health ramifications. Flossing was the best I could come up with on the fly.
OH JFC. I just read all the replies and holy hell folks, it's not like I sat there going HAH HAH HAH all your intactivists -TOLD YA YOUR KID WOULD GET THE AIDS.
That's what I get for only having five minutes to check in. mumblegrumblestupidwork.
With that said... I humbly apologize to anyone who thought I implied that the ACT of circumcision ITSELF was akin to the ACT of flossing. That was not my intention.
Just heard cdc is weighing advising all non-circd men/boys about the heath benefits of being circd. I have no problem with this but hope they explain the stats better than news organizations do.
I do have a problem with this. I'm not really interested in some government official helping my 3 and 5 year old by telling them how they are going to get a terrible disease and possibly die if they don't have someone chop off part of their penis. With a side of your parents kind of suck for not doing this for you as a baby.
Maybe this is turning into my hill to die on. I don't give a shit if other parents want to circ their sons, but swinging from insurance refusing to pay for circumcision because they see it as elective/cosmetic all the way to the CDC stepping in to counsel all uncircumcised men about how they should go get circumcised in the course of a few years is pure insanity. Clearly if we are swinging so drastically between opinions on this, it isn't as clear as I think it needs to be for the CDC to be involved.
Just heard cdc is weighing advising all non-circd men/boys about the heath benefits of being circd. I have no problem with this but hope they explain the stats better than news organizations do.
I do have a problem with this. I'm not really interested in some government official helping my 3 and 5 year old by telling them how they are going to get a terrible disease and possibly die if they don't have someone chop off part of their penis. With a side of your parents kind of suck for not doing this for you as a baby.
Maybe this is turning into my hill to die on. I don't give a shit if other parents want to circ their sons, but swinging from insurance refusing to pay for circumcision because they see it as elective/cosmetic all the way to the CDC stepping in to counsel all uncircumcised men about how they should go get circumcised in the course of a few years is pure insanity. Clearly if we are swinging so drastically between opinions on this, it isn't as clear as I think it needs to be for the CDC to be involved.
The reason i was not bothered is because i think of doctors advising sexually active men of additional ways they can prevent the spread of STDs. On one hand i think that is the medical communities duty. On another i would appreciate them telling the reality of the statistics. Like circumscion hasn't shown to reduce m2m hiv transmission or that the rate of transmission Expecially with proper condom use is very low even without circumcision
Just heard cdc is weighing advising all non-circd men/boys about the heath benefits of being circd. I have no problem with this but hope they explain the stats better than news organizations do.
I do have a problem with this. I'm not really interested in some government official helping my 3 and 5 year old by telling them how they are going to get a terrible disease and possibly die if they don't have someone chop off part of their penis. With a side of your parents kind of suck for not doing this for you as a baby.
Maybe this is turning into my hill to die on. I don't give a shit if other parents want to circ their sons, but swinging from insurance refusing to pay for circumcision because they see it as elective/cosmetic all the way to the CDC stepping in to counsel all uncircumcised men about how they should go get circumcised in the course of a few years is pure insanity. Clearly if we are swinging so drastically between opinions on this, it isn't as clear as I think it needs to be for the CDC to be involved.
You really think they mean they are going to pull 3 year olds aside and tell them they are going to get a terrible disease?
Ok, several hours later and I confess this is still bothering me. I was rushed last night and didn't express myself well; for that I am sorry. Among my weaknesses, my biggest is that it keeps me up at night when I think people I respect are disappointed in me - I *hate* feeling like I've let people down. And I'm particularly prickly when my scientific integrity (or whatever) is called into question or I'm deemed somehow less respected for a simple opinion - admittedly an inartfully worded one.
So let me try again:
First, a preface: I do not have deep seated feelings about what other people choose (or do not choose) to do with their child's penis. I just don't. I know that for many people it is an extremely important and emotional topic, and I would not ever try to tell someone that they should change their mind.
My perspective is (duh) largely academic. My point was that, unlike vaccines - where what one person chooses does have the potential to affect many others - circumcision is an essentially isolated event. One might call it abusive, but from a strictly technical sense, what happens to that one child does not directly affect anyone other than that child. So my feelings on it aren't nearly as strong as they would be on other things - it's just personal. I feel as strongly whether someone chooses to circumcise their child as I do whether they floss daily. I still think that's *interesting* that there seems to be a growing consensus (rooted in some combination of science, politics, and economics) that circumcision on a population level seems to have modest overall public health benefits. We can absolutely question the data or the motivation or whatever - and have and I am sure will continue to do so.
Anyway, I totally cop to feeling overly bothered by the fact that all of a sudden I'm not as respectable as a scientist by some of you due to this simple opinion. I am working on not letting stuff like this get to me but as I said, I know it's like my kryptonite.
You really think they mean they are going to pull 3 year olds aside and tell them they are going to get a terrible disease?
Lol.
Right?
Please, it's going to be an even milder version of the way they handle vaccines. Something like, well, here's some literature that discusses the pros and cons of circing if you want to go over it later but basically, the CDC says the benefits outweigh the risk but you can do what you want because your kid will be fine either way.
There is no way no how they will be trying to sweet talk little Johnny into granting permission for a circumcision. There is virtually no aspect of healthcare that they handle in that manner for children.
If there was, doctors all over the country would be telling stories of the big bad polio wolf and our rates of vaccinations would be much, much higher.
Ok, several hours later and I confess this is still bothering me. I was rushed last night and didn't express myself well; for that I am sorry. Among my weaknesses, my biggest is that it keeps me up at night when I think people I respect are disappointed in me - I *hate* feeling like I've let people down. And I'm particularly prickly when my scientific integrity (or whatever) is called into question or I'm deemed somehow less respected for a simple opinion - admittedly an inartfully worded one.
So let me try again:
First, a preface: I do not have deep seated feelings about what other people choose (or do not choose) to do with their child's penis. I just don't. I know that for many people it is an extremely important and emotional topic, and I would not ever try to tell someone that they should change their mind.
My perspective is (duh) largely academic. My point was that, unlike vaccines - where what one person chooses does have the potential to affect many others - circumcision is an essentially isolated event. One might call it abusive, but from a strictly technical sense, what happens to that one child does not directly affect anyone other than that child. So my feelings on it aren't nearly as strong as they would be on other things - it's just personal. I feel as strongly whether someone chooses to circumcise their child as I do whether they floss daily. I still think that's *interesting* that there seems to be a growing consensus (rooted in some combination of science, politics, and economics) that circumcision on a population level seems to have modest overall public health benefits. We can absolutely question the data or the motivation or whatever - and have and I am sure will continue to do so.
Anyway, I totally cop to feeling overly bothered by the fact that all of a sudden I'm not as respectable as a scientist by some of you due to this simple opinion. I am working on not letting stuff like this get to me but as I said, I know it's like my kryptonite.
If it helps, I did not take your analogy so very literally and understood that you grasped something close but not exactly.
And one more thing about the CDC and doctors, I highly HIGHLY doubt any doctor is going to discuss circing with the parents of children who aren't freshly born.
The CDC is not recommending that boys and men who aren't circ'd think about doing so. There would have to be a much stronger statement for someone very influential before it would give doctors a reason to press for the circing of someone beyond a few weeks old.
I'm not sure where I've heard it but my assumption was that if you aren't circ'd at birth or within a week or so of birth, no one really wants to circ you after that unless you really, really wanna and even then they'd rather not. So why on earth a doctor would try to talk anyone, toddler or mother into circing a non-newborn is really confusing to me.
And one more thing about the CDC and doctors, I highly HIGHLY doubt any doctor is going to discuss circing with the parents of children who aren't freshly born.
The CDC is not recommending that boys and men who aren't circ'd think about doing so. There would have to be a much stronger statement for someone very influential before it would give doctors a reason to press for the circing of someone beyond a few weeks old.
I'm not sure where I've heard it but my assumption was that if you aren't circ'd at birth or within a week or so of birth, no one really wants to circ you after that unless you really, really wanna and even then they'd rather not. So why on earth a doctor would try to talk anyone, toddler or mother into circing a non-newborn is really confusing to me.
not talked into it, but our 2 docs said once or twice we could if we chose to do so until he was 3
I guess I'm not reading that the same as you do. It seems, to me at least, that they are saying that if asked about it, that's the answer. Not that if you bring in your child for his middle school physical that a doctor should say, I notice you aren't circumcised, you wanna think about it?
I guess I'm not reading that the same as you do. It seems, to me at least, that they are saying that if asked about it, that's the answer. Not that if you bring in your child for his middle school physical that a doctor should say, I notice you aren't circumcised, you wanna think about it?
I am reading like, when they talk to you about if you are sexually active they would recommend it along with condoms, etc. Not a strong push for it, but still a change in actually recommending it. I am not that invested in this issue, I just thought it was interesting to see they are considering recommending the procedure for non-infants.
"This prick is asking for someone here to bring him to task Somebody give me some dirt on this vacuous mass so we can at last unmask him I'll pull the trigger on it, someone load the gun and cock it While we were all watching, he got Washington in his pocket."
epphd, I didn't take your analogy badly, though I see why some would. And I totally now see when you explain it how you meant it.
Actually, I'd really like to hear you weigh in on this more. I've never quite understood what appeals to people about the studies, as the Uganda one had to be discontinued because people stopped coming and it was determined that continued research would be unethical, and they all relied on self reporting. Further, the fact that men were supposed to abstain from sex after having the procedure would obviously mean they were not exposed to HIV? I'm still not sure why these studies are compelling in the least.
Bunny, I wish I had more time to do all the relevant reading and not just post review information, but I do want to weigh in with a reminder that HIV and penile cancer risk are not the only risks that studies have found reduced by male circumcision. Transmission of many viral and bacterial STIs are also reduced. I have not read each individual study but I'd suspect that while perhaps issues with some of them exist, serious concerns about every single one are not as likely.
More than 40 observational studies and three randomised trials have shown that male circumcision reduces HIV acquisition in men by 50–60%, and long-term follow-up studies show even higher efficacy of male circumcision.The randomised trials also showed that male circumcision decreases the risk of men acquiring genital ulcer disease, herpes simplex virus type 2, and oncogenic high-risk human papillomavirus.Additionally, male circumcision has direct benefits for female partners with reduced transmission rates of high-risk human papillomavirus, bacterial vaginosis, and trichomoniasis.
The study described by the above link additionally demonstrates a significant diminishment of syphilis incidence and transmission in circumcised men (as best I can tell, this was not an interventional trial where men were circumcised as part of the study and followed, but rather observational).
Now, from my understanding of the many studies done some questions remain: 1. Is the risk reduction observed in studies where adult men are circumcised translatable to RIC? 2. Is the risk reduction observed meaningful on a population level if only men enjoy the reduced risk? 3. Is the risk reduction observed due to reduced frequency of sex as a result of circumcision? 4. Is the risk reduction observed meaningful enough to implement widespread surgical intervention even though other prevention measures may be available (condoms, abstinence, etc)?
As far as question 1 goes, I think it's a fair one. We simply cannot know at this point because epidemiology takes a long time. It's theoretically possible that the protective effect of circumcision in adults is fundamentally different than it is in infants who grow up circumcised. Even a small part of the body like the foreskin of the penis is a complex environment, and the microbial flora of adults and infants are often different - and this can impact susceptibility to infection in ways we are no where near fully understanding.
As far as question 2 goes: I guess the same criticism could be leveled at the current implementation of HPV vaccination. If only one sex partner of two is protected, how long will it take for the reservoir of disease to be reduced? This to me doesn't argue against the existence of the protective effect.
Question 3: I haven't read the study design of the Uganda studies. I will do so and get back but I admit I'm skeptical since no scientist I know would not realize immediately that this is a variable that should be controlled for. And some of these studies do indeed derive (in part) from research units where I work and I'd hope controls are better implemented!
Question 4: This is a question of population dynamics, social norms, and personal philosophy. While I can see how many people would find circumcision to be far more dramatic an intervention - even an unacceptable one - to me the data are again akin to those for HPV vaccination or hormonal birth control. Sure, condoms and abstinence exist. But that does not mean that other methods of mitigating risk should not be considered as part of an overall approach to infection (or pregnancy) control.
man I should be working, but here you go. Regarding question 3 above:
Paper 1: www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.0020298 2005, interventional, 3200+ men in South Africa. 60% protection rate. No difference in number of sexual contacts after intervention compared to control group. The protective effect of MC on HIV infection was unchanged when controlling for sexual behaviour, including condom use, which was taken into account when defining those at-risk behaviour, the period of abstinence in the intervention group following MC, and heath-seeking behaviour, which was considered because treatment of STIs can have an effect on HIV acquisition [24]. This shows that these factors play a minor role in explaining the protective effect of MC on HIV infection. The reasons for this protective effect of MC on HIV acquisition have to be found elsewhere, and several direct or indirect factors may explain this [25]. Direct factors may be keratinization of the glans when not protected by the foreskin, short drying after sexual contact, reducing the life expectancy of HIV on the penis after sexual contact with an HIV-positive partner, reduction of the total surface of the skin of the penis, and reduction of target cells, which are numerous on the foreskin [26]. Indirect factors may be a reduction in acquisition of other STIs, which in turn will reduce the acquisition of HIV. Our study does not allow for identification of the mechanism(s) of the protective effect of MC on HIV acquisition.
Paper 2: www.sciencedirect.com/science/article/pii/S0140673607603134 2007, Uganda, interventional, ~5000 men. 50-60% protection rate depending on statistical set up. To my reading, no significant differences in sexual behavior following intervention.
To assess possible behavioural disinhibition, sexual risk behaviours were assessed at each follow-up visit (table 6). During the first 6 month follow-up interval, sexual activity was reported by 1801 (79%) participants in the intervention group, compared with 1787 (77%) of those in the control group (p=0·049).
note: this paper also has the following interesting admonitions: Future circumcision programmes must emphasise that circumcision provides only part protection, and that there is a critical need to practise safer sex after circumcision (eg, partner limitation and consistent condom use). Adult male circumcision is not without risk. In this trial the rate of moderate and severe adverse events related to surgery was almost 4%, which is comparable with rates in the South African and Kenyan trials. The use of surgery for disease prevention is an unusual public-health intervention. ...future provision of circumcision for HIV prevention must maintain the highest achievable levels of safety to be acceptable and sustainable.
Paper 3: www.sciencedirect.com/science/article/pii/S0140673607603122 2007, Kenya, inteventional, ~2800 men. ~60% protection rate. Men in the intervention group were indeed counseled to abstain from sexual activity 30 days following circumcision. However, not all did (about 5%). The other characteristics of sexual activity prior to and after intervention were fairly similar though.(table attached)
So... take home - from my admittedly cursory reading, at least 2 of the 3 trials showed no difference in sexual practices before or after circumcision yet still demonstrated a significant risk reduction among men undergoing male circumcision (MC) in the studies. In the third, Kenya trial, there was at least a 30 day window in which many participants in the intervention group alone abstained. Whether this could account for the similarly significant drop in HIV acquisition cannot be ruled out - but given the other characteristics of sexual activity as well as the two other studies, my take is this is unlikely.
NOW... again... this is not meant to imply that MC = HIV prevention or that RIC should be mandated to reduce HIV risk. The data are compelling though and to dismiss them because of a personal opposition to RIC doesn't make much sense. As I said above, there remain plenty of questions regarding the translatability of these studies to different geographies, cultures and interventions, but the data are what the data are - and they are dramatic.