Lop It Off- What You Need To Know About Circumcision

Circumcision has been performed on men and baby boys from the beginning of recorded history. The procedure is certainly controversial. This blog will discuss the pros and cons of circumcision and a hope that the article will help you make an informed decision for yourself and for your little boys.
Circumcision is the removal of the skin that covers the tip of a baby’s penis. In recent years, newborn circumcision has been a hot topic of debate. Differing opinions and advice may leave many new parents with more questions than answers.
Your choice of whether to circumcise your son may be a question of religion or custom. For instance, circumcision is part of Jewish and Muslim traditions. In other cases, parents may simply want their son to look like his father or other male family members.
But the trend in the United States is clearly changing. The rate of circumcision is falling. In the 1970s and 1980s, about 8 of every 10 boys born in the US were circumcised. Today, 5 or 6 of every 10 boys are circumcised. Circumcision rates in the US vary by region. Fewer boys in Western states are circumcised. The north central region has the highest rates of circumcision.
Only about one in three males are circumcised worldwide. Around the world, the highest rates for circumcision are in the Middle East, South Korea and the US. In Latin America, most of Asia and in Europe, circumcision is rare. It is on the rise in Africa, where studies have shown that circumcision lowers the risk of getting HIV. This is because the foreskin is different from skin on other parts of your body. It’s not like the skin on your arm, for instance. The foreskin has a type of cell called Langerhans cells, which are more likely to attach to HIV cells. Based on these findings, in 2007 the World Health Organization endorsed circumcision as a way to help stop the spread of HIV. Still, this thinking has not
taken hold in parts of the world where HIV is not as wide spread. In fact, the Royal Dutch Medical Association in the Netherlands called for a ban on circumcision in 2010. They stated that the procedure is “medically unnecessary and violates children’s rights.”
In the US, the American Urological Association (AUA) and the American Academy of Pediatrics (AAP) each have policy statements on circumcision. Both groups recommend the procedure be offered as a choice to parents. The AUA “believes that neonatal circumcision has potential medical benefits and advantages as well as disadvantages and risks.” The AAP states that “health benefits [from circumcision] are not great enough to recommend routine circumcision for all male newborns… [But are enough] to justify access for families choosing it.” Parents should talk with their child’s doctor about the health risks and benefits. With those facts, parents should then think over what will work for their family. They should keep in mind their own religious, ethical, and cultural beliefs and practices.
So what should parents know about the health risks and benefits of circumcision? Of course, circumcision can cause pain and stress for the patient. To lessen pain for newborns, an anesthetic (pain killer) may be used. With newborns, there is some evidence that babies may be less likely to feel discomfort 7 to 10 days after birth. This is because newborns have a high level of endorphins (substances made by the body that reduce pain). Also, as with any surgery—even a minor one—there is also a risk of bad
side effects. When circumcision is not done properly, the urethra (the tube that carries urine out of the body) or penis may be hurt. In rare cases, death has even occurred. Still, circumcisions done by skilled doctors rarely have bad side effects. And the problems that result are often not serious. The most common side effect is bleeding or infection. To help avoid problems, parents choosing to circumcise should make sure that whoever is doing it is skilled and practiced. Parents should also feel free to ask any questions they may have.
After circumcision, caring for the penis is simple but important. Wash the area gently with warm water. Pat dry and put on a new bandage with antibiotic ointment each time you change the diaper. The healing process should take about a week. It is normal for there to be a little swelling, redness and maybe blood at first. Still, it is important to have your baby seen by his doctor if these problems last several days or get worse. Also talk to a doctor if the baby gets a fever or does not have a wet diaper within 12 hours of circumcision. Almost all side effects are easily treated.
On the plus side, circumcised boys are less likely to have a urinary tract infection (UTI) in their first six months. As they grow older, circumcised males are also less likely to get penile cancer. Still, this type of cancer is rare in the US. And uncircumcised males can prevent penile cancer with good hygiene and keeping the area under the foreskin clean.
Parents who opt out of circumcision should wash their baby’s penis with soap and water with each bath. Parents should also be sure to teach their son good hygiene and care for his penis as he grows older. Treat the foreskin gently and make sure not to pull it back forcibly. Once it starts to retract, often around age five, it is important to clean under the foreskin with soap and water often. See a doctor if there is any swelling, pain or if the foreskin is itchy.
Bottom Line: The circumcision decision is not an easy one for parents to make. However, there are advantages for having this procedure on your little boys. Speak to your doctor for more information and more details.

Circumcision Tied to Less Sexual Pleasure-At Least In Belgium

I have read articles that circumcision results in less enjoyment from sexual intimacy than men who have retained their foreskins.  A report from Belgium supports that claim.

The study implies that men circumcised either as children or adults report less intense sexual pleasure and orgasm than their uncircumcised counterparts.

The new study surveyed 1,369 men over the age of 18, who responded to leaflets handed out in train stations across Belgium.

The men were asked whether they were circumcised, and were then asked to rate how sensitive their penis was, how intense their orgasms were and whether they experience any pain or numbness when aroused.

310 men who took the survey were circumcised, and 1,059 were not. Each rated how sensitive their penis was on a scale from 0 to 5, with higher numbers being the most sensitive.

Overall, uncircumcised men reported between 0.2 points and 0.4 points higher sensitivity and sexual pleasure compared to circumcised men.  This small difference does not seem significant.

Currently, about half of U.S. baby boys have their foreskin surgically removed at birth.

Some religions, such as Judaism and Islam, consider circumcision part of religious practice, while other people choose circumcision for possible health benefits – including a reduced risk of urinary tract infections.

It is also of interest that Dr. Aaron Tobian, who studies circumcision but was not part of the new study, said that previous randomized controlled trials looking at sexual performance and satisfaction did not find a difference.

One possible explanation for any potential difference in sensitivity is that a man’s foreskin may protect the glans from rubbing against underwear and clothing. It’s possible, the researchers write, that friction makes the head of the penis thicker, drier and ultimately less sensitive.

The American Academy of Pediatrics says the benefits of male circumcision outweigh the risks, but stops short of recommending universal circumcision (see Reuters story of Aug. 27, 2012).

Bottom Line: I personally haven’t heard too many complaints from circumcised men about their sexual enjoyment.  Not one man has ever come to my office and asked to have his foreskin restored.

Deciding Upon the Prime Cut- The Circumcision Decision

No descriptor required!

Parents often ruminate about the decision to circumcise their young baby boys. Certainly if you are of the Jewish faith, there is no question that you will consider cicrcumcision for your new baby boy. For non-Jews, and non-Moslems, the decision is much more difficult.

New evidence is out that circumcision reduces the risk of sexually transmitted diseases. A review of current medical research points out that the medical benefits of circumcision outweigh the risk of the procedure. Circumcised infants are 90
% less liekly than uncircumcised infants to develop urinary tract infections. Later in life, the circumcised boys are at a lower risk of contracting HIV, herpes, penile cancer, and human papilomavirus, which when passed to female partners, can cause cervical cancer. The serious complicaitons occur in only about 0.2 percent of baby boys who under the operation.

Bottom Line: The circumcision decision is often difficult for most parents to make. I suggest you speak to your pediatrician and obstetrician about the “prime cut.”

Some thoughts on Male Circumcision

This is a blog post by Nicholas Fogelson thought would be of interest to my fellow bloggers. Although I am of the Jewish faith and have been circumcised, I thought this was a balanced discussion by fellow physician. I am interested in reading your comments and opinions on this very controversial topic.

One of the interesting things about running a semi-popular blog is that from time to time the blog community decides to take up a topic and run with it, completely without any stimulation from me. This happened recently on the Academic OB/GYN Facebook page, where a group of concerned individuals carried on a serious and passionate discussion about the merits of circumcision. As such discussions tend to be, this one was dominated by the anti-circumcision activists, with occasional interjections by those that were less concerned about the issue, including myself.
Circumcision is an interesting issue because it crosses multiple boundaries. It is a social tradition in many cultures, and in some cases considered a religious mandate. It is also an ethical issue for many, with some feeling that it is an assault on an infant with long term negative impact on their psychosocial health. For some it is just cosmetic.
As a young person, I always thought that my penis looked like penises were supposed to look. It looked like my father’s and my brother’s, and anyone else’s I had ever seen. For the most part, I was blissfully unaware that a penis could look any other way, until one day in high school when my world completely changed. I happened to see a friend’s penis we were showering after wrestling practice, and in that flash of a moment all kinds of things went through my mind. Did he have some kind of growth on his penis? Could he pee out of that thing? A few other choice thoughts. I can still remember the shock to this day. All I had ever seen looked like mine, and in that moment what I saw was foreign, revolting even. You see, from my frame of reference he looked like an alien. It took me a few minutes and SNAP! it came to me like a ton of bricks – he has a foreskin. He probably doesn’t have an alien death ray then. I can relax about that one.

Of course now I realize that I also was born with a foreskin, and at some point in early life had it cut off. Despite what was no doubt a anesthesia free surgical procedure, I have no memory of ever having had a foreskin, or of any trauma of it having been removed. It never occurred to me to miss my foreskin, but apparently others do.
I hear stories from various anti-circumcision activists about how men are traumatized by their lack of foreskin, or even that some use strange devices to try to restore their foreskin in some way. I am struck with these stories, and have one burning question – when did they start missing their foreskin? From the moment they had the capability to store long term memories, they had no foreskin. Being circumcised was their frame of reference; it was their ‘normal’. The only way they could ever ‘miss’ their foreskin would be through some outside influence that convinced them of some new ‘normal’, and that they were somehow incomplete. Some of these men express anger at their parents or doctors for circumcising them as an infant, it seems to me that this anger is misplaced. It would make far more sense for them to be angry at the person who felt the need to drive a message into one’s head they were somehow incomplete, a message without which the feeling of loss never could have occurred.
I also hear stories of how the lack of a foreskin somehow interferes with sexual pleasure. I just don’t understand how this can be verified. I can say that from a personal point of view, everything down there seems to work just fine. I also don’t notice a preponderance of Jews who do not enjoy sex. Anecdote aside, one can only know what one has, and so again, anyone that feels that their sexual pleasure was supposed to be better than what it was got that idea from some other person, not from their personal experience. There’s plenty of people with foreskins that feel like their sexual pleasure was supposed to be better as well.
My biggest question in all of this is just why? Why do people care so much about this? Its really hard to say that an infant is being victimized by the procedure. Their frame of reference is being changed, no doubt, but as that frame is changed so early in their life there will be no sense of loss unless someone feels the need to convince them of it.
One could just as easily ask ‘why circumcise?”. There are plenty of data to suggest that circumcision decreases horizontal transmission of some STDs and the rate of penile cancer, though these effects are small. The anti-circumcision folks like to act like this data doesn’t exist, but this is just their ignorance. When I first thought of writing this blog post I was going to lay all this data out, but as I now write I realize that it doesn’t really matter. Those that believe or don’t care will see the strength in the data, those that are against will call it faulty or corrupt in some way. So goes academia. In the end, circumcision is a cultural practice that is done for cultural reasons, not for medical benefit. In Jewish tradition, circumcision is done as a way of honoring the covenant between God and Abraham, a covenant which commanded that all of Abraham’s sons and male servants, and their descendants, as a mark of allegiance and agreement. Though I have Jewish heritage, I am atheist. Nonetheless, I would feel a cultural desire to circumcise my son when and if I have one.
Some of my comenters, of which there no doubt will be many, will call this stance unethical. To this I say “grow up”. We are hard pressed to find ethical principles on which all humans agree, and this is certainly not one of them. A very large part of this world feels completely fine with male circumcision, and if one doesn’t, they certainly are under no pressure to circumcise their son. This is one of the many things that we don’t all agree on.
Other commenters will say “I’m not against circumcision, I’m against forcing it on newborns.” This is the same as saying that we shouldn’t do ritual circumcision at all. That’s a perfectly fine goal if one is really against the procedure, but just state it that way. Male circumcision is a cultural rite performed on newborns. Its pretty obvious that by 18 years old, very few boys are going to choose to have their foreskins removed. Their frame of reference has already been set, and they are fine with who they are. If we did that, we would be just fine, just as we are with a large part of the population circumcised. A cultural tradition would be lost, but that would also be ok. It just wouldn’t really matter.
Other commenters will say “they are dangerous and cause complications.” This is a half-truth. By in large, they are not very dangerous. That said, like any surgical procedure, there are some small risks. There have even been babies that have died from complications of the procedure. Ultimately, it is very important that anyone doing circumcisions know what they are doing and doesn’t do them wrong.
In truth, its an issue that I don’t care a great deal about, and as such am vexed on why it matters so much to others. Sometimes when someone writes a piece on the net, they are instantly labeled as an activist for that cause. People certainly label me as an activist for delayed cord clamping, which I would deny. I just wrote an article about the topic and lots of people read it. They can make up their own mind. I just wish people would treat this issue the same way. Everyone is free to circumcise their child or not, and the boy will grow up just fine either way.

Bottom Line: Circumcision is probably the most common surgical procedure performed on men for thousands of years. For many boys the decision is made by their parents and is done for religious reasons. For others it is a matter of looking like dad and grandpa and the parents don’t want any differences in the genitals of men in the family. Others have the procedure for hygenic purposes. To circumcise or not may be a difficult decision for those who are not motivated bh religious reasons. I hope this article helps with that decision.

5 Things Every Man Needs To Know About His Penis

There’s no topic that generates more myths and misinformation than a man’s penis. For example, one myth circulating among males is that men with large shoe sizes or large feet have longer penises. Two urologists at St. Mary’s Hospital in London conducted a study involving 104 men and found no statistically significant correlation between shoe-size and stretched penile length. So ladies, stop looking at a man’s feet and focus on his face and his personality, both of which are not related to his penis length.

Here are some things you might have wondered about your penis, but were afraid to ask.
No. 1: Your Penis Does Have a Mind of Its Own
You’ve probably noticed that your penis often does its own thing. You may remember times when it was completely inappropriate to have an erection; and yet you couldn’t wish it away.
It’s true that you have less command over your penis than body parts like your arms and legs. That’s because the penis answers to a part of the nervous system that’s not always under your conscious control. This is called the autonomic nervous system, which also regulates heart rate and blood pressure and the size of the iris of your eye.
Sexual arousal usually isn’t voluntary. The conscious mind is complicit in it, but a lot of sexual arousal goes on in the sympathetic nervous system. In addition, impulses from the brain during the REM phase of sleep cause erections, whether you’re dreaming about sex or about a test you forgot to study for. Heavy lifting or straining to have a bowel movement can also produce an erection.
Just as the penis grows without your consent, sometimes it shrinks. The flaccid penis varies in size considerably within a given man. Exposure to cold water or air makes your penis shrink. That’s a function of the sympathetic nervous system.
Psychological stress also involves the sympathetic nervous system, and stress has the same effect as a cold shower, Montague says. When you’re relaxed and feeling well, your flaccid penis looks bigger than when you’re stressed out. Psychological stress can result in loss of libido and problems with erections. Both stress and anxiety are leading causes of temporary erectile dysfunction or ED. Being able to manage stress and control anxiety will help you get your erectile function back.
Of course, not all ED is caused by psychological problems such as stress. Physical problems such as atherosclerosis or high blood pressure can inhibit the flow of blood to your penis. Type 2 diabetes can damage both blood vessels and the nerves involved in getting an erection. Excessive alcohol consumption can also interfere with getting an erection.
The penis is kind of a dangling stress test and provides a window to the cardiovascular system including heart disease. So the greeting, “How’s it hanging?” is more apt than you might have realized.
No. 2: Your Penis May Be a ‘Grower’ or a ‘Show-er’
Among men, there is no consistent relationship between the size of the flaccid penis and its full erect length.
In one study of 80 men, researchers found that increases from flaccid to erect lengths ranged widely, from less than a quarter inch to 3.5 inches longer.
Whatever the clinical significance of these data may be, the locker-room significance is considerable. You can’t assume that a dude with a big limp penis gets much bigger with an erection. And the guy whose penis looks tiny could surprise you with whopper.

No. 2: Penis, penis on the wall who is the longest of them all
An analysis of more than a thousand measurements taken by sex researcher Alfred Kinsey shows that shorter flaccid penises tend to gain about twice as much length as longer flaccid penises.
A penis that doesn’t gain much length with an erection has become known as a “show-er,” and a penis that gains a lot is said to be a “grower.” These are not medical terms, and there aren’t scientifically established thresholds for what’s a show-er or a grower.
Kinsey’s data suggest that most penises aren’t extreme show-ers or growers. About 12% of penises gained one-third or less of their total length with an erection, and about 7% doubled in length when erect.
No. 3: Your Penis Is Shaped Like a Boomerang
Your penis is shaped like a boomerang. Just like you don’t see all of a big oak tree above ground, you don’t see the root of your penis tucked up inside your pelvis and attached to your pubic bone.
In an MRI picture, the penis looks distinctly boomerang-like, as noted by a French researcher who studied men and women having sex inside an MRI scanner.
One method of surgical “penis enlargement” is to cut the ligament that holds the root of the penis up inside the pelvis. This operation may give some men a little extra length if more of the penis protrudes from the body, but there are side effects. This ligament, called the suspensory ligament, makes an erection sturdy. With that ligament cut, the erect penis loses its upward angle and it wobbles at the base. The lack of sturdiness can lead to injury.
No. 4: Your penis is not a bone but it can break
There is no penis bone, but you can break your penis all the same. It’s called penile fracture, and it’s not a subtle injury. When it happens, there’s a snap, no crackle, but a pop that can easily be heard by the man his partner. Then the penis turns black and blue. And there’s terrible pain.
Penile fracture is rare, and it typically happens to younger men because their erections tend to be quite rigid.
Here’s how to avoid penile fracture: don’t use your penis too roughly. A common way that penile fracture happens is when a man is thrusting too hard and fast during sex, and slams into his partner’s pubic bone. Also, a woman who moves wildly while on top of a man during sex can break a man’s penis. Most of these penile fractures occurs when there has been too much alcohol consumed.
No. 5: Most Penises in the World Are Untrimmed
A report by the World Health Organization (WHO) and the Joint United Nations Program on HIV/AIDS (UNAIDS) estimates that worldwide only 30% of males are circumcised.
Rates vary greatly depending upon religion and nationality. Almost all Jewish and Muslim males in the world have circumcised penises, and together they account for about 70% of all circumcised males globally.
The United States has the highest proportion of males circumcised for non-religious reasons. A whopping 75% of non-Jewish, non-Muslim American men are circumcised. Compare that to Canada, where only 30% are. In the U.K. it’s 20%; in Australia it’s merely 6%.
The practice of circumcising baby boys for medical and cosmetic reasons has become controversial in the U.S. But recently the World Health Organization (WHO) and the UUNAIDS recommended circumcision for adult men, based upon evidence that men with circumcised penises have a lower risk of being infected with HIV.
Bottom Line: A man’s best friend is his penis. He needs to know that they come in different sizes and shapes but nearly all of them are able to perform their job if given a chance.

This article was excerpted from an article by Martin F. Downs and appeared in WebMD

http://men.webmd.com/features/5-things-you-did-not-know-about-your-penis?src=RSS_PUBLIC

The Circumcision Decision

The first concern most men will have about their genital organs occurs right after birth when he undergoes a circumcision….and, unfortunately, the young boy has no part in the decision whether to lop off that precious piece of real estate!

Removal of the foreskin of the penis is one of the oldest surgical procedures known, dating back well over 5000 years. Hieroglyphs picturing ritual circumcision were found in ancient Egypt, and the religious significance of circumcision is described in the Old Testament.

Perhaps because of its long history, circumcision in the U.S. has been generally considered routine surgery. In the mid-1980s, up to 89 percent of newborn males were circumcised in some parts of the U.S.
There are many valid reasons for choosing circumcision, including cultural, religious and ethnic traditions. But in March 1999, the American Academy of Pediatrics (AAP) issued a policy statement that said they no longer recommend routine neonatal circumcision. It stated that although there are some potential medical benefits of newborn male circumcision, those benefits are so slight that they contribute little or nothing to the decision-making process.

So what does this mean for parents-to-be getting ready to make the circumcision decision? Mainly parents are on their own. The AAP does not make any specific recommendation. Parents need to talk with their physician and then carefully weigh the risks versus the benefits of the procedure.

Medical Risks and Benefits

Parents should be assured that the great majority of circumcisions are trouble-free. But circumcision is surgery, and all surgeries run the risk of complications. The most common complications, which occur in only about 1 percent of circumcisions, are: bleeding, which can easily be controlled with pressure, and minor infection, which can be treated with antibiotics.

The medical benefits of circumcision are small. Uncircumcised boys have a higher risk of developing urinary tract infections (UTIs) than circumcised boys, particularly in the first six months of life However, the overall risk of a UTI is still less than 1 percent. Generally, physicians will recommend circumcision for any boy who has two UTIs in the first year of life. A circumcision performed months or years after birth is done surgically under anesthesia, and seems to be associated with fewer complications and less pain and trauma.

Circumcision also has small but measurable benefit in preventing penile cancer, a very rare disease that strikes only about 1 in 100,000 men. Uncircumcised men are three times more likely to develop penile cancer than circumcised men.

Uncircumcised men are also reported to be at greater risk for developing sexually transmitted diseases such as syphilis and HIV infections than circumcised men, but behavioral factors, such as not practicing safe sex, are far more important risk factors.

Overall, the increased risk of developing UTIs, sexually transmitted diseases, or penile cancer is extremely low, regardless of circumcision status.

A Kinder Cut

For those parents who elect to have a circumcision performed on their newborn infant, it is important that the parents select an experienced surgeon to perform the procedure. The AAP recommends that pain relief with a local anesthetic should be used during the procedure. Safe and effective forms of analgesia for circumcision are easily accomplished using a local or topical anesthetic consisting of a gel or cream applied to the foreskin before the procedure. This method has been found to provide adequate pain relief during the 5-10 minute procedure.

Parents considering circumcision should talk with their doctors, and make sure that they are comfortable with whoever will be performing the procedure. Specify in advance what type of anesthesia will be used, and notify the doctor if there are any bleeding disorders in the family.

Parents who choose not to circumcise need to receive instructions on how to care for an uncircumcised penis. The foreskin should never be forced to retract, nor should objects such as swabs or cotton balls be used to clean underneath it. Although most boys will have retractable foreskins by age 3, in some cases, it may take 7 to 10 years. Parents must be patient and allow the process to happen naturally. All boys who are not circumcised need to be instructed on proper hygiene of the foreskin. Failure to do so can result in inflammation of the penis and a foreskin that is even more difficult to retract and clean. Occasionally, this condition, phimosis, or tight foreskin requires a circumcision as an adult.

So if you are considering the “prime cut” for you or your newborn son and have any questions, I suggest you contact your doctor.

Dr. Neil Baum is a urologist and can be reached at 504 891-8454 or on his web site http://www.neilbaum.com

Outlawing the Prime Cut-California Tries to Ban Baby Circumcisions

It’s a question parents of baby boys have to decide but now there’s a discussion on Beacon Hill in San Francisco that would take that choice away from parents in California.

State lawmakers in California will debate a bill that would make it illegal for parents to circumcise boys, unless there’s a medical reason.  The bill, if passed, would ban the procedure on any male under the age of 18 even for religious reasons.  Under the legislation, people who disregard the ban would face a $1000 fine and possible 14-year prison sentence.  The proposal classifies male circumcision as genital mutilation and supporters of the bill say baby male infants can’t possible consent to the procedure.

Many Jewish groups are objecting to the fact that ritual circumcision of men under the age of 18 would be made illegal, despite the fact that it is, in the words of these San Francisco-area Jewish organizations, “of fundamental importance in the Jewish tradition.” Male circumcision is also an important practice in Islam, although it is not compulsory.

My opinion:  Male circumcision has actually been associated with some health benefits which includes reducing the risk of HIV acquisition by men during vaginal intercourse.  Secondly, there is a decrease in urinary tract infections in baby boys who are circumcised compared to baby boys who are not circumcised.  Also, the risk of penile cancer is less in circumcised boys compared to those who have retained their foreskins.  And finally, an ancient religious ritual for both Jewish and Muslim boys should not be criminalized by the government.  Don’t we have bigger problems in America than trying to police doctors and mohels (Jewish ritual circumcisers) who perform circumcisions?  I truly believe that after we balance the budget we might discuss the decision of parents to allow their baby boys to be circumcised!