Saturday, September 4, 2010

If Circ Rates Are Dropping, Time for AAP & CDC to Act

I took a little hiatus over the summer break, so I have no idea if I lost all the wonderful posters -- both pro and anti-circumcision -- during that time. Most of the medical news over the last few months continues to support the benefit of a foreskin-free society, both to protect the health of the male and the health of his partners.

But the most worrisome report, trumped up or not, was this notion that circumcision rates have dropped to one-third of male newborns in the USA. Now the statistics have been debunked by many as way off -- and in this part of the world, nobody I talk to thinks that the circ rate is anything below 80% -- but any drop at all is troubling as a matter of public health.

I've heard that the theory that a lot of these uncircumcised future disease-promoters are illegal aliens from south of the border. It's true that many Hispanics do not circumcise until they become "Americanized" in the second or third generation. It's bad enough that illegals are sneaking into the country -- it's even worse if they are refusing to raise clean-cut boys.

The other theory I've heard is that the refusal of 16 states, including California, to cover circumcision under Medicaid (health care for the poor) has contributed to the growing number of uncircumcised boys. That would particularly hurt the Black community, along with Hispanics, and the refusal to cover circumcisions for these groups is obviously a form of racism.

Whatever the reason for any drop, this makes it all the more urgent for the Centers for Disease Control and the American Academy of Pediatrics to release their 2010 statements calling for the circumcision of all boys. The so-called "neutral" stance of the CDC and the AAP is causing great long-term damage, and we need that more positive statement right now.

Most parents want to do what is right for their sons. If the CDC and the AAP said that circumcision was an appropriate and healthy procedure with a great many benefits, I know that the circ rate -- assuming it even is dropping -- will return to historic high levels of 90%-plus. A foreskin-free America and the health of both males and females is in the balance.

Monday, June 7, 2010

Want to Avoid Penis Injuries During Sex? Get Circumcised!

Perhaps it's as obvious as a clean-cut penis, but still another study -- reported below by Reuters Health -- confirms more problems caused by the useless foreskin: penis injuries. Circumcised dudes are not as likely to have injuries to their male organ during sex as uncircumcised men.

To me this is pretty obvious. If you have a piece of useless skin flapping around and getting in the way of good sex (yes, there lot's of studies on that, too), it is bound to get injured -- cuts, abrasions, and minor injuries is the way the report notes it. I don't know about you but sex should never be painful, and it certainly shouldn't cause harm to your penis.

You can't help but feel sorry for these uncircumcised dudes. Not only are they at much higher risk for the transmission of HIV, HPV, STD, cancer, and the like -- but now they have to put up with a greater risk of penis injury during sex. Given all this, why would any parent allow their son to leave the hospital at birth with a filthy, disease-proned, and (now we know) injury-inducing foreskin?

Here's the full Reuters Health report:

"(Reuters Health) - A new study finds that circumcised men appear less likely to sustain cuts, abrasions and other minor injuries to the penis during sex -- which may help explain why circumcision lowers the risk of HIV transmission from heterosexual sex.

"For the new study, researchers used data from an HIV clinical trial in Africa, where nearly 2,800 men between the ages of 18 and 24 were randomly assigned to undergo circumcision or remain uncircumcised. In 2005 and 2006, that trial and two others in Uganda, South Africa and Kenya showed that circumcision can reduce a man's risk of HIV infection through heterosexual sex by up to 60 percent.

"In the current study, the researchers found that, over two years, circumcised men were 39 percent less likely than their uncircumcised counterparts to report any type of penile injuries during sex.

"This raises the possibility that lower injury risk is one reason that circumcision lowers the odds of HIV transmission, according to the researchers, led by Dr. Supriya D. Mehta of the University of Illinois at Chicago.

"Exactly why circumcision may protect against HIV during sex is unknown, Mehta and colleagues report in the Journal of Urology. There are a few theories: One is that, by reducing the amount of mucosal tissue exposed during sex, circumcision limits the virus' access to the body cells it targets. Another theory is that the thickened skin that forms around the circumcision scar helps block HIV from gaining entry.

"But there is also a possible role for mild penile injuries -- cuts, scratches and tears in the skin that could serve as a portal of entry for HIV. In some past studies, uncircumcised men have reported higher rates of such injuries than circumcised men.

"At the outset of the current trial, 64 percent of the men said they had sustained some form of penile injury during sex in the past six months -- most often general soreness, scratches, cuts or abrasions. Seventeen percent said they had bleeding.

"Six months into the trial, that rate was on the decline. By year two, 31 percent of circumcised men said they'd had a sex-related penile injury in the past six months.

"Men in the uncircumcised group also reported a reduction in injuries, though it was less significant -- with 42 percent saying they'd sustained a penile injury in the past six months. That decline, according to Mehta's team, is likely due to the general improvements both study groups showed in their sexual health practices -- including greater condom use and fewer sex partners.
Men who said they had had multiple sex partners in the past month were more likely to report sex-related penile injuries than those who had been monogamous. On the other hand, condom use and the habit of washing the penis within an hour of having sex were both linked to decreased risks of penile soreness and other injuries.

"Further studies, Mehta's team writes, should look at the role penile injuries may play in the transmission of HIV or other sexually transmitted diseases."

Saturday, May 29, 2010

Crazy Dutch Want to Ban Male Circumcision

At a time when much of the world is embracing the life-saving and healthy practice of male circumcision, Radio Netherlands is reporting that the Royal Dutch Medical Society wants to ban all male circumcisions in that country.

What's wrong with these Dutch doctors? What studies have they failed to read? What recommendations of the World Health Organization do they reject? What makes them incapable of seeing the benefits of a clean-cut penis?

My own view is that they have a deep cultural bias against the clean-cut penis, given that circumcision is so rare in that country. Now I know the anti-circ fanatics in USA will say this mirror our own cultural biases in favor of newborn circumcision, but the situation here is more nuanced than that. After all, we do have a strong anti-circumcision propaganda machine here that exerts inordinate pressure on medical societies and government agencies. In short, the USA has a national debate -- at least among the passionate -- on male circumcision.

That is apparently not true in Holland, where the uncircumcised doctors are simply rejecting, for their own cultural reasons, all the medical studies and evidence from around the world that support male circumcision. Forget the evidence. They want everyone to be uncircumcised because they are.

This blog supports the universal circumcision of all males, not because of any cultural norm, but because it is a medically proven way to protect not only the male but all his partners. If all males were circumcised, we would see a reduction in HIV, HPV, cancer, and so many other ailments directly linked to the useless foreskin. This is not a cultural argument; it's a medical one.

Here is an except from the Radio Netherlands report:

"The circumcision of boys is reportedly almost always unnecessary and medically risky. The Royal Dutch Medical Society (KNMG) has published recommendations advising doctors to discourage parents from having their sons circumcised. Jewish and Islamic organisations have reacted angrily."

"The KNMG would really like to ban the circumcision of boys altogether, but the organisation feels a legal ban would only lead to circumcision going underground, increasing the risks."

"More than 46,000 Dutch doctors and trainee doctors are members of the society. They call circumcision for non-medical reasons “an infringement of a child’s right to autonomy and the right to bodily integrity”. And they say there are unnecessary risks."

"However, the doctors are willing to take the cultural and religious sensitivities of parents into account. Which is why doctors, parents and religious groups plan to engage in a dialogue. And yet, Rasit Bal, chairman of the interest group Muslims and Government, was unpleasantly surprised by the advice of the medical community:

“I have noticed that it is becoming increasingly difficult to publicly display one’s religious identity. Things like this make it difficult. This is one of those issues that make life difficult for people who practice a religion”

"About 10,00 to 15,000 circumcisions are performed each year, most of them on Jewish and Muslim boys. Rabbi Raphael Evers says this figure includes about 80 Jewish boys. He argues peer pressure does not play a role in the decision to have one’s son circumcised. The rabbi says it’s the wish of the parents. He brushes aside any medical risks and even claims the surgery brings health benefits."

“Agitation against circumcision as a perceived threat against public health has been going on for quite some time, and it’s just nonsense. I have personally made extensive inquiries into both the physical and psychological problems of circumcision but never heard about any.”

"The growing number of circumcisions among boys has not led to any kind of serious discussion in the Netherlands, in marked contrast with the circumcision of the daughters of African immigrants. The excision of girls’ labia minora and/or clitoris is almost universally condemned as genital mutilation.

"So now the doctors have set their sights on the circumcision of boys. Medical ethicist Gert van Dijck says doctors will invoke children’s rights to emphatically discourage parents from requesting the procedure."

“We are asking doctors to actively and urgently warn parents that there are no medical advantages to circumcision and that there is a risk of complications. This way, we are hoping to achieve a culture change via the parents, so that they will eventually stop doing it.”

Friday, May 7, 2010

US Pediatrician Group Okays "Minor Circumcision" of Girls

Anti-circumcision fanatics have long argued that if female circumcision is outlawed, then male circumcision should be, too. Of course, this argument assumes that both types of circumcision are the same -- which they are clearly not.

Female circumcision has never been proven to offer any health advantage to the circumcised girl. It is solely a cultural tradition embraced by many around the world. In contrast, in one medical study after another, male circumcision offers positive benefits to the male and his partners. That should end the discussion, but it never does with the anti-circs.

Sure to complicate the debate is an apparent position change by the American Academy of Pediatrics in support of a "nick" or "minor circumcision" of a girl, as a means by which to discourage a full-scale removal of female genital parts. The New York Times below reports the story, and I invite your comments.

While I find female circumcision abhorrent as a practice because it has no medical benefits, I recognize the cultural myopia that we Americans have on this issue. Maybe the AAP is right. If a nick or little cutting makes parents feel comfortable that they do not need to remove the clitoris, labia, or whatever else is involved in full female circumcision, I suppose it is an option that should be considered carefully -- without American cultural blinders affecting our vision.

One thing is certain. The anti-circumcision fanatics will try to use this debate over female circumcision to denounce the obviously beneficial removal of the foreskin from males. Watch my words. I guarantee it.

NewYorkTimes: Group Backs Ritual ‘Nick’ as Female Circumcision Option
Published: May 6, 2010

"In a controversial change to a longstanding policy concerning the practice of female circumcision in some African and Asian cultures, the American Academy of Pediatrics is suggesting that American doctors be given permission to perform a ceremonial pinprick or “nick” on girls from these cultures if it would keep their families from sending them overseas for the full circumcision."

"The academy’s committee on bioethics, in a policy statement last week, said some pediatricians had suggested that current federal law, which “makes criminal any nonmedical procedure performed on the genitals” of a girl in the United States, has had the unintended consequence of driving some families to take their daughters to other countries to undergo mutilation."

“It might be more effective if federal and state laws enabled pediatricians to reach out to families by offering a ritual nick as a possible compromise to avoid greater harm,” the group said.

Wednesday, April 14, 2010

HPV Last Longer in Uncircumcised Males

The evidence keeps adding up for all males to shed that disease-entrapping foreskin as soon after birth as possible. This latest study comes from the May 2010 edition of the Journal of Infectious Diseases, as reported by Reuters Health news service today.

The good news for the uncircumcised, according to this study at least, is that they are no more likely to acquire human papillomavirus (HPV) than their clean-cut counterparts. But -- and here's the bad news for foreskin lovers -- it takes the uncircumcised a whole lot longer to get rid of HPV than circumcised dudes. The study found that clean-cut males can shed HPV in 91 days, compared to 154 days in uncircumcised males. The researchers concluded, "Circumcision may protect against HPV‐associated disease by enhancing the resolution of infection."

Here's the Reuters story:

Sex virus lasts longer in uncircumcised men
Wed Apr 14, 2010 2:27pm EDT

NEW YORK (Reuters Health) - While uncircumcised men don't seem to be at higher risk of acquiring human papillomavirus (HPV), it takes them longer to clear the virus from their bodies, new research shows. Because HPV causes genital warts and certain cancers, the finding, say researchers, could help explain why uncircumcised men have a higher risk of such penile cancers.

It could also play a role in how likely their partners are to develop infections.

"Our study demonstrates that the apparent protective influence of circumcision against genital HPV infection may not involve a reduction in new infections but rather the enhanced ability to resolve existing HPV infections," Dr. Brenda Y. Hernandez of the Cancer Research Center of Hawaii in Honolulu and her colleagues write.

But why this might be, and whether circumcision would be a good way to help prevent the spread of HPV-related disease, remains unclear, according to the researchers.

Some HPV strains cause cervical cancer in women, and are the targets of the vaccines Cervarix and Gardasil. Some strains may also be associated with penile cancer in men.

There's evidence that circumcision lowers a man's likelihood of developing cancer of the penis and contracting HPV infection, as well as HIV infection, in some populations. Because partners of uncircumcised men face a higher risk of cervical cancer, it's possible that circumcision could affect the spread of the virus as well, Hernandez and her team note.

The researchers had previously found that circumcised men were less likely than their uncircumcised peers to be infected with HPV at a given point in time. To determine if circumcision might influence a man's risk of acquiring HPV infection, as well as how readily he could clear the virus from his body, the researchers followed 357 men for an average of about 14 months. Every two months, the men, 290 of whom were circumcised, underwent HPV testing.

During the study, the researchers identified 536 different HPV infections, with no difference in risk between the circumcised and uncircumcised men. However, the researchers did find that HPV infections of the head, or glans, of the penis lasted 154 days, on average, in the uncircumcised men, compared to 91 days in the men who were circumcised. The increased duration was seen for both cancer-associated and non-cancer-associated HPV strains.

Cancer of the penis most commonly develops in the glans, Hernandez and her team point out, and the fact that infection with cancer-related strains lasted longer in uncircumcised men "has clinical significance."

It's possible, they add, "that transmission of HPV to sex partners is more efficient among circumcised men because of the greater duration of their infection." However, they add, "whether circumcision is an effective means of facilitating HPV clearance has yet to be demonstrated."

Sunday, April 11, 2010

South Africa to Circumcise Two Million Men

This amazing headline -- "South Africa to Circumcise Two Million Men" -- must drive the anti-circumcision fanatics crazy. After all, their goal is to keep the foreskin just where it is, thank you, free to infect the sad guy (or his partner) unfortunate to have one with STDs, HIV, and other diseases, to say nothing of his bad genital odor.

But this headline was prominent this past week as the South African government in one of its provinces committed to increase the health of its nation through the removal of that useless piece of ugly skin that has caused so much harm over the years.

Circumcising two million men sounds daunting, and would have never been necessary had routine neonatal circumcision been practiced throughout South Africa. It is so much better to snip a baby than to subject an adult male to a healthy circumcision. But it may take a generation or two before South Africa joins America in leaving the foreskin behind at the maternity hospital.

In the meantime, congrats to South Africa for setting an ambitious goal. You have a lot of fans in the USA rooting you on.

Here's the whole newspaper article:

"South Africa to circumcise two million men

Durban: In an effort to combat the scourge of HIV and Aids, over two million men will be circumcised in South Africa's eastern KwaZulu-Natal province, BuaNews reported on Friday.
The premier of KwaZulu-Natal province, Zweli Mkhize, said on Thursday this initiative had received overwhelming support from HIV activists and the medical fraternity.

The process will begin on April 11.

In late 2006, two randomised controlled trials on whether male circumcision reduces HIV transmission were halted because interim results showed an overwhelming protective effect, validating the results from an earlier South African trial conducted in Orange Farm.

Based on the weight of the evidence from both observational studies and randomised trials, public health leaders have concluded that male circumcision when performed by well-trained and well-equipped health professionals can significantly reduce the risk of HIV infection among adult men.

"We now have our task cut out for us to circumcise over two million males using the safety of professional techniques and encourage HIV pre-testing," he said.

Monday, March 15, 2010

Actress Thanks Congress for Strong Circumcision Support

Actress Debra Messing, better known as Grace Adler in the TV sitcom "Will & Grace," told members of Congress last week that circumcision was a key to reducing HIV/AIDs. Messing testified before the House Foreign Affairs Committee on behalf of PSI, a global health organization, after she returned from Zimbabwe which has an aggressive circumcision program.

Here's what Messing told legislators:

"I would like to tell you today about two prevention tools that could make a difference if there is continued investment: male circumcision and HIV testing and counseling.

"First, voluntary adult male circumcision. There is now strong evidence that male circumcision reduces the risk of heterosexually acquired HIV infection in men by about 60 percent, yet only about one in ten Zimbabwean adult men are circumcised. PSI and its partners run circumcision clinics in Zimbabwe and other countries, with support from PEPFAR and other donors.

"I was invited to observe the procedure, which is free to the client, completely voluntary and according to the young man I spoke with who underwent the procedure, painless. The cost of the procedure at that clinic—including follow-up care and counseling—is about $40 U.S. dollars.
UNAIDS and the World Health Organization have issued guidance stating that male circumcision should be recognized as an important intervention to reduce the risk of heterosexually acquired HIV infection in men.

"Even with no demand creation, the clinic I visited serves upwards of 35 clients per day. It is estimated that if male circumcision is scaled up to reach 80 percent of adult and newborn males in Zimbabwe by 2015, it could avert almost 750,000 adult HIV infections—that equals 40 percent of all new HIV infections that would have occurred otherwise without the intervention—and it could yield total net savings of $3.8 billion U.S. dollars between 2009 and 2025. Male circumcision programs get robust support from the U.S. government in Zimbabwe and other countries, but greater resources would yield greater results."

Zimbabwe does have a massive commitment to circumcise 1.3 million males over the next few years, and the country is beginning efforts to encourage newborn circumcision. In the long run, countries recognize that achieving universal 100% circumcision rates is best obtained by circumcising baby boys before the leave the hospital.

What is ironic to me is that while Messing thanks Congress for its "robust support" for the male circumcision programs in Africa, nobody says anything about America? It's time for government leaders to speak out with just the same passion on the value of circumcising every male in this country.