Newborn Circumcision: An Old Tried & True Friend

I like old books, so take me to a flea market and I am sure to find something that interests me. Not long ago, I bought for an original red-covered book for $1 entitled "Modern Home Medical Adviser." It was first published in 1935 but updated seven times until its last publication in 1953, still way long before I was born. The book was designed for parents to consult on just about any ailment in the body. Of course, I looked in the index under "circumcision" and it was a treasure trove of good advice.

I don't know how popular newborn circumcision was back in the 1930s, but these docs sure liked it. "The baby boy should be carefully examined to see if he needs circumcision. If the foreskin can be completely and easily retracted most authorities think circumcision should not be done, but when there is the least doubt about the matter decision should be made in favor of the operation, which is a trivial one when done within the first week or two of life."

Back in the 1930s, people did worry more about boys masturbating. These docs were modern. "Masturbation is probably far less harmful than has been supposed." But they certainly didn't recommend it, and observed the obvious: "When the foreskin is tight or adherent there will accumulate under it secretions which will produce bad odors and cause pain and itching. Such a child is likely to get into the ugly habit of pulling at and handling the genitals." We know that all boys play with their penises, but uncircumcised boys clearly have more reasons for doing that than clean-cut boys.

While the medical reasons for circumcision have certainly grown with the advance of medical science, back in the 1930s there were many more uncircumcised fathers in America and many more parents in general who did not have access to the latest medical developments. This is where the authors of "Modern Home Medical Adviser" get interesting, urging parents of the day to get informed about the latest medical advances and to take responsibility for their children's health.

"It is said that in times of old, parents had the power of life and death over their childrend and could make away with them or sell them into slavery. Atrocious! Nevertheless, parents still have the power of life and death over their children. Parents can neglect their young, and frequently do neglect them, so that they die of the results. We have in mind parents who are probably ruining a child by refusing to have him circumcised. . . . ."

Seventy-five years later, we still have parents who not only refuse to circumcise their sons but also make outrageous claims about the 'dangers' of circumcision and the 'benefits' of a foreskin. I find this all very ironic because the prescient doctors of the 1930s did not have all the medical studies of today. But they knew circumcision was valuable and recommended it. Today, with much more evidence of this "trivial" procedure's medical value, the medical organizations representing today's doctors (like the American Academy of Pediatrics and the Centers for Disease Control) are much more timid than their ancestors.

As we await some definitive conclusions from the AAP and the CDC, perhaps they might consult the docs of an earlier era -- and add a little backbone to taking a strong stand for newborn circumcision. Just saying . . . .

Circumcision Makes Comeback in Australia

Once upon a time, boys in Australia were as clean-cut as their American cousins. Then the national nannies stepped in to discourage and not pay for this important neonatal procedure. But even during the "bad times" a number of Australian parents opted to circumcise their sons. Now, the growing evidence of the medical benefits of circumcision are reaching parents, despite the reluctance of some in the Australian medical bureaucracy.

Under the headline -- "More boys go under knife as parents opt for kind cut" -- the Sydney Morning Herald reports a resurgence in newborn circumcision in New South Wales. It's still a long ways from American standards, but the good news is that trend is upward. One doctor predicts it will grow quickly to 30% over the next decade.

The headline is also a sign of the change in times. After some used to call circumcision "an unkind cut," how refreshing to see this simple health-giving procedure call what it is: a "kind cut" -- in fact, it's the kindest cut of all a parent can do for a newborn baby boy.

Here's the full story below:


CIRCUMCISION is making a comeback as a new generation of parents arm themselves with medical research to justify their decision.

The rate of circumcision for baby boys in NSW rose from 13 per cent in 1999 to 18 per cent last year, according to Medicare figures.

It's a long way from the 1950s when boys were routinely circumcised but Sydney paediatric surgeon Dr Anthony Dilley predicts the rate will keep rising. This is despite NSW Health banning circumcisions from public hospitals in 2006, except in cases of medical emergency.

"By the time today's baby boys are in kindergarten, it will be 30 per cent," Dr Dilley said.

Dr Dilley said parents were asking for circumcision because they thought it would benefit their child – "to look like dad", be more hygienic and reduce risk of disease – rather than for cultural or religious reasons."My own gut feeling is that there are parents who didn't get it done 20 or 30 years ago because they were bullied out of it," Dr Dilley said. "Most parents now don't stand for being told: 'Don't do it.' They will do their own research."

Proponents of circumcision such as Professor Brian Morris from the University of Sydney school of medical sciences say it is a kind of "surgical vaccine", pointing to studies showing it reduces the incidence of urinary tract infections, sexually transmitted diseases, penile cancer and penile inflammatory disorders, as well as being more hygienic.

It has also been shown to reduce the incidence of cervical cancer in female partners.
"At birth it's a very simple, safe procedure that gives immediate benefit through infancy and continues through life," he said.

The Royal Australian College of Physicians recently softened its opposition towards circumcision. Its 2004 position statement said there was no medical indication for routine neonatal circumcision and that benefits needed to be weighed against a complication rate of 1 to 5 per cent but its interim statement released last year was more nuanced, saying parental choice should be respected.

The college's paediatric and child health policy committee chairman Professor David Forbes said: "We have stepped back and said: 'Yes, there are ethical issues around circumcision but ultimately we have to have a policy that fits with society's practice and acknowledging parents' role in the decision-making process, while recognising the potential benefits and risks'."

But the statement recommends parents should wait until their boys are old enough to make their own decision on circumcision – the subject of a petition by pro-circumcision clinicians led by Professor Morris, who say infancy is best for the procedure.

Royal Australian College of General Practitioners national spokesman Dr Ronald McCoy said he didn't believe there was any reason to circumcise except for a handful of medical indications but agreed the debate was not going away.

"It certainly is a real issue. Parents want to find out what's best for their kids," Dr McCoy said.
General Practice NSW chairman Dr Ken Mackey said circumcision was generally safe but there were still slight risks of infection or deformity of the penis. "As always, fully informed consent is important," he said.

Tim Tebow, Superbowl, Abortion & Circumcision

Tim Tebow, the awesome quarterback for the University of Florida 'Gators, is getting a lot of flack because he and his mom are "out front" in the anti-abortion campaign. That will be highlighted in a Superbowl ad produced by Focus on the Family that has the pro-choice crowd up in arms.

Perhaps Tim might have gotten a better reception if he had used his notoriety to promote the universal circumcision of all males.

Now I want to be clear. The abortion issue really has nothing to do with circumcision. Those who "respect life" should obviously value circumcision for its life-giving medical advantages. Those who are "pro choice" should obviously value a parent's right to circumcise a child as that is in the best interests of everyone.

I'm just saying Tim Tebow should be the national spokesman for universal circumcision.

A lot of people may not know that, while other kids were carousing on the beach, Tim made an important missionary trip to the Phillipines during the 2008 spring break. During that trip, Tim took part in circumcising Filipino boys who almost all get circumcised in that country.

Circumcision is a rite of passage in a country that is about 95% foreskin-free. To be uncircumcised is to be "supot" or "pisot." Both words carry a negative connotation far beyond the simple expression "uncircumcised," the literal translation. If you call another dude supot, it's like saying he's unclean, a baby, and unworthy to be a man.

While some college kids go on drunken debaucheries during spring break, Tim was helping out his father on a mission trip. Here was the account at the time:

"In an impoverished village outside General Santos City in the Philippines, Tebow helped circumcise impoverished children. On the Friday of a weeklong trip to the orphanage his father's ministry runs in Southeast Asia, Tebow assisted with the care of locals who had walked miles to the temporary clinic that the ministry helped organize. More than 250 people underwent medical and dental procedures, some of them from "Dr. Tebow," who has no formal surgical training."

"The first time, it was nerve-racking," he said. "Hands were shaking a little bit. I mean, I'm cutting somebody. You can't do those kinds of things in the United States. But those people really needed the surgeries. We needed to help them."

"Tebow didn't plan on operating that day in the Philippines -- his job was to preach to the hundreds of people before they had teeth pulled or cysts removed. But as the day rolled on, he grew curious about the three Filipino doctors and his friend, UF graduate and aspiring doctor Richard "R.B." Moleno, in the bus-sized vehicle that served as a mobile hospital.

"Tebow started as a helper and gofer, holding tools and running errands for the medics. By afternoon, he was asking questions and looking for more active ways to help. And by the end of an exhausting day, he was wearing gloves and a mask, wielding surgical scissors, finishing off stitches with a snip."

In my view, Tim Tebow's public service circumcision of Filipino boys is something to praise, and it's a sign of his commitment to this life-saving procedure. I just hope as he enters the NFL, he'll remember how important it is to promote a clean-cut, foreskin-free country both here in America and in Asia, too.

I nominate Tim Tebow to be the national poster boy for universal circumcision. Is there a second?

Foreskin Dangerous on Males But Could Help Others

The foreskin is obviously a source of dirt and danger to the normal male, but it apparently does have some scientific value that is likely to grow in the decades ahead.

Have you ever wondered what happened to your foreskin? Probably not. But it is nice to think that this worthless piece of tissue when disfiguring (and harming) the male penis may have some positive benefits in collagen and skin repairs.

Here's what the alternative San Diego CityBeat wrote about this topic:

The $140-million foreskin
How San Diego biotech benefits from circumcision
By Dave Maass

In the bio-tech industry, the term “neonatal fibroblast” is often code for “baby foreskin,” or at least the cells derived from one.

Much like embryonic stem cells may revolutionize treatments for a wide range of chronic and genetic disorders, the neonatal fibroblast has changed how medical and cosmetic doctors heal the skin.

San Diego doctors have appreciated the potential of the foreskin as far back as the 19th century.

As Dr. Peter Charles Remondino wrote in 1891 in The History of Circumcision, “for skin-transplanting there is nothing superior to the plants offered by the prepuce of a boy.”

What Remondino couldn’t have foreseen is how San Diego County’s bio-science industry would develop foreskin technology. For example, Invitrogen Corp., a subsidiary of Carlsbad-based Life Technologies Corp., offers neonatal fibroblasts for $339 per 500,000-cell vial.

Asked where the foreskins come from, spokesperson Tim Ingersoll responded via e-mail: “Life Technologies produces research-use only products using neonatal foreskins discarded from circumcisions with full, informed consent.”

Foreskin research is more closely associated with La Jolla-based Advanced Tissue Sciences. In the early ’90s, the company invented a way to grow and use the fibroblast cells in a skin overlay that could produce collagen and other biological elements to heal wounds.

ATS eventually became financially insolvent and spent the past decade liquidating its assets. Co-founder Dr. Gail Naughton is now dean of the SDSU School of Business Administration.

The foreskin formula also stayed local. Advanced BioHealing, a Connecticut-based company with a 70,000-square-foot manufacturing facility in La Jolla, currently uses ATS’s “Dermagraft” treatment, which is applied primarily to diabetic foot ulcers. Carlsbad-based SkinMedica also employs ATS’s fibroblast process but discards the cells and uses only the protein-rich culture in its skin-cream products.

According to the corporate-analysis firm Hoovers, SkinMedica has a staff of 160 employees and reports $60 million annually in sales. Advanced BioHealing estimates that it pulled in $80 million in sales in 2009 and grew its workforce to 250 employees.

Neither company has acquired a prepuce in nearly 20 years: Advanced BioHealing and SkinMedica’s cells lines are both derived from a single foreskin.

Technically, a fibroblast can be made from any skin tissue, old or young, but the healing properties of infant skin are superior. The fibroblast can come from the skin of any body part, but circumcision means there’s already a surplus of infant skin that would otherwise be destroyed.

“It comes down to the availability of tissue,” Charlie Hart, chief scientific officer for Advanced BioHealing, says. “Collecting tissue from a different site would be an abnormal surgical procedure and there would be a lot of ethical issues with that.”

SkinMedica has been questioned for using the foreskin culture in its Oprah-endorsed anti-aging products.

“Initially, there was a misunderstanding and people thought we were actually grinding up the foreskin,” SkinMedica founder Dr. Richard Fitzpatrick says. “So, there was a lot of snickering and laughing about people putting this foreskin product on their face.”

How did SkinMedica put the urban legend to rest?

“We stopped mentioning it,” Fitzpatrick says.

Circumcise Newborns is Most Effective Strategy

Sometimes it just takes a little common sense to do what is right. But it never hurts to have an academic study back up your point of view. Common sense dictates that circumcising baby boys is the most cost-effective way to achieve the benefits of circumcision even if that boy is not likely to engage in sexually risky behavior until later in life. The anti-circ fanatics often rail against newborn circumcision, saying "baby boys don't have sex, don't circumcise them until later in life." Now comes still another study that establishes the obvious -- newborn circumcision is cheaper and safer and less complicated than adult circumcision. So let's do the obvious -- every baby boy should leave that foreskin behind when he comes home with mommy!

Check out this story below, and share your comments.


ScienceDaily (Jan. 21, 2010) — Circumcising newborn boys as a way to prevent HIV infection in later life is more cost-effective than circumcising adult males, finds a new Rwandan study in PLoS Medicine.

It has already been conclusively shown, from three randomized clinical trials in Uganda, Kenya, and South Africa, that adult male circumcision (MC) roughly halves the HIV transmission rate from women to men. Many African countries hit hard by HIV are therefore offering men the procedure as way to control the epidemic. Rwanda is one such country -- about 3% of adults in Rwanda are infected with HIV but only 15% of men are currently circumcised.

But performing the operation in adolescents and adults is linked with a higher risk of complications than circumcising newborns. And the operation is quicker and simpler to perform in newborns. The new study, by Agnes Binagwaho (Rwanda Ministry of Health) and colleagues, therefore set out to compare three different strategies as applied to Rwanda: circumcising newborns (neonates), adolescents, or adults.

The researchers used a technique called "cost-effective analysis," which looks at the balance between the costs of a medical intervention and its benefits. They estimated that each neonatal MC would cost just US$15 whereas each adolescent or adult MC would cost US$59. They found that neonatal MC would in fact save more money than it costs, because the operation is cheap to perform and would prevent HIV infections that are expensive to treat.

The study findings, say the authors, "suggest that Rwanda should be simultaneously scaling up circumcision across a broad range of age groups, with high priority to the very young."

In an expert commentary on the new study, Seth Kalichman (University of Connecticut) says: "The cost-savings of neonatal MC are compelling and suggest that implementation is economically feasible in developing countries hit hardest by HIV/AIDS. Neonatal MC should therefore be considered a priority in comprehensive HIV prevention plans for southern Africa."

Removal of Foreskin Rids Penis of Bad Bacteria, Study Shows

In another exciting study just released, medical researchers have confirmed that the removal of the foreskin allows the clean-cut penis to shed bad bacteria that can harm both the male and his female partners.

Here's the article from New Scientist

"A flap of foreskin isn't the only thing missing after a circumcision. Microbes that call the penis home disappear, too, which could explain why the procedure reduces a man's chance of contracting HIV.

"The microbes change dramatically," says Lance Price, a microbiologist at the Translational Genomics Research Institute in Flagstaff, Arizona, whose team identified thousands of microbes on the penises of 12 HIV-negative men. All had participated in a clinical study in Uganda which showed that circumcision halves the chances of getting the virus.

"The team discovered a total of 38 families of bacteria on the men's penises before circumcision, and 36 a year after. But the make-up of these communities had swung. Gone were a diverse population of bacteria intolerant of oxygen and linked with vaginal infection; now there was a more homogenous air-loving lot, more typical of other patches of skin.

"Price thinks that some of the expelled bacteria provoke an immune reaction on an uncircumcised penis, causing specialised immune cells to shuttle HIV throughout the body.
Residents of the penis

"Even where religion, culture or costs prevent widespread circumcision, Price says the work could be a first step in delivering the benefits of the procedure without surgery. "The really interesting thing about this study is the potential to modify somebody's risk for HIV."

"His team next plans to determine which microbes are most common on the penises of men who go onto to acquire HIV. Targeting these bacteria with antibiotics – while leaving harmless or even helpful residents of the penis alone – could stem the spread of HIV, he says.

"Martin Blaser, a microbiologist at New York University, says the new study is the most comprehensive look yet at the microbes living on the penis. But given that microbial populations on other parts of the body shift over time, he wonders whether the pre-circumcision bacteria will return. "I expect it will stay changed," he says.

New Calls for AAP to Embrace Newborn Circumcision

What a terrific way to begin 2010 that to see medical doctors call on the American Academy of Pediatrics to replace its so-called "neutral" policy on newborn male circumcision with an affirmative statement on the clear benefits of this procedure to the male, his partners, and society as a whole.

That's the focus of an article and editorial in the January 2010 issue of the Archives of Pediatric and Adolescent Medicine. Here are some excerpts from Fran Lowry's story in Medscape Medical News:

“During the past 4 years, substantial new data have been published on the health benefits of circumcision,” write Aaron A. R. Tobian, MD, from Johns Hopkins University School of Medicine, Baltimore, Maryland, and colleagues. “While the historical evidence strongly suggests that male circumcision reduces urinary tract infections and penile inflammatory disorders in infants, we reviewed the more recent evidence with regard to effects on sexually transmitted infections (STIs) in adulthood.”

"To evaluate the effect of circumcision on HIV prevention, the researchers analyzed 3 randomized controlled trials of more than 10,000 men from South Africa, Kenya, and Uganda.
The trials enrolled HIV-negative men to circumcision on enrollment or after 21 to 24 months, and all 3 trials demonstrated that male circumcision significantly decreased male heterosexual HIV acquisition by 53% to 60%, despite differences in age eligibility criteria, urban or rural settings, and surgical procedure.

"Because of this new evidence, the World Health Organization (WHO), together with the Joint United Nations Program on HIV/AIDS (UNAIDS), recommended that male circumcision be provided as an important intervention to reduce heterosexually acquired HIV in men, the study authors report.

"The trials also found that male circumcision decreased herpes simplex virus type 2 (HSV-2) acquisition by 28% to 34% and the prevalence of human papillomavirus (HPV) by 32% to 35% in men.

"Among female partners of circumcised men, bacterial vaginosis was reduced by 40% and Trichomonas vaginalis infection was reduced by 48%, the study authors write.

"The study authors note that the rates of neonatal circumcision complications are between 0.2% and 0.6% of operations performed. The most common complications are bleeding and local infection, which are controlled with pressure and wound care or antibiotics. Other complications, such as phimosis and concealed penis, adhesions, fistula, meatitis, meatal stenosis, and injury to the glans, are extremely rare.

"They add that there was no evidence of change in sexual behavior after circumcision in the African randomized controlled trials. “Thus, there are risks to neonatal circumcision, but serious long-term complications are extremely rare,” the study authors write.

“The rare short-term risks of neonatal circumcision need to be weighed against the potential benefits accrued in infancy and childhood (eg, reduction of urinary tract infections), the longer-term benefits that may accrue in adolescence and adulthood (eg, reduced risks of HIV, HSV-2, and HPV), as well as possible benefits to female sexual partners of circumcised men (eg, reduced bacterial vaginosis and trichomonas),” Dr. Tobian and colleagues write.

"Medicaid does not cover the cost of male circumcision in 16 states, and the lack of coverage particularly affects disadvantaged minorities, who have the highest risk for HIV and sexually transmitted diseases. “These socioeconomically disadvantaged groups could benefit most if Medicaid covered the costs of neonatal circumcision. Thus, the AAP’s policy has important implications for the health of disadvantaged minorities,” they write.

"They conclude that it is time for the AAP policy to fully reflect current data.

"In an accompanying editorial, Michael T. Brady, MD, from Nationwide Children’s Hospital in Columbus, Ohio, writes that the study authors have provided a very objective review of the available data. Although the 3 randomized trials were performed in Africa, “it is clear that circumcision does offer health benefits, even in the United States,” he notes.

"The current evidence on the health benefits of circumcision is adequate enough to include circumcision in medical coverage provided by Medicaid or commercial insurance providers, Dr. Brady points out. “This is particularly relevant since over the past decade many state Medicaid programs have discontinued payment for circumcision.”