Circumcision Being Recommended For All Baby Boys

Public health officials are considering promoting routine circumcision for all baby boys born in the United States to reduce the spread of H.I.V., the virus that causes AIDS.
The topic is a delicate one that has already generated controversy, even though a formal draft of the proposed recommendations, due out from the Centers for Disease Control and Prevention by the end of the year, has yet to be released.
Experts are also considering whether the surgery should be offered to adult heterosexual men whose sexual practices put them at high risk of infection. But they acknowledge that a circumcision drive in the United States would be unlikely to have a drastic impact: the procedure does not seem to protect those at greatest risk here, men who have sex with men.
Recently, studies showed that in African countries hit hard by AIDS, men who were circumcised reduced their infection risk by half. But the clinical trials in Africa focused on heterosexual men who are at risk of getting H.I.V. from infected female partners.
For now, the focus of public health officials in this country appears to be on making recommendations for newborns, a prevention strategy that would only pay off many years from now. Critics say it subjects baby boys to medically unnecessary surgery without their consent.
But Dr. Peter Kilmarx, chief of epidemiology for the division of H.I.V./AIDS prevention at the C.D.C., said that any step that could thwart the spread of H.I.V. must be given serious consideration.
“We have a significant H.I.V. epidemic in this country, and we really need to look carefully at any potential intervention that could be another tool in the toolbox we use to address the epidemic,” Dr. Kilmarx said. “What we’ve heard from our consultants is that there would be a benefit for infants from infant circumcision, and that the benefits outweigh the risks.”
He and other experts acknowledged that although the clinical trials of circumcision in Africa had dramatic results, the effects of circumcision in the United States were likely to be more muted because the disease is less prevalent here, because it spreads through different routes and because the health systems are so disparate as to be incomparable.
Clinical trials in Kenya, South Africa and Uganda found that heterosexual men who were circumcised were up to 60 percent less likely to become infected with H.I.V. over the course of the trials than those who were not circumcised.
There is little to no evidence that circumcision protects men who have sex with men from infection.
Another reason circumcision would have less of an impact in the United States is that some 79 percent of adult American men are already circumcised, public health officials say.
But newborn circumcision rates have dropped in recent decades, to about 65 percent of newborns in 1999 from a high of about 80 percent after World War II, according to C.D.C. figures. And blacks and Hispanics, who have been affected disproportionately by AIDS, are less likely than whites to circumcise their baby boys, according to the agency.
Circumcision rates have fallen in part because the American Academy of Pediatrics, which sets the guidelines for infant care, does not endorse routine circumcision. Its policy says that circumcision is “not essential to the child’s current well-being,” and as a result, many state Medicaid programs do not cover the operation.
The academy is revising its guidelines, however, and is likely to do away with the neutral tone in favor of a more encouraging policy stating that circumcision has health benefits even beyond H.I.V. prevention, like reducing urinary tract infections for baby boys, said Dr. Michael Brady, a consultant to the American Academy of Pediatrics.
He said the academy would probably stop short of recommending routine surgery, however. “We do have evidence to suggest there are health benefits, and families should be given an opportunity to know what they are,” he said. But, he said, the value of circumcision for H.I.V. protection in the United States is difficult to assess, adding, “Our biggest struggle is trying to figure out how to understand the true value for Americans.”
Circumcision will be discussed this week at the C.D.C.’s National H.I.V. Prevention Conference in Atlanta, which will be attended by thousands of health professionals and H.I.V. service providers.
Among the speakers is a physician from Operation Abraham, an organization based in Israel and named after the biblical figure who was circumcised at an advanced age, according to the book of Genesis. The group trains doctors in Africa to perform circumcisions on adult men to reduce the spread of H.I.V.
Members of Intact America, a group that opposes newborn circumcision, have rented mobile billboards that will drive around Atlanta carrying their message that “circumcising babies doesn’t prevent H.I.V.,” said Georganne Chapin, who leads the organization.
Although the group’s members oppose circumcision on broad philosophical and medical grounds, Ms. Chapin argued that the studies in Africa found only that circumcision reduces H.I.V. infection risk, not that it prevents infection. “Men still need to use condoms,” Ms. Chapin said.
In fact, while the clinical trials in Africa found that circumcision reduced the risk of a man’s acquiring H.I.V., it was not clear whether it would reduce the risk to women from an infected man, several experts said.
“There’s mixed data on that,” Dr. Kilmarx said. But, he said, “If we have a partially successful intervention for men, it will ultimately lower the prevalence of H.I.V. in the population, and ultimately lower the risk to women.”
Circumcision is believed to protect men from infection with H.I.V. because the mucosal tissue of the foreskin is more susceptible to H.I.V. and can be an entry portal for the virus. Observational studies have found that uncircumcised men have higher rates of other sexually transmitted diseases like herpes and syphilis, and a recent study in Baltimore found that heterosexual men were less likely to have become infected with H.I.V. from infected partners if they were circumcised.
from The New York Times

Penis Questions Of The Day

Dear Dr. Shieh,
My question is about the male penis. It's a little embarrassing, but my boyfriend is not circumcised and I don't know whether I should tell him that he should get circumcised or not. It doesn't really bother me, but my girlfriends were telling me that uncircumcised penises looked weird and I can catch more diseases, and if I have sex with him, he'll have a hard time because he is not circumcised. Is this true? -- Wondering
Dear Wondering:
Don't be embarrassed. There are many men that are not circumcised and the reality is that there really is no medical indication for routine circumcision. Some insurance companies do not cover this procedure, citing that it is more of a cosmetic reason.
At birth, the foreskin is fused and will separate with time. Circumcision is a surgical procedure that removes the top or front part of the skin of the penis, better know as "foreskin."
Now, if you think about the natural development of the penis, the foreskin may serve as protection over the gland of the penis and some sex counselors theorize that the foreskin is there for sexual pleasure. In fact, the inner part of the foreskin is usually much thinner and contains more nerve endings than the skin of the shaft of the penis and is similar to the mucosa of the inner aspect of the mouth. During erection, the foreskin usually will pull back without any problems during intercourse.
For your boyfriend, if he does not already know this, he needs to make sure that he provides good hygiene for himself. Make sure that he pulls back the foreskin to properly clean his penis. Men who do not use good hygiene will experience an increased incidence of urinary tract infections.
Lastly, sexually transmitted diseases such as Chlamydia, Herpes, Syphilis, HIV, HPV, Hepatitis, Gonorrhea and others do not discriminate. These STDs can be transmitted whether a person is circumcised or uncircumcised.
To decrease the risk of STDs, use a latex condom and choose carefully who you have sex with.
from The Pacific Daily News


Q I am only 12 but I can't stop masturbating. I can do it up to three times a day.
Even though it sometimes hurts I can't stop doing it. I worry I have damaged my penis but I don't want to go to the doctor because it would be embarrassing.
I would also have to tell my dad. So I need to stop. I have tried methods on websites but nothing works for me.
A Let me repeat yet again that masturbation will not harm your penis. Nor is it abnormal, particularly at your age, to occasionally overdo it.
If you really want to cut down, you have to do something that will distract you.
A group activity such as football or even hanging out with your mates should work.
It will also keep you fitter than reaching for a snack.
from The Daily Record

New York City Plans to Promote Circumcision To Reduce Spread Of AIDS

New York City’s Department of Health and Mental Hygiene is planning a campaign to encourage men at high risk of AIDS to get circumcised in light of the World Health Organization’s endorsement of the procedure as an effective way to prevent the disease.
While the Centers for Disease Control and Prevention in Atlanta is just beginning to convene meetings and design studies to help it formulate a national policy, New York City is moving ahead on its own.
In the United States, “New York City remains the epicenter of the AIDS epidemic,” Dr. Thomas R. Frieden, the city’s health commissioner, said in an interview. Referring to H.I.V., he said, “In some subpopulations, you have 10 to 20 percent prevalence rates, just as they do in parts of Africa.”
His department has started asking some community groups and gay rights organizations to discuss circumcision with their members, and has asked the Health and Hospitals Corporation, which runs city hospitals and clinics, to perform the procedure at no charge for men without health insurance.
A spokeswoman for the corporation said it was “having conversations” with the health department but had not reached a decision.
“As you know, the research on this is pretty recent,” the spokeswoman, Ana Marengo, said.
In three recent clinical trials in Africa, circumcision was shown to lower a man’s risk of contracting the virus from heterosexual sex by about 60 percent. On March 28, the World Health Organization officially recommended that countries adopt the procedure as part of their AIDS prevention plans.
No spontaneous outcry for circumcision has arisen in New York, Dr. Frieden conceded.
“This is not something that has a lot of buzz,” he said.
But he added that even 1,000 circumcisions in the right subgroups might slow the spread of AIDS.
For example, in Manhattan, 20 percent of all black men between 40 and 50 are infected with the virus that causes AIDS. About 10 percent of all gay men in the city are infected, and the rate rises to as high as 25 percent in the Chelsea neighborhood.
Dr. Frieden said black, Hispanic and foreign-born men were less likely to be circumcised than white Americans, and the percentage is smaller among men with lower incomes.
(About 65 percent of all male babies in the United States are circumcised, according to the National Center for Health Statistics, compared with about 30 percent of men worldwide, by W.H.O. estimates.)
Among men seeking treatment at the city’s clinics for sexually transmitted diseases — another risk group for AIDS infection because of genital sores — a large proportion are uncircumcised, Dr. Frieden said.
There are clear limitations, however, on extrapolating data from Africa to New York.
The studies, done in Uganda, Kenya and South Africa, enrolled men who said they had sex with women, while New York’s highest-risk groups are men who have sex with men, men who inject drugs and people who have sex with those men.
Nonetheless, Dr. Frieden said, it is logical to assume that circumcision would offer protection in some types of gay sex.
A man’s risk from performing penetrative anal sex is about the same as his risk from vaginal sex, Dr. Frieden said, so circumcision would presumably confer the same protection as it did in the African trials.
The risk from receptive anal sex is five times higher, he said, and circumcision would obviously not protect those men. Oral sex is much less risky.
Also, cutting down infections among bisexual men — some of whom do not admit to female partners that they participate in gay sex — would protect women, he said.
Dr. Frieden said he thought health insurance companies might agree to pay for preventive circumcisions since they already covered them for infections and urinary blockage. City hospitals also offer the operation in those cases, Ms. Marengo said.
Peter Staley, a longtime AIDS activist and co-founder of ACT-UP New York, the Treatment Action Group and AIDSmeds.com, said he was “intrigued” by the idea of offering circumcisions but worried because those in the studies supporting it bore little relation to New York’s risk groups.
“Should we proceed when we don’t have hard data yet on the population here?” he asked. “On the other hand, if we wait the three years it would take to answer that question, how many will be infected in the meantime?”
Also, after reading many postings on gay Web sites about the Africa trials, he said he feared a backlash among black and Hispanic men to endorsements of circumcision from white public health officials or gay activists.
“I’m white, Frieden’s white,” he said. “It’s going to sound like white guys telling black and Hispanic guys to do something that would affect their manhood.”
Tokes Osubu, executive director of Gay Men of African Descent, a 21-year-old gay rights organization, agreed.
“There will always be conspiracy theorists,” he said. “That’s par for the course.”
He also said he thought circumcision was “not the answer to our problems” and doubted that it would lower infection rates.
Many black men who have sex with men, he said, already face discrimination, stigma and an inability to talk about their sex lives with family members and sometimes even with doctors.
“No amount of circumcision is going to change that,” he said.
Bric Bernas, manager of information and counseling for the Asian and Pacific Islander Coalition on H.I.V./AIDS, said his organization wanted to see studies done in the United States and among gay men before taking a position on the issue.
Circumcision is not common among Asian men, except those from Muslim countries and the Philippines, Mr. Bernas said, “and there might be cultural sensitivities around it.”
from The New York Times

Circumcision Found To Lower HIV Risk

Circumcision reduces the risk of HIV infection by half, according to a new study conducted among nearly 8,000 adult males in Kenya and Uganda, researchers reported Wednesday.
Circumcision proved so effective that the study was halted a year early and the procedure was offered to all study participants.
Previous research has suggested that circumcision is beneficial, but the new trial is "definitive," according to Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, which cosponsored the study with the Canadian Institutes of Health Research.
"It's not a magic bullet," said Dr. Kevin De Cock, director of the World Health Organization's department of HIV/AIDS, but it has the potential to prevent "many hundreds of thousands and perhaps millions of infections over coming years."
The findings, which apply only to heterosexual transmission of HIV from women to men, will have less impact in the United States, where nearly 80% of males are circumcised and homosexual contact between men still plays a major role in transmission of the virus.
But they could have a major effect in the rest of the world, where heterosexual contact is the major form of transmission.
Nonetheless, experts cautioned that circumcision does not eliminate risk. The procedure "has to be integrated with all the other things that we do to prevent new HIV infections," said epidemiologist Robert Bailey of the University of Illinois at Chicago, who led the Kenya study.
Circumcision rates vary widely in Africa. The average is just over 60% for the entire continent, but less than 20% in South Africa, where the AIDS epidemic is most severe.
Early small trials of circumcision had shown a beneficial effect from the procedure, in which the foreskin is removed from the penis, but experts feared that the benefits might be related to cultural biases rather than the procedure itself.
Even a 2005 study of more than 3,000 men in South Africa, which showed that circumcision reduced HIV transmission by 60%, failed to move funding agencies, which feared that the findings could not be reproduced at other sites.
The new results appear to have tipped the balance. UNAIDS and the WHO said Tuesday that they would rapidly convene a panel of experts to determine how to implement the findings.
The Ugandan trial in Rakai enrolled 4,996 men ages 15 to 49, half of whom underwent circumcision. All the men in both studies also received counseling on HIV risk reduction and were advised to wear condoms.
But because condom usage is not 100%, the researchers expected to see infections in both groups.
A U.S. National Institutes of Health board reviewed the data Tuesday and found 43 cases of HIV infection among the uncircumcised men, compared with 22 among the circumcised — a 48% reduction in risk.
The Kenyan trial in Kisumu enrolled 2,784 men ages 18 to 24. The monitoring board found 47 cases among the uncircumcised men, compared with 22 among the circumcised — a 53% reduction in risk.
Faced with those results, the board said the trial should be terminated immediately.
"Circumcision is now a proven, effective prevention strategy to reduce HIV infections in men," Bailey said.
An ongoing trial in Africa is also studying whether circumcision of men will reduce the HIV infection rate among women.
Fauci said during a Wednesday teleconference that cells of the foreskin appeared to be more fragile than those on the rest of the penis, and thus more susceptible to invasion by HIV.
The folds of the uncircumcised penis can also trap the virus, holding it against the penis in a warm, moist environment that promotes infection.
from The Los Angles Times

Boy Gets Penis Sliced During Botched Circumcision

JOHOR BARU, MALAYSIA - A slip of the scalpel resulted in a 10-year-old boy’s penis being sliced at a private clinic in Mersing.
Muhamad Shahbuddin Zainalabidin was at the clinic for his circumcision when the medical assistant sliced off more than the foreskin on Thursday.
Shahbuddin’s father, Zainalabidin Ahmad, 46, a chief clerk in Felda Nitar, Mersing, said he was shocked when the medical assistant ran to him and apologised that he had accidentally severed his son’s penis.
A doctor then retrieved the sliced tip and put it on ice and rushed the boy in an ambulance to Sultanah Aminah Hospital. The tip was re-attached after a five-hour operation.
The father is keeping his fingers crossed as it will only be known tomorrow whether the surgery was successful.
Zainalabidin said Shahbuddin and his twin brother, Zaid Abidin, were among seven scheduled to be circumcised at 10am that day.
"Zaid was supposed to go first, but chickened out and convinced Shahbuddin to go first.
"But, after the incident, the doctor cancelled the remaining appointments and closed the clinic," Zainalabidin added.
The boy’s mother, Zunaidah Abd Rahman, 41, said although it was an accident and the doctor had offered to foot the medical expenses, she was afraid the traumatic experience would continue to affect her son.
from The New Sunday Times

Judge Rules 9-Year-Old Need Not Get Circumcised

CHICAGO - In a decision cheered by foes of routine circumcision for boys, a judge ruled on Tuesday that a 9-year-old need not be circumcised as his mother wanted.
A dispute between the boy's divorced parents about whether to circumcise him escalated into a court case, and Cook County Judge Jordan Kaplan declared in his ruling that it was unclear if the boy would benefit medically from having the procedure done.
Witnesses for the boy's mother argued he had suffered infections underneath his foreskin. The father's expert witnesses said the mother had wrongly retracted his foreskin in order to clean his penis and had irritated the area.
In granting the boy's father an injunction blocking the procedure, the judge said the boy could decide for himself whether to be circumcised when he turns 18.
The case is sure to fuel arguments for and against male circumcision.
The American Academy of Pediatrics has said it does not recommend routine circumcision, though it does have some potential medical benefits.
In a statement, the Doctors Opposing Circumcision said the judge's ruling protected "the boy's legal right to bodily integrity."
"Male circumcision in an irreversible amputation of functional tissue," it added.
"The ruling opens a very interesting question," said the group's John Geisheker. "If the benefits of circumcision are not available to a 9-year-old, what does that say about infants?"
At least one study has shown infants that have been circumcised later show a greater sensitivity to pain, "an infant analog to post-traumatic stress disorder," Geisheker said.
On the opposing side, one study suggested an uncircumcised penis may be more prone to becoming infected with HIV.
The practice of circumcising infant males is rare in Europe, while it is declining but remains common in the United States.
from Reuters

HIV Risk Reduced With Male Genital Hygiene

A latest report published in the September issue of Journal of AIDS, has established the importance of ensuring regular genital hygiene in males, which goes a long way in reducing the risk of contracting HIV infection. Previous studies have shown reduction in HIV rates with male circumcision.
Dr. Nigel O'Farrell and a team from Ealing Hospital in London observed the presence of "subpreputial penile wetness," under the foreskin of most uncircumcised men, likely to cause infection.
To understand the link, researchers examined the clinical reports of 386 uncircumcised men who did not suffer any genital lesions or discharge. Upon examination of these subjects, Physicians observed that in nearly 80 percent of the cases, there was a minimal wetness around the penis. Surprisingly, only one out of 36 circumcised men, they saw, really had wetness.
Further researchers observed that HIV infection was 66.3 percent prevalent in the men who had penile wetness, as against 45.9 percent in men who had no wetness. It was also observed that the extent of wetness did not have any bearing over the risk of infection.
The researchers said “information, education, and communication programs at a number of levels would be needed: for instance, encouraging washing related to sexual activity - precoital or postcoital or as an everyday life skill."
from Med India

Circumcision Decision

As soon as she found out she was pregnant with a boy, Cynthia Wood of Brewster researched everything she could find about circumcision.
She surfed the Internet, watched an online video and talked to other moms.
What she found was that a procedure that for decades has been routine for the majority of American baby boys but has increasingly become a more strident debate.
Traditionalists argue that removal of the foreskin that shields the head of the penis results in fewer infections and less risk of sexually transmitted disease. Some accuse of anti-circumcisionists of being a ''cult.''
Those opposed to circumcision, also known as ''intactivists,'' say the risks of infection, disease and penile cancer are grossly overblown, and there is no reason to surgically remove a healthy body part. Some intactivist bloggers have equated male circumcision with torture.
In the meantime, the American Academy of Pediatrics manages to sidestep the issue, stating that while scientific evidence demonstrates ''potential medical benefits of newborn male circumcision,'' it's not enough to recommend ''routine neonatal circumcision.''
Without a direct recommendation for or against, the academy tosses the ball to parents, who have the final call anyway.
Wood and her husband decided against circumcision for Owen, now 6, and Nathan, now 4.
They decided that foreskin removal was not only unnecessary but potentially horrifying.
''Why would you want to put a baby's brand-new brain through that kind of trauma?'' Wood asked.
Her husband, Gerry Bojanowski, agreed. ''It seems like mutilation,'' he said. ''To me, it makes no sense. At least not in this modern age.''
He likened it to pulling a child's teeth to prevent gingivitis and tooth decay.
Although the couple are part of a national trend of declining circumcision rates, they are still among the minority in the Northeast, where 65 percent of newborn males are circumcised in the hospital.
In fact, hospital circumcision rates in the Northeast have changed little between 1979 and 2003, dropping just one percentage point, according to the Child Trends Data Bank, which analyzes data from the National Hospital Discharge Survey.
What has pulled national hospital circumcision rates downward, from 64.5 percent in 1979 to 55.9 percent in 2003, is a precipitous rate of decline in the American West. Circumcisions in that region dropped from 64 percent to 31 percent. Some experts say the driving factor is the region's number of Hispanic families, who traditionally do not circumcise their baby boys.
Here on the Cape, the majority of baby boys are circumcised, said Dr. Leif Norenberg, a Yarmouthport pediatrician.
He estimated that between 66 and 75 percent of boys born at Cape Cod Hospital are circumcised, usually within the first three weeks of life.
In fact, Norenberg said, nurses say anecdotally that circumcision rates seem to be on the upswing since declining in the 1970s and '80s. Circumcision was popular in the 1950s and '60s, when rates reached 90 percent.
''It's mainly cosmetic surgery, for most reasons,'' Norenberg said.
Religion is another factor. The majority of practicing Jews routinely circumcise their sons, usually on the eighth day in a special ceremony that may be attended by multiple family members, said Dr. Patricia Fater of Complete Wellness in Cotuit. She is a mohel, a person who is specially trained to perform circumcisions according to the tenets of Reform Judaism.
Health issues are another concern of parents who favor the procedure and those who do not.
The American Academy of Pediatrics says all studies have shown an increased risk of urinary tract infections in uncircumcised boys under age 1, but the risk is still relatively low.
Infections can be treated, said Cynthia Wood, neither of whose uncircumcised boys has experienced a urinary tract infection. ''Eighty percent of the world is uncircumcised, and they don't seem to have problems with infection,'' she said.
Cancer of the penis is another concern for parents deciding whether or not to circumcise.
But, Norenberg said, ''It's such a rare cancer, it's a moot point.''
In the United States, the incidence rate for penile cancer is 1 case per 100,000 males.
''The literature on the relationship between circumcision status and risk of squamous cell carcinoma of the penis is difficult to evaluate,'' according to the American Academy of Pediatrics.
''Reports of several case series have noted a strong association between uncircumcised status and increased risk for penile cancer; however, there have been few rigorous hypothesis-testing investigations.''
Another health fear is whether remaining uncircumcised increases a grown male's risk of acquiring sexually transmitted diseases. The American Academy of Pediatrics says ''a substantial body of evidence'' links noncircumcision in men with risk for HIV infection, but notes that circumcision is no replacement for safe-sex practices.
In one case that has garnered national attention, divorced parents are battling in a Chicago court over whether to circumcise an 8-year-old boy.
The boy's mother says removing the foreskin would help prevent repeated bouts of inflammation. The father is suing to block the procedure, saying the infections can be treated with steroids.
With older children and adults, removal of the foreskin calls for sutures and general anesthesia.
''You remember it at that age,'' said Fater, who says she has known of 5- and 13-year-olds who have had to undergo circumcisions for medical reasons.
With infants, circumcision is a relatively simple procedure, although one study showed that 1 out of every 500 circumcised newborns suffered a serious side effect.
Infants typically will be given a shot of Lidocaine or a topical anesthetic to dull the pain of the procedure, which is over in a minute or two.
''Do most moms cry when I take the baby away to do a circumcision? Yes,'' Norenberg said. ''But the baby comes back and has a good feeding and a nap. Some kids scream the whole time. Some kids sleep right through the procedure.''
Without any strong medical evidence indicating the need for circumcision, Cynthia Wood said she saw no reason to put her boys through that experience. ''I really do think it's cruel,'' she said.
''It's one of those things that's a hard decision,'' Norenberg said. ''It can be quite emotionally charged.''
Parents should study the information about circumcision and come to a decision before their child is born, even if they don't know the child's sex yet, he said.

The United States has one of the highest rates of male circumcision at 60 percent, down from 85 percent 30 years ago. How do other countries stack up?

United Kingdom: 21 percent

Australia: 15 percent

Canada: 20 percent

South Korea: 90 percent, up from 10 percent recorded 20 years ago

Source: menshealth.about.com
from Cape Cod Times