Monday, February 18, 2013

Response to THE AAP REVISITS THE CIRCUMCISION DEBATE

In response to "THE AAP REVISITS THE CIRCUMCISION DEBATE"

You mention this key finding: "”Complications are infrequent,”  mostly mild and rarely severe, and that newborn circumcision has a much lower complication rate that of the procedure later in life"

In 2010 the Royal Australasian College of Physicians wrote: "Some of the risks of circumcision are low in frequency but high in impact (death, loss of penis); others are higher in frequency but much lower in impact (infection, which can be treated quickly and effectively, with no lasting ill-effects). Low impact risks, when they are readily correctable, do not carry great ethical significance. Evaluation of the significance of high-impact low-frequency risks is ethically contentious and variable between individuals."

The AAP pretty much avoided the discussion of low frequency high impact complications by  stating that "The majority of severe or even catastrophic injuries are so infrequent as to be reported as case reports (and were therefore excluded from this literature review)." This wishy washy attitude doesn't make those complications any less real.



You also said: "A spectrum of claims regarding negative aspects of circumcision has long existed, many of them having nothing  to do with infant health and lacking credible medical evidence."

So, in your opinion, is there no credible medical evidence that the foreskin has erogenous function? Or because the erogenous function has nothing to do with infant health, then it needs not be taken into consideration regardless of the effect it may have on the adult? Your argument that some of these things have nothing to do with infant health would make sense if the doctors were capable of giving children back their foreskins upon reaching the majority of age, but in lack of that, lifetime consequences of circumcision need to be evaluated before performing an irreversible surgery.

Things like:

"The amount of tissue loss estimated in the present study is more than most parents envisage from pre-operative counselling. Circumcision also ablates junctional mucosa that appears to be an important component of the overall sensory mechanism of the human penis. "(2)

"The prepuce provides a large and important platform for several nerves and nerve endings. The innervation of the outer skin of the prepuce is impressive; its sensitivity to light touch and pain are similar to that of the skin of the penis as a whole. The glans, by contrast, is insensitive to light touch, heat, cold and, as far as the authors are aware, to pin-prick. Le Gros Clark noted that the glans penis is one of the few areas on the body that enjoys nothing beyond primitive sensory modalities." (2)

"This study confirms the importance of the foreskin for penile sensitivity, overall sexual satisfaction, and penile functioning. Furthermore, this study shows that a higher percentage of circumcised men experience discomfort or pain and unusual sensations as compared with the uncircumcised population. Before circumcision without medical indication, adult men, and parents considering circumcision of their sons, should be informed of the importance of the foreskin in male sexuality." (3)

"Circumcision was associated with frequent orgasm difficulties in Danish men and with a range of frequent sexual difficulties in women, notably orgasm difficulties, dyspareunia and a sense of incomplete sexual needs fulfillment. Thorough examination of these matters in areas where male circumcision is more common is warranted." (4)

"The glans of the circumcised penis is less sensitive to fine touch than the glans of the uncircumcised penis. The transitional region from the external to the internal prepuce is the most sensitive region of the uncircumcised penis and more sensitive than the most sensitive region of the circumcised penis. Circumcision ablates the most sensitive parts of the penis." (5) This study was cited in the AAP's statement but its conclusions were largely ignored and dismissed.


References

(1) Royal Australasian College of Physicians, 2010, "Circumcision of Infant Males" http://www.racp.edu.au/index.cfm?objectid=65118B16-F145-8B74-236C86100E4E3E8E

(2)Taylor JR, Lockwood AP, Taylor AJ. The prepuce: specialized mucosa of the penis and its loss to circumcision. Br J Urol 1996;77:291-295.  http://www.cirp.org/library/anatomy/taylor/

(3) Bronselaer, et al. 2013. "Male circumcision decreases penile sensitivity as measured in a large cohort". BJU, doi: 10.1111/j. 1464-410x.212.11761.x http://www.ncbi.nlm.nih.gov/pubmed/23374102?dopt=Abstract

(4) Frisch et al, 2011. "Male circumcision and sexual function in men and women: a survey-based, cross-sectional study in Denmark." Int J. Epidemiol  2011 Oct;40(5):1367-81. doi: 10.1093/ije/dyr104. Epub 2011 Jun 14. http://www.ncbi.nlm.nih.gov/pubmed/21672947

(5) Sorrells et al,  2007. "Fine-touch pressure thresholds in the adult penis." BJU Int. 2007 Apr;99(4):864-9. http://www.ncbi.nlm.nih.gov/pubmed/17378847

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