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samatm

Is Tuli (Circumcision) really necessary

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jigsy

Source?

 

I've never heard that from any medical professional.  And I've been tested for HIV every 6 months for at least 20 years.  I've lost many many friends to AIDS related illnesses, and I have NEVER, repeat NEVER, heard any Doctor say that circumcision reduced the chances of acquiring HIV.

 

Having just googled that, there is no common agreement that circumcision has any impact on the transmission of HIV.  In fact HIV is most prevalent in sub-Saharan Africa, where circumcision is routinely practised.

Don't bite.

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ozboy

I tried to talk my sis inlaw about not having it done to her boy....even though she agreed, I can see her point that its up to taunting n ridicule among his peers.....like having a communal bath or in a public CR.....

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thebob

It is very tribal here. Often the "uncles" will turn up and explain that he can't be a real man unless it is done. He will disappear for a few days and then it is all over.

 

It is a barbaric practise and more should be done to highlight it.

Edited by thebob

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lamoe

As you get older it becomes an ever more major surgery (no pun intended).

 

Other than hygiene, old myth that being circumcised numbed the head somewhat and allowed for prolonged encounters.

 

 

Got married at 20, one week after wife joined me in Millington Tennessee, the rib (frenulum)  joining foreskin to penis tore. No smart ass remarks please.

 

Serious bleeding, wife rushed me to ER., Spent 3 days in sickbay then released on a Friday.

 

Given some very good meds,  cans of Freon, and strict instructions of no sexual activity what so ever until cleared.

 

The other newlywed who'd been circumcised  didn't listen, when I reported back on Monday for examination he wasn't there.  He was in ICU.

 

Tore out all his stitches and nearly bled out -  Insult to injury, he was court marshaled for disobeying direct orders.

 

The cans of Freon worked great to cool down my beers.

Edited by lamoe

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Jess Bartone

This thread carries the same amount of passion as the handbag thread, but delivered much more forcefully. Who are you fellas trying to convince? Each other?

 

When my son was born there was no way I was raising a kid whose dick looked different to his dad's. They were trying to shove words like "barbaric" down my throat even back in '79, so the hot air's been blowing at least 35 years. Besides, those floppy socks look disgusting and apparently a lot of women agree.

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mrlondon

As you get older it becomes an ever more major surgery (no pun intended).

 

Other than hygiene, old myth that being circumcised numbed the head somewhat and allowed for prolonged encounters.

 

 

 

It does. It dries out the head of the penis because the foreskin, which was designed to protect it and keep it moist, is no longer there. This dryness causes a loss of sensitivity, although it is to different degrees, depending on how much skin was removed. 

 

Cut guys are more likely to have trouble (less enjoyment) when using a condom. That's reason enough not to do it.

The other reason is that no pain releif is used (to CUT a very sensitive peice of the body off!).

And last of all, it should not be forced upon a child who is too young to understand what it is, let alone has much experience of how their body works yet.

 

Just my view.

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Mr. Mike

This thread carries the same amount of passion as the handbag thread, but delivered much more forcefully. Who are you fellas trying to convince? Each other?

 

When my son was born there was no way I was raising a kid whose dick looked different to his dad's. They were trying to shove words like "barbaric" down my throat even back in '79, so the hot air's been blowing at least 35 years. Besides, those floppy socks look disgusting and apparently a lot of women agree.

That's  your choice! Good for you.

Edited by Mr. Mike

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4thDan

The long and short of it (pun intended) is that it is an individual choice made for an individual (infant) who can not voice his own opinion at the time.  My own thoughts are that if you're going to have it done, do it shortly after birth.  Otherwise, forget it.  The pain isn't worth it.  

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Mr. Mike

........If you a born with a normal penis............leave it alone.............WTH?

Edited by Mr. Mike
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Headshot

Apparently, the CDC in the US doesn't agree that there is little medical value to circumcision.

 

Male Circumcision

 

Summary

 

Male circumcision reduces the risk that a man will acquire HIV from an infected female partner, and also lowers the risk of other STDs , penile cancer, and infant urinary tract infection.

 

For female partners, male circumcision reduces the risk of cervical cancer, genital ulceration, bacterial vaginosis, trichomoniasis, and HPV. Although male circumcision has risks including pain, bleeding, and infection, more serious complications are rare.

 

What is Male Circumcision?

 

Male circumcision is the surgical removal of some or all of the foreskin (or prepuce) from the penis.

 

Male Circumcision and Risk for HIV Acquisition by Heterosexual Men

Several types of research have documented that male circumcision significantly reduces the risk of men contracting HIV through penile-vaginal sex.

 

Biologic Plausibility

 

Compared with the dry external skin surface of the glans penis and penile shaft, the inner mucosa of the foreskin has less keratinization (deposition of fibrous protein) and a higher density of target cells for HIV infection. Some laboratory studies have shown the foreskin is more susceptible to HIV infection than other penile tissue, although others have failed to show any difference in the ability of HIV to penetrate inner compared with outer foreskin surface. The foreskin may also have greater susceptibility to traumatic epithelial disruptions (tears) during intercourse, providing a portal of entry for pathogens, including HIV. In addition, the microenvironment in the preputial sac between the unretracted foreskin and the glans penis may be conducive to viral survival. Finally, the presence of other sexually transmitted diseases (STDs), which independently may be more common in uncircumcised men, increase the risk for HIV acquisition.

 

International Observational Studies for Prevention of HIV Acquisition by Heterosexual Men

 

A systematic review and meta-analysis that focused on male circumcision and heterosexual transmission of HIV in Africa was published in 2000. It included 19 cross-sectional studies, 5 case-control studies, 3 cohort studies, and 1 partner study. A substantial protective effect of male circumcision on risk for HIV infection was noted, along with a reduced risk for genital ulcer disease. After adjustment for confounding factors in the population-based studies, the relative risk for HIV infection was 44% lower in circumcised men. The strongest association was seen in men at high risk, such as patients at STD clinics, for whom the adjusted relative risk was 71% lower for circumcised men.

 

Another review that included stringent assessment of 10 potential confounding factors and that was stratified by study type or study population was published in 2003. Most of the studies were from Africa. Of the 35 observational studies in the review, the 16 in the general population had inconsistent results. The one large prospective cohort study in this group showed a significant protective effect: The odds of infection were 42% lower for circumcised men. The remaining 19 studies were conducted in populations at high risk. These studies found a consistent, substantial protective effect, which increased with adjustment for confounding. Each of the four cohort studies included in the review demonstrated a protective effect, and two were statistically significant.

 

Ecologic studies also indicate a strong association between lack of male circumcision and HIV infection at the population level. Although links among circumcision, culture, religion, and risk behavior may account for some of the differences in HIV infection prevalence, the countries in Africa and Asia with prevalence of male circumcision of less than 20% have HIV infection prevalences several times higher than those in countries in these regions where more than 80% of men are circumcised.

 

International Clinical Trials for Prevention of HIV Acquisition by Heterosexual Men

 

Three randomized controlled clinical trials (RCTs) were conducted in Africa to determine whether circumcision of adult males reduces their risk for HIV infection. The controlled follow-up period in all three studies was stopped early, and the control group offered circumcision when interim analyses found that medical circumcision significantly reduced male participants' HIV infection risk. The controlled follow-up period in the study in South Africa was stopped in 2005, and the controlled follow-up periods for the studies in Kenya and Uganda were stopped in 2006.

 

In these studies, men who had been randomly assigned to the circumcision group had a 60% (South Africa), 53% (Kenya), and 51% (Uganda) lower incidence of HIV infection compared with men assigned to the wait-list group to be circumcised at the end of the study. In all three studies, a small number of men who had been assigned to be circumcised did not undergo the procedure; likewise, a small number of men assigned to the control groups did undergo circumcision. When the data were reanalyzed to account for these occurrences, men who had been circumcised had a 76% (South Africa), 60% (Kenya), and 55% (Uganda) reduction in risk for HIV infection compared with those who were not circumcised.

 

A 2008 meta-analysis, which examined data from the three RCTs, as well as from cohort and case-control studies, found that HIV risk was reduced 58% in circumcised men (overall risk ratio [RR], 0.42; 95% confidence interval [CI], 0.33-0.53). The authors concluded that the studies provided enough evidence to conclude that circumcision causes a reduction in transmission of HIV-1 infection.

 

Male Circumcision and Male-to-Female Transmission of HIV

 

Studies of whether circumcision of males reduces HIV transmission to their female sex partners overall indicate no protective effect.

 

A RCT of male circumcision in Uganda found no evidence of reduced HIV transmission to female partners. In the study, 922 HIV-infected men with uninfected partners were assigned to either immediate or delayed circumcision. Overall, 18% of women in the intervention group (partners in the immediate circumcision group) acquired HIV during follow-up, compared with 12% of women assigned to the control group (partners in the delayed circumcision group). There was no difference in HIV incidence between the circumcised and control groups when the couples waited to resume sex until the wound had healed, which in 93% of male subjects was within 6 weeks of circumcision. However, women appeared to be at somewhat higher risk for HIV acquisition when the couples resumed sex before the circumcision wounds had healed, although this difference was not statistically significant.

 

A systematic review and meta-analysis of male circumcision and risk of transmission to women identified 19 studies from 11 populations. The meta-analysis of data from the one RCT and six longitudinal analyses showed little evidence that male circumcision directly affects the risk of transmitting HIV to women (RR, 0.80; 95% CI, 0.53-1.36).

 

Male Circumcision and Male-to-Male Transmission of HIV

 

Observational studies have yielded mixed results in attempts to detect a protective effect of male circumcision among men who have sex with men (MSM). While some cross-sectional and prospective studies of MSM have shown statistically significant increases in risk of HIV acquisition by uncircumcised MSM, others have found no evidence that being circumcised was protective against HIV infection among MSM. In a recent meta-analysis of 15 observational studies of male circumcision and HIV acquisition by MSM, a statistically nonsignificant protective association was found (OR, 0.86; 95% CI, 0.65-1.13).

 

HIV Infection and Male Circumcision in the United States

 

The United States has a much lower population prevalence of HIV infection (0.4%) than sub-Saharan Africa, and an epidemic that is concentrated among men who have sex with men, rather than men who have sex with women. In 2006, it is estimated that approximately 56,300 new HIV infections occurred, of which 73% were in males. Of all new infections, 53% were in MSM, 31% in heterosexuals with reported high risk of exposure, 12% in injection drug users (IDUs), and 4% in MSM-IDUs. Among men, 72% of estimated new infections occurred in the male-to-male sexual contact transmission category, while heterosexual transmission accounted for 13%.

 

In one prospective study of heterosexual men attending an urban STD clinic, when other risk factors were controlled, uncircumcised men had a 3.5-fold higher risk for HIV infection than men who were circumcised. However, this association was not statistically significant due to small sample size. And in an analysis of clinic records for Blacks men attending an STD clinic, circumcision was not associated with HIV status overall, but among heterosexual men with known HIV exposure, circumcision was associated with a statistically significant 58% reduction in risk for HIV infection.

 

Male Circumcision in the United States

 

In national probability samples of adults surveyed during 1999–2004, the National Health and Nutrition Examination Surveys (NHANES) found that 79% of men reported being circumcised, including 88% of non-Hispanic white men, 73% of non-Hispanic black men, 42% of Mexican American men, and 50% of men of other races/ ethnicities. It is important to note that reported circumcision status may be subject to misclassification. In a study of adolescents¸ only 69% of circumcised and 65% of uncircumcised young men correctly identified their circumcision status as verified by physical exam.

 

According to the National Hospital Discharge Survey (NHDS), 65% of newborns were circumcised in 1999, and the overall proportion of newborns circumcised was stable from 1979 through 1999. In 2007, the NHDS found that 55% of male infants were circumcised. Notably, the proportion of black newborns circumcised increased during this reporting period (58% to 64%); the proportion of white newborns circumcised remained stable (66%). In addition, the proportion of newborns in the Midwest who were circumcised increased during the 20-year period—from 74% in 1979 to 81% in 1999—while the proportion of infants born in the West who were circumcised decreased from 64% in 1979 to 37% in 1999. In another survey, the National Inpatient Sample (NIS), circumcision rates increased from 48% during 1988–1991 to 61% during 1997–2000 but declined to 56% in 2008. Circumcision was more common among newborns who were born to families of higher socioeconomic status, born in the Northeast or Midwest, and who were black.

 

In 1999, the American Academy of Pediatrics (AAP) changed from a neutral stance on circumcision to a position that the data then available were insufficient to recommend routine neonatal male circumcision. The Academy also stated, “It is legitimate for the parents to take into account cultural, religious, and ethnic traditions, in addition to medical factors, when making this choice.” This position was reaffirmed by the Academy in 2005. AAP is currently reviewing and amending their policy in light of new data. Medicaid does not reimburse the costs of neonatal male circumcision in all states, which poses a barrier to male circumcision for individuals without private insurance. In a recent study conducted in 37 states in which the NIS is conducted, hospitals in states where Medicaid covers routine male circumcision had 24% higher circumcision rates than hospitals in states without such coverage.

 

Cost-Effectiveness and Ethical Issues for Neonatal Circumcision in the United States

 

A large, retrospective study of circumcision in nearly 15,000 infants found neonatal circumcision to be highly cost-effective, considering the estimated number of averted cases of infant urinary tract infection and lifetime incidence of HIV infection, penile cancer, balanoposthitis (inflammation of the foreskin and glans), and phimosis (a condition where the male foreskin cannot be fully retracted from the head of the penis). The cost of postneonatal circumcision was 10-fold the cost of neonatal circumcision. There are also studies showing very marginal cost-effectiveness.

 

A 2010 study estimated that newborn circumcision reduces a U.S. male’s lifetime risk of HIV acquisition through heterosexual contact by 15.7% overall, by 20.9% for black males, 12.3% for Hispanic males, and 7.9% for white males. In this model, the number of circumcisions needed to prevent one case of HIV was 298 for all males and ranged from 65 for black males to 1,231 for white males. Based on these estimates, the study concluded that newborn male circumcision was a cost-saving HIV prevention intervention.

Little has been published on the cost-effectiveness of adult circumcision among MSM. A study in Australia found that although a relatively small percentage of HIV infections would be prevented, adult circumcision of MSM could be cost effective or cost saving in some scenarios.

 

Many parents now make decisions about infant circumcision based on cultural, religious, or parental desires, rather than health concerns. Some have raised ethical objections to parents making decisions about elective surgery on behalf of an infant, particularly when it is done primarily to protect against risks of HIV and STDs that do not occur until young adulthood. But other ethicists have found it an appropriate parental proxy decision.

 

Considerations for the United States

 

A number of important differences from sub-Saharan African settings where the three male circumcision trials were conducted must be considered in determining the possible role for male circumcision in HIV prevention in the United States. Notably, the overall risk of HIV infection is considerably lower in the United States, changing risk-benefit and cost-effectiveness considerations. Also, studies to date have demonstrated efficacy only for penile-vaginal sex, the predominant mode of HIV transmission in Africa, whereas the predominant mode of sexual HIV transmission in the United States is by penile-anal sex among MSM. There are as yet no convincing data to help determine whether male circumcision will have any effect on HIV risk for men who engage in anal sex with either a female or male partner, as either the insertive or receptive partner. Receptive anal sex is associated with a substantially greater risk of HIV acquisition than is insertive anal sex. It is more biologically plausible that male circumcision would reduce HIV acquisition risk for the insertive partner rather than for the receptive partner, but relatively few MSM engage solely in insertive anal sex.

 

In addition, although the prevalence of circumcision may be somewhat lower in U.S. racial and ethnic groups with higher rates of HIV infection, most American men are already circumcised; and it is not known whether men at higher risk for HIV infection would be willing to be circumcised or whether parents would be willing to have their infants circumcised to reduce possible future HIV infection risk.

 

http://www.cdc.gov/hiv/prevention/research/malecircumcision/

Edited by Headshot

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Mr. Mike

Sorry...don't believe it! My father (the oldest living urologist in the world (93yrs,  OKAY  almost),,,,,,, says NO!

 

That is just one data point.

 

Keep yourself CLEAN..............no problems!

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Skywalker

Many strong views, most interestingly the guys who are circumcised defend it, but of course the majority had no choice so they certainly don't want the choice made by their parents to be questioned.

 

As for the stupid remark that a man didn't want his son's penis to look different to his own. Gosh.  That kind of thinking just makes me wonder where it would all stop.  If you had black hair and your child was ginger, would you dye the child's hair?  Pure comedy really.

 

As for the HIV thing, there is no real agreement.  One thing that everyone in the medical field does agree on, is if you are having sex with someone on a casual basis, you should be wearing a condom, regardless of whether you are cut or not.

 

I remain unconvinced that it's morally fine to damage a perfect baby, with such a stupid and unnecessary procedure.  Barbaric and absolute child abuse in it's simplest form.

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jigsy

I have girls, no decision. Wouldn't do it to them though.

 

I stood firm over ear piercings - my 13 year-old just had them done - 12 years after my wife wanted them done.

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Sonny

This thread carries the same amount of passion as the handbag thread, but delivered much more forcefully. Who are you fellas trying to convince? Each other?

 

When my son was born there was no way I was raising a kid whose d*ck looked different to his dad's. They were trying to shove words like "barbaric" down my throat even back in '79, so the hot air's been blowing at least 35 years. Besides, those floppy socks look disgusting and apparently a lot of women agree.

 

So it boils down to cosmetic surgury______on an infant.  If his ears stick out too far, might as well get them bobbed too.  Maybe the doc will give you a twofer  . :cool:

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