Harvard Men's Health
In most newborns, the foreskin still adheres tightly to the glans. During the first years of life, however, these tissues continue to separate; by the age of 5, the foreskin can be retracted away from the glans in more than 90% of boys. In adolescents and adults, the foreskin covers the glans when the penis is flaccid, but it retracts when the penis becomes erect, leaving the glans exposed. [...as though the glans were the important part. Clearly, the author of this has no notion of the action or function of the foreskin during sex - or even that it has one.]
Circumcision is the surgical removal of the foreskin; afterward, the glans is exposed when the penis is flaccid as well as erect. Today surgeons use a clamp to protect the glans during the operation; doctors generally prefer the Gomco clamp, but many of those who practice ritual Jewish circumcision use the Mogen clamp. In either case, a scalpel is used to remove the foreskin after the protective clamp is in place (see figure below). Although newborn circumcision has been performed without anesthesia for centuries, there is no reason to continue that practice. Effective pain control can be accomplished by injecting a local anesthetic into the penis; an anesthetic cream, EMLA, is also helpful but appears somewhat less effective. A sugar-coated pacifier can also reduce discomfort, as can acetaminophen (Tylenol and other brands); however, these techniques should be used only to supplement anesthetic injections or creams. [This only reduces pain, it does not eliminate it, and only operative, not post-operative pain.] In older boys and adults, circumcision often requires general anesthesia and somewhat more complicated surgical techniques, which include stitching the skins edges together. ["Hurry, hurry! Offer ends soon!" Infant circumcision has the great disadvantage that by adulthood the penis will have grown substantially, magnifying all surgical irregularities..]
Cultural and Religious
Although circumcision began as a religious rite, it became a routine medical practice in the U.S. about 100 years ago, when it was thought to improve hygiene and prevent disease; in some circles, circumcision was even believed to promote sexual morality [by preventing masturbation. This was the main reason for doing it]. By the 1950s, about 90% of American males underwent newborn circumcision. Since then, medical research has questioned its value, and the operation has become less popular. At present, about 60% of American boys are circumcised shortly after birth, but the rate is much lower in Canada and England.
Urinary tract infections. The most important benefit is a reduced risk of urinary tract infections during infancy. [This "most important benefit" was unknown before 1982 - long after circumcision had become routine.] Early studies reported that uncircumcised male infants were 1020 times more likely to get urinary tract infections than were circumcised babies; although recent studies found less benefit, they still report that uncircumcised male infants are 39 times more likely to develop urinary tract infections. Critics point to the flaws and limitations in various studies, but the AAP Task Force on Circumcision concludes that the protection is real. Still, its a small advantage, since urinary tract infections are not common even in uncircumcised male infants, and most respond well to antibiotic therapy. All in all, 718 of every 1,000 uncircumcised male infants will develop a urinary tract infection during the first year of life compared with 12 of every 1,000 circumcised male infants. [To et al. calculate that 195 babies must be circumcised to prevent one UTI.]
Cancer of the penis. In the U.S., uncircumcised men are about three times more likely to develop cancer of the penis than are circumcised men. Its a statistical plus for circumcision [or would be if it were true, but the American Cancer Society doesn't think so], but its less important than it seems. Thats because cancer of the penis is rare in America, developing annually in fewer than 10 of every one million men [usually in old age]. Good hygiene also appears to reduce the risk of penile cancer.
Disorders of the penis. Phimosis is the inability to retract the foreskin, usually because of inflammation or infection [or because it's the natural configuration of that penis: many men are perfectly happy never to retract their foreskins.]. The condition is usually mild, but it can produce painful erections and other symptoms. Because circumcision removes the foreskin, it prevents phimosis. But good hygiene is also protective, and when the disorder is treated promptly it usually improves rapidly; some men, though, require circumcision as adults to correct unusually severe cases of phimosis. Circumcision also prevents posthitis, inflammation of the foreskin [Duh!], and it appears to reduce the risk of balanitis, inflammation of the glans. Still, these generally mild conditions respond well to simple treatment.
Sexually transmitted diseases (STDs). New studies demonstrate that circumcision reduces a mans risk of being infected by HIV, the virus that causes AIDS. [No, they seem to show a correlation in different populations, when factors such as religion and sexual practice are neglected.] Unfortunately, though, the protection is far from complete, and circumcision does not provide any protection against other STDs for a man or his partner. [On the contrary, one study indicated it may even increase the risk of the commonest STD, chlamydia.] Safe sexual practices are the only effective way to prevent STDs.
Operative complications. All operations carry risks, and circumcision is no exception. In trained hands, however, complications are uncommon, occurring in between 2 and 6 of every 1,000 newborn circumcisions. [Some researchers rate the risk as much higher.] When complications occur, they are usually mild, with temporary bleeding and mild infections leading the list. In very rare cases, however, complications can be severe or even fatal. [As well as thse risks, there are inevitable disadvantages.]
Expense. Although the British National Health Service has stopped covering routine newborn circumcision because it could not document a medical benefit, most American insurers pay for the operation. Even so, circumcisions add $150 million$270 million to Americas annual medical bill.
Pain. Contrary to some cultural beliefs, infant circumcision is painful. However, [fairly] effective pain relief is available, and there is no evidence to support concerns about lasting psychological damage from the "trauma" of circumcision. [Yet when men complain bitterly about having been circumcised, their concerns are dismissed, they are told to "get over it", "get a life" etc. These men have been traumatised by their circumcisions. This also accounts for "emotional" opposition to circumcision.]
Sexual dysfunction. There is no reliable evidence to support the claim that newborn circumcision increases the risk of sexual problems in adulthood or that it impairs sexual satisfaction in either partner. [This is highly debatable. There is considerable anecdotal evidence. The foreskin was considered the centre of sexual pleasure for centuries - by men who had one. The proponents of the opposite view are virtually all themselves circumcised and have no idea what they are missing. It should be self-evident that an intact penis is better for sex than one with part cut off, and the onus is on the circumcisors to prove that it is not.]
Its an individual choice [And the individual most concerned is...?] with no wrong answer. [So you might as well toss a coin? How can the question "Should I have part of my son's penis cut off?" have no wrong answer?] Religious convictions, cultural attitudes, and personal beliefs are usually the determining factors. [And the person most concerned has not yet formulated any religious convictions, cultural attitudes or personal beliefs.] If parents cannot make a decision based on these factors, they may choose to consider the simple advice that a son should look like his father. [No, they should consider the simple advice, "If it's not broke, don't fix it."] But if parents choose circumcision, they should be sure that the procedure is performed by an experienced individual [Studies of complications have shown no correlation with the experience of the operator], that their son is healthy at the time of the operation, and that modern anesthesia is provided. [...which will only alleviate operative pain, not eliminate either that or post-operative pain]
Circumcision has been controversial since
its earliest days, and the controversy is not likely to disappear anytime
soon. [It has never been controversial in the many parts of the world where it has never been customary.] Doctors will continue to study the pros and cons, but they have
already produced enough information to allow parents to make a calm, rational
decision. And the best time to make that decision is before birth, when
there is time to consider circumcision with circumspection.
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