To snip or not to snip..?

[Trillian]

Michael, I agree with the point you make about Female circumcision in regards to it being done for religious reasons, and I believe that in these instances the families are encouraged to seek medical advice and have it done in a hospital setting so 1 it is done in a clean and sterile environment (I do understand that the Jewish Bris isn't done in this setting either) and 2 so that only the bare minimum is taken. Some girls were being done in dubious situations where their health was put in dire risk.

Personally, I would love it if there was a law against it, but that's just my personal view on it. It isn't up to me to talk others around to my POV, simply to share it with them.

[Phteven]

Micheal, I think that saying that religion is not a relevant reason is dismissing the deeply held beliefs of 2 billion Muslims and Jews who would argue that the creator's wisdom is superior to the wisdom of the created. They may be irrelevant to you they are not irrelevant to the people who hold these beliefs. I for one believe that it's in my sons' best interests to get it done because it is required in order for their prayers to be valid and it is kinder to have it performed for them now to save them from having to have it done as adults. I know adult Muslim men who's parents thought they would let them choose for themselves later and trust me they don't thank their parents for making (or not making) that choice. On the contrary they think their parents salved their conciences at their expense.
As for FGM as a religious requirement (hang on because I'm about to shock you rigid - you may fall off your chair). It is unfortunately a deeply ingrained cultural habit amongst a number of sub-saharan Africans of a number of faiths. The Islamic stance on it that it is disliked however at the same time we acknowledge that some cultures are unwilling to let go of it. For those people it is recomened that they merely make a small cut in the clitoral hood to satisfy the ritual requirements of their culture (not religion). People working in the field in Africa are finding that they are succeeding in saving more women from FGM with this approach than by saying "it's bad mmmmkay, now stop it!!".
It's harder to convince the Christians, animists and other faiths because they can't refer to religious texts that make it explicit that women have a right to sexual satisfaction in the way that the Quran does.
In Australia FGM is still carried out despite the fact that it's illegal. People either do a backyard job themselves (there are women in many African communities in Australia who earn money this way) or they send their children back to their home country to do it. It's patently clear than in Australia prohibition has sent the practice underground. This means that it's hidden even from other members of their community who might counsel them to perfom the lesser cut rather than FGM. I'm sure this will horrify you but since prohibition has so clearly failed I tend to advocate providing these communities with access to Drs who will perform the minor cut in order to reduce the use of backyard butchers. Whilst it's not ideal a 0.5millimeter cut in the clitoris is far preferable to cutting the whole thing off. Even though it offends our sensibilities harm minimisation is sometimes the best strategy. Until such time as people are prepared to drop their deeply held cutural beliefs I will continue to support harm minimisation over prohibition.


I can hear the screams of outrage building so I'll just duck to avoid the rotten tomatoes now lol.
Before you stuck chucking them please understand that this is a matter that I have considered at some length and discussed in depth with people who have worked to prevent FGM in both Africa and Australia.

The article below is from the American Medical Association. It contains statistical analysis of the incidence of things such as phimosis, UTIs etc and also the incidence of complications.
I think it's as balanced as any resource available because they don't really have any barrow to push.

Neonatal Circumcision

NOTE: This report, written in response to Resolutions 505 and 507 (I-98), represents the medical/sicentific literature on this subject as of December 1999.

This report is confined to circumcisions that are not performed for ritualistic or religious purposes. In this case, the term "non-therapeutic" is synonymous with elective circumcisions that are still commonly performed on newborn males in the United States.

Methods

Published studies from the years 1966 to July 1999 were identified through MEDLINE and Lexis/Nexis Medical Library searches of English-language articles using the key words circumcision, male, adverse effects, and pain control. Related articles in the MEDLINE database using the additional MeSH term pain prevention & control also were identified. A total of 338 articles were retrieved. Additional articles were identified by manual review of the references cited in these publications.

Background

The normal uncircumcised penis consists of a cylindrical shaft and rounded tip (glans) that are separated by a tissue groove (coronal sulcus). The fold of skin (foreskin) covering the glans is removed during the circumcision procedure to a point near the coronal sulcus. At birth, separation of the foreskin from the glans is incomplete. The separation process continues through childhood via desquamation and epidermal keratinization of the shaft. Keratinization does not occur on the mucosal surface of the foreskin, which may contain specialized sensory cells. Eventually, unforced and complete retraction of the foreskin can be accomplished.

The majority of newborn males in the United States are circumcised, although the percentage varies by location, religious affiliation, and socioeconomic classification. The prevalence of circumcision in the United States increased from about 30% in the 1930s to nearly 80% by the early 1970s. During this time frame, whites were more likely to be circumcised than blacks or Hispanics.1 While the circumcision rate appeared to decline in the 1970s and early 1980s, rates of more than 80% were described in studies limited to Atlanta and US Army Hospitals.2-4 Estimates based on the National Center for Health Statistics indicate that 61% and 65% of male infants were circumcised in the United States during 1987 and 1995, respectively.5,6 Ritual circumcision is common in the Jewish and Islamic faiths, but uncommon altogether in Asia, South and Central America, and most of Europe.

Based on recent survey data, 54% of pediatricians, family practitioners, and obstetricians perform at least 1 circumcision per month. Of physicians performing circumcision, 45% use anesthesia, most commonly dorsal penile block with lidocaine (71% of pediatricians, 56% of family practitioners, and 25% of obstetricians). Those physicians who reported not using anesthesia cited concern about adverse effects and a belief that circumcision does not warrant anesthesia.7

Current Specialty Society Recommendations

Recent policy statements issued by professional societies representing Australian, Canadian, and American pediatricians do not recommend routine circumcision of male newborns.5,8-10 The most recent statement by the American Academy of Pediatrics reads as follows: "Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In circumstances in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. If a decision for circumcision is made, procedural analgesia should be provided."

This statement modifies the Academy's 1989 conclusion that newborn male circumcision has "potential medical benefits and advantages as well as disadvantages and risks."11 The 1989 statement by the Academy reversed a long-standing opinion that medical indications for routine circumcision were lacking. It emerged primarily on the basis of data that suggested circumcision caused a large reduction in the risk of urinary tract infections, particularly within the first year of life.

In a joint publication with the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists (ACOG) concluded in 1997 that "newborn circumcision is an elective procedure to be performed at the request of the parents on baby boys who are physiologically and clinical stable."12 From the standpoint of ACOG's Practice Activities Division, as a surgical procedure with concomitant pain, the use of analgesia during circumcision is advocated, but the preferred mode of pain relief is not specified (Stanley Zinberg, MD. Personal communication. September 1999). The current clinical policy on neonatal circumcision contained in the American Academy of Family Physicians Reference Manual states: "Current medical literature regarding neonatal circumcision is controversial and conflicting& . The decision to perform neonatal circumcision should be based on the informed consent of the parents, and requires objective, factual counseling of parents by the family physician" (Available at: www.aafp.org/policy/camp/4.html). A 1995 Fact Sheet for physicians offered by the American Academy of Family Physicians is currently being revised.13 The British Medical Association has a longstanding recommendation that circumcision should be performed only for medical reasons.14

Risk-Benefit Analysis of Circumcision

Debate on the wisdom of routine circumcision centers on the possible benefits offered by circumcision, and whether they medically justify the risks associated with the procedure. Properly performed circumcision protects against the development of phimosis, paraphimosis in elderly men requiring intermittent or chronic bladder catheterization, and balanitis.5 The only longitudinal study to address the former found a 4% incidence of phimosis in uncircumcised boys.15 The medical benefits suggested to accrue from circumcision are reduced incidence of urinary tract infection in infant males, decreased incidence of penile cancer in adult males, and possibly decreased susceptibility to certain sexually transmissible diseases, including human immunodeficiency virus (HIV).

Urinary Tract Infection: There is little doubt that the uncircumcised infant is at higher risk for urinary tract infection (UTI), although the magnitude of this risk is debatable. A meta-analysis of 9 studies published between 1984 and 1992 revealed a 12-fold increased risk of UTI in uncircumcised males.4 Most of the studies analyzed were case-control designs that analyzed the rate of UTI in the first year of life. A more recent population-based cohort found a relative risk of 3.7 for hospitalization for UTI in the first year of life in uncircumcised boys.16 A similar relative risk (4.8) was detected in another case-control study.17The reliability of many studies examining circumcision status and UTI in infant males is weakened by lack of controls for potential confounders such as prematurity, extent of breastfeeding, and the method of urine collection used to identify bacteriuria.

Despite the increased relative risk in uncircumcised infants, the absolute incidence of UTI is small in this population (0.4%-1%).18 Depending on the model employed, approximately 100 to 200 circumcisions would need to be performed to prevent 1 UTI.16,19 In this case, a large relative risk reduction translates into a small absolute risk reduction because the baseline prevalence is low. One model of decision analysis concluded that the incidence of UTI would have to be substantially higher in uncircumcised males to justify circumcision as a preventive measure against this condition.20

Penile Cancer: Penile cancer is a rare disease in the United States (0.9 to 1 per 100,000). Among uncircumcised men the incidence is estimated to be 2.2/100,000.21 Six case series published between 1932 and 1986 found that all penile cancers occurred in uncircumcised individuals.11,22 Results of one case control study provide an exception to this general rule, although circumcision status was determined by self-report.23 Nevertheless, this study also found that the absence of neonatal circumcision increased the risk for penile cancer by a factor of 3.2 Other identified risk factors for penile cancer are phimosis (occurring exclusively in uncircumcised males), genital warts, infection with human papilloma virus, large number of sexual partners, and cigarette smoking.23-25 Nevertheless, because this disease is rare and occurs later in life, the use of circumcision as a preventive practice is not justified..

Human Immunodeficiency Virus Infection and Sexually Transmissible Diseases: The data on circumcision status and susceptibility to HIV infection and other sexually transmissible diseases have been recently reviewed.5,26,27 Five of 7 prospective studies involving heterosexual transmission of HIV-1 found a statistically significant association between lack of circumcision and elevated risk for acquisition of HIV (relative risks 2.3-8.1). In the other 2 studies the relative risk exceeded 3 in uncircumcised males, but a low proportion of uncircumcised men and a small percentage of seroconversion limited the statistical power of these studies.

At least 16 studies have examined the relationship between circumcision and sexually transmissible diseases other than HIV.27 In general, circumcised individuals appear to have somewhat lower susceptibility to acquiring chancroid and syphilis, possibly genital herpes, and gonorrhea compared to individuals in whom the foreskin is intact. The available data on nongonococcal urethritis and genital warts are inconclusive

Regardless of these findings, behavioral factors are far more important risk factors for acquisition of HIV and other sexually transmissible diseases than circumcision status, and circumcision cannot be responsibly viewed as "protecting" against such infections.

Complications of Circumcision

Two large series detected a complication rate between 0.2% and 0.6% in circumcised infants.28,29 Bleeding and infection, occasionally leading to sepsis, are the most common adverse events requiring treatment. In the majority of cases, bleeding is minor and hemostasis can be achieved by pressure application. Other untoward events can result from taking too much skin from the penile shaft causing denudation or rarely, concealed penis, or from not removing sufficient foreskin, producing an unsatisfactory cosmetic result or recurrent phimosis.30,31 Other postoperative complications include formation of skin bridges between the penile shaft and glans, meatitis and meatal stenosis, chordee, inclusion cysts in the circumcision line, lymphedema, hypospadias and epispadias, and urinary retention.32 Case reports have associated circumcision with other rare but severe events including scalded skin syndrome, necrotizing fasciitis, sepsis and meningitis, urethrocutaneous fistulas, necrosis (secondary to cauterization), and partial amputation of the glans penis.5,30,32

Provision of Anesthesia During Circumcision

Ordinary humanitarian sentiment prevents consideration of circumcision without anesthesia. It is perfectly true that millions of infants have been circumcised while entirely conscious, and no subsequent evil has befallen them; I do not believe, however, that any physician would rend a mother's heart by so tormenting her babe. It is specious to hold that an infant's sensibilities are not sufficiently developed to perceive pain. (Ferd C. Valentine, MD, Professor of Genito-Urinary Diseases, New York School of Clinical Medicine. Presented to the Section on Diseases of Children at the 51st Annual Meeting of the American Medical Association, June 5-8, 1900.)

Clinical and biochemical evidence indicates that newborn infants exhibit physiological, autonomic, and behavioral responses to noxious stimuli. Acute responses of neonates to painful stimuli include large increases in heart rate, increased blood pressure, decreased transcutaneous pO2 values , decreased vagal tone, crying, breath holding, gagging, behavioral changes, and increases in serum cortisol.33,34 Resolution of these changes is fairly rapid following the procedure.35 Although it has been assumed that there are no long-term psychological sequelae from this procedure, circumcised infants who were not anesthetized at the time of the procedure show stronger pain responses to vaccinations at 4 and 6 months of age than do uncircumcised infants or infants who received a topical anesthetic cream at the time of circumcision.36

The use of sucrose-dipped pacifiers (24% solution) reduces crying time during circumcision and also modestly attenuates increases in heart rates (50% solution), but less so than the use of dorsal penile nerve block (see below).37,38

Dorsal Penile Nerve Block (DPNB): First described in 1978,39 DPNB using 1% lidocaine effectively reduces the behavioral40 and physiological indicators of pain caused by circumcision. While recognizing that restraint itself is stressful, results of several double-blind, placebo-controlled studies confirm that DPNB prevents or decreases excursion from baseline values for heart rate, tissue oxygenation, and percentage of time spent crying during the circumcision procedure. Additionally, DPNB decreases behavioral scores indicative of agitation and pain and attenuates increases in plasma cortisol concentrations associated with circumcision.41-47 Chlorprocaine is comparable to lidocaine and may possess a slightly faster onset of regional anesthesia.48

The major complications of DPNB are bruising at the injection site (11%) that resolves within 1 to 2 weeks, and occasionally bleeding.49,50 Systemic lidocaine toxicity has not been described. One case of penile necrosis after DPNB has been reported.51 Evaluation of possible complications of DPNB has been limited to a 3-month follow-up.

Topical Local Anesthesia: (Eutectic mixtures [EMLA]) EMLA is an acronym for eutectic mixture of local anesthetic. Each gram (1 mL) of cream contains lidocaine 2.5% (25 mg) and prilocaine 2.5% (25 mg). In one unblinded study, the application of 0.5 mL (1 g) under occlusion 55 to 70 minutes prior to restraint was associated with only modest attenuation of changes in heart rate, oxygen saturation, crying time, and facial grimacing compared to placebo cream.52 Results of a randomized, double-blind, controlled trial were similar.53 It is noteworthy that in adults, the duration of anesthesia after genital application of EMLA is considerably less than at other cutaneous sites.54 In the absence of dose-response data, it is uncertain whether the maximal anesthetic effects on infants from EMLA had waned in these studies by the time the actual circumcision procedure was performed.

Because EMLA contains prilocaine, the development of methemoglobinemia (MetHb) is a possibility. However, when measured, blood concentrations of MetHb in neonates after application of 1 to 2 g of EMLA cream have been well below toxic values.53,55-57

In a randomized, placebo-controlled study, application of 0.5 g of 30% lidocaine cream 20 minutes prior to circumcision was associated with less stress-related behaviors and smaller increases in plasma beta-endorphin concentrations than placebo. No other physiological variables were monitored and other studies on topical lidocaine have not been reported.58

Subcutaneous Ring Block: Ring block performed using 1 mL of 0.5% lidocaine without epinephrine delivered subcutaneously and circumferentially at the base of the penis significantly attenuates circumcision-induced increases in heart rate and crying and decreases in O2 saturation.59

Comparative Studies: In 3 comparative studies DPNB was significantly more effective than EMLA cream in attenuating pain scores and physiological changes associated with circumcision.55,60,61 However, in one study the dose of EMLA was only 0.5 g and was applied 1 hour before the procedure.60 In another, the dose was 2 g applied 90 minutes before the procedure.55 In the third study, the dose of EMLA was not specified.61 Ring block was more effective than either DPNB or EMLA in preventing increases in heart rate and reducing crying time.55

Despite the clear evidence that newborn males generate brisk pain responses during circumcision, and the availability of methods to reduce pain during the procedure, a recent survey of residency training programs found that 26% of programs that taught circumcision provided no instruction on the use of local anesthesia. In programs that taught circumcision, pediatric (84%) and family practice residents (80%) were more likely than obstetric residents (60%) to learn about anesthetic techniques to prevent pain associated with circumcision.62 Significant regional variation occurred within and across medical specialties.

Summary and Comment

Virtually all current policy statements from specialty societies and medical organizations do not recommend routine neonatal circumcision, and support the provision of accurate and unbiased information to parents to inform their choice. The recent policy revision by the American Academy of Pediatrics also states that analgesia (anesthesia) should be provided for the procedure.

Circumcision decreases the incidence of urinary tract infections in the first year of life, and also protects against the development of penile cancer later in life. The circumcised male also may be somewhat less susceptible to HIV infection and certain sexually transmissible diseases. The low incidence of urinary tract infections and penile cancer mitigates the potential medical benefits compared with the risks of circumcision. In the case of sexual transmission of HIV, behavioral factors are far more important in preventing these infections than the presence or absence of a foreskin.

A majority of boys born in the United States still undergo nonritual circumcisions. This occurs in large measure because parental decision-making is based on social or cultural expectations, rather than medical concerns.63-67 Studies from the 1980s suggested that the presentation of medical information on the potential advantages and disadvantages of circumcision had little influence on parents' decisions.64-66 This finding was recently confirmed.68 In another contemporary study, nearly half of those physicians performing circumcisions did not discuss the potential medical risks and benefits of elective circumcision prior to delivery of the infant son. Deferral of discussion until after birth, combined with the fact that many parents' decisions about circumcision are preconceived, contribute to the high rate of elective circumcision.67,68 Major factors in parental decision-making are the father's circumcision status, opinions of family members and friends, a desire for conformity in their son's appearance, and the belief that the circumcised penis is easier to care for with respect to local hygiene.

When the decision is made to proceed with circumcision, local anesthesia should be provided for the procedure. Ring block or dorsal penile blocks are most effective. EMLA cream has limited utility but has not been sufficiently investigated with regard to dose-response effects.

RECOMMENDATIONS

The following statements, recommended by the Council on Scientific Affairs, were adopted by the AMA House of Delegates as AMA policy at the 1999 AMA Interim Meeting.

1. The AMA encourages training programs for pediatricians, obstetricians, and family physicians to incorporate information on the use of local pain control techniques for neonatal circumcision.

2. The AMA supports the general principles of the 1999 Circumcision Policy Statement of the American Academy of Pediatrics, which reads as follows: Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In circumstances in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. If a decision for circumcision is made, procedural analgesia should be provided.

3. The AMA urges that as part of the informed consent discussion, the risks and benefits of pain control techniques for circumcision be thoroughly discussed to aid parents in making their decisions.

AMA (CSAPH) Report 10 of the Council on Scientific Affairs (I-99) Full Text

[Bathsheba]

Dach: I'm not going to throw any rotten tomatoes Regarding your thoughts on harm minimization by accepting the notion of a 0.5mm cut in preference to a full FGM scenario. I get what you are saying. Maybe I'm hoping though that the faiths that require these actions will evolve over time like the Christian faith (see HERE how the New Testament revised the practise of circumcision from The Old Testament) and that one day they might accept that it's all unnecessary. Like i said, I would never challenge a parent for performing a circumcision for religious reasons but i will rejoice the day that any faith abandons the practice... I guess that's saying it as simply as I can.

[Phteven]

Bath, I would argue that it's nothing to do with faith and everything to do with culture. Faiths don't require FGM (maybe some animists do - not sure on that). The Christains of sub-Saharan Africa who perform FGM would argue that it's part of their faith.
Islam doesn't require female circumcision we merely recognise that some cultures are wed to their practices and have a harm minimisation policy.

[Damo]

I tend to agree with that point as well Michael... you beat me to it. I would never challenge a parent performing circumcision for religious reasons but I do most respectfully and in the hope of not offending but I do personally believe that circumcision ought to be performed only for purely medical reasons... just like an appendectomy. It's just my opinion and my opinion is no better than any one else's.

This thread is going to continue going in circles.

Michael, again, comparing a clitoridectomy to male circumcision is still vastly different. There is NOTHING that can be argued FOR this procedure. Nothing. I'm pretty sure every woman reading this right now would still prefer their clitoral hood to be intact. There is NO reason (except for fanatical religious reasons) why you would want to remove it.

However, there ARE reasons, MEDICAL reasons, why a foreskin should be removed.

Just ask one of my work colleagues. Split his foreskin during sex (just your normal type of sex he says, nothing adventurous), and required to be circumcised at 25yo to prevent an infection of his penis. The doctor told him had he NOT been circumcised, he risked losing erectile function. He's now a 'helmet', and is apparently quite happy with his little friend again. He did not mourn the loss of his 'skivvy'.

I haven't heard any horror stories of circumcised males having issue later in life because they didn't have a foreskin. But I've heard plenty of stories about guys WITH foreskins that did have issues.

It's all well and good to say 'you were born with it, don't mess with nature', but unless you're a tree hugging hippy, with all your pubic hair, no piercings, no tatts, no colour in your hair, no fillings in your teeth, and a foreskin (if you're male), then truth be told, sometimes people do things to their body because they can. Same reason a dog licks it's own balls. Because it can.

I apologise if this comes across as a little heated, it is not meant to be. This is one of 'those subjects' that will always be argued about. It's pointless trying to outdo each other on the pro's and con's of each. As long as you think you are making the right choice for your son, for the right reasons, then that's all you need to worry about

BTW - My son (if i have one) won't need his foreskin after he's born, so if any of you guys out there that are circumcised, and you want your foreskin back, get in touch with me.

[Bathsheba]

The Christains of sub-Saharan Africa who perform FGM would argue that it's part of their faith.

I wonder if they follow the Old or the New Testament? I've always assumed that Christians (being followers of the word of Christ) follow the New Testament in which is says:

"It is those who want to make a good showing in the flesh that would compel you to be circumcised, and only in order that they may not be persecuted for the cross of Christ. For even those who receive circumcision do not themselves keep the law, but they desire to have you circumcised that they may glory in your flesh. But far be it from me to glory except in the cross of our Lord Jesus Christ, by which the world has been crucified to me, and I to the world. For neither circumcision counts for anything, nor uncircumcision, but a new creation. Peace and mercy be upon all who walk by this rule, upon the Israel of God." Galatians 6:12-16.

"Look out for the dogs, look out for the evil-workers, look out for those who mutilate the flesh. For we are the true circumcision, who worship God in spirit, and glory in Christ Jesus, and put no confidence in the flesh." Philippians 3:2-3.


I guess I'm not overly familiar with the Bible but I've never heard of FGM within its teachings... I could have missed something though.

Damo: I'm not trying to sway anyone to my way of thinking mate I said my opinions were my own. It seems like you are preferring my opinion was changed so that it was in line with your own?

[Phteven]

Maybe I haven't made myself clear so here goes........
FGM is a cultural tradition practiced by people of all religions in parts of sub-saharan Africa. Whilst it isn't required by any of those faiths (although I'm not 100% sure on the animist faiths or Christianity for that matter) most of those who practice it argue (incorrectly in the case of Muslims) that it is required by their faith.
Whilst it is not a requirement of Islam the Islamic stance is, although it's best not to, if you must cut, then don't do so in such a way as to interfere with a woman's ability to achieve orgasm.

[GregMonarche]

I think we are only seeing a resurgence due to the fact that Gen X'ers are now becoming fathers themselves and are mostly going the purely cosmetic 'to look like Dad' route.

Nah - surely that can't be the reason, or nearly everyone today would be done. In the 80s numbers began to reduce. So increasing rates today would naturally mean more uncircumcised fathers (born in the 80s) are getting their sons done.

You do also have to ask yourself if there was such a need for it, why did it stop becomming a routine practice in newborns?

That's easy... Because people are cheapskates and didn't want to pay for what they used to get for free. The government decided (probably rightly so too) that it was an elective procedure and shouldn't be paid for by the government. Don't get me wrong - I'd like the government to pay for everything too... But it really is elective.

Why are there so few Drs that still do it these days? There must have been a reason for it to stop...

Well, it certainly hasn't been our experience there ARE fewer doctors doing it. In fact, when we had our first son done in 1996, there was only ONE doctor at the John Hunter Hospital that did circumcisions. The government still funded it under Medicare - and we were given no other option/doctor. That was just where you went, and that was all there was to it.

In 1999 we had our second son done - at a doctor in Taree because Medicare funding had been removed. He was cheaper than in Newcastle, and we had friends to visit there anyway.

Fast-forward to 2008 - still no government funding - and we found THREE doctors in the Newcastle area (and there could be more - we just stopped looking at that point). One of those is the same doctor from the John Hunter Hospital in 1996. We chose one in Gosford - again for price reasons. There were multiple doctors in Sydney - and some advertised in the yellow pages.

So from what we have seen at least, there are just as many (or perhaps even more, would be more correct for us to say) than there were a decade ago.

we all know the medical fraternity seems to hate change (or is that just in the obstetrict area?

The most recent doctor was an Ob Surg.

At the end of the day it is kind of pointless to even have a discussion about it because we will all do what WE think is best for OUR children and its none of our business what anyone else does with their children.

Yep, ditto.

I noted with interest that the link I posted a few messages back... That the forum recognised it and "changed" it. (All I did was type "www, etc".)

Anyway, someone commented that it was pro/biased towards circumcision. Well, of course it was. Just as the all other info being posted is biased one way or the other. As parents wanting info, we have to look at information from both - biases - and then make up our own mind. I think it would be strange to NOT to look at both sides of the coin.

[GregMonarche]

see HERE how the New Testament revised the practise of circumcision from The Old Testament)

This is one I find interesting, because people seem to read it the wrong way. The verse is in the New Testament (so the Old Testament has ended, as that site says). Part of that verse says, "Circumcision availeth nothing." But it is only part of what it's saying. It is warning people not to think they're automatically clean/holy just because they've been circumcised. It's basically saying if their heart is wrong, being circumcised won't change that, or score them any "holy" points. (Not that it that it shouldn't be done - and not that it has no benefit.)

[GregMonarche]

BTW - My son (if i have one) won't need his foreskin after he's born, so if any of you guys out there that are circumcised, and you want your foreskin back, get in touch with me.

The trouble with this offer is, no guy would admit to being that small.

[slyder]

This is one I find interesting, because people seem to read it the wrong way. The verse is in the New Testament (so the Old Testament has ended, as that site says). Part of that verse says, "Circumcision availeth nothing." But it is only part of what it's saying. It is warning people not to think they're automatically clean/holy just because they've been circumcised. It's basically saying if their heart is wrong, being circumcised won't change that, or score them any "holy" points. (Not that it that it shouldn't be done - and not that it has no benefit.)

Well that's all well and good for the Christians, but the average Muslim or Jew doesn't spend much time reading the Bible. The only way you'll settle that score is with a WWE style religion smack down, and I can't see that happening.

[Trillian]

Greg, I would like to see a real reason why it stopped being done as rountine - not just a off hand assumtption that it was because of costs (and if that was the reason then well and good) but I can't see what huge cost would be involved in a procedure that uses no anaesthetics, no theatre, no time in a recovery ward. The only cost would have been the Drs time to do it really.

Re the comments I made about Gen X'ers, Even if the majority of them are done, once they become fathers themselves, you are still going to have an element that DONT want it done even if they are. It is something that I think will always go in trends and waves. ATM I reckon even with a small resurgence the score would be roughly half and half for Gen Z (which starts around 1991-92 until now). I think once it was made redundant, for the first time parents were actually allowed to have thoughts on the subject and they were allowed to exercise their right as a parent to choose if they wanted it done or not.

[Schmickers]

As far as my comparison goes, I wasn't even comparing clitoridectomy to male circumcision. I was comparing removal of clitoral hood. And it's interesting to note that:

In the context of women who seek out labiaplasty, Stern opposes removal of the clitoral hood and points to potential scarring and nerve damage.[23]

From Female genital cutting - Wikipedia, the free encyclopedia

Problems which are very similar to those associated with male circumcision.

I am, of course, aware that no religions espouse FGM as part of their doctrine - that's not what I said. As I said, religious reasons are used as justification for the procedure, as pointed out, amongst the sub-Saraharan peoples, and Dachlostar is right that many of the faiths there consider it part of their religion even though it is not endorsed by the mainstream elements of said religions.

And as far as showing disrespect for Judaism and Islam? I have a great deal of respect for both of those religions. That does not mean, however, that I believe they are justified in performing a procedure in the name of their religion that is potentially harmful. I was brought up as a Pentecostal Christian, and I saw the practices - both very positive, and very harmful - that their doctrines espoused. Religious beliefs evolve and change - the Catholocism, Islam, and Judaism of today is very different from a century ago. I honestly believe the time will come when male circumcision stops being a tenet of those religions - or is sublimated into a sort of symbolic gesture.

Dachlostar - I wholeheartedly take your point about FGM being driven underground. You are right, it is a serious problem, it leads to more complications when performed by inexperienced practitioners, and it is probably not an unforseen consequence of the banning of the practice. Harm minimisation is a very reasonable strategy in this situation. But surely harm minimisation is a first step in a process that will eventually lead to re-education and a gradual shift away fom the practice?

Having said that, I think my discussion of FGM and religion has drawn us away from the topic at hand, and I apologise.

[GregMonarche]

Greg, I would like to see a real reason why it stopped being done as rountine - not just a off hand assumtption that it was because of costs (and if that was the reason then well and good) but I can't see what huge cost would be involved in a procedure that uses no anaesthetics, no theatre, no time in a recovery ward. The only cost would have been the Drs time to do it really.

This is just discussion, but surely people of both views would admit the rate would have taken a downturn when funding was withdrawn. Money (or not getting any) is a pretty big discouragement. (I mean, gee - even pensioners are taking their clothes off on TV for just another $10.)

Most babies are born at public hospitals. When someone asks about circumcision at a public hospital (as we recently did) - you get told, "We are not allowed to recommend a doctor." Only one out of 3 or 4 medicos we discussed it with, even bothered to mention there are private doctors that do it. (The others gave the impression by omission that there were none, which we now know is rubbish.)

So with the seed of doubt planted in parents' minds - and - the cost now on the parent... Those sitting on the fence (or not knowing where to look elsewhere), would say, "Well that decides that then."

As for the minimal cost... It costs ~$400 to ~$1000 at the doctors we approached. Some do it in their own rooms - but most use private hospitals, which they have to pay a small fortune for. (And the nurse, cleaner, admin, etc.) Cost is relative anyway. While ~$400 (or even the ~$1000) wasn't expensive to us, once we had weighed up the risk/benefits... For others it would be.

I think once it was made redundant, for the first time parents were actually allowed to have thoughts on the subject and they were allowed to exercise their right as a parent to choose if they wanted it done or not.

Well, I don't agree it's been made redundant, or we wouldn't have found three doctors within 40km of each other. But if we shift that slightly to mean "once medicare was withdrawn"... I'm not sure from how far back you mean, but parents have had thoughts on it for a long time now. Some of the anti-info been given here quotes mid to late 60s. So that's three or four decades. In 1996 when it was still done in the public system, we still had to actually ask for circumcision. It wasn't a case of, "Ok, when would you like to book in your new son to be done?" We still had to seek out, even though it was offered for free.

Also, many people only use the public system. So when they hit a wall of silence there, of course it would be a big part of falling rates.

I also wanted to point out, people may think a lack of funding is not a cause, but boy - the doctors/nurses/midwives certainly do! Every time we asked about circumcision, "it's not done in the public system anymore" was the first statement, and "Oh - and there's no medicare." was always the second. So they obviously think (no) money is a big (de)motivator.

Besides, the government uses money as a medical motivator all the time. (Doctors are paid a fee per vaccination... When Costello wanted Australians to have more babies, he gave the baby bonus... etc.)

Of course all of this gives medicos against circumcision statistics to quote... "Circ has fallen to only xx%!" (And they quote it as if to say, "See? Falling rates PROVE it's becoming more unpopular with parents.") LOL - yeah, right.

[Trillian]

But it has been made redundant with it no longer being done as routine where the baby was just whisked away and done before mum and dad could bat an eyelid. I do think that the effort involved in firstly tracking down a Dr who will do it and the cost of paying for it have certainly been a disincentive to get it done, but out here you have to travel a minimum of 2hrs to find a Dr who will do it. I think the cost of doing it 'in-house' in a public hospital would still have been cheaper than what it would cost now as they are charging whatever they want simply because THEY CAN. And if it was simply a cost cutting measure I am pleased that the government decided to cut funding for a procedure that is largely cosmetic - I am sure they would still fund it if it was done for medical necessity.

[Schmickers]

I also wanted to point out, people may think a lack of funding is not a cause, but boy - the doctors/nurses/midwives certainly do! Every time we asked about circumcision, "it's not done in the public system anymore" was the first statement, and "Oh - and there's no medicare." was always the second. So they obviously think (no) money is a big (de)motivator.

Well, it's certainly not the first thing I say when asked about circumcision. I simply explain that there is no satisfactory evidence that circumcision has any benefits to the child, and that it carries a risk of complications, and is painful; I also make sure I tell parents that if they want it done, they should wait until 12 months of age, when the child is old enough to have adequate anaesthesia and pain relief, and that at that stage they can get it done privately.

And more to the point - circumcision is still covered by Medicare. The site you posted earlier - it lists the rebates for the procedure.

[BellasBub]

It's all well and good to say 'you were born with it, don't mess with nature', but unless you're a tree hugging hippy, with all your pubic hair, no piercings, no tatts, no colour in your hair, no fillings in your teeth, and a foreskin (if you're male), then truth be told, sometimes people do things to their body because they can. Same reason a dog licks it's own balls. Because it can.

I believe I was 'one of those' who said why stuff with nature and no I'm not a hippy although I do love trees

You can't really compare the adult choice of piercing, tatts, colouring your hair, removing your pubes etc etc with removing the foreskin of a newborn can you??? Perhaps it's just me but that argument seems a little unbalanced.

Mind you I'm on the fence - think I'd prefer to leave the foreskin on because it's not my body I'm operating on.

[Trillian]

So Michael, it is covered under medicare, just not bulk billed then I take it? I'm gonig to ring my PHI to see if they cover it just out of curiosity.....