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Article: AAP to revise circumcision statement and release it in 6-12 months - Page 4

post #61 of 74
Quote:
Originally Posted by Super Pickle View Post
I'm just wondering why you think they would not feel that as scientists/doctors, they were "above" being influenced by popular opinion/politics? I don't know one way or the other, but I'm eager to hear what you have to say about it. Thanks!

Well, I'm not the person you asked, but my perspective is that I'd hope they'd be influenced by being given notice that we (parents) expect them to consider all relevant studies and their worth. So pointing out the why's behind skepticism of the HIV study, and pointing out the repeatable and verifiable result of the sensitivity study (as well as pointing out again and again that it exists and people KNOW it exists) would not so much be trying to sway them to popular opinion. It would be functioning as a watch dog who says, "You as a scientist/doctor should be considering the evidence and crafting a thoughtful and ethical policy statement in light of it."

Remember that, all things being equal as far as the validity of the AIDS studies go, "potential benefits" and "known reduction of sexual sensitivity/circumcision ablates the most sensitive parts of the penis" are very different animals. And one should trump the "potential" or "theoretical" benefit of the other, especially where such small statistics (i.e., protection against penile cancer, UTIs) are concerned.

That's why I think the letters should be useful. And I hope hope hope that they WILL be useful.
post #62 of 74
Remember that, re: sensitivity, the AAP's current statement refers to "anecdotal reports" of decreased penile sensitivity, then goes on to cite Masters & Johnson.

Quote:
There are anecdotal reports that penile sensation and sexual satisfaction are decreased for circumcised males. Masters and Johnson noted no difference in exteroceptive and light tactile discrimination on the ventral or dorsal surfaces of the glans penis between circumcised and uncircumcised men.
Given their willingness to cite that study reference as an "answer" to the anecdotal reports, I think they should be bound to reporting the findings of the newly published study in the British Journal of Urology.

In fact, my first thought when learning about the sensitivity study and reading the abstract was: "It's time for a revision of the AAP policy statement." When I heard last month that it was happening (at least, the review was happening), it was a no-brainer. Then I read that the impetus supposedly was the HIV studies. Argh!! I'm still hoping that's incomplete reporting. But I believe my letter (and others) are in order, just in case!! Watch Dogs, to say "this info exists and we know it exists and it's a scientific study and you need to review it."

In fact, looking back at the current statement, I think I'll need to comment (in my letter) on the factors that make Masters & Johnson's findings specious. (I was shocked to find it casually referenced in the AAP's policy statement, given all the problems with the study.) Just to help ensure that Masters & Johnson doesn't end up getting placed right next to the newer study as two equal and opposing viewpoints, cancelling each other out.

The current policy statement also references keratinization as a known (and inevitable) result of circumcising.

Quote:
Epidermal keratinization occurs on the skin of the penile shaft but not on the mucosal surface of the foreskin. One study suggests that there may be a concentration of specialized sensory cells in specific ridged areas of the foreskin but not in the skin of the penile shaft.
Dude. I've always said (well, "always" being as long as I've been aware and even a teensy bit informed about this issue) that I could totally decide not to circumcise based only on the AAP's policy statement. (That being based on knowing what "keratinization" means, though!) It's basically saying if you remove the mucousal membrane, the skin of the penis will become keratinized. Not "may," not "could," but it will. Add that to the next sentence and the "one study" suggesting the concentration of sensory cells? Right there is enough info to let me know it's too risky to circumcise my baby!!
post #63 of 74
To my mind, though, this review and revision should be more than the simple addition of more data into the statement.

Maybe I'm hopelessly biased, but it seems that something like the findings of the sensitivity study SHOULD be sufficient to tip the balance, as far as medical recommendations against neonatal circumcision. Their stance (not recommending routine circumcision, parents should weigh the potential medical benefits against the risks and decide) is predicated on finding no clear reason to discourage it across the board, but also not significant benefit to recommend it across the board, right? So with the results of the sensitivity study, and the concept of "do no harm," isn't the balance shifted? In a demonstratable way???

I welcome your feedback! I'm really asking.
post #64 of 74
Quote:
Originally Posted by buckeyedoc View Post
Also notice that the AAP has been quoted in recent articles as listing decreased penile sensitivity as a drawback to circumcision (check out this week's circumcision rates articles on MSNBC and you should see it in the box).

I am about to visit the MSNBC article again and check for such a comment. I haven't seen any articles referencing recent AAP comments about penile sensitivity, though I've been hoping for a little noise. Maybe it's been long enough since publication that it's happening, though? But I just checked, and I don't find anything with a Google search. Where are these recent articles? I'm really interested!
post #65 of 74
Well, I wrote my letter. I hope it sounds intelligent and rational. Thanks to AmyC and baybee for insisiting that it might make a difference.
post #66 of 74
Quote:
Originally Posted by AmyC View Post
I am about to visit the MSNBC article again and check for such a comment. I haven't seen any articles referencing recent AAP comments about penile sensitivity, though I've been hoping for a little noise. Maybe it's been long enough since publication that it's happening, though? But I just checked, and I don't find anything with a Google search. Where are these recent articles? I'm really interested!
I saw it on page 2 of the article and also in an article a few months ago (To Cut or Not to Cut). There is a little "fact file" box in the article. When you click on it, it shows benefits and drawbacks of circumcision and then references AAP: "As with any operation, circumcision has some surgical risks. Complications from circumcision are rare and usually minor. They may include bleeding, infection, cutting the foreskin too short or too long, and improper healing. When the foreskin is removed, the tip of the penis may become irritated and cause the opening of the penis to become too small. This can cause urination problems that may need to be surgically corrected. Circumcision may make the tip of the penis less sensitive, causing a decrease in sexual pleasure later in life. While uncircumcised boys may have a higher risk of urinary tract infections, STDs and penile cancer, they can be taught proper hygiene to decrease these risks."

I have never heard AAP representatives actually talk about it, but it's apparently in their blurb sent out to the media.
post #67 of 74
Thanks, buckeyedoc. I did eventually find it (and clicked on the negatives to actually see the part about the potential for a less sensitive "tip.") I think that's been their comment for awhile, and the way they say it ("may make the tip less sensitive") makes it easy to minimize or brush aside.

I don't think they are referencing the study in the BJU, though. There's no "may" about that, and it also covers a lot more than a less sensitive "tip." Such as establishing that the most sensitive parts of the penis are actually part of the foreskin. And that the foreskin lips and the ridged band are by far the most sensitive of all, and without exception were missing from every circ'd man in the study. (I am assuming they are removed with every circumcision, period.)

On the letter-writing issue....

Is there any way to know if there's an existing task force on circumcision, or one to be determined? Or is the AAP president the best recipient?

Are you emailing or sending an actual letter? (I was assuming I'd send a letter by mail, for the weight of that action and the signature and everything, but the thought of an email for easy forwarding from pres. to all members of task force--ha!, must think positively!-- appeals, as well.)
post #68 of 74
Quote:
Originally Posted by AmyC View Post
I've always said (well, "always" being as long as I've been aware and even a teensy bit informed about this issue) that I could totally decide not to circumcise based only on the AAP's policy statement. (That being based on knowing what "keratinization" means, though!) It's basically saying if you remove the mucousal membrane, the skin of the penis will become keratinized. Not "may," not "could," but it will. ...
The problem is, many Americans who circ have never seen an intact penis, at least not in an adult. So the keratinized skin of the penis is viewed as the "norm". They have no idea about the sensitivity benefits of mucousal membrane + protective covering.

I hope the AAP committee has at least one intact male.:
post #69 of 74
Thread Starter 
*bump*
post #70 of 74
Quote:
Originally Posted by smeep View Post
Why don't they recommend removal of the labia for females as a means of preventing HIV? Correct me if I'm wrong, but doesn't that also decrease HIV infection (going by the theory of the supposed circ "prevention")?

Women have the same inner foreskin and sebascous glands and etc. etc. as men. Its all just crazy. One reason I'm writing a book with a bit of history in it. Did you all know how racist medical history is?

anyway more on that later... running out the door.
post #71 of 74
Ooh, a book?!

If it is anywhere near as good as your site I'm sure that it will be damn fine.
post #72 of 74
I've formed an opinion on this. Just today really. I have a daughter, but I didn't know until very shortly before she was born that she'd be a girl (I said 27 weeks in another thread but that was a typo - it was 37), and I'd decided already that if I had a boy he wouldn't be circumcised. My mom remembers that, and now we're planning to have a second child, and she's been emailing me articles because of this study in Africa.

Anyway, my opinion is as follows.

IF the results of the study in Africa can be extrapolated to the US (and that is a big IF) then we have to consider those risks only in comparison to the risks of the surgical procedure of circumcision.

The rate of HIV infection in the US is 19.5 per 100,000, or 0.000195%. And not all of those were sexually transmitted (drug use, blood transfusions, etc. account for some percentage of that or another). So even if the chance of catching HIV were doubled by not being circumcised, it is still a relatively small risk, and a risk that can handled by using condoms better than by circumcision.

AND circumcision has risks too. What are those risks? What percentage of boys and men have complications? Does anyone know? And honestly, I'm not even interested in a medical determination of complications because some complications wouldn't show up till the kid hit puberty and started having erections, and then you'd have to rely on the kid (or later adult) telling his doctor about it. I know that someone I worked with had a baby who had to have a second surgery to repair a circumcision complication. I also dated someone who didn't have enough skin left after his circumcision and who therefore had skin from him scrotum area that pulled up when he had an erection. These risks need to be considered as well.

And finally, if surgical changes to genitalia help prevent HIV, then why aren't girls being altered in the US? We'd have fewer UTIs, it sounds like we might have fewer STDs. I bet there's a way to do something that would give the reported health benefits and still allow a woman to have at least some level of sexual pleasure. But we don't do it anyway. We wouldn't dream of it. If it's wrong for girls, it's wrong for boys.
post #73 of 74
Wow, I hope that they carefully consider this and the consequences it will have.

Kens
post #74 of 74

One more letter written!

I sent it to Dr. Berkelhammer (sp?). Thank you all so much for posting the address etc.!
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