| Medical Analysis Of Circumcision |
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Numerous medical studies have tried to assess the effects of circumcision. Several professional medical organizations are putting the evidence of medical benefits and risks of Circumcision under an increasing level of scrutiny. POSSIBLE COMPLICATIONS OF CIRCUMCISION The complications listed here are known to have occurred at least once, and have been reported in medical journals. They ''may or may not'' occur in a particular operation. Because circumcision is a surgical operation the complications from it are many and varied. Williams & Kapila state: "the literature abounds with reports of morbidity and even death as a result of circumcision." {Link without Title} Complications may be immediate or delayed. The immediate complications may be further classified into surgical mishap, Hemorrhage , Infection and Anesthetic Risk . Immediate Complications
: Mistakes can happen with any surgery. Surgical mistakes from circumcision include documented cases of penile denudation {Link without Title} , cutting off part or all of the which results in loss of the entire penis.
: Bleeding after circumcision is usually minor and easily controlled, but on rare occasions it has led to shock from blood loss ( Hypovolemic Shock ) or death ( Exsanguination ) Coagulation disorders affect from 2 to 4 per cent of the population and the condition is underdiagnosed [http://www2.healthcare.ucla.edu/pedsupdate/Peds-Update-Summer05.pdf . Severe bleeding following circumcision may be a sign of hemophilia [http://www.emedicine.com/med/topic3528.htm].
: Infections are usually minor and local, but they have led to or death [http://www.cirp.org/library/complications/cleary/ . :Staphylococcal infections are a growing problem in hospitals, [http://www.rsinewsrxreportingfrom.com/content.asp?myid=39&tid=353 and MSSA (methicillin susceptible) strains of ''s.aureus'' have affected neonatal nurseries. There is some evidence that golden staph (Staphylococcus aureus) infections may be more common in circumcised infants [http://www.cirp.org/library/complications/enzenauer2/ , though the difference was not statistically significant (p < 0.10) in one study, and another found no difference (''Pediatr Res'' 1989; 25: 193A). Boys have been found to be far more susceptible to golden staph infections than girls and methicillin susceptible strains (MSSA) have infected circumcision wounds. Enzenauer stated: "Circumcision, which is performed on approximately 90 per cent of male infants born in our hospital, may be a factor. Circumcision, by its very nature. requires more staff-patient "hands-on" contact, both during the procedure and during preoperative and postoperative care." [http://www.cirp.org/library/complications/enzenauer2/ ::Images of an infant with a life threatening ''s.aureus'' infection may be found here {Link without Title} . :MRSA (Methicillin Resistant Staphylococcus Aureus) infections are increasing fast, rising from 63% to 80% of ''s aureus'' infections in four years, according to one report ''Both MRSA and MSSA caused other serious infections..." and "Maternal SA or skin infection history occurred in 20% of MRSA vs 3% of MSSA infections.'' [http://www.rsinewsrxreportingfrom.com/content.asp?myid=39&tid=353 . :Another account of this study said: ::Although both MRSA and MSSA occurred predominantly in boys -- about 73% in each group -- after further analysis the investigators observed an infection peak only in boys infected with MRSA. ::In both groups, putulosis in the groin, upper thigh, and sacral area - areas covered by diapers - was a common presentation. Both groups had invasive infections, including shock, musculoskeletal infections, urinary tract infection, perinephric abscess, bacteremia, and empyema. There was one death, in a child with MRSA. ::"Interestingly 10 of the 12 invasive infections, including the death, occurred in male infants," Dr. Fortunov said. ''She and colleagues had no explanation for this.'' {Link without Title} :In another study, an outbreak of MRSA was checked by stricked hygienic measures. ::''Of particular interest was the fact that all 22 infected neonates were male and all but two were circumcised. Previous studies have reported that male neonates are more likely to become colonized78 and infected77,79 with S. aureus than are female neonates. In one study, the male-female infection rate was 3:179, in another it was 6:1.77 High male-female ratios have also been reported in outbreaks of neonatal scalded skin syndrome.80-82 Authors of these reports speculated that the circumcision site may be particularly susceptible to bacterial growth. In our study, however, none of the MRSA infections were at the circumcision site, although many were in the genital region. No conclusions could be drawn to explain the fact that only male infants were infected with MRSA in this outbreak." {Link without Title} :Herpes ''Metzizah b'peh'', (oral suction) is practised by a minority of Jewish circumcisers It has been linked with 8 cases of herpes infection in israeli infants, one of whom suffered brain damage [http://pediatrics.aappublications.org/cgi/content/full/114/2/e259 In New York, there were three cases of herpes linked with oral metzizah where one baby died and one suffered brain damage [http://www.thejewishweek.com/news/newscontent.php3?artid=11807 . In response to this, New York public health officials warned the Jewish community about the dangers of ''metzizah b'peh'' [http://www.nyc.gov/html/doh/html/std/std-bris.shtml] :The Israeli researchers said: ::"We support ritual circumcision but without oral metzitzah, which might endanger the newborns and is not part of the religious procedure," write researcher Benjamin Gesundheit, MD, of Ben Gurion University in Israel, and colleagues {Link without Title} . :The New York City Department of Health and Mental Hygiene said: ::Because there is no proven way to reduce the risk of herpes infection posed by metzitzah b'peh, the Health Department recommends that infants being circumcised not undergo metzitzah b'peh. {Link without Title} (emphasis in the original)
: Anesthetic risk includes Methaemglobinaemia {Link without Title} {Link without Title} . Infection and bleeding are by far the most common complications. Other immediate complications are extremely rare if the operator is competent and experienced. Delayed Complications
Some suggest that the opening to the urethra ( Some also argue that anger over being circumcised as a child is also a complication of circumcision.[http://www.cirp.org/news/penthouse11-01-01/ Pain, stress, trauma, and interference with breastfeeding initiation The American Academy Of Pediatrics ' policy states: :Some common painful minor procedures, such as circumcision, do not always receive the warranted attention to comfort issues. Available research indicates that newborn circumcisions are a significant source of Pain during the procedure and are associated with irritability and feeding disturbances during the days afterward. Opportunities for alleviating pain exist before, during, and after the procedure, and many interventions are effective. {Link without Title} :-- ''The Assessment and Management of Acute Pain in Infants, Children and Adolescents'', 2001. Many studies have examined adverse effects of the procedure; some employing various forms of Pain Relief . A few of these findings are summarised in the following table.
''1 Studies investigating several forms of pain relief have one entry for each form.'' Howard ''et al'' report that neonatal circumcision without Anaesthesia and using Acetaminophen (Tylenol) results in deteriorated breast-feeding immedately after circumcision. {Link without Title} They commented: :Numerous studies have shown that circumcision causes severe intraoperative pain as measured by changes in crying, heart rate, respiratory rate, transcutaneous PO2, and cortisol levels ... {Link without Title} ... Neonatal circumcision are often performed on the day of discharge with many neonates leaving the hospital 3 to 6 hours postoperatively. Thus the observed deterioration in ability to Breast-feed may potentially contribute to breast-feeding failure. Furthermore some neonates in this study required formula supplementation because of maternal frustration with attempts at breast-feeding, or because the neonate was judged unable to breast-feed postoperatively. This finding is disconcerting because early formula supplementation is associated with decreased breast-feeding duration. Howard ''et al.'' concluded that: :Acetaminophen was not found to ameliorate either the intra-operative or the immediate postoperative pain of circumcision, although it seems that it may provide some benefit after the postoperative period. {Link without Title} Many other studies have investigated the pain caused by circumcision, and the effectiveness of different forms of analgesia and anaesthesia. Taddio ''et al'' reported behavioural changes (heightened pain responses) during vaccinations in children circumcised with EMLA cream and with no anaethesia at the 99.9+% statistical confidence level (p<0.001) four to six months after their circumcision, suggesting a persistent effect on pain response. {Link without Title} The researchers commented: : "Study of the vaccination pain response of infants who had received more effective circumcision pain management (i.e., dorsal penile nerve block and adequate postoperative pain management) would be interesting." Kirya and Werthmann investigated the effect of Dorsal Penile Nerve block (DPNB), describing it as "painless". However, Lander ''et al'' found that DPNB is less effective than ring block.[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9417009&query_hl=1 Marshall ''et al'' report that the stress of Neonatal Circumcision may alter feeding behaviour and some male infants may be unable to breastfeed after circumcision. {Link without Title} They commented: :Despite differences between control and experimental infants shortly after surgery, by 24 h post-operatively no significant differences were observed between the groups. The behavioral effects of circumcision in the present study were immediate but brief. This should be comforting information to those who provide care for newborns and for their parents. {Link without Title} Marshall ''et al'' did not report whether anaesthesia was used. POSSIBLE PROTECTIONS GAINED BY CIRCUMCISION Prostate cancer is least common in Asian men, more common in European men and most common in Black men [http://www.hsc.stonybrook.edu/som/urology/urology_cp_prostatecancer.cfm . However, these high rates may reflect increased detection rates [http://jama.ama-assn.org/cgi/content/abstract/273/7/548]. Neither the American Cancer Society nor the professional medical organizations' policy statements on circumcision that are cited in this article mention a relationship between prostate cancer and circumcision status. Early Apt. in Sweden, concluded that uncircumcised males were at approximately twice the risk.. Ecological studies are considered unreliable but later Case-control Studies obtained results as follows: | |||||||||||||||||||||||||||||||||||||||||||||
| Mandel & Schuman | "J" class="copylinks" target="_blank">Gerontology 1987 May42(3):259-64 reported on a case-control study with 250 cases When compared to controls drawn from their neighborhood, circumcised men were less likely to develop prostate cancer (odds ratio 082) [abstract ] |
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| Ewings & Bowie | "Br" class="copylinks" target="_blank">J Cancer 1996 Aug74(4):661-6 performed a case-control study of 159 cases of prostate cancer, and found that circumcised men were at a reduced risk (odds ratio 062) [abstract ] They noted: ''"some statistically significant associations were found, although these can only be viewed as hypothesis generating in this context"'' |
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