View circumcision-Newborn male circumcisionNewborn male circumcision | Canadian Paediatric Society

Forgot Password? Register for Online Access. I mean, literally. As a woman, I lack the proper anatomy parts to be able to experience this particular rite of passage on my own body. So the recent brouhaha over a proposed circumcision ban in San Francisco raised a lot of powerful issues for me, highlighting my ongoing internal battle of allegiances between feminism and Judaism.

View circumcision

View circumcision

View circumcision

Even with procedural analgesia, individuals experience postprocedural pain that View circumcision be treated. Seen this way, the penis is just a very significant part of how men communicate important ideas, apparently. Frequently asked questions. The tip of the penis is likely to be sore at first, and the penis might look red, swollen or bruised. These articles View circumcision subsequently reviewed, as were their references when appropriate.

Sunset blvd waxing. A Woman’s View of Circumcision

As for circumcising a baby boy to make him "look like" the circumcised father, this always makes me wonder how much View circumcision the father circmcision son will be comparing genitals with one another. How to prepare for a circumcision. Focusing on families, individuals, self employed and small business. Tony says:. View circumcision is also important to note that sex can and is amazing with circumcised men. People who choose to circumcise are not circujcision it to fit the View circumcision Covenant, and it is unreasonable to call it mutilation. Circumcision in older children and adults Naughty daydreams katie morgan also be done for the same reasons. There is View circumcision medical reason to justify an elective surgery on an infant. Your life has not been altered in any meaningful way. July circmucision, at pm. By using a chart called The Wonder Weeks, parents can prepare for fussy periods. It was that voice in my head saying, This is really important.

Circumcising a newborn child is inherently done without his approval.

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The Canadian Paediatric Society gives permission to print single copies of this document from our website. For permission to reprint or reproduce multiple copies, please see our copyright policy. The circumcision of newborn males in Canada has become a less frequent practice over the past few decades. This change has been significantly influenced by past recommendations from the Canadian Paediatric Society and the American Academy of Pediatrics, who both affirmed that the procedure was not medically indicated.

Recent evidence suggesting the potential benefit of circumcision in preventing urinary tract infection and some sexually transmitted infections, including HIV, has prompted the Canadian Paediatric Society to review the current medical literature in this regard. While there may be a benefit for some boys in high-risk populations and circumstances where the procedure could be considered for disease reduction or treatment, the Canadian Paediatric Society does not recommend the routine circumcision of every newborn male.

The cultural and religious ritual of male circumcision has been practiced for thousands of years. Circumcision as a medical procedure arose in Britain and the United States in the late 19th century. The historical medical benefits of neonatal circumcision have included ease of genital hygiene, diminished risk of disease and avoidance of circumcision later in life. The AAP updated its own policy statement in These articles were subsequently reviewed, as were their references when appropriate.

The focus was on neonatal and infant male circumcision and its outcomes. The hierarchy of evidence from the Centre for Evidence-Based Medicine was applied, using levels of evidence for therapy and prognosis. In the male newborn, the mucosal surfaces of the inner foreskin and glans penis adhere to one another; the foreskin is not redundant skin. The foreskin gradually separates from the glans during childhood. Appropriate care for the uncircumcised penis has been well reviewed [6] and should include anticipatory guidance on hygiene and an understanding of the normal nonretractile foreskin.

Circumcision involves the partial or complete removal of the foreskin prepuce ; a number of methods are used. Whatever method is used, strict adherence to hygienic principles and the use of effective analgesia are essential. Phimosis is defined as a scarring and thickening of the foreskin that prevents retraction back over the glans. Phimosis needs to be differentiated from the normal nonretractile foreskin. Both conditions usually resolve with medical therapy but, if recurrent, can cause phimosis.

Other dermatoses of the penis can occur in childhood and should be considered if the skin over the penile shaft, foreskin or glans is abnormal. The preputial sac provides an environment for colonization of the urethra with uropathogenic organisms that can cause UTI in infant boys. The prevalence rate of UTI in febrile males circumcised and uncircumcised decreased to 1. In these cases, it is estimated that only four boys would need to be circumcised to prevent one UTI.

Conclusive evidence that circumcision is partially effective in decreasing the risk for heterosexually-acquired HIV infection among men in sub-Saharan Africa has been provided by three large randomized controlled trials involving men and adolescent boys in Uganda, [23] South Africa [24] and Kenya.

In the Kenyan study, this protective effect was sustained for at least 42 months [25] Level of Evidence 1. Observational studies undertaken in sub-Saharan Africa have also suggested that there is a similar degree of protection when circumcision is performed in the neonatal period [20] [26] Level of Evidence 4.

It remains unclear, however, whether these conclusions can be applied to populations in developed countries, where the HIV seroprevalence rates are lower and common routes of HIV transmission include injection drug use IDU and men who have sex with men MSM.

The number needed to treat to prevent one HIV infection varied from in white males to 65 in black males, with an average in all males of The model did not account for the cost of complications of circumcision. In addition, there is a risk that men may overestimate the protective effect of being circumcised and be less likely to adopt safe sex practices. In , the Public Health Agency of Canada reported that The report noted that the estimated rate of new infection in the latter group was nine times higher than in the general Canadian population.

A disproportionate number of new cases occurred in Aboriginal people IDU was the main reported source of exposure It is presumed that male circumcision, by reducing the burden of HIV in men, will indirectly protect women.

There does not appear to be a significant role in decreasing male-to-female transmission in HIV-discordant couples. Evidence obtained from observational studies that male circumcision can decrease the risk of other STIs has been conflicting.

Circumcision was not found to be protective against gonorrhea or chlamydia. The female partners of men circumcised in the same African studies had a lower adjusted prevalence rate of 0. Although circumcision can decrease the risk of acquiring and transmitting STIs, it should be emphasized that other preventative measures, including abstinence, use of condoms and other safe sex practices, must continue to be taught and practiced. Female partners of circumcised men have a reduced cervical cancer risk, with ORs ranging from 0.

Penile cancer is rare in developed countries one in , men. The benefit may also extend to penile cancer, especially as the program is broadened to include young men. Surgical procedures, including circumcision, are painful. Even with procedural analgesia, individuals experience postprocedural pain that must be treated. Newborns who experience procedural pain have altered response to later vaccinations, with demonstrated higher pain scores.

Acute complications of neonatal circumcision include minor bleeding, local infection and an unsatisfactory cosmetic result. Severe complications, such as partial amputation of the penis and death from hemorrhage or sepsis, are rare occurrences. A recent meta-analysis reporting on prospective and retrospective studies investigating circumcision found a median complication rate of 1. Such adhesions often resolve spontaneously by puberty but, when they are extensive, may also benefit from treatment with a topical steroid preparation.

Surgical lysis is rarely required. The foreskin serves to cover the glans penis and has an abundance of sensory nerves, [5] but medical studies do not support circumcision as having a negative impact on sexual function or satisfaction in males or their partners. Health care providers should be aware of potential contraindications to neonatal circumcision.

Hypospadias requires an assessment by a urologist before circumcision is considered. Any risk of bleeding diathesis requires further investigation and discussion with appropriate professionals and decision makers before proceeding with circumcision.

Neonatal circumcision is a contentious issue in Canada. The procedure often raises ethical and legal considerations, in part because it has lifelong consequences and is performed on a child who cannot give consent.

Infants need a substitute decision maker — usually their parents — to act in their best interests. Yet the authority of substitute decision makers is not absolute. In cases in which medical necessity is not established or a proposed treatment is based on personal preference, interventions should be deferred until the individual concerned is able to make their own choices. With newborn circumcision, medical necessity has not been clearly established. However, there are some health benefits, especially in certain populations.

A complete discussion of ethical and legal issues associated with newborn male circumcision is beyond the scope of this statement. Readers are referred to the July issue of the Journal of Medical Ethics , which is devoted to the topic. Current evidence indicates that there are potential health benefits associated with male circumcision, particularly in high-risk populations. Infant circumcision reduces the incidence of UTI in young boys and eliminates the need for medical circumcision in later childhood to treat recurrent balanoposthitis, paraphimosis and phimosis.

Circumcised men have a lower risk of developing penile cancer, while the incidence of trichomonas, bacterial vaginosis and cervical cancer in the female partners of circumcised men is also reduced. Minor complications of circumcision can occur, although severe complications are rare. The risk of complications is lower in infants than in older children.

The complication rate decreases significantly when the procedure is performed by experienced health care professionals, with close follow-up in the days postprocedure to ensure that bleeding does not increase. Because the medical risk:benefit ratio of routine newborn male circumcision is closely balanced when current research is reviewed Table 1 , it is challenging to make definitive recommendations for the entire male newborn population in Canada.

For some boys, the likelihood of benefit is higher and circumcision could be considered for disease reduction or treatment. Having the right information will enable them to make the best decision for their boys. Decision aids based on current medical information can be helpful.

Disclaimer: The recommendations in this position statement do not indicate an exclusive course of treatment or procedure to be followed. Variations, taking into account individual circumstances, may be appropriate. Internet addresses are current at time of publication. Focus Issues. Skip to Content. Home Clinical practice Position statements and… Current: Newborn male circumcision Position statement.

Posted: Sep 8 Reaffirmed: Feb 28 Information for parents Circumcision of baby boys: Information for parents.

During the newborn circumcision, your son will lay on his back with his arms and legs secured. It is not debilitating, but it is irritating that I should have to suffer for a procedure that is only cosmetic. What about if is for a medical reason if you are an adult? October 7, at am. It is an amputation and mutilation, and, to my knowledge, and as you note, no significant medical group in the world defends it as having any therapeutic value. Register for Online Access.

View circumcision

View circumcision

View circumcision

View circumcision

View circumcision. Cutting and, specifically, the removal of the prepuce, or from the penis

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Newborn Male Circumcision

For millennia, routine newborn male circumcision has been endorsed for a variety of purported benefits. Should public policy dictate that health care resources be redirected to this procedure when all but 1 province in Canada has delisted newborn circumcision from the schedule of insured services?

Let's look at the evidence. It is well established from epidemiological studies first carried out by Wiswell and colleagues that the incidence of febrile UTI in otherwise anatomically normal males in the first year of life is lower in circumcised, compared with intact, males. However, the actual incidence of UTI in the first year of life is low.

Even a fold reduction in infection rates equates to changing the incidence of UTI from 1 in to 1 in male babies. A complete discussion of the relation of male circumcision and HIV is beyond the scope of this paper. Despite the fact that the evidence indicating a protective effect of circumcision is based on observational studies of adult circumcision in a developing country, there is now a ground swell of support for considering the procedure as a viable strategy for preventing sexually acquired infections.

A recent Cochrane systematic review found insufficient evidence to support an interventional effect of male circumcision on HIV acquisition in heterosexual men. However, these trials were all terminated early, a characteristic that tends to overstate the effect of an intervention. Further, based on WHO data of developed countries, the United States has the highest rate of HIV and also the highest rate of infant circumcision.

It has been observed that the prevalence of cervical cancer is low where male circumcision is practised. Historically, this has been attributed to a decreased prevalence of human papilloma virus HPV on the circumcised penis. However, a recent meta-analysis on HPV and circumcision concluded that the medical literature does not support the claim that circumcision reduces the risk of genital HPV infection. The use of surgery for disease prevention is an unusual public health intervention.

Does that indicate that all males should be circumcised to prevent this rare cancer? It is notable that the incidences of penile cancer in Denmark, Finland, Norway and Japan, where less than 1.

The American Academy of Pediatrics policy notes that 9—10 cases of penile cancer are diagnosed each year per 1 million men, indicating that, although the risk is higher for uncircumcised men, the overall risk is extremely low. Gradual separation of the glans from prepuce takes place spontaneously over many years, often not being complete until puberty. Usually, in this setting, anxious parents and referring physicians require education on the care of the normal foreskin and the patient does not require an operation.

Health is not only about disease prevention, but also about well-being and the avoidance of harm. How harmful is routine non-therapeutic circumcision? The overall rate of immediate and long-term complications arising from newborn circumcision is a matter of debate and in truth unknown. The estimated rate of complication worldwide has been reported as lying between the extremes of 0.

Tragic partial or complete penile amputation, urethral injury and even the rare death have been reported. Newborn circumcision remains an area of controversy. Although penile cancer and UTIs are reduced compared with uncircumcised males, the incidence of such illness is so low that circumcision cannot be justified as prophylaxis.

The role of the foreskin in HIV transmission in developed countries is unclear, and safe sexual practice remains the cornerstone of prevention. There remains a lack of knowledge regarding what constitutes the normal foreskin both among parents and among primary care providers. Routine circumcision of all infants is not justified from a health or cost-benefit perspective.

This article has been peer reviewed. Competing interests: None declared. National Center for Biotechnology Information , U. Can Urol Assoc J. Author information Copyright and License information Disclaimer. Correspondence: Dr. This article has been cited by other articles in PMC. Prevention of urinary tract infection It is well established from epidemiological studies first carried out by Wiswell and colleagues that the incidence of febrile UTI in otherwise anatomically normal males in the first year of life is lower in circumcised, compared with intact, males.

Prevention of cervical carcinoma It has been observed that the prevalence of cervical cancer is low where male circumcision is practised. Complications of newborn circumcision Health is not only about disease prevention, but also about well-being and the avoidance of harm. Conclusion Newborn circumcision remains an area of controversy. Footnotes This article has been peer reviewed.

References 1. Dalton JD. Male circumcision — see the harm to get a balanced picture. JMGH ; Schoen EJ. C ircumcision as a lifetime vaccination with many benefits. JMHG ;4: Decreased incidence of urinary tract infections in circumcised male infants. Pediatrics ; Chessare JB.

Circumcision: is the risk of urinary tract infection really the pivotal issue? Clin Pediatr Phila ; Van Howe RS. A Cost-utility analysis of neonatal circumcision. Med Decis Making ; Hill G. The Case Against Circumcision. JMHG ; Male circumcision for prevention of heterosexual acquisition of HIV in men.

Denniston GC. Male circumcision in HIV prevention. Lancet ; PLoS Med ;2:e Human papillomavirus and circumcision: A meta-analysis. J Infect ; Prophylactic vaccination against human papillomavirus infection and disease in women: a systematic review of randomized controlled trials. CMAJ ; Falling incidence of penis cancer in an uncircumcised population Denmark BMJ ; Squamous cell carcinoma of the penis and of the cervix, vulva and vagina in spouses: is there any relationship?

An epidemiological study from Norway, Br J Cancer ; Maiche AG. Epidemiological aspects of cancer of the penis in Finland. Eur J Cancer Prev ; Muir CS, Nectoux J. Epidemiology of cancer of the testis and penis. Natl Cancer Inst Monogr ; Cancer statistics, CA Cancer J Clin ; Male circumcision: a review of the evidence.

The prepuce. BJU Int ;83 suppl 1 Phimosis-A diagnostic dilemma? Can J Urol ; Canadian Paediatric Society. A:vailable: www. Circumcision for phimosis and other medical indications in Western Australian boys.

Med J Aust ; The incidence of phimosis in boys. BJU Int ; Treatment of phimosis with topical steroids in children. J Urol ; Br J Urol ; A trade-off analysis of routine newborn circumcision. Incidence of meatal stenosis following neonatal circumcision in a primary care setting. Gibson DM.

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View circumcision