cadeuceus

MALE HEALTH
&
GENITAL CARE

cadeuceus  

PREVIOUS CIRCUMCISION RATIONALE and MODERN ALTERNATIVES

Produced by

Doctors Opposing Circumcision

2442 N.W. Market St., Suite 42

Seattle, WA 98107-4137

USA



Many doctors have been poorly trained in the conservative treatment of foreskin problems. All too often, they will perform a circumcision to treat the simplest problems that occasionally occur with the foreskin. This treatment is unsatisfactory and unethical because circumcision is a radical operation that removes large quantities of functional skin and mucosa from the penis, which has life-long adverse effects. This webpage provides conservative alternatives to radical circumcision to treat minor foreskin problems.

Urinary Tract Infection (UTI)

Prophylaxis: Breastfeeding1; rooming-in2; avoiding premature foreskin retraction reduces risk of exposing urinary opening to fecal bacteria.

Treatment: Antimicrobial therapy.3

Phimosis, Adhesions

Diagnosis inappropriate before completion of penile development (full preputial separation from glans may not occur until late adolescence.)4-7

Treatment: Topical steroid cream at preputial orifice resolves phimosis8-10; lysis resolves adhesions.11

Paraphimosis

Prophylaxis: Teach adults to leave the foreskin alone.12 Age appropriate materials exist to teach children not to prematurely retract prepuce beyond what is comfortable.13,14

Treatment: Compress glans with fingers, slip foreskin forward.15 Hyaluronidase also reduces swelling.16

Balanitis, Posthitis or Balanoposthitis

Prophylaxis: Avoid exposure to soiled diapers, bubble baths, soap on genitals/in clothing, chlorinated water; eat yogurt to replenish microbial flora after antibiotic therapy; drink water to reduce uric acid concentration.17

Treatment: Use of topical antimicrobials or effective herbal remedies.18

Risk Reduction for STDs, HIV/AIDS and Genital Cancers (penis/cervix)

Prophylaxis: Encourage safer sex behaviors (avoid sex with infected partners, limit number of sexual partners if status is unknown, use condoms; practice good genital hygiene)19,20; limit/avoid smoking.21

Improved Hygiene

Prophylaxis: No special hygienic intervention is warranted in children. In adults, smegma is a sexual emollient22 and hygiene for both sexes is best accomplished with plain water (and soap, if tolerated).12,17, 23

Zipper Entrapment

Prophylaxis: Instruct caution with zippers. Treatment: Cut bottom of zipper, open upward.24,25

Aesthetics, Peer Conformity, Social Custom, Family Tradition or Religion

On ethical26-28 and human rights grounds29-33, non-therapeutic circumcision is best decided by the person whose body it affects. Physicians are obliged to refrain from performing non-medically indicated circumcisions on persons who are unable to consent.33,34 Religious circumcisions are done outside hospitals, one week or more after birth. Complications caused by unskilled operators are handled by the legal system.34 Genital cutting of children by physicians acting as the agents of social custom compromises the physician's duty to protect the health and rights of those with no social power to protect themselves.33

References

1 Pisacane, A. et al. Breastfeeding and urinary tract infection. Journal of Pediatrics 1992;120:87-9.

2 Winberg J. et al. The prepuce: A mistake of nature? Lancet 1989;1:598-9.

3 McCracken G. Options in antimicrobial management of UTI in infants and children. Pediatric Infectious Disease Journal, 1989;8:552-5.

4 Gairdner D. Fate of the foreskin. British Medical Journal, 1949;2:1433-7.

5 Oster J. Further fate of the foreskin. Archives of Disease in Childhood, 1968;43:200-3.

6 Catzel P. The normal foreskin in the young child. SA MedieseTydskrif 1982;62:751.

7 Kayaba H. Analysis of shape and retractability of the prepuce in 603 Japanese boys. Journal Urology, 1996;156:1813-15.

8 Wright JE. The treatment of childhood phimosis with topical steroid. Australian-New Zealand Journal of Surgery, 1994;64:327-8.

9 Jorgenson ET. The treatment of phimosis in boys with a potent topical steroid (clobetasol propionate 0,05%) cream. Acta Dermato-Venereologica 1993;73:55-6.

10 Golubovic A. et al. The conservative treatment of phimosis in boys. British Journal of Urology 1995;78:786-8.

11 MacKinlay GA. Save the prepuce: painless separation of preputial adhesions in the outpatient clinic. British Medical Journal, 1988; 297:590-1.

12 AAP. Newborns: Care of the Uncircumcised Penis. (brochure) American Academy of Pediatrics; 1994.

13 Jensen J. Good News for Boys: A Newspaper for Intact Boys. J.C. Jensen, M.S.W., PO Box 584, Tacoma, WA 98401-0584.

14 Noble E. The Joy of Being a Boy! New Life Images, 448 Pleasant Lake Ave., Harwich, MA 02645; 1994.

15 Illingworth R. The Normal Child: some problems of the early years and their treatment. Churchill Livingstone, 1983:101.

16 DeVries C. Reduction of paraphimosis with hyaluronidase. Urology 1996;48:464-5.

17 NOCIRC. Answers to your questions about your young son's intact penis. (brochure) National Organization of Circumcision Information Resource Centers, PO Box 2512, San Anselmo, CA 94979; 1996.

18 Green J. Penis-Foreskin Inflammation. In The Male Herbal: Health Care for Men and Boys. Crossing Press, 1991:116-25.

19 Poland R. The question of routine neonatal circumcision. New England Journal of Medicine 1990;322:1312-14.

20 Frisch M, et al. Falling incidence of penile cancer in an uncircumcised population. British Medical Journal 1995;311:1471.

21 Harish K. The role of tobacco in penile carcinoma. British Journal of Urology 1995;75:375-7.

22 Wright J. How smegma serves the penis. Sexology 1970;37:50-53.

23 Kreuger H. Effects of hygiene among the uncircumcised. Journal Family Practice 1986;22:353-5<./p>

24 Flowerdew R. et al. Management of penile zipper injury. Journal of Urology 1977;117:671.

25 Chaflin L. Win one from the zipper. Emergency Medicine 1989;21:96.

26 AAP Committee on Bioethics. Informed Consent: Parental Permission and Assent in Pediatric Practice. Pediatrics 1995; 95:314-7

"A patient's reluctance or refusal to assent should carry considerable weight when the proposed intervention is not essential to his or her welfare and/or can be deferred without substantial risk. Providers have legal and ethical duties to child patients to render medical care based on what the patient needs, not what someone else expresses."

27 Denniston, G. Circumcision and the Code of Ethics. Humane Health Care International April, 1996;12:78-80.

"Circumcision violates all seven Principles of Medical Ethics" (AMA 1992)

28 Thompson R. Routine circumcision in the newborn: An opposing view. Journal Family Practice 1990;31:189-96

"Intervention based on risk factors differs qualitatively from the treatment of already manifest disease. The standard to be met is higher; it has not been met. Circumcision is not harmless and cannot be recommended."

29 LeBourdais E. Circumcision no longer a routine surgical procedure. Canadian Medical Assoc. Journal 1995;11:1873-6.

30 Phillips I. Advocacy: rhetoric or practice. Nursing BC 1994:37-8.

"Circumcision is an issue of self-determination and autonomy. Circumcisions done for the personal preference or religion of the parent(s) are not in the best interests of the infant."

31 Milos M. and Macris D. Circumcision: medical or human rights issue? Journal Nurse-Midwifery 1992;37-suppl.:87S-96S.

32 Katz-Sperlich B. and Conant M. R.N. Conscientious objectors to infant circumcision: A model for nurse empowerment. Revolution-Journal of Nurse Empowerment Spring 1996:86-9.

33 Toubia N. FGM and responsibility of reproductive health professionals. Int'l Journal Obstet.-Gynecology 1994; 46:127-35.

"The unnecessary removal of a functioning body organ in the name of tradition, custom, or any other non-disease related cause should never be acceptable to the health profession. All childhood circumcisions are violations of human rights and a breach of the fundamental code of medical ethics. In many societies, health professionals have successfully opposed ritual and other customary bodily mutilations. It is the moral duty of educated professionals to protect the health and rights of those with little or no social power to protect themselves."

34 Wallerstein E. Circumcision: ritual surgery or surgical ritual? Medicine and Law 1983;2:85-97.

"If a suit is brought (against a religious circumciser), this becomes a secular matter for the courts to decide. The medical profession in the United States has not put its own house in order. Newborn non-religious circumcision has no place in a rational society and should cease."


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