Medical Benefits Of Circumcision
(News & Information)

WESTPORT, Mar 25 (Reuters Health) - Circumcision performed before puberty appears to reduce the risk of HIV infection, according to a multicenter team. However, "...circumcision after age 20 years is not significantly protective against HIV-1 infection."

Results of several cross-sectional African studies suggest that male circumcision may have protective effects against HIV infection, Dr. Ronald H. Gray of Johns Hopkins University in Baltimore, Maryland, and colleagues explain. However, the potential benefits of postpubescent circumcision are uncertain.

To further investigate whether later circumcision confers the same level of HIV protection as early circumcision, Dr. Gray's group conducted a cross-sectional study of 6,821 Ugandan men between the ages of 15 and 59 years. The subjects were grouped by age of circumcision: before or after the age of 12 years. In addition, the older subjects were divided into younger (13 to 20 years) or older (21 years or older) age groups.

Overall, the "...men who were circumcised before puberty had a much reduced risk of prevalent HIV infection than men who were uncircumcised," they report in the February 25th issue of AIDS.

In the subjects who had prepubertal circumcision, they found that the multivariate adjusted odds ratio of prevalent HIV was 0.39. For the subjects who had circumcisions performed between the ages of 13 and 20 years, the adjusted odds ratio was 0.46. However, for subjects circumcised when they were 21 years or older, there was no statistically significant association between circumcision and reduced HIV risk.

Based on these findings, Dr. Gray's group concludes that circumcision before the age of 21 years is protective against HIV infection, but circumcision performed later in life is not. They also suggest that these protective effects are "...likely to be due to a biological mechanism and that there may be utility to providing circumcision to newborn infants or children, particularly if this is a cultural norm."

AIDS 1999;13:399-405.

From the Mayo Clinic's Book on Pregnancy & Baby's First Year

Health Issues: Researchers have attempted to learn more about whether circumcision prevents infection and certain types of cancer, but more studies need to be done to to answer some of these questions. It is known that circumcision prevents infection and inflammation of the foreskin. And it seems to decrease the risk of cancer of the penis. This disease occurs fewer than one of every 100,000 men in the United States.

Some studies have shown a greater risk of cervical cancer in female sexual partners of uncircumcised men who are infected with human papillomavaris. Circumcision might also have a role in reducing the risk of sexually transmitted diseases. Practicing safe sex is a far more important factor in preventing these diseases than whether a man is circumcised.

Recent studies suggest that infants who are not circumcised may be more likely to develop urinary tract infections. These infections early in life may lead to kidney problems later in life. Infants who have abnormalities of the kidney or bladder are at higher risk for urinary infections, so circumcision may be advised for these babies.

Occasionally, problems can occur with the uncircumcised penis which require circumcision at an older age. These problems include inflammation of the foreskin or adherence of the foreskin to the tip of the penis. These problems occur in about 2 to 6 percent of uncircumcised males. Circumcision in infancy eliminates the possible need for the procedure at an older age.

Cleanliness: Circumcision makes it easy to keep the end of the penis clean. However, the shedding skin cells that naturally accumulate on the glans of an uncircumcised boy are not harmful. Do not force the foreskin back to clean the penis of an infant or young boy. Washing with soap and water is all that's necessary. After you son's foreskin is fully retractable, then washing under the foreskin during a bath or shower is part of good hygiene habits. The risk of penile cancer appears to be linked to personal hygiene. Uncircumcised males with poor hygiene have a higher risk, whereas uncircumcised males with good hygiene have a lower risk.

Protection Against Infections, including Sexually Transmitted Diseases

In the present article I would like to focus principally on the protection afforded by circumcision against infections, including sexually transmitted diseases (STDs). I might add that I am a university academic who teaches medical and science students and who does medical research, including that involving genital cancer virology. I am not Jewish, nor a medical practitioner or lawyer, so have no religious bias or medico-legal concerns that might get in the way of a rational discussion of this issue.

The increased risk of infection may be a consequence of the fact that the foreskin presents the penis with a larger surface area, the moist skin under it represents a thinner epidermal barrier than the drier, more cornified skin of the circumcised penis, the presence of a prepuce is likely to result in greater microtrauma during sexual intercourse and, as one might expect, the warm, moist mucosal environment under the foreskin favours growth of micro-organisms.

In the 1950s and 60s 90% of boys in the USA and Australia were circumcised soon after birth. The major benefits at that time were seen as improved lifetime genital hygiene, elimination of phimosis (inability to retract the foreskin) and prevention of penile cancer. The trend not to circumcise started about 20 years ago, after the American Academy of Paediatrics Committee for the Newborn stated, in 1971, that there are no valid medical indications for circumcision. New evidence has suggested possible medical benefits .

Dr Edgar Schoen, Chairman of the Task Force on Circumcision of the American Academy of Pediatrics, has stated that the benefits of routine circumcision of newborns as a preventative health measure far exceed the risks of the procedure. During the period 1985-92 there was an increase in the frequency of post newborn circumcision and during that time Schoen points out that the association of lack of circumcision and urinary tract infection has moved from ;suggestive to conclusive. At the same time associations with other infectious agents, including HIV, have been demonstrated. In fact he goes on to say that newborn circumcision may be considered a preventative health measure analogous to immunization in that side effects and complications are immediate and usually minor, but benefits accrue for a lifetime.

Benefits included: a decrease in physical problems such as phimosis, reduction in balanitis (inflammation of the glans, the head of the penis), reduced urinary tract infections, fewer problems with erections at puberty, decreased sexually transmitted diseases (STDs), elimination of penile cancer in middle-aged men and, in addition, in older men, a decrease in urological problems and infections. Therefore the benefits are different at different ages.

Neonatologists only see the problems of the operation itself. However, urologists who deal with the problems of uncircumcised men cannot understand why all newborns are not circumcised. The demand for circumcision later in childhood has increased, but, with age, problems, such as anaesthetic risk, are higher.

Neonatal urinary tract infections
A study by Wiswell of 400,000 newborns over the period 1975-84 found that the uncircumcised had an 11-fold higher incidence of urinary tract infections (UTIs) . During this decade the frequency of circumcision in the USA decreased from 84% to 74% and this decrease was associated with an increase in rate of UTI . UTI was lower in circumcised, but higher in uncircumcised. In a 1982 series 95% of UTI cases were in uncircumcised . A study by Roberts in 1986 found that 4% of uncircumcised boys got UTI, compared with 0.4% of girls and 0.2% of circumcised boys . This indicated a 20-fold higher risk for uncircumcised boys. In a 1993 study by Wiswell of 200,000 infants born between 1985 and 1990, 1000 got UTI in their first year of life. The number was equal for boys and girls, but was 10-times higher for uncircumcised boys. Of these 23% had bacteraemia. The infection can travel up the urinary tract to affect the kidney and higher rate of problems such as pyelonephritis is seen in uncircumcised children . These and other reports all point to the benefits of circumcision in reducing UTI.

Indeed, Wiswell performed a meta-analysis of all 9 previous studies and found that every one indicated an increase in UTI in the uncircumcised . The average was 12-fold higher and the range was 5 to 89-fold, with 95% confidence intervals of 11-14 . Meta-analyses by others have reached similar conclusions. Other studies, including one of men with an average age of 30 years, have indicated that circumcision also reduces UTI in adulthood . The fact that the bacterium E. coli , which is pathogenic to the urinary tract, has been shown to be capable of adhering to the foreskin, satisfies one of the criteria for causality. Since the absolute risk of UTI in uncircumcised boys is approx. 1 in 25 (0.05) and in circumcised boys is 1 in 500 (0.002), the absolute risk reduction is 0.048. Thus 20 baby boys need to be circumcised to prevent one UTI. However, the potential seriousness and pain of UTI, which can in rare cases even lead to death, should weigh heavily on the minds of parents. The complications of UTI that can lead to death are: kidney failure, meningitis and infection of bone marrow. The data thus show that much suffering has resulted from leaving the foreskin intact. Lifelong genital hygiene in an attempt to reduce such infections is also part of the price that would have to be paid if the foreskin were to be retained. However, given the difficulty in keeping bacteria at bay in this part of the body, not performing circumcision would appear to be far less effective than having it done in the first instance.

Sexually-transmitted diseases
Early studies showed higher rates of gonococcal and nonspecific urethritis in uncircumcised men. Recent studies have yielded similar findings. In addition, the earlier work showed higher chancroid, syphilis, papillomavirus and herpes. However, there were methodological problems with the design of these studies, leading to criticisms. As a result there is still no overwhelming agreement. In 1947 a study of 1300 consecutive patients in a Canadian Army unit showed that being uncircumcised was associated with a 9-fold higher risk of syphilis and 3-times more gonorrhea . At the University of Western Australia a 1983 study showed twice as much herpes and gonorrhea, 5-times more candidiasis and 5-fold greater incidence of syphilis . In South Australia a study in 1992 showed that uncircumcised men had more chlamidia (odds ratio 1.3) and gonoccocal infections (odds ratio 2.1). Similarly in 1988 a study in Seattle of 2,800 heterosexual men reported higher syphilis and gonnorrhea in uncircumcised men, but no difference in herpes, chlamidia and non-specific urethritis (NSU). Like this report, a study in 1994 in the USA, found higher gonnorhea and syphilis, but no difference in other common STDs. In the same year Dr Basil Donovan and associates reported the results of a study of 300 consecutive heterosexual male patients attending Sydney STD Centre at Sydney Hospital . They found no difference in genital herpes, seropositivity for HSV-2, genital warts and NSU. As mentioned above, 62% were circumcised and the two groups had a similar age, number of partners and education. Gonorrhea, syphilis and hepatitis B were too uncommon in this Sydney study for them to conclude anything about these. Thus on the bulk of evidence it would seem that at least some STDs may be more common in the uncircumcised, but this conclusion is by no means absolute and the incidence may be influenced by factors such as the degree of genital hygiene, availability of running water and socioeconomic group being studied.

Cancer of the penis
The incidence of penile cancer in the USA is 1 per 100,000 men per year (i.e., 750-1000 cases annually) and mortality rate is 25-33% . It represents approximately 1% of all malignancies in men in the USA. This data has to be viewed, moreover, in the context of the high proportion of circumcised men in the USA, especially in older age groups, and the age group affected, where older men represent only a portion of the total male population. In a study in Melbourne published in Australasian Radiology in 1990, although 60% of affected men were over 60 years of age, 40% were under 60. In 5 major series in the USA since 1932, not one man with penile cancer had been circumcised neonatally, i.e., this disease only occurs in uncircumcised men and, less commonly, in those circumcised after the newborn period. The proportion of penile malignancies as a fraction of total cancers in uncircumcised men would thus be considerable. The predicted life-time risk has been estimated as 1 in 600 in the USA and 1 in 900 in Denmark. In under-developed countries the incidence is higher: approx. 3-6 cases per 100,000 per year .

The so-called high-risk papillomavirus types 16 and 18 (HPV 16/18) are found in a large proportion of cases and there is good reason to suspect that they are involved in the causation of this cancer, as is true for most cases of cervical cancer (see below). HPV 16 and 18 are, moreover, more common in uncircumcised males. These types of HPV produce flat warts that are normally only visible by application of dilute acetic acid (vinegar) to the penis and the data on high-risk HPVs should not be confused with the incidence figures for genital warts, which although large and readily visible, are caused by the relatively benign HPV types 6 and 11. Other factors, such as poor hygiene and other STDs have been suspected as contributing to penile cancer as well .

In Australia between 1960 and 1966 there were 78 deaths from cancer of the penis and 2 from circumcision. (Circumcision fatalities these days are virtually unknown.) At the Peter McCallum Cancer Institute 102 cases of penile cancer were seen between 1954 and 1984, with twice as many in the latter decade compared with the first. Moreover, several authors have linked the rising incidence of penile cancer to a decrease in the number of neonatal circumcisions . It would thus seem that prevention by circumcision in infancy is the best policy.

Circumcision Reduces the Risk of Acquiring Herpes

By Michael Smith, North American Correspondent, MedPage Today
Published: February 05, 2008
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of  Medicine, Harvard Medical School, Boston.

BOSTON, Feb. 5 -- Circumcision reduced the risk of acquiring herpes  simplex-2 (HSV-2) by 24% in a randomized clinical trial in Africa, a  researcher said here.

The procedure also reduced a range of genitorurinary complications in  female partners of men circumcised for the study, according to Aaron  Tobian, M.D., Ph.D., of Johns Hopkins University.   The finding may help explain why circumcision reduces the risk of  getting HIV, Dr. Tobian told attendees at the Conference on  Retroviruses and Opportunistic Infections.   Genitourinary disease, bacterial vaginosis, and HSV-2 are all  "co-factors for HIV," Dr. Tobian said, so lowering their incidence may  affect HIV acquisition.   He and colleagues in Rakai, Uganda, began with the observation that  HSV-2 infection more than doubles the risk for a man to get HIV and  the information from randomized trials that circumcision reduces the  risk of HIV. They enrolled 3,516 men who were not infected with either virus and  randomized them to immediate circumcision or circumcision two years  later.

At the end of two years, those in the circumcision arm had a relative  risk of HSV-2 of 0.76, with a 95% confidence interval from 0.60 to  0.96, which was significant at P=0.019 compared with controls, Dr.  Tobian said.   In higher risk categories -- those with two or more sex partners,  those ages 20 to 24, and those with inconsistent cond om use -- the  risk of HSV-2 increased in the control arm and remained low in the  circumcision arm, he said.   For instance, for men who were inconsistent in the use of condoms, the  relative risk of HSV-2 for those who were circumcised compared with  those in the control arm was 0.53, which was statistically significant  at P=0.001, Dr. Tobian said.

The researchers also enrolled 1,608 female partners of the men in the  trial, 825 linked to men who were circumcised and 783 to those in the  control arm.   They were followed for a year and tested for genitourinary disease,  bacterial vaginosis, and trichomonas. The study found, among other  things, that:

* The relative risk of symptomatic genitourinary disease in  intervention wives compared with control arm wives was 0.76 (with a  95% confidence interval from 0.60 to 0.97, which was significant at  P=0.03).  * There were no differences in vaginal discharge or dysuria by  study arm.  * The relative risk of trichomonas in intervention wives compared  with control arm wives was 0.53 with a 95% confidence interval from  0.33 to 0.85.  * The relative risk of bacterial vaginosis in intervention wives  compared with control arm wives was 0.80 with a 95% confidence  interval from 0.71 to 0.89.

The findings are consistent with previous observations, Dr. Tobian  said, although the mechanism for the protective effect of removing the  foreskin remains unclear.

From the point of view of genital health in general, the findings are  a "very important result," said John Mellors, M.D., of the University  of Pittsburgh, co-chairman of the conference's scientific program.   But he said it remains unclear what effect reducing HSV-2 acquisition  will have on the risk of HIV. One recent study -- and another being  reported here -- appear to show that suppressing HSV-2 with drugs has  little effect on HIV risk, he said.

"Why there is that dissociation is not clear," Dr. Mellors said.

Action Points

* Explain to interested patients that herpes simplex-2 infection  has been shown to more than double the risk of HIV infection, but that  circumcision has been shown to reduce the risk.

* Note that this study showed that circumcision reduces the risk  of getting HSV-2, which may help explain the effect of the procedure  on HIV acquisition.

* Explain that wives of men who were circumcised for the study  also had better genitourinary health.

The study was supported by the NIH, the NAIAD, the Fogarty  International Center, and the Gates Foundation. Dr. Tobian did not  report any potential conflicts.

Primary source: Conference on Retroviruses and Opportunistic  Infections  Source reference:  Tobian A, et al "Trial of male circumcision: prevention of HSV-2 in  men and vaginal infections in female partners, Rakai, Uganda" CROI  2008; Abstract 28LB.

http://www.medpagetoday.com/MeetingCoverage/CROIMeeting/tb/8230

Uncircumcised men more likely to harbor human papilloma virus

Journal of  Infectious Diseases. 2008 Feb 19

Hernandez BY, Wilkens LR, Zhu X, McDuffie K, Thompson P, Shvetsov YB,  Ning L, Goodman MT.  1Cancer Research Center of Hawaii and 2University Health Services,  University of Hawaii, Honolulu.

Background:  Lack of circumcision has been identified as a risk factor for male  genital human papillomavirus (HPV) infection, although this  association has not been consistently supported.

Methods:  Specimens for HPV testing were collected from a cohort of 379  (primarily heterosexual) adult males. HPV prevalence in the glans penis and coronal sulcus, penile shaft, scrotum, semen, and urine was  compared by circumcision status.

Results:  Overall, HPV DNA prevalence ranged from 6% in semen to 52% in the  penile shaft. The prevalence of any HPV infection in the glans/corona  was significantly higher in uncircumcised men (46%) than in  circumcised men (29%) (odds ratio [OR], 1.96 [95% confidence interval  {CI}, 1.02-3.75], adjusted for demographic characteristics and sexual  history). Uncircumcised men also had an increased risk of oncogenic  HPV infection (adjusted OR, 2.51 [95% CI, 1.11-5.69]) and infection  with multiple HPV types (adjusted OR, 3.56 [95% CI, 1.50-8.50]). Among  uncircumcised men, HPV prevalence in the foreskin (44%) was comparable  to that in the glans/corona, and type-specific positivity was observed  between the 2 sites.

Conclusions:  Uncircumcised men have an increased risk of HPV infection, including  with oncogenic HPV, specifically localized to the glans/corona,  possibly because of its proximity to the foreskin, which may be  particularly vulnerable to infection.

Scientists Discover Circumcision is Key

AIDS CLUES TURN TIDE

Widespread male circumcision would go a long way to protecting the world from AIDS, two Manitoba experts say. "Male circumcision, if it could be universally implemented, would be a very effective prevention." says Dr. Frank Palmer, an international pioneerin AIDS research.

Plummer and his colleague - University of Manitoba microbiology headDr. Allan Ronald - know that they say may be unpopular. For some time now, the tide has turned against circumcising infant boys as more parents believe it is unnecessary and painful. The two researchers base their conclusions on the work they have done in Africa, where a collaborative research project has begun unlocking the AIDS mystery.

Research teams led by Plummer and Belgian Dr. Peter Piot (who discovered the deadly Ebola virus in Zaire in 1976 and now leads the United Nations AIDS program) dug out many pieces to the puzzle of howe the human immunodeficiency virus is transmitted, how it locks into male and female genitalia and how it grows. For men research indicates that an intact foreskin plays a big role in contracting HIV.

"Its now recognized as an important risk factor for HIV infection among men," Plummer says. The whys of this are unclear. It sued to be thought that HIV would enter through the urethra but now that isn't so, Ronald says. It is believed to enter through the mucous membrane or skin of the penis. Ronald theorizes the uncircumcised penis, with its warm, moist conditions incubates the virus, protecting it until it can find a way in. Universal circumcision would give wider health benefits to boys, noting those not circumcised get about 15 times as many bladder and urinary tract infections.

Ronald notes the American Pediatric Association has begun to cautiously recommend circumcision again after actively discouraging it. "I think from a health perspective we need to encourage parents to consider male circumcision." Another discovery of the Kenyan research was that sexually transmitted diseases can be welcoming hosts to HIV.

While a healthy disease free woman is not very susceptible to HIV (the guestimate says Ronald, is that the virus is contracted in one in 100 sexual encounters with a partner in the early stages in HIV infection), prostitutes are at high risk because STDs are prevalent. In a Nairobi slum, HIV positive rates climbed to 90 per cent in the early 1990s. Prostitutes with a high rate of STDs are dying faster than others. Ronald describes the inflamed lesions STDs create on genitalia as "little virus factories" for HIV.

"Even though the rest of the body is saying shut it off, shut it off, and we've got the immune system in good shape, it's holding bock the virus in the local factory, it loses control." This finding was pivotal to AIDs research, he said, noting others have tinkered with mechanics of how this happens "but no one has really added toit since".

"And now it's a truism that the most direct way biologically to attack HIV spread heterosexually is through controlling other STDs. Behavior change and condom promotion are important and necessary and have to be hone but you'll fail unless you really address other STDs and control it."

By Catherine Mitchell, Staff Reporter

Comments from Dr. Robert Steele

Several readers have written in with questions concerning circumcision.

I am a big believer in the parent's right to choose between alternatives when it comes to their child's health but to do so, the parent should be supplied with enough information to make an informed decision. In the end, the decision to circumcise is usually made with other considerations (personal preference, religious,tc) in mind. But medical issues should be a piece of the puzzle in this decision. Thus, below is a summary about the MEDICAL facts involved when considering circumcision.

BALANOPOSTHITIS
This is inflammation of the glans penis (the tip of the penis) and foreskin. It has been shown that uncircumcised males have a higher incidence of penile inflammatory disorders and that 5-10% of those boys eventually undergo circumcision because of the complications of this. However, it is also felt that with careful hygiene and cleansing, these infections and complications may be substantially reduced. On the other hand, proponents of circumcision point to studies which show it is difficult to achieve good genital hygiene in boys throughout most of childhood.

URINARY TRACT INFECTIONS
Certain bacteria which tend to be the culprits of urinary tract infections easily adhere to the foreskin. This is felt to be the reason why uncircumcised males have been found to have approximately a 6-10 times greater risk for urinary tract infections. Opponents of circumcisiom point to the fact that these studies may have been flawed. Most agree that the incidence of infections in the urinary tract during the first year of life are greater in uncircumcised males.

CANCER OF THE PENIS
Cancer of the penis is rare and occurs in the US in about 1 per 100,000 men, but the mortality rate is about 25% in those who are unfortunate enough toget it. In the six major studies of US men with penile cancer, none were circumcised. Thus, many feel circumcision of newborns almost completely eliminates the possibility of cancer of the penis. However, in separate reports, circumcised men have had penile cancer. In addition, the risk of penile cancer may be more dependant on acquiring certain sexually transmitted viruses including herpes and human papilloma virus (HPV). Thus, opponents of circumcision feel penile cancer may have more to do with viral infection than the lack of circumcision. Of course, circumcision helps to prevent viral infections.

MY OPINION
I suspect that further study of circumcision will definitively show medical benefits. However, even at that time circumcision will not be right for everyone because there are obvious other considerations that for the individual family will outweigh those medical benefits.

Corona Papillae Rare in Circumcised Men

Does anyone know anything about a condition called Corona Papillae - small white wart-like growths around the corona of the glans. A Thai friend of mine has been told by a doctor that he should be circumcised as this will help clear up the condition. Is this true? Is it a serious condition? Is there any other treatment?

Answer:

I've had these, in 1972 before I was circumcised. I went to the Special VD Clinic where they were painted with something called podophyllin. They then shrivelled up and fell off, and have not returned as I was subsequently circumcised. Certainly they are rare in circumcised guys. I think your friend should take the opportunity to get circumcised.

Although papillae are not serious in themselves, they are infectious. They carry the human papilloma virus which is clearly associated with cervical cancer in women and maybe with other forms. Perhaps the strongest argument women have for wanting their men circumcised.

Diabetes and Circumcision

About eight years ago it was discovered that I am a type II diabetic (non-insulin dependent luckily) and now everytime I am at the doctor they are pestering me about getting circumcised. I don't have any problems with my penis or foreskin at all, no infections and it goes back easily. What is the deal with this? Do any of the other CircList members have some sort of information about it?

Answer:

Diabetics tend to excrete more sugar in their urine than other folk do. A foreskin, unless it is very short or exceptionally loose, traps a certain amount of urine every time you urinate (even if you pull it back to piss there will be a few drops which come out after you think you've completely finished).

The sugary solution is very conducive to the growth of fungal infections like BXO. Fungii like warm, moist, dark places - which the inside of theforeskin definitely is. If there is also some good nutrient then even better! Thus uncircumcised diabetics are more likely in the longer term to develop balanitis and other infections of the foreskin.

Your doctor thinks that you would be better off having a circumcision in your own time and whilst there is no infection there, rather than waiting until it becomes an emergency and there is risk of passing infection from the inflamed foreskin to the circumcision wound. Further more, the problem is most likely to occur after you reach 60 or so, a time at which the body takes much longer to heal even simple wounds.

Cancer of the Cervix

The rarity of the disease {cervical cancer} in Jewesses and its relative rarity in Moslem women suggest that male circumcision might materially reduce the risk of its development, but this is unlikely to be true as the state of circumcision of her husband has no substantial effect on the risk a woman runs of developing the disease in religious communities where only some of the men are circumcised. Cleanliness is likely to an important factor, as the disease may be relatively uncommon in communities that practise ritual ablution before and after intercourse and, within each community, it becomes less common with increasing economic status.

Cancer of the Penis

The most striking fact about the epidemiology of this disease is that circumcision protects against its development. Carried out within a week or two of birth, the protection is almost complete; carried out later in boyhood, the effect is obvious, but less marked. Circumcision is not the only way of preventing disease, as marked variations in incidence occur among tribal groups in Africa who are alike in not practicing circumcision, but otherwise have different social customs. In some the disease accounts for as much as 10% of all cancers in males; in others it is only slightly more common than in developed countries. Personal cleanliness may be an important factor, as it is in relation to some forms of cancer of the skin, and it seems that as long as the glans, coronary sulcus, and foreskin are kept clean, the risk of developing the disease is remote.

An observation that suggests the possibility of venereal (and hence perhaps a viral) origin is an association between cancers of the penis and cervix uteri in marital pairs. The association is not strong, but it has been observed in several countries and cannot be accounted for simply by confounding with socio-economic class. The human papilloma virus (types 16 and 18) is commonly found in the malignant cells, and probably causes the disease.

Book: Oxford Textbook of Medicine, 1987, Oxford Univ. Press

American Cancer Society Support Male Circumcision

The American Cancer Society states that circumcision of males reduces cancer of the cervix on females. Their study was done and published in The New England Journal of Medicine (Vol. 346, No. 15: 1105-1112). http://www.cancer.org/docroot/NWS/content/NWS_1_1x_New_Study_Shows_Benefit_of_Male_Circumcision.asp

They also seem to favor circumcision of males to prevent penile circumcision.

http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_What_are_the_risk_factors_for_penile_cancer_35.asp?sitearea=

Neonatal Circumcision: An End to the Controversy
Urinary Tract Infections 10 Times Higher In Uncircumcised Males

From the January, 1996 Southern Medical Journal
JAMES A. ROBERTS, MD, Covington, La

ABSTRACT: The incidence of urinary tract infections is 10 times higher in the uncircumcised male than in those circumcised. An extensive review of bacterial adherence, the initiating factor in urinary tract infections, is presented to show that bacterial adherence to the prepuce is necessary for pyelonephritis to occur. Colonization with maternal bactetria occurs at birth; thus the incidence of pyelonephritis in infants born of bacteriurtic mothers is much higher than it is in infants born of nonbacteriurtic mothers. The signtificant morbidity of acute pyelonephritis in infants is one reason for encouraging neonatal circumcision, but a more important reason is that acute pyelonephritis in the first years of life often leads to significant renal damage that may progress to end-stage renal disease during adolescence. Since circumcision can now be done under local anesthesia, the newborn infant can have a painless prophylactic operation that will prevent urinary tract infections, pyelonephritis, and endstage renal disease.

Uncircumcised Men Harbor More Bacteria

A recent study of immigrant MEN to Israel showed the uncircumcised men harbor more bacteria in the intact foreskin, including more microbes for sexually transmitted diseases, including the AIDS virus.

There were higher amounts of urinary tract infection bacteria in 17 percent of men with foreskins and 4 percent of circumcised men. That 17 to 4% seems to be pretty standard for all sorts of bacteria on the end of penises - so those women when suffer from various infections had best have their male sex partners treated, or better yet, married or not, made to use a condom unless they're trying to get pregnant and then make sure he sees a doctor REGULARLY.

Contrary to the brainwashing women have gotten regarding the "purity" of men's peni and their sperm - ignoring the fact that men handle their penises with dirty hands because few men wipe or wash their hands BEFORE and spread hand to penis infection/dirt to their precious reason for living. They seldom wash afterwards either.

It is fact that the peni is often the transmitters of bacteria that can cause women great harm and even death in unprotected sex."

In parts of sub-Saharan African, nearly 25 percent of the population is HIV-positive as a result of heterosexual transmission of the virus - Could lack of circumcision make men in this region particularly susceptible?

by John C Caldwell and Pat Caldwell.

The hetrerosexual AIDS epidemic in sub-Saharan Africa has been sustained by an unfortunate concurrence of circumstances: high levels of multiple sexual partners and prostitution, poor medical care ( resulting in a high incidence of untreated sexualy> transmitted diseases) and a large, contiguous population of uncircumcised men. Lack of male circumcision is not the critical factor promoting the spread of HIV, but it is the additional one that distinguishes the AIDS belt form the rest of Africa.

Furthermore, recent work with more than 4,000 women in Nairobi shows that lack of male circumcision trebles the likelihood of male-to female transmission: if a large number of uncircumcised men, who are more likely to be infected by female prostitutes, bring the disease home to their female partners, more women will contract HIV.

Chinese Alternative To Infant Circumcision Complex

Phimosis (an overtight foreskin) is not uncommon in young boys, and surgical circumcision is usually advised. Many of them have consequent urinary tract infection, frequent micturition or bradyuria but their parents are reluctant to agree to surgery because of fear and other concerns. We therefore developed a non-surgical treatment with a balloon catheter designed for pediatric use (patented in China), which was first applied to a 4-year-old boy in September 1987. Since then we have treated 512 patients aged from 5 months to 12 years at Changzheng Hospital, with satisfactory results as those of conventional methods. While the method is frequently successful at treating the phimosis, the other benefits of circumcision (reduction of disease in later life) are not delivered.

Call to Circumcise All Baby Boys

September 25, 1997

NEW YORK (Reuters) - Every boy should be circumcised at birth as a preventive health measure, according to a report in the British Journal Archives of Disease in Childhood.

In his summary of previous research, Dr. Edgar Schoen, director of regional perinatal screening at the Kaiser Foundation Research Institute in Oakland, California, says routine circumcision can significantly reduce the risk of urinary tract infection, sexually transmitted diseases (STDs) including HIV, and penile cancer.

"Newborn circumcision is a valuable preventive health measure, analogous to immunization, which offers protection against a number of diseases throughout a man's lifetime," writes Schoen, the former chairman of the American Academy of Pediatrics Task Force on Circumcision.

"And the best time to do it is in the newborn period," he adds, noting that studies in the past 10 years associate circumcision with a lower rate of both urinary tract or kidney infections in infants. "Kidney infection in the infant are most dangerous in the first two years of life when the kidneys are still developing and can lead to permanent kidney damage," notes Schoen.

According to the researcher, studies have shown that uncircumcised infants less than 1 year old have about 10 times the risk of urinary tract infections than circumcised infants. "And the mechanism for that is clear -- dangerous bacteria from the intestinal tract adhere to the warm, moist membrane of the foreskin and then they ascend up the urinary tract to cause severe infections of the bladder, kidney, and sometimes severe bloodstream infections," he explains.

Schoen points out that a second series of data summarized in his report points to a greater risk of STDs "involved with abrasions or tears in the foreskin" among uncircumcised men. These include genital herpes, human papilloma virus, and HIV - the virus that causes AIDS. "In terms of HIV, specifically, studies in sub-Saharan Africa found about a fourfold greater risk among men heterosexually exposed to the virus through contact with infected women, including prostitutes, compared with circumcised males," Schoen says.

Schoen contends that study results support the health benefits of newborn circumcision, even beyond STDs and urinary tract infection. "The evidence that circumcision protects against penile cancer is overwhelming," he states. "The United States incidence of penile cancer in circumcised men is essentially zero - about one reported case every five years - but in uncircumcised men about 1,000 cases are reported annually."

"When properly done, newborn circumcision is a quick, simple procedure with a low complication rate," writes Schoen, noting that circumcision does not appear to adversely affect either emotional health or sexual performance.

SOURCE: Archives of Disease in Childhood (1997;77:258-260, 194-195)

Simple Techniques Said to Relieve Pain of Circumcision

[Medical Tribune: Family Physician Edition 38(15): 1997. © 1997 Jobson Healthcare Group]

A special chair and a sugar-coated pacifier can help ease pain and discomfort during circumcision, researchers report. In a study of 80 newborns who underwent circumcision, researchers found that seating the infants in a newly designed, specially padded chair reduced their distress during the procedure 50% more than in infants who underwent circumcision in the rigid plastic restraining board that is typically used. Giving the newborns a pacifier dipped in a 24% sucrose solution and water further lessened their discomfort, reported researchers led by Howard J. Stang, M.D., of the department of pediatrics and adolescent medicine at Group Health, Inc., in Minneapolis.

Pain and discomfort were assessed according to a behavioral distress scale. All of the boys also received a dorsal penile nerve block. Although 70% to 90% of boys in the United States undergo circumcision, many physicians do not offer the boys any anesthesia or analgesia, falsely believing the infants do not feel much pain during the procedure, the researchers noted in their report, published in the August edition of the Pediatrics electronic pages, the online extension of the journal Pediatrics.

"When neonatal circumcisions are performed routinely, they should be done as humanely as possible," they concluded. The new findings show that "you can do this very common procedure in a very compassionate manner," said Thomas Wiswell, M.D., a professor of pediatrics at Thomas Jefferson University in Philadelphia. Dr. Wiswell said he had heard about Dr. Stang's research a few years ago and asked to borrow the chair system for use in his own practice for a couple of months.

The chair was developed by Dr. Stang, who has a patent on it. It is not commercially available. "What a wonderful idea to come up with," Dr. Wiswell said. --A.L.

Tissue engineering transforms healing
Important Use For Circumcised Infant Foreskins

WASHINGTON - Tissue engineering is starting to transform the way patients with gaping wounds are being healed, an expert said Monday.

The new technology, only named about 10 years ago, could prove a boon to patients with gaping wounds that do not heal, William Eaglstein of the University of Miami School of Medicinetold reporters.

It goes much farther than skin grafts, Eaglstein told an American Medical Association conference for science writers. "Two tissue engineering therapies have been tested on a large scale for chronic wounds and are awaiting Food and Drug Administration approval,'' he said.

"Both of them contain living cells. One starts as a mesh of absorbable surgical suture which is actually what surgeons and dermatologists use to sew the skin.''

Live cells from the foreskin of a newborn's penis -- used because babies are regularly circumcised, the tissue is young and available -- are put into a container with the mesh and fluid that encourages cell growth. ``The tissue which grows from the skin cells is laid down over the ulcer and the bioengineered tissue begins to heal,'' Eaglstein said.

But he said scientists still did not understand exactly how the method worked. "We have reason to believe it heals by stimulating the host tissue. We think that the tissue-engineered skin isn't really even there at the end.''

"I remember specifically it shortened the healing time of a venous ulcer from about 150 days to 50 days,'' Eaglstein said.

British healthcare group Smith & Nephew and partner Advanced Tissue Sciences Inc have applied for FDA approval of one such system, known as Dermagraft.

A third product already on the market allows doctors to remove skin cells from a patient and send them to a lab. The lab grows the cells and sends back a graft of the patient's own cells. It is used mostly for treating severe burn victims.

Syndactyly repair performed simultaneously with circumcision:
Use of foreskin as a skin-graft donor site.

J Pediatr Surg 1997 Oct;32(10):1482-1484 Oates SD, Gosain AK

Abstract

A boy who had simple syndactyly involving the third web space of the left hand presented for elective syndactyly repair. Circumcision had been delayed because of neonatal medical problems. Elective syndactyly repair and circumcision were performed in one operation at age 9 months. Penile foreskin was used as a full-thickness skin graft for the syndactyly repair.

The foreskin provided a functional syndactyly repair with good aesthetic characteristics. This obviated the need for two separate operations and for an additional skin graft donor site. To our knowledge, this is the first reported case in which foreskin was used for the repair of syndactyly. In boys with syndactyly, the authors advocate that parents be informed of this reconstructive option. Should the parents consider it to be suitable, then elective circumcision should be delayed until the time of syndactyly repair so that foreskin may be used for the syndactyly repair.

Prophylactic neonatal surgery and infectious diseases.

Pediatr Infect Dis J 1997 Aug;16(8):727-734 Weiss GN

Abstract

Infections worldwide are the primary cause of morbidity and mortality today. The need for prevention is essential. Prophylactic surgery with the reduction of infectious disease has been available for many millennia, but its recognition has been questionably accepted. This article presents evidence of former times when circumcision was performed in the ancient Egyptian, Coptic and Ethiopian cultures, probably as a therapeutic measure to combat the ravages of schistosomal infectious symptomatology. How this health measure was converted to a religious rite and the confusion caused by this misunderstanding is fully explored. The association of an operative procedure as a religious ritual among Jews, and Christian Biblical ambiguity toward it, has further clouded the issue.

Neonatal circumcision has been perpetuated in many societies and cultures, not because of the Jews and their Covenant of Circumcision, but because of its merit as a secular surgical prophylactic health measure. This article explores an interesting issue from its beginning to contemporary research and findings that justify the procedure as a viable option in maintaining and promoting quality genital health care for males of all ages.

CIRCUMCISED MEN HAVE MORE AND VARIED SEX

University of Chicago Research, 1997

Circumcision offers little advantage where health is concerned, but men who are circumcised tend to have more varied sex, a study published on Tuesday said.

The study, by University of Chicago researchers and published in this week's Journal of the American Medical Association, found "significant differences between circumcised and uncircumcised men in terms of their sexual practices."

"We were quite surprised to see such clear evidence, at least within the white population, that masturbation was correlated with being circumcised as well as engaging in oral sex and anal sex," University of Chicago researcher Edward Laumann said.

The study said 47 percent of circumcised men reported masturbating at least once a month versus 34 percent for their uncircumcised peers. The difference in frequency cannot be explained, but it does "cast doubt on the Victorian-era notion that circumcision reduces the urge to masturbate," the study said.

Reduced sensitivity?

Critics of circumcision claim the study shows the procedure reduces men's sensitivity. The researchers themselves don't make that point, saying that the study doesn't explain the cause of the differences.

Circumcised men were found to be nearly 1.4 times more likely to engage in heterosexual oral sex than uncircumcised men, the study reported. They also were more likely to have had homosexual oral sex and heterosexual anal intercourse.

The study was based on an analysis of data collected from a sample of 1,410 men, aged 18 to 59, in the United States, which has one of the world's highest non-religious circumcision rates.

No Advice To Parents

The new report offers no advise to parents to reach a decision on the question of whether or not to circumcise their sons. Family tradition and parents personal preferences are usually the deciding factors in routine infant circumcision.

Reduced Medical Risk

The study found circumcised men have a slightly lower risk of sexual dysfunction, especially later in life.

"The considerable impact of circumcision status on sexual practice represents a new finding that should further enrich such discussion," the researchers wrote. "Our results support the view that physicians and parents be informed of the potential benefits and risks before circumcising newborns."

AAP Update on Routine Infant Circumcision - 1999

For Release: March 1, 1999, 5 p.m. (ET)

Below is a highlight of a policy published in the March issue of Pediatrics, the peer-reviewed, scientific journal of the American Academy of Pediatrics (AAP).

CHICAGO - After analysis of almost 40 years of available medical research on circumcision, the American Academy of Pediatrics (AAP) issued new recommendations today stating that the benefits are not significant enough for the AAP to recommend circumcision as a routine procedure. The new policy statement was published in this month's issue of Pediatrics, the journal of the AAP.

"Circumcision is not essential to a child’s well-being at birth, even though it does have some potential medical benefits. These benefits are not compelling enough to warrant the AAP to recommend routine newborn circumcision. Instead, we encourage parents to discuss the benefits and risks of circumcision with their pediatrician, and then make an informed decision about what is in the best interest of their child," says Carole Lannon, M.D., MPH, FAAP, chair of the AAP’s Task Force on Circumcision.

The policy concluded, however, that it is legitimate for parents to take into account cultural, religious and ethnic traditions, in addition to medical factors, when making this decision. It states that to make an informed choice, parents of all male infants should be given accurate information and be provided the opportunity to discuss this decision with their pediatrician.

For the first time in AAP circumcision policy history, the new recommendations also indicate that if parents decide to circumcise their infant, it is essential that pain relief be provided. To assist parents in making the decision of whether or not to circumcise their sons, the AAP policy outlines the potential medical benefits and risks and discusses the use of analgesia.

AAP Policy History Regarding Circumcision Beginning in its 1971 manual, Standards and Recommendations of Hospital Care of Newborn Infants, and reiterated in the 1975 and 1985 revisions, the Academy concluded that there was no absolute medical indication for routine circumcision.

In 1989, due to new research exploring links between circumcision status and both urinary tract infections and sexually transmitted diseases, particularly AIDS, the Academy concluded that newborn male circumcision did have potential medical benefits and advantages, as well as risks. In light of continued medical debate over the last decade regarding those benefits and risks, as well as the publication of new research, the Academy chose to reevaluate its 1989 policy. The new policy recommendations released today are based on analysis of all available medical literature on circumcision currently available, including new studies published in the last 10 years.

Urinary Tract Infections

Although studies show the relative risk of developing a urinary tract infection (UTI) in the first year of life is higher for baby boys who are uncircumcised, the AAP policy concludes that their absolute risk of developing one is low and at most approximately 1 percent. Research indicates that during the first year of life an uncircumcised male infant has at most about a 1 in 100 chance of developing a UTI, while a circumcised male has about a 1 in 1000 chance.

Penile Cancer

Studies conclude that the risk of an uncircumcised man developing penile cancer is more than three-fold that of a circumcised man. However, the AAP policy notes that in the United States only 9 to 10 cases of this rare disease are diagnosed per year per 1 million men, indicating that while the risk is higher for uncircumcised men, their overall risk is extremely low.

Sexually Transmitted Diseases

Some research suggests that circumcised men may be at a reduced risk for developing syphilis and HIV infections. However, the AAP policy states that behavioral factors continue to be far more important in determining a person ’s risk of contracting sexually transmitted diseases than circumcision status.

Analgesia

Considerable new evidence shows that newborns circumcised without analgesia experience pain and stress measured by changes in heart rate, blood pressure, oxygen saturation and cortisol levels. Other studies suggest that the circumcision experience may cause infants to respond more strongly to pain of future immunization than those who are uncircumcised.

In response to this data, the AAP policy states that analgesia has been found to be safe and effective in reducing the pain associated with circumcision, and should be provided if the procedure is performed. Analgesic methods include EMLA cream (a topical mixture of local anesthetics), the dorsal penile nerve block and the subcutaneous ring block.

Complications

Research suggests that circumcision is generally a safe procedure. Complications occur in 1 in 200 to 1 in 500 circumcised newborn males and are most often minor; the two most common are mild bleeding and local infection.

EDITOR’S NOTE: This study was published in the peer-reviewed, scientific journal of the American Academy of Pediatrics, but does not necessarily reflect the policies or opinions of the Academy. The American Academy of Pediatrics is an organization of 55,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.

© 1999 American Academy of Pediatrics

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Dr. Weiss Responds to AAP 1999 Policy Statement

A newspaper headline reporting on the American Academy of Pediatrics’ (AAP) Task Force on Circumcision stated "PEDIATRICIANS NOT PROMOTING CIRCUMCISION, NOT AGAINST IT". This is a fair analysis and actually differs little from the 1989 conclusions reported by this same organization. The opening statements reflect the Committee’s opinion:

"Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision."

An accompanying footnote clearly states:

"The recommendations in this statement do not indicate an exclusive course of treatment or serve as a standard of medical care."

Two aspects in the 1999 Report are emphasized that were not in the earlier Task Force conclusions. As would be expected the cost factor is addressed in the opening paragraph and then concludes with the recommendation for procedural analgesia when performing the operation. Both of these considerations are of major public concern and controversy. Although for years the cost factors from an over all monetary point of view have favored prophylactic neonatal circumcision (Warner E & Strashin E 1981;

CMAJ: 125;973 and Wiswell, T 1990;AFP:41;862), there are other cost considerations. The real costs to patient and public involve aspects that to a large extent remain unresolved. Until such time as data becomes available including longitudinal studies of penile problems over a male’s lifetime and costs of neonatal to late circumcision surgery, it is not possible to debate this issue scientifically. A study by Lawler, FH et al (FM 1991:23;587-593) concluded:

"... that there is no medical indication for or against circumcision.

...The decision regarding circumcision may most reasonably be made on non-medical factors such as parent preference or religious convictions."

Cost considerations from the pediatric and surgical viewpoints are revealing. In the 1970s it became apparent that the power of insurance payments was directing health care. LR King, a member of the 1975 AAP Task Force on Circumcision reported that the reason for the statement "there is no absolute medical indication for circumcision of the newborn" was due to two factors (Weiss GN Int Surg 1986:71;62):

"1) a concern about needless surgery causing pain and suffering, and

2) the thought that insurance dollars spent on neonatal surgery would cover the cost of neonatal intensive care ."

The advances and expenses of the Neonatal Intensive Care Units have now been taken to task by insurers, government and general public. Survival of the afflicted "one-pounders" has become an ethical issue. Furthermore, expenses for genito-urinary care of the uncircumcised infant, child and young adults (not to mention later life penile problems), contrasted to the circumcised neonate, presents a pediatric, as well as adult, cost dilemma. The 1999 AAP Task Force Report conclusion only adds to the confusion:

"Although the relative risk of UTI (Urinary Tract Infection) in uncircumcised male infants is increased from 4- to as much as 10-fold during the first year of life, the absolute risk of developing a UTI in an uncircumcised male infant is low (at most, ~1%). "

Compounding a scientific cost analysis is data availability and manner of presentation. The Report acknowledges the greater frequency of STD, AIDS and penile cancer in the uncircumcised. The low frequency of penile cancer and significance of other considerations leads the Task Force to state:

"Nevertheless, in a developed country such as the United States, penile cancer is a rare disease and the risk of penile cancer developing in an uncircumcised man, although increased compared with a circumcised man, is low., and "However, behavioral factors appear to be far more important risk factors in the acquisition of HIV than circumcision status."

And, of course, the real "bottom line" to all such statements is the fact that:

"The true frequency of these problems [penile] is unknown."

The other consideration as to cost is the surgical one. As a retired surgeon I can speak with experience and more objective critical analysis. As late as the 1980s, when serving in the US military, neonatal circumcision was not even listed as a surgical procedure. It was performed but not recorded as "surgery" on our Report of Operations. Even to this day, this attitude may be reinforced by current malpractice insurance companies. Pediatricians and Family Practitioners, approved as qualified and performing circumcisions in the first year of a child’s life may do so with no special increase in rates. However, if performed after the first year of life, circumcision falls in the category of major surgery and thus premium rates increase!

It is recognized that the majority of American neonatal procedures of this type are done by nurses, medical students, physician assistants, interns or residents who have little or no surgical expertise, training and often no supervision. The most common neonate and male surgery is often performed by non-surgeons!! There is an explanation.

In the United States of America our country was founded on the distinct separation of State and Church. Following this direction, surgeons as a group attributed the procedure to the Hebrew ritual. As the advantage of the secular prophylactic surgical measure reached a height, prompted by military conflicts and scientific confirmations (Weiss, GN and Harter, AW, Circumcision: Frankly Speaking, 1998, Wiser Publications, Fort Collins, CO), neonatal circumcision became a norm for 80% to 90% of newborns during mid century in the U.S. The simplicity and safety of a surgical procedure, not basically considered surgery but ritual, was enhanced with new metal and plastic gadgetry. The Gomco Clamp and Plastibell devices for neonatal circumcision substituted for the trained surgeons’ hands. Hebrew Mohels (i.e., ritual circumcisers), who for centuries were guided by compassion and procedural speed for the eight day old Jewish infant, were rigidly trained for the delicate procedure. They were relegated to the ritual category. Others meantime were to be assured of a safe circumcision, by virtue of technology, even though the operators lacked or had minimal training. Surgeons of the time felt the common and important procedure to be in a ritual and safe category. As for safety of those in the non-ritual group, it depended more on technological safeguards than on trained operators. The warnings of a prominent English surgeon, P. Bousfield (St Bartholomew’s Hospital Journal 1916:24;5) almost a century ago went unheeded:

"The newly qualified surgeon or the advanced student who is called upon to perform some minor operation has in very many instances never seen that operation performed by any member of the senior staff; often his only experience of it may have been a textbook. ... One is inclined to approach circumcision in a somewhat light-hearted manner; it is simple, with but little danger and appears to be very easy. ...this simple little operation is in reality a delicate and by no means to be despised work of art..." Failing to learn the lessons of the past, cited by this Member of the Royal College of Surgeons, the rare complications can be attributed to those inexperienced operators.

Known to me personally is one outspoken anti-circumcision advocate who suffered at the hands of someone apparently untrained for the operation. Slowly, very slowly, others than those in the surgical sphere (Stang, HJ et al PEDIATRICS 1997:100;6) have come to recognize the need that:

"Further study of the procedures utilized in the Jewish brit is warranted."

The above author is recognized by the AAP 1999 Task Force report relative to his neurologic research pointing toward "a more humane circumcision". It seems reasonable and incumbent upon members of the surgical profession to recognize the extreme importance of this neonatal surgery and to begin education of medical students. An E-mail message received from a medical student in Germany this past month illustrates the point:

"Congratulations on your research on circumcision! I find it really deplorable that this uncomplicated but thus so beneficial operation is losing population so rapidly in our days. I am a 24 year old medical student from Germany and I have spent 18 years of my life with a foreskin...and with it with a great many problems. I am circumcised now and more than happy about it. I wish circumcision was the norm here in Germany, because it is - as you might know - very unpopular here. In my med school here circumcision is not even taught. Wish you all the best for your research, Signed"

It is distressing and depressing for me as one who spent a lifetime in surgical care of many thousands of patients while in medical training, private and clinic practice, military and governmental service to see a secular prophylactic health measure be so neglected by my surgical colleagues. Neonatal circumcision is safe preventive surgery that is a viable option in maintaining and promoting quality genital health for males of all ages. In the meantime, the AAP 1999 Task Force conclusion is justified:

"Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision." Long term scientific research will confirm the evidence of hygienic, aesthetic, health preventive and perhaps sociologic aspects of neonatal circumcision. Only by adequate training of pediatricians, family practitioners, urologists, obstetricians— for that matter ALL in the medical community—in the positive and negative concerns of this preventive neonatal surgery will the benefits be fully realized by the American public. It is then that the newborn’s parents will be equipped to give an unqualified informed consent on scientific grounds and not for religious reasons only. Of even greater significance is the need of the surgical profession to take on the responsibility of so vital and delicate an operation that is not below an American surgeon in spite of its simplicity and safety. Rather, "this simple little operation is in reality a delicate and by no means to be despised work of art."

Gerald N. Weiss, M.D.

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Male Genital Odors from Uncircumcised Men

Miami, FL (PRWEB) January 4 2008 - Synerfied Healthcare introduces NodorOT on ismellperfect.com.

NodorOT is a safe and effective OTC (Over The Counter) medicated cream developed in accordance with an FDA approved monograph; This brand was specifically created to remove and prevent MGO (Male Genital Odors) and can be obtained immediately without a prescription exclusively on NodorOT website.

President/CEO and NodorOT Creator, Dominic Adams suffered from MGO since he was a teenager, until he realized his discovery. Adams personally tested the product for several years, which inspired him to share his discovery with the world and created NodorOT. "I could not imagine my sexual life without NodorOT anymore. I have no more fears of repulsing my partner due to bad genital odors. For anyone who has ever dealt with MGO, it is a miracle cream. I went from being embarrassed because of the smell, to being confident." says Adams without embarrassment or shame anymore.

MGO affects men of different ages. It is more likely to occur to men who are not circumcised, due to the moist environment between the foreskin and the glans, which is a favorable ground for development of fungi cells. NodorOT targets the micro-fungi called tinea corporis.

However, MGO can also happen to men who are circumcised.

Statistically, during the past decade, circumcision has dropped from 90% to 56% (almost 50% of the US population*) and the number is increasing. At the present time, approximately one of every three American is not-circumcised. Therefore, there is a potential of approximately 33 million Americans who are at a high possibility of currently having MGO. The percentage is even greater worldwide. The WHO (World Health Organisation) stated in 2006, that about 70% of males are not circumcised worldwide. **

Unlike other products such as scented oils and perfumes, NodorOT does not mask or cover up the smell; it kills, destroys, removes and prevents odors. "Men have had to deal with this problem for centuries, and women had to deal with their partners having MGO. This subject has been taboo for the longest time" says Adams.

"The truth is that, bad MGO is a real turn off to women, and too embarrassing to discuss. Now that NodorOT is available, and that we are able to remove and prevent MGO, I predict that it will rejuvenate many couple's sex life for all users, due to the increased attraction from their partner, and men's increased confidence and happiness level. It inspired our slogan:"Lose the odor, keep your lover. NodorO, get someT".

NodorOT is proudly manufactured in the United-States in compliance with the FDA's GMP (Good Manufacturing Practice) regulations.

NodorOT is available for ordering on our website at: ismellperfect.com

 

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Surgical Glue Removes Much Pain and Time From Closing Wounds

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