Mannenbesnijdenis redt MILJOENEN levens

[morte-vivante]

Oorspronkelijk geplaatst door Eliyahu

de (niet-bestaande) nadelen.

Circumcision was associated with frequent orgasm difficulties in Danish men and with a range of frequent sexual difficulties in women, notably orgasm difficulties, dyspareunia and a sense of incomplete sexual needs fulfilment.

http://ije.oxfordjournals.org/conten...04.short?rss=1

[Havanna]

Oorspronkelijk geplaatst door Eliyahu

Bs'd

Geef aub onderbouwing en harde cijfers voor deze woeste kreten.

Kijk door je religieuse waas dan zie je misschien de link

[Havanna]

Myth 1: They just cut off a flap of skin.

Reality check: Not true. The foreskin is half of the penis's skin, not just a flap. In an adult man, the foreskin is 15 square inches of skin. In babies and children, the foreskin is adhered to the head of the penis with the same type of tissue that adheres fingernails to their nail beds. Removing it requires shoving a blunt probe between the foreskin and the head of the penis and then cutting down and around the whole penis. Check out these photos: http://www.drmomma.org/2011/08/intac...gnificant.html

Myth 2: It doesn't hurt the baby.

Reality check: Wrong. In 1997, doctors in Canada did a study to see what type of anesthesia was most effective in relieving the pain of circumcision. As with any study, they needed a control group that received no anesthesia. The doctors quickly realized that the babies who were not anesthetized were in so much pain that it would be unethical to continue with the study. Even the best commonly available method of pain relief studied, the dorsal penile nerve block, did not block all the babies' pain. Some of the babies in the study were in such pain that they began choking and one even had a seizure (Lander 1997).

Myth 3: My doctor uses anesthesia.

Reality check: Not necessarily. Most newborns do not receive adequate anesthesia. Only 45% of doctors who do circumcisions use any anesthesia at all. Obstetricians perform 70% of circumcisions and are least likely to use anesthesia - only 25% do. The most common reasons why they don't? They didn't think the procedure warranted it, and it takes too long (Stang 1998). A circumcision with adequate anesthesia takes a half-hour - if they brought your baby back sooner, he was in severe pain during the surgery.

Myth 4: Even if it is painful, the baby won't remember it.

Reality check: The body is a historical repository and remembers everything. The pain of circumcision causes a rewiring of the baby's brain so that he is more sensitive to pain later (Taddio 1997, Anand 2000). Circumcision also can cause post-traumatic stress disorder (PTSD), depression, anger, low self-esteem and problems with intimacy (Boyle 2002, Hammond 1999, Goldman 1999). Even with a lack of explicit memory and the inability to protest - does that make it right to inflict pain? Ethical guidelines for animal research whenever possible* - do babies deserve any less?

http://www.psychologytoday.com/blog/...likely-believe

[Eliyahu]

Oorspronkelijk geplaatst door Weyland

De penis wordt iets smaller in breedte en de gevoeligheid neemt sterk af.

Bs'd

Nee dus. De gevoeligheid neemt niet af:

Hier zijn nog wat wetenschappelijke onderzoeken naar de gevoeligheid bij besnijdenis:

http://www.nu.nl/wetenschap/1173562/...ksplezier.html

http://www.nu.nl/lifestyle/2148770/s...t-zo-fijn.html


Seks met besneden man net zo fijn

Laatste update: 21 december 2009 11:37 info
AMSTERDAM – Speculaties (zelfs van experts) ten spijt: seks met een besneden man blijkt net zo fijn als seks met een onbesneden evenknie. Dat stelden onderzoekers vast.
Foto: Gezondheidsnet

Lange tijd werd gedacht dat een besnijdenis bij mannen van negatieve invloed is op het seksplezier van vrouwen, maar onderzoek dat werd uitgevoerd in Uganda bewijst het tegendeel.

Een overgrote meerderheid van de 455 ondervraagde vrouwen geeft althans aan geen verschil te merken of de seks beter te vinden met een besneden man.

Beter

Slechts 13 vrouwen (nog geen 3 procent van het totaal) zegt wel minder bevredigd te zijn nadat haar man zich heeft laten besnijden. Het grootste deel (57 procent) merkt echter geen verschil en 40 procent noemt de seks beter.

De belangrijkste redenen voor het toenemen van de bevredigingen zijn betere hygiëne, meer orgasmen voor de man, meer orgasmen voor de vrouw, verhoogd libido bij de man en betere erecties.

Het afnemen van de seksuele bevrediging zou met name te maken hebben met verminderd libido bij de man of bij de vrouw, en erectieproblemen.

Positief

De overwegend positieve ervaringen van vrouwen met besnijdenis, moeten ertoe leiden dat de populariteit van de ingreep toeneemt. Dit is belangrijk omdat eerder onderzoek aantoonde dat de kans op hiv en aids met ruim de helft afneemt na een besnijdenis. In een interview met Reuters noemt dokter Robert Bailey, verbonden aan de universiteit van Illinois en niet betrokken bij het onderzoek, de uitslagen dan ook ‘uniek en belangrijk’.

De 455 vrouwen die deelnamen aan het onderzoek waren, voor en na de besnijdenis van hun man, allemaal tussen de 15 en 49 jaar oud. De cijfers zijn representatief voor de variabelen leeftijd, religie en opleidingsniveau.

Mannen

Hoe mannen seks ervaren na een besnijdenis is niet onderzocht. Een eerdere studie zou echter hebben vastgesteld dat zijn ervaringen, voor en na de ingreep, weinig veranderen. Het onderzoek wordt opgenomen in het British Journal of Urology International.

Oftewel: Volwassenen die besneden worden, die hebben daar gewoon geen problemen mee.

Besnijdenis geeft niet minder seksplezier

http://gezondheid.blog.nl/algemeen/2...er-seksplezier

Mannen die besneden zijn hebben net zo veel plezier tijdens de seks als hun seksegenoten die niet besneden zijn. Dit blijkt uit een Canadese studie. Tot nu toe werd aangenomen dat besnijdenis het seksuele genot vermindert.

Volgens de onderzoekers van de Mc Gill University in Montreal ervaren mannen zonder voorhuid dezelfde gevoeligheid voor tast en pijn in verschillende stadia van seksuele opwinding als die met voorhuid.

Veertig personen, waarvan de helft besneden is, deden mij aan het onderzoek. Tijdens het bekijken van een pornofilm kregen de deelnemers sensoren op de penis en onderarm om de seksuele prikkels te meten. De resultaten van het onderzoek zijn gepubliceerd in het vaktijdschrift The Journal of Sexual Medicine.


New Circumcision and Sexual Satisfaction Study a Cut Above

http://sexuality.about.com/b/2008/01...-cut-above.htm

98% of men reported sexual satisfaction and normal sexual function after circumcision

A study, published in the January issue of BJU International, sheds more light on the impact of circumcision on male sexual satisfaction and function. It also significantly raises the bar in terms of methodology and reduced rhetoric in a research area that is highly politicized and fraught with problems.

The study involved 4, 456 sexually experienced Ugandan men (aged 15 to 49) who were HIV negative. All men were scheduled to receive circumcision, however one group was circumcised as soon as the study began and a second group was circumcised 2 years later. Researchers looked at sexual desire, satisfaction and function in both groups at six, 12, and 24 months. Their findings included:

98.6 per cent of the circumcised men reported no problems in penetration, compared with 99.4 per cent of the control group.
99.4 per cent of the circumcised men reported no pain on intercourse, compared with 98.8 per cent of the control group.
Sexual satisfaction was more or less constant in the circumcision group – 98.5 per cent on enrolment and 98.4 per cent after two years – but rose slightly from 98 per cent to 99.9 per cent in the control group. This difference was not felt to be clinically significant.
At the six-month visit there was a small, but statistically significant, difference in problems with penetration and pain among the circumcised group, but this was temporary and was not reported at subsequent follow-up visits.

Soms (zelden) mislukt de operatie en heeft de besnedene voor de rest van zijn een pijnlijke penis en geen seksleven.

Dat komt zo weinig voor dat het verwaarloosbaar is. Misschien 1 op de miljoen keer.

Dat noem ik toch best nadelen. Verder wordt je zeker niet immuun voor SOA na een besnijdenis en wordt het effect ervan sterk overdreven ("miljoenen levens").

Waarom spui je zoveel onzin als je overduidelijk niet weet waar je het over hebt??

http://www.ucsf.edu/news/1999/11/505...hiv-infections

A preliminary analysis by Halperin and Malcolm Potts, MD, PhD, Bixby Professor of Population and Family Planning at the UC Berkeley School of Public Health estimates that the practice of male circumcision has so far prevented at least 8 million HIV infections in the 15 African and Asian countries cited in the editorial review alone.

Verder moet je weten dat het jodendom een rare religie is voor menige niet-jood en in feite een set van vooropgestelde sprookjes is waarin een volwassene dan gelooft voor het oog van de buitenstaander.

Het gaat hier over de besnijdenis, niet over het joods geloof.

Dat sommigen van die volwassenen bij hun zonen een stuk van hun geslacht afsnijden komt dat ook best eng over, zeker als mensen vinden dat dat stuk er perfect normaal uitziet (persoonlijk denk ik dat het er beter eruitziet intact en vind ik dat besneden penissen eruitzien alsof ze verminkt zijn geweest; bovendien vinden de meeste mannen in landen waar vrouwen besneden worden clitorissen ook 'vies', de arme stakkers).

The Badger study in Australia:

http://www.circinfo.net/socio_sexual_aspects.html

As far as attitudes and sexual behaviour are concerned, perhaps the first, albeit small and restricted, but interesting survey of circumcised versus uncircumcised men and their partners was conducted by University of Sydney biomedical scientist James Badger [Badger, 1989b; Badger, 1989a] (who used to regard himself as neutral on the issue of circumcision, but would now appear swayed by the evidence into adopting a ‘pro’ stance, not surprisingly for any scientist who follows the research findings). His study involved responses to a questionnaire placed in clinics of the Family Planning Association in Sydney. This led to 180 participants (79 male, 101 female) who were aged 15-60. The women were mainly (50%) in the 20-30 year-old age group cf. 25% of the men, more of whom (33%) were aged 30-40. It found that:

• 18% of uncircumcised males underwent circumcision later in life anyway.

• 21% of uncircumcised men who didn't, nevertheless wished they were circumcised. (There were also almost as many men who wished they hadn't been circumcised and it could be that at least some men of either category may have been seeking a scapegoat for their sexual or other problems. In addition, this would no doubt be yet another thing children could "blame" their parents for, whatever the decision was when their child was born.)

• No difference in sexual performance.

• Slightly higher sexual activity in circumcised men.

• No difference in frequency of sexual intercourse for older uncircumcised vs. circumcised men.

• Men who were circumcised as adults were very pleased with the result. The local pain when they awoke from the anesthetic was quickly relieved by pain killers (needed only for one day), and all had returned to normal sexual relations within 2 weeks, with no decrease in sensitivity of the penis and claims of "better sex". (Badger's findings are, moreover, consistent with every discussion the author has ever had with men circumcised as adults, as well as an enormous number of email messages received from many such men. The only cases to the contrary were a testimonial in a letter sent to the author from a member of UNCIRC and a very brief email message that didn't say why.)

• Women with circumcised lovers were more likely to reach a simultaneous climax - 29% vs. 17% of the study population grouped across the orgasmic spectrum of boxes for ticking labeled "together", "man first", "man after" and "never come"; some ticked more than one box. (Could the superior response involve psychological factors? ... Could it be that more circumcised men have a better technique? ... Or could other factors be involved?)

• Women who failed to reach an orgasm were 3 times more likely to have an uncircumcised lover. (These data could, however, possibly reflect behaviors of uncircumcised males that might belong to lower socio-economic classes and/or ethnic groups whose attitudes concerning sex and women may differ from the better-educated groups in whom circumcision is more common.)

• A circumcised penis was favoured by women for appearance and hygiene. (Furthermore, some women were nauseated by the smell of the uncircumcised penis, where, as mentioned in another section earlier, bacteria and other micro-organisms proliferate under the foreskin.)

• An uncircumcised penis was found by women to be easier to elicit orgasm by hand.

• An circumcised penis was favoured by women for oral sex (fellatio).

A survey of 5,000 men aged 16-49 (78% circumcised, 19% not, 3% "don't know") was subsequently conducted by Badger. This was open to all, and so included men who were anti-circumcision activists and those who were not. Circumcision had been performed at birth in 72%, before puberty in 12% and after puberty in 16%. Of those who said someone else decided for them to be circumcised, only 16% said they were unhappy to be circumcised; 46% were happy and 38% didn't care. Overall only 11% said they would not circumcise any son(s).

These findings are consistent with later studies.

[Eliyahu]

Oorspronkelijk geplaatst door Havanna

Kijk door je religieuse waas dan zie je misschien de link

Bs'd

Je kan dus zoals gewoonlijk geen onderbouwing geven.

Geraaskal zonder onderbouwing gaat zonder onderbouwing de afvalbak in.

[Havanna]

Oorspronkelijk geplaatst door Eliyahu

Bs'd
Je kan dus zoals gewoonlijk geen onderbouwing geven.
Geraaskal zonder onderbouwing gaat zonder onderbouwing de afvalbak in.

Je weigert dus zélf de nadelen je achterlijke godregeltje te lezen.

[Eliyahu]

Oorspronkelijk geplaatst door Havanna

Reality check: Not true. The foreskin is half of the penis's skin, not just a flap.

Bs'd

Gelukkig hebben ze meer verstand van psychologie.

Myth 2: It doesn't hurt the baby.

Reality check: Wrong. In 1997, doctors in Canada did a study to see what type of anesthesia was most effective in relieving the pain of circumcision. As with any study, they needed a control group that received no anesthesia. The doctors quickly realized that the babies who were not anesthetized were in so much pain that it would be unethical to continue with the study. Even the best commonly available method of pain relief studied, the dorsal penile nerve block, did not block all the babies' pain. Some of the babies in the study were in such pain that they began choking and one even had a seizure (Lander 1997).

Vandaar dat er in Israel, waar alle jongetjes besneden worden, er zoveel stikken en stuipen krijgen tijdens de besnijdenis.

Myth 4: Even if it is painful, the baby won't remember it.

Reality check: The body is a historical repository and remembers everything. The pain of circumcision causes a rewiring of the baby's brain so that he is more sensitive to pain later (Taddio 1997, Anand 2000). Circumcision also can cause post-traumatic stress disorder (PTSD), depression, anger, low self-esteem and problems with intimacy (Boyle 2002, Hammond 1999, Goldman 1999).

Dus daarom hebben alle joden PTSD, depressiviteit, woedeaanvallen, laag zelfvertrouwen, en problemen met intimiteit.

Is dat ook weer opgelost.

[Havanna]

Oorspronkelijk geplaatst door Eliyahu

Bullshit
Besnijdenis is een goede extra bescherming.

A baby's long foreskin prevents the re-entry of urine. Ammonia from stale urine attacking the meatus, the opening of the urethra in the glans of a circumcised baby, is believed to attack the delicate surface, creating an ulcer. Bacteria like E. coli may also play a part. This can lead to narrowing (stenosis) of the meatus, which may have to be corrected by surgery; meatotomy. Patel found 31 cases of meatal ulcer and 8 meatal stenoses in 100 circumcisions. Meatal ulcer can cause urinary retention and if untreated, kidney failure.

http://www.circumstitions.com/Complic.html#haemorrhage

[Eliyahu]

Oorspronkelijk geplaatst door Havanna

Je weigert dus zélf de nadelen je achterlijke godregeltje te lezen.

Bs'd

De feiten zijn dat de besnijdenis in de afgelopen decennia MILJOENEN mensen gered heeft van een langzame pijnlijke dood aan AIDS.

En nu de feiten over de complicaties:



Having described the benefits, let's look at the risks. Surgical complications for large published series range from 0.2% to 0.6% [Wiswell & Geschke, 1989; Cilento et al., 1999; Christakis et al., 2000]. Higher rates of 2–10% have been reported in much older and smaller studies [Kaplan, 1983; Griffiths et al., 1985; Frank, 2000].

One large study, conducted in US Army hospitals from 1980 to 1985, found that for 100,157 boys who were circumcised in the first month of life, there were 193 complications (0.19%) [Wiswell & Geschke, 1989]. These included 62 local infections, 83 instances of hemorrhage (31 requiring ligatures and 3 requiring transfusion), 25 instances of surgical trauma, 20 urinary tract infections (com,pared with 88 UTIs in the 35,929 boys in this study who had not been circumcised), and 8 cases of bacteremia (compared with 32 in the uncircumcised). There were no deaths or reported losses of the glans or entire penis. However, in the uncircumcised boys, 3 developed meningitis, 2 got renal failure and 2 died.

The largest study, of 354,297 male infants born in Washington State from 1987–1996, noted a complication rate in the 130,475 who were circumcised during their newborn hospital stay of only 0.21% (1 in 476) [Christakis et al., 2000]. It was then calculated that 6 UTIs could be prevented for every circumcision complication, and 1 penile cancer could be prevented for every 2 complications.

Of 9,668 neonatal circumcisions performed in Kaiser Permanente Northern California hospitals none resulted in complications [Schoen et al., 2006].

In a small study of 500 New Zealand boys followed over a longer period, namely from birth to 8 years of age, the rate of penile problems was almost 2-fold higher in those who were not circumcised (19% versus 11%). Moreover, if both minor and more serious problems had not been lumped together, this study would have shown a much higher rate of problems in the uncircumcised [Fergusson et al., 1988].

In a small study of 500 New Zealand boys followed over a longer period, namely from birth to 8 years of age, the rate of penile problems was almost 2-fold higher in those who were not circumcised (19% versus 11%). Moreover, if both minor and more serious problems had not been lumped together, this study would have shown a much higher rate of problems in the uncircumcised [Fergusson et al., 1988].

An old study, spanning 1963 to 1972, in a US hospital in which circumcision rate was 94%, reported 111 of 5,521 newborns incurred a complication of any degree [Gee & Ansell, 1976]. Thus total complication rate was 2.0% (1 in 50). This included easily treatable outcomes as well as serious ones. For only 0.2% were adverse outcomes serious (a single case of a life-threatening hemorrhage, 4 systemic infections, 8 circumcisions of infants with hypospadias, and one complete denudation of the penile shaft). Thus risk was very low even in an old study like this one.

A study in 2005 of 19,478 circumcisions in Israel (on day 8 after birth), and made up of 83% ritual circumcisions and 17% involving a physician, found a complication rate of 0.34% [Ben Chaim et al., 2005]. The breakdown is shown below, to which has been added comments by Dr Sam Kunin, a urological surgeon from Los Angeles who is very experienced in the field of circumcision.
–

Excess skin left 0.19%. This can be illusory. Dr Kunin says that if a baby is chubby, has an abundant prepubic fat pad or scrotal swellings from hydrocele or hernia it may look like not enough skin has been removed, when in reality the circumcision has been a good one. One can test this by seeing whether the glans penis is apparent in the erect state. To do this one can depress the fat surrounding the penis at the 3.00 and 9.00 o’clock positions to the pubic symphysis. If the glans is seen the circumcision is satisfactory. If the inner layer of foreskin is not completely freed up before circumcision there may be uneven inner skin left. This can lead to ‘buried penis’, which is when the penis retracts into the fat pad. It can occur with the Mogen method and is avoided by Gomco. Adhesions can develop between the glans penis and the remnant of the foreskin. To avoid this, parents must be instructed to routinely push the skin off the glans. Buried penis after newborn circumcision is not permanent, however, and, in most cases, resolves as the infant becomes older and begins to walk [Erog˘lu et al., 2009]. Thus surgery for buried penis is not recommended in boys less than 3 years [Erog˘lu et al., 2009].
–

Acute bleeding 0.08%. Although rare, this is more prone to occur with a ritual shield. It cannot occur with the Plastibell.

–


Penile torsion 0.03%. This is congenital, but can be revealed by circumcision. It does not affect function
–

Skin shortage 0.02%. This is unlikely to occur if the circumciser is experienced
–

Wound infection 0.01%. Although rare, this can be more common with Plastibell, if instruments are not sterilized adequately, or if in a ritual Jewish ceremony the mohel performs metzitza b’ pe (the sucking of blood from the would by mouth – which can also lead to herpes simplex type 1 infection).
–

Partial amputation 0.005% (n = 1). Partial amputation cannot occur with the Plastibell or Gomco clamp, but is a remote possibility for Mogen clamps or, in Jewish ritual circumcisions, shields.
–

Inclusion cysts can occur, most often with the Mogen procedure, since freeing up the foreskin from the glans is blind and does not include cleaning out smegma, which becomes trapped in the line of the clamp to form a cyst. In Gomco and Plastibell a dorsal slit in the foreskin is made after clamping and at this time all inner connections can be released and smegma removed.

Dr Kunin is acknowledged for the clinical explanations and advice above. He says that it is important to equate a given complication with what tool is used, but overall complications should approach zero for an experienced operator.

Thus, in this study, complications were rare, mild and virtually all easily correctable, with little difference in rate between ritual and medical circumcisions.

An overall summary of the various complications of circumcision in infancy and the rates of each appears below. This information is taken from references: [Wiswell & Geschke, 1989; Wiswell, 1992; Wiswell, 1995; Wiswell, 1997a; Alanis & Lucidi, 2004].

•


Excessive bleeding: Occurs in 1 in 1,000. This is treated with pressure or locally-acting agents, but 1 in 4,000 may require a ligature, and 1 in 20,000 may need a blood transfusion because they have a previously unrecognized bleeding disorder. Hemophilia in the family is of course a contra-indication for circumcision.

•


Infection: Local infections occur in 1 in 100-1,000 and are easily treated with local antibiotics. Systemic infections may appear in 1 in 4,000 and require intravenous or intramuscular injection of antibiotics.

•


Subsequent surgery: Needed for 1 in 1,000 because of skin bridges, or removal of too much or too little foreskin. Repair of injury to penis or glans required for 1 in 15,000. Loss of entire penis: 1 in 1,000,0000, and is avoidable by ensuring the practitioner performing the procedure is competent. Injuries (rare) can be repaired [Baskin et al., 1997; Thompson et al., 2006; Shaeer et al., 2008] and in the extraordinarily remote instance of loss of the penis it can be reattached surgically [Ozkan & Gurpinar, 1997] and reconstruction is also possible [Beniamin et al., 2008; Shaeer, 2008]. (Successful reattachment can also follow adult self-inflicted penile amputation [Landström et al., 2004].)

•


Local anesthetic: The only risk is when the type of anesthetic used is a dorsal penile nerve block, with 1 in 4 having a small bruise at the injection site. This will disappear.

•


Death: Data in the records show that between 1954 and 1989, during which time 50,000,000 circumcisions were performed in the USA there were only 3 deaths, but during this period there were 11,000 from penile cancer, a disease essentially confined to the uncircumcised [Wiswell & Geschke, 1989; Wiswell, 1997a]. Wiswell found there were 2 deaths in those NOT circumcised, but NONE in the 3 times as many who were circumcised [Wiswell & Geschke, 1989]. The 3 deaths noted by Wiswell for the 35 years to 1989 were in children circumcised at home by a mohel (a Jewish religious circumciser). Both of them had hemophilia (a new genetic mutation in their families, as there was no family history in either case). The remaining death was due to infection in a 1.9 kg premature infant. In the largest published series of complications due to circumcision …. Speert's in the 1950s (~500,000 boys) [Speert, 1953], Wiswell’s in 1989 (~100,000 boys) [Wiswell & Geschke, 1989], and Christakis's in 2000 (~135,000 boys) [Christakis et al., 2000] …. there were no deaths from medical circumcisions. One death was reported by Speert, but involved a circumcision performed by a mohel who was not only unqualified, he wasn’t even registered with the New York board of mohelim. In a personal email communication in July 2009, Wiswell states “In the U.SA. I have not read of or heard of any NEONATAL circumcision deaths over the subsequent 20 years since our [1989] publication.” But for later circumcisions, Wiswell states “I am aware of one death in Cleveland just prior to a child's second circumcision at 4 months of age ... the parents did not like the appearance and a urologist agreed to do the second procedure. Prior to even starting, the anesthesiologist inadvertently injected air into the child's vascular system and the child died before even being cleansed for the procedure.” In the U.K., a report in 1949 by Gairdner noted 16 deaths "due to circumcision" during the World War II years, even though “circumcision” and “phimosis” were lumped together on autopsy sheets for cause of death. Jake Waskett points out (personal email communication in July 2009) that this death rate has been used by the anti-circumcision movement to incorrectly claim a “curiously precise figure of 220. The figure does not represent actual, documented deaths. The figure is an estimate, extrapolated from (a) the number of circumcisions performed annually in the USA, and (b) the death rate reported by Gairdner (16 in 90,000) in 1949 in the UK. Applying Gairdner's figures seems wholly inappropriate, given that he didn't study neonatal circumcision, but that of (mostly) older children, and as he noted most of the deaths were due to the complications of general anesthesia (using the now outmoded and more dangerous anesthetics chloroform or ether), which is not required in infancy. The American Academy of Family Physicians quote a figure of 1 in 500,000, citing King who in turn cited the study by Speert. This translates to about 1–2 deaths per year in the U.S.A. Such deaths are surely outnumbered by the number of deaths due to severe kidney infections that, in turn, are attributable to non-circumcision.”

In Jewish ritual circumcision tightly wrapped gauze is used to stop minor bleeding (as compared to use of local pressure in hospitals), and it is thought that this can cause urinary retention and hence UTI [Harel et al., 2002]. Not surprisingly, complication rates are higher when circumcision is carried out by individuals who are not medically trained [Ozdemir, 1998].

Although very rare, complications from use of the Plastibell method have been reported, and include a higher rate of infection [Gee & Ansell, 1976], proximal migration and tissue strangulation if the Plastibell chosen is too large [Cilento et al., 1999], pressure necrosis of the glans if a Plastibell is used that is too small [Cilento et al., 1999], urinary retention [Mihssin et al., 1999], distended bladder [Ly & Sankaran, 2003], sepsis [Kirkpatrick & Eitzman, 1974; Lazarus et al., 2007] and post-operative bleeding because of failure to ensure that the ligature was tied sufficiently tightly [Lazarus et al., 2007]. In a study in Pakistan, the most common complication was Plastibell impaction, managed by cutting the Plastibell, and occurred in 2.3% of babies under 3 months, increasing gradually to 26.9% for children over 5 years [Samad et al., 2009]. To illustrate the rarity of complication, in a study of 2,000 neonates there were no serious sequelae at all [al-Samarrai et al., 1988]. In the case of the Gomco clamp excessive removal of foreskin tissue can occur [Gee & Ansell, 1976].

A 12-fold higher incidence of methicillin-resistant Staphyloccocus aureus (11 cases) has been seen in circumcised versus uncircumcised neonates during brief periods when there were outbreaks of this bacterium in a nonteaching community hospital [Nguyen et al., 2007]. Contributing factors were longer hospital stay, uncovered circumcision equipment, poor hand hygiene practices, and use of multiple dose lidocaine vials for the local anesthetic used. All of these are avoidable and can be addressed to greatly reduce this risk. None of the infants suffered long-term harm. Moreover, such occurrences are rare.

A claim by Robert Van Howe that circumcision leads to increased meatal stenosis lacks credibility, especially as this “research” study involved personal observations by this renowned anti-circumcision activist [Van Howe, 2006]. The study has been resoundingly criticized, and the conclusion drawn in that study even contradicts the data on which the claim is based [Schoen, 2007a]. Further flaws have been pointed out by an associate professor at The University of Sydney, Guy Cox (personal communication) who notes that the paper states: "a genital examination was performed only if indicated, usually at a well-child visit or for a complaint for which a genital examination would be warranted. This bias may have slightly increased the estimated incidence of meatal stenosis, but the impact of this potential source of bias is tempered by the predominance of examinations associated with well-child visits." Presumably complaints "for which a genital examination would be warranted" would be mainly urological (the only other condition one might think of would be undescended testes). Such complaints only need to represent 7% of his cases for the whole correlation to disappear! If well-child medicals gave such a large proportion of his subjects, why did he not confine the study to those? One can only assume that it was because the statistical significance of the data disappeared.

Topical use of a lubricant (petroleum jelly) on the circumcision site after diaper change for 6 months prevented meatal stenosis in boys aged less than 2 years [Bazmamoun et al., 2008]. In the group not managed in this way, meatal stenosis was 6.6%. The lubricant also reduced infection (by 87%), bleeding (by 84%), and time to recovery (3.8 versus 4.2 days). This study did not include an uncircumcised group for comparison, so frequency of meatal stenosis in the absence of circumcision is not known in this Iranian population.

Not surprisingly, nonmedical, co-called “community circumcision” of infants and children is associated with higher risk of complications, as reported in the U.K. [Corbett & Humphrey, 2003].

It should be stressed that there are contraindications to circumcision in the case of prematurity, family history of bleeding disorders (hemophilia), penile abnormalities (hypospadias, epispadias, micropenis, ambiguous genitalia, megalourethra, webbed penis) in which the foreskin might be required to reconstruct the penis at a later date [Alanis & Lucidi, 2004]. However, the use of tubularized incised plate urethroplasty has virtually eliminated the need for skin flaps in anterior hypospadias repair [Pieretti et al., 2008].

Thus risks in doing a circumcision are exceedingly low.

[Eliyahu]

Oorspronkelijk geplaatst door Havanna

http://www.circumstitions.com/Complic.html#haemorrhage

Bs'd

http://www.circinfo.net/urinary_tract_infections.html

Infections of the urinary tract (UTI) are regarded as being COMMON in the pediatric population [Koyle et al., 2003] and can lead to significant morbidity [Chon et al., 2001]. The highest prevalence and greatest severity of UTIs in boys is prior to 6 months of age [Wiswell, 1997a; Schoen et al., 2000a], decreasing after infancy [Zorc et al., 2005a]. The younger the infant, the more likely and severe will be the UTI and the greater the risk of sepsis and death [Schoen, 2005c]. In western Sydney, by the age of 7 years, 2% (definitely) and another 5% (probably) of boys have had at least one UTI [Sureshkumar et al., 2009].

UTI in children can involve just the lower urinary tract (acute cystitis) and/or infection of the kidney itself (acute pyelonephritis) [Bensman & Ulinski, 2009].

A preliminary study in Sweden has shown that early breastfeeding might also lower UTI [Marild et al., 2004], but, whilst worthwhile for many reasons, is less effective, and cannot be advocated as a replacement for circumcision. Moreover, a New Zealand study found no relationship between circumcision status and breastfeeding outcomes, nor health and cognitive ability outcomes [Fergusson et al., 2007]. Thus circumcision does not disrupt breastfeeding. In fact in this study uncircumcised infants had twice as many lower respiratory tract infections (21% vs. 11%) [Fergusson et al., 2007]. Research showing an association of UTI with lack of circumcision is extensive and the link is now unequivocal. Most of the evidence has emerged over the past 25 years or so.
High risk of UTI conferred by lack of circumcision:
INFANTS AND CHILDREN:

In 1982 it was reported that 95% of UTIs in boys aged 5 days to 8 months were in uncircumcised infants [Ginsburg & McCracken, 1982]. This was confirmed by Wiswell in 1982 and a few years later Wiswell and colleagues found that in 5261 infants born at one US Army hospital, 4% of UTI cases were in uncircumcised males, but was only 0.2% in those who were circumcised [Wiswell et al., 1985]. This relatively captive population in Hawaii was said to be more reliable than the rate reported for hospital admissions [Wiswell, 2000].

Wiswell then went on to examine the records for 427,698 infants (219,755 boys) born in US Armed Forces hospitals from 1975-79 and found that the uncircumcised had an 11-fold higher incidence of UTIs [Wiswell & Geschke, 1989]. 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 [Wiswell et al., 1987]. Reviews by others in the mid-80s concluded there was a lower incidence in circumcised boys [Roberts, 1986; Lohr, 1989].

The rate in girls was stable during the period it was increasing in boys, in whom circumcision was in a decline. In a 1993 study by Wiswell of 209,399 infants born between 1985 and 1990 in US Army hospitals worldwide, 1046 (496 boys) got UTI in their first year of life [Wiswell & Hachey, 1993]. The number was equal for boys and girls, but was 10 times higher for uncircumcised boys. Among the uncircumcised boys younger than 3 months, 23% had bacteremia, caused by the same organism responsible for the UTI.

In a study of 14,893 male infants aged less than 1 year who had been delivered during 1996 at Kaiser Permanente hospitals in Northern California, with 65% circumcised, 86% of the UTIs occurred in the uncircumcised boys [Schoen et al., 2000a; Schoen et al., 2000c]. The mean cost of management in the boys was US$1,111, being twice that of girls (US$542), reflecting a higher rate of hospital admission in uncircumcised males with UTI (27%) compared with females (7.5%). Mean age at admission also differed: 2.5 months for uncircumcised boys vs 6.5 months for girls. Total cost was 10-times higher for uncircumcised boys vs girls ($155,628 vs $15,466).

There were 132 episodes of UTI in uncircumcised males, but only 22 in those who had been circumcised. Hospital admissions were 38 vs 4, respectively. Incidence during the first year of life was 2.2% in uncircumcised boys and just 0.22% in circumcised boys (odds ratio = 9:1). The incidence in the girls was 2%. In a commentary to this article, Wiswell points out that half of infants with acute pyelonephritis get renal scarring that then goes on to predispose to serious, life-threatening conditions later in life, meaning also a large, ongoing cost [Wiswell, 2000]. If circumcisions were no longer done in the USA one woud expect 20,000 cases of acute pyelonephritis annually [Roberts, 1996]. Unlike adults, children, especially the very young, are more likely to develop such renal injury and scarring. In fact imaging studies have shown that 50-86% of children with febrile UTI and presumed pyelonephritis have renal parenchymal defects [Rushton & Majd, 1992b], which persist. Nuclear scans following the treatment of UTI in febrile infants have noted scarring in 10-30% of cases [Hoberman et al., 1999]. In a 27-year follow-up study risk of hypertension in these was 10-20%, and 10% were at risk of end-stage renal disease [Jacobson et al., 1989].

The UTI may be accompanied by increased sodium excretion, decreased filtration by the kidney and high levels of the pressor agents renin and aldosterone [Schoen et al., 2002]. In febrile infants bacteruria is seen in 36% of uncircumcised boys, indicating that a UTI is the likely cause of the febrile symptoms, but was only 1.6% of those who were circumcised, a 22.5-fold difference [Hsiao et al., 2006].

UTIs are thus far from benign disorders of infancy. Moreover, the AAP Subcommittee on Urinary Tract Infections recommends a urine culture for any child under 2 with unexplained fever.

It should be noted that these studies gave figures for infants admitted to hospital for UTI, so that the actual rate would undoubtedly have been higher. Moreover, many fevers for which infants are admitted could have an undiagnosed UTI as the basis. The rate of UTI in uncircumcised boys may thus be higher than 2%.

The infection can travel up the urinary tract to affect the kidney, so explaining the higher rate of problems such as pyelonephritis referred to above and renal scarring (seen in 7.5% [Ramet et al., 1997]) of uncircumcised children [Stull & LiPuma, 1991; Rushton & Majd, 1992a]. In those with febrile UTI, 34%-70% have pyelonephritis [Zorc et al., 2005a]. And, as mentioned above, imaging studies have revealed renal parenchymal defects in 50-86% of children with febrile UTI and presumed pyelonephritis [Rushton & Majd, 1992b]. In the first year of life 90% of UTIs have pyelonephritis [Rushton, 1997b]. Of those with acute pyelonephritis, 36-52% will subsequently develop renal scarring [Rushton, 1997b], [Wallin & Bajc, 1993; Jakobsson et al., 1994; Benador et al., 1997].

The E. coli responsible for UTI form impenetrable, protective “pods” on the walls of the bladder, so explaining the well-known ability of the bacteria responsible for UTI to persist in the face of robust host defences and antibiotic administration [Anderson et al., 2003; Mysorekar & Hultgren, 2006]. Such a mechanism explains recurrent UTIs.

Alarmingly, amongst boys with UTI, 19% of those uncircumcised experienced recurrent UTIs, whereas none of the circumcised did [Conway et al., 2007].

Premature uncircumcised boys had an 11-fold increase in risk of UTI and circumcision eliminated the risk of recurrence of UTI in a study in Augusta, Georgia [Cason et al., 2000].

These and other reports – e.g., [Ginsburg & McCracken, 1982; Glennon et al., 1988; Herzog, 1989; Crain & Gershel, 1990; Stull & LiPuma, 1991; Rushton & Majd, 1992b; Rushton & Majd, 1992a; Spach et al., 1992; Craig et al., 1996; Shaw et al., 1998; Cason et al., 2000; World, 2008b] – all point to the benefits of circumcision in reducing UTI. Because UTIs are associated with long-term morbidity and potential mortality [Koyle et al., 2003], prevention by measures such as infant male circumcision is highly desirable.

Wiswell performed a meta-analysis of all 9 studies that had been published up until 1992 and found that every one had observed an increase in UTI in the uncircumcised [Wiswell & Hachey, 1993]. The average was 12-fold higher and the range was 5- to 89-fold, with 95% confidence intervals of 11-14 [Wiswell & Hachey, 1993]. Meta-analyses by others have reached similar conclusions. A meta-analysis in 2005 of one (very small) randomized controlled trial [Nayir, 2001], 4 cohort studies, and 7 case-control studies found 8-fold higher UTI in uncircumcised boys (95% CI: 5-13) [Singh-Grewal et al., 2005]. This slightly lower estimate is from inclusion of data for older boys, and the conservative recommendations by the authors of this paper have been criticized [Schoen, 2005c]. This meta-analysis noted 1,222 UTIs in 107,873 uncircumcised infants, i.e., 1.1%, and the summary OR for the protective effect of circumcision against UTI was 0.13 (95% CI 0.08 - 0.20), i.e., circumcision reduced UTI 7.7-fold [Singh-Grewal et al., 2005]. In Sweden (where infant circumcision is rare), cumulative incidence of UTI was 2.2% by age 2 [Jakobsson et al., 1999]. A meta-analysis published in 2008 found that amongst febrile male infants aged less than 3 months (the age group with highest prevalence of UTI), UTI was the cause of the fever in 20.1% of uncircumcised boys, but only 2.4% of boys who were circumcised [Shaikh et al., 2008]. Prevalence was almost twice as high in white as in black boys. In febrile girls aged 0-3 months UTI prevalence was 7.5%. Among older children (< 19 years) pooled prevalence of UTI (both afebrile and febrile) was 7.8%.

A large study in Canada of equal numbers of neonatally circumcised and uncircumcised boys saw rates of UTI and hospital admissions for UTI that were 4-fold higher in the uncircumcised [To et al., 1998]. In Australia, a relatively small study in Sydney involving boys under 5 years of age (mean 6 months) found that 6% of uncircumcised boys got a UTI, compared with 1% of circumcised [Craig et al., 1996]. A US study of 1025 febrile infants aged less than 2 months found the cause was UTI in 21.3% of uncircumcised boys, 2.3% in circumcised boys, and 5% in girls [Zorc et al., 2005b]. Odds ratio of UTI associated with being uncircumcised was 10.4 (bias-corrected 95% CI: 4.7-31.4) in this study. In the Pediatric Research in Office Settings' Febrile Infant Study of 219 US practices, being uncircumcised was the strongest multivariate predictor of UTI, with an odds ratio of 11.6 (95% CI 5.9-22.6) [Newman et al., 2002]. Another US study found 10.3% of febrile infants aged 2-6 months had serious bacterial illness, the proportion being similar for girls and boys [Hsiao et al., 2006]. The incidence of serious bacterial illness was 36% in the uncircumcised and 1.2% in the circumcised, i.e., was 22.5 times higher in the uncircumcised.

A study of UTIs to age 16 in the UK noted a cumulative incidence of 3.6% [Coulthard et al., 1997].

According to a personal communication from Dr Tom Wiswell in 2005: “The best data indicate that ~2.5% of uncircumcised boys will have a UTI during the first year of life. The lowest percentage among studies is ~1.1%. There are approximately 130 million births around the world annually. A little more than half are boys. Of these 65 million boys, probably 80% or more are not circumcised (52 million). Thus, worldwide there would be anywhere from 560,000 to 1.45 million uncircumcised boys with UTIs annually. This does not include older uncircumcised males who are also more prone to have UTIs, but at much lower rates.”

Although UTIs are low in Jewish boys, who are all circumcised at day 8 after birth, those circumcised by a physician have a 2.8-fold lower incidence of UTI than those circumcised by a religious authority [Prais et al., 2009].

UTI in Japanese boys aged 0-6 months were more likely to have a meatus that was covered tightly by the foreskin compared to healthy boys (85% vs 42%) [Hiraoka et al., 2002]. In this study, the foreskin covered the external urethral meatus in 96% of healthy boys aged less the 3, and a a gentle retraction procedure was unable to uncover the meatus in 40% of those aged 0.6 months. The recurrence rate of UTI in Korean boys aged 0-6 months was 26% compared with 7.7% in older infants [Shim et al., 2009]. Recurrent UTI was seen in 34% of those with nonretractile foreskins compared with 18% of those whose foreskin could be retracted [Shim et al., 2009]. Acute pyelonephritis increased the likelihood of recurrent UTI by 4.6 [Shim et al., 2009]. Nonretractile foreskin and acute pyelonephritis were the biggest risk factors for recurrent UTI. Acute pyelonephritis is a major cause of renal scarring [Elder, 2007b]. It occurs even in the absence of vesicoureteral reflux and in this study had an incidence of 36% [Shim et al., 2009]. Posterior urethral valves are the most common cause of end-stage renal failure in childhood. Circumcision reduces the incidence of UTIs in such boys (mean age 6.7 years, range 1-18) by 83-92%, with every circumcision preventing one UTI on average [Mukherjee et al., 2009]. Early circumcision of boys with posterior urethral valves was thus advocated.

Despite the strong evidence and enormous differential, a randomized controlled trial (RCT) would provide the gold standard seal of support to the protection afforded by circumcision against UTIs. The only previous RCT was of 70 boys of mean age 3.5 (range 3 months to 10 years) with normal renal ultrasonography who had microbiologically confirmed UTI [Nayir, 2001]. One group of 35 boys had monthly urine cultures over a 6-month period, and when positive (with or without any symptoms), they received antibiotic treatment. After 6 months they were circumcised and then observed for another 6-month period. The rate of positive urine cultures in these boys dropped from 3.6 ± 1.1 to 0.14 ± 0.35 episodes after circumcision (P<0.001), i.e., circumcision decreased UTI by 96%. Another group of 35 boys were circumcised immediately after the first UTI and were followed for 6 months. The rate of significant bacteriuria during the period after circumcision was 0.17 ± 0.38 episodes. A larger study is probably unnecessary, but could be considered. This might involve a cohort of parents who are equivocating about whether to have their newborn son circumcised, and the circumcised and uncircumcised boys could then be followed for a year. To ensure all are otherwise treated the same, suprapubic aspiration would be needed for sample collection for urinalysis in each case, even though uncontaminated urine can be obtained from circumcised boys when they urinate naturally. However, given the striking and consistently higher rate of UTIs in uncircumcised boys in all studies to date, it might be difficult to obtain ethical approval for a study like this in which the outcome is virtually guaranteed.
UTI IN ADULTHOOD:

The benefit appears to extend beyond childhood and into adult life. In a Seattle study of men aged, on average, 32 years, and matched for race, age and sexual activity, the circumcised had a 5.6-fold lower rate of UTI [Spach et al., 1992]. A lifetime prevalence of UTI in a large, nationally-representative US study of men aged 18-85+, was 13.7% [Griebling, 2005; Griebling, 2007]. This did not take into consideration circumcision status. Based on a circumcision rate of 79% in the USA [Xu et al., 2007] it can be estimated that up to 44% of uncircumcised men, compared with 6% of circumcised men will get a UTI over their lifetime (J.H. Waskett and B.J. Morris, unpublished results - see diagram below).

Very high cumulative prevalence of urinary tract infections in uncircumcised males over their lifetime (from calculations by J.H. Waskett; unpublished).


UTI is the most costly (over $1 billion in men [Griebling, 2005]) and resource intensive urological condition in the USA, with 1.8 million physician visits [Litwin et al., 2005]. Circumcision may reduce this burden.

A report in 2010 identified the entire microbiome of the penis of 12 men before and after circumcision [Price et al., 2010]. Among the 42 unique bacterial families identified, Pseudomonadaceae and Oxalobactericeae were the most abundant irrespective of circumcision status. Circumcision was associated with a significant change in the overall microbiota (P = 0.007) and with a significant decrease in putative anaerobic bacterial families (P = 0.014). Two families in particular - Clostridiales Family XI (P = 0.006) and Prevotellaceae (P = 0.006) - were uniquely abundant before circumcision. Within these families the authors identified a number of anaerobic genera previously associated with bacterial vaginosis including: Anaerococcus spp., Finegoldia spp., Peptoniphilus spp., and Prevotella spp. The researchers concluded that the anoxic microenvironment under the foreskin may support pro-inflammatory anaerobes that can activate Langerhans cells to present HIV to CD4 cells in draining lymph nodes. They suggested that the reduction in putative anaerobic bacteria after circumcision may play a role in protection from HIV and other sexually transmitted infections.
Bacteria:

The fact that fimbriated strains of the bacterium Escherichia coli which are pathogenic to the urinary tract and pyelonephritogenic, have been shown to be capable of adhering to the foreskin, satisfies one of the criteria for causality [Kallenius et al., 1981a; Kallenius et al., 1981b; Fussell et al., 1988; Glennon et al., 1988; Wiswell et al., 1988; Stull & LiPuma, 1991]. In a prospective study of 25 boys who underwent circumcision for medical reasons, specimens of periurethral bacterial flora were taken prior to as well as 3 weeks after surgery [Wijesinha et al., 1998]. Before circumcision, 52% harboured uropathogenic organisms (E. coli and other coliforms 93%, Enterococcus spp 9%, Proteus spp 8%, Pseudomonas spp 4%, and Klebsiella spp 2%), but after circumcision, none of the boys had uropathogens. It was postulated that circumcision converts a 'cul-de-sac' that is a reservoir of organisms capable of causing ascending UTI into a surface colonized by natural skin organisms. This study supports the idea that circumcision protects against UTI.

In another study, in 2004, pathogenic bacteria were reported to be present in the peri-urethral region of 64% of boys (without phimosis) prior to circumcision, but in only 10% four weeks after circumcision [Gunsar et al., 2004]. For the glanular sulcus these figures were 68% and 8%, respectively, and the bacteria were similar in each location. This study concluded that the origin of periurethral flora is the deeper preputial regions and also emphasized the beneficial role of circumcision [Gunsar et al., 2004].

A similar study in boys aged 4 to 12 (mean 6) found that the 16% with phimosis had clinically significant uropathogenic bacterial colonization (greater than 100,000 cfu/ml). In the rest (i.e., the 84% without phimosis) 56% had uropathogenic species in their foreskin and in 93% of these the levels were clinically significant. Harmless species were seen in 15%, and in 30% no bacterial growth was found [Tokgoz et al., 2005]. Frequency of species overall was: 3% E. coli, 19% Klebsiella, 13% Staphylococci, and 44% Enterococcus. Thus significant preputial colonization by uropathogens persists in preschool and primary school children.

Thus in infancy and childhood the prepuce becomes colonized with bacteria. Fimbriated strains of Proteus mirabilis, non-fimbriated Pseudomonas, as well as species of Klebsiella and Serratia also bind closely to the mucosal surface of the foreskin within the first few days of life [Wiswell et al., 1987; Fussell et al., 1988; Glennon et al., 1988]. Circumcision prevents such colonization and subsequent ascending infection of the urinary tract [Roberts, 1986].

Swabs taken of the periurethral area (the region of the penis where urine is discharged) in 46 circumcised and 125 uncircumcised healthy males (mean age = 27; range = 2 to 54 years) showed a predominance of Gram positive cocci in both groups, facultative Gram negative rods in 17% of uncircumcised males, but in only 4% of circumcised (P = 0.01) [Serour et al., 1997]. Streptococci, strict anaerobes (bacteria that can grow without oxygen) and genital mycoplasms (bacteria that lack a cell wall) were found almost exclusively in uncircumcised males over the age of 15 years (82% of the study group) [Serour et al., 1997].

Since these organisms are common inhabitants of the female genital tract, acquisition via sexual transmission was suggested. These latter categories of bacteria, unlike the Gram positive cocci, are potential pathogens capable of causing UTIs. It was speculated that when Gram negative organisms are the only colonizers of the preputial space they achieve higher concentrations and that the quantitative difference may contribute to the development of UTI. The findings of this study provide a microbiological basis for the observed higher risk of UTI in uncircumcised adult men. The authors also concluded that their results pointed to a role for the prepuce as a reservoir for sexually transmitted organisms [Serour et al., 1997].

Another study, conducted in Dublin, involving swabs from the periurethral area, found that antibiotic prophylaxis in boys with vesicoureteral reflux was not effective in reducing the bacterial colonization of the prepuce, and recommended circumcision to reduce UTIs [Cascio et al., 2001]. Vesicoureteral reflux (VUR) increases risk of UTI, putting those boys in great danger from renal damage [Fischbacher, 1999]. But it is the parenchymal infection and inflammation, rather than the VUR, that is the prerequisite for renal scarring [Wallin & Bajc, 1993; Benador et al., 1997; Rushton, 1997a]. Moreover, the majority of children with renal scarring do not have VUR [Rushton, 1997a].

Circumcision, as an adjunct to prophylactic antibiotics, is advocated for all boys with severe uropathy whose main clinical problem is recurrent UTI [Thiruchelvam & Cuckow, 2005]. Salmonella typhimurium has also been found (in a 10 month old boy) and circumcision not only prevented further UTI, but also the spread of this organism to the general public [Sonmez et al., 2001].

A randomized controlled trial of children of average age 14 months (64% girls and 42% with a history of VUR) found a small but significant reduction in symptomatic UTI in those given long-term antibiotic treatment (UTI arose in 13% of antibiotic group versus 19% of placebo group during the 12 month study period) for recurrent UTI [[Craig et al., 2009]. For those with fever as well the difference was stronger (7% versus 13%). It was suggested that such therapy for infants at high risk of infection was warranted, but should not be recommended routinely for those with a single symptomatic UTI.

Whereas 92% of boys aged 0–6 tested positive for bacteria under the foreskin, this diminished to 73% for boys aged 6–12, and was accompanied by a shift from enteric pathogens to normal skin flora [Agartan et al., 2005].

An absence of CD8 T lymphocytes in the foreskin may help the colonization of uropathogenic bacteria [Balat et al., 2008]. In this study Langerhans cells were much higher in foreskin than normal skin.
Yeast fungi:

In boys (mean age 5.8 years, range 0.01-13) colonization of the glans penis by yeast was 11.7% just prior to circumcision and 1.3% one month later [Aridogan et al., 2009]. The species found were Candida albicans (50%), Malasserzia furfur (40%) and Malassezia sympodialis (10%).
Consequences:

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 to 50 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.

Obtaining a midstream urine sample for culture from a circumcised boy is easy [Bailis, 1997]. However, valid urine samples from uncircumcised boys requires invasive techniques such as transurethral catheterization or suprapubic bladder aspiration [Bailis, 1997; American., 1999; Koyle et al., 2003; Cheng & Wong, 2005; Schroeder et al., 2005]. Only a urinalysis can distinguish UTI as a cause of fever as distinct from upper respiratory tract or ear infection (otitis media), it being noted that "one would be amazed at the number of children with renal scarring who have had treatment in the past for multiple episodes of 'otitis media' without urine cultures having been obtained" [Belman, 1997]. Indeed, the AAP recommends a urine culture for any child under 2 with unexplained fever assessed as being sufficiently ill to warrant antibiotic therapy [American, 1999]. The higher the fever and the longer its duration, the greater the likelihood of UTI [Roberts, 2002].

The complications of UTI that can lead to death are: kidney failure, meningitis and infection of bone marrow. In the first month of life 21-36% of infants with UTI have bacteremia, with concomitant meningitis being seen in 3-5% of these [Wiswell & Geschke, 1989; Bachur & Caputo, 1995]. Other acute complications of infant UTI are severe dehydration, electrolyte imbalances, transient pseudohypoaldosteronism, and cachexia [Wiswell & Geschke, 1989], with the youngest at risk of renal failure [Wiswell & Geschke, 1989; Bachur & Caputo, 1995] or death [Littlewood, 1972; Wiswell & Geschke, 1989]. The later consequences of renal scarring include hypertension (high blood pressure), hyposthenuria (urine with low specific gravity due to impaired concentrating ability of the kidney), and chronic renal insufficiency.

The latter may proceed to end-stage renal disease, which, like hypertension, is not seen by pediatricians because such conditions generally manifest in adulthood. Consequently pediatricians are not aware of the high health risk posed by a UTI. Of children with VUR and UTI followed to age 18, 1.5% died (renal failure being a cause), 1.5% had renal transplants, 3% borderline hypertension, 4% high serum creatinine (indicating impaired filtration by the kidney), and 8% were being treated for hypertension [Smellie, 1991]. Over 27 years of observation, 23% developed hypertension and all had reduced glomerular filtration rate as well as lower renal plasma flow, with 10% getting end-stage renal disease [Jacobson et al., 1992].

Costs for treatment are 17 times higher, based on 1-year cumulative incidence in circumcised and uncircumcised boys of 0.22% vs 2.15%, respectively, and cost in each was stated as $703 vs $1,179 in a report in 2000 [Schoen et al., 2000a]. These estimates did not include longer-term expenses such as tests for renal scarring, screening for subsequent infection and costs of morbid consequences of renal scarring. So actual cost from lack of circumcision is very much higher. Other estimates at the time put the cost of treatment of UTI by intravenous antibiotics for 3 days followed by oral for 11 days at $3577 as compared with $1473 for oral antibiotic for 14 days [Hoberman et al., 1999]. The efficacy of low-dose long-term antibiotics for children prone to develop recurrent acute pyelonephritis (VUR, obstructive nephropathies, etc) has been questioned as it does not reduce risk and can increase risk of resistant infections [Conway et al., 2007]. In contrast to antibiotic treatment, the efficacy of circumcision in reducing UTI is questioned far less [Bensman & Ulinski, 2009].

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 [Oster, 1968; Schoen, 1993], not performing circumcision would appear to be far less effective than having it done in the first instance [Rushton & Majd, 1992a].

Moreover, the effectiveness of newborn circumcision in preventing UTI (> 90%) means it has a similar protective effect as many vaccines given to children to prevent diseases [Schoen et al., 2000c]. Thus, just as for immunization, in the era of preventative medicine circumcision should be promoted vigorously in an effort to prevent the hundreds of thousands of boys that are afflicted with this painful condition that can also have lifelong cardio-renal health implications, as well as fatal consequences.

[Weyland]

Je kan met zoveel links afkomen als je wil, mij zal je nooit overtuigen. Toch wil ik zeggen dat je links over dat 'vrouwen het zo mooier zullen vinden' zeer maatschappelijk gebonden zijn en zulke onderzoeken vaak gebaseerd zijn op enquêtes waar mensen zelden als ervaringsdeskundige praten. Ik ga daar niet op af. De natuur geeft de man een voorhuid en een vrouw die een voorhuid 'vies' vindt heeft een mankement in haar hersens nl. culturele indoctrinatie, biologie heeft daar weinig mee van zien.
Als man weet ik dat schoonheidsidealen van de samenleving ook niet steeds mijn voorkeuren zijn wat betreft vrouwen. Als de meerderheid der mannen photoshopillusies aanbidden neem ik aan dat de meerderheid der vrouwen net zo even misleid is.

Toch vind ik het raar dat er te lezen staat dat 'besneden mannen seksueel actiever zijn'. Nu wil ik niet opscheppen, maar seksueel actiever dan ik nu ben is moeilijk hoor. Een besnijdenis zou het voor mij eerder verbrodden (gezien ik het onnatuurlijk vind ogen en geen gevoeligheid wil opofferen; de voorhuid bevat immers véél zenuwen en die vermindert er zeker door)

[Thomas-]

Oorspronkelijk geplaatst door Eliyahu

Bs'd

De besnijdenis redt VELE MILJOENEN levens. Vermindert de kans op vele enge ziekten aanzienlijk.

Het wordt daaom ook aanbevolen door de Amerikaanse Academie van Kinderartsen:

http://www.npr.org/blogs/health/2012...=storycategory

Om SOA te vermijden heb je educatie en condooms. Besnijdenis ter preventie van HIV daar moet je in serieuze kringen niet mee afkomen. Als jij russische roulette wil spelen dan doe je dat maar.

Besnijdenis bij minderjarigen is kindermishandeling en dient verboden te worden.

[Weyland]

Mij valt op dat het altijd over extreem arme landen gaat die dan als voorbeeld worden gegeven wanneer we het over SOA's hebben. In welke zin heeft dat betrekking op ons? En in welke zin zijn statistieken uit zulke landen betrouwbaar? Tweemaal een negatief antwoord.

[Havanna]

Oorspronkelijk geplaatst door Thomas-

Om SOA te vermijden heb je educatie en condooms. Besnijdenis ter preventie van HIV daar moet je in serieuze kringen niet mee afkomen. Als jij russische roulette wil spelen dan doe je dat maar.

Besnijdenis bij minderjarigen is kindermishandeling en dient verboden te worden.

2

[Weyland]

Oorspronkelijk geplaatst door Eliyahu

Vandaar dat er in Israel, waar alle jongetjes besneden worden, er zoveel stikken en stuipen krijgen tijdens de besnijdenis.

Er bestaan ook atheïstische Israëlis die hun zonen niet laten besnijden. Een kleine groep, maar ze bestaan.
Al bestaan er ook kwalijke evoluties waar religie mensen in hun keuzevrijheid wil beperken.

http://www.cbc.ca/news/world/israeli...sion-1.2440644

[Havanna]

Het is hier al telkens gebleken dat het geen zin heeft op met religieuse gekken in gesprek laat staan discussie te gaan.

Deze is al op tientallen sites jaren bezig te zijn onzin te spammen

[Eliyahu]

Oorspronkelijk geplaatst door morte-vivante

http://ije.oxfordjournals.org/conten...04.short?rss=1

Bs'd

Je mag je wel eens scheren Morte.

[Eliyahu]

Oorspronkelijk geplaatst door Weyland

Er bestaan ook atheïstische Israëlis die hun zonen niet laten besnijden. Een kleine groep, maar ze bestaan.
Al bestaan er ook kwalijke evoluties waar religie mensen in hun keuzevrijheid wil beperken.

http://www.cbc.ca/news/world/israeli...sion-1.2440644

Bs'd

Ik betwijfel of ze bestaan. Atheïstische, ja. Niet-besnijdende, nee. Die website van een gescheiden moeder die, om de vader dwars te zitten, hun kind niet wil besnijden, dat is niet echt overtuigend.

[Havanna]

Oorspronkelijk geplaatst door Eliyahu

Bs'd

Ik betwijfel of ze bestaan. Atheïstische, ja. Niet-besnijdende, nee. Die website van een gescheiden moeder die, om de vader dwars te zitten, hun kind niet wil besnijden, dat is niet echt overtuigend.

http://en.wikipedia.org/wiki/No_true_Scotsman

[Eliyahu]

Oorspronkelijk geplaatst door Weyland

Een besnijdenis zou het voor mij eerder verbrodden (gezien ik het onnatuurlijk vind ogen en geen gevoeligheid wil opofferen; de voorhuid bevat immers véél zenuwen en die vermindert er zeker door)

Bs'd

En wat moet je nou precies met die zenuwen in je voorhuid? Kom jij klaar met je voorhuid of zo??