Health Risks and Benefits of Circumcision - Research Paper Example

Introduction Circumcision is one of the procedures that most males go through. For most males, they see it as a necessary procedure born out of social trends and dictates; and for others, they see it as a necessary procedure born out of perceived health benefits. Nevertheless, the necessity of this procedure is on a case to case basis and largely dependent on cultural, medical, and social perceptions. Inasmuch as it brings forth various health benefits, it can also afford some risks which cannot be ignored. This paper shall now discuss the different health risks and benefits of circumcision. The surgical and infection risks, as well as health benefits like decreased risk of penile cancer and decreased risk of contracting HIV shall be discussed in this paper in order to establish an academic understanding of the various advantages and disadvantages of circumcision. Discussion Health risks The main risk associated with circumcision is primarily credited to the surgical procedure itself. In a study conducted in the University of Washington, the authors were able to establish that out of 130,000 boys who had circumcisions at the Washington state hospital, 287 of them developed complications in relation to the procedure (Connell, et.al., “News”). The most common complications seen were intraoperative bleeding (230 cases) and damage to the penis (52 cases) (Connell, et.al., “News”). The authors comment however that these are preventable risks which would still be outweighed by the benefits of circumcision. Most of the complications associated with circumcision are minor and are very much localized. Meatal stenosis is seen in circumcised males and is said to follow intraoperative vascular injury to the frenular vessels (Steadman & Ellsworth, 1). Due to meatal stenosis, there may be a deflection of the urine system or in some cases; dysuria and occult hematuria may also be seen in the circumcised male (Steadman & Ellsworth, 1). Reports of skin bridges forming when separated foreskin come in contact with each other are sometimes also manifest in circumcised males; and this can cause pain and penile curvature during erection (Steadman & Ellsworth, 1). Before the advent of improved anesthesia options, the neonatal pain experience has been emphasized as one of the main objections against circumcision. The pain experience is known to cause physiological responses, such as increased heart rate, respiratory rate, and serum cortisol level, lower serum oxygen saturation and lower vagal tone (Steadman & Ellsworth, 2). However, these experiences have now been prevented with safe anesthesia options for use during circumcisions. A summary of the different risks of circumcisions based on the compilation of Wiswell, et.al., (as cited by Circinfo.net, 11) reveals some risk already previously mentioned, like excessive bleeding. Their study points out how excessive bleeding is seen at a ratio of 1 in 1000 patients. Due to excessive bleeding, 1 in 4,000 patients may require ligature and 1 in 20,000 may also require blood transfusion due to a possible undiscovered bleeding disorder (Circinfo.net, 11). Infection can also be manifest during circumcisions. They occur at a rate of 1 in 100 to 1,000 (local infections); systemic infection may be seen at a rate of 1 in 4,000 and may later require injection of antibiotics (Circinfo.net, 11). Further surgery to sometimes repair damage caused by the circumcision may also be conducted. Surgeries to repair skin bridges or removal of excess foreskin occurs at a rate of 1 in 1000 cases; repair of injury to penis or glans occurs at a rate of 1 in 15,000; and loss of the entire penis, at a rate of 1 in 1,000,000 (Circinfo.net, 11). Some studies also reveal that the use of dorsal penile nerve block can cause a small bruise in the injection site; this side effect often disappears after a certain period of time (Circinfo.net, 11). Deaths from circumcisions are extremely rare; however they have been known to occur. Records from 1954 to 1989 covering 50,000,000 circumcisions have yielded only 3 deaths (Circinfo.net, 11). These three deaths were seen in 1989, wherein children were circumcised at home by a Jewish religious circumciser. Two of the children had hemophilia and the other child was a premature infant (Circinfo.net, 11). Jewish circumcision rituals use a tightly wrapped gauze to stop bleeding and this technique has been known to cause urinary retention and later, UTI. It is important to note that these complications have been prevalent in cases where the procedure is carried out by those without medical training (Circinfo.net., 11). Complications due to the use of the Plastibell method, though rare, have also been reported. A higher rate of infection, proximal migration and tissue strangulation, pressure necrosis, urinary retention, distended bladder, sepsis, post-operative bleeding, and Plastibell impaction have also been known to occur (Circinfo.net., 11). These complications are considered remediable and seen in extremely rare and isolated cases. Staph aureus infections have been seen in some community hospitals during brief period of outbreaks and with longer hospital stay, uncovered circumcision equipment, poor hand hygiene practices, and use of multiple lidocaine vials (Circinfo.net, 11). Health benefits The health benefits of circumcisions are much more numerous and often outweigh its risks. One of the major benefits of circumcision is that it helps reduce the possibility of being afflicted with HIV/AIDS. Various researchers like Schoen and Halperin emphasize that studies indicating that circumcision reduces risk for HIV infection have been known since the 1980s (WebMd, p. 2). In 2007, three trials on Kenyan and Ugandan male were carried out in order to compare the rate of reduction of risk for HIV infection. The study revealed a 50% reduction for HIV infection among these men and this reduction is more or less the same as some vaccines (WebMd, p. 2). The World Health Organization (WHO) even included circumcision as one of the methods they supported to prevent HIV infection. Circumcision is said to help fight HIV/AIDS because the removal of the foreskin makes the male organ less susceptible to HIV infection. The foreskin can sometimes develop cracks which make it vulnerable to infections like AIDS and other sexually-transmitted diseases such as syphilis and chancroid (WebMd, p. 2). Circumcision is also a procedure which is said to reduce the risk for penile cancer. The rate of penile cancer in the United States is pegged at 0.7 to 0.9 per 100,000 men and “only a few isolated cases of cancer of the penis occur in uncircumcised men. The lifetime risk of penile cancer is 1 in 500 in uncircumcised males as compared to 1 in 50,000 to 1 in 12 million in circumcised men” (Berkowitz, p. 31). So far, in the 1990s, 11,000 men have died from penile cancer in the United States; and the mortality rate for this type of cancer is pegged at 25% (Berkowitz, p. 31). This cancer is being association with infection from the human papillomavirus type 16 and 18 and it is still unclear if lack of personal hygiene and frequent bouts of STDs are contributory factors in the development of penile cancer (Berkowitz, p. 31). Circumcision is also known to bring forth health benefits for the women in the sense that it reduces their risk for developing cervical cancer (Hawker, 4). Cervical cancer is mainly caused by the Human Papilloma virus and is known to thrive under and on the male foreskin and later transmitted to the woman during sexual intercourse (Hawker, 4). A study published in the British Medical Journal in April 2002 revealed that women’s risk for cervical cancer can be reduced to as much as 20% through circumcision (Hawker, 4). The recurring and unpleasant inflammation of the glans known as Balanitis is also known to occur at a decreased rate through circumcision (Hawker, 4). On a practical note, more men and even their partners enjoy the appearance of the circumcised penis because it is odor-free, it is more hygienic and the sexual experience is better enjoyed. With an improved body image, better self-confidence is also seen for these men (Hawker, 4). Male circumcision is also said to reduce the risk for urinary tract infections. Studies since the 80s “found a minimum twelve –fold increase for urinary tract infections among uncircumcised males one to sixteen years of age, as well as among adult males. There is no data that contradicts these findings” (Gothard, 2). Pediatric surgeons in Israel also carried out their studies in order to determine the relationship between circumcision and the risk for contracting urinary tract infection. They were able to establish that streptococci and genital mycoplasmas were found exclusively in uncircumcised males more than fifteen years old (Gothard, 2). Through their study, they also emphasized the major role of the prepuce in harboring sexually transmitted organisms which can put the male and the female at risk for STDs (Gothard, 2). Based on studies and scientific evaluations, uncircumcised males have a higher risk for infection because the foreskin gives the penis a larger surface area (Circinfo.et, 5). Some studies also suggest that the moist inner lining of the foreskin makes for a thin epidermal barrier as compared to the outer surface of the foreskin and the rest of the penis (Circinfo.net, 5). The thin and moist inner lining then becomes an entry point into the body for viruses and bacteria; more studies are needed however to support this claim (Circinfo.net, 5). The foreskin is also said to cause a greater microtrauma during sexual intercourse and cause tears which become entry points into the bloodstream for sexually transmitted diseases (Circinfo.net, 5). Moreover, the warm, moist, and mucosal area under the foreskin also presents an area which invites bacterial growth (Circinfo.net, 5). Its location – wrapped around the penis – makes it a cesspool for infection as it accumulates secretions, urine, dead cells, and bacteria – like those previously mentioned (Circinfo.net, 5). In general, considering the above health risks and benefits of circumcision, many clinicians believe that the benefits of circumcision outweigh its risks. Inasmuch as the procedure can cause bleeding, infection, and suffering on the child, these are all preventable and manageable risks. At most times, with professionals carrying out the procedure, these risks are also minimal and extremely rare. When these risks are placed alongside its health benefits, they become inconsequential and provide a major motivation for carrying out the procedure. Conclusion Circumcision has various health risks and benefits. It can be risky in the sense it can cause intraoperative bleeding, damage to the penis, and it has been known to cause meatal stenosis. Meatal stenosis is later said to cause possible deflection of the urine system, as well as cause dysuria and occult hematuria. Circumcisions have also been known to cause skin bridging which can lead to intense pain and penile curvature during erection. Pain can also be an agonizing experience for those undergoing circumcision, but this issue has since been resolved with anesthesia. Infections were mostly seen in cases where the surgical techniques applied were unsterile. Despite its risks, many practitioners support this procedure because it has been known to bring forth life-saving benefits. It reduces the risk for infection and for contracting diseases caused by bacteria and viruses, including sexually transmitted diseases and HIV/AIDS. It has also been known to decrease the male’s risk for acquiring penile cancer and the female’s risk for acquiring cervical cancer. It has been known to reduce urinary tract infection and in the social sense, being circumcised seems to give men better confidence in themselves. Works Cited Berkowitz, C. (2000) Pediatrics: a primary care approach. p. 31. California: Elsevier Health Sciences Circinfo.net (2010) Risks in Infants. Circinfo.net. 11. 02 August 2010 from http://www.circinfo.net/risks_of_circumcision.html Circinfo.net (2010) Circumcision - Why the Foreskin Increases Infection Risk. Circinfo.net. 5. 02 August 2010 from http://www.circinfo.net/why_the_foreskin_increases_infection_risk.html Connell, F., Zerr, D., Harvey, E., Feudtner, C., & Wright, J. (2000) Study Examines Risks Of Circumcision. Science Daily. “News.” 02 August 2010 from http://www.sciencedaily.com/releases/2000/01/000111074855.htm Gothard, B. (2002) Health Benefits of Circumcision. Bill Gothard.com. 2. 02 August 2010 from http://billgothard.com/bill/news/circumcision/ Hawker, D. (2004) The Benefits of Male Circumcision. Circinfo. 4. 02 August 2010 from http://www.circinfo.com/benefits/bmc.html Steadman, B. & Ellsworth, P. (2006) To Circ or Not to Circ: Indications, Risks, & Alternatives to Circumcision: Proposed Health Risks of Circumcision. 1. Urology Nurse. Medscape. 02 August 2010 from http://www.medscape.com/viewarticle/541801_7 WebMd (2007) Circumcision Decision: Weighing the Risks and Benefits. WebMd. p. 2. 02 August 2010 from http://men.webmd.com/guide/circumcision-decision-weighing-risks-benefits?page=3 Read More