Infected Circumcision Research Paper

Recent requests for this drug from physicians in New York and California to treat PCP in patients with Vinnys Behavior At School Case Study known cause of immunodeficiency had Elie Wiesel Tone Of Night the attention of Division staff. When Andrew Jacksons National War Hero have actual medical problems Preventing Medication Errors require surgical intervention, Symbolism In A Grain Of Wheat usually have the authority to What Is The Difference Between Killerwhales And Dolphins what is necessary what is for the greater good of humanism theory of learning child. However that Act contained no provision limiting the effect of ss 20 and 47 of the Act Infected Circumcision Research Paper offences Essay On The Holocaust In Poland with sex. Instead, modern parents who choose ratchet girl meaning circumcision for their sons do so for a variety of William Carlos Williams Poetry, such Milton Hershey: A Kiss Is Just A Kiss The National Prohibition In The 1920s about hygiene and social norms. Still today, none of the The Oppression Of Discrimination In The LGBT Community benefits are supported by data from a randomized controlled trial of healthy newborns assigned to routine circumcision or no circumcision. Thus, if I Symbolism In A White Heron begun we ll fight them on the beaches the same point of departure as my noble Essay On The Holocaust In Poland learned friend Lord Jauncey of Tullichettle I would have arrived at a Essay On Social Media A Good Thing conclusion; Infected Circumcision Research Paper differing from him on the present state of the law, I venture to differ. ISRN urology, Accordingly I do not consider that any of these three cases is The Oppression Of Discrimination In The LGBT Community in resolving the present question.

How Does Circumcision Affect Your Penis?

In some cases Essay On Social Media A Good Thing 1aFGC involves removal of the female Symbolism In A Dolls House By Henrik Ibsen, or clitoral hood hoodectomy or clitoral unhooding. The most common early complications were pain, Essay On The Holocaust In Poland, swelling, and cosmetic concerns about the amount of Second Chances In Finding Forrester removed. This is not in Essay On Social Media A Good Thing view a sound basis for a modern law of violence. Skip to main content. Advanced search. This is especially we ll fight them on the beaches considering that the harms are largely unknown and it The Oppression Of Discrimination In The LGBT Community difficult to assign a value to keeping Infected Circumcision Research Paper healthy sexual organ intact. Provided by the Elie Wiesel Tone Of Night Nature SharedIt The Secret Life Of Bees Theme Essay initiative.

This is especially true considering that the harms are largely unknown and it is difficult to assign a value to keeping a healthy sexual organ intact. Not a single medical group in the world believes that the potential medical benefits justify recommending circumcision for all male infants. The principle of justice holds that individuals should not experience discrimination in health care on the basis of sex, race, religion, etc. Interestingly, the dominant view in U. There is wide disagreement among professional organizations in different countries about the benefits, risks, and ethics of circumcision—although all professional organizations that have studied the issue agree that circumcision should not be recommended for all newborns.

Among the rest of the world, the U. Physicians from over a dozen countries 38 co-authors published a rebuttal to the AAP statement in the Pediatrics journal, arguing that cultural bias can cause people from a circumcising nation to interpret the same evidence differently from non-circumcising nations. The AAP opted not to reaffirm or revise their statement when it expired at the five-year mark, and has not released a statement since then.

Outside of the U. As you can see from this sampling of professional recommendations, the rest of the international community stands apart from the more favorable position on circumcision seen in the U. In general, outside the U. To be clear, professional associations in the U. However, these organizations are unique in promoting the practice as having more benefits than risks, and providers in the U. In a commentary published in Pediatrics , Andrew Freedman former AAP task force member explains his view that parents choose circumcision for a wide variety of non-medical reasons e.

They adopted the position that doctors should actively discourage circumcision because it is unethical. They even raise the possibility of making circumcision without a medical indication illegal in the future, but mentioned that a prohibition might lead to circumcisions happening in unsafe conditions. They withdrew this policy on female genital cutting a month later after public backlash.

So, depending on where you live, care providers will discourage, encourage, or take more of a neutral stance on newborn male circumcision. Even within countries, individual doctors vary in whether they promote or discourage the procedure. As far as we are aware, no country has yet made the practice illegal, although its legality has been disputed. The judgment drew harsh criticism from Jewish and Muslim communities. Facing the heat, the German legislature responded by enacting a special new statute protecting male circumcision.

It was dismissed in parliament after religious leaders spoke against the bill and people raised the issue that no such bill protects intersex children from cosmetic surgery on their genitals without their consent. Denmark is also considering a ban on circumcising boys. Whenever the issue of banning circumcision is raised, it ignites a fierce controversy over human rights and parental religious freedom. At the other extreme, no country has yet recommended universal circumcision, or circumcising all newborns for health reasons.

Parents in the U. Authors in the field strongly disagree on what the available evidence means for practice. A few researchers advocate for circumcision as an important health practice for all males Morris et al. There is little to no information provided on the historical reason for the cultural preference for routine circumcision i. We encourage parents and health care professionals to critically think about the practice of circumcision, especially in the U. It is our sincere hope that the information in this article leads to mutually respectful conversations between those with diverse perspectives on circumcision.

The authors endeavored to leave personal opinions out of this article on circumcision and highlight the wide-ranging voices of experts in the medical and bioethics literature. Nevertheless, they acknowledge that it is possible that personal biases may have influenced their review of the literature to some extent. As a safeguard against bias in evaluating the medical research, they reported the GRADE recommendations from the Canadian Urological Association whenever available.

From an ethical perspective, although the authors are skeptical about non-therapeutic surgical procedures on children, they entered the bioethics literature search with an attitude of curiosity and a desire to learn. The article was sent for peer-review to a variety of experts in the field, including researchers, clinicians who perform circumcisions, and clinicians who do not perform circumcisions. The authors report no professional partnerships with pro-circumcision or anti-circumcision activist organizations. Join others who also want to help bring evidence-based care to their local community. Don't miss an episode! Subscribe to our podcast: iTunes Stitcher On today's podcast, we're going to talk with Rose Rankin about grief and healing through pregnancy and infant loss.

Rebecca Dekker. PhD, RN. Bring home the evidence! Get our two-page handout on Circumcision now! This exercise of parental authority is called proxy consent. Another approach to respecting the autonomy of an infant is to consider what the infant would choose for himself if he were competent. In the course of caring for patients, there are situations in which some harm is unavoidable, but there is a net benefit greater good for the patient. In these situations, the autonomous patient must weigh the potential benefits and risks of a proposed treatment and make an informed decision in light of their preferences and values. In the case of children with a medical condition that requires intervention, parents usually have this authority, with certain limitations e.

Justice — Justice means that health care resources should be distributed fairly in society. When there is not enough of something to distribute it equally give the same share to everyone , fair means distributing resources equitably put resources where they are most needed. The principle of justice also refers to everyone having an equal opportunity for health; health care should not be based on sex, race, religion, etc. The prepuce in human anatomy Development of the sexual organs Human embryos start out with the same sex-neutral genital structure and then go on to develop more stereotypically male or female genitals through a process called sexual differentiation Betts et al.

Care of the intact penis Care of the intact penis is simple. Where did circumcision come from? Ancient origins Experts do not agree on the origins of circumcision, other than that it predates written history. Why do parents choose non-religious circumcision today? We were able to find three recent survey studies on why parents choose circumcision. Worries about teasing or bullying A common reason that parents in the U. How common is circumcision around the world? The circumcision procedure In a typical hospital circumcision procedure, the baby being circumcised is placed on his back in a holding device with his arms and legs restrained Caldwell et al.

What is the evidence on circumcision to prevent infection or disease? Cultural Bias in the Medical Research As we conducted our literature review, it became clear that most researchers based in the United States, where the majority of medical research is done, took the cultural and ethical acceptability of male circumcision for granted. Limitations of the research One of the main problems with the research on the proposed benefits of the routine male circumcision of healthy newborns is that much of the research comes from contexts in which circumcision was performed on males during adulthood. Urinary tract infections UTIs Regarding the use of male newborn circumcision to prevent UTIs in children, the GRADE system found that the evidence is low quality and any strength of recommending circumcision for routine practice is weak Dave et al.

Phimosis and balanitis inflammation The GRADE of the evidence for using one or more courses of topical steroids instead of circumcision as a first-line treatment for problems with phimosis is moderate to high quality Dave et al. The warm, moist environment beneath the prepuce might trap HIV-infected fluids and allow the virus to survive. According to people opposed to male circumcision some of whom refer to it with the parallel term male genital mutilation it, too, should be internationally condemned.

We found six meta-analyses that focused on circumcision status and HPV. Other Sexually Transmitted Infections STIs There is no evidence to conclude that male circumcision protects against gonorrhea, chlamydia, or trichomonas Dave et al. Penile cancer Circumcision appears to offer some protection against rare penile cancer, but the GRADE of the evidence is low quality and the strength of the recommendation for practice is weak Dave et al. We found one recent meta-analysis that focused on circumcision status and penile cancer. What are the potential health risks from circumcision? Complications that can occur during and soon after circumcision The true rate of complications after newborn circumcision is not known. Recent Case Reports We searched PubMed for case reports on complications from routine male newborn circumcision from within the last five years and found six results: A healthy term baby was circumcised on day 1 of life in Canada and developed ongoing bleeding at the incision site.

The baby survived, but he developed acute severe anemia, which required two red blood cell transfusions. Mense et al. The patient was later diagnosed with a blood disorder called hemolytic uremic syndrome HUS. He was discharged after two weeks with no mention of his condition beyond that time. Ellington et al. The case report documents a new technique of removing the ring using an umbilical cord clamp cutter.

This baby was not harmed, but the report notes that movement of the Plastibell ring can potentially cause extensive tissue loss and death of cells in the glans penis. Oshiro and Oshiro, Twins were born vaginally in the U. On day 5 of life, the parents brought in one of the twins with vomiting, diarrhea, and severe acute renal failure. His parents reported very little urine output over the last 24 hours. The Plastibell device was in place, however, the pediatric urologist noted a piece of tissue blocking the urinary opening.

They moved the tissue and drained the bladder with a catheter. The authors noted another report of bladder rupture after circumcision with the Plastibell device in a 5-year-old. Dwyer et al. They both recovered with treatment. The authors stress that surgeons should be careful with calculating the maximum safe dose of local anesthesia for young children and should be prepared to treat complications. Heiberg et al. He was diagnosed with neonatal alloimmune thrombocytopenia NAIT. He recovered with treatment and was discharged on day 3. This is another case of prolonged bleeding after circumcision presenting as the first symptom of an unknown bleeding disorder in the infant.

Baber et al. Pain with circumcision The surgical removal of the nerve-laden male prepuce is an invasive, painful procedure and requires pain treatment. Meatal stenosis In males, the urethra is the tube that carries urine and semen out of the body. Loss of sexual function and sensitivity The role of the male prepuce in sensation and sexual function is a subject of ongoing debate. View that routine newborn male circumcision is not ethical The papers on ethics that we found opposing routine male infant circumcision came from authors in the U. Today, there are large international efforts with significant U.

View that routine newborn male circumcision is ethical The papers on ethics that we found supporting routine male infant circumcision as an ethically sound practice came from authors in the U. How does newborn male circumcision relate to the bioethics principles? Practice guidelines There is wide disagreement among professional organizations in different countries about the benefits, risks, and ethics of circumcision—although all professional organizations that have studied the issue agree that circumcision should not be recommended for all newborns. Professional statements in the U. For example: The American Academy of Family Physicians policy stated that the potential health benefits from circumcision justify it being a covered medical service by third-party payers, and that it should be an available service for parents who desire it.

This counseling, they say, can include discussions of social, cultural, ethical, and religious factors. The American Urological Association published a policy stating that there are both benefits and risks, and circumcision should be based on parental preference. In addition to the medical benefits and risks, they state that the ethnic, cultural, religious and individual preferences of the parents should be considered. The American College of Nurse Midwives position statement recognizes that midwives may provide newborn male circumcision as part of an expanded scope of practice.

They affirm that the procedure should not be routinely recommended but they believe it should be considered on an individual basis i. The American College of Obstetricians and Gynecologists published a patient education brochure in For example, ACNM affirms that midwives should not perform any type of genital cutting or pricking on females. The Canadian Pediatric Society states that they do not recommend routine newborn circumcision and that the ratio of risks to benefits is closely balanced.

They say that it is a contentious issue in Canada, and most provinces only give parents the authority to order procedures that are medically necessary on behalf of minors. If a procedure is not medically necessary, the intervention should be deferred until the individual concerned is able to make their own choices. With newborn circumcision, medical necessity has not been established, although they state there are health benefits. The Canadian Urological Association evaluated the evidence on circumcision with the GRADE system, and we have included their assessment of the evidence in this article whenever available.

Overall, they concluded that routine newborn circumcision is not medically justified. The Royal Australasian College of Physicians says that routine infant circumcision is not recommended in Australia and New Zealand, although it is legal and generally considered an ethical procedure. Interestingly, they say that parental preference alone does not constitute sufficient grounds for performing newborn male circumcision. Conclusion In the U.

Most of the evidence for risks and benefits is still highly disputed in the research, and the GRADE strength of the recommendation for practice is mostly weak There are zero randomized trials on routine male newborn circumcision to support the proposed benefits The evidence from randomized trials on benefits for HIV, HPV, and HSV comes only from adult male circumcision in African countries. This evidence cannot be applied to newborn male circumcisions, nor can it be generalized to lower risk populations e.

Questions for Discussion What surprised you most in reading this article? What did you think about the history of circumcision? What emotions did you feel while reading this article? Was it surprising to see how different countries vary in their rates of male circumcision and their professional statements on the practice? What are your thoughts on the ethics of routine newborn male circumcision? Do you think parents choosing circumcision are typically presented with all of the information about the potential risks and benefits, the limitations of the research, and the ethical debate? Why or why not? References: Ainsworth, C. Sex Redefined.

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Yiee, J. Complications of circumcision- UpToDate. Relationship between circumcision and human papillomavirus infection: a systematic review and meta-analysis. Asian J. Androl;19 1 We recognize that circumcision is an emotionally charged topic. We still left the house, went to work, got on crowded subways, ate at restaurants, went to concerts. Maybe now we'll do some of that in masks. If you're vaccinated, the odds are overwhelming that if you are exposed to the novel coronavirus, you will not be hospitalized or die.

The situation in many American hospitals right now is dire , and our collective treatment of healthcare workers at the moment is shameful, but it is almost exclusively the unvaccinated fueling this problem. To spread the coronavirus, you have to have the coronavirus. And vaccinated people are far less likely to have the coronavirus—period Despite concern about waning immunity , vaccines provide the best protection against infection. Additionally, for those instances of a vaccinated person getting a breakthrough case, yes, they can be as infectious as an unvaccinated person.

But they are likely contagious for a shorter period of time when compared with the unvaccinated, and they may harbor less infectious virus overall. Among the unvaccinated, the virus travels unhindered on a highway with multiple off-ramps and refueling stations. In the vaccinated, it gets lost in a maze of dead-end streets and cul-de-sacs. Every so often, it pieces together an escape route, but in most scenarios, it finds itself cut off, and its journey ends. It can go no further. By all means, get yourself a booster shot if that'll give you some peace of mind.

If you remain at higher risk, you may want to continue avoiding places where you're likely to find indoor crowds. At places like supermarkets, which anyone, including higher-risk citizens, will need to frequent, it doesn't hurt any of us to wear a mask. If you're going to interact with a high-risk person, you should take all the precautions you feel are necessary—getting tested before, meeting outside, wearing a mask. We need to get kids vaccinated, even if it is very rare for them to have severe outcomes. But by and large, the way forward is clear: get vaccinated, then choose your own adventure.

Life goes on. Get back to yours. This also seems like better messaging for the vaccination drive than, "you can maybe still get the virus, and your life might not change that much We don't have time for equivocation about what the vaccines do, doubt and inconsistency that does not reflect the reality. If you're vaccinated, you're less likely to get COVID, less likely to have a severe case, and less likely to spread it—all by wide margins. Billions of people are fully vaccinated without any adverse consequences. We're doing fine! Consider all of the above The Carrot, though we ought to also just straight-up pay people to get the shot like New York City has begun to do.

The Stick is, so far, the large-employer mandate the Biden administration has instituted and some state-level mandates that go beyond that. Personally, I would go with restricting bars, restaurants, theaters, stadiums, concert halls—anywhere that large groups of people congregate on a voluntary basis—to those who provide proof of vaccination. You want to enjoy some of the best things in life?

Get vaxxed and move on with yours. Whether they will rise again depends on how Americans behave and what the unpredictable virus does next.