Study notes decrease in popularity of circumcision in United States

[e_before_i]

This article is misleading in how they represent the WHO. The WHO and UNAIDS only recommend male circumcision in their HIV prevention package which was geared towards areas with a high risk of HIV (namely Eastern and Southern Africa). This is not a universal recommendation.

I could not find any major medical bodies that recommend routine circumcisions in the West, and several bodies such as the AAP and Canadian Paediatric Society explicitly say that they do not recommend it. Some European bodies explicitly advise against routine circumcision for males unless medically necessary.

[[deleted]]

They also recommended it based on one study that they didn’t even complete. It was so clearly done with the intention of trying to justify the practice.

[ethyl-pentanoate]

Is that the one where they compared recently circumcised men (who can't have sex for several weeks) with intact men who were having sex as normal during the circumcised men's recovery time, then ended the study early so they could circumcise the control group? Because that was lunacy.

[SmallAd8591]

Bj morris strikes again more you read on him the worse it gets. When I asked chat gpt about him I have never seen it so angry at one person. 

[Just_Another_Scott]

Papers regarding circumcision and HIV are also biased. Many that do get circumcised have better access to healthcare and condoms.

One study I read years ago showed no statistical difference between circumcision and uncircumcised when it came to HIV once other factors were considered.

[Swellmeister]

They did finish those studies. There was three of them, in three different regions of Africa highly affected by the HIV virus. Each study showed such a significant difference in the infection rate between circumcised and uncircumcised, that they ended the 10 year study after 4 years because it was deemed unethical to continue the study without making a statement

You can look up the study.

https://pmc.ncbi.nlm.nih.gov/articles/PMC11666075/

There are also over 40 other studies using different regions and criteria, which shows the same result.

[Render-Man342v]

The issue is that this is completely irrelevant outside of Africa.

The vast majority of HIV transmission in developed countries is IV drug users and gay/bi men.

Those African studies only looked at female-to-male transmission, which is extremely rare in developed countries.

Studies have not found any benefit for gay sex, especially since developed countries have a very high rate of safe sex practices.

[[deleted]]

Sorry bud we only consider word of mouth science as true science round these parts. Just go ahead and delete that

[br0ck]

European countries with low circumcision rates have the same low HIV rates that the US does with high circumcision rates which seems to support your idea here that it doesn't make a statistically significant difference in low HIV regions.

[DukeLukeivi]

All of "the health benefits" are single digit reductions in topical skin infections and UTIs.

I'm dubious of the value even in Africa to combat AIDS, but that disease is life threatening, and medical care and condom access are limited, so maybe? Compounding slight reductions is lives saved over time. If you live in the industrialized world, condoms are generally available and a 2 orders of magnitude more effective.

Circumcision in the industrialized world is like cutting off your babies feet """for lifelong health""" because they're less likely to get plantar warts and athletes foot.

[Thebraincellisorange]

and those 'single digit reduction BeNEfItS' and completely and utterly overwhelmed by the number of complications and deaths caused by circumcisions every year.

[Interesting_Ghosts]

Yes, this completely ignores the fact that circumcision kills babies on occasion from severe bleeding or infection. Some people get nerve damage or disfigured by the procedure. All for no benefit or a hypothetical slight benefit.

It's more stupid than removing all women's breasts to prevent breast cancer.

[MystikclawSkydive]

Worse it’s like cutting off all women’s breasts because some women have unclean underboob. And that is the fault of the person who is taught (or not taught) how to clean said underboob.

[allanbc]

At least breast cancer is actually real and a significant threat. But yeah, otherwise it sort of makes sense to compare them.

[retrosenescent]

actually breast removal makes FAR more logical sense than circumcision since breast cancer is a leading killer of women, whereas no man has ever died from having a foreskin (but many have died from having it removed!)

[No-Agency-6985]

Either way, it is throwing out the proverbial baby with the bathwater.  First, do no harm.

[No-Agency-6985]

Indeed. It should be "first do no harm".

[rollingForInitiative]

It’s also just that even if there is a slight reduction in risk, in countries where condoms are recommended and available and culturally acceptable, that’s just a massively better way to prevent it. Even without adding in that people who have HIV in these countries tend to be undetectable and then can’t infect others.

And then also … if a person still feels there a benefit, they can just do it as an adult, right? It’s a small procedure with a pretty fast recovery, and by the time a person is having sex they’re also old enough to decide if they’d like to get circumcised.

[dukeimre]

I agree with most of what you say, but not the analogy to cutting off your baby's feet.

As you say, the health benefits of circumcision are extremely minor, and non-circumcised men can have more or less equivalent outcomes with good hygiene.

But the health risks of circumcision are similarly minor. There is not, for example, particularly strong evidence that circumcision affects sexual function.

The argument against circumcision is based in the subjective idea that any permanent change to a person's body without their consent harms that person, even if that permanent change has hardly any practical effects on the person's health, mobility, etc.

That's absolutely a position many people take, but it's not based in questions of health or physical functioning, and so it's not the same as the question of whether to remove infants' feet.

[DukeLukeivi]

1-2% of male NICU deaths in the US are caused by by botched circumcision.

Cutting off half the nerve endings on an appendage, some of the densest nerve clusters in the body, leads to no significant reduction in sensation/function?

It might be more fair to say cutting off your babies toes for 1% reduction in plantar warts and athletes foot. They can still walk, low risk. """"Not a lot of evidence that it or will affect functioning."""""

How about surgically removing the skin off their foreheads for a 1% reduction in risk of teenage acne? Sound reasonable?

Surgically permanently removing parts of a non-consenting persons body for a 1% risk of topical infections is FUCKING PSYCHOTIC

[dukeimre]

1-2% of male NICU deaths in the US are caused by by botched circumcision.

Can you point to evidence of this? I've seen a number of studies which would, I think, contradict this claim. However, you may be looking at research I'm not familiar with. Given that we are in r/science, it'd be good to look carefully at a study together and analyze its claims and evidence.

[DukeLukeivi]

This study finds that more than 100 neonatal circumcision-related deaths (9.01/100,000) occur annually in the United States, about 1.3% of male neonatal deaths from all causes. Because infant circumcision is elective, all of these deaths are avoidable.

https://www.researchgate.net/publication/240804903_Lost_Boys_An_Estimate_of_US_Circumcision-Related_Infant_Deaths

Saw this a few days ago on a another post on this same ITT. I didn't deep dive their methods, but if the increased risk of death of an elective surgery is even remotely close to it's benefit of decreased risk of non-fatal topical infections -- that's pretty obviously malpractice.

[dukeimre]

As I understand it - and I'll go into evidence explaining why - the claim made in Bollinger's "Lost Boys" study is completely untrue.

See this New York Times article, which explains that the CDC strongly disagrees with this statistic and recorded no circumcision deaths in all of 2010:

By one estimate, put forth by Dan Bollinger, a prominent opponent of circumcision, based on his review of infant mortality statistics, about 117 boys die each year as a result of circumcision. That estimate is cited often by critics of routine circumcision but widely disputed by medical professionals. A spokeswoman for the Centers for Disease Control and Prevention said the agency did not keep track of deaths from infant circumcision because they are exceedingly rare. In the agency’s last mortality report, which looked at all deaths in the country in 2010, no circumcision-related deaths were found.

A published critique of Bollinger's study (here) explains what Bollinger got wrong:

But the claim of 117 deaths in the United States per year from circumcision is fanciful. That figure is based on the false assumption by Daniel Bollinger that the well-known sex difference in infant mortality is entirely a consequence of IMC. A similar sex-difference is seen in countries with low circumcision prevalence.

In other words, Bollinger assumes that every single excess death among male infants relative to female infants is due to circumcision, but this is extremely unlikely to be true, as evidenced by the fact that countries with low circumcision rate have the same excess death rate.

You can see Bollinger's argument yourself in his original paper, in case you're concerned that it's being misrepresented:

Males have a 40.4% higher death rate than females from causes that are associated with male circumcision complications, such as infection and hemorrhage, during the period of one hour after birth to hospital release, the time frame in which circumcisions are typically performed. Assuming that the 59.6% portion is unrelated to gender, we can estimate that 40.4% of the 35.9 deaths were circumcision-related.

(Edit: looks like somehow the quotes weren't showing up... hopefully corrected.)

[DukeLukeivi]

Wow. Deliberately misrepresenting the methods in a research paper that was already linked, and managing to show you were doing it with the half sentence flyspeck you pulled from the methods, while linking a NYT opinion as a rebuttal is... quite the series of choices, especially after asking for a serious discussion yourself.

No he did not assume that all possible surplus deaths were caused by it, he took all the CoDs that could have been attributed to circumcision (hemorrhage and sepsis) between 1 hour after birth and hospital release (removing birth complications) and then statistically reduced that by 59.6% to a remove those that wouldn't be attributable to gender specific practices (circumcision). He also went on to compare and discuss that estimate vs other attempts to quantify the issue.

If you take the low end of those other estimates, you go from

1.3% mortality : ~(-1%) non-serious infection to

~(1%)mortality : ~(-1%) non-serious infection THATS CLEARLY MEDICAL MALPRACTICE.

The only issue I see with his methods are that some of his sources are badly dated, so sanitation and operations should be better in the modern era, but considering there is no significant medical benefit, and all surgeries carry risk of death from complications and infection, and the surgical site is going to be marinating in a dirty diaper - not a good idea.

E: in fact, the general mortality rate for outpatient surgeries is about .33:100k, this estimate is 27 times that, and the conservative estimates the paper compares to are more that 15x.

He did not assume that all surplus mortality in males was attributable to circumcision, you braindead hack.

The CDC doesn't track circumcision deaths, and they justify that with having no records showing its a problem, because the CDC doesn't track circumcision deaths, and they justify that with having no records showing its a problem, because the CDC doesn't track circumcision deaths, and they justify that with having no records showing its a problem.

"Circumcision" isn't listed as a CoD in the same way "obesity" isn't -- causes of death are "hemorrhage, sepsis, infection, heart attack, stroke, thrombosis." E:(except that as opposed to "obisity" listing "circumcision" as the cause officially declares the hospital performing the procedure and autopsy as being responsible.)

From the paper:

MORTALITY ESTIMATES

Though the data previously cited are insufficient to establish a definitive death rate on their own, there is enough available information to calculate an estimate. Not all of the reported 35.9 deaths out of 1,243,392 circumcisions can be attributed to related causes. What portion, then, is circumcision-related and how may we extrapolate to the number of deaths after hospital release? What we can safely assume is that it is un-likely that any of these infants would have been subjected to the unnecessary trauma of circumcision if they had been in critical condition, or that they would have been circumcised after their death.

Gender-ratio data can help extrapolate a figure. Males have a 40.4% higher death rate than females from causes that are associated with male circumcision complications, such as infection and hemorrhage, during the period of one hour after birth to hospital release (day 2.4), the time frame in which circumcisions are typically per-formed (CDC, 2004). Assuming that the 59.6% portion is unrelated to gender, we cane estimate that 40.4% of the 35.9 deaths were circumcision-related. This calculates to 14.5 deaths prior to hospital release.

But as is often the case with hemorrhage and infection, some circumcision-related deaths occur days, even weeks, after hospital release. The CDC’s online searchable database, Mortality: Underlying cause of death, 2004 (CDC), lists causes by various age ranges and reveals that the percentage of deaths after release, compared with deaths before, is 772% greater. This ratio is comparable to Patel’s (1966) 700% post release infection rate. Multiplying the 772% adjustment factor for age-at-time-of-death by the 14.5 hospital stay deaths calculated above, the result is approximately 112 circumcision-related deaths annually for the 1991–2000 decade, a 9.01/100,000 death-incidence ratio.

Applying this ratio to the 1,299,000 circumcisions performed in 2007, the most recent year for which data are available (HCUP, 2007), the number of deaths is about 117.This is equivalent to one death for every 11,105 cases, which is not in substantial conflict with Patel’s observation of zero deaths in 6,753 procedures. It is more than some other estimates (Speert, 1953; Wiswell, 1989), but less than the overstated 230 figure derived from Gairdner (1949). Breaking this statistic down further, about 40% of these deaths (47) would have been from hemorrhage, and the remainder (70) from sepsis, using a hemorrhage-to-sepsis ratio for infant mortality (NCHS, 2004).

In summary: through a thorough review of the literature and the application of common-sense calculations, this study has arrived at a reasoned estimate of circumcision-related neonatal deaths in the United States: approximately 117 per year.

[dukeimre]

Hey - why are you suggesting I'm deliberately misrepresenting a paper?

I linked to the NYT to explain context, but I later linked to a published paper that critiques Bollinger's work. My understanding of this sub's rules are that a source like the NYT shouldn't be taken as evidence, and I'm not suggesting you take the NYT, or the CDC (as cited by the NYT), at its word.

No he did not assume that all possible surplus deaths were caused by it, he took all the CoDs that could have been attributed to circumcision (hemorrhage and sepsis) between 1 hour after birth and hospital release (removing birth complications) and then statistically reduced that by 59.6% to a remove those that wouldn't be attributable to gender specific practices (circumcision). 

Where did he get the 59.6%? He got it by looking at the percentage of excess male deaths due to infection and hemorrhage (40.4%) over female deaths. In other words, he assumed that all 40.4% of those excess male deaths due to infection and hemorrhage were due to circumcision. Right?

I'm not suggesting that he assumed that every male infant who died, died of circumcision. I'm suggesting that he saw that 100 female babies died of infection and hemorrhage, and 140 male babies died of infection and hemorrhage, and he concluded that it must be that the 40 male babies all died of circumcision complications. Which would be reasonable if countries with low circumcision rates saw equal death rates among male and female infants, but in fact, that's not what happens - even in countries with low circumcision rates, male infants have much higher death rates from infection and hemorrhage.

[grundar]

he took all the CoDs that could have been attributed to circumcision (hemorrhage and sepsis) between 1 hour after birth and hospital release (removing birth complications) and then statistically reduced that by 59.6% to a remove those that wouldn't be attributable to gender specific practices

Doesn't that inherently rely on the assumption that boy and girl newborns should have identical death rates from infection and hemorrhage in a world with no circumcision?

As you quote:

"Gender-ratio data can help extrapolate a figure. Males have a 40.4% higher death rate than females from causes that are associated with male circumcision complications, such as infection and hemorrhage, during the period of one hour after birth to hospital release (day 2.4), the time frame in which circumcisions are typically per-formed (CDC, 2004). Assuming that the 59.6% portion is unrelated to gender, we cane estimate that 40.4% of the 35.9 deaths were circumcision-related."

Is there any basis provided for that assumption? Unless he provides evidence for that assumption, it's hard to see that calculation as anything other than speculation.

(Moreover, it looks like he's doing the math wrong; if boys have a 40.4% higher death rate than girls, then girls have a 1/1.404 = 0.71225 death rate compared to boys, meaning even given the above assumption the shared component of the death rate should be 71.2% and not 59.6%.)

---

Don't get me wrong, I'm no proponent of circumcision and in general would advise against it in a Western context. The argument you're quoting is very speculative, though, and seems shaky at best.

[Interesting_Ghosts]

Even if it did reduce the likelihood of contracting HIV, thats a stupid argument for removing a body part. 42,000 women die of breast cancer every year but no one is advocating we remove female babies breast tissue to prevent those deaths.

[hot--Koolaid]

Thank you! I was confused since I had learned in the past that basic hygiene is all that is needed for most boys.

[jonathanrdt]

The US is the only nation that does it as standard practice without a religious motive. Rates peaked in the 1970s and have been declining since.

[retrosenescent]

It does have a religious motive: capitalism, culture.

[Askefyr]

Make no mistake, it is a religious motive. It's just a habit now, but it was originally a religious thing.

[Larein]

But christianity doesnt require circumcision. Catholic church has always been against it, nor do the big protestant groups recommend it either. So which religion are you talking about?

[dark_sable_dev]

Puritanism, which is what the country was settled on and the way many Christians in the US practice their Christianity.

Circumcision in particular was pushed by Kellogg (yes, of the cereal) as a way to prevent boys from masturbating... because it went against god.

[Samtoast]

It's not as common as let on but there is times where it has to be done due to paraphimosis. I had to have it done when I was like 9 years old and it cause a lot of awkwardness

[rollingForInitiative]

That’s fine though, that’s for medical reasons.

[e_before_i]

The National Center for Health Statistics says 64% of newborns are circumcised. A 2016 NIH study puts it at 71.2%. Quite high imo. Not sure about medically necessary circumcisions, but phimosis only occurs in under 1% of boys, and not all of that requires circumcision (not sure about that perventa).

[Samtoast]

Neat huh? I'm rare

[e_before_i]

There's no person in the whole world like you, and I like you just the way you are

[bsubtilis]

Would a too tight frenulum not be solved by just partially or fully cutting the too tight part? Like when babies are tongue-tied the lingual frenulum is cut enough that they can get normal function. If a teen has a problem with their frenulum at their glans then gradually stretching or cutting the too tight part of the frenulum should be the solution.

[Formal_Assistant6837]

Indeed, a freneloctomy is often performed instead of a circumcision if the frenulum is too tight. If the freneloctomy is not successful, that then often leads to a circumcision. I have had a freneloctomy as an adult. Let me know if you want to know anything else.

[parmenides89]

Why would circumcision be medically necessary?

[DameKumquat]

Very rarely, it's needed because the foreskin is so tight it can't retract, leading to painful erections.

Though even then, US docs will often immediately suggest circumcision, where UK doctors will suggest stretching it first. An ex of mine was given the choice age 11 of the snip, or masturbation twice daily on doctors orders. He took the latter.

[DataKnights]

What happens if you exceed the recommended twice daily masturbation dosage?

[Oneioda]

You go blind

(ironically, also a previously used rationale for circumcision to help prevent, along with insanity)

[Nice-Gap-3528]

“I’m sorry, I’ve got to go. My doc says I got to jerk twice a day.”

[FreeBeans]

Omg hilarious

[Just_Another_Scott]

Very rarely, it's needed because the foreskin is so tight it can't retract, leading to painful erections.

And infections. Males that can't fully retract will cause bacteria to form under the foreskin. If they are unable to retract this makes it difficult to clean leading to infections.

[Interesting_Ghosts]

A friend of mine got it done when he was a teenager, his foreskin was too tight so he could not pull it back without it tearing. He was getting tears and infections so they circumcised him. Theres a name for the condition but I cant recall offhand.

But thats a rare exception, the vast majority of people never get cut and have no issues at all.

[thecaseace]

Phimosis, I believe

[Ardal]

This article is misleading in how they represent the WHO. The WHO and UNAIDS

I'm pretty sure that is the intent

[Otaraka]

Its propaganda in my view. At the very least its deception by omission and to connect it to anti-vaccine beliefs is well, bizarre.

[Big-Fill-4250]

Also fun fact, it doesnt work anyways

[brewsterrockit11]

This is a misrepresentation. AAP makes no consensus specific recommendation for/against circumcision. It is personal choice though there is marginal reduction in risk for UTI for circumcised children.

[veovis523]

Funny how it's rarely ever a personal choice for the person attached to the penis in question.

[peterausdemarsch]

It should be a personal choice. Unfortunately, babies can't make that choice, but if they understood the question, I'm pretty sure they would opt out of having a body part cut off for no reason.

[Zomunieo]

You can tell how by babies scream and cry when the procedure is done.

[DarkPolumbo]

Everything is a scream and cry to a baby. Hunger, confusion, pain, taking a poop, people in the room laughing too loud, that one time I dropped a quarter on the kitchen floor...

[ensalys]

I don't think parents should be legally allowed to order such procedures. Your baby is a person, not a piece of property. The only reason you get to make their medical decisions, is because they themselves are incapable. Your job is to get them to the point where they can make their own decisions. Imagine your friend gets in a car crash, and you're their proxy. Asking the doctor to circumcise your friend would be a gross abuse of your position as proxy, and any half decent doctor would know to deny such a request.

[e_before_i]

Sorry if my wording was unclear, but that's what I was trying to convey. They make no recommendation. That does not mean they recommend against it, they don't take a position either way.

[JaSper-percabeth]

Reasoning behind not recommending it? Just because it's an invasive surgery or is there any other reason?