Your son is fine….. But these boys weren’t

http://ripe-tomato.org/2013/02/16/cock-ups-happen/

Complications during male circumcision are rare, being estimated to occur in 1 of every 500 procedures. These complications, which can be severe, include poor cosmetic outcome, bleeding, infection, injury to the penis and the removal of too much or too little skin.

Using “rare” for a 1 in 500 risk, when earlier the benefit of “avoiding the need for circumcision later in life” (about 1 in 2,000) is mentioned without qualification, is biased. The figure also applies to the best series. Less well organised services report rates up to 20%, e.g. Nigeria, click here. Since the manual is for use in developing countries the possibility of higher complication rates should be mentioned. Finally, Complications, which can be severe, include poor cosmetic outcome… is clearly designed to play down severity.

But more importantly, catastrophic complications are omitted altogether. Fully informed consent means telling people everything, however rare, which might alter the decision of a reasonable patient/parent. In gynaecology we mention the 1 in 10,000 risk of temporary colostomy after laparoscopic surgery for example. Unless we have a double standard for Africa, the complications below, which all appear elsewhere in the guide, should be mentioned. Italic text and pictures are all taken from the guide.

None of these complications are common, but they all occur. If infant circumcision programmes get rolled out widely in developing countries, it is inconceivable that everyone will read all 140 pages of the WHO manual In the real world sterilisation goes wrong, mismatched Yellen clamps get packed together, and diathermy and wrong sized Plastibells get used. Even if they don’t, infants wriggle. Parents should be told.

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pics in link at top

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Different article

http://helpingmenblog.blogspot.co.uk/2013/03/majority-of-britons-support-ban-on-male.html?m=1

in Britain (UK)

Complications are common, two boys a week are admitted to the Emergency Department in Birmingham Children’s Hospital and one boy a month comes close to death as a result of male circumcision.

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Another baby hemorrhaging… Lucky to be alive and yet supposedly the risks are worth it? How is almost dying worth it? How is almost dying because of a medically unnecessary surgery being performed on a healthy infant worth it?

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Eck ick uck…. Pin worms

So my youngest has pin worms…. I’m assuming he got them from daycare cause my oldest doesn’t have them (as of the moment no visible egg laying adults or itchiness)
Supposedly, you ingest the microscopic eggs (obviously by accident) and 2 months later you get egg laying adults and that’s when the horribly fun itching begins.

So for about 5 days my youngest has been complaining about butt itching. (He’s 4)… I I applied diaper cream and that helped for a few days but in the past 2-3 days and nights he has been restless, cranky and non-stop complaining of itching. So yesterday when I was wiping his butt (I was up close and personal) I noticed 2 worms so immediately I read up on pin worms.
1) extremely contagious as the eggs are microscopic, get under nails, hands go in mouth and wah-la re-infestation… (Or eggs can float in air and you can swallow them and initial Infestation
2) combined medical treatments and homeopathic treatments work better than either alone….

So I bought pin x

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And the I bought garlic capsules and hydrocortisone cream and used in conjunction with diaper cream I already have and spread it several times a day. Supposedly, the eggs stick to the cream/Vaseline and don’t float and are easier to wipe off. The garlic supposedly kills the eggs. Raw garlic is best but I’m just popping the garlic capsule and mixing with the cortisone cream and diaper cream and then applying.
3) I’ve also bought through amazon a homeopathic alcohol free black walnut hull – wormwood tincture. (Alcohol free on cause its my son and not me)
It should arrive soon and I’ll give it daily to the boys just in case…..
4) treat your whole household just in case to prevent re-infections…..

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2 years ago my oldest (now 6) had Molluscum contagiosum

What finally got rid of them was thuja (herb) oral tablets on conjunction with medicated wart stickers from the drug store and in between stickers using a bandaid to hold a colloidal silver and lavender essential oil soaked cotton ball to the warts. Luckily they never spread in mass…. The stayed localized to one butt cheek and thigh with a total of no more than 8 warts. I’ve heard they can get bad if you pop them or then get scratched they can spread like crazy.

http://en.m.wikipedia.org/wiki/Molluscum_contagiosum

The tragedy of healthy eating! (Funny)

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http://www.nwedible.com/2012/08/tragedy-healthy-eater.html

Soon you learn that even vegetables are trying to kill you. Many are completely out unless they are pre-fermented with live cultures in a specialized $79 imported pickling crock. Legumes and nightshades absolutely cause problems. Even fermentation can’t make those healthy.
Goodbye, tomatoes. Goodbye green beans. Goodbye all that makes summer food good. Hey, it’s hard but you have to eliminate these toxins and anti-nutrients. You probably have a sensitivity. Actually, you almost positively have a sensitivity. Restaurants and friends who want to grab lunch with you will just have to deal.

Baby boy: If intact do not retract

Ok someone commented on a previous post of mine (same title) saying that you have to retract infant foreskin to clean intact babies and young children and told me I was wrong.

I wanted to flip out but I simply spammed the comment.

Even the AAP (who is an idiot on circumcision and intact care) knows not to retract infants.

http://www.healthychildren.org/English/ages-stages/baby/bathing-skin-care/pages/Care-for-an-Uncircumcised-Penis.aspx

In the first several years your son’s foreskin will separate from the tip of the penis. Some foreskins separate soon after birth or even before birth, but this is rare. When it happens is different for every child. It may take a few weeks, months, or years. Once this happens, the foreskin can be pulled back away from the tip of the penis. This is called foreskin retraction.

Most boys will be able to retract their foreskins by the time they are 5 years old, yet others will not be able to until the teen years. As a boy becomes more aware of his body, he will most likely discover how to retract his own foreskin. But foreskin retraction should never be forced. Until the foreskin fully separates, do not try to pull it back. Forcing the foreskin to retract before it is ready can cause severe pain, bleeding, and tears in the skin.

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http://www.blissfulbirth.com/index.php?option=com_content&task=view&id=13

So how do parents take care of their baby’s uncircumcised penis? With Zen-like wisdom and simplicity: leave it alone. Many people, including many pediatricians, mistakenly believe that it is necessary to retract or pull back the foreskin for cleaning. This is absolutely not the case. In fact, forcibly retracting the foreskin can create serious problems including intense pain and bleeding, even creating scarring and harmful adhesions that can cause long-term problems. Forcibly retracting the foreskin before it is naturally ready is the cause of the majority of childhood complications of the foreskin that necessitate later medical circumcision.

Infant foreskin is not like adult foreskin. The foreskin and glans need not even be considered separate in baby boys. Infant foreskin is naturally sealed to the glans of the penis, much like a fingernail is to the skin beneath. This creates a protective barrier, keeping the sensitive area between the foreskin and glans of the penis clean and free of infection.

Cleaning and hygiene

Intact baby boys only need basic cleaning. Common sense diaper care and washing the outside of the penis with warm water and a mild soap during bath time is all that is necessary. No creams, antiseptics or cotton swabs are needed to clean a healthy penis.

Some babies and children produce a substance called smegma, which appears white and has a waxy consistency. Smegma is normal and is common in intact boys, as well as in girls between their labial folds. Smegma is produced when dead cells slough off. If your little one has some smegma, simply wipe it off during a diaper change or in the bath with warm water.

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http://www.sebpmg.com/educational_topics/Care_of_Uncircumcised_Penis.pdf
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http://www.newbornbreath.com/downloads/Handouts/Circumcision%20Info/IgnoreTheMythsCIRC.pdf

Ignore the Myths, Get the Facts

Resume of a stay at home mom

http://holdinholden.blogspot.com/2013/01/the-resume-of-stay-at-home-mom.html?m=1

Who are we kidding here? The only job I’d be able to land with these skills is in a penitentiary or insane asylum- and the latter doesn’t even exist anymore.
I think instead I’ll just hope to win the lottery… y’know- without buying a ticket. Stranger things have happened.

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From holdinholden

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AAP’s flawed ethics and methodology

cultural bias of the AAP http://pediatrics.aappublications.org/content/early/2013/03/12/peds.2012-2896.full.pdf+html

 

here is the link to the sources so that you can choose to read and click links instead of trying to decipher my copy/pasting http://justasnip.wordpress.com/2013/03/18/aap-meets-strong-criticism-for-lack-of-ethics-and-flawed-medical-practice/

Just a Snip – against genital mutilation aka circumcision

Eager to read the entire paper on AAP’s flawed ethics and methodology? Well, here it is. I acquired it just for you. Enjoy!

by Lena Nyhus

“Cultural Bias in the AAP’s 2012 Technical Report and Policy Statement on Male Circumcision”

here is the entire article”

Cultural Bias in the AAP’s 2012 Technical Report and Policy Statement on Male Circumcision

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abstract

The American Academy of Pediatrics recently released its new Tech- nical Report and Policy Statement on male circumcision, concluding that current evidence indicates that the health benefits of newborn male circumcision outweigh the risks. The technical report is based on the scrutiny of a large number of complex scientific articles. Therefore, while striving for objectivity, the conclusions drawn by the 8 task force members reflect what these individual physicians perceived as trustworthy evidence. Seen from the outside, cultural bias reflecting the normality of nontherapeutic male circumcision in the United States seems obvious, and the report’s conclusions are different from those reached by physicians in other parts of the Western world, including Europe, Canada, and Australia. In this commentary, a different view is presented by non–US-based physi- cians and representatives of general medical associations and so- cieties for pediatrics, pediatric surgery, and pediatric urology in Northern Europe. To these authors, only 1 of the arguments put forward by the American Academy of Pediatrics has some theoret- ical relevance in relation to infant male circumcision; namely, the possible protection against urinary tract infections in infant boys, which can easily be treated with antibiotics without tissue loss. The other claimed health benefits, including protection against HIV/AIDS, genital herpes, genital warts, and penile cancer, are questionable, weak, and likely to have little public health relevance in a Western context, and they do not represent compelling reasons for surgery before boys are old enough to decide for themselves. Pediatrics 2013;131:796–800

Circumcision rates are steadily decreasing in most Western countries around the world, including the United States.1 Still, a majority of newborn male infants undergo the procedure in the United States. In its newly released Technical Report and Policy Statement on male cir- cumcision,2,3 the American Academy of Pediatrics (AAP) has changed from a neutral to a more positive attitude toward circumcision, claiming that possible health benefits now outweigh the risks and possible negative long-term consequences. The AAP does not recom- mend routine circumcision of all infant boys as a public health measure but asserts that the benefits of the procedure are sufficient to warrant third-party payment. In Europe, Canada, and Australia, where infant male circumcision is considerably less common than in the United States, the AAP report is unlikely to influence circumcision practices because the conclusions of the report and policy statement seem to be strongly culturally biased.

AUTHORS: Morten Frisch, MD, PhD,a Yves Aigrain, MD, PhD,b Vidmantas Barauskas, MD, PhD,c Ragnar Bjarnason, MD, PhD,d Su-Anna Boddy, MD,e Piotr Czauderna, MD, PhD,f Robert P.E. de Gier, MD,g Tom P.V.M. de Jong, MD, PhD,h Günter Fasching, MD,i Willem Fetter, MD, PhD,j Manfred Gahr, MD,k Christian Graugaard, MD, PhD,l Gorm Greisen, MD, PhD,m Anna Gunnarsdottir, MD, PhD,n Wolfram Hartmann, MD,o Petr Havranek, MD, PhD,p Rowena Hitchcock, MD,q Simon Huddart, MD,r Staffan Janson, MD, PhD,s Poul Jaszczak, MD, PhD,t Christoph Kupferschmid, MD,u Tuija Lahdes-Vasama, MD,v Harry Lindahl, MD, PhD,w Noni MacDonald, MD,x Trond Markestad, MD,y Matis Märtson, MD, PhD,z Solveig Marianne Nordhov, MD, PhD,aa Heikki Pälve, MD, PhD,bb Aigars Petersons, MD, PhD,cc Feargal Quinn, MD,dd Niels Qvist, MD, PhD,ee Thrainn Rosmundsson, MD,ff Harri Saxen, MD, PhD,gg Olle Söder, MD, PhD,hh Maximilian Stehr, MD, PhD,ii Volker C.H. von Loewenich, MD,jj Johan Wallander, MD, PhD,kk and Rene Wijnen, MD, PhDll

aDepartment of Epidemiology Research, Statens Serum Institut, Copenhagen and Center for Sexology Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; bDepartment of Pediatric Surgery, Hôpital Necker Enfants Malades, Université Paris Descartes, Paris, France; cLithuanian Society of Paediatric Surgeons, Kaunas, Lithuania; dDepartment of Pediatrics, Landspitali University Hospital, Reykjavik, Iceland; eChildren’s Surgical Forum of the Royal College of Surgeons of England, London, United Kingdom; fPolish Association of Pediatric Surgeons, Gdansk, Poland; gWorking Group for Pediatric Urology, Dutch Urological Association, Utrecht, Netherlands; hDepartments of Pediatric Urology, University Children’s Hospitals UMC Utrecht and AMC Amsterdam, Netherlands; iAustrian Society of Pediatric and Adolescent Surgery, Klagenfurt, Austria; jPaediatric Association of the Netherlands, Utrecht, Netherlands; kGerman Academy of Paediatrics and Adolescent Medicine, Berlin, Germany; lCenter for Sexology Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; mDepartment of Pediatrics, Rigshospitalet, Copenhagen, Denmark; nDepartments of Pediatric Surgery, Landspitali University Hospital, Reykjavik, Iceland, and Karolinska University Hospital, Stockholm, Sweden; oGerman Association of Pediatricians, Cologne, Germany; pDepartment of Pediatric Surgery, Thomayer Hospital, Charles University, Prague, Czech Republic; qBritish Association of Paediatric Urologists, London, United Kingdom;

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796 FRISCH et al

COMMENTARY

In this commentary, a different view is presented by non–US-based physi- cians and representatives of general medical associations and societies for pediatrics, pediatric surgery, and pediatric urology in Northern Europe.

CRITERIA FOR PREVENTIVE MEDICINE

It is commonly accepted that medical procedures always need to be justified because of their invasive nature and possible damaging effects. Preventive medical procedures need more and stricter justification than do thera- peutic medical procedures, as they are aimed at people who are generally free of medical problems. Even stricter criteria apply for preventive medical procedures in children, who cannot weigh the evidence themselves and cannot legally consent to the pro- cedure.4

The most important criteria for the justification of medical procedures are necessity, cost-effectiveness, sub- sidiarity, proportionality, and consent. For preventive medical procedures, this means that the procedure must effectively lead to the prevention of a serious medical problem, that there is no less intrusive means of reaching the same goal, and that the risks of the procedure are proportional to the intended benefit. In addition, when performed in childhood, it needs to be clearly demonstrated that it is essen- tial to perform the procedure before an age at which the individual can make a decision about the procedure for him- or herself.

The AAP technical report points to 4 health-related arguments in favor of circumcision: the reduced risks of urinary tract infections (UTIs), penile cancer, some traditional sexually trans- mitted diseases (STDs), and HIV infection and AIDS.

URINARY TRACT INFECTIONS

According to the literature reviewed, ∼1% of boys will develop a UTI within the first years of life.2 There are no randomized controlled trials (RCTs) linking UTIs to circumcision status. The evidence for clinically significant protection is weak, and with easy access to health care, deaths or long- term negative medical consequences of UTIs are rare. UTI incidence does not seem to be lower in the United States, with high circumcision rates compared with Europe with low cir- cumcision rates, and the AAP report suggests it will take ∼100 circum- cisions to prevent 1 case of UTI. Using reasonable European estimates cited in the AAP report for the frequency of surgical and postoperative compli- cations (∼2%), for every 100 cir- cumcisions, 1 case of UTI may be prevented at the cost of 2 cases of hemorrhage, infection, or, in rare instances, more severe outcomes or even death.

Circumcision fails to meet the criteria to serve as a preventive measure for UTI, even though this is the only 1 of the AAP report’s 4 most favored argu- ments that has any relevance before the boy gets old enough to decide for himself.

PENILE CANCER

Penile cancer is 1 of the rarest forms of cancer in the Western world (∼1 case in 100 000 men per year), almost always occurring at a later age. When diagnosed early, the disease gener- ally has a good survival rate. Accord- ing to the AAP report,2 between 909 and 322 000 circumcisions are needed to prevent 1 case of penile cancer. Penile cancer is linked to in- fection with human papillomaviruses,5 which can be prevented without tissue loss through condom use and prophylactic vaccination. It is

remarkable that incidence rates of pe- nile cancer in the United States, where ∼75% of the non-Jewish, non-Muslim male population is circumcised,1 are similar to rates in northern Europe, where #10% of the male population is circumcised.6

As a preventive measure for penile cancer, circumcision also fails to meet the criteria for preventive medicine: the evidence is not strong; the disease is rare and has a good survival rate; there are less intrusive ways of preventing the disease; and there is no compelling reason to deny boys their legitimate right to make their own informed de- cision when they are old enough to do so.

TRADITIONAL STDs

According to the AAP report,2 there is evidence that circumcision provides protection against 2 common viral STDs: genital herpes and genital warts. However, the evidence in favor of this claim is based primarily on findings in RCTs conducted among adult men in sub-Saharan Africa. For other STDs, such as syphilis, gonorrhea, and chla- mydia, circumcision offers no con- vincing protection. The authors of the AAP report forget to stress that re- sponsible use of condoms, regardless of circumcision status, will provide close to 100% reduction in risk for any STD. In addition, STDs occur only after sexual debut, which implies that the decision of whether to circumcise can be postponed to an age when boys are old enough to decide for themselves.

HIV AND AIDS

From a public health perspective, what seems to be the AAP technical report’s most important argument is that circumcision may reduce the bur- den of heterosexually transmitted HIV

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infections in the United States.2 Three RCTs in Kenya, Uganda, and South Africa suggest that circumcision in adulthood may lead to a noticeable reduction in risk of heterosexual HIV acquisition in areas with extremely high HIV prevalence.7–9 Specifically, the African RCTs seemed to show that adult male circumcision halves het- erosexual men’s (but not women’s) risk of HIV infection in the first few years after the operation from 2.49% to 1.18% in high-endemic areas where viral transmission occurs mainly through heterosexual intercourse. This evidence, however, is contradicted by other studies, which show no relation- ship between HIV infection rates and circumcision status.10

However, there is no evidence that cir- cumcision, whether in infancy, child- hood, or adulthood, is effective in preventing heterosexual transmission in countries where HIV prevalence is much lower and routes of trans- mission are different, such as Europe and the United States. Sexually trans- mitted HIV infections in the West occur predominantly among men who have sex with men, and there is no evidence that circumcision offers any pro- tection against HIV acquisition in this group.11,12

The African findings are also not in line with the fact that the United States combines a high prevalence of STDs and HIV infections with a high per- centage of routine circumcisions. The situation in most European countries is precisely the reverse: low circum- cision rates combined with low HIV and STD rates. Therefore, other factors seem to play a more important role in the spread of HIV than circumcision status. This finding also suggests that there are alternative, less in- trusive, and more effective ways of preventing HIV than circumcision, such as consistent use of condoms, safe-sex programs, easy access to

antiretroviral drugs, and clean needle programs.

As with traditional STDs, sexual trans- mission of HIV occurs only in sexually active individuals. Consequently, from an HIV prevention perspective, if at all effective in a Western context, cir- cumcision can wait until boys are old enough to engage in sexual rela- tionships. Boys can decide for them- selves, therefore, whether they want to get circumcised to obtain, at best, partial protection against HIV or rather remain genitally intact and adopt safe-sex practices that are far more effective.

As with the other possible benefits, circumcision for HIV protection in Western countries fails to meet the criteria for preventive medicine: there is no strong evidence for effectiveness and other, more effective, and less in- trusive means are available. There is also no compelling reason why the procedure should be performed long before sexual debut; sexually trans- mitted HIV infection is not a relevant threat to children.

COMPLICATIONS

As mentioned in the AAP report,2 the precise risk and extent of complica- tions of circumcision are unknown. It is clear, however, that infections, hemor- rhages, meatal strictures, and other problems do occur. Incidental deaths and (partial) amputations of the penis have also been reported, but exact figures are not available. Although some studies suggest that circumci- sion can lead to psychological, pain- related, and sexual problems later in life,13–15 population-based prospective studies of long-term psychological, sexual, and urological effects of cir- cumcision are lacking.

It seems that the authors of the AAP report consider the foreskin to be

a part of the male body that has no meaningful function in sexuality. How- ever, the foreskin is a richly innervated structure that protects the glans and plays an important role in the me- chanical function of the penis during sexual acts.16–20 Recent studies, sev- eral of which were not included in the AAP report (although they were pub- lished within the inclusion period of 1995–2010), suggest that circumcision desensitizes the penis21,22 and may lead to sexual problems in circumcised men and their partners.23–29 In light of these uncertainties, physicians should heed the precautionary principle and not recommend circumcision for pre- ventive reasons.

CONCLUSIONS

The AAP’s extensive report2 was based on the scrutiny of a large number of complex scientific articles. Therefore, while striving for objectivity, the con- clusions drawn by the 8 task force members reflect what these individual physicians perceived as trustworthy evidence. Cultural bias reflecting the normality of nontherapeutic male cir- cumcision in the United States seems obvious. The conclusions of the AAP Technical Report and Policy Statement are far from those reached by physi- cians in most other Western countries. As mentioned, only 1 of the aforemen- tioned arguments has some theoreti- cal relevance in relation to infant male circumcision; namely, the questionable argument of UTI prevention in infant boys. The other claimed health benefits are also questionable, weak, and likely to have little public health relevance in a Western context, and they do not represent compelling reasons for sur- gery before boys are old enough to decide for themselves. Circumcision fails to meet the commonly accepted criteria for the justification of pre- ventive medical procedures in children.

798 FRISCH et al

COMMENTARY

The cardinal medical question should not be whether circumcision can pre- vent disease, but how disease can best be prevented.

The AAP report2 lacks a serious dis- cussion of the central ethical dilemma with, on 1 side, parents’ right to act in the best interest of the child on the basis of cultural, religious, and health- related beliefs and wishes and, on the other side, infant boys’ basic right to

REFERENCES

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  2. American Academy of Pediatrics Task Force on Circumcision. Male circumci- sion. Pediatrics. 2012;130(3). Available at: http://www.pediatrics.org/cgi/content/full/130/ 3/e756
  3. American Academy of Pediatrics Task Force on Circumcision. Circumcision pol- icy statement. Pediatrics. 2012;130(3): 585–586
  4. BMA Ethics Committee. Consent, Rights and Choices in Health Care for Children and Young People. London, United Kingdom: BMJ Books, Wiley; 2000
  5. Backes DM, Kurman RJ, Pimenta JM, Smith JS. Systematic review of human papillo- mavirus prevalence in invasive penile cancer. Cancer Causes Control. 2009;20(4): 449–457
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  8. Gray RH, Kigozi G, Serwadda D, et al. Male circumcision for HIV prevention in men in

physical integrity in the absence of compelling reasons for surgery. Phys- ical integrity is 1 of the most funda- mental and inalienable rights a child has. Physicians and their professional organizations have a professional duty to protect this right, irrespective of the gender of the child.

There is growing consensus among physicians, including those in the United States, that physicians should

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2007;369(9562):657–666
9. Bailey RC, Moses S, Parker CB, et al. Male

circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised con- trolled trial. Lancet. 2007;369(9562):643–656

10. Boyle GJ, Hill G. Sub-Saharan African randomised clinical trials into male cir- cumcision and HIV transmission: method- ological, ethical and legal concerns. J Law Med. 2011;19(2):316–334

11. Sánchez J, Sal Y Rosas VG, Hughes JP, et al. Male circumcision and risk of HIV acquisition among MSM. AIDS. 2011;25(4): 519–523

12. Millett GA, Flores SA, Marks G, Reed JB, Herbst JH. Circumcision status and risk of HIV and sexually transmitted infections among men who have sex with men: a meta- analysis. JAMA. 2008;300(14):1674–1684

13. Boyle GJ, Bensley GA. Adverse sexual and psychological effects of male infant cir- cumcision. Psychol Rep. 2001;88(3 pt 2): 1105–1106

14. Goldman R. The psychological impact of circumcision. BJU Int. 1999;83(suppl 1):93– 102

15. Taddio A, Katz J, Ilersich AL, Koren G. Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet. 1997;349(9052):599–603

16. Moldwin RM, Valderrama E. Immunochem- ical analysis of nerve distribution patterns within prepucial tissue [abstract]. J Urol. 1989;141(4 pt 2):499A

17. Podnar S. Clinical elicitation of the penilo- cavernosus reflex in circumcised men. BJU Int. 2012;109(4):582–585

18. Taylor JR, Lockwood AP, Taylor AJ. The prepuce: specialized mucosa of the penis

discourage parents from circumcising their healthy infant boys because non- therapeutic circumcision of underage boys in Western societies has no compelling health benefits, causes postoperative pain, can have serious long-term consequences, constitutes a violation of the United Nations’ Dec- laration of the Rights of the Child, and conflicts with the Hippocratic oath: primum non nocere: First, do no harm.

and its loss to circumcision. Br J Urol.

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F, Aslan G. Histologic characteristics of the human prepuce pertaining to its clinical behavior as a dual graft. Ann Plast Surg. 2005;54(2):191–195

20. Wu ZM, Chen YF, Qiu PN, Ling SC. Correlation between the distribution of SP and CGRP immunopositive neurons in dorsal root ganglia and the afferent sensation of pre- putial frenulum. Anat Rec (Hoboken). 2011; 294(3):479–486

21. Smith DK, Taylor A, Kilmarx PH, et al. Male circumcision in the United States for the prevention of HIV infection and other ad- verse health outcomes: report from a CDC consultation. Public Health Rep. 2010;125 (suppl 1):72–82

22. Yang DM, Lin H, Zhang B, Guo W. Cir- cumcision affects glans penis vibration perception threshold [in Chinese]. Zhonghua Nan Ke Xue. 2008;14(4):328– 330

23. Cortés-González JR, Arratia-Maqueo JA, Gómez-Guerra LS. Does circumcision has an effect on female’s perception of sexual satisfaction [in Spanish]? Rev Invest Clin. 2008;60(3):227–230

24. Fink KS, Carson CC, DeVellis RF. Adult cir- cumcision outcomes study: effect on erec- tile function, penile sensitivity, sexual activity and satisfaction. J Urol. 2002;167 (5):2113–2116

25. Frisch M, Lindholm M, Grønbæk M. Male circumcision and sexual function in men and women: a survey-based, cross-sec- tional study in Denmark. Int J Epidemiol. 2011;40(5):1367–1381

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  1. Kim D, Pang MG. The effect of male cir- cumcision on sexuality. BJU Int. 2007;99(3): 619–622
  2. Shen Z, Chen S, Zhu C, Wan Q, Chen Z. Erectile function evaluation after adult circumcision

[in Chinese]. Zhonghua Nan Ke Xue. 2004;10

(1):18–19
28. Sorrells ML, Snyder JL, Reiss MD, et al.

Fine-touch pressure thresholds in the adult penis. BJU Int. 2007;99(4):864–869

29. Tang WS, Khoo EM. Prevalence and cor- relates of premature ejaculation in a primary care setting: a preliminary cross- sectional study. J Sex Med. 2011;8(7): 2071–2078

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rBritish Association of Paediatric Surgeons, London, United Kingdom; sCommittee on Ethics and Children’s Rights, Swedish Paediatric Society, Stockholm, Sweden; tEthics Committee of the Danish Medical Association, Copenhagen, Denmark; uEthics Committee of the German Academy of Pediatrics and Adolescent Medicine, Berlin, Germany; vFinnish Association of Pediatric Surgeons, Tampere, Finland; wDepartment of Pediatric Surgery, Helsinki University Children’s Hospital, Helsinki, Finland; xDepartment of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada; yEthics Committee of the Norwegian Medical Association, Oslo, Norway; zEstonian Society of Paediatric Surgeons, Tallinn, Estonia; aaNorwegian Paediatric Association, Tromsø, Norway; bbFinnish Medical Association, Helsinki, Finland; ccLatvian Association of Pediatric Surgeons, Riga, Latvia; ddDepartment of Pediatric Surgery, Our Lady’s Children’s Hospital, Dublin, Ireland; eeDepartment of Surgery, Odense University Hospital, Odense, Denmark; ffDepartment of Pediatric Surgery, Landspitali University Hospital, Reykjavik, Iceland; ggDepartment of Pediatrics, Helsinki University Children’s Hospital, Helsinki, Finland; hhSwedish Pediatric Society, Stockholm, Sweden; iiDepartment of Pediatric Surgery, Dr. v. Haunersches Kinderspital, Ludwig-Maximilians Universität, Munich, Germany; jjCommission for Ethical Questions, German Academy of Pediatrics, Frankfurt, Germany; kkSwedish Society of Pediatric Surgery, Stockholm, Sweden; and llDutch Society of Pediatric Surgery, Rotterdam, Netherlands

KEY WORDS

AIDS, HIV infection, male circumcision, penile carcinoma, sexually transmitted disease, urinary tract infection

ABBREVIATIONS

AAP—American Academy of Pediatrics RCT—randomized controlled trials STD—sexually transmitted disease UTI—urinary tract infection

Opinions expressed in these commentaries are those of the author and not necessarily those of the American Academy of Pediatrics or its Committees. http://www.pediatrics.org/cgi/doi/10.1542/peds.2012-2896
doi:10.1542/peds.2012-2896
Accepted for publication Jan 3, 2013

Address correspondence to Morten Frisch, MD, PhD, Statens Serum Institut, Department of Epidemiology Research, 5 Artillerivej, Copenhagen S, DK-2300 Denmark. E-mail: mfr@ssi.dk

PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). Copyright © 2013 by the American Academy of Pediatrics

FINANCIAL DISCLOSURE: Dr MacDonald declares World Health Organization advisor and consultant work on vaccines and vaccine safety; the other authors have indicated they have no financial relationships relevant to this article to disclose.

FUNDING: No external funding.
COMPANION PAPER: A companion to this article can be found on page 801, and online at http://www.pediatrics.org/cgi/doi/10.1542/peds.2013-0081.

800 FRISCH et al ”

continue with blog summary:

38 high-ranking medical doctors and professors from 17 western countries outside of the US strongly criticise the AAP stance on male circumcision in new medical article published in AAPs own journal Pediatrics (imagine that going through peer review). Danish medical Professor Morten Frisch is lead author on the paper..

I’m sure you’re eager to read the new article, but although they have promised to make the entire thing free to all readers, Pediatrics have only opened for the abstract. However, I got my hands on the whole thing. Read it herePediatrics-2013-Frisch-peds.2012-2896[1] (pasted above)

Don’t let anyone get the idea that these 38 widely respected medical professionals are alone. If you Google them, you’ll notice that they all represent major medical societies and other influential institutions in the European medical community and they’re backed up by statements made by several national medical associations in Europe, among them the Danish, Dutch and German.

And that’s not all. Several other articles have been written about the lack of ethics and flawed methods of medical analysis applied by AAP in their stance on male circumcision. Out of step: fatal flaws in the latest AAP policy report on neonatal circumcision is an immensely interesting read and that goes forProphylactic interventions on children: balancing human rights with public health as well.

Basically, what they say is: Hands of the boys! There is no reason what-so-ever to cut into non-consenting healthy children, anyone who claims otherwise must have a strong cultural bias in stead of the objective conservative view, that all medical professionals should strive for.

Of course the AAP responded to the criticism, read their response herePediatrics-2013–peds.2013-0081[1] (pasted below)

(the AAP’s response)

Cultural Bias and Circumcision: The AAP Task Force on Circumcision Responds

AUTHOR: TASK FORCE ON CIRCUMCISION

KEY WORDS

circumcision, HIV, urinary tract infection, sexually transmitted infections

http://www.pediatrics.org/cgi/doi/10.1542/peds.2013-0081 doi:10.1542/peds.2013-0081
Accepted for publication Jan 17, 2013

Address correspondence to Douglas S. Diekema, MD, MPH, Seattle Children’s Research Institute, C9S-6, 1900 Ninth Ave, Seattle, WA 98101. E-mail: diek@u.washington.edu

PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). Copyright © 2013 by the American Academy of Pediatrics

FINANCIAL DISCLOSURE: Dr Carlo is a Director of Mednax; the other authors have indicated they have no financial relationships relevant to this article to disclose.

FUNDING: No external funding.

COMPANION PAPER: A companion to this article can be found on page 796, and online at http://www.pediatrics.org/cgi/doi/10.1542/ peds.2012-2896.

The members of the American Academy of Pediatrics (AAP) Task Force on Circumcision appreciate the opportunity to respond to the concerns raised by Frisch et al in their commentary, “Cultural Bias in AAP’s 2012 Technical Report and Policy Statement on Male Circumcision.”

The central claim of these authors is that the conclusions of the task force report are culturally biased, leading the task force to a flawed understanding of what constitutes trustworthy evidence and to con- clusions that are far from those reached by physicians in most other Western countries. The “obvious” cultural bias to which they refer apparently has its genesis in “the normality of non-therapeutic male circumcision in the US.” All of the commentary authors hail from Europe, where the vast majority of men are uncircumcised and the cultural norm clearly favors the uncircumcised penis. In contrast, approximately half of US males are circumcised, and half are not.1 Although that heterogeneity may lead to a more tolerant view toward circumcision in the United States than in Europe, the cultural “bias” in the United States is much more likely to be a neutral one than that found in Europe, where there is a clear bias against circumcision. Yet, the commentary’s authors have, at no point, recognized that their own cultural bias may exist in equal, if not greater, measure than any cultural bias that might exist among the members of the AAP Task Force on Circumcision. If cultural bias influences the review of available evidence, then a culture that is comfortable with both the circumcised penis and the uncircumcised penis would seem predis- posed to a more dispassionate analysis of the scientific literature than a culture with a bias that is either strongly opposed to cir- cumcision or strongly in favor of it.

The task force’s process was systematic, objective, comprehensive, and transparently documented in its technical report.1 Members of the AAP Task Force on Circumcision were recruited on the basis of area of expertise. There was no consideration or knowledge of the individuals’ beliefs concerning circumcision at the time of their ap- pointment. Unlike other published policy statements and reports on circumcision, the task force did not selectively choose which articles to review, but reviewed all of the available literature identified in a comprehensive search and evaluated those manuscripts by using previously established, nationally recognized guidelines to determine the quality of the data being reviewed.2 Some articles were reviewed but not cited in the technical report, either because they were not data-based studies, the quality of the study was seriously flawed, or the findings of the study did not meaningfully address the specific area of task force inquiry.

Frisch et al present opinions that reflect a review of the literature that is not comprehensive, systematic, or unbiased. For example, the authors

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dismiss the data related to urinary tract infection on the grounds that no randomized controlled trial has been performed, despite the fact that there is good evidence from other studies that suggest a preventive benefit of cir- cumcision. At the same time, they readily dismiss 3 randomized con- trolled trials and 11 other studies that provide good to fair evidence of a re- duction in HIV acquisition associated with circumcision. They claim that these data are “contradicted by other studies, which show no relationship between HIV infection rates and cir- cumcision status,” yet support that claim with only a single reference to a review article authored by the vice president of an organization opposed to circumcision. We would refer the reader to the task force’s technical report for a comprehensive review of the literature related to the potential benefits of circumcision.1 Notably, the World Health Organization has con- cluded that the data strongly support a benefit of male circumcision with regard to prevention of HIV infection and has issued guidelines for its use, both for adults/adolescents and for neonates.3

COMPLICATIONS

Frisch et al charge that members of the AAP Task Force on Circumcision “consider the foreskin to be a part of the male body that has no meaningful function in sexuality.” They addition- ally claim, “Recent studies … suggest that circumcision desensitizes the penis and may lead to sexual prob- lems in circumcised men and their partners.” In fact, many of these stu- dies were reviewed by members of the task force but were not cited in the technical report, either because the findings were equivocal, they did not support a benefit or detriment with regard to sexual function and pleasure, or because the relevance to

individuals undergoing circumcision during infancy was questionable. For example, the authors cite 5 studies to support the claim that “the foreskin is a richly innervated structure that protects the glans and plays an im- portant role in the mechanical func- tion of the penis during sexual acts.” Of these 5 studies, 4 were histologic studies that were not designed to correlate anatomic findings with phys- iologic or functional roles.4–7 Members of the task force appreciate that the foreskin has nerve fibers: the task force clearly recommends adequate pain control for infants undergoing circumcision. However, the task force did not move beyond what these studies actually reveal (the foreskin has nerve bundles and pain fibers, the foreskin contains Meissner cor- puscles, the inner surface of the fore- skin resembles a mucous membrane) to speculate about the effect that cir- cumcision might have on sexual func- tion or pleasure. The fifth study cited was designed to determine whether the absence of the penilo-cavernosus reflex is a reliable indicator of a path- ologic sacral lesion and did not evalu- ate implications for sexual function or pleasure.8 In sum, of the 5 studies, not one sought to evaluate whether the foreskin protects the glans or whether it “plays an important role in the me- chanical function of the penis during sexual acts.”

The authors cite 2 articles as evidence that “circumcision desensitizes the penis.” One of these is not a study and does not present data.9 The other revealed that perception sensitivity to vibration decreases after circumci- sion.10 Neither the clinical implications nor impact on sexual experience were evaluated.

Finally, Frisch et al cite 7 studies to support their contention that circum- cision may lead to sexual problems in circumcised men and their partners.

Four of the studies involved only men circumcised as adults11–14 or some men circumcised as adults.15 Men circumcised as adults most frequently have the procedure performed for medical reasons, which introduces both physical and psychological fac- tors that may affect their reporting of sexual difficulties. In 2 of the studies cited by Frisch et al, a significant number of men reported improved satisfaction after circumcision.11,13 In- terestingly, another of their cited studies14 concluded that circumcision had neither a negative nor a positive effect on the female partner’s per- ception of sexual satisfaction, a con- clusion that contradicts that of Frisch et al. The shortcomings of the study by Sorrels et al16 are discussed in our technical report. Finally, the study by Frisch et al used a cross-sectional survey of Danish men that found that circumcised men were more likely to report sexual difficulties than uncircumcised men.17 Circumcised men represented only 5% of 2343 sexually experienced survey respond- ents, and only 15% of those circum- cised men (n 5 17) had the procedure in the first 6 months of life. Attributing these findings to de- creased penile sensitivity is a stretch. It seems far more likely that the findings are attributable to the kinds of social bias the authors attribute to the AAP task force. Male circumcision is rare in Denmark, rare enough that circumcised males are epidemiologic outliers, which may lead some of them to feel “different,” leading to anxiety about sexual experiences with women who perceive a circumcised penis as abnormal. In addition, be- cause many of the circumcised men had the procedure performed later in life, some likely for medical reasons, they are far from representative of a group of men circumcised as infants. It should be noted that the findings of the Danish survey contrast starkly to

802 BLANK et al

COMMENTARY

those of 2 randomized controlled trials from Africa, which are discussed in the AAP technical report.18,19

AGE AT CIRCUMCISION

A central claim of Frisch et al is that if circumcision is to be performed before an age at which an individual can de- cide for himself, there must be a com- pelling reason for doing so. They argue that there is no compelling reason for performing a circumcision before sexual debut and additionally claim that “sexually transmitted HIV infection is not a relevant threat to children.”

Underlying the authors’ views are sev- eral presuppositions that reflect the ideal, but not the reality, of human de- cision making. The first of these is that the responsible use of condoms will “provide close to 100% reduction in risk for any STIs.” We agree, and fully support efforts to make sexual activity as safe as possible through the routine use of condoms. However, despite huge educational efforts, many individuals around the world do not use condoms consistently. If they did, sexually trans- mitted infection and HIV would decline to the point of nonexistence. The added protective benefit of circumcision exists precisely because responsible condom use is far from universal. In 2011, 39.8% of sexually active high school students in the United States reported not using a condom during their last sexual in- tercourse.20 Condoms represent one of several tools for reducing the risk of infections transmitted during sexual contact. Circumcision is another.

The claim that “sexually transmitted HIV infection is not a relevant threat to children” is incorrect given the US data. In 2011, sexual debut occurred at or before age 13 years for 6.2% of US high school students, and most people in the United States are sexually active before the age at which they would possess

the legal authority to consent to a circumcision.20 A nationwide sample of adolescent females between the ages of 14 and 19 years estimated that 4 in 10 sexually active adolescent females have a sexually transmitted infection (defined as human papillomavirus, chlamydia, trichomoniasis, genital herpes virus, or gonorrhea).21 National HIV surveillance data show that, in 2008, there were at least 2266 HIV infections among US adolescents 13 to 19 years of age.22

ETHICAL ISSUES

Frisch et al claim that “the AAP report lacks a serious discussion of the central ethical dilemma with, on one side, parents’ right to act in the best interest of the child … and, on the other side, infant boys’ basic right to physical integrity in the absence of compelling reasons for surgery.” The authors’ argument about the basic right to physical integrity is an im- portant one, but it needs to be bal- anced by other considerations. The right to physical integrity is easier to defend in the context of a procedure that offers no potential benefit, but the assertion by Frisch et al of ‘no benefit’ is clearly contradicted by the published scientific peer-reviewed ev- idence. Although task force members did not find the data sufficiently compelling to justify a recommenda- tion for routine neonatal circumcision, we did find that the benefits are substantial enough to allow parents to make this decision for their male children. This stance is very similar to that of The Canadian Medical Society, the British Medical Association, and the Royal Australasian College of Physicians. Frisch et al appeal to the ethical precept “First, do no harm,” but they fail to recognize that in sit- uations in which a preventive benefit exists, harm can also be done by failing to act. Whereas there are rare

situations in which a male will be harmed by a circumcision procedure, it is also true that some males will be harmed by not being circumcised. Simply because it is difficult to iden- tify exactly which individuals have suffered a harm because they were not circumcised should not lead one to discount the very real harms that might befall some men by not being circumcised. There is no easy answer to this issue ethically. Regardless of what decision is made on behalf of a young male, harm might result from that decision. That is precisely why the AAP task force members found that this decision properly remains with parents and that parents should have information about both potential benefits and potential harms as they make this decision for their child.

TASK FORCE ON CIRCUMCISION 2012

Susan Blank, MD, MPH, Chairperson Michael Brady, MD, Representing the AAP Committee on Pediatrics AIDS and Committee on Infectious Disease Ellen Buerk, MD, Representing the AAP Board of Directors

Waldemar Carlo, MD, Representing the AAP Committee on Fetus and Newborn Douglas Diekema, MD, MPH, Repre- senting the AAP Committee on Bio- ethics

Andrew Freedman, MD, Representing the AAP Section on Urology
Lynne Maxwell, MD, Representing the AAP Section on Anesthesiology

Steven Wegner, MD, JD, Representing the AAP Committee on Child Health Financing

LIAISONS

Charles LeBaron, MD – Centers for Disease Control and Prevention

Lesley Atwood, MD – American Acad- emy of Family Physicians

Sabrina Craigo, MD – American College of Obstetricians and Gynecologists

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REFERENCES

  1. American Academy of Pediatrics Task Force on Circumcision. Male circumcision. Pediatrics. 2012;130(3). Available at: www. pediatrics.org/cgi/content/full/130/3/e756
  2. Cummins RO, Hazinski MF. The most important changes in the international ECC and CPR guidelines 2000 [edito- rial]. Circulation. 2000;102(8 suppl):I371– I376
  3. World Health Organization; UNAIDS. New data on male circumcision and HIV pre- vention: policy and programme implica- tions. Geneva, Switzerland: World Health Organization; 2007. Available at: http://libdoc. who.int/publications/2007/9789241595988_eng. pdf. Accessed January 7, 2013
  4. Moldwin RM, Valderrama E. Immunochem- ical analysis of nerve distribution patterns within prepucial tissue (abstract). J Urol. 1989;141(4 pt 2):499A
  5. Taylor JR, Lockwood AP, Taylor AJ. The prepuce: specialized mucosa of the penis and its loss to circumcision. Br J Urol. 1996;77(2):291–295
  6. Tuncali D, Bingul F, Talim B, Surucu S, Sahin F, Aslan G. Histologic characteristics of the human prepuce pertaining to its clinical behavior as a dual graft. Ann Plast Surg. 2005;54(2):191–195
  7. Wu ZM, Chen YF, Qiu PN, Ling SC. Correla- tion between the distribution of SP and CGRP immunopositive neurons in dorsal root ganglia and the afferent sensation of preputial frenulum. Anat Rec (Hoboken). 2011;294(3):479–486

8. Podnar S. Clinical elicitation of the penilo- cavernosus reflex in circumcised men. BJU Int. 2012;109(4):582–585

9. Smith DK, Taylor A, Kilmarx PH, et al. Male circumcision in the United States for the prevention of HIV infection and other ad- verse health outcomes: report from a CDC consultation. Public Health Rep. 2010;125 (suppl 1):72–82

10. Yang DM, Lin H, Zhang B, Guo W. Circumci- sion affects glans penis vibration perception threshold [in Chinese]. Zhonghua Nan Ke Xue. 2008;14(4):328–330

11. Fink KS, Carson CC, DeVellis RF. Adult cir- cumcision outcomes study: effect on erec- tile function, penile sensitivity, sexual activity and satisfaction. J Urol. 2002;167 (5):2113–2116

12. Kim D, Pang MG. The effect of male cir- cumcision on sexuality. BJU Int. 2007;99(3): 619–622

13. Shen Z, Chen S, Zhu C, Wan Q, Chen Z. Erectile function evaluation after adult cir- cumcision [in Chinese]. Zhonghua Nan Ke Xue. 2004;10(1):18–19

14. Cortés-González JR, Arratia-Maqueo JA, Gómez-Guerra LS. Does circumcision have an effect on female’s perception of sexual satisfaction? [in Spanish]. Rev Invest Clin. 2008;60(3):227–230

15. Tang WS, Khoo EM. Prevalence and corre- lates of premature ejaculation in a primary care setting: a preliminary cross-sectional study. J Sex Med. 2011;8(7):2071–2078

16. Sorrells ML, Snyder JL, Reiss MD, et al. Fine-touch pressure thresholds in the adult penis. BJU Int. 2007;99(4):864–869

17. Frisch M, Lindholm M, Grønbæk M. Male circumcision and sexual function in men and women: a survey-based, cross- sectional study in Denmark. Int J Epi- demiol. 2011;40(5):1367–1381

18. Kigozi G, Watya S, Polis CB, et al. The effect of male circumcision on sexual satisfaction and function, results from a randomized trial of male circumcision for human im- munodeficiency virus prevention, Rakai, Uganda. BJU Int. 2008;101(1):65–70

19. Krieger JN, Mehta SD, Bailey RC, et al. Adult male circumcision: effects on sexual func- tion and sexual satisfaction in Kisumu, Kenya. J Sex Med. 2008;5(11):2610–2622

20. Centers for Disease Control and Prevention. 1991-2011 High school youth risk behavior survey data. Available at: http://apps.nccd.cdc. gov/youthonline. Accessed January 7, 2013

21. Forhan SE, Gottlieb SL, Sternberg MR, et al. Prevalence of sexually transmitted infec- tions among female adolescents aged 14 to 19 in the United States. Pediatrics. 2009;124 (6):1505–1512

22. Centers for Disease Control and Pre- vention. HIV surveillance in adolescents and young adults. Available at: http://www.cdc. gov/hiv/topics/surveillance/resources/slides/ adolescents/slides/Adolescents.pdf. Accessed January 7, 2013

Cutting the ham

http://www.savingsons.org/2013/03/cutting-ham-why-do-you-do-this.html?m=1

Why do we do as we do?

——-
International physicians disagree with the AAP’s stance on circumcision
http://knmg.artsennet.nl/Nieuws/Nieuwsarchief/Nieuwsbericht-1/International-physicians-protest-against-American-Academy-of-Pediatrics-policy-on-infant-male-circumcision.htm

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—–

Poor boy!
Boy needs reconstructive surgery after dr botches circumcision.
http://www.chop.edu/service/urology/patient-stories/hadi-story.html

2007: circumcision no effect on HIV transmission

This was a USA study

http://mobile.reuters.com/article/idUSN0345545120071204?irpc=932

WASHINGTON (Reuters) – Circumcision may reduce a man’s risk of infection with the AIDS virus by up to 60 percent if he is an African, but it does not appear to help American men of color, U.S. researchers reported on Monday.

“Overall, we found no association between circumcision status and HIV infection status among black or Latino (men who have sex with men),” said Millett, who presented his findings to the CDC’s National HIV Prevention Conference in Atlanta.

Experts knew circumcision would not protect a female sex partner, nor the male sex partner being penetrated.

But Millett’s study found no benefit of circumcision to any of the men. “We also found no protective benefit of circumcision among those men reporting recent unprotected sex with a male partner in which they were exclusively the insertive male partner,” he said.

http://mobile.reuters.com/article/idUSN0345545120071204?irpc=932

Disney princesses not so happily ever after

Funny but not funny.

http://www.huffingtonpost.com/mobileweb/2013/03/13/after-ever-after-disney-jon-cozart_n_2867739.html

Click the link above

In case you were wondering what happens after your Disney princesses live happily ever after, Jon Cozart, aka “Paint,” has all the answers. And it’s not pretty… although his singing is.
Is it just us, or are you, too, intimidated by how talented this guy is?
WATCH:

After ever after
http://youtu.be/diU70KshcjA

Lord of the rings in 99 seconds
http://youtu.be/3FPxYDGfniM

Pray for this family

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—-this unverified bit is from this biased source

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“God, bring comfort and peace. Peace is your essence. Peace is your name. Bring peace to this family who has lost their precious child in death.
We come to you, God because we know that you sorrow, and are acquainted with grief. You too have endured the loss of a child. You empathize.
We can’t help but ask, “Why?” Forgive our insistence, our confusion, even our anger. We believe that you are just, and we ache to understand how this tragic death is an expression of that justice, how it expresses your love. We also know – in our minds at least – that you seldom answer the “why?” question. We press you, but on these matters you are mostly silent.
What we ask instead is “how?” How can we move forward? How can this bring us together and not tear us apart? How can we now live under the shadow of this untimely death? Answer this prayer with your comfort and guidance.
There is no way to remove the pain. The grief is real. The only sanity is to know, to believe, in a life beyond with you, when all the scales are righted and the sufferings are made good. We trust you and your promise that while this child’s life on earth is done, his life beyond has just begun. With that release we lose him and let him go into your arms, then by faith receive in return the boundless comfort of your presence. That is all, that is enough. In Jesus.”

Read more: http://blog.beliefnet.com/prayerplainandsimple/2011/06/a-prayer-for-a-family-grieving-the-death-of-a-child.html#ixzz2N3T3e12k