View source for American urologists and the practice of male circumcision

There are many '''issues with American urologists and the practice of male circumcision'''.
== The American Urological Association ==

The [[American Urological Association]] (AUA) is the [[medical trade association]] for the American urological industry. It has the primary function of advancing the business interests and financial well-being of its members. The AUA is considered to be a source of pro-circumcision [[bias]].

A search for "circumcision" on its website produces 755 hits, so male [[circumcision]] is a major business interest of the urological industry.
=== AUA position statement ===
Although obstetricians, pediatricians, and family doctors obtain most of the revenue from non-therapeutic infant circumcision, the AUA has provided a promotional position statement on infant [[circumcision]].<ref>{{REFweb
 |url=https://www.auanet.org/about-us/policy-and-position-statements/circumcision
 |title=Circumcision
 |last=Anonymous
 |publisher=[[American Urological Association]]
 |date=2018-10
 |accessdate=2023-04-08
}}</ref> There are many issues with this statement:
* This statement misleadingly uses the word "potential" to suggest the existence of "benefits" that don't actually exist except in someone's imagination. ''Potential'' means to exist in possibility but not in actuality.<ref>{{REFweb
 |url=https://www.thefreedictionary.com/potential
 |title=potential
 |last=
 |first=
 |init=
 |publisher=The Free Dictonary by Farlex
 |date=2013
 |accessdate=2023-04-13
}}</ref>
* This statement claims that non-therapeutic circumcision is safe "when performed by an experienced operator", however, infant circumcision is frequently assigned to the most junior and least-experienced operator.
* This statement claims that circumcision prevents [[phimosis]] and [[paraphimosis]], however, these are normal developmental conditions and not diseases.
* This statement claims that circumcision prevents [[balanoposthitis]], however, the treatment for this inflammation depends on accurate diagnosis of the cause, followed by appropriate treatment.
* This statement claims that circumcision reduces [[urinary tract infection]] (UTI) by 90 percent, but it ignores the [[Immunological and protective function of the foreskin| immunological and protective functions]] of the [[intact]] foreskin.<ref>{{FleissP HodgesF VanHoweRS 1998}}</ref> The proper treatment for UTI is anti-microbial, not surgery.<ref name="McCracken 1989">{{REFjournal
 |last=McCracken
 |init=GH
 |url=http://www.cirp.org/library/disease/UTI/mccracken/
 |title=Options in antimicrobial management of urinary tract infections in infants and children
 |journal=Pediatr Infect Dis J
 |volume=8
 |issue=8
 |date=1989-08
 |pages=552-555
 |accessdate=2023-04-08
}}</ref>
* This statement claims that circumcision reduces the risk of HIV infection in Africa by 60 percent, however, the RCTs on which is based have been shown to have disabling statistical faults with only a 1 percent reduction at best.<ref>{{BoyleGJ HillG 2011}}</ref>
* This statement proposes [[circumcision]] as a treatment for [[phimosis]] in boys, however, makes no mention of the effectiveness of non-invasive manual [[stretching]] to relieve phimosis and paraphimosis.
* This statement proposes circumcision as a treatment for [[balanoposthitis]], but fails to mention conservative, non-invasive, accurate diagnosis of the cause and specific appropriate treatment as a better alternative.<ref name="edwards1996">{{REFjournal
 |last=Edwards
 |first=Sarah
 |init=S
 |author-link=
 |title=Balanitis and balanoposthitis: a review
 |journal=Genitourin Med
 |date=1996
 |volume=72
 |issue=
 |pages=155-9
 |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1195642/pdf/genitmed00009-0009.pdf
 |pubmedID=8707315
 |pubmedCID=195642 
 |DOI=10.1136/sti.72.3.155
 |format=PDF
 |accessdate=2023-04-09
}}</ref>
* This statement completely excludes any mention of the important protective, immunological, sexual, and sensory functions of the [[foreskin]] which might dissuade a patient or his surrogate from granting [[Informed consent| consent]] for a foreskin [[amputation]].
* This statement is completely silent on [[human rights]] and [[medical ethics]] issues concerning the non-therapeutic excision of normal, functional body parts from a minor who is too young to grant [[Informed consent| consent]].<ref name="aap1995">{{REFjournal
 |last=Bioethics Committee, American Academy of Pediatrics.
 |first=
 |author-link=
 |etal=no
 |title=Informed consent, parental permission, and assent in pediatric practice
 |trans-title=
 |language=
 |journal=Pediatrics
 |location=
 |date=1995-02
 |volume=95
 |issue=2
 |pages=314-7
 |url=http://www.cirp.org/library/ethics/AAP/
 |archived=
 |quote=
 |pubmedID=7838658
 |pubmedCID=
 |DOI=
 |accessdate=2023-04-24
}}</ref>

When drafting this statement, it is evident that the AUA placed the income of its members above the legal rights, health, and well-being of American boys.

For comparison, the [[Canadian Urological Association]] (CUA) considered the matter of non-therapeutic infant [[circumcision]] and issued a statement in February 2018. The CUA concluded:

{{Citation
 |Text=Given the socioeconomic, educational status, and health demographics of our population, universal neonatal circumcision cannot be justified based on the current evidence available.
 |Author=[[Canadian Urological Association]]
 |ref=<ref name="cua2018">{{REFjournal
 |last=Dave
 |first=Sumit
 |init=S
 |author-link=
 |etal=yes
 |title=Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (abridged version)
 |journal=Can Urol Assoc J
 |date=2018-02
 |volume=12
 |issue=2
 |pages=18-28
 |url=https://cuaj.ca/index.php/journal/article/view/5034/3470
 |pubmedID=29381455
 |pubmedCID=5937397
 |DOI=10.5489/cuaj.5034. Epub 2017 Dec 1
 |accessdate=2023-04-10
}}</ref>
}}

Every circumcision causes both [[trauma| psychic and physical trauma]] to the patient. Svoboda (2017) considered whether the benefits of non-therapeutic circumcision (NTC) was sufficient to justify the trauma. He wrote:

<blockquote>
As argued here, nontherapeutic circumcision of male minors is not medically justifiable and violates the cardinal principles of medical ethics, including preserving a child’s future autonomy, nonmaleficence, beneficence, and justice. Circumcision should be at least delayed until the affected person reaches an age of understanding and is able to make his own risk-benefit analysis. Notably, the Danish Medical Association issued a policy paper in December 2016 that found NTC before the age of informed consent to be unethical. Physicians’ legal right to operate on healthy children is also questionable. In 2012, a German court held that circumcision constitutes criminal assault by causing bodily harm and denying a child his right to physical integrity, although the decision was later legislatively reversed. And in 2015, in a case involving female genital cutting/mutilation, a British judge found that nontherapeutic circumcision of male children is a “significant harm". As the balance of legal, ethical, and human rights discourse moves steadily against NTC, courts in the US and elsewhere might gradually conclude that NTC is inconsistent with medical professionals’ ethical and legal duties to the child.<ref name="svoboda2017">{{REFjournal
 |last=Svoboda
 |first=
 |init=JS
 |author-link=J. Steven Svoboda
 |etal=no
 |title=Nontherapeutic Circumcision of Minors as an Ethically Problematic Form of Iatrogenic Injury
 |journal=AMA J Ethics
 |date=2017-08-01
 |volume=19
 |issue=8
 |pages=815-24
 |url=https://journalofethics.ama-assn.org/sites/journalofethics.ama-assn.org/files/2018-04/msoc2-1708.pdf
 |pubmedID=28846521
 |pubmedCID=
 |DOI=10.1001/journalofethics.2017.19.8.msoc2-1708
 |format=PDF
 |accessdate=2023-04-09
}}</ref>
</blockquote>

== Lack of experience with a normal body part ==

American male urologists are part from the general population in which the great majority of males have received a medically-unnecessary, non-therapeutic infant [[circumcision]],<ref name="laumann1997">{{REFjournal
 |last=Laumann
 |first=Edward O.
 |init=EO
 |author-link=
 |last2=Masi
 |first2=Christopher M.
 |init2=CM
 |author2-link=
 |last3=Zuckerman
 |first3=Ezra W.
 |init3=EW
 |author3-link=
 |etal=no
 |title=Circumcision in the United States
 |journal=JAMA
 |date=1997-04-02
 |volume=277
 |issue=13
 |pages=1052-7
 |url=https://jamanetwork.com/journals/jama/article-abstract/414922
 |pubmedID=9091693
 |accessdate=2023-04-08
}}</ref> so most have no personal experience of the functions<ref>{{REFweb
 |url=http://www.intactaus.org/information/functionsoftheforeskin/
 |title=Functions of the Foreskin
 |last=Helard
 |first=Lou
 |init=L
 |author-link=
 |publisher=[[Intact Australia]]
 |date=2014-08-01
 |accessdate=2023-04-08
}}</ref> and [[Foreskin sensitivity|sensations]] from the natural [[intact]] foreskin. American female urologists don't have male body parts so they also have no personal experience at all of the functions and sensations of the natural intact [[foreskin]].

This abysmal state of ignorance cannot serve the patients well. Moreover, Muller (2010) found that [[circumcised doctors]] are biased in favor of infant [[circumcision]], and may also be biased in favor of [[Adolescent and adult circumcision|adult circumcision]].<ref>{{REFjournal
 |last=Muller
 |first=
 |init=AJ
 |author-link=
 |etal=no
 |title=To cut or not to cut? Personal factors influence primary care physicians’ position on elective newborn circumcision
 |journal=Journal of Men's Health
 |date=2010-10
 |volume=7
 |issue=3
 |pages=227-32
 |url=https://www.arclaw.org/wp-content/uploads/Muller-Cut-or-not-cut-JMH-2010.pdf
 |format=PDF
 |accessdate=2023-04-08
}}</ref>

== Issues with care of adult intact males ==
The AUA does not have a published policy or position statement regarding [[adolescent and adult circumcision| adolescent or adult circumcision]].

[[IntactiWiki]] is aware of a steady flow of inquiries and complaints from [[foreskinned]] males who have consulted various unnamed urologists for one reason or another. It appears that some urologists omit information on conservative foreskin preserving treatment, and immediately recommend circumcision.

The inquiries usually seek to validate information provided to the patient by the urologist. Patients with a narrow foreskin may be told that well-proven [[stretching]] to generate [[tissue expansion]] won't work, so they will have to receive a [[Adolescent and adult circumcision|circumcision]] to treat non-retractile foreskin.

The nature and function of the [[foreskin]] (prepuce) and its essential role in normal sexual intercourse has been known for many years,<ref name="cold1999">{{REFjournal
 |last=Cold
 |first=
 |init=CJ
 |author-link=Christopher J. Cold
 |last2=Taylor
 |first2=
 |init2=JR
 |author2-link=John R. Taylor
 |etal=no
 |title=The prepuce
 |trans-title=
 |language=
 |journal=BJU Int
 |location=
 |date=1999-01
 |volume=83 Suppl 1
 |issue=
 |article=
 |page=
 |pages=34-44
 |url=http://artemide.bioeng.washington.edu/InformationIsPower/cold-taylor-prepuce_bju_1999_83_34-44.pdf
 |archived=
 |quote=The prepuce is primary, erogenous tissue necessary for normal sexual function.
 |pubmedID=10349413
 |pubmedCID=
 |DOI=10.1046/j.1464-410x.1999.0830s1034.x
 |format=PDF
 |accessdate=2023-04-13
}}</ref> yet reports suggest that some urologists tend to omit information on the nature and function of the [[foreskin]] from discussions with [[intact]] patients.

The complaints usually are about efforts by the urologist eager to get a healthy patient to grant consent for an [[adult circumcision]]. It appears that some urologists try to enhance the revenue from their practice by doing more circumcisions, regardless of the [[trauma]], loss of [http://www.intactaus.org/information/functionsoftheforeskin/ function], and lifelong harm to the patient. 

According to Spend On Health, a surgeon would get about $625.00 for an adult circumcision that takes about one hour to perform. The total cost can run as high as $6,110.00. Spend On Health advises that insurance may not cover adult circumcision.<ref>{{REFweb
 |url=https://spendonhealth.com/circumcision-cost/
 |title=Average Cost Of Circumcision
 |last=Anonymous
 |first=
 |init=
 |publisher=Spend On Health
 |date=2023
 |accessdate=2023-04-12
}}</ref>

Masood et al. (2005) advised that urologists are informing men incorrectly. The authors said:
<blockquote>
"… we suggest that before circumcision, men should be warned of the long-term consequences (penile sensations and effect on erectile function) as well as be talked through the more traditional subjects (peri-operative complications)."<ref name="masood2005">{{REFjournal
 |last=Masood
 |init=S
 |last2=Patel
 |first2=
 |init2=HRH
 |author2-link=
 |last3=Himpson
 |first3=
 |init3=RC
 |author3-link=
 |etal=yes
 |title=Penile sensitivity and sexual satisfaction after circumcision: are we informing men correctly?
 |journal=Urol Int
 |date=2005
 |volume=75
 |issue=1
 |pages=62-6
 |url=http://www.cirp.org/library/sex_function/masood1/
 |pubmedID=16037710
 |pubmedCID=
 |DOI=10.1159/000085930
 |accessdate=2023-04-20
}}</ref>
</blockquote>
[[Intact]] males who consult a urologist should receive any recommendation for [[Adolescent_and_adult_circumcision| adolescent or adult circumcision]] with extreme caution. Doing one's own research is advised so one does not become another [[regret men| regret man]].
{{SEEALSO}}
* [[Adult circumcision]]
* [[Bias]]
* [[Circumcised doctors]]
* [[Financial incentive]]
* [[Phimosis]]
* [[Regret men]]
* [[Stretching]]
* [[Tissue expansion]]
{{REF}}


[[Category:Education]]
[[Category:Physicians]]
[[Category:Medical society]]

[[Category:USA]]