American urologists and the practice of male circumcision

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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.[1] 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.[2]
  • 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 functions of the intact foreskin.[3] The proper treatment for UTI is anti-microbial, not surgery.[4]
  • 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.[5]
  • This statement proposes circumcision as a treatment for phimosis and paraphimosis in boys, but 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.[6]
  • 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 consent for a foreskin amputation.
  • This statement is completely silent on human rights and medical ethics issues concerning the non-therapeutic excision of functional body parts from a minor who is too young to grant consent.

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:

“ Given the socioeconomic, educational status, and health demographics of our population, universal neonatal circumcision cannot be justified based on the current evidence available.
– Canadian Urological Association[7]

Every circumcision causes both 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:

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.[8]

Lack of experience with a normal body part

American male urologists are drawn from the general population in which the great majority of males have received a medically-unnecessary, non-therapeutic infant circumcision,[9] so most have no personal experience of the functions[10] and 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 adult circumcision.[11]

Issues with care of adult intact males

The AUA does not have a published policy or position statement regarding adolescent and adult circumcision.

IntactiWiki is aware of a steady flow of inquiries and complaints from foreskinned males who have consulted 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 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,[12] 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 a circumcision. It appears that some urologists try to enhance the revenue from their practice by doing more circumcisions, regardless of the trauma, loss of 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.[13]

Masood advised that urologists are informing men incorrectly. He said:

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).[14]

Intact males who consult a urologist should receive any recommendation for adult circumcision with extreme caution. Doing one's own research is advised so one does not become one of the regret men.

See also

Bias

References

  1. ↑ REFweb Anonymous (October 2018). Circumcision, American Urological Association. Retrieved 8 April 2023.
  2. ↑ REFweb (2013). potential, The Free Dictonary by Farlex. Retrieved 13 April 2023.
  3. ↑ REFjournal Fleiss P, Hodges F, Van Howe RS. Immunological functions of the human prepuce. Sex Trans Infect. October 1998; 74(5): 364-67. PMID. PMC. DOI. Retrieved 14 January 2022.
  4. ↑ REFjournal McCracken GH. Options in antimicrobial management of urinary tract infections in infants and children. Pediatr Infect Dis J. August 1989; 8(8): 552-555. Retrieved 8 April 2023.
  5. ↑ REFjournal Boyle GJ, Hill G. Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: Methodological, ethical and legal concerns PDF. Thompson Reuter. December 2011; 19(2): 316-34. PMID. Retrieved 30 December 2020.
  6. ↑ REFjournal Edwards S. Balanitis and balanoposthitis: a review PDF. Genitourin Med. 1996; 72: 155-9. PMID. PMC. DOI. Retrieved 9 April 2023.
  7. ↑ REFjournal Dave S, et al. Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (abridged version). Can Urol Assoc J. February 2018; 12(2): 18-28. PMID. PMC. Epub 2017 Dec 1 DOI. Retrieved 10 April 2023.
  8. ↑ REFjournal Svoboda JS. Nontherapeutic Circumcision of Minors as an Ethically Problematic Form of Iatrogenic Injury PDF. AMA J Ethics. 1 August 2017; 19(8): 815-24. PMID. DOI. Retrieved 9 April 2023.
  9. ↑ REFjournal Laumann EO, Masi CM, Zuckerman EW. Circumcision in the United States. JAMA. 2 April 1997; 277(13): 1052-7. PMID. Retrieved 8 April 2023.
  10. ↑ REFweb Helard L (1 August 2014). Functions of the Foreskin, Intact Australia. Retrieved 8 April 2023.
  11. ↑ REFjournal Muller AJ. To cut or not to cut? Personal factors influence primary care physicians’ position on elective newborn circumcision PDF. Journal of Men's Health. October 2010; 7(3): 227-32. Retrieved 8 April 2023.
  12. ↑ REFjournal Cold CJ, Taylor JR. The prepuce PDF. BJU Int. January 1999; 83 Suppl 1: 34-44. PMID. DOI. Retrieved 13 April 2023.
    Quote: The prepuce is primary, erogenous tissue necessary for normal sexual function.
  13. ↑ REFweb Anonymous (2023). Average Cost Of Circumcision, Spend On Health. Retrieved 12 April 2023.
  14. ↑ REFjournal Masood S, et al. Penile sensitivity and sexual satisfaction after circumcision: are we informing men correctly?. Urol Int. 2005; 75(1): 62-6. PMID. DOI. Retrieved 20 April 2023.
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