17,052
edits
Changes
Jump to navigation
Jump to search
In Infant boys are born with a healthy penis and foreskin. Treatment is not required. Infant boys do not engage in sexual intercourse so they cannot contract HIV infection by sexual intercourse. Infant boys cannot grant consent for this irreversible body altering surgery which violate several significant United Nations [[human rights]] instruments. Nevertheless, in partnership with other WHO departments, UNAIDS, and the Johns Hopkins Program for International Education in Gynecology and Obstetrics (JHPIEGO), the Department of Reproductive Health and Research (RHR) has developed a Manual for male infant circumcision under local anaesthesia.<ref>{{REFbook
→Circumcision Manual: add text.
=== Circumcision Manual ===
|last=[[World Health Organization]]
|last2=JHPIEGO
|accessdate=2011-06-01
}}</ref><ref name="for control"/> The manual is intended for use by clinical officers, who can be trained to perform uncomplicated circumcision, and to refer more complex cases. The manual is expected to be published in 2011. The manual itself is supported by training guides and a certification framework, to facilitate the upgrading of skills of officers who are not otherwise authorized to perform surgery.
As justification for circumcision, the Manual alleges that circumcision would reduce the incidence of [[urinary tract infection]] (UTI) in the first six months of life, however this is not a valid justification because UTI, if it should occur, is easily treated medically instead of with body-altering surgery.<ref name="McCracken 1989">{{REFjournal
|last=McCracken
|first=G.H.
|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
}}</ref>
Moreover the foreskin protects the penis from infection, so the amputation of the foreskin makes UTI more likely. In infant boys, UTIs originate from the external environment, strongly suggesting that these infections are iatrogenically caused.<ref>{{REFjournal
|last=Maskell
|first=R.
|etal=yes
|title=Urinary Pathogens in the Male
|journal=British Journal of Urology
|date=1975
|volume=47
}}</ref> Two interventions that put the male infant at immediate risk for UTIs are [[circumcision]], and [[forced retraction]] of the foreskin. These interventions tear away the synechia which binds the foreskin to the glans in male infants, thereby creating entry points for ''E. coli'' bacteria,<ref name="Winberg 1989">{{REFjournal
|last=Winberg
|first=J.
|etal=yes
|url=http://www.cirp.org/library/disease/UTI/winberg-bollgren/
|title=The Prepuce: A Mistake of Nature?
|journal=Lancet
|date=1989
|pages=598-599
}}</ref> which binds to the glans penis of the infant.<ref name="Cunningham 1986">{{REFjournal
|last=Cunningham
|first=N.
|url=http://www.cirp.org/library/disease/UTI/cunningham/
|title=Circumcision and urinary tract infections (letter)
|journal=Pediatrics
|date=1986
|volume=77
|issue=2
|page=267
}}</ref> Urinary tract infections (UTI) are a complication of circumcision.<ref>{{REFjournal
|last=Smith
|first=R.M.
|url=http://www.cirp.org/library/disease/UTI/smith1916/
|title=Recent contributions to the study of pyelitis in infancy
|journal=Am J Dis Child
|date=1916
|volume=XII
|pages=235.243
}}</ref><ref name="Cohen 1992">{{REFjournal
|last=Cohen
|first=H.
|etal=yes
|url=http://www.cirp.org/library/disease/UTI/cohen/
|title=Postcircumcision Urinary Tract Infection
|journal=Clinical Pediatrics
|date=1992
|pages=322-324
}}</ref><ref name="Goldman 1996">{{REFjournal
|last=Goldman
|first=M.
|last2=Barr
|first2=J.
|last3=Bistritzer
|first3=T.
|last4=Aladjem
|first4=M.
|url=http://www.cirp.org/library/disease/UTI/goldman/
|title=Urinary tract infection following ritual jewish circumcision
|journal=Israel Journal of Medical Sciences
|date=1996
|volume=32
|issue=11
|pages=1098-1102
}}</ref><ref>{{REFjournal
|last=Prais
|first=D.
|last2=Shoov-Furman
|first2=R.
|last3=Amir
|first3=J.
|title=Is circumcision a risk factor for neonatal urinary tract infections?
|journal=Arch Dis Child
|date=2008-10-06
|DOI=10.1136/adc.2008.144063
|url=http://adc.bmj.com/cgi/content/abstract/adc.2008.144063v1
}}</ref>
Promotion of infant circumcision by publishing a manual has the effect of increasing demand for circumcision devices.
=== Assessment ''Toolkit'' ===