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Monday March 3 12:06 PM EST
Circumcised Baby Boys "Re-live" Pain
NEW YORK (Reuters) -- Some may be right when they call it the unkindest cut
of all. New findings indicate that circumcision pain can affect an infant
several months after the operation, showing up as an increased pain
reaction to routine vaccinations.
The findings apparently run counter to the common belief among many people,
including doctors, that pain medication given to newborns before
circumcision are not of any benefit because pain from the operation is
short-lived and insignificant.
However, researchers from The Hospital for Sick Children in Toronto,
Canada, tested the validity of this notion.
Their study involved three groups of healthy baby boys ages 4 months and 6
months, who were scheduled for routine vaccinations against
diphtheria-pertussis-tetanus (DPT), Hemophilus influenza type B (HIB), and
polio.
The three groups were: uncircumcised infants; infants who had been
circumcised after application of a topical (applied to the skin) local
anesthetic cream; and infants who had been circumcised after application of
a placebo cream, which had no pain-killing effect.
The researchers allowed parents to be present when the infants were
circumcised but they were not allowed to touch their babies to comfort
them.
Videotape recordings measured the infants' pain reaction to vaccination,
defined as the percentage of time during the vaccination that they cried
and showed certain pain-related facial changes (brow bulge, furrow between
the nose and upper lip, and eyes squeezed shut.)
The researchers found that uncircumcised infants showed the least pain
reaction to vaccination. The group treated with placebo cream had the
greatest pain reaction. And the group treated with the active anesthetic
cream during circumcision showed pain reactions intermediate to the other
two groups.
The authors suggest that the increased pain reactions so long after
circumcision may be a sign of "the alterations in the infant's central
neural processing of painful stimuli" -- in other words, a kind of
molecular biochemical "memory" of pain from the earlier incision may have
been triggered by the pain from the injections.
In light of their new findings, the researchers recommend use of topical
pain killers before and after circumcision. SOURCE: The Lancet
(1997;349:599-602)
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Wednesday April 2 12:55 PM EST
Circumcision Debate Continues
NEW YORK (Reuters) -- Contrary to popular myth, circumcision is not likely
to help men avoid sexually transmitted diseases or other infections.
Indeed, circumcised men who have had many sex partners have a slightly
higher risk of infection than uncircumcised men, according to the report in
this week's issue of The Journal of the American Medical Association.
And the report has a few more surprises. Men who are circumcised are 1.4
times as likely as other men to have "a more elaborated set of sexual
practices" -- that is, to masturbate or engage in heterosexual oral sex,
reported lead study author Dr. Edward Laumann, of the University of Chicago
in Illinois. But they are less likely to have sexual dysfunction than
uncircumcised men, particularly in their later years.
"The difference between circumcised and uncircumcised men was greatest for
masturbation -- ironically, a practice that circumcision was once thought
to limit," Laumann wrote. "A total of 47% of circumcised men reported
masturbating at least once a month versus 34% for their uncircumcised
peers."
Laumann and colleagues surveyed 1,410 men, aged 18 to 59, as part of the
National Health and Social Life Survey, a sample representative of 97% of
the population in the U.S. About 77% of the U.S.-born men were circumcised
compared with just 42% of men born outside the country. Overall, 81% of
whites, 65% of blacks, and 54% of Hispanic men had had their foreskin
removed.
The researchers conducted the survey because the U.S. has much higher rates
of non-religious circumcision compared with the rest of the world. The
practice became common after World War II, resulting in up to 80% of male
infants being circumcised. The number of infants circumcised peaked in the
mid-1960s and then began to decline. In the early 1970s, the American
Academy of Pediatrics (AAP) concluded that there was no valid reason for
routine circumcision of infants. But by 1989, some studies had suggested
that circumcision could help avoid urinary tract infections in infancy,
penile cancer, and possibly, sexually transmitted diseases.
The AAP currently recommends that parents be informed of the risks and
benefits of the procedure and make an informed choice. According to the
AAP, their Task Force on Circumcision will be reconvened during the summer
to revisit the issue, and this may result in a new policy statement.
"Medical research on the topic has generated an ambiguous set of results
regarding the impact of circumcision status on the lives of men," Laumann
wrote. As a result, the debate over circumcision has "reached a fever
pitch," according to the Chicago researcher.
The survey found that circumcision did not protect men from sexually
transmitted disease. Indeed, those who had 20 or more sex partners had more
than twice the risk of bacterial or viral infections -- most often
gonorrhea -- compared to uncircumcised men.
The researchers found that 45% of all men reported some type of sexual
dysfunction -- such as inability to have an orgasm or a lack of interest in
sex -- in the previous year. Older men who were uncircumcised were more
likely to report such sexual dysfunction, including difficulty in achieving
or maintaining an erection.
The new report doesn't support either side of the "to circumcise or not to
circumcise" debate, according to Laumann.
"These findings suggest the need for continued research that should further
aid parents in weighing the benefits and risks of circumcising their sons,"
he concluded. SOURCE: The Journal of the American Medical Association
(1997;277:1052-1057)
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