When is circumcision in an older boy/teen necessary?

[Shellydon]

Is there a time when circumcision is medically necessary for tween/teens?

[Noreen Claire]

If the boy has been diagnosed with hypospadias, the surgery can be later in life (elementary/middle) and can involve using the circumcised skin to make the necessary repairs. 

[ktgrok]

23 minutes ago, Shellydon said:

Is there a time when circumcision is medically necessary for tween/teens?

Rarely. But sometimes doctors are not versed in treating an intact penis, and may not know other treatments for say, a tight foreskin. I would seek out a doctor from a country where circumcision is unusual, who is used to dealing with issues in other ways. 

[Slache]

4 minutes ago, Ktgrok said:

Rarely. But sometimes doctors are not versed in treating an intact penis, and may not know other treatments for say, a tight foreskin. I would seek out a doctor from a country where circumcision is unusual, who is used to dealing with issues in other ways. 

Almost 20 percent of males are not circumsized these days. I hope this is not a common problem!

[JenneinCA]

Maybe.  Private message sent.

[Ailaena]

15 minutes ago, Slache said:

Almost 20 percent of males are not circumsized these days. I hope this is not a common problem!

Allow me to quote my SIL, a hospitalist: Uncircumcised penises are just gross!   My point here is that there is still a definite bias and lack of education (she’s been practicing since 2015) 😕

OP, get an opinion from a urologist, then get a second opinion if you can.  

[maize]

27 minutes ago, Ktgrok said:

Rarely. But sometimes doctors are not versed in treating an intact penis, and may not know other treatments for say, a tight foreskin. I would seek out a doctor from a country where circumcision is unusual, who is used to dealing with issues in other ways. 

I know someone who lived in a country where newborn circumcision is almost never done and had to have a circumcision in his teens. 

After going through that he opted to have his own sons circumcised as infants and so did his brother.

[unsinkable]

Bill enters the thread in 3, 2,...

[ktgrok]

2 hours ago, Slache said:

Almost 20 percent of males are not circumsized these days. I hope this is not a common problem!

You'd be surprised. At least half a dozen times a friend has mentioned in the last few years a pediatrician giving harmful, wrong advice about penis care, or worse, the doctor has tried to forcibly retract the penis during an exam on a baby or toddler. This is recent, and not improving that I see. 

Edited to clarify - half a dozen different friends, not one friend with very bad luck, lol

Edited August 11, 2019 by Ktgrok

[catz]

I got bad advice from a particular doctor in regards to my son.  And I can say that definitively because the intact kid in question has no problems in the 13 years since.  So I highly recommend getting at least a second opinion if a doctor is recommending it.   That doctor definitely had an agenda.   I’m still mad.   His treatment of my kid was horrific.

Edited August 11, 2019 by FuzzyCatz

[Laura Corin]

Puberty often fixes this because of the natural exercise the child in question usually gives to the foreskin.

[DesertBlossom]

When I asked our (former) pediatrician not to attempt to retract the foreskin of my 4 year old, she told me "I had a 10 year old patient who had to be circumcised because his foreskin didn't retract." The ignorance of some doctors on normal penile development is disheartening. 

We never went back to her. 

I second the advice to find a doctor who does not have a bias towards circumcision as the cure all for any penile ailment.

[Tanaqui]

It does happen, but I advise you to get a few more opinions. It's not going to fall off while you work out the options.

[kiwik]

8 hours ago, Slache said:

Almost 20 percent of males are not circumsized these days. I hope this is not a common problem!

80% are circumcised?  I think it is unusual in NZ.  I know you can get it done under the public health system if they are under (maybe a week?) Old but it was never offered to me so I guess you have to request it.  After that you have to go private and it is expensive because of the anaesthetist etc.  I only know this because I knew someone who was considering it.   My youngest has a very tight foreskin and we put cortisone cream on it to thin it and the doctor thinks it will be OK but some kids are circumcised because of a tight foreskin.  The funny thing is my eldest got an infection under his foreskin at about two because I assumed his foreskin wasn't retractable since all the books said it wouldn't be but in his case it was and needed cleaning under.

Edited August 11, 2019 by kiwik

[Melissa in Australia]

I think she must have meant in USA that 20% are not circumcised.

it is extremely uncommon in Australia and has been for many many years

it is a form of genital mutilation.

 

Edited August 11, 2019 by Melissa in Australia

[Melissa in Australia]

just looked it up .In  Australia over 80%  of male 35 and younger are NOT circumcised .

 in 2016/2017 less than 4% of male babies were circumcised in Australia

[Lanny]

My Stepson decided that he wanted to be Circumcised when he was approximately 14 years old. It was his idea. Nobody talked to him about it as far as I know. Our Urologist did the procedure.  We have never discussed it, but when I read this thread I remembered that.  Possibly it has prevented Infections in him or his wife? I don't know the answer to that question.

[Slache]

4 hours ago, kiwik said:

80% are circumcised?  I think it is unusual in NZ.  I know you can get it done under the public health system if they are under (maybe a week?) Old but it was never offered to me so I guess you have to request it.  After that you have to go private and it is expensive because of the anaesthetist etc.  I only know this because I knew someone who was considering it.   My youngest has a very tight foreskin and we put cortisone cream on it to thin it and the doctor thinks it will be OK but some kids are circumcised because of a tight foreskin.  The funny thing is my eldest got an infection under his foreskin at about two because I assumed his foreskin wasn't retractable since all the books said it wouldn't be but in his case it was and needed cleaning under.

In the US. Sorry. The person I was responding to was American and I looked up our statistics.

[Pen]

3 hours ago, Melissa in Australia said:

I think she must have meant in USA that 20% are not circumcised.

it is extremely uncommon in Australia and has been for many many years

it is a form of genital mutilation.

 

 

US type ABC news where A is for American, not Australian:   Strong bias toward circumcision as the headline laments too few boy babies being circumcised :

https://abcnews.go.com/Health/Healthday/story?id=6519981&page=1

I think our rural area with lots of home births has a lower rate.  And the idea that it’s genital mutilation (I agree) is heard here too—but still seems the minority. 

[DesertBlossom]

13 hours ago, Slache said:

Almost 20 percent of males are not circumsized these days. I hope this is not a common problem!

It's been a while since I looked at the statistics, but I have heard that the numbers for intact babies are much higher. I am sure it depends on the state and whether or not Medicaid covers it. This 2014 article says that only 15 percent of boys in Washington are being circumcised. Towards the end of the article it says the national circumcision rate is 58%. 

https://www.theolympian.com/news/local/article26091799.html

[City Mouse]

I have a friend whose son was born with a malformation. Possibliy the type that was mentioned above but I don’t really remember. As a result, his drs requested that he not be circumsized at birth. He had reconstructive surgery at about 18mos old and the core skin was used as part of the reconstruction so he was circumcised then.

i haven’t looked up the statistics I Day, but when my DS now 17 was born, approximately 50% of baby boys were being circumcised in the US at that time. I hope it is less now.. With older generations having rates, I could see that the overall rates of circumcised males would be high now, but I would suspect that the overall rates would slowly decrease as the population changes. 

[Slache]

10 minutes ago, DesertBlossom said:

It's been a while since I looked at the statistics, but I have heard that the numbers for intact babies are much higher. I am sure it depends on the state and whether or not Medicaid covers it. This 2014 article says that only 15 percent of boys in Washington are being circumcised. Towards the end of the article it says the national circumcision rate is 58%. 

https://www.theolympian.com/news/local/article26091799.html

I had heard the same but that wasn't what I found last night. Maybe I was looking at old information. I know our Muslim population is on the rise and they tend to circumcise later, our Mexican population is booming and I've heard they don't do it (though I do live in San Antonio now and could walk around downtown asking random locals and find out), and if Medicaid doesn't cover it it's a pretty penny. When my son was born the doctors tried to pressure me into it and told me about this fancy new device they were excited to use. 

No thank you?

Edited August 11, 2019 by Slache

[ktgrok]

28 minutes ago, Æthelthryth the Texan said:

The reason I am assuming it is being pushed by doctors it the public health benefits are significant when it comes to increased numbers of circumcised men in a population. It lowers the risk of penile cancer, as well as the spread of HIV and can affect the spread of other STIs as well. I'm not weighing in on OP's questions or the whole mutilation thing, but just saw your post and wanted to chime in on "why" it's still being promoted in the US in many instances. It's one of the easier ways to drop a lot of risk factors across several categories. 

My problem with actually believing this is the reason is that the chance of complication during the surgery is higher than the chance of getting Penile cancer in this country. Now, in  some other places that MathWorks out very differently. Now, from a public health standpoint where you have no control of it for other factors I suppose maybe it’s still Mike makes sense, but from an individual‘s point of you, it is hard for me to understand why surgery makes more sense than say, using a condom or limiting sexual partners. Surgery on an infant Because you think he won’t be willing or intelligent enough to use a condom later just seems crazy to me, from a mothers standpoint.Medical stats are sometimes brought up, but from talking to people my understanding as most people do it because they think it is cosmetically better, not for medical reasons. They use medical reasons to justify the real reason.

[Slache]

31 minutes ago, Æthelthryth the Texan said:

The reason I am assuming it is being pushed by doctors it the public health benefits are significant when it comes to increased numbers of circumcised men in a population. It lowers the risk of penile cancer, as well as the spread of HIV and can affect the spread of other STIs as well. I'm not weighing in on OP's questions or the whole mutilation thing, but just saw your post and wanted to chime in on "why" it's still being promoted in the US in many instances. It's one of the easier ways to drop a lot of risk factors across several categories. 

I understand why, I just didn't want some new, untested machine cutting off pieces of my child. I don't know how well ot worked but I know that hospital doesn't use it anymore!

[DesertBlossom]

25 minutes ago, Æthelthryth the Texan said:

The reason I am assuming it is being pushed by doctors it the public health benefits are significant when it comes to increased numbers of circumcised men in a population. It lowers the risk of penile cancer, as well as the spread of HIV and can affect the spread of other STIs as well. I'm not weighing in on OP's questions or the whole mutilation thing, but just saw your post and wanted to chime in on "why" it's still being promoted in the US in many instances. It's one of the easier ways to drop a lot of risk factors across several categories. 

But when you weigh that against what is lost when a healthy, functioning foreskin is removed, it's not clear that the benefits outweigh the risks.  In a day when consent is the new buzzword, it surprises me that anyone would be advocating for altering the healthy genitals of infants who are unable to give informed consent for a procedure that will have lifelong effects on their health and sexual relationships. 

[Tanaqui]

Quote

The reason I am assuming it is being pushed by doctors it the public health benefits are significant when it comes to increased numbers of circumcised men in a population. It lowers the risk of penile cancer, as well as the spread of HIV and can affect the spread of other STIs as well. I'm not weighing in on OP's questions or the whole mutilation thing, but just saw your post and wanted to chime in on "why" it's still being promoted in the US in many instances. It's one of the easier ways to drop a lot of risk factors across several categories. 

 

Those studies are SERIOUSLY flawed.

[DesertBlossom]

2 minutes ago, Æthelthryth the Texan said:

If you want to take it up in another thread I'll be happy to discuss if you come bringing proof and peer reviewed papers that back you up. 

If the CDC wants to encourage grown men to get circumcised for all the reasons you stated in your previous post, fine. But we're talking about infants who can not consent. And we're talking about an elective procedure with real risks that has long-term consequences for one's sexual relationships. We don't do that on people who can't consent.

[ktgrok]

16 minutes ago, DesertBlossom said:

If the CDC wants to encourage grown men to get circumcised for all the reasons you stated in your previous post, fine. But we're talking about infants who can not consent. And we're talking about an elective procedure with real risks that has long-term consequences for one's sexual relationships. We don't do that on people who can't consent.

Right. Even IF the ONLY factor was cosmetic (and I don't believe that at all), we are cosmetically altering someones genitals in a very real and visible and irreparable way, without their consent. For the rest of their life their body will look different. Given that a man in the USA has a 0.06% chance of getting penile cancer, the idea that we would preventatively perform actual surgery to remove a functional, healthy body part without the patient's consent and defend that by saying we want to prevent penile cancer is ridiculous. Especially since 90% of the cases are associated with phimosis and poor hygiene.  Treat the freaking phimosis in the fraction of boys that actually have that problem, and give everyone a bar of soap seems a bit less radical than forcing males to have surgery without their consent to prevent a condiment they are very very very unlikely to ever get, and that could be prevented other ways. 

But when a pediatrician says "this will help reduce your son's risk of cancer" they don't mention that that's probably only true of boys with phimosis, and that the cancer they are talking about is incredibly rare, and that the risks of the procedure itself are much higher. When that is the way it is presented, that's not medicine, that's culture. Not to mention a huge violation of the idea of informed consent for medical procedures. 

[Spy Car]

Responsible parents make thousands of decisions (perhaps hundreds of thousands) for their children.

Same with irresponsible parents.

Bill

[DesertBlossom]

14 minutes ago, Spy Car said:

Responsible parents make thousands of decisions (perhaps hundreds of thousands) for their children.

Same with irresponsible parents.

Bill

In the absence of any kind of urgent, medical need for circumcision, it can be safely postponed. So why not wait and let the child make an informed decision for himself?

[ktgrok]

6 minutes ago, DesertBlossom said:

In the absence of any kind of urgent, medical need for circumcision, it can be safely postponed. So why not wait and let the child make an informed decision for himself?

You may not want to start this with Bill, but generally the argument is that doing it later increases the risks because then they need more anesthetic. Of course, one could question why a baby doesn't deserve the same type, but hey. Also because the penis is bigger, there is more area to bleed than when younger, increasing risk of blood loss. However, if you only did it for people who had a high risk profile or a problem overall the risks would be lower, since the majority wouldn't be doing it at all. 

[Spy Car]

10 minutes ago, DesertBlossom said:

In the absence of any kind of urgent, medical need for circumcision, it can be safely postponed. So why not wait and let the child make an informed decision for himself?

For a myriad of reasons that I've elaborated upon previously.

Bill

[Spy Car]

2 minutes ago, Ktgrok said:

You may not want to start this with Bill, but generally the argument is that doing it later increases the risks because then they need more anesthetic. Of course, one could question why a baby doesn't deserve the same type, but hey. Also because the penis is bigger, there is more area to bleed than when younger, increasing risk of blood loss. However, if you only did it for people who had a high risk profile or a problem overall the risks would be lower, since the majority wouldn't be doing it at all. 

More extreme rudeness from you.

Bad show.

Waiting increases the risks and complexity and reduces the benefits.

Bill

[ktgrok]

6 minutes ago, Spy Car said:

 

Waiting increases the risks and complexity and reduces the benefits.

 

Pretty sure that is exactly what I said. Well, I didn't say reduces the benefits, but yes, there is a small reduction in urinary infections in the first year of life for babies circumcised in infancy. Those infections are very rare even in intact males and when they do happen are easily treatable with common, inexpensive antibiotics. Google and the BMJ tell me you'd have to surgically remove the foreskin of 111 boys to prevent one urinary tract infection.

Edited August 11, 2019 by Ktgrok

[ktgrok]

For the OP, I did find literature saying if the problem is a non retractable foreskin that a steroid cream applied twice daily is effective in around 70% of boys. So definitely worth a shot I'd think, before jumping to surgery. 

[Spy Car]

2 minutes ago, Ktgrok said:

Pretty sure that is exactly what I said. Well, I didn't say reduces the benefits, but yes, there is a small reduction in urinary infections in the first year of life for babies circumcised in infancy. Those infections are very rare even in intact males and when they do happen are easily treatable with common, inexpensive antibiotics. But yes, that benefit is lost if done after 1 year of age, as after that point there is no difference in UTI risk. 

UTIs are but one risk. On that subject UTIs, while problematic in infancy is a very (very) serious problem in the elderly and a huge problem with uncircumcised men--who are at much greater risk--in their latter years. 

UTIs in old people lead to bad falls and delirium and can be hard to treat. We need to think about all life stages.

Bill

[Spy Car]

4 minutes ago, Ktgrok said:

For the OP, I did find literature saying if the problem is a non retractable foreskin that a steroid cream applied twice daily is effective in around 70% of boys. So definitely worth a shot I'd think, before jumping to surgery. 

For what it's worth, I'd also seek expert council before advocating circumcision in a teen.

Bill

Edited August 11, 2019 by Spy Car

[ktgrok]

4 minutes ago, Spy Car said:

UTIs are but one risk. On that subject UTIs, while problematic in infancy is a very (very) serious problem in the elderly and a huge problem with uncircumcised men--who are at much greater risk--in their latter years. 

UTIs in old people lead to bad falls and delirium and can be hard to treat. We need to think about all life stages.

Bill

i'm curious what other benefits are lost if one delays until the person is old enough to consent or not? 

[Spy Car]

3 minutes ago, Ktgrok said:

i'm curious what other benefits are lost if one delays until the person is old enough to consent or not? 

It is the wrong way to look at procedure that brings lifetime benefits to focus only on childhood issues, especially when a simple procedure in infancy becomes increasingly complex as a boy/man ages. It is far better to look at lifetime risks and benefits. 

That said, UTI, hygiene issues, and retraction issues (all of which are more problematic in uncircumcised boys) are something they have to face.

Later there is an increased risk of contracting STDs including AIDS. Plus the elder situation in men where having a UTI is a nightmare situation. Spend some time in a senior living facility and talk to nurses who care for elderly men about the risk of being uncircumcised.

Bill

 

 

[ktgrok]

Just now, Spy Car said:

It is the wrong way to look at procedure that brings lifetime benefits to focus only on childhood issues, especially when a simple procedure in infancy becomes increasingly complex as a boy/man ages.

 

Right, I was specifically responding to your comment where you said that UTI's were not the only benefit lost when doing it at the age of consent, rather than infancy. I'd already mentioned the increased risk. 

[ktgrok]

Right. The risks of the surgery are higher (but still low) if done in a person old enough to consent, but only a small percentage of boys will have a medical problem such as phimosis and most of those cases can be resolved with simple medications and won't require surgery. 

[Spy Car]

6 minutes ago, Ktgrok said:

Right, I was specifically responding to your comment where you said that UTI's were not the only benefit lost when doing it at the age of consent, rather than infancy. I'd already mentioned the increased risk. 

There are short-term benefits and long-term benefits.

Hopefully our children long outlive us and make it into advanced ages. 

Anyone who has witnessed what recurring UTIs do to an elderly person would not wish that on their worst enemy.

Bill

Edited August 11, 2019 by Spy Car

[Spy Car]

9 minutes ago, Arctic Mama said:

Yes, there are reasons to circumcise later, depending on the individual health and physiology.  We circumcise our infants for religious reasons, but most uncircumcised young men wouldn’t need the surgery later for health issues.  It’s definitely only a small number of them with restrictive foreskins or hypospadias.  The procedure is a much bigger deal and slower recovery in older children and grown men, so there’s that to consider, but again it’s statistically less likely than more that an older male would need one.  

Waiting increases the risks of what is a simple procedure in infancy and takes away all the advantages of being circumcised in youth.

Better in my estimation to provide a lifetime of benefits at the time the procedure is most advantageous.

Bill

[ktgrok]

14 minutes ago, Spy Car said:

. Plus the elder situation in men where having a UTI is a nightmare situation. Spend some time in a senior living facility and talk to nurses who care for elderly men about the risk of being uncircumcised.

Bill

 

 

Really? It's a nightmare, the number of elderly men with UTIs? Then what is it for women, given that elderly women are twice as likely as elderly men to have them?

And as a lifetime risk, uncircumcised mean do have a higher risk than circumcised, but that risk is highest in infancy, and over a lifetime still lower than the risk for a woman. 

I've never seen the risk of UTI in women referred to as a nightmare, or a reason to consider prophylactic surgery. 

Edited August 11, 2019 by Ktgrok

[ktgrok]

1 minute ago, Spy Car said:

Waiting increases the risks of what is a simple procedure in infancy and takes away all the advantages of being circumcised in youth.

Better in my estimation to provide a lifetime of benefits at the time the procedure is most advantageous.

Bill

Right, I said the risks were higher, what I'm confused on are the advantages you are talking about. I mentioned lower UTI risk so was wondering what the other advantages you were referring to that specifically came from being circumcised in youth, versus later. You seem to be saying advantages, plural. 

[Spy Car]

1 minute ago, Ktgrok said:

Really? It's a nightmare, the number of elderly men with UTIs? Then what is it for women, given that elderly women are twice as likely as elderly men to have them? And as a lifetime risk, uncircumcised mean do have a higher risk than circumcised, but that risk is highest in infancy, and over a lifetime still lower than the risk for a woman. 

I've never seen the risk of UTI in women referred to as a nightmare, or a reason to consider prophylactic surgery. 

UTIs are a nightmare in the elderly. You are dead-wrong if you don't think so.

UTI rates are far lower in this country for men precisely because circumcision rates are high among elderly men. Circumcision provides a HUGE advantage.

Talk to an elder care nurse. You will get an ear-full, I can assure you.

Bill

 

[ktgrok]

5 minutes ago, Spy Car said:

UTIs are a nightmare in the elderly. You are dead-wrong if you don't think so.

UTI rates are far lower in this country for men precisely because circumcision rates are high among elderly men. Circumcision provides a HUGE advantage.

Talk to an elder care nurse. You will get an ear-full, I can assure you.

Bill

 

Again, if they are a nightmare for men, what are they for women? As I stated before, intact men still have a lower rate of UTI than women. And the greatest risk factor for UTI in a man over 85 is not having a foreskin, it's having had a catheter, same as for women. 

As for an eldercare nurse, that was my mother's life long career. Started working in nursing homes as a candy striper in her teens and then went to nursing school. Worked as a nurse in geriatrics her entire career, except for a few year break to care for her mother, who had dementia, at home. She had no interest in pushing the benefits of circumsicion on me, regarding my sons. Neither did their pediatricians. In fact, one pediatrician when he heard I was not going to circumcise, said, "Lucky boy!". 

But anyway, none of this applies to the OP, who has an older child, not an infant. 

Edited August 11, 2019 by Ktgrok

[Spy Car]

2 minutes ago, Ktgrok said:

Right, I said the risks were higher, what I'm confused on are the advantages you are talking about. I mentioned lower UTI risk so was wondering what the other advantages you were referring to that specifically came from being circumcised in youth, versus later. You seem to be saying advantages, plural. 

Do I need to repeat myself?

Better hygiene, the elimination of retraction issues, and UTIs are some of the (plural) advantages. Plus the advantage of doing a simple procedure in infancy that bring lifetime advantages.

Waiting offers zero advantages and compounds every risk factor vs doing surgery later.

Bill

 

[Spy Car]

1 minute ago, Ktgrok said:

Again, if they are a nightmare for men, what are they for women? As I stated before, intact men still have a lower rate of UTI than women. And the greatest risk factor for UTI in a man over 85 is not having a foreskin, it's having had a catheter, same as for women. 

As for an eldercare nurse, that was my mother's life long career. Started working in nursing homes as a candy striper in her teens and then went to nursing school. Worked as a nurse in geriatrics her entire career, except for a few year break to care for her mother, who had dementia, at home. She had no interest in pushing the benefits of circumsicion on me, regarding my sons. Neither did their pediatricians. In fact, one pediatrician when he heard I was not going to circumcise, said, "Lucky boy!". 

But anyway, none of this applies to the OP, who has an older child, not an infant. 

And your mother thinks UTIs in the elderly are no big deal?

I sincerely doubt that's true.

UTIs are a nightmare irrespective of gender.

They cause falls, lead to broken hips, cause delirium, lead to hospitalizations (where exposure to other opportunistic infections are great) and take a great deal out of elderly people.

Bill

 

[DesertBlossom]

2 minutes ago, Spy Car said:

Do I need to repeat myself?

Better hygiene, the elimination of retraction issues, and UTIs are some of the (plural) advantages. Plus the advantage of doing a simple procedure in infancy that bring lifetime advantages.

Waiting offers zero advantages and compounds every risk factor vs doing surgery later.

Bill

 

Your arguments only make sense when one assumes that the foreskin has no function at all. But it does. So you still have to weigh the benefits of circumcision against the benefits of having a foreskin. Regardless of your personal opinions on the matter, many men would still choose to retain the benefits of their foreskin over the benefits of surgery. Which is why this decision ought to be made by the person whose life it affects most directly.