1
|
Choi UE, Nicholson RC, Grutman AJ, Cohen AJ. Personal genital satisfaction is associated with differences in perception of male and female sexual anatomy and function. J Sex Med 2024; 21:589-595. [PMID: 38721677 DOI: 10.1093/jsxmed/qdae053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Prior studies primarily of men correlated low personal genital satisfaction (PGS) with decreased sexual activity; however, the association between PGS and genital anatomy perceptions is unknown, and there is a paucity of studies examining women. AIM We assessed the relationship between genital satisfaction, survey respondent sexual activity, and perceptions of anatomy and function. METHODS A 54-item REDCap survey was distributed to any-gendered volunteers ≥18 years of age through ResearchMatch from January to March 2023. Responses were split into (1) high PGS and (2) low PGS. Analysis was performed using chi-square tests on survey responses and a Mann Whitney U test on median satisfaction level. OUTCOMES Outcomes were genital anatomy perceptions, sexual activity, and respondents' PGS. RESULTS Of the 649 respondents who started the survey, 560 (86.3%) completed it. Median PGS was 7 of 10, forming subgroups of high (≥7 of 10) satisfaction (n = 317 of 560 [56.6%]) and low (<7 of 10) satisfaction (n = 243 of 560 [43.4%]). The mean age was 45.8 ± 16.8 years, and demographics were notable for 72.1% women (n = 404 of 560), 83.2% White (n = 466 of 560), 47.9% married (n = 268 of 560), and 75.5% bachelor's degree holders (n = 423 of 560). Comparing high- and low-PGS groups, more low-PGS respondents felt normal flaccid penis length to be <2 inches (11.1% vs 5.1%; P = .008). High-PGS respondents more often responded that it is normal for women to have orgasms over half the time (20.8% vs 13.2%; P = .0002) or to identify as being sexually active (81.1% vs 71.6%; P = .008). Women were more likely than men to report larger normal testicle sizes as 60.1 to 90 mL (24.5% vs 10.3%; P < .0001), whereas more men felt that normal testicle size was 7 to 15 mL (26.3% vs 11.4%; P < .0001). Orgasm length perceptions also differed: more women felt female orgasm length was 2.6 to 5 seconds (36.6% vs 16.7%; P < .0001), and more men believed female orgasms to be longer, at 7.6 to 10 seconds (29.5% vs 17.3%; P = .002), 10.1 to 12.5 seconds (11.5% vs 5.2%; P = .0008), and >12.5 seconds (12.2% vs 5.7%; P = .009). Respondents' views on their genitalia differed by gender, with women more likely to feel that their genitals are normal compared with men (89.4% vs 75.0%; P < .0001). CLINICAL IMPLICATIONS PGS may be a useful screening tool given its association with sexual activity. STRENGTHS AND LIMITATIONS Our large-scale survey assesses public perceptions of genital anatomy and function. Limitations include a lack of gender nonbinary perceptions. CONCLUSION Gender and PGS interact with perceptions of male anatomy and female sexual activity, and the frequency of sexual activity was higher among high-PGS respondents; however, the direction of these interactions remains unclear and requires future causal analysis.
Collapse
Affiliation(s)
- Una E Choi
- James Buchanan Brady Urological Institute, Johns Hopkins Medicine, Baltimore, MD 21224, United States
| | - Ryan C Nicholson
- James Buchanan Brady Urological Institute, Johns Hopkins Medicine, Baltimore, MD 21224, United States
| | - Aurora J Grutman
- James Buchanan Brady Urological Institute, Johns Hopkins Medicine, Baltimore, MD 21224, United States
| | - Andrew J Cohen
- James Buchanan Brady Urological Institute, Johns Hopkins Medicine, Baltimore, MD 21224, United States
| |
Collapse
|
2
|
Zhang X, Li J, Tang G, Wang Z, Guo Q, Guo Q, Qin Q, Fan Y. The prevalence and factors of willingness to accept circumcision among MSM in Maanshan City, China. AIDS Care 2024; 36:752-761. [PMID: 38266488 DOI: 10.1080/09540121.2023.2299664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 12/18/2023] [Indexed: 01/26/2024]
Abstract
To investigate the prevalence of male circumcision and the willingness to undergo male circumcision and influencing factors among MSM in Maanshan City, we conducted a cross-sectional study from June 2016 to December 2019. Respondent-driven sampling (RDS) was used to recruit participants. Influential factors of willingness to accept circumcision were identified by a multivariable logistic regression model. The multivariable logistic regression model revealed that five variables were independent influential factors for willingness to participate. The factors include that used condoms during last anal intercourse (OR = 1.87, 95% CI:1.03-3.41, P = 0.04), sex with female sex partners (OR = 0.499, 95% CI:0.298-0.860, P = 0.012, level of education (junior college: OR = 0.413, 95% CI:0.200-0.854, P = 0.017; bachelor's degree or higher: OR = 0.442, 95% CI:0.208-0.938, P = 0.033), condom use during oral sex in the last six months (OR = 4.20, 95% CI:1.47-12.0, P = 0.007) and level of knowledge of PrEP (OR = 5.09, 95% CI:1.39-18.7, P = 0.014). Given the willingness of MSM to accept circumcision was low in China, establishing a proper understanding of circumcision is essential if it is to be used as a strategy to prevent HIV infection among MSM. Therefore, publicity and education on the operation should be strengthened to increase the willingness to undergo male circumcision.
Collapse
Affiliation(s)
- Xinhong Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, People's Republic of China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei, People's Republic of China
| | - Jianwei Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, People's Republic of China
| | - Gan Tang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, People's Republic of China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei, People's Republic of China
| | - Ziwei Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, People's Republic of China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei, People's Republic of China
| | - Qian Guo
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, People's Republic of China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei, People's Republic of China
| | - Qisheng Guo
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, People's Republic of China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei, People's Republic of China
| | - Qirong Qin
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, People's Republic of China
- Ma'anshan Center for Disease Control and Prevention, Ma'anshan, People's Republic of China
| | - Yinguang Fan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, People's Republic of China
- Anhui Province Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei, People's Republic of China
| |
Collapse
|
3
|
Morris B, Rivin BE, Sheldon M, Krieger JN. Neonatal Male Circumcision: Clearly Beneficial for Public Health or an Ethical Dilemma? A Systematic Review. Cureus 2024; 16:e54772. [PMID: 38405642 PMCID: PMC10889534 DOI: 10.7759/cureus.54772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 02/27/2024] Open
Abstract
Contrasting ethical and legal arguments have been made concerning neonatal male circumcision (NMC) that merit the first systematic review on this topic. We performed PRISMA-compliant keyword searches of PubMed, EMBASE, SCOPUS, LexisNexis, and other databases and identified 61 articles that met the inclusion criteria. In the bibliographies of these articles, we identified 58 more relevant articles and 28 internet items. We found high-quality evidence that NMC is a low-risk procedure that provides immediate and lifetime medical and health benefits and only rarely leads to later adverse effects on sexual function or pleasure. Given this evidence, we conclude that discouraging or denying NMC is unethical from the perspective of the United Nations Convention on the Rights of the Child, which emphasizes the right to health. Further, case law supports the legality of NMC. We found, conversely, that the ethical arguments against NMC rely on distortions of the medical evidence. Thus, NMC, by experienced operators using available safety precautions, appears to be both legal and ethical. Consistent with this conclusion, all of the evidence-based pediatric policies that we reviewed describe NMC as low-risk and beneficial to public health. We calculated that a reduction in NMC in the United States from 80% to 10% would substantially increase the cases of adverse medical conditions. The present findings thus support the evidence-based NMC policy statements and are inconsistent with the non-evidence-based policies that discourage NMC. On balance, the arguments and evidence reviewed here indicate that NMC is a medically beneficial and ethical public health intervention early in life because it reduces suffering, deaths, cases, and costs of treating adverse medical conditions throughout the lifetimes of circumcised individuals.
Collapse
Affiliation(s)
- Brian Morris
- Faculty of Medicine and Health, The University of Sydney, Sydney, AUS
| | - Beth E Rivin
- Schools of Medicine and Public Health, Department of Global Health, University of Washington, Seattle, USA
- Bioethics, Uplift International, Seattle, USA
| | - Mark Sheldon
- Medical Humanities and Bioethics Program, Feinberg School of Medicine, Chicago, USA
| | | |
Collapse
|
4
|
The effects of sound-and-light toy as a distraction method on pain and physiological parameters in infants regarding circumcision procedure. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.7497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background/Aim: Circumcision is a common surgical procedure and a cause of pain and stress for infants. Nurses are in a key role for providing pain relief through implementation of non-pharmacological practices for pain management. This study aimed to assess the impact of distraction using a sound- and light-producing toy on pain and physiological parameters in infants regarding circumcision procedure.
Methods: This randomized controlled study was conducted with infants between six months and two years of age who presented to a private circumcision clinic. The sample consisted of 60 infants randomly allocated into intervention (n = 30) and control (n = 30) groups. During the procedure, the mothers of the infants in the intervention distracted the infants with the toy for 15 min. Infants in the control group were accompanied by their mothers during the procedure and did not receive any additional intervention other than the standard care. Data were collected using a questionnaire and the face, legs, activity, cry, consolability (FLACC) pain scale. Data were assessed using descriptive statistical analyses and parametric tests.
Results: Infants in the intervention and control groups were similar in terms of current and gestational ages, lengths, weights, and maternal and paternal ages and showed no differences in terms of physiological parameters before and after the procedure (P > 0.05). Post-operative pain scores were lower in infants exposed to the toy with light- and sound than that in the infants in the control group; however, no significant difference between groups was found (P > 0.05).
Conclusion: Considering the effect of sound- and light-producing toys on causing a reduction in pain severity, it may be recommended to use distracting practices by nurses to reduce/relieve pain associated with circumcision.
Collapse
|
5
|
Nabavizadeh B, Li KD, Hakam N, Shaw NM, Leapman MS, Breyer BN. Incidence of circumcision among insured adults in the United States. PLoS One 2022; 17:e0275207. [PMID: 36251658 PMCID: PMC9576047 DOI: 10.1371/journal.pone.0275207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 09/13/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose Although circumcision is the most commonly performed surgery in males, less is known about the incidence and indications of adult circumcision. In this study, we aim to present the incidence of adult circumcision across the United States. Methods Using IBM MarketScan® Commercial Database from 2015 to 2018, we obtained claims for circumcision in men between 18 and 64 years of age. We calculated the incidence of adult circumcision over the study period and across the United States. We also collected data on indications for surgery using International Classification of Diseases codes. Results We identified a total of 12,298 claims for adult circumcisions. The mean age was 39 (±12.9) years. The average incidence rates remained relatively constant from 98.1 per 100,000 person-years in 2015 to 98.2 per 100,000 person-years in 2018 (Δ+0.1%). The age-standardized incidence rates varied significantly across the United States (from 0 to 194.8 per 100,000 person-years) with South Dakota having the highest rate. The most common indications for adult circumcision were phimosis (52.5%), routine/ritual circumcision (28.7%), phimosis + balanitis/balanoposthitis (6.8%), balanitis (3.8%) and balanoposthitis (2.6%), and significantly varied by age groups. Conclusion This study suggested a wide geographic variation in rates of adult circumcision between states with highest incidences in the Northeast United States. Future studies can identify the underlying causes for the observed variations.
Collapse
Affiliation(s)
- Behnam Nabavizadeh
- Department of Urology, Weill Cornell Medicine, New York, New York, United States of America
| | - Kevin D. Li
- Department of Urology, University of California San Francisco, San Francisco, California, United States of America
| | - Nizar Hakam
- Department of Urology, University of California San Francisco, San Francisco, California, United States of America
| | - Nathan M. Shaw
- Department of Urology, University of California San Francisco, San Francisco, California, United States of America
| | - Michael S. Leapman
- Department of Urology, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Benjamin N. Breyer
- Department of Urology, University of California San Francisco, San Francisco, California, United States of America
- Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
| |
Collapse
|
6
|
Morris BJ, Moreton S, Krieger JN, Klausner JD. Infant Circumcision for Sexually Transmitted Infection Risk Reduction Globally. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00811. [PMID: 36041835 PMCID: PMC9426975 DOI: 10.9745/ghsp-d-21-00811] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 06/21/2022] [Indexed: 12/26/2022]
Abstract
Population-based studies in high-income countries have failed to find that male circumcision protects against sexually transmitted infections. Using evidence from several sources, we show that male circumcision does protect against HIV during insertive intercourse for men who have sex with men.
Collapse
Affiliation(s)
- Brian J Morris
- School of Medical Sciences, University of Sydney, Sydney, Australia.
| | | | - John N Krieger
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - Jeffrey D Klausner
- Department of Medicine, Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
7
|
Morris BJ, Wodak AD. Causes and consequences of the decline in circumcision in Australia. ANZ J Surg 2021; 91:2546-2547. [PMID: 34766683 DOI: 10.1111/ans.17157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/27/2021] [Accepted: 08/08/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Brian J Morris
- School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Alex D Wodak
- Alcohol and Drug Service, St Vincent's Hospital, Darlinghurst, New South Wales, Australia.,Australian Tobacco Harm Reduction Association, Darlinghurst, New South Wales, Australia.,Australia21, Darlinghurst, New South Wales, Australia
| |
Collapse
|
8
|
Guevara CG, Achua JK, Blachman-Braun R, Cabrera-Valencia I, Ransford GA, Gosalbez R, Labbie AS, Castellan MA, Alam A. Neonatal Circumcision: What Are the Factors Affecting Parental Decision? Cureus 2021; 13:e19415. [PMID: 34926011 PMCID: PMC8654051 DOI: 10.7759/cureus.19415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The American Academy of Pediatrics (AAP) guidelines state that the health benefits of circumcision outweigh the risks, but these benefits are not enough to recommend universal newborn circumcision. Therefore, it is the guardians' decision to circumcise their son. In this study, we assess the factors that influence the decision-making process for newborn circumcision. METHODS A prospective study was done from January to April 2020 for newborn circumcision. AAP guidelines were used as an educational tool and given to the parents on the day of patient circumcision assessment. On procedure day, a self-reported survey regarding the reasons for circumcision and the usefulness of the guideline as an educational resource was given to guardians. RESULTS A total of 265 parents completed the survey. Of the study variables, the future health of the child and the circumcision status of the father were considered extremely important factors influencing the decision-making process for 168 (63.4%) and 90 (34%) guardians, respectively. The study showed that 226 (85.3%) of the parents found the AAP guidelines helpful whereas 39 (14.7%) did not. CONCLUSION Overall results suggest that the health of the child and the father of the child being circumcised are the primary factors that influence the guardians' decision to circumcise their child. In addition, providing parents with an educational resource such as the AAP guidelines policy statement prior to circumcision may serve as a way to supplement the discussion between parents and providers.
Collapse
Affiliation(s)
| | - Justin K Achua
- Urology, University of Miami Miller School of Medicine, Miami, USA
| | - Ruben Blachman-Braun
- Urology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, USA
| | | | | | | | | | | | - Alireza Alam
- Pediatric Urology, Nicklaus Children's Hospital, Miami, USA
| |
Collapse
|
9
|
Lewandowski K, Kretschmer B, Schmidt KW. [175 years of anesthesia and narcosis-Towards a "human right to unconsciousness"]. Anaesthesist 2021; 70:811-831. [PMID: 34529093 PMCID: PMC8444521 DOI: 10.1007/s00101-021-01043-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 01/01/2023]
Abstract
The Ether Day, a key moment in the history of mankind, commemorates its 175th anniversary on 16 October 2021. On that day the dentist William T. G. Morton successfully gave the first public ether anesthesia in Boston. From then on it was possible to save people from pain with justifiable risk and at the same time to protect them from psychological damage by inducing unconsciousness. The German philosopher Peter Sloterdijk, one of the most renowned and effective philosophers of our times, deduced that from then on humans, to some extent, had a right to unconsciousness when in psychophysical distress. This postulate unfolded from his concept of "anthropotechnics" developed around 1997, meaning the idea of treating human nature as an object of possible improvements. According to Sloterdijk, in favorable cases a synthesis of man and technology can result in a significant improvement of human capabilities in the sense of "enhancement", i.e. an increase, an improvement or even an expansion of intellectual, physical or psychological possibilities, as it were in a transgression of the human (so-called transhumanism). Man should go into vertical tension, i.e. strive for higher aims and exploit his inherent potential, he should not dwell in the horizontal. This is not meant as an appeal but as an imperative: "You must change your life!". In this context modern anesthesia may prove helpful: be operated on by others in order to undergo an enhancement. Or, in its most extreme form, the operation in the "auto-operational curved space", a person can even operate on himself as has been dramatically demonstrated by Rogozov, a young Russian physician and trainee surgeon who successfully performed a self-appendectomy under local anesthesia at the Novolazarevskaya Antarctic Station in 1961; however, the implementation of this idea is a long way off. On the one hand, many countries lack qualified personnel in sufficiently large numbers to perform even vital operations with patients under anesthesia. On the other hand, over the decades it has become clear that anesthesia is obviously beneficial for mankind in that it offers relief from pain and psychological stress but that it can also often show its dark side: substance abuse, use of anesthetics in torture and in executions. In addition, the role of anesthetics in resuscitation, palliative care, and allaying executions is unclear or controversial. Finally, the necessary formal legal steps to acknowledge a "human right to unconsciousness" have not yet been implemented.
Collapse
Affiliation(s)
- K Lewandowski
- Anästhesiologie und operative Intensivmedizin, Charité (extern), Berlin, Deutschland.
| | | | - K W Schmidt
- Zentrum für Ethik in der Medizin, Agaplesion Markus Krankenhaus, Frankfurt a. M., Deutschland
| |
Collapse
|
10
|
Arora HC, Hall M, Rosoklija I, Davis MM, Holl JL, Johnson EK. Longitudinal Sociodemographic Analysis of Operative Circumcisions at Children's Hospitals. Urology 2021; 162:84-90. [PMID: 34000277 DOI: 10.1016/j.urology.2021.04.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/06/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To characterize elective, post-neonatal operative circumcision at US children's hospitals, in the context of established sociodemographic disparities in access to neonatal circumcision. METHODS A retrospective cohort study was performed of boys undergoing elective, operative circumcision at the 23 Pediatric Health Information System (PHIS) hospitals who contributed data from 2004-2018. Boys > = 36 months' and those with congenital anomalies of the penis were excluded. Bivariate statistics were used to compare the circumcision cohort to a referent cohort of boys undergoing other ambulatory surgery or having an observational hospital stay. RESULTS The annual median number of operative circumcisions per hospital increased during the study (72 [IQR 54-162] to 136 [IQR 88-266], P = .003). Boys undergoing circumcision were mostly non-Hispanic White (46.7%) or non-Hispanic Black (30.9%), in the lowest income quartile (26.6%), from the Southern US (51.5%), and publicly-insured (60.5%). When compared to the reference cohort, boys undergoing circumcision were more likely to be non-Hispanic Black (30.9 vs 15.7%, P = .001) and publicly-insured (60.5 vs 45.9%, P = . 001). CONCLUSION The number of post-neonatal operative circumcisions performed at US children's hospitals nearly doubled from 2004 to 2018. Study findings suggest an emerging healthcare disparity, with non-Hispanic Black boys of lower socioeconomic status undergoing more post-neonatal operative circumcisions that are more expensive and higher risk.
Collapse
Affiliation(s)
- Hans C Arora
- Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | | | - Ilina Rosoklija
- Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Matthew M Davis
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Jane L Holl
- Division of Biological Sciences, University of Chicago, Chicago, IL
| | - Emilie K Johnson
- Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
| |
Collapse
|
11
|
Huen KH, Fong C, Roach G, Singer J. Is hyperbilirubinemia a contraindication for neonatal circumcision? A survey of practice patterns of pediatric urologists and a review of the literature. J Pediatr Urol 2021; 17:88.e1-88.e6. [PMID: 33268314 DOI: 10.1016/j.jpurol.2020.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/13/2020] [Accepted: 10/09/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND OBJECTIVE 50-80% of term newborns develop jaundice, or hyperbilirubinemia (HB), in their first week. The vast majority have benign etiologies, including physiologic jaundice of the newborn and breast milk/breastfeeding jaundice, which do not affect the synthetic capacity of the liver, thus conferring a low risk of peri-procedural bleeding. Though uncommon, HB in the setting of sepsis, biliary obstruction, or metabolic disease, may increase procedural bleeding risk. Circumcision of neonates with HB has not been well studied. We sought to characterize practice patterns among Society of Pediatric Urology (SPU) members and to explore whether HB confers increased bleeding risk for newborn circumcision. METHODS An anonymous survey of 14 multiple-choice questions was sent to members of the SPU listserv. Questions regarding circumcision and HB were presented. We performed a literature review regarding whether HB confers increased surgical bleeding risk. RESULTS 100/234 (43%) SPU members completed the survey. The majority (79/100) perform neonatal circumcision and use the Gomco© clamp (68%). 24/79 (30%) factor total bilirubin (Tbili) level in their decision prior to performing circumcision. Of those who consider HB a factor, 11/24 (46%) had cutoff Tbili levels at which they await improvement prior to proceeding. The most common cutoff level was Tbili level of 10-15 mg/dL (6/11, 55%). DISCUSSION Existing data suggest a possible increased bleeding risk isolated to cases of HB in the setting of biliary obstruction or other associated relevant findings (ill infant, recent infection, congenital syndromes) or known personal/family history (fulminant liver disease, familial bleeding diatheses). While literature from Jewish Mohels and Talmudic discussion suggest that elevated Tbili may be a contraindication to circumcision, no scientific studies exist directly assessing the impact of HB on bleeding risk with circumcision. A review of the scientific literature suggests that isolated HB in otherwise healthy newborns does not increase bleeding risk. CONCLUSIONS 30% of pediatric urologists survey respondents consider HB a potential contraindication to neonatal circumcision. Despite varied practices in circumcising jaundiced babies, neonatal jaundice rarely confers increased bleeding risks. While deferring circumcision is appropriate in an ill infant with HB, or in those with a genetic/congenital syndrome or with family history of coagulopathic, review of the scientific literature suggests that in otherwise healthy neonates, elevated Tbili likely represents benign causes and is unlikely to increase bleeding risk.
Collapse
Affiliation(s)
- Kathy H Huen
- Department of Urology, David Geffen School of Medicine at UCLA, 300 Stein Plaza, 3rd Floor, Suite 331, Los Angeles, CA, 90095, USA.
| | - Christina Fong
- Department of Pediatrics, Division of Hematology and Oncology, Children's Health Center, 200 UCLA Medical Plaza, Suite 265, Los Angeles, CA, 90095, USA
| | - Gavin Roach
- Department of Pediatrics, Division of Hematology and Oncology, Children's Health Center, 200 UCLA Medical Plaza, Suite 265, Los Angeles, CA, 90095, USA
| | - Jennifer Singer
- Department of Urology, David Geffen School of Medicine at UCLA, 300 Stein Plaza, 3rd Floor, Suite 331, Los Angeles, CA, 90095, USA
| |
Collapse
|
12
|
Circumcision in Hemophilia: A Multicenter Experience. J Pediatr Hematol Oncol 2021; 43:e33-e36. [PMID: 33003145 DOI: 10.1097/mph.0000000000001960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hemophiliac patients and their families have social pressure to undergo circumcision, despite the potential complications. The objective of this study was to report our experience in the circumcision of hemophilia patients. MATERIALS AND METHODS We included 35 patients with hemophilia who had circumcision in 3 centers from January 2010 to August 2019. Their age ranged between 0.3 months and 8 years. Hemophilia a was classified as mild (n=3), moderate (n=4), and severe (n=28). Patients received 2 doses of factor VIII concentrate 50μ/kg, 1 hour before the procedure and 12 hours after it. RESULTS Four neonates were diagnosed with hemophilia after circumcision because of prolonged bleeding. Two patients with severe hemophilia A had bleeding after hospital discharge (6.5%). They received additional factor concentrate, and 1 patient had an extra stitch. Two patients had wound gaping (6.5%), and 1 patient had a wound infection (3.2%). CONCLUSION Hemophilia is not an absolute contraindication for circumcision. Circumcision of hemophilic children should be performed under appropriate conditions in hemophilia centers. Bleeding is not frequent but could be serious.
Collapse
|
13
|
Rossi S, Buonocore G, Bellieni CV. Management of pain in newborn circumcision: a systematic review. Eur J Pediatr 2021; 180:13-20. [PMID: 32748017 PMCID: PMC7782363 DOI: 10.1007/s00431-020-03758-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/21/2020] [Accepted: 07/27/2020] [Indexed: 12/15/2022]
Abstract
Male circumcision (MC) is one of the most common surgical procedures performed on neonates. In the last decades, there have been consistent advances in the understanding of pain mechanisms in newborns, and analgesia has become a fundamental part of neonatal care. MC is still often performed with inappropriate analgesic methods, and there is still great variability among the various centers about surgical and anesthethic techniques to do it. The purpose of this review is to summarize the findings in the literature about pain management and analgesia during newborn MC. We performed a systematic review of neonatal MC studies published in the last 20 years. The most effective technique appeared to be the combination of pharmacological and non-pharmacological methods of analgesia.Conclusion: Combining local anesthesia with non-pharmacological analgesic strategies appears to be effective preventing procedural pain during MC. However, a standardized protocol for analgesia during MC is yet to be determined. Sensorial saturation appeared to help when used in conjunction with the local anesthesia techniques. What is Known: • Male circumcision is a painful procedure and it is frequently performed with inappropriate analgesic methods. • A gold standard practice in analgesia during male circumcision is still lacking and there is a great variability in the modus operandi between centers. What is New: • The combination of RB + EMLA + sucrose appears to be an analgesic strategy superior to other approaches. • We advocate for the integration of sensorial saturation during male circumcision in order to improve the efficacy of current analgesic practices.
Collapse
Affiliation(s)
- Serena Rossi
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Giuseppe Buonocore
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | | |
Collapse
|
14
|
Spinelli C, Bertocchini A, Leoni M, Calani C, Morganti R, Strambi S. Pediatric circumcision using n‐butyl‐cyanoacrylate plus
MS
monomer: Bacteriostatic and cosmetic advantages over suture. SURGICAL PRACTICE 2020. [DOI: 10.1111/1744-1633.12454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Claudio Spinelli
- Pediatric, Adolescent and Young Adults Surgery Division, Department of Surgical, Medical Molecular pathology and of the Critical Area, University of Pisa Pisa Italy
| | - Alessia Bertocchini
- Pediatric, Adolescent and Young Adults Surgery Division, Department of Surgical, Medical Molecular pathology and of the Critical Area, University of Pisa Pisa Italy
| | - Matteo Leoni
- Pediatric, Adolescent and Young Adults Surgery Division, Department of Surgical, Medical Molecular pathology and of the Critical Area, University of Pisa Pisa Italy
| | - Chiara Calani
- Pediatric, Adolescent and Young Adults Surgery Division, Department of Surgical, Medical Molecular pathology and of the Critical Area, University of Pisa Pisa Italy
| | - Riccardo Morganti
- Department of Clinical and Experimental Medicine Section of Statistics, University of Pisa Pisa Italy
| | - Silvia Strambi
- Pediatric, Adolescent and Young Adults Surgery Division, Department of Surgical, Medical Molecular pathology and of the Critical Area, University of Pisa Pisa Italy
| |
Collapse
|
15
|
Jacobson DL, D'Oro A, Abdullah F, Barsness KA, Liu DB, Maizels M, Rosoklija I, Johnson EK. Caregiver Reported Reasons for Delay of Neonatal Circumcision. Urology 2020; 140:143-149. [PMID: 32165277 DOI: 10.1016/j.urology.2020.01.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/15/2020] [Accepted: 01/21/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To determine caregiver-reported reasons for delay of desired neonatal circumcision. METHODS Caregivers requesting elective outpatient circumcision at two urban tertiary care hospitals were surveyed from 1/2017 to 12/2018. Boys >3 years and those with abnormal penile anatomy were excluded. Patient/parent demographics, insurance status, comorbidities, birth history, family history, reasons circumcision was desired, and reasons for circumcision delay were obtained. RESULTS Surveys were completed by 206/229 caregivers (90% response rate). Respondents were primarily mothers (74%) who identified as African-American (62%). Eligible boys presented at a median 7.5 months [0.3-35.6] and were predominantly African-American (63%), publicly-insured at birth (83%), and publicly-insured at present (86%). 80% were full-term. 83% had no comorbidities. Most caregivers (84%) requested inpatient circumcision, primarily for penile cleanliness (75%) and infection prevention (72%). Common reasons for delay included neonatal circumcision not being performed by the birth physician/hospital (26%) and prematurity (16%). Publicly-insured boys were more likely to encounter delays related birth physician/hospital not performing circumcisions (P = .02). Non-Caucasian/mixed race boys were less likely to be eligible for circumcision without general anesthesia (P = .004). In 108 cases (52%), circumcision was requested for full-term boys without comorbidities. Of these, 72 (35% of the cohort) now require general anesthesia to undergo circumcision. CONCLUSION Among 206 boys experiencing circumcision delay, most were full-term, African-American, and publicly-insured. Common reasons for delay included neonatal circumcision not being performed by the birth hospital/physician and prematurity. General anesthesia could have been avoided in >35% of boys if circumcision was performed at birth.
Collapse
Affiliation(s)
- Deborah L Jacobson
- Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Urology, Northwestern University, Chicago, IL
| | - Anthony D'Oro
- Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Urology, Northwestern University, Chicago, IL
| | - Fizan Abdullah
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Surgery, Northwestern University, Chicago, IL
| | - Katherine A Barsness
- Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Surgery, Northwestern University, Chicago, IL
| | - Dennis B Liu
- Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Urology, Northwestern University, Chicago, IL
| | - Max Maizels
- Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Urology, Northwestern University, Chicago, IL
| | - Ilina Rosoklija
- Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Urology, Northwestern University, Chicago, IL
| | - Emilie K Johnson
- Division of Pediatric Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Urology, Northwestern University, Chicago, IL; University of Illinois at Chicago, Department of Urology, Chicago, IL.
| |
Collapse
|
16
|
Vieira CB, Feitoza L, Pinho J, Teixeira-Júnior A, Lages J, Calixto J, Coelho R, Nogueira L, Cunha I, Soares F, Silva GEB. Profile of patients with penile cancer in the region with the highest worldwide incidence. Sci Rep 2020; 10:2965. [PMID: 32076037 PMCID: PMC7031540 DOI: 10.1038/s41598-020-59831-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 01/31/2020] [Indexed: 11/16/2022] Open
Abstract
To determine the epidemiological, histopathological, and clinical characteristics of patients diagnosed with penile cancer in the Brazilian state of Maranhão, the region with the highest incidence worldwide. One hundred and sixteen penile cancer patients were interviewed from July 2016 to October 2018. The majority of patients lived in a rural area (57%), worked in farming (58%), had a low level of schooling or no schooling (90%), and were married or in a stable relationship (74%). The mean age was 60.4 ± 16.51 years (range, 23–93 years). Phimosis (66%), poor/moderate genital hygiene (73%), history of sexually transmitted infections (55%), and zoophilia (60%) were found in the majority of patients. Most patients had their first sexual encounter at 16.2 ± 2.8 years (range, 10–25 years), and 75% had >6 sexual partners. The most common initial symptom was pruritus (37%), and most patients waited to seek treatment (average time to treatment, 18.9 months; range, 2–84 months). Human papillomavirus (HPV)-related histologies were observed in 62% of patients. Most patients had histological grades II or III (87%), stage ≥T2 disease (84%), and lymphadenopathy at admission (42%). Penectomy was performed in 96% of patients. The population with penile cancer in the region of highest incidence in the world is marked by low socioeconomic status, high prevalence of HPV infection, and phimosis. The delay in seeking treatment is related to a very high rate of advanced cancer and aggressive surgical treatment. The high prevalence of young patients was also a striking feature.
Collapse
Affiliation(s)
- Ciro Bezerra Vieira
- University Hospital of Federal University of Maranhão (UFMA), Barão de Itapari Street, Centro, São Luís, Brazil
| | - Laisson Feitoza
- Department of Radiology, University Clinic Hospital of Estadual University of Campinas, Campinas, Brazil
| | - Jaqueline Pinho
- Laboratory of Immunofluorescence and Electron Microscopy (LIME), Presidente Dutra University Hospital (HUUFMA), São Luís, MA, Brazil
| | - Antonio Teixeira-Júnior
- Postgraduate Program in Adult Health (PPGSAD), Federal University of Maranhão (UFMA), São Luis, MA, Brazil
| | - Joyce Lages
- Department of Public Health, Presidente Dutra University Hospital (HUUFMA), São Luís, MA, Brazil
| | - José Calixto
- Department of Medicine II, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
| | - Ronald Coelho
- Doctor, Oncologist at the Aldenora Bello Cancer Hospital (HCAB), São Luís, MA, Brazil
| | - Leudivan Nogueira
- Doctor, Urologist at the Aldenora Bello Cancer Hospital (HCAB), São Luís, MA, Brazil
| | - Isabela Cunha
- Doctor at the Antônio Prudente Foundation, São Paulo, Brazil
| | - Fernando Soares
- Department of Pathology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Gyl Eanes Barros Silva
- Laboratory of Immunofluorescence and Electron Microscopy (LIME), Presidente Dutra University Hospital (HUUFMA), São Luís, MA, Brazil. .,Department of Pathology, Ribeirão Preto Medical of School, University of São Paulo (USP), Ribeirão Preto, Brazil.
| |
Collapse
|
17
|
Litleskare LA, Strander MT, Førde R, Magelssen M. Refusals to perform ritual circumcision: a qualitative study of doctors' professional and ethical reasoning. BMC Med Ethics 2020; 21:5. [PMID: 31924198 PMCID: PMC6954583 DOI: 10.1186/s12910-020-0444-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/31/2019] [Indexed: 11/14/2022] Open
Abstract
Background Ritual circumcision of infant boys is controversial in Norway, as in many other countries. The procedure became a part of Norwegian public health services in 2015. A new law opened for conscientious objection to the procedure. We have studied physicians’ refusals to perform ritual circumcision as an issue of professional ethics. Method Qualitative interview study with 10 urologists who refused to perform ritual circumcision from six Norwegian public hospitals. Interviews were recorded and transcribed, then analysed with systematic text condensation, a qualitative analysis framework. Results The physicians are unanimous in grounding their opposition to the procedure in professional standards and norms, based on fundamental tenets of professional ethics. While there is homogeneity in the group when it comes to this reasoning, there are significant variations as to how deeply the matter touches the urologists on a personal level. About half of them connect their stance to their personal integrity, and state that performing the procedure would go against their conscience and lead to pangs of conscience. Conclusions It is argued that professional moral norms sometimes might become more or less ‘integrated’ in the professional’s core moral values and moral identity. If this is the case, then the distinction between conscience-based and professional refusals to certain healthcare services cannot be drawn as sharply as it has been.
Collapse
Affiliation(s)
- Liv Astrid Litleskare
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Mette Tolås Strander
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Reidun Førde
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Morten Magelssen
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway.
| |
Collapse
|
18
|
Stephanos K, Bragg AF. Pediatric Genitourinary Infections and Other Considerations. Emerg Med Clin North Am 2019; 37:739-754. [PMID: 31563205 DOI: 10.1016/j.emc.2019.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Pediatric patients pose a unique host of challenges to the emergency provider across all complaints and ages, but this is particularly notable in the genitourinary (GU) system. The pediatric GU system is different from that of the adult in its etiology of symptoms, complications, and treatments. Based on age, there are variations in the anatomy. These differences result in symptoms and diagnoses that must be managed differently. Although in many respects management is similar to GU emergency conditions in adults, there are, occasionally subtle, differences between the care of children and adults, which can greatly impact outcomes.
Collapse
Affiliation(s)
- Kathleen Stephanos
- Department of Emergency Medicine, University of Rochester, 601 Elmwood Avenue Box 655, Rochester, NY 14642, USA.
| | - Andrew F Bragg
- Department of Pediatrics, University of Rochester, 601 Elmwood Avenue Box 655, Rochester, NY 14642, USA
| |
Collapse
|
19
|
Elion RA, Kabiri M, Mayer KH, Wohl DA, Cohen J, Beaubrun AC, Altice FL. Estimated Impact of Targeted Pre-Exposure Prophylaxis: Strategies for Men Who Have Sex with Men in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1592. [PMID: 31067679 PMCID: PMC6539923 DOI: 10.3390/ijerph16091592] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/04/2019] [Accepted: 05/04/2019] [Indexed: 01/17/2023]
Abstract
Pre-exposure prophylaxis (PrEP) effectively reduces human immunodeficiency virus (HIV) transmission. We aimed to estimate the impact of different PrEP prioritization strategies among Black and Latino men who have sex with men (MSM) in the United States, populations most disproportionately affected by HIV. We developed an agent-based simulation to model the HIV epidemic among MSM. Individuals were assigned an HIV incidence risk index (HIRI-MSM) based on their sexual behavior. Prioritization strategies included PrEP use for individuals with HIRI-MSM ≥10 among all MSM, all Black MSM, young (≤25 years) Black MSM, Latino MSM, and young Latino MSM. We estimated the number needed to treat (NNT) to prevent one HIV infection, reductions in prevalence and incidence, and subsequent infections in non-PrEP users avoided under these strategies over 5 years (2016-2020). Young Black MSM eligible for PrEP had the lowest NNT (NNT = 10) followed by all Black MSM (NNT = 33) and young Latino MSM (NNT = 35). All Latino MSM and all MSM had NNT values of 63 and 70, respectively. Secondary infection reduction with PrEP was the highest among young Latino MSM (53.2%) followed by young Black MSM (37.8%). Targeting all MSM had the greatest reduction in prevalence (14.7% versus 2.9%-3.9% in other strategies) and incidence (49.4% versus 9.4%-13.9% in other groups). Using data representative of the United States MSM population, we found that a strategy of universal PrEP use by MSM was most effective in reducing HIV prevalence and incidence of MSM. Targeted use of PrEP by Black and Latino MSM, however, especially those ≤25 years, had the greatest impact on HIV prevention.
Collapse
Affiliation(s)
- Richard A Elion
- George Washington University School of Medicine, Washington, DC 20009, USA.
| | - Mina Kabiri
- Precision Health Economics, Los Angeles, CA 90025, USA.
| | - Kenneth H Mayer
- The Fenway Institute, Harvard Medical School, Boston, MA 02215, USA.
| | - David A Wohl
- Chapel Hill School of Medicine, The University of North Carolina, Chapel Hill, NC 27514, USA.
| | - Joshua Cohen
- Tufts University Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA 02111, USA.
| | | | - Frederick L Altice
- Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT 06510, USA.
| |
Collapse
|
20
|
Gerber JA, Borden AN, Broda J, Koelewyn S, Balasubramanian A, Tu D, Koh CJ, Austin PF, Roth DR, Seth A. Evaluating Clinical Outcomes of an Advanced Practice Provider-Led Newborn Circumcision Clinic. Urology 2019; 127:97-101. [DOI: 10.1016/j.urology.2019.01.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/21/2019] [Accepted: 01/28/2019] [Indexed: 11/29/2022]
|
21
|
Liu JL, Michaud JE, Ludwig WW, Gearhart JP. Diagnosis of hemophilia in newborn circumcision: A case presentation. Urol Case Rep 2019; 23:101-102. [PMID: 30740310 PMCID: PMC6357687 DOI: 10.1016/j.eucr.2019.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 01/17/2019] [Accepted: 01/23/2019] [Indexed: 12/03/2022] Open
Abstract
Circumcision is often the earliest surgery performed in a young male's life. Though complications in this procedure are rare, prolong postoperative bleeding may be the first sign of undiagnosed hemophilia. Hemophilia is a rare X-linked bleeding disorder and if not treated prophylactically or promptly during surgical intervention can be fatal. In this case presentation we describe the diagnosis of hemophilia in a child presenting with postoperative bleeding from circumcision. We review the literature regarding the history of this disease with early surgery and highlight the current treatments.
Collapse
Affiliation(s)
- James L Liu
- The James Buchanan Brady Urological Institute, Division of Pediatric Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jason E Michaud
- The James Buchanan Brady Urological Institute, Division of Pediatric Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wesley W Ludwig
- The James Buchanan Brady Urological Institute, Division of Pediatric Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John P Gearhart
- The James Buchanan Brady Urological Institute, Division of Pediatric Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
22
|
Bar-Yosef Y, Dekalo S, Bar-Yaakov N, Binyamini J, Sofer M, Ben-Chaim J. Scrotal injuries during neonatal circumcision. J Pediatr Urol 2019; 15:69.e1-69.e3. [PMID: 30449678 DOI: 10.1016/j.jpurol.2018.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/04/2018] [Accepted: 10/12/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To report very rarely encountered scrotal injuries during neonatal circumcision. Hospitals and physicians in the authors' country are mandated to report circumcision complications to the Ministry of Health. Those reports include the discharge summary from the emergency room or the admitting department. This is believed to be the first case series describing scrotal injuries during ritual circumcision. PATIENTS AND METHODS Reports of all circumcision complications between 2007 and 2014 were evaluated. Retrieved data on cases of scrotal injuries included patient's age, time between injury and hospital admission, nature of the injury, and administered treatment. RESULTS Twelve of a total of 489 reports of circumcision injuries involved the scrotum (2.5%). All circumcisions were performed during the neonatal period, and the infants were admitted on the day of injury. The only related genital injury was significant shortage of penile skin reported in six patients. Scrotal exploration and skin closure in the operating room was undertaken in six cases, five under general anesthesia. Suture closure in the emergency department was performed in three patients, and the scrotal skin was left to heal with secondary intention in three other patients. Scrotal content injury that extended to the tunica vaginalis of the testis was noted in one exploration. DISCUSSION The injuries sustained by the 12 study infants were mostly superficial and are not expected to cause long-term damage, although half of the patients required treatment under general anesthesia in the operating room or under sedation in the emergency department. While all reported patients emerged unscathed from the anesthetic procedures, the possible immediate complications of anesthesia as well as its long-term effects are not to be taken lightly, especially when treating a newborn. Further education of medical providers as well as performers of ritual circumcisions may help lower the risk of this rare injury as well as other more severe complications. CONCLUSION Scrotal injury during neonatal circumcision is rare. While half of the 12 reported patients required exploration in the operating room, the injuries were mostly superficial and did not involve scrotal content, although they often involved extensive resection of penile skin.
Collapse
Affiliation(s)
- Y Bar-Yosef
- Pediatric Urology, Dana-Dwek Children's Hospital, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University Tel-Aviv, Israel.
| | - S Dekalo
- Pediatric Urology, Dana-Dwek Children's Hospital, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University Tel-Aviv, Israel
| | - N Bar-Yaakov
- Pediatric Urology, Dana-Dwek Children's Hospital, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University Tel-Aviv, Israel
| | - J Binyamini
- Pediatric Urology, Dana-Dwek Children's Hospital, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University Tel-Aviv, Israel
| | - M Sofer
- Pediatric Urology, Dana-Dwek Children's Hospital, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University Tel-Aviv, Israel
| | - J Ben-Chaim
- Pediatric Urology, Dana-Dwek Children's Hospital, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University Tel-Aviv, Israel
| |
Collapse
|
23
|
Eisenberg ML, Galusha D, Kennedy WA, Cullen MR. The Relationship between Neonatal Circumcision, Urinary Tract Infection, and Health. World J Mens Health 2018; 36:176-182. [PMID: 29623700 PMCID: PMC6119846 DOI: 10.5534/wjmh.180006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 01/22/2018] [Accepted: 01/28/2018] [Indexed: 12/18/2022] Open
Abstract
The risk-benefit profile of neonatal circumcision is not clear. Most studies have focused on urinary tract infections but other health sequelae have not been evaluated. While evidence supports benefits of circumcision, a lack of randomized trials has been cited as a weakness. National guidelines provide mixed recommendations regarding neonatal circumcision. We review the weight of evidence and utilize current statistical methodology on observational data to examine the risks and benefits of neonatal circumcision.
Collapse
Affiliation(s)
- Michael L Eisenberg
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
- Department of Obstetrics/Gynecology, Stanford University School of Medicine, Stanford, CA, USA.
| | - Deron Galusha
- Statistician, Yale Occupational and Environmental Medicine Program, Yale University School of Medicine, New Haven, CT, USA
| | - William A Kennedy
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Mark R Cullen
- Department of Internal Medicine, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
24
|
Abstract
Anal intercourse is reported by many heterosexuals, and evidence suggests that its practice may be increasing. We estimated the proportion of the HIV burden attributable to anal sex in 2015 among heterosexual women and men in the United States. The HIV Optimization and Prevention Economics model was developed using parameter inputs from the literature for the sexually active U.S. population aged 13-64. The model uses differential equations to represent the progression of the population between compartments defined by HIV disease status and continuum-of-care stages from 2007 to 2015. For heterosexual women of all ages (who do not inject drugs), almost 28% of infections were associated with anal sex, whereas for women aged 18-34, nearly 40% of HIV infections were associated with anal sex. For heterosexual men, 20% of HIV infections were associated with insertive anal sex with women. Sensitivity analyses showed that varying any of 63 inputs by ±20% resulted in no more than a 13% change in the projected number of heterosexual infections in 2015, including those attributed to anal sex. Despite uncertainties in model inputs, a substantial portion of the HIV burden among heterosexuals appears to be attributable to anal sex. Providing information about the relative risk of anal sex compared with vaginal sex may help reduce HIV incidence in heterosexuals.
Collapse
|
25
|
Morris BJ, Krieger JN, Klausner JD. CDC's Male Circumcision Recommendations Represent a Key Public Health Measure. GLOBAL HEALTH, SCIENCE AND PRACTICE 2017; 5:15-27. [PMID: 28351877 PMCID: PMC5478224 DOI: 10.9745/ghsp-d-16-00390] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 01/31/2017] [Indexed: 12/20/2022]
Abstract
Frisch and Earp, opponents of male circumcision, have criticized draft recommendations from the CDC that advocate counseling men and parents of newborn boys in the United States about the benefits and risks of male circumcision. We provide a rebuttal to Frisch and Earp's criticisms and contend that the recommendations are entirely appropriate and merit consideration for policy development.
Collapse
Affiliation(s)
- Brian J Morris
- School of Medical Sciences and Bosch Institute, University of Sydney, Sydney, New South Wales, Australia.
| | - John N Krieger
- University of Washington School of Medicine and VA Puget Sound Health Care System, Section of Urology, Seattle, WA, USA
| | - Jeffrey D Klausner
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA, USA
| |
Collapse
|
26
|
Morris BJ, Kennedy SE, Wodak AD, Mindel A, Golovsky D, Schrieber L, Lumbers ER, Handelsman DJ, Ziegler JB. Early infant male circumcision: Systematic review, risk-benefit analysis, and progress in policy. World J Clin Pediatr 2017; 6:89-102. [PMID: 28224100 PMCID: PMC5296634 DOI: 10.5409/wjcp.v6.i1.89] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 11/17/2016] [Accepted: 12/27/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To determine whether recent evidence-based United States policies on male circumcision (MC) apply to comparable Anglophone countries, Australia and New Zealand. METHODS Articles in 2005 through 2015 were retrieved from PubMed using the keyword "circumcision" together with 36 relevant subtopics. A further PubMed search was performed for articles published in 2016. Searches of the EMBASE and Cochrane databases did not yield additional citable articles. Articles were assessed for quality and those rated 2+ and above according to the Scottish Intercollegiate Grading System were studied further. The most relevant and representative of the topic were included. Bibliographies were examined to retrieve further key references. Randomized controlled trials, recent high quality systematic reviews or meta-analyses (level 1++ or 1+ evidence) were prioritized for inclusion. A risk-benefit analysis of articles rated for quality was performed. For efficiency and reliability, recent randomized controlled trials, meta-analyses, high quality systematic reviews and large well-designed studies were used if available. Internet searches were conducted for other relevant information, including policies and Australian data on claims under Medicare for MC. RESULTS Evidence-based policy statements by the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) support infant and later age male circumcision (MC) as a desirable public health measure. Our systematic review of relevant literature over the past decade yielded 140 journal articles that met our inclusion criteria. Together, these showed that early infant MC confers immediate and lifelong benefits by protecting against urinary tract infections having potential adverse long-term renal effects, phimosis that causes difficult and painful erections and "ballooning" during urination, inflammatory skin conditions, inferior penile hygiene, candidiasis, various sexually transmissible infections in both sexes, genital ulcers, and penile, prostate and cervical cancer. Our risk-benefit analysis showed that benefits exceeded procedural risks, which are predominantly minor, by up to 200 to 1. We estimated that more than 1 in 2 uncircumcised males will experience an adverse foreskin-related medical condition over their lifetime. Wide-ranging evidence from surveys, physiological measurements, and the anatomical location of penile sensory receptors responsible for sexual sensation strongly and consistently suggested that MC has no detrimental effect on sexual function, sensitivity or pleasure. United States studies showed that early infant MC is cost saving. The evidence supporting early infant MC has further strengthened since the positive AAP and CDC reviews. CONCLUSION Affirmative MC policies are needed in Australia and New Zealand. Routine provision of accurate, unbiased education, and access in public hospitals, will maximize health and financial benefits.
Collapse
Affiliation(s)
- Brian J Morris
- School of Medical Sciences and Bosch Institute, University of Sydney, Sydney, NSW 2006, Australia
- School of Medical Sciences and Bosch Institute, University of Sydney, Sydney, NSW 2006, Australia
| | - Sean E Kennedy
- School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Alex D Wodak
- St Vincent’s Hospital and Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, NSW 2010, Australia
| | - Adrian Mindel
- School of Medical Sciences and Bosch Institute, University of Sydney, Sydney, NSW 2006, Australia
| | | | - Leslie Schrieber
- Department of Medicine, Sydney Medical School, Royal North Shore Hospital, Sydney, NSW 2060, Australia
| | - Eugenie R Lumbers
- School of Biomedical Sciences and Pharmacy, Mothers and Babies Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW 2305, Australia
| | - David J Handelsman
- Department of Medicine and ANZAC Research Institute, Concord Hospital, Sydney, NSW 2139, Australia
| | - John B Ziegler
- Department of Immunology and Infectious Diseases, Sydney Children’s Hospital, Randwick, Sydney, NSW 2031, Australia
| |
Collapse
|
27
|
Van Howe RS. Expertise or ideology? A response to Morris et al. 2016, ‘Circumcision is a primary preventive against HIV infection: Critique of a contrary meta-regression analysis by Van Howe’. Glob Public Health 2017; 13:1900-1918. [DOI: 10.1080/17441692.2016.1272939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Robert S. Van Howe
- Department of Pediatrics, Central Michigan University College of Medicine, Saginaw, MI, USA
| |
Collapse
|
28
|
Surgery of the Male Genital System. Fam Med 2017. [DOI: 10.1007/978-3-319-04414-9_106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
29
|
Frisch M, Simonsen J. Cultural background, non-therapeutic circumcision and the risk of meatal stenosis and other urethral stricture disease: Two nationwide register-based cohort studies in Denmark 1977-2013. Surgeon 2016; 16:107-118. [PMID: 28017691 DOI: 10.1016/j.surge.2016.11.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 10/04/2016] [Accepted: 11/30/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Meatal stenosis is markedly more common in circumcised than genitally intact males, affecting 5-20 per cent of circumcised boys. However, no population-based study has estimated the relative risk of meatal stenosis and other urethral stricture diseases (USDs) or the population attributable fraction (AFp) associated with non-therapeutic circumcision. METHODS In two nationwide cohort studies (comprising 4.0 million males of all ages and 810 719 non-Muslim males aged 0-36 years, respectively), we compared hospital contact rates for USD during 1977-2013 between circumcised and intact Danish males. Hazard ratios (HRs) were obtained using Cox proportional hazards regression, and the AFp estimated the proportion of USD cases in <10 year-old boys that is due to non-therapeutic circumcision. RESULTS Muslim males had higher rates of meatal stenosis than ethnic Danish males, particularly in <10 year-old boys (HR 3.44, 95 per cent confidence interval 2.42-4.88). HRs linking circumcision to meatal stenosis (10.3, 4.53-23.4) or other USDs (5.14, 3.48-7.60) were high, and attempts to reduce potential misclassification and confounding further strengthened the association, particularly in <10 year-old boys (meatal stenosis: 26.3, 9.37-73.9; other USDs: 14.0, 6.86-28.6). Conservative calculations revealed that at least 18, 41, 78, and 81 per cent of USD cases in <10 year-old boys from countries with circumcision prevalences as in Denmark, the United Kingdom, the United States and Israel, respectively, may be attributable to non-therapeutic circumcision. CONCLUSION Our study provides population-based epidemiological evidence that circumcision removes the natural protection against meatal stenosis and, possibly, other USDs as well.
Collapse
Affiliation(s)
- Morten Frisch
- Statens Serum Institut, Department of Epidemiology Research, DK-2300 Copenhagen S, Denmark; Aalborg University, Department of Clinical Medicine, Center for Sexology Research, DK-9000 Aalborg, Denmark.
| | - Jacob Simonsen
- Statens Serum Institut, Department of Epidemiology Research, DK-2300 Copenhagen S, Denmark
| |
Collapse
|
30
|
Brook I. Infectious Complications of Circumcision and Their Prevention. Eur Urol Focus 2016; 2:453-459. [DOI: 10.1016/j.euf.2016.01.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/14/2016] [Accepted: 01/25/2016] [Indexed: 12/15/2022]
|
31
|
Aydogmus Y, Semiz M, Er O, Bas O, Atay I, Kilinc MF. Psychological and sexual effects of circumcision in adult males. Can Urol Assoc J 2016; 10:E156-E160. [PMID: 27790295 DOI: 10.5489/cuaj.3364] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Our aim was to investigate the psychological and sexual effects of circumcision in adult men, and analyze these changes following circumcision. METHODS We included 37 adults who applied to our clinic for circumcision and who did not have any psychiatric or urologic disorders and age-matched 30 controls in our study. Body Cathexis Scale (BCS), Liebowitz Social Anxiety Scale (LSAS), and Premature Ejaculation Diagnostic Tool (PEDT) were applied to the study group twice, once before and once three months after circumcision, and only once in the control group. Also, intravaginal ejaculation latency time (IELT) was noted and premature ejaculation (PE) evaluation was done. Intra- and intergroup comparisons were performed. RESULTS The two groups were similar with regard to demographic data. Comparison of preoperative BCS and LSAS scores with the scores of the control group showed significant differences (p=0.003, p<0.001, and p<0.001, respectively). However, postoperative scores were similar to the scores obtained in the control group (p=0.768, p>0.05, and p>0.05, respectively). Scores of all scales showed significant improvements postoperatively. Also, PEDT scores and IELT changes before and after circumcision were significant in the study group, but not when compared to the control group. CONCLUSIONS Our results indicated that social anxiety and anxiety levels decreased after circumcision in adult Turkish men, and their body gratification increased. We found that not being circumcised might negatively affect individuals in adulthood when it comes to body image and sexual satisfaction, however, both improve after circumcision.
Collapse
Affiliation(s)
- Yasin Aydogmus
- Department of Urology, Etimesgut Military Hospital, Ankara, Turkey
| | - Murat Semiz
- Department of Psychiatry, Gulhane Military Medical Academy, Ankara, Turkey
| | - Okan Er
- Department of Psychiatry, Etimesgut Military Hospital, Ankara, Turkey
| | - Okan Bas
- Department of Urology, Abdurrahman Yurtaslan Oncology Education and Research Hospital, Ankara, Turkey
| | - Irfan Atay
- Department of Urology, Health Centre of Airforce Military Academy, Istanbul, Turkey
| | | |
Collapse
|
32
|
Morris BJ, Barboza G, Wamai RG, Krieger JN. Circumcision is a primary preventive against HIV infection: Critique of a contrary meta-regression analysis by Van Howe. Glob Public Health 2016; 13:1889-1899. [PMID: 27043484 DOI: 10.1080/17441692.2016.1164737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
A meta-analysis by Van Howe of 109 populations confirms the well-known association of male circumcision (MC) with reduced HIV prevalence. He then performed meta-regression adjusting for location, risk and MC prevalence. When one or two of these adjustments in combination were applied MC appeared protective, but when all three were introduced the association remained significant in high-risk populations, but not in general populations within Africa with a hypothetical MC prevalence of <25% or elsewhere with hypothetical MC prevalence of <75%. However, many MC prevalence values given differed from those reported in references cited (including all US studies). This and other problems invalidate his adjustments for MC prevalence, undermining most of his meta-regression results. Meta-regression is a highly sophisticated statistical tool and is prone to error if not applied correctly. The study contained a high risk of bias arising from confounding. We also question his use of crude, rather than adjusted, odds ratios and his inclusion of unpublished data, so precluding replication by others. Flawed statistics, opaque presentation of results and inclusion of previously repudiated arguments downplaying a role for MC in HIV prevention programmes should lead readers to be sceptical of the findings and conclusions of Van Howe's study.
Collapse
Affiliation(s)
- Brian J Morris
- a School of Medical Sciences and Bosch Institute , University of Sydney , Sydney , Australia
| | - Gia Barboza
- b Department of African-American Studies , Northeastern University , Boston , MA , USA.,c School of Criminology and Criminal Justice , Northeastern University , Boston , MA , USA
| | - Richard G Wamai
- b Department of African-American Studies , Northeastern University , Boston , MA , USA
| | - John N Krieger
- d University of Washington School of Medicine and VA Puget Sound Health Care System, Section of Urology , Seattle , WA , USA
| |
Collapse
|
33
|
Morris BJ, Wamai RG, Henebeng EB, Tobian AAR, Klausner JD, Banerjee J, Hankins CA. Estimation of country-specific and global prevalence of male circumcision. Popul Health Metr 2016; 14:4. [PMID: 26933388 PMCID: PMC4772313 DOI: 10.1186/s12963-016-0073-5] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 02/12/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Male circumcision (MC) status and genital infection risk are interlinked and MC is now part of HIV prevention programs worldwide. Current MC prevalence is not known for all countries globally. Our aim was to provide estimates for country-specific and global MC prevalence. METHODS MC prevalence data were obtained by searches in PubMed, Demographic and Health Surveys, AIDS Indicator Surveys, and Behavioural Surveillance Surveys. Male age was ≥15 years in most surveys. Where no data were available, the population proportion whose religious faith or culture requires MC was used. The total number of circumcised males in each country and territory was calculated using figures for total males from (i) 2015 US Central Intelligence Agency (CIA) data for sex ratio and total population in all 237 countries and territories globally and (ii) 2015 United Nations (UN) figures for males aged 15-64 years. RESULTS The estimated percentage of circumcised males in each country and territory varies considerably. Based on (i) and (ii) above, global MC prevalence was 38.7 % (95 % confidence interval [CI]: 33.4, 43.9) and 36.7 % (95 % CI: 31.4, 42.0). Approximately half of circumcisions were for religious and cultural reasons. For countries lacking data we assumed 99.9 % of Muslims and Jews were circumcised. If actual prevalence in religious groups was lower, then MC prevalence in those countries would be lower. On the other hand, we assumed a minimum prevalence of 0.1 % related to MC for medical reasons. This may be too low, thereby underestimating MC prevalence in some countries. CONCLUSIONS The present study provides the most accurate estimate to date of MC prevalence in each country and territory in the world. We estimate that 37-39 % of men globally are circumcised. Considering the health benefits of MC, these data may help guide efforts aimed at the use of voluntary, safe medical MC in disease prevention programs in various countries.
Collapse
Affiliation(s)
- Brian J Morris
- />School of Medical Sciences and Bosch Institute, University of Sydney, Sydney, NSW 2006 Australia
| | - Richard G Wamai
- />Department of African-American Studies, Northeastern University, Boston, MA 02115 USA
| | | | - Aaron AR Tobian
- />Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD 21287 USA
| | - Jeffrey D Klausner
- />Division of Infectious Diseases and Program in Global Health, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA 90095 USA
| | - Joya Banerjee
- />Jhpiego, an affiliate of Johns Hopkins University, Washington, DC 20009 USA
| | - Catherine A Hankins
- />Department of Global Health, Academic Medical Centre and Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, 1105 AZ The Netherlands
- />Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK
| |
Collapse
|
34
|
Warner L, Cox S, Whiteman M, Jamieson DJ, Macaluso M, Bansil P, Kuklina E, Kourtis AP, Posner S, Barfield WD. Impact of Health Insurance Type on Trends in Newborn Circumcision, United States, 2000 to 2010. Am J Public Health 2015; 105:1943-9. [PMID: 26180994 PMCID: PMC4539816 DOI: 10.2105/ajph.2015.302629] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVES We explored how changes in insurance coverage contributed to recent nationwide decreases in newborn circumcision. METHODS Hospital discharge data from the 2000-2010 Nationwide Inpatient Sample were analyzed to assess trends in circumcision incidence among male newborn birth hospitalizations covered by private insurance or Medicaid. We examined the impact of insurance coverage on circumcision incidence. RESULTS Overall, circumcision incidence decreased significantly from 61.3% in 2000 to 56.9% in 2010 in unadjusted analyses (P for trend = .008), but not in analyses adjusted for insurance status (P for trend = .46) and other predictors (P for trend = .55). Significant decreases were observed only in the South, where adjusted analyses revealed decreases in circumcision overall (P for trend = .007) and among hospitalizations with Medicaid (P for trend = .005) but not those with private insurance (P for trend = .13). Newborn male birth hospitalizations covered by Medicaid increased from 36.0% (2000) to 50.1% (2010; P for trend < .001), suggesting 390,000 additional circumcisions might have occurred nationwide had insurance coverage remained constant. CONCLUSIONS Shifts in insurance coverage, particularly toward Medicaid, likely contributed to decreases in newborn circumcision nationwide and in the South. Barriers to the availability of circumcision should be revisited, particularly for families who desire but have less financial access to the procedure.
Collapse
Affiliation(s)
- Lee Warner
- All of the authors are with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Shanna Cox
- All of the authors are with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Maura Whiteman
- All of the authors are with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Denise J Jamieson
- All of the authors are with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Maurizio Macaluso
- All of the authors are with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Pooja Bansil
- All of the authors are with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Elena Kuklina
- All of the authors are with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Athena P Kourtis
- All of the authors are with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Samuel Posner
- All of the authors are with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Wanda D Barfield
- All of the authors are with the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| |
Collapse
|
35
|
|
36
|
Latham JL. Surgery of the Male Genital System. Fam Med 2015. [DOI: 10.1007/978-1-4939-0779-3_106-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
37
|
Hart-Cooper GD, Tao G, Stock JA, Hoover KW. Circumcision of privately insured males aged 0 to 18 years in the United States. Pediatrics 2014; 134:950-6. [PMID: 25332502 DOI: 10.1542/peds.2014-1007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Male circumcision confers protection against HIV, sexually transmitted infections, and urinary tract infections. Compared with circumcision of postneonates (>28 days), circumcision of neonates is associated with fewer complications and usually performed with local rather than general anesthesia. We assessed circumcision of commercially insured males during the neonatal or postneonatal period. METHODS We analyzed 2010 MarketScan claims data from commercial health plans, using procedural codes to identify circumcisions performed on males aged 0 to 18 years, and diagnostic codes to assess clinical indications for the procedure. Among circumcisions performed in the first year of life, we estimated rates for neonates and postneonates. We estimated the percentage of circumcisions by age among males who had circumcisions in 2010, and the mean payment for neonatal and postneonatal procedures. RESULTS We found that 156,247 circumcisions were performed, with 146,213 (93.6%) in neonates and 10,034 (6.4%) in postneonates. The neonatal circumcision rate was 65.7%, and 6.1% of uncircumcised neonates were circumcised by their first birthday. Among postneonatal circumcisions, 46.6% were performed in males younger than 1 year and 25.1% were for nonmedical indications. The mean payment was $285 for a neonatal and $1885 for a postneonatal circumcision. CONCLUSIONS The large number of nonmedical postneonatal circumcisions suggests that neonatal circumcision might be a missed opportunity for these boys. Delay of nonmedical circumcision results in greater risk for the child, and a more costly procedure. Discussions with parents early in pregnancy might help them make an informed decision about circumcision of their child.
Collapse
Affiliation(s)
- Geoffrey D Hart-Cooper
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia; The CDC Experience Applied Epidemiology Fellowship, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; and
| | - Guoyu Tao
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeffrey A Stock
- Departments of Pediatrics and Urology, Mount Sinai Hospital, New York, New York
| | - Karen W Hoover
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia;
| |
Collapse
|
38
|
McCormick AW, Abuelezam NN, Rhode ER, Hou T, Walensky RP, Pei PP, Becker JE, DiLorenzo MA, Losina E, Freedberg KA, Lipsitch M, Seage GR. Development, calibration and performance of an HIV transmission model incorporating natural history and behavioral patterns: application in South Africa. PLoS One 2014; 9:e98272. [PMID: 24867402 PMCID: PMC4035281 DOI: 10.1371/journal.pone.0098272] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 04/28/2014] [Indexed: 11/19/2022] Open
Abstract
Understanding HIV transmission dynamics is critical to estimating the potential population-wide impact of HIV prevention and treatment interventions. We developed an individual-based simulation model of the heterosexual HIV epidemic in South Africa and linked it to the previously published Cost-Effectiveness of Preventing AIDS Complications (CEPAC) International Model, which simulates the natural history and treatment of HIV. In this new model, the CEPAC Dynamic Model (CDM), the probability of HIV transmission per sexual encounter between short-term, long-term and commercial sex worker partners depends upon the HIV RNA and disease stage of the infected partner, condom use, and the circumcision status of the uninfected male partner. We included behavioral, demographic and biological values in the CDM and calibrated to HIV prevalence in South Africa pre-antiretroviral therapy. Using a multi-step fitting procedure based on Bayesian melding methodology, we performed 264,225 simulations of the HIV epidemic in South Africa and identified 3,750 parameter sets that created an epidemic and had behavioral characteristics representative of a South African population pre-ART. Of these parameter sets, 564 contributed 90% of the likelihood weight to the fit, and closely reproduced the UNAIDS HIV prevalence curve in South Africa from 1990–2002. The calibration was sensitive to changes in the rate of formation of short-duration partnerships and to the partnership acquisition rate among high-risk individuals, both of which impacted concurrency. Runs that closely fit to historical HIV prevalence reflect diverse ranges for individual parameter values and predict a wide range of possible steady-state prevalence in the absence of interventions, illustrating the value of the calibration procedure and utility of the model for evaluating interventions. This model, which includes detailed behavioral patterns and HIV natural history, closely fits HIV prevalence estimates.
Collapse
Affiliation(s)
- Alethea W. McCormick
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Nadia N. Abuelezam
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Erin R. Rhode
- Divisions of General Medicine and Infectious Disease and the Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Taige Hou
- Divisions of General Medicine and Infectious Disease and the Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Rochelle P. Walensky
- Divisions of General Medicine and Infectious Disease and the Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
- Center for AIDS Research, Harvard University, Boston, Massachusetts, United States of America
| | - Pamela P. Pei
- Divisions of General Medicine and Infectious Disease and the Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Jessica E. Becker
- Divisions of General Medicine and Infectious Disease and the Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Madeline A. DiLorenzo
- Divisions of General Medicine and Infectious Disease and the Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Elena Losina
- Departments of Biostatistics and Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Kenneth A. Freedberg
- Divisions of General Medicine and Infectious Disease and the Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Center for AIDS Research, Harvard University, Boston, Massachusetts, United States of America
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Marc Lipsitch
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Center for Communicable Disease Dynamics and Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - George R. Seage
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
| |
Collapse
|
39
|
Morris BJ, Bailis SA, Wiswell TE. Circumcision rates in the United States: rising or falling? What effect might the new affirmative pediatric policy statement have? Mayo Clin Proc 2014; 89:677-86. [PMID: 24702735 DOI: 10.1016/j.mayocp.2014.01.001] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 12/19/2013] [Accepted: 01/02/2014] [Indexed: 02/06/2023]
Abstract
The objective of this review was to assess the trend in the US male circumcision rate and the impact that the affirmative 2012 American Academy of Pediatrics policy statement might have on neonatal circumcision practice. We searched PubMed for the term circumcision to retrieve relevant articles. This review was prompted by a recent report by the Centers for Disease Control and Prevention that found a slight increase, from 79% to 81%, in the prevalence of circumcision in males aged 14 to 59 years during the past decade. There were racial and ethnic disparities, with prevalence rising to 91% in white, 76% in black, and 44% in Hispanic males. Because data on neonatal circumcision are equivocal, we undertook a critical analysis of hospital discharge data. After correction for underreporting, we found that the percentage had declined from 83% in the 1960s to 77% by 2010. A risk-benefit analysis of conditions that neonatal circumcision protects against revealed that benefits exceed risks by at least 100 to 1 and that over their lifetime, half of uncircumcised males will require treatment for a medical condition associated with retention of the foreskin. Other analyses show that neonatal male circumcision is cost-effective for disease prevention. The benefits of circumcision begin in the neonatal period by protection against infections that can damage the pediatric kidney. Given the substantial risk of adverse conditions and disease, some argue that failure to circumcise a baby boy may be unethical because it diminishes his right to good health. There is no long-term adverse effect of neonatal circumcision on sexual function or pleasure. The affirmative 2012 American Academy of Pediatrics policy supports parental education about, access to, and insurance and Medicaid coverage for elective infant circumcision. As with vaccination, circumcision of newborn boys should be part of public health policies. Campaigns should prioritize population subgroups with lower circumcision prevalence and a higher burden of diseases that can be ameliorated by circumcision.
Collapse
Affiliation(s)
- Brian J Morris
- School of Medical Sciences, University of Sydney, Sydney, NSW, Australia.
| | | | | |
Collapse
|