Tuesday, July 10, 2012

On more lies.

There was recently a study published on USHealth's website about how uncircumcised boys are at higher risk for urinary tract infections, or UTIs, than their circumcised counterparts. The article itself is actually very small, and doesn't go into a lot of detail about the physical study itself, and I'll leave reading the article in its uninterrupted entirety up to you, as I figure you're quite capable of reading it yourself. But as I am an intactivist through and through, and the proud mama of two intact and happy (and I should note healthy) boys, I feel the need to show how painfully inept publications like this make an otherwise trusted source of news and health information look. So, for the sake of making some sense of this whole thing and figuring out how it actually applies to the general populace, I'm going to post the contents of the article, but with my added commentary in between, in red - along with plenty of factual, well-researched sources to back up my points.

MONDAY, July 9 (HealthDay News) -- Uncircumcised boys are at higher risk for urinary tract infections, common bacterial infections that can scar the kidneys if untreated, according to a new study. Oh, is that so? Well, on one hand, you're right there - UTIs can do some pretty serious damage if they're left untreated. But this already misses a huge point: Far more girls than boys develop UTIs after their first year of life, although some studies have shown that before the first year is reached, more boys develop UTIs than girls. The reason for this discrepancy within the first year is unknown, but beyond that it's believed that girls may often hold their urine for longer than boys do, which can cause a UTI, and that girls are more likely to be given baths in water that has been mixed with bubble solution or other potential irritants that can cause UTIs (never mind the fact that proper wiping techniques employed by both parents and child can affect her potential for UTIs). Also, when regarding figures in the US for male babies who develop a UTI before age one, there is a very real possibility that it happens because they are circumcised in the first place, and bacteria has an opportunity to get into places it otherwise wouldn't if the foreskin were still present. Check here, here, here, and here for some good, unbiased information on UTIs and how they affect boys and girls differently during their lives (including a link with great references on how circumcision may negatively affect boys when it comes to UTIs throughout life). Keep in mind, when a girl develops a UTI, we treat it with antibiotics and probiotic yogurts and cranberry - not with circumcision.

The Canadian researchers also found the infection risk is greater regardless of whether or not the boys have a visible urethra. A visible urethra is irrelevant, in all honesty. A boy could be only partially circumcised and still not have a visible urethra, uncircumcised with a visible urethra, or circumcised with a completely visible and bared urethra - so why is this even brought up?

Circumcision involves removal of the foreskin at the tip of the penis. Wrong again - circumcision removes the equivalent of a 3"x5" index card worth of skin on an adult male, over 20,000 nerve endings, and - since the penis typically emerges from the foreskin when engorged - actually removes length from the penis as well. To top it off, circumcision removes healthy, functioning skin that provides the penis with sensitivity and added lubrication that benefits both partners during sex. Check here and here for some basic illustrations and concepts showing exactly what circumcision removes. Warning: the first link is NSFW and contains a picture of a penis. Long story short (see what I did there?), circumcision removes a LOT more than just a little skin at the "tip" of the penis.

For the study, published July 9 in the journal CMAJ, the researchers analyzed information on nearly 400 boys who visited an emergency room with symptoms of a urinary tract infection. Forty of these boys had not been circumcised and had a visible urethra; 269 weren't circumcised and had a partially visible or nonvisible urethra; and 84 were circumcised. I see two issues with this. First, 400 is a very small study size, and numbers closer to the thousands would likely provide results that follow the typical curve that researchers are used to seeing. Second, this is a Canadian study, performed in a Canadian hospital, and Canada has a MUCH lower circumcision rate than America does. That being said, that is even more reason to up the ante and call for a higher number of boys to be followed. This also does not appear to follow any boys whose parents brought them to the doctor instead of to the ER, meaning there is likely a large portion of the study that has been completely ignored that should be included.

"We thought that incomplete foreskin retractability with a poorly visible urethral [opening] may be associated with increased risk of urinary tract infection," the study's co-author, Dr. Sasha Dubrovsky, of Montreal Children's Hospital at McGill University Health Center, said in a journal news release. "However, we found no difference in risk with degree of visibility of the urethral opening."

The researchers pointed out that boys with a completely visible urethra were also at higher risk of infection. They noted, however, that this finding was based on a small sample size and is not supported by previous research. So, again, two things here: One, they found that boys who had a completely visible urethra were at a higher risk of infection, which is a fact that most researchers can agree on - and it is more likely for a boy, especially a young one, to have a visible urethra if he is circumcised. The second problem is that last sentence there. Let me repeat it for you: "[...]  this finding was based on a small sample size and is not supported by previous research." In other words, the researchers are stating VERY PLAINLY that they are aware that this SINGLE research study, conducted with too few participants in a too-limited environment, is likely baseless because it doesn't follow along with pretty much ANY other study performed thus far that seems to agree with the concept that circumcision raises the likelihood of UTIs in otherwise healthy male babies. So, uh. Why is this news, then?

"We suggest that clinicians should consider circumcision status alone, not the degree of urethral visibility, when stratifying risk for boys presenting to the emergency department with symptoms suggesting a urinary tract infection," the researchers said. So, what? If a boy comes to the ER with a potential UTI, why does the status of his penis suddenly matter so much? Nearly every other study done in a first-world country plainly shows that a circumcised boy is more likely to develop a UTI at some point in his life than a non-circumcised boy. See here, here, here, and here for more info. It's believed at this point that the only reason there are studies potentially agreeing with the statement that circumcision CAN prevent UTIs is because parents with intact boys may not be educated as to how to properly care for the foreskin, and may be regularly retracting the foreskin and thus introducing bacteria needlessly into the urethra by retracting and cleaning, even though it is unnecessary and SHOULD NOT be done. (For reference, a boy's foreskin should not be retracted or cleaned under with soap; he should be the first to retract it when he is capable of doing so without causing himself pain or discomfort, and soap should NEVER be used to clean under the foreskin, only warm water, once the child's foreskin is retractable.)

The study does not show that not circumcising boys causes infection, merely that the risk for infection is greater among these boys. Hardly. There are innumerable studies that completely refute this "fact", and the researchers admitted to as much above. In truth, this study shows absolutely nothing, except that people are capable of skewing information as much as they please to get the result that they're looking for - such as openly admitting several glaring issues, and purposefully overlooking several more, but stating that somehow the results still speak for themselves.
The point here, folks, is that circumcision isn't necessary. Keeping your kids - male and female - intact does not somehow magically open them up to more infections, nor does it present them some mystical immunity to diseases. The fact of the matter is that responsibility (teaching children to use protection in the form of condoms during sexual encounters), education (introducing cranberry, probiotic yogurts and kefir drinks, along with antibiotics, during UTIs, and maintaining proper cleaning techniques for both genders), and common sense (don't retract if intact; only clean what is seen) are what will keep our kids from getting UTIs, and will decrease their risk of yeast infections and other STDs. Circumcision is not a condom, or an antibiotic, or a cure-all. It is a painful, unnecessary medical procedure that is illegal to perform on girls, although some "studies" have shown that the same supposed "benefits" would exist for females as they supposedly would for males. There is no reason to circumcise your son.