Medicaid stops paying for circumcision in 18 states

[deleted account] ( 172 moms have responded )

http://www.newser.com/story/121867/state...


18 states (so far) have decided that Medicaid will no longer fund circumcision. This will save teh state $186,500/year. Is this fair to moms who have to use Medicaid? Or should they have to pay out of pocket if they want the procedure done?

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Minnie - posted on 08/08/2011

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The HIV studies only showed a reuction in HIV transmission because the participants were instructed to abstain or use condoms for 6 weeks after. Like you said, condoms are effective in preventing transmission. Physiologically, circumcision has a greater chance of increasing transmission of HIV because there is greater friction when the man is circumcised. This creates microscopic tears in the vagina.

The reduction of UTIs is negligible.

I know you said you're on the fence about it, I'm just trying to clear things up for anyone else reading. You're right, education is VERY important- and it totally sucks that those who should be educating, health care providers, are for the large part, misinformed in the US.

Jodi - posted on 08/10/2011

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Private insurance is not public money though. Medicaid is. Why should public money pay for a cosmetic surgery? If you want your boys circumcised and you are on Medicaid, pay for it yourself. You'd have to if it was a boob job. If private insurance companies opt to continue covering the procedure, then that is their choice (which I don't agree with, but that's not relevant to the debate) because it isn't money that could be better directed elsewhere by the government.

Minnie - posted on 08/08/2011

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Sara- circumcision is a huge business in the US- it brings in billions of dollars each year. It really isn't pallative care- the only reason it began in the US was because some thought it would cure masturbation. From there they came up with all sorts of things it could cure, just to keep it in practice. It's been some serious brainwashing, how ingrained in our culture it's become.

Minnie - posted on 11/12/2011

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It's a significant enough change that rates have dropped quite a bit in states in which Medicaid no longer covers circumcision.

It sounds like most people don't really give it much thought. If it's covered, they do it, because everyone else does. If it's not covered they just see it as an extra expense.

Of course there are the die-hards, who I'm sure wouldn't blink an eye at the expense.

Minnie - posted on 11/10/2011

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The HIV studies in Africa were seriously flawed; it was bunk science. I don't know how anyone can support this study when the [adult] males participating in it were instructed to either abstain from sex or use condoms for six weeks after their circumcisions.

Well DUH the results would show a reduction in HIV transmission then!

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Merry - posted on 11/12/2011

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Ok I guess that's a possibility that if it's illegal it would get worse before it became better. But I just feel like its a violation of the infants rights. And that's when the law should step in and defend the baby. But sure' maybe just making parents pay out of pocket would be a good step. But doesn't it only cost like $200? That's pretty cheap IMO

Krista - posted on 11/11/2011

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after a few of these debates i have realized that circumcision is not AS beneficial as i was made to believe it is. i just don't feel that making it illegal as you suggested is the way to go. i feel education about it would be much, much wiser.

That's fair enough. And I actually agree with you. I think if it's made illegal, the sheer backlash would probably be even more harmful.

I think the key is for insurance companies to stop providing it. The medical benefits are really pretty negligible, so insurance companies would have good reason to start considering it an elective surgery. (Because really, it ISN'T medically necessary.)

If people had to pay out of pocket for it, I think you'd find that they'd start looking into the risks/benefits a bit more closely, and would in many cases decide that it's not worth it.

That's what happened here in Canada, anyway. And I find it a bit sad that people blithely had their babies circumcised...up until if affected their own wallets. But, what do you do?

Rosie - posted on 11/11/2011

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theres no medical benefit to any of that laura, that's the difference. and you obviously aren't thinking of the cultural entrenchment of circumcision in our country. which i know you do understand since you did it to your son. i feel we have a LOOOONNNGGG way to go before it's just yanked out from underneath us.

Stifler's - posted on 11/11/2011

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it's up to the parents... parents choice.. human rights... pfft!

Merry - posted on 11/11/2011

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So should the parents be able to decide to circumcise their daughters too? How about tattoos on infants? The government does a lot to protect infants and children from their parents making bad choices on their behalf. They're already not allowed to modify their daughters genitals, why are boys penises fair game?

Merry - posted on 11/11/2011

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They do that anyways :-/ there was a thread on here about some mom who read some crazy book and decided to circumcise her three month old on the kitchen table with a knife.
Idk, I'd like to think that education would fix it all, but I feel like it would take waaaaaay too much time money and effort to try to actually educate all the drs and parents. And in the end, what parent would choose to circ if they really knew all the facts.
Only crazy ones like the lady I mentioned before. And those who would do it illegally likely would have been endangered the kid in other ways anyways. No good sane mom would illegally circ her baby.

Rosie - posted on 11/11/2011

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i'm pretty much in the people should be able to do what they want in regards to this particular procedure. although i do feel that people are not nearly as informed about the procedure as they should be. nobody gave me any info. on it before i had my boys done. i did know that it helped with urinary tract infections which really the benefit is so overstated. you see the terms that your son will have a 12 fold higher chance of having a UTI and it immediately made me feel like i did the right thing. i have a friend who has constant urinary and kidney infections and was miserable as a child, had to have surgery. if i could prevent something like that from happening to my child i felt it was worth the small risk of something happening to him during the procedure-which is less than 1%. death was never mentioned which i think is crap. it's made to seem like death is not ever an option.
after a few of these debates i have realized that circumcision is not AS beneficial as i was made to believe it is. i just don't feel that making it illegal as you suggested is the way to go. i feel education about it would be much, much wiser. i can just see the drones of idiots chopping off parts of their sons penis in an alley with a rusty knife if it was made illegal.

Merry - posted on 11/11/2011

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Ohok. I wasn't sure where you stood on the topic.
I usually say 'preventative surgery' not cosmetic since I don't try toargue there's possibly some benefits. I'm not sure if there are any benefits for real' or if the studies are all simply biased and flawed but there's the potential for benefit so I say preventative.
Though some moms have admitted to doing it for purely cosmetic reasons :-/
Anyways, I DO think that it shouldn't be a legal optional surgery. I think that there should have to be a problem before you choose surgery on behalf of your child. I also think surgeries like removing an extra finger or toe shouldn't be allowed on an infant.

Pretty much, if it isn't fixing something that's obviously wrong for your child's best life then it shouldn't be legal.

Rosie - posted on 11/11/2011

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i'm actually not arguing that lauralei. :) it was mentioned that it was purely a cosmetic procedure with no medical benefit which is completely untrue. i was trying to clear that misconception up.

and lisa yes adult males. but my children will be adults one day correct? you choose not to have it done and they make their own choice later, i chose to have it done and make the choice for them based off of the medical benefits for them.

Minnie - posted on 11/11/2011

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And the WHO recognizes potential benefits on ADULT males in areas that pose severe risk.

Merry - posted on 11/11/2011

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There's benefit for a good many optional cosmetic or preventative surgeries.
Doesn't make it ok to force it onto a newborn baby.

Rosie - posted on 11/11/2011

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actually krista, it's all referenced there for you. it's not made up. no matter how hard you all want to close your eyes and ears and want to hear there is no benefit to circumcision, the fact is that there is. the AAP, the CDC, WHO and UNAIDS all recognize some benefit to circumcision.

whether that benefit is worth the risk is the question, cause in many cases it may not be, but that should be up for the parent to decide..

Angela - posted on 11/10/2011

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Wow all I have to say is I am glad I had all girls and one boy who came to me at age 13.

I have no clue as to how a parent is educated and helped to decide on circumcision in the USA. But it sounds like their is a lack of clear, unbiased information for parents to make a choice.

I have to start from the beginning.... when circumcision first started as a practice. I looked this up and it seems it was for religious reasons only, I found nothing about the act being done early on for health benefit.

Now I must go on and look when it started to be performed as a health benefit. I will save that for later when I have time.

If I look at the puritan roots in the USA and religion... it makes sense to me as to why it is so routine vs. many other countries in Europe for example where you would be hard pressed to find a circumcised male over an intact one.

Laurrelai, when I read the death rates for circumcision I was shocked. I can imagine when I was pregnant over 20 years ago with my first that I would have just done what everyone else did, thinking that made it best for my child if I were to have had a boy.

Today I would not do it, no way. I also remember when I was young my Grandmother telling me it was painless.... I did not believe her then nor do I know. But it shows just how inaccurate and how many opinions are out there, making it hard to wade through.

Doctors have the obligation to inform parents of all the risk and benefits with clear concise unbiased data.



I have to say in The Netherlands circumcision is not covered by insurance and in fact in recent years it was asked to be outlawed.

Stifler's - posted on 11/09/2011

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i don't buy that circ prevents HIV for one second. it's not even logical.

Merry - posted on 11/09/2011

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Yeah I hadn't heard of it either that's half the reason I got him circumcised! I thought it was easier to care for"
But upon asking around I found many moms had been warned about reattachment and been told to pull it back.
And of course the dr who saw Eric's reattachment said, didn't you know you were supposed to pull it back? And I felt utterly embarressed that I 'caused' this problem.

Sherri - posted on 11/09/2011

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Interesting, I have never heard of such a thing and have taken care of more than my fare share of circumcisions. I had always been told to leave it be and just wash it.

Merry - posted on 11/09/2011

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Sherri that's what I thought too. So I did what the dr said and when Eric's healed it had reattached. I had no idea I was supposed to ever pull back the remaining foreskin so I didn't. And since I didn't I never knew it had reattached.
By the time he was a year old he had an infection under the reattachment and it was quite the ordeal to rip it back. I asked my friends and their sons drs told them to regularly retract the remaining skin to prevent reattachments.
My sons dr said no such thing.
Had he told me to do that it would have saved Eric a year of me slowly pulling back adhesions over and over again as his skin continued to reattach over and over again.

Krista - posted on 11/09/2011

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Dyan, no offense, but if you're going to quote stats, you might want to pick a reputable medical or health site, instead of a site which has a blatantly pro-circ agenda.

When their second paragraph says this: "Unfortunately, the topic of circumcision has been made unnecessarily controversial because of emotive propaganda and opinions placed on the internet by extremist anti-circumcision organizations."...that's a pretty clear indicator that they're not going to be giving you unbiased information.

The fact of the matter is that every single country's medical association has the stance of not recommending RIC. Some don't go as far as to recommend against it, but they're pretty much all universal in saying that if there ARE benefits, they're so miniscule that it just doesn't make a case for them to recommend it. I don't know if that would be considered "emotive and extremist", but it's pretty compelling evidence to me that circumcising your baby isn't going to do jack-shit to keep him healthier.

Sherri - posted on 11/09/2011

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Actually Laurelai you never pull back the skin even on a circumcised child. Once circumcised you clean it and leave it be to heal. Obviously if you see a problem of reattaching which seems like an error with the circumcision to bring them into see the ped, if not you leave it be.

Merry - posted on 11/09/2011

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Essentially, yes there's studies finding benefits of circ but the studies are flawed. If the intact boys were forceably retracted then they WILL show more infections.

And think logically here. If a circumcised man has sex with an HIV infected person, will he get the infection? Or will the lack of skin save him from catching HIV from unprotected sex.

Seriously. Nothing other then a condom will prevent you from catching HIV from sex. Cut off as much skin as you want, unprotected sex with a HIV infected person is still risky.

Merry - posted on 11/09/2011

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If you choose to circumcise your newborn you have to make sure to help it heal, keep it clean, and then once it's healed you have to pull back the foreskin every diaper change to clean out under it and make sure it doesn't reattach. If your dr takes off too much skin the boy risks not having enough skin as an adult and he can have pain or bending or loss of sensation. So you want it done loosely but then you have to watch for the reattachment so it needs to be pulled back a lot.



If you leave your newborn son intact you have to make sure no one ever retracts his skin but other then that you have zero things to do with his penis" wash around it and on the outside but that's all.



When he is able to retract it himself all he has to do is pull back the skin and let the shower water run over it



. So, the reason all the studies show that circumcised boys get less infections is because the widespread advise is that intact penises should be pulled back and cleaned under. So in the studies odds are a fair many of the intact boys with infections were retracted at some point.

So if you don't retract it, it's not going to be ripped on the head to get infected.



Logic here says the foreskin is there to protect the head. Why dear God do we remove the penises protective covering! Now it's open to poopy explosions and sitting in pee and rubbing against diapers and boxers the rest of his life.



The foreskin is there for a reason.

Merry - posted on 11/09/2011

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I find it hard to believe that a uti causes deaths unless the mother or the man is completely inept and doesn't receive proper medical attention

Rosie - posted on 11/09/2011

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Lack of circumcision:

• Is responsible for a 12-fold higher risk of urinary tract infections in infancy. Risk = 1 in 20 to 1 in 50 for uncircumcised infants and 1 in 200 to 1 in 500 for circumcised infants. Higher risk of UTI at older ages as well. Overall lifetime cumulative prevalence of UTI = 1 in 3 for uncircumcised males compared with 1 in 20 for circumcised males, respectively.

• Confers a higher risk of death in the first year of life (from complications of urinary tract infections: namely kidney failure, meningitis and infection of bone marrow).

• One in ~400–900 uncircumcised men will get cancer of the penis, which occurs more than 20 times more commonly in uncircumcised men. A quarter of these will die from it and the rest will require complete or partial penile amputation as a result. (In contrast, invasive penile cancer never occurs or is extraordinarily rare in men circumcised at birth.) (Data from studies in the USA, Denmark and Australia, which are not to be confused with the often quoted, but misleading, annual incidence figure of 1 in 100,000).

• Higher risk of prostate cancer (50–100% higher in uncircumcised men)

• Is associated with 3-fold higher risk of inflammation and infection of the skin of the penis. This includes balanitis (inflammation of the glans), posthitis (inflammation of the foreskin), balanoposthitis (inflammation of glans and foreskin), phimosis (inability to retract the foreskin) and paraphimosis (constriction of the penis by a tight foreskin that will not return after retraction). Up to 18% of uncircumcised boys will develop one of these by 8 years of age, whereas all are unknown or much rarer in the circumcised. Risk of balanoposthitis = 1 in 6. Obstruction to urine flow = 1 in 10–50. Risk of these is even higher in diabetic men.

• Means increased risk of problems that may necessitate 1 in 10 older children and men requiring circumcision later in life, when the cost is 10 times higher, the procedure is less convenient, and the cosmetic result can be lesser, as stitches or tissue glue are required, as compared with circumcisions done in infancy.

• Increases by 2–4 fold the risk of thrush and sexually transmitted infections such as human papillomavirus (HPV), genital herpes (HSV-2), syphilis, chancroid, Trichomonas vaginalis and thrush.

• Is the biggest risk factor for heterosexually-acquired AIDS virus infection in men. 2 to 8-times higher risk by itself, and even higher when lesions from STIs are added in. Risk per exposure = 1 in 300.

• In the female partners of uncircumcised men lack of male circumcision is associated with an up to 5 fold higher incidence of cervical cancer (caused by sexually transmitted HPV), genital herpes, Trichomonas vaginalis, bacterial vaginosis (formerly called “Gardnerella”), and possibly Chlamydia (which is a cause of pelvic inflammatory disease, infertility from blockage of fallopian tubes, and ectopic pregnancy).

there are risks from dying from a UTI, or at least having renal failure.http://circinfo.net/urinary_tract_infect...

once again, the risk is waaay higher in uncircumcised boys, but the risk of getting a UTI in a boy is not that high. so it's up to the parent to decide if it is necessarily worth the .08% risk of something happening with the circ to avoid future problems.

Angela - posted on 11/09/2011

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Okay I read the links from Dyan and I looked very hard with an open mind of the other side.

The only benefit I see is that you have less of a risk of HIV. In some impoverished third world countries where HIV is rampant I would see the recommendation for circumcision. I say this because the risk of AIDS in such areas is much higher than average and it would be only beneficial to them.

But in countries where AIDS prevention is taught, access to condoms and safe sex devices are common it is not needed. I feel the risk of death may very well be over the risk of AIDS but I am not sure to it. If anyone has a stat I welcome it.

So I am going to make an assumption when I say I think the risk of complications and death of Circumcision

out weight the risk of contracting AIDS via lack of foreskin. I come to this because in lower AIDS patient countries that are not third world IE The Netherlands, AIDS incidents are very low and most boys are not circumcised.

I would not go so far as to call it cosmetic surgery for all, but I do know people who find it a cosmetic issue and have circumscribed their little one because well it "looks better" to them.

I feel parents have the right to choose, however every parent should be warned of the risks and the benefits and be helped to weigh them out and then they make a choice.

I am going to go as far as to say if a Doctor states it is in the best interest of the child than it should be paid for by health insurance. That is assuming the doctor is looking at the patients as to where he lives and if HIV will be a bigger risk factor than normal.

Where I struggle with this is if a person does it for religious reasons, and if it should be covered if they are Medicaid. A part of me say yes, because even if you are poor it may be very important to them.

On the other hand I feel maybe their place of worship could help fund it, if it is so important.

I suppose my bottom line is that I do not support circumcision paid for by health care providers unless the risk of other health issues are higher.



I want to thank you for the links Dyan because I was unaware of the facts abut AIDS.

Merry - posted on 11/08/2011

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If 1% of circumcised newborns die every year

And 0% of intact newborns die of their foreskin every year

Then in my mind circ is not worth doing.

Even if circ reduced risk of infection, even if it reduced HIV risk, even if it made it smell better.

All the little perks can't overshadow even 1% death rates.



No one dies of a foreskin right? You can still get penile cancer as a circed man, so it's not a full on cure for penile cancer. No one dies of an infection either unless they don't get treatment so really even that 1% is a lot considering the surgery doesn't prevent anything as dangerous as the surgery itself.

Stifler's - posted on 11/08/2011

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100 deaths. That is 100 people whose deaths could have easily been prevented.

Merry - posted on 11/08/2011

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It's not that we don't believe in it.
We see the facts stating that it's unnecessary, and risky.

Allie - posted on 11/08/2011

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I don't have to explain myself. If i want to do it again then that is mine and my fiance's decision. If we decide to do it again then fine. But I am not going to sit here and explain myself just because y'all don't believe in it.

[deleted account]

See this is the mindset I dont' understand. The evidence is overwhelming that the foreskin does not cause infections, they're not harder to keep clean and it has an actual function. Yet despite learning this, poeple still say, "Sorry, still going to do it."

I honestly am not picking on you but this is a mindset I seriously don't understand.

Merry - posted on 11/08/2011

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Sherri I'm certain it is a quite low percent. But in all honesty, any death for a preventative surgery disgusts me.
Healthy newborn boys aren't at risk of dying due to their foreskin and so even a few deaths for a preventative surgery s too much.

If it were my son, or yours, it would be too much.
The foreskin really just isn't that horrid a thing as to risk even slight odds of death to remove It to save possible future infections.

It just doesn't compute.

Allie - posted on 11/08/2011

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If i have another son I will circumcise him also. that is just what i believe in and i will do it again.

Merry - posted on 11/08/2011

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But would you choose it again? I chose to circ my son, so did a few of my friends, but many of us now see the truth of the issue and we won't be circumcising any future boys!
Yes your son has had no complications but trust me, many boys do. From simple ones like my son, to severe ones like death.

There's no shame in saying you did it because it was the best thing you thought at the time but new knowledge makes you decide it's not necessary for future sons.
There's many of us who have circed sons and now stand by the intactivist side.

Stifler's - posted on 11/08/2011

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They should have to pay. It's an outdated and unnecessary procedure. Why did the government ever fund it at all.

Chelsea - posted on 11/08/2011

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I honestly stand on completely neutral ground because so far i only have girls, if you want to circ your boys then do it and if you don't then that is ok too. i get that a lot of parents want there boys to be like dad or like other children, i dont think that they will remember the pain or be angry that it was done to them either but i honestly cant believe medicaid paid for them this long when all the medical data has been revised to show no medical reason to make it necessary. you wouldn't expect medicaid to pay for a baby girl to get her ears pierced in the hospital. both are done only for cosmetic reason, both are widely practiced yet you may say how dare i compare the two but honestly when it comes to insurance claims its the same, a voluntary, cosmetic procedure. i think the only reason people are mad about it not being covered is because they cant pay for it out of pocket which removes the choice

Sherri - posted on 11/08/2011

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100 infants die due to circumcision but what is the actual percentage vs. how many circumcisions are actually preformed. I would be willing to bet the percentage is extremely low like around 1 or 2%.

Allie - posted on 11/08/2011

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Why have to put your son on antibiotics when you could have prevented it. I dont care anymore ok. I had my son circumcised and I am happy with my decision. If you dont want to circumcise your son then dont that is your opinion, but i chose to and that is that!

Krista - posted on 11/08/2011

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So Allie, you think it makes sense to remove a body part, just on the off-chance that it MIGHT someday get infected, even though, nine times out of ten, the infection will be a one-time thing that can be cleared easily with a round of antibiotics?

Seems a tad drastic, no?

Merry - posted on 11/08/2011

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Preventing infections means leaving his penises natural defense intact. Meaning the foreskin.
The foreskin is there for a reason, it's a protective covering like a fingernail or an eyelid.
The head of the penis is designed to be an internal organ, but circumcising makes it adapt to being external which makes it rougher and drier and less sensitive.

Circ boys can get infections, intact boys who've been force ably retracted can get infections. No difference.
Besides, honestly, we don't circ our girls and girls get far far far more infections then any man!

Allie - posted on 11/08/2011

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Talking about infections, why keep giving your child antibiotics over and over when you could have prevented the infection in the first place. I know that not every uncircumcised boy has problems, but not every circumcised boy has problems either. My son was circumcised and he hasn't had any problems.

Merry - posted on 11/08/2011

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Oh and my circumcised son suffered from infections already! Due to a common and minor side effect of his surgery he had a reattachment that caused an infection.
Thanks circumcision now it caused the thing we thought we were preventing! Had we left him as he was made he likely would have had zero pain on his penis instead he had a painful surgery as a newborn, painful recovery, painful manual retraction and infection 5 times in a year!

Circ caused him WAY more pain then any intact boy

Merry - posted on 11/08/2011

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Ahh infections.
Here's the low down, infections happen when someone yanks back the foreskin prematurely on an intact boy, thus causing rips and tears on hs penises head which easily get infected.
A healthy intact penis is fussed to the head of the penis thus preventing any risk of infection!

Besides, infection? Give him antibiotics and it's over.
Circumcision kills over a hundred infants every year in America! Why risk death to spare a few possible infections!

The mind boggles.

Allie - posted on 11/08/2011

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I think they should pay for it. I was on Medicaid when I had my son and they paid for it, but when my brother in laws girlfriend had her baby they didnt cover it so they had to pay out of pocket. I believe that have a child circumcised is the best because of all the infections that they can have. I would rather make sure that my son will not get any infections that have to have a circumcision later on in life when it is a lot more painful.

[deleted account]

I had my son in Florida in 2007 and had to pay out of pocket for his circumcision. In fact, I had to pay for it BEFORE the procedure. They literally came into my room to collect the money, gave me a reciept and took him to do it. Of course, now, after gaining more knowledge and after seeing him suffer with an infection for the first year of his life, I'd never circ another boy of mine if I ever had one.

Diane - posted on 11/08/2011

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shouldn't be charged to do it to begin with! The medical community is like a slock shop for cars!! Every nut and bolt charged for! (no pun ntended!)

Angela - posted on 11/08/2011

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Thanks Dyan for your links I am going to read them and get back with you all. To be honest I have most my info from one side. Now for the other side :)

Merry - posted on 11/07/2011

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I say circumcision is cosmetic surgery at worst, and preventative surgery at best. Either way I wouldn't do it.

Rosie - posted on 11/07/2011

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http://www.cdc.gov/hiv/resources/factshe...
http://www.who.int/hiv/mediacentre/news6...
http://aappolicy.aappublications.org/cgi...

while the last one (the one from aap) states there is not enough evidence to suggest doing routine circ, there are benefits to doing a circ. as well. along with the ever taughted myth by those who are anti circ that circumcised men don't have as much feeling or sensation. there have been plenty of studies done on that with MANY varied results including ones that say circumcised men have MORE feeling. if the HIV thing was a "myth" then i'm sure UNAIDS and WHO wouldn't suggest circumcision to help in the prevention of aids.
it is simply NOT just a cosmetic procedure. it may not have enough benefit to warrant recommending doing it routinely for every male infant, but it certainly has enough benefit that they don't tell us NOT to do it.

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