California again?

dlowan, I agree with you and support your reasoning.

Some people just hate government---period.

BBB

This brings up my one and only worry about it: cleanliness.

I did not have my son circumcised because I was told by my pediatrician that it was not necessary and I did not want to cause him any unecessary pain.
But I was also told by my pediatrician that it was extremely important to retract the foreskin and clean his penis thoroughly at every bathtime. He taught me how to do it and I taught my son how to do it when he was old enough to do it himself.
It was impressed upon me how much pain and discomfort could result from infections that might arise if this was not pretty much religiously done on a daily basis.
I wonder if all children can count on their parents to be conscientious enough to teach them that this is a part of their necessary hygenic routine from the time they can bathe themselves and to, in fact, do it for their sons themselves while their children are still in diapers (nappies).

Some parents can't hold it together enough to give their children regular and appropriate diaper changes - much less a daily bath.

I wonder if they will start seeing more infections in baby boys in California.

What I do object to is the process of a ballot initiative wherein the "voters" of the city of San Francisco determine the legality with the potential of criminalizing a parent. I also question the probability of this voter initiative surviving challenge in State Courts, US Courts of Appeals or ultimately the Supreme Court.

David - it's a little different when you're wearing a diaper all day and your skin is constantly in contact with urine and/or stool. It is very important that the area under the foreskin be kept clean. It takes an extra effort with an uncircumcised boy so it's very important that the parents are conscientious about keeping that area clean.

When you get older and can use the toilet and are not constantly sitting in your own waste - yeah - the chance for infection lessens - you know?

Sorry to be so graphic - but yes - that's the truth. And if a parent isn't conscientous enough to keep a child's diaper changed so that s/he doesn't get diaper rash - do you think they'll be conscientious about retracting the child's foreskin and cleaning under it every day?

Again, sorry to be so graphic - but there it is.

My uncircumcised son never had an infection - but I made it my business to keep him clean.

That's all I'm saying - if California wants to ban circumcisions - they better make sure they do some basic and intensive parenting/child care education to back it up.

I don't have a strong opinion here about CA's decision to leave it up to the people, but do think it should be up to the family only. Both my boys were circumcized because that's just what doctors did then. Today, I'd give that a thought or two. Nobody asked me, then, if that's what I wanted.

My mother-in-law was, at about that time, assisting doctors as a volunteer. She said the doctors usually let a baby suck liquor off his finger before this sort of mutilation occurred.

Later on I worked as a medical assistant for two G.P.s I was the doctor's assistant one day when a mom brought her baby boy in for a circumcision. He was about 6 wks. old. I could scarcely believe what that doctor did. You see, it's an iron clamp that he placed over this baby's tiny penis. Then he just cuts this little thing's skin. Well, the baby screamed horribly, turned bright red and sweat popped out on him, all over. I have never gotten over that scene. Grotesque.

Male circumcision: a role in HIV prevention?
Isabelle de Vincenzi and Thierry Mertens*†
AIDS 1994, 8: 153-160

Keywords: HIV, sexual transmission, circumcision, prevention,
sexually transmitted disease.
Introduction

--------------------------------------------------------------------------------

Recent publications have reported an association between the lack of male circumcision and sexual transmission of HIV [1-7]. If confirmed, such an association may prompt interest in a possible intervention through male circumcision.

It has been suggested that following circumcision, the surface epithelium of the glans develops a protective keratin layer, a form of natural condom [8]. Thus, circumcision could reduce the HIV incidence by directly decreasing the susceptibility of uninfected men to HIV. Circumcision could also reduce the incidence of HIV by directly decreasing the infectivity of men with HIV, as suggested by the studies of tissue samples collected from macaques infected with the simian immunodeficiency virus (SIV), which showed infected mononuclear cells in the dermis and epidermis of the penile foreskin [9].

Furthermore, some or all sexually transmitted diseases (STD) may increase men's susceptibility to HIV [10,11]. If circumcision reduces the transmission of genital infections, either by improving local hygiene [12] or by accelerating the healing of otherwise subpreputial lesions [13-15], circumcision may also delay HIV transmission. Therefore, potential associations between the lack of circumcision and STD other than HIV are also of interest.

In the past, circumcision has been advocated for many reasons: for religious purposes among the Jews and Muslims; for cultural reasons among several African ethnic groups; for reasons of hygiene in the United States, Canada, and Australia and for therapeutic purposes—as the cure for phimosis. consequently, circumcision is almost universal in some parts of the world (United States and Muslim countries) and rare in others (Europe and South America). In all situations, cultural differences between circumcised and uncircumcised men may affect their sexual and hygienic behaviour, including their exposure to various STD and HIV.

In this article we review the evidence in support of the association between the lack of circumcision and STD, including HIV infection, and the possible biological explanations. we discuss implications for public-health interventions and suggest areas and methods for further research.

Epidemiological evidence

--------------------------------------------------------------------------------

Studies linking lack of circumcision to HIV infection
Twenty-three published study reports linking circumcision status to HIV infection were identified. The literature review included articles using circumcision as a key word, articles analysing risk factors for HIV infection and AIDS conference proceedings. Unfortunately, one-third of these studies were reported in abstracts with little detail. Four different study designs were used in these studies as described below.

Male circumcision for HIV prevention

There is compelling evidence that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%. Three randomized controlled trials have shown that male circumcision provided by well trained health professionals in properly equipped settings is safe. WHO/UNAIDS recommendations emphasize that male circumcision should be considered an efficacious intervention for HIV prevention in countries and regions with heterosexual epidemics, high HIV and low male circumcision prevalence. Male circumcision provides only partial protection, and therefore should be only one element of a comprehensive HIV prevention package which includes:

•the provision of HIV testing and counseling services;
•treatment for sexually transmitted infections;
•the promotion of safer sex practices;
•the provision of male and female condoms and promotion of their correct and consistent use.