Friday, February 06, 2009

On Circumcision

I was reading through old posts recently and realized that I don't think I ever talked on here about our decision not to circumcise Donovan. Which surprises me, as it certainly was a topic that weighed heavily on my mind for a while as we talked about this and looked at the pros/cons. So I'm taking time now to write a bit about it, and I'm gonna try to be careful because I know this issue can be pretty controversial and I don't want to start any fights. I just want to open up the discussion a bit-- there's so many things in parenting that I think we take for granted, decisions that we make without exploring other options or really thinking about them (eg., using a crib as baby's bed, giving birth in a hospital, using disposable diapers, etc). With all the other decisions that need to be made when welcoming a new baby, it's understandable that we are glad to just do certain things as everyone else does without questioning, and just be done with it, and for most of this stuff that's basically ok. But I do feel that the decision to circumcise or not should be one that's arrived to through careful consideration and after much thought, rather than just b/c it's "what everyone does."

My first instinct when considering circumcision, was that I'd need a really good reason to do it. I'm not going to have any surgery performed on my kid, foreskin removal included, without good reason. So I started researching. The fact that the AAP doesn't see enough medical reasons to endorsing circumcision said a lot to me.

I also was surprised to note, via various message board discussions, that a pretty large number of couples tend to make this decison mainly because they "want baby to look like his daddy" or "what his future girlfriends might think" as apparently women have an inherent dislike of an uncut penis. I must say, I don't understand this. I don't even agree with cutting a dog's ears or tail to make it look "cuter", so cutting off a very sensitive part of my son's body for a similar reason (aesthetics alone) makes no sense to me. As for the dad thing, I don't know many men who compare their penises to their dad's very often. I can see how a child who sees his dad naked might be confused at seeing him look "different", but I also think there's quite a bit more differences between a grown man's and a young child's penis than the presence of foreskin (maybe dads should all wax their pubic hair till their kids hit puberty, to "look more like their sons").

Here's an analogy that helps show how odd and slightly disturbing I think the above line of reasoning is-- would you give your daughter a boob or nose job so they can "look more like mom?" No? Why are we doing the same to our boys, then?

Then there's the cleanliness aspect. I am a little nervous about eventually needing to teach D how to properly clean himself, but at the same time I don't see it as any different from all the other personal-care basics we'll need to teach him like washing his hands, brushing his teeth, flossing, etc (or needing to teach a girl proper hygiene like always wiping front-to-back). I also expect boys to have a big enough interest in their penis and want to make sure it stays in good shape. ; )

Another reason I heard a lot was the fear of their kids being ridiculed in the locker room due to looking different from all their circumcised peers. About 80% of grown men in the US are circumcised, so this was probably a legitimate concern for them, but rates have been dropping a lot in recent decades and the US average is currently closer to 60% 33% (as of 2009, down from 56% in 2006) So this probably won't be much of an issue for our kids.

There are some medical reasons for circumcising. An un-circumcised male has a slightly higher chance of getting a UTI in the first year of life (1% vs 0.1%). Donovan came down with a UTI at 2 months old, and maybe it was because he's uncircumcised. It wasn't a fun experience, but it didn't affect how I feel about circumcision or our decision to opt out. Also, the UTI risk is balanced by the estimated 1-3% risk of complication from the procedure itself. When we weighed these risks against each other, I felt they didn't tip the scale enough to convince me to circumcise.

Now, of course there's always stories of men who have to undergo painful procedures later in life b/c of some complication that would have been avoided had they been circumcised as a baby. There's probably just as many stories on the flip side. Keep in mind that about 60-70% of the world population does not routinely circumcise. I would assume if complications from not circumcising were that major/prevalent/painful/costly, we'd hear about it more or see more of a movement towards world-wide circumcision.

One last reason for circumcising, and probably the most legitimate one I can think of, is that un-circumcised males may have a higher risk of contracting AIDS or other STDs-- some studies suggest a circumcised man might have a 60% lower chance of getting HIV from heterosexual sex (these studies are very controversial, though, and there's doubt as to their validity). The WHO now recommends circumcision as a tool in HIV prevention, particularly in countries where HIV is still spreading rapidly. I don't have much to counter on this one, other than that I have always been committed to doing everything I can to educate my kids on safe sex and to always use condoms, which is a much more reliable way to prevent STD transmission anyway (I would hate for anyone to rely on circumcision alone as their "protection," and if you're wearing a condom then being cut or not won't matter).

I'm not trying to tell people not to circumcise their boys (ok, I kind of am... a little). But more than anything, I want parents to think about the reasons why they're doing it. To remember that circumcision is a surgical procedure. That it has risks and benefits associated with it, and to weigh those against each other and base your decision on that evidence rather than what your parents did, or what your friends are doing, etc.

15 comments:

  1. Good for you!

    You might also want to check out the following:

    Canadian Paediatric Society
    Recommendation: Circumcision of newborns should not be routinely performed.

    http://www.caringforkids.cps.ca/pregnancy&babies/circumcision.htm
    Circumcision is a "non-therapeutic" procedure, which means it is not medically necessary.

    After reviewing the scientific evidence for and against circumcision, the CPS does not recommend routine circumcision for newborn boys. Many paediatricians no longer perform circumcisions.


    RACP Policy Statement on Circumcision
    "After extensive review of the literature the Royal Australasian College of Physicians reaffirms that there is no medical indication for routine neonatal circumcision."
    (those last nine words are in bold on their website, and almost all the men responsible for this statement will be circumcised themselves, as the male circumcision rate in Australia in 1950 was about 90%. “Routine” circumcision is now *banned* in public hospitals in Australia in all states except one.)

    British Medical Association: The law and ethics of male circumcision - guidance for doctors
    "to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate."

    National Health Service (UK)
    "Many people have strong views about whether circumcision should be carried out or not. It is not routinely performed in the UK because there is no clear clinical evidence to suggest it has any medical benefit."

    drops in male circumcision:
    USA: from 90% to 57%
    Canada: from 47% to 14%
    UK: from 35% to about 5% (less than 1% among non-Muslims)
    Australia: 90% to 12.6% ("routine" circumcision has recently been *banned* in public hospitals in all states except one, so the rate will now be a lot lower)
    New Zealand: 95% to below 3% (mostly Samoans and Tongans)
    South America and Europe: never above 5%

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  2. We decided to circumcise, primarily because I have two friends who had to have their boys circumcised when they were older (one was 5 and the other was 7) due to the foreskin not retracting correctly.

    It was pretty traumatic and painful for the children and their parents. I didn't want our child to ever have to go through that.

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  3. Anonymous3:44 AM

    re: Global Librarian
    Sometimes the foreskin doesn't retract until boys are in their teens. That is normal. Too bad some one who should have known that (the nurse) didn't or maybe did know but took advantage of your friends'ignorance and made some money$$$$$, which is what circumcision is - taking advantage of a parent's ignorance. You should have educated yourself about the functions of the foreskin and growth before you decided to have it cut off.

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  4. Global Librarian: "who had to have their boys circumcised when they were older (one was 5 and the other was 7) due to the foreskin not retracting correctly."

    Huh?!? Why are some parents obsessed with whether or not their sons can retract their foreskin? My son is six, and I have no idea whether he can retract or not. It sounds like your friends' sons were circumcised unnecessarily, which is not a reason to do it to other boys. In the UK, only 1 in 140 boys ever needs a circumcision for medical reasons, and it keeps getting rarer.

    What makes you think it is any less traumatic and painful for a 5-year-old than a newborn anyway? It's actually safer, hurts less, and the cosmetic results are better.

    AAP - "Care of the Uncircumcised Penis"
    "foreskin retraction should never be forced. Until separation occurs, do not try to pull the foreskin back — especially an infant's. Forcing the foreskin to retract before it is ready may severely harm the penis and cause pain, bleeding and tears in the skin."

    RACP policy statement on circumcision
    "The foreskin requires no special care during infancy. It should be left alone. Attempts to forcibly retract it are painful, often injure the foreskin, and can lead to scarring and phimosis."

    Canadian Paediatric Society
    "Keep your baby’s penis clean by gently washing the area during his bath. Do not try to pull back the foreskin. Usually, it is not fully retractable until a boy is 3 to 5 years old, or even until after puberty. Never force it."

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  5. Global Librarian, i'm sorry to have to say this but you were wrong to circumcise for that reason.

    A recent study in Denmark found that the mean age of first foreskin retraction is naturally 10.4 years of age...

    So cutting a boy at the age of seven because he can't retract is like putting a seven year old girl through invasive surgery to investigate her womb because she hasn't started her periods yet....!

    But this is what happens in societies where there is mass circumcision - after a while no one knows anything about the part which is so routinely cut off.
    It's rather crazy though that North American doctors don't seem capable of reading research like the study above, and all the others.

    But then maybe Anonymous is right - the money may seem more attractive than the truth.

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  6. This is a tough issue. If I have a boy I do NOT want him circumcised. I see it as genital mutilation...routine or not. However, my husband wants it and sees it as necessary. Maybe I can convince him otherwise

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  7. I guess a moderate blog like yours might convince more people than a strident voice like mine, but your whole argument is a careful balancing of the risks and benefits. You've left out his simple human right to decide for himself how much of his own genitals he is allowed to keep.

    That "1-3% risk of complications" is very conservative. A recent study in Kenya found an 18% risk even in hospitals (nearly twice as high for traditional circumcision) - and that's only immediate complications, not any of the many things that can go wrong long term.

    The main reason we are even having this discussion is that circumcision was virtually automatic for decades in the US. Only quite recently were parents given any choice, but by then it was so customary it was hard to buck the trend. Now, with the Internet, there is discussion of the issues at least, but the main reason it continues is that a generation of circumcised fathers can't bear the idea of their sons being different from them, nor mothers the idea of their sons being different from their fathers, brothers, husbands and old boyfriends. It's odd, when in any other respect they would rejoice if their children had a better chance in life than they did. Ah, but this is about sex, and jealousy trumps altruism every time.

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  8. As an uncircumcised man in his early 20s (i have an annoyance with the term uncircumcised, but i live with it)... I would just like to say, I think you made an absolutely great decision.

    Admittedly, the rates were higher where i grew up, and as a result, i did feel different, but was never publicly teased or anything, as no one really knew (I know none of the kids in my class were the type to strip down naked in front of everyone).

    However, when I actually learned about the procedure, and read the research, you have to know that I was so appreciative that my Mom did that research too, and decided to let me keep HONESTLY, one of my favorite body parts.

    It does depress me that so many guys are being forced to live life without ever getting to experience that, and I know they don't even miss it, but that is no excuse to do it!

    the cleaning issue is a non-issue... even when i am a complete slob, i never get infections there or anything... and the act of cleaning the foreskin is SO simple.

    as for HIV, thats entirely behavioural. I know that personally, I believe in being safe. That includes not sleeping with random strangers, and getting tested with my partner. To me, sex is saved for love, so it isn't an issue for me. Plus, the studies the WHO based its decision on were incredibly flawed, and that leads me to believe they have some ulterior motives behind the position. perhaps I am just paranoid, but I really think the large amounts of money they spend on circumcising people in those countries would be much better spent on setting up STD-testing clinics, and educating the people about sex, and busting the myths (like how sex with a virgin cures HIV).

    Anyways, ultimately, I just wanted to tell you that I truly, truly believe you made a wonderful, educated decision.

    To mothers, who fight for their son's rights everywhere, Thank-You!!!

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  9. Good for you! We had a daughter, but I've never even considered circumcision for a son. Part of that is being married to a European (uncirc'd), and most of the men in my life prior to DH were also uncirc'd. I don't think women have an inherent dislike of it, and frankly, I'd think anyone who did wouldn't deserve my child anyway ;). I do know someone who chose to be circ'd in his 30s due to a possible disease, but that was never confirmed, was just his urologist's recommendation based on a possibility rather than tests.

    As for WHO's recommendation, don't get me started....I think it's irresponsible to recommend circ as a way to prevent STDs, as it therefore implies that circ is sufficient for preventing STDs. Condoms and general safe sex practices are still more effective than circumcision.

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  10. I commend you on your research and decision not to circumcise your son. Regarding the studies showing reduced risk of HIV transmission in circumcised men... these studies were done in several African countries (eg not in the United States) where the incidence and prevalence of HIV infections is very different, and the study involved circumcisions done to adults. the studies did not look at the effects of HIV transmission in the US related to neonatal circumcision. One factor that was not taken into account in any of the studies is the rate of exposure (eg sexual contact) before and after circumcision.

    Having performed many circumcisions myself I completely agree that routine neonatal circumcision is totally unnecessary and the benefits do NOT outweigh the risks of the procedure.

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  11. Wow! Donovan is such a lucky boy. :) Great job! I liked your post though I also think it could use more discussion on the human rights side of the issue. Boys deserve the same respect for their bodies that we give to girls. It's as simple as that.

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  12. Hi there--I just found your blog through your post over on Meg's blog, and I'm enjoying it. I have a son about your son's age, and so many of your thoughts and experiences are familiar to me ... We also did not circumcise our son. The locker room argument held some weight with me for awhile (we live in the Midwest, and circumcision is still very much the norm here), but then I realized--wait a second. I'm not going to make other parenting decisions based on what everyone else is doing, so why would I make this decision that way?

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  13. I started thinking twice about what we would choose to do when we have a son when I became a fan of Woman Uncensored on Facebook, and reading your post here cemented things in my mind. It makes no sense to make an elective, surgical decision for a newborn buy on the basis of peer pressure, and now that the occurrence is becoming less frequent in the US, I hope it'll be a little easier to convince my husband...who is on the "he won't look like me" bandwagon.

    Thanks for your post, and I really liked the replies too!

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  14. @September Love-- Yay! Glad I could be of help. =) Hopefully your husband will come around, too, realizing that he wouldn't dye his son's hair to look like his, surgery on such a sensitive body part makes even less sense. ; )

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  15. @September Love

    Your son and husband won't look the same down there anyway, unless your husband wants to shave all his hair off, and keep his private parts in ice to shrink them.

    Your son may not want to look like his father anyway though, especially once he's a man himself. Children are renowned for wanting to be different from their parents.

    You couldn't have a baby tattooed or pierced to match dad, or dye its hair, or make it wear spectacles to look like dad, so why should you have surgery to try and make his genitals look similar?

    I think most men that use this argument are thinking about themselves rather than their children. We don't accept that circumcised women should be able to do the same to their daughters, so why should it be any different for boys?

    I think everyone should be able to decide for themselves whether or not they want parts of their genitals cut off or not.

    I'm intact, but if our son wants to be circumcised when he's 18 (16 if he knows what he's doing), I'll pay for it and help him find a good surgeon. Until then, he stays intact. His body - his decision. If he wants to be circumcised later, it's easy to fix - safer, less painful, and better cosmetic results. If we'd had him circumcised, and he wanted to be intact, it's a problem.

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