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.