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Tuesday, January 27, 2009

The Big "C"

One of my favorite blogs, finslippy, posted a link yesterday to a Momversation regarding The Big C--circumcision. I thought this was pretty fortuitous, as Aaron and I are wrangling with the circumcision question right now...to cut or not to cut? The post on finslippy as well as the Momversation were both very interesting and thought-provoking and soon both Aaron and I were reading and re-reading the post and all of the comments that the post generated. Seems as though we are not the only parents in the world who are struggling with this.

Here's the thing...before I knew our baby was going to be a boy, I never gave this any thought. I have always thought that if I had a son, I would have him circumcised. I never really knew why...I just knew that this is what was done and as I said, I never gave it much thought. It wasn't until we found out that we are having a boy and Aaron expressed his reservations about circumcision to me that I actually sat down and asked myself, "Why do I think we should do this?" Turns out I didn't have any reason other than "This is what is done," and I decided to do some research on the topic.

Unfortunately the internet is fraught with propaganda, both for and against circumcision. I had no idea people felt so strongly about this, on both sides of the coin. In my research, I found myself getting more and more frustrated with the rhetoric and finger pointing and holier-than-thou-ness of it all and decided to check out what the experts have to say. The American Academy of Pediatrics doesn't really take a stance on the topic, stating that,

"Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In circumstances in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child."

Wow...that's maddingly ambiguous but at the same time tells me there isn't a compelling medical reason to circumcise our son. Dr. Sears' website underscores this fact and basically tells parents that they should use no reason other than religion or personal preference in making the decision on whether or not to circumcise their sons--the medical benefits alone aren't enough to justify the decision. Well, neither Aaron or I hold any religious beliefs that would prompt us to circumcise our son, and neither of us believes so strongly in the idea of circumcision that we feel absolutely compelled to have it done.

Then again, there is some evidence out there that suggests that circumcising baby boys can have medical benefits. Many experts suggest circumcising boys lowers the rate of UTI's. Also, it can help prevent the boy from spreading HPV or other STD's when he becomes sexually active. Some also say that circumcision lowers the chance of a male developing penile cancer later in life. These are all positives to be sure!! However, I haven't been able to find anything that has said that circumcision ABSOLUTELY does these things. One would think that teaching their son proper hygiene and how to make responsible sexual decisions would also help prevent these things.

Clearly, I am torn. This decision is weighing heavily on me and I am losing sleep over it. To me, we have three options:

Circumcise...In my mind, this is the easy choice, because it is what a majority of parents in this country decide to do with their son, and I know that if we make this decision, our son will be in the norm (although this might not be quite so true nowadays, as circumcision rates are on the decline). The procedure is very safe, and if we are going to do this, we should do it while we are still in the hospital to save our son from a more serious procedure later in life. And, let's face it, things would be easier to clean down there, both for us and for Tater and the procedure COULD prevent all the icky things listed above.

Don't circumcise...The tougher choice of the two, because it goes against the norm in our society. However, I am going to take pains (literally) to ensure my son has a violence-free and medication-free delivery, so why would I subject him to this painful procedure and recovery less than 48 hours after his birth? Also, should we do something just because it is what a majority of people do? Seems like faulty logic to me...it's the whole "If all your friends were jumping off a bridge, would you?" thing. And, I know myself. I had a hard enough time sending Grace to the nursery for a heel stick after delivering her. How will I feel if and when I turn my son over to the nurses to have this procedure done? Will I feel immense guilt and regret my decision? And AND, should this be our decision or our son's decision? I know men who wish the choice had been left up to them.

Leave this up to Aaron...In reading finslippy's post and the comments on the post last night, I was surprised to see the number of women who left this decision up to their husbands. But it makes some sense to me. After all, I have no idea what it's like to have a penis. I didn't have surgery on my genitals hours after birth, and so I don't have any idea what that would be like. Part of me is like, "This is my son too, dammit, and have as much say as my husband does," but then again, I trust Aaron and I know that he would take his research as well as his own personal experience into account. I trust and know that he would make the right decision for our son.

We have less than eight weeks to make this decision, and while that might seem like a lot to some, I am a planner and I need to know what we are going to do about this. I foresee many more sleepless nights ahead, and it's not just going to be because of leg cramps and having to pee every hour.

17 comments:

Carrie said...

When we found out that Pebbles was going to be a girl, one of the first things I felt was relief that I wasn't going to have to face this question! This time around, we don't know yet if we'll be faced with it. I'd definitely let Epu have the final say, but I'm guessing we wouldn't do it. Like the AAP says, if it ain't broke, don't fix it.

Mark Lyndon said...

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. Parents who decide to circumcise their newborns often do so for religious, social or cultural reasons. To help make the decision about circumcision, parents should have information about risks and benefits. It is helpful to speak with your baby’s doctor.

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 that it is has any medical benefit.”

The College of Physicians & Surgeons of British Columbia
"Circumcision is painful, and puts the patient at risk for complications ranging from minor, as in mild local infections, to more serious such as injury to the penis, meatal stenosis, urinary retention, urinary tract infection and, rarely, even haemorrhage leading to death. The benefits of infant male circumcision that have been promoted over time include the prevention of urinary tract infections and sexually transmitted diseases, and the reduction in risk of penile and cervical cancer. Current consensus of medical opinion, including that of the Canadian and American Paediatric Societies and the American Urological Society, is that there is insufficient evidence that these benefits outweigh the potential risks. That is, routine infant male circumcision, i.e. routine removal of normal tissue in a healthy infant, is not recommended."

Anonymous said...

I highly recommend this site for all sorts of information about circumcision- http://www.icgi.org/birth_care_providers.htm

There are informative articles about the function of the foreskin and circumcision complications (with photos from medical journals). I recommend watching the video of an actual infant circumcision, as well as "The Prepuce." This page is designed for expectant parents, so I hope you'll find it useful.

Hugh7 said...

Sad to say, when a woman leaves the decision up to her circumcised husband, he has no idea what he is missing, and hence what he may be depriving his son of.

The AAP is covering its back. It daren't admit that circumcision is risky and harmful, or it would face a class-action the size of a bank bailout.


The US is the last English-speaking country in the world to non-religiously circumcise the majority of its boys, and in Europe, Scandinavia, Central and South America and most of Asia, they never did. The rate in the US is near 50% and falling; he is sure to have age-mates of both kinds, so conformity is no longer a reason (it was never a good one).

This website is frankly biased in favour of leaving babies alone, but it does try to be factual, and the human rights issue seems open-and-shut: his body, his choice (and he's very unlikely to choose have any of it off). Here's the page aimed at young parents-to-be.

emmopid said...

Sara, I just want to correct one notion from your post:

"And, let's face it, things would be easier to clean down there, both for us and for Tater"

This is a common misconception. In fact, care of an intact baby is much easier. There is no wound to deal with, you don't need to carefully avoid re-adhesions (which are common and no fun to re-separate), and the urethra is protected against feces (which, let's face it, are occasionally going to be all over the place). Care of the intact is just wipe and go. When he's older, he'll spend 2 seconds rinsing in the shower.

Avoiding the misconceptions is all there really is to do.

Here's a guide to intact care.

I think the way you are approaching this is great. I'm sure you'll get this right.

Mom said...

Does anyone remember how cruel children can be??????? Never mind the fact that cleaning a baby, that is circumcised and having worked in a nursing home, a senior citizen is easier. What about when the child is out of the norm in school. Other children can be incredibly cruel.

Mark Lyndon said...

Women's genitals are harder to keep clean than men's, but they don't need surgery.

Cleaning an intact baby boy's genitals is actually easier than cleaning a circumcised baby boy's, even after the healing is complete. You should not try to retract the foreskin.

As far as "the norm" goes, circumcision is falling out of fashion:

drops in male circumcision:
USA: from 90% to 57%
Canada: from 47% to 14%
UK: from 35% to about 4% (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%.

Sara said...

I wonder if the drop in circumcision rates in the US has anything to do with our growing Hispanic population. When I was doing medical interpreting, I had the opportunity to be present for several births of Hispanic boys, and none of those moms opted to circumcise their sons. I'm sure it doesn't account for the whole drop, but it might have something to do with it. Just a thought...

Thanks for the comments and the info...I had encountered virtually all of this information in my own research already, but thanks anyway.

One thing for Hugh7: I guess I see your point about the problem with letting an circumcised man make this decision, but rest assured that my husband is smart enough and sensitive enough to take EVERYTHING into consideration when making this decision. And I certainly don't believe he will be depriving our son of ANYTHING, no matter what decision he arrives at. In fact, as I stated in my post, he is the one that initially raised doubts about circumcision so, in my humble opinion at least, he is being responsible and is thinking of our son's best interests. But thanks for your concern.

emmopid said...

"I certainly don't believe he will be depriving our son of ANYTHING, no matter what decision he arrives at"

Circumcision would deprive your son of several things.

Physically, it deprives him of half of the mobile skin system of his penis, tens of thousands of nerve endings, and the most touch-sensitive parts of the organ.

It would also deprive him of individual autonomy, self determination, and the right to make his own choice.

Circumcision is not benign. It has real consequences.

Sara said...

emmopid:

So what you said, "I think the way you are approaching this is great. I'm sure you'll get this right." really means that we'll get it right as long as we decide not to circumcise.

This is the reason why I have been getting so frustrated with this whole topic. I am a parent that is trying to make the best decision for my child and instead of blindly deciding to do something for the sake of doing it, I am trying to be responsible and do my research. But, unfortunately, there are plenty of people out there who are going to make me feel bad and guilt me into a decision.

Aaron is going to have the final say on this. That is my decision.

emmopid said...

Sara, I was only presenting objective facts, but you are right about the decision I personally agree with. I think it's right for you to delegate the decision to a male in your family, however I think that should be your son (when he is able), not your mate. If you let him decide for himself, you can't make the wrong decision.

Before you leave the decision up to a circumcised male to decide for a child, make sure you understand the predicament he is in and the difficulties he may have being fully objective: Circumcision and Human Behavior

emmopid said...

Sara,

I just had to share this blog posted today with you because of the "mothers involvement in the decision" aspect.

The C Word

emmopid said...

Oops... I posted the wrong link.

The C Word

Super Ninja Mommy said...

we couldn't decide, so we decided to leave it up to our son. Who better to make the choice? You can always take it off, but you can never put it back, we figured. (DH is circ'ed and didn't care either way about his son's "status, since he didn't know what his own father's "status" was.)

FTR: I asked my brother, who is 17 and in high school, what the guys in the locker room said about their intact peers. His response? "No one looks, you would totally be called gay for looking."

I asked what if you accidentally saw an intact guy in the locker room, would you say anything to your friends? He said no way - that would be wrse than looking... that would be admitting to looking.

I truly feel its a decision best left up to your son later. What if he doesn't want to be circumcised? He can never get that back. But if he does? He can have it done under proper anesthesia.

One other thing. A newborn's penis is very small, and it's impossible for the doctor to know "exactly" how much to take off. A loose circumcision needs to be dealt with all the time, pulling the skin back to prevent adhesions, and a tight circumcision can have real sexual side effects later on. An intact penis is very easy to care for. The skin doesn't even look like it should be pulled back and cleaned... nothing about it looks like it needs to be messed around with.

Good luck and congrats on your new baby boy!!

Anonymous said...

Sara, You are doing the right thing by researching this. I can't say that I am non biased but I would rather see a fully informed decision made then to just do it to do it. I agree that the majority of boys in the world are intact. The rates of circs are falling every year. I work on the mother baby unit and see the nitty gritty of circs on a regular basis. I no longer assist in them bec it is too emotionally difficult for me. I don't like scare tactics but I would not say that the procedure is "very safe". Anytime you break the skin there is a risk for infection and or excess bleeding. I once had to assist with a little boy who was bleeding 2-3 hrs post circ. While we normally try to stop the bleeding with the least invasive methods first, this baby, after all the other methods failed, needed 6 stitches for the bleeding to stop. This was a life and death situation. This does
not happen often but one time is often enough to convince me I made the right decision. This was a very hard thing for my husband and I to overcome. He is circ'd and was not going to budge. We had many sleepless and tearful nights. We agreed to disagree and left the choice up to our boys. Once it is gone you can't get back all the benefits the foreskin has to offer. Good luck in this decision. It is a tough one but you are definitely not alone.

Anonymous said...

Mom said...

Does anyone remember how cruel children can be??????? Never mind the fact that cleaning a baby, that is circumcised and having worked in a nursing home, a senior citizen is easier. What about when the child is out of the norm in school. Other children can be incredibly cruel.

First of all, if a boy was caught looking at another man's penis he would be the one picked on. They would call him gay, and yes they can be cruel. By the time this blogger's (Sara?) baby is born and grown the majority of American boys will have an intact penis. Intact boys will have compassion towards the circ'd minority. They would not be teasing, trust me. Besides, kids get picked on for other reasons such as freckles or glasses or a big nose, big ears, bug eyes, being too tall, too short or what have you. This doesn't mean we should encourage our children to undergo cosmetic surgery just to appease a group of immature middle school kids. We all need to teach our children, weather boy or girl, self esteem no matter what they look like. It is our job to help our children build for themselves a strong healthy backbone.

Sara said...

I wonder if the drop in circumcision rates in the US has anything to do with our growing Hispanic population. When I was doing medical interpreting, I had the opportunity to be present for several births of Hispanic boys, and none of those moms opted to circumcise their sons. I'm sure it doesn't account for the whole drop, but it might have something to do with it. Just a thought...


An interesting thought, although I have quite a few Hispanic friends. So from personal experience I can tell you, my wonderful Latino friends have been coerced by their son's doctors to have their son circumcised and some did fall into that pressure because they thought it was the "American thing to do". This is really sad. I don't think it has anything to do with the rates dropping but the doctors whould like for you to believe that. Nearly ALL my white friends have intact son's. Every one of them have college degrees.



The nursing home argument really distresses me. I have two intact boys. I sure as heck hope they don't run into a nurse that is extremely shallow and uneducated about the intact penis and refuse to clean their patient. It makes me wonder how other intact cultures care for their elders. I doubt they would be treat their elders with such disrespect and discriminate their intact male patients. Perhaps by the time they're old this isn't going to be a concern.

Just remember, the intact prepuce (foreskin) is tightly bonded to the glans just as the fingernail is to the finger. A circumciser has to literally rip the foreskin away from the glans. This is just as painful as a fingernail being ripped from the finger. And it results in a raw open wound. I can't imagine defecating on my wounds. I can't see how that's cleaner either. Intact care is so simple, wipe and go and never retract. Natural retraction happens when the child hits puberty due to his prepubescent hormones facilitating the seperation process. Every intact male will develop this way. Its just another milestone. Teaching an intact male child hygiene is as easy as teaching our daughters to wipe from front to back. Just tell him to remember the three R's: Retract, Rinse, Replace. Too much soap will do more harm than good. He should also be aware of that as well. Good luck with the birth and congratulations on your upcoming arrival!

Joe said...

Sara, First I'll say I congratulate you for looking into this and especially your husband for raising the doubt. I hope you'll leave your boy intact and I just wanted to add some thoughts to what has been said.

The first is that I think if you consider the purported benefits carefully you'll see that for the most part they're either non-existent, trivially small, or can easily be achieved with safer, more effective, and less invasive ways. UTIs are very rare and treatable, the cancer benefit is trivial or non-existent, the STD benefit is very trivial (if it exists), and so is the HIV argument (especially in Western countries with low prevalence). Intact boys are not hard to take care of, that is nothing more than a myth too.

I have said this to others before, and in fact I read a similar though on the one of the blogs you mentioned, the difference between the two choices is that one you can't change. If you leave him intact you give him options, if you circumcise him you take them away. There aren't any compelling reasons medically speaking so why take the option from him? I think there is a lot of wisdom in that thought. It's really clear and to the point.

I would like to also add that as an intact guy who grew up in the US, there were no real social problems (that is a myth too as far as I knew). And in your son's case he'll have more intact peers as the rates are dropping (plus all the information that is easily available) so if I didn't encounter problems, he'll defiantly not encounter any.