circumcision-to do or not to do?

[Kotena]

Hello, we are expecting a boy and thinking about circumcision. I am trying to research whether it is a good thing or just recent fashion?

[Anonymous]

Oh dear. You may get more than you bargained for in posting about this. You may want to search the old forums for some of the debate. In regard to the question of whether it's "recent fashion," in the U.S. circumcision is less prevalent now (though among some groups -- Jewish and Islamic -- it is still widely practiced). Overall U.S. circumcision rates peaked about 30 years ago and rates differ by geographic region. It is most common in the midwest. Here's a link to some fairly recent NCHS data:

http://www.cdc.gov/nchs/products/pubs/pubd/hestats/circumcisions/circumcisions.htm

Of course, this only includes circumcisions performed in hospitals. Some Jewish families prefer to have a bris at home.

The American Academy of Pediatrics position is as follows: "Scientific studies show some medical benefits of circumcision. However, these benefits are not sufficient for the American Academy of Pediatrics (AAP) to recommend that all infant boys be circumcised." For the full statement, see the AAP website. It details pros and cons that may help you in making your decision. (It's worth noting that studies showing lower HIV transmission risk have primarily been done in Africa.) Good luck with your decision!

[Anonymous]

I don't want to scare you, but I feel that you should know that there can be complications from circumcisions. It rarely happens, but it did happen to us.

I was unsure about having a circumcision, but my husband felt strongly about it, so we went ahead with it and had it done by a very well-respected pediatric urologist. Unfortunately, our son had bleeding complications requiring stitches. He was (and is) fine, but it was very upsetting, scary, and stressful for us.

Now that it's been a few months, my husband and I talked about what we would do if we had another son. I said there's no way I'd go through that again, and he said he'd respect my decision, even though I think having his boys circumcised is important to him.

Only you know what's right for you and your family. But as the prior poster said, try to inform yourself as much as possible before making the decision.

Good luck to you, and congratulations on your son!

[Kotena]

The problem is that on the internet there is too much conflicting data. Official sites do not support either way, give pros and cons and leave the decision up to us. I read a lot, still not sure..

[Anonymous]

11:22 poster here. I don't know that the data necessarily conflict. For American boys/men, there appear to be some small medical benefits to circumcision. AAP describes these as follows:

*A slightly lower risk of urinary tract infections (UTIs). A circumcised infant boy has about a 1 in 1,000 chance of developing a UTI in the first year of life; an uncircumcised infant boy has about a 1 in 100 chance of developing a UTI in the first year of life.
*A lower risk of getting cancer of the penis. However, this type of cancer is very rare in all males.
*A slightly lower risk of getting sexually transmitted infections (STIs), including HIV, the virus that causes AIDS.
*Prevention of foreskin infections.
*Prevention of phimosis, a condition in uncircumcised males that makes foreskin retraction impossible.

One could argue that the two latter benefits are negligible, since the risk of such problems is so small. The same is true for the penile cancer risk.

On the flip side, AAP cites these reasons that parents don't circumcise:

*Fear of the risks. Complications are rare and usually minor but may include bleeding, infection, cutting the foreskin too short or too long, and improper healing.
*Belief that the foreskin is needed. Some people feel the foreskin is needed to protect the tip of the penis. Without it, the tip of the penis may become irritated and cause the opening of the penis to become too small. This can cause urination problems that may need to be surgically corrected.
*Belief it can affect sex. Some feel that circumcision makes the tip of the penis less sensitive, causing a decrease in sexual pleasure later in life.
*Belief that proper hygiene can lower health risks. Boys can be taught proper hygiene that can lower their chances of getting infections, cancer of the penis, and STIs.

As a PP noted, complications do happen. A notorious case is discussed in As Nature Made Him: The Boy Who Was Raised as a Girl, by John Colapinto.

Most people I know who have circumcised did it for these reasons:

*The father is circumcised and he felt strongly about his son's penis looking the same way.
*Their religion calls for it, or they are simply traditional in their views.
*They believe that an uncircumcised penis is dirty or aesthetically unappealing.
*Their family and/or friends support it.

Most people I know who haven't circumcised had these reasons:

*They believe the health benefits are minor.
*They don't want to cause pain to their sons and they are concerned about potential complications.
*They believe that the penis comes with a foreskin for a reason, and see no compelling reason to alter that.
*They move in social circles in which circumcision is not common.

There are impassioned arguments in both direction. You can probably make the case based on data either way (i.e., that the health benefits are real or that for average American males the findings are artifacts). Best of luck!

[Anonymous]

I think the thing with circumcision is that it is simply very difficult for Americans to remove ourselves from our severe cultural bias. If we could, I honestly think we would be absolutely confounded by why we bother circing. Instead, we have so much worry and stress about the issue. Because we've been told for so many decades that it is important, we've conditioned ourselves to find it not only acceptable, but necessary. Talk to a Canadian, a Mexican, a German, a Norwegian, a Russian, a Brazilian, an Italian...or even a Californian...almost anywhere in the world, and they will wonder what made you so crazy that you think cutting off part of your son's penis, for non-religious reasons, is a good thing.

The reality is that it makes about as much sense as removing our newborn's fingernails to prevent hangnail infections. We do not remove ANY body part on a newborn to prevent potential problems with that body part -- even though there are certain body parts which are thousands of times more prone to serious disease than the foreskin (breast tissue, anyone?). Imagine that someone is recommending that you cut off just a very small piece of skin from your daughter's labia; that it could prevent various problems or std's. I think every single one of us would run screaming. Why is it that we accept it with our sons? I think the answer is that we have been trained culturally to accept it -- much as families in Ethiopia have been trained that it is okay to cut off part of their daughter's labia -- and our cultural bias is so thick that we can't see beyond it.

I think it's exceptionally difficult to break out of this cultural cycle. Most grown women in the United States today have only had sexual experiences with circumcised guys. Most grown men will say how awful it was for the few intact kids at school. Or, everyone seems to have a story about some poor guy who needed it done as an adult, or about how some little boy always had infections. If you are considering leaving your newborn intact, there are things you can do to arm yourself against these things.

First, you should know four or five functions of the forskin. Actually, this holds true whether or not you want to circumcise. If you are going to cut, you should know what it is that you are cutting off. If you are leaving it there, you will happy to know what it does and how it does it. If you are researching at a website or in a book that does not tell you multiple foreskin functions, than you need to look further! Information is power, and it will help you feel more confident about your decision, and help you talk to your son about his body. Secondly, you should NEVER EVER let anyone pull back your son's foreskin - this includes daycare providers, husbands, MILS, and yes, even Doctors. You do not pull it back to clean it! Ever! Many people argue that the reason we see higher rates of infection with uncircumcised boys, and high rates of phimosis in the United States is that people pull back the foreskin at a young age. Anyone with an intact son should know that the foreskin is fused to the head of the penis, and that it will naturally loosen somewhere between 3 and 16 years of age. If anyone tries to pull it back (doctors are notorious for not knowing how to handle an intact penis) it can cause small tears in the skin, which increases the risk of infection and future problems with the foreskin, such as phimoses (which, incidentally, can usually be treated with medicine). To repeat, NEVER PULL BACK A CHILD'S FORESKIN. There is almost never a need to do this, even if your doctor needs to examine the penis or insert a catheter. Lastly, be aware of the fact that more and more people are leaving their boys intact in the United States. In some areas, 60-80% of baby boys now keep their foreskin; in DC I think it is around 50%. Obviously there are other areas where circumcision is still quite common, like the mid-west.

If you are one of those fence-sitters, know that there is no rush to make a decision. You can always have your son circumcised, and if you wait until he is older, at least he can have general anesthetic for the surgery, and he will be able to have pain killers afterwards. A newborn simply can not explain how much pain he is in, nor can he ask for more drugs if it hurts.

If you are certain you want to circumcise, be aware of the potential risks of the surgery. Again, if the material you are reading does not list the risks, you are looking at the wrong place. There are indeed risks of this surgery, and you owe it to yourselves to know what they are before you sign the consent form. Also, you can opt to have *less* foreskin removed, thus reducing the chance of your son having tight erections as he grows up (due to lack of penile skin). You should also make sure to have the circumcision done well after breastfeeding is established (perhaps when the baby is one week old) because sometimes the trauma of circumcision can add to breastfeeding problems in the newborn. Lastly, you should make sure that your baby is properly anesthetized (as much as is possible for a newborn) because a topical "numbing cream" simply is not enough!

[Anonymous]

My husband and I were completely on the fence as to whether or not to have our son circumcised. We could see all the pros and cons and decided to do it since it may decrease (even if it's slight) slightly his chance of getting an STD as an adult. My husband attended the circumcision and fwiw our son didn't even wake up when it happened.

[Anonymous]

Interesting. The recent African studies have been shown to be extraordinarily biased and even flawed, not to mention irrelavant to our culture. So what if circumcision, in fact, makes it easier to acquire std's or hiv? We find in areas where female circumcision is practiced, that these women have higher chances of getting std's. Also, if you look at the statistics, the United States - which as we all know is a circumcising country - has the highest rate of hiv of any industrialized nation. The foreskin contains Langerhan's cells, which are known to help the body fight off infection. A cut penis, with part of it removed, means that it is functioning imperfectly. Personally, I would put my money on leaving the penis to work as thousands of years of evolution has made it, and teaching my children safe sex.

[Anonymous]

Anonymous wrote:My husband and I were completely on the fence as to whether or not to have our son circumcised. We could see all the pros and cons and decided to do it since it may decrease (even if it's slight) slightly his chance of getting an STD as an adult. My husband attended the circumcision and fwiw our son didn't even wake up when it happened.

This is the 11:22 and 14:29 (or something) poster. I just want to point out that teaching your son proper hygiene, including pulling back the foreskin to wash under it once it retracts, would probably have the same effect. Teaching your son about safer sex behaviors is essential and will do far more to reduce his risk. The risk of acquiring an STD is directly, causally linked to risk behaviors. As far as Africa goes, the rigorously researched new book The Invisible Cure, by Helen Epstein, makes it clear that the concurrent sexual relationships that are culturally normative in much of Africa have contributed greatly to the epidemic there. Circumcision won't change that.

[Anonymous]

Ok, I know this may open a can of worms...please know I ask not to provoke, but instead due to pure interest in the knowledge....

Though of faith myself, I must admit that I really don't know the religous reasons behind circum. (or not to circum). I of course know that there is tradition amongst religions, however, can someone share with me how this tradition originated?

[Anonymous]

Good question, PP.

In Judaism, I believe the circumcision reflects Abraham's covenant with God. The Wikipedia page on the Jewish religioius ceremony (the Brit Milah, literally the "covenant of circumcision") is quite good:

http://en.wikipedia.org/wiki/Brit_milah

[Anonymous]

I think the other poster gave a good list of pros/cons and considerations.

For what its worth, I researched this heavily, and was unpersuaded by the medical literature. That's not to say I don't believe it may reduce the risk of certain things, but simply that I think the minimal risk is not worth cutting off a piece of his body. The other big worry I had was the "locker room" issue. Would my son be the ONLY kid not circumcised? Would he be ridiculed? etc.?

My research on this told me that if I lived in Kansas, it may have been more of an issue... but here, the rate of newborns being circ'ed/uncirc'ed is almost 50-50. So rest assured, he will not be the "only" one.

In the end, I decided to leave him intact... and I'm glad I did.

(that said, I think its a very personal choice, and as long as you are considering all the factors, I'm sure you will make the right choice for you and your son).

[Anonymous]

I agree with PP. I am due soon and will not be having my son cirumcised. (I left the final decision up to my husband (who is circumcised), but I agreed 100% with his choice.) If anything, I think the trend or "fashion" nowadays is more towards not circumcising (my opinion - not based on hard research but rather what I've read here and there and conversations with peers who have boys), so I certainly wouldn't let fear of a social stigma stop you and your husband from making the decision that is right for you both. I personally do not think there are legitimate health advantages to circumcision either.