Circumcision

[MamaGeek]

My husband and I are expecting our second child in January. Our first was a girl, but we just found out that this one is a boy, so we have to decide whether or not to have him circumcised. I’ve been doing a lot of reading, both pro and con, and have gathered some of the info here for anyone who wants to read about it. After reading at least some of the info, and weighing in with your own experiences and what you’d done with your own boys, please share what you think. We have not decided yet.

Some of the information is rather detailed, so I’d like to issue a **word of warning **for young readers.

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[MamaGeek]

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Circumcision Rates (Wikipedia)

In the United States, it is unclear whether circumcision rates are rising or falling. A recent study found that circumcision rates had significantly increased since 1988.[38] However, statistics collected by the National Center for Health Statistics show that the overall rate of neonatal circumcision has gone down recently, and has fallen from 64% in 1979 to 60% in 2002.[39] Strong regional differences in the circumcision rates have developed during this time. While almost 80% of newborn boys are circumcised in the Midwest and South, circumcision rates have declined to only 31.4% in 2003 in the West [40]. This has been attributed in part to increasing births among Latin Americans, who usually do not circumcise [41]. As of August 2005, 16 states have abolished payment for the procedure under Medicaid; 34 states still allow circumcision to be funded with taxpayers’ money.

The Foreskin (MedicineNet.com)

The penis is a cylindrical shaft with a rounded tip. The rounded tip is called the glans. There is a groove (termed the coronal sulcus) between the shaft and the glans of the penis. The fold of skin that covers the glans is the foreskin (the prepuce). A retractable foreskin is one that can be pulled back behind the groove of the coronal sulcus to expose the glans.

Only about 1 in every 20 boys is born with a retractable foreskin. This reflects the fact that the histologic (tissue) development of the foreskin is usually not complete at birth.

The foreskin is thus not fully separable from the glans in about 96% of newborn boys. By 1 year of age, the foreskin can be retracted in 50% of boys and by 3 years, the foreskin can be retracted in 80% to 90% of uncircumcised boys. This means that the inability to retract the foreskin at birth and in infancy is normal and does not constitute a medical reason for a circumcision.

The Circumcision Procedure (Circumcision: A Guide for Expectant Parents from Circumcision Information Australia)

“In male infants, circumcision is an operation which involves tearing the foreskin* away from the glans (head) of the penis, cutting along the top of the foreskin, then clamping the foreskin and cutting it off. The skin of the penis is a complex movable sheath with no clear indication of where it should be cut during a circumcision. This means that the amount of foreskin removed from one circumcision to the next can be very different, and no two circumcisions are the same.”

Some sites I looked at claimed that cutting too little or too much of the foreskin is rare, as long as the doctor performing it is an experienced cirumciser. I tend to believe this.

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[MamaGeek]

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Like Father, Like Son

I haven’t read too much on this, but here are a couple of links on the topic:
Circumcision Resource Center
Mothers Against Circumcision
Circumstitions.com

Penile Hygiene

The pro-circumcision say that the uncircumcised penis requiresproper care and more hygienic treatment than an uncircumcised penis. They also talk about a smelly whitish film, termed ‘smegma’, that is found under the foreskin, which uncircumsised men and their partners often find offensive. The anti-circumcision sites state that the foreskin does require special care, but that sparing parents having to teach their sons to clean themselves properly does not justify surgery. I found this page ( http://www.cirp.org/library/hygiene) to have the best information about how to care for an uncircumcised penis.

Ethics (from Circumcision.org)

When circumcision is performed, it does not treat any disease, injury, or other health problem. Since there is no urgency to do it, it must be delayed until the child is old enough to make the decision for himself [39].

Circumcision violates a major principle of medical practice: First, do no harm. It also violates all seven principles of medical ethics [40]. Some doctors and nurses refuse to perform or assist with circumcisions because of ethical considerations [41, 42]. They have organized to form Doctors Opposing Circumcision and Nurses for the Rights of the Child [43, 44].

The AAP Committee on Bioethics report states, “Pediatric health care providers. . . have legal and ethical duties to their child patients to render competent medical care based on what the patient needs, not what someone else expresses. . . .[T]he pediatrician’s responsibilities to his or her patient exist independent of parental desires or proxy consent” (p. 315) [45]. See also Response to American Academy of Pediatrics Policy Statement

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[MamaGeek]

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Pain and Behavioral Response (Advocate from Circinfo.net, Against from Circumcision.org )

Advocate on Pain
Circumcision, if performed without anaesthetic is [painful]. Cortisol levels, heart rate and respiration have registered an increase during and shortly after the procedure [211, 213], indicating that the baby is not unaware of having had something painful done in instances when circumcision has been carried out without anesthesia.

Against on Pain
Over a dozen studies confirm the extreme pain of circumcision. It has been described as among the most painful [procedures] performed in neonatal medicine.( 2) In one study, researchers concluded that the pain was severe and persistent.( 3) Increases in heart rate of 55 beats per minute have been recorded, about a 50 percent increase over the baseline.( 4) After circumcision, the level of blood cortisol increased by a factor of three to four times the level prior to circumcision.( 5)

Advocate on Restraint
The response is variable and, even without anesthetic, some babies show no signs of distress at all. Most do, however, and this may be contributed by the restraining procedure, as well as the surgery itself.

Against on Restraint
Since the infant is restrained during circumcision, the response to the use of restraint was similarly tested and was not found to be measurably distressing to newborns.( 1)

Advocate on Anesthesia Use
Despite the benefits and proven safety of anesthesia, many male newborn circumcisions in North America do not involve anaesthetics and this can be as much as 64-96% in some regions [289, 307]. In the USA 84% of pediatric, 80% of family practice and 60% of obstetric programs do indeed teach anaesthesia/analgesia techniques [130]. It is thus surprising that 71% of pediatricians, 56% of family practitioners, and only 25% of obstetricians use analgesia/anesthesia [274].

Against on Anesthesia Use
An anesthetic (local injection, the best option tested) still is not typically administered due to a lack of familiarity with its use, as well as the belief that it introduces additional risk.( 13) Although there is indication that the risk is minimal, most physicians who perform circumcisions do not use anesthetics even after they are taught how.

Advocate on Anesthesia Effectiveness
Dorsal penile nerve block [108] represents 85% of anaesthetic use in the USA [299] and is effective [131], even in low birth weight infants [128]. It involves injection of local anesthetic at the 10 and 2 o’clock positions at the base of the penis, where the dorsal penile nerve is situated. Ring block, which had initially been used for post-circumcision analgesia [39], is simpler, and extremely effective [118, 164, 183]. It involves injection of a local anesthetic around the circumference of the penis at the mid-shaft level. In fact this method may be the best. Pain from the infiltration of a local anesthetic is short-lived and significantly less than the pain from an un-anesthetized circumcision [165]. More on Anesthesia

Against on Anesthesia Effectiveness
When an anesthetic is used, it relieves only some but not all of the pain, and its effect wanes before the post-operative pain does.( 14) Because no experimental anesthetic has been found to be safe and effective in preventing all circumcision pain, research in this area continues.

Avocate on Behavioral Response
None of the pro-circumcision sites I looked at discussed behavioral responses following circumcision.

Against on Behavioral Response
Various studies have found that short-term effects of circumcision include changed sleep patterns, activity level, and mother-infant interaction, more irritability, and disruptions in feeding and bonding [2]. For more information, read Infant Responses During and Following Circumcision and Mothers Who Observed Circumcision

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[MamaGeek]

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Medical Risks/Benefits (Advocate from Circinfo.net, Against from Circumcision.org )

Advocate on Surgical Risk
Circumcision has low risk, less than 1% [6]. Most complications are bleeding and infection.

Against on Surgical Risk
The rate of surgical complications is reported to be from 0.2 to 38 percent.( 5) (The higher rate included complications reported during the infants’ first year.) There are at least twenty different complications including hemorrhage, infection, surgical injury, and in rare cases, death.( 6)

Advocate on UTI
The absolute risk of Uninary Tract Infections (UTI) in uncircumcised boys is approx. 1 in 25 (0.05) and in circumcised boys is 1 in 500 (0.002), the absolute risk reduction is 0.048. Thus 20 to 50 baby boys need to be circumcised to prevent one UTI. However, the potential seriousness and pain of UTI, which can in rare cases even lead to death, should weigh heavily on the minds of parents.

The benefit appears to extend beyond childhood and into adult life. In a study of men aged, on average, 30 years, and matched for race, age and sexual activity, the circumcised had a lower rate of UTI [272].

Against on UTI
In the last fifty years, circumcision advocates in the medical profession have promoted various claims. The most widely used current medical claim for circumcision is that it decreases the incidence of urinary tract infection (UTI) in the first year of life.( 1) However, the UTI studies this position is based on have been criticized by other physicians, most notably by the American Academy of Pediatrics (AAP). They concluded that the test designs and methods of these studies may have flaws.( 2) A similar study found no confirmed cases of UTI in intact male infants without urinary birth defects.( 3) Furthermore, the UTI defense of circumcision is weak, not just because the methods are flawed, but because the logic and reasoning leading to the conclusion are flawed.

1. 
   *]Even according to the questionable studies, the overwhelming majority (96-99 percent) of intact male infants do not get UTIs in the first year.( 4) It is not reasonable to subject them to circumcision and the associated pain without demonstrable benefit.
   *]Circumcision involves cutting off normal, healthy, functioning tissue to prevent potential UTI problems in the future. There is no disease or infection present at the time of surgery. If we were to apply this principle in trying to prevent other potential problems, then we would be pulling healthy teeth to prevent cavities. Clearly, this principle is irrational.
   *]UTI is treatable with antibiotics.( 8) If good medical practice requires the least intrusive form of effective treatment, then circumcision is not justified. Circumcision is a radical surgical treatment.
   *]Females have a higher UTI rate than males,( 9) yet no doctor advocates genital surgery to reduce female UTI.
   
   Advocate on Penile Cancer
   The predicted lifetime risk of penile cancer for an uncircumcised man has been estimated as 1 in 600 in the USA and 1 in 900 in Denmark [154]. Penile cancer accounts for approx. 0.2% of all malignancies in men in the USA and 0.1% of cancer deaths, the 5-year survival rate being 50% [9]. Neonatal circumcision virtually abolishes the risk [168, 189].
   
   Against on Penile Cancer
   There are no American studies of the incidence of penile cancer and its association with circumcision status. Penile cancer is rare, and the estimated American incidence is about 1 per 100,000 [20]. In other developed countries where circumcision is rare, such as Denmark and Norway, the incidence of penile cancer is lower than the estimated American rate [21, 22]. Penile cancer occurs generally in elderly men [20]. Therefore, a male may make a decision to be circumcised when he is older without losing this claimed benefit.
   
   Advocate on STDs
   The overall picture [for STDs] indicates greater prevalence in uncircumcised men, although some more recent studies have shown no difference (reviewed in [190]). A wealth of evidence indicates that male circumcision protects against HIV infection, as acknowledged in the major journals Science [138] and Nature [3 05], and its promotion in HIV prevention is advocated [76].
   
   Against on STDs
   Studies are conflicting for each sexually transmitted disease [25]. Sexually transmitted diseases and circumcision involve behavior, hygiene practices, culture, and religion, and it is impossible to control all the confounding variables that affect sexual behavior and circumcision status. Sexually transmitted diseases obviously cannot be transmitted until an individual engages in sexual activity. Therefore, a male may make a decision to be circumcised when he is older without losing this claimed benefit.
   
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[vluvski]

All I have to say is that we are clearly not bound by any moral standard to circumcise, and it sounds like you understand that. However, Christopher West presents an interesting case for circumcision based on redemptive suffering. It is covered briefly in his series Naked Without Shame. He points out that women suffer in childbirth, and Abraham likewise suffered to circumcise himself before they could have children. Later, at the crucifixion, Jesus’ circumcised penis would have been visible to any passerby, which would have been a witness to his Jewish faith. West says it much better.

My fiance’s family does not circumcise; mine does. I believe it is important for sons to “look like” their dad, so we will not circumcise our children. It seems like the biggest case in favor of circumcision is hygiene, and that can be taught. Fiance’s sister is very emphatic that circumcision is bordering child abuse and will contribute to birthing trauma.

You’ve clearly done your homework. Pray about it.

 

[carol_marie]

Hello!
I too am expecting a child in January (seems like forever away doesn’t it??) If it’s a boy we will have him circumcised. Both his brothers were circumcised and seemed no worse for wear. At the hospital the baby is taken away - the procedure is done & he’s brought back in a matter of minutes… not the least bit fussy.

Since 80% of all boys in the midwest are circumcised (and didn’t the study say that those who weren’t were typically Hispanic ?) So it’s probably higher for my demograpic - I think my son will want to “look like” all the other boys. My oldest son is in 7th grade this year. He said there are two boys in his gym class who wear white underware instead of boxer shorts & they are teased like crazy. I can’t imagine what it would be like to be the only uncircumcised kid in the class ??

Stupid reason? Probably… but then again I’m not a 7th grade boy. I guess I go with… it didn’t hurt my husband… or my other sons… or my brothers… so I don’t give it a second thought.

Besides… if it was so horrible, surely God, who loved his people, wouldn’t have asked them to do it to their baby boys?

This is only my opinion.

Blessings,
CM

 

[Princess_Abby]

This is really interesting, thank you, MamaGeek.

I do not want to circumscize if I’m carrying a boy, but my husband is circumscized and I also feel like it would be important for any sons to identify with their father in that way. So, I do feel somewhat torn about what we would do, as does my husband. I can’t stand thinking about the pain factor for such a little one, right after birth.

 

[YinYangMom]

Have one son.
Remember considering options early on.
Went with circumcision for hygenic reasons and for future peer pressure reasons. We were trying not to make the awkward years any more trying than they already are. But who can really foresee into the future? By the time my son hit Jr. High/High school mandatory showering was banned from the school system so it became a non-issue so he didn’t have to worry about teasing from classmates like our generation had to. Heck, nowadays it’s possible there’s more of a balance anyway so maybe he wouldn’t have stood out as much as we thought he would have. Add to that the old testament history to it. Granted, we’re of the new testament so you’d think we Catholics would have a policy against it, but since we don’t, then we figured it wouldn’t matter.

The circumcision decision is one you and your husband will reach together. It seems you really can’t go wrong either way since looking at the research you presented there doesn’t seem to be significant health risks one way or the other.

If you don’t circumcise now, and it bothers your son so much, he can do something about it himself. If you do, and it bothers him, then, he’s stuck.

Going uncircumcised is not going to jeapordize his health unless he doesn’t clean himself properly. All that STD stuff, if he takes to being Catholic, shouldn’t be much of a concern. But if there’s a good chance he won’t take to being Catholic that much and will end up taking sex risks, then if you didn’t circumcise him and he gets an STD then that’s not your fault - that’s his for engaging in risky behavior knowing his non-circumcised status puts him at higher risk.

I think I struggled more with the decision about vaccinations than I did about circumcision. Those have a greater risk if we don’t vaccinate for certain illnesses and greater risks from reactions if we do.

 

[tee_eff_em]

:twocents:

I only skimmed the posts above, and did not see this mentioned, and really don’t know much about it, but believe a Google search would turn up the research and statistics.

When our son was circumcized years ago, the one objective thing that seemed to be in favor of it was to reduce the risk of HPV infection (Human Pampilla Virus(sp?)). I don’t know if HPV is merely a matter of hygiene, nor whether there is any ill-effect for a gentleman wrt penile cancer, but it **is **correlated with cervical cancer in women. The research we had access to at that time indicated that women with circumcized partners had a lower occurence of cervical cancer.

tee

 

[carol_marie]

YinYangMom:

I think I struggled more with the decision about vaccinations than I did about circumcision. Those have a greater risk if we don’t vaccinate for certain illnesses and greater risks from reactions if we do.

So true! I think the conflicting information about vaccinations lead to MUCH confusion & worry… much more than circumcision for me.

 

[Princess_Abby]

YinYangMom:

I think I struggled more with the decision about vaccinations than I did about circumcision. Those have a greater risk if we don’t vaccinate for certain illnesses and greater risks from reactions if we do.

ITA…

 

[YinYangMom]

I only skimmed the posts above, and did not see this mentioned, and really don’t know much about it, but believe a Google search would turn up the research and statistics.

When our son was circumcized years ago, the one objective thing that seemed to be in favor of it was to reduce the risk of HPV infection (Human Pampilla Virus(sp?)). I don’t know if HPV is merely a matter of hygiene, nor whether there is any ill-effect for a gentleman wrt penile cancer, but it **is **correlated with cervical cancer in women. The research we had access to at that time indicated that women with circumcized partners had a lower occurence of cervical cancer.

tee
[/quote]

Well that’s an interesting bit of info. That alone would lead me to lean toward circumcision as we married folks tend to want the same for our kids. Of course we didn’t have that info when we had to make the decision, so I’m glad we went with circumcision after all.

 

[MamaGeek]

carol marie:

I think my son will want to “look like” all the other boys. My oldest son is in 7th grade this year. He said there are two boys in his gym class who wear white underware instead of boxer shorts & they are teased like crazy. I can’t imagine what it would be like to be the only uncircumcised kid in the class ??

Stupid reason? Probably… but then again I’m not a 7th grade boy. I guess I go with… it didn’t hurt my husband… or my other sons… or my brothers… so I don’t give it a second thought.

I think the Circumcision Resource Center (see link in post above) said it best on this issue: “If a boy gets teased because he looks different, that indicates an emotional problem in the perpetrator. The solution is appropriate communication to address this behavior and associated problem directly.” Surgery does not seem like the best way to resolve teasing issues.

 

[carol_marie]

MamaGeek:

I think the Circumcision Resource Center (see link in post above) said it best on this issue: “If a boy gets teased because he looks different, that indicates an emotional problem in the perpetrator. The solution is appropriate communication to address this behavior and associated problem directly.” Surgery does not seem like the best way to resolve teasing issues.

I don’t mean to giggle… honestly. But I’m just trying to picture my 7th grade uncircumcised son coming home & telling me that he was picked on because of his penis. Wouldn’t happen. I think he’d suffer the torture in silence (and trust me… Jr. High kids are sooooo mean!) And if - by chance - he did muster up the courage to tell me… I can’t fathom he’d want me to do anything about it. Imagine the HORROR of having to have your Mom call the school & say…“Umm… my son is being picked on because of his penis… could we get sit the perpetrators down & discuss it?”

 

[dulcissima]

My husband is circumsized, but decided that was not what he wanted for our sons. They seem pretty happy with that decision. I don’t think you will really make a wrong decision, either way you go.

As far as the HPV issue - that is a sexually transmitted disease - and we all know the best way to avoid those.

 

[YinYangMom]

MamaGeek:

I think the Circumcision Resource Center (see link in post above) said it best on this issue: “If a boy gets teased because he looks different, that indicates an emotional problem in the perpetrator. The solution is appropriate communication to address this behavior and associated problem directly.” Surgery does not seem like the best way to resolve teasing issues.

No offense, honest, but tell that to the one being teased.
The thing about this kind of teasing (yes, it reflects more poorly on the one doing the teasing), is that at that age your son is not likely going to tell you or anyone else that he’s being ridiculed for that personal reason…instead, they soak in the teasing, they internalize the anguish, and it festers inside affecting his psyche. If you’re lucky, the son begins to lash out, display symptoms of mood swings, but then so many parents chalk those up to ‘hormones’, which it could be, but taking that approach stops the parent from asking specific questions to find out if indeed that’s all it is.

The reason bullying and teasing falls under “Thou Shalt Not Kill” in a proper examination of conscience is because these actions and words kill the spirit in the victim. I wouldn’t want to do anything which may place my child in the position of being the victim of that kind of killing, it’s such a slow and painful death.

That’s not to say not circumcising your son will put him in this situation. As I noted before, the way the schools are these days don’t seem to lend themselves to what our generation experienced. Nowadays I can’t imagine a situation where a young man would be naked with a group of strangers, let alone friends, so it seems a non-issue. Can you???

I just wanted to clarify that while bullies are the ones with the problems, knowing that doesn’t minimize the affect they have on the victims. My daughter endured much cruelty in 5th grade because she’s short, hispanic, and got along with the teachers. She survived, but she and I had a lot of hugging, rationalizing, talking to do to get her through it.

 

[MamaGeek]

YinYangMom:

No offense, honest, but tell that to the one being teased.
The thing about this kind of teasing (yes, it reflects more poorly on the one doing the teasing), is that at that age your son is not likely going to tell you or anyone else that he’s being ridiculed for that personal reason…instead, they soak in the teasing, they internalize the anguish, and it festers inside affecting his psyche. If you’re lucky, the son begins to lash out, display symptoms of mood swings, but then so many parents chalk those up to ‘hormones’, which it could be, but taking that approach stops the parent from asking specific questions to find out if indeed that’s all it is.

Then should we buy nose jobs, boob jobs, liposuction, or any other of a broad range of cosmetic surgeries just to preclude teasing? Surgery is surgery, and of all the reasons to circumcise, that one is the least of my concern.

 

[Nimue]

After much consideration prior to this thread (the above pro vs con posts are awesome!) I have chosen not to circumsise any sons that I might have in the future.

Though I understand the logic of many of the posters here who are voting TO circumcise, it just seems to me an unnecessary surgery. I agree with the poster who stated that if my son wished it later in life for medical reasons- he would have the opportunity to make that decision then.

There are a number of organizations on the web who are on both sides of the fence, and who have a lot of great information. But I like this article. It is concise, and it is logical and scientific.

healthcentral.com/drdean/408/9985.html

 

[YinYangMom]

MamaGeek:

Then should we buy nose jobs, boob jobs, liposuction, or any other of a broad range of cosmetic surgeries just to preclude teasing? Surgery is surgery, and of all the reasons to circumcise, that one is the least of my concern.

No, not at all. We have what God gave us and we should see the beauty in that. Which is certainly the same approach you should use in explaining why your son is not circumcised, if that’s the case.

As I said earlier, the chances anyone will be in the position to tease young men about their ‘members’ is neglible these days which pretty much makes peer pressure a non-issue.

I was just pointing out that the statement about bullies being the ones with the problem doesn’t make being the victim any easier. It’s neither here nor there with regard to the decision to circumcise or not.