Top Ten Reason NOT to Circumcise

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When my husband and I found out we were having a boy, our first reaction was unbridled excitement. A week later when my doctor was reviewing the ultrasound and found out it was a boy, her first reaction came in the form of a question. “So are you going to circumcise him?”

I have to admit, it wasn’t a topic I had given much consideration to. After all, daydreaming about nursery themes and baby names is a lot more fun than thinking about my son’s penis status. But like all of the less than ideal parts of parenthood, I knew I couldn’t avoid the issue forever. So what did I do? I talked to my doctor,  turned to family and friends for advice, and searched around online. I was hoping this would just be another one of those easy parenting decisions (you know, like the decision to feed the baby (yes!) or the decision to bath the baby from time to time (yes again!)). Boy oh boy, was I in for a surprise

Reactions ranged from “why wouldn’t you circumcise?” to “I can’t believe you would circumcise!” Arguments swung from wildly emotional to purely scientific. Personal biases ran rampant. Cultural and religious justifications added to the confusion. After my initial investigation, the only thing I was clear on was that both sides of the controversy believed they possessed irrefutable evidence for why their viewpoint was correct.

Facing this maelstrom of opinions, I did the only thing I could do—I put on my thinking hat and uncovered the facts for myself.

After weeks of research, sifting through evidence-based studies, reading the testimonials of medical professionals, and, probably most important, listening to the nagging feeling I had in my own heart, my husband and I decided NOT to circumcise our son.

At the time, I knew we had made the decision that was best for our family, but I was hesitant to say our decision should be applied universally to baby boys everywhere. Today, after educating myself even more about the topic, I would openly encourage all parents-to-be to pass on routine-infant circumcision and leave their baby boy’s penis intact. Want to know why? Here are my top ten reasons.

1) Important protective function

Human males, like all mammals, evolved to have a foreskin, and like most things evolution selects to retain, it serves a vital protective function. A good analogy is to think of the foreskin like the eyelid for the penis—it keeps out irritants, lubricates, and protects from abrasive surfaces.  Throughout childhood, the foreskin is attached to the head of the penis (glans) and covers the opening through which urine passes (urinary meatus), making contamination difficult. On the rare occasion that a contaminant does make it inside, the foreskin produces antibacterial and antiviral proteins to prevent infection, along with hosting a rich flora of good bacteria. Additionally, the foreskin creates the optimal environment for penile health by maintaining healthy pH levels, warmth, and lubrication, which prevents hardening (keratinization) of the skin.

2) Important sexual function

The foreskin is home to a high density of nerve endings and blood vessels that make it the most sensitive part of the penis. Couple that with the fact that it comprises about one-third to one-half of all the skin covering the penis, or approximately fifteen square inches, and it’s easy to see how removing it could impact sexual function. During sex, the foreskin helps to maintain lubrication, reducing vaginal dryness and making intercourse less abrasive for the female partner. Intact men are also significantly less likely to suffer from erectile dysfunction disorder, and their partners are more apt to experience frequent orgasms.

3) A murky history

The first documented case of circumcision appears on an Egyptian tomb dating back to around 2400 BC. While the exact purpose of circumcision is debated, hypotheses include: a religious sacrifice, a rite of passage for young men, a sign of social status, a way to alter sexual pleasure, or a health preventative measure. It gained popularity in Western medicine when two French doctors linked masturbation to a host of diseases like polio and tuberculosis. By circumcising boys, the doctors believed they could prevent masturbation and in turn, prevent illness. This same thought process was applied to a host of diseases and disabilities, and before long, circumcision became the new snake oil of preventative medicine.

Circumcision gained popularity in the Victorian-era United States amidst a climate of negative attitudes toward sex. It was believed that through circumcision sexual desires and promiscuity could be curbed, cases of rape reduced, especially the rape of white women by black men, and marriages saved. During the World Wars, rates increased as the military led a concerted effort to circumcise soldier serving in sub-Sahara Africa in order to prevent the spread of AIDS. In the period of prosperity following World War II, families chose to deliver their babies in hospitals where it was common to offer routine circumcision. Since most fathers were already circumcised, they saw it as only natural that their sons be too, thus passing on the tradition for decades to come.

4) Not recommended by any medical association

It’s true! There is not a single medical organization that recommends routine-infant circumcision. In fact, most organizations actively condemn the procedure. Take the KNMG for example, a Dutch medical organization representing 40,000 doctors. In 2010 they issued a detailed analysis stating that circumcision does not have the preventative benefits its supporters claim, does have real and clear risks, and is an ethical issue on par with female genital mutilation. The American Academy of Pediatrics, whose official stance is that preventative health benefits, “outweigh the risks of the procedure,” still does not recommend it for all male newborns.

5) The benefits are exaggerated

Most new parents will do anything if they believe it is in the best interest of their child, so when they hear things like ‘circumcision reduces urinary tract infections, the spread of AIDS, and penile cancer rates,’ it seems like a no-brainer. Unfortunately these sweeping statements only tell half the story.

Take UTIs for example. Your doctor would be correct in telling you that circumcision lowers UTI rates in boys. That’s a fact. It can’t be disputed. But the thing about facts is they only tell part of the story; they lack meaning without the proper context. What your doctor is leaving out by only citing this single statistic is that UTI infections are rare. They only occur in about 1% of boys under the age of one, a rate that is much lower than their female counterparts. When baby girls get a UTI they are easily treated with antibiotics. Now I may be in the minority here, but if I have to choose between administering an antibiotic or removing healthy genital tissue, I’m choosing the less invasive option.

What about STDs? Research found that circumcision reduces the risk of HIV by 47%. At first glance this seems like a compelling reason to circumcise. But if you look at the actual data, the risk decreases from 2.49% to 1.18%. Yes, that’s 47%. Again, facts can’t be disputed, but that 47% sure seems a lot less scary when you see the actual percentage of the population that is infected. Something else to note, all scientific research is not created equal (gasp!). Many medical organizations, including the AAP, point out that these studies, carried out in Sub-Sahara Africa with heterosexual men, are full of methodological flaws and are not relevant to the United States where most HIV cases result from homosexual contact or the use of contaminated needles. Similar studies carried out in the United States do not show significant reductions in HIV rates in circumcised men. Additionally, in many European countries where HIV cases are very, circumcision is almost nonexistent.

Let me reiterate, a single statistic does not tell the whole story. And even if it did, say even if the African HIV studies were accurate, promoting circumcision as a way to prevent HIV infection does a disservice to patients because it reduces the use of condoms and other safe sex practices

6) The risks are real

Common risks of circumcision include oozing or bleeding from the surgical site, infection, and irritation from exposure to environmental contaminants or abrasive surfaces. More serious risks, occurring in 0.2 to 0.6% of circumcisions, include damage to the opening of the urethra, the formation of scar tissue, the removal of too little or too much foreskin, excessive bleeding that requires stitches, and partial or full removal of the tip of the penis.

Even without suffering from any of these immediate risks, circumcision still impairs important physical and sexual functions that were discussed in previous points. It also can by psychologically damaging to the circumcised baby later in life, when he realizes the implications of his parents’ decision. Don’t believe me, a quick internet search turns up numerous message forums and websites set up solely for the purpose of talking through these issues with others who have experienced similar trauma. In an interview in Psychology Today, one man who was circumcised later in life expresses a deep regret over undergoing the procedure and mentions both a reduced libido and loss of sensation even with a complication-free surgery.

There is conflicting evidence surrounding whether or not babies experience psychological trauma as a result of circumcision. Some studies suggest circumcision can cause behavioral changes that interfere with parent-infant bonding and breast feeding. Others suggest that, even with local anesthetics, babies still experience pain during the procedure. More research still needs to be done. As a parent, I know it’s impossible (and probably not healthy) to shield my child from all potentially distressing situations, but unless I know the benefits are substantial, I sure am going to try.

7) He doesn’t have to look like everyone else

Would you let your child undergo plastic surgery if he thought his nose was too big? What about if he thought he was too short, too tall, too thin, too fat, too freckled, too…. This list could go on forever. As parents, we routinely tell our children to embrace their differences, so why then does this not apply to his penis—a part of his body that shouldn’t even be on display that frequently to begin with. I realize bullying is a very real concern for many parents, but making a major medical decision to avoid future potential teasing is shortsighted. It also sends the subtle yet very destructive message that the appropriate way to stop bullying is to conform.

What’s even more relevant to note is that compared to the worldwide population, circumcised men are in the minority. And with rates declining steadily in the United States, it might not be long before the same is true here.

8) It’s a violation of his rights

Unless it is medically necessary, circumcision is a cosmetic procedure performed for religious or cultural reasons. It violates a child’s right to physical integrity, to freedom of religion, and to protection from physical and mental violence. Many worldwide medical communities are taking a stand, issuing statements that condemn the practice. For example, The Royal Dutch Medical Association issued a statement that “children must not be subjected to medical proceedings that have no therapeutic or preventative value.” The Ombudsman for Children in Norway advocates that boys should not be circumcised until they are old enough to provide consent. The Central Union for Child Welfare in Finland calls circumcision “a violation of personal integrity” and ruled it unlawful in 2006. Many other countries are following suit.

Why then, in the United States, do we extend this protection to women but not men? Many argue there is a difference between female genital mutilation and routine male circumcision. While that’s true, it’s interesting to note that in cultures where female genital mutilation is still common, the rationales cited include many of the same used to support circumcision in male babies—hygiene, disease prevention, improved appearance, and social acceptance.

9) It’s his penis, not yours

As parents, we make hundreds of decisions for our children—whether or not to vaccinate, what kids of food we feed them, the types of medicines they receive. Many would argue circumcision falls under this umbrella of health-related decision making. I would disagree. The majority of the medical benefits cited for circumcision are only relevant to a sexually active, adult male. Circumcising a baby boy does nothing to prevent STDs (he’s not sexually active) or penile cancer (a disease that occurs most commonly in men over 55). Choosing to circumcise as an infant to prevent diseases only occurring in sexually active adults is premature and irreversibly alters a part of his body without his consent. Wait until he is an adult, and let him make the decision for himself. After all, he is the one who will have to live with the consequences of the decision.

10) It’s easy to clean an intact penis

There is a big misconception that an intact penis is dirty. The truth is, it’s only as dirty as you let it get. For babies and children, the best way to clean an intact penis it to leave it alone. An infant’s foreskin is non-retractile and self-cleaning. The fusion of the foreskin to the glans keeps dirt out and sterile urine washes the penis out daily. To care for the outside, washing with simple soap and water, the same way you would a finger, will suffice. It’s important to note that the foreskin should NEVER be retracted during cleaning, until it has retracted on its own. When this happens, usually by puberty for most boys, teach your son retract the skin and wash underneath with soap and water, the same way he would wash any other body part.

Still uncertain what to do? Why not wait and decide later? Circumcision can be performed at any time during a boy’s life. Completely undoing the procedure once it’s done, that will never be an option.

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