Circumcision

The Babble Staff

The United States is one of few countries in the world that practices routine circumcision of infant boys for non-religious reasons. Once regarded as fairly innocuous, broaching the topic of circumcision has become a sure-fire way to start a shouting match. There are those, like the group Mothers Against Circumcision, who believe circumcision is tantamount to child abuse, and others who believe it is a safe, preventative health measure. For an issue that is seemingly black and white — there is, after all, no such thing as a little bit of circumcision — there is a remarkable amount of middle ground. The American Academy of Pediatrics diplomatically concedes that there are "some benefits but not enough to recommend circumcision for all infant boys." Circumcision is widely thought to reduce risk of disease in both circumcised men and their partners. Another argument in favor of circumcision is cosmetic; some say ladies like circumcised men better and that a quick snip in infancy will eliminate any risk, once your son reaches adulthood, of women laughing at him behind his back because they think his penis looks funny. So: is circumcision a barbaric custom or a civilized way of improving health? Do you really want to remove your baby's foreskin because there is a chance it might cause cervical cancer in your future daughter-in-law? Then again, why put your baby at increased risk for penile cancer?

In order for parents to make an informed decision on circumcision, they must carefully consider the benefits and risks. Since the foreskin traps bacteria and other infectious agents, as well as accumulating malodorous smegma, its removal improves genital hygiene and reduces risk of diseases and other conditions over the lifetime for the boy and his future sexual partners.

Circumcision has been performed for thousands of years as part of the culture of indigenous people who live in hot environments such as in Australia, the Pacific Islands, equatorial countries, the Middle East, Africa and the Americas. In Australia all newborn boys were once circumcised routinely. Circumcision then decreased in the mid-1970s, but is now rising again, in line with research. Over 60 percent of Australian men are circumcised.

Benefits of circumcision

? Eliminates the risk of phimosis, which affects 1 in 10 older boys and men. This condition refers to a tight foreskin that cannot be pulled back fully, so making cleaning under it, and passing urine, difficult. Phimosis also greatly increases the risk of penile cancer, and is the cause of foreskin and catheter problems in nursing homes.

? Reduces by 3-fold the risk of inflammation and infection of the skin of the penis. One in 10 uncircumcised men get inflammation of the head of the penis, which is covered by the foreskin. This rises to 1 in 3 if the uncircumcised man is diabetic. (Diabetic men also have other severe problems.) In contrast only 2 percent of circumcised men get this condition.

? Over tenfold decrease in risk of urinary tract infection. Whereas risk of this is only 1 in 500 for a circumcised boy; 1 in 50 uncircumcised male infants will get a urinary tract infection. This very painful condition is particularly dangerous in infancy, and in 40 percent of cases can lead to kidney inflammation and disease; sepsis and meningitis can also result.

? Over 20-fold decrease in risk of invasive penile cancer, which has a high fatality rate. One in 600 uncircumcised men get penile cancer, which often requires penile amputation.

? Uncircumcised men have 1.5–2 times the risk of prostate cancer, which affects 1 in 6 men.

? Reduces by approximately threefold the risk of getting HIV (AIDS), during sex with an infected woman. HIV enters via the vulnerable inner lining of the foreskin of a healthy penis, but can also infect via sores anywhere on the penis (caused for example by genital herpes). In countries such as Australia that have a low prevalence of HIV the risk of a heterosexual man being infected with HIV sexually is generally low. His risk, especially if uncircumcised, will be much greater if he engages in unsafe sex with people of countries in which HIV abounds.

? Circumcision also affords substantial protection against sexually transmitted infections such as papilloma (wart) virus, syphilis and chancroid.

? Circumcision reduces by up to 5 times the risk of the man's female partner being infected by chlamydia or getting cervical cancer (which is caused by human papilloma virus). The load of infectious bacteria and viruses that accumulate under the foreskin is delivered into the female genital tract during sex. Chlamydia has more than doubled over the past 5 years in Australia and can cause infertility (in both sexes), pelvic inflammatory disease, and ectopic pregnancy.

? If not circumcised soon after birth, up to 10 percent will later require one anyway for medical reasons.

? Credible research shows that most women prefer the appearance of the circumcised penis. They also prefer it for sexual activity. Hygiene is one reason.

? There is no significant difference in sensitivity of a circumcised and uncircumcised penis.

? In general, sexual function is the same or better.

Risks of circumcision

? For 1 in 500 circumcisions there may be either a little bleeding — easily stopped by pressure or, less commonly, requiring stitches (1 in 1000), the need for repeat surgery (1 in 1000), or a generalized infection that will require antibiotics (1 in 4000). Although there can be a local infection, often what seems like a local infection is actually part of the normal healing process.

? Serious complications (requiring hospitalization) are rare — approximately 1 in 5000.

? Mutilation or loss of the penis, and death, is virtually unheard of with circumcisions performed by a competent medical practitioner. Ensure your doctor is experienced.

? If a bleeding disorder such as haemophilia runs in the family, then the doctor needs to be advised as circumcision may require special preoperative treatment. ? Anaesthetic is imperative, preferably a local, since a general anaesthetic carries risks, and is unnecessary. For age 0–4 months a local, not general, and for older children or teenagers a mild sedative might be considered in addition to the local. Young children who wriggle can be gently restrained. For pain after the anaesthetic wears off, an oral analgaesic medication is often prescribed.

? Delay means stitches being used for circumcision of older children, teenagers and men.

? So if circumcision is delayed past 4 months, total cost will become increasingly greater.

In conclusion

Circumcision confers a lifetime of medical benefits. 1 in 3 uncircumcised boys will develop a condition requiring medical attention. This means various degrees of suffering and, in rare cases, death. In contrast, risk of an easily-treatable condition is 1 in 500, and of a true complication is 1 in 5000. A successful circumcision is very unlikely to have any long-term adverse consequences.

Thus, benefits exceed moderate risks by over a hundred to one!

Circumcision is controversial, since it is unclear if there are significant medical advantages, and there are small risks. Many parents who choose circumcision do so for cultural or religious reasons. In the US, newborn circumcision is widely practiced, although the rates vary by region, from about 60 to as high as 90 percent. In contrast, in the UK only a quarter of newborns get circumcised, and in Canada, about half.

Circumcision may be done as a religious observance (as in Islam and Judaism). Other parents opt for circumcision for cosmetic reasons, so that a boy will look "like his father," for example, or so that he will look like the other guys in the locker room. Many parents worry that if they don't have their baby circumcised at birth he may need it later, when it would be more emotionally traumatic.

In 1999, an expert panel of the American Academy of Pediatrics concluded that circumcision does have some demonstrated medical benefits. For example, circumcised infants are significantly less likely to develop infections of the bladder and kidneys. Circumcision also seems to reduce the risk of developing penile cancer and certain sexually transmitted diseases. However, the expert panel did not feel that these benefits were large enough to justify recommending circumcision for all baby boys.

Since it isn't clear that circumcision is medically necessary for the majority of newborns, you could say that this procedure is basically cosmetic surgery with some small risks for the new baby. There are even some who say that circumcision diminishes sexual pleasure, although that hasn't been proven. As for the medical issues, most males, circumcised or not, will never get bladder infections or penile cancer.

If you aren't going to circumcise your son, it is important to note that the foreskin can't be pulled down for cleansing in babies, but is usually retractable by the age of four years. A pediatrician or family doctor familiar with the care of uncircumcised children will know what is normal, can help you know what to expect, and is unlikely to recommend circumcision later on.

Newborn circumcisions are usually done by the obstetrician or family doctor who delivers the baby. A number of nurse-midwives do circumcisions, also. In some regions of the US it is the pediatricians, instead of the obstetrical practitioners, who do them. Urologists generally only do circumcisions on older children and adults (under general anesthesia), and occasionally on newborns with unusual anatomy.

The cost of non-ritual newborn circumcision varies regionally and by practitioner. The range is from $100 to about $250. In the past, circumcision has been covered by insurance as a necessary expense, but there is a trend for insurance companies to say that it is an unnecessary cosmetic procedure, so check with your insurance carrier if you have any questions.

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. Parents may want their sons circumcised for religious, social and cultural reasons. Since circumcision is not essential to a child's health, parents should choose what is best for their child by looking at the benefits and risks.

As noted above, research studies suggest that there may be some medical benefits to circumcision. These include the following:

? A 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 both circumcised and uncircumcised males.

? A slightly lower risk of getting sexually transmitted diseases (STDs), including HIV, the AIDS virus.

? Prevention of foreskin infections.

? Prevention of phimosis, a condition in uncircumcised males that makes foreskin retraction impossible.

? Easier genital hygiene.

Just as there are reasons parents may choose circumcision, they are reasons why parents may choose NOT to have their son circumcised:

? Possible risks. As with any surgery, circumcision has some risks. Complications from circumcision are rare and usually minor. They may include bleeding, infection, cutting the foreskin too short or too long, and improper healing.

? The belief that the foreskin is necessary to protect the tip of the penis. When removed, the tip of the penis may become irritated and cause the opening of the penis to become too small. Rarely, this can cause urination problems that may need to be surgically corrected.

? Some people believe that circumcision makes the tip of the penis less sensitive, causing a decrease in sexual pleasure later in life. This has not been proven by any medical or psychological study.

Almost all uncircumcised boys can be taught proper hygiene that can lower their chances of getting infections, cancer of the penis, and sexually transmitted diseases.

Many parents choose to have their sons circumcised because "all the other men in the family were circumcised" or because they do not want their sons to feel "different." Others feel that circumcision is unnecessary and choose not to have it done. Some groups, such as followers of the Jewish and Islamic faiths, practice circumcision for religious and cultural reasons. Since circumcision may be more risky if done later in life, parents may want to decide before or soon after their son is born if they want their son circumcised.

Circumcision is a decision that many parents face. There are many misconceptions and out-of-date information that parents may read. Here is a summary of the pertinent issues that you should consider when making this decision.

1. Medical benefits — THERE ARE NONE! Do not circumcise your baby because you think there are some medical benefits. A recent review by the American Academy of Pediatrics looked at all the data from the past decades to see if there truly were any medical benefits. Their conclusion — NO. There are no significant medical benefits that make circumcision worth doing. Here are a few benefits that we used to think were true, and now know are not.

2. Religious reasons — some people choose to circumcise for religious or cultural reasons. This is a personal decision.

3. Don't want to be teased — while this may have been true in the U.S. decades ago, the truth is that your uncircumcised kids will be in good company in the locker room when they are teenagers. Less and less people in the U.S. are now circumcising their boys.

4. Too much trouble to take care of — some people think that an intact penis is too much trouble to pull back and clean, especially during childhood. Well, the truth is, you are not even supposed to pull back the foreskin until it naturally comes back on its own between age 3 years and adolescence. So there really isn't anything to even take care of until then.

5. Want your boy to look like dad — the main difference that your child will notice between him and dad is the hair. He won't even notice any difference in the penis until he is old enough that you can then explain the difference to him.

So, what are the reasons TO circumcise?
Here is the list:
Religious reasons — as discussed above.
That is all. There really is no good reason to circumcise other that personal preference and religious reasons.

Are there any reasons NOT to circumcise? Consider these:

1. Leave nature alone — whether you believe God created men with a foreskin, or nature simply evolved this way, there must be some reason men have foreskins. Why change something that God/nature has created?

2. Sensation and sexual pleasure — the foreskin is filled with nerves, and is therefore extremely sensitive to touch. This enhances sexual pleasure.

3. Protects the glans (head) of the penis — the glans is another highly sensitive area. The foreskin protects the glans from constant rubbing and chaffing against clothing that can desensitize it over the years. This preserves sexual pleasure.

4. Ethical issues — there are groups of people worldwide, including medical societies, that oppose routine circumcision because they feel it is unethical for a parent to decide to alter the penis of their child without the child's consent. Parents who are deciding whether or not to circumcise their son may wish to consider the impact this may have in the future if the child decides they wish they were not circumcised.

So, when making this decision, the first thing to ask yourself is this — "Do I have any good reason to circumcise my baby?" If your answer is for religious reasons, then follow your faith. If not, and you can't think of any other significant reason other than just "because", then consider the above information as you make your decision.

Routine Infant Circumcision [RIC] is not practiced in most medically advanced nations. Unlike American parents, few parents worldwide are actually faced with this choice. Their babies are automatically brought home intact. 82 percent of the world's living men are intact. Few people are aware of the fact that circumcision was introduced to our culture in an attempt to eliminate masturbation.

Do not forfeit this decision out of respectful submission to your doctor. There are many benefits to keeping the foreskin intact. Typically, American doctors have limited knowledge in these areas. Many are totally unaware that the foreskin actually requires no special care. People mistakenly believe the circumcised penis is cleaner. The myth that the penis with a foreskin is difficult to clean is exactly that — a myth. The big hoopla over hygiene is pure and unnecessary paranoia.

Although many suggest that anesthesia solves that problem, there are risks associated with anesthesia, including death. It isn't always effective and the needle itself is extremely painful. Some children are surprised to learn that their penis has been cut and that a part of it has been discarded. Some have to live with circumcisions that had unsatisfactory results and the pursuit of foreskin restoration is not uncommon. Circumcision does not guarantee a problem-free penis. In fact, in many cases it is the very thing that initiates numerous problems. Careful cleaning must be performed. Infections of the raw wound are common.

Repeated infections can result in meatal stenosis (a narrowing of the urinary opening) which may require surgery. Meticulous care is needed in order to avoid the formation of an adhesion (scar tissue). This can result in a disfigurement and corrective surgery may be necessary. Some people complain that not enough skin was removed during their son's circumcision. They fear he looks uncircumcised. Children are often subjected to circumcisions being 'redone.' Sometimes, a circumcision may only appear to be incomplete when actually it is not. There may be fat pads in the pubic area. "When the child grows and the fat pad disappears," it will likely have the look of an ordinary circumcised penis. Often too much tissue is removed, although this is not become obvious until later. This can cause painful erections and curvature of the penis. And finally, the circumcised penis is not immune to infections, sexually transmitted diseases or penile cancer.

Many parents are led to believe that circumcision is safer than leaving the penis in its natural form. Your Child's Health by Barton Schmitt reports one out of every 500 circumcisions results in a serious complication. Many things can go wrong including hemorrhage, infections and damage to the penis. Much of the harm of circumcision does not become apparent until adulthood. The assumption that circumcision is inevitable at some later time is a myth. This fear is unwarranted. In Taking Care of Your Child, the authors state "The overwhelming majority of uncircumcised boys never develop medical problems." There is a less than 1 percent chance that circumcision will ever be medically necessary. If only one out of a hundred boys will require circumcision later, why then should the remaining 99 be automatically circumcised?

Even in the unlikely event it were necessary, which is worse — adult or infant circumcision? Many are told or automatically assume it's easier and less complicated for an infant. This just isn't so.

Inappropriately, the foreskin is still blamed for countless problems. So with the best of intentions, parents continue to authorize the procedure totally unaware of the risks taken and loss involved. But these medical problems are usually caused by other means. Penile and cervical cancers, urinary tract infections and sexually transmitted diseases have nothing to do with the foreskin itself. The information as to what actually causes these conditions is readily available. It appears that the major reason circumcision persists in this country is that many think all penises should look alike. The "like father, like son" argument is famous as is the locker room question.

Some insist it simply 'looks better' that way. There are women who claim to sexually prefer a circumcised penis. What they may not realize is that there are sexual advantages to remaining intact. One thing is certain and those who are fully informed know that non-religious circumcision is not medically necessary. Knowing this, if a parent still chooses to circumcise their baby, they are doing it for so-called cosmetic reasons. Non religious RIC persists in America because it has become part of our culture. It has evolved into a purely cosmetic procedure. As an infant, he is forced to experience the parent's preference. Upon maturity, the son may not share the same preference. He may later conclude that if it had been left up to him, he would have preferred to remain intact.

Parents who choose circumcision for cosmetic reasons do not realize that it cannot be accurately described as truly cosmetic. When it is presented so lightly, people naturally assume the effects of circumcision are minimal — even insignificant. The word is extremely misleading. Cosmetic surgery is performed to improve physical appearance without affecting function. The foreskin, commonly believed to have no purpose, actually has numerous functions and all of them are eliminated when the foreskin is removed.

Circumcision is irreversible. Healthy, functioning tissue is amputated from a helpless baby. Many have taken the position that the procedure is a human rights violation. The question is whether parents have the right to consent to an unnecessary procedure that has lifelong consequences.

Some medical and childbirth professionals recommend that expectant parents request permission from their hospital to observe a circumcision being performed. There are also videos available. As with any medical event, people should be made aware of what exactly is involved. This site and others describe the details of all the different circumcision methods.

Today, many Jews are questioning circumcision and opting against it. Some Christians also believe circumcision is required. An organization called Doctors Opposing Circumcision (D.O.C.) is committed to stopping RIC.