To Circumcise or Not to Circumcise

If you have a little boy on the way, you have probably thought about whether to have the foreskin on your son’s penis removed, or leave it intact. With both “pros” and “cons” to consider, some new parents may be confused about this decision. In the end, it’s a family’s personal choice. However, here are some things to consider.

Dr. George Steinhardt, a urologist at Helen DeVos Children’s Hospital in Grand Rapids, Michigan, says the biggest reasons American parents choose to circumcise their boys are still religious and cultural. “I think it’s done primarily for cultural reasons,” he explains.

travelling-newborn-baby-photographer.jpg

photo by Proud to Introduce

The Medical Perspective
Medical professionals today debate whether or not the procedure is medically necessary. Dr. Mark Reiss, a retired physician and executive vice president of the nonprofit organization, Doctors Opposing Circumcision, believes that there is no medical reason to circumcise.  “The penis is meant to be covered by the foreskin. The normal state is intact. The U.S. is the only country in the world that performs routine circumcisions.”

Yet, other experts point that there are valid reasons to consider the procedure. Among them are the following:

Infections: Dr. Anthony Chin, a Los Angeles-based obstetrician, points out that circumcision does make it easier to keep the penis clean, and decreases the chances of infection.  “Let’s face it, boys aren’t the cleanest of genders,” he points out!  Today, however, we have antibiotics to treat infections, making them less dangerous than they were in the past. “Before antibiotics, people got really sick, but now in the post antibiotic era, circumcisions are not ‘medically’ necessary anymore.”

Kindney Problems: “We see a lot of babies with kidney problems,” notes Steinhardt. “For those boys, I would recommend that a circumcision be done. It protects against the possibility of an infection.”  In particular, when his patients are diagnosed with fetal hydronephrosis, or dilated kidneys (which is more common in boys than girls) he almost always believes that circumcision is necessary to alleviate the risk of infection and other complications.

Sexually Transmitted Disease: Steinhardt believes that circumcision may have other serious benefits. “There’s valid scientific evidence that HIV is more likely in a man with foreskin than in a man without foreskin.” Steinhardt also says that you rarely see cancer of the penis in a man who has been circumcised.  However, other experts say there is not evidence that circumcision prevents any STD’s or cancers.

Appearance
Chin notes that circumcisions are basically for cosmetic purposes now, saying that sometimes an uncircumcised child decides to have the procedure done later in life.  In the US, women seem to prefer a circumcized penis, and there are plenty of teenagers who get  circumcised for cosmetic reasons.

Ease
A 5-minute procedure as an infant is easier than the same procedure on an adolescent or adult.  Barbara Dehn, RN, MS, NP, a practicing nurse who teaches at Stanford University, says if you opt to circumcise, do it soon after birth. “The key with circumcision,” she says, “is that if you decide to do it, don’t wait too long. Even when they’re 3, that’s probably too late, since the experience will be too traumatic for them.”

Pain Control
Those who oppose circumcision often call it as a barbaric procedure that leaves infants in terrible pain.  The issue of pain and cruelty is often one of parents’ biggest concerns. Will he feel the incision? Will there be a long, difficult recovery? Will there be complications?

The claim that circumcision causes tremendous pain is simply not true, says Steinhardt. “In general, it’s a pretty harmless procedure. It’s well tolerated, it’s done with great care, and complications are rare and few and far between.”  Plus, with proper pain control, many babies just sleep right through the procedure. “You can have confidence that it can be done safely.” If you are concerned, have a conversation with whoever will be doing the procedure, whether the pediatrician, OB/GYN, or mohel, about what measures can be taken for pain control. A local anesthetic can be used to ensure a painless circumcision.

For more info:

TheCradle: Circumcision: What you need to know

Dr. Sears: Frequently Asked Questions about Circumcision

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Comments

  1. Beyond the pain issues, the biggest objection most people have is ethical. It just simply isn’t right to amputate pieces of anyone’s genitals unless it is an emergency. To do otherwise is morally questionable. That boy will one day be a man with his own opinions about his genitals and what he wants or doesn’t want to keep.

  2. In the U.S., where 75 to 80% of adult men are circumcised, the prevalence of HIV is 7.4 times that in Germany, where circumcision is rare. The prevalence of other STD’s in the U.S. is much greater than in the Netherlands, where circumcision is also rare. In Sub Saharan Africa many tribes that practice circumcision have a greater prevalence of HIV than tribes that don’t. Even if circumcision offers 60% protection, that’s not good enough. The ABC protocol Abstain Be Faithful and / or use Condoms) provides almost 100% protection to all. Male circumcision reduces penile sensation by 75% and is probably the cause of the high rate of female sexual dysfunction (43%) in the U.S. In view of these facts the only person who has the right to request circumcision is your son when he is of age and fully informed.

  3. Your article tiptoes on the same information that is readily available in most pro-circ informational pieces on the internet. Why don’t you present some cold-hard facts instead? Do you have any idea how RARE it is for boys to develop UTI/Kidney issues? Girls are much more likely to develop bladder and kidney problems than girls, yet we always hear this argument when people are looking for reasons to justify the mutilation of their baby boy. Also, this article fails to mention the possibility of these young boys growing up to realize that a vital part of their anatomy is missing. There is no way that new parents can make a decision based on the selective thoughts presented here.

  4. One should be aware that obstetricians perform most of the non-therapeutic circumcisions in the United States, and profit enormously thereby. One can be certain that there is a severe conflict of interest between the best interests of the child-patient and the obstetrician’s bank account. Such advice as given by Dr. Chin and other such “experts” should be considered in that light.

    In reality, male non-therapeutic circumcision is an injurious and unnecessary irreversible operation that amputates large quantities of erogenous tissue from the penis and contributes to sexual and emotional problems in adult life.

  5. Everyone should be able to decide for themselves if they want part of their genitals cut off.

    Canadian Paediatric Society
    http://www.cps.ca/english/statements/fn/fn96-01.htm
    “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.”
    “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.”

    Royal Australasian College of Physicians
    http://www.racp.edu.au/index.cfm?objectid=B5610716-9E3E-6C97-A8D87880FD002E3B
    “After extensive review of the literature, the Paediatrics & Child Health Division of the Royal Australasian College of Physicians has concluded that there is no medical reason for routine newborn male circumcision.”
    (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
    http://www.bma.org.uk/ethics/consent_and_capacity/malecircumcision2006.jsp#Circumcisionformedicalpurposes
    “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.”

    drops in male circumcision:
    USA: from 90% to 57%
    Canada: from 48% to 32%
    UK: from 35% to about 5% (about 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%

  6. First of all, if the procedure takes 5 minutes you can be assured no effective pain relief was used for the amputation.

    The bottom line is it’s HIS body, and morally it’s HIS decision whether to lose about half his specialized pleasure-recpetive nerve endings.

    When it becomes relevant to him, he can decide based on the best evidence THEN available. As of today, not one national medical association of doctors on earth (not even Israel’s) endorses routine circumcision.

  7. Who can know at birth how much the shaft of a man’s penis will expand when erect as an adult? Many men have continuous tears around the circumcision scars and other areas of the remaining shaft skin and mucous membrane (inner area of the foreskin) with each erection. This is from pressure of shaft erection that is greater than the amount of remaining skin and prepuce so it cannot be contained without ripping the surface tissue. The pain makes it difficult have normal sex and to ejaculate. Women find the excessive force of the circumcised penis causes vaginal pain not pleasure.

    Such pain with erection and sexual intercourse for both men and women is only caused by infant circumcision. What man would consent to this experience, destructive from infancy through every subsequent stage of life?

    Only a mercenary sadist would do this to another person. It is not a medical act.

    The only remedy for this is foreskin restoration; about 120,000 men are presently restoring their foreskins and are very happy about it as are their wives. Millions of others have never heard about it and will continue to live out unhappy sexual experiences.

    All this to satisfy “cultural” or “cosmetic” appearance on an unconsenting, powerless individual, right after his birth? What is cosmetic about an injury? Injuries look disturbing and are saddening, on penises and every other part of the body. Causing any injury is not a medical act.

  8. “Steinhardt also says that you rarely see cancer of the penis in a man who has been circumcised.” – He should have stopped at the word “penis”, it’s such a rare cancer that it’s hard to get good statistics. It’s rarer than breast cancer in men (routine neonatal male mastectomy, anyone?) and rarer in non-circumcising Denmark than the US. (The original claim that circumcision prevents penile cancer failed to correct for age: it was made when circumcision was becoming fashionable, and older men – penile cancer is a disease of old men – were not circumcised.)

    “Dr. Anthony Chin, a Los Angeles-based obstetrician, points out that circumcision does make it easier to keep the penis clean,” – trivially so: it takes seconds, and as Penn Teller pointed out, it’s not difficult to get boys to handle their penises.

    “…and decreases the chances of infection.” – Maybe, but from what, to what? Bear in mind too, that many of those infections are caused by meddling, retracting the foreskin (which is usually securely attached to the glans at birth, and may not separate for years) before it is ready. US doctors are generally taught nothing about the foreskin except how to cut it off, so that’s what they prescribe.

    “Let’s face it, boys aren’t the cleanest of genders,” – This is some of the shortsightedness that pervades the discussion. They will be boys for about 15 years, men for about 55, with, as Paul points out, their own opinions on the matter.

    “sometimes an uncircumcised child decides to have the procedure done later in life.” – Yes, and sometimes he decides to put rings in his ears, eyebrows, nose, lips, tongue, nipples, navel and/or genitals, so should we do that at birth on the off-chance he will decide to have those procedures done, too? (And if he changes his mind, he can take those out and the holes will close over, unlike circumcision.)

    “In the US, women seem to prefer a circumcized penis,” – One study of new mothers, most of whom knew no other kind, seemed to show that, but it was statistically weak and clearly slanted. Many women in the US and worldwide prefer men who still have all they were born with: who are we to second-guess them?
    “…and there are plenty of teenagers who get circumcised for cosmetic reasons.” – Or for conformity and an artificial fear of rejection. Whatever happened to “If they were all jumping off a cliff…”?

    “A 5-minute procedure as an infant is easier than the same procedure on an adolescent or adult.” – This assumes it will inevitably be done sooner or later. Why assume that? Actually, any mistake on a baby’s penis will grow with it, but distorted, like writing on a balloon before blowing it up, instead of after.

    “The claim that circumcision causes tremendous pain is simply not true, says Steinhardt.” – Then why is circumcision used as a benchmark for pain studies? Numerous studies have shown that the pain of circumcision is intense, and one found that it affects the reaction to the pain of vaccination, months later. He may not remember it, but how long does it take him to forget?

    ““In general, it’s a pretty harmless procedure. It’s well tolerated, it’s done with great care, and complications are rare and few and far between.” – But in particular, the complications can be severe, up to and including death, and it’s your particular baby they will be circumcising. And it may be “done with great care” but often by an intern as part of their training. Why is Dr Steinhardt so keen on selling the procedure? Would he be so dismissive of the complications of any other surgery? Why do you quote this single ardent advocate at such length?

    “many babies just sleep right through the procedure.” – Or rather, they go into shock.

    “A local anesthetic can be used to ensure a painless circumcision.” – It wears off, and despite your best efforts, he experiences the pain of urine in an open wound for a week or two afterwards.

    And first things last: “To circumcise or not to circumcise”? That is not the question. Hamlet was contemplating suicide, that’s why he equated being and not being. How about “To cut part of his genitals off or to just leave him alone”? In that case, the answer would be so clear it was hardly worth asking.

  9. “Penn Teller” – Whoops, I meant Penn Gillette of Penn & Teller.

  10. i was had it done and everything went fine, i cant remember any pain and i get plenty sensation. all these comments are one sided. it is better to have it done.

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