On circumcision

I just followed a link from Facebook to an article (which I then discovered was a series of articles) about infant circumcision by a Doctor Darcia Narvaez.

And, wow. I mean, that’s all I can say. Wow.

Some of what I read I’d heard before, both inside and outside the hospitals where I worked for several years. But some of it shocked me a little bit.

This became a real question for us, as we recently welcomed a baby boy into our family. We decided not to – I’d heard that the possible benefits were well outweighed by the risks and effects, and we decided not to. According to this series of articles (and I did check a few things it claims elsewhere), turns out I was right.

The first thing I found out was that it wasn’t simply the skin on the tip that’s removed, at least how it’s done here in the US. I have to be frank, when I think of my foreskin, I think of the skin loosely covering the head of my penis…turns out it’s about half the skin on your penis…ouch. I’m probably very wrong, but when I read Genesis 17, I didn’t think of nearly that much being removed, nevermind the performance of such a delicate procedure (half the skin, not just the tip…) on an infant with ANE (Ancient Near East) implements. I’d be afraid of cutting the flesh, if not the whole lot off if I had to do it to my son!

I didn’t know babies were in pain when the procedure was performed, I assumed (again, wrongly, isn’t that becoming a habit?) that they weren’t but that if they were that anaesthesia was used. Turns out yes they are in pain, according to studies, probably severe pain, and that a local wouldn’t work completely. Noone does it under a general. Apparently most doctors don’t use any at all. Furthermore, it’s possible that it “causes a rewiring of the baby’s brain so that he is more sensitive to pain later” and could cause PTSD. Dang.

When I think about it, it is unethical to remove healthy tissue without good medical reason. The exception might be for a religious reason, but I would assume (please correct me if I’m wrong) that the majority of circumcisions, at least in the US and non-Jewish/non-Islamic cultures, are not for this reason.

The list of possible complications is longer and more serious than I anticipated. I mean, that’s somewhat obvious considering much more tissue is being removed than I realised. The article (which is well referenced) states that over 100 babies die as a result every year. How’s that for a possible complication? Vaccines are discontinued for far less.

Now, there is a lot of talk about the necessity of circumcision to keep the penis free from infection and disease, particularly “because it is really hard to keep a baby’s penis clean.” Well just from what I’ve learnt in the last few months, babies get covered in poop, sometimes outside the nappy (diaper) even when it’s put on perfectly. I definitely couldn’t pull the skin down to clean it when I gave him a bath for the first time (good thing I didn’t because it doesn’t come down easily and all and it’s not supposed to!). and if there was a wound from a circumcision there to get infected…it wouldn’t be difficult. Turns out, it doesn’t move for at least three years (and often more like nine to twelve), and protects very well even then with normal bathing. Apparently the old advice was that you did need to pull the baby’s foreskin down to clean it, which tears the tissue and hence the reported infections. Ironically, this can cause a need for intervention, even circumcision, aside from the pain, scarring and side effects later in life. The fifth article in the series calls this false fear and desire to pull the foreskin back to clean “the Greatest Danger…most dangerous event facing an ‘intact’ (not circumcised) boy” – pretty scary stuff. Now we (although evidently not enough of us) know better (and all the men thinking about it said “thank goodness”). 

Apparently, it’s also a myth that circumcision can help prevent UTI, but I didn’t know that breastfeeding does help prevent/protect against UTIs. About 1% of circumcised boys develop a UTI, although much of this is blamed on premature forced retraction of the foreskin, and whatever the cause, simple treatment of antibiotics is effective, and I think infinitely preferable to circumcision (which I’d compare to scalping for lice or amputation for athlete’s foot).

Turns out I was right, and wrong, about how many people are circumcised. Globally, “30% of men are circumcised, and most of these men are Muslim” – more than I thought, but correlating with demographic as I had guessed. More interesting is that in most western countries “well below” one fifth of men are circumcised, but in the United States these days it’s around a third of men, down from 85% a quarter-century ago.

Disturbingly enough, circumcision wasn’t popular in the US until the second half of the 19th century, “when a few doctors began to recommend it to prevent children from masturbating” – because it would make it painful to masturbate! Apparently Dr Kellogg (maybe he should have stuck to corn flakes) was a particular supporter of this, among females as well as males. It only reached a majority of men in the middle of the 20th century because it was too expensive for many Americans. Narvaez says to “think of it as “your parent’s body mod.”

Ironic in the light of it’s advocation to prevent masturbation is the assertion that circumcision makes sex more enjoyable for both man and woman. Apparently, not, due to lessened sensation for the man, and reduced (or lessened effectiveness of) lubrication for the woman. Not so fun. Apparently this is contrary to popular rumour, but it always seemed to me that the head would dry out and be sore and much less sensitive without the foreskin.

The fourth article covers “Circumcision Ethics and Economics” and repeats the ethical problem that to non-interventionally circumcise violates the Hippocratic Oath “First, do no harm,” and expresses the concern that what is being done  is being done without consent. This is against international human rights law and treaties, which is why we can’t carte blanche experiment on inmates and psych  and coma patients anymore. Parents can give consent for a minor, obviously, but the issue is whether they can give consent for an elective and potentially damaging procedure without the minor expressing any opinion on the matter. There is the question of whether parents’ preferences are even relevant over medical opinion – are unnecessary cosmetic procedures like nose jobs or breast impants ok too? And if the preference is out of fear of later disease, why could it be okay to remove part of the penis, but not the breasts for fear of breast cancer because the mother and grandmother did? Quite a conundrum.

Here’s a particularly, ahem, blunt quote:

You were circumcised because your dad was circumcised because everyone else was circumcised because 140 years ago, some perverted doctors wanted to stop boys from masturbating.  Being circumcised isn’t better, and it isn’t popular anymore.  The 70% of the world’s men who have foreskins almost never choose to have them cut off and consider them to be the best part of the penis.  You don’t have this part of your penis, and that’s really terrible, but it would be even more terrible to make the same mistake with your own child. 

Apparently it is very costly also. $198 million from Medicaid in the US, more from insurance companies, totalling $1.75 billion dollars when the cost of complications is included. Pricey. 

What do we do about this? One might ask. I suppose my thought would be to seriously reconsider or abandon non-interventionist (ie unnecessary, not medically warranted) circumcision, much like we’ve discontinued the practice of prophylactic appendectomy.
And, given the apparent ignorance even in much of the medical community, I need to be on my toes when we go to the pediatrician to make sure they don’t do it even to ““just see the urethra”” – and anyone who cares for him who might have been misinformed by their parents and grandparents.

Here’s the article links:

Myths about Circumcision You Likely Believe
Part 1: Surgery Myths
Part 2: STD/Hygiene myths
Part 3: Social and sexual myths
Part 4: The ethics and economics of circumcision
Part 5: Greatest danger for uncircumcised boys
Part 6: Harming boys through ignorance of male anatomy

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