Tag Archives: RIC

The Truth of Routine Circumcision

28 Mar

In honor of Genital Integrity Awareness Week, I thought I would dedicate my first post to this issue that is very near and dear to my heart.  I have two daughters, why does this issue have anything to do with me?  This is a child’s rights issue.  Bottom line.  I do not discriminate.

There have been countless articles and blog posts on the issue of routine infant circumcision.  I am not going to say anything new, but I do hope that in my attempt to educate on this topic, that maybe someone will read this and decide to question circumcision.

I am going to approach this from two angles, medical and ethical.  Before I go there, let’s discuss anatomy, the circumcision procedure, and the history of circumcision.

Anatomy

In utero, the penis and the clitoris are analogous organs.  They actually develop from the same tissue.  Their functions are very similar, their design is similar…both the glans (the head) of the penis and the clitoris are actually internal organs, both protected by the prepuce, or foreskin.  Yes, females have foreskin too.  At birth, the foreskin is fused to the glans, very much like a fingernail to a finger.  The glans is highly sensitive, and highly innervated, and when born, it isn’t fully developed yet.  The foreskin is attached to the glans by a natural membrane to protect it from feces, ammonia from urine, and any other invading pathogen.  The foreskin naturally begins to separate itself from the glans as the boy’s body grows and matures.  Throughout his life, the foreskin serves many functions.  It keeps the glans moist, lubricated, and supple.  This in turn will increase sexual function and pleasure.  It regulates pH balance of the penis, temperature, and covers the vulnerable urinary meatus (opening in the glans) to protect from harmful invaders.  All of this can be said about the clitoris and it’s “clitoral hood” as well as the vaginal opening and the labia minora and majora.

Circumcision Procedure

There are a couple popular ways circumcision is performed in the US, and I will discuss the most commonly used one, Gomco and Circumstraint, here.  The baby is strapped onto a Circumstraint board.  Each arm is strapped down to either side, as well as each leg.  (I will note that this is the most unnatural position for a new baby who has been in the fetal position for the past 9 months, and you can imagine how traumatic this would be.)

cstraint

Circumstraint Board

After the boy is strapped down, the penis is rubbed with alcohol.  This both sterilizes the surface of the penis pre-op, and causes an erection in the infant so it is easier for the doctor to tear and cut the foreskin away from the glans.  Anesthesia is then injected into the penis (only numbing the dorsal nerve at the base).  The administering of anesthesia isn’t always used, and is definitely a “new” part of the procedure.   The doctor now uses the Gomco clamp.  The vertical post and bell are placed over the glans and the foreskin is pulled over the outside of the bell. Post and bell are then drawn through a hole in the base plate, clamping the foreskin between the bell and the plate. The foreskin is then cut off with a scalpel that is run around the bell.  Once this happens, three feet of veins, arteries and capillaries, 240 feet of nerves and more than 20,000 nerve endings are destroyed; so are all the muscles, glands, epithelial tissue and sexual sensitivity associated with the foreskin. Finally, what nature intended as an internal organ is irrevocably externalized.

gomco

Gomco Clamp

Let’s take a moment to look at this from nature’s view.  I think that from whatever theological backround you come from, we can all agree that babies are born perfect.  There isn’t anything that our bodies have that doesn’t serve a purpose.  For nine months, the woman’s body is meticulously, and intricately putting together a person.  Our bodies know what to do, as they have been doing this since the very beginning.  So, why is it that parents are opting to remove an obviously vital part of their perfect child’s body?  Over the years, there have been several “routine” procedures on organs that are viewed as “pointless” or “not needed.”  Think of appendectomies and tonsillectomies.  Doctors are now discovering the vital roles these organs actually DO play in the overall homeostasis of our bodies.  The foreskin is FUSED to the glans.  It doesn’t want to budge.  And won’t for YEARS.  There is a reason for this.  The circumcision we are seeing in America today, is a relatively new practice.  So how did this act against nature become so widely performed?

The History of Circumcision

Circumcision dates back past 3000 BCE.  However, the circumcision that is performed now is drastically different than the circumcision depicted then.  It is rare to see images of circumcision being performed on infants, and the entire foreskin was not removed.  Circumcision was done for a variety of reasons; religious tradition, rite of passage, to decrease sexual sensation, and done as torture to prisoners.  To this day, many people believe that the circumcision that is being performed today is biblical.  The two Hebrew words used to describe Old Testament circumcision are “namal & muwl.”  Namal means “clipped,” like you might clip your fingernails. The word muwl means “to curtail, to blunt, to cut shorter.”  There are totally different words used in Hebrew for “cut off” or “removed.”  A little cut in the tip of the foreskin was done to draw a drop of blood.  The drop of blood was a symbol of the sin of the world that would someday be paid for by the coming Messiah.  Today, the amount of penile skin that is removed during a typical infant circumcision is equivalent to 15 square inches in an adult male.  Since Christians believe that Jesus’ death paid the price for the sin of the world, circumcision falls into the same category as animal sacrifice, and is no longer required.  Nowhere in the Bible does God demand the amputation or mutilation of male or female genitalia.

Circumcision came to America from Britain in the 1800’s and was said to cure a wide array of  maladies, imaginary or not.  Mainly, it was used to cure masturbation, as it can drastically decrease sexual sensation.  It was believed that masturbation caused blindness, mental illness, alcoholism, epilepsy and several other illnesses.  It therefore made sense to some physicians that circumcision would stop masturbation and prevent the onset of these illnesses.  Circumcision didn’t get extremely popular in America until World War II, many soldiers were circumcised because they believed that it would cut down on venereal disease and other infections.  After the War, the urban and suburbanization of America meant more babies were born in hospitals, and some say that upwards of 80% of boys were circumcised.

Circumcision is now losing its popularity in America.  Last year, an estimated 38% of boys born in the US were circumcised.  A dramatic decrease from a whopping 90% from the 1950’s-1970’s.

Ok, now that we have a good backround…

Medically Necessary?

NO.  Not-a-one health organization in the world states that routine infant circumcision is medically necessary.  Many state it is simply a cosmetic procedure.  Even the AAP, with it’s flippy-floppy “eh, it doesn’t do too much harm,” stance…states that it “is not medically necessary.”  There are a growing number of countries, Sweden being one of them, that have actually banned routine infant circumcision unless there is a medical reason.

Here are some myths surrounding the medical necessity of circumcision:

MYTH:  Circumcision makes the penis easier to clean.

FACT:  An intact penis is extremely easy to clean.  In an infant, you just wipe the end like the tip of a finger.  Since you do not forcibly retract the foreskin until it does so by itself, a simple wipe is sufficient.  As the boy matures and his foreskin retracts, teaching him to wash in the bath or shower will be just fine.  Why is it that we worry about boys not being able to wash their genitals, but we don’t have this concern with girls?  Don’t vaginas have more flaps and folds?

MYTH:  Circumcision decreases UTI rates

FACT:  While circumcision does decrease UTI’s, they are still very rare, and even so…they aren’t life threatening.  Again, UTI’s are much more prevalent in girls, yet we don’t circumcise them.   A round of antibiotics will do the trick, just as you would for your daughter.

MYTH:  Circumcision reduces STI’s.

FACT:  Wrong again.  With the world population of men mostly being intact…the US has the highest rate of STI’s AND the highest rate of circumcised males.  Circumcision isn’t an excuse to not practice safe sex.  Teach your children the importance of using protection.  There have also been very eye opening studies showing that the function of the foreskin, and it’s natural smegma actually decreases transmittal of STI’s.

MYTH:  Circumcision reduces the risk of penile cancer

FACT:  In a letter to the American Academy of Pediatrics, the American Cancer Society stated that it “does not consider routine circumcision to be a valid or effective measure to prevent [penile or cervical] cancers. …Penile cancer rates in countries which do not practice circumcision are lower than those found in the U.S.”

MYTH:  Boys who are left intact will have a greater chance of needing circumcision later in life

FACT:  Actually, boys have a greater risk of dying from their circumcision than they do needing a circumcision later in life.  Many people talk about the Uncle who was intact and got recurring infections, or had phimosis (foreskin that is “too tight” or will not retract).  This is primarily due to medical advice that was given.  Back when circumcision was at it’s peak in the 50’s and 60’s, we didn’t know as much about how to care for an intact penis.  Medical professionals would (incorrectly) tell parents to retract the foreskin and clean with Q-tips.  Doing this tears the foreskin and the tissue (called synechia) that connects it to the head of the penis, leading to scarring and infection.  Instead of preventing infection, it would actually cause problems by introducing harmful bacteria.  Remember that humans evolved from animals, so no body part that required special care would survive evolutionary pressures.  The human genitals are wonderfully self-cleaning and require no special care.  (Again, Creationists, God made you perfect in your Mother’s womb.  He wouldn’t give you something so highly functional, just to be amputated and discarded.)

MYTH:  PHIMOSIS!!! PHIMOSIS!!!

FACT:  First of all, if your infant is diagnosed with phimosis…you need to get a new doctor.  We know that the foreskin is fused to the glans at birth, and naturally separates and starts to retract as the boy’s penis matures, anywhere from age 3 to puberty.  So, a diagnoses of phimosis in an infant is completely incorrect.

Some men actually DO have phimosis.  This is mostly caused by incorrect care for the penis in infancy, but sometimes, it does occur naturally.  As long as it doesn’t interfere with sexual intercourse, it is no problem at all, as urination itself cleans the inside of the foreskin (note that urine is sterile when leaving the body.) Phimosis can also be treated conservatively with a steroid cream and gentle stretching done by the man himself, should he so desire it, or, at worst, a slit on the foreskin, rather than total circumcision.

MYTH:  It doesn’t hurt the baby.  My baby fell asleep right after.

FACT:  Babies feel pain.  Bottom line.  There was a study done in Canada in 1997.  They wanted to see what type of anesthesia helped the most with the pain of circumcision.  So, like every study, there is the control group…who didn’t receive any anesthesia.  It was realized that the babies in the control were in so much pain during the circumcision that it was unethical to continue with the study.  A couple of babies began choking, while another had a seizure.

“Falling asleep” after a circumcision is a COMMON myth.  Babies are equipped with the same protective mechanisms you and I have.  It is called the sympathetic nervous system.  In the face of physical or mental trauma that is TOO much for one to handle, the body retreats within itself and goes into a state of shock.  There will be no crying, and the baby basically is in a trauma induced sleep.

MYTH:  Well…MY doctor uses anesthesia!

FACT:  Not necessarily. Most newborns do not receive adequate anesthesia.  Only 45% of doctors who do circumcisions use any anesthesia at all.  Obstetricians perform 70% of circumcisions and are least likely to use anesthesia – only 25% do.  The most common reasons why they don’t?  They didn’t think the procedure warranted it, and it takes too long.

Risks of Circumcision

Meatal Stenosis: Many circumcised boys and men suffer from meatal stenosis.  This is a narrowing of the urethra which can interfere with urination and require surgery to fix.

Adhesions. Circumcised babies can suffer from adhesions, where the foreskin remnants try to heal to the head of the penis in an area they are not supposed to grow on.  Doctors treat these by ripping them open with no anesthesia.

Buried penis. Circumcision can lead to trapped or buried penis – too much skin is removed, and so the penis is forced inside the body.  This can lead to problems in adulthood when the man does not have enough skin to have a comfortable erection.  Some men even have their skin split open when they have an erection.  There are even more sexual consequences.

Infection. The circumcision wound can become infected.  This is especially dangerous now with the prevalence of hospital-acquired multi-drug resistant bacteria.

Accidental amputation of entire penis.  This happens much more frequently than you would imagine.

Death. Babies can even die of circumcision.  Over 100 newborns die each year in the USA, mostly from loss of blood and infection.

Ethical Issues

Now that I have discussed the anatomy of the penis, the circumcision procedure, the history…then we have found that it isn’t medically necessary and actually causes plenty of harm, let’s finish off by discussing the ethical boundaries routine infant circumcision crosses.

1.  It isn’t your penis.  This is a cosmetic procedure that is being inflicted on a non-consenting infant.  It is the amputation of a highly innervated and extremely functional part of the male genitalia.  This is not only a physical and mental assault, but also a sexual one.

2.  It isn’t your penis.  I hear so many people say their main concern is that they want their son to look like Daddy.  Out of all of the reasons, this one bothers me the most.  So, taking into consideration all of the medical and health issues circumcision causes, DEATH being one of them, having a son “look” like his Daddy trumps it all?  How often do fathers and sons compare penises?  I know I never compared my vagina with my mother’s.  Circumcised or not, all penises don’t look exactly the same.  It is easy to be honest.  “Son, you look different because you have your foreskin and your father does not.  His was removed in a surgery that was popular when he was a child.”  I am sure he will shrug it off and move on with his day.  As an adult, I guarantee you he will be thankful that he has his entire penis.

3.  It isn’t your penis.  I have a feeling that if you were to have a cosmetic procedure done to you as a child, against your consent, you would be highly upset.  So many circumcised men DO care.  They DO speak out.  They DO suffer LASTING consequences from their circumcision.  It affects their sexual relationship with their partner.  Many circumcised men also state they have no problems with their penis.  They are happy they don’t have their foreskin.  Well, that is fine and dandy, but you can’t compare it to something that you never remember having.  That is like someone who can only see out of one eye saying that their eyesight is amazing.  They will never know what it would be like to see with both eyes.  Taking into consideration the tens of thousands of damaged nerves, and completely amputated nerves…I have a feeling there is QUITE the difference in penises.

4.  It isn’t your penis.  You think whole penises look weird?  Ok.  So, subjecting your son to a dangerous cosmetic procedure against his will is OK because you don’t like the look of it?  Well.  It isn’t your penis.  It isn’t the penis you will be sexually active with.  Why does your sexual preference have ANYTHING to do with the state of your son’s penis?  This argument weirds me out too.  Think of it this way.  Aesthetic preferences change drastically every generation.  Whatever is popular in society at the moment is what wins.  Styles change…body style preferences.  There was a time when heavier women were all the rage.  Then Twiggy skinny.  Then muscular.  Yadda yadda.  In places where circumcision is almost nonexistent, circ’d penises look “weird” to them.  Worried he won’t find a partner?  Think again.  Plenty of women prefer natural penises (I will discuss the anatomy of sex with circumcised and natural penises in a separate post).   How superficial of a woman to refuse to be with your son because he has his whole penis.  I wouldn’t want my son partnering up with a woman or man like that, anyways.

5.  It isn’t your penis.  “My son will thank me for having him circumcised while he was a baby.”  Maybe.  But maybe not.  He may have physical and medical complications.  He may learn the truths of circumcision (since it is greatly losing it’s popularity in the US) and be very upset that he was violated as an infant.  He may be enraged that he never had a choice.  It’s his body.  Give him the choice.

6.  It isn’t your penis.  Just like your daughter’s vagina isn’t your vagina.  Just as you would never even consider having her circumcised because it would be easier to clean.  Or you thought it would look better.  Why is circumcising a girl called “female genital mutilation,” but circumcising a boy is just a common, no-big deal, happens everyday surgery?  Boys deserve better.  His body, his choice.

It isn’t your penis.  His body, his choice.  Boys deserve better.

I hope that this post has sparked even the tiniest amount of interest in you. I hope that you dig a little deeper.  I hope that you question circumcision.  Do your own research.  I hope that if you have circumcised your son, that you don’t beat yourself up, but that you take this information and run with it.  Once you know better, you do better.  You can’t take this information and shrug it off thinking that it is no big deal.  This is a huge deal.  Hundreds of thousands of our sons are being subjected to this procedure in this country.  Babies are permanently scarred.  Babies are dying.  For what?  This madness has to end.

References:

Anand et al., “Can Adverse Neonatal Experiences Alter Brain Development and Subsequent Behavior? Biol Neonate 77 (2000): 69-82.

Bollinger, D.  “Lost Boys: An Estimate of U.S. Circumcision-Related Infant Deaths,” Thymos: Journal of Boyhood Studies Volume 4, Number 1 (2010).

Boyle, G.,et al., “Male Circumcision: Pain, Trauma, and Psychosexual Sequelae,” Journal of Health Psychology 7 (2002): 329-343.

Hammond, T., “A Preliminary Poll of Men Circumcised in Infancy or Childhood,” BJU 83 (1999): suppl. 1: 85-92.

Goldman, R., “The Psychological Impact of Circumcision,” BJU 83 (1999): suppl. 1: 93-102.

Lander, J. et al., “Comparison of Ring Block, Dorsal Penile Nerve Block, and Topical Anesthesia for Neonatal Circumcision,” JAMA 278 (1997): 2157-2162.

Schwartz, William M., MD et al., PEDIATRIC PRIMARY CARE: A Problem-solving Approach, 2nd Edition, Year Book Medical Publishers, Inc., 1990, pp. 861-862.

Stang, H. et al., “Circumcision Practice Patterns in the United States,” Pediatrics Vol. 101 No. 6 (1998): e5.

Taddio A, et al.,  “Effect of neonatal circumcision on pain response during subsequent routine vaccination.” Lancet 1997;349(9052):599-603.

Van Howe, R., “Variability in Penile Appearance and Penile Findings: A Prospective Study,” BJU 80 (1997): 776-782.

Van Howe, R., “A Cost-Utility Analysis of Neonatal Circumcision,” Med Decis Making, December 1, 2004; 24(6): 584 – 601.

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