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The Circumcision Decision.

Among all the decisions made when expecting a baby, the issue of circumcision is frequently overlooked. This is an issue that all parents need to consider and account for in their plans for birth. There are many people who feel passionately about this issue, and sometimes it's hard to find information without being made to feel guilty or wonder about your decision. Here I hope to provide accurate information to help you decide what is right for your baby.

What are the origins of medical circumcision?.

Only about 25% of the world's males are circumcised, and the age of circumcision varies. Cultural and religious forms of circumcision, of males and females, is performed by many ethnic groups. This article does not intend to discuss or offer an opinion on ritual circumcision.

Medical circumcision was introduced by the Victorians in the belief that it would "cure" masterbation and prevent asthma, epilepsy, mental illness and tuberculosis. This belief has been discredited, so why are circumcisions still being performed?

Belief that it is medically beneficial.

Reasons given for recommending circumcision, and rebuttals:

• Reduced cervical cancer in female partners.
  • There is a lot of conflicting information in the studies.
  • The studies which showed an increased risk were poorly controlled for other factors that may have led to increased cancer rates.
• Circumcision may decrease the risk of cancer of the penis.
  • Cancer of the penis is so rare (less than 1 in 100,000 men gets it) that it's hard to find enough men for a study.
  • It's hard to justify a traumatic and permanent procedure on 99,999 people to prevent a treatable disease in 1.
• Fewer urinary tract infections occur in circumcised boys.
  • Urinary tract infections in boys are much less common than in girls.
  • UTI's are also treatable and preventable in large part.

Societal Norms.

These are some of the social reasons parents give for circumcision:

• "So he'll look like everyone else in the locker room."
  But: The national circumcision rate is around 50%, 35% in western states. The locker room theory no longer holds true.
• "So he'll look like...[dad, big brother]."
  But: Kids don't care. They ask questions and then walk away.
• "It's just what's done."
  I'm not even going to dignify that one.
• "I'd feel uncomfortable touching my baby's genitals."
  But: Sooner or later, you'll have to anyway.

How is circumcision done?.

The operation is usually performed just before the infant is discharged from the hospital, although you can have it done as an outpatient operation, as homebirth couples do, after the baby has had a few days to get adjusted.

• The infant is strapped down to a form-shaped board and covered with sterile cloths.
• Due to infant penile anatomy, it is necessary to peel the foreskin from the tip of the penis (glans).
• The instrument covers the glans so it is usually protected from injury.
• A cut is made around the penis to remove the foreskin.
• Depending on what is used, it may leave a plastic piece around the penis that falls off in a few days with the amputated foreskin.
• The injury takes about a week to heal.
• During healing the penis needs to protected from contact with wet diapers (ouch!) and covered with antibiotic ointment.
• Serious complications, usually excessive bleeding, occur in 1 to 2 in 100 babies.
• Less serious complications: a twist or bend to the penis, or excessively tight skin causing painful erections.
• The skin removed is about 1/3 to 1/2 the skin of the infant's penis.
• Equivalent adult loss is about the size of a 3x5 index card.
• Removes tissue which contains a higher than usual amount of nerve endings--it is quite painful.
• Lingering pain may interfere with breastfeeding.
• Local anesthetic has been used by some physicians, but not much information available on safety or usefullness.
• Follow this link for a page with pictures of a plastibell circumcision. Long load time.

Options for Circumcision.

You may want to consider the following options to make circumcision easier on your child:

• Wait until the baby is a week old. That way you have had a chance to better establish breastfeeding and you and your baby have recovered a little from birth.
• Use anesthetic if you and your practicioner agree.
• Be with your baby during the procedure to comfort him.
• Consider a mohel. A mohel (sounds like "boil") is a ritual Jewish circumciser. They sometimes do circumcisions for non-Jewish couples. They use wine to relax the baby and he is held by an honored friend or family member.

Care of the intact penis.

• Leave him alone. Injuries can be caused by a parent pulling back the foreskin forcibly.
• Protect his penis. Complete retractability may take 3 or even 10 years. Don't let a doctor amputate your son's foreskin because he's not willing to wait.
• Clean the penis. Simply pull back the foreskin as far as it will go back easily, and rinse with warm water. When he's a little older, teach him to do it himself.

Some things to keep in mind when making the decision.

• Circumcision is not medically necessary, and is at best marginally beneficial.
• Circumcision is a decision that you make for your child before he is able to decide for himself.
• Some men are resentful later in life due to their infant circumcision.
• Circumcision is painful.
• Circumcision does not ensure good hygiene. That's something you must teach.
• Many people on both sides of the debate are very pushy about their views. Don't let them decide what's right for your child.

Final Thoughts.

This is a difficult decision, made even more difficult by the fact that one often gets unsolicited advice from friends and family members who may feel strongly about this issue. Remember that it is your decision to make for your family, and making the decision that you know is right in your heart will give you confidence as you learn to parent.

Flame-Free Links for More Information.

• The Circumcision Resource Center.
• Circumcision Reference Library.
• Circumcision: A Medical Journal is a great site for anyone who understands a little about medical literature. If you don't, try out my "How to Read Medical Literature Primer."
• A site with a large collection of information is the Circumcision Information and Resource Pages.
• If you have some time and a little understanding of medical terminology, try "From Ritual to Science: the medical transformation of circumcision in America."

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