Saturday, January 1, 2011
No Cutting, Thank You
Circumcision is a divisive issue, and one that I have my hands firmly planted into. The practice and the fact that it is socially accepted, medically condoned and legal makes me quite angry. But I didn't always have these strong feelings. There was a time when I just didn't see a point in it. Now I have lost friends over my views. There are a lot of "why we did" and "why we didn't" stories out there. This is my "why we didn't" story.
When I was a senior in high school, a friend told me her brother was intact (I'm not sure what the conversation was that lead to that fact being revealed). In my years up to that point, I had never really given circumcision a thought. My only sibling was my younger sister. It's not a topic that ever came up in polite conversation. She told me that her parents had made that decision because, in their minds, there was just no reason to do it. They must have had a progressive doctor, being the late 70's. Her telling me that planted a seed in my mind. There was no use for circumcision? Why do they do it then? What does an uncut penis look like?
Outside of one Canadian male 'friend' in college and an older man whom I cared for in a group home in my mid-twenties, I only knew circumcised penises as the norm. But, when I found out I was carrying a baby boy, circumcision was one of the first thoughts that popped into my mind.
I didn't broach the topic with Shane for several weeks, until I finally blurted out, "I just want you to know, I don't plan on circumcising our son."
He took issue with this. In fact, it became a point of contention for a good chunk of my pregnancy. His were the typical concerns a father has; his son won't look like him, what about being made fun of in the locker room, isn't it cleaner?, I heard it prevents HIV transmission...
His were the typical gross misunderstandings about circumcision.
For his sake, I hit up Google with some pretty basic search criteria. I came up with some poorly executed study that showed a slightly higher prevalence of HIV/AIDS in intact men. Regarding that study, even if it were true, I have this to say, "Correlation does not necessarily prove causation." I learned that in College Psych 101. Regarding that myth, I have this to say, "Safer sex practices prevent HIV, not circumcision." Sadly, because of this myth, adult men in Africa are now choosing to be cut because they think that in being circumcised alone, they are preventing HIV transmission.
(You can read more about the HIV/AIDS study here.)
I was able to quickly debunk the 'cleaner' myth. And I addressed the "he won't look like me" and "standing out in the locker room" worries like this: "If we were having a daughter, her vaginal area and breasts would never look like mine" and "If we cut him, the other boys would just find something else to pick on him for." It hardly seemed like a viable reason to cosmetically alter the boy's body, in case he might be picked on. As for the cleaner/STI prevention myth, I informed him we would teach our son proper hygiene and safer sex practices.
I did, at one point, pull out the big guns. Firstly, since we're not married, it was my consent, not Shane's, that the hospital needed to preform the surgery. Secondly, in the state of Wisconsin, it doesn't matter whether we are married or not, they won't preform the surgery without the mother's consent. So, basically, he had no choice. I had only hoped he would understand my reasoning for not cutting our son. I also pointed out very bluntly, it's his body, not ours. We really have no place in even having this choice to make for him.
Bottom line, that was why we chose not to have it done. What was the point? None. And besides, it's not our body.
At this point, let me point out that I am not against circumcision. Like any cosmetic surgery, every consenting adult above the age of 18 has the right to go to a doctor and have a part of their body altered. I AM against routine infant circumcision. That baby boy had no say in the matter. His signature was not collected on an informed consent, nor was he given the option of informed consent.
When my son was born, a lot was going on, I gave little thought to his penis, let alone his fingers and toes. He was taken away from me almost immediately. However, I can't even begin to imagine that if he had been born under the most peaceful circumstances, that I would have gone from awing over how amazingly beautiful he was to thinking "But, something's not quite right... Let's chop off his foreskin!"
So that was that. I left the hospital with a baby boy, perfect the way he was born.
It wasn't until I got home and started doing some real reading into what might have gone wrong during his birth, that I stumbled across information about circumcision. Information I hadn't stumbled across while researching it while pregnant. The more I learned, the more enraged I became that this practice has become an allowable, even preferable, part of our culture.
The more I learn, the more angry I become over this practice. This is the point in this post where we go from 'why we didn't' to 'why no one should'...
First, let's talk about the history of circumcision.
The United States is the only country that practices routine infant circumcision for non-religious reasons (Isreal is the only country that preforms it regularly for religious reasons, although it is preformed around the world for both religious and non, though on a much, much smaller scale).
It began in the US during the Victorian Era as a way to punish boys who were caught masturbating. Eventually, it became recommended to prevent boys from masturbating. Doctors at the time acknowledged that removing the foreskin resulted in a reduction of sensitivity. In fact, circumcision has been recommended as a way to prevent a whole host of diseases and malfunctions, more than any other 'preventative' procedure.
It seems, with every generation, circumcision 'prevents' something new. It started with masturbation and over time has come to prevent everything from epilepsy to mental retardation to HIV transmission and penile cancer. The everlasting favorite of medical professionals and other pro-circers is that it's 'cleaner'. Also, very much not true.
In fact, the foreskin is an ingenious piece of skin which preforms it's job well. When an intact male is getting ready to urinate, the opening at the end of the foreskin opens slightly to allow the urine to pass through, once the urine passes through, it snaps tightly shut. The myth about UTI's being less common in circumcised men? The fact is, UTI's are very uncommon in men at all. They are far more common in women. But, when a woman gets a UTI, she takes antibiotics (or, if she catches it quickly, a round of cranberry capsules and lots of water). Saying that we should remove the foreskin of baby boys because of the potential for a future UTI is like saying we should remove all appendices at birth because of the potential for appendicitis in the future.
Another common argument for the "it's cleaner" camp is that an intact penis is 'cheesy' and/or 'smelly', and that cleaning a circumcised penis is just easier. Firstly, let's address the cheese (the technical term is smegma). Circumcised men produce smegma, but more than that, women produce more smegma in their labial folds than men, intact or otherwise. Secondly, cleaning an intact penis is barely one step more than a circumcised penis. Once the foreskin detaches itself naturally (usually between three and puberty, although some can detach when the boy is still a baby, or not until the man is sexually active... more on that in a moment), all that is needed is for the boy (or the caregiver) to pull back the foreskin, rinse with water and let it go. (It should be noted that foreskin which has not already detached naturally should never be retracted for any reason).
I'm thinking, just from what I've heard about circumcised babies, that it sounds like a heck of a lot more work to care for a freshly circumcised penis during the healing process than an intact one takes over the course of a life time.
Before moving on, I'd like to point out one more reason against the locker room argument. The fact is, that all intact men have the ability to pull back their foreskin and closely resemble a circumcised penis.
Okay, let's talk about that naturally retracting thing. All baby boys are born with their foreskin fused to the glans (head) of their penis. When a circumcision is preformed, the foreskin is peeled away from the glans and cut off (A full 1/3 of the skin of the penis is removed, to be exact. This equals approximately 15 square inches of the full grown man's penis skin being removed).
That leaves a red, raw, exposed mucus membrane (much like the inside of your cheeks and lips, and exactly like the labia in women). It can take as much as a year for the exposed skin to karotinize. This is a process during which several layers of skin form to protect the sensitive area. Think about if someone removed your eye lids and left your eyeball exposed to the elements. What was once a moist, sensitive part of your body will now harden. Without the lids (foreskin) to protect and moisten the surface, it is left open, exposed to air, left to dry. Your vision would never be right again. In the case of circumcision, the boy's sensitivity is taken away. You don't even have to imagine this. Just think about when you wake up with a stuffy nose and your mouth has been gaping all night, think about how dry and leathery the inside of your mouth feels compared to how it feels normally.
I think what grossed me out more about the idea of that open wound was throwing that open wound inside a diaper. I can't think of any other situation where anyone would think it was okay to put an open wound in an environment in which it can come into contact with urine and feces on a regular basis.
What about religious reasons? Totally not valid. The historical tradition of circumcision bears almost no resemblance to the circumcision begun in Victorian United States. It was once a nick on the tip of the foreskin to allow a few drops of blood out, from which the mohel drank. It was seen as a sacrifice to humble oneself for God. Personally, this practice seems equally wrong, but, my point is only to point out that removing a baby's entire foreskin (typically without anesthesia when done as a religious ceremony) for religious reasons is just not historically accurate.
This list is not exhaustive. This is not all there is to know about circumcision. But, these are the things that stand out to me as the most commonly cited reasons for being pro-circumcision. In all the research I've done, I have never come across one compelling reason FOR circumcision. Over time, I found myself realizing more and more, it is a human rights violation.
I've heard people take issue with attaching such a strong connotation as 'human rights violation' to circumcision. But, I counter, marches on Washington have been carried out over less. The moment that baby boy's right to genital integrity was taken away, his rights were violated. Circumcision indeed meets the very definition of the term 'human rights violation'. That foreskin doesn't regenerate (although painful re-adhesion can form, another side effect rarely mentioned). There are no second chances.
Consider this, several grown men have filed law suits against the hospitals and doctors that preformed their circumcisions, siting a lack of informed consent. And they have won. That alone, in a culture with a massive fear of medical malpractice, should really get people thinking.
If I were born a boy, I would have been circumcised. And I would be pissed.
At what age does it become not okay to take your child in to be circumcised? One month? Twelve months? Two years? There have been cases of fathers trying to take their seven year old (in one case) and twelve year old (in another case)sons into be cut. Both cases went to court and in both cases the boys 'got' to keep their foreskins.
At what point does it become abusive? If it's performed by a medical professional or religious official (who by the way, are not held to any standards), it is deemed okay by society. But recently, a man was taken to court for circumcising his two sons at home (I believe one was an infant and the other a young toddler). He cited lack of funds as his reason for doing the surgery at home with a kitchen knife. The judge released him as innocent since there is no law banning circumcision of males, even outside the hospital, in our country. The judge was kind enough to point out that it IS illegal to circumcise females, and for that, the father would have gone to jail.
Three babies died in Infantino Slingriders. The product was recalled and banned from the market. Several babies have died in drop-sided cribs, so they were recalled and banned from the market. But, some 120-200 infant boys a year die from circumcision, and it continues as a legal, medically and culturally condoned practice.
How does a baby boy die from circumcision? Whether or not anesthesia is used during the circumcision, the boy experiences all the same bodily and hormonal responses. The heartrate spikes to 200 beats per minute during and for several minutes after the procedure. Cortisol, the stress hormone, is released in massive quantities, along with endorphins and adrenaline. The baby typically falls into shock within seconds of the start of the procedure. This is where you hear the old myth 'my baby slept right through it' or 'my baby didn't cry at all', because they are in shock, much as anyone would respond to a major physical trauma. Can you imagine the baby born with an unnoticed heart defect? (It is these responses that can also hamper a successful nursing relationship. Often, the baby is too traumatized to nurse or latch properly).
It takes the loss of only one ounce of blood for a baby to hemorrhage, and the loss of only 2.3 ounces of blood for a baby to die. If you can imagine, this is about two shot glasses worth of blood. The typical disposable diaper is designed to hold 15 times it's weight in water. Often, the loss of blood is not even noticed until it's too late. Most babies die within hours, or even days, of the procedure, not necessarily during.
For this reason alone, circumcision strikes me as a completely unnecessary risk. Why on earth would any parent put their child's life on the line for aesthetics?
Click here for a wonderful, to the point list of 'one liners against circumcision'.
One man sues and wins!
For a medical perspective: Not all doctors recommend or condone circumcision.
Death by circumcision:
Circumstitions (For other complications listed on this site, click here.)
Ending Medicaid funding of circumcision (On average, in states where medicaid stops covering routine infant circumcision, the rate drops by about 25% within a couple of years).