My wife and I will be having a son in about a month and we are still deciding if we should have him circumcised.
There does not seem to be a strong medical opinion on the matter but we are concerned about potential social issues associated with him being different than the other boys.
Can anyone suggest resources that might help us better understand the pros and cons of circumcision?
Thank you.
This was a difficult decision for us, as well.
I was convinced that circumcision was the wrong choice for us (despite my upbringing teaching me that all boys should be circumcised), but my wife was hesitant, for exactly the same reason you cited.
I did some research, and we were surprised to find that circumcision rates were much lower than we had expected. In our area, the doctors we asked said that it was roughly 50% of the male babies. It turns out that this is not too far from the national average in the US.
We came up with a list of pros and cons for circumcision, and eventually decided to not have our son circumcised. Here is the list that we came up with:
For circumcision:
Against circumcision:
Despite the claims, circumcision is painful, stressful, and traumatic to an infant. Even the best methods of anesthesia are only partially effective.
Once done, it cannot be undone.
There is a risk of infection and other complications.
Poorly performed circumcisions can leave scarring.
Religion. Some religions are opposed to circumcision.
In the end, we decided to leave him uncircumcised, with the understanding that if he decides he does want to be circumcised, he can always opt for the procedure later.
I personally saw no benefit to circumcising my son.
My reasoning:
There's three schools of reasoning often used here. 1: "The son should look like the father." and 2: "Locker room teasing" and 3: girls don't like a guy with a foreskin
The son isn't going to resemble the father (size wise, hair wise, etc) until he's 15+ and at that point, are they really going to care?
Locker room teasing - all you have to say is, "Dude, stop staring at my junk" out loud towards the person and I guarantee the interest will rapidly disappear.
Girls and foreskins: As a female I can say that the presence (or absence) of a foreskin wasn't a priority for me. It was more a question of the proper usage and how long. My personal opinion: if there's a girl out there that doesn't want to be intimate with my son because he has a foreskin, then he didn't need to be having sex with her anyway.
Having a foreskin isn't difficult to keep clean. A stroke back, wash around the head and rinse. Done. You'll spend more time trying to teach him to dry between his toes thoroughly than you will worrying about smegma. My son is 3 and already knows that that portion of his anatomy is fun to play with in his bath.
Until the foreskin retracts on its own, you don't have to do anything to it - it won't be 'dirty' since it's attached to the head of the penis in the manner your fingernail is attached to your finger. It's fused.
When it does retract on its own (anywhere between the ages of 2-10), then it needs to be cleaned daily in the shower (or bath).
The studies linking circumcision and HIV infection are flawed in a number of ways. I would prefer to teach my son to be responsible and use barrier birth control (condoms) rather than rely on a medical procedure and a false sense of security.
HPV has been likened to a 'sexual cold' due to its prevalence. Again - with the proper use of condoms the presence (or absence) of a foreskin is irrelevant. Certainly HPV can be transmitted on areas which the condom doesn't cover (base of the shaft, scrotum, etc) but then - again - the presence or absence of a foreskin is irrelevant.
Recent research is also discovering HPV's role in penile cancer.
A Danish Study determined that the falling rate of penile cancers in Denmark could not be a result of the circumcision rate. In fact, the penile cancer rates of Denmark (where 1.5% of the population is circumcised) are similar to rates in the US, where the circumcision rate is MUCH higher.
Circumcision is a surgery and therefore carries real risks: blood loss, scarring, disfigurement and/or amputations have occurred.
Consent: an infant can't possibly consent to a surgical procedure such as this. Once it's gone - it's gone (there exists methods for foreskin restoration, but the damage is done). I wouldn't pierce my daughter's ears until she was old enough to ask for them (and understand the ramifications of having pierced ears - cleaning, etc), and I wouldn't cut my son. If when he's 15+ and he wants to be circumcised, then I will arrange to have it done for him. He'll be old enough to understand what he's doing to his body and how it'll affect it - and it'll have been HIS choice.
I know you asked for the benefits of circumcision, but in my opinion there aren't any. Assuming no disfiguration of the foreskin/urethra, circumcision shouldn't be necessary.
Circumcision removes a huge portion of the most sensitive erogenous skin a boy has. What possible reason could one have for doing that unless for religion? (As far as I know this means Jews and Muslims only, and, specifically, not Christians.)
The arguments about hygiene are flat wrong. The foreskin, even after the synechiae attaching it to the glans have all released, houses what is more an internal organ than an external one, just like in a female. Use of soap on the glans or foreskin, just like its use inside a female's outer genitals, is more likely to cause an infection than anything else. Urine is sterile, and just like in a female, helps wash out the foreskin. Any other washing should be done with plain water.
Also, an intact foreskin may be attached and unretractable even up to age 18. If sexual activity is desired and it is still not fully retractable, some cream and gentle stretching will do the job. Forceful retracting is a source of pain and infections. Leave the penis alone, just like you leave a girl's genitals alone, and you will have fewer problems.
Frankly, the belief that circumcision has any material health benefits is just plain wrong.
Last, an intact foreskin provides a kind of mechanical lubrication that eliminates the need for artificial lubrication. Why would you destroy that? In my experience most circumcision proponents have NO CLUE how this actually works and thus can see no benefit to having a foreskin.
I find it sad that parents are cutting off an organ they do not understand the function of.
I was once* invited to a friend's son's bris (Jewish ritual circumcision). I was already in the "why?" camp about circumcising my then-theoretical sons, but witnessing one put me firmly into the "no [expletive] way" camp. The mohel used a topical anesthetic, but that was still one very very unhappy baby. My elder son is now 6, has an entirely age-appropriate interest in comparative anatomy, and has never once asked why I look different, and if he did I'd tell him.
*Actually twice, but the second time we intentionally arrived after the main event.
Absolutely not.
For females, anything "circumcision" is binned under female genital mutilation. In many countries FGM is banned.
As to the "benefits" (such as reduced STI/HIV transmission rates) I would suggest using condoms and carefully selecting sex parters instead.
You can watch this video to see the procedure (warning: shows entire medical procedure).
The only one reason to circumcise another male is on qualified medical advice
I believe that the only reason to circumcise is if a qualified doctor advises it and that the operation should be performed in a hospital/health centre by qualified professionals using proper techniques, sterile tools, anaesthetic and pain-relief medication for after care.
The religious or cultural belief of a parent or relative is no grounds for justification, in my opinion. Would you also get your son a tattoo? How about a tongue piercing?
Since this has come up in the news again, I'd like to present evidence in favor of allowing the choice to circumcise or not.
First, I don't think anyone these days would advocate a blanket policy of "all male children should be circumcised", and I am certainly not. Overall I agree with the official position of the American Academy of Pediatrics:
Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In the case of circumcision, in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child
I do not think the evidence is compelling in either direction, but I believe there are "enough" mild medical benefits to circumcision that I support it for my child, at least. But I would certainly not fault any other parents for deciding otherwise. It is hardly a life threatening or even important decision in the big scheme of things. At best it is minor, on the scale of the deciding to keep your appendix or pierce your ears.
The Wikipedia page Medical Analysis of Circumcision has tons of great citations. Specifically the ones I found compelling in my decisionmaking are:
Ewings and Bowie performed a case-control study of 159 cases of prostate cancer, and found a reduced rate among circumcised men (odds ratio 0.62). The authors noted: "...some statistically significant associations were found, although these can only be viewed as hypothesis generating in this context."
A 1988 New Zealand study of penile problems by Fergusson et al., in a birth cohort of more than 500 children from birth to 8 years of age found that by 8 years, circumcised children had a rate of 11.1 problems per 100 children, and uncircumcised children had a rate of 18.8 per 100. The majority of these problems were for penile inflammation including balanitis, meatitis, and inflammation of the prepuce.
Three studies that have found that boys with foreskins tend to have higher rates of various infections and inflammations of the penis than those who are circumcised:
- Fakjian, N; S Hunter, GW Cole and J Miller (August 1990). "An argument for circumcision. Prevention of balanitis in the adult". Arch Dermatol 126 (8): 1046–7.
- Herzog, LW; SR Alvarez (March 1986). "The frequency of foreskin problems in uncircumcised children". Am J Dis Child 140 (3): 254-6.
- O’Farrel, Nigel; Maria Quigley and Paul Fox (August 2005). "Association between the intact foreskin and inferior standards of male genital hygiene behaviour: a cross-sectional study". International Journal of STD & AIDS 16 (8): 556-588.
Singh-Grewal (2005) performed a meta-analysis of 12 studies (one randomised controlled trial, four cohort studies, and seven case–control studies) looking at the effect of circumcision on the risk of urinary tract infection (UTI) in boys. Circumcision was associated with a reduced risk of UTI (OR = 0.13; 95% CI, 0.08 to 0.20; p<0.001).
According to the American Medical Association, "There is little doubt that the uncircumcised infant is at higher risk for urinary tract infection (UTI)."
Researchers from the Imperial College School of Medicine, Chelsea & Westminster Hospital, London, England reported the results of their study of 357 patients referred for genital skin disease. Most cases of inflammatory dermatoses were diagnosed in uncircumcised men, suggesting that circumcision protects against inflammatory dermatoses.
On Wednesday, March 28, 2007, the World Health Organisation (WHO) and UNAIDS issued joint recommendations concerning male circumcision and HIV/AIDS.[159] These recommendations are: Male circumcision should now be recognized as an efficacious intervention for HIV prevention. Promoting male circumcision should be recognized as an additional, important strategy for the prevention of heterosexually acquired HIV infection in men.
So for me, I want my child to have the best chance of not having these problems associated with foreskins, even if the incidences are quite rare.
Also, having this procedure completed at day 2 of your life when you won't remember it, and as a part of all the other crazy-ass things that happen when you're born (and obviously performed with anasthetic in any case) is preferable to the risk, however small, that you might need a medical circumcision later at an age where you will remember the procedure and the recovery.
