Friday, June 27, 2014

More about Circumcision

My first post about circumcision ended up focusing on the religious (non-)requirement in my faith. However, there were certainly other issues my husband and I had to assess and resolve concerning circumcision. 

There are several common concerns about circumcising or not circumcising, and some are more valid than others.  I would like to address this list of the most common ones I have encountered in my research on the topic.
  • Cleanliness/The Perception of Uncleanliness: As far as I know, the United States is the only place where there is an active cultural "dissing" of the intact male anatomy. The harshest displays I have encountered were only from internet comments, but I know I tend to be relatively sheltered. Anyway, you may run into statements like "uncircumcised men stink because they can't get themselves properly clean" and "its gross" and even a desire to link intact men with a lower "class" of people (dirty, uneducated, even criminals), exists out there on the web. Even if you know those things aren't true, you can feel like you are putting your son in a difficult social situation.  I really do understand that instinctive desire to give your child the best possible start to life- including social aspects. It bothered me to think that because of an elective medical procedure that we might choose not to have performed on our brand new baby, he would automatically be labeled dirty, disgusting, or anything else. There is good news though. First of all, the statistics seem to show (to varying degrees) that this practice is being reconsidered by a growing segment of the population. In the 1980's something like 85% of boys were circumcised, now that number is less than 50% in some states (it varies greatly by region- western states have the fewest circumcisions, but in the north east it is still very popular). Also, as Latter-Day Saints, we should probably be accustomed to doing things the rest of the world considers "strange" or "different" especially since it should feel a little weird to do something just because "everyone else it doing it." It is still uncomfortable sometimes though. THIS page is one of a series and the best resource I think I have found for dispelling hygiene myths. 
  • Fear of Later Problems: Perhaps the strongest fear-based argument in favor of circumcision goes something like this; "I know a man who was forced to get circumcised for medical reasons when he was 30! He says he wouldn't wish that on anyone and that he wishes he was circumcised as a baby."  Just for arguments' sake, consider this hypothetical story; "I know a woman who had to get a mastectomy when she was 30! She says it was a horrible experience. Wouldn't it have been so much better for her if she had been able to have that done as a baby?" My answer to that question would go something like this: I imagine if she had been able to have the procedure performed in her infancy she would not remember the trauma of the surgery. She also would have missed out to some degree. More importantly though, what would that have meant about her parents that they would decide to deprive her of a part of her body for the first 30 years of her life because of the risk of needing to have it removed at some later period? One day I may have to have a mastectomy or appendectomy or tonsillectomy or any number of procedures if a part of my body fails to such a degree that it must be removed. However, I would not find that to be a reasonable justification for my parents to have a part of my infant body removed before it was necessary.  This argument, while scary, and accusatory ("if your son's penis catastrophically fails later in life it will basically be your fault for not performing prophylactic surgery on him in his infancy"), is not logically sound. 
  • Father-Son "Matching": This is, perhaps, the dumbest argument I can imagine- yet one of the most popular. Let me address it in two ways. First, your son is not going to "match" his father's looks entirely in any way (unless he is a clone)- he is likely to have different color hair and eyes, be a different height, and even have a different skin tone than his father. He is not going to match the way his father's penis looks, even if they are both circumcised, for a very long time. Among other things, I imagine the presence of hair would be one of the most obvious differences to a young boy.  Secondly, this argument sounds as absurd as it ought to when we replace it with any other procedure. Is this a good reason for a baby to get his tongue pierced? To have his appendix or tonsils removed? To have his arm amputated?  Think about it.
  • Fear of Minor "Issues": This usually boils down to things like urinary tract infections and "extra trouble." As far as "extra trouble" is concerned, this usually is in reference to washing, baths and diaper changes. Ironically, it is circumcised boys that are significantly "extra trouble" initially since they have an open wound in their diapers that must be protected, kept clean, and watched for signs of infection. But after that wound is healed, hygiene is not much different. As a baby, toddler, and small child the foreskin is fused on, and only the visible outside needs to be washed (the inside keeps itself clean like the inside of your eyelids keep themselves clean).  More is explained about that on THIS excellent website that I refer to all over this page.  As far as urinary tract infections go, girls are at a much higher risk of UTIs than intact or circumcised boys (and we don't normally suggest surgery as a solution for that).  There are studies that suggest that circumcised boys are at a slightly reduced risk, there are also some concerns about the accuracy of the conclusions of those studies. Quoting from the article linked above "This claim [that circumcision protects boys from UTIs] is based on one study that looked at charts of babies born in one hospital (Wiswell 1985).  The study had many problems, including that it didn't accurately count whether or not the babies were circumcised(!?), whether they were premature and thus more susceptible to infection in general, whether they were breastfed (breastfeeding protects against UTI), and if their foreskins had been forcibly retracted (which can introduce harmful bacteria and cause UTI)  (Pisacane 1990).  There have been many studies since which show either no decrease in UTI with circumcision, or else an increase in UTI from circumcision. Thus circumcision is not recommended to prevent UTI  (Thompson 1990).  Girls have higher rates of UTI than boys, and yet when a girl gets a UTI, she is simply prescribed antibiotics.  The same treatment works for boys." 
  • Desire to Protect "Women"/Desire to Sacrifice Son: Not really sure how to address this one other than to suggest you watch THIS video (it is less than a minute long) of famous obstetrician Lisa Masterson (who I disagree with on almost everything I have ever heard her say) and the host of some late show, Craig Ferguson. Also THIS page I continue to recommend you read. If you want information on the ways circumcision of male babies may be harmful to women I have links at the bottom of the page.
  • Concern For Dad's Well-Being: This is a very real concern and one that all loving wives need to be conscientious and considerate about. It can be hard to approach this topic.  It is important to find a way to discuss this topic without hurting your husband's feelings or ego.  If you and your husband find yourselves in perfect agreement (whatever that may be) it is much easier, but you can have a great marriage and not start out in perfect agreement about everything. If you find yourself leaning against circumcision and your husband leaning for it, please tread gently. It is hard to hear that your wife doesn't want her son to be like you. It is very personal. As THIS page explains "The real issue at play here is [...] the father: if it is okay for his son to not be circumcised, then he did not have to be circumcised, and so he is missing something from his penis" and that is a big deal and a really overwhelming thought. I actually really liked this little essay on discussing this issue with your husband- the best part starts near the end (about paragraph 7). But I like how he explains the goal: "So, the problem is how do we save our son's genitals without psychologically emasculating their fathers?"  Because as much as I didn't want to circumcise our [hypothetical] son, I am not sure sacrificing my marriage or my husband's psychological health would have been worth it. I am grateful that I didn't have to choose between those options, but some women do. 
  • Fear of botched Circumcision: This one did influence my decision, and is also part of how I addressed the above concern. You see, in my digging, I found some surprising stories. Obviously one should not make a decision based on one, or even multiple, anecdotal horror stories.  However, one also rarely makes decisions based on statistics alone, particularly on a topic in which statistics are frustratingly unavailable. It is hard to be sure that the data we have on the percentage of boys who are actually circumcised at all are very accurate- let alone the statistics that are openly "guesstimated" such as circumcisions that require corrective surgery, circumcisions with "complications" and deaths caused by circumcisions. And there are horror stories. There are stories of little boys who came back from the experience with problems that required additional corrective surgeries. Stories of little boys who died from hemorrhage, or who lost their entire penis.  Stories of men who live with unique mutilations, usually in silence.  I remember telling my husband, that if I could be 100% certain that our son would have a perfect circumcision, with no complications, that I could be certain he would look just like his dad, I would think about it differently, and I would probably have considered it more heartily. But nobody could give me that kind of guarantee- and I knew it. So regardless of what the actual (unknown) statistics are- is it worth the risk? For me, it wasn't.
Interestingly, one of my personal greatest concerns came from a story I had heard in regards to a very different issue that came up when my brother was born. The relevant part boiled down to this: when my brother was born my Mom had some concerns about circumcision, she thought she would rather not do it (which was rather radical at that time; yes my dear sisters, we come by it honestly). My Dad, who deeply respects my Mom and her concerns, was cool with that plan. My maternal grandfather, who is not circumcised, heard about this plan and... basically panicked.  He talked to my Dad and the two of them came back to my Mom and basically told her that it really needed to be done; and it was.  

The first time I heard that story I was not pregnant and though I casually inquired as to the nature of the problem Grandpa had brought to my father's attention, my Mom told me she didn't know or couldn't remember and I left it at that.  But once I was pregnant, and considering that the circumcision question would have to be addressed in the event my baby was a boy, this story quickly came back to haunt me.  I had to know- what was the big deal that had changed everyone's minds? What was this incredibly persuasive argument?  I asked my Mom, but she again told me that she couldn't remember if she had even ever heard the argument. So I asked my Dad. Amazingly, he also couldn't remember what it was that Grandpa said that persuaded him. I am however still very curious and may ask him about it if I get a good opportunity.

In the meantime, I have made the educated guess that it was related to his military experience and the theories of the medical establishment at that time.

Like so many parenting decisions, the circumcision question is a tough one.  And if you have a boy, there is no escaping it.  I am not even sure that the "right" answer to this question is the same for everyone. But I do know that Heavenly Father will comfort and guide you if you invite His help through fasting and prayer.  


If you are looking for additional resources with information against circumcision, I have compiled the following links with descriptions. While my husband and I decided not to circumcise our baby, I want to make it clear that this is a very personal decision and that many of the sites and videos I share below have opinions with which I disagree.

-This YouTube video (14:40) is a critique of an episode of "The Doctors" which aired on January 12, 2011 in which the panel of doctors discuss the proposed circumcision ban in San Francisco. The creator of the video tries to use logic-based arguments and has references at the end for his assertions. There are no visually graphic scenes (but because of the nature of circumcision, discussions are almost inevitably verbally graphic- we are talking about male anatomy), although some of his video-editing gets obnoxious and annoying (but it does get better later on).

-Ryan McAllister, PhD,  from Georgetown University has several YouTube videos regarding circumcision.
     -Child Circumcision: An Elephant in the Hospital (33:32) if you are interested in academic/scientific rebuttals to some of the controversial conclusions of various studies and arguments in favor of circumcision, he addresses several starting about 26 minutes in.  At the beginning he talks about the history of circumcision and the procedure itself and the functions of the foreskin and really its just an overall very thorough informative video- but it has a very strong anti-circumcision position and there is a graphic video of a circumcision being performed on an infant as well as pictures of male anatomy- he usually gives a warning/heads up before showing anything like that to give his audience an opportunity to turn away.
     - Unrepresented Voices in Circumcision (15:43) has some personal perspectives from men. The most memorable part of this video for me starts at 6:50 and is about a botched circumcision that was not medically addressed. There is also a brief clip of an interview with a circumcised gay man who is in a relationship with an intact man. There are pictures of male anatomy (without warning).

-Eliyahu Ungar-Sargon made a documentary on Circumcision called Cut: Slicing Through the Myths of Circumcision (which I cannot recommend as it is *very* graphic, as I found out in the first 5 seconds of the YouTube preview- I only watched the first 8 seconds so I don't know much else about it). But honestly, this interview clip (3:27) had a big impact on me. This is exactly the sort of thing that is hardest and scariest for circumcised Daddy's to consider, but as a Mommy I am glad I saw this. This YouTube video (33:32) is an interview he gave on how he decided to make the film (Cut: Slicing Through the Myths of Circumcision) and some of his experience and perspective on circumcision (which is not visually graphic- only shows him talking)- one of my favorite quotes in this starts at 18:53 where he says "Its not a comfortable subject. Its not something people want to spend time thinking about. If you are a circumcised man it is definitely not something you want to think about. And if you've done this to someone else- if you're a mother or a father who has done this to your child, its probably not something you want to think about. And that sort of covers a lot of people." One of the most indisputable statements on circumcision I have ever heard!

-History of Circumcision (it says "short history" but it still takes a fair amount of time to read) also, if you prefer, Chronological Timeline of Circumcision (doesn't really get interesting until about the 12th century)

-THIS page contains the basic intactivist spiel. It is not particularly academic or scientific, but it does contain links that are more so.  What probably hit me hardest was this little piece at the end:

It takes a brave man to admit
that his sexuality might not be
all that it could be.
It takes a strong man
to grant his son
something that was taken from him.

-How male infant circumcision harms women. This is at the very end for a reason.  I almost didn't include it at all. There are other resources for information on this subject if you are really interested, but I will share two. THIS essay by Ronald Goldman, PhD, is very thorough- too thorough in fact- I don't agree with all of his suggestions for harm, but as he mentions, more research is needed (Also, he refers to THIS study, but I did not notice an actual reference). Speaking of research, there is THIS article from about some research that has been done and what the results were. 

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