Circumcision

It's usually exciting to talk about penises, but when specifically discussing circumcision, if somehow loses the "wow" factor.  First of all, you should know that I really have no opinion on this matter.  My son isn't circumcised, but not for the normal reasons.

1. We didn't want to pay the $200 because we were poor.
2. I could barely handle the belly button, and didn't think I'd do well with the circumcision care.
3. I couldn't change the meconium poop because it make his butt red.  There was no way I was messing with a legitimate wound.

So those were MY reasons for skipping the circumcision.  Whatever YOU decide to do - I really don't care.  I can't find evidence on either side that screams the decision actually matters.  Sometimes in parenting there are clear right and wrong answers (letting your kids play in traffic is dangerous, beating them in wrong, etc), but this just isn't one of them.  Not for me anyways.  However, I do think some of the arguments on both sides are completely and utterly ridiculous and need to be addressed.  So let's discuss some common arguments for and against, shall we?

Arguments For Circumcision

An intact penis is dirty/smelly/gross: As the parent, it's really your job to keep your child in a sanitary and hygienic state.  You bathe him, you wash the jelly out of his hair, and it stands to reason that you will clean his penis, no? Likewise, you teach him to wash his hair and use soap, so one would think you would also teach him how to care for his uncircumcised penis.  If you've ever encountered a smelly/disgusting intact penis,  I would wager it's more the fault of the owner of the penis and/or his parents, as opposed to the blame being solely on the status of penile alterations.

An intact penis means more UTIs: Again, this is really a hygiene.  Some people are more susceptible to infections than others, but as women we wipe from front to back in order to avoid UTIs, and the men shall clean themselves properly.  This will not eliminate all chance of infection, but will greatly reduce it.

1. The CDC says "Lack of male circumcision has also been associated with [. . .] infant urinary tract infections" and that's all.  The CDC cares more about STDs, which we'll discuss later.  It gave me no numbers and no evidence, but since it's the CDC I'll have to take their word for it.
2. It should be noted that this supposed connection was not discovered until 1982, and circumcision was establish long before that.  I only mention this because I find it odd that it's one of the most common reason given to circumcise these days, but doesn't work for any circumcision prior to 1982
3. Anyway you look at it, about 1% of all baby boys, intact or not, contract a UTI in the first year.
4. Some studies have proven the complete opposite - that circumcision causes UTIs.

An intact penis is more at risk for contracting HIV: This one is actually true, according to the CDC:

In 2005, men who have sex with men (MSM) (48%), MSM who also inject drugs (4%), and men (11%) and women (21%) exposed through high-risk heterosexual contact accounted for an estimated 84% of all HIV/AIDS cases diagnosed in U.S. areas with confidential name-based HIV infection reporting. Blacks accounted for 49% of cases and Hispanics for 18%. Infection rates for both groups were several-fold higher than the rate for whites. An overall prevalence of 0.5% was estimated for the general population [23]. Although data on HIV infection rates since the beginning of the epidemic are available, data on circumcision and risk for HIV infection in the United States are limited. In one crosssectional survey of MSM, lack of circumcision was associated with a 2-fold increase in the odds of prevalent HIV infection [24]. In another, prospective study of MSM, lack of circumcision was also associated with a 2-fold increase in risk for HIV seroconversion [25]. In both studies, the results were statistically significant, and the data had been controlled statistically for other possible risk factors. However, in another prospective cohort study of MSM, there was no association between circumcision status and incident HIV infection, even among men who reported no unprotected anal receptive intercourse [26]. And in a recent cross-sectional study of African American and Latino MSM, male circumcision was not associated with previously known or newly diagnosed HIV infection [27]. 

There are two ways of contracting HIV during consensual sex.  Having unprotected sex that you know is unsafe, and having unprotected safe that you think is safe (being in what you think is a monogamous relationship that really isn't, mostly).  I find it odd to consider circumcising our infant boys to protect them from their own stupidity (scenario one).  But whether you want to take scenario two into consideration is up to you.

An intact penis is more at risk for various other STDS: Again, according to the CDC, this is true.

Lack of male circumcision has also been associated with sexually transmitted genital ulcer disease and chlamydia, infant urinary tract infections, penile cancer, and cervical cancer in female partners of uncircumcised men [1]. The latter two conditions are related to human papillomavirus (HPV) infection. Transmission of this virus is also associated with lack of male circumcision. A recent meta-analysis included 26 studies that assessed the association between male circumcision and risk for genital ulcer disease. The analysis concluded that there was a significantly lower risk for syphilis and chancroid among circumcised men, whereas the reduced risk of herpes simplex virus type 2 infection had a borderline statistical significance [4].

And again, it mostly comes down to our sons practicing safe sex, and not whether or not they are intact.

It should also be noted that there are also studies that cite that circumcision has no bearing on sexually transmitted diseases at all.

He'll just need to get it done later: This would be a myth.  About 1% of boys and men ever have a medical need for circumcision.  This is one of those things where you can cross that bridge when you get to it.

An intact penis looks funny: If you say so? Personally, I think penises are ugly regardless if they've been altered or not.  I'm sure some women prefer the look of an intact penis, much like some prefer the look of a pierced or tattooed one.  If my son meets a girl who doesn't want to date or marry him because of the way his penis looks, then I'd rather he not marry her anyways.

I want him to look like his daddy: This is the dumbest one to me, personally.  Like I said, I don't care which way you go with this decision, but this reason is totally lame.

1. Your son's penis will never look completely like your husband's.  One major difference is going to be pubic hair, because I really doubt that once your son hits puberty he's still going to be comparing his penis to his father's (it's possible, just unlikely).
2. It also doesn't make sense why it's so important for him to "look like daddy" when we know our daughters will never "look like us."  Her breasts will be a different size and/or shape (especially before she has kids), and maybe even a different color.  Her vulva will not look the same either.
3. It's just a nonsensical argument on the "for" side.  There are plenty of logical reason to head to the surgeon, and this one should just be left off the table.

He'll be teased in the locker room if I don't: Well, yeah.. maybe.  But he'll be teased in the locker room if he develops pubic hair before or after his classmates, or if he is larger or smaller in.. stature.  He'll be teased if he's short, or if his belly button looks funny.  More and more boys aren't being circumcised (see some of the reasons below), and it's getting less and less likely that your kid will be the only "torpedo" in the locker room.

Religious or Cultural reasons: This is probably the REAL reason most people circumcise their babies (everything is thrown in because they feel like they need to justify themselves to others).  It's because "everyone else" does it, because they don't want their kid to be abnormal, because it's just what's done, and what's been done in our country for a long time.  I don't know if I have an argument for this one except maybe that sometimes cultures change their practices with time and information, if the information is conclusive.

Arguments Against Circumcision

Here's where the medical reasons disappear, and everything comes down to emotion, ethics, and opinion.  First I will list them, then I will talk about them.

It's unethical to:

1. Make surgical decisions for an infant who can make it themselves later in life
2. To force an unnecessary medical procedure on a newborn
3. To surgically alter a person without their consent
4. To perform surgery without anesthesia

Dicuss:

1. We make all kinds of decisions for our kids, even before they are born, some of them effecting them for life, just like circumcision.  Furthermore, any surgical procedure, any wound, any broken bone heals faster in a newborn.  That's fact.  The process may not be less painful for an infant than an adolescent or adult male, but it certainly heals faster.
2. Anyway you look at it, circumcision is "medically unnecessary" in most cases. You can say that you want to prevent STDs and cancer, but if that's REALLY your reason, then you would have to try to have his testicles removed, and to have your daughter's ovaries and mammary glands removed as well, so they don't get cancer later in life.  No one does this.  Of course this is an exaggerated argument.  Circumcision is A LOT less invasive, isn't considered a major surgery, etc.  But the point is the same.  What other surgical procedure is routinely performed on infants in order to maybe prevent things later in life?
3. This is true in cases where the person in question is able to consent in the first place.  But we remove skin tags and take care of "port wine stains" without batting our eyelashed.
4. I'm gonna have to give this one to the intactivists.  I can't even argue against it.

It reduces their sexual function and pleasure: Since I already used the CDC more than once, I'll go ahead and do it again:

Well-designed studies of sexual sensation and function in relation to male circumcision are few, and the results present a mixed picture. Taken as a whole, the studies suggest that some decrease in sensitivity of the glans to fine touch can occur following circumcision [18]. However, several studies conducted among men after adult circumcision suggest that few men report their sexual functioning is worse after circumcision; most report either improvement or no change [19–22]. The three African trials found high levels of satisfaction among the men after circumcision [9, 10,11, 16]; however, cultural differences limit extrapolation of their findings to U.S. men.

 Since the foreskin has a large collection of nerves, it stands to reason that sensation would be reduced, and yet there is evidence here to support that it's not reduced enough for the guys to notice a difference.

The Foreskin is an organ that's necessary for protection and immunological defense:  According to the CDC, the opposite is true, but if you consider all the studies as a whole, the results are mostly inconclusive.  So, assuming it is necessary and useful, losing it does not have a crippling effect on the body's defense system.

It has possible side effects/complications - it is surgery after all:
Meatal Stenosis
Infection at the wound site
Secondary bacterial infections (staph, even tuberculosis)
Hemorrhage during the procedure
Human error (doctor screws up)

These are all valid concerns, and should be taken into consideration when making the decision, even if they may not require you to completely rule out the surgery all together.

Cost: Ever since the AAP decided circumcision wasn't medically necessary, many insurance providers have stopped covering it - including Medicaid in many states.  This is probably the leading reason people aren't having it done, to be honest - because the potential benefits and cosmetic motives aren't enough to warrant the out-of-pocket cost of the procedure.  This is mainly why I think that your little boy won't be the only one in the locker room that's intact.



And that's pretty much all the research that I'm willing to do for you.  If you want to know more about anything I discussed, I encourage you to try Google.  I do have to sleep at some point. ;)