Intactivists speak for those who cannot speak for themselves in the hope of changing hearts and minds on the issue of routine infant circumcision. I'm not here to accuse or argue. I'm here to inform and discuss. Welcome, and play nice! Find us on Facebook at http://www.facebook.com/savingbabies.blogspot !

Friday, June 24, 2011

It’s a Boy!

Are you expecting a baby boy? Congratulations!
There are a few things you’ll probably want to consider while waiting for the little gentleman to arrive. Breast milk vs. formula, cloth diapers vs. disposable diapers. There are a lot of choices you have to make for your son. One choice you may be thinking about is whether or not to circumcise your baby. You’ve probably heard a lot about circumcision, but can you trust everything you’ve heard?
The fact of the matter is that the U.S. has a lot of untruths circulating about circumcision.
What You’ve Heard
Hygiene:
It’s cleaner. It prevents the build-up of smegma and unpleasant odors.
Appearance:
If you don’t circumcise, his penis will look like an anteater and he will be teased in the locker room by all the other boys. A boy should look like his father, so if dad is circumcised, baby should be as well. Otherwise, he’ll notice that he and dad are different, and it’ll make him think there is something wrong with him.
Health:
Studies have shown that circumcised men have a lesser chance of becoming infected by HIV. Circumcision prevents penile cancer. My baby will get a UTI if he isn't circumcised.
Function:
The foreskin is just a flap of skin. I and/or my partner are circumcised and just fine.
It is inevitable:
My uncle’s cousin’s daughter’s husband’s hair dresser’s baby wasn’t circumcised at birth, and he kept getting infections and/or his foreskin was too tight and they had to cut it off.

The REAL reason we circumcise:
The sad fact of the matter is that circumcision became popular in the United States for NONE of the reasons you’ve heard. The practice of infant circumcision outside of the Jewish faith started gaining popularity in the U.S. as a means to curb masturbation. Masturbation, they claimed, caused blindness, seizures, and all manner of maladies.
Dr. John Harvey Kellogg, co-inventor of the cornflake (and quite a fruit loop, if you know what I mean), had a hand in starting the trend in the U.S. In his book “Plain Facts for Old and Young: Embracing the Natural History and Hygiene of Organic Life,” he says of circumcision, “the operation should be performed by a surgeon without administering an anesthetic, as the brief pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment.” In brief, make it hurt so they won’t ever want to touch it.  To curb masturbation, he claimed that “A remedy which is almost always successful in small boys is circumcision.”
Dr. Kellogg also found that the “application of pure carbolic acid to the clitoris” is “an excellent means of allaying the abnormal excitement, and preventing the recurrence of the practice.” Yep… let’s burn their genitals with acid so they won’t get aroused.
The Truth
Hygiene:
There is nothing unclean about a foreskin, especially in infancy. The foreskin is actually fused to the head (glans) of the penis in infancy and through much of childhood.  For all intents and purposes, they are one in the same. “[The foreskin] protects the developing penis from feces, bacteria and other harmful pathogens. This is especially important during the diaper-wearing years when a baby is continually exposed to his/her own feces (e-coli and other harmful bacteria/viruses).”

As far as smegma is concerned, “During or after the separation process, there may be some shedding of dead skin cells in the form of smegma (please note that women and girls also have smegma). This shedding of dead cells aids in separation since it helps the foreskin differentiate itself from the glans. There is no need to try to clean smegma from underneath a child's foreskin. It will slowly work itself out via the narrow opening.”

Smegma is not unique to men and boys – women and girls also have smegma, but no one suggests genital surgery to prevent such a thing. Instead, we simply bathe regularly. There is no need to wash the inside of a girl’s vagina, just as there is no need to wash the inside of a boy’s foreskin. If intact, don't retract - only clean what is seen. When the foreskin is differentiated and retractable, the boy (who will likely be in his teens by the time this happens) can simply retract the foreskin in the shower and gently rinse the glans with warm water.

We teach our children to brush their teeth twice daily. If we’re lucky, they won’t skimp on flossing. Teaching healthy bathing habits is so much easier than teaching proper oral hygiene.

Appearance:
The circumcised penis and the natural penis only look different when flaccid. One has a protective covering over the glans (head) and the other does not. Having the foreskin there to protect and cover the glans allows the glans to remain soft, smooth, and sensitive. Without the foreskin, the mucosa of the glans thickens and causes a decrease in sensation. This, sadly, often leads to sexual dysfunction in later life when the desensitization makes it difficult to become erect and/or achieve orgasm. The United States of America, the country with the highest rate of circumcision (70% of the current male population, compared to 10-15% worldwide), also seems to have the highest prevalence of erectile dysfunction. This is not a cause-and-effect comparison, simply a correlation, but it does make you wonder...

These days, the circumcision rate for American baby boys is on the decline. Almost one in three American boys were circumcised in 2009, and it is suspected that the rates have fallen more since that time. Locker room comparisons (which I suspect are much less common than we’ve been led to believe) will not make the intact boy look strange – most of his classmates will be intact as well.

But honestly, do boys compare penises with one another? Or with their dads? There may be the occasional pissing contest, but it’s not the same as a dick comparison.

If your son DOES ask why he and daddy don’t look the same, the easy answer is either or both of the following: “Everybody is different” and/or “Daddy had a surgery when he was little, but we didn’t have to do that to you.” Neither of these will make your son feel somehow inadequate. Honestly, he's more likely to point out his dad's pubic hair, not his lack of foreskin.

Health:
There are three main issues that circumcision claims to fix. Hot in the news lately has been the claim that HIV can be prevented through circumcision. To this I would like to state the following: this particular "benefit" seems to be confined to very few countries in Africa. It is not the case in North America.  Greg Millett of the U.S. Centers for Disease Control and Prevention said the following: "overall, we found no association between circumcision status and HIV infection status" when he presented his findings to the CDC's National HIV Prevention Conference. 

Experts knew circumcision would not protect a female sex partner, nor the male sex partner being penetrated. But Millett's study found no benefit of circumcision to any of the men. "We also found no protective benefit of circumcision among those men reporting recent unprotected sex ... in which they were exclusively the insertive male partner," he said.

Penile cancer is among the diseases circumcision claims to prevent. What I have to say on that is this: penile cancer is incredibly rare. The chance of dying from penile cancer is so low that it is not even presented separately by http://www.cancer.gov/ - it is lumped in with all male genital cancers (including testicular cancer and the much more common prostate cancer) at a total of 310 estimated deaths in 2010.  Compare this to the annual circumcision death rate of approximately 117 neonates (first month of life).  That's more than SIDS (115 annually) and more than suffocation (44) and auto accidents (8) combined.

It is important to point out that penile cancer, like cervical cancer, is tied to HPV. Not circumcision. I have heard many personal accounts of women who contracted HPV from circumcised partners. Circumcision does not make you immune to HPV. The use of a condom is not only required to effectively prevent HPV, but is effective enough that circumcising is completely unnecessary for this purpose.

Urinary Tract Infections are very rare in boys. They do not hit both sexes equally. The prevalence of UTI in girls up to 2 years is more than twice the prevalence in boys of the same age. The rate in girls up to one year of age is 6.5%, while it is 3.3% in boys. From age one to two, it is 8.1% in girls and only 1.9% in boys. The rate for circumcised boys IS lower than intact boys. It is the difference of 0.2-0.4% for circumcised boys and 1.0 - 4.0% in intact boys.

With our girls at a much greater risk of UTI, we still do not suggest surgical removal of genital tissue to prevent them. We treat with antibiotics if and when the infection occurs. On the very rare occasion that a boy gets a UTI, we treat it with antibiotics. Surgical removal of genital tissue to prevent an infection when the risks of that infection are so low seems ludicrous to me, as well as to Dr. Benjamin Spock, renowned pediatrician, who said this: "You don't want to do something to 100% of boys just because of a very slight difference in infection. My own preference, if I had the good fortune to have another son, would be to leave his little penis alone."  

Function:
The foreskin is NOT a flap of skin. In infancy and much of a boy’s early years, it is adhered to the glans of the penis to protect it. In teens and adult years, it has important sexual functions for both your son and his future partner(s). Women who have experienced intercourse with both intact and circumcised men overwhelmingly prefer the intact partner. Please learn more about the sexual function of the foreskin at www.sexasnatureintendedit.com [ADULT CONTENT]. Men who were circumcised at birth may tell you they are “just fine,” but they will never experience sex the way nature intended it. They have forever lost tens of thousands of fine-touch nerve endings that cannot be replaced. They can choose foreskin restoration in order to regain SOME of the function lost, but those nerve endings are gone forever. And please remember there seems to be a link between circumcision and erectile dysfunction.

Inevitability:
There are many boys who suffered through infections or were not able to retract. That is because the foreskin is not supposed to retract in childhood. Some parents who choose to keep their sons intact are told by misinformed doctors or friends or relatives that you must pull back the baby’s foreskin to clean his penis every time you change his diaper. This is both wrong and incredibly harmful. The foreskin in an infant should never be forcefully retracted – to do so is to rip the skin away from the glans and it causes injury, bleeding, and possible infection. It is akin to ripping a fingernail out of its nail bed.

There is a very clever rhyme that can help you remember how to properly care for your intact infant: if intact, don’t retract: only clean what is seen.

As far as the “too tight” foreskin, this is referring to what is called “phimosis” – a condition where the foreskin does not allow retraction. American doctors are not familiar with intact care and they misdiagnose many infants and young boys with phimosis. TRUE phimosis can only be diagnosed in an adult man. In childhood, the foreskin should not be retractable. The hormones a boy produces during puberty cause a gradual change in the tissues of the foreskin and allow a gradual widening of the opening of the foreskin. It is only if a boy reaches adulthood without retracting that he can truly be diagnosed with phimosis. Even if this diagnosis were correctly applied, a much simpler treatment is to apply a steroid cream and use gentle stretching exercises. It is very rare for circumcision to be medically necessary. A study in Finland found that the rate of medically necessary circumcision is just under 0.006%.

Simply put, the foreskin does not and should not retract until puberty or later. If your son can urinate, he is doing just fine.

It IS Surgery 
There will always be risks associated with any surgery. The risk of serious complications (the type that require additional surgeries) is very low (I believe <1%) when performed by a medical professional in a clinical setting. That said, all boys suffer a great deal of pain from this procedure that can be shown by raised cortisol (stress hormone) levels prior to, during, and after circumcision. In 1998 reportedly only 26% of circumcisions in the United States used anesthesia.  This is because for YEARS we labored under the insane idea that infants do not feel pain.  The number is believed to be closer to 60% these days, but it's difficult to find a concrete answer since circumcision takes place in hospitals, clinics, homes, synagogues, etc. If you would like to watch a circumcision that was performed recently WITH anesthesia, I recommend this video. I will warn you it is graphic and shows a child's genitals, but this video was created by and for medical professionals.

Please also remember that death is a risk associated with this surgery, even if it is rare. The statistic of 117 per year may not seem earth shattering to you, but it was earth shattering to the families that lost those babies. Each and every one is a person, a life that was lost needlessly, a family that was broken. They are not just statistics - they are children.

Regret
There are scores of men who learned what was lost to them, and they deeply regret their parents' choice to circumcise them as infants. Please remember that your infant son will become your school aged son, your teenage son, and your adult son. He will eventually be able to make his own decisions, and he may wish you'd left this one up to him. If you don't believe me, please check out the National Organization for Restoring Men, or TLC Tugger or RestoringForeskin.org or ForeskinRestore.com or Restoring Tally. These are not every man's story, but these men give a voice to the many who did not consent to this surgery.

In Conclusion
The simple truth is that circumcision is neither necessary nor required. There is no special care required of you when you leave your baby whole (no Vaseline and bloody bandages in diapers). There is no compelling reason to perform surgery on the genitals of a healthy infant. There is no condition in childhood that would be cured by removal of the foreskin. After six years of research, I have never come across a single sound reason to circumcise an infant. You should not need to be convinced NOT to have genital surgery on your bouncing baby boy. It should be the other way around. Why WOULD you circumcise?

5 comments:

  1. Your best post yet! I hope this helps parents make the right choice.

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  2. Watching that video...it's odd how the mum kept covering her ears.

    Really good article :)

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  3. Fabulous resource! Thank you for speaking up, writing this, and pulling all these links together. I appreciate your effort and skill with words. Well done!!!

    ReplyDelete