Making Balanced Decision about Circumcision

It’s the “hot topic”—one that mom bloggers are vehement and nasty about. And yet we are still so divided, like we are when it comes to breastfeeding versus bottle feeding, vaccinations, co-sleeping, and baby sleep training.

Here’s the thing with controversial topics: You need to do the research, you need to hear from both sides, you need to make an educated decision. And then you really need to forget about it. Give other moms the benefit of the doubt and assume they are doing what they believe is best for their kids. Judging them doesn’t make them change—it just makes you a bitter, resentful person.

That said, I’d like to come to the topic of circumcision.

I’m going to try to cover as many approaches to the topic as possible, and list the pros and cons. But here’s the thing—I’m going to let YOU make the decision for yourself.

When reading the links I have provided below, be sure to think on them critically. Are their arguments sound? Do they make comparisons that are not logical? Do they cite historical or medical sources? Are their sources up to date? Do they have ulterior motives that cause them to think the way they do? Remember that no source is completely unbiased.

Types of Circumcision

First off, you need to know that there are different types of circumcision. (Uncircumcision is considered “intact.”) One form of circumcision is snipping off the edge of the foreskin, leaving most of it intact. This form of circumcision has long been practiced by many different cultures contemporary to the ancient Israelites (Archaeological Bible, ESV, page 1080).

Israelite Jews practiced the full removal of the foreskin. Quite a few sites (all against circumcision) claim that Israelites did not practice the full removal of the foreskin until more recent years, like Circumcision: Then and Now. Unfortunately, I can’t find any sources used in these articles or any other historical evidence to back this up. What I do have is the Archaeological Bible, which states that Israelite Jews did remove the entire foreskin, and 1 Samuel 18, which suggests that David removed a significant amount of foreskin in order to present a hundred of them to King Saul. If you know of sources that are pro-circumcision that can back this up, or if you know of any non-biased historical sources, please link to them in the comments!

Anti-circumcision timelines claim that the full removal of the foreskin is as contemporary as the 19th century. They claim that the move to full circumcision was an act to discourage masturbation. You can read a timeline (which unfortunately also does not include sources) linking circumcision and masturbation here. I don’t doubt a correlation between circumcision and attempts to curb masturbation, but I do question the claim that full removal of the foreskin did not occur before the 19th century.

Jewish Circumcision

For information on traditional Jewish circumcision, read Advantages and Possible Complications of a Brit Milah (a Jewish source). For information on the controversial practice of metzitzah, read Jewish newborn infected with herpes after metzitzah b’peh (Jerusalem news source).

Modern Medical Circumcision

Read about the procedure, risks, and complications of modern circumcision here.

Considerations

Appearance

Circumcision is basically a cosmetic surgery, but it won’t guarantee boys from being teased or comparing themselves with others. Some boys are teased for being intact, some for being circumcised. Today in the US, about half of young boys are circumcised and half are intact (According to statistics from a study conducted in 2009).

Reading online forums, I’ve heard of more intact men getting teased in the locker room (about 80% of men in the US are circumcised). But now that more boys have been left intact, teasing should not really be a deciding factor. Do boys really need to look like their fathers, brothers, or friends? That’s something to think about.

Health considerations

In 2012, the American Academy of Pediatrics came out with a statement in favor of circumcision, saying the benefits outweigh the risks (reversing the recommendations they’d been making since the 1970s).

“Specific benefits identified included prevention of urinary tract infections, penile cancer, and transmission of some sexually transmitted infections, including HIV. The American College of Obstetricians and Gynecologists has endorsed this statement.”

Many articles have been written in response to the AAP’s statement, claiming for example:

1. Pediatricians profit from circumcision and therefore the AAP cannot be considered an unbiased source (Doctors Opposing Circumcision)
2. Urinary Tract Infections can be treated with antibiotics (“Cultural Bias in the AAP“)
3. The studies used to inform the AAP’s statement, namely the ones regarding HIV contraction being 60% lower among uncircumcised men in Africa, do not apply to the US, where men have access to clean water (DOC)

While #1 is certainly an important consideration, the AAP had ruled against circumcision from 1971—2012. Studies and statistical results are never 100% accurate for all people. Be sure to look at the numbers, who is performing the study, who is participating in the study, and whether the conclusion is accurate based on the study’s findings.

Other things to consider:

• “Boys who are not circumcised as newborns may later have circumcision for the treatment of phimosis, paraphimosis, or balanoposthitis. When done after the newborn period, circumcision is considerably more complicated.” (MedicineNet)
• “Meatitis is more common in boys who have been circumcised.” (MedicineNet)
• “Circumcision prevents the growth of bacteria under the foreskin and this, in turn, protects male infants against urinary tract infection. The high incidence of urinary tract infections in uncircumcised boys has also been found to be accompanied by an increased incidence of other significant infections such as bacteremia (bacterial infection of the bloodstream) and meningitis (infection of the covering of the brain). The protective effect of circumcision may thus extend to a number of infectious diseases.”  (MedicineNet)

STDs and Circumcision—different sources will give different results.

• “Male circumcision reduces the risk that a man will acquire HIV from an infected female partner, and also lowers the risk of other STDs , penile cancer, and infant urinary tract infection” (Center for Disease Control, African study).
• “For female partners, male circumcision reduces the risk of cervical cancer, genital ulceration, bacterial vaginosis, trichomoniasis, and HPV. Although male circumcision has risks including pain, bleeding, and infection, more serious complications are rare” (CDC, African study).
• In a study surveying a male population of the US Navy, both US- and foreign-born, circumcision did not statistically or significantly effect the prevalence of HIV or other STDs (Naval Health Research).
• “After correction for age, circumcision was unrelated to reporting STI, but appeared to protect against penile candidiasis [thrush]” (Widespread Australian Study).

Pain

Circumcision will hurt—anyone that tells you differently is missing serious brain cells. Here’s what the AAP has to say:

“Analgesia is safe and effective in reducing the procedural pain associated with newborn circumcision; thus, adequate analgesia should be provided whenever newborn circumcision is performed. Nonpharmacologic techniques (eg, positioning, sucrose pacifiers) alone are insufficient to prevent procedural and post procedural pain and are not recommended as the sole method of analgesia. They should be used only as analgesic adjuncts to improve infant comfort during circumcision. If used, topical creams may cause a higher incidence of skin irritation in low birth weight infants, compared with infants of normal weight; penile nerve block techniques should therefore be chosen for this group of newborns” (Pediatrics, Sept 2012).

It can take 7-10 days for recovery time.

Some mothers have reported that their sons go on a nursing strike after circumcision.

Proponents of circumcision say the baby usually starts crying before the procedure, usually stops crying soon afterward, and sometimes falls asleep after.

Opponents of circumcision claim that some babies actually go into shock from the pain, and just appear to be sleeping.

Using topical analgesic and other pain relief (like infant Tylenol or suppositories) seem to be effective pain relief, though some soreness will be felt and care must be given while changing the diaper or any dressings.

Sex life

Some men that have been circumcised later in life say their sexual pleasure has diminished from being circumcised, others say it has increased.

• “Does circumcision improve couple’s sexual life?” is a study reporting on men’s perception on their sex life before and after adult circumcision. However, note that the sample size is so small, the findings cannot be considered statistically significant. Therefore the conclusion of the study cannot be taken as fact. 
• “Circumcision was unrelated to most sexual difficulties, but circumcised men were less likely to report physical pain during intercourse or trouble keeping an erection.” (Large Australian Study, also cited above) 

Intact men have more natural lubrication, but that moist atmosphere might put them at a higher risk of contracting certain STDs and/or passing them along to their partner (see health considerations, above).

Because circumcised men do not have the foreskin, they  might require more supplemental lubrication during sex (see Anatomy of the Penis, in the further reading, below).

Women have different preferences. However, if your son marries a virgin, she won’t have anybody else to compare him to. Even if your son’s future partner does have a preference, a superficial reason should not be a factor if she truly loves him.

Further Reading:

• Article against circumcision: Anatomy of the Penis, Mechanics of Intercourse (Most recent source is 1997)
• Article from Men’s Health, saying sex is pleasurable either way: The Sexual Effects of Circumcision (includes both medical and anecdotal opinions) 

Potty training

Circumcised boys may need to be taught to point down, since the foreskin won’t direct their urine downward.

The foreskin of intact boys may get stuck to their skin, causing them to spray on themselves.

Consent

The ethics of circumcision. This is where the debate gets ugly. The problem is, like the debate between pro-choice and pro-life, there will be people that disagree with you, and you aren’t going to convince them otherwise, because it comes down to personal ethics.

One of the major reasons many choose not to circumcise is that they feel the child needs to consent to such a surgery. They equate circumcision with mutilation. If the mutilation of female genitalia is so horrendous, shouldn’t the mutilation of male genitalia be as well? If the surgery is unnecessary, why do it? If it ain’t broke, why fix it? Isn’t the foreskin there for a purpose—otherwise why is it there in the first place?

These are all valid questions that need to be thought about.

Both intact males and circumcised men have come out saying they regretted their parents’ decision. Circumcised men may feel like they were taken advantage of and that part of them is missing. Intact men might resent their parents for not giving them the procedure as newborns, because adult circumcision has a much longer recovery time, during which the man may not be able to walk or have sex for weeks or months (neither of these complications are issues with newborns).

Religious reasons

As a Christian, I can only speak on the behalf of those beliefs. Circumcision is considered important or mandatory in Jewish and Muslim practices.

Christians are under the “New Covenant,” which means circumcision is unnecessary for them. Paul, in Galatians 5, uses no uncertain terms to condone forcing circumcision upon Gentiles. However, the Bible in no way suggests that circumcision is a sin, like this writer would have you believe, correlating the practice with Satanism. The sin is believing that you must be circumcised to be saved—it’s putting a higher emphasis on religious practices than on the grace of God. If circumcision were a sin according to the New Testament, Paul would not have allowed Timothy to be circumcised. The bottom line is that there is now freedom to choose to not be circumcised.

Conclusion

Whether you choose to circumcise or not is entirely up to you and the father of your child. Weigh the benefits and the risks and make the decision that you feel is best for your son and your family. The biggest factors are ethical and religious—so note that other parents are going to make different decisions based on their own ethical and religious backgrounds.

If you choose to circumcise

Wait eight days after birth—that’s when a baby’s Vitamin K levels increase and there’s a lower risk of bleeding.

The Mogen Clamp or Jewish Shield seem to have fewer disadvantages and complications than the Plastibell or Gomco clamp.

Ask what types of pain relief will be given to your son during the procedure. (The AAP

Take care of the circumcised penis as it heals and have it checked regularly at newborn check-ups.

If getting a traditional Jewish brit milah, determine whether the mohel will practice oral metzitzah.

Teach your child to respect other boys, whether intact or circumcised.

If you choose not to circumcise

Do not retract the foreskin forcibly. An intact penis will begin to retract between the ages of 3 and puberty (Psychology Today).

Once the foreskin retracts, teach your child how to clean the foreskin with water to avoid infection. Some soaps may irritate or dry out the foreskin (Psychology Today).

Teach your child to respect other boys, whether intact or circumcised.

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That was easily the longest post ever to appear here on Bewildered Mother. Feel free to comment below, but realize that this isn’t a public forum, this is my blog. Offensive or judgmental posts MAY be removed at my discretion. This is a place to learn and encourage, not judge or convert. If you have a passionate response, I suggest you write your own blog post in protest, and post the link below—then people that agree with you can read your article, and people that disagree just as vehemently as you do can angrily disagree with you over there.