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16 September 2009

A Modest Proposal Upon the Occasion of a Routine Medical Procedure Involving the Removal of a Small Piece of My Nephew

First, let me get this out of the way: My name is Patrick, and I'm a circumcised man. Whew! That was easier than I thought it would be. But there it is, the bald truth. Why, you might find yourself wondering, did I feel it necessary to share this juicy bit of information with the 1.6 readers of this blog? Because I have a new nephew, and like me, he is circumcised, although the experience is for him, I'm sure, a much more vivid memory. Until my wife and I did some research into the topic prior to our son Lysander's birth, I never really thought about my missing foreskin. After all, how can I miss something I don't even remember having? Why has it become a standard procedure to remove most of a newborn boy's foreskin within days of his birth? Why do we insist on making an already stressful couple of days excruciatingly painful as well? There must be a good reason, right?

As the story goes, Moses brought the practice of circumcision out of Egypt and introduced it to the Jewish people as a rite of passage. It was part of a contract with God: in exchange for the sacrifice of a bit of nerve-rich skin, God would ensure the fertility of the tribes of Judea. At first, the procedure was performed with blades of flint, upon willing males who had reached the age of puberty and were ready to move into adulthood. As time went by, however, the ritual began to be performed on the eighth day after birth rather than at the start of puberty. Rather than being something a young man would choose to have done, it became something a child's parents would decide for him. Obviously, when the first generation of Jewish men, who had never even seen their own foreskin, grew up, they too chose to have their baby boys circumcised--it sure beat having it lopped off just as things started to get interesting. So how do we get from that point to my nephew? After all, we don't perform animal sacrifice anymore, but we still cut foreskins down like they were dandelions. This is where things get interesting.

Alexander the Great outlawed circumcision in the area 300 years before Christ's birth. And yet by the time the early Christian Church got rolling, male converts were required to be circumcised. Paul put a stop to it before long, however, citing the idea that the New Covenant (with Jesus) superseded the older Jewish arrangement with the big guy. Baptism replaced circumcision as the initial rite of passage for the faithful, and foreskins everywhere breathed a sigh of relief (except the Jewish and Muslim ones--they were still on the chopping block).

Christian Europe was largely unfamiliar with circumcision, except as a mark of Jewish or Muslim faith, until the late 1800s when the medical establishment began to promote it as a health precaution. "Masturbatory insanity" is one of the health risks that circumcision was touted to prevent. The procedure caught on throughout the United Kingdom and many of the former British colonies in the early 1900s, though not so much on the Continent. The practice fell out of vogue in most of the former empire sometime after WWII, though it is still fairly standard in the United States. It should be noted that the ghoulish practice of female circumcision, which has received so much press of late under the title "female genital mutilation," was also popularized in the Western World in the early 1900s, also as a cure for masturbation. The question remains over why it is considered mutilation in one case and a standard procedure in another (I do realize that a clitorectomy usually involves the removal of the entire clitoris, which is considerably more drastic than your garden-variety circumcision, but in essence, they are both unnecessary surgery).

Let's take a moment here to be sure we all know exactly what we're talking about. The foreskin is a covering of loose skin over the glans of the penis. In an adult male, the foreskin rolls back to reveal the glans and forward to cover it. However, in an infant, the foreskin is not nearly as mobile--in fact, it is attached to the glans and essentially forms the outer layer of skin. By the end of late puberty, the foreskin separates from the glans and becomes retractable. This is the way it is supposed to go. In a neonatal circumcision, however, the doctor has to forcibly tear the foreskin back from the glans before it can be clamped into one of a variety of devices and cut away. Anyone cringing yet? In actuality, much of the major trauma from a circumcision may not be a result of the incision at all, but of the premature peeling of the glans. The raw wound left behind is prone to all sorts of irritation and infection in the weeks following the operation, and sometimes requires a pediatrician to repeatedly tear the remnant of the foreskin back from where it continually tries to heal onto the glans where it belongs. Whew. I'm just glad that it can only happen to a guy once!

Since the mid-twentieth century, medical science has disproved many of the claimed benefits of circumcision, though a study has indicated that circumcision may decrease the chances of HIV infection. And yet, circumcision continues. Why? Here's my guess: a father who has no foreskin of his own is unlikely to protest when his son's is removed, because (1.) it hasn't affected him, and (2.) he wouldn't know how to deal with it if his son had one. When Larissa and I started to discuss the issue, I was firmly on the pro-cutting side. I had no good reason, just some vague ideas about cleanliness and the possibility of being teased in the locker room. And yet, here I was, ready to have a piece of my son's penis sliced off within days of his introduction to this world of ours. "Welcome to the world, kid. You won't be needing that here." Snip!

The arguments for circumcision these days are pretty feeble: babies can't feel it, or at least won't remember how much it hurt; it might reduce the chances of them catching STD's fifteen years down the road; we don't want other kids to laugh at them in the shower. Anyone who has changed the diaper of a recently circumcised boy knows that they damn well can feel it, and if we're doing painful things to kids while they are young simply because we're pretty sure they won't remember them, why not open them up and get that pesky appendix out and root out those incipient wisdom teeth while we're at it? As for the STD issue, not only is the evidence scanty, but if that were our only motivation, wouldn't chopping off the whole thing work even better? And the shower thing...seriously?! We mutilate out children as a result of peer pressure?! Give me a break.

There are, it seems, only three truly valid medical reasons for circumcision, though even these come under fire when used to justify circumcision as a preventative: phimosis (a painfully tight foreskin on an infant), balanitis (inflammation of the foreskin due to irritation or infection), and a foreskin that makes sex painful for an adult man (I guess this one doesn't get a fancy name). That's it. One is a hygiene or soap allergy issue while the other two amount to a rare birth defect.

Let me take another stab at why men might decide to put their boys under the knife in this day and age: fear of the unknown, lack of empathy, and in some cases, perhaps even guilt. To some extent, we all fear what we don't know, but seriously, an uncircumcised infant or toddler is not scary, at least no more so than a circumcised one. On the other hand, some dads may think "Hey, it was good enough for me, why not for my son?" That backward rationale is the exact opposite of the hope most parents profess to have: don't we all want something better for our children? Still other parents may already have a circumcised boy and may be unwilling to say no to a repeat simply because they already put one kid through it, and they don't want to play favorites. Whatever the reason, it is almost always more about the parents' feelings than those of the helpless child whose future is being decided.

It is sad, really. My son is now almost a year-and-a-half old, and we have not had a single problem with his intact foreskin. We don't have to do anything special to keep it clean, it never causes him pain, and he never had to go through the extended and painful recovery following the operation. So my proposal is this: open your minds. We need not be stuck in the same ruts our parents and their parents were in. Think for yourself. Ask questions. Why do we do this? Why should we? You might be surprised by some of the answers you get. The worst case scenario is that your son will decide that he wants to be circumcised when he is old enough to do so, and will have it done himself, but at least then he will be the one making the choice.

Male Health


History of Circumcision


Anonymous said...

Yes to all this.

Why parents think the decision to remove a healthy, functioning part of their child's body belongs to them, I'll never understand.

Why they want to alter the organ their son will, in the future, use as a sexual individual, again, I don't get it.

Whose penis is it, anyway? Mom and Dad's?

I didn't think so.

Joe said...

Thumbs up! :) I couldn't agree with you more. It's hard to contemplate why parents in the US still do this to their boys. Perhaps one day it will end; standing up and speaking out will hasten that day. Sorry for your nephew. :( Your son is a lucky boy though. :)

TLC Tugger said...

You cite infant phimosis as one of the valid reasons to cut, but it's not. Phimosis (tight foreskin) is indistinguishable from a normal infant foreskin that as you note is still fused to the glans. Even if the skin tube is so tightly puckered that the foreskin balloons up when the child urinates, this is not a problem; it's normal. The child will grow out of it.

Adult phimosis is generally the result of not enough masturbation and it is not a reason for circumcision either. An adult can gently stretch his foreskin opening for a few months and most of the time this will make it easily retractable during erection. If it doesn't respond and surgery is resorted to, that procedure is NOT circumcision, but Dorsal Slit with Transverse Closure, which amputates no sensual tissue.

Only about 1 in 10,000 adult men or women actually needs circumcision, to resolve a case of LS/BXO that hasn't responded to Protopic ointment.

Melissa said...

Awesome journal! It's good to hear a circumcised mans prospective. I totally understand your frustration...I'm in school for nursing and in my book there's a sentence or 2 on why male circ'ing is done but a half a page on the horrors of female genital mutilation. Our society is sad! Anyway...keep up the good fight!

Dennis said...

Even worse than having it snipped is the problem with getting an MD to use even a topical anesthetic to lessen the pain for the poor baby who "doesn't feel any discomfort at all".

Anonymous said...

Great post! Thank you for taking the time to put your thoughts down. We are expecting our first boy and I feel VERY strongly about leaving him intact. My husband is circ'd and is totally with me in this decision. I really love to hear a male's perspective on this.

Dirt Worshipping Treehugger said...

So glad to hear a man speaking out on this. Thank you!

Patrick S. McGinnity said...

Thanks, everyone, both for stopping by and commenting. Regarding the phimosis issue, I'm going to defer to TLC Tugger. I was just glad to find a respectable medical website that even acknowledged that circumcision was not always best (that being Male Health). The less-invasive therapies TLC Tugger describes would, I'm sure, eliminate the vast majority of "medically necessary" circumcisions.

Dennis, I had a great last line involving anaesthetic, but the majority of sources I found indicated that at least some infant circumcisions are now done with at least local anaesthetic. So the line got cut. Still, a local anaesthetic wears off pretty quickly, and the pain lasts and lasts.

wendilou92 said...

I reviewed all the literature, pro's and con's of circumcision while pregnant with Thaddeus and arrived at a similar conclusion as you regarding its necessity. It isn't necessary. BUT, husband was very pro-circ (for some of the emotional reasons you mentioned) and I was noncommittal either way. I was still undecided when he was born and much to the consternation of the maternity nurses, I declined the procedure. After a few days at home, I did decide to have TRB circumcised because husband definitely leaned that way and also because I decided to trust God's judgment. I mean, why would He tell all the Israelite men to be circumcised for no particular reason? Oftentimes with God, there are reasons behind the reasons behind the reasons that we never even know about. So anyway, TRB was circumcised when he was 8 days old (a coincidence, actually. Or was it? lol.) The doc did use anesthetic, but I must admit I cowered in the waiting room the whole time and cried when I heard TRB wail. *sigh* Poor baby. Fortunately, he settled down quickly. It healed over the next 10 days or so. Anyway, I don't necessarily regret moving forward with the circumcision; once it was done and healed, I haven't even thought about it. But I do agree with you that it isn't necessary.

Patrick S. McGinnity said...

A fine author with both a fine first name and a fine beard has also weighed in on this tender issue. See Patrick Rothfuss's post from last year: