Thursday, March 18, 2010

Circumcision: A Male's Perspective

Update: This post has been featured as a guest article on the Peaceful Parenting blog...and features a comic. So you almost might as well go there!

Before having my first son, we were presented with the routine decision (at least in the United States) of whether to circumcise him. While we were initially assuming we would, we did some research. We began finding that not only is male infant circumcision almost never medically necessary, but it's not even performed by most of the developed world. Most European countries never began circumcising in the first place. The United Kingdom doesn't pay for it; it's an out-of-pocket expense. The United States is the only secular country which routinely circumcises males.

I can attest to this now, because I worked for six years as a certified nurse aide prior to becoming an RN. I worked with countless uncircumcised men, mostly European immigrants in Chicago: Poles, Serbs, Lithuanians, etc. Younger men and older men. Men who could walk to the bathroom and men who constantly soiled themselves. Men who had indwelling Foley catheters and men who didn't. Men who were impeccably clean and men who were homeless. Men who were healthy and men who were critically ill and severely immunocompromised.

Never once did I encounter an adult male patient who had ever had a medical problem due to being uncircumcised.

Not only that, but during the cleaning of patients, I only ever worked with two nurses (that I remember) who would actually go through the rigamarole of retracting the foreskin, cleaning the glans, and replacing the foreskin. That's what we were taught in CNA and nursing school, but almost everyone would leave it alone. I suspect most people who work with a high uncircumcised population do the same. If it never presents a problem, it's always clean, and you're just causing discomfort, why do it?

In fact, female patients are far more prone to fungal and bacterial genitourinary infections than male patients are—yeast infections, urinary tract infections, abscesses, etc. And we know that this is largely due not only to their shorter urethras, but also to their labial folds—their "excess" skin. Why don't we cut that off? Why isn't female circumcision considered for infection prophylaxis? That's how we think of male circumcision. Except the reality is that, as with male patients, the benefit of circumcision would be minimal, because the number of serious complications of letting women stay "uncircumcised" is extremely minor.

So as it stands, we have two boys who are uncircumcised. One's almost five years old and the other's nearly three. They've never had a problem. During diapering they required less care and bother than our girls did. And now, during bathing, we don't retract or mess with it.

They're clean. They're fine. I suspect that someday they'll be like my patients were: ninety years old and uncircumcised—with no regrets.

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27 comments:

  1. Thank you for writing this! I can't tell you how many times I have seen a female nurse and mom to be use the "If you saw the kinds of problems those old men have..." excuse as justification for why they are choosing to circumcise their baby! If an old infirm woman's hygienic needs don't make a case for female circumcision- then neither do a man's.

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  2. Thank you for this excellent post both for your male, and medical, experiences and opinion.

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  3. Yes, thank you; I ran across a rage-causing comment (totally unrelated to the subject) by someone blaming a "nasty STD" she got from an intact partner on his not being circumsized, because her circumsized partners had not given her STDs, therefore, why don't all boys get cut? And I had to go off because even if that is true (and we didn't have these things called, you know, condoms), it does not change the fact you're cutting off part of a baby's penis for no immediate medical benefit, rather than trying to reduce infection in other ways.

    I didn't have to read much about circumcision when I found out I was having a boy to say "over my dead body you'll do that."

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  4. Thank you for your perspective. As a mom of two uncircumcised young boys, I do doubt my decision sometimes. This really helps re-inspire my confidence. I always thought my boys were born perfect and this just confirms it.

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  5. Thank you for writing about this! Its a topic that I feel very strongly about and Im very glad that you came to the same conclusion I did- that its unecessary surgery!
    Im proud to have a sweet, perfect INTACT (not "uncircumcised") little boy :)

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  6. Great post - However, I have two sons and they are both circumcised - guess I'm the old fashioned mom and nurse! Stephanie

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  7. You are an interesting case: a male nurse with 4 children and hence very straight.

    I spent a decade of my life in Chicago, paralysed by the fear of being ridiculed for having the body that God gave me. I now am deeply glad that my mother bucked the tidal wave and threatened to divorce my father in 1949 if he had me circumcised against her wishes.

    I know of no careful objective evidence about the health implications of being intact in the USA. Before 1985 or so, being an intact American was strongly correlated with income and education deficits, and hence compromised health status and greater risks of contracting an STD. (Socioeconomically deprived women have more STDs, and socioeconomically deprived men are more likely to patronise prostitutes.)

    I have been an intactivist since 1983. Ever since then, I have been waiting to read a study comparing the incidence of urological problems between the USA & Canada, and Japan & continental Europe. If intact raises the incidence of such problems, such a study would be quite revealing. I am not holding my breath...

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  8. Thank you for this post! I was born and raised in Finland, and like in the rest of Europe, male (and female) circumcision is very, very rare, usually only performed on Jewish boys. I myself know of one man who has had it done - my American husband. I find it very strange how so many Americans think that getting circumcised means less infections - shouldn't that mean that basically all European men get repeated infections and urological problems? There is absolutely no evidence to support this. My son is obviously intact, luckily my husband didn't care either way, and for me, getting him circumcised was never an option.

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  9. Fantastic post!!!

    I'm so glad my son was my 3rd child and not my first (Jewish and all that). Thankfully, I no longer support circumcision at all and am rather passionately anti-circ. Good points and thank yo so much for sharing your perspective, both as a father and as a nurse!

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  10. I also read that most circumcisions are made without giving medication to the baby.

    No painkillers for the little boy, just strap him and then start clamping and cutting because even now most people believe that newborn babys have not developed pain receptors in a way neccessary to feel pain as a bigger kid would.

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  11. Vegancat - pain control for boys during circumcision is still a little controversy, from what we were told in school. If I remember right, AWHONN (the obstetric nurse association) is in favor of pain control (i.e. Tylenol) but I think typically boys just get a sucrose solution pacifier. We saw a boy being circumcised without pain control—it was horrific. I would never want to see it again. Anyone who says "Do it before they're old and they can really feel it" probably needs to be punched. Or at least whoever invented that idea.

    Tytti - that's exactly what I'm saying. Does anyone believe that European men are urologically less healthy than Americans? Nobody believes that. The AAP and AMA don't beleive it, even though their statements on the matter are wishy-washy and try to completely avoid rocking the boat, science be damned.

    Anonymous 3/19 - See my comment above. I don't think there's been any studies comparing the US to the EU, but I don't think anyone is even curious. It's kind of obvious. European urologists aren't clamoring for infant circumcision, aren't they?

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  12. man-nurse: You are missing out on pain info. A 1997 study found that the ring block was most effective as an anesthetic. The study was stopped early because they determined it was unethical to continue with the control group not receiving anesthesia.
    http://www.cirp.org/library/pain/lander/

    Otherwise, a very good article. I was circumcised at birth and wish I had been left intact. I dislike being circumcised so much that I am restoring my foreskin. As I slowly regain some of what was taken from me by circumcision, my resolve grows to speak out against the harm caused by circumcision.

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  13. I am a (male) nursing student, currently doing my OB rotation. I told my instructor that I did not want to observe a circumcision, and that I consider it barbaric. She was cool with it.

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  14. Great post, sir. I can't thank you enough for it. No doubt, you will inspire and empower other medical professionals to stand up and say no to participating in circs.

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  15. Thank you for these wonderful posts. I am a nurse graduated in the diploma course at the Montreal General Hospital in 1962. I didn't have the option of not witnessing infant circumcision and nearly fainted, lost my lunch and screamed at the doctor for being such a sadistic barbarian. If it hadn't been for the nursing coordinator, a friend of my parents defending me I would have been thrown out of training. Needless to say both my sons are intact (uncircumcised), and I have actively opposed it ever since. I recently did counselling of a couple on the verge of divorce because of the husband's terrible circumcision making sex almost impossible. I discussed the physical and emotional aspects of the problem, introduced them to foreskin restoration and all the nocirc uncirc literature and they are really doing well. He is a little too impatient to reach full (re)coverage, but the marriage is surviving. His parents didn't consent to circumcision. I find it unbelievably unethical and arrogant that anyone would brutalize a perfect healthy infant with such a repulsive injury that is still harming him and his loved one nearly 50 years later.

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  16. Great post! Just one correction - Your sons are not uncircumcised, they are intact. It's important that correct terminology is used. Uncircumcised leads people to believe that something that should have been done wasn't.

    Ex: I am not unmastectomized - I have both of my breasts, I am also not unlobotomized - I still have my whole brain (well, most of it anyway).

    Words are powerful things.

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  17. Thenks Fyrestorm Creations for your post. It's just what I would have said, except that I am not "unclitoridectomized," I am intact, normal, natural, and whole.

    Yes, nice to have a male nurse chime in in such a positive way!

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  18. Fyrestorm - you're absolutely correct, though 'uncircumcised' indicates that circumcision is the norm (which it kinda still is, even if I would rather it not be). But I'll try to adjust my terminology!

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  19. Thanks so much for the great and honest blog entry! I'm an RN also and I left my son intact (my daughter too)! All of us health care professionals need to speak out on the truth about the horrors of circ and how doctors often use scare tactics to get parents to circ. In return, those MD's make a greater profit from performing circs. A foreskins worst enemy is truly a US doctor. I've never once taken care of an adult or child with a foreskin that suffered any problems because of it. I have seen several really botched circ jobs, though. It always amazes me how this country has such a high non-religious circ rate.
    Anyway, keep up the good work and thanks for 1 - joining the ranks of nursing in the country (we need all the help we can get) and 2 - for speaking up for keeping boys whole!

    Andi

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  20. More on pain control: Slater et al. found sugar was ineffective as pain relief, but it relaxes the facial muscles, giving a false impression of calm. Sneaky!

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  21. About cleaning and retraction: I think nurses and CNAs may not do this due to embarrassment or ignorance, but it definitely needs to be done for a fellow who can't do it for himself. I work with a geriatric population and it is not uncommon for me to come upon men who have not had a proper clean for so long that they cannot retract their foreskin without discomfort. Then there are the fungal infections...retract and clean, please!

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  22. A decent soak in the bath or a good long shower is plenty. I'd say unless visibly mucky (eg after faecal incontinence getting everywhere or similar) you can probably leave well enough alone - possible exception for someone who due to physical or intellectual impairment is not able to handle their penis at all, a friend with full C2 quadriplegia who breathes with the assistance of a ventilator has had an... erm... 'interesting' time adequately training his personal assistants (in the US I think you'd say personal care aides?) to care for his penis and foreskin appropriately.

    SO glad to hear so many parents who have chosen to leave their perfect sons as they were made. I'm from a mixed-culture family and the discussions over what to do if my sisters and I had been born with a penis almost ignited World War III between my Jewish grandfather and Atheist/Humanist granny.

    Fortunately, we were all nice straightforward XX girls and as such the problem was neatly averted.

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  23. I am all for leaving boys intact. I work in maternity and have to say that all babies who undergo circumcision, receive a local anesthetic. however, no time is wasted to cut unlike at the dentist where you get a shot and they come back in 5 or 10 min and make sure you are numb. babies cry from the moment they strapped to the board, it must be so frightening for them and so some pain might be due to anxiety. I just wish parents would educate themselves and not do this. I refuse to partake in this at work, makes me sick to my stomach and I do not understand why professionals do not discourage parents

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  24. Thank you for writing this. I am happy for threads like these that opened my eyes and made me see the truth. That Americans hand over their babies to health care proffessionals without asking questions. Just like many proffessionals never ask questions. It is sad so many little babies are circumcised for no reason, with no one asking themselves why.

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  25. Thankyou so much for this post! I didn't start doing the research until I was pregnant with my son. Once I found out it was basically preventive surgery (why don't they just remove the appendix and gallbladder too?!!) I decided to leave my son intact, the way God made him. My husband was circumcised but he found the procedure just as confusing as I did. We have decided to let our son choose for himself when he gets older. It has been great to find some real information and support!

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  26. It was never an necessity for the procedure to be carried out. But I believe some religion in other part of the world does encourage that and also the process are carried out in religious centre.

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