Previous Post: The Latest on Breech Birth   Next Post: Summer 2009 Class Schedule is up!

Happy Independence Day–for Newborn Boys

Circumcision in the land of the free, home of the brave…its a touchy topic!

Here in America most men are circumcised–in contrast to the rest of the world where at least 80% of men are not circumcised.  While groups opposed to circumcision say that circumcision rates have declined to the point that it is now 50/50 with babies born in America today, I certainly don’t see that in my area.  I know very few parents other than my clients who leave their sons intact.

Recently I came across a rather unique argument in favor of circumcision.  I asked an expectant couple why they were planning to circumcise, and they gave some of the usual answers:  so he’ll look like dad, and for hygiene.

I chuckled and quickly answered that he would not “look like dad” while he was still doing any comparing, and pointed out that my sons don’t notice the circumcision difference, they notice the hair.  My husband actually wonders where that argument came from since he never saw his own father and as a teen did NOT want to–thus why I must say, I was more than surprised when I found out my husband had shared a toilet with our sons!

I didn’t answer the hygiene issue, but I think Penn & Teller (Part II, Part III) put it best when they said “how tough is it to get a kid to rub his penis in the shower?” (language in the video is crude)  Seriously…in infancy, the foreskin provides protection to the penis against diaper contents (50% of circumcised boys get “meatal ulcers” from this, meatal ulcers do not occur in intact boys), and requires no special care.  Once the foreskin is retractable, the boy can be taught to pull back, rinse, replace; its easier than female hygiene.

But what was that unique reason?  The mother had encountered a situation where a 13 year old boy had been teased about being intact, and thus tried to circumcise himself.  So the Dr. recommended doing circumcision to stop the boy from trying again.

Seriously?  Would we apply the same reasoning to smoking, drinking alcohol, or doing drugs?  “They will experience peer pressure, so lets just provide them with all they can use!”  That’s different, you say, because those are harmful activities?  Well, how about breast augmentation for girls teased for being flat chested?

I mean really…what kind of a message is that?  The best response to peer pressure is to surgically alter yourself so that you fit in?  One time a few years ago I met with a small group of women.  As we gathered and made some “small talk,” one of the women commented on a marriage book that she had been reading.  She thought it was ludicrous that the author felt that women should do whatever was necessary to maintain a youthful and “desirable” appearance–even if that meant submitting to cosmetic surgery the husband wanted, but that the woman did not want.  The women in the group unanimously agreed that this was absurd.  Ironically, by the end of that meeting the topic of circumcision had come up, and the major consensus of the group was that circumcision of infants should be performed, the main reason being because the intact penis “looks funny.”  Hmmm…so adult women should not be forced to have cosmetic surgery to meet the sexual preferences of their mates, but newborn boys should?

I hope the Dr. attending to that unfortunate adolescent boy ALSO recommended some psychological counseling as well, because his self image was the problem, not his circumcision status.

I pointed out to the couple that kids tease about LOTS of things…if they have decided to tease someone, they will tease about something.  In my case, it was my last name, my glasses, and my academic performance.  And the answer to that teasing was not to eliminate my last name, glasses, or academic skills–it was to live through it, and more ideally, to find ways to boost my self esteem.

Of course while this couple are swayed by the idea of an intact boy attempting to circumcise himself, others are swayed by the case of a circumcised man who sued the Dr. who performed his infant circumcision.

I think though, that many people are just completely unaware of how common complications are with circumcisions, because the complications are just not talked about.  I’ve rarely heard a medical professional talk about the risks–just yesterday I heard a labor & delivery nurse tell some expectant parents that circumcision is a “benign procedure.”  Indeed, many studies do show a low complication rate, however the glaring error with these studies is that they are typically limited to just 24-48 hrs after the circumcision is done.  One researcher who followed 100 babies for 1-2 years following circumcision found a 55% complication rate.  The majority of those complications occurred after hospital discharge, for example, of 8 infections, only 1 occurred prior to hospital discharge.  So I’m going to talk about some of the more common complications one might expect from infant circumcision.

A study found that among other responses, the infant heart rate increases 40-60 beats per minute during circumcision.  To put this in perspective, if, just a short 1-2 days earlier during labor the baby’s heart rate had increased by this amount, most likely the baby would have been born by immediate emergency cesarean–most likely under general anesthesia–due to concerns about distress.  Other physical changes include increased blood pressure, increased stress hormones, and breathing changes.  Many babies appear to fall asleep during circumcision, but what has actually happened is that they have passed out to escape the pain.  No one has adequately studied how this event may impact on the boy’s physical and emotional health.

Use of EMLA cream results in the heart beat “only” increasing 25-40 beats per minute.  In this study the EMLA cream was allowed to soak in for 45-60 minutes–it is quite common for it to only be allowed 10 minutes or less to take effect.  Drugs.com reports that EMLA should be allowed 1-2 hours to take effect if total numbness is desired.  However, it should be noted that EMLA cream applied to the exterior of the foreskin is unlikely to do anything to reduce the pain felt when the inner mucousal area of the foreskin is separated from the glans, or when it is cut.  Likewise, a penile nerve block will reduce pain to the outer portion of the foreskin, while providing no pain relief for the inner mucousal area.  Further, simply applying the nerve block is extremely painful.  One of my client’s baby had the nerve block applied, but then for various reasons, could not continue the circumcision that day.  The baby was heard screaming down the hall from the procedure room, and fell into an exhausted and sweaty sleep for many hours following the experience, missing a normal feeding time.

Further, there is pain following the experience.  I’ve been told by several parents that they knew exactly when their son wet his diaper for at least a week following circumcision because the babies would cry in pain.

I mentioned “meatal ulcers” above.  This condition can result in “meatal stenosis”–a narrowing of the urinary opening.  30% of circumcised boys experience this, just under 10% have a “pin hole” sized opening.  Two moms have told me over the years that their sons had to have surgery to correct this, and I dated a guy in college who’d had surgery to correct this.  I have to wonder how many of the other men I’ve known over the years had to have surgery to repair the damage done by circumcision.

If the circumcision removes too much skin, or removes it in unequal proportions to the sides of the penis, the conditions of “buried penis,” hypospadias, epispadias, chordee, or painful erections can occur.  Conversely, if too little skin is removed, “phimosis” (inability to retract) of the foreskin can occur.  Any of these may require surgical correction.

Skin bridges or penile adhesions can form across the scar, which can cause painful erections.

Up to 10% of circumcisions are followed by infection of the wound, hardly surprising considering that the diaper environment is less than sterile.

And finally, lets not forget death.  Yes, death.  1 in 5000-6000 circumcised boys die from the procedure, which may not seem like a high risk…until you consider that the largest study to date on vaginal birth after cesarean (over 300,000 women attempting VBAC) found that the risk of neonatal death from uterine rupture is less than 1 in 20,000, and yet VBAC is often painted as being unreasonably risky to the baby.  If circumcision is 2.5-4 times more likely to kill the baby than VBAC…shouldn’t there be warnings about this?  Shouldn’t parents be required to sign “circumcision consent forms” that are similar in intent to VBAC consent forms?  That is…designed to scare parents about the risks?

And those are just the risks to the boy…there are possibly longer term “relational risks” as well.  Dr. Christine Northrup, author of Women’s Bodies, Women’s Wisdom writes about the topic:

The natural penis may be more comfortable for the vagina than the circumcised penis. The coronal ridge of the natural penis is more flexible; O’Hara likens it to the resiliency of Jell-O. The circumcised penile head is considerably harder–overly firm and compacted like an unripe tomato. This is because circumcision cuts away 33-50 percent of penile skin. As a result, the skin of the penile shaft can get stretched so tightly during an erection that it pulls down on the skin covering the glans, compressing the tissue of the penis head. The abnormally hardened coronal ridge can then be very uncomfortable to vaginal tissue during intercourse. Women sometimes experience a scraping feeling with each outward stroke and even report discomfort after intercourse or even the next day (note: studies show this is more common in women who are over the age of 35). The brain makes pain-relieving endorphins that may partially block any discomfort during intercourse itself. As a gynecologist, I can tell you that painful intercourse is a very common symptom in women, many of whom blame themselves or who feel that something is wrong with their sexual response….

Circumcised sex may cause the vagina to abnormally tense up and decrease its lubrication. Women report more problems with lubrication when having sex with circumcised men, possibly because of irritation from the harder tip and involuntary tensing against it, and also because the longer stroke length tends to remove lubrication from the vagina. Often an artificial lubricant is necessary.

Wow…so not only does the boy suffer from circumcision, but we women might as well!  I’ve got to admit…after learning about this a few years back, I felt I had been robbed of something, not just my husband.

My husband and I did not have our sons circumcised for a variety of factors–the lack of a clear cut medical need (and here), lack of Christian religious directive (Jewish) (Islamic), knowledge that the original circumcision commanded to Abraham is not the same as the circumcision that is performed today, and the bottom line that it seemed to us to be an extremely painful elective cosmetic surgery that we felt our sons should be the ones to make the decision on.

So here’s my hope for Independence Day…that sometime soon the majority of newborn boys will never feel the restraint of the circumstraint board.

Tags: circumcision, death, marriage, Newborn Care, VBAC