Why do I...

leave my babies intact? Why don't I have them circumcised?

Short answer: Because they are girls. Ha ha... okay, so that isn't really funny, as I will explain later...

I would not have them circumcised, male or female. This is something I looked into heavily while pregnant with my second baby before finding out the gender. With Caroline, we'd already found out she was a girl long before anyone even mentioned circumcision, and so it wasn't given much thought - and zero research - until early in my second pregnancy.

This post is not for Jews... I understand Jews have religious reasons for circumcision and it is done in a religious ceremony by a mohel and not in the hospital. This post is also not intended to make people feel bad for circumcising their sons. If the research was done and the parents are confident in their decision, then okay. This post is primarily for those who do not yet have a son and haven't given much thought to the issue, and to those who may already have a circumcised son and are re-thinking this decision for future sons. If you regret your son's circumcision, please, do not feel badly. We do the best we can with the information we have at the time. So I want to give the future moms who read this blog the information, so they can make a fully informed decision and not have to feel regret.

I wasn't even going to touch this topic as it tends to be even more controversial than the breastfeeding/formula feeding debate... but in light of women reading this blog who don't yet have children - and after having heard from moms who say they wish somebody had talked to them about circumcision before they'd consented to having it done to their sons - I thought I would put it out here. So I bring up this topic not to judge, but to inform, so that other parents have the information and may not have to live with regret as many moms do whose stories I have heard.

Another thing to keep in mind - there is much more information currently available on this topic than there was years ago. Of the males born around the time I was (1979), about 80-90% were circumcised. It was simply not questioned much, and people generally accepted it as a necessary thing that is done to all baby boys. Currently, the nationwide numbers are closer to even: almost half of boys born currently remain intact. This percentage varies from region to region, of course.

First of all, some basics and vocabulary words, because most people don't go around discussing circumcision daily and especially if you have never had a son before, then these terms might not be familiar. So, a brief glossary, and trying to use technical and accurate terminology (so if you don't want to see words that refer to genitals, please skip this post. I promise to not be too graphic ;) :

circumcision: the surgical removal of the foreskin of the penis
foreskin: the fold of skin which covers the head (the glans) of the penis. Also called the prepuce. It is a continuation of the skin on the shaft of the penis and is not a seperate anatomical structure.
intact: term used to describe the unaltered male. Use of this term is intended to show that "uncircumcised" is not the opposite of being circumcised (the opposite of circumcise would be "restored," technically). "Intact" is meant to describe the natural and biological norm, and it does not make sense to use a word which has at its root a surgical procedure that was not performed - is that as clear as mud? ;)
RIC: routine infant circumcision, the term which refers to this procedure when done on a baby for non-therapuetic or non-religious reasons (a newborn hospital circumcision)
circ: shorthand for circumcision
retract: to pull the foreskin back, exposing the glans

Probably everyone knows that circumcision is the removal of the foreskin. Here's the basics of the procedure: It is usually done with a scalpel and a device that is made to fit over the glans to protect it during the procedure. The procedure takes around 15 minutes typically. Sometimes local anesthetics are used and sometimes they are not. To perform the circumcision, the baby is placed in a device called a Circumstraint (I couldn't make that up! - here's a photo) where his arms and legs are secured and he is immobilized. The foreskin, which is fused to the glans on the penis in infants (much like a fingernail is adhered to the skin beneath it), is physically separated from the glans using surgical instruments. After it is torn from the glans, it is cut off. Here is a video clip of an infant circumcision that shows it being done step by step (be warned, this does not make for pleasant viewing - you may want to mute your speakers. I have not been able to watch it all the way through with the sound turned up! There are reasons why parents are not typically invited to watch their babies' circumcisions!). The same video can be found larger here.

So, now that we have the terms defined and the basics of the procedure, what are the reasons that people choose to circumcise their male infants?

Religious reasons:
As I mentioned before, Orthodox Jews believe in circumcision as a religious rite. They are following Old Testament Law. While today's Jewish religious circumcisions are similar to hospital circs, they are done as a part of a religious ceremony and not by a doctor in a hospital. I believe Muslims also circumcise on religious grounds. I am sure other religions may as well, but I am most familiar with the Jewish traditions.

As far as Christianity goes, I cannot speak o the positions of all the subsets of Christianity, but I can say what I know about the Catholic teachings. the Catholic Church, as far as I can tell, has no position on circumcision directly. As Paul wrote in the New Testament, it is not necessary for our salvation. Whether a Christian circumcises or not has no bearing on his salvation because it is no longer a requirement under the New Law. In other words, his genital status has no bearing on whether or not he gets into heaven! However, for those who continued to circumcise because of a belief that it was tied to their salvation, and for those who tried to "uncircumcise" or restore their foreskin, this was problematic and Paul warned against it:

Was someone called after he had been circumcised? He should not try to undo his circumcision. Was an uncircumcised person called? He should not be circumcised.

Circumcision means nothing, and uncircumcision means nothing; what matters is keeping God's commandments.

Everyone should remain in the state in which he was called. (1 Cor. 7:17b-20)

Based on the New Testament, it would appear that no Christians are mandated to be circumcised, then. And speaking as a Catholic, there is nothing in official Church teaching regarding circumcision of male infants (correct me if I'm wrong, Seminarian Tim). The only thing I could find that might be applied to circumcision is this (which I came across by chance when looking for something else awhile back), found in the Catechism of the Catholic Church, paragraph 2297: "Except when performed for strictly therapeutic medical reasons, directly intended amputations, mutilations, and sterilizations performed on innocent persons are against the moral law." (Italics theirs, not mine)

RICs are performed for non-medical, non-therapeutic reasons, as I will discuss in a few moments. I would think a baby qualifies as an innocent person. And circumcision is certainly an amputation of a healthy part of the body. It seems to me that RIC could fall into this category. Any Catholic theologians want to weigh in on this (after reading below to find that circumcisions are not medically necessary)? I did find this info from fisheaters.com which makes good sense, although it is not necessarily official Church doctrine, although it may very well be...

There are some interesting points to ponder regarding the New Testament and circumcision at this link. I cannot vouch for the theological soundness because I really don't know the source other than the author's name, but she does make some valid points and bring up some interesting information. And some more interesting thoughts about the Bible and circumcision here.

Which leads us to the next reason to circumcise an infant...

Personal preference for the appearance of the circumcised penis:
When stated this way, it sounds almost petty. "I just think it looks better, so that is why I had my son circumcised." Sometimes it is said this way, too, as if it is okay to surgically alter a baby's body so that its appearance fits the parents' norm. If they are not used to seeing the intact penis, then sometimes parents are uncomfortable with it and base their decisions on what they know.

This often comes across in statements such as:
"We want him to look like his father."
"We want him to look like his peers so he won't be teased in the locker room."
"We want him to look normal."
"His older brother(s) is circumcised, and we want them to look the same."

But should it really be someone else's choice as to how his anatomy looks?

Let's look at the first statement, wanting the boy to look like his father. Sometimes people are concerned that the son will notice a difference and ask questions. Often situations are imagined where father and son would be comparing their anatomy. Well, I don't have any sons yet, but I do have three little brothers and a father, and I can honestly say that none of them ever compared anatomy with their dad. If a child did notice a difference, a simple answer of, "When Daddy was born, they thought it was better/healthier to cut off a part of the penis. We now know that it is not healthier, so we did not have a doctor do that to you when you were a baby." Furthermore, if a son is comparing his genitals to his dad's, circumcised or not, he is likely to notice differences. A grown man and a five year old have many bodily differences and I don't think I have to go into any details here because I am sure the readers can come up with some differences on their own. There are many parts of the anatomy that don't always look just the same - if a father had lost his finger to amputation, we certainly wouldn't have his son's finger removed so they could look alike, would we? And the difference in the fingers would be far more visible than the differences in the genitals!

The second part, about being teased in the locker room... of course, nobody wants their child to be teased. But how likely is this to happen? In the midwest, where the circumcision rate is still very high, I would say it may be likely to happen. However, the percentage of male infants being circumcised is now close to half, so it is really quite likely that there will be nearly as many intact boys as circumcised ones in the locker room. I have heard from males that yes, locker room teasing did happen, and I have heard from others that no, it didn't because you'd get teased if you were caught looking at another boy's genitals! Teasing or not - bottom line is that some kids will always find something to tease about, and should that be the justification for whether we have surgery performed on our sons? Would we allow a seven year old girl to shave her legs and wear makeup to avoid being teased by peers? Would we allow a 13 year old to get nipple rings and tattoos? If a boy was being teased about the size of his genitals, would we allow him to have surgery or take steroids to remedy his being teased? If a daughter were to be slower in developing and was being teased for being flat-chested, would we give her breast implants? Another thing to keep in mind... if a boy is teased about his intact penis so much that he wishes he were circumcised, then he can always get circumcised (if his parents will take him to have it done, or once he becomes of age and can go have the surgery done as an adult). If a boy is teased or otherwise unhappy about being circumcised, he cannot just go get his foreskin restored. (of note: some men do try to "restore" their foreskins, but this is just stretching the skin that is left and is thus not the same as having the original foreskin)

As for wanting him to "look normal," this again goes back to the growing number of intact boys nowadays. Circumcised is no longer necessarily "normal." In fact, the norm worldwide is not circumcision. It is rare in most countries, including European countries. It is most common in Jewish and Muslim-populated areas, but this is for religious reasons and is not the same as how circumcision is relatively common in the US as a non-religious procedure. However, I have heard of people saying/writing that leaving the baby intact is just "gross" or "ugly" or "weird-looking." I am trying to write this in as tasteful and respectful way as possible, but to this reasoning I say - how shallow! How ignorant! To alter a baby's natural, healthy body because of a misguided perception of appearance... this baffles me. Who is to say that any natural, normal part of the body is ugly or gross-looking? Are girls' ears "ugly" until they are pierced? No, of course not - they just look different before they are pierced (different AND normal!). Just as some people think breastfeeding is "weird" or "gross" because they are used to seeing babies fed with bottles, some people also think this about intact boys - for the same reason, because they are only used to seeing circumcised boys. As the percentages change, hopefully this perception will follow suit.

So, what about having an older child who is circumcised and then re-thinking this decision once the second (or third or beyond) son is on the way? Many parents feel like once the first one is done, then they all have to be done - like it would be hurtful to their circumcised child to not be the same as his younger brother. Again, in that case, if it even comes up as an issue between the boys, "When you were born, we thought that circumcision was best for you. We got some new information by the time your brother was born, and we realized that it is not necessary to do. We are sorry we didn't have that knowledge when you were a baby." Siblings don't all look exactly the same... it is okay if they have some physical differences! Off the top of my head, I can think of two families I know personally where the older sons were circumcised and the younger sons left intact. There are many more stories I have read. It has not created any issues for these families.

Perceived hygiene reasons:
This one is sited relatively frequently. Unfortunately, it is mostly perpetuated by the myth that you have to clean under the foreskin of an infant. Not true!!! Remember what I said earlier about the foreskin being fused to the glans at birth? For several years, the foreskin does not retract naturally because of this. It is made this way for a reason - protection. Also, the boy is not ready to use his penis for sexual functions, so there is really no need for the glans to be visible at all. Some boys do not have retractable foreskins until late adolescence.

Therefore, the cleaning instructions for an intact infant are: clean what is seen. Don't try to force the foreskin back - this is painful and can cause damage! The urine is sterile when it leaves the body and thus causes no hygiene issues for the boy - it is not poor hygiene to not clean the glans when it cannot even be seen yet. Once the foreskin becomes retractable, a boy can be instructed to pull it back and rinse it with water when he takes a shower. No other cleaning is required.

Some people argue that it might be hard for a boy to keep himself clean once his foreskin becomes retractable. This argument never seems to be given for girls... the female anatomy would be easier to clean also if it were circumcised (and yes, some cultures practice female circumcision). It is also hard to clean one's own back, under the fingernails, and in the navel. But we don't routinely amputate these body parts for reasons of it being difficult to care for properly!

Perceived health benefits:
This is the reason which is most controversial. Currently, no health organization in the world recommends RIC. The health benefits of circumcision are slim to nil. The only one that seems to hold true is that intact boys are at a very slightly increased risk of UTIs in the first year of life only than their circumcised counterparts. Likewise, baby girls who are circumcised have a lower risk of UTIs in the first year (and this risk is actually larger for females - yet we don't routinely circumcise them here, and in fact, it is illegal!).

There are some studies which claim that circumcised men have a lower risk of HIV/AIDS. These studies were done in Africa, where AIDS is very prevalent. However, these studies were done on men who were circumcised as adults and not infants. There were many issues with the studies which may have skewed the results as well, such as the circumcised men in the study being told to abstain from sexual relations for longer period of time than the intact men. Also looking at the relatively high rate of AIDS in the US along with the relatively high rate of circumcision among the current adult males here... and the lower AIDS rate in many other countries who have lower rates of circumcision... see the point? Circumcision may not really reduce the rate of AIDS infection at all. Here is another link full of studies and how their flaws.

Now, even if the studies showed beyond a shadow of a doubt that circumcision was directly related to a reduced AIDS transmission rate in adult Africans, would that justify performing RICs on American infants? That would be akin to giving the controversial HPV vaccine to all infant girls in an effort to protect them from some STDs. Baby boys are at an extremely low risk of getting AIDS through sexual means. So even if circumcision afforded them with some protection against AIS, it would not be until much later in life!

There is also some evidence that removal of the foreskin can be linked to a very, very slight decreased risk in penile cancer (which is a rare form of cancer). However, studies again may have been flawed. Even if the very slight reduction in risk was able to be proven, penile cancer is so incredibly rare to begin with (more males get breast cancer than penile cancer) that the risks associated with circumcision are not worth it.

The clincher on this for me was the following: Why perform surgery to remove a healthy, functioning part of the body, even if done as a preventative measure for something that could potentially occur in the future? The percentage of men who have medical problems related to their foreskins is very small... well over 90% of intact men have no problems with it at all, ever. However: do you know what the breast cancer rate is for females? One in eight women will develop breast cancer - one in eight. Breast cancer is a serious cancer, too... it kills, and it is common. But do we routinely amputate the breast tissue from young girls in an effort to reduce their risk of developing breast cancer later in life? No! We wouldn't even do this in infant girls whose families have a high incidence of breast cancer. To do so would be considered unethical. So why, then, do we justify removal of a part of the baby boy by saying that it might be decreasing his risk for some sort of health issue later in life?? This is the big "aha" to me... the number one reason to leave a baby intact. There is no other healthy body part on a newborn baby which we amputate for the reason of slim potential health reasons down the road.

This leads us right into the next reason given for circumcision...

Because it is better to do it now when he can't remember than to have to have it done later in life:
This reason is cited often by people who know somebody who had to undergo circumcision as an older child or an adult because of some problem with the foreskin. Their rationale is that it is better to perform the surgery on a baby who can't consciously remember it than on an older child or adult who will have lasting memories of a uncomfortable surgery. In fact, it used to be thought that newborns felt no pain, and thus needed no anesthesia during a circumcision (and sometimes they are still not given pain relief during the procedure to this day!).

So, are there really a whole bunch of males who had to undergo circumcision later in life? It seems like many people at least know the horror story from a friend of a friend on this topic.

If left alone, the intact penis will develop normally and will rarely have any issues which need to be treated medically. However, since circumcision was so common in years past, many doctors didn't know how to care for their intact patients. Many parents didn't know either and thought that the foreskin had to be pulled back from an early age in order to properly clean the area. When young boys are forcibly retracted, damage can be done which can cause scarring and lead to later problems. Sometimes these problems are so great that circumcision is necessary. This problem could be prevented if more people knew how to care for intact infants. Many parents today are hyper-vigilant about this, making sure that their doctors and any caregivers of the baby know not to try to pull back the foreskin at all. How many of these older boys and adults had to be circumcised due to damage done by early forced retraction??

Then there is also the issue of doctors recommending circumcision before trying less invasive measures. If a doctor is much more familiar with circumcised patients, then he may not know of alternative ways to try to solve problem with the intact foreskin. A doctor may go straight for a circumcision recomendation rather than trying, say, a topical steroid cream first.

All in all... the number of older males actually requiring circumcision is smaller than what is seen. It could be made a very small number indeed if people would learn more about caring for the intact penis properly - just clean what is seen and never forcibly retract!


So...................................

What reasons are there then to leave male infants intact?

Because the procedure is painful
Sometimes infants are given pain relief, but often they are not. Some people say that circumcision is not a big deal to the baby because, after all, some actually fall asleep during the procedure. In truth, falling asleep during a painful procedure is an escape response, a shutting down. When infants have trouble coping with a stressful situation, sometimes they fall asleep to "escape." Even with effective pain relief, the raw wound is still there when the drugs wear off. Remember that the foreskin is fused to the glans and had to be torn from it before it can be cut off. Ouch! Often, babies scream when urinating for several days because of the burning sensation on the fresh skin of what was intended to be an internal organ.

Because the procedure causes early separation of baby from mother
As with any medical procedures, early separation of mother and baby has the potential to interfere with bonding. The early days are important for establishing breastfeeding and in the baby becoming acclimated to life outside the womb. His mother is all he has ever known. So, whenever possible, I feel that those early days should not have any unnecessary interference.

Because circumcision is a cosmetic surgery
Neonatal circumcision is the most common surgery done in the US. Most people do not think of it this way, but circumcision is actually a cosmetic surgery. When it is not done for medical or religious reasons, then cosmetic is the only thing left. I would guess that nearly all people would answer "no!" to the question, "Would you agree to having cosmetic surgery done on your newborn before he leaves the hospital?" Looking at the words separately: cosmetic has to do with the outward appearance. Newborn babies are beautiful and created in God's own image. Their looks need no alterations - they are already perfectly made this way! Many people tend to describe their newborn babies as "perfect" when they look at them for the first time. So thinking about their appearance being anything less than perfect is a bit odd to me. Then the second word, surgery... this is not a word that parents want to think about in relation to their new baby! Surgery means that something is wrong and needs to be fixed. And no parent wants their newborn to undergo unneeded surgery, and even when surgery is necessary, parents feel concerned and worried about it. Most people do not think of circumcision as surgery. However, it is clearly a surgical procedure - it is an amputation. And it is not just a tiny piece of skin as many people believe. The foreskin makes up a large percentage of the skin of the penis (anyone have a link to the approximate percentage which I cannot remember offhand?).

Because circumcision carries risks
This follows the discussion of surgery well. As with any medical procedure, circumcision carries risks which range from discomfort and poor healing all the way up to accidental amputation of the penis and death! Every year there are a few deaths of infant boys as a result of complications of their circumcisions. Deaths! How could even the perceived benefits outweigh this risk? Nobody has ever died as a result of remaining intact! There are also cases of boys having so much damage done from botched circumcisions that they are permanently disfigured or lose part or all of their genitals! Just a few examples.

Because the foreskin is a healthy, functioning part of the body, not a birth defect
There are some myths about the intact penis - that it is not healthy and that it serves no function anyway, so what is the big deal about cutting it off? Well, we don't remove the appendix of infants unless it becomes infected and unhealthy, even though it serves no purpose. Many people think the foreskin is like the appendix and is unnecessary and serves no purpose. In truth, the foreskin is a protective body part, causing the glans to be an internal organ. Further, the foreskin is full of very sensitive nerves that are designed to aid in sexual intercourse. The glans of the circumcised penis is constantly exposed to the elements, to having clothing rub against it, which causes callousing and desensitizing. More details on this can be found here.

So.............
We have explored the arguments for and against circumcision. But what about other issues that may come up when deciding whether or not to circumcise a son?

When one parent disagrees
It is typically the father who disagrees and wants his son circumcised - usually because he was circumcised and so he thinks his sons should be as well. Sometimes it is the mother though who wants the circumcision and the father wants his son to remain intact. Either way, this can be a very difficult thing when the parents are in opposite camps. Obviously, the ideal thing to do would be to discuss and research this ahead of time, early on in the pregnancy (which is why I have looked into it so much - I researched before I knew that Cecilia was a girl!). Of course, this is not always possible, especially when many people don't even think about circumcision as a decision... they view it as just "what is done" and don't even consider that they have a choice. I hope that in my writing this, somebody is able to read it and decide to think about and read up on circumcision well ahead of time and be able to discuss it with the other parent and hopefully come to an agreement.

For people who are in this tough situation of disagreement, I can say first that I am sorry and that it must be difficult to feel so torn between wanting unity in the relationship while also wanting to do what you feel is best for your child. Perhaps if both parents agree to do some research and thinking on it, they can have discussion on what they see as the reasoning and rationale behind their choice. I have read of some parents who come to the decision to leave their son intact since it is the default - it is not really making a choice because it is just doing nothing, leaving it alone, whereas circumcising is actually taking a physical action. remember, circumcision can always be performed later in life, but you can never get your foreskin back once the decision is made for it to be cut off! For the parent who opposes the circumcision, it may be a better approach to take to be neutral than opposed: "I think we should just let it be. I don't think anything should be done."

If anyone has struggled with disagreement between spouses over this and would like to share your perspective, please do feel free to do so.

You may be wondering, why did circumcision become so popular as a medical procedure in the US anyway? What is the history? Well, just briefly, circumcision was thought by doctors in the 1800s to cure a variety of ailments, from cancer to insanity. It was also done in an effort to deter boys from masturbating. At one point it was done for status (the wealthiest people could afford circumcisions). Of course, it didn't cure the medical issues that doctors claimed it did over 100 years ago, and so it has never really had medical benefit. But the trend continued nonetheless. For more info on the history of circumcision in the US, click here.

I said I would say a bit about why my "short answer" at the beginning of this post was actually not humorous... and that is because female circumcision is performed in many parts of the world. It is a common tribal practice in many places. Most Americans would be aghast at the thought of females having their genitals mutilated in tribal ceremonies. However, female circumcision - often referred to as "female genital mutilation" - is illegal in our country. Perhaps male circumcision should also be illegal then? Why are girl infants protected and boys are not? Why is circumcision of males not referred to as "male genital mutilation"? I cannot say that I would agree to RIC of males becoming illegal... but I am pretty darn close. Because it is done as a Jewish religious rite, I have trouble saying that it should be outright illegal, but then I also think... some religious practices say that it is acceptable to have multiple wives, yet polygamy is illegal in this country. That is not because we are discriminating against a religious belief. And so neither would outlawing RIC be discriminating. I am pretty much as conservative as you can go on protecting individual freedoms and such, including parental rights (like the right to home-educate our children!)... but what about the baby's rights? Like I said, I am really, really close on this one...

I will close with this: leaving a baby intact is the default and the norm. By choosing to do nothing, nothing has been changed, no harm has been done, there is nothing done that cannot be reversed or changed in the future. I think this is a topic that has far too little attention by doctors and parents alike. It needs to be brought to the attention of parents-to-be so that they can make informed decisions. So please, encourage people to do their research and to consider this before making an irreversible decision. I hope that something here has been useful for a future parent of a baby boy. And if you made it all the way to the end, then wow! Thanks! ;) And as always, if I have missed anything or left questions, feel free to ask away!

For additional reading:

The Case Against Circumcision
This one is excellent. If there is only one link you read, make it this one.

Daddy, Why is Your Penis Different from Mine?

The Unkindest Cut (a video - contains good historical info)

Circumcision Choices (shows the differences between Old Testament Biblical circumcision and the newer methods)

A Catholic Priest's words on circumcision

Penn & Teller on Circumcision (FYI, they are crude and use vulgar language, but their message is good)
Part 1
Part 2
Part 3

And a short clip from one of the above segments regarding to what happens to the foreskin after it is cut off... I didn't even go into this, but it is unethical and a money-maker:
Who Buys Foreskin Cut Off from Babies?

Protect Your Uncircumcised Sons