I usually meet with prospective families once a week so they can get a feel for our office. Generally, it is the mothers who ask the most pointed questions: how do you feel about vaccines? How much medicine do you prescribe? How do we reach you with a question? All pretty typical stuff. At some point, I usually ask if anyone had given any thought to circumcision. Invariable, all of the mother’s heads turn 90 degrees to look at their male partners. It appears this is the one decision that falls under a dad’s jurisdiction. I typically get a “oh yeah, we’re gonna have it done” answer. I’m not sure if there was a lot of thought put into it. The feeling I get is that this is a “no brainer, that’s just what you do” kind of decision.
If we could ignore our misconceptions about uncircumcised boys being in the minority, or that it is important medically, or that it honors some long standing tradition and just look at the baby, what would you really think. This baby, in it’s first days of life. Perfect, whole, peaceful, content. Now take an honest look at what happens next. That child is strapped to a “circ board” with arms and legs restrained by Velcro bands. Betadine antiseptic is poured on his genitals. The adherent foreskin is physically separated from the glans of the penis with a probe. A slit is cut into the foreskin and a metal bell is placed over the glans. Then a circular clamp crushes and pinches the foreskin which is then cut off. Are we all good with that? I can assure you that the male foreskin is not some cosmic mistake. Like most body parts I can think of, it is there for pretty good reason.
Let’s look at the benefits of the foreskin. Full of sensation, protects the glans, loaded with nerves. Seems like it is worth keeping. Next, some may think it is completely useless--an evolutionarily quirky but harmless mistake. That still does not give us the right to subject babies to this intensely painful procedure. Lastly, maybe that foreskin would be harmful if not removed—that is what we have been led to believe. First, once removed, men are protected against penile cancer, which about one in a thousand older men may develop. It is a tough sell for me to start removing body parts just because they may turn cancerous in our geriatric years. Second, circumcised men may transmit HIV at a lower rate. Why not keep the foreskin and wear a condom? Lastly, there is the urinary tract infection story. This is the big seller. In a study of 136,000 boys born in army hospitals in the early 1980’s, 0.2% of those circumcised had complications—bleeding, infection, etc. Urinary tract infection in infant boys is rare enough in uncircumcised boys, about 0.2% will get one. In circumcised boys, it is about ten-fold less, about 0.02%. But what we learned from this study is that 444 boys would have to undergo circumcision to prevent one UTI. Reasonable people could disagree about the implications of this, but I believe that routine circumcision is not warranted for UTI prevention.
Here is what I am asking. Please don’t brush off the circumcision question without giving it some serious thought. Moms, don’t defer this important decision to the father. Have a discussion and get involved. Just because dad is circumcised does not preordain that his son should be too. Educate yourself. Go to websites like www.intactamerica.org or www.nocirc.org. If your boy wants to undergo circumcision when he is older, let it be his choice. You can take it off, but you cannot put it back on. There are situations when circumcision may be medically necessary. Sadly though, thousands and thousands of infant boys are subject to this painful procedure that is of no benefit to them.
Part of my job as a pediatrician is to advocate for those who cannot speak for themselves. I do not believe there is any justification to impose this procedure on those who cannot be involved in the decision. It is time for the culture of routine circumcision to end.