Foreskin stories: Pt. 2

Posted in CULTURE to Prophylaxing Politely by emma reaux on Thursday, February 11, 2010 at 3:59 pm

As an adult actively avoiding procreation, I hadn't put much thought into the genital aesthetics of my potential offspring. Once I started interviewing subjects for Part 1 of this article it occurred to me the foreskinned friends answering my questions had absolutely nothing to do with the outcome of their penises. The majority of males circumcised in the U.S. undergo the removal of their foreskin within days of birth, leaving new parents faced with yet another decision to make regarding the future health and well-being of their child.

In the last decade the American Academy of Family Physicians and the American Urological Association have issued statements recognizing the controversy surrounding the routine circumcision of infants and citing evidence of its potential benefits as well as harms.

In 1999, the American Academy of Pediatrics stated, "Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision." The American Medical Association later affirmed, "Policy statements issued by professional societies representing Australian, Canadian, and American pediatricians do not recommend routine circumcision of male newborns." If the leading medical establishments no longer recommend what is now considered a cosmetic procedure, why are 60-75% of American male babies still circumcised every year? What medical advice and social assumptions lead parents to their final choice? Three young couples with interesting takes on the whole circumcision decision explain.

Weighing the options

Lynn, MBA (non-profit fundraising, 27) and Jack, JD (Lawyer, 28) have been married two and a half years. Lynn is currently 7 ½ months pregnant.

Emma Reaux: Were you planning on starting a family?

Lynn: Yes, we planned this pregnancy.

ER: Have you found out the sex of your little one?

L: We decided not to find out the sex when we had the opportunity.

ER: Why?

Jack: It will be a fun surprise when the kid is born. We use a gender-neutral nickname.

L: I am also not really interested in the big push toward gender-specific clothing and gear for infants either; it wasn't a concern to me to be able to have the perfect pink or blue something for the baby.

ER: Will you find out the sex before you give birth?

L: No, we do not plan to find out the sex even if we have another ultrasound.

ER: If you have a male baby, will you circumcise him?

J: Probably, although we haven't really reached a decision on this.

L: This is something we've been discussing recently.

ER: If you have a female, will you circumcise her?

L: I didn't even think this was an option in the United States. Even if it was, it is not something I would consider.

ER: It's illegal in the U.S.

J: I hate that both procedures share a name — they really aren't related at all, and it implies that the female version is somehow okay.

ER: What have you read or researched about male circumcision?

L: We've done reading on our own, reviewed information provided by our midwives and discussed circumcision with a childbirth educator. There are mixed messages about the health benefits either way. We learned about the procedure and its risk factors, about the percentage of those circumcised and about common reasons people may choose to circumcise or not.

J: [More research] is on the to-do list.

ER: What are the benefits and drawbacks to leaving your son's foreskin intact?

L: Some studies say that it is healthier to be uncircumcised, though the same has been found about circumcision. There can also be similar social benefits — if everyone in the locker room is uncircumcised, a boy may feel he fits in better if he is also uncircumcised. By choosing not to circumcise, you can avoid a painful procedure and its risks.

J: I have no idea. Maybe kids will make fun of him if that's not the standard thing to do in this area.

ER: What are the benefits/drawbacks to circumcising?

L: Again, there are mixed reviews out there about the health benefits. There is the benefit of father and son looking the same, as well as the social aspect. As far as disadvantages, the procedure and healing process can be quite painful. Some providers and insurance companies also consider it a cosmetic procedure. It may mean having an unnecessary surgery done depending on your provider's point of view or paying more out of pocket for your son's care depending on the insurance company's classification.

ER: Have you two disagreed at all about your thoughts on circumcision?

L: No. We both agreed that this was something we did not have a strong opinion on that we should research more before making a decision together. One of the biggest things we did agree on was that this is a decision for us to make together, not just one left to the father.

J: Both of us are pretty ambivalent about it at this point.

ER: If you have a boy, what do you think about the argument that circumcision is more sanitary and healthier over the lifespan of your son?

L: We have seen studies from reputable medical bodies that claim health benefits of either choice. Because of this, I don't personally feel that one or the other is definitively more beneficial from a health standpoint.

J: Could be true; could be false. It makes sense to me, but that doesn't make it right.

ER: What about the argument that male circumcision is a violation to, or mutilation of, the child's body and rights?

J: Also a good argument. But then, isn't jabbing a child with a needle a violation of the child's body and rights too? A parent must make decisions for the child.

ER: Why do you think circumcising males in our culture is acceptable, while female circumcision is considered mutilation and very controversial?

J: Circumcising males is acceptable because that is what has always been done. Female circumcision is not widespread in the U.S., so people are afraid of it. Plus, it reeks of male dominance and repression of females.

L: I think male circumcision grew out of both cultural practices and a belief about health benefits, so it is generally much more widely accepted. It is also more commonplace and thus more accepted. In my understanding, when female circumcision is practiced it is done as a punishment and often not in an ideal medical setting. I think the difference in intention is the biggest reason there is a difference in acceptance.

ER: Would you even be thinking about the genitals of your child if you knew you were having a girl?

L: Probably not.

J: Nope. But then, we haven't really thought about it much for the guy either.

ER: Jack, are you circumcised?

J: Yup.

ER: One of the main arguments I've heard in conversation about this issue is that fathers want their son to "look like them." How would you feel if your son's penis looked different from yours? For example, uncircumcised if you are circumcised?

J: Doesn't make a difference to me. It might take some more explaining if the kid is different, but I don't think that's a big deal.

ER: On a scale of 1-10, how important is the issue of circumcision to you if you have a son?

L: I think it is a very important decision for us to make. I would consider it at the upper end of the scale.

J: I'd say 1. But it's a decision that has to be made before the kid gets here, so in that light, it's very important.

ER: Do you think your decision could be swayed at the hospital?

L:  We've made a conscious effort to do our own research and make our own informed decision. We have also chosen medical providers who use a more collaborative model of care. While I don't think our decision can be swayed, I certainly think it is possible for others in different circumstances to receive pressure one way or the other that may influence their decision.

J: If we get it done, it won't be the first day. We'll wait until the first doctor's appointment, if possible.

ER: If you choose circumcision, how would you feel if something went wrong with the procedure and it maimed your son's penis?

J: Well, that would suck, wouldn't it? But we have to make a lot of decisions for our children, and you can't get caught up and feel guilty about each one. You just have to make the best decision you can at any given point and move on.

ER: If you decided against circumcision, what steps would you take to prepare your son for reactions he might get from other children or teens as he grows up?

J: I haven't thought about it. It'll be a while before I have to deal with that.

L:  Everything we've read indicates that only about 50% of boys are circumcised. While it's certainly more common for some races or religious groups where a boy may be more likely to encounter reactions for being different, this is a question you could ask either way. I don't have a plan for this quite yet, but I also think that addressing this goes to a larger issue — teaching children about their bodies and making it normal instead of shameful.

ER: What would you say to another expecting couple considering their options about circumcision?

J: It's not my decision. I have no opinions or advice on this issue.

L: I would encourage them to do research, talk with their medical team about their wishes and, if possible, choose a medical team that strongly supports their point of view. I think it is ultimately a personal decision.

Circumcised

Melody, MSW (25, Hospital Social Worker) and Jim, MBA (26, Sales) have been married 2.5 years. The couple welcomed their first child, Samuel, into the world in early December.

ER: When did you find out the sex of your baby?

M: At our 20-week ultrasound, but we had MD confirm it every ultrasound after that!

ER: Had you discussed circumcision prior to finding out the sex?

J: Yes, we just knew that we wanted to get it done.

ER: When you say you "just knew" what you wanted to do about circumcision, what do you mean?

M: We didn't consider not getting him circumcised.

ER: Why was circumcision the best choice for you two and your son?

M: Circumcision is done to reduce risk of infection and there wasn't a thought of us not doing it.

ER: Why do you think you researched the hell out of everything else, but this was an easy decision?

J: There was no question; we were going to get it done.

ER: What fears or concerns did you have about the circumcision process?

M: There are risks of the MD making a mistake and we wanted to make sure that we helped it to heal well. We did feel bad after they brought him back and showed him to us, like what did we do to him? But we know it was the right decision.

ER: If you had a baby girl, would you think at all about circumcision, or the cleanliness of her genitals?

M: No, we never knew that girls could have a circumcision.

ER: Why do you think more people are concerned about male circumcision in our culture than female circumcision?

J: It is the social norm.

M: In the locker room you don't have a girl notice if another girl is circumcised.

J: But with a guy, it is noticed or talked about.

M: Girlfriends getting together talking about their new love interest. It is likely to come up as a comment if he didn't have a circumcision.

Foreskinned

Rita, MS (27, PhD candidate) and her partner Jose, JD (27, Lawyer) have been together over 8 years. Rita gave birth to their first child, Rex, in November.

ER: When did you find out the sex of your baby?

R: During the usual time that they tell you, I think week 23?

ER: Had you discussed circumcision prior to finding out the sex?

R: No, we actually didn't talk about it until pretty late.

ER: Did you research circumcision during your pregnancy?

R: I took the Bradley class, which is a natural labor and childbirth preparation class. They gave us a few articles on circumcision and some arguments against it. I didn't look into it beyond that.

ER: What fears or concerns did you have about the circumcision process?

R: The whole process itself is kind of scary.

ER: What agreements/disagreements did you two as a couple have about circumcision?

R: Oddly, my husband didn't seem to care much one way or the other, he just supported my decision. I was expecting him to feel strongly about it, but he didn't.

ER: Is he circumcised?

R: No.

ER: If you had a baby girl, would you think at all about circumcision, or the cleanliness of her genitals?

R: No, and that was part of why I decided against it. I would never think of doing that to a girl (although I know they do it in some parts of the world) so why do it to a boy? I think our bodies come out the way they are meant to be, no need to be cutting parts off, boy or girl.

ER: Why do you think more people are concerned about male circumcision in our culture than female circumcision?

R: It just seems to have become one of those cultural norms, although I don't know how. I think originally it started off as a religious practice for Jewish families, but somehow it is now the standard practice even though there is minimal medical evidence supporting it.

ER: Tell me about your experience at the hospital once your son was born.

R: They just asked if he was going to be circumcised and I said no and that was the end of it. I did not feel pressured and was happy with our care.

ER: Have you thought about how not having him circumcised will impact him in the future?

R: I hope it will be a non-issue and should not impact him at all. If anything, I hope I've left him with some natural protection against zippers and other unpleasant things.

To learn more about the history of circumcision, and why its practice varies by country and culture, check out this informative site. A special thanks to all 11 participants for Foreskin Stories Part 1 and 2; I appreciate all of the enthusiastic cooperation and honest responses over the past several weeks of interviews!