The circumcision decision: To snip or not to snip?

I remember walking through the grocery store one day while I was pregnant, and a woman came up to me and asked whether I was having a boy or a girl. When I told her I was having a boy, her first question was whether I was going to have him circumcised. Then she told me the story of her son's circumcision. I just wanted to buy bread.

Like most parenting issues, circumcision debate is both personal and polarized. Some parents in the circumcision camp argue that non-cicumcisors (I made that word up) are just setting their kids up for a lifetime of infections and ridicule, while some in the no-snip camp consider circumcisors baby mutilators. The rest of us don’t really care what choices other families make, as long as they are the right ones for them.

It’s a tough decision that every family must make on its own. My goal here is to provide information about circumcision, not to tell anyone that they are wrong. As long as you love your babies and treat them well, I really don’t care whether they have foreskin. Let’s break it down by argument.

A matching set
Some argue that it is important for sons to look like their fathers, but in our family, that was not a convincing argument. Everyone’s body is different, and that’s okay. I can barely fill an A cup, but many of my friends are pouring out of Ds (selfishly, I might add). Will I have to explain to my son why I am different some day? I don’t think so. Besides, I’m not sure that sons see their daddy’s penises far beyond the potty training years. I mean, I’ve never seen my parents naked.

I’ve also heard some parents argue that they don’t want their sons to feel different from their peers when they become sexually active. Again, if we do a good job of teaching self acceptance, then it shouldn’t be a problem. Whether you choose to circumcise or not, the decision shouldn’t be based on wanting a “matching set.” It’s not chess.

Hygeine
Many medical professionals argue that if you remove the foreskin, bacteria can’t collect underneath it, thus preventing infection. According to one study, circumcision can indeed decrease the risk of urinary tract infections in preschool boys.  However, another study argues that circumcision might only be beneficial for boys who are prone to UTIs in the first place, and you’re not going to know that until the second or third trip to the emergency room on Sunday at 3 a.m.

Yet another study says that circumcised penises need more care during the first three years of life. Not only do parents have to clean the delicate snip site while it heals, but they also need to keep a keen eye on it afterward.  “Parents should be instructed to retract and clean any skin covering the glans in circumcised boys to prevent adhesions forming and debris for accumulating.” For an uncircumcised penis, the foreskin doesn’t separate from the penis until early childhood, so the skin covering the head serves as a shield (in other words, it can’t retract, so it can’t collect debris).

A hundred years ago when people were lucky to get a weekly bath, the hygiene argument might have been stronger, but with today's hygiene standards, it's losing momentum. Ryan Lee writes in an Art of Manliness article: “As an owner of an intact penis, I can confidently say that my cleaning habits are probably identical to yours and are more than sufficient to get the apparatus clean as a whistle. If our primary goal is removing people’s folds of protective, functional skin to prevent the possible accumulation of secretions, we should be going after baby girls with the scalpel.”

Circumcision has been beneficial in preventing the spread of HIV in adult men, which is why, according to this World Health Organization distribution map, 80-100% of men in African countries, where the disease is most prevalent, are circumcised. The risk of HIV in the US is lower, but not remote, so for some, this might be the argument that pushes them into the snip-snip camp.

Sexual problems later in life
Some men may experience sexual dysfunction attributable to being circumcised, and some may experience it due to being uncircumcised. There is no clear answer because every penis is different.

According to a British Journal of Urology study, typical North American neonatal circumcisions remove what would become 51% of the penile skin (yowza). When you remove it, the head can keratinize (toughen up), and become less sensitive to stimuli. In this study, men reported reduced sensitivity to stimuli, needing extraordinary stimulation to achieve orgasm, erectile and ejactulatory problems, and dysfunction resulting from emotional distress.

However, another BJU study reports that circumcised men’s sexual satisfaction remained constant, with 98.5% reporting sexual satisfaction before circumcision (later in life), and 98.4% reporting so two years after the procedure.

If keeping the head exposed can desensitize it, on the other side of the coin, if you keep it covered, it may stay ultra sensitive and cause early ejaculation. Jeff Trexler writes for Art of Manliness: “Men who are circumcised later in life do sometimes say that it takes more friction to get things going, but find their orgasms equally or sometimes even more intense. And if you can keep the great orgasms while also lasting longer and pleasing your woman, isn’t that a good thing? I doubt a lot of women are wishing their men were more sensitive than they already are.”

Ryan Lee, in the same article, argues that neither he nor his wife have any complaints about his sheathed member.

Pain
Well, we don’t know. Some babies sleep through the procedure, some scream bloody murder. Having waxed my bikini line for more than 10 years, I can imagine that cutting off some genital skin might sting a bit. But the big concern is the risk of botched circumcisions and infections. According to Stop the Cut (an anti-circumcision organization), it’s not uncommon for a physician to take too much or too little skin, or to accidentally cut the head of the penis.  I mean, they have a point: it is so much easier to make a mistake on a teeny tiny penis than a full-grown one. And the risk of MRSA (methicillin-resistant Staphylococcus aureus), a nasty, nasty infection usually acquired at hospitals, is greater for individuals with a skin wound.

The counter argument is that circumcisions are so routine nowadays, that physicians are getting better at them. It’s unlikely that you’re going to get a physician who hasn’t done at least a few snips.

The plus: the baby won’t remember it, but that’s one hell of an introduction to the world.

Choice
It is our job as parents to make choices for our children until they are old enough to make them on their own. Thus, some parents feel it is the best to make the decision for their sons (one way or the other) based on their own experiences and beliefs. Others contend that you would never hold down a full-grown man and cut off his foreskin without his permission, so those parents would rather leave the circumcision decision to their sons, not wanting to do anything that can't be undone later in life.

Unfortunately, like the cloth versus disposable diaper debate, there is no clear answer to the circumcision debate. You could talk to a hundred different people about circumcision and get a hundred different responses. One pediatrician I talked to was almost forcefully pro-circumcision, while another was against it. So the bottom line is that every family must make decisions based on what they feel comfortable with and armed with information.