To Cut Or Not To Cut

Photo Source:  Luke Brugger

Photo Source: Luke Brugger

When I learned that male circumcision is so widespread in the US due to Dr. John Harvey Kellogg’s fear of masturbation, and not health concerns, I took major pause.

When I was ~4 months pregnant, my doctor called to tell me that my womb created a “male”.  I remember thinking it surreal that my body had just created a penis. How rad and crazy and insane. I have two sisters . . . my childhood centered on periods, long hair stuck in shower drains, and “borrowing” clothes. So when my partner asked my opinion on whether we should circumcise or not (sorry, CUT my child’s BODY PART) I felt sick to my stomach.

I honestly didn’t think I would ever have to make such a decision. It also felt like a foregone conclusion that if I had a son, I would circumcise him, without question, since I grew up in a Muslim family. Except, I. Question. Everything.

I thought to myself: What are the cultural roots behind why Jewish and Muslim males are circumcised? Do those historical conditions pertain to the present day? Is male circumcision really about “cleanliness” and STIs? Why do so many males in the US get cut when males in Europe, Central and South America, and many other parts of the world don’t? Does it really matter if my child’s genitals match his father’s? Do doctors really know what babies feel? How do we know that the trauma of cutting doesn’t stay imprinted in the baby’s psyche? Is there a benefit to keeping the foreskin? If so, what is it?

So, dear reader, I went on an all out full throttle inquiry. I googled, read, asked a pediatric urologist, public health professional and every OB/GYN that I knew about the procedure. Finally, I sent out an open call on social media to my friends and family about male circumcision and asked them to send me confidential emails about their experiences. I can’t even tell you how many folks came out of the woodworks with messages, emails, texts, phone calls. I had opened a real life pandora’s box. To some, male circumcision was akin to child abuse while to others it was a religious ritual that shouldn’t be questioned. But most folks seemed to just go with the flow and do what others around them did to fit in.

Spoiler alert: No, I will not tell you about my son’s genitals and our decision. He can do that when he’s older, if he chooses. I will fill you in on what I discovered - the information was enough for us to make a confident and informed opinion.

But first, a fun fact. Did you know that the bland cereal we know as Kellogg's Corn Flakes was created to curb masturbation by the good ‘ole Michigan doctor? That and cutting the male foreskin. Don’t believe me? Just read through his book, Plain Facts for Old and Young: Embracing the Natural History and Hygiene of Organic Life, published in 1887. Who knew?

Benefit vs. Risk Analysis

Every medical procedure follows a benefit vs. risk analysis, so that’s what I wanted to follow. However, the public information was (and remains) contradictory and confusing! Especially considering that the vast majority of males in Europe and throughout Latin America are not circumcised.

So, is the American Academy of Pediatrics correct? Do the benefits of male circumcision slightly outweigh the risks? Or are those slight benefits uncompelling as other doctors in the US believe? To me, the answer is Both/And. It really is a personal decision that will inevitably vary. I found that each family/individual needs to analyze the benefits vs. risks for their child based on their specific situation (Where do you live? Does your family have a history of diabetes? Do you observe a specific religion?).

A conversation with my friend, Dr. Erin McNamara, a pediatric urologist, was the most helpful in uncovering a lot of misconceptions about male circumcision. Overall, her opinion was that it is very much a personal decision. She both conducts the procedure and mentioned that the current trend in the US is to leave the foreskin intact. She clarified a lot of dubious medical studies for me and underscored that if a parent is planning on the procedure, it is ideal for a surgeon to do it (Urologist or OB/GYN, NOT a Pediatrician), as they are trained in cutting. She also said that if a parent chooses to circumcise, a baby will heal quickest if it is conducted as close to birth as possible. We left our conversation with Erin much more confident about what our gut was telling us to do.

She basically broke up the information into two categories (Irrelevant and Relevant) for my family since we live in the United States.

Irrelevant

  • UTIs: UTIs in babies are *extremely* rare (around 1%) and can be treated with antibiotics, so it is pretty irrelevant in this analysis.

  • HYGIENE: For the first 5 years of life, there is no need to retract the foreskin. After that, a child can learn to clean themselves, like any other body part.

  • STI TRANSMISSION: The studies that indicate circumcision lowers rates of sexually transmitted infections were all conducted in Sub-Saharan Africa on heterosexual cisgender males, where the public health conditions are very different than in the US. For example, The American Academy of Pediatrics strangely uses the Sub-Saharan Africa statistics and studies instead of studying and focusing on the health concerns of the population in the United States. Also, LGBTQI populations are not included in most popular medical studies.

Relevant

  • DIABETES: If your family has a history of diabetes, it does make sense to circumcise a male baby due to painful diabetes-related complications that could occur later in life, like phimosis.

  • JEWISH: Male circumcision is a commandment in the Torah, so for those who practice the Jewish faith, it can be an important cultural and identity marker. However, observant families don’t always cut.

  • MUSLIM: Male circumcision is not in the Q’uran, but it is mentioned in Sunnah (recorded sayings and actions of the Prophet Muhammad). Therefore, it is not compulsory but has become a common ritual practice for many who practice Islam. It is mainly conducted for cleanliness purposes (from the days of the Prophet). So, this leaves it open to how one interprets their religion. I have also recently learned from my open call (see above) that many males from Muslim-majority countries/communities are not cut.

And then, I got a whole lotta feedback from people who have an intact foreskin (both gay and straight) and their partners. I was told that no lubrication is needed for the partner and there is much less pain during sex. I was repeatedly told that the foreskin is the most sensitive part of the penis and cutting it reduces pleasure for males. One person told me that cutting the foreskin “cuts off male sensuality” since it’s so sensitive to the touch. This blog has a lot more to say…

What are your thoughts about male circumcision in the US vs. around the world?