NOTE: Primary author is Lillian Dell'Aquila Cannon (see her blog)
When I was pregnant with my first child, I just thought that circumcision was what you did, no big deal, and that every man was circumcised. Then one day I saw a picture of a baby being circumcised, and everything changed. Just one tiny, grainy photo was enough to make me want to know more, and the more I knew, the worse it got. It turns out, circumcision really is a big deal.
Part 1 - Circumcision Surgery Myths
Myth 1: They just cut off a flap of skin.
Reality check: Not true. The foreskin is half of the penis's skin, not just a flap. In an adult man, the foreskin is 15 square inches of skin. In babies and children, the foreskin is adhered to the head of the penis with the same type of tissue that adheres fingernails to their nail beds. Removing it requires shoving a blunt probe between the foreskin and the head of the penis and then cutting down and around the whole penis. Check out these photos: http://www.drmomma.org/2011/08/intact-or-circumcised-significant.html
Myth 2: It doesn't hurt the baby.
Reality check: Wrong. In 1997, doctors in Canada did a study to see what type of anesthesia was most effective in relieving the pain of circumcision. As with any study, they needed a control group that received no anesthesia. The doctors quickly realized that the babies who were not anesthetized were in so much pain that it would be unethical to continue with the study. Even the best commonly available method of pain relief studied, the dorsal penile nerve block, did not block all the babies' pain. Some of the babies in the study were in such pain that they began choking and one even had a seizure (Lander 1997).
Myth 3: My doctor uses anesthesia.
Reality check: Not necessarily. Most newborns do not receive adequate anesthesia. Only 45% of doctors who do circumcisions use any anesthesia at all. Obstetricians perform 70% of circumcisions and are least likely to use anesthesia - only 25% do. The most common reasons why they don't? They didn't think the procedure warranted it, and it takes too long (Stang 1998). A circumcision with adequate anesthesia takes a half-hour - if they brought your baby back sooner, he was in severe pain during the surgery.
Myth 4: Even if it is painful, the baby won't remember it.
Reality check: The body is a historical repository and remembers everything. The pain of circumcision causes a rewiring of the baby's brain so that he is more sensitive to pain later (Taddio 1997, Anand 2000). Circumcision also can cause post-traumatic stress disorder (PTSD), depression, anger, low self-esteem and problems with intimacy (Boyle 2002, Hammond 1999, Goldman 1999). Even with a lack of explicit memory and the inability to protest - does that make it right to inflict pain? Ethical guidelines for animal research whenever possible* - do babies deserve any less?
Myth 5: My baby slept right through it.
Reality check: Not possible without total anesthesia, which is not available. Even the dorsal penile nerve block leaves the underside of the penis receptive to pain. Babies go into shock, which though it looks like a quiet state, is actually the body's reaction to profound pain and distress. Nurses often tell the parents "He slept right through it" so as not to upset them. Who would want to hear that his or her baby was screaming in agony?
Myth 6: It doesn't cause the baby long-term harm.
Reality check: Incorrect. Removal of healthy tissue from a non-consenting patient is, in itself, harm (more on this point later). Circumcision has an array of risks and side effects. There is a 1-3% complication rate during the newborn period alone (Schwartz 1990). Here is a short list potential complications.
Meatal Stenosis: Many circumcised boys and men suffer from meatal stenosis. This is a narrowing of the urethra which can interfere with urination and require surgery to fix.
Adhesions. Circumcised babies can suffer from adhesions, where the foreskin remnants try to heal to the head of the penis in an area they are not supposed to grow on. Doctors treat these by ripping them open with no anesthesia.
Buried penis. Circumcision can lead to trapped or buried penis - too much skin is removed, and so the penis is forced inside the body. This can lead to problems in adulthood when the man does not have enough skin to have a comfortable erection. Some men even have their skin split open when they have an erection. There are even more sexual consequences, which we will address in a future post.
Infection. The circumcision wound can become infected. This is especially dangerous now with the prevalence of hospital-acquired multi-drug resistant bacteria.
Death. Babies can even die of circumcision. Over 100 newborns die each year in the USA, mostly from loss of blood and infection (Van Howe 1997 & 2004, Bollinger 2010).
Isn't it time to think more carefully about whether we should be circumcising our boys?
But, you say, aren't there important health benefits? See the next post.
* Ethical guidelines for animal research are listed in the Animal Welfare Act and the Guide for the Care and Use of Laboratory Animals, published by the National Academy of Sciences. Every research facility is required to consult with the institution's veterinarian and its Institutional Animal Care and Use Committee (IACUC). The IACUC ensures that alternatives to using animals was considered and that pain relief is given unless it interferes with the purpose of the study.
Read about how early trauma influences brain development and morality in Neurobiology and the Development of Human Morality:Evolution, Culture and Wisdom (Norton book; discount code: NARVAEZ)
POSTS IN BLOG SERIES ON CIRCUMCISION
Anand et al., "Can Adverse Neonatal Experiences Alter Brain Development and Subsequent Behavior? Biol Neonate 77 (2000): 69-82.
Bollinger, D. "Lost Boys: An Estimate of U.S. Circumcision-Related Infant Deaths," Thymos: Journal of Boyhood Studies Volume 4, Number 1 (2010).
Boyle, G.,et al., "Male Circumcision: Pain, Trauma, and Psychosexual Sequelae," Journal of Health Psychology 7 (2002): 329-343.
Hammond, T., "A Preliminary Poll of Men Circumcised in Infancy or Childhood," BJU 83 (1999): suppl. 1: 85-92. Goldman, R., "The Psychological Impact of Circumcision," BJU 83 (1999): suppl. 1: 93-102.
Lander, J. et al., "Comparison of Ring Block, Dorsal Penile Nerve Block, and Topical Anesthesia for Neonatal Circumcision," JAMA 278 (1997): 2157-2162.
Schwartz, William M., MD et al., PEDIATRIC PRIMARY CARE: A Problem-solving Approach, 2nd Edition, Year Book Medical Publishers, Inc., 1990, pp. 861-862.
Stang, H. et al., "Circumcision Practice Patterns in the United States," Pediatrics Vol. 101 No. 6 (1998): e5.
Taddio A, et al., "Effect of neonatal circumcision on pain response during subsequent routine vaccination." Lancet 1997;349(9052):599-603.
Van Howe, R., "Variability in Penile Appearance and Penile Findings: A Prospective Study," BJU 80 (1997): 776-782.
Van Howe, R., "A Cost-Utility Analysis of Neonatal Circumcision," Med Decis Making, December 1, 2004; 24(6): 584 - 601.