The world of medicine is like a bubble. A lot of people THINK they know what goes on there, but unless you're down in the trenches it's unlikely you do. So here is my semi-anonymous blog, here to tell you what really goes on in the life of a medical resident.

Saturday, January 21, 2006

Whose Penis is it Anyway?

So I did my first circumcision this week. It was the little newborn that I had helped bring into the world just two days before, having a family medicine preceptor who is one of only a handful of family doctors who still has the balls to do obstetrics. He was adorable, in spite of the dry cracked skin and long nails that are a hallmark of a baby having way too much fun in there to arrive in the world in a timely manner. The poor mom was over a week overdue and PLENTY tired of being pregnant.

I had been dreading the procedure since the mom's 38 week prenatal visit, when she asked how soon the baby could be circumcised. Apparently, the town where I am doing family medicine is still a bit behind the rest of the world, and circumcision is still pretty common. I, as you may have figured, am VERY against the procedure. But I kept my mouth shut and assured her that Dr. D's general practice, assuming that the baby is healthy (and male, obviously) was to perform the procedure on day 2, just before mom and baby are discharged.

I hated every second of it. From the moment the baby was strapped down to the the board until the last exhausted scream as his poor, bloody little weenie was packed with gauze. Why do people still do this to their kids? I wonder if so many parents would be eager to circumcise if we made them watch what we have to do to their little ones. The worst part is prying the foreskin off the glans... it isn't supposed to retract that early, and it just LOOKS painful. Dorsal penile nerve block be damned, that kid had to be hurting.

Honestly, I don't know the history of circumcision. I don't know what bonehead decided it was a good idea to slice off the foreskin, or what the initial purpose was. That's why I try not to judge people who still circumcise their sons for religious reasons... if that's the way you choose your covenent with God, so be it. I still don't agree, but I can't judge something I don't understand and haven't done my homework on. So this is really going out to all those people who decide to have their boys circumcised "so that he'll look like daddy", "because it looks better", "so that they other boys won't make fun of him in the locker room" or, the one that drives me RIGHT up the wall in 0.3 seconds... "because it's cleaner".

ARGH!!!

The Canadian Institute for Health Information reports that in in 2003, less than 20% of infant boys were circumcised. Even back in the heyday of circumcision (around 1970 or so), the rates hovered around 50%. So if anyone is getting made fun of in the locker room, it's not the boys with the turtlenecks. They're now the majority. And they have been for quite some time. Even if daddy is circumcised, looking different is hardly going to leave a lasting scar on the child. First of all, baby penis does not look like adult penis. It just doesn't. Second of all, how often are little boys and their fathers sitting around comparing penises (peni?)? I'm the first to admit that I lack the equipment in question, but I'm somehow doubting that this happens.

There is also a common thought out there that circumcision prevents diseases and foreskin complications in later life. This argument is flawed on many levels. Let's address a few of these 'diseases' individually. The only thing that circumcision has been PROVEN to reduce the risk of is urinary tract infections-- and even then, only in the infant period. A UTI is an infection that can usually be treated easily with an antibiotic, but that can develop complications in babies. The incidence of UTI in infant males is 1-2%. The incidence of complications of circumcision is 0.2-2%. Hmm.

And the other stuff? There isn't enough evidence to say that circumcision prevents HIV and penile cancer. Not according to the Canadian Pediatric Society, anyway. And the incidence of phimosis (when the foreskin gets stuck over the glans) is far too low to consider circumcision as a valid preventive measure.

Using the argument that circumcision is a preventive measure at all is flawed. If we routinely removed parts of our bodies that had the potential to cause problems later, we'd all have our appendix and gall bladder removed at birth. And hell, while you're at it, why not remove both breasts? They only cause problems in the long run...

And circumcised men are "cleaner"? Ugh. Don't get me started. Any crease or crevice on the human body has the potential to be pretty gross if it's not cleaned properly. Do you think girly bits are self-cleaning? No. Boys with foreskins learn to clean them the same way they learn to clean all the rest of their nooks and crannies. Seriously, people... it's not brain surgery. Pull foreskin back. Clean. Let go. Honest, that's all there is to it.

The bottom line is that this is an unnecessary cosmetic procedure performed on infants who are unable to give informed consent. And this decision is often based on the parent's preference, which is based on their experience. Is this fair to baby boys? I don't think so.

But that being said, I'll keep my opinions to myself and tell parents only that the Canadian Pediatric Society's current position is that there isn't enough evidence supporting circumcision to recommend doing it on medical grounds. So the decision is up to them. But I'll also tell them that less than 20% of newborn boys in Canada are being circumcised these days. And if they ask my opinion, I'll tell them that I think it's unncessary. And then I'll stand quietly by while another infant boy is strapped to a board and the Gomco clamp is fitted over the head of his penis. But there's no way in hell I'll ever perform one myself.

(This post is dedicated to my uncle Andy, who wanted to hear my rant on circumcision. If you're circumcised, Andy, I'm sorry. ;-) )

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18 Comments:

Blogger DrPak said...

Hmmm... I was circumscribed when I was around 6. I still remember it. It wasn't pleasant at all. However, it was done for 'religious' reasons, as I'm a muslim.

Your post got me thinking though, I never really thought about this before and you raise some good points. I'll look into the religious basis of circumcision and see what comes up.

11:02 PM

 
Blogger Ada said...

I think the original religious basis of it actually had to do with cleanliness. ) In the olden days people lived in warm climates and didn't have the luxury of washing as often as we do... hence it was probably cleaner to cut off the foreskin, eliminating the crevice it naturally makes.

(but don't quote me on this, i'm female AND (by definition) christian

11:32 PM

 
Anonymous ron said...

check out genesis chapter 17. verses 9-11.

9:21 AM

 
Anonymous cingulus said...

there's no way in hell I'll ever perform one myself

You awesome. Thousands of boys will thank you.

3:50 PM

 
Blogger Nikki said...

I completely agree that the parents should have to watch. I "assisted" (as much as a first year medical student is ever of any assistance at anything) on four or five circs this past summer, during a peds elective. I HATED it. I felt so sorry for the little guys.

4:30 PM

 
Blogger Foxy said...

Oh god, that is so upsetting. I truly don't know how parents can make that decision. I'm loving all your arguments.

7:19 PM

 
Anonymous Anonymous said...

Love your blog. My dad is a 75 year old FP doc who retired last year. Your attitudes remind me of him:

He delivered thousands of babies and hated circumcision. A lot of boys and men are walking around the little rural town where he practiced uncircumcised, due a discussion he had with the parents. There's no medical reason for it, and it has risks.

One of his favorite sayings is "most childbirths require no medical intervention". Your discussion with the OB/Gyn residents is revealing. Dad had a great relationship with the local midwife (she called him "my mentor") and didn't like performing C-sections unless absolutely necessary. (Our town was too small for a OB/Gyn, and too rural to safely transport every C section case, so he sometimes did them.) His view was that OB/Gyn specialists were too procedure-oriented, turning birth into an "unnatural act".

Also, your experience with "teaching" you got from the Anesthesiologists was terrible. I know that Dad really liked teaching students, and thought it was a duty as well. One memory stands out: my wife and I were visiting with our 6-month old daughter when she had her first ice-cream cone, and her first allergic reaction to cows milk. We took her to his clinic, and after he quickly assessed her, his next step was to call in the NP he was training and have her examine the baby and give her opinion. The NP still works in our home town and is his primary care provider today, watching his high BP. I just can't understand the attitude of those anesthesiologists -- have they forgotten that they were once students?

Anyway, just wanted to say that the world needs a lot more family physicians with common sense, a good attitude, and some guts. Sounds like you're well on the way there. Good luck.

11:06 AM

 
Blogger Andrew said...

I am thrilled to have been named in your blog post ...and yes I have been clipped! Now after reading your dick-rant...can I have it sewn back on?? You must have s pare one lying around?

2:34 PM

 
Anonymous john in rural Alberta said...

Excellent blurb.
I am circumcised, my son (aged 4 years)is not. He hasn't had a problem with me being snipped and his penis not being snipped yet. He sees they are a tiny bit different and he doesn't care.
I was in favor of circ, but my ex-wife was not, the arguments to not circ exceed the arguments to circ, unless one has a religious reason.
Strictly speaking almost all of the Old Testament laws and rules relate to making clear separations and differences between the people (foods,practices) that God has chosen and everybody (everything) else.

11:25 AM

 
Blogger Andrew said...

Gee Doc...I am so pleased to finally get a credit on your fabulous Blog. In now having a complete understanding of your views regarding the snip....can I get mine sewn back on when you return to town???
Uncle Andy

10:43 AM

 
Anonymous Outdoorgal said...

Well you've sold me. I've been a fence sitter forever because my little bro was not circumsized. Because my Mom didn't really know that she was supposed to pull back the foreskin to clean it, I remember hearing the poor little guy scream in the bathtub as she tried to deal with his infections. I figured getting rid of it was probably better, but now I think that if I have a son, I'll leave him be. I'll just make sure to have a long talk with my family doctor about the difference between boy parts and girl parts!
Love your blog and wish I could find a doctor like you!

3:21 PM

 
Anonymous Lindsay said...

DrCouz,

Sounds like in addition to explaining about why babies should be given the choice for themselves, you should post some explanation about care of the intact penis as there is still much confusion about it (separation of the prepuce from the glans, inelasticity of the preputial sphincter in young boys, cleansing effectiveness of smegma, etc).

Thanks!

-Lindsay (me)

4:39 PM

 
Anonymous Anonymous said...

It's refreshing to read your blog and get your perspective on circumcision. I am an OB nurse in Texas and the mother of an intact little boy. I'm very much against routine infant circumcision, and have been ever since I saw my first one in nursing school. Unfortunately, the rednecks in Texas aren't as progressive as many US folks on the east & west coasts. Our circ rates are still pretty high but I try to educate parents and pregnant friends as often as I can.
There's no doubt in my mind that circ rates would drastically drop if parents were required to actually research the foreskin and then view a circ video before they had it done to their son.
Oh, and as far as circumcision in the US, it was encouraged as a general practice as a method of reducing masterbation and curing all sorts of ailments way back when. Crazy, huh?

Anyhow, I'm so glad to know there are doctors out there who know the truth and some who refuse to do the procedure. Have you visited http://www.DoctorsOpposingCircumcision.org ? I know it's hard, but sometimes you have to just face the uncomfortableness and flat out tell people why circumcision is wrong. It's hard for me, but if I'm truly a patient advocate (for the newborn patient), I have to speak what I know. It's still uncomfortable for me, but I'm getting better at it.

Good luck to you in your medical career!

2:33 AM

 
Anonymous Anonymous said...

Circumscision started way, way back when when they thought that masturbation would make you crazy. They thought that if boys were circumscised it would take away the pleasure of masturbating and therefore they would not go crazy. From there it developed into various reasons for why it should be done.
Momma of an intact little boy.

12:30 PM

 
Anonymous Anonymous said...

You know, you can refuse to do it and refer them to a doctor who will.

In Australia it is very difficult to find a doctor who'll circumcise a halthy newborn, and oftne that is the first and only thing that makes the parents think twice. SO MANY PEOPLE are planning on it because they just think it's the done thing, and then when they have to search for a doctor willing to do it really makes them think twice, three times and often not do it at all.

2:36 PM

 
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Anonymous JBloodthorn said...

I have a severed dorsal nerve from the circumcision that I was subjected to as an infant. I tell everyone I know who is pregnant or planning to have a boy at some point about it. I didn't even know my penis was abnormal until I was married. There is no line of reasoning in the world that justifies what was done to me, or what was taken from me.

You are my hero for telling people the truth about this vile procedure.

11:00 PM

 

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