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. ;-) )