Snip It

Week 38

Nothing (and I mean nothing) evokes more vitriol and controversy on mom-to-be internet sites than the topic of circumcision– the most commonly performed surgical procedure in the world. 

It's a crazy and confusing thing. 

On one hand you have Moms (primarily from North America) citing scary statistics about penile cancer and genital infection rates in uncircumcised boys and men. On the other hand you have Moms accusing parents who circumcise their kids of child cruelty and genital mutilation. So either you mutilate and harm your child, putting him at a small risk as a baby to save the potential of a small risk in the future OR you leave your kid as-is, saving him pain in the present but risking possible complications later in life. 

Heavy stuff, whichever way you slice it...

The funny thing is that until very recently I didn't think circumcision was a big deal. Almost every guy I've ever been with (and trust me there are MANY-- just kidding Mom!) has been circumcised. In my generation around 50% had the procedure done fully covered by the Canadian medical system. Of those I know who have been circumcised, no-one has admitted suffering unduly. Of those who haven't, I have at least one older family member who had to undergo the operation at the age of five due to infection. It was unpleasant, but not life destroying.

These days around 32% of boys in Canada are circumcised. Since 1996 the official position of The Canadian Pediatric Society opposed the routine circumcision of newborns. This year, the Society (after dealing with much of the aforementioned vitriol no doubt) issued a more 'neutral' statement that captured the risks and the benefits of circumcision while respecting personal preferences, religious issues and many other things that dictate this very personal decision. The bottom line is that according to our country's medical professionals: it's OK if you don't, and it's OK if you do. It's pretty much up to you.

To complicate the issue further, the positions of the world's major medical organizations range from considering neonatal circumcision as having a modest health benefit that outweighs small risks, to viewing it as having no benefit and significant risks. No major medical organization recommends either universal circumcision for all infant males or banning the procedure altogether.

So what's a Mom to do?

The reality is that parents opt for circumcision of their baby boys for a host of reasons: religion, culture, tradition (the “I want him to look like Dad and all the other boys in class” argument). What I find interesting is that most of the indisputable benefits of circumcision (aside from an oh-so-slightly lower rate of easily treatable UTIs in the first year of life) are conferred on sexually active adults.

For example, in the U.S. circumcised men have about a 15 per cent lower lifetime risk of contracting HIV. They have a lower risk of contracting syphilis as well as genital herpes, but there is no protective effect for gonorrhea. These differences, apparently, are really only significant in sub-populations that have high rates of infection, such as men who have sex with men and/ or sex trade workers.

It has long been believed that circumcised men have lower rates of penile cancer. Again, this is common knowledge these days, to which I'd like to add a couple of lesser-known important provisos:

1) penile cancer is very rare and;
2) the risk is apparently exclusive to uncircumcised men with phimosis (a condition in which the foreskin does not fully retract).

There is no evidence that penile sensitivity, sexual satisfaction or sexual function varies between circumcised and uncircumcised men.

So taking all this into account, if circumcision really only affects men later in life, why not let adolescent boys and young men make the decision to be circumcised once they are old enough and wise enough to make an informed decision? Is the procedure really so much more traumatic once a man is older?

Apparently not. Excising the foreskin of a man is no more complicated than doing so to a newborn (this argument was made quite forcefully in the Canadian Medical Association Journal) and in fact poses less of a risk for adult males because adolescents/ adults can take better care of themselves and also communicate more effectively than newborns. The main difference of course is that an adult will remember any pain and discomfort, where as a newborn will forget.

At the end of the day I can only say for sure that I agree with The Canadian Pediatric Society on this one. In the words of this cynical mom-to-be: 

You're damned if you do and you're damned if you don't. 

Do whatever feels best for you. Trust your intuition because chances are your baby will be just fine either way. Teach him to be grateful for the gift of life, and celebrate the fact that people are different, that everyone and every body is unique. In the end that's what will make the most positive impact on your kid's life... not what the hell his penis looks like.