Search Results For circumcision

Readers continue to provide the best MGM conversation out there:

This is in response to this reader. The condition that worries the dads is called phimosis. Until my mid-twenties, I couldn’t see more than a dime-sized area of my glans when I pulled back my foreskin. I didn’t even realize my foreskin was supposed to retract until I stumbled upon information about the condition online.

I recommend the dads look at the archives of this forum. It contains many first-hand accounts of successfully overcoming phimosis with stretching exercises. After stretching my foreskin twice per day for a year, I was able to fully retract my foreskin when flaccid. My sensitivity decreased, but that was necessary. I was overly-sensitive, and now I’m able to retract to wash my glans every shower with soap and water, which any healthy uncircumcised man will tell you is simple and necessary. I don’t stretch now, years later, and my frenulum is still a bit tight when erect, but I was amazed by the improvement.

The forum is sometimes antagonistic to doctors, with the allegation that American doctors are too willing to circumcise in phimosis cases because they don’t know any better. Some extreme phimosis cases may need circumcision, but I recommend the dads do extensive research of their own before subjecting their son to a scalpel.

Another reader is pretty antagonistic toward American doctors:

America just doesn’t know how to deal with foreskins.  We didn’t circumcise my son and his foreskin didn’t retract by age 5.  We were told that it should by age 3, and the cure for a non-retracting foreskin was circumcision.  No other advice was offered in England or America.

Then we moved to Bulgaria.

The doctor said we should pull the foreskin back to the point of gentle tension every day in the bath.  Now, it’s a bit awkward for a mother to be handling her son’s penis, so I tried to get my son to do this himself, with so-so results.  Not many months later, my son got an infection in his foreskin, from sloughed off skin cells trapped under the foreskin. He didn’t tell me in time, because he was an accident-prone kid and his solution to avoiding the doctor was to ignore the infection until he had a fever and was walking funny.

I checked on the web, consulted my home medical books, and called my American insurance company’s hotline.  All the advice was to lop off that useless (and, it was hinted, disgusting) foreskin.  But we were in Bulgaria, so we went to a Bulgarian hospital.  The doctor was built like a weight lifter and had odd English. I explained my husband’s preference was to try to save the foreskin, if possible, expecting to be told it wasn’t.  The doctor was absolutely horrified at the barbaric notion that anyone would consider removing a part of a man’s or a boy’s penis, especially for a trivial problem like a nonretracting foreskin with a treatable infection.

He forced the foreskin back, disinfected the infection, slathered antibiotic cream and told us to keep putting the cream on and that the foreskin now retracted. The procedure took under 5 minutes, cost $60 (10$ fee, 50$ tip) and solved the problem.  That was years ago.  My son remains intact.

I think it’s the cultural value that foreskins are useless at best and otherwise potential for disgusting reservoirs for grunge that makes the American and English solution to be lop it off at the slightest hint of any problem – and better yet, before there’s a problem.

And back Stateside:

I have been reading your circumcision thread and thought your readers may want a perspective from a female pediatrician who actually performs circumcisions on a regular basis.

My patient base is semi-rural, mostly white, blue collar, in the heart of Appalachia. They feel that their newborn sons are not “normal” if they are not clipped, and in fact that is sometimes the only question they ask when their son is just born – “Will he be circumcised?” Typically my partners and I will do a circumcision before the child leaves the hospital, but it can be done with local anesthesia up to two months of age in an office setting. There are different types of circumcision procedures that can be done and different doctors are trained on different procedures, but the basic principle is the same: the foreskin is loosened from the glans, a dorsal slit is performed and the foreskin is either placed in a clamp, or tied off around a plastic ring. There are pluses and minuses to each procedure, but it is mostly doctor preference regarding which one is done. And as I said, local anesthesia is given.

As part of my practice, I want my patients’ parents to make the right decision, and so I typically perform a thorough explanation of the risks and benefits of the procedure. But I do get frustrated that despite letting them know they don’t need the procedure, the parents feel it must be done.

Reading your readers stories, I am sad and a little disappointed because although I was not involved in these cases, I feel like the medical field have let them down.  And I think the reason is because the majority of males in the US are circumcised, and that creates a bias and a misunderstanding of the true nature of the foreskin and the male sex organs. If you only see circumcised boys, you may not really know when the foreskin should protract, and you would view something that is completely normal as abnormal just because it is different.

First off, ALL males are born with a natural phimosis. With time the phimosis loosens. This can vary, but there is a key ingredient needed and that is TESTOSTERONE. That is why the doctors of the various readers gave them steroid cream, but that is just not as effective as your own production of testosterone. Now some mothers with uncircumcised boys are aggressive with “cleaning”  and that traction will loosen the foreskin. Some boys are more playful, and that too will loosen foreskin, but a boy of age 3, 5, 7, 8 – even sometimes 14 – has very little testosterone flowing, so it is needed to mature the the male sex organ to function like it should. (As a side note, we recommend not pulling the foreskin down to clean, as that may cause it to rip from the glans but stick, swell and potentially cause loss of blood to the glans, which is bad.) Once the testosterone is flowing, the adolescent maleusually provides enough friction that any minor tightness will also loosen.

Obviously there are some exceptions to this rule, and a circumcision may need to be performed for medical reasons, but that is the exception. I would highly question any physician who tells you a prepubertal boy needs a circumcision if they are urinating with no problems. I also feel very sorry for the man that had a circumcision as an adult with just a local anesthetic that is cruel. No child or adolescent would get a circumcision out of the newborn period without general anesthesia, so why would we do that to an adult?

One more thing: I am surprised that nobody has mentioned circumcisions that had complications. Commonly I see penile adhesions where the foreskin has reattached itself to the glans of the penis, sometimes making it appear as though the child has never been circumcised.  Unfortunately I actually had a mother re-circumcise her son due to this very issue, despite my explaining that this was completely unnecessary, as the boy was two and thus had no testosterone, and that it will get better with time. Unfortunately she became obsessed with it and insisted it be done. I will never forget that boy. (Interestingly enough, prepubertal girls have a similar condition in which the labia minor fuse together, because there is no estrogen blocking the opening of the vagina and even the urethra, but of course we would never perform procedures to separate that.)

So that’s my two cents, for what it’s worth. I found you a few years ago and have thoroughly enjoyed reading your blog.

And we never cease to enjoy these incredible contributions from readers. Update from another:

(Interestingly enough, prepubertal girls have a similar condition in which the labia minor fuse together, because there is no estrogen blocking the opening of the vagina and even the urethra, but of course we would never perform procedures to separate that.)

Actually, this is exactly what my daughter’s pediatrician recommended when she was less than a year old; we were told to put estrogen cream on it (don’t worry if your infant develops breasts, that’ll be temporary … never mind the people freaking out about exposing their children to tiny amounts of estrogenic compounds in BPA plastics and possible links to the obesity epidemic). And if that didn’t work, we were told surgery might be necessary. Thank god for the Internet. The problem went away on its own at about 18 months. Never caused any trouble.

More readers share their stories:

My heart goes out to your reader. We opted not to circumcise our son, only to have him develop the same non-retraction problem at age three. We tried a variety of topical treatments and visited a number of doctors. We were told that the problem might resolve with time, but if it didn’t, we’d be looking at circumcision of an even older child. That seemed untenable to us, so we went ahead with the procedure, which required a visit to an outpatient facility, general anesthesia, and several hundred dollars out of pocket.

He’s now almost seven and doing just fine, but it was a sad experience for all of us. To this day he talks about the time “when Mommy was crying so hard.” I’d tried to put the antibiotic ointment on his incision and he ran away screaming. I was emotionally worn out and worried about infection but also hoping and praying that he wouldn’t get a complex from having a wound on his penis that his parents had to slather with ointment several times a day.

As much as my husband and I couldn’t stomach the thought of a newborn undergoing this procedure, what our son experienced was more traumatic. Would we have done it differently had we known? Probably, but that’s the problem – there’s no way to know ahead of time if your child will develop this issue.

Another got his penis sliced much later than age three:

Having read about your reader’s dilemma regarding his child’s circumcision, I’d recommend that he go ahead and do it. I had issues with phimosis in adolescence and actually needed a circumcision, but I had to wait until I had health insurance to get one. I remained a virgin through college because I was too afraid of something bad happening during sex, which I will forever regret, even though I am happily married now.

One of the first things I did after getting healthcare coverage through a job was to get a circumcision. I was 24 then, and I can attest as to how terrible it is. Imagine getting multiple shots of local anesthetic on your johnson, feeling the sutures being sewn because the anaesthetic is wearing out, and having the whole thing witnessed by four nurses, presumably because of the sheer novelty of an adult circumcision. The recovery is equally horrendous, with painful mid-sleep boners and the skin of my glans getting chapped and flaking off. I took three days off work when I was told one would suffice.

When all was said and done, I had a scarred dick that lost a lot of its sensitivity, but that was mitigated by the lost fear of actually using my penis.

So having experienced circumcision as a grown man, I can attest that it is a barbaric experience. Performing it on a newborn child does not change that. I do not plan on having my children circumcised, if I have any. Still, if it is an issue of medical necessity – which it can be – the sooner it gets dealt with, the better. Once puberty hits and shame becomes inevitably correlated with private parts, a lot of damage can be done.

Another suggests a novel solution:

Why do stories on circumcision never discuss the “dorsal slit” procedure, which leaves the foreskin intact? This simple procedure combines the health benefits of circumcision with all the pleasure of remaining intact. While I do not advocate routine mutilation, this neatly resolves the issue for anyone with retraction problems.  Those seeking middle-ground might consider this compromise.

A colleague of a reader seems to have done just that:

The image that came to me when I read your post was when I was working in a very busy neonatal unit. The head of the department did the circumcisions if the child did not have a pediatrician yet. I came on to work one morning and was so shocked when I pulled back the diaper to reveal something – to my eyes – that was horribly wrong. It looked like a mutilation, and I have seen lots of circs (performed by the pediatricians on their patients – this was the first one I saw that the neonatologist had performed).

I immediately went to find him and asked him to come and take a look. I thought he would really want to know – thinking that there was swelling or infection or some thing gone awry. He made a rather sniping comment – that I had been to Paris and seen the best or something to that effect. What I learned about this doctor is that he did not like to do circumcisions and so he performed a “mini circ” – essentially just nipping a bit off. Everybody is happy.

The start of another fascinating thread:

I feel for the couple with the seven year old whose foreskin won’t retract.  We went through that with both of our boys.  My husband is cut, but I put my foot down and demanded that both of our boys be left intact.  The older of the two started having problems with his foreskin when he was around four (he’s eight now).  It wouldn’t retract and the doctor thought it was very tight.  The urologist gave us some steroid cream and said, basically, “good luck, it probably won’t work; see you back in two weeks to schedule the circumcision.”

Two weeks later his foreskin was retracting like it was supposed to. Yea! Problem solved.

Fast-forward two years to when our youngest was two. Same problem. We went to a different urologist (for insurance reasons). He spent less than two minutes looking at my son’s penis and said: “He’s fine, leave it alone. A lack of retraction isn’t an issue until he is at least eight or older.”

Guess what: both foreskins now retract normally.  I’m very glad I pushed for alternatives and didn’t immediately agree to a circumcision.  So definitely get a second opinion before you cut.

A second:

I’m sure you’ll have some doctors who can speak to the medical aspect of your reader’s question, but I may be able to offer a useful personal perspective. I wasn’t circumcised when I was born, but I did get circumcised when I was 15 for medical reasons that sound similar to your reader’s son’s.

In my case, the foreskin was fused with the bottom of the head, which meant I couldn’t pull it back very far (and the few times I tried, growing up, were quite painful). I just thought that was normal. I heedlessly peed into the damn thing for years and never got any infections to indicate something was amiss. I think I just nodded when doctors would ask if I was careful to pull the skin back when I used the bathroom. At a physical when I was 15, I finally understood the question, so the doctor sent me to a urologist who proscribed a circumcision. Things were pretty swollen and grody for a few weeks; after that everything worked fine.

One thing that gets elided in the hyperbole “male genital mutilation” is the distinction between a medically-indicated procedure and a purely cosmetic one. It doesn’t make medical sense to circumcise all boys at birth, but being circumcised is not a particularly onerous condition.

My dad may have gone through some of what your reader is going through when we decided I needed to get circumcised. He was adamant that I not be circumcised at birth – partly for the reasons you bring up on this site, and partly because he was very not cool with the idea of some doctor cutting on his newborn’s dick without anesthetic (which was the standard in the mid-’80s, when I was born). When I later had to get circumcised, he expressed some guilt: in an attempt to not mutilate his son, he mutilated his son!

This was ridiculous, of course: I was (and am) grateful that I wasn’t circumcised at birth, just as I’m grateful my idiosyncratic problem was so easily treatable, just as I’m content now to live without foreskin. And I told him as much, with more respect than I was usually able to muster at 15. For one thing, I was very much looking forward to sex, and with a mostly immovable foreskin there can be complications. At 15, I would have hitchhiked to the hospital and panhandled for my copay if it meant I could have sex sometime in the future.

It is important to note that I was able to consent to the procedure. I knew what was going on and I was very clear as to the reasons we were doing it. But I can’t imagine I would have harbored any ill-will if I’d been circumcised a few years earlier for the same reason.

More stories to come. Follow the whole thread here.

A reader writes:

I always read your circumcision posts with great interest because both my husband and I are both circumcised and we elected NOT to have our boys (ages seven and eleven) circumcised.  We have no regrets.  Unfortunately, we are now faced with a very unexpected dilemma:  our seven-year-old’s foreskin does NOT functionally retract, and this has caused some problems with urination.  We are also told that this will cause a bigger problem as he matures.  Currently, our urologist has him applying steroid cream treatment four times a day, but this has produced no positive results.  We are NOW faced with very real fact of circumcising our seven-year-old son.  This was the last thing we ever expected and, believe it or not, have never heard of such a condition.  The information available to us via our doctor and online research is both limiting and overwhelming, respectively.

So, as a shot in the dark, I wonder if you and your gifted readers could shed any light on this condition and/or any solutions other than circumcision.

That problem with retraction was apparently why my own willy was mutilated when I was an infant. I have no medical expertise on this … but I bet the Dish collective mind has some. Meanwhile, another reader underscores the difference between circumcising a newborn and a child:

I’m pro-circumcision, but when I saw the story you linked to yesterday about the four-year-old boy in Florida whose father went and obtained a court order to authorize a circumcision, my reaction was “No fucking way!”  My own gut reaction surprised me.  So I stopped and thought further: Wait, why would I be opposed to this boy’s circumcision and not to an infant, when the health benefits cited by the American Academy of Pediatrics would still apply either way?

To answer that question I thought back to an incident at my dentist’s office just this week.

As my dentist and his assistant were working away at my problem tooth I could hear from the next room over a child who was very unhappy about being at the dentist.  The whining and complaining eventually turned into blood curdling screams as his procedure was getting under way.  I’ve never been in the presence of someone being tortured, but I can only imagine that the sounds coming from this child are similar.

I have a small child myself.  It’s heart wrenching to see him in pain or fear when getting an inoculation or exam at the doctor.  All I wanted to do was run into that next dentist’s room, stop whatever was going on, give him the boy a hug and tell him it’s all over.  But that would be wrong.  We (parents) put our kids through these things because we know in the end that the benefits of the shots and the dental work outweigh the pain and psychological trauma the kids experience when it happens.

So what of circumcision then?  Do the benefits outweigh the pain and psychological trauma?  Even as someone who is pro-circumcision, I knew immediately that the benefits for this boy will not outweigh the pain and psychological torture he would suffer by going through the procedure at that age.  A newborn infant heals quickly, cannot even reach his genitals, and has no mental understanding of them.  None of those conditions applies by the time a boy is four.  He should be left alone.  The benefits of circumcision are less notable in a modern clean civilization such as ours – and non-existent when looking at it in the context of what that boy will have to endure.  I pray that no urologist will actually perform this procedure at that father’s request.

While I’m not moved enough to change sides on the overall debate (I still think parents should have this option for their newborns), the whole incident has be thinking and questioning it all.  This would not have happened without the Dish, as I would not have even known about this story with you.  Thanks again for making me think.  Keep the circumcision debate going.

Rhys Southan offers one, writing that the practice “hurts some people, but we can’t pretend that it doesn’t bring joy to others”:

I agree with [philosopher Brian D.] Earp and [intactivist Matthew] Hess that this is honest and significant pain, not a laughable quirk to be mocked into hiding – and this is why I can’t fully side with the intactivists. If harm is in large part subjective – and to credibly amplify the voices of a tiny minority who regret circumcision, intactivists need to admit it is – cutting is bad only for the people who find it so. It’s dishonest to claim that the joy the Jewish practice of brit milah brings its practitioners counts for nothing when most people who are circumcised for religious reasons do not grow up to think of themselves as abused. The organisation Friends of Refugees of Eastern Europe (FREE), based in New York, says that it has circumcised more than 13,000 Jewish adults who were prohibited from infant circumcision in the Soviet Union. Many of them no doubt felt harmed by not having been circumcised in their infancy. Until far more Jews and Muslims step forward to protest their own circumcisions, to me it looks more hurtful to ban religious circumcision than to leave it alone.

The “joy” of others is a strange defense for the infliction of physical pain and permanent scarring on an infant’s body. But, look: I do not favor banning it for Muslims and Jews and others. I simply favor ending it as a routine procedure for most infant boys and raising some consciousness about the men whose own bodies were permanently altered without their consent.

Will Feminism End Circumcision?

Andrew Sullivan —  Jul 10 2014 @ 12:32pm

There’s a long, engaging and fascinating piece in Tablet on the growing movement among American Jews to abjure male genital mutilation in favor of a less draconian way of bringing a Jewish infant boy into the traditions and community of his family and ancestors. The variations – which do not involve permanently cutting the genitals – are called brit shalom and brit atifah. I found out in the article that even a small minority of Israelis are now leaving their infant boys unmutilated – up to “4.8 percent of Israeli boys weren’t circumcised, for reasons including parents’ objection to disfiguring the body — the reason cited by actress Alicia Silverstone — and not wanting to cause the baby pain.” But what intrigued me was the idea that women and feminism may have played a part in Jewish moves away from the ritual. The analogue in female genital mutilation has played a part, according to one reformer:

Consider the anatomy of the penis. If you deprive the penis of its covering, it externalizes what should be an internal organ. Some people are uncomfortable comparing circumcision to female genital cutting, but removing the external labia, while it may be more complicated, is not entirely dissimilar to removing the foreskin; you’ve changed mucosal tissue into non-mucosal tissue. If you know this, it’s hard to defend the practice.

The fact that Maimonides himself defended circumcision as a way to tame excessive lust by blunting male sexual pleasure only adds to the parallels. And then this observation about the rise of female rabbis:

Wechterman enumerated some of the reasons people choose not to do brit milah: “One of the biggest impetuses is the growth of the natural childbirth movement; parents are questioning a whole bunch of previously held conceptions, for good reasons. And I think the impact of feminism can’t be understated. A core predicate of contemporary feminism is the notion of bodily integrity and physical self-determination.” … The resistance to opting out of brit milah, she thinks, has manifold reasons. But one of them is that the deciders have always been men who are circumcised. “Men who are circumcised can’t imagine not doing it, just as men who aren’t circumcised can’t imagine doing it,” she pointed out. “But with significant numbers of women rabbis, things are changing.”

May the change continue.

The Onion On Circumcision

Andrew Sullivan —  Apr 23 2014 @ 12:02pm

An exhaustive look at the pros and cons. Among the pros:

Kid already European enough as it is

Among the cons:

Mohel looks like he’s had about eight cups of coffee

Yeah, I know. Sullybait. A reader adds:

I think there is a third way of looking at the question of circumcision.  As my grandfather likes to say, “Don’t cut it off; wear it off.”

A boy shouts as he under goes circumcisi

Amid dropping rates in the US, a married couple debates whether or not to perform the operation on their son:

[O]ne of my husband’s ex-jock friends wrote a surprisingly thoughtful, persuasive, and well reasoned emailed argument to my husband in favor of circumcising our son.  After the analysis though, his final—and key—factor was, “And it’s hard enough for a guy to get blowjobs as it is.” Shockingly, the misguided belief that uncircumcised men have more difficulties procuring oral sex is shared beyond the male college athlete demographic. An OBGYN mother-in-law asked my friend, who was carrying her grandson-to-be at the time: “Don’t you want him to get blow jobs some day?”

Still, it seems that a groundswell against circumcision has begun in our country. Circumcision rates in the United States are dropping. They decreased 8 percent from 1999 to 2009. Interestingly, in my circle, the movement against the procedure seems to be led not by men, but by women. Predictably, these are the same mothers who are also advocating for natural childbirth (more midwives and birthing balls) and less medical intervention (fewer oxytocin drips, monitors, and less laboring while laying one one’s back) during delivery.

Today, only about half of infant boys have their genitals mutilated and permanently scarred in the US. That’s a big shift away from the expectations of the past. It will surely provoke more questioning of the strange, ancient, religious practice as routine medical care in the US. In many parts of the US, especially the West, unmutilated men will soon greatly outnumber those whose sensitive, tiny dicks have been painfully sliced after birth. Razib Khan puzzles over the declining numbers:

One might think that this is due to demographic changes in the West, as Hispanics have lower rates of circumcision than non-Hispanics (black or white). But while California had circumcision rates of 22% in 2009, Washington state’s was 15%.

It seems that Medicaid coverage has a strong effect, but this can’t explain all of the variation. In the late 1970s the western states had the same circumcision rates as the northeastern states. Today northeastern states have circumcision rates two to three times higher than in the west. And it doesn’t map onto politics either. Extremely conservative (and western) Utah has circumcision rates of 42%. Blue Rhode Island has rates of 76%.

Finally, I want to observe here that the males who were born during the era of diverging circumcision rates are now entering sexual maturity en masse. This is going to shape the expectations of both sexes, and perhaps result in some surprises for those who relocate to the other coast as they transition to adulthood….

(Photo: A boy shouts as he under goes circumcision during ceremony in Kajang outside Kuala Lumpur on November 20, 2011. By Mohd Rasfan/AFP/Getty Images)

Why Not Delay Circumcision?

Andrew Sullivan —  Jul 11 2012 @ 6:15pm

Holm Putzke is asking:

In countries where daily personal hygiene is possible and routine, there are no, or at least only highly doubtful, verifiable medical advantages of circumcising a child. Even if the removal of the foreskin could minimize the man’s risk of contracting H.I.V. or reduce his female partners’ risk of developing cervical cancer, this does not justify the circumcision of children. Whatever risks might exist for an uncircumcised man and his partners, they would not become relevant until the man is sexually active. For young boys, there are no medical benefits.

It's a helpful summary of the debate at the NYT – revealing the hysterical non-arguments of those defending this anachronism. Abraham Foxman doesn't disappoint.

Circumcision Spreads HIV?

Andrew Sullivan —  May 23 2012 @ 11:14am

Brian Earp savages the studies purporting to show that male genital mutliation would prevent the spread of HIV/AIDS in African countries:

The "randomized controlled clinical trials" upon which these recommendations are based represent bad science at its most dangerous: we are talking about poorly conducted experiments with dubious results presented in an outrageously misleading fashion, toward public health recommendations on a massive scale whose implementation would have the opposite of the claimed effect, with fatal consequences. Read that sentence again if you want to get the point.

Here's how the mutilation-beats-HIV crowd conducted the tests (pdf):

While the "gold standard" for medical trials is the randomised, double-blind, placebo-controlled trial, the African trials suffered [a number of serious problems] including problematic randomisation and selection bias, inadequate blinding, lack of placebo-control (male circumcision could not be concealed), inadequate equipoise, experimenter bias, attrition (673 drop-outs in female-to-male trials), not investigating male circumcision as a vector for HIV transmission, not investigating non-sexual HIV transmission, as well as lead-time bias, supportive bias (circumcised men received additional counselling sessions), participant expectation bias, and time-out discrepancy (restraint from sexual activity only by circumcised men).

And here's how they came up with that stunning conclusion that mutilating the penis reduces HIV transmission by a relative 60 percent:

Across all three female-to-male trials, of the 5,411 men subjected to male circumcision, 64 (1.18%) became HIV-positive. Among the 5,497 controls, 137 (2.49%) became HIV-positive, so the absolute decrease in HIV infection was only 1.31%, which is not statistically significant.

Go deeper into the studies he cites and links to and it seems quite clear to me that this massive campaign to rid Africa of foreskins is likely to accelerate HIV transmission rather than slow it.