When we think of female genital mutilation in America, most have strong opposition to it, citing its barbaric victimization of women. Yet, there seems to be a blasé attitude towards neonatal male circumcision in America. It is what has been done for years, it’s cleaner, and we want little boys to fit in. The fact is, infant males are not born needing plastic surgery. While the rates of routine circumcision are declining in America, intact men are often left alone with health care workers who are unaccustomed for caring for an intact penis. But the intact penis requires no additional care! In neonates, and children, when the foreskin is not retractable, it requires no extra cleaning–just as you would not open your eyelid to wash your eyeball or cut off your ear to prevent a possible infection. Soap and water externally are efficient in the prepubescent years. Afterwards, a young man can be taught to gently retract the foreskin, rinse the glans of the penis and replace the foreskin.
You will find many arguments for circumcision; the reasons are well known, yet are out of date and no longer applicable. The truth is that “foreskin is perfectly normal part of the human body, and it has very definite purposes, as do all body parts, even if we do not readily recognize them” (Fleiss, 2009, p.51).
“Evolution has determined that mammals’ genitals should be sheathed is a protective, responsive, multipurpose foreskin. Every normal human being is born with a foreskin. In females, it protects the glans of the clitoris; in males, it protects the glans of the penis” (Fleiss, 2009, p.60).
Another argument for circumcision is that boys should look like their father. I have two sons who look like their father, and they look like me. No child is going to look entirely like their parent why compare genitals? Mine don’t look like my mothers’ though I haven’t actually compared for over 25 years.
In America circumcision is seen as a normal practice, “what is familiar becomes a cultural value. Circumcision is familiar” (Circumcision Resource Center, 2009). Even the term “uncircumcised” suggests that circumcision is the norm. Penises depicted in medical books are often circumcised giving the impression that this is nature’s way.
In America, circumcision began during the Victorian Era when masturbation was viewed as vile. American doctors then began “punishing” young men by amputating the foreskin. These same doctors claimed that circumcision would cure “epilepsy, paralysis, elephantiasis, tuberculosis, eczema, bedwetting, hip-joint disease, fecal incontinence, rectal prolapse, wet dreams, hernia, headaches, nervousness, hysteria, poor eyesight, idiocy, mental retardation and insanity” (F.A. Hodges, 1997, p.35). Circumcision became routine in the 1940’s.
The foreskin serves as protection. Just as the eyelids and eyelashes protect the eye, the foreskin protects the penis (Fleiss, 2009, p.52). The foreskin is also highly innervated and provides sexual pleasure. Amputation of foreskin victimizes the infant male and permanently disfigures him. The procedure irrevocably “externalizes the glans, normally an internal organ” (Fleiss, 2009, p.58). The common thought is that circumcision will be more hygienic for the male. However, a recent study published in the British Journal of Urology states the contrary: for at least a week after the surgery the baby is left with a large open wound that is almost in constant contact with urine and feces. Additionally, the circumcised penis is exposed to dirt and contaminants, so the wrinkles and folds that often form around the circumcision scar frequently harbor dirt and germs (R. Kerwat, A., 1998). The Circumcision Resource Center declares that routine circumcision denies a male’s right to genital integrity or choice for his own body (Circumcision Resource Center, 2009).
Mothers in America are often inundated with consents and forms further medicalizing birth. Its been shown that it is often difficult to make rational decisions in the immediate postpartum period because of the exhaustion and hormone surge that takes over. Yet this is the time mothers are presented with the decision. A nurse or doctor, may say something to the degree of, “You look so tired, why don’t you let me take the baby to the nursery for his circumcision so can rest. It will only take a few minutes and it will only hurt for a second.” Working as an obstetrical nurse, this is by far my least favorite thing to assist in. I am blessed to be able to witness birth on most days that I work. Unfortunately, I must also assist in circumcisions. Infants are undressed and placed on a cold, hard plastic board and then have all four limbs strapped down. Occasionally, a nurse stands at the bedside and offers a sucrose pacifier. Some doctors will give a nerve block before starting, which in itself is painful with four injections to the sensitive area. All babies cry. Some cry throughout the entire procedure, and some withdraw and appear to go in to a state of shock. We then explain to the mothers that it is common for a baby to be sleepy and not eat afterwards. Then a new string of problems arise with a baby who won’t wake to eat and has an increased risk for low blood sugar, jaundice and need for supplementation.
The nurse’s role along with the obstetrician and pediatrician caring for the mother-infant dyad is to provide true informed consent for the procedure. To make an informed choice parents should be given accurate unbiased information and be provided the opportunity to discuss decision. Risks mentioned should always include pain, damage to the penile shaft, damage to the urethra, hemorrhage, postoperative infections, penile amputation and death (Fauntleroy, 2005). Additional risks are irretrievable loss of sexual sensitivity, sexual function and pleasure, neurological damage to the developing brain, lowered immunological defense as a result of the loss of glans in the foreskin that produce antibacterial and antiviral proteins and disruption of the maternal-child bond in the newborn period (R.E.Marshall, 1982). When parents of newborns are presented with this information, only then they can then make informed decisions.
I live in the state of Illinois which, like most states, is in billions of dollars of debt and continues to deny necessary care to the severely ill. Yet routine circumcision is paid by public aid 100%, citing social and cultural factors that mandate circumcision for religious reasons. Of course, a parent can still choose circumcision for their son but only after true informed consent and paying for the cosmetic procedure out-of-pocket.
Cutting off any body part including foreskin is extreme and should be done with extreme caution and in extreme conditions when a life-threatening situation arises. When you leave your son intact you are respecting his wholeness in all of its perfection. Shame on the AAP for taking a neutral stance on circumcision. It is their obligation as professionals to protect the child. This topic is without a doubt a personal choice–so let’s leave that choice up to the one who will live with the result.
Molly is mama to 3 children and part-time obstetrical nurse and lactation consultant. When she is not fervently defending foreskin she enjoys hiking, cooking, reading and going to the bathroom by herself.
Fauntleroy, G. (September/October 2005). Whose decision is it?. Mothering, 132, 46-48.
R.E. Marshall. “Circumcision: Effects upon Mother-Infant Interaction,” Early Human Development 7, no. 4 December 1982.
The American Academy of Pediatrics (2009). Circumcision. retrieved 10 December 2009, from Healthy Children Web Site: http://www.healthychildren.org/English/ages-stages/prenatal/decisions-to-make/pages/Circumcision.aspx
Fleiss, P. (November/December 2009). Protect your uncircumsised son: expert medical advice for parents. Mothering, 103, 52-60.
R. Kerwat, A., “Reduction of Paraphimosis with Granulated Sugar,’ British Journal of Urology 82(5). November 1998: 755.
F.A. Hodges, “Short History of the Insititutionalization of Involuntary Sexual Mutilation in the United State,” in G.C. Denniston and M.F. Milos, eds., Sexual Mutilations : A Human Tragedy (New York: Plenum Press, 1997), 35.
Circumcision Resource Center (2009). Statement. retrieved 10 December 2009, from Circumcision resource Center Web Site: http://www.circumcision.org