When I was pregnant with our first son Elliot, I gave little thought to circumcision. I honestly don’t remember discussing it with my midwife, although she probably asked because she knew it would come up at the hospital soon after delivery.
Sadly, I remember very little about the subject. No reading. No research. No questions for the midwife or the OB. Nothing. Despite the countless books I had read about natural childbirth and my elaborate plans to have a drug-free birth, Mike and I made the circumcision decision blindly, based on cultural, social expectations. I think I assumed circumcision was just a little snip that didn’t hurt.
At some point during our hospital stay after Elliot was born, a nurse asked if we were going to have him circumcised. We said yes. They took him out of the room. He wasn’t gone long, and she brought back him swaddled tightly. He seemed calm and was asleep. However, I will never forget her words as she handed him back to me: “I had to give him lots of loving to get him to stop crying.”
With the exception of the sadness I felt when he was not in the room with me – the only time he left the room during our entire hospital stay – this was the first time that I had any emotions about circumcision.
“Oh, really?” I replied. I felt terrible that my sweet newborn baby had been crying, and I wasn’t there to comfort him.
“Yes, but he did fine, and he’s calm now.”
She gave me instructions on how to care for the circumcised penis during diaper changes, and that was that.
Elliot had trouble latching and nursing from the first time we tried after birth. It was incredibly frustrating to me because I desperately wanted to breastfeed. During our two days in the hospital, nursing didn’t improve. He seemed agitated any time I put him to the breast.
A lactation consultant tried to help, and she asked for confirmation: “The nurses told me you had him circumcised?”
“Yes,” I answered.
I could sense her disappointment – my second indication that perhaps circumcision was not a wise decision. She explained that the pain from circumcision could be adding to the breastfeeding difficulties. I had no idea. Obviously. How could I? I had read exactly nothing about the risks of circumcision.
With nursing still going terribly, we left the hospital and went home. Thankfully, I have a lactation consultant friend who came to our house and helped us. She saved our breastfeeding relationship, and from that day on, Elliot nursed like a champ. We were lucky – Elliot’s circumcision healed with no problems.
Ten years later, I can’t help but wonder – what if we had chosen differently? What if we had left him intact? I have thought about the circumcision decision many, many times over the past decade. I will admit, I regret it. As I wrote the above story, I cried remembering that nurse’s comment and the thought of my son’s tiny body being strapped down and cut as he screamed.
A second chance at the circumcision decision
Now to present day. When I first became pregnant with our third baby, I thought for sure it was a girl because I felt nauseous, like I had during my pregnancy with Cecilia. A small part of me hoped this was true because I was scared to deal with the circumcision issue again.
Well, the ultrasound revealed a boy! I knew I didn’t want our new baby to be circumcised, but I avoided the topic with my husband for a long time. My reasons were mostly emotional; I could not subject another child to the pain. Also, there were logistical questions that I didn’t want to deal with; we were having a home birth, so how would circumcision work? Would we have to schedule it at a hospital like a surgery? Could the pediatrician do it?
One evening, I nervously approached Mike. That first attempt did not go well. He felt blindsided. He didn’t understand why I would want the new baby to look different from him and Elliot. I dropped the topic and decided to try again another time.
Weeks went by and, little did I know, Mike had been researching circumcision on his own. While we were on vacation at the beach, he nonchalantly, out-of-the-blue, said, “If you don’t want to have the baby circumcised, I’m OK with that. I did some research, and it’s barbaric and unnecessary.” I was surprised but so, so happy. Mike later told me an article a friend of ours posted on social media was what ultimately cemented his decision.
Interestingly, that very same day, my mom was asking some questions related to the home birth. Does the midwife examine the baby instead of a pediatrician? Yes. What if the midwife can’t make it in time for the birth? She has three assistants. One of the four of them should be able to make it. How will he be circumcised since you won’t be in the hospital? We’re not circumcising. It’s unnecessary. That was a proud moment.
Terminology and connotations in the circumcision discussion
So, now to the title of this post, which I have tried to write gently, to be helpful to expectant parents of baby boys and to encourage them to consider leaving their babies intact. Why did we choose to leave our second son intact, besides Mike’s answer of circumcision being “barbaric and unnecessary?” Let me say that I know barbaric is a strong word, and there are many people out there who are extremely opinionated about leaving boys intact. They often identify themselves as intactivists.
Before I go any farther and because I am a word person, I’d like to address some terminology.
- I prefer the term intact because I think it is the most straightforward and has the least chance of being hurtful to parents who are searching for answers, like we were a few months ago.
- I do not prefer uncircumcised because it suggests that circumcised is the norm, thereby leaving uncircumcised to be abnormal.
- The intactivist community often uses whole as a synonym for intact. I wasn’t sure about this one at first. I mean, what could be controversial about the term whole? The more I thought about it, though, the more I didn’t care for it. What if a baby was born without one leg? Or with a cleft lip? Would we go around pronouncing them not whole?
- The terms cut and uncut are also fairly common among intactivists. While direct, I feel that these words, especially cut, can be insensitive, particularly to parents looking for gentle education about circumcision.
- Finally, you might hear some intactivists refer to circumcision as male genital mutilation. For parents who have chosen circumcision, this is a difficult term to hear. In the United States, genital mutilation tends to evoke images of a young girl in a tribal community having her clitoris or labia forcibly cut. This female genital mutilation seems heinous and unthinkable. I will say – once I removed my cultural blinders related to circumcision, I could understand applying that same terminology to boys.
Why leave a baby boy intact?
Let me answer the why question by starting with my husband’s words. We believe circumcision is unnecessary because it removes a substantial amount of healthy, functioning tissue from a non-consenting child. It’s not just a snip. The foreskin contains tens of thousands of nerve endings and serves a purpose; it protects the glans of the penis, keeping it lubricated. Many adult intact men and even their female partners report that the foreskin is an important part of sexual function.
Circumcision is barbaric because it is painful, especially to a newborn who cannot be given adequate, if any, anesthetic. Many providers, like the one who performed Elliot’s circumcision, admit to using no analgesics. Others may use sugar water and/or local numbing agents. When I got the courage to bring up circumcision months after Elliot’s birth, the doctor who circumcised him told me that neither is effective; that’s why he uses nothing. However, even if circumcision could be made 100 percent pain free, it is still a medically unnecessary surgery done without the patient’s consent. In any other instance, the medical community would consider this situation unethical.
In addition, the circumcision healing process is not always as easy as it was with Elliot. Essentially, circumcision leaves an open wound exposed to urine and fecal matter. As I already mentioned, the pain from circumcision can affect breastfeeding, and I truly believe it did in our case.
Much like c-sections in the United States, I believe the risks of circumcision are often glossed over by medical professionals. They were when Elliot was a newborn. It has become so routine in hospitals that most nurses and doctors simply ask parents to sign a consent without truly discussing the potential complications, which include excessive bleeding and, in rare cases, death. There is also a chance of penile adhesions as a result of circumcision.
The arguments for opposing circumcision
So why do many of us choose circumcision? The following is a list based on my experience and reading. I’ve also included rebuttals to these arguments.
- As I said, it’s fairly routine in U.S. hospitals following birth. It seems most healthcare providers assume patients will choose circumcision, so it’s odd when someone declines. Interestingly, the United States is one of the world’s only developed countries that routinely circumcises for non-religious reasons. Most other nations do not; therefore, most countries’ national medical associations do not recommend circumcision. Even the American Academy of Pediatrics is neutral on the issue, noting in its most recent statement in 2012 (which is expired), that the “health benefits are not great enough to recommend routine circumcision for all male newborns.”
- Many families choose it because of pressure for boys to look like their dads, older brothers or other male family members. Although I subscribed to this line of thinking 10 years ago, now it seems absurd. Should we also dye children’s hair and give them tattoos to make them look like Dad? Do men really sit around and compare and contrast each other’s genitals? My husband and older son never have; pretty sure my dad and brother never did either. If children notice their genitals look differently than Dad’s or a sibling’s, that’s an opportunity for education, not surgery.
- Along the same lines, some mothers relinquish the circumcision decision completely to the baby’s father because he’s the one with a penis. Despite our naivete 10 years ago, Mike and I prefer to make parenting decisions together. Also, having a penis does not make one an expert on it. Similarly, the absence of a body part does not mean one cannot become an expert on it. If that were true, men could not study to become gynecologists, and women could not be urologists. So it’s totally logical for moms, especially with their innate protective instincts, to have a say in leaving a boy intact. Most importantly, the penis in question belongs to the boy, so it should be his decision, when he’s a consenting adult, if he wants part of it removed.
- I’ve heard people say a circumcised penis “looks better,” or even refer to an intact penis as “gross.” This is simply cultural conditioning – what we’re used to. This often leads to the locker room argument, or the notion that peers might make fun of intact boys. How about we teach boys, and all children for that matter, to be kind? To respect each other’s differences, whether that’s skin color or wearing glasses or being intact? As parents, we should discuss these differences with our children, but we should also prepare our kids for how to react to bullies.
- Some say a circumcised penis is cleaner. Again, I think this assumption is partly due to cultural conditioning. But it also has to do with negligible purported “health benefits” of circumcision. These include claims that circumcised men have lowered risks of urinary tract infections (UTIs), penile cancer and HIV. The truth is that all men have a low risk of UTIs – much lower than women, and we don’t advocate for female circumcision because of UTIs. The American Cancer Society considers penile cancer to be rare and reports that about 1 in 100,000 men will be diagnosed with it. This is tough to explain briefly, but studies in Africa claiming that circumcision – performed on adult males, not infants – reduces risk of HIV have been shown to be flawed. According to University of Notre Dame Professor Psychology Darcia Narvaez, Ph.D., “In the USA, during the AIDS epidemic of the 1980s and 90s, about 85% of adult men were circumcised (much higher rates of circumcision than in Africa), and yet HIV still spread.”
- We don’t understand how to care for the intact penis. In truth, it’s easy. Wipe from base to tip like a finger. Never pull back, or retract, the foreskin, not even a little. In fact, this is not even easily possible with a baby because the foreskin is fused to the shaft of the penis, much like a fingernail is connected to a finger. This is one of the reasons why circumcision is so painful – because before the foreskin can be removed, it has to be separated from the shaft. Again, this is equivalent to ripping off a fingernail. As boys mature, the foreskin naturally separates, but this should be done only by the owner, never by a parent, caregiver or healthcare provider. Age of separation varies widely – usually by puberty. After the foreskin is retractable, the boy should be taught proper intact care. During normal shower or bath time, retract the foreskin, rinse with water only and put it back. Soap is not necessary for babies or older boys, just like it’s not needed for female genitalia at any age. It messes with the body’s natural chemicals.
I’ve heard other arguments in favor of circumcision, most of them somehow related to the points I’ve listed above. For example, there’s the nursing home argument – the notion that elderly intact men aren’t able to care for their penises and end up with infections and other problems. Therefore, it’s better to proactively circumcise them when they’re babies. The United States is probably the only country where people try to make this case. It’s problematic because 1) we don’t advocate that girls or women have their lady bits chopped, just in case they end up in a nursing home when they’re older, and 2) caregivers should know proper intact care and adequately clean male patients.
Resources for circumcision research
For anyone searching for answers on circumcision, I would like to end with a couple video suggestions: “Circumcision: The Whole Story” narrated by Christopher Guest, M.D., and “An Elephant in the Hospital” presented by Ryan McAllister, Ph.D. The “Elephant” video shows an infant circumcision.
Finally, to those readers who are expectant moms and dads, if you are planning to circumcise or are not sure, I would like to humbly ask that you consider watching a video of a baby being circumcised. Meditate on this thought: If you don’t think you can stomach watching someone else’s baby undergo this surgery, how can you subject your own child to circumcision?