Categories After My Birth My Birth

Circumcision

by ACNM Posted on

As midwives one of our primary responsibilities to the families we serve is helping them “understand the why.” For instance, why are we doing this test today? Why might induction of labor vs. waiting to go into labor on your own be recommended for your individual pregnancy? Why might you want to consider breastfeeding?

There are so many topics in pregnancy and early postpartum for which we try to help families sort through the “why.” But there is one topic that often gets overlooked because of cultural norms, personal decisions of the provider, and the concept of parental choice: circumcision.

Why might families choose circumcision? One obvious answer is for religious reasons. In the United States, 99% of Jewish and Muslim families choose to circumcise their infant sons as part of an Abrahamic covenant. But what if that isn’t your faith or your “why”?

According to both well-cited studies and informal surveys, these are the primary reasons why families in the United States choose circumcision, in addition to religion:

Hygiene
There is generally a perception that the circumcised penis is “cleaner” or “easier to clean.” This is a long held and re-taught belief that is rarely questioned. In fact, cleaning the intact penis is not difficult, it is just a skill that a lot of new parents do not have because they have never done it, and learning about can seem more overwhelming than just choosing to circumcise.

Circumcision is not medically necessary to maintain good genital hygiene. Here are some basic details about infection risks of having an intact (not-circumcised) penis:

Infant boys who have intact penises do have a slightly higher risk of getting a urinary tract infection in their first year of life. However, these infections are generally treatable with a simple course of antibiotics, and the risk decreases as he becomes an older child.

There are some studies done in other parts of their world where HIV is very prevalent showing that circumcision can decrease rates of sexually transmitted infections. It is important to remember that these studies were performed on adults, not infants, and they were not done in the United States so the results do not translate very well to babies born in the US. Also, condoms are much better prevention for sexually transmitted infections than circumcision.

Men who have intact penises do have a higher chance of getting penile cancer, however, the risk of any man (circumcised or not) getting this type of cancer is extremely rare. In fact, 300,000 circumcisions would prevent one case of penile cancer! Penile cancer comes from having an HPV infection, and now that HPV vaccines are readily available, the chance of getting penile cancer will go down even further.

Looking Like Dad
This reason seems to be especially important to fathers, and many men expecting a boy state this is their primary motivation. A child’s penis, which is small and does not have pubic hair, will not “look like” their father’s penis until they are a teenager or adult. And of course, all penises are different so it will never really “look like” their father’s penis anyway!

The Locker Room
Another commonly stated “why” reason, this rationale is very dependent on where the family lives. In 2020, circumcision rates in many parts of the country are only about 50% and in some places, even less common than that. When parents choose the reason that they want their child to look like other boys, it is very possible half of the other boys in that child’s class or team will in fact not be circumcised.

What Women Will Think
Many women like intact penises. And many young baby boys will grow up to love men, or love a person who does not conform to any binary construction of gender, and many of those partners will actually like foreskin and the functions that it provides to sex.

In this discussion of “why,” it’s often skipped over considering why not to circumcise:

Autonomy
The baby will not get a say in this very permanent change to his body. Many medical ethics experts believe that there is a serious problem with circumcision being the “parents’ choice” when it is an elective procedure that is not medically necessary.

Function
Foreskin has many functions for the penis: natural “hygiene” (keeping the tip of the penis safe from bacteria), sexual pleasure, and sexual lubrication to name a few. It is not just a little skin, it has many nerve endings and glands.

Pain
We cannot prove that circumcision is a pain-free experience, both in the procedure itself and in potential complications later, because it is performed on infants who cannot tell us about their experience.

Complications
Many parents do not know that it is possible for there to be minor (or major) complications from their child’s circumcision. Their child might need to have the procedure re-done, might have permanent disfiguration, or have psychological trauma from the experience. While complication rates are difficult to really understand as far as how often this happens, they are a risk often not considered.

This is a very controversial topic, and so difficult for many parents to discuss because of deeply held beliefs about their own bodies and their own families or childhoods. Thinking about the “why” behind circumcision is not an easy exercise for most parents, but it is an important one. In thinking through your “why” questions, here are some thoughtful, evidence based resources to help you work through these complicated ideas:

Here are links to short summaries about circumcision from medical organizations:

 

by Emily Rumsey, CNM

Emily is a midwife and media producer in Minneapolis, Minnesota. She directed The Circumcision Movie, co-produced with another midwife Emily Fitzgerald, because the two “Emilies” could not find good resources to share with their patients on this topic.

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