Monday, July 29, 2013

Health : The Atlantic: The Circumcision Wars: What's a Parent to Do?

Health : The Atlantic
Health news and analysis on The Atlantic. 
thumbnail The Circumcision Wars: What's a Parent to Do?
Jul 29th 2013, 13:05, by Shawnee Barton

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The deadlock began around week 20 of my pregnancy, when my mom casually asked about when and where our son would be circumcised.  I presumptuously told her we weren't going to do that. Then I saw the surprised look on my husbands face.

"We're not?" he asked.

Sensing an opportunity to mount an offensive, my mom backed him with the full force of the guilt-inducing tone she'd perfected over the years. "But honey, it's not natural to leave your son uncircumcised," she said.  "You don't want to do that to him, do you?"

Quickly realizing that I would never win a drawn-out argument, I decided to end the conversation. To do this, I summoned the petulant teenager lying dormant inside me—something that only a mom can awaken in a 33-year-old woman—and said, "Actually mom, circumcision is the exact opposite of natural. That's the whole point, to do away with the 'natural'." Then I gave my husband the 'you'd like to have sex with me again, right?' look and said to him, "We'll talk about this later."

But we didn't.  We avoided the conversation until a full week past our little boy's due date, and it seemed like our little boy might never arrive until we made a decision.

When we finally started talking, we quickly realized that neither of us had any rational reason to feel strongly about the subject. We hadn't done any research, nor did we have any current medical information. This is just an emotional topic, in which opinions tend toward the extreme.

To begin working our way towards agreement, we consulted the professionals. Our pediatrician was impossible to read and exasperatingly diplomatic. Either decision would be fine, she assured us. We also learned that the American Association of Pediatrics (AAP) recommends circumcision, but not enough to assert that it should be a routine procedure.

In fact, we got the impression from the AAP's website that it was actually trying to talk us out of its position. According to the AAP, circumcision only "slightly lowers" the risk of urinary tract infections for baby boys, which are already "not common," and while the procedure does prevent penile cancer, they note that that form of cancer is "very rare," which I read as "not worth worrying about."  They also present a lot of cons to consider, such as pain and a belief that the procedure can affect sexual pleasure later in life.

Other medical organizations aren't more definitive. The American College of Obstetricians and Gynecologists, for example, supports the AAP's recommendation, but also notes that the benefits are only "modest." To fully support the idea of cutting my son's penis, I was looking for convincing arguments and significant benefits. These lukewarm endorsements only complicated our decision. Still, I was willing to accept that if multiple groups of medical professionals say that removing the foreskin is reasonable and preferable, I should stop putting up so much of a fight.

This was good news to my husband, who in return committed to a good-faith second phase of research.  He looked at numerous photos of the medical procedure online. They were much bloodier than he expected, and he came away confident that there are less intrusive ways to protect oneself from STDs and HIV, two of the major arguments for circumcising.  Next, he tried to assuage a personal concern by watching a few "adult" movies to see how an uncircumcised penis "worked." Not surprisingly, this critical investigation revealed that (as 80% of European men could have told us) bedroom mechanics tend to "work" for uncircumcised men just as "naturally" as they do for circumcised men.

We were now united in complete uncertainty, so we decided to do something a little unusual. We polled our friends about their sons' penises, and as you might guess, we learned a lot of interesting things.

First, I learned that the little "we don't recommend routine circumcision [as an after-birth procedure]" clause in the AAP's position is there for good reason. Back in the 1970s, my friend Brad was wheeled out of his parent's hospital room for "routine" tests and came back a foreskin lighter. This happened without notifying or getting permission from his parents. As an adult, Brad based the decision to not have his son circumcised partly on this experience. "I don't have a chip on my shoulder about it," he said.  "But it is a little annoying that the decision was made for me at all…and the fact that my parent's didn't get a say is also frustrating."    

Our second realization came from the parents of twin boys who told us that not all doctors are equally talented artisans when it comes to genital whittling. "One of our sons has a much better circumcision than the other, which really annoys me," the mother said.  "If we have another boy, I seriously might consider getting a mohel (even though I'm not Jewish)."

I'd never thought about circumcision quality control—asking to see examples of previous work seems pretty awkward, but it looked like that's one more thing we'd need to do.

The twins' parents, who both have advanced degrees, based their original decision to circumcise not on sound reasoning, as one might expect, but rather on what was the most common deciding factor we heard—whether or not the father had been circumcised. When our pediatrician told us that this is also the most common reason she encounters, I started referring to this as the golden rule of penises:  Do unto your son what was done unto you.

To me, this seems a little irrational. I wouldn't allow my daughter's nose to be broken, just so her cute little button nose would more resemble my own crooked honker. But after this factor was so often cited, I realized that a father's desire to have his son's penis resemble his own is inexplicable to those of us without a fifth appendage.  And similarly, a woman's preference is likely to be influenced by the men she has been intimate with.

I believe this reasoning comes from a desire to protect. We all want our kids to feel comfortable, confident, and accepted (particularly when it comes to genitalia).  I'm no social scientist, but it seems to me that this could be a explanation for why circumcision rates vary so much based on cultural groups and geography (for example, in 2009, 87 percent of boys born in West Virginia were circumcised compared to only 12 percent of boys in Nevada).

That being said, the dads' concern might also be motivated by their interest in their sons getting laid—as absurd as that sounds.  Almost half of our friends admitted that they considered the best way to help their sons procure oral sex as adults when making their "circumcision decision."

For example, one 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.

The moms in this demographic that we reached out to pointed us to loads of information, including this clever, if slightly inaccurate, blank blog post titled "The Medical Benefits of Circumcision," a Penn and Teller break down, and a Facebook community that shares sentiments like this quote from Dr. Spock: "My own preference, if I had the good fortune to have another son, would be to leave his little penis alone."

But they also encouraged me to read articles equating male circumcision to female circumcision. As a woman, I find that comparison a little insulting. Female circumcision, which is often—and rightly—called genital mutilation, destroys female sexual pleasure, and almost always comes with other complications and problems, while the vast majority of men who are circumcised orgasm and function just fine.

When we began this little experiment, we both expected our opinions to be validated. In a way they were. When our son finally arrived, we shared an opinion similar to that of our pediatrician—either decision would be reasonable, though each has legitimate negatives to weigh. Realizing this makes all the deeply felt convictions (outside of religious reasons) and the controversy surrounding the subject now seem a little perplexing.

One of the funniest and, in a way, most profound sentiments shared with us came from a similarly confused friend (who is also one of the best dads we know). "We didn't know what the hell to do," he said. "So, in the end, we just got 'er done."    

In the end, however, we opted not to get 'er done. Our son was born with some medical issues, and the AAP recommends that only healthy babies be circumcised. When we told our pediatrician, she let her poker face slip a bit. She smiled and said, "This little guy is going to have enough poking and prodding during his first year as it is." We found comfort in her response and also in the fact that should our son ever feel, like our friend Brad, that the wrong decision was made for him, our choice is reversible.

As parents, we want to make the best, most informed decisions for our kids, but often, there are no easy answers. Sometimes, you've just got to go with your gut and remember to reserve judgment against other parents, who are also doing their best to find clarity in a world murky with differing opinions and too much information.

    


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