When I was pregnant with my first child, I just thought that circumcision was what you did, no big deal, and that every man was circumcised.
Then one day I saw a picture of a baby being circumcised, and everything changed. Just one tiny, grainy photo was enough to make me want to know more, and the more I knew, the worse it got. It turns out, circumcision really is a big deal.
Male Circumcision Surgery Myths
Myth #1: They just cut off a flap of skin.
Reality check: Not true. The foreskin is half of the penis’s skin, not just a flap. In an adult man, the foreskin is 15 square inches of skin. In babies and children, the foreskin is adhered to the head of the penis with the same type of tissue that adheres fingernails to their nail beds.
Removing it requires shoving a blunt probe between the foreskin and the head of the penis and then cutting down and around the whole penis. Check out these photos.
Myth #2: It doesn’t hurt the baby.
Reality check: Wrong. In 1997, doctors in Canada did a study to see what type of anesthesia was most effective in relieving the pain of circumcision. As with any study, they needed a control group that received no anesthesia.
The doctors quickly realized that the babies who were not anesthetized were in so much pain that it would be unethical to continue with the study. Even the best commonly available method of pain relief studied, the dorsal penile nerve block, did not block all the babies’ pain.
Some of the babies in the study were in such pain that they began choking and one even had a seizure.
Myth #3: My doctor uses anesthesia.
Reality check: Not necessarily. Most newborns do not receive adequate anesthesia. Only 45% of doctors who do circumcisions use any anesthesia at all. Obstetricians perform 70% of circumcisions and are least likely to use anesthesia – only 25% do.
The most common reasons why they don’t? They didn’t think the procedure warranted it, and it takes too long (Stang 1998). A circumcision with adequate anesthesia takes a half-hour – if they brought your baby back sooner, he was in severe pain during the surgery.
Myth #4: Even if it is painful, the baby won’t remember it.
Reality check: The body is a historical repository and remembers everything. The pain of circumcision causes a rewiring of the baby’s brain so that he is more sensitive to pain later (Taddio 1997, Anand 2000).
Circumcision also can cause post-traumatic stress disorder (PTSD), depression, anger, low self-esteem and problems with intimacy (Boyle 2002, Hammond 1999, Goldman 1999 – STUDY). Even with a lack of explicit memory and the inability to protest – does that make it right to inflict pain?
Myth #5: My baby slept right through it.
Reality check: Not possible without total anesthesia, which is not available. Even the dorsal penile nerve block leaves the underside of the penis receptive to pain. Babies go into shock, which though it looks like a quiet state, is actually the body’s reaction to profound pain and distress.
Nurses often tell the parents “He slept right through it” so as not to upset them. Who would want to hear that his or her baby was screaming in agony?
Myth #6: It doesn’t cause the baby long-term harm.
Reality check: Incorrect. Removal of healthy tissue from a non-consenting patient is, in itself, harm (more on this point later). Circumcision has an array of risks and side effects. There is a 1-3% complication rate during the newborn period alone (Schwartz 1990).
Here is a short list potential complications:
- Meatal Stenosis: Many circumcised boys and men suffer from meatal stenosis. This is a narrowing of the urethra which can interfere with urination and require surgery to fix.
- Adhesions: Circumcised babies can suffer from adhesions, where the foreskin remnants try to heal to the head of the penis in an area they are not supposed to grow on. Doctors treat these by ripping them open with no anesthesia.
- Buried penis: Circumcision can lead to trapped or buried penis – too much skin is removed, and so the penis is forced inside the body. This can lead to problems in adulthood when the man does not have enough skin to have a comfortable erection. Some men even have their skin split open when they have an erection. There are even more sexual consequences, which we will address in a future post.
- Infection: The circumcision wound can become infected. This is especially dangerous now with the prevalence of hospital-acquired multi-drug resistant bacteria.
- Death: Babies can even die of circumcision. Over 100 newborns die each year in the USA, mostly from loss of blood and infection (Van Howe 1997 & 2004, Bollinger 2010).
Myth #7: You have to get the baby circumcised because it is really hard to keep a baby’s penis clean.
Reality check: In babies, the foreskin is completely fused to the head of the penis. You cannot and should not retract it to clean it, as this would cause the child pain, and is akin to trying to clean the inside of a baby girl’s vagina. The infant foreskin is perfectly designed to protect the head of the penis and keep feces out.
All you have to do is wipe the outside of the penis like a finger. It is harder to keep a circumcised baby’s penis clean because you have to carefully clean around the wound, make sure no feces got into the wound, and apply ointment.
Myth #8: Little boys won’t clean under their foreskins and will get infections.
Reality check: The foreskin separates and retracts on its own sometime between age 3 and puberty. Before it retracts on its own, you wipe the outside off like a finger. After it retracts on its own, it will get clean during the boy’s shower or bath.
Once a boy discovers this cool, new feature of his penis, he will often retract the foreskin himself during his bath or shower, and you can encourage him to rinse it off. But he should not use soap as this upsets the natural balance and is very irritating.
There is nothing special that the parents need to do. Most little boys have absolutely no problem playing with their penises in the shower or anywhere else! It was harder to teach my boys to wash their hair than it was to care for their penises. (Camille 2002)
Myth #9: Uncircumcised penises get smelly smegma.
Reality check: Actually, smegma is produced by the genitals of both women and men during the reproductive years.
Smegma is made of sebum and skin cells and naturally lubricates the foreskin and glans in men, and the clitoral hood and inner labia in women. It is rinsed off during normal bathing and does not cause cancer or any other health problems.
Myth #10: “My uncle wasn’t circumcised and he kept getting infections and had to be circumcised as an adult.”
Reality check: Medical advice may have promoted infection in uncircumcised males. A shocking number of doctors are uneducated about the normal development of the foreskin, and they (incorrectly) tell parents that they have to retract the baby’s foreskin and wash inside it at every diaper change.
Doing this tears the foreskin and the tissue (called synechia) that connects it to the head of the penis, leading to scarring and infection.
Misinformation was especially prevalent during the 1950s and 60s, when most babies were circumcised and we didn’t know as much about the care of the intact penis, which is why the story is always about someone’s uncle.
Doing this to a baby boy would be like trying to clean the inside of a baby girl’s vagina with Q-tips at every diaper change. Rather than preventing problems, such practices would cause problems by introducing harmful bacteria.
Remember that humans evolved from animals, so no body part that required special care would survive evolutionary pressures. The human genitals are wonderfully self-cleaning and require no special care.
Myth #11: My son was diagnosed with phimosis and so had to be circumcised.
Reality check: Phimosis means that the foreskin will not retract. Since children’s foreskins are naturally not retractable, it is impossible to diagnose phimosis in a child.
Any such diagnoses in infants are based on misinformation, and are often made in order to secure insurance coverage of circumcision in states in which routine infant circumcision is no longer covered.
Even some adult men have foreskins that do not retract, but as long as it doesn’t interfere with sexual intercourse, it is no problem at all, as urination itself cleans the inside of the foreskin (note that urine is sterile when leaving the body.)
Phimosis can also be treated conservatively with a steroid cream and gentle stretching done by the man himself, should he so desire it, or, at worst, a slit on the foreskin, rather than total circumcision. (Ashfield 2003) These treatment decisions can and should be made by the adult man.
Myth #12: Uncircumcised boys get more urinary tract infections (UTIs.)
Reality check: This claim is based on one study that looked at charts of babies born in one hospital (Wiswell 1985).
The study had many problems, including that it didn’t accurately count whether or not the babies were circumcised, whether they were premature and thus more susceptible to infection in general, whether they were breastfed (breastfeeding protects against UTI), and if their foreskins had been forcibly retracted (which can introduce harmful bacteria and cause UTI) (Pisacane 1990).
There have been many studies since which show either no decrease in UTI with circumcision, or else an increase in UTI from circumcision. Thus circumcision is not recommended to prevent UTI (Thompson 1990). Girls have higher rates of UTI than boys, and yet when a girl gets a UTI, she is simply prescribed antibiotics. The same treatment works for boys.
Myth #13: Circumcision prevents HIV/AIDS.
Reality check: Three studies in Africa several years ago that claimed that circumcision prevented AIDS and that circumcision was as effective as a 60% effective vaccine (Auvert 2005, 2006). These studies had many flaws, including that they were stopped before all the results came in.
There have also been several studies that show that circumcision does not prevent HIV (Connolly 2008). There are many issues at play in the spread of STDs which make it very hard to generalize results from one population to another.
In Africa, where the recent studies have been done, most HIV transmission is through male-female sex, but in the USA, it is mainly transmitted through blood exposure (like needle sharing) and male-male sex.
Male circumcision does not protect women from acquiring HIV, nor does it protect men who have sex with men (Wawer 2009, Jameson 2009).
What’s worse, because of the publicity surrounding the African studies, men in Africa are now starting to believe that if they are circumcised, they do not need to wear condoms, which will increase the spread of HIV (Westercamp 2010).
Even in the study with the most favorable effects of circumcision, the protective effect was only 60% – men would still have to wear condoms to protect themselves and their partners from HIV.
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.
It is important to understand, too, that the men in the African studies were adults and they volunteered for circumcision. Babies undergoing circumcision were not given the choice to decide for themselves.
Myth #14: Circumcision is worth it because it can save lives.
Reality check: Consider breast cancer: There is a 12% chance that a woman will get breast cancer in her lifetime. Removal of the breast buds at birth would prevent this, and yet no one would advocate doing this to a baby.
It is still considered somewhat shocking when an adult woman chooses to have a prophylactic mastectomy because she has the breast cancer gene, yet this was a personal choice done based upon a higher risk of cancer.
The lifetime risk of acquiring HIV is less than 2% for men, and can be lowered to near 0% through condom-wearing (Hall 2008). How, then, can we advocate prophylactic circumcision for baby boys?
Science and data do not support the practice of infant circumcision. Circumcision does not preclude the use of the condom. The adult male should have the right to make the decision for himself and not have his body permanently damaged as a baby.+