Tuesday, November 13, 2012

Routine Infant Circumcision - The Facts I Wish I'd Had

When we found out that we were having a boy, I was already pretty sure that I didn't want to circumcise. Sean was pretty sure (completely, absolutely sure) that he wanted to. We agreed to research both sides, and come to an informed agreement. After a few days, we were both still on opposite sides of an agreement, and unfortunately for Sean, the procedure required equal consent. Eventually Sean begrudgingly accepted that his son wouldn't be cut.

Ironically enough however, the pediatrician waited until Sean was gone to come in and ask if James would be circumcised. When I said no, the response was, "Thank you - it's completely unnecessary." I hadn't asked before he was born what the medical stance at my hospital was, I didn't care - but I was pleasantly surprised.

The day James was born - I will never forget this - Sean was sitting on the couch in our hospital room, holding his son. He was looking down at his face when he said, "I'm glad we're not doing it (circ'ing), he's perfect." Yes, yes he is :)

Since then, I have written my masters capstone paper on routine infant circumcision, and if I could share one set of of statistics, it'd be this set:

Patient group
Risk of UTI
UTI in uncircumcised (n)
UTI in circumcised (n)
UTI prevented by circumcision (n)
Complications of circumcision (n)
OR, odds ratio; UTI, urinary tract infection; VUR, vesicoureteric reflux.
Normal
1%
10
1
9
20
Past UTI
10%
100
13
87
20
High grade VUR
30%
300
39
261
20

Look at the chart. In normal, healthy boys the risk of circumcision complications are DOUBLE the risk of a urinary tract infection (UTI). The only cases where a UTI is a larger risk factor for boys are those in boys who are more prone to a UTI. What percentage of boys are more prone? 1% of boys will have a single UTI by 11 years of age, with 30% of that 1% being more "prone." So...that means 0.3%. When a parent chooses to circumcise, they are attempting to prevent a UTI that is less than 1% likely to occur, and less than 0.3% likely to be recurring. So they are choosing a 100% chance of trauma over a 0.3% chance of infection.

That doesn't make any sense to me. The procedure has even been changed to "cosmetic" in nature, and is being denied coverage by a growing number of insurance companies.

I understand that circumcision decreases the risks of STDs as well. So do condoms. And the risk of cancer? That comes down to a link between cancer and HPV - an STD. Safe sex reduces a man's risk of penile cancer, not circumcision.

There isn't nearly enough accurate information out there for parents to be - I got most of my information through scholarly articles not found on Google. People are still clinging to the idea that it's important for a son's penis to look like his dad's - hey, a child's penis will not look like his dad's,  and by the time it does, why would they be comparing dicks? Ew.

I believe that this procedure can be beneficial to health - but I also believe it should be performed as needed, or as decided by each patient. I believe that we will see an end to routine infant circumcision in males just like we did in females, less than thirty years ago.

If James wants to be circumcised later, he still has the option - in fact, the risks are fewer in older boys and men. Had we circumcised, well...he'd have no choice but to deal with it. If he hates the decision we've currently made, he has options - and I can sleep on that.

Here are my sources, feel free to add your own in favor.


Singh-Grewal, D., Macdessi, J., & Craig, J. (2005). Circumcision for the prevention of urinary tract infection in boys: a systematic review of randomised trials and observational studies. Arch Dis Child, 90, 853-858. Retrieved from http://adc.bmj.com/content/90/8/853.full



6 comments:

  1. When we were finding out the gender, I thought for sure I would circumcise. I gave birth to Alexa still believing I would have circumcised her if she were a boy. After having her, and knowing how I would do anything to keep her pain, sickness, etc, I came to the conclusion that maybe I wouldn't circumcise a son. Thankfully I had a girl first because if I hadn't, my son would definitely without-a-doubt be circumcised. I just thought that's the way it was done. But now I've realized that I need to do more research. The research I have done has, honestly, been hard to read because it seems like such an unnecessary thing to put a NEWBORN baby through right after they are born. I can't imagine being all cozy in my mommy's tummy, going through the struggles of labor and delivery, and then endure the trauma of circumcision. It makes me so sad to think about it considering it's mostly cosmetic, like you said. My husband is still on the "yes" side of circumcision but I recently told him that I was leaning more towards "no". He was a little surprised. He seems open though so I'm hopeful that if we do have a boy, we can come to an agreement so that neither of us are upset. I just know that I don't think I can put my newborn or even older baby through a traumatic procedure without it being necessary for her health or well-being.

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  2. A few years ago, I would've done it too. Fortunately the attitude is slowly changing and people are more informed.

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  3. Also, just a note - an uncirc'd Levi's requires no extra care until the skin retracts on it's own (around 3-5 yrs old). I wash James' man parts like any other part of his body. A circ'd penis actually requires you to retract the skin regularly to avoid adhesions. I've seen loads of baby center posts on post circ revisions and complications, but only one post from a family who needed to circ their boy for medical reasons (penis too large for foreskin). Food for thought.

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  4. I came back to check to see if you posted any more entries but it looks like you've been away for a week! Does this mean you've been sleeping? ;)

    I'm on a couple facebook pages that are very anti-circ - I joined them so I could get more informed and who better to get information from than those who got it themselves during their own research. And what you say is pretty much what I've read - that the uncirc'd/intact penis (or Levi's, hah!) is easy to take care of. The way nature intended, right? I have a hard time believing that boys are born naturally requiring some sort of surgery to make them healthier.

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  5. I have been so busy!! I'll write more soon :)

    As for circ, the best reason not to do it is that the AAP doesn't recommend it. They admit to health benefits, but say that it still isn't beneficial enough to recommend. And the uncirc'd boy is very, very easy to clean - you wash it like you would a finger. No special cleaning! But circ'd boys, you have to retract and clean. Surprise!

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