Circumcision: Not Just a Little Snip

Note: The views expressed are solely those of the author and do not necessarily reflect the views of Pregnancy.org.

Circumcision. It's just a little snip, right? It doesn't really hurt. Especially with the numbing shots they give for it nowadays. And besides, it's for his own good.

Circumcision is as American as apple pie. For the most part, it is not questioned but rather accepted as the standard of care given to newborn babies. Why is this the case? Is the foreskin such a hideous invention of nature that must be stricken from the body as soon as possible after birth?

Or is it a parental choice? "Excuse me madam, would you like your son with foreskin or without?"

Circumcision is surgery. Like any surgery, it involves a scalpel, blood, and the cutting of flesh. Unlike other surgeries, it is done in the absence of pathology. Unlike other surgeries, it is done without adequate pain management.

You would think that an intelligent society such as ours would have realized that it is not wise cut the genitalia of babies. Looked at objectively, it doesn't make much sense. But I do realize that it is hard to look at sex organs, or sex, objectively. Perhaps that is why this tradition, once implemented, has taken such a strong hold on the collective unconscious of our society.

What are the arguments used to justify newborn circumcision? Are babies really better off from having had part of their penis surgically removed? No medical organization in the world advocates newborn circumcision. Arguments in favor of newborn circumcision claim reduced rates of urinary tract infections, penile cancer, foreskin ailments, and "getting it over with" while the child is still a baby so they won't remember the trauma of the surgery should it become necessary later in life.

If newborn circumcision does indeed reduce the risk health problems, does this reduction far outweigh the risks of the surgery itself? The American Academy of Pediatrics claims the potential benefits and the risks are about equal. This means that any given child has the same chance of experiencing a reduced risk of the above ailments as he does of experiencing a short-term side effect of the surgery. Side effects that develop later on, such as meatal stenosis or painful erections, are not entered into the equation. When long-term risks are added, the risks outweigh any potential benefits.

This is not even taking into account the psychological trauma of the procedure itself. It used to be believed that infants could not feel pain. As a result of this erroneous belief, babies were forced to undergo invasive, traumatic procedures without anesthesia. We now know that babies do feel pain, and that they feel pain more profoundly than adults or children. We also know that babies who have undergone painful experiences react more strongly to pain later in life.

What is the purpose of the foreskin? Since every mammal except bats have a foreskin, it would seem logical that it is there for a reason. The foreskin provides mammals penile protection, sexually sensitive nerve endings, and a gliding action that enables non-traumatic copulation.

What is circumcision? Circumcision is the surgical removal of the prepuce, or foreskin of the male penis. The baby is first strapped down so that he cannot move, which is a necessary intervention. Babies are human and do try and move away from a painful stimuli. At birth, the foreskin is adhered to the glans much as the fingernail is adhered to the finger. A probing instrument is used to break the connection between the foreskin and the glans. A clamp is then applied to the foreskin in order to prevent hemorrhage. Once the skin is blanched white, showing that circulation has been effectively cut off, a scalpel is used to cut off the foreskin. How much skin to cut off is not a science but rather an estimation on the part of the doctor. No one knows how much skin will be necessary for the child to comfortably grow into as his penis enlarges at puberty.

This is still sometimes done with absolutely no pain medication whatsoever. Little or no post op pain management is given, and the open wound must then attempt to heal itself while constantly exposed to urine and feces. Many doctors are now using pain medication for newborn circumcision. However, we know that even the most effective method, which is EMLA cream applied topically, then an injection called a penile block, is not so effective that 60% of babies still experience excessive pain. Other countries defer circumcision until the baby is old enough to undergo sedation anesthesia and be given effective pain medications in the post op period.

Cultural blinders can be so opaque that they block even the blindingly obvious light of common sense. This is the case of newborn circumcision. Circumcision is a big deal. It is not just a little snip. It does remove numerous nerve endings and blood vessels. It does really hurt. And it may not be for his own good.

Sources:
• Reducing Pain from Surgery: What a Parent Should Know
• The Assessment and Management of Acute Pain in Infants, Children, and Adolescents
• Evolution of pain management in children holds parallels for animals
• Pain During Circumcision • The law & ethics of male circumcision - guidance for doctors
• Circumcision: A Closer Look
• Deciding whether or not to circumcize your baby boy
• The Circumcision Information and Resource Pages
• Circumcision study halted due to trauma
• Effect of neonatal circumcision on pain response during subsequent routine vaccination
• References for Mother-Friendly Childbirth Initiative Step 9: Discourages non-religious circumcision of the newborn
• Circumcision
• Paediatric Policy: Routine Circumcision of Normal Male Infants and Boys - Summary Statement
• Circumcision: hemorrhage

Copyright © Kimberly Levine. Permission to republish granted to Pregnancy.org, LLC.

Kimberly Levine is the mother of six; five daughters and one son. She is also a childbirth educator and professional labor assistant. Kim believes that infant circumcision is a subject that needs to be taken more seriously by parents and medical professionals alike. Her hope is that people set down their ingrained cultural beliefs about this practice and really take a look at what it entails.