Monday, May 22, 2006

Snips and snails and--hey! that's not a puppy dog's tail!

Over at Blogging Baby, Kristin writes about a piece in the Ottowa Citizen entitled "We're not born needing repairs," which is an anti-circumcision piece. But it's not the writer's stance on circumcision that caught my eye, it's his stance on nudity.

To begin by digressing, this seems to be circumcision day at the Bradstein household. First, we had our latest biweekly doctor/midwife visit which went well. This was with a doctor who we hadn't met before and he asked us if we knew what sex our baby is. When we told him that 3B is a boy, he asked if we had considered whether to circumcise him or not.

Although we've pretty much made up our mind to circumcise 3B, we're open to all possibilities, so we asked the doctor what he thought. He admitted that he's biased, since he's a Mohel who has performed over 4,500 circumcisions both in religious ceremonies and medical procedures. That said, he gave us the advantages and disadvantages and told us that there is no standard or recommendation; it's entirely up to us.

Perhaps to show us that it's not a difficult procedure and set our minds at ease, he told us of his son's bris, to which the Mohel arrived with his wife. The Mohel explained, "She has to come with me. I can't see well enough to drive."

Hm. I wonder how long that awkward pause lasted.

"But," our doctor said with a wry smile, "everything was fine. He's 29 now and very popular with his girlfriends."

I think that we may know more about his son than he knows about us and 3B. But that's one reason that I like this practice--I really feel like we've gotten to know who the doctors and midwives are as people.

Then we went to visit the pediatric practice that we're considering using. I admit, we're the ones who asked about circumcision, as much to hear how they addressed it as what their opinion is on it. But again, we spend a good 10 minutes discussing it.

May 22. Circumcision Day. Think of all the money Hallmark can make off of this holiday.

But, back to the original piece in the Ottowa Citizen about circumcision. The writer projects onto mankind his childhood experiences:

Most men, I'd venture to guess, have no memory of seeing their fathers naked. I know I don't.

I remember, on occasion, seeing my dad shuffle toward the bathroom wearing only a pair of droopy, powder-blue briefs. But if he walked around the house in the buff when I was a toddler, I don't recall it (thank goodness).

Starting at the end, I'm not sure why he's so thankful to goodness for never having seen his dad in the buff. What is wrong with nudity--especially among family?

Perhaps it was growing up in Northern California that made me this way, but I don't see why a son should care so deeply about seeing his dad naked. My parents never sought to hide or flaunt their bodies from us, which I'm still impressed by, since it left me with the abiding feeling that there's nothing wrong about nudity. After all, they saw all of us kids naked regularly--all too regularly when it was associated with a diaper, I'm sure.

Or perhaps it was growing up in the shadow of Stanford, where streakers were a dime a dozen in the 70's, my early formative years. I do recall once, as a young lad, running out from the bathtub to find my parents to tell them some fascinating, amazing, supercool thing about stuff and things, only to find that when I entered the room in the buff, it sure stopped the conversation they were having with their guests.

Someone, it could have been either Mom or Dad, made some suitably dry observation that made us all laugh, and then I went back and put on my pajamas before rejoining them. It wasn't traumatic, but it was when I realized that I could no longer just run around naked whenever I wanted--a sad moment for Papa.

To this day, I'll tolerate most clothes, some more than others, although I'm not a big fan of the oeuvre. And I really don't like most shoes, although I do have this thing for hats. I'm sure that these are the results of being raised barefoot and naked, which is something that I want to do with 3B for the most part. Although I'll have to allow Mama to keep him in some of his cute little outfits from time to time, judging by her reaction to just the outfits without a cute little baby in them.

But will I be scarring the kid for life--after actually scarring, according to the Ottowa Citizen, him for life? Or are our penises, our bodies, our nudity not anxiety and anguish inducing, but rather natural parts of growing up naturally?

What do you think?

8 comments:

  1. Couldn't have picked a more perfect moment to bring up the topic of household nudity. Berkeley's barely famous "Naked Guy" just died in jail after being arrested for assault with a deadly weapon:

    http://www.msnbc.msn.com/id/11100863/

    I regret to say the story does not make clear whether the deadly weapon was circumcised.

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  2. You may or may not be scarring him for life (emotionally; the physcial scarring is definite) if you choose to circumcise him. The key here is that you can't know. If he's happy with it, great, no (emotional) harm done. If he's not happy with it, though, that would cause a bit of a problem. Again, you can't know which you're going to get. I'd leave the decision to him unless it becomes medically necessary, which it most likely won't. Based on the background you provided, intact is the more natural way to live, anyway. If nudity is okay, what would make the nudity he's born with not okay?

    As an example, I wish my parents had done that for me. Not much I can do about it now, of course. Am I wrong for being angry about their choice?

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  3. Thanks for shedding some light on a part of this that we hadn't really considered.

    That uncertainty that you describe is a part of the equation. There are those who, like yourself, are angry at having been circumcised, but there are plenty who aren't too.

    I've read many references that cite the perils of the surgery and other reasons (like the possible future need for the foreskin for eyelid replacement, which seems a bit far-fetched. . .but OK) for not circumcising. There are also those references that cite the decreased risk of urinary tract infection in infancy and HIV transmission later, although, as both doctors pointed out, those risks may be minimal to begin with. There are those who believe that it's emotionally scarring, without question, and those who are still waiting for some proof, like a significantly higher rate of mental disorders among circumcised men.

    As I said, we haven't firmly decided one way or the other, and with no certain answer apparent, we're glad for input like yours that exposes something we were unaware of. I'm sorry that you harbor anger toward your parents; I can only hope that we don't make a decision that 3B doesn't resent later--I say "only hope" because I'm sure that we will make mistakes as parents, that we will do something that he regrets.

    Whatever our trespasses against him, I can only hope that he loves us enough to forgive us for them, because we probably won't be capable of forgiving ourselves.

    I also feel that this is probably a debate in which people of one mind likely will not be convinced to change it, judging by some of the heated rhetoric that we've seen. I have faith, however, that we're all doing our best to do what we believe is right for our children, and that we all are doing our best to love our children. On that I hope we can agree. To misquote Sting, I hope those parents love their children too.

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  4. "the possible future need for the foreskin for eyelid replacement"

    So, uh, were you just winking at me, or was that, uh, your, um, you know . . .

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  5. I'm happy to help in any way possible. For more information, I recommend the excellent documentary "Mother, Why Was I Circumcised?", found here. (It can also be found in iTunes by searching for circumcision and/or MacDocman.)

    I'll apologize in advance for the length of the remaining portion of my response. Please, ignore me if I'm being a pest, but I'd like to elaborate on some of what you said.

    As I said, I'm definitely angry, though I don't carry it so far that I hate my parents or isolate myself. I accept that they did what they thought was best when I was born in '73, no matter how obvious I think the decision to do nothing should've been. My contention now is that we know better. The facts of circumcision don't support its perpetuation in our society. No medical society recommends it, so its continuation is only cultural acceptance. That's not a standard for surgery.

    Your counterpoint is valid. Most circumcised men in America are content with their status, even going so far as believing that what they have is better. I have no issue with that. They're not wrong, as much as I might disagree. But, all of the intact men I know are happy with what they have. Not one would ever consider being circumcised for anything other than absolute medical necessity. That is telling to me. So again, it gets back to individual choice for the boy. Being circumcised at birth is the only scenario he faces in which he can't fix the situation through his own decision.

    I'm not going to go too far into detail, since you didn't specifically ask, but a lot of the benefits are clearly potential at best. The two examples you mentioned, UTIs and HIV, have reasonable counter-arguments. HIV first. No one suggests that circumcision prevents HIV to the point that unprotected sex becomes an option. Hence, abstinence/monogamy and condoms are still the best solution. No cutting necessary. I've never engaged in risky sexual behavior, so the hypothetical protection I've receieved is invalid. Since we can't know a child's eventual behavior, surgical alteration for a possible outcome is extreme.

    With UTIs, the argument is a little more concrete. Intact boys do get more than circumcised boys. Girls get more than both groups of boys, though. We treat girls with antibiotics, but boys get surgical intervention. I've seen no studies that show antibiotics to be ineffective on boys.

    Outside that point, though, the number of UTIs just isn't significant. Be very skeptical when reading the benefits of circumcision. Most emphasize an N-times decrease in risk of this scary disease for circumcised or a 100% increase in risk of that scary outcome if intact. Look at the hard numbers. A 100% increase in risk isn't a good measure if the incidence rate jumps from 1 to 2 cases per year. For example, check the penile cancer statistics commonly given. They'll be described as percentage decrease in risk, but looking at the actual cases, there are more cases of breast cancer in men than penile cancer every year. What radical surgery are we performing at birth to protect men from breast cancer? (Or women, who clearly suffer much more from breasts cancer?)

    P.S. If you do decide to keep your son intact, make sure you learn how to care for it. It's not complicated, because it amounts to doing nothing, but improper care will cause problems. Specifically, do not retract the foreskin. It will not retract on its own for a few years, with full retraction not likely before puberty. Doctors sometimes ignore this and will force the foreskin back prematurely. (After all, circumcision requires this forceful separation of the foreskin from the glans.) Until full retraction is possible, no extra cleaning is necessary outside normal bathing.

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  6. Apologies for not getting back to you sooner. You've likely moved on, but if you haven't, I just wanted to say that I'm not ignoring this, and you're not a pest.

    I've just been too busy to get back to you. Given that I've been so busy, I also haven't been able to look into some of the other stats--thanks for all the ones that you provided. They match up with what we've read in books and heard from the doctors.

    You mention that the rates for UTIs is very low. Some of the reasons that are most frequently given for not circumcising are the risk of psychological damage or physical damage including complications that lead to death.

    Any research that shows how often psychological complications, physical complications, or death occur?

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  7. No problem, I'll help in any way for as long as you have questions. I'll pull some figures tomorrow, and provide an answer.

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  8. I apologize again for the length. If you have any questions on this or other aspects, please ask. I'll stick around as long as you want me to hang around.

    I began a response but stopped in the middle because I realized I was giving a narrative of how complications arise after circumcision. That's not what you asked, so I abandoned it and will address statistics, instead. Some rates will be fuzzy because of under-reporting and miscategorization, but I'll explain those briefly to provide the necessary explanation. To answer your question...

    The research I've come across shows that psychological and physical complications (including death) do occur, as you suspect. I'll start with the most distressing and work backwards. (Only because I think it builds the framework better...) I've read numbers with wild variations, but the common figure I've seen is 1 death per 2 million circumcisions. This is a relatively low number, given the number of circumcisions. However, one common problem is that deaths attributable to circumcision are often categorized as something else. A child may die from an infection or excessive bleeding. That will be rarely be classified as circumcision-related, even though the boy would not have become infected or bled had he not been circumcised. It's reasonable to assume that the death rate is higher than official statistics, though it's not necessary to do so. The real question is, while that extreme complication is unlikely, is the risk worth it?

    As to more likely complications, UTIs seem the place to start. I touched on it before, but the actual numbers are revealing. The results of the studies vary, but only slightly. A reasonable basis can be found here. The gist is

    195 circumcisions would be needed to prevent one hospital admission for UTI in the first year of life.

    Following that, this link indicates shows in graph form the risk attributed to circumcision status for boys. Circumcised boys face a .188% risk of UTI in the first year, while intact boys face a .702% risk. My decimal points are in the right place. There is a difference between the two, but they're both small. As for girls, the rate I've seen is in the 3% in the first year. Again, those are treated with antibiotics.

    I'm not sure how in depth you want specific risks for each physical complication, but possible physical and psychological complications include bleeding, infection, tight circumcision leading to painful erections, skin bridges, adhesions requiring further surgical intervention, glans/penile damage, misshapen penis, decreased sensitivity, frustration, anger, and shock (during the procedure - often confused for sleeping). Some of these complications are not included in statistics because they're not studied or they don't occur until adulthood, when the causal link is ignored. That said, the rate of short-term complications is 2-10%, but potentially as high as 30+% (referenced from the link above). This is the nature of the surgery, as the foreskin is attached to the glans. The forceful retraction required causes complications. The qualification of the doctor also impacts the qualification rate.

    An interesting discussion concerning rates of prevention and complications can be heard with this discussion from KQED. It includes Dr. Ed Schoen, who is very much pro-circumcision, and Ronald Goldman, who is against. The basic lesson from it is an exchange in which Dr. Schoen kept citing X greater risk of this and Y decreased chance of that. Dr. Goldman (Ph.D.) challenges him to cite actual numbers, which Dr. Schoen never does. It's quite telling. You can also still find the discussion on iTunes for download, I think, if you don't want to listen online. Also, Goldman's book, Circumcision, the Hidden Trauma is an excellent resource for detailing the physical and psychological impact of circumcision.

    Another great interview is at Chiropractic's ON. The topic covers many good circumcision topics, but is most useful for the audio of an actual circumcision. It's unbelievably disturbing, but it's worth hearing to counteract all the nonsense that infants sleep through their circumcisions or don't feel anything.

    Finally, an interesting point based on your original discussion with your doctor, there's a difference between traditional Jewish circumcision and modern medical circumcision. Jewish circumcision takes only the tip, requiring only a small slice. Typical hospital circumcision removes most of the foreskin, preventing its anatomical purpose. I still contend that's either is too much, but the difference is worth noting.

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