Getting Better All the Time 3.18

Circumcision

Dear Uber, soon you will be circumcised. Later in life you may wonder why we did this for you. I hope this will prove to be explanation, and also show that we did put some bit of thought into this.

Now, first of all, my son, you may wonder why this is being posted to the best web-site for sports-fans in the whole galaxy. Well, your mother let it be known that we are going to do this, and it elicited some emotional responses. (Yes, your mother is a bit more open about stuff like this. You could even say she is brave. I never would have told people about the problems we were having with infertility, but that is important for people to know since it raises awareness.) Who would have guessed that people would have such strong feelings when it comes to a boy’s penis? So, this will hopefully be an explanation to others that we didn’t enter into this lightly. Also, there is a better chance of me finding this later, since it will be written in pixels, as opposed to on a piece of paper amongst your father’s notes. Or worse, relying on my memory.

Why?
Tradition. I suppose that might be good enough of a reason if we were Jewish, or some other faith. And, truth be told, it was my first reaction when asked if we would. Why wouldn’t I want my boy to “look like me”? There is a bit of comfort in the familiar. But I investigated if there were better reasons. (And no, I did not seek the opinion of Penn & Teller. For medical affairs I will trust the World Health Organization above a couple of excellent magician/comedians.)

But doesn’t blind tradition allow female-circumcision. Yes. I suppose it does. But, unlike the tribal circumcised females, males can still enjoy sex later in life, and since it is done in a sterile environment, the risks are tiny.

Basically we went with an analysis of risks versus benefits.

What are the risks??
Death: less than one in half-a-million (7). A car ride to grandmas is more dangerous.

Later will be angry that it was done to him. I don’t think it is prudent to base child rearing decisions on the possibility that the child may have a neurosis later in life. Who can predict what the child will be bitter about? And I suspect for most circumcised males, you will grow up with it, and not even be aware that it was an issue until your son is born.

Mutilation. Something could go wrong. What if the doctor makes a mistake? Now that is something to worry about. But, the same could be applied to any medical procedure. What if the dentist slips and that metal scraper thing gets gouged in the back of the throat. What if the pharmacist gives us the wrong medicine? What if the doctor improperly sets a broken bone? What if the doctor, when looking into the child’s eye, accidentally uses a laser pointer instead of the flashlight? What if they have an allergic reaction to a vaccination? Forbidding a procedure because of possible mistakes or complications, we would have to forbid all medical procedure.

Less sexual pleasure. I don’t even know how they quantify this. Do they hook up groups of men, half-circumcised, half not, to an Orgasmeter, submit all of them to the exact same sexual experience, and compare the results? Masters & Johnson reported, “the circumcised glans is no less sensitive” (7). Son, TMI warning, but speaking from personal experience of a circumcised male, masturbation and sex are enjoyable.

Most likely, you will cry, you will be sore, and you will bleed. You will be feeling your normal self in about a week. Statistically speaking, that’s it.

Even if the benefits are correct (see below) won’t it encourage risky behavior? This argument frustrates me. It has been raised recently with HPV vaccination. We have a way to prevent 70% of cervical cancer cases and 90% of genital warts (8), but some people are worried that it is sending the wrong message to kids. The message I want to send my children is “I love you, and I want to protect you.” And I don’t believe that seatbelts encourage teens to drive dangerously, or that condoms give kids the desire to have sex, or that the tetanus vaccine encourages children to step on rusty nails.

And the final…wait until he is old enough to decide for himself . “When the message is aimed at the uninfected, often young and eager for sexual experience, it is a very hard sell indeed. Those aged between 15 and 24 years are at the centre of the AIDS pandemic.” (2) We want to protect him before he is old enough to get into trouble. And as side note, more than 80% of men in AIDS ravaged Botswana would like to be circumcised if it were safe and sterile (1).

We parents make decisions for our children, for their benefit, before they are old enough to make a wise choice. We send them to school (they could get shot by a disgruntled teenager, or sexually molested by a teacher). We give them dental and orthodontia care (pain and bleeding), swim lessons (drowning), and piano lessons (risk of carpel tunnel syndrome, or turning out like Elton John). We vaccinate them, even against diseases that are fairly rare in modern day American society.

Some risks for various vaccinations (6)…
Measles vaccine: transient rash, anaphylaxis, and thrombocytopenia
Hepatitis B vaccine: pain, elevated temperature, and anaphylaxis
Diphtheria and tetanus vaccines: swelling, tenderness, and anaphylaxis
Acellular pertussis vaccine: convulsions or shock
Measles vaccine: elevated temperature, transient rashes, anaphylaxis, and thrombocytopenia
Rubella vaccine: acute arthritis

What are the benefits?
The first benefit of circumcision now, as opposed to later, is that the protections can be in place far before they are necessary.

The main rational for male circumcision these days is as a way to combat the AIDS epidemic. I think I first heard about this in the Economist (2). In Africa it was noticed “circumcised men have lower levels of HIV infection than uncircumcised men” (1). “[Male circumcision] could lead to substantial reductions in HIV transmission and prevalence over time among both men and women.” (3)

How can this be? It is believed “that the foreskin increases risk of HIV infection due to the high density of HIV target cells and lack of keratinization of the inner mucosal surface.” (4) TC Quin of Johns Hopkins’s School of Medicine, Division of Infectious Disease wrote this year: “Biological studies also demonstrate an increased number of HIV receptor cells in the mucosa of foreskin providing additional evidence of HIV susceptibility in the uncircumcised male.” (5)

Other medical benefits?
It reduces the risk of syphilis and chancroid (4).
It appears to provide some protection against the rare penile cancer (7).
Lowers transmission of STD to your future partner (5).
Less chance of urinary tract infection (7).

Because we believe it to be medically beneficial, we have decided to continue the custom.

And when your sister Unter is old enough, we will take her to for HPV vaccination. Even though there is risk with it, because once again, the potential benefits out weigh the risks.

My sources:

(1) “Male Circumcision: Weighing the Pros and Cons” World Health Organization, (2006)
www.who.int/hiv/mediacentre/AFRO-prevention_fs.pdf

(2) “Stand and Deliver” the Economist, August 17th 2006

(3)Nagelkerke NJD, Bailey RC, et al “Modelling the public health impact of male circumcision for HIV prevention in high prevalence areas in Africa” BMC Infectious Diseases, (2007), 7:16

(4)Weiss HA, “Male circumcision as a preventive measure against HIV and other sexually transmitted diseases.” Current Opinion in Infectious Diseases 20 (1): 66-72, FEB 2007

(5)Quinn TC, “Circumcision and HIV transmission” Current Opinion in Infectious Diseases, 20 (1): 33-38

(6) a handout from our pediatrician

(7) Benatar M, Benatar D “Between Prophylaxis and Child Abuse: the ethics of neonatal male circumcision” The American Journal of Bioethics 3.2 (2003) pp 35 – 48. This reading I recommend for anyone who is undecided, or who would like to see both sides of the issue examined in a calm rational manner. It is written by a Harvard neurologist and a University of Cape Town philosopher. They weigh out both the pros and cons and state, “We argue against both of these [extreme] views….We conclude that nontherapeutic circumcision of infant boys is a suitable matter for parental discretion.”

(8) CDC “HPV Vaccine Questions and Answers” (2006)
http://www.cdc.gov/std/hpv/STDFact-HPV-vaccine.htm

Posted by joncim at July 23, 2007 03:23 PM