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A response to the AAP Statement on Circumcision

faith October 17, 2012
http://www.intactivistgosling.com/view/classic

You’re pregnant, and you’ve found out you’re having a baby boy. You’ve likely talked about circumcision by now. Maybe you’re for it, maybe you’re against it, or maybe you don’t know how you feel yet. So, you start looking around. You ask your doctor or healthcare provider. And, you find a lot of information about the American Academy of Pediatrics’ stance on circumcision. You had heard that they didn’t recommend it at all, but all of the sudden, now…

On August 27, 2012, the American Academy of Pediatrics released its revised statement on its male circumcision policy. The last statement released in 1999, stated that the “Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision.” This year, the new statement reads, “Systematic evaluation of English-language peer-reviewed literature from 1995 through 2010 indicates that preventive health benefits of elective circumcision of male newborns outweigh the risks of the procedure”, yet ultimately leaves the decision to the parent on whether or not they feel circumcision is best for their child.

So, Why is This Change in Policy so Important?

Parents look to organizations like the American Academy of Pediatrics for trustworthy advice on how to best care for their children. When a large organization, which we expect to be looking out for the best interests of our children suggests that we are doing a service to our babies by cutting healthy tissue because it will provide them health benefits in the long term, parents tend to listen. Because preventative health benefits sounds scary, and no parents want to hurt their babies right?

http://www.aap.org/en-us/Pages/Default.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token

Conversely, the AAP “opposes all types of female genital cutting”. I can only assume that if the AAP endorses the cutting of male genitals and not female, there must be some great inherent danger in having a foreskin, whereas the labia and clitoris are inherently riskless.

Or, could it be that the AAP hasn’t told a complete truth? Is this simply scare tactics that still didn’t leave parents with any valuable information regarding the best practice when it comes to their son’s genitals.

Let’s examine some of the risks the AAP outlines in the statement:

Reduced Risk of Urinary Tract Infections

The AAP statement suggests that the risk of acquiring a UTI is reduced in the first year of life.

This study in 2000 states that of infants under the age of 1 born in 1996, 446 were diagnosed with UTIs, 154 of those being male. Of these, 132 were uncircumcised. The study also showed that the cost of UTI management in males was about twice that of females, and the cost of management in the uncircumcised male was 10 times that of the circumcised male.

In 1996, the Registry of Births, Deaths, and Marriages shows that 87,877 babies were born. So, in this study alone, the risk of a UTI was .5% if you were born at all, .175% if you were born a male, and .15% if you remained uncircumcised. That means that  the recommendation to remove an infant male’s foreskin forever (and ever and ever and ever and ever and ever) is being made to prevent a relatively minor and highly treatable complication that happens in 1/571 male infants regardless of having the procedure done, just because an uncircumcised male appears to be at greater risk.

And, where is the recommended prevention technique for females at birth? Being that females are at a greater risk than males as a general rule, I would expect a similar preventative technique for them as well.

That’s right, there isn’t one.

One can only assume this is so, because UTIs don’t require some extreme and surgical preventative measure. So, then, for the AAP to use this as a reason to endorse the surgical removal of healthy penile tissue seems extreme.

http://www.telegraph.co.uk/health/7046525/Breastfeeding-the-miracle-of-mothers-milk.html

Simple, non surgical, non medical measures can be taken to help ensure your baby, male or female, doesn’t acquire a UTI.

  • Breastfeedingbreastfed infants have been shown to have a significantly lower risk of UTI.
  • Breastfeeding moms should avoid artificial and sugary drinks, drink plenty of water, and avoid excessive caffeine.
  • Avoid artificial bubble bath products
  • Don’t forcibly retract the foreskin of a baby. The child should always be the first to retract his foreskin
  • Keep baby’s diaper clean and dry
  • In the older child, teaching proper hygiene and promoting a good diet

Reduction in the Risk of Penile Cancer

According to the American Cancer Society, penile cancer makes up less than 1% of male cancers in the US, but is significantly higher in other parts of the country (accounting for about 10% of cancers in males). 95% of these cancers are in squamous cells, and can develop anywhere on the penis, but most are on the foreskin or glans. The risk of acquiring penile cancer in developed countries is about 1/600 in uncircumcised males.

Some of the risk factors for penile cancer are:

  • Intact foreskin
  • Phimosis (tight foreskin that is difficult to retract)
  • Smegma (normal build up of dead skin cells and oils under a foreskin – females also produce smegma)
  • HPV
  • Smoking
  • UV light treatment for psoriasis
  • AIDS
  • Age (about 4 of 5 cases were diagnosed in men over the age of 55, the median age being 67)

Since we’re interested in how circumcision affects penile cancer rates, we’ll leave age, psoriasis treatment, and smoking alone, and touch on STDs in a bit. For now, let’s focus on the top three.

In older research, it was suggested that smegma caused penile cancer, but it is now more widely accepted that excessive build up of smegma may irritate the penis, which may increase the risk of cancer. Since phimosis can make the penis hard to clean, the theory is that it can contribute to this build up.

These are both easy to deal with. To reduce the build up of smegma, boys need to be taught proper hygiene, which, by the way, consists of retracting the foreskin and rinsing the head of the penis off with water. If phimosis is a concern, there are many non surgical options. The foreskin can be stretched either manually using an array of stretching tools like the Glansie or the TLC Tugger.

Now – what about the female external reproductive cancers? Surely the risk must be very low? According to the American Cancer Society, 1 in 406 women will develop vulvar cancer. That’t right – women are at higher risk of being affected with genital cancer, and more likely to die from said cancer, yet the AAP does not deem this a worthy cause for removal of healthy tissue at birth.

(Fun fact: in 2012, 1570 new cases of penile cancer and 310 deaths were expected, while 2190 cases of male breast cancer were expected, resulting in 410 deaths.)

Reduction of Risk of STDs

The AAP statement argues that circumcision reduces the risk of certain STDs, including HPV, genital herpes infections, and heterosexual HIV. The idea is that by removing the mucosal lining of the inside of the foreskin, it is harder for germs to permeate through the tougher skin left around the head of the penis. This conclusion was made from a 2009 study connecting male circumcision to increased HIV and other STD infection in Ugandan men.

Female genitals also have mucosal lining. The studies regarding male circumcision consistently state that the benefits to the male throughout his life will be passed on to his female sexual partners through his life. If the concern is with female infection as well, why are similar ‘preventative health measures’ not also taken for them?

http://www.knowabouthealth.com/breakthrough-microbicide-gel-protect-women-against-hiv/4272/

Forgetting, for now, that the study is based on adult males in an entirely different culture than our own, the AAP statement does not once mention the word condom. In the aforementioned study, 60 circumcisions were required to prevent one case of HIV infection. In other words, circumcision had a .016% effectiveness rate in prevention of HIV. This study from 2000 shows that condoms have an 85% success rate in preventing HIV infection. Another study found similar results of 80-95%. In short, a more affordable, less invasive solution exists to a problem that you may or may not be exposed to.

It stands worthy of addressing that there is a general stigma against wearing condoms, mostly for reasons of fit and discomfort. There is a cool company addressing these issues called They Fit , begging the question ‘Why didn’t I think of that!?

What the Statement Does Not Address

The AAP statement focuses on the supposed health risks of being uncircumcised, but never discusses the health risks of being circumcised, nor does it mention what is to be lost by not having a foreskin.

  • The biological function of the foreskin
  • Infant response to pain, both physically and psychologically
  • Disruption of breastfeeding and bonding with mother
  • Studies that suggest infants remember the pain of their circumcisions
  • Questions that circumcision violates male children’s rights
  • Complications and deaths from circumcision
  • Medical ethics questionability – First Do No Harm
  • Reduction of sexual function as a result of the removal of the foreskin
  • Potential of emotional trauma as an adult

http://www.savingsons.org/2012/08/circumcision-my-story.html

Ultimately, the AAP leaves the choice of whether or not to circumcise in the hands of the parents. And, I agree. The decision of whether or not to circumcise is a deeply personal one – a decision that requires a lot of thought. The people who are at the forefront of the medical community shouldn’t be doling out advice based solely on fear. The information should be broad spectrum and cover all possible outcomes of the procedure, not just those that are at a low risk of happening or preventing.

More resources:

What do you think? Was the AAP’s recommendation in favor of circumcision skewed in its presentation? How did you make the decision on whether or not to circumcise?

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15 Comments

  1. Will have to make this decision soon. Unfortunately, one thing that plays a big role (wether it should or shouldn’t-it is still a factor) is the fact that his father and his older brother both are.

    Reply

    • Jennifer, I understand your concern. We faced the same decision. Ultimately it came down to a couple of things for us. 1. NO little boy has a penis that looks like his daddys; unless there is something significantly abnormal about the adult male penis, it will always look different regardless of the circ/non-circ status of each of them. 2. Each of your children will have other things about them that are different…if they even notice there is a difference, it can be explained as simply as comparing it to blue eyes or brown, straight hair or curly, big feet or little ones. At least until the children are old enough to be able to explain that you made a choice for each of them, based on your understanding at the time, of what was helpful for them. 3. No adult has the right to make permanent surgical amputation choices for another adult – why should we be less respectful of out sons bodily integrity? Circumcision, (on the basis that the AAP gives for supporting/recommending it) is a choice that adult males can make for themselves. The intact infant penis needs no special treatment, just wash and dry it as you do his toes. Good luck with your research and decision making. It is hard when we seem to have taken a stance on something to change our minds and behaviour, but it is absolutely imperative that we be clear about our reasons for choosing to permanently alter our non-consenting sons. My hope is that you will watch a film of a circumcision and let your heart guide your decision. best wishes

      Reply

    • Hugs, Jennifer. I have two boys and I had the same problem when I was pregnant with number two. I didn’t exactly research the way I should have when I had the first, and circumcision was just ‘that thing you did’. I had such a bad experience with #1 that with #2 I researched EVERYTHING! We didn’t find out the sex with the second, and although I really, really wanted a little girl just to have a little girl, my dirty little secret was that I wanted to have a girl mostly because I didn’t want to face making the circumcision decision.

      But, lo and behold, C was a boy. The first thing that went in my favor was that we had him in a birth center and to have a circumcision performed meant that we would have to make an appointment with a doctor and take him. The second thing that went in my favor was that his father and I didn’t communicate too well about pretty much anything, and I was the decision maker in our relationship.

      Long story short, I had reservations, and I could never make the call. I was pressured by everyone to have it done – his father, all the grandparents – everyone. The looking like his father thing was a big reason everyone felt I should have it done, but I stuck to my guns. It’s still hard. His father has said really awful things, and it seems like everyone is still really angry about the choice I made. And, if I am being honest, there was a period of time where I was waiting for all the things that everyone said would go wrong to go wrong. But, they never did.

      Ultimately, I have never, ever felt guilty about making the decision. C is almost 3 now, and I stand behind my decision 100%, and even more, he doesn’t even care.

      My heart goes out to you. I can imagine how you feel right now. All you can do is the best you can do and follow your heart. The decision can ALWAYS be made later, but can never be taken back. Find a local support system – maybe attend a LLL meeting and try to find some like minded people, or see if any natural parenting groups exist in your area. At the very least, join an online forum of moms and dads who can support you. I hope you and his father can come together about this.

      Reply

    • Jennifer, I think you ultimately need to do your own research and decide based on what you think is better for the baby and not the opinion of others.. whether related or not. I have an 8 month old uncircumsized son, and I do not regret the decision after doing my own research. It’s about putting your child’s health and rights ahead of personal opinions. My husband was for circumcision because he was circumsized. I showed him what I had learned and he decided to support me. He thought the same thing.. and it’s true.. nobody looks the same anyway.. as for teasing in school? I talked to my hospital affiliated midwife when I was pregnant and she supported my decision whether to circumsize or not.. whatever I chose to do.. she told me that more and more people are deciding against it. So this would mean more kids born from then on out might not be circumsized so the numbers of the ones who are and who aren’t will even out when they are in school and will become the norm. I can’t tell you how many hot famous guys aren’t circumsized. You’d be surprised if you looked up the list like I did to show my husband that it won’t interfere with intimacy as an adult. He was surprised at how many male handsome actors and male models weren’t circumsized and some that were are now against it after doing their own research.

      I think a child goes through enough just to be born.. the world is a new and scary place. Adding surgery that causes the child pain, discomfort, and possible infection adds more stress to the new little baby. They can be free to choose to go through with the circumcision as adults if they so choose to.. that’s their choice to make with their body. As for cleanliness? My son’s never had any rashes there or any problems.. and it won’t need to be pulled back to clean ’til they’re old enough to do it themselves. It’s a lot less maintenance than circumcision recovery.

      http://www.circumstitions.com/Famous2a.html

      http://www.circumstitions.com/Famous3a.html

      http://www.circumstitions.com/Famous4.html

      Leaders and such including Martin Luther King, Ronald Reagan, Prince William, ect…

      Actually, the foreskin helps to keep the vaginal area from becoming overly dry during intercourse.

      There’s so much to learn about it. As for being a cancer preventative? think of it this way.. circumcizing boys to prevent penile cancer which they might not even get to begin with.. They might as well remove every girl’s breasts to prevent possible future breast cancer. Girl circumcision is wrong.. but girls do have small foreskins which is why they could also be circumsized. It’s how we’re made, so why tamper with it? If we’re not meant to have it, then we wouldn’t. It serves a purpose.

      Reply

  2. Jennifer,
    I have been where you are. My husband, and two older boys ALL are circumcised. I did not know any better when I had my first two. By the time I had my third, I had much more information, and knew that it was a cosmetic surgery, and a permanent and painful alteration to my son’s body. I regret having my first two sons cut, and am so, SO thankful that I got correct info in time for my third. They don’t all have to match-my boys don’t all have the same color hair (in fact, all three are different!), nor do they all have the same color eyes. Matching penis’s is not a requirement for good relationships. Please don’t put your new baby boy through this, “when we know better, we do better”
    Blessings

    Reply

  3. There is also the fact that, if a boy wants to have part of his penis cut off to look like his dad, he will probably ask. you can’t assume he will want to match his dad more than he will want to have a normal penis. how much time have you spent thinking about your mom’s genitals? your son probably won’t spend a lot of time looking at his dad’s penis, but if he does, he’ll probably notice the pubic hair more than the lack of foreskin. I have two intact boys and a cut husband, and my boys have never ever noticed their dad doesn’t have a foreskin.

    Reply

  4. Also where you refer to the new testament for reasoning that circumcision is no longer promoted. Those verses we’re talking about salvation and Paul was trying to bring the Jews and Gentiles together. He clearly says you don’t have to become circ as an adult to enter the faith just because you weren’t as a babe. He wasn’t say don’t circ. Paul was often trying to tell the Jewish people to stop making it difficult for the Gentiles to come into the faith. He often was showing the people that salvation was based on faith not works. However it’s clear when you love Jesus you have a desire to follow his word and everything that you feel he’s calling you to do in and out of the Bible. But Bible does not say not to circ. I have researched this and prayed about it. I am a lover of Jesus and don’t appreciate you backing this subject with the Bible because that’s not clear. If you chose not to good for you.

    Reply

    • Hi Kathy!

      Thanks for posting! I’m not sure where you saw mention of the Bible as being for or against circumcision. Can you help me out? Did you see this in my post or in a response? I can’t seem to find it.

      This post is a response to the medical community. As always, the choice of whether or not to circumcise is a deeply personal one. I choose not to use faith based arguments, because faith belongs to each person alone, and I don’t feel it my place to judge for something I most likely understand.

      Thank you for the insight into the testaments, though! It provides a view point that I am not familiar with, and I always love learning new ways to look at things!

      Reply

    • It should also be noted that the circumcision of the Bible was *not* a complete amputation of the foreskin. The Hebrew word for circ is a word that mean “to blunt”. The circumcision of the Bible was the cutting off of the part of the foreskin that extends beyond the glans. If you are familiar with the Old Testament, you will remember the mention of Zipporah circumcising her newborn son with a sharp stone. (Exodus 4:25) In newborns, the foreskin is fused to the glans in the same way as your fingernail is fused to your finger. It would be impossible to cut off the entire foreskin of a newborn using a rock, without accidentally cutting off the glans as well. From a practical standpoint it should be obvious that this is not what God commanded of the Israelites.

      Secular history shows that the practice of complete amputation began well after the Bible was completed. Some Jewish rabbi decided that, if God is pleased by cutting off the tip of the foreskin, He would be even more pleased by its complete removal. Complete amputation was never commanded by God; it is a doctrine of men. The Bible teaches that following the doctrines of men, and adding commandments to His Word, is sinful. Saying that the Bible commands us to amputate our babies’ foreskins is doing just that, adding our doctrines to His Word.

      It should also be noted that the Bible is very clear on the fact that the circumcision required of Christians is to be baptized. Colossians 2 says that we are circumcised with the circumcision made without hands, being buried with him in baptism. We also see that he nailed the old commandments to His cross. If you feel the Bible demands circumcision for us today, then you also have to practice animal sacrifices, grain offerings, keeping the Sabbath (traveling only short distances and doing no work on Saturdays), bashing enemies’ babies’ heads in, strict dietary laws, and every other commandment given to the Jews. You can’t just pick and choose the ones you like, because if you offend in one point, you offend in all. (James 2:10)

      It is good to have a desire to follow God’s Word, but you can’t just drift through life based on what you “feel” he’s calling you to do. He’s already given us “all things that pertain to life and godliness” in His Word. (2 Peter 1:3) You can’t go on your “feelings” or what you “think” He’s calling you to do, you have to go on what the Bible actually says, because that’s what you will be judged by.

      Reply

  5. And of course if you don’t believe in the Bible this doesn’t apply. I would not expect you to follow Biblical practice. My comment was for people who started using the Bible for back up. I don’t believe you can. I agree everyone should have the choice.

    Reply

  6. Thanks, Jaime

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  7. One other point not often discussed is that in addition to losing about 50% of the male foreskin (which is a pleasure center), sex is better for women with an intact man. A natural foreskin provides a rolling lubrication which reduces the friction that often causes a woman to need to add an artifical lubricant. There is no good reason to circumcised., as evidenced by the fact that there are very few, if any, intact adults who choose to get circumcised.

    Reply

  8. when we figure out the answer to ‘ who owns your penis ‘ circumcision rates will plummet

    Reply

  9. […] Response To The AAP Statement On Circumcision by Jamie at Modern Alternative Pregnancy […]

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I’m Kate, mama to 5 and wife to Ben.  I love meeting new people and hearing their stories.  I’m also a big fan of “fancy” drinks (anything but plain water counts as ‘fancy’ in my world!) and I can’t stop myself from DIY-ing everything.  I sure hope you’ll stick around so I can get to know you better!

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