Wednesday, January 21, 2015

Someone's Cousin's Neighbor's Grandpa

We’ve all heard stories about how someone’s cousin had to be circumcised at 6 for “problems,” and how terrible it was, and how someone’s ex had to be circumcised at 19 for “medical reasons,” and how terrible it was, or how someone’s grandpa had to be circumcised when he was 40 because his foreskin kept getting infected, and how terrible it was. It can make someone who doesn’t have the bigger picture wonder if the foreskin really is bound to go bad, so, it’s important to understand why these anecdotal stories keep popping up. 

When we are confused about how to clean a boy’s penis we CAUSE problems. Retracting and cleaning under a prepubescent's foreskin (especially with soap) would be like douching a little girl. You can imagine what trouble you’d bring doing that, right? Genitals of young people are NOT the genitals of mature people.   Retraction of the male foreskin is part of its sexual function.  In young boys, the foreskin is meant to stay forward. It’s there to protect the glans, and keep contaminants away from the urethra. Start yanking on it, and you can tear his “hymen” (actually named preputial lamina or synechia) a membrane that bonds the foreskin to the glans, and releases slowly over time.  You also introduce bacteria which can cause a UTI.  Use soap, and you upset the delicate PH balance, which can cause inflammation, a UTI, or a yeast infection, FUN!  So leave a young foreskin alone, the way you would leave a young vagina alone. 

When we have confused expectations for a young or teen foreskin we see a problem where there isn't one.  It's normal for the foreskin to do weird things during its development.  Strange white bumps, which are the cells of the aforementioned synechia membrane releasing and collecting under the foreskin, will work their way out the end; ballooning of the foreskin with urine, or a stream of pee that sprays at an angle; or a foreskin that was retractile becoming non-retractile later are all things that, if you don’t know to expect them, can seem like a “problem” but are actually just normal development.  It’s even normal for the foreskin to remain snug into the early 20's. If your expectations say that the foreskin freely comes back by age 5 (like the AAP erroneously states) then at 20 when it’s still a little snug, you might falsely believe there’s an issue. 

When our doctors know nothing about foreskin but how to cut it off, we end up with stories of circumcision instead of less invasive treatment. In places where foreskins are normal, men rarely need medical circumcisions.  They are empowered by knowledge of their body, and they know that their issues can be corrected without surgery.  Their doctors also, are familiar with more than just amputation for treatment, so they don’t offer it first, like they do in the US.  The problem with our doctors’ foreskin ignorance isn’t limited to knowing only one solution to issues, it’s also the mindset that issues must be the FAULT of the foreskin.  In the US, a problem causing a foreskin issue is ignored in favor of treating only the symptom.  If a man has recurrent yeast infections, for example, a doctor in a ‘foreskin friendly’ medical community might check for problematic blood sugar.   A man in the US is denied an opportunity to find a legitimate cause of his issue, because doctors instantly assume that his foreskin is the problem, and offer amputation.  And it’s terrible.  And people find out and tell others. 

In places where foreskin is not vilified at every age and cut off at every opportunity, you have healthy men unwilling to allow amputation of the best part of their penis.  But don’t take my word for it.  YOU can check this by comparing health statistics of places that do and don’t routinely circumcise, and by conversing with intact men from intact cultures.

We need to keep an objective perspective when we hear stories.  Imagine for a moment circumcised women from circumcising cultures hearing about a little intact girl with adherent labia, or a teen or young woman with tearing from intercourse, or an older woman with recurrent yeast infections and thinking that the solution was amputation every time.  I've personally known women with each of those problems.  Imagine if those women HAD been circumcised to fix those issues.  I might start believing that circumcision is the only solution, and that it is always eventually needed.  I would be especially susceptible to believing in labia amputation if I were raised in an environment that constantly blamed problems on the labia.  It would take looking at a population of women that do not do that to see that it's not necessary to cut them off.

Also keep in mind that people have a tendency to share impressive stories as IF they were experienced fact, and the reports of “problems” can multiply beyond reality.  Someone’s friend can become 6 other someones’ friend when people share stories that aren’t actually their own.  Suddenly it seems like it’s the same story 10 times, when it was really just once. 

If you applied the logic of “I’ve seen it needed, therefore it’s ok to do it before it’s needed” to other issues that need surgery to correct, then it would be ok to remove breast buds from infant girls, because we ALL know someone who had to have a legitimate medical mastectomy.  And that would just be absurd.  The bottom line is that even if the story about the circumcision at 8, 18, or 38 IS true, that doesn’t mean it wasn’t avoidable, and it doesn’t mean that a healthy baby doesn’t deserve to have HIS healthy foreskin left alone.  

11 comments:

  1. What I find strange is that so many people, including medical professionals, still think that parents should retract their sons' foreskins. These national medical organizations all say not to:

    AAP – "Care for an Uncircumcised Penis"
    http://www.healthychildren.org/English/ages-stages/baby/bathing-skin-care/Pages/Care-for-an-Uncircumcised-Penis.aspx
    "foreskin retraction should never be forced. Until the foreskin fully separates, do not try to pull it back. Forcing the foreskin to retract before it is ready can cause severe pain, bleeding, and tears in the skin."

    Canadian Paediatric Society
    http://www.caringforkids.cps.ca/handouts/skin_care_for_your_baby
    "Keep your baby’s penis clean by gently washing the area during his bath. Do not try to pull back the foreskin. Usually, it is not fully retractable until a boy is 3 to 5 years old, or even until after puberty. Never force it."

    Canadian Urological Association
    http://www.uroinfo.ca/brochures_pediatric/foreskinCare.html

    "Care of the normal foreskin

    The uncircumcised penis requires no special care. It can be kept clean with a gentle soap and warm water wash daily. No attempt should be made to retract the foreskin until it can be pulled back with ease. Then, your son should be taught to pull his foreskin back gently to clean its inner surface and the glans with soap and water.

    It should be thoroughly rinsed with water before being dried with a towel. The foreskin must always be brought back to its usual position covering the glans after washing.

    It is important not to retract the foreskin forcefully for any reason. Some parents feel the need to pull the foreskin back to “clean under it”. Since the young boy’s inner foreskin and the glans are initially fused, there is no space to clean.

    Forceful retraction also may lead to cracking and bleeding of the foreskin tip. Over time, this may cause scarring of the tip making retraction impossible. Circumcision may then be necessary."


    RACP policy statement on male circumcision
    http://www.racp.edu.au/index.cfm?objectid=65118B16-F145-8B74-236C86100E4E3E8E
    "The foreskin requires no special care during infancy. It should be left alone. Attempts to forcibly retract it are painful, often injure the foreskin, and can lead to scarring and phimosis."

    Both the AAP and CPS suggest that early retraction is a lot more common than seems to be the case. A Danish study (Øster) found that only 23% of boys could retract by the age of 6-7, and an average age of ten. Why would anyone know or care though? We don't go poking around in the genitals of small girls.

    ReplyDelete
    Replies
    1. "Then, your son should be taught to pull his foreskin back gently to clean its inner surface and the glans with soap and water."

      Still there is bad advice.

      Delete
  2. Excellent post and so very true. I also wanted to point out the nursing home myth too..... Which is another story we hear over and over. Elderly women can have genital issues too ..... But there is no mention of genital cutting on them and no one sharing "intact" horror stories about women. It's all ridiculous!

    ReplyDelete
  3. Excellent points and well written post. The title is especially fitting, because I've heard this exact "argument" and it always starts out like that: "My co-worker's best friend's dog walker's cousin's stepdad's hairstylist's son wasn't circumcised and..."

    It starts off an awful lot like an urban legend. Just like the "need" for boys to be circumcised is an urban legend.

    ReplyDelete
  4. Sharing this far and wide. Very well written, thank you!

    ReplyDelete
  5. Anecdotal is just that. Do your research people!

    ReplyDelete
  6. Sorry responding to the first paragraph

    ReplyDelete
  7. When I was 27 our son was born. The family doctor tried to present convincing arguments for having him circumcised but both my wife and I felt it wasn't our decision to make since it wasn't our body being modified. I did buy his rationale and asked for a referral to get myself done. I never had a problem with hygiene, infections or any other issues. He just made it sound like things would be better. A few friends commented that I was going to be in agony and that it was difficult for an adult. I was nervous as heck but went to the outpatient surgery section for my appointment. I was given an injection of demerol I'm thinking more for anxiety than anything else. The procedure took about 35 minutes and I was kept for an hour and a half to check for bleeding. I was told to leave the compression bandage on for two days. That evening we went to the company Christmas party and I went to work next day. I was astounded at the lack of expected pain. When I took the bandage off it wasn't a pretty sight with bruising swelling and stitches. For me the worst part was the itching caused by the stitches but they soon dissolved. The part that had been formerly covered was a distraction being constantly in contact with my clothes but it soon desensitized. When fully healed and able to resume sexual activity I was surprised at how much sensation I had lost. For those cut at birth they would never have anything to compare. Also my wife noticed a big difference which wasn't for the better. She truly preferred me intact and in hindsight so did I. The reason I'm telling this is to dispel the myth that adult circumcision is much more difficult than for infants. I made a choice and got the type of cut I asked for, I just never really knew what I was giving up. I'm totally against routine infant circumcision and honestly believe we as a society need to respect a boy's right to bodily autonomy and remove the decision from parents to take that right away from him by having him cut. Thanks

    ReplyDelete
    Replies
    1. Wow!! Thank you for sharing this!

      Delete
  8. Fabulous blog and perfect timing, as I need to address these same lingering concerns a doula expressed regarding working with expecting families - "what if he needs circumcision later?" Regardless of any problem, even a recurrent one, that I could be having with my genitals, I would never choose to have my clitoral hood or any other part cut amputated. But I know a lot about sexual parts and functions. Many people don't and could be persuaded by a misinformed, fear mongering doctor. I am grateful for what you have written here!

    ReplyDelete
  9. "Retraction of the male foreskin is part of its sexual function."
    What an excellent point! I'd never thought of that.

    ReplyDelete