Rates of routine infant circumcision are dropping (thankfully), but that doesn’t mean there aren’t a lot of myths and misinformation still making the rounds.  In some cases, parents and others don’t quite know how to react because the misinformation can even come from health providers.  This happens because regardless of what we like to think about science and medicine, even the most ‘objective’ of methods is still steeped in culture and can be highly influenced by it.  Take, for example, the fact that for many years (and still today in some cases) medical textbooks used in North America do not include an image of an intact penis.  This means that to learn about the human body, the medical norm was that of circumcision and everything learned about penile function was done under that umbrella.  Sadly, a lot of misinformation can make it out when that is the case.  Let us take a look at five of the most common myths and compare it to the reality; after all, when we know more, we can do better.

Myth #1: Male circumcision is nothing like female circumcision.

When we think of female circumcision, most people turn immediately to infibulation, the most severe form of female circumcision.  However, there are actually four types of female circumcision that range in being far less invasive than male circumcision to the atrocity that is infibulation (the sealing of the labia minor and major, with or without the removal of the clitoris).  In between are two types, one of which is pretty much akin to male circumcision – the removal of the clitoral hood or the entire clitoris – and the other that is slightly more invasive with the partial or full removal of the clitoris and labia minor.  The less invasive involves any other type of procedure with the female genitals which can include a prick to draw blood, a piercing, scraping, and so on, but no flesh is removed.  Notably 10% of female circumcisions are made up of infibulations and 90% of the other forms combined.

What is male circumcision?  It is the removal of the foreskin which is adhered to the glans, the way our fingernails are adhered to our fingers.  To do this in infancy, the foreskin must first be opened (as it is naturally closed at birth), then a knife is used to separate the foreskin from the glans, and finally the skin is cut off.  Notably, the foreskin is one of the most sensitive areas of the male human body, meaning it is quite sensitive to the procedure.  Infants are not able to have full anesthesia, but limited pain relief is given.

Myth #2: It’s worse to be circumcised when older.

This is similar to the argument above about pain.  For some reason many people think that the procedure is worse as they get older.  Arguably, there are some more limitations for adults because they have to stop certain activities that infant simply don’t partake in.  However, there are two very good reasons that getting it done when older is far preferable.

First, there is the issue of pain.  Many parents will swear their child “slept through” the procedure.  Nurses may tell the parents that if they aren’t there.  Perhaps somewhere in the world is a child for whom this is true, I cannot say.  However, on the whole, this is not the case.  The procedure is quite painful (think about using a knife to cut off your fingernails then slicing off any skin that was left hanging) and according to research undergone in the 1990s, when done without any pain relief, babies simply go into shock, and unfortunately, shock looks like sleep in newborns.  It was not until additional physiological measures were included that allowed researchers to see what was happening (and end that arm of the study early due to ethical considerations).  Today, most children have some pain relief, but not all, and the pain relief that is given is not complete.

In addition to the actual practices being painful, we now know that infants experience pain just as us adults do, contrary to the previously held belief that their experience was blunted.  This means that if you think having the surgery done sounds awful as an adult, know that your infant is experiencing the exact same pain as you would, only with a fraction of the pain relief available to an adult.  This is likely why we have documented long-term effects on the experience of pain in neonates based on circumcision status and the use of any pain relief.

Second, there is the issue of bodily autonomy and consent.  An infant cannot consent to this procedure (and routine infant circumcision is not a medical procedure, but considered an elective surgery, often classified as similar to plastic surgery and this is why most insurers no longer cover it, particularly national or state-level insurance) and thus it is not the business of anyone other than the child to make that decision.  Should it become a medical issue, then that changes things and a child is given a medical procedure.  As an elective surgery, it should be the choice of no one other than the individual to whom the penis belongs.  Without that, we are violating our children’s basic human rights, rights that we have given baby girls in our culture, but are currently withholding from our boys.

Myth #3: Lots of people need circumcision for medical reasons.

You hear this a lot and it’s a myth, but there is some truth to it.  Let me explain.  In our North American culture where circumcision has been prominent, there was a lot of misinformation around what parents of intact children should do.  This led to advice such as the parent should retract the child’s foreskin.  (If you didn’t know, the parent should absolutely never ever do this.)  Doing the things that were being recommended (again, because the circumcised penis was the norm so many people didn’t know much about how to care for a biologically normal body part), children were getting infections and creating the very problem that others feared.  In the elderly, there were problems because nurses in nursing homes also lacked the knowledge of how to care for an intact penis and this resulted in infections as well.  This fed the idea that intact is unhygienic, but in fact was really a product of ignorance on behalf of the medical community.

This has started to change in some areas and really has fully changed in others.  The result is that with proper care, there are no big swings of needed circumcisions in older children or adults.  In fact, we can also look to Europe where routine infant circumcision is very uncommon and the rates of medical circumcision are also very low.  So there’s really no reason to fear later medical complications, or at least not more than we should consider the very real complications that come with routine infant circumcision including:

  • Bleeding
  • Infection
  • Loss of skin/wound dehiscence
  • Trapped/concealed penis
  • Redundant foreskin/circumcision revision
  • Preputial adhesions/skin bridges
  • Meatitis/meatal stenosis
  • Urethrocutaneous fistula
  • Glanular necrosis/glanular amputation
  • Hypospadias
  • Death

You can read about all of these and their documentation in this academic research article.

Myth #4: I’m Christian and so I’m supposed to circumcise.

I don’t often like talking about religious circumcision here because I do believe that it requires discussion from within the religious community as the reasons for the circumcision are different and the myths here are not really much of an issue.  However, I will touch on this one as it’s prominent in North America for reasons I will never comprehend.

Here you go folks: If you are Christian, you believe that Jesus died for your sins and that his death negated all of the previous covenants, including circumcision, and replaced it with trusting in Jesus and belief in his sacrifice.  This is why the New Testament does not have a circumcision requirement.  If you are circumcising because of your Christian religion, you need to learn more about it because you have made a serious mistake.

Myth #5: An intact penis is gross/My kid will be made fun of.

The locker room and girl arguments are of the social kind and may be harder to consider myth, but let’s take a look.  The idea is that children will suffer socially for having an intact penis.  First, this is dependent upon a lot, including culture.  In cultures with little circumcision, there is no issue of females thinking the penis is gross or children being made fun of for it.  In North America, there may have been a time where this was the case, but this is changing too and with the number of boy babies being circumcised declining steadily, in many areas, those that are circumcised are in the minority now.  However, let’s be clear that if children are being made fun of, we really need to be focusing on raising better kids who don’t mock people because of something different on their body.  That’s a problem with us as parenting, not being intact.

As for the “gross” or girl issue, I will say that research has found that from a purely physical perspective, sex with someone with an intact penis is considered more pleasurable than with a circumcised penis.  Now this isn’t to say sex with a circumcised guy can’t be amazing because sex is often more than just the physical element; however, the physical element means that women’s experience of sex when with a circumcised man is often more painful than with an intact one.  This is for two reasons.  One, the foreskin allows for greater lubrication which makes sex better.  Two, as the foreskin is most sensitive, it means sex is often gentler as the man doesn’t need to be as rough to obtain satisfaction.  There is also another thing to consider here: research has found that because of the reduced sensitivity in circumcised males, they are also less likely to use condoms which protect from a variety of diseases.  The overall health and healthy sex practices of our kids should definitely fall under something we care about.

I will leave you with this wonderful article that pretty much takes the piss out of the whole female argument: https://www.yourwholebaby.org/from-finland/.

 

Relevant References

Brady‐Fryer B, Wiebe N, Lander JA. Pain relief for neonatal circumcision. Cochrane Database of Systematic Reviews 2004.

Frisch M, Aigrain Y, Barauskas V, Bjarnason R, Boddy SA, Czauderna P, … Gahr M. Cultural bias in the AAP’s 2012 Technical Report and Policy Statement on male circumcision. Pediatrics 2013; peds-2012.

Herschel M, Khoshnood B, Ellman C, Maydew N, Mittendorf R. Neonatal circumcision: randomized trial of a sucrose pacifier for pain control. Archives of pediatrics & adolescent medicine 1998; 152: 279-84.

Kim D, Pang MG. The effect of male circumcision on sexuality. BJU International 2007; 99: 619-22.

Krill AJ, Palmer LS, Palmer JS.  Complications of circumcision.  Scientific World Journal 2011; 11: 2458-2468.

Lander J, Brady-Fryer B, Metcalfe JB, Nazarali S, Muttitt S. Comparison of ring block, dorsal penile nerve block, and topical anesthesia for neonatal circumcision: a randomized controlled trial. JAMA 1997; 278: 2157-62.

O’Hara K, O’Hara J. The effect of male circumcision on the sexual enjoyment of the female partner. BJU International 1999 ; 83: 79-84.

Taddio A, Katz J, Ilersich AL, Koren G. Effect of neonatal circumcision on pain response during subsequent routine vaccination. The Lancet 1997; 349: 599-603.

Taddio A, Katz J. The effects of early pain experience in neonates on pain responses in infancy and childhood. Pediatric Drugs 2005; 7: 245-57.

Taddio A, Pollock N, Gilbert-MacLeod C, Ohlsson K, Koren G. Combined analgesia and local anesthesia to minimize pain during circumcision. Archives of pediatrics & adolescent medicine 2000; 154: 620-3.