Circumcision Decision, A Doula's Letter to Her Client

Hi Mother of Son about to be born,

Here is what I've assembled as far as I can supply for unbiased resources-

My Advice as your doula: never take them at face value and definitely discuss from opposing viewpoints when figuring out one's stance on a controversial topic.  First, I recommend getting familiar with the anatomy of the penis, specifically the glans.  Wikipedia is a good enough source for this, but some anatomy books from the library may also be of benefit. Naturally, most of the links I'm sending you have various photographs and illustrations and videos of penises.

https://en.wikipedia.org/wiki/Glans_penis

Next are some resources from reputable institutions regarding their stance on male circumcision:

The National Institute of health did a review of the CDC's Stance on pro-circumcision: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5478224/#box1

And published an opinion on it (against it) as well: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4364150/

and here

https://www.nih.gov/news-events/news-releases/adult-male-circumcision-significantly-reduces-risk-acquiring-hiv

The recommendation from the CDC was difficult to find- but it's key wording is quoted in the first of the above articles.

Also, I think the L.A. times did a fantastic article regarding the CDC recommendation and offered context to their finding: https://www.latimes.com/science/sciencenow/la-sci-sn-circumcision-cdc-guidelines-20141202-story.html

Also the AAP has an opinion-  http://pediatrics.aappublications.org/content/130/3/585 essentially saying there is benefit to the lowering of the risk of male urinary tract infection in the first year of life.   No mentioned in the piece is an evaluation of the relative lowered risks created by regular bathing and diaper changing during said first year, but with some digging I could probably find that info.  A critical statement from that research reads as follows, "Although health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it and to warrant third-party payment for circumcision of male newborns. "

Of course, as your doula I can only implore both you and your partner to make fully informed decisions for yourselves and your baby. As parents you must make medical choices on their behalf as their wishes simply can not be communicated.  Understand the principals you wish to follow regarding what medical decisions you make for your children.  Are you a parent who fully or alternatively vaccinates? Do you treat fevers with childrens medications or let them run their course?  Do you choose medical interventions for yourself or your family based on their necessity or for other reasons?  Articulating these points of view will hopefully help to steer you both to a decision for your son. 

 Making choices for your son.

Making choices for your son.

 

That being said, understanding exactly what is involved with the procedure is very important to understanding your choices and then making them. Also, as part of taking responsibility for any choice at had, KNOWING what that choice includes is important. To that end I'm linking a video of an infant circumcision (identical to the one I witnessed at your local hospital several years ago).  Be advised, open heart surgery and root canals are as barbaric as circumcision.  The difference for many is whether one should consider it necessary or not: https://www.youtube.com/watch?v=IVCJLiBk_fI

Again, I implore parents to make fully informed choices for themselves and their children.

Other resources- A very good description of circumcision with analysis of cultural context.

https://en.wikipedia.org/wiki/Circumcision

All humans are born with a pupace- in females it is referred to as a clitoral hood, and despite it's relatively diminutive size, it too is somewhat retractable  and has sensitivity as you have perhaps noticed.

By circumcising, the tip of the penis looses that tissue and thus sensitivity by definition, in addition to which, the biological function of the pupace SEEMS obvious in that it is a retractable cover for the glans.  Besides the loss of the nerves of the removed tissue, what follows over time is a keratinization of the outer tissue of the glans. This part of the anatomy which was not initially exposed to stimuli is now continuously touched by diapers and then clothing.   https://www.quora.com/Do-men-lose-sensitivity-on-their-glans-after-circumcision - see the image in comments.

This process of keratinization will also reduce sensitivity.   Though frankly, we must admit that "sensitivity" is a highly subjective word that must be left to the perception of the individual. https://www.ncbi.nlm.nih.gov/pubmed/23937309

The individual. Which leads me to my next morsel of thought- the terms "genital autonomy" "self determination" and "personal choice" - who are they for? Again, as parents, we MUST make some choices for our children.  I was given pause for thought when a friend told me she would not pierce her baby's sears because "they are HER ears, not mine" -again, a decision one can not undo. This was the beginning of my counselling as a doula to have parents consider whether their decisions for their children are consistent with their other choices in birth and parenting.  Do you foresee your children as being eventually capable of making such a choice as you let them make other choices for themselves?  And should you?  "Are you going natural or not in pregnancy birth and parenting, and WHY" often is a question I ask inside my head.  I find knowing where you stand on birth approaches and health choices in general helps to drive how deeply this topic is explored.

I support families and the decisions they make. I feel good about doing that when I know a family is making an informed choice.

As a doula, I've spoken to several clients regarding this decision and I will tell you my experience is probably right along the lines of the national statistic of 58% in favor to circumcise.  Curiously I find overwhelmingly parents who make this choice for their child are reticent to communicate the reasons behind their choice whereas by contrast, those who choose not to circumcise are vocal regarding their reasons.  One of my past clients said "We wouldn't do it to a girl, so why would we do it to a boy?"

I met a researcher and intactivist by the name of Christopher Guest a few years ago who made some very calm and compelling arguments regarding circumcision as a human rights issue. Here is a copy of a video he produced, answering several of the common arguments for circumcision- including reducing STD risks and hygiene.

 https://www.youtube.com/watch?v=SeAXantm4tE

Yes, it is biased, but also informative. 

Compelling commentary in FAVOR of circumcision can be found here:

http://www.slate.com/articles/health_and_science/medical_examiner/2013/09/intactivists_online_a_fringe_group_turned_the_internet_against_circumcision.html

(again citing reduction in risk of STD)

The question regarding circumcision is often asked in triage, and so I include this topic in every prenatal education meeting.  As a mother of four sons, I also have personal experience, but that is a conversation for another time perhaps.

I hope these resources are helpful to you and your partner, and I am GRATEFUL you are seeking to make an educated decision!