Thursday, March 18, 2010

Circumcision: A Male RN's Perspective

By Chris, author of The Man-Nurse Diaries
posted with author's permission


Before having my first son, we were presented with the decision (at least in the United States) of whether or not to circumcise him. While we were initially assuming we would, we did some research. We began finding that not only is male infant circumcision almost never medically necessary, but it's not even performed in most of the developed world. The majority of European countries never began circumcising in the first place. The United Kingdom doesn't pay for it; it's an out-of-pocket expense. The United States is the only secular country that routinely circumcises males.

I can personally attest to this now, because I worked for six years as a certified nurse aide prior to becoming an RN. I worked with countless intact men, mostly European immigrants in Chicago: Poles, Serbs, Lithuanians, etc. Younger men and older men. Men who could walk to the bathroom, and men who constantly soiled themselves. Men who had indwelling Foley catheters and men who didn't. Men who were impeccably clean, and men who were homeless. Men who were healthy, and men who were critically ill and severely immunocompromised.

Never once did I encounter an adult male patient who had ever had a medical problem due to being intact.

Not only that, but during the cleaning of patients, I only ever worked with two nurses (that I remember) who would actually go through the rigmarole of retracting the foreskin, cleaning the glans, and replacing the foreskin. That's what we were taught in CNA and nursing school, but almost everyone would leave it alone. I suspect most people who work with a high intact population do the same. If it never presents a problem, it's always clean, and you're just causing discomfort, why do it?

In fact, female patients are far more prone to fungal and bacterial genitourinary infections than male patients are—yeast infections, urinary tract infections, abscesses, etc. And we know that this is largely due not only to their shorter urethra, but also to their labial folds—their "excess" skin. Why don't we cut that off? Why isn't female circumcision considered for infection prophylaxis? That's how we think of male circumcision. Except the reality is that, as with male patients, the 'benefit' of circumcision would be negligible, because the number of serious complications with women staying 'uncircumcised' is extremely minor.

So as it stands, we have two sons who are intact. One is almost five years old and the other is nearly three. They've never had a problem. During diapering they required less care and bother than our daughters did. And now, during bathing, we don't retract or mess with their prepuce (foreskin).

They're clean.

They're fine.

I suspect that someday they'll be like my patients were: ninety years old and intact—with no regrets.



Chris is the father of four (intact) children, 2 daughters, 2 sons. His career as an RN has taken him to the intensive care unit at one of the largest urban trauma centers in the Midwest (United States). More of his chronicles as an RN can be read at The Man-Nurse Diaries.





Related Reading:

The Day I Withdrew From Nursing School

Circumcision: What I Wish I'd Known

RN Conscientious Objectors to Infant Circumcision: A Model for Nurse Empowerment 

Nurses of St. Vincent Say No to Circumcision [video]

Tora Spigner, RN [video]

Nurses For the Rights of the Child


~~~~

30 comments:

  1. When I have sons, there's no WAY i'm going to have them circumcised. I will not.
    I refuse. And if I have a husband who wants it done I'll find some way to get him to change his mind. It's not needed!

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  2. I had that comic on my office wall for YEARS. I remember the first time my son was old enough to take a look and ask about it. I explained in terms a young child could understand, but nevertheless, he was incredulous that parents allowed part of a baby's penis to be removed. I'm with him.

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  3. I love how the little bio at the end lists him as having four intact children, 2 sons and 2 daughters.

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  4. As a peds nurse who has also witnessed the horrors of infant circumcision, I appreciate others standing up and speaking. It really does take us within the 'system' to make change happen.

    I feel a responsibility to my patients (I work alongside OBs in Labor & Delivery) to give new parents whatever information I have at my disposal. For me, it is that I have seen many, many babies damaged by circumcision surgery. Some cannot or will not nurse after. Some lapse into coma from the pain and become withdrawn, sleeping full days. Most never have their parents aware of what they have experienced (and why they are now 'different') because we make sure they are stable before taking them back to the parents waiting in the other room.

    Like Chris, I also spent time in training working with elderly men - both in a nursing homes and in the hospital. Many were intact because they were born before the surge of genital cutting in the United States. NEVER did I witness someone with complications or issues (or all these fears) from being intact. Foreskins do not cause 'problems' in men anymore than the clitoris/labia cause 'problems' in women.

    I noticed this other post from a nurse-in-training: http://www.drmomma.org/2010/01/day-i-withdrew-from-nursing-school.html I can certainly appreciate why she would withdraw from the program. Sometimes it is almost too much to bear. But I also applaud those, like Chris, who are working within the system to invoke change. We CAN bring awareness to parents that we meet, and slowly bring an end to something that (as Chris said) only happens in such a way in the U.S.

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  5. It was part of my job description as a neonatal nurse to assist in circumcisions for 2 day old boys. Although 10 years have passed, I will never forget the looks of shock in their eyes, their quivering chins, and the high pitched screams of these little boys as they were strapped down at the wrists and ankles and subjected to this barbaric procedure. I'm expecting a boy in May, and there's no way I'll do that to my son!!

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  6. I cannot imagine subjecting my son to this cruelty. I just hope more people get how sad this is.

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  7. :'( Michelle. How horrible that must have been to watch! Congrats on your baby! :)

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  8. As fathers are all too often the ones with cognitive dissonance and in denial on this issue, it's great to have more examples of strong, responsible men doing what they're supposed to do and PROTECT their children from harm (surgical or otherwise).

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  9. When I was in nursing school I too witnessed a circumcision done on a newborn. Before the start I wondered why the parent wasn't allowed in the room, and after I saw what they did, I was in horror, and realized that if parents witnessed the procedure this would not be happening to as many babies as it does.

    I have a nine year old who was not circumcised and who has never had any problems.

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  10. These comments all remind me of the clear horrors captured on camera by Patti Ramos not many months ago during a Plastibell circumcision procedure... http://www.doulapattiramos.com/2009/11/circumcision-warning-very-graphic.html

    Thank you to all the doctors and nurses speaking up on behalf of our children.

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  11. Another RN here. I also must say in all my years of nursing (18 total, 10 as an OB nurse) I've never encountered a foreskin with a problem. Now I could tell several awful stories about botched circ jobs, but intact males, both old and young, seem to do fine as long as a doctor isn't giving bad advice on what to do.
    Circumcision is horrific and I'm glad so many health care professionals are speaking out against it.
    By the way, I'm also the mom to both a healthy intact son and daughter.

    Andi

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  12. I am so glad to see more medical professionals speaking out against circumcision. My husband is an MD and had to perform them in residency training. As a result of his experiences, we knew before our oldest son was born that we would never harm him this way. I now have 2 intact sons and another on the way. They are perfect the way God made them!

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  13. My 7yo son is circumcised and if I had it to do all over, I never would have let his father talk me into letting it happen. My son's was done with a small plastic ring, around which was placed a rubber band. The idea was that the "excess skin" would just fall off and the doctors assured me he would have no discomfort. The problem is, that when the skin fell off, it did so unevenly and, at one year of age, my poor little boy actually had to have a SECOND circumcision, this time surgical and requiring SIX stitches around his tiny little penis. All so he "wouldn't be made fun of in the locker room" and "would look like his dad"... If I had it to do all over again, I wouldn't allow it to be done.

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  14. Well done. I am glad to see information such as this made available. Congratulations to you and your healthy family!

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  15. Thank you for sharing your views. I could not agree more.

    --Jay M, RN, Seattle, WA

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  16. I have been wondering about this for sometime now.

    I believe God did in fact make us perfect the way we are and foreskin is apart of that perfection, although God has commanded his "chosen people" the Jews to circumcise their boys so that they stand apart from others not of their faith. It is all apart of the sacrifice I suppose, but it is much different than asking a person to choose to be apart of a religion. They do not get to choose at this age obviously.

    As for the procedure being traumatic, I understand that it is traumatic for a baby to be circumcised. It is also traumatic for them to come out of the womb and I would like to see if there are any differences psychologically, etc between babies that were circumcised vs those that were not.

    I'm glad to hear there is a case for not circumcising, but I'm wondering after reading his entry: if there are no differences between those with foreskin and those without, why can't those who deem it a religious, traditional, or cultural norm continue to practice it without negativity?

    This is all very interesting. Thank you for the food for thought. All the best.

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  17. But there is a difference.

    1. Circumcision leads to a lower pain tolerance.
    http://www.cirp.org/library/pain/taddio2/

    2. Male Circumcision has a negative impact on his female partner's satisfaction.
    http://www.cirp.org/library/anatomy/ohara/ http://www.sexasnatureintendedit.com/

    3. "First do no harm". Is it really okay to cut into someone's genitals 'because you feel like it'?

    4. Just because something is a religious, traditional, or cultural norm doesn't make it right. Many horrid things have been legal and widespread at one time and place or another: slavery, violence against women, child marriage, infanticide of disabled children, ect.

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  18. Josh - simply because it is an entirely unnecessary procedure. It was put there for a reason, and through my research, there are more complications with circumcision than without.

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  19. Well if you're going to base your decision to circumcise on religion you need to read
    1 Corinthians 7:19
    "Circumcision is nothing and uncircumcision is nothing. Keeping God’s commands is what counts."
    and
    Romans 2:29
    "No, a person is a Jew who is one inwardly; and circumcision is circumcision of the heart, by the Spirit, not by the written code. Such a person’s praise is not from other people, but from God."
    When Jesus died it took away the need for physical circumcision...
    It's our hearts that He now requires..

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  20. Josh,

    He didn't say "there is no difference"; he said that being intact does not cause the problems that the pro-circ culture seems to think.

    Circumcision definitely hurts; and many men who were circumcised as adults can attest that there *is* a difference in sexual feeling. Plus, it's an unnecessary surgery that has risks (like bleeding to death, which has been documented; and shock and all sorts of things).

    -Kathy

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  21. "....why can't those who deem it a religious, traditional, or cultural norm continue to practice it without negativity?"

    They CAN!!! No problems from me with that! I just want them to wait until the ones they want to do it TO are old enough to agree with it, or not.

    My son won't be old enough to decide for another 17 years, but he's got the chance at the choice!

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  22. Josh, while most circumcised men under 40 years of age are quite satisfied with their sex lives, some aren't. Let me explain why. Routine circumcision:
    * Can give rise to premature ejaculation or erectile dysfunction;
    * Is the cause of meatal stenosis;
    * Sometimes results in too much skin being cut off, making erection painful and sex less than pleasant;
    * Almost always removes all of the highly sensitive ridged band, and often partially or totally destroys the frenulum. These structures are major pleasure triggers;
    * Circumcision detracts from the pleasure afforded by digital stimulation of the penis. Hence masturbation and HJ are less satisfying. Americans tend to forget that the standard way women do foreplay on men is to pump their foreskins, rather than oral sex.

    Routine circ can also detract from a woman's pleasure:
    * Quite a few North American women with varied sex lives report that vaginal intercourse is more pleasant if the man is intact;
    * Specifically, the desensitisation stemming from circumcision can lead a man to perform vaginal intercourse in a frantic and aggressive manner that is understandably off-putting to women.

    Finally, there are circumcised men whose sex lives before middle age were fine, but who experience a gradual loss of sensation after age 40, culminating in the inability to perform vaginal intercourse. Couples in this situation typically suffer in silence or divorce. Only hard core intactivists know that routine neonatal circ is the likely culprit.

    This comment is not intended to be exhaustive. I welcome additions from readers.

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  23. Josh, there are a number of unbelievably negative effects on male sexuality. Most notably, (1) circ permanently removes the most sensitive part of the penis, the "ridged band" of nerve endings, that is analogous in many ways to the female clitoris and (2) the foreskin "gliding action;" lack of foreskin is why Americans have to use lube for masturbation/sex. Other kids have their penises completely ruined/amputated, or even die (every year!) from botched circumcisions. Here is a brief summary I wrote on the sexual functions of the foreskin and the pain/risks of circumcision.


    Negative effects of male circumcision include:

    PERMANENT SEXUAL DAMAGE

    **Ridged Band: Circumcision removes the most sensitive part of the penis, the "ridged band" of nerve endings on the fold where the outer foreskin turns into the inner foreskin. The specialized nerve endings (called Meissner's corpuscles) on the ridged band are equivalent to the nerve endings found in the female clitoris. (See study here: http://www.nocirc.org/touch-test/bju_6685.pdf) The ridged band can never be recovered and cutting it off permanently and significantly reduces the pleasure that a man can feel during sex. One side effect is that many circumcised men often resort to harder, almost violent sex, just to achieve an orgasm. This excessive force can be damaging not only to the man's partner, but also to the man's own penis.

    **Gliding Action: By removing all slack skin, circumcision destroys the natural gliding action of the penis. As a result, sex and masturbation cause vastly more friction, which is why circumcised men often use lube for sex and lotion for masturbation. This is unheard of in intact men. The extra friction, of course, is shared by the circumcised man's partner as well. Moreover, the corona of a circumcised man actually scoops out vaginal fluid, causing even more dryness during sex. Our circumcision habit is why the lube industry thrives in the U.S. It's so ingrained in our culture that Eminem actually raps about having "a bottle of Jergens" nearby. People from any other country would have no idea what he was talking about -- intact men masturbate by sliding their own foreskins back and forth, naturally. The same gliding action of the foreskin keeps things smooth (without lube) during sex. Penetration is also easier because (1) the head of the intact penis is supple and oily, like you would expect a mucous membrane to be and (2) the foreskin catches pre-cum and spreads it around. Last, but not least, circumcision seriously puts a damper on foreplay by ruining the handjob. This is one reason American men are notorious for seeking oral sex during foreplay -- a dry handjob when you are circumcised can just feel awful unless your partner is very very gentle.

    **Keratinization: After circumcision, the glans and what's left of the inner foreskin are left to be dried out and desensitized from years of exposure, rubbing against clothing, and the damaging excess friction of sex/masturbation without the foreskin. The inner foreskin and glans are meant to be mucous membranes, like the inside of the eyelid or the mouth; after circumcision they are externalized and hardened. The "keratinization" process can takes years; many men don't even realize the effects of desensitization until they are in their 40's or 50's and can no longer enjoy sex.

    Here's a link where you can see what a normal intact penis looks like, compared to the damage from circumcision (NSFW): http://www.noharmm.org/IDcirc.htm

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  24. Part 2:


    "BOTCH" RISK, RISK OF DEATH & TOTAL AMPUTATION

    **"Complications": And the aforementioned effects are only if you're lucky. Many others are left with tight painful erections due to too much skin being cut off, skin bridges where the wound didn't heal properly, total loss of sensation, or accidental amputations of the glans. At least 100-200 U.S. babies die each year due to complications from circumcision, such as hemorrhaging, infection, and internal bleeding. (A very small %, but remember a million circumcisions are performed each year here.) Here's an article about David Llewellyn, a lawyer who specializes in botched circumcision cases and recently succeeded in bankrupting Mogen Corporation after the company's circumcision device was used to sever the head of a little boy's penis: http://www.law.com/jsp/article.jsp?id=1202464033969&rss=newswire

    EXTREME AND TRAUMATIC PAIN

    **Too Small For Proper Anesthesia: To top it off, circumcision is unbelievably painful. Infants are more hard-wired for pain than adults, and because of their small size, it is too dangerous to put them under general anesthesia. So they are strapped down to a board and left fully awake while part of their penis is cut off. Studies have shown that the local anesthesia commonly used for circumcisions is completely worthless in reducing the pain, and is used mainly for calming parents' nerves. Applying even enough local anesthesia would be too dangerous, and to be effective, doctors would have to wait 30 minutes or more after giving the anesthesia to operate -- that's not cost effective! Oh well... it's just a baby, right?

    **Foreskin & Glans Are Fused At Birth: As it turns out, babies boys are born with foreskins that are fused to the glans. Neither the glans nor the foreskin is yet fully developed. The first step of a modern day circumcision is actually to take a metal probe and shove it between the foreskin and the glans, tearing them apart and leaving a bloody red, raw glans.

    But don't take my word for it, watch the torture yourself and listen to the unanswered screams for help (be sure to crank up the volume): http://youtu.be/nAo1PCDtgBY

    And here's another one, note the increased intensity of screaming when the cutting begins, despite the anesthesia given beforehand: http://youtu.be/bXVFFI76ff0

    "Welcome to Earth, Son! Here, how about a knife to the penis!"

    **Sleeping Through Circumcision... Say What?: You've probably heard stories about babies "sleeping right through" circumcision. As it turns out, they are actually passed out from shock due to sheer pain. Their little bodies couldn't take it anymore and just shut down. Anybody who thinks a baby is going to *sleep* while part of his penis is being cut off in front of his very eyes... well I've got a bridge in Brooklyn I could sell you...

    **Pain For Weeks: After the circumcision, the boy remains in pain and at risk of infection for weeks with his bloody stump of a penis stuck in a diaper, burning from all the urine and feces.

    Hope this helps.

    Best,
    Kevin

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  25. I wish I had a source to link to, but it's been too long (almost 3 years) since I was doing my own research to prepare for the birth of my son.

    In my reading, more than once, as people would bring up religious exceptions, it was pointed out that the Jewish circumcision, when done in the traditional/biblical manner rather than the modern manner, was not a removal of the foreskin, but a cutting of the foreskin. I don't remember now what part of the foreskin was cut, but to my understanding the process would not have created a significant difference in physical appearance between a circumcised and uncircumcised male. The people who did the studies I read were never able to come to a conclusion of exactly how or why the full removal of the foreskin ever evolved from the original cutting.

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  26. Danielle NethertonJuly 29, 2011 9:00 PM

    The reason you didn't come into any problems with intact males is because overseas they doctors know NOT TO RETRACT and they know how to care for an intact man. Here, in the U.S., hardly anyone knows how to care and they are the ones that retract and cause the problems people hear about to begin with!!!!

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  27. Stefanie, Thanks you so much for sharing. I feel that one of the hurdles in stopping this barbaric practice is mothers who have had their sons circumcised feel guilty and often feel attacked by intactivist. They end up going on the defense and fighting for the right to choose circumcision when deep down they wish the had never done it and brings them much pain. When you know better, you do better. If more moms spoke out about wishing they had kept their sons intact, and wishing they had knew then what they know now, I think the impact good be very positive. My heart goes out to you and your son. THank you again for sharing.

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  28. @BecomingThatFamily ~ I really enjoyed the links that are connected to this page (they discuss a lot of what you mentioned):

    http://www.drmomma.org/2009/06/information-on-circumcision-for.html

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