So, here we are one year later.
When the question of whether or not we'd circumcise came up I was taken aback because I'd never thought about it before. Circumcision is fairly standard in the evangelical American world but without many good reasons, and there is heavy push back now from folks who say circumcision is a completely unnecessary cosmetic procedure, akin to infant mutilation.
I reacted against the rhetoric on both sides and dove into research. I read up on medical sites, blogs, called our pediatrician and my OB, and talked to parents, and friends. My own experience of my infant brother being circumcised made me both take it seriously and also take seriously that the procedure could be done painlessly and safely.
Dismissing Weak Reasons Supporting Circumcision
I concluded that there are a lot of bad reasons to circumcise. It doesn't make sense to me to circumcise just so a boy is like his father. It's too serious of a procedure if that is your only reason. It's true that the Old Testament prescribes circumcision for Israel, but that is to mark them as the Israelites, and the NT clearly says that the followers of Jesus need not follow suit. Circumcision reducing penile cancer is a very small reduction of a very rare form of cancer that really doesn't justify the risk of a serious medical procedure on an infant, in my opinion. There's a lot of old wives tales that people used to hold about circumcision that simply aren't true, and there's no evidence about circumcision affecting sexual pleasure one way or another.
Dismissing Weak Reasoning Against Circumcision
I wrestled with the arguments against circumcision and found that so many of them are guilt and emotion-ridden rather than based on fact. A lot of people talk about how how different organizations "don't recommend" circumcision, but I found that to be misleading because they also don't specifically speak against it. They don't recommend circumcision. They also don't recommend leaving kids intact. They simply don't recommend at all, but try to educate parents.
As I said, I don't buy the arguments that it's necessarily a terribly painful process, because doctors can make it next to painless with painkillers, and yet potentially causing my baby pain is something I take very seriously. It's false to say that Americans are the only people who circumcise, since most Jewish, Muslim, Coptic, and some indigenous African, Australian, and Pacific people also circumcise (though I don't envy the Muslim cultures that circumcise on entry into adolescence!). I don't buy the argument that we shouldn't make this sort of choice for our child. Circumcising and choosing not to circ are equally choices that we make for our kids, since a child can grow up and decide he wants to be circumcised but desperately not want to have to go through it as an adult when they will carry the memory of it and (arguably) experience more pain.
So, I knew essentially that circumcision is a surgical procedure that I should take seriously. The essential question is whether it was beneficial or harmful.
The stories people told
A huge factor for me was actually anecdotal. Personal stories are powerful, ya'll! When we started discussing this, Isaac told me the story of a friend of ours that I'd never heard. He wasn't circumcised but contracted an infection when he was a young teen that was so bad he had to be circumcised and it was terrible. He wished he'd been circumcised as an infant. When I talked to our pediatrician he shrugged his shoulders and said it was controversial and we could go either way, it was our personal choice. However, when I pushed harder he told me that his father was not circumcised and wished he had been so he'd circumcised both of his sons, and that as a doctor he'd never met an adult that wished they weren't circumcised but had met those that wished they were. Both he and my OB and it seemed like many others I talked to knew someone that had to be circumcised as a teen or adult because of an infection and wished they'd had it done as an infant instead.
Does circumcision have health benefits or risks?
Those stories were a large influence, but I also wanted to see what medical world said. The vast majority of professional organizations around the world take a hands off approach. It's controversial, there's not a lot of solid research, and so they think parents should be informed and not forced either way. The exception is the World Health Organization, which cites tests in Africa on the effect of circumcision on the transmission of HIV. They say that tests show transmission drops by 60% in heterosexual men that are circumcised, which is pretty dramatic. The findings are dramatic enough that I was surprised to hear Bono talk about it on the Jon Stewart show recently about finding hope that we could begin to reduce the AIDs pandemic.
It seems at this point we know circumcision reduces transmission, but we don't know how (here's a Scientific American article on the question). It also seemed despite a lot of rhetoric to the contrary, the real medical studies pointed to a decrease in urinary tract infections in circumcised males (University of Michigan study here, other cited in sources below). It just makes sense to me that in general, tests and research seem to show that circumcision increases resistance to infection.
With that in mind, we moved forward and had Judah circumcised. Research and personal anecdotes point to there being medical benefit to the procedure. It's not enough to make me (or major organizations) say that everyone should do it, but it made me comfortable enough to go ahead with the procedure and feel like we were doing something good for our son - I believe he is safer from infection this way, and not just sexually transmitted infection. This is from the Center for Disease Control :
"A large retrospective study of circumcision in nearly 15,000 infants found neonatal circumcision to be highly cost-effective, considering the estimated number of averted cases of infant urinary tract infection and lifetime incidence of HIV infection, penile cancer, balanoposthitis, and phimosis. The cost of postneonatal circumcision was 10-fold the cost of neonatal circumcision ."From an article in the Journal of the AAP:
In the 1989–1999 decade, multiple studies confirmed the beneficial effect of newborn circumcision in preventing infant UTIs19–21 and transmission of HIV.22,23 The safety and efficacy of local anesthesia were established also. Since 1999, further convincing data have documented the preventive health benefits of circumcision.
Circumcision is still a procedure that requires an incision, so it carries some risk and should only be done professionally, and I'd say with painkillers. For me, the potential health benefits made it worth it because I thought it could be done painlessly.
All that said, I did have some anxiety about actually having Judah circumcised - I did not want him in pain even though I'd been told it would be painless. I get why people choose not to circ. Our pediatrician did the circumcision with a topic anesthetic as well as giving Judah his first paci for comfort (covered in sugar water, which he took eagerly). The doctor told me Judah didn't cry - I'm sure he wants to comfort worried parents, but I'm hoping I can take him at his word. We were given instructions to care for the circ, and Judah wasn't any extra teary over the next days. He slept an extra amount that afternoon. When we changed his diaper we had to be careful how we cleaned him up so as not to cause any discomfort, but by just dripping lukewarm water on him we cleaned him up without bothering him at all. He didn't cry over it and it healed up in a few days - my fears allayed
US News and World Report articles here and here.
NY Times article here and on the HIV efforts with circumcision here.
Other articles quoted and sourced above.