Wednesday, June 6, 2012

Circumcision: when it's needed

I am circumcised. I was circumcised at some point between 5 and 6 years old, if I remember correctly. I spoke with the doctor prior to my surgery, with the voice and the mind of a scared child. I remember the conversation. I don't remember the procedure. I didn't want it to happen.

Did I need it? I don't know for sure. The doctor said I had phimosis, and he said he would have to put a needle through my penis if he didn't circumcise me. That's what I remember - I've never validated this information with my family.

Today it is said that phimosis cannot be diagnosed until later in life. There is however, acquired phimosis. Since the glans and the foreskin are fused in the infant, retracting causes tearing of membranes. They heal into scars. Retracting again hurts them, and they become harder. In the end, the foreskin may not retract more, and circumcision might become necessary. I wonder if that's what happened to me.

Teenagers and adults may suffer from phimosis: either the glans is too big or the foreskin too tight, either way preventing retraction. Sometimes this can be treated by stretching and with the help of steroid creams; sometimes it doesn't work, and circumcision is required. Not treating phimosis may lead to painful sex, or inability to have penetrative sex.

There's also a condition called paraphimosis: retraction is possible, but the foreskin gets stuck behind the corona and cannot roll again over the glans. This can become really dangerous, as it can cut the supply of blood to the glans or prevent urination.

Acute balanoposthitis is a swelling of the foreskin that can cause burning sensation, pain and difficulty to urinate. Normally it reacts to medication, but sometimes it becomes a recurrent condition, and circumcision can become an option to prevent further incidences of the problem.

Circumcision per se is an aesthetic procedure. Some people may prefer to look circumcised, especially if they are immerse in cultures where circumcision is prevalent. In this case, opting for circumcision as a consenting adult is a valid option. It is important to know that by having the procedure, some discomfort will come initially from having the glans exposed, and some sensitivity might be lost in the future. Some of the risks include the possibility of injury and even loss of the penis, as it happened in 2012 to a man in China (http://www.examiner.com/article/botched-circumcision-leaves-man-without-penis-weeks-before-his-wedding) and one in Kentucky in 2007 (http://www.theoaklandpress.com/articles/2011/01/20/news/doc4d3854e8c6c85725927068.txt) when the doctor changed the operation upon finding a tumor in the penis. Of course it doesn't happen to everybody, but it's important to be informed; there is no such thing as a risk-free surgery.

Once you evaluate the risks, it is your choice.

Personally, I find the aesthetic value of circumcision strange, somewhat similar to scarrification in some African tribes, or enlargement of the lips or the ear lobes. But it's understandable that after over 150 years of brain washing, the American culture is conditioned to believe that cut is nicer. The point is, if you believe that circumcised looks better, get circumcised yourself if you are not. But let your children decide for themselves. Think about it in a similar light to breast enlargement: you don't take a 12 year old daughter to get breast enlargement because you prefer women with big breasts. If this sounds creepy, then circumcising your baby because your wife prefers circumcised males or because baby has to look like his daddy is just as creepy!

For those suffering of some of the medical reasons listed above, circumcision might be the final resort to eliminate the condition. It may not be pleasant, nor your ideal state, but it may be the only way to get rid of a health issue.

Most of the situations that require circumcision can wait until the adult age. And most of those situations have alternative, less destructive treatments that can be tried first, prior to operating.

Acquired phimosis and really bad cases of other conditions might not be able to wait, if they become too recurrent or too acute and present danger for the patient; in those cases, waiting might not be practical and parents should take the course of action in the best interest of their child.

Intactivists don't oppose circumcision as a whole. What we oppose is the indiscriminate circumcision of babies without any medical need, because we feel that it takes away their right to have a whole body and any possibility of making an informed choice as consenting adults.

We don't endorse routine circumcision as prevention of the transmission of HIV, or to prevent penile cancer or STDs. There are too many ethical issues with this. Circumcision alone does not prevent STDs or transmission of HIV, but improper information might become a false security blanket that will promote unsafe sex. Incidences of penile cancer are generally too low to justify massive action.

People don't just get preventive surgeries for every possible malady. We don't perform double mastectomy of teenage girls to prevent breast cancer for example. We don't take antibiotics today for the infection of next week. As such, performing a circumcision on a baby to prevent things that may not even happen to a baby when he becomes adult is a very invasive course of treatment -one that does not come without sacrifices.

However, once we are adults, we can ponder  those sacrifices, we can weight the benefits vs the risks based on knowledge of our own body, our own experience and circumstances, and make our choice. If that choice means that we need to sacrifice a part of our body for a more integral life experience, so be it: we are adults, we can handle it.

One thing to remember is that circumcision is not just trimming something. It's not a haircut or a manicure. It's the excision of an organ. As every surgery, it does not come without risks. However, those risks are in general more manageable and less critical on an adult.

The loss of blood that can kill a baby can be easier to control and much less critical in an adult. Infections that would kill a baby can be easily treated in an adult - and there is less risk, as an adult wouldn't have a diaper collecting feces and urine while he heals. An adult might be less likely to have a bad reaction to anesthesia, so pain during the surgery is easier to manage. An adult is less likely to go into cardiac arrest after the surgery. The recovery process might be uncomfortable and disrupt your life for a couple of weeks, but as an adult you can act on pain, you can take pain medication as needed, you can take action. A baby can't even tell you when it hurts really bad.

Even for religious reasons: if an adult believes that his way to follow his religious path is to be circumcised as an expression of his faith, so be it. But we don't agree with circumcising babies for religious reasons: again, as a parent, you may hope, but you don't know if your child will wish to continue in your religion. In the end you may sacrifice a part of your child's body, just to have your child choose to follow a different path, one that doesn't require such sacrifice, and he might resent you for having hurt his body. By imposing your religion on your son through a flesh ritual, you violate his religious freedom and his right to a whole body.

But if you, as an adult, wish to express your faith by cutting your foreskin, go ahead. We won't do anything to stop you.

As an adult, you are free to choose how you want to experience life, or how you want to deal with your own health and sexuality. That freedom needs to be protected. And that is why we need to protect infants, so that they may, years from now, have the same freedom to choose what they want to do with their lives and their bodies.

His body, his choice.

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