The Designated Hitter

Now batting, the Designated Hitter, David Ryan.

Merry Christmas to one and all! I'm Donna's husband and am posting for Donna this week. I just read some of the requests on the Facebook page and will try my best to address some of the topics listed. (I just can't get over how every group seems to develop their own set of acronyms. I noticed one that was used was DH -- which to me, a rabid baseball fan, means "Designated Hitter".  I'm pretty sure that was not the intended use, but I decided to go with it anyway.)

Christmas can be a wonderful time of year full of tradition, both good and bad.  Traditions are pretty powerful -- especially when it comes to family.  We do things because of tradition. It's the way we've always done things and we like it that way! Like cutting both ends off of a pot roast before cooking it because that's the way mom showed me how to do it. (Anyone not heard that story before?)

I thought the theme of traditions would tie a couple of the requested topics together.

A few of you wanted to get a "male perspective" on circumcision. I don't hunt or follow NASCAR -- but I do have a penis. For purposes of full disclosure (don't worry -- no photos will be posted), I am circumcised.  I wasn't circumcised for religious purposes.  I am a Christian and have learned from my study of the scriptures that circumcision is not necessary per Christ's teachings.  So why was I circumcised?  Tradition.  I've never discussed the issue with my mother or my father.  I have to admit that I don't even know for sure if my father is circumcised.  I assume he was because that's just the way things were done.

We have a son.  We chose not to circumcise him because we did not see a reason to do so.  We broke away from tradition to what I believe is a better way.  Why wouldn't I want my son to be better off than me?  Was I worried about the "Jock Kingdom" mocking him in the showers? No. Did it bother me that his penis wouldn't look like my penis? No. In fact, I proactively avoid showing anyone in my family my penis (with the exception of Donna). 

I've heard all of the pro-circumcision rationales and the only one that makes any sense to me is religious in nature.  Covenants with God I understand.  Concerns about Junior's penis being intact while Daddy is circumcised I don't get. Pot roast.

Tradition plays a huge role in how we choose to give birth.  With our first, Donna wanted an epidural and didn't care to learn anything more about giving birth.  We toured the hospital, took a hospital class, and would have ended up with a C-section had it not been for my sister Tamara.  We were fortunate.

Initially, Donna didn't care because that's just the way women have babies.  They go to the hospital and let the doctors do the rest. That's the way it is done. Pot roast. There is a much better way.

Well, I think that does it for me. Happy New Year everybody! I am hungry for some pot roast.

Mr. BFBS

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Social Circumcising

We had a great meeting and discussion this week at the Tarrant County Birth Network meeting.  One of our topics was circumcision.  I've written quite a bit on the blog about circumcision, but I haven't addressed the social reasons that I hear so frequently regarding the decision.  So let's talk about them.  If I miss any, please comment below and we'll try to address them all.

If you have not read about the purpose of the foreskin previously, I want you to do that now.  Click here.

The foreskin is obviously not just a flap of skin.  It has many purposes.  So why are 50% of American males still being circumcised?  It's these social traditions or concerns that need to be addressed.


1.  We want him to to look like his dad.  A little boy looks no more like his dad than a little girl looks like her mother.  Things grow bigger and grow hair, which, in my opinion, is much more distracting than the foreskin!  Mostly, after the first couple of years of life, when does a boy ever see his father naked?  My 14-year-old intact son has no idea what his father looks like and vice versa.  Frankly, in my opinion, it's a really odd and disturbing argument.

2.  What about the locker room?  Won't he be made fun of?  Maybe 20, 30, 40 years ago, but with 50% of males not being circumcised, it becomes a matter of education in my opinion.  When my son went to 5th grade we knew he would be dressing out for PE.  We sat him down and told him about circumcision.  He was, to say the least, appalled -- very much the same way you were when you found out about episiotomies.  We explained that we researched it and felt there was no reason to do it and that most parents do it because of tradition.  He knows that those kids' parents probably just didn't know any better.  He politely thanked us for "not doing that" to him.

Last year, in 8th grade, I asked him if it was ever an issue, and he laughed.  He said, "No one is looking!  Creepy!"  As a side note, as a boy grows into a man, it becomes less and less obvious that he is not circumcised, especially when it is erect.  This is, again, in my opinion, an argument made by (jealous?) men envious of their intact friends who are, on average, 25% longer than the circumcised male.  Just saying.

3.  Isn't it cleaner to be circumcised?  There has been misconception about smegma, the tiny, white, ball-like substance that the foreskin produces.  In the past, by those that don't understand it's purpose, it's been thought to be unclean.  In fact, just the opposite it true.  The foreskin is self-cleaning, as smegma is antiviral and antibacterial.  No soap is required, just warm water in the shower, later, when the foreskin retracts on its own.  Next time you hear someone say in regards to circumcision, "I guess, as long as he is taught how to properly clean himself..." you can let them know that remaining intact is not unclean.  That is part of the misconception, created by a society that wanted males circumcised because they believed it prevented masturbation.  Seriously?  I guess when 20,000 nerve endings are removed...  Mostly, he'll just never know what he's missing.


4.  Circumcision was a law in the Old Testament so we should follow that law.  It must be noted that circumcision was nothing in the Old Testament like it is in America today!  Removing as much as 80% of the penile covering is not what was going on back then!  It was more like a nick in the foreskin.  Of course, circumcision is still a part of religions today, so I am mainly addressing those of the Christian faith at this point.  If you continue reading the New Testament, it's very clear that the law of circumcision, along with many other laws, were done away with through the blood of Christ.  I'll encourage you to search that out.  For my LDS readers, it is stated many other places as well -- The Book of Mormon and the Doctrine and Covenants.  

5.  Circumcision prevents being sexually active at an early age.  Seriously? 

6.  His future wife will think it's ugly and wish he was circumcised.   Who comes up with this stuff?  Very likely, she won't even know the difference.  I have friends that had no idea their husband wasn't circumcised until he told her. 

 7.  I'm leaving it up to my husband to decide.  Why?  It's not his penis in jeopardy!  Your baby cannot speak for himself and he needs his mother to advocate for him.  This is where we get into informed consent issues.  I'm convinced that one day a boy/man will sue his parents over this issue.  If you think that "he has a penis, he knows what it's like," it's a different time today than it was 30 years ago.  Parents are educating themselves and questioning (foolish) traditions.  This is surgery for your baby.  Both parents should be making this decision, not one or the other.  What about letting your son decide for himself?

8.  Better to do it now since he won't remember it.  Babies feel pain more acutely than adults, they just can't say so.  This argument also implies that it will have to be done later, which is highly unlikely.  See the argument below.

9.  It's better to do it now than later when it's more painful.  I compare this argument to elective cesarean (surgery that is not needed) and cesarean with an OB or midwife who has an extremely low cesarean rate (only doing surgery when it's truly required).   Some doctors or pediatricians have no idea about the intact male.  They try to pull the foreskin back at each appointment because they haven't researched it or know any better.  They are looking for things to go wrong.   We all know what happens when you have an OB like that -- you have surgery.  The same is true for an intact male.  It is very important that you have a pediatrician/family practice doctor who is up-to-date on the intact male.  If they are supportive of not circumcising (supportive, not compliant) and for whatever reason believes that your son needs to be circumcised (extremely rare), then you won't need to second-guess that decision.   It's always best to get more than one opinion, regardless.

10.  His brother(s) is circumcised, so we have to keep doing it.  Two wrongs don't make a right.  The cycle has to stop somewhere.  I've had guys in class tell stories about some of the boys in their families being circumcised and others not, and not once have they made it to be a big deal.  They all knew why some were and some weren't.  I even had one guy say that he and his brother didn't know that one was and one wasn't until they were adults and their mom was talking about it as they were making the decision for their baby.  As far as who is envious of the other, I can't help but think it will be the circumcised male that is envious of his intact brother.

Just a couple other things to touch on:  Female circumcision has been in the news quite a bit lately.  When we mentioned it the other day at our meeting, everyone cringed.  Why do we do that when we are talking about females, but not males?  Why?  It's the same thing.  Think about it.

I like to see parents take this bold step in protecting their sons.  Some are breaking tradition and bucking the system.  Chances are, if you are reading this blog, this isn't the only area you are breaking out of the mold!  When we chose not to circumcise our son, 14 years ago, we had no friends that didn't circumcise their sons.  As the months went by, we found out that most of his male cousins aren't circumcised either.  We found it was more prevalent than we had thought when we made the decision.  That is great, but it is so important that we share this information with expectant parents.

The 9th step to the Mother Friendly Childbirth Initiative is to discourage non-religious circumcision.  Discourage is an action word!

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Another Petition to the AAP Protesting Circumcision

This petition goes to the American Academy of Pediatrics about NOT recommending circumcision to all baby boys. Their stand for years has been to leave it alone, but they are considering changing it because of these reports out of Africa which I've been writing about.

The last petition was for the CDC. This is a different petition.

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Part II: Will a Mandate to Circumcise Newborns Reduce the Spread of HIV in the United States?

I am hoping that you read the last post about the Studies that this possible mandate is based. If not, I encourage you to do so.

I have thought about the statistics all week long. When I hear that circumcision lowers risk for HIV infection by 50-60%, I automatically think in crazy numbers. When worded that way, it leads the reader to think that only 40-50% of the circumcised males may contract the HIV virus. Or that the uncircumcised males have a 50-60% increased risk of contracting HIV.

I'd just like to point out again that this 50-60% rate that keeps getting thrown in our face is based on a HALF PERCENTAGE POINT. There were many factors involved that were not kept track of. The men received extensive counseling on the benefits of using condoms and approximately 98% of the men did not contract the HIV virus.

Circumcising Newborns:
This would be a "preventative" measure that we would not see the effects of for many years. The complication rate ranges from 20%-35% (based on those African studies!), and this must be considered when weighing benefits and risks.

Ironically, we have an HIV epidemic in the US now, and the majority of those males are circumcised. The use of condoms has been shown to reduce the spread of HIV, and there has been no evidence that being circumcised and wearing condoms is any better than just using condoms alone. We have twice as many HIV infected males in the US as does Europe and our circumcision rates are significantly higher. According to many medical organizations, including the American Academy of Pediatrics, in 2005, stated that the "data on the potential medical benefits of circumcision are not sufficient to recommend routine neonatal circumcision."

The way that HIV is transmitted in the US is so different from Africa, it is hard to even compare the two. We actually have an effective social program in place with education, safe-sex practices, and consistent condom use. These methods do not require surgery, are much more cost-effective, and they work! In fact, consistent condom use reduces the lifetime risk by 20% compared to only 8% for circumcision. A recent report from South Africa shows that condom use is increasing and the HIV rates are beginning to level off. There is no evidence that circumcision will aid in this progress.

Quite honestly, it is irresponsible for the CDC to even consider promoting an intervention that will create a false sense of security, while actually increasing the risk to women. Promoting circumcision will drain resources that should be put into safe-sex education and condom promotion.

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Part 1: Will Circumcision Prevent HIV?

Two steps forward, three steps back describes the direction circumcision is taking in the United States. We have seen the newborn circumcision rates gradually decrease over the years as parents have researched and discovered that there are benefits to keeping the foreskin intact. In many states, Medicaid, as well as many insurance companies, have stopped paying for circumcisions, declaring it "cosmetic" surgery. The American Academy of Pediatrics took the stand, essentially, to "leave it alone." Is all of this education and hard work about to be dismissed? The possibility is very real thanks to a couple of poorly-done studies. The CDC is said to have an official statement on mandatory circumcision for newborns by the end of this year.

Here's the fuss: The studies have concluded that circumcision reduces the risk of contracting HIV by 50-60% in heterosexual males only. First of all, this group is not the greatest at risk, which is -- no surprise -- men who have sex with other men. If it is truly an issue of a circumcised penis being protected from HIV , wouldn't he be greater "protected" no matter what, no matter who he is having sex with?

The reasons for contracting HIV in Africa are numerous. Heterosexual sex only accounts for about a third of cases. The rest is likely transmitted through unsafe medical procedures, including injections, transfusions, and other contact with infected blood. In fact, in the journal of the American College of Epidemiology, it has been suggested that some HIV infections are resulted from circumcisions themselves.

The Studies:
This is a lot of information and when you read so many numbers, I think a lot of us glaze over. I am going to try to make this as uncomplicated as possible.

Most people are aware that the area of the world hardest hit by the AIDS epidemic is Africa. It is important to note from the beginning that heterosexual sex is NOT the leading cause of contracting HIV in Africa. Conditions are very poor in many parts of the continent.

There were two studies done over a 24 month period, one in Uganda and the the other in Kenya. In Uganda, researches began with almost 5000 men and randomly divided them into 2 groups, circumcising one group and leaving the other group intact. For whatever reason, the intact group of men had almost 50 more men in its numbers than the circumcised group. The men were given extensive counseling on the use of condoms, but the researchers made no attempt to determine the HIV status of their female partners, which is a major flaw with both studies. After the 24 months, both groups were tested for HIV. The circumcised group had 22 positive results, while the uncircumcised group had 45 test positive. The researchers derived a 55% risk-prevention figure from the numbers.

The Kenyan study was very similar. They began with almost 2500 men and divided them evenly, circumcising half of the men. Two years later, 47 of the uncircumcised men and 22 of the circumcised men tested HIV positive.

Concerns with the Studies:
First of all, the number of men tested was such a small number to apply to large populations. In the Ugandan study, 0.8% of the circumcised men tested positive and 1.7% of the non-circumcised men tested positive. The numbers sound quite different when read in actualities. Plus, look at it from the flip-side: About 98% of the men remained HIV negative, possibly because of the extensive counseling about condoms. The actual numbers from the Kenyan study are: 1.5% circumcised men became infected, while 3.3% of the intact men became infected.

The timing of the release of these results is significant. They were released to the media in conjunction with UN World AIDS Day, 2 months before being released anywhere else. This unusual move "produced world-wide publicity that was heavy on eye-catching headlines and light on details because, in the absence of the published studies themselves, few journalists took the time to dig beyond the press releases made available to them."

Another concern is the short duration of the studies. Short time span and small numbers. The men who participated in the study were paid, which was significant, also, because more than half of them were unemployed when they signed up. They also received free health care for 2 years. For these reasons, it is impossible for their experience to reflect the larger population in other parts of Africa. In addition, there are more than 60 pre-existing conditions that can trigger an HIV false-positive result, including pregnancy, influenza, tuberculosis, hepatitis, and malaria.

There are other findings in the study. Circumcision does not appear to protect women. As mentioned earlier, it does not protect gay men either. Here's the reasoning behind believing that circumcision protects against HIV: "The mucosal tissue of the foreskin is more susceptible to HIV and can be an entry portal for the virus." More research has been done and has found the following: Langerhans cells in the foreskin have a protective effect against pathogens (including HIV) by secreting langerin. The original idea, stated earlier, believed these cells were an entrance point for viruses, and while this is partially true, the true mechanism at work is the cells set a trap for viruses in order to destroy them with langerin.

HIV infection is about behavior, not biology! Circumcision cannot prevent the spread of HIV. In fact, if men believe that they are safe because they are circumcised, that could make the problem worse! Circumcised men do contract HIV, they transmit HIV, and circumcised men die of AIDS. Anyone who participates in high-risk behavior, intact or not, carries a risk of contracting HIV and other STDs.

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Petition to CDC: Do Not Make Circumcision Required for Newborns

It took me about 2 minutes to add my name to this petition. I have done my research -- I just haven't sat down to write a post about this topic. The CDC is declaring, falsely by many accounts, that circumcision might reduce the risk of HIV for males. There is a lot to talk about, as you can imagine. In the meantime, add your name to the petition.

http://www.thepetitionsite.com/takeaction/760537185?z00m=19802998

Thanks.

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To Circumcise or Not to Circumcise?

This summer, I was talking to the head honchos at Babies 'R Us about doing a seminar on a Tuesday night as a trade for displaying my brochures. I was trying to be creative, get people thinking outside the box, so I suggested a class on circumcision. There were a couple of people standing there, and an older woman said, "Oh, that would be good! They could learn how to take care of it afterwards." I told her that, no, I wanted to teach about NOT circumcising. Her entire disposition changed. She became defensive. She paused for a minute and said, "Well, that would be fine, as long as you present both sides." Ironic that she wanted both sides presented now, but not a minute ago!

When I was pregnant with Daymon, I was all about the drugs, remember. But when it came to reading about the procedure and recovery of this type of surgery -- and that's exactly what it is -- I started to ask questions. I couldn't imagine putting my baby through this. Is it necessary? Do I, medically, need to have my baby boy circumcised?

The answer is an emphatic NO!

Let's talk numbers for a minute: Only about 10-15% of all males worldwide are circumcised, the majority being Muslim. In the US, the rate is about 50%. That usually surprises people that it's that low. In some states, Medicaid has cut spending by not covering circumcision, which is considered to be cosmetic surgery. Even the American Academy of Pediatrics, which is notoriously conservative, has said to "leave it alone."

The definition of circumcision reads, "the permanent removal of healthy tissue."

OK, so what is the foreskin? It counts for about 80% of the penile covering. It consists of more than 3 feet of veins, arteries, and capillaries; 240 feet of nerves, and more than 20,000 nerve endings. It acts as a protection for the glans, which is actually an internal organ before circumcision. Like eyelids, the foreskin provides moisture and protection against infection. At the time of birth, the foreskin is attached to the glans, or penis, like a fingernail is attached to the finger. As the child grows into puberty, and then adulthood, the body will produce smegma, an antiviral and antibacterial substance between the penis and foreskin. It is white and forms in tiny "balls." Smegma contains protective enzymes called lysozymes, which are also found in tears and breastmilk. The foreskin is self-cleaning.

An intact male, or his parents, should not pry the foreskin back in order to clean it. Gradually, over time, it will begin to retract. A boy doesn't need help with this! Some boys will be fully retracted by a year, others 5 years, and others will be well into their teens. Rinsing with warm water is adequate. Cleaning with soap actually would destroy the beneficial bacteria, just like douching does in women.

There are some other interesting tidbits about circumcision that I'd like to share:
*Boys who are circumcised have a lower pain tolerance that boys who are not, and even lower than girls.
*Circumcision severely interrupts sleep cycles and patterns
*About 1/500 circumcisions have surgical complications (infection, severe bleeding, complications from medications) and about 1/500,000 will result in death.
*Circumcision causes the penis to be about 25% shorter.
*Better sex for both partners when male is NOT circumcised.

Finally, what do they do with all those forskins?! It is actually a multi-million dollar industry. They are used to produce artificial skin, wrinkle creams, and moisturizers. It is also used as research material and as raw materials for a type of breathable bandage.

I feel like the information I've given you here speaks for itself. If you would like more information, feel free to comment and we can keep the dialogue going. As always, Mothering is a great resource on this topic. I will also mail out a lengthy circumcision packet to anyone requesting one.

This is my advice if you just can't decide: Your baby will be given Vitamin K at the time of birth (unless you are at home and then you will make the choice to give it or not). It is given so that his blood will clot sooner. If you choose to circumcise, he needs to have been given Vitamin K. If not given Vitamin K, he will be getting it through breastmilk and his body will start producing it on day 8. In Biblical times, circumcisions were done on the 8th day. Interesting. (On that note, the law of circumcision was taken away and no longer exists.) It is probably easier to send your child to the nursery to be circumcised when you have not bonded with him. My recommendation is to wait those 8 days and then make your decision. You will find two things: The pee comes out just fine, and you can't imagine putting your sweet baby boy through this unnecessary, medically unjustified procedure.

Oh yeah, in the end, Babies 'R Us said that they didn't think there would be enough interest in the topic of circumcision. Half of all new parents, every year, will have to make this decision for their baby boy. Not enough interest?

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