Skins of the fathers

Dad thinks boys should be circumcised. Mom believes the operation is barbaric. Chatelaine health editor Amy Cross and her husband suddenly found themselves on opposite sides of the fence when they learned they were expecting a son

First published in Chatelaine's November 1999 issue.
© Maclean Hunter Publishing Limited

The gel felt cool on my belly as the ultrasound technician roved my bulge with her wand, looking for the prize inside. Our first baby. We were dying to know: was it healthy? Was it a girl or a boy? My husband held my hand but kept his eyes glued to the screen, which I couldn't see. As the baby swam around, Patrick said gleefully, "It's moving. I see something between the legs; I think it's a boy." The sheer reality of a moving living baby with a real gender exhilarated us. But it spelled bad news for me.

I was thrilled to be pregnant and relieved that the baby was well, but my emotional pie chart had a big slice of dread too. I had hoped and hoped we wouldn't have a boy. That meant we'd have to decide about circumcision. I couldn't stand the idea of cutting a centimetre or so of skin off a newborn; my husband assumed boys are circumcised for good reasons. After trying together for years to conceive, we were suddenly at odds over a small part of our baby, and the stakes were things we held to be important. For me: the right to personal freedom, empathy, distrust of unneeded medical intervention and an unwillingness to harm or cause pain. For him: safeguarding health, esthetics, tradition and belonging to a group.

I hadn't started out as an advocate for the foreskin. For most of my life I wasn't sure what it was or which penises had it (French?, I thought) and which didn't (Canadian?). The more I learned about circumcision, the more opposed I became. It started when I was invited to a bris. Jewish custom has boys circumcised on the eighth day after birth. The family throws a party; the community watches as the newborn is inducted into the faith. The bris represents a covenant between God and every Jewish male--it is a physical expression of faith, of culture. We had pastries and coffee until the women were shooed into the kitchen, the mother upstairs. The mohel said prayers; they gave the baby some wine and then he started crying--a shrieking high-pitched cry. When it was done, the father held and comforted his son. I was glad it wasn't my child--hell, I was glad it wasn't me who was the guest of honour that day. I thought, if God wasn't asking you to, why would you put any infant through that?

Soon after, I found myself reading up on circumcision at the medical library and my position moved into the zealous, almost evangelical range. As someone brought up to empathize with the less fortunate, I thought defenceless babies needed my support just like the homeless or dispossessed. If it were up to me, I'd ban circumcision except for religious reasons. If the British Kennel Club doesn't allow the docking of dogs' ears, how can we do something similar to baby boys?

My husband felt just as strongly that circumcising boys was the right thing to do. It had been done to most men of his generation. A good portion of society would agree: the cut penis is the norm. Patrick thought it looked better, familiar. An intact penis meant difference. Most circumcised men don't question what's missing and feel insulted when you imply they're damaged.

Many of their mothers and wives feel the same way. A generation ago, approximately half of Canadians circumcised their boys; today many health insurance plans no longer cover the procedure except when medically necessary. It costs between $150 and $250 at the doctor's office or at a hospital. Yet, a study at the University of Western Ontario found that once the provincial health plan ceased to cover it, there was no big drop in the number of procedures done in London, Ont. Money doesn't matter when you're upholding culture.

Although foreskin removal has been deeply entrenched in North America, I wasn't alone in wanting to throw out this surgical welcome to the world. A revolt has been gaining momentum since the early 1980s.

Last year, McGill University ethics scholar Margaret Somerville gained worldwide attention for calling circumcision technically criminal assault. In Australia, it has been recognized as actually falling within the definition of assault, and some doctors may need to worry about facing civil claims for damage. Advocating against the procedure are organizations such as NOHARMM and NOCIRC--the latter started by a California nurse who didn't want to assist in the operation anymore. Likewise, today some militant doctors and nurses refuse to participate in the procedure and urge colleagues to do likewise. Now, even some Jewish couples are starting to question or even refuse the bris--just as they might choose not to keep kosher, says psychologist Ronald Goldman, executive director of Boston's Circumcision Resource Center.

The revolt seems young compared to circumcision's history. For the past 3,500 odd years, Jewish people have done it. Muslims have too, but in some countries they wait until the boys are at least six (in Turkey, they sometimes hold mass circumcisions in stadiums). The procedure came into English-speaking culture in the late Victorian era when doctors used it to "cure" masturbation, as well as urological problems such as impotence. Then circumcision crept into medical practice as doctors started claiming its other medical benefits, all now hotly contested: prevention against venereal disease, penile cancer or urinary tract infection.

Early in this century, circumcision was mainly restricted to well-to-do kids born in hospital. Home-birthed babies didn't get the knife. In that way, the foreskin became a kind of class marker--a perception that endures.

Only in the past 50 years did circumcision become a well-accepted middle-class practice that's considered as clean and convenient as Tupperware. Nearly 70 percent of all boys born in North America in the years following the Second World War were circumcised--except in Quebec and the Maritime provinces, where fewer went under the knife. But the numbers have been declining since the 1980s.

My marriage was split 50-50 on circumcision, so we reflected North American society at large. I was the vanguard of strident opposition; he stood for people who do things the way they always have. Like so many issues that centre on control over the body, such as breastfeeding and abortion, circumcision can get people emotional and judgmental. Being polarized ourselves, Patrick and I made a deal: rather than trying to convert one another, each of us would research the other person's position. Call it disagreeing empathically. I went back to the medical library.

Medically speaking
Patrick wanted to safeguard the baby's health, and I found some evidence to support his position in journal articles that suggested circumcision protects against penile cancer--which is incredibly rare--and reduces the transmission of HIV.

According to Dr. Jorge DeMaria, a pediatric urologist at McMaster University in Hamilton, removing the foreskin means infants under one year old will have fewer urinary tract infections. There's also a prevention angle: those born with a congenital urinary tract problem might avoid trouble down the line if they have the operation. Pediatric urologist Peter Anderson of IWK Grace Health Centre in Halifax says no more than 5 per-cent of men develop foreskin problems, sometimes requiring circumcision later in life.

Like many people, Patrick believed that circumcision was more hygienic. Although, normally the foreskin does not retract in children, Dr. DeMaria explains that people with intact penises may have problems retracting the foreskin later, which could leave them prone to infections of the foreskin and glans. (I asked my husband:"Do genitals need to be low-maintenance, like self-cleaning ovens?")

On my side, the medical arguments were mounting up. The Canadian Paediatric Society's position, released in 1996, stated that infant circumcision was not recommended. The experts have worked out the math: you would need to remove 195 foreskins to prevent one baby from being hospitalized for a urinary tract infection. This year, the American Academy of Pediatrics echoed that view.

Indeed, I couldn't find a doctor--not even one who specializes in circumcision in Canada--who would state publicly that it's a good medical practice that should be done on all boys. And I learned that the foreskin--like the once-maligned tonsils--does have a purpose: it provides lubrication and protection for the delicate glans and may maintain its sensitivity.

While finding no medical need for circumcision, I worried about the risks. Neonatologist Robin Walker of Ottawa says parents should be told that complications occur in about 6 percent of circumcision cases. Some, like infection, don't last, but others, although rare, stay for life: a bent or scarred penis or painful sex (the result of too much skin being removed).

I made my husband look at some pictures of botched jobs--babies with the scrotum swollen like acorn squash and green with gangrene. They were grotesque worst-case scenarios but still real little boys. Patrick would groan and push the stuff away, accusing me of scare tactics.

Gangrene may be rare, but pain is just about guaranteed. Until a few years ago, doctors insisted that newborns didn't feel pain, so didn't need pain relief.

Yet, research was starting to show that infants can experience physiological stress: an elevated heart rate, disturbed sleep and harder sucking. A landmark study conducted at Toronto's Hospital for Sick Children found that babies who were circumcised with no pain relief experienced more pain later, upon receiving vaccinations, than uncircumcised boys or those who had received anesthesia during the operation. This suggests that cutting infants actually hardwires them for pain.

A colleague told me how following her son's circumcision, he would shudder and cringe whenever she removed his clothes, as if he were having a physical memory. That wasn't something I wanted to see my baby do.

An emotional question
Patrick and I talked about all those points--cancer, pain, infection--and tried to be rational. But the arguments always heated up. Like many people, Patrick assumed a boy should look like his father. "Even if you were an amputee?" I'd ask. Patrick asked me whether I wanted other boys to laugh at our son for looking different. Dr. DeMaria sees many intact teenagers who ask for the operation because their girlfriends think their youthful members look ugly.

My husband challenged me: what if our son wishes he were circumcised? So, maybe he'd grow up to hate me for refusing to bend to convention--he'd hate me for something anyway. And if he wanted to get circumcised as an adult or even a teen, that would be his body, his business, his right.

But I did wonder: like the teenagers who want to look "normal" for their girlfriends, would my son feel pressure from women? With my bellyful of boy, I canvased women to see what they thought. Some of my female colleagues felt grossed out by men with natural-born penises. It was ugly, said a woman from the Middle East. Her Canadian-born friend agreed that "normal"--circumcised--was definitely nicer.

I asked men too. And surprisingly, I was able to find more agreement in the opposite gender than my own. Patrick's best friend, an English-born painter (and thus intact), thinks circumcision is horrid--"esthetically very uncool. It alters the natural design of the body."

John Antonopoulos of Montreal's Circumcision Information Resource Centre was more forceful. "Parents have been misled by the medical establishment," he said, explaining that many men feel traumatized and angry at the medical profession about being circumcised. I also polled my father and brother--both circumcised. They both voted strongly against the operation. Taking me somewhat aback with their candour (I expected a more abstract discussion), the male members of my family thought that little piece of skin made for more pleasurable sex and better sensation.

While some medical literature says that circumcision doesn't change sexual response, other research suggests some men have felt the difference. I asked a man called Pierre from Montreal, who was circumcised as an adolescent. A few months after his operation, he realized that something was missing: "The glans is dry and loses its sensitivity whether for masturbation or for sex." Sex with an intact penis he describes as "another dimension."

To understand the difference in sensitivity, touch the back of your hand with your index finger, then touch your palm. Apparently, the former feels like a cut penis, which has been exposed without the foreskin to protect it; the latter feels like an intact one.

As I talked to people and learned more, I became convinced I was right. Then Patrick lobbed his most convincing argument: no Jewish woman would marry our son, nor any nice middle-class girl who would notice with disgust that he wasn't like her father or brothers. Not People Like Us. That nearly threw me over the surgical edge: thinking of how my decision about his body might affect my son's future. Would I be limiting his choices by insisting on his freedom?

My belly grew so that it touched people on the subway. My Christmas due date loomed. But Patrick and I were still miles from agreement. In our birthing class, the teacher asked very nonjudgmentally who planned to circumcise their baby. Patrick called out "yes" and I called out "no."

But the debate was wearing us down. Was I fighting so hard to keep the baby's foreskin, only to risk losing his father? Looking for a reason to change my mind, I pored through the studies again--and suddenly, the slightly lower risk of urinary tract infection seemed like it might justify the procedure. As much as I hated to give in, I began to think that maybe I should allow my husband to have our baby circumcised if it were so important to him.

Just two weeks before my due date, we lay in bed. I shoved a new batch of studies in Patrick's hands. He groaned and dutifully picked one up and read that it seemed circumcision might scramble the neural pathways and confuse the pain-pleasure response.

This, Patrick could relate to. It made sense. Just think, the baby gets scrubbed down, has his first erection perhaps, then feels the squeeze of a clamp, the scalpel. Patrick paused. Finally, here was a reason to leave well enough alone: don't mess up those neural pathways and risk damaging our son's ability to experience the full range of sexual pleasure. Let his sexuality develop naturally. Patrick said, "Maybe we shouldn't circumcise him after all."

After long months of fighting, we were finally on the same side. I wouldn't even say I won. My husband came out of this whole thing--the gross pictures, the hectoring, the contradicting--a real hero. Rarely does anyone have the courage to change his position--allow new ideas into a broken-in collection. I doubt I could have done the same. Now, as my son is about to turn three, he has a father I am proud of, and he has the whole body he was born with.


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