Wednesday, January 21, 2015

Someone's Cousin's Neighbor's Grandpa

We’ve all heard stories about how someone’s cousin had to be circumcised at 6 for “problems,” and how terrible it was, and how someone’s ex had to be circumcised at 19 for “medical reasons,” and how terrible it was, or how someone’s grandpa had to be circumcised when he was 40 because his foreskin kept getting infected, and how terrible it was. It can make someone who doesn’t have the bigger picture wonder if the foreskin really is bound to go bad, so, it’s important to understand why these anecdotal stories keep popping up. 

When we are confused about how to clean a boy’s penis we CAUSE problems. Retracting and cleaning under a prepubescent's foreskin (especially with soap) would be like douching a little girl. You can imagine what trouble you’d bring doing that, right? Genitals of young people are NOT the genitals of mature people.   Retraction of the male foreskin is part of its sexual function.  In young boys, the foreskin is meant to stay forward. It’s there to protect the glans, and keep contaminants away from the urethra. Start yanking on it, and you can tear his “hymen” (actually named preputial lamina or synechia) a membrane that bonds the foreskin to the glans, and releases slowly over time.  You also introduce bacteria which can cause a UTI.  Use soap, and you upset the delicate PH balance, which can cause inflammation, a UTI, or a yeast infection, FUN!  So leave a young foreskin alone, the way you would leave a young vagina alone. 

When we have confused expectations for a young or teen foreskin we see a problem where there isn't one.  It's normal for the foreskin to do weird things during its development.  Strange white bumps, which are the cells of the aforementioned synechia membrane releasing and collecting under the foreskin, will work their way out the end; ballooning of the foreskin with urine, or a stream of pee that sprays at an angle; or a foreskin that was retractile becoming non-retractile later are all things that, if you don’t know to expect them, can seem like a “problem” but are actually just normal development.  It’s even normal for the foreskin to remain snug into the early 20's. If your expectations say that the foreskin freely comes back by age 5 (like the AAP erroneously states) then at 20 when it’s still a little snug, you might falsely believe there’s an issue. 

When our doctors know nothing about foreskin but how to cut it off, we end up with stories of circumcision instead of less invasive treatment. In places where foreskins are normal, men rarely need medical circumcisions.  They are empowered by knowledge of their body, and they know that their issues can be corrected without surgery.  Their doctors also, are familiar with more than just amputation for treatment, so they don’t offer it first, like they do in the US.  The problem with our doctors’ foreskin ignorance isn’t limited to knowing only one solution to issues, it’s also the mindset that issues must be the FAULT of the foreskin.  In the US, a problem causing a foreskin issue is ignored in favor of treating only the symptom.  If a man has recurrent yeast infections, for example, a doctor in a ‘foreskin friendly’ medical community might check for problematic blood sugar.   A man in the US is denied an opportunity to find a legitimate cause of his issue, because doctors instantly assume that his foreskin is the problem, and offer amputation.  And it’s terrible.  And people find out and tell others. 

In places where foreskin is not vilified at every age and cut off at every opportunity, you have healthy men unwilling to allow amputation of the best part of their penis.  But don’t take my word for it.  YOU can check this by comparing health statistics of places that do and don’t routinely circumcise, and by conversing with intact men from intact cultures.

We need to keep an objective perspective when we hear stories.  Imagine for a moment circumcised women from circumcising cultures hearing about a little intact girl with adherent labia, or a teen or young woman with tearing from intercourse, or an older woman with recurrent yeast infections and thinking that the solution was amputation every time.  I've personally known women with each of those problems.  Imagine if those women HAD been circumcised to fix those issues.  I might start believing that circumcision is the only solution, and that it is always eventually needed.  I would be especially susceptible to believing in labia amputation if I were raised in an environment that constantly blamed problems on the labia.  It would take looking at a population of women that do not do that to see that it's not necessary to cut them off.

Also keep in mind that people have a tendency to share impressive stories as IF they were experienced fact, and the reports of “problems” can multiply beyond reality.  Someone’s friend can become 6 other someones’ friend when people share stories that aren’t actually their own.  Suddenly it seems like it’s the same story 10 times, when it was really just once. 

If you applied the logic of “I’ve seen it needed, therefore it’s ok to do it before it’s needed” to other issues that need surgery to correct, then it would be ok to remove breast buds from infant girls, because we ALL know someone who had to have a legitimate medical mastectomy.  And that would just be absurd.  The bottom line is that even if the story about the circumcision at 8, 18, or 38 IS true, that doesn’t mean it wasn’t avoidable, and it doesn’t mean that a healthy baby doesn’t deserve to have HIS healthy foreskin left alone.