The deepest cut

As a parent, Angelica Dilts had a lot of important decisions to make. And as the mother of a baby boy, her first boy, there was one big, irreversible decision that needed to be made within the first few days of his life: whether to have him circumcised.

She chose not to.

“It’s a painful, unnecessary and traumatic procedure,” she said. “For me, it’s not my right to be cutting off parts of my baby’s body when there’s nothing wrong with him.”

Dilts made that decision at the end of her pregnancy, when she was gathering information about the procedure—the removal of the foreskin of males—from midwives, doctors and other experts. Her research, coupled with the freethinking values her parents taught her as a child, led to her one conclusion. It was a choice that alarmed the baby’s father, who Dilts said expressed social and cosmetic reasons for wanting to have his son circumcised.

“We both had very strong reactions,” she said. “But as a parent, it’s your job to make decisions based on the information you gather. It’s about what’s best for the child.”

Granite Bay mom Katy Stuehm likewise decided that circumcision was unnecessary for her young son. The mother of a daughter and a uncircumcised 1-year-old boy, Stuehm said she developed an opposition to infant circumcision through intensive research, education and talking to her pediatrician.

Like Dilts, she became a self-taught expert on the subject. She thinks more mothers should do their homework. “Do some research and think before you make a decision that impacts [your son’s] life,” she said.

Disagreement about one of the world’s oldest surgical procedures is nothing new. But lately, more parents than ever are deciding to keep their newborn sons intact—especially on the West Coast. The reasons range from changing recommendations by medical authorities to the growing trend of parents not wanting to blindly follow social norms.

On the other side, many parents continue to seek the procedure for their young sons for social and cosmetic reasons. Some have concerns about their infant’s hygiene and future experiences in social and romantic situations. Then there are the cultural and religious reasons many parents have for circumcising their sons—especially those who come from Jewish and Muslim backgrounds.

This split in values has widened in the past decade, Dr. John Asarian, who lives in Chico and has been a practicing pediatrician in Northern California for more than 30 years.

Twenty years ago, most infant boys in the United States were circumcised for a combination of social, cosmetic and cultural reasons, said Asarian. However, a shift appears underway. In Asarian’s case, he began to notice more of a 50-50 split in the number of parents who choose to have their sons circumcised. In fact, Asarian stopped performing circumcisions four years ago when he decided that the risk of the surgery did not outweigh the medical benefits, which are mostly related to hygiene.

With more and more parents choosing to keep their sons intact, the social and cosmetic arguments—which often concern the infant boys’ “looking” like their fathers and peers—could be losing ground.

The practice of circumcising infant males became widespread in the United States during the “hygiene era” of the late 1800s, when natural processes such as reproduction became increasingly medicalized, said Lyndall Ellingson, a health and community services professor who focuses on multicultural health at CSU Chico. The procedure of removing the foreskin was believed to cure myriad conditions, including masturbation, whooping cough and a variety of other ailments.

Since then, the medical reasons for circumcision have largely been debunked. In 1999, the American Medical Association released a statement discouraging routine circumcision, and that same year the American Academy of Pediatrics released a circumcision policy statement relaying that, while there are possible medical benefits to having the procedure performed, the data are not sufficient to prove the procedure is necessary to ensure the well-being of a normal infant boy. The academy reaffirmed its findings in 2005.

Ellingson said the shift in attitude by medical authorities likely has been influenced by a shift in social attitudes that’s been taking place since the 1960s and ’70s, when many individuals began questioning authority and challenging the dominant social paradigm. Changing attitudes about circumcision, she said, were a part of that “constellation” of societal changes.

“It was based on grassroots change and then incorporated into the system,” Ellingson offered. “And now you have the system itself changing its attitude. It’s just kind of this wave of moving forward.”

The circumcision procedure is uncomfortable for the infant boys, who are laid on a molded plastic instrument and restrained by their arms and legs. The procedure is usually performed on the second or third day of life, and cannot be performed within the first eight hours because a newborn’s midsection cannot be exposed to the cold.

“There are a lot of physiologic changes at birth, so the baby has enough to do just to get used to breathing, for example,” Asarian said. “So it’s not the time to do surgery unless it’s needed for a real medical emergency.”

Asarian also noted that, while many parents choose circumcision to prevent infection, the risk is not as great as many think, and most infections intact boys develop can easily be treated with topical or systemic antibiotics.

“I tell [the parents] it’s more of a social decision than a medical decision, because the evidence is not very clear-cut in the U.S.,” he said. “There is a small decrease in the number of infections in male babies who are circumcised compared to noncircumcised. You’d have to perform circumcisions on 300 to 400 babies to prevent one infection.”

And while the Centers for Disease Control and Prevention has warned Americans about the risk of increased incidences of HIV and other sexually transmitted infections for intact adult males, Asarian said it is important to understand that simple hygiene, preventative behaviors and increased education may be more appropriate ways of dealing with those risks.

Asarian also highlighted the fact that properly cleaning an intact penis is not more difficult than cleaning a girl’s genitalia.

Granite Bay mom Stuehm agrees.

“The foreskin serves a lot of the same function as the labia and it harbors just as much nastiness if it isn’t cleaned properly,” she said. “As far as cleanliness is concerned, of course I’m going to teach my son good hygiene, just like I teach my daughter.”

Ultimately, Stuehm thinks it’s all about choice.

“When they’re 12, 15 years old, if they say they want to look like their friends and dads, give them a choice,” she said. “But it’s a valid part of a man’s anatomy, and there’s no reason to take it off.”