Medical authorities strongly recommend anesthesia for circumcision; however, a 1998 survey showed that 45% of doctors do not use anesthesia.(5) Circumcision is a painful, stressful, exhausting, debilitating, and traumatic experience for many infants. Emde et al
found that infants have prolonged periods of non-REM sleep after circumcision consistent with a theory of conservation-withdrawal,(6) so they are less capable of interaction with the mother.

Infant circumcision is a nontherapeutic procedure without documented benefit for the infant.(7) Therefore, no harm can come to the infant from foregoing or postponing a circumcision. The Work Group on Breastfeeding of the American Academy of Pediatrics (AAP) formally recommends that such stressful procedures be avoided.(8) The AAP “recognizes breastfeeding as primary in achieving optimal infant and child health, growth, and development.”(8) Therefore, successful initiation of breastfeeding should be given absolute priority over neonatal circumcision.

Prospective parents should be warned in advance of circumcision’s interference with breastfeeding. While current informed medical opinion does not support the practice, some parents, however, still have their baby circumcised. In this case, circumcision should be avoided at least until breastfeeding is well established. Such a recommendation should be a part of all printed materials regarding breastfeeding that is provided to expectant mothers in advance of delivery and should be volunteered by lactation consultants in every prepartum counseling session.

References

1. Lee N. Circumcision and breastfeeding. [Letter]. J Hum Lact. 2000;16:295.
2. Caplan L. Circumcision and breastfeeding: a response to Nikki Lee’s letter. [Letter.] J 
    Hum Lact. 2001;17:7.
3. Marshall RE, Porter FL, Rogers AG, et al. Circumcision: II effects on mother-infant 
    interaction. Early Hum Dev. 1982;7:367-374.
4. Howard CR, Howard FM, Weitzman ML. Acetaminophen analgesia in neonatal
     circumcision: the effect on pain. Pediatrics. 1994;93:641-646.
5. Stang HJ, Snellman LW. Circumcision practice patterns in the United States. 
    Pediatrics.1998;101:e5.
6. Emde RN, Harmon RJ, Metcalf D, et al. Stress and neonatal sleep. Psychosom Med.
    1971;33:491-497.
7. Council on Scientific Affairs, American Medical Association. 
     Report 10: Neonatal Circumcision. Chicago, IL: American Medical 
    Association,1999:URL: http://www.ama-assn.org/ama/pub/article/2036-2511.html.
8. Workgroup on Breastfeeding. Breastfeeding and the use of human milk (RE97929). 
    Pediatrics. 1997;100:1035-1039. URL: http://www.aap.org/policy/re9729.html.


 

Jeff L. a veterinarian and a circumcised man, shares his own perspective on keeping his sons intact. Read his wife Kristi's story here.

Until my first son was born, I never really gave circumcision much thought. I knew about it from church, but not much more than that-it was just something people did. Fast forward many years (no, I am not going to say how many!) to when my wife was pregnant with our first son. By this time, I understood that circumcision was an optional procedure and I expected the medical staff to counsel us on the options: pros and cons. As the old proverb goes: “No plan survives first contact.” My son was born 5 weeks early and was extremely jaundiced (yellow-orange color!), he had to stay in the hospital NICU under the UV lights until it resolved and he was eating consistently on his own. Obviously during this time we had much more pressing concerns that circumcision, but I was still expecting the docs to speak to us about it. 

I kept waiting for a doc to talk to be about circumcision, but no one ever did and in retrospect, that was a good thing. I started to do my own research about it and started learning things. Things that made me VERY skeptical of the medical community and their intentions. The kicker for me was stumbling on a YouTube video of a circumcision being performed. Kid strapped down to a papoose board and screaming. At about this time, the pediatricians figured out that my son was not cut yet, called my wife and pretty much demanded that they be allowed to do it. (I had to return to the clinic by this time.) So she calls me in a panic, “What do I do? They want to do it now!” I asked if they offered any guidance, you know, pros and cons, about cutting him. “No! He (the pediatrician) just told me if we want to have him cut we have to do it now!” As a medical person myself, I know that VERY few medical decisions need to be made that quickly and without talking to the patient about options. Usually that occurs for cases of life or limb (you don’t want the ER doctor consulting with you about the pros and cons of CPR!) and that urgency certainly does NOT apply to cosmetic procedures!
Right there I had made my decision, I told my wife to tell the pediatrician “no”, well, I probably was a lot more colorful than that. That night I showed her what I had found online about the procedure. She was rightfully horrified! After that, I started to do more research and try to tease out the history, methods, prevalence, complications, and benefits, of circumcision. (Yes, I am a scientist. My wife refers to me as “Sheldon”, but I still don’t know why.) By this time, I am pretty pissed that I was cut as a baby! To make matters worse, it was at this time I learned that my father was not circumcised! I confronted my mother about the matter and her defense was that “was what the doctors said to do!” Newsflash, even though they are doctors, they are still human and make mistakes. A hallmark of good doctor (or veterinarian) is that they will talk to you and lead you through the medical issue so that you understand what is going on. You should never be told to “just do it because I am the doctor.” If one tells you that-----“Run Away!”

Through research, I learned that there is very little evidence for the benefits of being circumcised and there are two very real downsides that occur 100% of the time: 1) you get changes to the skin of the glans (or head) of the penis, 2) your penis is smaller. I am not going to get into the pathology of these here, I’ll do it later. However, after learning about these downsides (again with the learning! Why are MD’s afraid of that?) I shifted the focus to foreskin regeneration (another topic deserving of its own paper). I am in the process of regenerating mine currently. I am already seeing physical benefits, as of today I have restored approximately 80% of the skin and penis size has increased by about 1 inch in circumference and about 0.75 inch in length. (There are two kinds of guys, those who have measured their penis and those that lie about it! Besides, I am a scientist and need hard data in order to evaluate the outcome!) Another notable benefit is sex. Once I hit about 50% coverage, I noticed that we stopped needing lubrication and my wife reported a more enjoyable experience!
So as I see it, the benefits of HAVING a foreskin far outweigh the slight, possible, maybe a little benefit.

I have rambled enough and should let you get back to your life (congratulations if you have read to here!) I do feel I should make one more fact know that gives validity to my viewpoint (as if having my own penis is not enough). I have eluded that I am a scientist, I am. I am also a clinician. I am a veterinarian, practicing medicine and surgery on all kinds of animals for the past 20 years. I know how to make risk assessments when it comes to disease control. I am also familiar with the methods of evaluation scientific papers and how to draw proper conclusions from them. Just because someone wrote it down, does not make it so. 

On a final note, one of the last conversations I had with an MD (and I do have MD friends) regarding circumcision benefits was on the subject of penile cancers and preputial infections. My MD friend pointed out that circumcision reduces the risk of both. While factually, this might be true, you need to look at the big picture. Mainly, how often does the disease occur in intact people (or animals). So I pointed out that in twenty years of medicine, I have yet to see a penile tumor or infection, and of all the penises that I have seen, ALL have been intact! Actually, to perform a routine circumcision on a dog or cat or horse, etc, is considered malpractice in the veterinary world. It is a normal part of the body and serves a highly important function.

Is circumcision a surgery best performed in infancy? If he's going to get it done, isn't it better done sooner rather than later? The WHOLE Network answers your questions.

Many parents believe that circumcising their son in infancy is a kindness. They assume getting it done sooner will save him the pain of having to endure the procedure later on in life, but what we've found is that the opposite is true.

Foreskin Retraction
In infancy, the foreskin is fused tightly to the glans penis via a connective membrane known as the balano-preputial lamina. To perform a circumcision, the doctor must insert a probe and forcibly rip the foreskin away from the glans before it can be clamped and cut. This is extremely painful for the baby, not unlike ripping a fingernail from the nail bed. In adulthood, the natural foreskin retraction process will have already released the foreskin so that it is freely movable, eliminating this part of the procedure. 

Issues with Breastfeeding
The postpartum period is already difficult time of adjustment for both mother and infant, and management of a post-surgical circumcision wound will add additional unneeded stress to the situation. Circumcision has been shown to interfere with breastfeeding, a complication that would not exist for circumcision in adulthood.

Effectiveness of Pain Management for Infant Circumcision
A report from the University of Alberta in Edmonton determined that up to 96% of babies circumcised in North America receive no pain medication whatsoever. For babies that do receive pain management, tylenol, sucrose (sugar water), EMLA cream, and dorsal penile nerve block are the various methods currently utilized. Numerous studies have been done examining these medications, and overwhelmingly the data concludes that these methods of managing infant circumcision pain do not work:

"Based on 35 clinical trials involving 1,997 newborns, it can be concluded that DPNB and EMLA do not eliminate circumcision pain... Trials of oral acetaminophen, sugar solutions, pacifiers, music, and other environmental modifications to reduce circumcision pain did not prove them effective." (Brady‐Fryer 2004)

Some will dismiss this point, claiming while the child may feel the pain, he won't remember it. However science has shown us that children do remember the pain of their circumcisions, and there have even been numerous accounts of adult men who remember. The least traumatic option is leaving this procedure to be performed in adulthood when use of general anesthesia guarantees the event can not be recalled, and the patient can request and safely take adequate post-surgical pain medication.

Circumcision Pain in Infancy Versus Adulthood
It's a common belief that circumcision is more painful if done in adulthood. However a 2012 study published in the Official Journal of the American Urological Association concludes that circumcision hurts less the older the patient is: 

"We performed a prospective, observational cohort study in patients undergoing circumcision. Patients were asked to complete a questionnaire using a visual analog scale for pain... Conclusions: Pain is mild to moderate after circumcision in adults under general anesthesia with an intraoperative penile block. Severe pain is rare and mostly related to complications. Younger patients generally have more discomfort."

Complications
Aside from crying, an infant cannot communicate that he's in pain or if something is wrong. That's what makes acute complications of circumcision so scary. An infant will hemorrhage with as little as one ounce of blood lost, and with only 2.3 ounces of blood loss he will die. That's as much as a child could lose into his diaper on the way home after a circumcision! An estimated 117 baby boys die every year in the US from circumcision complications. Because circumcision is an unnecessary surgery, these deaths are 100% preventable. 

Many of the complications caused by routine infant circumcision will not occur with adult circumcision for numerous reasons, primarily the wound is healing inside clean underwear rather than a urine and feces filled diaper. Meatal stenosis, which occurs in 9-10% of boys circumcised in infancy, is arguably the most common circumcision complication. It's caused by scar tissue building up where the boy's delicate urethral opening is exposed to urine and mechanical rubbing inside the dirty diaper.

The size of the patient is also an issue. It's very difficult on a tiny thrashing newborn to determine exactly how much tissue to take from the penis while still leaving enough behind to comfortably allow for growth and erections. Often too much tissue is removed, which will cause tight, painful erections as well as hairy scrotal skin being pulled up onto the shaft. An adult man can indicate exactly how much or how little tissue he'd like removed during his circumcision, thus eliminating all the guesswork.

Additional short-term complications from circumcision include: Infection, urinary retention, urethral fistula, dislodged Plastibell circumcision device, complications from anesthetics, pain, abnormal sleep patterns, excessive crying, and unwillingness to feed. Long term complications include adhesions, preputial stenosis, buried penis, curved penis, excessive scarring, keratinization, desensitization, erectile dysfunction, and sense of loss. 

Likelihood of Him Ever Wanting or Needing the Procedure
If he doesn't get circumcised now, he's just going to need it done later, right? Wrong. "In Finland, where the circumcision rate is zero at birth, the risk of needing the foreskin removed later is one in sixteen thousand, six hundred sixty seven (1/16,667), an extremely rare event! The prepuce is invariably normal and almost never requires removal." -Doctors Opposing Circumcision Physicians Guide to the Normal Intact Penis

It's not  uncommon to hear cautionary tales of young boys needing to be circumcised. But in almost every case, the issue was not the child's foreskin but rather a doctor who was ignorant about normal male anatomy. Dr. Paul Fleiss writes: "I often receive calls from distraught parents who say that a doctor insists that their little boy needs to be circumcised because there is something wrong. When they bring their son into my office, I almost always find that there's nothing wrong with the child's penis. Occasionally there's a slight infection, but that can be quickly cleared with an antibiotic cream. In all my years of practice, I've never had a patient who had to be circumcised for medical reasons.

When a doctor advises that your son be circumcised, it's usually because he or she is unfamiliar with the intact penis, misinformed about the true indications for surgical amputation of the foreskin, unaware of the functions of the foreskin, and uncomfortable with the movement away from routine circumcision."

According to the most recent World Health Organization estimates, approximately 70% of the world's male population is intact. That means the vast majority of males never need or choose to get circumcised. If given the choice, it's likely your son would fall into this category as well. 

The Issue of Legal Consent: Who Should the Decision Belong To? 
Does a parent have the legal right to consent to have their son's foreskin taken away without an immediate medical reason? Attorneys for the Rights of the Child has concluded they do not. "Numerous legal scholars have concluded that routine neonatal circumcIsion falls within the legal definition of child abuse and violates children's civil and human rights under national and international law. Consent to a procedure that is per se illegal is, of course, invalid regardless of the motives of the consenting party." (Svoboda, 2000)

Many men are upset that the most sensitive part of their penis was taken from them in infancy without their consent or any actual medical reason. (You can read their stories here and here.) When your son is born, you have no idea whether or not he'll even want to be circumcised. Rather than guessing wrong and leaving him to deal with the lifelong consequences of an irreversible decision, leave the decision for him to make for himself at the age of consent. If he feels strongly about having his foreskin removed, he can provide his consent and opt for the procedure to be done at that time.

Shouldn't He Be Circumcised Young So He Can Start to Reap the Benefits of Circumcision? 
There have been many alleged benefits of circumcision since its start in the US in the 1800s. Over time, many of these claims have been debunked. Today, the most prevalent arguments the American Academy of Pediatrics give in favor of circumcision include: hygiene, social conformity, prevention of urinary tract infection, STDs, HIV, and penile prostate cancer. None of these issues are of any concern whatsoever to an infant, apart perhaps from hygiene and UTIs. Ironically, care and hygiene are made profoundly more difficult by circumcision. The difference in the rate of urinary tract infection between intact and circumcised boys is only about 1%. Given the high rate of risks and complications with circumcision, this is not a significant enough difference to justify the routine circumcision of infant boys. Urinary tract infections are rare and when they do occur, they respond well to antibiotics for both boys and girls. Amputation of tissue is not needed, especially when you consider the 12x higher rate of MRSA infection in circumcised boys. 

Conclusions
Both the pain and rate of complications associated with circumcision are worse when the procedure is performed in infancy than in adulthood. Numerous legal authorities have determined that parents do not have the right to consent to circumcision on their infant son's behalf, and any of the highly disputed benefits of circumcision either do not apply in infancy and childhood or are not worth the risks of the procedure. Parents simply cannot go wrong with leaving the permanent and highly personal decision of whether or not to circumcise for their sons to make for themselves at the age of consent. 

Dr. Kenneth Zatz is a pediatrician practicing in South Nyack, New York. Here's what he has to say about circumcision.

I usually meet with prospective families once a week so they can get a feel for our office. Generally, it is the mothers who ask the most pointed questions: how do you feel about vaccines? How much medicine do you prescribe? How do we reach you with a question? All pretty typical stuff. At some point, I usually ask if anyone had given any thought to circumcision. Invariable, all of the mother’s heads turn 90 degrees to look at their male partners. It appears this is the one decision that falls under a dad’s jurisdiction. I typically get a “oh yeah, we’re gonna have it done” answer. I’m not sure if there was a lot of thought put into it. The feeling I get is that this is a “no brainer, that’s just what you do” kind of decision.

If we could ignore our misconceptions about uncircumcised boys being in the minority, or that it is important medically, or that it honors some long standing tradition and just look at the baby, what would you really think. This baby, in it’s first days of life. Perfect, whole, peaceful, content. Now take an honest look at what happens next. That child is strapped to a “circ board” with arms and legs restrained by Velcro bands. Betadine antiseptic is poured on his genitals. The adherent foreskin is physically separated from the glans of the penis with a probe. A slit is cut into the foreskin and a metal bell is placed over the glans. Then a circular clamp crushes and pinches the foreskin which is then cut off. Are we all good with that? I can assure you that the male foreskin is not some cosmic mistake. Like most body parts I can think of, it is there for pretty good reason.

Let’s look at the benefits of the foreskin. Full of sensation, protects the glans, loaded with nerves. Seems like it is worth keeping. Next, some may think it is completely useless--an evolutionarily quirky but harmless mistake. That still does not give us the right to subject babies to this intensely painful procedure. Lastly, maybe that foreskin would be harmful if not removed—that is what we have been led to believe. First, once removed, men are protected against penile cancer, which about one in a thousand older men may develop. It is a tough sell for me to start removing body parts just because they may turn cancerous in our geriatric years. Second, circumcised men may transmit HIV at a lower rate. Why not keep the foreskin and wear a condom? Lastly, there is the urinary tract infection story. This is the big seller. In a study of 136,000 boys born in army hospitals in the early 1980’s, 0.2% of those circumcised had complications—bleeding, infection, etc. Urinary tract infection in infant boys is rare enough in uncircumcised boys, about 0.2% will get one. In circumcised boys, it is about ten-fold less, about 0.02%. But what we learned from this study is that 444 boys would have to undergo circumcision to prevent one UTI. Reasonable people could disagree about the implications of this, but I believe that routine circumcision is not warranted for UTI prevention.

Here is what I am asking. Please don’t brush off the circumcision question without giving it some serious thought. Moms, don’t defer this important decision to the father. Have a discussion and get involved. Just because dad is circumcised does not preordain that his son should be too. Educate yourself. Go to websites like www.intactamerica.org or www.nocirc.org. If your boy wants to undergo circumcision when he is older, let it be his choice. You can take it off, but you cannot put it back on. There are situations when circumcision may be medically necessary. Sadly though, thousands and thousands of infant boys are subject to this painful procedure that is of no benefit to them. 

Part of my job as a pediatrician is to advocate for those who cannot speak for themselves. I do not believe there is any justification to impose this procedure on those who cannot be involved in the decision. It is time for the culture of routine circumcision to end.

What do Atheists have to say about circumcision?

Ayaan Hirsi Ali
"The foreskin is cut off the penis. That's a form of mutilation. You should leave the child as he is, as he comes out of the womb. He's finished, he's complete. You shouldn't take things off, especially when there's no medical reason. I think male circumcision is worse than an incision of a girl. With boys, a lot of skin is removed. The consequences can be worse for boys than for girls." -In an interview

George Carlin
"I also survived circumcision, a barbaric practice designed to remind you as early as possible that your genitals are not your own." -In his memoir: Last Words

Richard Dawkins
"Creator of the Universe went to great trouble to create the foreskin. Then insisted that you cut it off. Makes sense." - Via Twitter

"If circumcision has any justification AT ALL, it should be medical only. Parents' religion is the worst of all reasons –– pure child abuse." - Via Twitter

Christopher Hitchens
"Handed a small baby for the first time, is it your first reaction to think, beautiful, almost perfect, now please hand me the sharp stone for its genitalia." -In His Book

"I can't find the compulsory mutilation of the genitals of children a subject for humor... It's designed to repress sexual pleasure... The full excision, not just the snip but the full mandatory covenant is fantastically painful, leads to trauma, leads to the dulling of the sexual relationship. And can be, in itself life-threatening at that moment. We have records, I can show them to you, of hundreds and hundreds and hundreds in the United States of boy babies who died or had life-threatening infections as a result of this disgusting practice." -Debating Rabbi Harold Kushner

Penn Jillette
"The vast majority of the world knows there’s no reason to circumcise. Someone should tell the doctors." -Penn & Teller: Circumcision is Bullsh*t

"Shouldn't our son have the choice whether he wants to wear a condom or cut off part of his dick? Put down the knife. Step away from the baby." -We're Still Right About Circumcision
 
Joe Rogan
"People mutilate their kid's dicks because of visuals. That's what circumcision is about. Look, I'm circumcised, I didn't ask to be. I'm sure a lot of you are circumcised. I'm sure a lot of you circumcised your kids. When you really stop and think about it, it's kinda fuckin' crazy... I would never circumcise my kid." -Live at the Tabernacle 

"I think it's stupid. If I had a boy I wouldn't circumcise him... I got robbed. I got robbed. Sliced. I think it's a fuckin' gross tradition man... I just think it's a weird fuckin' tradition that we need to end. People get like, really bad infections. It's not completely innocuous- kids have lost their penises because of circumcision... It's a dick it's not a Jack-O-Lantern alright? You don't have to chop parts off of it to make it look better." -Joe Rogan Experience

Howard Stern
"I am circumcised, and I tell you something, I despise it. I despise it. I despise it... I am completely pissed off that I'm circumcised." - On his radio show


This compilation of quotes was assembled in preparation of our trip to the American Atheists Convention April 17-20 in Salt Lake City, Utah. We are currently raising funds to make our presence at this convention possible. If you appreciate the work that we do, please show your support by making a tax-deductable donation today.

In October of 2013, The WHOLE Network contacted magazine Fit Pregnancy with recommended corrections to an article they published that was heavily biased in favor of circumcision. See the official letter we sent them here.

We never heard back, but clearly they weren't listening. Today Fit Pregnancy released a new article, Your Newborn: A User's Guide. This article includes incomplete instructions on how to care for a circumcision wound, and absolutely no information whatsoever regarding intact care. Once again, Fit Pregnancy is sugar coating what is truly a life-threatening, excruciatingly painful surgical amputation that forever violates the rights of an innocent child and the man he will one day grow up to be.

Here's an excerpt from their article:

Fit Pregnancy: where is the information for care of baby boys that AREN'T circumcised? Intact care is easy- never retract the foreskin, just clean the outside of the penis as you would clean any other body part. By only including care for the circumcised infant and neglecting to mention intact care, you make an apparent assumption that all of your readers will be circumcising their sons. We know based on the most recent statistics from the CDC that more and more parents are taking their WHOLE babies home, and you have just effectively alienated that portion of your readership. Not only that, but by including circumcision wound care alongside advice about umbilical cord care, you make infant circumcision seem like a completely normal, even necessary part of the infant care process. Well we are here to let you and your 500,000 subscribers know that circumcision is NOT normal. It is NOT necessary. It is NOT natural. Here's the rest of the truth about what you may face when dealing with a post-surgical circumcision wound:
 
Post Operative Complications to Watch For Immediately Following the Circumcision:
Bleeding, infection, urinary retention, urethral fistula, dislodged Plastibell circumcision device, complications from anesthetics, pain, abnormal sleep patterns, excessive crying, unwillingness to feed, and death.

Long-Term Complications to Watch For Following the Circumcision:
Adhesions, meatal stenosis, preputial stenosis, buried penis, curved penis, excessive scarring, tight erections, keratinization, desensitization, erectile dysfunction, and sense of loss. 


Intactivists: it's time to take action. Let Fit Pregnancy know that we are fed up with them normalizing the genital cutting of infants! Share this TWN News article, leave a comment on Fit Pregnancy's Facebook page, call them at 800-423-5590, and write them a letter and mail it to: