How often is circumcision needed later in life?

[drs0410]

On other message boards, I often read about people having their sons circumcised as infants because they knew of older boys/men who kept getting infections and didn't want their sons to have to go through that. Are infections really that common? My intact son is just about 10 months, so I don't have any experience with the intact penis of an older male.

[vachi73]

Someone else who is better informed than I am will have a better answer to your question, but I think it's hard to know *exactly* what the incidence/prevalence of foreskin infections requiring adult circ are in the U.S. Sadly, urologists in the U.S. are trained to circ, and will circ for *any* reason. So, IMO, amongst adults who are circ'd, I think that a huge proportion are medically unnecessary. This is further complicated by doctors CODING circs as "medically necessary" when they are actually for cosmetic or other reasons (if coded this way, insurance will cover it; not so much for cosmetic circ).

That said, someone here has posted stats about adult circs in the U.S.; however, I would read them with caution. My memory is that it is less than 1% of intact adults that elect circ as an adult, but that's just my memory.

In order to truly assess the risk of medically-necessary circ, I think you should consider European cultures, where infant circ is really uncommon except for religious reasons; and where proper intact care is practices more universally. For example, look at Sweden, or the U.K., or virtually any country other than the U.S. or heavily Jewish or Muslim countries (where there would be very, very few intact adult males). Again, someone here has posted stats, but my understanding is that the rate of adult circ in Sweden is less than 0.1% -- so virtually unheard of, for ANY reason (medical or cosmetic).

I believe that, when foreskin is properly cared for and cleaned (e.g., no one forcibly retracts!), the true medical need for circ is approaching 0, but I'd be interested in seeing stats to support that belief. I think the reason that there are so many anecdotal stories of "infection requiring circ" or "phimosis requiring circ" among the 35-60 age cohort is because, for any boys left intact during that time, forcible retraction and cleaning was recommended -- which, as we know, creates tears, scarring, and adhesions that very well COULD cause problems in an adult. So, again, take it all with a grain of salt.

Cheers!

EDITED TO ADD THIS: A similar question was asked recently, read this thread all the way through (not just some of the top posts):

http://www.mothering.com/community/forum/thread/1294868/frequency-of-adult-male-circumcisions

Edited by vachi73 - 3/11/11 at 7:53am

[drs0410]

I have also read about men who don't like being intact but haven't really done anything about it because it's embarrassing and complicated. I don't want to cut off any part of my son that's meant to be there, but I hope he doesn't grow up wishing he had been circumcised. I just wish that having a foreskin was considered just as acceptable as having a nose and that no one questioned it.

[GoBecGo]

In the UK the rate of circumcision for medical problems, according to some study which looked at how penile problems were diagnosed and treated in children, should be under 2%.  It is currently higher because there are still, even here where circumcision has been out of fashion for a long time, doctors who think "cut it off" is the best way to treat anything even vaguely foreskin related.

If you live in a place where most boys are circ'd then most doctors will not be familiar with normal penises and their various functions and foibles and will circumcise at an astonishing rate for very little reason.  This is worth bearing in mind when choosing a doctor.

[vachi73]

I, too, have worried that one of my sons will later wish he had been circ'd as a baby, or that he will elect it as an adult. (The scenario that makes me the most frantic is the "floozy," flaky girfriend demands a circ. In my mind, she is always a floozy and very shallow, LOL!) My DH thinks I am crazy to worry about this ... he says none of his sons will EVER want any part of the their penises cut off.  Period. LOL. And that they would kick any woman who demanded it to the curb. I hope that he is right, and we do everything we can to promote a happy, healthy body image in support of self-confidence regarding foreskin (and every other aspect of their bodies).

However, I have had this fear. This is how I look at this "fear of future regret" scenario: I believe that the odds of feeling, "I wish I had been circ'd, why didn't you cut me?" are far, far lower than the odds that a circ'd boy would later say, "I wish I *hadn't* been circ'd, why did you do that to me?!"  Anecdotally, I hear a lot more of the latter (boys who are outraged to learn what was done to their penises) than the former (actually, I've never even heard of this outside mainstream media -- e.g., TV shows that portray an adult getting circ'd. -- but it is theoretically possible. In fact, now that I type that, it makes me kind of irritated -- no doubt, these TV shows are written by circ'd males who *assume* that there are intact men/boys who would -- OF COURSE -- want to be circ'd. Sigh. I digress.)

Anyway, I have an answer -- and very, very compelling reasons -- as to why we left each of our sons intact, just as nature intended. I do *not* have an answer or compelling reasons to explain why a parent chooses to circ a baby. (I suppose this is a statement of the obvious, seeing as we did not circ and would never consider it for any reason other than frostbite, gangrene, or cancer.) 

Anyway, to the extent that you can, I would try not to worry about your son's potential, future regret regarding his intactness. By the time he understands that there is a different option, he will very, very likely have discovered that the foreskin is, in fact, the best part of his "package" and will be totally baffled as to why circ would ever be considered.

HTH!

[Storm Bride]

With respect to the "what if he needs a circ later in life?" argument, I have only one thought.

I would't cut off my child's finger, just because he or she might lose one to frostbite later in life. I wouldn't remove my daughter's breasts, just because she might need a mastectomy later in life. I wouldn't remove my daughter's labia, just because she might get infections in that area later in life. Why is a foreskin any different?

I'll also add that I talk about this with ds1 sometimes, when I'm reading this forum and he happens to be around. He doesn't talk to me about his penis a whole lot, but I remember reading some post or other to him, and he looked at me and said, in a deadly serious tone (and ds1 is usualyl very good natured and goofs around a lot), "mom - if someone tried to cut off my foreskin, he would LOSE his junk - no joke - he'd lose it".

[Storm Bride]

Originally Posted by vachi73 

My DH thinks I am crazy to worry about this ... he says none of his sons will EVER want any part of the their penises cut off.  Period. LOL. And that they would kick any woman who demanded it to the curb.

I would guess that your dh is totally right about this. I can guarantee that anyone trying to mess with ds1's penis would regret it.

[Cyllya]

Even if you had psychic powers and could see into the future and know with 100% certainty that you're son would need to be circ'd sooner or later... later is still better. There are many risks associated with infant circumcision that are not problems for adults being circumcised. The only reason for circ'ing as an infant to avoid circ'ing later is that babies allegedly don't feel pain.

[Greg B]

One more thought.

If you leave your son intact, and he later decides to get circumcised, he can.  You have preserved his right to bodily integrity, you have preserved his options, and you have given him the choice.  His body, his choice.

If you have him circumcised as an infant, and he later wants to be intact, he can't.  You have violated his right to bodily integrity, taken aways his options, and made the decision for him, without his informed input. 

The only time it is acceptable to take away his rights and choices in if you can make a good argument that the medical benefits signficantly outweigh these losses.

Arguing that RIC is a good decision because he may need it later in life is pure fear mongering at its worst.

Regards

[sosurreal09]

Well my DH was circ'ed and his skin is so tight it is sometimes painful...

We are both anti-infant-circ now!

You did the right thing mama!

I think in reality *hardly* any really *NEED* to be circ'ed as adults. The AAP changed their view on circ, and now says there are no medical benefits to circ in newborns.

[hakunangovi]

I read a quote that I sadly can't remember where, which stated that in Sweden only one man in 16,000 will die without his foreskin.  Those are pretty good odds that no male will ever HAVE to have his foreskin cut off.  The issue in North America is that a vast majority of doctors (especialy urologists) are woefully uneducated about the normal form and function of a foreskin. Most will recommend circumcision for any problem, be it real or percieved.  If you think about it, there is not one other body part that is removed for supposedly prophylactic reasons.

As Greg satated, it is far preferable to preserve your son's options than make an unreversible decision on his behalf.  I can't imagine how a parent would answer the question as to why they had the most sensitive part of junior's penis amputated.  Bottom line - you have nothing to worry about.

[A&A]

The biggest problem that the average intact male will have is that somebody THINKS he has a problem.

[4chunut1]

Originally Posted by A&A 

The biggest problem that the average intact male will have is that somebody THINKS he has a problem.

Totally agree...  GREAT answers, all of them..!  As an older intact male, I just wish that other parts of my body gave me as little trouble as my foreskin has. 

There are MANY more men (and boys) wishing they WEREN'T circumcised than those wishing they were.  And those in the latter category can always opt for circumcision, if that is their desire...(rarely will there be a "need" for that operation).  And for those in the former category, restoration is their only recourse. 
 

[luv my 2 sweeties]

Originally Posted by Greg B 

If you leave your son intact, and he later decides to get circumcised, he can.  You have preserved his right to bodily integrity, you have preserved his options, and you have given him the choice.  His body, his choice.

  Exactly.  And if, on the off chance he *does* decide to be circumcised, I bet he won't be obsessing over your choice for him as an infant.  He'll just go get it done and maybe not even tell you about it.  My BIL got circ'ed as an adult because of discomfort he was experiencing.  It was no big deal.  He's happy now and he doesn't blame his parents for anything.  My DH (his brother) remains intact and likes it that way.  He's happy too!  Their bodies, their choices. 

[drs0410]

Thanks! I agree with the replies and have no intention of getting my son or any possible future sons circumcised. However, when you read about males getting circumcised at age 4, 10, 25, etc. because of infections, it can make you think.

[jessjgh1]

The 2% rate seems high, but you could use it.  The risks if you compare them side to side, are, at the very least a wash.  To me, circumcision always looks riskier.

• Remind people that 1% of children that are circumcised will need a 2nd procedure.
• 2-3% will have complications- with some being severe
• 20-80% have adhesions that may be from mild to severe  (but this figure is rarely mentioned, it is not a surgical complication)
• 2-7% will develop meatal stenosis as a toddler, which often needs to be surgically corrected. (again, rarely mentioned because it is not directly caused BY the circumcision)

Remind them that the circumcision rate for intact males is a _lifetime_ risk and most problems can be solved with proper care first.  How many problems are exacerbated by poor treatment- we don't know?  But most say this is 1%, not 2%, and likely should be lower than the  1% seen as we move towards intact as norm and drs and caregivers stop forcibly retracting intact children.

In the link from the Canadian Paediatric Society I list below there is no circumcision study that shows a risk analysis benefit from circumcision as the procedure causes more problems than it solves.  Any of the 'benefits' are pretty much a wash.  The new info out on HIV/STD's is highly unreliable, but even so, I doubt there will be a true benefit if one does a complete analysis.  Circing to prevent a problem from happening is simply causing more problems. 

Intactness is the normal, natural do nothing state.  It is peaceful and pain free.  The foreskin has a biological and sexual function and altering it forever changes the penis.  The benefits of the intact penis are never considered in the cost-benefits analysis we see.  Purely from an ethical point of view, it is unethical to remove a functioning body part. 

Even though this page doesn't show all the risks (nothing ever seems to mentions adhesions or meatal stenosis because they are secondary problems and can be dropped from the stats) and some of the studies we could pick apart more, I really like this comparison of risks:  http://www.caringforkids.cps.ca/pregnancybabies/Circumcision.htm

The policy statement this links to looks more into the individual studies, mentions cost analysis, and shows how circumcision always causes more problems than it solves, as I mentioned.

HTH's

Jessica

[nd_deadhead]

Originally Posted by drs0410 

However, when you read about males getting circumcised at age 4, 10, 25, etc. because of infections, it can make you think.

It makes me think, too. I think "Since when do we treat infections with amputation?" I am having a hard time imagining huge numbers of males who have foreskin infections that do not respond to antibiotics. I strongly suspect that the vast majority of males getting circumcised because of infection are being treated with the most invasive option (amputative surgery) first, instead of as a last resort (which is where surgery should fall in a treatment process).

[serendipity22]

Wallerstein found that in Finland 6 males per 100,000 per lifetime had a circumcision for medical reasons. The foreskin is respected there.

In the US many many circumcisions have been done for highly dubious "medical reasons" or because of iatrogenic injury.

The argument do a circumcision now because he might need it later is irrational. To make a point, even if 90% of boys needed one later, it would be unfair on the 10% who don't, to circumcise all boys in infancy.