Well, if you really want to respond, here are my two cents. I don't know if you would want to acknowledge her "evangelical zeal" and "a bit taken aback" comments, but I probably would go ahead and do it. I mean, she's telling you she was surprised at your message, and she's probably mincing words a bit. I would acknowledge that in some way and just clarify that your "zeal" comes from a place of conviction about every person's right to genital integrity, and your convictions lead you to be persuaded that it
is a big deal and not just an either/or kind of choice with no right answer (in your own words; own your passion & acknowledge that it could be off-putting.) I wouldn't apologize as if it's wrong, but find some way to acknowledge and maybe build a bridge.
I'd have to think about it for awhile to figure out how to do it briefly and strongly, and in a way that felt true to myself.
As far as the "I've heard every argument against it before, and considered them before coming to my decision" bit? I'd maybe use that as an opportunity to bring up the April 2007 publication in the British Journal of Urology, "Fine-touch pressure thresholds in the adult penis," because it's brand-new research she wouldn't have had access to, previously.
So no, she hasn't heard "every argument"
I don't know, that might be better as a response to another point, though. But I might at least mention it here, and reference it later. It's such a strong point about new information not available to people who have made this decision in the past. (Well, logically available, but nothing demonstrated in this way.)
This one got me, and I would have to respond:
If there were harm or risks associated with the surgery, he would know about them, because he is a very competent and informed nurse. Oh my gosh, that statement is so frustrating. (I don't know how precise or meticulous she is in her expression, though. It could just be poor wording.) But HELLO! What surgery does this guy know of that has no associated risks?! (Again, I know it could be her poor choice of wording, or reflecting her lack o' grasp more than his. Perhaps he thinks the immediate risks are pretty standard, and like many surgeries, the good outweighs the risks. Except, um, this surgery is elective, non-therapeutic surgery on a newborn so it's hard to dismiss
any risk as mitigated by its benefits. At least, it is once you get outside the cultural dismissiveness of this whole thing as "no big deal.")
Depending on how pissy you want to get, you could mention the whole "I'm surprised your DH would suggest that there is
any surgical procedure with no associated risks." But that might be too nit-picky and just a turnoff.
I suppose you could throw in a "what method does your doctor use" bit to suggest (to her, if she doesn't actually have an answer or any clue) that she actually is very poorly informed about this procedure she's planning to choose as an informed decision.... Same with the pain relief issue....pressing to know what he will have, and knowing to insist on a particular one (not leaving it up to the medical professional to "pick" the right option.) Not sure that it's worth it to go there, to make the point that she is not all that informed on this surgery she's electing.
BTW, there's a great doctor/student page on the pros & cons of the various methods, jessjgh1 has posted the link before. It's not anti-circ at all, but it's enough to give a person the heebie-jeebies, looking at the methods and thinking, "So, do you want to consider the 'least commonly used method' or the one with the 'higher rate of shaft denudation'?!" (Jessica, I've always loved that post of yours, and your poignant comment about not being willing to decide how your son's penis should LOOK, and how that's an important conversation parents NEED to have if they are considering circ'ing. I think I've memorized it!
)
Anyway, my response to that line about the "if there were harm or risks associated with the surgery" absolutely would be to reference the
AAP's circumcision task force policy statement. Quote the statement that "the Academy concluded that newborn male circumcision has potential medical benefits and advantages as well as disadvantages and risks." Tell her that a
potential benefit is one that has been suggested but not realized. Tell her that, according to the AAP (which is hardly an anti-circ organization), circumcision has built-in risks and only provides potential benefits. This means that
there may be no benefit whatsoever to circumcision. (That could be misunderstood as semantics or fear-mongering or over-stating the case. And afterall, there might be slim potential benefits that actually do bear out to be statistically, like the UTIs in the first year and all. But the point of my italicized phrase is that "potential" means it's entirely possible that there may be no benefit whatsoever. That's how strong those benefits are.)
Point out, however, that the disadvantages and risks are not labeled "potential," and that the policy statement does mention some of the disadvantages. To believe that this is a procedure with no associated harms or risks flies in the face of what the AAP's statement confirms.
From the
Anatomic Considerations section, quote the point-blank keratinization admission, (
Epidermal keratinization occurs on the skin of the penile shaft but not on the mucosal surface of the foreskin.), and then flesh it out a bit. (No pun...) Let her know what this word means, and what the AAP is admitting happens. (My instinct is to tread lightly rather than to be extreme or wild in claims of keratinization, because it's easy to brush it off if you have a functioning intact partner and you don't think of his penis as tough or desensitized.) I just would mention that without the protection of the foreskin, it is inevitable that years of contact with and friction against clothing is going to keratinize that permanently externalized organ. And for keratinization, I would stick with a simple but stark definition, or link to a definition, such as
The conversion of squamous epithelial cells into a horny material, such as nails. Also called cornification.
This might be a very good place to mention the Sensitivity study! Or maybe hold off and finish your explication of the AAP's anatomic considerations. Yes, there's a good segue with the next one. [As an aside, I'm a little torn on the keratinization issue. I mean, it's tempting to think that the foreskin is gone and the shaft becomes tougher and less sensitive. But it seems that the foreskin being gone is the chief reason for the significantly lower sensitivity--not because the rest of the penis is so much less sensitive than the corresponding parts on the intact penis, but because the foreskin is so much
more sensitive than the other parts. According to the bar graph giving the visual representation of the study, the shaft is about equal for both circ'd and intact men. I'm guessing the glans is most affected by the loss of protection, and that would be because of being keratinized.)
One study suggests that there may be a concentration of specialized sensory cells in specific ridged areas of the foreskin but not in the skin of the penile shaft. (Here, you would point out that the new sensitivity study is completely absent in the AAP's policy statement because it didn't yet exist when they were drafting the statement. You would say that there's no longer a mere suggestion, that there are study results providing objective sensitivity measurements that are quantifiable and reproducible.)
Another comment in the AAP's anatomic considerations section is:
There are conflicting data regarding the immune capabilities of preputial tissue. Studies differ on the number, distribution, and location of Langerhans' cells in the foreskin. Actually, current research indicates that the Lagerhans cells in the genital mucosa (Langerhans cells are present in the foreskin of both males and females) actually capture and destroy the HIV virus, acting like a "virus vacuum cleaner." This is a far cry from the earlier assumption that the cells in the foreskin were the ones most easily infected by HIV.
http://health.msn.com/healthnews/art...&wa=wsignin1.0
I don't know if you'd want to point out (from the AAP) any of the potential medical benefits. Just to level the playing field when comparing those "pros & cons," by pointing out just how minimal the potential benefits are and comparing that slight benefit to the known quantity of a 75% reduction of sexual sensitivity. The stats are there in the AAP statement; I like the AAFP (American Association of Family Physicians) summary statement because it is so succinct and it hits all the major players: UTIs, cancer, STDs, and how evidence about HPV is inconclusive (which is kind of important, since most think it offers significant protection.)
from AAFP policy statement (summary section)
The evidence indicates that neonatal circumcision prevents UTIs in the first year of life with
an absolute risk reduction of about 1% and prevents the development of penile cancer with
an absolute risk reduction of less than 0.2%. The
evidence suggests that circumcision reduces the rate of acquiring an STD, but careful sexual practices and hygiene may be as effective. Evidence regarding the association between cervical cancer and a woman’s partner being circumcised or uncircumcised, and evidence regarding the effect of circumcision on sexual functioning is
inconclusive.
Ask, do any of these statistics demonstrate a meaningful decline in risk? (Especially when you stop and realize something like: the usual treatment for a UTI is....antibiotics. After all, we're talking about the same infections that girls get, far more frequently.) Are these the kind of statistics that would justify elective surgery altering a newborn's body? Especially when it's clear that the same "potential benefits" are achievable by normal hygiene and proper care of the intact penis? You can achieve the same "protective" results, without surgery. So if you're making your decision
to perform surgery on a newborn based on the idea of medical benefit, does it even make sense?
This does not even take into account the new information about how circumcision reduces penile sensitivity. We now have evidence that demonstrates objectively that when you circumcise, you are cutting off the most sensitive part of a boy's penis. (This
bar graph....oh my gosh.)
Do they really believe that they as parents have the right to reduce the sexual sensitivity of their child's genitals?
Maybe reiterate that this information wasn't available to be brought to bear on generations of past decisions to circumcise. Parents who've made this decision in the past could honestly tell their children they did not know. But having it now frames things differently.
By the way, I don't know if you have that info about the study. Here's a cut and paste with a fair bit of info. News of this study could probably be a stand-alone email, actually!
There was a recent sensitivity study published in the BJU International (British Journal of Urology) in
April 2007.
Abstract
here
Full text of article (pdf)
here
A collection of graphs illustrating the comparison findings,
here
This recent study was the first time that the intact and circumcised penis were thoroughly, systematically and scientifically tested for sensitivity. The method was monofilament testing, the same method used in assessing peripheral neuropathy, such as lack of feeling in the feet of diabetics. The resulting measurements of sensitivity are quantifiable and reproducible. The study was submitted for peer review before being approved for publication.
The study's objective was: to map the fine-touch pressure thresholds of the adult penis in circumcised and uncircumcised men, and to compare the two populations.
The conclusion, from the abstract, was:
The glans of the circumcised penis is less sensitive to fine touch than the glans of the uncircumcised penis. The transitional region from the external to the internal prepuce is the most sensitive region of the uncircumcised penis and more sensitive than the most sensitive region of the circumcised penis.
Circumcision ablates the most sensitive parts of the penis.
Oh wow. What a chilling conclusion.
I don't know, I'm getting very tired and I know I've been blathering. I know I've gotten very carried away with this, and I suspect you weren't exactly looking for a blueprint for a response, either!
I don't really recommend too involved of a response because I'm sure it will invite skimming, but dang! I just feel fired up! (I don't have a son, btw!)
Okay, I'm going to sign off. These next two points were some of the first things I typed, when I read her message to you. I hit enter a few times and kept them at the bottom of my screen. They're totally not integrated, but oh well!
Good luck to you,
however you decide to proceed.
My guess about the religion part (which I sort of understood what she was saying, actually) is that she's saying that she and her husband don't feel religiously obligated to circ, and that's not why they're planning on doing it. However, she has a hard time believing that the procedure is harmful (as you told her), because she doesn't believe God would decree something that is harmful. So her attitude and beliefs about the procedure are influenced by the fact that circumcision has a religious connection, even though she does not feel any religious obligation to circ. She believes in God, and believes he would never require something inherently harmful. So she disbelieves your claims, or takes them with a great big grain of salt. That's what I got from her letter, and that's my impression on why she's "spouting religion" even though her motivation to circ doesn't involve religion.
I hate when people generalize it to "you're leaving the option open for your son," as if that's what parents are doing when they leave their sons intact. Yes, we always say (when the "What if he hates it and wishes he'd been circ'd?" comes out) that he can make the choice to have the procedure on his own. And then it always turns into, "But that is so painful and why not do it when he won't remember it if he's just going to want it anyway. How awful to make him do it himself" blah blah blah.
But we are
not keeping sons intact so they can get circ'd as adults, as much as we are leaving them intact to preserve the genital integrity that is their birthright! I don't expect an intact male to grow up and want to have his foreskin removed! If someone says "Well, what if?" I'll say the choice has been saved for him. But that's not the
point of keeping him intact. (As if they're all going to want it or wish for it, inevitably.)
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