On Fathers and Foreskins

My mobile was ringing.

A glance at the screen told me that it was my friend Jake calling from Jordan, where he was news editor for a Syrian resistance website. Jake and I have been friends since college, staying in touch as our journalism careers took us around the country (me) and around the world (him). Still, our voice conversations were usually limited to when he was in town, or for important occasions like Scud missiles falling on Tel Aviv. I wondered what was prompting this call.

“Hi,” he said, as he wasted no time getting to the point of his call, “if you have a boy, you are going to circumcise him, right?”

While I wasn’t sure that for me the topic would have warranted an international call, the truth is, it had been occupying much of my thought. Our twins were due in two months via surrogacy in India, where clinics are prohibited by law from revealing the gender of a fetus. I’m half-Jewish, and while I’m not religious, Jake wanted to be certain that my children remained culturally “members of the tribe.” I was unconvinced that that required subjecting them to an otherwise unnecessary surgical procedure. And my European husband, never under the knife himself, was no help, other than to state this: He would accept circumcision for medical reasons. He would accept it for cultural reasons. But not a hint, not a whiff, of a religious rationale. And good luck separating it all out.

* * *

Along with breast feeding, attachment parenting and SpongeBob, circumcision arouses strong passions among parents – and not just the parents of the child in question. For something with a 10,000-year history, it still generates a great deal of controversy.

Carved figures link the practice to at least the third millennium B.C.E. in the Middle East and, possibly, to much earlier in Europe and elsewhere. The rite is central to Jewish culture and religion where it represents identity and the biblical covenant between God and Abraham, but historians say it was likely acquired from the Egyptians, who depicted it as early as 2300 B.C.E. and for whom it appeared to be a rite of passage into manhood. Circumcision is also an integral part of Islam, and Muslims account for the majority of the 30% of the global male population estimated to be circumcised.

For Israeli-born, Toronto gay father Eytan Havneh, who asked that his real name not be used, the decision to circumcise his sons required no thought. While his upbringing was not religious, the cultural pull was strong.

“We never considered not doing it,” he said. “I was circumcised as a baby as part of the Jewish cultural context. In fact, where I grew up, not being circumcised was shameful.”

His boys, born in the United States, were circumcised in a hospital by a pediatrician rather than by a mohel, a specialist in Jewish ritual circumcision.

“It was important for us to keep in line with our cultural tradition,” he said.

* * *

It became an unofficial part of the cultural tradition of much of the English-speaking world in the late 19th century, promoted as a protection against everything from syphilis to masturbation to bedwetting. By 1960, some 80 percent of males born in U.S. hospitals were being circumcised.

That percentage has spiked and fallen somewhat over the years as the American Academy of Pediatrics has changed its guidelines, but the procedure appears to be in gradual decline: according to the Centers for Disease Control, from 1979 to 2010 the numbers dropped to about 58 percent of hospital newborns. Numbers vary from region to region, though, and are lowest in the heavily-Latino Western states.

One of strongest factors influencing whether a child will be circumcised in the United States appears to be a father’s desire for his son to “fit in,” along with the status of the father: One survey in Denver found that some 90 percent of circumcised fathers chose the procedure for their children; only 58 percent of uncircumcised dads did.

That desire for their son not to stand out in a locker room was part of what led Vietnamese immigrant Linh Nguyen, 30, and his Cambodian-American husband, Kong Chhour, 40, to circumcise their son, Landon. Chhour is circumcised, Nguyen is not.

“I circumcised Landon because I want him to be clean and not different from other American kids,” said Nguyen, of Herndon, Va. “I am glad because it’s very easy to clean him up now.”

Kong Chour, Linh Nguyen and their son Landon

* * *

My mobile was ringing.

This time, it was my friend Marcus in San Francisco. Like Jake, Marcus didn’t waste time getting to what’s on his mind. “You are going to circumcise your son, right?” he demanded to know. Marcus is African-American, uncircumcised himself, and told me that he suffered repeatedly from urinary tract infections as a child. “You don’t know what I went through,” he insisted.

In fact, studies suggest that circumcision can significantly reduce the risk of HIV transmission, reduce risk of penile cancers (already quite rare) and, yes, can reduce the rate of urinary tract infections more than 10 times. While much of the data comes from research done in Africa, where prevalence of HIV and sexually transmitted infections (STIs) is especially high, researchers say the studies are still relevant in the developed world. “Even though much of the work has been done in high-prevalence areas of the world, we can make some reasonable extrapolations to lower-prevalence areas,” said Dr. Paul Chung, chief of general pediatrics at Mattel Children’s Hospital UCLA. “The CDC estimated that even in the U.S. risk of HIV would drop by about 15 percent in circumcised men — less than the 60 percent we saw in African trials, but still meaningful.”

Chung says the benefit to female partners of circumcised men may be even greater. “People forget that HPV (human papillomavirus, which causes genital warts) is incredibly common in the US, infecting about half of all women — although that should diminish as the HPV vaccine becomes more widely used. It causes high rates of cervical cancer in women. Women get HPV mainly from infected male partners. Male circumcision seems to reduce HPV infection in men by about 30 percent.”

In 2012, a review of recent data led the American Academy of Pediatrics (AAP) to revise its longstanding position recommending against the routine circumcision of newborns to say that the health benefits of the procedure do outweigh the risks. Chung said that the shift was due to continuing research suggesting a stronger link between circumcision and reduced risk of HIV and sexually transmitted infections. “Even now, however, the statement reflects a relatively small shift in the recommendation,” he said. “Although evidence for health benefits of circumcision is a bit stronger than it was, the statement still does not recommend universal male circumcision.”

The Canadian Paediatric Society takes an even more cautious approach: “The overall evidence of the benefits and harms of circumcision is so evenly balanced that it does not support recommending circumcision as a routine procedure for newborns.” Both organizations say the ultimate decision is up to the parents. Studies conflict on whether, or how much, circumcision reduces later sexual function or pleasure.

The AAP stresses the importance of clear, unbiased information to parents as they make a decision — often in short supply, as the tone of some websites run by anti-circumcision activists, or “intactivists,” strays into anti-Semitic caricatures that would not have been out of place in Nazi Germany.

The AAP recommendations did little to sway Toronto residents Gregg Stolinski, 52, and John Leonardo, 49. Both dads are circumcised themselves, but when their son Joseph was born through surrogacy in India in 2012, the decision not to circumcise him happened almost accidentally.

At first, Stolinski and Leonardo were concerned that Indian doctors, not used to performing circumcisions, might lack the expertise needed. They also worried about bleeding, swelling, or other complications at a time when their only priority was to bring Joe and his twin sister Juliana safely home. Back in Toronto, their pediatrician told them that Joe, by now 6 months old, would need general anesthesia for the procedure and that it would no longer be covered by their health insurance. For Leonardo, himself an anesthesiologist, it was no longer worth the risk.

“I guess this gave us the time to think about permanently altering Joe’s body and whether or not that was our decision to make,” Stolinski said. “Did the benefits outweigh the risks? We decided that they didn’t, and that Joe is the only one who should make the decision about his foreskin.”

John Leonardo and Gregg Stolinski with their twins Juliana and Joseph

Doug Graiver and Matt Larkin, of Lambertville, N.J., adopted their two sons at birth. Both fathers are circumcised and felt that the procedure was the right thing to do.

“We both feel there are many issues our kids could face being children with two dads and being adopted,” Graiver said. “We didn't want them to have another way they are different from the other kids.”

But when both boys had complications, they regretted their decision. “Our oldest had a serious bleed from the site of circumcision,” he said. “It was extremely traumatic watching our 10-day-old baby being surrounded by a bunch of nurses and docs trying to stop the bleeding. All I could think about was, Why would we do this?

Still, complications of newborn circumcision in a medical setting appear to be rare. “With my own patients, I tell them it’s a personal choice,” said Chung. “I say that the individual and public health benefits probably do outweigh the risks, but in most U.S. communities, it’s not a health emergency one way or the other. If I had sons, I’d probably circumcise them. And because I have daughters, I’d generally like to see more boys get circumcised.”

Havneh agrees that the decision is intensely personal. “My response to the anti-circumcision fanatics would be to mind their own willies,” he said. “Body worshipping in terms of invasive décor, tattoos, piercing or other alterations are dated as far back as 10,000 B.C.E. We can’t claim anything we do is natural or unnatural.”

* * *

I never did reach a decision. In fact, I never had to. A week after the unrelated calls from Jake and Marcus, our twins were born seven weeks early. I was relieved that, in spite of their early arrival, both were strong and healthy. I was just as relieved that both were girls.

Posted by Jason Howe

Jason Howe became a dad to twin girls in 2012 through surrogacy in India. A former TV reporter, he now is a media relations manager for a national conservation non-profit. He lives with his girls and husband in Los Angeles

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