Monday, February 28, 2011

Circumcision: Let's Talk About Dicks

These days, parents of baby boys are faced with a tough decision: whether or not to have their sons circumcised. Just a generation ago, it was a no-brainer--circumcision was widely known to result in a cleaner, more attractive, and socially acceptable penis. Boys with foreskins were the exception, the freaks in the locker-room covering their crotches in shame while the "normal" boys pointed and laughed.

But the world is moving on, and as the years pass and my peers flood the earth with their children, the practice is becoming less common. In fact, only 56% of baby boys born in the US were circumcised in 2008, down from more than 80% in the 1960's. And thanks to the growing intactivism movement, that number is likely to continue decreasing. Parents are becoming more aware of their choices, as well as the potential risks and benefits to accepting or declining the procedure. We've realized that whether or not to circumcise really and truly is entirely up to us. Unfortunately, this means that we get to take the blame if, someday, our boys decide that we made the wrong choice. With all the shouting surrounding this issue, it can be hard to decipher hyperbole from fact. Here's my attempt to cut through the bullshit and help you make a choice both you and your child can be comfortable with.

What does the AAP (American Academy of Pediatrics) have to say about circumcision?

AAP policies reflect the current medical consensus among pediatric practitioners based on the most recent evidence. In the case of circumcision, however, they're not much help. While the AAP acknowledges that "existing scientific evidence demonstrates potential medical benefits," their official policy statement concludes that "...these data are not sufficient to recommend routine neonatal circumcision." In other words, the decision is left to parents and their pediatricians. However, the AAP plans to update this policy in light of new evidence about potential health benefits of the procedure. Whether or not this will affect their recommendations remains to be seen.

Why do people have their boys circumcised?

According to this article on PubMed, circumcision reduces the incidence of urinary tract infections (which are especially dangerous in infants), lowers the risk of many types of STD (including HIV and HPV), has a protective effect against penile cancer, eliminates the medical need to have the procedure performed as an adult (well, duh), and improves "sexual function and creativity". One study found that circumcised men enjoy "...a more elaborate sexual lifestyle," and their female partners report being "...more pleased with the aesthetics of the circumcised penis."  (I'm not sure if that last part counts as a health reason, but hey, I didn't write the article.)

However, the health issue is kind of a red herring, because most parents make this decision for cultural reasons, such as religion or family tradition. One study found that circumcision status of the father, as well as the parents' education level and ages, are the most important factors in the decision. In this same study, mothers-to-be were given an informative brochure put together by the AAP which outlined the health benefits and potential complications. Not one woman changed her mind after reading the brochure.

What is the history of circumcision?

The oldest documented evidence of circumcision comes from ancient Egypt. Many historians believe that the Jews acquired this practice during their period of enslavement to the Egyptians, though competing evidence suggests that it has been a custom in Semitic tribes going back much further than that. The tradition also has roots in Islamic culture, tracing back to the tribal practice of circumcising both boys and girls. It is still a common cultural tradition among orthodox Jews and devout Muslims.

Circumcision didn't catch on in the United States until the late nineteenth century. Doctors who advocated for the procedure recommended it to curb masturbation, or in the words of  John Harvey Kellogg, as a "PREVENTION OF SECRET VICE" (apparently cranks have always had a love affair with caps lock). Kellogg, who helped popularize the practice in the US, believed that masturbation was an act of evil and that the inability (or refusal) to abstain from it constituted a disease. In addition to performing circumcisions (without anesthetic, so the pain would have a "salutary effect upon the mind,")  he encouraged parents to force their children to work long and hard during the day so they would be too exhausted to "defile" themselves at night. For younger children, he suggested tying their hands, or, more effectively, "bandaging the parts" to prevent access. Fortunately, his more extreme ideas did not catch on (such as applying pure carbolic acid to the clitoris if a woman proved unable to "exercise entire self control"), but other doctors of the era took his anti-foreskin fervor and ran with it. To this day, many Americans still consider circumcised penises to be cleaner and more civilized than their intact counterparts.

How is circumcision performed?

I always imagined it to be rather neat and precise: the doctor pulls the foreskin up from the penis between his fingers, the way a barber prepares to trim a lock of hair, then pulls out a specialized penis guillotine that resembles a cigar-cutter, and snip snap snip, the penis is circumcised. The nurses dab off the tiny amount of blood with a soft cloth, and the smiling baby boy is delivered safely to his mother's arms.

But it's not like that at all. The Wikipedia page on circumcision goes into graphic, gory, detail on how it really happens (warning: pictures!). There is a clamp involved, used in conjunction with a "restraining device". The inner lining of the foreskin is "bluntly separated" from the glans so that the clamp can be forced into place. Sometimes this requires a dorsal slit, and sometimes the frenulum band near the urethra needs to be "broken or crushed" so the foreskin can be cut. The clamp stays in place until the penis has healed, at which point it should fall off on its own (the clamp, not the penis).

Most boys have pediatricians (or mohels) who follow AAP recommendations and use local anesthtic, either in the form of a topical cream or by a series of injections. But not all practitioners believe that babies feel pain (or perhaps, like Kellogg, they believe the babies deserve pain), so sometimes the procedure is performed with no pain relief at all.

Do the benefits make it worth doing anyway?

In sub-Saharan Africa, where most of the studies showing a positive benefit were conducted, it probably is worth doing. AIDS and other STD's are rampant, people have limited or no access to contraception, rape is commonly used as a tactic of warfare, and access to clean water and adequate medical care is scarce. In conditions like these, medical interventions that even slightly lower the risk of passing on infectious disease make perfect sense.

Here in the US, it makes less sense. The typical American man has the luxury of plenty of hot water and soap in the comfort of his own home. He can dry off with a clean towel and put on freshly-laundered underwear. He can waltz down to the CVS and pick up a box of condoms any time he likes. He is unlikely to force himself upon an unwilling woman.

However, health issues aside, some people do prefer the aesthetics of the circumcised penis, seeing it as cleaner and more streamilined. Plus, circumcised men don't get smegma (which is not a health risk but is still pretty gross.)


Though circumcision's popularity in the US is fading, it is unlikely that the intactivists will get their wish and put an end to the practice altogether. I personally feel that the procedure is unnecessary and opted out for my son, but I also don't buy the more extreme claims of men feeling violated by their parents and mourning the loss of their foreskins. I'd imagine the average guy doesn't give it much thought; his dick is as familiar to him as the contours of his own face and, as long as it works like it should, he should be happy.

Wednesday, February 9, 2011

Open Letter to Mayim Bialik: Why Can't We Be Friends?

Dear Mayim,

I hope you'll forgive me for calling you by your first name, but I can't help but feel like I know you. You see, you and I grew up together. No, we didn't live in the same neighborhood or attend the same schools. This relationship is purely one-sided: to me, you will always be the girl who played Blossom. This isn't a bad thing--Blossom was by far the smartest, hippest, savviest, and most confident girl on TV in the early 90's. They just don't make girl's role models like that any more, to the detriment of Miley Cyrus fans everywhere. And it wasn't just your TV persona--judging from what I saw in interviews, you were pretty hip and savvy yourself. I admired your unwavering, uncompromising, you-ness. You didn't wait for others to hand you your self-esteem. You took it as your birthright, and nerdy, insecure girls like me were inspired and emboldened to do the same.

But we arrived at adulthood along very different paths. You went on to gain a Ph.D. in neuroscience while I delivered pizzas, taught preschool, and went into debt to finance my liberal arts degree from a state college. I'm not saying that my way was "better" or gave me some profound insight you are lacking. I don't begrudge you your good fortune or opportunities in the slightest. I'm just pointing out that our respective paths taught us each very different lessons and, as a result, we approach parenting from different perspectives. Yet I'd like to think our core values are still in alignment--we both care deeply about the earth and preserving its resources, we both want humane treatment for all animals, and we share the belief that children are our most tangible investment in the future of our planet and the survival of our species.

So why do we find ourselves on opposite sides of an impenetrable wall when it comes to parenting? Do our families' respective sleeping arrangements and meal habits really matter so much that they would strangle a potential friendship before it is formed? Does the fact that I had a C-section while you had your babies at home make us the Capulets and the freaking Montagues?

It hasn't always been like this. In a past interview you said, " ...everyone does things differently and that’s OK. It’s very important to us to raise nonjudgmental children who don’t go finger-wagging." You were also self aware enough to acknowledge that "...a lot of people hear that term [attachment parenting] and automatically get turned off or automatically assume that you think you're doing things better than them."  Based on statements like these, I think we could get along despite our differences as parents.

But then I read the intro to your new blog on TODAYMoms. You start out by condemning labels and distancing yourself from the term attachment parent...but then you go on to state all the ways in which you are, indeed, a full-on attachment parent. You say you don't want to judge anybody, but you also say that "natural" childbirth should be the norm and that "almost all women should [emphasis mine] be able to...successfully breast-feed, barring rare genetic conditons." Mayim, when you say things like these, women who prefer to give birth in a hospital  or who choose to bottle feed feel like you are attacking their parenting choices. Your attitude has changed from: "this is how I choose to raise my kids" to "this is the right way to raise all kids, everywhere."

I think I know how this happened. When you first started revealing your particular, somewhat peculiar, parenting choices, the sanctimommies piled on. I'm sure there were plenty of fingers wagging at you as thousands of moms felt it their duty to tell you every little thing that was wrong with every little detail of your parenting plan. No doubt you felt a bit defensive; after all, you made these decisions consciously, with your children's best interest in mind. What right did these people have to judge you? So you did what anyone in your position would likely have done--you looked for support from like-minded people. And, thanks to the internet, you found it in spades. Not only are your choices acceptable, your support group assured you, they are deeply, fundamentally, right.  But by this logic, people who make different choices are simply, flat-out wrong. Such is the danger of the echo chamber, where extremism is born.

Mayim, I respect your right to make the choices you feel are right for your family. But if you refuse to extend the same courtesy to others, you run the risk of alienating readers like me, with whom you may have more in common than you realize. I have a feeling that if you and I met as total strangers, in a park with our children perhaps, we would strike up a lively and enjoyable conversation. Let's not let the sanctimommies of the world ruin our chance to get along, and to model for our kids a very important lesson: that just because we're different doesn't mean we can't be friends.


Sane Mom

Tuesday, February 1, 2011

Hot Saucing: Hurting Kids for Christ?

Sometimes I worry that I'm coming up short as a mom. Does my son eat enough healthy food? Are his toys stimulating and age-appropriate? Should I really let him wile away the afternoon watching Dino Dan, or should I bundle him up and drag him outside to play in the howling wind?

Then I see videos like this one, and I feel much better about myself.

This video is all over parenting websites, leading people to debate furiously in comment sections. The majority, thankfully, sees this as a clear-cut instance of child abuse (and the state of Alaska agrees) but an alarming number of commenters are rushing to this horrible lady's defense. Apparently, a large subset of the population still practices "hot saucing" as a disciplinary technique. But why? Who are the defenders of this practice, and are they, in fact, torturing children?

What is hot saucing? 

Hot saucing refers to placing a drop of hot sauce on a child's tongue as punishment, usually for offenses such as lying, talking back, and swearing. The idea is to have the child associate the pain with the misbehavior in order to deter the behavior in the future. This is more commonly practiced among Christians (though by no means do all of them do this), who believe that children need to learn respect and obedience for parents so they will learn to respect and obey God. They claim this will lead to a more "moral" society, one which is being threatened by permissive parenting and the disrespectful, entitled children it produces.

Who is encouraging people to do this?

Blair from The Facts of Life. No, seriously. Though she didn't invent the practice herself, former actress turned born-again Christian Lisa Whelchel heartily endorses hot saucing in her parenting book, Creative Correction. The book is published and endorsed by the hugely influential Focus on the Family, a evangelical organization that works to promote socially conservative social policy. While this book isn't exactly mainstream (it's ranked #55 in popularity among books focused on parental discipline), it does appeal to a significant portion of the population, and does influence the day-to-day discipline strategies of many, many parents.

It's just a drop of Tobasco. What's the worst that could happen?

For the record, the makers of Tobasco Sauce condemn the use of their product as a disciplinary tool. They are wise to distance themselves from hot saucers, whose children can suffer severe consequences such as burned esophagus, swollen tongue, and anaphalaxis. A third of the adult population has no tolerance for capsaicin and has a severe negative reaction to ingesting it. Children's palates are even more sensitive than that--for a capsaicin-intolerant child, a dab of hot sauce goes beyond mere pain, creating a sensation as agonizing as a lit cigarette being ground out on the tongue.

Is hot saucing always abusive?

In my opinion, yes. If we accept the notion that pain is a necessary part of punishment, then why not just squirt children in the face with pepper spray? What about tasers and shock collars? They work for subduing criminals and dogs, so why not kids? Should we bring back the hair shirt? If the ends (obedience) justify the means (pain), then where do we draw the line?

Hopefully, the controversy caused by this video will cause some hot saucing parents to renounce their ways, or at least consider alternative forms of discipline. Unfortunately, this pattern of abuse goes beyond mere hot sauce. As the above video shows, hot saucing is part of a larger disciplinary strategy, one by which the parent rules through fear and intimidation. Pain and humiliation are the desired outcomes of this form of discipline. Even if we outlaw hot saucing, abusive parents will still do it, or just find another form of torture to take its place.

How can we influence hot saucing parents to change their ways?

I don't know any parents who admit to doing it (and I kind of doubt any of them are readers of my blog), but I have a couple of arguments handy in case I find myself debating a hot saucer.

The first argument is one based on  their own Christianity. I'm not a religious person myself, but I was raised as a member of the Seventh-Day Adventist church and I'm quite familiar with the Bible. I would ask the abusive parent why he or she chooses to model the behavior of the vengeful, cruel god of the Old Testament instead of after His representative here on earth, the benevolent and kind Jesus Christ. Did God intend for us to act just like Him, or was Jesus meant to provide an example of idealized human behavior? Personally, I think Jesus would have made a great dad, always ready to listen with an understanding heart, reacting to his children's misbehavior with love and gentle guidance. I have a hard time imagining the Prince of Peace shouting in a child's face, taking pleasure from inflicting misery onto one of God's most helpless and sensitive creations.

If that argument didn't get through, I would try a more practical approach. The world is an uncertain place and we're all getting older, fast. Chances are, the economy will not have significantly improved by the time our generation gets too old to work. We can't count on Social Security to still be in place, and most jobs nowadays offer no hope of pension or comfortable retirement. Who will take care of us when we are, ourselves, helpless and frail? Who will ensure that our deaths are tender and meaningful, that our memories endure after our bodies are long gone? How we treat our kids is an investment, not just in their future, but in ours as well. We have the right to expect them to be as respectful and loving as we once were. And something tells me that the poodle-haired lady from the video will die bitter and alone.