The Great Circ Debate

Before my I start my short rant on how it's irresponsible and dangerous for parents not to get their boys circumcised, I want to tell a really sweet urology story.

We had a visiting professor from Arizona earlier this week. He was coming for a second look at a faculty job, and he brought his family along to take a look at the area. Unfortunately, the famed Sunny California weather did not comply with my program director's desires to show him a good time. We might as well have been England or Seattle at their worst, it was so soggy and dreary.

Luckily, Dr. C brought his children along, and when we tried to apologize jokingly for the weather, he demurred. Oh, no, his children LOVED it. Growing up in Arizona, they had never seen grass this green before. And the puddles! They wanted to go out and play in the puddles. They had so much fun.

So, on to the perils of a rogue foreskin. And another forewarning - today I'm grossing you out intentionally. I'm being graphic for pedagogic effect :)
In fact, I'm thinking of creating a ratings system (vs. early warning system?) for my blog. We can call it the Cringe-o-meter.

I would give this post a 90% reading on the Cringe-o-meter. Let's say that the previous post would be a 60%. Proceed at your own risk.

Phimosis, from the Greek word "to muzzle," is the medical term used to essentially describe a trapped penis. About one in twenty boys (though the statistics are controversial) have a narrowing of their foreskin that prevents them from retracting it behind the head of the penis (the glans). Among the many glorious sequelae of this wrongful imprisonment, during which the poor penis literally doesn't see the light of day, are, in no particular order: ballooning during urination, painful erection, and the accumulation of cheesy sebaceous gunk under the foreskin, leading to infection and irritation of the penis, ultimately leading to (in the very worse cases) squamous cell carcinomas of the penis requiring a partial or total penile amputation and/or raging fulminating gangrene of the genitals. While the latter two scenarios are admittedly rare, I am only a bit smug when I present as a trump card the recent very convincing and well-publicized WHO data showing that circumcision leads to reduced transmission of sexually transmitted diseases.

Statisticians can doubtlessly bring out a cartload of data showing that it's not cost efficient to circumcise everyone, and that there are known risks of the procedure (narrowing of the urethra or pee-hole, infection, bleeding risk, and perhaps unknown cultural effects on a child). But you really only have to see one person nearly die of Fournier's gangrene because of a penile infection gone awry to consider that tiny little cut when a boy's a newborn to be a worthwhile endeavor. The subsequent horror stories merely stoke the flames: the time when I had to cut a two inch slit into a man's foreskin in the ER because they couldn't get a foley catheter in him; the farmer who was so obese that he couldn't retract his foreskin, and thus missed the large fungating cancer that was eating into his penis.

Neonatal circumcisions have become so safe and standardized that pediatricians regularly do it with minimal complication. However, circumcisions later in life require either anaesthesia (which costs significant $$$), or extreme fortitude on the part of the brave men who are willing to undergo awake circumcisions under local anaesthesia (they can literally smell their own foreskin burning as we cauterize the bleeding). What's more, it can take weeks to recover from a delayed circumcision. Walking is extremely uncomfortable, let alone driving a car or riding a bike.

So, to paraphrase Willie Nelson: Mamas, please don't let your babies grow up to be uncircumcised.