A Parent’s Choice In Families And In The Medical World, Infant Circumcision Remains A Heartfelt Issue

The day-old baby boy lies naked in a plastic tray called a Circumstraint. His arms and thighs are strapped down. And he’s screaming. Using a long clamp, the doctor grasps the foreskin over the baby’s penis and presses it tight, crushing blood vessels so there won’t be a lot of bleeding.

With another instrument, the doctor loosens the foreskin and places a bell-shaped plastic piece over the head of the penis to protect it. Then he ties a string around the foreskin and snips it off.

It only takes a minute or two. Through it all, the baby screams, stopping only when a nurse wraps him in a blanket.

This is a circumcision, one of the most common surgical procedures done in the United States.

Despite its popularity, debate over its advantages and drawbacks refuses to die. Now the debate has fresh fuel in several recent surveys. In the 1970s, the American Academy of Pediatrics discouraged routine circumcision, saying there were “no valid medical indications.” But in 1989, the group took a more neutral position, agreeing that there “may be a medical basis” for circumcision, and leaving it up to parents and pediatricians.

Now the academy is rethinking its stance. A task force is reviewing the scientific literature and preparing a new recommendation, expected by early 1998.

“There has just been a lot of information that’s been published in the last six years,” said Dr. Carole Lannon, a University of North Carolina Chapel Hill pediatrician who chairs the task force. “One could not categorize it as all pro or all anti. It really requires some thoughtful consideration.”

Some doctors believe circumcision helps prevent urinary tract infections, cancer of the penis and sexually transmitted diseases. But circumcision has always been a cultural issue too. Jews and Muslims believe it is God’s command. Many Americans believe it’s just normal or more socially acceptable.

Twenty-five years ago, about 90 percent of American newborn boys were circumcised. But after 1971, when the pediatrics academy decided not to recommend the practice, the rate began dropping. Since 1979, the rate has remained fairly consistent, from 58 to 65 percent, according to the National Center for Health Statistics.

On the other hand, circumcision is uncommon in northern European countries, Central and South America and Asia. In Canada, where the national pediatric society recommends against routine circumcision, about a quarter of newborn males are circumcised.

In recent years, studies have reinforced earlier findings that circumcised boys and men have lower rates of urinary tract infections.

But other studies have found that circumcision reduces sexual satisfaction, prompting the introduction of a surgical technique to undo it.

Wayne Griffiths, co-founder of the California-based National Organization of Restoring Men, estimates that 7,000 men worldwide have had their foreskins restored.

Last year, the American Cancer Society entered the fray. Two cancer society doctors urged the pediatrics academy not to promote circumcision as a preventive measure for penile cancer in men or cervical cancer in their partners.

Research suggesting a link between circumcision and cervical cancer is flawed and “has not been taken seriously in the medical communities for decades,” they said in a letter. “Likewise, research claiming a relationship between circumcision and penile cancer is inconclusive … Penile cancer rates in countries which do not practice circumcision are lower than those found in the United States.”

In April, a study in the Journal of the American Medical Association added to the criticism of routine circumcision, finding that it does not lead to lower rates of sexually transmitted diseases. The study found that the incidence of herpes and chlamydia infections was even higher among circumcised men. The study also found that circumcised men have lower rates of sexual dysfunction and engage in a wider range of sexual behaviors, including oral sex, anal sex and masturbation.

UNC’s Lannon said the research needs to be reviewed carefully.

“There are studies … which some people interpret to support and others might interpret to argue against circumcision,” she said. “I’ve just come to realize how strongly people feel on both sides.”

A passionate minority believes circumcising baby boys is unnecessary and harmful.

“It’s when sex and violence meet for the first time,” said Marilyn Milos, founder and director of the National Organization of Circumcision Information Resource Center, or NOCIRC, based in California.

Milos, whose three sons are circumcised, didn’t oppose the procedure until 20 years ago when, as a student nurse, she watched in horror as a doctor circumcised a baby without anesthesia.

“Nothing could have prepared me for this experience,” she said. “I could not believe that medical professionals, dedicated to helping and healing, could inflict such pain and anguish.”

Many doctors perform infant circumcisions without anesthesia. Some believe a shot of painkiller is as painful as circumcision itself.

But others insist on injections or Emla, a topical cream made of the anesthetics lidocaine and prilocaine.

Dr. Mark Williams, a pediatric urologist in Charlotte, N.C., favors using an anesthetic.

“The argument that it doesn’t hurt in newborns is ridiculous,” he said. “They have skin and nerves.”