Circumcision needs careful study by parents

Chicago Tribune, March 28, 1999

Male circumcision has become so controversial that some doctors won't even talk about it, at least not on the record. Speakers presenting positive aspects of circumcision at medical conferences say they use an alias during hotel stays to avoid activist groups.

There's something wrong here, and it doesn't matter which side you are on. Parents need to be fully informed about whether or not to circumcise an infant boy. Doctors shouldn't make their decision, but neither should alarmist campaigns from anti-circumcision groups.

Respecting the parents' decision is about allowing them to gather information, then, most important, trust their own instincts. Respecting the infants is about examining the issue from all angles.

Circumcision lacks the neatness of absolute rights and wrongs, though not everyone agrees.

"Legally, we have no problem with the right of parents to circumcise their boys, but it's still a wrong decision when you look at their reasons," said Harry Meislahn, Illinois director for the National Organization of Circumcision Resource Centers (the acronym, NOCIRC, reveals which side it prefers).

Time was, American parents could decide to circumcise their boys for social, cultural or religious reasons and still rely on a safety net of medical evidence about protecting against urinary tract infections, sexually transmitted diseases and penile cancer. While "looking like Dad" or saving a boy from locker room teasing were among primary reasons, along with Jewish and Muslim tradition in some households, parents could always note the health advantages to any skeptics.

Times have changed.

Earlier this month, the American Academy of Pediatrics revised its policy statement about male circumcision. Based on an exhaustive research analysis, the AAP does not recommend routine newborn circumcision.

The AAP didn't say don't do it; it advised parents to make a decision based on reasons other than medical benefits. There are indeed health advantages, the AAP said, but relative risk for uncircumcised boys is not considered high enough to recommend it universally.

An uncircumcised boy has a 1-in-100 chance of developing a urinary tract infection during his first year of life, while a circumcised boy has a 1-in-1,000 chance. More than a few parents might choose to reduce the probabilities.

One NOCIRC argument focuses on increased sexual pleasure for uncircumcised men, based on the additional nerve sensors of the foreskin. Another is eliminating pain associated with circumcision, both physical and emotional.

Research on such issues is inconclusive, said Dr. Carole Lannon, a pediatrician and researcher at the University of North Carolina and chairwoman of the AAP task force.

If making the decision weren't difficult enough, parents who plan on circumcision should be checking on who will perform the procedure. One urologist said the task too often falls to a less experienced intern or resident.

Even obstetricians and family doctors delivering babies might be worried about taking too much foreskin and may not cut away enough. Such imprecision can lead to infection, bleeding and having to redo the circumcision.

Parents who decide not to circumcise their sons need to know how to properly clean the foreskin and genitals.

The best advice for parents is talk with your pediatrician, read the literature, surf the Internet, confer with family members and friends, then go with your heart and gut, no matter who disagrees.

"I see one family in which the first boy is circumcised and the second boy is not," Lannon said. "The parents explained how new information changed their minds."