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Circumcision choice more complex than ever

Pat Etheridge

By Pat Etheridge
CNN Parenting Correspondent

March 4, 1999
Web posted at: 9:35 a.m. EST (1435 GMT)

This news analysis was written for CNN Interactive.


In this story:

On culture, pain and pleasure

Medical benefits defended

What's a parent to do?



(CNN) -- The first big decision parents of baby boys must make is painful and irreversible. Now, the practice of circumcision faces renewed scrutiny following a new policy statement by the American Academy of Pediatrics.

"Circumcision is not essential to a child's well-being at birth, even though it does have some potential medical benefits," Dr. Carol Lannon, chairwoman of the AAP's Task Force on Circumcision, said in a statement this week.

"These benefits are not compelling enough to warrant the AAP to recommend routine newborn circumcision. Instead, we encourage parents to discuss the benefits and risks of circumcision with their pediatrician, and then make an informed decision about what is in the best interest of their child."

That means the choice, according to the AAP, can be based on cultural considerations as well as medical ones. For many, that can alter the decision-making process.

On culture, pain and pleasure

Circumcision is still routine for most baby boys in the United States.

Twins
Twin brothers, whose parents decided to have them circumcised   

Statistics vary, but every year at least 60 percent of newborn boys in the United States undergo a procedure that removes the foreskin from the penis.

In the Victorian era, doctors theorized the operation would discourage boys from masturbation. During World War II, circumcision gained popularity as a means of preventing infection.

The rate of surgery peaked in the 1960s, when about 80 percent of all males born in the United States were circumcised. There has been a slow but steady decline since then, in large part because parents feel more empowered to make their own choices.

The surgery is not widespread in the rest of world except among Jews, who consider it a religious practice. The vast majority of the world's men are uncircumcised.

A growing number of critics contend that circumcision is not only medically unnecessary, but also traumatic, and may even reduce sexual pleasure later in life.

"Circumcision is not essential to a child's well-being at birth, even though it does have some potential medical benefits. These benefits are not compelling enough to warrant the AAP to recommend routine newborn circumcision."

— Dr. Carol Lannon, American Academy of Pediatrics

"Who are we to question Mother Nature. Little boys are born this way. And just like little girls, they should not have their sexual parts cut and harmed in any way," said Dr. George Denniston, founder of Doctors Opposing Circumcision.

There is also the issue of pain. It was once thought that newborns did not experience pain in the same way as adults, so circumcisions were often performed without anesthesia.

Doctors now know that while the operation is quick, it is painful. Yet in many cases, it remains up to parents to request the use of anesthesia. For the first time, the AAP is urging parents who choose circumcision to ask that doctors provide the baby with pain relief.

Then there is the matter of sexual pleasure. There is no doubt that the foreskin is a highly sensitive erogenous zone.

The question is how much the removal of that tissue affects sexual sensation. Some men who were circumcised as adults report diminished pleasure. But others counter that there is still plenty of penile sensation following circumcision.

Medical benefits defended

Circumcision is still strongly supported in some medical circles.

Circumcision instruments
Different methods are used in medical circumcisions, including a clamping device and a scalpel   

Dr. Thomas Wiswell, a professor of pediatrics at Thomas Jefferson University in Philadelphia, once opposed the procedure but is now an ardent advocate.

He says the associated health benefits changed his mind, including: "... the prevention of urinary tract infection, the prevention of cancer of the penis, prevention of local infection and inflammation in and around the head of the penis."

"And there's also evidence that circumcision prevents some sexually transmitted diseases," Wiswell said.

These benefits are not disputed, though urinary tract infections and penile cancer are extremely rare. The AAP points out that when the uncircumcised penis is cleaned properly, the risk of infection drops dramatically.

What's a parent to do?

The ongoing debate leaves many prospective and new parents confused. Doctors generally offer information but are careful to stay out of the decision-making process.

"Instead, we encourage parents to discuss the benefits and risks of circumcision with their pediatrician, and then make an informed decision about what is in the best interest of their child."

— Dr. Carol Lannon, American Academy of Pediatrics

Mothers and fathers must also weigh medical evidence against emotional considerations. Over the years, circumcision has become a deeply rooted cultural tradition. Quite simply, in the United States, the choice often comes down to wanting the son to look like the father.

The intensity of this emotional debate puts the nation's most influential group of pediatricians in the hot seat.

The AAP's carefully worded policy statement stops short of advising against circumcision altogether. Instead, it says parents should take into account religious and cultural traditions as well as a pediatrician's advice when considering circumcision.

What remains to be seen is how the new recommendations might influence parents, and whether the rate of circumcision in the United States will continue to drop.


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CNN Interactive: Health

Pediatricians turn away from circumcision
March 1, 1999

RELATED SITES:
American Academy of Pediatrics

Pediatrics.org

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