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— Over just the past week, two reputable medical journals published articles on male circumcision and came to totally different conclusions, leaving parents of newborn boys with a stark realization they are on their own, without a consensus from the medical profession.
In the most recent issue of the Archives of Pediatric and Adolescent Medicine, Dr. Thomas Quinn of Johns Hopkins University and colleagues argue that the American Academy of Pediatrics ought to revise its circumcision policy which states that scientific evidence of potential medical benefits is “not sufficient to recommend routine neonatal circumcision.” The essay’s authors want new guidelines to reflect recent and substantial evidence of circumcision’s health benefits.
Meanwhile, in the Annals of Family Medicine, Caryn Perera of the Royal Australasian College of Surgeons in Adelaide, Australia, and colleagues argue that “current evidence fails to recommend widespread neonatal circumcision.”
The two groups of authors came to their disparate conclusions after looking at the same set of evidence and making a judgment call — pretty much what new parents have been expected to do since routine male circumcision became a political issue more than 25 years ago.
As a result some parents find themselves wrestling with the decision. Posts on message boards visited by parents-to-be reflect the problem: “So much pressure from family friends to get it done, but my gut told me not to” wrote Kelly714 on the Café Mom Web site.
Collin Childers, a 25-year-old first-time father had his son Colton circumcised two days ago at Sharp Mary Birch Hospital for Women & Newborns in San Diego. Nobody gave him advice either way, he said, and Childers didn’t really do any research on the issue. He ultimately decided that since most men he knew, including his family members were all circumcised and since he’d heard that “it’s cleaner, it doesn’t allow bacteria to grow,” Colton would join the family tradition.
Family precedent is how many such decisions are made — like father, like son, said Dr. Jean Robertson, a pediatrician in Lancaster, Ohio.
“I would have to say that most infants whose fathers are circumcised end up getting circumcised,” she said. When parents are conflicted, she said, they don’t usually ask about health benefits, they ask about the pain of the surgery and most parents who get their newborn boys circumcised “desire it for the cosmetic effects.”
The lack of consensus leaves a wide opening for anti-circumcision campaigners. Just as actress-turned-autism-activist Jenny McCarthy’s scare mongering over childhood vaccines only makes the job of parents tougher, so-called “intactivists,” are trying to scare parents with wild hyperbole like equating circumcision to female genital mutilation — which is about like equating an appendectomy with an amputation.
In this age when parents agonize over pre-natal kindergarten enrollment, finding organic strained peas and which brand of $1,000-stroller will survive an impact with an Escalade, who needs foreskin angst? Especially when the issue isn’t really that complicated.
Circumcision has been around since before recorded history. Still, most American males were not circumcised routinely until the post-World War II era. Today about 80 percent of American males are circumcised, though rates vary by region.
As of 1999, the latest figures available from the Centers for Disease Control and Prevention, 81.4 percent of all baby boys in the Midwest were being circumcised, compared to 36.7 percent of baby boys in the West. On the East Coast, 65.4 percent of baby boys were circumcised.
The regional difference is at least partly explained by prevailing attitudes among ethnic groups, with Hispanic boys being much less likely to be circumcised.
Anti-circumcision movement
Starting in the late 1980s a no-circumcision movement began questioning the practice.
Anti-circumcision campaigners focus their objections on several issues. First, they accurately point out that the foreskin is rich in nerves and that cutting it away removes erogenous tissue.
Second, they argue that circumcision is usually medically unnecessary surgery and that it carries risks like bleeding or infection. Most men, they say, never have a problem with their foreskins and if parents are willing to hold a brief hygiene seminar — and the penis’s owner is willing to perform some simple routine maintenance — there is no reason why they should. Any possible benefits of circumcision are hypothetical at best, they say.
Finally, they argue that the decision doesn’t really belong to the parents — it belongs to the baby boy, and he’s in no position to conduct a risk/benefit analysis.
Those arguments are not necessarily wrong, just woefully incomplete.
Your newborn son’s sexual pleasure may not be much on your mind, but eventually it will be on his mind, so parents may fear that cutting away erogenous tissue might be a sin the young man will never forgive.
In an editorial accompanying the Pediatrics essay, Dr. Michael T. Brady of Ohio State University points out that studies on circumcision and sexual pleasure are all over the map, leaving parents once again without clear guidance on that point.
The possible complications cited by intactivists, Brady told me, are “exceedingly rare.” Circumcision does carry very small risks for bleeding and for infection, but, he said, these have been minimized. One big change in the last generation is that babies are now given pain medication before and sometimes after surgery. In the past, baby boys had to tough it out.
Medically necessary?
A more nuanced issue is whether circumcising newborns is “medically necessary” surgery. By the usual definitions it’s not. Circumcision does not cure anything and a foreskin isn’t a deformity. This is partly the basis for Perera’s objections.
She does, however, acknowledge the validity of new data on preventing sexually transmitted diseases, the same data that led Quinn and colleagues to lean the other way. These studies show that circumcision reduces the risks of HIV infection and other viral STDs like herpes and HPV, the human papilloma virus, some strains of which can cause penile and cervical cancer. There is some evidence that male circumcision reduces the risks of bacterial STDs, too.
Male circumcision also has other preventive benefits, too, such as reducing the risk of urinary tract infections, especially in boys younger than a year old.
Confusion arises because these are possible benefits, not a sure thing. As Brady told me, on one hand “your child may be one that is spared getting HIV,” but on the other hand, “he may never even have that risk” in the first place.
There are two other non-medical points that parents often consider, ones most doctors won’t mention because they aren’t politically correct considerations: convenience and looks. Circumcision can be more convenient for parents and for the boy. Second, with four out of five males in the U.S. circumcised, at some point after his first gym class you may have to take that non-circumcised chip off the old block to a museum to show him some Greek urns so he understands that he is perfectly normal.
Deciding to skip a circumcision can be a responsible choice. So can opting for one.
“It is important to give parents information,” Brady explained. “Then they can make the decision they think is in the best interest of the child and (doctors) should be supportive of that.”
So ignore the politics swirling around circumcision; they only obscure the issue. No parent needs what may be the first decision they make on behalf of their child to become a morality play.
