THE CIRCUMCISION NEWS LIBRARY
The Wall Street Journal, Tuesday, May 28, 1996, Page A21 ANXIOUS PARENTS QUESTION MERITS OF CIRCUMCISION By KEVIN HELLIKER Staff Reporter of THE WALL STREET JOURNAL The age-old procedure of circumcision is the increasingly controversial center of a modern-day debate. At issue is whether the procedure -- the surgical removal of the foreskin from the penis -- is beneficial, medically unnecessary or even harmful. Studies abound but are often contradictory. Many physicians -- as well as the colleges that govern pediatricians and obstetricians -- decline to take a position, leaving the decision up to parents. "It's just one of those issues that you don't argue, because everyone has a strong belief about it," says Frank Hinman Jr., clinical professor of urology at the University of California at San Francisco. It is an issue that is particularly American. Although Jewish and Islamic males throughout the world undergo circumcision as a ritual, males of other faiths outside the U.S. are almost without exception uncircumcised. And most U.S. physicians agree that circumcision is culturally, rather than medically, indicated. As recently as 1980, circumcision in this country was routine and rarely mentioned: In that year,about 90% of newborn males in America were circumcised. Today, only 60% undergo the procedure, and the topic is discussed over and over by confused, even anguished, prospective parents and throughout the medical community. Anticircumcision groups have sprung up, the largest of which is Nocirc, founded by Marilyn Milos, a California nurse. The talk focuses on reams of conflicting data, often from eminent sources. Edgar Shoen, an Oakland, Calif., pediatrician and a prominent proponent of circumcision, feels so strongly about it that he publishes sentimental poetry supporting the procedure. Seattle physician George Denniston is so strongly opposed to circumcision -- he calls it "a national tragedy" -- that he carries pickets and proselytizes other physicians. Each side has its evidence. Proponents cite recent studies by researchers around the world that have shown uncircumcised men to be at higher risk for penile cancer and various diseases, including AIDS. Moreover, foreskin-related problems require as many as 10% of uncircumcised males to undergo the procedure postinfancy, when it is much more traumatic. Scores of recent studies have also shown that urinary-tract infections, which are uncommon in circumcised males, occur in from 1% to 4% of those who are not. In one in every 100 cases of infant UTI, the newborn kidney suffers damage that results in failure of the organ as an adult. Pauline Corso, a hospital administrator in Philadelphia, worries about that. Before the 1991 birth of her son, she did a lot of reading on circumcision and concluded that "there's no medical argument for it, and lots of other boys aren't circumcised, so why do it?" Three urinary-tract infections later, she says, "I feel I made the wrong decision." Opponents of circumcision say the procircumcision studies are tainted by greed -- the $10,000 a year, before expenses, that circumcising physicians can typically earn from the $150 fee -- and call the procedure needless torture. But practitioners say it doesn't appear to hurt that much. "I do 30 to 40 circumcisions a year, and if I saw any indication that it was torture I wouldn't do it," says Sarina Schrager, a family practitioner in Berwyn, Ill. After all, she says, "I'm not aware of any medical benefit." Nearly all insurers pay for circumcision, but that doesn't mean they view the elective procedure as a medical necessity. In a 1994 letter defending Blue Cross Blue Shield of Utah's decision to reimburse for circumcision, vice president W. Knox Fitzpatrick said that "it has been known for decades that circumcision provides no demonstrably medically necessary purpose, [but] it is rooted in our culture." Adult males who underwent circumcision in infancy are adding their voices to the debate. "Forcefully restraining an infant and cutting off part of his genitals can have a very deep psychological impact on him as a man," says Ron Goldman, who relates many such stories in an upcoming book called "Circumcision: The Hidden Trauma." Other men claim that circumcision has a desensitizing effect on their sex life. Circumcision opponents are seizing on the national outcry over female genital mutilation -- a common rite in Africa -- and the recent U.S. Senate vote to criminalize that procedure. A North Dakota law prohibits any surgical alteration of the genitals of underaged females, and circumcision opponents hope to force an extension of that protection to underaged males. "There is no medical or legal basis for distinguishing male from female circumcision," says Zenas Baer, a Minnesota plaintiff's attorney recently retained to challenge the constitutionality of North Dakota's law. Amid all the passion, one physician counsels parents to put the issue in perspective. "Compared with the other decisions you've got ahead of you as a parent, this is trivial," says Ronald Poland, a Pennsylvania pediatrician. "If you can't get past this one, you're in trouble."