The Wall Street Journal, Tuesday, May 28, 1996,

Page A21


                     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."

(File revised 10 May 2008)