THE PRESS-CITIZEN, Iowa City, Iowa, Monday, July 28, 2003

Gannett News Service


Once a widely accepted procedure among American doctors, male circumcision has experienced a steady decline in the last few decades.

Circumcision of newborns peaked in the United States some 30 years ago at about 85 percent to 90 percent, says Dr George Denniston, president of Doctors Opposing Circumcision, a Seattle based-anti-circumcision organization with members worldwide. These, days, those numbers are around 55-60 percent, he says. The rates are even lower In the western states of California, Oregon and Washington, which have a combined rate of 35 percent, Denniston adds. Some states also have stopped covering circumcisions under Medicaid.

Denniston attributes the decline to increased awareness among parents of what he considers a dangerous, needless, procedure.

"It doesn't take anybody with an IQ over 70 to realize that taking off half the skin of a normal penis causes problems," Denniston says. "There's not a single medical association in the entire world that approves routine infant circumcision."

Others, however, point to studies showing the benefits of circumcision. These include reduced risk for urinary tract infections in babies and penile cancer in older men, and potential benefits in preventing HIV.

Then there are the religious and cultural reasons behind the procedure.

"It's a ritual that celebrates the covenant into the Jewish (religion)," says Rabbi Myra Soifer of Temple Sinai in Reno, Nev. "Its central to the Jewish faith because that's how Abraham came into the covenant as the first Jew and agreed to the foundation and theological commitment that is now Judaism."

No one can quite peg the origins of circumcision, which dates back even further than Biblical accounts of Abraham, according to the online Circumcision Information and Resource Page.

"It's one of those things that have been done for a long time and nobody even knows why it started," Denniston says.

In the, 1800s, circumcisions were encouraged by some doctors in the United States as a way to prevent boys from masturbating. These days, the touted benefits for circumcision are more grounded in science than the masturbation-induced madness and eternal damnation that old proponents used to warn people about.

A common advantage mentioned is easier hygiene, although this is more a convenience factor and not a pressing need, says Dr. Catherine Wagoner, a pediatrician. Proper hygiene, or the lack thereof, might be considered as an indication for circumcision in men who are either too old or unable to properly clean underneath the foreskin, since this can cause infections, Wagoner says.

Circumcision also is used to treat phimosis, a rare condition in which the foreskin is too tight to be pulled back. In some cases, this condition can restrict blood flow to the head of the penis.

Studies show that babies who are circumcised have a significantly lower risk for urinary-tract infections during their first year - about a one in 1,000 chance as opposed to one in 100 for their uncircumcised counterparts. Some studies also show increased protection against genital warts and sexually transmitted diseases such as gonorrhea and syphilis, and a reduced risk of penile cancer in men and cervical cancer in female partners.

One of the strongest findings for circumcision's benefits appeared 'in the June 10, 2000, issue of the British Medical Journal. The study found that circumcised men are two to eight times less likely to contract HIV through sex. Researchers said the likely culprits were cells with HlV receptors found in the inner surface of the foreskin. Although stopping short of recommending routine male infant circumcision, the researchers went on to suggest circumcision an additional means of preventing infection, especially those in central and southern Africa.

Anti-circumcision advocates, though, are quick to dismiss the mentioned benefits.

Hygiene, for one, shouldn't be a problem as long as boys are taught how to clean underneath the foreskin properly, Denniston says. Urinary tract infections also should be treated just like any infection - with medication, not by cutting off the foreskin, he added. And as far as phimosis goes, even the worst cases should be treatable by regularly stretching the foreskin, he says. Denniston also dismisses the studies about circumcisions medical benefits as inconclusive, adding that a study has yet to come out with strong enough findings to recommend routine routine infant ciremcision.

For some, that is an argument that cuts both ways.

If you look at the reseach there's no reason to do it or not to do it," Wagoner says.

The American Academy of Pediatrics mirrors Wagoner's view. in its circumcision policy released in 1999, the AAP states that circumcision does have some potential health benefits, although those benefits aren't significant enough to recommend routine circumcision. The AAP went on to say that the decision for circumcision ultimately rests on parents, a neutral stance that ultimately doesn't forbid or encourage the procedure.


For Denniston, the AAP response is largely political.

"The AAP said the data is not sufficient to recommend routine circumcision," Denniston says. "Either data is sufficient or insufficient ... but they go on to waffle because it's a 'CYA' operation - Cover Your Ass. If they said it absolutely shouldn't be done, then they open their members for lawsuits. They're trying to ease their way out of this."

Cultural Decisions:

With the medical debate for circumcision raging to a standoff, the driving force behind circumcision now largely rests on two factors- culture and religion.

For anti-circumcision advocates, these could be the biggest roadblocks of all.

People like Denniston, for example, cite psychological damage to infants due to pain and to boys who realize "they aren't whole" when they first learn about their circumcision.

In some cases, though, not being circumcised also opens a boy to the same psychological trauma due to ridicule from circumcised peers. This is especially worse for boys in cultures that traditionally circumcise their adolescents as a rite of passage to manhood.

Soifer whose religion has been practicing circumcision for thousands of years, also doesn't agree with the way anti-circumcision proponents portray the procedure as being highly dangerous.

"Some doctors raise issues of psychology and, of course, none of us can ever really know what's going on inside the head of a tiny baby," Soifer says. "I think there are a lot of questions one can raise about circumcision but I think the fact that it's medically dangerous is not factually verifiable."

Some don't even need reasons of higher purpose, such as culture and religion. For others, the preference for circumcision boils down to good, old looks - not just in the eyes of men but for female partners as well.

With many women, the preference doesn't stop there. Even Denniston, who says that circumcised males feel less sexual pleasure because of the removal of the highly sensitive foreskin, admits that there is a common view among women in the United States that sex with a circumcised penis feels better.

"It's in the eye of the beholder," says Denniston, adding that the perceived extra pleasure is likely psychological.

With the medical debate at a standstill and the strong influence of religion and culture, circumcision in the United States will likely stay at the near 50-50 split it's been hovering at lately. For people like Wagoner, that isn't exactly a bad thing.

"You can go through your whole life either circumcised or uncircumcised and be completely fine," Wagoner said. "It still remains a parent's choice."

(File prepared 4 August 2003)