Back to the News 2007 page.THE LEDGER, Lakeland, Florida, Sunday, July 8, 2007
Published Sunday, July 8, 2007Amanda Mann doesn't claim to be a perfect mother.
Like any other parent, she has her momentary lapses,
including the occasional loss of her temper, which are
understandable for the mother of four boys.
Mann doesn't castigate herself for such episodes. But
one moment from her first days as a parent does cause
her continuing remorse.
"The circumcision of my first son is the only thing I
regret as a parent," said Mann, a Bartow
resident.
Mann represents a growing segment of the American
populace, parents who have turned against the
previously routine practice of having their sons
circumcised in their first days of life. Circumcision
rates in the United States have declined from a high of
nearly 90 percent in the early 1960s to about 57
percent in 2004, according to the National Health and
Social Life Survey. The recently issued report found
rates below 50 percent in some states.
Health experts say immigration from Latin American and
Asian countries, where circumcision is not a cultural
custom, has contributed to the decline. But the
statistics suggest a rise in the number of white,
native-born parents, like Mann and her husband, Curtis
Romey, who have decided to go against the norm.
Circumcision - the surgical removal of the foreskin
from the penis - has ancient origins. In the book of
Genesis, it is described as a symbol of the covenant
between God and the Hebrews, and a passage in Leviticus
mandates circumcision on the eighth day of a boy's
life. Observant modern Jews regard the procedure as a
religious obligation, and circumcision is also common
in Islam.
Some historians say circumcision gained wide
acceptance because it was believed that removal of the
sensitive foreskin would make boys less likely to
masturbate or pursue sex. The practice, long shunned by
Christians, became prevalent among Western countries in
the early 20th century and was routine in American
hospitals by the 1950s. It remains the default choice
for many Americans.
Though official rates are not available for Polk
County, Dr. Jeffrey Puretz, a Lakeland
obstetrician/gynecologist, said he has noticed no
decline in circumcisions during his 19 years in
practice.
"Every parent is counseled during pregnancy and given
information on circumcision," Puretz said. "They
ultimately make the decision, but I haven't noticed
that most are not having their sons circumcised."
Mann, 32, hadn't given much thought to circumcision
before the birth of her first son, Zain, 11 years ago.
She recalled giving written permission for the surgery
as she signed a stack of papers in a local
hospital.
"When I changed his diaper the
first time and saw the wound he'd been given, it made
me horribly regretful and I couldn't believe I'd
allowed something so mutilating to happen to one of my
children, which I'd been given to protect," Mann said.
"At that point, it became clear to me with any future
son there was not a chance it would
happen."
Mann, a childbirth educator at
Labor of Love, a natural birthing center in Lakeland,
said Zain seemed to be in pain for more than a week
after the circumcision and had difficulty nursing and
sleeping as a result. Zain also developed adhesions -
bits of leftover foreskin stuck to the glans - that
Mann said caused the newborn boy additional
pain.
Mann said she went to almost comical extremes after
the birth of Asher, her second son.
"I was worried about him being accidentally
circumcised, so I was maybe a little overvigilant," she
said. "Anyone who walked in the room, I was making sure
(they knew) he's not going to be circumcised, even if
they were delivering a newspaper."
Nancy Moses, a friend of Mann's, arrived at the same
outlook while pregnant with her first child, who turned
out to be a girl. Four years later, Moses gave birth to
a son, John, who is now 2 and, as Moses proudly states,
not circumcised.
"I think I always knew that I
found circumcision odd, creepy and cruel, even," said
Moses, 31. "But it wasn't until I was pregnant that I
knew how horrible it would be if someone hurt my baby.
And imagine if I was the one to allow
that."
Though some gentiles cite biblical passages as a
reason for circumcision, Mann and Moses - both
professed Christians - said their spiritual covenant
obviates the need for the physical symbol of the Jewish
covenant.
Moses, 31, a stay-at-home mom, said her husband, Rob,
was at first inclined toward circumcision, "but as soon
as he learned about how it happens and how pointless it
is, he was protective of our son's foreskin."
Leading medical organizations, such as the American
Academy of Pediatrics, are neutral on circumcision. The
AAP on its Web site mentions possible health benefits
of the surgery, including a decreased risk of urinary
tract infections and sexually transmitted diseases and
the prevention of foreskin infections, but says the
"data are not sufficient to recommend routine neonatal
circumcision."
When patients ask Puretz for his advice on
circumcision, he lists the pros and cons without making
a recommendation either way on what he called an
"elective" procedure. Puretz, who is Jewish, regularly
performs circumcisions for Jewish parents as part of
the brit milah ceremony.
Dr. William Ray, a Lakeland pediatrician, said he
tells parents the practice is based on cultural rather
than clear-cut medical factors.
"Most people have made their minds up without the aid
of a physician," said Ray, a hospitalist in pediatrics
for Watson Clinic.
Ray said the most influential
factor, aside from cultural and family traditions, is
insurance coverage. In 2003, Florida joined more than a
dozen other states in dropping circumcision from the
list of procedures covered under Medicaid, the program
for low-income families. Ray said he noticed fewer
requests for the surgery after the change in coverage,
though some parents choose circumcision even if they
have to pay for it themselves.
Tabatha Richardson of Winter Haven is one of those
parents. She chose circumcision for her 10-month-old
son, Tyler, even though her health plan didn't cover
the procedure.
Richardson, who made the same decision for an older
son, said she carefully researched the issue and
concluded that circumcision made sense.
"There were just so many pros for not just the
immediate but the lifelong (health) that I decided to
do it with my second son as well," Richardson said.
"Even as infants it's easier to keep that general area
clean and free from infections with them being
circumcised."
Parents such as Mann and Moses quail at the notion of
having elective surgery performed on a newborn boy.
Mann equates circumcision with breast augmentation, and
Moses calls it "optional cosmetic surgery."
There are three prevalent methods of circumcision. Two
involve placing a clamp over the penis so the foreskin
can be excised with a scalpel, and the third uses a
thread that causes the foreskin to wither and fall off
in a few days. The newborn usually receives a local
anesthetic, either in a topical cream or an
injection.
Opponents of circumcision say the
procedure is doubly harmful, inflicting pain at the
time of surgery and reducing sexual pleasure later
through the removal of the nerve-rich foreskin.
Puretz, the obstetrician, said it isn't clear the
procedure has negative physical or emotional
effects.
"When I first trained, there were a lot of physicians
who weren't using any anesthetic at all, and I felt a
little disconcerted about that," Puretz said. "Local
anesthetics ... have virtually eliminated pain from the
procedure. A lot of babies don't even know it's going
on while it's happening.
"I don't know one way or the other how babies feel
about it later in life, subconsciously or consciously,
if they remember it," he added. "For me personally,
it's not something I remember."
Mann and Moses would rather err on the side of
caution. The two mothers also question the validity of
studies finding lower rates of HIV among circumcised
men, and they say foreskin hygiene is no more of a
challenge than keeping ears or noses clean.
Mann, whose sons clustered affectionately around her
at the family's Bartow home on a recent morning, said
she's unconcerned that Asher, Atticus or Ivan might
feel self-conscious or face ridicule for having a
different penis from other boys.
"The locker-room argument never really held a lot
water with me," Mann said. "I kind of liken it to,
well, if I had a daughter who wasn't chesty would I
consider breast augmentation for her? And the answer to
that is absolutely, unequivocally not."
Mann and Moses use such words as "amputation" and
"mutilation" in describing circumcision, they don't
align themselves with militant "intactivists" who would
like to see the procedure banned. Both said they
respect the decisions of any parents who consider the
matter carefully.
Mann said she hopes more and more parents will arrive
at the same choice she did.
"I'm proud to have three more intact boys in the
world," she said.
Gary White can be reached at gary.white@theledger.com
or at 802-7518.
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