Circumcision Decision

As soon as she found out she was pregnant with a boy, Cynthia Wood of Brewster researched everything she could find about circumcision.
She surfed the Internet, watched an online video and talked to other moms.
What she found was that a procedure that for decades has been routine for the majority of American baby boys but has increasingly become a more strident debate.
Traditionalists argue that removal of the foreskin that shields the head of the penis results in fewer infections and less risk of sexually transmitted disease. Some accuse of anti-circumcisionists of being a ''cult.''
Those opposed to circumcision, also known as ''intactivists,'' say the risks of infection, disease and penile cancer are grossly overblown, and there is no reason to surgically remove a healthy body part. Some intactivist bloggers have equated male circumcision with torture.
In the meantime, the American Academy of Pediatrics manages to sidestep the issue, stating that while scientific evidence demonstrates ''potential medical benefits of newborn male circumcision,'' it's not enough to recommend ''routine neonatal circumcision.''
Without a direct recommendation for or against, the academy tosses the ball to parents, who have the final call anyway.
Wood and her husband decided against circumcision for Owen, now 6, and Nathan, now 4.
They decided that foreskin removal was not only unnecessary but potentially horrifying.
''Why would you want to put a baby's brand-new brain through that kind of trauma?'' Wood asked.
Her husband, Gerry Bojanowski, agreed. ''It seems like mutilation,'' he said. ''To me, it makes no sense. At least not in this modern age.''
He likened it to pulling a child's teeth to prevent gingivitis and tooth decay.
Although the couple are part of a national trend of declining circumcision rates, they are still among the minority in the Northeast, where 65 percent of newborn males are circumcised in the hospital.
In fact, hospital circumcision rates in the Northeast have changed little between 1979 and 2003, dropping just one percentage point, according to the Child Trends Data Bank, which analyzes data from the National Hospital Discharge Survey.
What has pulled national hospital circumcision rates downward, from 64.5 percent in 1979 to 55.9 percent in 2003, is a precipitous rate of decline in the American West. Circumcisions in that region dropped from 64 percent to 31 percent. Some experts say the driving factor is the region's number of Hispanic families, who traditionally do not circumcise their baby boys.
Here on the Cape, the majority of baby boys are circumcised, said Dr. Leif Norenberg, a Yarmouthport pediatrician.
He estimated that between 66 and 75 percent of boys born at Cape Cod Hospital are circumcised, usually within the first three weeks of life.
In fact, Norenberg said, nurses say anecdotally that circumcision rates seem to be on the upswing since declining in the 1970s and '80s. Circumcision was popular in the 1950s and '60s, when rates reached 90 percent.
''It's mainly cosmetic surgery, for most reasons,'' Norenberg said.
Religion is another factor. The majority of practicing Jews routinely circumcise their sons, usually on the eighth day in a special ceremony that may be attended by multiple family members, said Dr. Patricia Fater of Complete Wellness in Cotuit. She is a mohel, a person who is specially trained to perform circumcisions according to the tenets of Reform Judaism.
Health issues are another concern of parents who favor the procedure and those who do not.
The American Academy of Pediatrics says all studies have shown an increased risk of urinary tract infections in uncircumcised boys under age 1, but the risk is still relatively low.
Infections can be treated, said Cynthia Wood, neither of whose uncircumcised boys has experienced a urinary tract infection. ''Eighty percent of the world is uncircumcised, and they don't seem to have problems with infection,'' she said.
Cancer of the penis is another concern for parents deciding whether or not to circumcise.
But, Norenberg said, ''It's such a rare cancer, it's a moot point.''
In the United States, the incidence rate for penile cancer is 1 case per 100,000 males.
''The literature on the relationship between circumcision status and risk of squamous cell carcinoma of the penis is difficult to evaluate,'' according to the American Academy of Pediatrics.
''Reports of several case series have noted a strong association between uncircumcised status and increased risk for penile cancer; however, there have been few rigorous hypothesis-testing investigations.''
Another health fear is whether remaining uncircumcised increases a grown male's risk of acquiring sexually transmitted diseases. The American Academy of Pediatrics says ''a substantial body of evidence'' links noncircumcision in men with risk for HIV infection, but notes that circumcision is no replacement for safe-sex practices.
In one case that has garnered national attention, divorced parents are battling in a Chicago court over whether to circumcise an 8-year-old boy.
The boy's mother says removing the foreskin would help prevent repeated bouts of inflammation. The father is suing to block the procedure, saying the infections can be treated with steroids.
With older children and adults, removal of the foreskin calls for sutures and general anesthesia.
''You remember it at that age,'' said Fater, who says she has known of 5- and 13-year-olds who have had to undergo circumcisions for medical reasons.
With infants, circumcision is a relatively simple procedure, although one study showed that 1 out of every 500 circumcised newborns suffered a serious side effect.
Infants typically will be given a shot of Lidocaine or a topical anesthetic to dull the pain of the procedure, which is over in a minute or two.
''Do most moms cry when I take the baby away to do a circumcision? Yes,'' Norenberg said. ''But the baby comes back and has a good feeding and a nap. Some kids scream the whole time. Some kids sleep right through the procedure.''
Without any strong medical evidence indicating the need for circumcision, Cynthia Wood said she saw no reason to put her boys through that experience. ''I really do think it's cruel,'' she said.
''It's one of those things that's a hard decision,'' Norenberg said. ''It can be quite emotionally charged.''
Parents should study the information about circumcision and come to a decision before their child is born, even if they don't know the child's sex yet, he said.

The United States has one of the highest rates of male circumcision at 60 percent, down from 85 percent 30 years ago. How do other countries stack up?

United Kingdom: 21 percent

Australia: 15 percent

Canada: 20 percent

South Korea: 90 percent, up from 10 percent recorded 20 years ago

Source: menshealth.about.com
from Cape Cod Times