Date: Wed, 22 Mar 1995 10:45:36 -0500 From: CircInfoNe@aol.com Subject: Action Alert, St. Petersburg Times >From the St. Petersburg Times, Friday, March 10, 1995 ------------------------------------------------------------------------- MAKING THE CIRCUMCISION DECISION Bruce A. Epstein, M. D. More Parents are considering the both sides of the question before answering the question, "Do we or don't we?" Parenting is full of decisions, and the first one some parents have to make is whether to have a newborn son circumcised. This minor surgical procedure removes the foreskin or tissue that covers the end of the penis and is usually done within days of birth by an obstetrician or certified nurse midwife. (pediatricians do not generally do circumcisions). There are physicians and parents who stand firmly on both sides of an issue, and particular studies and magazine articles can be used to support each point of view. For some parents, religious or cultural decisions make this decision automatic. For others the choice is personal. In addition, there are some situations in which circumcision is not indicated: infant boys who are ill, genitourinary malformations or when there is a known history of bleeding problems. Most Americans would be surprised to learn that more than 75 percent of the world's male population is not circumcised; yet until recently circumcision was almost routinely performed in the United States. But in 1975 the American Academy of Pediatrics said that "there is no valid medical indication for routine infant circumcision of the neonate." This statement was followed by a reduction in the circumcision rate, from 90 percent in 1979 to 60 percent of newborn males in 1986. In the late 1980s, however the academy made a subtle but significant change in policy by concluding that there were "medical benefits and advantages" to routine circumcision. With this announcement the circumcision rate began rising to earlier levels as many physicians began to rethink their positions. The Academy's Task Force on Circumcision based its revised report on new studies that showed uncircumcised boys were 10 times more likely to get urinary tract infections than their uncircumcised counterparts. Other studies- suggested lower risks of contracting gonorrhea, herpes, yeast and HIV infections among circumcised men. Furthermore, uncircumcised men had a higher rate of infection with human papilloma virus - a virus associated with penile and cervical cancers. Before these statements, many parents had their newborn sons circumcised for other reasons. One was so that the boy will "look like his father." A boy's self-image would be stronger, parents felt, if his anatomy reflected that of his father or brothers. Furthermore, boys mature, they compare themselves with other boys in school locker rooms and it was felt that a boy might develop negative feelings if he looked radically different from his peers. Another reason parents had their sons circumcised was to enhance cleanliness since it is more work to keep an uncircumcised penis clean, no matter how well it is washed. Probably the strongest medical argument favoring circumcision is its ability to curb infant urinary tract infections. Uncircumcised boys, ages 1 week to 8 months, are ten times likelier to have this type of infection than those circumcised. Childhood urinary tract infections usually require hospitalization and can scar fragile young kidneys or even lead to kidney failure. Urinary tract infections can also lead to potentially fatal meningitis and generalized blood infections. The major argument against circumcision is that the procedure is surgery, and any surgery carries risk of complications. Fortunately the risk is rare occurring in one of 500 circumcised newborns. The most common problems include bleeding, post-operative infection and scarring. Parents who do not favor circumcision also feel that any boy can be taught good hygiene by gently retracting the foreskin until resistance is met (full retraction does not occur until age three), and washing well with soap and water. In addition, circumcision is painful. Although local anesthesia techniques have been developed in recent years, experts disagree about their effectiveness. Parents must weigh the pros and cons when deciding where to have a son circumcised, remembering always to consider circumcision as they would any to her procedure for their child. There are risks to retaining the foreskin and risks in having it removed, but the difference is probably too small to help "swing the vote" in either direction. ___________________________________________________________________________ This column is meant to draw attention to the issues discussed and should not be relied on as medical advice. It is not intended to replace the advice of your child's physician. Dr. Bruce A. Epstein has practiced pediatrics in St. Petersburg since 1973. He is a member of the American Academy of Pediatrics. He is married and has three grown children and a granddaughter. SHARE YOUR OPINIONS Letters for publication should be addressed to Letters to the Editor P. O. Box 1121 St. Petersburg, 33731 Or they can be sent by facsimile machine by calling the times fax number: 893-8675. They should be brief and must include the handwritten signature and address of the writer. Letters may be edited for clarity taste and length. 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