POSITIVE ACTION ALERT TIMES ADVOCATE John M. Armstrong, Publisher Richard K. Peterson, Editor Logan Jenkins, Editorial Page Editor 207 E. Pennsylvania Ave. Escondido, Calif., 92025 Tel: (619) 745-6611 Fax (619) 745-3759 TAOpinion@aol.com 1 Aug 95 A PAINFUL CHOICE Stories by Cindy Siok MORE PARENTS ARE PASSING ON CIRCUMCISION Why do North Americans circumcise their newborn boys? Muslims and Jews practice circumcision as part of their religious tradition, but being in North American isn't a religion. The majority of the world's men aren't circumcised, yet it is the most common surgery in the United States. Most parents are given the option to have their son's circumcised at birth and, though the health benefits are dubious, many choose it. Circumcision rates are gradually declining in this country as parents discover there is no real medical reason for the routine removal of a boy's foreskin. Confusion, outdated information and controversy surround the subject - even the American Academy of Pediatrics has flip-flopped its position on circumcision in the past 20 years. In 1975, the organization stated, "there is no valid medical indication for routine circumcision of the neonate." Then in 1989, the organization outlined medical benefits of circumcision including reduced risks of infant urinary tract infections, less risk of penile inflammation and possibly less risk of penile cancer and sexually transmitted diseases. The updated recommendation of the American Academy of Pediatrics says parents should familiarize themselves with all the pros and cons before deciding what to do. But studies showing an increase in urinary tract infections among uncircumcised boys "may have been influenced by selection bias," according to the Academy of Pediatrics after the 1989 statement. Even so urinary tract infections are rare in men or boys altogether compared to women. And studies at the Center for Disease Control have not found circumcision to be either protective or a risk factor for AIDS or HIV infection. And other research shows that circumcision does not prevent penile cancer, a disease so rare more people die from circumcision complications than from cancer of the penis. Aside from religious reasons, most circumcisions are justified on the basis of personal hygiene, yet 85 percent of the world's men are not circumcised which indicates the penis is easily cared for. "Cleansing the intact penis is simply a matter of common sense," say Milos and Macris in their article. Opponents of routine infant circumcision say removing a baby boys foreskin to keep the rest of the penis clean is like pulling teeth instead of brushing them. "it seems a bit radical to substitute a knife and surgery for a little diligent cleaning with soap and water." writes Dr. Thomas J. Ritter in his book, "Say No to Circumcision!" Dr. Ritter, who is uncircumcised, said he thinks it's preposterous to presume members of the male population cannot properly care for their penises. "I feel that it's an insult to presume that a child who would grow up to clean his fingernails, blow his nose and brush his teeth . . would be too stupid to learn how to retract the foreskin and wash the glans penis - a procedure no more difficult than washing a finger," said Ritter. Another common reason given by parents and doctors to have circumcision done is to prevent the procedure having to be done later, when the child will remember the pain and trauma of the incident. In the United States, studies have shown the rate for older infants is as high as 15 percent. But, in Finland - a non-circumcising country - the operative rate is only .006 percent. In Britain 1 to 2 percent of boys need circumcision for medical reasons. The differences reflect an American attitude that the foreskin is expendable and the tendency to remove it at the first sign of trouble. Not only do medical studies show there's no compelling medical reason to routinely circumcise boys, medical research shows the foreskin serves a useful medical purpose. A July 1992 medical journal article by Dr. George Denniston explains that in infancy the foreskin protects the head of the penis from irritation and fecal matter. In adulthood the foreskin accommodates an organ that is capable of marked increase in size and is one of the most sensitive areas of the penis because of its concentration of complex nerve endings. Men circumcised as adults commonly complain of the loss of sensitivity. Dr. Ritter quotes several men's statements in his book, one Denver man had the following to say: "After 30 years in the intact state, I allowed myself to be persuaded by a physician to have the foreskin removed - not because of any problems at the time, but because, in the physicians view, there might be problems in the future. That was five years ago, and I am sorry I had it done now from my standpoint and from what my female sex partners have told me. For myself, the sensitivity has been reduced by at least 50 percent . . ." Frederick Hodges of the National Organization to Halt the Abuse and Routine Mutilation of Males (NOHARMM) says women are also victims of circumcision because the removal of the foreskin can create problems during sex. Hodges said a sexuality study done in the United States named dryness, friction, and pain as the three most frequent complaints of women. The foreskin contains lubricating glans which, Hodges said, could be a benefit for women who complain of dryness. Circumcision has not always been common in the United States. It was introduced to the English speaking world during the 1860s as a cure for masturbation. At that time, Masturbation was believed to cause a variety of diseases and if a boy was caught in the act the consequence was often circumcision. The procedure became popular in the 1940s and 1950s and form 1950 to 1970 baby boys in the United States were routinely whisked away to be circumcised without parental consent. That ended in 1970 when hospitals were required to have parental consent forms signed for any surgical procedure. Four local doctors said the decision to circumcise is entirely up to the parents personal desires. The doctors said the procedure is not medically necessary, although Escondido obstetricians and gynecologists said they'd both recommend he procedure if a patient specifically asked for their opinion in order to reduce the risk of boys having urinary tract infections. Trifunovic and fellow Escondido OB/GYN Dr. John Hanig also mentioned that they'd rather remove a newborn's foreskin than have to remove it later on. While Jones said he hasn't really noticed the practice of circumcision on the decline in the 35 years he's been practicing, Hannig and pediatrician Doug Dechairo said they have both noticed the procedure requested less often. Newborn circumcision also presents ethical and legal questions in the opinion of pediatrician George L. Williams, who stated in an October 1992 presentation to the Second International Childbirth Conference: "Do parents have the right to choose medically unnecessary and harmful cosmetic surgery for their children? I do no believe so." THE PROCEDURE: WHAT DO BABIES GO THROUGH? "Often the less there is to justify a traditional custom, the harder it is to rid of." -Mark Twain Most people avoid unnecessary medical procedures, but newborn circumcision continues to be a popular choice with American parents. The rate of circumcision is dropping by as much as 10 percent every three years according to Frederick Hodges, a member of National Organization to Halt the Abuse and Routine Genital Mutilation of Males (NOHARMM). But despite dropping rates, the United States is the world's most prevalent circumciser with 50 to 75 percent of the population being circumcised according to a 1993 report. In Canada and Australia about 25 percent of the population is circumcised, but in other countries the practice is rare. In fact, 85 percent of the men in the world are not circumcised. In the United States, parents must consent to the procedure before it can be done. The procedure takes five to 15 minutes and is usually done without anesthetic, because the side effects are considered too risky. "We were told that babies don't feel very much but we know that babies do feel, at least as much as adults do," said a St. Vincent Hospital Nurse in a 1995 article. After parents consent to circumcision the surgical area is cleaned and the foreskin is removed after a special instrument or plastic ring is applied. In most cases bleeding is minimal and easily controlled. Usually ointment and gauze are applied to protect the cut from rubbing against a diaper. Most babies begin crying after being strapped down in preparation for the surgery and shriek, struggle and whimper thoughout the procedure. Many parents believe their babies didn't feel any pain and some report that their baby actually slept though the circumcision. However the relaxed state may be deceptive according to a medical journal article by nurses Marilyn Milos and Donna Macris which states: "Some babies respond to the trauma by going into a semi-comatose state. They only appear to be sleeping. The physiological and behavioral changes associated with the pain of circumcision have been well documented." Other babies become breathless from the shrill, continuous screaming and are limp and exhausted after the procedure. If left uncircumcised, infants do not require special care as is commonly believed. Parents should wash both circumcised and uncircumcised babies with soap and water and no attempt should be made to pull back the foreskin of an uncircumcised infant until it becomes naturally retractable - usually when the child is three or older. After the foreskin is retractable, boys should be taught to wash their penis, including under the foreskin just as they wash every where else.