LIFESTYLES
                                
                THE CIRCUMCISION DECISION
        LINDA BERKHOUDT O'CONNOR -   Special to The News

     The Ezquerro family's decision not to circumcise their sons,
Stanley, age 2, and Thomas, born May 12, wasn't a
spur-of-the-moment one.

     While pregnant with her first son, Lynda Sawicki de Ezquerro
spent hours at the University at Buffalo Health Science Library
poring over medical articles about the pros and cons of routine
newborn circumcision. She talked to her pediatrician and
gynecologist.

     "I wanted to double-check to see if any problems might arise
if the foreskin wasn't removed."

     But when the time arrived to make the decision, what really
made the difference was the thought of her baby boy being
restrained on a board -- with his legs and arms strapped down so he
couldn't move -- while his foreskin was forcibly separated from the
head of his penis and cut off. It made her cringe.

     So Mrs. Ezquerro and her husband, Luis, did what an increasing
number of parents are doing today: They said no to circumcision.

     "If he's born with a foreskin, he should keep it," said the
31-year-old Lackawanna mother. "I really couldn't see any benefit
to having my son circumcised."

     The Ezquerros aren't the only ones questioning the need for
newborn circumcision. For years, the medical community has debated
whether there are valid medical reasons for it.

     In recent years, more parents have decided against the
procedure, though most American boys still are circumcised. In
1979, 64 percent of newborn boys were circumcised. By 1993, that
number had fallen to around 59 percent, according to the National
Center for Health Statistics.

     Many doctors, including noted pediatrician Dr. Benjamin Spock,
oppose routine male circumcision. Some physicians are just as
convinced that circumcision has benefits.

     "At every stage of life, (males who are not circumcised) are
at increased risk for certain health problems," says Dr. Edgar J.
Schoen, senior consultant in the department of pediatrics at Kaiser
Permanente Medical Center in Oakland, Calif., and a clinical
professor of pediatrics at the University of California at San
Francisco School of Medicine.

     "(Those health problems) may be minor or major. But the
benefits of circumcision far outweigh the risks," he says.

     Even the American Academy of Pediatrics, an organization that
frequently advises parents on children's health issues, offers
little guidance. That group says that newborn circumcision "has
potential medical benefits and advantages, as well as inherent
disadvantages and risks."

     Circumcision is an elective procedure, one that is not
required by law or hospital policy. While some parents choose
circumcision for religious or cultural reasons, many opt for the
procedure because the father is circumcised.

     The most common concern friends and family voiced when the
Ezquerros decided against circumcision was that their son would
look "different" from the other boys if he weren't circumcised.

     "I said, 'Of course he's going to look different, he's
Stanley,' " recalls Mrs. Ezquerro. Growing up, she says, "we were
taught that everybody is their own individual and has their own
characteristics." Although circumcision is extremely painful, the
procedure continues to be performed without anesthesia most of the
time.

     Circumcision causes behavioral, cardiovascular and hormonal
changes in infants. They usually scream frantically. Stress
hormones rise. Blood pressure and heart rate show marked increases.
Blood oxygen diminishes. Following the procedure, the baby is
usually irritable. Sleeping and eating patterns may be disrupted.

     Not only is circumcision painful, but "it's very traumatic,"
says Dr. Michael B. Rothenberg, co-author of "Dr. Spock's Baby and
Child Care." "Whether the pain lasts a long time or not, which is
controversial, why subject a newborn baby -- who has all kinds of
adjustments to make -- to an unnecessary one?"

     Furthermore, adds Rothenberg, "any surgery carries a risk, and
circumcision is surgery."

     Counters Schoen: "If it's done by someone who knows what he's
doing, it's practically the safest operation in the world."

     So why do baby boys have a foreskin? This fold of skin covers
the head (glans) of the penis and protects it from soiled or wet
diapers, as well as abrasive clothing. As the baby grows, the
foreskin separates from the glans and becomes retractable, usually
by age 3. Throughout life, the foreskin protects the tip of the
penis and keeps the glans moist. During erection, the foreskin
covers the lengthened penile shaft. Many believe that nerve endings
in the foreskin enhance sexual pleasure.

     Other points to consider before making the circumcision
decision include:

     Newborn circumcision may lower the risk of getting a urinary
tract infection.

     "There is a very small increased risk of UTI in uncircumcised
boys under the age of 1," says Dr. Saul P. Greenfield, director of
pediatric urology at Children's Hospital of Buffalo and associate
professor of urology at University at Buffalo Medical School.

     But many doctors believe the research on UTIs is flawed and
the results unconvincing. Further, UTIs are rare -- only 1 percent
of uncircumcised infants get one -- and generally treated with
antibiotics. Besides, "you can still get a UTI, even if you're
circumcised," notes Greenfield.

     Penile cancer is virtually unheard of in circumcised men. But
penile cancer is extremely rare -- each year about seven out of a
million American men contract the disease -- and has been linked to
poor hygiene. Many believe that good genital hygiene would convey
the same benefits as circumcision. Some contend that genital
hygiene is easier after circumcision, but caring for the
uncircumcised penis is simple: Cleanse with soap and water.

     Men who are circumcised may have a slightly lower risk of
getting sexually transmitted diseases such as syphilis, HIV virus
and chancroid, but evidence is scanty.

     A small percentage -- as low as 1 or 2 percent -- of boys who
are not circumcised may later require the procedure due to of
disorders of the foreskin and penis.

     If the foreskin is removed, the exposed end of the penis may
become irritated and cause the opening of the penis to become too
small. This condition, called meatal stenosis, causes difficulty in
urination and may need to be surgically corrected.

     "I firmly believe that there's no health advantage to cutting
off a person's foreskin," says Dr. Mark Burns, a pediatric
urologist in Seattle. He considers the procedure cosmetic. "And
that doesn't take into account all the bad circumcisions."

     Sometimes too little skin is removed, giving the appearance of
an uncircumcised penis. Other times, too much skin is removed. In
some cases, the circumcision heals improperly or just looks bad.

     A parent should keep in mind that "either route is
acceptable," says Greenfield, who believes that "there are
advantages to being circumcised, but most males who are not
circumcised do not have problems."

     Your best bet is to consult with your pediatrician early so
you have enough time to make an informed decision.

     "It's a personal choice," notes Mrs. Ezquerro. "But you're
making it for your child and it will impact his life."

TABULAR OR GRAPHIC MATERIAL SET FORTH IN THIS DOCUMENT IS NOT
DISPLAYABLE
                                
     ROBERT KIRKHAM/Buffalo News Lynda Sawicki de Ezquerro and her
husband, Luis, of Lackawanna, chose not to circumcise their sons,
Stanley, age 2, and Thomas, 1 month.