Intelligencer Journal  Lancaster, PA
               Copyright 1996 Lancaster Newspapers
                                
                      Tuesday, May 7, 1996
                                
                            LIFESTYLE
                                
        Parents must weigh pros and cons of circumcision
                         Charlene Duroni

     To circumcise or not to circumcise - it's an ongoing debate in
the United States, where the current rate of circumcised infants is
more than 80 percent, according to Dr. William S. Martens II of Red
Rose Pediatrics.

     Martens, who has been in practice for almost 20 years, says he
has seen the numbers rise and fall with the controversy. "When I
came out of residency, close to 90 percent of white males were
circumcised. At that point it was considered medically indicated,
without anyone having looked at it other than it was the custom,"
he says.

     Then in the early to mid '80s, Martens says, the procedure
began to be regarded as unnecessary surgery. Many insurance
companies stopped paying for it. There wasn't much literature to go
on as to why it should be done, and there was an obvious savings in
medical costs if it was not. The percentage began to fall. Less
than 80 percent of white and black male babies were being
circumcised, and the numbers were at about the 50 percent range for
Hispanic infants. In other parts of the world, less than 25 percent
of infant boys are circumcised, as reported in the January 1996
issue of Reader's Digest.

     The American Academy of Pediatrics held the position that
there were no clear indications for circumcision and it was
something that should be discussed and decided between parents and
the physician. "Basically it was more a social and emotional choice
than it was a medical choice," Martens says.

     In matters of simple hygiene, Martens says there is a good
case to be made for circumcision, as it expedites cleanliness and
decreases the possibility of infection. He adds that, in instances
where recurring infections of the foreskin have led to circumcision
later on, the procedure becomes much more complicated.

     Between 2 percent and 5 percent of uncircumcised males do
eventually require the procedure as youngsters or adults, Martens
says. "This is relatively major surgery compared to the newborn
circumcision, where the foreskin is much thinner and easier to
remove without much bleeding. Older males need to be sutured and it
requires general anesthesia and major discomfort."

     By the early '90s, Martens says, several factors began to turn
public, and medical, opinion toward circumcision. For one thing,
there was a changing climate in the health-care industry. Many HMOs
began to include circumcisions in their coverage. The state, which
had stopped paying for circumcisions in the '80s, was again
covering them.

     Evidence about the medical benefits of the procedure began to
surface, too. Martens says a study of more than 200,000 male
infants determined that there was a significantly higher incidence
of urinary tract infections in the first few months of life in
uncircumcised infants.

     "The problem with early infections is that they may lead to
chronic renal infections, scarring and eventually renal failure,"
Martens says.

     There were other studies that indicated circumcised males were
less likely to spread sexually-transmitted diseases, and
circumcision was found to be an almost guaranteed preventive
against cancer of the penis.

     "Cancer of the penis almost always involves the foreskin,"
Martens says. "It is almost unheard of in circumcised males." He
points out that while this form of cancer has a high mortality
rate, it is a fairly rare disease and generally affects men in
older age. "But it does occur and is preventable by circumcision,"
he adds.

     Such findings have begun to swing the pendulum back in the
other direction and national circumcision rates have climbed into
the upper 80th percentile, Martens says. The Academy, too, has
changed its position to read that there may be some indications for
the procedure. However, it is still a decision to be made by the
parents and their doctor.

     In this county, Martens says, circumcisions are done primarily
by pediatricians and family physicians. Some years ago the
procedure was often performed by obstetricians almost immediately
after birth. Today, however, conventional wisdom dictates that the
baby needs to be stabilized for at least 6 to 8 hours to make sure
he is healthy and able to withstand the procedure, according to
Martens.

     To help parents decide what to do, the American Academy of
Pediatrics has published the pamphlet, "Circumcision: Pros and
Cons, Guidelines for Parents." Along with the pros, the pamphet
points out some reasons parents may choose not to circumcise their
infants. Like any surgery, the procedure has some risks, although
they are considered minimal. Also, the foreskin is viewed by many
as an important part of the human body, necessary for the
protection of the tip of the penis. It further states that many
believe that circumcision will desensitize the tip of the penis,
causing a decrease in sexual pleasure later in life.

     "Another reaction that I have heard against it," Martens says,
"is that the person being operated on has no choice."

     To receive a copy of the publication, write to American
Academy of Pediatrics, Division of Publications, 141 Northwest
Point Boulevard, P.O. Box 927, Elk Grove Village, IL 60009-0927.

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