Circumcision losing favor with U.S. parents

When Nancy McIlvaine told her parents that her newborn son wouldn't be circumcised, her mother gasped. McIlvaine, who lives in Napa with her husband, Willem Maas, said she consulted with health professionals about circumcision and never heard a compelling reason to snip her baby's foreskin.

"It's just inflicting pain to a newborn when there doesn't seem to be any evidence of it being beneficial," said McIlvaine, who gave birth to Theodore on June 8.

McIlvaine is part of a growing trend away from male circumcision. According to the Centers for Disease Control and Prevention, the circumcision rate in the United States dropped to 55.9 percent in 2003 -- an all-time postwar low. In the early '60s, it peaked at 90 percent.

In the Bay Area, the numbers are even lower. Dr. Laurence S. Baskin, chief of pediatric urology at UC San Francisco, said, "I would say it's only 40 percent in San Francisco. People are more educated about the reasons for it now. In the past it was part of the package: You had a boy, he was circumcised and you would be sent home with a car seat, and that was it."

Immigration also is a big factor in the decrease in male circumcision nationwide, Baskin said. Among Asian cultures and Latin American cultures, circumcision is the exception, not the norm.

During the 1950s, the rate of routine infant circumcision leapt from 50 to 90 percent in response to the advice of medical doctors, like the author Dr. Benjamin Spock, who argued that it was beneficial.

But in 1999, after decades of debate, the American Academy of Pediatrics issued a policy statement on circumcision stating, "Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision."

When Baskin speaks to parents of infant boys, he describes the pros and cons of the procedure. On the pro side: Circumcision can decrease the likelihood of urinary tract infections, penile cancer, HIV and sexually transmitted diseases. On the con side: Circumcision has a small risk factor, like any surgery, and in most cases is unnecessary. With good hygiene, an uncircumcised male can maintain good health throughout life.

Baskin said that most of the clinical studies measuring the reduction of HIV, STDs and penile cancer were conducted in sub-Saharan Africa and "not really germane to people living in San Francisco." Penile cancer, he said, is a problem in Africa but almost unheard-of in the United States.

Dan Savage, a popular sex adviser whose Savage Love column is syndicated to 70 newspapers, has a 9-year-old adopted son, Daryl. When he and his partner, Terry Miller, made the decision not to circumcise, he said, "My parents didn't interfere. They had their three sons circumcised because that's what everyone did, but they're informed enough now to know that it's not what everyone does. It's a choice that parents make."

Initially, Savage said, "there was some discussion on my boyfriend's part of wanting him to look like us. All I had to tell him was, 'I don't remember ever comparing penises with my dad. You don't sit around the Thanksgiving dinner table, haul it out and say, 'Hey, don't we all look alike!' "

Stacy Nye of Redwood City agrees. She has an uncircumcised 8-year-old son and says the like-father-like-son argument is absurd. "Dr. Dean Edell (the talk-show host) made a good point on his show once when he said the penis is the last thing that others see to compare a father and a son, unless you hang out at a nudist colony."

Even among young Jewish parents, there has been a change. Jonathan Marks, a Marin County real-estate agent, said he and his wife, Paula, did a "vast amount of research" when their son, Gabriel, was born five years ago.

"I can't say we were torn about it. Actually, we were torn, but only in the expectation of others around us and especially my Jewish heritage. But after doing the research and speaking with midwives and others around us with boys, we decided that the trend at the time was moving away from this blanket circumcision edict that comes down from God knows where."

"It comes up frequently in my column," Savage said. "Where it really creates conflict and stress for my readers is when they're young, hip, alternative-scene Jews who may not even be practicing. But suddenly they're having a boy, and they get all this pressure from their families. I know one couple who were disinherited, and they went ahead and didn't do the circumcision anyway."

Jeff Lewis, a San Francisco optometrist who practices in Orinda, is Jewish and is expecting a daughter with his wife, Shem. If they have a boy in the future, he said, "We would circumcise, not only for the sake of tradition, but also because I've seen in hospital training too many elderly men go through the circumcision process for hygiene reasons. The trauma is measurable."

For a lot of parents, the notion of inflicting pain on their newborn son is loathsome. David Fortner of Berkeley, whose son Wyatt was born seven months ago, said, "He was such a small, little, delicate guy that the last thing I'd want to do was start carving up his little ween."

"I'm not going to buy the argument that it's brutal," Baskin said. "There's a general anesthetic involved, so they're not going to experience any pain, because they're asleep. And afterwards, with good nerve blocks, they basically do fine." Infants 3 to 6 months old are given a general anesthetic; newborns 1 to 8 days are given a local anesthetic.

Baskin also dismissed the argument that circumcised men experience less sexual pleasure because of the loss of foreskin. "I think that's been pretty much debunked by a number of articles in the British Journal of Urology and the Journal of Urology." Regarding men who endeavor to restore their foreskin in their adult years -- Web sites are devoted to the practice -- Baskin said, "In my mind that would go under the heading, 'Get a life.' "

"It's pretty hard to scientifically quantify pleasure under any circumstances," said retired San Francisco urologist Dale McGhee, "and particularly hard to compare pleasure quantitatively between circumcised and uncircumcised penises. I know that in all my career in medicine, I never met one man who was circumcised in adulthood and who said he experienced less sexual pleasure after than before."

Curiously, one of the least-mentioned factors in the cut versus uncut debate is the sexual experience of women. "Friends who have made love to men who were not circumcised have told me it felt a whole lot better to them than men who were circumcised," said Nye. "That may have more to do with the skills of the man than the circumcision. But who knows?"

E-mail Edward Guthmann at eguthmann@sfchronicle.com.