Doctors differ on circumcision need

By Judy Peres
Tribune staff reporter
Published June 13, 2006, 8:44 PM CDT

In a case that has drawn the attention of anti-circumcision groups nationwide, doctors testified Tuesday that there is no medical justification for removing the foreskin of an 8-year-old Northbrook boy.

Dr. M. David Gibbons of Washington, D.C., a pediatric urologist, said he saw nothing in the boy's medical records to warrant circumcision, an operation he said could cause serious complications.

But the boy's pediatrician, Dr. Arnold Goldstein of Highland Park, said he believed circumcision was the "best and easiest way" to prevent problems in the future.

The boy's mother insists, on the advice of Goldstein and two other doctors, that the operation is necessary to prevent recurring bouts of inflammation, called balanitis.

His father, a building manager from Arlington Heights, is suing to block the operation, calling it an "unnecessary amputation" that could cause his son irreparable physical and emotional harm.

"If you have an infection in your finger, you don't cut it off," the father said from the witness stand. "First you try to treat it."

The parents are divorced. The Tribune is not naming them to protect the boy's privacy.

Gibbons and Dr. Robert Van Howe, a pediatrician from Marquette, Mich., said balonitis, often caused by chemical irritants, is nearly always treatable with a steroid ointment.

Goldstein admitted the boy never received a steroid. The only medication recommended was an antibiotic ointment such as Neosporin, which Goldstein acknowledged did not help. The two experts said Neosporin is not recommended for balanitis and sometimes even causes inflammation.

Goldstein also testified that the boy had a history of phimosis, or adherence of the foreskin to the head of the penis. But he conceded under cross-examination that he could not document such a history in the child's chart.

Gibbons and Van Howe testified that phimosis is normal for a child of this age.

"Sixty-five percent of 9-year-old boys still have a partially attached foreskin," Gibbons said. The boy will turn 9 next month.

"Intactivist" groups are eagerly awaiting Kaplan's ruling, which could break new legal ground.

"If the court were to rule that circumcision is not in the best interests of this child, that would set an American precedent that doesn't exist today," said George Hill, director of bioethics for Doctors Opposed to Circumcision.

In his opening statement, David Llewellyn, one of the father's attorneys, told Cook County Circuit Court Judge Jordan Kaplan that routine circumcision became popular in the 1870s in a "misguided attempt to punish and deter masturbation." But doctors now know it is rarely medically necessary, he said, and its risks outweigh its benefits.

Llewellyn, an Atlanta attorney who specializes in circumcision cases, said the boy's penis is normal. Surgically removing the boy's foreskin, he said, would cause pain and discomfort for a significant period of time and would be sexually and possibly psychologically damaging.

The hearing is expected to continue Wednesday with a pediatric urologist testifying on behalf of the mother.

DOC's executive director, John Geisheker of Seattle, said he has a special empathy with the boy at the center of the dispute.

Born 60 years ago in New Zealand, where routine circumcision of newborns was not common, Geisheker said in an interview that he was circumcised at age 5 when an American doctor persuaded his mother it was medically necessary because his foreskin was still attached.

"Today we know that it can take up to 17 years for the membrane (that attaches the foreskin to the head of the penis) to dissolve so that the foreskin can completely retract," said Geisheker.

Geisheker said he has no real memory of the experience, although his mother remembers it well.

"In those days—unlike today—it was common to use no anesthesia," he said. "They just strapped me down and ordered her out of the room. She had to listen to me scream."

His mother, he said, "now accosts pregnant women in the grocery store" to urge them not to circumcise their newborn sons.

Geisheker, a lawyer, said he hoped Kaplan would prevent the circumcision now and let the child "make his own decision when he's 18. In the meantime, the problem might well resolve on its own."

Harry Meislahn of Winnetka, who heads the Chicago-area chapter of NOCIRC, the National Organization of Circumcision Information Resource Centers, said supporters are contributing to a fund set up to help cover legal expenses.

Llewellyn is serving pro bono. Marilyn Milos, the director of NOCIRC, said supporters had raised enough money – "several thousand dollars" – to pay the expenses of the expert witnesses.

Alan Toback and John D'Arco, the father's local counsel, said they had not received payment from anyone other than their client.

jperes@tribune.com