The unkindest cut? Many parents disenchanted with circumcision

TO cut or not to cut, that is the question.

For generations, the choice to circumcise a baby boy has been second nature for American parents, for reasons ranging from health to hygiene to religious beliefs.

But increasingly, Bay Area parents are questioning whether circumcision -- a surgical procedure that removes the foreskin covering the tip of the penis -- truly is what nature intended. Even some Jewish families, who once wouldn't have thought twice about the religious tradition, are having second thoughts, seeing the procedure as cosmetic at best, inhumane at worst.

When Rachel Berger, an Oakland-based journalist, gave birth to her son, Isaiah, 11 months ago, she was adamant against circumcising him, despite her own Jewish heritage.

"I thought, 'Why mutilate my child?'" she recalls. "I didn't believe it was a medical necessity. I thought it was a pretty barbaric practice."

Fueling the fire are a cluster of anti-circumcision activists based in the Bay Area, who heatedly claim that circumcision is tantamount to genital mutilation conducted without the child's medical consent.

The foreskin is normal tissue," declares Marilyn Milos, director of the National Organization of Circumcision Information Resource Centers, an anti-circumcision group based in San Anselmo. "Circumcision is amputation of a normal body part that hurts, leaves psychological scars and denies a baby (its) right to its own determinism. It's a human rights issue."

This concept of denial of personal choice especially resonates with Berger. "If my son decides at some point he wants to be circumcised, he can do it," she points out. "But it can't be undone."

References against circumcision are popping up on TV sitcoms such as "Arrested Development," which has a character running a group called H.O.O.P., or Hands Off Our Penises. The debate has also entered the political arena, with 13 states, including California, no longer covering the procedure for infants covered by Medicaid.

For Dr. Joel Piser, a Berkeley urologist and a mohel -- someone trained to perform the bris, or ritual circumcision for Jewish newborns -- the backlash is understandable.

"I think we live in a time where people question everything," he says. "It's a reflection of that more than anything."

Still, that small scrap of skin undeniably carries a lot of weight. "The foreskin is sacred in Berkeley," Piser observes. "It is quite an emotional issue for a lot of people."

For those of Jewish faith, the ritual of circumcision must be performed on the eighth day of life, as prescribed in the Torah, or Bible, in the book of Genesis. A joyous ceremony, the bris is a covenant made between God and the Israeli people. Although circumcision is not specifically discussed in the Koran, sayings of the prophet Mohammed encourage the practice, and Muslim baby boys are usually circumcised and named when they are seven days old.

Adam Edell, a San Rafael software engineer, deeply regrets his own circumcision and that of his only son, who was born in Israel seven years ago.

Had I to do it over again, I definitely would not," he says. "I feel robbed of millions of nerve endings, of sensations I'm not going to feel and my son's not going to feel."

Edell once passionately believed in circumcision as a part of his Jewish faith. But after leaving Israel and his religious beliefs behind, Edell now bemoans his choice.

"It's ridiculous. It has no medical purpose," he says. "It's quite amazing that something so unfounded is something everyone does -- and in a very sensitive place, too."

Health benefits examined

Some health experts, however, strongly disagree there is no medical benefit.

"From a medical side, do you need to be circumcised? The answer is no," Piser says. "But are there medical benefits from circumcision? The overwhelming answer is yes."

Some of those include a dramatically lower chance of developing penile cancer or contracting urinary tract infections and sexually transmitted diseases such as AIDS, herpes and syphilis. In addition, circumcised men are less likely to pass along the human papillomavirus, or HPV, and its subsequent risk of cervical cancer to their partners.

"I think it's the most important thing you can do to prevent your son from getting AIDS," Piser says.

But weakening that case is the decidedly neutral policy put out by the American Academy of Pediatrics (AAP) in 1999. Although it did concede religious traditions are at play for groups such as Muslims and Jews, the academy concluded that it cannot recommend a policy of routinely circumcising newborns, after weighing the proven health benefits against the known risks.

"The pediatricians are wimps," Piser says. "They didn't want to be in a position to tell all parents, 'You have to do this.'"

Essentially, the academy deemed the various health benefits to be only "potential," while the established risks, such as infections or bleeding occurring in one in 500 procedures, are "known."

"They put a negative spin on all the preventive health benefits," says Dr. Edgar Schoen, the former senior consultant of pediatrics at Kaiser Permanente Oakland Medical Center, who chaired an earlier AAP committee that came to a more positive conclusion. "With that group, nothing would have been sufficient."

Schoen, although retired, is among the remaining avid defenders of circumcision, laying out his case at his Web site, www.medicirc.org. But more and more, the medical community, including Schoen's protege, Dr. Roberta Cunningham, a pediatrician who now heads the well baby program at Kaiser Oakland, is taking a neutral stance.

"The (AAP) guidelines said there was no medical indication for performing circumcisions," she says. "Even though a lot of us felt that way already, at least we had that backing when advising parents."

Cunningham had her own three sons circumcised years ago, knowing it was safe and not a traumatic experience, but would make a different decision today. "If I was having my kids now," she says flatly, "I wouldn't."

For parents mainly concerned about subjecting their newborns to pain, however, Cunningham assures them there is little to fear. "There's very little physical trauma," says Cunningham, who has seen many children sleep right through the procedure. "I don't believe there's any psychological trauma."

Today, pain relief is typically provided either with topical creams or new methods, such as the subcutaneous ring block, an injection under the skin.

Health benefits aside, some parents still choose circumcision for aesthetic reasons or for no other reason than the gut instinct that boys should look like their father.

The issue of hygiene

Then there is the much-debated idea that circumcision is more "hygienic."

"The thing that really started it in this country around the turn of the century was the big obsession people had with hygiene," says Schoen. "Circumcision started from the standpoint of improved cleanliness."

But anti-circumcision activists claim those who are "intact" have no greater challenges staying clean, provided they are diligent about washing beneath the foreskin.

Instead, they charge that the true motivation of circumcision was a Puritan urge to decrease sexual desire and masturbation among men.

Circumcision diminishes sexual function," Milos states flatly. She adds that diminished feeling in men can translate into a less pleasurable experience for women as well.

Some circumcised men who agree with Milos are taking action.

The National Organization of Restoring Men runs monthly support sessions inside a Berkeley church for men who aim to restore themselves to their previous state by stretching their foreskins back into shape.

At the meetings, the group's founder, R. Wayne Griffiths, 70, a Concord-based construction inspector, reviews a variety of devices from tape to more elaborate weights that use "moderate tension" to stimulate the creation of muscle tissue, as in weight lifting.

"I've always been jealous or whatever about not being covered, and uncomfortable in whatever briefs I wear from the rubbing, so I decided I would restore," explains Griffiths, who circumcised his own sons before his change of heart but has convinced them not to circumcise his grandsons.

To date, his group's Web site has elicited more than a thousand responses to an online survey. "Men are becoming more aware of what has been done to them -- mutilation that has denied them their physical pleasures -- and they're getting angry," he says.

But for Schoen, the retired Kaiser pediatrician, this is just a sign of desperation.

"Every year, as the (medical) evidence is coming in, the anti-circumcision people are getting angrier and more active," says Schoen. "Now, a lot have given up (disputing) the health benefits. They talk about that it ruins sex.

"These are men who have problems with sexual function and blame it on circumcision. But we have 100 million circumcised men in the United States, (so) a lot of them are going to have (unrelated) sexual problems."

It's essentially an unresolvable debate, Cunningham says, because you can never truly compare what a man's sex life would have been like had he not been circumcised.

On the decline

Regardless, in California, the percentage of male newborns being circumcised is dropping dramatically, in contrast to national trends. Nationwide, there has been a small uptick in the percentage of newborns circumcised between 1979 and 1999, with two-thirds of all male babies circumcised in the hospital, and an additional five to 10 percent at home afterwards.

But in California during that time, the rate of hospital circumcisions dropped from 64 percent to 37 percent, according to the Centers for Disease Control and Prevention. Both sides in the debate agree this is primarily because of the high population of Asian and Hispanic residents, who don't have a strong cultural tradition of circumcision.

But Milos claims her crusade has also changed minds. "I think it has to do with our educational efforts," she says. "People on the coasts don't cling to tradition. We're more progressive and open to new ideas."

Schoen believes the Bay Area's "genital chic" movement and the pediatricians' naysaying ultimately will be dismissed by most Americans.

"The U.S. public seems to be smarter than the professionals," he says. "My prediction is, as the evidence gets out, it'll be more popular."

You can e-mail Melissa Schorr at mschorr@angnewspapers.com or call her at (925) 416-4814.