Parents must weigh pros and cons of circumcision

INTELLIGENCER JOURNAL, Lancaster, Tuesday, 7 May 1996.

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 againstcancer 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 decreasein 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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