Lifestyles: The Circumcision Decision

The Ezquerro family's decision not to circumcise their sons, Stanley, age 2, and Thomas, born May 12, wasn't a spur-of-the-moment one.

While pregnant with her first son, Lynda Sawicki de Ezquerro spent hours at the  University at Buffalo Health Science Library poring over medical articles about the pros and cons of routine newborn circumcision. She talked to her pediatrician and gynecologist.

I wanted to double-check to see if any problems might arise if the foreskin wasn't removed.

But when the time arrived to make the decision, what really made the difference was the thought of her baby boy being restrained on a board – with his legs and arms strapped down so he couldn't move – while his foreskin was forcibly separated from the head ofhis penis and cut off. It made her cringe.

So Mrs. Ezquerro and her husband, Luis, did what an increasing number ofparents are doing today: They said no to circumcision.

If he's born with a foreskin, he should keep it, said the 31-year-old Lackawanna mother. I really couldn't see any benefit to having my son circumcised.

The Ezquerros aren't the only ones questioning the need for newborn circumcision. For years, the medical community has debated whetherthere are valid medical reasons for it.

In recent years, more parents have decided against the procedure, though most American boys still are circumcised. In 1979, 64 percent of newborn boys were circumcised. By 1993, that number had fallen to around 59 percent, according to the National Center for Health Statistics.

Many doctors, including noted pediatrician Dr. Benjamin Spock, oppose routine male circumcision. Some physicians are just as convinced that circumcision has benefits.

At every stage of life, (males who are not circumcised) are at increased risk for certain health problems, says Dr. Edgar J. Schoen, senior consultant in the department of pediatrics at Kaiser Permanente Medical Center in Oakland, Calif., and a clinical professor of pediatrics at the University of California at San Francisco School of Medicine.

(Those health problems) may be minor or major. But the benefitsof circumcision far outweigh the risks, he says.

Even the American Academy of Pediatrics, an organization that frequently advises parents on children's health issues, offers little guidance. That group says that newborn circumcision has potential medical benefits and advantages, as well as inherent disadvantages and risks.

Circumcision is an elective procedure, one that is not required by law or hospital policy. While some parents choose circumcision for religious or cultural reasons, many opt for the procedure because the father is circumcised.

The most common concern friends and family voiced when the Ezquerros decided against circumcision was that their son would look different from the other boys if he weren't circumcised.

I said, Of course he's going to look different, he's Stanley,  recalls Mrs. Ezquerro. Growing up, she says, we were taught that everybody is their own individual and has their own characteristics. Although circumcision is extremely painful, the procedure continues to be performed without anesthesia most of the time.

Circumcision causes behavioral, cardiovascular and hormonal changes in infants. They usually scream frantically. Stress hormones rise. Blood pressure and heart rate show marked increases. Blood oxygen diminishes. Following the procedure, the baby is usually irritable. Sleeping and eating patterns may be disrupted.

Not only is circumcision painful, but it's very traumatic, says Dr. Michael B. Rothenberg, co-author of Dr. Spock's Baby and Child Care. Whether the pain lasts a long time or not, which is controversial, why subject a newborn baby – who has all kinds of adjustments to make – to an unnecessary one?

Furthermore, adds Rothenberg, any surgery carries a risk, and circumcision is surgery.

Counters Schoen: If it's done by someone who knows what he's doing, it's practically the safest operation in the world.

So why do baby boys have a foreskin? This fold of skin covers the head (glans) of the penis and protects it from soiled or wet diapers, as well as abrasive clothing. As the baby grows, the foreskin separates from the glans and becomes retractable, usually by age 3. Throughout life, the foreskin protects the tip of the penis and keeps the glans moist. During erection, the foreskin covers the lengthened penile shaft. Many believe that nerve endings in the foreskin enhance sexual pleasure.

Other points to consider before making the circumcision decision include:

Newborn circumcision may lower the risk of getting a urinary tract infection.

There is a very small increased risk of UTI in uncircumcised boys under the age of 1, says Dr. Saul P. Greenfield, director of pediatric urology at  Children's Hospital of Buffalo and associate professor of urology at University at Buffalo Medical School.

But many doctors believe the research on UTIs is flawed and the results unconvincing. Further, UTIs are rare – only 1 percent of uncircumcised infants get one – and generally treated with antibiotics. Besides, you can still get a UTI, even if you're circumcised, notes Greenfield.

Penile cancer is virtually unheard of in circumcised men. But penile cancer is extremely rare – each year about seven out of a million American men contract the disease – and has been linked to poor hygiene. Many believe that good genital hygiene would convey the same benefits as circumcision. Some contend that genital hygiene is easier after circumcision, but caring for the uncircumcised penis is simple: Cleanse with soap and water.

Men who are circumcised may have a slightly lower risk of getting sexually transmitted diseases such as syphilis, HIV virus and chancroid, but evidence is scanty.

A small percentage – as low as 1 or 2 percent – of boys who are not circumcised may later require the procedure due to of disorders of the foreskin and penis.

If the foreskin is removed, the exposed end of the penis may become irritated and cause the opening of the penis to become too small. This condition, called meatal stenosis, causes difficulty in urination and may need to be surgically corrected.

I firmly believe that there's no health advantage to cutting off a person's foreskin, says Dr. Mark Burns, a pediatric urologist in Seattle. He considers the procedure cosmetic. And that doesn't take into account all the bad circumcisions.

Sometimes too little skin is removed, giving the appearance of an uncircumcised penis. Other times, too much skin is removed. In some cases, the circumcision heals improperly or just looks bad.

A parent should keep in mind that either route is acceptable, says Greenfield, who believes that there are advantages to being circumcised, but most males who are not circumcised do not have problems.

Your best bet is to consult with your pediatrician early so you have enough time to make an informed decision.

It's a personal choice, notes Mrs. Ezquerro. But you're making it for your child and it will impact his life.

TABULAR OR GRAPHIC MATERIAL SET FORTH IN THIS DOCUMENT IS NOT DISPLAYABLE

ROBERT KIRKHAM/Buffalo News Lynda Sawicki de Ezquerro and her husband, Luis, of Lackawanna, chose not to circumcise their sons, Stanley, age 2, and Thomas, 1 month.

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