The unkindest cut

More parents deciding to forgo circumcision for newborn sons

Her parents were against her. Her in-laws were against her. Her husband was against her. And the medical establishment, if it wasn't against her, it certainly wasn't offering any insight.

In deciding whether to circumcise her newborn son, Tina Lesniok was all alone. And struggling.

When I had my son, I was asking a lot of people working at the hospital questions about the pros and cons of circumcision, she said. No one could really tell me anything. I even asked the guy who came in to empty the trash can in my hospital room what he thought.

I got no information while I was pregnant. I got no information while I was in the hospital. I think doctors just assume everyone will do it.

Not Lesniok.

She – like a mounting number of parents nationwide -- decided against tradition and societal pressures, choosing to forgo circumcision.

In the late 1960s, about 85 percent of newborn boys nationwide were circumcised, according to  HCIA-Sachs, a health information firm serving the insurance industry. Now, the percentage has slipped to about 65 percent.

And in the past year, both the American Medical Association and the American Academy of Pediatrics have revised their official stances, saying thatcircumcision is not medically necessary.

While Lesniok's research told her that four years ago, family and friends said otherwise. They warned her of infections. They told her the other boys would make fun of him in the locker room. They said he should look like Dad.

None of those arguments swayed her.

The deciding factor for me came when I was holding my son in my arms, knowing how much I loved him and knowing that I didn't want to do anything to cause him pain, Lesniok said. He was born perfect. He was born this way for a reason.

The vast majority

By far, the practice of circumcision is most common here in the Midwest. In 1997 – the most recent statistical year available from the  National Center for Health Statistics – 82 percent of newborn Midwestern boys were circumcised. That compares with 38 percent in the West, 65 percent in the South and 68 percent in the Northeast.

As far as Akron obstetrician/gynecologist Dr. Ken Davis can tell, though, Akron isn't following a national trend away from circumcision.

I'd have to say that the proportion of patients that go ahead with it are the vast, vast majority, said Davis, who has performed an estimated 1,000 circumcisions in the past 20 years. Most who don't have it done, in my recent experience, have been for cultural reasons – Asians, Indians, it's something they often don't do.

Probably 99 percent do it. It's really exceptional if someone doesn't have it done.

Steven Hunter is hoping to change that.

Six years ago, while vacationing in Venice Beach, Fla., Hunter was confronted by anti-circumcision advocates. Suddenly, he began to fixate on an issue he had never even thoughtabout before.

I was confronted with the literature and it shocked me, he said. I began to look at it as a personal violation. I was shocked to see what had been done to me as an infant.

He returned to Akron from vacation and he became angry, resenting his parents for taking away a part of him. Promptly, he organized the local chapter of NOCIRC, the  National Organization of Circumcision Information Resource Centers, which is based in theSan Francisco Bay area.

Last week, for the first time, the group went public, demonstrating in front of Akron City Hospital, holding signs that read Whose Body Whose Rights? and No Medical Excuse for Child Abuse!

Children and infants are the least represented members of society, Hunter said. They should have the same rights as adults. If you did this to an adult by force, like we do to infants, I don't have to tell you what would happen. You'd be prosecuted.

A lifetime of loss

Other groups have sprung up across the country to protest circumcision: Newborn Rights Society, NOHARMM ( National Organization to Halt the Abuse and Routine Mutilation of Males), DOC (Doctors Opposing Circumcision), NORM ( National Organization for Restoring Men), and  Nurses for the Rights of Children [sic], among others. Some of these -- such as NOCIRC, NOHARMM and NORM – go beyond the surgical procedure of circumcision, arguing that circumcised men are forced into a lifetime of loss, even if they aren't aware of it.

Davis scoffs at these notions.

It's not a terrifically complicated issue when you come right down to it, Davis said. From a medical perspective, as far as the procedure itself goes, it's really a minor procedure. Removing a centimeter of skin – it takes me about 90 seconds. We're not talking about someone having to make a major decision like a heart transplant.

As for groups like NOCIRC, he said, I sort of put them in the same category as People for the Ethical Treatment of Animals. These are people with not enough in their lives to keep them busy. On top of that, it's the parents' decision; it's their child. Demonstrate the major harm. I don't think youcan.

According to the American Academy of Pediatrics, the risks of circumcision are extremely low. Only about 0.2 percent of circumcisions – or 1 out of 476 -- lead to complications. Still, Hunter and Lesniok do see harm, pointing to two serious complications locally. In 1994, a 2-day-old boy's penis was severed at the tip during a botched circumcision at  Medina General Hospital; it was later reattached. In 1998,  a 1-month-old boy died from anesthesia complications, during a surgery to correct a circumcision at  Rainbow Babies and Children's Hospital in Cleveland.

I don't think there's any justification for this, Hunter said.

Even without complications, he said, a healthy baby is being subjected to unnecessary surgery – a surgery in which the infant's arms and legs are strapped down; a surgery that is done without anesthesia.

Cultural sensitivity

It's not a question of the baby experiencing discomfort, argues Davis, who doesn't use anesthesia for newborn circumcisions. A big part of this comes from the parent. As a man, we become sensitized to the genital area. When there's any thought of something being done to that, we think, `Oh my gosh, no!'

A baby doesn't have that cultural sensitivity. It's just like poking the heel to draw blood. Does it really matter what you're poking? I don't know the answer to that. I don't know that anybody does. Certainly, the baby cries. But babies cry at many of the procedures.

However, a 1987 study in the New England Journal of Medicine argues that newborns, as well as fetuses, can feel pain, based on measurements of heart rate, blood pressure, motor responses, facial expressions and cortisol levels. A 1997 study in the British medical journal the Lancet argued that circumcised infants showed a stronger pain response to routine vaccinations than uncircumcised infants.

And part of the American Academy of Pediatrics' revised policy includes an urging to use anesthetic for circumcision. The problem, Lesniok said, is that too few parents know about the research surrounding circumcision. No matter what a parent decides, she said, it should be based on an informed opinion. That's why she formed the Cleveland-area NOCIRC chapter after her son was born. In birthing classes, they teach you how to feed your baby, how to breast-feed, how to change a diaper, but they don't talk about circumcision, she said. In this country, it's so accepted. It's always been done, so wedon't think about it, we just do it.

Tracy Wheeler can be reached at 330-996-3721 or  tawheeler@thebeaconjournal.com

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