ACOG

October 2, 1985

Committee on Patient Education
American College of Obstetricians and Gynecologists
600 Maryland Ave., S.W., Suite 300 East
Washington, D.C.
20024-2588

Dear Committee:

I am concerned by the pro-circumcision bias in ACOG's booklet
"Circumcision:  A Personal Choice."  I urge you to revise that
booklet.

That brochure is being used by New Jersey obstetricians and
hospitals to promote medically unnecessary surgery.  The
maternity patients and fathers assume that anything printed must
be true.  Often, that booklet is the only educational material
made available.

In Texas, Houston's Harris County Hospital does not perform
circumcisions on the 8000 to 9000 male infants born there
annually.  A commercial marketing person has hired a few
part-time ob/gyn residents, rented nearby office space, and
opened a circumcision clinic where parents can bring their infant
without an appointment.  "Marketing of the clinic is handled
through advertising the clinic's address on a brochure
distributed by the American College of Obstetricians and
Gynecologists in a gift pack given to new mothers." (From
American Medical News, Jan.11, 1985).  The booklet that has
proven suitable for soliciting circumcision business in Houston
and around the country is ACOG's "Circumcision:  A Personal
Choice"--Copyright March, 1984.

The ACOG booklet has been widely criticized.  Being published by
those doctors who benefit financially when the surgery is
performed, the booklet is slanted in their favor.  Throughout the
booklet, speculative and unproven reasons for circumcision are
presented.  Even though the booklet immediately dismisses many of
these reasons as not true, such dismissals to not erase the ideas
that have been shrewdly placed in the minds of new parents.

Examples of questionable statements presented as facts by ACOG:

-    The procedure (circumcision) has very few risks involved.

-    Some doctors routinely recommend circumcision, often for
     reasons of hygiene or traditional values.  Other factors relate
     to possible prevention of cancer, as well as personal views.

-    The parents are also concerned that their child not be
     different physically from his peers during the adolescent period
     when children feel an intense need to belong.

-    Many people believe that circumcision prevents cancer of the
     penis and prostate from occurring in old age.

-    Smegma...is thought to contain a carcinogen, a
     cancer-causing agent.

-    Some people believe that circumcision prevents masturbation,
     increases fertility, is more pleasing aesthetically, and enhances
     sexual relations.

-    It is generally believed that pain is minimal and last only
     a short time.

The American Academy of Pediatrics' corresponding booklet "Care
of the Uncircumcised Penis" was published two months after ACOG's
booklet and was written in a different perspective.  Compare
several areas where the ACOG and the AAP booklets differ
substantially:

-    The ACOG views smegma only as a substance that "can lead to
     odor or infection if the penis is not cleaned regularly."  The
     AAP also advocates regular washing, but goes further to explain
     "adult smegma serves a protective, lubricating function for the
     glans."

-    Under the heading "Circumcision is Not for Everyone" the
     ACOG lists some reasons for not doing circumcision:  Prematurity,
     Sickness, Distress, Hemophilia, and Malformations.  This listing
     implies that circumcision should be performed if none of these
     conditions are present.  The ACOG booklet does not recognize any
     benefits of NOT being circumcised.  The AAP booklet describes the
     physiology of the foreskin as protecting against irritations,
     infections, meatitis, meatal stenosis, and ulcers of the glans.
     "The foreskin protects the glans throughout life."

-    The ACOG warns:  "Some boys may need a doctor's care because
     the foreskin does not retract after age three; some of those boys
     may eventually need a circumcision so that the foreskin can be
     moved."  The AAP says:  "Although most foreskin are retracted by
     age 5, there is no need for concern even after a longer period."
     It is interesting to note that the ACOG presents only the
     surgical method of treatment.

Officially, the ACOG in 1978 supported the 1975 conclusion of the
AAP that "there is no absolute medical indication for routine
circumcision of the newborn."  When seeking health information
about infants, the opinions of pediatricians rather than
obstetricians should be sought.  One can not ignore the facts
that obstetricians have a financial interest in circumcision and
that pediatricians often treat the complications of circumcision.

I urge you to take care that the information presented as factual
is documented by the latest medical research studies.  I also
urge that any opinions or theories be clearly labeled as such.

I look forward to the reply of the committee.


Sincerely,


Warren F. Smith
105 Old Bridge Drive
Howell, NJ
07731-2333
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