Should Your Son Be Circumcised?
Aug. 21, 2000 -- In the 1960s, when I was born, cutting the foreskin of a newborn American boy was about as routine as cutting his umbilical cord. I didn't really think much about circumcision until I was faced with the prospect of having it done to my own son. After the amazing ordeal of his birth, my wife and I agreed that the last thing we wanted was to send him into surgery to have the end of his penis cut off. A nurse bolstered our sentiments, telling us -- wrongly, it turns out -- that there was really no medical advantage to being circumcised. Without a compelling medical or religious reason, we felt, why would we choose to have this done to our son?
Today, a growing number of people are looking at the issue as my wife and I did. While two-thirds of Americans still choose to have their sons circumcised, according to 1997 data from the National Center for Health Statistics, there is a strong counter-trend among people like us: educated, middle-class folks in sophisticated urban areas like San Francisco and New York. For these people, amputating the healthy erogenous tissue of newborns who have no say in the matter seems unfair and unnecessary. Indeed, in recent years, some activists have turned their opposition to circumcision into a crusade for the human rights -- and future sexual pleasure -- of infant boys.
Opponents of circumcision have long argued that there was little justification for routinely inflicting the procedure on newborn boys; the purported medical benefits, they contended, were either so unproven or so minor that they amounted to little more than poor excuses for perpetuating an outdated practice. And the medical establishment hasn't been a big help, either. The American Academy of Pediatrics, for example, has recently changed its position so that it no longer takes a stand on circumcision.
But an interesting thing has happened in the last decade: Quietly, and with little fanfare, a body of research has emerged suggesting that there may be some compelling medical reasons after all. Circumcised boys, the new research has found, seem to be at lower risk for a number of infections and diseases. For those who have been influenced by the arguments of the anti-circumcision movement, this new information creates an agonizing dilemma: Should they cut and join the brutal status quo, or leave their sons' foreskins intact, perhaps exposing them to avoidable diseases?
A Link That Couldn't Be Denied
The first evidence that uncircumcised boys may have a higher risk of avoidable diseases began to emerge in 1987. At the time, Tom Wiswell, MD, a neonatologist then at Walter Reed Army Medical Center in Washington, D.C., was an outspoken critic of circumcision. When a report from Texas came across his desk, suggesting a high rate of urinary-tract infections (UTIs) among uncircumcised boys in the first year of life, Wiswell set out to shoot the foreskin explanation down. He employed the Army's huge database of 200,000 boys to see if there was any association between circumcision and UTIs in the first year of life. To Wiswell's surprise, his study, published in the July 1986 issue of the journal Pediatrics, showed uncircumcised boys to be far more likely to have UTIs than their circumcised counterparts. He looked at the data every way he could. The association was undeniable.
In the 14 years since Wiswell's study, at least nine others have confirmed the connection between UTIs and circumcision. Taken together, the studies suggest that an uncircumcised boy is 10 times more likely than a circumcised one to contract such an infection in his first year of life. Other research suggests that possible kidney scarring caused by these early infections could also increase the risk of severe kidney problems and high blood pressure later in life, according to Edgar Schoen, MD, a researcher and clinician at Oakland, California's Kaiser Permanente Medical Center.
But the risks don't end with UTIs. Sexually transmitted diseases (STDs) like genital herpes and syphilis also seem to strike uncircumcised men more frequently than those without foreskins, according to numerous studies.
And then there's invasive penile cancer, an agonizing disease that often leads to amputation and death. In the United States, about 1,300 men a year are diagnosed with the condition, and virtually all of them are uncircumcised (see the March 2000 issue of Pediatrics). And it is far more common in Europe and in parts of the developing world where circumcision is less common.
Finally -- and most intriguing of all -- circumcision may help unravel a medical mystery that has puzzled AIDS researchers for years. Having a foreskin just might be the elusive "X-factor" that explains, at least in part, the huge differences in HIV infection rates in otherwise similar regions. Why, for instance, is the infection rate in Thailand 40 times higher than in the nearby Philippines? In most important respects, both countries are quite similar: They have lots of STDs and prostitution, as well as a bias against condom use. But there is one big difference -- and some researchers think it may be key: In the Philippines, newborn circumcision is the rule. In Thailand, it is very rare.
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