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Cutting to the Point on Circumcision

Cutting to the Point on Circumcision

WebMD Feature

From the time Debra Sherman and her husband, Mark Wilcox, learned through prenatal genetic tests that they were having a boy, they agonized over whether to circumcise their baby. "I didn't want the first decision we make for him to be a bad one," Sherman says.

In the end, the Chicago couple decided against taking that extra surgical snip of foreskin from their son's penis. Without overwhelming medical evidence favoring circumcision, Sherman says, it would have seemed to her like deciding to cut off his ear lobes.

"From everything we read and everyone we talked to, it seemed like there was no medical reason to do it," says Sherman, whose son, Alex, is 7 months old. "Plus, I'm not religious, Mark's not religious, and I just thought it was an awful thing to do to a baby."

The fact is, the circumcision decision is a very personal one. Experts say parents need to understand the advantages and disadvantages, then decide what's right for them. Here are the latest facts and a look at how some parents are choosing.

Vive la Difference

Locker rooms have a way of reducing each sex to its least common denominator. Peel away the Levi's and Jockeys, put aside sizes and shapes, and the equipment is all basically the same -- at least that was the case when today's generation of new dads were kids.

Parents in the United States have routinely circumcised their sons since the 1940s, in large part because doctors believed it promoted good hygiene and prevented disease. To Jews and Muslims, circumcision is a sacred ritual symbolizing their covenant with God. By the mid-1960s and early 1970s, about 90% of all boys were circumcised.

But that trend is shifting. In 1996, circumcision rates declined to about 65%, although rates differ depending on demographics: 80% in the Midwest, 68% in the Northeast, 64% in the South and 34% in the West. Among whites, the rate is 81%, compared with 65% among blacks and 54% among Hispanics.

In fact, many observers predict that by the time the first generation of boys born in the new millennium is old enough to hit the locker-room showers, the haves and have-nots may be about equally divided.

The biggest reason for the change is mounting evidence that the medical benefits aren't as compelling as once believed. In addition, anti-circumcision groups have turned up the heat on the debate. They claim the practice is cruel and unnecessary and are spreading the word via Web sites, mailings, bumper stickers, T-shirts and international conferences.

Circumcision rates are much lower in other parts of the world, including most of Europe, Asia and Latin America. Only 48% of boys in Canada, 24% in the United Kingdom and 15% of boys worldwide are circumcised.

Probably the strongest cause for pause among parents, however, came this year when the American Academy of Pediatrics issued a policy statement saying it does not endorse routine circumcision.

"There are potential benefits as well as risks, but the data wasn't sufficient for us to say every newborn male needs to be circumcised," says Dr. Carole Lannon, clinical associate professor of pediatrics and internal medicine at the University of North Carolina, Chapel Hill, and chairwoman of the task force on circumcision. "Each parent needs to make that decision."

To Snip or Not To Snip

A circumcision is usually performed within 48 hours of birth by an obstetrician or pediatrician in the hospital, or on the eighth day after birth for the Jewish ritual, called brit milah or bris. The baby is restrained, then the layer of tissue that covers the tip of the penis is surgically removed. It should take no more than five minutes in skilled hands.

When weighing the pros and cons of circumcising your baby, the most clear-cut medical benefits of circumcision are a four- to 10-fold decrease in the risk of urinary-tract infections during the first year of life, and a three-fold reduction in the risk of penile cancer among adult men.

However, urinary-tract infections and cancer of the penis are rare. The risk of developing a urinary-tract infection in an uncircumcised male infant is no more than 1%, and breast-feeding has been shown to protect against these infections among this group, according to the AAP. Only 10 or fewer men per 1 million get cancer of the penis each year worldwide.



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