to cut or not to cut
Circumcision: What used to be a routine decision is now a big quandary for many parentsÂtoÂbe.
Medical pros and cons
Scientific evidence gives circumcision a slight advantage in terms of long-term health benefits. Studies have shown that uncircumcised males are six to 10 times more likely to develop urinary-tract infections (UTIs) in their first year of life. Also, cancer of the penis, though rare, is almost exclusively a disease of uncircumcised men. This cancer is thought to be hygiene-related, because viruses and bacteria can thrive in a cheesy substance called smegma that collects underneath the foreskin.
But Marilyn Milos, R.N., founder of The National Organization of Circumcision Information Resource Centers in San Anselmo, Calif., says the argument that circumcision may have medical benefits carries little weight with her. “Penile cancer is extremely rare,” she says. The American Cancer Society estimates that 1,500 new cases will be diagnosed in the United States in 1998, with 200 deaths projected. “Penile cancer affects one in 100,000 men,” Milos adds. “But one in nine women [will] get breast cancer. It would make more sense to cut off the breasts of baby girls.” As for UTIs, Milos concedes that intact males are at greater risk but maintains that the condition is still relatively benign. “Most males never get one, and besides, UTIs are easily treated with antibiotics,” she says.
Milos’ argument doesn’t end there. “Circumcision is surgery, with all the inherent risks, such as hemorrhaging, infection and surgical mishap,” she says. (The complication rate is less than .1 percent, according to the December 1994 issue of Clinical Pediatrics.) Finally, Milos’ organization objects to circumcision for ethical reasons: “Doesn’t every human being have the right to his own body?”
And then there’s the pain
For many years, babies were thought to be incapable of experiencing pain because their nervous systems aren’t fully mature immediately after birth. But today, we know better: Researchers believe circumcision does involve pain for the baby. According to a 1991 study published in American Family Physician, “Behavioral, cardiorespiratory and hormonal changes caused by the stress of circumcision have been documented.” The AAP also supports the contention that infants do feel pain during surgery.
How much that pain affects babies still is a matter of debate. Some doctors maintain that the pain is no greater than that of drawing blood, while others suggest that circumcision may alter a baby’s general response level for months after surgery. In fact, one recent study conducted by Gideon Koren, M.D., at the Hospital for Sick Children in Toronto, observed that circumcised infants cried longer during vaccinations than did uncircumcised babies.
In any case, pain-management options are available. They include the use of a nerve-blocking injection at the base of the penis and a topical cream to numb the skin, as well as doses of acetaminophen before and after surgery; these choices should be discussed with your pediatrician. “I want to say emphatically that under no circumstances should any child have a circumcision without anesthetic — that is barbaric and unconscionable,” Brandt says.