New Studies Sharpen Circumcision Debate
More and more parents are weighing the pros and cons of circumcising their baby boys.
Rachel Spencer, a neonatal intensive care nurse in Lake Bluff, Ill., and her
physician husband had their first son circumcised in 2000. But over the next
seven years, as three more sons were born, the Spencers chose not to repeat the
procedure. "After doing research, I learned that circumcision isn't any
cleaner or healthier. And as a nurse, I knew there were risks."
The Spencers did what many parents of newborn boys do: Weigh the pros and
cons of the procedure. Today, despite certain risks Rachel Spencer researched,
some doctors are beginning to think that circumcision actually might be a
healthy choice, based on recent studies on the links between circumcision and
disease prevention. "Objectively speaking, the medical benefits now seem to
outweigh the medical risks," says Thomas Newman, MD, MPH, and a professor
of epidemiology, biostatistics, and pediatrics at University of California, San
Francisco. "But that's not to say all boys should be circumcised, because
it is not purely a medical decision."
Circumcision -- in which the foreskin on a penis is cut off -- was uncommon
in the United States until the late 1800s, when doctors started recommending it
as a way to curtail masturbation in young boys. By the mid-1950s,
masturbation was more accepted, but 85% of American parents still were
circumcising their newborn infant sons. The reason? Unlike in Europe, where the
procedure never caught on, many American parents continued to believe a
circumcised penis was easier to keep clean (it's not) and many wanted their
sons to look like their fathers.
Beginning in the 1980s, however, some midwives, parents, and physicians began to decry the
practice, saying it was unnecessary, unnatural, and painful. "All
mammals have foreskin," says George C. Denniston, MD, MPH, director of the
nonprofit group Doctors Against Circumcision. "It's blasphemy to say we
should take it off." Denniston and other anticircumcision supporters also
believe removing the foreskin reduces the amount of sexual pleasure a grown man
experiences, although studies have been inconclusive.
The procedure does have risks. It can be so painful that many pediatricians
recommend using nerve blocks as well as a local anesthetic. Other risks include
infection, excess bleeding, adverse reactions to the anesthesia, disrupted
breathing, and a poor cosmetic result.
After reviewing existing medical research, the American Academy of
Pediatrics announced in 1999 that circumcision has no medical benefit and
shouldn't be recommended for all baby boys. And by 2002, only 61% of American
parents were circumcising their sons. But complicating the debate now are
recent studies that do show some medical benefits: Circumcised men have a lower
risk of getting HIV and other sexually transmitted diseases. The
procedure also reduces the risk of urinary tract infections in infants by 90%
and the risk of penile cancer in older men by 50% or more. Both conditions are
quite rare in this country.
Bottom line? "In the United States," says Newman, "the benefits
have not been compelling enough to recommend it routinely. And the medical
risks are not compelling enough to recommend against it. So the decision is
really up to the parents."
Originally published in the March/April 2008 issue of WebMD the Magazine.