New Studies Sharpen Circumcision Debate

By Susan Davis
WebMD the Magazine - Feature Reviewed by Brunilda Nazario, MD

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.聽 "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 聽 WebMD the Magazine.

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