Deconstructing circumcision

Pittsburgh Post-Gazette, By Jon Delano Tuesday, March 16, 1999

It was a tough week for American boys.

First, the Academy of Pediatrics issued its latest circumcision policy statement, advising, too late for most of us, that there is no real medical evidence to justify tampering with male genitals in the United States.

Then, contrary to the old saw that infants don't feel pain, the baby docs declared that when it comes to this little surgery, yikes, it hurts. The Academy says that hospital circumcision accompanied by tears and increased rates of heartbeat, blood pressure and oxygen levels should now include local anesthesia to reduce some of the surgical stress on a day-old boy.

Finally, the Pittsburgh Post-Gazette reported that a Boston bio-engineering company is "harvesting" foreskins to make a quasi-synthetic skin for burn victims and folks with skin disorders. While this may be a medical advancement, the notion of people walking around with someone else's foreskin is a bit bizarre, especially if it wasn't necessary to remove it from the kid in the first place!

Admittedly, I'm not an expert in these things. But like most parents, we confronted the circumcision dilemma when my son arrived a few years ago. After some Internet research, I concluded that America's medical community, and many parents too, have a hard time dealing with this issue.

How else do you explain why the United States is the only country left in the world in which hospitals, with parental consent, still circumcise boys without medical necessity?

While most Europeans, Asians and South Americans never picked up the habit, Australia, Canada and Great Britain - countries that once circumcised as much as we do - have dramatically reduced their circumcision rates, primarily through strong statements against the practice by their medical academies, good counseling by doctors to parents and the refusal of national health insurance to pay for it.

The result is that 85 percent of the world's males are left intact at birth unless, of course, there is a religious reason to circumcise - or you happen to be born in the USA. In America, 60 percent of baby boys go under the hospital knife. While that's down from the high rates of the 1960s - and on the West Coast only 36 percent of boys are circumcised - the national rate has not changed much over the past decade.

In figuring out what was best for my son, I tried to surmise why this country is out of step with everyone else. First, unlike its counterparts overseas, the U.S. medical community seems unable to speak with one mind on the subject. Trying to get a straight answer out of a doctor about circumcision is harder than getting the IRS to admit it's wrong on a tax bill.

"Don't do it," is the obvious conclusion after reading the latest 10-page report from the pediatricians. But most doctors use the "on-the-one-hand this and on-the-other-hand" that approach, leaving parents more confused than ever about the old myths of health and hygiene. And parents rarely hear about the purported benefits of not circumcising or the risks of the surgery.

Contrast this with other medical procedures, like tonsillectomy. A few decades ago, children's tonsils were removed as fast as their foreskins. Today, the procedure is rare, an absolute last resort. Doctors, not parents, made that happen.

Part of the problem may be that the baby docs, who do the research on the topic, are rarely present at delivery. In U.S. hospitals, circumcision of males, ironically, is usually done by obstetrician/gynecologists, experts in the anatomy of females. These doctors are competent, but let's face it, doing "circs" on boys is not exactly why they specialized in women's health care.

Increasingly, doctors blame parents for insisting on an unnecessary surgery for their sons. But if they are not given clear medical advice, what are parents to do?

Frankly, we fall back on non-medical rationales. "The everybody does it" refrain is still commonly heard if no longer valid. With 40 percent of American males born today left intact, 21st century high school locker rooms will have penile parity.

Frankly, my recollection is that we were more concerned about size, not style, anyway.

The other rationale for circumcision makes even less sense but is better psychoanalyzed by others. "He should look like me," some dads insist, but of all the places to look like dad, well, you get the point. It's a peculiar argument anyway. Most parents born in the 1950s and 60s had lots of things done to their bodies that they should never wish on their kids. Besides, if Prince Charles, who is circumcised, could leave his two sons intact, why can't the rest of us?

In the end, what convinced us not to circumcise our son was the ethical issue. If there is no medical or religious reason to do it and the social justifications seem silly, then what right do we have to remove a normal, healthy part of our son's body?

The latest pediatric statement recognizes the ethical issues in circumcising a non-consenting infant, but defers the decision to the parents. Still, when it comes to that body part, who better to make the choice than the guy who has to live with it - or without it!

Besides, my son can always have it done when he's old enough to pierce his nose, tattoo his buttocks and knowingly donate his foreskin to some biotech firm in Boston.

Jon Delano, a local attorney, political analyst and parent of two, teaches at Carnegie Mellon University's H. John Heinz School of Public Policy & Management.

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