Circumcision Benefits Questioned

(As reported 3/1/99)
The American Academy of Pediatrics has revised its guidelines for circumcision, saying the potential benefits are not significant enough to warrant widespread and routine surgery for every male newborn, reports CBS News Health Correspondent Dr. Emily Senay. However, the organization stopped short of advising against the procedure.

The new policy statement, outlined in a report in the March issue of Pediatrics, says parents should take into account cultural, religious and ethnic traditions as well as the advice of a pediatrician when considering circumcision.

"The weight of the evidence would have to be significant for the academy to recommend an elective surgical procedure on every newborn male, and the evidence is not sufficient for us to make such a recommendation," said Dr. Carole Lannon, chairwoman of the AAP task force that wrote a new policy statement for the academy.

Further, the academy recommended for the first time that pain relief be used if parents do decide to have their newborns circumcised. Doctors have routinely performed circumcisions without anesthesia or painkillers. However, studies have shown that infants circumcised without painkillers experience pain and physiologic stress, including changes in heart rate and blood pressure.

The academy reviewed three forms of pain relief. One involves applying a local anesthetic in a cream about an hour before the procedure. The two others involve injecting anesthetics into the penis. One of those, a subcutaneous ring block, was deemed the most effective.

The pediatrics academy, with 55,000 primary care physicians, is the largest pediatrics medical group in the United States and Canada - two countries where circumcision is widely carried out on male children for health reasons.

"I think circumcision is now an ethical issue," said Ronald Goldman, director of the Circumcision Resource Center, an anti-circumcision educational organization. "It challenges us to empathize with newborn infants and consider that what we do to them can have immediate and long-term consequences,"

Goldman believes that the AAP's announcement "means is the medical debate is over."

In its last policy statement on the issue, in 1989, the AAP said circumcision has potential medical benefits as well as risks and should be carefully explained to parents.

After reviewing scientific evidence, the task force found some medical benefits of circumcision:

• Boys who have not been circumcised are as much as 12 times more likely to get urinary tract infections than those who have been circumcised. Uncircumcised boys had a 1 in 100 chance of developing such an infection in their first year of life; for circumcised boys the chance was 1 in 1,000.
• Some evidence exists showing penile cancer is more prevalent among uncircumcised males. But the disease is so rare, striking just 1 in 100,000 American males a ear, that the researchers found any added risk insignificant.

Rabbi Gerald Chirnomas of Boonton, N.J., said the new policy statement should not affect observant Jews.

"Jewish people don't do circumcision because it's a healthy thing. We do it because it's a covenantal ritual ordained by the Bible," said Chirnomas. He said he has performed more than 12,000 circumcisions.

Chirnomas said he allows the infant to suck a little wine from his finger, then gives him some sugar water from a bottle after the circumcision for pain relief.

The debate has raged on for decades: Are the benefits of circumcision really worth the pain and the cost? Doctors used to say yes, but now, that advice may change.

"I think that it's pretty much a parental based decision on their customs and beliefs, their religious thoughts, and whether the father was circumcised or not," said Dr. Robert Yetman of the University of Texas Herman's Children Hospital.

New mother Desiree Deleon didn't think twice about having her infant son circumcised.

"I wanted to get him circumcised because I felt it would be better for him in the long run, like when he's older, it will be easier to keep himself clean, and run less risk of infection," she told CBS News Correspondent Andrew Colton.

But for Tanya Bernard, moments away from having her labor induced, circumcision is the last thing she would do to her son.

"It's something that was there at birth, it's there for a reason, it doesn't need to be taken away," Bernard said.

According to the Circumcision Resource Center, about 60 percent of males in the United States are circumcised at birth, down from a peak of 85 percent in the late 1960s.

In Canada the rate is 48 percent, but the practice is uncommon in Asia, South and Central America and most of Europe, according to the pediatrics academy report.