Unkindest Cut?

By Christine Gorman

As if parents didn't have enough to feel guilty about. Some advocacy groups are trying to convince them that circumcision--the cutting away of the foreskin of the penis--is the most barbaric thing they can do to a newborn boy. Others believe circumcision will make a boy healthier and happier all his life. The truth is far less dramatic. According to a review of 40 years of data published last week by the American Academy of Pediatrics, circumcision does provide some potential medical benefits, but they are not so overwhelming that parents should feel compelled to have it done.

If you want to circumcise your son for religious, personal or cultural reasons, fine. If you don't, that's fine too. The pediatricians' group is adamant, however, in saying no boy should be circumcised without adequate pain relief. Perhaps 45% of U.S. circumcisions are still carried out without analgesia.

Circumcision is, of course, nothing new. Egyptian priests practiced it as a purification rite more than 4,500 years ago. To this day, it is an important religious ritual in Islamic and Jewish communities worldwide. Circumcision became popular in the U.S. in the early 1900s, in the belief that it promoted good hygiene and discouraged masturbation. World War II veterans swore by its health benefits in unsanitary tropical conditions. Currently, more than two-thirds of U.S. infant boys are circumcised.

What are the medical benefits? According to the pediatricians' review, boys who are not circumcised are at least four times as likely to develop urinary-tract infections in their first year of life. These infections occasionally lead to kidney problems. But the rate of urinary-tract infections among uncircumcised infants in the U.S. is still no more than 1%. Intriguingly, uncircumcised boys who are breast-fed suffer fewer such problems than uncircumcised boys who are bottle-fed.

Uncircumcised men are three times as likely to develop penile cancer, but, again, the absolute risk is quite low. Only about 9 U.S. men out of 1 million ever develop the disease. Circumcised men are one-third to one-half as likely to become infected after exposure to HIV or other sexually transmitted diseases. But they are not by any means immune, and the difference in infection rates would probably diminish among men who use condoms and practice safer sex.

The pain that circumcision inflicts on babies, usually during their first days of life, can be dulled by an analgesic cream or shots of local anesthetic. Amid all the other shocks and discomforts of adjusting to life outside the womb, it's unlikely the procedure would leave a boy with lifelong trauma. Complications are uncommon and generally minor, involving a little bleeding or inflammation (and not accidental amputation). Older boys who undergo circumcision are typically given general anesthesia.

In short, medical considerations shouldn't be the parents' primary concern when deciding whether or not to circumcise their son. Health benefits do exist, but they aren't great enough to override any personal preferences.

For more on circumcision, visit time.com/personal or read the report at www.aap.org E-mail Christine at gorman@time.com