Circumcision losing favor with U.S. parents

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By EDWARD GUTHMANN
San Francisco Chronicle
Thursday, June 21, 2007

When Nancy McIlvaine told her parents that her newborn son wouldn't be circumcised, her mother gasped. McIlvaine, who lives in Napa, Calif., with her husband, Willem Maas, said she consulted with health professionals about circumcision and never heard a compelling reason to snip her baby's foreskin.

"It's just inflicting pain to a newborn when there doesn't seem to be any evidence of it being beneficial," said McIlvaine, who gave birth to Theodore on June 8.

McIlvaine is part of a growing trend away from male circumcision. According to the federal Centers for Disease Control and Prevention, the circumcision rate in the United States dropped to 55.9 percent in 2003 -- an all-time postwar low. In the early '60s, it peaked at 90 percent.

Immigration is a big factor in the decrease in male circumcision nationwide, said Dr. Laurence S. Baskin, chief of pediatric urology at the University of California-San Francisco. Among Asian cultures and Latin-American cultures, circumcision is the exception, not the norm.

During the 1950s, the rate of routine infant circumcision went from 50 percent to 90 percent in response to the advice of medical doctors, like the author Dr. Benjamin Spock, who argued that it was beneficial.

But in 1999, after decades of debate, the American Academy of Pediatrics issued a policy statement on circumcision stating, "Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision."

When Baskin speaks to parents of infant boys, he describes the pros and cons of the procedure. On the pro side: Circumcision can decrease the likelihood of getting urinary-tract infections, penile cancer, HIV and sexually transmitted diseases. On the con side: Circumcision has a small risk factor, like any surgery, and in most cases is unnecessary. With good hygiene, an uncircumcised male can maintain good health throughout life.

Even among young Jewish parents, there has been a change. Jonathan Marks, a Marin County, Calif., real-estate agent, said he and his wife, Paula, did a "vast amount of research" when their son, Gabriel, was born five years ago.

"I can't say we were torn about it. Actually, we were torn, but only in the expectation of others around us and especially my Jewish heritage. But after doing the research and speaking with midwives and others around us with boys, we decided that the trend at the time was moving away from this blanket circumcision edict that comes down from God knows where."

Jeff Lewis, a San Francisco optometrist, is Jewish and is expecting a daughter with his wife, Shem. If they have a boy in the future, he said, "We would circumcise, not only for the sake of tradition, but also because I've seen in hospital training too many elderly men go through the circumcision process for hygiene reasons. The trauma is measurable."

For a lot of parents, the notion of inflicting pain on their newborn son is loathsome. David Fortner of Berkeley, Calif., whose son Wyatt was born seven months ago, said, "He was such a small, little, delicate guy that the last thing I'd want to do was start carving ..."

"I'm not going to buy the argument that it's brutal," Baskin said. "There's a general anesthetic involved, so they're not going to experience any pain, because they're asleep. And afterwards, with good nerve blocks, they basically do fine."

Baskin also dismissed the argument that circumcised men experience less sexual pleasure because of the loss of foreskin. "I think that's been pretty much debunked by a number of articles in the British Journal of Urology and the Journal of Urology." Regarding men who endeavor to restore their foreskin in their adult years -- Web sites are devoted to the practice -- Baskin said, "In my mind that would go under the heading, 'Get a life.' "

"It's pretty hard to scientifically quantify pleasure under any circumstances," said retired San Francisco urologist Dale Pollack, "and particularly hard to compare pleasure quantitatively between circumcised and uncircumcised penises. I know that in all my career in medicine, I never met one man who was circumcised in adulthood and who said he experienced less sexual pleasure after than before."

(E-mail Edward Guthmann at eguthmann(at)sfchronicle.com.)