Medical groups may recommend procedure on boys, but opponents say benefits exaggerated

By Deborah L. Shelton

Chicago Tribune

(MCT)

For years the medical establishment in the U.S. has avoided advising parents on whether to circumcise their newborn sons, saying the benefits do not outweigh the risks. Now, however, new research suggests the procedure could be used to combat a major health problem: AIDS.

The groups are expected to make their decisions late this year or early in 2010, but already their actions are sparking debate over the medical ethics associated with a long-standing cultural practice. The U.S. has one of the highest circumcision rates in the world, though rates have fallen over the last several decades.

Vocal anti-circumcision groups, who refer to themselves as "intactivists," applaud that trend and oppose any changes in medical policy. They say male circumcision — the surgical removal of some or all of the foreskin from the penis — is an unnecessary mutilation performed without consent.

Until now, mainstream medical groups have said circumcision should be decided by cultural, religious and personal preferences. Potential benefits include lower rates of urinary tract infection and cancer of the penis, which already is rare; the surgery carries risks of bleeding, infections and removal of too much skin.

The federal agency also is planning a study in the U.S. to study the use of adult circumcision to prevent the spread of sexually transmitted diseases.

Scientists think circumcision can protect against HIV because the tissue of the foreskin has a high number of target cells for HIV infection and is susceptible to tearing during intercourse, providing an entry point for the virus. The higher rates of certain sexually transmitted diseases, such as syphilis, observed in uncircumcised men also may increase susceptibility to HIV infection, studies suggest.

Her organization views male circumcision as akin to female genital mutilation, a practice widely condemned by physicians and human rights advocates. It is illegal to perform female circumcision, which involves partial or total removal of the genitalia or other genital injury, in the U.S. on girls younger than 18.

"There's no ethical justification for differentiating male genital alteration from female genital alteration," Chapin said.

Intact America recently launched a national campaign aimed at persuading parents not to circumcise, but Strandjord said his protest is aimed at doctors. "Why are they doing something that no medical organization in the world recommends?" he asked.

"If they ask, 'Is it necessary?' most of us would say no," he said. "If they say, 'We are thinking about it,' I say, 'That's fine.' If they say, 'We're thinking about not having it,' I say, 'Fine.'"

His advice to parents who don't have strong feelings one way or another: "If you have no opinion about it, I wouldn't circumcise my kid."

During his wife's 48-hour hospital stay, three other doctors asked why the baby was still intact, he said.

Hospital officials declined to comment on the particulars of the case but said that, in general, they regard circumcision as a decision ultimately made by parents.

"Male circumcision is an elective procedure to be performed, at the request of the parents, on newborn boys who are physiologically and clinically stable," according to a joint policy statement issued by the two groups.

"If there is a 10 percent benefit for urinary tract infections and 60 percent for HIV and 50 percent for (human papillomavirus), you are protecting yourself against all of these diseases," he said.

Neither boy suffered complications, but one had to undergo the procedure a second time because not enough foreskin was removed.

"(Circumcision) would have been more painful for them when they were older, and I thought it could become a medical issue," she said. "I think it was a choice they would want me to make."