Flashback 1987: Circumcision — The procedure, the controversy

"The circumcision of Christ," by Giuliano Traballesi (Met)

     Circumcision is back in the news, unfortunately, now that Donald Trump's pet psycho, RFK Jr., has tied the practice to autism, through the administration of Tylenol to the wee snipped bairn. It is a subject I have dealt with occasionally, and this weekend I'm disinterring two examples from the dusty past. This story is nearly 40 years old, but nothing has changed. It led to years of squirming, as an unwilling subscriber to the National Organization of Circumcision Information Resource Centers' NO-CIRC newsletter, the joys of which I will allude to tomorrow. 

     It is a painful surgery, holding the potential for rare but hideous complications, performed on most men in this country before they are 10 days old. It is usually done without anesthesia and — according to many medical experts — has no medical value whatsoever.
     If the procedure wasn't circumcision, or the removal of the foreskin of the penis, it probably would have died out a long time ago.
     But circumcision holds a special place in our society. It is perhaps our only modern operation that comes with its own cultural baggage — commanded by God in the Bible as a covenant and practiced by Jews and Moslems as part of their religions, it also has, over the years, developed the nonsectarian image of cleanliness and sophistication.
     The traditional medical reasons for circumcision are cleanliness and lower incidence of disease. Circumcision eliminates the need for careful penile hygiene by removing the foreskin, which otherwise would trap skin cells and oil that combine to form a substance known as smegma.
     The diseases associated with uncircumcised males — penile cancer, phimosis, urinary tract infections — while rare as a group, are also eliminated or reduced by circumcision.
     Improved sexual function is one reason given for circumcision, but sexual problems with uncircumcised men are rare and treatable.
     "You occasionally get pain on intercourse," said Dr. Domeena Renshaw, professor of psychiatry at Loyola University Medical Center and director of its Sexual Dysfunction Clinic. Renshaw added that the pain usually occurs only during a man's first experience with sexual activity.
     A more significant problem among uncircumcised men is attributing sexual problems, caused by other factors, to their lack of circumcision.
     "Occasionally, a man of 20 will go to the urologist asking for a circumcision when absolutely nothing is wrong," said Renshaw. "There have been studies in England and Israel, and there is no difference in incident of sexual difficulties. Israelies, with circumcisions, still have premature ejaculations."
      In recent years, the question has been, do the medical benefits of circumcision outweigh the risks of the procedure, which include bleeding, pain, infection and mutilation.
     As far back as 1971, the American Academy of Pediatrics said "no." In a position paper summing up these medical arguments, the AAP concluded there were no valid medical reasons for circumcision, stating that the benefits of circumcision were the same benefits that can be had by good hygiene.
     "Surgery is a rather drastic substitute for soap and water," said Dr. Thomas Sisson, a neonatologist at the Pennsylvania Hospital in Philadelphia. "Cleanliness is the usual rationale given, but that is the weakest excuse."
     Since the mid-1970s, the practice of circumcision among Americans has decreased dramatically. A study of 427,698 infants born in U.S. Army hospitals between 1975 to 1984 saw the rate drop from 85 percent to 70 percent. Illinois Masonic Hospital reports that out of 1,145 males born there last year, only 50.5 percent were circumcised.
     St. Francis Hospital in Evanston reports having 52 percent of its babies circumcised last year (although it should be noted both hospitals serve a considerable Hispanic population, Hispanics being one of the ethnic groups that, as a rule, do not circumcise).
     The most important change in the general medical view of circumcision is the realization that, contrary to what was thought before, the process hurts.
     "For a long time, the general opinion was that the pain of circumcision was brief and relatively minor in the newborn, simply because the newborn's nervous system was relatively undeveloped," said Sisson. "We now know that this is nonsense. They do hurt. The nerves are there. Cutting the skin in order to remove it is a painful procedure. If you ever watched one, babies really scream."
     Several groups have sprung up to combat circumcision, expanding on the medical profession's position that it is a medically unnecessary procedure with the claim that it is also an atrocity.
     "We've only begun to hear from all the men who were devastated by what has been done to them," said Marilyn Milos, director of the National Organization of Circumcision Information Resource Centers. "If you want to circumcise your dog, the humane society will be after you, but somehow removing an important, functioning body part of a baby boy is all right."
     "My own concern about it arose when I realized that people had memories of it," said Dr. David Chamberlain, a California psychologist. "I know a couple of professional men who say they still, even as adults, have definite memories of being circumcised, and of course it was not a comfortable or pleasurable experience."
     Indeed, there are at least half a dozen doctors in the country who perform foreskin restorations - processes that, through surgery and other means, restore circumcised foreskins.
     Many parents, however, do not really take the medical pros and cons into account when deciding whether to have a circumcision. Rather, the decision is made on a cosmetic basis, the decision being made so the child will resemble his father, brothers, or friends at school.
     "Of the hundreds of people coming here, desiring to (have their children) be circumcised, I have yet to convince anybody not to have one," said Dr. Mark Zaontz, a pediatric urologist at Children's Memorial Hospital, who said he is opposed to circumcision, but performs them anyway because he feels the procedure is not as damaging as critics claim.
     If you decide to have your child circumcised, here are some guidelines:
     Make provisions beforehand. Some hospitals delegate circumcisions to interns, and while they need to practice on somebody, you probably will not want them honing their technique on your child. Organizations such as NO CIRC have a field day collecting gruesome circumcision mistake stories, most of which are the result of sloppy or incompetent technique. Find a doctor — preferably a pediatric urologist — who has been doing circumcisions for a long time.
     Insist that a local anesthetic be used. While many might question whether men carry with them submerged memories of their circumcisions, nobody questions that the process hurts babies a lot. There is no reason the doctor should not use a local anesthetic to numb the area.
     Take proper care of the circumcised area. A baby's diaper is not precisely the best area for a wound to heal. Making sure the dressing is in place, changing it frequently, and religiously following any other instructions from your doctor to prevent infection.
     If you decide not to have your child circumcised:
     Get information about hygiene. The AAP has an informative pamplet, "Care of the Uncircumcised Penis," that will tell you just about everything you need to know, and should be available from your pediatrician or the hospital. The most important thing to bear in mind is not to forcibly retract the foreskin — it is naturally adhered to the glans of the penis for some time in infants, and will retract later of its own accord.
     Be aware of the possibility of complications. The most common problem is phimosis, which affects between 2 percent and 10 percent of uncircumcised infants. Phimosis is a condition when the foreskin is too tight around the glans to permit an unrestricted flow of urine, causing the urine to back up and balloon out the foreskin. Should phimosis occur, circumcision will be necessary.

     — Originally published in the Sun-Times, Sept. 13, 1987