In Last Four Decades, Circumcision Has Lost Popularity in United States

Published Sunday, July 8, 2007

CUTTING THE PROCEDURE

In Last Four Decades, Circumcision Has Lost Popularity in United
States

By GARY WHITE
The Ledger

Amanda Mann doesn't claim to be a perfect mother. Like any other
parent, she has her momentary lapses, including the occasional loss of
her temper, which are understandable for the mother of four boys.

Mann doesn't castigate herself for such episodes. But one moment from
her first days as a parent does cause her continuing remorse.

"The circumcision of my first son is the only thing I regret as a
parent," said Mann, a Bartow resident.

Mann represents a growing segment of the American populace, parents
who have turned against the previously routine practice of having
their sons circumcised in their first days of life. Circumcision rates
in the United States have declined from a high of nearly 90 percent in
the early 1960s to about 57 percent in 2004, according to the National
Health and Social Life Survey. The recently issued report found rates
below 50 percent in some states.

Health experts say immigration from Latin American and Asian
countries, where circumcision is not a cultural custom, has
contributed to the decline. But the statistics suggest a rise in the
number of white, native-born parents, like Mann and her husband,
Curtis Romey, who have decided to go against the norm.

Circumcision - the surgical removal of the foreskin from the penis -
has ancient origins. In the book of Genesis, it is described as a
symbol of the covenant between God and the Hebrews, and a passage in
Leviticus mandates circumcision on the eighth day of a boy's life.
Observant modern Jews regard the procedure as a religious obligation,
and circumcision is also common in Islam.

Some historians say circumcision gained wide acceptance because it was
believed that removal of the sensitive foreskin would make boys less
likely to masturbate or pursue sex. The practice, long shunned by
Christians, became prevalent among Western countries in the early 20th
century and was routine in American hospitals by the 1950s. It remains
the default choice for many Americans.

Though official rates are not available for Polk County, Dr. Jeffrey
Puretz, a Lakeland obstetrician/gynecologist, said he has noticed no
decline in circumcisions during his 19 years in practice.

"Every parent is counseled during pregnancy and given information on
circumcision," Puretz said. "They ultimately make the decision, but I
haven't noticed that most are not having their sons circumcised."

Mann, 32, hadn't given much thought to circumcision before the birth
of her first son, Zain, 11 years ago. She recalled giving written
permission for the surgery as she signed a stack of papers in a local
hospital.

"When I changed his diaper the first time and saw the wound he'd been
given, it made me horribly regretful and I couldn't believe I'd
allowed something so mutilating to happen to one of my children, which
I'd been given to protect," Mann said. "At that point, it became clear
to me with any future son there was not a chance it would happen."

Mann, a childbirth educator at Labor of Love, a natural birthing
center in Lakeland, said Zain seemed to be in pain for more than a
week after the circumcision and had difficulty nursing and sleeping as
a result. Zain also developed adhesions - bits of leftover foreskin
stuck to the glans - that Mann said caused the newborn boy additional
pain.

Mann said she went to almost comical extremes after the birth of
Asher, her second son.

"I was worried about him being accidentally circumcised, so I was
maybe a little overvigilant," she said. "Anyone who walked in the
room, I was making sure (they knew) he's not going to be circumcised,
even if they were delivering a newspaper."

Nancy Moses, a friend of Mann's, arrived at the same outlook while
pregnant with her first child, who turned out to be a girl. Four years
later, Moses gave birth to a son, John, who is now 2 and, as Moses
proudly states, not circumcised.

"I think I always knew that I found circumcision odd, creepy and
cruel, even," said Moses, 31. "But it wasn't until I was pregnant that
I knew how horrible it would be if someone hurt my baby. And imagine
if I was the one to allow that."

Though some gentiles cite biblical passages as a reason for
circumcision, Mann and Moses - both professed Christians - said their
spiritual covenant obviates the need for the physical symbol of the
Jewish covenant.

Moses, 31, a stay-at-home mom, said her husband, Rob, was at first
inclined toward circumcision, "but as soon as he learned about how it
happens and how pointless it is, he was protective of our son's
foreskin."

Leading medical organizations, such as the American Academy of
Pediatrics, are neutral on circumcision. The AAP on its Web site
mentions possible health benefits of the surgery, including a
decreased risk of urinary tract infections and sexually transmitted
diseases and the prevention of foreskin infections, but says the "data
are not sufficient to recommend routine neonatal circumcision."

When patients ask Puretz for his advice on circumcision, he lists the
pros and cons without making a recommendation either way on what he
called an "elective" procedure. Puretz, who is Jewish, regularly
performs circumcisions for Jewish parents as part of the brit milah
ceremony.

Dr. William Ray, a Lakeland pediatrician, said he tells parents the
practice is based on cultural rather than clear-cut medical factors.

"Most people have made their minds up without the aid of a physician,"
said Ray, a hospitalist in pediatrics for Watson Clinic.

Ray said the most influential factor, aside from cultural and family
traditions, is insurance coverage. In 2003, Florida joined more than a
dozen other states in dropping circumcision from the list of
procedures covered under Medicaid, the program for low-income
families. Ray said he noticed fewer requests for the surgery after the
change in coverage, though some parents choose circumcision even if
they have to pay for it themselves.

Tabatha Richardson of Winter Haven is one of those parents. She chose
circumcision for her 10-month-old son, Tyler, even though her health
plan didn't cover the procedure.

Richardson, who made the same decision for an older son, said she
carefully researched the issue and concluded that circumcision made
sense.

"There were just so many pros for not just the immediate but the
lifelong (health) that I decided to do it with my second son as well,"
Richardson said. "Even as infants it's easier to keep that general
area clean and free from infections with them being circumcised."

Parents such as Mann and Moses quail at the notion of having elective
surgery performed on a newborn boy. Mann equates circumcision with
breast augmentation, and Moses calls it "optional cosmetic surgery."

There are three prevalent methods of circumcision. Two involve placing
a clamp over the penis so the foreskin can be excised with a scalpel,
and the third uses a thread that causes the foreskin to wither and
fall off in a few days. The newborn usually receives a local
anesthetic, either in a topical cream or an injection.

Opponents of circumcision say the procedure is doubly harmful,
inflicting pain at the time of surgery and reducing sexual pleasure
later through the removal of the nerve-rich foreskin. Puretz, the
obstetrician, said it isn't clear the procedure has negative physical
or emotional effects.

"When I first trained, there were a lot of physicians who weren't
using any anesthetic at all, and I felt a little disconcerted about
that," Puretz said. "Local anesthetics ... have virtually eliminated
pain from the procedure. A lot of babies don't even know it's going on
while it's happening.

"I don't know one way or the other how babies feel about it later in
life, subconsciously or consciously, if they remember it," he added.
"For me personally, it's not something I remember."

Mann and Moses would rather err on the side of caution. The two
mothers also question the validity of studies finding lower rates of
HIV among circumcised men, and they say foreskin hygiene is no more of
a challenge than keeping ears or noses clean.

Mann, whose sons clustered affectionately around her at the family's
Bartow home on a recent morning, said she's unconcerned that Asher,
Atticus or Ivan might feel self-conscious or face ridicule for having
a different penis from other boys.

"The locker-room argument never really held a lot water with me," Mann
said. "I kind of liken it to, well, if I had a daughter who wasn't
chesty would I consider breast augmentation for her? And the answer to
that is absolutely, unequivocally not."

Mann and Moses use such words as "amputation" and "mutilation" in
describing circumcision, they don't align themselves with militant
"intactivists" who would like to see the procedure banned. Both said
they respect the decisions of any parents who consider the matter
carefully.

Mann said she hopes more and more parents will arrive at the same
choice she did.

"I'm proud to have three more intact boys in the world," she said.

Gary White can be reached at or at
802-7518.

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