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Male Circumcision Views

Two years ago, Carl Redmond decided he wanted to undergo adult circumcision. The 36-year-old Seattle man had no medical reason for going under the knife. "I thought about it for years," he says. "I just wanted to look like everyone else. It was a cosmetic decision. I thought it looked more normal."

According to surveys, most parents decide to have their infant circumcised for much the same reasons. Indeed, there is no clear health incentive to perform routine circumcisions. That's the policy statement of every medical society in the world, including the American Academy of Pediatrics. But in the United States, which has the highest rate of neonatal circumcision, the debate has yet to abate.

"In America, it's still an ongoing controversy about whether circumcision is really necessary," says Jack Sherman, M.D., associate chairman of pediatrics at Nassau County Medical Center in East Meadow, N.Y. "In 1971 and 1975, the AAP said it wasn't necessary. Later, they amended their policy statement."

Medical Reasons

The AAP's 1999 policy statement, based on a review of 40 years of data, states that circumcision has potential medical benefits. "But they advise that parents not use that as their primary criterion when making a decision," says Sherman. "That's like not expressing an opinion at all."

The primary risk associated with an intact penis is thought to be penile cancer, a rare condition affecting 10 in every million American men annually. In the U.S., uncut men contract the disease at three times the rate of circumcised men, yet American Cancer Society officials cite lower penile-cancer rates in countries that do not practice circumcision.

Meanwhile, studies swing back and forth regarding a correlation between early urinary-tract infections and circumcision. They are similarly inconclusive about the foreskinned being more susceptible to STDs; the latest research, published in the Journal of the American Medical Association, found "no significant differences between circumcised and uncircumcised men in their likelihood of contracting sexually transmitted diseases."

The perception that foreskin is unhygienic is a myth, says George C. Denniston, M.D., president of the Seattle-based Doctors Opposing Circumcision. "Foreskin protects against disease; it doesn't cause disease. If foreskin is unhygienic, eyelids should be considered unhygienic."

A 1989 AAP policy statement recognized the pain and trauma caused by the procedure and attendant behavioral changes among the young patients. Still, circumcision is the only surgery in America routinely performed without anesthesia. The AAP now recommends analgesic cream or shots of local anesthetic.

Cutting Costs

So what goes missing during circumcision? Excised is about half the penile skin that grows to a postcard-size sheath in adults. Also removed is the mucosa, the foreskin's supple underside that shields the head while producing an odorous, and possibly antibacterial, secretion called smegma.

What is also lost, insist the anti-circumcisionists, is a significant amount of sexual sensitivity. In 1987, a Canadian researcher found 12 ridged bands inside the tip of the foreskin, dense with specialized nerve endings akin to those found on the ends of fingertips. The glans has similar receptors along the corona, or edge, though the head itself has poor sensitivity. During intercourse or male masturbation, the bands touch the corona, sparking receptors on both surfaces.

"The entire penis is designed as a sensory platform for sexual pleasure, just as the vulva is in females," says pathologist Christopher Cold, M.D. "Just as you can't draw the exact line where the G spot is in women, I don't think it's possible to point to one portion of the penis and claim it's more important than the rest."

Some urologists report otherwise. "We've done hundreds of circumcisions on adult men over the past 20 years and never had one complaint about lack of sensitivity," says Baylor College of Medicine's Larry Lipshultz, M.D.

The AAP now says that doctors should allow parents to make an "informed choice" and hospitals should provide an unbiased overview of the surgery -- an expectation that some consider optimistic. Meanwhile, parents continue to opt for circumcision, as Carl Redmond did, because it seems "normal" to them.

A loaded word, to be sure, when talking about a man's penis, no matter how you cut it.

Paul Ellis