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Spirited Debate Over the Question of Circumcision

November 04, 1986|ALLAN PARACHINI | Times Staff Writer

Dr. Loraine Stern, a Newhall pediatrician, recalls the incident as if it were yesterday--even though it occurred in the early 1970s when she was finishing her residency.

She was delegated to perform a circumcision on a newborn baby boy who was about to be discharged from the hospital. So, dutifully, the young doctor prepared the baby and began cutting away his foreskin.

In the process, though, the scalpel inflicted a slight cut and, after she applied pressure to stem the blood flow, Stern realized her heart was pounding because she had nearly inflicted a serious injury on what many would argue is, psychologically, the most important part of the male anatomy.

"I thought," Stern said as she recalled the incident a few days ago, " 'Why am I putting myself and this baby through this?' " The bleeding quickly stopped, but Stern's reaction stayed with her.

She had no idea then that circumcision would become a quasi-political issue and even figure--as it now has--in the nation's preoccupation with acquired immune deficiency syndrome (AIDS).

Spirited Debated

Stern's doubts about circumcision inadvertently had coincided with a trend just taking root at that time--and still gaining speed today. In the intervening years, this movement has begotten an ongoing and spirited debate in medicine, the formation of at least one strident national anti-circumcision organization, books, magazine articles and hours of conversation on television and radio talk shows.

But questions remain about whether circumcision is or is not good medicine. The extremes of the debate range from the assertion that circumcision is no better than a procedure where "children die or are mutilated" to a view by a small number of physicians that circumcision may very well prove to prevent such diverse problems as urinary tract infections in infants, kidney infection in adult men, the spread of herpes and other sexually transmitted diseases and penile cancer.

Moreover, there is the prospect--introduced just last week in a letter to the editor of a major medical journal--that circumcision may be instrumental in impairing the rate of heterosexual transmission of AIDS. This speculative view is held by Dr. Aaron Fink, a Mountain View, Calif., urologist who has emerged as the most prominent defender of circumcision on the national scene today. He bases his beliefs about circumcision and AIDS in part on a review of tribal and religious circumcision practices in Africa, where AIDS is more common among heterosexuals than it has been, so far, in the United States.

To Fink, circumcision may be an area of health care in which parents should be asked to sign a statement of "informed refusal," as opposed to the traditional informed consent, in which they attest to having been told of the potential benefits of circumcision but decline to have the procedure done on their son.

He Recommends It

"I would encourage circumcision to be done," Fink said in an interview. "I would recommend it."

Fink is most frequently at odds with the National Organization of Circumcision Information Resource Centers, based in the San Francisco Bay-area suburb of Corte Madera, which has sponsored a national campaign against circumcision that includes three malpractice suits filed in California that seek to make circumcision such a potential liability that physicians will no longer offer it.

In the most recent court action, filed last July, the parents of an Oakland infant sued the doctor who circumcised their son. The suit argues that though the parents authorized the circumcision, the doctor is liable because he offered to perform a surgery with no legitimate purpose. It could be five years or more before the action is resolved.

The circumcision resource center's head, Marilyn Milos, a nurse, contends that circumcision is "an important issue and, for me as a mother, extremely urgent. Surgery is being performed on babies that can be dangerous and is unnecessary," she contends. "It should be stopped now."

There is even a debate over terminology focusing on whether a male who still has his foreskin should be called "intact" or "uncircumcised." Such an emotional overlay has been introduced to the question that even physicians like Stern, who has acted as a national spokesperson counseling against circumcision for the American Academy of Pediatrics, find a regrettable intrusion of rhetoric into what ought to be, she contends, a private decision for parents.

In 1975, the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists--the two leading professional associations in their respective fields--issued a carefully worded statement concluding there is "no absolute medical indication" for routine circumcision.

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