The circumcision decision

It’s a decision all parents of baby boys will have to make: to circumcise or not.

When she had her son, Reese, 10 months ago, Margot Lam of Honolulu decided in favor of circumcision, which involves the surgical removal of the foreskin, exposing the tip of the penis.

“It wasn’t really that hard of a decision for us,” she said.

Lam’s reasons included not wanting her son to feel different from his peers later on, as well as for hygiene. She felt she wouldn’t have to worry about the possibility of infections later on “if it’s not cleaned properly.”

Brynne Caleda, whose due date is April 28, and husband Alexander Kuch are breaking family tradition by deciding against circumcision if their baby is a boy. Kuch, who was circumcised as an infant, said he assumed it was the “normal thing to do” until they talked to doctors and did their own research, coming to the conclusion the procedure is not medically necessary.

With the medical community somewhat ambivalent on the subject, the decision to circumcise male infants remains a personal one for parents. But moms and dads today are armed with more information and are more assertive about discussing the issue with their pediatricians than in years past.

“It’s the Information Age,” said Dr. Ronald Sutherland, a pediatric urologist at Kapiolani Medical Center for Women & Children. “Everybody can get on the Internet, Google ‘circumcision’ and look at horrifying photos. Oppositional voices are beginning to be heard.”

Hawaii’s circumcision rate appears higher than the national average, although there are indications fewer parents are opting for the procedure.

Of the 2,655 male babies born at Kapiolani Medical Center in 2010, 2,127 — or 80 percent — were circumcised. Data from other hospitals were not available, but a study published in the Hawaii Medical Journal reported that 89 percent of newborn males at Kapiolani were circumcised from 1996 to 2005.

Nationally, the Centers for Disease Control and Prevention noted a drop in circumcision among baby boys to 55 percent in 2010 from 58 percent in 2001.

With its multicultural population, Hawaii does not necessarily follow mainland trends, and there are no vocal “intact-ivist” organizations to influence public opinion here as there are in other states, where moms have staged protests against what they consider genital mutilation.

Additionally, the procedure is more common in states like Hawaii that provide Medicaid coverage. Health care plans offered by the state’s largest insurers, HMSA and Kaiser, also generally cover circumcision for infants.

In any event, Sutherland does notice parents are asking more questions about it.

“I am seeing a change,” he said. “They’re beginning to think about why we are doing this. They are more willing to say it’s not necessary. In my practice I generally see kids who did not get circumcised for one reason or another. Either they were too sick at birth or (their parents) made a decision not to do it.

“I tend to talk parents out of it, to tell them it’s not medically necessary.”

Only about 1 percent of uncircumcised boys might have problems involving infections of the foreskin that require surgery later on, according to Sutherland. Otherwise, he said, it’s more a matter of educating people how to care for the foreskin.

His advice: “Leave it alone.”

“Don’t attempt to retract the foreskin until it is ready to do so on its own,” he said. “To retract it prematurely before the natural adhesions release it is to invite pain, bleeding and infection.”

In most boys the foreskin naturally loosens over the first three to five years of life, he said.

Newborn circumcision is uncommon in most other parts of the world, including most of Asia, Europe and South America. The United States circumcises the highest number of newborn boys without medical or religious reason, according to an anti-circumcision group called the National Organization of Circumcision Information Resource Centers.

Originally it was advocated in the 1800s as a way to curtail masturbation, and it’s been claimed to cure or prevent everything from epilepsy to deafness, tuberculosis and paralysis of the bladder.

Recent medical studies indicate a slightly lower risk of urinary tract infections and sexually transmitted infections, including HIV, for males who are circumcised, as well as a lower risk for cancer of the penis, already a rare occurrence in all men.

But health experts say many of those concerns can be addressed by teaching boys proper hygiene.

In its most recent policy statement on the matter, the American Academy of Pediatrics said existing scientific evidence is not sufficient to recommend routine circumcision, although there are “potential medical benefits and advantages, as well as risks.” But the group also acknowledges “religious, cultural and ethnic traditions” may play a role in making a decision “in the best interests of the child.”

So the debate continues.

For Leah Harrison and Tal Adelson of Kapaa, Kauai, the focus was on how the procedure would be done for their son Jaidun, now 18 months old.

Adselson, who was born and raised in Israel, said there was no question in his mind his son would be circumcised.

“It’s part of my faith,” said Adelson, who is Jewish. “I was circumcised by a rabbi when I was 8 days old.”

After seeing a video about the procedure, Harrison wasn’t thrilled about the idea, but understood it was part of her husband’s faith.

“If the situation was different and it wasn’t so important to him, I would personally prefer not to do it,” she said.

But they wanted to make sure it was done safely and correctly. Instead of having the procedure done by a specially trained rabbi, or mohel, their son was circumcised by a pediatrician at Castle Medical Center in Kailua. Following tradition, they waited until the eighth day after the birth and also had a friend studying to be a rabbi say a prayer and blessing.

Harrison had another baby boy, Jacob, just last week, and the couple went to a pediatrician on Kauai this time for the circumcision, also performed on the eighth day and with a prayer and blessing.

Janis Bush, an educator who has been teaching Lamaze, breast-feeding and CPR for infants since 1977, encourages parents in her infant care class to do their homework and talk about circumcision well before the arrival of their baby. Most alarming for her is when someone says they plan to circumcise their son but don’t know why.

“That’s a huge decision you’re making for your child,” said Bush, president of a nonprofit childbirth organization, Normal Birth Hawaii. “It’s a social, physical and sexual decision.”

When Mary Magyar, a Honolulu yoga teacher and owner of Open Space Yoga, gave birth to her first son, Sage, at Kapiolani’s birth center 20 months ago, she asked the on-call pediatricians whether circumcision was medically necessary and was told it was not.

She said she hadn’t given it much prior thought, knowing her husband, Rain, wanted to circumcise.

“I thought I was going to let my husband make the decision,” she said, “but when I had the baby in my arms, I asked both pediatricians, ‘Why should we?’”

Then she told her husband to go down the hall and watch a circumcision in progress in the nursery. He did, came back and changed his mind.

Magyar just had her second son, Devo, a little over three weeks ago and did not circumcise him, either. She said the decision was easy and that she has no regrets about it.