CIRCUMCISION HAS NO NOTICEABLE BENEFITS, DOCTOR SAYS

The majority of newborn boys in the Cape Girardeau area are circumcised, local pediatricians say.

Most parents have it done because its the accepted norm rather than for its medical value, doctors say.

"I've never had parents ask significant questions about circumcision," said Dr. Scott Weiner, a doctor at Southeast Missouri Hospital. He treats hospital patients who don't have their own doctors.

Nor has he had parents change their minds when he explains circumcision is an elective procedure with no real medical benefit.

That point was reaffirmed by a new study from the University of Washington Child Health Institute released this week that found circumcising newborns offers practically no medical benefit or harm.

It's not that Weiner is trying to push parents in one direction or another about circumcision. Like most American doctors, he responds to the parents' desires.

But Weiner does think parents should think of circumcision as a choice, rather than a foregone conclusion, and consider the risks and benefits as they would any other medical procedure. Those risks, says the new study, include a 1-in-476 chance of complications from the procedure compared to the benefit of a slightly reduced chance of urinary tract infections and penile cancer.

By the time Dr. Beverly Brown meets expectant parents toward the end of the pregnancy, the pediatrician at Physician Associates said, they have already made the decision on circumcision.

In practice in Cape Girardeau since August, Brown said she's not had any parents who decided not to circumcise.

"It's how dad looks and how everyone else looks," Brown said. "For most people, circumcision is the accepted norm."

Weiner said close to 80 percent of male newborns locally are circumcised. The national average is 65 percent. That's down from a high of 90 percent in the 1970s.

Circumcision is becoming less common nationally amid new information that its benefits are not as significant as previously thought, said a report on the new circumcision study.

In fact, the influential American Academy of Pediatrics no longer recommends routine circumcision because of questionable benefits and medical and anecdotal evidence that circumcised men have less penile sensitivity.

The AAP's announcement of that revised recommendation last year prompted the new study, said researcher Dr. Dimitri Christakis. The study found that circumcision does not provide the protection against urinary tract infections and penile cancer as was previously thought.

The circumcision rate began to climb in the United States after World War II when insurance companies and other payer systems began to pay for the procedure, Weiner said. In Great Britain where circumcision is not generally covered by insurance and must be paid for out of pocket, the rate is less than 10 percent.

Prior to World War II only the wealthy could afford circumcision, Weiner said, and it became something of a status symbol. Once insurance started paying for the procedure, everyone wanted to have it for their sons.

Today, when most insurance, including Medicaid, pays for circumcisions, the procedure has become so routine the only question most parents ask Weiner about circumcision is if it's done with anesthetic.

Weiner does use anesthetic, though he said that until just a few years ago most doctors gave infants no pain medications for circumcision.

Until recently, it was thought infants didn't feel pain the way an adult would. When studies showed infants do have a pain response, it became routine to use anesthetic, Weiner said..

And he added, circumcision is most likely painful.

"If people watched the procedure being done, they might choose not to circumcise," Weiner said.