The controversial cut

As a parent, Angelica Dilts has a lot of important decisions to make. And as the mother of a baby boy, her first boy, there is one big, irreversible decision she needed to make within the first few days of his life: whether to have him circumcised. She chose not to.

“It’s a painful, unnecessary and traumatic procedure,” she said. “For me, it’s not my right to be cutting off parts of my baby’s body when there’s nothing wrong with him.”

Dilts made that decision at the end of her pregnancy, when she was gathering information about the procedure from midwives, doctors and other experts in the Chico area. The knowledge she acquired through her research, coupled with the free-thinking values her parents taught her as a child, led to her conclusion.

It was a choice that alarmed the baby’s father, who Dilts said expressed social and cosmetic reasons for wanting to have his son circumcised.

“We both had very strong reactions,” she said. “But as a parent, it’s your job to make decisions based on the information you gather. It’s about what’s best for the child. It’s about being a critical thinker.”

The disagreement between Dilts and the baby’s father is representative of the growing fundamental split American society is facing regarding the issue of circumcision, which has been called one of the world’s oldest and most controversial surgical procedures. More and more parents are deciding to keep their newborn sons intact, for reasons ranging from changing recommendations by medical authorities to the growing trend of parents not wanting to blindly follow social norms.

On the other side, more-traditional individuals continue to seek the procedure for social and cosmetic reasons. Some have concerns about their infant’s hygiene and future experiences in social and romantic situations. Then there are the cultural and religious reasons many parents have for circumcising their sons—especially those who come from Jewish and Muslim backgrounds.

This split in values has widened in the past decade, said Dr. John Asarian, a pediatrician who has been practicing in Chico for almost 13 years.

Asarian said that 20 years ago “most” infant boys in the United States were circumcised for a combination of social, cosmetic and cultural reasons. However, he has noticed more of a 50-50 split in the number of parents who are choosing to have their sons circumcised today. And with more and more parents choosing to keep their sons intact, the social and cosmetic arguments—which often concern the infant boys’ “looking” like their fathers and peers—are losing ground.

The practice of circumcising infant males became widespread in the United States during the “hygiene era” of the late 1800s, when natural processes such as reproduction became increasingly medicalized, said Lyndall Ellingson, a professor in Chico State’s Health and Community Services Department who focuses on multicultural health. The procedure of removing the foreskin was believed to cure myriad conditions, including masturbation, whooping cough and a variety of other ailments.

Since then, the medical reasons for circumcision have largely been debunked. In 1999, the American Medical Association released a statement discouraging routine circumcision, and that same year the American Academy of Pediatrics released a circumcision policy statement relaying that, while there are possible medical benefits to having the procedure performed, the data are not sufficient to prove the procedure is necessary to ensure the well-being of a normal infant boy. The academy reaffirmed its findings in 2005.

Ellingson said the shift in attitude by medical authorities likely has been influenced by a shift in social attitudes that’s been taking place since the 1960s and ’70s, when many individuals began questioning authority and challenging the dominant social paradigm. Changing attitudes about circumcision, she said, were a part of that “constellation” of societal changes.

“It was based on grassroots change and then incorporated into the system,” Ellingson offered. “And now you have the system itself changing its attitude. It’s just kind of this wave of moving forward.”

Asarian stopped performing circumcisions four years ago when he decided that the risk of the surgery did not outweigh the medical benefits, which are mostly related to hygiene.

The circumcision procedure is uncomfortable for the infant boys, who are laid on a molded plastic instrument and restrained by their arms and legs. The procedure is usually performed on the second or third day of life, and cannot be performed within the first eight hours because a newborn’s midsection cannot be exposed to the cold.

“There are a lot of physiologic changes at birth, so the baby has enough to do just to get used to breathing, for example,” Asarian said. “So it’s not the time to do surgery unless it’s needed for a real medical emergency.”

Asarian also noted that, while many parents choose circumcision to prevent infection, the risk is not as great as many think, and most infections intact boys develop can easily be treated with topical or systemic antibiotics.

“I tell [the parents] it’s more of a social decision than a medical decision, because the evidence is not very clear-cut in the U.S.,” he said. “There is a small decrease in the number of infections in male babies who are circumcised compared to non-circumcised. You’d have to perform circumcisions on 300 to 400 babies to prevent one infection.”

And while the Center for Disease Control has warned Americans about the risk of increased incidences of HIV and other sexually transmitted infections for intact adult males, Asarian said it is important to understand that simple hygiene, preventative behaviors and increased education may be more appropriate ways of dealing with those risks.

Dilts said that while she always had an idea of how she would handle the decision whether to circumcise her son, the process of defending her decision has been more challenging than she expected.

“Until you are put in the actual situation, you’re not personally affected. I’ve become more of an advocate [against circumcision] since I’ve had a boy,” she said. “And you need to make decisions for yourself and your baby despite whether that’s the social norm. If we all wanted to stay with what the norms are, people would never change. Society would never move forward.”