To Cut or Not to Cut?

Critics of routine circumcision call it a “procedure in search of an indication.” But do the latest findings concerning HIV transmission provide that indication?

So far, the AAP and the AMA haven’t revised their statements on the procedure, while the Centers for Disease Control and Prevention in Atlanta is reportedly only beginning to design studies that might lead to a national policy. In the Twin Cities, Carolyn McKay notes that the recent AIDS–related headlines may seriously confuse the issue. “Cutting the HIV transmission rate by 50 percent is great, but what you really want is a zero rate of transmission,” she says, adding that the only way to prevent AIDS is to use condoms.

Interesting as the public health debate may be, studies have shown that it’s had almost no bearing on parents’ decision to cut or not to cut. “It’s so far down the road, most parents can’t even grasp that their kids are going to grow up and have sex,” says Laurie Frattalone. Few parents ask questions about sexually transmitted diseases and infection rates, she says. They wonder, instead, about other, more esoteric questions: Will our son be teased if he’s circumcised—or if he’s not? Will he be confused if he doesn’t look like his dad? What if he’s unhappy with the choice we’ve made for him? What will his grandparents say? Will the procedure go out of fashion, cosmetically or politically, or will it experience new popularity because of some new medical advance?

Maria Douglas Reeve, a newspaper editor in St. Paul, asked herself these questions when her first son was born, and then decided in favor of circumcision. “It just seemed like the accepted thing to do,” she says. “I didn’t want him getting dressed one day and wondering why he looks different from his dad.” Now expecting her third child, another boy, she says the recent headlines gave her new confidence about making the choice again.

The Macgowan–Hays family, expecting their newest addition this month, read the latest news about circumcision and came to the opposite conclusion. “The [new findings] may give us an opportunity to talk to our sons sometime in the future about safe sex and being responsible,” says Macgowan. “[But] we still feel we made a good decision, and we’ll definitely make it again.’’

Perhaps not surprisingly, McKay says that in her nearly forty years of pediatric practice, there seems to be only one constant in the debate about circumcision. “It’s a deeply personal decision,” she says. “And parents feel quite passionate about their choice.”