By Benjamin Spock, M.D.

Dr. Spock now believes that circumcision of males is traumatic, painful, and of questionable value.
When a baby boy is circumcised, the sleeve of skin that normally covers the head of the penis (the foreskin) is pulled forward and cut off. Circumcision is usually performed without anesthesia a few days after birth - on the unproven assumption that babies will not remember the pain later, although they certainly cry out with pain at the time.

The practice of circumcision has been around for at least 4,000 years. It is traditionally practiced by Jews and Moslems. But around 100 years ago, it became a more widely accepted practice in this country for all infant boys, due to a new emphasis on cleanliness. In fact, when circumcision came into vogue, it was believed to cure all manner of ailments in boys. Today, of course, we know that this is not the case, but the practice has continued.

Approximately half of all male babies born in this country are still being circumcised. But doctors are questioning whether or not routine circumcision is necessary, given the pain the baby experiences, the risks involved in performing the procedure, and the questions being raised about whether circumcision actually prevents disease.

What I recommended to parents about circumcision in early editions of Baby and Child Care is quite different from what I recommend now. In the 1940s, I favored circumcision performed within a few days of birth for a couple of reasons. First, there was, at the time, a commonly held belief in medical circles that women married to uncircumcised men were more likely to develop cancer of the cervix. The second reason I favored routine circumcision was that if the operation were performed on a newborn, there would be no chance of a physician scaring the bejeebers out of a boy by performing the operation when he was older. I personally had known of several instances in which an uncircumcised boy had been brought into the family doctor because he had been holding onto his penis, which bothered the parents. The physician would then suggest that the area under the foreskin had perhaps become mildly infected, causing an irritation of the penis, and that the best treatment would be to cut off the foreskin, which was believed to be harboring the infection. But the psychological trauma of circumcising an older child cannot be overestimated.

Boys, especially between the ages of two and four, tend to become quite anxious about the safety of their penises: It is at this time that they usually become aware that little girls don't have a penis, and boys tend to assume that girls somehow lost theirs in an accident, or that it has been cut off. And so, when an older boy is circumcised, even though the body of the penis remains, the circumcision suggests to the child that an attempt has been made to cut his penis off and, in fact, the attempt has been partially successful. It is understandable, then, that a young boy would become deeply upset by the operation.

In the 1940s and 1950s circumcision became quite common. By the 1960s, 90 percent of all male newborns in the United States were being circumcised as routine procedure. Ten years later, however, opinion among doctors swung away from the belief that certain groups of women developed cancer of the cervix because their husbands were uncircumcised. It was concluded that the cause was actually lack of good male hygiene - which is not as much of a problem in this country as it is in some other parts of the world. Also, by the early 1970s, more physicians - though not all - were aware of the psychological harm that could come from circumcision after infancy, and circumcision of an older child was not suggested as frequently as in the past.

In 1971 a task force of the American Academy of Pediatrics concluded that there is no medical reason to recommend routine circumcision, and I voiced the same opinion in the 1976 revision of Baby and Child Care. I hoped that the controversy would then be settled once and for all. But today, there are again some physicians who favor routine circumcision because they are of the opinion (not substantiated by solid scientific proof) that circumcision will decrease, at least to a small degree, the risk of contracting various venereal diseases in adulthood. But many physicians, myself included, are unconvinced.

One recent study did indicate that urinarytract infections in infancy, which is an uncommon disease in boys, does occur less frequently among circumcised boys, but this has not yet been confirmed by further studies. There is no doubt in medical circles that routine circumcision does prevent cancer of the penis, but this is a very rare disease which causes only approximately 150 deaths a year in the United States. Should one million baby boys be circumcised each year because of this small risk? Each parent must answer that question for him or herself.

In view of the renewed controversy regarding circumcision, the American Academy of Pediatrics has again appointed a task force to reconsider its position on routine circumcision, although no final decision has yet been reached.

Though the debate continues within the medical community, parents do have a few facts and various opinions on which to base their own decision on this matter. In earlier days many parents were not informed about what the issues were. The attending obstetrician or an intern or resident would appear at the mother's bedside a few days after delivery and say, ``Do you want the boy circumcised?'' or ``I suppose you want him to be circumcised,'' as if it were the only sensible choice.

We now know that it is not the only choice, nor is it agreed that it is the most sensible choice. My own preference, if I had the good fortune to have another son, would be to leave his little penis alone.

Dr. Spock, a contributing editor of Redbook, is the author of Baby and Child Care, which has sold more than 40 million copies.