c.1997 N.Y. Times News Service=
A debate over the benefits and drawbacks of circumcision hasintensified in recent years. Several studies have reported lowerrates of urinary tract infections and sexually transmitted diseasesin circumcised males. But others have found reduced sexualsatisfaction, prompting a backlash against circumcision and eventhe introduction of a surgical technique to undo it.
A new study has added to the criticism of routine circumcision,finding that circumcision does not lead to lower rates of sexuallytransmitted diseases. The study found that the incidence of two ofthose diseases was even higher among circumcised men. However,sexual dysfunction was found to be slightly more common amonguncircumcised men.
The study also found that circumcised men were significantlymore likely to engage in a varied repertoire of sexual practices,including oral sex, anal sex and masturbation.
The study was the first systematic look at the effects ofcircumcision on disease and sexual behavior, according to a reportbeing published Wednesday in The Journal of the American MedicalAssociation.
The latest findings came from a nationally representative sampleof 1,410 men 18 to 59 years old, interviewed in person in 1992 aspart of the National Health and Social Life survey by researchersat the University of Chicago.
In the report, circumcision was found to be most prevalent amongwhite men and men from educated families. The rate was 87 percentfor sons of mothers who were college graduates, 81 percent fornon-Hispanic white men, 65 percent for black men and 54 percent forHispanic men. As expected, the rate was highest among Jewish men _96 percent—because circumcision is a Jewish religious custom.
Circumcision is widespread in this country because doctors havelong thought that it prevented sexually transmitted disease, butthe researchers found no evidence for that. In fact, circumcisedmen in the study were more likely to report herpes and chlamydiainfections.
The researchers could not explain why circumcised men had ahigher incidence of some sexually transmitted diseases. But Dr.Edward O. Laumann, the lead author of the study and the chairman ofthe sociology department at the University of Chicago, said thathis study was stronger than previous studies that reported theopposite results about sexually transmitted diseases.
Those studies looked at the circumcision rates of men beingtreated for the diseases, he said, whereas his study compareddisease rates in circumcised and uncircumcised men and controlledfor factors that would predispose them to disease.
The major finding of the new study is that there is asubstantial relationship between circumcision and sexual activity.Circumcised men in the study engaged in a wider range of sexualpractices, like oral and anal sex and masturbation. For example, 81percent said they had received heterosexual oral sex at some pointin their lives, compared with just 61 percent of uncircumcised men.
Though religion and social class are known to influence sexualbehavior, Laumann said that they did not explain the variationsfound in this study because the researchers had controlled forthese factors.
Laumann had two possible explanations for the variations. One isthat uncircumcised men, a minority in this country, may feel astigma that inhibits them. Another is that circumcision reducessensitivity in the penis, leading circumcised men to try a range ofsexual activities.
The study also found that circumcised men were less likely toexperience sexual dysfunction, like loss of interest in sex,anxiety about sexual performance or difficulty with achieving ormaintaining an erections. That difference was seen in men of allages, but it was most striking among men 45 to 59 years old.
The incidence of sexual dysfunction reported in this group was40 percent among the circumcised men and 58 percent among theuncircumcised. Here, too, Laumann said, any stigma linked to beinguncircumcised may be a factor.
Since 1989, the American Academy of Pediatrics has been neutralon circumcision, leaving it up to parents and pediatricians. But anacademy panel is reconsidering that position in light of severalrecent studies, said Dr. Carole M. Lannon, the panel's chairwoman,and is expected to issue a statement by the end of the year.<
Circumcision, a common practice in the United States, offers menlittle health benefit, according to a new study.
It has long been believed that circumcision, in which theforeskin of the penis is removed, is more hygienic and thereforehelps protect men against infections, including sexuallytransmitted diseases (STDs).
But in the study of 1,410 American men ages 18 to 59 years,circumcised and uncircumcised men showed similar rates of STDs.
``A lot of parents are motivated by cosmetic reasons—they want[their sons] to be like their dads, their brothers, and to not bedifferent in the locker room,'' said lead author Edward O. Laumann,chair of the department of sociology at the University of Chicago.Many newborn males also are circumcised for religious reasons.
But although many doctors believe circumcision helps improvehygiene of the penis, thorough washing of an uncircumcised peniscan be just as hygienic, said Laumann, whose findings appearWednesday in the Journal of the American Medical Association.
Circumcision ``is not a cost effective solution to a problem ofhygiene,'' he said.
Dr. Lorraine Stern, an associate clinical professor ofpediatrics at the University of California in Los Angeles, agreed.
``Surgery should not be a replacement for hygiene,'' Stern said.
``Routine neonatal circumcision is, in my opinion, a ritual,''she said, and one that is not medically necessary.
But Dr. Thomas E. Wiswell, director of neonatal research atThomas Jefferson University in Philadelphia, said that ``themedical benefits far outweigh the risks and medicalcomplications.''
Circumcision, for instance, helps protect against penile cancerand urinary tract infections, he said. In addition, other studieshave found that circumcision does help protect a man against STDs,he said.
Both the American Urological Association (AUA) and the AmericanAcademy of Pediatrics (AAP) have policies stating that neonatalcircumcision has potential medical benefits and advantages as wellas disadvantages and risks.
For the first three to six months after birth, uncircumcisedinfants are 10 times more likely to have a urinary tract infectionthan circumcised babies, according to the AUA. Complications _including bleeding, penile injury and infection—occur in about 3percent of all circumcisions.
``Newborn circumcision is a rapid and generally safe procedurewhen performed by an experienced operator,'' wrote the AAP TaskForce on Circumcision. ``It is an elective procedure to beperformed only if an infant is stable and healthy.''
The AUA and AAP advise parents to discuss the risks and benefitsof the procedure with their doctors, taking into account their ownethnic, cultural, religious and individual preferences.
Journal of the American Medical Association (1997;277:1052-1057)
c.1997 Seattle Post-Intelligencer
Some issues outlined by Stephanie Coontz, author of ``The Way WeReally Are: Coming to Terms with American's Changing Families.'
TEENS
There's no evidence that most teens are any more irresponsibleor destructive than teens were in the past, but they lack somethingthat many older men grew up with: meaningful work with adultmentors.
Apprenticeships, summer jobs in their parents' workplace andcommunity service are possible remedies.
Instead, teenagers complain of being shoved out of themainstream by adults who ostracize and exclude them. Curfews,school uniforms and attempts to ban teens from public places arebound to backfire.
``These are containment policies,'' Coontz said. ``This is whatyou do to occupied countries. We shouldn't be doing that to ourkids. That's part of our denial that this is a larger communityproblem.''
SOCIAL SUPPORT
Corporate and government support for families has steadilyeroded, putting a greater financial and emotional burden onfamilies.
``Never before in American history have we expected parents todo so much for their children, on their own,'' Coontz says.
Urging a return to 1950s-style families makes no sense, sheadds, without a return to the economic climate of the '50s, whichincluded the GI Bill, a livable wage, affordable housing, highercorporate income taxes and a corporate culture that valuedworkplace stability.
MARRIAGE
Marriage isn't dying, but it won't be the pivotal institution itonce was.
``Women and men simply need each other economically less than inthe past,'' Coontz said. ``You will never again be able toreconstruct marriage on the old basis, where there is no (other)option.''
But people are still taking the plunge. In 1867 there were 9.6marriages per 1,000 people. A hundred years later there were 9.7.
Meanwhile, the proportion of women who remain single all theirlives is lower today than at the turn of the century, and fewerwomen feel they must forgo marriage in order to accomplish anythingelse in life.
``I think the reason (gay marriage) has become such a hot-buttonissue,'' Coontz added, ``is because marriage is no longer thecentral institution of our lives. A productive question is, `How dowe redefine marriage in today's world?'''
DIVORCE
Divorce isn't a new phenomenon in America and it isn't alwaysthe worst possible outcome for a rocky marriage.
``America had the highest divorce rate in the world going backto 1889,'' Coontz said. ``We have a culture that has a problemsustaining long-term commitments.''
Coontz acknowledges that divorce can be devastating and agreescouples should try to work things out. But she said studies showthat children generally do worse in ``intact'' families filled withconflict than in divorced or never-married families. Higher wagesand fairer child support could minimize some of the worst effectsof divorce, such as single-parent poverty.
``We're never going to shove the divorce rate back to what itwas in the 1950s,'' Coontz said. ``To save more marriages thanwe're currently saving, we have to come up with new value systemsand new supports.''
UNWED MOTHERHOOD
Don't blame the libertine '60s for the rise in unwedpregnancies. The fastest increase took place between 1940 and 1958,when the rate tripled from 7.1 births per 1,000 unmarried women to21.2 births.
The rate of unwed motherhood is rising worldwide and exceeds 20percent in places as diverse as South Africa and northern Europe.Reasons include more economic independence, less social controlover personal life and a decline in birth rates among marriedcouples, which makes unwed births a bigger proportion of the total.
In the United States, poverty and social deprivation feed thetrend. One researcher says the correlation is so strong that, from1969 to 1993, the teen birth rate could be calculated with 90percent accuracy from the previous decade's child poverty rate.
CRIME
Barbara Dafoe Whitehead of the Institute for American Values,who in 1993 wrote an Atlantic Monthly cover story titled ``DanQuayle Was Right,'' has said that more than 70 percent of alljuveniles in state reform institutions come from fatherless homes.
But Coontz says the evidence isn't so clearcut. According to a1993 report by the National Academy of Sciences, ``personal andneighborhood income are the strongest predictors of violentcrime.''
``If single parenthood `caused' crime and violence,'' Coontzargues, ``then Sweden and Denmark ought to have higher rates thanthe United States, instead of rates that are dramatically lower.''
WELFARE
Complaining about welfare is sometimes the only way people canconvey their legitimate concerns about the growing gap between workand reward in America. Just don't confuse these people with thefacts.
Nearly half of Americans think welfare accounts for 20 to 50percent of the federal budget, when in fact welfare programs totalonly 5 percent of federal spending. Three-fourths of welfarerecipients get off the dole within two years, and half get offwithin a year, but a shortage of stable jobs often drives themback. Contrary to myth, out-of-wedlock birth rates havehistorically been lowest in states with the highest welfarebenefits.
``The real dirty little secret about welfare,'' Coontz says,``is that it's cheaper to write checks than to invest in creatingjobs. Welfare serves as a safety valve for an economy that cannothandle full employment.''
Because of the oversupply of workers, she adds, even if we couldmove every welfare recipient into full-time jobs, the ironic effectwould be to depress wages for all low-income workers.
c.1997 Seattle Post-Intelligencer
Stephanie Coontz, who studies the history of American families,was riding to the airport one day when her taxi driver startedrailing against the welfare system.
Always eager to take the public pulse, Coontz probed deeper andfound the driver had good reason to feel resentful.
The driver said she had worked for the same company for 29 years_ six days a week, often 13 hours a day. Yet she had no pension andno medical benefits. She worried about her daughter, who wasdivorced and struggling.
Someone, it seemed, had stolen the American Dream.
Behind the angry rhetoric, Coontz found a beleaguered womantrying to make sense of an intensely stressful and competitive eraof social change.
Multiply her by 263 million and you've got an American societydesperate for quick fixes and, Coontz believes, easy prey for family-values hucksters with quack social remedies.
If only people respected marriage ...
If only mom stayed home with the kids ...
If only people believed in an honest day's work ...
If only people took responsibility ...
If only ...
If only it were that easy.
Coontz, a historian at The Evergreen State College in Olympia,Wash., hopes to inject fact and perspective into a national debateoften characterized by hype and emotion.
In her new book, ``The Way We Really Are: Coming to Terms WithAmerica's Changing Families'' (Basic Books, 238 pages, $23), Coontzframes the issues of divorce, welfare, crime and working couples interms of historical analysis, new sociological research andinterviews with families of all types.
Her conclusion: We're living through a period of social,cultural and economic change every bit as wrenching as theIndustrial Revolution of the early 19th century.
No wonder people feel anxious and unsettled.
But Coontz says there's no going back. Instead of trying toforce people to reclaim ``traditional'' family values, we mustadapt our social institutions to fit the changing times. The newpro- family culture might include, say, flex time at work, paidleaves for caregivers and clearer roles and expectations arounddivorce and stepparenting.
Society will have to work out the details, but Coontz says thesooner we get on with the process, the sooner we can regain a senseof stability.
``If I told you what a family-friendly society would looklike,'' she said during an interview, ``it would be no moreaccurate than my telling you what I wanted to be when I was 7. I'ma product of all the old patterns, too.
``I'd like to just get people to ask the right questions.''
She added that moralizing and one-size-fits-all solutions haveno place in complex family issues such as divorce.
``It's just too complicated to play God,'' she said.
Coontz achieved national recognition five years ago with herbook ``The Way We Never Were: American Families and the NostalgiaTrap,'' which debunked comfortable notions about life in the ``goodold days'' of the 1950s. The book went to press just as Dan Quaylewas taking aim at TV's Murphy Brown for having a sitcom baby out ofwedlock.
For the next four months, as the public clashed over familyvalues, Coontz averaged three radio talk shows a day and severaltelevision appearances a month. As new issues came up—fromno-fault divorce to concerns over AWOL fathers—Coontz testifiedbefore Congress and appeared on ``Oprah,'' ``Crossfire'' and othernational shows. As she tells it, ``I was quoted by Newsweek andmisquoted by the National Enquirer.''
Her academic insights struck a chord with everyday people, whocorralled her at PTA meetings, sent her e-mail and wrote heartfeltletters about their concerns for the future. Now that we know howwe never were, people asked, what's next?
Again, history provides some clues.
``You have to look at: Where have families come from, how havethey actually behaved in the past?'' Coontz said. ``What changesseem really, really deep and won't go away?
``You can't come up with either social policies to helpfamilies, or individual help, unless you understand these broadersocial forces.''
Coontz said learning history can be as useful in sorting outfamily issues as undergoing counseling—and a lot moreenlightening than political platitudes.
``When I listen to the political discourse in this country, Iget discouraged,'' she said, ``because I think it's at a very lowlevel. But I have been so impressed with the hunger that I see—atthe grass-roots level—to be treated like adults. People are verycapable of handling and understanding these complex issues.''
To illustrate how simplistic the national dialog has become,Coontz ran a computer search of newspaper articles from March 1993through January 1995. She found 263 articles blaming more than 20crises—such as teen drug use, unemployment, America's declininginternational competitiveness, federal budget deficits andindividual narcissism—on the ``collapse of family values'' or thedecline of two-parent families.
While politicians describe family styles solely in terms ofindividual morality, Coontz says personal decisions are shaped bybroader cultural and economic realities.
Divorce, for instance, is twice as likely among parents livingin poverty, and divorce rates climb among affluent couples whoexperience job loss. One researcher calculates that each 1 percentrise in unemployment results in 10,000 extra divorces.
Likewise, Coontz notes, people who are laid off are almost sixtimes more likely to engage in violent behavior than people withjobs, regardless of whether they had a prior history of, say,psychiatric disorder or alcohol abuse.
The same pattern showed up in a 1989 study of 350 white familiesin rural Iowa. Researchers found a link between declining income,unstable work or family debt and significantly higher levels ofaggression in middle-school children two years later.
But the connection between cultural and personal stresses isn'talways obvious, even to those involved.
Coontz writes of two therapists who were working with a familywracked by hostility, with constant battles between father and son.Until the therapists pointed it out, the family didn't make theconnection between their personal rage and the fact that the father_ along with hundreds of coworkers—had been fired from his jobwithout notice.
To expand the picture even further, Coontz says our own era isbut one of many historic periods of upheaval. We mourn the declineof the male breadwinner; early 19th-century Americans mourned thedecline of the farm economy that gave rise to the male breadwinner.
Consider the parallels between then and now.
By 1830, as the factory age took hold, alcoholism rose tohistoric highs. Gangs sprang up in poverty-stricken sections ofcities, with frequent bloody clashes between the Bowery Boys andthe Dead Rabbits of New York. Anxious citizens sought comfort inreligious revivals and scapegoated Catholics, Masons, bankers andforeigners. There were 16 urban riots in 1834, and 37 the followingyear.
As society changed, so did family life. Coontz says leisurelyfamily dinners and holiday get-togethers developed amid concernsthat men's outside work was making them strangers to the family _and to soothe men's anxiety that their domestic authority was beingundercut by their absence.
That kind of puts things in perspective. Not only is our currentangst predictable, it's proceeding right on schedule, according toresearch on the stages of cultural and social transformation.
We've already passed stage one—a rise in individual and familystress, as the old ways are toppled without new customs andexpectations to replace them. In this stage, most people don'trealize they're facing irreversible social change, so they tend tothink ``if we just tried harder, we could get back to the waythings used to be.''
Stage two, where we are today, is marked by public debate andcultural struggle. Tired of feeling inadequate for failing topreserve the old ways, people conclude that someone else has beenundoing their efforts. Scapegoating flourishes.
Only later, when people begin to understand why change isoccurring and what parts are irreversible, do they begin to adaptto new realities. At that point, society stabilizes.
None of this is easy.
``As a historian, I have tremendous confidence in people'sability to solve problems,'' Coontz said. ``But as a historian, Iknow there's a lot of resistance to rethinking institutions.''
Yet the movement must be forward, not backward.
``There's no way to go back,'' Coontz said. ``This is where boththe liberals and the conservatives are refusing to look realitysquare in the eye.''
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