Circumcision

Many parents choose to have their baby boys circumcised for religious, cultural, ethnic, hygienic, or medical reasons. In addition, many parents don’t want their son’s penis to appear different from his father’s or brother’s. However, others see it as an unnecessary and cruel procedure to inflict on a newborn boy.

According to the National Hospital Discharge Survey, 55.9 percent of all male newborns born in U.S. hospitals were circumcised in 2003, down from a high of 64.7 percent in 1980. However, circumcision is uncommon in Asia, South America, Central America, and most of Europe. In fact, 82 percent of the world’s men are intact.

Circumcision is the surgical removal of the prepuce of the foreskin, which is the skin that covers the tip of the penis. It is usually performed within 48 hours of birth before the baby is discharged from the hospital unless he is unstable, premature, or otherwise unhealthy, or if his urethral opening is in an abnormal position (on the side or base of the penis) which may require surgery to correct. In the case of premature babies or unhealthy babies, they may be circumcised when they are ready to leave the hospital. It may also be performed at home for religious reasons several days after birth. Circumcision becomes more complicated and involves greater risk in infants older than 2 months and in older boys and men, so the decision whether or not to circumcise your son should be made before he is born.

The circumcision procedure should only take about 10 or 15 minutes, during which the doctor will clean the penis and surrounding area. The procedure is painful and the American Academy of Pediatrics (AAP) recommends using a local anesthetic or topical numbing cream to reduce pain and distress. Once the anesthetic has been administered and has taken affect, the doctor will attach a special clamp or plastic ring to the penis and cut away the foreskin. He or she will then apply a protective ointment to the area and wrap the penis loosely with gauze.

It will take approximately 7 to 10 days for the baby’s penis to heal after a circumcision, during which time a clear crust may form over the area and you may notice a small amount of blood in his diaper – both normal and common. Infection is rare, but signs include:

• a foul-smelling, yellow discharge

• persistent bleeding

• redness or swelling of the penis (some minor swelling is common and normal)

• if your baby doesn’t urinate six to eight hours after the circumcision

• if your baby has a temperature of 100.4 F or higher

Call your pediatrician immediately if you notice any of these symptoms or if a Plastibell device was used during the circumcision and it does not fall off within 10 to 12 days.

You should gently clean the area every time you change his diaper and with water every day. If there is a bandage covering the circumcision area instead of a Plastibell, the bandage should be changed with every diaper change as well. Some doctors recommend applying a dab of petroleum jelly to the tip of the penis to prevent it from sticking to the diaper while it’s healing. Read more about circumcision care.

The Controversy

Scientific studies about the necessity or harm of circumcision have provided conflicting results and the debate rages on about the procedure. Few experts recommend infant circumcision on a routine basis, but they also recognize there are benefits and advantages as well as disadvantages and risks. The American Academy of Pediatrics and the American Academy of Family Physicians (AAFP) do not endorse the procedure for all newborn boys, and the AAP does not find sufficient evidence to medically recommend routine neonatal circumcision or argue against it.

Benefits

• Decreased risk of urinary tract infections – A circumcised boy has a 1 in 1,000 chance of developing a UTI in the first year, while an uncircumcised boy has a 1 in 100 chance.

• Decreased risk of developing cancer of the penis and a reduced risk of cervical cancer in female sex partners – Although cancer of the penis is exceedingly rare among both circumcised and uncircumcised men, circumcised men have a slightly lower risk.

• Decreased risk of contracting sexually transmitted diseases (STDs) – Although proper protection against STDs (the use of condoms) is still absolutely necessary, there appears to be a reduced risk of contracting STDs, including HIV.

• Prevents foreskin infections and phimosis – Phimosis is a condition in uncircumcised males that makes foreskin retraction impossible.

• Easier genital hygiene – Although keeping an intact penis clean is simple and easy.

Disadvantages

• Complications – Immediate complications include bleeding, infection, improper cutting of the foreskin (either too long or too short), and improper healing. Later complications include buried penis, meatal stenosis, skin bridges, chordee, and poor cosmetic appearance.

• Decreased penile sensitivity – Although it has not been proven by medical or psychological studies, many people believe that circumcision decreases sensitivity and sexual pleasure later in life.

• Removal of protective barrier – Rarely, the exposed tip of a circumcised penis can become irritated and the urethral opening can become too small, causing urination problems and may require surgery to correct.

• Pain – The procedure is painful and traumatic. While the use of anesthetics has increased in recent decades, the needles used to inject many anesthetics are painful themselves.

• Expense – Some insurance companies do not cover the cost of circumcision.

The decision whether or not to circumcise your son is a personal one that should be made after taking into consideration your religious, cultural, and personal beliefs, as well as the associated benefits and risks, and discussing it with your doctor.