Circumcision Facts
Should You Circumcise Your Baby Boy?
Many new parents have questions about circumcision. What are the risks? What are the benefits? Who will do it? Does it hurt? This column provides information that will enable you to make an informed decision about whether or not to circumcise your son.
The foreskin is the skin that covers the head (called the glans) of the penis in an uncircumcised male. If a baby is not circumcised, the connections between the foreskin and the glans will loosen and separate during the first few years of life, allowing the foreskin to be retracted behind the glans. Circumcision involves separating the foreskin from the glans and removing it so that the glans is exposed.
Long before the American Academy of Pediatrics issued its first policy statement on circumcision, the practice was well established in the Judeo-Christian tradition. Thousands of years later, in 1971, the Academy acknowledged the historical tradition, but found “no absolute medical indication for routine circumcision.” This position was maintained until 1989, when the Academy’s evaluation of then-recent data led to the belief that “medical benefits, as well as risk” were associated with newborn circumcisions. In 1999, as a result of new research, the Academy modified its position and while acknowledging potential medical benefits, clearly stated that these benefits were not sufficient to cause the Academy to recommend routine circumcision.
The Academy’s 1999 policy against routine circumcision is based on an attempt to establish a balance between the “benefits” of circumcision with the “risks” of remaining uncircumcised. Specifically, the Academy noted that while circumcised boys younger than 1 year of age were less likely to get a urinary tract infection (UTI) compared to uncircumcised boys, the overall rate of UTI’s in boys is so low that the “benefit” is negligible.
The Academy also noted that while circumcised men are less likely to get cancer of the penis anytime during their lifetimes compared to uncircumcised men, the overall rate of penile cancer is so low that the “benefit” is negligible.
To this balance, the Academy also added the risks of the actual circumcision procedure. Such risks include infection, excessive bleeding, pain, and cosmetic concerns. Infection, as a result of the procedure, is very uncommon. So too, are incidences of excessive bleeding. A thorough family history regarding bleeding disorders can significantly decrease this risk. The issue of pain is very real, as research indicates that newborns are capable of feeling pain. Infants who experience pain have elevated blood pressure, heart rate, and stress hormone levels. Therefore, every attempt must be made to minimize the pain associated with the procedure. The most effective form of pain relief is the injection of numbing medicine in a ring around the base of the penis.
Finally, cosmetic concerns may exist following a circumcision. In the majority of cases, these concerns diminish over time as the natural growth and development of the penis takes place.
In the end, the Academy could offer no significant medical benefits to advocate routine circumcision. Their policy is against routine circumcision.
Why, then, do the majority of American newborn boys get circumcised? The answer is because of social reasons. Most parents who choose to have their son circumcised do so because they “want him to look like his dad” or brother
The obstetrician or the baby’s pediatrician will perform the circumcision before the baby is discharged from the hospital. Following the circumcision, the glans will appear red and the cut edge of the foreskin may ooze for several hours. Care involves applying A&D ointment or Vaseline jelly on a cotton gauze and placing the gauze loosely over the glans. This will prevent the irritated glans from rubbing against the diaper. Over the course of 3 to 5 days, a soft, yellowish scab will develop over the glans, and by the 7th day, the site should be essentially healed.
Care of the uncircumcised penis involves cleansing the outside with warm water and a gentle soap. No attempt to force the foreskin back should be made, as the ability to retract the foreskin will occur gradually over the course of 3 to 5 years. Boys should be taught to retract the foreskin and clean this area during regular bathing.
Certain situations, such as a significantly premature delivery, make a circumcision prior to hospital discharge difficult or impossible. In such cases, arrangements to have the baby circumcised may be possible as soon as the baby has grown enough. Such arrangements, however, are difficult should the parents of a full term, normal infant elect to have the circumcision performed after discharge. Matters of insurance coverage come into play, and if the baby is older than one month, a urologist may need to perform the procedure. Beyond a few months of age, the use of general anesthesia is the standard practice.
In the event the cosmetic outcome is undesirable, a consult with a urologist will be necessary, as this is the specialist best suited to explain the situation and discuss the risks and benefits of a possible revision.
In the end, the decision to circumcise or not to circumcise is one for parents to ponder long before the eventual birth. Parents should speak freely and honestly with each other. Information should be read and discussed. The obstetrician or pediatrician should be consulted. Ultimately, it will be your decision, and one that will have a lasting impact.