|SSM Cardinal Glennon Children's Medical Center|
For some families, the choice is simple because it's based on cultural or religious beliefs. But for others, the right option isn't as clear. Before you make a circumcision decision, it's important to talk to your doctor and consider some of the issues.
Boys are born with a hood of skin, called the foreskin, covering the head (also called the glans) of the penis. In circumcision, the foreskin is surgically removed, exposing the end of the penis.
Approximately 55% to 65% of all newborn boys are circumcised in the United States each year, though this rate varies by region (western states have the lowest rates and the north central region has the highest). The procedure is much more widespread in the United States, Canada, and the Middle East than in Asia, South America, Central America, and most of Europe, where it's uncommon.
Parents who choose circumcision often do so based on religious beliefs, concerns about hygiene, or cultural or social reasons, such as the wish to have their son look like other men in the family.
Routine circumcision is usually performed during the first 10 days (often within the first 48 hours), either in the hospital or, for some religious ritual circumcisions, at home.
If you decide to have your son circumcised at the hospital, your pediatrician, family doctor, or obstetrician will perform the procedure before you bring your baby home. The doctor should prepare you by telling you about the procedure he or she will use and the possible risks. Circumcision after the newborn period can be a more complicated procedure and usually requires general anesthesia.
In some instances, doctors may decide to delay the procedure or forgo it altogether. Premature babies or those who have special medical concerns may not be circumcised until they're ready to leave the hospital. And babies born with physical abnormalities of the penis that need to be corrected surgically often aren't circumcised at all because the foreskin may eventually be used as part of a reconstructive operation.
The Pros and Cons
On the plus side, circumcised infants are less likely to develop urinary tract infections (UTIs), especially in the first year of life. UTIs are about 10 times more common in uncircumcised males than circumcised infants. However, even with this increased risk of UTI, only 1% or less of uncircumcised males will be affected.
Circumcised men also might be at lower risk for penile cancer, although the disease is rare in both circumcised and uncircumcised males. Some studies indicate that the procedure might offer an additional line of defense against sexually transmitted diseases (STDs) like HIV in heterosexual men. For HIV in particular, the findings come from studies done on populations of African men, and some experts feel that these data might not be as relevant to men in other areas of the world, like the United States.
Penile problems, such as irritation, inflammation, and infection, are more common in uncircumcised males. It's easier to keep a circumcised penis clean, although uncircumcised boys can learn how to clean beneath the foreskin once the foreskin becomes retractable (usually some time before age 5).
Some people claim that circumcision either lessens or heightens the sensitivity of the tip of the penis, decreasing or increasing sexual pleasure later in life. But none of these subjective findings are conclusive.
Although circumcision appears to have some medical benefits, it also carries potential risks — as does any surgical procedure. These risks are small, but you should be aware of both the possible advantages and the problems before you make your decision. Complications of newborn circumcision are uncommon, occurring in between 0.2% to 3% of cases. Of these, the most frequent are minor bleeding and local infection, both of which can be easily treated by your doctor.
One of the hardest parts of the decision to circumcise is accepting that the procedure can be painful. In the past, it wasn't common to provide pain relief. But the American Academy of Pediatrics (AAP) recommends it and studies show that infants undergoing circumcision benefit from anesthesia, so most doctors now use it. But because this is a fairly new standard of care, it's important to ask your doctor ahead of time what, if any, pain relief your son will receive.
Two main types of local anesthetic are used to make the operation less painful for a baby:
In addition to anesthesia, an acetaminophen suppository can be inserted into the baby's rectum. This helps reduce discomfort during the procedure and several hours afterward. Giving a pacifier dipped in sugar water also can help reduce a baby's stress and discomfort.
Caring for a Circumcised Penis
Following circumcision, it is important to keep the area as clean as possible. Gently clean with warm water — do not use diaper wipes. Your doctors may recommend putting a dab of petroleum jelly on the baby's penis or on the front of the diaper for 3 to 5 days to ease any potential discomfort caused by friction against the diaper.
If your son has a bandage on his incision, you might need to apply a new one whenever you change his diaper for a day or two after the procedure (put petroleum jelly on the bandage so it won't stick to his skin).
It usually takes between 7 to 10 days for a penis to heal. Initially the tip may appear slightly swollen and red and you may notice a small amount of blood on the diaper. You also may notice a slight yellow discharge or crust after a couple of day. Although this is normal, certain other problems are not.
Call your doctor right away if you notice any of the following:
However, with quick intervention, almost all circumcision-related problems are easily treated.
Caring for an Uncircumcised Penis
As with a penis that's circumcised, an uncircumcised one should be kept clean. Also, no cotton swabs, astringent, soap, or any special bath products are needed — just warm water every time you bathe your baby will suffice.
Initially, do not pull back the foreskin to clean beneath it. Over time, the foreskin will retract on its own so that it can be pulled away easily from the glans toward the abdomen. This happens at different times for different boys, but most can retract their foreskins by the time they're 5 years old.
As your son grows up, teach him to wash beneath the foreskin by gently pulling it back from the glans, rinsing the glans and the inside of the foreskin with warm water, then pulling the foreskin back over the head of the penis.
The Circumcision Decision
After reviewing multiple studies on circumcision, the AAP reports that "the health benefits of newborn male circumcision outweigh the risks." But at the current time, the scientific evidence is not strong enough for the AAP to recommend routine circumcision of all newborn boys. Instead, the AAP advises parents to learn the facts about circumcision and weigh the pros and cons.
In addition to considering the medical factors, religious and cultural beliefs might play a role. If these are important to you, they deserve to be seriously considered.
Talk to your doctor to help you make the choice that's right for your son.
Reviewed by: Elana Pearl Ben-Joseph, MD