It’s the subject of much debate and a source of anxiety for many parents of newborn boys: to circumcise or not? Here’s an unbiased review of the pros and cons of a controversial procedure.
Rhonda Ruiz awaited the birth of her son with great excitement, but also with a bit of trepidation. She knew that when her son arrived, she would have to make a very important decision: whether or not to circumcise him.
When she began to research circumcision and query her friends and family, Ruiz was astounded by what she found. “It seemed to me that I was the only person on the Earth who had ever questioned circumcision,” she says. “I could not find anyone who had opted not to have their son circumcised.” In the end, she wound up choosing the procedure for her son, but she secretly worried whether she had made the right choice.
If you do some reading on circumcision, you’ll notice there is quite a debate on the subject. Advocates of the procedure say that it keeps the penis cleaner and protects against a number of diseases. Opponents say that circumcision is not medically necessary and that it is painful and traumatic for the baby.
If you’re on the fence about circumcision, it’s a good idea to examine both sides of the issue, carefully weighing the pros and cons of the procedure. This article is not intended as advice, but rather provides some background to help you make an informed choice.
What is Circumcision?
Circumcision is a surgical procedure in which the foreskin—the piece of skin that naturally covers the tip (glans) of the penis—is removed. A circumcision can be performed in a hospital or in a religious ceremony (the Jewish ritual is called a bris and is performed by a medically and religiously trained practitioner called a mohel).
In the hospital, circumcision is usually performed within a day or two after the baby is born. The infant is generally placed in a special restraint chair and given a local anesthetic (a topical cream or injection). After pulling back the foreskin with a special clamp that protects the glans, the doctor cuts the foreskin. The incision site is covered in antibacterial ointment and wrapped in gauze to protect it against infection.
Circumcision Facts and Fallacies
“I have to circumcise my son—everyone else does.”
Actually, just over 65 percent of American newborn males are circumcised each year in the United States, according to the National Center for Health Statistics. You may decide to have your son circumcised for religious, cultural, or health reasons, but it is your choice to make.
Although the American Academy of Pediatrics (AAP) acknowledges that there are potential health benefits to the procedure, it does not recommend routine newborn circumcision. Certain babies—for example those born with genital malformations—may not be good candidates.“It will hurt.”
Without anesthesia, circumcision can be painful—and stressful—for the infant. A local anesthetic can ease the baby’s pain.
The most common types of anesthetics used are these:
- EMLA cream: A topical anesthetic cream is applied to the penis about an hour before the procedure. Topical anesthetic is probably the least effective of these methods for reducing pain, but it is the only method that does not require a needle stick.
- Ring block: A ring of the anesthetic lidocaine is injected around the bottom of the foreskin.
- Dorsal penile nerve block (DPNB): An anesthetic is injected at the base of the penis to dull the nerves.
- At a bris, the baby may be given acetominophen, a topical anesthetic, and/or a bit of red wine to calm him and ease some of his discomfort.
“It can cause infection and other complications.”
While any surgical procedure carries a risk of complications, circumcision is generally considered a safe procedure and side effects are uncommon. Although there is some debate about the actual numbers, the rate of complications is generally between 1 in 200 and 1 in 500 cases. Minor bleeding and infection are the most common complications. Less often, either too much or too little skin is removed, requiring additional surgery.
“It reduces sexual sensitivity.”
Some people argue that removing the foreskin can make the penis less sensitive and can reduce a man’s sexual pleasure later in life. Others claim that circumcision actually increases penile sensitivity. But there hasn’t been any real research to prove that the procedure affects sensitivity either way.
“It protects against disease.”
Circumcision may protect against several diseases, including urinary tract infections (UTIs), though even that stance is debatable.
“When it comes to urinary tract infections, I think there’s pretty good agreement that circumcision is protective in the first six months of life, which is when most UTIs occur in boys, but the magnitude of that protective effect is in question,” says Dr. George Kaplan, MD, a pediatric urologist and chief of surgery at Children’s Hospital in San Diego and a member of the AAP Task Force on Circumcision (1998-1999).
Some studies have found that circumcision reduces the risk of UTIs tenfold; others say the figure is closer to threefold or fourfold. Circumcision also appears to protect against cancer of the penis, although the disease is quite rare in general. And there has been some evidence that circumcision lowers the risk of contracting certain sexually transmitted diseases, including AIDS and HPV—the virus that is believed to cause cervical cancer in women.
A circumcised penis may be easier to keep clean. In uncircumcised males, bacteria can breed under the foreskin and cause infection, though this is not normally a frequent problem. Uncircumcised boys can be taught to wash underneath the foreskin (once it retracts at about age five) to prevent infection.
The circumcision debate rages on. When it comes to this issue, unfortunately there is no easy answer for parents. “There are risks and there are benefits to circumcision, as is true with almost any medical procedure,” says Dr. Kaplan. He advises you to discuss the issue with your partner and your child’s pediatrician before your baby is born. Make your decision based on your own beliefs and values, but with your baby’s best interests in mind.