(reading time ~13 minutes)
This article will discuss Should I Circumcise My Newborn Son, Pros and Cons. This is a difficult decision both mom and dad should make together. Team up together just as you did in making the best labor and delivery birth plan.
I do understand from a pregnancy group of moms my daughter is a part of that very often, mothers will ask dads to step up to the plate and take the lead in helping make this decision. If that's the case in your household, then go for it dads, but I still recommend both mom and dad read this article first.
What Exactly Is Circumcision?
Circumcision is a common elective procedure in which the foreskin, the sleeve of skin that covers the tip of the penis, is removed. The procedure is normally performed in the first two to ten days after birth.
Why Some Parents Have Difficulty With Circumcision
Some parents agonize about this decision, and with good reason. They don't want their first important decision for their baby boy to be misguided, yet the choice can be difficult. They don't want to put their baby through pain. Do the pros outweigh the cons?
A parent is naturally looking for overwhelming medical evidence for or against circumcision. Although this article recommends circumcision, I would not call the medical evidence in favor of circumcision a slamdunk.
But I would say the medical evidence gets at least 55% in favor of circumcision, so I suggest doing so or strongly considering it.
Current Professional Recommendation From The AAP
What does the American Academy of Pediatrics recommend about circumcision? The AAP says that while the health benefits of circumcision outweigh the risks, the benefits aren't strong enough to recommend that every newborn male be circumcised.
Does it sound as if the AAP is hedging to steer clear of controversy? It does to me.
Most Circumcision Decisions Today Are Based On Nonmedical Reasons
While some moms and dads carefully research the health benefits of circumcision, which is a good thing that shows conscientiousness, most parents will base their decision for or against circumcision based on nonmedical reasons. That is, cultural, religious, family identity, and personal and aesthetic preferences.
All these factors, in most cases, play a part in a father and mother's decision. For example, for many families, especially those of the Jewish and Muslim faiths, circumcision is a given – a sacred ritual and covenant with God.
Many choose to do what their families have always done-- like father, like son. Others just want their child to look like their peers.
Some will choose between circumcision or going natural as an aesthetic decision.
Did you know, for instance, one survey indicated that the look of a circumcised penis is favored 3 to 1 by American women? But then again, there are more circumcised males in the US, so that is the look more US females are used to.
Other parents wouldn't even consider circumcision when one can live a healthy lifestyle without it. They consider the practice to be painful, cruel, and even downright barbaric. This sentiment is gaining momentum, and I don't think one can argue that circumcision is not painful.
Circumcision Rates Have Been Declining
This growing sentiment and the diminishing belief that circumcision is a far more hygienic option are probably why circumcision rates have been declining in the United States since the 1970s.
According to a 2013 Centers for Disease Control and Prevention study, hospital data shows circumcision rates have fallen from about 65% in the US to 58% between the years 1979 to 2010. This drop is partly due to rising percentages of the Hispanic and black communities, as these groups are less likely to circumcise.
So we see the rates of circumcised and uncircumcised males in the United States are beginning to even out. Compare this to Western Europe, where children's rights groups have proposed banning the circumcision of minors, and circumcision rates are less than 20%.
And for a broader perspective, the World Health Organization estimated that in 2007 about 30% of all males globally were circumcised, counting the young and old.
Relying On Medical Information
I am most interested in addressing those parents who want as much medical information as possible before making their decision. As indicated, I believe the advantages of circumcision tip the scale in favor of recommending it.
The Two Most Cited Medical Reasons For Circumcision
The two most clear-cut medical advantages of circumcision are a tenfold decrease in the risk of urinary tract infections (UTIs) during the first year of life and a threefold decrease in the risk of penile cancer later in life as adult men.
However, UTIs for babies in the first year of life are somewhat rare. Approximately 0.9% to 4.2% of uncircumcised infants will develop a urinary tract infection in their first year. Breastfeeding, however, offers some protection against UTIs for both circumcised and uncircumcised infants, according to the AAP.
A urinary tract infection can be serious during the first two years of life. Untreated UTIs can introduce bacteria into the bloodstream and lead to kidney damage. Though unlikely, in severe instances, this can lead to sepsis.
UTIs are particularly dangerous during the first few months of life. "36% of uncircumcised boys with UTIs were found to have bacteraemia, 3% to have meningitis, and 2% acute renal failure. Moreover, 2% died."
Not only that, but if UTIs occur repeatedly, the kidney can scar and deteriorate to the point of kidney failure. And severe urinary tract infections in infancy can lead to kidney problems later in life. Circumcision reduces the risk of having UTIs by a factor of 10 times in the first 15 months of life.
Sometimes circumcision is recommended if a baby is born with a condition that puts him at high risk for UTIs. This protection carries on into adulthood, where circumcised males (CM) have a 3.7 times lower risk of developing a UTI. Later in life, however, UTIs are not very dangerous.
Though extraordinarily rare, circumcision provides a threefold reduction in the risk for penile cancer among adult men (1 case in 100,000). Penile cancer is nearly exclusively found among uncircumcised men, potentially resulting from a condition called phimosis, when the foreskin does not fully retract.
Other Medical Advantages of Circumcision
I believe, however, it is a combination of all the additional benefits listed below that tips the scale in favor of circumcision, though I understand how painful circumcision is for a baby.
There are numerous additional benefits of circumcision:
- Easier hygiene.
- Circumcision facilitates the washing of the penis, though uncircumcised boys can be taught to clean beneath the foreskin.
- Circumcision reduces the number of bacteria that can live under the foreskin. These bacteria can cause sexually-transmitted infections in adults. Therefore, uncircumcised men show a somewhat higher incidence of STDs. This may be due to the foreskin tissue being prone to microabrasions that allow STIs to penetrate.
- Circumcision may reduce the risk of phimosis, a condition when the foreskin becomes too tight to be pulled back and causes swelling. Skin tightening can make it painful to have an erection and challenging to clean the penis properly. This can cause an unpleasant smell and increase the risk of infection.
- Circumcision helps reduce the risk of balanitis, which is inflammation of the tip of the penis. It reduces phimosis and balanoposthitis, which are inflammation of the glans and an inability to retract the foreskin. It also prevents paraphimosis, the inability to return the foreskin to its original position.
- Uncircumcised males have a higher incidence of irritation, infection, and inflammation of the penis. They also have a greater chance of developing HPV warts on the foreskin.
- Many of the benefits of circumcision correlate with lower rates of STDs and STIs (sexually transmitted infections). It should go without saying that men outside of monogamous relationships or in relationships with infected partners should wear condoms, whether circumcised or not. It's the most effective prevention measure against STDs and STIs by a long, long shot.
- Thirteen observational studies have shown that male circumcision decreases syphilis by 33%. Another study showed that circumcision reduced incidence syphilis by 42% in uncircumcised men. Circumcision also decreases the risk of acquiring chancroid and reduces the risk of general herpes.
- Circumcision also reduces a man's risk of HIV from his infected female partner. Overall, male circumcision was found to reduce the incidence of HIV by at least 60% over non-circumcised males. That's because the foreskin often gets small tears during intercourse, allowing HIV cells to enter the bloodstream. This benefit should have vast implications, especially in the 14 priority countries in sub-Saharan Africa with HIV epidemics. Circumcision in these countries would improve the health of men and their female partners and reduce the healthcare costs associated with treating HIV and other STIs.
- In randomized trials, male circumcision also decreased the risk of acquiring genital ulcer disease, oncogenic high-risk human papillomavirus, and herpes simplex virus type 2.
- There is a direct benefit for partners of circumcised men as well. Male circumcision showed a reduced risk for cervical cancer in their female partners. Male circumcision was also shown to reduce transmission rates of high-risk human papillomavirus, trichomoniasis, and bacterial vaginosis in their female partners.
- Male circumcision was proven to reduce female partner syphilis incidence by 59%.
- Upon examination, many uncircumcised men have been shown to have asymptomatic discharge from the urethra due to chlamydia or gonorrhea that would otherwise have gone undetected. This is a threat to the health of the male as well as his female partner(s).
The John Hopkins Study
A recent Johns Hopkins study states that declining US infant male circumcision rates will lead to substantially higher rates of STDs and related cancers in men and their female partners, leading to billions lost in avoidable healthcare costs in treating STDs. 4.4 billion, to be precise, if US levels drop to levels now seen in Europe.
There is adequate research to make a case recommending in favor of circumcision. But now, let's look at the drawbacks of circumcision and the procedure itself.
The Drawbacks Of Circumcision
Probably the largest drawback of circumcision is that it is painful. It is surgery. It clearly hurts. Following circumcision, babies experience temporary changes in blood pressure, hormone levels, heart rate, and oxygen saturation.
How Is The Circumcision Procedure Done?
About an hour before the procedure, a numbing cream is placed on the baby's penis, typically by an obstetrician or sometimes by a pediatrician. Immediately preceding the procedure, the doctor injects a local anesthetic at the base of the penis.
The penis is stabilized by a clamp, and the foreskin is removed by a scalpel. The procedure is over in 10 to 15 minutes, and parents may be present if they choose. The medication wears off soon afterward. Acetaminophen can be given to keep the baby comfortable following the procedure.
Swaddling your baby or giving him a pacifier dipped in sugar water can also help to make him more comfortable. With infant Tylenol and proper care, your child's penis should heal comfortably in a few days to a week.
Circumcision is normally performed in the first few days of life before leaving the hospital. Of course, the baby must be in good health, not underweight, and without any bleeding disorders or other serious medical complications. If bleeding disorders run in the family, consult your doctor before having your son circumcised.
Boys with hypospadias, a condition where the urinary opening develops along the shaft of the penis instead of the tip, should not be circumcised. A surgeon may eventually have to use the baby's foreskin for a reconstructive procedure, usually when the baby is 6-12 months old.
What Are The Risks Of Circumcision?
As with all surgery, there are associated risks though they are considered low. Risks include:
- inflammation of the opening of the penis
- irritation of the head of the penis
- injury to the penis.
Surgical complications are considered rare, somewhere between .2% and .6%. The most common complication is bleeding, though it is very unusual for a baby to require a blood transfusion. Minor infection is the second most typical complication.
Less common complications are improper or excessive cutting to the penis or urethra, which can impair function. Another complication, the tip can become irritated and cause the opening of the penis to become too small.
This can cause problems with urination which may need to be corrected by additional surgery. However, infant circumcision is generally considered safe, having a complication rate of about 1.5%, such as infection, which topical antibiotics can take care of.
More serious complications include removing too much skin, a poor cosmetic look, or other damage to the penis. In these cases, reconstructive surgery or a follow-up circumcision could be required. But again, surgical mistakes only happen in about .2% to .6% of cases.
For instance, in extremely rare cases, a surgical error can remove too much of the tip of the penis. However, this can almost always be repaired.
It is a great deal to consider, and although I feel that the benefits of circumcision outweigh the risks, the decision, as I said before, is a close call. Basically, there is always pain involved and an outside possibility of a botched surgery. No, it isn't easy being a parent. Not even starting off.
However, when complications occur, they are usually minor – bleeding, infection or scarring. Complications are generally less likely when the circumcision is performed by someone very well trained in the procedure.
Following The Circumcision Procedure
Follow the instructions from your nurse or doctor for taking care of your baby after a circumcision. Gently clean the penis with water at each diaper change. Use mild soap to clean any stool off the penis.
If there is a bandage on the penis, it will most likely fall off when the baby urinates. Ask your doctor whether you should put a new dressing on each time you change your child's diaper.
Apply ointment to the penis with each change, so the penis doesn't stick to the diaper. You may even choose to put some petroleum jelly on the inside of the diaper to prevent the penis from sticking to it as it heals.
If the newly exposed skin on the tip of the penis becomes irritated, you may want to treat it with Vaseline as well.
It can be useful to have an extra set of helping hands for diaper changes to prevent the baby from kicking the circumcision area, which can cause bleeding. The area should get better after a few days. After a week or so, you should be able to continue with regular diaper care.
When To Call The Doctor
Call your doctor if:
- your baby hasn't had a wet diaper 6 to 8 hours after the circumcision
- you see a bloodstain larger that is larger than a quarter
- you notice signs of infection, for instance, redness or foul-smelling odor, discharge, or swelling around the penis tip that doesn't go away for 3 to 5 days
- a yellowish discharge on the penis tip doesn't go away after seven days
- a plastibell device was used, which doesn't naturally fall off within 10-12 days
- your baby's temperature is 100.4 or higher
Other Potential Downsides To Circumcision
Will Sexual Pleasure Be Decreased?
Some parents and opponents of circumcision are concerned that circumcision may harm a man's sexual desire, function, and satisfaction. They argue that circumcision may decrease the sensitivity in the tip of the penis, decreasing sexual pleasure later in life. However, the current evidence does not yet bear this out.
The foreskin is not the same as the skin on the head of the penis and isn't erectile tissue, so there is no obvious connection with sexual satisfaction. And studies have not been done to prove a decreased related sensitivity, so we don't know definitively at this time.
Some men circumcised as adults have reported that sexual sensitivity decreased significantly. However, another study found that circumcised men remain sexually active longer.
We do know from a few studies of African men circumcised as adults that some found intercourse better after circumcision, some found it worse, but most found it to be pretty much the same.
Will Insurance Cover Circumcision?
A typical hospital circumcision ranges from $225-$500. Some insurance companies consider the procedure elective and will not pay for it. If you plan to circumcise your son, call your insurance provider to see if the procedure is covered. Fewer and fewer insurance companies are allowing the procedure.
In 2012 the American Academy of Pediatrics recommended, in light of increasing evidence of circumcision's health benefits, that circumcision be covered by insurance.
Caring For An Uncircumcised Penis
Keep your baby's penis clean with soap and water to reduce the risk of infection, inflammation, and related scar tissue. As your son ages, his foreskin will separate from the head of the penis, a process called retraction.
Don't rush it by pulling. If you do, this can cause pain, bleeding, and damage to the penis. Retraction of the foreskin happens at different times, usually between the ages of 3 to 8, but typically around the age of 5.
When the foreskin can retract, teach your son how to gently pull it back and clean the underneath skin with mild soap and water. Rinse and dry the area and gently pull the foreskin back over the glans. This should be done daily while bathing or showering.
Is Circumcision The Child's Decision?
Many parents feel it is the child's decision whether or not to be circumcised. After all, circumcision cannot be reversed. While the temptation may be there for making the decision later, there is also a strong argument that this should be the parents' decision.
There are also cultural traditions that affect this decision. In North Africa, West and Southeast Asia, the procedure is normally done when the child is a young boy. In many parts of southern and east Africa, the procedure is performed once males reach the age of adolescence or early adulthood.
Circumcision, however, is safest to perform when the child is a newborn. After that, it becomes a riskier, more involved procedure the older a child gets. The recovery time usually takes longer as well.
Even in older babies and children, general anesthesia is used in an operating room, and the edges of the skin are sutured to prevent bleeding and facilitate healing. Sutures dissolve on their own a few days after surgery.
And insurance will seldom cover it once the child is no longer a young baby. The likelihood is that the older a child gets, the more hesitant he will be about having an elective procedure on his penis. So, you may have decided for your child in a sense.
Also, with circumcisions performed later in life, your child would have lost the protection against UTIs at the most important time, in the first two years of life.
Plus, if your child opts for circumcision as an adult he would have lost out on the many protective benefits during his sexually active years.
The Circumcision Decision
The decision of whether to circumcise is not an easy one for parents to make. This author feels that the medical advantages outweigh the risks, but the ultimate choice is in the parent's hands, or if you feel so inclined, the choice of the child when he is ready.
I hope this article on such a controversial topic has helped, and I welcome your comments and suggestions.