The Pros And Cons Of Circumcising Your Baby Boy Are Discussed
What is circumcision?
At birth, boys have skin covering the tip of the penis, referred to as foreskin. Circumcision surgically removes the foreskin to expose the tip of the penis. The procedure, which is one of the most common in-patient surgeries in the U.S., usually occurs in the first few days following birth and is performed by a doctor. In order for an infant to undergo the surgery, he must be stable and healthy. This means premature infants and male infants born with complications are excluded from the procedure until they are considered stabilized.
According to the 1999 Circumcision Policy Statement put forth by the AAP’s Task Force on Circumcision, there are three common methods of circumcision, all including surgical devices such as the Gomco clamp, the Plastibell device, and the Mogen clamp.
To accomplish the circumcision, the doctor estimates the amount of external skin to be removed, dilates the opening to ensure that the glans is normal, bluntly frees the inner epithelium (skin) from the glans epithelium, puts the clamp or device in place, and leaves it long enough to produce hemostasis (halt bleeding), and then amputates the foreskin.
The policy statement warns, “It is important that those who practice circumcision become sufficiently skilled at the technical aspects of the procedure so that complications can be minimized.” Further, the AAP emphasizes that those who practice circumcision be skilled at suturing to ensure that hemostasis can be secured when necessary and that the skin edges can be brought together if they separate widely.
The choice to circumcise or not circumcise is a hotly debated topic among parents as well as the medical community. The incidence rates of circumcision in the U.S. have varied from 31 percent in the early 1930’s to a high of 85 percent in 1965. Research indicates the circumcision rate in 2005 was about 56 percent.
Even though accurate circumcision statistics are difficult to obtain, the incident trends indicate that circumcision is no longer the norm. The trends have tended to follow the AAP policy statements on neonatal circumcision (which have primarily posited that circumcision is an elective, not necessary, medical procedure), yet parents feel very strongly about their decisions and, oftentimes, the medical community does, too.
Why do parents circumcise?
There are a variety of reasons why parents choose circumcision, including medical reasons such as lower risks of urinary tract infections (UTI), cancer of the penis, sexually transmitted diseases (STD), foreskin infections, phimosis and easier genital hygiene. Many parents also cite social reasons, such as all the males in the family or community are circumcise, as well as cultural or religious reasons.
“All of our boys are circumcised, just like their father,” says C.B., mother of three boys. “We looked into all of the options and just felt it was the best decision. I think it is important to have children be confident in their bodies and not feel as if they are different in anatomy from the parent that is of the same gender. Later in life they most likely won’t be teased in the locker room shower…and way later, when they become sexually active, they will be less likely to have an STD.”
K.T., mother of two boys, followed doctor’s orders with her first son. “We only had our first son circumcised because we thought that it was the best thing at the time. And our doctor told us that we should just do it, and being that this was our fist child, we didn't really debate it. We weren’t doing it for religious purposes…we were just following the norm at the time.” However, K.T. felt very different with her second son.
Why do parents not circumcise?
More and more parents are opting to not circumcise their sons due to fear of the risks and pain of a surgical procedure, belief that the foreskin is needed to protect the penis (the body was born with it, so it must serve an essential purpose), belief it can be properly cleaned to reduce risks of UTI or other penile conditions, negative effects in sexual pleasure later in life and the fact that it is becoming less common to circumcise.
K.T.’s second son was born a year later. She recalls, “After having seen what our first son went through, we decided that we did not want our second son to be put through something that was so horrendous and painful…and done for no real reason. Also, more and more parents are not putting their sons through that these days, so we figure that by the time our second son starts school, he will not be ostracized for it.”
K.T. is not alone. “My husband, who is circumcised, and I did a lot of thinking and researching before making our decision to not circumcise our son, who is now almost a year old,” says S.T., mother of one boy.
She explains, “We saw no reason to put our son through a painful elective procedure that has no medical benefit. We were aware of the controversy, especially since it is widely practiced in the U.S. and the males in our families are circumcised, but even the AAP does not consider circumcision a mandatory medical procedure. Sure there may be a higher risk for some conditions, but there are also risks with surgery. Our pediatrician told us that fewer parents are circumcising their sons, so we are confident that by the time our son gets into locker room situations or relationships, he won’t be an anomaly.”
B.B., the mother of one boy, adds, "My husband and I didn't feel like the potential benefit of elective circumcision outweighed the potential harm that could occur in making this irreversible decision on behalf of our infant son. Why treat him NOW for diseases he's statistically not even likely to have in adulthood? What other body part to we remove in infancy to prevent a potential disease in adulthood? Masectomy? Appendectomy? We find that reasoning illogical. Ultimately, we feel making the decision about a completely elective surgical procedure (particularly one that could eventually impact his sex life) is a basic human right and that our son should be involved in this decision about his body."
Of course, there is always the risk that uncircumcised boys will be taunted, but children are taunted for a variety of reasons, circumcised or not.
K.P., also the mother of one boy, says “Originally we wanted to have our son circumcised because that was what we thought everyone did. However, the doctor inadvertently forgot to do it and, after we had some time to think about it, we decided against it. Our son is in his 20’s and has never been taunted, nor has he had any problems with being uncircumcised. He is in a long-term relationship, has a child, and, now, looking back, I’m glad we opted to not have him circumcised.”
What are parents to do?
The AAP’s opinion is “Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. To make an informed choice, parents of all male infants should be given accurate and unbiased information and given the opportunity to discuss this decision.”
Pros and cons
- Pain during circumcision: There is considerable evidence that newborns circumcised without analgesia experience pain and physiological stress. Research also suggests that circumcised infants exhibit a stronger pain response to subsequent routine immunization than uncircumcised infants. The AAP recommends that analgesia be used during circumcision.
- Penile problems: According to the AAP, penile problems, such as minor penile inflammation and inflammation of the foreskin, may develop in both circumcised and uncircumcised males, though the true frequency is unknown.
- Hygiene: Circumcision has been suggested as an effective way to maintain penile hygiene, yet there is little evidence to affirm the association. Penile hygiene should be taught and emphasized regardless.
- Sexual pleasure: Despite anecdotal evidence to the contrary, research by Masters and Johnson, renowned researchers of human sexual response, note no difference in sensation between circumcised or uncircumcised men.
- Complications of circumcision: The true incidence of complications, such as bleeding, infection, and other penile conditions, are unknown but research indicates that they are below 1 percent and most are minor. However, if circumcision is performed after the newborn period, there is an added risk related to general anesthesia, if used.
- UTI: Over the past 15 years, research on the association between circumcision status and UTI suggests that there is an increased incidence of UTI in uncircumcised boys in the first year of life (ranging from four to ten times more likely). However, the absolute risk of an uncircumcised male infant getting a UTI is low, at most around 1 percent.
- Penile Cancer: Literature on the relationship between circumcision status and the risk of squamous cell carcinoma of the penis (SCCP) is difficult to analyze, but studies suggest that there is an increased risk of uncircumcised males getting SCCP. The AAP policy statement states, “Nevertheless…penile cancer is a rare disease (incidence of 1 in every 100,000 males) and the risk of penile cancer developing in an uncircumcised man, although increased compared to a circumcised man, is low.” Further, good hygiene may be a preventative factor.
- STD: Studies suggest that circumcised males may be at a lower risk for syphilis and HIV infection, plausibly due to the presence of the mucosal surface of the uncircumcised penis, which can allow a viral attachment. However, practicing safe sex and being aware of the risk of STD is a more important factor in prevention than circumcision status.
The bottom line
There are pros and cons in circumcising and not circumcising and it is legitimate for parents to take medical factors into account as well as the cultural, religious, and ethnic factors. However, it is paramount that parents are presented with factual information before making their decision and, in cases of a healthy infant, not be encouraged by doctors one way or the other.
Douglas S. Diekema MD, MPH of Treuman Katz Center for Pediatric Bioethics and Children's Hospital and Regional Medical Center in Seattle, Washington, says, “I would argue that parents should be allowed to make the choice to authorize a procedure (like circumcision) unless there is clear and compelling evidence that doing so would place their child at significant risk of serious harm that is not justified by the potential benefits of the procedure.”
Dr. Diekema adds, “With regard to circumcision, there are some demonstrated medical benefits and some potential harms. Different people come to different conclusions when presented those potential benefits and potential harms. I think parents are the proper individuals to be making these decisions for their children.”
The bottom line? Whether you feel that circumcision is essential to the well-being of your sons or if you have chosen to forgo the procedure for the well-being of your sons, this important decision rests in your hands. As your child's steward, it is your obligation to make the most informed choice possible for your child.
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