Circumcision Decision

Question: We are expecting a baby boy, and we need to decide whether or not to have him circumcised. What are the pros and cons of circumcision?

Learn about it.

For some parents, circumcision has a deep religious significance; the procedure is central to establishing a newborn boy’s identity. But for many other parents, the circumcision decision has become increasingly difficult. Thirty years ago, up to 90% of American newborn baby boys were circumcised; currently, around 60% are circumcised. On the West Coast, this figure has gone as low as 40%, and in parts of Canada, 25% and less. Worldwide, the uncircumcised penis is clearly the norm: 85% of the world’s male population has “intact” (uncircumcised) penises.

Traditionally, many parents turn to the medical profession for advice, but the American Academy of Pediatrics has made it clear that there is no right or wrong decision on the circumcision issue. According to their Task Force of Circumcision (1999):

“Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In the case of circumcision, in which there are potential benefits and risks, yet the procedure is not essential to the child’s current well being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision.”

You are the only ones who can make the decision about what is best for your child.

The changing circumcision statistics and new information leave many parents in a quandary. This is a decision that cannot be made overnight, and you are right to think about, research, and discuss the pros and cons of circumcision well before your baby is born. While this issue occasionally is highly sensationalized and passionately debated in the media, be sure to look as objectively as possible at the procedure, its history, and its potential benefits and risks. In the end, you are the only ones who can make the decision about what is best for your child.

An explanation of circumcision

Every physically normal male is born with a foreskin, or prepuce, that covers the glans (tip) of the penis. The inside of this foreskin is a mucous membrane similar to the inside of the cheek, with numerous nerve endings. The foreskin is thought to protect the glans, and to keep it moist and clean. During a circumcision, the physician removes the foreskin surrounding the glans. The procedure is normally performed within the first two weeks of life, because the risks of a circumcision are greater if the baby is more than two months old. There are several different surgical approaches, but the following is typical: The baby is put on his back, and his legs and feet are restrained. Then the foreskin is separated from the glans with a type of forceps (necessary because tight adhesions connect a baby’s foreskin with his glans). Clamps hold the foreskin in place, a protective cover is put over the glans, the foreskin is pulled over the cover, and then about one-third to one half of the skin is cut off using a clamp. Antiseptic petroleum jelly may then be put on the penis to prevent irritation and infection. Complications are rare.

A history of circumcision

So how did circumcision become such a routine procedure in the United States? And why are opinions changing? Circumcision has existed for thousands of years, going back to Egyptian times; it is typically an intricate part of religious faith for Jewish and Muslim families. In the United States, circumcision was not practiced widely, however, until the late 19th century. Around the beginning of the 20th century, cleanliness became associated with wealth, and a circumcised penis was thought to be cleaner; about 25% of men were circumcised at that point. In the 1930s, the military began requiring circumcisions because soldiers in the field had little access to water, and maintaining adequate personal cleanliness was difficult. Studies in the 1940s and 1950s (some of them questionable) showed medical advantages for circumcised men and their partners, and circumcision became almost universal within the United States. Circumcision has always carried an element of tradition: When the father is circumcised, the parents want their son to “be like the father” (or the brother, or the other boys in the locker room). This is probably a key reason for the relatively high rates of circumcision in the U.S.

Opinion has started to change, however, and the rate of routine circumcision is decreasing. Recent studies have shown benefits of circumcision as well as risks, and the decision falls fully into the hands of parents.

Pain relief

One thing is abundantly clear: pain relief should be provided to the infant undergoing a circumcision, as the ridiculous belief that infants do not feel pain during circumcision has been completely refuted. The American Academy of Pediatrics now recommends analgesia for all circumcisions, as it is “both safe and effective.” The three primary forms of pain relief are a topical numbing cream (EMLA), a dorsal penile nerve block (a local anesthetic injected into the penis) or a subcutaneous ring block (also a local anesthetic).

Circumcision information checklist

If you do decide to circumcise your son, use the following checklist to make sure everything goes as smoothly as possible:

• Have you discussed the issue with your doctor? Make sure that you understand exactly what will happen during the operation, what type of pain relief will be used, what the possible risks are of the surgery and of the analgesia (pain relief).
• Have you made sure that the right doctor will perform the surgery? Often your Ob-Gyn will do the circumcision, but pediatricians also perform the surgery. Especially in an area or hospital that doesn’t have a high rate of circumcision, ask about the doctor’s experience with circumcisions and the complication rate. If you are unhappy with your doctor’s answers to your questions about the surgery or pain relief, or if you don’t think he has enough experience with circumcision, find another doctor to do the surgery. You are your child’s advocate.
• Have you checked with your insurance company as to whether it will cover the surgery? Have you asked about the cost of the procedure?
• Have you written your wishes in a birth plan and read the consent form very carefully?
• Have you talked to your doctor so that you know what to expect as the circumcision wound heals?