The Circumcision Decision

Having a baby requires new parents to make a lot of decisions. For parents of baby boys, one of the first decisions is often whether or not to have your baby circumcised. Circumcision is an optional procedure where the foreskin of the penis is removed. When this is done in the newborn period, it is a much more minor and much less traumatic procedure than when it is done later in childhood or in adulthood. But is it necessary for penises to be circumcised at all?  ​

The American Academy of Pediatrics’ current policy statement on circumcision says that there is enough medical benefit to recommend that the procedure should be made available but that the decision should be left up to parents and that the procedure should be covered by insurance. Circumcision for other than religious reasons is not routinely done in South America, Europe, or Asia, so there is a lot of data in what happens in uncircumcised kids.

Benefits
Circumcised boys have a somewhat lower risk of developing urinary tract infections during the first year of life (this risk goes away after the first year), and circumcised men have lower rates of transmission of the viruses that cause AIDS, herpes, and genital warts. In fact, circumcision is recommended by the World Health Organization as a strategy to prevent the spread of HIV in some countries. Also, removal of the foreskin prevents problems specific to the foreskin, such as foreskin infections and phimosis, a condition in uncircumcised adults in which the foreskin cannot be retracted. Frequency of conditions requiring circumcision are estimated to be anywhere from 0.5-2%.

Risks
As with any surgical procedure, there are risks that parents should take into account. The procedure itself has a risk of bleeding, which may require further treatment, including stitches or medication to stop bleeding. In infants with bleeding disorders, post-circumcision bleeding can be severe enough to require transfusion or result in death. Post-circumcision bleeding can be the first sign of a bleeding disorder. There is a risk of infection, including local skin and soft tissue infection and more serious bacterial infection that may require oral or IV antibiotics. Most doctors inject numbing medicine in and around the penis to numb the penis for the procedure, but there is still a risk of the infant experiencing pain during or after the procedure. There is a risk of a poor cosmetic result and the potential for your son to need an additional procedure to achieve the appearance you want. Finally, there is a risk of trauma to the penis itself during the procedure. This trauma can be minor or can be as serious as amputation of the penis itself. 

The foreskin protects the glans of the penis and the urinary meatus (the hole where the urine comes out). When this protection is removed, the tip of penis may become irritated and cause the opening of the penis to become too small, a condition known as meatal stenosis. As the circumcision heals, there is a risk of scar tissue, known as adhesions, developing between the healing skin and edge of the glans. To prevent meatal stenosis and adhesions from forming, parents need to put petroleum jelly on the baby’s penis and in the diaper with every diaper change for 3 to 6 months after circumcision (this instruction comes from a urologist and is often not given to parents by pediatricians). It is difficult to anticipate how your baby will act after his circumcision. Some babies are fussier than usual after their circumcisions. Some babies want to sleep more. Some babies want to feed more. I have seen every version of that, and there is no way to predict.  

Finally
Lots of parents circumcise their sons, because they are concerned about how the child will react if his penis looks different from other boys or from daddy. Some parents I know have simply explained that everyone looks different, like different hair color and eye color. Kids are usually fine with that. When kids are older, parents can explain that a circumcision is where some parents decide to have a little piece of skin cut off of the baby boys’ penises when they are born, because they want the penis to look a certain way or they are worried about infection. Kids are pretty accepting of straightforward explanations like that.  

In terms of hygiene, an intact foreskin isn’t retractible until kids are 10 or so, so in infancy, a circumcised penis is actually a little more work than an uncircumcised penis. Any residual foreskin on a circumcised penis needs to be retracted with every diaper change and petroleum jelly needs to be applied. Every once in a while, little boys’ uncircumcised penises will get a little red and angry looking, but you can usually just fix that with some warm water soaks. It is important to remember, as you make this decision, that you are making a decision for a medical procedure with risks and benefits. This procedure will impact the appearance of your child’s body without your child having the opportunity to have a say in the decision. Waiting to do the procedure when the child is older and letting him decide if he wants to do it is an option, although the procedure is more painful and has a longer recovery time outside of the newborn period. If you have questions about circumcising your son, you should speak to your child’s doctor.