What to Expect
Circumcision Facts and Figures
Globally, circumcision is not a popular choice. Firm statistics on worldwide circumcision rates don't exist, but the Seattle-based organization Doctors Opposing Circumcision estimates that 85 percent of men haven't been circumcised.
In the United States, based on hospital discharge data, the National Center for Health Statistics (NCHS) says 60 percent of boys were circumcised in 2002, the most recent year for which figures are available. But this rate, based on data from about 10 percent of United States hospitals, varies significantly by region. In 2002, 81 percent of boys in the Midwest were circumcised; 69 percent in the Northeast; 64 percent in the South; but only 33 percent in the West.
"The regional differences may be due to varying rates among ethnic groups," says Mary Jones, an NCHS spokeswoman. "Low circumcision rates in the West may be caused, in part, by increased births among Hispanics. Studies have shown that Hispanics are less likely to opt for circumcision than other whites or blacks."
Between 1999 -- when the AAP came out against routine circumcision -- and 2002, the percentage of boys being circumcised in United States hospitals decreased by more than 5 percentage points, based on NCHS data. But the biggest drop, 4 points, was in the West; Northeast numbers actually increased by 3 points.
When a circumcision is part of the Jewish ritual called a bris, the procedure is usually performed at home when the baby is eight days old. In the hospital, male circumcision is most commonly done on newborns about 24 hours old.
Generally a safe procedure, it can be completed in less than 15 minutes. Either a nurse holds the infant, or he is placed on a firm surface, often called a papoose board, and Velcro straps are wrapped around the boy's arms and legs to keep him very still. The penis is cleaned, and the performing doctor should administer some type of analgesia (pain relief), which is typically a lidocaine injection. A sterile circumcision clamp or device is placed over the head of the penis. The foreskin is removed with a sterile scalpel or scissors.
In practice, Dr. Swanson says the number of boys who received analgesia was low in 1999. Ob-gyns, family practitioners, and pediatricians performed the surgery in equal numbers, but the task force found that ob-gyns used analgesia the least. "Pain relief was not given routinely at that time, but now many hospitals have adopted policies that support the use of analgesia during circumcision," says Carole M. Lannon, MD, codirector of the Center for Children's Healthcare Improvement and the task force chair. If your physician does not use pain relief for circumcisions, the AAP strongly recommends that parents request it for their sons to spare them unnecessary discomfort.
After the Procedure
Usually, the tip of a circumcised penis heals in about seven days. Complications occur in 1 in 500 to 1 in 200 cases; mild bleeding and local infection are the two most common. A botched job can result in injury to the penis, sepsis (when an infection gets into the bloodstream), or even death, but severe complications like these are extremely rare.
After our son was born, my doctors needed a decision on his circumcision, so Alain and I flipped a coin in my hospital room. Alain won. "Wow, no circ," said my ob-gyn, clapping his hands, apparently in Alain's corner.
Unfortunately, our son fell into the statistical minority, developed UTIs, and was circumcised before 2 years old to prevent recurrence. I no longer had to fear for my son's fragile teenage years (which will soon be upon us), and Alain understood that, for our son, the procedure was medically necessary. But if I were making the decision today for a newborn, given the current medical advice, I hope I'd be more open to leaving things the way nature intended them.