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Should Your Son Be Circumcised?

Although the American Academy of Pediatrics' position on circumcision states that there's not enough medical evidence to recommend it to everybody, two recent studies offer strong evidence that circumcision can be beneficial to your child's health. A 2006 study in the journal Pediatrics found that uncircumcised men are three times more likely to contract a sexually transmitted disease than men who have been circumcised, and a Kenyan study in the Lancet found that circumcision reduced the risk of HIV infection in heterosexual men by as much as 60 percent. (Even though experts aren't completely sure how circumcision lowers a man's risk of HIV, most theorize that the foreskin contains receptors that the virus attaches to or that the foreskin gets microscopic tears during intercourse, making it easier for the virus to enter the bloodstream.)

These results were enough for the American Urological Association to recommend that circumcision be presented to parents as an option with health benefits. "Sixty percent lower risk of HIV is an astronomical success rate -- especially when you consider that there is no cure for AIDS," explains Craig Niederberger, MD, head of the department of urology at the University of Illinois at Chicago.

Not so fast, say other experts. For starters, that study was done in Africa, where the virus is rampant. The risk of HIV to men in the United States is much lower. "Even if you circumcise your son, you'll still need to teach him about abstinence and safe sex," says Parents advisor Jennifer Shu, MD, coauthor of Heading Home with Your Newborn: From Birth to Reality.

Although it's true that circumcision does reduce a baby's risk of getting a urinary-tract infection (UTI), the fact is that UTIs are not very common in boys. The same goes for penile cancer, which is diagnosed in fewer than 1,600 men every year.

If this matters to your family, then that should factor in to your decision. "Kids are different from their parents in a variety of ways -- you wear glasses, they don't; you have blue eyes, they have brown. If a child notices that you are circumcised and he's not, you just need to have a matter-of-fact conversation about how people are different," says Russell Reiff, MD, a pediatrician at Kaiser Permanente's San Francisco Medical Center. Along these same lines, parents-to-be often worry that if they don't circumcise their son, he won't look like the majority of boys -- which could open him up to teasing during the teen years. However, this is less of an issue now that fewer boys are getting snipped. Circumcision is far less common now than it was in the past, and most boys born in the U.S. today will notice a 50/50 split by the time they hit the high-school locker room.

Not when your child is a baby. "If your baby is uncircumcised, leave the foreskin alone -- don't try to pull it back since this can cause pain," says Dr. Shu. "Instead, simply wash the penis -- including the foreskin -- with soap and water when he's in the bathtub." Once your son reaches 4 or 5 years old, the foreskin will start to naturally pull back on its own. At this point, it does take a bit more effort to clean. You'll need to teach him how to gently roll the foreskin down, wash the head of the penis, then roll the skin back.

If you check out the anti-circumcision Web sites, many claim that the foreskin is a highly erogenous zone and they highlight studies showing that "intact" men have more penile sensitivity than those who have been circumcised. Still, most experts warn parents not to let this influence their decision. "We do circumcisions on adult men in our clinic every day, and most do not have any complaints about sexual sensation," says Dr. Niederberger. "And remember, these are men who have experienced both." If your son is circumcised from birth, he's never going to know the difference. Whether they are circumcised or not, most men have very satisfying and fulfilling sex lives.

For years, doctors believed that newborns couldn't feel pain and didn't advise the use of medication during the procedure. But the American Academy of Pediatrics acknowledges that babies do feel pain and recommends the use of medication. Most often, a baby is given a sugar-water solution to suck on (which causes an infant's natural endorphins to increase) in combination with a numbing cream applied to the tip of the penis or a shot of lidocaine at the base of the shaft. Most experts believe that when a circumcision is performed correctly and pain medication is used, discomfort can be minimized quite effectively.

Complications such as bleeding and infection occur only about 3 percent of the time. "Disfigurement from complications is extremely rare," says Dr. Reiff.

Why I Didn't Circumcise My Son

I decided not to have my son circumcised when he was born. While you will hear arguments for and against circumcision, and there are numerous statistics on the topic, what really affected my decision as a first-time mother was the fact that I would be giving permission to have my newborn baby cut. This decision was permanent; I couldn't change my mind later. It just kept floating through my head: Why would I take this risk with my child, when he is perfectly fine the way he is? If he wants a circumcision later in life, fine. The choice is his.
-- Becky Stegmaier; Chattanooga, Tennessee

Why I Circumcised My Son

My husband and I decided to circumcise our son for a multitude of reasons. For starters, we thought it was important that he look like -- and be able to identify with -- his father, who is also circumcised. But more than that, I read some articles and talked to several pediatricians about the health benefits. After learning that circumcision would lower his risk of UTIs and help protect him from STDs and cancer, it was an easy decision to make.
-- Stephanie Richards; Portland, Oregon

Copyright © 2008. Used with permission from the March 2008 issue of Parents magazine.

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