Doctors and parents voice their views.
Pros and Cons
During my 16 years of marriage, there have been very few issues on which my husband and I fervidly disagreed. Whether or not to circumcise our son, however, was one of them.
When we found out in early 1993 that we were having a boy, I just assumed he'd be circumcised. But my husband, Alain, was born and raised in France, where circumcision is not done routinely the way it is here, and he assumed exactly the opposite. We did not have a religious reason for circumcision, as Jews and Muslims do. "Why would you want to put a baby through a painful, unnecessary surgery?" Alain asked me, incredulous.
The real reason I wanted to do it was so our son wouldn't look different in the locker room when he got older. Alain didn't think that was a good enough reason to snip off the baby's foreskin, a fold of skin that covers the tip of the penis. Maybe I didn't think so, either. I heard varying rumors: Uncircumcised men have stronger sexual sensations because the tip of the penis is not constantly exposed to the everyday elements; it's hard to keep an uncircumcised penis clean. So I started doing research, looking for a solid, medical reason to warrant the procedure.
The Procedure's Pros and Cons
At that time, the American Academy of Pediatrics (AAP) said that circumcising newborn boys did have potential medical advantages, primarily related to preventing urinary tract infections (UTIs). But by 1999, the AAP had formed a task force on circumcision that decided the procedure shouldn't be routinely recommended. The task force based this policy on 40 years of studies of both circumcised and uncircumcised boys, and it concluded the following:
- Problems with the penis, such as irritation, can occur with or without circumcision.
- With proper care, there is no difference in hygiene.
- There may or may not be differences in sexual sensation in adult men.
- There is an increased risk for a UTI in uncircumcised males, especially babies under 1 year. However, the risk for a UTI is still less than 1 percent.
- Newborn circumcision provides some protection from penile cancer, which only occurs in the foreskin. However, the risk of this cancer is very low in developed countries such as the United States.
"We also looked at whether being circumcised prevents HIV in a man's partner," says Jack Swanson, MD, a pediatrician in Ames, Iowa, and a task force member. "There may be a slight benefit to being circumcised, but the statistics were inconclusive. There weren't any medical reasons that were convincing enough for us to say that all boy babies should be circumcised," he says.
However, in 2002, a study found male circumcision was linked to a reduced risk of penile human papillomavirus infection (HPV). The study also showed a lower risk of cervical cancer in the current female partners of circumcised men with a history of multiple sexual partners. (HPV is associated with an increased risk of cervical cancer.) But no medical evidence has been weighty enough to reverse the AAP's policy on circumcision. In fact, this past May it reaffirmed its stand that circumcision shouldn't be recommended unless the procedure is essential to the newborn's health.
The Bottom Line?
"If you want it done for nonmedical reasons, that's the parents' choice," says Dr. Swanson.
And most American parents choose newborn circumcision in spite of medical advice; in fact, for many it's a no-brainer. "My husband and I probably spent only 10 minutes discussing it," says Suzette MacKenzie, of Concord, Massachusetts, of their son's circumcision last year. "We didn't want Spencer to look different from his dad."
The MacKenzies aren't alone in their view. Gabrielle Horn, of Brooklyn, New York, delivered a boy in March and had him circumcised, too. "I went to high school in Marin County, California, in the early '90s. My friend's boyfriend was uncircumcised, and it was a topic of conversation among the girls," she recalls. "But if I lived in a place where 80 percent of the boys were not circumcised, then I probably wouldn't do it."
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.
Caring for Your Baby
If your son is not circumcised...
Clean the genital area carefully with soap and water. The foreskin usually does not fully retract until about age 5. Until then, retract the foreskin gently during baths, only as far as it will go without forcing it. Don't use cotton swabs or antiseptics, which can cause irritation. Once the foreskin fully retracts, boys should wash underneath it every day.
Your son should:
- Gently pull the foreskin back away from the head of the penis.
- Rinse the head of the penis and inside fold of the foreskin with soap and warm water.
- Pull the foreskin back over the head of the penis.
If your son is circumcised...
The tip of the penis may seem raw or yellowish, and Dr. Swanson advises against putting soap or water on the area until it heals. Change bandages with each diapering to lower the risk of infection. You can use petroleum jelly to keep the bandage from sticking.
Sometimes doctors use a plastic ring instead of a bandage. This ring, which is put on the tip of the penis, usually drops off within eight days. A little yellow discharge or coating around the head of the penis is normal but should not last more than a week.
Call your pediatrician right away if there is:
- Persistent bleeding
- Redness around the tip of the penis that gets progressively worse after three to five days
- Any sign of infection, which includes redness, swelling, or pus
- No normal urination within six to eight hours after the circumcision