Should Your Son Be Circumcised?

Circumcision has never been as controversial as it is today. This is what doctors want you to know about the procedure.
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When their first child was born, Karin Davidson and her husband decided to have him circumcised. But if they have another son, they're not sure they'll make the same choice. "I know all the men in our immediate families are circumcised, so it wasn't a question for me at the time," says Davidson, of Madison, Wisconsin.

But after reading up on the subject recently, she started questioning the origins of the practice -- "I even read that in the past some people advocated for it in order to reduce masturbation among boys," she recalls -- as well as the validity of the research on its pros and cons. "I want to base my decision on whether there are any real medical benefits to it and whether it's important for two boys to match each other and their dad."

Granted, these are tricky issues to sort through. In a survey of more than 1,000 Parents readers, 81 percent of respondents said that circumcision would be the right decision for their family. When asked how they feel about circumcision in general, 14 percent thought that most mothers and fathers aren't aware of possible negative outcomes of circumcision, and 7 percent consider it a bygone tradition that's no longer relevant.

While newborn circumcision rates have declined from 65 percent in 1981, approximately 58 percent of all boys born in American hospitals still undergo the procedure, according to the National Center for Health Statistics. "The U.S. is one of only a handful of countries where circumcision is common," says Marvin Wang, M.D., director of newborn nurseries and an associate pediatrician at Massachusetts General Hospital, in Boston. "In the majority of the world, it's generally almost never done, except for religious reasons."

Fights Over Foreskin

The decision has never been easy for many parents, but it has become increasingly controversial and even political. Eighteen states have cut Medicaid coverage for routine circumcision, and researchers at the UCLA Luskin School of Public Affairs found that this may be part of the reason for the declining rate. In recent years, bans on circumcision have been proposed in San Francisco and Santa Monica. Opponents such as the advocacy group Doctors Opposing Circumcision (DOC) and Intact America assert that circumcision is an unnecessary and potentially risky procedure -- and that it's essentially a violation of human rights on a par with female genital mutilation.

"Medical ethics state that parents only have the right to make medical decisions that are in a child's best interest," asserts physician and DOC president George Denniston, M.D. "All mammals have a foreskin and that's the way nature intended it. Circumcision shouldn't be done to children because they can't give informed consent. They have the right to an intact body."

In 2012, the American Academy of Pediatrics (AAP) published an updated policy statement declaring that new scientific evidence shows that the medical benefits outweigh the risks of the procedure. However, it went on to say that the advantages are not substantial enough to make it a routine practice and that the decision should be made by parents in consultation with their doctor. "The AAP has taken a fairly neutral stance on the subject of circumcision since 2000 -- but some people have found the lack of a strong recommendation to be annoying and unhelpful," says Douglas Diekema, M.D., a member of the AAP Task Force on Circumcision and a professor of pediatrics at the University of Washington School of Medicine, in Seattle. "Although parents often want to be told how to best take care of their babies, this is an area where some neutrality really is appropriate, because of the potential for both harm and benefit from the procedure."

The Case For -- And Against

Any medical procedure carries some risk. A new study in JAMA Pediatrics found that among babies younger than 1, adverse events occurred in less than 0.5 percent of circumcisions (though the risk jumped to between 10 and 20 times higher when performed after infancy). Complications include minor bleeding or oozing from the wound; rarely, babies can get a skin infection that is treated with antibiotic cream. "It's generally a safe procedure, especially with an experienced provider," says Lise Johnson, M.D., division chief of newborn pediatrics at Brigham and Women's Hospital, in Boston. Opponents claim that circumcision leads to decreased sexual sensitivity and function later in life, though Dr. Diekema and other experts say there's no compelling data to support these contentions.

Studies have shown, however, that circumcised males have a decreased risk of urinary-tract infections in the first year of life, as well as of cancer of the penis and sexually transmitted diseases such as herpes and human papillomavirus (HPV) later in life. Recent research found that adult male circumcision in Africa reduces the risk of acquiring HIV by up to 60 percent. There is clear evidence showing that male circumcision offers protection against STDs in both men and their female partners, notes Aaron Tobian, M.D., associate professor of pathology and epidemiology at Johns Hopkins University, in Baltimore.

What's interesting is that when Dr. Tobian and his wife had their first child in 2005, they'd decided against circumcision before they even knew the baby's sex. They had a daughter, so it was a moot point. But when their son was born in 2008, they had him circumcised. "We were swayed by the numerous medical benefits found in randomized trials," says Dr. Tobian.

Approximately 3 percent of boys who are not circumcised will end up needing the procedure when they get older, because of an infection or the fact that their foreskin doesn't retract properly (a condition known as phimosis). The procedure is slightly more complicated for teenagers or adults because a larger piece of tissue needs to be removed, it requires stitches, and the surgery needs to be done under general anesthesia in an operating room.

Beyond medical considerations, there are religious factors. In the Jewish faith, a boy is circumcised when he's 8 days old in a bris ceremony performed by a specially trained professional. Routine circumcision is also a tradition in the Islamic faith. It's standard protocol with many Americans as well, but not in Latino or European cultures.

Naturally, parents can have very strong feelings about the topic. Despite objections from family members, Morgan Roberts and her husband, who is circumcised, decided they wouldn't circumcise their son, now 3. "When my son was born, I looked into his gigantic blue eyes and at his chubby, soft body and thought he was absolutely perfect in every way -- who were we to alter a newborn, especially when he has no say in the matter?" explains Roberts, who lives in Southbury, Connecticut.

On the other side of the fence is Nicole Emmi, who has three sons under age 9, all of whom are circumcised. "I wanted them to look like their dad in that way and I also felt most comfortable with circumcision from a hygiene perspective," explains Emmi, of Ferndale, Michigan.

Ultimately, it's best if you can balance the potential risks and benefits with your own personal feelings about the procedure. You might also want to discuss the matter with your doctor, especially if you or your spouse have any doubts. If you decide in favor of circumcision, you'll want it to be done by a practitioner (usually an obstetrician or a pediatrician, sometimes a pediatric urologist) who has plenty of experience. The procedure is typically covered by private insurance; Medicaid picks up the cost in 32 states. Otherwise, the price starts at around $250 for newborns.

Discussing Differences

One of the issues parents really wrestle with is how to handle it when a child is circumcised but his dad isn't -- or vice versa. And what if the first son in a family is but the second or third isn't? As the kids get older, what's the best way to explain why some boys in the locker room have a foreskin while others don't?

Fortunately, the issue of "being different" may not be as big a deal to a child as parents often fear it is. "If you really listen to what he's asking, usually it can be answered in a pretty straightforward way, by telling him that sometimes parents decide to have that skin taken off when a child is a baby and sometimes they don't," Dr. Johnson says. "You don't need to explain the whole backstory."

That's what Morgan Roberts says she plans to do as soon as her son is old enough to ask why his penis looks different from his father's. "We'll tell him that some men will look like he does, and others will look like Daddy, but that everyone is special."

Splish, splash! Here are some tips on how to bathe your little one.

Originally published in the September 2014 issue of Parents magazine.

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9 Comments

  1. No, we should not subject our children to genital cutting. The harm begins at the first cut, any cut. I endured traumatic corrective surgery at age 5 for meatal stenosis, a common iatrogenic injury of infant [filtered] cutting, and have had live with other damage of haphazard cutting. When we know better, we do better. All my children are happily intact. Intaction and Intact America are two of several non-profit organizations working to raise public awareness of the value of intact genitals and the harms of genital cutting.

  2. In the four years that have passed since this article was written:
    * The AAP's policy has gone out of date and not been renewed
    * A Danish study has found that only one boy in 200 will need his foreskin cut off by the age of 18
    * A South African study has found that cutting men makes no significant difference to HIV rates
    * The Intactivist movement has grown in strength, with "Bloodstained Men" demonstrating against what was done to them in cities across the USA
    * The number of rabbis on record as willing to name boys without them has grown to more than 150.

    The medical claims you cite are weasel-worded: All of the complaints mentioned are rare, so large percentage reductions amount to many babies being cut in vain for every one protected from anything.

    Non-religious genital cutting is not just "not standard protocol" in "European cultures", it's virtually unheard-of throughout the rest of the developed world. Other English-speaking countries used to do it, but gave it up a generation ago without ill-effects. So almost any non-Muslim you see overseas - film stars, sports stars, leaders - probably has his foreskin.

    1. ^...to name boys without cutting them...

  3. Totally agree with the commenters that mention future sexual pleasure - for both the man and sexual partners.

    The medical justifications are absurd. Urinary tract infections are easily treated and much less serious than the "corrections" that are done for botched circumcisions. There are babies who literally die from this unnecessary surgery.

    The studies in Africa are in places where they don't have easy access to runnning water - soap and water is the medical intervention for uncircumcised men.
    ALSO we have a real problem with language. The "all about circumcision" articl right on this site starts with "When boys are born, they have a piece of skin that covers the end of the [filtered], called the foreskin." It doesn't cover the end of the [filtered], it IS the end of the [filtered]! On a grown man it's about the size of a 3x5 index card.

    Girls and boys look nothing like their parents until they hit puberty.

  4. Aaron Tobian follows a religion that mandates baby boys be circumcised. For him to suggest that he would never circumcise a son,then claim his "medical" research changed his mind is a bold faced lie. He probably is concerned "medical" research would face recriminations of religious bias...why else make up stories?

  5. middle eastern women invented circumcision to enslave males. by losing 20%-50% of his nerves in his [filtered], he is dulled and more focused on work and gathering resources for the female in her comfortable position in society. also, the female can much more easily lie and claim she doesn't even enjoy sex, whilst cheating with alpha males behind her beta male's back. he raises the kids and works, she gets as much sex as she wants. why don't we cut off girls' clits? because it's not in women's self interests. look up esther vilar's the manipulated man.

    1. Seriously, the article is about circumscision and the site filters out the correct word for a ding dong in my comment below.

    2. I always wonder why these articles don’t focus on the sexual benefit of leaving the entire [filtered] there. God created the foreskin for a purpose and anyone who has had sex with an uncircumcised man would never deprive their son of giving his future partners that pleasure.

  6. If there is any chance that your son will not be satisfied with the decision and it's not absolutely necessary for your son's health, no, no he should not!

    I, myself personally hate that I was not given the opportunity to decide what was best for my own body, so I think it's safe to say that I will not make the same big mistake with my boy.

  7. The confusion in the u.s. comes from not knowing which parts are sensitive and which are not. Hint: the most sensitive parts are the ones that are removed.
    Also, as usual, the most common complication is not mentioned at all. Meatal stenosis is an issue in 10% to 20% of cases.

  8. Doctors are biased, some are circumcised so that's all they know.
    Doctors are conflicted, circ is a $2 Billion industry.
    Doctors are wrong, most only studied the [filtered] for 1 day in med school.
    Doctors are overstepping, they say circ is cultural, and then say they are experts on the topic.

  9. Education
    NEVER MUTILATION
    Protect your sons.
    They’ll thank you
    StopInfantCircumcision.org


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