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Ask Dr. Sears: The Circumcision Decision

Q. I'm expecting a boy in a few weeks, and my husband and I are trying to decide whether to have our newborn circumcised. We need more information before we can make a decision. Can you explain the pros and cons of this procedure?

A. Should the foreskin stay or go? This continues to be a subject of debate among parents and even some pediatricians. Once considered routine in the U.S., more and more parents are wisely considering the pros and cons of circumcision, rather than blindly subjecting their infant to a surgical procedure that is usually unnecessary. Assuming there are no religious reasons to influence your decision, here are a few points to consider before making a final decision:

Uncircumcised penises require some simple cleaning.

Most men want a maintenance-free penis. Little boys (and even grown men) are often lazy about caring for the foreskin, even though it's quite simple -- all it requires is a few seconds of extra hygiene during a bath. Normal secretions accumulate beneath the foreskin, requiring the foreskin to be retracted and the secretions to be gently removed. Rarely, the accumulation of secretions beneath the foreskin can lead to a painful infection. By removing the foreskin, care of the penis is streamlined and the rare risk of infection beneath the foreskin is alleviated.

Circumcision at birth reduces the need for the procedure later on.

As your child grows and begins getting normal erections (typically by age 1), the foreskin gradually completely retracts. The foreskin is usually completely retractable by three to four years of age. Rarely, the foreskin does not retract or actually tightens, which obstructs the flow of urine. In this case, a circumcision is medically necessary.

Foreskin can protect the head of the penis.

Leaving the foreskin intact protects the penis from irritation caused by rubbing against soiled and wet diapers.

Your decision needn't be based on whether others are circumcised or not.

Just because your husband may be circumcised, doesn't necessarily mean your newborn son should be as well. Sons and fathers rarely compare the appearance of their penises, and today we know much more about the non-necessity of circumcision than parents did in past generations. Also, forget the notion of boys "looking alike in the locker room." Boys don't stand around comparing the look of penis tips after gym class. Plus, the percentage of intact boys is steadily increasing, so that by the time your son is school-age, it quite possibly could be a 50/50 split.

Does circumcision affect sexual pleasure?

There is a theory, reinforced by some evidence, that intact men experience more sexual pleasure during intercourse, perhaps because of the extra stimulation from the foreskin.

Circumcision doesn't prevent disease.

Whether or not circumcision lowers the risk of penile cancer (an extremely rare condition) is still not proven. Also, the risk of passing sexually-transmitted diseases to partners is not more common as long as an intact man practices proper hygiene.

If you do decide to have your baby circumcised, be sure the doctor uses a local anesthetic -- nearly all doctors now use some sort of painkiller. If you choose to leave your son intact, care of the foreskin is quite easy -- see my tips above. The most important tip to follow: Don't retract the foreskin in a forcible manner. This will actually increase the risk of infection. Rather, allow it to retract naturally over the first few years of life. Between ages 3 and 4, you can teach your son to care for the penis and foreskin himself.

You and your husband are wise to talk through the pros and cons of circumcision. Make a decision and live with it for a few weeks. If the decision still feels right to you, go with it. Either way, your little boy will be just fine.

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