Q. We are expecting a baby boy in a couple of months and can't agree whether to have him circumcised or not. My husband, who is circumcised, says there's nothing to it, but I've heard that the procedure is not medically necessary, is painful to the baby and carries some risks. What's your opinion?
A. Having followed the often heated circumcision debate with keen interest for 25 years, I truly empathize with your dilemma. In past decades, neonatal circumcision in the United States was so routine that most parents consented to the procedure without giving the matter any thoughtful consideration.
At birth, a baby's entire penis is sheathed by a layer of skin. The sensitive skin that covers the rounded head of the penis, or glans, is known as the foreskin. Circumcision involves removal of this foreskin so that the glans and the urinary opening are exposed. In the 1970s, the American Academy of Pediatrics (AAP) concluded that there was no valid medical reason to routinely recommend circumcision. But after years of debate, a consensus still has not been reached on whether circumcision of newborn males is justifiable.
Proponents claim that circumcision prevents infections of the foreskin and makes genital hygiene easier. In addition, medical research has demonstrated a lower rate of urinary tract infections among circumcised boys during the first year, while other data conclude that the procedure can protect against cancer of the penis later in life (this condition is both extremely rare and easily prevented by adequate hygiene, however). Although circumcision has been linked to a lower incidence of sexually transmitted diseases (STDs), a man's lifestyle plays a far more important role in this risk than does the presence or absence of his foreskin.
Aside from the medical considerations, in many cases some parents choose newborn circumcision for personal or religious reasons. While many families express concern about fathers, sons and brothers "looking alike," declining circumcision rates guarantee that the locker rooms of tomorrow will include plenty of intact boys. (Presently, about 60 percent of male newborns in the U.S. are circumcised.)
Like any surgery, circumcision carries some risks. These include excess bleeding, infection, surgical error or dissatisfaction with the appearance of the penis after healing. The AAP recommends that circumcision be performed only on healthy newborns and that the procedure be postponed or avoided completely whenever an infant is sick, has birth defects or has a bleeding problem, such as hemophilia.
In addition to medical risks, other arguments against circumcision are that it's a traumatic, painful experience for the baby, that his foreskin is important in protecting his glans, and that leaving the sensitive foreskin intact will contribute to greater sexual pleasure later in life. Infants undoubtedly experience pain and distress during circumcision and may display physiologic and behavioral changes, such as irritability, changes in eating habits, or sleeplessness, hours after the procedure. To alleviate the pain, some physicians choose to inject a local anesthetic, while others allow a baby to suck on a pacifier dipped in a sugar solution or use a topical anesthetic ointment to reduce discomfort and crying.
While social and emotional factors are inevitable influences on most parents' final decision, I urge you to discuss the medical benefits and risks with your baby's doctor. The AAP Task Force on Circumcision is again reviewing the topic and plans to issue an updated policy statement within the next six months.