To cut or not to cut? Parents of newborn boys must decide whether their child will be circumcised. “The circumcision process involves surgically removing the foreskin to expose the head of the penis,” says Vanessa Elliott, M.D., a urologist at UCP Urology of Central PA, Inc. For many families, particularly those of the Jewish and Muslim faiths, circumcision is a given. For others, though, deciding whether or not to do it can be fraught.
Mounting research over the past decade has shown that surgical removal of the penis's foreskin has potential health benefits, including decreased risk of urinary tract infections (UTIs), penile cancer, and sexually transmitted diseases. Yet there are risks, and the percentage of American families choosing to circumcise has actually decreased in recent years. In fact, 58.3 percent of boys were circumcised in 2010, according to the Centers for Disease Control and Prevention (CDC)—and this is a 10 percent decrease from circumcision rates in 1979.
The cost of circumcision may be one reason for the trend, especially because fewer insurance companies are covering it, says Ronald Gray, M.D., a professor of epidemiology at Johns Hopkins University in Baltimore. But America's changing demographics also affect the number of boys undergoing the procedure. "The increased proportion of black and Hispanic births in the U.S. affects rates, because these groups are less likely to circumcise," Dr. Gray says.
The American Academy of Pediatrics (AAP) released a task force report in 2012 recognizing the potential medical advantages of circumcision, primarily related to preventing UTIs. But even though the AAP says the benefits of circumcision outweigh the risks, they decided that circumcision shouldn't be routinely recommended. They encourage parents to make their own decision based on religious, ethical, and cultural beliefs.
Still held up on the circumcised vs. uncircumcised debate? We broke down some advantages and disadvantages of the procedure.
Benefits of Circumcision
Parents often choose to circumcise their sons for the following reasons.
Decreased Risk of Urinary Tract Infections
The AAP reports that circumcised boys have a lower chance of getting a potentially serious urinary tract infection during their first year than uncircumcised boys do. Left untreated, UTIs could introduce bacteria into the bloodstream, possibly leading to kidney damage.
Lowered Rates of Sexually Transmitted Diseases
It's difficult enough for most moms to picture their tiny newborn saying Mama, much less growing up to have an active sex life, so prevention of STDs is almost too abstract to contemplate. But the results of three randomized clinical trials of adult men in Africa were sufficient for the World Health Organization to endorse male circumcision as an effective way to reduce the risk for HIV acquired through heterosexual sex in regions with heterosexual epidemics, high HIV rates, and few circumcised men.
Although the research was conducted in Africa, where the risk of AIDS is much higher, American experts believe the findings are relevant for us, too. This foreskin is thought to increase a man's risk of HIV contraction for two reasons. First, the underside of the foreskin contains immune system cells to which HIV cells can easily attach. Second, the foreskin often suffers small tears during intercourse, allowing the HIV cells to enter the bloodstream. Circumcising your baby can eliminate these two risk factors.
What’s more, a 2009 study in the New England Journal of Medicine linked male circumcision to a reduced risk of penile human papillomavirus infection (HPV) and herpes simplex virus type 2 (HSV-2). And studies have also shown a lower risk of cervical cancer in female partners of circumcised men with a history of multiple sexual partners. (HPV is associated with an increased risk of cervical cancer.)
Protection Against Penile Cancer
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.
No Worry of Foreskin-Related Issues
Circumcised men have no chance of developing foreskin infections. They also won’t be at risk for phimosis, a rare condition that makes foreskin retraction impossible.
Drawbacks of Circumcision
Of course, circumcision also has some downsides. Here are common reasons parents choose not to circumcise their sons.
Circumcision Side Effects
As with any surgery, circumcision comes with some side effects and potential complications, says Dr. Elliot. If the circumcision is performed by an experienced physician in a sterile environment, though, the risk of complications should be low. One to 3 percent of circumcisions will result in minor complications, such as extra bleeding or infection, which topical antibiotics can clear up.
Other risks include poor cosmesis (the penis doesn’t look right) and penile adhesions. Also, the tip of the circumcised penis may become irritated, which restricts the size of the urinary opening. This might lead to urinary tract problems—some of which might need surgical corrections.
A Botched Circumcision
Serious complications include removal of too much skin or other damage to the penis. A follow-up circumcision or reconstructive surgery may be needed. However, these complications are estimated to occur in less than 1 percent of circumcisions.
Infant Pain During the Procedure
Prior to the incision, all infants should be given anesthesia, either as a topical cream or an injection. Still, "newborns do feel pain," Dr. Gray says. Many families who choose to forgo circumcision say they simply can't imagine putting their child through a painful procedure when he can live a healthy life without it. With proper care and infant Tylenol, though, your son's penis should heal comfortably in a few days to a week.
Some Men Claim Uncircumcised Sex is Better
Those who are against circumcision bring up the question of sexual pleasure, pointing out that there are thousands of nerve endings in the foreskin that will be excised. It's impossible to study the difference in sexual sensation for men who were circumcised at birth. However, Douglas Diekema, M.D., a member of the AAP's circumcision task force, notes that the few studies done with African men who were circumcised as adults show that some find intercourse better afterward, some describe it as worse, and the vast majority say it is pretty much the same as before.
Should I Circumcise My Son?
"If you want a circumcision done for non-medical reasons, that's the parents' choice," says Jack Swanson, M.D., a pediatrician in Ames, Iowa, and a task force member. Some parents feel like it’s easier for a son's parts to look more like his father’s, whether he’s circumcised or not. Others lean toward circumcision so their son’s penis will eventually match the others in the locker room at school. But consider this: If the current circumcision trend continues, at least a few other boys in his class will be unsnipped.
It can be tempting to put off making the circumcision decision until later. Some parents argue that circumcision isn't their call to make. Still, the AAP points out that the risk for complications is much greater for older boys than for infants, so it's better to do it when your child is a baby. "Plus, if he waits to make the decision as an adult, he will have missed out on the protective benefits during any previously sexually active years," Dr. Diekema says.
In some cases, though, the choice not to circumcise (or at least to wait) is a medical one: Baby boys with hypospadias (a condition where the opening of the urethra, the tube that empties urine, is in the wrong place) should not be circumcised, because a surgeon may eventually use the boy's foreskin for a reconstructive procedure. If you have a family history of bleeding disorders, consult your pediatrician before getting your son circumcised. And if your baby is born prematurely, he will need to wait until he is healthy enough to leave the hospital before having the surgery.