To cut or not to cut? Parents of newborns with penises 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 simply a given. For others, though, deciding whether or not to do it can be fraught with worry and stress.
Research 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 some sexually transmitted infections (STIs).
Yet as with any surgery, there are risks, and the percentage of American families choosing to circumcise has decreased over time. In fact, 58.3% of males were circumcised in 2010, according to data from the Centers for Disease Control and Prevention (CDC), which represents a 10% decrease in the rate of male circumcisions since 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 males 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 an updated policy statement on circumcision in 2012 recognizing the potential medical advantages of circumcision, primarily related to preventing UTIs. But even though the AAP says the benefits of circumcision generally outweigh the risks, they concluded 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 potential advantages and disadvantages of the procedure.
Potential Benefits of Circumcision
Parents often choose circumcision for the following reasons.
Decreased risk of urinary tract infections
The AAP reports that circumcision can lower a male baby's chance of getting a potentially serious urinary tract infection during their first year compared to their uncircumcised counterparts. Left untreated, UTIs can introduce bacteria into the bloodstream, possibly damaging the kidneys.
Lowered rates of sexually transmitted infections
It can be difficult for some parents to picture their newborn as a grown-up with an active sex life, which can make prevention of future STIs feel almost too abstract to contemplate, but as with other choices parents make for their children, there are future implications.
In the case of circumcision, the results of three randomized clinical trials of adult males in Africa were sufficient for the World Health Organization (WHO) to endorse male circumcision as an effective way to reduce the risk of HIV in regions with generalized HIV epidemics, high HIV rates, and few circumcised people.
Although the research was conducted exclusively in Africa, where the risk of HIV/AIDS is much higher, experts in the U.S. believe the findings are relevant for Americans, too. The foreskin is thought to increase the risk of contracting HIV 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 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 males 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 like the United States. (It represents less than 1% of all cancer cases in the U.S. and Europe.)
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No foreskin-related issues
Since the foreskin is removed during circumcision, there is no chance of developing a foreskin infection or other infections related to the foreskin, such as phimosis, a rare condition that makes foreskin retraction impossible.
Potential Drawbacks of Circumcision
Of course, circumcision also has some downsides. Here are common reasons parents choose to decline circumcision.
Risks and complications of surgery
As with any surgery, circumcision comes with risks and potential complications, says Dr. Elliot. If the circumcision is performed by an experienced physician in a sterile environment, the risk of complications should be low. One to 3% 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 can restrict the size of the urinary opening. This restriction can then lead to urinary tract problems, some of which might require additional surgery to correct.
Serious complications of circumcision, while rare, can include the 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% of circumcisions.
Pain during and after surgery
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 don't want to put their child through a painful elective procedure and recovery when they can live a healthy life without it.
Experts say that with proper care and infant Tylenol (acetaminophen), a circumcised penis should heal comfortably in a few days to a week, but that is not to say that it comes with no discomfort.
Potential impact on sexual pleasure
Another consideration for some parents is the question of sexual pleasure. There are thousands of nerve endings in the foreskin that is excised with circumcision, so the question raised is whether the surgery can have a negative impact on a person's future sexual pleasure and sexual satisfaction.
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From a scientific standpoint, it’s impossible to study the potential difference in sexual sensation for those 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 males who were circumcised as adults show that some found intercourse better afterward, some described it as worse, and the vast majority reported that it was pretty much the same as before.
Should I Circumcise My Baby?
“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 member of the AAP task force on circumcision. Some parents feel like it's easier for a male baby's penis to look more like their male parent's, whether they're circumcised or not. Others lean toward circumcision so their child's penis will eventually be similar to others in the locker room at school. But consider this: If the current circumcision trend continues, at least a few other kids in their class will be uncircumcised.
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 children than for infants, so it's better to do it when your child is a baby if you're inclined to. “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: Babies 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 foreskin for a reconstructive procedure. Additionally, if you have a family history of bleeding disorders, consult your pediatrician before getting your baby circumcised. And if your baby is born prematurely, they will need to wait until healthy enough to leave the hospital before having the surgery should you choose.