Circumcision

Question: "I'm confused about whether to have my baby boy circumcised. Isn't this routine? What should I do?"

Before you became pregnant, you probably never imagined you'd spend so much time pondering medical procedures on baby boy parts. You may not have even realized that the decision whether or not to keep your child’s foreskin intact was yours to make. But now you've got a son on the way, and — if you don’t have religious or cultural traditions guiding you (or a husband who insists that his son look just like him) — you’ve got what may be a very confusing decision ahead of you.

Circumcision may be considered the oldest surgical procedure still performed, with roots dating back thousands of years. It started out as a religious ritual among Jews and later Muslims, as a sign of their covenant with God. In the late nineteenth century, circumcision became common practice in the United States. 

The thought at the time was that a circumcised penis would be less sensitive, therefore reducing masturbation — which, not surprisingly, didn't happen. Over the past century, circumcision has been touted as the panacea for syphilis, lunacy, and tuberculosis — all theories that have (thankfully) been debunked. 

Though it’s still performed for religious reasons and because many parents simply "feel it should be done," more and more are deciding against circumcision. Currently, slightly more than half of all boys in the US are circumcised — down from 80 percent in 1980. And in more recent years, rates have further declined — from 58.4 percent in 2001 to 54.7 percent in 2010.

What does the procedure entail? In a circumcision, the foreskin (or prepuce) — a double-layered sleeve of skin and mucosal tissue that covers the head (glans) of the penis — is surgically removed.

Those in favor of circumcision point to the medical benefits: a decreased chance of infection of the penis (although thorough washing under the foreskin, once it becomes retractable around the second birthday, works just as well); a moderately reduced risk of urinary tract infections during the first year of life (although the risk that an uncircumcised baby will get a UTI is quite low — 1 percent or less); a slightly reduced risk of contracting sexually transmitted diseases including AIDS; and a slightly reduced risk of penile cancer (although the disease is very rare in all men). Others opt for the procedure simply because they think the circumcised penis looks more attractive and is easier to keep clean.

Those opposed to routine newborn circumcision say that there is no medical necessity for the procedure. Though complications from circumcision are extremely rare, there are concerns about bleeding and infection. Plus, if Dad is uncircumcised, he might have an equally strong feeling about wanting junior to also have his foreskin intact.

What’s the official word? The American Academy of Pediatrics states that the health benefits of circumcision outweigh the risks. Parents (or parents-to-be), they recommend, who choose to circumcise their baby boys should be able to do so.

The upshot is that whatever you decide is entirely up to you and your partner. So talk about it together and then again with both your practitioner and your potential pediatrician so you can determine which route is best for you and your son. If you do opt for circumcision, make sure you find a qualified expert to do the procedure — and insist on topical analgesia (painkillers) such as EMLA cream for your baby. (Although baby folklore — and, until recently, many doctors — used to hold that newborns felt no pain while being cut, researchers now know that's just not so.) And be sure to follow the recommendations for newborn circumcision care — it should heal in a week to 10 days.

Good luck,