Circumcision

Whether you're expecting a baby boy or have just welcomed your new little guy into the world, you have an important decision to make before you take your son home: whether to circumcise him.

For some families, the choice is simple because it's based on cultural or religious beliefs. But for others, the right option isn't as clear. Before you make a circumcision decision, it's important to talk to your doctor and consider some of the issues.

About Circumcision

Boys are born with a hood of skin, called the foreskin, covering the head (also called the glans) of the penis. In circumcision, the foreskin is surgically removed, exposing the end of the penis.

Approximately 55% to 65% of all newborn boys are circumcised in the United States each year, though this rate varies by region (western states have the lowest rates and the north central region has the highest). The procedure is much more widespread in the United States, Canada, Africa, and the Middle East than in Asia, South America, Central America, and most of Europe, where it's uncommon.

Parents who choose circumcision often do so based on religious beliefs, concerns about hygiene, or cultural or social reasons, such as the wish to have their son look like other men in the family.

Routine circumcision is usually performed during the first 10 days (often within the first 48 hours), either in the hospital or, for some religious ritual circumcisions, at home.

If you decide to have your son circumcised at the hospital, your pediatrician, family doctor, or obstetrician will perform the procedure before you bring your baby home. The doctor can tell you about the procedure and the possible risks. Circumcision after the newborn period can be a more complicated procedure and usually requires general anesthesia.

In some instances, doctors may decide to delay the procedure or forgo it altogether. Premature babies or those who have special medical concerns may not be circumcised until they're ready to leave the hospital. And babies born with physical abnormalities of the penis that need to be corrected surgically often aren't circumcised at all because the foreskin may eventually be used as part of a reconstructive operation.

The Pros and Cons

On the plus side, circumcised infants are less likely to develop urinary tract infections (UTIs), especially in the first year of life. UTIs are about 10 times more common in uncircumcised males than circumcised infants. However, even with this increased risk of UTI, only 1% or less of uncircumcised males will be affected.

Circumcised men also might be at lower risk for penile cancer, although the disease is rare in both circumcised and uncircumcised males. Some studies indicate that the procedure might offer an additional line of defense against sexually transmitted diseases (STDs) like HIV in heterosexual men. 

Penile problems, such as irritation, inflammation, and infection, are more common in uncircumcised males. It's easier to keep a circumcised penis clean, although uncircumcised boys can learn how to clean beneath the foreskin once they're older.

Some people claim that circumcision lessens the sensitivity of the tip of the penis, decreasing sexual pleasure later in life. But none of these subjective findings are conclusive.

Although circumcision appears to have some medical benefits, it also carries potential risks — as does any surgical procedure. These risks are small, but you should be aware of both the possible advantages and the problems before you make your decision. Complications of newborn circumcision are uncommon, occurring in between 0.2% to 2% of cases. Of these, the most frequent are minor bleeding and local infection, both of which can be easily treated by your doctor.

One of the hardest parts of the decision to circumcise is accepting that the procedure can be painful. In the past, it wasn't common to provide pain relief. But the American Academy of Pediatrics (AAP) recommends it and studies show that infants undergoing circumcision benefit from anesthesia, so most doctors now use it. But because this is a fairly new standard of care, it's important to ask your doctor ahead of time what, if any, pain relief your son will receive.

Two main types of local anesthetic are used to make the operation less painful for a baby:

1. a topical cream (a cream put on the penis) that requires at least 20 to 40 minutes to take its full effect
2. an injectable anesthetic that requires less time to take effect and may provide a slightly longer period of anesthesia

In addition to anesthesia, acetaminophen is sometimes given. This helps reduce discomfort during the procedure and for several hours afterward. Giving a pacifier dipped in sugar water and swaddling a baby also can help reduce stress and discomfort.

Caring for a Circumcised Penis

Following circumcision, it is important to keep the area as clean as possible. Gently clean with warm water — do not use diaper wipes. Soapy water can be used if needed.

If there is a dressing on the incision, apply a new one (with petroleum jelly) whenever you change a diaper for the first day or two. Even after the dressing is no longer needed, put a dab of petroleum jelly on the penis or on the front of the diaper for 3 to 5 days. This can help avoid discomfort from rubbing and sticking to the diaper.

It usually takes between 7 to 10 days for a penis to heal. Initially the tip may appear slightly swollen and red and you may notice a small amount of blood on the diaper. You also may notice a slight yellow discharge or crust after a couple of days. This is part of the normal healing process.

 If you notice any of the following problems, call your doctor right away:

• persistent bleeding or blood on the diaper (more than quarter-sized)
• increasing redness
• fever
• other signs of infection, such as worsening swelling or discharge, or the presence of pus-filled blisters
• not urinating normally within 12 hours after the circumcision

However, with quick intervention, almost all circumcision-related problems are easily treated.

Caring for an Uncircumcised Penis

As with a penis that's circumcised, an uncircumcised one should be kept clean. Also, no cotton swabs, astringent or any special bath products are needed — just warm water every time you bathe your baby will suffice.

Initially, do not pull back the foreskin to clean beneath it. Over time, the foreskin will retract on its own so that it can be pulled away easily from the glans toward the abdomen. This happens at different times for different boys, but most can retract the foreskin by the time they reach puberty.

As your son grows up, teach him to wash beneath the foreskin by gently pulling it back from the glans, rinsing the glans and the inside of the foreskin with warm water, then pulling the foreskin back over the head of the penis.

The Circumcision Decision

After reviewing multiple studies on circumcision, the AAP reports that "the health benefits of newborn male circumcision outweigh the risks." But at the current time, the scientific evidence is not strong enough for the AAP to recommend routine circumcision of all newborn boys. Instead, the AAP advises parents to learn the facts about circumcision and weigh the pros and cons.

In addition to considering the medical factors, religious and cultural beliefs might play a role. If these are important to you, they deserve to be seriously considered.

Talk to your doctor to help you make the choice that's right for your son.