The decision whether or not to circumcise your newborn son is a personal one. For some it is as simple as wanting a boy to look like his father. For others it is a religious decision. But for the great majority of people there is no dictate about which path to take and so the debate begins.
- It hurts. It is a quick procedure, most (if not all) doctors place a numbing cream on the area beforehand, and studies have shown that sucking (pacifier, finger, sugar water) can decrease the response to pain. If local anesthesia is used the procedure itself may not hurt but it will be sore for a few days post-procedure. So, pain and discomfort are involved.
- Complications –Up to 1% of boys will have complications. Most are mild – bleeding that requires pressure for 5-10 min. But some circumcisions may not be done correctly/evenly and may need eventual surgical revision.
- After circumcision the skin along the shaft can stick to the ridge around the tip and it may need to be separated with tension at home, at the doctor’s office, or in extreme cases with a surgical revision of the circumcision. This can be prevented by applying Vaseline to the tip and ridge at diaper changes, but it requires, in some boys, attention and vigilance.
- Decrease in the incidence of a urinary tract infection (UTI). There is a 50% decrease in the incidence of a UTI in circumcised boys. This sounds compelling but you need to know that the overall incidence of a UTI in boys is only 2% so this is not a big risk in your child’s life. To be clear, circumcised boys have a 1% chance of a UTI; uncircumcised boys have a 2% risk. A UTI, caught early in a child more than 2 months of age, can usually be treated with outpatient antibiotics fairly easily. In infants less than 2 months of age and in complicated UTIs hospitalization and IV antibiotics are necessary. If the UTI progresses it can, though rarely, cause infection and scarring of the kidneys.
- Decrease in HIV transmission during at-risk sexual encounters. What this means is that if a man has sexual intercourse with a person who is HIV positive and is not using a condom he has a 60% greater chance of contracting HIV if he is uncircumcised than if he is circumcised. We all hope and pray that our children, once grown up and sexually active, will be smart and safe. We also hope that with the decreasing numbers of HIV positive young adults there will less chance of exposure. Regardless- if your son is ever in an at-risk situation he will be better protected if he is circumcised.
- Decrease in penile squamous cell carcinoma. This is a malignant cancer that occurs most commonly in men over the age of 50 and begins at the tip or foreskin of the penis. It is a very rare cancer in Western Countries – there are only about 1000 cases a year. The risk is extremely low, but the incidence is 3 times higher in uncircumcised (as compared with circumcised) men.
- Elimination of risk of phimosis. Phimosis is when the foreskin becomes so narrow/tight that the head of the penis cannot emerge. Surgery is required to correct this. NOTE: It is normal for the foreskin to be too tight for the penile head to emerge during the first few years of life, and the foreskin should never be forced open because this can cut off the circulation to the head of the penis and is a medical emergency.
To circumcise or not? Everyone will have an opinion and many feel strongly about it. If you haven’t already noticed, most people believe that whatever decisions they’ve made in their lives were the right ones – from spacing of children and choice of school to circumcision. But this is a personal decision and it is your son. So, sit down with your co-parent and decide what you believe in and what feels right for your family.
-Monique Araya, MD, FAAP
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