Is it better to circumcise or not to circumcise? Infant circumcision historically has been a hotly debated topic. There are people who take a strong stance either for or against the procedure for a whole host of different reasons. Religious practices or cultural affiliations can make the decision quite easy for some. Yet, for those who are in the process of assessing whether or not to circumcise, the decision can be quite daunting. This can be particularly true when it comes to weighing the short- and long-term health-related factors.
In an attempt to alleviate this process, U.S. health officials last month released a draft of long-awaited guidelines on circumcision in which they indicated that they are more in favor of the practice. To provide further perspective, I have outlined below what I tell my patients when they are on the fence and ask for my opinion.
In the spirit of open disclosure, it’s important to share that in addition to being a pediatrician, I am a mohel. A mohel is a Jewish person trained to perform circumcisions. In the Jewish faith, a circumcision ceremony called a “bris” is performed on the eighth day of a Jewish male’s life. I am called in by parents to perform that ceremony. As a mohel, I intend only to share with you my expert knowledge on the circumcision procedure. As a pediatrician, I have streamlined for you some of the benefits and risks to your child based on scientific research.
Trends in circumcision
For the last 30 years, the national rate of newborn circumcision has declined by approximately 10 percent.(1) This change in circumcision rate may be due to reductions in insurance coverage as well as increases in ethnic populations that tend not to circumcise. Yet recently, experts, such as researcher Dr. Aaron Tobian of Johns Hopkins University, have pointed out that circumcision continues to be on the decline at a time when the evidence to support its benefits is stronger than ever.(2)
Benefits and risks of circumcision
There is scientific evidence to support that circumcised males experience important long-term health benefits. Specifically, they are at a decreased risk of contracting urinary tract infections and sexually transmitted diseases such as herpes, HPV and HIV, as well as penile cancer. While penile cancer is relatively rare, with an estimated 1,640 new cases reported in the U.S., in 2014 it is almost non-existent in circumcised males.(4-5) Lastly, uncircumcised males can contract balanitis, which is swelling of the foreskin and head of the penis often caused by poor hygiene. Balanitis is treatable.
Like any medical procedure, circumcision does have risks. The most commonly reported ones are bleeding and infection, both of which are generally mild and easily treated. Occasionally a circumcision will need to be revised if not enough foreskin was removed or if the tissue doesn’t heal properly. Damage to the penis is possible but extremely rare. Some claim that removing the foreskin can affect sensation and sexual performance later in life. There are few well-organized studies to substantiate this. In evaluating the studies that do exist, the Centers for Disease Control and Prevention (CDC) suggests that this is generally not the case.(6) They acknowledge that minor reduction in sensitivity to fine touch can occur, but at the same time men who have undergone circumcision as an adult generally report either no change or actual improvement in their sexual functioning.
The circumcision procedure
Circumcisions are typically performed in hospitals one or two days after a child’s birth and in the Midwest they are generally done by the obstetrician. While all procedures are not exactly the same in terms of the anesthetic or equipment used, the basic concept involves providing pain relief, removing adhesions (tissue attachments between the inner lining of the foreskin and head of the penis), applying a protective clamp, excising the exposed foreskin, removing the clamp and finally covering the area with Vaseline and gauze.
I’m often asked if the procedure is painful and the answer is yes; but any pain subsides quickly. To lessen the discomfort I inject numbing medicine prior to the procedure as well as have the baby suck on gauze with sugar water (or wine for a ceremonial circumcision). I remind people that it’s not uncommon to do something painful in the very short-term that has potential health benefits for their child in the long term. Vaccinations are a perfect example of this.
After the procedure I instruct parents that the gauze and Vaseline should be replaced with each diaper change until things look well healed, which typically takes about a week. After the first day, it is not unusual to see a little swelling followed by the formation of an off-white or yellowish, patchy type of scab. The head of the penis might also appear to be deep red or purplish and have a shiny or glossy appearance. All of this is associated with normal healing.
As you gather information on whether circumcision is right for your baby, I highly recommend involving a pediatrician in the discussion. They likely are most informed on the latest facts of the procedure and should always serve as your partner in managing the health of your little ones from birth to adulthood.
1 Huffington Post, Rachael Rettner: “U.S. Circumcision Rates Drops Over Last Three Decades, Report Says”
2 Associated Press, Mike Stobbe: “CDC: Circumcision Benefits Outweigh Risks”
3 CDC: HPV-Associated Penile Cancer Rates by Race and Ethnicity
4 National Cancer Institute: Penile Cancer
5 Advances in Urology :The Strong Protective Effect of Circumcision against Cancer of the Penis
6 CDC: Male Circumcision Research