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Deciding About Circumcision
You’re getting ready to welcome your new baby into the world. In most ways, preparing for a baby boy and baby girl is similar, as you learn about newborn sleeping, feeding, and development. However, if you’re having a baby boy, you have an important decision to make—whether or not to have your baby circumcised. You may immediately know what you prefer; or you may need to get more information and to discuss the question with your partner and physician before making the decision.

What is circumcision?
Boys are born with a tube of skin, the “foreskin,” covering the head of the penis. (There is an opening at the tip of the foreskin through which they urinate.) Circumcision is a minor surgical procedure in which the foreskin is removed, uncovering the head of the penis. It is usually done by a doctor or a religious practitioner. The procedure takes approximately 10-20 minutes to perform, and the baby’s penis heals over the course of 1-2 weeks.

Circumcision has been a traditional practice in Islamic and Jewish populations. During the past century, it has been a routine medical practice in the United States and Canada. It is not a routine practice throughout most of the world’s population in Europe, Asia, Latin America, and Africa.

Over the past several decades, studies have examined the risks and benefits of circumcision. As a result, medical experts have actively debated whether or not circumcision should be recommended; and if it is done, what is the safest and most humane way to do it. In recent years, doctors in the United States and Canada have become less likely to recommend circumcision, and some health insurance providers have decided not to pay for it. The rates of circumcision in the United States and Canada have been dropping, and currently parents are as likely to choose not to circumcise as to circumcise their baby boys.

What doctors currently recommend
In 1999, the American Academy of Pediatrics released a new policy statement on circumcision stating, “Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In circumstances in which there are potential benefits and risks, yet the procedure is not essential to the child’s current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. If a decision for circumcision is made, procedural analgesia should be provided.” The American College of Obstetrics and Gynecology and the Canadian and Australian pediatric societies have issued similar recommendations. In short, parents should talk with their doctor, get information about the risks and benefits of circumcision, and make the choice they feel is right for their child and family. If circumcision is done, medication should be used to prevent pain.

Making the decision that is right for you
Get the information you need and take the time to discuss this question with your partner and your doctor before making your decision. Here are some things to consider:

Some reasons why parents choose circumcision:
  • Religious or cultural reasons: for some families, circumcision is an important traditional practice that they are committed to continue.
  • Medical benefits: circumcised boys have a lower rate of urinary tract infection, although this is fairly rare—1 in 100 uncircumcised boys vs. 1 in 1,000 circumcised boys gets a urinary infection—and most infections are easily treated with antibiotics. Circumcised men also have slightly lower rates of sexually transmitted diseases. They also have lower rates of penile cancer, which is extremely rare—1 in 100,000 men.
  • Personal beliefs and preferences: some parents choose to have their son circumcised because the father is circumcised, and they want their son to look like his father. Others don’t want their son to feel different from other boys, although currently boys are likely to have both circumcised and uncircumcised peers. Some parents also believe it is easier to keep a circumcised penis clean.
Some reasons why parents choose not to circumcise:
  • Medical risks: there are risks to circumcision, as there are for any surgical procedure. Babies can experience significant pain during and after the procedure, although medications are available to reduce the pain. While circumcision is considered a very safe procedure, approximately 1 in 200-500 boys have complications such as bleeding, infection or improper healing.
  • Personal beliefs and preferences: some parents believe that it is natural for the tip of the penis to remain covered by foreskin to protect it from irritation and to maintain the natural sensitivity to sexual pleasure. They may believe that it is unnecessary and inhumane to cut off the foreskin. Most parents also find it is easy to keep an uncircumcised penis clean.
  • Cost: if the procedure is not covered by health insurance, parents must pay out-of-pocket.
After you make your decision
If you choose to have your son circumcised, discuss with your doctor the ways to reduce his pain during the procedure. There are several options for pain relief: a numbing cream (called EMLA) spread on the penis before the procedure; an injection of numbing medicine (lidocaine) into the penis; having the baby suck on a sugary solution during the procedure; and giving the baby acetaminophen drops by mouth. Check with your health insurance company to find out whether the procedure is covered. Also, review information about the post-surgical care of the circumcised penis at www.med.umich.edu/1libr/pa/pa_circcare_hhg.htm. If you choose not to circumcise your baby, see the information on this website about care of the uncircumcised penis. Remember, the decision is yours to determine what is best for your child.
Karen Sokal-Gutierrez M.D., M.P.H. Pediatrician