A: Brooke, it’s good that you and your husband are asking questions about this surgery, in which the foreskin covering the tip of the penis is removed. For many years it was a routine practice in the United States and several other countries to perform circumcision on newborn boys. It was also routine to do circumcision without anesthetic or analgesic (numbing or pain relief) based on the assumption that newborns did not experience pain or would not remember it. However, recent studies have shown that newborns do experience pain and show changes in heart rate, blood pressure and stress hormones with circumcision. Other studies have closely examined the risks and benefits of circumcision. As a result, medical experts have been actively debating whether circumcision should be routine; and if it is done, what is the safest and most humane way to do it.

In 1999, the American Academy of Pediatrics released a new policy statement on circumcision. They stated, “Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision…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 Canadian and Australian pediatric societies have issued similar recommendations. In short:

• Some medical benefits of circumcision have been found—lower rates of urinary tract infection (which is rare, one in 100 uncircumcised boys, and easily treated), lower rates of penile cancer (which is extremely rare, one in 100,000 men) and possibly slightly lower rates of sexually transmitted diseases. But there are also risks to circumcision, as there are for any surgical procedure. Although circumcision is generally a safe procedure, approximately one in 200 to 500 boys have complications such as bleeding, infection or improper healing. In all, since there are risks to circumcision and the benefits are rare, it does not appear necessary to routinely circumcise all baby boys.
• Parents need to get information about the risks and benefits of circumcision and make their own choice. Many parents choose to circumcise their boys for religious or cultural reasons, or personal preference (e.g., to look like dad). Many other parents choose not to circumcise their boys because they believe that it is natural for the tip of the penis to remain covered by foreskin, and they want to avoid the risks of the surgery, the pain and cost.
• If parents choose circumcision, it should be done with medicine to reduce the pain. Several options for pain relief have been found to be effective:
  
  
  • Numbing cream: EMLA (Eutectic Mixture of Local Anesthetics) cream contains the numbing medicines lidocaine and prilocaine. It can be spread on the tip of the penis 60 to 90 minutes before the procedure. It helps numb the penis and relieve pain during the circumcision procedure, and wears off shortly afterward.
  • Injections of numbing medicine: There are two common methods of numbing the penis by injection. Dorsal penile nerve block is an injection of lidocaine at the base of the penis; subcutaneous ring block is an injection of lidocaine around the shaft. They numb the nerves in the penis during the procedure and wear off two hours later. A study comparing pain relief found the injections slightly more effective than the cream.
  • Oral pain relief: Giving the baby a pacifier dipped in sucrose (sugar) solution during the circumcision and acetaminophen drops afterwards can also help relieve pain.

If you decide on circumcision, be sure to talk with your doctor about it in advance. Ask:

• Who will perform the circumcision? How many circumcisions have they do