Circumcision is one of today's most controversial parenting topics. For some families, religious or traditional reasons make circumcision an obvious choice, but for others, it can be a tough decision. Unfortunately, it's nearly impossible to have an educated discussion about this procedure, because of all the different, heated opinions on the subject. But without neutral, bias-free information for parents outlining circumcision pros and cons, how can any of us make an informed choice about whether or not to circumcise our babies?
In that spirit, here are some facts about the procedure, as well as information about the risks and benefits of circumcision, according to physicians and medical organizations.
What is circumcision?
A circumcision is a surgical procedure where the foreskin (the skin covering the head of the penis) is removed. This is often done while a newborn is still in the hospital, using local anesthetic, by an obstetrician or pediatrician. Some parents opt to have it done later, by a urologist (a doctor specializing in the male reproductive system). The American Academy of Pediatrics acknowledges that there are benefits to the procedure but does not recommend routine circumcision, instead leaving it to parents to make the decision based on personal, medical, and religious factors.
Benefits of circumcision for babies
According to the Center for Disease Control and Prevention (CDC), male circumcision can reduce the risk of contracting HIV from an infected partner by 50-60 percent, and also reduce the risk of men transmitting sexually transmitted diseases like HPV and bacterial vaginosis to their female partners. There's also evidence that circumcision may reduce the risk of penile cancer. For babies and young boys, there is a lower risk of infant urinary tract infections if they are circumcised.
Beyond the medical benefits, many families feel that there are compelling religious or personal reasons to make this choice. "Different social groups in America are more likely or less likely to circumcise their sons and parents choose circumcision for their sons because they feel, like after examining all the evidence, it's the right thing to do for their child the same way we make lots and lots of decisions for our children as they grow up and become adults," says Dr. Lauren Hyman, an OB/GYN.
Disadvantages of circumcision for babies
While the risks of circumcision in the United States are very low, the most common complications are inflammation and minor bleeding. Occasionally, more serious complications can occur. For example, the foreskin might be cut too short or too long, or not heal properly.
Despite the relative safety of circumcision, it is a highly volatile topic. "The negative ideas or the negative thoughts about circumcision right now in the U.S. and also in Europe are that... basically, you're cutting a healthy child's penis for really no good reason," says Mikael Brisinger, MD, an obstetrician in Los Angeles. "And a lot of people who are worried talk about ethics -- is it okay without the child's consent? Is it okay to expose a child to the risk of surgery for, some people say, very little medical benefit?"
Lastly, there's no scientific evidence that circumcision affects sexual function or satisfaction, but there are many anecdotal reports from anti-circumcision groups who feel that this is a legitimate concern.
Later circumcision: From toddler to adults
Experts say that circumcision is less risky (and less expensive) when done in infancy.
Most circumcisions are performed within the first days or weeks of a baby's life, and if you are planning on having it done, better to do it sooner than later. If the circumcision is done before a baby is 12 pounds or six weeks old, it can usually be done using only local anesthesia; after that, it requires being "put under." "The longer you wait, the bigger the baby gets," explains Dr. Brisinger. "He then has to be referred over to a urologist, and they usually want you to wait until [your child] is a couple of years old. They usually have to do a general anesthesia to do the procedure. The other issue is insurance coverage. Some plans do not cover circumcision in newborns, after 30 days of life. It could cost you several hundred or a thousand dollars to pay for out-of-pocket."
There are times, however, when circumcision is done later in life for medical or personal reasons.
Some toddlers and young children have a condition called phimosis, where the foreskin is too tight to be retracted (pulled back) over the head of the penis. This typically doesn't require medical intervention unless the child begins to
suffer from repeated infections, in which case circumcision might be recommended. But there are other circumstances, like when a child has a "trapped penis" (a foreskin which is so tight that urine can become trapped inside it), repeated infections, birth defects or other penile dysfunction problems, where circumcision might be the best solution.
Some parents choose not to circumcise, believing that it should be their son's decision - one that he can make later in life. Adult circumcision does occur, not only for medical reasons, but also for cosmetic or social concerns.
The risks of circumcision do increase with age. Toddlers and preschoolers who have to undergo the procedure, for example, do tend to experience pain and anxiety around the surgery.
Making the "right" decision.
Like so many other parenting decisions, everyone has a strong opinion about whether or not to circumcise. It can be hard to shut out the background noise, but remember that this is highly personal decision, with little evidence on either side that provides a clear right or wrong answer. Says Dr. Hyman, "At the end of the day, parents really need to examine medical evidence and the social and cultural norms in their community and decide whether they feel like this is something that is right for their child."