Circumcision – Decision

  • Circumcision – Decision

Most of us learned very early that some boys are “haves” and some are “have-nots.” Whether you stumbled upon this revelation in the grade school rest room or the junior high locker room, it may have come as a shock to you that all boys are evidently not created equal. I, for one, remember being amazed and curious about this strange difference. I promptly quizzed my mother about another boy’s apparent deformity.

She chose to be honest and explained to me – as clearly as she could to a 6-year-old – the reason for the phenomenon I’d observed. All men may be created equal, but they don’t necessarily stay that way.

Now that you’re all grown up and expecting a child of your own, there’s a chance you’ll face the circumcision decision. While you may not have the sole and final say on the matter, it’s likely that your opinion will carry weight. After all: It’s a guy thing.

For most couples, the decision is fairly simple: Like father, like son. If you are circumcised, it’s likely you will want your son to “follow in your footsteps” in every way possible. Likewise if you are not. Similarly, if you follow the Jewish or Islamic faiths, your beliefs dictate the necessity of male circumcision.

One thing is certain. The procedure, usually performed on a healthy baby in the first few days of life, is much safer when done on an infant. If performed later in life, the simple surgical procedure, in which excess foreskin is removed from the tip of the penis, is somewhat riskier.

For many years the operation was considered standard operating procedure. Most doctors recommended it, citing numerous medical benefits. Among them: a slightly lower risk of urinary tract infections (UTIs), a lower risk of contracting cancer of the penis, a lower risk of being infected by sexually transmitted diseases, including the AIDS virus HIV, and prevention of phimosis, in which the foreskin cannot be retracted.

But in March, 1999, the American Academy of Pediatrics issued a new policy in the peer-reviewed journal, “Pediatrics” which effectively reversed a decades-old pro-circumcision stance. Although the academy had begun to back away from wholesale endorsement of the procedure as early as 1971, the new recommendation clearly states that the benefits of circumcision are not significant enough for the AAP to recommend routine circumcision.

A task force appointed by the Academy studied nearly 40 years of evidence before announcing the latest policy. While the academy recognizes that circumcision does, indeed, have “some potential medical benefits,” it finds that the benefits are “not compelling enough” to warrant routine newborn circumcision.

Parents are encouraged, however, to discuss the matter with their physicians and make an informed decision. Many will prefer to follow tradition, and there is clearly still some justification for electing to have an infant circumcised. For instance, research indicates that circumcised males have a 1 in 1,000 chance of developing a UTI in the first year of life, while uncircumcised males have a 1 in 100 chance. The chances of an uncircumcised male developing rare cancer of the penis is three-fold that of circumcised males. It’s important to note however that overall this cancer is extremely rare, occurring in only about 10 out of a million men.

Some of the recent debate regarding the circumcision decision has centered on the fact that the procedure was done for decades without analgesia, on the theory that infants would either not feel the pain, or would not remember it. New evidence suggests that infants do experience considerable pain and stress during the procedure. The new AAP policy recommends analgesia as a safe and effective means of reducing this discomfort when circumcision is performed. Several forms of such pain relief are available.

Finally, some of the cons associated with circumcision include the following: Although generally a safe procedure, complications occur in 1 in 200 to 1 in 500 cases. Most are minor and involve mild bleeding or local infection. Some argue that removing the foreskin reduces future male sexual pleasure, but there is no evidence to support this claim.

If a boy is left intact, he must be taught to clean the penis thoroughly and carefully each day. The foreskin produces a cheese-like substance called smegma, which must be washed away daily for good hygiene. In this regard, circumcised males have the advantage in that their personal hygiene is easier.

For more information regarding your circumcision decision, visit the web site of the American Academy of Pediatrics at www.aap.org. Follow the links to “You and your family,” “Advocacy,” and “Publications” for more information. And certainly discuss the matter with your physician.

A final note: while a common practice among some cultures around the world, so-called female circumcision is considered barbaric in most of the civilized world. There is no medical justification for this genital mutilation, in which the clitoris is surgically removed (usually without any analgesia) or the vagina is sewn shut. The practice is designed only to “benefit” males who consider their young women property. Rather than having medical benefits, the practice involves clear medical risks, including the risk of multiple infections, loss of sexual pleasure for the female, erosion of self-esteem and the inability to deliver babies vaginally. The Academy absolutely opposes this disfiguring practice