Whether you're expecting a baby boy or have just welcomed
your new little guy into the world, you have an important decision
to make before you take your son home: whether to circumcise
him.
For some families, the choice is simple because it's based
on cultural or religious beliefs. But for others, the right option
isn't as clear. Before you make a circumcision decision,
it's important to talk to your doctor and consider some of the
issues.
About Circumcision
Boys are born with a hood of skin, called the foreskin, covering
the head (also called the glans) of the penis. In circumcision, the
foreskin is surgically removed, exposing the end of the penis.
Approximately 55% to 65% of all newborn boys are circumcised in
the United States each year, though this rate varies by region
(western states have the lowest rates and the north central region
has the highest). The procedure is much more widespread in the
United States, Canada, and the Middle East than in Asia, South
America, Central America, and most of Europe, where it's
uncommon.
Parents who choose circumcision often do so based on religious
beliefs, concerns about hygiene, or cultural or social
reasons, such as the wish to have their son look like other men in
the family.
Routine circumcision is usually performed during the first 10
days (often within the first 48 hours), either in the hospital or,
for some religious ritual circumcisions, at home. If you decide to
have your son circumcised at the hospital, your pediatrician,
family doctor, or obstetrician will perform the procedure before
you bring your baby home. The doctor should prepare you by telling
you about the procedure he or she will use and the possible risks.
Circumcision after the newborn period can be a more complicated
procedure and usually requires general anesthesia.
In some instances, doctors may decide to delay the procedure or
forgo it altogether.
Premature
babies or those who have special medical concerns may not be
circumcised until they're ready to leave the hospital. And
babies born with physical abnormalities of the penis that need to
be corrected surgically often aren't circumcised at all because
the foreskin may eventually be used as part of a reconstructive
operation.
The Pros and Cons
On the plus side, circumcised infants are less likely to develop
urinary tract infections (UTIs)
, especially in the first year of life. UTIs are about 10 times
more common in uncircumcised compared with circumcised infants.
However, even with this increased risk of UTI, only 1% or less of
uncircumcised males will be affected.
Circumcised men may also be at lower risk for penile cancer,
although the disease is rare in both circumcised and uncircumcised
males. Some studies indicate that the procedure might offer an
additional line of defense against sexually transmitted diseases
(STDs), including
HIV
.
Penile problems, such as irritation, inflammation, and
infection, are more common in uncircumcised males. It's easier
to keep a circumcised penis clean, although uncircumcised boys can
learn how to clean beneath the foreskin once the foreskin becomes
retractable (usually some time before age 5).
Some people claim that circumcision either lessens or heightens
the sensitivity of the tip of the penis, decreasing or increasing
sexual pleasure later in life. But neither of these subjective
findings has been proved.
Although circumcision appears to have some medical benefits, it
also carries potential risks - as does any surgical procedure.
These risks are small, but you should be aware of both the possible
advantages and the problems before you make your decision.
Complications of newborn circumcision are uncommon, occurring in
between 0.2% to 3% of cases. Of these, the most frequent are minor
bleeding and local infection, both of which can be easily treated
by your doctor.
Perhaps one of the hardest parts of the decision to circumcise
is accepting that the procedure can be painful. In the past, it
wasn't commonplace to provide pain relief for babies being
circumcised, but because studies have indicated that it benefits
the infant to receive anesthesia, most doctors will now provide
it.
Also, the American Academy of Pediatrics (AAP) recommends the
use of pain relief measures for circumcision. Even up until
recently, though, anesthesia hasn't been universally used, so
it's important to ask your doctor ahead of time what, if any,
pain relief will be utilized with your son.
Two primary forms of local anesthetic are used to make the
operation less painful for a baby:
- a topical cream (a cream put on the penis) that requires at
least 20 to 40 minutes to take its full effect
- an injectable anesthetic that requires less time to take
effect and may provide a slightly longer period of
anesthesia
In addition to anesthesia, giving a pacifier dipped in
sugar water can help reduce your baby's level of stress.
Caring for a Circumcised Penis
Following circumcision, it is important to keep the area as
clean as possible. Gently clean with soap and warm water - do not
use diaper wipes. Your doctors may recommend putting a dab of
petroleum jelly on the baby's penis or on the front of the
diaper for 3 to 5 days to alleviate any potential discomfort caused
by friction against the diaper. If your son has a bandage on his
incision, you might need to apply a new one whenever you change his
diaper for a day or 2 after the procedure (put petroleum jelly on
the bandage so it won't stick to his skin).
It usually takes between 7 to 10 days for a penis to heal.
Initially the tip may appear slightly swollen and red and you may
notice a small amount of blood on the diaper. You may also notice a
slight yellow discharge or crust after a couple of day. Although
this is normal, certain other problems are not.
Call your doctor right away if you notice any of the
following:
- persistent
bleeding
or blood on diaper (more than quarter-sized)
- increasing redness
-
fever
- other signs of infection, such as worsening swelling or
discharge, or the presence of pus-filled blisters
- not urinating normally within 12 hours after the
circumcision
However, with quick intervention, almost all
circumcision-related problems are easily treated.
Caring for an Uncircumcised Penis
As with a penis that's circumcised, an uncircumcised one
should be kept clean. Also, no cotton swabs, astringents, or any
special bath products are needed - simple soap and warm water every
time you bathe your baby will suffice.
Initially, do not pull back the foreskin to clean beneath
it. Over time, the foreskin will retract on its own so that it can
be pulled away easily from the glans toward the abdomen. This
happens at different times for different boys, but most can retract
their foreskins by the time they're 5 years old.
As your son grows up, teach him to wash beneath the foreskin by
gently pulling it back from the glans, rinsing the glans and the
inside of the foreskin with soap and warm water, then pulling the
foreskin back over the head of the penis.
The Circumcision Decision
In addition to the medical issues discussed, religious and
cultural beliefs often figure into the equation. Of course, if
these are important to you, they deserve to be seriously
considered.
Despite the possible benefits and risks, circumcision is neither
essential nor detrimental to a boy's health. The AAP and the
American Academy of Family Physicians (AAFP) do
not
endorse the procedure as a way to prevent any of the medical
conditions mentioned previously. The AAP also does
not
find sufficient evidence to medically recommend circumcision
or
argue against it.
Talk to your doctor about the pros and cons of circumcision to
help you make the choice that's right for your son.
Reviewed by:
Mary L. Gavin, MD
Date reviewed: July 2008
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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