To Do, or Not To Do... The Circumcision
Soon-to-be parents come to “interview” me almost every day. Typically, they come prepared with a long list of questions for a pediatrician. I answer them as best as I am able. For parents soon-to-be-expecting sons, I am frequently asked about circumcision.
Most parents are just curious about how the procedure is technically done, when their baby can get the procedure, and how many of “these things” I have done.
(Answer: A lot.)
For some families, however, the decision to have a child circumcised is not that easy. These parents want to know the medical benefits of circumcision, the risks of the procedure, and the rates of circumcised boys in our community. They want to know if they will “look like” other boys when they grow older. And, what if they do/don’t “look like” dad?
All of these families just want to make the best decision for their son.
In some areas of the world, circumcision is performed nearly universally. And in some areas, it is rarely desired. The vast differences in circumcision rates are largely attributed to regional cultural, ethnic, and social values around our world.
What is also interesting is that regional rates of circumcision seem to be varied based on the need for parents to pay for it. Meaning, if the cost of circumcision is not covered by insurance plans, parents are less likely to have it performed. This is noted by the decreased rates of newborn circumcision performed in the US in states where Medicaid does not cover the procedure.
In turn, the number of circumcisions being performed has dropped slowly over the years. Currently, in the US, it is reported that 55% of men are circumcised. This is well below the 80% of men circumcised in the 1980s.
This cost-factor for this elective procedure is at the center of a recently released Statement on circumcision from the American Academy of Pediatrics (AAP). The Statement emphasizes the health benefits of the procedure in order to adequately justify circumcision being covered by a family's insurance policy.
Ultimately, the AAP is advocating for a parent’s personal choice to circumcise their child without the cost of the procedure being a factor.
The new reportdetails the medical benefits from circumcision. For infants, circumcision decreases the rate of urinary tract infections in the first year of life by 3-10 fold. As he grows up, studies have shown that circumcised men have a lower rate of certain sexually transmitted infections (STIs).* These studies have focused on certain STIs with significant long-term health detriments including HIV, HPV (human papilloma virus), HSV (herpes), and syphilis. Maintaining higher circumcision rates in a community may, in turn, decrease complications and suffering from long-term consequences of these infections; including penile cancer in men, and cervical cancer in women of infected partners.
The most common risks of circumcision include blood loss, infection, pain, poor cosmetic outcome, and penile adhesions. Rarely can damage to the penis occur. All of these complications can be reasonably avoided by having boys circumcised by trained health care providers, and with adequate pain control. Parents should be educated on appropriate care after the procedure.
As with all medical procedures, I believe that each individual family should be able to ultimately decide what is best for their sons based upon their unique family history, traditions, and expectations. Every family should have the opportunity to ask questions, and discuss the benefits and risks of this elective procedure, with the qualified health care provider who is able to perform their child’s circumcision.
Like most pediatricians, I am equally comfortable performing a circumcision, as I am educating parents on how to care for an uncircumcised penis.
So, blend your knowledge of this procedure with the history and experience of your unique family. Then allow yourself - whether you do or don’t - to be confident that it was the best decision you could make for your child.
For more information about circumcision, I recommend the following patient education article from UpToDate.
*Of note, circumcision is not the only way to protect against STIs. Regardless of circumcision status, STI transmission can be reduced by avoiding sexual activity or practicing safer sex.