The decision to have a child circumcised

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 report details 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.

Natasha Burgert is a pediatrician who blogs at KC Kids Doc.

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  • NormRx

    Circumcision should be called what it is, “Male genital mutilation.” Being male is treated as a pathology that only a physicians scalpel can correct.

  • http://www.facebook.com/profile.php?id=100002314951570 June Park

    “We know that you benefit from not only the payment for circumcisions,
    but also by selling the foreskins to cosmetic and research companies. We
    know you rarely use pain medication and that you routinely consider
    sugar pacifiers and lollipops to be “enough” pain medicine for an
    infant. We know there are no health benefits to circumcision, but there
    are downfalls. A child may die from shock or from bleeding out. A child
    may have psychological issues such as PTSD or other psychological and
    social problems. We know circumcision affects breastfeeding and often
    ceases the nursling/mother relationship. A child may also have physical
    injuries beyond the amputation of the foreskin and it’s immunological
    protections. He will not be as protected as his intact peers from
    disease and infection. He will not be able to perform properly during
    intimate acts with his partner due to the keratinization of his glans
    among other issues. We know circumcision is illegal under child abuse
    laws in each state which say you cannot leave a mark on a child.
    Circumcision is illegal under the 14th Amendment which guarantees equal
    rights to all regardless of religion or age. Yes, children do have
    religious freedom as well as the freedom to not be harmed by others.
    Courts have repeatedly ruled that parents cannot martyr their children
    which makes religious freedom and parents’ rights arguments invalid.
    Muslim parents are not supposed to circumcise and a growing number of
    Jewish families keep their children intact because they know it is
    harmful to circumcise. Yes, we know the truth. We know that mandated
    reporters are the perpetrators of many of these child abuses you so
    lightly call circumcisions. No matter what your policy states when it
    comes out in September, we will continue to share the true facts instead
    of bow to those who are in it for the money and the power. We hold you
    accountable to “do no harm”.” http://happymommy1.blogspot.com/2012/08/dear-aap-we-know-truth.html

  • http://www.facebook.com/profile.php?id=100002314951570 June Park

    “The AAP has lost its credibility, and we should no longer view it as a valid medical association.” http://www.psychologytoday.com/blog/moral-landscapes/201209/what-happened-ethics-in-pediatric-medicine/comments

  • http://www.facebook.com/profile.php?id=100002314951570 June Park

    ‘Using sensitivity analysis, it was impossible to arrange a
    scenario that made neonatal circumcision
    cost-effective. Neonatal circumcision is not good health policy, and
    support for
    it as a medical procedure cannot be justified
    financially or medically.” http://mdm.sagepub.com/content/24/6/584.abstract

  • http://www.facebook.com/judith.bakley Judith Bakley

    If you truly were equipped to educate parents on how to care for an intact penis, you wouldn’t be calling it “uncircumcised”. It’s either natural, normal, intact or even not circumcised. Saying uncircumcised makes about as much sense as saying unabnormal instead of normal. I’ll bet your “education” includes telling these new parents to be sure to retract their baby son’s foreskin every day and clean beneath it, right? And anyone who knows about the foreskin KNOWS how wrong that advice is, and that it can cause problems that lead to circumcision…but then that is probably the point, right? SMH

  • http://www.facebook.com/profile.php?id=814935367 Tara Dickson

    What kind of crazy world have we come to live in that “medical professionals” can justify the torture and amputation of genitalia of an non consenting human being?? So sick of these lies.

    • http://www.facebook.com/lo.maret Lo Maret

      lies indeed. shame on these doctors, what happened to their oaths to “do no harm”? they line their pockets with money, while torturing these poor babies.

  • Vanessa

    Your link to how to care for an uncircumcised penis is giving out incorrect information. It says to wash the inside fold of the foreskin with soap and warm water when it retracts on it’s own. Using soap on the inside of the foreskin is irritating and can cause infections. It’s the same as using soap inside your vagina. You NEVER do that. Warm water is enough. No wonder many intact boys and men in the USA have problems with their foreskins and need circumcisions later in life. Their doctors giving out false information is the problem. I am disgusted with this article. What about giving the owner of the penis the choice?

  • http://www.facebook.com/bohemiankitten Cindy Alchin

    Every parent should make the best decision for their son by leaving the decision entirely up to him when he is old enough to consent!!

    • Jackson Foreman

      Then In Regards To Your Answer; What About The Parents That Decide That They Want To Have Their “Baby Girl’s” Ears Pierced? Should We Not Let Them Do This And Wait Until They Are Of Age To Decide?

  • http://www.facebook.com/nick.kalish Nik K Malis

    I hate to break this to a medical professional, but, you don’t use soap on a mucosal membrane, dear good doctor. You know it’s bad when “medical professionals” are giving out this type of misinformation. I suppose you advise parents to use massengill regularly on their little girls?

  • http://www.facebook.com/carrie.simonagnese Carrie Simon Agnese

    Are there any other unnecessary surgeries that I, as the parent, are encouraged to decide upon? Do I also have the right to ask for a mastectomy for my baby girl? There would be a decrease risk of cancer and infection. Do I also have the right to decide whether or not to circumcise her? Isn’t it my choice, based on my culture and family history? Also, can you tell me exactly what the function of the foreskin is and what exactly is removed during the circumcision? Thanks.

    • http://www.circumstitions.com/ Hugh7

      A study in Korea has found that CASTRATION greatly increases men’s life-expectancy, and hemicastration (or hemiorchidectomy – what a beautful word, it sounds like like plucking a rare flower!) would have little effect on fertility but HALVE the rate of testicular cancer – which is much more common than penile cancer, fast and aggressive. I expect the AAP to set up a Task Force on Castration and recommend that this too is “an important decision for parents”.

  • NormRx

    I can’t tell you how pleased I am to read the comments regarding circumcision from the women on this board. Thank you ladies. Most men have totally abdicated their responsibility fighting this barbaric procedure. This procedure is not benign, it has resulted in death and gender reassignment surgery of babies.

  • MissMeg

    Why all the hostility, People? Such intolerance!

    • http://www.facebook.com/profile.php?id=100000348254476 Joseph Lewis

      Do you tolerate “sunat” as performed on baby girls by physicians in South East Asia? How about a “ritual nick” as sanctioned by the AAP?

      Let’s see how far you preach “tolerance.”

  • http://www.facebook.com/people/Rebecca-Fine/100002306266703 Rebecca Fine

    Parents of all backgrounds, white, black, asian & latino have their boys circumcised in America. It has widespread practice across all demographics.

    • http://www.facebook.com/profile.php?id=100000348254476 Joseph Lewis

      Well if it isn’t out “unbiased,” neutral, objective and dispassionate circumcision advocate. The name of this logical fallacy is argumentum ad populum. As if “everybody’s doing it” were any kind of excuse. Let’s see what other practices were up taken by the masses; slavery, women oppression… You know, female circumcision was once practiced in the United States and insurance paid for it… Maybe if “people across demographics” started doing it, it would be OK…

  • http://www.facebook.com/profile.php?id=100000348254476 Joseph Lewis

    The bottom line question is always this; without a medical or clinical indication, can a doctor even be performing surgery on a healthy, non-consenting individual, let alone be giving his parents any kind of a “choice?” Shouldn’t circumcision be governed bythe laws that apply to any other surgery, which dictate that it should be reserved as a very last resort, where all other forms of treatment have failed?

    I’m afraid that doctors who profit from non-medical procedures on non-consenting individuals are getting away with medical fraud. It is only a matter of time before circumcised of healthy, non-consenting minors will be seen for the charlatans they are.

  • http://twitter.com/KOTFrank Frank McGinness

    Cold/Taylor-the presence of smegma preputii is a rare finding; in a prospective examination of 4521 uncircumcised boys, only 0.5% had smegma.

    Dr. John Taylor penile and heart researcher – Sexual Function of the Dartos Muscle (loosely):
    Upon erection the Dartos muscle tenses creating a one-piece solid skin tube, where any action on the penile shaft is transferred to act on the erogenous Taylor’s Ridged Band and through its loop to the Frenulum, this action it transferred to act on the erogenous Frenulum, together the male’s sexual nexus. No action on the shaft is wasted on these sexual structures.
    Circumcision always removes all of the erogenous Taylor’s Ridged Band and part to all of it’s connecting Frenulum. Having this hangman’s noose of the male’s sexual receptors missing no longer keeps the whole of the penile Dartos muscle tense. With tension gone, all action on the erect penile shaft is wasted to act on the Ridged Band and Frenulum. Action must be applied directly to the Frenulum remnant, if any remains. Meaning the intact has the whole penile skin area to activate the erogenous receptors whereas the circumcised if lucky has just the short narrow string, the frenulum remnant and scarred and keratinized glands coronal erogenous receptors.
    Circumcision cuts off 65%-85% of the male’s sexual receptors (85% when the frenulum is cut or scraped off infant). This leaves 15% sexual receptors located in the glans corona where it’s overpowered by the more populous pain/thermal receptors, ratio 5% to 95%. It is this case that men report “If I felt anymore sensitivity, I think I would die of a heart attack!” (Larry David) Circumcision changes the way, means, and type of sensations felt. Circumcision sexually handicaps.

  • Jeff

    “Rarely can damage to the penis occur.” False. Damage to the penis always occurs. It occurs 100% of the time. That is what circumcision IS – irreversible damage to the part of the penis that is designed to provide adult men with the majority of their sexual pleasure.

    A circumcised penis is a partial penis. An intact penis is a whole penis.

    Parents are deliberately lied to about the damage that always occurs during circumcision because the American doctors who perform circumcisions either don’t don’t understand male anatomy or are unable to give up such an enormously profitable part of their practice – or both.

    This article is a good example of that sort of shameful and ignorant lying.

    Whoever wrote and published this article should have their license to practice medicine revoked.

  • sciencereader

    So, if a child is circumcised, he has a lowered probability of contracting some maladies. He also has a 100% probability of going through life with part of his penis missing and never knowing what it’s like to have a complete, normal penis. Isn’t that a malady?
    Another thing that parents might want to consider is that circumcised boys growing up today will know that their parents made a conscious decision to have part of their penis cut off, and that the parents of some of their friends made a different decision. This is different from how it was when old fogies like me were born, when it was a given that boys were circumcised, and nobody thought anything about it. Circumcised boys growing up today might well come to resent their parents for their decision. Circumcision is controversial, obviously; why do you think your child would agree with your decision to amputate his foreskin? I’m sure in the years to come we’ll start hearing stories of males being angry at their parents about this.

    • Jordan

      Met a lot of guys in my life. Hard to say how many, probably a couple thousand. I’ve yet to hear one say “Man, I really wish my parents wouldn’t have circumsized me. I’d really like to have made that decision when I turned 18.”

  • dr_nic

    As a physician and mother who reluctantly has to have her son circumcised (true medical necessity) I was appalled to read the link about circumcision. When it discussed the reasons why a parent would/would not circumcise their son, they were presented in such a was as to make it appear than only the ill-informed and uneducated would choose not to circumcise their son.

  • carmewn montaner. M.D.

    I agree that circumcision is barbaric, but, isn’t the sucking out of the unborn baby’s brain or the killing of a fetus just as barbaric? Yet these practices are acceptable! I can not understand how people, especially women, can justify these inhumane acts.