Circumcision

 

Circumcision is an optional procedure for infant males to surgically remove the foreskin that covers the tip (glans) of the penis. The practice is common in the United States, but much less so in other parts of the world. For parents from traditions or religious groups where boys are customarily circumcised, there may not be much of a dilemma. Most other U.S. parents will wade into a debate that can become contentious at times, and parents may find themselves conflicted as well.

Competing Opinions

Perspective #1: Circumcision comes with risks, and it just doesn’t make sense to gamble with the health or physical integrity of a newborn, especially with what is essentially an elective surgery on a “private” part of the body. Aside from the avoidable, unnecessary pain to the baby boy, the penis can become irritated and even injured. Excessive bleeding and infection are possibilities as well.

Beyond the pain and risk of injury, a key reason not to circumcise is that the foreskin is a normal, healthy part of a boy’s body, just like the female foreskin (clitoral hood) is a normal and healthy part of a girl’s body. It’s a fairly drastic step to remove that part of a child’s genitalia. When a boy gets older he might decide on the procedure for himself, but circumcising an infant entails having parents decide what to do with their son’s body. He should have an open future. He should have the right to make an informed decision for himself once he’s old enough.

Perspective #2: The main reasons to circumcise a baby boy are related to health. Circumcision slightly reduces the risk of urinary tract infections (UTIs) during the first year of life; it decreases the chance of getting some sexually transmitted infections (STIs) later in life, including HIV; and it lowers the risk of penile cancer as well as cervical cancer in female partners. Plus, if the boy doesn’t get circumcised and decides to undergo the procedure later—possibly because he’s been teased for not being circumcised—the potential for complications is greater, and it will be more painful and take him longer to recover.

What the Science Says

RESEARCHERS ARE OFTEN split on the risks and benefits of circumcision. Let’s begin with risks, the first of which is pain. Whereas previously there was a belief that newborns didn’t experience pain the way adults might, it’s clear that they do, and relief from that pain should be a part of any circumcision. Local anesthesia is generally effective and can consist of a penile nerve block and topical anesthetic, both during the procedure and afterward.

Another concern is infection, as is the case with any operation. However, assuming the procedure is performed properly at a hospital and parents follow post-surgical advice, such as not putting the baby in the bath until after the wound has healed, the risks are minimal. There’s also the chance that further surgery might be required due to residual foreskin or what’s called meatal stenosis, where the urethra is compressed, making it difficult for the child to urinate. How significant this problem is in circumcised boys ranges widely, with estimates ranging from rare (0.7 percent) to common (20 percent).

One other biological point worth addressing is the claim made by opponents that circumcision can decrease the sensitivity of the penis, meaning that sexual pleasure will be diminished later in life. This position is vigorously debated, and it is difficult at this time to draw confident conclusions regarding whether circumcision has negative effects on sexual function, sensitivity, or pleasure. Those are the primary risks that come with circumcision, although opponents of circumcision point out that the risks of the practice are still understudied.

As for the benefits, research has found a lower rate of UTIs among circumcised males. One study found that over their lifetime, one in three uncircumcised boys will get a urinary tract infection, compared with one in twelve circumcised boys. However, a recent review by the Canadian Urological Association states that the evidence of circumcision-related decreases in UTIs is insufficient to recommend universal circumcision, and opponents argue that since UTIs are minor and easily treated with antibiotics, they should not be considered as significant factors in the decision. Research has also demonstrated that circumcised males are at a lower risk of getting HIV and other STIs from an infected female partner, but these studies have been performed in Africa, and questions have been raised regarding their applicability outside of that geographical and cultural context. And evidence shows that circumcision decreases the odds of developing penile cancer. Again, though, there is debate regarding whether the risk of that cancer is great enough to be considered a significant factor.

Based on analysis of these issues, the AAP declared in a 2012 statement that the benefits of circumcision outweigh the risks, and the CDC supports that position. Both, though, stop short of recommending the procedure across the board, as do the Canadian Paediatric Society and the Canadian Urological Association. It’s worth noting, too, that certain health organizations around the world disagree with the AAP statement, and a group of mostly European doctors has criticized it, pointing to what it calls cultural bias on the part of the AAP task force. It’s also noteworthy that the AAP has allowed its 2012 statement to expire after the five-year mark and has so far opted not to reaffirm it.

While this book focuses more on research studies, I would be remiss if I didn’t mention that a key aspect of the debate surrounding circumcision involves examining the issue from an ethical perspective. In 2019 more than ninety ethicists and scholars published an article arguing that, as one of the authors put it, “children of all sexes and genders have a right to be protected from genital cutting that isn’t medically necessary.”

The Bottom Line

BOTH PROPONENTS AND opponents claim that the debate about circumcision is over. It clearly isn’t. Increasingly, medical authorities (especially those outside the United States) are concluding that circumcision can’t be justified based on any health benefits it offers. But authors in the field still strongly disagree as to whether that’s the case. If you have misgivings about the practice for your child, you’ll find no shortage of support in the available evidence. Likewise, though, if you’re already committed to circumcising your baby, you can also find evidence that supports your decision and authorities who agree with you.

This is one example of the many parenting (and non-parenting) decisions where we can be driven more by our values, beliefs, tradition, emotions, preconceptions, and culture than by information and facts. In other words, if we already hold a particular position, then we might tend to pay attention to and reassure ourselves with the rational scientific data that bolster our view. If you’re conflicted but feel like you want your son to “look like his dad” or “follow family tradition,” then you’re more likely to find the data and arguments on the health benefits of circumcision more compelling, and the claims about the risks or concerns less significant. On the other hand, if you’re conflicted but it really bothers you that a doctor is going to remove a healthy part of your child’s body and cause unnecessary pain, then you may be more likely to find the data and arguments on the risks of circumcision more compelling, and the evidence on the benefits minimal.

I would love to give you clear-cut advice based on the science, but in this case, the decision is up to you. In conversation with your pediatrician, weigh the risks and benefits for your child, then take into account other issues including culture, religion, premature birth, family medical history, personal preference and values, and any ethical and human rights concerns you may have. All of these factors can lead you to the best decision you can make for your son.