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The Circumcision Decision

Answers for 6 Important Questions

Circumcision is a centuries-old procedure and continues to be performed for a variety of reasons, including medical, cultural, and religious. In the United States, most male infants are circumcised for non-religious reasons. Today, 80 percent of males ages fourteen to fifty-nine are circumcised. We are an anomaly among developed countries in this regard; in France, for example, approximately 14 percent of males are circumcised. 

Most circumcisions in the U.S. occur during infancy, but the rate has dropped over the last several decades. According to a 2013 CDC report, the U.S. newborn circumcision rate declined from about 65 percent in 1979 to 58 percent in 2010.

As obstetricians, we tend to get a lot of questions about circumcision from parents during pregnancy checkups because we perform the majority of circumcisions. I’ve answered a few of the most common questions below to help you know what to expect and what factors to consider when making your decision. 

Is it a necessary procedure?

For most newborns, circumcision is an elective procedure. The decision involves much consideration, but usually the choice to have a newborn circumcised is based on non-medical aspects, such as conformity in appearance, the father’s circumcision status, religious beliefs, and family and cultural influence.

Are there medical benefits of circumcision?

The benefits of circumcision for males include lower rates of urinary tract infections, penile cancer, penile inflammation, penile dermatological problems, and sexually transmitted infections (HIV, HPV, and herpes). There is also evidence that female partners of circumcised men may have a lower risk of cervical cancer. Human papillomavirus (HPV) is the leading cause of cervical cancer in women. Circumcised men have a lower prevalence of HPV infection than uncircumcised men, and thus they are less likely to transmit HPV to
their sexual partners. 

What are the disadvantages or risks associated with circumcision?

It’s important for parents to be aware of the possibility of complications related to circumcision. Inadequate skin removal may leave parents dissatisfied with the results. On the other hand, too much skin removal may also be problematic and can result in delayed healing. There is a risk of bleeding, but it is minimal and easily controlled. Rarely is further surgical intervention needed. While there is also a mild risk of infection, it is easily treated with local antibiotics. Urethral complications (at the opening of the penis) can occur, but these are rare if caregivers use proper diaper changing techniques. Injury can also occur; however, this is rare, especially with experienced surgeons. 

Sexual dissatisfaction is not seen to be associated with circumcision; however, there is concern that the end of the penis may become less sensitive if the foreskin is removed. 

Finally, pain during the procedure is a potential disadvantage. The American Academy of Pediatrics recommends administering local anesthesia prior to circumcision. Some surgeons use an injection while others use anesthetic cream. We don’t know if it works because the infants can’t tell us, but anesthesia use for circumcision is widespread.

Who performs infant circumcision (and when)?

Generally, infant circumcisions are performed by obstetricians. If you choose to have your baby circumcised, your obstetrician will typically perform the circumcision the day after delivery or sometime before you and your baby are discharged from the hospital. Your baby will be observed for an hour or so after the procedure and until he has one episode of urination. 

Pediatricians may also perform circumcision. Only in rare cases when an infant has an anatomical abnormality (such as hypospadias, a common defect where the urethra does not open at the head of the penis) will the obstetrician or pediatrician refer the baby to a pediatric urologist to perform the circumcision.

When to circumcise – as an infant or later in life?

While most parents who choose to have their babies circumcised do so during the neonatal period (the first month), other parents might opt to wait until their son reaches an age where he can make his own decision. If you are thinking about delaying, be aware that circumcision performed later in life comes with greater risks, cost, and pain, as well as a longer recovery period for older boys.

Who can offer guidance about circumcision?

Hopefully, I have helped answer some common questions that might arise as you contemplate the circumcision decision. Don’t hesitate to have a conversation with your obstetrician or pediatrician about additional questions or concerns you may have. We are here to help guide you through this decision.

Rebecca Schnatz, DO, FACOG, is an OB/GYN at Virginia Physicians for Women and the first in her family to pursue a career in medicine. After practicing for six years in Pittsburgh, Pennsylvania, and Charleston, West Virginia, Dr. Schnatz moved to Midlothian where she enjoys outdoor activities, soccer, cooking, and spending time with her husband and two young children. 
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