Newborn Male Circumcision

What is circumcision?

Male circumcision is the surgical removal of some or all of the skin covering the tip of the penis, called the foreskin or the prepuce. In the United States, this surgery is often performed within the first few days of an infant’s life, when it is considered the most “simple.” It can also be performed later in life, should a man choose, though the procedure is considered “more complex.”

Infant male circumcision is one of many decisions parents are asked to make during their pregnancy or shortly after their boy is born. Socio-culturally speaking, this issue is very controversial and carries a lot of cultural, religious, and ethical charge. We believe that informed decision-making is paramount and want to empower our families to make an educated decision about infant male circumcision. While we cannot cover all of the information about male circumcision here, we hope to offer a broad look of this issue, as a launching point for gathering more information.

How prevalent is circumcision?

Globally, it was estimated in 2006 that approximately 30% of the world’s men were circumcised. The practice is nearly universal in some parts of the world (in most of these countries the practice is done almost exclusively for religious or cultural reasons), while in other areas the numbers are quite low.

In the United States, most estimates show that between 70-90% of males are circumcised, with the numbers peaking in the 1960s and falling by 5 to 10% since then. The practice has seen a greater decline in other developed nations including Canada, England, other parts of Europe, and Australia. The rates also vary by race, region, and class in the United States today.

The Controversy

There are a variety of views about circumcision. Generally speaking, those in favor of circumcision point to medical evidence that circumcision offers some health benefits to men. These advocates state that the benefits of the procedure greatly outweigh the potential risks. Some believe that circumcision should be performed for religious or cultural reasons (this is the more common reason, globally speaking).

Critics of the procedure believe it is entirely unnecessary, traumatic, and painful to a child.

Some people talk about the importance of choice—that parents should be able to make a choice about whether or not to circumcise their child. Others argue that the choice should be with the child because it is their body—in this view, circumcision is not considered ethical to perform on someone who is not able to make that choice.

Parents are often weighing all of these views and conflicting information in the context of cultural and familial norms. That is, many of the men in our country (and within our families) are circumcised, so there may be an additional pressure (stated or unstated) to conform to this norm.

It can be helpful to become aware of the reasons you may feel compelled toward or against the procedure as you explore this issue for yourself or your family.

The purported pros of male circumcision

In the US, the practice began in the late 1800s, prior to the germ theory of disease, when circumcision was thought to be “morally hygienic” (reducing sexual excitation) and even curative of such things as paralysis, masturbation, epilepsy, and insomnia. Those views have changed, but the health benefits of circumcision are still widely touted by the dominant medical community in our country.

For a long time, the American Academy of Pediatrics had remained neutral on the practice of circumcision. Then in 2012, it changed its policy (on which many insurance and social health care decisions are made). This new statement on circumcision stated that medical evidence shows that the health benefits of circumcision significantly outweigh the potential risks. They stopped short of actually recommending the practice, however, and instead said that families should have access to the procedure if they so desire.

The health benefits of male circumcision, as described by the AAP report include but are not limited to the following:

  • Reduced lifetime risk of urinary tract infections
  • Lowered risk of some cancers of the penis and prostate
  • Lowered risk of some, but not all, sexually transmitted diseases

They claim that the benefits outweigh the risks by 100 to 1 and that 50% of all those uncircumcised will experience some negative health effects as a result. They also claim that circumcision does not appear to have any negative effects on sexual sensitivity or function later in life.

The purported cons of male circumcision

There are many reasons given against male circumcision. The group Intact America, one of several organizations in the United States that are against circumcision, offers the following 10 arguments against circumcising, which you can read more about on theirs and other websites. 

  1. There is no medical reason for "routine" circumcision of baby boys and it is not recommended by any major organization in the nation.
  2. The foreskin is not a birth defect; it is a normal, sensitive, functional part of the body.
  3. Federal and state laws protect girls of all ages from forced genital surgery and they should protect boys as well.
  4. Circumcision exposes a child to unnecessary pain and medical risks
  5. Removing part of a baby's penis is painful, risky, and harmful.
  6. Times and attitudes have changed and it is becoming more acceptable not to circumcise.
  7. Most medically advanced nations do not circumcise baby boys
  8. Caring for and cleaning the foreskin is easy and being intact doesn’t present hygienic concerns.
  9. Circumcision does not prevent HIV or other diseases
  10. Children should be protected from permanent bodily alteration inflicted on them without their consent in the name of culture, religion, profit, or parental preference.

Risks of circumcision

Significant complications are believed to occur in approximately one in 500 procedures.  One source states that over 100 infant males die each year as a result of circumcision complications, although this number is hotly contested by some members of the medical community and does not seem to be supported by medical data (although reports of circumcision deaths are not actually reported to the CDC, making it difficult to gather data at all).

Possible complications of circumcision can include:

  • Local Bruising
  • Bleeding
  • Scarring (always occurs)
  • Adhesions
  • Puncture and skin bridges
  • Amputation
  • Difficulty breastfeeding
  • Difficulty with urination
  • Long term aggravated response to pain
  • Infection
  • Subsequent corrective surgery
  • Permanent disability or death

Many also argue that because the foreskin is so sexually sensitive, that circumcision reduces sexual pleasure and function.

This list doesn’t include the potentially negative psychological impact of this procedure on the newborn child, which is more difficult to account for.

Bottom Line

As mentioned we encourage our families to research and talk to their pediatric care providers about circumcision. We hope this article serves as a “launching off” point for one’s own exploration of this issue and we hope that each family makes an informed decision based on their own preferences and values, as well as a clear understanding of the available information on circumcision.

Resources

http://www.mayoclinicproceedings.org/article/S0025-6196%2814%2900036-6/fulltext#tbl4fne

http://www.mayoclinic.org/tests-procedures/circumcision/basics/why-its-done/prc-20013585

http://pediatrics.aappublications.org/content/early/2012/08/22/peds.2012-1990

http://www.nytimes.com/2012/08/27/science/benefits-of-circumcision-outweigh-risks-pediatric-group-says.html?_r=0

http://www.who.int/hiv/pub/malecircumcision/infopack_en_2.pdf

http://www.jurology.com/article/S0022-5347(12)05623-6/abstract

http://www.intactamerica.org

http://www.circumcision.org/

http://www.cirp.org

www.cirp.org