Whether or Not to Circumcise

Deciding whether or not to circumcise your infant son is not an easy choice. Whatever your reason for or against the surgery, it ultimately comes down to a very personal decision. Interestingly, this is one practice that even the American Academy of Pediatrics (AAP) leaves to opinion. Until recently, the AAP had said they were neither for nor against infant circumcision. However, in their most recent review of the practice, the organization revised its policy stating that the preventative health benefits of infant circumcision clearly outweigh the risks. The AAP also emphasized that the procedure should be covered by third-party payers, including Medicaid, so more families have access to it. But, the organization still stopped short of recommending circumcision routinely for all infant boys, saying it’s up to parents to weigh the health, cultural and religious implications to make the best decision for their child.

Just to be clear, circumcision is a surgical procedure that removes the foreskin, a small flap of skin that covers the tip of the penis, and is generally performed in the days after birth. Many people of Jewish and Muslim faith circumcise their sons because of their religious beliefs. Other parents choose to snip for hygiene reasons, believing it’s easier to keep a circumcised penis clean, or even cosmetic ones, wanting junior to “look like dad.”

The AAP’s previous policy statement, published in 1999 and affirmed in 2005, took a somewhat neutral stance on circumcision, noting “potential medical benefits,” but saying it’s “not essential to the child’s current well-being.” However, an AAP task force formed in 2007 examined scientific studies conducted between 1995 through 2010 to evaluate if a revision was needed. The new, stronger language is a result of emerging evidence that found links between circumcision and decreased risk of urinary tract infections, some kinds of cancer, HPV, HIV and other sexually transmitted diseases. “The evidence was becoming clearer, and it’s now obvious there’s a preventative effect,” says Michael Brady, M.D., chairman of the department of pediatrics at Nationwide Children’s Hospital in Columbus, OH, and a member of the AAP task force.

The Debate

Circumcision used to be a  routine practice in the U.S., but rates have continuously declined over the past several years. The Centers for Disease Control and Prevention now estimate that a little more than half of all infant males are circumcised. Globally, about 30 percent of men are circumcised, although rates range drastically from country to country.

Passionate opponents of circumcision call the procedure barbaric. The Internet, and its increasing use as a resource for medical decisions, has helped anti-circumcision groups get their message out. “We believe that circumcision of children violates numerous legal rights of the child and is highly unethical, if not unlawful,” says a public notice posted by on a website for the organization Doctors Opposing Circumcision.

Some groups have even tried to make the practice illegal. Activists in San Francisco proposed a measure to ban circumcision, but it was struck down by California Governor Jerry Brown. Courts in Germany recently called circumcision “grievous bodily harm,” and ruled that the “fundamental right of the child to bodily integrity outweighed the fundamental rights of the parents.”

Because circumcision is such a sensitive issue, moral or religious concerns might be more important than medical studies to many parents. “It’s a reduction of risk, not an elimination,” says Dr. Brady. “We recognize some people have very strong personal feelings about this issue, and those should be used in any decision-making.”

Choosing Circumcision

For those parents that do choose to circumcise, the decision doesn’t stop there. They also have to choose between knife or not. Most circumcisions in the U.S. are done with one of three devices: the Mogen Clamp, the Plastibell and the Gomco clamp.

The Mogen clamp is a scissor-like device consisting of two flat blades that are clamped over the foreskin, cutting off blood flow. A scalpel is then used to slice away the tip of the foreskin.

The Plastibell is a plastic device that is placed over the head of the penis, under the foreskin. The doctor or nurse then ties a string around the foreskin, cutting off circulation. The string may be used as a guide for the surgical removal of the foreskin, or the Plastibell may be left on for a week or so, after which the dead foreskin will fall off on its own.

The Gomco clamp is also inserted between the head of the penis and the foreskin. Again, the surgeon clamps the device over the foreskin, cutting off circulation. After about five minutes, the blood around the clamp will begin to clot, and the surgeon uses a scalpel to cut away the foreskin.

It’s best to discuss these options with your doctor to see what he or she recommends several months before birth. That way everyone is clear on the procedure in advance.

Before you make the decision, Dr. Brady suggests talking to your doctor about the health benefits and risks, and doing your homework to make sure whoever is performing the procedure has been properly trained, will perform the surgery in a sterile environment and use analgesia for pain relief. Regardless of your decision, Dr. Brady says parents should be clear on how to care for their newborn’s penis, cut or uncut.