Circumcision in Newborns

You’re the proud parent of a newborn boy. Congratulations! One of the first medical decisions you may face is whether or not to get your child circumcised. Many parents choose to have their child undergo this procedure, while others opt against it. Before making the decision, it is helpful to understand what circumcision is and know the potential benefits and risks.

What Is Circumcision?

Circumcision is a surgical procedure in which a physician removes the foreskin of the penis. The foreskin is a fold of skin that covers the tip of this organ.

Before removing the foreskin, the physician will clean the penis, and apply an anesthetic topically and/or by injection to accomplish a nerve block in order to numb the area with pain-fighting medication/anesthesia. The foreskin is clamped in place, cut, and then removed. The wound generally heals within one week.

Circumcision is most often performed just after birth, while the newborn is still in the hospital. Less often, a male may be circumcised as a child or adult.

Is Circumcision Necessary?

Circumcision is not a necessary procedure. A newborn boy doesn’t have to have this procedure in order to live a healthy life.

Many males are circumcised for religious reasons. In particular, circumcision is an important religious tradition for Jews and Muslims. Some parents also choose circumcision for cultural reasons or because of health benefits.

Some parents choose not to have their child circumcised because of ethical reasons, personal preferences, or concerns about the risks of the circumcision procedure.

How Many Males Get Circumcised?

Researchers have estimated different rates of circumcision within the United States. The number of U.S. males who are circumcised is between 55% and 80%, according to one study. Rates of circumcision vary across the country, with males in the Midwest being circumcised most often and males in the West undergoing the procedure less often. People of different races and ethnicities also tend to choose circumcision at different rates. Overall, circumcision has been declining over the past few decades.

What Do Experts Say About Circumcision?

In 2012, the American Academy of Pediatrics (AAP) released a statement explaining their recommendations surrounding circumcision. This panel of experts identified both benefits and risks for this procedure. They concluded, “although health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it.”

This means that the AAP has concluded that circumcision leads to health benefits that outweigh the risks, so parents who want to elect to have this procedure done should be able to have this procedure for their child. However, the benefits are relatively minor, and don’t warrant every male getting the procedure purely for health reasons. The AAP says people should be allowed to choose circumcision if they want.

An article in the American Family Physician Journal states:

Established health benefits of circumcision include a reduced lifetime incidence of urinary tract infections, penile cancer, phimosis, HIV, and several other sexually transmitted infections. A 2017 systematic review concluded that the health benefits of newborn circumcision are greater than the risks associated with the procedure. Despite these benefits, the newborn male circumcision rate has declined in the United States, from 83% in the 1960s to 77% in 2010. There are racial and ethnic differences in the overall circumcision rate: over the past decade, 91% of white males reported having been circumcised compared with 76% of black males and 44% of Hispanic males. In some states, these differences may be related to an increasing Hispanic population and lack of Medicaid coverage.The data used by the AAP and CDC to support their policy statements have largely been extrapolated from adult circumcision studies performed in the sub-Saharan region of Africa. Because of the lack of direct evidence of benefit, some consider newborn circumcision unnecessary. A 2010 systematic review found that although complications are rare, there is little evidence to support circumcision. (Am Fam Physician. 2020 Jun 1;101(11):680-685, citations omitted.)

Thus, many physicians advocate for giving parents the choice to circumcise their newborn. However, some doctors oppose the procedure and believe that males are better off in the long run when they have a foreskin. Circumcision is a somewhat controversial topic, and not all medical experts and healthcare providers are in agreement about whether it should be performed.

Deciding Whether to Circumcise Your Newborn

There are many factors that weigh into a parent’s decision to circumcise their newborn. It is helpful to learn more about the potential good and bad effects that circumcision may cause and how this procedure may affect your child’s health and future experiences, both short — and long — term.No one is legally required to circumcise their newborn as it is a parent’s decision.

Because circumcision is not required, it is considered an elective procedure. This means that not all health insurance policies may cover it. Alternatively, some policies may cover circumcision during the first few days of a child’s life, but not after that time period. When deciding whether to circumcise your child, you may want to check with your insurance provider to get more information about potential costs.

Potential Health Benefits of Circumcision

Circumcision can reduce risk of several different medical conditions. Many parents choose to have their newborns get this procedure for these reasons.

Urinary Tract Infections

Urinary tract infections (UTIs) develop when bacteria enters the bladder, kidneys, or urethra (tubes that carry urine out of the body). Males who have been circumcised are 3.6 times less likely to develop these infections over their lifetime. The benefit is even bigger during the first year of life: circumcised newborns are 10 times less likely to have a UTI.

Although circumcision helps protect against UTIs, these infections are not generally a large problem for men. First, UTIs in males only affect about 13-14% of men. Additionally, it is important to note that some healthcare professionals believe that better hygiene practices will help prevent conditions like UTIs in males with a foreskin. Finally, if a man does contract a UTI, it is not hard to treat. Antibiotics usually work well to clear the infection.

Viral Infections

Several studies have found that men who are circumcised are less likely to become infected with different types of viruses. In particular, circumcision cuts a man’s risk of contracting human immunodeficiency virus (HIV) in half.

The reason for this increased risk of viral infection is not entirely clear although several theories exist. Viruses may be more likely to survive for longer periods of time in the area under the foreskin, which tends to be damper compared to the circumcised penis. Additionally, HIV primarily infects certain types of immune cells within the body. The foreskin contains many of these cells, so it may be easier for HIV to attach to and enter cells when a foreskin is present.

Additional research has also found that other viral infections are also less common in circumcised males. When males are circumcised at birth, they later have a lower risk of becoming infected with viruses such as human papillomavirus (HPV) and herpes simplex virus type 2 (HSV-2). Circumcised men may also be less likely to pass along viral infections, including certain sexually transmitted infections (STIs), to female partners.

Cancer Risk

Circumcision can help protect against cancer of the penis. In fact, men who are uncircumcised are 20 times more likely to develop this cancer. However, penile cancer is rare, making up less than 1% of all cancers seen in men. It is very unlikely that a male will be diagnosed with this condition over the course of his life, even if he remains uncircumcised.

Men who are circumcised are also less likely to develop prostate cancer, a much more common condition. However, the protective benefit of circumcision is slight — uncircumcised men are just 1.2-2 times more likely to be diagnosed with this cancer.

Potential Risks of Circumcision

While circumcision may bring some benefits, it may also lead to certain hazards. There is some indication that leaving the foreskin in place may also be a good thing.

Short-Term Risks of the Procedure

Circumcision is a surgery, and any surgery comes with risks. Experts estimate that about 1 out of 500 newborns experience a complication from circumcision. Most of these complications are mild.

During circumcision, a newborn may experience redness and bleeding. This procedure also leaves a wound that takes some time to heal. Although rare, there is a possibility that circumcision could lead to infection or injure the penis.

Some newborns can’t be circumcised because they have health conditions that would make the procedure too risky. Babies who are born very prematurely usually can’t be circumcised. Other conditions that may prevent circumcision include blood disorders, bleeding problems, such as hemophilia, or infants with certain birth defects, such as penile torsion, epispadias, and a condition known as penoscrotal webbing.

Circumcision is also thought to cause pain for newborns. Ask your doctor what kind of pain-numbing medication will be used for the procedure.

Long-Term Loss of Sexual Sensation

It is a common belief that men who are circumcised have a loss of sensation in their penis that prevents them from experiencing sexual satisfaction in the same way as men who are uncircumcised. Because of this, some experts say that newborns shouldn’t be circumcised. However, the scientific evidence in this area is not entirely clear.

The foreskin contains many nerve endings that help provide feeling. Some studies have found that within uncircumcised men, the foreskin is more sensitive to touch than other parts of the penis. However, some of these studies have also found that there was not a large difference between how sensitive the penis was overall between men who had been circumcised and men who hadn’t.

Other survey-based studies have found that circumcised men are slightly more likely to experience unusual sensations in the penis, experience less sexual pleasure, and have trouble having an orgasm. However, the majority of both circumcised and uncircumcised men said that they never or rarely had problems in this area. Additionally, other studies have found no difference in sexual function when a man is circumcised.

More research is needed in this area, and not all experts agree on how circumcision affects sensation in the penis. However, it is possible that men who are circumcised at birth are more likely to have trouble with sexual satisfaction later on in life.

Caring For Your Newborn After Circumcision

It may take up to a week for the circumcision wound to heal. Make sure to follow your pediatrician’s instructions when caring for the wound. You may need to protect the wound by covering it with ointment or Vaseline (petroleum jelly) when changing your child’s diaper. Your physician may also tell you to occasionally wash the area with mild soap.

After circumcision, your doctor should tell you to watch out for any signs of infection or injury. Contact your child’s physician if the circumcision wound is bleeding or releasing pus from the surgical wound, or if the penis is swollen and red. Additionally, talk to a physician if your child seems to be in a lot of pain.

Caring For a Newborn With an Uncircumcised Penis

If you choose not to circumcise your newborn, you should also know how to provide proper care. In newborns and children, the foreskin will be too tight to be pulled back very far. This is normal. Don’t try to pull or stretch the foreskin away from the rest of the penis. When bathing your child, gently move the foreskin only as far back as it will naturally go, and wash the exposed area with water and mild soap.

The foreskin gradually becomes looser over time. As it begins to separate from the rest of the penis, you can teach your child to begin regularly washing under the foreskin.

Circumcision in Older Males

Occasionally, circumcision happens in older boys, teens, or adults. In this case, the risks of infection and bleeding are higher. Additionally, the wound often takes longer to heal — up to three weeks.

The procedure is handled a little differently when it takes place in an older child or adult. The person will usually be put to sleep with general anesthesia. After the foreskin is removed, the wound is closed with stitches that slowly dissolve as the wound heals.

The patient will usually be able to go home the day of surgery. However, he may have to rest for the next couple of weeks and avoid strenuous physical activity until the wound is healed. Pain medication and ice packs can help relieve pain during recovery.

Conclusions

Currently, circumcision is a controversial issue, and there is no consensus on whether or not it should be performed. Many medical experts and healthcare providers are in favor of allowing circumcision, saying that the religious and cultural traditions and health benefits surrounding the procedure make it worthwhile. Others are against the procedure, noting that the risks do not outweigh the potential benefits when the surgery is not necessary for the health of the child.

Currently, the choice of whether to circumcise a newborn is left up to the parents. If you are struggling to make a decision, it may be a good idea to talk to your child’s physician, who can discuss the risks and benefits of the circumcision procedure for parents to be able to make the best-informed decision for their child and their family.

If you would like to discuss this topic further with Dr. Connor, please make an appointment.