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Guide for a Healthy Pregnancy

DECIDING ABOUT CIRCUMCISION

If you have a baby boy, one decision you’ll need to make is whether to have him circumcised. This information sheet has general information to help you make an informed choice. After you read it, please discuss any questions you have with your clinician.

What is circumcision?

During circumcision, the foreskin of the penis is surgically removed. The foreskin is a fold of skin that covers the glans, the rounded tip of the penis. Circumcision is usually done on newborns at the hospital by an obstetrician or pediatrician. The procedure may be deferred to the office or referred to a Pediatric Urologist if the penis appears abnormal or is especially small. Circumcision is a brief and safe procedure when done by an experienced practitioner.

Why is circumcision practiced?

Muslims and Jews practice circumcision for religious reasons. In America, circumcision wasn’t common until the late 1800s, when many doctors began to suggest it had medical, hygienic, and even mental benefits. These theories weren’t based on scientific studies.

Currently, about 60% newborn boys in the U.S. are circumcised, some for religious or cultural reasons and others because of tradition. This varies from place to place. Some parents may be concerned that a boy fit in with his peers, or may feel that if a father is circumcised, his son should be too. Circumcision is less common in other countries. Approximately 5 in 10 boys are circumcised in Canada. In Central and South America, Asia and most of Europe, circumcision is rarely practiced.

Does circumcision have medical benefits?

Circumcision is a controversial issue in the medical community. In 1999 the American Academy of Pediatrics (AAP) noted that although circumcision for newborns may have medical benefits, as well as disadvantages and risks, the potential medical benefits of circumcision are not significant enough to recommend it as a routine procedure.

Some medical studies suggest that circumcised men have lower rates of sexually transmitted diseases (STDs) than uncircumcised men. Other studies suggest that women whose sexual partners were circumcised have a lower rate of cervical cancer. However, many experts question the results of these studies. Behavioral factors (e.g. condom use) continue to be far more important in determining the risk of contracting an STD than circumcision status.

Does circumcision have medical risks?

Complications may occur with any surgical procedure. Circumcision carries a 0.2 to 0.6 percent risk (about 1 to 3 cases in 500) of certain minor or serious complications. These are the most common problems:

What are options for pain relief?

Infants do feel pain during a circumcision. There is some disagreement, however, about the best approach to pain relief. Clinicians sometimes use a local anesthetic to reduce the amount of pain experienced during the circumcision. In studies determining effectiveness of anesthesia, pain is defined by the amount of time the infant cries, increases in heart rate and other stress responses. The options for pain relief have risks and benefits as outlined below.

General anesthesia is not used on newborns because it adds another element of risk to the operation. If circumcision is performed after the newborn period, a general anesthetic is usually required.

Caring for an uncircumcised infant

If you choose not to have your son circumcised, good hygiene will help prevent certain health problems. Early in life, the foreskin of an uncircumcised boy is firmly attached to the glans of his penis. As a child gets older, the foreskin slowly separates from the glans until it can fully retract. This happens in about 90% of boys by age 4 and in 99% by age 17.

Skin cells from the glans and foreskin are shed throughout life. The cells beneath the foreskin help form a substance called smegma. In an infant, smegma may look like white, cheesy grains under the skin. Simple bathing usually removes smegma and helps prevent possible infection in uncircumcised males of any age.

Caring for a circumcised infant

Following circumcision, it is important to keep the area as clean as possible. Gently clean with soap and warm water — do not use diaper wipes. Your doctor may recommend putting a dab of petroleum jelly on the baby’s penis or on the front of the diaper for three to five days to alleviate any potential discomfort caused by friction against the diaper. If your son has a bandage on his incision, you might need to apply a new one whenever you change his diaper for a day or two after the procedure. (Put petroleum jelly on the bandage so it won't stick to his skin.)

It usually takes between 7 to 10 days for a penis to heal. Initially the tip may appear slightly swollen and red and you may notice a small amount of blood on the diaper. You may also notice a slight yellow discharge or crust after a couple of days. Although this is normal, certain other problems are not.

Call your doctor right away if you notice any of the following:

Making your decision

You need to decide if you will have your son circumcised, and if so, whether you will request that anesthesia be provided. Your clinicians can help you learn more about circumcision by answering questions about the various options and medical controversies. Ultimately, though, whether or not to have a baby circumcised is a personal decision left up to you and your partner.

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