To Circumcise Or Not To Circumcise: That Is the Question

Whether to circumcise a baby boy is a frequent topic at prenatal discussions with expectant parents in my pediatric practice.

Most parents who choose to circumcise their newborn son have the procedure done in the hospital shortly after the baby is born, or at home as part of a religious ceremony (circumcision is a rite of passage for many in both the Jewish and Muslim faiths). Thus, if you are undecided it is important to gather information and talk to health care professionals before your baby is born so that you can be comfortable with your decision.

Fortunately we have the freedom to make this decision. Some citizens in San Francisco want to take away that freedom, and have succeeded in placing a referendum on the November ballot to ban the procedure for anyone under age 18, even if being done for religious reasons. If it passes, those who perform circumcisions, as well as the parents of the child, could face a $1,000 fine and a year in jail.

As a result of the First Amendment issues involved with this referendum, over the next few months you can expect to hear about what many perceive to be the positives and negatives of circumcision. I will leave the First Amendment and moral issues to the lawyers and others so inclined to engage in such a discussion.

Instead, I want to focus on the medical information available so that parents can make an informed decision.

In the interest of full disclosure, as a Jewish mother I chose to have my son circumcised at home by a mohel, a person specially trained to perform both the circumcision and the religious ritual associated with the procedure (a bris). As a pediatrician, however, my interest in the ceremony went beyond religion. I watched the mohel prepare for and perform the procedure, and was impressed by his skill. He was clearly well-trained and knew exactly what he was doing.

My professional opinion on circumcision matches that of the American Academy of Pediatrics (“AAP”). The AAP’s policy is to neither recommend for or against male circumcision. Rather, they leave the choice to parents to make for their newborns. The abstract of the AAP’s “Circumcision Policy Statement,” which was published in March 1999, states:

"Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In circumstances in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. If a decision for circumcision is made, procedural analgesia should be provided."

The AAP’s policy is based on some known benefits associated with circumcision including decreased rates of urinary tract infections, penile cancer, and some sexually transmitted diseases (including HIV). Circumcision also makes it easier to clean the penis, which can result in a lower chance of skin infection.

However, currently available data does not reflect enough of a benefit to justify a recommendation by the AAP that circumcision be performed on all male infants.

Proponents of the legislation to ban circumcision argue that the procedure is painful, permanently alters the normal form and size of the penis, desensitizes it, and results in the loss of full sexual function as an adult. They further claim other potential medical consequences such as impotence, and that the trauma it causes to an infant can interrupt the mother-infant bonding and permanently alter the way the infant’s brain functions and tolerates pain.

Needless to say, if you do enough research on the web you will find plenty of arguments against circumcision. Other than the fact that the procedure may be physically painful for the newborn and that there is risk of bleeding and infection after the procedure, the AAP has not recognized the validity of other claims cited by the proponents of the referendum.

My logical side also believes that there are enough circumcised men on this planet to elicit appropriate data if such evidence existed.

For those parents who decide to have their newborn son circumcised, the AAP recommends the use of pain relief and/or local anesthesia to make the procedure as painless as possible for the infant. To address the potential of bleeding and infection, Vaseline should be applied to the area for a few days after the procedure and extra care should be used when attending to diaper changes. As with everything associated with a newborn, if you see anything out of the ordinary you should contact your pediatrician immediately.

As a pediatrician, I form opinions from observation, experience, and scientific evidence. To date, the only supportable justifications I have seen against circumcision are the pain endured by the newborn and the risk of bleeding and infection. In my experience as both a pediatrician and mother, most infants tolerate brief pain (including the pain associated with circumcision).

I also rarely see complications associated with the procedure such as bleeding or inflection. The remaining claims cited against circumcision are simply unsupported by scientific evidence. As for the proponents of circumcision, the AAP’s policy makes it clear that the data supporting the medical benefits are not sufficient to recommend universal circumcision for all males.

In the end, my role as a pediatrician is to offer guidance and to provide unbiased information on the topic so that you (the parent) can make an informed decision. Unless you are bound by your religious beliefs, this may not be an easy decision to make.

Then again nobody said parenting was easy!