Circumcision/Intact: Considerations

by Pregnancy.org Staff

Recent policy statements issued by professional societies representing Australian, British, Canadian, and American pediatricians do not recommend routine circumcision of male newborns.

What is circumcision?

Circumcision involves surgical removal of the foreskin that shields the head of the penis. The foreskin (prepuce) is the movable fold of skin on the distal portion of the penis. It forms half or more of the penile skin system.

What is the function of the forskin?

The foreskin has three known functions:

  1. Protection: The foreskin covers and protects the urinary opening, keeping the urinary tract sterile, and the glans (head) of the penis, keeping the mucous membrane soft, moist, and sensitive.
  2. Sensory: The foreskin contains 20-40,000 highly specialized, erogenous nerves that allow a male to know what his penis is feeling and where he is in relation to the orgasmic trigger. These specialized nerves are concentrated in the ridged band encircling the foreskin's opening.
  3. Sexual: The foreskin provides the tissue necessary for a full erection and the gliding mechanism necessary for normal sexual function. The ridged band turns inside out with intercourse, exposing the concentrated sensory nerve endings.

How common is circumcision?

Worldwide, about 12% of males are circumcised. In 1999, the neonatal circumcision rate in the United States was 65%; in the western states, 37%. Current polls indicate that about 50% of baby boys are circumcised in the first few days or weeks after birth. Some parents choose to circumcise because it's an important and religious ritual while others choose to circumcise because they have heard it's better from the standpoint of hygiene and health.

Making a decision

Question about medical benefits
A recent review by the American Academy of Pediatrics looked at all the data from the past decades to see if there were any medical benefits. Their conclusion -- data does not demonstrate sufficient reason to recommend routine neonatal circumcision. In Canada, circumcision has been ruled not medically justified. A position statement on circumcision, released in 1996 by the Canadian Pediatric Society and reaffirmed in 2003, recommended that circumcision of newborns should not be routinely performed.

In the past, there were studies backed by the medical profession that listed certain benefits for circumcision. In recent years, however, many of these have been further scrutinized. A few examples include:

  • Cleanliness -- An intact penis is not less sanitary than a circumcised penis, nor is it more difficult to clean. Only the outside of the foreskin needs to be cleaned during the first year (or longer). Read Cleaning the penis with intact foreskin.

  • Decreased risk of STD's -- Behavioral factors have been found to be far more important than circumcision status when it comes to the risk of STD infection.

  • Penile cancer -- Penile cancer occurs in 0.9 to 1 males in every 100,000 in the United States. There is a slightly lower rate of penile cancer in circumcised male (approximated 1:100,000 to 3:100,000). However, risk factors such as genital warts, HPV, multiple sex partners and cigarette smoking may play a large role in causing penile cancer.

  • Avoiding infections in the foreskin -- It is true, occasionally intact foreskins get irritated. This is easily treated with warms soaks and washing. Rarely, the irritated foreskin becomes infected, requiring antibiotics, but it is easily treatable.

  • Avoiding the need to do it later on -- Most complication involving foreskin can be resolved without surgical intervention. Very rarely, someone has a problem with recurrent infections in the foreskin that need antibiotic treatment. Some of these men may need to be circumcised in an operating room under general anesthesia.

  • Avoiding bladder infections -- Urinary tract infections seem to be slightly less common in circumcised babies (the rates of UTI are low in both groups -- a recent population-based study found a relative risk of 3.7 for hospitalization for UTI in the first year of life in uncircumcised boys). They are easily treated with antibiotics. After age one, circumcision status ceases to affect UTI rates.

  • Decreasing risk of sexually transmitted diseases -- In general, circumcised individuals appear to have somewhat lower susceptibility to STD's. According to the AMA Policy Statement, "behavioral factors are far more important risk factors for acquisition of HIV and other sexually transmissible diseases than circumcision status, and circumcision cannot be responsibly viewed as "protecting" against such infections."

Religious Reasons
Some people choose to circumcise for religious or cultural reasons.

Teasing
While an intact child may have been teased in the U.S. decades ago, the truth is that your uncircumcised son will be in good company in the locker room when he is a teenager. Today, the circumcision rate is less than 60% nationally and less than 35% in the western states. Parents don't need to worry about children being different in the locker room because there will be both circumcised and intact boys.

Penis Care
Some people think that an intact penis is too much trouble to clean, especially during childhood. The uncircumcised penis is easy to keep clean. No special care is required! No attempt should be made to forcibly retract the foreskin. There is no need for special cleansing with Q-tips, irrigation, or antiseptics; soap and water externally will suffice.

Look Like Dad
With today's looser circumcision, boys may not necessarily look like their Daddies. The main difference a young child will likely notice between him and dad is the hair. When he is old enough, you can explain.

Risks of circumcision

Problems from the surgery are usually minor. Although serious complications are rare, they do occur. Newborn circumcision has been associated with surgical mistakes, such as having too much skin removed.

Of every 1,000 boys who are circumcised:

  • 20 to 30 will have a surgical complication, such as too much bleeding or infection in the area
  • 2 to 3 will have a more serious complication that needs more treatment. Examples include having too much skin removed or more serious bleeding
  • 2 will be admitted to hospital for a urinary tract infection (UTI) before they are one year old
  • About 10 babies may need to have the circumcision done again because of a poor result

In rare cases, pain relief methods and medicines can cause side effects and complications. Read Circumcision: Information for parents, (CPS).

Summary

When making this decision, ask yourself, "Do I have any good reason to circumcise my baby?" If your answer is for religious reasons, then follow your faith. If not, and you can't think of any other significant reason, then consider the above information as you make your decision. Editor's note: If you chose to circumcise your baby, insist on proper pain relief measures.

Resources:
Care of the Uncircumcised Penis: Guidelines for Parents (pamphlet). Elk Grove Village, IL: American Academy of Pediatrics, 1984.
Trends in circumcisions among newborns, National Center for Health Statistics; February 08,2005
Dickey, Nancy W. M.D., "To Circumcise or Not to Circumcise ... Many Parents Are Asking the Question". Medem.com; 2002

Peron JE. "Care of the intact penis". Midwifery Today (November) 1991; Issue 17:24
Milne, Celia, "Weighing the foreskin's value: New studies suggest the foreskin is more sexually important than once thought". The Medical Post.com (January 09) 2001; Volume 37 Issue 01

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