BY JAMIE LOBER
Is Circumcision the Right Decision?
You’re pregnant. The baby is a boy. So the debate over the merits of circumcision begins. Even in medical circles, there are differing opinions. We’ll explore here some of the pros and cons. But finally, it comes down to a religious, cultural, or personal decision for the parents. Parents are talking about circumcision and wonder where the truth may lie. “The recommendation is that it is a personal decision and up to the families as to whether or not they want to do it, because right now there is no medical recommendation to do everybody,” said Dr. Jennifer Shu, spokeswoman for the American Academy of Pediatrics—Georgia. While there are clear-cut pros and cons to circumcision, we do not know how long the medical community will remain neutral.
“People are looking at it on an ongoing basis to see if the recommendation might change,” said Dr. Shu. Circumcision, if desired, usually is performed within the first few days of life, often before the newborn is discharged. The decision about having a newborn circumcised usually depends on the parents’ religious beliefs or personal preferences.
Reasons to Circumcise
According to the Merck Manual— the medical bible—the main medical reason for circumcision is to remove an unusually tight foreskin that is obstructing the flow of urine. Although circumcised males also have a lower risk of cancer of the penis and urinary tract infections, these risks can be minimized with proper hygiene and are not by themselves sufficient reasons to perform circumcision, the Manual states.
Some notable pediatricians, such as Dr. William Sears, believe there is never a medical reason to perform circumcision. Yet, for some, circumcision is not up for debate. In the Jewish and Muslim religions, circumcision is a belief. There are also social reasons, such as the parents’ wish for their child to look like his buddies after football practice.
Health-wise, some argue that there are some advantages. “There have been some studies that show that babies who have been circumcised get fewer urinary tract infections in the first year of life, and some research shows there is decreased risk of a man getting cancer of the penis, but both of those are rare to begin with,” said Shu. Some research indicates that males who have been circumcised are less likely to contract HIV, but this argument can be tough to make in the United States. “Through behavior like practicing safe sex, you can cut down your risk of HIV,” said Dr. Bryan Weidner, pediatric surgeon at Georgia Pediatric Surgical Associates.
If the child is healthy with no colds or anything that will increase the risk of the operation, “I want it [the penis] to look good, because the child will look at it the rest of his life and has to stare down at it every time he goes to the bathroom,” stated Weidner.
Reasons not to Circumcise
Any surgery comes with risk. “If your child is over six months, he will probably need general anesthesia, and there is a risk to anybody going to sleep for surgery,” said Weidner. Since the skin is being cut, there is risk of infection, though that is rare. There is also a risk of bleeding severe enough to need to go back to the operating room, which happens about three percent of the time. “There is the risk of damaging the urethra, which is the tube that urine or sperm passes through, and if you cut too deeply you can injure it, which would set up problems,” said Weidner. You can also injure the head of the penis, which is a small structure when you are working on a baby.
A week after the circumcision, you still have to pull back on the residual foreskin or it may try to seal itself down on the penis, and the penis will once again look uncircumcised. “We call it post-circumcision adhesion, so you can get adhesions after surgery where sometimes the skin will come back across the whole gland. Then you have to go back to surgery to get that done,” said Weidner.
Although reported deaths are rare according to Wikipedia, in 2010, Dan Bollinger, Boy’s Health Advisory, estimated a death rate of 9.01 per 100,000, or 117 per year in the United States.
Consider these reasons as well:
•Leave nature alone – whether you believe God created men with a foreskin, or nature simply evolved this way, there must be some reason men have foreskins. Why change something that God/nature has created?
•Sensation and sexual pleasure – the foreskin is filled with nerves, and is therefore extremely sensitive to touch. This enhances sexual pleasure.
•Protects the glans (head) of the penis – the glans is another highly sensitive area. The foreskin protects the glans from constant rubbing and chaffing against clothing that can desensitize it over the years. This preserves sexual pleasure.
•Ethical issues – there are groups of people worldwide, including medical societies, who oppose routine circumcision because they feel it is unethical for a parent to decide to alter the penis of their child without the child’s consent. Parents who are deciding whether or not to circumcise their son may wish to consider the impact this may have in the future if the child decides he wishes he was not circumcised.
If You Decide to Circumcise
There are several healthcare professionals who can do the circumcision:
Most often, it is done at the hospital by a pediatrician or obstetrician. The key is to find somebody who has done a lot of them and feels comfortable with the job. You also want someone who is knowledgeable on how to take care of complications.
How It Is Done
Though there are four to five different ways to circumcise a boy, they all involve removing the excess skin. “On newborns, we do a penile block, which is where we give them anesthetic at the base of the penis which will numb the entire penis,” said Dr. Weidner. Depending on the size of the penis and how the foreskin looks, the doctor chooses the best technique. “The most common way to do it is the free hand technique, where I use a scalpel and some scissors and cut away the skin and sew it back together,” said Weidner. There is also a thing called a Gomco clamp that is used by most obstetricians. “You put a metal shield over the top of the penis, pull the foreskin over the shield and the device clamps down and crushes the skin between it,” said Weidner. There is a low bleeding rate, it makes a nice circumcision, and is fairly safe.
Several devices can be used to circumcise a child. “There is a little ring that goes across the head of the penis, you tie this suture material down on it, and it crushes the skin between the suture and the plastic ring that we call a Plastibell. Then, that falls off in ten to fourteen days,” said Weidner. In the case of a Jewish rabbi, a Mogen clamp is used. “It looks like a big old pair of scissors, where you stretch the foreskin out and cut it off on the eighth day of life,” said Weidner.
Remember that circumcision is not universal. “About ninety percent of Europe does not circumcise,” said Weidner. In Europe, if you are circumcised, you are the one who is different from everybody else; whereas in the United States, if you are not circumcised, you are more likely to be the guy who is different. It is now estimated that around 75% of males in the United States are circumcised. “It is your choice if you want your baby to be circumcised,” Weidner stated. It is important to talk the decision over with your spouse and your doctor and do what is right for your baby. “Thousands of boys get circumcised everyday across the country without any problem, but it is not like getting your ears pierced where you say ‘let’s go to the mall’,” said Weidner.