Are you pregnant and expecting a bouncing baby boy? Maybe you’ve recently had a son. Choosing circumcision is a much-debated topic, but is it good or bad?
People will sit in different camps. For some, it’s a religious or cultural necessity, and for others, it’s a matter of choice. So how do you decide what is best for your child?
We will give you a complete overview of the reasons why circumcision takes place and what the benefits and risks are. We’ll also look at the procedure and what to expect after it’s been done.
What Is Circumcision?
Circumcision is a surgical procedure which removes the piece of the skin that covers the tip of the penis. It’s a common procedure in many countries, including the U.S. It’s performed on a baby boy, often when he’s a newborn, usually before he is 10 days old.
The procedure takes about 10 minutes and a local anesthetic is applied. A plastic ring is put on the penis and what we call the foreskin is removed. The procedure is similar for older boys and men but is usually carried out under general anesthesia.
Why People Circumcise Their Sons
Circumcision is common in many countries. Before we look at reasons for male circumcision, let’s see what the statistics are in the U.S. and elsewhere in the world. Globally, it’s thought that an estimated 37 percent of males are circumcised (1).
- United States: In the United States, about 70 percent of males have undergone this procedure. This varies between the different U.S. regions. The highest prevalence of circumcision at birth is in the Midwest at about 70 percent, and Northeast just under that. Lower figures are reported elsewhere, down to just over 55 percent in the South and 35 percent in the West. The trend for circumcision rose during the 90s and then started dropping at the turn of the millennium. It has risen again slightly in recent years (2).
- Canada: The rate for circumcision in Canada is much lower, at about 31 percent. Again this varies in different parts of the country. Labrador and Newfoundland have close to zero and Alberta is at 44 percent (3).
- Asia: Most of Asia also has low circumcision rates, with the exception of those who circumcise for religious reasons. These include Israel, the Philippines, Malaysia, the United Arab Emirates, and Saudi Arabia, to name a few. The prevalence in these particular countries is high, at more than 90 percent.
- Africa: Africa has a high prevalence in some areas. In the North for religious reasons, and Central Africa for cultural reasons as part of tribal rituals, the figures are over 90 percent. The overall percentage for the continent is about 62 percent.
- Europe: Europe has on average less than 20 percent of males circumcised.
- Australia and New Zealand: Circumcision was quite popular in Australia in the 1950s, reaching about 80 percent. However, in recent years it has dropped to around 26 percent (4). New Zealand, like Europe has less than 20 percent of males circumcised.
Now, it’s time to find out what the reasons are for people having their babies circumcised.
- Religion: Followers of Islam and Judaism perform circumcision on their male children. For Jews, known as “brit milah,” it is usually done when they are eight days old as part of a religious ceremony. For Muslims, known as “Khitan,” it is generally performed in infancy, but sometimes at puberty (5).
- Culture: Some African and Aboriginal groups, as well as Aztecs, Mayans, and some other cultures, circumcise boys as part of tribal rituals. It is done to denote a passage into manhood (6).
- The desire to conform: Some get their infants circumcised so they don’t appear different from their father. Others, where circumcision is done as a teen, do it so they don’t look different from their peers.
- Aesthetic preference: Some might think the penis looks better without the foreskin and circumcise for this reason.
There are also health reasons why parents might choose to circumcise their son or why it has to be done later in life. These include:
- Hygiene: A circumcised penis is easier to clean than one that is intact.
- Less risk of urinary tract infection: Although this is not a common complaint in males, it is lower in those that are circumcised.
- Decreased risk of sexually transmitted diseases: Infection from diseases of this nature, including HIV, is lowered. It does not prevent them, however, and safe sex should still be practiced.
- Less risk of penile cancer: The risk of cancer of this nature is lower when the penis is circumcised (7).
The following health conditions can happen in both children and adults:
- Balanitis: This infection of the glans area of the penis can cause swelling of the foreskin and require circumcision (8).
- Balanoposthitis: This condition only occurs in intact males. It presents as a red, swollen painful glans and foreskin with a foul discharge. It can cause scar tissue and tighten the foreskin (9).
- Phimosis: This condition means the foreskin cannot be retracted over the glans (10).
- Paraphimosis: This happens when a retracted foreskin cannot be moved back over the glans. It can cause a restrictive band around the penis and needs to be dealt with as a medical emergency. One of the treatments for this is circumcision (11).
What Are the Benefits of Circumcision?
There are benefits to health which can be gained from circumcision. We have touched on some of them briefly, so let’s delve a little deeper.
1. Reduced Risk of Urinary Tract Infection
Intact boys under one year old are between 10 and 20 times more likely to get a urinary tract infection. It is one of the most common reasons discussed when parents decide whether to get their son circumcised (12).
These infections are caused by bacteria which collect and colonize near the entrance to the urethra. These organisms, like E. coli and Klebsiella, are more likely to be found in higher concentrations when a foreskin is present. This is especially the case in infants under six months old (13).
While the risk is low, these types of infection, particularly when they are recurrent, can lead to kidney problems later in life (14).
Circumcision does not eliminate the risk of urinary tract infections but significantly lowers it.
The overall risk of urinary tract infection in men is still low. For example, for infants 0 to 1 years old, the risk of an intact male getting a UTI is 1.3%, while a circumcised male is only 0.3%. That difference is very small between the two. (15)
Editor's Note:Caitlin Goodwin, MSN, RN, CNM
2. Reduced Risk of Penile Cancer
It’s worth noting this type of cancer is rare. Studies estimate that about 2,320 men were diagnosed with penile cancer in the U.S. in 2018 (16).
There are several risk factors for this cancer, which include HPV infection, smoking, age, HIV, and some psoriasis treatments. The other two risk factors that come into play in respect of circumcision are smegma and phimosis (17).
Smegma is a build-up of skin cells, oily skin secretions, and bacteria under the foreskin. It’s a thick substance which, if not cleaned properly, can irritate the penis. It also contains some small amounts of substances which can cause cancer.
Phimosis, as we have mentioned, means you can’t retract the foreskin easily. In turn, you then won’t be able to clean the penis properly and smegma can build up.
While circumcision cannot completely prevent penile cancer, it lowers your risk. It makes it easier to keep the penis clean, as smegma cannot be trapped and build up (18).
3. Reduced Risk of STDs and HIV
Circumcision can reduce the risk of some sexually transmitted diseases. One of these is the human papillomavirus or HPV. This virus can cause genital warts and cancer (19).
There are also indications male circumcision can help prevent HPV from causing cervical cancer in women (20).
There is less likelihood of a circumcised male contracting gonorrhea or syphilis (21).
In the case of HIV, reports from the World Health Organization indicate circumcision can reduce the risk by up to 60 percent (22).
On the inside of the foreskin, Langerhans cells, which prevent threats from entering our body through the skin, are close to the surface. It is thought that viruses, like HIV, can enter our system by attaching to these cells. When the foreskin is removed, the skin on the glans is thicker and does not allow passage of the virus as easily.
4. Easier to Keep Genital Area Clean
Cleaning a penis which has been circumcised simply means washing it daily in warm water. When a foreskin enters the equation, it’s a little more involved.
The foreskin needs to be gently retracted to ensure it is cleaned underneath. If this isn’t done, then smegma can build up and bacteria can breed. The result could be the redness and swelling we have mentioned, called balanitis (23).
In infants, the foreskin cannot and should not retract and you should simply clean it with soap and water. Don’t be tempted to try to clean underneath with cotton swabs. You can cause significant issues by retracting it too early. More than 90% of children can retract their foreskins by age 5 years old, but you should never force it. The foreskin should retract by puberty.
As your child gets older, the foreskin becomes detached from the glans and can be retracted gently. You will need to teach your little one how to clean it properly (24).
5. Prevention of Certain Medical Conditions
The medical conditions we highlighted earlier — balanoposthitis, phimosis, and paraphimosis — can be eliminated through circumcision.
In the case of balanitis, the chances of contracting it are far less once a boy has been circumcised (25).
The Drawbacks Associated with Circumcision
Circumcision is not all clear sailing. As well as the pros, there are also some cons to circumcision. To give you a full picture, let’s detail some of them.
1. Changes to the Natural Appearance of the Genitals
There are many controversies associated with infantile circumcision. One of these is the school of thought that the foreskin is there for a purpose. It is part of the male anatomy when they are born, formed as nature intended.
Cutting this off is viewed by some as deforming the natural appearance of the genitals (26).
2. Is Circumcision Unethical?
This is another controversial topic in respect to circumcision. Many see circumcision of an infant as unethical and a violation of their right to choose. The decision is made for them, whether this is for religious or cultural reasons, or just the wishes of their parents.
Some feel that unless it is medically necessary, then circumcision should be left until a boy is old enough to make his own informed decision.
There are even some people who believe it goes against the ethics of doctors to perform this procedure. They see it as unnecessary and believe that doctors should protect a child from such a procedure (27).
3. Circumcision Can Be Painful
Let’s be honest, as a new mom, the last thing you want to do is put your little one through a painful surgical procedure. When you weigh the pros and cons, this is a factor to take into account.
One study in Canada was set up to find out which anesthesia was best for performing circumcision. To do this, they needed a control group that had no anesthesia. The doctors and surgical assistants recognized which babies were anesthetized and which weren’t, due to their reactions to the procedure.
While the study recommends the use of anesthesia, the trial was stopped sooner than planned, due to the obvious difference in the babies’ reactions.
4. Risks Associated With Procedure
While circumcision is a straightforward procedure and is regularly completed by many doctors, it is not without risks.
About 35 percent of babies can hemorrhage after the operation. This bleeding is associated more with babies who are circumcised at three months or older. It seems the best time for circumcision to avoid excess bleeding is during the first four weeks of life (28).
Wound infection can also affect about 10 percent of baby boys after this surgery. The risk of infection is likely to be higher when circumcision is performed by untrained people, including unqualified nurses, physicians, or religious leaders.
Infections include streptococcal and staphylococcal infections, abscesses, and cellulitis. For this reason, the procedure should be carried out by a trained professional under sterile conditions (29).
Meatitis is inflammation in the urinary tract and can manifest in about eight to 20 percent of circumcisions. It is caused by exposure to the ammonia in urine-saturated diapers (30).
5. Health Benefits Are Not Immediate
Of the many health benefits that circumcision offers, few of these will apply while your child is still small.
One of the immediate advantages is the ease of keeping the penis clean. The other, the slight reduction in risk for urinary tract infections. The other medical conditions are not present in babies and therefore don’t make any difference at this stage of their lives.
Is Circumcision Necessary?
Circumcision is a choice that you as parents will make on behalf of your child. The American Academy of Pediatrics (AAP) advocates that there are many health benefits to performing circumcision on newborns. Nevertheless, although the benefits outweigh the risks, they don’t recommend it as a matter of course for all boys.
When performed under proper sterile conditions with the right anesthetic, it’s a well-tolerated procedure. Circumcision on a newborn has fewer complications than when it is done later in a child’s or man’s life. When there are any complications, they are generally minor.
Circumcision is not mandatory for all newborn males. The decision rests with the parents who make an informed choice on their child’s behalf (31).
Your doctor can advise you of the benefits and risks that apply to your child. You are entitled to make a choice taking into account your own religious, ethical, and cultural beliefs.
There are occasions when circumcision is necessary for medical reasons. For example, some boys are born with the meatus or opening through which they pee, in the wrong position. This is called hypospadias.
Circumcision is one of the treatments for this condition, possibly accompanied by surgery to reconstruct the penis, if necessary (32).
What Happens If I Approve Circumcision?
Once your decision has been made, and you consent to your baby being circumcised, you will want to know what the procedure entails. We will detail this for newborns and older males so you can decide whether immediate circumcision is right for your baby.
The Procedure for Newborn Babies
Circumcision is a common procedure, which will generally be done before your baby is two days old and is still in the hospital. For people of Jewish faith, it’s performed at home as part of a special ceremony, at eight days old.
The procedure removes the foreskin of the penis and leaves the glans exposed. The procedure is quick, taking about 15 minutes, and there is little bleeding. Stitches are not usually required.
We have mentioned that babies are generally circumcised within the first two days following birth. However, if there are any medical conditions which need to be taken into account, it can be delayed. Your neonatologist or pediatrician will be able to advise you accordingly.
If they give the go-ahead, then the doctor operating will inform you of the exact procedure, risks, and aftercare. They will likely ask if there is any family history of medical disorders, like hemophilia, which interfere with blood clotting. Remember, if you don’t understand anything, ask for an explanation.
Once you are fully informed and comfortable with all the information, you will need to sign a consent form. This gives permission for the procedure to be carried out and states that you understand what will happen and the risks that are involved.
The procedure can be done in the treatment room of the nursery at the hospital. You might choose to stay with your baby, or maybe wait in the hospital roomuntil it’s over. Just tell your doctor if you want to be in the room.
Baby is usually awake throughout the procedure. He will be placed into a molded seat or firm surface called a “papoose board.” This has velcro straps to secure his legs and arms to keep him still.
The penis and surrounding area will be thoroughly cleansed with antiseptic. An anesthetic will then be administered.
To Help With Pain
Your baby may also be given a pacifier which has been dipped in sugar water. This can reduce discomfort and stress. They could take acetaminophen to help further relieve pain.
Discuss with your doctor what pain relief will be administered before the procedure commences, so you know what’s happening.
There are three common types of circumcision techniques for newborns, which are:
- The Gomco clamp: After a probe is used to separate the foreskin from the penis, this special instrument fits over the head of the penis. It is bell-shaped and slides under the foreskin. The skin is then pulled up and clamped to reduce blood flow before a scalpel is used to remove the foreskin (33).
- The Mogen clamp: This again involves a probe separating the foreskin, which is then pulled out in front of the head of the penis. The clamp has a slot in it, through which the foreskin is inserted. It is then cut with a scalpel and the clamp is held in place for a few minutes to make sure the bleeding has stopped (34).
- The Plastibell technique: This method also uses a probe for separating the foreskin, and a bell-shaped device to place over the head of the penis. The device has a groove in a ring over which a suture is tied, holding the foreskin in place. The foreskin is removed and the top of the device detached, leaving a plastic ring in place – this will fall off in about seven to 10 days (35).
Circumcision for Older Children or Adults
The male will be admitted to the hospital as a day patient where they will meet the anesthetist and the medical team. They will explain everything that will happen.
Consent forms will again be signed stating either that you, or you as a parent and your child, know what the procedure entails. This confirms you agree to the surgery. This is a good time to ask the doctor about anything you’re unsure of.
As an adult, this procedure will be done either under a general anesthetic, spinal block, or local anesthetic injection. This means you won’t be able to feel the surgery when it’s being carried out.
The foreskin will be removed at the base of the head of the penis. The edges of the skin will be sutured together with dissolvable stitches.
Recovery usually takes about ten days, and you should not have sex for about four weeks. You might experience discomfort and swelling in the first few days. Petroleum jelly applied to the head of the penis can stop it from sticking to your clothing (36).
Dealing with the Aftermath for Infants
Undoubtedly, you will be concerned about how to care for your baby following this surgery. The aftercare is quite straightforward — the main focus is on keeping the penis clean.
Following surgery for circumcision on a newborn, petroleum ointment will be applied over the wound and it will be wrapped in gauze. This will stop it from sticking to their diaper. If the circumcision was done using the Plastibell, then no dressing is necessary.
There is little or no bleeding following this procedure. There might be small amounts which will be visible on your baby’s diaper, but this should stop on its own.
If a dressing has been used, you will need to change this for a fresh one when you change their diaper. Dab the penis with petroleum jelly each time to stop the dressing from sticking.
After a few days, a dressing should no longer be needed. Continuing with the petroleum jelly will help prevent the penis from sticking to the diaper or rubbing and causing discomfort.
Double diapering might help stop the baby’s legs from pressing against the penis and make him more comfortable. The healing process usually takes between 7-10 days.
Signs of a Problem After Circumcision
The head of the penis might appear a bit yellowish and raw. However, if you notice any of the following symptoms, you should contact your doctor (37).
- Bleeding which is persistent.
- Swelling or redness around the top of the penis which gets worse over time.
- Discharge from the tip of the penis which smells, or sores on the penis, indicating infection.
- Increased temperature, indicating fever.
- Not urinating 12 hours after the surgery is complete.
- The plastic ring does not fall off within two weeks if one is in place.
- Continued fussiness in babies, or complaints of pain from older boys.
What If I Decide Against Circumcision?
Deciding to have a newborn circumcised will likely be the first medical one you have to make for your child. While it was common in the past for babies to be circumcised as a matter of course, this is no longer the case.
Unless there is a medical reason for circumcision, then it’s your right to choose. The procedure seems to be less traumatizing for a newborn. Despite that, you might feel your boy has a right to choose for himself when he is older.
There are health benefits associated with circumcision that can still be prevented by following good hygiene practices. There is a notion that intact penises are dirty, but this is not the case. Still, it’s important to instill good hygiene at an early age and practice this yourself.
In an intact baby, the foreskin is attached and covers the head of his penis. All you need to do is keep it clean by washing with warm water and a non-irritating soap when you bathe him. Make sure you wipe it during diaper changes. Simply put, clean the penis like you would clean your finger.
Keep an eye on the foreskin and consult a doctor if your baby seems to have problems urinating. Other causes for concern are ballooning under the foreskin during urination, and redness, swelling, or itching.
As your little boy grows, the foreskin will separate from the tip of the penis on its own. When this happens, it can be pulled back. At this point, you need to teach your child to clean beneath the foreskin regularly.
Show him how to gently pull the foreskin back from the head of the penis. He should be encouraged to clean beneath it with warm water and mild soap. The head of the penis should be dried thoroughly before the foreskin is pulled back over it.
Good practices taught at this early age should be carried through into adult life (38).
It’s Your Decision
The decision to allow circumcision on your newborn lies with you, his parents. There is no right or wrong choice — it’s a matter of personal preference.
Circumcision is a common procedure, but with some risks. There are health benefits associated with circumcision that can as easily be gained by practicing good hygiene.
For medical reasons, whether as a baby or later in a boy’s life, there could be a time when circumcision is necessary.
We hope you found this guide useful and informative. Whether you end up choosing circumcision or not, we would love to hear your insights and thoughts. Please leave us a comment and don’t forget to share this article with other soon-to-be moms.