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Deciding Whether or Not to Circumcise Your Son
U.S. circumcision rates are on the decline. Why? Here's a look at the pros, cons and future of circumcision in our country as parents weigh out the decision.
Choosing whether to circumcise a newborn male for non-religious reasons can unleash plenty of fears, ethical quandaries and conflicting feelings for parents. But in recent years, more moms and dads are opting not to circumcise – particularly in the western part of the country and states where Medicaid does not cover the cost of the procedure.
Trend changes
Specific stats on circumcision rates vary a bit. But one thing seems clear: In the United States, they've been on the decline, particularly in the last decade. One well-publicized 2010 report noted a steep drop from around 56 percent in 2006 to about 33 percent just three years later. The actual rate may still be closer 55 percent, according to sources cited by the Centers for Disease Control and Prevention. Still, that's definitely a nosedive from a peak as high as 85 percent in the 1960s.
Yet the tradition still holds up – and was reinforced by the American Academy of Pediatrics in 2012. In a new policy statement, it noted that the "health benefits of newborn male circumcision outweigh the risks" and "the procedure's benefits justify access to this procedure for families who choose it." Previously, its 1999 statement was more neutral, noting the potential medical benefits weren't sufficient to recommend it and advising the use of pain medication.
The newer policy may spark a reverse trend – and many parents still opt to circumcise, whether because dad was or simply because their insurance covers it. But it seems many parents across the country have indeed been reconsidering whether the procedure is necessary.
Making the decision
Parents considering circumcision should discuss it at length before the baby is born, recommends Clinton Township pediatrician Elaine Byers.
"It's really not medically necessary, so it comes down to religious or personal preferences of the parents," she says.
Few medical societies outright recommend routine infant circumcision; actually, some European medical societies recommend against it. And more than 80 percent of the males in the world are uncircumcised. Still, advocates say it results in fewer urinary tract infections, a potentially lower incidence of sexually transmitted disease and prevention of penile cancer.
Medical details
Here is some information surrounding these and other factors in the circumcision debate, much of which is from the American Medical Association (AMA) policies on the medical aspects of circumcision.
- Urinary tract infections: "There is little doubt that the uncircumcised infant is at higher risk for urinary tract infection (UTI), although the magnitude of this risk is debatable," states the AMA. UTIs can be up to 12 times as common in uncircumcised boys during the first year.
- Sexually transmitted diseases: Some studies show that circumcised males have a lower risk of syphilis and HIV, but many of these studies were done in Africa, so it is difficult to relate these results in developing countries to proven protective effects in the United States. The best prevention for STDs is safe sex – whether a man is circumcised or not.
- Penile cancer: The incidence of penile cancer is extremely low, accounting for only 0.2 percent of cancers in men and 0.1 percent of cancer deaths in men in the United States. Other factors like hygiene, family history and sexual history are more significant.
- Cleanliness: A thick white substance called smegma can accumulate under the foreskin and sometimes cause inflammation, but this is not common.
The takeaway
Like any surgery, circumcision requires anesthesia and carries risks such as bleeding, infection and surgical errors.
Byers says circumcision techniques can vary depending on the obstetrician. She also has noticed a decline in the numbers of parents choosing circumcision, but says the change seems partly due to cultural norms.
"Certain cultures, like Hispanics, don't tend to circumcise their children, and as we see an increase in these cultures, the rate of circumcision goes down," she says.
As a practicing Ob/Gyn, performing male infant circumcision procedures, I fully respect the AAP's position, holding that 'the health benefits of newborn male circumcision outweigh the risks, but the benefits are not great enough to recommend universal newborn circumcision'...as well as the parent's right to choose. With respect to the data presented on percentages of circs performed nationally, whether for traditional/cultural, 'cosmetic' or perceived medical benefit, more than 95 percent of the parents in our suburban, Metro Detroit practice, at this time, are still choosing the procedure.