WHAT TO DO ABOUT CIRCUMCISION
My male friend Emilio was circumcised as an adult.
He grew up in South America where circumcision was not widely practiced. As a child, he suffered from numerous infections of the foreskin. As an adult, the scar tissue from the infections grew too much to bear, and he decided to undergo the procedure at age 28. He underwent general anesthesia and had stitches in his penis for two weeks. He says it was the one of the most painful things he has gone through, but is so happy he finally did it.
When one of my new moms finds out she is having a boy, one of the first questions she asks me is whether or not she should have him circumcised. I perform circumcisions, but am often puzzled how this became the job of an OB. I am not a pediatrician or urologist, and I certainly don’t take care of men, yet this procedure has become part in my practice.
Circumcision has been performed for thousands of years, with some of the earliest documented cases in ancient Egypt in 2000 BC. It is unclear if it began as a religious practice, a rite of passage, or as an aid to hygiene. In the modern era, it has continued as a tradition. However, fewer patients are making the choice to circumcise. In the United States, the rate of circumcision in 1999 was 62%. In 2008, it was 56%. There are great regional differences as well. According to the National Hospital Discharge Survey, in the Midwest, nearly 80% of boys undergo the procedure, while the rate is 60% in the Northeast, 30% in the South, and only 20% in the West.
Many of our patients ask if it is “recommended”. The American Academy of Pediatrics issued their statement on circumcision in 1999 saying “While there are potential medical benefits to newborn circumcision, the data is not sufficient to recommend it routinely.” One contributing factor to lower circumcision rates is that many insurance plans and Medicaid stopped paying for the procedure after the pediatrician statement.
The main risks of not circumcising are related to infection. The chance of a baby boy developing a urinary tract infection is 12 times higher if he is not circumcised. Later in life, the risks of contracting STD’s are higher is uncircumcised men. Circumcision decreases the risk of contracting herpes by 27%, HPV by 35%, and HIV by 50-60%.
Overall, the risk associated with the procedure itself is minor. As a newborn, it is performed under local anesthesia, takes less than 5 minutes, and carries less than a 1% risk of bleeding and infection. However, some people assert circumcision causes negative effects on sexual function as well as potential psychological problems. Obviously, these problems are difficult to document. My friend Emilio, who is the only person I know who was sexually active before and after a circumcision, insists that sexual function is exactly the same. And psychologically, he is the same as well.
Ultimately, to circumcise or not to circumcise? I think it is a personal choice, and greatly a cosmetic one. I agree with the pediatricians who say the evidence is not strong enough to issue a blanket statement that all boys should be circumcised. Yet, their statement was issued in 1999, before scientists had the data on the decreased risk of STD’s. Unlike years ago, if your son isn’t circumcised, he won’t be the only one. I offer one bit of advice to my patients who are truly on the fence and can’t decided: Have your son look like his father.
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