You have the choice to accept or decline surgery to remove the foreskin from your son's penis (known as circumcision).
Male infants are born with foreskin fused to the head of their penis. By the time intact (uncircumcised) males reach an early adolescent age, the foreskin will naturally detach itself from the head of the penis, and the foreskin can then be retracted to expose the head of the penis (parents and caretakers of intact babies/children should be advised that retraction of the foreskin should not be done before this natural separation happens on an intact penis because it can be very painful and can cause bleeding, infection, scarring, and other complications)
In circumcised infants, the foreskin is pulled away from the head of the penis and surgically removed.
Below are links and information on the various reasons for keeping infants intact or circumcising, statements of position on circumcision from various agencies, and ethical considerations. There also links for information on how to care for an intact male penis.
How to Care for Your Son's Penis
At the Hospital :Tips for parents who are having their baby at the hospital and plan to keep their son intact.
Overview of the Why / Why Not
Evidence Based Birth recently published their much anticipated article Evidence and Ethics on Circumcision in July 2019. Episode 88 from Evidence Based Birth's podcast summarizes the findings in their article. Here is a link to their podcast. The full-length article and the podcast include a discussion of the following:
- Anatomy and physiology of the prepuce (foreskin)
- The history of circumcision (both ancient history and more recent history)
- Why some parents in the U.S. choose routine circumcision
- Rates of circumcision around the world and in the U.S.
- The circumcision procedure
- Research evidence on proposed benefits and risks
- The opposing views on the ethics of circumcision
- Practice guidelines from around the world
- A summary of the findings
Circumcision - A Guide for Parents published by the Royal Australian College of Physicians is a brochure which has been developed to help parents make an informed decision about circumcision.
The table below gives information from the website of The Mayo Clinic on the various health benefits that circumcision might have. It also gives information and direct links to resources on the realistic scenarios associated with each potential benefit. [If the table does not appear for you, please let me know immediately as the information is very valuable for your decision making process].
The Mayo clinic also notes that:
The risks of not being circumcised, however, are not only rare, but avoidable with proper care of the penis.
Circumcision - Possible Health Benefits
Visit the Mayo Clinic link to learn about possible risks of circumcision, how to prepare for circumcision, and what to expect.
Physical complications as a result of circumcision are generally considered to happen infrequently. The most common of these complications (according to online research) seem to be bleeding, pain, and infection. The Boston Children's Hospital claims to perform more than 300 re-circumcision procedures each year due to circumcisions not being performed correctly and not being done by an experienced team.
The Royal Australian College of Physicians gives the following list of potential harm or risks:
- pain due to the operation (this can be extreme where the right type of pain medication is not used)
- loss of some function of the penis due to complications,
- in some cases psychological harm for the child,
- the ‘violation’ of individual rights – as the child is unable to decide for themselves in regards to their body
Meatal Stenosis is a complication of the penis which occurs mostly from circumcision and is rarely seen in uncircumcised males. In this link, the Urology Care Foundation describes what this complication is, what causes it, and how it is treated.
Stanford Medicine gives a list and description of possible complications of circumcision. It also provides references. This list includes:
- Insufficient Foreskin Removed
- Excessive Foreskin Removed
- Adhesions / Skin Bridges
- Inclusion Cysts
- Abnormal Healing
- Meatal Stenosis
- Urinary Retention
- Urethrocutaneous Fistula
- Necrosis of the Penis
- Amputation of the Glans
There is pressure worldwide and a growing movement within the U.S. to raise questions about the ethics of circumcision. Their belief is that "it is unethical to circumcise babies or children because they cannot consent to it, and because it is not medically necessary. There is no health benefit that warrants the removal of a normal body part that has such important functions." More here.
The psychological effect of the circumcision operation can possibly cause more fear in babies when receiving routine vaccinations. The conclusion of this research article was: "Circumcised infants showed a stronger pain response to subsequent routine vaccination than uncircumcised infants. Among the circumcised group, preoperative treatment with Emla attenuated the pain response to vaccination. We recommend treatment to prevent neonatal circumcision pain." (Emla is a topical cream to prevent pain before certain procedures such as inserting a needle).
What is the Function of Male Foreskin?
- Sorrells et. al. conducted research to map the fine-touch pressure thresholds in adult men, both circumcised and intact. The conclusion of the research was:
The glans [head] of the circumcised penis is less sensitive to fine touch than the glans of the uncircumcised penis. The transitional region from the external to the internal prepuce [foreskin] is the most sensitive region of the uncircumcised penis and more sensitive than the most sensitive region of the circumcised penis. Circumcision ablates [surgically removes] the most sensitive parts of the penis.
- This article (Cold et. al.) gives a detailed description of the role of the foreskin (prepuce).
- The video What is the Function of the Prepuce? gives a description of the function of foreskin (prepuce) and how it develops in males and females. It describes the role the foreskin plays in protecting the urethra and gland. It explains the difference between the type of nerve endings that are found in the foreskin vs the type of nerve endings that are found in the gland (head of the penis). In circumcision, the many clusters of nerves that exist in abundance in the foreskin are removed. It also discusses the role foreskin has in sexual intercourse for both the pleasure of the intact man and of his partner. Even if you are in intact adult male, there is information to learn from this video!
Statistics on Circumcision
Worldwide: In 2007, the World Health Organization estimates that less than 30% of the world's males aged 15+ were circumcised. Using data from 2015, this source estimated that less than 40% of the world population is circumcised.
2017 Graphic. Date range of data used is unknown
In the United States, slightly more than 50% of newborn males are circumcised at the time they are discharged from the hospital. Notice the two graphics below are from data up through 2010.
2017 Graphic. Date range of data used is unknown
Circumcision : What to Expect
Mayo Clinic has an explanation of How to Prepare and What You Can Expect both during and after the procedure.
This information was received from St. Luke's Hospital in regards to circumcision:
- it is performed by the babies doctor
- it is usually done the day you go home
- each doctor has their own method of performing the operation
- lidocaine is injected into the penis, no medication is used afterward for pain management
- you will be instructed to use vasoline in the front of their diaper until their wound is fully healed
- if the baby is struggling with nursing, maybe put off the procedure (the stress of circumcision can impact breastfeeding, which you wouldn't want to do if the baby is already struggling)
- your baby has to have had the Vitamin K shot in order to be circumcised
The authors of the article Circumcision of Neonates and Children without Appropriate Anaesthesia is Unacceptable conclude: "that general anaesthesia is arguably the most reliable way of ensuring adequate anaesthesia, although this may mean deferment of the procedure until the child is older. Local or regional anaesthesia for neonatal circumcision ideally requires a separate skilled anaesthetist (other than the proceduralist) to monitor the patient and intervene if the anaesthesia is inadequate. Topical anaesthesia with lignocaine-prilocaine (EMLA) cream is insufficient."
If you choose to have circumcision performed on your son, it is possible to wait until general anesthesia can be administered and to have the operation performed by a doctor that specializes in medical issues relating to the penis, such as a urologist.
The video The 5-minute Circumcision is an educational video for the medical and nursing profession. It gives an overview of how circumcision is performed and shows the circumcision of a newborn (no sound during this part except music and an overcast voice explaining the procedure). There are multiple different ways that anesthesia might be administered and multiple different ways that circumcision might be performed. This video shows one specific mode of anesthesia and one specific device for circumcision. This video also shows how an infant is placed on a form and strapped onto it so you can understand what an infant will experience during his procedure.
Click video below to play
Statements from Medical Associations
Circumcision Information has a compilation of Statements and policies on circumcision by medical authorities. You can also read below for specific statements from various medical organizations from countries around the world.
Although health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it... It is important that clinicians routinely inform parents of the health benefits and risks of male newborn circumcision in an unbiased and accurate manner.
The American Academy of Pediatrics’ (AAP) Policy Statement and Technical Report on male circumcision has been met with many criticisms (both from within the U.S. and worldwide) as being culturally biased, lacking ethical considerations, and flawed. There are many publications discussing these issues with the AAP statement and technical report on circumcision.
British Medical Association (2019). Excerpts are from the BMA publication Nontherapeutic Male Circumcision (NTMC) of Children Guidance 2019
The BMA considers that the evidence concerning health benefit from NTMC is insufficient for this alone to be a justification for boys undergoing circumcision. (p 11)
The BMA has never taken a position in the debate about the acceptability or otherwise of NTMC. Instead, as with other procedures involving children who lack the capacity to consent, we have made clear that those wishing to authorise the procedure for their children need to demonstrate that it is in the child’s best interests. (p 2)
Canadian Pediatric Society (2018)
While there may be a benefit for some boys in high-risk populations and circumstances where the procedure could be considered for disease reduction or treatment, the Canadian Paediatric Society does not recommend the routine circumcision of every newborn male.
Follow the link to the Canadian Pediatric Society to read their review of the potential benefits of circumcision, the potential risks of circumcision, ethics and legalities of circumcision, as well as their summary and recommendations regarding circumcision.
Danish Medical Association (2016)
“To be circumcised should be an informed, personal choice. It is most consistent with the individual’s right to self-determination that parents not be allowed to make this decision but that it is left up to the individual when he has come of age,” Lise Møller, the chairwoman of the doctors’ association’s ethics board
I was unable to find an English version of the 'Danish Medical Associations policy on circumcision on baby boys without medical indication.' This link is to the English-language news cite, The Local, in Denmark. The New York Times also published an article about it.
Republic of South Africa (2005)
(1) Every child has the right not to be subjected to social, cultural and religious practices which are detrimental to his or her well-being.
(8) Circumcision of male children under the age of 16 is prohibited, except when-
(a) circumcision is performed for religious purposes in accordance with the practices of the religion concerned and in the manner prescribed; or
(b) circumcision is performed for medical reasons on the recommendation of a medical practitioner.
(9) Circumcision of male children older than 16 may only be performed-
(a) if the child has given consent to the circumcision in the prescribed manner;
(b) after proper counselling of the child; and 25
(c) in the manner prescribed
(10) Taking into consideration the child’s age, maturity and stage of development, every male child has the right to refuse circumcision.
Ethical and human rights concerns have been raised regarding elective infant male circumcision because it is recognised that the foreskin has a functional role, the operation is non-therapeutic and the infant is unable to consent.
After reviewing the currently available evidence, the RACP believes that the frequency of diseases modifiable by circumcision, the level of protection offered by circumcision and the complication rates of circumcision do not warrant routine infant circumcision in Australia and New Zealand.
Royal Dutch Medical Association (KNMG) (2010)
There is no convincing evidence that circumcision is useful or necessary in terms of prevention or hygiene. Partly in the light of the complications which can arise during or after circumcision, circumcision is not justifiable except on medical/therapeutic grounds. Insofar as there are medical benefits, such as a possibly reduced risk of HIV infection, it is reasonable to put off circumcision until the age at which
such a risk is relevant and the boy himself can decide about the intervention, or can opt for any available alternatives.
Non-therapeutic circumcision of male minors conflicts with the child’s right to autonomy and physical integrity.
There are good reasons for a legal prohibition of non-therapeutic circumcision of male minors, as exists for female genital mutilation.