A few weeks ago, I attended the national conference for the American Academy of Pediatrics. It was a positive experience with many “friendly pediatricians” (as we are often called) wandering the conference center drinking insane amounts of Starbucks with their cell phones encased in colorful cases. Throughout the day, I glanced out the south end of the building and watched as 20-30 people picketed against circumcision. I tried to avoid that group because I was not interested in their negative energy. Circumcision is always a source of controversy just like the vaccine debate. As pediatricians we aim to be mindful of both perspectives. It is a personal decision impacted by ethical, religious, scientific and emotional beliefs. Here is some unbiased information for you to ponder.
The Amercian Academy of Pediatrics (AAP) policy statement published in 2012, states that “the health benefits of newborn male circumcision outweigh the risks.” then, “the procedure’s benefits justify access to this procedure for families who choose it,” and later “health benefits are not great enough to recommend routine circumcision.” Well that doesn’t make it easy to make this decision if you have a boy now does it? So, it basically says the good outweighs the bad, but there’s not enough good for the AAP to recommend circumcision. Where does that leave parents of males in the US with regard to this decision? …caught somewhere in between the social norms, religious beliefs, scientific studies and the desire to make the “right” decision for their child.
The Negatives (b/c I’d like to end this blog on a positive note)
Male circumcision is a surgical procedure. Albiet a minor one, the risks are still real. There can be bleeding, disfigurement of the penis, infection and pain. Studies show that newborns who are circumcised have high heart rates, elevated blood pressures and high cortisol levels (stress hormones) during and following the procedure. Therefore, it is standard practice to use a local anesthetic as well as another method of pain control (lollipop for comfort? pacifier?). Excessive bleeding can occur, particularly if there is an unknown bleeding disorder, but also in normal, healthy newborns. It is usually minor and easily controlled with simple measures. Infection is always possible, but the procedure is done following strict, sterile precautions. Then there is the ethical point that the newborn cannot verbalize consent. Consider though that performing a circumcision after 1-2 months old or years later is more risky and more painful. It usually requires general anesthesia, incurs a higher cost and has a higher risk of complications. Circumcision is not usually covered by insurance unless medically indicated (rarely the case). Circumcisions can be costly (over $200). Paying cash upfront is normally required. Lastly, it is not guaranteed that a circumcision will end with the desired cosmetic effect. Some physicians remove less foreskin than others which can result in excess foreskin.
According to the CDC website, these are some conditions which may occur in uncircumcised males at higher rates:
• Urinary tract infection
• Penile inflammation (swelling)
• Candidiasis (yeast infection)
• Phimosis and paraphimosis (where the retracted foreskin gets stuck)
• Inferior hygiene (can result in a collection of smegma or dead skin cells)
• Sexually transmitted infections including high-risk human papillomavirus (HPV), genital herpes simplex virus (HSV), trichomoniasis, mycoplasma, syphilis, chancroid, and HIV
• Physical injuries to the foreskin, including coital injuries
• Cancers of the penis, prostate, and cervix
While some of these are rare, others can be recurrent issues for some boys/ men. A circumcision can make the above less likely. Some believe that it is easier to keep a circumcised penis clean, however, good hygiene is possible in an uncircumcised male. Regardless, care should be taken to gently pull back the foreskin when bathing. Eventually it will be easily retracted although this can take years.
So, as pediatricians, we strive to “do no harm” when caring for our patients. Unfortunately, there are some situations where we can only educate parents on the facts, debunk the myths and share our experiences. We can tell you with honesty what we would choose for our own children as far as vaccination, circumcision, medication choices, etc. We realize that these are ultimately your decisions. Just remember that trust is a vital part of any relationship. We trust our parents because they know their children better than we do. We aim for our parents to trust us and the information we provide as pediatricians.
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