Circumcision is one of the oldest medical procedures in the world, a practice involving the removal of the foreskin from the head of the penis. In certain cultures, circumcising male newborns is a standard and widespread practice, while in others, it is very rare. In the United States, just over 70% of all males undergo circumcision surgery. However, for many parents, deciding whether to circumcise their newborn male is a complex choice. This discussion will delve into the evidence regarding the risks and benefits of the procedure, providing insights into factors to consider when making this decision.
Exploring the Pros and Cons of Circumcision
In 2012, the American Academy of Pediatrics issued a policy statement evaluating the medical evidence surrounding circumcision, outlining the following points:
- From a preventative health standpoint, the advantages of circumcision outweigh the associated risks.
- The benefits are substantial enough that insurance companies should include coverage for the procedure.
- However, the health benefits are not compelling enough to endorse routine circumcision for all male newborns.
- The decision regarding circumcision is best left to parents, who should weigh the medical information alongside their personal “religious, ethical, and cultural beliefs and practices.”
Pros of Circumcision
The removal of the foreskin is associated with lower risks of the following medical conditions:
- Urinary Tract Infection (UTI): Particularly in the first few months of life.
- HIV: Relevant in regions with high HIV prevalence, primarily in African countries.
- Sexually Transmitted Infections (STIs): Including herpes and HPV.
- Penile Cancer: The likelihood of penile cancer is reduced after circumcision.
- Inflammatory Conditions of Foreskin: Such as balanitis (inflammation of the penis) and balanoposthitis (inflammation of the penis and foreskin).
Cons of Circumcision
While complications are infrequent, circumcision is not entirely without risks. Potential risks include:
- Bleeding
- Pain
- Infection
- Injury to the penis (a rare complication, estimated at around 4 in 10,000 cases)
Typically, these risks are minimized when employing safe and sterile techniques to prevent infection. To manage pain, healthcare providers may use a numbing cream, a nerve-blocking shot, and/or administer acetaminophen (Tylenol). In the case of premature babies, a nerve-blocking shot is preferred over a numbing cream to avoid skin irritation.
Does Circumcision Decrease or Increase Sexual Pleasure?
The discussion around circumcision often revolves around its potential effects on sexual pleasure. Critics of circumcision argue that the removal of the foreskin, which contains numerous nerve endings, may lead to a reduction in sexual pleasure. Conversely, proponents contend that the nerve endings associated with sexual pleasure are located in the penile shaft, and circumcision does not impact them.
Studies conducted on males who underwent circumcision as adults have yielded conflicting results, adding complexity to the question. Some studies indicate a decrease in sexual pleasure, while others report no change or even an increase in sexual pleasure post-circumcision. A recent meta-analysis suggested that higher-quality studies tended to demonstrate either no change or an improvement in sexual functioning.
What’s the Impact of Circumcision on UTIs and STIs?
In brief, circumcision provides a modest reduction in risk, but the dynamics are not as straightforward as they may appear.
Urinary Tract Infections (UTIs) are relatively uncommon, affecting less than 1% of boys. Circumcision is notably linked to a reduced risk of UTIs in male newborns below 3 months old. However, beyond this age, circumcision status does not influence UTI risk significantly. Approximately 1 UTI is prevented for every 111 male infants circumcised.
Concerning Sexually Transmitted Infections (STIs), the landscape is intricate. Circumcision is effective in reducing the risk of HIV in regions with high prevalence, such as certain African countries. In countries with low HIV rates, like the U.S., the evidence is inconclusive regarding circumcision’s impact on HIV rates. While circumcision lowers transmission for HPV and HSV-2, it does not affect the risk of acquiring chlamydia or gonorrhea.
It’s crucial to note that the most effective preventive measures for these diseases involve practicing safe sex and undergoing regular screening.
Does Circumcision Affect Penis Size?
Uncircumcised (Uncut): The presence of a foreskin may lend a slightly bulkier appearance to your penis when flaccid. However, during an erection, the foreskin retracts and nearly disappears, thus not influencing the perceived size when erect.
Circumcised (Cut): The size of your penis is predominantly determined by your genetic makeup, which dictates the physical expression or phenotype of your penis. Additionally, blood flow to penile tissues plays a role in penis size. The removal of the foreskin, a layer of skin tissue, has no impact on other penile tissues or the erect size of the penis. Nevertheless, it may result in a slightly less substantial appearance when the penis is flaccid.
How to Decide if Circumcision is Right for My Child?
Beyond the health-related aspects discussed earlier, several other factors may play a role in a parent’s decision regarding circumcision for their baby:
- Religious Background: Circumcision holds cultural significance in certain religions, such as Judaism or Islam.
- Cultural Reasons: Some parents may base their decision on cultural norms, desiring their child’s circumcision status to align with the father’s or the majority of boys in the community.
- Parental Agreement: It is essential for both parents to reach a consensus on the decision they make regarding circumcision.
- Safety: Circumcising an infant born prematurely or with specific medical conditions, like bleeding disorders, can be unsafe. In such cases, it is often recommended to postpone circumcision.
The Bottom Line
Opting for circumcision surgery for your child is a personal decision. In Australia, there is no universally right or wrong choice regarding circumcising your male baby. The paramount considerations should revolve around the baby’s health, the safety of the procedure, and complete agreement between the parents. The Medicare rebate is available only for certain conditions. Please discuss this with your surgeon before proceeding.
