You’re having a baby boy. Congratulations! You’ve probably already picked out a name, gotten the nursery ready and your hospital bag is packed. However, there may be one thing you have not decided: Will you circumcise your baby boy?
This is a very personal decision, obviously, and the choice may have religious or health reasons behind it. We asked pediatric urologist Hiep Nguyen, MD, to help explain what the procedure is, when it should be done and what the health benefits of having it done might be.
What is circumcision?
Circumcision is an elective procedure to remove the skin, called the foreskin, covering the head, or glans, of the penis. Parents choose to have this done for a variety of reasons, including cultural, religious, social, hygienic and health reasons.
Circumcision can be done at any age, but Dr. Nguyen notes that younger patients have a quicker recovery time. The other advantage of having the circumcision done before 1 month of age is if can be done in office and under local anesthesia. Doctors perform circumcision on older children under general anesthesia, but the lower-age cut off is 3 to 4 months because of the risk of general anesthesia.
The procedure itself takes between 15 and 45 minutes for newborns with local anesthesia, and with general anesthesia, it takes from 30 minutes to 1 hour.
What are the benefits of circumcision?
Dr. Nguyen notes the benefits of circumcision include reduced risks for:
- Urinary tract infections (UTI) in young children
- Specific STDs, such as HIV, HPV, syphilis and herpes
- Balanitis, an inflammation of the glans
- Penile cancer
“However, how much reduction in risk may be more important than whether it does or does not reduce the risk.” Dr. Nguyen said. “For example, a reduction of UTI is from 1.1% to 0.1%. Whether a difference of 1% is enough to recommend routine circumcision remains a debate and is dependent on personal interpretation.”
Research from the American Academy of Pediatrics shows that circumcised men have:
- 28% to 34% fewer cases of herpes simplex virus type 2.
- A 30% to 40% reduction in risk of HPV infection.
The AAP believes these benefits outweigh the risks.
What are the risks of circumcision?
Like with any procedure, there is a risk of complications. Dr. Nguyen notes that a professional must perform the circumcision to reduce the risk of complications.
Risks commonly associated with circumcision include:
- Wound dehiscence
- Potential injury to the penis
- Development of adhesions or skin bridges
- The need to redo circumcision
- Development of inclusion cysts
But, what about sexual function and satisfaction?
“In adult circumcision, there have been reports of having problems with sexual function and satisfaction.” Dr. Nguyen said. “However, it is important to understand that sexual function and satisfaction is not based on the penis alone.”
He goes on to say that more than 50% of function and satisfaction has to do with the brain. However, Dr. Nguyen notes there have been a lot of men circumcised when they were infants and children and only a small percentage of them have sexual function and satisfaction issues due to missing foreskin.
Conditions causing delayed circumcision
Dr. Nguyen notes there are cases where a doctor would not perform a circumcision. Typical conditions that would stop your baby from having a circumcision include:
- Hypospadias or epispadias, conditions where the hole on the penis opens on the top or bottom of the penis
- Buried penis
- Penile scrotal webbing
- Penile torsion
- Large scrotal hydroceles distorting penile skin anatomy
- Disorders of sexual differentiation
These do not mean that the child can never have a circumcision, but it means your child will need to be referred to a pediatric urologist to manage the conditions. Part of that management might include a circumcision.
Making the choice
Dr. Nguyen says the best first step is to talk to your child’s pediatrician to discuss the benefits and risks. If needed, your child’s pediatrician can refer you to a pediatric urologist for an in-depth conversation.
“It is a very controversial topic, and there are pros and cons,” Dr. Nguyen said. “Parents just need to understand the risks and benefits. In most cases, it comes down to a religious, social and personal preference.”
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