Cutting to the Point on Circumcision
Weigh the Options
To Snip or Not to Snip
A circumcision is usually performed within 48 hours of birth by
an obstetrician or pediatrician in the hospital, or on the eighth day after
birth for the Jewish ritual, called brit milah or bris. The baby is restrained,
then the layer of tissue that covers the tip of the penis is surgically
removed. It should take no more than five minutes in skilled hands.
When weighing the pros and cons of circumcising your baby, the
most clear-cut medical benefits of circumcision are a four- to tenfold decrease
in the risk of urinary tract infections during the first year of life, and a
threefold reduction in the risk of penile cancer among adult men.
However, UTIs and cancer of the penis are rare. The risk of
developing a UTI in an uncircumcised male infant is no more than 1%, and
breastfeeding has been shown to protect against these infections among this
group, according to the AAP. Only 10 or fewer men per 1 million get cancer of
the penis each year worldwide.
Studies also show a somewhat higher incidence among
uncircumcised men of sexually transmitted diseases, including syphilis and HIV.
However, the AAP says that the data are conflicting and highly controversial
since behavioral factors play a larger role in contracting STDs than the
existence or absence of foreskin.
Boys who are circumcised avoid the risk of phimosis, a
condition that makes foreskin retraction impossible. However, the overall risk
of penile problems for uncircumcised boys is unclear. The AAP cited one study
that followed 500 boys up to age 8 and found higher rates of penile problems --
typically inflammation -- in infants who were circumcised, but more problems
among older boys who were not circumcised.
As for the argument that circumcision improves hygiene,
"that one doesn't really hold up," says George Kaplan, MD, a clinical
professor of surgery and pediatrics at University of California at San Diego
and AAP task force member. "If you're not circumcised, I think that as long
as you wash your penis, that's probably fine," Kaplan says. Bathing an
uncircumcised baby simply requires washing the penis with soap and water. After
the foreskin becomes retractable (typically by age 5), boys can be taught to
gently pull back the foreskin to clean the tip of the penis.
On the other side of the coin, circumcision also presents some
For one thing, it hurts. Doctors used to think that infants
didn't feel pain like adults and that circumcision didn't require anesthetic.
Not anymore. Although it's hard to know just what they're feeling, it's clear
that babies who are circumcised experience temporary changes in heart rate,
blood pressure, oxygen saturation, and hormone levels.
New research even shows that early exposure to pain may have
long-term effects. One study found that infants who underwent circumcision
without pain medications were more sensitive to pain during immunizations at
four months and six months. Another found that newborns exposed to pain by
circumcision or illness were more anxious about pain as children and