Dr. Bob Wiskind has practiced general pediatrics in Atlanta for more than 20 years. He was a longtime board member of Kids Health First, a pediatric IPA, and currently serves as president of the Georgia chapter of the American Academy of Pediatrics.
For thousands of years male infants have been circumcised for religious reasons. (The practice is traditionally a requirement among Jews and Muslims, while the general Christian position is that it is optional.)
Circumcisions for purely medical reasons have been done since the early 1800s, though not without controversy and debate.
I meet regularly in my office with expectant couples during prenatal visits as they choose their pediatrician. Circumcision is often a topic of discussion.
I explain that there are clear medical benefits to circumcision. While urinary tract infections (UTIs) are rare in male infants, uncircumcised males have more than 10 times the number of UTIs as circumcised males. In more than 20 years of practice, I have never encountered a UTI in a circumcised infant.
Many of the health benefits of circumcision are due to hygiene. An uncircumcised penis requires care, including gently retracting the foreskin when washing to clean around the urethral opening and gently retracting the foreskin when urinating. If a male is taught proper care of his uncircumcised penis and follows those directions perfectly, his health risks will probably be the same as those of his circumcised peers.
Uncircumcised males are also susceptible to phimosis (inability to retract the foreskin) and balanitis (inflammation of the penile head).
As adults, circumcised males have lower rates of penile cancer. There is some evidence that the sex partners of circumcised males have lower rates of cervical cancer. Circumcised males also have lower rates of some sexually transmitted infections, specifically HIV.
Circumcision is typically performed in the hospital before the newborn goes home with his mother. An anesthetic cream or superficial injection is used to minimize discomfort. The procedure is very safe. Longtime Georgians may remember a handful of cases 20 years ago where infants suffered significant injuries during circumcision. This was due to malfunctions with an electrocautery device, which is not typically used during the procedure.
After the newborn period, circumcision is an outpatient surgical procedure, with the accompanying risks of being put to sleep and a more difficult recovery process. I counsel expectant parents that if they choose not to circumcise their son as a newborn, they should view that as a final decision, rather than thinking he will have the procedure when he is older.
In 1999, the American Academy of Pediatrics (AAP) issued a policy statement on circumcision, stating that there were risks and benefits and the decision was left to parents in consultation with their physician. This left many parents confused.
Fortunately, in September 2012, the AAP updated its statement, indicating that recent literature shows the health benefits outweigh the risks.
The statement stopped short of recommending circumcision for all males, leaving the parents to weigh the risks and benefits. Importantly, the recent statement also indicates that newborn circumcision is cost effective and should be paid for by health insurers, including Medicaid.
Finally, some people question why the AAP supports male circumcision while condemning “female circumcision,” more properly called female genital mutilation (FGM).
FGM, which involves partial or total removal of the female external genitalia, has no health benefits, and can cause severe health consequences, both immediate and long-term. FGM is recognized internationally as a violation of the human rights of girls and women. There is no correlation between male circumcision and FGM.
My advice to expectant parents is to have their son circumcised unless they have a specific reason (religious, cultural, etc.) not to do so. Circumcision is good preventative medicine, lowering a male’s risk for future illness.