Pros and Cons for Circumcision
By Dr. Brown
One very controversial surgery is circumcision of the penis. Here are some things you might think about as you make your decision.
Reasons for Not Circumcising your Boy:
1. Pain. Babies feel the circumcision procedure, although this is for a very short while (see below).
2. Emotional. Many parents do not feel they should put their son through this procedure.
3. Cultural. Many Europeans are not circumcised. Do I want my son to look like me, or the other boys?
4. Cost. Some insurance companies do not cover the cost of the procedure.
5. Is it Necessary? There is ongoing controversy over this issue.
Risks associated with doing a circumcision:
1. Pain
The surgery for a newborn is usually less than 5 minutes. In skilled hands it is less than 2 minutes. They seem to cry as much for changing a poopy pair of pants as they do for a circumcision. Crying is dramatically less when they are not also hungry. Feeding about thirty minutes before works very well. Babies are in a naturally sleepy mood after they feed. Alternatives include topical and injectable anesthesias. Topical pain relieving creams like EMLA are not FDA approved. Many people feel that it does not work very well anyway.
Lidocaine is an injectable anesthetic. There are several risks here:
1. It hurts to put it in, almost as much crying as the circumcision done without anesthesia.
2. In really good hands, 25% of the time the anesthesia does not seem to change the crying amount during the circumcision.
3. Where it is injected, there can be bruising, especially in fair skinned children like blondes and redheads. These bruises may last several days.
4. Several hours later there can be an "irritable focus" when the medicine is wearing off. The children cry a bit for the time that it takes to wear off which may be minutes or even hours.
5. If the Lidocaine gets into a major blood vessel, it can circulate to the heart and cause a cardiac arrhythmia. This is rare but if it occurs can be dangerous.
2. Bleeding
The usual blood loss for a circumcision is minimal, 1-3 drops only. If the child is an unknown Hemophiliac this could be far more.
3. Infection
Although a day or two later there is a dried egg yoke looking secretion on the glans of the penis, this is not infection. This is normal and need not be treated. White petrolatum works well to prevent this from sticking to the diaper during changes of the diaper. Some physicians use antibiotic creams or gels. However this may make the child allergic to these medicines later in life and is not needed anyway. True infection in the days following a circumcision is extremely rare.
4. Cost
The cost of newborn circumcision is usually $ 200-400. The cost is ten times higher as an older child or adult. This is because it involves adding costs for anesthesia, recovery room, urologist, operating room charges.
5. Age
The main reason for this discussion is really age and memory. However, as an older child or adult, this can be very emotionally traumatic. Making an informed decision as the child is just a few hours old is important. Many parents have expressed that if they were aware of these issues they certainly would have asked their doctor to do a circumcision on their boy as a newborn and not wait until older. This discussion is to prevent parents from saying "I wish I had known that at birth".
Risks of an Intact Foreskin (non-circumcised)
1. Urinary tract infections (bladder infections, kidney infections) are increased by between 4 times and 12 times as common in uncircumcised boys.
2. Phimosis is the condition when you can not retract the foreskin off of the glans. At birth most boys can not and by age 4 most can retract the foreskin.About 4 % of boys who are not circumcised will eventually require circumcision in order to clean under and prevent infections.
3. Cancer of the tip of the penis, although extremely rare, almost always ocurs in the uncircumcised penis.one in 600 men who are not circumcised. Amputation of the glans is required to treat this very dangerous cancer. Penile cancer is almost unheard of in the circumcised male.
4. HIV prevention. New studies show that an intact foreskin is very risky for acquiring HIV. Although this is clearly not intended as a way to avoid unprotected intercourse, the numbers are very clear that circumcision is useful for prevention as a population.
After reading this you may still have questions and we invite further discussion on this important subject. We encourage a decision as a newborn as this seems not only the easiest time but also the fastest recovery and least complex for emotional reasons for the boy.
By the Way: here in the midwest, your obstetrician is the physician that performs the procedure.
One very controversial surgery is circumcision of the penis. Here are some things you might think about as you make your decision.
Reasons for Not Circumcising your Boy:
1. Pain. Babies feel the circumcision procedure, although this is for a very short while (see below).
2. Emotional. Many parents do not feel they should put their son through this procedure.
3. Cultural. Many Europeans are not circumcised. Do I want my son to look like me, or the other boys?
4. Cost. Some insurance companies do not cover the cost of the procedure.
5. Is it Necessary? There is ongoing controversy over this issue.
Risks associated with doing a circumcision:
1. Pain
The surgery for a newborn is usually less than 5 minutes. In skilled hands it is less than 2 minutes. They seem to cry as much for changing a poopy pair of pants as they do for a circumcision. Crying is dramatically less when they are not also hungry. Feeding about thirty minutes before works very well. Babies are in a naturally sleepy mood after they feed. Alternatives include topical and injectable anesthesias. Topical pain relieving creams like EMLA are not FDA approved. Many people feel that it does not work very well anyway.
Lidocaine is an injectable anesthetic. There are several risks here:
1. It hurts to put it in, almost as much crying as the circumcision done without anesthesia.
2. In really good hands, 25% of the time the anesthesia does not seem to change the crying amount during the circumcision.
3. Where it is injected, there can be bruising, especially in fair skinned children like blondes and redheads. These bruises may last several days.
4. Several hours later there can be an "irritable focus" when the medicine is wearing off. The children cry a bit for the time that it takes to wear off which may be minutes or even hours.
5. If the Lidocaine gets into a major blood vessel, it can circulate to the heart and cause a cardiac arrhythmia. This is rare but if it occurs can be dangerous.
2. Bleeding
The usual blood loss for a circumcision is minimal, 1-3 drops only. If the child is an unknown Hemophiliac this could be far more.
3. Infection
Although a day or two later there is a dried egg yoke looking secretion on the glans of the penis, this is not infection. This is normal and need not be treated. White petrolatum works well to prevent this from sticking to the diaper during changes of the diaper. Some physicians use antibiotic creams or gels. However this may make the child allergic to these medicines later in life and is not needed anyway. True infection in the days following a circumcision is extremely rare.
4. Cost
The cost of newborn circumcision is usually $ 200-400. The cost is ten times higher as an older child or adult. This is because it involves adding costs for anesthesia, recovery room, urologist, operating room charges.
5. Age
The main reason for this discussion is really age and memory. However, as an older child or adult, this can be very emotionally traumatic. Making an informed decision as the child is just a few hours old is important. Many parents have expressed that if they were aware of these issues they certainly would have asked their doctor to do a circumcision on their boy as a newborn and not wait until older. This discussion is to prevent parents from saying "I wish I had known that at birth".
Risks of an Intact Foreskin (non-circumcised)
1. Urinary tract infections (bladder infections, kidney infections) are increased by between 4 times and 12 times as common in uncircumcised boys.
2. Phimosis is the condition when you can not retract the foreskin off of the glans. At birth most boys can not and by age 4 most can retract the foreskin.About 4 % of boys who are not circumcised will eventually require circumcision in order to clean under and prevent infections.
3. Cancer of the tip of the penis, although extremely rare, almost always ocurs in the uncircumcised penis.one in 600 men who are not circumcised. Amputation of the glans is required to treat this very dangerous cancer. Penile cancer is almost unheard of in the circumcised male.
4. HIV prevention. New studies show that an intact foreskin is very risky for acquiring HIV. Although this is clearly not intended as a way to avoid unprotected intercourse, the numbers are very clear that circumcision is useful for prevention as a population.
After reading this you may still have questions and we invite further discussion on this important subject. We encourage a decision as a newborn as this seems not only the easiest time but also the fastest recovery and least complex for emotional reasons for the boy.
By the Way: here in the midwest, your obstetrician is the physician that performs the procedure.