Nothing can ruin a conversation between new-mommy friends like a discussion on infant circumcision. Over the ten years that I’ve been working with new moms and families I’ve heard all sides of the argument and even participated in a heated discussion or two, while conversations with my own loved ones have given me pause to consider opinions in opposition to my own.
I decided to write this post because the feedback that I’ve received from parents has made me realize that there aren’t many non-biased sources of information on the subject that explore all sides of the debate. I’m going to do my best to present the facts to you so that if you are on the fence, you can use the information here to make up your own mind.
On a normal newborn penis, the foreskin is attached to glans (head) of the penis and is not able to be rolled back fully. The foreskin retracts anywhere between the ages of two and ten. Newborn male circumcision is defined as the surgical removal of the foreskin from the penis. This surgery is usually performed in the first week after birth.
The most recent statistics on Canadian circumcision rates are from 2009. The nation-wide survey What Mothers Say: The Canadian Maternity Experiences states that among women who gave birth to a male baby, 31.9% chose circumcision. This number represents a significant decline over the course of a few generations, but the numbers fluctuate greatly from province to province; Ontario’s rate of circumcision is one of the highest in Canada and is closer to 44%. The procedure is not considered medically essential, so it isn’t covered by provincial health care plans such as OHIP. The main reasons for deciding to circumcise are the desire for the baby to be like the father, religion, and health and hygiene,.
The most common reason that Canadians give for newborn circumcision is that they want the new baby to look like a father or sibling. Many fathers feel that circumcision was fine for them so it will be fine for their child, too. There also appears to be an old stigma at work here that I can’t proclaim to have first hand experience with because I was born a female. Concerns about boys being teased have been mentioned, although it’s worth remembering that most boys are no longer circumcised. If a boy is not circumcised then what does that say about a couple’s feeling about a father’s own circumcision? These are deeply personal issues to grapple with and I can’t possibly know what the right answer is for anyone other than my own family.
Circumcision is a practice that is seen as extremely important to both the Jewish and Muslim faiths. Islam considers the circumcision a symbol of those who follow Allaah and the Jewish faith considers it a covenant between God and the child. These views are of the utmost importance to many members of these religions.
So, what is the evidence in support of circumcision for the purposes of health and hygiene?
I’ll often hear people say that it’s better to have an infant circumcised because otherwise they may need it later. What they are likely referring to is circumcision for the treatment of phimosis. Phimosis is the thickening and scarring of the foreskin which prevents the foreskin from properly retracting from the head of the penis. This can be caused by recurrent infection or foreskin trauma when the foreskin has been forced to retract before it has fully separated from the head of the penis. These occurrences can usually be resolved without surgery and phimosis can often be treated with steroid cream and other methods, but approximately 0.8% to 1.6% of boys will require circumcision before puberty.
Circumcision reduces the risk of urinary tract infections slightly. A recent analysis has shown that the risk of urinary tract infection is 2.4% for circumcised males and 20.1% for uncircumcised males under three months of age. But this risk drops sharply to about one in 1000 by one year of age. Approximately 111 to 125 normal infant boys would need to be circumcised at birth to prevent one case of urinary tract infection. There are boys who have a higher risk of urinary tract infections such as those with urinary tract abnormalities and in those cases, circumcision may be of greater benefit.
Three randomized controlled trials have shown that circumcision reduces the risk of acquiring HIV infection in males. Many countries with high rates of HIV transmission are attempting to expand access to male circumcision as a public health initiative and the World Health Organization recommends that men and boys be circumcised in areas where HIV is prevalent. The Center for Disease Control in the United States has estimated that an average of 298 boys would need to be circumcised to prevent one case of HIV transmission; this rate varies depending on the race of the boys that were studied. No studies have examined the impact of routine infant circumcision on sexually transmitted infections other than HIV.
There is a greater risk of penile cancer among men who have not been circumcised and phimosis, or the thickening and scarring of the foreskin, is the strongest associated risk factor; therefore, personal hygiene and treatment of phimosis are very important for uncircumcised males. Female partners of circumcised men may have a decreased risk of cervical cancer, but this also varies greatly depending on the sexual history of her male partner. It is hoped that the best defence against cervical cancer will be the HPV vaccination that is accessible to Canadian women and girls.
The Canadian Pediatric Society says,
While there may be a benefit for some boys in high-risk populations and circumstances where the procedure could be considered for disease reduction or treatment, the Canadian Paediatric Society does not recommend the routine circumcision of every newborn male.
So, if there is evidence of health benefits, why does the Canadian Pediatric Society recommend against routine circumcision?
There are risks, and the risks don’t outweigh the benefits for every baby boy in Canada.
These risks range from common to extremely rare. All surgical procedures are painful. Even with administered pain medication, baby boys experience pain after the circumcision. It has been demonstrated that newborns who experience this type of pain have an altered response to later pain stimulation such as vaccinations and demonstrate a higher pain response. Immediate complications of newborn circumcision include minor bleeding, local infection and an unsatisfactory cosmetic result. These risks increase the later a circumcision is performed.
Extremely rare complications include partial amputation of the penis and major blood loss or sepsis, which can both cause death. Long term complications can include something called meatal stenosis which occurs in 2% to 10% of all circumcisions, this is when the urethra narrows, and treatment is required.
Talk to your doctor about your own child’s risks versus benefit and make sure you mention your unique reasons for wanting to circumcise or not. If you don’t choose to circumcise, make sure that you take proper care of your son’s penis and teach him how to care for it too. The foreskin should never be pulled back prematurely. As your son grows and his foreskin begins to retract, it should be gently rolled back from the head of penis and cleaned. Never force it back further than it will comfortably go and seek medical attention if you have concerns.
If you choose to circumcise, get a referral to an appropriate medical care provider and have a discussion about pain management.
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