To Circumcise or not to Circumcise?

If you’re thinking about starting a family one day, there are countless decisions you’ll make during your pregnancy and birth (heck, even before you conceive, too). When should I stop taking birth control in order to get pregnant? Should I find out my baby’s gender? Can I drink that glass of wine? Cloth or disposable diapers? If your baby is a boy, you’ll also need to decide whether or not he will be circumcised.

While having a baby is a time of immense excitement, there’s no denying all the choices can leave you feeling overwhelmed. Don’t worry — we’re here for you, whether you’re at that point in your life or not. Ultimately, being aware of the risks and benefits will prepare you to make an informed decision no matter when that day finally comes.

A procedure with a long history

The first circumcision record dates back to 3000 BC (seriously!). Experts report the procedure was initially only performed on upper-class males, but became a more common medical procedure during the 1880s. By the 20th century, circumcision was mainstream in many English-speaking countries, however, its popularity has decreased over time as rates in the United States have fallen from 64.5 percent in 1979 to just over 58 percent in 2010.

Err...what exactly is circumcision again?

Great question. Here’s the deal: circumcision is often performed in the hospital just hours after birth. Research suggests that circumcision is safest and offers more health benefits (more on this in a bit) when performed on newborns. A doctor will clean the baby’s penis and the surrounding area before numbing them with a local anesthetic. The retractable skin covering the tip of the penis — known as the foreskin (if the penis is the banana, the foreskin is the peel) — is then removed using one of the three most common circumcision techniques:

The Gomco Clamp: UpToDate says that the provider will stretch the foreskin over the bell of a three-part clamp while the clamp is tightened over the foreskin. The excess skin is cut away.

The Plastibell Device: A plastic ring is fitted over the penis while a sterile string is tied around the device and over the foreskin to cut off the blood supply. The foreskin tissue is trimmed off and the bell is removed, leaving the ring tied in place.

The Mogen Clamp: This technique is the fastest and least painful method of circumcision. The clamp’s hinged metal plate is curved on one side and divided by three-millimeter slits. The blades lock together, compressing the skin. The skin above the clamp is trimmed away. After the clamp is then removed, the skin pushed into proper position.

Why the heck is this done to baby boys?

If you’re unsure of what you’ll decide when the time comes, here are some of the reasons why many choose to circumcise their little one. First, circumcised babies have less of a chance of developing urinary tract infections (UTIs), which are common in boys during their first year of life. These infections usually result in additional trips to your pediatrician’s office, invasive procedures, or even hospitalization. There are some that believe foreskin removal also makes the penis easier to clean. (However, little boys with uncircumcised penis’ can always be taught how to wash properly to keep things fresh.)

Circumcision has also been found to lower the risk of human papillomavirus (HPV) and other sexually transmitted infections (STIs). Specifically, the American Academy of Pediatrics (AAP) reports that circumcised men have 30 to 40 percent less chance of contracting the HPV virus. Removing the foreskin also protects against herpes and decreases the likelihood that female partners will develop bacterial vaginosis (an imbalance of normal vaginal bacteria). Circumcising your baby boy may also lower his risk of developing penile cancer, foreskin infections, and phimosis (problems retracting the foreskin). The Centers for Disease Control and Prevention (CDC) notes that heterosexual men without foreskins have less of a chance of acquiring HIV.

It’s important to call out that for some parents, foreskin removal and circumcision are an important religious or cultural statement. In the Jewish faith, circumcisions are performed by a mohel eight days after birth. Circumcision is also a customary ritual for young Islamic boys that can occur at any age. Parents may circumcise based on personal reasons, too. For example, a study reported that 46 percent of parent choose to circumcise their infant because they wanted their sons “to resemble other males,” perhaps suggesting an existing stigma against uncircumcised penises in American culture.

But my friend told me circumcised penises are less sensitive

There aren’t any scientific studies that show that removing the foreskin will negatively affect sexual function, sexual satisfaction, or sensitivity (despite what you may come across online or overheard). For example, this 2013 systematic review published in the Asian Journal of Andrology analyzed all of the studies that observed whether or not circumcision impacted male sexual functions. Out of the ten studies the researchers identified, which encompassed a total of 9317 circumcised and 9423 uncircumcised men, there were no significant differences in sexual desire, premature ejaculation, ejaculation latency time (the amount of time it takes until orgasm), erectile dysfunctions, and orgasm difficulties.

OK — so what are the reasons for not circumcising?

It’s important to recognize that there are some risks associated with the procedure, the most common being bleeding and infection. UptoDate notes that major complications from foreskin removal are rare and often develop later as boys mature. These complications include skin adhesions, skin bridges, and a narrowing of the tip of the penis.

Some circumcision critics believe that the procedure subjects infants to unnecessary pain. However, both the AAP and the CDC encourage doctors to use a local or topical anesthetic to reduce the amount of pain a baby may experience. Others contend that removing the foreskin negatively impacts sexual pleasure, despite the aforementioned study suggesting otherwise. Here’s why: the foreskin is made up of a web of skin, membrane, muscle fibers, blood vessels, and nerves (yup — all of that). When the foreskin slides back and forth or retracts, this motion stimulates and lubricates the penis to improve sexual pleasure. So, this is why some believe removing it can make the penis less sensitive.

Opponents to foreskin removal also argue that the practice violates the rights of the minor, who as an infant is too young to give consent or even refuse the treatment. Therefore, they believe the decision should be delayed until the individual is old enough to form their own opinion about the procedure.

How do you care for a circumcised penis?

After the procedure, your baby’s penis will be wrapped in gauze dressing. To prevent discomfort from rubbing, petroleum jelly may be applied to the tip of the penis. At first, his penis might look red. In a few days, you’ll likely see a soft yellow scab. Don’t worry — this is completely normal and will disappear over time. You should remove and replace the gauze with every diaper change for the first few days and clean the circumcision site with warm water and a cotton ball once or twice a day. Make sure to monitor how much your baby is urinating, too. He should urinate within 12 hours of the procedure. It’s also useful look out any signs of trouble, like increased redness, swelling, bleeding (bigger than the size of a quarter on his diaper), or any drainage that does not go away. If you notice any of these signs, call your doctor.

And an uncircumcised penis?

Caring for an uncircumcised penis during the first few months requires no extra effort — you simply clean with soap and water. Initially, the foreskin will be connected by tissue to the head of the penis, so you shouldn't try to retract it. Your doctor will let you know when the foreskin has safely separated and retracted from the penis. Forcing the skin to retract before it is ready can actually cause bleeding and tears in the skin. Once the foreskin separated from the penis, you should retract it occasionally to clean the head of the penis underneath.

Generally, care for an uncircumcised penis is pretty low maintenance. But if your child’s urine only comes out as a little trickle or if your baby seems to have pain while urinating, then make an appointment with your pediatrician. As your son ages, teach him how to clean his penis by having him gently pull back on the foreskin and clean the penis head and inside the fold of the foreskin with soap and warm water. Afterwards, he should pull the foreskin back over the head of the penis when he’s finished.

For some, the decision to circumcise will come easily. Others, however, may struggle with the choice. Speak to your healthcare provider (preferably during pregnancy — so you can take plenty of time to make an informed and intuitive choice) to answer any questions and address any concerns you may have. Ultimately, understanding both the risks and benefits of the procedure will assist you in making the best decision for you and your family.



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Janelle King

Janelle King is a Registered Nurse, public health expert, and writer living in Atlanta, Georgia. Follow her @thenursenote.com

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