Newborn Circumcision

Question: We have two beautiful girls. I am pregnant with our third child, and this will be a boy. My husband and all the boys in his family were circumcised. It is the opposite on our side of family. My husband says that we should have our son circumcised. I am on the fence, trying to find out about the pros and cons of newborn circumcision. Please give us your advice.

Answer:

Newborn circumcision was very much a fashion in North America, especially in United States, for many decades.  It was believed that the circumcised penis is easier to clean.  Since most boys are circumcised, parents feel pressured that they should do the same.

In the past two decades, the opinion has changed.  Newborn circumcision is now an uncommon procedure in many parts of Canada.  This is due to recommendations from Canadian Paediatric Society and American Academy of Pediatrics, the two organizations for paediatricians in Canada and US.  Both organizations do not recommend routine circumcision of all newborn males.  Many provincial health departments also have stopped paying for this procedure.

Newborn circumcision does provide some benefit.  Young boys can develop urinary tract infection (UTI).  This tends to happen more in uncircumcised boys, but we are reducing an uncommon condition to even more uncommon.  It has been estimated that one needs to circumcise close to 125 newborn boys in order to prevent a single infection.

Research in Africa showed that uncircumcised men are more likely to contract HIV infections that cause AIDS than circumcised men.  This may be true in Africa, where most HIV infections are contracted through heterosexual intercourse.  In North America, HIV transmission occurs mostly through IV drug use and male homosexual intercourse.

Circumcision may reduce other sexually-transmitted diseases.  Human papillomavirus (HPV) is the main cause of cervical cancer in women, and can rarely cause penile cancer in uncircumcised men.  However, in Canada, we are vaccinating all girls, and in some provinces (including PEI), all boys, against HPV.  Widespread sex education of school-aged children have taught them about protection and use of condom.  All of these are far more effective in preventing sexually-transmitted diseases than newborn circumcision.

As boys get older, some of them may need circumcision.  Phimosis, caused by inflammation and narrowing of the foreskin opening, is the main indication for circumcision.  However, only a very small percentage of boys will have this problem.  The vast majority of newborn circumcisions are unwarranted.

Furthermore, newborn circumcision is not completely harmless.  All surgical procedures are painful.  Although procedural anesthesia is used in newborn circumcision, babies still experience a lot of pain for days afterwards.  They don’t experience less pain than older children, although most parents can’t tell that their baby is in pain unless when he cries.  Pain medicine does not always relief pain adequately at this young age.  Research has shown that these babies tend to have higher pain scores when they are vaccinated.

Other complications include local infections and bleeding.  Rarely, babies with unrecognized bleeding disorder can lose a lot of blood after circumcision.  I am also concerned about unsatisfactory cosmetic results, which may not become obvious until many years later.

My suggestion for your family is to wait until your son gets older.  If he needs circumcision at that time, it can easily be done.  There will be pain involved, but it is no more than if circumcision is done earlier, and pain medicine is a lot safer when he gets older.