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Circumcision 101: To Cut or Not to Cut

Published on: June 28, 2011

Circumcision: What new parents will want to know

Expecting a baby boy? Then one of the important decisions you’ll need to make is whether or not you’ll have him circumcised after he’s born.

Circumcision is the removal of the foreskin, a fold of skin that covers the rounded tip of the penis. The infant is generally given a local anesthetic (a topical cream or injection) before the procedure. Parents often opt for circumcision because of ethnic or religious reasons, or so the child will “look like” the circumcised father.

The procedure is often performed in a hospital setting before a baby is discharged. However, many circumcisions are done in homes eight days after birth as an important traditional Jewish religious ritual known as brit milah.

Once routine for baby boys born in the U.S., circumcision has become a source of anxiety and debate for many parents. Are ethical or religious reasons enough to justify a procedure that can seem archaic and not medically essential? Is it painful and traumatic for the baby?

The issue reached new heights last May, when a proposal to ban the circumcision of male minors in San Francisco earned enough signatures to qualify to appear on that city’s upcoming November ballot. If passed, performing a circumcision on a male younger than age 18 would be a misdemeanor offense punishable by a fine of as much as $1,000 or up to one year in jail.

Minimal risks

“The risks of the procedure are pretty small when done in a medical setting,” says Dr. Douglas Diekema, director of education for the Treuman Katz Center for Pediatric Bioethics at Seattle Children’s Hospital.

The risk of bleeding is less than 1 percent, and major bleeding is very rare, he says. Risk of infection is also less than 1 percent, and most of those are not major infections that require hospitalization. “Causing major damage to a penis is incredibly rare. It is not something most physicians have ever seen,” Diekema says.

Babies, he says, shouldn’t be “screaming” through the procedure. “Circumcision is going to hurt if the baby has not been anesthetized, just as there would be pain involving any procedure where the skin is being cut.”

Studies show circumcised babies have a lower risk of urinary tract infections in their first year of life, he says. “We also know that later in life, once men become sexually active, men who have undergone circumcision are less likely to contract the HIV virus, syphilis and HPV [human papillomavirus] virus.” Uncircumcised men are at greater risk of contracting foreskin infections and penile cancer, Diekema says.

For most Jewish families, circumcision is a given. “Brit milah is an extremely important and sacred part of the Jewish tradition,” says James Mirel, rabbi at Bellevue’s Temple B’nai Torah. “It is a sign of our covenant with God and the first ritual commanded by God.” While Mirel understands that the topic is contentious, he explains, “For us, it isn’t a matter of medical benefit, it is a religious requirement.”

Circumcision rates decliningRates declining

Since 1965, when 85 percent of boys in the U.S. were circumcised, rates of circumcision in hospital settings have declined. The Centers for Disease Control and Prevention reports that in 2009 the overall rate of circumcision among male infants in the U.S. was 33 percent, down from 56 percent in 2006. The figures don’t include procedures done outside of a hospital, as brit milah most often is.

The American Academy of Pediatrics no longer recommends circumcision as a routine procedure. According to its policy statement, “Parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision.” Now, most parents who elect to have the procedure in a hospital setting pay between $150 and $500 for what is considered an elective procedure, usually not covered by insurance.

Ali Tromblay, an instructor and licensed midwife at Bastyr University’s Department of Midwifery, is co-owner of the Puget Sound Birth Center. She’s also the mother of two uncircumcised sons, ages 4 and 5. None of the midwife moms in her practice have had their boys circumcised, she says.

“Licensed midwives are all about informed choice in hope of educating parents to make an informed decision. Given that, I would guess that most midwives would oppose circumcision.” Any medical procedure has risks associated with it, she says. “A responsible parent weighs the risks and benefits. It is a personal decision; I believe there is no need for it medically and the procedure involves risk.”

Diekema says that parents who choose circumcision should ask questions before agreeing to the procedure. “Ask the doctor, ‘How many circumcisions have you performed?’ ‘Will you use some type of analgesic block to limit the pain?’”

The best source of information for parents contemplating the pros and cons of the procedure is a general pediatrician, Diekema says. “If parents don’t have one yet, they should connect with one before the birth of their baby.”

Kathleen F. Miller is a Sammamish-based freelance writer and mother of two.

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