pediatric housecalls Robert R. Jarrett M.D. M.B.A. FAAP

Infant Circumcision

When I speak at a prenatal childbirth class, I usually talk about "little things."

The things which sometimes seem insignificant, but which in reality really do make a great deal of difference.

Things like: fluoride drops, car seats, feeding the right foods, etc.

Circumcision is just one of those "little things", but one in which there is a fair amount of misunderstanding.

Circumcision is removal of the foreskin (prepuce) of the boy’s penis, and it is probably the most common surgical procedure that I perform.

It has been practiced almost as long as recorded history.  Egyptian artifacts depict circumcisions of young men, and it’s also mentioned in the Bible.

For members of the Jewish and Moslem faiths, circumcision is a ceremonial procedure.  On the eighth day of life, Jewish infants are circumcised by a Mohel in a ceremony called a Brith.

In the late 1800’s, American boys who were caught masturbating were circumcised as a means of stopping the habit because it was believed that removal of the foreskin made self-stimulation less pleasurable.

The procedure grew in its acceptance, until today in the US between 80 – 90 percent of male infants are circumcised.

It has almost become standard procedure, and it shouldn’t be.

I have been in hospitals where I have had to crumple up the signed parents permission sheet to circumcise their baby girl.  (Of course it was signed before the infant was even born).

Why has circumcision become so popular in the US?  Historically, there have been some assumed medical benefits, which have now been proven untrue.

For example, it was believed that circumcision prevented the boy’s masturbating and reduced the man’s chance of contracting a venereal disease.  Of course, these are false.

It was felt that circumcision prevented penile and prostatic cancer in a man and cervical cancer in his partner. Also not accurate.

There has always been found to be a low incidence of cervical cancer in Jewish women; and erroneously, circumcision was given the credit.

More recent studies, however, have shown that cervical cancer is almost nonexistent in nuns, indicating a possible relation to sexual activity.

Cervical cancer is now felt to be related to cultural and socio-economic factors, like hygiene, and possibly to a virus.

Penile cancer appears to be related to poor penile hygiene.  Studies comparing men from European countries, where circumcisions are rarely performed, showed no relationship between lack of circumcision and penile and prostatic cancer.

In 1975 there was a "task force" formed on circumcision comprised of notable and learned men in the American Academy of Pediatrics.

They reviewed mounds of medical data and interviewed physicians for their personal "observations."

One observation by physicians back then was that  children who were circumcised had less balanitis (infection of the foreskin).  Some felt that possibility of infections medical indication to circumcise all males.

(Personally — this argument makes as much sense to me as taking out all infants tonsils because of the few who have peritonsillar abscess; or removing the nails from the great toes of infants because of all the problems with ingrown toenails men have.)

The task force found, however, that there was no difference in infection rate when you took into account personal hygiene habits.

Therefore, the task force stated, "there is no absolute medical indication for routine circumcision of the newborn."

There are conditions in which circumcision should NOT be performed.  For example: congenital malformation of the penile structures, prematurity, illness, or bleeding disorders.

The procedure may be indicated when there is phimosis (stricture of the foreskin) so tight that it restricts the flow of urine; for children living in tropical areas where infectionsare common; or when proper hygiene is not possible (retardation).

The committee further stated that daily personal hygiene offers "all the advantages of routine circumcision without the attendant surgical risk."

The reasons people have for circumcision their children are religious (as mentioned), preference; and psychosocial.

Because most American boys are circumcised, the "peer pressure" may be a factor.  Parents sometimes wish their son to be "like his father".

Some parents may be embarrassed or resistant to perform the cleansing necessary and teaching this to their son.

While not having medical indications, there may be valid reasons in the cultural context.

The point of this article is that having the procedure done on your son is your decision, and it should be a decision, and not just routine procedure.  You should make it in consultation with your son’s pediatrician.

There are no routine medical reasons for circumcision, and the procedure carries a small risk to the baby.

However, there are religious and/or cultural indications for circumcision that might be considered.  If you choose not to have your son circumcised, you must be willing to cleanse him properly and teach him to do this himself later.

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