The Circumcision Decision – The Prime Cut

The first concern most men will have about their genital organs occurs right after birth when he undergoes a circumcision….and, unfortunately, the young boy has no part in the decision whether to lop off that precious piece of real estate!

Removal of the foreskin of the penis is one of the oldest surgical procedures known, dating back well over 5000 years. Hieroglyphs picturing ritual circumcision were found in ancient Egypt, and the religious significance of circumcision is described in the Old Testament.

Perhaps because of its long history, circumcision in the U.S. has been generally considered routine surgery. In the mid-1980s, up to 89 percent of newborn males were circumcised in some parts of the U.S.

There are many valid reasons for choosing circumcision, including cultural, religious and ethnic traditions. But in March 1999, the American Academy of Pediatrics (AAP) issued a policy statement that said they no longer recommend routine neonatal circumcision. It stated that although there are some potential medical benefits of newborn male circumcision, those benefits are so slight that they contribute little or nothing to the decision-making process.

So what does this mean for parents-to-be getting ready to make the circumcision decision? Mainly parents are on their own. The AAP does not make any specific recommendation. Parents need to talk with their physician and then carefully weigh the risks versus the benefits of the procedure.

Medical Risks and Benefits

Parents should be assured that the great majority of circumcisions are trouble-free. But circumcision is surgery, and all surgeries run the risk of complications. The most common complications which occur in only about 1 percent of circumcisions are: bleeding which can easily be controlled with pressure, and minor infection which can be treated with antibiotics.

The medical benefits of circumcision are small. Uncircumcised boys have a higher risk of developing urinary tract infections (UTIs) than circumcised boys, particularly in the first six months of life However, the overall risk of a UTI is still less than 1 percent. Generally, physicians will recommend circumcision for any boy who has two UTIs in the first year of life. A circumcision performed months or years after birth is done surgically under anesthesia, and seems to be associated with fewer complications, less pain and trauma.

Circumcision also has small but measurable benefit in preventing penile cancer which is a very rare disease that strikes only about 1 in 100,000 men. Uncircumcised men are three times more likely to develop penile cancer than circumcised men.

Uncircumcised men are also reported to be at greater risk for developing sexually transmitted diseases such as syphilis and HIV infections than circumcised men, but behavioral factor such as not practicing safe sex are far more important risk factors.

Overall, the increased risk of developing UTIs, sexually transmitted diseases, or penile cancer is extremely low, regardless of circumcision status.

A Kinder Cut

For those parents who elect to have a circumcision performed on their newborn infant, it is important that the parents select an experienced surgeon to perform the procedure. The AAP recommends that pain relief with a local anesthetic should be used during the procedure. Safe and effective forms of analgesia for circumcision are easily accomplished using a local or topical anesthetic consisting of a gel or cream applied to the foreskin before the procedure. This method has been found to provide adequate pain relief during the 5-10 minute procedure.

Parents considering circumcision should talk with their doctors, and make sure that they are comfortable with whoever will be performing the procedure. Specify in advance what type of anesthesia will be used, and notify the doctor if there are any bleeding disorders in the family.

Parents who choose not to circumcise need to receive instructions on how to care for an uncircumcised penis. The foreskin should never be forced to retract, nor should objects such as swabs or cotton balls be used to clean underneath it. Although most boys will have retractable foreskins by age 3, in some cases, it may take 7 to 10 years. Parents must be patient and allow the process to happen naturally. All boys who are not circumcised need to be instructed on proper hygiene of the foreskin. Failure to do so can result in inflammation of the penis and a foreskin that is even more difficult to retract and clean. Occasionally, this condition, phimosis, or tight foreskin requires a circumcision as an adult.

So if you are considering the “prime cut” for you or your newborn son and have any questions, I suggest you contact your doctor.

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