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Weighing the Pros and Cons

If you have a baby boy, you'll need to decide whether to have him circumcised. Consider the benefits and drawbacks.

Circumcision is the surgical removal of the skin covering the tip of the penis. The procedure is fairly common in the United States, but is it right for your son? Here's help making an informed decision.

Opinions are Mixed

For some parents, circumcision is a religious ritual. It can also be a matter of family tradition, personal hygiene or preventive health care. For others, however, the procedure seems unnecessary or disfiguring.

The American Academy of Pediatrics (AAP) says the benefits aren't strong enough to recommend routine circumcision for all male newborns. The AAP leaves the decision up to parents - and supports use of pain relief for infants who have the procedure.

The Benefits

Circumcision may have health benefits, including:

• Easier hygiene. Circumcision makes it easy to wash the penis - although it's simple to clean an uncircumcised penis, too.
• Decreased risk of urinary tract infections. The risk of urinary tract infections in the first year is low, but these infections may be up to 10 times as common in uncircumcised baby boys. Severe infections early in life can lead to kidney problems later on.
• Prevention of penile problems. Occasionally, the foreskin on an uncircumcised penis may narrow so much that it's difficult or impossible to retract. This can also lead to inflammation of the head of the penis.
• Decreased risk of penile cancer. Although cancer of the penis is very rare, it's less common in circumcised men.
• Decreased risk of sexually transmitted diseases. Safe sexual practices remain essential, but circumcised men may have a slightly lower risk of certain sexually transmitted diseases - including HIV, the virus that causes AIDS, and human papillomavirus (HPV), which causes genital warts. Some strains of HPV also cause cervical cancer.

The Drawbacks

Circumcision also has drawbacks, including:

• Surgical risks. Excessive bleeding and infection are uncommon, but possible. The foreskin may be cut too short or too long or fail to heal properly. If the remaining foreskin reattaches to the end of the penis, minor surgery may be needed to correct it.
• Pain. Circumcision hurts. Local anesthesia can block nerve sensations during the procedure.
• Permanence. After the procedure, it may be impossible to re-create the appearance of an uncircumcised penis.
• Expense. Some insurance companies don't cover the cost of circumcision.

Other Considerations

Circumcision shouldn't be done when a baby's urethral opening is in an abnormal position on the side or base of the penis. This condition is treated surgically and may require the foreskin for repair. Circumcision may not be an option in an infant with ambiguous genitalia or a family history of hemophilia.

Circumcision doesn't affect fertility. Whether the procedure enhances or detracts from sexual pleasure for men or their partners remains unknown.

The Procedure

Circumcision is often done in the hospital nursery. It may be done in an outpatient setting as well.

Your son will lie on his back with his arms and legs restrained. After the penis and surrounding area are cleansed, an anesthetic will be injected into the base of the penis. A special clamp or plastic ring will be attached to the penis, and the foreskin will be removed. Afterward, the penis will be covered with an ointment, such as petroleum jelly, and wrapped loosely with gauze.

The entire procedure takes about 15 minutes.

Medical problems after a circumcision are rare. However, please call the baby's doctor or healthcare provider if any of the following conditions occur:

• continued bleeding
• inability to urinate normally within 4 to 6 hours after the circumcision (in a hospital-setting, this is monitored by nurses)
• redness around the tip of the penis that seems to be getting worse

Circumcision Care

It will take approximately 7-10 days for the penis to heal. Provide the following special care until then:

• Examine the tip of the penis each time you change his diaper. Call your doctor or health care provider if there is any new bleeding, increased swelling, foul-smelling drainage, or reddened skin on the shaft of the penis.
• After each diaper-change, completely cover the tip of the penis with petroleum jelly (or an antibiotic ointment, if prescribed by your doctor).
• Do not use baby wipes until the tip of the penis has healed.
• Some physicians may incorporate a plastic ring - known as a "plastibell" - by placing it under the foreskin & securing it. The plastibell should naturally fall off 5-8 days later. Do not apply any petroleum jelly or ointment to the end of the penis in this case.

It will take about seven to 10 days for the penis to heal. The tip of the penis may seem raw at first, and you may notice a yellowish mucus or crust. A small amount of bleeding also is common the first day or two.

It's OK to wash the penis as it's healing. Change the bandage with each diaper change, and apply a dab of petroleum jelly to the tip of the penis to keep it from sticking to the diaper. If there's a plastic ring instead of a bandage, it will drop off on its own - usually within a week.

Problems after circumcision are rare. Call your baby's health care provider if:

• Your baby doesn't urinate normally within six to eight hours after the circumcision.
• There's persistent bleeding or redness around the tip of the penis.
• The tip of the penis is swollen.
• You suspect an infection - there's foul-smelling drainage from the tip of the penis, or crusted sores fill with fluid.

Uncircumcised Care

• An uncircumcised baby's penis requires no special care. Just wash the genital area with soap and water at bath time. There is no need to force the foreskin back to try and clean beneath it, as this can cause bleeding, pain and possible scarring.
• The foreskin loosens on its own over the next few years. Later, as your son grows, the foreskin can be pulled back, and he can then be taught how to care for his penis.