Circumcision is a family decision

Circumcision of the male is the surgical removal of the foreskin on the tip of the penis. Circumcision is often performed for cultural, health, hygiene, family tradition or religious reasons.

In the United States, circumcision is commonly performed before the boy leaves the hospital, usually on the first or second day. In some religions the procedure is performed slightly later.

Circumcision cannot be undone. Circumcision is not as common in other parts of the world including Asia, Europe, and South America as is it is in the United States. In 1900, only about 25 percent of American boys were circumcised. In the 1960s-‘70s, the rate was about 85 percent, and currently the numbers have decreased to approximately 65-70 [percent.

The topic of whether to have a circumcision can be both controversial and emotional. The benefits of circumcision have been long debated, and opinions about the need for circumcision in healthy boys can vary widely. Opponents go as far as to claim it is a form of mutilation.

In 2012 the American Academy of Pediatrics, after carefully reviewing the issue, reported that the health benefits of newborn male circumcision outweigh the risks. The American Academy of Pediatrics endorsed the opinion that that parents who chose it should have access to the procedure of circumcision.

Additionally, The Centers for Disease Control and Prevention, for the first time ever, just released a draft of circumcision guidelines the first week of December 2014. The guidelines indicate that there is medical evidence supporting the performance of circumcision and that healthcare insurance programs should cover the cost of the procedure.

“The scientific evidence is clear that the benefits outweigh the risks but the final decision is a personal/family decision that may involve religious or cultural preferences,” said Dr. Jonathan Mermin, a Centers for Disease Control and Prevention official.

The American Academy of Pediatrics also encourages families to carefully consider the health risks and benefits of the procedure taking into account their own personal and cultural preferences. They stated that medical benefits of circumcision, by itself, may not be more significant than those other considerations. As a result, the American Academy of Pediatrics and The Centers for Disease Control do not routinely recommend circumcision for every baby boy but leaves the decision up to the family.

The procedure of circumcision: In newborns, the area is anesthetized locally. The skin at the end of the penis is painlessly surgically removed, much like the skin on the tip of a banana. Healing takes about one week.

Some have suggested that the decision be delayed so that the boy can make up his own mind when he is older. Unfortunately, circumcision is much more complex and difficult in older boys and men. There is a significant and increased risk for healing complications. General anesthesia is used. Healing time may take up to three weeks or longer in older boys and adults.

Although many of these are rare, circumcision can have the following benefits:

• Decrease the occurrence of cancer of the penis

Decrease certain sexually transmitted diseases, including HIV

• Decrease infections of the penis, including recurrent yeast infections, especially in elderly men

• Decrease the risk of phimosis (tightness of the foreskin that prevents it from retracting)

• Decrease urinary tract infections

Decrease recurrent itchy and painful inflammation of the penis, especially in elderly men

• May decrease the risk of cervical cancer in sexual partners

• Decrease difficulty in maintaining good hygiene

Deciding whether to have your newborn son circumcised may be challenging. You should consider all of the risks and benefits of circumcision. Other considerations, such as family tradition, culture, religion, hygiene issues and personal preferences should also shape your final decision.

As a physician, I have never had a circumcised patient tell me that he regretted having it done. With an admitted selection bias, I have had several patients, after struggling with recurrent infections and even penile cancer, tell me that they wish they had had a circumcision performed when they were younger.

In summary, I agree with the Centers for Disease Control and the American Academy of Pediatrics; the final decision, after appropriate consideration, is that of the family.

Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine and one of the top 21 African American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians, MABP.org.