Should You Circumcise Your Son?

Oh boy. The question of whether to circumcise our sons has divided U.S. parents nearly in half, with one side insisting it makes smart medical sense and the other condemning the practice as barbaric. An estimated 58 percent of male newborns have had the permanent surgery – in which an obstetrician removes some or all of the foreskin from the penis — in the hospital at birth. Still others opted for religious ceremonies shortly after leaving. (The World Health Organization reports that one in three males is circumcised worldwide, 68% of which are Muslim, and that the procedure is “almost universally” practiced in Judiasm). But the rate in America has been going down. The Centers for Disease Control’s National Center for Health Statistics reports hospital circumcisions declined 10 percent from 1979 to 2010.

The following year, the American Academy of Pediatrics’ reiterated their long held stance of not recommending neonatal circumcision as standard routine, contending that there was little medical benefit. They changed their tune in 2012 though, announcing that new research indicated the health benefits outweighed the risks of the surgery (namely: bleeding, infection at the circumcision site and irritation). Still, the AAP doesn’t advise circumcision as a general policy. “The procedure’s benefits justify access to this procedure for families who choose it,” reads a statement on their Healthy Children website. “However, existing scientific evidence is not sufficient to recommend routine circumcision.”

The Research

"The health benefits of male circumcision include a drop in the risk of urinary tract infection in the first year of life by up to 90 percent," Susan Blank, who led the AAP task force reconsidering the circumcision stance, told NPR, adding: “It drops the risk of heterosexual HIV acquisition by about 60 percent.” The WHO, in fact, includes circumcision as one of the ways to fight the spread of HIV.

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A study published in the New England Journal of Medicine also found that male circumcision reduced the incidence of Herpes Simplex virus Type 2 and the prevalence of Human Papillomavirus infection, which can cause cervical, penile and anal cancers as well as genital warts.

The risk of complications (bleeding and penile injury) is estimated to be about 0.2 percent. And a 2013 systematic review of all the research on the subject published in a 2013 Journal of Sexual Medicine concluded: “The highest-quality studies suggest that medical male circumcision has no adverse effect on sexual function, sensitivity, sexual sensation, or satisfaction.”

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Critics of the practice, however, insist that there are serious side effects. “According to some studies, circumcised men are more likely to have erectile dysfunction (4.5 times higher likelihood of using ED drugs), orgasm difficulties and premature ejaculation,” Dr. Ronald Goldman, executive director of the Circumcision Resource Center in Boston, wrote in The Wall Street Journal.

At the time of the procedure, Goldman adds, “Studies show that circumcision is significantly painful and traumatic, resulting in large increases in heart rate, blood pressure and stress hormone levels. Penile anesthetic injections, if used, don’t completely eliminate pain.” The operation, he contends, “can cause behavioral and neurological changes and disrupt mother-child bonding and feeding.”

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For its part, The American Academy of Pediatrics admits, “The true incidence of complications after newborn circumcision is unknown.” 

What Experts Say

"I think that all healthy newborn babies should be circumcised," former AAP Chairman Edgar Schoen tells NPR. "I feel about newborn circumcision the way I do about immunization: It’s a potent preventive health procedure that gives you a health advantage."

Not so, counters Goldman. “The claimed health benefits are either questionable or too weak to justify surgery on boys before they are old enough to provide consent,” he wrote in The Wall Street Journal. “The conditions the procedure supposedly reduces the risk of acquiring are either rare (penile cancer), easily treatable (urinary tract infections) or can be prevented in less intrusive and more effective ways (condoms in the case of sexually transmitted diseases)… Most of the world instinctively rejects routine neonatal circumcision as harmful genital surgery, like removing other natural, healthy, functioning body parts.”

What Parents Say

“We didn’t circumcise our son but it was actually a far more difficult decision than I’d have ever imagined. I passed the buck to my husband and said it was his call, but I did mention that back home in New Zealand, absolutely no one did it. Right up until the minute we left the hospital, we kept going back-and-forth. In the end, he didn’t feel strongly enough one way or the other to make the decision for our son so we left it intact. If my son wants to, he can always revisit it!” – Charlotte S.

“This was our thought process for both my husband and me: Should we circumcise him? Yes. The main reason was the football locker room and girlfriends. We just didn’t want him to be different when it came to showering with the guys or being intimate with a girl. Literally, that’s as simple as it was. Not doing it was never even a consideration. Our doctor even let my husband watch the whole procedure!” – Agnes W.

“Because all of the males in my family were circumcised, I was, naturally, inclined towards this outcome. But eventually, we came to the conclusion that it was not the right one for our son. The body is made a certain way and so, in our minds, this is the way it should be unless there is a medical reason to change it. We don’t circumcise baby girls, so why would we do this to baby boys?” – Meghan C.

The Bottom Line

It’s really an individual choice. “Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks,” rules the AAP. But the surgery is still an unnecessary procedure, so parents will want to balance all the pros and cons, emotional and cultural in additional to medical. Still unsure?

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Consider this: “Parents consent to many health decisions, such as immunization, on behalf of their children,” Dr. Ronald Gray, a professor in the Johns Hopkins Bloomberg School of Public Health, told The Wall Street Journal. And note that postponing a pick comes with catches. “Delaying circumcision until boys are 18 years old and can legally provide consent is a bad idea because at that point the procedure is more complex and has a higher rate of complications. It also would deprive boys of circumcision’s benefits during childhood and adolescence.”