Deciding Whether to Circumcise Your Baby Boy

Dr. Vilma Ruddock, M.D.

Dr. Vilma received her M.D. in Obstetrics, Gynecology, Infertility and Reproductive Endocrinology from Harvard. With twenty years of practical experience, she knows everything there is to know about babies, from their gestation to their birth and beyond.

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Like many parents, you may have difficulty deciding whether to circumcise your baby boy. Some people consider circumcising their infant not for medical benefits, but because of deeply-rooted religious, cultural or family traditions. To help you decide, talk to your doctor about all the pros and cons, including the potential medical benefits and risks.

Pros and Cons of Circumcision

According to the 2012 American Association of Pediatrics (AAP) Task Force report, the benefits of circumcision of a baby boy outweigh the risks. They note, however, that though the risks are small, the benefits are not great enough to recommend routine newborn circumcision and that it's up to you to decide.

Potential Benefits of Circumcision

Deciding to circumcise is a decision that all parents who have boys will be faced with in the hospital. It is best if you are educated before the birth so you have a plan of action at the hospital and aren't forced into making a decision one way or the other when you're not quite at your best. While there are risks to circumcision, studies support the idea that there are some potential benefits.

Easier hygiene: Kidshealth.org notes that it is easier to keep the head of circumcised penis (glans) clean of secretions. (They do also note that boys can be taught to keep the foreskin clean as well.)
Decreased Risk of Diseases: According to Center for Disease Control review, there does appear to be a decrease risk of a few infections and diseases:
- Urinary tract infections: The risk of urinary tract infections (UTIs) is lower in uncircumcised children. However, the overall risk of UTIs in male children is only about 1% to begin with, according to CDC.
- Sexually Transmitted Infections (STIs): There appears be a decreased risk of acquiring an STI, such as HIV, and of passing on an STI such as HIV and the human papilloma virus (HPV) to a sexual partner.
- Penile Cancer: Penile cancer appears to be less common in circumcised men, however penile cancer is rare in the overall population.
- Cervical Cancer in Female Partners: There is a decreased risk of cervical cancer in female partners of circumcised men because of the lower risk of passing on an HPV infection.

It is important to note that safe sex practices, especially the use of condoms, is the primary prevention of STIs, not circumcision.

Risks of the Procedure

According to a 2011 review in the Scientific World Journal, though uncommon, there are a few surgical risks to your baby for you to consider before deciding to have him circumcised. The major complications are rare and the more common complications are minor, according to this review. These risks include:

Bleeding: There is a small risk of persistent bleeding from the raw skin edges where the penile foreskin was removed because it is not stitched after the procedure.
Infection: As with any surgical procedure, there is a small risk of infection, though the risk is low with a circumcision.
Improper Healing: The incision may not heal properly, scarring or disfiguring the penis and requiring a corrective procedure
Botched Procedure: Removal of too much skin can lead to poor healing and disfigurement. If too little skin is removed a second procedure may be needed to complete the job.

The risk of complications is 0.2% to 0.4% of procedures, with bleeding and infection the most common, according to the CDC review and the AAP Task Force report.

Concerns About Circumcision

The American College of Obstetricians and Gynecologists' (ACOG) patient education leaflet, states that some parents may decide against circumcision because of:

Ethical Concerns of Doing it So Early: According to a 2015 article in the Kennedy Institute of Ethics Journal, various medical groups in Europe argue that the degree of the risks and the benefits is not clear, and that there are ethical considerations that are not resolved, such as the inability of the infant to give consent. There is also the possibility that when your boy grows gets older he may regret that the procedure was done; once it's done it can't be undone.
Lack of Anesthesia: Historically all newborns and infants were circumcised without anesthesia or pain medicines. The AAP recommends using topical analgesia for circumcision procedures.
Psychological Effects: According to a 1999 review in the British Journal of Urology International, there is some evidence that circumcision has a negative impact on infant behavior and maternal-child bonding. It may possibly also have long-term psychological effects.
Future Effect on Sexual Function: Despite popular concern, according to the CDC review, there is no conclusive evidence that circumcision, or lack of it, affects sexual arousal or sexual satisfaction in any way.

Pros and Cons of Not Circumcising Your Baby

Many men who were not circumcised as an infant go through life without major penile problems.

Benefits of Not Circumcising

Avoid the Risks of Surgery: Though surgical risks are small, and complications are uncommon, not circumcising avoids the potential for infection and scarring during healing.
Protection of the Glans of the Penis: The foreskin of your uncircumcised baby's penis protects the glans from getting irritated by wet or soiled diapers.

In addition, anti-circumcision groups such as Doctors Opposing Circumcision argue that, beyond protection, the foreskin contains many nerve endings which are important for a man's sexual response and therefore should be left intact.

Problems of Not Circumcising

More Complications Later: According to a 2014 study in JAMA Pediatrics, the risk of complications of circumcision were 10 to 20 times greater when done in older boys and men.
Later Procedure more Difficult to Handle: A newborn or early infant will have no conscious memory of recovery from the procedure, whereas an older boy or man will, making it more difficult to handle. General anesthesia with its added risks may also be needed at an older age.
Difficulty With Cleaning: Smelly secretions and dead cells can collect underneath the foreskin of an uncircumcised penis which might be difficult to clean. Knowing how to care for the uncircumcised penis from birth should prevent problems of inflammation and infection, according to a 2002 review in Contemporary Pediatrics.
Risk of Persistent Phimosis and Infection: in the normal young penis the glans is attached to the foreskin by adhesions (phimosis). According to a 2007 review in Canadian Family Physician, in 99% of boys these adhesions disappear by age 16. If they do not, or scarring occurs at the end of the penis (pathologic phimosis) an d the fore sk in ca n't be roll ed back , the glans may become inflamed. There is a small chance your child may need circumcision when he is older if other treatments don't work.
Interference With Urination: Phimosis may also cause obstruction of the flow of urine out the end of the penis, according to the Canadian Family Physician review, and may require circumcision to correct.
Small Increased Risk of Diseases: Not circumcising increases the risk of UTIs, STIs and penile cancer, as noted in the AAP report and the CDC review.

A Personal Decision

In the absence of significant health benefits, and therefore no compelling medical reasons, the decision to circumcise your baby boy is a personal one.

If you are struggling with your decision, discuss the pros and cons of circumcising your baby with your healthcare providers. Have the discussion weeks before delivery even if you don't know the gender of your baby.