A pediatrician's guide to circumcision

The practice of male circumcision dates back as far as ancient Egypt when it was performed to improve hygiene and for purification.

Today, approximately 70 percent of all newborn boys in the United States undergo circumcision making it the most common procedure in this population.

In the absence of certain medical conditions or anatomic abnormalities, circumcision during the newborn period is an option you may want to consider for your baby. The decision should be made on the basis of accurate and unbiased information from your physician regarding the medical implications, taking into account your personal, religious and cultural beliefs and traditions.

What happens during circumcision?

Circumcision in the male refers to the surgical removal of the foreskin of the penis. For infant circumcision, different clamps can be used, but the same basic procedure is followed.

First, the amount of foreskin to be removed is estimated and marked before it is opened with a scalpel to reveal the glans underneath. The inner lining of the foreskin is then separated from its attachment to the glans. The device is then placed and remains until blood flow has diminished.

Finally, the foreskin is removed. When performed in the hospital, circumcision is typically performed by a pediatrician, obstetrician, family medicine doctor, surgeon or urologist.

Circumcisions for religious reasons are sometimes done during ceremonies outside of the hospital, by a non-medical person trained in the procedure.

Does it hurt?

Studies have shown that newborns undergoing circumcision exhibit behavioral and physiological signs of stress, such as irritability and increased heart rate and blood pressure.

The stress may be due, in part, to the fact that infants are restrained prior to a circumcision. Still, both the American Academy of Pediatrics (AAP) and American College of Obstetricians and Gynecologists (ACOG) have clear guidelines which recommend using something to control the pain during the procedure.

Pain control measures include oral solutions, like a pacifier dipped in sugar water; topical anesthetics, like numbing creams containing Lidocaine; and/or a local nerve block, such as an injection of Lidocaine to the base of the penis.

But rest assured mom and dad – when performed properly – pain and complications are minimized.

What are the advantages?

Circumcision has been associated with a number of medical benefits for the newborn and later in life.

In general, genital hygiene is easier in the absence of the foreskin. Circumcised males are less likely to develop urinary tract infections (UTI), especially in the first year of life.

In a study of male infants under three months of age with fever, the prevalence of UTI was 2.4 percent in circumcised infants compared to more than 20 percent in the uncircumcised group. In addition, older circumcised males are believed to be at lower risk for penile cancer and sexually transmitted diseases including HIV and herpes virus.

What can go wrong?

While the chance that something can go wrong is relatively low when a circumcision is performed by a trained medical professional, like any procedure, it does carry some risk.

The two most common problems are bleeding and local infection. That said, most bleeding can be controlled with applying pressure and many infections can be treated with a short course of topical or oral antibiotics. Rarely, adhesions or unsatisfactory cosmetic results can occur.

Overall, the decision should be made on an individual basis. In a 1999 policy statement the AAP recognized the potential benefits of newborn circumcision; but they determined that the data was not sufficient enough to recommend routine circumcision since the procedure “is not essential to the child's current well-being.”

Together with your obstetrician and pediatrician, you should discuss the pros and cons of circumcision to determine what’s best for your child.

Dr. Corey Wasserman is a resident pediatrician at New York Presbyterian Hospital-Weill Cornell Medical Center. She received her undergraduate degree in psychology with an emphasis on child development at Bucknell University and went on to attend Jefferson Medical College in Philadelphia, where she received her M.D. and graduated with high honors.