Circumcision-under debate

Circumcision


Definition:


Circumcision is the surgical removal of the foreskin of the penis. It is often performed in healthy boys for cultural or religious reasons. In the U.S., circumcision of a newborn boy is usually done before he leaves the hospital. Jewish boys, however, are circumcised when they are 8 days old.

The merits of circumcision are currently under debate. There is NOT a compelling medical rationale for the procedure in healthy boys. However, some boys have medical conditions where circumcision may be needed.

Many physicians, rather than routinely recommending circumcision for healthy boys, allow the parents to make the decision after presenting them with the pros and cons.

Alternative Names:
Foreskin removal; Removal of foreskin
Description:

A numbing medication (local anesthesia) is recommended during the procedure. It might be injected at the base of the penis, in the shaft, or applied as a cream to reduce pain.

There are a variety of ways to perform a circumcision. Most commonly, the foreskin is pushed from the head of the penis and clamped with a metal or plastic ring-like device.

If the ring is metal, the foreskin is cut off and the metal device removed. The circumcision heals in 5-7 days.

If the ring is plastic, a piece of suture is tied tightly around the foreskin. This pushes the tissue into a groove in the plastic over the head of the penis. Within 5-7 days, the plastic covering the penis falls free, leaving a completely healed circumcision.

A sweetened pacifier or lollipop may be given to the baby during the procedure. This may reduce pain. Tylenol (acetominonphen) may be given afterward.

Circumcision of older and adolescent boys is usually done while the child is completely asleep and pain-free (using general anesthesia). The foreskin is removed and stitched onto the remaining skin of the penis. Stitches that will dissolve (absorbable sutures) are used and will be absorbed within 7 to 10 days.

Indications:

In some faiths, including Judaism and Islam, circumcisions are performed on all baby boys as a religious rite. In some parts of the world, including Europe, Asia, and South and Central America, circumcision is rare among the general population.

Opinions vary among physicians regarding the need for circumcision in healthy boys. Some place great value on the benefits of an intact foreskin, including a more natural sexual response during adulthood.


However, some studies suggest that uncircumcised male infants have an increased risk of urinary tract infections. Other studies show correlations between being uncircumcised and an increased risk of developing penile cancer, some sexually transmitted diseases including HIV, infections of the penis, and phimosis (tightness of the foreskin, not allowing it to retract over the glans penis). The overall increased risk for these conditions is thought to be relatively small.
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Proper hygiene of the penis and safe sexual practices can help prevent phimosis, penile cancer, AIDS, and other sexually transmitted diseases. Proper hygiene is always important, but is thought to be especially important for an uncircumcised male.

The American Academy of Pediatrics revised their policy statement on circumcision in March 1999, and this policy is supported by the American Medical Association. Their summary of the policy is the following:

"Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In circumstances in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. If a decision for circumcision is made, procedural analgesia should be provided."