CIRCUMCISION: To Do or Not To Do, is the Question!

Circumcision is not a subject most of my readers ever give much thought. Folks in our age group aren’t having newborns and are long past having to make the decision whether to circumcise their infant. It’s a topic that never comes up in casual conversation, but in our day, nearly every male newborn had it done. It was a given. I suspect upward of 95% of babies born in the 1940’s were circumcised.

Circumcision is the surgical removal of the skin covering the head (glans) of the penis. This procedure is most often done during the first two days of a healthy male infant’s life and takes less than 5 minutes. The reasons for circumcision are many, but the main emphasis is on genital hygiene.

In the 1970’s and 80’s, attitudes changed and circumcision rates began declining until today only about 50-60% of boys are circumcised. Jewish and Islamic families, however, still practice circumcision as a religious and cultural ritual so virtually 100% of those males undergo the procedure.

Controversy and disagreement still surround circumcision with some adamantly against it and others recommending it for all infant boys. The American Academy of Pediatrics (AAP) has stated that the benefits outweigh the risks, but don’t recommend it for all infants. Their position calls for parents to make an informed decision based on counsel from their physician. They stop short at a blanket recommendation, but acknowledge its worth.

What are the benefits of removing that quarter-inch piece of foreskin?

1. Circumcision reduces the chances of a urinary tract infection in the first 6 months of life.

2. Circumcision improves genital hygiene. The excess skin over the glands traps bacteria

and allows them to multiply causing infection. Removing it eliminates that problem.

3. Circumcised men have a lower incidence of the relatively rare penile cancer.

4. Circumcised men have a lower risk of a sexually transmitted disease (STD).

5. Circumcision prevents the skin from contracting, tightening, and being unable to retract.

This prevents phimosis (shrinkage and contraction) and balanitis (foreskin infection).

6. Studies have shown that circumcision lowers the risk of getting HIV.

7. Circumcised boys look the same as their circumcised fathers or brothers.

Circumcision should not be done in these circumstances:

1. The infant’s parents don’t want it done.

2. If the infant is born prematurely (a preemie).

3. The infant has congenital abnormalities

4. The infant has bleeding problems or a family history of bleeding disorders.

5. The infant appears unhealthy or unstable.

The two most frequently used methods of circumcision are the Gomco clamp and the Plastibell. I used both but preferred the Plastbell, finding it much easier to use, and bleeding was never a problem.

The Plastibell is a plastic, bell-shaped ring with a short handle attached. The bell fit over the glans and was tied in place with a ligature. The excess skin was excised and the handle detached leaving the bell securely in place. In 5-7 days, the foreskin healed and the bell fell off in the infants diaper. The results were always good, and bleeding was never a problem.

The Gomco Clamp is a metal device with three parts—a base, an arm, and a bell. The advantage to this procedure was when you were done, you were done. There was no bell left to fall off. But the incision often oozed blood and had to be wrapped in Vaseline gauze. Using a Gomco was a more difficult procedure, and the results were messier. They often oozed blood and looked angry.

The real complaint about infant circumcision isn’t so much whether it’s beneficial or not, but that the procedure is most often done without anesthesia and is traumatic for the newborn. The baby’s arms and legs are strapped to a restraining device, and since the procedure takes only 1-2 minutes, no anesthetic is employed. There is pain for a short time, but infants don’t remember it, and afterward, the healing penis seems not to be sensitive.

Complications of circumcision are rare and results are usually good. Swelling, redness, and bleeding can occur but are not usually significant. Occasionally too much or not enough foreskin is removed, but if done by an experienced practitioner that should not happen. Care required after circumcision is minimal and healing is complete in 7-10 days.

Dr. G’s Opinion: Attitudes toward Circumcision, like vaccinations, have become skewed in recent years. I don’t equate the importance and life-saving capability of vaccines to circumcision, because there is no comparison. It’s more the shift in public sentiment about such things. The hygienic significance of circumcision has been de-emphasized while any negative consequences have been magnified. It’s the same with vaccines—the benefits have been forgotten over unsubstantiated fear of harm.

I’m not a circumcision fanatic. However, I do agree with the AAP that the benefits outweigh any risks, and that parents need unbiased information and advice before deciding to have it done. I do believe circumcision has a positive benefit for men in adulthood. Studies have proven that. And I saw several elderly men who had to have it done after they developed balanitis (foreskin infection) and phimosis (adhesions that prevented retraction of the foreskin). Circumcision at age 70+ is an unpleasant procedure.

Infant circumcision has become a less-often done procedure, but it still has benefits that should be recognized. I can honestly tell you, those men who had it done in their 70’s or 80’s wish their parents had chosen to do it when they were infants.


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