INFANT CIRCUMCISION
FAQ
Compiled from various sources by
Geoffrey T. Falk
What is circumcision?
Circumcision is the surgical removal of the sleeve of skin
and mucosal tissue that normally covers the glans (head) of the penis. This
double layer, sometimes called the prepuce, is more commonly known as the
foreskin.
Parents are encouraged to read as much as possible about
circumcision. They should make themselves aware of the complexities of the
circumcision procedure itself. Speak to your doctor about the step-by-step
procedure. If possible, ask to observe a circumcision at your hospital, so
that you will know fully what is involved.
Pictures and video of a circumcision are available
on the Circumcision Information and Resource Pages (CIRP) website.
What is the foreskin there for?
The foreskin serves three functions: protective, sensory,
and sexual.
In most cases, the foreskin is still fused to the glans at
birth and will separate over a variable period of time over the first few
years. During the diaper period, the foreskin protects against abrasion from
diapers and feces. Throughout life, the foreskin keeps the glans soft and
moist and protects it from trauma and injury.
Parts of the foreskin, such as the mucosa (inner foreskin)
and frenulum, are particularly sensitive and contribute to sexual pleasure.
Specialized nerve endings enhance sexual pleasure and control
[19].
The foreskin provides ample loose skin for the penis to
occupy when erect. It is a movable skin sheath for the penis during
intercourse, reducing chafing and the need for artificial lubricants, and
allowing the glans and foreskin to naturally stimulate each other. Warren
and Bigelow described some of the physiological functions of the foreskin in
sexual activity. [1]
What are some reasons that circumcision is
performed?
Circumcision is primarily performed for cultural or
religious reasons.
Because a large number of men in English-speaking Western
countries are circumcised, many think of the foreskin as an unnecessary part
of the penis. Many circumcisions are performed because a circumcised father
often does not want to feel that he is different from his son.
It is often said that a circumcised penis
is cleaner, or easier to keep clean, than an intact penis.
Smegma (a natural substance composed of dead skin cells, normal flora, and
secretions containing the natural antibacterial agent lysozyme) is more
likely to accumulate when the foreskin is present.
Medical grounds for circumcision that are most commonly
cited are: Reduced risk of urinary tract infections (UTI); reduced risk of
penile cancer; reduced risk of cervical cancer in partners of intact males;
reduced risk of sexually transmitted disease (STD).
There is contradictory evidence in the research literature
as to whether circumcision reduces UTI [16,17], but
this seems to be the strongest of all medical claims in favour of
circumcision, because UTI can have serious consequences. These infections
can, however, in most cases be treated by antibiotics. The frequency of UTI
in US male infants is approximately 1%, but is higher for females. There is
evidence that babies who are breastfed have a lower incidence of UTI.
[8]
Penile cancer is an extremely rare form of cancer. It occurs
mostly in older men, and most doctors will not recommend infant circumcision
as a preventative measure. Penile cancer can occur in both circumcised and
intact men: The Maden study (an ongoing study of penile cancer at Fred
Hutchinson Cancer Research Center in Seattle) observed that 37% of penile
cancer cases occurred in circumcised men. [2]
The theory that wives of men with intact foreskins are more
prone to cervical cancer has been disproven [12]. The
theory that the presence of a foreskin may cause an increased risk of
sexually transmitted diseases was disproved by a new study
[22]. The question of HIV warrants further study [20],
[7]. Although there is an
apparent geographical correlation between male non-circumcision and HIV
infection on the African continent, this is not true globally, and the
pattern seen in Africa could easily be due to other factors.
The only known effective means of preventing HIV infection
are fidelity, condom use and abstinence.
The
foreskin is easy to care for and the intact penis is easy to keep clean.
The foreskin usually does not fully retract for several years and should
never be forced. When the foreskin is fully retractable, boys should be
taught the importance of washing underneath the foreskin every day.
Gently rinsing the genital area while bathing is sufficient.
Harsh soap and excessive washing can irritate the penis, which can lead to
inflammation of the glans (balanitis). [24]
Smegma is a white waxy substance that can appear under the
foreskin. It consists of natural secretions and shed skin cells. In the past
it was feared that smegma might be carcinogenic, but this has been disproven.
Good general hygiene and common sense are key to preventing infection and
disease.
If my son isn't circumcised, won't it have to be
done later?
Abnormalities or diseases of the foreskin can be treated
conservatively, if and when they occur, on a case-by-case basis.
Probably the most common abnormality of the penis is
"phimosis", or tight foreskin. (This is not the same as the natural
attachment of the foreskin to the glans in very young children, which is
completely normal.) The foreskin can normally be retracted by adolescence.
If retraction is not possible, a number of newer treatments
are available which do not involve circumcision: Steroid creams, stretching,
and preputioplasty. [18] Some of these treatments have
only been published recently, and not all doctors are aware of them.
If your son has a serious problem with his foreskin, such as
a severe infection (balanitis xerotica obliterans) or gangrene, perhaps
related to diabetes, removal of the affected area may be a medically
advisable option.
If my son isn't circumcised, won't he be teased?
Children can be cruel, and will find things to pick on
another child about, whether it be his chubbiness, glasses, or freckles.
Some parents think that their son should be circumcised so that he will
"match" his father, brothers, or friends. As parents, we can help our
children to feel good about their bodies and to respect individual
differences.
Parents often express a fear that their son will "feel
different in the locker room" if he is intact. There is good evidence that
proper education is the answer. Boys who are taught from an early age that
they are normal, whole and healthy will have a lesser chance of suffering
embarrassment in the locker room, especially if some of the other boys are
also intact.
Nonreligious infant circumcision is not an issue in
European, Asian or South American countries. In Canada the average rate of
infant circumcision for boys is roughly 25%, with large regional variations.
The rate in the United States has dropped to less than 60%, and will drop
below 50% in a few years if present trends continue. This is already true in
the Western US (35% in 1993).
What are some reasons not to have my son
circumcised?
Your son's foreskin is a healthy, natural part of his body.
It is possible, though very unlikely, that it will cause serious problems
during his life. When he becomes an adult, he may prefer not to be
circumcised. Leaving your baby's foreskin alone preserves his right to a
whole and intact body.
Circumcision will be painful for the baby (see below).
The medical evidence in favor of routine circumcision of
healthy babies is not persuasive. If your son has a problem with his
foreskin, such as a severe infection (balanitis xerotica obliterans) or
gangrene, perhaps related to diabetes, your doctor may recommend partial or
complete circumcision or removal of the affected area. Phimosis (nonretractable
foreskin, if it persists much longer than normal) can usually be treated by
gentle stretching and/or steroid creams. The vast majority of boys will
never have any foreskin problems that necessitate surgery.
[18]
The often repeated statement that babies can't feel pain is
not true. It is documented in the medical literature that babies are as
sensitive to pain as anyone else, and perhaps more so.
[13,14]
Most circumcisions are performed without anaesthetic,
because there are risks involved with using anaesthetics on babies.
Sometimes local injections are used, but this does not eliminate pain. Most
babies will show signs of pain during the procedure and in the week or ten
days following circumcision. Recent studies have shown that the pain is
remembered long beyond the time of the procedure itself.
[23]
While pain may help parents decide against circumcision,
parents should look at the long term effects of their decision first, not
only during infanthood, but all the way to adulthood. Your decision will
affect your son for the duration of his life.
Does infant circumcision have risks?
Circumcision is surgery, and like all surgery it has risks.
These include:
