The debate over circumcision is centuries old. Worldwide, about 25% of males undergo this procedure. In the United States, over 60% of males are circumcised. New evidence has recently emerged that brings forth additional benefits of this procedure, making it more appealing to new parents.
Parental decision about circumcision is often based upon religion, culture, social, and medical factors. In order to make an informed decision, parents must weigh the benefits versus the risks very carefully.
There is a growing need for obstetricians and pediatricians to provide parents with this knowledge and to help them make their decision. Unfortunately, only one-third of the participants in one study received ANY information from their health care providers regarding circumcision, and 40% of them felt that they had not been provided with enough information to make an informed decision (Pediatrics, 2001).
Documented Benefits
The literature shows that circumcision gives protection against a variety of conditions:
1) Urinary tract infections
The risk of urinary infections in uncircumcised males is 10 to 20 times greater as compared to circumcised males. The greatest risk occurs during the first year of life. However, increased risk of infection has been shown to continue into preschool and adult life. The consequences of urinary tract infections can be severe and include dissemination to the blood, meningitis, kidney infections and renal scarring. High blood pressure, and severe renal disease later in life can also occur.
2) Penile cancer
Penile cancer is relatively rare (1 per 100,000 males in the United States). Nonetheless, many studies have shown a three fold increased risk of penile cancer as well as precancerous lesions in uncircumcised men. Circumcision later in life offers only partial protection.
3) Prevention of HIV and other Sexually Transmitted Diseases (STDs)
Recent studies (March 2009) have shown circumcised males at lower risk for herpes, HPV infections as well as HIV. In addition, reducing the risk of STDs to the male will decrease transmission to females and may have an impact on decreasing the risk of cervical cancer.
4) Decrease risk of penile problems
Uncircumcised men suffer a higher incidence of phimosis (narrowing of the opening of the foreskin) and balanoposthitis (inflammation of the foreskin and head of the penis).
Risks of Circumcision
The risk of circumcision is low and has been reported to be 1 out of 476 cases (0.20% risk).
Some of the mentioned complications include:
1) Necrotizing fasciitis and cellulitis
This includes severe skin infections requiring antibiotic therapy and hospitalization.
2) Hemorrhage
As with other surgical procedures circumcision can result in bleeding. Bleeding can be controlled with conservative measures (pressure or gauze of epinephrine solution) or might require suture of an artery, vein, or an other vessel. Some infants can have bleeding abnormalities at birth and should not have this procedure performed.
3) Injury
In order to avoid penile injuries the clinicians performing circumcisions must be experienced, well trained and familiar with the equipment used to perform the procedure. Certain congenital penile abnormalities require an experienced pediatric urologist to perform the procedure. Other abnormalities such as hypospadias are an absolute contraindication to perform circumcision since the foreskin is an important tissue source to repair this defect.
Poor technique can lead to penile injury, deformities and long-term physical and emotional consequences to the child and his family.
4) Pain to the newborn
Local anesthesia is highly recommended for circumcision and is gaining wider acceptance. Various types of local anesthetic techniques are available. The proper technique can be tailored to the individual case.
5) Meatal stenosis
Narrowing of the urethral opening is generally caused by infection and inflammation. It presents on an average of 48 months after the circumcision is performed and needs to be identified and treated immediately to prevent further damage.
In conclusion, evidence as to the benefits of circumcision is mounting. The American Pediatric Association, however, does not advocate routine neonatal circumcision. The parent’s decision as to whether to circumcise their son should be made after receiving proper counseling regarding the risks and potential benefits of this procedure, as well as their cultural and religious background. Experienced clinicians should advise the couple and assist them in making a good decision. Finally, an experienced clinician using local anesthesia should perform the procedure.
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