This Canadian document is very helpful for parents of newborn boys. Parents considering circumcision now have a clearer understanding of the risks and the benefits. The document reassures parents who decide against circumcision that not every newborn boy needs this procedure.
Male circumcision removes a sac of skin (foreskin) that covers the top of the penis (glans). In newborns, the foreskin is attached to the skin of the glans. As boys grow, the attachments release, allowing the foreskin to move freely over the glans. When the foreskin is removed by choice rather than for medical reasons, this is referred to as routine male circumcision.
According to the Canadian Paediatric Society, every 1000 circumcisions of normal male newborns carries the following benefits and risks.
Routine circumcision is done for a variety of reasons. Parents may choose to circumcise their newborn for religious or cultural reasons. Some hope to prevent future complications or disease. Other reasons include personal preference, and concerns about hygiene.
This procedure has several benefits (see sidebar). Studies show that it reduces the risk of bladder and kidney infections in boys less than one year of age. (Bladder and kidney infections are known as urinary tract infections or UTIs.) Circumcision also lessens the risk of sexually transmitted diseases like HIV, herpes, human papilloma virus (HPV), and cancer of the penis. Female partners of circumcised men have a lower risk of cervical cancer.
Occasionally, problems with the foreskin may require circumcision at an older age. Newborn circumcision prevents these problems.
In the past, circumcision helped to lower the rates of HPV and cervical cancer, which are strongly linked. Now that we have an HPV vaccine, it is unclear whether circumcision will still be important for lowering HPV rates.
Circumcising a newborn boy does have some risks (see sidebar). They include bleeding, infection, and meatal stenosis, a narrowing of the hole at the tip of the penis. If the penis is damaged or there are appearance issues as a result, surgery may be required later on.
More serious problems are rare. These include bleeding that requires a blood transfusion, or infection requiring a hospital admission. In extremely rare cases, deaths due to circumcision have been reported.
Some medical care providers think that the Canadian Paediatric Society underestimated the benefits and overestimated the risks of circumcision. They feel there is enough evidence to support routine newborn male circumcision.
Others argue that we should not routinely remove the foreskin because most males will never develop problems with it. They believe that it plays an important role in sexual function. They reassure us that an uncircumcised penis is easy to keep clean.
The main controversy involves the idea of consent. Newborns are too young to agree to the procedure themselves. Their parents must make the decision for them. The worry is that one day the child will regret the decision made on his behalf.
Parents are allowed to decide for their newborn because:
Some parents really struggle with this decision. For this reason, it should be considered before the baby is born. This allows enough time to think about all of the important facts. The risk of complications is lower when circumcision is done before six weeks of age. If the parents disagree about what to do, having an open and honest discussion and reviewing the risks and benefits together is important. Meeting with the doctor who would perform the procedure may also help.
The position statement from the Canadian Paediatric Society reassures us that the risks and the benefits of routine circumcision seem to be in balance. With this information in hand, parents can discuss this decision and explore the most current information with their family doctor.