For expecting parents, preparing for a new baby comes with a number of decisions, including planning for their child’s healthy start to life.
For parents expecting a baby boy, the question of whether to circumcise is one of those decisions that needs to be made ahead of time, as hospital circumcisions are generally performed within 48 hours of birth.
Circumcision, the surgical removal of the skin covering the tip of the penis, dates back to before biblical times. Trends in circumcision for male newborns fluctuate nationally and regionally, but the World Health Organization estimates that overall male circumcision is currently somewhere between 76 and 92 percent in the United States. Interestingly, U.S. rates are much higher than most Western European countries where rates are estimated at less than 20 percent.
It can be a confusing decision for new parents who may be influenced by trends from their own parents’ generation, as well as recent ethical debates regarding a newborn’s rights to what is an irreversible surgical procedure. To add to the confusion, scientific research continues to result in recommendations that go back and forth on the benefits versus the risks. In 1970, the American Academy of Pediatrics (AAP) task force reported there were no medical benefits for routine circumcisions. However, in 1989, AAP revised its position, stating there were potential medical benefits to newborn circumcision.
A decade later, the AAP switched gears again, declaring that despite the potential medical benefits of newborn male circumcision, there was insufficient evidence to recommend routine circumcision. And then in 2012, AAP again restated its position, saying that the benefits of circumcising boys outweighed the risks, but because the risks vary, these benefits were not great enough to recommend that all newborns be routinely circumcised. Ultimately, according to AAP, the final decision should be left to the parents.
To confuse the issue more, the American Cancer Society reports that men who were circumcised as children have a lower chance of getting penile cancer than those who were not. According to the American Cancer Society, the reason for lower risk isn’t entirely clear, but it may be related to other known risk factors, including evidence that men who are circumcised can’t develop phimosis, the inability to retract the foreskin covering the head of the penis. Penile cancer is more common in men with phimosis, possibly related to the buildup of smegma, secretions made up of shed skin cells, skin oils and moisture, that can collect underneath an intact foreskin. Irritation and inflammation of smegma buildup under the foreskin has been associated with a slight risk factor for penile cancer.
Never miss another Cancer Talk blog!
Sign up to receive our monthly Cancer Talk e-newsletter.Sign up!
The good news is that even with the changing recommendations, penile cancer is very rare in the United States. It’s estimated that to prevent one case of penile cancer, more than 300,000 baby boys might need to be circumcised, making the decision to circumcise much less about reducing risks for cancer, and more about following religious, social or cultural beliefs. Fathers who are circumcised may choose to have their sons circumcised so that they look the same as Dad, making the decision an emotional one rather than one that potentially reduces health risks.
“The only reason to have a circumcision in America is for cosmetic reasons - if you want to look like everyone else,” says James Mohler, MD, Associate Director and Senior Vice President, Translational Research, Chief, Inter-Institutional Academics, and Professor of Oncology. “Cancer risk is not lowered if you live in an area with good personal hygiene, but cancer risk may be lowered by circumcision if one is unable to keep their foreskin washed properly,” says Dr. Mohler.
For those parents who do decide to have their baby boys circumcised, pain medications that are safe and effective can reduce the trauma associated with the procedure. Following proper care, as recommended by your doctor will reduce the risk of infection and promote healing, which typically takes 7-10 days. For boys who are not circumcised, the intact foreskin will naturally separate from the glans, the tip of the penis, during the first years of life. No special cleansing is required, other than regular bathing with soap and warm water. By age 18, most boys will be able to retract their foreskins fully, allowing for safe cleaning.
Deciding to circumcise or to not circumcise can feel overwhelming for some, so give yourself time to reflect on your decision and weigh in with the reasons that will ultimately affect your child. Whatever decision you do make, be sure speak to your pediatrician about the best way to care for your baby and ensure the best and safest outcome.