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| |    The Circumcision Decision by Marjorie Greenfield, M.D. reviewed by Marjorie Greenfield, M.D. Circumcision is a minor surgical procedure to remove the foreskin from the penis. Circumcision is controversial, since it is unclear if there are significant medical advantages, and there are small risks. Many parents who choose circumcision do so for cultural or religious reasons. In the US, newborn circumcision is widely practiced, although the rates vary by region, from about 60 to as high as 90 percent. In contrast, in the UK only a quarter of newborns get circumcised, and in Canada, about half. Why do it? Circumcision may be done as a religious observance (as in Islam and Judaism). Other parents opt for circumcision for cosmetic reasons, so that a boy will look "like his father," for example, or so that he will look like the other guys in the locker room. Many parents worry that if they don't have their baby circumcised at birth he may need it later, when it would be more emotionally traumatic. In 1999, an expert panel of the American Academy of Pediatrics concluded that circumcision does have some demonstrated medical benefits. For example, circumcised infants are significantly less likely to develop infections of the bladder and kidneys. Circumcision also seems to reduce the risk of developing penile cancer and certain sexually transmitted diseases. However, the expert panel did not feel that these benefits were large enough to justify recommending circumcision for all baby boys. Why not do it? Since it isn't clear that circumcision is medically necessary for the majority of newborns, you could say that this procedure is basically cosmetic surgery?with some small risks for the new baby. There are even some who say that circumcision diminishes sexual pleasure, although that hasn't been proven. As for the medical issues, most males, circumcised or not, will never get bladder infections or penile cancer. If you aren't going to circumcise your son, it is important to note that the foreskin can't be pulled down for cleansing in babies, but is usually retractable by the age of four years. A pediatrician or family doctor familiar with the care of uncircumcised children will know what is normal, can help you know what to expect, and is unlikely to recommend circumcision later on. Who performs non-ritual circumcisions? Newborn circumcisions are usually done by the obstetrician or family doctor who delivers the baby. A number of nurse-midwives do circumcisions, also. In some regions of the US it is the pediatricians, instead of the obstetrical practitioners, who do them. Urologists generally only do circumcisions on older children and adults (under general anesthesia), and occasionally on newborns with unusual anatomy. How much does it cost? The cost of non-ritual newborn circumcision varies regionally and by practitioner. The range is from $100 to about $250. In the past, circumcision has been covered by insurance as a necessary expense, but there is a trend for insurance companies to say that it is an unnecessary cosmetic procedure?so check with your insurance carrier if you have any questions. How do we decide? Whether or not to circumcise your newborn is a personal decision, based on your assessment of the medical risks and benefits and your personal feelings about having a circumcised or uncircumcised child. If you are having trouble deciding, make an appointment with your baby's doctor during your pregnancy to talk about the issues.
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