A. Circumcision of the newborn male has been a topic of debate for well over 25 years now in North America. A large number of papers in medical journals have attempted to address the issues and a growing interest in the lay media has certainly added to the debate. Although a whole host of factors may come into a parents decision about whether or not to circumcise their son (religious tradition, cultural tradition, family tradition), I will limit my response to the medical tradition: whether circumcision of the newborn son is medically indicated or not.
Circumcision is one of the oldest known surgical procedures, but despite thousands of years of precedent, the medical need for it has never been definitively established. Statistically speaking, approximately 1 in 7 males worldwide is circumcised. More than 1 million circumcisions are performed each year in the USA, and the procedure is considered uncommon in Europe.
In 1971, 1975 and again in 1983 the American Academy of Pediatrics and the American College of Obstetrics and Gynaecology issued statements saying it was their opinion that "there is no absolute medical indication for routine circumcision of the newborn". Since the 1975 report, new evidence has been questioning these statements and suggesting medical benefits to routine circumcision. The main issues now include whether or not routine circumcision reduces the incidence of urinary tract infections, cancer of the penis, and sexually transmitted diseases. Because of new evidence, by 1988 the physicians of California had begun endorsing the routine procedure of circumcision. In 1989 the same groups that had issued statements in 1971,1975 and 1983 had issued a new statement which stated that there are "potential medical benefits and advantages" to routine circumcision. Let's look at the issues:
URINARY TRACT INFECTIONS (UTI)
Beginning in 1985, a number of large scale studies have repeatedly shown a greater than tenfold increase in urinary tract infections in uncircumcised boys as compared to those that were circumcised. Other authors have noted that in areas where circumcisions are being done less often, they are finding increasing incidences of UTIs in young boys. So what? Well, most can be easily treated with antibiotics. But some of these UTIs progress to scarring of the kidney. If you believe that it only takes one urinary tract infection to initiate the complications that can lead to scarring of the kidney...well, then the difference in incidences of infections in uncircumcised boys compared to those who were circumcised becomes very important.
CANCER OF THE PENIS
Cancer of the Penis is an uncommon disease with an incidence of less than 1 in 100,000 men in the USA. This condition occurs almost exclusively in uncircumcised men. In fact, of the reported 60,000 cases of penile cancer in the USA since 1930, less than 10 cases occured in circumcised men. There is also a theory that cancer of the penis is related to personal hygiene, but no reports have ever shown that proper hygiene is as effective against penile cancer as circumcision.
SEXUALLY TRANSMITTED DISEASES
The most polite way to put the results of these studies would be that they are "conflicting". Early studies suggested a higher incidence of gonorrhea, syphillis, chancroid, herpes, and Human Papilloma Virus in uncircumcised men, but other studies do not show this higher incidence. Problems in the methodology used in most of these reports make them inconclusive. Recent studies suggesting higher risks of HIV infection have refuelled this debate, but more studies are needed.
And what of other issues? What about foreskin problems in childhood. These would be eliminated if every boy was circumcised. But does it make sense that every boy should be circumcised so the few will not suffer in the future? Complication rates of circumcisions are about 0.2%-0.6% with mortality in 1 in every 500,000. And babies do feel pain.
BOTTOM LINE
A discussion amongst both parents and the family doc, taking into consideration family, cultural, religious and medical traditions will hopefully bring you to a decision regarding circumcision for your son.
Some sources
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