Issues to consider

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Although circumcision is fairly common in the United States, it's still controversial. There's some evidence that circumcision may have medical benefits. But the procedure also has risks. The American Academy of Pediatrics doesn't currently recommend routine circumcision of all male newborns, saying there isn't enough evidence of benefit.

Consider your own cultural, religious and social values in making this decision. For some people, such as those of the Jewish or Islamic faith, circumcision is a religious ritual. For others, it's a matter of personal hygiene or preventive health care. Some parents may not want their son to look different from his family members or peers.

Some people feel strongly that circumcision is disfiguring to the baby's normal appearance. Some feel it's wrong to circumcise a boy when he's too young to consent. Still others feel that circumcision is unnecessary.

As you decide what's best for you and your son, consider these potential health benefits and risks.

Potential benefits of circumcision

Some research suggests that circumcision has health benefits, including:

• Decreased risk of urinary tract infections (UTIs). Although the risk of UTIs in the first year is low, various studies suggest that UTIs may be as much as 10 times more common in uncircumcised baby boys than in those who are circumcised. Uncircumcised boys are also more likely to be admitted to the hospital for a severe UTI during the first three months of life. Severe UTIs early in life can lead to kidney problems later on.

• Decreased risk of cancer of the penis. Although this type of cancer is very rare, circumcised men show a lower incidence of cancer of the penis than do uncircumcised men.

• Slightly decreased risk of sexually transmitted diseases (STDs). Some studies have shown a lower risk of human immunodeficiency virus (HIV) and human papillomavirus (HPV) infections in circumcised men. Still, safe sexual practices are much more important in the prevention of STDs than is circumcision.

• Prevention of penile problems. Occasionally, the foreskin on an uncircumcised penis may narrow to the point where it's difficult or impossible to retract, a condition called phimosis. Circumcision may then be

How is circumcision done?

If you decide to have your son circumcised, ask your son's health care provider for advice on whether circumcision is permissible or advisable. Your son's doctor can also answer questions about the procedure and help you make arrangements at your hospital or clinic.

Usually, circumcision is done before you and your son leave the hospital. At times, circumcision is done in an outpatient setting. The procedure itself takes about 15 minutes. It's generally done before the morning feeding.

Typically, the baby lies on a tray with his arms and legs restrained. After the penis and surrounding area are cleansed, an anesthetic is injected into the base of the penis. A special clamp or plastic ring is attached to the penis, and the foreskin is cut away. An ointment, such as petroleum jelly, is applied. The penis is then wrapped loosely with gauze.

After circumcision, it's OK to wash the penis while it's healing. In the first week, there may be a yellowish mucus on the skin, but this is normal. Apply petroleum jelly to the tip of the penis to keep it from sticking to the diaper. It takes about seven to 10 days for the penis to heal.

Problems after circumcision are very rare. But call your baby's doctor immediately if your baby isn't urinating normally, if there's persistent bleeding or if you suspect an infection.

needed to treat the problem. A narrowed foreskin can also lead to inflammation of the head of the penis (balanitis).

• Ease of hygiene. Circumcision makes it easy to wash the penis. But even if the foreskin is intact, it's easy to keep clean. Normally the foreskin adheres to the end of the penis in a newborn, then gradually stretches back during early childhood. Simply wash your baby's genital area gently with soap and water. Later, when the foreskin fully retracts, your son can learn to wash it properly by gently pulling the foreskin back and cleansing the tip of the penis with soap and water.

Potential risks of circumcision

In general, circumcision is considered to be a safe procedure, and the risks related to it are minor. Several studies found the overall complication rate of circumcision to be around 0.2 percent. Circumcision does have some risks and possible drawbacks, including:

• Risks of minor surgery. All surgical procedures, including circumcision, carry certain risks, such as excessive bleeding and infection. There's also the possibility that the foreskin may be cut too short or too long, or that it doesn't heal properly. If the remaining foreskin reattaches on the end of the penis, a minor surgery may be needed to correct it. These occurrences are uncommon.

• Pain during the procedure. Circumcision does cause pain. Typically a local anesthesia is used to block the nerve sensations. Talk to your doctor about what type of anesthesia might be used.

• Difficult to undo. Following most circumcisions, it would be difficult to recreate the appearance to look uncircumcised.

• Cost. Some insurance companies don't cover the cost of circumcision. If you're considering circumcision, you may wish to check whether your insurance company will cover it.

• Complicating factors. Sometimes, circumcision may need to be postponed, such as if your baby is born prematurely. In some situations, circumcision shouldn't be done. That may be the case when the baby's urethral opening is in an abnormal position on the side or base of the penis (hypospadias). This condition is treated surgically and may require the foreskin for repair. Other conditions that may prevent circumcision include an illness with high fever, ambiguous genitalia, or a family history of hemophilia.

Circumcision doesn't affect fertility or prevent masturbation. Whether it enhances or detracts from sexual pleasure for men or their partners hasn't been proved. Research on circumcision is ongoing. More studies are needed to verify some of the claims made about the procedure. The good news is that whatever your choice, negative outcomes are rare and mostly minor.

Circumcision care

If your newborn boy was circumcised, the tip of his penis may seem raw for the first week after the procedure. Or a yellowish mucus or crust may form around the area. This is a normal part of healing. A small amount of bleeding is also common the first day or two.

Clean the diaper area gently and apply a dab of petroleum jelly to the end of the penis with each diaper change. This will keep the diaper from sticking while the penis heals. If there's a bandage, change it with each diapering. Sometimes a plastic ring is used instead of a bandage. The ring will remain on the end of the penis until the edge of the circumcision has healed, usually within a week. The ring will drop off on its own. It's OK to wash the penis as it's healing.

Problems after a circumcision are rare. But call your baby's health care provider in the following situations:

• Your baby doesn't urinate normally within six to eight hours after the circumcision.

• Bleeding or redness around the tip of the penis is persistent.

• A foul-smelling drainage comes from the penis tip or there are crusted sores that contain fluid.

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