Circumcision - Still Controversial After All These Years

Introduction: People feel very strongly about whether circumcising a child is a good or a bad idea. Fifteen years ago, the Academy of Pediatrics called the procedure “unnecessary and without merit”; when evidence of an increased incidence of UTI’s in uncircumcised males was discovered, the AAP changed that statement. In 1989 the AAP Task Force waffled:

“Newborn circumcision has potential medical benefits and advantages as well as disadvantages and risks.” On the other hand the Canadian Paediatric Society in 1996 stated: “Circumcision of the newborn should not be routinely performed.” In 1999, the AAP has again stated that circumcision is not routinely indicated.

Despite all the controversy, in the US, circumcision is still the most commonly performed surgical procedure in males.

Pros and Cons of Circumcision:

Pros: Hygiene easier, reduced cervical cancer in spouses of circumcised males (may be due to HPV), reduced incidence of sexually transmitted diseases (not all agree), reduced number of foreskin cancers, reduced Urinary Tract Infections (while some articles very definitive on this subject, others not as conclusive), reduced phimosis, paraphimosis and balanitis, locker room issues.

Cons: May be an unnecessary procedure, can have complications such as amputation of the penis, scarring of the penis, bleeding and infection of the penis; procedure can have bad cosmetic results; if done after the neonatal period, procedure is much more difficult requiring hospitalization; some worry about potential psychological effects because of lack of anesthesia.

Pain Control During the Procedure: Most pediatricians consider it the standard of care to try and control pain when doing this procedure. Either do a penile block can be done or other methods such as giving sucrose (Arch Ped & Adol Med 98;152:279-284) are routinely done. Recent study: Pediatrics June 98: Pediatricians use anesthesia in 71% of cases; FPs in 56% of cases and Obs in only 25% of circumcisions done.

Voiding After the Procedure: Article Arch Ped & Adol Med June 98: no need to be concerned about this. Children can be sent home right after procedure. First void could be up to 10-12 hours after the procedure.

Conclusion: No matter what doctors have advised, there has been no change in the frequency of doing circumcisions in recent years. One investigator has published many of the pro-circumcision articles and that may be a problem. In the final analysis, parents choose. In general, if the father is circumcised, the baby boy will be too.

Department of Pediatrics | Medical College of Georgia
Please email comments, suggestions or questions to:
John T. Benjamin M.D., jbenj@mcg.edu

February 27, 2004

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