Newborn Circumcisions

Risks and Benefits

Although many male infants born in this country are circumcised, routine circumcision of newborn males in the United States remains controversial.  In other parts of the world (e.g., in most of Europe), routine circumcision is not carried out.  Newborn circumcision has potential medical risks, as well as benefits.  The purpose of this form is to provide you with the information you need to make your decision about circumcision.

What is circumcision?

The penis consists of a round shaft and a rounded tip called the glans.  The foreskin is a piece of skin that covers the glans.  In circumcision, the foreskin is removed, thereby permanently exposing the glans and the opening of the urethra out of which comes the urine.

How is it done?

Newborn circumcisions are usually done during the first few days of life.  An instrument is placed over the end of the foreskin and fits tightly, allowing the doctor doing the circumcision to cut away the foreskin from the remainder of the penis with a surgical knife.  The procedure takes about 15 minutes and should be done with anesthesia.  Only healthy infants with no current medical problems should be considered for circumcision.  There should be no evidence of bleeding problems and the urethra must be normally placed.

What are the potential risks and disadvantages of circumcision?

The immediate risks of circumcision are bleeding, inadvertent injury to the remainder of the penis, and infection.  Although circumcision is considered to be a generally safe procedure, in rare cases these or other complications can lead to severe problems and even death.  Inflammation of the external urethral opening (meatitis) is more common in circumcised boys.  Newborn circumcision should be performed with local anesthesia.  The newborn will experience some pain and discomfort during and following the procedure.  A newborn undergoing circumcision is sometimes diagnosed with hypospadias (a condition in which the urethra is on the underside of the glans) when the foreskin is taken back during the procedure.  This condition can be surgically repaired and requires that the foreskin be left intact.  If this condition is found during the procedure, the circumcision will not be completed.

What can be done to help with the pain during and after the procedure?

We recommend that the newborn should receive local anesthesia (pain control) for a circumcision.  Local anesthesia is provided by injecting a medication into the nerves at the base of the penis.  This procedure will reduce the newborn’s pain and behavioral changes.  Complications due to local anesthesia are rare and consist mainly of bleeding and damage to the skin where the injection occurs.  Local anesthesia adds an element of risk to the procedure, but has been used safely and effectively in thousands of newborns.  You should discuss the use of local anesthesia with your doctor.

In addition to the local anesthesia, a 24% solution of sucrose on a pacifier helps to control pain during procedures for newborns.  Tylenol can be given orally to the newborn both before and after the procedure to help control the discomfort that he may feel for several days following the procedure.

What are the potential advantages of newborn circumcision?

There is a decreased risk of urinary tract infections in boys circumcised as newborns.  Circumcision will prevent conditions that cause an accumulation of fluid and swelling around the foreskin and glans, as well as a problem known as phimosis, which is the inability to retract the foreskin.  Newborn circumcision protects against the later development of penile cancer, although, this is an extremely rare disease.  These potential advantages are not felt to validate a medical indication for circumcision.  Teaching an uncircumcised boy good hygiene will decrease the potential for some of these concerns.

Summary

The issue of newborn circumcision is an emotional one.  There are no clear medical benefits to circumcision and we urge you, the parents of the infant, to carefully consider the question.  In addition to the medical aspects discussed in this information form, other factors will affect your decision, such as religious, cultural, and ethnic traditions.  It is our desire to answer any questions that you have or to discuss this issue further to help you make the decision that is right for you and your family.

Peer Review Status: Internally
Peer Review Date: 2004