]]>Circumcision]]>, the surgical removal of the foreskin from the penis, may be one of the oldest surgical procedures known to mankind. For more than 3,800 years, Jews have circumcised their newborn males as a sign of a covenant with God. Visitors to the Museum of History in Cairo can see a statue showing a circumcised Pharaoh, and in fact, the Egyptian hieroglyphic for penis is the circumcised organ.
Illustrations of the operation itself have been found dating from 3000 BC, and it is the only surgical procedure mentioned in the Old Testament. In 1928, newborn circumcision was bolstered by an editorial in the Journal of the American Medical Association calling for the routine circumcision of all male infants at birth—primarily to prevent masturbation. Most Jews, Muslims, and Ethiopians still routinely circumcise their newborns.
Today, circumcision is much more common in certain parts of the world, namely the Middle East, Canada, and the US. In the United States 55% to 65% of male newborns are circumcised. Why do some parents decide against this procedure? What are the controversies surrounding it?
Pros and Cons
The issue here is whether the procedure is beneficial, medically unnecessary, or harmful. Unfortunately, studies are controversial and subject to individual interpretation. Many studies have shown that ]]>urinary tract infections]]> are more common in uncircumcised infants. And advocates of the procedure cite studies showing that circumcised men have lower rates of penile cancer (a very rare disorder) and ]]>AIDS]]> (most of the studies were done in underdeveloped countries). In fact, recent studies have reported significant drops in rates of HIV infection among men who were circumcised, compared with men who were not. One study involved 5,000 uncircumcised men in Uganda. Half of the men were circumcised, while the other half served as controls. After two years of follow-up, the rate of HIV infection was 51%-60% lower among the men who were circumcised.
A number of studies have also documented higher rates of ]]>cervical cancer]]> in women who have had at least one uncircumcised partner. The uncircumcised male is more prone to a build-up of smegma, which is a cheesy substance composed of dead cells and other secretions. This accumulation, which can be easily controlled with proper hygiene techniques, may lead to unpleasant odors.
Without circumcision, men may develop phimosis, a condition in which the foreskin gets stuck in a “pulled back” state. The majority of these cases, though, can be easily treated without any surgical intervention. Only severe cases of phimosis may require circumcision to prevent recurrence.
Circumcision, though, is a painful procedure and requires local anesthesia and about 7-10 days of healing. In addition to complications like bleeding and infection, there are occasional surgical mishaps in which too much or too little of the foreskin is removed. Occasionally there can even be injury to the penis itself. These problems, which are rare, may require further surgery.
Making a Decision
There are many issues involved when deciding to have your baby circumcised. You may choose for or against the procedure based on ethical, religious, or societal reasons. By talking with the doctor, you can gain a better understanding of what circumcision entails and further discuss the pros and cons.
American Academy of Pediatrics
National Library of Medicine
Canadian Family Physician
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Last reviewed July 2010 by ]]>Brian Randall, MD]]>
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