The Benefits of Neonatal Circumcision

There is a mountain of decisions to be made before a mother gives birth to her baby — and whether or not to circumcise a baby boy is an important decision that expecting parents need to address before the due date. Circumcision, the surgical removal of the foreskin that covers the head of the penis, was until relatively recently a traditional procedure performed on newborn Jewish boys. But in the 1800’s, it began gaining acceptance as a way to improve personal hygiene (it was also mistakenly believed to cure paralysis and insanity!) By the 1970’s, circumcision in the United States was being performed on 90 percent of male babies born in hospitals, even when no medical organization anywhere in the world was officially recommending this elective procedure, due to the risks involved. Eventually, North Carolina and many other American states ended Medicaid coverage for routine newborn circumcisions. As a result, circumcisions in the U.S. have declined today to between 31 and 79 percent, depending on the region and different preferences among diverse ethnic groups. The average national rate of circumcision declined from 62.7 percent in 1999 to 54.5 percent in 2009. Research in the last three decades has shown that circumcision can be beneficial. Still, in 1999, the American Academy of Pediatrics stated that while medical evidence showed that newborn circumcision had benefits, the data were “not sufficient to recommend routine neonatal circumcision.” But in 2012, the AAP shifted its position, stating in a report published in the August 27, 2012 issue of the journal Pediatrics, that new research, including studies done in Africa showing that the procedure may protect heterosexual men against HIV, has health benefits that outweigh its risks. The academy did not go so far as to recommend routine neonatal circumcision for all baby boys, stating that the choice should be left up to the family. Benefits of Circumcision In addition to the newly discovered link between circumcision and lower HIV infections among heterosexual men, male circumcision also correlates with lower rates of infection with human papillomavirus, a virus that can cause  from genital warts to penile, vaginal and cervical cancers. Circumcision was also found to help prevent infections  with the herpes simplex type 2 virus. Additionally, circumcision lowers urinary tract infections early in life and reduces overall penile cancer rates (1,500 new cases of penile cancer are diagnosed each year in the U.S.). Neonatal circumcision can also prevents problems that could require the surgery at a later age: infections beneath the foreskin or the inability to draw back the foreskin. Risk Factors and Negative Points to Consider There is bleeding, there can be a localized infection, and there can be possible injury to the penis. A botched operation, while rare, can result in damage or even accidental removal of part of the penis. There is also the pain to consider, as general anesthesia is not used. For this reason, a local nerve block should be applied, to eliminate or reduce the pain. While deaths from circumcision do occur, they are extremely rare. In its 2010 mortality report, the Centers for Disease Control and Prevention listed no deaths from circumcision-related complications in the U.S. The decision about whether or not to circumcise a newborn boy should be made soon after birth, as the penis undergoes a growth spurt in the first few months of life; once it becomes larger, the safe removal of the foreskin becomes more difficult. For this reason, most doctors perform the procedure on newborns only during the first month of life. When the baby is older than one month, most doctors will refer the family to a urologist to do the surgery in an operating room, under general anesthesia, which adds more risks and is considerably more costly. By Jamell Andrews