Circumcision on the decline? What parents need to know about the procedure

Having your newborn baby boy circumcised used to be a common practice in the United States, but in recent years, more parents are opting out. According to Charge Data Master, newborn circumcision rates declined from 58.4 percent in 2001 to 54.7 percent in 2010. Yet these numbers don’t take into account circumcisions performed outside of the hospital – such as those for religious reasons.

“I think parents realize babies are born perfectly intact,” said Anthony Losquadro, executive director of Intaction.org, a non-profit organization that opposes infant circumcision.  “Although the reasons have tried to be rationalized over the decades as a necessary procedure, I think parents are becoming more educated on the issue.”

There has also been a change in the demographics as certain ethnicities are declining the procedure and a cultural shift where parents are realizing it’s not necessary, according to Dr. Andrew Freedman, a member of the American Academy of Pediatrics task force on circumcision.  Financial access is another factor as Medicaid covers routine circumcision in only 30 states.

Several studies conducted during the 1970s and 1980s confirm that babies experience some pain from circumcision. And even though topical and local anesthetics are used, they don’t eliminate the pain completely.

Nevertheless, when used, pain relief methods are effective. According to a 2004 report published in the Cochrane Database of Systematic Reviews, when pain relief methods were administered, babies had lower heart rates and spent less time crying than the placebo group.

“There’s no question that these pain control techniques reduce the pain, and there’s no viable excuse not to use some form of pain relief,” Freedman said.

However, some doctors don’t use an anesthetic because they are either unfamiliar with using it or they think it could cause side effects, according to the Circumcision Resource Center. According to a 2005 study published in the journal Academic Pediatrics, of the residency programs that taught circumcision, only 84 percent used an anesthetic frequently or always. Regardless, Freedman says many hospitals have policies in place that spell out what the minimal pain control standards should be.

Like any medical procedure, there are also several risks associated with circumcision. Since the clamp used is so large, it can be difficult to ascertain how much of the foreskin to remove, according to Losquadro. “It’s really guesswork on the part of the doctor as to how much skin to remove,” he said.

In 2010, the makers of the Mogen clamp, one of the three types used for circumcision, closed its doors after several lawsuits were brought against the company for botched procedures. Yet the devices are still in use.

Circumcision is associated with other risks as well, such as bleeding, infection, skin adhesions, scarring, and curvature of the penis.  But it’s important to note that these effects are extremely rare.  According to a report published in the journal BMC Urology, severe complications occurred at a frequency of just 2 percent in two of the 16 prospective studies.

And despite the risks, circumcision has several benefits. In August 2012, the American Academy of Pediatrics issued a revised policy statement, which outlines the advantages of circumcision.
For one, there is a decreased risk of urinary tract infections within the first year of life. According to the American Academy of Pediatrics, the risk of a urinary tract infections within the first year of life is 1 in 1,000 for circumcised boys and 1 in 100 for uncircumcised.

Circumcision has also been shown to reduce the risk of penile cancer and provide protection against the transmission of sexually transmitted infections. According to data studied by the American Academy of Pediatrics, cases of herpes simplex virus type 2 were 28 percent to 34 percent lower in men who had been circumcised. In addition, the risk of contracting HPV was reduced by 30 to 40 percent with circumcision.

The risk of contracting HIV is also significantly lowered when a boy is circumcised. According to the World Health Organization, the risk of a woman infecting a circumcised man with HIV is reduced by approximately 60 percent.

The American Academy of Pediatrics also cites the prevention of foreskin infections, phimosis—the inability of the foreskin to retract—and easier hygiene as benefits of the procedure. In addition, they did not find any data to conclude that circumcision alters sexual function or sensitivity.

“On balance, we feel that the benefits probably outweigh the risks, but not by such a margin that we’re advocating circumcision for everybody,” Freedman said.

“Circumcision cuts across more paradigms than purely the medical decision,” said Freedman, who cites religious and cultural reasons for having the procedure – as well as aesthetics, personal identity, and the choices families make generation after generation. “The medical aspect is never going to be the knockout punch, because it’s going to be a decision based on a lot of factors.”

What you should know

Experts agree that choosing for or against circumcision is easier before giving birth, because sleep-deprivation, recovery from childbirth, and other issues can make it more difficult to make an informed decision. It’s also important for both you and your partner to agree because if a problem does happen, it can create conflict later.

If you decide on circumcision, find out who will be performing the procedure—a pediatrician or an obgyn— if that person is comfortable with the procedure, and what type of pain relief will be available before and after. Make sure you know the side effects you should look for and how to care for your baby afterwards. If your baby will not be circumcised, speak with the pediatrician on how to provide proper hygiene for your son/

In the end, whether you decide to have your baby circumcised or not, it’s a personal decision that you should feel confident making. “There’s no single right or wrong answer. Your child’s going to be fine one way or the other,” Freedman said.