Circumcision
The surgical removal of the foreskin that covers the end, or glans, of the penis.
Until the early 1970s, male infants born in the United States were routinely circumcised. In fact, the National Center for Health Statistics (NCHS) reports that about 90% of boys born in the 1960s and 70s were circumcised. This procedure was done for what were then believed to be hygienic reasons. An estimated 10% of uncircumcised males contract bacterial infections when smegma, a cheese-like secretion of a sebaceous gland, accumulates under the foreskin. Since the mid 1970s, the American Academy of Pediatrics (AAP) and the United States Public Health Service have advised that circumcision is not medically necessary. By 1995, the NCHS reported that the rate of circumcision had fallen to about 62%.
Despite the AAP's recommendation that "there are no medical indications for routine circumcision of the newborn," there is no consensus among doctors regarding the procedure. Those physicians who advise parents to circumcise point to research indicating that circumcision reduces the risk of urinary tract infections (UTI), and that uncircumcised men experience higher incidence of penile cancer, and have a higher risk of contracting HIV and other sexually transmitted diseases (STD). Physicians on the other side of the issue argue that the incidence of UTI, penile cancer, and STDs is too low to justify circumcision.
Most physicians who recommend circumcision suggest that it be done within a week of birth, but at least 12 hours after the birth. The procedure involves removing the foreskin, a flap of skin that covers the glans, or head, of the penis. The baby is swaddled or bound to a board to restrain his arms and legs while the foreskin is cut away.
The pain associated with the procedure is another area of controversy. The pain lasts for about one-half hour after the procedure, but researchers have found a link between the pain of circumcision and the way an infant experiences pain for the next four to five months. Circumcised infants appear to experience more pain during routine immunizations than uncircumcised infants.
Some doctors administer a local anesthetic to the base of the penis during circumcision, but this practice carries the risk of possible damage to the nerve endings in the penis. Following circumcision, infants are often given acetaminophen to relieve the pain, which continues in lesser intensity for a few days, until the wound around the circumference of the glans is completely healed.
The foreskin will remain firmly attached to the head of the penis of uncircumcised boys until about age three or four; by age five the foreskin is retractable in 90% of uncircumcised males. By that time, parents can begin teaching their son to pull back the foreskin carefully during bathing to clean the glans area.
Phimosis, a rare condition in which the foreskin does not move freely, can cause discomfort during urination and sexual relations. Phimosis can be corrected by circumcision. Another condition, paraphimosis, occurs when the foreskin retracts but does not move back over the glans. The symptomatic pain and swelling can be reduced by applying cold compresses and gentle pressure to move the foreskin back to its normal position. Paraphimosis can also be corrected by circumcision.
Prospective parents should discuss whether to circumcise their child with their doctor before the child is born to evaluate medical opinion and research results. Also influencing the decision are social and religious issues, and the parents' own comfort level with the procedure.
Circumcision: a Traditional Jewish Ceremony
A bris milah is a ceremonial religious circumcision, usually performed at home. According to Jewish tradition, the bris milah, performed on the eighth day after birth, is the beginning of the male infant's Jewish life. The procedure itself is performed by a mohel. A mohel is a person who has studied Jewish religious traditions and has been trained in the circumcision procedure. Often, the mohel is a physician. The occasion is one of celebration, with the ritual circumcision carried out with family members and friends in attendance.
For Further Study
Books
Diamant, Anita. The New Jewish Baby Book: Names, Ceremonies, Customs. Woodstock, VT: Jewish Lights, 1993.
Fink, Aaron J. Circumcision: A Parent's Decision for Life. Mountain View, CA: Kavanah, 1988.
Romberg, Henry C. Bris Milah: A Book About the Jewish Ritual of Circumcision. New York: Feldheim Publishers, 1982.
Romberg, Rosemary. Circumcision: The Painful Dilemma. South Hadley, MA: Bergin and Garvey, 1985.
Periodicals
Bourland, Julie. "The Circumcision Decision." Parenting, February 1997, pp. 103-106.
Audiovisual Materials
Hammond, Tim, producer. Whose Body, Whose Rights?: Examining the Ethics and the Human Rights Issue of Infant Male Circumcision. Los Angeles, CA: Dillonwood, 1995. (One 56-minute videocassette. Explores customs, practices, and the human rights issue of infant male circumcision.)
Organizations
National Organization of Circumcision Information Resource
Centers (NO-CIR)
Address: 731 Sir Francis Drake Boulevard
San Anselmo, CA 94960
Telephone: (415) 454-5669
National Center for Education in Child and Maternal Health
Telephone: (202) 625-8400
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