By Dr. Art Zaltz, chief of the department of obstetrics and gynaecology at Sunnybrook.
If you're pregnant, and you've heard the words "it's a boy," you may be wondering about circumcision.
My first advice to parents is: you have a choice.
For some of my patients, there are religious or cultural beliefs that will guide their decision. For others, it may be that the baby's father is circumcised, or not, that is the driving force in their decision. As an obstetrician, I'm often asked, "What does the science say?"
In recent years, circumcision of babies in Canada has dropped, with estimates that around 30 per cent of newborn males are now circumcised. In the fall of 2015, the Canadian Paediatric Society issued a position statement on newborn male circumcision. It states that routine circumcision for every newborn male is not recommended. That's not to say that circumcision is harmful, but there isn't medical evidence saying that the good significantly outweighs the bad.
It is worth noting that several clinician-researchers in Canada have been critical of the Society's statement, and groups such as the Centers for Disease Control and Prevention in the United States suggest that the benefits of circumcision outweigh the negatives.
Benefits of circumcision
The medical evidence summarized in the Canadian Paediatric Society's statement runs through the potential benefits of circumcision, including the reduction of:
- Foreskin conditions: The foreskin can become inflamed or infected in one to four per cent of uncircumcised boys. Topical steroids usually help this, but there is a small chance that these conditions could result in circumcision as treatment.
- Urinary tract infections: Research shows a slight reduction in urinary tract infections in circumcised boys. It is worth noting that this is quite a modest number, and has a low chance of impacting long-term kidney function.
- Sexually transmitted diseases: Studies in Africa show that uncircumcised males have a higher chance of contracting HIV/AIDS. It's difficult to draw the same conclusions for developed countries like Canada, as our rates of HIV/AIDS are much lower. The Society does encourage that focus should be on other preventive measures, such as abstinence, condom use and other safe sex practices.
Risks of circumcision
The Society also looked at the potential risks of circumcision, including:
- It hurts: It's no surprise, surgical procedures are painful, and there is some pain while the baby's penis is healing.
- Small risk of infection: There's a 1.5 per cent chance of medical complication, such as minor bleeding or local infection.
- An impact on sexuality sensitivity: A study of circumcised and uncircumcised men in 2013 suggests that the foreskin enhances sexual pleasure.
When should my baby be circumcised?
If you decide to get your baby circumcised, the best time for elective circumcision is between birth and eight weeks when the foreskin in thinner. The timing within this range may vary depending on your religious or cultural beliefs.
In the Jewish faith, circumcision is done when a baby is eight days old. In some Islamic communities, circumcision is carried out in babies, while in others it is carried out when the child is older.
What if your baby was born prematurely? In this case, and especially if your baby is in the neonatal intensive care unit or NICU, it's often recommended to wait to circumcise once the baby is old enough and well enough to be discharged from the hospital.
If you opt for circumcision:
The one thing I can't stress enough to patients that choose to have their sons circumcised is that they be referred to a practitioner who is trained in the procedure and strictly adheres to medical best practices. Circumcisions should only be performed by trained practitioners whose skills are up-to-date.
Talk to your midwife, family doctor or obstetrician for recommendations. Your baby should also be closely followed after the procedure, and you should have a good sense of how to care for the circumcised penis and possible complications.
Remember, this is your decision as parents, and you will make it with the best intentions for the new addition to your family.
Read more health tips & information from Sunnybrook experts at health.sunnybrook.ca