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Harvard Commentaries
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Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School


A Parent's Life A Parent's Life
 

Circumcision: What Parents Need To Know


September 14, 2012

By Claire McCarthy

Boston Children's Hospital


There are so many decisions that new parents need to make. One of them on the list for parents of boys is whether or not to circumcise.

In circumcision, the foreskin, the skin covering the end of the penis, is removed. In my experience as a pediatrician, most people make the decision based on religious or cultural reasons. And for many years, that's how the American Academy of Pediatrics (AAP) felt the decision should be made. The medical benefits of circumcision, they said, were about the same as the risks.

Recently, however, the AAP changed its position. While they aren't ready to say that all babies should be circumcised, they want parents to know that there are important health benefits. They include:

    • A lower risk of urinary tract infection
    • A lower risk of some sexually transmitted infections, including HIV, herpes and HPV. The foreskin is easily injured, allowing germs to enter the body, and the skin can trap germs underneath it. HPV, or human papillomavirus, is the main cause of cervical cancer. So not only could circumcision decrease sexually transmitted infections, it could decrease cervical cancer in women.
    • A lower risk of penile cancer and prostate cancer. Penile cancer is very rare. And the decrease in risk of prostate cancer is very small, but a lower risk of any cancer is a good thing.
    • A lower risk of rashes of the foreskin, or of the foreskin getting stuck (phimosis). Obviously, if you don't have a foreskin you aren't going to have problems with it.

There are risks to any medical procedure. Circumcision is no exception. There is the risk of bleeding. Or that it could be done wrong. But in skilled, experienced hands those complications are rare.

And what about the concern that removing the foreskin could make the penis less sensitive and decrease sexual pleasure? Studies don't show any differences in sexual pleasure and sensitivity of the penis between circumcised and uncircumcised men.

Pain is a real risk. Circumcision hurts. In the recently released policy statement, the AAP stressed the importance of pain control. Swaddling, sugar water and other non-medical ways of controlling pain aren't enough. Pain medicines should be given. Circumcision is minor surgery, but it's surgery. And babies who are being circumcised should have the anesthesia needed for surgery.

The newborn period is the best time for circumcision, the AAP said. When done later in life, the risks increase.

Some people believe that we shouldn't be removing part of a child's body. No doctor, study or policy statement can really address this concern. It's a personal concern. That's why ultimately the decision about circumcision is one that rests with families, not doctors. Parents should know about the medical benefits and risks of circumcision. But any decision needs to take into account more than just the medical aspects.

Read more about the AAP's policy statement on circumcision.

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Claire McCarthy, M.D., a senior medical editor for Harvard Health Publications, is an assistant professor in pediatrics at Harvard Medical School. She is an attending physician and Medical Communications Editor at Children's Hospital Boston.

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