Should You Circumcise Your Baby - Ethics, Procedure, and Decision (2024)
What we’ll cover in this post:
As if there aren’t enough things to think about when you find out you’re pregnant, once you find out you are having a boy, you may be conflicted about whether you should circumcise him or not.
Depending on where you live in the world, this may sound totally crazy, or it may be weighing heavily on your mind.
People choose to circumcise their baby boys for a few different reasons. These reasons could be related to:
Culture/religion
Societal norms
Information received from a healthcare professional; usually regarding hygiene/infection concerns
Cosmetic reasons/appearance
Family pressures/circumcision being the norm in your family
Circumcision rates have begun to drop worldwide over the last few years as parents begin to research the topic more. It’s important to educate yourself with the evidence and up-to-date facts regarding circumcision before deciding what is best for your baby.
What is circumcision?
Circumcision, in medical terms, refers to the removal of the skin and tissue (foreskin) that covers the glans of the penis, exposing the head of the penis.
How is circumcision performed?
While there are a few different surgical techniques that can be used to perform a circumcision, all techniques are relatively the same. The baby is placed in a special surgical table where his arms and legs are typically strapped down to prevent movement.
The foreskin is fused to the glans of the penis, so a probe needs to be inserted in order to break up the connective tissue, separate the foreskin, and pull it back.
A tool is then used to clamp the foreskin which is then cut and removed.
After the skin is removed, some kind of barrier ointment (usually petroleum or vaseline) is applied to the penis to avoid friction from the diaper.
We have some videos and photos of the different procedures here.
Is pain medication administered prior to a circumcision?
The use of medication or a local anesthetic depends on the facility your baby is being circumcised in. Some facilities will apply a local anesthetic ointment to the penis for 10-20 minutes prior to the procedure. Another method of local anesthetic involves using numbing medication that is administered directly into the penis via injection. Other facilities will offer the baby sugar water; which is thought to calm the baby and possibly provide some pain relief.
If you do choose to circumcise your baby, it’s important that you advocate for him to receive some kind of pain medication prior to the procedure. Unfortunately, no nerve block or topical ointment will fully relieve pain for your baby during or after the procedure.
There is typically no medication or ointment, other than petroleum/vaseline, prescribed for the days following the procedure. If your baby seems exceptionally agitated, he’s crying a lot, refusing to eat, or is unable to settle/get to sleep, you should reach out to your healthcare provider to see if infant acetaminophen is appropriate to help with the post-surgical pain.
Anatomy of the penis
Just like vaginas/vulvas, all penises can look a little bit different. Whether circumcised or not, every penis has the same anatomical components.
Glans - The glans of the penis, also known as the head of the penis, is the very tip of the penis that contains the urinary meatus (opening). This meatus is where urine and semen exit the body. For most, this (along with the foreskin) is the most sensitive part of the penis. It contains more nerve endings than in the entire penis.
Shaft - The shaft, or the body, of the penis is the portion that extends from the tip of the penis to the lower abdomen. The shaft is where the urethra (the tube that carries urine outward) is located.
Foreskin - The foreskin is a “hood” of skin that covers the glans of the penis. The foreskin has some major functions, which we’ll discuss a bit later. The foreskin is the part of the penis that is removed during a circumcision.
Frenulum - The frenulum is the area where the foreskin meets the underside of the penis. This is typically visible in both circumcised and uncircumcised men and is usually a pretty sensitive area.
What is the purpose of the foreskin?
The foreskin has a few major purposes, including:
Protection - The foreskin protects the mucous membranes and sensitive skin on the glans (head) of the penis when the penis is flaccid. This is simialr to the way the clitorial hood protects the clitoris.
Sensation - The foreskin actually has the highest number of nerve endings on the penis, so it plays a pretty important role in sexual activity and sensation.
Providing lubrication - Mucous membranes of the foreskin help to provide and maintain lubrication, while aiding in gliding during intercourse.
Immune system functions - The foreskin contains anti-microbial cells that help to destroy bacteria and keep the penis clean.
Medical benefits of circumcision
According to the American Academy of Pediatrics (AAP), the health benefits of newborn circumcision do outweigh the risks of the procedure, but not enough to recommend universal newborn circumcision for all male newborns. Instead, they say the decision should be up to the parents.
Decreased risk of developing urinary tract infections (UTIs)
This benefit could really go either way. If you dig deep into the studies, you will find that there are studies showing that uncircumcised males seem to have a higher prevalence of UTIs, but there are also studies showing that UTIs were more prevalent among males who had recently been circumcised.
Either way, the risk of developing a UTI in a male, circumcised or uncircumcised is very very rare; especially when proper hygiene is taking place. You teach your kids to brush their teeth, you need to teach them how to care for their bodies as well.
Slightly decreased risk of developing penile cancer
While the risk of developing penile cancer, circumcised or uncircumcised, is very low, there is a slightly higher incidence of penile cancer in uncircumcised males.
It’s also worth noting that this higher rate of penile cancer does tend to be in underdeveloped countries, where access to medical care is limited.
Another reason why circumcision may slightly decrease the risk of developing penile cancer is due to phimosis. Phimosis is when the foreskin is unable to be retracted from the head of the penis. This is totally normal for the first few years of life. In fact, the foreskin should never be forcefully retracted, despite what you may have been taught in the past.
Sometime between childhood and adolescence, the foreskin will naturally separate from the glans (head) of the penis. In the meantime, you should only clean what you can see.
Phimosis becomes an issue when:
It causes redness/irritation
The skin becomes very tight around the glans of the penis, causing swelling of the glans
Pain while urinating
Pain during erections
Phimosis can also occur in circumcised males. We’ll chat about that a bit later.
There is a slight chance that your son will require circumcision later in life
While adult male circumcision is pretty uncommon, there are some reasons why it happens.
Most of the time, it is done for cosmetic reasons and/or peer pressure, if they would just simply prefer a penis with no foreskin.
Some medical reasons why an adult male may get circumcised later in life include:
Phimosis
Foreskin that feels too tight; especially during erections
Recurring urinary tract infections (UTIs) or other infections
The risk of developing/spreading HIV, herpes, and other STIs may be higher
Just like with the increased incidence of UTIs, this evidence can also go either way.
While some studies do show a higher rate of HIV and other STIs among uncircumcised males and their partners, hygiene and location are a huge factor here.
Most of these studies done regarding HIV were done in locations where circumcision rates are predominately low and HIV rates are predominately higher than other areas.
It’s important to note that circumcised people can (and do) contract HIV. Even if circumcision decreases HIV transmission rates slightly, the best way to prevent HIV transmission is to practice safe sex, especially when having sex with multiple partners, to decrease the risk of infection.
Potential risks of circumcision
Just like with any surgical procedure comes risks.
Some potential risks of a circumcision include:
Pain
Swelling
Infection
Excessive bleeding
Reattachment of the foreskin (phimosis) - This sometimes results in excessive scar tissue, which can cause pain with urination and erections. Some men may need a re-circumcision in these cases.
Cutting the foreskin too short or too long
Skin bridges - Where the scar edge of the circumcision starts to reattach to the glans
Irritation of the glans (head) of the penis
Narrowing of the urinary meatus (opening)
Reduced sensation
Can your son get circumcised when he’s older?
Anybody can get circumcised later in life. The biggest thing to keep in mind is that an adult can consent to a cosmetic procedure like circumcision, where a newborn doesn’t understand the implications of what’s happening.
Like we previously discussed, it’s a pretty uncommon occurrence for an adult male to undergo circumcision unless it’s a medical necessity. More often than not, especially within the United States, adult male circumcision is desired for cosmetic reasons. Up until recently, the large majority of American males were circumcised. The rates of circumcision have dropped significantly in the United States, so it is likely that less adult males will seek circumcision for cosmetic purposes.
Other common reasons adult circumcision is desired are:
Skin conditions that cause recurrent irritation and scarring, which lead to pain and discomfort
Genital warts - If a man develops recurring genital warts, especially on the foreskin, the preferred method of treatment includes removing the foreskin
Phimosis
How to care for an intact penis
If you choose to keep your newborn son’s foreskin intact, you may feel worried about how to care for an intact penis; especially if you/your partner are circumcised.
Good news is, it’s very simple! When your son is an infant/young child, you clean the penis just as you would a finger. You clean the parts you can see with water and never retract the foreskin.
During diaper changes, wiping the visible areas, from base to tip (a wet wipe is totally fine). Feces will not get trapped under the foreskin because, remember, the foreskin is fused to the head of the penis. Although it’s unlikely that anything would even get into the foreskin, if it did, once your son urinates, it will help eliminate any foreign substances.
As your son gets older, his foreskin will naturally separate from the glans of the penis. Allowing him to retract his own foreskin to his comfort is important so he can avoid injury. The foreskin may begin to naturally separate around age five, or it may not happen until well into adolescence; both occurrences are normal.
This may sound much simpler than you expected, but that is because most healthcare professionals are unaware that they are giving outdated information out to parents. This also means that choosing to keep your son intact, especially in America, means you may have to make sure no healthcare professionals or caregivers are retracting his foreskin during examinations and/or diapers changes.
Some healthcare professionals insist that they need to retract the foreskin in order to make sure there is a visible urinary meatus (opening). This is not necessary and can be assessed by ensuring the baby is having wet diapers and you’ll notice a urine stream at some point.
If you want to read more about intact care and lots of other great information, check out: YourWholeBaby.org
If you chose to not circumcise your newborn son, you may still have some concerns regarding the penis/foreskin.
Some reasons you’d want to reach out to your healthcare provider include:
Any signs of infection - Redness, swelling, yellow/green drainage, fever. It’s important to clean the uncircumcised penis just as you would a finger; only clean the parts you can see. If the foreskin is forcefully retracted, this can create opening/cuts, which can cause bacteria to be trapped
Paraphimosis - If the foreskin is retracted, for whatever reason, sometimes it can get stuck. This is a medical emergency, as it can cause pain and swelling of the penis.
Urine only trickling out versus flowing out
If your son seems uncomfortable upon urinating
How to care for a circumcised penis
Immediately following a circumcision, your healthcare provider should give you some post-surgical instructions. These instructions typically consist of having you apply some ointment (usually vaseline or petroleum) to the surgical site with every diaper change along with some gauze. This will help to keep the surgical site moist and the gauze will help prevent a diaper from sticking to the surgical site.
*If a diaper or the gauze do end up sticking to the surgical site, it’s important that you use water to release it instead of pulling. Putting the item off will just cause more trauma to the already sore surgical site.
When cleaning soiled diapers during the first few days/weeks following circumcision, you should use water on the penis rather than wiping the area with baby wipes. Wet wipes can sting in that open wound!
The surgical site should begin to heal within 5-10 days. Until the site is completely healed, it’s fine to use the ointment during each diaper change. It is normal to see some small dots of blood during the first few days of healing. It is also normal for the surgical site to develop a yellow, crusty discharge as it heals. Some redness on the penis/surgical site can also be expected.
Your baby should not be submerged into a bath until after the surgical site has healed.
Sometimes, a device called a Plastibell is used during a circumcision. This method of circumcision involves leaving a small plastic rim around the penis during the first week or so of healing. You can follow the same methods regarding cleaning and using ointment during diaper changes, but you should reach out to your healthcare provider if the plastibell has not fallen off within 8-10 days. You should also seek medical attention if the Plastibell falls down the shaft of the penis. This can cause swelling and constriction.
It’s important that you never pull on or apply pressure to the Plastibell; it will fall off on its own.
Unlike the uncircumcised penis, you actually do want to retract the foreskin of a circumcised baby if there is enough skin left to do so. This is because, if you do not retract the skin, you run the risk of the skin readhering to the glans of the penis (this can create adhesions, skin bridges, and/or phimosis). This is the body’s way of trying to heal itself.
Also, unlike the uncircumcised penis, debris (including feces) can get trapped underneath the foreskin. It’s important to gently retract the foreskin, if there is enough to do so, and clean the area underneath, during each diaper change.
When to contact your doctor
If you choose to circumcise your newborn son, there are some reasons you’d want to contact your healthcare provider.
Of course, if you have any concerns or questions, you should always reach out to your healthcare provider.
Contact your doctor immediately if:
Excessive bleeding (the surgical site really shouldn’t bleed at all after a few days) - Your baby only has 1 ⅓ cup of blood in their whole body, so they can lose that rapidly if they are hemorrhaging
If your baby hasn’t peed within 12 hours after the circumcision
If it seems like your son is inconsolable/in pain
If there are any signs of infection on the surgical site - Excessive redness, swelling, green drainage, fever
Visible bruising of the penis
The Takeaway
Choosing whether or not you should circumcise your son is a simple decision for some, but may be difficult for others. The most important thing you can do prior to making this decision is to educate yourself. Unfortunately, especially in America, most healthcare providers do not have accurate/up-to-date information regarding circumcision.
Aside from religious/cultural purposes, the most common reason for newborn circumcision within America is solely for aesthetic/cosmetic reasons and, simply because we don’t know anything different. The circumcision rates in America are steadily declining as parents become more educated on the subject.
Once you and your partner read through the research, you will be able to come up with a decision that is best for your baby boy.
Whether you choose to keep your son intact or if you choose to circumcise him, you can add this to your birth plan so your birth team is aware of your preferences.
🤍 The Motherboard Team
