Table of Contents


Introduction

The choice to circumcise a child is a very personal one, involving tradition, common beliefs, and sometimes religious practice. This page is not intended to condemn those who chose to circumcise their sons. What it is intended to do is address myths regarding circumcision, many of which are still considered truths today, especially in the United States. Please read over this information before circumcising your son -- it is possible that you may still decide to, but you can at least do so knowing that you are as informed as possible on the subject. I can guarantee that some of this information will be shocking -- it was not until recently that I learned myself what actually happens during circumcision and what the foreskin is useful for.

In 1999 the American Academy of Pediatrics issued the opinion that current data are "not sufficient to recommend routine circumcision," adding "circumcision is not essential to the child's well-being." The American Medical Association issued a policy agreeing with this statement shortly after.

If you find my information to be biased please see this unbiased article from the Canadian Pediatric Society -- it utilizes over 100 sources in compiling the information included.

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How is circumcision performed?

Baby is placed on a restraining board, and his hands and feet are secured by straps. A local anesthetic can be injected into the foreskin of the penis, although over half of all circumcisions are performed without. The tight adhesions between the foreskin and the glans (or head) of the penis are separated with a medical instrument. The foreskin is held in place by metal clamps while a vertical cut is made into the foreskin to about one-third of its length. A metal or plastic bell is placed over the head of the penis to protect the glans, and the foreskin is pulled up over the bell and circumferentially cut. Between one-third and one-half of the skin of the penis (which is what the foreskin is) is removed. A protective lubricant is put on to cover the incision area for a few days. The healing of the circumcised area takes approximately one week, during which time you can expect the circumcision, like most cuts, to go through the usual stages of healing.

Here are pictures and video of a circumcision -- warning: this is quite graphic.

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Is circumcision a safe procedure?

Circumcision is usually a safe surgical procedure. However, complications from the procedure itself occur in 2-6 per 1,000 circumcisions and range from minor to serious. They include irritation of the head of the penis from the friction of wet diapers, pain on urination, bleeding, infection, pain during erection throughout your son’s life (because of too much skin being removed), scarring of the urinary outlet, and accidental removal of the glans or the entire penis, in which case apenectomy (removal of the penis) is sometimes needed. Some of these complications require further surgery or surgeries. If there is a family history of bleeding tendencies or one of your previous newborns bled a lot during circumcision, be sure to inform your doctor of this fact.

Every year, about 100 boys die as a consequence of being circumcised, through infection, shock, or blood loss.

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Does it hurt? I've been told that newborns can't feel pain, and isn't it just some thin skin anyways?

Yes, it hurts. The skin of the penis of a newborn baby has pain receptors completely sensitive to clamping and cutting. The myth that newborns do not feel pain came from the observation that newborns sometimes withdraw into a deep sleep toward the end of the operation. This does not mean that they do not feel pain. Falling into a deep sleep is a retreat mechanism, a withdrawal reaction as a consequence of overwhelming pain. Not only does circumcision cause pain in the penis, the rest of the newborn's overall physiology is upset. During circumcision, stress hormones rise, the heart rate speeds, and valuable blood oxygen diminishes. Sick babies and premature babies should never be subjected to this shock. For this reason, please make sure your baby is given local anesthetic if you choose to circumcise. But do be aware that sometimes the anesthetic does not work, doctors do not give it enough time to work, or it does not remove a majority of the pain. Newborns are also not given painkillers for the healing process.

The foreskin is more than "just thin skin" -- it is the most sensitive part of the penis (yes, even more sensitive than the glans!). What the foreskin is not: The foreskin is not a flap of skin on the end of the penis. This kind of terminology has been used to imply that the foreskin is something redundant with no real function, that can easily be removed with no consequence. This is not the case. The foreskin can be thought of as a continuation of the tube of skin that covers the shaft of the penis, but much longer. This tube of skin is firmly attached only at the base of the penis and at the head of the penis. In between the points of attachment this tube of skin has the special property that easily slides on the shaft of the penis rather than being firmly connected as most skin is.

The foreskin is also filled with nerve endings called stretch receptors that fire when they are stretched, rolled, or massaged, making sex more pleasurable. The foreskin also increases lubrication for male and female comfort during intercourse. A study done in 2007 found that circumcision removes the most sensitive part of a man's penis. Sorrells and others enlisted 159 men from the San Francisco Bay area, 91 of them circumcised, and conducted touch-sensitivity tests, using instruments that press with calibrated hairs, on 11 or 17 different places on their penises. The men could not see where they were being touched. Removing the foreskin would be exactly like removing the hood of the clitoris. Clitoral stimulation is possible by moving the hood, and this is what happens with stimulation of the intact penis.

The head of the penis has no skin. This may be a surprise to those of you who are familiar only with circumcised penises. It is actually covered by a very thin moist mucus membrane, very much like the inside of the lip or the inside of the eyelid. The head of the penis is not meant to be exposed to the elements such as friction against clothing, friction during sex, the sun's rays, soap, or in infant urine or feces. The glans is supposed to be protected by the warm, moist cocoon that the foreskin creates. If the foreskin is removed, the mucus membrane of the penis thickens in response to the lack of protection. It may look like skin, but it is not.

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Ok, but I still don't want to have to clean my baby's foreskin. That's gross, and frankly, one more thing I'll have to do.

Making hygiene easier is often a reason given for performing circumcision. Understandable, but another myth. In the adolescent and the adult male the glands of the foreskin create a fluid called smegma. These secretions may accumulate beneath the foreskin. With normal bathing, however, an intact foreskin is quite easy to care for.

At birth the foreskin is attached to the glans much like a fingernail attached to the nail bed. The foreskin usually will spontaneously widen with age until complete retractability is obtained. About 50-60 percent of boys at age ten still do not have fully retractable foreskins. This is normal. After puberty, the percentage of boys with full retractability rapidly increases.

Once the foreskin retracts easily, it becomes part of normalmale hygiene to pull back the foreskin and cleanse beneath it during a bath.

NEVER EVER forcibly retract your baby's foreskin. The only one who should retract your son's foreskin is your son, and yes, this does include doctors - a doctor worth their salt will know not to retract, not even "a little bit." Retracting the foreskin before it is time loosens the protective seal between the foreskin and glans and increases the chance of infection. Plus, it really hurts! Forcibly retracting (or separating the foreskin from the glans for circumcision) is like ripping a fingernail off, although on the most sensitive part of the body.

As the foreskin naturally retracts, gently clean out the secretions that may have accumulated between the foreskin and the glans of the penis with warm water, not soap. This should be done as part of the child's normal bath routine if your child is retractable – it does NOT need to be done every time your child goes to the bathroom!

It should be added that women have smegma too, which usually accumulates in the folds of their labia. Most women are not told this, not taught how to clean it out, and it is not usually suggested (except for in the case of female genital mutilation) that they cut their labia off to increase hygiene. What other body part do we cut off to keep clean?

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How do I care for my young son's intact penis?

The intact penis needs no special care and should never be retracted by force.

During the first few years of a male's life, the inside fold of his foreskin is attached to his glans, very much the way the eyelids of a newborn kitten are sealed closed. The tissue that connects these two surfaces dissolves naturally over time - a process that should never be hurried.

The foreskin can be retracted when its inside fold separates from the glans and its opening widens. This usually happens by age 18. Even if the glans and foreskin separate by themselves in infancy, the foreskin may not be retractable then because the opening of a baby's foreskin may be just large enough to allow for the passage of urine.

The first person to retract a child's foreskin should be the child himself.

A very young boy usually pulls his foreskin outward. This is normal and natural and no cause for concern; he won't hurt himself. Once a boy discovers that his foreskin is retractable (a wondrous discovery for an intact child), he can easily learn to care for himself. Telling your son about retractability beforehand will keep him from becoming alarmed the first time his foreskin retracts.

When a boy is old enough to bathe himself, he can wash his penis when he washes the rest of himself. Simple instructions may be helpful.

  1. Gently slip your foreskin back (if it is retractable).
  2. Rinse your glans and the inside fold of your foreskin with warm water.
  3. Slip your foreskin forward, back in place over the glans.

At puberty, you can let your son know that with hormonal activity comes new responsibility, including genital hygiene.

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How do I clean my son's penis before his foreskin fully retracts?

Are you ready for this?

1. Wash the outside of the penis like a finger.
2. Don't try to pull the foreskin back or retract it.
3. That's all!

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If he isn't circumcised, won't he feel different from his friends? Shouldn't my son be the same as his father?

You cannot predict how different your son will feel if he is circumcised or intact, which is why I recommend that you let your son make the decision for himself. In the United States, around 56 percent of newborn boys are circumcised, and that number is getting steadily lower year by year. Men can always decide later in life to be circumcised if they do not like having a foreskin.

Some fathers do have strong feelings that if they are circumcised, their sons should be, and this feeling is only natural. But the "like father, like son" complex alone is not a good reason to choose circumcision, as few fathers and sons compare foreskins. There will be many other ways in which your son resembles his father besides what his penis looks like.

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Does circumcision prevent any diseases? I heard something recently about circumcised men being linked to a reduced AIDS rate.

Circumcision does not prevent cancer of the penis, which is a very rare disease (more rare than breast cancer in males) and occurs more frequently in elderly men who do not practice proper hygiene. Cervical cancer, which is caused by HPV, is not more common in the sexual partners of intact males who practice proper hygiene.

Some studies have found an association between not being circumcised and urinary tract infection in the first year of life. The risk of developing a urinary tract infection is low (about 7-14 in 1,000 compared to 1-2 in 1,000 in circumcised males). A less drastic way to treat UTIs is antibiotics, which are used with females (who are four times more likely to have a UTI). Exclusive breastfeeding, which reduces the incidence of urinary tract infections three-fold, can also serve as a source of prevention for urinary tract infections.

Most news in the last few years about circumcision has been dominated by the results of three randomized trials in African countries that found the procedure considerably reduces a man's risk of contracting HIV. In one of the studies, the risk was reduced by as much as 76 percent. Since then, public-health officials in some African countries have been scrambling to develop large-scale circumcision programs. The implications for Americans, however, remain murky. There are differences between the African and North American HIV epidemics, and the CDC has emphasized that benefits seen in the African trials, where HIV and AIDS is much more common, don't necessarily translate to America. Sexual practices also make a difference -- "dry sex" is practiced in Sub-Saharan Africa, which causes more abrasions in the vaginal wall, increasing the incidence of HIV. Please see this statement issued by the group Doctors Opposing Circumcision for more discrepancies within this study. Scientists have even discovered in some studies that the foreskin and the protective cells included therein protect against HIV.

Also note that 80-85% of the world’s male population has intact genitals, including nearly all European males. One would then expect (after hearing about the African studies) that AIDS and HIV rates are higher in Europe, but this is NOT the case. America has the highest rate of both circumcision and sexually transmitted diseases (including HIV/AIDS) of any developed country.

While scientists and doctors are still debating the issue of HIV and circumcision, one thing is clear -- all children, male, female, intact or circumcised, need to be taught the value of using condoms and protecting themselves against sexually transmitted diseases. If circumcision is found to reduce the chance of HIV, it still can't and won't be 100%, and sexual education is more important in preventing the spread of HIV and AIDS.

NEW UPDATE 5/6/08: This article has been released stating that "promoting male circumcision in Africa is risky and dangerous and could lead to more HIV infections." For more information and research please see the full article here.

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Does circumcision have any affect on the breastfeeding relationship?

Yes. Think about it -- urinating after circumcision is essentially urinating on an open wound. It hurts. The more baby breastfeeds, the more he urinates. This commonly results in a short breastfeeding strike, and when this happens at the beginning of a breastfeeding relationship, it really has the potential to impact a mother's milk supply and a baby's desire to breastfeed overall. Some people say that babies cannot possibly be smart enough to make that connection, but babies are instinctual. Their lives at the newborn age revolve around bodily functions, feeding, and being held -- and they'll stop feeding if they know that it'll stop them from experiencing pain.

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But I want to circumcise for religious reasons. How does this advice work for me?

I suggest reading this pamphlet. It details the history of circumcision for Jewish, Muslim, and Christian peoples, and how much debate has been going on for years (sometimes hundreds!) about discontinuing the practice. Obviously, infants are not aware of circumcision’s religious significance, and few Jews, Muslims, or Christians actually choose to be circumcised. There are also groups that deal with following religious obligations while at the same time NOT circumcising. It is possible!

www.jewsagainstcircumcision.org

www.catholicsagainstcircumcision.org

www.muslimsagainstcircumcision.org

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After reading this, I still don't know what to do! Can you help me decide?

There are generally some questions that you can ask yourself regarding circumcision. Your answers may help you decide how you feel.

(1) Does the child have any condition at birth that requires a circumcision?

(2) Will circumcision confer any definitive benefits on him?

(3) If there are any benefits, can the circumcision be delayed until he has a say in the procedure?

(4) Are there any risks to your son?

(5) Can the decision be deferred until your son can consider the risks?

(6) Do you know without a shadow of a doubt if your son would want to be circumcised?

(7) If your son's circumcision is botched, can you explain the importance of circumcising him?

(8) If you circumcise him and he decides he wants to restore his foreskin, will you fully support him?

(9) How will you feel if your future grandson is not circumcised? Will you still feel confident of your decision to circumcise your son?

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I've already circumcised my son, and now I think I made a mistake. Is there anything I can do?

I'm sorry this page did not find you sooner! Unfortunately, there's no way to reattach your baby's foreskin, but some men do go through the process of restoring their foreskins to try and regain what they have lost. Don't be too hard on yourself -- you are not the only parent to regret circumcising their son, and most likely you were never given accurate information about what circumcision entails. Some parents go to counseling to deal with this, some parents join support or no-circ groups, and a lot of parents like informing other expecting parents about circumcision so they can at least be informed about what happens. What's important is that at the time you were doing what you thought was best for your baby. Intentions are important in this world -- you didn't do this to harm your baby, you did it because you love them and thought it was what everyone wanted. That is all any of us can do, especially as new parents.

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More Information:

How to take care of your baby's foreskin

Circumcision information for health professionals and parents

One line responses for people who question your decision not to circumcise

Unbiased pamphlet discussing the basics of circumcision (PDF file)

A pamphlet containing the information on this page (.doc file)

AAP Statement

How to care for the intact penis

www.babyboy.info

www.circumstitions.com

www.cirp.org

www.doctorsopposingcircumcision.org

www.icgi.org

www.mothersagainstcirc.org

www.nocirc.org

www.noharmm.org

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Resources:

Brennan, Patty. "DONA Postpartum Doula Training Manual." DONA Postpartum Doula Training/DONA International. Center for the Childbearing Year, Ann Arbor, MI. 06 APR 2008.

Mundell, E.J.. "Scientists Discover 'Natural Barrier' to HIV." HealthDay 05 MAR 2007. Acc: 22 APR 2008 <http://www.cirp.org/news/healthday2007-03-05/>.

Sears, William, M.D., and Martha Sears, R.N.. The Baby Book: Everything you need to know about your baby from birth to age two. 2nd ed. New York: Little, Brown and Company, 2003.

Voiland, Adam. "On Circumcision Debate, Studies Cut Both Ways." U.S. News and World Report 02 APR 2008. Acc: 22 APR 2008 <http://www.usnews.com/blogs/on-men/2008/4/2/on-circumcision-debate-studies-cut-both-ways.html>.