JB 21/5/2005

It's a Boy!

Benefits        Disadvantages        Pros and Cons

Congratulations! Now comes the question you may have been expecting - or dreading: should he be circumcised? Fashions change - some of the English speaking countries (but not North America) almost abandoned the practice some years ago, but now the pendulum is swinging back in favour. And it's becoming quite popular in some Asian and European countries. But should it be a matter of fashion? Which choice should you make for your son?

This page is not here to make up your mind for you. Its aim is to provide a quick summary of the pros and cons, with links to the main parts of this site if you want more details.

This happy toddler, Robert B., is now in his 50s and remains very happy with the decision his parents made.

Mother and Baby

Circumcision - the benefits

Medical Issues
Circumcision at an early age prevents cancer of the penis. This cancer is uncommon, but often fatal, and treatment means amputation of all or most of the penis. In Australia or Western Europe, about one uncircumcised man in 1,500 will contract cancer of the penis, generally in later life. It is much more common in some Asian countries. Circumcision will also help protect his future wife from cervical cancer.   More details

Uncircumcised boys and men are much more liable to urinary tract infections. These infections usually just need a course of antibiotics, but they can, sometimes, have serious consequences. Infections of the head of the penis - medically called balanitis - don't occur in circumcised boys. 10-15% of uncircumcised boys will suffer from these infections, which are uncomfortable but not life-threatening. Some individuals are more susceptible to them than others, and even if you chose against circumcision when your boy was born it's worth reconsidering the question if he gets these infections often.   More details

Recent studies have shown that circumcised men run much less risk of catching AIDS through unprotected sex with an infected woman. In Africa this is the major way AIDS is transmitted, but it is less significant in the developed world.   More details

Foreskin problems
The foreskin of a newborn baby generally cannot be retracted.   More details   This is normal, but if it persists beyond the age of about four or five it is called phimosis, and a secretion called smegma starts to accumulate underneath the skin, causing irritation and an unpleasant smell (from a bacterium which infects it). If phimosis continues into his teenage years it will not help his sex life. At least 10% of uncircumcised boys are likely to have this problem (the figure is even higher in some Asian countries). This is quite a large proportion and many parents think that such a high risk of foreskin trouble is a good enough justification for infant circumcision.   More details

More serious is the case of a tight foreskin which is pulled back and cannot be got forward again (paraphimosis). This is a medical emergency and failure to seek prompt attention can have serious consequences, such as loss of the head of the penis.   More details

If a boy is still unable to pull back his foreskin by school age you should get medical advice about whether either circumcision or stretching of the foreskin is required. Leaving a child uncircumcised does imply a duty of care in teaching him to manage his foreskin.

Circumcision - the disadvantages

Medical Issues
There is one problem which only affects circumcised babies - ulceration of the meatus (the hole at the end of the penis). This is not common, and requires no more treatment than a mild ointment, but left untreated can lead to narrowing of the opening. Even so, this rarely causes trouble; surgical rectification (a tiny cut) is simple but not often necessary. (It has also been claimed that in fact uncircumcised boys get these ulcers too - they are just hidden by the foreskin.) Either way, not leaving your baby in a wet nappy / diaper is the best preventative.   More details

Then there are also the hazards of the operation itself. The major risks - death or serious damage to the penis - are very low indeed. Your baby is much more likely to die from a urinary tract infection resulting from being uncircumcised than he is to die from the operation. If you include the risk of cancer in later life circumcision is the safer option by some hundreds of times. However, the risk either way is pretty low. It is not comparable to the risks your baby faces if you don't have him immunised against the common infectious diseases.   More details

The risk of less serious complications - haemorrhages, infections etc., is higher, but still lower than the risk of urinary tract infections in uncircumcised babies. The other risk is that you (or your son) won't be happy with the end result. While serious damage is vanishingly rare, minor imperfections such as an uneven amount of skin remaining can happen. So if you do get your boy circumcised make sure it is done by an expert. Fortunately the bad old days where routine circumcision was left to the most junior intern seem to be well in the past.

Arguments for and against

The major argument against circumcision is that it is his foreskin, and you don't have the right to take it away. If he grows up unhappy about being circumcised there is nothing you can do about it, whereas a boy who is unhappy about his foreskin can always be circumcised later.

The balance of the medical arguments is strongly in favour of circumcision, whether one considers the rare but nasty conditions such as cancer or AIDS or the common ones such an infections or phimosis. The risks from these far outweigh the minuscule risks of the operation.

If circumcision does anything to his future sex life it's likely to improve it; in spite of what you may read elsewhere circumcision doesn't reduce the sensitivity of the penis. Obviously phimosis is a disaster for a boy's sex life, but no caring parent should let a foreskin remain unretractable beyond age 8 or 9 at the very latest. Apart from that both circumcised and uncircumcised men can expect happy and fullfilling marital relations. So this is not a major factor in the decision.   More details

Then there is the question of peer pressure. 'Fitting in' can be quite important to a boy. So if you don't have strong views either way you might choose to match the majority - which would generally be circumcised in the USA, foreskins in the UK. Both are common in Australia.

In the end it comes down to your philosophy of child rearing.

Whichever choice you make it is important to be open about it if the child asks. Some time or other he is going to see a boy with a different sort of willy, and ask the question 'why?'. You should be able and willing to explain why you had him circumcised, or why you didn't. In the end that is probably even more important for his future happiness than which choice you make.

The basic choice is this: modify nature for better health, or leave it alone?

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