Should my baby boy get circumcised?

One of the first health decisions parents of baby boys must make is whether to have the baby circumcised. Circumcision is an optional procedure in which the sleeve of skin that covers the tip of a newborn boy’s penis is removed. It’s a common procedure for boys born in the United States and less common in other parts of the world.

At Clements University Hospital and Parkland Hospital, where UT Southwestern Ob/Gyns deliver, we see a fairly equal mix of boys who are circumcised and who aren’t. Nationally, circumcision is trending down across the country.

Newborn circumcision is a controversial topic and often invokes heated discussions because of its association with certain religious and cultural traditions. The most recent American Academy of Pediatrics (AAP) guidelines state that the health benefits of circumcision in newborn boys outweigh the risks of the procedure for families that choose to do it, but the AAP makes no recommendation for or against the procedure.

Some parents are staunchly opposed to circumcision, and some really want it for their sons. We’ve compiled a list of frequently asked questions and answers to help you make a decision.

Does my baby boy have to be circumcised?

No. Years ago, circumcision was the norm in the United States. When a baby boy was born, he’d be taken down the hall without discussion, circumcised, and returned to his parents. Today, the decision to circumcise or not — whether it’s based on cultural, aesthetic, or religious reasons — is yours as a parent, and we respect your decision.

In certain medical situations, we might recommend not circumcising a baby boy. One such reason is a common birth condition called hypospadias, in which the urinary opening develops along the shaft of the penis instead of at the tip. The Centers of Disease Control and Prevention estimate that five out of every 1,000 boys born in the United States each year have hypospadias. The condition is almost always correctable with surgery. We can use some of the foreskin as part of the reconstruction surgery, which typically is performed when the baby is 6-12 months old.

Sometimes we recommend circumcision if a baby is born with a condition that might put him at higher risk for urinary tract infections. Though rare in baby boys, UTIs can lead to severe illness.

Can I let my son choose to be circumcised later in life?

We typically say that if parents want their son to be circumcised, they should consider having it done when their son is a newborn. Newborns do feel pain, but they seem to get through the procedure easier than older children do.

In newborns, we numb the penis and perform the procedure in the hospital nursery while the baby is awake. We use a clamp technique, which does have a small risk of bleeding. For older babies and children, we have to use general anesthesia and actually suture the cut edges of the skin to prevent bleeding and facilitate healing. The older a child gets, the more likely he will be to become hesitant and uncomfortable about having an elective procedure on his genitals.

Another thing to consider is that many insurance companies do not cover circumcision after the newborn period. We think of this period in terms of weight, so a baby up to 12 pounds, which is typically around 2 to 3 months of age. If you’re thinking about it for a child over 12 pounds or older than 2 months of age, talk to your hospital of choice and contact your insurance company to find out what is covered.

What are the risks of having my newborn circumcised?

In general, newborn circumcision is a low-risk procedure. However, as with any procedure, there is some risk involved. The two most common risks are bleeding and infection.

We’ll ask you if there is a family history of bleeding disorders such as hemophilia before we perform the circumcision. After the procedure, some babies might develop an infection in the incision, though this is rare.

Serious complications also are rare but can include excessive bleeding or skin infection that enters the bloodstream. Very rarely, a surgical error can occur in which the tip of the penis is removed. This nearly always can be repaired.

What are the benefits of having my baby boy circumcised?

It’s well-documented that circumcision can reduce the risk of UTIs in a baby’s first year of life. A 2012 meta-analysis of 30 years of circumcision data suggests that uncircumcised boys are nearly 10 times as likely as circumcised boys to develop a UTI in the first year of life. However, most baby boys are at low risk, so we don’t recommend circumcision solely for UTI prevention.

In the long term, research suggests that circumcision can help reduce the transmission of sexually transmitted infections (STIs), though we do not have enough data to recommend circumcision for all boys based solely on that reason.

Circumcision can simplify hygiene. The notion that uncircumcised penises are dirty is untrue, but uncircumcised boys do require different hygiene than circumcised boys to prevent infections, inflammation, and related scar tissue. If you choose to not circumcise your son, make sure you receive up-to-date information about how to clean under and around the baby’s foreskin.

Who can I talk to if I have more questions?

During a prenatal care appointment, feel free to ask your Ob/Gyn about circumcision procedures in your hospital of choice. Some questions you might want to ask include:

• Who will do the circumcision?
• What type of numbing medicine will be used?
• What will I need to do after the procedure?

Ob/Gyns, physicians, and certified nurse midwives perform newborn circumcisions for boys born at Clements University Hospital and Parkland Hospital. If a child is older or has a genital or urinary medical condition, a pediatric urologist at Childrens’ Health will do it. We’ll explain how we numb the baby’s penis before the procedure and give you thorough instructions for caring for the incision at home.

The decision about whether to get your baby boy circumcised is personal, and it’s often among the first of many choices you’ll make for your child. If you have questions, you should feel comfortable asking your doctor. And if your son has a medical condition to consider, make sure you fully understand the options before you decide.