Before my son was born, my husband, Mike, and I had a brief conversation about the circumcision decision. We knew we were having a boy, and I naively told Mike that he could make the final call, being a guy and all.

After Elliot Conrad entered the world in May 2007, my motherly instinct (that I doubted I would ever have!) kicked in, and I wanted to do everything in my power to keep my baby safe. When the doctor confronted me with the circumcision question, I hesitated. My son and I were already having troubles breastfeeding, and the lactation consultant told me the pain response from circumcision could worsen that situation.

Still, I felt pressured by cultural expectations and the possibility of locker room awkwardness. I didn’t want my son to be made fun of because his penis looked different from all the other boys!

Ultimately, I signed the paper, and the doctor returned later that afternoon to perform, according to an Associated Press story on MSNBC.com, the most common surgery in the United States — newborn circumcision. It is a choice that continues to trouble me. Here is the information I should have gathered before making the circumcision decision.

The American Academy of Pediatrics Web site states, “At birth, boys have skin that covers the end of the penis, called the foreskin. Circumcision surgically removes the foreskin, exposing the tip of the penis.

Circumcision is usually performed by a doctor in the first few days of life. An infant must be stable and healthy to safely be circumcised.

“Scientific studies show some medical benefits of circumcision. However, these benefits are not sufficient for the AAP to recommend that all infant boys be circumcised. Because circumcision is not essential to a child’s health, parents should choose what is best for their child by looking at the benefits and risks. Circumcision may be more risky if done later in life, so parents should decide before or soon after their son is born if they want it done.”

Dr. Robert Wetzel, an obstetrician and gynecologist at East Ohio Regional Hospital in Martins Ferry, said the American College of Obstetricians and Gynecologists also does not recommend or discourage circumcision.
“The bottom line is that the true medical benefits are extremely limited,” he noted. “There are not a whole of pros and cons.”

The AAP Web site lists the following medical benefits for newborn circumcision:

- A slightly lower risk of urinary tract infections (UTIs). A circumcised infant boy has about a 1 in 1,000 chance of developing a UTI in the first year of life; an uncircumcised infant boy has about a 1 in 100 chance of developing a UTI in the first year of life.

- A lower risk of getting cancer of the penis. However, this type of cancer is very rare in all males.

- A slightly lower risk of getting sexually transmitted infections, including HIV, the virus that causes AIDS.

- Prevention of foreskin infections.

- Prevention of phimosis, a condition in uncircumcised males that makes foreskin retraction impossible.

- Easier genital hygiene.

Cultural, religious and ethnic traditions affect parents’ decisions to circumcise, Wetzel added. The AAP Web site also states that followers of Judaism and Islam routinely circumcise because of religious obligations.

“The rest of the world does not routinely circumcise,” Wetzel said. “For example, in Canada, national health care does not pay for circumcision.”

Dr. Lori Archbold, a pediatrician at Wheeling Hospital, said cultural influences are the most common reasons for circumcision in the United States.

“The biggest advantages are cultural,” she noted. “When Dad, Grandpa, brothers and peers are circumcised, we follow that tradition. As Americans, we all want to look the same.”

However, Dr. Ralph R. Salimpour, the senior attending physician of the Salimpour Pediatric Medical Group in Los Angeles, Calif., and a clinical professor of pediatrics at the UCLA School of Medicine, laments that circumcision is not as popular in various immigrant populations, specifically his Latino patients.

“We know that the rate of urinary tract infections declines significantly following a circumcision, so that’s very important to the health of boys,” he explained. “We also know that it is more hygienic.

“The incidence of sexually transmitted disease, everything from gonorrhea to AIDS, is much less in circumcised men,” he continued. “When people lack knowledge about the health benefits of circumcision, it’s the male babies of the population that suffer.”

In addition, the U.S. National Institutes of Health in December 2006 announced the results of two trials that showed an approximate halving of risk of HIV infections among men who were circumcised. The trials, carried out in Kenya and Uganda, support results from the earlier South Africa Orange Farm Intervention Trial in 2005, which demonstrated at least a 60 percent reduction in HIV infection among circumcised men.

“The AAP is in the process of reviewing its policy on circumcision in terms of benefits,” Archbold said. “It does have risks, but it’s not terribly risky.”

According to the AAP Web site, “Complications are rare and usually minor but may include bleeding, infection, cutting the foreskin too short or too long and improper healing.”

“If not enough skin is removed during circumcision, if the remaining skin has some slack to it or if the skin isn’t regularly retracted, it can reattach to the glans of the penis,” Archbold noted. “If the skin does reattach, that can usually be fixed by using a topical medicine.”

The AAP states the reasons parents choose not to circumcise are:
- Belief that the foreskin is needed. Some people feel the foreskin is needed to protect the tip of the penis. Without it, the tip of the penis may become irritated and cause the opening of the penis to become too small. This can cause urination problems that may need to be surgically corrected.

- Belief it can affect sex. Some feel that circumcision makes the tip of the penis less sensitive, causing a decrease in sexual pleasure later in life.

- Belief that proper hygiene can lower health risks. Boys can be taught proper hygiene that can lower their chances of getting infections, cancer of the penis and STIs.

The AAP’s stance on circumcision also states that “if parents decide to circumcise their infant, it is essential that pain relief be provided.” Archbold said all doctors who perform circumcision at Wheeling Hospital use some form of analgesia, such as a nerve block, topical anesthetic or sugar-dipped pacifier.

The effects on breastfeeding add another dimension to the circumcision decision.

La Leche League International’s Web site states, “Circumcision, in and of itself, is not directly related to breastfeeding. However, like other elective surgeries, this procedure can affect the early days of breastfeeding.”

Jean Cooper, certified lactation consultant at East Ohio, said she hopes more parents will research circumcision and the possible results it can have on breastfeeding.

“Frequently, circumcision is done at a time when mom and baby are learning to breastfeed,” she said. “It interrupts the crucial learning time, that first 48 hours. I’ve seen babies who are finally getting it (breastfeeding properly), then have to be taken off the breast to be circumcised.

“Also, if they’ve been nursing well, they might want to go to the breast for comfort,” Cooper continued. “If it hasn’t been going well, circumcision can make the difficulties worse. I’ve observed babies exhibit signs of discomfort.”

Archbold added that obstetricians generally do the procedure, which most babies born at Wheeling Hospital undergo.

“The vast majority of parents do opt to have newborns circumcised, probably for more cultural reasons that anything else,” Archbold explained. “I personally feel much better about analgesics for the babies.”

Wetzel had similar comments about the baby boys born at EORH.

“I would say in this area, easily 99 percent of parents decide on circumcision,” he noted. “In the past year at The Birthplace, we’ve had two mothers who have refused.”

According to data compiled by the federal Agency for Healthcare Research and Quality, the national circumcision rate is 57 percent, but figures show West Virginia in the 70 percent to 85 percent category.

“We’re not overwhelmingly pressuring families to circumcise,” Archbold said. “Every family should talk to their doctor to find out what the pros and cons are and whether it’s going to be right for their baby.”

April Henry is a freelance writer who lives in Martins Ferry, Ohio, with her husband, Mike, and son, Elliot.