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Should You Nip The Tip?

Whether you should circumcise your newborn son is a big decision. Personal beliefs, religion, culture, and ethnic traditions play a big role in your ultimate decision. As a physician, I feel like it is my job to present the facts and let parents decide whether to circumcise based on what they think is best. To be clear, circumcision is an elective procedure (meaning it is chosen and consent has to be obtained) and not essential to a child’s health.

What is circumcision?

Circumcision is surgical removal of the skin covering the tip or end of the penis (foreskin). Circumcision is usually done by a doctor (either a pediatrician or OB depending on the state where you live) in the first few days of life. An infant must be healthy before a circumcision is done.

What are the circumcision risks and benefits?

Anytime you are talking about a surgical procedure, there are inherent risks. Your son could experience pain, have a reaction to anesthesia (which is typically a nerve block done with lidocaine), have bleeding, experience some surgical mistake (cutting the penis or something), or get a post-op infection. It is also reported that removing the foreskin decreases sensitivity during sex. Risks can be reduced by a good doctor who uses sterile technique and proper pain management.

As for benefits, there are quite a few. The cultural and social benefits aside (because that is entirely based on where you live), there are many medical benefits. Boys who are circumcised have decreased rates of urinary tract infections (UTIs), decreased rates of sexually transmitted diseases (including HIV, Human papilloma virus, which causes genital warts and some cancers, and genital herpes). Some research has shown that circumcision also decreases risk of developing prostate cancer.

How is it circumcision done?

Traditionally, there are two major methods of a doing a circumcision.

  1. The Gomco Clamp. Also called the Yellen clamp (named for the inventor). Gomco stands for the GOldstein Medical COmpany, the original manufacturer of the clamp. The clamp is a metal apparatus with two major pieces. The first part, the “bell,” slips over the tip of the penis (the glans) to protect it from being cut off. The second part, the “clamp,” tightens against the bell, to prevent bleeding. The foreskin is then cut off along the bell. This is the method I use when performing a circumcision.
  2. The Plastibell. The plastibell is a clear ring with a deep grove that runs around it. It is placed on the tip of the penis and uses a string that tightens in the groove to prevent bleeding. The excess skin that protrudes beyond the ring is then cut off. The ring stays attached to the penis and typically falls off in 3-7 days.
  3. Other methods: Mogen Clamp. This clamp is traditionally used by a Jewish Mohel in the ceremonial circumcision, the bris.

The AAP (American Academy of Pediatrics) Stance on Circumcision

After years of maintaining a neutral stance, the AAP released a policy statement in support of circumcision in August of 2012. Taken directly from their site:

“After a comprehensive review of the scientific evidence, the American Academy of Pediatrics found the health benefits of a newborn male circumcision outweigh the risks, but the benefits are not great enough to recommend universal newborn circumcision. The final decision should still be left to parents to make in the context of their religious, ethical, and cultural beliefs.”

Good luck in your decision. Keep in mind, however, that this particular one is time sensitive. If you’re going to circumcise your newborn son, it needs to be in the first few days of life. Most offices have a policy not to circumcise beyond a certain point (our office is 30 days, some go as far as 60 days).