Circumcision has become a controversial issue in the Western world. One urologist suggests this age-old practice shouldn’t be shunned.
By Dr. Marcos Del Rosario-Santiago, M.D. Originally published on Healthline.com on February 21, 2019.
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When soon-to-be parents find out they’re having a boy, they don’t usually run to a urologist for advice about whether or not to circumcise their child. In my experience, most parents’ first point of contact on the topic is their pediatrician.
That said, while a pediatrician can help shed light on the subject of circumcision, it’s also important to speak to a urologist while your child is still young.
With a medical specialty focused on the male genitalia and the urinary tract system, urologists can provide parents with a clearer understanding of whether circumcision is right for their child, and the risks associated with not doing so.
Circumcision has been around for years, but it’s becoming less common in some cultures
While circumcision has been on the decline for the past 30 years in the United States and other parts of the Western world, it’s been practiced for thousands of years and performed in various cultures worldwide. Where a child is from often determines at what age they might be circumcised, if at all. In the United States, Israel, some parts of West Africa, and Gulf states, for example, the procedure is usually performed right after birth.
In West Asia and North Africa, as well as some places in Southeast Asia, the procedure is done when the child is a young boy. In parts of southern and east Africa, it’s performed once males reach adolescence or young adulthood.
In the Western world, however, the topic has become controversial. From my medical perspective, it shouldn’t be.
The benefits of circumcision outweigh the risks
The American Academy of Pediatrics (AAP) has recommended the procedure for years. The association argues that the overall benefits outweigh the risks, which most often include bleeding and infection at the site of circumcision.
Like many issues in medicine, the recommendation to circumcise a child doesn’t apply across the board for all newborns. In fact, the AAP recommends that the matter be discussed on a case-by-case basis with the family’s pediatrician or another qualified specialist, such as a pediatric surgeon or a pediatric urologist.
While circumcision isn’t a guarantee that a young child won’t develop a UTI, infant males have a 9.9 times higher risk for developing the infection if uncircumcised.
If these infections occur frequently, the kidney — which is still developing in small children — may scar and can potentially deteriorate to the point of kidney failure.
Meanwhile, over the course of a man’s lifetime, the risk of developing a UTI is 3.7 times higherthan a man who’s circumcised.
Not being circumcised can lead to complications later on in life
Despite AAP’s support for infant and childhood circumcision, many Western pediatricians continue to argue that there’s no need to perform the procedure on an infant or child.
These pediatricians don’t see those children later on in life, as I do, when they present urological complications that are often linked to not being circumcised.
In my clinical practice in Mexico, I often see adults who are uncircumcised come to me with:
- foreskin infections
- phimosis (inability to retract the foreskin)
- HPV warts on the foreskin
- penile cancer
Conditions such as infections of the foreskin are reliably more common with uncircumcised men, while phimosis is exclusive to men who are uncircumcised. Unfortunately, many of my younger patients come to see me thinking that their phimosis is normal.
This tightening of the skin can make it painful for them to have an erection. Not to mention, it can make it difficult to clean their penis properly, which has the potential to cause unpleasant smells and increases the risk of infection.
Once these same patients have the procedure done, however, they’re relieved to be pain-free when they have an erection. They also feel better about themselves, in terms of personal hygiene.
While it’s a controversial point among scientists, there’s also the discussion about the risk of HIV transmission. Many studies have pointed to a decrease in the risk of the transmission and infection of HIV by circumcised men. Of course, men who are circumcised should still wear condoms, as it’s one of the most effective preventive measures.
Research, however, has found that circumcision is one of the more partially effective measures that can help prevent the transmission and infection of various sexually transmitted infections, including HIV.
As for HPV warts and more aggressive forms of HPV that can lead to penile cancer, there’s been debate in the medical community for a long time.
In 2018, however, the Centers for Disease Control and Prevention published a paper declaring male circumcision to be a partially effective risk reduction method that should be used along with other measures, such as the HPV vaccination and condoms.
The decision to have your baby circumcised needs to start with a discussion
I understand that there’s debate about whether circumcising a young child overrides their autonomy because they don’t have a say in the decision. While this is a valid concern, families should also consider the risks of not having their child circumcised.
From my own professional experience, the medical benefits far outweigh the risks of complications.
I urge parents of newborns to speak with a urologist to find out if circumcision is the right option for their baby and to better understand the benefits of this procedure.
In the end, this is a family decision, and both parents have to be able to discuss the subject and come to an informed decision together.
Marcos Del Rosario, MD, is a Mexican urologist certified by the Mexican National Council of Urology. He lives and works in Campeche, Mexico. He’s a graduate of the Anáhuac University in Mexico City (Universidad Anáhuac México) and completed his residency in urology at the General Hospital of Mexico (Hospital General de Mexico, HGM), one of the most important research and teaching hospitals in the country.