Parents awaiting the arrival of their new babies have many decisions to make – how to decorate the baby’s room, how to install the car seat, which day care to choose.
Something that parents of baby boys need to decide is if they want their baby to be circumcised.
Some parents circumcise their sons because of religious, cultural or social reasons. Other parents decide not to circumcise because it is not medically necessary.
The decision is up to each family.
How do you decide what is right for your family? Today’s guest is Dr. Arnold London, a pediatrician at Allina Health Bandana Square Clinic in St. Paul.
Selected Podcast
Circumcision: What is Right For Your Family?
Featured Speaker:
Arnold London, MD, Pediatrician
Arnold London, MD is a Board-certified pediatric physician with professional interests in health counseling, vaccine promotion and circumcision. Transcription:
Melanie Cole (Host): Something that parents of baby boys need to decide is if they want their baby to be circumcised. Some parents circumcise their sons because of religious or cultural or social reasons. Other parents decide not to circumcise because it may not be medically necessary. But the decision is certainly up to each family. My guest today is Dr. Arnold London. He is a pediatrician at Allina Health Bandana Square Clinic in St. Paul. Welcome to the show, Dr. London. Tell us a little bit about circumcision. Is it as routinely done as maybe it used to be? What are the benefits and/or side effects from it?
Dr. Arnold London (Guest): Well, circumcision is a procedure that’s been done since they were building the pyramids. It was a way to mark slaves indelibly at that time, and more recently, it’s done for religious or ethnic purposes. It has benefits and risks. The benefits are primarily in the first 12 months of life, babies who are circumcised are only 10 percent as likely to get a urinary tract infection as if they are uncircumcised. About 10 percent of babies who are not circumcised in the newborn period later in life requires circumcision for medical problems related to the foreskin, such as related to diabetes and infections. Finally, getting a circumcision protects adults against contracting HIV infection—about 50 percent compared to not being circumcised—so it’s better than any vaccine that’s being developed. The risks are mainly bleeding and infection. Bleeding is most common on the mother’s side if the family there is hemophilia, which is a genetic bleeding disorder where you don’t make clotting factors and the mother carries one defective X chromosome that can be given to the baby boy. And if that happens, then the baby boy can’t clot well after incisions or injuries. In general, most babies with hemophilia have a positive family history where the mother’s male relatives have bleeding disorders. The other risk is infection. Infection is very rare, as is significant bleeding after circumcision. I’ve been doing them for about 40 years, and I’ve never seen a significant infection that was in any way life-threatening.
Melanie: Tell us a little bit about the actual medical procedure of a circumcision that takes place at a clinic rather than at the hospital following the birth of the baby. Is there an advantage to one over the other?
Dr. London: The procedures are identical. Just the timing is different. There are some proponents of breastfeeding who recommend delaying circumcision until after the breastfeeding is well established at five to 10 days of age. That’s certainly debatable, and a lot of babies still are circumcised in the nursery. The procedure itself is fairly brief. Initially, the baby has oral Tylenol given for pain control, and some sugar solution is usually given to the baby to drink, which helps with pain control as well. Then an injection of lidocaine is used to block pain in the penis area. It’s given under the skin. That’s allowed to work for a minute or two before the procedure. During the procedure, the foreskin is removed using several different devices. A clamp or a Mogen clamp can be used, or a Plastibell can be used. In the clamp procedures, there is nothing left on the penis after the procedure and the skin edges are fairly well approximated. In a Plastibell procedure, a plastic ring is left on the foreskin with a ligature around the outside of it. It causes the skin downstream from the ligature to fall off, and the entire ring falls off at about five to 10 days after the procedure. After circumcision, with the clamp devices where there is nothing left on the penis, the parents have to apply Vaseline every diaper change for about five days until the incision is healed. During that time, they watch for signs of complications, such as infection or bleeding. Bleeding is pretty self-evident when it happens but very rare. Infection can be noted by babies who, for example, stop eating well, start having fever, or have redness go up the shaft of the penis from the incision. Something that is sometimes confused with infection is the fact that the head of the penis frequently becomes mattery and yellow, like a scraped knee, because of the procedure causing a little abrasion at the head of the penis. That’s totally normal and doesn’t need any special treatment other than the routine application of Vaseline every diaper change for five days.
Melanie: After the circumcision and parents are caring for the baby, just as you say, what is the difference for parents who choose not to circumcise and how they care for this new little baby’s penis and teaching the baby on down the line what to do?
Dr. London: Well, the foreskin does not retract back behind the head of the penis in most children until they’re five to 10 years of age. Until that time, when it’s easy to pull it back, nothing need be done at all about the underlying head of the penis. The foreskin is just treated like the rest of the body and washed with soap and water when needed, and no special care need be done. Only when it gets quite lose and it’s easy to see the head of the penis through the pulled back foreskin is that the time when one would recommend starting routine retraction and cleaning underneath the head of the penis.
Melanie: When somebody asks you for your advice on whether or not they should circumcise—is this painful for the baby, will it create a stigma in their later life if we don’t circumcise—what do you tell them? What is your best advice?
Dr. London: Well, every 10 years or so, the American Academy of Pediatrics reevaluates the risks-benefit ratio of circumcision, whether it’s worth doing or not. More recently, about a year ago, the last reassessment emphasized that the risks are much less significant than the benefits. It’s a good idea to consider it, although it’s totally up to the parents. We don’t try to talk anybody into it. We just try to give them the facts of the benefits and the risks. If the father is circumcised and he wants his son to look like him, then that’s a factor. I think it’s a good idea. Some of the insurance payers such as medical assistance has stopped paying for circumcision about eight to 10 years ago because they didn’t consider it medically necessary, but I think they are going to reconsider that over the next few years as more and more evidence of HIV prevention is presented.
Melanie: Wow, that really is amazing. In just the last minute, if you would, just tell parents what you want them to know about circumcision and making that decision.
Dr. London: Well, for some people, it’s not much of a decision to make because their ethnic groups don’t routinely circumcise, and that’s fine. If you’re wondering about the risks and the benefits, that’s really what drives the decision for most parents these days who are willing to consider it. And I believe that the benefits outweigh the risks. Preventing HIV is a pretty cool benefit. Preventing urinary tract infections is desirable. There is more risk at doing circumcisions later in life. I do them up to two months of age, while most pediatricians do them up to two to four weeks of age. Doing them after a year of age has more complications, so it’s better if you’re going to do it to do it in the first month or two of life.
Melanie: If you have any questions about whether or not to circumcise your baby, speak to your pediatrician. Get the facts. Get the information, and then make your decision as a family. Thank you so much, Dr. London. You are listening to the WELLcast with Allina Health. For more information, you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): Something that parents of baby boys need to decide is if they want their baby to be circumcised. Some parents circumcise their sons because of religious or cultural or social reasons. Other parents decide not to circumcise because it may not be medically necessary. But the decision is certainly up to each family. My guest today is Dr. Arnold London. He is a pediatrician at Allina Health Bandana Square Clinic in St. Paul. Welcome to the show, Dr. London. Tell us a little bit about circumcision. Is it as routinely done as maybe it used to be? What are the benefits and/or side effects from it?
Dr. Arnold London (Guest): Well, circumcision is a procedure that’s been done since they were building the pyramids. It was a way to mark slaves indelibly at that time, and more recently, it’s done for religious or ethnic purposes. It has benefits and risks. The benefits are primarily in the first 12 months of life, babies who are circumcised are only 10 percent as likely to get a urinary tract infection as if they are uncircumcised. About 10 percent of babies who are not circumcised in the newborn period later in life requires circumcision for medical problems related to the foreskin, such as related to diabetes and infections. Finally, getting a circumcision protects adults against contracting HIV infection—about 50 percent compared to not being circumcised—so it’s better than any vaccine that’s being developed. The risks are mainly bleeding and infection. Bleeding is most common on the mother’s side if the family there is hemophilia, which is a genetic bleeding disorder where you don’t make clotting factors and the mother carries one defective X chromosome that can be given to the baby boy. And if that happens, then the baby boy can’t clot well after incisions or injuries. In general, most babies with hemophilia have a positive family history where the mother’s male relatives have bleeding disorders. The other risk is infection. Infection is very rare, as is significant bleeding after circumcision. I’ve been doing them for about 40 years, and I’ve never seen a significant infection that was in any way life-threatening.
Melanie: Tell us a little bit about the actual medical procedure of a circumcision that takes place at a clinic rather than at the hospital following the birth of the baby. Is there an advantage to one over the other?
Dr. London: The procedures are identical. Just the timing is different. There are some proponents of breastfeeding who recommend delaying circumcision until after the breastfeeding is well established at five to 10 days of age. That’s certainly debatable, and a lot of babies still are circumcised in the nursery. The procedure itself is fairly brief. Initially, the baby has oral Tylenol given for pain control, and some sugar solution is usually given to the baby to drink, which helps with pain control as well. Then an injection of lidocaine is used to block pain in the penis area. It’s given under the skin. That’s allowed to work for a minute or two before the procedure. During the procedure, the foreskin is removed using several different devices. A clamp or a Mogen clamp can be used, or a Plastibell can be used. In the clamp procedures, there is nothing left on the penis after the procedure and the skin edges are fairly well approximated. In a Plastibell procedure, a plastic ring is left on the foreskin with a ligature around the outside of it. It causes the skin downstream from the ligature to fall off, and the entire ring falls off at about five to 10 days after the procedure. After circumcision, with the clamp devices where there is nothing left on the penis, the parents have to apply Vaseline every diaper change for about five days until the incision is healed. During that time, they watch for signs of complications, such as infection or bleeding. Bleeding is pretty self-evident when it happens but very rare. Infection can be noted by babies who, for example, stop eating well, start having fever, or have redness go up the shaft of the penis from the incision. Something that is sometimes confused with infection is the fact that the head of the penis frequently becomes mattery and yellow, like a scraped knee, because of the procedure causing a little abrasion at the head of the penis. That’s totally normal and doesn’t need any special treatment other than the routine application of Vaseline every diaper change for five days.
Melanie: After the circumcision and parents are caring for the baby, just as you say, what is the difference for parents who choose not to circumcise and how they care for this new little baby’s penis and teaching the baby on down the line what to do?
Dr. London: Well, the foreskin does not retract back behind the head of the penis in most children until they’re five to 10 years of age. Until that time, when it’s easy to pull it back, nothing need be done at all about the underlying head of the penis. The foreskin is just treated like the rest of the body and washed with soap and water when needed, and no special care need be done. Only when it gets quite lose and it’s easy to see the head of the penis through the pulled back foreskin is that the time when one would recommend starting routine retraction and cleaning underneath the head of the penis.
Melanie: When somebody asks you for your advice on whether or not they should circumcise—is this painful for the baby, will it create a stigma in their later life if we don’t circumcise—what do you tell them? What is your best advice?
Dr. London: Well, every 10 years or so, the American Academy of Pediatrics reevaluates the risks-benefit ratio of circumcision, whether it’s worth doing or not. More recently, about a year ago, the last reassessment emphasized that the risks are much less significant than the benefits. It’s a good idea to consider it, although it’s totally up to the parents. We don’t try to talk anybody into it. We just try to give them the facts of the benefits and the risks. If the father is circumcised and he wants his son to look like him, then that’s a factor. I think it’s a good idea. Some of the insurance payers such as medical assistance has stopped paying for circumcision about eight to 10 years ago because they didn’t consider it medically necessary, but I think they are going to reconsider that over the next few years as more and more evidence of HIV prevention is presented.
Melanie: Wow, that really is amazing. In just the last minute, if you would, just tell parents what you want them to know about circumcision and making that decision.
Dr. London: Well, for some people, it’s not much of a decision to make because their ethnic groups don’t routinely circumcise, and that’s fine. If you’re wondering about the risks and the benefits, that’s really what drives the decision for most parents these days who are willing to consider it. And I believe that the benefits outweigh the risks. Preventing HIV is a pretty cool benefit. Preventing urinary tract infections is desirable. There is more risk at doing circumcisions later in life. I do them up to two months of age, while most pediatricians do them up to two to four weeks of age. Doing them after a year of age has more complications, so it’s better if you’re going to do it to do it in the first month or two of life.
Melanie: If you have any questions about whether or not to circumcise your baby, speak to your pediatrician. Get the facts. Get the information, and then make your decision as a family. Thank you so much, Dr. London. You are listening to the WELLcast with Allina Health. For more information, you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thanks so much for listening.