NOTE:   This article was adapted from an article that Dr. Zwiers (Avivo Health Alliance’s circumcision Physician) wrote for Family Health Magazine in 2018.

For years, many doctors in Canada advised parents that the risks of routinely circumcising a newborn boy exceeded the benefits and that circumcision should be avoided.    A 2012 policy statement questioned this standard advice.   The American Academy of Pediatrics concluded that in light of new research, the health benefits outweigh the risks.   Then in 2015, the Canadian Paediatric Society reviewed the available scientific information on circumcision and released the following position statement:

While there may be a benefit for some boys in high-risk populations, and circumstances where the procedure could be considered for disease reduction or treatment, the Canadian Paediatric Society does not recommend the routine circumcision of every newborn male.”

This Canadian document is very helpful for parents of newborn boys.   Parents considering circumcision now have a clearer understanding of the risks and the benefits.   The document reassures parents who decide against circumcision that not every newborn boy needs this procedure.

What is male circumcision?

Male circumcision removes a sac of skin (foreskin) that covers the top of the penis (glans).    In newborns, the foreskin is attached to the skin of the glans.   As boys grow, the attachments release, allowing the foreskin to move freely over the glans.   When the foreskin is removed by choice rather than for medical reasons, this is referred to as male circumcision.

Why do some parents choose circumcision for their newborn sons?

Routine circumcision is done for a variety of reasons.   Parents may choose to circumcise their newborn for religious or cultural reasons.   Some hope to prevent future complications or disease.   Other reasons include personal preference, and concerns about hygiene.

What are the medical benefits?

This procedure has several benefits (see below).   Studies show that it reduces the risk of bladder and kidney infections in boys less than one year of age.   (Bladder and kidney infections are known as urinary tract infections or UTI’s).    Circumcision also lessens the risk of sexually transmitted diseases like HIV, herpes, human papilloma virus (HPV), and cancer of the penis.   Female partners of circumcised men have a lower risk of cervical cancer.

Occasionally, problems with the foreskin may require circumcision at an older age.   Newborn circumcision prevents these problems.

In the past, circumcision helped to lower the rates of HPV and cervical cancer, which are strongly linked.   Now that we have an HPV vaccine, it is unclear whether circumcision will still be important in lowering HPV rates.

What are the medical risks?

Circumcising a newborn boy does have some risks (see below).   They include bleeding, infection, and meatal stenosis, a narrowing of the hole at the tip of the penis.   If the penis is damaged or there are appearance issues as a result, surgery may be required later on.

More serious problems are rare.   These include bleeding that requires a blood transfusion, or infection requiring a hospital admission.   In extremely rare cases, deaths due to circumcision have been reported.

Circumcision:  Benefits & Risks

According to the Canadian Paediatric Society, every 1,000 circumcisions of normal male newborns carry the following benefits and risks:

Prevents

• 10 to 20 urinary tract infections in the first year of life
• Three to four cases of HIV
• 60 cases of genital herpes
• Eight to 16 boys needing medically required circumcision before puberty
• Less than one case of cancer of the penis (penile cancer is extremely rare)

Risks

• 10 cases of meatal stenosis
• 15 cases of minor bleeding
• About 15 cases of minor infection
• Meatal stenosis (narrowing of the opening of the urethra)

Why is there controversy?

Some medical care providers think that the Canadian Paediatric Society underestimated the benefits and overestimated the risks of circumcision.   They feel there is enough evidence to support routine male circumcision.

Other argue that we should not routinely remove the foreskin because most males will never develop problems with it.   They believe that it plays an important role in sexual function.   They reassure us that an uncircumcised penis is easy to clean.

The main controversy involves the idea of consent.   Newborns are too young to agree to the procedure themselves.   Their parents must make the decision for them.  The worry is that one day the child will regret the decision made on his behalf.

Making the decision

Parents are allowed to decide for their newborn because:

• The risk of complications, as well as the expense, increase when the procedure is done later in life. (Most provincial health care plans do not cover routine circumcision).
• Many of the benefits of the procedure occur during childhood.

Some parents really struggle with this decision.   For this reason, it should be considered before the baby is born.   This allows enough time to think about all the important facts.   The risk of complications is lower when circumcision is done before six weeks of age.   If the parents disagree about what to do, having an open and honest discussion and reviewing the risks and benefits together is important.   Meeting with the doctor who would perform the procedure may also help.

The position statement form the Canadian Pediatric Society reassures us that the risks and the benefits of routine circumcision seem to be in balance.   With this information in hand, parents can discuss this decision and explore the most current information with their family doctor.