CIRCUMCISION (NEWBORN):

CIRCUMCISION (NEWBORN):

Dear Sumner:

I have spent an inordinate amount of time with one of my families, Mary and Bob Stevens, discussing with them whether or not they should have their soon to be born son circumcised. This is not a religious issue. Dad is circumcised, as are their other 2 sons, but Mom has been reading a lot recently about the “brutality” of cutting on a defenseless newborn, who has no say in the matter. I realize that this is a very controversial topic, which is fraught with much emotional overtones (as has definitely been the case in this family!) What is your personal opinion (based on scientific facts, of course) re circumcision of the newborn? The family has requested a consultation with you. I think it would be wise to allot sufficient time in your schedule to go over the subject with them.

Dear Myron:

I really appreciated your alerting me to the possible time which I should allow to talk with the Stevens family about having their newborn son undergo a circumcision. As you mentioned, they have literally agonized over this subject for the entire time of Mary’s pregnancy. The Stevens’ dilemma is made more acute by the fact that all males in that family are circumcised. They had obviously read extensively about the pros and cons of circumcision, including the possible complications of the procedure itself. I tried to act as a sounding board, while interjecting my own interpretation of the available material on the subject. While it is a fact that over 80% of males in this country are circumcised, in the world at large, this figure is probably well under 5%.

We reviewed the evidence, both pro and con re circumcision. On the negative side, we considered the risks of the procedure itself, including reactions to anesthesia (if anesthesia were to be used), bleeding, infection, secondary scarring, fistula formation, incomplete or excessive skin removal necessitating surgical revision, and inclusion cyst formation. On the positive side, circumcision reputedly decreases the chance of urinary tract infections, HIV infections, penile carcinoma, and carcinoma of the cervix in women whose partners are circumcised. After spending close to an hour with the Stevens, I still felt that although they seemed to be leaning toward arranging for the circumcision, they still seemed a bit ambivalent. I suggested that they postpone the decision for a bit longer. I also emphasized to them that, if they opted to defer or not circumcise their son, they should avoid the temptation to try to retract the foreskin themselves at this time, since it is “normal” that the foreskin is non-retractable in most boys until they are about 2 years of age. I remain ever available.