To circumcise or not
Guardian Lifestyles Editor
Published: Aug 13, 2013
To circumcise or not to circumcise — that is certainly one of the big questions facing parents giving birth to baby boys. For most people, the decision as to whether to surgically remove a male child’s foreskin comes down to culture and religion. Then there are those people who ponder whether circumcision really is a sound, preventative health measure or an unnecessary surgery that carries too many risks. It’s a pros and cons decision that parents have waged battle with for many years to come up with the right one for their family.
For one Bahamian mother, there was no waffling about whether she would have her son circumcised — she was going to do it. The 33-year-old first time mother said her son’s father, who is not circumcised, had no say in the matter. From the time Shanell Sands (name changed), the mother of a seven-month-old baby boy knew she was pregnant with a son, she said she knew she would have him circumcised and that non-circumcision was not even up for consideration. The mother said she did not want to leave her son open to the chance of an infection later in life after hearing horror stories over the years form parents and men in general.
“My co-worker’s seven-year-old son caught a bad infection and he had to be circumcised at that age, and hearing him talk about how horrible that period was for his son and him, when I thought about that, I just had to do it to avoid my son having problems as he grows from infections,” she said.
Sands’ son was four weeks old when he was circumcised. His mother said he cried when the needle was administered [but that she suffered and cried more than the baby did, so much so that she had to leave the room and allow the father to remain in during the procedure], but that she was surprised how quickly her son got over it. She said because it was done so early, it’s a procedure he won’t even remember.
Male circumcision is a common procedure generally performed during the newborn period. According to the American Academy of Pediatrics on male circumcision, evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks, and that the procedure’s benefits justify access to the procedure for families who choose it. And that specific benefits identified included prevention of urinary tract infections, penile cancer and transmission of some sexually transmitted infections.
According to a local physician, while circumcision is not mandatory, Dr. Ayana Remy-Taylor, who practices out of Pediatric Associates on Collins Avenue, said there are more advantages to circumcising a male child than disadvantages. But she says as long as a child is taught routine, good penile hygiene and takes care of their penis, they should be okay and circumcision is not needed.
“But we counsel parents on the advantages of having it [circumcision] done — less incidence of UTI, less incidence of penile cancer and a slightly lower risk of sexually transmitted diseases. Of course medically, that really is in the eye of the beholder, and really a decision that a parent has to make, based on their own personal, cultural beliefs,” said Dr. Remy-Taylor. “But it’s not a medical necessity that they have to do. But when they think about hygiene, that’s when that decision becomes more of a non-medical one.”
In the practice where Dr. Remy-Taylor works, to have a baby circumcised or not is more of a cultural decision and that they have noticed that about 60 to 70 percent of their male parents opt to have their male child circumcised. A decision that she said is usually guided by what the father believes, and where they are from.
“We find that clientele from Latin America and most European countries, reflect what the circumcision rates are there. In Europe it’s more like five to 10 percent, as opposed to the United States where it’s more like 60 to 80 percent. In the Caribbean it’s probably more reflective of what’s happening in the States so you have more of a 60 to 70 percent circumcision rate,” she said.
Optimal age for circumcision
Parents opting to circumcise their male child she said should look to have the procedure done in the newborn period of their child’s life. Beyond three months she said would require the child having to undergo general anesthesia, which would bring in the concerns about the risk of general anesthesia.
“So in the earlier period when they’re just born, usually in the first 30 days of life, it’s a lot easier to perform, and we just usually need local anesthesia. We [at Pediatric Associates] do something called a dorsal penile nerve block [liquid medicine injected though a tiny needle into the bottom of the penis, numbing the whole penis within minutes.] The physician [Dr. Charelle Lockhart] who does it here would also give something called sucrose pacifier [a pacifier dipped in sugar water which has been shown to reduce newborn distress].”
If parents decide to have their newborn circumcised, Dr. Remy-Taylor said it’s an easier procedure to have done during the newborn period and also because general anaesthesia isn’t required. And a decision parents will want to make either prenatally when the mother is pregnant and into the first month of life. At Pediatrics Associates they don’t like to circumcise boys beyond the newborn stage.
“[Circumcision] is a little more difficult in terms of post-op care, because you have an older child who is going to be having some pain, who will not quite understand that they’re not supposed to fuss with the area and so you have more risks as far as taking care of [the penis] is concerned.”
The surgery takes a few minutes, and in a newborn the healing time is approximately 10 to 14 days. Dr. Remy-Taylor said the first two days are probably the most difficult, because parents have to be careful with the op-site, applying adhesive dressings, and ensuring that ointment is applied.
“Really, it’s not difficult at all. It’s just a matter of being careful with how you manipulate the penis afterwards.”
Who should not be circumcised
“There are contraindications to circumcisions, for example, if there is abnormal curvature to the penis, or if the urethra is in an abnormal location, or if there is history of bleeding disorders in the family, these are indications for not doing it,” said the pediatrician. “Or, if for example, you have a preemie baby who is very sick, obviously, that baby would have to have a consultation with the operating physician, and that is a decision that has to be made considering the personal beliefs of the family and weighed in context of the medical information.”
According to Dr. Remy-Taylor, the cost to have the procedure done depends on the facility. She said every facility has it own price, but that the operation can range between $300 and $400 and in some instances is covered by insurance.