Is Circumcision Necessary?

Though attitudes are changing in the United States, some American medical doctors feel so uncomfortable with intact boys in their care that they try to pressure or bully parents into agreeing to circumcise their sons after infancy. Usually all that is needed is for you to find a new doctor. Childhood circumcision is rarely medically necessary.

Circumcision may be necessary if your son has:

• Pathological phimosis: Severe scarring of the opening of the foreskin making it truly non- retractable can be a medical indication for circumcision. This condition is extremely rare before age five. In America pathological phimosis is most often iatrogenic—caused by a doctor who forcibly retracted the foreskin and initiated the scarring.

• Balanoposthitis: Recurring troublesome infections beneath the foreskin that have not responded to other treatments. Most balanophosthitis is treatable.

• Frostbite: If the foreskin is severely frostbitten to the point that the tissue has died, partial or full amputation may be required.

• Gangrene: Diabetics and chronic alcoholics sometimes have circulatory problems that result in gangrene of the foreskin. A condition called Fournier’s gangrene very rarely occurs in children.

• Cancer: Should a tumor develop on the foreskin, circumcision is usually indicated. Penile cancer is rare and mostly occurs in men over 67 years old.

• Irreparable trauma to the foreskin: If a plastic surgeon cannot repair damage to the foreskin caused by an accident or forcible retraction, circumcision may be indicated.
Circumcision not medically necessary over 99 percent of the time.

Infant circumcision is almost never medically indicated. The majority of boys and men around the world have intact penises throughout their lives without medical complications.

Though you may hear some of these arguments from your doctor, family, or friends for why your son needs to be circumcised, the following arguments in favor of childhood circumcision are incorrect.

He’ll be cleaner.

No he won’t. The foreskin protects the head of the penis and urinary tract from dirt and contamination. Once past infancy when the foreskin naturally becomes retractable, any boy can learn to wash the head of his own penis.

His foreskin is too tight.

No it isn’t. If your son is urinating, his penis is normal and is functioning. There is no cause for concern. A tight foreskin will resolve with sexual maturity.

His foreskin won’t retract.

It’s not supposed to. A non-retractable foreskin is normal in infancy and childhood. Though by three years of age most boys will have a retractable foreskin (about 90 percent, according to British medical professionals), it’s normal for the process of separation to last into early adolescence. The foreskin and glans are connected by a common membrane, and will separate spontaneously as the child matures and the penis grows. If a foreskin is not retractable before puberty, the hormones of puberty will help the process. A small percent of males will live their entire lives with a non-retractable foreskin. For them, this is perfectly normal and does not interfere with urination or normal sexual functioning.

His foreskin is red, inflamed, and itching.

This is common and treatable. When a child is experiencing an uncomfortably inflamed foreskin it is usually caused by one or several of the following factors: infrequent diaper changes, bubble baths, overly chlorinated swimming pool water, chemical-laden soaps and detergents used on the skin or clothing, antibiotic use leading to a yeast or bacterial overgrowth, and concentrated urine from dehydration.

Extra hydration, soaking in soap-free bath water, bacterial replacement therapy (liquid Acidophilus culture both ingested and applied to the foreskin 4-6 times a day), and lots of diaper-free air time are usually all that is needed—not circumcision—to heal the inflammation.

He has white lumps under his foreskin.

This is also normal and never a medical indication for circumcision. In some boys, small white lumps form under the foreskin as the foreskin is separating from the head of the penis, indicating that the separation process has begun. These white lumps are an accumulation of smegma, a cheesy substance comprised of dead skin cells that you find in under the foreskin in boys and in the folds of the vulva in girls. The smegma will be discharged naturally by the body and can easily be wiped away, if you even notice it.

He sprays when he urinates.

So does every boy, intact or circumcised. It takes youngsters awhile to learn to control and direct their urine. Boys, unlike their mothers, often take great delight in this phase of learning. Rest assured, it is a normal part of developmental and requires no treatment.

His foreskin balloons when he urinates.

Another fun one for young boys. Ballooning is a normal and temporary phase of penile development in some boys. It disappears as the opening of the foreskin increases in diameter and requires no special treatment.

His foreskin got caught in a zipper.

Ouch. Painful? Yes. An indication for circumcision? No. Why would a doctor possibly think that cutting off more tissue and creating a larger would be necessary? It’s not. Usually gently unzipping the zipper or cutting it off does the trick and any tears in the foreskin will heal on their own. Rejoice that your son has a foreskin in these instances—it protects the glans from zipper injuries! Wearing underwear (which some boys object to) also helps.

His foreskin is stuck behind the head of his penis.

If a doctor prematurely retracts your child’s foreskin, it can get stuck behind the head of the penis. This is called paraphimosis and it can be a dangerous condition. The stuck foreskin acts as a tourniquet trapping blood in the head of the penis, and causing it to swell. Squeezing blood out of the glans and using the thumbs to push the glans back inside the foreskin will bring the foreskin forward again. Ice packs and injected medication can also be used to reduce the swelling in the head of the penis. Circumcision is not necessary. Consult an intact-friendly doctor.

His foreskin’s too long.

Foreskins come in varying sizes. In some boys, it represents more than half the length of the penis. In others, it barely reaches the end of the glans. All variations are normal. There is never “too much” or “redundant” foreskin.

He has phimosis.

So does every baby. Phimosis, the inability to retract the foreskin, is a normal condition of childhood. Post-puberty phimosis, unless it is severe, is usually resolved by using topical steroid creams combined with manual stretching of the foreskin.

He’s having anesthesia anyway, so we might as well circumcise him.

If your infant needs surgery for something unrelated, it would be a terrible mistake to subject his body to an additional and unnecessary surgery that carries the risk of blood loss, infection, and severe complications. Doctors suggest it because they can charge you and your insurance company more money for a double procedure, making it more lucrative for them. Write in permanent marker on his inner thigh, “No circumcision,” as well as across the consent form the hospital asks you to sign and explain to everyone involved in the surgery that no one has permission to touch your son’s penis for any reason.