Circumcision of newborn boys

Is it really necessary to circumcise a baby boy? The answer is no. The various scientific bodies in paediatric medicine agree that it is not a necessary procedure for the vast majority of baby boys and that it should not be done routinely. Some parents nonetheless choose this surgery for religious or cultural reasons.

Before making a decision, it is important to talk about it with the attending physician. The doctor makes sure the baby has no health problem that would make him more vulnerable to the potential complications of surgery. He or she can then refer the parents to the right people to carry out the procedure safely and professionally, if that is their choice.

What the surgery involves

Circumcision is an operation that consists of cutting the foreskin, the skin that covers the head of the penis.

In Canada, this procedure is performed in a sterile setting, by doctors trained and experienced in paediatric surgery. For a long time it was done without any pain relief for the baby; today it is done under local or general anaesthesia in order to ease the pain.

The cost of such surgery is not covered by the province's health insurance card, unless the doctor judges it essential to the baby's health. Although it is rare, circumcision may be appropriate for a newborn who has an abnormality in that area; it is then performed free of charge in the days following the birth. When it is done at the parents' request alone, with no medical indication, they pay the full cost, which can easily reach a few hundred dollars.

The possible benefits

Some fathers want their baby circumcised so that he will not have to go through this surgery as an adult. A circumcision can indeed be performed later, in an older child, a teenager or an adult, but that remains very rare.

According to the scientific community, some data indicate that being circumcised can reduce certain infections over the longer term:

• urinary tract infection;
• HIV infection (human immunodeficiency virus, which causes AIDS);
• HPV infection (human papillomavirus).

Circumcision could also help prevent penile cancer later in life, even though this type of cancer remains rare.

The possible complications

As with any surgery, the potential risks have to be considered and the impact of a circumcision should not be played down. In general, complications are less frequent in a baby than when the procedure is carried out during childhood or adulthood. The doctor must nonetheless watch for certain things:

• significant bleeding after the operation, for a few hours and then a few days. The baby could bleed into his diaper, which absorbs a great deal, with nothing being visible, even in the case of a haemorrhage: closer monitoring is therefore required;
• signs of infection at the wound site. Follow-up is necessary and parents must be told which signs to watch for so they can seek care quickly if needed;
• the possible side effects of the anaesthesia used to relieve the baby's pain.

Care after the operation

After the surgery, the baby needs:

• to be comforted: holding him, rocking him, breastfeeding him, etc.;
• to have his dressing changed. The doctor specifies when to change it, how to wash the wound and with what;
• the wound to be monitored for 7 to 10 days. The redness and swelling at the operated site go down within a few days and disappear over time. The bleeding stops within a few days and gives way to a rather yellowish exudate (discharge) that fades as healing progresses;
• to be watched for signs of complications: fever; redness and swelling that increase instead of decreasing; a general condition that is different and worrying; no urine in the hours following the surgery; suspicious greenish discharge from the penis and foul odours.

Even though circumcision is considered minor surgery, it is important to know the details in order to make an informed decision. If you have any doubt, do not hesitate to talk about it with your doctor.