Should Boys be Circumcised?

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Minor surgery is said to be any surgery that is performed on someone else. To infants and children, amputation of a normal, healthy, sensitive, functional body organ is not minor surgery. Non-therapeutic neonatal circumcision is performed on non-consenting patients. In the case of older boys, it is often performed when less invasive treatments would suffice─alternatives that do not have the risks, complications, and lifelong loss inherent in circumcision.

The short-term risks of circumcision include:

• Bleeding—the foreskin is highly vascularized, making hemorrhage a particular risk.

• Infection—from trivial to life-threatening systemic infections are quite common, especially with the rise of deadly hospital MRSA infections.

• Surgical accident—the foreskin is tiny and there are no guidelines for the amount of skin to be removed, allowing for the accidental denuding of the entire shaft of the penis or the amputation of part or all of the glans penis.

• Death—may result from bleeding, infection, urinary retention, or cardiac arrest. Since there is no central registry of circumcision deaths, the actual number of babies who die from circumcision is unknown, but has been estimated to be over 100 annually in the United States.

Less common immediate complications include life-threatening pulmonary embolism, apnea, projectile vomiting, tachycardia, heart failure, and pneumothorax.

The long-term, post-operative, iatrogenic (doctor-caused) complications of circumcision, not seen in intact boys, include:

• Urinary retention—from improperly placed bandages or a slipped Plastibell ring, which may result in a ruptured bladder, renal failure, or interruption of circulation in the lower extremities.

• Adhesions and skin bridges—the result of two raw surfaces becoming attached when healing.

• Meatal complications—including meatitis (inflammation of the urinary opening), meatal ulceration (due to loss of protection of the meatus), and meatal stenosis (narrowing of the meatal opening).

• Post-circumcision phimosis—caused when the circumcision scar forms beyond the glans, entrapping it.

• Inconspicuous, buried, trapped, or concealed penis—caused by circumcision.

• Loss of the gliding action of the foreskin.

• Loss of full sensitivity.

Miscellaneous post-operative complications include chordee (curved penis), inclusion cysts, lymphedema, and neuromas.