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Cara Barone, M.D.Cara Barone, M.D.PediatricsPalo Alto Medical Foundation
Cara Barone, M.D.PediatricsPalo Alto Medical Foundation

Cara Barone is a general pediatrician in the Palo Alto Pediatrics Dept of PAMF. In addition to her pediatrics practice, she is the mother of two busy school-aged children who bring much joy to her life!

Question of the Week

I chose not to circumcise my son. Now the AAP issued a policy statement that actively endorses circumcision. While my son is only two years old, I worry that I made the wrong decision. Should I have him circumcised now?

Cara Barone, M.D. answered: As it stands now, the AAP does not actively endorse routine circumcision, but is leaning more in favor of recommending circumcision to expectant parents of boys. Current evidence suggests the medical benefits to circumcision outweigh the risks. However, current evidence also does not yet push the AAP to support the recommendation for routine circumcision for all boys.

As you are likely aware, circumcision is easiest and best accomplished in the newborn phase of life. There is no need for general anesthesia, as newborns do just fine with a local anesthetic around their penis. Also, bleeding and swelling in the newborn period is much less than in an older infant or child.

Your question is a tricky one. You’ll have to weigh the known medical benefits of circumcision in males versus the risk of general anesthesia in your child. A circumcision in a child your son’s age may have more bleeding that needs to be controlled in the operative or post-operative phase.In addition, you’ll need to consider the pain and discomfort an older child will feel for a few weeks.

There certainly are medical benefits to consider with the main one being significantly less risk of contracting sexually transmitted diseases such as Chlamydia, Gonorrhea, Herpes and HIV in circumcised males compared to uncircumcised males. We’d all like to think the boys we raise will practice extremely safe sex when they are older, but in reality, we have no control over this as parents. A circumcised penis is also less likely to have painful inflammation around the head of the penis (phimosis), is easier to clean, and is less likely to develop penile cancer (which is relatively rare).

Talk with your pediatrician about your deliberations. If you are leaning towards circumcision, it is important to make sure your son is a healthy surgical candidate and to consider the optimal timing in his life to proceed.

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