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Dear Dr. Johnson: We are expecting a son in August and we cannot decide whether to have him circumcised. What are the risks and are there any medical benefits?

Dear Reader: Circumcision can be a highly devisive and controversial topic for some. However, the American Academy of Pediatrics does not recommend for or against this procedure. They do not feel the benefits outweigh the risks or the risks outweigh the benefits.

The benefits of a circumcision include:

• Decreased risk if urinary tract infection (UTI) in the first year of life. The rate of occurrence for boys under age 1 who are not circumcised is only 1 in 100, but being circumcised decreases the risk 10-fold to 1 in 1,000.

• Decreased risk of penile cancer, a very rare form of cancer.

• Slightly lower risk of getting and transmitting sexually transmitted infections (STIs), including HIV.

• No risk of infection of the foreskin and no risk of phimosis (inability to retract the foreskin).

The risks of circumcision include:

• Bleeding. If excessive bleeding occurs, this usually is initially managed by holding pressure on the area that is bleeding. The next step is to use a gel foam with clotting factors. Very rarely, a stitch has to be placed to stop the bleeding.

• Pain of the procedure. This can be decrease by use of a local anesthetic and allowing the infant to suck on a finger or pacifier coated in sugar water.

• Undesireable cosmetic outcome.

After a circumcision is performed, petroleum jelly should be placed on the penis to protect the skin until it has healed.

A baby who is not circumcised does not require any special care. The penis should be washed just like the rest of the body with baths. The foreskin should never be forced back, as this can lead to phimosis and inflammation. With time and gentle pressure, the foreskin will easily retract and then the boy can be taught to retract the foreskin when bathing to cleanse the area underneath.

Whether or not to have your son circumcised is one of the first big parental decisions. Unless you are certain you are having a girl, the decision is best made before the baby's birth. The time after the birth is full of excitement and sleep deprivation and not always the best time to make large decisions.

Circumcisions usually are done before the baby leaves the hospital. It varies in different regions of the country whether circumcisions are performed by an obstetrician or pediatrician/family practice doctor. Here in Madison, they are mainly done by the baby's doctor.

During the newborn period, circumcisions have a faster recovery and do not require general anesthesia. After the newborn period, circumcisions are done in the operating room with general anesthesia, which increases the risks of the procedure.

If you are pregnant and want more information about circumcisions, I recommend you make an appointment with the doctor who will care for your baby to discuss the issue further.

This column provides general health information and is not specific advice intended for any particular individual(s). It is not a professional medical opinion or a diagnosis. Always consult your personal health care provider about your concerns. No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Johnson to people submitting questions.

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