A couple who is expecting a first child comes to the office to discuss circumcision. They recently learned that the baby is a boy, but they have not decided whether to have him circumcised. The father says that he is circumcised and had expected his son would also be. However, the mother says one of her closest friends thinks circumcision is "barbaric." The couple wants to know the health implications of neonatal circumcision. Which of the following is the most appropriate response?

Question

A couple who is expecting a first child comes to the office to discuss circumcision.  They recently learned that the baby is a boy, but they have not decided whether to have him circumcised.  The father says that he is circumcised and had expected his son would also be.  However, the mother says one of her closest friends thinks circumcision is "barbaric."  The couple wants to know the health implications of neonatal circumcision.  Which of the following is the most appropriate response?

Quizplus · Accepted Answer

Explanation: For centuries, male circumcision (ie, removal of the penile foreskin) has been performed for a variety of cultural, religious, and medical reasons. Until recently, most boys and men in the United States were circumcised. However, US neonatal circumcision rates have been decreasing, and the rates in many other developed nations have historically been lower. Because the procedure is elective, parents expecting boys often seek clarification about the medical implications of neonatal circumcision, including its risks and benefits. Health benefits associated with neonatal circumcision include the following: Significant decrease (~10-fold) in urinary tract infections in the first year of life Prevention of pathologic phimosis (ie, foreskin constriction preventing retraction) and modest reduction in the risk of penile cancer (likely due to reduction in phimosis, which is a risk factor) (Choice D) Reduction in certain penile inflammatory disorders (eg, balanitis) Reduction in the risk of acquiring some sexually transmitted infections (STIs) (eg, human papillomavirus) and HIV through penile-vaginal sex, especially in countries where HIV is endemic Circumcision, like any surgical procedure, has associated risks and complications (eg, infection, inadequate skin removal, urethral injury); however, the complication rate is low (<1%). Although most professional medical societies have refrained from recommending routine neonatal circumcision for male infants in developed nations, they support a thorough presentation of these health implications to deciding parents. (Choice B) Circumcision can be helpful for maintaining penile hygiene but is not essential. As the foreskin progressively becomes more retractable with a child's increasing age, routine cleansing under the foreskin (retract, cleanse, dry, return) can maintain appropriate hygiene. (Choice C) Circumcision has not been shown to significantly affect (either positively or negatively) sexual performance and satisfaction. (Choice E) Although circumcision reduces the risk of acquiring HIV and certain STIs (eg, human papillomavirus) through penile-vaginal sex, it does not protect against all STIs, including many of the most common (eg, gonorrhea, chlamydia). Educational objective: Neonatal circumcision is an elective procedure associated with several medical benefits, including reduced risk of urinary tract infections in the first year of life and penile phimosis, cancer, and inflammatory disorders in adulthood. Circumcision also decreases the risk of acquiring some, but not all, sexually transmitted infections. References: CDC's male circumcision recommendations represent a key public health measure. (http://www.ncbi.nlm.nih.gov/pubmed/28351877) Pros and cons of circumcision: an evidence-based overview. (http://www.ncbi.nlm.nih.gov/pubmed/27497811) Male circumcision. (http://www.ncbi.nlm.nih.gov/pubmed/22926175)

A Couple Who Is Expecting a First Child Comes to the Office