Circumcision Study: If You’re Gonna Snip, Do It Early

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Equipment used for carrying out circumcision. Credit: Ilya Melnikov

If you are debating whether to circumcise your son, you should make a decision before his first birthday. Complications from circumcision performed in the first year of life are rare, but the risk increases significantly if the procedure if performed later, according to a study published last week in the medical journal JAMA Pediatrics.

About 0.4 percent of the circumcisions the study looked at in boys less than 1-year old resulted in complications. The risk increased about 20-fold for boys between 1 and 9 years old. For males at least 10 years old, the risk was 10-fold higher than for infants.

In the study, the researchers used data from U.S. insurance claims on more than 1.4 million circumcised males between 2001 and 2010. The vast majority, 93%, were newborns. The data does not cover children who underwent ritual circumcisions in a non-medial setting.

“This is what we found about the risks of circumcision: It’s low overall, but it increases with age at circumcision,” said Charbel El Bcheraoui, the study’s lead author from the Institute for Health Metrics and Evaluation at the University of Washington in Seattle. “What we assume is it’s probably because between 1 and 10 years of age is the age when caring after procedure is the most complicated."

Previous research had found wide variations in rates of complications following male circumcisions. Many of the studies were small and based on patients from a single hospital.

Circumcision, or removing the foreskin from the penis, is a ritual obligation for infant Jewish boys and a common rite among Muslims, who account for most circumcised men worldwide.

The wider U.S. population adopted the practice due to potential health benefits, such as reducing the risk of urinary tract infections in infants and cutting the risk of sexually transmitted disease later in life, including HIV.

But the practice has been the focus of heated debate lately, including efforts to ban it in San Francisco and Germany. The rate of circumcisions performed on newborns in U.S. hospitals has dropped over the past three decades.

Among the adverse effects the World Health Organization cites are pain, excessive bleeding, removing too much skin, damage to the sexual organ, problems urinating, scars and deformation, swelling and infection. The most common adverse effects the researchers found for boys aged 1 to 9 were functional problems caused by infection from improper removal of the foreskin. The findings were similar to those of a clinical study conducted in Kenya of boys aged 12 and older.

The American Academy of Pediatrics updated its recommendations in 2012 to say the benefits of male circumcision justify families having access to the procedure if they choose.

According to the JAMA Pediatrics study, about 0.5 percent of all the circumcisions ended with some type of adverse event regardless of age, but the rates for specific complications varied.

Damage to the urethra occurred in about 0.8 per 1 million circumcisions. Leaving behind too much foreskin occurred in about 702 per 1 million circumcisions.

The researchers note that some complications might not have been included in the study because they reviewed claims data on problems that typically occurred within a month of circumcision.

Professor Jack Baniel, the head of Urology at Beilinson Hospital in Petah Tikva, said circumcision for males who are no longer babies is significantly different than for newborns. “Circumcision at an older age is an operation in every way. It is more painful and has a greater risk because it requires anesthesia,” he said.

In addition, the surgical procedure is more complicated and requires stitches and reattaching the skin, sometimes involving real plastic surgery, said Baniel. Young babies heal much more quickly.

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