Postponing Circumcision

Most infant circumcisions are performed within days of the birth, usually in the hospital or birthing center. Then the infant goes home with some gauze around his circumcised penis, perhaps some Tylenol to ease the pain and an instruction sheet on how to care for his penis while it heals. By his first pediatric checkup, a few weeks later, the circumcision will be totally healed.

Some parents postpone the circumcision. Jewish ritual circumcision, for example, is traditionally performed when the infant is eight days old. Sometimes the circumcision is delayed for health reasons, such as an infant’s low birth weight, jaundice or a malformation that may require surgery using foreskin tissue to correct it. Some parents, however, postpone circumcision for another good reason – because they are still waffling about the decision!

Postponing a few weeks

Postponing a circumcision for a few weeks or even a few months may actually be helpful for the child and his parents. That’s because circumcision for an infant, two months old and weighing 15 pounds or less, follows the pattern of a newborn’s circumcision. Local pain relief is usually adequate, and no stitches are needed. There is little risk of bleeding or infection, and the costs are about the same – a few hundred dollars or less, usually covered by insurance.

There are other benefits to postponing a circumcision a few weeks or months. This allows time for the infant to stop losing and start gaining weight. Feeding and perhaps even sleeping routines may be established. And it gives parents, especially first-time parents, a chance to get used to changing diapers and to the responsibility of caring for an infant.

Postponing circumcision longer than a few months

Delaying circumcisions for babies who are severely underweight, have serious health issues, or are premature and may face weeks or months of hospitalization is routinely advised. It’s a common – and a good – decision to postpone circumcision even years for an adopted child who may have been traumatized during the first months or years of his life. Finally, postponing circumcision until a son reaches adolescence will allow him to participate in the decision or even make it himself.

However, there may be negatives to postponing circumcision, especially postponing it for years. First, only infant circumcisions provide the medical benefit of lowering urinary tract infections (UTIs) that are most prevalent during the first months of life. Also, only infant circumcision effectively lowers a male’s risk of penile cancer. But the major drawback of delaying circumcision is that the procedure becomes more complicated. A general anesthetic and stitches may be required. Healing takes longer, and there is a greater risk of bleeding and infection. And instead of costing a few hundred dollars, the procedure will cost several thousand dollars, a cost that is unlikely to be covered by insurance or Medicaid unless the circumcision is medically required.

Another option that may be available for delayed circumcision is something most parents making the decision don’t know about yet. If the circumcision is postponed until the boy is a teenager, he may then be circumcised with a new technique – the PrePex device developed by an Israeli company, and currently used for adult men in Africa, in the fight against HIV/AIDS. Removing a foreskin with the PrePex (registered, but not yet available in the U.S. or Canada) is endorsed by the World Health Organization because the procedure is remarkably easy to perform, is painless, bloodless and carries practically no risk of infection or botched circumcision cuts.

Finally, for expectant parents who cannot make the circumcision decision by the time their son is born, or who cannot reach an agreement about circumcision, postponing the circumcision is more than possible. It is prudent. Why? Because a circumcision can be postponed – but it can never be undone.