Ask the Pediatrician: Dr. Molly

Category: Private parts

Circumcision pros and cons

Considering circumcision? There are two sides to every argument and let me tell you, both sides of this issue are passionate.

Circumcision has some concrete pros. Firstly, the rate of HIV and penile cancer in circumcised men is lower than those who are not. Secondly, the rate of HPV infection (the virus that causes cervical cancer in women) is much lower as well. Because women get colonized with this virus through sex with men who have it (and are usually without any symptoms themselves) this is a benefit for men and women. Third, hygiene is straightforward in the cirumcised penis. Lastly, boys who are circumcised are much less likely to have urinary tract infections than uncircumcised boys.

Circumcision has some concrete cons, too. It is a surgical procedure and has some small but real risks, including bleeding, damage to the head of the penis and pain. Second, men who have been circumcised as adults report a change in sexual sensation afterward, although reports of sexual enjoyment overall do not differ between circumcised and uncircumcised men.

If boys are taught good hygiene, men use condoms regularly unless they are in a long-term monogamous relationship, the medical advantages to circumcision diminish and what is left are primarily issues of culture. In many cultures, male circumcision is not the norm. Indeed, most of the world doesn't circumcise except for religious reasons. In the United States, however, circumcision has become very common - especially among white middle and upper classes.

I often get asked if an uncircumcised boy is more likely to be the object of teasing in school and my answer is no. I often suggest parents consider the circumcision status of the other male family members in the decision as well as their comfort teaching the hygiene and sexual practices that would minimize risk if they choose not to have their son circumcised.

Circumcision does have medical benefits, but given the fact that the risks can be minimized through good teaching about hygiene and sexual practices, the decision is still on the shoulders of parents.

Category: Private parts

Masturbation in youngsters is common - and normal

Your 5-year-old son is constantly "adjusting" his underwear.

Your 3-year-old daughter is "riding" the arm of the couch a lot lately.

Your 4-year-old daughter seems to "dance" in her car seat and wriggle her hips up against the clasp for the seat belt between her legs.

Your 6-year-old son is complaining that when his penis gets big it hurts.

Your 7-year-old daughter is "itching" her private parts so much that you wonder if she has a yeast infection.

What all these children have in common is that they are masturbating. I know you are surprised but it is true. Virtually all children, both boys and girls, starting around the time of potty training discover themselves and let's face it, it feels good. Because it feels good, the exploration continues and some children will find lots of ways to stimulate themselves.

I get a ton of questions from worried parents about this on a regular basis. I think it is a bit of a taboo topic for parents to discuss with each other and sheepishly or with great angst they bring it up with me. Most parents are worried that interest in masturbation at this age means they are going to have a "sexpot" as an older child but this is not the case. Masturbation before the hormones of puberty are contributing is not sexual. It just feels good. It feels good like scratching an itch feels good or having someone rub your back feels good. It isn't sexual, just satisfying.

I advise parents who are worried that the child will do these behaviors in public that it is important to teach kids at this young age that private parts are private for a reason and if they want to touch them, they need to do so in a private place like the bathroom or the bedroom. Because kids don't experience this as a sexual feeling (even though they may really enjoy it), the fact that this sort of good feeling can't be done in the kitchen or the classroom makes it that much more appealing for some. Often, parents will find the child will increase the behavior after the parent has drawn attention to it and consistency about the need to be in a private place is important.

Some kids start to ask more pointed questions about their bodies and yours during this time and others will even want to see the private parts of their peers through "playing doctor." This is a great opportunity for parents to talk frankly and openly with their kids about their bodies and how they differ from grownup bodies. It is a great opportunity to reinforce the rules about who can see private parts and who can't, who can touch private parts and who cannot. It is also a great opportunity to lay the groundwork for later discussions about sex and sexuality. By talking openly, frankly and without embarrassment about this, you will start a dialogue that is natural and comfortable and will serve you well as your child grows and matures.

Here are some good books to help open the discussion with your younger children (ages 3-8):
Amazing You
What's The Big Secret

For older kids (9-12):
Body Science

For parents:
Speaking of Sex: What your child needs to know and when they need to know it