Circumcision Overview

Circumcision is removal of the foreskin from the penis. This is a practice that is hotly debated and people feel passionately on both sides. There are definite medical benefits to circumcision but these benefits are small in most circumstances. The arguments against circumcision are mostly on the grounds that circumcision alters the baby’s genitalia without the child’s consent. There is no absolute right or wrong answer and what you decide to do depends on many factors. This is an attempt to explain both sides of the debate to allow you to come to your own decision.

The penis has skin that lies over the head of the penis and can be retracted. This skin is called foreskin. Circumcision is the removal of the foreskin from the penis. The circumcised penis has the head of the penis (or glans) exposed all the time. The practice of circumcision has been around for thousands of years dating back to at least 2000 years BC. Circumcision was first a religious practice but is done for medical reasons in modern times. The benefits of circumcision vs. the benefits of not circumcising is hotly debated. Circumcision can be done in the first month of life with a simple office procedure under local anesthetic.Once the baby is older than one month of age the blood vessels in the foreskin become to big to use the standard office procedure and the circumcision must be done in the operating room usually under general anesthesia.

There are several medical benefits to routine neonatal circumcision. Boys that are circumcised have a 7 fold decreased risk of urinary track infection in the first year of life. This can be significant because urinary track infections in a baby can be very dangerous and generally require hospitalization. There are disease and infections of the foreskin that cannot happen if the foreskin is removed, phimosis and paraphimosis are examples. Man that where circumcised in the newborn period do not get penile cancer. Penile cancer is a fairly rare cancer with a lifetime risk of 1:600 but circumcision essentially eliminates that risk. Men who are circumcised have a decreased risk of transmission of sexually transmitted diseases. Circumcised males are less likely to have HPV and less likely to transmit HPV to their partners. This means that women who are married to circumcised males have a decreased risk of cervical cancer. Circumcised males have a 60% decreased risk of HIV transmission through heterosexual intercourse.

A cost benefit analysis has also been used to argue in favor of routine neonatal circumcision in the US. About 10% of US males who are not circumcised at birth are circumcised later in life for various reasons. Because circumcision after one month of age requires the procedure be done in the operating room, this is very expensive. It is actually less expensive to circumcise all males in the first month of life than to circumcise 10% of males later in life. In my opinion cost benefit analysis is not a good way to make medical decisions. I present this information to expose people to the relevant arguments that are made for circumcision.

The arguments against circumcision are more social in nature. The main argument is that circumcision removes a piece of normal tissue from the penis altering its appearance.  This is done without the child’s consent. Some people feel this is unethical and argue that circumcision should not be done for this reason. Others argue that circumcision changes the sensitivity of the glans penis and therefore alters the sexual experience. There is no good date to either prove or disprove this theory.

The medical arguments for circumcision are valid but in my opinion not overwhelming. If you live in an area of the world with a very high HIV rate such as some areas of Africa, the protection against HIV is significant. In areas of the world where HIV is less prevalent the benefits of circumcision become less important. Clearly circumcision has some medical advantages but there are also valid social arguments against its routine use. The American Academy of Pediatrics puts it well in their most recent statement regarding circumcision:

“Although health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it and to warrant third-party payment for circumcision of male newborns. It is important that clinicians routinely inform parents of the health benefits and risks of male newborn circumcision in an unbiased and accurate manner. Parents ultimately should decide whether circumcision is in the best interests of their male child.”

My personal advice is to make the child look like other males in his family and peer group. Life may be easier for the child if he looks like the other male members of the family and his community. Ultimately this is a choice for the parents to decide. There are reasonable arguments on both sides of the debate. The choice becomes a balance of medical as well as social issues.