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Circumcision , the surgical removal of the foreskin from the penis, may be one of the oldest surgical procedures known to mankind. There are several reasons parents may choose to have their sons circumcised, including religious customs, social or cultural reasons, and to prevent medical complications. While some studies have shown that circumcision may have medical benefits, it is not a necessary procedure for all boys. Parents should carefully examine the evidence for and against circumcision before making a decision.

Today, circumcision is much more common in certain parts of the world, namely the Middle East, Canada, and the US. In the United States more than half of male newborns are circumcised. Why do some parents decide against this procedure? What are the controversies surrounding it?

Pros and Cons

The issue here is whether the procedure is beneficial, medically unnecessary, or harmful. Unfortunately, studies are controversial and subject to individual interpretation.

Advocates of the procedure cite studies showing that circumcised men have lower rates of urinary tract infections , penile cancer (a disorder that is very rare in all men) and heterosexual HIV infection (most of the studies were done in African countries, which may make them less relevant for men in other parts of the world). One study involved almost 5,000 uncircumcised men in Uganda. Half of the men were circumcised, while the other half served as controls. The trial was stopped early after the study found a 50% relative risk reduction in acquiring HIV among the men who were circumcised.

Other studies have also shown that women who have had an uncircumcised partner may have a higher risk of cervical cancer . This is because human papillomavirus (HPV) infection in men can be transferred to women during sexual intercourse. Although evidence is inconsistent, there may be an association between penile HPV rates and uncircumcised men. HPV vaccines, which are recommended for boys and girls starting after age 11, offer protection against the most common types HPV.

Parents may be concerned about keeping their son's uncircumcised penis clean. While it may seem easier to clean a circumcised penis, there is no special care needed for an uncircumcised penis. Gentle washing with warm water is all that is needed during infancy. As boys get older, they can be taught how to clean beneath their foreskin daily with soap and warm water where dead skin cells and oils mix together (smegma). Smegma is normal and is not a cause for concern. Be aware that foreskin retraction should never be forced. In most cases, it will be retractable by age 5 (in some, it may not occur until adolescence).

Without circumcision, men may develop phimosis , a condition in which the foreskin gets stuck in a “pulled back” state. The majority of these cases, though, can be easily treated without any surgical intervention. Only severe cases of phimosis may require circumcision to prevent recurrence.

Circumcision, though, is a painful procedure and requires local anesthesia and about 7-10 days of healing. In addition to complications like bleeding and infection, there are occasional surgical mishaps in which too much or too little of the foreskin is removed. Occasionally there can even be injury to the penis itself. These problems, which are rare, may require further surgery.

Making a Decision

There are many issues involved when deciding to have your baby circumcised. You may choose for or against the procedure based on ethical, religious, or societal reasons. By talking with the doctor, you can gain a better understanding of what circumcision entails and further discuss the pros and cons.

RESOURCES:

Healthy Children—American Academy of Pediatrics
http://www.healthychildren.org

National Library of Medicine
http://www.nlm.nih.gov

CANADIAN RESOURCES:

Health Canada
http://www.hc-sc.gc.ca

The College of Family Physicians of Canada
http://www.cfpc.ca

References:

American Academy of Pediatrics Task Force on Circumcision. Circumcision policy statement. Pediatrics. 2012;130(3):585-586.

Care for an uncircumcised penis. American Academy of Pediatrics Healthy Children website. Available at: http://www.healthychildren.org/English/ages-stages/baby/bathing-skin-care/Pages/Care-for-an-Uncircumcised-Penis.aspx. Updated May 11, 2013. Accessed August 14, 2014.

Circumcision. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated May 9, 2013. Accessed August 14, 2014.

Gray RH, Kigozi G, Serwadda D, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomized trial. Lancet. 2007;369:657-666.

Hernandez BY, Wilkens LR. Circumcision and human papillomavirus infection in men: a site-specific comparison. J Infect Dis. 2008; 197(6):787-794.

HPV vaccines. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/hpv/vaccine.html. Updated February 13, 2013. Accessed August 14, 2014.

Kids Health. Circumcision. Nemour's Kid's Health website. Available at: http://kidshealth.org/parent/system/surgical/circumcision.html. Updated March 2013. Accessed August 14, 2014.



Last reviewed August 2014 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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