Circumcision: The Health Benefits and Risks

Circumcision, the surgical removal of some or all of the foreskin, is an important cultural and religious practice for many people around the world. Many think of circumcision as a routine procedure performed before a newborn leaves the hospital to ensure that he “looks like everyone else in the family.”  There are those, however, who view the practice as mutilation and a violation of their baby’s individual rights.

The first documentation of circumcision was found in an Egyptian tomb dating back to 2400 BC. In the U.S. and Canada, circumcision first appeared as a medical procedure in the late 19th century. Today, circumcision is one of the most common surgical procedures in the world. Circumcision in the U.S. varies greatly from state to state, ranging from approximately 10% in Washington state and Nevada in 2023, to 91% in West Virginia.¹ Because of religious and cultural traditions, circumcision rates are particularly high in Jewish and Muslim families.

Many parents will decide whether to circumcise their sons based on culture or religion, and the debate about the health benefits and risks has become increasingly controversial. In August 2012, the American Academy of Pediatrics Task Force on Circumcision released guidelines that stated that the benefits of circumcision outweigh the risks of the procedure. The Task Force, composed of experts from a variety of healthcare fields, examined evidence from studies on the health risks and benefits of circumcision. However, they concluded that since there are risks and benefits, parents should weigh the evidence in the context of their personal beliefs.²  The Academy’s 2012 guidelines expired and have not been updated, and prominent medical centers continue to provide information about the risks and benefits and to suggest parents should decide.

Health Benefits of Circumcision

Reduced Risk of HIV and Other Sexually Transmitted Infections

Research shows that circumcised males are less likely to become infected with HIV than non-circumcised males. Even in the U.S., where HIV is not primarily spread through sex between men and women, the Centers for Disease Control and Prevention (CDC) states that circumcision could reduce the lifetime risk of acquiring HIV among American males³ and also reduce the spread of other sexually transmitted diseases.⁴

Penile Cancer

Circumcision appears to reduce the risk of penile cancer.⁵ HPV also contributes to the risk for penile cancer, so that is one likely reason, but since penile cancer is very rare in the United States, the benefit of reducing penile cancer is small.

Urinary Tract Infections (UTIs)

Urinary tract infections are very common in the United States, and most UTIs in males occur during the first year of life. Circumcision reduced the risk of these infections,⁶ which can lead to hospitalization and invasive procedures in children.

Sexual Function and Satisfaction

Research on sexual satisfaction after circumcision is difficult to conduct, because it is influenced by cultural values.⁷ Circumcision has not been shown to result in any change in sexual function (such as getting and maintaining an erection).

Risks of Circumcision

While circumcision provides some health benefits, like most medical procedures, it also comes with risks. Studies have indicated that between 0-3% of all circumcisions have complications such as bleeding or infection.  And, although rare, some complications from circumcision occur later on. These complications include incomplete circumcision (in which some excess skin remains on the penis), excessive skin removal, adhesions, cysts, and infection.

The risk of later-occurring complications is higher among prematurely born infants.  While adverse events are rare among boys circumcised as infants, they are more likely for boys ages 1-10 years. Circumcisions done after age 1 typically involve general anesthesia, which in itself poses a small risk.  

Major complications from circumcision include penile amputation, antibiotic resistant staph infection, and death. However, these events are extremely rare.

Ethical Considerations

Some people believe that circumcision during infancy goes against an individual’s right to informed consent because parents make a choice that can’t ever be reversed. However, it is important to consider that the risks of circumcision increase with age, so that by the time a male is old enough to make an informed choice for himself, the risks would be much greater.  In countries where male circumcision is not customary and HIV rates are high due to heterosexual transmission, the benefits of being circumcised as an adult are likely to outweigh the risk of complications.

To get the greatest benefit from circumcision, the procedure should be performed before a boy begins having sex. Many males start having sex before they are mature enough to choose circumcision for themselves. And, males are unlikely to choose circumcision during adolescence and early adulthood, and if they do, it requires a longer healing time. Despite the apparent health benefits of circumcision on newborns, some parents may still be uncomfortable having a permanent, body-altering procedure performed before their child can choose for himself.

Conclusion

Circumcision is an ancient, cultural and religious practice. Studies show that circumcision can reduce the risk of several diseases—not just in an individual but in a community or even in a country. If you choose to have your newborn circumcised, be sure the procedure is performed in a safe and sterile environment by a highly trained professional. Before going through with the procedure, make sure that the baby’s condition is stable and healthy. Whether or not you choose circumcision, consult with your healthcare provider about how to clean your newborn’s penis — gently with soap and water, without any aggressive pulling of the skin.

REFERENCES

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