Laura Covarrubias, MPH, and Rebecca Silverman
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. About 80% of adult men in the U.S. are circumcised, 1 but in 2008, only 58% of newborn boys were circumcised before leaving the hospital. 2 Jewish babies and others, however, may be circumcised according to tradition outside of the hospital days, weeks or even years after being born.
While many parents will decide whether to circumcise their sons based on culture or religion, the practice of circumcision can also be evaluated based on health benefits and risks.
In August 2012, the American Academy of Pediatrics Task Force on Circumcision released a report in support of circumcision, saying that the benefits 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. They concluded that while the procedure has significant health benefits, ultimately, parents should weigh this evidence in the context of their personal beliefs.3
Health Benefits of Circumcision
Reduced Risk of HIV and Other Sexually Transmitted Infections
The Task Force concluded that studies consistently show that circumcised males were 40-60% less likely to become infected with HIV than non-circumcised males. This means that circumcision could greatly reduce HIV rates in many countries in the world.
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) estimated that circumcision of all newborn males could reduce the lifetime risk of acquiring HIV by over 15% among American males. The benefits would be even greater for black males, decreasing the lifetime risk of getting HIV by 21%.
If more men were circumcised, would it help reduce HIV among women as well? More studies are needed to answer that question. However, studies show that circumcision reduces the risk of getting the human papillomavirus (HPV), which is the main cause of cervical cancer in women. The Task Force concluded that male circumcision may contribute a “small” amount to preventing cervical cancer in women. Additionally, the Task Force concluded that circumcision may provide protection against the spread of syphilis, although more research is needed to confirm this.
Researchers are unsure how circumcision prevents these sexually transmitted infections, but the Task Force hypothesized that foreskin may be particularly susceptible to microscopic cuts and wounds during sex, which would allow more disease-causing agents (pathogens) to enter the body. The foreskin may also “trap” these viruses and bacteria, providing more time for infection to occur.
Penile and Cervical Cancer
Circumcision appears to reduce the risk of penile cancer, although researchers are unsure why. HPV 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, which can lead to hospitalization and invasive procedures in children.
Sexual Function and Satisfaction
Research on sexual satisfaction after circumcision is generally limited to men circumcised as adults, particularly in Africa. Studies of these men show that circumcised men experienced less pain during sex than uncircumcised men. One study found no difference in reported sexual satisfaction between men circumcised as adults and men who were not circumcised. 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, about two-thirds of 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. While one study found a 7% complication rate among boys circumcised after infancy, more research is needed to confirm that finding
Major complications from circumcision include penile amputation, antibiotic resistant staph infection, and death. However, these events are extremely rare.
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.
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.
- Xu, F, L Markowitz, M Sternberg, and S Aral href=”http://www.iasociety.org/abstract/show.asp?abstract_id=2193307″>Prevalence of circumcision in men in the United States: data from the National Health and Nutrition Examination Survey (NHANES), 1999–2002. XVI International AIDS Conference. Retrieved 2006-09-21 ▲
- href=”http://www.hcup-us.ahrq.gov/reports/statbriefs/sb45.jsp”>”Circumcisions Performed in U.S. Community Hospitals, 2005″. Statistical Brief #45. Healthcare Cost and Utilization Project (HCUP). January, 2008. Retrieved 2010-08-29. In 2005, about 56 percent of newborn boys were circumcised before their release from the hospital, resulting in over 1.2 million circumcisions performed at U.S. community hospitals. ▲
- href=”http://pediatrics.aappublications.org/content/early/2012/08/22/peds.2012-1989.full.pdf+html”>Circumcision Policy Statement. Pediatrics. September 2012;130(3):585-586.doi: : 10.1542/peds.2012-1990 ▲