Should I circumcise my baby boy?

Circumcision practices vary widely due to different cultural and religious expectations that exist. Medical groups around the world that discuss circumcision acknowledge the same facts surrounding circumcision, but they highlight some aspects for and against circumcision differently to either encourage, discourage, or remain neutral about the practice. Some facts are more relevant in other countries than in the United States; for example, the local rate of HIV infection will make circumcision more or less valuable.

Here we will list evidence-based statements surrounding circumcision in a neutral manner and allow you to draw your own conclusions.

• Circumcision is associated with a lower risk of HIV transmission in HIV endemic locations like Africa. In the U.S., the overall incidence of HIV is so low that circumcision has yet to show a protective benefit, even in populations that are more at risk for HIV, such as men who have sex with men.
• Circumcision is protective against invasive penile cancer. However, the rate of penile cancer in the U.S. is 1/100,000 men.
  • 50% of those penile cancers are caused by HPV 16 and 18, similarly to cervical cancers. We now vaccinate against those subtypes with the GARDASIL vaccine.
  • Widespread adopted vaccination with GARDASIL would provide a more protective benefit against penile cancers as well as reduction in smoking and proper hygienic practices.
• 3% of uncircumcised males will get a urinary tract infection (UTI) compared to about 1% of baby girls and circumcised boys. Circumcision only reduces the risk during the first year of life and most UTIs are easily treatable.
• Circumcision of males does reduce the risk of transmitting certain infections to female partners: HPV (a cause of cervical cancer), herpes, chlamydia, and syphilis.
• Phimosis occurs when the skin around the glans penis becomes scarred/swollen/painful and is unable to retract. This can occur in about 1% of uncircumcised males. There are also cases of phimosis occurring in circumcised males due to the scarring from the procedure (mainly the Gomco clamp method); however, the true incidence of this is unknown. There are multiple steps that males can take to reduce their risk of phimosis – whether circumcised or uncircumcised. The cure for phimosis is circumcision.

Known risks of circumcision include: bleeding, infection, need for repeat surgery, meatal stenosis, and partial loss of penis.

There is no quality evidence that circumcision reduces sexual pleasure. Newborns, of course, cannot directly consent to receiving circumcision, though this is true of many things and parents ultimately have a duty and right to make decisions on behalf of their children that involve their health or safety.

A lot of the claims of benefit and harm regarding circumcision are exaggerated. Most men in the world are not circumcised. The CDC states that in 2010 in the U.S., 58.3% of men were circumcised, and in first world countries, we don’t really see significant health differences. Obviously, you may have a religious preference for circumcision. Discuss these issues with your doctor for and make a decision you feel is best for you and your son.