The Pros and Cons of Circumcision

To cut or not to cut? Parents of newborns with penises must choose whether their child will be circumcised or not. There are multiple pros and cons of circumcision to consider. These include any cultural or religious traditions that are important to you as well as a variety of potential health benefits, drawbacks, and risks.

Ultimately, however, there is no right or wrong, just what you believe is best for your baby. Learn more about the pros and cons of circumcision and how the procedure works to help you make this decision for your newborn.

What Is Circumcision?

Before deciding on whether or not to opt for circumcision, it's helpful to understand what it is and how the procedure works. "The circumcision process involves surgically removing the foreskin to expose the head of the penis," says Vanessa Elliott, M.D., a urologist at UCP Urology of Central PA, Inc.

Research has shown that surgical removal of the penis's foreskin has potential health benefits, including decreased risk of urinary tract infections (UTIs), penile cancer, and some sexually transmitted infections (STIs). Yet as with any surgery, there are risks.

How Common Is Circumcision?

For many families, particularly those of the Jewish and Muslim faiths, circumcision is expected or simply a given as a part of religious or cultural traditions. Some people decide based on what they know, as well. So, if one of the baby's parents has a circumcised penis, they may be more inclined to follow that tradition. For others, though, deciding whether or not to do it can be fraught with worry and stress.

For a variety of reasons, the procedure is becoming less popular. According to data from the Centers for Disease Control and Prevention (CDC), in 2010, 58.3% of newborn American males were circumcised compared with 80.5% of males aged 14 to 59. This newborn circumcision rate represents a 10% decrease compared with 1979.

The cost of circumcision may be one reason for the trend, especially because fewer insurance companies are covering it, says Ronald Gray, M.D., a professor of epidemiology at Johns Hopkins University in Baltimore. But America's changing demographics also affect the number of males undergoing the procedure. "The increased proportion of Black and Hispanic births in the U.S. affects rates because these groups are less likely to circumcise," says Dr. Gray.

The American Academy of Pediatrics (AAP) released an updated policy statement on circumcision in 2012 recognizing the potential medical advantages of circumcision, primarily related to preventing UTIs. But even though the AAP says the benefits of circumcision generally outweigh the risks, they concluded that circumcision shouldn't be routinely recommended. They encourage parents to make their own decision based on religious, ethical, and cultural beliefs.

Still uncertain about the circumcised vs. uncircumcised debate? We broke down some potential advantages and disadvantages of the procedure to help you decide.

Potential Benefits of Circumcision

There are multiple benefits to circumcision that inspire some parents to choose this procedure for their child. Parents often choose circumcision for the following reasons.

Decreased risk of urinary tract infections

The AAP reports that circumcision reduces a male baby's chance of getting a potentially serious urinary tract infection (UTI) during their first year. Left untreated, UTIs can introduce bacteria into the bloodstream, possibly damaging the kidneys. That said, the risk of a baby with an uncircumcised penis developing a UTI in their first year of life is already quite low at 1% (1 in 100). Circumcision reduces that already low risk to 0.1% (1 in 1,000).

Lowered rates of some sexually transmitted infections

Circumcision can lower the risk of some sexually transmitted infections (STIs). The results of three randomized clinical trials of adult males in Africa were sufficient for the World Health Organization (WHO) to endorse male circumcision as an effective way to reduce the risk of HIV in regions with generalized HIV epidemics, high HIV rates, and few circumcised people.

Some experts in the U.S. believe the findings are relevant for Americans, too, while others say that the risk reduction is minimal and less significant in the U.S. where HIV rates are much lower.

The foreskin is thought to increase the risk of contracting HIV for two reasons. First, the underside of the foreskin contains immune system cells to which HIV cells can easily attach. Second, the foreskin often suffers small tears during intercourse, allowing HIV cells to enter the bloodstream. Circumcising your baby can eliminate these two risk factors, but cannot eliminate the risk of infection entirely.

Research has also linked circumcision to a significantly reduced risk of penile human papillomavirus infection (HPV) and herpes simplex virus type 2 (HSV-2). Studies have also shown a lower risk of cervical cancer in female partners of circumcised males with a history of multiple sexual partners. (HPV is associated with an increased risk of cervical cancer.)

Of course, it's important to note that consistent and proper use of condoms during sexual activity is highly effective against STIs whether the penis is circumcised or uncircumcised, and the HPV vaccine is one of the most important protections against HPV infection and related cancers, according to the CDC.

Protection against penile cancer

Newborn circumcision provides some protection from penile cancer, which only occurs in the foreskin. However, the risk of this cancer for people with both circumcised and uncircumcised penises is very low in developed countries like the United States. (It represents less than 1% of all cancer cases in the U.S. and Europe.)

According to the American Cancer Society, some research has suggested that the protective effect of circumcision against penile cancer wasn't seen after factors like smegma and phimosis were taken into account.

No foreskin-related issues

On an uncircumcised penis, the foreskin remains over the head of the penis, potentially trapping dead skin cells and germs, which can lead to infection. Since the foreskin is removed during circumcision, there is no chance of developing a foreskin infection or other infections related to the foreskin, such as phimosis, a rare condition that makes foreskin retraction impossible. That said, research has shown that following proper care and hygiene practices for uncircumcised penises can mitigate these risks.

Potential Drawbacks of Circumcision

Of course, circumcision also has some downsides. Here are common reasons parents choose to decline circumcision.

Risks and complications of surgery

As with any surgery, circumcision comes with risks and potential complications, says Dr. Elliot. If the circumcision is performed by an experienced physician in a sterile environment, the risk of complications is very low. Just 1% to 3% of circumcisions will result in minor complications, such as extra bleeding or infection, which topical antibiotics can typically clear up.

Other risks include poor cosmesis (the penis doesn't look right) and penile adhesions. Also, the tip of the circumcised penis may become irritated, which can restrict the size of the urinary opening. This restriction can then lead to urinary tract problems, some of which might require additional surgery to correct.

Serious complications of circumcision, while rare, can include the removal of too much skin, infection, or other damage to the penis. A follow-up circumcision or reconstructive surgery may be needed. However, these complications are estimated to occur in well under 1% of circumcisions in the United States.

Pain during and after surgery

Prior to the incision, all infants should be given anesthesia, either as a topical cream or an injection. "Newborns do feel pain," says Dr. Gray. Many families who choose to forgo circumcision say they don't want to put their child through a painful elective procedure and recovery when they can live a healthy life without it.

Experts say that with proper care and infant Tylenol (acetaminophen), a circumcised penis should heal comfortably in a few days to a week, but that is not to say that it comes with no discomfort.

Potential impact on sexual pleasure

Another consideration for some parents is the question of sexual pleasure. There are thousands of nerve endings in the foreskin that is excised with circumcision, so the question raised is whether the surgery can have a negative impact on a person's future sexual pleasure and sexual satisfaction.

From a scientific standpoint, it's impossible to study the potential difference in sexual sensation for those who were circumcised at birth. However, Douglas Diekema, M.D., a pediatrician in Seattle and member of the AAP's circumcision task force, notes that the few studies done with males who were circumcised as adults show that some found intercourse better afterward, some described it as worse, and the vast majority reported that it was pretty much the same as before.

Should I Circumcise My Baby?

"If you want a circumcision done for non-medical reasons, that's the parents' choice," says Jack Swanson, M.D., a pediatrician in Ames, Iowa, and a member of the AAP task force on circumcision. Some parents feel like it's easier for a male baby's penis to look like their male family members', whether they're circumcised or not. Others lean toward circumcision so their child's penis will eventually be similar to others in the locker room at school. But consider this: If the current circumcision trend continues, many other kids in their class will be uncircumcised.

It can be tempting to put off making the circumcision decision until later. Some parents argue that circumcision isn't their call to make. Still, the AAP points out that the risk for complications is greater for older children than for infants, so it may be better to do it when your child is a baby if you're inclined to pursue it. "Plus, if he waits to make the decision as an adult, he will have missed out on the protective benefits during any previously sexually active years," Dr. Diekema says.

In some cases, though, the choice not to circumcise (or at least to wait) is a medical one: Babies with hypospadias (a condition where the opening of the urethra, the tube that empties urine, is in the wrong place) should not be circumcised, because a surgeon may eventually use the foreskin for a reconstructive procedure. Additionally, if you have a family history of bleeding disorders, consult your pediatrician before getting your baby circumcised. And if your baby is born prematurely, they will need to wait until healthy enough to leave the hospital before having the surgery.