To circumcise or not?

In my daily work as a pediatric surgeon, parents often ask me what I would do if the patient in clinic was my child. To be fair, most of the situations that trigger such inquiries involve serious conditions and complex surgeries. And even though circumcision is a straightforward surgical procedure, the decision to have it done can often be a thorny dilemma, complicated by societal and cultural norms or religious beliefs. All of these considerations aside, the science is clear: Circumcision is a matter of good medicine and smart prevention. It reduces the risk of certain infections and can have important implications for a newborn boy’s lifelong health. This is why, when asked, I tell families that if I had a son, I would have him circumcised.

To be clear, the decision to circumcise is first and foremost a matter of personal preference. A family must be comfortable with their decision. As physicians, we must respect their choice. But we also have a professional obligation to educate parents and help them make as informed and as safe a call as possible.

New Science Behind an Ancient Ritual



Circumcision – the surgical removal of the foreskin covering the tip of the penis – has been performed for millennia for religious and cultural reasons. But research conducted over the last 20 years reveals this symbolic practice also has important health effects.

Studies indicate that circumcised males have fewer urinary tract infections and a lower risk for sexually acquiring and transmitting certain infections. In fact, several long-term clinical trials conducted in Africa have shown that circumcision could slash the risk of HIV infection by 40 to 60 percent. Research elsewhere has found circumcision may reduce transmission of other sexually transmitted viral infections, such as HPV and genital herpes, by up to 30 percent and lower a man’s lifelong risk of penile cancer. Several studies have also shown that, to a lesser degree, circumcision may ward off sexually transmitted bacterial infections, such as gonorrhea, chlamydia and syphilis. However, the greatest impact is believed to be on reducing the risk for viral infections, such as HIV, HPV and herpes.

The biological mechanism behind the protective effects of circumcision is not entirely clear, but scientists believe that the foreskin of the penis can attract and trap germs, which can then multiply and cause an infection. Thus, removing the foreskin deprives viruses and bacteria from a place to aggregate and “hang out.”

It is important to point out that circumcision is no silver bullet. It is no replacement for practicing safe sex, nor is it a substitute for other preventive measures, such as vaccines against HPV and hepatitis B. Circumcision is but one of several ways to minimize risk. Together with vaccines, well-child care and safe-sex counseling, it’s an important piece in our armamentarium to set children on a lifelong path to health.

So far, the American Academy of Pediatrics has stopped short of making routine neonatal circumcision the standard of care, but it has endorsed the evidence of the medical benefits of this procedure.

Myths About Circumcision

Circumcision can interfere with penile sensitivity. One of the more pernicious and persistent myths about circumcision is that it can dampen sensitivity and function and reduce pleasure. Research has found that it doesn’t.

Only newborns can get circumcised. While it is true that the optimal time for the procedure is before 3 months of age, older infants, children and even adults can be circumcised safely. Neonatal circumcision is simpler and patients recover faster. It involves the use of local anesthesia – usually a combination of nerve block and numbing cream – and requires no trip to the operating room. Older infants, children, teens and adults, on the other hand, must undergo surgery in the OR under full anesthesia because the procedure itself is more complex and takes longer. Some parents choose to defer circumcision until a child is older and can decide for himself. That is a valid option, but I do caution these families that circumcision later in life tends to be more emotionally scarring for young boys and teens and may lead to a more tumultuous recovery.

Circumcision can damage the penis. Circumcisions can go bad, but they very rarely do. With fewer than half percent of newborns developing complications, circumcision is an overwhelmingly safe procedure. There is ample evidence that clinicians who regularly perform circumcisions have lower complication rates, and their patients fare much better. When complications do occur, they usually involve infection and bleeding, both of which are relatively easy to manage. More serious – and thankfully, far rarer – complications include abnormal scarring and healing due to poor surgical technique. Most of these complications can be corrected with additional surgery. Premature babies, those with certain bleeding disorders and newborns with anatomic abnormalities of the penis are at higher risk for complications. Such patients must be treated by experienced surgeons, preferably in pediatric hospital with advanced expertise in the field.