The Facts

happyBabyStandingParents who choose not to circumcise their baby boy often make this decision because they believe that the child should be able to decide for himself, when he is old enough to have patient autonomy. Many of these parents also want to avoid unnecessary pain in the newborn, and believe that the foreskin of the penis has valuable sexual sensation later in life.

Parents who choose to circumcise their baby boy do so for a variety of reasons: religious or cultural tradition, aesthetic preference (how the penis looks), wanting the baby to “look like his dad,” and presumed medical benefits.

Medical professionals who support routine male circumcision cite reduced transmission of sexually transmitted infections, fewer urinary tract infections (UTIs), and less penile cancer as primary health reasons to do the procedure on a healthy baby. Other medical professionals who question routine male circumcision often point out that the risks of UTIs and penile cancer are statistically low, and that there are better ways to prevent HIV than circumcision.

Clinical recommendations in the United States about whether or not to routinely circumcise newborn baby boys have waivered back and forth over the years.

At present, here are the current recommendations:

  • The American Academy of Pediatrics (2012): “Preventive health benefits of elective circumcision of male newborns outweigh the risks of the procedure. Benefits include significant reductions in the risk of urinary tract infection in the first year of life and, subsequently, in the risk of heterosexual acquistion of HIV and the transmission of other sexually transmitted infections….Although health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it and to warrant third-party payment for circumcision of male newborns.”
  • The American Academy of Family Physicians (2013): “The decision whether to circumcise a newborn male is affected by parents’ values and beliefs and should be made by parents after a discussion of the benefits and harms.”
  • The American College of Nurse-Midwives at present (2016) does not have a position statement on routine circumcision.
  • The American College of Obstetricians and Gynecologists (2012): From Patient Education FAQs “Circumcision is an elective procedure. This means that it is the parents’ choice whether to have their infant sons circumcised. It is not required by law or by hospital policy. Because it is an elective procedure, circumcision may not be covered by your insurance policy….Circumcised infants appear to have less risk of urinary tract infections than uncircumcised infants. The risk of urinary tract infection in both groups is low. It may help prevent cancer of the penis, a rare condition. Some research suggests that circumcision may decrease the risk of a man getting HIV from an infected female partner….At the present time, there is not enough information to recommend routine newborn circumcision for health reasons.”
  • The American Urological Association (2012): “Neonatal circumcision has potential medical benefits and advantages as well as disadvantages and risks….There are immediate risks to circumcision such as bleeding, infection and penile injury, as well as complications recognized later that may include buried penis, meatal stenosis, skin bridges, chordee and poor cosmetic appearance. Some of these complications may require surgical correction….The minor complications are reported to be 3%….Circumcision may be required in a small number of uncircumcised boys when phimosis, paraphimosis, or recurrent balanoposthitis occur and may be requested for ethnic and cultural reasons after the newborn period.

Do these position statements alone help parents decide what to do?

Many parents find all this data confusing and difficult to sift through! Especially for parents who are not familiar with how to read research studies, it can be hard to know how to interpret what these position statements are saying.

Here are a few things to consider when interpreting the data:

  • The main studies researching circumcision for HIV prevention were conducted outside of the United States on adult heterosexual males (not newborns). This makes the results hard to apply to US-born infants, who likely have better health care coverage and better access to condoms as they grow older. Furthermore, HIV transmission is highest in groups of men having sex with men, who were not included in the study. (Bossio, Pukall,  & Steele, 2014)
  • More than 50% of new HIV cases reported in Europe and North America in 2014 were in the United States. Europe has a circumcision rate of less than 20% of infant boys, significantly less than the circumcision rate in the United States. Therefore, since more than half of new HIV cases were in the United States where circumcision rates are much higher, circumcision as a protective measure against HIV in the United States seems questionable. (WHO, 2014) and (UNAIDS, 2015).
  • In studies conducted in Sub-Saharan Africa, circumcision has shown some protection against genital herpes and genital warts. However, condoms have been shown to provide close to 100% reduction in sexually transmitted infections and are a much less invasive intervention. (Frisch et al, 2013).
  • 100 male infants need to be circumcised to prevent one case of urinary tract infections. (Frisch et al, 2013).
  • For every one case of urinary tract infection that a circumcision could prevent, two infants will experience complications from the circumcision itself.  Hemorrhage (severe blood loss) and infection are both possible complications. While extremely rare, death is also possible complication. (Frisch et al, 2013).
  • Between 909 and 322, 000 circumcisions need to be performed to prevent one case of penile cancer. (Frisch et al, 2013).

Many people do not know that there are potential risks involved with circumcision, and some parents do not get very good informed consent from clinicians before deciding to have the procedure done for their sons. While long term side effects are not common, they do happen.

Here are some possible long term risks to consider:

  • Some men with circumcision complications have reported impaired erectile function, orgasm difficulties, difficulty and decreased pleasure with masturbation, decreased sensitivity with age, and increased penile pain. (Bossio, Pukall,  & Steele, 2014)

 


 

RESOURCES

American Academy of Family Physicians. (2013). Neonatal Circumcision Policy Statement. AAFP Website. Retrieved from http://www.aafp.org/about/policies/all/neonatal-circumcision.html.

American Academy of Pediatrics. (2012). Male Circumcision. Pediatrics, 130(3), e756–e785. doi:10.1542/peds.2012-1990

American College of Obstetricians and Gynecologists. (2012). FAQ 039: Newborn Circumcision. ACOG Patient Education FAQs. Retrieved from http://www.acog.org/Patients/FAQs/Newborn-Circumcision

American Urological Association (2013). AUA Policy Statements: Circumcision. AUA Website. Retrieved from http://www.auanet.org/about/policy-statements/circumcision.cfm

Bossio, J. A., Pukall, C. F., & Steele, S. (2014). A review of the current state of the male circumcision literature. The Journal of Sexual Medicine, 11(12), 2847–64. doi:10.1111/jsm.12703

Frisch, M., Aigrain, Y., Barauskas, V., Bjarnason, R., Boddy, S.-A., Czauderna, P., … Aigrain, Y. (2013). Cultural Bias in the AAP’s 2012 Technical Report and Policy Statement on Male Circumcision. Pediatrics, 131(4), 796–800. doi:10.1542/peds.2012-2896

World Health Organization. (2014). The Global Prevalence of Male Circumcision.  (View PDF)

UNAIDS. (2015). Fact Sheet 2015. (View PDF)