So apparently male circumcision is cool again

Illustration for article titled So apparently male circumcision is cool again

An influential American medical organization is overturning recently overturned convention by suggesting that the health benefits of infant circumcision outweigh any risks. According to the American Academy of Pediatrics, there is now sufficient evidence showing the advantages for male circumcision, namely the prevention of urinary tract infections, penile cancer and some sexually transmitted infections, including HIV. But as to whether or not parents and the medical establishment will adjust their practices accordingly remains an open question.


Writing in the Globe and Mail, Andre Picard explains further:

Let's start with an objective look at the benefits and risks of circumcising a newborn boy. The AAP task force reviewed 1,031 published studies and the most significant advantage they identified is that circumcised boys have a lot fewer urinary-tract infections. Most UTIs occur in the first year of life and the number is three to 10 times lower in babies who have had their foreskin removed. The task force noted though that many of these infections can also be avoided with good penile hygiene.

Research shows that circumcised men have lower rates of sexually transmitted infections. In the U.S. circumcised men have about a 15 per cent lower lifetime risk of contracting HIV (considerably different from the 60 per cent reduction in African studies). They have a lower risk of contracting syphilis (something that has been known for about 300 years) as well as genital herpes, but there is no protective effect for gonorrhea. These differences, however, are really only significant in sub-populations that have high rates of infection, such as men who have sex with men.

The AAP findings show that having a sexual partner who is circumcised can benefit women too, because they are less likely to contract infections such as bacterial vaginosis, chlamydia and human papillomavirus, again because a foreskin is a good place for bacteria and viruses to hide.

It has long been believed that circumcised men have lower rates of penile cancer. That is confirmed in the new paper but with a couple of important provisos: 1) penile cancer is very rare and; 2) the risk is exclusive to uncircumcised men with phimosis (a condition in which the foreskin does not fully retract).

On the key question – for some – there is no evidence that penile sensitivity, sexual satisfaction or sexual function varies between circumcised and uncircumcised men.

There are several important side-components to this issue, including an assessment of the risks of not being circumcised (which Picard correctly assesses as being relatively low), the problem of informed consent from the newborn (which is obviously impossible), and the potential for this procedure to be legislated into standard medical practice (which no one is arguing for — at least not yet).

Now, while there may be some valid medical reasons behind circumcision, these are ultimately social and cultural issues that are probably best left to the individual and his parents.

In the case of informed consent, it's not unreasonable to recommend that parents not have their newborns circumcised in favor of allowing them to make that decision for themselves when they come of age and become sexually active; adult circumcision is always an option.

And as for the procedure being imposed upon parents and their male offspring, the AAP was very clear that infant circumcision should remain an elective practice. This is probably wise, given the various cultural, religious, and personal reasons involved. You can read the AAP's policy statement here.


Image credit: Louro.


Dr Emilio Lizardo

Adult circumcision is really not a good option. It is impossible to know just how painful a week old baby finds the procedure, but the baby shows no obvious ill effects a few hours later. It is much more painful for an adolescent or adult to undergo the procedure nd then it requires general anesthesia. At least, that's the way it was when I was in medical school 25 years ago.