Circumcision: Medical Pros and
Cons
Medical Author: David Perlstein, MD, FAAP
Medical Editor: Melissa Conrad Stöppler, MD
The issue of circumcision is as controversial as it ever has been. There are well-known religious, social, and medical reasons to recommend circumcision; however, most major medical societies have taken an "impartial" view of the procedure, neither recommending nor renouncing the practice.
What has been the medical view of circumcision?
In 1975, the American Academy of Pediatrics (AAP) stated in no uncertain terms
that "there is no absolute medical indication for routine circumcision of the
newborn." In 1983, the AAP and the American College of Obstetricians and
Gynecologists (ACOG) restated this position. In 1999 and again in 2005, the AAP
again restated this position of equivocation.
Currently, the practice of
newborn circumcision is very common. It has been estimated that 60%-75% of all
males in the United States are circumcised. This number, of course, varies
depending upon ethnicity and religious affiliation.
Regarding newborn
circumcision, most physicians today agree with the practice of informing parents
of the risks and benefits of the procedure in an unbiased manner. Recently,
however, several large studies revealed a 60% decrease in HIV transmission in
circumcised males compared to uncircumcised males. This may ultimately influence
some changes in recommendations in the near future.
What is the anatomy of the penis?
The penis is a cylindrical shaft with a rounded tip. The rounded
tip is called the glans. There is a groove (termed the coronal
sulcus) between the shaft and the glans of the penis. The fold of
skin that covers the glans is the foreskin (the prepuce).
What is a retractable foreskin?
A retractable foreskin is one that can be pulled back behind the
groove of the coronal sulcus to expose the glans.
What is newborn circumcision?
Newborn circumcision consists of removal of the foreskin -- the
foreskin is resected to near the coronal sulcus -- in the newborn
period (before the age of 2 months).
Incidentally, the Latin circum means around (or about).
Circumcision is a cutting around.
What is the status of the foreskin at birth?
Only about one in every 20 boys is born with a retractable foreskin.
This reflects the fact that the tissue development of
the foreskin is usually not complete at birth.
The foreskin is thus not fully separable from the glans in about
96% of newborn boys. By 1 year of age, the foreskin can be
retracted in 50% of boys and by 3 years, the foreskin can be
retracted in 80%-90% of uncircumcised boys.
What does this have to do with circumcision?
It means that the inability to retract the foreskin at birth and
in infancy is normal and does not constitute a medical reason for a
circumcision.
Next: What is phimosis? »
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