Circumcision: Medical Pros and Cons

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Medical Author:

David Perlstein, MD, MBA, FAAP

David Perlstein, MD, MBA, FAAP

Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.

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Medical Editor:

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Circumcision: medical pros and cons facts

• Inability to retract the foreskin fully at birth is not a medical reason for a circumcision.
• Circumcision prevents phimosis (the inability to retract the foreskin at an age when it should normally be retractable), paraphimosis (the painful inability to return the foreskin to its original location), and balanoposthitis (inflammation of the glans and foreskin).
• Circumcision increases the chance of meatitis (inflammation of the opening of the penis).
• Circumcision may result in a decreased incidence of urinary tract infections.
• Circumcision may result in a lower incidence of sexually transmitted diseases and may reduce HIV transmission.
• Circumcision may lower the risk for cancer of the cervix in sexual partners.
• Circumcision may decrease the risk for cancer of the penis.
• There is still no absolute medical indication for routine circumcision of the newborn.

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, and there is significant pressure for the AAP and ACOG to reconsider their positions.

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.