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November 22, 2009
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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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Circumcision: The Medical Pros and Cons

When was HIV discovered, and how is it diagnosed?

In 1981, homosexual men with symptoms of a disease that now are considered typical of the acquired immunodeficiency syndrome (AIDS) were first described in Los Angeles and New York. The men had an unusual type of lung infection (pneumonia) called Pneumocystis carinii (now known as Pneumocystis jiroveci) pneumonia (PCP) and rare skin tumors called Kaposi's sarcomas. The patients were noted to have a severe reduction in a type of cell in the blood that is an important part of the immune system, called CD4 cells. These cells, often referred to as CD4 T cells, help the body fight infections. Shortly thereafter, this disease was recognized throughout the United States, Western Europe, and Africa. In 1983, researchers in the United States and France described the virus that causes AIDS, now known as the human immunodeficiency virus (HIV) and belonging to the group of viruses called re...

Read the Human Immunodeficiency Virus article »










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