According to an article published in the India Journal of Urology, circumcision is the most commonly performed elective surgical procedure among men . Circumcision refers to the surgical removal of the foreskin, which is the skin that covers the tip of the penis, and it’s a very controversial procedure. Although it’s quite common in the United States and various parts of the Middle East and Africa, it’s not as common in European countries.
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Today, the use of circumcision for health reasons continues to be hotly debated. In 2012, after doing a review of scientific evidence, the American Academy of Pediatrics (AAP) released a policy statement noting that while the health benefits that come with circumcision of newborns does outweigh the associated risks, these benefits aren’t great enough to recommend that all newborn males be circumcised . The AAP notes that the final decision should be left to the parents, who can take their cultural, ethical, and religious beliefs into account when making the decision. However, it’s important for parents considering newborn circumcision and adult males considering circumcision to take a look at both the pros and cons of this elective procedure.
The History of Circumcision
The exact origin of circumcision is not known, although the practice goes back thousands of years, with hieroglyphs dated before 2300 BC showing a circumcised penis. This practice also has ancient roots among various ethnic groups across the continent of Africa, and it’s still performed today as a coming-of-age ritual as boys transition into adulthood or warrior status . Circumcision was also performed by Pacific Islanders and Australian Aborigines as a coming-of-age ceremony, and a significant portion of the population in these areas continue to practice it today. .
The practice is also recorded in the Bible as being a part of the covenant Abram, and ultimately the Jews, entered with God. Typically, other peoples practicing ritual circumcision did not circumcise males until boyhood or adolescence, and the Jewish law stands out by requiring healthy boys to be circumcised on the eighth day .
During the mid-1800s, circumcision rates within the United States and in some European countries became more prevalent, since it was believed to cure masturbation in both children and adults. Masturbation was feared, especially in the Victorian era, and was seen as a type of self-abuse that could lead to hysteria, clumsiness, epilepsy, and other medical problems .
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Recent Attitudes Towards Circumcision
Today, circumcision is no longer looked at as a way to cure masturbation in most cultures. Global male circumcision rates are estimated to be between 37-39% . Among Muslims and Jews, circumcision rates have stayed steady. However, a look at US circumcision rates showed that the percentage of circumcisions have declined from 83% back in the 1960s to 77% in 2010 .While circumcision rates may be declining within the United States, the fact that male circumcision has been found to help prevent the spread of HIV and STIs (learn about the symptoms of STIs) has made it part of HIV prevention programs across the world. Although it’s not considered to be an essential medical procedure, today it’s become associated with the ability to reduce the risk of HIV, STIs, and even genital cancers.
Risks of Circumcision
Any medical procedure comes with a risk of complications, and it’s important for parents or adult males considering circumcision to consider the potential risks before deciding to go through the procedure. Potential risks include:
- Bleeding – The most common complication experienced with circumcision is bleeding. Typically only a few drops of blood are lost during most neonatal circumcisions. Any bleeding that exceeds that is considered a complication. Bleeding that does occur is usually quite mild and controlled with direct pressure to the site. In rare cases, more serious reports of bleeding have resulted among older boys affected by underlying bleeding disorders .
- Infection – While infection is very rare when a circumcision is done in sterile conditions, infection is always a risk with any type of surgical procedure. If an infection does occur, prompt treatment is essential. As with other early complications that may occur with circumcision, surgical site infection is usually very minor and easy to treat . It’s important to note that infection has been found to be more common when the Plastibell technique of circumcision was used, although most infections do respond to a combination of oral antibiotic therapy and topical treatment .
- Loss of Skin – No matter what technique is used for circumcision, there is a small risk of losing extra skin. Excess skin may be accidentally drawn into the clamp and amputated with the removal of the foreskin. Determination of the right amount of skin to remove when a free-hand circumcision is done may also result in the loss of excess skin. These injuries usually need treatment with local wound care and may result in extra healing time .
- Insufficient Removal of the Foreskin – The foreskin is usually removed so the glans of the penis is totally exposed. However, if an insufficient amount of skin is removed, the appearance may be unacceptable and may need to be revised in the future. This is an even bigger problem if the bit of foreskin left behind slides over the glans, scaring down and creating what is known as a phimosis, which must be repaired .
- Risk of Infection and Herpes Increases with Metzitzah b’peh – When ritual Jewish circumcisers use the mouth to suck away blood from the circumcision wound, a practice known as Metzitzah b’peh, public health experts have found that the risk of infection and the risk of the baby being infected with the herpes simplex virus is much higher. Even if adults do not have symptoms of the virus, babies are too young to fight off this virus. Organizations that advise against having the practice of Metzitzah b’peh done on infants include the American Academy of Pediatrics, Pediatric Infectious Diseases Society, and the Infectious Diseases Society of America .
- Higher Risk of Meatitis – Meatitis refers to the inflammation of the opening of the penis, and in most cases, it is relatively easy to treat. Several studies have shown that circumcision does increase the risk of developing meatitis, although ensuring circumcision is performed in a sterile environment lowers this risk significantly .
- Pain – Studies have shown that the pain that comes with circumcision in infants can result in changes in the infant’s behaviors, and lidocaine and penile nerve blocks are often used to control this pain in babies. However, circumcisions that are not done in a medical environment are not done with analgesics to reduce the pain, which can have long-term and short-term effects on an infant  . Later in life, pain is also a concern for men who decide to undergo circumcision. While general anesthesia is usually used for adult circumcision, men still report mild or moderate pain after the procedure .
Health Benefits of Circumcision
While circumcision does come with some potential risks and complications, multiple studies have shown that there are some health benefits to circumcision as well, although every individual has to weigh the risks versus the benefits. Some of the health benefits of circumcision include:
- Lower Risk of Urinary Tract Infections – Urinary tract infections are very common (discover the source of that burning feeling after sex), and among males, urinary infections often occur within the first year of life. In fact, these infections can lead to kidney problems while a young child’s kidney is still growing. Multiple studies have shown that circumcision not only reduces the risk of urinary tract infections during infancy but throughout the life of a male .
- Protects Men from HIV Infection – Several different trials done in Africa have shown that circumcision reduces the risk of acquiring the human immunodeficiency virus (HIV) by as much as 51-60%, and observational studies done within the United States and Africa have both found that circumcision has the ability to lower the risk of HIV infection. However, it’s still unclear whether circumcision reduces the acquisition of HIV among men who have sex with other men .
- Reduces the Risk of Other Sexually Transmitted Infections – Male circumcision has also been found to reduce the risk of other sexually transmitted infections (STIs) with heterosexual sex. Certain trials found that the risk of contracting genital herpes is lowered by as much as 34% with circumcision and the risk of being infected by high-risk human papillomavirus (HR-HPR) is reduced by up to 35% . Not only does it reduce the risk of contracting STIs for men, but it also reduces the risk of STIs for female partners as well. For female partners, the risk of contracting bacterial vaginosis (read about BV) is reduced by 40% and the risk of contracting trichomoniasis is reduced by 48% when the male has been circumcised .
- Protects Against Cancer of the Penis – Since most cases of penile cancer are among men who are uncircumcised, scientific evidence does support the idea that circumcision can protect against this type of cancer . Multiple conditions known to increase the risk of penile cancer, such as high-risk types of HPV, phimosis, and balanitis, are more prevalent in uncircumcised men. One abstract published in Advances in Urology went as far as to recommend the promotion of male circumcision, particularly in infants, to reduce the risk of penile cancer. .
- May Reduce the Risk of Cervical Cancer in Women – Some observational studies done on female partners of men who are circumcised have shown these women have a lower risk of cervical cancer . Experts believe that male circumcision may reduce the risk of HPV infection in their female partners, which may result in a lower risk of cervical cancer. One observational study published in the New England Journal of Medicine looked at data from several different studies of cervical cancer and found that when men had a history of several sexual partners, circumcision lowered the risk of cervical cancer in their female partners .
- Improved Hygiene – Personal hygiene may be more complicated for uncircumcised men since they have to retract the foreskin to wash the entire genital area, so circumcision offers significant improvements in genital hygiene for men . The ability to better cleanse the genitals helped reduce skin irritations and inflammatory conditions, particularly in hot, humid climates, and one study showed that yeast infections (learn what else causes yeast infections) of the penis are 60% lower in men who have been circumcised .
Circumcision and Male Sexual Pleasure
Some opponents of circumcision have cited anecdotal reports that male circumcision can result in sexual dysfunction and reduced male sexual pleasure. However, multiple trials and studies have disproven this idea. Studies have been done to examine whether sensory receptors responsible for sexual sensation lie in the foreskin, and these studies have found that these sensory receptors are actually found in the glans of the penis, not the foreskin. This means that removing the foreskin does not reduce sexual pleasure in men . In fact, removing the foreskin to expose the glans should result in increased sexual pleasure for men. In one trial, circumcised men reported that their penis was more sensitive after circumcision and they found it easier to reach orgasm as well .
Multiple systematic reviews have been done by experts to determine whether circumcision has any effect on sexual function. These reviews have looked at sexual desire, premature ejaculation, erectile dysfunction, and orgasm difficulties in both circumcised and uncircumcised men. The results showed little difference between the two, suggesting that circumcision has little effect on male sexual function and is not likely to cause sexual dysfunction in men .
Circumcision and Female Sexual Pleasure
Does male circumcision have any impact on female sexual pleasure? Several trials and studies have been done to investigate the impact of male circumcision on female sexual satisfaction. In one trial, just 2.9% of women reported that they had less sexual satisfaction with an uncircumcised partner, while 39.8% of women noted that they enjoyed greater sexual satisfaction after their partner had been circumcised. Approximately 57% of women saw no change at all in their sexual satisfaction, leading researchers to conclude that male circumcision has little negative effect on female sexual satisfaction .
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In another study that looked at sexual satisfaction before and after the circumcision procedure, 63% of women said that they enjoyed greater sexual pleasure after their partner was circumcised and 94% of women said they would recommend the procedure to others. Women also reported being happier with the appearance and cleanliness of their partner’s penis after circumcision .
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FAQ #1 – If uncircumcised men are more prone to carrying an STI, should I avoid sex with them?
Several studies have shown that women prefer to have circumcised men as sexual partners for a variety of reasons, including their own sexual pleasure, improved male hygiene, and the knowledge that men have a lower risk of STIs when circumcised . Men are more likely to carry an STI if they are uncircumcised, and studies definitely show a decreased risk of contracting and carrying STIs in circumcised men .
Does this mean you need to avoid sex with an uncircumcised man? Not necessarily. Consistent use of male latex condoms is still considered one of the best ways to prevent the transmission of HIV and STIs, and the condom’s effectiveness for preventing HIV and STIs have been noted in many studies .
FAQ #2 – Should I ask my man to get circumcised?
In multiple places around the world, women have a big influence on whether an adult male chooses to get circumcised . Since it does reduce the risk of contracting the HPV virus, bacterial vaginosis, and other STIs for women, it is something to consider . While it can offer some benefits to both men and women, this is a very personal decision. Instead of asking your partner to get circumcised, consider presenting him with the pros and cons so he can make his own informed decision.
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FAQ #3 – How should an uncircumcised penis be cared for?
As a boy ages, eventually it’s possible to retract the foreskin, and once the foreskin is retractable, it’s important that it is retracted far enough back during urination to see the opening of the penis where urine comes out. Retracting the foreskin during urination helps prevent urine from accumulating under the foreskin, which can cause infection. Once the foreskin easily retracts, it should also be pulled back gently, and the area beneath it cleansed. Cleansing beneath the foreskin is an important part of daily hygiene necessary for preventing infections. The foreskin should always be placed back in its original position over the head of the penis to keep it from squeezing the head of the penis, resulting in pain and swelling .
FAQ #4 – Are there medical issues that may indicate I should be circumcised now?
If males have not been circumcised as a newborn, there are conditions in older children or adult men that may indicate the need for circumcision. If a male is unable to pull the foreskin back from the tip of the penis, a condition known as phimosis, it may cause pain or an increased risk of infection. This may be a sign that circumcision needs to be done to eliminate this problem. If the foreskin is so tight that urine collects in it and makes it balloon out during urination, a condition known as trapped penis, then circumcision may be needed to allow normal urination .
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