Circumcision/Intact: Considerations

by Staff

Recent policy statements issued by professional societies representing Australian, British, Canadian, and American pediatricians do not recommend routine circumcision of male newborns.

What is circumcision?

Circumcision involves surgical removal of the foreskin that shields the head of the penis. The foreskin (prepuce) is the movable fold of skin on the distal portion of the penis. It forms half or more of the penile skin system.

What is the function of the forskin?

The foreskin has three known functions:

  1. Protection: The foreskin covers and protects the urinary opening, keeping the urinary tract sterile, and the glans (head) of the penis, keeping the mucous membrane soft, moist, and sensitive.
  2. Sensory: The foreskin contains 20-40,000 highly specialized, erogenous nerves that allow a male to know what his penis is feeling and where he is in relation to the orgasmic trigger. These specialized nerves are concentrated in the ridged band encircling the foreskin's opening.
  3. Sexual: The foreskin provides the tissue necessary for a full erection and the gliding mechanism necessary for normal sexual function. The ridged band turns inside out with intercourse, exposing the concentrated sensory nerve endings.

How common is circumcision?

Worldwide, about 12% of males are circumcised. In 1999, the neonatal circumcision rate in the United States was 65%; in the western states, 37%. Current polls indicate that about 50% of baby boys are circumcised in the first few days or weeks after birth. Some parents choose to circumcise because it's an important and religious ritual while others choose to circumcise because they have heard it's better from the standpoint of hygiene and health.

Making a decision

Question about medical benefits
A recent review by the American Academy of Pediatrics looked at all the data from the past decades to see if there were any medical benefits. Their conclusion -- data does not demonstrate sufficient reason to recommend routine neonatal circumcision. In Canada, circumcision has been ruled not medically justified. A position statement on circumcision, released in 1996 by the Canadian Pediatric Society and reaffirmed in 2003, recommended that circumcision of newborns should not be routinely performed.

In the past, there were studies backed by the medical profession that listed certain benefits for circumcision. In recent years, however, many of these have been further scrutinized. A few examples include:

  • Cleanliness -- An intact penis is not less sanitary than a circumcised penis, nor is it more difficult to clean. Only the outside of the foreskin needs to be cleaned during the first year (or longer). Read Cleaning the penis with intact foreskin.

  • Decreased risk of STD's -- Behavioral factors have been found to be far more important than circumcision status when it comes to the risk of STD infection.

  • Penile cancer -- Penile cancer occurs in 0.9 to 1 males in every 100,000 in the United States. There is a slightly lower rate of penile cancer in circumcised male (approximated 1:100,000 to 3:100,000). However, risk factors such as genital warts, HPV, multiple sex partners and cigarette smoking may play a large role in causing penile cancer.

  • Avoiding infections in the foreskin -- It is true, occasionally intact foreskins get irritated. This is easily treated with warms soaks and washing. Rarely, the irritated foreskin becomes infected, requiring antibiotics, but it is easily treatable.