Circumcision: To Cut Or Not?

For decades, it was standard practice to circumcise newborn boys in the U.S. But within the last 25 years, routine circumcision has come into question.

According to an article in the Circumcision Information Resource Pages, the rate of circumcision for newborns in the U.S. reached a high of 85 percent in 1979. By 2001, the rate was down to 55.1 percent. Some say that circumcision is dangerous and puts boys at risk. Others believe it is a necessary preventive measure. What is a parent of a newborn boy to believe?

What Gets Clipped?

Male circumcision refers only to removing the foreskin, or prepuce, from a newborn’s penis.

When an uncircumcised penis is flaccid, the foreskin serves as a protective "sleeve" covering the glans, the ridged head of the penis. When a penis is erect, the foreskin retracts -- at nwhich point an uncircumcised penis looks no different from a circumcised penis.

Risks

The National Organization of Circumcision Information Resource Center lists a number of complications that can result from circumcision. They include discomfort, scarring, desensitization and a sense of loss.

The group also lists conditions that could result in surgery, such as problems urinating or a scar that forms a tight ring.

Other sources warn that surgical errors during circumcision are possible, if rare. One study in the journal Pediatrics found that 1 out of every 476 newborns experiences some kind of complication related to circumcision. Only 1 out of about 10,000 uncircumcised newborns has a complication related to the fact that he was not circumcised.

Who Does It?

Male circumcision has long been a part of many religious traditions. A circumcision ceremony is standard among Jewish boys and common in many Islamic traditions.

But few Christian sects have required circumcision. Most countries with predominantly Christian populations have very few circumcised males. According to an article in the British Medical Journal, the rates of newborn circumcision in Great Britain are consistently less than 5 percent. In Scandinavia, less than 2 percent of newborn males are circumcised.

Even with recent declines, more than half of boys born in the U.S. are still circumcised. How did it become so prevalent here?

Male neonatal circumcision became standard in the 19th and early 20th centuries, according to David Gallaher's 1994 article in the Journal of Social History. One of the main early justifications was to cure a condition called phimosis, in which the foreskin is too tight and will not retract.

Circumcision quickly solves phimosis, but it affects only 4 of every 10,000 boys. By itself, it has never been seen as a reason to routinely circumcise all boys.

According to Gallaher, circumcision became routine after it was promoted as a cure-all for everything from insanity to frequent masturbation. Most of these justifications have been discredited.

Cutting Infections

One of the few lasting justifications for male circumcision addresses the greater chance of infection. Gallaher's article notes that the germ theory of disease was coming into prominence in the late 19th century. At the time, it was believed that the area under the foreskin could be a breeding ground for germs and infections.

There is some truth to this. Bacteria can grow easily there, and boys with uncircumcised penises must be taught to pull back the foreskin and wash thoroughly.

However, even the cleanest boys run some risk of infection. An influential study showed that urinary tract infections are significantly more common among uncircumcised males. There is also evidence that sexually transmitted diseases are easier to catch if a penis is uncircumcised.

What Do Doctors Say?

Boston Dr. Kevin Long summed up the typical opinion of most medical professionals:

“The bottom line seems to be that while circumcision may have some minor health benefits, like lower rates of UTIs and (sexually transmitted diseases), the benefits alone are not significant enough reasons to have circumcision," he said. “Circumcision is not medically necessary."

Despite some necessary cases, Long emphasized that in the huge majority of cases “the benefits and risks are both small and essentially cancel out, leaving it up to more personal values and beliefs to determine whether or not the foreskin stays or goes."