RESEARCH STARTER

Male circumcision

Male circumcision is a surgical procedure involving the removal of the foreskin from the penis, commonly performed on newborn males. The practice is often influenced by cultural, religious, and social factors, with the United States being notable for a high rate of circumcision performed without explicit religious justification. The medical necessity of routine circumcision is debated; while some advocate for its potential benefits, such as reduced risks of urinary tract infections and sexually transmitted diseases, others question its necessity, arguing that many of the perceived health benefits can be achieved through proper hygiene.

Complications can arise from circumcision, including bleeding and infection, and the procedure carries risks that are often weighed against its benefits. Public opinion on circumcision has evolved over the years, with increasing skepticism leading to a decline in its prevalence in various regions. This shift has sparked discussions about the ethics of performing the procedure on infants who cannot consent. As societal attitudes continue to change, the future of circumcision remains uncertain, with advocates for both sides of the debate emphasizing the need for informed parental choice.

Full Article

DEFINITION: The removal of the foreskin (prepuce) covering the head of the penis.

Indications and Procedures

Routine circumcision of the newborn male—in which the foreskin of the penis is stretched, clamped, and cut—is a relatively controversial procedure. Famed pediatrician Benjamin Spock once contended that circumcision is a good idea, especially if most of the boys in the neighborhood are circumcised; then a boy feels “regular.” This, however, may not be a suitable justification for circumcision. Allowing routine circumcision of newborns as a religious and cultural rite still leaves the debate over medical necessity. The United States is one of the few countries in the world that circumcises many newborn males without a religious reason. In fact, circumcision has been termed a “cultural surgery.”

True medical indications for the surgery are seldom present at birth. Conditions such as infections of the head or shaft of the penis may be indications for circumcision; an inability to retract the foreskin in the newborn (phimosis) is not an indication. Some argue that circumcision should be delayed until the foreskin has become retractable, making an imprecise surgical procedure presumably less traumatic. In 96 percent of infant boys, however, the foreskin is not fully retractable; it is normally so tight and adherent that it cannot be pulled back and the penis cleaned (forced retraction should be avoided). By age seven, that percentage decreases significantly, and only about 1 percent of boys continue to experience phimosis by age sixteen.

There are other contraindications to newborn circumcision. Circumcising infants with abnormalities of the penile head or shaft makes treatment more difficult because the foreskin may later be needed for use in reconstruction. Prematurity, instability, or a bleeding problem also preclude early circumcision. The foreskin is a natural protective membrane that contains numerous nerve fibers, nerve endings, veins, arteries, and capillaries. It keeps the sensitive head protected, facilitating intercourse, and prevents the surface of the glans from thickening and becoming desensitized. Also, within the inner surface of the foreskin are a series of tiny, ridged bands that contribute significantly to stimulating the glans.

The two most persistent arguments for the operation, however, are the risks of infection and cancer in the uncircumcised. Without circumcision, smegma accumulates beneath the base of the covered head of the penis. This cheeselike material of dead skin cells and secretions of the sweat glands was once thought to be a cause of cancers of the penis and prostate gland in uncircumcised men and cancer of the cervix in their female partners. However, further research showed that the presence of smegma itself is not a risk factor for cancer, but if it creates a buildup under the foreskin, it can cause chronic irritation and inflammation. Smegma is a sign of poor personal and sexual hygiene, but not a risk factor for cancer. Sexually transmitted infections (STIs) like the human papillomavirus (HPV) increase the risk of some cancers; some studies indicate that HPV is more common in uncircumcised men.

Proponents of the procedure have said that the increased incidence of urinary tract infections and STIs in uncircumcised males sufficiently argues for circumcision. They warn that the intact foreskin invites bacterial colonization, leading to urethral infection ascending to the bladder, which may spread upward to the kidneys and sometimes cause permanent kidney damage. On the other hand, no proof exists that uncircumcised male infants who sustain urinary tract infections will have future urologic problems. Furthermore, no operation is without risks.

Research indicates an increased rate of certain STIs in those who are uncircumcised, including human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). In Africa, male circumcision was historically seldom practiced; the acquisition of HIV/AIDS by men from infected women during vaginal intercourse was one of the most common modes of transmission. HIV/AIDS infection requires a break or an abrasion of the skin to gain entry. The intact foreskin provides a site for the transfer of infected cervical secretions. Doctors at the University of Nairobi in Kenya noted a relationship between HIV infection, genital ulcers, and lack of circumcision. Uncircumcised men had a history of genital ulcers more often than did the circumcised, and they were more often HIV-positive. They were also more frequently HIV-positive, even if they did not have a history of genital ulcer disease. Modern research confirmed these findings, indicating a reduction in female-to-male transmission of about 60 percent after circumcision.

Every evaluation of circumcision, pro or con, should reflect the confounding genetic and environmental variables, and the actual increased risks and benefits. All the pros and cons should be explained to parents before informed consent is obtained.

Uses and Complications

Worldwide studies of predominantly uncircumcised populations have shown a higher incidence of urinary tract infection (UTI) in boys during the first few months of life, which is the reverse of what is found in older infants and children, where girls predominate. In 1986, Brooke Army Medical Center in Texas took a closer look. The doctors found the incidence of urinary tract infection in circumcised infant males to be 0.11 percent, but 1.12 percent in the uncircumcised. While modern research continued to find a higher incidence of UTIs among uncircumcised infants, the risk that this posed for healthy boys remained extremely low.

The rate of surgical complications associated with circumcision of newborns is very low, with most research indicating rates below 3 percent. In adults, this risk increased to around 9 percent. The most common complication is bleeding, which is usually minor. Chordee (a downward curve of the penis) can result if the doctor uses improper technique. Other complications include infection, ulceration, or incomplete or excessive tissue removal.

Infant circumcisions are performed with a local topical anesthetic and a nerve block before the procedure for immediate pain control. Soreness may persist after the anesthetic stops working, however, and healing takes about a week. Oral pain relievers like acetaminophen and ibuprofen may be administered for inflammation reduction and pain relief following the procedure.

Some adult males are circumcised by their own choice. Many complain of at least a week’s discomfort after the operation.

Perspective and Prospects

Routine newborn circumcision originated in the United States in the 1860s, ostensibly as prophylaxis against disease. Some medical historians, however, believe that nonreligious circumcision was a deliberate surgical procedure to desensitize and debilitate the penis to prevent masturbation. During this era, and for nearly one hundred years afterward, most American physicians viewed masturbation as an inevitable cause of blindness, weak character, insanity, nervousness, tuberculosis, sexually transmitted disease, and even death. One physician maintained that a painful circumcision would have a salutary effect upon the newborn’s mind, so that pain would be associated with masturbation. As late as 1928, the American Medical Journal published an editorial that justified male circumcision as an effective means of preventing the dire effects of masturbation. During World Wars I and II, soldiers were forcibly circumcised under threat of court-martial, being told that the surgery was for reasons of hygiene and the prevention of epilepsy and other diseases. Eventually, a general change in attitude occurred, notably in Great Britain and New Zealand, which largely abandoned routine circumcision. Rates of circumcision also fell dramatically in Canada, Australia, and even the United States.

While it was once considered likely that circumcision would disappear completely, some groups actively proposed an end to routine neonatal circumcision. Even as work continued to advance the procedure, nursing groups and concerned mothers formed local groups to oppose circumcision in male neonates. Some argued that subjecting a baby to this procedure may impair mother-infant bonding. Another question some physicians and parents have posed is the ethics involved in the unnecessary removal of a functioning body organ, particularly without the patient’s consent. Others claim that the baby’s rights are being violated, noting that the child must live with the outcome of the decision to perform a circumcision.


Bibliography

Ahmed, Faisal, et al. “Catastrophic Complications of Circumcision by Traditional Circumcisers.” Open Access Emergency Medicine, vol. 13, 2021, pp. 425–29, doi:10.2147/OAEM.S322683. Accessed 7 Sept. 2025.

Apuzzio, Joseph J., et al., editors. Operative Obstetrics. 4th ed., Taylor & Francis, 2017.

Bigelow, Jim. The Joy of Uncircumcising! Exploring Circumcision—History, Myths, Psychology, Restoration, Sexual Pleasure, and Human Rights. Rev. ed., Hourglass, 1998.

Campo-Flores, Arian. "Circumcision Coverage Comes into Focus." The Wall Street Journal, 20 Jan. 2014, www.wsj.com/articles/circumcision-coverage-comes-into-focus-1390264031. Accessed 7 Sept. 2025.

"Circumcision." Cleveland Clinic, 31 Jan. 2024, my.clevelandclinic.org/health/procedures/circumcision. Accessed 7 Sept. 2025.

"Circumcision in Men." NHS, 21 Sept. 2022, www.nhs.uk/conditions/circumcision-in-men. Accessed 7 Sept. 2025.

"Circumcision (Male)." Mayo Clinic, 20 Apr. 2024, www.mayoclinic.org/tests-procedures/circumcision/about/pac-20393550. Accessed 7 Sept. 2025.

"Circumcision." MedlinePlus, US National Library of Medicine, 6 Nov. 2023, medlineplus.gov/ency/article/002998.htm. Accessed 7 Sept. 2025.

"Circumcision: A Parent's Choice." HealthyChildren.org, 3 Feb. 2025, www.healthychildren.org/English/ages-stages/prenatal/decisions-to-make/Pages/Circumcision.aspx. Accessed 7 Sept. 2025.

Gollaher, David L. Circumcision: A History of the World’s Most Controversial Surgery. Basic Books, 2000.

King, Lowell R., editor. Urologic Surgery in Neonates and Young Infants. W. B. Saunders, 1998.

Kliegman, Robert M., et al., editors. Nelson Textbook of Pediatrics. 22nd ed., Saunders/Elsevier, 2025.

Ronchi, Piero, et. al. “Technology Meets Tradition: CO2 Laser Circumcision versus Conventional Surgical Technique.” Dovepress, 16 July 2020, www.dovepress.com/technology-meets-tradition-co2-laser-circumcision-versus-conventional--peer-reviewed-fulltext-article-RRU. Accessed 7 Sept. 2025.

Full Article

DEFINITION: The removal of the foreskin (prepuce) covering the head of the penis.

Indications and Procedures

Routine circumcision of the newborn male—in which the foreskin of the penis is stretched, clamped, and cut—is a relatively controversial procedure. Famed pediatrician Benjamin Spock once contended that circumcision is a good idea, especially if most of the boys in the neighborhood are circumcised; then a boy feels “regular.” This, however, may not be a suitable justification for circumcision. Allowing routine circumcision of newborns as a religious and cultural rite still leaves the debate over medical necessity. The United States is one of the few countries in the world that circumcises many newborn males without a religious reason. In fact, circumcision has been termed a “cultural surgery.”

True medical indications for the surgery are seldom present at birth. Conditions such as infections of the head or shaft of the penis may be indications for circumcision; an inability to retract the foreskin in the newborn (phimosis) is not an indication. Some argue that circumcision should be delayed until the foreskin has become retractable, making an imprecise surgical procedure presumably less traumatic. In 96 percent of infant boys, however, the foreskin is not fully retractable; it is normally so tight and adherent that it cannot be pulled back and the penis cleaned (forced retraction should be avoided). By age seven, that percentage decreases significantly, and only about 1 percent of boys continue to experience phimosis by age sixteen.

There are other contraindications to newborn circumcision. Circumcising infants with abnormalities of the penile head or shaft makes treatment more difficult because the foreskin may later be needed for use in reconstruction. Prematurity, instability, or a bleeding problem also preclude early circumcision. The foreskin is a natural protective membrane that contains numerous nerve fibers, nerve endings, veins, arteries, and capillaries. It keeps the sensitive head protected, facilitating intercourse, and prevents the surface of the glans from thickening and becoming desensitized. Also, within the inner surface of the foreskin are a series of tiny, ridged bands that contribute significantly to stimulating the glans.

The two most persistent arguments for the operation, however, are the risks of infection and cancer in the uncircumcised. Without circumcision, smegma accumulates beneath the base of the covered head of the penis. This cheeselike material of dead skin cells and secretions of the sweat glands was once thought to be a cause of cancers of the penis and prostate gland in uncircumcised men and cancer of the cervix in their female partners. However, further research showed that the presence of smegma itself is not a risk factor for cancer, but if it creates a buildup under the foreskin, it can cause chronic irritation and inflammation. Smegma is a sign of poor personal and sexual hygiene, but not a risk factor for cancer. Sexually transmitted infections (STIs) like the human papillomavirus (HPV) increase the risk of some cancers; some studies indicate that HPV is more common in uncircumcised men.

Proponents of the procedure have said that the increased incidence of urinary tract infections and STIs in uncircumcised males sufficiently argues for circumcision. They warn that the intact foreskin invites bacterial colonization, leading to urethral infection ascending to the bladder, which may spread upward to the kidneys and sometimes cause permanent kidney damage. On the other hand, no proof exists that uncircumcised male infants who sustain urinary tract infections will have future urologic problems. Furthermore, no operation is without risks.

Research indicates an increased rate of certain STIs in those who are uncircumcised, including human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). In Africa, male circumcision was historically seldom practiced; the acquisition of HIV/AIDS by men from infected women during vaginal intercourse was one of the most common modes of transmission. HIV/AIDS infection requires a break or an abrasion of the skin to gain entry. The intact foreskin provides a site for the transfer of infected cervical secretions. Doctors at the University of Nairobi in Kenya noted a relationship between HIV infection, genital ulcers, and lack of circumcision. Uncircumcised men had a history of genital ulcers more often than did the circumcised, and they were more often HIV-positive. They were also more frequently HIV-positive, even if they did not have a history of genital ulcer disease. Modern research confirmed these findings, indicating a reduction in female-to-male transmission of about 60 percent after circumcision.

Every evaluation of circumcision, pro or con, should reflect the confounding genetic and environmental variables, and the actual increased risks and benefits. All the pros and cons should be explained to parents before informed consent is obtained.

Uses and Complications

Worldwide studies of predominantly uncircumcised populations have shown a higher incidence of urinary tract infection (UTI) in boys during the first few months of life, which is the reverse of what is found in older infants and children, where girls predominate. In 1986, Brooke Army Medical Center in Texas took a closer look. The doctors found the incidence of urinary tract infection in circumcised infant males to be 0.11 percent, but 1.12 percent in the uncircumcised. While modern research continued to find a higher incidence of UTIs among uncircumcised infants, the risk that this posed for healthy boys remained extremely low.

The rate of surgical complications associated with circumcision of newborns is very low, with most research indicating rates below 3 percent. In adults, this risk increased to around 9 percent. The most common complication is bleeding, which is usually minor. Chordee (a downward curve of the penis) can result if the doctor uses improper technique. Other complications include infection, ulceration, or incomplete or excessive tissue removal.

Infant circumcisions are performed with a local topical anesthetic and a nerve block before the procedure for immediate pain control. Soreness may persist after the anesthetic stops working, however, and healing takes about a week. Oral pain relievers like acetaminophen and ibuprofen may be administered for inflammation reduction and pain relief following the procedure.

Some adult males are circumcised by their own choice. Many complain of at least a week’s discomfort after the operation.

Perspective and Prospects

Routine newborn circumcision originated in the United States in the 1860s, ostensibly as prophylaxis against disease. Some medical historians, however, believe that nonreligious circumcision was a deliberate surgical procedure to desensitize and debilitate the penis to prevent masturbation. During this era, and for nearly one hundred years afterward, most American physicians viewed masturbation as an inevitable cause of blindness, weak character, insanity, nervousness, tuberculosis, sexually transmitted disease, and even death. One physician maintained that a painful circumcision would have a salutary effect upon the newborn’s mind, so that pain would be associated with masturbation. As late as 1928, the American Medical Journal published an editorial that justified male circumcision as an effective means of preventing the dire effects of masturbation. During World Wars I and II, soldiers were forcibly circumcised under threat of court-martial, being told that the surgery was for reasons of hygiene and the prevention of epilepsy and other diseases. Eventually, a general change in attitude occurred, notably in Great Britain and New Zealand, which largely abandoned routine circumcision. Rates of circumcision also fell dramatically in Canada, Australia, and even the United States.

While it was once considered likely that circumcision would disappear completely, some groups actively proposed an end to routine neonatal circumcision. Even as work continued to advance the procedure, nursing groups and concerned mothers formed local groups to oppose circumcision in male neonates. Some argued that subjecting a baby to this procedure may impair mother-infant bonding. Another question some physicians and parents have posed is the ethics involved in the unnecessary removal of a functioning body organ, particularly without the patient’s consent. Others claim that the baby’s rights are being violated, noting that the child must live with the outcome of the decision to perform a circumcision.


Bibliography

Ahmed, Faisal, et al. “Catastrophic Complications of Circumcision by Traditional Circumcisers.” Open Access Emergency Medicine, vol. 13, 2021, pp. 425–29, doi:10.2147/OAEM.S322683. Accessed 7 Sept. 2025.

Apuzzio, Joseph J., et al., editors. Operative Obstetrics. 4th ed., Taylor & Francis, 2017.

Bigelow, Jim. The Joy of Uncircumcising! Exploring Circumcision—History, Myths, Psychology, Restoration, Sexual Pleasure, and Human Rights. Rev. ed., Hourglass, 1998.

Campo-Flores, Arian. "Circumcision Coverage Comes into Focus." The Wall Street Journal, 20 Jan. 2014, www.wsj.com/articles/circumcision-coverage-comes-into-focus-1390264031. Accessed 7 Sept. 2025.

"Circumcision." Cleveland Clinic, 31 Jan. 2024, my.clevelandclinic.org/health/procedures/circumcision. Accessed 7 Sept. 2025.

"Circumcision in Men." NHS, 21 Sept. 2022, www.nhs.uk/conditions/circumcision-in-men. Accessed 7 Sept. 2025.

"Circumcision (Male)." Mayo Clinic, 20 Apr. 2024, www.mayoclinic.org/tests-procedures/circumcision/about/pac-20393550. Accessed 7 Sept. 2025.

"Circumcision." MedlinePlus, US National Library of Medicine, 6 Nov. 2023, medlineplus.gov/ency/article/002998.htm. Accessed 7 Sept. 2025.

"Circumcision: A Parent's Choice." HealthyChildren.org, 3 Feb. 2025, www.healthychildren.org/English/ages-stages/prenatal/decisions-to-make/Pages/Circumcision.aspx. Accessed 7 Sept. 2025.

Gollaher, David L. Circumcision: A History of the World’s Most Controversial Surgery. Basic Books, 2000.

King, Lowell R., editor. Urologic Surgery in Neonates and Young Infants. W. B. Saunders, 1998.

Kliegman, Robert M., et al., editors. Nelson Textbook of Pediatrics. 22nd ed., Saunders/Elsevier, 2025.

Ronchi, Piero, et. al. “Technology Meets Tradition: CO2 Laser Circumcision versus Conventional Surgical Technique.” Dovepress, 16 July 2020, www.dovepress.com/technology-meets-tradition-co2-laser-circumcision-versus-conventional--peer-reviewed-fulltext-article-RRU. Accessed 7 Sept. 2025.

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