To Circumcise or Not to Circumcise: What's a Parent to Do?

Whether or not to circumcise is a question fraught with emotional, religious, psychological, medical and moral implications. All sides have argued both for and against circumcision with a high degree of emotion, leaving some parents at a loss about how to make the right choice for their child.

To help parents make a rational decision regarding neonatal circumcision, it can help to set aside these implications and examine the medical evidence for circumcision's effects on health and safety, disease prevention and penile sensitivity.

From a urologist's perspective, it is better (on balance) for a newborn male to be circumcised than not to be. Here are the reasons why:

Health and Safety

Let's talk first about safety. Circumcision is the most common "surgical" procedure performed in the United States. More than 20 percent of the world's male population is circumcised. Complications are rare.

In its most simplistic form, it is all about hygiene. If an uncircumcised man does not regularly retract the foreskin and wash underneath it, the natural secretions from the skin can produce a smelly, cheesy substance known as smegma. Lack of cleanliness can lead to irritation, pain and even infection. Many women complain about the odor that results from a man's failure to wash frequently and thoroughly under the foreskin.

With regards to genital health, the importance of hygiene, particularly in uncircumcised males, cannot be emphasized enough. If an uncircumcised male has a foreskin that is easily retracted and meticulously cleaned, the likelihood of problems is reduced. Interestingly, in the Scandinavian countries, where very few men are circumcised but meticulous penile hygiene is taught, practiced and promoted, the incidence of penile cancer and other such problems is extremely low. It is all about genital hygiene, a retractable foreskin and meticulous attention to genital cleanliness.

HIV and Cancer Prevention

Uncircumcised men have a vastly greater chance of getting penile cancer. In fact, penile cancer, which is rare in any case, is virtually unheard of among circumcised men. Recent studies of AIDS prevention in Africa suggest that male circumcision can reduce the chance of HIV in men and perhaps in women. The validity of this theory is still being tested. Research shows that cells on the underside of the foreskin are prime targets for the virus; tears and abrasions in the foreskin serve as easy points of entry for the retrovirus. Studies have estimated that circumcised men have a greater than 40 percent lower risk for HIV infection.

Penile Sensitivity

The concept of penile sensitivity is always added to the mix in the debate for or against circumcision. There are no scientifically controlled experiments regarding the sexual performance of circumcised versus uncircumcised men. Based on my clinical experience, there is no difference.

Some people assume that a circumcised man has greater sensitivity because he has no foreskin covering the glans. Others believe that an uncircumcised man has greater sensitivity because he has a foreskin. Neither theory is true. The fact is that the foreskin retracts when an uncircumcised man has an erection. So in the aroused state, the penises are virtually the same.

Based on these factors, generally speaking, neonatal circumcision remains a healthier choice. Parents who choose to circumcise their newborn sons can do so with the confidence that they are making a good decision for the health and safety of their child.

One final note: While I do recommend infant circumcision, I do not recommend circumcision for my adult uncircumcised patients unless a medical problem warrants it, such as persistent irritation, infection, rash or the inability to retract the foreskin for cleaning. Adult circumcision is quick, simple and safe when performed by an experienced and qualified urologist.

Dudley Seth Danoff, MD, FACS, is president and founder of the Cedars-Sinai Tower Urology Group in Los Angeles, a Diplomate of the American Board of Urology, a Fellow of the American College of Surgeons, and the author of two books on men's health.

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