Male circumcision—the surgical removal of the foreskin of the penis, typically done to a newborn—has always been controversial, at least outside of Jewish, Muslim, and Coptic communities, where it is nearly universal. Only about one-third of men worldwide are circumcised. In Europe, Latin America, and most of Asia, the procedure is not often done. In contrast, about four out of five men in the U.S. have been circumcised.
But rates have fallen somewhat in the U.S., from 83 percent of male newborns in the 1960s to 77 percent in 2010, according to a new review article in Mayo Clinic Proceedings. It attributed this drop to the withdrawal of Medicaid coverage for routine circumcision in 18 states (including California) and to faster growth of Hispanic groups, who traditionally do not circumcise. This is bad news, the authors say, because the lifetime health benefits of circumcision outweigh the risks by at least 100 to 1.
The most common arguments against routine circumcision are that it is unnecessary, unnatural, potentially dangerous, and even “barbaric.” The arguments for the procedure, other than religious and cultural ones, focus on the health benefits, which mostly occur later in life. As the review points out, these benefits have become clearer in recent years. They include prevention of urinary tract infections (from infancy to adulthood), penile cancer (a rare disease that occurs almost exclusively in uncircumcised men), balanitis (inflammation of the head of the penis, often caused by poor hygiene of the foreskin), and some sexually transmitted infections (including HIV, genital herpes, and cancer-related HPV). There are also reduced risks of infections, such as chlamydia and herpes, in the female partners of circumcised men.
In infants, the procedure itself may cause localized bruising and, rarely, infection and scarring. Such risks can be minimized by using a qualified practitioner.
By the way, two systematic reviews last year concluded that circumcision does not diminish sexual function and sensitivity, despite some claims to the contrary.
“Based on risk-benefit considerations, neonatal circumcision might rationally be considered in the same light as childhood vaccination,” the new paper concluded. On the basis of its comprehensive review of the scientific evidence in 2012, the American Academy of Pediatrics has concluded that the health benefits of circumcision outweigh the risks, though it says the decision should be left to parents to make in light of their “religious, cultural, and personal preferences.” The authors of the new paper make a good case for providing parents with the facts about the health benefits of circumcision— and for restoring Medicaid coverage.
Note: In parts of the world where heterosexual HIV infection is endemic, notably Africa, the World Health Organization and UNAIDS recommend male circumcision as an essential part of a comprehensive HIV prevention program.