Circumcision is a surgical procedure during which the foreskin of the glans of the penis is excised. The procedure is routinely performed by followers of the Islam and Judaism. The foreskin is the loose tissue which surrounds the glans of the penis. Most often circumcision is performed as a religious ritual. Other reasons cited for circumcision include health benefits. This article examines the underlying reasons for circumcision and examines the benefits of circumcision, if any. An extensive literature review is done and it is concluded that there are no benefits attributable to this ancient practice.

The Trend to Circumcise is Declining

In 1988 approximately 90 % of newborn American Infant males were circumcised. In 2008 less than 60 % newborn male infants are circumcised. In the western states of the U.S. the number of circumcised male infants is less than 40 %. In Canada the number of circumcised male infants is less than 25%. Globally and naturally the uncircumcised penis is the norm. Statistics show that 85% of the world’s male population is uncircumcised. So the biological norm is the uncircumcised penis.

The Medical Perspective

Historically, society and parents of new born infants have relied upon the medical profession to provide direction about medical procedures even though Professional Organizations tend to remain neutral on many issues. The American Academy of Paediatrics is no exception. The AAP has made it clear that there is no right or wrong decision on the issue of circumcision. They appointed a task force in 1999 which recommended that:

To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision.

Emerging statistics and biology provide parents a clearer sense of direction. Latest statistics show a trend away from circumcision. However, for followers of Judaism and Islam faiths the answer may not be that simple. Parents of new born infants can be under immense pressure to have their male infants circumcised. In the end, it is my view that parents should defer the decision to circumcise until the child grows up and is able to decide for himself.

In some areas of the world circumcision is done without anaesthesia. The infant is held down by a group of family members or hospital employees and the foreskin is cut off. The amount of foreskin that is cut off depends many variables. The crying and bleeding infant is then treated with topical or systemic antibiotics so that the cut area does not become infected. The sensitive glans is wrapped tightly to prevent bleeding. Gradually the bleeding stops and the sensitive glans becomes keratinized.

Wound and glans dressings are painful procedures. Dried blood adheres to the wound and the glans penis. When dressings are due the nurse or professional health worker has to remove the old dressings, clean the glans and the wound and apply new dressings. This procedure will be painful to the infant. Sometimes the psychological trauma will last a life time.

The Bare Facts

1. Circumcision is Painless? Let us look at the facts.

   Advocates of circumcision argue that circumcision is painless. I request them to cut a part of their foreskins, 0.5 cm will do, and then to write to me to inform me if it is painless.

   If circumcision was painless why does the child need to be restrained physically by the parents or hospital employees? I argue that circumcision is a painful procedure.

   All males will know that the skin of the shaft of the penis is very sensitive. When skin is cut or pinched it causes pain. For example, when the skin of the penis gets caught in a zip the pain is excruciating. So, circumcision must be painful.

   Advocates of circumcision also argue that the pain lasts only for a short time. This is not true either. It takes a few days for the wound to heal. First the bleeding has to stop, then a scar must form over the cut part, finally tissue will form over the excised part. If there is no infection and the child is otherwise healthy then it will take about one painful week before the pain goes away.

   Bandaging and un-bandaging a sensitive cut penis has to be painful. Individuals who say that circumcision is not painful are not being honest. Even one celled creatures can experience pain. For example, if you irritate an amoeba with a sharp instrument it will move away from the pain.

2. Circumcision reduces Urinary Tract Infections.

   Many studies show that circumcised boys have a 1 in 1000 of UTI versus 1 in 100 chances of uncircumcised boys. The reality is that Urinary Tract Infections are rare in boys and are easily treated. Performing circumcisions of all male infants to reduce Urinary Tract Infections which rarely affect male infants seem to be a overkill.

3. Circumcision reduces penile cancer.

   Cancer of the shaft of the penis is three times more common than amongst uncircumcised males than circumcised males. Cancer of the shaft of the penis is literally nonexistent in circumcised men.

   Further studies show that cancer of the shaft of the penis affects only one in 100,000 older men and that cancer is due to the behaviours of the individuals rather than the circumcision or the lack of it.

4. Circumcision reduces sexually transmitted diseases.

   Some studies have established a relationship between STDs and circumcision. Vaginal disorders and rates of HIV infections are lower for circumcised men. Detailed analysis showed that the risk is only slightly lower. In fact the sexual behaviours of the uncircumcised men were better predictors of STDs.

5. Circumcision is cleaner.

   Uncircumcised males run the risk of infection of the foreskin. Simple education is all that is needed to reduce this risk. Circumcision is not the best option.

6. Circumcision reduces the probability of complicated adult circumcision. Really?

   There are instances when circumcision is necessary for medical conditions such as phimosis. This is a condition in which the foreskin cannot be retracted over the glans; Research shows that post-infancy circumcisions are more painful and carry a higher risk of complications.

   The bottom line reality is that phimosis and other penile conditions requiring circumcision are not very common and not generally considered a valid reason for routine circumcisions of all male infants.

7. Son should look like father.

   Some believers of ancient mythology argue that sons should look like fathers. They worry that there may be confusion, even psychological problems, if the father’s penis is circumcised and the son’s is not.

   The bottom line reality is that boys do not always look like their fathers. Sons may have different hair colour, eye colour, body shape and a differently shaped penis. If boys always looked and behaved like their fathers then there will be no room for growth, change and evolution.

8. Young male infants may worry that they will strange if not circumcised. What are the facts?

   In days gone by, some adult males requested circumcisions because they had heard from sexual partners that their penises were “strange.” Sometimes they were teased as children and felt ashamed because in the locker room situations their penises were different.

   Over the last thirty years statistics have changed. More males are uncircumcised therefore it is more normal to be uncircumcised. Also, nowadays children are taught to respect individual differences.

9. Circumcision makes the penis function better. What’s the evidence?

   There is no evidence that excising an infant’s foreskin makes it function better. Circumcision actually interferes with the way nature designed and evolved the human body. The benefits of circumcision if any, are minimal at best and do not justify circumcision of all male infants.

10. Circumcision is financially expensive. What are the facts?

    In many states in the U.S. circumcision is covered by insurance companies or by Medicare. However, in Canada circumcision is not covered by insurance companies because it is considered elective surgery.

    It is clear that circumcision could be costly in financial terms if it is not covered by insurance companies.

11. Complications of circumcision surgery. What are the facts?

    All surgeries have associated complications. Circumcision is no exception. The complaint rate is estimated to be one in two hundred circumcisions. It must be remembered that an infant at that age is unlikely to complain that his penis has been mutilated. Complications of surgery can be read here.

12. Pain of circumcision. What are the facts?

    Some infants remember the pain associated with circumcision throughout their lives. It is for this reason that the AAP now recommends that pain relief be used for all circumcisions.

    Circumcision Under Local Anaesthesia

    Circumcision can be performed painlessly under local anaesthesia. Many new medications are available for this purpose. However, circumcision is an operation and carries all the risks associated with such surgery.

    There are three forms of pain relief available to infants undergoing circumcision. These are topical numbing with EMLA cream, dorsal penile nerve block and subcutaneous ring blocks. All should be used to control pain associated with circumcision.

    Circumcision Under General Anaesthesia

    It is true that circumcision under general anaesthesia is painless. It is true that the costs are low. It is also true that when a child or adult is exposed to general anaesthesia then they are exposed to all the risks associated with postoperative complications. More can be read about possible postoperative complications here.

13. Complications of circumcision. What are the facts?

    Circumcision is a surgical procedure and it has the all potential complications of such surgeries. A full description of all possible complications is beyond the scope of this short article. Some of the commonest complications of circumcision are:

    • Loss of useful tissue
    • Infection of operative site
    • Systemic infections
    • Anaesthetic complications
    • Bleeding
    • Death from septicaemia and shock

14. Circumcision: Effect on glans penis

    When the foreskin is removed then the glans of the penis becomes keratinized. Naturally, the glans is protected from rough clothing and dry conditions by the fore skin. When the fore skin is circumcised then the protection disappears. Keratinization occurs because the foreskin is no longer there to protect the sensitive and moist epithelial layers of the glans. The keratinised penis does not give the same amount or type of sexual pleasure. In the initial stages of keratinisation the glans penis is sensitive to even the gentle touch but with keratinisation it becomes insensitive and leathery.

    The erogenous zone of the penis is the glans and the foreskin. The foreskin is rich with nerve endings. When the nerve endings are removed during circumcision the pleasurability of the sex act is reduced.

    I would hate to see it get cut The cry of the child is a sharp scream. I can still hear it. If it was painless I would have expected the child to sleep through the procedure.

15. Child’s Rights: Let us look at reality

    Mothers against circumcision have a website which point to many of the disadvantages of Circumcision. They argue that during circumcision Healthy, functioning tissue is excised from helpless male infants. Further many mothers have taken the view that this procedure should not be performed because the child whose penis is being circumcised is not of legal age and therefore cannot consent to the procedure. The author of this article is of the view that male infant circumcision is a human rights violation except where medically indicated. My argument is based on the fact that circumcision is not a necessary medical procedure therefore parents do not have the right to amputate the child’s penis. Amputation of the penis has lifelong consequences for the newborn child.

In conclusion and in all fairness I must state that I am personally opposed to circumcision. However I recognise that parents always have their infant’s interests at heart. I believe that when parents consent to their infant son’s circumcision they believe that they are doing the best thing for their child. I do not agree with this assertion but it is reality.

If you choose to have your young son circumcised I suggest that it be a pain free circumcision. A pain free circumcision can be achieved if you follow the following checklist.

1. Have a detailed discussion with the doctor and surgeon. Make sure that you know the type of pain relief that will be used and the possible risks of the surgery.
2. Know exactly which surgeon will perform the surgery
3. Choose a surgeon who has experience in the field
4. Read the consent form carefully
5. Have an understanding as to when the wound will heal
6. The parent is the child’s advocate and all decisions must be based with the child’s interests in mind

Remember, the uncircumcised penis is the natural penis. Nature wanted it that way – Uncircumcised. Only 25 % of the world’s male penises are circumcised.