Key points about circumcision

Deciding whether to have your son circumcised can be hard. You may want to weigh a number of factors. Consider the following when making your decision:

• In most cases, there isn't a medical reason for circumcision. Your child was born with a natural penis, and it is safe and healthy to keep it that way if you decide to do so.
• Some parents choose circumcision based on religious or cultural reasons.
• If your son is healthy, circumcision most likely won't affect his health either way. There may be some slight health benefits for circumcised males, but these are not reason enough to choose circumcision. The American Academy of Pediatrics does not recommend circumcision as a routine procedure for newborn males. ¹
• Circumcision is surgery. It causes pain during and after the procedure. Like all surgeries, circumcision has risks. Major problems, such as scarring of the penis, are rare. Minor risks include bleeding and infection.
• Circumcision is not just done in newborns. Keep in mind that your son may have his own feelings about circumcision and can decide later in life if he wants a circumcised penis.

What is circumcision?

Male circumcision is a surgery to remove the foreskin, a fold of skin that covers and protects the rounded tip of the penis. The foreskin provides sensation and lubrication for the penis. In most cases, circumcision is elective surgery, which means there isn't a medical reason for it. If circumcision is done, it is usually done soon after birth.

In the United States, about 60 out of 100 boys are circumcised, and about 40 out of 100 are not. ² Worldwide, the rate of circumcision is much lower. ³

See a picture of a penis before and after circumcision.

When should a baby not be circumcised?

If you do not want your baby to be circumcised, he should not be circumcised. Circumcision is a decision you make because you want it for your baby.

Your doctor may feel that it's not safe to circumcise your baby if the baby is sick or weak, has a problem with his penis, has a family history of bleeding problems, or was born early (premature) and is not yet ready to go home.

What can I expect after circumcision?

Some swelling and slight bleeding are normal after circumcision. Your baby may be fussy and have trouble sleeping for the first few days. He may feel some pain for a few days when he urinates. For about 2 weeks, he may feel some pain whenever urine or stool touches the tip of the penis.

Your baby will probably start feeling better within 3 to 4 days after circumcision. Even though he may feel better, his penis may look worse. The penis will usually look better about 7 to 10 days after circumcision.

What are the risks of circumcision?

Problems from circumcision are not common. If they occur, they are usually short-term, such as minor bleeding or infection. Other possible problems include pain and irritation of the tip of the penis.

Long-term problems are even more uncommon, but they can include damage to the opening of the urethra, heavy bleeding, severe infection, or scarring.

Some people have concerns that circumcision can decrease sensitivity in the penis. Some people also wonder if circumcision disrupts the bonding that occurs between mother and son during breast-feeding. But there is not a lot of research about these concerns.

Are there benefits to circumcision?

If your son is healthy, circumcision most likely will not affect his health either way. There may be some slight health benefits for circumcised males, but these must be weighed against the risks. Most experts in the United States agree that these possible benefits are not reason enough to choose circumcision.

The American Academy of Pediatrics (AAP) does not recommend circumcision as a routine procedure for newborn males. When making this policy, the AAP looked at the possible benefits, risks, and costs of the procedure. ¹ Other major medical organizations, including the American Medical Association and the American College of Obstetricians and Gynecologists, agree with the AAP policy.

In the first year of life, urinary tract infections (UTIs) happen less often in circumcised boys than in boys who are not circumcised. But UTIs are not common. No studies support having circumcision done to prevent UTIs. ^{4, 5, 6}

Some studies in other countries have shown that circumcised men are a little less likely than men who have not been circumcised to get a sexually transmitted disease (STD), including HIV. ^{7, 8} But circumcision will not prevent STDs and HIV, and it should not be done solely to prevent these problems.

What if I decide to keep my son's penis natural?

Your child was born with a natural penis and it is safe and healthy to keep it that way if you decide to do so.

When cleaning your son's natural penis, be careful not to force the foreskin to retract. As your son gets older, teach him how to wash and care for his penis. It's important to keep your son's penis clean whether he has been circumcised or not.

There may be reasons later in life when your son may need a circumcision. A boy or man may have problems retracting the foreskin or may have swelling of the foreskin that requires circumcision. But these problems are rare.

Circumcision is not just done in newborns. Keep in mind that your son can decide on his own later in life if he wants a circumcised penis.

If you need more information, see the topic Circumcision.

Your choices are:

• Keep your son's penis natural.
• Have your son circumcised.

The decision about whether to have your son circumcised takes into account your personal feelings and the medical facts.

Making a decision about circumcision

Reasons to have your son circumcised	Reasons to keep your son's natural penis
Circumcision is a part of your religious or cultural tradition, or it is common practice in your family. Are there other reasons you might want to have your son circumcised?	Circumcision is not medically necessary. Experts do not recommend it as a routine surgery for healthy newborns. The surgery causes pain and in rare cases causes problems such as bleeding and infection. Having a natural penis is safe and healthy. Are there other reasons you might not want to have your son circumcised?

These personal stories may help you make your decision.

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about circumcision. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

I love my baby just the way he was born.	Yes	No	Unsure
My religious beliefs make circumcision the best choice.	Yes	No	Unsure
I don't want my baby to have surgery he doesn't need.	Yes	No	Unsure
Most of the men in our family are circumcised.	Yes	No	Unsure
Most of the men in our family have a natural penis.	Yes	No	Unsure
I am worried about the risks of surgery and how I would feel if something went wrong.	Yes	No	Unsure
The risks of surgery don't worry me.	Yes	No	Unsure

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to decide for or against circumcision.

Check the box below that represents your overall impression about your decision.

Leaning toward having my son circumcised

Leaning toward NOT having my son circumcised

Citations

1. Task Force on Circumcision, American Academy of Pediatrics (1999, reaffirmed 2005). Circumcision policy statement. Pediatrics, 103(3): 686–693.

2. National Center for Health Statistics (2006). Table 44. Number and percentage of male infants circumcised during hospitalization, by geographic region: United States, selected years 1980–2004. National Hospital Discharge Survey: 2004 Annual Summary With Detailed Diagnosis and Procedure Data. Available online: http://www.cdc.gov/nchs/about/major/hdasd/listpubs.htm.

3. Lerman SE, Liao JC (2001). Neonatal circumcision. Pediatric Clinics of North America, 48(6): 1539–1557.

4. Singh-Grewal D, et al. (2005). Circumcision for the prevention of urinary tract infection in boys: A systematic review of randomised trials and observational studies. Archives of Disease in Childhood, 90(9): 853–858.

5. Malone P, Steinbrecher H (2007). Clinical review: Medical aspects of male circumcision. BMJ, 335(7631): 1206–1209.

6. Van Howe RS (2005). Effect of confounding in the association between circumcision status and urinary tract infection. Journal of Infection, 51(1): 59–68.

7. Siegfried N, et al. (2003). Male circumcision for prevention of heterosexual acquisition of HIV in men. Cochrane Database of Systematic Reviews (3). Oxford: Update Software.

8. Auvert B, et al. (2005). Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: The ANRS 1265 Trial. PLoS Medicine, 2(11): 1–22. Also available online: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0020298.

Other Works Consulted

• Auvert B, et al. (2005). Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: The ANRS 1265 Trial. PLoS Medicine, 2(11): 1–22. Also available online: http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0020298.

• Castellsague X, et al. (2002). Male circumcision, penile human papillomavirus infection, and cervical cancer in female partners. New England Journal of Medicine, 346(15): 1105–1112.

• Singh-Grewal D, et al. (2005). Circumcision for the prevention of urinary tract infection in boys: A systematic review of randomised trials and observational studies. Archives of Disease in Childhood, 90(8): 853–858.

Author	Debby Golonka, MPH
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Adam Husney, MD - Family Medicine
Specialist Medical Reviewer	Peter Anderson, MD, FRCS(C) - Pediatric Urology
Last Updated	February 19, 2008