Newborn Circumcision:
Do the Risks Outweigh the Benefits?
| The United States is one of the only Western countries in the world that circumcises newborns as a "routine" medical procedure. Circumcision is often described as a safe and painless procedure, while risks and potential long term effects are downplayed in ways that are (in my opinion) not true to the spirit of informed consent. So what are the real risks and benefits to newborn circumcision? |  |
Note: This article does not address the ethical or religious issues around circumcision (of which there are many) nor does it address studies that have looked at the psychological or sexual effects of circumcision (of which there are also many!). For the purpose of this blog I wanted to just present the medical side of the question of circumcision... which is plenty to cover in one post!
Medical Benefits
- Reduced risk of urinary tract infection (UTI): Circumcision is known to reduce risk of UTI in infant boys. Still, the risk of UTI in male infants is very small - the odds of having a UTI are around 1 in 100 for uncircumcised males and can be as low as 1 in 400-1000 for circumcised infants. UTI’s are generally short term conditions that are easy to treat, either with antibiotics or botanical medicine.
- Reduced risk of penile cancer: while there has been a slightly higher incidence of penile cancer in uncircumcised individuals, the risk of penile cancer is still incredibly low, regardless of circumcision status.
 | It's actually much more likely that a male child will get breast cancer than penile cancer - in the US the rate of penile cancer is less than 1 in 100,000 men, while the risk of male breast cancer is 1 in 833. In addition, individuals who get the HPV vaccine in early adolescence are most likely at even lower risk, as infection with HPV is strongly associated with penile cancer risk. |
- Reduced risk of sexually transmitted infections (STI’s): While there has been some conjecture that circumcision reduces transmission of HIV, this is still murky. In some studies in areas with high HIV rates, circumcised makes had lower rates of HIV infection, in others no significant difference was seen. Information on other STI's is also unclear - while there has been some concern that being uncircumcised can increase risk of HPV (the STI that causes cervical cancer, penile cancer, and genital warts), several studies showed no increase in HPV rates for individuals with intact genitalia.
Medical Risks
As many as 50% of infants have either short-term or long term complications after circumcision. The following is a list of common medical issues and complications after circumcision:
- Bleeding and infection: Around 10,000 infants per year experience infections after circumcision. These are generally treatable but can cause pain, irritability, and interrupted sleep and may require antibiotics. Bleeding can be minor or major, and may even result in the infant needing stitches or even (very rarely) a blood transfusion.
| - Complications from medications: Circumcision is a surgical procedure that requires multiple medications, such as lidocaine injection, lidocaine-prilocaine cream, topical antibiotics, and acetaminophen. All medications carry some risk of adverse effects. These may include allergic reactions, rash, digestive upset, irritability, and issues with oxidative stress / detoxification pathways. |  |
- Adhesions and “Skin Bridges”: Adhesions are one of the most common complications after newborn circumcision. An adhesion/skin bridge is where the wound where the foreskin was removed fuses to the head of the penis, either adhering one part of the head of the penis to the shaft or, in severe cases, even fusing the whole head of the penis to the shaft, so that there’s no visible ridge around the base of the head. This can result in pain and, hygiene issues, and cosmetic issues. Up to 70% of circumcised infants experience some degree of adhesions within the first month of life. While most of these resolve on their own, many need additional surgical revisions.
- Meatal stenosis: Meatal stenosis is a narrowing of the urethra (the opening in the tip of the penis where urine passes through). This occurs in 5-20% of kids who are circumcised as newborns (the risk starts to go down as age of circumcision goes up).
| Meatal stenosis can be mild and asymptomatic but in many cases it results in urinary retention, increased risk of bladder and kidney issues, and urinary tract infections. Many of these children ultimately require surgery. |  |
- Scarring of the penis: scar formation is common after circumcision, either at the attachment site of the foreskin to the shaft or on the head of the penis. Circumcision scars are a common site of pain in adulthood and may result in decreased sexual sensation.
- Hematoma: depending on the procedure used, as many as 1 in 20 children have a hematoma after circumcision, or excessive bleeding and blood clot formation in the penis. This causes painful swelling and purple or red blotches in the genital area. Depending on severity, this may resolve on its own or require medical drainage or even surgical evacuation.
| - Botched surgery / amputations: botched surgeries are a rare but tragic outcome of routine circumcision. Common types of botched surgeries include partial or total amputation of the head of the penis and the removal of too much skin, resulting in painful erections later in life and the need for skin grafting and revisionary surgeries. Necrosis of the penis or even total loss of the penis have been reported. |  |
- Death: While death from circumcision is rare, all surgeries carry inherent risk, including risk of death. Even the most modest estimates for number of deaths due to complications of circumcision are around 15 children per year (estimated ranges vary hugely and can go up to as many as over 200 deaths per year). Clear data on risk of death from circumcision complications are hard to find, as deaths may occur as a result of complications and be attributed to “hemorrhage,” “infection,” etc, rather than the procedure that caused these to happen.
There is currently research underway to investigate the potential links between neonatal circumcision and SIDS, or Sudden Infant Death Syndrome. SIDS is more common in male infants than female, and it is more common in countries and communities that have a high circumcision rate. There is some concern that the trauma of circumcision causes dysregulation of the nervous system in newborns and abnormal levels of serotonin which reduce a baby's ability to wake up if they are unable to breathe.
There is currently research underway to investigate the potential links between neonatal circumcision and SIDS, or Sudden Infant Death Syndrome. SIDS is more common in male infants than female, and it is more common in countries and communities that have a high circumcision rate. There is some concern that the trauma of circumcision causes dysregulation of the nervous system in newborns and abnormal levels of serotonin which reduce a baby's ability to wake up if they are unable to breathe.
While many families still choose to circumcise based on religious reasons or even occasionally due to medical malformations are other medical conditions, the decision whether or not to circumcise as a "routine" medical procedure should be carefully considered alongside all of these potential long and short term risks.
Further Reading:
Further Reading:
- Pros and cons of circumcision: an evidence-based overview, B. Friedman, Clinical Microbiology and Infection
- A longitudinal population analysis of cumulative risks of circumcision, Y. Hung et al, Journal of Surgical Research
- Routine circumcision: the opposing view, A. MacNeily, Canadian Urological Association Journal
- The psychological impact of circumcision, R Goldman, British Journal of Urology
