How Safe Is Circumcision?

Circumcision, of all things, has been in the news of late. The American Academy of Pediatrics announced that the need for circumcision "revision" surgery among infant boys had increased by more than 100% between 2004 and 2009. And a German court recently ruled that circumcising for religious reasons constitutes grievous bodily harm and is a crime, regardless of parental consent.

This latest turn of events contrasts the usual research that confirms the safety and benefits of circumcision.

Why The Trend?

Jewish and Muslim males are virtually always circumcised in infancy for religious reasons, but among the rest of Americans, the popularity of the procedure—which involves cutting off the foreskin of the penis-has ebbed and flowed over the years. The proportion of circumcised American male infants rose to about 90% in the 1970s since then it has declined to about 55% as of 2010, according to the Centers for Disease Control and Prevention (CDC). Many parents have questioned whether this procedure is necessary, and the American Academy of Pediatrics continues to take a neutral position as to whether or not it is advisable.

Is circumcision more dangerous than we had realized? Are there good reasons to be or not to be-circumcised?

What The Research Says

Harry Fisch, MD, a urologist at New YorkPresbyterian Hospital/Weill Medical College of Cornell University in New York City explained that like any procedure, circumcision has risks. But, he said, evidence-based research now demonstrates clear and compelling medical benefits of circumcision throughout life--not only for men, but also for the women who are their sexual partners...

• For men, it decreases the risk of acquiring HIV, the virus that causes AIDS, by as much as 50%, but it is not clear whether or not it reduces transmission of HIV to a partner.
  
• It reduces the risk among men and women of transmitting and acquiring genital herpes by about 28% and human papillomavirus (HPV), which can lead to cervical cancer in women and penile cancer in men, by 35%.
  
• It decreases infant boys' risk of getting urinary tract infections in the first year of life from one in 100 to one in 1,000. UTIS should be avoided in infancy because in 10% to 30% of cases they scar kidneys for life, and UTIs can lead to major health problems such as hypertension and chronic renal failure.
  

Dr. Fisch said that it's not entirely clear how circumcision provides all of these health protections, but since the foreskin leaves a warm, moist pouch between the inside of the foreskin and the head of the penis, disease-causing microbes can multiply there. And because the inner surface of the foreskin is especially permeable, said Dr. Fisch, it may facilitate entry of microbes into the male's body.

Removing the foreskin also makes genital hygiene easier and therefore allows men to avoid a wide variety of foreskin-related health problems, such as infections and phimosis, a condition

that's often triggered by an infection in which the foreskin becomes tightly stretched around the head of the penis and makes retraction impossible. Phimosis may interfere with urination and sexual function, and because it makes genital hygiene even more difficult, it can lead to further infections.

In terms of sexual satisfaction, though, no studies have yet been able to evaluate whether or not being circumcised increases or decreases pleasure for a man or a woman, said Dr. Fisch. He added that they would be difficult to conduct, since pinpointing the exact cause of pleasure isn't easy.

To Snip Or Not To Snip?

Experts are looking into the reasons behind the doubling of the need for circumcision revisions among infant boys (it rose up to 119%from around 2,600 to around 5,600 cases), but, according to Dr. Fisch, it's surprising. Up until now, it has generally been widely accepted that complications from infant circumcision are rare, minor (e.g., bleeding, infection and easily controlled. He added that a local anesthetic will reduce any associated pain and discomfort and that the penis heals fully in less than 10 days.

According to Dr. Fisch, the most significant health advantages of circumcision do not kick in until many years later when males become sexually active-but he and others in the medical community believe that infant circumcision is a safer and less traumatic procedure than adult circumcision. When you have the procedure done as an adult, it is generally quite painful, often requiring general anesthesia-as opposed to local anesthesia—which makes it a much riskier option. Plus, the healing tends to take longer (four to six weeks).

Parents: It's a tough decision, but it's up to you to decide for yourselves.

HPV Affects Half of All Men

Most men don't know that they have the IV sexually transmitted disease because they usually don't have symptoms and doctors rarely test men for it. While most of the 40 strains of HPV affecting the genital areas aren't harmful, several strains can lead to a variety of cancers in men and women, as well as genital warts.