Scott Iwashyna, MD

Creating relationships with families by offering personalized care that is honest, open and respectful.

Taking a Little Off the Top: To Circumcise or Not to Circumcise

The American Academy of Pediatrics’s current position states “circumcision has potential medical benefits and advantages, as well as risks. The existing scientific evidence is not sufficient to recommend routine circumcision.” The AAP is reportedly working on an updated statement that is more in favor of circumcision, although the medical argument for or against has not changed.

I, personally, feel that the medical benefits from circumcision are too small for it to play a role in the decision whether or not to circumcise:

  • Over 100 male infants would need to be circumcised to possibly prevent 1 urinary tract infection.
  • The likelihood of penile cancer is too low to even be considered.
  • The studies on reduced rates of sexually transmitted infections often do not translate to our patient population, who are less likely to be having unprotected sex in areas with endemic HIV.  Plus, the cost/benefit analysis between teaching your child to use a condom (as well as not having unprotected sex in an area with 40-60% HIV rates) or getting a circumcision seem pretty obvious.
  • The care of the circumcised penis is nearly identical to the care for the uncircumcised penis.
  • The rates of foreskin infection or phimosis (a narrowing of the foreskin that prevents retraction and may require surgery) are similar to the rates of further surgical revisions in the circumcised males.

However, the side against circumcision also lacks good data that circumcisions are causing problems. I have only been a pediatrician for 5 years, but none of the circumcised teenage males in my practiced have complained that they don’t enjoy sexual activity. Severe complications from circumcision are extremely rare; it is certainly safer to have a circumcision than to drive in your car on any given day. While the procedure is clearly painful, we also have no evidence that it has lasting effects on children.

From my perspective, the decision to cut or not to cut is entirely personal/cultural and needs to be made by the family.

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1 Comment

  1. We have a family friend who is a doctor who works at a VA hospital in Wisconsin. He says that he runs into a very large number of infections related to not being circumcised in elderly men, because they have a hard time keeping the penis clean, or have gotten lazy with hygiene. I agree that it’s not an issue for young men or adults, but from what I’ve heard (anecdotal, yes) it can become a problem for the elderly.

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