The first federal guidelines on circumcision, issued recently by the U.S. Centers for Disease Control and Prevention (CDC), promote the health benefits of the elective medical procedure. But the report stops short of recommending routine circumcision for all newborn boys, and Megan Chen, MD, a family-practice doctor in Santa Monica, says the decision remains a personal one in which all factors — including religious, cultural and individual preferences as well as potential health risks — should be considered.
“Most parents come in knowing what they want, but it’s important that they understand that this is an elective procedure and that they be counseled on the potential benefits and risks so that they are making an informed decision on whether newborn circumcision is appropriate for them,” Dr. Chen says.
Although there is enough evidence on the health benefits of circumcision — including reductions in both urinary tract infections (UTIs) and sexually transmissible viral infections — that most insurance companies will cover the procedure, Dr. Chen notes that the diseases for which the risk may be reduced are rare. Similarly, she adds, risks associated with circumcision are very low.
The reduced UTI risk is particularly applicable to boys with urological conditions that predispose them to infection, including posterior urethral valves and vesicoureteral reflux. “Most pediatric urologists recommend circumcision in boys who are at high UTI risk,” says Jennifer Singer, MD, a UCLA pediatric urologist. “But for boys without these predispositions, the risk of UTI during childhood is extremely low, whether they are circumcised or not.” Circumcision has been shown to reduce the risk of HIV transmission through heterosexual sex, but not for men having sex with men, Dr. Singer notes. She adds that the evidence of reduced risk is only in regions with high HIV prevalence, such as sub-Saharan Africa.
In some cases, circumcision can increase the risk of future health concerns. Circumcised boys are more prone to a condition known as meatal stenosis, in which the opening through which urine leaves the body is constricted. There is also the potential for cosmetic concerns regarding the amount of foreskin removed, as well as the very rare but serious risk of injury to the glans. The newborn circumcision procedure itself has a 0.5 percent risk of complications, most commonly minor bleeding and pain.
Overall, Dr. Singer notes, about 5 percent of males who have been circumcised will require a future procedure to manage complications such as meatal stenosis. Similarly, about 5 percent of uncircumcised males ultimately require circumcision for problems that include infections of the glans and foreskin, as well as the inability to retract unretractable foreskin trapping the penis (phimosis) or problems in reducing retracted foreskin. Dr. Singer notes that proper hygiene and care for the uncircumcised penis significantly reduces these risks.
“There are many good reasons to circumcise newborn boys and men, including urological predispositions to infection, cultural and religious traditions, a desire in families with other male members who have been circumcised to look the same, personal preference and the slight reduction in risks of urinary tract infections, viral infection transmission and penile cancer,” concludes Dr. Singer. “However, it is incumbent on those performing circumcision to counsel families in a balanced way on the true benefits and risks.”