Circumcision, the surgical removal of the foreskin from the penis, may be one of the oldest surgical procedures known to mankind. There are several reasons parents may choose to have their sons circumcised, including religious customs, social or cultural reasons, and to prevent medical complications. While some studies have shown that circumcision may have medical benefits, it is not a necessary procedure for all boys. Parents should carefully examine the evidence for and against circumcision before making a decision.

Today, circumcision is much more common in certain parts of the world, namely the Middle East, Canada, and the US. In the United States 55% to 65% of male newborns are circumcised. Why do some parents decide against this procedure? What are the controversies surrounding it?

The issue here is whether the procedure is beneficial, medically unnecessary, or harmful. Unfortunately, studies are controversial and subject to individual interpretation. Some studies have shown that urinary tract infections are more common in uncircumcised infants.

Advocates of the procedure cite studies showing that circumcised men have lower rates of penile cancer (a disorder that is very rare in all men) and AIDS (most of the studies were done in African countries, which may make them less relevant for men in other parts of the world). One study involved almost 5,000 uncircumcised men in Uganda. Half of the men were circumcised, while the other half served as controls. The trial was stopped early after the study found a 50% relative risk reduction in acquiring HIV among the men who were circumcised.

Other studies have also shown that women who have had an uncircumcised partner may have a higher risk of cervical cancer.

Parents may be concerned about keeping their son's uncircumcised penis clean. While it may seem easier to clean a circumcised penis, there is no special care needed for an uncircumcised penis. Gentle washing with warm water is all that is needed during infancy. Foreskin retraction should never be forced. After the foreskin becomes retractable (usually by age five, but sometimes not until adolescence), boys can be taught how to clean beneath their foreskin daily with soap and warm water. When the foreskin is separating from the head of the penis, skin cells are shed and may look like small, white bumps under the foreskin. These are called smegma and are not a cause for concern.

Without circumcision, men may develop phimosis, a condition in which the foreskin gets stuck in a “pulled back” state. The majority of these cases, though, can be easily treated without any surgical intervention. Only severe cases of phimosis may require circumcision to prevent recurrence.

Circumcision, though, is a painful procedure and requires local anesthesia and about 7-10 days of healing. In addition to complications like bleeding and infection, there are occasional surgical mishaps in which too much or too little of the foreskin is removed. Occasionally there can even be injury to the penis itself. These problems, which are rare, may require further surgery.