There are at least six medically proven circumcision advantages, beginning in newborns and continuing through old age. Some of these benefits are grouped together below:
A. Reduced Risk of Urinary Tract Infection – Numerous major scientific studies have shown that an uncircumcised infant boy has 10 times the risk of developing a urinary tract infection (UTI) in the first year of life. Why would that be? The answer is that the foreskin acts as a haven for bacteria such as E. Coli, which contaminate the urine and migrate up to the kidney. UTIs in infants can be serious, causing both permanent scarring of the kidney with loss of function, as well as spread of infection to the blood and other parts of the body. Therefore, circumcision serves as a protective effect against urinary tract infection in newborns and infants.
B. Reduction of Local Penile Problems – Care of an uncircumcised penis of a young boy or adult requires proper hygiene and regular cleaning underneath the foreskin with soap and water. Poor hygiene can lead to an unpleasant infection of the foreskin and glans called balanoposthitis, in which the glans and foreskin become red, swollen, and painful with discharge. Balanposthitis requires treatment with antibiotics.
Yeast can also get trapped under the foreskin causing candida balanitis. In some instances, the foreskin can become painfully trapped below the head of the penis (paraphimosis), or it can remain tightly adherent to the glans into adulthood (phimosis), both of which may require surgical intervention, including general anesthesia.
Finally, certain genital dermatological diseases, such as lichen sclerosis and Zoon’s balanitis, are more prevalent in uncircumcised men. And, in fact, circumcision is often the treatment of choice for these diseases.
C. Reduced Acquisition of Sexually Transmitted Infections – Abrasions and microscopic tears of the foreskin create a portal of entry for sexually-transmitted organisms. Newborn circumcision has been shown to reduce the acquisition of the following sexually-transmitted diseases:
HIV (Human Immunodeficiency Virus) – There is a 40% to 60% reduction in acquisition of HIV among heterosexual males in areas of high HIV prevalence.
HPV (Human Papilloma Virus) – There is approximately 30% to 40% reduction in HPV acquisition among circumcised men. Since human papilloma virus is the primary cause of cervical cancer, there seems to be a protective effect of male circumcision against cervical cancer in female partners (3 fold reduction).
Genital Herpes (Herpes Simplex Virus) – Approximate 35% reduction in acquisition of HSV-2 in circumcised men.
There is some additional data, though less conclusive, that circumcision reduces acquisition of syphilis and bacterial vaginosis.
D. Reduced Risk of Penile Cancer – Uncircumcised men are only three times as likely to develop noninvasive squamous carcinoma of the penis (a relatively benign form of the disease). However, they are more than 20 times as likely to develop invasive (malignant) squamous cell cancer of the penis (a rarer, but more devastating disease).
The true incidence of complications after newborn circumcision is unknown, in part due to different definitions of “complication.” In experienced hands, the risks are minimal, and significant complications are quite rare. Nonetheless, all surgical procedures involved some risks, including:
Bleeding – A tiny amount of bleeding immediately after the procedure is normal. “Spotting” of blood (without active bleeding) may continue for up to 24 hours and is also normal. More serious bleeding may occur if there is a history of hemophilia or other bleeding disorders, such as a low platelet count. There may be a slight increased risk of bleeding in babies who do not receive Vitamin K.
In the usual case that bleeding occurs (1 in 500 newborns), it is typically controlled by direct pressure or application of a bandage. Sometimes bleeding requires the use of hemostatic agents, such as aluminum chloride or electrocautery. And rarely, stitches may be needed. If bleeding is uncontrollable, hospitalization and transfusion may be necessary. In the 20 years that Dr. Singer has been performing circumcisions, he has never had a bleeding complication that he could not handle in the home/office.
Infection – The risk of infection with newborn circumcision is exceedingly rare (less than 1 in 1,000 newborns). Infection is rare because of the use of sterile autoclaved instruments as well as the outstanding blood flow to the area (which carries protective immune cells with it). Nonetheless, the risk of infection is still rarely possible and would require antibiotics. In the 20 years that Dr. Singer has been performing circumcisions, he has never had a baby develop an infection.
Errors in Skin Removal – This is the most common complication of newborn circumcision. The exact prevalence of this complication is unknown, and varies significantly depending upon level of experience of the practitioner. Typically, the more experienced the surgeon, the better the cosmetic result. There is some estimation when deciding how much skin to remove, especially since there is so much anatomic variability. Those babies who have hydroceles (fluid around the testicle), torsion or rotation of the penis, shorter penises, and prematurity may present challenges in deciding how much skin to remove. Practitioners and parents do not want excessive skin removed nor do they want too little skin removed (in which cases the penis looks incompletely circumcised).
In order to be as precise as possible, Dr. Singer analyzes all of the anatomy before the procedure and uses a surgical marking pen to guide the exact amount of skin to be removed. Dr. Singer’s rate of revision is less than 1%. Unfortunately, no guarantees can be made as to the cosmetic outcome of the procedure.
Injury to the Head of the Penis – This is an extraordinarily rare complication, and has never occurred in Dr. Singer’s hands.
Death – There are perhaps one or two case reports in the world’s literature of a baby dying from newborn circumcision. Fortunately, this is an extraordinarily rare complication, and has never occurred in Dr. Singer’s hands.
Late complications of circumcision may also occur months after the procedure and include physiological adhesions, skin bridges, medical stenosis, phimosis, buried penis, and epidermal inclusion cysts. Some of these complications are easily treated in the office while others may require surgical intervention by a urologist.