Circumcised vs. Uncircumcised: Benefits, Risks, and Controversy

One of the oldest medical procedures in the world is male — or penis — circumcision (a procedure that removes the foreskin from the head of the penis). In some cultures, circumcision of male newborns is routine and commonplace. In other communities it’s very rare. Just over 70% of all males in the U.S. are circumcised. But for many parents the decision about whether to circumcise their newborn male isn’t straightforward. Here we’ll discuss what the evidence says about the risks and benefits of the procedure, and what you should consider when making the choice. 

What are the risks and benefits of circumcision?

The American Academy of Pediatrics released a policy statement in 2012 that reviewed the medical evidence about circumcision. It states the following:

• From a preventive health perspective, the benefits of circumcision outweigh the risks of the procedure.

• The benefits are high enough that insurance companies should cover the procedure.

• But the health benefits aren’t strong enough to recommend routine circumcision for all male newborns.

• Parents should be the ones to decide if circumcision is the right choice for their child. They should consider the medical information along with their own “religious, ethical, and cultural beliefs and practices.” 

Circumcision benefits

The medical benefits of removing the foreskin are lower risks of:

• Urinary tract infection (UTI): This effect is mostly in the first few months of life.

• Human immunodeficiency virus (HIV): This is only true in countries with high rates of HIV, primarily in African countries. 

• Sexually transmitted infections (STIs): Examples include herpes and human papillomavirus (HPV).

• Penile cancer: Cancer of the penis is less likely after circumcision.

• Inflammatory conditions of foreskin: Examples include balanitis (when the penis becomes inflamed) and balanoposthitis (when the penis and foreskin become inflamed).

Circumcision risks

While the rates of complication are low, circumcision isn’t a risk-free procedure. There’s risk of: 

• Bleeding

• Pain

• Infection

• Injury to penis (a rare complication, estimated at around 4 in 10,000 cases)

In general, these risks are minimal when using safe and sterile techniques that help prevent infection. 

For pain, numbing cream, a nerve-blocking shot, and/or a dose of acetaminophen (Tylenol) helps. For premature babies, a numbing cream can lead to skin irritation, so a nerve-blocking shot is better. 

Does circumcision decrease or increase sexual pleasure?

One debate about circumcision is about the impact on sexual pleasure. Opponents of circumcision say that there are a lot of nerve endings in the foreskin, so circumcision may lead to decreased sexual pleasure. Others say that the nerve endings linked to sexual pleasure are in the shaft of the penis, and circumcision doesn’t affect them.

Studies in males who have undergone circumcision as adults haven’t helped to shed light on the question. Some show decreased sexual pleasure, and others show no change or even increased sexual pleasure after circumcision. A 2020 meta-analysis showed that the higher-quality studies tended to show either no change in sexual functioning or improved sexual functioning. 

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How much does circumcision reduce the risk of UTIs or STIs?

The short answer is, a little bit. But it’s not as straightforward as you may think. 

UTIs are relatively rare, affecting under 1% of boys. Circumcision is strongly associated with a decreased risk of UTI in male newborns under the age of 3 months. Beyond 3 months, circumcision status doesn’t affect the risk of getting a UTI. It’s estimated that for every 111 male infants who are circumcised, 1 UTI is prevented. 

When it comes to STIs, the research can get a little complicated. Circumcision reduces the risk of getting HIV in countries where rates of HIV are high (for example in African countries). In countries with low rates of HIV, like the U.S., there’s no clear evidence that circumcision lowers HIV rates. For other STIs, circumcision reduces HPV and herpes simplex virus type 2 (HSV-2) transmission. But it doesn’t make a difference in the risk of getting chlamydia or gonorrhea. 

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Keep in mind that the best way to prevent these diseases is to practice safe sex and to do regular screening.

What are other factors to consider when deciding if circumcision is right for my child?

In addition to the health-related factors above, there are other factors that may influence a parent’s decision about whether to circumcise their baby: 

• Religious background: Circumcision is commonplace in some religions, like Judaism or Islam. 

• Cultural reasons: Some parents want their child’s circumcision status to be similar to their father, or to most other boys in the community. 

• Parental agreement: It’s important for both parents to agree on whatever choice they make.

• Safety: It can be unsafe to circumcise an infant who is born prematurely or with certain medical conditions (like bleeding disorders). In these cases, it’s often best to delay circumcision. 

How common is circumcision?

Circumcision rates vary widely depending on location. Almost 40% of the world’s male population is circumcised. But there are huge variations across different countries. In the Philippines and Indonesia, over 90% of males are circumcised. But in Poland and Honduras, that number is under 1%.

In the U.S., about 71% of males are circumcised, though rates in hospitalized babies have decreased in the past few decades. In the past 30 years, the rates of circumcision in hospitals decreased by about 10% in the U.S.

But there were some interesting regional differences. In the Northeast, rates remained constant over the 30 years. In the West, there was a more dramatic decrease of 37% during that time. The reason for this trend isn’t entirely clear. One possible reason is insurance coverage. Researchers found that if state Medicaid coverage doesn’t reimburse for circumcision, then the rates of routine hospital circumcision are about 24% lower compared with states that have Medicaid coverage. California, Oregon, and Washington are some of the states where Medicaid didn’t reimburse for circumcision during those years. So that may explain the geographic differences.

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Written by:

Karen Hovav, MD, FAAP

Karen Hovav, MD, FAAP, has more than 15 years of experience as an attending pediatrician in a variety of clinical settings. She has worked in a large academic center in an urban city, a small community hospital, a private practice, and an urgent care clinic.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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