Circumcision benefits far outweigh risks

In the United States the rate of circumcision in men has increased to 81% over the past decade. In an important new study just published in advance in Mayo Clinic Proceedings authors from Australia and the United States have shown that the benefits of infant male circumcision to health exceed the risks by over 100 to 1. Brian Morris, Professor Emeritus in the School of Medical Sciences at the University of Sydney and his colleagues in Florida and Minnesota found that over their lifetime half of uncircumcised males will contract an adverse medical condition caused by their foreskin.

Whereas circumcision rates have risen in white men to 91%, in black men to 76%, and in Hispanic men to 44%, the study authors found an alarming decrease in infants. To get the true figures they had to correct hospital discharge data for underreporting. This showed that circumcision had declined from a high of 83% in the 1960s to 77% today.

There seemed to be two major reasons for the fall.

One is a result of demographic changes, with the rise in the Hispanic population. Hispanic families tend to be less familiar with the custom, making them less likely to circumcise their baby boys.

The other is the current absence of Medicaid coverage for the poor in 18 US states. In those states circumcision is 24% lower.

Professor Morris stated, “The new findings now show that infant circumcision should be regarded as equivalent to childhood vaccination and that as such it would be unethical not to routinely offer parents circumcision for their baby boy. Delay puts the child’s health at risk and will usually mean it will never happen.”

In infancy the strongest immediate benefit is protection against urinary tract infections (UTIs) that can damage the kidney in half of babies who get a UTI. Morris and co-investigator Tom Wiswell, MD, Center for Neonatal Care, Orlando, showed last year that over the lifetime UTIs affect 1 in 3 uncircumcised males.

In a landmark systematic review, Morris, with John Krieger, MD, Department of Urology, University of Washington, Seattle, showed that there is no adverse effect of circumcision on sexual function, sensitivity, or pleasure. This helped dispel one myth perpetuated by opponents of the procedure.

Taken together, the new findings should send a strong message to medical practitioners, professional bodies, educators, policy makers, governments, and insurers to promote this safe, simple procedure, best done in infancy under local anesthesia and to increase access and third party coverage, especially for poor families, who tend to suffer most from foreskin-related diseases. Infant circumcision has, moreover, been shown to be cost saving.