Questions about Circumcision and the Foreskin

What is circumcision?

Circumcision is the surgical removal of the foreskin, the natural covering of the glans (head) of the penis. In one common method, the doctor inserts a metal instrument under the foreskin to tear it from the glans, slits the foreskin, and inserts a circumcision device. The foreskin is then crushed with the device and cut away with a scalpel or scissors. You can view pictures or videos of a circumcision online to understand what the surgery entails.

What is the foreskin?

In the intact (non-circumcised) penis, the glans is covered by a double-layered fold of skin and mucous membrane called the foreskin. The foreskin is a normal part of male anatomy, and is an integral part of the skin system of the penis, not something extra. It contains large numbers of nerves and blood vessels, and a thin layer of muscle. The adult foreskin is roughly the size of a 3x5 index card, and makes up about half the skin the penis is naturally designed to have. With the foreskin, the skin covering the penis is very mobile, and can easily move back and forth over the glans and shaft of the penis.

What does the foreskin do?

First, the foreskin is erogenous tissue, with dense concentrations of sexually sensitive nerve endings. Second, the foreskin protects the glans from abrasion, irritation, and foreign material, keeping it soft, moist, and comfortable throughout life. It also protects the delicate urinary opening. Third, the foreskin provides sufficient skin length to accommodate penis growth and to allow for comfortable erections. Fourth, the foreskin allows for a gliding action with the motions of intercourse and helps retain natural sexual lubrication. By reducing friction in these ways, the foreskin makes sex more comfortable for both partners.

Circumcision alters all of these functions. A baby boy will one day grow up to be a man, with his own preferences about how his body works, so it is important to consider the purposes of the foreskin when deciding about circumcision. Diagrams of the foreskin and how it works can be found at www.cirp.org/pages/anat

How common is circumcision?

Circumcision is rare in most of the world, including Canada, Australia, Europe, Asia, and South America. Most men in the world are intact (~75%). In the U.S., circumcision rates were as high as 90% during the 1970s, but have since been decreasing. Currently, about 55% of American baby boys are circumcised, with lower rates on the West Coast and higher rates in the Midwest.

How did circumcision start in the US?

Non-religious circumcision was introduced in the late 19th century during the sexually repressive Victorian Era, in the English-speaking countries only. At that time, the causes of disease were not well understood and few effective treatments were available. Some influential doctors believed that masturbation was the cause of many mental and physical ailments, and circumcision was promoted as the 'cure'. Circumcision rates in the U.S. gradually increased during the early 20th century, but it was not until after World War II that the majority of American boys were circumcised.

Are there medical benefits?

Most physicians feel there is no compelling medical reason to circumcise newborns. Some studies indicate that circumcision may provide a benefit on occasion, such as reducing the already low chance of an infant developing a urinary tract infection, or possibly reducing the risk of certain sexually transmitted diseases, including HIV. However, other studies show no health difference between circumcised and intact males. In any case, only a small minority of boys might ever experience a benefit from circumcision, and these conditions can be prevented or treated without surgery. Practicing safe sex is always necessary whether one is circumcised or not.

For these reasons, no medical organization in the world recommends circumcision for all males - and some advise against it. Medical organizations consider newborn circumcision to be an elective and non-essential procedure.

Is circumcision painful?

Yes. Because of the sensitivity of the foreskin and the steps required to remove it, newborn circumcision is very painful. Pain in the newborn period has been shown to have long-term neurological effects. According to the American Academy of Pediatrics, if circumcision is chosen, it is vital that pain relief be provided. However, circumcisions are still sometimes performed without adequate pain relief. Even when anesthesia is used, studies show that it may only reduce the pain of circumcision, but is not guaranteed to eliminate it.

Can there be complications?

Yes. While circumcision is generally considered safe if performed by an experienced medical professional, as with any surgical procedure, complications can and do occur. While most complications are minor, some can be serious. The true rate of complications is not known because there is no national system for collecting this data. However, the following problems have been documented: pain, infection, excessive bleeding, removing too much skin, need for repeat surgery (1%), problems with the start of breastfeeding, buried penis, adhesions between the glans and remaining foreskin (15-30%), meatal stenosis (scarring of the urinary opening, 7-10%), damage to other parts of the penis, and in rare cases, loss of part or all of the penis, and death.

However, the risks of the procedure should not be confused with the guaranteed consequences. Every circumcision results in the loss of a normal and functional body part.

Is circumcision ethical?

Newborn circumcision is performed without the child's consent. Because it is not possible to accurately predict what a boy would want for himself if given the choice, this raises ethical concerns. Since circumcision results in the permanent loss of healthy, functional tissue and is medically unnecessary, a number of medical organizations now suggest that parents consider letting the boy make his own decisions about circumcision once he is an adult.

Shouldn't a boy look like his family members or peers?

Parents may be concerned that a boy, if not circumcised, will feel uncomfortable being 'different' from a circumcised father, brothers, or friends. However, many circumcised fathers are raising intact sons, and many families with circumcised sons have chosen to leave younger brothers intact, without any feelings of awkwardness in either father or sons. Circumcision is becoming less common in America, so intact boys will soon no longer be in the minority in settings with peers.

Part of parenting is helping children learn to accept individual differences and develop healthy self-esteem. The most important thing is for parents to teach their children to appreciate and feel good about their bodies as they are.

What about religion?

Even religious circumcision deserves careful, informed consideration. Remember that a baby boy will one day be an adult, with his own spiritual beliefs, which may not be the same as his parents'.

Circumcision is not a part of Christianity. The following passages in the New Testament state that circumcision has no spiritual value and should no longer be practiced: Acts 15:1-31, I Corinthians 7:18-20, Galatians 5:6, Galatians 6:15, and Colossians 3:11. More information is available at: www.CatholicsAgainstCircumcision.org and www.Acts15.net

Circumcision has long been practiced by Jews and Muslims. However, increasing numbers of parents from both these religions are reconsidering circumcision. More information is available at: www.JewishCircumcision.org and www.quranicpath.com/misconceptions/circumcision.html.

What about hygiene?

Circumcision does not make the penis any cleaner or healthier. Contrary to myth, hygiene is simple and easy for intact men. Good hygiene through normal bathing is necessary for all males, whether they are circumcised or not.

How do I care for my son's intact penis?

A boy's intact penis needs very little care. The best advice is to simply leave it alone.

At birth, the inner foreskin is normally fused to the glans. As the child develops, the foreskin naturally separates from the glans and its opening becomes looser, allowing it to be retractable. It is normal for these changes to continue into adolescence and the process does not need to be rushed.

A child's foreskin should never be forcibly retracted. Trying to retract the foreskin before it has naturally separated can cause pain, bleeding, infection, adhesions, and scarring. The first person to retract a boy's foreskin should be the boy himself.

Before the foreskin is retractable, cleaning under it is not needed. Simply wash the outside of the penis. Once the foreskin is retractable, you can easily teach your son to clean his penis using the 'Three Rs' as a guide: In the tub or shower, have him occasionally Retract the foreskin, Rinse with warm water, and Replace the foreskin back over the glans.

If you have medical concerns, seek out a pediatrician who has a good understanding of foreskin development and care.

How can I learn more?

See the following web sites for more information about circumcision and the foreskin.