Benefits and Risks of Circumcision

Major medical societies (AAP, ACOG, AAFP, CDC) conclude that the health benefits of newborn male circumcision outweigh the risks, but the benefits are not large enough to recommend routine universal circumcision. The decision is left to parents, weighing medical evidence alongside religious, cultural, and personal preferences, after unbiased counselling on both benefits and risks.

Potential benefits

• Urinary tract infection prevention: Circumcision reduces UTI risk, with the greatest impact in the first 1–2 years of life. First-year UTI rates are 0.1–0.2% in circumcised versus 0.7–1.4% in uncircumcised infants.
• HIV acquisition: It reduces heterosexual (vaginal-to-penile) HIV acquisition by 40–60% in high-prevalence settings; no protective association has been demonstrated in men who have sex with men.
• Other sexually transmitted infections: It reduces HPV infection and is mildly protective against HSV-2. No reduction in syphilis, gonorrhea, or chlamydia acquisition has been shown.
• Penile conditions: Circumcision is associated with a lower risk of invasive penile cancer and can reduce the risk of phimosis and balanitis.
• Sexual function: Available research does not appear to show an adverse effect on sexual function, sensitivity, or satisfaction, though existing studies have limitations.

Risks and possible complications

Newborn circumcision complication rates are low, commonly cited at 0.19–0.5%. Complication rates are substantially higher when circumcision is performed later in childhood or adulthood.

• Acute complications: Bleeding (the most common, under 0.1%), infection, penile injury, and inadequate or excessive tissue removal.
• Later complications: Adhesions, skin bridges, meatal stenosis, penile torsion, insufficient shaft skin, phimosis, and an unsatisfactory cosmetic appearance.
• Procedural pain: The procedure is painful, so adequate analgesia should always be used. A dorsal penile nerve block is preferred and is more effective than topical lidocaine/prilocaine; nonpharmacologic measures such as sucrose and positioning are not sufficient alone.
• Provider experience: Training and experience matter. Untrained providers have higher complication rates regardless of professional background.

A large systematic review of more than four million patients found an overall complication risk of approximately 3.84%, with therapeutic and older-childhood circumcisions driving higher rates. Infant nontherapeutic circumcision carried a substantially lower risk.

Every family should have the opportunity to ask questions and make an informed decision that is right for them.