One of the earliest decisions two parents make is whether to have their baby boy circumcised. It can be a fickle process, as people have yet to agree on the practice’s benefits and risks. But a new study hopes to quiet that controversy, arguing circumcision’s importance equals that of childhood vaccination.

The practice of severing a male’s foreskin has great historical roots in some cultures, and in many parts of the Western world it’s simply hygienic. But not everyone is onboard. Those who choose not to circumcise their children, or get circumcised themselves, tend to cite decreased sexual function and pleasure as their core motivators. The present researchers hope to change that mindset, finding that the benefits of circumcision outweigh the risks by a magnitude of 100 to 1.

What The Data Shows

Researchers from the University of Sydney and other U.S. institutions conducted a comprehensive review of all existing studies mentioning the word “circumcision” found in PubMed, the online library for all academic research. They scanned prior data, corrected for misrepresented numbers, and produced a robust picture of circumcision in the United States. Ultimately, they found opting out of circumcision not only offers no benefits in terms of pleasure; it actually ups the risk for complications, as half of all men will need to seek treatment for a condition related to their foreskin retention.

The American Academy of Pediatrics issued a policy statement in 2012 that upheld circumcision as a safe practice whose benefits outweighed its risks. By all accounts, snipping a strip of foreskin from an infant given local anesthesia should be widely accepted. But the truth is, not all male babies are circumcised. The latest data show 91 percent of white men are circumcised, 76 percent of black men, and 44 percent of Hispanic men.

In fact, the trend has declined over the last 30 years. A 2013 report from the Centers for Disease Control and Prevention states that in 32 years between 1979 and 2010, newborn circumcision rates fell from 64.5 percent to 58.3 percent. Coupled with the rates of circumcision in adult men, between the ages of 14 to 59, and after correcting for hospital under-reportage of circumcision rates, the present researchers found the unsettling trend that the practice was dwindling.

"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,” Brian Morris, professor emeritus in the School of Medical Sciences at the University of Sydney, said in a statement. “Delay puts the child's health at risk and will usually mean it will never happen."

Why The Data Shows It

Morris and his colleagues offered two reasons that prevalence is waning. The first concerns families for whom education about circumcision simply can’t reach. There are pockets around the country where knowledge and information about healthy practices haven’t penetrated yet, and the researchers suggest it’s among these groups — they single out Hispanics in their latest study — that contribute to a falling rate. The other concern is that 18 states don’t cover circumcision under Medicaid, producing an overall rate 24 percent lower. So even if the families did know their stuff, they wouldn’t be able to follow through.

The health risks are great. Morris and his co-researcher Dr. Thomas Wiswell found in a joint study last year that uncircumcised newborns face a 50/50 chance of contracting a urinary tract infection (UTI) — a risk that stays with uncircumcised males throughout their lifetime at a one-third risk in adulthood.

And to assuage doubts that circumcised men risk decreased sexual function or pleasure, Morris teamed up with University of Washington physician, Dr. John Krieger in a separate study last year. In that investigation, the team collected data on 40,473 men, split evenly among the two conditions, and found, despite a 0.2 percent complication rate (in the form of mild infections or bleeding), no evidence that circumcision reduces sexual function, sensitivity, sexual sensation, or satisfaction.

To the researchers, the story couldn’t be clearer: Circumcision can only be helpful. “As with vaccination,” they explained, “circumcision of newborn boys should be part of public health policies. Campaigns should prioritize population subgroups with lower circumcision prevalence and a higher burden of diseases that can be ameliorated by circumcision.”

 

Source: Morris B, Bailis S, Wiswell T. Circumcision Rates in the United States: Rising or Falling? What Effect Might the New Affirmative Pediatric Policy Statement Have? Mayo Clinic Proceedings. 2014.