In regard to male circumcision, health care professionals tend to remain on the fence when it comes to parental recommendations. The fact and fiction surrounding the practice of removing some or all of the foreskin from a penis has been met with uncertainty due to conflicting research and religious traditions. From its impact on sexual function to possible mental health implications, expecting parents may find it hard to make a final decision on circumcising their infant. 

“Circumcision is a safe procedure, but it is a surgical procedure and care must be taken,” Dr. Carey Chronis, author of Dr. Carey's Baby Care: First Year Baby Care Guide, told Medical Daily in an email, adding: “The two major risks are typical of any procedure where skin is cut, namely, bleeding and infection. With proper care and periodic inspection, this should not be an issue. Two major benefits of circumcision are the ease in cleanliness and a slightly lower chance of urinary tract infections. Although benefits exist, they are minimal and are usually not the deciding factor for having a child circumcised.”

Let's clear up some of the myths and realities facing male circumcision by discussing five things you may or may not know about the procedure:

1. Lowers STD Risk

Although research in the past has shown that circumcision can reduce the risk of contracting the human immunodeficiency virus (HIV) in men by 50 to 60 percent, the exact cause has not been well understood. A recent study conducted at the Translational Genomics Research Institute revealed that removing the foreskin from a penis can change the bacterial community known as the “microbiome,” leading to improved protection against the HIV infection. TGRI researchers based the study on 156 men in Uganda who were circumcised as adults and reported back a year after the procedure when bacteria amounts had dropped by 33.3 percent. A specific type of bacteria reduced by circumcision was found to activate Langerhans cell in the foreskin. Although Langerhans cells are known as the body’s first line of defense, when activated, they can actually enable HIV transmission by binding the virus to CD4 and T cells — cells that are specifically targeted by HIV.

2. Lowers Prostate Cancer Risk

Researchers from the University of Quebec’s INRS-Institut Armand-Frappier in Montreal have found that on top of STI protection, circumcision may also protect a man against the risk of developing prostate cancer. The study, following up on research surrounding lower rates of prostate cancer among Muslim and Jewish men in the West, was based on interviews from 3,208 men (1,590 of which had been diagnosed with prostate cancer). Compared to uncircumcised men, those who were circumcised as infants were 14 percent less likely to develop prostate cancer. Surprisingly, men who were circumcised later in life were 45 percent less likely to be diagnosed with prostate cancer compared to uncircumcised men.

3. Risk Grows With Age And Personal Choice

Possible risk factors associated with circumcision such as bleeding, infection, excessive skin removal, difficulty urinating, and scarring seem to become more common with age. This is why many physicians urge parents to have the procedure done early if they are planning to have it done at all. A study out of the Institute for Health Metrics and Evaluation at the University of Washington took into account literature reviews and medical billing codes of over 1.4 million males. Findings revealed that boys between the ages of 1 and 10 were 10 to 20 times more likely to suffer adverse health concerns as a result of circumcision compared to boys under the age of 1. Common risks of a late circumcision among boys in the study included damage to the urethra and too much foreskin left behind.  

4. There Is Some Pain Involved With The Procedure

While circumcision is generally regarded as a quick and easy procedure, that does not mean the infant will be free from any pain. In circumcisions that are done without pain relieving medication such as analgesia or lidocaine, babies can experience changes in heart rate, blood pressure, oxygen levels, behavior, and cortisol levels. This is why many doctors recommend analgesia, a mixture of local anesthetics, or a numbing injection like lidocaine to reduce the amount of pain the infant experiences before and after the procedure.

“Personal preference is often the main deciding factor,” Carey added. “The procedure is very quick, usually taking about five minutes. Although many options are available for pain control, typically, lidocaine is injected at the base of the penis to numb the area before performing the procedure. After the circumcision, most babies appear not to exhibit significant levels of discomfort. In the rare instance that your baby is more fussy than usual following the procedure, some acetaminophen can be given as directed by your physician. Once circumcised, healing usually takes one week.”

5. Mental Health Implications

A preliminary investigation surrounding the trauma experienced by infants who undergo a circumcision has revealed a possible link to alexithymia, difficulty identifying and expressing feelings. Researchers issued the Toronto Twenty-Item Alexithymia Scale checklist to 300 men who also filled out personal history questionnaires. Compared to uncircumcised men, men who were circumcised scored 19.9 percent higher on the alexithymia scale and had a higher prevalence of two of the three alexithymia factors, most notably difficulty identifying feelings and difficulty describing feelings.

“The act of a boy being separated from his primary attachment figures, his four limbs restrained, his penis forcibly handled and then enduring excruciating pain can certainly cause psychological and sexual trauma to a boy,” Laurie A. Couture, licensed mental health counselor and author of Instead of Medicating and Punishing, told Medical Daily in an email, adding:

Unfortunately, this trauma will almost always be unconscious, as most medical circumcisions occur when a child is pre-verbal, putting him at risk for alexithymia. Circumcision disrupts secure mother-son attachment, as the child's mother is not available to respond to her child's cries of distress. Many boys are so distressed by the procedure that they dissociate and fall asleep. Circumcision also violates a non-consenting child's body with an invasive procedure that is often done for little more than tradition and parental cosmetic preferences. The practice has the implication of shaming boys and their natural penises which could lead to low self esteem, body image issues, self hatred or even self harm.