Medical Benefits from Circumcision

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Circumcision should be offered ‘like vaccines’ to the parents of baby boys, new study :

It reduces the risk of heterosexually acquired HIV infection in men by approximately 60%.

American Academy of Pediatrics: Benefits of Circumcision Outweigh Risks

Medical Benefits from Circumcision
by Dr. Brian J. Morris
from Circ-Online

Circumcision has historically been a topic of emotive and often irrational debate. At least part of the reason is that a sex organ is involved. (Compare, for example, ear piercing.) During the past two decades the medical profession have tended to advise parents not to circumcise their baby boys. In fact there have even been reports of harrassment by medical professionals of new mothers, especially those belonging to religious groups that practice circumcision, in an attempt to stop them having this procedure carried out. Such attitudes are a far cry from the situation years ago when baby boys were circumcised routinely in Australia. But over the past 20 years the rate has declined to as low as 10%.

However, a reversal of this trend is starting to occur. In the light of an increasing volume of medical scientific evidence (many publications cited below) pointing to the benefits of neonatal circumcision a new policy statement was formulated by a working party of the Australian College of Paediatrics in August 1995 and adopted by the College in May 1996 [2] . In this document medical practitioners are now urged to fully inform parents of the benefits of having their male children circumcised. Similar recommendations were made recently by the Canadian Paediatric Society who also conducted an evaluation of the literature, although concluded that the benefits and harms were very evenly balanced. As discussed below the American College of Pediatrics has moved far closer to an advocacy position.

In the present article I would like to focus principally on the protection afforded by circumcision against infections, including sexually transmitted diseases (STDs). I might add that I am a university academic who teaches medical and science students and who does medical research, including that involving genital cancer virology. I am not Jewish, nor a medical practitioner or lawyer, so have no religious bias or medico-legal concerns that might get in the way of a rational discussion of this issue.

The increased risk of infection may be a consequence of the fact that the foreskin presents the penis with a larger surface area, the moist skin under it represents a thinner epidermal barrier than the drier, more cornified skin of the circumcised penis, the presence of a prepuce is likely to result in greater microtrauma during sexual intercourse and, as one might expect, the warm, moist mucosal environment under the foreskin favours growth of micro-organisms.

In the 1950s and 60s 90% of boys in the USA and Australia were circumcised soon after birth. The major benefits at that time were seen as improved lifetime genital hygiene, elimination of phimosis (inability to retract the foreskin) and prevention of penile cancer. The trend not to circumcise started about 20 years ago, after the American Academy of Paediatrics Committee for the Newborn stated, in 1971, that there are ?no valid medical indications for circumcision?. In 1975 this was modified to ?no absolute valid ... ?, which remained in the 1983 statement, but in 1989 it changed significantly to ?New evidence has suggested possible medical benefits ...? [49] .

Dr Edgar Schoen, Chairman of the Task Force on Circumcision of the American Academy of Pediatrics, has stated that the benefits of routine circumcision of newborns as a preventative health measure far exceed the risks of the procedure [48] . During the period 1985-92 there was an increase in the frequency of postnewborn circumcision and during that time Schoen points out that the association of lack of circumcision and urinary tract infection has moved from ?suggestive? to ?conclusive? [48] . At the same time associations with other infectious agents, including HIV, have been demonstrated. In fact he goes on to say that ?Current newborn circumcision may be considered a preventative health measure analogous to immunization in that side effects and complications are immediate and usually minor, but benefits accrue for a lifetime? [48] .

Benefits included: a decrease in physical problems such as phimosis [36] , reduction in balanitis (inflammation of the glans, the head of the penis) [17] , reduced urinary tract infections, fewer problems with erections at puberty, decreased sexually transmitted diseases (STDs), elimination of penile cancer in middle-aged men and, in addition, in older men, a decrease in urological problems and infections [reviewed in: 2, 18, 30, 44, 47, 49]. Therefore the benefits are different at different ages.

Neonatologists only see the problems of the operation itself. However, urologists who deal with the problems of uncircumcised men cannot understand why all newborns are not circumcised [47, 48] . The demand for circumcision later in childhood has increased, but, with age, problems, such as anaesthetic risk, are higher. Thus Schoen states ?Current evidence concerning the life-time medical benefit of newborn circumcision favours an affirmative choice? [48] .

In a letter written by Dr Schoen to Dr Terry Russell in Brisbane in 1994 Schoen derides an organization known as ?NOCIRC? for their use of ?distortions, anecdotes and testimonials to try to influence professional and legislative bodies and the public, stating that in the past few years they have become increasingly desperate and outrageous as the medical literature has documented the benefits. For example they have compared circumcision with female genital mutilation, which is equivalent to cutting off the penis. In 1993 the rate of circumcision had risen to 80% in the USA and Schoen suggests that ?Perhaps NOCIRC has decided to export their ?message? to Australia since their efforts are proving increasingly futile in the US?. He also noted that when Chairman of the Task Force his committee was bombarded with inaccurate and misleading communications from this group. Another of these groups is ?UNCIRC?, which promotes procedures to reverse circumcision, by, for example, stretching the loose skin on the shaft of the retracted penis. Claimed benefits of ?increased sensitivity? in reality appear to be a result of the friction of the foreskin, whether intact or newly created, on the moist or sweaty glans and undersurface of the prepuce in the unaroused state and would obviously in the ?re-uncircumcised? penis have nothing to do with an increase in touch receptors. The sensitivity during sexual intercourse is in fact identical, according to men circumcised as adults.

Another respected authority is Dr Tom Wiswell, who states ?As a pediatrician and neonatologist, I am a child advocate and try to do what is best for children. For many years I was an outspoken opponent of circumcision ... I have gradually changed my opinion? [56, 57] . This ability to keep an open mind on the issue and to make a sound judgement on the balance of all available information is to his credit ? he did change his mind!

The complication rates of having or not having the procedure have been examined. Amongst 136,000 boys born in US army hospitals between 1980 and 1985, 100,000 were circumcised and 193 (0.19%) had complications, with no deaths [58] . Of the 36,000 who were not circumcised the complication rate was 0.24% and there were 2 deaths [58] . In 1989 of the 11,000 circumcisions performed at New York?s Sloane Hospital, only 6 led to complications, none of which were fatal [44] . Also no adverse psychological aftermath has been demonstrated [46] . Cortisol levels have registered an increase during and shortly after the procedure, indicating that the baby is not unaware of the procedure in its unanaesthetized state and one has to weigh up the need to inflict this short term pain in the context of a lifetime of gain from prevention or reduction of subsequent problems. Anaesthetic creams and other means appear to be at least partially effective in reducing trauma and some babies show no signs of distress at all when the procedure is performed without anaesthetic.

The proponents of not circumcising nevertheless stress that lifelong penile hygiene is required. This acknowledges that something harmful or unpleasant is happening under the prepuce. Moreover, a study of British schoolboys found that penile hygiene does not exist [44] . Furthermore, Dr Terry Russell, writing in the Medical Observer states ?What man after a night of passion is going to perform penile hygiene before rolling over and snoring the night away (with pathogenic organisms multiplying in the warm moist environment under the prepuce)? [44] .

The reasons for circumcision, at least in a survey carried out as part of a study at Sydney Hospital, were: 3% for religious reasons, 1-2% for medical, with the remainder presumably being ?to be like dad? or a preference of one or both parents for whatever reason [16] . The actual proportion of men who were circumcised when examined at this clinic was 62%. Of those studied, 95% were Caucasian, with younger men just as likely to be circumcised as older men. In Adelaide a similar proportion has been noted, with 55% of younger men being circumcised. In Britain, however, the rate is only 7-10%, much like Europe, and in the USA, as indicated above, the rate of circumcision has always been high [16] .

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Neonatal urinary tract infections

A study by Wiswell of 400,000 newborns over the period 1975-84 found that the uncircumcised had an 11-fold higher incidence of urinary tract infections (UTIs) [58] . During this decade the frequency of circumcision in the USA decreased from 84% to 74% and this decrease was associated with an increase in rate of UTI [61] . UTI was lower in circumcised, but higher in uncircumcised. In a 1982 series 95% of UTI cases were in uncircumcised [60] . A study by Roberts in 1986 found that 4% of uncircumcised boys got UTI, compared with 0.4% of girls and 0.2% of circumcised boys [42] . This indicated a 20-fold higher risk for uncircumcised boys. In a 1993 study by Wiswell of 200,000 infants born between 1985 and 1990, 1000 got UTI in their first year of life [59] . The number was equal for boys and girls, but was 10-times higher for uncircumcised boys. Of these 23% had bacteraemia. The infection can travel up the urinary tract to affect the kidney and higher rate of problems such as pyelonephritis is seen in uncircumcised children [43, 52] . These and other reports [e.g., 21, 43, 52] all point to the benefits of circumcision in reducing UTI.

Indeed, Wiswell performed a meta-analysis of all 9 previous studies and found that every one indicated an increase in UTI in the uncircumcised [59] . The average was 12-fold higher and the range was 5 to 89-fold, with 95% confidence intervals of 11-14 [59] . Meta-analyses by others have reached similar conclusions. Other studies, including one of men with an average age of 30 years, have indicated that circumcision also reduces UTI in adulthood [51] . The fact that the bacterium E. coli , which is pathogenic to the urinary tract, has been shown to be capable of adhering to the foreskin, satisfies one of the criteria for causality [52, 62, and refs in 18]. Since the absolute risk of UTI in uncircumcised boys is approx. 1 in 25 (0.05) and in circumcised boys is 1 in 500 (0.002), the absolute risk reduction is 0.048. Thus 20 baby boys need to be circumcised to prevent one UTI. However, the potential seriousness and pain of UTI, which can in rare cases even lead to death, should weigh heavily on the minds of parents. The complications of UTI that can lead to death are: kidney failure, meningitis and infection of bone marrow. The data thus show that much suffering has resulted from leaving the foreskin intact. Lifelong genital hygiene in an attempt to reduce such infections is also part of the price that would have to be paid if the foreskin were to be retained. However, given the difficulty in keeping bacteria at bay in this part of the body [38, 48] , not performing circumcision would appear to be far less effective than having it done in the first instance [48] .

Sexually-transmitted diseases

Early studies showed higher rates of gonococcal and nonspecific urethritis in uncircumcised men [39, 48] . Recent studies have yielded similar findings. In addition, the earlier work showed higher chancroid, syphilis, papillomavirus and herpes [53] . However, there were methodological problems with the design of these studies, leading to criticisms. As a result there is still no overwhelming agreement. In 1947 a study of 1300 consecutive patients in a Canadian Army unit showed that being uncircumcised was associated with a 9-fold higher risk of syphilis and 3-times more gonorrhea [55] . At the University of Western Australia a 1983 study showed twice as much herpes and gonorrhea, 5-times more candidiasis and 5-fold greater incidence of syphilis [39] . In South Australia a study in 1992 showed that uncircumcised men had more chlamidia (odds ratio 1.3) and gonoccocal infections (odds ratio 2.1). Similarly in 1988 a study in Seattle of 2,800 heterosexual men reported higher syphilis and gonnorrhea in uncircumcised men, but no difference in herpes, chlamidia and non-specific urethritis (NSU). Like this report, a study in 1994 in the USA, found higher gonnorhea and syphilis, but no difference in other common STDs [12] . In the same year Dr Basil Donovan and associates reported the results of a study of 300 consecutive heterosexual male patients attending Sydney STD Centre at Sydney Hospital [16] . They found no difference in genital herpes, seropositivity for HSV-2, genital warts and NSU. As mentioned above, 62% were circumcised and the two groups had a similar age, number of partners and education. Gonorrhea, syphilis and hepatitis B were too uncommon in this Sydney study for them to conclude anything about these. Thus on the bulk of evidence it would seem that at least some STDs may be more common in the uncircumcised, but this conclusion is by no means absolute and the incidence may be influenced by factors such as the degree of genital hygiene, availability of running water and socioeconomic group being studied.

Cancer of the penis

The incidence of penile cancer in the USA is 1 per 100,000 men per year (i.e., 750-1000 cases annually) and mortality rate is 25-33% [27, 31] . It represents approximately 1% of all malignancies in men in the USA. This data has to be viewed, moreover, in the context of the high proportion of circumcised men in the USA, especially in older age groups, and the age group affected, where older men represent only a portion of the total male population. In a study in Melbourne published in Australasian Radiology in 1990, although 60% of affected men were over 60 years of age, 40% were under 60 [45] . In 5 major series in the USA since 1932, not one man with penile cancer had been circumcised neonatally [31] , i.e., this disease only occurs in uncircumcised men and, less commonly, in those circumcised after the newborn period. The proportion of penile malignancies as a fraction of total cancers in uncircumcised men would thus be considerable. The predicted life-time risk has been estimated as 1 in 600 in the USA and 1 in 900 in Denmark [27] . In under-developed countries the incidence is higher: approx. 3-6 cases per 100,000 per year [27] .

The so-called ?high-risk? papillomavirus types 16 and 18 (HPV 16/18) are found in a large proportion of cases and there is good reason to suspect that they are involved in the causation of this cancer, as is true for most cases of cervical cancer (see below). HPV 16 and 18 are, moreover, more common in uncircumcised males [35] . These types of HPV produce flat warts that are normally only visible by application of dilute acetic acid (vinegar) to the penis and the data on high-risk HPVs should not be confused with the incidence figures for genital warts, which although large and readily visible, are caused by the relatively benign HPV types 6 and 11. Other factors, such as poor hygiene and other STDs have been suspected as contributing to penile cancer as well [8, 31] .

In Australia between 1960 and 1966 there were 78 deaths from cancer of the penis and 2 from circumcision. (Circumcision fatalities these days are virtually unknown.) At the Peter McCallum Cancer Institute 102 cases of penile cancer were seen between 1954 and 1984, with twice as many in the latter decade compared with the first. Moreover, several authors have linked the rising incidence of penile cancer to a decrease in the number of neonatal circumcisions [13, 45] . It would thus seem that ?prevention by circumcision in infancy is the best policy?.

Cervical cancer in female partners of uncircumcised men

A number of studies have documented higher rates of cervical cancer in women who have had one or more male sexual partners who were uncircumcised. These studies have to be looked at critically, however, to see to what extent cultural and other influences might be contributing in groups with different circumcision practices. In a study of 5000 cervical and 300 penile cancer cases in Madras between 1982 and 1990 the incidence was low amongst Muslim women, when compared with Hindu and Christian, and was not seen at all in Muslim men [22] . In a case-control study of 1107 Indian women with cervical cancer, sex with uncircumcised men or those circumcised after the age of 1 year was reported in 1993 to be associated with a 4-fold higher risk of cervical cancer, after controlling for factors such as age, age of first intercourse and education [1] . Another study published in 1993 concerning various types of cancer in the Valley of Kashmir concluded that universal male circumcision in the majority community was responsible for the low rate of cervical cancer compared with the rest of India [14] . In Israel, a 1994 report of 4 groups of women aged 17-60 found that gynaecologically healthy Moshav residents had no HPV 16/18, whereas healthy Kibbutz residents had a 1.8% incidence [24] . Amongst those with gynaecological complaints HPV 16/18 was found in 9% of Jewish and 12% of non-Jewish women. HPV types 16 and 18 cause penile intraepithelial neoplasia (PIN) and a study published in the New England Journal of Medicine in 1987 found that women with cervical cancer were more likely to have partners with PIN, the male equivalent of cervical intraepithelial neoplasia (CIN) [6] . Thus the epidemic of cervical cancer in Australia, and indeed most countries in the world, would appear to be due at least in part to the uncircumcised male and would therefore be expected to get even worse as the large proportion that were born in the past 10-20 years and not circumcised reach sexual maturity.

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AIDS virus

In the USA the estimated risk of HIV per heterosexual exposure is 1 in 10,000 to 1 in 100,000. If one partner is HIV positive and otherwise healthy then a single act of unprotected vaginal sex carries a 1 in 300 risk for a woman and as low as a 1 in 1000 risk for a man [9] . (The rates are very much higher for unprotected anal sex and intravenous injection). In Africa, however, the rate of HIV infection is up to 10% in some cities. (A possible reason for this big difference will be discussed later.) In Nairobi it was first noticed that among 340 men being treated for STDs they were 3-times as likely to be HIV positive if they had genital ulcers or were uncircumcised (11% of these men had HIV) [50] . Subsequently another report showed that amongst 409 African ethnic groups spread over 37 countries the geographical distribution of circumcision practices indicated a correlation of lack of circumcision and high incidence of AIDS [7] . In 1990 Moses in International Journal of Epidemiology reported that amongst 700 African societies involving 140 locations and 41 countries there was a considerably lower incidence of HIV in those localities where circumcision was practiced [33, 34] . Truck drivers, who generally exhibit more frequent prostitute contact, have shown a higher rate of HIV if uncircumcised. Interestingly, in a West African setting, men who were circumcised but had residual foreskin were more likely to be HIV-2 positive than those in whom circumcision was complete [40] .

Of 26 cross-sectional studies, 18 have reported statistically significant association [e.g., 15, 23, 25, 54], by univariate and multivariate analysis, between the presence of the foreskin and HIV infection, and 4 reported a trend. The findings have, moreover, led various workers such as Moses and Caldwell to propose that circumcision be used as an important intervention strategy in order to reduce AIDS [9, 19, 23, 26, 32-34].

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Male circumcision - the Islamic View

Male infants, worldwide, are circumcised for various social, religious and/or medical reasons.

Generally, the ritual of circumcision is traced back to the time of the greatest of prophets Ibraheem (peace be upon him) when Allah commanded him to circumcise himself, his son Ishmael and all his male family members, and he followed Allah's order.

Today Muslims are the largest religious nation to circumcise their male offspring. This ritual shows their belonging and closeness to their spiritual ancestor and the physical forefather, Prophet Ibraheem (peace be upon him).

Because circumcision was also practised by all prophets, traditionally it has been in practice throughout the history among the followers of Prophet Ibraheem and establishes an Islamic connection to the ritual.

Allah ordered the Prophet Muhammad (peace be upon him) to follow the religion of Ibraheem (peace be upon him). Allah says in the Holy Qur'an:

"Then We inspired you: 'Follow the religion of Ibraheem, the upright in Faith'." [The Holy Qur'an 16:123]

And an important part of the religion of Ibrahim is circumcision.

The Prophet Ibraheem showed by his actions that he completely sumbitted himself to God's will, and encouraged his family and household members to obey Allah's commands without fail.

The Prophet Muhammad (peace be upon him) said: "The Prophet Ibrahim circumcised himself when he was eighty years old." [Related by Al-Bukhari, Muslim & Ahmad]

But unlike the Jewish tradition, in Islam circumcision is not a symbol of Allah's covenant with humans.

The Holy Qur'an does not impose an obligation on parents to circumcise their children, but the prophet Mohammed is reported to have stated that "Circumcision is a sunnah (customary or traditional) for the men. Most references to male circumcision occur in the examples and traditions of the Prophet (peace be upon him). Therefore the scholars strongly recommend circumcision for male.

From this point of view, traditionally, adult male converts to Islam are encouraged to undergo the operation.

Furthermore, besides submission to the Will of God, male circumcision is an important ritual aimed at improving cleanliness. Therefore, in Arabic, circumcision is also known as tahara, meaning purification or cleanliness.

Islam strongly emphasises cleanliness and purification both spiritual and physical. The mental and spiritual purification cleanses the heart while the social and physical purification cleanses the body as in circumcision. It also indicate that circumcised males are regarded as more pure (clean).

Although circumcision is not one of the Five Pillars of the Faith, which consist of: the profession of faith, daily prayer, fasting at Ramadan, giving money to the poor (charity), and the pilgrimage to Mecca. However, this ritual is an act of purification and connects the person to the Prophet Ibraheem (peace be upon him) and his religion, Islam.

The Qur'an says: "Allah does not want to place burden on you. Rather, He wants to purify you and to complete His favours to you so that you may be grateful." [The Holy Qur'an 5:7]

The Hadith, the acts and the approvals of the Prophet Muhammad (peace be upon him) together constitute the Sunnah. This is the second source of Islamic Law.

God says in the Holy Qur'an: "Verily in the Messenger of Allah you have a good example for anyone whose hope is in Allah and the Last Day, and who engages much in the praise of Allah." [The Holy Qur'an 33:21]

A Hadith related by Bukhari reads: "The practices related to Fitrah (the nature) are five: circumcision, shaving the pubic hair, trimming the moustache, cutting the nails and removing the hair of the armpits."

In fact these are general practices that humans have discovered by instinct to be good for them with or without organized religion.

All the practices grouped under the fitrah
(The Natural Way) heading indicate a certain understanding of the importance of hygiene that would have been evident to people living in any age, even without the dictates of any religious philosophy.

Circumcision: a measure of protection against cancer
and the HIV infections

Circumcision, throughout history, has been thought to provide a measure of protection against infections of the foreskin. The surgical removal of the skin surrounding the head of the penis makes it easier to keep the penis clean because urine cannot get trapped there.

It is also a preventive measure against infection and diseases, becuase without circumcision excrements may collect under the foreskin which may lead to fatal diseases such as cancer. It's been suggested in modren studies that penile cancer and transmission of the HIV infection are less likely in circumcised men.

According to the Islamic tradition there is no fixed age for Muslim circumcision therefore it varies depending on family, region and country.

Hadith are reported indicating that the Prophet Muhammad’s grand sons, Hassan and Hussaiyn (peace be upon them) were circumcised on the seventh day after their birth and daughter of the Prophet Muhammad, Fatima (peace be upon them) herself is quoted talking about her sons’ circumcision on the seventh day after their birth.

Therefore, commonly, the preferred age considered is the seventh day after birth and can be as late as puberty. Though the medical profession has encouraged medical circumcisions in the first week after birth to reduce complications.

According to Muslim scholars the male convert should be circumcised, as this is part of the natural manners recommend in Islam. However, if circumcision would pose any health risks such as cause ing other complications or infections, it may be delayed until the person becomes more able to cope with it. In such situation the scholars refer to the example of Ibrahim (peace be upon him) who circumcised himself at the age of eighty.

Circumcision: according to the Bible

We read very clear instructions about circumcision in the present Bible, in the book of Genesis:
Abraham was 99 years old. God appeared to him and said, 'I am God Almighty. Walk before Me and be perfect. I may make you father of many nations. You shall be circumcised in the flesh of your foreskin. This shall be the mark of the covenant between Me and you. Abraham was 99 years old when he was circumcised on the flesh of his foreskin. His son Ishmael was thirteen years old when the flesh of his foreskin was circumcised. On that very day Abraham and his son Ishmael were circumcised. And all the males of his household. [Genesis, chapter 17]

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Absolute truth

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Medical Benefits

Reasons many parents choose circumcision

Research studies indicate that there are good medical reasons why your son should be circumcised. These include:

  • Circumcision substantially reduces an infantīs chances of getting a urinary tract infection (UTI) during the first year of his life. Although the rate of urinary tract infections for infants is not very high (around xxx %), UTIīs are becoming increasingly difficult to treat (see here for a discussion).
  • Cancer of the penis - that effects xxx men in a thousand - is essentially eliminated in circumcised males.
  • Research shows that males who are circumcised have a lower risk of getting sexually transmitted diseases (STDs). In addition, partners of circumcised males are less likely to contract vaginal infections (e.g. yeast infections).
  • Circumcision eliminates foreskin infections that occur throughout childhood.
  • Circumcision prevents phimosis, a narrow opening that makes it impossible to retract the foreskin at a later age.
  • Genital hygiene is easier after circumcision.
  • Circumcision virtually eliminates the accumulation of smegma.
1. E.J. Schoen et al., Report of the Task Force on Circumcision Pediatrics 1989; 84: 388-391

2. Canadian Medical Association Journal; March 1996: 154 (6)

3. Agarwal SS, Sehgal A, Sardana S, Kumar A, L uthra UK. Role of male behaviour in cervical carcinogenesis among women with one lifetime sexual partner. Cancer 1993; 72: 1666-9

Hygiene and Other Benefits from Circumcision

A study [1], performed over a period of ten years, on the factors affecting the reason why parents choose to circumcise their children has shown that hygiene is still the most common reason for choosing circumcision.

1. J.D. Tiemstra, Factors affecting the circumcision decision, J Am Board Fam Pract 19991; 12(1): 16-20. (for the abstract, see here)

2. Canadian Medical Association Journal; March 1996: 154 (6)

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Benefits of Circumcision
"Circumcision is the most commonly performed surgical procedure in the United States. As a pediatrician and neonatologist, I am a child advocate and try to do what is best for children. For many years I was an outspoken opponent of circumcision and believed there was no justification for its routine performance in the newborn. However, over the past four years I have gradually changed my opinion. Several factors have influenced this change.
There is irrefutable evidence that circumcised boys have far lower risk for urinary tract infections during infancy than their uncircumcised counterparts. In addition, circumcision leads to almost complete protection against penile carcinoma. Furthermore, important but controversial data show an apparent link between the state of uncircumcision and a higher risk for many of the sexually transmitted diseases."
Taken from:
T.E. Wiswell, MD, Do you favor routine neonatal circumcision? Yes., Postgrad. Med. 1988; 84: 98-104.

"... the benefits of circumcision accumulate over a lifetime and help to prevent numerous diseases, while the risks are immediate and generally short-term. My own views are that the long-term medical benefits are greater than the risks.
Taken from:
Richard M. Parker, MD, Pediatric Urologic Information Resources

"Circumcision is like a substantial and well-secured annuity; every year of life you draw the benefits. Parents cannot make a better paying investment for their little boys."
Taken from:
Dr. P.C. Remondino, The History of Circumcision, published in 1891.

"The lifetime health benefits of neonatal circumcision—including the long-known benefits of genital-hygiene improvement and prevention of local infection and penile cancer—far exceed the risks of the procedure. Circumcision prevents serious kidney infections, particularly in infancy; and there is strong evidence that it has a protective effect against some serious STDs, especially HIV infection, syphilis, and chancroid. A one-week-old circumcised boy has a significant health advantage over his uncircumcised contemporary. And being without a foreskin won't dent his sex life."
Taken from:
E.J. Schoen, MD, Is Circumcision Healthy? — Yes.

"The beneficial effects of newborn circumcision are multiple and cumulative during a lifetime. During the 1950s and 1960s, when 90% of US newborn boys were circumcised, major benefits of newborn circumcision were considered to be improved lifetime genital hygiene, elimination of phimosis, and the prevention of penile cancer. Currently, newborn circumcision may be considered a preventive health measure analogous to immunization in that the side effects and complications are immediate and usually minor, but benefits accrue for a lifetime.

The benefit of immunization is long-term, constant protection form disease. The multiple benefits of newborn circumcision vary with age. In infancy, circumcision protects against UTI [Urinary Tract Infections]; in the 3- to 5-year age group, local foreskin infection (balanoposthitis) is prevented; and at puberty, with onset of erections and sexual activity, problems of phimosis are prevented.

Circumcised men have improved genital hygiene during their lifetime. Uncircumcised young men are predisposed to certain sexually transmitted diseases, including HIV, and uncircumcised middle-aged men have propensity for penile cancer. In old age, uncircumcised men are not only more likely to contract penile cancer, but those with indwelling catheters have increased prevalence of local infection. Thus, the specific benefits of newborn circumcision depend on age; this fact explains the conflicting attitudes of medical professionals toward the procedure."
Taken from:
E.J. Schoen, MD, Circumcision Updated - Indicated? Pediatrics 1993; 92: 860-1.

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"... For at least the last 10 years I have been doing circumcision on request and recording the effects of all operations in a questionnaire. One would expect men circumcised for medical reasons to be satisfied with the improvement in their sex lives even if the operation was badly performed. In fact these men and their partners often said that their sex lives were better than before the trouble occurred. Equally one would expect patients circumcised for trivial reasons (e.g. long prepuce, smelly in the Summer) or who were done on the suggestion of someone else (e.g. shipping company, fiancée) to be more critical about the operation. In practice nearly all these patients and their partners found that their sex lives were improved by the operation. I have been surprised how many patients volunteered that they were more comfortable after circumcision even though they did not complain of discomfort before operation. Irrespective of whether circumcision was done to cure a problem or as a preventive measure no one has ever regretted having the operation, or found it has spoiled his sex life. My observations on the effects of circumcision in about 1,000 cases over the last 25 years have converted me from anti- to pro-circumcision.
Taken from:
J. Smith, MD, Circumcision: A Guide to a Decision
Article available online at ICIRC

"The question to be answered is; īdo the benefits [of circumcision] outweigh the risksī. When considering each factor in isolation there could be some difficulty in choosing. However, when viewed as a whole, in my opinion the answer to whether to circumcise a male baby is YES. ..." Taken from:
B.J. Morris, PhD, Medical Benefits from Circumcision
Paper available online:

It is our conclusion that, as the safest and most commonly performed surgical procedure in this country, the benefits of posthetomy, which include a reduction in some kinds of cancer and sexually transmitted diseases, well outweigh the risks cited by those who oppose it.
Taken from:
Gerald N. Weiss and E.B. Weiss, A Perspective on Controversies over Neonatal Circumcision, Clinical Pediatrics 1994: 33; 726-730.
Paper available online at ICIRC:

"The overwhelming evidence, therefore, leads to my conclusion that the common American practice of neonatal circumcision is an important prophylactic operation, even though the practice was not previously well founded."
Taken from:
James R. Roberts, MD, Neonatal Circumcision: An End to the Controversy?, Southern Med. J. 1996; 89: 167-170.

Absolute truth

لا إله إلا الله
Sexual Sensitivity and Dysfunction

"Clinical and neurologic testing has not detected differences in penile sensitivity between men who were circumcised and those who were not. I know of no data indicating that circumcised men have more long-term genital-related problems with either psychological, social, emotional, and sexual function of sexual pleasure."
Taken from:
T.E. Wiswell, MD, Circumcision Circumspection, New England J. of Med. 1997; 336: 1244-5.

Anti-Circumcision Activities

"The current anti-circumcision crusade can be attributed to a concatenation of factors old and new. From a phylogenic viewpoint the oldest of these factors is manīs high valuation of the genitals and the guilt-induced anxiety leading to a fear of genital injury. Since the individualīs dread of genital injury or castration is usually resolved by relegation to the unconscious, it may later emerge as a sincere effort to have every penis remain intact. Potentiating this primordial anxiety is a quite understandable backlash against the originally unscientific origins of circumcision and against the lavish claims that were made regarding the benefits accruing to those who underwent the procedure. Like all backlashes, the reaction has been excessive and the anti-circumcision camp now attempts to demolish fact as well as fancy. The analogy of throwing out the baby with the bath water was never more applicable."
Taken from:
R. Dagher, M.L. Selzer and J. Lapides, Carcinoma of the Penis and the Anti-Circumcision Crusade, J. of Urology 1973; 110: 79-80.

Absolute truth

لا إله إلا الله
"The anti-circumcision craze has developed because groups of conservative, sensitive, medically misinformed individuals, some with fanatical emotionalism, have not seen the consequences of a society where males are not circumcised. While medical prophylactic measures are readily accepted by our society, surgical prophylaxis is in danger of being discarded by an overemphasis on the return to the "natural". The intense pain of natural childbirth is seen as a reward while the minor discomfort, if any, of circumcision is magnified beyond reason."
Taken from:
G.N. Weiss, MD, Neonatal Circumcision Is Necessary,

"At the height of the anti-circumcision sentiment during the early 1980's formal groups opposed to the procedure were formed. These incude BUFF (Brotherhood United for Future Foreskins). INTACT (Infants Need To Avoid Circumcision Trauma), and the largest organization, NOCIRC (National Organization of Circumcision Information Resources Center). The latter group sends out a newsletter periodically to its members and to physicians. In addition, it has sponsored several symposia on circumcision. These latter meetings have been forums for anticircumcision advocates to vocalize their positions. Members of the anticircumcision movement generally refer to the procedure as "rape, butchering, amputation, or torture." During the past decade, the literature and letters I have received from these organizations have made many claims. These include: that circumcision encodes the brain with violence...which is why America is the "murder capital" of the world; that long-term effects of the procedure include suicide, sudden infant death syndrome, and homosexuality; that male circumcision should be considered equivalent to elective removal of the clitoris and labia in female children: that men without prepuces feel a loss, relive the violence, are not "whole" and have a "diminished penis"; that the loss of erotic tissue in the prepuce diminishes sexual pleasure and function; and that the reasons physicians advocate neonatal circumcision are twofold-to make money and to "pay back" for the pain they had when they were circumcised themselves. There is no scientific foundation for any of these claims or for the myriad other assertions of these organizations. The groups attempt to support their conjectures with a handful of testimonials."
Taken from:
T.E. Wiswell, Neonatal Circumcision: a Current Appraisal Focus & Opinion Pediat 1995; 2:93-9.

Absolute truth

لا إله إلا الله
Why are human males born with a foreskin?

Several authors have suggested that the prepuce functions to protect the glans penis from injury and irritations from ammoniacal urinary contents.1,3 ..The role of the prepuce in erection and sexual satisfaction is uncertain.4,13 Overall, it is fair to state the function of the prepuce has not been clearly defined.2,12

1. Gairdner D. The fate of the foreskin: A study of circumcision. BMJ. 1949;2:1433–7.
2. Oster J. The further fate of the foreskin. Arch Dis Child. 1968;43:200–3. [PMC free article]
3. Shahid SK. Phimosis in children. ISRN Urology. 2012;2012:707329.
4. McGregor TB, Pike JG, Leonard MP. Pathologic and physiologic phimosis: Approach to the phimotic foreskin. Can Fam Physician. 2007;53:445–8. [PMC free article] [PubMed]
12. Morris BJ, Wamal RG, Henebeng EB, et al. Estimation of country-specific and global prevalence of male circumcision. Popul Health Metr. 2016;14:11. [PMC free article] [PubMed] [Google Scholar]
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