Sometimes you have a sex question that's not just, you know, an idle passing thought. And in those times you need a real answer—one that's based on deep research and scientific rigor. In those times you need Hard Data.
Nearly 60 percent of infant boys in the United States are circumcised each year. The US is unique among developed nations in terms of how widespread this practice is and how strongly our medical community supports it. The American Academy of Pediatricians argues that the benefits of circumcision far outweigh the risks, and the Centers for Disease Control and Prevention (CDC) has begun recommending the procedure for infants and adult men alike.
These recommendations are based on the idea that removing the foreskin from the penis promotes better health and hygiene. But are the benefits of circumcision strong enough to merit such sweeping endorsements? A critical look at the evidence suggests that things aren't quite so clear-cut.
One of the most commonly claimed benefits of circumcision is that it reduces rates of urinary tract infections (UTIs) during infancy. Although study after study has found support for this idea, it is important to recognize that UTIs in male infants are quite uncommon to begin with. For example, one study put the rate at just 2.15 percent among uncircumcised boys and 0.22 percent among those who were circumcised. It's also worth pointing out that the vast majority of these infections are treatable with antibiotics and do not cause complications, meaning UTIs usually aren't a major health concern when they do occur.
What these numbers tell us is that, regardless of whether a boy is circumcised, odds are that he's not going to develop a UTI. Furthermore, they also tell us that we need to perform a whole lot of circumcisions for every UTI we hope to prevent. This raises the question of whether it makes sense to try preventing a very rare and mostly harmless infection with a surgical procedure that introduces risks of its own.
Some studies have found that up to 2 percent of infant boys experience severe side effects following circumcision. Most commonly, we're talking about prolonged bleeding or infection; in very rare cases, though, circumcision has resulted in disfigurement (including a few cases where the glans—or head—of the penis has been amputated) and death. To be clear, those latter outcomes are extremely, extremely unlikely to occur—but one might reasonably wonder whether trying to prevent the rare UTI is worth introducing any risk—no matter how slight—for a truly devastating outcome.
Beyond UTIs, proponents of routine circumcision also point to research showing that this procedure may reduce rates of sexually transmitted infections (STIs) in adulthood. Most notably, several clinical trials in Africa have found that heterosexual transmission rates of HIV and other STIs, such as syphilis, were lower among adult men who voluntarily opted to be circumcised compared to those who did not undergo the procedure.
On the surface, this might sound like a powerful reason to encourage routine circumcision; however, it is problematic to draw inferences about what these findings mean for circumcisions performed in other parts of the world. For one thing, HIV is much more prevalent in Africa than it is anywhere else. Consider that whereas 10 percent of the population (or more) is infected with HIV in some African countries, less than 1/10th of 1 percent is infected in the US—so there's a lot less to be gained here, especially when you factor in that condoms are much more widely available and used in the US. It's also important to highlight that, because the African studies focused on heterosexual transmission, they don't tell us whether circumcision offers any protective benefits for gay and bisexual men—the men by far most likely to contract HIV in the US.
In other words, the potential benefits of circumcision for reducing HIV in America are, at best, uncertain. Plus, we need to be mindful of the fact that while circumcision may reduce rates of HIV infection, it doesn't eliminate risk and it's nowhere near as effective as using condoms.
There's also reason to be skeptical that encouraging more circumcisions in the US would meaningfully reduce the STI rate when you look at how we stack up to Europe. In Northern and Western Europe, rates of HIV are lower than they are in the US, despite the fact that most American men are circumcised and most European men are not. If circumcision was as effective at preventing STIs in developed nations as American medical experts have claimed, we'd expect the US to have a much lower HIV rate compared to Europe—but that's not at all what the data show.
One final argument offered by circumcision proponents is that it's linked to a decrease in risk for penile cancer. While there is research to support this, keep in mind that penile cancer is extremely rare to begin with, affecting less than 1 in 100,000 men. Plus, penile cancer has many potential causes that circumcision doesn't address, such as smoking. Effectively, what this means is that you would need to perform several hundred thousand circumcisions to prevent a single case of penile cancer.
Taken together, what the research shows is that circumcision appears to offer limited protection against a couple rare health conditions (UTIs and penile cancer). However, those potential gains must be weighed against the rare but real risks that circumcision introduces, not to mention the ethical concerns about boys not being able to decide what happens to their own genitals. (Some adult men regret that they were circumcised, and a few have gone so far as to seek foreskin restoration surgery). Additionally, while some studies do suggest that circumcision reduces rates of STIs in Africa, these data are too preliminary to use as a basis for making recommendations elsewhere.
Overall, evidence for the health benefits of male circumcision just isn't as compelling as it might seem at first glance. Besides, if we're truly serious about tackling the health issues circumcision helps to prevent, performing genital surgery on infants isn't the most effective way to accomplish this anyway, especially in the case of STIs. Improving the quality of sex education in America will do far more to help boys and men lead healthier lives than cutting off their foreskin ever could.
Justin Lehmiller is the director of the Social Psychology Program at Ball State University, a Faculty Affiliate of The Kinsey Institute, and author of the blog Sex and Psychology. Follow him on Twitter @JustinLehmiller.