The Facts About Circumcision

Globally, it is estimated that 37 percent to 39 percent of men are circumcised. Data for 2010 from the Centers for Disease Control and Prevention showed that 58.3 percent of newborns in the United States were circumcised during their birth hospitalization. That figure was down from 64.9 percent in 1981. Overall, about 70 percent of men in the U.S. are circumcised.

When a baby boy is born, their penis head is typically covered with a sheath of pliable skin called the foreskin or prepuce. In many cultures and societies, this skin is surgically removed shortly after birth. Some cultures dictate it be removed later in life. Some adult men choose to have it removed for medical or aesthetic reasons. This procedure is known as circumcision.

Circumcision was recorded as early as 2300 B.C.E., emerging in those early days as a religious practice and a signifier of cultural identity. It's one of the most commonly performed procedures in the world, particularly among men of Muslim and Jewish faiths, as well as regionally in the U.S., and parts of the Middle East, Africa and Southeast Asia.

The circumcision procedure involves pulling the foreskin back and exposing where it connects to the rest of the penis. The connective tissue is cut and a section of the foreskin is removed so it doesn't cover the penis head anymore. The skin on the penis heals, leaving the shaft to appear as one piece, albeit with a circumcision scar: a slightly discolored ring on the shaft where the foreskin was removed.

In Western medicine, it has long been preferred to perform the procedure on infants, so they have no memory of the trauma. However, with modern techniques and medication, today, the procedure can be relatively low on pain even for adults. Afterward, recovery often requires only ibuprofen, caution with the bandages and reduced activity for a period of time, including no sexual activity until the wound is fully healed.

Apart from the cultural and religious reasons people get circumcised, there are some health and hygiene considerations.

Some evidence indicates circumcised men fare better than their uncircumcised counterparts regarding rates of infection from conditions such as herpes, urinary tract infections, chancroids, penile cancer and HIV. It's also believed that general genital hygiene is improved in men who are circumcised simply because they have easier access to the area, and there's no foreskin to trap bacteria.

However, having a foreskin is no "dirtier" than not having one, and learning to clean the area properly is easy.

Some uncircumcised men may experience a condition called phimosis, in which the foreskin is too tight to be retracted. It can cause irritation, inflammation and scarring due to forcing the skin back. Moreover, men with phimosis may be more susceptible to infections due to that irritation and the foreskin being too tight to adequately clean underneath.

It's common for uncircumcised boys to be unable to retract their foreskin at all before age 3. By 17 years old, their prepuce should be completely retractable.

Another condition uncircumcised men sometimes face is paraphimosis. This occurs when the foreskin, in its retracted position, gets stuck behind the penis head. This situation can be particularly dangerous for the health of the penis because blood and fluids can get trapped in the area by the tight foreskin, preventing normal blood flow. Left untreated long enough, paraphimosis can lead to a medical emergency and possibly even gangrene of the penis. Daily stretching of the foreskin and the use of corticosteroid cream can help prevent paraphimosis.

Another condition that disproportionately affects uncircumcised men is balanoposthitis, in which both the penis head and foreskin become inflamed. It's related to both phimosis and balanitis, which is a condition that causes inflammation of the penis head and results in swelling.

Balanoposthitis, on the other hand, results in the inflammation of both the penis head and the foreskin. It can have many causes, including yeast infections, fungal infections, chlamydia and gonorrhea. Some of the symptoms may include pain or tenderness, dry skin, discolored skin, itching or burning, leathery skin and a discharge.

Some men undergo circumcision as adults for relief from frenular problems. The frenulum is the highly sensitive band of tissue that stretches from the underside of the penis head and connects to the shaft. If it is extremely tight, it can tear during sex or masturbation and later develop a scar, making it prone to tear again. Circumcision with a frenuloplasty—a surgical procedure to release the frenulum—can alleviate this issue.

Other men may choose circumcision due to insecurities about the aesthetics of their uncircumcised penis. Some may choose it for their male infant so the child feels "normal," that is to say, feels like the other kids they grow up with in their area or culture.

As with any other medical procedure that involves cutting into the skin, circumcisions do have a small risk of bleeding and infection. There is also a risk of something called penile adhesion, in which excess skin that is left behind after a circumcision begins to adhere to the penis head, and the skin of the shaft grows into the glans or head. The procedure may also cause irritation of the penis head and comes with a higher risk of inflammation at the opening of the penis. If the patient receives anesthesia, that, too, carries a risk.

There is a good deal of controversy about the sexual benefits or detriments of circumcision. The past decade has seen a rise in "intactivist" groups that advocate against circumcising babies because they have no choice in the matter. They claim the penis is robbed of sensitivity without the foreskin.

However, groups advocating for adult circumcision exist, too. They cite the cosmetic benefits and share stories of men who suffered phimosis and other conditions that resulted in years of painful sex before they sought relief through circumcision.

The truth, according to many experts, is that we simply don't have good data to resolve the issue of sensitivity either way.

The first phase of recovery after circumcision involves a few days of alleviating any discomfort, using an ice pack and taking NSAIDs, such as ibuprofen. You need to take care of the dressings, keep the area clean to prevent infection and change the bandages as needed. Anecdotal evidence suggests that urinating and rising from sitting to standing are particularly uncomfortable in the first few days. During this phase, getting an erection can cause particular discomfort, especially waking up with "morning wood."

The second phase takes several weeks, during which you should avoid strenuous activity, such as working out or heavy lifting. You need to avoid sex for at least a few weeks—up to six weeks for some guys.

To learn more about the various viewpoints on circumcision, check out some of the links below.

The American Academy of Pediatrics has a policy statement on circumcision that can be read at this link.

Various studies on topics such as penis sensitivity, sexual satisfaction and erectile dysfunction (ED) with and without a foreskin include:

• https://www.sciencedirect.com/science/article/pii/S2050116120301240
• https://pubmed.ncbi.nlm.nih.gov/11956453/
• https://pubmed.ncbi.nlm.nih.gov/23374102/

Intactivist groups advocating against circumcision include:

• The Intactivist Circle at https://intactivist.org/
• Reddit's r/intactivists at https://www.reddit.com/r/Intactivists/

Adult circumcision support groups include:

• My Adult Circumcision at https://www.myadultcircumcision.org/
• An adult circumcision center in Atlanta at https://circumcisioncenter.com/center-info.php
• Reddit's r/circumcision at https://www.reddit.com/r/circumcision/

What happens if you don't get circumcised?

Nothing in particular. You live your life with an intact foreskin and you must pay attention to cleaning beneath it to avoid infections and other conditions listed above. You must pay special attention to how you put on a condom. Also, you should be aware of conditions such as phimosis and paraphimosis in case your foreskin is particularly tight, and recognize the symptoms of balanitis and other conditions. Apart from that, the main considerations are aesthetic and cultural.

How does circumcision affect intimacy?

This is a topic surrounded by controversy. As far as physical sensation during sexual intimacy, there's not much in the way of solid evidence to prove whether sex with or without a prepuce is better for either the person with the penis or their partner. You can read more about the studies on this topic as well as the advocacy on both sides at the links above.

Are there psychological aspects of intimacy with or without a foreskin? As with most things sexual, personal preference is just that, personal. It is something that can and should be discussed between sexual partners.

What's the best age for circumcision?

Tradition and a desire to reduce trauma contributed to circumcision commonly being performed shortly after birth. Today, adult circumcision has become much more common. Modern methods and medications have greatly reduced the associated pain and the recovery time to the point where many adult men choose to undergo the procedure for a variety of reasons, both medical and aesthetic. Be sure to fully explore your reasons for wanting such a procedure with your doctor and your partner before undergoing it.