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Dear Dr. Joe, What Do You Think About Circumcision?

Wed, Aug 25, 2010

Advice, What's Up Doc?

photo by Evil Erin

Please welcome Dr. Joe to our site! Once a month, Dr. Joe DeOrio, a urologist in Chicago, will be answering your questions on male sexual health. To ask him your own question, click here.

Dear Dr. Joe,

To circumcise or not to circumcise — what’s your medical take on the matter?

– Parent-to-Be

Dear PTB,

To snip or not to snip? That is the question. And, oh, what a question it is. While this is not the most difficult topic to discuss with a parent, it is one heck of a controversial topic to debate on the internet. There is an overwhelming abundance of information on the web, and like all information on the net, it’s confusing and difficult to navigate. Just googling circumcision returns over 11 million results. Is there a right answer? Well, I guess that depends on your point of view.

Circumcision started as a religious practice, well-known today in Jewish and Muslim culture, but it also occurred ritually in ancient Egypt and in many other cultures all over the world. In the United States, doctors began performing circumcisions as a way to discourage young boys from masturbating (it’s true!). Though its roots remain religious and cultural, the medical community has found health benefits to circumcision, thus justifying its non-religious practice. These proven health benefits, however, are not overly dramatic when you actually look at absolute improvements. For example, a 10-fold decrease in urinary tract infections seems pretty impressive, but you’d have to circumcise 100 boys to prevent just 1 infection.

If you believe that circumcision is proper from a religious or cultural viewpoint, far be it from me, or any doctor, to tell you differently. It is a relatively simple procedure, and has a very low complication rate. Complications, when they do occur, are almost always minor, and soon to resolve. Can bad things happen? Sure. Bad things can happen during any medical procedure, no matter how minor. Avoiding risk, however, is not always a strong argument against action. Fact is, bad things happen everywhere in life, yet we take the risk of living. And for those that refer to the procedure as “mutilation,” I can understand your argument, but it is nonetheless an accepted practice within our culture, just like body piercing and tattoos.

So let’s get to the skin of the matter, the medical pros and cons, so to speak. On the pro side, circumcision does decrease the risk for urinary tract infections in the newborn male (10-fold in the first 3-6 months of age), as well as decrease the risk for HIV transmission in the sexually active adult (>50% in men studied in sub-Saharan Africa). Circumcision has also been shown to decrease the risk for penile cancer. This finding, however, is likely more closely related to improved penile hygiene after foreskin removal. Finally, it also eliminates potential future problems arising from the foreskin itself, such as phimosis, which is scarring of the foreskin preventing retraction.

On the downside, there certainly are risks for complications. These range from bleeding (sometimes severe) and infection at the time of the procedure, to long-term cosmetic issues, such as skin bridging and buried penis. Complications also include very rare, though downright catastrophic events such as penile amputation, sometimes requiring gender reassignment. This outcome, however, is outrageously rare. And I’ve heard all the stuff about decreased sensitivity or sex drive after a circumcision. Truth is, there is just no good data on that front. It’s all anecdotal (the few studies that were done were poorly designed), and for every guy who tells you that his aardvark is the cat’s meow, I’ll find you a cut guy that swears his little fella is the best.

So, what to do? To snip or not to snip? I really can’t answer that for you. And that is the answer that I give my patients as well. Circumcision is an individual choice, tied to health, religious, and cultural viewpoints. Think circumcision is right for religious reasons? Go ahead, knowing that the procedure is low risk. Planning a circumcision because of cultural influences? Snip away, as there is arguably a benefit to looking like Dad, your brothers, or your peers. Completely against circumcision? No problem, the health benefits are not overly compelling. Weigh the pros and cons, and just do for your child what you think is best. In all honesty, he’ll likely be quite happy with his “little partner” either way.

– Dr. Joe

Dr. Joe earned his undergraduate degree in Molecular Biology from Princeton University. After attending the Loyola University Stritch School of Medicine, he completed his residency training in urological surgery at the Los Angeles County Medical Center. He lives and works in Chicago, IL. Keep an eye out for his upcoming blog at docjoe.net.

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20 Responses to “Dear Dr. Joe, What Do You Think About Circumcision?”

  1. Restoring Tally Says:

    The doctor is right, circumcision is an individual choice. The individual who should decide is the individual that the penis is attached to. After all, circumcision removes erogenous tissue. The foreskin is part of the sex organ and makes sex better. It should be up to the person attached to the sex organ to decide if he wants part of it removed.

    I was circumcised at birth. I dislike it so much that I am restoring my foreskin. The difference is amazing. Thanks to the Internet, many young men are learning about the harms of circumcision. Many of these young men are questioning why they were circumcised when there was so little, if any, true benefit to the surgery. They are questioning why their parents consented to the surgery when there was all sorts of information available about how circumcision is primarily a cosmetic surgery performed for the benefit of the parents.

  2. Johnny Says:

    ^Oh, come on, with the foreskin restoration. That’s quackery. Even if you can stretch out your remaining dick skin to LOOK like foreskin, that doesn’t make it the same thing.

    I hope the doctor will comment.

  3. Restoring Tally Says:

    A restored foreskin is not identical to the original equipment that was taken from circumcised men. Some structures, like the ridged band and the frenular attachment are gone and cannot be replaced.

    But, the sensitivity lost by keratinization of the exposed mucous membranes of the glans and inner foreskin remant can be returned to what it was previously. Also, the gliding action is restored. I never knew about the gliding action until I experienced it for myself.

    Unfortunately, many cut guys think their penis is perfect and are in denial that sex could be better if they had a foreskin. There is a reason most men in the world are not circumcised and do not wish to be cut.

  4. Lovereaction Says:

    The one that owns the penis is the one to decide.

  5. Jeffrey Says:

    Is it just me, or did this answer seem like a complete copout? I mean, obviously it’s up to the parents and their religious/cultural beliefs. We knew that before we read your answer. I think the majority of the people who have issues with it (me included), don’t like the fact that it is medically unnecessary and done without consent.

  6. Caroline Says:

    Dr. Joe,

    Thanks for tackling this issue. I appreciate that you covered the procedure from it’s beginnings as a religious act, and that you shared how it was originally intended to reduce masturbation.

    However, I”m disappointed that you do not address the issue of PERSONAL choice. A parent choosing something for you is not a personal choice. Circumcision IS a personal choice- but the choice belongs to the individual with the penis, not the parents, or the parents’ religion.

  7. whatUneverknew Says:

    Same old same old. It’s disappointing that what CONSISTENTLY gets ignored is the function and benefit of the foreskin. There’s always the underlying assumption that benefit and risk are the ONLY things that need to be addressed in the evaluation. Do you even know anything about the foreskin? It has functions, and these functions must be part of this discussion. It protects the infant’s and adult’s penis, and aids in intercourse in more than one way for the man and the woman. What about a doctor’s duties to his patient to do what is in their immediate best interest? If there is no diagnosis (like most circs) then you are performing unnecessary surgery. Complications (which are more common than you think) even if they were rare are still 100% inappropriate. What excuse can you give to a boy who has lost part of his glans when you were performing an unnecessary procedure? In fact, what can you say to a man who simply WANTS to have a normal penis but was denied it for no valid reason? Primum non nocere doctor.

  8. Joel Says:

    Dr. Joe DeOrio,

    Thank you for pointing out that even if the UTI data you referenced IS correct, that 100 circumcisions would have to be done to prevent a single infection. (The studies showing the higher rates have been argued to be biased, using data that includes prematurely born infants who have higher rates of UTIs and also are too young to handle the risks of circumcision).

    I found it a strange (but perhaps somewhat accurate) comparison when you suggested that circumcision is accepted like tattoos and piercings in our culture. However, one difference is that genital piercing of an infant is illegal, as is tattooing of an infant. Certainly cutting off ANY healthy, normal tissue from an infant, besides the foreskin, would be illegal. Things are different when done to an infant, in comparison with informed adults consenting about their own bodies.

    Cultural influences is a HIGHLY questionable reason to allow a circumcision, and I would hope you re-evaluate THIS part of your advice VERY CRITICALLY, Dr. DeOrio. Think about it very carefully, because if cutting off foreskins is okay for that reason, what else are you willing to allow for the same reason?

    I also noticed that your response left off some very important data – perhaps it seemed too obvious to note? The foreskin is an extremely sensitive part of the body, jampacked with sensitive nerve endings. This fact is certainly not anecdotal.

    Your role as a doctor is to be informed about this fact. You should be aware of the fact that the foreskin contains nerve endings like those found in the fingertips, lips, and palms of the hand. These are details that you should be sharing with parents who may find that their “cultural influences” have led them to believe the foreskin is just a bit of skin.

    In fact, calling the procedure a “snip” is quite misleading. I also question the use of the word aardvark to describe the natural state of the penis as perhaps the wrong approach for a doctor whose role is that of an educator, not a stand-up comedian. I know some men who would be offended to hear their genitals referred to in such a way – just as some women would be offended to hear their labia or other intimate body parts referred to in such a way.

    The foreskin is an undeniably functional body part – providing pleasure and protection.

    A woman’s clitoral hood and labia protects her clitoral glans and the urethra and reproductive tract. The foreskin performs the exact same role, and deserves credit for such.

    that doesn’t even touch on the sexual role the mobility of the foreskin provides.

    In short – we’re talking about normal, healthy, functional, VALUABLE genital tissue – why on earth are our children’s ear lobes and pinky toes protected from amputation, but any STUPID reason a parent comes up with to cut off a baby BOY’s foreskin (but not a baby girl’s prepuce) TOTALLY ‘fine and dandy’?

    Where are our ethics? When will our doctors stand up for the one on the chopping block – the one with no voice?

    Let’s stop permanently and painfully damaging the genitals of our children in this country! Dr. DeOrio – don’t be afraid to critically question this practice – some would say it is your duty.

  9. also need some Says:

    wow, obviously this hit a nerve for some of yall and I cannot say what’s right for your bodies but I could never have sex with a man that wasn’t circumsized !! I thought the ardvark thing was hilarious – I always thought they looked like anteaters myself. I understand yalls sensitivity on the topic but I would like to add that there are many men out there who love being “cut” and wouldn’t have it any other way!

  10. Dannie Says:

    To also need some:

    You are aware that, when erect, an uncircumsized penis looks pretty much the same as a circumsized penis, and that the foreskin provides comfort benefits to the woman involved in intercourse as well, right? Which leaves only the aesthetic of the flaccid penis to be your criterium for whom you will and will not sleep with. Sorry, but that seems a bit shallow to me. And as for my personal preference, I find nothing aesthetically attractive about a penis that has a strip of skin missing at the glans–but even so, that wouldn’t prevent me from judging a person’s potential for sex based solely on that little personal physical preference. Also, the man has a right to decide what he wants to do with his body–a woman/partner’s preferences shouldn’t weigh in on his own personal comfort and satisfaction. A mean, a woman with her labia minora extending past her labia majora shouldn’t have her inner labia trimmed just because a man thinks it looks bad. She’d be losing precious nerves, protective tissue, and risking awful complications. Sound familiar? It should be the informed, consenting adult man’s choice. Period.

  11. Hybrid Says:

    Ugh, cut I say, cut! I dated an uncut guy for five years, and he had no idea he was supposed to pull back the foreskin and, you know, clean down there. Even when I pointed this out to him he refused. It’s a miracle his dick didn’t rot and fall off.

    ^As for comparing it to female gential mutilation as above, seeing as it’s usually performed on a young woman with no anasthetic and not an oblivious baby by an actual doctor, you are comparing apples to oranges. A fair comparison would be FGM done within the first year of the baby’s life, with local anasthetic/freezing. Removing the hood over the clitoris would be comparable. And so long as women led healthy, happy sex lives without that hood (like cut men) and the procedure had been performed by a professional with the parents’ consent (like cut men), I would have zero problem with it.

    It’s all about culture, people. We could just as easily be having this discussion about female circumcision as I described above (hood cut as a baby) if we had grown up in a culture where such a procedure was considered normal. There would be people whining about wanting their hoods back, and people pooh-poohing the whiners.

    And before everyone starts screaming about the horrors of FGM performed in other cultures, save yourself the breath ’cause it’s apples and oranges.

  12. Betty boo Says:

    Hybrid and other’s who have complained about cleanliness, I have to point out that over here in the UK where being as nature intended is definitely the norm I have never encountered a man with cleanliness issues down there and I’ve never heard any of my friends complain about that either. Over here little boys (and their father’s and the men they grow into) have foreskins so their foreskin owning dads or foreskin aware mums make sure they keep clean, no one wants knob cheese, and believe me thoroughly cleaning your dick isn’t something any guy i’ve ever met is gonna find onerous.. :0P I suggest that the guy you were with, having grown up in a largely circumcised country probably had parents who were unaware and didn’t teach him how to look after it.. still bad on him for not taking the hint, but don;t tar everyone with the same brush

  13. Catgirl Says:

    I’m another female who doesn’t care for the foreskin. The erect penis does NOT look the same in both varieties. It’s like the difference between Twiggy & JLo. I prefer the nice (clean) curves. But what really matters is how it feels. The uncircumcised penis is like a spear as compared to a fist. I didn’t have my son circumcised, but am secretly sorry for this, because I don’t think his sex life will be as good because his partner’s won’t. Hopefully he will not need to have a frenulum release like his dad did, which Dr. Joe didn’t mention with his uncircumcised con’s (ripped frenulums.) I realize many men will feel hurt by my comments, but remember that I’m just ONE woman. Also, I would never let a man’s penis get in the way of a relationship. They’re ALL good! I also hope that you will let your wives HONESTLY help decide the future of your sons. I, too, believe that the person who owns the penis should decide whether he wants the whole thing.

  14. people r hilarious Says:

    i think its funny how women complain about
    not liking the way it looks=either way..too ignorant to know that genitals (male or female) were designed for a purpose-reproduction…pleasure is a perk of the process.Our privates (men and women)were not to be gawked at like were some f-n statues and judged in such manner.

  15. Mikey Says:

    oh please…our privates (and the rest of our bodies for that matter) are captivating by nature, and therefore straight-up begging to be gawked at. Thats why we do it so damn often. Entire cultures, societies, industries and institutions have been devoted to gawking at the human body. “a perk of the process” – lmao. The pleasure element of our privates was as much an integral part of the design as the reproductive element is. This is evidenced in many ways, including the inescapable truth that privates are so damn PLEASURABLE to gawk at in the first place. It isnt just women who judge privates based on looks. Men do it more often, more harshly, and more openly. I, for one, am circumcised and love it. I could care less about the “harms of circumcision” in so much as I am gratefull that my parents had it done when I was an infant. ALL of my sexual partners have indicated an overwhelming preference for the snipped member vs. the unsnipped.

  16. Tori Says:

    Of course a Urology surgeon isn’t going to say NO to circumcision. He gets paid to do them, repair them, etc. He would of course not defend a defenseless infant boy to not have his penis mutilated by his parents. He wouldn’t have a job if penises didn’t need surgery.

  17. windigo Says:

    Despite a few problems, this article is relatively good, in my opinion

    However, the final statement:
    “In all honesty, he’ll likely be quite happy with his “little partner” either way”

    Is inaccurate. There are MANY MANY people who were cut and resent it, including me. The probability of this according to my research is around 38%, which is very significant.

  18. Michael Says:

    He said it: “Circumcision is an individual choice, tied to health, religious, and cultural viewpoints.”

    If it is the individual’s choice then why does he say it is the parent’s decision?

    The baby boy is the individual getting the hoodectomy not the parents. Why should the parents be deciding this before the boy grows up?

  19. Lakatos Says:

    I have read that in the 3 oldest exiinstg copies of the Torah that there is no mention of circumcision being part of the covenant between God and Abraham the reference to circumcision was inserted some 1000 years later. Unfortunately I do not now have the reference to this claim. Has anyone else heard of it? If true, it rather makes nonsense of the Jewish claim for circumcision to be a necessary rite.

  20. life insurance Says:

    Excellent commentaire d’Alphonsi.Cet article est puant par son manque d’objectivitĂ©. On fait passer la « pauvre » famille pour des martyrs et le cadre ATD pour un justicier des opprimĂ©s. Il aurait Ă©tĂ© prĂ©fĂ©rable selon moi de fournir a ces gens de quoi se vĂŞtir convenablement et de quoi se laver avant de les emmener au musĂ©e. Par respect pour eux mĂŞmes. Le cadre ATD est en parti responsable de l’échec et de l’humiliation reçu par ces gens.

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