Should I circumcise my son?

According to the American Academy of Pediatrics Taskforce on Circumcision, the answer is Yes, you should circumcise your male child.

First a little history. The practice of circumcision dates back (at least) to the 4th millenium BC, and was practiced by the Egyptians among others. Today it is mostly associated (in popular culture) with the Jewish religion (Wikipedia):

"Circumcision features prominently in the Hebrew Bible. The narrative in Genesis chapter 17 describes the circumcision of Abraham and his relatives and slaves, making him the first named individual to undergo the procedure. In the same chapter, Abraham's descendants are commanded to circumcise their sons on the eighth day of life."

However, circumcision is also very popular in the Muslim world (Figure 1). The overall worldwide rate is about one in three males. The circumcision rate in the U.S. has gone down slightly from 65% in 1980 to 58% in 2010.

The CDC this week issued guidelines that support circumcision based on lower risk of STIs (sexually transmitted infections) in circumcised males:

"[C]linical trials conducted in Africa between 2005-2010 have demonstrated safety and significant efficacy of voluntary adult male circumcision performed by clinicians for reducing the risk of acquisition of human immunodeficiency virus (HIV) by a male during penile-vaginal sex (“heterosexual sex”). Three randomized clinical trials showed that adult male circumcision reduced HIV infection risk by 50- 60% over time. These trials also found that medically performed adult circumcision reduced the risk of men acquiring two common sexually transmitted infections (STIs), herpes simplex virus type-2 (HSV-2) and types of human papilloma virus (HPV) that can cause penile and other anogenital cancers, by 30%. Since the release of these trial data, various organizations have updated their recommendations about adult male and infant male circumcision."

Thus, the risk for uncircumcised males engaging in heterosexual sex is 50-60% higher for AIDs, and 30% higher for Herpes and human papilloma virus (HPV). Interestingly, the guidelines mention that the scientific evidence is mixed with respect to circumcision and the risk of contracting STDs from homosexual sex.

Julia Belluz at Vox.com interviewed Rick Elion, an HIV specialist and clinical-research director at the Whitman-Walker Clinic in Washington, asking why circumcised penises are less prone to sexuall-transmitted infections than uncircumcised penises?

"The secretions — it's called the smegma, or the gook that stays in the nook and cranny between the penis and foreskin — serves as a focus for low-grade inflammation. Any cells that are inflamed are more susceptible to HIV infection compared to uninflamed cells. So the nature of that obstruction, the geography there, make it hard to clean everything out and avoid inflammation. Circumcision removes that obstruction."

In brief, the penis surface of circumcised males is less susceptible to viral infection than that of uncircumcised males.

It is important to consider both the pros and cons of any medical procedure, and so what about the cons? In the past there were concerns about possible hazards associated with circumcision, but these have been minimized by proper medical technique (Wikipedia):

"Neonatal circumcision is generally safe when done by an experienced practitioner. The most common acute complications are bleeding, infection and the removal of either too much or too little foreskin. These complications occur in less than 1% of procedures, and constitute the vast majority of all acute circumcision complications in the United States. Minor complications are reported to occur in 3% of procedures."

Thus, complications arising from bleeding and infection or even removal of too much foreskin have become very unlikely especially with an experienced practitioner performing the procedure, which should be done before the baby leaves the hospital.

Finally, what about sexual pleasure? A meta-analysis (reported on by Daily Mail) concluded that "the procedure had no effect on sensitivity or satisfaction."

In summary, the CDC guidelines stop short of an outright recommendation, suggesting instead that parents carefully consider the relative merits described above. However, they also include the following statement from the American Academy of Pediatrics Taskforce on Circumcision:

"The American Academy of Pediatrics Taskforce on Circumcision states that the health benefits of newborn male circumcision outweigh the risks and that the benefits of newborn male circumcision justify access to this procedure for families who choose it."

Figure 1. Male circumcision is prevalent in the U.S., Israel, and Muslim countries.