Circumcision Academy of America

Medically Based Information on Male Circumcision


The aim of this site is to provide the American mainstream view regarding male circumcision, where circumcision of newborn boys has long been a part of traditional American culture, discussing the many positive health aspects associated with this minor surgical procedure, as well as the risks, which are minimal. This information is not based on irrational views and claims, but instead on scientific evidence and every-day experiences, as well as religious and cultural arguments.

It is highly significant that the American Academy of Pediatrics (AAP) and the Centers of Disease Control (CDC) both have recently re-endorsed the health benefits of circumcision (for more information, see below).

Many generations of American boys and men have experienced the many benefits of circumcision, and there are many reasons why this procedure remains popular in the US. So please have a look at the information provided on the site, as well as the links to other sites, and please contact us if you have any questions.

Please note that on this site, "circumcision" will refer exclusively to male circumcision, the subject of female genital cutting, which has no medical advantages, is not discussed here.

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Important Facts to Consider

Both the AAP and CDC Endorse Male Circumcision for Health Reasons

In December 2014 the US Centers for Disease Control (CDC) in Atlanta made a policy statement strongly supporting circumcision. The new draft guidelines mirror an updated policy on circumcision released by the American Academy of Pediatrics (AAP) in 2012. For further information regarding the CDC Statement, see e.g. the article in Scientific American, and for more on the AAP Statement, see WebMD and CNN.

Circumcision does not affect penile sensitivity - a major part of the circumcision debate is settled!

One of the major - and most emotionally charged - accusations that are often used by anti-circumcision activists to persuade parents not to circumcise their infant boys is that circumcision makes the penis less sensitve, and therefore has a negative influence on the infant's future sex life.

There have been many studies in the past refuting this accusation, but a recent study has provided new evidence showing that the procedure doesn't affect sensitivity - in fact, circumcised and uncircumcised men alike enjoy the same level of sensitivity a study published in The Journal of Urology has found. Further information can be found here, and also this article.

There is now overwhelming evidence based on sound medical research that the claims made that circumcision negatively affects penile sensitivity are completely bogus, and are only used as emotional blackmail by desperate people trying to influence parents. Please do not fall for this!

For further information, see the section "Circumcision and Sexual Function".

Circumcision Brochures

Below are links to brochures on circumcision in English, French and Spanish:

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Circumcision: a guide for parents

• English (pdf)
• Español (pdf)
• Français (pdf)

Have you heard about the benefits of circumcision - a guide for men

• English (pdf)
• Español (pdf)

Sex and Male Circumcision - What every woman should know

• English (pdf)
• Español (pdf)

Circumcision - a Guide for Parents

The Issue of Pain

The question of how much pain is experienced by an infant during the circumcision procedure is of course a valid one. Infants only a few days old (which is the time when infant circumcisions are normally performed) don't experience pain the way children and adults do, but a circumcision performed without the use of analgesia and/or anesthesia can be painful and uncomfortable to the infant

For the last decade or so the use of local anesthesia (for more information, see the Section Pain Relief Methods) has become standard, with virtually all circumcisions being performed using some kind of pain relief. The American Association of Physicians (AAP) provides explicit guidelines concerning the use of anesthesia, and considers several methods safe for the use on infants.

If this issue remains a worry to you, then speak to the person who will be performing the procedure (normally the obstetrician or a urologist) and ensure that he/she will use some kind of pain relief. With the use of anesthesia like the dorsal penile ring block (recommended by the AAP) the operation can be made almost painless.

One of the favorite scare tactics used by those who oppose circumcision is to show pictures from videos about babies crying during circumcision. These images often have nothing to do with the procedure being carried out, but just shows the infant crying. It should be remembered that the birth process is quite a traumatic experience for the infant, and infants often cry for a vary of different reasons, and they cry very easily. Some babies cry more than others. In order to ensure that the docotor can do the procedure safely without the baby moving during the procudure, the infant is normally fastened so that he cannot move during the procedure. This restraining position is of course not always the position the infant wants to be in, hence it can easily cry. On Youtube there is a video showing a circumcision procedure where the baby cries a bit, then stops and then starts again. The crying has nothing to do with the procudure as can obviously be seen from the video. The video (which requires a loggin in for age reasons) can be found here.

The Issue of Risk

Circumcision is a surgical procedure and, as such, inherently has some risks attached to it. However, it is still one of the safest surgical procedures around:

  • Significant bleeding is rare: only 1-2 per 1000 performed circumcisions may need pressure to stop bleeding, while 1 in 400 cases will require a stitch to stop the bleeding.
  • Serious infections develop in about 1 in 4000 cases. These can usually easily be treated using anti-biotics.
  • In the 40 year period 1953-1993, there were three reported infant fatalities due to hemorrhage. However, two of these cases involved circumcision at home by non-medical persons. To further put these statistics into perspective: during the same period, 9,000 - 12,000 men died of penile cancer, and approximately 40-50 million men were circumcised.

For a detailed risk-benefit analysis, see Circumcision Risk-Benefit Analysis.

Parents can - and should - go one step further by ensuring that the circumcision is performed by an experienced person. Like most things in life, practice makes perfect, and having an experienced person do the procedure, this will not only reduce the risks involved, but also shorten the time it takes to do the operation (which normally lasts only a few minutes anyhow).

Taking into account the above, you can ensure as much as humanly possible that things will go well. And remember, nearly 2.5 million circumcisions are performed every year in the US. This is a very common and safe procedure!

Health Benefits

Medical studies have shown that circumcision greatly reduces the risk of urinary tract infections (UTI), especially in the first year of life. These infections can cause serious problems, especially in infants. For example, UTI can cause scarring of the kidney and ultimately hypertension or kidney failure. To make matters worse, studies have shown that UTI are becoming more resistant to anti-biotics, thereby making treatment both much harder and less effective.

Cancer of the penis is virtually non-existent in circumcised men. Of the 60000 cases reported since the 1930´s, fewer than 10 occurred in circumcised men. The risk of penile cancer in uncircumcised men is 1 case per 400-600 men, while in circumcised men it is 0.2 per 100,000 per year. Circumcision also helps to reduce the risk of cervical cancer in female partners. Prostate cancer may also be increased for uncircumcised men.

Extensive research done during the past 15 years have convincingly shown that infant circumcision reduces the risk of contracting sexually transmitted diseases, including HIV/AIDS (for further information, see the section on HIV/AIDS).

Circumcision also eliminates problems like phimosis (intractable foreskin) and balanitis (inflammation of the foreskin). Even though these problems only occur in as many as 10% of men, they can be very painful if not treated. In older males, phimosis can cause urine blockage with acute hypersensitive kidney damage. Other painful problems that might occur include paraphimosis (where the retracted foreskin cannot be brought back again over the glans) and posthitis (inflammation of the foreskin). Uncircumcised men are often unaware that these problems are all related to the presence of a foreskin, and that the discomfort and pain that they are experiencing are easily treatable. In almost all cases, the only permanent treatment is circumcision.

Hygiene Benefits

Those opposing circumcision often state that the uncircumcised penis can be kept sufficiently clean by just using soap and water. However, what they fail to mention is the fact that the build-up of bacteria that causes smegma and odors starts again immediately after cleaning. Urine further worsens matters. To maintain a sufficient standard of penile hygiene would therefore entail cleaning under the foreskin at least every time after urinating. Everyone knows that in real life with people at school or work this is almost totally impossible to accomplish. Young boys, especially between the ages of 4-14, are often very water-shy. Getting them to bathe frequently can be a hard task for parents. If maintaining general hygiene is a problem, just imagine how difficult the situation regarding penile hygiene will be. A boy who does not like to bathe is not likely to clean under his foreskin.

One day your son will be a grown man, and studies have shown that women have a preference for a circumcised penis. The reasons for this are not hard to understand: most women find the circumcised penis more aesthetically pleasing, and a circumcised penis is also cleaner, which makes spontaneous sexual intercourse possible. There are also health benefits by reducing the risk of transmitting or spreading vaginal (e.g. yeast) infections.

In an age where the general population in the US and other developed nations is getting older, there has been a steady increase in the number of people who need extended care. In older men, the absence of circumcision can cause various health problems, and cleanliness if often difficult to achieve among those with limited mobility. For those unable to take care of themselves, there often are added emotional problems caused e.g. by the embarrassment of having one's personal cleaning done by another person. It should therefore come as no surprise that most nursing personal that work with extended-care mature men are in favor of circumcision!

Sensitivity of the Penis

The claim that circumcision reduces the sensitivity of the penis, thereby diminishing sexual pleasure for both partners, is one of the most controversial and most hotly debated and emotional issues surrounding circumcision. This claim is, however, a complete fallacy for the following reasons. Firstly, there is no scientific evidence that supports this allegation. Remember, the foreskin is not the only erogenous part of the penis! Furthermore, some men who were circumcised as adults report that sex without a foreskin is totally different, which makes direct comparisons meaningless (see the section Personal Testimonies. What is also interesting is that often these men have testified that for them sex is better than before.

The allegation that the foreskin "facilitates" intercourse by being able to slide back and forth is another popular myth that has been refuted by the above-mentioned testimonies: most men have reported just the opposite, namely that the foreskin covers the glans for most of the time, which lessens the sensitivity experienced by the male partner during intercourse.

The use of condoms, which in the light of the increase in the spread of sexually transmitted diseases has become more important than ever, is far easier if the penis is circumcised. Since the foreskin is often in the way, and has to be retracted correctly for the condom to fit properly.

During circumcision far less than the 80% often quoted by those opposing circumcision is removed. If you are still worried that too much foreskin might be removed, then the best solution is to talk to the person who will be performing the procedure. Also, circumcision does not shorten the penis! For further information, see the section Circumcision and Sexual Function.

Legal Matters

The issue of informed consent has frequently been raised in recent years. The opponents of circumcision often allege that it is "illegal", since it is performed without the child´s consent. That this statement does not make sense can easily be seen by considering what parental duties and obligations are all about. Parents are responsible for the well-being of their child, and they have to act in his/her best interest. That includes things like immunization - and having their son circumcised if they believe that it is in his best interest. As a parent you have both the legal and moral right to make this decision. The American Academy of Pediatrics (AAP) furthermore supports this position.

Medical Costs

Circumcision has a prophylactic health value regardless of the reason why it is performed, and its benefits last a lifetime. Moreover, the average infant circumcision costs less than $200, compared to several thousand dollars for a normal hospital birth. Taking all these factors into account, circumcision can be considered to offer exceptional value for money.

Why Infant Circumcision?

Infant circumcision has several benefits over adult circumcision. As a newborn, the procedure can be done using local anesthesia and in most cases without hospitalization. This, and the fact that the operation lasts only a few minutes, means that the medical costs involved are low (see previous section). The healing process normally only takes around a week. Studies have furthermore shown that post-pubertal circumcision provides less protection against HIV-1 infection than circumcision performed before the onset of puberty.

As an adult, the operation is more complicated and therefore also takes longer, and hospitalization is often required. As a result, the medical costs are at least a factor of 10 larger ($1500 - $2000). The healing process also takes longer - normally 3-4 weeks. During this time, sexual activity should be avoided to prevent rupturing the stitches. Then there is also a kind of "embarrassment" factor: since a sexual organ is involved, it is often difficult to discuss the topic with friends and colleagues (try explaining to colleagues at work why you have to go to the hospital for a few days!). As a result, some men might be hesitant to get circumcised for fear of being teased or made fun of.
For further information, see the section Neo-Natal Circumcision.

The long term benefits of circumcision

In older men it often happens that they cannot take care of themselves for various reasons, maybe due to physical empediments, or issues related to Alzeihmer or Parkinson or other related age-related illnesses. For people like these, personal hygiene becomes very difficult to do themselves, and many issues related to improper penile health can happen.

In a recent very insightful article, a nurse reported on issues experienced by older men who are not circumcised. From this article:

One of the most gut wrenching experiences of my hospital career came when I was a nurse’s aide on a medical/surgical floor. A stoic elderly man was transferred to my unit from a nursing home and it was my responsibility to remove his street clothes and dress him in a hospital gown. The stench of gangrene filled the room and overwhelmed me when I removed his pants. He was too sick to communicate with words but looked at me with soft eyes and an apologetic face. I discovered a severe infection that fused the meatus inside the foreskin. I alerted the nurse to what I had found and she delegated the laborious task of cleaning to me. It took hours of warm compresses followed by excruciating crust removal. I apologized repeatedly and when tears flowed from beneath his thick horn-rimmed glasses, I cried too.

I will never forget this experience and I offer it to others when they consider circumcision. The elderly population, specifically 85 years and older, is growing at a rapid rate in the United States. Men are living longer than ever and the health care system is struggling to keep up. Hospitals, rehabs and nursing homes are filled with patients who need increasing assistance with activities of daily living. Dementia, incontinence, decreased sensation, and impaired vision are risk factors which can lead to infection in the uncircumcised elderly male. Lack of awareness in this area by family and/or overworked, underpaid nursing home staff contributes to the problem."

In a rapidly ageing population, the benefits of circumcision becomes more imperative in assuring a dignified final chapter and end to men's lives without the need to suffer unnecessary embarrassment on daily basis.

Other Issues

In spite of what you might have read or heard,
  • there is no medical evidence that circumcision affects the mother-child bonding in any negative way. It is possible that the infant may be fussy for a day or two after the circumcision, but no long-term effects have been found;
  • there is no scientific evidence that circumcision disrupts the child´s behavioral development. A recent study has shown that infants who were circumcised without anesthesia did show a stronger response to the immunization shots performed at 4-6 months of age than those who were uncircumcised or who had received pain relief during circumcision. It should be noted however (and even the authors admit it) that the conclusions of the study [6] was based on only a small statistical sample. In should also be noted that no credible scientific study has ever shown long-term sensitivity to pain as a result of infant circumcision;
  • will not cause your son to be violent when he grows up;
  • circumcision can in no way be described as being a barbaric practice. This statement is an insult to all parents who have made an informed decision, and with the well-being and interest of their child in mind. By the same argument, circumcision also cannot be considered to violate the human rights of the child, since parents have both the legal and moral right to act in the best interest of their child.

Finally ...

Ultimately the decision whether or not to circumcise your son lies with you as the parents. Even though circumcision is a minor surgical procedure, for many parents faced with the decision the issues involved are often anything but minor. It is totally understandable for parents to be worried about issues like pain and safety. To make a decision of this magnitude and importance you have to be convinced that is the right one. It is a huge responsibility - but that is, after all, what parenthood is all about! Hopefully by reading the articles, testimonies and information contained on this site and the links provided you will have enough information to help you make the right decision.

If you are still unsure, or still have issues that you would like to have explained, please contact us, and we will try our best to answer your questions. Talking to your personal physician is also strongly recommended. Whatever you decide, don´t be ambivalent about this issue, and don´t allow yourselves to be influenced by other people´s opinions and dubious agendas. One day, your son will surely thank you for your foresight and concern on his behalf. Good luck with the decision, and congratulations!

In summary, the bottom line on circumcision is:

  • Circumcision is a minor surgical procedure:
    1. performed on newborns, the procedure takes only a few minutes.
    2. with the use of anesthesia, the procedure is painless to the infant.
    3. circumcision is a very safe surgical procedure, with minimal risks and complications if done by an experienced person.
  • There is no evidence that circumcision prevents or negatively influences mother-child bonding.
  • As you are acting on your child´s behalf - and in his best interest - you as parents have both the legal and moral right to have your son circumcised. There have been several attempts in the past to ban circumcision, but the courts have always come out in support of parents' right to choose what is best for their child.
  • Genital hygiene is far easier to maintain after circumcision.
  • In addition to improved lifetime genital hygiene, circumcision offers many health benefits that accrue over a lifetime:
    1. problems like phimosis, paraphimosis, balanitis and posthitis are caused exclusively by the presence of a foreskin. If not treated, these conditions can be very painful.
    2. foreskin problems also mean that sexual intercourse could be painful.
    3. uncircumcised males have a higher risk of sexually transmitted diseases like syphilis, gonorrhea and HIV.
    4. cancer of the penis is almost completely confined to uncircumcised men and, less commonly, in those circumcised after the new-born period.
  • In old age, men who are not circumcised could face many embarassing situations while ensuring daily personal hygiene because they are no longer able to take of this very private matter themselves and are dependent on other people to help them.
  • The lack of a foreskin will not diminish sexual pleasure:
    1. the foreskin is not the only erogenous part of the penis!
    2. without a foreskin the risk of getting infections - and transmitting them to your partner - during sexual intercourse is greatly reduced.
  • Even though circumcision can never be 100% risk free, the potential benefits outweigh the risks 100 to 1 and and which will last a lifetime.

CircumcisionAmerica is a wholly non-profit website with the aim of providing medically based information about circumcision. It is not intended to replace the advice or information provided by professional medical practitioners.
CircumcisionAmerica 2016