More Information

For further information about the benefits of circumcision go to the website of one of foremost and well known medical researchers Prof. Brian Morris

What is Male Circumcision?

Circumcision is the removal of a fold of skin (the foreskin) that covers the head (glans) of the un-erect penis. The amount of this skin varies from virtually none, to a considerable amount that droops down from the end of the flaccid penis. Thus, in some men, during an erection, the head of the penis peeks out from the loose foreskin that surrounds it, but in men with a lot of foreskin the head of the penis remains covered, either partially or completely. A questionairre-based survey conducted by Badger in Sydney, Australia found that among men with a foreskin it not only covered the glans of the penis when flaccid, but 67% had extra skin hanging off the end, in 15% it covered the glans, in another 15% it half covered it, and in 4% the glans was bare. In the erect state these numbers were 15% extra skin, 22% still covered, 32% half covered, and 41% glans bare. Racial differences exist. For example, in Malaysia, New Guinea, Sri Lanka and southern India the foreskin is very long and ends in a narrow extension that acts like a muzzle. This is an impediment to sexual intercourse, so that circumcision facilitates procreation for these men. A short prepuce that rarely covers the glans completely is seen in Whites of the northern Mediterranean and many Asians (Chinese and Japanese). In uncircumcised males the head of the penis is pink. This becomes more apparent when the head of the penis emerges during an erection, giving the overall penis a "two-toned" look.  In male babies the foreskin is lightly attached to the penis underneath it, much like the skin on an orange, and comes free over the course of the first few years of life. A variety of methods are, moreover, used to remove the foreskin, and the amount eliminated also varies.

Who does it?

Circumcision is one of the most common medical procedures in the world. It is also one of the oldest, and one of the simplest. The fact that it is still popular must mean that there is something in it! In the USA, which has the greatest medical knowledge and medical expertise in the world, 81% of males are circumcised (> 1 million newborns per year. Those who are not circumcised are mainly from cultures in which it is unfamiliar (e.g., Hispanic, as well as many European and Asian). Globally approx. 25% of men are circumcised. Such a high rate for elective surgery involving the genitalia suggests important net benefits. Moreover, in most western countries circumcision, where practiced, tends to be a family tradition that has nothing to do with religion. With the rise in information from medical research in recent years, informed parents are learning more and more of the lifelong benefits that circumcision can convey to the health and well-being of their children, and are insisting on this simple procedure. In majority populations of the Middle East and in peoples derived from there, such as Jews and Muslims, circumcision is a mandatory part of their religion. However, on the other side of the world in Australia, aboriginals also practice circumcision. So did the Aztecs. Why is this? A common theme in each case is that these diverse races and cultures have traditionally inhabited a hot and often arid sandy environment, where the heat and sand getting under the foreskin would be expected to cause considerable irritation. Ritual removal has been the outcome, irrespective of whether this was a "command from God" or just plain common sense, that when embedded in the religion or culture over millennia lost its original health-related significance. Interestingly, in some places, such as Madagascar, circumcision is 100% regardless of religion, and the reason is actually dictated by the women, who maintain that circumcised sex is "longer, stronger and cleaner". All of this is good "dinner party" conversation. However, sociology is a muddy area to trek in to, so this review tries to steer clear of issues like this, as well as religion, as far as possible.

The Circumcision Debate

Historically circumcision has been a topic of emotive and often irrational debate. At least part of the reason is that a sex organ is involved (compare for example ear piercing). In the USA circumcision has always been common amongst the majority Anglo-Celtic Whites and also amongst Afro-American Blacks. Australia similarly conducted routine circumcision of all newborn boys. In both countries a down-turn took place after the mid-1970s, but is now rising again as the medical and health benefits are becoming better known.

Why the foreskin increases risk of infection?

It has been suggested that the increased risk of infection in the uncircumcised may be a consequence of the following:

The foreskin presents the penis with a larger surface area.

The moist inner lining of the foreskin represents a thinner epidermal barrier than the more cornified outer surface of the foreskin and the rest of the penis, including the glans of both circumcised and uncircumcised penis, which have been found recently to have the same amount of keratin (i.e. similar skin thickness and protection from invasion of microorganisms). This means that the inner lining is a potential entry point into the body for viruses and bacteria.

The presence of a prepuce is likely to result in greater microtrauma during sexual intercourse, thereby permitting an entry point into the bloodstream for infectious agents.

The warm, moist mucosal environment under the foreskin favours growth of micro-organisms (discussed later). This "preputial sac" has even been referred to by Dr Gerald Weiss, an American surgeon, as a 'cesspool for infection', as its unfortunate anatomy wrapped around the end of the penis results in accumulation of secretions, excretions (urine), dead cells and growths of bacteria. Parents are told not to retract the foreskin of male infants, which makes cleaning difficult. Even if optimal cleansing is performed there is no evidence that it confers protection.

What is the best age for circumcision?

Circumcision can be done at any time of life, but medical studies indicate that the major benefits are obtained if circumcision is done as an infant (just after birth or within a few months thereafter).

For example, an article that appeared in the BMC Pediatrics Journal stated that:

"We show here that infancy is an optimal time for clinical circumcision because an infant's low mobility facilitates the use of local anesthesia, sutures are not required, healing is quick, cosmetic outcome is usually excellent, costs are minimal, and complications are uncommon. The benefits of infant circumcision include prevention of urinary tract infections (a cause of renal scarring), reduction in risk of inflammatory foreskin conditions such as balanoposthitis, foreskin injuries, phimosis and paraphimosis. When the boy later becomes sexually active he has substantial protection against risk of HIV and other viral sexually transmitted infections such as genital herpes and oncogenic human papillomavirus, as well as penile cancer. The risk of cervical cancer in his female partner(s) is also reduced. Circumcision in adolescence or adulthood may evoke a fear of pain, penile damage or reduced sexual pleasure, even though unfounded. Time off work or school will be needed, cost is much greater, as are risks of complications, healing is slower, and stitches or tissue glue must be used."

The full text of the article can be found online here.

For further information about circumcision done at different ages, see the sections on this site:

Neo-natal (infant) Circumcision
Teenage and Adult Circumcision

For further information, see the article

Infant male circumcision: An evidence-based policy statement