Circumcision: A guide for parents
by Professor Brian Morris
Circumcision is a simple surgical procedure that removes the
foreskin a sleeve of skin covering the tip of the penis.
Parents have the legal right to authorize circumcision. In order
to make an informed decision, they must carefully consider the
benefits and risks.
Since the foreskin traps bacteria and other infectious agents,
as well as accumulating malodorous smegma, its removal improves
genital hygiene and reduces risk of diseases and other
conditions over the lifetime for the boy and his future sexual
Circumcision has been performed for thousands of years as part
of the culture of indigenous people who live in hot environments
such as in Australia, the Pacific Islands, equatorial countries,
the Middle East, Africa and the Americas. In Australia all newborn
boys were once circumcised routinely. Circumcision then decreased
in the mid-1970s, but is now rising again, in line with research.
Over 60% of Australian men are circumcised.
Benefits of circumcision
- Eliminates the risk of phimosis, which affects 1 in
10 older boys and men. This condition refers to a tight foreskin
that cannot be pulled back fully, so making cleaning under it,
and passing urine, difficult. Phimosis also greatly increases
the risk of penile cancer, and is the cause of foreskin and catheter
problems in nursing homes.
- Reduces by 3-fold the risk of inflammation and infection
of the skin of the penis. One in 10 uncircumcised men get inflammation
of the head of the penis, which is covered by the foreskin. This
rises to 1 in 3 if the uncircumcised man is diabetic. (Diabetic
men also have other severe problems.) In contrast only 2% of
circumcised men get this condition.
- Over 10-fold decrease in risk of urinary tract infection.
Whereas risk of this is only 1 in 500 for a circumcised boy;
1 in 50 uncircumcised male infants will get a urinary tract infection.
This very painful condition is particularly dangerous in infancy,
and in 40% of cases can lead to kidney inflammation and disease;
sepsis and meningitis can also result.
- Over 20-fold decrease in risk of invasive penile cancer,
which has a high fatality rate. One in 600 uncircumcised men
get penile cancer, which often requires penile amputation.
- Uncircumcised men have 1.5 2 times the risk of prostate
cancer, which affects 1 in 6 men.
- Reduces by approximately 3-fold the risk of getting HIV
(AIDS), during sex with an infected woman. HIV enters via
the vulnerable inner lining of the foreskin of a healthy penis,
but can also infect via sores anywhere on the penis (caused for
example by genital herpes). In countries such as Australia that
have a low prevalence of HIV the risk of a heterosexual man being
infected with HIV sexually is generally low. His risk, especially
if uncircumcised, will be much greater if he engages in unsafe
sex with people of countries in which HIV abounds.
- Circumcision also affords substantial protection against
sexually transmitted infections such as papilloma (wart) virus,
syphilis and chancroid.
- Circumcision reduces by up to 5 times the risk of the man's
female partner being infected by chlamydia or getting
cervical cancer (which is caused by human papilloma virus).
The load of infectious bacteria and viruses that accumulate under
the foreskin is delivered into the female genital tract during
sex. Chlamydia has more than doubled over the past 5 years in
Australia and can cause infertility (in both sexes), pelvic
inflammatory disease, and ectopic pregnancy.
- If not circumcised soon after birth, up to 10% will later
require one anyway for medical reasons.
- Credible research shows that most women prefer the appearance
of the circumcised penis. They also prefer it for sexual activity.
Hygiene is one reason.
- There is no significant difference in sensitivity of a circumcised
and uncircumcised penis.
- In general, sexual function is the same or better.
Risks of circumcision
- For 1 in 500 circumcisions there may be either a little bleeding
easily stopped by pressure or, less commonly, requiring
stitches (1 in 1000), the need for repeat surgery (1 in 1000),
or a generalized infection that will require antibiotics (1 in
4000). Although there can be a local infection, often what seems
like a local infection is actually part of the normal healing
- Serious complications (requiring hospitalization) are rare
approximately 1 in 5000.
- Mutilation or loss of the penis, and death, is virtually
unheard of with circumcisions performed by a competent medical
practitioner. Ensure your doctor is experienced.
- If a bleeding disorder such as haemophilia runs in
the family, then the doctor needs to be advised as circumcision
may require special preoperative treatment.
- Anaesthetic is imperative, preferably a local, since
a general anaesthetic carries risks, and is unnecessary. For
age 0-4 months a local, not general, and for older children
or teenagers a mild sedative might be considered in addition
to the local. Young children who wriggle can be gently restrained.
For pain after the anaesthetic wears off, an oral analgaesic
medication is often prescribed.
- Delay means stitches being used for circumcision of
older children, teenagers and men.
- So if circumcision is delayed past 4 months, total cost
will become increasingly greater.
Circumcision confers a lifetime of medical benefits. 1 in
3 uncircumcised boys will develop a condition requiring medical
attention. This means various degrees of suffering and, in rare
cases, death. In contrast, risk of an easily-treatable condition
is 1 in 500, and of a true complication is 1 in 5000. A successful
circumcision is very unlikely to have any long-term adverse consequences.
Thus, benefits exceed moderate risks by over a hundred
may be obtained from the following web sites:
The author wishes to thank the various international medical
experts who helped in formulation of this Guide.
is a Professor in the School of Medical Sciences at the University
of Sydney, where he has taught medicine and science students since
After graduating from the University of Adelaide, he conducted
research for doctoral studies in the departments of medicine of
the University of Melbourne and Monash University, at the Austin
and Prince Henry hospitals, respectively, from 1972. This was
followed in 1975 by further reasearch as a C J Martin Fellow of
the National Health & Medical Research Council of Australia,
in the School of Medicine of the University of Missouri in Columbia,
and the University of California in San Francisco. In 1993 he
was awarded a DSc based on his published work, which currently
extends to over 230 research articles on molecular biology and
genetics, hypertension, and cervical screening. It is the latter
topic that fostered his interest in circumcision.
He is not aligned with any religious, political, medical or other
group that may have any influence on the topic of circumcision.
The views he expresses arise from independent research published
in medical journals.
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Updated April 2006
Copyright © 2006 Brian Morris and The