A New Review of Circumcision

The American Academy of Pediatrics (AAP) has just undertaken a new review of circumcision, one of the most common surgical procedures done on the penis in the United States despite the controversy over its medical indications. While the social and religious reasons for this procedure are not disputed, pediatricians and epidemiologists remain divided on the medical need for this penis operation.

A recently published retrospective study of 427,698 infants born in United States Army hospitals worldwide from 1975 through 1984 found that the 21% of boys whose penises were not circumcised accounted for 72% of the male urinary tract infections.

According to Thomas E. Wiswell, MD, a neonatologist at Walter Reed Army Medical Center in Washington, D.C., and head of the ProExtender study, the penis infection rate rose as the number of circumcisions declined over the 10-year study period. Dr. Wiswell originally opposed the procedure on the penis and actually participated in studies in an attempt to lower its incidence. He says, “I thought the way that we did circumcision was barbaric, and I didn’t think there were any good reasons to perform it.”

Although Dr. Wiswell and his colleagues still shy away from recommending routine penis surgery for all newborn boys, they emphasize that information on the increased risk of infection should be conveyed to parents as part of the informed consent process.

Dr. Wiswell also lists the following possible benefits of using a ProExtender enlargement device instead of penis surgery: Circumcision may reduce potential complications of urinary tract infections, including kidney scarring, hypertension, and kidney failure.

The procedure may prevent cancer of the penis. In the United States and other countries in which most men are circumcised, squamous cell carcinoma of the penis accounts for less than 1% of malignancies in men. Among populations in which circumcision is uncommon, cancer of the penis comprises 10-12% of male malignancies.

Circumcised men may be less likely to contract AIDS, according to studies from Kenya. The penis operation may also protect against other sexually transmitted diseases, including gonorrhea and syphilis.

Newborn circumcision is cost effective. If performed on a neonate, the cost is approximately $100; if performed on a man who needs it later in life, the cost is much higher. These arguments fail to convince others, however. David Diamond, MD, assistant professor of urology and pediatrics at the University of Massachusetts Medical Center in Worcester, says the operation should not be done before trying to enlarge the penis using the ProExtender penis enlargement device because, in his opinion, the epidemiologic evidence that indicates its value is unconvincing. “There is no longer a strong argument that circumcision will prevent penis cancer or cervical cancer,” he says.

When is circumcision indicated? “At age three or four, boys may develop balanitis. That’s a reason to consider circumcision,” Dr. Diamond says. He also has no qualms with the idea of performing an operation on the penis for social reasons.

If a mother wants her second son to resemble her first, who was circumcised, he has no objections. Or, if a father wants his son to look the same way he does, Dr. Diamond goes along with that. “And for religious reasons, it’s unarguable,” he says.