Male circumcision refers to the removal of the foreskin which surrounds the glans of the penis. This medical procedure—often considered to be the oldest documented surgical procedure—is mostly performed on infants, but it is not uncommon for adults to undergo circumcision as well.¹ While it most likely began as a religious practice, circumcision is the norm in many areas of the world for its supposed health benefits, and often for a preference towards aesthetics, rather than for religious obligation.¹

What Is the Procedure Like? 

Circumcision, like any surgical procedure, is inherently risky. Circumcision should only be performed by a licensed professional in a sterile environment to avoid infection and potential lifelong damage to the penis. There are a variety of methods used to perform circumcision. The methods used for circumcising infant males are generally not the same as those used for circumcising adult males due to the increased risks of the procedure associated with age.

There are three main methods of circumcision used for infant males. These methods include the Plastibell technique, the Gomco clamp, and the Mogen clamp:

• The Plastibell technique. This method utilizes a Plastibell, a device comprised of a small plastic bell with a rim around it. The size of the Plastibell will vary depending on the infant. In this technique, after an incision is made in the foreskin, the Plastibell is inserted directly under the foreskin and over the glans. A string is tied around the rim of the Plastibell to cut off blood supply to the foreskin. Then, a scalpel is used to cut off the extra foreskin. The Plastibell is left on until it falls off naturally, about six to twelve days later.¹
• The Gomco clamp. This method is similar to the Plastibell technique. After the foreskin is separated from the glans, a bell-shaped device is placed directly over the glans and under the foreskin. The foreskin is pulled around the device, and a clamp is fastened around it to reduce blood flow. Again, a scalpel is then used to remove the foreskin.²
• The Mogen clamp. In this method, like the others, the foreskin is first separated from the head with a probe. It is then pulled out in front of the head and inserted through a slot in a metal clamp. Still held in place inside the clamp, the foreskin is then cut with a scalpel. It remains in place for a short time after being cut to ensure any bleeding is under control.³

Aftercare for an infant who has just undergone circumcision includes applying antibiotic ointment to the wound to protect against infection and aid in the healing process. The wound should be monitored in case signs of infection or bleeding occur. If the Plastibell technique was used, parents are encouraged to take their children back to the professional who performed the procedure once the ring has fallen off or if it has not fallen off after two weeks.⁴

There are two popular methods of circumcision for adult males. These include the dorsal slit technique and the sleeve technique.

• The dorsal slit technique. This technique is favorable when the reason for circumcision is severe phimosis or paraphimosis. The corona of the glans is identified, and a single slit is made starting from the corona and going along the upper length of the foreskin. The dorsal slit technique is performed to relieve pain, and it is not necessarily a full circumcision.³
• The sleeve technique. This method may be used in both adult and adolescent males. Unlike the dorsal slit technique, which pulls the foreskin over the head of the penis before the circumcision, the sleeve technique performs the circumcision while the foreskin is retracted. Two circumferential marks are made on the penis—one near the corona and one farther down on the shaft. Then, the foreskin between the two markings is removed. The edges of the two cuts are then stitched together.³

When caring for the wound post-procedure, people should wear loose-fitting bottoms such as sweatpants, boxers, or athletic shorts. The wound should be regularly cleaned for at least a week following the circumcision. It is also important that the person who has undergone circumcision avoids sexual arousal for about six weeks, as an erection might pull at the stitches on the wound and could interfere with the healing process.

There are complications associated with circumcisions that, although not too common, are experienced by some people either during or after the procedure. The most common complications are bleeding and infection. Beyond those, there are also fewer common complications:

• Pain and/or swelling
• Tearing of the stitches, most likely due to sexual arousal
• Too much skin removed during the procedure
• Too little skin removed during the procedure
• Damage to the urethra
• Formation of a hematoma

In extreme but rare cases, complications resulted in amputation and even death.⁵ However, these are both extremely rare and are often avoided by going to an experienced and licensed medical professional in a sterile environment.³

What Is the History of Circumcision? 

Male circumcision has a long history and was most likely started as a religious practice. In fact, one of the oldest mentions of the practice comes from religious texts such as the Torah and the Old Testament of the Bible, which may be dated back to the 6th century BCE. These texts describe Abraham’s covenant with God, in which he promised that he and his male descendants would be circumcised from then on. It is because of this covenant that circumcision is a ritual in Judaism. Male infants from Jewish families are still regularly circumcised on the eighth day of their lives in what is called the Bris Ceremony. Beyond Judaism, circumcision is also practiced in Islam. Muslims believe that Abraham’s first circumcised son was Ishmael, one of their prophets and an ancestor to Muhammad. However, the Islamic tradition of circumcision differs from the Judaic tradition in that Muslim families do not necessarily circumcise their children eight days after birth. Instead, they might choose to wait up to twelve years, because Ishmael’s foreskin was not removed until puberty.¹

Other religions have more complicated histories with circumcision. Different sects of Christianity vary regarding their views on the practice. For example, the Catholic Church’s stance is that circumcision that is not conducted out of medical necessity violates moral law.² On the other hand, sects of Christianity that read and follow the teachings of both the Old and New Testaments might be more supportive of the practice, as the Old Testament advocates for circumcision.

During the Hellenistic period, male circumcision changed dramatically. Nudity was common in Greek and Roman societies, but it was considered indecent and even vulgar to expose the glans of one’s penis.⁹ Therefore, many Jews and other circumcised people were excluded from much of the culture of Roman society. Since circumcision was a physical marker for Jewish men, people would often use the fact that one was circumcised to identify them as a Jew and subsequently discriminate against them.⁸ 

This led much of the Jewish population to undergo procedures that made them appear uncircumcised. There were two main styles of these procedures. One involved pulling the skin on the shaft of the penis over the glans and tying or pinning the skin in place. The other more popular procedure was carried out by making an incision just below the corona of the glans, pulling the skin up over the glans, and securing the “faux foreskin” in that position.⁸ After the skin healed in this position, sutures were removed. These procedures were quite dangerous, especially considering no anesthetic was used, and they posed a serious threat to the function of the penis. Undergoing these risky procedures allowed Jewish people to participate in society more actively without offending others or being discriminated against.

Another development to male circumcision occurred in the late 1800s when John Harvey Kellogg and others led an anti-masturbation campaign.  Kellogg believed that masturbation was inherently wrong, led to health issues, and was a form of “self-abuse.”¹⁰ He believed that circumcision, especially without anesthetic, was an effective way to treat masturbation in young people. He thought that the pain associated with the procedure as well as the healing period following the procedure would stop young people from masturbating.¹⁰ The popularity of this campaign contributed to the prevalence of non-religious and non-therapeutic circumcision.

Globally, almost half of people with penises who are fifteen years or older are circumcised.³ The prevalence of circumcision varies widely depending on each country’s cultural and dominant religion. For example, countries with large Jewish and Muslim populations will have a greater prevalence of male circumcision, while primarily Christian countries might have a smaller prevalence. Another factor that affects circumcision rates is access to affordable healthcare. For example, it was found that shifts in insurance coverage in the United States may have contributed to a decrease in newborn circumcision from 61.3 percent in 2000 to 56.9 percent in 2010.⁴

What Are Some Possible Health Benefits of Circumcision?

The benefits listed below are true, but keep in mind that they are limited and must be viewed with a critical mindset.  The benefits of circumcision are limited for two main reasons: (1) the problems that they prevent are very rare or (2) the benefits found from this research are limited to specific populations; they are not generalizable to most of the world’s population. These potential benefits include the following:

• Decreased bacterial infections. Bacterial infections are less common in circumcised males because there are not as many hospitable places for bacteria to accumulate and grow. Circumcised males are less likely to experience urinary tract infections (UTIs) than uncircumcised males because it is not as easy for bacteria to build up and enter the urinary tract without the presence of a foreskin.⁵ However, UTIs are rare to begin with for people with penises. They affect about 3% of people with penises worldwide each year.¹⁴ UTIs are also easily treatable using antibiotics.
• Decreased risk of phimosis and other related medical conditions. Phimosis occurs when the foreskin cannot be fully retracted from the head of the penis. This medical condition is normal and usually harmless in infants.¹⁵ In older adolescents and adults, it is more commonly attributed to scarring, infection, or inflammation under the foreskin and can cause issues with urination and sexual activity.¹⁵ Circumcision can proactively eliminate the possibility of phimosis and can even be used to treat the condition depending on the severity of the case.¹⁵ However, phimosis can usually be treated with means other than circumcision and can often be prevented by using proper hygiene methods.¹⁵
• Decreased risk of HIV. In the last few decades, research conducted in Africa has found that circumcision on people with penises in populations like the ones studied lowers their risk of being infected with human immunodeficiency virus (HIV.)  In these specific populations, male circumcision may decrease a person’s risk of HIV infection by 50 to 60 percent.⁷ This lowered risk also benefits people who engage in intercourse with circumcised males, as they are less likely to contract HIV from their partner. However, protection such as external or internal condoms should still be used to protect against HIV and other STIs until both partners have been tested. Since this research can only be generalized to the populations in Africa in which the studies were produced, a decrease in the risk of contracting HIV for circumcised people cannot be guaranteed outside of these populations. Another limitation of these studies is that MSM (men who have sex with men), who make up a large part of new HIV cases in much of the world, have not been specifically studied regarding circumcision and HIV risk.¹⁷
• Decreased risk of other STIs. Studies have found that the likelihood of contracting other sexually transmitted infections (STIs) such as human papillomavirus (HPV), mycoplasma, and genital ulcer disease (GUD) was also reduced after circumcision in certain parts of Africa.¹⁷ A connection has even been found between circumcision and a decreased chance of contracting herpes, syphilis, and chancroid, although circumcision’s connection to these STIs might not be as strong as its connection to HPV.¹⁷  As with the studies on HIV, these results are limited to the African populations in which they were conducted. Once again, despite the decreased risk of transmission, protection should still be used during intercourse. 

What Are Some Possible Disadvantages of Circumcision? 

There are also some possible disadvantages to circumcision. These include the following:

• Possible reduced sensitivity. The foreskin is very erotically sensitive, leading many to fear that circumcision diminishes some of their sexual sensitivity and overall satisfaction. However, research has found that there are no significant adverse effects on sexual function, sensitivity, sensation, or satisfaction that accompany circumcision.¹⁹ Still, many uncircumcised males claim that their foreskins give them increased sexual pleasure.
• Possible complications during and after surgery. As with any surgical procedure, there are risks that accompany circumcision. The older a person is, the more likely they are to experience complications during their circumcision.¹⁷ If a person is sure they want to circumcise their child, it is best to have the procedure done earlier in life rather than later. However, adverse events—although very low in frequency—are not unheard of when it comes to circumcisions performed on infants. Still, this disadvantage might be seen as significant to some.
• Possible distress experienced by circumcised people later in life. Although there has not been much research done on the topic, many people who have undergone male circumcision report feeling psychological distress about their genitals later in life.²¹ Some feel distressed by the fact that their genitals were changed without their consent. They believe they would not have chosen to be circumcised if given the choice. Others report having intimacy issues as a result of their circumcision.²¹ They may feel anxious about the possible loss of sensitivity, which can lead to psychological difficulties with sexual intimacy.

What are the Ethical Implications of Male Circumcision?

Although many view circumcision as completely morally permissible, not everyone shares this view. Some argue that it is against the principle of bodily autonomy to circumcise a young child before they can understand or have an opinion on what is happening to their genitals.²² Others deem it unethical on the grounds that it is unnecessary.²² They do not believe that non-religious neonatal male circumcision should take place unless it is for a therapeutic reason such as treating phimosis. It is up to each person’s discretion whether they find these arguments compelling or not. However, the ethical implications of circumcision are worth considering when making the decision whether to circumcise one’s child.

Concluding Remarks 

Male circumcision continues to be a controversial issue: many believe there are benefits to removing the foreskin, while others feel it is better to leave it intact. In the end, both circumcised and uncircumcised males can lead satisfying sex lives. However, when the presence of a foreskin leads to a serious medical condition, circumcision should be considered as a viable option.

References

1. Jimoh, Bioku Muftau et al. “Plastibell Circumcision of 2,276 Male Infants: a Multi-Centre study.” Pan African Medical Journal, 23(25), 2016.
2. Elgendy, Hesham. “Evaluation of Gomco Clamp in Neonate and Early Infant Male Circumcision.” The Egyptian Journal of Surgery, 35(20), January 2016.
3. Abdulwahab-Ahmed, Abdullahi, and Ismaila A. Mungadi. “Techniques of Male Circumcision.” Journal of Surgical Technique and Case Report, 5(1), 2013.
4. “Newborn Circumcision: Caring for your child at home after the procedure.” About Kids Health, 10 June 2016.
5. “The Circumcision Procedure.” My Virtual Medical Centre, 27 July 2018.
6. Massry, Shaul G. “History of Circumcision: A religious obligation or a medical necessity.” Origins of Nephrology, 24(17). 2011.
7. Clark, Father Peter A. “To Circumcise or Not to Circumcise?” Catholic Health Association of the United States. Journal of the Catholic Health Association of the United States, 2006.
8. Hall, Robert G. “Epispasm: circumcision in reverse.” Bible Review. The Circumcision Referece Library, August 1992, revised 14 August 2012.
9. Nair et al. “De-circumcising the Past: Aulus Cornelius Celcus’s Contribution to Epispasm During the Hellenistic Period (323 BCE – 146 BCE).” The Journal of Urology,  vol. 189, no. 4S. AUA Journals, May 2013.
10.  Kellogg, J.H. Plain Facts for Old and Young. Segner & Condit, Burlington, Iowa, 1881.
11. Morris et al. “Estimation of country-specific and global prevalence of Male Circumcision.”Population Health Metrics, 14(4), 2016.
12. Warner et al. “Impact of Health Insurance Type on Trends in Newborn Circumcision, United States 2000 to 2010.” American Public Health Association, American Journal of Public Health, 105(9), September 2015.
13. Dubrovsky et al. “Visibility of the urethral meatus and risk of urinary tract infections in uncircumcised boys.” Canadian Medical Association Journal, 2012. 14 May 2018.
14.  ​​Silva, Joana C. “All you need to know about UTIs in men.” Medical News Today, 10 February 2018.
15. “Phimosis.” UCSF Department of Urology, n.d.
16. “Draft CDC Recommendations for Providers Counseling Male Patients and Parents Regarding Male Circumcision and the Prevention of HIV Infection, STIs, and Other Health Outcomes.” U.S. Department of Health and Human Services. E1-3. Centers for Disease Control and Prevention. 2 Dec. 2014.
17. Friedman, B. et al. “Pros and cons of circumcision: an evidence-based overview.” Clinical Microbiology & Infection, 22(9), 2016.
18. “Male circumcision.” Pediatrics 130.3 (2012): E756-785. Centers for Disease Control and Prevention. Web. 8 Jan. 2014.
19. Morris, Brian J. and John N. Krieger. “Does Male Circumcision Affect Sexual Function, Sensitivity, or Satisfaction? —A Systematic Review” The Journal of Sexual Medicine, 10(11), November 2013.
20. LeVay, Simon, Janice I. Baldwin, and John D. Baldwin. Discovering Human Sexuality. Sunderland, MA: Sinauer Associates, 2012. Print.
21.  Narvaez, Darcia F. “Circumcision’s Psychological Damage.” Psychology Today, 11 January 2015.
22.  Svoboda, S. “Nontherapeutic Circumcision of Minors as an Ethically Problematic Form of Iatrogenic Injury.” AMA Journal of Ethics, 19(8), 815-824, 2017.

Last Updated: 9 November 2021