What is circumcision?

At birth, most boys have a sleeve of skin covering the end of the penis. This protective sleeve is called the foreskin. During a circumcision, this sleeve of skin is cut away, exposing the glans (head) of the penis. Circumcision is sometimes done a few days after birth under local anaesthetic or with no anaesthetic. Alternatively, it can be done at several months of age in hospital with a local or general anaesthetic, or even later in life.

Around the world, most Muslim and Jewish parents circumcise their boys for religious reasons. Among other families around the world, about 85% of boys aren’t circumcised. The only major western countries where circumcision is very common are the United States and Canada. Circumcision is uncommon in Britain, most of Europe and Asia, South America and Central America.

In Australia, most boys born around 1950 were circumcised. Since then, there has been a big move away from circumcision. Now only around 10 to 20% of Australian boys are circumcised.

What happens if a boy is uncircumcised?

At birth, the foreskin is joined to the underlying glans of the penis, so the foreskin can’t be pulled back. During childhood, the foreskin continues to cover and protect the sensitive glans. At some time during childhood for most boys, the foreskin separates from the glans and can be pulled back to expose the glans.

Once the foreskin can be easily pulled back, boys can wash underneath it while in the bath or shower. Generally, the foreskin is designed to look after itself. No special care is needed for an uncircumcised penis.

The foreskin is rich in nerve endings, and is felt to play an important role in sexual sensation and functions as boys grow older.

What happens if a boy is circumcised?

After the circumcision scar has healed, the glans will be permanently exposed. The appearance of the penis will depend on how much skin has been removed and where the cuts into the foreskin have been made. No special care is required for a circumcised penis.

Lots of parents worry about their boy’s penis, circumcised or uncircumcised. They worry that their son will feel or look different from other boys, or that his circumcision — or lack of it — is untidy or unusual. But boys themselves usually aren’t so bothered. An uncircumcised boy might ask a circumcised friend why he looks different, or vice versa, but it’s very unlikely to be a big issue for either of them.

What do the experts recommend?

Medical experts at The Royal Australasian College of Physicians (RACP) regularly review all the available evidence and have developed a circumcision policy for parents.

The most recent policy update from 2010 states that the RACP does not recommend routine circumcision of infant boys in Australia. However, the RACP makes it clear that it is reasonable for parents to weigh up the risks and benefits and to make the decision whether or not to circumcise their sons.

The circumcision debate

What are the arguments against circumcision?

Many parents may be against circumcision because the foreskin is a natural part of a boy’s body. Doctors advise against routine circumcision of baby boys as it is surgical procedure that carries risks that do not outweigh health benefits in most cases. In Australia, there are few medical reasons for circumcising a boy. Most health conditions caused by the foreskin can be easily treated these days.

Things can go wrong with circumcisions, even when the most experienced doctors do the operation. Short-term problems are mainly minor, such as bleeding after the operation. In very rare cases, problems can lead to damage to the urethra, gangrene and loss of the penis, or sometimes death. Long-term problems can include restricted urine outflow (meatal stenosis) and concerns about the appearance of the penis, particularly if too much skin has been removed, or if it’s uneven.

What are the arguments for circumcision?

People circumcise boys for religious, cultural, medical or personal reasons.

Being circumcised significantly reduces the risk that a baby boy will get a urinary tract infection and reduce the risk of infections under the foreskin. Urinary tract infection in males are not common.

Circumcision may also prevent the problem of having a foreskin that is inflamed or too tight. In most cases, your doctor can easily manage this condition using simple measures.

Circumcision isn’t known to have any other benefits for boys before puberty.

Men who are circumcised, either as adults or as children, have been shown to be partly protected from catching HIV (AIDS) in high-risk regions such as in Africa. They also have a lower risk of catching genital warts in countries where there’s no vaccination against genital warts (Australia does vaccinate).

Circumcision also almost eliminates the risk of cancer of the penis, which mainly occurs in older men who have tight foreskins that can’t be pulled back. However, this an extremely rare condition with an incidence of 1 in 250,000 men in Australia.

Your choice

Whatever you decide, your boy is likely to have a normal childhood and adult life, without significant concerns about his penis.

Talk to your doctor about the risks and benefits of circumcising your son. If you’re not sure what to do, you can leave your boy with his foreskin and allow him to make the decision for himself as an adolescent boy or young adult.

Planning in advance

If you decide to have your son circumcised, you can take steps to make sure the operation is done safely. Start by ensuring that the doctor circumcising your son is experienced. Ask how many procedures the doctor has done and how many complications have occurred. All doctors are required to give you balanced information and to respect your decision.

Try also to ensure that your son receives adequate pain relief during and after the procedure. Check that you have good access to the doctor for follow-up after the surgery. Also ask about any costs to you.

Note that some Australian states won’t allow circumcisions to be done in public hospitals without a medical reason.