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Cutting to the Point on Circumcision

To Snip or Not To Snip

A circumcision is usually performed within 48 hours of birth by an obstetrician or pediatrician in the hospital, or on the eighth day after birth for the Jewish ritual, called brit milah or bris. The baby is restrained, then the layer of tissue that covers the tip of the penis is surgically removed. It should take no more than five minutes in skilled hands.

When weighing the pros and cons of circumcising your baby, the most clear-cut medical benefits of circumcision are a four- to 10-fold decrease in the risk of urinary-tract infections during the first year of life, and a three-fold reduction in the risk of penile cancer among adult men.

However, urinary-tract infections and cancer of the penis are rare. The risk of developing a urinary-tract infection in an uncircumcised male infant is no more than 1%, and breast-feeding has been shown to protect against these infections among this group, according to the AAP. Only 10 or fewer men per 1 million get cancer of the penis each year worldwide.

Studies also show a somewhat higher incidence among uncircumcised men of sexually transmitted diseases, including syphilis and human immunodeficiency virus. However, the AAP says that the data are conflicting and highly controversial since behavioral factors play a larger role in contracting STDs than the existence or absence of foreskin.

Boys who are circumcised avoid the risk of phimosis, a condition that makes foreskin retraction impossible. However, the overall risk of penile problems for uncircumcised boys is unclear. The AAP cited one study that followed 500 boys up to age 8 and found higher rates of penile problems -- typically inflammation -- in infants who were circumcised, but more problems among older boys who were not circumcised.

As for the argument that circumcision improves hygiene, "that one doesn't really hold up," says Dr. George Kaplan, a clinical professor of surgery and pediatrics at University of California at San Diego and AAP task force member. "If you're not circumcised, I think that as long as you wash your penis, that's probably fine," Dr. Kaplan says. Bathing an uncircumcised baby simply requires washing the penis with soap and water. After the foreskin becomes retractable (typically by age 5), boys can be taught to gently pull back the foreskin to clean the tip of the penis.

On the other side of the coin, circumcision also presents some clear disadvantages.

For one thing, it hurts. Doctors used to think that infants didn't feel pain like adults and that circumcision didn't require anesthetic. Not anymore. Although it's hard to know just what they're feeling, it's clear that babies who are circumcised experience temporary changes in heart rate, blood pressure, oxygen saturation and hormone levels.

New research even shows that early exposure to pain may have long-term effects. One study found that infants who underwent circumcision without analgesics were more sensitive to pain during immunizations at four months and six months. Another found that newborns exposed to pain by circumcision or illness were more anxious about pain as children and adolescents.

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