To Cut or Not To Cut: Examining the Evidence

Editor's Note (2026): This article has been updated where medical or scientific recommendations have changed since it was originally published. Updated information is marked with an asterisk (*) and explained in the Update Notes at the end of the article.

Circumcision is still a heated argument. The majority of American men are circumcised, while circumcision is much less common in most of Europe. Many myths and misplaced arguments float around the debate. I have researched the general stance of the major players, and the debate seems to come down to two very different questions.

The first question is medical: does circumcision provide measurable health benefits? The answer appears to be yes, although the size and practical importance of those benefits remain part of the debate. Circumcision is associated with lower rates of urinary tract infections in infancy, reduced risk of some sexually transmitted infections in men, lower risk of phimosis, and lower risk of penile cancer, although penile cancer is very rare.* Urinary tract infections during infancy are uncommon overall but occur several times more frequently in uncircumcised male infants than in circumcised infants. Phimosis is a condition in which the foreskin cannot be retracted normally; many young boys naturally have a non-retractable foreskin that resolves on its own, but persistent or pathologic phimosis can occasionally require treatment. Many foreskin conditions, including most cases of phimosis, can be treated medically (for example, with topical corticosteroid creams) before circumcision is considered. Because penile cancer is already extremely uncommon in developed countries, this particular benefit has relatively little influence on most medical recommendations.

Many of these benefits are real, but they are not all equally large. Physicians often distinguish between relative risk reduction and absolute risk reduction: a treatment that cuts risk in half may sound dramatic, but if the original risk is already very small, the actual benefit to an individual may also be small. Modern medical guidelines also recommend using appropriate pain control during the procedure, such as local anesthetics, because newborns experience pain just as older children and adults do.* Complications are uncommon when the procedure is performed by trained clinicians, especially in newborns, but they can include bleeding, infection, inadequate or excessive skin removal, irritation, pain, and rarely injury; serious complications remain rare when the procedure is performed by experienced clinicians during infancy.

The second question is ethical: are those benefits enough to justify performing an irreversible surgery on an infant who cannot consent? That question is harder. Opponents are not simply arguing that circumcision is cruel. Their strongest argument is that the procedure is usually not medically urgent, is permanent, and removes tissue from a child before he is old enough to decide for himself.

For many families, circumcision is not primarily a medical decision. It is a religious, cultural, or family tradition that has been practiced for thousands of years. For some families, religious obligation alone settles the question regardless of the medical evidence. My goal isn't to argue against those traditions or encourage them. Instead, I want to summarize what current medical research says so parents can make an informed decision alongside their own religious, cultural, and personal beliefs.

The American Academy of Pediatrics does not recommend routine circumcision for every newborn boy. Its 2012 policy statement concluded that the health benefits outweigh the risks and that the procedure should be available to families who choose it.* Many European medical organizations tend to be more cautious, often placing more weight on consent, bodily autonomy, and the fact that many of the possible benefits can also be reduced through hygiene, condoms, vaccines, safe sex education, and medical treatment when problems occur.* This matters because circumcision is only one possible prevention tool, not the only way to reduce these risks. Interestingly, European medical organizations have reviewed much of the same scientific evidence as American organizations but have generally placed greater emphasis on bodily autonomy and informed consent, leading them to different policy recommendations. HPV vaccination in particular has changed the discussion considerably since 2011, when routine vaccination for boys was recommended in the U.S.*

The HIV evidence is probably the most cited medical argument for circumcision. Randomized trials in sub-Saharan Africa found that voluntary medical male circumcision reduced female-to-male heterosexual HIV transmission by about 50 to 60% among adult heterosexual men in high-HIV-prevalence African settings.* That is significant evidence, but it should not be overstated. Those figures describe voluntary circumcision performed on adult men in a specific high-prevalence context; they do not automatically apply to newborn circumcision in the United States, and they do not by themselves prove that routine circumcision of American newborns is necessary as a public health strategy. Since those original trials, WHO, UNAIDS, CDC, and PEPFAR have continued to support voluntary medical male circumcision as one component of HIV prevention in high-prevalence countries, but they consistently emphasize that circumcision provides only partial protection and should always be combined with other prevention strategies such as condoms, HIV testing, and treatment.* Modern HIV prevention also includes highly effective strategies such as PrEP (pre-exposure prophylaxis), along with widespread testing and treatment, all of which have changed the public health landscape considerably since the original circumcision trials were conducted.* As with the other benefits discussed above, the 50-60% figure is a relative risk reduction, not an absolute one, and its practical impact depends heavily on the underlying prevalence of HIV in a given population.

Researchers have also studied whether circumcision affects sexual pleasure or function. The evidence remains mixed: some systematic reviews, including work published in the Journal of Sexual Medicine, have found little or no consistent difference in sensitivity, arousal, or satisfaction, while other reviews have described the overall body of evidence as contrasting and inconclusive. The topic continues to be debated.

So I would no longer say, as strongly as I once did, that circumcision will eventually be accepted worldwide as a cost-effective fight against STDs. The evidence supports real benefits. But whether those benefits justify routine infant circumcision remains a debated medical, ethical, cultural, and religious question. Please read the information and decide for yourself.

One thing I noticed while researching circumcision is that there is actually much more agreement than disagreement among medical organizations. Many major medical organizations recognize measurable medical benefits from circumcision, but they differ on how much weight those benefits should carry in recommending routine infant circumcision.

The strongest evidence for circumcision includes:

• Lower rates of urinary tract infections during infancy.*
• Reduced risk of developing phimosis and several other foreskin disorders.*
• Lower risk of penile cancer, although penile cancer is already extremely rare.*
• Lower rates of female-to-male heterosexual HIV transmission in high-risk populations.*
• Some reduction in the risk of HPV and possibly herpes infection.*

The strongest arguments against routine circumcision are different. Most opponents are not arguing that circumcision has no medical benefits. Instead they argue that:

• The surgery is irreversible.
• The child cannot consent.
• Serious medical problems requiring circumcision are relatively uncommon.
• Many of the health benefits can also be achieved through hygiene, vaccination, condoms, and modern medical care.

This is one reason the debate continues. The disagreement today is less about whether circumcision has benefits and more about whether those benefits justify routine infant circumcision.

Update Notes

1. Medical benefits (UTIs, phimosis, penile cancer)
   Originally written: "Those include preventing recurring infections of the head of the penis, avoiding obstruction of urine flow that can result when the prepuce's opening narrows, and preventing a tight prepuce from retracting over the glans. Also, circumcision may reduce the incidence of penile cancer (a very rare condition)."
   Why I changed it: The underlying list of benefits hasn't changed, but I added language clarifying that a real relative benefit can still be a small absolute benefit, since several of these conditions are already rare in developed countries.
   Current understanding: UTIs remain several times more common in uncircumcised infants; phimosis is common in young boys and often resolves on its own, and when treatment is needed, topical steroid creams are usually tried before circumcision; penile cancer risk reduction is real but carries little practical weight given how rare the disease already is in developed countries.
   Sources: American Academy of Pediatrics; American Urological Association; European Association of Urology Guidelines on Paediatric Urology.

2. Pain management
   Originally written: Not addressed in the original article.
   Why I changed it: Pain management wasn't discussed at all in 2010ish sourcing. Current pediatric guidelines treat adequate pain control (such as local anesthesia) as a standard part of newborn circumcision, so I added it.
   Current understanding: Pain control is considered standard of care for newborn circumcision, and serious complications remain uncommon when the procedure is performed by trained clinicians.
   Sources: American Academy of Pediatrics.

3. AAP policy statement
   Originally written: "The American Academy of Pediatrics has called the evidence 'complex and conflicting,' and has continued to take a neutral stance on the subject."
   Why I changed it: The AAP later issued a formal 2012 policy statement concluding that the benefits of newborn circumcision outweigh the risks, though it stopped short of recommending routine circumcision for every boy.
   Current understanding: AAP policy statements automatically expire five years after publication unless reaffirmed, and the 2012 statement expired in 2017 without being reaffirmed or replaced. It remains the AAP's most recently published statement on the topic and is still widely cited, but it should not be described as active official policy.
   Sources: AAP 2012 policy statement; AAP commentary noting the 2012 statement's expiration.

4. HPV vaccination
   Originally written: Not addressed in the original article.
   Why I changed it: Routine HPV vaccination for boys wasn't recommended in the U.S. until the CDC's Advisory Committee on Immunization Practices (ACIP) added it in October 2011, after this article was first written.
   Current understanding: Vaccination now offers a non-surgical way to reduce HPV risk, which has somewhat changed the calculus around circumcision as an HPV-prevention strategy.
   Sources: CDC/ACIP recommendations on HPV vaccination for males, 2011.

5. HIV risk figures
   Originally written: "National Institutes of Health published a surprising report in The Lancet showing that circumcision reduced a man's risk of contracting HIV through heterosexual sex by 51 to 60 percent..." and, elsewhere, "Male circumcision reduces the risk that men will contract HIV through intercourse with infected women by about 70 percent."
   Why I changed it: I consolidated these into the commonly cited 50-60% range and made explicit that the figure describes voluntary medical male circumcision among adult heterosexual men in high-HIV-prevalence African settings, not newborn circumcision in the United States, and that it reflects a relative risk reduction, not an absolute one.
   Current understanding: WHO, UNAIDS, CDC, and PEPFAR continue to support voluntary medical male circumcision as one part of combination HIV prevention in high-prevalence countries, but all consistently frame it as partial protection to be paired with condoms, testing, and treatment, not a stand-alone solution. The prevention landscape has also changed substantially since the original African trials: highly effective PrEP (pre-exposure prophylaxis), along with wider testing and treatment, are now major tools that didn't exist when those trials were conducted.
   Sources: CDC, Voluntary Medical Male Circumcisions for HIV Prevention; WHO, Voluntary medical male circumcision for HIV prevention; CDC, Preventing HIV with PrEP.

6. European policy differences
   Originally written: "According to the BBC in the UK, routine circumcision isn't thought to be medically necessary."
   Why I changed it: I expanded this into a fuller point: European medical bodies aren't a single voice, but many of them have reviewed much of the same evidence as U.S. organizations and simply weigh consent and bodily autonomy more heavily, leading to more cautious recommendations rather than a disagreement over the underlying science.
   Current understanding: The European Association of Urology's paediatric guidelines, for example, favor conservative treatment (such as topical steroids) over routine circumcision for most non-medical cases, and explicitly state that routine neonatal circumcision to prevent penile cancer is not indicated, a more cautious position than the AAP's, drawn from much of the same underlying evidence.
   Sources: European Association of Urology, Guidelines on Paediatric Urology.

Sources

• American Academy of Pediatrics. Circumcision Policy Statement. Pediatrics, 2012. https://publications.aap.org/pediatrics/article/130/3/585/30235/Circumcision-Policy-Statement
• American Academy of Pediatrics. Commentary noting the 2012 circumcision policy has expired. https://publications.aap.org/pediatrics/resources/26134/Commentary-From-the-Section-on-Uniformed-Services
• CDC. Voluntary Medical Male Circumcision for HIV Prevention. https://www.cdc.gov/mmwr/volumes/72/wr/mm7210a2.htm
• WHO. Voluntary Medical Male Circumcision for HIV Prevention. https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hiv/prevention/voluntary-medical-male-circumcision
• CDC/ACIP. Recommendations on HPV Vaccination for Males, 2011. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6050a3.htm
• American Urological Association. Circumcision Statement. https://www.auanet.org/about-us/aua-statements/circumcision
• CDC. Preventing HIV with PrEP. https://www.cdc.gov/hiv/prevention/prep.html
• CDC. HIV Prevention. https://www.cdc.gov/hiv/prevention
• European Association of Urology. Guidelines on Paediatric Urology. https://uroweb.org/guidelines/paediatric-urology