I've written before about the circumcision debate as San Francisco decides whether to ban routine infant circumcision. I thought I'd break down my thoughts on the risk/benefit analysis, bearing in mind that I'm not medically trained. I'll start by looking at the benefits that are often listed for circumcision.
- decreased risk of UTI. From the studies I've seen, there does appear to be a decreased risk of UTI with circumcision. However, the risk of the child contracting a UTI in the first place is rather small, so that over 100 boys would need to be circumcised in order to prevent 1 UTI. Of those that do contract UTIs, very few will be serious. I've seen some debate about whether the increased risk of UTI is more about lack of breastfeeding (which protects against UTI) and premature, forceful retraction of the foreskin, since the foreskin protects against infection when left alone. It therefore seems like a miniscule risk of UTI, so I don't see circumcision as a necessity for that.
- HIV and other STDs. There are conflicting data on whether circumcision decreases a man's odds of contracting HIV and other STDs. Even if it does, though, abstinence and monogamy remain the only surefire ways of avoiding these diseases. Abstinence and monogamy don't require anything to be done to the infant boy, either. Once again, I don't see how this justifies a surgical procedure.
- cancer. It's often noted that penile cancer seems to occur exclusively in uncircumcised men. There's also information about partners of uncircumcised men having a higher incidence of cervical cancer. Both penile and cervical cancer are often caused by HPV, a sexually transmitted disease. Again, abstinence and monogamy are the best protectors. It's true that I cannot guarantee that my son will follow Church teachings on sexual morality, but neither can I assume that he won't follow them. I can't see justifying a surgical procedure on the chance that my son might not follow Church teachings, though.
- avoid phimosis and similar issues - Sometimes phimosis is actually caused by premature retraction of the foreskin, done by well-meaning family or medical professionals to clean or examine the penis. This shouldn't be done. Proper hygiene also decreases the risks of problems. Rarely, circumcision will be needed later, but there are usually other treatments to try first. Also, these issues are not unique to uncircumcised men, though they are rarer in circumcised men.
-hygiene - There seems to be a myth that circumcision allows for better hygiene. But there isn't any special care needed for uncircumcised boys, and the foreskin should be left alone until it's retractable. At that point, the boy can clean under the foreskin when bathing, but nothing else is required. Given that we have access to clean water and modern sanitation, I don't see this as an argument for routine infant circumcision, either.
So just based on the stated benefits of circumcision, I don't see that the benefits are significant enough to justify any action. So what about any risks? I've read that risks occur in anywhere from 1-5% of circumcisions; while this number isn't huge, it's something to take into account, especially given that, as far as I am concerned, the benefits of circumcision are not great enough to warrant action. I do think it's telling that the AAP also states that there's no compelling reason to circumcise, since the benefits don't outweigh the risks. These are just my thoughts, of course.