Ask the Doctor: ‘Are there any real medical reasons for or against circumcision that we should consider ahead of the birth of our son?’

“My husband and I disagree about getting our soon to be born son circumcised. I was always led to believe it is more hygienic for males to be circumcised. My husband disagrees and says there are no medical reasons why we should do this to our child. Are there any real medical reasons for or against circumcision that we should consider making the right decision?”

Answer from Fardod O’Kelly MD MBA FFSEM FEBU FRCS (Urol) Consultant Paediatric & Adolescent Urological Surgeon, Beacon Hospital.

Male circumcision (or removal of the foreskin) is a practice which has likely been around for about 15,000 years. It has been described in tribal regions of Africa, Australasian aborigines, ancient Egyptian culture, Judaism and Islam. The practice is not necessarily one borne of religious practice, but has also become a cultural practice as well. The rate of circumcision is about 2-3% in Ireland, 6-8% in the UK, 20-25% in Canada, 50-60% in the USA, and in countries such as Turkey and Syria is less than 98%.

There have been a number of arguments put forward for circumcision including reduced risks of UTIs, hygiene and being preventative against things like penile cancer, cervical cancer and HIV. There is no compelling evidence that it does any of these things outside of high-risk populations, of which Ireland is not one.

There are some indications for circumcision which are reasonable including the prevention of infections in male infants with high-grade vesicoureteric reflux (reflux of urine from the bladder to the kidneys), conditions such as hypospadias where the underside of the penis needs to be reconstructed and the foreskin is sometimes used, recurrent infections of the foreskin and head of the penis (balanoposthitis), and BXO (Balanitis Xerotica Obliterans) which is an auto-immune condition where the body’s immune system affects the foreskin causing significant scarring.

As kids get older and the foreskin starts to retract, then maintaining good hygiene as well as bladder and bowel habits are arguably more important than having a child circumcised.

Unless there is a strong cultural, religious or health element to this, then it is important to consider the rights of the child to have kept their foreskin. Having an informed discussion with the parents and the child when they are older to understand, and ensuring they understand the risks, benefits and alternatives are critical here as regret can play a large part in the psyche of boys as they get older. Ultimately, weigh up the pros and cons and medical evidence and ask yourself if the child would be “better off” as a result of the procedure.

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