Should You Circumcise Your Baby Boy?

I don't know.

In the spirit of “strong opinions, loosely held” and inspired by Nancy Reddy who, like me, doesn’t know a lot of things, this post is about a topic on which I hold very uncertain, conflicting opinions: circumcision of newborn baby boys.

I’m writing about this in part because a report just came out showing that the rate of neonatal circumcision in the U.S. has fallen significantly over the last decade, from 54.1% in 2012 to 49.3% in 2022—meaning less than half of baby boys are now circumcised.

So have no fear—whatever you decided, your son will not be the lone weirdo ashamed to undress in the locker room.

This change is partially driven by demographics, with Hispanic babies, whose parents typically don’t circumcise, representing a bigger slice of the newborn pie than in years past. But it is also because non-Hispanic White people are choosing to circumcise their sons less often.

Here’s a quote from the research summary article, and a link to the JAMA article.

There was a significant 5.3 percentage point decline among white neonates to 60%, while prevalence among Black and Hispanic neonates remained stable, at 66.1% and 21% in 2022, respectively, the researchers noted in JAMA Pediatrics.

So apparently, our nation is about as polarized on the issue of male circumcision as we are gun control, abortion and support for Trump.

You may think I’m joking, but I’m really not. My co-worker attended a neonatal circumcision training at the American College of Nurse Midwives (ACNM) conference a few years back, and the room was not announced publicly due to concerns about “Intactivist” protesters who gathered outside the convention hall with plans to dissuade people participating in this workshop. The Intact America advocacy group is frequently seen outside hospitals and medical conventions of the American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG) advocating against routine infant circumcision.

On the other side of things, we have the AAP making the statement that:

Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks and that the procedure’s benefits justify access to this procedure for families who choose it.

But also pointing out:

Although health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it and to warrant third-party payment for circumcision of male newborns. It is important that clinicians routinely inform parents of the health benefits and risks of male newborn circumcision in an unbiased and accurate manner.

So where do we go from here?

A bit of background: I am a hospital-based certified nurse-midwife (CNM) in the United States, and my job requires performing neonatal circumcisions when requested by parents. I trained in this procedure over a decade ago, and it is relatively simple and safe—something I feel confident performing. No part of my salary is determined by how many circumcisions I do. I promise that I get paid the same whether or not parents choose circumcision for their sons.

When well-informed parents have reviewed the risks and benefits and chosen to circumcise, I have no qualms about providing it. If I believed neonatal circumcision were deeply unethical, I wouldn’t do it.

At the same time, when I discuss the procedure’s risk and benefits, I often have parents ask me “What do you think?” or “What would you do?” or “Did you circumcise your sons?”

These questions make me squirm a little bit. Enter UNCERTAINTY.

The rest of this post is an embrace of that uncertainty. It will undoubtedly offend some people who have strong opinions, strongly held on the issue of male circumcision. In spite of this, I’m going to share my meandering thoughts in the hopes that it will make the decision easier for some parents, or perhaps soften the views of people who feel completely sure they know the right answer.

First thought: Sometimes the best decision is only known in retrospect

I have a cousin who says his circumcision was botched. He has three kids, so clearly it wasn’t botched THAT badly, but I don’t know the details (and I’m not asking—that’s weird). Anyway, because of this, he feels strongly that routine neonatal circumcision is the wrong, and given his experience, that makes sense. He didn’t circumcise either of his sons.

His sister, however, works in public health and has done extensive research in Africa, where male circumcision has been shown to reduce rates of STIs significantly. She was appalled by his decision not to circumcise. From her perspective, circumcision is a public health measure—comparable to vaccination—that helps prevent the spread of infections like HIV, HPV, herpes, syphilis, and gonorrhea. These benefits extend to women as well, since female partners have a lower risk of cervical cancer (linked to HPV) and HIV when men are circumcised.

I can see both sides. I am public-health–minded myself, but this is a difficult conversation to have with parents during the consent process. I mean, can you imagine a medical professional having this conversation with you?

“So, let’s talk about your newborn baby’s future sex life. Do you think he’ll be fairly monogamous, or more promiscuous? Because if you expect the latter, circumcision may offer some protection to him and his female partners.”

You can see how this is awkward. It’s not an easy pitch—asking parents to accept immediate risks (pain, bleeding, infection) for benefits that may or may not materialize decades later.

Beyond STI prevention, there’s also evidence that circumcision lowers the risk of urinary tract infections in infancy (though those are rare to begin with) and certain penile conditions—like balanitis, posthitis, balanoposthitis, and phimosis. If you’ve never heard of these, that’s probably because they’re not all that common.

Still, I’m not fully convinced by this argument. By the same logic, we could eliminate appendicitis by removing everyone’s appendix, or prevent ovarian cancer by routinely removing women’s fallopian tubes after childbearing. Preventive surgery for hypothetical problems doesn’t always feel justified—especially when surgery is kind of a big deal.

I mean, I guess it depends on the extent of the protection verses the extent of the intervention’s risks—facts which simply aren’t known with a one-day-old baby.

Personally, I practice in a community that’s largely Hispanic, where circumcision is not common. When I discuss the procedure with immigrant parents, I often get blank stares, followed by looks of confusion or even disgust, and a sort of a “No, I would not like you to mutilate my baby boy’s penis” response. However, I do see that Hispanic families who choose circumcision often have good reasons—like an older child who had problems and required circumcision later, or a father who regrets not having had one done in his childhood because of adult medical issues.

Obviously, if I had a crystal ball and knew who was going to have problems later on, I’d know when to recommend circumcision. But I don’t. I will point out that a boy or man can always get a circumcision later in his life to treat a medical problem—though admittedly, the trauma is greater—whereas you cannot change your mind and undo a circumcision that’s already done.

Second thought: It’s hard to have a strong opinion when I don’t have a penis

When I had to make this decision for my two boys, it was hard, so I did what many moms do—I forced the decision on my husband. I’m mostly kidding. We decided together, but I will say that I was on the fence enough that if he’d had a strong opinion, we would have gone with it. Afterall, what do I know about having a penis?

One thing that my pediatrician said that really helped me was “No matter what you decide, he’ll probably own it.”

His point was simple: most men like their penises. They don’t spend a lot of time wishing for a different one. While some “intactivists” claim that circumcised men are denied sexual pleasure, it is not my impression that too many men struggle with enjoying sex, whether or not they are circumcised. It also doesn’t seem like penis problems with intact foreskins are popping up left and right.

Knowing this calmed my fears because I always wondered “What if my boys grow up to resent this decision and hate me?! What if they compare themselves to other boys in the locker room and get made fun of?! What if they hate their bodies and it’s all my fault?!”

It turns out, this is probably just overdone parental worry. And honestly, it’s reassuring to see the stats and realize that, whichever way we went, about half of his peers would look like him anyway.

Final thought

In conclusion, the risks of neonatal circumcision are fairly small, and so are the benefits. It is not known whether your newborn baby boy will experience more of the risks, or more of the benefits from either decision. Circumcision can always be done later—but would likely be much more traumatic. It cannot be undone once it is done.

So with that being said, if you are parents making this decision, good luck! Compared to many other parenting decisions you’ll make down the line, this one is a cupcake because either decision is probably fine. More than anything, I hope you feel confident and all goes well.