What Parents Need To Know About Infant Circumcision

Circumcision (the surgical removal of the foreskin from the penis) is a common practice in some parts of the world, but in most cases, it is not a medically required one. In the U.S., around 58% of newborn boys are circumcised (1). In many European countries, circumcision is under 5% (2). Globally, most boys grow up intact. 

In this article, we break down the facts behind circumcision, explain the role of vitamin K in circumcision safety, and offer guidance on how to care for an intact penis. 

Why Do Some Parents Choose Circumcision? 

Circumcision is a deeply personal decision, and for some families, religious or cultural tradition will guide the choice. For others, understanding the true medical risks and any potential benefit is an important part of the decision-making process. 

Let’s review what the science shows:  

Circumcision & Urinary Tract Infections (UTIs) 

There is a 1999 study in which circumcision was shown to slightly reduce the risk of UTIs during infancy (3). It is important to note that the overall risk of UTI is low in healthy boys. Only about 1% of boys experience a UTI in the first year of life (4). It is also important to note that UTIs are usually treatable with antibiotics. Routine circumcision solely for the potential protective benefit against UTIs is not medically recommended. 

I want to note that in my 15 years of clinical practice, I’ve often observed the opposite: boys who were circumcised sometimes experienced more UTIs, and I have seen this be accompanied by adhesions from the circumcision surgery, which can complicate hygiene and increase risk of urinary tract infection. 

Circumcision & Sexually Transmitted Infections (STIs) 

Historically, research has shown circumcision to reduce the risk of HIV transmission among men in some high-risk adult populations (5). In low-prevalence countries like the U.S. and most of Europe, with access to safe sex practices and education, this benefit is minimal. 

For other STIs such as HPV, herpes, or syphilis, the protective effect of circumcision is either small, inconsistent, or clinically insignificant when safe sex practices are used (6).  

Circumcision & Penile Cancer 

Penile cancer is extremely rare in developed countries, with fewer than 1 case per 100,000 men per year in the U.S. (7). While circumcision is associated with slightly lower rates of penile cancer (8), it’s important to note that most cases of penile cancer are linked to underlying conditions such as chronic inflammation, poor hygiene, HPV infection, or untreated phimosis, not the presence of a foreskin. In other words, it’s not the foreskin itself that poses the risk, but how it’s cared for. 

Good hygiene and attention to these risk factors can offer the same protective effect as circumcision, without the need for surgery (9). 

Circumcision & Hygiene 

Modern evidence shows that proper hygiene can easily be maintained without circumcision. Claims that an intact penis is inherently “unclean” or difficult to care for are outdated and not supported by research (10). 

Circumcision & Phimosis 

Phimosis (a condition where the foreskin cannot be retracted) is normal in infancy and early childhood (11). Most foreskins naturally become retractable over time, often by puberty.  

Pathological phimosis is rare. When does occur, first-line treatment consists of 4-6 weeks of corticosteroids, which resolves about 65-95% of cases (12,13). In the rare situation where pathological phimosis does not resolve with topical corticosteroids, circumcision is sometimes medically indicated (14).  

Circumcision & Family/Cultural Norms 

Some families choose circumcision to match the appearance of a father or siblings or to align with social expectations. While this is a valid personal consideration, it is not a medical necessity. 

To learn more about other procedures commonly performed soon after birth, read these articles:

• Newborn Screening: The Infant Heel Stick Test
• Understanding Newborn Antibiotic Eye Ointment
• Infant Hearing Tests: What Every Parent Should Know 

The Risks of Circumcision 

It is important for parents to understand the risks of this elective surgical procedure: 

Is Circumcision Painful? 

As is the case with all surgeries, circumcision causes some degree of pain, even when local anesthetic is used.  

Circumcision & Surgical Complications  

Though uncommon, complications occur in around 1.5% of hospital circumcisions (13) and can include: 

• Bleeding 
• Infection 
• Poor cosmetic result 
• Meatal stenosis (narrowing of the urethral opening; more common in circumcised males) 
• Excessive or insufficient skin removal 
• Adhesions or skin bridge 

Circumcision & Loss of Erogenous Tissue 

The foreskin contains thousands of nerve endings and specialized tissue. Circumcision permanently removes this tissue, which has led some to question whether it affects future sexual function. While studies don’t show a significant difference in sexual satisfaction, function, or overall pleasure (14), the fact is that we are removing tissue and nerve endings. 

Ethical Considerations around Circumcision 

Circumcision is irreversible and performed on babies who cannot consent.  

It is important to note that circumcision can still be chosen at a later time. 

Parents often feel pressured to make this decision in the newborn period. However, circumcision is not urgent unless there is a rare medical indication. Boys can safely choose circumcision later in adolescence or adulthood, at an age where they are able to provide informed consent. 

Vitamin K & Circumcision 

Vitamin K is essential for blood clotting. Newborns naturally have low vitamin K levels, which is why a vitamin K shot is commonly given after birth to prevent Vitamin K Deficiency Bleeding (VKDB), a rare but potentially fatal condition. 

Because circumcision involves cutting tissue, providers are generally very hesitant to perform this procedure in babies who have not received vitamin K, and many will decline to circumcise if the shot is refused. In the U.S., some hospitals are becoming more open to an oral regimen, which is already commonly used in Europe, though acceptance still varies by provider. 

If declining vitamin K all together, there is evidence to suggest that timing matters: in one small study, circumcisions performed at 14 days of age on infants who had not received intramuscular vitamin K showed no bleeding complications (15). 

To learn more, read this article: Why Infants Get Vitamin K1 At Birth and listen to this podcast episode. 

Caring for the Intact Penis 

Caring for an intact penis is simple: 

• In infants and young boys, the foreskin is typically not retractable. This is normal and protective. 
• Do not forcibly retract the foreskin. This can cause pain, scarring, and infection. 
• Clean the external penis with warm water during baths. No internal cleaning is needed until the foreskin becomes naturally retractable. 
• As your child grows, teach gentle hygiene: once the foreskin retracts naturally, it can be pulled back to rinse with water during bathing. 

Summary 

Circumcision is an elective procedure, not a medical necessity for most healthy newborn males. Any minor protective benefits it may offer are typically achievable through less invasive means, such as simple good hygiene. The procedure carries risks, removes specialized tissue, and is performed on infants who cannot consent. Globally, the majority of men are not circumcised. 

For families choosing to leave their sons intact, penis care is simple: no forced retraction, gentle external cleaning, and proper hygiene as the child grows. 

References:  

1. National Center for Health Statistics. Products – Health E Stats – Trends in Circumcision Among Male Newborns Born in U.S. Hospitals: 1979–2010. (2019, June 1). Www.cdc.gov. https://www.cdc.gov/nchs/data/hestat/circumcision_2013/circumcision_2013.htm 
2. Morris, B.J., Wamai, R.G., Henebeng, E.B. et al. Estimation of country-specific and global prevalence of male circumcision. Popul Health Metrics 14, 4 (2016). https://doi.org/10.1186/s12963-016-0073-5 
3. Shapiro E. American academy of pediatrics policy statements on circumcision and urinary tract infection. Rev Urol. 1999 Summer;1(3):154-6. PMID: 16985788; PMCID: PMC1477524. 
4. Practitioners, T. R. A. C. of general. (2016, August). Paediatric urinary tract infections: Diagnosis and treatment. Australian Family Physician. https://www.racgp.org.au/afp/2016/august/paediatric-urinary-tract-infections-diagnosis-and 
5. Weiss HA, Dickson KE, Agot K, Hankins CA. Male circumcision for HIV prevention: current research and programmatic issues. AIDS. 2010 Oct;24 Suppl 4(0 4):S61-9. doi: 10.1097/01.aids.0000390708.66136.f4. PMID: 21042054; PMCID: PMC4233247. 
6. Morris BJ, Hankins CA, Tobian AA, Krieger JN, Klausner JD. Does Male Circumcision Protect against Sexually Transmitted Infections? Arguments and Meta-Analyses to the Contrary Fail to Withstand Scrutiny. ISRN Urol. 2014 May 13;2014:684706. doi: 10.1155/2014/684706. PMID: 24944836; PMCID: PMC4040210. 
7. Engelsgjerd JS, Leslie SW, LaGrange CA. Penile Cancer and Penile Intraepithelial Neoplasia. [Updated 2024 Sep 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499930/ 
8. Larke NL, Thomas SL, dos Santos Silva I, Weiss HA. Male circumcision and penile cancer: a systematic review and meta-analysis. Cancer Causes Control. 2011 Aug;22(8):1097-110. doi: 10.1007/s10552-011-9785-9. Epub 2011 Jun 22. PMID: 21695385; PMCID: PMC3139859. 
9. Morrison BF. Risk Factors and Prevalence of Penile Cancer. West Indian Med J. 2014 Jul 3;63(6):559-60. doi: 10.7727/wimj.2015.381. PMID: 26225809; PMCID: PMC4663967. 
10. Krueger H, Osborn L. Effects of hygiene among the uncircumcised. J Fam Pract. 1986 Apr;22(4):353-5. PMID: 3958682. 
11. Shahid SK. Phimosis in children. ISRN Urol. 2012;2012:707329. doi: 10.5402/2012/707329. Epub 2012 Mar 5. PMID: 23002427; PMCID: PMC3329654. 
12. Stacey, S. K., & McEleney, M. (2021). Topical Corticosteroids: Choice and Application. American Family Physician, 103(6), 337–343. https://www.aafp.org/pubs/afp/issues/2021/0315/p337.html 
13. Shahid SK. Phimosis in children. ISRN Urol. 2012;2012:707329. doi: 10.5402/2012/707329. Epub 2012 Mar 5. PMID: 23002427; PMCID: PMC3329654. 
14. McPhee AS, Stormont G, McKay AC. Phimosis. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK525972. 
15. Weiss HA, Larke N, Halperin D, Schenker I. Complications of circumcision in male neonates, infants and children: a systematic review. BMC Urol. 2010 Feb 16;10:2. doi: 10.1186/1471-2490-10-2. PMID: 20158883; PMCID: PMC2835667. 
16. Morris BJ, Krieger JN. The Contrasting Evidence Concerning the Effect of Male Circumcision on Sexual Function, Sensation, and Pleasure: A Systematic Review. Sex Med. 2020 Dec;8(4):577-598. doi: 10.1016/j.esxm.2020.08.011. Epub 2020 Sep 30. PMID: 33008776; PMCID: PMC7691872. 
17. Mendelson JL, Jacobs A, Vega DA, Brenseke W, Glasser C, Fine RG, Friedman SC, Horowitz M, Gitlin JS. Neonatal circumcisions and parental refusal of intramuscular vitamin K: A review of the literature and current guidelines. J Pediatr Urol. 2024 Dec 24:S1477-5131(24)00675-2. doi: 10.1016/j.jpurol.2024.12.014. Epub ahead of print. PMID: 39743430.