Circumcision Should Be a Last Resort
A board-certified dermatologist's clinical perspective on routine medical circumcision — and why the evidence doesn't support it
Circumcision is a very common practice in the US, with most male babies being circumcised regardless of religion. This is going to generate disagreement — but it needs to be said. In my view, circumcision should be performed under two circumstances: religious faith (Jewish at 8 days of age, or Muslim according to the faith tradition), or an ongoing medical issue that genuinely requires circumcision to resolve. I do not support the wide use of so-called routine medical circumcision. Here's why.
First: Circumcision Is Not a Minor Procedure
Leaving costs aside, circumcision is a surgical procedure. Even when performed to address a medical problem or as an article of faith, it carries real risks — infection, scarring, disfigurement, altered sensitivity of the area, and others. As a physician, my foremost principle is to do no harm. Before recommending any surgical procedure, the benefits must clearly outweigh the risks. For routine non-religious circumcision in the general US population, that threshold is not convincingly met.
The STI Prevention Argument — Examined
The Research Is Inconsistent
Studies claiming circumcision reduces the prevalence of sexually transmitted infections — including HIV, HSV, and warts — are of mixed quality and design. Some claim significant reduction in certain infection types in high-risk populations, though this is not consistent across the literature. These studies also relied heavily on self-reported behavior, which is by default highly unreliable as a data source.
Causality Has Not Been Established
Even accepting a lower rate of infection in treated groups at face value, establishing causality — the direct effect of circumcision leading to decreased infection — requires ruling out the enormous number of other variables that determine one's trajectory of infection over a lifetime in society. That standard has not been met.
The Numbers Needed to Treat
In the most favorable studies — conducted in high-risk populations — the number of men who would need to be circumcised to prevent one HIV infection is approximately 50. The vast majority of the US population is not at high risk for HIV or STIs. For the general population, circumcision as a preventive measure against HIV is a serious overkill — particularly when HIV is effectively preventable through condom use, and when pre-exposure and post-exposure prophylaxis are available, far safer, and far easier to implement.
The Medical Conditions Argument — Condition by Condition
Balanitis
Probably the most common condition cited in support of circumcision. And the most easily managed without it. In many hundreds of balanitis cases seen in clinical practice, circumcision was not required a single time. Exceptional skincare and targeted topical medication from an experienced dermatologist resolves the vast majority of balanitis cases.
Urinary Tract Infections
UTIs are exceptionally rare in men. When they do occur, they frequently point to a specific structural issue that needs direct investigation and targeted treatment — not circumcision as a preventive measure.
Penile Cancer
Very rare. Recognizable in the vast majority of cases by simple physical examination. Screening is the appropriate response — not preventive surgery on the general population.
Phimosis — Tight Foreskin
If phimosis is the issue, circumcision is one option — but prepuceplasty, a procedure to loosen a very tight foreskin, may also be appropriate. The risks and benefits of each should be weighed carefully against the specific presentation.
Lichen Sclerosus / Balanitis Xerotica Obliterans
Fairly rare. When it occurs and when appropriate, circumcision may be a genuine game changer for select cases. This is one of the few scenarios where circumcision can be the right clinical decision.
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🩺 The Bottom Line
All of the conditions cited as justification for routine circumcision are real — they happen. But they are uncommon, and the preventive utility of circumcision in the general population is doubtful. Outside of religious faith or a specific medical indication that has failed conservative management, circumcision should be a last resort — not a default.
Dr. Yuval Bibi, MD/PhD
Board Certified Dermatologist
Thanks for reading and God bless.
