Introduction: Why Circumcision Still Sparks Debate
Circumcision, the surgical removal of the foreskin, is the world’s oldest planned medical procedure, with roots in religion, culture, and medicine. Despite its long history, it remains one of the most debated topics in sexual health. Global rates vary widely, influenced by cultural norms, healthcare access, public policy, and evolving evidence on both risks and benefits.
Recommendations and attitudes toward circumcision also differ significantly across countries and regions. Many countries cite insufficient evidence to support circumcision for non-medical indications, while others – including the United States – maintain that the benefits outweigh the risks.
In some regions, circumcision rates are declining; in others, medical campaigns are expanding access as part of HIV prevention programs. The discussion continues to raise important questions about consent, cultural sensitivity, and how healthcare professionals navigate personal bias when supporting patients.
US Trends: Who’s Circumcised and Why
From 1979 to 2010, national newborn circumcision rates declined from 64.5% to 58.3%, and recent data suggest this trend continues.
A recently JAMA Pediatrics published research letter reported significant declines in circumcision across all U.S. Census regions between 2012-2022.
Rates also vary by race, income, and region:
Circumcision is most common in the Midwest (68%) and the lowest rates are reported in the West (20%).
White and Black infants have the highest rates of circumcision.
Boys in the highest incomes families are most likely to be circumcised.
Insurance coverage plays a role; at least 17 U.S. states do not cover the procedure under Medicaid.
The American Academy of Pediatrics (AAP) last updated its stance in 2012, concluding that health benefits outweigh risks, citing reduced risks of urinary tract infections, penile cancer, and some STIs including HIV. However, that policy expired in 2017 and has not been renewed, leaving professionals without updated national guidance.
Global Snapshot: Who’s Circumcised and Why
Worldwide, an estimated 33–39% of men are circumcised. Motivations differ dramatically:
Religious and cultural traditions drive high prevalence in the Middle East, North Africa, and Jewish and Muslim communities globally.
Medicalized circumcision programs in some regions, such as sub-Saharan Africa, are promoted as part of HIV prevention strategies, though evidence on long-term outcomes remains mixed.
Countries through Europe and parts of Asia report low or declining neonatal rates, citing ethical concerns and limited perceived medical need
The Health Conversation: What the Research Says about Circumcision and Sexual Health
Medical indications for circumcision include:
Phimosis (tight foreskin)
Recurrent infections or inflammation (balanitis)
Recurrent urinary tract infections
Potential benefits include:
Reduced risk of HIV and some STIs (strongest evidence for female-to-male protection in high-prevalence areas)
Lower rates of HPV infection and penile cancer
Hygiene and infection prevention
Possible impacts on sensation or satisfaction, with research showing mixed results
Potential drawbacks include:
Pain and minor complications (though generally rare)
Possible impacts on sensation or satisfaction, with research showing mixed results
Ethical questions around consent and bodily autonomy for infant procedures
Research indicates that majority of uncircumcised children medical benefits listed above are also achievable through proper hygiene measures
Recent studies also suggest psychosocial nuances: early-circumcised men may report slightly lower emotional stability but higher sexual drive and sensation-seeking, though findings remain inconsistent.
Ultimately, evidence remains context-dependent, and universal recommendations are not supported.
Shifting Attitudes: Parents, Patients, and Providers
Parents’ decisions are shaped by a mix of medical, cultural, and familial factors. Many cite the future health of the child as the key reason, but the circumcision status of the father often plays a surprisingly strong role in parental choice.
Healthcare professionals and institutional policies also carry influence. Most parents view AAP guidelines as helpful, yet the expiration of national guidance leaves gaps in consistent counseling.
Meanwhile, advocacy groups such as “intactivists” — who oppose infant circumcision — have gained traction online, pushing for bodily integrity and informed consent. Social media continues to shape perceptions and amplify polarizing narratives.
Interestingly, circumcision isn’t just a pediatric issue. Recent data show increasing adult circumcision, with nearly 30% of adult procedures done for routine, ritual, or aesthetic reasons rather than purely medical necessity.
Circumcision and Sexual Health: Sexual Pleasure and Function
Findings are mixed:
A Danish study linked circumcision to more difficulty reaching orgasm.
A Chinese study found higher satisfaction and better ejaculation control among circumcised men.
In the Dominican Republic, men who underwent voluntary medical circumcision reported greater sexual enjoyment post-procedure.
In the Republic of Korea, participants reported decreased masturbatory pleasure following circumcision.
Interpretation remains complex; outcomes may depend on timing, surgical method, cultural attitudes, and expectations rather than anatomy alone.
Implications for Sexual Health Professionals
Sexual health professionals play a pivotal role in facilitating informed and respectful discussions about circumcision. It’s equally important to reflect on our own beliefs and biases, as these can subtly shape how we approach these conversations.
When engaging individuals in these conversations, consider how various factors may influence decision-making, including:
Cultural and social norms surrounding body image, masculinity, and sexual pleasure
Religious beliefs and rituals that inform identity and practice
Medical guidance and professional recommendations provided by healthcare providers
Broader sexual health considerations such as STI prevention, fertility, and body autonomy and confidence
Looking Ahead at Circumcision and Sexual Health
From foreskin restoration techniques to advances in regenerative medicine, the conversation around circumcision continues to evolve. As gender and sexual health dialogues grow more inclusive, attitudes toward circumcision likely will continue to shift, especially as (ideally) public policies adapt to cultural pluralism and patient autonomy.
Circumcision remains a complex intersection of medicine, culture, and sexuality. Navigating these nuances requires empathy, neutrality, and respect for individual choice.
SHA believes in cultivating inclusive dialogue, even on topics that challenge us.
Interested in exploring these questions further?
Join global experts at the SHA Male Sexual Health and Functioning Conference in December 2025, where we’ll unpack the latest research and ethical perspectives shaping the future of sexual medicine.
Written by Emma Sell-Goodhand, MPH
Emma is a doctoral student and Global One Health Fellow at North Carolina State University studying adolescent sexual health. She brings prior experience as a Technical Advisor at the World Health Organization.
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