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My wife and I will be having a son in about a month and we are still deciding if we should have him circumcised.

There does not seem to be a strong medical opinion on the matter but we are concerned about potential social issues associated with him being different than the other boys.

Can anyone suggest resources that might help us better understand the pros and cons of circumcision?

Thank you.

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I don't have anything constructive to add beyond the answers below, but I felt I should add another bit of anecdotal evidence that being "different" as an uncircumcised male wasn't an issue. I was dealing with the school locker rooms in a suburban area as a child, and starting to date in a much more rural and conservative area - it hardly came up, and when it did it was mostly just a mild curiosity. I'm a definite vote in the don't do it category. –  Saiboogu May 13 '11 at 13:59
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I thought parents don't have their sons circumcised in US anymore (at least some medical book I read about 15 years ago stated that 'circumcise-by-default' was an outdated practice). I'm not circumcised and I like that. –  Andrew Андрей Листочкин May 13 '11 at 14:44
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@Andrew It still happens a lot, but you are correct in that the 'circumcise-by-default' mentality is outdated. The AAP recommends that parents evaluate unbiased information on the subject and decide what is best for the child. While they recognize that there are studies indicating potential medical benefit, those benefits are not sufficient to recommend routine neonatal circumcision. aappolicy.aappublications.org/cgi/content/full/pediatrics;103/3/… –  Beofett May 13 '11 at 15:54
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FWIW, I am circumcised and had my son circumcised as well, mainly out of a sense of tradition and a fear of answering the "why am I not like Daddy" questions. There may have also been an element of "If my father had it done on me, and I don't have it done on my son, I'm calling my father a bad father." In retrospect, I wish I had not circumcised my son. There's not really any GREAT reason to do it, and when in doubt, go with not cutting off part of your (or your son's) body –  Kevin May 13 '11 at 19:06
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I had a medical circumcision at ten. It hurts like bloody <deleted> <deleted> <deleted> for a week every time you pee. No cream in the world will help. Circumcising your child is child abuse, fully on par with spanking your child everytime you change his diapers for a week. Sorry for stating it that strongly, but there is no way I can state it less strongly without being inaccurate. Don't do it. Full stop. –  Lennart Regebro May 15 '11 at 19:14
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8 Answers

up vote 45 down vote accepted

This was a difficult decision for us, as well.

I was convinced that circumcision was the wrong choice for us (despite my upbringing teaching me that all boys should be circumcised), but my wife was hesitant, for exactly the same reason you cited.

I did some research, and we were surprised to find that circumcision rates were much lower than we had expected. In our area, the doctors we asked said that it was roughly 50% of the male babies. It turns out that this is not too far from the national average in the US.

We came up with a list of pros and cons for circumcision, and eventually decided to not have our son circumcised. Here is the list that we came up with:

For circumcision:

  • Less chance of a feeling of being "different" (while not much of a margin, it is still true that most men in our area are circumcised).
  • Easier hygiene. By all accounts, the extra effort required to maintain an uncircumcised penis versus a circumcised is minimal, and amounts to only a few extra seconds of effort a day (and no extra effort prior to the foreskin being naturally retractable).
  • Won't have to explain why he "looks different than daddy", should that ever come up (I am, to my regret, circumcised).
  • Religion. Some religions require that all males be circumcised. Personally, I had no problem putting aside my religious heritage when it came to this matter.
  • Some studies indicate that there is a reduced risk of catching the HIV virus for circumcised men. This was another point that my wife considered as a strong argument in favor at first, but eventually we decided that we would rather our son learn to have safe sex, instead of relying upon a slightly lessened risk for HIV from unprotected sex.

Against circumcision:

  • Despite the claims, circumcision is painful, stressful, and traumatic to an infant. Even the best methods of anesthesia are only partially effective.

  • Once done, it cannot be undone.

  • There is a risk of infection and other complications.

  • Poorly performed circumcisions can leave scarring.

  • Religion. Some religions are opposed to circumcision.

In the end, we decided to leave him uncircumcised, with the understanding that if he decides he does want to be circumcised, he can always opt for the procedure later.

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+1 for a thorough treatment of concerns on both sides. In our case, I was against circumcision and my husband for it: in the end, I relented because we lived at the time in an area with near-100% circumcision rates, and rife with religious violence. My husband felt that he'd lived fine with circumcision, and that lack thereof was a more visible sign (say in school locker rooms) of difference than (theoretically concealable) religious beliefs. Were we living elsewhere, we may have made a different choice. –  HedgeMage May 13 '11 at 2:19
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+1. My wife and I made similar analysis and decided to circumcise our son(s) -- for her, the possible health benefits were paramount. I think that it's important to discount the hysterics on either side that state that circumcising (or not) will ruin your child's life. –  JSBձոգչ May 13 '11 at 13:13
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The "less chance of feeling different argument" should be in both columns: as the rate approaches 50%, a circumcised kid is as different from his mates as an uncircumcised one. –  luispedro May 29 '11 at 17:25
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One thing I've never understood - if you are 'to your regret, circumcised' why on earth would you consider it for your son? –  Darwy Jun 4 '11 at 23:16
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Easier hygiene is not a valid reason. You ignore an intact foreskin, with instructions to the boy after his foreskin is retractable to occasionally wash with only water. It takes less effort than brushing one's teeth or wiping one's bottom! –  Ready To Learn Jun 12 '11 at 18:39
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I personally saw no benefit to circumcising my son.

My reasoning:

Being Different

There's three schools of reasoning often used here. 1: "The son should look like the father." and 2: "Locker room teasing" and 3: girls don't like a guy with a foreskin

  1. The son isn't going to resemble the father (size wise, hair wise, etc) until he's 15+ and at that point, are they really going to care?

  2. Locker room teasing - all you have to say is, "Dude, stop staring at my junk" out loud towards the person and I guarantee the interest will rapidly disappear.

  3. Girls and foreskins: As a female I can say that the presence (or absence) of a foreskin wasn't a priority for me. It was more a question of the proper usage and how long. My personal opinion: if there's a girl out there that doesn't want to be intimate with my son because he has a foreskin, then he didn't need to be having sex with her anyway.

Hygiene

Having a foreskin isn't difficult to keep clean. A stroke back, wash around the head and rinse. Done. You'll spend more time trying to teach him to dry between his toes thoroughly than you will worrying about smegma. My son is 3 and already knows that that portion of his anatomy is fun to play with in his bath.

Until the foreskin retracts on its own, you don't have to do anything to it - it won't be 'dirty' since it's attached to the head of the penis in the manner your fingernail is attached to your finger. It's fused.

When it does retract on its own (anywhere between the ages of 2-10), then it needs to be cleaned daily in the shower (or bath).

STD's: HIV, HPV

The studies linking circumcision and HIV infection are flawed in a number of ways. I would prefer to teach my son to be responsible and use barrier birth control (condoms) rather than rely on a medical procedure and a false sense of security.

HPV has been likened to a 'sexual cold' due to its prevalence. Again - with the proper use of condoms the presence (or absence) of a foreskin is irrelevant. Certainly HPV can be transmitted on areas which the condom doesn't cover (base of the shaft, scrotum, etc) but then - again - the presence or absence of a foreskin is irrelevant.

Penile cancer

Recent research is also discovering HPV's role in penile cancer.

Penile Cancer rates Dk, Frish, et al.

A Danish Study determined that the falling rate of penile cancers in Denmark could not be a result of the circumcision rate. In fact, the penile cancer rates of Denmark (where 1.5% of the population is circumcised) are similar to rates in the US, where the circumcision rate is MUCH higher.

Circumcision is a surgery and therefore carries real risks: blood loss, scarring, disfigurement and/or amputations have occurred.

Consent: an infant can't possibly consent to a surgical procedure such as this. Once it's gone - it's gone (there exists methods for foreskin restoration, but the damage is done). I wouldn't pierce my daughter's ears until she was old enough to ask for them (and understand the ramifications of having pierced ears - cleaning, etc), and I wouldn't cut my son. If when he's 15+ and he wants to be circumcised, then I will arrange to have it done for him. He'll be old enough to understand what he's doing to his body and how it'll affect it - and it'll have been HIS choice.

I know you asked for the benefits of circumcision, but in my opinion there aren't any. Assuming no disfiguration of the foreskin/urethra, circumcision shouldn't be necessary.

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I am British, and have a foreskin, most of us do. In America, where I spent a good 3 years in the 80's, I found women were curious about my penis, and not in a bad way. I'd always suggest surgery was avoided, if not necessary. I personally wouldn't subject my child to non necessary cosmetic invasive surgery. There are always risks in surgery as Darwy has outlined. I just don't get why people do this to their kids anymore... –  Hairy May 13 '11 at 10:00
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In America its more normal to be circumcised, I am but did not do it to either of my sons as I would rather something like that be their choice. Though who knows if they will decide. –  MichaelF May 13 '11 at 12:02
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I'd disagree that it's more 'normal'. The act of cutting off a perfectly good piece of skin isn't 'normal' by any means. Is it done often? Yes. Is it normal? That's another question entirely. –  Darwy May 13 '11 at 12:09
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Normal means common, not rational, so technically it is normal in the US. Although it is just as normal to not do it in the US (despite popular perception): about 44% intact vs. 56% cut in 2006, with a marked trend towards fewer circumcisions overall. However, I agree with you 110% that there aren't really any good reasons to cut. Unfortunately, in the US the medical community strongly advocated for it in the 70's, despite poor research which has since been discredited. –  Beofett May 13 '11 at 12:34
    
@Darwny thanks for your input - in particular the info from the Danish study and the hygiene info. –  KennyPeanuts May 13 '11 at 15:16
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Circumcision removes a huge portion of the most sensitive erogenous skin a boy has. What possible reason could one have for doing that unless for religion? (As far as I know this means Jews and Muslims only, and, specifically, not Christians.)

The arguments about hygiene are flat wrong. The foreskin, even after the synechiae attaching it to the glans have all released, houses what is more an internal organ than an external one, just like in a female. Use of soap on the glans or foreskin, just like its use inside a female's outer genitals, is more likely to cause an infection than anything else. Urine is sterile, and just like in a female, helps wash out the foreskin. Any other washing should be done with plain water.

Also, an intact foreskin may be attached and unretractable even up to age 18. If sexual activity is desired and it is still not fully retractable, some cream and gentle stretching will do the job. Forceful retracting is a source of pain and infections. Leave the penis alone, just like you leave a girl's genitals alone, and you will have fewer problems.

Frankly, the belief that circumcision has any material health benefits is just plain wrong.

Last, an intact foreskin provides a kind of mechanical lubrication that eliminates the need for artificial lubrication. Why would you destroy that? In my experience most circumcision proponents have NO CLUE how this actually works and thus can see no benefit to having a foreskin.

I find it sad that parents are cutting off an organ they do not understand the function of.

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Technically speaking circumcision is an Abrahamic covenant; therefore also performed in the Muslim faith. –  Darwy Jun 12 '11 at 18:03
    
@Darwy thank you; updated. –  Ready To Learn Jun 12 '11 at 18:33
    
Technically most American Protestant-Christians (that is to say non-Catholics) still adhere to the Abrahamic covenants regarding circumcision as well. At least, through when my generation was born. –  jcolebrand Jun 12 '11 at 19:02
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There's a lot of opinion here with precious little scientific data backing it. While I'll be the first to admit that the circumcision data is at best mixed -- meaning neither pro or con are particularly strong -- to say that "Frankly, the belief that circumcision has any material health benefits is just plain wrong" is, ironically, wrong.. per The American Academy of Pediatrics "existing scientific evidence demonstrates potential medical benefits of newborn male circumcision" –  Jeff Atwood Jun 13 '11 at 4:07
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also per aafp.org/online/en/home/clinical/clinicalrecs/guidelines/… "No valid evidence to date, however, supports the notion that being circumcised affects sexual sensation or satisfaction." –  Jeff Atwood Jun 13 '11 at 4:12
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Since this has come up in the news again, I'd like to present evidence in favor of allowing the choice to circumcise or not.

First, I don't think anyone these days would advocate a blanket policy of "all male children should be circumcised", and I am certainly not. Overall I agree with the official position of the American Academy of Pediatrics:

Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In the case of circumcision, in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child

I do not think the evidence is compelling in either direction, but I believe there are "enough" mild medical benefits to circumcision that I support it for my child, at least. But I would certainly not fault any other parents for deciding otherwise. It is hardly a life threatening or even important decision in the big scheme of things. At best it is minor, on the scale of the deciding to keep your appendix or pierce your ears.

The Wikipedia page Medical Analysis of Circumcision has tons of great citations. Specifically the ones I found compelling in my decisionmaking are:

Ewings and Bowie performed a case-control study of 159 cases of prostate cancer, and found a reduced rate among circumcised men (odds ratio 0.62). The authors noted: "...some statistically significant associations were found, although these can only be viewed as hypothesis generating in this context."

A 1988 New Zealand study of penile problems by Fergusson et al., in a birth cohort of more than 500 children from birth to 8 years of age found that by 8 years, circumcised children had a rate of 11.1 problems per 100 children, and uncircumcised children had a rate of 18.8 per 100. The majority of these problems were for penile inflammation including balanitis, meatitis, and inflammation of the prepuce.

Three studies that have found that boys with foreskins tend to have higher rates of various infections and inflammations of the penis than those who are circumcised:

  • Fakjian, N; S Hunter, GW Cole and J Miller (August 1990). "An argument for circumcision. Prevention of balanitis in the adult". Arch Dermatol 126 (8): 1046–7.
  • Herzog, LW; SR Alvarez (March 1986). "The frequency of foreskin problems in uncircumcised children". Am J Dis Child 140 (3): 254-6.
  • O’Farrel, Nigel; Maria Quigley and Paul Fox (August 2005). "Association between the intact foreskin and inferior standards of male genital hygiene behaviour: a cross-sectional study". International Journal of STD & AIDS 16 (8): 556-588.

Singh-Grewal (2005) performed a meta-analysis of 12 studies (one randomised controlled trial, four cohort studies, and seven case–control studies) looking at the effect of circumcision on the risk of urinary tract infection (UTI) in boys. Circumcision was associated with a reduced risk of UTI (OR = 0.13; 95% CI, 0.08 to 0.20; p<0.001).

According to the American Medical Association, "There is little doubt that the uncircumcised infant is at higher risk for urinary tract infection (UTI)."

Researchers from the Imperial College School of Medicine, Chelsea & Westminster Hospital, London, England reported the results of their study of 357 patients referred for genital skin disease. Most cases of inflammatory dermatoses were diagnosed in uncircumcised men, suggesting that circumcision protects against inflammatory dermatoses.

On Wednesday, March 28, 2007, the World Health Organisation (WHO) and UNAIDS issued joint recommendations concerning male circumcision and HIV/AIDS.[159] These recommendations are: Male circumcision should now be recognized as an efficacious intervention for HIV prevention. Promoting male circumcision should be recognized as an additional, important strategy for the prevention of heterosexually acquired HIV infection in men.

So for me, I want my child to have the best chance of not having these problems associated with foreskins, even if the incidences are quite rare.

Also, having this procedure completed at day 2 of your life when you won't remember it, and as a part of all the other crazy-ass things that happen when you're born (and obviously performed with anasthetic in any case) is preferable to the risk, however small, that you might need a medical circumcision later at an age where you will remember the procedure and the recovery.

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your answer is well cited and thorough, but I have to disagree with the final conclusion. Its an irreversible change to someone's body - who are we to force it upon our children for such incredibly minor benefit? Also, and this falls in the realm of opinion, but I can't imagine doing such a thing to an infant who can't grasp what is happening. At a later age it may not be comfortable, but the child/adult can make an informed decision based on benefits and deal with the discomfort like any other elective surgical procedure. –  Saiboogu Jun 13 '11 at 13:50
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I'm curious how many of those statistics reflect the results of inadequate hygiene. At least one of the cited references is specifically looking at the hygiene angle ("Association between the intact foreskin and inferior standards of male genital hygiene behaviour: a cross-sectional study"). –  Beofett Jun 13 '11 at 14:27
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@sai it's irreversible like piercing of ears is irreversible.. it's a very minor cosmetic change to the human body for the benefits cited above. There are tons of "unnatural" things we do to our bodies in the name of medical science, so it just depends if you agree with the studies cited above about the benefits or not. IMHO it's really not a big deal either way. –  Jeff Atwood Jun 13 '11 at 21:07
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you call it a minor cosmetic change to the body, but the foreskin is nearly 15 square inches in the adult male - I wouldn't personally consider that a 'minor' cosmetic change. –  Darwy Jun 27 '11 at 10:40
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Those who make the argument that removing an organ results in fewer diseases to that organ (thus removal is beneficial) completely overlook the utter irony: the "health" benefits apply because the organ is gone, not because the organ is itself a risk. Did you know that if you remove your child's hands he will never burn them on the stove, either? There is a gigantic and unwarranted presupposition here: the foreskin is useless or even harmful, like an appendix--a prejudgment is made that its "ectomy" is acceptable. Only then does the "amputate" argument start to sound like sense. –  Ready To Learn Jan 1 '13 at 19:27
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The only one reason to circumcise another male is on qualified medical advice

I believe that the only reason to circumcise is if a qualified doctor advises it and that the operation should be performed in a hospital/health centre by qualified professionals using proper techniques, sterile tools, anaesthetic and pain-relief medication for after care.

The religious or cultural belief of a parent or relative is no grounds for justification, in my opinion. Would you also get your son a tattoo? How about a tongue piercing?

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If you'd like to present scientific data, fine, but posting explicit videos to make your point is not acceptable behavior. Anything prefaced by "warning: contains blood, nudity, and may be upsetting" simply isn't appropriate here. Let's stick to the science. Thanks! –  Jeff Atwood Jun 16 '11 at 19:44
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Point taken, but please post your comment at the same time as editing my post. –  JBRWilkinson Jun 20 '11 at 14:06
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I was once* invited to a friend's son's bris (Jewish ritual circumcision). I was already in the "why?" camp about circumcising my then-theoretical sons, but witnessing one put me firmly into the "no [expletive] way" camp. The mohel used a topical anesthetic, but that was still one very very unhappy baby. My elder son is now 6, has an entirely age-appropriate interest in comparative anatomy, and has never once asked why I look different, and if he did I'd tell him.

*Actually twice, but the second time we intentionally arrived after the main event.

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Absolutely not.

For females, anything "circumcision" is binned under female genital mutilation. In many countries FGM is banned.

As to the "benefits" (such as reduced STI/HIV transmission rates) I would suggest using condoms and carefully selecting sex parters instead.

You can watch this video to see the procedure (warning: shows entire medical procedure).

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I think your answer would be better if you can get your point across without resorting to the (assumed) shock factor of a video clip. I will not downvote the answer just because of the link, but it stops me from upvoting. (I haven't seen the clip but I guess it contains what you say.) –  Torben Gundtofte-Bruun Jan 3 '12 at 7:44
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@Torben the clip is a very important part of the answer. The majority of people have never seen a circumcision before, so they don't really know what's involved. –  bobobobo Jan 4 '12 at 19:30
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-1. So-called female circumcision is different than male circumcision simply because the parts are completely different. In male circumcision, the parts that give sexual pleasure are not removed. –  Steve Taylor Mar 16 '12 at 20:29
    
@SteveTaylor Not totally removed, but some of them are removed. You should already know this. –  bobobobo May 6 '12 at 18:24
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@SteveTaylor Incorrect. Circumcision removes much of the ridged band (NSFW: penis picture). The band "contains more Meissner's corpuscles than does the smooth mucosa and exhibits features of specialized sensory mucosa. ... The amount of tissue loss estimated in the present study is more than most parents envisage from pre-operative counselling. Circumcision also ablates junctional mucosa that appears to be an important component of the overall sensory mechanism of the human penis." –  Ready To Learn Jan 1 '13 at 19:24
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If you do decide to do it, and I would definitely be in the 'for' camp on this one I would say wait until your son is older. While an infant doesn't understand, at 3 or 4 it doesn't hurt, is a simpler operation and it is simple to look after during the healing process.As per the comments, I have first hand experience, as does my son.

Where I grew up it certainly wasn't the norm so you get the odd look in changing rooms at school, but that is pretty much irrelevant.

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-1 for "at 3 or 4 it doesn't hurt." While I'm sure they'll use some anesthetic to minimize pain during the actual procedure, I can't imagine any surgical removal of flesh falling in the "doesn't hurt" category. At the very least, its going to be uncomfortable and sensitive while healing. –  Saiboogu May 13 '11 at 20:15
    
Nah, it really doesn't. Mildly uncomfortable and itchy whilr healing. –  Rory Alsop May 14 '11 at 0:56
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Are you speaking from personal experience? I'm firmly rooted in the "informed consent" camp, so I don't believe circumcision should even be an option for minors. However, if you have first hand experience that it wasn't that painful, I'll drop my downvote. I assumed you were just making a blanket statement, similar to the advocates who claim that the infants don't feel any pain during un-medicated circumcision. –  Saiboogu May 14 '11 at 1:02
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One serious problem with your recommendation is that circumcising when older can lead to a permanent loss of more erogenous skin. In a newborn the nerves "rewire" a bit to compensate for cutting off all those nerve endings. This is awful advice. Do you think a 3-year-old could possibly be properly informed about the ramifications of cutting off part of his genitals, the sexual use of which he can't possibly understand. –  Ready To Learn Jun 12 '11 at 17:22
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It is certainly clear that removing the foreskin does not affect one's ability to receive sexual stimulation and achieve orgasm. But your experience that with a circumision you have adequate erogenicity (if such is a word) says nothing about its benefits or drawbacks compared to being intact. Nothing. How do you know you're not missing anything? You've never experienced the other side! –  Ready To Learn Jan 1 '13 at 20:05
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