Circumcision for the Child at Risk of UTI

Adrienne Carmack, MD

What about non-"routine" "preventive" male infant circumcision? Should I circumcise my child whose medical condition puts him at risk from UTIs?

I see this question raised quite often--should a child with vesicoureteral reflux, congenital ureteropelvic junction (UPJ) obstruction, posterior urethral valves, or some other congenital problem making a UTI a potentially more serious threat to health be circumcised? Let's explore a few facts around this scenario.

The medical profession has traditionally recommended male circumcision as a means to reduce the chance of acquiring UTIs in little boys who have a condition that predisposes them to harm from UTIs.* For example, if a child has vesicoureteral reflux and gets a bladder infection, that infected urine can reflux back to the kidney, potentially causing a more serious infection and long-term kidney damage.

There are two beliefs underlying this recommendation that we must examine. The first of these beliefs is that, in the past, circumcision has often not been recognized as harmful. However, many of us are now aware of the real harms experienced immediately and later by little boys undergoing infant circumcision, and of the growing numbers of adult men who are speaking out, saying they wish they hadn't been circumcised.

The second belief is that removing the foreskin lowers the chance of acquiring a UTI. Though many have raised concerns about the methodology, there is data suggesting that this is true. (There is also some evidence contradicting this claim.) However, most of us who are truly aware of the harms of circumcision do not feel the lowered risk of UTI, even if the evidence is valid, justifies the harm of circumcision. We must therefore also rethink the recommendation for foreskin removal in the case of a child with a problem related to UTIs, as we carefully meet our responsibilities, as parents and physicians, who are making irreversible choices for a child.

If you are a parent who is aware of the harms of circumcision and wishes to keep your son intact, but your child has a condition for which circumcision is being recommended to mitigate an actual threat to his health, ask your doctor these questions:

1) What other preventive measures that are less harmful than circumcision can be tried?

2) If these other preventive measures are less effective and my child does get a UTI, how serious is the threat to his health and well-being, with proper treatment?

3) Are there other therapeutic measures (such as repairing a UPJ obstruction) that can be taken to make the health threat from a UTI smaller?

*Note that the reason we are not discussing this for little girls is because no one has published any studies to evaluate whether removing parts of their genitals lessens their UTI risk. It is hypothetically possible that measures such as removing the labia minora would work in a similar way as removal of the male foreskin to lower UTI risk, but these studies would be considered unethical, as would the treatment. Little girls with problems predisposing them to UTIs are typically treated with good toileting habits, preventive substances such as cranberry and low-dose daily antibiotics, therapeutic courses of antibiotics, observation, and surgery to correct anatomic abnormalities when it is believed that they will not improve with age. These treatments are also available for little boys.

Draft a Letter

Do you need help presenting your stance against circumcision to your urologist? Use this document by Dr. Carmack as a guide to draft your letter.