Risk of Urinary Tract Infections
Mothers who want to take steps to reduce the liklihood of UTIs can do so without surgical risk by breastfeeding their babies. In a Dec. 1997, policy statement from the Work Group on Breastfeeding [Pediatrics], the American Academy of Pediatrics, has concluded that there is strong evidence that breastfeeding decreases the incidence urinary tract infection. [Pisacane]
Interestingly, one of the many reasons given to continue the practice of female circumcision in Egypt is the claim that it lowers the rate of UTI's among girls!
Based on the often-referred-to Wiswell study, Noncircumcised male infants had a 10-fold greater incidence of infection than did circumcised male infants. Standing alone, this statement sounds pretty powerful and is probably quite effective in convincing many people who have no other facts to go on that circumcision is a good idea. It implies that the foreskin is to blame for any UTIs that occur among intact infants. However, when you look at the actual figures in the study, it is obvious that UTIs are rare among the intact.
And when they do occur, they are most often caused by factors totally unrelated to the foreskin. The Wiswell study fails to point this out. 60% of children with UTIs have anatomic abnormalities in their urinary tracts. UTIs are significantly more common in girls. [Urinary] UTIs are rarely seen in boys and young men. [U.S.] It also fails to mention other links to UTIs which include malnutrition, diabetes, constipation and incomplete drainage of the urinary system. [New] Infections have also been caused by exposure to E. Coli. Additionally, serious problems can occur in uncircumcised males who experience invasive inspections, overzealous cleaning efforts and retraction attempts. It has been proven that retraction and washing of the infant foreskin can cause urinary tract infections. [Hodges]
A parent or doctor might be alarmed if they notice that the tip of the penis under the foreskin is pink or red rather than flesh tone. They might suspect an infection and run a test. False positive results for UTIs occur in 16% of the tests. [Schlager] [Fleiss] Because the intact penis is protected by its sheath, the tip of the penis is pink or reddish in color. This is normal and not cause for alarm. The coloring by itself is not an indication that an infection is present.
In the rare case where a boy does have an abnormal upper tract, and has suffered from recurrent UTIs, a doctor may suggest circumcision in an attempt to eliminate at least one possible cause of another UTI, -- from bacteria in the foreskin. However, even if he is circumcised, the child may still suffer from more UTIs caused by other factors as indicated above.
The Wiswell study reviewed the occurrence of UTIs in 209,399 infants born in US Army hospitals worldwide from 1985 to 1990. During the first year of life, 1,046 (0.5%: 550 girls and 496 boys) were hospitalized for UTIs. This draws me to the conclusion, rightly or wrongly, that about 45 boys were circumcised and about 450 were intact. According to this study, about one boy out of 464 uncircumcised males gets a UTI during the first year of life.
The Wiswell study has been challenged and questioned by many. The American Academy of Pediatrics said It should be noted that these studies in army hospitals are retrospective in design, and may have methodological flaws.
In Europe, routine infant circumcision is not performed. From what I understand, UTI rates are lower there than in the U.S. In fact, 82% of the worlds living men are not circumcised and yet we dont hear about alarming rates of UTIs worldwide.
A study was also done in California by a Dr. Martin Altschul of 118,000 births and infants admitted with a diagnosis of UTI. His findings for intact boys was 120 cases per 100,000. That works out to one infection per 833 boys.
All of the UTIs in both of these studies were caused by different factors. But lets take a worst case scenario and say they all occurred from bacteria in the childs foreskin. Depending on which study you choose to rely on, either 464 or 833 boys would have to be circumcised to prevent the occurrence of a single UTI that could usually be treated effectively with oral antibiotics. How does this small of a threat justify automatic circumcision of all boys?
Even if UTIs occurred at a much higher rate than the Wiswell study concluded, say at the rate of 1 in 100, then it still does not make sense to circumcise 99 boys who will never experience a UTI all because one boy might. To top it off, those who do get circumcised are still at risk of UTI's.
Another study was completed in 1995 on preputial development. 603 Japanese boys from newborns to 15 years of age were evaluated. The average age was 3.8. Neonatal circumcision is not common in Japan. All of the boys were intact. During the year long study, none had a symptomatic urinary tract infection. [Journal]
The subject of UTIs is covered extensively in The New Child Health Encyclopedia. In it, there is absolutely no mention of the foreskin as a culprit or cause, nor is circumcision suggested as a treatment or cure. The fact remains that UTIs are rare and can usually be treated effectively with antibiotics.
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Fleiss, P.M., Explanation for False Positive Cultures Obtained by Bag Technique. Archives of Pediatrics and Adolescent Medicine 1995; 149:1041-1042.
Hodges, Frederick and Fleiss, M.D. Paul M. The Foreskin is Necessary, the Townsend Letter for Doctors and Patients, April 1996.
JOURNAL OF UROLOGY 1996 NOV, Volume 156 No. 5: (November 1996): Pages 1813-1815.
New Child Health Encyclopedia, p. 701, Boston Childrens Hospital, Dell Publishing, 1987.
Pediatrics Volume 100, Number 6 December 1997, pp 1035-1039, Breastfeeding and the Use of Human Milk (RE9729)
Pisacane A, Graziano L, Mazzarella G, et al. Breastfeeding and urinary tract infection. J Pediatr. 1992;120:87-89
Schlager, T.A., Hendley, J.O., Dudley, S., et al. Explanation for False Positive Cultures Obtained by Bag Technique. Archives of Pediatrics and Adolescent Medicine 1995; 149:170-3.
U.S. Dept. of Health & Human Services, Understanding Urinary Tract Infection
Urinary Tract Infection in Childhood [Infect Urol 8 (4), 111, 114-120, 1995.]
Last Revised: 12/3/97