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Whether to circumcise your child is an incredibly personal choice. There are always strong opinions for and against the procedure online and elsewhere, and if you ask (or even if you do not), you’re likely to get feedback. But other people outside of your immediate family really do not deserve an opinion about what your child’s penis is going to look like. Full stop.
For some people, circumcision is a core part of their cultural values. For others, it is more clearly a choice. And whether choice or not, there are open questions about how to circumcise, notably around pain relief.
Here, the benefits and possible risks of circumcision, what we know about pain relief if you do choose to circumcise, and, finally, a discussion of whether circumcision is linked to autism.
What is circumcision?
Male circumcision is a procedure in which the foreskin of the penis is surgically removed. This is a practice with a long history (going back many thousands of years), and it’s unclear when it first started. Although circumcision can be performed at any age, in the U.S., it is most commonly performed shortly after birth, in the hospital, or several days later, either at home or at a doctor’s office.
Circumcision rates vary across countries and cultural groups. For people who practice Judaism, circumcision is typically done in a ritual called a bris at 8 days of age. Circumcision is also a common practice in Islam. Across the U.S. broadly, circumcision rates have fallen over time, even in the last decade. As of 2022, about half of newborns in the U.S. are circumcised.
What are the benefits of male circumcision?
There are several purported benefits of male circumcision: lower risk of UTIs, possibly lower risk of sexually transmitted infections later in life, and a lower risk of penile cancer. Hygiene is also sometimes cited as a benefit; it is easier to clean a circumcised penis, although boys are generally able to keep their penis clean even if it is not circumcised.
The most significant of these benefits is a reduced risk of UTIs. Summary data suggests boys between 0 and 1 are approximately 10 times as likely to get a UTI if they are uncircumcised, and those between 1 and 16 are more than six times as likely. UTIs are a relatively common source of fever in children and, overall, an estimated 2% of boys will have had a UTI by the age of 6. There are good mechanistic reasons to think that circumcision would reduce UTI risk, so this link seems very likely to be causal. However, the risk of UTI still remains relatively small.
There is also evidence that circumcision prevents HIV in particular; nearly all of this evidence comes from Sub-Saharan Africa, but the CDC has estimated that circumcision could reduce HIV transmission in the U.S. The evidence on other STIs is not as strong. These risks are also, overall, relatively low.
Finally, circumcision is thought to reduce the risk of penile cancer. The evidence for this largely comes from case-control studies, which I do not generally find very compelling. Plus, penile cancer is incredibly rare, and rates are declining. The numbers suggest you might need to do hundreds of thousands of circumcisions to prevent a single penile cancer case.
What are the risks of male circumcision?
Circumcision is a surgical procedure and, therefore, carries some risk. A 2014 study covering 1.4 million births in the U.S. showed an overall risk of adverse events of 0.5% — about one in 200. Most of these adverse events were not considered serious; the most common was minor bleeding. There were rare cases of more significant complications. The most common of these is a need for a repair of an incomplete circumcision with a second procedure. This is estimated to occur in 7 of 10,000 circumcisions.
The other concern commonly raised is that male circumcision might impact penile sensitivity. Meta-analysis data do not support that claim; sexual function, including sensitivity, appears to be similar in men who are circumcised and those who are not.
What pain relief options are available for circumcision?
Traditionally, pain relief was not used during circumcision. At a bris, for example, the standard approach was (and sometimes still is) to give the baby a little bit of wine. Sugar water (oral sucrose) is another approach.
More recently, the AAP and others have recommended that medical pain relief be used during this procedure. The reason for this is that it is clear from monitoring their responses that infants do feel pain during the procedure. In addition, randomized evidence suggests that infants who were circumcised without pain relief actually show more response to the pain of vaccination even months later. Pulling this together, along with the basic observation that this is a surgical procedure, pain relief is strongly recommended.
There are several common pain relief options. One is topical lidocaine, either alone in a higher concentration or in combination with a second topical anesthetic. There are also two procedures with injected lidocaine — a “dorsal penile nerve block” (DPNB) or a “ring block.” These differ in where the injection occurs in the penis, but both have the goal of numbing the area.
A 2004 Cochrane Review of randomized controlled trials showed that the DPNB procedure performed better than the topical treatment at controlling pain in newborns. Both were better than either placebo or oral sucrose, where the data is only inconsistent in showing it provides any relief at all.
A more recent paper, in 2021, attempted a meta-analysis across all of these approaches. Their results suggest that if you had to choose only one method of pain relief, one of the injected options is best. However, they argue that the best pain relief is provided with a combination of these pharmacological approaches plus oral sugar and possibly also topical pain relief.
The summary of all of this work is that some type of pain relief beyond sugar water should be used when circumcising newborns. If you are planning to have your child circumcised at a hospital or elsewhere, you should ask about what options they provide. Despite this general expert consensus, there are still (many) hospitals where this type of pain relief is not standard.
Post-circumcision, there is less evidence and consensus on pain relief. Some doctors will suggest parents use Tylenol if the infant seems to be in pain; others do not. We do not have good evidence or monitoring on this.
Does circumcision cause autism?
No, circumcision does not cause autism. This claim is misinformation.
In October of 2025, Secretary of Health and Human Services Robert F. Kennedy, Jr., suggested in a cabinet meeting that circumcision may cause autism. The mechanism he suggested was the use of Tylenol as pain relief. That is, his theory was less about the circumcision itself and more about Tylenol.
There is no data to support a link between the use of Tylenol in infants and autism, circumcision or otherwise. And as noted above, Tylenol is only sometimes used post-circumcision, so this mechanism is not realistic or meaningful. However, he also mentioned a study on the circumcision-autism link, which got people talking.
The study he was referring to was published in 2015, and it looked at the relationship between circumcision and an autism diagnosis in Denmark. The authors of the paper argue that circumcised boys are more likely to be diagnosed with autism. The paper, however, is subject to many concerns. Their results are largely not significant or only borderline significant. They show up only for children aged 1-4, not those 5-9. The paper can only show an association, not a causal link. Many of the largest results are driven by an extremely small number of observations. Overall, this is not a compelling result.
It is worth noting that this paper has nothing to do with Tylenol; it’s not about pain relief, and that isn’t mentioned. The link with Tylenol is one that RFK Jr. made himself.
There has not been any follow-up on this study, no additional data, and nothing mechanistic that would make sense as a link. Certainly, circumcision cannot explain trends in autism over time, since the rate of circumcision has declined as the rate of autism has risen.
Closing thoughts
Should you circumcise your infant? I don’t know! It’s not any of my business. If you do choose to circumcise, ask about pain relief. And do not think about autism.
The bottom line
- Male circumcision is a procedure in which the foreskin of the penis is surgically removed. It remains common in some religious and cultural groups, though U.S. rates have declined to about 50%.
- Circumcision modestly lowers the risk of UTIs and, to a lesser extent, some infections later in life, but these conditions are rare, so the absolute benefits are small.
- Circumcision does carry some risks, but they are minor and rare.
- Newborns do feel pain during circumcision, and research strongly supports using medical pain relief beyond sugar water during the procedure.
- Circumcision does not cause autism. This claim is misinformation.
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