Critical evaluation of arguments opposing male circumcision: A systematic review

Abstract

Objective To systematically evaluate evidence against male circumcision (MC). Methods We searched PubMed, Google Scholar, EMBASE and Cochrane databases. Results Database searches retrieved 297 publications for inclusion. Bibliographies of these yielded 101 more. After evaluation we found: Claims that MC carries high risk were contradicted by low frequency of adverse events that were virtually all minor and easily treated with complete resolution. Claims that MC causes psychological harm were contradicted by studies finding no such harm. Claims that MC impairs sexual function and pleasure were contradicted by high‐quality studies finding no adverse effect. Claims disputing the medical benefits of MC were contradicted by a large body of high‐quality evidence indicating protection against a wide range of infections, dermatological conditions, and genital cancers in males and the female sexual partners of men. Risk‐benefit analyses reported that benefits exceed risks by 100‐200 to 1. To maximize benefits and minimize risks, the evidence supported early infant MC rather than arguments that the procedure should be delayed until males are old enough to decide for themselves. Claims that MC of minors is unethical were contradicted by balanced evaluations of ethical issues supporting the rights of children to be provided with low‐risk, high‐benefit interventions such as MC for better health. Expert evaluations of case‐law supported the legality of MC of minors. Other data demonstrated that early infant MC is cost‐saving to health systems. Conclusions Arguments opposing MC are supported mostly by low‐quality evidence and opinion, and are contradicted by strong scientific evidence.

Do False Beliefs Predict Increased Circumcision Satisfaction in Men?

“…Could it be that being duped by anti-circumcision propaganda leads to distress, and hence sexual disfunction? MC opponents make many false claims about the effect of circumcision on sexual function and pleasure which may lead to psychological distress in those deceived [40]. This makes misleading articles such as ES&J's particularly pernicious as they further a false narrative of circumcision causing harm.…”

“…Given Earp's long history of writing anti-circumcision polemics, one can only suspect that the article critiqued here is just another attempt by circumcision opponents to build a body of literature that they can cite in support of their misguided agenda. They appear to feel the need to do this because most of the literature does not support their claims [40]. The need for journal editors and reviewers to be alert to the contents of manuscripts with a clear anti-circumcision agenda is becoming more important than ever, even more so considering MC's vital importance in HIV epidemic settings.…”

“…Svoboda) are highly prominent in the anti-circumcision movement, and have histories of publishing low quality papers on the topic, often attracting harsh criticism[40]. Thus 38 of the citations (37% of ES&J's total) are to authors biased against MC.…”

Should liberal government regulate male circumcision performed in the name of Jewish tradition?

“…Risk-benefit analyses reported that benefits exceed risks by 100-200 to 1. To maximize benefits and minimize risks, the evidence supported early infant male circumcision rather than arguments that the procedure should be delayed until males are old enough to decide for themselves (Morris et al 2019).…”

Critical Evaluation of a Survey Claiming “Long-Term Adverse Outcomes from Neonatal Circumcision”*

“…Most claims have been based on anecdotes or low-quality surveys. An extensive systematic review has recently evaluated the claims by MC opponents and found them to be based on speculation or misinformation [11].…”