Infant male circumcision: An evidence-based policy statement

Abstract

Here we review the international evidence for benefits and risks of infant male circumcision (MC) and use this to develop an evidence-based policy statement for a developed nation setting, focusing on Australia. Evidence from good quality studies that include meta-analyses and randomized controlled trials showed that MC provides strong protection against: urinary tract infections and, in infancy, renal parenchymal disease; phimosis; paraphimosis; balanoposthitis; foreskin tearing; some heterosexually transmitted infections including HPV, HSV-2, trichomonas, HIV, and genital ulcer disease; thrush; inferior hygiene; penile cancer and possibly prostate cancer. In women, circumcision of the male partner protects against HPV, HSV-2, cervical cancer, bacterial vaginosis, and possibly Chlamydia. MC has no adverse effect on sexual function, sensitivity, penile sensation or satisfaction and may enhance the male sexual experience. Adverse effects are uncommon (<1%), and virtually all are minor and easily treated. For maximum benefits, safety, convenience and cost savings, MC should be performed in infancy and with local anesthesia. A risk-benefit analysis shows benefits exceed risks by a large margin. Over their lifetime up to half of uncircumcised males will suffer a medical condition as a result of retaining their foreskin. The ethics of infant MC and childhood vaccination are comparable. Our analysis finds MC is beneficial, safe and cost-effective, and should optimally be performed in infancy. In the interests of public health and individual wellbeing, adequate parental education, and steps to facilitate access and affordability should be encouraged in developed countries

Effects of circumcision on male sexual functions: a systematic review and meta-analysis

“…Although the literature contains a wide range of evidence for and against circumcision, the better quality studies affirm the recommendations of reputable experts who have evaluated the benefits and risks of circumcision as a desirable intervention early in life. 14,18,22 Regardless of the present study outcome that shows an absence of adverse circumcision effects on a range of parameters related to sexual function and penile sensitivity, there is scope for further research, especially additional large, well-designed RCTs in diverse settings and over much longer time periods.…”

“…Nevertheless, the data provided here affirm that the majority of published research arises from good to excellent studies on sexual function and sensitivity following circumcision. Because policy-makers have emphasized that infancy is the optimum time for circumcision for a variety of reasons, 14,18,22 our findings should provide reassurance to parents when considering this procedure for their newborn sons.…”

“…There is widespread belief that circumcision provides improved penile hygiene and protects against urinary tract infections, phimosis, paraphimosis, balanoposthitis, venereal diseases and cancer. 5,14,18,22,31,32 It is claimed that the foreskin has important functions, 32 but this has been disputed by lots of studies. 14,[18][19][20][21][22] The existing evidence from case-control, cross-sectional, cohort and RCT studies were analysed in our systematic review to ascertain pooled estimates of the sexual-function consequences of male circumcision.…”

“…14 Speculative assertions that the removal of fine-touch neuroreceptors of the foreskin, reorganization/atrophy of neural circuitry and keratinisation of the glans penis as a result of circumcision might lower sensitivity and lead to sexual dysfunction 8,[15][16][17] have been refuted by the American Academy of Pediatrics and through evaluations by experts of such reports. 14,[18][19][20][21][22] Across cultural, religious and health-related differences around the world, the pleasures of sexual intimacy and orgasm are ubiquitously considered as important for well-being and health, and sexual dysfunction may give rise to lowered self-esteem and dysfunctional relationships. 23,24 In this context, we attempted to perform a systematic review and meta-analysis of the comparative effectiveness of circumcised and uncircumcised men on their sexual functions, including sexual desire, dyspareunia, premature ejaculation (PE), ejaculation latency time and erectile dysfunctions (EDs), by collecting all published relevant studies to provide a comprehensive survey that addresses this controversy.…”

A “Snip” in Time: Circumcision Revisited

“…Although hardly any disadvantages of circumcision have been reported [35,36], every now and then, in medical publications invectives against it emerge, sometimes from a pediatric, sometimes from an alternative, rarely from a gynecological background. At the same time, in scientific urological and sexual medical journals more often than not, functional, hygienic, and sexual advantages after circumcision are reported.…”