A 'snip' in time: what is the best age to circumcise?

Abstract

Background Circumcision is a common procedure, but regional and societal attitudes differ on whether there is a need for a male to be circumcised and, if so, at what age. This is an important issue for many parents, but also pediatricians, other doctors, policy makers, public health authorities, medical bodies, and males themselves. Discussion We show here that infancy is an optimal time for clinical circumcision because an infant's low mobility facilitates the use of local anesthesia, sutures are not required, healing is quick, cosmetic outcome is usually excellent, costs are minimal, and complications are uncommon. The benefits of infant circumcision include prevention of urinary tract infections (a cause of renal scarring), reduction in risk of inflammatory foreskin conditions such as balanoposthitis, foreskin injuries, phimosis and paraphimosis. When the boy later becomes sexually active he has substantial protection against risk of HIV and other viral sexually transmitted infections such as genital herpes and oncogenic human papillomavirus, as well as penile cancer. The risk of cervical cancer in his female partner(s) is also reduced. Circumcision in adolescence or adulthood may evoke a fear of pain, penile damage or reduced sexual pleasure, even though unfounded. Time off work or school will be needed, cost is much greater, as are risks of complications, healing is slower, and stitches or tissue glue must be used. Summary Infant circumcision is safe, simple, convenient and cost-effective. The available evidence strongly supports infancy as the optimal time for circumcision.

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.…”

Circumcision of Privately Insured Males Aged 0 to 18 Years in the United States

“…Social norms, religious beliefs, and perceived health benefits have influenced the uptake of nonmedical circumcision over time. [2][3][4] In recent years, several studies have provided evidence that circumcision confers health benefits which are estimated to outweigh risks 100 to 1. 5 An uncircumcised male is almost 10 times more likely to have a urinary tract infection (UTI) during infancy, and 4 times more likely to have a UTI during his lifetime.…”