Male circumcision: get the timing right

MacDonald, Noni E.

doi:10.1503/cmaj.101425

Cited by 9 publications

(4 citation statements)

References 5 publications

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“…Although an abundance of evidence exists about the benefits of MC [ 9 , 12 , 13 , 18 ], it is reasonable to ask whether these dictate infant MC rather than MC later in life when a boy can make up his own mind [ 19 , 20 ]. Some of the advantages of MC in infancy were featured in a report arising from an expert consultation conducted by the US Centers for Disease Control and Prevention (CDC) in 2007 [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

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

Waskett²,

et al. 2012

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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.

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Section: Discussionmentioning

confidence: 99%

“…Nowhere is MC illegal. Concern has, however, been expressed by some authors about the ethical implications of circumcising boys who are too young to give consent [ 19 , 20 ]. The "autonomy-centered" argument of these authors is that MC should be delayed until the individual can decide for himself.…”

Section: Discussionmentioning

confidence: 99%

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

Waskett²,

et al. 2012

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“…The authors of one bioethical analysis concluded that MC is appropriate for parental discretion [191]. An alternative view, based on right to autonomy, is that circumcision should be delayed until the male can decide for himself [192,193]. Other bioethicists and legal commentators argue that in view of the risks of not circumcising, infant MC is a justifiable public health measure [194,195].…”

Section: Ethical Considerations Regarding Neonatal Circumcisionmentioning

confidence: 99%

Infant male circumcision: An evidence-based policy statement

Morris¹,

Wodak²,

Mindel³

et al. 2012

OJPM

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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

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“…While there might be some sense in offering circumcision to young adolescent males (just before the onset of sexual activity), there is no medical justification for circumcision in infancy. 5 Second, the authors refer to the 2004 circumcision policy of the Royal Australasian College of Physicians, but do not mention the policy issued in October 2010 that took a stronger line against routine infant circumcision, concluding that it is both medically unwarranted and ethically problematic. 6 Furthermore, although infant circumcision remains common in Australia, the practice is in steady decline, with an incidence of less than 15% of boys by age 4 nationally, and far less in some states.…”

mentioning

confidence: 99%

To avoid circumcision complications, avoid circumcision

Darby¹

2014

CUAJ

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Male circumcision: get the timing right

Cited by 9 publications

References 5 publications

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

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

Infant male circumcision: An evidence-based policy statement

To avoid circumcision complications, avoid circumcision

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