What is the best age to circumcise? A medical and ethical analysis

Abstract

Circumcision is often claimed to be simpler, safer and more cost-effective when performed in the neonatal period as opposed to later in life, with a greater benefit-to-risk ratio. In the first part of this paper, we critically examine the evidence base for these claims, and find that it is not as robust as is commonly assumed. In the second part, we demonstrate that, even if one simply grants these claims for the sake of argument, it still does not follow that neonatal circumcision is ethically permissible absent urgent medical necessity. Based on a careful consideration of the relevant evidence, arguments and counterarguments, we conclude that medically unnecessary penile circumcision-like other medically unnecessary genital procedures, such as 'cosmetic' labiaplasty-should not be performed on individuals who are too young (or otherwise unable) to provide meaningful consent to the procedure.

WITHDRAWN: Neonatal Circumcision: Public Health Necessity or Ethical Dilemma? – Systematic Review

“…Despite the medical evidence of bene ts, philosophical arguments claiming that NMC, and MC of older children, is unethical persist [74,80,82,85,135,152]. Rather than a calm, nuanced discourse, arguments by NMC opponents have sometimes been emotive [74,75,119,135,153].…”

“…Opponents claim that MC has no bene ts, only harms, and argue against scienti c ndings and evidence-based policies supporting the rights of parents to choose NMC for a newborn son as a desirable public health measure [72][73][74]81,83,100,104,105,111,112,157].They further argue that, even if there are bene ts, they only apply to males who are old enough to decide for themselves whether or not to get circumcised, or that the bene ts are insu cient to merit the procedure [72][73][74]83,[102][103][104][105]118]. A systematic review evaluating the various claims found them to be based on speculation or misinformation [106].…”

Neonatal male circumcision is associated with altered adult socio-affective processing

“…Approximately one-third of males in the world are circumcised ( World Health Organization, 2010 ), primarily for cultural reasons. Nevertheless, the social and health-related aspects of newborn circumcision, including the degree and magnitude of associated benefits and risks, remain contentious and hotly debated ( Darby, 2015 ; Freedman, 2016 ; Myers and Earp, 2020 ). Relatively little research has investigated pain-related responses to circumcision in infants ( Dixon et al., 1984 ; Fergusson et al., 2007 ; Gattari et al., 2013 ; Gunnar et al., 1981 , 1995 ; Marshall et al., 1980 , 1982 ; Mondzelewski et al., 2016 ; Page, 2004 ; Svoboda and Van Howe, 2013 ; Taddio et al., 1997a , 1997b ; Talbert et al., 1976 ; Williamson et al., 1986 ; Williamson and Williamson, 1983 ), and only a handful of studies have generated evidence regarding potential long-term effects lasting into adulthood ( Bauer and Kriebel, 2013 ; Bollinger and Van Howe, 2011 ; Frisch and Simonsen, 2015a ; Ullmann et al., 2017 ).…”

The need for a unified ethical stance on child genital cutting

“…This is especially the case if there are other, less risky, more autonomy-respecting ways of achieving the same or substantively similar health benefits. 50 Such an assumption can only incentivize supporters of non-consensual genital cutting to medicalize the practice and look for evidence of “health benefits,” however questionable or readily achievable by other means (see Box 2), as has happened historically in the case of male circumcision. 51–53…”