Evidence-based circumcision policy for Australia

Brian J Morris; Athos Katelaris; Norman J Blumenthal; Mohamed Hajoona; Adrian C Sheen; Leslie Schrieber; Eugenie R Lumbers; Alex D Wodak; Phillip Katelaris

doi:10.31083/j.jomh1806132

Evidence-based circumcision policy for Australia

J Mens Health. 2022;18(6):132. doi: 10.31083/j.jomh1806132. Epub 2022 May 30.

Authors

Brian J Morris¹, Athos Katelaris², Norman J Blumenthal³, Mohamed Hajoona⁴, Adrian C Sheen⁵, Leslie Schrieber⁶, Eugenie R Lumbers⁷, Alex D Wodak⁸, Phillip Katelaris⁹

Affiliations

¹ School of Medical Sciences, University of Sydney, Sydney, NSW 2006, Australia.
² Department of Urology, St George Hospital, Sydney, NSW 2217, Australia.
³ Department of Obstetrics and Gynaecology, SAN Clinic, Wahroonga, NSW 2076, Australia.
⁴ Victoria Circumcision Clinic, The Regent Medical Group, Preston, VIC 3072, Australia.
⁵ Mulgoa Medical Centre, Mulgoa, NSW 2745, Australia.
⁶ Department of Medicine, Royal North Shore Hospital, St Leonards, NSW 2065, Australia.
⁷ School of Biomedical Sciences and Pharmacy, University of Newcastle, Pregnancy and Reproduction Program, Hunter Medical Research Institute, New Lambton Heights; Priority Research Centre for Reproductive Sciences, University of Newcastle, Callaghan, NSW 2308, Australia.
⁸ St Vincent's Hospital, Australian Tobacco Harm Reduction Association and Australia21, Darlinghurst, NSW 2010, Australia.
⁹ Katelaris Urology, North Shore Private Hospital, St Leonards, NSW 2065, Australia.

Abstract

The aim was (1) to perform an up-to-date systematic review of the male circumcision (MC) literature and (2) to determine the number of adverse medical conditions prevented by early MC in Australia. Searches of PubMed using "circumcision" with 39 keywords and bibliography searches yielded 278 publications meeting our inclusion criteria. Early MC provides immediate and lifetime benefits, including protection against: urinary tract infections, phimosis, inflammatory skin conditions, inferior penile hygiene, candidiasis, various STIs, and penile and prostate cancer. In female partners MC reduces risk of STIs and cervical cancer. A risk-benefit analysis found benefits exceeded procedural risks, which are predominantly minor, by approximately 200 to 1. It was estimated that more than 1 in 2 uncircumcised males will experience an adverse foreskin-related medical condition over their lifetime. An increase in early MC in Australia to mid-1950s prevalence of 85% from the current level of 18.75% would avoid 77,000 cases of infections and other adverse medical conditions over the lifetime for each annual birth cohort. Survey data, physiological measurements, and the anatomical location of penile sensory receptors responsible for sexual sensation indicate that MC has no detrimental effect on sexual function, sensitivity or pleasure. US studies found that early infant MC is cost saving. Evidence-based reviews by the AAP and CDC support early MC as a desirable public health measure. Although MC can be performed at any age, early MC maximizes benefits and minimises procedural risks. Parents should routinely be provided with accurate, up-to-date evidence-based information in an unbiased manner early in a pregnancy so that they have time to weigh benefits and risks of early MC and make an informed decision should they have a son. Parental choice should be respected. A well-trained competent practitioner is essential and local anaesthesia should be routinely used. Third party coverage of costs is advocated.

Keywords: circumcision male; complications; cost benefit; inflammatory conditions; penile cancer; policy; prostate cancer; risk benefit; sexual function; sexually transmitted infections; urinary tract infection.

Grants and funding

P20 GM125526/GM/NIGMS NIH HHS/United States