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Does the evidence support circumcision of infant males in the United Kingdom?-a systematic review
Brian J Morris1, Stephen Moreton2, Stefan A Bailis3
1School of Medical Sciences, University of Sydney, Sydney, NSW, Australia.
Insights
Non-therapeutic male circumcision (NTMC) offers significant medical benefits, including protection against infections and cancers, with minimal risks. The evidence supports early circumcision as a beneficial public health intervention for the UK.
Area of Science:
- Public Health
- Medical Interventions
- Pediatric Health
Background:
- The UK lacks an evidence-based policy for non-medical male circumcision.
- This review addresses the public health benefits of non-therapeutic male circumcision (NTMC) in the UK.
Purpose of the Study:
- To systematically review the evidence on whether NTMC is a beneficial public health intervention for the UK.
Main Methods:
- A PRISMA-compliant systematic review of PubMed, EMBASE, SCOPUS, and Cochrane databases up to January 2024.
- Inclusion of high-quality studies rated by the Scottish Intercollegiate Grading Network (SIGN) system.
Main Results:
- 183 high-quality articles were reviewed, indicating early circumcision provides immediate and lifetime medical benefits.
- Benefits include protection against UTIs, STIs (including HIV), and certain cancers; no adverse sexual effects noted.
- Risk-benefit analysis shows benefits outweigh risks by over 200:1; female partners have lower STI and cervical cancer risk.
Conclusions:
- Medical evidence strongly supports early circumcision as a public health recommendation in the UK.
- NTMC is legal and ethically supported, with benefits exceeding risks.
- Informed parental decisions and cost coverage are recommended.
Background:
The United Kingdom (UK) does not have an evidence-based policy on circumcision for non-medical reasons. The aim of this systematic review is to address the question "Is non-therapeutic male circumcision (NTMC) a beneficial public health intervention for the UK?".
Methods:
A PRISMA-compliant, PROSPERO-registered, systematic review was conducted involving PubMed, EMBASE, SCOPUS and Cochrane databases searches for male circumcision articles to January 2024. Those rated high-quality by the Scottish Intercollegiate Grading Network (SIGN) system were included in results.
Results:
Searches retrieved 183 articles rated as high-quality and relevant to the objectives. These showed early circumcision provided immediate and lifetime medical benefits by protecting against urinary tract infections, penile dermatological inflammation, phimosis, inferior penile hygiene, candida, sexually transmitted infections (STIs) such as human papillomavirus, genital herpes virus type-2, human immunodeficiency virus, and penile and prostate cancers. NTMC had no long-term adverse effect on sexual function or pleasure. Female partners were at lower STI and cervical cancer risk. A risk-benefit analysis for the UK found benefits of early circumcision exceeded procedural risks by over 200 to one, and that as many as half of uncircumcised males may be affected during their lifetime from an adverse medical condition attributable to foreskin retention. Costs for treatment of these exceeds procedural costs for early NTMC. A recent systematic review found NTMC of male minors is legal and supported by ethical arguments as well as the United Nations Convention of the Rights of the Child which emphasizes the right to health. Routine provision of accurate, evidence-based information on risks and benefits should assist parents in making an informed decision about circumcision should they have a boy. Cost coverage is warranted.
Conclusions:
In summary, the medical evidence supports early circumcision as a public health recommendation in the UK.
