evidence-based circumcision policy for Australia
Journal of Men’s Health. 2022; 18(6): 132.
Brian J. Morris, Athos Katelaris, Norman Blumenthal, Mohamed Hajoona, Adrian C. Sheen, Leslie Schrieber, Eugenie R. Lumbers, Alex D. Wodak, Phillip Katelaris, for the Circumcision Academy of Australia.
Brian J. Morris, Athos Katelaris, Norman Blumenthal, Mohamed Hajoona, Adrian C. Sheen, Leslie Schrieber, Eugenie R. Lumbers, Alex D. Wodak, Phillip Katelaris, for the Circumcision Academy of 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.
Brian J. Morris1,*, Athos Katelaris,2 Norman Blumenthal3, Mohamed Hajoona4, Adrian C. Sheen5, Leslie Schrieber6, Eugenie R. Lumbers7, Alex D. Wodak8, Phillip Katelaris9, for the Circumcision Academy of Australia
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.
Brian J. Morris1,*, Athos Katelaris,2 Norman Blumenthal3, Mohamed Hajoona4, Adrian C. Sheen5, Leslie Schrieber6, Eugenie R. Lumbers7, Alex D. Wodak8, Phillip Katelaris9, for the Circumcision Academy of Australia
- School of Medical Sciences, University of Sydney, Sydney, New South Wales, Australia
- Department of Urology, St George Hospital, Sydney, New South Wales, Australia
- Department of Obstetrics and Gynaecology, SAN Clinic, Wahroonga, New South Wales, Australia
- Victoria Circumcision Clinic, The Regent Medical Group, Preston, Victoria, Australia
- Mulgoa Medical Centre, Mulgoa, New South Wales, Australia
- Department of Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- 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, New South Wales, Australia
- Alcohol and Drug Service, St Vincent's Hospital, Australian Tobacco Harm Reduction Association and Australia21, Darlinghurst, New South Wales, Australia
- Phillip Katelaris, Katelaris Urology, North Shore Private Hospital, St Leonards, New South Wales, Australia