Circumcision health risks and benefits – experts respond

A new review of US data has prompted a team of researchers to call on practitioners and policy makers to promote infant male circumcision as a health intervention.

The article, published in the Mayo Clinic Proceedings, argues that the benefits of infant male circumcision to health exceed the risks by over 100 to one. The authors cite research indicating that circumcision lowers the risk of urinary tract infections and conditions such phimosis in infants and the transmission of a variety of sexually transmitted infections in adulthood. They also note that studies show circumcision has no adverse effect on sexual function, sensitivity, or pleasure.

In a media release lead author Prof Brian Morris from the University of Sydney states: “The new findings now show that infant circumcision should be regarded as equivalent to childhood vaccination and that as such it would be unethical not to routinely offer parents circumcision for their baby boy. Delay puts the child’s health at risk and will usually mean it will never happen.”

The article has been covered widely overseas with headlines such as ‘Circumcision should be offered ‘like vaccines’ to the parents of baby boys, study claims‘ in the Daily Mail and ‘Circumcision Rate Falls Despite Health Risks‘ on NBC News.

In response to the strong claims made by the authors, the SMC contacted local experts and collected the following commentary.

Prof Kevin Pringle, Professor of Paediatrics and Head of Obstetrics and Gynaecology, University of Otago, Wellington, comments:

“I find this paper to be extremely worrying. The most worrisome aspect is the emphasis on possible diseases that are reported to be significantly more common in the uncircumcised population and the complete lack of any attempt to accurately document the risk of the complications of circumcision. The authors, for instance, quote a >20-fold increase in the risk of penile cancer, affecting 0.1% of the uncircumcised population. In fact, the incidence of penile cancer in Israel (almost 100% of males circumcised) is about the same as that in Scandinavia (circumcision the exception) suggesting that it is cleanliness, rather than godliness that is important. The increased risk for urinary tract infection in the first year of life only reached significance in a very large population and may be important if there is a congenital anomaly in the genitourinary tract.

“As I read their table, the authors suggest that performing 10 circumcisions will prevent 1 case of phimosis and/or 1 case of balanitis. 80% of children with a phimosis respond to the simple application of a steroid cream and only a small percentage need a circumcision. Similarly, many cases of balanitis are associated with phimosis and if the phimosis is treated, they have no further trouble. Paediatric Surgeons see most of the cases of phimosis and balanitis. They are nowhere near as common as is suggested in this paper.

“To compare the risks of circumcision with the risks associated with vaccination is just not true. Most of the diseases for which infants are vaccinated are potentially lethal or produce significant handicap. Go back to the last Polio epidemic and compare the risks of getting Polio with the risks of having the vaccination. Compare that with a 5-10% risk of infection or ulceration of the tip of the penis after circumcision and the small, but significant risk of death after neonatal circumcision. Vaccination is a low-risk intervention to prevent a problem with significant adverse outcomes. Circumcision is an intervention with significant risks (ignored or minimised by the authors of this paper) to prevent problems that will not develop in the vast majority of males; most of which can be simply addressed if and when the need arises.

“Paediatric Surgeons see most of the cases of phimosis and balanitis. They are nowhere near as common as is suggested in this paper.

“This situation was reviewed in New Zealand after the AAP [American Academy of Pediatrics] Position Statement was published. The current Paediatric Opinion can be found here:”

Prof Pringle’s comments were picked up on by Australasian media, examples include:

TVNZ News:  Circumcision study ‘worrying and non-substantive’
Herald Sun: To snip or not to snip
New Zealand Doctor: NZ health expert damns research calling for the return of male circumcision
The Telegraph: To snip or not to snip
3 News: Circumcision study questioned
NZ Herald: Circumcision as important as vaccination, controversial study suggests
MSN NZ News: NZ academic questions circumcision study