What are the pros and cons of circumcision?

Pros and Cons of Circumcision

Male circumcision provides significant health benefits including reduced risk of HIV and STI transmission, while carrying minimal risks when performed by trained practitioners in appropriate settings.

Benefits of Circumcision

Infection Prevention

• HIV Prevention: Circumcision reduces heterosexual HIV acquisition by 53-60%, with durable and population-level measurable effects 1
• STI Reduction: Decreases transmission of:
  • Human papillomavirus (HPV) 1, 2
  • Herpes simplex virus 2 (HSV-2) 1
  • Syphilis and chancroid 2
• Urinary Tract Infections: Uncircumcised males have higher risk of UTIs compared to circumcised males 2, 3

Cancer Prevention

• Penile Cancer: Provides protection against penile cancer 2, 4
• Prostate Cancer: May offer protection against prostate cancer 2
• Cervical Cancer: Female partners of circumcised men have reduced risk of cervical cancer 2

Other Medical Benefits

• Prevention of Phimosis: Eliminates risk of phimosis (inability to retract foreskin) 3
• Prevention of Paraphimosis: Eliminates risk of paraphimosis (foreskin trapped behind glans) 3
• Prevention of Balanoposthitis: Reduces risk of inflammation of glans and foreskin 3
• Hygiene: Improves genital hygiene 2

Risks and Disadvantages

Procedural Complications

• Pain: Substantial procedural pain if performed without adequate analgesia 4, 3
• Bleeding: Hemorrhage is a potential complication 3
• Infection: Local infection can occur at the surgical site 3
• Meatal Stenosis: Narrowing of the urethral opening can develop 3

Ethical Considerations

• Consent Issues: When performed on infants, the child cannot provide informed consent 5
• Elective Nature: It's an elective procedure on healthy tissue 4
• Cultural Attitudes: Acceptance varies based on cultural and religious perspectives 1

Special Populations

Newborns and Infants

• Safety: Observational studies in Africa involving large numbers of neonates have found male circumcision to be safe 1
• Timing: The American Academy of Pediatrics notes that health benefits outweigh risks and justify access for families who choose it 4
• Provider Training: Complications are more common with untrained providers regardless of whether they are physicians, nurses, or traditional religious providers 4

Men Who Have Sex with Men (MSM)

• Limited Evidence: No trials of adult male circumcision have been conducted among MSM 1
• Potential Benefit: Some epidemiological data suggest protection for MSM who engage primarily in insertive anal sex 1, 6

Implementation Considerations

Pain Management

• Analgesia Required: Adequate analgesia should be provided during circumcision 4
• Techniques: Both pharmacologic and non-pharmacologic techniques should be considered 4

Provider Qualifications

• Training: Procedure should be performed by trained and competent practitioners 4
• Sterile Technique: Sterile techniques should be employed 4

Common Pitfalls to Avoid

1. Inadequate Pain Control: Failing to provide appropriate analgesia during the procedure
2. Poor Technique: Complications are more common with untrained providers
3. Lack of Informed Consent: Parents should receive factually correct, nonbiased information before making decisions
4. Improper Aftercare: Regular foreskin hygiene is important for all males, whether circumcised or not 3
5. Overstating Benefits: While benefits exist, the number needed to treat to prevent one case of various conditions should be considered 5

The decision about circumcision should be made after weighing the medical benefits and risks alongside religious, cultural, and personal preferences, as medical benefits alone may not outweigh other considerations for individual families 4.