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Open Access Highly Accessed Debate

A 'snip' in time: what is the best age to circumcise?

Brian J Morris1*, Jake H Waskett2, Joya Banerjee3, Richard G Wamai4, Aaron AR Tobian5, Ronald H Gray5, Stefan A Bailis6, Robert C Bailey7, Jeffrey D Klausner8, Robin J Willcourt9, Daniel T Halperin10, Thomas E Wiswell11 and Adrian Mindel12

Author Affiliations

1 School of Medical Sciences, University of Sydney, Sydney, NSW 2006, Australia

2 Circumcision Independent Reference and Commentary Service, 157 Stand Lane, Radcliffe, Manchester M26 1JR, UK

3 Global Youth Coalition on HIV/AIDS, Pretoria, South Africa

4 Department of African-American Studies, Northeastern University, Boston, MA 02115, USA

5 Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA

6 Research & Education Association on Circumcision Health Effects, Bloomington, MN 55425, USA

7 Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, IL, USA

8 Divisions of AIDS & Infectious Diseases, University of California, San Francisco, CA 94122, USA

9 Pregnancy Advisory Centre, The Queen Elizabeth Hospital, Adelaide, SA 5011, Australia

10 Department of Education and Behavior, University of North Carolina School of Public Health, Chapel Hill, NC 27599, USA

11 Center for Neonatal Care, Orlando, FL 32804, USA

12 Sexually Transmitted Infections Research Centre, Westmead Hospital and University of Sydney, Sydney, NSW 2145, Australia

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BMC Pediatrics 2012, 12:20  doi:10.1186/1471-2431-12-20

Published: 28 February 2012

Abstract

Background

Circumcision is a common procedure, but regional and societal attitudes differ on whether there is a need for a male to be circumcised and, if so, at what age. This is an important issue for many parents, but also pediatricians, other doctors, policy makers, public health authorities, medical bodies, and males themselves.

Discussion

We show here that infancy is an optimal time for clinical circumcision because an infant's low mobility facilitates the use of local anesthesia, sutures are not required, healing is quick, cosmetic outcome is usually excellent, costs are minimal, and complications are uncommon. The benefits of infant circumcision include prevention of urinary tract infections (a cause of renal scarring), reduction in risk of inflammatory foreskin conditions such as balanoposthitis, foreskin injuries, phimosis and paraphimosis. When the boy later becomes sexually active he has substantial protection against risk of HIV and other viral sexually transmitted infections such as genital herpes and oncogenic human papillomavirus, as well as penile cancer. The risk of cervical cancer in his female partner(s) is also reduced. Circumcision in adolescence or adulthood may evoke a fear of pain, penile damage or reduced sexual pleasure, even though unfounded. Time off work or school will be needed, cost is much greater, as are risks of complications, healing is slower, and stitches or tissue glue must be used.

Summary

Infant circumcision is safe, simple, convenient and cost-effective. The available evidence strongly supports infancy as the optimal time for circumcision.

Keywords:
Circumcision; Public health; Surgery; Infant health; Adolescent health; Foreskin; Urinary tract infections; Sexually transmitted infections; Penile cancer; Cervical cancer; Dermatology; Psychology