Safety and Efficacy of Nontherapeutic Male Circumcision: A Systematic Review
- Caryn L. Perera, BA, Grad Cert EBP1,
- Franklin H. G. Bridgewater, MBBS, FRACS2,
- Prema Thavaneswaran, BSc (Hons), PhD1 and
- Guy J. Maddern, PhD, FRACS1,2,3
- 1ASERNIP-S, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
- 2Department of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- 3Department of Surgery, The University of Adelaide, Adelaide, South Australia, Australia
- CORRESPONDING AUTHOR: Guy J. Maddern, PhD, FRACS, ASERNIP-S, First Floor, 38 Payneham Rd, Stepney SA 5069, Australia, guy.maddern{at}adelaide.edu.au
Abstract
PURPOSE We wanted to assess the safety and efficacy of nontherapeutic male circumcision through a systematic review of the literature.
METHODS We systematically searched The York Centre for Reviews and Disseminations, Cochrane Library, PubMed, and EMBASE databases for randomized controlled trials published between January 1997 and August 2008. Studies reporting on circumcision in an operative setting in males of any age with no contraindications to or medical indications for circumcision were eligible for inclusion. The main comparator was intact genitalia. From 73 retrieved studies, 8 randomized controlled trials were ultimately included for analysis.
RESULTS Severe complications were uncommon. Analgesia/anesthesia during circumcision was promoted. The prevalence of self-reported genital ulcers was significantly lower in circumcised men than uncircumcised men (3.1% vs 5.8%; prevalence risk ratio 0.53; 95% confidence interval [CI], 0.43–0.64; P<.001). Circumcised sub-Saharan African men were at significantly lower risk of acquiring human immunodeficiency virus/acquired immune deficiency syndrome than were uncircumcised men (random effects odds ratio = 0.44, 95% CI, 0.32–0.59; P <.001). The evidence suggests that adult circumcision does not affect sexual satisfaction and function.
CONCLUSIONS Strong evidence suggests circumcision can prevent human immunodeficiency virus/acquired immune deficiency syndrome acquisition in sub-Saharan African men. These findings remain uncertain in men residing in other countries. The role of adult nontherapeutic male circumcision in preventing sexually transmitted infections, urinary tract infections, and penile cancer remains unclear. Current evidence fails to recommend widespread neonatal circumcision for these purposes.
- Circumcision, male
- sexually transmitted diseases
- HIV
- acquired immunodeficiency syndrome
- penile cancer
- urinary tract infections
- prophylactic procedures
- Received for publication January 13, 2009.
- Revision received April 22, 2009.
- Accepted for publication May 11, 2009.
- © 2010 Annals of Family Medicine, Inc.












