Infant male circumcision: An evidence-based policy statement

作     者：Brian J. Morris Alex D. Wodak Adrian Mindel Leslie Schrieber Karen A. Duggan Anthony Dilley Robin J. Willcourt Michael Lowy David A. Cooper Eugenie R. Lumbers C. Terry Russell Stephen R. Leeder 

作者机构：School of Medical Sciences and Bosch Institute The University of Sydney Sydney Australia 

出 版 物：《Open Journal of Preventive Medicine》 (预防医学期刊（英文）)

年 卷 期：2012年第2卷第1期

页      面：79-92页

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Male Circumcision Public Health Infant Infections Sexually Transmitted Infections Cervical Cancer 

摘      要：Here we review the international evidence for benefits and risks of infant male circumcision (MC) and use this to develop an evidence-based policy statement for a developed nation setting, focusing on Australia. Evidence from good quality studies that include meta-analyses and randomized controlled trials showed that MC provides strong protection against: urinary tract infections and, in infancy, renal parenchymal disease;phimosis;paraphimosis;balanoposthitis;foreskin tearing;some heterosexually transmitted infections including HPV, HSV-2, trichomonas, HIV, and genital ulcer disease;thrush;inferior hygiene;penile cancer and possibly prostate cancer. In women, circumcision of the male partner protects against HPV, HSV-2, cervical cancer, bacterial vaginosis, and possibly Chlamydia. MC has no adverse effect on sexual function, sensitivity, penile sensation or satisfaction and may enhance the male sexual experience. Adverse effects are uncommon (1%), and virtually all are minor and easily treated. For maximum benefits, safety, convenience and cost savings, MC should be performed in infancy and with local anesthesia. A risk-benefit analysis shows benefits exceed risks by a large margin. Over their lifetime up to half of uncircumcised males will suffer a medical condition as a result of retaining their foreskin. The ethics of infant MC and childhood vaccination are comparable. Our analysis finds MC is beneficial, safe and cost-effective, and should optimally be performed in infancy. In the interests of public health and individual wellbeing, adequate parental education, and steps to facilitate access and affordability should be encouraged in developed countries.