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Pros and cons of circumcision: an evidence-based overview.
Clin Microbiol Infect. 2016 Sep; 22(9):768-774.CM

Abstract

Based on three large randomized controlled trials (RCTs) conducted in Africa, it can clearly be stated that circumcision lowers the risk of infection with the human immunodeficiency virus (HIV) and some sexually transmitted infections (STIs) among males in settings of high HIV and STI endemicity. Similar effects on STI risk may exist for females, although this may result from an indirect effect of decreasing risk of infection among male partners. It is unknown whether circumcision prevents HIV acquisition in men who have sex with men (MSM), although there might be a protective effect for men who engage mainly in insertive anal intercourse. When the effects of adult circumcision on sexual function and satisfaction of men are examined, high-quality evidence strongly supports lack of harm. Whether circumcision alters sexual satisfaction of female partners is not known as fewer and smaller studies reported conflicting results. Circumcision rarely causes serious complications if practiced by trained practitioners, in a sterile setting, and with a proper follow-up. These conclusions are limited by the lack of high-quality data from areas outside of Africa. RCTs have not been conducted to assess the effects of circumcising infants or MSM. Circumcision has well-proven benefits for people residing in areas with high prevalence of STIs, including HIV, and is not unethical for those who choose to be circumcised or have their children circumcised on religious, social, or cultural grounds. For many others, a definite pro or con recommendation, based on a risk-benefit ratio, cannot be made.

Authors+Show Affiliations

Department of Urology, Lady Davis Carmel Medical Center, Haifa, Israel.Unit of Infectious Diseases, Rambam Medical Center, Haifa, Israel; Internal Medicine B, Rambam Medical Center, Haifa, Israel.Unit of Infectious Diseases, Rambam Medical Center, Haifa, Israel; Internal Medicine B, Rambam Medical Center, Haifa, Israel.Unit of Infectious Diseases, Rambam Medical Center, Haifa, Israel.Unit of Infectious Diseases, Rambam Medical Center, Haifa, Israel; Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel.Unit of Infectious Diseases, Rambam Medical Center, Haifa, Israel; Internal Medicine B, Rambam Medical Center, Haifa, Israel; Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel. Electronic address: a_neuberger@rambam.health.gov.il.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

27497811

Citation

Friedman, B, et al. "Pros and Cons of Circumcision: an Evidence-based Overview." Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases, vol. 22, no. 9, 2016, pp. 768-774.
Friedman B, Khoury J, Petersiel N, et al. Pros and cons of circumcision: an evidence-based overview. Clin Microbiol Infect. 2016;22(9):768-774.
Friedman, B., Khoury, J., Petersiel, N., Yahalomi, T., Paul, M., & Neuberger, A. (2016). Pros and cons of circumcision: an evidence-based overview. Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases, 22(9), 768-774. https://doi.org/10.1016/j.cmi.2016.07.030
Friedman B, et al. Pros and Cons of Circumcision: an Evidence-based Overview. Clin Microbiol Infect. 2016;22(9):768-774. PubMed PMID: 27497811.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pros and cons of circumcision: an evidence-based overview. AU - Friedman,B, AU - Khoury,J, AU - Petersiel,N, AU - Yahalomi,T, AU - Paul,M, AU - Neuberger,A, Y1 - 2016/08/04/ PY - 2016/04/24/received PY - 2016/07/17/revised PY - 2016/07/25/accepted PY - 2016/8/9/pubmed PY - 2017/2/7/medline PY - 2016/8/8/entrez KW - Benefits KW - Circumcision KW - Effect KW - HIV KW - Impact KW - Infections KW - Male circumcision KW - Sexually transmitted infections SP - 768 EP - 774 JF - Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases JO - Clin Microbiol Infect VL - 22 IS - 9 N2 - Based on three large randomized controlled trials (RCTs) conducted in Africa, it can clearly be stated that circumcision lowers the risk of infection with the human immunodeficiency virus (HIV) and some sexually transmitted infections (STIs) among males in settings of high HIV and STI endemicity. Similar effects on STI risk may exist for females, although this may result from an indirect effect of decreasing risk of infection among male partners. It is unknown whether circumcision prevents HIV acquisition in men who have sex with men (MSM), although there might be a protective effect for men who engage mainly in insertive anal intercourse. When the effects of adult circumcision on sexual function and satisfaction of men are examined, high-quality evidence strongly supports lack of harm. Whether circumcision alters sexual satisfaction of female partners is not known as fewer and smaller studies reported conflicting results. Circumcision rarely causes serious complications if practiced by trained practitioners, in a sterile setting, and with a proper follow-up. These conclusions are limited by the lack of high-quality data from areas outside of Africa. RCTs have not been conducted to assess the effects of circumcising infants or MSM. Circumcision has well-proven benefits for people residing in areas with high prevalence of STIs, including HIV, and is not unethical for those who choose to be circumcised or have their children circumcised on religious, social, or cultural grounds. For many others, a definite pro or con recommendation, based on a risk-benefit ratio, cannot be made. SN - 1469-0691 UR - https://www.unboundmedicine.com/medline/citation/27497811/Pros_and_cons_of_circumcision:_an_evidence_based_overview_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1198-743X(16)30268-3 DB - PRIME DP - Unbound Medicine ER -