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Pokarowski M, Kim JK, Milford K, Yadav P, Koyle M, Mahood Q, Santos JD, Rickard M, Lorenzo A, Chua M. Examining Clinical Practice Guidelines for Male Circumcision: A Systematic Review and Critical Appraisal Using AGREE II. J Pediatr 2022; 244:186-193.e6. [PMID: 35063471 DOI: 10.1016/j.jpeds.2021.12.073] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify and critically appraise available clinical practice guidelines (CPGs) targeting male circumcision using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. STUDY DESIGN A literature search was conducted using electronic databases, CPG databases, and national/international societies providing recommendations to guide clinical decision making for male circumcision. We selected pediatric-focused CPGs related to male circumcision published between January 2010 and December 2020. Non-English CPGs and publications involving narrative reviews, primary research, training manuals, patient and allied health professional guidelines, and technical guides were excluded from our search. Complete CPG documents (including full-text articles, supplemental documents, and associated information) were reviewed. Quality appraisal of CPGs was conducted in accordance with the AGREE II manual. RESULTS A total of 163 CPGs were identified, of which 93 were screened and 13 were reviewed. All AGREE II domains demonstrated good to excellent interrater reliability, with intraclass correlation coefficients ranging from 0.82 (95% CI, 0.72-0.89) to 0.93 (95% CI, 0.90-0.95). Most CPGs performed satisfactorily in the clarity of presentation domain and performed poorly in the applicability and editorial independence domains. The top 3 CPGs identified were those of the American Academy of Pediatrics, Centers for Disease Control and Prevention, and Canadian Urological Association. Consistencies among the CPGs were demonstrated across most recommendations. CONCLUSIONS Current CPGs are of variable quality, and our findings should be taken into consideration by clinicians and health care professionals when selecting appropriate guidelines for male circumcision.
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Affiliation(s)
- Martha Pokarowski
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada.
| | - Jin Kyu Kim
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Karen Milford
- Department of Surgery, Nelson Mandela Children's Hospital, University of The Witwatersrand, Johannesburg, South Africa
| | - Priyank Yadav
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Martin Koyle
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Quenby Mahood
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Joana Dos Santos
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Mandy Rickard
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Armando Lorenzo
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Michael Chua
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada; Institute of Urology, St. Luke's Medical Center, Quezon City, Philippines
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Morris BJ, Hankins CA, Lumbers ER, Mindel A, Klausner JD, Krieger JN, Cox G. Sex and Male Circumcision: Women's Preferences Across Different Cultures and Countries: A Systematic Review. Sex Med 2019; 7:145-161. [PMID: 31031121 PMCID: PMC6523040 DOI: 10.1016/j.esxm.2019.03.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/26/2019] [Accepted: 03/14/2019] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Women's choices for a sexual partner are influenced by numerous personal, cultural, social, political and religious factors, and may also include aspects of penile anatomy such as male circumcision (MC) status. AIM To perform a systematic review examining (i) whether MC status influences women's preference for sexual activity and the reasons for this, and (ii) whether women prefer MC for their sons. METHODS PRISMA-compliant searches were conducted of PubMed, Google Scholar, Embase, and the Cochrane Database of Systematic Reviews. Articles that met the inclusion criteria were rated for quality using the SIGN system. RESULTS Database searches identified 29 publications with original data for inclusion, including 22 for aim (i) and 4 of these and 7 others pertaining to aim (ii). In the overwhelming majority of studies, women expressed a preference for the circumcised penis. The main reasons given for this preference were better appearance, better hygiene, reduced risk of infection, and enhanced sexual activity, including vaginal intercourse, manual stimulation, and fellatio. In studies that assessed mothers' preference for MC of sons, health, disease prevention, and hygiene were cited as major reasons for this preference. Cultural differences in preference were evident among some of the studies examined. Nevertheless, a preference for a circumcised penis was seen in most populations regardless of the frequency of MC in the study setting. CONCLUSION Women's preferences generally favor the circumcised penis for sexual activity, hygiene, and lower risk of infection. The findings add to the already well-established health benefits favoring MC and provide important sociosexual information on an issue of widespread interest. Morris BJ, Hankins CA, Lumbers ER, et al. Sex and Male Circumcision: Women's Preferences Across Different Cultures and Countries: A Systematic Review. Sex Med 2019;7:145-161.
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Affiliation(s)
- Brian J Morris
- School of Medical Sciences and Bosch Institute, University of Sydney, Sydney, NSW, Australia.
| | - Catherine A Hankins
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada; London School of Hygiene and Tropical Medicine, London, UK
| | - Eugenie R Lumbers
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine and Priority Research Centre for Reproductive Science, University of Newcastle, Callaghan, NSW, Australia; Mothers and Babies Research Centre, Hunter Medical Research Institute, New Lambton, NSW, Australia
| | - Adrian Mindel
- School of Medical Sciences and Bosch Institute, University of Sydney, Sydney, NSW, Australia
| | - Jeffrey D Klausner
- Division of Infectious Diseases and the Program in Global Health, Fielding School of Public Health, University of California Los Angeles Care Center, Los Angeles, CA, USA
| | - John N Krieger
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - Guy Cox
- School of Medical Sciences and Bosch Institute, University of Sydney, Sydney, NSW, Australia
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Fay M, Grande SW, Donnelly K, Elwyn G. Using Option Grids: steps toward shared decision-making for neonatal circumcision. PATIENT EDUCATION AND COUNSELING 2016; 99:236-242. [PMID: 26324111 DOI: 10.1016/j.pec.2015.08.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 08/17/2015] [Accepted: 08/19/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To assess the impact, acceptability and feasibility of a short encounter tool designed to enhance the process of shared decision-making and parental engagement. METHODS We analyzed video-recordings of clinical encounters, half undertaken before and half after a brief intervention that trained four clinicians how to use Option Grids, using an observer-based measure of shared decision-making. We also analyzed semi-structured interviews conducted with the clinicians four weeks after their exposure to the intervention. RESULTS Observer OPTION(5) scores were higher at post-intervention, with a mean of 33.9 (SD=23.5) compared to a mean of 16.1 (SD=7.1) for pre-intervention, a significant difference of 17.8 (95% CI: 2.4, 33.2). Prior to using the intervention, clinicians used a consent document to frame circumcision as a default practice. Encounters with the Option Grid conferred agency to both parents and clinicians, and facilitated shared decision-making. Clinician reported recognizing the tool's positive effect on their communication process. CONCLUSIONS Tools such as Option Grids have the potential to make it easier for clinicians to achieve shared decision-making. PRACTICE IMPLICATIONS Encounter tools have the potential to change practice. More research is needed to test their feasibility in routine practice.
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Affiliation(s)
- Mary Fay
- Dartmouth Hitchcock Medical Center, Lebanon, USA; Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, USA.
| | - Stuart W Grande
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, USA.
| | - Kyla Donnelly
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, USA.
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, USA.
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Ekwunife OH, Ugwu JO, Okoli CC, Modekwe VI, Osuigwe AN. Parental circumcision preferences and early outcome of plastibell circumcision in a Nigerian tertiary hospital. Afr J Paediatr Surg 2015; 12:251-6. [PMID: 26712290 PMCID: PMC4955474 DOI: 10.4103/0189-6725.172565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Parents are central in decisions and choices concerning circumcision of their male children and plastibell circumcision is a widely practiced technique. This study determined parental preferences for male neonatal and infant circumcisions and evaluate the early outcomes of plastibell circumcisions in a tertiary centre. PATIENTS AND METHODS This is a prospective study on consecutive male neonates and infants who were brought for circumcisions at Nnamdi Azikiwe University Teaching Hospital Nnewi, South-East Nigeria and their respective parents between January 2012 and December 2012. Data on demography, parental choices and early outcome of plastibell circumcision were obtained and analysed. RESULTS A total of 337 requests for circumcisions were made for boys with age range of 2-140 days. Culture and religion were the most common reasons for circumcision requests in 200 (59.3%) and 122 (36.2%), respectively, other reasons were medical, cosmesis, to reduce promiscuity and just to follow the norm. Most parents, 249 (73.9%) preferred the procedure to be performed on the 8 th day and 88.7% would like the doctors to perform the procedure while 84.6% preferred the plastibell method. Among those who had circumcision, 114 complied with follow-up schedules and there were complications in 22 (19.3%) patients. Parents assessed the early outcome as excellent, very good, good and poor in 30.7%, 45.6%, 18.4% and 5.3% of the patients, respectively. CONCLUSION Parents request for male circumcision in our environment is largely for cultural and religious reasons; and prefer the procedure to be performed by a physician. Plastibell method is well known and preferred and its outcome is acceptable by most parents.
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Affiliation(s)
- Okechukwu Hyginus Ekwunife
- Department of Surgery, Paediatric Surgery Unit, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Jideofor Okechukwu Ugwu
- Department of Surgery, Paediatric Surgery Unit, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Chinedu C. Okoli
- Department of Surgery, Paediatric Surgery Unit, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Victor Ifeanyichukwu Modekwe
- Department of Surgery, Paediatric Surgery Unit, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
| | - Andrew N. Osuigwe
- Department of Surgery, Paediatric Surgery Unit, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
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Bossio JA, Pukall CF, Bartley K. You either have it or you don't: The impact of male circumcision status on sexual partners. THE CANADIAN JOURNAL OF HUMAN SEXUALITY 2015. [DOI: 10.3138/cjhs.242-a2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study was an exploration of the impact of men's circumcision status on their sexual partners, focusing on sexual functioning, sexual satisfaction, general preferences for circumcision status, and beliefs about circumcision status. A total of 196 individuals (168 women, 28 men) currently in a sexual relationship with a man were recruited for an online survey. Sexual functioning for female or male participants (assessed by the FSFI or IIEF-MSM, respectively) was not impacted by circumcision status, but women with intact partners reported higher levels of sexual satisfaction, while no differences were observed in the male sample. Women's responses indicated that circumcision status minimally impacted satisfaction with partner's genitals, while men with intact partners indicated significantly higher levels of satisfaction than those with circumcised partners. Overall, women and men rated high levels of satisfaction with their partner's circumcision status and did not wish for it to change. Women indicated a slight preference for circumcised penises for vaginal intercourse and fellatio, and held more positive beliefs about circumcised penises, while men indicated a strong preference toward intact penises for all sexual activities assessed and held more positive beliefs about intact penises. The current study demonstrates distinct gender differences in attitudes toward circumcision status but minimal impact of circumcision status on sexual functioning. Future research should further explore sexual correlates of circumcision status, with a focus on directionality of said correlates and the impact on couples, as well as replicating the findings with a larger sample, specifically with respect to the male sample.
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Affiliation(s)
| | | | - Katie Bartley
- Department of Psychology, Queen's University, Kingston, Ontario
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Hart-Cooper GD, Tao G, Stock JA, Hoover KW. Circumcision of privately insured males aged 0 to 18 years in the United States. Pediatrics 2014; 134:950-6. [PMID: 25332502 DOI: 10.1542/peds.2014-1007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Male circumcision confers protection against HIV, sexually transmitted infections, and urinary tract infections. Compared with circumcision of postneonates (>28 days), circumcision of neonates is associated with fewer complications and usually performed with local rather than general anesthesia. We assessed circumcision of commercially insured males during the neonatal or postneonatal period. METHODS We analyzed 2010 MarketScan claims data from commercial health plans, using procedural codes to identify circumcisions performed on males aged 0 to 18 years, and diagnostic codes to assess clinical indications for the procedure. Among circumcisions performed in the first year of life, we estimated rates for neonates and postneonates. We estimated the percentage of circumcisions by age among males who had circumcisions in 2010, and the mean payment for neonatal and postneonatal procedures. RESULTS We found that 156,247 circumcisions were performed, with 146,213 (93.6%) in neonates and 10,034 (6.4%) in postneonates. The neonatal circumcision rate was 65.7%, and 6.1% of uncircumcised neonates were circumcised by their first birthday. Among postneonatal circumcisions, 46.6% were performed in males younger than 1 year and 25.1% were for nonmedical indications. The mean payment was $285 for a neonatal and $1885 for a postneonatal circumcision. CONCLUSIONS The large number of nonmedical postneonatal circumcisions suggests that neonatal circumcision might be a missed opportunity for these boys. Delay of nonmedical circumcision results in greater risk for the child, and a more costly procedure. Discussions with parents early in pregnancy might help them make an informed decision about circumcision of their child.
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Affiliation(s)
- Geoffrey D Hart-Cooper
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia; The CDC Experience Applied Epidemiology Fellowship, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia; and
| | - Guoyu Tao
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeffrey A Stock
- Departments of Pediatrics and Urology, Mount Sinai Hospital, New York, New York
| | - Karen W Hoover
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia;
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Bossio JA, Pukall CF, Steele S. A review of the current state of the male circumcision literature. J Sex Med 2014; 11:2847-64. [PMID: 25284631 DOI: 10.1111/jsm.12703] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Male circumcision is one of the most commonly performed surgical procedures worldwide and a subject that has been the center of considerable debate. Recently, the American Association of Pediatrics released a statement affirming that the medical benefits of neonatal circumcision outweigh the risks. At present, however, the majority of the literature on circumcision is based on research that is not necessarily applicable to North American populations, as it fails to take into account factors likely to influence the interpretability and applicability of the results. AIMS The purpose of this review is to draw attention to the gaps within the circumcision literature that need to be addressed before significant changes to public policy regarding neonatal circumcision are made within North America. METHODS A literature review of peer-reviewed journal articles was performed. MAIN OUTCOME MEASURES The main outcome measure was the state of circumcision research, especially with regard to new developments in the field, as it applies to North American populations. RESULTS This review highlights considerable gaps within the current literature on circumcision. The emphasis is on factors that should be addressed in order to influence research in becoming more applicable to North American populations. Such gaps include a need for rigorous, empirically based methodologies to address questions about circumcision and sexual functioning, penile sensitivity, the effect of circumcision on men's sexual partners, and reasons for circumcision. Additional factors that should be addressed in future research include the effects of age at circumcision (with an emphasis on neonatal circumcision) and the need for objective research outcomes. CONCLUSION Further research is needed to inform policy makers, health-care professionals, and stakeholders (parents and individuals invested in this debate) with regard to the decision to perform routine circumcision on male neonates in North America.
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Bates MJ, Ziegler JB, Kennedy SE, Mindel A, Wodak AD, Zoloth LS, Tobian AAR, Morris BJ. Recommendation by a law body to ban infant male circumcision has serious worldwide implications for pediatric practice and human rights. BMC Pediatr 2013; 13:136. [PMID: 24010685 PMCID: PMC3846407 DOI: 10.1186/1471-2431-13-136] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 09/06/2013] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Recent attempts in the USA and Europe to ban the circumcision of male children have been unsuccessful. Of current concern is a report by the Tasmanian Law Reform Institute (TLRI) recommending that non-therapeutic circumcision be prohibited, with parents and doctors risking criminal sanctions except where the parents have strong religious and ethnic ties to circumcision. The acceptance of this recommendation would create a precedent for legislation elsewhere in the world, thereby posing a threat to pediatric practice, parental responsibilities and freedoms, and public health. DISCUSSION The TLRI report ignores the scientific consensus within medical literature about circumcision. It contains legal and ethical arguments that are seriously flawed. Dispassionate ethical arguments and the United Nations Convention on the Rights of the Child are consistent with parents being permitted to authorize circumcision for their male child. Uncritical acceptance of the TLRI report's recommendations would strengthen and legitimize efforts to ban childhood male circumcision not just in Australia, but in other countries as well. The medical profession should be concerned about any attempt to criminalize a well-accepted and evidence-based medical procedure. The recommendations are illogical, pose potential dangers and seem unworkable in practice. There is no explanation of how the State could impose criminal charges against doctors and parents, nor of how such a punitive apparatus could be structured, nor how strength of ethnic or religious ties could be determined. The proposal could easily be used inappropriately, and discriminates against parents not tied to the religions specified. With time, religious exemptions could subsequently be overturned. The law, governments and the medical profession should reject the TLRI recommendations, especially since the recent affirmative infant male circumcision policy statement by the American Academy of Pediatrics attests to the significant individual and public health benefits and low risk of infant male circumcision. SUMMARY Doctors should be allowed to perform medical procedures based on sound evidence of effectiveness and safety with guaranteed protection. Parents should be free to act in the best interests of the health of their infant son by having him circumcised should they choose.
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Affiliation(s)
| | - John B Ziegler
- Department of Immunology & Infectious Diseases, Sydney Children’s Hospital, Randwick, Sydney, NSW 2031, Australia
- School of Women’s & Children’s Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Sean E Kennedy
- School of Women’s & Children’s Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Adrian Mindel
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia
| | - Alex D Wodak
- St Vincent’s Hospital and Kirby Institute, University of New South Wales, Sydney, NSW 2010, Australia
| | - Laurie S Zoloth
- Program in Bioethics and Medical Humanities, Northwestern University School of Medicine, Chicago, IL 60611-3015, USA
| | - Aaron AR Tobian
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Brian J Morris
- School of Medical Sciences and Bosch Institute, University of Sydney, Sydney, NSW 2006, Australia
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Morris BJ, Wodak AD, Mindel A, Schrieber L, Duggan KA, Dilley A, Willcourt RJ, Lowy M, Cooper DA. The 2010 Royal Australasian College of Physicians' policy statement 'Circumcision of infant males' is not evidence based. Intern Med J 2013; 42:822-8. [PMID: 22805686 DOI: 10.1111/j.1445-5994.2012.02823.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Infant male circumcision (MC) is an important issue guided by Royal Australasian College of Physicians (RACP) policy. Here we analytically review the RACP's 2010 policy statement 'Circumcision of infant males'. Comprehensive evaluation in the context of published research was used. We find that the Statement is not a fair and balanced representation of the literature on MC. It ignores, downplays, obfuscates or misrepresents the considerable evidence attesting to the strong protection MC affords against childhood urinary tract infections, sexually transmitted infections (human immunodeficiency virus, human papilloma virus, herpes simplex virus type 2, trichomonas and genital ulcer disease), thrush, inferior penile hygiene, phimosis, balanoposthitis and penile cancer, and in women protection against human papilloma virus, herpes simplex virus type 2, bacterial vaginosis and cervical cancer. The Statement exaggerates the complication rate. Assertions that 'the foreskin has a functional role' and 'is a primary sensory part of the penis' are not supported by research, including randomised controlled trials. Instead of citing these and meta-analyses, the Statement selectively cites poor quality studies. Its claim, without support from a literature-based risk-benefit analysis, that the currently available evidence does 'not warrant routine infant circumcision in Australia and New Zealand' is misleading. The Statement fails to explain that performing MC in the neonatal period using local anaesthesia maximises benefits, safety, convenience and cost savings. Because the RACP's policy statement is not a fair and balanced representation of the current literature, it should not be used to guide policy. In the interests of public health and individual well-being, an extensive, comprehensive, balanced review of the scientific literature and a risk-benefit analysis should be conducted to formulate policy.
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Affiliation(s)
- B J Morris
- School of Medical Sciences and Bosch Institute, The University of Sydney, NSW, Australia.
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Rediger C, Muller AJ. Parents' rationale for male circumcision. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2013; 59:e110-e115. [PMID: 23418252 PMCID: PMC3576965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To determine which factors parents consider to be most important when pursuing elective circumcision procedures in newborn male children. DESIGN Prospective survey. SETTING Saskatoon, Sask. PARTICIPANTS A total of 230 participants attending prenatal classes in the Saskatoon Health Region over a 3-month period. MAIN OUTCOME MEASURES Parents' plans to pursue circumcision, personal and family circumcision status, and factors influencing parents' decision making on the subject of elective circumcision. RESULTS The reasons that parents most often gave for supporting male circumcision were hygiene (61.9%), prevention of infection or cancer (44.8%), and the father being circumcised (40.9%). The reasons most commonly reported by parents for not supporting circumcision were it not being medically necessary (32.0%), the father being uncircumcised (18.8%), and concerns about bleeding or infection (15.5%). Of all parents responding who were expecting children, 56.4% indicated they would consider pursuing elective circumcision if they had a son; 24.3% said they would not. In instances in which the father of the expected baby was circumcised, 81.9% of respondents were in favour of pursuing elective circumcision. When the father of the expected child was not circumcised, 14.9% were in favour of pursuing elective circumcision. Regression analysis showed that the relationship between the circumcision status of the father and support of elective circumcision was statistically significant (P < .001). Among couples in which the father was circumcised, 82.2% stated that circumcision by an experienced medical practitioner was a safe procedure for all boys, in contrast to 64.1% of couples in which the father of the expected child was not circumcised. When the expecting father was circumcised, no one responded that circumcision was an unsafe procedure, compared with 7.8% when the expecting father was not circumcised (P = .003). CONCLUSION Despite new medical information and updated stances from various medical associations, newborn male circumcision rates continue to be heavily influenced by the circumcision status of the child's father.
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Affiliation(s)
- Chris Rediger
- University of Saskatchewan, 204 Brookside Ct, Warman, SK S0K 0A1.
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Bisono GM, Simmons L, Volk RJ, Meyer D, Quinn TC, Rosenthal SL. Attitudes and decision making about neonatal male circumcision in a Hispanic population in New York City. Clin Pediatr (Phila) 2012; 51:956-63. [PMID: 22511191 PMCID: PMC3777274 DOI: 10.1177/0009922812441662] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To understand attitudes and decision making regarding neonatal male circumcision. METHODS Parents (n = 150) with a son 3 years old were interviewed regarding demographics, communication with a medical provider, attitudes, and process by which the neonatal circumcision decision was made. RESULTS Thirty-three percent of sons were circumcised. In univariate analyses, choosing male circumcision was associated with parents being interviewed in English, the father being circumcised, positive attitudes, being informed of the advantages of circumcision, making a decision before birth, and being offered a choice. In the final model, parents who came from a culture and family that believed in circumcision and who believed that it was not too risky were more likely to circumcise their sons. CONCLUSIONS Decisions regarding circumcision appear to be influenced by values, risk perceptions, and medical providers. Future research should address ways of ensuring that families have the opportunity to make an informed decision.
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Affiliation(s)
- Gabriela M. Bisono
- Department of Pediatrics, Columbia University Medical Center - College of Physicians and Surgeons, Morgan Stanley Children's Hospital at New York-Presbyterian New York, NY
| | - Lisa Simmons
- Department of Pediatrics, Columbia University Medical Center - College of Physicians and Surgeons, Morgan Stanley Children's Hospital at New York-Presbyterian New York, NY
| | - Robert J. Volk
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Dodi Meyer
- Department of Pediatrics, Columbia University Medical Center - College of Physicians and Surgeons, Morgan Stanley Children's Hospital at New York-Presbyterian New York, NY
| | - Thomas C. Quinn
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, and Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Susan L. Rosenthal
- Department of Pediatrics and Psychiatry, Columbia University Medical Center - College of Physicians and Surgeons, Morgan Stanley Children's Hospital at NewYork Presbyterian
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Morris BJ, Waskett JH, Banerjee J, Wamai RG, Tobian AAR, Gray RH, Bailis SA, Bailey RC, Klausner JD, Willcourt RJ, Halperin DT, Wiswell TE, Mindel A. A 'snip' in time: what is the best age to circumcise? BMC Pediatr 2012; 12:20. [PMID: 22373281 PMCID: PMC3359221 DOI: 10.1186/1471-2431-12-20] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Accepted: 02/28/2012] [Indexed: 12/21/2022] Open
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.
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Affiliation(s)
- Brian J Morris
- School of Medical Sciences, University of Sydney, Sydney, NSW 2006, Australia.
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Morris BJ, Wodak AD, Mindel A, Schrieber L, Duggan KA, Dilley A, Willcourt RJ, Lowy M, Cooper DA, Lumbers ER, Russell CT, Leeder SR. Infant male circumcision: An evidence-based policy statement. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/ojpm.2012.21012] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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