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Restore elective male circumcision to public hospitals

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It is important that NSW Health facilitate access to parent approved infant male circumcision (IMC) as a means of improving public health and individual wellbeing. The current evidence shows that IMC benefits far exceed risks [1-3]. IMC is also cost effective [4,5]. This position accords with current evidence-based IMC policy statements by the American Academy of Pediatrics [1] (endorsed by the American College of Obstetricians and Gynecologists), the American Urological Association [6], the Centers for Disease Control and Prevention [7], and others [2] These policies are based on findings from high quality studies, meta-analyses and large randomized controlled trials. IMC protects against urinary tract infections, kidney damage, as well as foreskin inflammation, tightness and tearing, sexually transmitted infections and ulceration, Candida infections, poor hygiene and genital cancers in both sexes [1-3,7-16]. Circumcision has no adverse effect on a man’s sexual function, sensitivity, penile sensation or satisfaction, and may enhance the male sexual experience [15]. Adverse events during IMC are uncommon and virtually all minor and easily treated with complete resolution [1,3,17]. For maximum benefits, safety, convenience and cost savings, the circumcision should be performed in infancy and with local anesthesia [1-3,19]. The ethics of parental decision-making and legal consent for IMC and childhood vaccination are comparable [19,20]. In the interests of public health and individual wellbeing, adequate parental education, and steps to facilitate access and affordability should be encouraged by NSW Health and Departments of Health in all Australian states [1,2,22].


1.      American Academy of Pediatrics. Circumcision policy statement. Task Force on Circumcision. Pediatrics. 2012; 130: e756-e785.

2.      Morris BJ, Wodak AD, Mindel A, Schrieber L, Duggan KA, Dilly A, Willcourt RJ, Cooper DA, Lumbers ER, Russell CT, Leeder SR. Infant male circumcision: An evidence-based policy statement. Open J Prevent Med. 2012; 2: 79-82.

3.      Morris BJ, Bailis SA, Wiswell TE. Circumcision rates in the United States: Rising or falling? What effect might the new affirmative pediatric policy statement have? Mayo Clin Proc. 2014; 89: 677-686. (Supporting video at:

4.      Kacker S, Frick KD, Gaydos CA, Tobian AA. Costs and effectiveness of neonatal male circumcision. Arch Pediatr Adolesc Med. 2012; 166: 910-918.

5.      Sansom SL, Prabhu VS, Hutchinson AB, et al. Cost-effectiveness of newborn circumcision in reducing lifetime HIV risk among U.S. males. PLoS One. 2010; 5: e8723.

6.      American Urological Association. Circumcision. AUA Policy Statements. 2012.

7.      Centers for Disease Control and Prevention. Male circumcision.

8.      Morris BJ, Wiswell TE. Circumcision and lifetime risk of urinary tract infections: A systematic review and meta-analysis. J Urol. 2013: 189: 2118-2124.

9.      Albero G, Castellsagué X, Giuliano AR, Bosch FX. Male circumcision and genital human papillomavirus: A systematic review and meta-analysis. Sex Transm Dis. 2012; 39: 104-113.

10.   Tobian AA, Gray RH. The medical benefits of male circumcision. JAMA. 2011; 306: 1479-1480.

11.   Morris BJ, Castellsague X. The role of circumcision in preventing STIs. Chapter 54. In: Gross GE, Tyring S, eds. Sexually Transmitted Infections and Sexually Transmitted Diseases, (ISBN 978-3-642-14662-6), chapter 54, Springer, Heidelberg, 2011, pp 715-739.

12.   Siegfried N, Muller M, Deeks JJ, Volmink J. Male circumcision for prevention of heterosexual acquisition of HIV in men. Cochrane Database Syst Rev. 2009; Issue 2 (CD003362): 1-38.

13.   Morris BJ, Bailey RC, Klausner JD, Leibowitz A, Wamai RG, Waskett JH, Benerjee J, Halperin DT, Zoloth L, Weiss HA, Hankins CA. A critical evaluation of arguments opposing male circumcision for HIV prevention in developed countries. AIDS Care 2012: 24: 1565-1575.

14.   Morris BJ, Gray RH, Castellsague X, et al. The strong protection afforded by circumcision against cancer of the penis. Adv Urol. 2011(Article ID 812368):1-21.

15.   Wright JL, Lin DW, Stanford JL. Circumcision and the risk of prostate cancer. Cancer. 2012; 118: 4437-4443.

16.   Castellsagué X, Bosch FX, Muñoz N, Meijer CJLM, Shah KV, de Sanjosé S, Eluf-Neto J, Ngelangel A, Chichareon S, Smith JS, Herrero R, Moreno V, Franceschi S, for the IARC Multicentric Cervical Cancer Study Group.Male circumcision, penile human papillomavirus (HPV) infection and cervical cancer in female partners.N Engl J Med 2002; 15: 1105-12.

17.   Morris BJ, Krieger JN. Does male circumcision affect sexual function, sensitivity or satisfaction? – A systematic review. J Sex Med. 2013; 10: 2644-2657.

18.   El Bcheraoui C, Zhang X, Cooper CS, Rose CE, Kilmarx PH, Chen RT.Rates of adverse events associated with male circumcision in US medical settings, 2001 to 2010.JAMA Pediatr. 2014 May 12. doi: 10.1001/jamapediatrics.2013.5414. [Epub ahead of print]

19.   Morris BJ, Waskett JH, Banerjee J, et al. A ‘snip’ in time: what is the best age to circumcise? BMC Pediatr. 2012; 12 (article20): 1-15.

20.   Bates MJ, Ziegler JB, Kennedy SE, et al. Recommendation by a law body to ban infant male circumcision has serious worldwide implications for pediatric practice and human rights. BMC Pediatr. 2013; 13 (article 136): 1-9.

21.   Morris BJ, Tobian AA. Legal threat to infant male circumcision. JAMA Pediatr. 2013; 167: 890-1.

22.   Leibowitz AA, Desmond K, Belin T. Determinants and policy implications of male circumcision in the United States. Am J Public Health. 2009; 99: 138-145.

22.   Leibowitz AA, Desmond K, Belin T. Determinants and policy implications of male circumcision in the United States. Am J Public Health. 2009; 99: 138-145.

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