Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Aug 8, 2016; 5(3): 251-261
Published online Aug 8, 2016. doi: 10.5409/wjcp.v5.i3.251
Critical evaluation of unscientific arguments disparaging affirmative infant male circumcision policy
Brian J Morris, John N Krieger, Jeffrey D Klausner
Brian J Morris, School of Medical Sciences, University of Sydney, Sydney, New South Wales 2006, Australia
John N Krieger, Section of Urology, VA Puget Sound Health Care System and School of Medicine, University of Washington, Seattle, WA 98195, United States
Jeffrey D Klausner, Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, United States
Author contributions: All authors contributed to this manuscript.
Conflict-of-interest statement: No conflict-of-interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Brian J Morris, DSc, PhD, Professor Emeritus, School of Medical Sciences, University of Sydney, Building F13, Sydney, New South Wales 2006, Australia.
Telephone: +61-2-93513688 Fax: +61-2-93512227
Received: January 20, 2016
Peer-review started: January 20, 2016
First decision: March 1, 2016
Revised: March 11, 2016
Accepted: April 21, 2016
Article in press: April 22, 2016
Published online: August 8, 2016

We evaluate recent claims opposing infant male circumcision, a procedure now supported by the evidence-based policy of the American Academy of Pediatrics. We find those criticisms depend on speculative claims about the foreskin and obfuscation of the strong scientific evidence supporting pediatric policy development. An argument that circumcision should be delayed to allow a boy to make up his own mind as an adult fails to appreciate the psychological, scheduling and financial burdens later circumcision entails, so reducing the likelihood that it will occur. In contrast, early infant circumcision is convenient, safer, quicker, lower risk, healing is faster, cosmetic outcome is routinely good and the lifetime benefits accrue immediately. Benefits include reduction in urinary tract infections, inflammatory skin conditions, foreskin problems, and, when older, substantial protection against sexually transmitted infections and genital cancers in the male and his female sexual partners. Some authorities regard the failure to offer parents early infant circumcision as unethical, just as it would be unethical to fail to encourage the vaccination of children. In conclusion, the criticisms of evidence-based infant male circumcision policy are seriously flawed and should be dismissed as unhelpful to evidence-based development and implementation of pediatric policy intended to improve public health and individual wellbeing.

Keywords: Male circumcision, Policy, American Academy of Pediatrics, Newborn, Foreskin

Core tip: This article critically assesses an extensive compendium of detailed arguments criticizing the American Academy of Pediatrics policy in support of infant male circumcision. The article we assess is by an historian, Robert Darby, who is opposed to infant circumcision. It should be recognized that the American Academy of Pediatrics policy on infant male circumcision was developed on the basis of the latest scientific evidence. The policy reported that benefits exceed risks and recommended unbiased education of parents and providers, as well as facilitation of access and improvement in affordability by increased third party insurance coverage. We present the scientific evidence undermining Darby’s arguments. Our evaluation leads us to conclude that the criticisms by Darby should be dismissed as unreliable.