Systematic Reviews
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Feb 8, 2017; 6(1): 89-102
Published online Feb 8, 2017. doi: 10.5409/wjcp.v6.i1.89
Early infant male circumcision: Systematic review, risk-benefit analysis, and progress in policy
Brian J Morris, Sean E Kennedy, Alex D Wodak, Adrian Mindel, David Golovsky, Leslie Schrieber, Eugenie R Lumbers, David J Handelsman, John B Ziegler
Brian J Morris, Adrian Mindel, School of Medical Sciences and Bosch Institute, University of Sydney, Sydney, NSW 2006, Australia
Sean E Kennedy, School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW 2052, Australia
Alex D Wodak, St Vincent’s Hospital and Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, NSW 2010, Australia
David Golovsky, IVF Australia, Sydney, NSW 2000, Australia
Leslie Schrieber, Department of Medicine, Sydney Medical School, Royal North Shore Hospital, Sydney, NSW 2060, Australia
Eugenie R Lumbers, School of Biomedical Sciences and Pharmacy, Mothers and Babies Research Centre, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW 2305, Australia
David J Handelsman, Department of Medicine and ANZAC Research Institute, Concord Hospital, Sydney, NSW 2139, Australia
John B Ziegler, Department of Immunology and Infectious Diseases, Sydney Children’s Hospital, Randwick, Sydney, NSW 2031, Australia
Author contributions: All authors contributed to this manuscript.
Conflict-of-interest statement: Authors are members of the Circumcision Academy of Australia, a medical body formed to provide accurate, evidence-based information on male circumcision to parents, practitioners and others, as well as contact details of doctors who perform the procedure.
Data sharing statement: The technical appendix, statistical code, and dataset are available from the first author at
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: John B Ziegler, AM, MD, MB, BS, DipHEd, FRACP, FAAAAI, Professor, Department of Immunology and Infectious Diseases, Sydney Children’s Hospital, High St, Randwick, Sydney, NSW 2031, Australia.
Telephone: +61-2-93821515 Fax: +61-2-93821580
Received: May 31, 2016
Peer-review started: June 6, 2016
First decision: July 25, 2016
Revised: November 17, 2016
Accepted: December 27, 2016
Article in press: December 28, 2016
Published online: February 8, 2017
Core Tip

Core tip: Australia and New Zealand should follow the lead of the American Academy of Pediatrics and the United States Centers for Disease Control and Prevention in facilitating education, provider training, patient access and affordability of circumcision of male infants and boys. Our systematic review of the current scientific evidence finds the protection afforded by early infant male circumcision against infections and other adverse medical conditions exceed risks by 200 to 1 and that over their lifetime over 1 in 2 uncircumcised males will suffer an adverse medical condition caused by their foreskin. Strong evidence shows no adverse effect on penile function, sexual sensitivity or pleasure. Circumcision is a desirable public health intervention. It is moreover cost-saving.