Systematic Reviews
Copyright ©The Author(s) 2017.
World J Clin Pediatr. Feb 8, 2017; 6(1): 89-102
Published online Feb 8, 2017. doi: 10.5409/wjcp.v6.i1.89
Table 1 Risk-benefit analysis for newborn male circumcision
ConditionDecrease in risk1Percent affected2Study type and refQuality score3
A: Conditions avoided and risk reduction
Pyelonephritis (infants)0.6OS[24,25]2+
With concurrent bacteremia0.1
Hypertension in early adulthood0.1
End-stage renal disease in early adult0.06
Urinary tract infections: Age 0-1 yr90%1.3Meta[22]1+
Urinary tract infections: Age 1-16 yr85%2.7Meta[22]1+
Urinary tract infections: Age > 16 yr70%28Meta[22]1+
Urinary tract infections: lifetime72%27Meta[22]1+
Phimosis4> 90%10OS[33-45,47]2+
Balanitis68%10Meta[54]1+
Candidiasis (thrush)60%10OS[19]2+
High-risk HPV infection56%10Meta[73]1++
53%-65%4Meta[65]1++
40%6-10RCT[61-63,70-72]1++
HIV (acquired heterosexually)60%0.2OS[90]2+
70%0.1Meta[87]1++
Genital ulcer disease50%1OS[81,82,161]2+
Syphilis47%1Meta[67]1+
40%-55%1OS[79,80]2+
Trichomonas vaginalis50%1RCT[77]1+
Mycoplasma genitalium40%0.5RCT[78]1+
Herpes simplex virus type 230%4RCT[68,69,75,76]1++
15%4Meta[67]1++
Chancroid50%< 1Meta[67]1+
Penile cancer (lifetime)67%0.07Meta[119]1+
95%50.1OS[116]2+
95%60.11OS[117]2+
99%70.07OS[118]2+
Prostate cancer: Population-based17%2.1Meta[125]1+
Black race42%17Meta[125]1+
Total percentage of uncircumcised males affected = approximately 80%
B: Risks of infant MC
Excessive minor bleeding0.1-0.2OS[128,132]2++
Infection, local0.06OS[128,132]2++
Infection, systemic0.03OS[128]2++
Need for repeat surgery0.08OS[128]2++
Meatal stenosis< 0.1OS[128-131]2++
Partial loss of penis0.0002OS[128]2++
Death< 0.000001OS[132]2++
Reduced penile function, sensitivity, sexual pleasure0SR[133,134,137]2++
Reduced penile function0Meta[134]1+
Total percentage of adverse events from infant circumcision: About 0.4%
Risk: Benefit
Thus, over the lifetime, the risk to an uncircumcised male of developing a foreskin-related condition requiring medical attention may be up to 80%. In comparison the procedural risk during infant MC of experiencing an easily treatable condition is approximately 1 in 250. The risk of a moderate or serious complication is approximately 1 in 3000. Thus benefit to risk = 1:200.
C: Risks reduced by female partners
Cervical cancer658%78OS[59,60]2++
28%7RCT[101]1++
Herpes simplex virus type 2655%7OS[102]2+
Genital ulceration622%7RCT[103]1+
Trichomonas vaginalis648%7RCT[103]1+
Syphilis675%7OS[79]2++
Bacterial vaginosis640%7RCT[103]1+
Chlamydia trachomatis68279OS[104]1++