Does the evidence support circumcision of infant males in the United Kingdom?-a systematic review.

BACKGROUND

The United Kingdom (UK) does not have an evidence-based policy on circumcision for non-medical reasons. The aim of this systematic review is to address the question "Is non-therapeutic male circumcision (NTMC) a beneficial public health intervention for the UK?".

METHODS

A PRISMA-compliant, PROSPERO-registered, systematic review was conducted involving PubMed, EMBASE, SCOPUS and Cochrane databases searches for male circumcision articles to January 2024. Those rated high-quality by the Scottish Intercollegiate Grading Network (SIGN) system were included in results.

RESULTS

Searches retrieved 183 articles rated as high-quality and relevant to the objectives. These showed early circumcision provided immediate and lifetime medical benefits by protecting against urinary tract infections, penile dermatological inflammation, phimosis, inferior penile hygiene, candida, sexually transmitted infections (STIs) such as human papillomavirus, genital herpes virus type-2, human immunodeficiency virus, and penile and prostate cancers. NTMC had no long-term adverse effect on sexual function or pleasure. Female partners were at lower STI and cervical cancer risk. A risk-benefit analysis for the UK found benefits of early circumcision exceeded procedural risks by over 200 to one, and that as many as half of uncircumcised males may be affected during their lifetime from an adverse medical condition attributable to foreskin retention. Costs for treatment of these exceeds procedural costs for early NTMC. A recent systematic review found NTMC of male minors is legal and supported by ethical arguments as well as the United Nations Convention of the Rights of the Child which emphasizes the right to health. Routine provision of accurate, evidence-based information on risks and benefits should assist parents in making an informed decision about circumcision should they have a boy. Cost coverage is warranted.

CONCLUSIONS

In summary, the medical evidence supports early circumcision as a public health recommendation in the UK.