Ethics of male circumcision in minors: a scoping review of parental authority, adolescent involvement, and implications for sexual medicine practice and policy.

INTRODUCTION

Male circumcision in minors remains widely practiced in many regions of the world, although its prevalence varies considerably across cultural, religious, and geographic contexts. Beyond its medical dimensions, circumcision is closely linked to religion, culture, masculinity, family identity, and public health agendas. Ethical debates commonly involve tensions between parental authority, bodily autonomy, assent, and children's rights, particularly because minors are often minimally involved in decision-making processes.

METHODS

A scoping review was conducted to examine ethical, sociocultural, legal, and decision-making dimensions related to circumcision in minors. Literature searches were performed across MEDLINE, Web of Science, Scopus, ProQuest, SpringerLink, CINAHL/EBSCO, SAGE, and Taylor & Francis. Thirty-one eligible studies were included and analyzed using narrative and thematic synthesis approaches.

RESULTS

Ethical dilemmas surrounding circumcision in minors were found to be highly context-dependent and not ethically interchangeable across all forms of circumcision. Five major contextual typologies were identified: religious circumcision, traditional or rite-of-passage circumcision, therapeutic circumcision, public-health-driven voluntary medical male circumcision (VMMC), and elective or family-preference circumcision. Six major thematic frameworks emerged, including parental authority, constrained adolescent agency, public health versus bodily autonomy, masculinity formation, moral conflict and regret, and healthcare and legal systems as ethical gatekeepers. Circumcision decision-making was shaped by multilayered interactions involving family structures, sociocultural norms, healthcare systems, and public health priorities.

CONCLUSION

Ethical interpretations of circumcision in minors cannot be reduced to a simple binary distinction between ethical and unethical practices. Greater recognition of contextual differences and developmentally appropriate assent may support more ethically responsive and culturally sensitive circumcision practices. Policies and clinical guidelines should avoid applying uniform ethical approaches across all circumcision contexts. More context-sensitive frameworks incorporating assent procedures, adolescent involvement, culturally sensitive counseling, and safeguards against coercion may strengthen ethical governance in circumcision practices involving minors.

TRIAL REGISTRATION: This study was registered in the PROSPERO database (CRD420251074798). URL: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251074798. Date of registration: September 26, 2025.