CIRCUMCISION:
An Evidence-Based Appraisal
MEDICAL, HEALTH & SEXUAL

New brochures and key publications are on homepage.

Updated 2022

Circumcision of males is a very popular procedure. The purpose of this website is to provide a balanced up-to-date evidence-based review of scientific studies on male circumcision that have been published mainly in reputable international medical and scientific journals after a formal, critical refereeing process by experts in the field.

The information reviewed herein is the most extensive and accurate in the world. Listed are over 1,000 references. Most can be found by the reader in any medical library or Internet referencing service, such as PubMed. The message they convey is quite clear and have helped in formulation of affirmative circumcision policy statements by major international and national organizations such as the American Academy of Pediatrics, the Centers for Disease Control and Prevention, the World Health Organization (WHO), UNAIDS, and the Circumcision Academy of Australia, over recent years.

It is the intention of the present overview to provide easily-accessible, reliable, balanced information that should be of assistance to parents, medical professionals, scholars, as well as men and their sexual partners. The author is a professor emeritus in the medical faculty of the University of Sydney. He has over 50 years of scientific research experience and more than 450 research publications, including over 130 on male circumcision, mostly in peer-reviewed international journals. As such he is often invited by journals, book publishers, professional organizations and the news media for his comments or other contributions.

© Professor Emeritus Brian Morris. (The author freely grants permission for others to copy and distribute this review, provided it is not for financial gain. Complete and accurate translation is also permitted.)

Male Circumcision Brochure
- Information Guides in various languages

• Guide for Parents (Australian) PDF

• Guide for Parents (American version) (A4 Page Size) PDF

• Guide for Parents (American version) (US Letter Page Size) PDF

• Guide for Parents - Afr (Black) (A4 Page Size) PDF

• Guide for Parents - Afr (Black) (US Letter Page Size) PDF

• Guide for Parents (European) PDF

• Guide for Parents (German) PDF

• Guide for Parents (French) PDF

• Guide for Parents (Spanish) PDF

• Guide for Parents (Italian) PDF

• Guide for Parents (Traditional Chinese) or (PRC; Mainland China)

Benefits of circumcision - a guide for men

• Guide for Men & Teens (English) PDF

• Guide for Men (German) PDF

• Guide for Men & Teens (Dutch) PDF

• Guide for Men & Teens (Spanish) PDF

• Guide for Men & Teens (Hungarian) PDF

Male Circumcision Brochure,
- an Information Guide for Women

• Guide for women (English) PDF

• Guide for women (Spanish) PDF

• Guide for women (German) PDF

(Alternative cover picture)

• Guide for women dating (English) PDF

SUMMARY

Circumcision of males has been referred to as a "surgical vaccine" against a wide variety of infections, adverse medical conditions and potentially fatal diseases over their lifetime, and also protects their sexual partners. In experienced hands, this common, inexpensive, simple procedure is very safe, and can be pain-free. Although it can be performed at any age, the ideal time is early in infancy. The benefits vastly outweigh the risks.

The public health benefits are enormous, and include protection from urinary tract infections, that are common over the lifetime and often cause permanent kidney damage in babies, phimosis, paraphimosis, thrush, and inflammatory skin conditions such as balanitis and balanoposthitis, inferior genital hygiene, smegma, sexually transmitted HIV, oncogenic types of human papillomavirus, genital herpes, trichomoniasis, mycoplasma, syphilis and chancroid, penile cancer, and prostate cancer. In women circumcision of the male partner provides substantial protection from cervical cancer, genital herpes, bacterial vaginosis (formerly termed "gardnerella"), possibly Chlamydia (that can cause pelvic inflammatory disease, infertility, and ectopic pregnancy), and other infections.

Circumcision has socio-sexual benefits and reduces sexual problems with age and diabetes. It has no adverse effect on penile sensitivity, erectile function, or sensation during sexual arousal and is reported to enhance the sexual experience for men. Most women prefer the circumcised penis for appearance, hygiene, lower infection risk and sexual activity. At least half of all uncircumcised males will develop one or more problems over their lifetime caused by their foreskin, and many will suffer and die as a result. The benefits exceed the risks by over 100 to 1, and if the level of suffering and fatalities are taken into account in men and their sexual partners the benefit is orders of magnitude higher than this. Given the convincing epidemiological evidence and biological support, routine circumcision should be highly recommended by all health professionals and access facilitated by the health systems of every country. It is also cost saving.

Click the Links Below to Access pdf files

• Evidence-based circumcision policy for Australia
J Mens Health 2022, 18: 132.
https://pubmed.ncbi.nlm.nih.gov/36034719/

• American Academy of Pediatrics 2012 policy statement.
2012 AAP Policy

• Circumcision Rates in the United States: Rising
or Falling? What Effect Might the New
Affirmative Pediatric Policy Statement Have?
Mayo Clinic Proceedings 2014
MayoClinProc_IMC_2014.pdf

Accompanying video available at: http://www.youtube.com/watch?v=6Oq9GONsBIk

• Risk-benefit analysis.
http://www.circinfo.net/pdfs/risk-benefits_v3.6.pdf

• Country-specific and global prevalence of male circimcision.
Morris_Global MC prevalence_PHM_2016.pdf

Erratum.
Erratum_Morris_PopulatHealthMetr_2016.pdf

• A 'snip' in time: what is the best age to circumcise?
BMC Pediatrics 2012; 12 (article 20): 1-15.
http://www.biomedcentral.com/1471-2431/12/20

• Circumcision and lifetime risk of urinary tract infection:
a systematic review and meta-analysis.
J Urol 2013; 189: 2118-2124
http://www.ncbi.nlm.nih.gov/pubmed/23201382

• Infant circumcision for sexually transmitted infection reduction globally.
Glob Health Sci Pract 2022; 10: e2100811.
https://pubmed.ncbi.nlm.nih.gov/36041835/

• Does Male Circumcision Affect Sexual Function,
Sensitivity, or Satisfaction? — A Systematic Review.
J Sex Med. 2013 (Nov issue)
http://www.ncbi.nlm.nih.gov/pubmed/23937309

• The contrasting evidence concerning the effect of male circumcision on sexual function, sensation and pleasure: A systematic review.
Sex Med 2020; 8: 577-598.
https://pubmed.ncbi.nlm.nih.gov/33008776/

• Histological correlates of penile sexual sensation: Does circumcision make a difference? Sexual Medicine 2015
http://onlinelibrary.wiley.com/doi/10.1002/sm2.67/full

• Costs and effectiveness of neonatal male circumcision
Kacker S, Frick KD, Gaydos CA, Tobian AA.
Johns Hopkins University.
Arch Pediatr Adolesc Med. 2012; 166: 910-8
http://www.ncbi.nlm.nih.gov/pubmed/22911349

• Why circumcision is a biomedical imperative for the 21st century.
BioEssays 2007; 29: 1147-58.
CLICK HERE TO DOWNLOAD:
(CircBioEssays07.pdf)

• A critical evaluation of arguments opposing male circumcision for HIV prevention in developed countries.
AIDS Care 2012: Dec issue (Epub ahead of print 28 Mar).
http://www.ncbi.nlm.nih.gov/pubmed/22452415

• International Journal of Children's Rights article.
Rivin_IntJChildrensRights_2016.pdf

• Recommendation by a law body to ban infant male circumcision has serious
worldwide implications for pediatric practice and human rights.
BMC Pediatr. 2013; 13: 136 (9 pages)
http://www.ncbi.nlm.nih.gov/pubmed/24010685

• The ethical course is to recommend infant male circumcision – Arguments disparaging
American Academy of Pediatrics affirmative policy do not withstand scrutiny.J Law Med Ethics 2017; 45: 647-663.
http://journals.sagepub.com/

• Early infant male circumcision: Systematic review, risk-benefit analysis, and progress in policy. World J Clin Pediat 2017; 6: 89-102.
https://www.ncbi.nlm.nih.gov/pubmed/?term=Early+infant+male+circumcision
%3A+Systematic+review%2C+risk-benefit+analysis%2C+and+progress+in+policy.

• The strong protective effect of circumcision against cancer of the penis.
Adv Urol 2011: article ID 812368.
https://pubmed.ncbi.nlm.nih.gov/21687572/.

• Male circumcision and prostate cancer: a meta-analysis revisited.
Can J Urol 2021; 28: 10768-19776.
https://pubmed.ncbi.nlm.nih.gov/34378513/ .

• Penile inflammatory skin disorders and the preventive role of circumcision. Int J Prevent Med 2017; 8: 32
https://www.ncbi.nlm.nih.gov/pubmed/?term=Penile+inflammatory
+skin+disorders+and+the+preventive+role+of+circumcision.

• Does circumcision increase meatal stenosis risk? – A systematic review and meta-analysis. Urology 2017; 110: 16-26.
https://www.ncbi.nlm.nih.gov/pubmed/28826876

• Does male circumcision reduce women’s risk of sexually transmitted infections, cervical
cancer and associated conditions? (Systematic Review) Front Public Health 2019; 7: article 4 https://www.ncbi.nlm.nih.gov/pubmed/?term=Does+male+circumcision
+reduce+women’s+risk+of+sexually+transmitted
+infections%2C+cervical+cancer+and+associated+conditions%3F

• Sex and male circumcision: Women’s preferences across different cultures and countries – A systematic review. Sex Med 2019: 7: 145-161.
https://www.ncbi.nlm.nih.gov/pubmed/?term=Sex+and+male+circumcision%3A
+Women’s+preferences+across+different+cultures+and+countries+–+A+systematic+review

• Critical evaluation of arguments opposing male circumcision: A systematic review. J Evid Based Med 2019; 12: Epub ahead of print 8 Sep https://www.ncbi.nlm.nih.gov/pubmed/?term=Critical+evaluation+of
+arguments+opposing+male+circumcision%3A+A+systematic+review.

• Critical evaluation of survey claiming “long-term adverse outcomes from neonatal circumcision”. Adv Sex Med 2019; 9: 67-109. http://www.scirp.org/Journal/paperinformation.aspx?paperid=95051

• Prevalence of phimosis in males of all ages: Systematic review. Urology 2020.
https://www.ncbi.nlm.nih.gov/pubmed/31655079

• Critical evaluation of contrasting evidence on whether male circumcision has adverse psychological effects: A systematic review.
J Evid Based Med 2022: 15: 123-135.
https://pubmed.ncbi.nlm.nih.gov/35785439/

• Causes and consequences of the decline in circumcision in Australia.
Surg 2021; 91: 2546-2547.
https://pubmed.ncbi.nlm.nih.gov/34766683/