J Korean Med Assoc.  2016 Oct;59(10):785-792. 10.5124/jkma.2016.59.10.785.

Medical perspectives on the clinical value of male circumcision

• Park K

• KMID: 2391517
• DOI: http://doi.org/10.5124/jkma.2016.59.10.785

Abstract

Male circumcision (MC) is one of the most common surgical procedures in the world, but its medical benefits remain under debate. In the context of evidence-based medicine, MC is beneficial in reducing the risks of infantile urinary tract infection, viral-mediated sexually transmitted diseases, penile/cervical cancers, and poor hygiene. The claims of opponents against MC, such as reduced sexual performance, psychological trauma, and an excess of complications, are gradually losing credibility. Possibly influenced by US troops stationed in Korea following the Korean War, MC is highly prevalent in South Korea, though it has been losing popularity recently. The practice of MC in Korea is different from that in other countries, in that most cases of MC are performed in adolescence under local anesthesia. Although this eliminates the benefit of reducing urinary tract infection in neonates, it still offers the benefits of reducing the risk of viral sexually transmitted diseases and penile/cervical cancers. Moreover, MC can lead to improved hygiene for the majority of Koreans who are willing to undergo the procedure. The practice of MC in adolescence may reduce the risk of significant complications, though the risk of bleeding may be higher than for neonates.

Keyword

Male circumcision; Phimosis; Sexually transmitted diseases; Benefits

MeSH Terms

Adolescent
Anesthesia, Local
Circumcision, Male*
Evidence-Based Medicine
Female
Hemorrhage
Humans
Hygiene
Infant, Newborn
Korea
Korean War
Male
Male*
Phimosis
Psychological Trauma
Sexually Transmitted Diseases
Sexually Transmitted Diseases, Viral
Urinary Tract Infections

Figure

• 

  Figure 1 Global map of mal circumcision prevalence at country level as of 2006 (Reproduced from Weiss H. Male circumcision: global trends and determinants of prevalence, safety, and acceptability. Geneva: World Health Organization; 2008) [1].

Reference

1. Weiss H. Male circumcision: global trends and determinants of prevalence, safety, and acceptability. Geneva: World Health Organization;2008.

2. Pang MG, Kim DS. Extraordinarily high rates of male circumcision in South Korea: history and underlying causes. BJU Int. 2002; 89:48–54.

3. Kim D, Koo SA, Pang MG. Decline in male circumcision in South Korea. BMC Public Health. 2012; 12:1067.

4. Ku JH, Kim ME, Lee NK, Park YH. Circumcision practice patterns in South Korea: community based survey. Sex Transm Infect. 2003; 79:65–67.

5. Dunsmuir WD, Gordon EM. The history of circumcision. BJU Int. 1999; 83:Suppl 1. 1–12.

6. Oster J. Further fate of the foreskin: incidence of preputial adhesions, phimosis, and smegma among Danish schoolboys. Arch Dis Child. 1968; 43:200–203.

7. Hayashi Y, Kojima Y, Mizuno K, Kohri K. Prepuce: phimosis, paraphimosis, and circumcision. ScientificWorldJournal. 2011; 11:289–301.

8. Fleiss PM, Hodges FM, Van Howe RS. Immunological functions of the human prepuce. Sex Transm Infect. 1998; 74:364–367.

9. Taylor JR, Lockwood AP, Taylor AJ. The prepuce: specialized mucosa of the penis and its loss to circumcision. Br J Urol. 1996; 77:291–295.

10. Aridogan IA, Ilkit M, Izol V, Ates A, Demirhindi H. Glans penis and prepuce colonisation of yeast fungi in a paediatric population: pre- and postcircumcision results. Mycoses. 2009; 52:49–52.

11. Gunsar C, Kurutepe S, Alparslan O, Yilmaz O, Daglar Z, Sencan A, Genç A, Taneli C, Mir E. The effect of circumcision status on periurethral and glanular bacterial flora. Urol Int. 2004; 72:212–215.

12. Serour F, Samra Z, Kushel Z, Gorenstein A, Dan M. Comparative periurethral bacteriology of uncircumcised and circumcised males. Genitourin Med. 1997; 73:288–290.

13. Bleustein CB, Fogarty JD, Eckholdt H, Arezzo JC, Melman A. Effect of neonatal circumcision on penile neurologic sensation. Urology. 2005; 65:773–777.

14. Fink KS, Carson CC, DeVellis RF. Adult circumcision outcomes study: effect on erectile function, penile sensitivity, sexual activity and satisfaction. J Urol. 2002; 167:2113–2116.

15. Schober JM, Meyer-Bahlburg HF, Dolezal C. Self-ratings of genital anatomy, sexual sensitivity and function in men using the 'Self-Assessment of Genital Anatomy and Sexual Function, Male' questionnaire. BJU Int. 2009; 103:1096–1103.

16. Shaikh N, Morone NE, Bost JE, Farrell MH. Prevalence of urinary tract infection in childhood: a meta-analysis. Pediatr Infect Dis J. 2008; 27:302–308.

17. Singh-Grewal D, Macdessi J, Craig J. Circumcision for the prevention of urinary tract infection in boys: a systematic review of randomised trials and observational studies. Arch Dis Child. 2005; 90:853–858.

18. Tobian AA, Serwadda D, Quinn TC, Kigozi G, Gravitt PE, Laeyendecker O, Charvat B, Ssempijja V, Riedesel M, Oliver AE, Nowak RG, Moulton LH, Chen MZ, Reynolds SJ, Wawer MJ, Gray RH. Male circumcision for the prevention of HSV-2 and HPV infections and syphilis. N Engl J Med. 2009; 360:1298–1309.

19. Fergusson DM, Boden JM, Horwood LJ. Circumcision status and risk of sexually transmitted infection in young adult males: an analysis of a longitudinal birth cohort. Pediatrics. 2006; 118:1971–1977.

20. Turner AN, Morrison CS, Padian NS, Kaufman JS, Behets FM, Salata RA, Mmiro FA, Chipato T, Celentano DD, Rugpao S, Miller WC. Male circumcision and women's risk of incident chlamydial, gonococcal, and trichomonal infections. Sex Transm Dis. 2008; 35:689–695.

21. Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, Puren A. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS Med. 2005; 2:e298.

22. Gray RH, Kigozi G, Serwadda D, Makumbi F, Watya S, Nalugoda F, Kiwanuka N, Moulton LH, Chaudhary MA, Chen MZ, Sewankambo NK, Wabwire-Mangen F, Bacon MC, Williams CF, Opendi P, Reynolds SJ, Laeyendecker O, Quinn TC, Wawer MJ. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet. 2007; 369:657–666.

23. Bailey RC, Moses S, Parker CB, Agot K, Maclean I, Krieger JN, Williams CF, Campbell RT, Ndinya-Achola JO. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet. 2007; 369:643–656.

24. Albero G, Castellsague X, Giuliano AR, Bosch FX. Male circumcision and genital human papillomavirus: a systematic review and meta-analysis. Sex Transm Dis. 2012; 39:104–113.

25. Cherpes TL, Meyn LA, Krohn MA, Hillier SL. Risk factors for infection with herpes simplex virus type 2: role of smoking, douching, uncircumcised males, and vaginal flora. Sex Transm Dis. 2003; 30:405–410.

26. Cherpes TL, Hillier SL, Meyn LA, Busch JL, Krohn MA. A delicate balance: risk factors for acquisition of bacterial vaginosis include sexual activity, absence of hydrogen peroxide-producing lactobacilli, black race, and positive herpes simplex virus type 2 serology. Sex Transm Dis. 2008; 35:78–83.

27. Fergusson DM, Lawton JM, Shannon FT. Neonatal circumcision and penile problems: an 8-year longitudinal study. Pediatrics. 1988; 81:537–541.

28. American Academy of Pediatrics Task Force on Circumcision. Male circumcision. Pediatrics. 2012; 130:e756–e785.

29. Daling JR, Madeleine MM, Johnson LG, Schwartz SM, Shera KA, Wurscher MA, Carter JJ, Porter PL, Galloway DA, McDougall JK, Krieger JN. Penile cancer: importance of circumcision, human papillomavirus and smoking in in situ and invasive disease. Int J Cancer. 2005; 116:606–616.

30. Castellsague X, Bosch FX, Munoz N, Meijer CJ, Shah KV, de Sanjose S, Eluf-Neto J, Ngelangel CA, Chichareon S, Smith JS, Herrero R, Moreno V, Franceschi S. International Agency for Research on Cancer Multicenter Cervical Cancer Study Group. Male circumcision, penile human papillomavirus infection, and cervical cancer in female partners. N Engl J Med. 2002; 346:1105–1112.

31. Oh SJ, Kim KD, Kim KM, Kim KS, Kim KK, Kim JS, Kim HG, Woo YN, Yoon YL, Lee SD, Han SW, Lee SI, Choi H. Knowledge and attitudes of Korean parents towards their son's circumcision: a nationwide questionnaire study. BJU Int. 2002; 89:426–432.

32. Lee SD, Park E, Choe BM. Parental concerns on the circum-cision for elementary school boys: a questionnaire study. J Korean Med Sci. 2003; 18:73–79.

33. Kacker S, Frick KD, Gaydos CA, Tobian AA. Costs and effectiveness of neonatal male circumcision. Arch Pediatr Adolesc Med. 2012; 166:910–918.

34. O'Brien TR, Calle EE, Poole WK. Incidence of neonatal circumcision in Atlanta, 1985-1986. South Med J. 1995; 88:411–415.

35. Wiswell TE, Tencer HL, Welch CA, Chamberlain JL. Circumcision in children beyond the neonatal period. Pediatrics. 1993; 92:791–793.

36. Okeke LI, Asinobi AA, Ikuerowo OS. Epidemiology of complications of male circumcision in Ibadan, Nigeria. BMC Urol. 2006; 6:21.

37. Kaufman MR, Smelyanskaya M, Van Lith LM, Mallalieu EC, Waxman A, Hatzhold K, Marcell AV, Kasedde S, Lija G, Hasen N, Ncube G, Samuelson JL, Bonnecwe C, Seifert-Ahanda K, Njeuhmeli E, Tobian AA. Adolescent sexual and reproductive health services and implications for the provision of voluntary medical male circumcision: results of a systematic literature review. PLoS One. 2016; 11:e0149892.