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Male Circumcision: An Appraisal of Current Instrumentation

B. Morris,C. Eley

Published 2011 in Unknown venue

ABSTRACT

The topic of male circumcision (MC) is of considerable current interest, largely because of widespread publicity generated by research findings attesting to its ability to prevent HIV infection during heterosexual intercourse. In addition, its long-recognized ability to protect against other sexually transmitted infections (STIs) has also been well publicized in recent times, especially now that support has been provided by large randomized controlled trials (RCTs). While MC can be performed at any age, the ease with which circumcision can be performed in infancy makes this time of life preferable to intervention later in childhood or in adulthood. As well as the issue of safety, convenience, simplicity and consequent cost reductions, circumcision in infancy provides greater net benefits over the lifetime of the individual. It provides immediate 10-fold protection against urinary tract infections and thus kidney damage in baby boys, and greater protection against penile cancer than circumcision later in life, virtually eliminating the risk of this disease with its high morbidity and mortality (Morris, 2007; Morris, 2010; Tobian et al., 2010; Morris et al., 2011). Another benefit is prevention of phimosis, a common cause of sexual problems in adolescent boys and men, and a major risk factor for penile cancer. It also lowers to risk of inflammatory skin conditions such as balanoposthitis. Circumcised men have superior hygiene (O'Farrell et al., 2005) and half the prevalence of thrush (Richters et al., 2006). As far as protection against STIs is concerned, the most notable is human papillomavirus (HPV), the pathogen not only responsible for most cervical cancers in women, but also a proportion of penile cancers in men (Morris et al., 2011). MC also reduces the incidence of ulcerative STIs, including syphilis, chancroid, Trichomonas vaginalis, and herpes simplex virus type 2 (HSV-2) (Weiss et al., 2006; Morris & Castellsague, 2010; Tobian et al., 2010). Circumcised men have lower genital ulcer disease as a result of this and the reduction in penile injury arising from tearing of the foreskin and frenulum during sexual activity (Bailey & Mehta, 2009). MC reduces sexual problems with age and diabetes (Morris, 2007; Morris, 2010; Tobian et al., 2010; Morris et al., 2011), and has no adverse effect on sexual function, sensation or acceptability (Morris, 2007; Tobian et al., 2010), if anything the reverse (Krieger et al., 2008). MC provides a public health benefit to women by lowering their risk of various STIs, including high-risk HPV types that cause cervical cancer, HSV-2,

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