The 2010 Royal Australasian College of Physicians' policy statement ‘Circumcision of infant males’ is not evidence based
Article first published online: 18 JUL 2012
© 2012 The Authors. Internal Medicine Journal © 2012 Royal Australasian College of Physicians
Internal Medicine Journal
Volume 42, Issue 7, pages 822–828, July 2012
How to Cite
Morris, B. J., Wodak, A. D., Mindel, A., Schrieber, L., Duggan, K. A., Dilley, A., Willcourt, R. J., Lowy, M. and Cooper, D. A. (2012), The 2010 Royal Australasian College of Physicians' policy statement ‘Circumcision of infant males’ is not evidence based. Internal Medicine Journal, 42: 822–828. doi: 10.1111/j.1445-5994.2012.02823.x
Conflict of interest: None.
- Issue published online: 18 JUL 2012
- Article first published online: 18 JUL 2012
- Received 15 September 2011; accepted 17 November 2011.
- male circumcision;
- public health;
- infant infection;
- sexually transmitted infection;
- cervical cancer
Infant male circumcision (MC) is an important issue guided by Royal Australasian College of Physicians (RACP) policy. Here we analytically review the RACP's 2010 policy statement ‘Circumcision of infant males’. Comprehensive evaluation in the context of published research was used. We find that the Statement is not a fair and balanced representation of the literature on MC. It ignores, downplays, obfuscates or misrepresents the considerable evidence attesting to the strong protection MC affords against childhood urinary tract infections, sexually transmitted infections (human immunodeficiency virus, human papilloma virus, herpes simplex virus type 2, trichomonas and genital ulcer disease), thrush, inferior penile hygiene, phimosis, balanoposthitis and penile cancer, and in women protection against human papilloma virus, herpes simplex virus type 2, bacterial vaginosis and cervical cancer. The Statement exaggerates the complication rate. Assertions that ‘the foreskin has a functional role’ and ‘is a primary sensory part of the penis’ are not supported by research, including randomised controlled trials. Instead of citing these and meta-analyses, the Statement selectively cites poor quality studies. Its claim, without support from a literature-based risk-benefit analysis, that the currently available evidence does ‘not warrant routine infant circumcision in Australia and New Zealand’ is misleading. The Statement fails to explain that performing MC in the neonatal period using local anaesthesia maximises benefits, safety, convenience and cost savings. Because the RACP's policy statement is not a fair and balanced representation of the current literature, it should not be used to guide policy. In the interests of public health and individual well-being, an extensive, comprehensive, balanced review of the scientific literature and a risk-benefit analysis should be conducted to formulate policy.