Nontherapeutic Male Circumcision: Tackling the Difficult Issues

Authors

  • Caryn L. Perera BA (Lib & Info Mgt), Grad Cert EBP,

    1. ASERNIP-S, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia;
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  • Franklin H.G. Bridgewater MBBS, FRACS,

    1. Department of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia;
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  • Prema Thavaneswaran BSc (Hons), PhD,

    1. ASERNIP-S, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia;
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  • Guy J. Maddern PhD, FRACS

    Corresponding author
    1. ASERNIP-S, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia;
    2. Department of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia;
    3. Department of Surgery, The University of Adelaide, Adelaide, South Australia, Australia
      Guy Maddern, PhD, FRACS, ASERNIP-S, First Floor, 38 Payneham Road, Stepney, South Australia 5069, Australia. Tel: +61-8-8363-7513; Fax: +61-8-8362-2077; E-mail: asernips@surgeons.org
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Guy Maddern, PhD, FRACS, ASERNIP-S, First Floor, 38 Payneham Road, Stepney, South Australia 5069, Australia. Tel: +61-8-8363-7513; Fax: +61-8-8362-2077; E-mail: asernips@surgeons.org

ABSTRACT

Introduction.  Male circumcision is the most commonly performed surgical procedure in the world. Circumcision may be performed to treat an underlying pathological process (“therapeutic circumcision”). However there may be religious, cultural, and social indications.

Aim.  This article addresses the religious, cultural, social, and ethical issues surrounding nontherapeutic male circumcision (NTMC).

Main Outcome Measures.  Any religious, social, cultural, or ethical issues relating to NTMC.

Methods.  Because of the absence of high level evidence, a concise literature review was undertaken to identify articles published between January 1990 and February 2009 summarizing current knowledge on NTMC.

Results.  There are complex religious, cultural, social, and prophylactic incentives for NTMC. The procedure may have associated clinical and psychosocial adverse events and raises such ethical issues as bodily integrity and consent. Because of the strength of the incentives for NTMC, there may be important implications in denying patients the procedure. Several important issues must be considered when introducing mass circumcision as a preventative strategy for HIV/AIDS.

Conclusion.  When assessing whether NTMC will benefit or harm a patient, clinicians must take his religious, cultural, and social circumstances into account. Males requiring mandatory religious or cultural NTMC are likely to suffer significant harm if they do not receive circumcision and should be considered separately to males in general. Perera CL, Bridgewater FHG, Thavaneswaran P, and Maddern GJ. Nontherapeutic male circumcision: Tackling the difficult issues. J Sex Med 2009;6:2237–2243.

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