Neonatal circumcision: a dispassionate analysis.

Abstract

This review provides a dispassionate analysis of the evidence on the benefits and risks of neonatal circumcision. The evidence is considered within a clinically relevant framework in which decision-making relies on three interrelated factors: 1) clinical experience, 2) scientific evidence, and 3) patient preference. The roles of patient preference and clinical experience are outlined; then health benefits, risks, and economic costs of circumcision are explored. The most commonly proposed benefits of circumcision are prevention of penile inflammatory disorders, urinary tract infections, penile cancer, and sexually transmitted diseases. Meanwhile, the short-term risks of circumcision include surgical complications and the infliction of pain and distress on the neonate. A potential long-term consequence of the procedure is sexual dysfunction. In considering the cost-effectiveness of circumcision, the following areas are taken into account: 1) economic data on the direct and indirect cost of the procedure and subsequent care, 2) valid estimates of the probability of events prevented and events cause by the intervention, and 3) an accurate estimate of the circumcision's impact on health status. Evidence of the technical aspects of circumcision, namely, the surgical and anesthetic techniques, are also reviewed.