Pediatric Circumcision Recommended, and as Early as Possible

A new study reports that few severe complications are seen following circumcision in neonates; mild or moderate complications are seen, however, when circumcision is undertaken at in older children, by inexperienced providers, or in nonsterile conditions.

Researchers at the London School of Hygiene & Tropical Medicine (United Kingdom) searched health databases for studies from all available years to estimate the frequency of adverse events following neonatal, infant, and child circumcision. There was no language restriction, and additional searches of the Arabic literature included searches of relevant databases and University libraries for research theses on male circumcision. A total of 1,349 prospective published papers were identified, of which 52 studies from 21 countries met the inclusion criteria. The Arabic literature searches identified 46 potentially relevant papers, of which six were included.

The results showed that in most of the studies that evaluated complications following circumcision in infants aged less than a year, no severe adverse events (SAE) were reported, apart from two studies that reported a SAE frequency of 2%. The median frequency of any complication was 1.5%. Child circumcision by medical providers tended to be associated with more complications--with a median frequency of 6%--than for neonates and infants; more complications, including severe complications, were seen when the procedure was done by inexperienced providers, or with inadequate equipment and supplies. The study also found that traditional circumcision, as a rite of passage in older children was associated with substantially greater risks, as well as more severe complications, than medical circumcision or traditional circumcision among neonates. The study was published on February 15, 2010, in the open access journal BMC Urology, a publication of BioMed Central.

"Male circumcision is commonly practiced and will continue to occur for religious, cultural, and medical reasons,” said lead author Helen Weiss, M.D. "There is a clear need to improve safety of male circumcision at all ages through improved training or retraining for both traditional and medically trained providers, and to ensure that providers have adequate supplies of necessary equipment and instruments for safe circumcision.”

Both the World Health Organization (WHO; Geneva, Switzerland) and the Joint United Nations Program on HIV/AIDS (UNAIDS; Geneva, Switzerland) have stated that male circumcision is an efficacious intervention for HIV prevention, but should be carried out by well-trained medical professionals and under conditions of informed consent. The recommendation also notes that circumcision only provides partial protection from HIV and should never replace known methods of HIV prevention.

Related Links:
London School of Hygiene & Tropical Medicine
BioMed Central
World Health Organization
Joint United Nations Program on HIV/AIDS