Comments by opponents on the British Medical Association’s guidance on non-therapeutic male circumcision of children seem one-sided and may undermine public health

Abstract

The British Medical Association (BMA) guidance on non-therapeutic circumcision (NTMC) of male children is limited to ethical, legal and religious issues. Here we evaluate criticisms of the BMA’s guidance by Lempert et al. While their arguments promoting autonomy and consent might be superficially appealing, their claim of high procedural risks and negligible benefits seem one-sided and contrast with high quality evidence of low risk and lifelong benefits. Extensive literature reviews by the American Academy of Pediatrics and the United States Centers for Disease Control and Prevention in developing evidence-based policies, as well as risk-benefit analyses, have found that the medical benefits of infant NTMC greatly exceed the risks, and there is no reduction in sexual function and pleasure. The BMA’s failure to consider the medical benefits of early childhood NTMC may partly explain why this prophylactic intervention is discouraged in the United Kingdom. The consequence is higher prevalence of preventable infections, adverse medical conditions, suffering and net costs to the UK’s National Health Service for treatment of these. Many of the issues and contradictions in the BMA guidance identified by Lempert et al stem from the BMA’s guidance not being sufficiently evidence-based. Indeed, that document called for a review by others of the medical issues surrounding NTMC. While societal factors apply, ultimately, NTMC can only be justified rationally on scientific, evidence-based grounds. Parents are entitled to an accurate presentation of the medical evidence so that they can make an informed decision. Their decision either for or against NTMC should then be respected.

Keywords: Circumcision, Male; Child; Infections; Risk; Policy; Public health

Core Tip: This article assesses arguments by circumcision opponents Lempert et al criticizing the British Medical Association (BMA)’s guidance on non-therapeutic male circumcision (NTMC) for failing to consider all of the issues. We find that the BMA’s focus on non-medical issues expose it to such claims by NTMC opponents. Indeed, the medical evidence, as used for evidence-based NTMC policies in the United States, does not support their claims. The lifetime benefits of early infant NTMC greatly exceed the risks, and the procedure has no adverse effect on sexual function or pleasure. The neonatal period is the optimal time for parent approved NTMC.