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

Table 1 Conclusions and recommendations by the American Academy of Pediatrics in its non-therapeutic male circumcision policy statement

The AAP Systematic evaluation of English-language peer-reviewed literature from 1995 through 2010 indicates that preventive health benefits of elective circumcision of male newborns outweigh the risks of the procedure

Benefits include significant reductions in the risk of urinary tract infection in the first year of life and, subsequently, in the risk of heterosexual acquisition of HIV and the transmission of other sexually transmitted infections

The procedure is well tolerated when performed by trained professionals under sterile conditions with appropriate pain management. Complications are infrequent; most are minor, and severe complications are rare. Male circumcision performed during the newborn period has considerably lower complication rates than when performed later in life

Although health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it and to warrant third-party payment for circumcision of male newborns. It is important that clinicians routinely inform parents of the health benefits and risks of male newborn circumcision in an unbiased and accurate manner

Parents ultimately should decide whether circumcision is in the best interests of their male child. They will need to weigh medical information in the context of their own religious, ethical, and cultural beliefs and practices. The medical benefits alone may not outweigh these other considerations for individual families. Findings from the systematic evaluation are available in the accompanying technical report. The American College of Obstetricians and Gynecologists has endorsed this statement

HIV: Human immunodeficiency virus.

Table 2 Nontherapeutic male circumcision policy statements showing arguments by opponents (left column) and responses to each (right column)

2012 AAP policy on NTMC[16,67]
Frisch et al[95], 2013	AAP Task Force[15], 2013
Svoboda & Van Howe[96], 2013	Morris et al[99], 2014
Jenkins[97], 2014	Morris et al[100], 2014
Darby[98], 2014	Morris[170], 2014
Darby[171], 2015	Morris et al[101], 2016
Svoboda et al[172], 2016	Brady[102], 2016; Morris et al[103], 2017
2014 CDC MC draft policy[17,88]
Earp[150], 2015	Morris[151], 2015
Adler[173], 2016	Rivin et al[174], 2016
Frisch et al[175], 2018	Morris et al[177], 2017; CDC[153], 2018
Van Howe[177], 2015	CDC[178], 2018
2015 CPS policy on NTMC[27]
Sorokan et al[27], 2015	Morris et al[70], 2016
Robinson et al[180], 2017	Morris et al[180], 2017
RACP policy on NTMC[183], 2010
RACP[181], 2010	Morris et al[182], 2012
Forbes[183], 2012	Morris et al[184], 2012
Jansen[185], 2016	Wodak et al[186], 2017

AAP: American Academy of Pediatrics; CDC: Centers for Disease Control and Prevention; CPS: Canadian Paediatric Society; NTMC: Non-therapeutic male circumcision; RACP: Royal Australasian College of Physicians.

Table 3 The advantages of non-therapeutic male circumcision in neonates compared with older boys and men

Neonatal non-therapeutic male circumcision	Non-therapeutic male circumcision of older boys and men
Is a simple surgical procedure for a well-trained competent medical practitioner	More complex
No psychological considerations	Possibility of adverse peer pressure, especially in societies such as the UK where MC is uncommon
Quick: Takes several minutes	Takes 30 min or more
Cost is lower	Much more expensive and often unaffordable
Low risk of adverse events (0.4%), and almost all are minor	Higher risk of adverse events (4%–8%)
Any bleeding is minimal and easily stopped	Bleeding is more common, requiring cautery or other interventions
Sutures not needed	Sutures or tissue glue are needed
Convenient since the baby sleeps most of the day	Inconvenient owing to need for time off school or work
Local anesthesia used if the infant is less than 2 mo of age	General anesthesia for age 2 mo to age 9 yr. For men local anesthesia may be used, although general anesthesia is sometimes preferred by the surgeon
Healing is fast (less than 2 weeks)	Healing takes 6 weeks or more
Cosmetic outcome usually good	If stitches are used, stitch marks may be visible permanently
No long-term memory of the procedure, or anxiety in anticipation	May be a source of fear in the boy or man of undergoing an operation
Does not disrupt breast-feeding or other activities	Abstinence from sexual intercourse required for the healing period of 6 or more weeks

MC: Male circumcision; UK: United Kingdom.