Nontherapeutic Male Circumcision: Tackling the Difficult Issues

© 2009 International Society for Sexual MedicineIntroductionMale 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.AimThis article addresses the religious, cultural, social, and ethical issues surrounding nontherapeutic male circumcision (NTMC).Main outcome measuresAny religious, social, cultural, or ethical issues relating to NTMC.MethodsBecause 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.ResultsThere 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.ConclusionWhen 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.Caryn L. Perera, Franklin H.G. Bridgewater, Prema Thavaneswaran, Guy J. Madder