Paper published in Medical Decision Making, Vol. 24, No. 6, 584-601 (2004). The author, Robert S. Van Howe, MD, MS, FAAP, determined that it was more costly to circumcise than to leave baby boys intact. The study concludes, "Neonatal circumcision is not good health policy, and support for it as a medical procedure cannot be justified financially or medically."

Article in the Journal of Medical Ethics, Vol. 31, Issue 8, 2005;31:463-469 doi:10.1136/jme.2004.009340. The authors conclude that "it is ethically inappropriate to subject children—male or female—to the acknowledged risks of circumcision and contend that there is no compelling legal authority for the common view that male circumcision is lawful."

Article published in The Journal of Infection in Developing Countries, Vol 2, No 05, 2008 Oct 1;2(5):328-34. The full text of the article is available as a pdf file.  The authors cannot say enough good things about male circumcision as a way to reduce HIV in Africa. The article does not address the finding that male circumcision increases the HIV rate for the male to female vector.

An article in Advocates of Youth that compares data between Europe and the United States.

In France, Germany, and the Netherlands, two things create greater, easier access to sexual health information and services for all people, including teens. They are: 1) societal openness and comfort in dealing with sexuality, including teen sexuality; and 2) pragmatic governmental policies. The result - better sexual health outcomes for French, German, and Dutch teens when compared to U.S. teens.

Study published in the Journal of Urology, Volume 167, Issue 5, Pages 2113-2116 (May 2002).  The study's purpose was to determine the effect of the prepuce (foreskin) on sexual intercourse. The researchers examined sexual function outcomes in men who experienced sexual intercourse in the uncircumcised and circumcised states.

The study chose as subjects men who were circumcised for medical reasons. Only 7% of the men were circumcised as elective surgery. Even with such a large proportion of the subjects being circumcised for having problems with their foreskin, 38% reported that it was worse being circumcised.

A paper published BJU International, Vol. 100, Issue 1, pp 5-6 (April 2007).  Three avid pro-circumcision advocates wrote a paper justifying male circumcision as a preventative against prostate cancer. The authors claim that lack of circumcision is a risk factor of prostate cancer.

Dr. Van Howe responded to the Morris paper in the BJU International, Vol. 100, Issue 5, pp. 1193-94 (2007). Dr. Van Howe identified faults and unsubstantiated assumptions in the original paper. He states, "The concept of using circumcision to reduce prostate cancer risk has no biological or epidemiological foundation. Even if one is willing to depart from reality and use the most extreme assumptions as put forth by Morris et al., circumcision of infants is not cost-effective."

A study published Sexually Transmitted Infections, doi:10.1136/sti.2010.042895, determined that there was no association between circumcision and HIV for men having sex with men. The researchers concluded that circumcision is unlikely to be a feasible HIV prevention strategy for gay men in the UK.

This study supports other studies that found no link between circumcision status and HIV infection rates among homosexual men.

Critical Appraisal published in Canadian Family Physician, Vol. 49, 1096-7, September 2003. The author attempts to answer the question if circumcision is warranted as a preventative measure against HPV and cervical cancer. Using only 7 case-control studies, the author's results were ambiguous and and apparently tied to other factors. "If both male and female partners were at low risk of infection, the women's risk of cervical cancer was similar whether their partners were circumcised or uncircumcised."

CATIE-News: Bite-sized HIV/AIDS news bulletins published by Canadian AIDS Treatement Information Exchange. The page addresses many of the current studies and meta-analysis for HIV and the gay man. The results of the various studies and meta-analysis are consistent and show that there is little to no benefit in circumcising gay men to reduce HIV.

Researchers studying the increase and spread of HIV have concluded in several studies that increases in high-risk sex have overwhelmed any decrease in infectivity due to HAART (highly active antiretroviral therapy). This does not mean that current HIV prevention efforts have failedwithout these efforts, rates of new cases of HIV and STIs might be much higher. This environment of high-risk sex and STIs must be taken into account when considering the potential impact and rollout of new prevention interventions--such as male circumcision, microbicides or pre-exposure prophylaxis (PrEP)--in gay and bisexual men in high-income countries.

Study published in The Journal of Infectious Diseases, 2009; 200:000–000. DOI: 10.1086/648376. The authors found a correlation of reduced incidence of syphilis among men who reported predominantly insertive unprotected anal intercourse.

Study published in The Journal of Pediatrics, Volume 152, Issue 3, Pages 383-387 (March 2008). The study's objective was to determine the impact of early childhood circumcision on sexually transmitted infection (STI) acquisition to age 32 years.  "Overall, up to age 32 years, the incidence rates for all STIs were not statistically significantly different . . . for the uncircumcised and circumcised men, respectively. This was not affected by adjusting for any of the socioeconomic or sexual behavior characteristics."

Study published in the BJUI (British Journal of Urology International), Volume 101, Issue 1, Pages 65-70 (January 2008). The study determinded that for men in Uganda, there were no differences between intact men and men circumcised after 24 months.

Study published in MJA, Vol. 178, 155-58, February 2003. The study was to investigate the incidence rate of circumcision for phimosis and other medically indicated reasons in Western Australian boys. The authors found that as the national rate of routine circumcision decreased, the rate of medically indicated circumcisions increased for boys aged less than 15 years. More than half of the boys circumcised for phimosis were under the age of 5. Pathological phimosis is rare in that age group. The authors attributed the high rate of circumcision to physicians mistaking normal penile development for pathological phimosis.

Study published in Australian and New Zealand Journal of Public Health, Vol. 34 Issue 2, Pages 160 - 164 (April 2010).  The study concluded that "Circumcision appears to have minimal protective effects on sexual health in Australia." Translated into English, "Circumcised men do not have any additional protection against sexually transmitted diseases."

Study published in The Lancet, Volume 374, Issue 9685, Pages 229 - 237, 18 July 2009. doi:10.1016/S0140-6736(09)60998-3.  The study assessed whether circumcision in HIV-infected men would reduce transmission of the virus to female sexual partners. Circumcision of HIV-infected men did not reduce HIV transmission to female partners over 24 months; longer-term effects could not be assessed. Condom use after male circumcision is essential for HIV prevention.  The results indicate that there is a probability of 21.7% HIV infection rate for female partners of circumcised HIV infected men, compared to 13.4% HIV infection rate for female partners of HIV infected men. Women with circumcised partners had more than a 50% increase in the infection rate of women compared to women with un-circumcised partners.

Study published in JAMA, 1997; 277(13): 1052-1057. The objective was to assess the prevalence of circumcision across various social groups and examine the health and sexual outcomes of circumcision. The authors analyzed the National Health and Social Life Survey (NHSLS) data to determine the effects of circumcision. The results indicate, "We find no significant differences between circumcised and uncircumcised men in their likelihood of contracting sexually transmitted diseases." 

An article by Ronald Goldman, PhD, published in Paediatrics & Chid Health, Vol. 9, No. 9, pp. 630-33 (November 2003).  The article provides a very good overview of the current social standing of male infant circumcision. The author makes the point that the current reluctance to confront the religious issue undermines the core values (e.g., the health of the patient is paramount) and ethics (e.g., first, do no harm) that drive medical decision-making.

Published in Pediatrics, Vol. 118 No. 5 November 2006, pp. 1971-1977 (doi:10.1542/peds.2006-1175). The authors conclude that their "findings suggest that uncircumcised males are at greater risk of acquiring sexually transmitted infection than circumcised males. Male circumcision may reduce the risk of sexually transmitted infection acquisition and transmission by up to one half, suggesting substantial benefits accruing from routine neonatal circumcision."

Study published in The Lancet, Volume 352, Issue 9143, Pages 1813-16, 5 December 1998. doi:10.1016/S0140-6736(98)02392-7. The authors interpreted their findings to "support the notion that circumcision may protect boys from UTI, [although] the magnitude of this effect may be less than previously estimated." The study found that "195 circumcisions would be needed to prevent one hospital admission for UTI in the first year of life."

Study published in the Journal of the American Medical Association (JAMA), Volume 278 No. 24, pages 2157-2162, December 24/31, 1997. The study was a randomized controlled trial to compare various anesthesia methods for infant circumicison. Enrollment in the study was stopped after it was determined that the control group (babies not receiving any anesthesia) were in great distress from their circumcision.  "The results of this study suggest that an anesthetic should be administered to newborns prior to undergoing circumcision.

A study published in BMC Urology, 2010, 10:2 doi:10.1186/1471-2490-10-2 February 2010. The results showed: "Sixteen prospective studies evaluated complications following neonatal and infant circumcision. Most studies reported no severe adverse events (SAE), but two studies reported SAE frequency of 2%. The median frequency of any complication was 1.5% (range 0-16%). Child circumcision by medical providers tended to be associated with more complications (median frequency 6%; range 2-14%) than for neonates and infants. Traditional circumcision as a rite of passage is associated with substantially greater risks, more severe complications than medical circumcision or traditional circumcision among neonates."

Paper published in Clinical Ethics, 2009;4:181-186.  doi:10.1258/ce.2009.009029. David Shaw, Faculty of Medicine and Centre for Applied Ethics & Legal Philosophy, University of Glasgow, writes that the current General Medical Council (GMC) guidelines are flawed in stating that any doctor who does not wish to carry out a non-therapeutic circumcision (NTC) on a boy must invoke conscientious objection.

Study published in BJU International, Volume 94, Issue 4, Pages 627-629 (Aug. 25, 2004).  The authors concluded "that circumcision during antireflux surgery has no effect on the incidence of postoperative UTI."

Study published in The Lancet, Volume 349, Issue 9052, Pages 599 - 603, 1 March 1997.

The authors found, "There was a significant linear trend on all outcome measures, showing increasing pain scores from uncircumcised infants, to those circumcised with Emla, to those circumcised with placebo." Their interpretation was, "Circumcised infants showed a stronger pain response to subsequent routine vaccination than uncircumcised infants."

Study published in Urology, April 2005, 65(4):773-77. The objective was to evaluate penile sensory thresholds in neonatally circumcised and uncircumcised men. The authors evaluated 125 patients, splitting them into functional and dysfunctional groups based on a questionaire. In the dysfunctional group, circumcised men were significantly younger than the intact men (7 year mean difference). The sample size was small, and when attempting to control for age, hypertension, and diabetes, all t-test significance was lost.

Article published in Journal of the New Zealand Medical Association, September 12, 2003, Vol 116, No. 1181. Women reported that they are significantly more likely to experience vaginal dryness during sexual intercourse with circumcised men than with genitally intact men. The authors thought that the vaginal dryness becomes more apparent as women get older.

The authors concluded "Most likely, reported vaginal dryness and the related clinical designation female arousal disorder is but a normal female response to coitus with a man with an iatrogenically deficient penis." An iatrogenically deficient penis is one that has been circumcised.

Letters published in Canadian Family Physician, December 2003, are critical of the Circumcision and cervical cancer article. 

Study published in BJUI (British Journal of Urology International), Volume 99, Issue 4, Pages 864-869 (March 2007). This is the Sorrells study. See a YouTube video of Dr. Sorrells discussing the study and his results.

Article published in Thymos: Journal of Boyhood Studies, Vol. 4, No. 1 / Spring 2010. doi 10.3149/thy.0401.71.

Author J. Steven Svoboda discusses how genital integrity advocates struggle to safeguard all children from genital cutting. Gender equity activists promote true equality of men and women. Commonalities and differences between the two movements are very illuminating. Three words relevant to genital integrity are: exceptional, muddle, and discomfort.

Paper from 16th Conference on Retroviruses and Opportunistic Infections (2009).  A pdf file of the paper is available on the website.

Study published in Clinical Pediatrics, Vol. 45, No. 1, 49-54 (2006). DOI: 10.1177/000992280604500108. Dr. Howe concluded, "Meatal stenosis may be the most common complication following neonatal circumcision. The frequency of this complication and the need for surgical correction need to be disclosed as part of the informed consent for neonatal circumcision." The study found 24 of 329 (7%) circumcised boys had meatal stenosis.

Part of a debate published in BMJ, 2007;335:1180 (8 December), doi:10.1136/bmj.39406.520498. Geoff Hinchley argues that the practice of male infant circumcision is harmful and should be stopped.

The unpalatable truth is that logic and the rights of the child play little part in determining the acceptability of male genital mutilation in our society. The profession needs to recognise this and champion the argument on behalf of boys that was so successful for girls.

A small study published in AIDS, January 21, 2010. Researchers at the Division of Infectious Diseases, Department of Medicine, Chicago, Illinois, USA, examined the foreskins removed by circumcision of 16 men. The researchers found that there was no significant differences in the thickness of the keratin layers of the inner foreskin and the outer skin. The authors concluded: "Keratin layers alone are unlikely to explain why uncircumcised men are at higher risk for HIV infection."

Study published in Pediatric Surgery International, doi 10.1007/s00383-010-2566-9. The authors studied later complications of children who had neonatal circumcisions. Penile adhesions, skin bridges, meatal stenosis, redundant foreskin (incomplete circumcision with uncircumcised appearance), recurrent phimosis, buried penis and penile rotation were the most frequent complications treated after the original circumcision had healed.

Article published in Archive of Pediatrics & Adolescent Medicine, Jan. 2010; Vol. 164, No.

Study published in Journal of Health Psychology, Vol. 7, No. 3, 329-343 (2002). DOI: 10.1177/135910530200700310. The abstract states, "Infant male circumcision continues despite growing questions about its medical justification. As usually performed without analgesia or anaesthetic, circumcision is observably painful. It is likely that genital cutting has physical, sexual and psychological consequences too. Some studies link involuntary male circumcision with a range of negative emotions and even post-traumatic stress disorder (PTSD). Some circumcised men have described their current feelings in the language of violation, torture, mutilation and sexual assault."

Study published in Journal of Paediatrics and Child Health, Volume 44 Issue 1-2, Pages 44 - 49, 4 Sep 2007. The study documents a longitudinal study of over 1000 individuals born in Christchurch New Zealand in mid 1977. The authors concluded, "There was no evidence of an association between neonatal circumcision status and breastfeeding outcomes, or between circumcision status and health and cognitive ability outcomes associated with breastfeeding, and the findings do not support the view that neonatal circumcision disrupts breastfeeding."

Study published in The Journal of Urology, Volume 169, Issue 6, Pages 2332-2334 (June 2003). Doctors at a clinic reviewed their experience in treating patients with a trapped penis due to phimosis following newborn circumcision. The infants were circumcised with a Gomco device. Fifteen of 521 circumcised boys (2.9%) developed phimosis after circumcision.  Three boys had recurrence of phimosis after treatment.

A pdf file of the report of the trial investigating the effects of circumcision on Africans with respect to HIV infections.

A randomized controlled trial (RCT) has shown that male circumcision (MC) reduces sexual transmission of HIV from women to men by 60% (32% - 76%; 95% CI) offering an intervention of proven efficacy for reducing the sexual spread of HIV. We explore the implications of this finding for the promotion of MC as a public health intervention to control HIV in sub-Saharan Africa.

A study published in Urologia Internationalis, Vol. 75, No. 1, 2005 (Urol Int 2005;75:62-66) (DOI: 10.1159/000085930). The authors assessed the effect of circumcision on sexually active men and the relative impact this may have on informed consent prior to surgery. 

The male subjects were circumcised for a benign desease. Penile sensation got worse for 18% of the men who got an adult circumcision. Only 61% of the men were satisfied with their adult circumcision. Considering that circumcision was for a disease, it is significant that not more men were satisfied with the cure.

A study published in BMC Infectious Diseases, 2010, 10:59doi:10.1186/1471-2334-10-59. The authors determined that male circumcision was positively associated with HSV-2 infection.

Article by Dr. Andrew E. MacNeily, FRCSC, FAAP, published in Canada Urological Association Journal: Can Urol Assoc J. 2007 November; 1(4): 395397. Dr. MacNeily addresses the common myths that male infant cicrumcision has medical benefits. Using evidence based analysis, he disputes various claims and gives sound reasons why there is no benefit sufficient to justify infant circumcision.

Unfortunately, Dr. MacNeily does not address the current evidence that refutes many previous studies and information. For example, he says that penile cancer is reduced compared with uncircumcised men, although the American Cancer Society states that other factors contribute to penile cancer.

Study published in Annals of Family Medicine, 8:64-72 (2010). doi: 10.1370/afm.1073. A meta analysis of the literature from 1997 through 2008 regarding male circumcision. The study found, "There is little evidence showing clinical benefit from nontherapeutic male circumcision." The implications were stated: "Patients who request circumcision for clinical reasons should be informed of the lack of consensus surrounding the procedure, the lack of strong evidence regarding its benefits, and the potential medical and psychosocial harms of the procedure."

The study concluded:

The role of adult nontherapeutic male circumcision in preventing sexually transmitted infections, urinary tract infections, and penile cancer remains unclear. Current evidence fails to recommend widespread neonatal circumcision for these purposes.

The study was published in Journal of Sexual Medicine, Vol. 4 Issue 3, Pages 667 - 674, May 2007. The researchers had 20 intact men and 20 circumcised men watch erotic films before they were tested for touch sensitivity. The researchers tested a spot on the glans, the penile shaft, and the forearm of each subject. The researchers found no significant difference in glans sensitivity between the subjects. Surprisingly, the intact men were less sensitive to touch on the forearm than the circumcised men.

Study published in the BJUI (British Journal of Urology International), Volume 104, Issue 11, Pages 1698-1701 (2009). The study determinded that for women in Uganda who had partners that were circumcised, 57.3% reported the same level of sexual satisfaction for before and after the circumcision, 39.8% reported more sexual satisfaction, and 2.9% reported less satisfaction.

A study published at PLoS ONE 2(6): e543. doi:10.1371/journal.pone.0000543. "This paper provides strong evidence that when conducted properly, cross country regression data does not support the theory that male circumcision is the key to slowing the AIDS epidemic. Rather, it is the number of infected prostitutes in a country that is highly significant and robust in explaining HIV prevalence levels across countries." The article received several critical comments, including one by Halperin. The article's author John R. Talbott provides a very good rebuttal attacking the Africa trials' statistical analysis methodology.

Research article published in Archives of Disease in Childhood, Vol. 62, Issue 1, pp. 80-81, 1987. doi:10.1136/adc.62.1.80 

Abstract

Four newborn babies developed acute heart failure a few hours after circumcision at 8 days. During this procedure, a sponge soaked in epinephrine was applied to the circumcision site and left there for several hours. Treatment was with digoxin and diuretics and signs of heart failure disappeared within 24-72 hours.

Study published in the BJUI (British Journal of Urology International), Volume 99, Issue 3, Pages 619-622 (March 2007). The study showed that there was a loss of sexual pleasure and enjoyment for a significant percentage of men.

Paper published in BJUI (British Journal of Urology International), Volume 83, Suppl. 1, pages 79–84, (1999), and authored by K. O'Hara & J. O'Hara. The authors surveyed women having sexual experience with both circumcised and anatomically complete partners to determine if there were any differences in sexual enjoyment. They determined that circumcision results in a less satisfying sexual experience.

Study published in PLoS ONE, 5(1): e8422. doi:10.1371/journal.pone.0008422. The authors determined that there is a difference in the microbiota between circumcised and intact men.  Circumcision was associated with a significant change in the overall microbiota  and with a significant decrease in putative anaerobic bacterial families.

Study published in Journal of Pediatric Urology, 2009 Aug 7. doi:10.1016/j.jpurol.2009.07.007. "Knowledge of normal meatal/urethral width in a growing boy is important to create a neourethra of adequate size to correct hypospadias. Thus far, normal size values have been based on the study of circumcised, awake boys. The aim of this study was to measure normal urethral width in healthy uncircumcised boys under general anesthesia to provide a tool to create a neourethra of adequate size."

HAARETZ.com reports in a 2008 article that traditional circumcision results in an increased rate of urinary tract infections (UTIs) for male infants. "Circumcision as performed by mohels, men whose profession is performing the Jewish ritual of brit milah, leads to a high rate of urinary tract infections among babies, according to a report released recently by physicians at Schneider Children's Medical Center in Petah Tikva."

The article reports that the researchers "found urinary tract infections to be far more common among babies who had undergone circumcision by a mohel rather than a physician." One researcher said, "Without appropriate and intensive treatment, the bacteria could reach the blood, possibly even causing death." The researchers believe the infections are caused by the bandage left on the penis after circumcision.