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circumcision

A surgical procedure to remove the prepuce of the penis. It is generally performed on newborn boys. Indications: 1) may confer some hygiene benefits 2) reduced risk of HPV infection (3-fold) [2] 3) reduction in risk of cervical cancer for female partners (60%) [2] 4) reduced risk of HSV-2, HPV & syphilis transmission [3,5] 5) reduced risk for genital herpes & some strains of papillomavirus ~ 30% [10] 6) reduced risk of HIV1 transmission? - transmission among high-risk men but not transmission to women? [4] - reduces risk of HIV infection acquired through heterosexual sex by 50-60% [10] 7) may reduce risk of STD transmission to female partners [5] 8) when performed prior to 1st sexual intercourse, lowers risk of prostate cancer (HR=0.85) [6] 9) circumcision is not explicitly recommended for newborns - parents should be told of the potential benefits & risks [10] Contraindications: - does not reduce risk of recurrent urinary tract infection in uncircumsized male children [11] Complications: - complications increase markedly if the procedure is done after the first year of life [9] - ~9% in boys age 1-9 years [9] - most common complications relate to correctional procedures & bleeding [9] - Jewish ritual circumcision using orogenital suction may result in Herpes simplex infection (RR = 3.4) [7] Notes: - benefits outweigh risks [7]

General

genitourinary surgery (urogenital surgery)

References

  1. Stedman's Medical Dictionary 27th ed, Williams & Wilkins, Baltimore, 1999
  2. Journal Watch 22(10):75, 2002 Castellsague X et al, N Engl J Med 346:1105, 2002 Adami H-O & Trichopoulos D, N Engl J Med 346:1160, 2002
  3. Tobian AAR et al Male circumcision for the prevention of HSV-2 and HPV infections and syphilis. N Engl J Med 2009 Mar 26; 360:1298. PMID: 19321868
  4. Journal Watch, Massachusetts Medical Society (subscription may be required) http://infectious-diseases.jwatch.org/cgi/content/full/2009/325/1?q=etoc_jwgenmed
  5. Tobian AAR et al. Male circumcision for the prevention of acquisition and transmission of sexually transmitted infections: The case for neonatal circumcision. Arch Pediatr Adolesc Med 2010 Jan; 164:78. PMID: 20048246 - Brady MT. Newborn circumcision: Routine or not routine, that is the question. Arch Pediatr Adolesc Med 2010 Jan; 164:94. PMID: 20048249
  6. Wright JL et al Circumcision and the risk of prostate cancer Cancer, published online: 12 MAR 2012 PMID: 22411189 http://onlinelibrary.wiley.com/doi/10.1002/cncr.26653/abstract
  7. American Academy of Pediatrics Task Force on Circumcision Circumcision Policy Statement Pediatrics, Aug 27, 2012 PMID: 22926180 http://pediatrics.aappublications.org/content/early/2012/08/22/peds.2012-1989.full.pdf+html
  8. Centers for Disease Control and Prevention Neonatal Herpes Simplex Virus Infection Following Jewish Ritual Circumcisions that Included Direct Orogenital Suction - New York City, 2000-2011 MMWR. June 8, 2012 / 61(22);405-409 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6122a2.htm
  9. El Bcheraoui C et al Rates of Adverse Events Associated With Male Circumcision in US Medical Settings, 2001 to 2010. JAMA Pediatr. Published online May 12, 2014 PMID: 24820907 http://archpedi.jamanetwork.com/article.aspx?articleid=1870232
  10. Federal Register. Dec 2, 2014 Centers for Disease Control and Prevention (CDC) Recommendations for Providers Counseling Male Patients and Parents Regarding Male Circumcision and the Prevention of HIV Infection, STIs, and Other Health Outcomes. https://www.federalregister.gov/articles/2014/12/02/2014-27814/recommendations-for-providers-counseling-male-patients-and-parents-regarding-male-circumcision-and
  11. NEJM Knowledge+ Question of the Week. July 18, 2017 https://knowledgeplus.nejm.org/question-of-week/4371/