Male Circumcision: Is It the Proper Treatment or Not?

In Rae Cho; Sung Yong Cho

doi:10.5124/jkma.2008.51.7.653

J Korean Med Assoc > Volume 51(7); 2008 > Article

Cho and Cho: Male Circumcision: Is It the Proper Treatment or Not?

Continuing Education Column

Journal of the Korean Medical Association

Journal of the Korean Medical Association 2008; 51(7): 653-663.

Published online: July 31, 2008

DOI: http://dx.doi.org/10.5124/jkma.2008.51.7.653

Male Circumcision: Is It the Proper Treatment or Not?

In Rae Cho, MD, Sung Yong Cho, MD

Department of Urology, Inje University College of Medicine, Korea. ircho@paik.ac.kr

Abstract

Recently the male circumcision becomes a hot issue not only in abroad but especially in Korea. Under this circumstance, it will be right that doctors and scholars restart to study about the merits and demerits of the male circumcision. There are little clear answers about its advantages in urinary infection, penile cancer, sexual function, etc. The only issue is that WHO and UNAIDS admit the male circumcision as a significant precautionary measure against HIV (human immunodeficiency virus) after finishing a large scale study. As a doctor, it will be desirable to explain to the patients or parents about the advantages and disadvantages of the male circumcision and help them make a choice considering its cultural, religious, legal, social, and emotional situation when the patient comes to the hospital for a male circumcision. However, it will be difficult to follow the Western statistics impetuously since the course of diffusion of HIV in Korea is different from that in USA, and there is no study in Korea about the merits and demerits of the male circumcision. Therefore, we conclude that it will be an impetuous assertion to argue that the male circumcision should be done before the adolescence, before starting an active sexual life, without any countermeasure.

Male circumcision; Sexually-transmitted infection (STI); Human immunodeficiency virus (HIV)

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Figure 1

The uncircumcised foreskin is susceptible to minor trauma and abrasion and can facilitate entry of pathogens (48).

Table 1

Association of penile infections with male circumcision

^*For meta-analyses of HIV infections in adults, only studies with adjusted RRs are included, as crude RRs are likely to be misleading due to potential confounding with behavior and other factors. The meta-analyses of chancroid, syphilis and HSV-2 include "best estimates" of effect which are the adjusted RR if it was available, otherwise the crude RR

^†Protective effect in 6 out of 7 studies, of which 4 had a significant protective effect

^‡Protective effect in 18/19 studies, of which 14 were significantly protective

^§Unpublished data presented by Weiss at the Consultation on STI interventions for preventing HIV: appraisal of the evidence WHO/Geneva, 11~13 July 2006

^∥Protective effect in 9 out of 11 studies, of which 2 were significantly protective