Biomedical Engineering – From Theory to Applications

1. Introduction
14
Male Circumcision:
An Appraisal of Current Instrumentation
Brian J. Morris 1 and Chris Eley 2
1 School of Medical Sciences, The University of Sydney, Sydney,
2 Editor, www.circlist.com, London,
1 Australia
2 United Kingdom
The topic of male circumcision (MC) is of considerable current interest, largely because of
widespread publicity generated by research findings attesting to its ability to prevent HIV
infection during heterosexual intercourse. In addition, its long-recognized ability to protect
against other sexually transmitted infections (STIs) has also been well publicized in recent
times, especially now that support has been provided by large randomized controlled trials
(RCTs).
While MC can be performed at any age, the ease with which circumcision can be performed
in infancy makes this time of life preferable to intervention later in childhood or in
adulthood. As well as the issue of safety, convenience, simplicity and consequent cost
reductions, circumcision in infancy provides greater net benefits over the lifetime of the
individual.
It provides immediate 10-fold protection against urinary tract infections and thus kidney
damage in baby boys, and greater protection against penile cancer than circumcision later in
life, virtually eliminating the risk of this disease with its high morbidity and mortality (Morris,
2007; Morris, 2010; Tobian et al., 2010; Morris et al., 2011). Another benefit is prevention of
phimosis, a common cause of sexual problems in adolescent boys and men, and a major risk
factor for penile cancer. It also lowers to risk of inflammatory skin conditions such as
balanoposthitis. Circumcised men have superior hygiene (O'Farrell et al., 2005) and half the
prevalence of thrush (Richters et al., 2006). As far as protection against STIs is concerned, the
most notable is human papillomavirus (HPV), the pathogen not only responsible for most
cervical cancers in women, but also a proportion of penile cancers in men (Morris et al., 2011).
MC also reduces the incidence of ulcerative STIs, including syphilis, chancroid, Trichomonas
vaginalis, and herpes simplex virus type 2 (HSV-2) (Weiss et al., 2006; Morris & Castellsague,
2010; Tobian et al., 2010). Circumcised men have lower genital ulcer disease as a result of this
and the reduction in penile injury arising from tearing of the foreskin and frenulum during
sexual activity (Bailey & Mehta, 2009). MC reduces sexual problems with age and diabetes
(Morris, 2007; Morris, 2010; Tobian et al., 2010; Morris et al., 2011), and has no adverse effect on
sexual function, sensation or acceptability (Morris, 2007; Tobian et al., 2010), if anything the
reverse (Krieger et al., 2008). MC provides a public health benefit to women by lowering their
risk of various STIs, including high-risk HPV types that cause cervical cancer, HSV-2,