A survey of recent medical literature on circumcision has concluded that many of the studies are of poor quality, are not sufficiently evidence-based, lack methodological rigour, and are often not applicable to developed countries. The paper, by J.A. Bossio and colleagues, concludes that more research is needed, particularly on the impact of circumcision on sexual experience and other harms and risks arising from the surgery. Parts of the abstract read as follows:

Introduction. Male circumcision is one of the most commonly performed surgical procedures worldwide and a subject that has been the center of considerable debate. Recently, the American Academy of Pediatrics released a statement affirming that the medical benefits of neonatal circumcision outweigh the risks. At present, however, the majority of the literature on circumcision is based on research that is not necessarily applicable to North American populations, as it fails to take into account factors likely to influence the interpretability and applicability of the results.

Results. This review highlights considerable gaps within the current literature on circumcision. The emphasis is on factors that should be addressed in order to influence research in becoming more applicable to North American populations. Such gaps include a need for rigorous, empirically based methodologies to address questions about circumcision and sexual functioning, penile sensitivity, the effect of circumcision on men’s sexual partners, and reasons for circumcision. Additional factors that should be addressed in future research include the effects of age at circumcision (with an emphasis on neonatal circumcision) and the need for objective research outcomes.

Conclusion. Further research is needed to inform policy makers, health-care professionals, and stakeholders (parents and individuals invested in this debate) with regard to the decision to perform routine circumcision on male neonates in North America.

CIA comment: For all it moderation of language, this paper, by three impartial observers, is a pretty devastating indictment of claims that the “benefits” of circumcision outweigh the risks. As the authors of the study point out, most of the research cited to back up this assertion was conducted in poverty-stricken Third World countries with poorly developed health services and high levels of sexually transmitted disease, especially HIV-AIDS. The results of this research is simply not applicable to developed countries such as north America, Canada and Australia. Just as serious is the study’s conclusion that much of the pro-circumcision literature is not based on sufficient evidence or conducted with sufficient methodological rigours to justify the sort of conclusions that the American Academy of Pediatrics came up with in 2012. As the authors of the survey point out, a great deal more research is needed before any firm conclusions about the balance of benefits, risks and harms can be reached.

Source: Bossio JA, Pukall CF, and Steele S. A review of the current state of the male circumcision literature. Journal of Sexual Medicine, Online first, 6 October 2014.