With 2 new states recently joining 16 others in eliminating Medicaid insurance for male circumcision, possible ballot initiatives to ban male circumcision, and the long-awaited American Academy of Pediatrics male circumcision policy statement, there is a need to evaluate the medical risks and benefits of male circumcision, particularly in light of recent medical evidence.
Three randomized trials in Africa demonstrated that adult male circumcision decreases human immunodeficiency virus (HIV) acquisition in men by 51% to 60%,1 and the long-term follow-up of these study participants has shown that the protective efficacy of male circumcision increases with time from surgery. These findings are consistent with a large number of observational studies in Africa and in the United States that found male circumcision reduces the risk of HIV infection in men.1 Thus, there is substantial evidence that removal of the foreskin reduces the risk of male heterosexual HIV acquisition. However, the effect of male circumcision on reducing HIV acquisition among men who have sex with men is unclear. There may be protection against insertional but not against receptive anal intercourse, so men practicing both forms of sexual intercourse may have limited protection associated with male circumcision.
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