Benefits of Male Circumcision—Reply

In Reply: We agree with Dr Masem that medical recommendations should be “based on the effective treatment of disease.” It was not possible in a Commentary to review all studies of male circumcision, so we focused on the randomized trials, the criterion standard of evidence-based medicine. All 3 circumcision trials demonstrated remarkable consistency in the efficacy of male circumcision to reduce STIs, similar to that reported in numerous observational studies and meta-analyses.^1- 2 In addition, the majority of observational studies demonstrate that neonatal male circumcision reduces urinary tract infections and penile inflammatory disorders, such as meatitis, balanitis, and phimosis, as mentioned by Drs Klausner and Morris. One randomized trial demonstrated that male circumcision of HIV-positive men did not have an impact on either HIV or high-risk human papillomavirus transmission to female partners over 2 years.^3- 4 However, observational studies suggest possible longer-term benefit in women whose partners were circumcised during infancy.⁵