Circumcision: Risky by untrained providers with inappropriate equipment

How safe is circumcision? A systematic review, published in the open access journal BMC Urology has found that neonatal and infant circumcision by trained staff rarely results in problems. Risks can be higher among older boys, especially when undertaken by untrained providers with inappropriate equipment.

Dr Helen Weiss, from the London School of Hygiene & Tropical Medicine, UK, studied the medical literature relating to circumcision. Dr Weiss said, "We identified 52 studies from 21 countries which included sufficient information to estimate frequency of adverse events following neonatal, infant and child circumcision. This forms a systematic review of the published literature on complications associated with the procedure at young ages."

The researchers found that among infants aged less than one year old, the frequency of relatively minor adverse events such as excessive bleeding, swelling and infection was low (median 1.5% for any adverse event) and severe complications were very rare. Circumcisions by medical providers on children aged one year or older tended to be associated with more complications (median 6%), although there were still few serious adverse events. However, more complications, including severe complications, were seen when the procedure was undertaken by inexperienced providers, or with inadequate equipment and supplies.

Dr Weiss said, "Male circumcision is commonly practiced and will continue to occur for religious, cultural and medical reasons. There is a clear need to improve safety of male circumcision at all ages through improved training or re-training for both traditional and medically trained providers, and to ensure that providers have adequate supplies of necessary equipment and instruments for safe circumcision".