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Submitted by Patricio V Marquez on
Males can be circumcised at any age, however, there are significant benefits in performing MMC in early infancy (pl. see Manual for early infant male circumcision under local anaesthesia. WHO/Jhpiego. http://www.who.int/hiv/pub/malecircumcision/manual_infant/en/index.html.) Why? The procedure is simpler and less painful than that performed on older boys and men because the penis is less developed and the foreskin is thinner and less vascular. The wound typically does not need to be sutured. Healing is quicker with complete healing usually within 14 days, and complication rates are lower compared to adult circumcision. The procedure is also less costly when carried out in early infancy. A comparison in Rwanda showed that neonatal MMC was four times less expensive than adult MMC, and highly cost-effective (pl. see Binagwaho A et al. (2010) Male Circumcision at Different Ages in Rwanda: A Cost-Effectiveness Study. PLoS Med 7(1): e1000211. doi:10.1371/journal.pmed.1000211). In addition, early infant circumcision ensures that the wound will be healed before sexual activity begins, and that the protective effect of the circumcision against HIV and other STIs is available when sexual activity starts. Also, early infant MMC leads to reduced risk of urinary tract infections in the first 6 months of life. In many countries, there is local expertise in routine neonatal MMC since it is sometimes medically indicated for the health of the baby, and sometimes more widely practiced by some religious and ethnic groups. When it comes to MMC of infants, parents act on behalf of their children’s health. Therefore, parents need to be provided with information derived from evidence-based medicine about the risks and benefits of MMC so that they can make an informed choice for their children. Most importantly, routine early infant MMC will prevent resource-intensive “catch-up” MMC campaigns in the future. It will significantly contribute to East and Southern African countries’ long-term objectives of decimating the HIV epidemic. As USAID figures are cited in the comment, perhaps it would be good to take into account US PEPFAR assessments as well. For example, a comparison in Rwanda showed that neonatal MMC was not only four times less expensive than adult MMC, but also highly cost-effective (Pl. see US PEPFAR presentation: Voluntary medical male circumcision for HIV prevention in Eastern and Southern Africa – cost, impact, service delivery models and progress update. September 2011).