Adult Circumcision Healing Time

I want to revisit the AAP’s technical report accompanying its revised circumcision policy statement. In the Ethical Issues section, on page 760, this:

… Parents who are considering deferring circumcision should be explicitly informed that circumcision performed later in life has increased risks and costs. Furthermore, deferral of the procedure also requires longer healing time than if performed during the newborn period and requires sexual abstinence during healing. …

This is so often repeated that it’s simply become the accepted truth about voluntary adult circumcision. It should be questioned¹. Does circumcision require a longer healing time in adults than if it’s forced on infants? Evidence suggests this is overblown, at best.

From a 1999 paper by Daniel T. Halperin, PhD and Dr. Robert C. Bailey, “Male circumcision and HIV infection: 10 years and counting”:

By avoiding this issue althogether (sic, medical professionals and public-health authorities may inadvertently be harming the very individuals whom they are trying to help. As increasing numbers of men and boys turn to circumcision as perceived protection from AIDS, many will be exposed to harm by untrained practitioners who use unsafe methods. Yet, contrary to some popular misconceptions, safe and inexpensive male circumcision is routinely performed in developing countries in clinical settings. The procedure is normally performed on an outpatient basis with local anaesthesia, and most men return to light work activities the next day.

From the Brian Morris et al. paper I didn’t like, in the “Absence from work or school” section on Page 10 (pdf):

Unlike the convenience of circumcising a baby that (sic) sleeps most of the time and is a dependent in society, circumcision during productive work or school years will typically require taking time off, although the amount of time off required is typically small. In one study of men circumcised with the Shang Ring device, men took an average of 1.1 days off work; 80% were back at work by day 2, with only 20% requiring more than 2 days, and little disruption to activities or discomfort was reported for the week the ring was in place [121]. Eighteen percent of men in the study reported disruption to their work while the device was present, and 30% had not resumed routine leisure activities by 7 days. In the large Kenyan RCT, only 4% of men required 3 days or more before they could return to normal activities [57]. In a study of childhood MC, median times of 5 days to return to normal activity and 7 to return to school have been reported [182]. This may have been because children are usually more active than adults, thus increasing the chances of injury and so prolonging the healing period.

It’s also interesting that the AAP’s claim is unsourced in the technical report. On what evidence do they claim that adult (i.e. deferred) circumcision requires a longer healing time than infant circumcision? It doesn’t seem to be an accurate statement.

¹ The claim that it costs more should also be questioned. If nothing else, the time value of money must be factored in. The several hundred dollars saved now (that will accumulate) must be compared to the present value of the future cost. The unlikelihood of needing circumcision must also be included. If adult circumcision costs 10x more but is only performed in 8% of males, the net effect is that it’s cheaper. No results from such an analysis would change the sufficient ethical argument against non-therapeutic infant circumcision.

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