This meta-analysis aims to systematically evaluate the effects of male circumcision on sexual function, providing insights that may inform clinical practice and future research. A comprehensive literature search was conducted in eight databases until January 30, 2025, with no language restrictions. Data analysis was performed using Review Manager 5.4.1, and the certainty of the evidence was assessed using the GRADE approach. This meta-analysis included 15 studies with a total of 14,737 participants. Although circumcision was associated with higher sexual satisfaction levels compared to noncircumcised men (OR: 2.48, 95% CI: 1.62-3.79, p < 0.00001), the findings should be interpreted with caution due to significant heterogeneity among the studies. Additionally, circumcised men reported a small but statistically significant improvement in erectile function (MD: 0.28, 95% CI: 0.11-0.46, p = 0.002) and a reduced likelihood of dyspareunia (OR: 0.38, 95% CI: 0.16-0.88, p = 0.03), suggesting possible improvements in comfort during intercourse. Furthermore, circumcision was linked to a lower risk of orgasm difficulties (OR: 0.26, 95% CI: 0.10-0.73, p = 0.01). However, the impact on premature ejaculation remains inconclusive, indicating a need for further research. Overall, this meta-analysis suggests that male circumcision may have potential positive effects on certain aspects of sexual function, particularly sexual satisfaction and erectile function. Nonetheless, the clinical significance of these findings is uncertain, and further investigation is warranted given the heterogeneity observed.

Contrasting ethical and legal arguments have been made concerning neonatal male circumcision (NMC) that merit the first systematic review on this topic. We performed PRISMA-compliant keyword searches of PubMed, EMBASE, SCOPUS, LexisNexis, and other databases and identified 61 articles that met the inclusion criteria. In the bibliographies of these articles, we identified 58 more relevant articles and 28 internet items. We found high-quality evidence that NMC is a low-risk procedure that provides immediate and lifetime medical and health benefits and only rarely leads to later adverse effects on sexual function or pleasure. Given this evidence, we conclude that discouraging or denying NMC is unethical from the perspective of the United Nations Convention on the Rights of the Child, which emphasizes the right to health. Further, case law supports the legality of NMC. We found, conversely, that the ethical arguments against NMC rely on distortions of the medical evidence. Thus, NMC, by experienced operators using available safety precautions, appears to be both legal and ethical. Consistent with this conclusion, all of the evidence-based pediatric policies that we reviewed describe NMC as low-risk and beneficial to public health. We calculated that a reduction in NMC in the United States from 80% to 10% would substantially increase the cases of adverse medical conditions. The present findings thus support the evidence-based NMC policy statements and are inconsistent with the non-evidence-based policies that discourage NMC. On balance, the arguments and evidence reviewed here indicate that NMC is a medically beneficial and ethical public health intervention early in life because it reduces suffering, deaths, cases, and costs of treating adverse medical conditions throughout the lifetimes of circumcised individuals.

The British Medical Association (BMA) guidance on non-therapeutic circumcision (NTMC) of male children is limited to ethical, legal and religious issues. Here we evaluate criticisms of the BMA's guidance by Lempert et al. While their arguments promoting autonomy and consent might be superficially appealing, their claim of high procedural risks and negligible benefits seem one-sided and contrast with high quality evidence of low risk and lifelong benefits. Extensive literature reviews by the American Academy of Pediatrics and the United States Centers for Disease Control and Prevention in developing evidence-based policies, as well as risk-benefit analyses, have found that the medical benefits of infant NTMC greatly exceed the risks, and there is no reduction in sexual function and pleasure. The BMA's failure to consider the medical benefits of early childhood NTMC may partly explain why this prophylactic intervention is discouraged in the United Kingdom. The consequence is higher prevalence of preventable infections, adverse medical conditions, suffering and net costs to the UK's National Health Service for treatment of these. Many of the issues and contradictions in the BMA guidance identified by Lempert et al stem from the BMA's guidance not being sufficiently evidence-based. Indeed, that document called for a review by others of the medical issues surrounding NTMC. While societal factors apply, ultimately, NTMC can only be justified rationally on scientific, evidence-based grounds. Parents are entitled to an accurate presentation of the medical evidence so that they can make an informed decision. Their decision either for or against NTMC should then be respected.