Notat om omskæring af drenge - Sundhedsstyrelsen

FROM THE AMERICAN ACADEMY OF PEDIATRICSeczema, and irritant dermatitis, amongothers.From 1995 to 2011, all publicationsaddressing this concern were caseseries and were therefore excludedfrom the literature forming the currentanalysis. Before 1995, a New Zealandprospective cohort study with goodevidence explored rates of penileproblems for 635 boys from birth to 8years of age. 125 Four types of penileproblems were defined: first was thenumber of episodes of inflammation ofthe penis experienced by the child.Penile inflammation included balanitis,meatitis, inflammation of the prepuce,and conditions in which the penis wasdescribed as sore or inflamed withoutany further diagnostic elaboration. Thesecond type was the number of episodesof phimosis experienced by thechild. These episodes included everytime medical attention was sought forphimosis and associated symptoms.Episodes in which the child wasbrought to medical attention for “tight”or “non-retractable” foreskin but wasnot treated were not classified asphimosis, due to the likelihood thatmost of these attendances resultedfrom parental anxiety or uncertaintyabout the development of the foreskinrather than any pathologic condition inthe child. The third type was inadequatecircumcision requiring repairor recircumcision. Fourth waspostoperative infection after circumcisionfrom birth to 8 years of age bycircumcision status. Findings were inconclusivefor the first year of life; theadjusted rate of problems experiencedwas 5.2 penile problems per 100 circumcisedboys over the study period,compared with 1.2 penile problems inuncircumcised boys at risk. From ages1through8years,therateswere6.5penile problems per 100 circumcisedboys over the study period, comparedwith 17.2 penile problems per 100 uncircumcisedboys.Sexual Function and Penile SexualSensitivityThe literature review does not supportthe belief that male circumcision adverselyaffects penile sexual functionor sensitivity, or sexual satisfaction,regardless of how these factors aredefined.Sexual Satisfaction and SensitivityLiterature since 1995 includes 2 goodqualityrandomized controlled trialsthat evaluated the effect of adult circumcisionon sexual satisfaction andsensitivity in Uganda and Kenya, respectively.126,127 Among 5000 Ugandanparticipants, circumcised men reportedsignificantly less pain on intercoursethan uncircumcised men. 126At 2 years’ postcircumcision, sexualsatisfaction had increased significantlyfrom baseline measures in thecontrol group (from 98% at baselineto 99.9%); satisfaction levels remainedstable among the circumcised men(98.5% at baseline, 98.4% 2 years afterthe procedure). This study included nomeasures of time to ejaculation orsensory changes on the penis. In theKenyan study (which had a nearlyidentical design and similar results),64% of circumcised men reportedmuch greater penile sensitivity postcircumcision.127 At the 2-year followup,55% of circumcised men reportedhaving an easier time reaching orgasmthan they had precircumcision, althoughthe findings did not reach statisticalsignificance. The studies’ limitation isthat the outcomes of interest weresubjective, self-reported measuresrather than objective measures.Other studies in the area of function,sensation, and satisfaction have beenless rigorous in design, and they fail toprovide evidence that the circumcisedpenis has decreased sensitivity comparedwith the uncircumcised penis.There is both good and fair evidencethat no statistically significant differencesexist between circumcised anduncircumcised men in terms of sexualsensation and satisfaction. 128–131 Sensationend points in these studies includedsubjective touch and painsensation, response to the InternationalIndex of Erectile Function, the Brief MaleSexual Function Inventory, pudendalnerve evoked potentials, and IntravaginalEjaculatory Latency Times (IELTs).There is fair evidence that men circumcisedas adults demonstrate ahigher threshold for light touchsensitivity with a static monofilamentcompared with uncircumcised men;these findings failed to attain statisticalsignificance for most locations on thepenis, however, and it is unclear thatsensitivity to static monofilament (asopposed to dynamic stimulus) has anyrelevance to sexual satisfaction. 132There is fair evidence from a crosssectionalstudy of Korean men of decreasedmasturbatory pleasure afteradult circumcision. 133Sexual FunctionThere is both good and fair evidencethat sexual function is not adverselyaffected in circumcised men comparedwith uncircumcised men. 131,134–136 Thereis fair evidence that no significant differenceexists between circumcisedand uncircumcised men in terms ofsexual function, as assessed by usingthe IELT. 129Limitations to consider with respect tothis issue include the timing of IELTstudies after circumcision, becausestudies of sexual function at 12 weekspostcircumcision by using IELT measuresmay not accurately reflect sexualfunction at a later period. Also, the selfreportof circumcision status mayimpact study validity. This could bein an unpredictable direction, althoughit is most likely that the effect wouldbe to cause an underestimation ofthe association. Other biases includePEDIATRICS Volume 130, Number 3, September 2012Downloaded from pediatrics.aappublications.org by guest on June 19, 2013e769