A 'snip' in time: what is the best age to circumcise?

We show here that infancy is an optimal time for clinical circumcision because an infant's low mobility facilitates the use of local anesthesia, sutures are not required, healing is quick, cosmetic outcome is usually excellent, costs are minimal, and complications are uncommon. The benefits of infant circumcision include prevention of urinary tract infections (a cause of renal scarring), reduction in risk of inflammatory foreskin conditions such as balanoposthitis, foreskin injuries, phimosis and paraphimosis. When the boy later becomes sexually active he has substantial protection against risk of HIV and other viral sexually transmitted infections such as genital herpes and oncogenic human papillomavirus, as well as penile cancer. The risk of cervical cancer in his female partner(s) is also reduced. Circumcision in adolescence or adulthood may evoke a fear of pain, penile damage or reduced sexual pleasure, even though unfounded. Time off work or school will be needed, cost is much greater, as are risks of complications, healing is slower, and stitches or tissue glue must be used.Infant circumcision is safe, simple, convenient and cost-effective. The available evidence strongly supports infancy as the optimal time for circumcision.The English proverb "A stitch in time saves nine" teaches that to avoid a bigger problem later immediate effort is preferable to procrastination. Thus fixing a small hole in a sock with one stitch will avoid the need for nine stitches later when the hole becomes bigger. In the present article we consider whether this applies to medical male circumcision (MC) - referred to colloquially as a "snip".Worldwide 1 in 3 males are circumcised [1,2], totaling an estimated 1.2 billion [2]. In the USA, medical MC is performed on 1.2 million newborns (56% of baby boys) in community hospitals annually [3,4]. The true number is higher because some boys are circumcised in ambulatory facilities, a physician's clinic or in a private home. In other develope