We disagree with Boyleââ?¬â?¢s recent article questioning our systematic review in Journal of Sexual\nMedicine in 2013 (Volume 10, pages 2644-2657). In particular, he disputed the quality ranking we\nassigned to 7 of the 36 articles that met our inclusion criteria. These had been ranked for quality\nby the Scottish Intercollegiate Guidelines Network (SIGN) grading system. We found that, ââ?¬Å?the\nhighest-quality studies suggest that medical male circumcision has no adverse effect on sexual\nfunction, sensitivity, sexual sensation or satisfaction.ââ?¬Â This conclusion was supported by two randomized\ncontrolled trials, regarded as high-quality (1++) evidence and the majority of surveys\nand studies involving physiological measurements comparing uncircumcised and circumcised\nmen. Here we explain why the 2 randomized controlled trials merit a 1++ ranking and why 4 reports\nthat Boyle believes merit a higher ranking only meet the criteria set down for low quality\n(2?) evidence according to the SIGN system. We therefore stand by our conclusions. These are\nsupported by a meta-analysis of sexual dysfunctions and by a recent detailed systematic review of\nthe histological correlates of male sexual sensation.
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