Since 2007 the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) have recommended voluntary medical male circumcision (VMMC) as an important strategy for the prevention of heterosexually acquired HIV in men in settings where the prevalence of heterosexually transmitted HIV is high (1). The prevalence of male circumcision was particularly low in East and Southern Africa. This region is home to only 6.2% of the world’s population, but it accounted for 47% of the 1.7 million people newly infected with HIV in 2018, and a significant proportion of incident infections are attributable to heterosexual transmission (2). Accordingly, VMMC has been a priority intervention in 15 countries in East and Southern Africa. Since the 2007 recommendation, other interventions have been shown to be effective in reducing HIV incidence as well as the secondary prevention effect of antiretroviral therapy (ART). Thus, it is timely to review the recommendation on VMMC for HIV prevention in the current environment of prevention options. In the decade following the 2007 recommendation, the feasibility of implementing VMMC services has been demonstrated, with more than 23 million males circumcised through VMMC programmes in East and Southern Africa (3). A large proportion of those circumcised were adolescents, including those ages 10–14 years, a group not included in the trials that informed the 2007 recommendation. Younger adolescents are unique, given their dynamic physical and cognitive development. Since 2007 more information has become available on age-specific considerations for VMMC programmes. In order to sustain high circumcision coverage, many countries are increasing their focus on reaching uncircumcised adolescents, and so specific consideration of the adolescent age group is needed, as well as guidance on transitioning services so as to maintain coverage and sustain delivery. Reaching adult men remains important, too, as they are at more immediate risk of HIV infection than many adolescents. However, uptake of VMMC among adult men has been limited in some settings, and Member States have asked WHO for guidance on enhancing uptake of VMMC to support them in achieving higher coverage among adult men. Since 2007 innovative methods of male circumcision have been tested and their use expanded in an effort to enhance safety, to expand the range of health care workers able to perform VMMC, to increase the choice of methods available and, potentially, to increase uptake. More evidence is now available on the safety of conventional and device-based surgical circumcision methods, motivating this update to the 2013 WHO guidance on device-based methods.