Official Circumcision Policy Updated

Circumcision benefits outweigh risks but procedure should remain family decision

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) To cut, or not to cut? That is literally the centuries-old question. The American Academy of Pediatrics (AAP) has wavered on their position regarding circumcision.

Now, however, they have updated their Circumcision Policy Statement. The group of pediatricians still does not officially say they recommend that all boys be circumcised.

However, they do say that snipping the foreskin has more benefits than drawbacks.

"Discuss pluses and minuses of circumcision with your doctor."

The policy statement, released this week, updates the AAP's position from 1999. They formed a task force in 2007 to review the most recent evidence about the effects of circumcising or leaving boys intact on everything from urinary tract infections to sexually transmitted infections.

"Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks and that the procedure’s benefits justify access to this procedure for families who choose it," the AAP wrote.

"Specific benefits identified included prevention of urinary tract infections, penile cancer, and transmission of some sexually transmitted infections, including HIV."

The statement alludes to the recent increase in families who do not choose to circumcise their sons and to recent legislation that has cropped up in some areas that would make the practice illegal.

San Francisco planned to have a referendum on a circumcision ban until a California state law was passed to prevent it. Germany also came under fire and praise from different camps recently for banning circumcision in the country.

The AAP task force reviewed the literature from 1995 through 2010.

They determined that the primary benefits of circumcision are fewer urinary tract infections during the first year of life and a lower risk of being infected by HIV and other sexually transmitted diseases during heterosexual sex.

The procedure must always be done by a trained professional in a sterile environment with "appropriate pain management," they stated.

Some families have gone to rabbis to have the procedure done because of their religious beliefs, so there have been some concerns that the procedure is not always done in sterile conditions in these circumstances.

The AAP emphasized that the procedure is generally safe when done in sterile environments by trained professionals.

"Complications are infrequent; most are minor, and severe complications are rare," they wrote. "Male circumcision performed during the newborn period has considerably lower complication rates than when performed later in life."

The influential medical group still stopped short of recommending the procedure as routine for all families because the health benefits are limited.

"Although health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it and to warrant third-party payment for circumcision of male newborns," they wrote.

They stated that health professional should still be sure to tell families about the risks of the surgical procedure in addition to the potential benefits.

The AAP wrote their statement with sensitivity toward all the different considerations families may have in making their decision. Circumcision has been controversial for centuries, and the debate has become louder in recent years.

"Parents ultimately should decide whether circumcision is in the best interests of their male child," the AAP wrote. "They will need to weigh medical information in the context of their own religious, ethical, and cultural beliefs and practices. The medical benefits alone may not outweigh these other considerations for individual families."

The practice has also declined over the years, beginning in 1965. The rate in 1994 was 62.7 percent, which dropped to 56.1 percent by 2006.

The New York Times reported on a report from the U.S. Centers for Disease Control and Prevention in 2010 that the rate had dropped to 32.5 percent in 2009, but those numbers are still preliminary findings.
 

Reviewed by: 
Review Date: 
August 28, 2012
Last Updated:
August 30, 2012