AAP on Circumcision

From the AAP: Cutting-edge Evidence about Circumcision

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New scientific evidence suggests that while the health benefits of newborn male circumcision outweigh the risks of the procedure, the benefits are not great enough to recommend routine circumcision for all newborn boys, according to an updated policy statement published by the American Academy of Pediatrics (AAP).[1] The revised policy, like earlier policy statements, recommends that the ultimate decision about whether or not to circumcise their son should be left to the parents, in consultation with their child’s healthcare provider. The documents update the previous policy published by AAP in 1999 and reaffirmed in 2005.

Since the last policy was published, scientific research suggests clearer health benefits to the procedure than had previously been demonstrated. According to a systematic and critical review of the scientific literature, the health benefits of circumcision may include lower risks of HIV, genital herpes, human papilloma virus and syphilis. Circumcision also lowers the risk of penile cancer over a lifetime, reduces the risk of cervical cancer in sexual partners and lowers the risk of urinary tract infections in the first year of life. And the risks? According to Dr. Douglas Dyskma, a member of the committee’s taskforce, “Studies in large databases including thousands of patients have found very few adverse events, and most of the complications are not serious. Minor complications generally occur one to two percent of the time, and include minor bleeding that may require a suture, or minor skin infections that require a topical antibiotic. Serious complications are very, very rare.” The medical data show that the procedure is safest and offers the most health benefits if performed during the newborn period.

In the United States, circumcision rates have declined sharply. Research from Johns Hopkins[2] suggests that if rates continue to drop (from 79% to 55% in the past 10 years), extra and avoidable health care costs may exceed $4.4 billion. And if rates fall as low as in Europe (fewer than 20%), an additional 10% of U.S. men would be infected with HIV, almost 30% more would contract human papillomavirus, close to 20% more would be infected with herpes simplex, and more than 200% would be prone to urinary tract infections.[2]

Circumcision remains a very polarizing and controversial among parents, healthcare providers, and advocacy groups (Box 1).[3] Because parents who are considering newborn circumcision are urged to speak with their child’s healthcare provider about the benefits and risks of the procedure, you should be prepared to have the conversation. Try explaining the procedure in an unbiased way—focusing on the potential risks and benefits—and remind them that the procedure is entirely elective. For those patients who choose circumcision as a religious or cultural practice, you might want to focus on the choice between having the procedure done in the hospital or clinic versus a religious or cultural practitioner outside of the medical environment. Regardless of where the circumcision is done, the AAP policy recommends infant circumcision should be performed by trained and competent providers, using sterile techniques and effective pain management. The AAP also believes that the health benefits are great enough that infant male circumcision should be covered by insurance, which would increase access to the procedure for families who choose it.

Box 1

The authors of the document suggest that prospective parents have this conversation during pregnancy, and to learn whether their insurance will cover the procedure. The policy has been endorsed by the American College of Obstetricians and Gynecologists. This information will be helpful for obstetricians who are often the medical providers who counsel parents about circumcision,” said Sabrina Craigo, MD, the College’s liaison to the AAP task force on circumcision. “We support the idea that parents choosing circumcision should have access to the procedure.”

“Ultimately, this is a decision that parents will have to make,” said Susan Blank, MD, FAAP, chair of the task force that authored the policy statement and technical report. “Parents are entitled to medically accurate and nonbiased information about circumcision, and they should weigh this medical information in the context of their own religious, ethical and cultural beliefs.”

 

Jill Shuman, MS, ELS
Published on October 23, 2012

 

References

  1. American Academy of Pediatrics. Circumcision policy statement. Pediatrics 2012; August 27. http://pediatrics.aappublications.org/content/early/2012/08/22/peds.2012-1989.
  2. Kacker S, Frick KD, Gaydos CA, Tobian A. Costs and effectiveness of neonatal male circumcision. Arch Ped Adolesc Med. 2012;166:1-9.
  3. American Academy of Pediatrics. http://www.healthychildren.org/English/ages-stages/prenatal/decisions-to-make/Pages/Circumcision.aspx. Last updated: Aug 27, 2012.