CHICAGO - The American Academy of Pediatrics (AAP) issued new recommendations stating that the benefits of circumcision are not significant enough to recommend it as a routine procedure.
"Circumcision is not essential to a child's well-being at birth, even though it does have some potential medical benefits," said Carole Lannon, MD, MPH, chair of the AAP's Task Force on Circumcision. "These benefits are not compelling enough to warrant the AAP to recommend routine newborn circumcision. Instead, we encourage parents to discuss the benefits and risks of circumcision with their pediatrician, and then make an informed decision about what is in the best interest of their child."
Parents may consider cultural, religious and ethnic traditions, as well as medical factors, when making this decision. To make an informed choice, parents of male infants should be given accurate information and be provided with the opportunity to discuss this decision with their pediatrician.
The new recommendations also indicate that if a child is circumcized, it is essential that pain relief be provided.
To assist parents in making the decision whether to circumcise their sons, the AAP policy outlines the potential medical benefits and risks and discusses the use of analgesia.
Between 1971 and 1985, the AAP said there was no absolute medical indication for routine circumcision. In 1989, due to new research exploring links between circumcision and urinary tract infections (UTIs) and sexually transmitted diseases (STDs), particularly AIDS, the AAP concluded that male circumcision did have potential medical benefits and advantages, as well as risks.
The AAP reevaluated its 1989 policy in light of new research and ongoing debate about circumcision. The new policy recommendations are based on an analysis of all available medical literature on circumcision.
Although studies show the relative risk of developing a UTI in the first year of life is higher for uncircumcised boys, the policy concludes that their absolute risk of developing one is low, approximately 1% at most. Research indicates that during the first year of life an uncircumcised infant has a 1:100 chance of developing a UTI, while a circumcised male has about a 1:1,000 chance.
Studies also concluded that the risk of an uncircumcised man developing penile cancer is more than threefold that of a circumcised man. In the U.S., however, only nine to 10 cases of this rare disease are diagnosed annually per 1 million men, indicating that while the risk is higher for uncircumcised men, their overall risk is extremely low.
Some research suggests that circumcised men may be at a reduced risk for developing STDs. However, the AAP policy states that behavioral factors continue to be more important in determining a person's risk of contracting STDs than circumcision status.
The policy states that analgesia has been found to be safe and effective in reducing the pain associated with circumcision, and should be provided if the procedure is performed. Analgesic methods include lidocaine cream (EMLA, Astra), the dorsal penile nerve block and the subcutaneous ring block.
Considerable new evidence shows that newborns circumcised without analgesia experience pain and stress measured by changes in heart rate, blood pressure, oxygen saturation and cortisol levels. Other studies suggest that the circumcision experience may cause infants to respond more strongly to the pain of immunization than those who are uncircumcised.
Research suggests that circumcision is generally a safe procedure. Complications occur in 1:200 to 1:500 circumcised newborn males and are most often minor, the two most common are mild bleeding and local infection.
The policy also said "analgesia is safe and effective in reducing the procedural pain associated with circumcision and, therefore, adequate analgesia should be provided if neonatal circumcision is performed. EMLA cream, DPNB, and a subcutaneous ring block are options, although the subcutaneous ring block may provide the most effective analgesia."
For more information:
- AAP. Task Force on Circumcision: Circumcision Policy Statement. Pediatrics. 1999;3:686.
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