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AAP Issues New Circumcision Recommendations

The American Academy of Pediatrics (AAP) issued new recommendations today stating that the benefits of circumcision are not significant enough for the AAP to recommend it as a routine procedure.

CHICAGO - The American Academy of Pediatrics (AAP) issued new recommendations today stating that the benefits of circumcision are not significant enough for the AAP to recommend it as a routine procedure. The new policy statement was published in this month's issue of Pediatrics, the journal of the AAP.

“Circumcision is not essential to a child’s well-being at birth, even though it does have some potential medical benefits,” says Carole Lannon, M.D., MPH, FAAP, 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.”

The policy concluded, however, that it is legitimate for parents to take into account cultural, religious and ethnic traditions, in addition to medical factors, when making this decision. It states that to make an informed choice, parents of all male infants should be given accurate information and be provided the opportunity to discuss this decision with their pediatrician. For the first time in AAP circumcision policy history, the new recommendations also indicate that if parents decide to circumcise their infant, it is essential that pain relief be provided.

For the first time in AAP circumcision policy history, the new recommendations also indicate that if parents decide to circumcise their infant, it is essential that pain relief be provided.

Here are some of the conditions surrounding circumcision and what the AAP thinks about them:

Urinary Tract Infections
Although studies show the relative risk of developing a urinary tract infection (UTI) in the first year of life is higher for baby boys who are uncircumcised, the AAP policy concludes that their absolute risk of developing one is low -- approximately one percent. Research indicates that during the first year of life an uncircumcised male infant has at most about a one in 100 chance of developing a UTI, while a circumcised male has about a one in 1000 chance.

Penile Cancer
Studies conclude that the risk of an uncircumcised man developing penile cancer is more than three-fold that of a circumcised man. However, the AAP policy notes that in the United States only nine to 10 cases of this rare disease are diagnosed per year per one million men, indicating that while the risk is higher for uncircumcised men, their overall risk is extremely low.

Sexually Transmitted Diseases
Research suggests that circumcised men may be at a reduced risk for developing syphilis and HIV infections. However, the AAP policy states that behavioral factors continue to be far more important in determining a person’s risk of contracting sexually transmitted diseases than circumcision status.

Analgesia
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 pain of future immunization than those who are uncircumcised. In response to this data, the AAP 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 EMLA cream (a topical mixture of local anesthetics), the dorsal penile nerve block and the subcutaneous ring block.

Complications
Research suggests that circumcision is generally a safe procedure. Complications occur in one in 200 to one in 500 circumcised newborn males and are most often minor; the two most common are mild bleeding and local infection.