CIRCUMCISION: AN ISSUE REEXAMINED
In 1975 the American Academy of Pediatrics (AAP) updated a 1971 policy by stating “there is no absolute medical indication for routine circumcision of the newborn.” This position was reiterated in 1983 by both the AAP and the American College of Obstetrics and Gynecology.
After a recent rigorous review process that included an AAP Task Force on Circumcision and many AAP committees, etc., the AAP has modified its position. Unfortunately, the statement of that position does not at this time clearly come down on either side of this issue of whether to circumcise a newborn male or not.
“Newborn circumcision has potential medical benefits and advantages as well as disadvantages and risks. When circumcision is being considered, the benefits and risks should be explained to the parents, and informed consent obtained.”
Points of interest in the background material presented:
*Preliminary data suggests that the incidence of urinary tract infection in male infants may be reduced when circumcision is performed in the newborn period. Though one very large study in US Army hospitals reported a tenfold increase in these infections in uncircumcised, as compared with circumcised males, the AAP has concerns about possible methodological flaws with the study, and suggests that conclusions should not be definitely drawn at this time. *Cancer of the penis occurs almost exclusively in uncircumcised men. The decision not to circumcise a male infant must be accompanied by a lifetime commitment to genital hygiene to minimize the risk of developing penile cancer.
*Evidence linking uncircumcised men to cancer of the cervix in their sexual partners and evidence regarding the relationship of circumcision to sexually transmitted diseases is conflicting and inconclusive.
*Infants undergoing circumcision without anesthesia demonstrate responses suggesting that they are experiencing pain. Local anesthesia may reduce this response, but adds an element of risk; information regarding its use has not been reported in large numbers of cases. More data from large controlled studies is required before local anesthesia can be advocated.
*Though circumcision should not be performed in an unstable or sick infant; it is a rapid and generally safe procedure when performed by an experienced operator. The most common complications are a local infection and bleeding. Hopefully, there will be sufficient interest in this issue to result in the kind of studies required providing definitive answers. It is surprising and frustrating that with a surgical procedure so widely used for centuries, we continue to be lacking the data needed about its benefits and hazards.