Circumcision of Newborn Infants

Stephen Barrett, M.D.

Question

What are the pros and cons of circumcision?

Answer

Circumcision has been practiced for religious reasons since ancient times and for health reasons for more than a century. In the United States most newborn males are still circumcised, although in recent years the rate appears to be falling. Although research shows that circumcision slightly lowers the incidence of cancer of the penis and first-year urinary infections, these conditions are uncommon enough that the actual health benefit is small. The exact incidence of postoperative complications of circumcision (local infection and bleeding) is unknown but appears to be from 0.2% to 0.6% [1,2]. Most complications are minor. In 2012, after its Task Force on Circumcision conducted a thorough study of the scientific evidence, the American Academy of Pediatrics (AAP) stated:

Systematic evaluation of English-language peer-reviewed literature from 1995 through 2010 indicates that preventive health benefits of elective circumcision of male newborns outweigh the risks of the procedure. Benefits include significant reductions in the risk of urinary tract infection in the first year of life and, subsequently, in the risk of heterosexual acquisition of HIV and the transmission of other sexually transmitted infections. The procedure is well tolerated when performed by trained professionals under sterile conditions with appropriate pain management. Complications are infrequent; most are minor, and severe complications are rare. Male circumcision performed during the newborn period has considerably lower complication rates than when performed later in life. 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. It is important that clinicians routinely inform parents of the health benefits and risks of male newborn circumcision in an unbiased and accurate manner. Parents ultimately should decide whether circumcision is in the best interests of their male child. 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 [3].

The United Nations Inter Agency Task Team has concluded that in countries with high rates of HIV infections, male circumcision may be useful as a public health measure because it reduces the risk of HIV infection [4].

Female genital mutilation, sometimes called female circumcision, involves removing part or all of a female's clitoris and/or surrounding tissue. It may also involve sewing up the opening of the vagina. The AAP [4], the American Medical Association [5] and the World Health Organization [6] oppose this practice because it is disfiguring, has serious physical and emotional complications, and provides no medical benefits. In the United States, it is prohibited by federal law [7], and several states have declared it a criminal act.

For Further Information

References

  1. Gee WF, Ansell JS. Neonatal circumcision: A ten-year overview with comparison of Gomco clamp and Plastibell device. Pediatrics. 58:824-827, 1976.
  2. Harkavy KL. The circumcision debate. Pediatrics 79:649-650, 1987.
  3. American Academy of Pediatrics Task Force on Circumcision.Circumcision policy statement. Pediatrics 130:585, 2012.
  4. Information package on male circumcision and HIV prevention. United Nations Inter Agency Task Team (IATT), 2007.
  5. American Academy of Pediatrics: Circumcision information for parents (2001).
  6. AMA Council on Scientific Affairs. Female genital mutilation. JAMA 274:171401716, 1995.
  7. World Health Organization. Female genital mutiliation. Fact Sheet No 241, May 2008.
  8. Federal prohibition of female genital mutilation act of 1996. Public Law 104-140, 110 Stat. 1327.

This article was revised on February 22, 2013.

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