AAP endorses elective newborn circumcision of boys

The health benefits of newborn circumcision of boys outweigh the risks and justify elective, although not routine, use of the procedure, according to the latest policy statement on circumcision from the American Academy of Pediatrics (AAP).

The American College of Obstetricians and Gynecologists (ACOG) has endorsed the statement, which updates AAP’s 1999 circumcision recommendations.

The recommendations grew out of an evaluation of English-language, peer-reviewed literature from 1995 through 2010 by a multidisciplinary task force established by AAP in 2007. The task force, which included AAP representatives and liaisons from ACOG, the American Academy of Family Physicians, and the Centers for Disease Control and Prevention, published its findings and conclusions in a technical report accompanying the policy statement.

Benefits include reduced risk of urinary tract infection during the first year, heterosexual transmission of human immunodeficiency virus and some other sexually transmitted infections, and penile cancer.

The AAP notes that the health benefits are not sufficient to recommend routinely circumcising all newborn boys, but they do justify access to circumcision for families who want it done as well as third-party reimbursement.

Newborns tolerate circumcision well when trained professionals perform it under sterile conditions with appropriate pain control, AAP says. Complications in stable, healthy infants are rare and mostly minor. The procedure has significantly lower complication rates in newborns than circumcision later in life. It apparently does not have an adverse effect on penile sexual function or sensitivity or sexual satisfaction.

The technical report emphasizes the importance of adequate training, noting that untrained providers-whether physicians, nurses, or religious providers-generally have higher complication rates than providers who are well trained.

The task force recommends that clinicians routinely provide parents with accurate, unbiased information about the health benefits and risks of circumcision, including its elective nature. Parents need to consider the medical information in light of their religious, ethical, and cultural beliefs and practices, which may outweigh the medical benefits for some families.

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