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 1999, after its Task Force on Circumcision conducted a thorough study of the scientific evidence, the American Academy of Pediatrics (AAP) stated:

Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In the case of circumcision, in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. It is legitimate for parents to take into account cultural, religious, and ethnic traditions, in addition to the medical factors, when making this decision. Analgesia is safe and effective in reducing the procedural pain associated with circumcision; therefore, if a decision for circumcision is made, procedural analgesia should be provided. If circumcision is performed in the newborn period, it should only be done on infants who are stable and healthy [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 all of a female's clitoris. 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 at least ten 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. Task Force on Circumcision. Circumcision policy statement. Pediatrics 103:686-693, 1999, reaffirmed Sept 1, 2005.
  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 November 6, 2008.

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