New AAP Circumcision Policy Released

CHICAGO - After analysis of almost 40 years of available medical research on circumcision, the American Academy of Pediatrics (AAP) issued new recommendations today stating that the benefits are not significant enough for the AAP to recommend circumcision 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. 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,” says Carole Lannon, M.D., MPH, FAAP, chair of the AAP’s Task Force on Circumcision.

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. To assist parents in making the decision of whether or not to circumcise their sons, the AAP policy outlines the potential medical benefits and risks and discusses the use of analgesia.

AAP Policy History Regarding Circumcision
Beginning in its 1971 manual, Standards and Recommendations of Hospital Care of Newborn Infants, and reiterated in the 1975 and 1985 revisions, the Academy concluded that there was no absolute medical indication for routine circumcision.

In 1989, due to new research exploring links between circumcision status and both urinary tract infections and sexually transmitted diseases, particularly AIDS, the Academy concluded that newborn male circumcision did have potential medical benefits and advantages, as well as risks.

In light of continued medical debate over the last decade regarding those benefits and risks, as well as the publication of new research, the Academy chose to reevaluate its 1989 policy. The new policy recommendations released today are based on analysis of all available medical literature on circumcision currently available, including new studies published in the last 10 years.

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 ¾ at most approximately 1 percent. Research indicates that during the first year of life an uncircumcised male infant has at most about a 1 in 100 chance of developing a UTI, while a circumcised male has about a 1 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 9 to 10 cases of this rare disease are diagnosed per year per 1 million men, indicating that while the risk is higher for uncircumcised men, their overall risk is extremely low.

Sexually Transmitted Diseases
Some 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
Considerable 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 1 in 200 to 1 in 500 circumcised newborn males and are most often minor; the two most common are mild bleeding and local infection

If you have any questions for a Pediatricians, contact one of our New York Pediatricians today.

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