Circumcision Policy Statement

Abstract

ABSTRACT. Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In circumstances 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. If a decision for circumcision is made, procedural analgesia should be provided.ABBREVIATIONS. UTI, urinary tract infection; STD, sexually transmitted disease; NCHS, National Center for Health Statistics; DPNB, dorsal penile nerve block; SCCP, squamous cell carcinoma of the penis; HPV, human papilloma virus; HIV, human immunodeficiency virus.A lthough 1 the exact frequency is unknown, it is estimated that 1.2 million newborn males are circumcised in the United States annually at a cost of between $150 and $270 million. This practice has been advocated for reasons that vary from symbolic ritual to preventive health measure. Until the last half century, there has been limited scientific evidence to support or repudiate the routine practice of male circumcision.Over the past several decades, the American Academy of Pediatrics has published several policy statements on neonatal circumcision of the male infant. [1][2][3] Beginning in its 1971 manual, Standards and Recommendations of Hospital Care of Newborn Infants, and reiterated in the 1975 and 1983 revisions, the Academy concluded that there was no absolute medical indication for routine circumcision.In 1989, because of new research on circumcision status and urinary tract infection (UTI) and sexually transmitted disease (STD)/acquired immunodeficiency syndrome, the Academy concluded that newborn male circumcision has potential medical benefits and advantages as well as disadvantages and risks.4 This statement also recommended that when circumcision is considered, the benefits and risks should be explained to the parents and informed consent obtained. Subsequently, a number of medical societies in the developed world have published statements that do not recommend routine circumcision of male newborns. [5][6][7] In its position statement, the Australian College of Paediatrics emphasized that in all cases, the medical attendant should avoid exaggeration of either risks or benefits of this procedure. 5Because of the ongoing debate, as well as the publication of new research, it was appropriate to reevaluate the issue of routine neonatal circumcision. This Task Force adopted an evidence-based approach to analyzing the medical literature concerning circumcision. The studies reviewed were obtained through a search of the English language medical literature from 1960 to the present and, additionally, through a search of the bibliographies of the published studies. EPIDEMIOLOGYThe percentage of male infants circumcised va...

Does the use of diapers have an effect on complications of circumcision?

“…Sünnet genel anestezi veya lokal anestezi altında yapılmaktadır. Batı toplumlarında çoğunlukla genel anestezi ile yapılırken, ülkemiz gibi gelişmekte olan ülkelerde lokal anestezi daha fazla tercih edilmektedir (10,11) . (12) .…”

Prepuce health and childhood circumcision: Choices in Canada

“…26 The policy statements from the American Academy of Pediatrics and the Canadian Pediatric Society likely influenced this decline. [5][6][7]27 A more recent study of 69 100 neonates in Ontario born in 1993-1994, found a prevalence rate of 44%; 26 there was evidence of declining hospital-based circumcision rates among male infants <28 days old in Ontario during the 1990s (in-hospital prevalence of 39% from 1989-1992 and 30% from 1994-1995 26 ). In 2007, estimation of number of Canadian males aged 15 or older circumcised for non-religious reason was reported as 30% 28 and may have changed slightly since then.…”

Libertarianism and circumcision

“…This is especially true as circumcision rates amongst infants continues to decline, from 85% of babies in 1985 to 32% in 2009, and the bandwagon effect of so-called "prepuce envy" becomes irrelevant (9). Furthermore, the American Academy of Pediatrics specifically states in their policy on circumcision that it is in no way essential to the well-being of a child (27).…”

“…However, other surgical and non-surgical treatments exist with high success rates, with lower cost and lesser morbidities than circumcision, such as the use of steroid topical cream; nevertheless, most cases of phimosis are physiologic in nature, and understanding the distinction between these types of phimosis can prevent overdiagnosis and unnecessary circumcision, as gentle retraction and normal washing over time can serve to treat physiologic phimosis (55)(56)(57). Furthermore, penises that have not been forcibly retracted are statistically no more prone to UTIs than circumcised penises, and overall an uncircumcised male is less than 1% more likely to get a UTI than a circumcised male, with the highest prevalence seen at less than one year of age (27,54). One study concludes that it would take 195 circumcisions to prevent one UTI (58).…”

“…Regardless, a UTI is easily treated with antibiotics, and circumcision need not play a role in preventing them (54) 14 . Ultimately, there is little significant evidence to "affirm the association between circumcision status and optimum penile hygiene" (27). Arguably the most cited evidence that a circumcised state is preferable is relatively recent, originating during the HIV/AIDS crisis in the 1980s.…”