pediatrics
September 2012, VOLUME130 /ISSUE 3

Circumcision Policy Statement

  1. TASK FORCE ON CIRCUMCISION

    Abstract

    Male circumcision is a common procedure, generally performed during the newborn period in the United States. In 2007, the American Academy of Pediatrics (AAP) formed a multidisciplinary task force of AAP members and other stakeholders to evaluate the recent evidence on male circumcision and update the Academy’s 1999 recommendations in this area. Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks and that the procedure’s benefits justify access to this procedure for families who choose it. Specific benefits identified included prevention of urinary tract infections, penile cancer, and transmission of some sexually transmitted infections, including HIV. The American College of Obstetricians and Gynecologists has endorsed this statement.

    KEY WORDS
    • male circumcision
    • penis
    • prepuce
    • phimosis
    • sexually transmitted infections
    • HIV
    • urinary tract infection
    • analgesia
    • parental decision-making
    • ethics
  1. Abbreviations:
    AAP
    American Academy of Pediatrics
  2. Policy Statement

    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.

    Findings from the systematic evaluation are available in the accompanying technical report. The American College of Obstetricians and Gynecologists has endorsed this statement.

    Task Force on Circumcision

    Susan Blank, MD, MPH, Chairperson

    Michael Brady, MD, Representing the AAP Committee on Pediatrics AIDS

    Ellen Buerk, MD, Representing the AAP Board of Directors

    Waldemar Carlo, MD, Representing the AAP Committee on Fetus and Newborn

    Douglas Diekema, MD, MPH, Representing the AAP Committee on Bioethics

    Andrew Freedman, MD, Representing the AAP Section on Urology

    Lynne Maxwell, MD, Representing the AAP Section on Anesthesiology

    Steven Wegner, MD, JD, Representing the AAP Committee on Child Health Financing

    Liaisons

    Charles LeBaron, MD – Centers for Disease Control and Prevention

    Lesley Atwood, MD – American Academy of Family Physicians

    Sabrina Craigo, MD – American College of Obstetricians and Gynecologists

    Consultants

    Susan K. Flinn, MA – Medical Writer

    Esther C. Janowsky, MD, PhD

    Staff

    Edward P. Zimmerman, MS

    Footnotes

    • This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication.

    • All policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.