AAP Policy Statement on Male Circumcision

Bottom line: medically justified if the family wants it.

The American Academy of Pediatrics (AAP), with endorsement from the American College of Obstetricians and Gynecologists, has published a policy statement on male circumcision to update the 1999 recommendations. On the basis of an additional 5 years (1995–2010) of evidence, the policy states that the health benefits of newborn male circumcision outweigh the risks and that the procedure should be available for families who choose it, as a procedure covered by health insurance.

The supporting evidence for the AAP statement and recommendation is carefully outlined in an accompanying technical report: Data consistently show that neonatal circumcision reduces risk for urinary tract infection (UTI) in males, especially in those younger than 2 years, and clear evidence demonstrates protection against acquisition of HIV, herpes simplex virus, and human papillomavirus after circumcision. Mixed evidence suggests possible protection from syphilis, chancroid, and lymphogranuloma venereum. Evidence does not support protection from chlamydia or gonorrhea. Some evidence suggests circumcision is associated with lower rates of phimosis, dermatoses, and penile cancer. Studies in sexually active men do not indicate that circumcision affects penile sensation, satisfaction, or sexual function. Complications are relatively rare and most are minor (e.g., controllable bleeding, infection at site). Later complications, including meatal stenosis and adhesions, are even less common.

The AAP outlines the pros and cons of different methods of anesthesia and clearly states that sucrose pacifiers and positioning are inadequate and should be used only as adjuncts to other analgesic methods. They also emphasize the clear benefit of sterile technique and documented training of practitioners (medical or religious).

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