This is a different type of post than I normally write. It is a gathering of research that I did for some of my students last summer on the topic of circumcision. So, none of the information below is in my words. It is simply a collection of quotes from sources including the American Urological Association, the Cochrane Review, the CDC, and the American Academy of Pediatrics.
For my students, this will give you a window into how online research can be done. Removing bias, we simply look to see what the research says, what the major organizing bodies are recommending, and look for information from both sides to ensure we are presenting balanced, evidence-based information.
For parents, this will give you a quick overview of the information that is available on this topic – all in one place! The links to the full articles are at the bottom of each section if you would like to dig in further!
The most recent major statements by the organizations related to the topic of circumcision were made in 2012. That is why you will see that date a lot throughout these reports.
Data Gathered Re: Circumcision
Compiled by Laura Speece, CLD, CCCE, July 2018
American Urological Association
Circumcision
The American Urological Association, Inc.® (AUA) believes that neonatal circumcision has potential medical benefits and advantages as well as disadvantages and risks. Neonatal circumcision is generally a safe procedure when performed by an experienced operator. There are immediate risks to circumcision such as bleeding, infection and penile injury, as well as complications recognized later that may include buried penis, meatal stenosis, skin bridges, chordee and poor cosmetic appearance. Some of these complications may require surgical correction. Nevertheless, when performed on healthy newborn infants as an elective procedure, the incidence of serious complications is extremely low. The minor complications are reported to be three percent.
Properly performed neonatal circumcision prevents phimosis, paraphimosis and balanoposthitis, and is associated with a markedly decreased incidence of cancer of the penis among U.S. males. In addition, there is a connection between the foreskin and urinary tract infections in the neonate. For the first three to six months of life, the incidence of urinary tract infections is at least ten times higher in uncircumcised than circumcised boys. Evidence associating neonatal circumcision with reduced incidence of sexually transmitted diseases is conflicting depending on the disease. While there is no effect on the rates of syphilis or gonorrhea, studies performed in African nations provide convincing evidence that circumcision reduces, by 50-60 percent, the risk of transmitting the Human Immunodeficiency Virus (HIV) to HIV negative men through sexual contact with HIV positive females. There are also reports that circumcision may reduce the risk of Human Papilloma Virus (HPV) infection. While the results of studies in other cultures may not necessarily be extrapolated to men in the United States at risk for HIV infection, the AUA recommends that circumcision should be presented as an option for health benefits. Circumcision should not be offered as the only strategy for HIV and/or HPV risk reduction. Other methods of HIV and/or HPV risk reduction, including safe sexual practices, should be emphasized. Circumcision may be required in a small number of uncircumcised boys when phimosis, paraphimosis or recurrent balanoposthitis occur and may be requested for ethnic and cultural reasons after the newborn period. Circumcision in these children usually requires general anesthesia.
The risks and disadvantages of circumcision are encountered early whereas the advantages and benefits are prospective. When circumcision is being discussed with parents and informed consent obtained, medical benefits and risks, and ethnic, cultural, religious and individual preferences should be considered.
Board of Directors, May 1989
Board of Directors, October 1996 (Revised)
Board of Directors, February 1998 (Revised)
Board of Directors, February 2003 (Revised)
Board of Directors, May 2007 (Revised)
Board of Directors, May 2012 (Reaffirmed)
Board of Directors, May 2017 (Revised)
http://www.auanet.org/guidelines/circumcision
Cochrane Review, 2012
Newborn circumcision for the prevention of urinary tract infections in infancy
(Introduction and abstract)
Routine neonatal circumcision is a fairly common surgical procedure that may be carried out for medical or religious reasons. The incidence of urinary tract infection (UTI) is greater in uncircumcised babies. Circumcision is a relatively simple procedure and is associated with minimal complications when carried out in neonates rather than in later life. We did not find any trials to support or refute the effectiveness of routine neonatal circumcision to prevent UTI in infancy. Although limited data from previous studies have shown that this intervention might be beneficial, questions regarding the safety and effectiveness of routine neonatal circumcision for the prevention of UTIs in infancy remain unanswered.
Authors’ conclusions:Â
We were unable to identify any randomised controlled trials on the use of routine neonatal circumcision for prevention of UTI in male infants. Until further evidence becomes available, clinicians should continue to base their decisions on position statements and recommendations and in conjunction with the opinions of the children’s parents.
Review Article on PubMed
CDC’s Male Circumcision Recommendations Represent a Key Public Health Measure
Brian J Morris,a John N Krieger,b and Jeffrey D Klausnerc
Author information ► Article notes ► Copyright and License information ► Disclaimer
INTRODUCTION
After an extensive evaluation of the scientific evidence, the United States Centers for Disease Control and Prevention (CDC) released draft policy recommendations in December 2014 affirming male circumcision (MC) as an important public health measure.1–3 The CDC’s summary1 (Box 1) was accompanied by a 61-page literature review.2 The CDC supported the 2012 American Academy of Pediatrics (AAP) infant MC policy4,5 (Box 2) and recommended that providers: (1) give parents of newborn boys comprehensive counseling about the benefits and risks of MC; (2) inform all uncircumcised adolescent and adult males who engage in heterosexual sex about the significant, but partial, efficacy of MC in reducing the risk of acquiring HIV and some sexually transmitted infections (STIs) through heterosexual sex, as well as about the potential harms of MC; and (3) inform men who have sex with men (MSM) that while it is biologically plausible that MC could benefit MSM during insertive sex, MC has not been proven to reduce the risk of acquiring HIV or other STIs during anal sex.3
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5478224/
Science and Sensibility (Lamaze)
Review Article
American Academy of Pediatrics Releases Revised Policy on Newborn Male Circumcision
Sharon Muza, BS, LCCE, FACCE, CD(DONA), BDT(DONA), CLE
On August 27th, 2012, the American Academy of Pediatrics (AAP) released their updated policy on newborn male circumsion along with their updated technical report reviewing current research. This official statement follows a week or so of speculation in the media that the AAP’s new statement would fall on the side of supporting newborn male circumcision, stating that the benefits outweigh the risks.
The new policy statement replaces the last AAP recommendation on this topic released in 1999 (1). The just released statement makes the following recommendations:
* Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks, and the benefits of newborn male circumcision justify access to this procedure for those families who choose it.
* Parents are entitled to factually correct, nonbiased information about circumcision that should be provided before conception and early in pregnancy, when parents are most likely to be weighing the option of circumcision of a male child.
* Physicians counseling families about elective male circumcision should assist parents by explaining, in a nonbiased manner, the potential benefits and risks and by ensuring that they understand the elective nature of the procedure.
* Parents should weigh the health benefits and risks in light of their own religious, cultural, and personal preferences, as the medical benefits alone may not outweigh these other considerations for individual families.
* Parents of newborn boys should be instructed in the care of the penis, regardless of whether the newborn has been circumcised or not.
* Elective circumcision should be performed only if the infant’s condition is stable and healthy.
* Male circumcision should be performed by trained and competent practitioners, by using sterile techniques and effective pain management.
* Analgesia is safe and effective in reducing the procedural pain associated with newborn circumcision; thus, adequate analgesia should be provided whenever newborn circumcision is performed.
– Nonpharmacologic techniques (eg, positioning, sucrose pacifiers) alone are insufficient to prevent procedural and postprocedural pain and are not recommended as the sole method of analgesia. They should be used only as analgesic adjuncts to improve infant comfort during circumcision.
– If used, topical creams may cause a higher incidence of skin irritation in low birth weight infants, compared with infants of normal weight; penile nerve block techniques should therefore be chosen for this group of newborns.
* Key professional organizations (AAP, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the American Society of Anesthesiologists, the American College of Nurse Midwives, and other midlevel clinicians such as nurse practitioners) should work collaboratively to:
– Develop standards of trainee proficiency in the performance of anesthetic and procedure techniques, including suturing;
– Teach the procedure and analgesic techniques during postgraduate training programs;
– Develop educational materials for clinicians to enhance their own competency in discussing the benefits and risks of circumcision with parents;
– Offer educational materials to assist parents of male infants with the care of both circumcised and uncircumcised penises.
* The preventive and public health benefits associated with newborn male circumcision warrant third-party reimbursement of the procedure.
As a result of research by the AAP Task Force commissioned for the purpose of updating their policy statement, specific benefits from male circumcision were identified for the prevention of urinary tract infections, acquisition of HIV, transmission of some sexually transmitted infections, and penile cancer. Male circumcision does not appear to adversely affect penile sexual function/ sensitivity or sexual satisfaction. This task force was made up of AAP representatives from specialty areas, including anesthesiology/ pain management, bioethics, child health care financing, epidemiology, fetus and newborn medicine, infectious diseases (including pediatric AIDS), and urology. The Task Force also included members of the AAP Board of Directors and liaisons representing the American Academy of Family Physicians (AAFP), the American College of Obstetricians and Gynecologists (ACOG), and the CDC
Male circumcision consists of the removal of some or all of the foreksin (prepuce) from the penis. It is one of the most commonly performed procedures in the world and in the United States is most commonly done during the newborn period. The current estimated rate of male circumcision in the United States ranges from 42% to 80% among various populations.(2–6)
Circumcision rates were highest in the Midwestern states (74%), followed by the Northeastern (67%) and Southern states (61%). The lowest circumcision rates were found in the Western states (30%) (See Table 1)
CDC’s Male Circumcision Recommendations Represent a Key Public Health Measure
Brian J Morris,a John N Krieger,b and Jeffrey D Klausnerc
Author information ► Article notes ► Copyright and License information ► Disclaimer
https://www.scienceandsensibility.org/blog/american-academy-of-pediatrics-releases-revised-policy-on-newborn-male-circumcisionÂ