What is your view on circumcision?
The position of the AAP remains that there are both
risks and benefits of circumcision, and that parents should decide after discussing these issues with their pediatrician.
The risks of newborn circumcision are largely those of surgical
complications, primarily bleeding. Although the overall
complication rate has been reported to be 2 to 3 percent,
most of these are minor, and serious injury to the penis
and life-threatening hemorrhaging are rare. The technical
challenges of newborn circumcision are widely under-appreciated, and a significant (but unknown) number of
boys end up undergoing revision of their circumcision. Although claims are often made that circumcision negatively impacts
sexual function or satisfaction later in life, few data support this.
The possible benefits of circumcision continue to be subject
to debate, but potential benefits include near-elimination of the lifetime risk of penile cancer, reduction in risk of UTI during
infancy and reduced incidence of balanitis and phimosis. There have also been a number of studies suggesting that circumcised men are less likely to acquire and transmit a variety of sexually transmitted diseases. The most dramatic recent development with respect to this were the results of two randomized
controlled trials showing that adult circumcision of men in
sub-Saharan Africa reduced HIV transmission dramatically. Even though these studies do raise new questions (Do the findings apply to newborn circumcision?
Do they apply to HIV transmission
in developed countries? Is the risk of non-HIV STDs lower after
circumcision?), this is the first time that any urological surgical
procedure has been conclusively demonstrated to positively
Newborn circumcision continues to be highly prevalent in most parts of the United States. When
performed by experienced physicians, the complication rate is low and cosmetic and functional results are excellent. Although newborn circumcision continues to be an elective procedure and not without risk, it seems increasingly likely that there are also measurable medical benefits associated with it.
- Caleb Nelson, MD, MPH, assistant in Urology