AMERICAN ACADEMY OF PEDIATRICS Task Force on Circumcision Circumcision Policy Statement

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. Although 1the 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.1–3 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.5–7 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.5 Because 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.